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1.
JNMA J Nepal Med Assoc ; 62(269): 24-26, 2024 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-38410017

RESUMEN

Introduction: Conjunctivitis is a highly prevalent ocular disease that flares up every year. The humidity and high temperature favour the causative agents responsible for the epidemic. Acute infective conjunctivitis may be either viral or bacterial, a distinct type of condition with unique clinical features and treatment approaches. The aim of the study was to find out the prevalence of acute conjunctivitis among patients visiting the outpatient Department of Ophthalmology in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among the patients visiting the outpatient Department of Ophthalmology. Data of 30 August 2023 to 30 September 2023 was collected between 21 November 2023 to 24 November 2023. All patients presenting in the Ophthalmology Department having complete hospital record were included in the study. Patients having missing data on the medical records of the hospital were excluded. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 5,507 patients, acute conjunctivitis was seen in 1240 (22.52%) (21.42-23.62, 95% Confidence Interval). The majority were male 732 (59.03%) and adults 760 (61.29%) with a mean age of 32.56±18.74 years. Conclusions: The prevalence of conjunctivitis among patients visiting the outpatient Department of Opthalmology was found to be higher than other studies done in similar settings. Keywords: conjunctivitis; disease outbreaks; enterovirus.


Asunto(s)
Conjuntivitis , Pacientes Ambulatorios , Adulto , Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Persona de Mediana Edad , Centros de Atención Terciaria , Estudios Transversales , Conjuntivitis/epidemiología , Enfermedad Aguda
2.
Ann Med Surg (Lond) ; 85(12): 5899-5907, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38098592

RESUMEN

Introduction: The non-prescription antibiotics dispensing (NPAD) from pharmacies is on the rise in low- and middle-income countries, which contributes to the emergence of antimicrobial resistance (AMR). This study was conducted with the objective to determine the community pharmacy personnel's perspectives on NPAD and its implications for AMR. Methods: A questionnaire-based cross-sectional survey was conducted in Pakistan among 336 pharmacies. The data were analyzed using SPSS v21 and MedCalc for Windows v12.3.0. Modified Bloom's cut-off point was utilized to categorize the participants' overall knowledge, attitude, and practice. For univariable logistic regression analyses, odds ratio (OR) was calculated at 95% confidence interval (CI). For multivariable logistic regression analyses, adjusted OR was calculated at 95% CI. Spearman's rank correlation coefficient test was used to assess the relationships among knowledge, attitude, and/or practice scores. Results: The majority of the respondents were staff pharmacists (45.5%). About four-fifths (78.9%) and half (50.9%) of the participants demonstrated moderate to good knowledge and practice, respectively. However, about only one-third (33.1%) had a moderate to good attitude. Staff pharmacists had higher odds of moderate to good knowledge (OR: 2.4, 95% CI: 1.2-4.7) and practice (OR: 2.3, 95% CI: 1.4-3.8). Total knowledge and practice (Spearman's ρ: 0.280; P <0.001) and total attitude and practice (Spearman's ρ: 0.299; P <0.001) scores were significantly correlated. Conclusion: The qualified pharmacists had satisfactory knowledge, attitude, and practices toward antibiotics. However, non-pharmacist staff lacked knowledge and had probable NPAD practice, which has a negative impact on public health. Regular refresher training, seminars, and strict enforcement of rules and regulations are essential.

