Podcasts about nirmatrelvir

Qui dit fin d'année dit Gala des grands crus et des piquettes du Pharmascope! Ne manquez pas cette 8e édition du Gala au velours des plus sérieux, le grand retour de Sébastien, des effets sonores entraînants, l'inclusion de nouvelles catégories exotiques… ** Veuillez noter que cet épisode ne rencontre pas les critères d'admissibilité pour l'octroi d'unités de formation continue ou de crédits Mainpro+** Ressources pertinentes en lien avec l'épisode La catégorie « L'éditorial de l'année »van Dijk SHB, Bui M, Eijkelboom AH. Living happily ever after? The hidden health risks of Disney princesses. BMJ. 2024;387:q2497. La catégorie « Nouvelles études de vieilles affaires pour de vieilles maladies »Kingsbury SR, Tharmanathan P, Keding A, et al. Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial. Ann Intern Med. 2024;177(9):1145-1156. Wang Y, Jones G, Keen HI, et al. Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial. Lancet. 2023;402(10414):1764-1772. La catégorie « Patente à gosse incroyable »Bartholdy C, Døssing A, Stisen ZR, et al. Effect of heated mittens on physical hand function in people with hand osteoarthritis: randomised controlled trial. BMJ. 2024;387:e078222. La catégorie « Je pleure tellement je ris »Li J, Liao Y, Zhang SY, et al. Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial. BMJ. 2024;386:e080474. La catégorie « Alimentaire »Hakam N, Guzman Fuentes JL, Nabavizadeh B, et al. Outcomes in Randomized Clinical Trials Testing Changes in Daily Water Intake: A Systematic Review. JAMA Netw Open. 2024;7(11):e2447621. Hodder RK, O'Brien KM, Wyse RJ, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2024;9(9):CD008552. La catégorie « On n'est plus capable! »Duarte Romero B, Waterhouse M, Baxter C, et al. The effect of three years of vitamin D supplementation on erectile dysfunction: Results from the randomized placebo-controlled D-Health Trial. Clin Nutr ESPEN. 2024;60:109-115. La catégorie « L'étude ayant pris le plus de temps à être publiée »Hammond J, Fountaine RJ, Yunis C, et al. Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19. N Engl J Med. 2024;390(13):1186-1195. La catégorie « Visuospatial »R Patel V, Liu M, Worsham CM, Jena AB. Alzheimer's disease mortality among taxi and ambulance drivers: population based cross sectional study. BMJ. 2024;387:e082194. Published 2024 Dec 17. La catégorie « Hommage »Yndigegn T, Lindahl B, Mars K, et al. Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. N Engl J Med. 2024;390(15):1372-1381. Silvain J, Cayla G, Ferrari E, et al. Beta-Blocker Interruption or Continuation after Myocardial Infarction. N Engl J Med. 2024;391(14):1277-1286.

Contributor: Megan Hurley, MD Educational Pearls: Fevers Tylenol Up until 20 weeks NSAIDs are ok but after 20 weeks they are contraindicated Can limit the amount of amniotic fluid produced Can lead to growth restriction Can cause premature closure of the ductus arteriosus Cough Cough drops Humidifier Guafenesine and dextromethorphan (Mucinex) is not well studied but is probably ok with caution in certain circumstances such as post-tussive emesis causing poor PO intake and weight loss Congestion Flonase (Fluticasone nasal spray) Nasal rinses Humidifier 1st generation anti-histamines (Diphenhydramine, Doxylamine, etc.) However, these tend to have more side effects such as fatigue, drowsiness, and dizziness Concider switching to a 2nd generation (Cetirizine, Loratidine, etc.) during the day Disease specific treatments Flu (A and B) gets tamiflu (Oseltamivir) Covid gets paxlovid (Nirmatrelvir/ritonavir) Antibiotics for suspected pneumonia Additional recommendations Elevating the head of bed Nasal strips Stay well hydrated Tea Ice chips Echinacea Zinc Rest Avoid NSAIDs Pseudophedrine Afrin (Oxymetazoline) Combined meds in general References Antonucci, R., Zaffanello, M., Puxeddu, E., Porcella, A., Cuzzolin, L., Pilloni, M. D., & Fanos, V. (2012). Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. Current drug metabolism, 13(4), 474–490. https://doi.org/10.2174/138920012800166607 Black, E., Khor, K. E., Kennedy, D., Chutatape, A., Sharma, S., Vancaillie, T., & Demirkol, A. (2019). Medication Use and Pain Management in Pregnancy: A Critical Review. Pain practice : the official journal of World Institute of Pain, 19(8), 875–899. https://doi.org/10.1111/papr.12814 D'Ambrosio, V., Vena, F., Scopelliti, A., D'Aniello, D., Savastano, G., Brunelli, R., & Giancotti, A. (2023). Use of non-steroidal anti-inflammatory drugs in pregnancy and oligohydramnios: a review. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 36(2), 2253956. https://doi.org/10.1080/14767058.2023.2253956 Summarized by Jeffrey Olson MS3 | Edited by Meg Joyce, MS1 & Jorge Chalit, OMS3  

Commentary by Dr. Candice Silversides

In his weekly clinical update, Dr. Griffin discusses expanded use of the RSV vaccine by GSK, how the youngest member of the MicrobeTV family was hospitalized with RSV, why we are seeing more RSV infections than before the pandemic and how administration of monoclonal antibody therapy does not prevent infection but disease, before reviewing the weekly US COVID update, how SARS-CoV-2 affects neurodevelopment of the fetus and probability of preeclampsia, if giving Paxlovid prevents long COVID, and FDA recommends switching from the XBB.1.5 variant to JN.1 for fall COVID-19 vaccine formulations. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Young “Immune” co-host with RSV (YouTube) RSV on Immune (MicrobeTV) More children hospitalized with RSV after pandemic than before (Pediatrics) France supports Nirsevimab for RSV (Influenza and other respiratory viruses) Protects against disease not infection Nirsevimab (CIDRAP) TWiV tells it likes it is: protects against disease NOT infection (TWiV 695) RSV vaccine access expanded 50-59 (CIDRAP) GSK RSV vaccine expanded use for high risk 50-year olds (GSK) COVID-19 deaths COVID-19 national trend Neurodevelopmental delay in children whose mothers exposed to SARS-CoV-2 (Scientific Reports) Preeclampsia associated with SARS-CoV-2 infection (Journal of Maternal-Fetal & Neonatal Medicine) Effectiveness of nirmatelvir/ritonavir in children and adolescents (Nat Comm) JN.1 for fall COVID-19 boosters (FDA) COVID-19 vaccine booster switch (CIDRAP) EUA for pemgarda (FDA) Infusion centers near you! (pemgarda.com) CDC quarantine guidelines (CDC) Early phase of SARS-CoV-2 infection (COVID.gov) NIH COVID-19 treatment guidelines (NIH) Infectious Disease Society guidelines for treatment and management (IDSociety) Drug interaction checker (University of Liverpool) Molnupiravir safety and efficiacy (JMV) Convalescent plasma recommendations for immunocompromised (ID Society) Updated respiratory virus guidelines (CDC) What to do when your healthcare provider is infected with SARS-CoV-2 (CDC) Managing healthcare staff shortages (CDC) Steroids, dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Long COVID evidence based review TWiV shout out (TWiV 1088) Nirmatrelvir-ritonavir prevents long COVID-19? (JAMA Medicine) Contribute to our Floating Doctors fundraiser Letters read on TWiV 1122 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Welcome back Rounds Table Listeners!We are back today with our Classic Rapid Fire Podcast!This week, Drs. Mike Fralick and Emily Hughes discuss two recent papers exploring the role of beta blockers after myocardial infarction when there is preserved ejection fraction and the utility of Paxlovid in vaccinated versus unvaccinated adult outpatients with symptomatic COVID-19. Two papers, here we go!Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with COVID-19 (0:00 – 14:02). Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction (14:02 – 27:24).And for the Good Stuff: A 65-Year-Old Woman with an Incorrect Operation on the Left Hand (27:24 – 31:04).Bradycardia associated with remdesivir therapy for COVID-19 in a 59-year-old manQuestions? Comments? Feedback? We'd love to hear from you! @roundstable

In "H5N1 Uncertainty," Dr. Osterholm and Chris Dall discuss the latest national COVID trends, a recent study on Paxlovid, and cases of H5N1 in cattle. Dr. Osterholm also shares the latest "This Week in Public Health History" segment and interviews two members of the podcast team.Please fill out our Listener Feedback Survey!Swedish study suggests link between long COVID and severity of illness (Stephanie Soucheray, CIDRAP News)Study: long COVID affects 8% of those with COVID-19, is more common in women (Stephanie Soucheray, CIDRAP News)New neurologic issues less likely after severe COVID than flu, research suggests (Mary Van Beusekom, CIDRAP News)Nirmatrelvir for vaccinated or unvaccinated adult outpatients with COVID-19 (Hammond et al., New England Journal of Medicine)Treating acute COVID-19 — final chapters still unwritten (Gandhi & Hirsch, New England Journal of Medicine)More episodesSupport this podcast

