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Background: Antiviral agents, such as remdesivir, have shown promising results in helping reduce the morbidity and healthcare burden of coronavirus disease 2019 (COVID-19) in hospitalized patients. However, many studies have reported a relationship between remdesivir and bradycardia. Therefore, this study aimed to analyze the relationship between bradycardia and outcomes in patients on remdesivir. Methods: We conducted a retrospective study of 2,935 consecutive COVID-19 patients admitted to seven hospitals in Southern California in the United States between January 2020 and August 2021. First, we did a backward logistic regression to analyze the relationship between remdesivir use and other independent variables. Finally, we did a backward selection Cox multivariate regression analysis on the sub-group of patients who received remdesivir to evaluate the mortality risk in bradycardic patients on remdesivir. Results: The mean age of the study population was 61.5 years; 56% were males, 44% received remdesivir, and 52% developed bradycardia. Our analysis showed that remdesivir was associated with increased odds of bradycardia (odds ratio (OR): 1.9, P < 0.001). Patients that were on remdesivir in our study were sicker patients with increased odds of having elevated C-reactive protein (CRP) (OR: 1.03, P < 0.001), elevated white blood cell (WBC) on admission (OR: 1.06, P < 0.001), and increased length of hospital stay (OR: 1.02, P = 0.002). However, remdesivir was associated with decreased odds of mechanical ventilation (OR: 0.53, P < 0.001). In the sub-group analysis of patients that received remdesivir, bradycardia was associated with reduced mortality risk (hazard ratio (HR): 0.69, P = 0.002). Conclusions: Our study showed that remdesivir was associated with bradycardia in COVID-19 patients. However, it decreased the odds of being on a ventilator, even in patients with increased inflammatory markers on admission. Furthermore, patients on remdesivir that developed bradycardia had no increased risk of death. Clinicians should not withhold remdesivir from patients at risk of developing bradycardia because bradycardia in such patients was not found to worsen the clinical outcome.
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Background Although computed tomography (CT) has revolutionized the field of medicine due to its incredible diagnostic capabilities, the trends regarding the usage of CT scans, especially in the field of neuroscience, are not very clear. We aim to find the trends in the usage of inpatient head CT scans in the United States using a robust database. Methods We queried the national inpatient usage of head CT scans in the United States from 1997 to 2014 using a robust national database. The trends in usage were analyzed based on age, gender, insurance types, and patients' income. Results During the study period, we recorded a total of 5,309,329 head CT scans, of which 51% were female. The total number of head CT scans in the United States dropped significantly from 527,026 cases to 181,095 cases (p=0.000). The decrease was with a steep slope from 1997 to 2002, and since then the decreasing slope turned to a steady state. The decrease in head CT scans was significant in all age groups (p = 0.001), more significant in uninsured payers (-79.4%, p=0.000), and prominent in low-income patients (-70.5 %, p=0.000). Conclusions Our study showed that national inpatient usage of CT scans of the head significantly decreased during the past two decades. This decrease is presumably multifactorial: reducing the number of unnecessary radiations, increased appropriateness audits by the government, payers' payment reductions, and integrated electronic platforms.
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CONCLUSION: A cutoff value of 6.0â mm for optic nerve sheath dilation may be used as a screening imaging marker to suspect elevated opening pressure with specificity of 88% in pediatric patients with new-onset idiopathic seizures.
