Call interview for early detection and appropriate treatment to decrease COVID-19 pandemic burden

One of the most important concerns during the covid-19 pandemic is an imbalance in health services. Considering significant mortality among hospital staff and the general population, a great apprehension was raised in society. Consequently, many patients with symptoms were rushed to hospitals. In this regard, to keeping clinics away from overcrowding, call interview with patients plays a crucial role in not only patients screening but also treatment approach. &nbsp

Remdesivir associated sinus bradycardia in patients with COVID-19: A prospective longitudinal study

Background: Remdesivir is effective against SARS-Cov-2 with little evidence of its adverse effect on the cardiac system. The aim of the present study is investigating the incidence of bradycardia in COVID-19 patients treated with Remdesivir.Methods: This prospective longitudinal study was conducted in a tertiary center on COVID-19 patients for Remdesivir therapy. The objectives were to investigate the incidence of sinus bradycardia, and also the association between their demographics, underlying diseases, and the disease severity with developing bradycardia in COVID-19 patients treated with Remdesivir.Results: Of 177 patients, 44% were male. The mean (±standard deviation) age of patients was 49.79 ± 15.16 years old. Also, 33% were hospitalized due to more severe symptoms. Oxygen support was required for all hospitalized subjects. A total of 40% of the patients had comorbidities, with the most common comorbidity being hypertension. The overall incidence of bradycardia (heart rate<60 bpm) in patients receiving Remdesivir was 27%, of whom 70% had extreme bradycardia (heart rate <50 bpm). There was also a statistically significant reduction in heart rate after five doses of Remdesivir compared to the baseline heart rates. In the multivariable model, none of the covariates including age above 60 years, female sex, CRP>50 mg/L, O2 saturation<90%, underlying cardiovascular disease, hypertension and diabetes mellitus, and beta-blockers were associated with Remdesivir-induced bradycardia. No association was found between the COVID-19 severity indicators and bradycardia.Conclusion: As sinus bradycardia is a prevalent adverse cardiac effect of Remdesivir, it is recommended that all COVID-19 patients receiving Remdesivir, be evaluated for heart rate based on examination; and in the case of bradyarrhythmia, cardiac monitoring should be performed during administration to prevent adverse drug reactions

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality among Patients with COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 � 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 �103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7) were included in the primary analysis (median interquartile range age, 62 50-71 years; 237 42.2% women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% 95% CI,-6.6% to 9.8%; odds ratio, 1.06 95% CI, 0.76-1.48; P =.70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% 1-sided 97.5% CI,-� to 3.4%; odds ratio, 1.83 1-sided 97.5% CI, 0.00-5.93), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% 95% CI, 0.4%-3.8%; P =.01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. © 2021 American Medical Association. All rights reserved

بررسی تجربه زیسته در بیماران کرونایی: مقاله مروری

زمینه و هدف: کروناویروس‌ها گروه بزرگی از ویروس‌ها هستند که با گسترش سریع، ماهیت کشنده و درمان ناپذیر بودن توانست جهان پیشرفته کنونی با تمام فنّاوری های فوق بشری را تهدید کند. هدف از مطالعه حاضر بررسی تجربه زیسته مردم در جهان در مورد بیماری کوید-19 می باشد. روش‌ ها: در این مطالعه مروری جهت یافتن مقالات مرتبط با کلیدواژه های مرتبط با موضوع ( ،SARS-COV-2 ،COVID-19، qualitative research، lived experiences، phenomenology، تجربه زیسته، کرونا ویروس، کووید19، پدیدارشناختی، مطالعه کیفی) در پایگاه های اطلاعاتی فارسی و انگلیسی Google Scholar،  Web of Science،  Pubmed،  Science Direct،  Scopus، SID ، Magiran تا آوریل 2022 مورد جستجو قرار گرفتند. در مجموع 79 مطالعه در سایت های خارجی عنوان شده یافت گردید و همچنین 7 مطالعه به صورت فارسی و در پایگاه های اطلاعاتی فارسی استخراج شد. در نهایت 12 مقاله از مطالعاتی که در زمینه تجارب زیسته در بیماران کرونایی بود انتخاب و مورد بررسی مروری قرار گرفتند. یافته ها: در اکثر مطالعات مورد بررسی مصاحبه شوندگان اثرات ناخوشایند جسمی، روانی و اجتماعی بیماری خود را تجربه کردند و بسیاری از آنها واکنش های استرس پس از سانحه را بیان کردند. بیماران مبتلا به دلیل غیرقابل پیش بینی بودن بیماری احساس خطر می کنند و ممکن است به عنوان یک واکنش غریزی به شرایط ناشناخته، ترس دائمی از مرگ داشته باشند. نتیجه گیری:  با توجه به مطالعات مورد بررسی قرار گرفته، می توان گفت اکثر بیماران تفسیری که از وضعیت همه گیری بیماری کرونا داشته اند، آن را تهدید بزرگ و فاجعه بزرگی برای زندگی فردی و اجتماعی و روانی عنوان کرده اند. لذا از آنجایی که علائم روانی در این بیماران شایع است، توصیه می شود برای درمان این بیماران از روان درمانگر کمک گرفته شود

پیامدهای قلبی دسته ی دارویی گلیفلوزین در بیماران دیابتی نوع 2 مبتلا به نارسایی قلبی با کسر جهشی حفظ شده