In his weekly clinical update, Dr. Griffin reviews recent statistics on the circulation of measles influenza and SARS-CoV-2, before discussing the development of new monoclonal antibody therapy, if vaccines and antivial drugs can used effectively together. revised guidelines for how to treat respiratory viral infection guidelines by the CDC, continues to dispel the myth of viral rebound including that after administration of the “oral remdesivir”, revised guidelines SARS-CoV-2 treatment and how to treat respiratory viral infections, when to use steroids and the benefits of convalescent plasma, what do when healthcare workers succumb to SARS-CoV-2 infection, if one can predict the loss infectivity of healthcare workers with mild COVID-19 disease and the dynamics of household transmission of the virus in children. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Measles tracking (CDC) Influenza/flu surveillance  (CDC) Influenza/flu map (CDC) COVID-19  hospital admissions (CDC) COVID-19 national trend (CDC) COVID-19 wastewater testing (biobot) Variant tracker (CDC) Variant hospital admissions (CDC) What new monoclonal antibody therapy? (FDA) A New pre-exposure prophylaxis for COVID-19? (Invivyd) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Really COVID-19 rebound after Nirmatrelvir-ritonavir treatment? (JAMA Network Open) Can vaccines and antiviral be effective for COVID-19 together (International Journal of Infectious Diseases) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (IDSociety) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) What do when your heathcare provider is infected with SARS-CoV-2 (CDC) Managing healthcare staffing shortages (CDC) Can loss of infectivity among healthcare works with mild and recurrent COVID-19 be predicted (CID) Household transmission dynamics in children with asymptomatic infection (CID) Steroids,dexamethasone at the right time (OFID)Anticoagulation guidelines (hematology.org) Contribute to our ASTMH fundraiser at PWB Letters read on TWiV 1098 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss how to optimize the use of COVID-19 antivirals and how to navigate drug-drug interactions between COVID-19 treatments and a patient's home medications. Their discussion includes:Current COVID-19 landscapeCOVID-19 testing and vaccination recommendationsTreatment guidelines and antiviral options for nonhospitalized adults with COVID-19Resources for assessing and managing COVID-19 antiviral-related drug-drug interactionsAnswers to learners' most pressing questionsPresenters:Renslow Sherer, MDProfessor of MedicineSection of Infectious Diseases and Global HealthUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of PharmacyEmory University Hospital MidtownAtlanta, GeorgiaSlideset: https://bit.ly/4c6kwbJDownloadable resource:https://bit.ly/49rofP6Full program: https://bit.ly/3P16TR8Get access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts or Spotify.

Does nirmatrelvir reduce the risk of developing long COVID? Find out about this and more in today's PV Roundup podcast.

Dr. Centor discusses rebound of COVID-19 after treatment with nirmatrelvir-ritonavir with Dr. Myron Cohen.

I divide Paxlovid, nirmatrelvir, and ritonavir into syllables, explain which syllables have the emphasis, and reveal the sources of my information.  The written pronunciations are below and on https://www.thepharmacistsvoice.com.  The purpose of my pronunciation episodes is to provide the intended pronunciations of drug names from reliable sources so you feel more confident saying them and less frustrated learning them.  Paxlovid = pax LO vid; emphasize LO.  Nirmatrelvir = NIR ma TREL vir; emphasize NIR and TREL.  TREL gets the most emphasis. Ritonavir = ri TON a vir; emphasize TON. Thank you for listening to episode 254 of The Pharmacist's Voice ® Podcast! To read the FULL show notes, visit https://www.thepharmacistsvoice.com/podcast.  Select episode 254. Subscribe to or follow The Pharmacist's Voice ® Podcast to get each new episode delivered to your podcast player and YouTube every time a new one comes out!   Apple Podcasts   https://apple.co/42yqXOG  Google Podcasts  https://bit.ly/3J19bws  Spotify  https://spoti.fi/3qAk3uY  Amazon/Audible  https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt Links from this episode How to Pronounce Nirmatrelvir - YouTube (recommended by Pfizer Media Relations - 212-733-1226, pfizermediarelations@pfizer.com) Paxlovid package insert.  See patient information section (after section 17/pt counseling info) Pfizer website, Paxlovid pronounced (healthcare provider video) YouTube, Paxlovid direct-to-consumer commercial (published by Pfizer) USP Dictionary Online (aka “USAN”)  **Subscription-based resource USP Dictionary's (USAN) pronunciation guide (Free resource on the American Medical Association's website) The Pharmacist's Voice ® Podcast episode 250, pronunciation series episode 22 (metformin/Glucophage) The Pharmacist's Voice Podcast ® episode 245, pronunciation series episode 21 (naltrexone/Vivitrol) The Pharmacist's Voice ® Podcast episode 240, pronunciation series episode 20 (levalbuterol) The Pharmacist's Voice ® Podcast episode 236, pronunciation series episode 19 (phentermine)  The Pharmacist's Voice ® Podcast episode 228, pronunciation series episode 18 (ezetimibe) The Pharmacist's Voice ® Podcast episode 219, pronunciation series episode 17 (semaglutide) The Pharmacist's Voice ® Podcast episode 215, pronunciation series episode 16 (mifepristone and misoprostol) The Pharmacist's Voice ® Podcast episode 211, pronunciation series episode 15 (Humira®) The Pharmacist's Voice ® Podcast episode 202, pronunciation series episode 14 (SMZ-TMP) The Pharmacist's Voice ® Podcast episode 198, pronunciation series episode 13 (carisoprodol) The Pharmacist's Voice ® Podcast episode 194, pronunciation series episode 12 (tianeptine) The Pharmacist's Voice ® Podcast episode 188, pronunciation series episode 11 (insulin icodec)  The Pharmacist's Voice ® Podcast episode 184, pronunciation series episode 10 (phenytoin and isotretinoin) The Pharmacist's Voice ® Podcast episode 180, pronunciation series episode 9 Apretude® (cabotegravir) The Pharmacist's Voice ® Podcast episode 177, pronunciation series episode 8 (metoprolol)  The Pharmacist's Voice ® Podcast episode 164, pronunciation series episode 7 (levetiracetam) The Pharmacist's Voice ® Podcast episode 159, pronunciation series episode 6 (talimogene laherparepvec or T-VEC)  The Pharmacist's Voice ® Podcast episode 155, pronunciation series episode 5 Trulicity® (dulaglutide)  The Pharmacist's Voice ® Podcast episode 148, pronunciation series episode 4 Besponsa® (inotuzumab ozogamicin) The Pharmacist's Voice ® Podcast episode 142, pronunciation series episode 3 Zolmitriptan and Zokinvy The Pharmacist's Voice ® Podcast episode 138, pronunciation series episode 2 Molnupiravir and Taltz The Pharmacist's Voice ® Podcast episode 134, pronunciation series episode 1 Eszopiclone and Qulipta

In his weekly clinical update, Dr. Griffin discusses health worker–perceived working conditions and symptoms of poor mental health, Mpox neutralizing antibodies at 6 months from mpox infection or MVA-BN vaccination, newborn and early infant outcomes following maternal COVID-19 vaccination during pregnancy, duration of SARS-CoV-2 culturable virus shedding in children, prescribing outcomes in outpatients treated with nirmatrelvir–ritonavir for COVID-19 in an interdisciplinary community clinic, Nirmatrelvir and molnupiravir and post-COVID-19 condition in older patients, optimal duration of systemic corticosteroids in COVID-19 treatment, association between Guillain-Barré syndrome and COVID-19 infection and vaccination, SARS-CoV-2 infection correlates with male benign prostatic hyperplasia deterioration, Transplanting candidates with COVID-19, and favorable experience of transplant strategy including liver grafts from COVID-19 donors. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Routine vaccination coverage (CDC) Outbreak of invasive Group A Streptococcus in children (PIDS) Nirmatrelvir/ritonavir use in pregnant women with SARS-CoV-2 (Nature) Outcomes of SARS-CoV-2 omicron variant infections compared with seasonal influenza and RSV infections in adults (CID) Remdesivir is associated with reduced mortality in COVID-19 patients requiring oxygen (OFID) Effectiveness of nirmatrelvir/ritonavir against the development of Post–COVID-19 conditions among U.S. veterans (AIM) Contribute to our MicrobeTV fundraiser at PWB Letters read on TWiV 1058 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In his weekly clinical update, Dr. Griffin discusses health worker–perceived working conditions and symptoms of poor mental health, Mpox neutralizing antibodies at 6 months from mpox infection or MVA-BN vaccination, newborn and early infant outcomes following maternal COVID-19 vaccination during pregnancy, duration of SARS-CoV-2 culturable virus shedding in children, prescribing outcomes in outpatients treated with nirmatrelvir–ritonavir for COVID-19 in an interdisciplinary community clinic, Nirmatrelvir and molnupiravir and post-COVID-19 condition in older patients, optimal duration of systemic corticosteroids in COVID-19 treatment, association between Guillain-Barré syndrome and COVID-19 infection and vaccination, SARS-CoV-2 infection correlates with male benign prostatic hyperplasia deterioration, Transplanting candidates with COVID-19, and favorable experience of transplant strategy including liver grafts from COVID-19 donors. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Health worker–perceived working conditions and symptoms of poor mental health (CDC) Neutralizing antibodies at 6 months from mpox infection or MVA-BN vaccination (The Lancet) Newborn and early infant outcomes following maternal COVID-19 vaccination during pregnancy (JAMA) Duration of SARS-CoV-2 culturable virus shedding in children (JAMA) Prescribing outcomes in outpatients treated with PAXLOVID for COVID-19 (PLOS ONE) Nirmatrelvir and molnupiravir and post–COVID-19 condition in older patients (JAMA) Optimal duration of systemic corticosteroids in COVID-19 treatment (OFID) Intravenous vitamin C for patients hospitalized with COVID-19 (JAMA) Association between Guillain-Barré syndrome and COVID-19 infection and vaccination (NH) SARS-CoV-2 infection correlates with male benign prostatic hyperplasia deterioration (JIM) Transplanting candidates with COVID-19 (TID) Favorable experience of transplant strategy including liver grafts from COVID-19 donors (TID) Contribute to our Floating Doctors fundraiser at PWB Letters read on TWiV 1056 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In this podcast, expert Rasika Karnik, MD, MS, discusses how to manage the health risks posed by COVID-19 infection and long COVID in individuals with metabolic syndrome or obesity.Dr Karnik discusses the interplay between COVID-19 outcomes, obesity/metabolic syndrome, and social determinants of health and delves into detail on how to address and mitigate these social determinants of health in a high-risk population.Presenters:Rasika Karnik, MD, MSAssistant ProfessorDivision of Primary Care, Department of Internal MedicineUniversity of ChicagoChicago, IllinoisContent based on an online CME program supported by independent educational grants from Pfizer.Link to full program: https://bit.ly/46yuChS

