NHS offers lung volume reduction procedures for severe emphysema

alexandrossfakianakis shared this article with you from Inoreader NHS offers lung volume reduction procedures for severe emphysema Via British Medical Journal Lung volume reduction is being made available for adults in England who have severe emphysema, after NHS England approved the treatment. An estimated 660 people in England are currently suitable for... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Erythema migrans mimicking early morphea

alexandrossfakianakis shared this article with you from Inoreader Erythema migrans mimicking early morphea Via Wiley: JDDG: Journal der Deutschen Dermatologischen Gesellschaft: Table of Contents View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Emergency Department Psychiatric Observation Units: Good Care and Good Money?

alexandrossfakianakis shared this article with you from Inoreader Emergency Department Psychiatric Observation Units: Good Care and Good Money? Via Wiley: Academic Emergency Medicine: Table of Contents Abstract The boarding of Psychiatric Emergency Department patients continues to be a crisis across our country. As healthcare leaders navigate the challenges of COVID ‐19 there is an amplified urgency for novel solutions to this complex problem. Congested waiting rooms and hallways, the unfortunate byproduct of boarding, result in emergency departments becoming a potential focal point for disease transmission. Given the financial losses that many health care institutions have incurred due to the pandemic, understanding the fiscal implications of any intervention is paramount. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

'The Pause: A Second Chance for a Meaningful Connection'

alexandrossfakianakis shared this article with you from Inoreader "The Pause: A Second Chance for a Meaningful Connection" Via Wiley: Academic Emergency Medicine: Table of Contents Abstract I often reflect on how small this world is, or how meeting a new person can forever change your life. This happened in September 2018 when I met two amazing emergency department nurses from Baltimore at a conference in Ohio. Little did I know at the time, but we had much more in common than our shared specialty of Emergency Medicine. They were sharing their outcomes after introducing "The Pause," a short verbal reflection and silent moment performed after a patient death meant to recognize and acknowledge the patient and the care team, at their busy Emergency Department. While intrigued, I also knew we had previously tried implementing this in our own ED without consistency or success. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Paracetamol or nonsteroidal anti‐inflammatory drugs or combination of both analgesics in acute post‐trauma pain: a randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader Paracetamol or nonsteroidal anti‐inflammatory drugs or combination of both analgesics in acute post‐trauma pain: a randomized controlled trial Via Wiley: Academic Emergency Medicine: Table of Contents Abstract Objectives Non‐steroidal anti‐inflammatory drugs (NSAIDs) and acetaminophen (also called paracetamol) are the most frequent analgesics used to relieve post‐trauma pain in the emergency department. However, the utility of combining both treatments is still controversial. We sought to explore the benefits of combining a NSAID with acetaminophen compared to acetaminophen alone, or NSAID alone, in the treatment of post‐traumatic pain of the extremity after discharge from the emergency department (ED). Methods This is a prospective, randomized controlled trial, carried out in a single ED from March 2017 to November 2018. The included patients were randomly assigned to receive paracetamol alone, or high‐dose NSAID (piroxicam) alone, or a combination of paracetamol and high‐dose NSAID for 7 days after ED discharge. The primary outcome was need for additional oral analgesics. Secondary outcomes included the change of the visual numeric scale (VNS) between ED discharge (VNS D0) and 7 days later (VNS D7), ED revisits for residual pain, side effects and patient satisfaction as assessed by a Likert satisfaction scale. Results The need for additional oral analgesics were comparable between paracetamol‐NSAID combination group (9.8%) and paracetamol group (11.4%) (p=0.43). ED readmission rate was also comparable between the two groups at 5.6% and 5.8% respectively (p=0.86). In contrast, need for new analgesics and ED revisit rates were both more frequent in the high‐dose NSAID group. Mean VNS decrease on D7 compared to D0 was 66%, 63% and 67%, respectively in paracetamol group, NSAID and paracetamol‐NSAID combination group (p=0.32). Frequency of dissatisfaction was higher in NSAID group. Side effects were more frequent in NSAID and paracetamol‐NSAID combination groups. Conclusion This study found that the combination of a high‐dose NSAID with paracetamol does not increase the analgesic effect compared to paracetamol alone. We also found that paracetamol alone is superior to high‐dose NSAID alone for post‐traumatic extremity pain. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Subcutaneous Rapid‐Acting Insulin Analogs for Diabetic Ketoacidosis