3.
Ann Med Surg (Lond) ; 85(9): 4329-4333, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37663740

RESUMEN

Introduction: While proteinuria aggravates dyslipidemia in diabetic patients, dyslipidemia further worsens proteinuria via inflammatory cytokines-mediated glomerular damage. Urinary albumin creatinine ratio (ACR) is an easy and reliable method of detecting proteinuria. This study aims to determine the association of ACR with lipid abnormalities and glycemic control in the Nepalese population. Methods: This was a cross-sectional study conducted among 201 diabetes patients visiting the outpatient department of internal medicine. Based on ACR values, patients were categorized as nonalbuminuric (less than 300 µg/mg) or albuminuric (more than 300 µg/mg). An unpaired t-test was used to compare the mean of various lipoproteins in these two categories. Binary logistic regression was used to check the association of ACR with sociodemographic factors (age, sex, and education), hypertension, and glycated hemoglobin. Results: Albuminuric patients had higher mean cholesterol (192.8±53.5 vs. 184.2± 37.6; P=0.209), triglyceride (194.9±97.8 vs. 164.4±73.7; P=0.017) and low-density lipoprotein (99.9±38.4 vs. 90.0±27.4; P=0.034) but lower high-density lipoprotein (53.9±18.5 vs. 61.3±19.9; P=0.008) compared to nonalbuminuric patients. There was a significant difference in mean HbA1c values across albuminuria and nonalbuminuria groups (7.1±1.1 vs. 6.7±0.8; OR: 1.4, 95% CI=1.1-1.9, P=0.030). Conclusions: Urine ACR of more than 30 mg/gram was associated with higher triglyceride and low-density lipoprotein levels and lower high-density lipoprotein levels. The HbA1c level strongly correlates with the development of albuminuria.

4.
Ann Med Surg (Lond) ; 85(7): 3372-3380, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37427215

RESUMEN

Inappropriate antimicrobial use leading to antimicrobial resistance is a matter of public health concern globally. This research was conducted with the objective of preventing antimicrobial misuse across knowledge, behavior, and practice domains among the general people of Nepal. Methods: It was a cross-sectional survey conducted among 385 participants visiting tertiary care center from all over Nepal from February 2022 to May 2022. Modified Bloom's cut-off point was utilized to categorize the participants' overall knowledge, behavior, and practice. The chi-square (χ 2) test and odds ratio (OR) using binary logistic regression at 95% CI and Spearman's rank correlation coefficient test (r) were calculated wherever appropriate. Results: More than three-fifths of the participants (248, 64.42%) demonstrated good behavior, whereas less than half of the participants showed good knowledge (137, 35.58%) and practice (161, 41.82%) about rational use of antimicrobials. Health professionals had higher knowledge (OR: 1.07, 95% CI: 0.70-1.62) and good behavior (OR: 0.42, 95% CI: 0.27-0.64) than other professionals (P<0.05). Those with higher income [≥50 000 NRS (Nepalese rupees)] had good behavior (OR: 3.37, 95% CI: 1.65-6.87) and good practice (OR: 2.58, 95% CI: 1.47-4.50) scores than those with less monthly income (P<0.05). Similarly, higher educational degrees, viz. master's and/or above, had good behavior (OR: 4.13, 95% CI: 2.62-6.49) and good practice scores (OR: 2.55, 95% CI: 1.68-3.87). Additionally, there were significant positive correlations between knowledge (K), behavior (B), and practice (P) scores (r=0.331 for K and B, r=0.259 for K and P, and r=0.618 for B and P, respectively; P<0.05). Conclusions: The findings imply the demand for effective legislature, strict enforcement of the drug act, and proper implementation of plans and policies to curb antimicrobials misuse. Lack of execution of existing laws and the unawareness of the public led to the extravagant use of antimicrobials.

