Nevin Manimala

J Assoc Physicians India. 2024 Aug;72(8):40-43. doi: 10.59556/japi.72.0598.

ABSTRACT

OBJECTIVES: The objectives of the study were to (1) study risk factors of thrombotic complications in coronavirus disease 2019 (COVID-19) pneumonitis, and (2) study progression of thrombotic complications after COVID-19 pneumonitis and its outcome.

MATERIALS AND METHODS: A total of 50 COVID-19-positive admitted patients were studied using a purposive random sampling method. A questionnaire was used to collect data from patients’ case records.

RESULTS: Diabetes (42%) and hypertension (40%) were common comorbidities. The most common presentation of patients was thromboembolism, followed by cerebrovascular accident (CVA) and myocardial infarction (MI). Around 32% of patients died during the course of treatment. Deaths were more commonly seen in the age-group of 56 years or above than in those below 56 years. Death rates were higher among the group of patients with diabetes, hypertension, and ischemic heart diseases than the group of patients without those diseases, respectively. Patients in whom intubation was needed had a higher death rate than those without the need for it. The mean C-reactive protein (CRP) value was higher in patients who died than in those who survived. The death rate was lower in patients who were thrombolysed than in those who were not, in both pulmonary embolism and MI cases.

CONCLUSION: The most common age-group admitted to the hospital was 46-55 years. The two most common underlying risk factors were diabetes and hypertension. Three common presentations of patients were thromboembolism, followed by CVA and MI. Around 32% of patients died during the course of treatment. Deaths were more commonly seen in the age-group of 56 years or above than in those below 56 years. Death rates were higher among the group of patients with diabetes, hypertension, and ischemic heart diseases than the group of patients without those diseases, respectively. Patients in whom intubation was needed had a higher death rate than those without the need for it. The mean CRP value was higher in patients who died than in those who survived.

PMID:39163061 | DOI:10.59556/japi.72.0598

J Assoc Physicians India. 2024 Aug;72(8):36-39. doi: 10.59556/japi.72.0575.

ABSTRACT

INTRODUCTION: Oxidative stress (OS) may have a role in the pathogenesis and severity of the coronavirus disease 2019 (COVID-19) disease. The present study was conducted to estimate the association of inflammatory markers, total antioxidant status (TAS), and malondialdehyde (MDA) levels with the severity of the disease and to identify their trends after recovery.

MATERIALS AND METHODS: Adult patients admitted with moderate or severe COVID-19 were included after obtaining written informed consent from patient or next of kin. Patients who were critically ill, on ventilator, or in sepsis/septic shock were excluded. Levels of inflammatory markers, TAS, and OS as measured by MDA were estimated within 24 hours of admission and reevaluated at 12 weeks following discharge.

RESULTS: The mean age of the 40 patients (42.5% females) was 55 ± 15 years. TAS values (in trolox equivalents/L) were significantly reduced in severe compared to moderate COVID-19 patients at admission (7.2 ± 4.19 vs 12.3 ± 5.21). These increased at 12 weeks after discharge. The MDA levels (in nmol/mL) were significantly higher in severe in comparison to moderate disease (7.1 ± 2.68 vs 4.1 ± 1.81). These values showed a downward trend 12 weeks after discharge in severe disease group. Admission levels of interleukin-6 (IL-6), D-dimer, and lactate dehydrogenase (LDH) were statistically higher in severe COVID-19 patients in contrast to moderate disease.

CONCLUSION: Moderate and severe COVID-19 are associated with a state of high OS and a low total antioxidant levels which tend to recover at 3 months following discharge.

PMID:39163060 | DOI:10.59556/japi.72.0575

J Assoc Physicians India. 2024 Aug;72(8):26-29. doi: 10.59556/japi.72.0526.

ABSTRACT

OBJECTIVE: In this study, we tried to analyze the utility of the HACOR score in the acute exacerbation of post-tuberculosis obstructive airway disease (post-TB-OAD).

