Paxlobid use is associated with reduced risk of cardiovascular disease in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study

1. Use of paxlobid from the first day of confirmed COVID-19 infection in patients with autoimmune rheumatic diseases was associated with a lower risk of cardiovascular complications.

Evidence evaluation level: 2 (good)

Paxrobid is an oral antiviral treatment used to reduce hospitalization and mortality rates in patients with COVID-19. Patients with rheumatic diseases are known to be at increased risk of infections and complications. Therefore, it is important to control COVID-19 infection in these patients at the early stages of the disease. Researchers reported that in patients who survived COVID-19 and had an underlying autoimmune rheumatic disease (AIRD), the first day after COVID-19 diagnosis We aimed to determine whether treatment with paxlobid within a period of time reduces the risk of cardiovascular complications. 238,142 patients with AIRD and COVID-19 infection in 2022 were included in this cohort study through the US collaborative network TriNetX data. This cohort was divided into two groups: those who received treatment with paxlobid and those who did not. Compared to the non-paxlobid group, paxlobid use was associated with a lower risk of cerebrovascular complications (HR = 0.65) [0.47–0.88]), arrhythmia outcome (HR = 0.81) [0.68–0.94]), ischemic heart disease and other heart diseases (HR = 0.51) [0.35–0.74]) Heart failure (HR = 0.41) [0.26–0.63]), serious adverse cardiac events (HR = 0.56) [0.44–0.70]) and deep vein thrombosis (HR = 0.46) [0.24–0.87]). A limitation of this study is that information on health insurance status was not available, which is known to be an important potential confounding variable influencing health care utilization during the COVID-19 pandemic. It was getting worse. Overall, this study demonstrates that paxlobid use during COVID-19 infection in AIRD patients is associated with a reduced risk of cardiovascular complications.

Active Surveillance and Preterm Birth After Loop Resection for Cervical Intraepithelial Neoplasia Grade 2

1. For women with CIN2, the risk of preterm birth was similar for women who underwent active surveillance compared with immediate loop electrosurgical excision (LEEP), but who underwent delayed LEEP compared with immediate LEEP. Women had a higher risk of preterm birth.

Evidence evaluation level: 2 (good)

Cervical intraepithelial neoplasia grade 2 (CIN2) is usually managed by surgical resection. 50-60% of CIN2 cases regress spontaneously within 2 years. Therefore, managing all cases with surgical resection may be overtreatment. Furthermore, surgical treatment is associated with an increased risk of future obstetric complications, such as preterm birth and early preterm rupture of membranes. In this cohort study, researchers aimed to compare the risk of preterm birth between CIN2 patients who underwent active surveillance and women who underwent immediate loop electrosurgical excision (LEEP). 10,537 Danish women with CIN2 and monoparity were included in this study. 42% received active surveillance and 58% were managed with immediate LEEP. Overall, 8.2% of her births were preterm. The risk of preterm birth was similar between active surveillance and immediate LEEP (RR, 1.03; 95% CI, 0.90-1.18). Women who received delayed LEEP after a period of active surveillance had an increased risk of preterm delivery compared with women who received immediate LEEP (RR, 1.29; 95% CI, 1.08-1.55). A limitation of this study is that the authors lacked information on some confounding variables that may influence the risk of preterm birth, such as socioeconomic status. Overall, this study found that the risk of preterm birth in women with CIN2 was similar in women who received active surveillance compared with LEEP, but the risk of preterm birth was similar in women who received delayed LEEP compared with immediate LEEP. This indicates that the female female had a larger size.

Teenage pregnancy and the risk of early death

1. This cohort study of teenage women in Ontario, Canada, found that women who had one pregnancy as a teenager had an increased risk of premature death, and women who had two or more pregnancies as a teenager had an even higher risk of premature death. Ta.

Evidence evaluation level: 2 (good)

