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RECOVERY Trial: Dexamethasone in COVID-19
Inflammatory events following infection with SARS-CoV-2 can often worsen the morbid or mortal outcomes with COVID, yet it has been unclear if glucocorticoids may modulate inflammation-mediated damage and lung injury. The RECOVERY trial reports that dexamethasone (DEX) use lowered 28-day mortality among COVID-19 patients requiring respiratory support.
The RECOVERY trial was performed in the UK and enrolled hospitalized COVID-19 patients who were randomly assigned patients to usual care alone or the addition of oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days. The primary outcome was 28-day mortality.
RheumNow Podcast – LTF – Listen to Fauci (7.17.20)
Dr. Jack Cush reviews the news, tweets and journal articles from the past week on RheumNow. Let's dig into this week's 14 highlights.
ACR Position Statement on Telemedicine
The American College of Rheumatology (ACR) has released an official position statement supporting the role of telemedicine as a tool with the potential to increase access and improve care for patients with rheumatic diseases.
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First Look at COVID-19 Global Rheumatology Alliance Registry
Gianfresco et al have published the first peer-reviewed analysis of COVID-19 infected, rheumatic disease patients entered into the Rheumatology Global Alliance registry; showing that a) rheumatic disease patient can be infected with COVID-19, b) that DMARD and biologic use has no apparent effect on outcomes and c) steroid increase and TNF inhibitor decrease the odds of hospitalization.
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TNR Grand Rounds - Cytokine Storm Syndromes
This week's Tuesday Nite Rheumatology featured Dr Randy Cron from the University of Alabama - Birmingham as he spoke and took questions on the immunology, immunopathogenesis and treatment of Cytokine Storm Syndrome, especially as they relate to COVID-19 and rheumatic disease patients. The program was moderated by Dr. Jack Cush.
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High Dose Anakinra Effective in COVID-19
Anakinra was studied in 29 COVID(+) patients with respiratory distress and high inflammatory markers (CRP or ferritin) and compared to non-anakinra patients, those on anakinra had better survival (90% vs. 56% ;p=0·009) and greater improvements in CRP and pulmonary function (72% vs 50%) compared to controls at day 21.
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Kids' COVID-Linked Ailment Is Not Your Typical Kawasaki Disease
As data continue to emerge about a multi-system inflammatory disorder in children apparently connected to COVID-19, evidence is growing that this is not your typical Kawasaki disease.
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TNR Grand Rounds - What does COVID-19 have to do with Lupus?
Last night's Tuesday Nite Rheumatology featured Dr. Joan Merrill (OMRF). In her lecture, "What does COVID-19 have to do with lupus?", she discusses the pathogenesis of lupus, and specifically thrombotic microangiopathy, complementopathies, catastrophic lupus syndrome and the potential overlap with the vascular pathology seen with COVID-19 infection.
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God Bless Nurses
It's Nurses Week and time to reaffirm our reverence for nurses. Dr. Jack Cush gives a video testimonial to the dedication, dependability and excellence Nurses bring to patient care. God Bless our Nurses!
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Risk of COVID-19 at Choir Practice
MMWR reports that after attending a 2.5 hr choir practice with one COVID+ symptomatic person, 87% of the choir developed COVID 19; 3 were hospitalized, and two died.
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Physical Activity Prevents Hospitalization
Modifiable lifestyle choices can impact long term health. A recent study shows that usual and increased physical activity can results in less hospitalization amongst the the general population.
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Hydroxychloroquine's World of Confusion - What you Need to Know
Hydroxychloroquine has been a dominant news item since the start of the COVID-19 crisis, with a great deal of misconceptions by those who don't know or use or take the drug. HCQ leaped to the headlines on March 19th when President Trump endorsed the drug as being “approved” by FDA. Of course at that time, it was still only approved for SLE, RA and malaria and it wasn't until 2 weeks later (March 31st) that the FDA issued an "emergency use authorization" allowing the use of either chloroquine or HCQ for treatment of severe, hospitalized patients with COVID-19.
To provide clarity and evidence - here are some of the facts you need to know.
ACR: In-Person Urgent vs. Virtual Non-Urgent Medical Care
On April 26, 2020 the American College of Rheumatology (ACR) published a guidance paper to assist rheumatologists and rheumatology health professionals in assessing the need for urgent or face-to-face medical care versus virtual or telehealth patient care. The driving principals being
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German Society of Rheumatology COVID Pandemic Recommendations
The Annals of Rheumatic Disease has published the preliminary recommendations of the German Society of Rheumatology for the management of Inflammatory rheumatic diseases patients during the SARS-CoV-2/Covid-19 pandemic.
These preliminary recommendations are based on an expert consensus from 17 experienced German rheumatologists.
Rheum Views on the Upside and Downside of COVID-19
The world has been turned upside down in the last 6 weeks. Medicine and rheumatology have certainly changed – a frightening experience for Chicken Little, a disaster for the pessimist, a challenge for the pragmatist and an opportunity for the optimists amongst us. Last week I asked our audience to tell me their “upside or downside of COVID-19”. Read on to see how your peers have operating or thinking.
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High Dose Chloroquine Harmful in Severe COVID-19
JAMA Open Network reports an interim analysis of the Brazilian CloroCovid-19 trial showing thta higher doses of chloroquine (CQ) in the treatment of severe COVID-19 was associated with QTc interval prolongation and increased mortality.
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