Ann Intern Med Research Articles

Guidelines for the assessment and management of addiction in the hospitalized patient with opioid use disorder: a twenty-first century update.

While there have been many articles published on managing the medical sequelae of opioid use disorder in specific patient populations or settings, there is a dearth of literature on assessing and managing opioid use disorder in the acute hospital setting. In 1975, Fultz and Senay published proposed guidelines on the management of what they called the "hospitalized narcotic addict" Fultz and Senay (Ann Intern Med 82(6):815-818, 1975). Since then, many new developments in the treatment of opioid use disorder have occurred. In our experience, services in the acute inpatient hospital turn to psychiatric consultation teams for recommendations on how to manage these complicated and, sometimes, difficult patients. This article serves to provide the internal medicine physician a foundation of understanding how to address the main issues in hospitalized patients with opioid use disorder on a general medical or surgical floor.

Asians and Asian Subgroups are Underrepresented in Medical Research Studies Published in High-Impact Generalist Journals.

Including diverse participants in biomedical research is essential to reduce health disparities. Weassessed the inclusion of Asians in original research studies conducted in North America and published from 2015-2016in sixhigh-impact generalist journals: New England Journal of Medicine, Journal of the American Medical Association (JAMA), JAMA Internal Medicine, JAMA Pediatrics, Annals of Internal Medicine, and Pediatrics. We determined race reporting method, participant percentage, and reporting of outcomes or implications of findings for Asians and Asian subgroups. Of 1077 studies, 263 articles (24.4%) identified Asians as a distinct race/ethnicity; the median percentage of Asians per study was 3.8%. Of the 263 articles, 28 (10.6%) studies reported outcomes for Asians; nine (3.4%) articles included information about Asian subgroups. Asians are underrepresented in high-impact medical research studies in North America. Efforts to improve study enrollment, data collection, and reporting of findings of Asians in studies remain essential to improve health outcomes for this population.

Uptake of core outcome sets by clinical trialists publishing in major medical journals: Protocol.

Background: Outcome heterogeneity, selective reporting, and choosing outcomes that do not reflect needs and priorities of stakeholders, limit the examination of health intervention effects, particularly in late phase trials. Core outcome sets (COS) are a proposed solution to these issues. A COS is an agreed-upon, standardised set of outcomes that should be measured and reported as a minimum in all trials in a specific area of health or healthcare. COS are intended to increase standardisation of outcome measurement and reporting to better enable comparisons between, and synthesis of findings of trials in a particular health area. Methods: This study will examine late phase trials, published between October 2019 and March 2020 (inclusive), in the following five medical journals: New England Journal of Medicine, Journal of the American Medical Association, Lancet, BMJ, and Annals of Internal Medicine. Trials will be examined to determine if they refer to a COS, and whether they use a COS. Trialists for each identified trial will subsequently be contacted to complete an online survey examining trialists' awareness of, and decisions to search for and use a COS. Discussion: This study will provide important information on uptake of COS by later phase trialists in major medical journals, and the views of these trialists on COS use in trials. These findings will inform approaches to increasing awareness and uptake of COS in future health trials.

Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study

Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study

COVID-19 vasculitis and novel vasculitis mimics.

COVID-19 has been occasionally linked to histologically confirmed cutaneous vasculitis and a Kawasaki-like vasculitis, with these entities generally having minimal or no lung involvement and a good prognosis. Unlike these vasculitis types, patients with severe COVID-19 pneumonia can develop cutaneous vasculitis-like lesions and systemic arterial and venous thromboemboli, including cryptogenic strokes and other vasculopathy features. Proposed underlying mechanisms for these severe manifestations have encompassed immune dysregulation, including an anti-phospholipid syndrome-like state, complement activation, viral dissemination with direct systemic endothelial infection, viral RNAaemia with immunothrombosis, clotting pathway activation mediated by hypoxaemia, and immobility. In this Viewpoint, we highlight how imaging and post-mortem findings from patients with COVID-19 indicate a novel thrombosis in the pulmonary venous territory distal to the alveolar capillary bed, a territory that normally acts as a clot filtration system, which might represent an unappreciated nidus for systemic microembolism. Additionally, we suggest that this mechanism represents a novel vasculitis mimic related to COVID-19 that might lead to cryptogenic strokes across multivessel territories, acute kidney injury with haematuria, a skin vasculitis mimic, intestinal ischaemia, and other organ ischaemic manifestations. This finding is supported by pathological reports of extensive pulmonary venular thrombosis and peripheral organ thrombosis with pauci-immune cellular infiltrates. Therefore, severe COVID-19 pneumonia with extensive pulmonary intravascular coagulopathy might help to explain the numerous systemic complications of COVID-19, in which the demonstration of direct organ infection has not adequately explained the pathology.

Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis.

Comprehensive patient education is necessary for shared decision-making. While patient–provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from Annals of Internal Medicine were the most readable (P < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients’ understanding of their disease processes and treatment options.

Top-cited Articles in Primary Aldosteronism: A Bibliometric Analysis

Background: The objective of this study was to identify the top 100 cited articles in primary aldosteronism, and examine their characteristics. Methods: Science Citation Index Expanded database was utilized to search for the top 100 cited articles published since 1900. Articles were evaluated for several characteristics, including the number of citations, authorship, country and institution of origin, publication year, journal, and study design. Results: The top 100 articles were cited between 88 and 762 times, with a median of 130. The articles were published between 1955 and 2012, with the majority of the primary aldosteronism publications (n=35) being published between 2000 and 2009. The biggest number of the top 100 cited articles (n=19) were published in the <i>Journal of Clinical Endocrinology Metabolism</i>, followed by <i>Hypertension</i> (n=9), <i>Annals of Internal Medicine </i>(n=6), and<i> Archives of Internal Medicine</i> (n=6). The United States and Italy had the most publications, whereas University of Michigan and University of Padua were the top two institutions. Observational studies were the most popular article type, followed by reviews and basic science. The impact factor of a journal was not correlated with the number of top-cited articles it published. Furthermore there was no correlation between the number of citations and the number of years since publication, authors, participating institutions, or countries involved. Conclusion: These findings will assist researchers in quickly identifying the most significant advances in the field of primary aldosteronism, as well as deciphering the characteristics of top-cited articles in this subject, and laying a basis for further research.

In adults with hypertension, more- vs. less-intensive BP-lowering treatment reduces orthostatic hypotension.

Juraschek SP, Hu JR, Cluett JL, et al. Effects of intensive blood pressure treatment on orthostatic hypotension: a systematic review and individual participant-based meta-analysis. Ann Intern Med. 2020. [Epub ahead of print.] 32909814.

Uptake of core outcome sets by clinical trialists publishing in major medical journals: Protocol

Background: Outcome heterogeneity, selective reporting, and choosing outcomes that do not reflect needs and priorities of stakeholders, limit the examination of health intervention effects, particularly in late phase trials. Core outcome sets (COS) are a proposed solution to these issues. A COS is an agreed-upon, standardised set of outcomes that should be measured and reported as a minimum in all trials in a specific area of health or healthcare. COS are intended to increase standardisation of outcome measurement and reporting to better enable comparisons between, and synthesis of findings of trials in a particular health area. Methods: This study will examine late phase trials, published between October 2019 and March 2020 (inclusive), in the following five medical journals: New England Journal of Medicine, Journal of the American Medical Association, Lancet, BMJ, and Annals of Internal Medicine. Trials will be examined to determine if they refer to a COS, and whether they use a COS. Trialists for each identified trial will subsequently be contacted to complete an online survey examining trialists’ awareness of, and decisions to search for and use a COS. Discussion: This study will provide important information on uptake of COS by later phase trialists in major medical journals, and the views of these trialists on COS use in trials. These findings will inform approaches to increasing awareness and uptake of COS in future health trials.

