Methods We designed a cross‐sectional, observational follow‐up for 284 COVID‐19 patients involving healthy patients, smokers, diabetics, and diabetic plus smokers recruited from May 1, 2020 to June 25, 2020. The clinical features, severity, duration, and outcome of the disease were analyzed. Results Of 284 COVID‐19 patients, the median age was 48 years (range, 18–80), and 33.80% were female. Common symptoms included fever (85.56%), shortness of breath (49.65%), cough (45.42%), and headache (40.86%). Patients with more than one comorbidity (diabetes and smoking) presented as severe‐critical cases compared to healthy patients, diabetics, and smokers. Smokers presented with a lower rate of death in comparison to diabetic patients and diabetic + smoking, furthermore, smoking was less risky than diabetes. Although the mortality rate was high in patients with smokers compared to healthy patients (4.22%, the hazard ratio [HR], 1.358; 95% confidence interval [CI], 1.542–1.100; p = .014), it was less than in diabetics (7.04%, HR 1.531, 95% CI: 1.668–1.337, p = .000), and diabetic plus smoker (10.00%, HR, 1.659; 95% CI, 1.763–1.510; p = .000). Conclusion Multiple comorbidities are closely related to the severity of COVID‐19 disease progression and the higher mortality rate. Smokers presented as mild cases compared to diabetic and diabetic + smoking patients, who presented as severe to critical cases. Although a higher death rate in smokers was seen compared with healthy patients, this was smaller when compared to diabetic and diabetic + smoking patients.
Context COVID-19 caused a worldwide pandemic, and there are still many uncertainties about the disease. C-reactive protein (CRP) levels could be utilized as a prognosticator for disease severity in COVID-19 patients. Objectives This study aims to determine whether CRP levels are correlated with COVID-19 patient outcomes and length of stay (LoS). Methods A retrospective cohort study was conducted utilizing data obtained between March and May 2020. Data were collected by abstracting past medical records through electronic medical records at 10 hospitals within CommonSpirit Health. Patients were included if they had a positive COVID-19 test from a nasopharyngeal swab sample, and if they were admitted and then discharged alive or had in-hospital mortality and were ≥18 years. A total of 541 patients had CRP levels measured and were included in this report. Patient outcome and LoS were the endpoints measured. Results The 541 patients had their CRP levels measured, as well as the demographic and clinical data required for analysis. While controlling for body mass index (BMI), number of comorbidities, and age, the first CRP was significantly predictive of mortality (p<0.001). The odds ratio for first CRP indicates that for each one-unit increase in CRP, the odds of death increased by 0.007. For LoS, the first CRP was a significant predictor (p<0.001), along with age (p=0.002). The number of comorbidities also predicted LoS (p=0.007), but BMI did not. The coefficient for the first CRP indicates that, for each one-unit increase in CRP, LoS increased 0.003 days. Conclusions The results indicate that there is a positive correlation between the CRP levels of COVID-19 patients and their respective outcomes with regard to death and LoS.
The goal of this study was to assess the clinical effectiveness and safety profile of the COVID‐19 treatment protocol (containing both hydroxychloroquine (HCQ) and azithromycin) in an Iraqi specialised hospital. Methods This prospective study used a pre‐ and post‐intervention design without a comparison group. The intervention was routine Ministry of Health (MOH) approved the management of COVID‐19 for all patients. The study was conducted in a public healthcare setting in Baghdad, Iraq from March 1st to May 25, 2020. The study outcome measures included the changes in clinical and biochemical parameters during the hospitalisation period. Paired t‐test and Chi‐square test were used to compare the measures of vital signs, lab tests and symptoms before and after treatment. Results The study included 161 patients who were admitted with positive RT‐PCR and clinical symptoms of COVID‐19. In terms of severity, 53 (32.9%) patients had amild condition, 47 (29.2%) had moderate condition, 35 (21.7%) had severe condition and 26 (16.1%) had critical condition. Most patients (84.5%) recovered and were discharged without symptoms after testing negative with RT‐PCR, while 11 (6.8%) patients died during the study period. The signs and symptoms of COVID‐19 were reduced significantly in response to a therapy regimen containing HCQ and azithromycin. The most common reported side effects were stomach pain, hypoglycemia, dizziness, itching, skin rash, QT prolongation, arrhythmia, and conjunctivitis. Conclusions This natural trial showed that the COVID‐19 regimen containing both HCQ and azithromycin can be helpful to promote the recovery of most patients and reduced their signs and symptoms significantly. It also shows some manageable side effects mostly those related to heart rhythm. In the absence of FDA‐approved medications to treat COVID‐19, the repurposing of HCQ and azithromycin to control the disease signs and symptoms can be useful.
Pharmaceutical care is a patient-centered, outcomes oriented practice that requires the pharmacist to work in concert with the patient and the patient’s other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective. In addition, the presence of clinical pharmacists has led to a higher quality of patient education and provision of complete detailed information for patients. In developed countries Pharm D has become the professional degree for practice of Pharmacy. The graduates will be enrolled in a pharmacy residency program; admission to the residency programs is available to Pharm D graduates of an accredited College of Pharmacy. The residency is also designed to prepare the residents to become Board Certified Specialists in their field. In many developing countries three new pharmaceutical education programs have currently been established to serve the pharmaceutical care development. Firstly, a six-year curriculum leading to the doctor of pharmacy (Pharm. D) degree as the sole professional degree. Secondly, Pharmacy Residency and Fellowship Training Program have been developed to provide intensive training in pharmaceutical care practice to the pharmacists. Lastly, the continuing pharmaceutical education program (CPE) has been adopted to ensure the competency of all pharmacists to deliver the best knowledge and skills in pharmaceutical sciences in their specialties. In our opinion we lack for most of these programs, even the program of clinical pharmacy in ministry of health is not residency program and it is short and not subspecialized apart from being not recognized by academic institutes and references. In conclusion, pharmacy profession has to change towards the more responsibility on patient care. New training program has to be adopted by medical education institutes to provide clinical pharmacists as a profession and to prepare board certified clinical pharmacists as specialists to cope with the advances in all medical fields. Key words: clinical pharmacy, board certification.
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