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Wednesday 19 Aug 2020
Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?
Co-infection is possible among COVID-19 patients. There is a variable prevalence of co-infection among COVID-19 patients in different studies, which could be up to 50% among non-survivors. Co-pathogens included bacteria, such asS.pneumoniae, S.aureus, K.pneumonia, Mycoplasmapneumoniae, Chlamydia pneumonia,Legionella pneumophilaandAcinetobacter baumannii;Candidaspecies andAspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus. Influenza A was one of the most common co-infective viruses, which may have caused initial false-negativeresults of real time RT-PCR for SARS-CoV-2.
Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited kn…
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Tuesday 18 Aug 2020
Another important asthma pathogenesis pathway
The lung is a mechanically active organ, but uncontrolled or excessive mechanical forces disrupt normal lung function and can contribute to the development of disease. In asthma, bronchoconstriction leads to airway narrowing and airway wall buckling. A growing body of evidence suggests that patholog...
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Tuesday 18 Aug 2020
Strategies for Enhancing Patient Adherence to Asthma Therapy
I hope you will enjoy our educational activity in Medscape with David Price!
Drs Price and Kostikas discuss poor adherence to asthma therapy and the strategies for improving it, in particular the use of new technology.
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Tuesday 18 Aug 2020
Ομοιότητες και διαφορές μεταξύ γρίπης και COVID-19 λοίμωξης
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Tuesday 18 Aug 2020
Patient-Reported Outcomes (PROs) in COPD Clinical Trials: Trends and Gaps
Our latest addition to the literature, discussing most available PROs in COPD
Patient-reported outcomes (PROs) are essential to evaluate symptoms, impact of symptoms on activities of daily living, and treatment response. This review summarizes COPD-specific PRO endpoints from randomized controlled trials of approved and commonly used COPD drugs.
A search conducted in “ClinicalTrials.gov” to identify COPD clinical trials (only completed Phase III and IV) incorporating PRO endpoints yielded a total of 104 clinical trials for inclusion in this analysis. Both symptom-based and HRQoL-specific PRO measures were reported.
Several COPD-specific PRO measures are available; however, the St. George’s Respiratory Questionnaire (SGRQ) and the Baseline and Transition Dyspnea Indexes (BDI/TDI) were reported in the majority of the studies.
Results reflected a gap in terms of full coverage of key impacted areas from a patient’s perspective.
Methodological issues identified in this review related to scoring of instruments require careful consideration, as these challenges may limit the complete assessment of drug benefits. Selection of PRO measures aligned with the expected treatment benefit of a drug in a clinical trial should reflect patients’ perspective holistically.
Patient-Reported Outcomes (PROs) in COPD Clinical Trials: Trends and Gaps
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Monday 17 Aug 2020
Chest CT manifestations of new coronavirus disease 2019 (COVID-19)
Although bilateral ground glass opacities (GGO) and consolidation were reported as the predominant imaging characteristics in COVID-19, chest CT manifestations can vary in different patients and stages. Changes such as:
- reticular pattern
- crazy paving pattern
- air bronchogram
- airway and pleural changes
- subpleural curvilinear line
- fibrosis
- vascular enlargement
- air bubble sign
- nodules
- halo sign
- reversed halo sign or atoll sign
- lymphadenopathy
- pericardial effusion can also appear.
Coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, has rapidly swept around the world just within a month, causing global public health emergency. In diagnosis, chest computed tomography (CT) manifestations can supplement parts ...
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Monday 17 Aug 2020
Updated Isolation Guidance Does Not Imply Immunity to COVID-19
On August 3, 2020, CDC updated its isolation guidance based on the latest science about COVID-19 showing that people can continue to test positive for up to 3 months after diagnosis and not be infectious to others.
Contrary to media reporting today, this science does not imply a person is immune to reinfection with SARS-CoV-2, the virus that causes COVID-19, in the 3 months following infection. The latest data simply suggests that retesting someone in the 3 months following initial infection is not necessary unless that person is exhibiting the symptoms of COVID-19 and the symptoms cannot be associated with another illness.
People with COVID-19 should be isolated for at least 10 days after symptom onset and until 24 hours after their fever subsides without the use of fever-reducing medications.
CDC is closely monitoring an outbreak caused by a novel (new) coronavirus in Wuhan City, China.