5.
Libyan J Med ; 18(1): 2184297, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36855244

RESUMEN

COVID-19 pandemic has triggered psychological stress such as anxiety and depression among people around the globe. Due to the nature of the job, healthcare professionals (HCPs) are at high risk of infection and are facing social stigma as well. This research was conducted with the objective to evaluate the psychological influence of the COVID-19 pandemic among HCPs in Yemen and the coping strategies adopted thereof. A web-based, as well as face-to-face cross-sectional study was carried out from July to December 2021 among HCPs of Yemen. The generalized anxiety disorder (GAD-7), patient health questionnaire (PHQ-9), and Brief-COPE scales were applied for the evaluation of anxiety, depression, and coping strategies. A total of 197 HCPs participated in the study where 28.4% and 43.1% had anxiety and depression respectively. The prevalence of both anxiety and depression in the majority were found of the minimal to none and mild categories (71.6% vs. 56.9% respectively). The respondents who had received training on COVID-19 had statistically significant lower GAD-7 scores than those who did not (6.32 vs. 8.02 respectively). A significant statistical difference was observed between physicians versus nurses regarding depression based on the working area (p < 0.05). The physician and pharmacist had a significant positive association with brief COPE scores at the 50th centile compared to other HCPs. The female respondents had statistically significant higher mean Brief COPE scores than male respondents (78.11 vs. 69.50 respectively). Our findings illustrate the requirement for efficient policies through administrative, clinical, and welfare perspectives from the regulatory body in preparedness and preventive measures towards such a pandemic that aids HCPs to provide service in a stress-free condition and assurance of a better healthcare system..


Asunto(s)
Adaptación Psicológica , COVID-19 , Personal de Salud , Pandemias , Femenino , Humanos , Masculino , COVID-19/epidemiología , Estudios Transversales , Yemen/epidemiología , Personal de Salud/psicología
6.
J Nepal Health Res Counc ; 20(3): 739-745, 2023 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-36974867

RESUMEN

BACKGROUND: The skill, accessibility, and knowledge of community pharmacists have been paramount in managing pandemics. This study was conducted to assess the knowledge, attitude, and practice of community pharmacy personnel towards tackling COVID-19 pandemic which might help concerned authorities to take effective actions to eliminate the gaps for the management of such pandemic in an efficient way. METHODS: A cross-sectional study was conducted among 428 community pharmacy personnel from different community pharmacies in Kathmandu, Nepal from December 2021 to February 2022. Statistical analysis was done through SPSS® v21 and MedCalc for Windows v12.3.0. RESULTS: Most of the participants (42.76%) had certificate-level degrees in their respective fields and one to five years of working experience (48.84%). Only 29.67% of the respondents had good knowledge towards tackling COVID-19, whereas good attitude and practice were demonstrated by 59.11% and 42.29% respectively. The participants with higher degrees and more working experience had better knowledge, attitude, and practice. Education level bachelor and above was independent predictor of good knowledge (OR 20.69, 95% CI 11.30-37.90). Knowledge and practice (Spearman's rho: 0.135; P ≤0.005) and attitude and practice (Spearman's rho: 0.095; P = 0.049) scores were positively correlated. CONCLUSIONS: The significant association of community pharmacy personnel's educational level with knowledge, attitude, and practices demands the necessity of policy-making bodies' involvement for the mandatory presence of well-qualified pharmacists and regular training at the community pharmacy level. Furthermore, it is high time to reinforce the drug regulatory acts, regulations, and codes all over the nation.


Asunto(s)
COVID-19 , Farmacias , Humanos , COVID-19/epidemiología , Pandemias , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Encuestas y Cuestionarios , Nepal
7.
Adv Pharmacol Pharm Sci ; 2023: 3081422, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36925562

RESUMEN

Pharmacotherapy, in many cases, is practiced at a suboptimal level of performance in low- and middle-income countries (LMICs) although stupendous amounts of data are available regularly. The process of drug development is time-consuming, costly, and is also associated with loads of hurdles related to the safety concerns of the compounds. This review was conducted with the objective to emphasize the role of pharmacometrics in pharmacotherapy and the drug development process in LMICs for rational drug therapy. Pharmacometrics is widely applied for the rational clinical pharmacokinetic (PK) practice through the population pharmacokinetic (popPK) modeling and physiologically based pharmacokinetic (PBPK) modeling approach. The scope of pharmacometrics practice is getting wider day by day with the untiring efforts of pharmacometricians. The basis for pharmacometrics analysis is the computer-based modeling and simulation of pharmacokinetics/pharmacodynamics (PK/PD) data supplemented by characterization of important aspects of drug safety and efficacy. Pharmacometrics can be considered an invaluable tool not only for new drug development with maximum safety and efficacy but also for dose optimization in clinical settings. Due to the convenience of using sparse and routine patient data, a significant advantage exists in this regard for LMICs which would otherwise lag behind in clinical trials.

