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Is Remdesivir OK for COVID Patients With Severe Renal Impairment? – Medpage Today

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Antiviral remdesivir (Veklury) appeared safe for hospitalized COVID-19 patients with severe kidney dysfunction, according to a secondary analysis of the CATCO trial.

In the analysis of the 59 patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 at study randomization, no increased risk for hospital death was identified among those treated with remdesivir rather than standard of care (40.6% vs 52%, respectively; relative risk [RR] 0.78, 95% CI 0.41-1.49), reported Srinivas Murthy, MD, CM, MHSc, of the University of British Columbia in Vancouver, and colleagues.

This held true in a model that adjusted for sex and baseline eGFR as well (odds ratio [OR] 0.74, 95% CI 0.23-2.40), the group noted in a research letter in JAMA Network Open.

Need for new mechanical ventilation or incidence of any adverse events also trended lower in patients treated with remdesivir:

  • New mechanical ventilation: RR 0.57 (95% CI 0.15-1.80)
  • Adverse event: RR 0.37 (95% CI 0.05-1.33)

Furthermore, total average length of hospital stay wasn’t significantly different between the groups (23.1 days for remdesivir vs 21.6 for standard of care).

In this group of hospitalized patients with severe renal impairment, remdesivir also appeared to be safe for the kidneys, without any additional risk of transaminitis or toxic kidney effects by day 5:

  • Day 5 eGFR: 31.2 mL/min/1.73 m2 for remdesivir vs 20.5 mL/min/1.73 m2
  • Day 5 creatinine: 2.83 mg/dL for remdesivir vs 4.12 mg/dL
  • Day 5 alanine aminotransferase: 40.8 for remdesivir vs 91.9

For patients who didn’t require dialysis at baseline, the need for new dialysis was also no different for those given remdesivir (RR 0.95, 95% CI 0.25-3.56).

“These findings suggest that remdesivir can be safely administered in patients with kidney dysfunction, balancing possible risks and benefits,” Murthy’s group said, while noting the small study population as a limitation.

This is particularly reassuring as remdesivir is not currently recommended for use in patients with severe renal dysfunction, particularly those with an eGFR below 30, “owing to the presence of excipients that may accumulate in kidney dysfunction and worsen kidney or hepatic outcomes,” the researchers wrote.

They added that the “need for assessing kidney function in the absence of clinical suspicion before and during outpatient administration of remdesivir can be questioned.”

Data for the analysis came from the Canadian Treatments for COVID-19 (CATCO) trial that was part of the larger global Solidarity Trial. This trial didn’t impose any kidney-specific exclusion criteria to participation.

Patients randomized to receive open-label remdesivir were administered lyophilized remdesivir, diluted and administered intravenously with a loading dose of 200 mg on the first day, and then followed by daily 100-mg doses for 9 days or until the patient was discharged. The dose of remdesivir was not adjusted for baseline kidney functioning.

Standard of care was delivered in the form of “best-quality supportive care,” the team noted.

Along with the small study population (34 patients in the remdesivir group and 25 in the standard-of-care group), the current analysis was also limited by baseline differences, according to the researchers.

Between the remdesivir and control groups, respectively, baseline differences included median age (74 vs 80 years), male sex (38.2% vs 68%), median frailty score (4 vs 5), need for intensive care (32.4% vs 28%) or oxygen (47.1% vs 56%), as well as median creatinine (2.62 vs 3.88 mg/dL) and eGFR levels (22.7 vs 12.4 mL/min/1.73 m2), among others.

  • Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

Disclosures

The study was funded by the Canadian Institutes of Health Research.

Murthy reported a relationship with the Canadian Institutes of Health Research; other co-authors also reported disclosures.

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Health unit hosting pop-up COVID vaccine clinics – BradfordToday

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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The Simcoe Muskoka District Health Unit is continuing to offer one-day pop-up COVID-19 vaccination clinics at locations throughout Simcoe Muskoka, with upcoming clinics taking place from Sept. 26 to Oct. 2. Walk-ins for individuals aged 5 years and older will be available, including the bivalent booster dose for people 18 years of age and older, as capacity allows as follows:

Monday, Sept. 26

  • Clinic location:  POP-UP Clinic – Stayner Arena and Community Centre, 269 Regina St. Stayner
    Time: 1 – 6 p.m.
  • Clinic location:  POP-UP Clinic – Chappell Farms, 617 Penetanguishene Rd., Barrie
    Time: 10 a.m. – 4 p.m.