Особенности вязко-эластических свойств сгустка крови и проявления геморрагического синдрома при тромбоцитопении у онкогематологических больных

Введение. Тромбоцитопения является частым осложнением онкогематологических заболеваний, которое провоцирует развитие геморрагического синдрома. Уровень тромбоцитов в периферической крови, являющийся пороговым для переливания концентрата тромбоцитов (КТ), окончательно не установлен. Применение тромбоэластографии (ТЭГ) при тромбоцитопениях у онкогематологических больных может повысить прогностические возможности определения риска кровотечений. Цель исследования: оценить вязко-эластические свой ства сгустка крови при тромбоцитопении менее 50×109/л и их взаимосвязь с проявлениями геморрагического синдрома у онкогематологических больных. Материалы и методы. В исследование включено 84 пациента с гемобластозами и тромбоцитопенией менее 50×109/л, 54 (64%) мужчины и 30 (36%) женщин, медиана возраста — 54 года. В зависимости от уровня тромбоцитов в периферической крови пациентов разделили на 2 группы: группа 1 — 44 пациента с числом тромбоцитов от 25 до 50×109/л, группа 2 — 40 больных с содержанием тромбоцитов менее 25×109/л. Исследовали показатели периферической крови, коагулограммы и ТЭГ. Степень тяжести кровотечений оценивали по шкале проявлений геморрагического синдрома (ВОЗ) и по шкале оценки побочных явлений Национального института рака (США). Результаты. Гипокоагуляция по ТЭГ в группе 1 выявлена в 46% случаев, в группе 2 — в 75%. Значимые межгрупповые различия показателей ТЭГ получены только в отношении максимальной амплитуды. Геморрагический синдром в группе 1 диагностирован у 6 (13%) пациентов, в группе 2 — у 14 (35%). Однако предиктивная роль влияния количества тромбоцитов на частоту развития геморрагического синдрома не установлена (β = 0,016; p = 0,92). Сочетание тромбоцитопении и гипокоагуляции по ТЭГ проявлялось в виде геморрагического синдрома в 3,3 раза чаще, чем без гипокоагуляции (RR = 3,3; 95% ДИ = 1,20–9,05). В ряде случаев основанная на результатах ТЭГ трансфузионная тактика позволила избежать переливания КТ при инвазивных манипуляциях у больных с тромбоцитопенией менее 25 × 109 / л. Заключение. Глубина тромбоцитопении не является надежным предиктором геморрагического синдрома. Применение ТЭГ у пациентов с тромбоцитопенией позволяет оптимизировать трансфузионную тактику, избежав ненужных переливаний КТ. Сочетание тяжелой тромбоцитопении с гипокоагуляцией по данным ТЭГ служит показанием для профилактических трансфузий КТ. Background. Thrombocytopenia is a frequent complication of hemoblastosis that causes hemorrhagic syndrome. The threshold of peripheral blood platelet count for transfusion of platelet concentrate is discussed. Thromboelastography (TEG) can be considered as additional prognostic method for bleeding risk assessment in thrombocytopenic patients with leukemia. Objectives: to study changes in the viscoelastic properties of blood clot in hemoblastosis patients with thrombocytopenia less than 50×109/L and their relationship with the manifestations of hemorrhagic syndrome. Patients/ Methods. The study included 84 hemoblastosis patients — 54 (64%) men и 30 (36%) women with thrombocytopenia less than 50 × 109/L, median age — 54 years. All patients are divided into 2 groups according to the platelet count: Group 1 — 25–50×109/L, Group 2 — less than 25×109/L. Peri pheral blood counts, TEG and coagulogram parameters were evaluated in both groups. Manifestations of hemorrhagic syndrome were assessed according to the WHO bleeding scale and Common terminology criteria for adverse events of the National Cancer Institute (USA). Results. Hypocoagulation according TEG in Group 1 was found in 46% of cases, in Group 2 — in 75%. Significant intergroup differences in TEG parameters were obtained only in maximum amplitude. Hemorrhagic syndrome in Group 1 diagnosed in 6 (14%) patients, in Group 2 — in 14 (35%). There was no dependence of hemorrhagic syndrome frequency on the severity of thrombocytopenia (β = 0.016; p = 0.92). The combination of thrombocytopenia and hypocoagulation according TEG manifested as a hemorrhagic syndrome 3.3 times more often than without hypocoagulation (RR = 3.3; 95% CI = 1.20–9.05). In some cases, TEG-based transfusion tactics allowed to avoid unnecessary platelet concentrate transfusion during invasive procedures in patients with thrombocytopenia less than 25 × 109/L. Conclusions. Severity of platelet depletion is not accuracy predictor for hemorrhagic events. Use of TEG in patients with thrombocytopenia allows to optimize the transfusion tactics and to avoid unnecessary platelet concentrate transfusions. The combination of severe thrombocytopenia with hypocoagulation according TEG serves as indication for prophylactic platelet concentrate transfusion.