alexandrossfakianakis shared this article with you from Inoreader Subcutaneous Rapid‐Acting Insulin Analogs for Diabetic Ketoacidosis Via Wiley: Academic Emergency Medicine: Table of Contents Abstract Diabetic ketoacidosis (DKA), characterized by hyperglycemia, metabolic acidosis, and ketosis, is a serious complication of diabetes mellitus. Treatment focuses on fluid restoration, correction of hyperglycemia, and inhibition of ketogenesis. Insulin is considered a fundamental component of DKA treatment as it promotes the peripheral tissues' utilization of glucose in peripheral tissues by reducing hepatic gluconeogenesis and suppressing ketogenesis.1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Unraveling the Crucial Roles of FoxP3+ Regulatory T Cells in Vascularized Composite Allograft Tolerance Induction and Maintenance

alexandrossfakianakis shared this article with you from Inoreader Unraveling the Crucial Roles of FoxP3+ Regulatory T Cells in Vascularized Composite Allograft Tolerance Induction and Maintenance Via Transplantation - Published Ahead-of-Print Background: The role of regulatory T cells (Treg) in tolerance induction of vascularized composite allotransplantation (VCA) remains unclear. This study was designed to examine characteristics of Treg after VCA, and their capacity to rescue allografts from rejection. Methods: Osteomyocutaneous allografts were transplanted from Balb/c to C57BL/6 mice. All mice received costimulatory blockade and a short course of rapamycin. To elucidate the role of Treg for tolerance induction, Treg depletion was performed at postoperative day (POD) 0, 30 or 90. To assess capacity of Treg to rescue allografts from rejection, injection of 2x106 Treg isolated from tolerant mice was applied. Results: 80% of VCA recipient mice using costimulatory blockade and RPM regimen developed tolerance. The tolerant recipients had higher ratio of circulating Treg to effector T cells and elevated IL-10 at POD 30. A significantly higher rejection rate was observed when Treg were depleted at POD 30. But Treg depletion at POD 90 had no effect on tolerance. Treg from tolerant recipients showed stronger suppressive potential, and the ability to rescue allografts from rejection. Furthermore, transplanted Treg-containing skin grafts from tolerant mice delayed rejection elicited by adoptively transferred Teff to Rag2-/- mice. Conclusion: Circulating Treg are crucial for inducing VCA tolerance in early posttransplant phase and allograft-residing Treg may maintain the tolerance. Treg may therefore serve as a potential cellular therapeutic to improve VCA outcomes. Financial Disclosure: This work was supported by grants from Ministry of Science and Technology of Taiwan (MOST 106-2314-B-182A-048-MY3 and MOST 109-2811-B-182A-515) and Chang Gung Medical Foundation (CMRPG3C1541-3 and CMRPG6H0511). Disclaimer: The authors of this manuscript have no conflicts of interest to disclose. Correspondence: Cheng-Hung Lin, MD, FACS Center for Vascularized Composite Allotransplantation, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing St. Kuei-Shan, Taoyuan, Taiwan Tel: 886-3-3281200 Ext. 2946 Fax: 886-3-3289582 E-mail: lukechlin@gmail.com Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

COVID-19 in Lung Transplant Recipients

alexandrossfakianakis shared this article with you from Inoreader COVID-19 in Lung Transplant Recipients Via Transplantation - Published Ahead-of-Print Background: A concern about the susceptibility of immunocompromised patients to the worldwide pandemic of coronavirus disease 2019 (COVID-19) has been raised. We aimed at describing COVID-19 infections in the French cohort of lung transplant (LT) patients. Methods: Multicenter nationwide cohort study of all LT recipients with COVID-19 diagnosed from March 1 to May 19, 2020. Recipient main characteristics and their management were retrieved. Hospitalization characteristics, occurrence of complications and survival were analyzed. Results: Thirty-five LT patients with a COVID-19 infection were included. Median age was 50.4 [40.6-62.9] years, 16 (45.7%) were female, and 80% were double-LT recipients. Infection was community-acquired in 25 (71.4%). Thirty-one (88.6%) required hospitalization, including 13 (41.9%) in the intensive care unit. The main symptoms of COVID-19 were fever, cough, and diarrhea, present in 71.4%, 54.3%, and 31.4% of cases, respectively. Extension of pneumonia on chest CT was moderate to severe in 51.4% of cases. Among the 13 critically ill patients, 7 (53.9%) received invasive mechanical ventilation. Thrombotic events occurred in 4 patients. Overall survival rate was 85.7% after a median follow-up of 50 days [41.0-56.5]. Four of 5 nonsurvivors had had bronchial complications or intensification of immunosuppression in the previous weeks. On univariate analysis, overweight was significantly associated with risk of death (odds ratio 16.0 [95% confidence interval1.5-170.6], p=0.02). Conclusion: For the 35 LT recipients with COVID-19, the presentation was severe, requiring hospitalization in most cases, with a survival rate of 85.7%. Financial Disclosure: None Disclaimer: JM declares congress reimbursement fees from Fisher&Paykel, and CSL Behring. JFM declares fees from LFB, CSL Behring, Actelion, Astra Zeneca, Bayer, Boehringer Ingelheim, Chiesi, GSK, LFB Biomédicaments, MSD, Mundi Pharma, Novartis, Pfizer, Roche. NC reports non-financial support from Mylan, Novartis, Herakos. HM reports grants from Pfizer and fees from Novartis, and Boehringer. Correspondence: Jonathan Messika, MD, PhD Service de Pneumologie B et Transplantation Pulmonaire APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard 46 rue Henri Huchard 75018 Paris, France Tel +33140256919 Fax +33140256104 Email: jonathan.messika@aphp.fr Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

