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Article ; Online: Healthcare workers preparedness for COVID-19 pandemic in the occupied Palestinian territory

Osaid Alser / Heba Alghoul / Zahra Alkhateeb / Ayah Hamdan / Loai Albarqouni / Kiran Saini

BMC Health Services Research, Vol 21, Iss 1, Pp 1-

a cross-sectional survey

2021 Volume 7

Abstract: Abstract Background The COVID-19 pandemic threatens to overwhelm the capacity of a vulnerable healthcare system in the occupied Palestinian territory (oPt). We aimed to evaluate the availability of personal protective equipment (PPE) and the level of ... ...

Abstract	Abstract Background The COVID-19 pandemic threatens to overwhelm the capacity of a vulnerable healthcare system in the occupied Palestinian territory (oPt). We aimed to evaluate the availability of personal protective equipment (PPE) and the level of preparedness among HCWs in the oPt. Methods A cross-sectional study was conducted using a validated online questionnaire distributed through convenient sampling between March 30, 2020 and April 12, 2020. Outcomes were availability of PPE, healthcare workers (HCWs) preparedness in oPt for COVID-19 pandemic, and regional and hospital differences in oPt in terms of availability of PPE and HCWs preparedness. Descriptive statistics and univariate analysis were used in this study. Results Of 138 respondents, only 38 HCWs (27.5%) always had access to facemasks and 15 (10.9%) always had access to isolation gowns. Most HCWs did not find eye protection (n = 128, 92.8%), N95 respirators (n = 132, 95.7%), and face shields (n = 127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers (p = 0.03) and gloves (p < 0.001). On average, governmental hospitals were significantly less likely to have all appropriate PPE than non-governmental institutions (p = 0.001). Only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case, 57 (41.3%) having received any COVID-19-related training, and 57 (41.3%) not having a local hospital protocol. Conclusion HCWs in oPt appear to be underprepared and severely lacking adequate PPE provision. The lack of PPE provision will exacerbate spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.
Keywords	COVID-19 ; Coronavirus ; PPE ; Palestine ; Occupied Palestinian territory ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Serious complications and risk of re-operation after Dupuytren’s disease surgery

Osaid Alser / Richard S. Craig / Jennifer C. E. Lane / Albert Prats-Uribe / Danielle E. Robinson / Jonathan L. Rees / Daniel Prieto-Alhambra / Dominic Furniss

Scientific Reports, Vol 10, Iss 1, Pp 1-

a population-based cohort study of 121,488 patients in England

2020 Volume 10

Abstract: Abstract Dupuytren’s disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England’s Hospital Episode Statistics database and ... ...

Abstract	Abstract Dupuytren’s disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England’s Hospital Episode Statistics database and included all adult DD patients who were surgically treated. A longitudinal cohort study and self-controlled case series were conducted. Between 1 April 2007 and 31 March 2017, 121,488 adults underwent 158,119 operations for DD. The cumulative incidence of 90-day serious local complications was low at 1.2% (95% CI 1.1–1.2). However, the amputation rate for re-operation by limited fasciectomy following dermofasciectomy was 8%. 90-day systemic complications were also uncommon at 0.78% (95% CI 0.74–0.83), however operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications such as myocardial infarction. Re-operation was lower than previous reports (33.7% for percutaneous needle fasciotomy, 19.5% for limited fasciectomy, and 18.2% for dermofasciectomy). Overall, DD surgery performed in England was safe; however, re-operation by after dermofasciectomy carries a high risk of amputation. Furthermore, whilst serious systemic complications were unusual, the data suggest that high-risk patients should undergo treatment under local anaesthesia. These data will inform better shared decision-making regarding this common condition.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Heterogeneity and temporal variation in the management of COVID-19

Albert Prats-Uribe / Anthony G. Sena / Lana Yin Hui Lai / Waheed-Ul-Rahman Ahmed / Heba Alghoul / Osaid Alser / Thamir M Alshammari / Carlos Areia / William Carter / Paula Casajust / Dalia Dawoud / Asieh Golozar / Jitendra Jonnagaddala / Paras Mehta / Gong Menchung / Daniel R Morales / Fredrik Nyberg / Jose D Posada / Martina Recalde /

a multinational drug utilization study including 71,921 hospitalized patients from China, South Korea, Spain, and the United States of America

2020

Abstract: Objectives: A plethora of medicines have been repurposed or used as adjunctive therapies for COVID-19. We characterized the utilization of medicines as prescribed in routine practice amongst patients hospitalized for COVID-19 in South Korea, China, Spain, ...

