Internal and emergency medicine
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Multicenter Study Observational Study
Safety and effectiveness of biosimilar enoxaparin (Inhixa) for the prevention of thromboembolism in medical and surgical inpatients.
In 2016, biosimilar enoxaparin (Inhixa®, Techdow) was introduced in European markets with the same indications as branded enoxaparin (Clexane®, Sanofi). Its use is constantly increasing in clinical practice, however, little information from post-marketing clinical trials is available on its safety and effectiveness. We conducted an observational, retrospective study to assess the safety and effectiveness of Inhixa in preventing venous thromboembolism (VTE) in medically ill patients and in patients undergoing major abdominal surgery. ⋯ The pooled estimate of the incidence of major bleeding with Clexane was 0.5% (IC 95%: 0.2-1.1) in medical patients and 2.6% (IC 95% 1.3-5.1) in surgical patients. The incidence of thrombotic events was 0.6% (IC 95%: 0.2-1.8) and 0.7% (CI95% 0.3-1.6), respectively. The incidence of bleeding and thrombosis in medical and surgical patients receiving Inhixa was low suggesting biosimilar enoxaparin is a valid alternative to branded enoxaparin.
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One of the most controversial issues among rheumatologists is the best approach to managing a rheumatic patient (RP) with coronavirus disease 2019 (COVID-19). This study aims to evaluate the prevalence of COVID-19 in RPs compared to the general population and to relatively assess the potential role of RPs' treatment regimen against COVID-19. In a cross-sectional study, all RPs with an updated medical record between December 1, 2019, and February 29, 2020, at the rheumatology clinic of Shahid Beheshti Hospital, Qom, Iran were included (as the case group), and the prevalence of COVID-19 was compared to the paired control group-individuals without RDs, randomly selected from the Qom Health Network's database. ⋯ Two RPs died from COVID-19, both of whom had granulomatosis and polyangiitis (GPA). The prevalence of COVID-19 in the RPs was lower than the control group, which could be associated with more adherence to the quarantine and social distancing rules by RPs and stricter routine follow-ups than the general population. Besides, taking DMARDs, such as leflunomide, might possess a protective effect against severe COVID-19, probably as a result of preventing cytokine storm.
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Clinical profile and outcome of patients with chronic inflammatory arthritis and metabolic syndrome.
Systemic chronic inflammation may favor the onset of metabolic syndrome (MetS) which represents a risk factor for CV events. Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are disorders with high prevalence of MetS. We assessed the factors associated with MetS and its prognostic role in non-selected RA/AS/PsA patients. ⋯ At multivariate Cox regression analysis, MetS was related to primary end point (HR 1.52 [CI 1.01-2.47], p = 0.04) together with higher LVM, disease duration and higher prevalence of biologic DMARDs refractoriness, and to co-primary end point (HR 2.05 [CI 1.16-3.60], p = 0.01) together with older age and higher LVM. The RA/AS/PsA phenotype MetS + is a subject with moderate/high disease activity, LV structural and functional abnormalities at increased risk for cancer. MetS + identifies RA/AS/PsA patients at higher risk for CV and non-CV events, independently of traditional CV risk factors analyzed individually and traditional indexes of inflammation.
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Randomized Controlled Trial
Using gel for difficult mask ventilation on the bearded patients: a simulation-based study.
The beard is a well-known cause of difficult mask ventilation due to excessive air leaks. Various techniques have been proposed to overcome this difficulty, such as applying a gel on the mask edge. Our objective was to determine whether the gel technique will improve ventilation and to assess the comfort of the provider. ⋯ In addition, only nine participants believed the technique was not comfortable, while the remaining individuals found it comfortable or natural. In our bearded simulation model, applying the gel significantly improved ventilation without negatively affecting comfort. Further studies and education are encouraged in the field of basic airway management.
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Whether the carriership of inherited antithrombin (AT), protein C (PC), and protein S (PS) deficiency increases the risk of arterial thromboembolic events (ATE) is controversial. This information has the potential to inform the management of family members of probands with inherited deficiency of natural anticoagulants. ⋯ Among family members of probands with an inherited deficiency of natural anticoagulants, carriers exhibit a risk of ATE that is almost five times higher than in non-carriers.