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Ramakrishnan M, Poojari PG, Rashid M, Nair S, Pulikkel Chandran V, Thunga G. Impact of COVID-19 pandemic on medicine supply chain for patients with chronic diseases: Experiences of the community pharmacists. Clin Epidemiol Glob Health 2023; 20:101243. [PMID: 36743947 PMCID: PMC9885111 DOI: 10.1016/j.cegh.2023.101243] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Problem considered Coronavirus disease(COVID-19) outbroke towards the end of December 2019 in China, soon it started spreading rapidly to various countries leading to an outburst of pandemic. Due to the restrictions imposed to control the spread of the infection, globally the manufacturing, import and export of medicine and the healthcare services to patients with chronic illness had been affected. This study aimed to explore the perspectives of the pharmacists on the medicine supply chain for patients with chronic diseases during COVID-19 pandemic in India. Methods This study is a prospective, qualitative research involving telephonic, semi-structured in-depth interviews. An interview guide for pharmacists was prepared and validated using "Interview Protocol Refinement" method. Purposive sampling method was used to recruit the pharmacists; a telephonic oral consent was obtained. The interview session was audio recorded and the recordings were transcribed verbatim. Further, transcripts were validated and later analysed using NVivo software. Results A total of 8 participants were interviewed during our study. Thematic analysis of the transcripts resulted in seven main themes. The study showed that there was deficiency in medicine supply during the COVID-19 pandemic and the pharmacists faced several challenges in procuring and storing the medication, arranging for unavailable medicines, medication dispensing and provision of the services such as medicine delivery, patient counselling. There was also scarcity of manpower leading to extra workload and working overtime. Conclusion Uninterrupted supply of essential medicine is the backbone of health care system. An effective plan and appropriate strategies are vital to combat such future emergencies.
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Affiliation(s)
- Manasvini Ramakrishnan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Pooja Gopal Poojari
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Viji Pulikkel Chandran
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Shukla AK, Atal S, Banerjee A, Jhaj R, Balakrishnan S, Chugh PK, Xavier D, Faruqui A, Singh A, Raveendran R, Mathaiyan J, Gauthaman J, Parmar UI, Tripathi RK, Kamat SK, Trivedi N, Shah P, Chauhan J, Dikshit H, Mishra H, Kumar R, Badyal DK, Sharma M, Singla M, Medhi B, Prakash A, Joshi R, Chatterjee NS, Cherian JJ, Kamboj VP, Kshirsagar N. An observational multi-centric COVID-19 sequelae study among health care workers. Lancet Reg Health Southeast Asia 2023; 10:100129. [PMID: 36531928 DOI: 10.1016/j.lansea.2022.100129] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
Background India has seen more than 43 million confirmed cases of COVID-19 as of April 2022, with a recovery rate of 98.8%, resulting in a large section of the population including the healthcare workers (HCWs), susceptible to develop post COVID sequelae. This study was carried out to assess the nature and prevalence of medical sequelae following COVID-19 infection, and risk factors, if any. Methods This was an observational, multicenter cross-sectional study conducted at eight tertiary care centers. The consenting participants were HCWs between 12 and 52 weeks post discharge after COVID-19 infection. Data on demographics, medical history, clinical features of COVID-19 and various symptoms of COVID sequelae was collected through specific questionnaire. Finding Mean age of the 679 eligible participants was 31.49 ± 9.54 years. The overall prevalence of COVID sequelae was 30.34%, with fatigue (11.5%) being the most common followed by insomnia (8.5%), difficulty in breathing during activity (6%) and pain in joints (5%). The odds of having any sequelae were significantly higher among participants who had moderate to severe COVID-19 (OR 6.51; 95% CI 3.46-12.23) and lower among males (OR 0.55; 95% CI 0.39-0.76). Besides these, other predictors for having sequelae were age (≥45 years), presence of any comorbidity (especially hypertension and asthma), category of HCW (non-doctors vs doctors) and hospitalisation due to COVID-19. Interpretation Approximately one-third of the participants experienced COVID sequelae. Severity of COVID illness, female gender, advanced age, co-morbidity were significant risk factors for COVID sequelae. Funding This work is a part of Indian Council for Medical Research (ICMR)- Rational Use of Medicines network. No additional financial support was received from ICMR to carry out the work, for study materials, medical writing, and APC.
