NEJM Evidence’s Post

July 28, 2024, is #WorldHepatitisDay. Let's go through a quick recap of the general treatment for hepatitis viruses: #Hepatitis A: • Supportive care with hydration, rest, and avoiding alcohol. • There is no specific antiviral therapy for HAV infection. #Hepatitis B: #Acute Hepatitis B: • Supportive and similar to the treatment of acute HAV infection unless a more severe infection is present. • Medication treatment should be considered for those who present with: 1. Acute liver failure (INR >1.5, bilirubin >10 mg/dL). 2. Protracted course (>4 weeks). 3. Immunocompromised patients. 4. co- infection with other viruses e.g. HCV or HDV. • Antivirals medications such as entecavir or tenofovir may be used in severe cases. #Chronic Hepatitis B: • Antiviral medications (e.g., entecavir, tenofovir, lamivudine) to reduce viral load. • Regular monitoring of liver function. • Screening for liver cancer. #Hepatitis C: #Acute Hepatitis C: • Acute HCV infection is infrequently detected as most cases are asymptomatic. • When detectd; the treatment is similar to that for chronic HCV infection. #Chronic hepatitis C: • Second generation of direct-acting antivirals (DAAs) like sofosbuvir, ledipasvir, and velpatasvir are the main stay of treatment. • Interferon-based therapy has become obsolete since the introduction of DAAs in 2013-2014. • Regular monitoring for liver function. • Screening for liver cancer. #Hepatitis D: • Pegylated interferon-alpha is the primary treatment. • Oral nucleoside and nucleotide analogs have limited or no efficacy. • liver transplantation may be necessary in advanced cases. #Hepatitis E: • Supportive care with hydration, rest, and avoiding alcohol. • Ribavirin may be used in severe cases. #General tips: 1. Prevention through vaccination 2. Safe practices 3. Good hygiene 4. Lifestyle adjustments e.g. avoiding alcohol and maintaining a healthy diet 5. Provide supportive care (hydration and symptom management) 6. Patients education 7. Mental health and psychological support Links: 1. American Association for the Study of Liver Diseases: https://lnkd.in/d4SHiWvf 2. European Association for the Study of the Liver: https://lnkd.in/d546Br5Y

📃Scientific paper: Late diagnosis of respiratory syncytial virus and influenza co-infection during coronavirus disease 2019 pandemic: a case report Abstract: Background Respiratory syncytial virus (RSV)-induced disease is one of the important causes of flu-like illness in older adults and can cause serious disease in those who are at high-risk medical conditions. During coronavirus disease 2019 (COVID-19) pandemic, because of overlapping symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection with other respiratory infections, diagnosing diseases based on clinical and radiological findings was challenging and could cause misdiagnosis. Case presentation An 87-year-old Persian man was admitted to the hospital due to loss of consciousness, respiratory distress, tachypnea, and oliguria. He had previously hospitalized because of cough, fever, loss of appetite, and fatigue. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test was performed which was negative; however, based on ground glass opacity on his chest computed tomography (CT) scan and being on the outbreak of COVID-19, he fulfilled case definition of COVID-19; therefore, he received protocol’s treatment (remdesivir) for COVID-19 and relatively recovered and discharged. In our center, we requested brain and chest CT scans, blood tests, and multiplex PCR. Multiplex PCR revealed co-infection of influenza virus and RSV. Although we had started pneumonia and sepsis treatment, old age, weak immune system and the delay in initiation of right antibiotic and antivirus therapy altogether led him to die. Con... Continued on ES/IODE ➡️ https://etcse.fr/baM ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Late diagnosis of respiratory syncytial virus and influenza co-infection during coronavirus disease 2019 pandemic: a case report Abstract: Background Respiratory syncytial virus (RSV)-induced disease is one of the important causes of flu-like illness in older adults and can cause serious disease in those who are at high-risk medical conditions. During coronavirus disease 2019 (COVID-19) pandemic, because of overlapping symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection with other respiratory infections, diagnosing diseases based on clinical and radiological findings was challenging and could cause misdiagnosis. Case presentation An 87-year-old Persian man was admitted to the hospital due to loss of consciousness, respiratory distress, tachypnea, and oliguria. He had previously hospitalized because of cough, fever, loss of appetite, and fatigue. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test was performed which was negative; however, based on ground glass opacity on his chest computed tomography (CT) scan and being on the outbreak of COVID-19, he fulfilled case definition of COVID-19; therefore, he received protocol’s treatment (remdesivir) for COVID-19 and relatively recovered and discharged. In our center, we requested brain and chest CT scans, blood tests, and multiplex PCR. Multiplex PCR revealed co-infection of influenza virus and RSV. Although we had started pneumonia and sepsis treatment, old age, weak immune system and the delay in initiation of right antibiotic and antivirus therapy altogether led him to die. Con... Continued on ES/IODE ➡️ https://etcse.fr/baM ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

