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No early treatment intervention for COVID-19 has proven effective to date. We systematically reviewed the efficacy of hydroxychloroquine as early treatment for COVID-19.
Randomized controlled trials (RCTs) evaluating hydroxychloroquine for early treatment of COVID-19 were searched in five engines and preprint websites until September 14, 2021. Primary outcomes were hospitalization and all-cause mortality. Secondary outcomes included COVID-19 symptom resolution, viral clearance, and adverse events. Inverse variance random-effects meta-analyses were performed and quality of evidence (QoE) per outcome was assessed with GRADE methods.
Five RCTs (
= 1848) were included. The comparator was placebo in four RCTs and usual care in one RCT. The RCTs used hydroxychloroquine total doses between 1,600 and 4,400 mg and had follow-up times between 14 and 90 days. Compared to the controls, early treatment with hydroxychloroquine did not reduce hospitalizations (RR = 0.80, 95% CI 0.47-1.36,
= 2%, 5 RCTs, low QoE), all-cause mortality (RR = 0.77, 95% CI 0.16-3.68,
= 0%, 5 RCTs, very low QoE), symptom resolution (RR = 0.94, 95% CI 0.77-1.16,
= 71%, 3 RCTs, low QoE) or viral clearance at 14 days (RR = 1.02, 95% CI 0.82-1.27,
= 65%, 2 RCTs, low QoE). There was a larger non-significant increase of adverse events with hydroxychloroquine vs. controls (RR = 2.17, 95% CI 0.86-5.45,
= 92%, 5 RCTs, very low QoE).
Hydroxychloroquine was not efficacious as early treatment for COVID-19 infections in RCTs with low to very low quality of evidence for all outcomes. More RCTs are needed to elucidate the efficacy of hydroxychloroquine as early treatment intervention.
Hydroxychloroquine was not efficacious as early treatment for COVID-19 infections in RCTs with low to very low quality of evidence for all outcomes. More RCTs are needed to elucidate the efficacy of hydroxychloroquine as early treatment intervention.
The aim of the study was to address the fatty acid (FA) status and its relationship with disease activity in patients with inflammatory bowel disease (IBD).
FA levels of the phospholipid fraction in serum and a colon biopsy specimen were measured in 17 patients with IBD.
A negative correlation between the histological activity of inflammation of the disease and the ratio of polyunsaturated FAs/no polyunsaturated FAs was observed. Moreover, the level of that ratio was lower in patients with IBDs as compared to controls.
The FA profile in serum and in a colon biopsy specimen in patients with IBD is characteristic for essential fatty acid insufficiency.
The FA profile in serum and in a colon biopsy specimen in patients with IBD is characteristic for essential fatty acid insufficiency.
Three-dose mRNA vaccination against COVID-19 is unable to elicit a sufficient immune response in immunocompromised subjects.
The aim of the study was to conduct a retrospective evaluation of the efficacy of a heterologous mRNA booster with mRNA-1273 in constantly seronegative kidney transplant recipients (KTRs) after three doses of the BNT162b2 mRNA vaccine. Twelve seronegative KTRs received a mRNA-1273 booster 5 months after the third dose of BNT162b2.
A total of 5 out of 12 patients (41.7%) seroconverted, with a mean titer of 353 BAU/ml.
The administration of a heterologous mRNA vaccine as a booster may be an effective alternative for achieving post-vaccination immunity in seronegative KTRs.
The administration of a heterologous mRNA vaccine as a booster may be an effective alternative for achieving post-vaccination immunity in seronegative KTRs.
The aim of our study was to assess the potential value of the Comirnaty vaccine (BNT162b2) in Poland. A model was used to estimate patient events, direct medical costs, utilities, and cost-effectiveness for 1 year with and without implementation of the vaccine.
The Markov model with 1-week cycles was used to estimate patient events, direct medical costs, utilities, and cost-effectiveness for 1 year with and without implementing the Comirnaty vaccine in Poland. selleck chemicals llc The incremental cost per quality-adjusted life-year (QALY) gained vs. no vaccine was calculated for the general population and selected age-groups. All costs are reported in PLN (average exchange rate in 2020 1 EUR = 4.44 PLN).
In the base case analysis the incremental cost per QALY gained associated with vaccinating the whole population is 6249 PLN. For individuals aged 60-69 years and > 80 years vaccination is less costly and more effective than no vaccination. The incremental cost per QALY gained when vaccinating individuals aged 40-49 and 30-39 years is 28,135 PLN and 67,823 PLN, respectively. In the general population and in younger subpopulations the incremental cost-effectiveness ratio is most sensitive to the vaccine effectiveness, vaccine price, and SARS-CoV-2 infection rates.
When prioritization is required due to supply constraints, vaccination of the elderly is justified because it gives the highest number of QALY gained and generates savings for the health care system. Continual updates of the model concerning vaccine real-life effectiveness and epidemic course are required to refine the prioritisation scheme in the future.