MATERIALS AND METHODS: The HACOR score for patients in acute exacerbation of post-TB-OAD who needed noninvasive ventilation (NIV) support was calculated at 1, 12, 24, and 48 hours. The history of NIV success or failure was noted. Using a cutoff score of >5, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated. The receiver operating characteristic (ROC) curve was plotted based on the HACOR score 1 hour after the NIV trial. In subjects requiring NIV for up to 2 days, the trend in the HACOR score was analyzed using a paired t-test.

RESULTS: A total of 38 out of 100 patients belonged to the NIV failure group. The mean HACOR score at 1 hour was 9.47 in the NIV failure group. The sensitivity was 89.47%, and the specificity was 87.09% for a score of >5. The positive predictive value and negative predictive value were 80.95 and 93.10%, respectively. The area under the curve (AUC) for the ROC was 0.853. The mean score showed an upward trend in the NIV failure group and a downward trend in the NIV success group. The change in the score in the NIV success group was statistically significant (t = -4.290, p-value = 0.00044).

CONCLUSION: The HACOR score can predict NIV failure in patients with acute exacerbation of post-TB-OAD.

PMID:39163058 | DOI:10.59556/japi.72.0526

J Assoc Physicians India. 2024 Aug;72(8):22-25. doi: 10.59556/japi.72.0613.

ABSTRACT

BACKGROUND AND AIM: Coronavirus disease 2019 (COVID-19) led to a major global health crisis, leading to a worldwide pandemic. Several therapeutic interventions have been tried with varied results. The purpose of this academic work was to assess the efficacy of immunoglobulin M (IgM)-enriched Ig in the management of patients with severe COVID-19 pneumonia.

MATERIALS AND METHODS: In this retrospective cohort study, severe COVID-19 pneumonia patients who received IgM-enriched immunoglobulin, in addition to standard-of-care treatment, were retrospectively enrolled. Levels of inflammatory biomarkers, oxygenation status, and organ dysfunction were evaluated, and differences were noted after giving IgM-supplemented IgM.

RESULTS: Data from 32 consecutive severe COVID-19 patients admitted to medical intensive care units (ICUs) were analyzed. After giving IgM-enriched Ig, there was an improvement in oxygenation indices as shown by saturation of oxygen/fraction of inspired oxygen (SpO₂/FiO₂) on days 3 and 7, but it was not statistically significant. Oxygen support could be de-escalated in 13 (40.6%) patients on day 3 and in 8 (25%) patients on day 7, after giving IgM-enriched Ig. After giving IgM-enriched Ig, there was a reduction in the levels of all the studied inflammatory markers [interleukin-6 (IL-6), D-dimer, and ferritin) on days 3 and 7, but it was statistically significant only for IL-6. The overall ICU mortality was 53.1%.

CONCLUSION: Outcomes of patients with severe COVID-19 requiring ICU care remain dismal. IgM-enriched Ig may be helpful in improving oxygenation and combating cytokine storm in these patients. However, in the present study, the improvement in oxygenation indices (SpO₂/FiO₂) and reduction in inflammatory markers like D-dimer and ferritin were not statistically significant. Hence, larger randomized controlled trials are required to get more definitive evidence to support this therapy and show significant clinical and mortality benefits.

PMID:39163057 | DOI:10.59556/japi.72.0613

J Assoc Physicians India. 2024 Aug;72(8):15-21. doi: 10.59556/japi.72.0495.

ABSTRACT

AIM: The study aims to identify factors influencing referral patterns and delays in rheumatoid arthritis (RA) patients across clinical settings in India.

MATERIALS AND METHODS: A prospective, multicenter, observational study collected data from eight centers using the Indian Rheumatology Association (IRA) database. Patient-related factors and referral factors were determined based on patient narration. The modified PRASAD scale categorized patients’ socioeconomic status.