In this podcast, experts Donna Ryan, MD, and Renslow Sherer, MD, discuss how to manage the health risks posed by COVID-19 infection and long COVID in individuals with metabolic syndrome or obesity.First, Dr Ryan presents an overview of the relationship between COVID-19 and weight, including the mechanisms of how obesity may drive COVID-19 disease and how COVID-19 may in turn worsen obesity, through both immunologic and social or societal drivers.Dr Ryan also discusses the relationship between obesity and the risk for long COVID.In his segment, Dr Sherer discusses COVID-19 vaccination and antiviral therapy within the context of obesity and metabolic syndrome. Dr Sherer also delves into detail on how obesity-related risk factors or comorbidities may affect treatment decisions and presents strategies on individualizing treatment, including in patients with long COVID.This episode includes results from several reviews and meta-analyses examining the relationship between vaccination, as well as an observational study investigating the impact of nirmatrelvir/ritonavir therapy on long COVID in vaccinated patients.Presenters:Donna Ryan, MDProfessor Emerita Pennington Biomedical Research Center New Orleans, Louisiana Renslow Sherer, MDDirector of the International HIV Training Center Professor of MedicineInfectious Diseases and Global Health Department of Medicine University of Chicago Department of Medicine Chicago, IllinoisContent based on an online CME program supported by independent educational grants from Pfizer.Link to full program:https://bit.ly/46yuChS

In his weekly clinical update, Dr. Griffin discusses modeling poliovirus transmission and responses in New York State, FDA approves first vaccine for pregnant individuals to prevent RSV in infants, prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, Nirmatrelvir resistance – de novo E166V/L50V mutations in an immunocompromised patient treated with prolonged nirmatrelvir/ritonavir monotherapy leading to clinical and virological treatment failure, incidence of new-onset hypertension post–COVID-19: comparison with influenza, and post-acute sequelae of COVID-19 at 2 years. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Modeling poliovirus transmission and responses in New York State (JID) FDA approves first vaccine for pregnant individuals to prevent RSV in infants (FDA) Prevention and control of seasonal influenza with vaccines (CDC) De novo E166V/L50V mutations in an immunocompromised patient treated with nirmatrelvir/ritonavir (CID) Incidence of new-onset hypertension post–COVID-19 (Hypertension) Postacute sequelae of COVID-19 at 2 years (Nature Medicine) Contribute to our Floating Doctors fundraiser at PWB Letters read on TWiV 1038 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In his weekly clinical update, Dr. Griffin discusses the new risk assessment for the H5N1 avian flu viruses, the development of monoclonal antibody-based blocking ELISA for detecting SARS-CoV-2 exposure in animals, repeated antibiotic exposure and risk of hospitalization and death following COVID-19 infection, COVID-19 rebound study: a prospective cohort study to evaluate viral and symptom rebound differences in participants treated with Nirmatrelvir plus Ritonavir versus untreated controls, exaggerated blood pressure elevation in response to orthostatic challenge a post-acute sequelae of SARS-CoV-2 infection (PASC) after hospitalization, long term follow-up of a multicenter cohort of COVID-19 patients with pulmonary embolism, and risk of cardiovascular disease after COVID‐19 diagnosis among adults with and without diabetes. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode New risk assessment for H5N1 avian flu viruses (CDC) Development of monoclonal antibody-based blocking ELISA for detecting SARS-CoV-2 exposure (Virology) Repeated antibiotic exposure and risk of hospitalization and death following COVID-19 infection (eClinicalMedicine) COVID-19 Rebound Study (CID) Exaggerated blood pressure elevation in response to orthostatic challenge (AN) Long term follow-up of a multicenter cohort of COVID-19 patients with pulmonary embolism (TR) Risk of Cardiovascular disease after COVID‐19 diagnosis among adults with and without Diabetes (JAHA) Contribute to our FIMRC fundraiser at PWB Letters read on TWiV 1025 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Mr. Pierre Giguère and Dr. Swapnil Hiremath provide an overview of their study, "Management and Outcome of COVID-19 Infection Using Nirmatrelvir/Ritonavir in Kidney Transplant Patients," on behalf of their colleagues.

Mr. Pierre Giguère and Dr. Swapnil Hiremath provide an overview of their study, "Management and Outcome of COVID-19 Infection Using Nirmatrelvir/Ritonavir in Kidney Transplant Patients," on behalf of their colleagues.

In his weekly clinical update, Dr. Griffin discusses autochthonous leprosy in the United States, a systematic review to identify novel clinical characteristics of Mpox virus infection and therapeutic and preventive strategies to combat the virus, two-year duration of immunity of inactivated poliovirus vaccine, evaluation of novel oral polio vaccine type 2 SIA impact in a large outbreak of circulating vaccine-derived poliovirus in Nigeria, performance of rapid antigen tests to detect symptomatic and asymptomatic SARS-CoV-2 Infection, effectiveness of the COVID-19 bivalent vaccine, oral Nirmatrelvir and Ritonavir for COVID-19 in vaccinated, non-hospitalized adults ages 18-50 years, genome-wide association study of long COVID, vaccination ameliorates cellular inflammatory responses in SARS-CoV-2 breakthrough infections, and high incidence of autonomic dysfunction and postural orthostatic tachycardia syndrome in patients with long-COVID. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Autochthonous leprosy in the United States (NEJM) Systematic review to identify novel clinical characteristics of Monkeypox (Archives of Virology) Two-year duration of immunity of inactivated poliovirus vaccine (JID) Evaluation of novel oral polio vaccine type 2 SIA impact in a outbreak of vaccine-derived poliovirus in Nigeria (IDSA) Performance of rapid antigen tests to detect symptomatic and asymptomatic SARS-CoV-2  (AIM) Effectiveness of the COVID-19 bivalent vaccine (OFID) Oral Nirmatrelvir and Ritonavir for COVID-19 in vaccinated, non-hospitalized adults (CID) Genome-wide association study of long COVID (medRxiv) Vaccination ameliorates cellular inflammatory responses in SARS-CoV-2 breakthrough infections (JID) High incidence of autonomic dysfunction and postural orthostatic tachycardia syndrome in patients with long-COVID (AJM) Contribute to our FIMRC fundraiser at PWB Letters read on TWiV 1022 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine. This episode delves into new methodologies which can use observational data to emulate trial data. We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica. There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately? Reading list; Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312 Surgical versus non-surgical treatment for sciatica https://www.bmj.com/content/381/bmj-2022-070730 CONSORT Harms 2022 statement, explanation, and elaboration https://www.bmj.com/content/381/bmj-2022-073725 Funders crack down on unpublished clinical trials—but is it enough? https://www.bmj.com/content/381/bmj.p840 Communication of anticancer drug benefits and related uncertainties to patients and clinicians https://www.bmj.com/content/380/bmj-2022-073711

Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine. This episode delves into new methodologies which can use observational data to emulate trial data. We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica. There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately? Reading list; Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312 Surgical versus non-surgical treatment for sciatica https://www.bmj.com/content/381/bmj-2022-070730 CONSORT Harms 2022 statement, explanation, and elaboration https://www.bmj.com/content/381/bmj-2022-073725 Funders crack down on unpublished clinical trials—but is it enough? https://www.bmj.com/content/381/bmj.p840 Communication of anticancer drug benefits and related uncertainties to patients and clinicians https://www.bmj.com/content/380/bmj-2022-073711

In this week's episode we'll review imbalances in gut microbiota may impact the efficacy and safety of immunochemotherapy in patients with diffuse large B-cell lymphoma. Next, the NFIA-ETO2 fusion, found exclusively in pediatric patients with pure erythroid leukemia, impairs the normal process of erythroid differentiation. Finally, we'll look at the effectiveness of nirmatrelvir plus ritonavir in patients with CLL infected with SARS-CoV-2 during the Omicron surge.  