Turmeric for knee pain

Turmeric may be an effective analgesic in treating chronic knee pain, according to a randomized, clinical study published on September 15 in the Annals of Internal Medicine. Turmeric is already well known for its anti-inflammatory properties and is a common spice traditionally and widely used in India. Turmeric contains the phytochemical curcumin, which not only gives curry and mustard that unmistakable golden color but also has caused turmeric to score as the most anti-inflammatory food on the Dietary Inflammatory Index. Available as a dietary supplement, turmeric's antioxidant and anti-inflammatory properties may address numerous health conditions, including arthritis. Turmeric's therapeutic potential originates from curcumin's mediation of inflammatory enzyme expression. Curcumin regulates numerous signaling molecules, including pro-inflammatory cytokines, apoptotic proteins, NF–κB, cyclooxygenase-2, 5-LOX, STAT3, C-reactive protein, prostaglandin E2, prostate-specific antigen, adhesion molecules, phosphorylase kinase, transforming growth factor-β, triglyceride, ET-1, creatinine, HO-1, AST, and ALT in human participants. Curcumin also downregulates cyclin D1, cyclin E, and MDM2. According to the National Institutes of Health, turmeric and curcumin have a variety of interesting biological activities, but they’re challenging to study because curcumin is unstable and has low bioavailability when it's taken orally. In addition, curcumin products may differ in composition or contain more substances than expected, which makes the results of research on these products difficult to understand and compare. The most common type of arthritis, osteoarthritis (OA), has no cure, and treatments such as exercise, weight loss, and pain relievers are not always effective. Often, patients with OA look for dietary or natural alternatives to anti-inflammatory drugs. Several studies have evaluated turmeric (Curcuma longa) and curcumin for treatment of arthritis. In one recent study, the researchers randomly assigned 70 patients with painful knee OA and knee effusion or synovitis to receive placebo or 1,000 mg of C. longa capsules daily for 12 weeks. Primary outcomes of knee pain changes were measured on a visual analogue scale, and effusion–synovitis volume was measured by MRI. While the C. longa group showed a statistically significant, but modest, reduction in pain over the placebo group, there was no significant difference between groups for change in effusion–synovitis volume or cartilage composition on MRI. In addition, no differences were reported in the incidence of adverse events. This study indicates that while C. longa may not impact joint effusion, it may help reduce knee pain. While these results are promising, limitations to the study include small sample size and short duration. The authors noted that larger, longer-term studies are needed to assess clinical significance of C. longa in inflammatory knee OA. Clinical trials have established the safety and tolerability of turmeric at high doses and indicate that 500 mg to 2,000 mg per day may be effective. The average Indian diet provides around 2,000 mg of turmeric per day, and WHO recommends an acceptable daily intake of 1.4 mg per pound of body weight. Turmeric can be added to the diet as a supplement, as tea, or in meals. NIH warns that turmeric supplements have low bioavailability and need fat or heat to enhance absorption. Combining turmeric with black pepper or ginger, or coconut milk or other fats, enhances bioavailability. Most turmeric supplements contain 1,000 mg of the spice along with 5 mg of black pepper. Advise patients that turmeric and curcumin are safe in recommended amounts when taken orally or applied to the skin. While there are no reported adverse effects and many potential health benefits, turmeric should not replace conventional therapy for OA. Caution pregnant or breastfeeding women as well as patients who have gallstones or are susceptible to kidney stones to moderate their turmeric consumption and not to exceed amounts commonly found in food.