8.
J Pharm Policy Pract ; 16(1): 45, 2023 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-36932458

RESUMEN

BACKGROUND: The COVID-19 pandemic, a serious global health threat, has excruciating social and economic implications given its transmissibility, lack of therapy, and severity. In such a situation, pharmacists as frontline healthcare professionals hold a significant position to tackle. This study was designed to explore the perception and preparedness of pharmacists working in public sector hospitals amid such a pandemic in Pakistan. METHODS: A total of 11 pharmacists were interviewed for this qualitative study design through a semi-structured interview guide. The interviews were recorded and transcribed verbatim. RESULTS: The thematic content analysis yielded six major themes; understanding of COVID-19, perceptions towards COVID-19, preventive aspects, management aspects, changes to lifestyle, and psychological aspects. Though efficient preparedness and approach to fighting against such pandemics were reported, pharmacists were found susceptible to infection and psychological stress. They also expressed lockdown as an effective measure to prevent the disease from spreading but still were concerned about its economic and social impact. CONCLUSIONS: Adequate planning and facilities from the national level should be made available for strengthening the hospital pharmacy service that helps improve the overall healthcare system of low- and middle-income countries like Pakistan. The provision of a protective facility, incentives, and occupational health surveillance packages are deemed necessary to boost the self-esteem and morale of hospital pharmacists that safeguard the early and effective management of such disasters.

9.
BMJ Open ; 13(2): e067238, 2023 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-36854582

RESUMEN

OBJECTIVE: To estimate the prevalence of chronic kidney disease (CKD) among patients with type 2 diabetes mellitus (T2DM) and determine the sociodemographic and clinical risk factors associated with CKD. DESIGN AND SETTINGS: Cross-sectional study among diabetic outpatients of a tertiary hospital in Nepal. PARTICIPANTS: 201 patients with T2DM above 18 years of age. INTERVENTION: Participants completed a questionnaire regarding their socioeconomic information and underwent pertinent physical and haematological examinations. PRIMARY AND SECONDARY OUTCOMES MEASURE: The prevalence and risk factors of CKD among patients with T2DM. RESULTS: The prevalence of CKD in T2DM was 86.6%. In univariable analysis, the variables like age (p=0.026), hypertension status (p=0.002), duration of diabetes (p=0.009) and haemoglobin levels (p=0.027) were significantly associated with CKD among the participants with T2DM. Kruskal-Wallis H test showed that age was significantly different between various CKD stages. Multivariate analysis demonstrated a significant relationship between CKD with age (Adjusted odds ratio (AOR) 3, 95% CI 1.1 to 8.8) and literacy status (AOR 5.8, 95% CI 1.4 to 24.6) CONCLUSION: Advancing age, concomitant hypertension, increasing duration of T2DM and presence of anaemia were found to be important risk factors of CKD. Age is the most important predictor of CKD showing increasing prevalence in the elderly population. Periodic screening tests are essential at an early age to identify kidney diseases at incipient stages, thereby preventing progression to end-stage renal disease.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipertensión , Insuficiencia Renal Crónica , Humanos , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Estudios Transversales , Centros de Atención Terciaria , Nepal/epidemiología , Prevalencia , Factores de Riesgo , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Pacientes Ambulatorios , Hipertensión/complicaciones , Hipertensión/epidemiología
11.
Ann Med Surg (Lond) ; 78: 103776, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35600203