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Current COVID-19 landscapeRapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides: bit.ly/3oHKC09To view the full online program: bit.ly/4201xcO

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Current COVID-19 landscapeRapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides: bit.ly/3oHKC09To view the full online program: bit.ly/4201xcO

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Current COVID-19 landscapeRapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides: bit.ly/3oHKC09To view the full online program: bit.ly/4201xcO

In this episode, Tracey Piparo, PA-C, and Renslow Sherer, MD, discuss cases of nonhospitalized patients with COVID-19, including:Young, healthy patient with no risk factorsYoung, healthy patient with risk factorsOlder patient with immunocompromiseOlder patient with renal dysfunctionPatient experiencing hypoxia Presenters: Tracey Piparo, PA-C Department of Palliative Medicine RJWBarnabas New Brunswick, New Jersey Renslow Sherer, MD Director, International HIV Training Center Professor of Medicine Section of Infectious Diseases and Global Health Department of Medicine University of Chicago Chicago, Illinois To download the slides: bit.ly/44cgH0qTo view the full online program: https://bit.ly/4201xcO

In his weekly clinical update, Dr. Griffin discusses an update on vaccine-derived poliovirus outbreaks, how the dream of wiping out polio might need a rethink, risk of death in patients hospitalized for COVID-19 vs seasonal Influenza in fall-winter, French Mpox cluster includes fully vaccinated patients, two individuals with potential Mpox virus reinfection, epidemiologic and clinical features of Mpox-associated deaths, FDA authorizes changes to simplify use of bivalent mRNA COVID-19 vaccines, SARS-CoV-2 during Omicron variant predominance among infants born to people with SARS-CoV-2, severe maternal morbidity and mortality of pregnant patients with COVID-19 infection during the early pandemic period in the US, sickness presenteeism in healthcare workers during the COVID-19 pandemic, ventilation improvements among k–12 public school districts, risk factors and vectors for SARS-CoV-2 household transmission, SARS-CoV-2 neutralizing antibodies after bivalent versus monovalent, durability of bivalent boosters against Omicron subvariants, Nirmatrelvir and risk of hospital admission or death in adults with COVID-19, evolving real-world effectiveness of monoclonal antibodies for treatment of COVID-19, effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support–free days in patients hospitalized with COVID-19, efficacy and safety of Anakinra plus standard of care for patients with severe COVID-19, higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support, risk of autoimmune diseases in patients with COVID-19, definition of post–COVID-19 condition among published research studies, and sleep disturbance severity and correlates in post-acute sequelae of COVID-19.  Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Update on vaccine-derived poliovirus outbreaks (CDC) The dream of wiping out polio might need a rethink (NPR) Risk of death in patients hospitalized for COVID-19 vs influenza (JAME) French mpox cluster includes fully vaccinated patients (CIDRAP) Two individuals with potential Monkeypox reinfection (The Lancet) Epidemiologic and clinical features of Mpox-associated deaths (CDC) FDA authorizes changes to simplify use of Bivalent mRNA COVID-19 vaccines (FDA) Omicron variant predominance among infants born to people with SARS-CoV-2 (Pediatrics) Severe maternal morbidity and mortality of pregnant patients with COVID-19 (JAMA)  Sickness presenteeism in healthcare workers during the COVID-19 pandemic (ICHE) Ventilation improvements among K–12 public school districts (CDC) Risk factors and vectors for SARS-CoV-2 household transmission (The Lancet) SARS-CoV-2 neutralising antibodies after bivalent vs monovalent (The Lancet) Durability of bivalent boosters against Omicron subvariants (NEJM) Nirmatrelvir and risk of hospital admission or death in adults with COVID-19 (BMJ) Real world effectiveness of Monoclonal Antibodies for treatment of COVID-19 (AIM) Study on ACE inhibitor and ARB effect on COVID-19 patient outcomes (JAMA) Efficacy and safety of Anakinra plus standard of care for patients with severe COVID-19 (JAMA) High-dose corticosteroids in non-ventilated COVID-19 patients with hypoxia (The Lancet) Risk of autoimmune diseases in patients with COVID-19 (eClinical) Definition of post–COVID-19 condition (JAMA) Sleep disturbance severity and correlates in Post-acute Sequelae of COVID-19 (JGIM) Contribute to our ASTMH fundraiser at PWB Letters read on TWiV 1001 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In his weekly clinical update, Dr. Griffin discusses how antibiotics don't reduce risk of death from viral respiratory infections, norovirus infections continue to rise in the US, ABO blood types and SARS-CoV-2 infection assessed using seroprevalence data in a large population-based sample, maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization, association of treatment with Nirmatrelvir and the risk of Post–COVID-19 condition, mechanically ventilated patients with COVID-19 had a higher chance of in-hospital death if treated with high-flow nasal cannula oxygen before intubation, high-flow nasal cannula and outcomes in COVID-19, severe infection and risk of Cardiovascular disease, and the risk factors associated with post−COVID-19 condition. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Antibiotics don't reduce risk of death from viral respiratory infections (CIDRAP) ABO blood types and SARS-CoV-2 infection (Nature) Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization (Nature Medicine) Association of treatment with Nirmatrelvir and risk of post–COVID-19 (JAMA) Ventilated patients with COVID-19 had a higher chance of in-hospital death with usage of nasal cannula oxygen (IARS) High-flow nasal cannula and outcomes in COVID-19 (IARS) Severe infection and risk of cardiovascular disease (AHA) Risk factors associated with post−COVID-19 condition (JAMA) Contribute to our ASTMH fundraiser at PWB Dr. Griffin's treatment guide (pdf) Letters read on TWiV 996 Don't crush Paxlovid (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In his weekly clinical update, Dr. Griffin discusses clearance of longstanding, immune-deficiency-associated, vaccine-derived poliovirus infection following remdesivir therapy for chronic SARS-CoV-2 infection, SARS-CoV-2 exposure in New York City rats, clinical characteristics and outcomes of children with SARS-CoV-2 infection during the Delta and Omicron variant-dominant periods in Korea, exhaled breath aerosol shedding of SARS-CoV-2 variants, outpatient treatment of COVID-19 and the development of long COVID over 10 months, Nirmatrelvir and the risk of post-acute sequelae of COVID-19, assessment of the risk of venous thromboembolism in nonhospitalized patients with COVID-19, and the optimal duration of systemic corticosteroids in COVID-19 treatment. Click arrow to play Download TWiV 992 (19 MB .mp3, 32 min) Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Clearance of vaccine-derived poliovirus following remdesivir therapy for SARS-CoV-2 infection (Frontiers)  SARS-CoV-2 exposure in Norway rats from New York City (mBio) Clinical characteristics and outcomes of children with SARS-CoV-2 Infection in Korea (JKMS) Exhaled breath aerosol shedding of SARS-CoV-2 variants (CID) Outpatient treatment of COVID-19 and the development of Long COVID (The Lancet)  Nirmatrelvir and the risk of post-acute sequelae of COVID-19 (medRxiv) Risk of venous thromboembolism in nonhospitalized patients with COVID-19 (JAMA) Optimal duration of systemic corticosteroids in COVID-19 treatment (OFID) Contribute to our ASTMH fundraiser at PWB Dr. Griffin's treatment guide (pdf) Letters read on TWiV 992 Don't crush Paxlovid (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In this episode, Alba Azola, MD, and Monica Verduzco-Gutierrez, MD, discuss diagnosis and management of long COVID, including: Definitions of post COVID conditionsDiagnosis, including symptoms and clinical presentationEpidemiologyRisk factorsPossible treatment optionsClinical guidance statementsPresenters:Alba Azola, MDAssistant ProfessorDepartment of Physical Medicine and RehabilitationJohns HopkinsCo-DirectorJohns Hopkins Post Acute COVID Team ClinicBaltimore, MarylandMonica Verduzco-Gutierrez, MDProfessor and Distinguished ChairDepartment of Rehabilitation MedicineUniversity of Texas Health Science Center at San AntonioDirector, UT Health COVID-19 Recovery ClinicDepartment of Rehab MedicineUT Health San AntonioSan Antonio, TexasLink to full program:https://bit.ly/3Gn4tXOLinks to Consensus Guidance Statements on Assessment and Treatment of Post-Acute Sequelae of COVID-19:Autonomic Dysfunction:https://bit.ly/3GHeUGYCardiovascular Complications:https://bit.ly/3CmupkXCognitive Symptoms:https://bit.ly/3X9tnkwFatigue:https://bit.ly/3ihiLRQRespiratory Sequelae: https://bit.ly/3IrUkMc

