Knowledge and practice of foot self-care among patients with diabetes attending primary healthcare centres in Kuwait: A cross-sectional study

BackgroundDiabetes mellitus is a major public health issue and is the main cause of morbidity and mortality worldwide. At the time of diagnosis, many patients with type 2 diabetes (T2D) have one or two risk factors for diabetic foot diseases, such as diabetic peripheral neuropathy (DPN) and diabetic foot ulcers (DFUs). Patients can overcome such complications through good knowledge and practice of foot self-care. This study aims to evaluate the knowledge and practice of foot care among patients with diabetes mellitus attending primary healthcare centres (PHCs) in Kuwait and to identify those at risk for developing DPN.MethodsA cross-sectional study was conducted using a pre-tested self-administered questionnaire. The questionnaire included questions on demographic characteristics and patients’ knowledge and practices of foot care. Adult patients (aged 21 and above) with a diagnosis of diabetes mellitus for at least 1 year were randomly selected from PHCs located in the five governorates of Kuwait. Data were analysed using SPSS, version 26.ResultsA total of 357 patients participated in this study, giving a response rate of 87.3%. The overall mean knowledge score of foot care was 12.7 ± 2.7 (equals 81.3%). Most patients (n = 283, 79.3%) showed good knowledge. In comparison, less than one-third of patients (n = 110, 30.8%) practiced good foot care. The overall mean score of patients’ practices was 55.7 ± 9.2 (equals 64.0%). Approximately 17.4% of the patients had a higher risk of developing DPN. University students had lower odds of having good knowledge about foot care [OR: 0.19 (95%CI: 0.04–0.86)]. On the other hand, patients who reported having diabetes for a long duration (10 years and above) [OR: 1.88 (95%CI: 1.11–3.18)] and patients who did not have any other comorbidities [OR: 0.49 (95%CI: 0.26–0.90)] had higher odds of having good foot care knowledge. Patients who were on oral hypoglycaemic agents (OHAs) only had lower odds [OR: 0.63 (95%CI: 0.39–1.00)] of practicing good foot care. Patients who reported having diabetes for a duration between 5 to less than 10 years [OR: 1.75 (95%CI: 1.06–2.90)] and those who are on a diet only [OR: 1.76 (95%CI: 1.06–2.94)] had higher odds of practicing good foot care. Patients who were using combination therapy with OHAs and insulin had a higher risk [OR: 2.67 (95%CI: 1.11–6.41)] of developing DPN. On the other hand, patients who reported that they did not have a previous history of foot ulcer had a lower risk of developing DPN [OR: 0.21 (95%CI: 0.09–0.47)].ConclusionThe knowledge of patients with diabetes regarding foot care is rated as good, while their self-practice is considered satisfactory. To improve the foot care knowledge and self-care practice of patients, healthcare providers (HCPs) need to support patients through educational programmes and appropriate training.     

Effectivity and safety of PD-1/PD-L1 inhibitors for different level of PD-L1-positive,advanced NSCLC: A meta-analysis of 4939 patients from randomized controlled trials

BackgroundEffective improvement for the programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors had been shown in advanced non-small cell lung cancer (NSCLC) patients compared with traditional therapy. However, we do not have ample evidences to demonstrate the safety and effectivity in the treatment of PD-L1-positive, advanced NSCLC. The relation was controversial about the expression of PD-L1 and survival outcomes of PD-1/PD-L1 inhibitors.Materials and methodsElectronic databases (PubMed, EMBASE, and the Cochrane library) and major conference proceedings were systematically searched for all clinical trials in NSCLC using PD-1/PD-L1 inhibitors. Randomized controlled trials (RCTs) were included to compare PD-1/PD-L1 inhibitors with chemotherapy in advanced NSCLC patients reporting adverse events (AEs) and immune-related AEs (irAEs). The incidence, Hazard Ratio (HR), Odds Ratio (OR), and corresponding 95% confidence interval (CI) of outcomes were calculated.ResultsA total of 4939 patients from 10RCTs were included. In the group of PD-L1 ≥ 1%, PD-L1 ≥ 5%, PD-L1 ≥ 10%, PD-L1 ≥ 50%, the HR of OS is 0.31(95%CI 0.38–0.23; p < 0.0001), 0.47(95%CI 0.82–0.12; p = 0.008), 0.85(95%CI 1.17–0.53; p < 0.0001), 0.47(95%CI 0.59–0.36; p < 0.0001) respectively. The HR of PFS is 0.13(95%CI 0.01–0.24; p = 0.027), 0.31(95%CI 0.00–0.62; p < 0.0001), 0.62(95%CI 0.30–0.93; p < 0.0001), 0.40(95% CI 0.20–0.59; p < 0.0001) respectively. In terms of summary adverse events, PD-1/PD-L1 inhibitors groups had a significant lower risks in any treat-realated AEs than chemotherapy. About irAEs, PD-1/PD-L1 inhibitors groups had a significant higher risks in irAEs than chemotherapy.ConclusionPD-1/PD-L1 inhibitors are generally effected and safer than chemotherapy for patients with PD-L1-positive, advanced NSCLC. However, PD-1/PD-L1 inhibitors can generate a unique spectrum of irAEs, and even life-threatening.     

