Frequency Of Clinical Outcomes Research Articles

The rs11385942 and rs657152 variants are not associated with COVID-19 severity and outcomes in patients treated with favipiravir and remdesivir

Background. There is a mounting evidence in the scientific literature that susceptibility to SARS-CoV-2 infection could vary. The severity of COVID-19 symptoms can range from asymptomatic to severe respiratory failure, requiring prolonged artificial ventilation. The underlying causes of this range of clinical manifestations remain unclear. Identification of the risk factors that may cause this variation in clinical symptoms is important for identifying the most susceptible populations at highest risk. This should help improve prevention measures, reduce hospitalizations, and decrease the mortality rate of the disease. Previously, an association has been found between the severity of COVID-19 and the genetic markers rs11385942 G>GA and rs657152 A>C.The aim. To assess the impact of carrying polymorphic markers rs11385942 G>GA and rs657152 A>C on the severity of COVID-19 in patients undergoing specific therapy. Materials and methods. A total of 240 patients hospitalized with a coronavirus infection were included in the study. All patients received therapy with favipiravir or remdesivir. The presence of the rs11385942 G>GA and rs657152 A>C variants was determined in all patients. The study compared the length of hospital stays, frequency of patient transfers to the intensive care unit (ICU), and frequency of clinical outcomes (recovery or death) among carriers of allelic variants of the markers under investigation.Results. There were no significant associations between the carriage of variants rs11385942 G>GA and rs657152 A>C and the duration of patients’ hospitalization, frequency of patient transfers to the ICU, and patient outcomes.Conclusion. The carriage of rs11385942 G>GA and rs657152 A>C variants did not affect the severity or type of clinical outcomes in patients with COVID-19.

Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review.

BackgroundAcute ischemic stroke (AIS) is a common and fatal complication of infective endocarditis (IE); however, there is a lack of understanding regarding treatment efficacy. This systematic review aimed to evaluate the safety and efficacy of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) in IE patients experiencing AIS.ObjectivesThe aim of this study was to perform a systematic review investigating the outcomes of AIS in IE patients receiving IVT and/or EVT as a treatment method and to evaluate the safety and efficacy of these methods of reperfusion therapy.DesignA systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted.Data Sources and MethodsThe EMBASE, Cochrane, and PubMed databases were searched for literature published between 2005 and 2021 investigating outcomes of reperfusion therapy post-AIS in IE and non-IE patients. Descriptive statistics were used to describe the overall frequency of clinical outcomes, and groupwise comparisons were performed using Fisher’s exact test to assess the significance of groupwise differences.ResultsThree studies were finally included in the systematic review. A total of 13.5% of IE patients compared to 37% of non-IE patients achieved a good functional outcome (modified Rankin Scale score≤ 2) (P < .001). Furthermore, a larger percentage of the IE cohort achieved good functional outcomes after EVT (22.0%) compared to IVT (10.4%) (P = .013). The IE cohort also had a higher 3-month postreperfusion mortality rate (48.8%) compared to the non-IE cohort (24.9%) (P < .001). The rate of intracranial hemorrhage (ICH) postreperfusion was also significantly higher in the IE cohort (23.5%) than in the non-IE cohort (6.5%) (P < .001).ConclusionAIS patients with IE, treated with IVT, EVT, or a combination of the two, experience worse clinical and safety outcomes than non-IE patients. EVT yielded better functional outcomes, albeit with higher postreperfusion ICH rates, than IVT.