In his weekly clinical update Dr. Griffin discusses the infectiousness of SARS-CoV-2 breakthrough infections and reinfections during the Omicron wave, virological characteristics of the SARS-CoV-2 XBB variant derived from recombination of two Omicron subvariants, antibody evasion properties of rising SARS-CoV-2 BQ and XBB subvariants, comparative effectiveness of third doses of mRNA-based COVID-19 vaccines in US veterans, time to negative PCR conversion among high-risk patients with mild-to-moderate Omicron BA.1 and BA.2 COVID-19 treated by Sotrovimab or Nirmatrelvir, COVID drug Paxlovid was hailed as a game-changer, what happened?, the Fc-effector function of COVID-19 convalescent plasma contributes to SARS-CoV-2 treatment efficacy in mice, SARS-CoV-2 infection and persistence in the human body and brain at autopsy, long-term cardiovascular outcomes of COVID-19, and how heart-disease risk soars after COVID — even with a mild case. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Infectiousness of breakthrough infections & reinfections during Omicron wave (Nature) Virological characteristics of the SARS-CoV-2 XBB variant (bioRxiv) Antibody evasion properties of BQ and XBB subvariants (Cell) Comparative effectiveness of third doses of mRNA vaccines in US veterans (Nature) Time to negative PCR conversion among high-risk patients treated by Sotrovimab or Nirmatrelvir (CMI) Paxlovid patient eligbiliity screening checklist (FDA) COVID drug Paxlovid was hailed as a game-changer. What happened? (Nature) Fc-effector function of COVID-19 convalescent plasma contributes to treatment efficacy (Cell) SARS-CoV-2 infection and persistence in the human body and brain at autopsy (Nature) Long-term cardiovascular outcomes of COVID-19 (Nature) Heart-disease risk soars after COVID (Nature) Contribute to our MicrobeTV fundraiser at PWB Dr. Griffin's treatment guide (pdf) Letters read on TWiV 972 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Fernando Carnavali, MD; Rasika Karnik, MS, MD; Renslow Sherer, MD; and Joseph Torrisi, PharmD, BCIDP, discuss COVID-19 treatments and the possibility for antiviral resistance, including:Treatment resistance mechanismsCOVID-19 testingCOVID-19 treatments, including antivirals and monoclonal antibodiesPresenters:Fernando Carnavali, MDAssociate Professor of MedicineDivision ChiefGeneral Internal MedicineDepartment of MedicineSite DirectorCOVID Center of Excellence Satellite-Ansonia Mount Sinai Health New York, New YorkRasika Karnik, MS, MDAssistant ProfessorDivision of Primary CareDepartment of Internal MedicineUniversity of ChicagoMedical DirectorPost-COVID Recovery ClinicChicago, IllinoisRenslow Sherer, MDDirectorInternational HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisJoseph Torrisi, PharmD, BCIDPClinical Pharmacy SpecialistInfectious Diseases PharmacyGrady Health SystemAtlanta, GeorgiaLink to slides: https://bit.ly/3hXMgIdLink to full program: https://bit.ly/3G271KL

In his weekly clinical update Dr. Griffin discusses modelling the adjustment of COVID-19 response and exit from dynamic zero-COVID in China, canine real-time detection of SARS-CoV-2 infections in the context of a mass screening event, two masks can be worse than one: N95 respirator failure caused by an overlying face mask, airflow patterns in double-occupancy patient rooms may contribute to roommate-to-roommate transmission of severe SARS-CoV-2, clinical validation of a novel T-Cell receptor sequencing assay for identification of recent or prior SARS-CoV-2 infection, antibody-dependent cellular cytotoxicity against SARS-CoV-2 Omicron sub-lineages is reduced in convalescent sera, regardless of the infecting variant, VV116 versus Nirmatrelvir–Ritonavir for oral treatment of Covid-19, Nirmatrelvir plus Ritonavir for early COVID-19 in a U.S. health system, Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes, higher dose corticosteroids in hospitalized COVID-19 patients with hypoxia but not requiring ventilatory support, FDA approves Roche's Actemra (tocilizumab) for the treatment of COVID-19 in hospitalized adults, structural brain changes in post-acute COVID-19 patients with persistent olfactory dysfunction, persistent post–COVID-19 smell loss is associated with immune cell infiltration and altered gene expression in olfactory epithelium, epidemiology of long COVID in US adults, persistent symptoms and sequelae after SARS-CoV-2 infection not requiring hospitalization, and outpatient treatment of Covid-19 with metformin, ivermectin, and fluvoxamine and the development of Long Covid over 10-month follow-up. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Modeling the adjustment of COVID-19 response and exit in China (Nature) Canine real-time detection of SARS-CoV-2 infections in mass screening events (BMJ) N95 respirator failure caused by an overlying face mask (ICHE) Airflow in patient rooms may contribute to transmission of severe SARS-CoV-2 (CID) Clinical validation of a T-Cell receptor for identification of recent or prior SARS-CoV-2 infection (CID) Antibody-dependent cellular cytotoxicity against SARS-CoV-2 Omicron sub-lineages (Cell) VV116 vs. Nirmatrelvir–Ritonavir for oral treatment of Covid-19 (NEJM) Nirmatrelvir plus Ritonavir for early COVID-19 in a U.S. health system (ACP) Molnupiravir as early treatment for adults with COVID-19 (The Lancet) Higher dose corticosteroids in hospitalized COVID-19 patients with hypoxia but not requiring ventilatory support (medRxiv) FDA approves Tocilizumab for the treatment of COVID-19 in hospitalized adults (Roche) Structural brain changes in post-acute COVID-19 patients with olfactory dysfunction (Annals) Paxlovid patient eligbiliity screening checklist (FDA) Persistent post–COVID-19 smell loss association (Science) Epidemiology of long COVID in US adults (CID) Persistent symptoms & sequelae after SARS-CoV-2 infection not requiring hospitalization (OFID) Outpatient treatment of COVID-19 with metformin, ivermectin, and fluvoxamine & the development of long COVID (medRxiv) Contribute to our MicrobeTV fundraiser at PWB Dr. Griffin's treatment guide (pdf) Letters read on TWiV 970 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Fernando Carnavali, MD; Rasika Karnik, MS, MD; Renslow Sherer, MD; and Joseph Torrisi, PharmD, BCIDP, discuss COVID-19 rebound, including:Prevalence of COVID-19 reboundCOVID-19 rebound and antiviral useManagement of COVID-19 rebound Presenters:Fernando Carnavali, MDAssociate Professor of MedicineDivision ChiefGeneral Internal MedicineDepartment of MedicineSite Director COVID Center of Excellence Satellite-Ansonia Mount Sinai Health New York, New YorkRasika Karnik, MS, MDAssistant ProfessorDivision of Primary CareDepartment of Internal MedicineUniversity of ChicagoMedical DirectorPost-COVID Recovery ClinicChicago, IllinoisRenslow Sherer, MDDirectorInternational HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisJoseph Torrisi, PharmD, BCIDPClinical Pharmacy SpecialistInfectious Diseases PharmacyGrady Health SystemAtlanta, GeorgiaLink to slides: https://bit.ly/3hXMgIdLink to full program: https://bit.ly/3G271KL

Fernando Carnavali, MD; Rasika Karnik, MS, MD; Renslow Sherer, MD; and Joseph Torrisi, PharmD, BCIDP, discuss how to ethically prioritize patients for COVID-19 treatment when treatment supplies may be limited, including insights on:Risk stratificationMedication acquisitionDrug interactionsPresenters:Fernando Carnavali, MDAssociate Professor of MedicineDivision ChiefGeneral Internal MedicineDepartment of MedicineSite Director COVID Center of Excellence Satellite-Ansonia Mount Sinai Health New York, New YorkRasika Karnik, MS, MDAssistant ProfessorDivision of Primary CareDepartment of Internal MedicineUniversity of ChicagoMedical DirectorPost-COVID Recovery ClinicChicago, IllinoisRenslow Sherer, MDDirectorInternational HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisJoseph Torrisi, PharmD, BCIDPClinical Pharmacy SpecialistInfectious Diseases PharmacyGrady Health SystemAtlanta, GeorgiaLink to slides: https://bit.ly/3hXMgIdLink to full program: https://bit.ly/3G271KL

In this episode, Jason Gallagher, PharmD, and Emily Heil, PharmD, MS, BCIDP discuss landmark clinical trials of COVID-19 antivirals for nonhospitalized patients and COVID-19 rebound phenomenon, including:  EPIC-HR study of nirmatrelvir plus ritonavirPINETREE study of remdesivirMOVe-OUT and Panoramic studies of molnupiravirCOVID-19 rebound in treated and untreated patientsPresenters:Jason Gallagher, PharmDClinical ProfessorSchool of PharmacyTemple UniversityClinical Pharmacy SpecialistInfectious DiseasesTemple University HospitalPhiladelphia, PennsylvaniaEmily Heil, PharmD, MS, BCIDP, AAHIVPAssociate ProfessorDepartment of Pharmacy Practice and ScienceUniversity of Maryland School of PharmacyInfectious Diseases Clinical Pharmacy SpecialistUniversity of Maryland Medical CenterBaltimore, Maryland 

In this episode, Princy N. Kumar, MD, and Paul E. Sax, MD, discuss new COVID-19 data from IDWeek 2022, including:COVID-19 vaccines, including omicron BA.1 bivalent boosterRisk factors for breakthrough COVID-19 infectionsCOVID-19 diagnostics, including digital droplet PCRCOVID-19 therapeutics, including:Nirmatrelvir plus ritonavirTixagevimab plus cilgavimabBaricitinibTocilizumabInhaled interferon β-1aCOVID-19 therapeutics and outcomes in patients with immunocompromiseLong COVIDPresenters:Princy N. Kumar, MD, FIDSA, MACPProfessor of Medicine and MicrobiologyChief, Division of Infectious Diseases and Travel MedicineSenior Associate Dean of StudentsGeorgetown University School of MedicineWashington, DCPaul E. Sax, MDClinical DirectorHIV Program and Division of Infectious DiseasesBrigham and Women's HospitalProfessor of MedicineHarvard Medical SchoolBoston, MassachusettsFollow along with the downloadable slideset at:http://bit.ly/3gkJI67Link to full program:http://bit.ly/3TSVthM