Comparison between standard Vs. Escalated dose venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19: A two centers,observational study

IntroductionThe risk of mortality in patients with COVID-19 was found to be significantly higher in patients who experienced thromboembolic events. Thus, several guidelines recommend using prophylactic anticoagulants in all COVID-19 hospitalized patients. However, there is uncertainty about the appropriate dosing regimen and safety of anticoagulation in critically ill patients with COVID-19. Thus, this study aims to compare the effectiveness and safety of standard versus escalated dose pharmacological venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19.MethodsA two-center retrospective cohort study including critically ill patients aged ≥ 18-years with confirmed COVID-19 admitted to the intensive care unit (ICU) at two tertiary hospitals in Saudi Arabia from March 1st, 2020, until January 31st, 2021. Patients who received either Enoxaparin 40 mg daily or Unfractionated heparin 5000 Units three times daily were grouped under the “standard dose VTE prophylaxis and patients who received higher than the standard dose but not as treatment dose were grouped under ”escalated VTE prophylaxis dose“. The primary outcome was the occurance of thrombotic events, and the secondary outcomes were bleeding, mortality, and other ICU-related complications.ResultsA total of 758 patients were screened; 565 patients were included in the study. We matched 352 patients using propensity score matching (1:1). In patients who received escalated dose pharmacological VTE prophylaxis, any case of thrombosis and VTE were similar between the two groups (OR 1.22;95 %CI 0.52–2.86; P = 0.64 and OR 0.75; 95% CI 0.16–3.38; P = 0.70 respectively). However, the odds of minor bleeding was higher in patients who received escalated VTE prophylaxis dose (OR 3.39; 95% CI 1.08–10.61; P = 0.04). There was no difference in the 30-day mortality nor in-hospital mortality between the two groups (HR 1.17;95 %CI0.79–1.73; P = 0.43 and HR 1.08;95 %CI 0.76–1.53; P = 0.83, respectively).ConclusionEscalated-dose pharmacological VTE prophylaxis in critically ill patients with COVID-19 was not associated with thrombosis, or mortality benefits but led to an increased risk of minor bleeding. This study supports previous evidence regarding the optimal dosing VTE pharmacological prophylaxis regimen for critically ill patients with COVID-19.     

Opioid users with comorbid hepatitis C spent more time in agonist therapy: A 6-year observational study in Taiwan

BackgroundHepatitis C virus (HCV) infection is highly prevalent among opioid agonist therapy (OAT) patients, but little is known about long-term OAT use among this population.MethodsSubjects diagnosed as opioid dependence were recruited from Mar. 2006 to Jul. 2008 in a psychiatry center in southern Taiwan with the OAT censored in 2012, and their socio-demographics, drug use characteristics, and markers of blood-borne infection were assessed at entry. Correlates with HCV infection and OAT retention were analyzed by multivariate logistic regression. Retention (OAT utilization) was defined as the in-treatment period of OAT during the 6-year observation period.ResultsA total of 983 patients (88.3% men) were included. The prevalences of HCV and HIV infection were 91.4% and 17.9%, respectively. The mean duration of OAT during the study period was 2.3 ± 0.8 years. Significant correlates with HCV infection were retention of at least three years in OAT (AOR: 4.24, 95%CI: 1.49–12.03), ever sharing injection equipment (AOR: 227.04, 95%CI: 57.22–900.87), not living with family (AOR: 5.54, 95%CI: 1.45–21.16), lower educational attainment (AOR: 2.10, 95%CI: 1.15–3.82) and previous drug offense (AOR: 6.35, 95%CI: 1.69–23.83). Significant correlates with retention were HCV infection (AOR: 2.53, 95%CI: 1.30–4.93) and divorced or separation in marriage (AOR: 0.65, 95%CI: 0.44–0.96).ConclusionsThis six-year observational study revealed a better retention in OAT if opioid-dependent individuals had comorbid hepatitis C. This provided opportunities for OAT patients with HCV infection to obtain medical treatment while staying in an OAT program. Further research could explore the possibility of eradicating comorbid HCV infection among these long-term treatment cases.     

