Pseudo-Chilblains in Adult Patients with Confirmed COVID-19: A Systematic Review

Background: Pseudo-chilblains have been associated with COVID-19. Many reports, however, lack confirmation of COVID-19 infection. While likely associated, all chilblains/chilblain-like lesions during this time should not be assumed to be COVID-19 related. This study examines the characteristics of adults with pseudo-chilblains and confirmed COVID-19. Methods: A systematic review of PubMed/MEDLINE database was performed using the PRISMA guidelines. Adults (>18 years) with confirmed COVID-19 were included. De-identified registries were excluded to avoid duplication. We extracted study design, age, sex, race, geographic location, relationship of COVID-19 diagnosis to chilblains onset, confirmatory testing, hospitalization status, anatomical location, cold/damp exposure, presence/absence/description of pseudo-chilblains symptoms, presence/absence of biopsies/histopathologic findings, tissue IHC/PCR, presence/absence/details of extracutaneous COVID-19 disease, pre-existing chilblains, treatment and resolution timeline. The search was completed in July 2022. Results: We identified 13 studies (29 patients). In COVID-19-infected adults, pseudo-chilblains were reported primarily from North America and Europe, occurring in both sexes over a wide age-range, affected well and ill patients, favored the hands and feet and could be symptomatic or asymptomatic. Most patients had extracutaneous symptoms. Resolution time ranged from 50 days. There was marked variation in treatment strategies and appearance of pseudo-chilblains relative to entire disease course. Biopsies were infrequently performed but findings similar to classical chilblains were described. Conclusions: Many patients reported as pseudo-chilblains of COVID-19 lack confirmed infection. Infection confirmation, photographic documentation and histopathology are critical to establish homogeneity in reported pseudo-chilblains during this global pandemic. Further work clarifying the relationship of acral eruptions and COVID-19 is necessary

Risperidone Provides Better Improvement of Sleep Disturbances Than Haloperidol Therapy in Schizophrenia Patients With Cannabis-Positive Urinalysis

A high percentage of persons with Schizophrenia also uses Cannabis and this may potentially alter the therapeutic benefits of the antipsychotic medications prescribed. The aim of this study was to assess the impact of Cannabis usage on antipsychotic therapy of sleep disturbances in schizophrenia subjects. Male subjects, ≥18 years, admitted to the University Hospital of the West Indies psychiatric ward between October 2015 and October 2016, and diagnosed with schizophrenia were recruited for the study. Following written informed consent to the study, subjects were prescribed either risperidone monotherapy or haloperidol monotherapy orally for 14 days and classified as Cannabis users (CU) or non-users (non-CU), with presence/absence of Cannabis metabolite in urine samples. After 1 week of admission, subjects wore the Actiwatch-2 device, to record sleep data for 7 consecutive nights. Inferential statistical analysis involved non-parametric tests, expressed as median and inter-quartile ranges (IQR), with p<0.05 considered statistically significant. Fifty subjects were assessed, with a median (IQR) age of 28 (14) years. Majority (30; 60%) were CU, displaying longer sleep latency (SL) than non-CU when receiving haloperidol; but equivalent SL when receiving risperidone. In comparison to non-CU, the CU also displayed longer time in bed, but shorter durations asleep, awoke more frequently during the nights and for longer durations, whether receiving haloperidol or risperidone. This resulted in lower sleep efficiency for the CU (<85%) compared to the non-CU (≥85%). Over the study period, sleep efficiency was significantly improved for non-CU receiving either risperidone (p = 0.032) or haloperidol (p = 0.010); but was only significantly improved with risperidone for the CU (p = 0.045). It is apparent that the presence of Cannabis may be impacting the therapeutic benefits of antipsychotic drugs on sleep. In schizophrenia subjects with concomitant Cannabis use, risperidone is more beneficial than haloperidol in improving sleep efficiency

Antihypertensive medication class and diastolic orthostatic hypertension in older Caribbean adult patients

Abstract In the Caribbean there is limited data on orthostatic hypertension (OHT) in elderly hypertensive patients with atherosclerotic disease who are at risk for cardiovascular events. The authors examined the association of antihypertensive classes of drugs with diastolic OHT in patients 60 year and older with hypertension and hyperlipidemia attending public primary care facilities. These relationships were evaluated in a cross‐sectional study of hypertensive hyperlipidemic older patients (n = 400) to determine orthostatic changes in blood pressure based on seated to standing measurements. OHT was defined as an increase in systolic blood pressure of ≥20 mm Hg and/or increase in diastolic blood pressure of ≥10 mm Hg upon orthostasis at 3 min. Patients were categorized based on their orthostatic blood pressure response: orthostatic normotensive (n = 200) and blood pressure dysregulated (n = 200) of which 168 were diastolic OHT. Multivariable logistic regression models were used to examine associations of antihypertensive classes and diastolic OHT. Renin‐angiotensin‐aldosterone‐system (RAAS) blockers were the most commonly prescribed (79.3%), followed by diuretics (DIUs) (61.6%), dihydropyridine calcium channel blockers (dCCBs) (53.8%), and beta‐blockers (BBs) (19.3%). Most normotensive (76.0%) and diastolic OHT (75.0%) patients were prescribed two or more antihypertensive medications. Pharmaceutical prescription of triple combination RAAS blockers + dCCBs + DIUs (OR, 0.55; 95% CI, 0.31–0.99) or RAAS blockers + dCCBs + BBs (OR, 0.23; 95% CI, 0.06–0.92) showed a protective effect of diastolic OHT in analyses adjusted for age, sex, sitting diastolic blood pressure, and comorbidities. Our study suggests prescription of triple combination antihypertensive drugs of RAAS blockers + dCCBs + DIUs or RAAS blockers + dCCBs + BBs may reduce the likelihood of diastolic OHT

Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy – a balance of risks for aspirin?

Objectives: Sickle cell disease (SCD) occurs in 2.8% of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. Methods: A retrospective comparative analysis of HbSS, HbSC and HbSβThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. Results: Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the 'non-HbSS' group, i.e. HbSβThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95 % 3.5-32.3; p&lt;0.001), hospitalizations (OR 7.6, 95 % CI 3.4-16.9; p&lt;0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSβThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03-0.9, p=0.03)). Conclusions: HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.</p