In this episode, Renslow Sherer, MD, and Jason E. Farley, PhD, MPH, ANP-BC, FAAN, FAANP, AACRN, discuss patient cases that illustrate key concepts for managing ambulatory patients with acute COVID-19 infection, including:A young, otherwise healthy patientAn older patient with multiple comorbidities A patient with immunocompromiseA patient requiring emergency department-level carePresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisJason E. Farley, PhD, MPH, ANP-BC, FAAN, FAANP, AACRNProfessorSchool of NursingJohns Hopkins UniversityNurse PractitionerDepartment of Infectious DiseasesJohn G. Bartlett Specialty PracticeBaltimore, MarylandTo download the slides:http://bit.ly/3G9IrJxTo view the full online program:https://bit.ly/3TqnNIX

Commentary by Dr. Valentin Fuster

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Rapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Monoclonal antibody treatment (bebtelovimab)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides:https://bit.ly/3TkT7sJTo view the full online program:https://bit.ly/3TqnNIX

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Nirmatrelvir/ritonavir (Paxlovid) reduces hospitalization, mortality in patients 65+ with COVID-19; effect on younger patients unclear '

In his weekly clinical update Dr. Griffin reviews the public health response to poliovirus in New York, impact of mandatory influenza vaccination, monkeypox in a young infant, health care worker exposure to monkeypox virus, monkeypox testing delays, transmission potential of monkeypox virus, TPOXX trial for monkeypox, detection of SARS-CoV-2 subgenomic mRNA, mucosal IgA against SARS-CoV-2, BNT262b2 against Omicron, awareness and use of SARS-CoV-2 antivirals, comparable outcomes for Bebtelovimab and Nirmatrelvir, and COVID-19 and Alzheimer's disease. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Support MicrobeTV with a Spike t-shirt at Vaccinated.US Research assistant position with Amy Rosenfeld (pdf) Public health response to polio in New York (MMWR) Impact of mandatory influenza vaccination (Cambridge Core) Monkeypox in young infant (MMWR) Health care worker exposure to monkeypox virus (MMWR) Monkeypox testing delays (Cambridge Core) Monkeypox in smallpox vaccinated patient (Emerg Inf Dis) Transmission potential of monkeypox virus (Int J Epidemiol) TPOXX trial for monkeypox (ACTG) SARS-CoV-2 subgenomic mRNA detection (J Inf Dis) Quantitative SARS-CoV-2 subgenomic mRNA for Remdesivir treatment (Clin Inf Dis) Anti-spike mucosal IgA (NEJM) BNT262bs against Omicron sublineages (NEJM) Awareness and use of SARS-CoV-2 antivirals (Clin Inf Dis) Comparable outcomes for Bebtelovimab and Nirmatrelvir treatment (J Inf Dis) COVID-19 and Alzheimer's disease (J Alzheimer's Dis) Dr. Griffin's treatment guide (pdf) Contribute to Floating Doctors fundraiser at PWB Letters read on TWiV 938 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In his weekly clinical update Dr. Griffin discusses vaccine effectiveness against influenza illness in children, clinical manifestations of infection with poliovirus, spike protein-independent attenuation of SARS-CoV-2 Omicron variant in laboratory mice, concordance of SARS-CoV-2 results in self-collected nasal swabs vs swabs collected by health care workers in children and adolescents, probable animal-to-human transmission of SARS-CoV-2 causing a pet shop-related outbreak, laboratory-confirmed COVID-19–associated hospitalizations among adults during BA.2 variant, SARS-CoV-2 specific T-cells and antibodies, Nirmatrelvir use and outcomes during the Omicron surge, real-world effectiveness of early Molnupiravir or Nirmatrelvir–ritonavir in hospitalized patients, and distinguishing features of long COVID. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Vaccine effectiveness against Influenza illness in children (CID) Clinical manifestations of infection with Polio (JAMA) Characteristics of deaths among fully vaccinated persons with Coronavirus (CID) Spike protein attenuation of Omicron Variant in lab mice (Cell Reports) Concordance of SARS-CoV-2 results in nasal swabs self-collected vs healthcare collected (JAMA) Probable animal-to-human transmission of Sars-Cov-2 (CID) PAXLOVID patient eligibility screening checklist (FDA) Remdesivir fact sheet for providers (Veklury)  Bebtelovimab fact sheet for providers (FDA) COVID-19–associated hospitalizations among adults during BA.2 variant (CDC) Sars-Cov-2 specific T-cells and antibodies (CID) Nirmatrelvir use and outcomes during the Omicron surge (NEJM) Effectiveness of early Molnupiravir or Nirmatrelvir–Ritonavir in hospitalized patients (The Lancet) Distinguishing features of long COVID (medRxiv) Contribute to Floating Doctors fundraiser at PWB Dr. Griffin's treatment guide (pdf) Letters read on TWiV 932 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Omicron-adapted COVID-19 booster vaccines; guidance for the 2022-23 influenza season; efficacy of COVID-19 antiviral; ‘rainbow fentanly' targeting youth; and a device to treat chronic idiopathic constipation. 

Find out how tirzepatide might revolutionize weight loss, pharmacogenomics might improve antidepressant prescribing, seasonal edema affects Google searches, and whether nirmatrelvir/ritonavir helps standard-risk patients with COVID-19, and patient-centered recommendations for inpatient care from SHM/Choosing Wisely! Time to fill your plate with a fresh stack of hotcakes! Drs. Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Nora Taranto (@NoraTaranto), and Matt Watto (@doctorwatto) catch us up on recent practice-changing articles and guidelines! Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, Picks of the Week Case from Kashlak; Definitions Tirzepatide for weight loss Pharmacogenomics for personalized antidepressants Seasonal Edema Nirmatrelvir/ritonavir for standard-risk COVID-19 Hospital Medicine Choosing Wisely recommendations Outro Credits Hosted and Written by: Nora Taranto MD; Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Matthew Watto MD, FACP Reviewer: Rahul Ganatral MD, MPH Technical Production: Pod Paste Sponsor: Medmastery Visit medmastery.com/curbsiders to claim a discount on any subscription.  Sponsor: Green Chef Go to GreenChef.com/curb135 and use curb135 to get $135 off across 5 boxes and your first box shipped free.  Sponsor: South California Permanente Medical Group Visit scpmgphysiciancareers.com or call (866) 449-1684 to apply to join SCPMG as an Outpatient Internal Medicine Physician.  The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. 

In this episode, Sharon R. Lewin, AO, FRACP, PhD, FAHMS, discusses:  Principles for antiviral agent use in nonhospitalized patientsPreferred and alternative treatment optionsTreatment prioritization when there are logistical or supply constraintsOutpatient remdesivir usePINETREE data (adult patients)CARAVAN data (pediatric patients)FDA approval and treatment candidacyTherapeutic updatesIvermectin and the TOGETHER studyMonoclonal antibody use during current omicron eraPresenter:  Sharon R. Lewin, AO, FRACP, PhD, FAHMSZDirector, The Peter Doherty Institute for Infection and ImmunityProfessor of Infectious DiseasesUniversity of MelbourneConsultant Infectious Diseases PhysicianAlfred Hospital and Royal Melbourne HospitalMelbourne, AustraliaReview the downloadable slideset at:https://bit.ly/3FXc90w 

We recap the top pearls from ACP #IM2022 including important drug interactions/intolerance (acetaminophen, tramadol, ticagrelor, nirmatrelvir-ritonavir), perioperative medicine (bridging, DOAC reversal agents, dental procedures, MINS), recognizing PMR, when to initiate urate-lowering therapy in gout, glucocorticoid-induced osteoporosis, food as medicine, dietary potassium, OSA, nocturia, telemedicine and health equity, a new obesity medicine paradigm, advances in HIV/PrEP, and rethinking atrial fibrillation!  Note: Due to a rapid turnaround there is no CME for this episode, but visit curbsiders.vcuhealth.org to claim credit for past episodes. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro Tapering long-term opioids Physician Wellbeing Common drug interactions (acetaminophen, ticagrelor, tramadol, Nirmatrelvir-ritonavir) Perioperative medicine (bridging, DOAC reversal agents, dental procedures, MINS) Nocturia and OSA Food as Medicine Rheumatology (how to diagnose PMR, when to initiate ULT for gout and steroid-induced osteoporosis) Avi's pearls on (diversity, telemedicine, telehealth, burnout) Obesity medicine (a new paradigm and a new medication) HIV in primary care (PrEP, long-acting injectable antiviral therapy) Atrial fibrillation Outro Credits Written, Produced, and Hosted by: Nora Taranto MD; Molly Heublein MD; Chris Chiu MD, FACP, FAAP; Avital O'Glasser MD, FACP; Alan Dow MD, FACP; Matthew Watto MD, FACP; Paul Williams MD, FACP   Show Notes: Matthew Watto MD, FACP Cover Art: Chris Chiu MD, FACP, FAAP Production team: Pod Paste Sponsor: Indeed Visit indeed.com/internalmedicine to claim you $75 credit now. Sponsor: Locumstory Visit Locumstory.com to learn more about locums

Antiviral agents continue to be effective against different strains of SARS-CoV-2 when used early in the disease course. In this episode, learn about the role of antiviral agents in hospitalized and high-risk nonhospitalized patients with COVID-19 and in different age groups. Listen as David A. Wohl, MD, discusses when and how to use IV and oral antiviral agents including:Nirmatrelvir + ritonavirRemdesivirMolnupiravirPresenter:David A. Wohl, MDProfessor of MedicineSchool of MedicineSite Leader, Global Infectious Diseases Clinical Trials UnitUniversity of North Carolina at Chapel HillChapel Hill, North CarolinaReview the downloadable slidesets at:https://bit.ly/3Ou4tbELink to full program: https://bit.ly/3EBdf38

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Nirmatrelvir/ritonavir (Paxlovid) reduces risk of hospitalization in at-risk outpatients (EPIC-HR) '

In this episode, Dr. Christopher Tookey and Dr. Rose Wolbrink talk about the two new pills for COVID; nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Veklery). We review who should think about these medications if they test postive for COVID.  A disclaimer, we're providing general guidance but everyone is different and you should always discuss with your health care professional management of any disease and therapy before trying anything you discover from a source on the internet (including this podcast). This podcast does not reflect the opinion of our employer. 