Factors associated with public injection and nonfatal overdose among people who inject drugs in street-based settings

Background: In 2016, BC Canada declared a public health emergency in response to increasing illicit drug overdose deaths. Previous research has shown that adverse social conditions including unstable housing and insufficient harm reduction services can exacerbate public injection and overdoses.

Methods: Cross-sectional interview data from Victoria (2008–2015) and Vancouver (2008–2012), BC (n?=?548) were analysed using multivariate logistic regression models to assess differences in risks and harms for people 19+ who inject drugs in street-based settings.

Results: Living in Victoria (OR: 5.55, 95%CI: 3.44–8.95; p?p?p?p?p?p?p?p?p?p?Conclusions: Mitigating risk environments for public injection and overdose requires attention to micro- and macro-level factors. Overall findings indicate that implementation of a supervised injection facility in Victoria would likely reduce public injection and overdoses.     

Drug use and risk behaviour profile,and the prevalence of HIV,hepatitis C and hepatitis B among people with methamphetamine use in Iran

BackgroundStimulants substances use, particularly methamphetamine use, is increasing globally, including in Iran. This study assessed the drug use and risk behaviour profile, and prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among a large population using methamphetamine as their primary drug in Iran.MethodsThis cross-sectional study was conducted in eight provinces of Iran. Individuals using methamphetamine for ≥3 months during the past three years, with no life-time history of injecting opioid drugs were enrolled. Drug use and risk behaviour data were collected through interviews. Blood samples were tested for HIV antibodies (HIV Ab), HCV antibodies (HCV Ab), and HBV surface antigen (HBs Ag).ResultAmong 567 participated, 84% were men and mean age was 36 years. Smoking with pipe was the most common method of methamphetamine use (53%), while 13% had a history of injecting methamphetamine, among whom 30% shared needles or syringes. Among those having sex during intoxication phase (n = 270), 48% never used condom. The prevalence of HIV Ab, HCV Ab and HBs Ag was 6.7% (95%CI: 4.7–9.1), 19.4% (95%CI: 16.2–22.9) and 1.4% (95%CI: 0.6–2.7), respectively. Age ≥ 30 years (adjusted OR [aOR]: 2.10, 95%CI: 1.18–3.76), lower education (high school vs. tertiary education, aOR: 13.95, 95%CI: 1.90–102.60), and injecting methamphetamine (aOR: 1.92, 95%CI 1.10–3.35) were significantly associated with HCV exposure. No factor was found associated with HIV infection. Among those reporting no potential injecting or sexual risk factors, 19.8% and 6.8% have HCV Ab positive and HIV Ab positive, respectively.ConclusionHigh prevalence of injecting and sexual risk behaviours, HIV infection and HCV exposure were found among individuals using methamphetamine as their primary drug, demonstrating them as an emerging population at risk of HIV and HCV in Iran. Targeted screening and harm reduction programs for this population are required.     