RESUMEN

Introduction: Health seeking behavior is any activity undertaken by individuals who find themselves with a health-related problem with the aim of seeking an appropriate remedy. It includes decision making that is not homogenous among all as it is determined by different demographic factors. Self-medication and alternative medicine are also choices made by an individual that comes under health care seeking behavior. This study aimed to put light on the health seeking behavior of undergraduate medical students and to assess how they deal with their illnesses, including the practise of self-medication. Methods: In this web-based cross-sectional study, conducted among undergraduate medical students, a total of 210 students were selected through a systematic sampling method. The data were analyzed using SPSS version 20. Frequency was calculated for all the variables. The Mann-Whitney U or Kruskal-Wallis H test was used to see if any difference existed in the response. A significant association was declared at a p-value less than 0.05. Results: Response from 208 respondents was received and among those 88.9% of the respondents were aware of physical, mental and social aspects of health; about 40.8% of the respondents sought help only when their symptoms got worse; while 27.4% of them sought the help of alternative medicine. Around 74.2% of the respondents took medicines without a proper prescription and the commonly self-medicated drug group was NSAIDs. Conclusions: The knowledge of medical science has not satisfactorily ensured better health-seeking behavior and good practices. Also, there is high prevalence of self-medication practice among medical students.

12.
J Obes ; 2022: 6755436, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35342646

RESUMEN

Introduction: Obesity has been reported to be linked with menstrual abnormalities including abnormality in cycle length, duration, and period blood loss. However, which anthropometric parameter is a better marker of menstrual abnormality is yet unknown. This study aims to explore the association of BMI, waist-hip ratio (WHR), and waist-height ratio (WHtR) with menstrual abnormalities. Methods: This was a cross-sectional study conducted among 240 nursing students on two nursing campuses of Nepal. Demographic and menstrual characteristics related data were collected from the participants via the face-to-face interview technique followed by anthropometric measurements. Binary logistic regression was used to study the association of BMI, WHR, and WHtR with menstrual characteristics. Univariable and multivariable regression models were calculated at 95% confidence interval and a P value of 0.05 using a Statistical Package for Social Sciences, IBM SPSS® v21 (IBM, Armonk, New York). Results: Out of 240 participants, 52 participants (21.67%) were underweight (<18.5 kg/m2), and 47 participants (19.58%) were either overweight (≥23 kg/m2) or obese (≥25 kg/m2). Overweight and obese BMI was associated with abnormality in menstrual cycle length (AOR = 4.24; 95% CI = 1.77-10.17), duration of the menstrual period (AOR = 2.52; 95% CI = 1.09-5.81), and periodic menstrual blood loss (AOR = 9.04; 95% CI = 3.55-23.01). Increase in WHtR (>0.5) was associated with abnormal cycle length (AOR = 3.09; 95% CI = 1.09-8.80) and abnormal period duration (AOR = 3.05; 95% CI = 1.10-8.44). An increase in WHR (>0.8) was associated with abnormal cyclical menstrual blood loss (AOR = 4.93; 95% CI = 1.55-15.71). Conclusions: Obesity predisposes to menstrual irregularities. BMI is a better predictor of menstrual irregularity as the increase in BMI is associated with abnormality in menstrual cycle length, period duration, and blood loss. Increased WHR was associated with periodic blood loss only. Increased WHtR was associated with abnormal cycle length and period duration, but not menstrual blood loss.


Asunto(s)
Sobrepeso , Estudiantes de Enfermería , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Nepal/epidemiología , Obesidad/epidemiología , Factores de Riesgo , Circunferencia de la Cintura , Relación Cintura-Estatura , Relación Cintura-Cadera
13.
Nepal J Ophthalmol ; 14(28): 33-40, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37609964