Ärzte können seit einer Woche die COVID-Arznei Paxlovid® verordnen. DEGAM-Präsident Scherer und Pfizer-Medizin-Direktor Kalanovic diskutieren im „EvidenzUpdate“, welche Patienten profitieren können.

Molnupiravir Nedir? Bir ribonükleozid olan beta-D-N4-hydroksi sitidinin (NHC) oral öncülü ilaçtır. Bu nükleozid RNA virüslerine karşı geniş antiviral aktiviteye sahiptir. NHC'nin viral RNA bağımlı RNA polimeraz tarafından hücre içine alınımı, viral mutasyonlara ve ölümcül mutageneze neden olmaktadır. Bu şekilde molnupiravir SARS-CoV-2' ye karşı potent antiviral aktivite göstermektedir. Mutajenik bir ribonükleozid olduğundan molnupiravirin insan konak hücreleri tarafından metabolize edilerek konak DNA'sına dahil olmak sureti ile mutasyonlara neden olması gibi teorik bir risk bulunmaktadır. Literatürde bu konuda yer alan iki in vivo mutajenisite çalışmasının sonucunda FDA (Food and Drug Administration) mevcut olan genotoksisite bilgileri ve tedavinin 5 günlük süreci dahilinde molnupiravirin genotoksisite açısından düşük risk taşıdığı sonucuna varmıştır (1). Bu risk aynı şekilde COVID-19 virüsünün kendisi için de mevcut olduğundan, bu ilacın kullanımı COVID-19 mutasyon oranlarında bir değişikliğe neden olabilir. Bu nedenle FDA üretici firmaya, COVID-19 varyantlarının ortaya çıkması açısından genomik veri tabanlarının takibini şart koşmaktadır. Peki ya Kullanım Onayı? 2021 yılı 22 ve 23 aralıkta FDA'in, yüksek riskli olan, hastaneye yatışı gerekli olmayan, hafif ve orta şiddetli COVID-19 hastalarında kullanılmak üzere acil kullanım onayı verdiği iki antiviral ajandan biri molnupiravirdir. Bu Onay Kimler İçin Geçerlidir? Molnupiravir: SARS-CoV-2 için doğrudan viral testi pozitif olan,Hastaneye yatış ve ölüm açısından, ağır COVID-19 klinik süreci gelişimi için yüksek riske sahip olan,FDA tarafından yetkilendirilen veya onaylanan alternatif COVID-19 tedavi seçeneklerine ulaşılamadığında veya bu seçenekler klinik olarak uygun olmadığında,Sadece hafif-orta şiddette COVID-19 kliniğine sahip erişkinlerin tedavisinde kullanılmalıdır. Molnupiravir Kimlerde Kullanılmamalıdır? Molnupiravir: 18 yaş altındaki hasta popülasyonu için: 18 yaş altındaki çocuklarda kullanımı ile ilgili veri bulunmamaktadır, bu nedenle bu yaş grubu çocuklarda olası kemik ve kartilaj gelişimi üzerine olası etkileri nedeni ile yetkilendirilmemektedir.COVID-19 nedeni ile hastane yatışı gereken hastalarda başlangıç tedavisi olarak ya da5 ardışık günden daha uzun süre kullanımı konusunda onaya sahip değildir. FDA Yüksek Riskli Hasta Grubunu Nasıl Tanımlamaktadır? Aşılanmayan,Aşılanan ancak çeşitli nedenlerle aşıya karşı yeterli bağışıklık yanıtı oluşturması beklenmeyen hastalar yüksek riskli olarak tanımlanmaktadır. Neden Molnupiravir? Güncel Literatür Ne Demektedir?             Çok uluslu Faz 3, randomize bir çalışma olan MOVe-OUT (2) çalışmasında, molnupiravirin 12 saatte bir 800 mg oral olarak 5 gün boyunca kullanımı plasebo ile karşılaştırılmıştır. Çalışmaya: Hastaneye yatışı gerekmeyen,Aşılı olmayan,Gebe olmayan,Hafif-orta şiddette COVID-19 enfeksiyonuna sahip,COVID-19 açısından ağır klinik progresyon için yüksek riske sahip olan veSemptom başlangıcının ilk 5 günü içinde olan hastalar dahil edilmiştir. Çalışmanın primer sonlanım noktası 29. gündeki mortalite ve tüm nedenlere bağlı hastane yatışları olarak belirlenmiştir (yatışlar 24 saatten uzun süren hastanede kalış olarak tanımlanmaktadır). MOVe-OUT Çalışması MOVe-OUT Çalışması MOVe-OUT çalışmasında molnupiravir, plasebo ile kıyaslandığında hastaneye yatış ve ölüm oranını %30 oranında azaltmıştır. Molnupiravir, NIH (National Institute of Health) Kılavuzu Önerileri Arasında Yer Almakta Mıdır? Hastaneye yatışı gerekmeyen hafif-orta şiddetli hastalık progresyonu açısından yüksek riske sahip  hastalar için NIH kılavuzları tercih sırasına göre aşağıdaki tedavileri önermektedir: Nirmatrelvir 300 mg+ ritonavir 100 mgSotrovimab 500 mgRemdesivir 200 mgMolnupiravir 800 mg Yukarıdaki diğer tedavi seçenekleri mevcut olmadığında molnupiravirin, 18 yaş ve üzeri erişkinlerde semptom başlangıcının ilk 5 günü içerisinde, mümkün olan en kısa sürede,

Dans cette 46e baladodiffusion, le Dr Luc Lanthier discute de l'efficacité du nirmatrelvir/ritonavir (Paxlovid), un nouvel agent antiviral, comme traitement des sujets ambulatoires avec COVID-19, en plus de réviser la littérature médicale de janvier 2022. Quiz clinique (4 min 32), étude principale (5 min 00), critique (24 min 59), autres articles (38 min 35), réponse … Continuer la lecture de « BC 046 – Efficacité du nirmatrelvir oral dans le traitement ambulatoire de la COVID-19 (étude EPIC-HR) »

Can an oral COVID-19 treatment prevent hospitalization and death in unvaccinated patients? Find out about this and more in today's PV Roundup podcast.

In COVID-19 clinical update #102, Daniel Griffin reviews children and COVID, effectiveness of maternal vaccination, vaccines for immunocompromised, primary care physicians and vaccination rates, booster safety among adults, placentitis, azithromycin, oral Nirmatrelvir, Omicron antibody evasion, EUA for bebtelovimab, IL-1 blocking agents, thromboprophylaxis, effectiveness of vaccines against long COVID, and risks of mental health outcomes. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Children and COVID state data (AAP) Effectiveness of maternal vaccination (MMWR) Vaccines for immunocompromised (CDC) PCP and vaccination rates (JAMA) Booster safety among adults (MMWR) Placental tissue destruction and placentitis (Arch Path Lab Med) Azithromycin meta-analysis (J Antimicrob Chemo) Oral Nirmatrelvir for high-risk, nonhospitalized adults (NEJM) Omicron antibody evasion (bioRxiv) EUA for bebtelovimab (FDA) IL-1 blocking agents (Cochrane) Thromboprophylaxis (Chest) Effectiveness of vaccines against long COVID (UK Health) COVID complications in Australia (Lancet) Risks of mental health outcomes (BMJ) Letters read on TWiV 868 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