RESULTS: The study included 4,643 RA patients from eight centers. Data from 35 patients were excluded due to inconsistent reporting of diagnosis and delay. Lack of awareness was the predominant factor causing the delay in referral. Approximately, 39% of patients were referred to the rheumatology specialty within 6 months of disease onset, while 26% reported later, and 34% reported over 2 years. Referral delays were linked to socioeconomic factors in Madhya Pradesh (21.43%) and West Bengal (28.57%). Lack of awareness about the disease and rheumatology specialty was highest in West Bengal (100%), followed by Delhi and Rajasthan (93.70%). Misconceptions about modern medicine, reluctance to refer patients to the rheumatologist, and previous treatment by other specialities were other factors influencing referral delay. Primary care clinicians’ unawareness of the rheumatology specialty was the primary reason for referral delay in Gujarat (33.56%) and Delhi and Rajasthan (25.18%).

CONCLUSION: Both patient and healthcare professional-related factors contribute to referral delays in RA patients. Major factors causing referral delays include reluctance to refer and inadequate knowledge about rheumatology among primary care physicians and the general public. Patients’ education and occupation also influence the timing of referrals to specialty care.

PMID:39163056 | DOI:10.59556/japi.72.0495

JAMA Netw Open. 2024 Aug 1;7(8):e2423335. doi: 10.1001/jamanetworkopen.2024.23335.

NO ABSTRACT

PMID:39163050 | DOI:10.1001/jamanetworkopen.2024.23335

JAMA Netw Open. 2024 Aug 1;7(8):e2428235. doi: 10.1001/jamanetworkopen.2024.28235.

NO ABSTRACT

PMID:39163049 | DOI:10.1001/jamanetworkopen.2024.28235

JAMA Netw Open. 2024 Aug 1;7(8):e2429286. doi: 10.1001/jamanetworkopen.2024.29286.

NO ABSTRACT

PMID:39163047 | DOI:10.1001/jamanetworkopen.2024.29286

JAMA Netw Open. 2024 Aug 1;7(8):e2423385. doi: 10.1001/jamanetworkopen.2024.23385.

ABSTRACT

IMPORTANCE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained use primarily due to their weight-reduction effects, although a regulatory review was undertaken for potential suicidality concern.

OBJECTIVES: To evaluate potential signals for suicidal and self-injurious adverse drug reactions (ADRs) associated with the GLP-1 RAs semaglutide and liraglutide.

DESIGN, SETTING, AND PARTICIPANTS: Disproportionality analysis through the case-control design using the World Health Organization (WHO) global database of suspected ADRs. Participants were clinical patients worldwide experiencing an ADR suspectedly attributable to semaglutide or liraglutide in the database from inception to August 30, 2023. Data were analyzed from September to December 2023.

EXPOSURE: Treatment with semaglutide or liraglutide regardless of indication or treatment duration.

MAIN OUTCOMES AND MEASURES: Reporting odds ratio (ROR) and the bayesian information component (IC) with 95% CIs were calculated as measures of disproportionate reporting of suicidal and self-injurious ADRs associated with semaglutide and liraglutide compared with all other medications. Sensitivity analyses were conducted including patients with coreported use of antidepressants and benzodiazepines and using dapagliflozin, metformin, and orlistat as comparators. A disproportionality signal was considered when the lower limits of the ROR and IC were above 1 and 0, respectively.

RESULTS: A total of 107 (median [IQR] age 48 [40-56] years; 59 female patients [55%]) and 162 (median [IQR] age 47 [38-60] years; 100 female patients [61%]) cases of suicidal and/or self-injurious ADRs were reported between November 2000 and August 2023 with semaglutide and liraglutide, respectively. Significant disproportionality was detected only for semaglutide-associated suicidal ideation (ROR, 1.45; 95% CI, 1.18-1.77; IC, 0.53; 95% CI, 0.19-0.78), which remained significant in patients with coreported use of antidepressants (ROR, 4.45; 95% CI, 2.52-7.86; IC, 1.96; 95% CI, 0.98-2.63) and benzodiazepines (ROR, 4.07; 95% CI, 1.69-9.82; IC, 1.67; 95% CI, 0.11-2.65), when compared with dapagliflozin (ROR, 5.56; 95% CI, 3.23-9.60; IC, 0.70; 95% CI, 0.36-0.95), metformin (ROR, 3.86; 95% CI, 2.91-5.12; IC, 1.20; 95% CI, 0.94-1.53) and orlistat (ROR, 4.24; 95% CI, 2.69-6.69; IC, 0.70; 95% CI, 0.36-0.95).