زمینه: نارسایی قلبی یک سندرم بالینی است که منجر به اختلال در پر شدن بطن یا خروج خون از قلب می شود. تا 40 درصد از بیماران نارسایی قلبی، همزمان دیابت نوع 2 دارند و نسبت مشابهی، با اختلال تحمل گلوکز تظاهر می کنند که هر دو باعث افزایش مرگ و میر می شوند. مهارکننده‌های ناقل سدیم-گلوکز-2 ، دسته جدیدی از داروهای کاهنده ی قند خون هستند که توانایی خود را در بیماران در معرض خطر و مبتلا به دیابت نوع 2 ثابت کرده‌اند. بحث: مطالعات زیادی اثر این دسته ی دارویی بر کاهش حوادث قلبی و بستری شدن در بیمارستان به دلیل نارسایی قلبی را در بیماران مبتلا به دیابت نوع 2 و بیماری عروقی آترواسکلروتیک همزمان، بیماران دیابتیک با عوامل خطر متعدد قلبی یا بیماران نفروپاتی دیابتی بررسی کردند. نتیجه گیری: این مطالعه ی مروری نشان می دهد که در بیماران مبتلا به دیابت نوع 2 و خطر حوادث قلبی عروقی بالا، امپاگلیفلوزین، علاوه بر مراقبت استاندارد، بستری شدن در بیمارستان ناشی از نارسایی قلبی و مرگ ناشی از حوادث قلبی عروقی را کاهش می دهد

Bronchial Artery Embolization for Life-Threatening Hemoptysis in COVID-19 Patients

After the outbreak of the novel coronavirus at the end of December 2019 in China, it has become a global pandemic. Clinical manifestation of COVID-19 has a wide range of presentations ranging from asymptomatic to severe multi-organ involvement. Hemoptysis appears to be one of the major manifestations of severe acute respiratory syndrome that is related to COVID-19 infection. The occurrence of hemoptysis is multifactorial. However, massive hemoptysis is usually related to pulmonary aspergillosis or severe bronchiectasis due to corticosteroid pulse therapy which can be life-threatening. This manuscript presents five cases of successful life-saving bronchial artery embolization in patients with COVID-19 infection who were suffering from massive hemoptysis that were mostly related to aspergillosis and bronchiectasis. These cases are followed by a review of the literature.12 month embargo; first published 19 May 2022This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The Outcome of Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension during the COVID-19 Pandemic

Background: The coronavirus 2019 (COVID-19) has affected the lives of many people worldwide. Patients with chronic underlying morbidities are vulnerable to get the severe form of the infection. The goal of this study was to evaluate the outcome of patients with pulmonary arterial hypertension during the COVID-19 pandemic in Iran. Methods: This cross-sectional study was conducted at a large tertiary center for pulmonary artery hypertension (PAH) patients. The primary end point was the prevalence of SARS-CoV-2 infection in PAH patients. The secondary end points were investigating the severity and mortality of COVID-19 infection in PAH patients during the COVID-19 pandemic. Results: Totally 75 patients were enrolled in the study from December 2019 to October 2021 and 64% were female. The mean ± SD age was 49 ± 16 years. The prevalence of COVID-19 in PAH/chronic thromboembolic pulmonary hypertension patients was 44%. About 66.7% of patients had comorbidities, which was a prognostic factor for COVID-19 infection in PAH patients (P < 0.001). Fifty-six percent of infected patients were asymptomatic. The most reported symptoms in symptomatic patients were fever (28%) and malaise (29%). Twelve percent of patients were admitted with severe symptoms. The mortality rate in infected individuals was 3.7%. Conclusions: COVID-19 infection in PAH/chronic thromboembolic pulmonary hypertension patients seems to be associated with high mortality and morbidity. More scientific proof is needed to clarify different aspect of COVID-19 infection in this population12 month embargo; first published 23 March 2023This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

مروری بر برادی کاردی سینوسی، طولانی شدن فاصله QT و سایر عوارض قلبی داروی رمدسیویر در بیماران مبتلا به کووید-19

علی رغم اقدامات صورت گرفته جهت پیشگیری، بیماری کووید-19 ناشی از SARS-Cov-2 همچنان به عنوان یک پاندمی و معضل سلامت جهانی موجب آمار بالای مورتالیتی و موربیدیتی در سراسر جهان می باشد. داروی رمدسیویر پس از تایید توسط سازمان غذا و داروی امریکا در سال 2020 به عنوان داروی ضد ویروسی موثر در درمان کووید-19 به صورت گسترده در طول پاندمی مورد استفاده قرار گرفت. بررسی دقیق ایمنی و عوارض دارویی رمدسیویر به عنوان درمان ضد ویروسی در این بیماری، جهت ارتقا سلامت و پیشگیری از پیامدهای ناخواسته در بیماران مبتلا به کووید-19 تحت درمان با این دارو امری ضروری می باشد. در این میان آگاهی در زمینه ی عوارض قلبی این دارو که هنوز مطالعات کمی پیرامون آن انجام پذیرفته از اهمیت ویژه ای برخوردار است. در این مطالعه ی مروری خلاصه ای از مطالعات انجام شده در زمینه ی عوارض قلبی این دارو مورد بحث و بررسی قرار خواهد گرفت. از میان عوارض قلبی، همراهی ویژه ای میان برادی کاردی سینوسی و مصرف رمدسیویر مشاهده شده است که در مواردی حتی بسیار شدید و کشنده و نیازمند مداخله ی درمانی بوده است.&nbsp; از سایر عوارض قلبی میتوان به طولانی شدن فاصله ی QT، فیبریلاسیون دهلیزی، بلوک &nbsp;AV، تاکی کاردیهای فوق بطنی، کاهش فشار خون و در موارد نادر ایست قلبی اشاره کرد. با توجه به احتمال پیش آمد عوارض قلبی در بیماران تحت درمان با رمدسیویر توصیه می شود بیماران حین درمان تحت مانیتورینگ قلبی قرار بگیرند