Vaping for weight control: A cross-sectional population study in England

IntroductionConcern about weight gain is a barrier to smoking cessation. E-cigarettes may help quitters to control their weight through continued exposure to the appetite-suppressant effects of nicotine and behavioural aspects of vaping. This study explored the views and practices of smokers, ex-smokers and current e-cigarette users relating to vaping and weight control.MethodsCross-sectional survey of past-year smokers (n = 1320), current smokers (n = 1240) and current e-cigarette users (n = 394) in England, conducted April–July 2018. Data were weighted to match the English population on key sociodemographic characteristics.ResultsOf e-cigarette users, 4.6% (95%CI 2.6–6.6) reported vaping for weight control, and 1.9% (95%CI 0.6–3.2) reported vaping to replace meals/snacks. It was rare for individuals who had smoked in the past year to have heard (8.8%, 95%CI 7.3–10.3) or believe (6.4%, 95%CI 5.1–7.7) that vaping could help control weight. Women (OR = 0.62, 95%CI 0.42–0.93) and older people (OR = 0.30, 95%CI 0.13–0.72) were less likely to have heard the claim and women were less likely to believe it (OR = 0.44, 95%CI 0.27–0.72). However, 13.4% (95%CI 11.3–15.5) and 13.1% (95%CI 11.0–15.2) of current smokers who did not use e-cigarettes said they would be more likely to try e-cigarettes or quit smoking, respectively, if vaping could help control their weight.ConclusionOne in 16 English people who have smoked in the last year believe that vaping would prevent weight gain after stopping. One in 22 people who vape are using e-cigarettes for this purpose. However, should evidence emerge that e-cigarettes prevent weight gain, one in eight people who smoke would be tempted to quit smoking and use e-cigarettes.     

Linezolid versus vancomycin for the treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials

This review aimed to compare data regarding the effectiveness and safety of linezolid and vancomycin in the treatment of Gram-positive bacterial infections. PubMed and other databases were searched to identify relevant randomised controlled trials (RCTs). Nine RCTs studying 2489 clinically assessed patients were included in the meta-analysis. Overall, there was no difference between linezolid and vancomycin regarding treatment success in clinically assessed patients [odds ratio (OR) = 1.22, 95% confidence interval (CI) 0.99–1.50]. Linezolid was more effective than vancomycin in patients with skin and soft-tissue infections (OR = 1.40, 95% CI 1.01–1.95). However, there was no difference in treatment success for patients with bacteraemia (OR = 0.88, 95% CI 0.49–1.58) or pneumonia (OR = 1.16, 95% CI 0.85–1.57). Linezolid was associated with better eradication rates in all microbiologically assessed patients compared with vancomycin (OR = 1.33, 95% CI 1.03–1.71). There was no difference in total adverse effects possibly or probably related to the study drugs (OR = 1.14, 95% CI 0.82–1.59). However, nephrotoxicity was recorded more commonly in patients receiving vancomycin (OR = 0.31, 95% CI 0.13–0.74). In conclusion, linezolid is as effective as vancomycin in patients with Gram-positive infections. There is superior clinical and microbiological outcome with linezolid in complicated skin and soft-tissue infections caused by Staphylococcus aureus.     

The use of ceftolozane-tazobactam in the treatment of complicated intra-abdominal infections and complicated urinary tract infections—A meta-analysis of randomized controlled trials

ObjectiveThe aim of this study was to assess the clinical efficacy and safety of ceftolozane-tazobactam in the treatment of complicated intra-abdominal infections (cIAIs) and complicated urinary tract infections (cUTIs) in adult patients through meta-analysis.MethodsPubMed, Embase and Cochrane databases were searched up to June 2019. Only randomized controlled trials (RCTs) that evaluated ceftolozane-tazobactam and comparators for treating cIAIs and cUTIs in adult patients were included. Primary outcome was clinical cure rate; secondary outcomes were clinical failure rate, microbiological eradication rate, and risk of an adverse event (AE).ResultsThree RCTs were included. Overall, ceftolozane-tazobactam had a clinical cure rate similar to comparators in the microbiological intent-to-treat (mITT) population (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.43–1.79; I² = 73%) and in the clinically evaluable (CE) population (OR, 1.22; 95% CI, 0.79–1.88; I² = 0%). Furthermore, ceftolozane-tazobactam had a similar microbiological eradication rate for pathogens (OR, 1.31; 95% CI, 0.42–4.10; I² = 37%). There were no significant differences in the risks of treatment-emergent AEs (OR, 1.04; 95% CI, 0.87–1.23; I² = 0%), serious AEs (OR, 1.16; 95% CI, 0.67–1.99; I² = 37%), discontinuation of study drug due to an AE (OR, 0.77; 95% CI, 0.17–3.47) and mortality (OR, 1.62; 95% CI, 0.69–3.77, I² = 0%) between ceftolozane-tazobactam and comparators.ConclusionsThe clinical efficacy of ceftolozane-tazobactam is as high as that of comparators in the treatment of cIAIs and cUTIs in adult patients, and this antibiotic is well tolerated.     

