Background The coronavirus disease 2019 (COVID-19) pandemic has required timely and informed decisions about treatment recommendations for clinical practice. One such drug used for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is remdesivir (RDV), and several cardiac side effects have been reported including bradyarrhythmia (e.g., transient sinus bradycardia, symptomatic sinus bradycardia, complete atrioventricular (AV) block). The current study aimed to explore the association between RDV treatment for SARS-CoV-2 infection and the risk of bradyarrhythmia by presenting a review and meta-analysis of available published studies. Methods We presented a review of published literature and meta-analysis of observational studies (MOOSE). A narrative summary of RDV and bradyarrhythmia in COVID-19 infection and pooled analysis of observational studies that meet inclusion criteria was included. Studies included were published between January 2020 and December 2021 (identified through PubMed and ScienceDirect) and examined the association between treatment with RDV in SARS-CoV-2 infection and the risk of bradyarrhythmia. Results Three studies (two retrospective cohort studies and one prospective cohort study) met inclusion criteria for pooled meta-analysis of bradyarrhythmia and RDV therapy in COVID-19 patients. Treatment with RDV was associated with increased risk of sinus bradycardia when compared to controls (odds ratio 3.27 (95% confidence interval 1.90 - 5.63)). In the pooled analysis, the incidence of bradycardia in those that received RDV was 34.07% vs. 18.13% among controls. Thirteen case reports, three case series, and three disproportionality analyses were identified in review of the literature. Conclusion Data from real-world observational studies suggest that treating COVID-19 patients with RDV may predispose the development of bradyarrhythmia. The importance of this observation is of uncertain clinical significance as some observational studies have reported more favorable outcomes among patients who experience bradycardia after RDV therapy. The current study is limited by the small number of studies that could be meaningfully pooled and more well-designed cohort studies are needed to explore this association.
We discuss a case report of a 38-year-old uncircumcised male on pre-exposure prophylaxis for human immunodeficiency virus who presents to the emergency department for painful lesions over his penile region following unprotected sexual intercourse. Following the development of these lesions he developed painless, itchy pustules over his bilateral arms and back. He also had extensive pain and swelling over his penile region, which prevented him from unretracting his foreskin. Chlamydia trachomatis, Herpes simplex virus, Neisseria gonorrhoeae, and syphilis tests were negative. He was positive for orthopoxvirus using polymerase chain reaction. A diagnosis of paraphimosis as a complication of monkeypox infection was made.
The rapid spread of COVID-19 worldwide resulted in critical illness and mortality. Supportive measures have been the center stage for therapy. One crucial question since the onset of the deadly SARS-CoV-2 pandemic was the development of a vaccine. Developed by Moderna, the mRNA1273 vaccine, Elasomeran contains a lipid nanoparticle (LNP) that encapsulates a nucleoside-modified messenger RNA (modRNA), which encodes the spike (S) protein of the SARS-CoV-2 virus. This vaccine is administered as a dual dose regimen 28 days apart (1 month). Seven days following Pfizer's BNT162b2 vaccine, mRNA1273 received FDA-Emergency Use Authorization (EUA) on December 18, 2020, making it the second candidate. During the randomized, placebo-controlled, observer-blinded, phase 3 clinical trials, the mRNA1273 vaccine demonstrated 94.1% efficacy. Clinical trials in children aged 5–12 and adolescents also received FDA-EUA. The Moderna vaccine is also the second vaccine following Pfizer's BNT162b2 vaccine to receive full FDA approval on January 31, 2020, for use in individuals aged 18 and above for COVID-19 prevention. Real-world outcomes have been profoundly positive, reflecting its effectiveness in reducing hospitalization rates, infections, and mortality. This review article encompasses Moderna's vaccine journey, summarizing the mRNA1273 vaccine's preclinical studies, phase 1, phase 2, phase 3 clinical trials, dosages, immune response, adverse effects, FDA-EUA, FDA approval, and real-world outcomes discussing the overall effectiveness of the vaccine in healthy individuals, individuals with pre-existing underlying medical conditions, single-dose effects, delayed second dose, SARS-CoV-2 variants, and mix and match vaccines.
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