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Key Words
- ACE2, Angiotensin-converting enzyme 2
- AE, Adverse events
- BMI, Body mass index
- CAD, Coronary artery disease
- CI, Confidence interval
- COVID sequelae
- COVID-19
- COVID-19, Corona virus disease 2019
- CTRI, Clinical Trials Registry- India
- DASS-21, Depression, Anxiety, and Stress Scale-21
- ENT, Ear, nose, and throat
- GERD, Gastroesophageal reflux disease
- HCQ, Hydroxychloroquine
- HCW, Health care worker
- ICMR, Indian council of medical research
- ICMR-RUMC
- Long COVID
- MOHFW, Ministry of Health and Family Welfare, Govt. of India
- NICE, National Institute for Health and Clinical Excellence
- OR, Odds ratio
- PCOS, Polycystic Ovarian Disease
- PLOG, Polymerase gamma-related disorders
- RHD, Rheumatic heart disease
- RUMC, Rational use of medicine center
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- WHO, World Health Organization
- p-value, Probability value
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Agstam S, Yadav A, Kumar-M P, Gupta A. Hydroxychloroquine and QTc prolongation in patients with COVID-19: A systematic review and meta-analysis. Indian Pacing Electrophysiol J 2021; 21:36-43. [PMID: 33075484 PMCID: PMC7563579 DOI: 10.1016/j.ipej.2020.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/11/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Among many drugs that hold potential in COVID-19 pandemic, chloroquine (CQ), and its derivative hydroxychloroquine (HCQ) have generated unusual interest. With increasing usage, there has been growing concern about the prolongation of QTc interval and Torsades de Pointes (TdP) with HCQ, especially in combination with azithromycin. AIMS This meta-analysis is planned to study the risk of QTc prolongation and Torsades de pointes (TdP) by a well-defined criterion for HCQ, CQ alone, and in combination with Azithromycin in patients with COVID-19. METHODS A comprehensive literature search was made in two databases (PubMed, Embase). Three outcomes explored in the included studies were frequency of QTc > 500 ms (ms) or ΔQTc > 60 ms (Outcome 1), frequency of QTc > 500 ms (Outcome 2) and frequency of TdP (Outcome 3). Random effects method with inverse variance approach was used for computation of pooled summary and risk ratio. RESULTS A total of 13 studies comprising of 2138 patients were included in the final analysis. The pooled prevalence of outcome 1, outcome 2 and outcome 3 for HCQ, CQ with or without Azithromycin were 10.18% (5.59-17.82%, I2 - 92%), 10.22% (6.01-16.85%, I2 - 79%), and 0.72% (0.34-1.51, I2 - 0%) respectively. The prevalence of outcome 2 in subgroup analysis for HCQ and HCQ + Azithromycin was 7.25% (3.22-15.52, I2 - 59%) and 8.61% (4.52-15.79, I2 - 76%), respectively. The risk ratio (RR) for outcome 1 and outcome 2 between HCQ + Azithromycin and HCQ was 1.22 (0.77-1.93, I2 - 0%) & 1.51 (0.79-2.87, I2 - 13%), respectively and was not significant. Heterogeneity was noted statistically as well clinically (regimen types, patient numbers, study design, and outcome definition). CONCLUSION The use of HCQ/CQ is associated with a high prevalence of QTc prolongation. However, it is not associated with a high risk of TdP.
