Internal and emergency medicine
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Comparative Study
Comparison of characteristics and outcomes of patients admitted to hospital with COVID-19 during wave 1 and wave 2 of the current pandemic.
In this study of patients admitted with COVID-19, we examined differences between the two waves in patient characteristics and outcomes. Data were collected from the first COVID-19 admission to the end of study (01/03/2020-31/03/2021). Data were adjusted for age and sex and presented as odds ratios (OR) with 95% confidence intervals (CI). ⋯ Survivors of COVID-19 in wave 1 stayed longer in hospital (median = 6.5 days; interquartile range = 2.9-12.0) as compared to survivors from wave 2 (4.5 days; interquartile range = 1.9-8.7). Patient characteristics differed significantly between the two waves of COVID-19 pandemic. There was an improvement in outcomes in wave 2, including shorter length of stay in hospital and reduction of mortality.
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Observational Study
All-cause mortality in COVID-19 patients receiving statin therapy: analysis of veterans affairs database cohort study.
Statins have been advocated as a potential treatment for coronavirus disease-2019 (COVID-19) due to its pleotropic properties. The aim of the study was to elucidate the association between antecedent statin exposure and 30-day all-cause mortality, intensive care unit (ICU) admission and hypoxic respiratory failure requiring mechanical ventilation in patients diagnosed with COVID-19. Observational cohort study derived from the VA Corporate Data Warehouse of all veterans tested positive for COVID-19 between January 1st and May 31st, 2020. ⋯ After adjusting for covariates, statin exposure was not associated with a decreased mortality in the overall cohort by either Cox proportional hazards stratified model (HR 0.99; 95% CI 0.88-1.12) or propensity matching (HR .86; 95% CI 0.74-1.01). Similarly, there was no demonstrated advantage of statins in reducing the risk of ICU admission (HR 0.92; 95% CI 0.74-1.31) or hypoxic respiratory failure requiring mechanical ventilation (HR 1.02; 95% CI 0.81-1.29). Antecedent statin exposure in patients with COVID-19 was not associated with a decreased risk of 30-day all-cause mortality or need for mechanical ventilation.
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Tofacitinib has only been available in China for 2 years to treat rheumatoid arthritis (RA). Our purpose was to compare real-world effectiveness of tofacitinib with that of disease-modifying anti-rheumatic drugs (DMARDs) in Chinese patients with RA. The records of patients with RA treated at Guangdong Provincial People's Hospital between July 2017 and September 2019 were retrospectively reviewed. ⋯ All disease indices in the three groups decreased with time, indicating improvement of symptoms, with no differences among the groups at 12 months. Tofacitinib appeared to improve symptoms more rapidly than other treatments; however, differences in disease indices were not significant. This real-world study suggests that tofacitinib is rapidly effective and that the effects are sustained after 12 months in Chinese patients with RA.
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Military studies have identified significant trends in combat related preventable death, particularly with respect to limb hemorrhage. Little is known, however regarding preventable death due to firearms in the civilian patient population, or the anatomic distribution of these injuries. An understanding of this information and the applicability of military studies to the civilian patient population is critical to developing strategies for treating these injuries. ⋯ These four anatomic locations were the most likely to be classified as Critical-Red by prehospital providers: 62.66% of chest injuries, 54.22% of abdomen injuries, 48.42% of neck injuries, and 42.31% of back injuries. The NEMESIS data on patient acuity indicates that the number of firearm related preventable deaths due to torso injury may be significantly greater than those due to limb exsanguination. In addition to the focus on tourniquet use, research focused on improved prehospital care of firearm injuries to the torso may provide additional strategies for reducing preventable death.
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Individuals with Chronic Kidney Disease (CKD) are at high risk for cardiovascular morbidity and mortality. The aim of this study was to examine the relationship between renal dysfunction and all-cause mortality in a sample of subjects undergoing coronary angiography (CA). We evaluated 1017 subjects who consecutively underwent CA. ⋯ Again, the increased risk remained significant after adjusting for several potential confounders. In conclusion, kidney disease measures (i.e. low eGFR or albuminuria) independently predict increased risk for all-cause death in a large sample of subjects undergoing CA. These results have a relevant clinical impact.