&lt;p&gt;The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population – Public Health Implications&lt;/p&gt;

Rahman, Sayeeda; Singh, Keerti; Dhingra, Swati; Charan, Jaykaran; Sharma, Paras; Islam, Salequl; Jahan, Dilshad; Iskandar, Katia; Samad, Nandeeta; Haque, Mainul

doi:10.2147/tcrm.s272908

Cited by 40 publications

(31 citation statements)

References 173 publications

(222 reference statements)

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“…Age is the most important risk factor for disease severity and mortality in COVID-19 [21]. In our series, older patients that died within the first 8 days of hospital admission had a larger proportion of the fibroproliferative and less of the exudative patterns in their lung samples.…”

Section: Discussionmentioning

confidence: 48%

Tracking the time course of pathological patterns of lung injury in severe COVID-19

et al. 2021

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Background Pulmonary involvement in COVID-19 is characterized pathologically by diffuse alveolar damage (DAD) and thrombosis, leading to the clinical picture of Acute Respiratory Distress Syndrome. The direct action of SARS-CoV-2 in lung cells and the dysregulated immuno-coagulative pathways activated in ARDS influence pulmonary involvement in severe COVID, that might be modulated by disease duration and individual factors. In this study we assessed the proportions of different lung pathology patterns in severe COVID-19 patients along the disease evolution and individual characteristics. Methods We analysed lung tissue from 41 COVID-19 patients that died in the period March–June 2020 and were submitted to a minimally invasive autopsy. Eight pulmonary regions were sampled. Pulmonary pathologists analysed the H&E stained slides, performing semiquantitative scores on the following parameters: exudative, intermediate or advanced DAD, bronchopneumonia, alveolar haemorrhage, infarct (%), arteriolar (number) or capillary thrombosis (yes/no). Histopathological data were correlated with demographic-clinical variables and periods of symptoms-hospital stay. Results Patient´s age varied from 22 to 88 years (18f/23 m), with hospital admission varying from 0 to 40 days. All patients had different proportions of DAD in their biopsies. Ninety percent of the patients presented pulmonary microthrombosis. The proportion of exudative DAD was higher in the period 0–8 days of hospital admission till death, whereas advanced DAD was higher after 17 days of hospital admission. In the group of patients that died within eight days of hospital admission, elderly patients had less proportion of the exudative pattern and increased proportions of the intermediate patterns. Obese patients had lower proportion of advanced DAD pattern in their biopsies, and lower than patients with overweight. Clustering analysis showed that patterns of vascular lesions (microthrombosis, infarction) clustered together, but not the other patterns. The vascular pattern was not influenced by demographic or clinical parameters, including time of disease progression. Conclusion Patients with severe COVID-19 present different proportions of DAD patterns over time, with advanced DAD being more prevalent after 17 days, which seems to be influenced by age and weight. Vascular involvement is present in a large proportion of patients, occurs early in disease progression, and does not change over time.

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Section: Discussionmentioning

confidence: 48%

Tracking the time course of pathological patterns of lung injury in severe COVID-19

et al. 2021

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“… Men with COVID-19 infection are more at risk for worse outcomes and death, independent of age. Rahman et al (2020) [ 123 ] Age Reported severe outcomes increased with age e.g hospitalizations, ICU admissions. Deaths were highest among persons aged ≥70 years, regardless of underlying conditions, and lowest among those aged ≤19 years.…”

Section: Clinical and Pathological Characteristics Of Covid-19mentioning

confidence: 99%

Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence

Rahman¹,

Montero²,

Rowe³

et al. 2021

Expert Review of Clinical Pharmacology

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182

143

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Introduction The COVID-19 pandemic has created a public health crisis, infected millions of people, and caused a significant number of deaths. SARS-CoV-2 transmits from person to person through several routes, mainly via respiratory droplets, which makes it difficult to contain its spread into the community. Here, we provide an overview of the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment of COVID-19. Areas covered Direct person-to-person respiratory transmission has rapidly amplified the spread of coronavirus. In the absence of any clinically proven treatment options, the current clinical management of COVID-19 includes symptom management, infection prevention and control measures, optimized supportive care, and intensive care support in severe or critical illness. Developing an effective vaccine is now a leading research priority. Some vaccines have already been approved by the regulatory authorities for the prevention of COVID-19. Expert opinion General prevention and protection measures regarding the containment and management of the second or third waves are necessary to minimize the risk of infection. Until now, four vaccines reported variable efficacies of between 62–95%, and two of them (Pfizer/BioNTech and Moderna) received FDA emergency use authorization. Equitable access and effective distribution of these vaccines in all countries will save millions of lives.

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“…A high rate of polypharmacy for the treatment of existing aging-related chronic disease conditions is expected in this population [ 6 , 7 ]. The polypharmacy burden is likely to be increased in hospitalized COVID-19 patients by the addition of specific treatments for SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

Drug–Drug Interactions and Prescription Appropriateness at Hospital Discharge: Experience with COVID-19 Patients

et al. 2021

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Background Patients with coronavirus disease 2019 (COVID-19) are often elderly, with comorbidities, and receiving polypharmacy, all of which are known factors for potentially severe drug–drug interactions (DDIs) and the prescription of potentially inappropriate medications (PIMs). Objective The aim of this study was to assess the risk of DDIs and PIMs in COVID-19 patients at hospital discharge. Method Patients with a proven diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were hospitalized between 21 February and 30 April 2020, treated with at least two drugs, and with available information regarding pharmacological treatments upon admission and at discharge were considered. The appropriateness of drug prescriptions was assessed using INTERcheck ® . Results A significant increase in the prescription of proton pump inhibitors and heparins was found when comparing admission with hospital discharge (from 24 to 33% [ p < 0.05] and from 1 to 17% [ p < 0.01], respectively). The increased prescription of heparins at discharge resulted in a highly significant increase in the potentially severe DDIs mediated by this class of drugs. 51% of COVID-19 patients aged > 65 years had at least one PIM upon admission, with an insignificant increment at discharge (58%). Conclusion An increased number of prescribed drugs was observed in COVID-19 patients discharged from our hospital. The addition of heparins is appropriate according to the current literature, while the use of proton pump inhibitors is more controversial. Particular attention should be paid to the risk of bleeding complications linked to heparin-based DDIs.

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<p>The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population – Public Health Implications</p>

Cited by 40 publications

References 173 publications

Tracking the time course of pathological patterns of lung injury in severe COVID-19

Tracking the time course of pathological patterns of lung injury in severe COVID-19

Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence

Drug–Drug Interactions and Prescription Appropriateness at Hospital Discharge: Experience with COVID-19 Patients

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