This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To compare the effects of early intrauterine device (IUD) removal and conventional treatment, including ...antibiotic treatment (any concentration, frequency, duration and route), plus any other specified intervention, such as nonsteroidal anti‐inflammatory drugs (NSAIDS), with conventional treatment only (without early IUD removal for women with PID).
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Hypertension (HTN) has been found to increase the risk of Covid-19 mortality when compared with normotensives, and those ...discontinuing the antihypertensive treatment have an additional fatality risk.
Objective
The survey was carried out to seek the opinion of Indian healthcare practitioners (HCPs) on the risk factors, challenges and management of HTN during the ongoing Covid-19 pandemic.
Method
This was a structured web-based objective questionnaire survey involving 2545 HCPs PAN-India. The survey comprised questions related to the risk factors for HTN, home blood pressure monitoring (HBPM), BP control, treatment, complications and challenges of uncontrolled HTN during Covid-19.
Results
This study showed that tobacco use, obesity and comorbidities are top three modifiable risk factors for HTN followed by emotional stress, during Covid-19 pandemic. A majority of HCPs (44%) reported that <30% of their hypertensive patients check BP at home while 36% and 20% reported that 30-50% and >50% of their patients respectively, practice HBPM. 20%, 63%, and 17% of HCPs respectively, reported that <20%, 20-40% and >40% of their patients presented with BP > 150/100 mmHg during lockdown. Of all the HCPs, 53% and 33% respectively, reported BP increase in <20% and 20-40% of their patients on monotherapy while 14% of HCPs reported BP increase in >40% of their patients on monotherapy during the lockdown. As compared to high dose monotherapy, dual and triple combination therapies (TDC) were selected as most preferred for the management of uncontrolled BP opted by 56% and 34% of the HCPs, respectively. The dual combination antihypertensives were ranked as angiotensin receptor blockers (ARB) + diuretic (DU) > ARB + calcium channel blockers (CCB) > ARB + beta-blocker. The TDC with ARB + CCB + DU was the most favored TDC antihypertensive therapy during Covid-19 era. Acute coronary syndrome was anticipated as the most common complication of HTN in the Covid-19 pandemic, followed by renal dysfunction, cerebral ischemia and cerebral hemorrhage reported by 47%, 17%, 14% and 14% of HCPs, respectively. Multiple challenges in HTN care during Covid-19 as opined by HCPs included BP measurement while avoiding the risk of infection (57%), advising treatment via teleconsultation (48%), dose modification (41%), patient compliance (32%) and transport-related issues (30%). Most of the HCPs believed that self-monitoring of BP (32%) and economical medicines (24%) can improve medication adherence in patients with HTN.
Conclusion
The study underlined that the provision of economic medicines, single pill combinations, doctor-patient digital connect, and patient education can help in improving medication adherence leading to better outcomes in patients with HTN during Covid-19. The study also suggested the need to enhance HBPM and the use of ARB-based dual and triple combination therapies to improve BP control in patients uncontrolled on monotherapy during Covid-19 pandemic.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Reportedly, hypertension (HTN) independently increases the risk of Covid-19 severity and doubles the risk of Covid-19 ...mortality. Also, individuals with untreated HTN remain at high risk of covid-19 complications in comparison to those managed with antihypertensive treatment.
Objective
The survey was carried out to seek the opinion of healthcare practitioners (HCPs) on the impact of Covid-19 lockdown on the blood pressure (BP) control, and the role of triple drug therapy in management of uncontrolled BP.
Method
This PAN India study was carried out through a structured web-based objective questionnaire survey involving 479 HCPs. The survey comprised questions related to the prevalence and causes of uncontrolled BP during the Covid-19 lockdown, and the use of triple drug therapy in the management of uncontrolled BP.