Abstract	Objectives: A plethora of medicines have been repurposed or used as adjunctive therapies for COVID-19. We characterized the utilization of medicines as prescribed in routine practice amongst patients hospitalized for COVID-19 in South Korea, China, Spain, and the USA. Design: International network cohort Setting: Hospital electronic health records from Columbia University Irving Medical Centre (NYC, USA), Stanford (CA, USA), Tufts (MA, USA), Premier (USA), Optum EHR (USA), department of veterans affairs (USA), NFHCRD (Honghu, China) and HM Hospitals (Spain); and nationwide claims from HIRA (South Korea) Participants: patients hospitalized for COVID-19 from January to June 2020 Main outcome measures: Prescription/dispensation of any medicine on or 30 days after hospital admission date Analyses: Number and percentage of users overall and over time Results: 71,921 people were included: 304 from China, 2,089 from Spain, 7,599 from South Korea, and 61,929 from the USA. A total of 3,455 medicines were identified. Common repurposed medicines included hydroxychloroquine (<2% in NFHCRD to 85.4% in HM), azithromycin (4.9% in NFHCRD to 56.5% in HM), lopinavir/ritonavir (<3% in all US but 34.9% in HIRA and 56.5% in HM), and umifenovir (0% in all except 78.3% in NFHCRD). Adjunctive medicines were used with great variability, with the ten most used treatments being (in descending order): bemiparin, enoxaparin, heparin, ceftriaxone, aspirin, vitamin D, famotidine, vitamin C, dexamethasone, and metformin. Hydroxychloroquine and azithromycin increased rapidly in use in March-April but declined steeply in May-June. Conclusions: Multiple medicines were used in the first months of COVID-19 pandemic, with substantial geographic and temporal variation. Hydroxychloroquine, azithromycin, lopinavir-ritonavir, and umifenovir (in China only) were the most prescribed repurposed medicines. Antithrombotics, antibiotics, H2 receptor antagonists and corticosteroids were often used as adjunctive treatments. Research is needed on the comparative risk and benefit of these treatments in the management of COVID-19.
Keywords	COVID-19 ; Electronic health records ; Hydroxychloroquine ; Lopinavir/Ritonavir ; Umifenovir ; Azithromycin ; covid19
Subject code	950
Publishing date	2020-09-25
Publishing country	eu
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Risk of depression, suicidal ideation, suicide and psychosis with hydroxychloroquine treatment for rheumatoid arthritis

Jennifer C.E Lane / James Weaver / Kristin Kostka / Talita Duarte-Salles / Maria Tereza F Abrahao / Heba Alghoul / Osaid Alser / Thamir M Alshammari / Carlos Areia / Juan M. Banda / Patricia Biedermann / Edward Burn / Paula Casajust / Kristina Fišter / Jill Hardin / Laura Hester / George Hripcsak / Benjamin Skov Kaas-Hansen / Sajan Khosla /

Spyros Kolovos / Kristine E. Lynch / Rupa Makadia / Paras P. Mehta / Daniel R Morales / Henry Morgan-Stewart / Mees Mosseveld / Danielle Newby / Fredrik Nyberg / Anna Ostropolets / Rae Woong Park / Albert Prats-Uribe / Gowtham A. Rao / Christian Reich / Peter Rijnbeek / Anthony G. Sena / Azza Shoaibi / Matthew Spotnitz / Vignesh Subbian / Marc A Suchard / David Vizcaya / Haini Wen / Marcel de Wilde / Junqing Xie / Seng Chan You / Lin Zhang / Simon Lovestone / Patrick B Ryan / Daniel Prieto-Alhambra

a multi-national network cohort study

2020

Abstract: Objectives Concern has been raised in the rheumatological community regarding recent regulatory warnings that hydroxychloroquine used in the COVID-19 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident ... ...

