Abatacept, Cenicriviroc, or Infliximab for Treatment of Adults Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial

IMPORTANCE: Immune dysregulation contributes to poorer outcomes in COVID-19. OBJECTIVE: To investigate whether abatacept, cenicriviroc, or infliximab provides benefit when added to standard care for COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-masked, placebo-controlled clinical trial using a master protocol to investigate immunomodulators added to standard care for treatment of participants hospitalized with COVID-19 pneumonia. The results of 3 substudies are reported from 95 hospitals at 85 clinical research sites in the US and Latin America. Hospitalized patients 18 years or older with confirmed SARS-CoV-2 infection within 14 days and evidence of pulmonary involvement underwent randomization between October 2020 and December 2021. INTERVENTIONS: Single infusion of abatacept (10 mg/kg; maximum dose, 1000 mg) or infliximab (5 mg/kg) or a 28-day oral course of cenicriviroc (300-mg loading dose followed by 150 mg twice per day). MAIN OUTCOMES AND MEASURES: The primary outcome was time to recovery by day 28 evaluated using an 8-point ordinal scale (higher scores indicate better health). Recovery was defined as the first day the participant scored at least 6 on the ordinal scale. RESULTS: Of the 1971 participants randomized across the 3 substudies, the mean (SD) age was 54.8 (14.6) years and 1218 (61.8%) were men. The primary end point of time to recovery from COVID-19 pneumonia was not significantly different for abatacept (recovery rate ratio [RRR], 1.12 [95% CI, 0.98-1.28]; P = .09), cenicriviroc (RRR, 1.01 [95% CI, 0.86-1.18]; P = .94), or infliximab (RRR, 1.12 [95% CI, 0.99-1.28]; P = .08) compared with placebo. All-cause 28-day mortality was 11.0% for abatacept vs 15.1% for placebo (odds ratio [OR], 0.62 [95% CI, 0.41-0.94]), 13.8% for cenicriviroc vs 11.9% for placebo (OR, 1.18 [95% CI 0.72-1.94]), and 10.1% for infliximab vs 14.5% for placebo (OR, 0.59 [95% CI, 0.39-0.90]). Safety outcomes were comparable between active treatment and placebo, including secondary infections, in all 3 substudies. CONCLUSIONS AND RELEVANCE: Time to recovery from COVID-19 pneumonia among hospitalized participants was not significantly different for abatacept, cenicriviroc, or infliximab vs placebo. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04593940

An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units

Pod terminom nedonošče označavamo novorođenče koje je rođeno prije 37.tjedna gestacije, ili prije 259. dana od prvog dana ženine posljednje menstruacije. Unazad šezdeset godina termin nedonoščeta obuhvaćao je i djecu niske porođajne mase (< 2500 g),a u posljednja dva desetljeća za takvu djecu koristi se naziv nedostašče. Početak trudnoće se klinički određuje računanjem od datuma zadnje menstruacije te procijenjena na ovaj način prosječno iznosi 280 dana ili 40 tjedana, odnosno 10 lunarnih mjeseci. Prenatalni razvoj čovjeka se dijeli na embrionalno i fetalno razdoblje. Embrionalno razdoblje traje 8 tjedana i u to vrijeme formiraju se ljudski embrij i posteljica. Prema RonanuO'Rahillyu i Fabioli Muller embrionalno razdoblje ima 23 Carneige stadija. Na kraju te faze fetus je težak samo 2,8 grama. Fetalno razdoblje traje oko 30 tjedana i tad se u potpunosti počinju razvijati strukture i funkcije nezrelih organskih sustava formiranih tijekom embrionalnog razvoja. Uspješan prijelaz iz fetalnog u neonatalni život zahtijeva složenu interakciju između sljedećih sustava: respiratornog, kardiovaskularnog, imunološkog i termoregulacijskog. Zbog nerazvijenosti organskih sustava ta promjena je otežana nedonoščetu te se ono smješta na specijalizirani odjel neonatologije. Neonatologija je specijaliziran odjel za njegu naših najmanjih i najosjetljivijih pacijenata. Rad medicinske sestre na neonatologiji je vrlo odgovoran i zahtijeva timski i uigran rad kako bi se pružila najadekvatnija skrb.Premature born baby is defined as every newborn born before the 37th week of gestation or 259 days after the first day of woman's last menstruation. In the 1960's, term premature include dinfants with low birth weight (< 2500g) born around their estimated due date (born after 37 th week of gestation). Bythe 2000's term for low birth weight infants became separate term. Clinically, pregnancy starts from the last womans menstruation, estimated this way it lasts 280 days, or 40 weeks or 10 lunar months. Human prenatal development divides into embryonic and fetal periods. The duration of the embryonic period is 8 weeks, during which time a human embryo and placenta are formed. According to RonanO'Rahilly and Fabiola Muller, an embryonic period can be divided into 23 Carneige stages. At the end of the stage, the fetus weighs only 2.8 grams. Fetal period takes about 30 weeks during which time the body structures begin to fully form and function after the start of process. Successful transition from fetal to neonatal life requires a complex interaction between the following systems: respiratory, cardiovascular immune and thermoregulatory. Due to under developed organ systems, this change is difficult for preterm babies and therefore they are placed into neonatal intensive care also known as NICU. NICU specializes in the care of our smallest and most sensitive patients. Nurses workin neonatology unit is very responsible and seeks team work in order to provide the most appropriate care

Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use: Insights from the patient and provider assessment of lipid management registry

Importance: African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. Objective: To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. Design, setting, and participants: Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. Main outcomes and measures: Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. Results: A total of 5689 patients (806 [14.2%] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%], respectively; P \u3c .001; relative risk, 1.07 [95% CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P \u3c .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2%] vs 2800 [57.3%]; P \u3c .001) or effective (564 [70.0%] vs 3635 [74.4%]; P = .008) and were less likely to trust their clinician (663 [82.3%] vs 4579 [93.8%]; P \u3c .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95% CI 0.96-1.11]; P = .35). Conclusions and relevance: African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for interventio

Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography?: Results of the Randomized Comparative Effectiveness ROMICAT II Trial

Background: Cardiac computed tomography angiography (CCTA) reduces emergency department length of stay compared with standard evaluation in patients with low‐ and intermediate‐risk acute chest pain. Whether diabetic patients have similar benefits is unknown. Methods and Results: In this prespecified analysis of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT II) multicenter trial, we randomized 1000 patients (17% diabetic) with symptoms suggestive of acute coronary syndrome to CCTA or standard evaluation. The rate of acute coronary syndrome was 8% in both diabetic and nondiabetic patients (P=1.0). Length of stay was unaffected by the CCTA strategy for diabetic patients (23.9 versus 27.2 hours, P=0.86) but was reduced for nondiabetic patients compared with standard evaluation (8.4 versus 26.5 hours, P50% stenosis had a high prevalence of acute coronary syndrome, invasive coronary angiography, and revascularization. Conclusions: Knowledge of coronary anatomy with CCTA is beneficial for diabetic patients and can discriminate between lower risk patients with no or little coronary artery disease who can be discharged immediately and higher risk patients with moderate to severe disease who warrant further workup. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01084239