HLA and AB0 Polymorphisms May Influence SARS-CoV-2 Infection and COVID-19 Severity

alexandrossfakianakis shared this article with you from Inoreader HLA and AB0 Polymorphisms May Influence SARS-CoV-2 Infection and COVID-19 Severity Via Transplantation - Published Ahead-of-Print Background: SARS-CoV-2 infection is heterogeneous in clinical presentation and disease evolution. To investigate whether immune response to the virus can be influenced by genetic factors, we compared HLA and AB0 frequencies in organ transplant recipients and waitlisted patients according to presence or absence of SARS-CoV-2 infection. Methods: A retrospective analysis was performed on an Italian cohort composed by transplanted and waitlisted patients in a January 2002-March 2020 time frame. Data from this cohort were merged with the Italian registry of COVID+ subjects, evaluating infection status of transplanted and waitlisted patients. A total of 56304 cases were studied with the aim of comparing HLA and AB0 frequencies according to the presence (n=265, COVID+) or absence (n=56 039, COVID-) of SARS-CoV-2 infection. Results: The cumulative incidence rate of COVID-19 was 0.112% in the Italian population and 0.462% in waitlisted/transplanted patients (OR=4.2, 95%CI [3.7-4.7], P View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Summary of International Recommendations for Donation and Transplantation Programs During the Coronavirus Disease (COVID-19) Pandemic

alexandrossfakianakis shared this article with you from Inoreader Summary of International Recommendations for Donation and Transplantation Programs During the Coronavirus Disease (COVID-19) Pandemic Via Transplantation - Published Ahead-of-Print Background: The COVID-19 pandemic has disrupted all aspects of the international organ donation and transplantation (ODT) system. Multiple organizations have developed guidance, but to date, no comparative summary has emerged to understand differences in existing recommendations. Methods: We developed and applied a comparative methodology to a convenience sample of recommendations available on The Transplantation Society website. Document types were classified according to characteristics such as type of organization (e.g. governing body or professional society) and geographic region. Recommendations were grouped according to content and summaries were posted on a public website. This process is ongoing and will be updated as new recommendations become available. Results: 18 documents were extracted in the initial review. All documents were based on expert opinion, and none described a formal literature review or adherence with clinical guideline development processes. Recommendation categories included screening of potential donors, risk assessment of potential recipients, post-transplant risk, living/paired donation, protection of ODT professionals, and ethics/logistics. While many documents included similar recommendations, such as the need to screen and test patients who are potential donors, there was variation on some topics. Type of recommended laboratory testing varied with 64% recommending nasopharyngeal swabs, 43% oropharyngeal, and 24% bronchial aspirates. Updated results are available at https://cdtrp.ca/en/covid-19-international-recommendations-for-odt/ Conclusion: The current state of COVID-19 ODT recommendations are limited to expert opinion. Substantial variation exists regarding recommendations, which are based on emerging, but currently low-quality evidence. This summary of existing recommendations will serve to inform priorities for evidence-based recommendations. Funding: This work was supported by financial and in-kind contributions from Canadian Blood Services and the Canadian Donation and Transplant Research Program. Disclosure: The authors declare no conflicts of interest. No author has a conflicting interest with a for-profit entity. All authors are either employees or consultants for not-for profit, governmental organ donation organizations or research organizations as listed in the affiliations. Authorship: All authors have reviewed and approve of the final manuscript, which represents original work. All authors participated in the design of the review. MJW, JL, LH, and AH participated in the performance of the research and analysis of the results. MJW and JL prepared the original draft. Corresponding Author: Matthew Weiss, M.D., FRCPC Pediatric Intensivist at the Centre Mère-Enfant Soleil du CHU de Québec Medical Director of Organ Donation at Transplant Québec 3-880 Calixa-Lavallée Québec, Québec, G1S 3G9 Canada Cell: 418-717-6418 Email: matthew-john.weiss@chudequebec.ca Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

