Objective To compare baseline characteristics, clinical presentations, and outcomes of patients with rheumatic conditions requiring hospitalization for COVID-19 who received chronic hydroxychloroquine to those who did not receive chronic hydroxychloroquine. Methods We identified all patients with a rheumatologic disease who were admitted with COVID-19 to two hospitals in New York City between March 3-April 30 2020. Patients who received chronic hydroxychloroquine prior to admission were matched 1:2 (±10 years of age) to patients who did not receive chronic hydroxychloroquine. We compared demographics, comorbidities, hydroxychloroquine dosages, concurrent medications, presentations, and outcomes between the groups. Results There were 14 patients receiving hydroxychloroquine and 28 matched control subjects. The median age of cases was 63 years (IQR 43–73) and 60 years (IQR 41–75) for controls. Control subjects had a higher prevalence of pulmonary diseases (42.8%), diabetes (35.7%), and obesity (35.7%) than their case counterparts (28.6%, 14.3%, and 7.1%, respectively). A higher proportion of case than control subjects (50% vs.s 25%) reported usage of prednisone for their rheumatic conditions prior to admission. Despite these differences in baseline characteristics, univariate logistic regression revealed no statistically significant differences in the need for mechanical ventilation (OR 1.5; 95% CI: 0.34–6.38) or in-hospital mortality (OR 0.77; 95% CI: 0.13–4.56). Conclusion Hydroxychloroquine therapy in individuals with rheumatic conditions was not associated with less severe presentations of COVID-19 among hospitalized patients compared with individuals with rheumatic conditions not receiving hydroxychloroquine.
Purpose of ReviewThis review summarizes the current options for human monkeypox virus diagnostic testing, vaccination, and treatment. Recent Findings Information on non-lesion monkeypox virus diagnostic testing is limited to small studies with unclear sensitivities and specificities. Early data on the JYNNEOS vaccine has shown a lower incidence of monkeypox infection among vaccinated individuals. Drug options for human monkeypox, which include tecovirimat, cidofovir, brincidofovir, and vaccinia immune globulin intravenous, are limited without an FDA-approved medication and data on drug efficacy pending. Summary Data on non-lesion-based tests for human monkeypox infection, though limited, seems promising for certain clinical manifestations and to potentially screen asymptomatic patients if there is conclusive evidence of asymptomatic transmission. Vaccination with JYNNEOS appears effective in the prevention of monkeypox infection in early data. Of the limited medications available for monkeypox, tecovirimat's safety profile appears to be the best with data suggestive of efficacy though further conclusive evidence from clinical trials is lacking.
Background Microbial contamination of high-touch surfaces (HTS) in health care settings contributes to pathogen transmission. HTS quickly become re-contaminated after disinfection. A quaternary ammonium (QA) and isopropyl alcohol (IPA)-based disinfectant (Sani-24®) with reported continuously active disinfection (CAD) properties for up to 24 hours has been associated with reduced microbial buildup on HTS over time in in vitro studies and inpatient healthcare settings. The performance of this product in ambulatory care settings has not been reported. Methods HTS bioburden associated with use of QA-IPA with CAD (Sani-24®) was compared to that of a QA-IPA disinfectant without CAD (Super Sani-Cloth®) in an urgent care center (UCC) and outpatient clinic (OPC). Surfaces/rooms were assigned 1:1 to the disinfectants. Study team used pre-saturated wipes to disinfect designated HTS (stretcher/exam table, stretcher rail, armrest, doorknob, counter, light switch) at the beginning of each sampling period. In the UCC, unit staff performed subsequent disinfection per routine protocols. In the OPC, unit staff used the study-assigned disinfectant for disinfection between patients. HTS were sampled at 0, 4-6, 8-12, and 24 hours using Eswabs soaked in neutralizing broth. Microbial burden was quantified after 48 hours of incubation. Average CFU/cm² were compared using T-tests and proportion of samples with < 2.5 CFU/cm², a microbiologic standard for environmental surfaces, were compared by chi-square test. Results 66 UCC HTS (33 per disinfectant) and 70 OPC HTS (35 per disinfectant) were included. There were no statistically significant differences in average CFU/cm² on individual HTS (Figure 1) or average CFU/cm² on all HTS combined between the disinfectants. There were also no significant differences in the proportion of surfaces with < 2.5 CFU/cm² (Figure 2) between the disinfectants. Conclusion No differences were observed in the HTS bioburden in ambulatory settings over 24 hours following disinfection using products with and without CAD. These findings differ from those of studies in other settings, perhaps due to frequent disinfection, less extensive recontamination, or Hawthorne effect in these ambulatory settings. Further study in other ambulatory care settings is warranted. Disclosures Harjot K. Singh, MD, clinical care options: Advisor/Consultant|MJSciences/HCP Live: Advisor/Consultant|NYC Health and Hospitals: Advisor/Consultant Lars Westblade, PhD, Accelerate Diagnostics, Inc.: Grant/Research Support|BioFire Diagnostics, LLC: Grant/Research Support|Hardy Diagnostics: Grant/Research Support|Roche Molecular Systems, Inc.: Advisor/Consultant|Roche Molecular Systems, Inc.: Grant/Research Support|Shionogi, Inc.: Advisor/Consultant|Talis Biomedical: Advisor/Consultant.
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