Understanding Parental Health Literacy for Clean and Healthy Behavior in Early Childhood During the Covid-19 Pandemic

In the COVID-19 pandemic scenario, parents need to be familiar with health literacy by applying clean and healthy living habits to their family members, especially those with early childhood. This study aims to explain parents' perceptions of health literacy for a clean and healthy behavior in their children during the COVID-19 pandemic. The method used in this study is a cross-sectional study involving 22 men and 62 female respondents. Respondent requirements were used in data analysis to determine parents' perceptions of health literacy and the efforts they have made to practice clean and healthy lifestyle in their children. The research findings show that knowing the health awareness of parents has an impact on a child's balanced lifestyle. Based on six measures of clean and healthy behavior for children, three indicators were determined in the category of discipline and high discipline: using clean water, using the toilet, and doing physical activity. The act of washing children's hands with soap indicators has a high discipline score and the use of masks in children has low discipline. If the use of masks is not disciplined by parents, exposure to COVID-19 in early childhood can be disrupted.&#x0D; Keywords: Early Childhood, Parental health literacy, Clean and healthy behaviors&#x0D;

Early breast cancer screening in childhood cancer survivors treated with chest radiation may reduce deaths by more than 50.

The early initiation of annual breast cancer screening with magnetic resonance imaging (MRI) among survivors of childhood cancer who have been treated with chest radiation may reduce their breast cancer mortality risk by at least 50% according to a new study published in the Annals of Internal Medicine.1 Girls who receive chest radiation for childhood cancer are at increased risk for breast cancer. Indeed, research suggests that as many as 30% develop the disease by the age of 50 years. Nonetheless, there are various schools of thought regarding how and when to monitor for the disease in these survivors. In an effort to determine the best screening strategies for this population, investigators used modeling to compare the results of different strategies. Corresponding author Jennifer Yeh, PhD, an assistant professor of pediatrics at Harvard Medical School and an associate scientific researcher in the Division of General Pediatrics at Boston Children's Hospital, and colleagues across the country used 2 breast cancer simulation models that were developed to guide screening recommendations for non–breast cancer survivors. The models are part of the Cancer Intervention and Surveillance Modeling Network and were adapted with information from the Childhood Cancer Survivor Study, a cohort study following outcomes in more than 24,000 survivors of childhood and adolescent cancers. One study limitation was that the data came from childhood cancer survivors diagnosed between 1970 and 1986. Cancer treatment has evolved since then to incorporate decreased doses and improved delivery of radiation as well as digital mammography screening. Nonetheless, results show that early screening can save lives, Dr. Yeh says.

Women's Preventive Services Initiative recommends screening women for anxiety.

Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: a recommendation from the Women's Preventive Services Initiative. Ann Intern Med. 2020;173:48-56. 32510990.

Publication Non Grata: The Challenge of Publishing Non-COVID-19 Research in the COVID Era.

