In this double-blind, randomized trial, 821 asymptomatic persons with a high-risk or moderate-risk exposure to SARS-CoV-2 were assigned to receive hydroxychloroquine or placebo within 4 days after ...the exposure. No benefit in preventing illness compatible with Covid-19 was found.
No effective oral therapy exists for early coronavirus disease 2019 (COVID-19).
To investigate whether hydroxychloroquine could reduce COVID-19 severity in adult outpatients.
Randomized, ...double-blind, placebo-controlled trial conducted from 22 March through 20 May 2020. (ClinicalTrials.gov: NCT04308668).
Internet-based trial across the United States and Canada (40 states and 3 provinces).
Symptomatic, nonhospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 and high-risk exposure within 4 days of symptom onset.
Oral hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 more days) or masked placebo.
Symptoms and severity at baseline and then at days 3, 5, 10, and 14 using a 10-point visual analogue scale. The primary end point was change in overall symptom severity over 14 days.
Of 491 patients randomly assigned to a group, 423 contributed primary end point data. Of these, 341 (81%) had laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or epidemiologically linked exposure to a person with laboratory-confirmed infection; 56% (236 of 423) were enrolled within 1 day of symptoms starting. Change in symptom severity over 14 days did not differ between the hydroxychloroquine and placebo groups (difference in symptom severity: relative, 12%; absolute, -0.27 point 95% CI, -0.61 to 0.07 point;
= 0.117). At 14 days, 24% (49 of 201) of participants receiving hydroxychloroquine had ongoing symptoms compared with 30% (59 of 194) receiving placebo (
= 0.21). Medication adverse effects occurred in 43% (92 of 212) of participants receiving hydroxychloroquine versus 22% (46 of 211) receiving placebo (
< 0.001). With placebo, 10 hospitalizations occurred (2 non-COVID-19-related), including 1 hospitalized death. With hydroxychloroquine, 4 hospitalizations occurred plus 1 nonhospitalized death (
= 0.29).
Only 58% of participants received SARS-CoV-2 testing because of severe U.S. testing shortages.
Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19.
Private donors.
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly emerging viral infection causing coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine have ...garnered unprecedented attention as potential therapeutic agents against COVID-19 following several small clinical trials, uncontrolled case series, and public figure endorsements. While there is a growing body of scientific data, there is also concern for harm, particularly QTc prolongation and cardiac arrhythmias. Here, we perform a rapid narrative review and discuss the strengths and limitations of existing in vitro and clinical studies. We call for additional randomized controlled trial evidence prior to the widespread incorporation of hydroxychloroquine and chloroquine into national and international treatment guidelines.
Hydroxychloroquine and chloroquine have garnered unprecedented attention as potential therapeutic agents against coronavirus disease 2019 (COVID-19), yet evidence of clinical benefit is scant. We review these studies and call for additional randomized clinical trials.
The incidence of group C and G Streptococcus (GCGS) bacteremia, which is associated with severe disease and death, is increasing. We characterized clinical features, outcomes, and genetic ...determinants of GCGS bacteremia for 89 patients in Winnipeg, Manitoba, Canada, who had GCGS bacteremia during 2012-2014. Of the 89 patients, 51% had bacteremia from skin and soft tissue, 70% had severe disease features, and 20% died. Whole-genome sequencing analysis was performed on isolates derived from 89 blood samples and 33 respiratory sample controls: 5 closely related genetic lineages were identified as being more likely to cause invasive disease than non-clade isolates (83% vs. 57%, p = 0.002). Virulence factors cbp, fbp, speG, sicG, gfbA, and bca clustered clonally into these clades. A clonal distribution of virulence factors may account for severe and fatal cases of bacteremia caused by invasive GCGS.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Tick paralysis Lother, Sylvain A; Haley, Laura
CMAJ. Canadian Medical Association journal,
10/2017, Letnik:
189, Številka:
43
Journal Article
Recenzirano
Odprti dostop
A healthy and active 83-year-old man presented to the emergency department after five days of paresthesias, followed by rapidly progressive ataxia, weakness and severely impaired ambulation. Symptoms ...started eight days after he worked at his cabin in the Thompson- Nicola region of British Columbia Canada. Upon examination, the patient was afebrile with normal vital signs and mentation. He had diplopia, marked dysarthria, four-limb weakness, dysmetria, areflexia, and reduced vibration sense and proprioception distally. Physicians removed an engorged tick that was adherent to his mid-back. Routine analyses of blood and cerebrospinal fluid were normal. Tick paralysis, a neurotoxidrome, occurs after tick attachment, engorgement and injection of potent tick salivary toxins. Women and children are most affected. Ticks hide in long body hair, skin folds and difficult-to-reach areas.
Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly emerging virus causing the ongoing coronavirus disease 2019 (COVID-19) pandemic with no known effective ...prophylaxis. We investigated whether hydroxychloroquine could prevent SARS-CoV-2 in healthcare workers at high risk of exposure.
Methods
We conducted a randomized, double-blind, placebo-controlled clinical trial of healthcare workers with ongoing exposure to persons with SARS-CoV-2, including those working in emergency departments, intensive care units, COVID-19 hospital wards, and first responders. Participants across the United States and in the Canadian province of Manitoba were randomized to hydroxychloroquine loading dose then 400 mg once or twice weekly for 12 weeks. The primary endpoint was confirmed or probable COVID-19–compatible illness. We measured hydroxychloroquine whole-blood concentrations.
