Smartphone electrocardiogram for QT interval monitoring in Coronavirus Disease 2019 (COVID-19) patients treated with Hydroxychloroquine.

INTRODUCTION: The global pandemic of Corona Virus Disease 2019 (COVID-19) has led to the re-purposing of medications, such as hydroxychloroquine and lopinavir-ritonavir in the treatment of the earlier phase of COVID-19 before the recognized benefit of steroids and antiviral. We aim to explore the corrected QT (QTc) interval and 'torsadogenic' potential of hydroxychloroquine and lopinavir-ritonavir utilising a combination of smartphone electrocardiogram and 12-lead electrocardiogram monitoring. MATERIALS AND METHODS: Between 16-April-2020 to 30-April- 2020, patients with suspected or confirmed for COVID-19 indicated for in-patient treatment with hydroxychloroquine with or without lopinavir-ritonavir to the Sarawak General Hospital were monitored with KardiaMobile smartphone electrocardiogram (AliveCor®, Mountain View, CA) or standard 12-lead electrocardiogram. The baseline and serial QTc intervals were monitored till the last dose of medications or until the normalization of the QTc interval. RESULTS: Thirty patients were treated with hydroxychloroquine, and 20 (66.7%) patients received a combination of hydroxychloroquine and lopinavir-ritonavir therapy. The maximum QTc interval was significantly prolonged compared to baseline (434.6±28.2msec vs. 458.6±47.1msec, p=0.001). The maximum QTc interval (456.1±45.7msec vs. 464.6±45.2msec, p=0.635) and the delta QTc (32.6±38.5msec vs. 26.3±35.8msec, p=0.658) were not significantly different between patients on hydroxychloroquine or a combination of hydroxychloroquine and lopinavir-ritonavir. Five (16.7%) patients had QTc of 500msec or more. Four (13.3%) patients required discontinuation of hydroxychloroquine and 3 (10.0%) patients required discontinuation of lopinavirritonavir due to QTc prolongation. However, no torsade de pointes was observed. CONCLUSIONS: QTc monitoring using smartphone electrocardiogram was feasible in COVID-19 patients treated with hydroxychloroquine with or without lopinavir-ritonavir. The usage of hydroxychloroquine and lopinavir-ritonavir resulted in QTc prolongation, but no torsade de pointes or arrhythmogenic death was observed.

First Asian case of biopsy-confirmed manubriosternal joint involvement in rheumatoid arthritis.

Rheumatoid arthritis (RA) is an inflammatory polyarthritis that typically affects the small joints but can also involve the manubriosternal joint (MSJ). Although cases of MSJ involvement in RA are rare, such cases present with chest pain, a mass-like lesion, and subluxation. These cases can also be diagnosed incidentally, while patients are asymptomatic. It is important to differentiate RA involving the MSJ from other diseases such as ankylosing spondylitis that can affect the MSJ. Several cases of RA affecting the MSJ have been reported in Western countries, but none have been reported to date in Asia, especially with disease activity of RA. Here, we report a case of RA in the MSJ that was confirmed by imaging and histological investigation in a middle-aged Asian woman.

Effect of induction agent on posttransplant outcomes in deceased donor kidney transplant recipients: influence of race.

BACKGROUND: The effect of induction agents on kidney transplant outcomes with respect to race is not well studied. We aimed to compare the outcomes of deceased donor kidney (DDK) transplants in African American (AA) and non-African American (non-AA) recipients who underwent induction therapy with rabbit-antithymoglobulin (rATG), alemtuzumab (ALE), or interleukin (IL)-2 receptor blocker (IL-2B) and were maintained on a calcineurin inhibitor, (CNI)/mycophenolate mofetil (MMF)-based regimen with/without steroid. METHODS: Using OPTN/UNOS database, we identified patients (≥18 years) who underwent DDK transplants from January 2000 to December 2008 and received rATG (n = 21,506), ALE (n = 3476), or IL- 2B (n = 17,869) and were maintained on a CNI/MMF-based regimen with/without steroids. Multivariate analysis was performed adjusting for steroid use and factors known to adversely impact graft outcome. RESULTS: The median follow up was 29.6 months (range, 10.7-60.1). ALE induction as compared to rATG had inferior adjusted graft (P < .001) and patient (P = .003) survivals in non-AA recipients but similar in AA recipients. In non-AA recipients, IL-2 induction as compared with rATG had similar adjusted graft but inferior patient survival (P = .04), and in AA recipients had inferior graft (P = .002) but similar patient survival. CONCLUSION: Our study shows racial differences in renal transplant outcomes with regard to induction modality.

Acute gastroenteritis caused by multiple enteric pathogens in children.

Of 303 children hospitalized with acute non-bloody, non-mucoid diarrhoea, 69 (22.8%) had polymicrobial infection, including 52 (17.2%) multiple viral infection and 17 (5.6%) viral and bacterial co-infection. Rotavirus had the most important role in both categories; thus the control of rotavirus infection is crucial for maintaining children's health in Taiwan.