Our paper is out in NEJM Evidence on the risk of acute myocardial infarction during severe influenza infection. To our surprise, this risk of acute myocardial infarction was most elevated (sixteen fold) in influenza patients without a history of previous hospitalisation for cardiovascular disease, while those with a cardiovascular history were relatively protected. We hypothesize that the use of cardiovascular preventive medication such as anticoagulation might protect them during the acute influenza infection, explaining the difference in observed risk. The use of preventive anticoagulation therapy during severe acute influenza infection for patients without a cardiovascular history should be further investigated. Furthermore, annual influenza vaccination among those without a known cardiovascular risk should be further encouraged. https://lnkd.in/eNXxJA4E

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs, but can also affect other parts of the body. It is a chronic infection that can remain dormant for years, causing no symptoms, or it can progress to active disease, causing a range of symptoms. TB is typically characterized by: 1. _Chronic cough_ (lasting more than 2 weeks) 2. _Coughing up blood or sputum_ 3. _Chest pain or difficulty breathing_ 4. _Fatigue or weakness_ 5. _Weight loss_ 6. _Loss of appetite_ 7. _Fever_ 8. _Night sweats_ 9. _Chills_ TB can affect various parts of the body, including: 1. _Lungs_ (pulmonary TB) 2. _Lymph nodes_ (extrapulmonary TB) 3. _Bones and joints_ (ostearticular TB) 4. _Central nervous system_ (meningitis or TB encephalitis) 5. _Genitourinary tract_ (genitourinary TB) 6. _Gastrointestinal tract_ (gastrointestinal TB) TB is typically diagnosed through: 1. _Chest X-rays_ 2. _Sputum smears_ 3. _Culture tests_ 4. _Blood tests_ 5. _Biopsies_ TB treatment involves a combination of antibiotics, typically taken for 6-9 months. *Extrapulmonary TB (TB outside the lungs):* 1. Swollen lymph nodes 2. Pain or swelling in the affected area (e.g., spine, joints, or abdomen) 3. Fever 4. Fatigue 5. Weight loss 6. Loss of appetite 7. Swollen or painful testicles (in men) 8. Vaginal discharge or abdominal pain (in women) *TB in specific parts of the body:* 1. *TB meningitis* (TB in the brain and spinal cord): headache, fever, stiff neck, confusion, and seizures. 2. *TB pleurisy* (TB in the lining surrounding the lungs): chest pain, fever, and difficulty breathing. 3. *TB peritonitis* (TB in the lining surrounding the abdominal organs): abdominal pain, fever, and swelling. *Latent TB infection (LTBI):* No symptoms, but can progress to active TB if left untreated. Keep in mind that vaccine development and availability may vary depending on your location and local health guidelines. Consult a healthcare professional for the latest information Preventions Prevention of Tuberculosis (TB) involves a combination of strategies: 2. _Early detection and treatment_: Identify and treat TB cases promptly to prevent transmission. 3. _Contact tracing_: Identify and screen individuals who have been in close contact with a TB patient. 4. _Infection control measures_: - Use personal protective equipment (PPE) - Ensure proper ventilation - Implement cough etiquette 5. _Screening high-risk groups_: - Healthcare workers - People living with HIV/AIDS - Prisoners - Migrants 6. _Improve ventilation and reduce crowding_: - In homes - In public places 7. _Practice good hygiene_: - Cover mouth and nose when coughing or sneezing - Wash hands regularly 8. _Avoid sharing personal items_: - Towels - Utensils - Drinking glasses 10. _Public awareness and education_: - Raise awareness about TB symptoms and prevention