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Key Words
- Aminoquinoline
- COVID-19
- COVID-19, Coronavirus disease2019
- CQ, Chloroquine
- Chloroquine
- Coronavirus
- EAD, Early afterdepolarization
- ECG, Electrocardiography
- HCQ, Hydroxychloroquine
- HERG, human ether-a-go-go-related gene
- Hydroxychloroquine
- ICU, Intensive care unit
- QTc prolongation
- RCT, Randomized control trial
- RR, Risk ratio
- SA, Sinoatrial
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- TdP, Torsades de pointes
- Torsades de pointes
- VT, Ventricular tachycardia
- WHO, World Health organization
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Affiliation(s)
- Sourabh Agstam
- Department of Cardiology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Ashutosh Yadav
- Department of Cardiology, Fortis Hospital, Mohali, Punjab, India
| | - Praveen Kumar-M
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
The outbreak of SARS-CoV-2 started in Hubei province of China in December 2019 and rapidly spread all over the world. It has infected more than 7 million people worldwide and has pushed half of the world in a state of lockdown. There is an urgent unmet need of interventions both for prevention and treatment of this disease and more than 500 clinical trials are ongoing in this regard. At present, no study with robust methodology have clearly demonstrated benefits of hydroxychloroquine for treatment, preexposure prophylaxis in healthcare workers or post exposure prophylaxis in COrona VIrus Disease-2019. Remdesivir has been shown to have modest benefits in moderate to severe disease, if administered early. Given the rapid pace of clinical information and discoveries, it is important for clinicians to be up to date with the latest, evidence-based treatment options available for this novel disease. Keeping up with this current pace of information, we review the clinical studies of different therapeutic options available to treat SARS-CoV-2.
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Key Words
- ARDS, Acute Respiratory Distress Syndrome
- COVID-19
- COVID-19 treatment
- COVID-19, COrona VIrus Disease - 2019
- CQ, Chloroquine
- HCQ, Hydroxychloroquine
- IL-6, Interleukin-6
- INF, Interferon
- LPV/TRV, Lopinavir/ritonavir
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- TCZ, Tocilizumab
- WHO, World Health Organization
- coronavirus disease
- novel coronavirus
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Affiliation(s)
- Swapnil Dhampalwar
- Institute of Liver Transplantation & Regenerative Medicine, Medanta- The Medicity, Gurugram, India
| | - Sanjiv Saigal
- Institute of Liver Transplantation & Regenerative Medicine, Medanta- The Medicity, Gurugram, India
| | - Arvinder S. Soin
- Institute of Liver Transplantation & Regenerative Medicine, Medanta- The Medicity, Gurugram, India
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Almazrou SH, Almalki ZS, Alanazi AS, Alqahtani AM, Alghamd SM. Comparing the impact of Hydroxychloroquine based regimens and standard treatment on COVID-19 patient outcomes: A retrospective cohort study. Saudi Pharm J 2020; 28:1877-1882. [PMID: 33020690 PMCID: PMC7527306 DOI: 10.1016/j.jsps.2020.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background Pharmacological treatments including antivirals (Lopinavir/Ritonavir), Immuno-modulatory and anti-inflammatory drugs including, Tocilizumab and Hydroxychloroquine (HCQ) has been widely investigated as a treatment for COVID-19. Despite the ongoing controversies, HCQ was recommended for managing mild to moderate cases in Saudi Arabia . However, to our knowledge, no previous studies have been conducted in Saudi Arabia to assess its effectiveness. Methods A hospital-based retrospective cohort study involving 161 patients with COVID-19 was conducted from March 1 to May 20, 2020. The study was conducted at Prince Mohammed bin Abdul Aziz Hospital (PMAH). The population included hospitalized adults (age ≥ 18 years) with laboratory-confirmed COVID-19. Each eligible patient was followed from the time of admission until the time of discharge. Patients were classified into two groups according to treatment type: in the HCQ group, patients were treated with HCQ; in the SC group, patients were treated with other antiviral or antibacterial treatments according to Ministry of Health (MOH) protocols. The outcomes were hospitalization days, ICU admission, and the need for mechanical ventilation. We estimated the differences in hospital length of stay and time in the ICU between the HCQ group and the standard care (SC) group using a multivariate generalized linear regression. The differences in ICU admission and mechanical ventilation were compared via logistic regression. All models were adjusted for age and gender variables. Results A total of 161 patients fulfilled the inclusion criteria. Approximately 59% (n = 95) received HCQ-based treatment, and 41% (n = 66) received SC. Length of hospital stay and time in ICU in for patients who received HCQ based treatment was shorter than those who received SC. Similarly, there was less need for ICU admission and mechanical ventilation among patients who received HCQ based treatment compared with SC, (8.6% vs. 10.7 and 3.1% vs. 9.1%). However, the regression analysis showed no significant difference between the two groups in terms of patient outcomes. Conclusion HCQ had a modest effect on hospital length stay and days in ICU compared with SC. However, these results need to be interpreted with caution. Larger observational studies and RCTs that evaluate the efficacy of HCQ in COVID-19 patients in the Saudi population are urgently needed.
