Stigma experienced by men diagnosed with COVID-19

ABSTRACT Objective: to analyze the stigma characteristics perceived in the experience of men who had COVID-19. Method: this qualitative study involved men living in Brazil, diagnosed with COVID-19, who answered semi-structured questions in an online form. Data were subjected to thematic and lexical analysis, interpreted in the light of the stigma theory. Results: 92 men, adults, cisgender, heterosexual, of mixed race/color, belonging to middle class, living in the urban area, with higher education participated. The stigma characteristics evidenced were the occurrence of leave, perception of impolite treatment, use of labels and discrimination by co-workers, family members, neighbors and even healthcare professionals, with consequences for the psycho-emotional dimension. Final considerations: discrimination and exclusion derived from stigma surprised men marked by class and gender privileges, little used to being downgraded in interactions when compared to other groups.

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

The objective of this retrospective cohort study was to describe pre-treatment characteristics, treatment patterns, health resource use, and clinical outcomes among adults hospitalized with COVID-19 in the United States (US) who initiated common treatments for COVID-19. The Optum® COVID-19 electronic health records database was used to identify patients >18 years, diagnosed with COVID-19, who were admitted to an inpatient setting and received treatments of interest for COVID-19 between September 2020 and January 2021. Patients were stratified into cohorts based on index treatment use. Patient demographics, medical history, care setting, medical procedures, subsequent treatment use, patient disposition, clinical improvement, and outcomes were summarized descriptively. Among a total of 26,192 patients identified, the most prevalent treatments initiated were dexamethasone (35.4%) and dexamethasone + remdesivir (14.9%), and dexamethasone was the most common subsequent treatment. At day 14 post-index, <10% of patients received any treatments of interest. Mean (standard deviation [SD]) patient age was 65.6 (15.6) years, and the most prevalent comorbidities included hypertension (44.8%), obesity (35.4%), and diabetes (25.7%). At the end of follow-up, patients had a mean (SD) 8.1 (6.6) inpatient days and 1.4 (4.1) days with ICU care. Oxygen supplementation, non-invasive, or invasive ventilation was required by 4.5%, 3.0%, and 3.1% of patients, respectively. At the end of follow-up, 84.2% of patients had evidence of clinical improvement, 3.1% remained hospitalized, 83.8% were discharged, 4% died in hospital, and 9.1% died after discharge. Although the majority of patients were discharged alive, no treatments appeared to alleviate the inpatient morbidity and mortality associated with COVID-19. This highlights an unmet need for effective treatment options for patients hospitalized with COVID-19.

Effect of COVID‐19 on Acute Ischemic Stroke Hospitalizations and Treatments: Population‐Level Experience

BACKGROUND Several studies have reported changes in the volume and type of acute ischemic stroke (AIS) hospitalizations during the early stage of the COVID‐19 pandemic. However, population‐based assessments, which include lower volume centers and more comprehensive geographic areas, are limited. Here, we evaluate an entire state‐level experience during the first peak COVID pandemic and compare against a 1‐year prior historical period. METHODS We conducted a retrospective population‐based study using the Texas Inpatient Public Use Data File, capturing all discharges from hospitals in the State of Texas, except federal hospitals. AIS admission volumes, patient characteristics, proportions of large vessel occlusion (LVO), admission rates to comprehensive stroke centers, use of intravenous tissue plasminogen activator and endovascular treatment, and patient outcomes were compared between April 1, 2019 and June 30, 2019 (historical control period) and April 1, 2020 and June 30, 2020 (pandemic period). RESULTS A total of 9277 hospitalized AIS cases were identified during the pandemic period, a decrease of 12% (10 524) compared with the control period. Cases without LVO dropped by 15%, whereas LVO cases dropped by only 5%. There were no significant differences in age or race and ethnicity of patients. While admission rates to comprehensive stroke centers (39.6% versus 39.4%, P =0.81) and endovascular treatment use in LVO (17.0% versus 16.3%, P =0.45) were not different between the 2 periods, the use of intravenous tissue plasminogen activator (15.0% versus 13.6%, relative risk [RR], 0.90; 95% CI, 0.84–0.97; P =0.004) decreased. The percentage of patients who died or were discharged to hospice increased from 7.2% to 8.25% (RR, 1.17; 95% CI. 1.06–1.29; P =0.001). CONCLUSIONS This study from a statewide population‐level analysis confirms smaller hospital‐based cohorts observing decreasing numbers of milder AIS admissions, and lower use of thrombolysis. Although LVO admissions and endovascular treatment use were largely unchanged, these findings suggest missed treatment opportunities for patients with AIS in the pandemic.