Objectives: We aimed to determine publication trends in leading clinical research journals (impact factor >20) during the rise of the coronavirus disease 2019 (COVID-19) pandemic and to check for an increase in publication times of non-COVID-19 original research articles.Methods: We collected publication data from five print-based medical journals and one online journal--JAMA: The Journal of the American Medical Association, The Lancet (Lancet), The New England Journal of Medicine, Annals of Internal Medicine, The BMJ (BMJ), and BMC Medicine (BMC Med)--for the December 2019 through May 2020 period. We categorized each article as either "COVID-19-related" or "non-COVID-19-related". When available, we further extracted data on submission-to-acceptance dates and acceptance-to-publication dates for original research articles for the January through July 2019 and January through July 2020 periods. We compared the time from submission to publication for non-COVID-19 original research articles during the two periods and tested for statistical significance with a one-tailed Wilcoxon rank-sum test.Results: We found that non-COVID-19-related articles began decreasing in volume as COVID-19-related articles increased. In BMJ and Lancet, the COVID-19-related articles began overtaking the non-COVID-19-related articles in number during April and May 2020. However, COVID-19-related primary research articles only began consistently appearing in journal issues during May 2020. Only BMJ and BMC Med publicly recorded complete data regarding their publication timelines. After removing outliers, we found that the mean time from submission to publication for articles published in BMJ from January through July 2019 was 204 days (median: 194 days; IQR: 163-236), and from January through July 2020 was 223 days (median: 218 days; IQR: 177-261) (p=0.04). In BMC Med, the mean time from submission to publication from February through July 2019 was 153 days (median: 150 days; IQR: 123-181), and from February through July 2020 was 163 days (median: 157 days; IQR: 132-191) (p=0.06). Conclusion: We discovered a steadily increasing trend in the percentage of COVID-19-related articles and a concomitant decreasing trend in the percentage of non-COVID-19-related articles published in high-impact print journals during the period from December 2019 through May 2020. For non-COVID-19-related articles published in BMJ, we found a statistically significant increase upon comparing the submission-to-publication times for the period from January through July 2020 with the submission-to-publication times for the period from January through July 2019.

Web Exclusive. Annals On Call - Remdesivir as Treatment for COVID-19.

Web Exclusives1 December 2020Annals On Call - Remdesivir as Treatment for COVID-19FREERobert M. Centor, MD and Rebecca Andrews, MS, MDRobert M. Centor, MDHuntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)Search for more papers by this author and Rebecca Andrews, MS, MDUConn Health, Farmington, Connecticut (R.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/A19-0043 Eligible for CME Point-of-CareCME/MOC SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this episode of Annals On Call, Dr. Centor discusses the American College of Physicians' recommendations for the use of remdesivir in the treatment of COVID-19 with Dr. Rebecca Andrews.Annals articles discussed include...Remdesivir for Adults With COVID-19: A Living Systematic Review for an American College of Physicians Practice Points: https://www.acpjournals.org/doi/10.7326/M20-5752Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 1): https://www.acpjournals.org/doi/10.7326/M20-5752About Annals On CallAnnals On Call focuses on a clinically influential article published in Annals of Internal Medicine. Dr. Robert Centor shares his own perspective on the material and interviews topic area experts to discuss, debate, and share diverse insights about patient care and health care delivery.For more information on Annals On Call and for more episodes, visit go.annals.org/OnCall. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)UConn Health, Farmington, Connecticut (R.A.)Disclosures: Dr. Centor has disclosed the following: Consultancy: DynaMed, MDCalc, Medscape, National Kidney Foundation, The Curbsiders. Employment: U.S. Department of Veterans Affairs. Dr. Andrews has disclosed no conflicts of interest.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he has no financial relationships or interests to disclose. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.This article was published at Annals.org on 5 November 2020. Previousarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoShould Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 1) Amir Qaseem , Jennifer Yost , Itziar Etxeandia-Ikobaltzeta , George M. Abraham , Janet A. Jokela , Mary Ann Forciea , Matthew C. Miller , Linda L. Humphrey , and Remdesivir for Adults With COVID-19 Timothy J. Wilt , Anjum S. Kaka , Roderick MacDonald , Nancy Greer , Adam Obley , and Wei Duan-Porter Metrics 1 December 2020Volume 173, Issue 11Page: OC1 ePublished: 5 November 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.Loading ...

Evaluating sleep quality with coronavirus disease 2019 (COVID-19) testing.

