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Background The US Food and Drug Administration issued an Emergency Use Authorization for remdesivir use in patients with severe COVID-19. Methods We utilized data from two quaternary, acute care hospitals. The outcomes of interest were the impact of remdesivir on in-hospital death by day 28 as well as time to recovery, clinical improvement, and discharge. We utilized Cox proportional hazards models and stratified log-rank tests. Results 224 patients were included in the study. Median age was 59 years; 67.0% were male; 17/125 patients (13.6%) who received supportive care and 7/99 patients (7.1%) who received remdesivir died. The unadjusted risk for 28-day in-hospital death was lower for patients who received remdesivir compared to patients who received supportive care (HR 0.42; 95% CI: 0.16-1.08). Although this trend remained the same after adjusting for age, sex, race and oxygen requirements on admission (aHR 0.49; 95% CI: 0.19-1.28), as well as chronic comorbidities and use of corticosteroids (aHR 0.44; 95% CI: 0.16-1.23), it did not reach statistical significance. The use of remdesivir was not associated with an increased risk of acute kidney injury (AKI) and liver test abnormalities. Although not statistically significant, the rate ratios for time to recovery, clinical improvement, and discharge were higher in women and Black or African American patients. Conclusion Patients on remdesivir had lower, albeit not significant, all-cause in hospital mortality, and the use of remdesivir did not increase the risk for AKI. Promising signals from this study need to be confirmed by future placebo-controlled randomized clinical trials.

Objective We aimed to externally validate the predictive performance of two recently developed COVID‐19‐specific prognostic tools, the COVID‐GRAM and CALL scores, and prior prognostic scores for community‐acquired pneumonia (CURB‐65), viral pneumonia (MuBLSTA) and H1N1 influenza pneumonia (Influenza risk score) in a contemporary US cohort. Methods We included 257 hospitalised patients with laboratory‐confirmed COVID‐19 pneumonia from three teaching hospitals in Rhode Island. We extracted data from within the first 24 hours of admission. Variables were excluded if values were missing in >20% of cases, otherwise, missing values were imputed. One hundred and fifteen patients with complete data after imputation were used for the primary analysis. Sensitivity analysis was performed after the exclusion of one variable (LDH) in the complete dataset (n = 257). Primary and secondary outcomes were in‐hospital mortality and critical illness (mechanical ventilation or death), respectively. Results Only the areas under the receiver‐operating characteristic curves (RO‐AUC) of COVID‐GRAM (RO‐AUC = 0.775, 95% CI 0.525‐0.915) for in‐hospital death, and CURB65 for in‐hospital death (RO‐AUC = 0.842, 95% CI 0.674‐0.932) or critical illness (RO‐AUC = 0.766, 95% CI 0.584‐0.884) were significantly better than random. Sensitivity analysis yielded similar trends. Calibration plots showed better agreement between the estimated and observed probability of in‐hospital death for CURB65, compared with COVID‐GRAM. The negative predictive value (NPV) of CURB65 ≥2 was 97.2% for in‐hospital death and 88.1% for critical illness. Conclusions The COVID‐GRAM score demonstrated acceptable predictive performance for in‐hospital death. The CURB65 score had better prognostic utility for in‐hospital death and critical illness. The high NPV of CURB65 values ≥2 may be useful in triaging and allocation of resources.

Background In order for healthcare systems to prepare for future waves of COVID-19, an in-depth understanding of clinical predictors is essential for efficient triage of hospitalized patients. Methods We performed a retrospective cohort study of 259 patients admitted to our hospitals in Rhode Island to examine differences in baseline characteristics (demographics and comorbidities) as well as presenting symptoms, signs, labs, and imaging findings that predicted disease progression and in-hospital mortality. Results Patients with severe COVID-19 were more likely to be older (p = 0.02), Black (47.2% vs. 32.0%, p = 0.04), admitted from a nursing facility (33.0% vs. 17.9%, p = 0.006), have diabetes (53.9% vs. 30.4%, p<0.001), or have COPD (15.4% vs. 6.6%, p = 0.02). In multivariate regression, Black race (adjusted odds ratio [aOR] 2.0, 95% confidence interval [CI]: 1.1–3.9) and diabetes (aOR 2.2, 95%CI: 1.3–3.9) were independent predictors of severe disease, while older age (aOR 1.04, 95% CI: 1.01–1.07), admission from a nursing facility (aOR 2.7, 95% CI 1.1–6.7), and hematological co-morbidities predicted mortality (aOR 3.4, 95% CI 1.1–10.0). In the first 24 hours, respiratory symptoms (aOR 7.0, 95% CI: 1.4–34.1), hypoxia (aOR 19.9, 95% CI: 2.6–152.5), and hypotension (aOR 2.7, 95% CI) predicted progression to severe disease, while tachypnea (aOR 8.7, 95% CI: 1.1–71.7) and hypotension (aOR 9.0, 95% CI: 3.1–26.1) were associated with increased in-hospital mortality. Conclusions Certain patient characteristics and clinical features can help clinicians with early identification and triage of high-risk patients during subsequent waves of COVID-19.

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Highlights In this observational study, no clear clinical benefit associated with HCQ use in COVID-19 patients was found. In our centre, HCQ use did not decrease the risk of in-hospital death. HCQ use did not decrease the time to clinical improvement or the length of hospitalisation. Antimicrobial stewardship programmes can allow for the safe evaluation of agents and treatments against COVID-19.

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid. Majority of the PTC carries an excellent prognosis. However, patients with tall cell variant (TCV) of papillary thyroid carcinoma have a worse prognosis than those with the classic variant. On the other hand, squamous cell carcinoma of the thyroid (SCT) is an unusual neoplasm thought to arise as a primary tumor or as a component of an anaplastic or undifferentiated carcinoma. We report a patient with TCV of PTC presenting years later with squamous transformation. In addition, the patient was found to have BRAF mutation. Such dedifferentiation is considered to be a rare phenomenon and has been reported only in the form of case reports in the literature. The relationship between BRAFV600E mutation and squamous cell transformation of papillary thyroid cancer is unknown at this time. Meticulous pathology is needed to identify such variants. Our patient responded to treatment with concurrent chemotherapy with carboplatin and paclitaxel along with radiation.