Lanelohmann0423
Anakinra is a selective IL-1 inhibitor, which has been used in the context of secondary haemophagocytic lymphohistiocytosis. Although usually given in the s.c. form, previous anecdotal reports have emphasized its utility when given i.v. Our aim is to report our experience on the beneficial effects of anakinra i.v. in patients with SARS-CoV-2 and evidence of hyperinflammation.
We report four patients with severe COVID-19 infection requiring intensive care admission and ventilatory support.
All four patients showed evidence of deterioration, with hyperferritinaemia and increasing oxygen requirements and with superadded bacterial infections. Upon commencement of anakinra i.v., there was subsequent improvement in the patients clinically, with reduction in ventilatory support and inotropic support, and biochemically, with rapid improvement in inflammatory markers.
Anakinra is safe to use i.v. in patients with COVID-19 and evidence of superadded bacterial infection. Although its utility has not been confirmed in a randomized trial, current research in the COVID-19 pandemic aims to establish the utility of immunosuppression, including IL-1 blockade, on the outcomes of patients with moderate to severe disease. Our case series supports its use in patients with severe, life-threatening COVID-19 and evidence of hyperinflammation.
Anakinra is safe to use i.v. in patients with COVID-19 and evidence of superadded bacterial infection. Although its utility has not been confirmed in a randomized trial, current research in the COVID-19 pandemic aims to establish the utility of immunosuppression, including IL-1 blockade, on the outcomes of patients with moderate to severe disease. Our case series supports its use in patients with severe, life-threatening COVID-19 and evidence of hyperinflammation.Introduction We previously reported that during the course of anticoagulation for venous thromboembolism (VTE) patients using statins were at a lower risk to die than nonusers. Methods We used the R egistro I nformatizado E nfermedad T rombo E mbólica (RIETE) registry to validate our previous findings in a subsequent cohort of patients and to compare the risk of death according to the use of different types of statins. Results From January 2018 to December 2019, 19,557 patients with VTE were recruited in RIETE. Of them, 4,065 (21%) were using statins (simvastatin, 1,406; atorvastatin, 1,328; rosuvastatin, 246; and others, 1,085). During anticoagulation (192 vs.182 days, for statin and no statin users respectively), 500 patients developed a VTE recurrence, 519 suffered major bleeding, and 1,632 died (fatal pulmonary embolism [PE], 88 and fatal bleeding, 78). On multivariable analysis, statin users were at a lower risk to die (hazard ratio [HR] = 0.68; 95% confidence interval [CI] 0.59-0.79) than nonusers. When separately analyzing the drugs, on multivariable analysis, patients using simvastatin (HR = 0.64; 95% CI 0.52-0.80), atorvastatin (HR 0.72; 95% CI 0.58-0.89), or other statins (HR = 0.67; 95% CI 0.52-0.87) were at a lower risk to die than nonusers. For those using rosuvastatin, difference was not statistically significant (HR = 0.77; 95% CI 0.50-1.19), maybe due to the sample size. Conclusion Our data validate previous findings and confirm that VTE patients using statins at baseline are at a lower risk to die than nonusers. No statistically differences were found according to type of statins.
Loss of smell and taste are considered potential discriminatory symptoms indicating triaging for coronavirus disease 2019 (COVID-19) and early case identification. However, the estimated prevalence essential to guide public health policy varies in published literature. This meta-analysis aimed to estimate prevalence of smell and taste loss among COVID-19 patients.
We conducted systematic searches of PubMed, Embase, Web of Science, and Google Scholar databases for studies published on the prevalence of smell and taste loss in COVID-19 patients.
Two authors extracted data on study characteristics and the prevalence of smell and taste loss. Random-effects modeling was used to estimate pooled prevalence. Subgroup analysis and meta-regression were conducted to explore potential heterogeneity sources. This study used PRISMA and MOOSE guidelines.
Twenty-seven of 32 studies reported a prevalence of loss of smell, taste, or both from a combined sample of 20,451 COVID-19 patients. The estimated global pooled prevalence of loss of smell among 19,424 COVID-19 patients from 27 studies was 48.47% (95% CI, 33.78%-63.29%). Loss of taste was reported in 20 studies and 8001 patients with an estimated pooled prevalence of 41.47% (95% CI, 3.13%-31.03%), while 13 studies that reported combined loss of smell and taste in 5977 COVID-19 patients indicated a pooled prevalence of 35.04% (95% CI, 22.03%-49.26%).
The prevalence of smell and taste loss among COVID-19 patients was high globally, and regional differences supported the relevance of these symptoms as important markers. Health workers must consider them as suspicion indices for empirical diagnosis of severe acute respiratory syndrome coronavirus 2 infection.