Results
We enrolled 1483 healthcare workers, of whom 79% reported performing aerosol-generating procedures. The incidence of COVID-19 (laboratory-confirmed or symptomatic compatible illness) was 0.27 events/person-year with once-weekly and 0.28 events/person-year with twice-weekly hydroxychloroquine compared with 0.38 events/person-year with placebo. For once-weekly hydroxychloroquine prophylaxis, the hazard ratio was .72 (95% CI, .44–1.16; P = .18) and for twice-weekly was .74 (95% CI, .46–1.19; P = .22) compared with placebo. Median hydroxychloroquine concentrations in whole blood were 98 ng/mL (IQR, 82–120) with once-weekly and 200 ng/mL (IQR, 159–258) with twice-weekly dosing. Hydroxychloroquine concentrations did not differ between participants who developed COVID-19–compatible illness (154 ng/mL) versus participants without COVID-19 (133 ng/mL; P = .08).
Conclusions
Pre-exposure prophylaxis with hydroxychloroquine once or twice weekly did not significantly reduce laboratory-confirmed COVID-19 or COVID-19–compatible illness among healthcare workers.
Clinical Trials Registration
Clinicaltrials.gov NCT04328467.
In this randomized clinical trial of 1483 high-risk healthcare workers, there was no significant reduction in incidence of COVID-19 with once-weekly or twice-weekly hydroxychloroquine compared with placebo.
The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary ...pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions. This “flattening of the curve” has inevitably prompted discussions around reopening of the economy, relaxing some public health restrictions, and resuming nonurgent health care delivery. This document provides a template for cardiac surgical programs to begin to ramp-up the delivery of cardiac surgery in a deliberate and graded fashion as the COVID-19 pandemic burden begins to ease that is guided by 3 principles. First, all recommendations from public health authorities regarding COVID-19 containment must continue to be followed to minimize disease spread, ensure patient safety, and protect health care personnel. Second, patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. Finally, case volumes should be steadily increased in a mutually agreed upon fashion and must balance the clinical needs of patients awaiting surgery against the overall requirements of the health care system.
La maladie à coronavirus 2019 (COVID-19) a eu de profondes répercussions partout dans le monde. Sa vitesse de transmission a forcé des pays entiers à mettre en place des mesures rigoureuses pour en limiter la propagation. Conformément aux plans établis en cas de pandémie, la plupart des programmes de chirurgie cardiaque du Canada ont établi l’ordre de priorité des interventions et reporté celles qui n’étaient pas urgentes, afin de réduire les pressions sur le système de santé et de mobiliser les ressources en prévision d’une flambée pandémique. Bien que le nombre de cas de COVID-19 dans le monde ne cesse d’augmenter, les nouveaux cas ont commencé à diminuer dans beaucoup de pays. Cet « aplatissement de la courbe » a inévitablement suscité des discussions sur la réouverture de l’économie, l’assouplissement de certaines mesures de santé publique et la reprise de la prestation des soins de santé non urgents. Le présent article propose un modèle reposant sur trois principes pour aider les programmes de chirurgie cardiaque à reprendre graduellement leurs activités d’une manière ordonnée, alors que le fardeau de la pandémie de COVID-19 commence à s’alléger. D’abord, il faut continuer de suivre toutes les recommandations des autorités de santé publique visant à endiguer la COVID-19, afin de limiter le plus possible la propagation de la maladie, d’assurer la sécurité des patients et de protéger le personnel soignant. Ensuite, il faut prendre en charge de manière proactive les patients qui sont en attente d’une intervention chirurgicale cardiaque non urgente, et revoir la priorité de ceux qui présentent un problème anatomique associé à un risque élevé et de ceux dont l’état de santé se détériore. Enfin, il faut augmenter régulièrement le volume de cas traités, d’une manière approuvée par tous les intervenants, et trouver un juste équilibre entre répondre aux besoins des patients en attente d’une intervention et répondre aux besoins globaux du système de santé.
Surgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients’ quality of life. Numerous guidelines and ...expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery.
Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type.
Preventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement.
Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.
Purpose of the Review
Methicillin-sensitive
Staphylococcus aureus
(MSSA) bacteremia is a common cause of morbidity and mortality. First-line treatment requires frequent daily doses of an ...anti-staphylococcal beta-lactam. However, some physicians prescribe simpler once-daily regimens to improve compliance and improve healthcare utilization. We reviewed the literature regarding advantages, pitfalls, and efficacy of once-daily treatment options for MSSA bacteremia.
Recent Findings
Several once-daily antibiotics are effective in vitro against MSSA (ceftriaxone, daptomycin, telavancin, dalbavancin, oritavancin, tedizolid, ertapenem, fluoroquinolones, and others), but there is insufficient evidence to support these agents for MSSA bacteremia. Ceftriaxone may be considered for therapy completion with MSSA bacteremia from osteomyelitis, and daptomycin may be considered in patients who cannot tolerate first-line therapy. However, they have not been compared to traditional second-line agents, and their role remains uncertain.
Summary
Current evidence does not support the use of once-daily treatment options for MSSA bacteremia.
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