Cognitive function and blood pressure control in hypertensive patients over 60 years of age: COGNIPRES study

ABSTRACT

Background and aims: The aim of the COGNIPRES study was to analyze the prevalence of cognitive impairment in hypertensive individuals over 60 years of age, treated in primary care centres in the context of routine clinical practice. Degree of blood pressure control and treatment compliance, as well as other possible factors that influence cognitive function, were also evaluated.

Methods: An epidemiological, multicentre cross-sectional study was made. Demographic, clinical, therapeutic and blood pressure data for the first three hypertensive patients aged over 60 years seen in the primary care centre, and for the first patient visited at home by the physician were recorded. The study was carried out by 477 physicians in 333 primary care centres throughout Spain. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE), and therapeutic compliance was assessed using the Haynes-Sacket and Morisky-Green tests.

?Results: Of 1579 patients included in the study, 12.3% (95%CI 10.7–14.0) (n = 195) had cognitive impairment. This was significantly associated with patients over 80 years of age (OR 4.97; 95%CI 2.98–8.29), exclusive home care (OR 1.84; 95%CI 1.19–2.83), anxiety (OR 1.84; 95%CI 1.19–2.83), stroke or transient ischemic attack (OR 4.37; 95%CI 2.81–6.78), Parkinson's disease (OR 8.15; 95%CI 2.54–26.12), essential tremor (OR 2.25; 95%CI 1.34–3.79), uncontrolled blood pressure (OR 0.60; 95%CI 0.39–0.94) and poor treatment compliance (OR 0.53; 95%CI 0.37–0.75). Overall, 28.3% of the patients showed controlled blood pressure, and 33.6% showed poor adherence to antihypertensive treatment.

Conclusions: In this study, the prevalence of cognitive impairment in hypertensive patients aged over 60 years was 12.3%. Less than a third of the patients had good blood pressure control. Compliance with therapy and good control of blood pressure are associated with better MMSE scores.     

Acute generalized exanthematous pustulosis with a focus on hydroxychloroquine: A 10-year experience in a skin hospital

ObjectiveAcute generalized exanthematous pustulosis (AGEP) is a severe skin pustular drug reaction that can lead to life-threatening consequences. In this study, we have investigated the characteristics and outcomes of patients with AGEP in a tertiary skin hospital.MethodsFrom March 2007 to December 2019, medical records of all patients diagnosed with AGEP, were assessed. Demographic data, culprit drug, past medical history, laboratory tests, recurrence, and systemic organ involvement were all documented as well.ResultsSeventy-four patients, including 54 women (73%) and 20 men (27%), with a mean age of 44.3 ± 16.5 years were evaluated. The most common comorbidities among the patients were rheumatoid arthritis and diabetes. In addition, hydroxychloroquine, cephalosporin, and amoxicillin were found as the three most common medications associated with AGEP induction. Among the study group, seventeen (23%) patients had systemic organ involvement (nine (12.2%), six (8.1%), and five (6.8%) had hepatic, renal and pulmonary involvement, respectively). All patients responded to oral prednisolone within a median of five days (IQR = 4; ranged 2–14). The median duration of treatment was significantly longer in hydroxychloroquine group compared to other drugs (8 versus 5 days; HR 0.57,95%CI 0·35–0.91). Likewise, the median duration of treatment was significantly longer in febrile patients compared to the afebrile ones (7 versus 4 days; HR 0.46, 95%CI 0.25–0.85). Recurrence occurred in six patients after resuming treatment with the same medication. The mean Naranjo score was 7.6 ± 0.9 denoting a probable causal relationship.ConclusionIn this study, we found that using hydroxychloroquine and presence of fever are the risk factors potentially leading to a prolonged treatment duration of AGEP.     