RESUMEN

INTRODUCTION: This retrospective, non-randomized, observational study was conducted at ASG Eye Hospital, Kathmandu to evaluate the outcome of phacoemulsification without anti-Vascular Endothelial Growth Factor (VEGF) in patients with treatment naïve diabetic retinopathy. MATERIALS AND METHODS: Records of all patients who underwent phacoemulsification without Bevacizumab in treatment of naïve patients with any grade of non-proliferative Diabetic Retinopathy (NPDR) were seen. Pre-operative and post-operative visual acuity along with central macular thickness (CMT) was compared. RESULTS: The study comprised 32 eyes of 20 patients with treatment naïve non-proliferative Diabetic Retinopathy who underwent phacoemulsification. Twelve were men and eight were women with an average age of 69.2 years (range 55 years to 83 years). The average preoperative central macular thickness as measured on optical coherence tomography was 254.63± 20.25 microns and 1-month postoperative central macular thickness was 254.72± 19.96 microns; the study did not find any significant difference (p-value 0.918). The average difference in the central macular thickness between the 1-month postoperative and preoperative values was 0.09 microns. CONCLUSION: Uneventful phacoemulsification in eyes with treatment naïve diabetic retinopathy does not cause an increase in central macular thickness after surgery and thus anti-Vascular Endothelial Growth Factor as an adjunct is not mandatory.


Asunto(s)
Extracción de Catarata , Diabetes Mellitus , Retinopatía Diabética , Facoemulsificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/cirugía , Estudios Retrospectivos , Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anciano , Anciano de 80 o más Años
15.
J Nepal Health Res Counc ; 19(1): 1-9, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33934125

RESUMEN

BACKGROUND: The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to hydroxychloroquine alone for COVID-19 treatment. METHODS: PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, and World Health Organization clinical trial registry were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed or random effects for the pooling of studies based on heterogeneities. RESULTS: The risk of mortality (RR=1.16; CI: 0.92-1.46) and adverse cardiac events (OR=1.06; CI: 0.82-1.37) demonstrated a small increment though of no significance. There were no increased odds of mechanical ventilation (OR=0.84; CI: 0.33-2.15) and significant QTc prolongation (OR=0.84, CI: 0.59-1.21). Neither the critical QTc threshold (OR=1.92, CI: 0.81-4.56) nor absolute ?QTc ?60ms (OR=1.95, CI:0.55-6.96) increased to the level of statistical significance among hydroxychloroquine and azithromycin arm compared to hydroxychloroquine alone, but the slightly increased odds need to be considered in clinical practice. CONCLUSIONS: The combination of hydroxychloroquine and azithromycin leads to small increased odds of mortality and cardiac events compared to hydroxychloroquine alone. The use of hydroxychloroquine and azithromycin led to increased odds of QT prolongation, although not statistically significant.


Asunto(s)
Azitromicina/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Enfermedades Cardiovasculares/inducido químicamente , Hidroxicloroquina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Azitromicina/efectos adversos , COVID-19/mortalidad , Enfermedades Cardiovasculares/mortalidad , Quimioterapia Combinada , Humanos , Hidroxicloroquina/efectos adversos , Neumonía Viral/mortalidad , Neumonía Viral/virología , SARS-CoV-2
16.
Life Sci ; 264: 118663, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33121991

RESUMEN

AIMS: COVID-19 outbreak has created a public health catastrophe all over the world. Here, we have aimed to conduct a systematic review and meta-analysis on remdesivir use for COVID-19. MAIN METHODS: We searched Pubmed, Scopus, Embase, and preprint sites and identified ten studies for qualitative and four studies for quantitative analysis using PRISMA guidelines. The quantitative synthesis was performed using fixed and random effect models in RevMan 5.4. Heterogeneity was assessed using the I-squared (I2) test. KEY FINDINGS: Comparing 10-day remdesivir group with placebo or standard of care (SOC) group, remdesivir reduced 14 days mortality (OR 0.61, CI 0.41-0.91), need for mechanical ventilation (OR 0.73, CI 0.54-0.97), and severe adverse effects (OR 0.69, 95% CI 0.54 to 0.88). Clinical improvement on day 28 (OR 1.59, CI 1.06-2.39), day 14 clinical recovery (OR 1.48, CI 1.19-1.84), and day 14 discharge rate (OR 1.41, CI 1.15-1.73) were better among remdesivir group. Earlier clinical improvement (MD -2.51, CI -4.16 to -0.85); and clinical recovery (MD -4.69, CI -5.11 to -4.28) were seen among the remdesivir group. Longer course (10 days) of remdesivir showed a higher discharge rate at day 14 (OR 2.11, CI 1.50-2.97), but there were significantly higher rates of serious adverse effects, and drug discontinuation than the 5-day course. SIGNIFICANCE: Remdesivir showed a better 14 days mortality profile, clinical recovery, and discharge rate. Overall clinical improvement and clinical recovery were earlier among the remdesivir group. 10-day remdesivir showed more adverse outcome than 5-day course with no significant benefits.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Tratamiento Farmacológico de COVID-19 , Adenosina Monofosfato/efectos adversos , Adenosina Monofosfato/uso terapéutico , Alanina/efectos adversos , Alanina/uso terapéutico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Humanos , SARS-CoV-2
18.
Immunopharmacol Immunotoxicol ; 43(1): 30-36, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33356684