Results
The respondent pool of 479 HCPs consisted of consulting physicians (51.5%), family physicians (19%), diabetologists (15%), cardiologists (14%) and nephrologists (0.5%). In this study a majority (40%) of HCPs agreed that stress was the most common reason behind uncontrolled BP during Covid-19 lockdown followed by non-compliance of treatment and sedentary lifestyle, each opined by 30% of HCPs. Almost 54% and 40% of the HCPs respectively, mentioned that 10-40% and 40-80% of their patients with hypertension have reported uncontrolled BP levels following the Covid-19 lockdown. 4% of the HCPs reported that all of their patients lost BP control, while 2% of HCPs mentioned that none of their patients reported uncontrolled BP after the Covid-19 lockdown. Of all the HCPs, 12% opined that they will choose a triple drug combination (TDC) for patients uncontrolled with high dose monotherapy, ∼75% opined that they will chose TDC for patients uncontrolled with dual therapy while 13% mentioned that they will chose TDC for patients at high risk. Regarding the TDC of choice, more than half (51%) of the HCPs opted for Telmisartan + Amlodipine + Hydrochlorothiazide as the preferred combination. Among other TDCs, Telmisartan + Amlodipine + Chlorthalidone, Telmisartan + Cilnidipine + Chlorthalidone, and Olmesartan + Amlodipine + Hydrochlorothiazide were ranked as the next three choices opted by 28%, 17.5% and 2.5% of HCPs for the management of uncontrolled BP. A majority of HCPs (58%) also agreed that they would adopt TDC early in the treatment, during the ongoing Covid-19 pandemic.
Conclusion
This study underlined the negative impact of Covid-19 lockdown on the blood pressure control in patients with hypertension. It also highlighted the HCPs perspectives on the early use of TDC, and that Telmisartan + Amlodipine + Hydrochlorothiazide is the most commonly preferred TDC in patients with uncontrolled BP levels in Indian settings.
Cardiac involvement in patients with coronavirus pneumonia Germanova, O; Tereshina, O
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology,
07/2021, Volume:
20, Issue:
Supplement_1
Journal Article
Peer reviewed
Open access
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. New COVID-19 disease is well known by its primary damage of respiratory system. However, it is also possible to involve ...other organs and systems.
Purpose. To determine the cardiac involvement in patients with COVID-19 pneumonia.
Materials and methods. We performed echocardiography with speckle tracking in 48 patients. All of them had serologically verified COVID-19 pneumonia with lung involvement 5-60% on CT. None of them were treated by antimalarial drugs. 28 of them were men and 20 women, mean age - 45 ± 4,4 years old. We performed echocardiography in 1 month period from onset of the disease.
Results. Most of the patients (30 patients) had enlargement of right heart chambers. Despite of right ventricle enlargement, in none of the patients had reduced right ventricle function (TAPSE 22 ± 2 mm, right ventricle strain -21,2 ± 1,5%). The mean systolic pulmonary artery pressure was slightly elevated (38 ± 2 mm Hg).
Left ventricle was enlarged in 9 patients (with mean end diastolic volume 82 ± 5 ml/m2). In 25 of them, the ejection fraction was decreased (44 ± 4%). In all patients with COVID-19 pneumonia, the changes in circumferential and longitudinal strain were observed. Both parameters were decreased. The mean value of circumferential strain was -16,3 ± 1,9%. The longitudinal strain parameter was -14,2 ± 1,4%. 25 patients had enlargement of left atrium (>40ml/m2) and the reservoir strain of left atrium was decreased (-23,3 ± 1,5%) in 29 of them.
After 2 months from the onset of the disease, we noticed the normalization of echocardiography data in all patients.
Nevertheless, we observed cardiac structural and functional changes in all patients, troponins levels were increased only in 12 patients.
Conclusion. We observed cardiac involvement in different degree in all of patients with COVID-19 pneumonia. Changes characterized by atriums and ventricles enlargement, and left ventricle contractile dysfunction. Due to the fact that only part of the patients with COVID-19 with cardiac changes had elevated troponins, we believe that the mechanism of these pathological changes need further research.
