Torsades de pointes associated with remdesivir treatment for COVID-19 pneumonia.

Background: Prolonged QT interval (QTc) can be a serious adverse event from SARS-CoV-2 infection and associated treatment, including remdesivir. Methods: We present a case of a 55-year-old woman with COVID-19 pneumonia who was treated with remdesivir. The QTc on admission was 483 ms. After three doses of remdesivir, she had an episode of non-sustained ventricular tachycardia. Repeat QTc was significantly prolonged at 609 ms. She experienced a polymorphic ventricular tachycardic cardiac arrest the next morning, thought to be secondary to torsades de pointes. Results: Transthoracic echocardiogram showed normal biventricular function. Electrolytes were within normal limits. In the absence of other QTc-prolonging medications, remdesivir was thought to be inciting agent. Following discontinuation of remdesivir, the patient's QTc returned to baseline. Conclusions: There is a risk for cardiac events from QTc prolongation effects of SARS-CoV-2 infection and associated treatment. We recommend pharmacological profile review and cardiac monitoring for patients receiving remdesivir.

Historique: Un intervalle QT prolongé (QTc) peut être un grave effet indésirable de l'infection par le SRAS-CoV-2 et du traitement qui s'y associe, y compris le remdésivir. Méthodologie: Les chercheurs présentent le cas d'une femme de 55 ans atteinte d'une pneumonie à COVID-19 qui a reçu un traitement au remdésivir. Son QTc à l'admission était de 483 ms. Après trois doses de remdésivir, elle a subi un épisode de tachycardie ventriculaire non soutenue. La reprise du QTc était particulièrement prolongé, à 609 ms. La patiente a vécu un arrêt cardiaque causé par une tachycardie ventriculaire polymorphe le lendemain matin, considéré comme secondaire à des torsades de pointe. Résultats: L'échocardiogramme transthoracique a révélé une fonction biventriculaire normale. Les électrolytes se situaient dans les limites normales. En l'absence d'autres médicaments pour prolonger le QTc, le remdésivir a été présumé comme responsable. Après l'arrêt de ce médicament, le QTc de la patiente est redevenu normal. Conclusions: La prolongation du QTc découlant de l'infection par le SRAS-CoV-2 et du traitement qui s'y associe entraîne un risque d'arrêt cardiaque. Il est recommandé de procéder à une évaluation du profil pharmacologique et d'assurer la surveillance cardiaque des patients qui reçoivent du remdésivir.

Evaluation of the early weigh-in policy for mixed martial arts events adopted by North American athletic commissions.

OBJECTIVE: To characterize the epidemiology of overweight athletes before and after the introduction of the Early Weigh-In Policy (EWIP). METHODS: A retrospective cohort study examined the weigh-in results for professional mixed martial arts (MMA) events over a 2-year period around the introduction of the new EWIP between 2014 and 2018. Descriptive statistics were used to characterize the study populations. Risk ratios were used to identify differences in the study populations before and after the introduction of the EWIP. RESULTS: After the introduction of the EWIP, the number of overweight athletes increased from 5.7% to 8.4% and the average overweight mass increased from 1.3 kg (2.9 lbs) to 1.8 kg (3.9 lbs) [difference, 0.5 kg (1.0 lb), p = 4.35 × 10^(-5)]. The proportion of athletes is not distributed similarly across the different overweight mass categories when comparing the pre- and post-EWIP time frames (p = 0.006). More athletes in the pre-EWIP period were overweight by smaller amount, while in the post-EWIP period athletes were overweight by larger amount. Of the athletes who were overweight before the regulation change, 28.7% were over the weight limit by greater than 1.8 kg (4 lbs), compared to 39.5% after the new EWIP introduction. On average, the ratio of overweight athletes per events by commission was 1.2 before the introduction of the EWIP and 2.1 after. CONCLUSION: These results appear to indicate that the EWIP has not altered weight-cutting culture in MMA in a positive manner. This study casts doubt on the benefits of an EWIP and raised the possibility of utilizing the longitudinal weight monitoring approach to mitigate rapid weight-cycling behavior. However, before additional changes are made by any athletic commission, further research is needed to examine the efficacy of the abovementioned longitudinal weight monitoring approach or any other strategy.