RESUMEN

The novel coronavirus disease (COVID-19) has been declared a pandemic by the World Health Organization (WHO) and is ominously threatening the survival of humankind on the whole planet. With a quick spread of the outbreak from its origin, Wuhan, China, to almost all over the world, it has affected more than seven million people to date, hence it has devastated every part of the infrastructural skeleton of governance. Continuously escalating disease burden and lack of proven therapeutic approaches are mounting challenges to health scientists and ultimately to healthcare providers. Although recent studies have shown benefits in decreasing the severity and duration of the illness and there are more benefits compared to risks, plasma therapy cannot be considered as a standard of care until the ongoing trials are completed and they establish definite evidence on its therapeutic efficacy and safety. Though a beneficial aspect may be there, acquiring donors and adequate availability of plasma is equally challenging, and its associated untoward effects related to biological therapeutic agents. The rational practice of CP therapy guided by risk-benefit judgment from aspects of donor and recipient can be a therapeutic option in such a global health crisis.


Asunto(s)
COVID-19/terapia , Humanos , Inmunización Pasiva/efectos adversos , Inmunización Pasiva/métodos , Inmunización Pasiva/tendencias , Pandemias , Resultado del Tratamiento , Sueroterapia para COVID-19
19.
SN Compr Clin Med ; 2(12): 2600-2620, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33103063

RESUMEN

Due to a lack of definitive treatment, many drugs were repurposed for Coronavirus disease (COVID-19) treatment; among them, corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19. Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative syntheses, 41, and quantitative studies, 40, were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I 2) test and random/fixed effect analysis was done to determine the odds/risk ratio. We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76-8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1.89-8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with the corticosteroid-receiving group compared with the SOC alone (RR 2.01, 1.12-3.63) was observed. Neither increased discharge rate (RR 0.79, 0.63-0.99) nor recovery/improvement rate was shown among the corticosteroid-receiving group (OR 0.24, 0.13-0.43). Approximately, the overall 4-day longer hospital stay was found among the treatment groups (MD 4.19, 2.57-5.81). For the negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), approximately a 3-day (MD 2.42, 1.31-3.53) delay was observed with corticosteroid treatment cases. Our study concludes that more severe and critically ill patients tend to get corticosteroids, and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed.

20.
Clin Pharmacol ; 12: 115-121, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32904117

RESUMEN

Coronavirus disease (COVID-19) pandemic has been a global disease burden. It has affected more than sixteen million people in the world within seven months of its first outbreak in Wuhan. Different treatment modalities, therapeutic and prophylactic agents for its therapy are underway. Until the proven therapy gets available, repurposing of drugs is a better way out. Hydroxychloroquine (HCQ) has been a potential recourse of treatment in this regard for COVID-19 management. As different episodes of cardiac adverse events of HCQ are reported, safety concerns are now a prime objective. The risk-benefit analysis is mandatory to address rational drug therapy even in such a global health crisis. In this article, we want to evaluate the safety and efficacy of HCQ in COVID-19 management.

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