Abstract	Objectives Concern has been raised in the rheumatological community regarding recent regulatory warnings that hydroxychloroquine used in the COVID-19 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation, or psychosis associated with hydroxychloroquine as used for rheumatoid arthritis (RA). Methods New user cohort study using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and US). RA patients aged 18+ and initiating hydroxychloroquine were compared to those initiating sulfasalazine (active comparator) and followed up in the short (30-day) and long term (on treatment). Study outcomes included depression, suicide/suicidal ideation, and hospitalization for psychosis. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate database-specific calibrated hazard ratios (HR), with estimates pooled where I2<40%. Results 918,144 and 290,383 users of hydroxychloroquine and sulfasalazine, respectively, were included. No consistent risk of psychiatric events was observed with short-term hydroxychloroquine (compared to sulfasalazine) use, with meta-analytic HRs of 0.96 [0.79-1.16] for depression, 0.94 [0.49-1.77] for suicide/suicidal ideation, and 1.03 [0.66-1.60] for psychosis. No consistent long-term risk was seen, with meta-analytic HRs 0.94 [0.71-1.26] for depression, 0.77 [0.56-1.07] for suicide/suicidal ideation, and 0.99 [0.72-1.35] for psychosis. Conclusions Hydroxychloroquine as used to treat RA does not appear to increase the risk of depression, suicide/suicidal ideation, or psychosis compared to sulfasalazine. No effects were seen in the short or long term. Use at higher dose or for different indications needs further investigation.
Keywords	COVID-19 ; Hydroxychloroquine ; Safety ; Rheumatoid Arthritis ; Psychosis ; Depression ; Sulfasalazine ; Risk ; covid19
Subject code	310
Publishing date	2020-08-07
Publishing country	eu
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Baseline characteristics, management, and outcomes of 55,270 children and adolescents diagnosed with COVID-19 and 1,952,693 with influenza in France, Germany, Spain, South Korea and the United States

Talita Duarte-Salles / David Vizcaya / Andrea Pistillo / Paula Casajust / Anthony G. Sena / Lana Yin Hui Lai / Albert Prats-Uribe / Waheed-Ul-Rahman Ahmed / Thamir M Alshammari / Heba Alghoul / Osaid Alser / Edward Burn / Seng Chan You / Carlos Areia / Clair Blacketer / Scott DuVall / Thomas Falconer / Sergio Fernandez-Bertolin / Stephen Fortin /

an international network cohort study

2020

Abstract: Objectives To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children/adolescents diagnosed or hospitalized with COVID-19. Secondly, to describe health outcomes amongst children/adolescents ... ...

Abstract	Objectives To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children/adolescents diagnosed or hospitalized with COVID-19. Secondly, to describe health outcomes amongst children/adolescents diagnosed with previous seasonal influenza. Design International network cohort. Setting Real-world data from European primary care records (France/Germany/Spain), South Korean claims and US claims and hospital databases. Participants Diagnosed and/or hospitalized children/adolescents with COVID-19 at age <18 between January and June 2020; diagnosed with influenza in 2017-2018. Main outcome measures Baseline demographics and comorbidities, symptoms, 30-day in-hospital treatments and outcomes including hospitalization, pneumonia, acute respiratory distress syndrome (ARDS), multi-system inflammatory syndrome (MIS-C), and death. Results A total of 55,270 children/adolescents diagnosed and 3,693 hospitalized with COVID-19 and 1,952,693 diagnosed with influenza were studied. Comorbidities including neurodevelopmental disorders, heart disease, and cancer were all more common among those hospitalized vs diagnosed with COVID-19. The most common COVID-19 symptom was fever. Dyspnea, bronchiolitis, anosmia and gastrointestinal symptoms were more common in COVID-19 than influenza. In-hospital treatments for COVID-19 included repurposed medications (<10%), and adjunctive therapies: systemic corticosteroids (6.8% to 37.6%), famotidine (9.0% to 28.1%), and antithrombotics such as aspirin (2.0% to 21.4%), heparin (2.2% to 18.1%), and enoxaparin (2.8% to 14.8%). Hospitalization was observed in 0.3% to 1.3% of the COVID-19 diagnosed cohort, with undetectable (N<5 per database) 30-day fatality. Thirty-day outcomes including pneumonia, ARDS, and MIS-C were more frequent in COVID-19 than influenza. Conclusions Despite negligible fatality, complications including pneumonia, ARDS and MIS-C were more frequent in children/adolescents with COVID-19 than with influenza. Dyspnea, anosmia and gastrointestinal symptoms could help differential diagnosis. A wide range of medications were used for the inpatient management of pediatric COVID-19.
Keywords	COVID-19 ; Demographics ; Comorbidities ; Symptoms ; Treatments ; Health outcomes ; Children ; Influenza ; Real-world data ; Primary care records ; Claims ; Hospital databases ; covid19
Subject code	360
Publishing date	2020-10-30
Publishing country	eu
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Clinical characteristics, symptoms, management and health outcomes in 8,598 pregnant women diagnosed with COVID-19 compared to 27,510 with seasonal influenza in France, Spain and the US

