Impact of COVID-19 Pandemic on the Exacerbation Rates in COPD Patients in Southern India - A Potential Role for Community Mitigations Measures.

Introduction: The impact of the coronavirus 2 (SARS-CoV-2) pandemic and the effect of preventive health strategies on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are largely unknown. The public health model imposed during the pandemic and the lessons learnt have implications on recommending future preventive strategies for COPD care in general and exacerbations in particular. Aim: This study endeavors to assess the role of preventive strategies of COVID-19 on exacerbation rates of COPD during the lockdown period compared to similar periods the previous year and assess the compliance to preventive strategies for COVID-19 among COPD patients. Methods: This is a hospital-based descriptive cross-sectional study at a tertiary care center. AECOPD in patients during a period spanning five months in the pre-lockdown days was compared with exacerbation rates for a similar period during the national lockdown. Results: Sixty-eight patients were recruited (mean age: 67.38) among whom 47 were males and 21 were females. There were only 7 (10.3%) reported admissions during the lockdown period of 5 months compared to 50 (73.5%) during the corresponding period pre-lockdown. Mild exacerbations reported during the lockdown period were also significantly less with only 17 (25%) against 58 (85.3%) during the pre-lockdown period. Adherence to measures such as donning of masks, hand hygiene, and social distancing was observed among COPD patients with good compliance to the health practices promulgated in the pandemic. Discussion: A significant reduction in exacerbation rates among AECOPD patients during the period of lockdown was observed compared to a similar period the year prior. Noticeable were the findings that both community-based milder exacerbations and severe exacerbations necessitating hospitalizations showed a reduction during the period of lockdown. Adaptability, compliance and acceptance to usage of masks, hand hygiene measures, and norms such as physical distancing were observed in the majority of COPD patients.

Removal of incorrect penicillin allergy labels in a UK hospital.

OBJECTIVES: Penicillin allergy records are common, often incorrect and are associated with broad spectrum antibiotic use. We piloted a pharmacist-led multidisciplinary penicillin allergy de-labelling daily ward round to determine the opportunity for penicillin allergy de-labelling in a UK hospital. METHODS: A daily ward round, delivered by antibiotic pharmacists or junior doctors, identified adult medical and surgical patients between 7 November 2022 and 31 January 2023 with a penicillin allergy record that was preventing first-line penicillin use. An allergy history was taken before risk stratifying likelihood of future harm from penicillin re-exposure and an allergy testing method was determined (direct de-label on history alone or after direct drug provocation testing). After successful allergy de-label, the antibiotic was switched to a penicillin antibiotic. RESULTS: Of 7214 inpatients during the study period, 1133 (15.7%) had a penicillin allergy record. Of 285 allergy histories taken, 105 (36.8%) met high-risk criteria, 45 (15.8%) met low-risk criteria eligible for direct de-label and 73 (25.6%) met criteria eligible for direct drug provocation testing. We were unable to obtain a history for 61 (21.4%) patients. Of 45 low-risk patients eligible for direct de-label, 40 (88.9%) were de-labelled of whom 24 (53.3%) were switched to a penicillin antibiotic. Of 73 patients with a low-risk allergy history eligible for direct drug provocation testing, 16 (21.9%) received direct drug provocation testing, of whom 9 were switched to a penicillin antibiotic. Two direct de-label patients experienced harm (thrush within 5 days and delayed skin reaction after day 5); none of the direct drug provocation testing patients had a reaction by day 5. The switches resulted in reduced alternative antibiotic use by 173 Daily Defined Doses (DDDs). DISCUSSION: Penicillin allergy de-labelling patient pathway delivered by pharmacists and junior doctors was safe and effective and well accepted by patients and the wider clinical teams.

In pursuit of the primary.

Extraovarian primary peritoneal carcinoma (EOPPC) is a rare tumour of the peritoneum that shares many features with serous ovarian carcinoma because of a common embryological origin. We report a case of EOPPC presenting with a malignant pleural effusion. https://bit.ly/3GMuKgL.