822-P: Insulin Pump Use in Patients with Type 1 Diabetes: Real-World Data from a Large U.S. Based Multicenter Observational Study

Background: Insulin pump use is known to improve glycemic control in patients with type 1 diabetes (T1D), however, uptake of insulin pump varies among people in U.S. This study aims to examine the distribution of patient demographics and frequency of clinical outcomes across people using insulin pump. Methods: The analysis included 21,821 T1D patients in the T1D Exchange Quality Improvement (T1DX-QI) database for whom electronic medical record data was available in the T1DX-QI collaborative. Patients over 2 years with at least one completed clinic encounter between January 2014 - February 2020 were included for analysis. Results: In this population, 58% (N=12,729) of T1D patients were insulin pump users, whereas 42% (N=9,092) were non-users. HbA1c levels in the insulin pump group were lower compared to non- users (Mean [SD], %: 8.5 [2.6] vs. 8.9[2.1] [p Conclusions: This study highlights inequities in uptake of insulin pump therapy, while confirming previous findings demonstrating the use of insulin pump in combination with CGMs to be critical in effective management of blood glucose levels in one of the largest multi-center observational studies in the U.S. Disclosure N. Noor: Research Support; Self; Dexcom, Inc. M. A. Clements: Consultant; Self; Eli Lilly and Company, Employee; Self; Glooko, Inc., Research Support; Self; Abbott Diabetes, Dexcom, Inc. G. T. Alonso: None. S. Rompicherla: None. N. Noor: Research Support; Self; Dexcom, Inc. S. Lyons: None. J. M. Lee: Advisory Panel; Self; GoodRx. M. Gallagher: None. J. A. Indyk: None. O. Ebekozien: None. M. Greenfield: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Metformin reduces the relapse rate of tuberculosis patients with diabetes mellitus: experiences from 3-year follow-up.

The role of metformin (MET) on treatment effect of diabetic tuberculosis (TB) patients has not been studied in China. Thus, we conducted a retrospective study to investigate whether MET exhibited more efficacy in combination with anti-TB regimens for diabetic TB patients. All patients recruited came from five tuberculosis control and prevention institutes from July 2009 to July 2016 and completed 3years of follow-up. We used chi-square test or Fisher's exact test to evaluate the demographic characteristics and the frequency of clinical outcome between MET and non-MET group. A total of 58 TB patients with diabetes mellitus (DM), of these 27.6% (16/58) patients in the MET group and 72.4% (42/58) patients in the non-MET group, there was no significant difference in blood glucose level between MET and non-MET group (P = 0.494), in addition, there was a higher proportion of treatment success (93.8 vs. 71.4%) and culture conversions by the end of 2months (87.5 vs. 71.4%) among MET group; the relapse rates of patients in MET and non-MET group were 6.3% (1/16) and 35.7% (15/42) through a 3-year follow-up (P = 0.045). Our data revealed that the use of MET as a combination drug with existing regimen improved the success rate of anti-TB treatment and reduced the relapse rate in TB patients with DM.

Remote ischaemic preconditioning versus sham procedure for abdominal aortic aneurysm repair: an external feasibility randomized controlled trial.

BackgroundDespite advances in perioperative care, elective abdominal aorta aneurysm (AAA) repair carries significant morbidity and mortality. Remote ischaemic preconditioning (RIC) is a physiological phenomenon whereby a brief episode of ischaemia-reperfusion protects against a subsequent longer ischaemic insult. Trials in cardiovascular surgery have shown that RIC can protect patients’ organs during surgery. The aim of this study was to investigate whether RIC could be successfully introduced in elective AAA repair and to obtain the information needed to design a multi-centre RCT.MethodsConsecutive patients presenting for elective AAA repair, using an endovascular (EVAR) or open procedure, in a single large city hospital in the UK were assessed for trial eligibility. Patients who consented to participate were randomized to receive RIC (three cycles of 5 min ischaemia followed by 5 min reperfusion in the upper arm immediately before surgery) or a sham procedure. Patients were followed up for 6 months. We assessed eligibility and consent rates, the logistics of RIC implementation, randomization, blinding, data capture, patient and staff opinion, and variability and frequency of clinical outcome measures.ResultsBetween January 2010 and December 2012, 98 patients were referred for AAA repair, 93 were screened, 85 (91 %) were eligible, 70 were approached for participation and 69 consented to participate; 34 were randomized to RIC and 35 to the sham procedure. There was a greater than expected variation in the complexity of EVAR that impacted the outcomes. Acute kidney injury occurred in 28 (AKIN 1: 23 %; AKIN 2: 15 % and AKIN 3: 3 %) and 7 (10 %) had a perioperative myocardial infarction. Blinding was successful, and interviews with participants and staff indicated that the procedure was acceptable. There were no adverse events secondary to the intervention in the 6 months following the intervention.ConclusionsThis study provided essential information for the planning and design of a multi-centre RCT to assess effectiveness of RIC for improving clinical outcomes in elective AAA repair. Patient consent was high, and the RIC intervention was carried out with minimal disruption to clinical care. The allocation scheme for a definite trial should take into account both the surgical procedure and its complexity to avoid confounding the effect of the RIC, as was observed in this study.Trial registrationCurrent Controlled Trials ISRCTN19332276 (date of registration: 16 March 2012). The trial protocol is available from the corresponding author.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0899-3) contains supplementary material, which is available to authorized users.

Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement

The Commission on Information and Accountability for Women's and Children's Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and "not timely enough for practical use by health planners and administrators". Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Clinical "dashboards" based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility's clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Implementation of the maternity dashboards was feasible and 28months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.

MID-TERM CLINICAL OUTCOMES OF ZOTAROLIMUS-ELUTING STENT IN PATIENTS WITH STABLE ANGINA PECTORIS

Objectives: The study was designed to evaluate the safety and effectiveness ofthe Endeavor zotarolimus-eluting stent (ZES) for the treatment of stable coronaryartery disease. Methodology: This was a cross sectional descriptive study. Patients who wereadmitted to Cardiology Unit of Lady Reading Hospital, Peshawar, through OPD orcasualty department, fulfilling the inclusion criteria were enrolled in the study.This study included all the patients with stable coronary artery disease who hadreceived Endeavor stents from January 2010, to March 2011. Total studyduration was 15 months. The primary end point was the rate of major adversecardiac events (MACE) at 12 months. All patients who underwent PCI withEndeavor stent implant for stable angina pectoris were followed up andreassessed after 12 months from the index procedure. Results: A total of 128 patients were included in the study. Mean age was 54±2.4years. Male were 91 (71.1 %) while females were 37 (28.9). Of these 49.2%were hypertensive, 28.9% diabetic, 19.5% smokers, and 39.8% dyslipidemics.Overall 12-month outcome rates were: MACE 5.5%; cardiac death 0.8%; STEMI0.8%; NSTEMI 1.6% and revascularization 2.3%. Conclusion: This study provides important information regarding the mid-termsafety and efficacy of the Endeavor zotarolimus-eluting stent. Frequency ofclinical outcomes including cardiac death, myocardial infarction, andrevascularization were low and consistent with pooled results of other majortrials.

The Quinapril Ischemic Event Trial (QUIET): evaluation of chronic ace inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function

Angiotensin-converting enzyme inhibitors improve endothelial function, inhibit experimental atherogenesis, and decrease ischemic events. The Quinapril Ischemic Event Trial was designed to test the hypothesis that quinapril 20 mg/day would reduce ischemic events (the occurrence of cardiac death, resuscitated cardiac arrest, nonfatal myocardial infarction, coronary artery bypass grafting, coronary angioplasty, or hospitalization for angina pectoris) and the angiographic progression of coronary artery disease in patients without systolic left ventricular dysfunction. A total of 1,750 patients were randomized to quinapril 20 mg/day or placebo and followed a mean of 27 ± 0.3 months. The 38% incidence of ischemic events was similar for both groups (RR 1.04; 95% confidence interval 0.89 to 1.22; p = 0.6). There was also no significant difference in the incidence of patients having angiographic progression of coronary disease (p = 0.71). The rate of development of new coronary lesions was also similar in both groups (p = 0.35). However, there was a difference in the incidence of angioplasty for new (previously unintervened) vessels (p = 0.018). Quinapril was well tolerated in patients after angioplasty with normal left ventricular function. Quinapril 20 mg did not significantly affect the overall frequency of clinical outcomes or the progression of coronary atherosclerosis. However, the absence of the demonstrable effect of quinapril may be due to several limitations in study design.