Lana Yin Hui Lai / Asieh Golozar / Anthony Sena / Andrea V. Margulis / Nuria Haro / Paula Casajust / Neus Valveny / Albert Prats-Uribe / Evan P. Minty / Waheed-Ul-Rahman Ahmed / Thamir M Alshammari / Daniel R. Morales / Heba Alghoul / Osaid Alser / Dalia Dawoud / Lin Zhang / Jose D. Posada / Nigam H. Shah / Clair Blacketer /

a network cohort analysis

2020

Abstract: OBJECTIVES To describe comorbidities, symptoms at presentation, medication use, and 30-day outcomes after a diagnosis of COVID-19 in pregnant women, in comparison to pregnant women with influenza. DESIGN Multinational network cohort SETTING A total of 6 ... ...

Abstract	OBJECTIVES To describe comorbidities, symptoms at presentation, medication use, and 30-day outcomes after a diagnosis of COVID-19 in pregnant women, in comparison to pregnant women with influenza. DESIGN Multinational network cohort SETTING A total of 6 databases consisting of electronic medical records and claims data from France, Spain, and the United States. PARTICIPANTS Pregnant women with ≥ 1 year in contributing databases, diagnosed and/or tested positive, or hospitalized with COVID-19. The influenza cohort was derived from the 2017-2018 influenza season. OUTCOMES Baseline patient characteristics, comorbidities and presenting symptoms; 30-day inpatient drug utilization, maternal complications and pregnancy-related outcomes following diagnosis/hospitalization. RESULTS 8,598 women diagnosed (2,031 hospitalized) with COVID-19 were included. Hospitalized women had, compared to those diagnosed, a higher prevalence sof pre-existing comorbidities including renal impairment (2.2% diagnosed vs 5.1% hospitalized) and anemia (15.5% diagnosed vs 21.3% hospitalized). The ten most common inpatient treatments were systemic corticosteroids (29.6%), enoxaparin (24.0%), immunoglobulins (21.4%), famotidine (20.9%), azithromycin (18.1%), heparin (15.8%), ceftriaxone (7.9%), aspirin (7.0%), hydroxychloroquine (5.4%) and amoxicillin (3.5%). Compared to 27,510 women with influenza, dyspnea and anosmia were more prevalent in those with COVID-19. Women with COVID-19 had higher frequency of cesarean-section (4.4% vs 3.1%), preterm delivery (0.9% vs 0.5%), and poorer maternal outcomes: pneumonia (12.0% vs 2.7%), ARDS (4.0% vs 0.3%) and sepsis (2.1% vs 0.7%). COVID-19 fatality was negligible (N<5 in each database respectively). CONCLUSIONS Comorbidities that were more prevalent with COVID-19 hospitalization (compared to COVID-19 diagnosed) in pregnancy included renal impairment and anemia. Multiple medications were used to treat pregnant women hospitalized with COVID-19, some with little evidence of benefit. Anosmia and dyspnea were indicative symptoms of COVID-19 in pregnancy compared to influenza, and may aid differential diagnosis. Despite low fatality, pregnancy and maternal outcomes were worse in COVID-19 than influenza.
Keywords	COVID-19 ; Pregnancy ; Comorbidities ; Influenza ; Medication ; Electronic health records ; covid19
Subject code	150 ; 610
Publishing date	2020-10-14
Publishing country	eu
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Characteristics and outcomes of 627 044 COVID-19 patients with and without obesity in the United States, Spain, and the United Kingdom