β-lactam antibiotics vs. vancomycin for the early treatment of enterococcal bacteraemia: A retrospective cohort study

BackgroundThe efficacy of vancomycin compared with ampicillin for enterococcal infections is unknown. This study aimed to compare their efficacy among patients with enterococcal bacteraemia.MethodsRetrospective cohort study including adults aged >16 years with enterococcal bacteraemia, treated with β-lactam antibiotics active against Enterococcus spp. or vancomycin. Treatment classification was based on the first antibiotic used for >4 days in the 7 days after blood culture collection. Subgroup analyses for patients with penicillin-susceptible enterococcal bacteraemia and patients with monomicrobial penicillin-susceptible enterococcal bacteraemia were performed. The dependent variable was 30-day all-cause mortality. The propensity score (PS) for vancomycin treatment was calculated. Univariate and multi-variate analyses adjusted for PS were performed.ResultsIn total, 516 patients with enterococcal bacteraemia were included. Mortality was similar for patients treated with β-lactams (123/315, 39%) and vancomycin (82/201, 40.8%). Independent factors significantly associated with mortality included healthcare-associated or hospital-acquired infection, age, female sex, Charlson Comorbidity Index, dialysis, SOFA score and low albumin. After adjustment for these factors and PS, the odds ratio (OR) for death in patients treated with vancomycin was 0.95 [95% confidence interval (CI) 0.56–1.59]. Results were similar among patients with penicillin-susceptible enterococcal bacteraemia and patients with monomicrobial penicillin-susceptible enterococcal bacteraemia (n=237, adjusted OR 0.59, 95% CI 0.25–1.43).ConclusionNo difference in mortality was observed following treatment with a β-lactam or vancomycin among patients with enterococcal bacteraemia. Vancomycin is not recommended for the treatment of penicillin-susceptible enterococcal infections; however, when needed, it is not inferior to β-lactams and the addition of a β-lactam is not necessary.     

Meta-analysis of the incidence and risk of arterial and venous thromboembolic events associated with anti-EGFR agents in non-small-cell lung cancer patients

Background: To determine the risk of arterial and venous thromboembolic events (ATEs and VETs) associated with anti-epidermal growth factor receptor (EGFR) agents in non-small-cell lung cancer (NSCLC) patients.

Methods: Prospective randomized trials evaluating therapy with or without anti-EGFR agents in NSCLC patients. Data on VTEs and ATEs were extracted.

Results: A total of 8,410 patients from 12 trials were included for analysis. Anti-EGFR agents significantly increased the risk of all-grade and high-grade VTEs (Peto OR 1.50, 95%CI 1.16–1.95, P = 0.002; Peto OR 1.73, 95%CI: 1.32–2.26, p < 0.001, respectively), but not for all-grade and high-grade ATEs.

Conclusion: The use of anti-EGFR agents significantly increased the risk of all-grade and high-grade VTEs but not for ATEs in NSCLC patients.     

The efficacy and safety comparison between tenofovir and entecavir in treatment of chronic hepatitis B and HBV related cirrhosis: A systematic review and Meta-analysis

BackgroundThe purpose of this study was to assess the efficacy and safety between tenofovir and entecavir in the treatment of CHB and HBV related cirrhosis through Meta-analysis. MethodsThe electronic databases of PubMed, the Cochrane Library, Nature, CNKI and WanFang data were searched. The key words were: (“tenofovir”, “entecavir”) and (“Chronic Hepatitis B” or “CHB”) and “Liver cirrhosis”. Heterogeneity and report bias were analyzed.ResultsThere was significant difference of ALT norm level in the short-term period of 3 months (RR = 1.43, 95%CI: 1.06–1.94, P < 0.017) and 6 months (RR = 0.89, 95%CI: 0.81–0.97, P < 0.017), and significant difference of undetectable HBV-DNA only in 3 months follow-up period (RR = 1.59, 95%CI: 1.04–2.42, P < 0.017) between TDF and ETV, but no significant difference in the long-term period. There is significant difference between TDF and ETV in eGFR level (RR = 1.601, 95%CI: 1.035–2.478, P = 0.0034) and hypophosphatemia incidence (RR = 4.008, 95%CI: 1.485–10.820, P = 0.006).ConclusionTDF has a better efficacy than ETV in 3 months treatment duration, but intriguingly, TDF might not better than ETV during the 6 months treatment period in the viral suppression and liver function improvement. There's no significant difference between TDF and ETV in the long-term treatment duration and in the treatment of HBV related liver cirrhosis. Both TDF and ETV could influence renal function but patients under TDF therapy may have more risk to suffer from renal damage and hypophosphatemia.     