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Affiliation(s)
- Saja H Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ziyad S Almalki
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Abdullah S Alanazi
- Clinical Pharmacy Department, College of Pharmacy, Jouf University, Al-Jouf, Saudi Arabia
| | - Abdulhadi M Alqahtani
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saleh M Alghamd
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Abstract
Due to the unprecedented public health crisis caused by COVID-19, our first contribution to the newly launching journal, Advances in Biomarker Sciences and Technology, has abruptly diverted to focus on the current pandemic. As the number of new COVID-19 cases and deaths continue to rise steadily around the world, the common goal of healthcare providers, scientists, and government officials worldwide has been to identify the best way to detect the novel coronavirus, named SARS-CoV-2, and to treat the viral infection - COVID-19. Accurate detection, timely diagnosis, effective treatment, and future prevention are the vital keys to management of COVID-19, and can help curb the viral spread. Traditionally, biomarkers play a pivotal role in the early detection of disease etiology, diagnosis, treatment and prognosis. To assist myriad ongoing investigations and innovations, we developed this current article to overview known and emerging biomarkers for SARS-CoV-2 detection, COVID-19 diagnostics, treatment and prognosis, and ongoing work to identify and develop more biomarkers for new drugs and vaccines. Moreover, biomarkers of socio-psychological stress, the high-technology quest for new virtual drug screening, and digital applications are described.
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Key Words
- ACE2, Angiotensin-converting enzyme 2
- ACEI, Angiotensin-converting enzyme inhibitor
- AI, Artificial intelligence
- AIOD-CRISPR, All-In-One Dual CRISPR-Cas12a
- ARB, Angiotensin receptor blocker
- ARDS, Acute respiratory distress syndrome
- COVID
- COVID-19, Coronavirus disease 2019
- CQ, Chloroquine
- CT, Computed tomography
- Coronavirus
- DC, Dendritic cell
- Detection
- Diagnosis
- ELISA, Enzyme-linked immunosorbent assay
- EUA, Emergency use authorization
- FDA, U.S. Food and Drug Administration
- GenOMICC, Genetics of Mortality in Critical Care
- HCQ, Hydroxychloroquine
- LFAs, Lateral flow assays
- LSPR, Localized surface plasmon resonance
- MERS, Middle East respiratory syndrome
- ML, Machine learning
- NIAID, U.S. National Institute of Allergy and Infectious Diseases
- NIH, National Institutes of Health
- PAC-MAN, Prophylactic Antiviral CRISPR in huMAN cells
- PCR, Polymerase chain reaction
- PCT, Procalcitonin
- Prevention
- Prognosis
- RT-PCR, Reverse transcription polymerase chain reaction
- SARS, Severe acute respiratory syndrome
- SARS-CoV-2, SARS coronavirus type 2
- SaaS, Software as a Service
- TCM, Traditional Chinese medicine
- Treatment
- UCB, University of California Berkeley
- UCSF, University of California San Francisco
- cDNA, Complementary DNA
- mAb, Monoclonal antibody
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Affiliation(s)
- Luoping Zhang
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Helen Guo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, 94720, USA
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