📢 Roche rolls out Elecsys Anti-HEV IgM and IgG tests to detect HEV infections The Elecsys Anti-HEV IgM is designed for in-vitro qualitative detection of IgM antibodies to HEV in human serum and plasma, to help detect an acute or recently acquired HEV infection. Its Elecsys Anti-HEV IgG is intended for the in vitro quantitative determination of IgG antibodies to HEV in human serum and plasma, to help detect a recent or past HEV infection. Both are fully automated assays and provide results within 18 minutes. The World Health Organization (WHO) has developed an ‘Essential Diagnostics List’ comprising necessary in-vitro diagnostics to ensure timely and life-saving diagnoses in all countries. The Swiss healthcare company said that its HEV tests have been added to the list for the first time this year, to aid the diagnosis and surveillance of HEV infection. Roche Diagnostics CEO Matt Sause said: “These tests highlight Roche’s commitment to contributing to the elimination of infectious diseases globally. Infection with HEV, a virus of significant global impact, results in 70,000 deaths and 3,000 stillbirths annually. “The Anti-HEV IgM inclusion in the newly released WHO 2023 Essential Diagnostics List, demonstrates the important role this test plays in disease management for patients globally.” The testing for HEV infection would help clinicians identify the symptoms of their patients, determine appropriate treatment, and monitor and prevent its progression to severe disease. Read more online: bit.ly/47j73dt 📰 Follow Medical Device Developments to receive the latest medical device news daily and to subscribe to our weekly newsletter #MedicalDeviceDevelopments #roche #hev

Coronavirus Nirmatrelvir During Acute SARS-CoV-2 Does Not Reduce Risk for Long COVID By Elana Gotkine No association seen for rebound symptoms or test positivity with symptoms of long COVID Treatment with nirmatrelvir during acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is not associated with a reduced risk for subsequent development of long COVID, according to a study published online Jan. 4 in the Journal of Medical Virology. Matthew S. Durstenfeld, M.D., from the University of California in San Francisco, and colleagues conducted an observational cohort study involving 100,000 participants to examine whether nirmatrelvir treatment during acute SARS-CoV-2 infection reduces the risk for developing long COVID. A total of 4,684 individuals met the eligibility criteria: 21.1 percent were treated and 78.9 percent were untreated. Overall, 353 of 988 treated and 1,258 of 3,696 untreated participants responded to a survey regarding long COVID. The researchers found that nirmatrelvir treatment was not associated with subsequent symptoms of long COVID at 5.4 ± 1.3 months after infection (odds ratio, 1.15; 95 percent confidence interval, 0.80 to 1.64; P = 0.45). Rebound symptoms or test positivity were not associated with symptoms of long COVID among the 666 treated individuals who answered the rebound questions (odds ratio, 1.34; 95 percent confidence interval, 0.74 to 2.41; P = 0.33). "Our finding that Paxlovid treatment during acute infection is not associated with lower odds of long COVID surprised us, but it is consistent with two other rigorously conducted studies finding no difference in post-COVID conditions between four and six months after infection," Durstenfeld said in a statement. Larry Cole - click on image below to access entire abstract.