Causes of vancomycin dosing error; problem detection and practical solutions; a retrospective,single-center,cross-sectional study

Vancomycindosing error and inappropriate monitoring is a common problem in hospital daily practice. In King Abdulaziz Medical City (KAMC) in Jeddah, a high percentage of abnormal vancomycin trough levels is still detected despite using the recommended dose. Therefore, the current research objective is to study the major causes of vancomycin dosing errors. This retrospective, single-center, cross-sectional study was carried out at KAMC hospital in Jeddah from January 1st until December 31st 2019. All adult patients (≥15 years) who received vancomycin and had an initial abnormal trough level at the measured steady-state were included in this study. 472 patients have met the study inclusion criteria.The current study evaluated the factors that play a role in causing vancomycin trough level abnormalities such as sampling time, vancomycin dosing, and patient’s pharmacokinetic and pharmacodynamic variations.In this study, we found that pharmacokinetic and pharmacodynamic variability was attributed to 65% of vancomycin's abnormal trough level. Also, the result showed a significantly increased odds of the low trough in the non-elderly group (OR 6, 95% CI 2.48 – 14.9, P < 0.001) and febrile neutropenic patients (OR 2.21, 95% CI 1.119 – 4.365, P < 0.05). However, the odds of high trough levels were significantly elevated among patients who have CrCl < 50 ml/min (OR 5, 95% CI 1.262–20.539, P < 0.05). In addition, the present investigation revealed that the occurrence of abnormal vancomycin levels was not affected by daily duty time or working days (p > 0.05). The current study indicated that vancomycin dosing errors were common in KAMC patients; thus, there is an unmet need to evaluate the causes of vancomycin abnormal trough level and optimize a strategy that would enhance the therapeutic effectiveness and minimize the potential toxicity.     

The effect of oseltamivir use in critically ill patients with COVID-19: A multicenter propensity score-matched study

BackgroundOseltamivir has been used as adjunctive therapy in the management of patients with COVID-19. However, the evidence about using oseltamivir in critically ill patients with severe COVID-19 remains scarce. This study aims to evaluate the effectiveness and safety of oseltamivir in critically ill patients with COVID-19.MethodsThis multicenter, retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care unit (ICU). Patients were categorized into two groups based on oseltamivir use within 48 hours of ICU admission (Oseltamivir vs. Control). The primary endpoint was viral load clearance.ResultsA total of 226 patients were matched into two groups based on their propensity score. The time to COVID-19 viral load clearance was shorter in patients who received oseltamivir (11 vs. 16 days, p = 0.042; beta coefficient: −0.84, 95%CI: (−1.33, 0.34), p = 0.0009). Mechanical ventilation (MV) duration was also shorter in patients who received oseltamivir (6.5 vs. 8.5 days, p = 0.02; beta coefficient: −0.27, 95% CI: [−0.55,0.02], P = 0.06). In addition, patients who received oseltamivir had lower odds of hospital/ventilator-acquired pneumonia (OR:0.49, 95% CI:(0.283,0.861), p = 0.01). On the other hand, there were no significant differences between the groups in the 30-day and in-hospital mortality.ConclusionOseltamivir was associated with faster viral clearance and shorter MV duration without safety concerns in critically ill COVID-19 patients.     

Comparing torsemide versus furosemide in patients with heart failure: A meta-analysis

