1/ COVID-19
As a first step, guidelines for outpatient management of COVID have been published by the French council for public health with the participation of the Academic College of General Practice. The warning signs have been slightly modified: SpO2 < 95%, Respiratory rate > 24/min (not 22), SBP < 100mmHg, altered general condition; and the signs of severity motivating a call to the centre-15: SpO2 < 90%, RR > 30/min, SBP< 90mmHg, altered consciousness/confusion. No diagnostic tests are recommended, either biological (except hemogramm, CRP if pneumonia is suspected) or radiological (if CT scan is required, there is an indication for hospitalization). There is no specific drug treatment recommended (this was suspected and makes sense). Monitoring should be done on the 2nd week (between D6 and D12) with emphasis on SpO2 and respiratory rate (word flow is insufficiently assessed).
Concerning the masks, the French Respiratory Society confirmed the effectiveness of the surgical mask for caregivers on the majority of viruses (N95 being superior for tuberculosis, measles and chickenpox).
Regarding NSAID therapy, the NICE says there is no good clinical evidence to suggest that NSAIDs aggravate COVID and that there is no justification for their avoidance. (I've seen some figures that would therefore be worth publishing).
To avoid cross-reactions between pholcodine cough syrups and curares used (if needed) in resuscitation and anesthesia, the French Medicine Agency recommends that physicians do not prescribe pholcodine. In fact, cough syrups have already been discussed many times...
Concerning the caregivers, the French Academy of Medicine recommends screening by PCR and serology of health professionals with a new control in case of exposure. Asymptomatic professionals with COVID should be stopped in the same way as symptomatic individuals. The Academy also recommends screening of contact persons of infected professionals.
Finally, let's talk about testing, thanks to an article in the Annals of Internal Medicine. Overall, the reference test to date remains RT-PCR on nasopharyngeal swab, rapid tests (POC) are insufficiently reliable, and serology is a good option, but the techniques still lack precision because cross-reactions with other coronaviruses can give false positives and a negative result cannot exclude exposure to the disease, particularly in the case of recent exposure.
2/ Gynecology
The gynaecology part will be very COVID-oriented as well. To begin with, as some laboratories no longer do OGTT to screen for gestational diabetes so as not to keep a patient in the waiting room for 2 hours, the French diabetology and gynecology societies have proposed an alternative. Thus, at 24-28 week of gestation, OGTT can be replaced by fasting blood glucose and HbA1C and the diagnosis of late gestational diabetes is made if fasting blood glucose > 0.92g/L or HbA1c > 5.7% (with fasting blood glucose > 1.26g/L or HbA1c > 6.5% triggering a more urgent procedure).
Canadian guidelines for breastfeeding by COVID+ or suspected COVID+ mothers are as follows: breastfeeding should be encouraged because the virus does not appear to be transmissible through breast milk, but a mask should be worn to avoid droplet contamination.
To facilitate access to abortion during a pandemic, an decree now authorises outpatient medical abortions up to 9 weeks of gestation (instead of the previous 7 weeks). The protocol described by the French Healt Authority (HAS) is therefore 1cp or 3cp of mifepristone 200 followed at 24-48h later by 800mg of oral, sublingual or jugal misoprostol (and not 400mg as up to 7weeks because the 1cp of 200mg of mifepristone is no longer reserved for the use of gemeprost, and the HAS is in line with international standards).
3/ Drug safety
Annals of family medicine goes back over the risks of treatments with an anticholinergic effect. Depending on the scale used, between 8% and 18% of patients were taking one of these treatments. Patients treated with anticholinergics had an increased risk of overall mortality, falls, cardiovascular events and dementia. In short, there are still treatments to be considered for deprescribing, especially in elderly subjects.
4/ Respiratory
The American Thoracic Society has published guidelines for COPD. As a starting point, in patients with dyspnea, the company recommends dual anticholinergic (LAMA) + long-acting beta2 stimulant (LABA) therapy. In patients who are still experiencing dyspnea, they recommend the addition of an inhaled corticosteroid (ICS) only if there is an exacerbation or hospitalization within a year. In the case of triple therapy, the ICS may be discontinued if there has been no exacerbation within the previous 12 months. In case of persistent dyspnea despite optimal treatment, they suggest discussing symptomatic treatment with opioids, but that will leave the specialists to decide, I think ...
An article in Annals of family medicine evaluated the accuracy of pulse oximeters labelled "not for medical use". The sensitivity and specificity of these oximeters for detecting SpO2<90% is 80% and 96% respectively, and their PPV and NPV in the study was 33% and 99%. Thus, they appear to be quite acceptable for eliminating hypoxemia when used by patients.
5/ The qualitative study of the week by @DrePetronille
This article interviewed 22 people over 70 years old about their experiences after an acute infection, through semi-structured interviews. Regarding the symptoms felt, they were classic and often not very specific: feeling feverish ("hot/cold"), chills, extreme asthenia ("everything was an effort"), "feeling bad", pain, vomiting, confusion or symptoms specific to the topography of the infection. Symptoms were difficult to identify in patients with chronic conditions with persistent symptoms or in patients who had never had an infection in the past. On the other hand, previous experience with a similar infection was useful for accurate self-assessment. Some participants were able to minimize their symptoms, feeling young and fit or with the hope of symptom improvement, while others, feeling more fragile due to their age, were more anxious and vigilant. To arrive at the consultation, participants mentioned outside advice, symptoms that had become intolerable, or criteria for monitoring at home that were getting worse. Delay in seeking care was motivated by the belief that they were getting better now or in the near future, that they could manage on their own, or that they did not want to bother caregivers.
That's it for this week! You can subscribe on Facebook, Twitter or to the newsletter by email or all 3! (You have to write your email at the very top right of the page, without forgetting to confirm the inscription in the email, whose subject looks like a spam name, which will be sent to you). See you soon!
@Dr_Agibus
No comments:
Post a Comment