Using genetics to understand the role of kidney function in COVID-19: a mendelian randomization study

Background Kidney dysfunction occurs in severe COVID-19, and is a predictor of COVID-19 mortality. Whether kidney dysfunction causes severe COVID-19, and hence is a target of intervention, or whether it is a symptom, is unclear because conventional observational studies are open to confounding. To obtain unconfounded estimates, we used Mendelian randomization to examine the role of kidney function in severe COVID-19. Methods We used genome-wide significant, uncorrelated genetic variants to predict kidney function, in terms of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), and then assessed whether people with genetically instrumented higher eGFR or lower UACR, an indication of better kidney function, had a lower risk of severe COVID-19 (8779 cases, 1,001,875 controls), using the largest available cohorts with extensive genotyping. For comprehensiveness, we also examined their role in COVID-19 hospitalization (24,274 cases, 2,061,529 controls) and all COVID-19 (1,12,612 cases, 2,474,079 controls). Results Genetically instrumented higher eGFR was associated with lower risk of severe COVID-19 (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.83, 0.98) but not related to COVID-19 hospitalization or infection. Genetically instrumented UACR was not related to COVID-19. Conclusions Kidney function appears to be one of the key targets for severe COVID-19 treatment. Use of available medications to improve kidney function, such as antihypertensives, might be beneficial for COVID-19 treatment, with relevance to drug repositioning.

Immunocorrective treatment use in the prevention of hematological and infectious complications of chemotherapy in cancer patients

The article analyzes the use of immunocorrection of hematological toxicity that occurs during chemotherapy in cancer patients. Hematological toxicity, along with cardiotoxicity and hepatotoxicity often prevents the implementation of the entire planned volume of chemotherapy.Standard therapy (colony stimulating factor use) may not be always available and there is a need to develop new and more effective strategies for supportive care. Among the various methods and approaches, the most promising may be the use of systemic immunecorrecting therapy, the possibilities of which are far from being realized in oncological practice.The analysis of the studies summarized in this review demonstrates the effectiveness of the immunomodulator/immu‑ noadjuvant – azoximer bromide in hematological toxicity prevention in patients with various types of cancer.

Early Pregnancy Failure: Medical versus Surgical Management

Introduction: Misoprostol is increasingly used to treat women who have a failed pregnancy may be due to blighted ovum (anembryonic gestation), incomplete abortion, missed abortion, inevitable abortion in the first trimester. Medical treatment with Misoprostol is an alternative to conventional surgical treatment. Use of Misoprostol is simple, highly acceptable, noninvasive and preferred by women. In addition to surgical risk and patient's preference, medical evacuation reduces the need for hospital stay and the overall management cost. Objective: To determine the efficacy and safety of Misoprostol for evacuation of uterus in early pregnancy loss and to compare the result with surgical evacuation. Materials and Methods: It was a prospective randomized study conducted on 50 patients at the department of Obstetrics and Gynaecology, Border Guard Hospital, Dhaka during the period from February 2018 to July 2019. Here 25 patients received Misoprostol as medical treatment and 25 patients received surgical treatment. Results: Of the 25 women assigned to receive Misoprostol, 19(76%) had complete expulsion by 24 hours and 22(88%) by 7 days. Complete evacuation after 1st dose was 68% and after 2nd dose 88%. Misoprostol treatment failed in 3(12%) cases and required surgical evacuation. Among the respondents 80% women stated that they would use Misoprostol again if the need arises. Conclusion: Medical treatment with Misoprostol is a cheaper alternative to surgery. Given its success rate near about 88% with mild side effects controllable with additional medication and above all patient’s satisfaction, it should be prioritized over the evacuation curettage in patients who meet the treatment criteria. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 63-67