Free AccessLetters to the EditorEvaluating sleep quality with coronavirus disease 2019 (COVID-19) testing Katie Viehmann-Wical, DrPHc, MCHES, RRT-NPS Katie Viehmann-Wical, DrPHc, MCHES, RRT-NPS Search for more papers by this author Published Online:February 1, 2021https://doi.org/10.5664/jcsm.8966SectionsAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTCitation:Viehmann-Wical K. Evaluating sleep quality with coronavirus disease 2019 (COVID-19) testing. J Clin Sleep Med. 2021;17(2):355.INTRODUCTIONWhat a great time to be in sleep medicine! This is the perfect time for sleep specialists to speak up about the immune-boosting, virus-fighting health benefits of sleep.Rapid eye movement (REM) sleep is the key sleep cycle for fighting viruses.1–3 The 2–5% of patients positive for coronavirus disease 2019 (COVID-19) admitted into the hospital and intensive care units are most likely patients with REM sleep problems. Asking patients getting tested for COVID-19 if they have untreated snoring (even better using a Pittsburgh Sleep Quality Index form) would quickly identify the high-risk population for sleep problems and worse COVID-19 prognosis.Promoting sleep health and educating individuals how to protect REM sleep would decrease deaths, restore economic stability, and decrease severity for the 2–5% of individuals admitted for COVID-19 treatment. Unfortunately, sleep health knowledge and understanding are low among health care providers and even lower within the general public.4The 3 main underknown health challenges that fragment, block, or decrease REM sleep are as follows: undiagnosed and untreated nightly snoring/sleep apnea,5 drinking alcohol within 6 hours of bedtime,6 or having caffeinated products in the last 6 to 8 hours before bed.7 Sleep specialists are key to diagnosing and treating chronic snoring and sleep apnea, plus educating patients about major risk factors that decrease high-quality REM sleep.The key area where sleep specialists can decrease virus severity is with patients with undiagnosed/untreated sleep apnea. Sleep apnea fragments and blocks REM sleep,5 decreasing immunity.1,3 Apnea is also associated with gut dysbiosis, leading to weight gain and hormone imbalance.8 A body mass index, especially over 40 kg/m2 in males, is associated with higher risk of COVID-19 symptoms and death.9 Diagnosing and treating the nearly one-quarter of females and one-half of males10 with undiagnosed moderate–severe chronic snoring/apnea would protect health and ability to fight off viruses.1,3DISCLOSURE STATEMENTThe author has seen and approved this manuscript. The author reports no conflicts of interest.REFERENCES1. Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol. 2019;19(11):702–715. https://doi.org/10.1038/s41577-019-0190-z CrossrefGoogle Scholar2. Redwine L, Dang J, Hall M, Irwin M. Disordered sleep, nocturnal cytokines, and immunity in alcoholics. Psychosom Med. 2003;65(1):75–85. https://doi.org/10.1097/01.PSY.0000038943.33335.D2 CrossrefGoogle Scholar3. Moldofsky H. Sleep and the immune system. Int J Immunopharmacol. 1995;17(8):649–654. https://doi.org/10.1016/0192-0561(95)00051-3 CrossrefGoogle Scholar4. Jaiswal SJ, Owens RL, Malhotra A. Raising awareness about sleep disorders. Lung India. 2017;34(3):262–268. Google Scholar5. Kimoff RJ. Sleep fragmentation in obstructive sleep apnea. Sleep. 1996;19(9, Suppl):S61–S66. https://doi.org/10.1093/sleep/19.suppl_9.S61 CrossrefGoogle Scholar6. Stein MD, Friedmann PD. Disturbed sleep and its relationship to alcohol use. Subst Abus. 2005;26(1):1–13. https://doi.org/10.1300/J465v26n01_01 CrossrefGoogle Scholar7. Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013;9(11):1195–1200. https://doi.org/10.5664/jcsm.3170 LinkGoogle Scholar8. Mashaqi S, Gozal D. Obstructive sleep apnea and systemic hypertension: gut dysbiosis as the mediator? J Clin Sleep Med. 2019;15(10):1517–1527. https://doi.org/10.5664/jcsm.7990 LinkGoogle Scholar9. Tartof SY, Qian L, Hong V, et al.. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020;173(10):773–781. CrossrefGoogle Scholar10. Heinzer R, Vat S, Marques-Vidal P, et al.. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310–318. https://doi.org/10.1016/S2213-2600(15)00043-0 CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 17 • Issue 2 • February 1, 2021ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationOctober 19, 2020Submitted in final revised formOctober 27, 2020Accepted for publicationOctober 27, 2020Published onlineFebruary 1, 2021 Information© 2021 American Academy of Sleep MedicinePDF download

COVID-19 Vaccine: What Physicians Need to Know.