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Monday 17 Aug 2020
Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis
Comment/question: should we repeat sleep studies in patients with low AHI and high pre-test probability?
While there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA.
Of 2143 identified papers, 24 studies, comprising 3250 participants, were included.
The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was −1.70/hour (95% CI −3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428).
On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night.
Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing.
Background It is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported. Methods We evaluated the NtNV of respiratory events in adults with suspe...
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Monday 17 Aug 2020
Association between COPD exacerbations and lung function decline during maintenance therapy
A clinically important observation by great epidemiologists
Exacerbations are associated with a more rapid loss of lung function among COPD patients with elevated blood eosinophils, defined as ≥350 cells/µL, not treated with ICS.
More aggressive prevention of exacerbations using ICS in exacerbating COPD patients with ≥350 cells/µL may prevent excess loss of lung function.
Background Little is known about the impact of exacerbations on COPD progression or whether inhaled corticosteroid (ICS) use and blood eosinophil count (BEC) affect progression. We aimed to assess this in a prospective observational study. Methods The study population included patients with mild to....
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Sunday 02 Aug 2020
A Nature study authored by a global team of scientists and led by Sumit Chanda, Ph.D., professor at Sanford Burnham Prebys Medical Discovery Institute,...
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Saturday 01 Aug 2020
No therapies have been shown to be effective early in patients with mild disease. Investigators randomized 423 nonhospitalized patients with ≤4 days of
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Saturday 01 Aug 2020
As the coronavirus disease (COVID-19) continues to wreak havoc across the globe, it has been thought that children mostly seemed to be spared by severe illness. In the majority of cases, children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) only develop a mild illne...
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Friday 31 Jul 2020
Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study
These results suggest that most of the population of Geneva remained uninfected during this wave of the pandemic, despite the high prevalence of COVID-19 in the region (5000 reported clinical cases over <2·5 months in the population of half a million people). Assuming that the presence of IgG antibodies is associated with immunity, these results highlight that the epidemic is far from coming to an end by means of fewer susceptible people in the population. Further, a significantly lower seroprevalence was observed for children aged 5–9 years and adults older than 65 years, compared with those aged 10–64 years. These results will inform countries considering the easing of restrictions aimed at curbing transmission.
These results suggest that most of the population of Geneva remained uninfected during this wave of the pandemic, despite the high prevalence of COVID-19 in the region (5000 reported clinical cases over <2·5 months in the population of half a million people). Assuming that the presence of IgG antib...
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Friday 31 Jul 2020
Home Monitoring in Patients with Idiopathic Pulmonary Fibrosis. A Randomized Controlled Trial
The results of this first-ever eHealth RCT in IPF showed that a comprehensive home monitoring program did not improve overall HRQOL measured with K-BILD but tended to improve psychological well-being. Home monitoring was greatly appreciated by patients and allowed for individually tailored medication adjustments.
Rationale: Idiopathic pulmonary fibrosis (IPF) is a deadly disease with increasingly impaired health-related quality of life (HRQOL). eHealth technologies facilitate collection of physiological out...
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Friday 31 Jul 2020
A new study published on the preprint server medRxiv in July 2020 reports the potential of cell-free DNA as a marker of the severity of disease in COVID-19. This could help triage patients as well as provide a prognostic marker.
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Friday 31 Jul 2020
The current COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), seems to attack the human airway epithelium primarily. In severely affected patients, the illness progresses to hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS). The latt...
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Friday 31 Jul 2020
Now, a new study published in the preprint server bioRxiv in July 2020 reports on the antiviral activity of two drugs found in an antimalarial drug currently in phase II trials in South Korea, called Pyramax.
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Friday 31 Jul 2020
Even as the COVID-19 pandemic claims increasing numbers of patients, testing numbers are rising in most nations at the leading edge. However, the current reverse transcriptase-polymerase chain reaction (RT PCR) testing is often unavailable and takes up to several days for results to arrive.
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Thursday 30 Jul 2020
Time for a change: anticipating the diagnosis and treatment of COPD
COPD is a major public health problem because of its high prevalence (about 10% of the adult population), rising incidence (likely related to the ageing of the population), associated morbi-mortality (it is currently the third leading cause of death globally), and personal, social and economic costs...