Martina Recalde / Elena Roel / Andrea Pistillo / Anthony G Sena / Albert Prats-Uribe / Waheed Ul-Rahman Ahmed / Heba Alghoul / Thamir M Alshammari / Osaid Alser / Carlos Areia / Edward Burn / Paula Casajust / Dalia Dawoud / Scott L DuVall / Thomas Falconer / Sergio Fernandez-Bertolin / Asieh Golozar / Mengchun Gong / Lana Yin Hui Lai /

Jennifer C.E Lane / Kristine E Lynch / Michael E Matheny / Paras P Mehta / Daniel R Morales / Karthik Natarjan / Fredrik Nyberg / Jose D Posada / Christian G Reich / Lisa M Schilling / Karishma Shah / Nigham H Shah / Vignesh Subbian / Lin Zhang / Hong Zhu / Patrick Ryan / Daniel Prieto-Alhambra / Kristin Kostka / Talita Duarte-Salles

2020

Abstract: Background: COVID-19 may differentially impact people with obesity. We aimed to describe and compare the demographics, comorbidities, and outcomes of obese patients with COVID-19 to those of non-obese patients with COVID-19, or obese patients with ... ...

Abstract	Background: COVID-19 may differentially impact people with obesity. We aimed to describe and compare the demographics, comorbidities, and outcomes of obese patients with COVID-19 to those of non-obese patients with COVID-19, or obese patients with seasonal influenza. Methods: We conducted a cohort study based on outpatient/inpatient care, and claims data from January to June 2020 from the US, Spain, and the UK. We used six databases standardized to the OMOP common data model. We defined two cohorts of patients diagnosed and/or hospitalized with COVID-19. We created corresponding cohorts for patients with influenza in 2017-2018. We followed patients from index date to 30 days or death. We report the frequency of socio-demographics, prior comorbidities, and 30-days outcomes (hospitalization, events, and death) by obesity status. Findings: We included 627 044 COVID-19 (US: 502 650, Spain: 122 058, UK: 2336) and 4 549 568 influenza (US: 4 431 801, Spain: 115 224, UK: 2543) patients. The prevalence of obesity was higher among hospitalized COVID-19 (range: 38% to 54%) than diagnosed COVID-19 (30% to 47%), or diagnosed/hospitalized influenza (15% to 48%) patients. Obese hospitalized COVID-19 patients were more often female and younger than non-obese COVID-19 patients or obese influenza patients. Obese COVID-19 patients were more likely to have prior comorbidities, present with cardiovascular and respiratory events during hospitalization, require intensive services, or die compared to non-obese COVID-19 patients. Obese COVID-19 patients were also more likely to require intensive services or die compared to obese influenza patients, despite presenting with fewer comorbidities. Interpretation: We show that obesity is more common among COVID-19 than influenza patients, and that obese patients present with more severe forms of COVID-19 with higher hospitalization, intensive services, and fatality than non-obese patients. These data are instrumental for guiding preventive strategies of COVID-19 infection and complications
Keywords	COVID-19 ; Obesity ; Hospital admission ; Case-fatality rate ; covid19
Subject code	610
Publishing date	2020-09-03
Publishing country	eu
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Deep phenotyping of 34,128 adult patients hospitalised with COVID-19 in an international network study

Edward Burn / Seng Chan You / Anthony G. Sena / Kristin Kostka / Hamed Abedtash / Maria Tereza F. Abrahão / Amanda Alberga / Heba Alghoul / Osaid Alser / Thamir M. Alshammari / Maria Aragon / Carlos Areia / Juan M. Banda / Jaehyeong Cho / Aedin C. Culhane / Alexander Davydov / Frank J. DeFalco / Talita Duarte-Salles / Scott DuVall /