ObjectivesTo compare the efficacy and safety of torsemide versus furosemide in patients with heart failure (HF).Data sourcesMedline, Cochrane Library, Web of Science, and Google Scholar database searches for relevant articles from 1946 to May 2018 were performed with the use of the key words torsemide and furosemide.Study selectionStudies were included if they met the following criteria: (1) cohort studies or randomized controlled trials of adult patients 18 years of age or older who received oral torsemide or furosemide for HF with reduced or preserved ejection fraction; and (2) studies that reported mortality rate, rehospitalization rate for HF or cardiovascular disease (CVD), or New York Heart Association (NYHA) functional class changes.Data extractionEfficacy outcomes were mortality from any cause, rehospitalization for HF, rehospitalization for CVD, and NYHA functional class improvement. Safety outcome included hypokalemia.ResultsIn the 5 included studies, there was no significant difference in mortality between torsemide and furosemide (odds ratio [OR] 1.00, 95% CI 0.58–1.72; P = 0.99; I² = 79%). There was no significant difference in rehospitalization rates for HF (OR 0.79, 95% CI 0.57–1.09; P = 0.15; I² = 64%) or CVD (OR 0.83, 95% CI 0.62–1.12; P = 0.22; I² = 40%) between torsemide- and furosemide-treated patients. The use of torsemide was associated with significant improvement in NYHA functional class compared with furosemide (OR 1.44, 95% CI 1.18–1.76; P = 0.0004; I² = 0%).ConclusionOur meta-analysis showed that torsemide is associated with statistically significant improvement in NYHA functional class for patients with HF compared with furosemide. However, torsemide did not provide significant benefits in reducing mortality or rehospitalization rates for HF or CVD compared with furosemide. The authors suggest switching from furosemide to torsemide in patients with HF not achieving symptomatic control with the use of furosemide despite maximizing guideline-directed medical therapy and furosemide dosing.     

Prognostic and clinicopathological utility of PD-L2 expression in patients with digestive system cancers: A meta-analysis

ObjectiveProgrammed death ligand-2 (PD-L2) has been detected in various cancers. However, its prognostic value in digestive system cancers (DSCs) remains unclear. Accordingly, this meta-analysis investigated the prognostic and clinicopathological utility of PD-L2 in patients with DSCs.MethodsWe systematically searched PubMed, EMBASE, Web of Science, ClinicalTrials.gov., Scopus, and Cochrane Library databases for eligible studies up to April 30, 2020. The hazard ratio (HR), odds ratio (OR), and corresponding 95% confidence interval (CI) of the outcomes were calculated.ResultsTwenty two studies with 4886 patients were included in this meta-analysis. The pooled results showed that PD-L2 overexpression was significantly associated with poor overall survival (OS) (HR 1.470, 95% CI: 1.252–1.728, p < 0.001) and worse disease-free survival (DFS) (HR1.598, 95% CI: 1.398–1.826, p < 0.001). Subgroup analysis revealed that elevated PD-L2 was a significant prognostic indicator of worse OS in hepatocellular carcinoma (HR 1.703, 95% CI: 1.456–1.991, p < 0.001) and colorectal cancer (HR 3.811, 95% CI: 1.718–8.454, p = 0.001). Concerning clinicopathologic factors, PD-L2 overexpression was associated with lymphatic metastasis (OR 1.394., 95% CI: 1.101–1.764, p = 0.006), tumor metastasis (OR 1.599, 95% CI: 1.072–2.383, p = 0.021), and the histopathological stage (OR 0.704, 95% CI: 0.566–0.875, p = 0.002).ConclusionPD-L2 overexpression in DSCs after surgery might predict a poor prognosis, especially in hepatocellular carcinoma and colorectal cancer. Larger patient cohorts are needed to validate its prognostic role.     

Exploring the drug-induced anemia signals in children using electronic medical records

ABSTRACT

Objectives: The objectives were to identify drugs related with anemia in children and evaluate the novelty of these correlations.

Methods: The authors established a two-step method for detecting the relationship between drugs and anemia using electronic medical records (EMRs), which were obtained from 247,136 patients in Beijing Children’s Hospital between 2007 and 2017. The authors extracted potential drugs by mining cases for hemoglobin abnormalities from the EMR and then performed a retrospective cohort study to correlate them with anemia by calculating the matched odds ratios and 95% confidence interval using unconditional logistic regression analysis.

Results: In total, nine positive drug-anemia associations were identified. Among them, the correlations of drugs fluconazole (OR 3.95; 95%CI: 2.65–5.87) and cefathiamidine (OR 3.49; 95%CI: 2.94–4.15) with anemia were considered new signals in both children and adults. Three associations of drugs, vancomycin, cefoperazone-sulbactam and ibuprofen, with anemia were considered new signals in children.

Conclusion: The authors detected nine signals of drug-induced anemia, including two new signals in children and adults and three new signals in children. This study could serve as a model for using EMR and automatic mining to monitor adverse drug reaction signals in the pediatric population.