Abstract Background Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness ...of compulsory drug treatment. Methods We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism. Results Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. Conclusion There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.
•Review provides a comprehensive update on evidence base for residential treatment.•Of 23 studies, 10 were rated as methodologically strong, 5 as moderate and 8 as weak.•Results provide moderate ...evidence for the effectiveness of residential treatment.•Effectiveness evident for substance use and other life outcomes.•Best practice integrates mental health treatment and provides continuity of care.
Residential treatment is a standard treatment for individuals with severe and complex substance use problems. However, there is limited evidence on best practice approaches to treatment in these settings. This review provides a comprehensive update on the evidence base for residential treatment, and directions for future research and clinical practice.
A systematic review of all studies published between January 2013 and December 2018 was conducted. Public health and psychology databases (Medline, CINAHL, PsycARTICLES and PsycINFO) were systematically searched, and forward and backward snowballing were used to identify additional studies. Studies were included if they were quantitative, assessed the effectiveness of residential substance treatment programs for adults, were published in the English language and in peer-reviewed journals. The Effective Public Health Practice Project’s Quality Assessment Tool for Quantitative Studies was used to assess methodological quality.
Our search identified 23 studies. Eight were rated as methodologically strong, five as moderate and ten rated as weak. Quality ratings were impacted by attrition at follow-up and research design. Despite limitations, results provide moderate quality evidence for the effectiveness of residential treatment in improving outcomes across a number of substance use and life domains.
With caution, results suggest that best practice rehabilitation treatment integrates mental health treatment and provides continuity of care post-discharge. Future research and practice should focus on better collection of outcome data and conducting data linkage of key health, welfare and justice agency administrative data to enhance understanding of risk and recovery trajectories.
It is becoming clear that the wastewater treatment plants (WWTPs) is a key repository for antibiotic resistance genes (ARGs), and WWTPs also represent an important node for limiting ARGs spreading ...via altering the magnitude and distribution of ARGs in environment. This review provides an overview of the ARGs degradation performance both in sewage sludge and wastewater in WWTPs. The ARGs reduction behaviors during sludge treatment processes including anaerobic digestion (AD), composting, aerobic digestion, bio-drying and air-drying were reviewed, and parameters affecting ARGs reducing efficiency and the probable mechanisms were concluded. In particular, pretreatment approaches such as microwave, thermal hydrolysis and ozone before sludge AD are found to provide the extra benefits for ARGs removal. Additionally, ARGs fates and reduction mechanisms during sewage biological treatments such as anaerobic, aerobic, anaerobic combined with aerobic process and physical-chemical treatment including coagulation, advanced oxidation and disinfection processes were appraised. Furthermore, problems or doubts of previous study are proposed, and some in-depth mechanism researches are anticipated to elucidate the ARGs decay in sewage and sludge treatment process. This can help further enhance the ARGs removal efficiency in WWTPs.
On the basis of an examination of the colonial mercury and silver production processes and related labor systems, Mercury, Mining, and Empire explores the effects of mercury pollution in colonial ...Huancavelica, Peru, and Potosí, in present-day Bolivia. The book presents a multifaceted and interwoven tale of what colonial exploitation of indigenous peoples and resources left in its wake. It is a socio-ecological history that explores the toxic interrelationships between mercury and silver production, urban environments, and the people who lived and worked in them. Nicholas A. Robins tells the story of how native peoples in the region were conscripted into the noxious ranks of foot soldiers of proto-globalism, and how their fate, and that of their communities, was-and still is-chained to it.
Highlights • In the US, clients with psychiatric comorbidity have lower substance use disorder (SUD) treatment retention. • Comorbidity is most strongly associated with treatment (tx) non-completion ...for alcohol users. • Comorbidity does not impact retention of opioid users in programs that utilize medication assisted treatment (MAT).
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