In late December 2019, a cluster of atypical pneumonia cases was noticed in Wuhan, China, which was later identified as an outbreak of coronavirus disease 2019 (COVID'Äê19). Since then, it has spread globally, causing public health emergency and urgency, and declared as a pandemic by the World Health Organization (WHO). As of 1 April 2020, the data shows more than 200 countries and territories have been affected, with more than 824,000 con-firmed cases and 41,000 deaths. Across the globe, many cancer patients visit the hospital and clinics for treatment and investigations. A large number of this population are immunocom-promised, either due to their underlying disease or cancer treatments which put them at higher risk for infection and complications. In addition, several risk factors have been identified that increase the risk and severity of infection with COVID-19, and cancer patients commonly have many of them. Recently, a large retrospective study among cancer patients infected with COVID-19 in Wuhan, China, found a higher incidence of severe events in cancer patients compared to patients without cancer. As doctors working amid this pandemic, we all have responsibilities and duties to act upon local guidelines to ensure the continuation of essential cancer services without overwhelming the health care system. In this review, we addressed the potential challenges and possible actions for clinicians to manage cancer patients during this unusual time.
Cancer is a severe public health issue that seriously jeopardizes global health. In individuals with coronavirus disease 2019 (COVID-19), cancer is considered an independent risk factor for severe illness and increased mortality.
There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV).This is a hospital-based case-control study comparing MERS-CoV-positive patients (cases) with MERS-CoV-negative controls.A total of 17 case patients and 82 controls with a mean age of 60.7 years and 57 years, respectively (P = .553), were included. No statistical differences were observed in relation to sex, the presence of a fever or cough, and the presence of a single or multilobar infiltrate on chest radiography. The case patients were more likely to be overweight than the control group (mean body mass index, 32 vs 27.8; P = .035), to have diabetes mellitus (87% vs 47%; odds ratio [OR], 7.24; P = .015), and to have end-stage renal disease (33% vs 7%; OR, 7; P = .012). At the time of admission, tachypnea (27% vs 60%; OR, 0.24; P = .031) and respiratory distress (15% vs 51%; OR, 0.15; P = .012) were less frequent among case patients. MERS-CoV patients were more likely to have a normal white blood cell count than the control group (82% vs 52%; OR, 4.33; P = .029). Admission chest radiography with interstitial infiltrates was more frequent in case patients than in controls (67% vs 20%; OR, 8.13; P = .001). Case patients were more likely to be admitted to the intensive care unit (53% vs 20%; OR, 4.65; P = .025) and to have a high mortality rate (76% vs 15%; OR, 18.96; P < .001).Few clinical predictors could enhance the ability to predict which patients with pneumonia would have MERS-CoV. However, further prospective analysis and matched case-control studies may shed light on other predictors of infection.
Upshaw-Schulman syndrome is a rare inherited form of thrombotic thrombocytopenic purpura disease caused by deficiency of ADAMTS13 and reversible by fresh frozen plasma infusions. Unlike the more common acquired thrombotic thrombocytopenic purpura, patient with Upshaw-Schulman syndrome generally presents early life with a repeated episodes of microangiopathic haemolytic anaemia, usually triggered by acute illness. There are few reported cases about congenital thrombotic thrombocytopenic purpura and long term prognosis. We describe a 16 months old Palestinian male patient with history of severe neonatal jaundice, microangiopathic haemolytic anaemia and thrombocytopenia triggered by febrile illness associated with facial palsy as neurological manifestation favoured congenital thrombotic thrombocytopenic purpura. Low ADAMTS13 level and improvement in platelet counts after fresh frozen plasma infusion with novel mutation of Leu209Pro in exon 6 of the ADAMTS13 gene confirmed the diagnosis of congenital thrombotic thrombocytopenic purpura in our patient who later on developed coarctation of aorta suggested thrombotic complication of ADAMTS13/VWF missing axis dysfunction.
To examine the impact of safety warnings issued between 2005 and 2007 by the Irish Medicines Board (IMB) on the rate of prescribing of clopidogrel, co-amoxiclav, celecoxib and haloperidol by primary care physicians in the General Medical Services (GMS) scheme across Ireland.This study was performed using the Irish Health Service Executive-Primary Care Reimbursement Services national prescribing database. Rate of prescribing per 1000 GMS population was calculated for each of the 12 months before and after the IMB warnings were issued to physicians. A segmented regression analysis was used to examine the change in level and trend in prescribing rates before and after the IMB warnings. Regression coefficients are presented with SEs. Significance at p < 0.05 was assumed. SPSS 16 and SAS were used for statistical analysis.Prescribing of clopidogrel continued to rise in both genders following the warning. This increase was slightly higher in male patients. The prescribing of co-amoxiclav showed seasonal variation with significant autocorrelation. The rate of prescribing of celecoxib declined approximately 4 months prior to the IMB warning. A significant decrease in the level and trend of the rate of prescribing of celecoxib was observed with evident discontinuity. The IMB warning had no significant effect on the level of trend in the prescribing of haloperidol, suggesting no discontinuity.Results indicate that the IMB safety warnings had inconsistent effects on the rate of prescribing of drugs considered.
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