When prioritization is required due to supply constraints, vaccination of the elderly is justified because it gives the highest number of QALY gained and generates savings for the health care system. Continual updates of the model concerning vaccine real-life effectiveness and epidemic course are required to refine the prioritisation scheme in the future.
Constipation and faecal incontinence are not so uncommon in patients with multiple sclerosis, impairing quality of life. The gut microbiota is altered in multiple sclerosis patients and likely contributes to disease pathogenesis. Trans-anal irrigation has been proven to allow treatment of neurogenic bowel dysfunction and may affect gut microbiota.
The primary outcome was trans-anal irrigation effectiveness on constipation and faecal incontinence. The secondary outcome was gut microbiota profiling compared to healthy subjects and during trans-anal irrigation adoption.
We conducted a prospective cohort study on multiple sclerosis patients, screened with Patient Assessment of Constipation Quality of Life questionnaire before undergoing constipation and faecal incontinence scoring, abdomen X-ray for intestinal transit time, compilation of food and evacuation diaries and faecal sample collection for gut microbiota analysis before and after 4 weeks of trans-anal irrigation.
Eighty patients were screened of microbiota diversity and reduction of the proportions of pro-inflammatory taxa (p less then 0.05). Trans-anal irrigation was safe, satisfactory and could help counteract multiple sclerosis-related dysbiosis.
Access to affordable, appropriate housing is one of the key social determinants of health, affecting well-being across the lifecourse. However, beyond a recognition that housing quality is linked to place of death, little is known about the ways in which housing status impacts social, emotional, and practical aspects of dying and bereavement.
The Checking Out project is a qualitative study aiming to explore the ways in which socio-economic status impacts people's experiences of, and attitudes towards, death, dying, and bereavement in the United Kingdom. Qualitative interviews were carried out with 14 bereaved individuals with experience of poverty at end of life or in bereavement, and 15 professionals supporting individuals in low-income communities. Interviews were conducted via phone/video call, and data include experiences of end of life and bereavement both before and during the pandemic. Transcripts were examined using thematic analysis.
Housing emerged as an important factor affecting people's exp how trusted professionals are able to advocate or address the issues faced by bereaved individuals and suggests implications for policy and practice. A greater awareness of the potential impact of housing status across public services, including healthcare practitioners, welfare support, and housing providers, could better support patients and practitioners to address these issues proactively. Housing providers and policy-makers should be included as key partners in collaborative public health approaches to palliative care.Primary CNS lymphoma presents unique challenges for the clinician. New evidence has emerged regarding the appropriate workup, management considerations, and treatment. In this paper, we highlight the clinical presentations, disease prognosis, and management considerations. We place specific emphasis on the decision tree for immunocompetent and immunocompromised. The key imaging characteristics are discussed. Once biopsy prove lymphoma, important management considerations are addressed. We highlight need for follow up and role for surgery verse radiation. Finally, we present emerging treatment options and pre-clinical work that will be making its way through the pipeline. This up-to-date review will serve as a key learning tool for clinicians and researchers.Advancement of implanted left ventricular assist device (LVAD) technology includes modern sensing and control methods to enable online diagnostics and monitoring of patients using on-board sensors. These methods often rely on a cardiovascular system (CVS) model, the parameters of which must be identified for the specific patient. Some of these, such as the systemic vascular resistance (SVR), can be estimated online while others must be identified separately. This paper describes a three-staged approach for designing a parameter identification algorithm (PIA) for this problem. The approach is demonstrated using a two-element Windkessel model of the systemic circulation (SC) with a time-varying elastance for the left ventricle (LV). A parameter identifiability stage is followed by identification using an unscented Kalman filter (UKF), which uses measurements of LV pressure (Plv), aortic pressure (Pao), aortic flow (Qa), and known input measurement of LVAD flowrate (Qvad). Both simulation and experimental data from animal experiments were used to evaluate the presented methods. By bounding the initial guess for left ventricular volume, the identified CVS model is able to reproduce signals of Plv, Pao, and Qa within a normalized root mean squared error (nRMSE) of 5.1%, 19%, and 11%, respectively, during simulations. Experimentally, the identified model is able to estimate SVR with an accuracy of 3.4% compared with values from invasive measurements. Diagnostics and physiological control algorithms on-board modern LVADs could use CVS models other than those shown here, and the presented approach is easily adaptable to them. The methods also demonstrate how to test the robustness and accuracy of the identification algorithm.Cranial dermoids have the tendency to occur in the midline, especially near fontanelles and sutures early in the life of a patient. Here we present an unusual case of an intraosseous dermoid that presented initially as a lytic lesion, off of the midline and not associated with cranial sutures or fontanelles. The diameter of the lesion grew to approx 15 mm over time, thus the decision was made to take the child to surgery for removal of dermoid with the use of neuronavigation and cranioplasty. A dermoid cyst was confirmed on histopathologic analysis.