Thomas Falconer / Sergio Fernandez-Bertolin / Weihua Gao / Asieh Golozar / Jill Hardin / George Hripcsak / Vojtech Huser / Hokyun Jeon / Yonghua Jing / Chi Young Jung / Benjamin Skov Kaas-Hansen / Denys Kaduk / Seamus Kent / Yeesuk Kim / Spyros Kolovos / Jennifer C. E. Lane / Hyejin Lee / Kristine E. Lynch / Rupa Makadia / Michael E. Matheny / Paras P. Mehta / Daniel R. Morales / Karthik Natarajan / Fredrik Nyberg / Anna Ostropolets / Rae Woong Park / Jimyung Park / Jose D. Posada / Albert Prats-Uribe / Gowtham Rao / Christian Reich

Nature Communications, Vol 11, Iss 1, Pp 1-

2020 Volume 11

Abstract: Detailed knowledge of the characteristics of COVID-19 patients helps with public health planning. Here, the authors use routinely-collected data from seven databases in three countries to describe the characteristics of >30,000 patients admitted with ... ...

Abstract	Detailed knowledge of the characteristics of COVID-19 patients helps with public health planning. Here, the authors use routinely-collected data from seven databases in three countries to describe the characteristics of >30,000 patients admitted with COVID-19 and compare them with those admitted for influenza in previous years.
Keywords	Science ; Q
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Safety of hydroxychloroquine, alone and in combination with azithromycin, in light of rapid wide-spread use for COVID-19: a multinational, network cohort and self-controlled case series study

Jennifer C.E Lane / James Weaver / Kristin Kostka / Talita Duarte-Salles / Maria Tereza F. Abrahao / Heba Alghoul / Osaid Alser / Thamir M Alshammari / Patricia Biedermann / Edward Burn / Paula Casajust / Mitch Conover / Aedin C. Culhane / Alexander Davydov / Scott L. DuVall / Dmitry Dymshyts / Sergio Fernández Bertolín / Kristina Fišter / Jill Hardin /

Laura Hester / George Hripcsak / Seamus Kent / Sajan Khosla / Spyros Kolovos / Christophe G. Lambert / Johan ver der Lei / Ajit A. Londhe / Kristine E. Lynch / Rupa Makadia / Andrea V. Margulis / Michael E. Matheny / Paras Mehta / Daniel R. Morales / Henry Morgan-Stewart / Mees Mosseveld / Danielle Newby / Fredrik Nyberg / Anna Ostropolets / Rae Woong Park / Albert Prats-Uribe / Gowtham A. Rao / Christian Reich / Jenna Reps / Peter Rijnbeek / Selva Muthu Kumaran Sathappan / Martijn Schuemie / Sarah Seager / Anthony Sena / Azza Shoaibi / Matthew Spotnitz / Marc A. Suchard / Joel Swerdel / Carmen Olga Torre / David Vizcaya / Haini Wen / Marcel de Wilde / Seng Chan You / Lin Zhang / Oleg Zhuk / Patrick Ryan / Daniel Prieto-Alhambra

Abstract: Background: Hydroxychloroquine has recently received Emergency Use Authorization by the FDA and is currently prescribed in combination with azithromycin for COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with ... ...

Abstract	Background: Hydroxychloroquine has recently received Emergency Use Authorization by the FDA and is currently prescribed in combination with azithromycin for COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with azithromycin. Methods: New user cohort studies were conducted including 16 severe adverse events (SAEs). Rheumatoid arthritis patients aged 18+ and initiating hydroxychloroquine were compared to those initiating sulfasalazine and followed up over 30 days. Self-controlled case series (SCCS) were conducted to further establish safety in wider populations. Separately, SAEs associated with hydroxychloroquine-azithromycin (compared to hydroxychloroquine-amoxicillin) were studied. Data comprised 14 sources of claims data or electronic medical records from Germany, Japan, Netherlands, Spain, UK, and USA. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate calibrated hazard ratios (CalHRs) according to drug use. Estimates were pooled where I2<40%. Results: Overall, 956,374 and 310,350 users of hydroxychloroquine and sulfasalazine, and 323,122 and 351,956 users of hydroxychloroquine-azithromycin and hydroxychloroquine-amoxicillin were included. No excess risk of SAEs was identified when 30-day hydroxychloroquine and sulfasalazine use were compared. SCCS confirmed these findings. However, when azithromycin was added to hydroxychloroquine, we observed an increased risk of 30-day cardiovascular mortality (CalHR2.19 [1.22-3.94]), chest pain/angina (CalHR 1.15 [95% CI 1.05-1.26]), and heart failure (CalHR 1.22 [95% CI 1.02-1.45]) Conclusions: Short-term hydroxychloroquine treatment is safe, but addition of azithromycin may induce heart failure and cardiovascular mortality, potentially due to synergistic effects on QT length. We call for caution if such combination is to be used in the management of Covid-19.
Keywords	covid19
Publisher	medrxiv
Document type	Article ; Online
DOI	10.1101/2020.04.08.20054551
Database	COVID19