Tuesday, Sept 27

  • Clinic location:  POP-UP Clinic – South Innisfil Community Centre, 1354 Killarney Beach Rd, Innisfil
    Time: 10 a.m. – 3:30 p.m.

Wednesday, Sept 28

  • Clinic location:  POP-UP Clinic – Huntsville Trinity United Church, 33 Main St. E., Huntsville
    Time: 10 a.m. – 2 p.m.

Thursday, Sept. 29

  • Clinic location:  POP-UP Clinic – Orillia Common Roof – Boardroom, 169 Front St. S., Orillia
    Time: 9:30 a.m. – 3:30 p.m.

GO-VAXX bus and mobile clinics continue to operate on an appointment only basis. Appointments for the GO-VAXX clinics may also be booked up to four days prior to the clinic through the COVID-19 vaccination portal or by calling the Provincial Vaccine Contact Centre at 1-833-943-3900. 

The health unit continues to offer COVID-19 vaccinations on an appointment only basis to individuals aged six months and older at the Georgian Mall, 509 Bayfield St. (upper level) in Barrie: 

  • Wednesday: 1 p.m. – 7 p.m.
  • Friday: 10 a.m. – 4 p.m.
  • Saturday: 10 a.m. – 4 p.m.

Appointments are also available at the health unit office immunization clinic locations in Midland, Orillia, Cookstown, Collingwood, Huntsville and Gravenhurst and can be booked through the COVID-19 vaccination portal or by calling the Provincial Vaccine Contact Centre at 1-833-943-3900.

In addition, the RVH COVID-19 Immunization Clinic at 29 Sperling Dr. in Barrie continues to offer booked appointments and walk-ins from 10 a.m. to 6 p.m. on Tuesdays and Thursdays. Appointments may also be booked with the Couchiching Ontario Health Team Clinic  located in the Orillia Soldier’s Memorial Hospital Kiwanis Building – West Entrance 170 Colborne St., W.

Individuals six months of age and older may also receive the vaccine at some local pharmacies or booked appointments through some primary care providers, and Family Health Teams who are offering the vaccine as part of their regular clinical practice. Pop-up and GO-VAXX mobile clinics will continue to be scheduled throughout Simcoe and Muskoka.

Staying up to date with all COVID-19 vaccine doses you are currently eligible for remains the best defense against infection, severe illness, long term COVID-19 symptoms, hospitalization and death.

For more information about COVID-19 vaccination, dose eligibility and booking an appointment, please visit www.smdhu.org/GetVaccinated.

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Advancing care for burn patients | Queen's Gazette – Queen's University

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New research finds that glutamine, previously thought to help with burn injuries, does not improve patients’ time to discharge from hospital.

Dr. Daren Heyland, Director of the Clinical Evaluation Research Unit at Queen’s University and principal investigator and sponsor of the glutamine trial.

Queen’s researcher Daren Heyland (Medicine) has spent his career studying what nutrients are best for intensive care patients who cannot eat for themselves, trying to understand if certain nutrients assist with their recovery. Patients in intensive care who cannot eat for themselves are fed artificial nutrition through a feeding tube or an intravenous catheter. For over 20 years, Dr. Heyland has been evaluating the role of glutamine, which is an amino acid that is made in the body and is found in foods like fish, eggs, and nuts.  

Worldwide, burn injuries are among the most expensive traumatic injuries to treat and 50 per cent of burn patients are treated using glutamine. Before adopting this practice more broadly, however, the medical community wanted more evidence of the efficacy of glutamine.

Seeking to understand the role of the amino acid in burn recovery, Heyland has been involved in a decade-long scientific trial involving 1,200 patients around the world with severe burns. The study was recently published in the high-impact New England Journal of Medicine (NEJM), and marked the first time a clinical trial on burn patients was featured in the prestigious publication. It yielded some unexpected results – the glutamine did not appear to harm or help burn patients.