CONCLUSIONS AND RELEVANCE: This study using the WHO database found a signal of semaglutide-associated suicidal ideation, which warrants urgent clarification.

PMID:39163046 | DOI:10.1001/jamanetworkopen.2024.23385

JAMA Netw Open. 2024 Aug 1;7(8):e2428267. doi: 10.1001/jamanetworkopen.2024.28267.

ABSTRACT

IMPORTANCE: Approximately one-fifth of Medicare Advantage (MA) contracts terminated their participation in the MA program between 2011 and 2020. Little is known about subsequent insurance choices following a termination.

OBJECTIVE: To examine the insurance destinations of MA enrollees and the characteristics of enrollees who switch into traditional Medicare (TM) after a contract termination.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined MA program data of MA beneficiaries in the Medicare Master Beneficiary File from 2016 to 2018. Statistical analysis was performed from June 2023 to April 2024.

EXPOSURES: Beneficiary characteristics, including age, sex, race and ethnicity, dual eligibility; hospital, nursing home, and home health utilization; and contract characteristics, including plan type, vertical integration, premium, and MA star rating.

MAIN OUTCOME AND MEASURES: The main outcome was switching to TM in the year immediately after termination. We also evaluated the characteristics of contracts among those who remained in MA.

RESULTS: A total of 117 681 beneficiaries were included in this analysis (64 654 [54.9%] female; 409 [0.4%] American Indian or Alaska Native; 2817 [2.4%] Asian; 76 725 [16.8%] Black; 11 131 [9.5%] Hispanic; 81 226 [69.0%] White; and 2373 [2.0%] other race or ethnicity; 27 078 [23.0%] dual-eligible; mean [SD] age, 71.2 [10.4] years). Following a contract termination, 20.1% (95% CI, 19.9%-20.4%) of enrollees switched to TM, including 32.7% (95% CI, 32.4%-33.1%) of dual-eligible beneficiaries and 16.4% (95% CI, 16.2%-16.5%) of non-dual-eligible beneficiaries. In nonterminated contracts, the concurrent switch rate was 6.2% (95% CI, 6.2%-6.2%) for all, 10.4% (95% CI, 10.4%-10.4%) for dual-eligible beneficiaries and 5.1% (95% CI, 5.1%-5.1%) for non-dual-eligible enrollees. The highest switch rates to TM were among Black enrollees (32.3% [95% CI, 31.7%-32.8%]) and those with prior use of hospital (31.3% [95% CI, 30.7%-31.9%], nursing home, 41.4% [95% CI, 40.4%-42.4%], or home health care (28.3% [95% CI, 27.4%-29.2%]). Beneficiaries who stayed in MA selected higher-rated star plans (mean posttermination contract star rating of 3.8 [95% CI, 3.8-3.8] stars compared with 3.3 [95% CI, 3.3-3.3] stars in the terminated year), but did not pay more in monthly premiums with 66.5% (95% CI, 66.2%-66.8%) paying the same or lower premiums.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, 1 in 5 MA beneficiaries switched to TM after a contract termination, with Black beneficiaries and those with more intensive health needs having the highest switch rates. These findings highlight the need to examine consequences of contract terminations and subsequent insurance destinations on access to care and health outcomes, especially among those with marginalized race and ethnicity, those who are dual-eligible, and beneficiaries with higher health care needs.

PMID:39163045 | DOI:10.1001/jamanetworkopen.2024.28267