Background
Treatment of coronavirus disease-2019 (Covid-19) with nirmatrelvir plus ritonavir (NMV-r) in high-risk non-hospitalized unvaccinated patients reduced the risk of progression to severe disease. However, the potential benefits of NMV-r among vaccinated patients are unclear.
Methods
We conducted a comparative retrospective cohort study using the TriNetX research network. Patients ≥18 years of age who were vaccinated and subsequently developed Covid-19 between December 1, 2021, and April 18, 2022, were included. Cohorts were developed based on the use of NMV-r within five days of diagnosis. The primary composite outcome was all-cause emergency room (ER) visit, hospitalization, or death at a 30-days follow-up. Secondary outcomes included individual components of primary outcomes, multisystem symptoms, Covid-19 associated complications, and diagnostic test utilization.
Results
After propensity score matching, 1,130 patients remained in each cohort. A primary composite outcome of all-cause ER visits, hospitalization, or death in 30 days occurred in 89 (7.87%) patients in the NMV-r cohort as compared to 163 (14.4%) patients in the non-NMV-r cohort (OR 0.5, CI 0.39-0.67; p<0.005) consistent with 45% relative risk reduction. A significant reduction in multisystem symptom burden and subsequent complications such as lower respiratory tract infection, cardiac arrhythmia, and diagnostic radiology testing were noted in NMV-r treated patients. There was no apparent increase serious complications between days 10 to 30.
Conclusion
Treatment with NMV-r in non-hospitalized vaccinated patients with Covid-19 was associated with a reduced likelihood of emergency room visits, hospitalization, or death. Complications and overall resource utilization were also decreased.
The world health organization (WHO) has declared the novel coronavirus disease (COVID-19 or 2019-nCoV) outbreak a pandemic, and quarantines are playing a vital role in containing its spread. But globally, the defections of the quarantined subjects are raising serious concerns. If COVID-19 positive, the absconding quarantine subjects can infect more people, which makes their timely detection vital. As the literature suggests, a wearable makes a subject more compliant towards healthcare routines/restrictions; thus, in this work, we have designed an IoT based wearable quarantine band (IoT-Q-Band) to detect the absconding. While designing it, we kept in mind the cost, global supply chain disruption, and COVID-19 quarantine duration, which the WHO recommends. This wearable prototype, with the bundled mobile app, reports and tracks the absconding quarantine subjects in real-time. IoT-Q-Band is an economical solution that could benefit lowincome regions to prevent the spread of COVID-19.
Current evidence is limited to small studies describing the association between cardiac injury and outcomes in patients with COVID-19. To address this, we performed a comprehensive meta-analysis of studies in COVID-19 patients to evaluate the association between cardiac injury and all-cause mortality, intensive care unit (ICU) admission, mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and coagulopathy. Further, studies comparing cardiac biomarker levels in survivors versus non-survivors were included. A total of 14 studies (3175 patients) were utilized for the final analysis. Cardiac injury in patients with COVID-19 was associated with higher risk of mortality [RR:7.79; 95%CI: 4.69-13.01; I
2
=58%], ICU admission [RR: 4.06; 95%CI: 1.50-10.97; I
2
=61%], mechanical ventilation [RR: 5.53; 95%CI: 3.09-9.91; I
2
=0%], and developing coagulopathy [RR: 3.86; 95%CI:2.81-5.32; I
2
=0%]. However, cardiac injury was not associated with increased risk of ARDS [RR:3.22; 95%CI:0.72-14.47; I
2
=73%] or AKI [RR: 11.52, 95%CI:0.03-4159.80; I
2
=0%]. The levels of hs-cTnI [MD:34.54 pg/ml;95%CI: 24.67- 44.40 pg/ml; I
2
=88%], myoglobin [MD:186.81 ng/ml;95% CI: 121.52-252.10 ng/ml; I
2
=88%], NT-pro BNP [MD:1183.55 pg/ml; 95% CI: 520.19-1846.91 pg/ml: I
2
=96%] and CK-MB [MD:2.49 ng/ml;95% CI: 1.86-3.12 ng/ml; I
2
=90%] were significantly elevated in non-survivors compared with survivors with COVID-19 infection. The results of this meta-analysis suggest that cardiac injury is associated with higher mortality, ICU admission, mechanical ventilation and coagulopathy in patients with COVID-19.
Dietary constituents are shown to play an important role in the development of diabetes. Studies have shown that the fruits of Emblica officinalis Gaertn or Phyllanthus emblica Linn, colloquially known as Indian gooseberry or amla and/or some of its important constituents (including gallic acid, gallotanin, ellagic acid and corilagin), possess anti-diabetic effects through their antioxidant and free radical scavenging properties. Amla has also been reported to prevent/reduce hyperglycemia, cardiac complications, diabetic nephropathy, neuropathy, cataractogenesis and protein wasting. However, clinical trial data with human subjects are limited and preliminary. For the first time this review summarizes the anti-diabetic affects of amla and also addresses the mechanisms mediating these properties.
This cross-sectional study assesses the annual proportions and overall trend of female first authors in cardiology randomized clinical trials from 2011 to 2020.
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