Telemedicine for Diabetic Retinopathy Screening in an Urban, Insured Population Using Fundus Cameras in a Primary Care Office Setting.

BACKGROUND AND OBJECTIVE: This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS: Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the "capture rate." RESULTS: Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION: The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274-e277.].

Paramedics' Perspectives on Factors Impacting On-Scene Times for Trauma Calls.

IntroductionAccording to Ontario, Canada's Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves. It is also the first study to explore this issue from a complex, adaptive systems approach which recognizes that OSTs may be impacted by local, contextual features.ProblemResearch addressed the following problem: what are the facilitators and barriers to achieving 10-minute OSTs? METHODS: This project used a descriptive, qualitative design to examine facilitators and barriers to achieving 10-minute OSTs on trauma calls, from the perspective of paramedics. Paramedics from a regional Emergency Services organization were interviewed extensively over the course of one year, using qualitative interviewing techniques developed by experts in that field. All interviews were recorded, transcribed, and entered into NVivo for Mac (QSR International; Victoria, Australia) software that supports qualitative research, for ease of data analysis. Researcher triangulation was used to ensure credibility of the data. RESULTS: Thirteen percent of the calls had OSTs that were less than 10 minutes. The following six categories were outlined by the paramedics as impacting the duration of OSTs: (1) scene characteristics; (2) the presence and effectiveness of allied services; (3) communication with dispatch; (4) the paramedics' ability to effectively manage the scene; (5) current policies; and (6) the quantity and design of equipment. CONCLUSION: These findings demonstrate the complexity of the prehospital environment and bring into question the feasibility of the 10-minute OST standard. LevitanM, LawMP, FerronR, Lutz-GraulK. Paramedics' perspectives on factors impacting on-scene times for trauma calls. Prehosp Disaster Med. 2018;33(3):250-255.

INTRAVITREAL SULFUR HEXAFLUORIDE INJECTION FOR THE TREATMENT OF VITREOMACULAR TRACTION SYNDROME.

PURPOSE: Vitreomacular traction (VMT) syndrome can cause symptomatic metamorphopsia and decreased visual acuity. Although it is typically treated with vitrectomy or intravitreal ocriplasmin injection, these procedures can be invasive and costly. The purpose of this retrospective, consecutive case series was to evaluate the efficacy of intravitreal expansile sulfur hexafluoride gas injection for the treatment of symptomatic VMT syndrome. METHODS: Nine eyes of 9 patients with symptomatic VMT syndrome on spectral domain optical coherence tomography received an intravitreal injection of 0.3 mL of 100% sulfur hexafluoride. The primary outcome was the number of eyes with release of VMT on spectral domain optical coherence tomography at 1 month after treatment. Secondary outcomes included change in visual acuity and central subfield thickness 1 month after treatment. RESULTS: Five patients (55.6%) had release of VMT on spectral domain optical coherence tomography by 1 month after injection. Two patients who had Stage I macular holes before injection had closure of the macular holes. Mean visual acuity at 1 month improved slightly after injection by 0.09 logMAR units, although this change was not statistically significant (P = 0.15). Central subfield thickness on spectral domain optical coherence tomography decreased by an average of 35.3 microns after injection (P = 0.004). All eyes with release of VMT had pretreatment vitreomacular adhesion of less than 521 microns and none had epiretinal membranes. One patient (11.1%) developed a peripheral retinal hole at 1 month after injection. CONCLUSION: Intravitreal injection of expansile sulfur hexafluoride gas is a low-cost and minimally invasive alternative for the treatment of symptomatic VMT syndrome. Further study is warranted.