PCV12 One-Year Clinical And Economic Outcomes of Primary Coronary Angioplasty Using A National Database

OBJECTIVE: To determine clinical and economic outcomes of primary PTCA and assess the effects of comorbidities (congestive heart failure, diabetes, hypercholesterolemia, hypertension) on outcomes using a national database. METHODS: Data were obtained from MarketScanâ Medstatâ, which contains claims data for 4–5 million people. Patients with a hospital admission for PTCA (CPT codes 92982, 92984) in 1992 and one year of follow-up charge data were identified. A total of 2,663 patients with a single vessel and 331 with a multiple vessel procedure were included. Patients who died or were missing prior to one-year follow-up were excluded (n = 653). Total charges were calculated by summing charges for the index procedure plus all inpatient and outpatient charges incurred during the year following PTCA. Multivariate regression was used to assess effects of comorbidities on outcomes (adjusted for age and other factors). RESULTS: Patients with single vessel versus multiple vessel PTCA did not differ according to comorbid and other characteristics, or most clinical or economic outcomes; therefore combined data are presented. The frequency of clinical outcomes in the year following PTCA was: rehospitalization for angina-41%, myocardial infarction (MI)-33%, repeat PTCA-15%, coronary artery bypass grafting-7%, and stroke-3%. Comorbidities related to clinical outcomes were: congestive heart failure (CHF) for MI (p = 0.0001), diabetes for angina rehospitalization (p = 0.06), and diabetes (p = 0.05) and hypertension (p = 0.004) for repeat PTCA. Total charges per patient at one year after primary PTCA were $35,257, and total charges were strongly related to the presence of diabetes (p = 0.001) and CHF (p = 0.001). There was no association with hypertension or hypercholesterolemia. CONCLUSION: These findings show that the presence of certain comorbid factors does influence clinical and economic outcomes following PTCA.

Cost-effectiveness of Alternative Screening Strategies for Developmental Dysplasia of the Hip

To compare the cost-effectiveness of adding either a general or a selective ultrasound screening program to the routine clinical examination for developmental dysplasia of the hip (DDH) with use of the data from a large, randomized study of 11,925 newborns. Our previous study comparing the clinical outcomes of three strategies for screening infants for DDH suggested (but results were not statistically significant) that general ultrasound screening resulted in fewer children requiring hospitalization and surgery for DDH than did a strategy based on ultrasound screening of the 11.8% of infants considered to be at increased risk of DDH or one with no ultrasound screening. General ultrasound screening led to early splinting of 3.4% of the newborns compared with 2.0% for the selectively screened group and 1.8% for the group not receiving ultrasound screening. Using these data, we decided on sequences and intervals of diagnostic and therapeutic actions considered to be sufficient for each regimen. We applied estimates of the costs of screening, treatment of DDH discovered early and late, and follow-up examinations to arrive at total program costs for each strategy. Total program costs were similar for each of the three screening strategies (costs varied by < 5%). However, treatment of late cases accounted for only 22% of total costs in the group undergoing general screening vs 65% in the two latter groups. The cost estimates were sensitive to several variables. Application of the data to a hypothetical ultrasound program in which all girls and only boys at increased risk for DDH underwent an ultrasound examination showed substantially reduced total program costs. Application of costs from other centers to our data regarding frequency of clinical outcomes may yield different comparative program costs. If the findings of our clinical study can be generalized to other centers, a strategy of screening all girls and boys with risk factors for DDH may be the most cost-effective approach.