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Keith P, Bohn RIC, Nguyen T, Scott LK, Richmond M, Day M, Choe C, Perkins L, Burnside R, Pyke R, Rikard B, Guffey A, Saini A, Park HJ, Carcillo J. Improved survival in COVID-19 related sepsis and ARDS treated with a unique "triple therapy" including therapeutic plasma exchange: A single center retrospective analysis. J Clin Apher 2024; 39:e22107. [PMID: 38404046 DOI: 10.1002/jca.22107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Throughout the COVID-19 pandemic, the mortality of critically ill patients remained high. Our group developed a treatment regimen targeting sepsis and ARDS which we labeled "triple therapy" consisting of (1) corticosteroids, (2) therapeutic plasma exchange (TPE), and (3) timely intubation with lung protective ventilation. Our propensity analysis assesses the impact of triple therapy on survival in COVID-19 patients with sepsis and ARDS. METHODS Retrospective propensity analysis comparing triple therapy to no triple therapy in adult critically ill COVID-19 patients admitted to the Intensive Care Unit at Lexington Medical Center from 1 March 2020 through 31 October 2021. RESULTS Eight hundred and fifty-one patients were admitted with COVID-19 and 53 clinical and laboratory variables were analyzed. Multivariable analysis revealed that triple therapy was associated with increased survival (OR: 1.91; P = .008). Two propensity score-adjusted models demonstrated an increased likelihood of survival in patients receiving triple therapy. Patients with thrombocytopenia were among those most likely to experience increased survival if they received early triple therapy. Decreased survival was observed with endotracheal intubation ≥7 days from hospital admission (P < .001) and there was a trend toward decreased survival if TPE was initiated ≥6 days from hospital admission (P = .091). CONCLUSION Our analysis shows that early triple therapy, defined as high-dose methylprednisolone, TPE, and timely invasive mechanical ventilation within the first 96 hours of admission, may improve survival in critically ill septic patients with ARDS secondary to COVID-19 infection. Further studies are needed to define specific phenotypes and characteristics that will identify those patients most likely to benefit.
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Affiliation(s)
- Philip Keith
- Lexington Medical Center, West Columbia, South Carolina, USA
| | | | - Trung Nguyen
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - L Keith Scott
- Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Monty Richmond
- Medical Center Downtown, MUSC Health Columbia, Columbia, South Carolina, USA
| | - Matthew Day
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Carol Choe
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Linda Perkins
- Lexington Medical Center, West Columbia, South Carolina, USA
| | | | - Richard Pyke
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Ben Rikard
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Amanda Guffey
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Arun Saini
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - H J Park
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph Carcillo
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Pyke R. 016 Effectiveness of Medications for Female Sexual Dysfunction: Number Needed To Treat (NNT). J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pyke R. 067 Number Needed to Harm for Treatments of Female Sexual Dysfunction. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pyke R. 042 Sexual Performance Anxiety: Impact on Women and Pharmacology for Rational Nutritional Treatment. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pyke R, Clayton A. 076 Lumping, Splitting, and Treating: Therapies are Needed for Women with Overlapping Sexual Dysfunctions. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pyke R. 099 Flibanserin vs. Mini-Dose Trazodone for Female Sexual Dysfunction? A Challenge. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pyke R. 149 Would Ultra-low-dose Trazodone Treat HSDD Without Causing CNS Depression? J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pyke R. 251 Search for a Rational Supplement Combination for Prostatism and Erectile Dysfunction. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- R. Pyke
- University of Washington and University of Cambridge
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Pyke R. 078 Exo-clinical Trials to Test Nutraceuticals for Sexual Dysfunction. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.03.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pyke R, Clayton A. 001 Composite Endpoints for Clinical Trials of Women with HSDD: Content, Responder Values, and Remitter Cutoffs. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pyke R. 049 Remitter Cutoffs for Clinical Trials in Female Sexual Interest/Arousal Disorder. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pyke R. 011 Behavioral Measures for Clinical Trials of Women with Decreased Sexual Desire. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pyke R. 047 Responder Values for Clinical Trials in Female Sexual Interest/Arousal Disorder. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jayne C, Simon J, Taylor L, Kimura T, Pyke R, Lesko L. A 12-month, open-label trial of flibanserin in North American women with generalized acquired hypoactive sexual desire disorder (HSDD): the sunflower trial. Fertil Steril 2010. [DOI: 10.1016/j.fertnstert.2010.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clayton AH, Dennerstein L, Pyke R, Sand M. Flibanserin: A Potential Treatment for Hypoactive Sexual Desire Disorder in Premenopausal Women. Womens Health (Lond Engl) 2010; 6:639-53. [DOI: 10.2217/whe.10.54] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hypoactive Sexual Desire Disorder (HSDD) is defined as a persistent or recurrent deficiency of sexual fantasies and desire for sexual activity, which causes marked personal distress or interpersonal difficulty, and is not better accounted for by another psychiatric disorder or the direct physiological effects of a substance (e.g., a medication) or medical condition. HSDD is believed to be the most common form of Female Sexual Dysfunction and is associated with emotional distress and relationship problems. No pharmacologic therapy is approved for the treatment of HSDD in premenopausal or naturally postmenopausal women. Flibanserin is a 5-HT1A agonist/5-HT2A antagonist that is under investigation as a treatment for HSDD in women. The aim of this article is to present an overview of the pharmacology, clinical efficacy and safety of flibanserin. Flibanserin is an investigational drug that is not licensed for any indication in any country.
