Search

Background: There is an urgent need to understand the real-world effectiveness of remdesivir in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Methods: This was a retrospective comparative effectiveness study. Individuals hospitalized in a large private healthcare network in the United States from 23 February 2020 through 11 February 2021 with a positive test for SARS-CoV-2 and ICD-10 diagnosis codes consistent with symptomatic coronavirus disease 2019 (COVID-19) were included. Remdesivir recipients were matched to controls using time-dependent propensity scores. The primary outcome was time to improvement with a secondary outcome of time to death., Results: Of 96 859 COVID-19 patients, 42 473 (43.9%) received at least 1 remdesivir dose. The median age of remdesivir recipients was 65 years, 23 701 (55.8%) were male, and 22 819 (53.7%) were non-White. Matches were found for 18 328 patients (43.2%). Remdesivir recipients were significantly more likely to achieve clinical improvement by 28 days (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI], 1.16-1.22). Remdesivir patients on no oxygen (aHR 1.30, 95% CI, 1.22-1.38) or low-flow oxygen (aHR 1.23, 95% CI, 1.19-1.27) were significantly more likely to achieve clinical improvement by 28 days. There was no significant impact on the likelihood of mortality overall (aHR 1.02, 95% CI, .97-1.08). Remdesivir recipients on low-flow oxygen were significantly less likely to die than controls (aHR 0.85, 95% CI, .77-.92; 28-day mortality 8.4% [865 deaths] for remdesivir patients, 12.5% [1334 deaths] for controls)., Conclusions: These results support the use of remdesivir for hospitalized COVID-19 patients on no or low-flow oxygen. Routine initiation of remdesivir in more severely ill patients is unlikely to be beneficial., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background and Objectives: Current clinical guidelines recommend thromboprophylaxis for adults hospitalized with coronavirus disease 2019 (COVID-19), yet it is unknown whether higher doses of thromboprophylaxis offer benefits beyond standard doses., Methods: We studied electronic health records from 50 091 adults hospitalized with COVID-19 in the United States between February 2020 and February 2021. We compared standard (enoxaparin 30 or 40 mg/day, fondaparinux 2.5 mg, or heparin 5000 units twice or thrice per day) versus intermediate (enoxaparin 30 or 40 mg twice daily, or up to 1.2 mg/kg of body weight daily, heparin 7500 units thrice per day or heparin 10 000 units twice or thrice per day) thromboprophylaxis. We separately examined risk of escalation to therapeutic anticoagulation, severe disease (first occurrence of high-flow nasal cannula, noninvasive positive pressure ventilation or invasive mechanical ventilation), and death. To summarize risk, we present hazard ratios (HRs) with 95% confidence intervals (CIs) using adjusted time-dependent Cox proportional hazards regression models., Results: People whose first dose was high intensity were younger, more often obese, and had greater oxygen support requirements. Intermediate dose thromboprophylaxis was associated with increased risk of therapeutic anticoagulation (HR, 3.39; 95% CI, 3.22-3.57), severe disease (HR, 1.22; 95% CI, 1.17-1.28), and death (HR, 1.37; 95% CI, 1.21-1.55). Increased risks associated with intermediate-dose thromboprophylaxis persisted in subgroup and sensitivity analyses varying populations and definitions of exposures, outcomes, and covariates., Conclusions: Our findings do not support routine use of intermediate-dose thromboprophylaxis to prevent clinical worsening, severe disease, or death among adults hospitalized with COVID-19., (© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).)

A new species of proteocephalid cestodes, provisionally assigned to the polyphyletic genus Ophiotaenia La Rue, 1911 (Cestoda: Proteocephalidae), is described from Compsophis infralineatus (Günther) (Serpentes: Pseudoxyrhophiidae) endemic to Madagascar. Ophiotaenia oreae n. sp. differs from all African and Asian species of Ophiotaenia by possessing more uterine diverticula (68-82 on one side). It is also characterised by the absence of an apical organ, the relative sizes of the cirrus-sac and ovary, the almost equatorial position of the gonopore, the diameter of the embryophore, and other biometric characteristics. Phylogenetic relationships of the new species indicate its relatedness to Indomalayan and Australasian proteocephalids from reptiles. Ophiotaenia oreae n. sp. formed a well-supported clade composed of species of Australophiotaenia de Chambrier, Beveridge and Scholz, 2018 from Australian snakes, Macrobothriotaenia ficta (Meggitt, 1931) from Xenopeltis unicolor Reinwardt in Boie from Vietnam, Ophiotaenia sp. from Trimeresurus flavomaculatus (Gray) from the Philippines, and Ophiotaenia bungari de Chambrier, Binh and Scholz, 2012 from Bungarus fasciatus (Schneider) from Vietnam. The only proteocephalid from Madagascan snakes sequenced so far, Ophiotaenia lapata Rambeloson, Ranaivoson and de Chambrier, 2012 from Madagascarophis colubrinus (Schlegel), does not form a monophyletic group with the new species. The actual species diversity of reptilian cestodes in Madagascar is undoubtedly underestimated. Because of the assumed strict (oioxenous) host specificity of reptilian proteocephalids and rich fauna of snakes occurring in Madagascar, it is plausible to expect the existence of dozens new species of proteocephalids on this island., (Copyright © 2022. Published by Elsevier B.V.)