Original Investigation November 17, 2020 Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial Yonathan Freund, Marine Cachanado, Quentin Delannoy, et al JAMA. 2020;324(19):1948-1956. doi:10.1001/jama.2020.19378 Abstract Importance Clinical guidelines for the early management of acute heart failure in the emergency dep...

Lung Histopathology: COVID-19 Compared to SARS, H1N1 The coronavirus disease has spread throughout the world and has resulted in many challenges for healthcare systems. It is a new disease with a significant burden of respiratory failure. This has led to questions about the pathogenesis and pulmonary pathology of COVID-19.  Patients with severe COVID-19 have respiratory failure with hypoxaemia, and acute bilateral pulmonary infiltrates. This is consistent with ...

ORIGINAL ARTICLE Repurposed Antiviral Drugs for Covid-19 — Interim WHO Solidarity Trial Results WHO Solidarity Trial Consortium N Engl J Med December 2, 2020DOI: 10.1056/NEJMoa2023184 Abstract BACKGROUND World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs — remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a — in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS ...

Corticosteroids and Mortality in COVID-19 Patients The use of corticosteroids to treat severe infections has been a controversy for quite a long time. Now, as we face the COVID-19 pandemic, clinical research on corticosteroids has received a significant push. During the first six months of 2020, 55 studies of corticosteroids for the treatment of COVID-19 have been registered. The RECOVERY trial has reported its findings demonstrating that 6mg/d of dexamethasone resu...

Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes Daniel E Leisman, Lukas Ronner, Rachel Pinotti, et al Lancet Respir Med Published:October 16, 2020 DOI:https://doi.org/10.1016/S2213-2600(20)30404-5 Summary The description of a so-called cytokine storm in patients with COVID-19 has prompted consideration of anti-cytokine therapies, particularly interleukin-6 antagonist...

COVID-19 and Antimicrobial Stewardship COVID-19 is a new disease. On initial presentation, clinicians can find it difficult to differentiate between coronavirus disease and bacterial community-acquired pneumonia. COVID-19 patients often develop a hyperinflammatory phase during the disease process, which could again be difficult to distinguish from a secondary bacterial infection. That is why nearly 72% of patients suffering from COVID-19 receive antibiotic therapy...

ARTICLES|ONLINE FIRST Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial Demetris Yannopoulos, Jason Bartos, Ganesh Raveendran, et al Lancet Published:November 13, 2020 DOI:https://doi.org/10.1016/S0140-6736(20)32338-2 Summary Background Among patients with out-of-hospital cardiac arrest (OHCA) and ventricular ...

Tocilizumab and COVID-19 Pneumonia Tocilizumab is a humanised monoclonal antibody that binds human interleukin 6 (IL-6) receptors. It is generally used in inflammatory arthritis, giant cell arteritis and cytokine release syndrome after chimeric antigen receptor T-cell therapy.  Tocilizumab has come under close scrutiny during the COVID-19 pandemic. Early observations from China showed an increased risk of death in COVID-19 patients with elevated IL-6 levels, an...

Venous Doppler to Predict Adverse Kidney Events In patients admitted to the ICU following surgery, trauma or septic shock, fluid boluses are often used to increase cardiac output and blood pressure. However, clinical evidence shows that excess fluid administration could be detrimental for patients and could lead to increased rates of acute kidney injury (AKI), prolonged days of mechanical ventilation and death. There are currently no established ultrasound measures of ...

ORIGINAL ARTICLE SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19 Peter Chen, Ajay Nirula, Barry Heller, et al N Engl J Med October 28, 2020DOI: 10.1056/NEJMoa2029849 Abstract BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (Covid-19), which is most frequently mild yet can be severe and life-threatening. Virus-neutralizing monoclonal antibodies are predicted to reduce viral lo...