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Affiliation(s)
- AH Clayton
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, 2955 Ivy Road, Northridge Charlottesville, VA 22903, USA
| | - L Dennerstein
- Office for Gender & Health, Department of Psychiatry, National Ageing Research Institute, University of Melbourne, Parkville, Vic 3050 Australia
| | - R Pyke
- Boehringer Ingelheim Pharmaceuticals Inc, 900 Ridgebury Road, Ridgefield, CT 06877, USA
| | - M Sand
- Boehringer Ingelheim Pharmaceuticals Inc, 900 Ridgebury Road, Ridgefield, CT 06877, USA
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Nappi R, van Lunsen R, Tignol J, Goldmeier D, Pyke R, Staehle H. T09-P-10 Validation of the Sexual Interest and Desire Inventory-female (SIDI-F) in European women. Sexologies 2008. [DOI: 10.1016/s1158-1360(08)72891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goldfischer E, Pyke R, Mikl J. T09-O-15 The rose study: placebo-controlled randomized withdrawal trial of flibanserin for hypoactive sexual desire disorder in premenopausal women. Sexologies 2008. [DOI: 10.1016/s1158-1360(08)72848-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Benign tumours of both the pharynx and oesophagus are rarely seen, cavernous haemangiomas even less so. We present a case in which a large lesion was the cause of non-specific symptoms but which only appeared intermittently on nasendoscopic examination of the pharynx.
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Affiliation(s)
- L J Hollis
- Department of Otolaryngology, Northampton General Hospital, UK
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Pyke R. Ear, Nose and Throat Disease. Postgrad Med J 1990. [DOI: 10.1136/pgmj.66.780.883-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dunner D, Myers J, Khan A, Avery D, Ishiki D, Pyke R. Adinazolam--a new antidepressant: findings of a placebo-controlled, double-blind study in outpatients with major depression. J Clin Psychopharmacol 1987; 7:170-2. [PMID: 3298327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Adinazolam mesylate, a new triazolobenzodiazepine with antidepressant properties, was significantly superior to placebo based on the following efficacy measures: number of subjects who completed the study; number of subjects whose total score on the 21-item Hamilton Rating Scale for Depression (HAM-D) decreased by 50% or more; and number of subjects who reported that the drug helped them. Mean scores on three HAM-D clusters (anxiety/somatization, sleep disturbance, and an endogenomorphic cluster) also showed significant differences in favor of adinazolam. Side effects were generally mild and transient; however, a seizure of moderate intensity occurred during rapid tapering of adinazolam from 90 to 40 mg/day. There were no significant anticholinergic effects, and no mania or hypomania was reported in any subject. No consistently significant differences were observed between subjects whose primary diagnosis was major depression and those with a diagnosis of bipolar II depression.
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Matthews DE, Farewell VT, Pyke R. Asymptotic Score-Statistic Processes and Tests for Constant Hazard Against a Change-Point Alternative. Ann Stat 1985. [DOI: 10.1214/aos/1176349540] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Edwards N, Elcock HW, Pyke R, Griffiths MV, Resouly A. An antihistamine-sympathomimetic amine combination in vasomotor rhinitis. Practitioner 1973; 211:220-3. [PMID: 4147011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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