Researchers Uncover Long COVID Risk Factors By Columbia University Irving Medical Center Early in the pandemic, many people who had SARS-Cov-2 infection or COVID-19 began to report that they couldn't shake off their symptoms even after a month or more—unusually long for a viral infection of the upper respiratory tract—or developed new, persistent symptoms soon after the infection cleared. Although it's still not clear what causes post-COVID-19 conditions or "long COVID" (symptoms and conditions that develop, linger, or reoccur weeks or months after SARS-CoV-2 infection), a new study by researchers at Columbia University Vagelos College of Physicians and Surgeons confirms the high burden of long COVID and sheds light on who's at greatest risk. The study found that people with a milder infection—including those who were vaccinated against SARS-CoV-2 and those who were infected with an Omicron variant—were more likely to recover quickly. Recovery time was similar for subsequent infections. "Our study underscores the important role that vaccination against COVID has played, not just in reducing the severity of an infection but also in reducing the risk of long COVID," says Elizabeth C. Oelsner, the study's lead author and the Herbert Irving Associate Professor of Medicine. Study details The study involved over 4,700 participants from the Collaborative Cohort of Cohorts for COVID 19 Research(C4R), who were asked to report their time to recovery after infection with SARS-CoV-2. The study found that, between 2020 and early 2023, the median recovery time after SARS-CoV2-infection was 20 days, and more than one in five adults did not recover within three months. Women and adults with pre-pandemic cardiovascular disease were less likely to recover within three months. Other pre-pandemic health conditions—including chronic kidney disease, diabetes, asthma, chronic lung disease, depressive symptoms, and a history of smoking—were linked to longer recovery times, but these associations were no longer significant after accounting for sex, cardiovascular disease, vaccination, and variant exposure. Cont'd ***Please click on image in banner below to access the entire study. Posted by Larry Cole

📃Scientific paper: Severe Morbidity and Mortality Associated With Respiratory Syncytial Virus Versus Influenza Infection in Hospitalized Older Adults Abstract: BACKGROUND: Respiratory syncytial virus (RSV) is an important cause of serious respiratory illness in older adults. Comparison of RSV and influenza infection in hospitalized older adults may increase awareness of adult RSV disease burden. METHODS: Hospitalized adults aged ≥60 years who tested positive for RSV or influenza between 1 January 2011 and 30 June 2015 were identified from Kaiser Permanente Southern California electronic medical records. Baseline characteristics, comorbidities, utilization, and outcomes were compared. RESULTS: The study included 645 RSV- and 1878 influenza-infected hospitalized adults. Patients with RSV were older than those with influenza (mean, 78.5 vs 77.4 years; P = .035) and more likely to have congestive heart failure (35.3% vs 24.5%; P < .001) and chronic obstructive pulmonary disease (COPD) (29.8% vs 24.3%; P = .006) at baseline. In adjusted analyses, RSV infection was associated with greater odds of length of stay ≥7 days (odds ratio [OR] = 1.5; 95% confidence interval [CI], 1.2–1.8; P < .001); pneumonia (OR = 2.7; 95% CI, 2.2–3.2; P < .001); intensive care unit admission (OR = 1.3; 95% CI, 1.0–1.7; P = .023); exacerbation of COPD (OR = 1.7; 95% CI, 1.3–2.4; P = .001); and greater mortality within 1 year of admission (OR = 1.3; 95% CI, 1.0–1.6; P = .019). CONCLUSIONS: RSV infection may result in greater morbidity and mortality among older hospitalized adults than influenza. Increased recognition of adult RSV disease burden will be ... Continued on ES/IODE ➡️ https://etcse.fr/6r ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

Three-year outcomes of post-acute sequelae of COVID-19 Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes post-acute sequelae of coronavirus disease 2019 (COVID-19) (PASC) in many organ systems. Risks of these sequelae have been characterized up to 2 years after infection, but longer-term follow-up is limited. Here we built a cohort of 135,161 people with SARS-CoV-2 infection and 5,206,835 controls from the US Department of Veterans Affairs who were followed for 3 years to estimate risks of death and PASC. Among non-hospitalized individuals, the increased risk of death was no longer present after the first year of infection, and risk of incident PASC declined over the 3 years but still contributed 9.6 (95% confidence interval (CI): 0.4–18.7) disability-adjusted life years (DALYs) per 1,000 persons in the third year. Among hospitalized individuals, risk of death declined but remained significantly elevated in the third year after infection (incidence rate ratio: 1.29 (95% CI: 1.19–1.40)). Risk of incident PASC declined over the 3 years, but substantial residual risk remained in the third year, leading to 90.0 (95% CI: 55.2–124.8) DALYs per 1,000 persons. Altogether, our findings show reduction of risks over time, but the burden of mortality and health loss remains in the third year among hospitalized individuals. ***Click on image below to access entire study with conclusions. Posted by Larry Cole