Disclosure of conventional and complementary medicine use to medical doctors and complementary medicine practitioners: A survey of rates and reasons amongst those with chronic conditions

Chronic conditions are prolonged and complex, leading patients to seek multiple forms of care alongside conventional treatment, including complementary medicine (CM). These multiple forms of care are often used concomitantly, requiring patient-provider communication about treatments used in order to manage potential risks. In response, this study describes rates and reasons for disclosure/non-disclosure of conventional medicine use to CM practitioners, and CM use to medical doctors, by individuals with chronic conditions. A survey was conducted online in July and August 2017 amongst the Australian adult population. Participants with chronic conditions were asked about their disclosure-related communication with CM practitioners (massage therapist, chiropractor, acupuncturist, naturopath) and medical doctors. Patients consulting different professions reported varying disclosure rates and reasons. Full disclosure (disclosed ALL) to medical doctors was higher (62.7%-79.5%) than full disclosure to CM practitioners (41.2%-56.9%). The most strongly reported reason for disclosing to both MDs and CM practitioners was I wanted them to fully understand my health status, while for non-disclosure it was They did not ask me about my CM/medicine use. Reasons regarding concerns or expectations around the consultation or patient-provider relationship were also influential. The findings suggest that patient disclosure of treatment use in clinical consultation for chronic conditions may be improved through patient education about its importance, direct provider inquiry, and supportive patient-provider partnerships. Provision of optimal patient care for those with chronic conditions requires greater attention to patient-provider communication surrounding patients’ wider care and treatment use.

P.004 Autoimmune Encephalitis: Modifiable and Non-Modifiable Predictors of Relapse

Background: Approximately 25% of encephalitis cases in North America are immune mediated. For most forms of autoimmune encephalitis (AIE), risk of relapse is unclear and little evidence exists to guide which patients have the highest risk and whether standard treatments reduce this risk. Our objective was to determine the factors associated with AIE relapse. Methods: We performed a chart review consisting of patients with AIE presenting to the Calgary Neuro-Immunology Clinic and Tom Baker Cancer Centre between 2015 and 2020. Predictors of relapse were determined with use of t-test. Results: Outcome data was assessable in 39/40 patients, 17/39 (44%) patients relapsed. Seropositive patients and those with abnormal CSF were more likely to relapse, although neither reached statistical significance (p=0.12, 0.059). Patients with longer duration of steroid and steroid sparing treatment prior to relapse, and those on steroids at the time of relapse, had milder relapses (p=0.024, 0.026, 0.047). There was no difference in steroid or steroid sparing treatment use at 3, 6, and 12 months between groups. Conclusions: Risk of relapse in AIE is high (44%), with most relapses occurring in the first 3 years. Continuous immunosuppression lessens the severity of relapse, although our study did not confirm it reduced the occurrence of relapse.

Relevance of Objective Measures in Psychiatric Disorders—Rest-Activity Rhythm and Psychophysiological Measures

Purpose of Review We present a review of recent methods of objective measurement in psychiatry and psychology with a focus on home monitoring and its utility in guiding treatment. Recent Findings For individualized diagnostics and treatment of insomnia, actigraphy can generate clinically useful graphical presentations of sleep timing and patterns. Psychophysiological measures may complement psychometrics by tracking parallel changes in physiological responses and emotional functioning, especially during therapy for trauma symptoms and emotion regulation. It seems that rather than defining universal cut-offs, an individualised range of variability could characterize treatment response. Summary Wearable actigraphy and psychophysiological sensors are promising devices to provide biofeedback and guide treatment. Use of feasible and reliable technology during experimental and clinical procedures may necessitate defining healthy and abnormal responses in different populations and pathological states. We present a “call for action” towards further collaborative work to enable large scale use of objective measures.