COVID-19 Vaccine: What Physicians Need to Know.

In adults exposed to COVID-19, hydroxychloroquine did not reduce confirmed or probable COVID-19; trial stopped for futility.

Boulware DR, Pullen MF, Bangdiwala AS, et al. A randomized trial of hydroxychloroquine as postexposure prophylaxis for COVID-19. N Engl J Med. 2020;383:517-25. 32492293.

The second wave of COVID-19 is knocking at the doors: have we learned the lesson?

In light of escalating rates of COVID-19 cases, the world stands stunned. The health, social, and global economic situation continues to deteriorate. The seriousness of the situation became evident to most people, yet no one had a radical solution. Scientifically, there is no sure treatment for viral infections other than strengthening the immune system. Therefore, the idea of ​​a vaccine is the most appropriate to reduce infections. However, vaccines will not be accessible to everyone, considering the genetic changes that the virus may create later. The idea of ​​re-imposing a global quarantine, with international leadership for a limited period, is emerging as a strategic alternative, on the condition that it should be launched simultaneously in all countries of the world. To ensure the quarantine's success, all countries must adhere to the comments of the World Health Organization and the Centers for Disease Control and Prevention.&#x0D; &#x0D; References&#x0D; &#x0D; World Health Organization, Novel Coronavirus 2019-nCoV) SITUATION REPORT –1, 21 JANUARY 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf [Accessed on 08 October 2020].&#x0D; Fani M, Teimoori A, Ghafari S. Comparison of the COVID-2019 (SARS-CoV-2) pathogenesis with SARS-CoV and MERS-CoV infections. Future Virol. 2020:10.2217/fvl-2020-0050. https://doi.org/10.2217/fvl-2020-0050&#x0D; Ali Jadoo, SA. Was the world ready to face a crisis like COVID-19? Journal of Ideas in Health2020;3(1):123-4. https://doi.org/10.47108/jidhealth.Vol3.Iss1.45&#x0D; Worldometer, Coronavirus Cases. Available from: https://www.worldometers.info/coronavirus/? [Accessed on 08 October 2020]&#x0D; Cyranoski D. Profile of a killer: the complex biology powering the coronavirus pandemic. Nature, 04 MAY 2020. Available from: https://www.nature.com/articles/d41586-020-01315-7 [Accessed on 08 October 2020].&#x0D; CDC, Centers for Disease Control and Prevention. Considerations for Wearing Masks Help Slow the Spread of COVID-19. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html [Accessed on 08 October 2020].&#x0D; Atalan A. Is the lockdown important to prevent the COVID-9 pandemic? Effects on psychology, environment and economy-perspective. Ann Med Surg (Lond). 2020; 56:38-42. https://doi.org/10.1016/j.amsu.2020.06.010.&#x0D; Gewin V. On the front lines of the coronavirus-vaccine battle. Nature; 2020 Apr 16. Available from: https://www.nature.com/articles/d41586-020-01116-y [Accessed on 08 October 2020].&#x0D; Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, Azman AS, Reich NG, Lessler J. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020;172(9):577-582. https://doi.org/10.7326/M20-0504.&#x0D; Acter T, Uddin N, Das J, Akhter A, Choudhury TR, Kim S. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency. Sci Total Environ. 2020; 730:138996. https://doi.org/10.1016/j.scitotenv.2020.138996.&#x0D; Ali Jadoo SA. COVID -19 pandemic is a worldwide typical biopsychosocial crisis. Journal of Ideas in Health2020;3(2):152-4. https://doi.org/10.47108/jidhealth.Vol3.Iss2.58.&#x0D;