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Article ; Online: An international characterisation of patients hospitalised with COVID-19 and a comparison with those previously hospitalised with influenza

Edward Burn / Seng Chan You / Anthony Sena / Kristin Kostka / Hamed Abedtash / Maria Tereza F. Abrahao / Amanda Alberga / Heba Alghoul / Osaid Alser / Thamir M Alshammari / Carlos Areia / Juan M Banda / Jaehyeong Cho / Aedin C Culhane / Alexander Davydov / Frank J DeFalco / Talita Duarte-Salles / Scott L DuVall / Thomas Falconer /

Weihua Gao / Asieh Golozar / Jill Hardin / George Hripcsak / Vojtech Huser / Hokyun Jeon / Yonghua Jing / Chi Young Jung / Benjamin Skov Kaas-Hansen / Denys Kaduk / Seamus Kent / Yeesuk Kim / Spyros Kolovos / Jennifer Lane / Hyejin Lee / Kristine E. Lynch / Rupa Makadia / Michael E. Matheny / Paras Mehta / Daniel R. Morales / Karthik Natarajan / Fredrik Nyberg / Anna Ostropolets / Rae Woong Park / Jimyung Park / Jose D. Posada / Albert Prats-Uribe / Gowtham A. Rao / Christian Reich / Yeunsook Rho / Peter Rijnbeek / Selva Muthu Kumaran Sathappan / Lisa M. Schilling / Martijn Schuemie / Nigam H. Shah / Azza Shoaibi / Seokyoung Song / Matthew Spotnitz / Marc A. Suchard / Joel Swerdel / David Vizcaya / Salvatore Volpe / Haini Wen / Andrew E Williams / Belay B Yimer / Lin Zhang / Oleg Zhuk / Daniel Prieto-Alhambra / Patrick Ryan

Abstract: Background To better understand the profile of individuals with severe coronavirus disease 2019 (COVID-19), we characterised individuals hospitalised with COVID-19 and compared them to individuals previously hospitalised with influenza. Methods We report ...

Abstract	Background To better understand the profile of individuals with severe coronavirus disease 2019 (COVID-19), we characterised individuals hospitalised with COVID-19 and compared them to individuals previously hospitalised with influenza. Methods We report the characteristics (demographics, prior conditions and medication use) of patients hospitalised with COVID-19 between December 2019 and April 2020 in the US (Columbia University Irving Medical Center [CUIMC], STAnford Medicine Research data Repository [STARR-OMOP], and the Department of Veterans Affairs [VA OMOP]) and Health Insurance Review & Assessment [HIRA] of South Korea. Patients hospitalised with COVID-19 were compared with patients previously hospitalised with influenza in 2014-19. Results 6,806 (US: 1,634, South Korea: 5,172) individuals hospitalised with COVID-19 were included. Patients in the US were majority male (VA OMOP: 94%, STARR-OMOP: 57%, CUIMC: 52%), but were majority female in HIRA (56%). Age profiles varied across data sources. Prevalence of asthma ranged from 7% to 14%, diabetes from 18% to 43%, and hypertensive disorder from 22% to 70% across data sources, while between 9% and 39% were taking drugs acting on the renin-angiotensin system in the 30 days prior to their hospitalisation. Compared to 52,422 individuals hospitalised with influenza, patients admitted with COVID-19 were more likely male, younger, and, in the US, had fewer comorbidities and lower medication use. Conclusions Rates of comorbidities and medication use are high among individuals hospitalised with COVID-19. However, COVID-19 patients are more likely to be male and appear to be younger and, in the US, generally healthier than those typically admitted with influenza.
Keywords	covid19
Publisher	medrxiv
Document type	Article ; Online
DOI	10.1101/2020.04.22.20074336
Database	COVID19

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