Deaths during teenage pregnancy and childbirth, including deaths from hemorrhage, hypertensive disorders, or sepsis, are rare events. However, the researchers hypothesized that teen pregnancy may be a marker of adverse childhood experiences (ACEs) before or during a teen’s formative years, which may increase the risk of early death. . This cohort study included 2,242,929 women who were alive at age 12 years between 1991 and 2021 in Ontario, Canada. Of this cohort, 7.3% experienced a teenage pregnancy with a median age of 18 years. Median age at follow-up was 25 years for non-pregnant teens and 31 years for pregnant teens. Of those who became pregnant as teenagers, 36.8% ended in childbirth, and 65.1% ended in induced abortion. The mortality rate for non-pregnant teens was 1.9 deaths per 10,000 person-years (95% CI, 1.9 to 2.0 per 10,000 person-years); the mortality rate for teens who had ever become pregnant was 4.1 deaths per 10,000 person-years. (95%). CI, 3.8–4.5 per 10 000 person-years), and the mortality rate for those who had more than one pregnancy in their teens was 6.1 per 10 000 person-years (95% CI, 5.5–6.8 per 10 000 person-years). ). Compared with zero pregnancies, those with one pregnancy had a higher risk of early death (adjusted HR) [AHR], 1.51; 95% CI, 1.39-1.63), and patients with two or more pregnancies (AHR, 2.14; 95% CI, 1.92-2.39). This study has potential implications for clinical practice and policy-making, showing that teenage pregnancy may be an important point in identifying individuals who would benefit from increased social support. Overall, this study shows that the risk of early death is high for women who have had one pregnancy as a teenager, and even higher for women who have had two or more pregnancies at age 10.

Risk of encephalitis and meningitis after COVID-19 vaccination in South Korea: A self-controlled case series analysis

1. This large population-based study of Korean adults found that only those vaccinated with the AstraZeneca (ChAdOx1-S) vaccine were at increased risk of developing encephalitis within 28 days after receiving the COVID-19 vaccine. increased, but did not increase the risk of developing encephalitis. Developing meningitis after vaccination.

Evidence evaluation level: 2 (good)

More than 5.5 billion people around the world have received at least one dose of a COVID-19 vaccine. Encephalitis and meningitis are reported as rare but serious adverse events of special interest (AESI). In this self-controlled case cluster analysis, researchers used data from the Korea Disease Control Agency from February 2021 to March 2022 to identify cases of South Korean patients who had received at least one dose of the COVID-19 vaccine. Adult medical claims were evaluated. The risk window for developing meningitis or encephalitis was defined as days 1 to 28 after vaccination, and the control window was defined as the remainder of the 240-day follow-up period. Overall, 129,956,027 doses of COVID-19 vaccines were administered to a total of 44,564,345 participants. Within this group, there were 251 cases of encephalitis and 398 cases of meningitis during the risk window. There was an increased risk of developing encephalitis during the first 28 days after vaccination against COVID-19, but this was only significant in patients who received the AstraZeneca (ChAdOx1-S) vaccine ( IRR 1.26; 95% CI 1.08-1.47). No increased risk of developing meningitis was observed after receiving any type of coronavirus disease (COVID-19) vaccine (IRR 1.03; 95% CI 0.91-1.16). Future studies could investigate whether there is a long-term risk of neurological complications after receiving a coronavirus vaccine, which was not addressed in this study. Overall, the study shows an increased risk of developing encephalitis only in people who received the AstraZeneca vaccine, and no significant association between COVID-19 vaccination and meningitis.

Adherence to long-term surveillance for late effects of cancer treatment: A population-based study of adult survivors of childhood cancer.

1. In this retrospective population-based cohort study, adherence to health surveillance guidelines among adult childhood cancer survivors in Ontario, Canada, was suboptimal.

Evidence evaluation level:2 (good)

Adherence to long-term health surveillance guidelines among adult cancer survivors is known to be low. In this retrospective population-based cohort study, researchers aimed to assess compliance with surveillance guidelines for high-yield testing in adult childhood cancer survivors. Participants in this study included adults diagnosed with childhood cancer in Ontario, Canada, between 1986 and 2014. Data were collected from health administrative data for this state. All 3,241 participants in the study were at increased risk for treatment-related complications. 3,205 (99%) had an increased risk of developing cardiomyopathy, 234 (7%) had an increased risk of breast cancer, and 327 (10%) had an increased risk of developing colorectal cancer. Of these three cohorts, only 53%, 6%, and 13%, respectively, adhered to surveillance guidelines. The researchers found that higher levels of comorbidity were associated with higher adherence to surveillance guidelines. A limitation of this study is that the data may not be generalizable to populations outside of Ontario or outside of Canada. Adherence may be even lower in areas without publicly funded health insurance, which was available to participants in this study. Overall, this study shows that adherence to surveillance guidelines among adult childhood cancer survivors in Ontario, Canada is suboptimal.

Image: P.D.

©2024 2 Minute Medicine, Inc. All rights reserved.No work may be reproduced 2 Minute Medicine, Inc. provides written consent. For licensing inquiries, please contact us here.no This article should be construed as medical advice and is not intended as such by any medical authority. Author or 2 Minute Medicine, Inc.