The prevalence of smell and taste loss among COVID-19 patients was high globally, and regional differences supported the relevance of these symptoms as important markers. Health workers must consider them as suspicion indices for empirical diagnosis of severe acute respiratory syndrome coronavirus 2 infection.Purpose Maintaining a healthy eating pattern plays a key role in ensuring optimal health outcomes, yet, in areas considered "food deserts" and lower-income neighborhoods where the accessibility of healthy foods and beverages is limited, the pursuit of adequate nutrient intake is rendered cumbersome. This pilot program aims to improve access to healthful foods by supporting corner stores in stocking and promoting the purchase of produce. Methods DC Central Kitchen's Healthy Corners program in Washington, DC piloted a nutrition incentive model in 17 corner stores that were upgraded to stock an increased variety and quantity of fresh produce. This program, entitled "5-for-5," provided a $5 coupon toward the purchase of fresh produce to Supplemental Nutrition Assistance Program (SNAP) shoppers making a qualifying purchase of $5 or more with SNAP benefits. Results Evaluation based on store owner buy-in and customer intercept surveys indicated overall satisfaction in program offerings with 77% of SNAP shoppers polled indicating an increase in produce consumption as a direct result of the program. Coupon distribution data indicated that in the 5-for-5 program's first year, 76.5% of all 57,989 distributed coupons were redeemed, amounting to $221,770 worth of incentivized fresh produce sales. Conclusion The results of the incentive program were promising with increases in the amount of produce purchased as a result of the program. Lessons learned concerning the use of a financial incentive to encourage the purchase of produce at corner stores is explored, as well as the feasibility of the corner store as a sustainable venue to increase produce consumption in underserved communities.Purpose To assess the trends and sociodemographic disparities of anal cancer. Akt inhibitor Methods For this time series, billing claims were reviewed for all encounters between 2007 and 2011 in the Yale New Haven Health System. link2 Results There were 80 new cases identified. Decreasing trends were seen in women and increasing trend in men (-30.1% and 27.3%). Diagnoses were more common in areas with the highest proportion of racial minorities (incidence rate ratio [IRR]=1.75; p≤0.01) and poverty (IRR=1.72; p=0.04). link3 Conclusions Anal cancer continues to rise in men during the postvaccine era. Communities with the highest proportion of poverty and racial/ethnic minority groups bear the highest burden of disease.
Familial longevity is associated with higher circulating levels of thyrotropin (TSH), in the absence of differences in circulating thyroid hormones, and a lower thyroid responsivity to TSH, as previously observed in the Leiden Longevity Study (LLS). Further mechanisms underlying these observations remain unknown.
We hypothesized that members from long-lived families (offspring) have higher thyroid hormone turnover or less negative feedback effect on TSH secretion compared to controls.
In a case-control intervention study, 14 offspring and 13 similarly aged controls received 100 µg 3,5,3'-triiodothyronine (T3) orally. Their circulating T3, free T3 (fT3), and TSH levels were measured during 5 consecutive days. We compared profiles of circulating T3, fT3, and TSH between offspring and controls using general linear modeling (GLM) and calculated the percentage decline in TSH following T3 administration.
Circulating T3 and fT3 levels increased to supraphysiologic values and normalized over the course of 5 days. There were no serious adverse events. T3 and fT3 concentration profiles over 5 days were similar between offspring and controls (T3 GLM
= .11, fT3 GLM
= .46). TSH levels decreased in a biphasic manner and started returning to baseline by day 5. The TSH concentration profile over 5 days was similar between offspring and controls (GLM
= .08), as was the relative TSH decline (%).
Members of long-lived families have neither higher T3 turnover nor diminished negative feedback of T3 on TSH secretion. The cause and biological role of elevated TSH levels in familial longevity remain to be elucidated.
Members of long-lived families have neither higher T3 turnover nor diminished negative feedback of T3 on TSH secretion. The cause and biological role of elevated TSH levels in familial longevity remain to be elucidated.Cancer immunotherapies are changing the landscape of cancer care. Intratumoral talimogene iaherparepvec (T-VEC), an oncolytic viral vaccine, has been approved for treatment of unresectable melanoma with minimal toxicity. We describe the first case of a centenarian who developed autoimmune diabetes while on T-VEC immunotherapy. The patient's high titer of glutamic acid decarboxylase 65 autoantibodies as well as insulin deficiency are consistent with autoimmune diabetes. Autoimmune diabetes has previously been seen following immune checkpoint inhibitor use; however, it has never been reported with T-VEC. This case highlights that autoimmune diabetes can be a rare but morbid complication of intratumoral T-VEC immunotherapy and can occur in the ultra-elderly.
Standard Precaution (SPs) practices protect health-care workers prevent hospital-acquired infections. With Competency Based Medical Education (CBME) and early clinical exposure (ECE) implemented in the new curriculum, the first year medical students need to be aware of SPs, so as to protect themselves and the patients from these hazards.
To assess the knowledge of standard precautions among the medical students and find out association of knowledge with selected demographic variables.
This cross-sectional study was done among first year medical undergraduate students of a medical college.Data was collected through google form with researcher-made questionnaire including questions on knowledge about SPs and socio-demographic variables of the study participant and their parents.
Response rate was 97.9%. Mean age of the participants was 19.13±0.858 years; 57.7% were girls.Although 80.3% had heard of SPs but as high as 83.1% were of the opinion that "SPs were only for protection of the health-care team", 23.