COVID-19 Therapeutics for Solid Organ Transplant Recipients; 6 Months Into the Pandemic: Where Are We Now?

alexandrossfakianakis shared this article with you from Inoreader COVID-19 Therapeutics for Solid Organ Transplant Recipients; 6 Months Into the Pandemic: Where Are We Now? Via Transplantation - Published Ahead-of-Print As in the general population with COVID-19 infection, therapeutic interventions in solid organ transplant (SOT) recipients have evolved over time. The preceding 6 months of the pandemic can be divided into 2 main therapeutic eras: the early era and the later era. The first era was characterized by widespread use of drugs such as hydroxychloroquine with or without azithromycin, lopinavir-ritonavir, and tocilizumab. More recently, with the publication of larger trials, there has been increasing use of remdesivir, dexamethasone, and convalescent plasma, with rapid proliferation of clinical trials including a wide variety of investigational and repurposed agents with antiviral or immunomodulatory effects. This overview focuses on what is known about the effects of different therapie s in SOT recipients with COVID-19, mainly from case series and, more recently, larger multicenter registries; as well as outlining the information that will be needed in order to optimize management and outcomes in SOT recipients with COVID-19 in the future. Conflicts of Interest: None Funding: None Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Race, Education, and Gender Disparities in Transplantation of Kidneys from Hepatitis C Viremic Donors

alexandrossfakianakis shared this article with you from Inoreader Race, Education, and Gender Disparities in Transplantation of Kidneys from Hepatitis C Viremic Donors Via Transplantation - Published Ahead-of-Print Background: Transplantation of kidneys from hepatitis C virus (HCV)-viremic donors into HCV-negative patients followed by direct-acting antiviral therapy was an important breakthrough to increase the number of lifesaving kidney transplants. Data suggest these transplants offer several benefits, however it is unknown whether adoption of this practice has been shared equitably, especially among disadvantaged groups. Methods: We evaluated United Network for Organ Sharing data on HCV-seronegative adult deceased-donor kidney transplant (DDKT) recipients from 1/1/2017-6/12/2020. We compared recipients of a kidney from an HCV Ab-/nucleic acid test -(NAT-), HCV Ab+/NAT-, and HCV NAT+ donor. The primary covariates were: 1) race/ethnicity; 2) female sex; and 3) highest level of education. Models included variables associated with being offered an HCV NAT+ kidney. We fit mixed-effects multinomial logistic regression models with center as a random effect to account for patient clustering. Results: Of 48,255 adult kidney-alone DDKT HCV-seronegative recipients, 1,641 (3.4%) donors were HCV NAT+-, increasing from 0.3% (1/2017-6/2017) to 6.9% (1/2020-6/2020). In multivariable models, racial/ethnic minorities, women, and those with less education were significantly less likely to receive a kidney from an HCV NAT+ donor relative to an HCV Ab-/NAT- and HCV Ab+/NAT- donor. The disparities were most pronounced among Hispanic and Asian patients with less educational attainment (grade school, high school, or some college/tech school). Discussion: Despite an increase in transplants from HCV NAT+ donors, we found substantial racial/ethnic disparities in transplantation of these kidneys. These data highlight how the benefits of a scientific breakthrough are often made less available to disadvantaged patients. Disclosure: Dr. Goldberg receives research grant support paid to his institution from Gilead, Abbvie and Merck, and has received consulting fees from Pfizer for topics unrelated to this manuscript. Dr. Sise receives research grant support, paid to her institution, from Gilead, Abbvie and Merck, and has been a scientific advisory board member for Gilead and Abbvie, and has received funding from NIH K23 DK117014. Dr. Reese receives research grant support, paid to his institution, from Abbvie and Merck. Funding: No funding source for this work Corresponding Author: David Goldberg, MD, MSCE Don Soffer Clinical Research Building 1120 NW 14th Street, Office # 807 Miami, FL 33136 USA Tel: 305-243-7956 E-mail: dsgoldberg@med.miami.edu Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.