“In the past, small, single-centre trials had suggested that glutamine was beneficial in the recovery of patients with severe burns. However, our previous work with glutamine in stressed, sick patients suggested that glutamine might actually be harmful in critically ill patients with organ failure. The only way to resolve these conflicting data was to conduct a large trial evaluating glutamine in severe burns,” said Dr. Heyland.

Dr. Heyland is the Director of the Clinical Evaluation Research Unit at Queen’s University, which functioned as the coordinating centre for the trial. He also serves as the principal investigator and sponsor of the trial, partnering with over 60 hospital burn units in nearly 20 countries.

“It took us 10 years to complete the trial, including recruiting patients and securing funding,” said Dr. Heyland. “The results of this trial will hopefully cause burn units that were using glutamine to put a stop this unnecessary practice.”

The trial was funded by the Canadian Institutes of Health Research and the Department of Defense (DOD) in the U.S. through their competitive granting programs. About 20-30 per cent of wounded soldiers have burns, and the DOD is looking for new ways to manage burns.

Dr. Heyland’s research evaluating the use of nutrition or specific nutrients and their role in improving the recovery of critically ill patients is not over. With $1.5 million in new funding from the DOD, he is now looking at high-dose intravenous vitamin C in burn-injured patients, which may help reduce the amount of fluid burn patients require to stay alive.

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Feds lift border vaccine requirements, mandatory masks on planes and trains

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OTTAWA — Federal ministers say all COVID-19 border restrictions will be removed as of Saturday, including mandatory vaccination, testing and quarantine of international travellers, as well as the requirement for masks on planes and trains.

The cabinet order maintaining COVID-19 border measures will not be renewed when it expires on Sept. 30.

But Health Minister Jean-Yves Duclos is once again warning that pandemic restrictions could be reinstated if they are needed.

“We have learned over the last (two-and-a-half) years the type of measures that can work,” Duclos said Monday.

“We will therefore leave open all possible options when it comes to protecting the health and safety of Canadians.”

The changes mean foreign nationals will no longer require an approved series of vaccinations to enter the country.

In addition, Canada-bound travellers will no longer be subject to random COVID-19 tests, and unvaccinated Canadians will not need to isolate when they return to the country.

Cruise passengers will not have to do pre-board tests or prove they have been vaccinated.

And people who enter the country after Saturday will not need to monitor and report if they develop signs or symptoms of COVID-19.

The five federal ministers making the announcement said the changes are informed by science and epidemiology, adding that modelling indicates the peak of the latest wave of the disease has “largely passed.”

But they did face questions about whether the move is at least partially politically motivated as the Liberals contend with the newly elected Opposition leader, Pierre Poilievre.

The Public Health Agency of Canada is still strongly recommending that people wear masks, particularly in crowded environments such as planes and trains.

“The science is clear: wearing a mask is clearly a means of personal protection that is extremely effective,” said Dr. Howard Njoo, Canada’s deputy chief health officer.

“I hope Canadians will make an enlightened decision about this.”

Duclos said the negative attitudes of some passengers have made things very difficult for airlines and crews to enforce the mask mandate in recent months, and cited that as a factor in the decision.

“The transmission of the variants of COVID are domestic-based, for the most part, and therefore, this is what we should stress: masking is highly recommended … but it is not something that can be, in a sense, forced.”

That is a change in messaging from earlier in the summer, when the government and public health officials insisted that maintaining measures at the border was necessary to track and prevent the introduction of new variants.

Public Safety Minister Marco Mendicino said there have been 38 million entries at the border in 2022 so far, more than double the number in all of last year. “We want to keep that momentum going.”

The controversial ArriveCan app will no longer be mandatory when the order expires.

“Going forward, use of ArriveCan will be optional, allowing travellers who so choose to submit their customs declaration in advance at major airports,” Mendicino said.

So far that option is available at international airports in Toronto, Montreal and Vancouver, but that will be expanded to include Calgary, Edmonton, Winnipeg, Ottawa, Quebec City, Halifax and Billy Bishop airport in Toronto.

In addition, the Canada Border Services Agency is looking at adding features to ArriveCan to be able to provide information such as border wait times.

The changes do not remove the quarantine or testing requirements for people who enter Canada before Saturday.

This report by The Canadian Press was first published Sept. 26, 2022.

 

The Canadian Press

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