In COVID-19 clinical update #102, Daniel Griffin reviews children and COVID, effectiveness of maternal vaccination, vaccines for immunocompromised, primary care physicians and vaccination rates, booster safety among adults, placentitis, azithromycin, oral Nirmatrelvir, Omicron antibody evasion, EUA for bebtelovimab, IL-1 blocking agents, thromboprophylaxis, effectiveness of vaccines against long COVID, and risks of mental health outcomes. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Children and COVID state data (AAP) Effectiveness of maternal vaccination (MMWR) Vaccines for immunocompromised (CDC) PCP and vaccination rates (JAMA) Booster safety among adults (MMWR) Placental tissue destruction and placentitis (Arch Path Lab Med) Azithromycin meta-analysis (J Antimicrob Chemo) Oral Nirmatrelvir for high-risk, nonhospitalized adults (NEJM) Omicron antibody evasion (bioRxiv) EUA for bebtelovimab (FDA) IL-1 blocking agents (Cochrane) Thromboprophylaxis (Chest) Effectiveness of vaccines against long COVID (UK Health) COVID complications in Australia (Lancet) Risks of mental health outcomes (BMJ) Letters read on TWiV 868 Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Episode 80: Oral Meds for COVID-19. The US department of human health and services recently launched the COVID19 Therapeutics Locator website to allow providers find locations where they can send prescriptions for Paxlovid and Molnupiravir. Find the COVID19 therapeutics locator online: https://arcg.is/iuuW50Yasmin and Arti discuss oral medications under emergency use authorization for COVID-19: Paxlovid and Molnupiravir. Introduction: Meds for COVID-19.  By Hector Arreaza, MD.  For the last 2 years, humanity has faced the challenge to find an effective way to fight COVID-19. This pressing charge has not been free of obstacles. It has been hindered by politics, misinformation, greed, jealousy, and many other not-so positive human traits. For me, living through the pandemic has been somewhat frustrating and shaming. Stupidity, vulgarity, and mediocrity are a few of the attributes that have flourished during the last 2 years all around us. But not everything about the pandemic has been negative. Many talented people with good intentions have engaged in serious research and have made tremendous contributions to science and humanity. Vaccines have been developed using cutting-edge technology and their efficacy has been very positive so far. Many medications have been tried to fight COVID-19 since the beginning. Some clinicians have tried to repurpose old medications in their honest desires to fight COVID-19. Examples include ACE inhibitors, statins, azithromycin, hydroxychloroquine, and chloroquine, which have not proven to be effective against this virus so far. Ivermectin, for example, has been very controversial since the beginning of the pandemic. Ivermectin is not approved by the FDA for the treatment of COVID-19. Until today, the National Institutes of Health do not have enough data to recommend for or against using ivermectin for COVID-19. “Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19.” Ivermectin is still being used by some clinicians in the United States based on personal experience and opinions.At this time, remdesivir (brand name Veklury®) is the only medication approved by the FDA to treat COVID-19. IV remdesivir won full FDA approval in October 2020 for hospitalized patients, and its use has been expanded a couple days ago to include use in non-hospitalized high-risk patients. The NIH recommends against IL-6 inhibitors, such as tocilizumab or sarilumab, in COVID-19 patients who are not in the ICU. At this moment, there is not enough data for the NIH to make a recommendation for patients who are in the ICU. Baricitinib is an oral medication used to treat rheumatoid arthritis authorized in November 2020 to be used in combination with remdesivir for the treatment of COVID-19 in certain hospitalized children and adults who require supplemental oxygen, mechanical ventilation, or Extracorporeal membrane oxygenation (ECMO). Baricitinib is now authorized to be used without remdesivir against COVID-19 in hospitalized patients. We cannot forget the use of dexamethasone in hospitalized patients requiring oxygen.Today we want to give you a little taste of two oral medications: Paxlovid® and molnupiravir. You will listen to two brave medical students presenting what they have found about these medications. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. Paxlovid®.   By Yasmin Fazli, MS3, Ross University School of Medicine.  What is it?Paxlovid® is the first oral treatment for mild-to-moderate coronavirus disease (COVID-19) in patients over 12 years-old to be issued by the FDA. The FDA issued an emergency use authorization (EUA) on December 22, 2021. It is made up of two different medications: nirmatrelvir and ritonavir. Nirmatrelvir is a protease inhibitor while ritonavir helps decrease the breakdown of nirmatrelvir.  The combination authorized is nirmatrelvir 300 mg plus ritonavir 100 mg. You may remember ritonavir use in combination with other antiretrovirals for the treatment of HIV/AIDS. At the end of the 2021, Pfizer announced that results from a trial comparing between Paxlovid® versus a placebo revealed that Paxlovid® reduced proportion of mortality and morbidity by 88% compared to placebo after a 5-day course. When and how to prescribe it?To use Paxlovid® some criteria must be met by the patient. First, a positive result of COVID-19 viral testing, second, the patient must be at high risk for illness progression to a more severe state, including hospitalization and death; and third, the patient must be 12 years or older.  Paxlovid® should be started as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. It is to be taken by mouth 2 times a day for 5 days straight with or without food. You take 3 pills twice a day. It is not authorized for more than 5 days.  It is not authorized for the pre-exposure or post-exposure prevention of COVID-19. It's not meant to be a replacement for the vaccine.  Side effects?Possible side effects of Paxlovid® include dysgeusia (altered or impaired sense of taste), diarrhea, increased blood pressure, and myalgia (muscle aches). Nirmatrelvir and ritonavir, which comprise Paxlovid®, also interact with other medications, which may lead to serious or life-threatening adverse reactions.  It's contraindicated in patients taking medications that are dependent on CYP3A metabolism for clearance, for example, warfarin, amiodarone, clozapine, midazolam, sildenafil (for pulmonary hypertension), etc. A list of these medications has been reviewed by the FDA and you can find it online.  Liver problems have occurred in patients receiving ritonavir. Therefore, caution should be exercised when administering Paxlovid® to patients with pre-existing liver diseases, liver enzyme abnormalities, or hepatitis. Furthermore, Paxlovid® is not recommended for patients with severe kidney problems, and if they do use it, the dose should be adjusted.Because nirmatrelvir is co-administered with ritonavir, there may be a risk of HIV-1 developing resistance to HIV protease inhibitors in individuals with uncontrolled or undiagnosed HIV-1 infection. As for pregnancy or lactation, there currently is no data available for it to understand any potential effects on miscarriages, birth defects, or maternal and fetal outcomes. Considering all of this, please review your patients' list of medications and supplements and medical history prior to initiating Paxlovid®.Concerns?Due to its limited clinical data availability, other adverse effects that have not been reported may also occur while using Paxlovid® on top of the side effect list we are aware of. Ritonavir is a well-known medication, but nirmatrelvir is brand new.  Another concern is its limited availability. So even though it has shown positive results, it is not widely available yet, which leads to having to prioritize certain populations such as the unvaccinated patients. This may prove to be a moral and ethical concern.  Effectiveness?There is no long-term data on Paxlovid® yet; however, from what we do know, it is proving to be effective more than placebo by almost 90% which shows much promise. It works against current or previous variants of COVID-19.  EPIC-HR is the randomized, double-blind, 2-arm study done to prove Paxlovid®. It included 2246 patients with laboratory-confirmed SARS-CoV-2 infection, mild to moderate symptoms, and at least one comorbidity with increased risk of developing severe illness from COVID-19. Patients were randomly assigned 1:1 to receive either Paxlovid or placebo orally every 12 hours for 5 days. Results: Paxlovid significantly reduced the risk of COVID-19-related hospitalization or death from any cause by 89% (within 3 days of symptom onset) compared with placebo. Through day 28, 0.7% (5/697) of patients in the Paxlovid® arm were hospitalized compared with 6.5% (44/682) of those in the placebo arm. The study also showed that nobody died taking Paxlovid® while 12 people died taking placebo. These are promising results and Pfizer will be announcing more information on the effectiveness as time passes by.  Pricing?The original pricing was announced to be $530.00; however, it's been added that it'll be at no cost to the people in the United States.  Molnupiravir.   By Arti Patel, MS3, Ross University School of Medicine.  1. What is molnupiravir? Molnupiravir is an antiviral medication that can be used to treat COVID-19. Molnupiravir is a nucleoside analog that inhibits viral replication. The active drug of molnupiravir (N-hydroxycytidine) tricks the RNA polymerase enzyme into incorporating the drug instead of uridine or cytidine. Nucleobases continue to get added to the RNA chain and eventually the new RNA molecule has accumulated enough errors that the virus cannot replicate further.    2. When and how to prescribe it? Molnupiravir is available for Emergency Use Authorization for “mild to moderate COVID-19 disease in adults with positive results of direct viral testing who are at risk of developing severe COVID-19, including hospitalization or death or those in whom alternative COVID-19 treatment options approved by the FDA are not accessible or clinically appropriate.”  FDA provided EUA status on December 23, 2021. It should be taken as soon as COVID-19 is diagnosed, and within 5 days of symptom onset. It is not to be used as a method to prevent COVID-19 disease. Not for prophylaxis.  Benefits of treatment have not been seen after hospitalization, so administration of molnupiravir in patients hospitalized due to COVID-19 is not recommended. Adults above the age of 18 should take 800 mg orally every 12 hours for 5 days, with or without food. Use for longer than 5 days has not been studied.  3. Side effects? Most common adverse effects are diarrhea, nausea, and vomiting.  4. Concerns? Pediatric patients: Molnupiravir may not be used in patients under the age of 18 due to effects on bone and cartilage growth. Studies in rats with repeated doses of molnupiravir showed bone and cartilage toxicity.  Pregnancy: Fetal toxicity was observed when given to pregnant individuals in animal reproduction studies. Risk of adverse maternal or fetal outcomes or birth defects have not been studied in humans as of now. Use of molnupiravir in pregnant individuals may be considered once the prescribing physician has assessed the potential risks and benefits. Prior to initiating treatment of molnupiravir, if clinically indicated, assess whether a patient is pregnant. If a patient is having irregular menstrual cycles, first day last menstrual period is unknown, or patient is not using an effective method of contraception, a pregnancy test is advised.  Females of childbearing age are advised to use an effective method of contraception while under treatment of molnupiravir and for 4 days after the final dose. Effects of molnupiravir on sperm are not known, thus effective contraception must be used while under treatment of molnupiravir and for 3 months after the last dose.  Additionally, breastfeeding is not recommended during treatment and for 4 days after the last dose.  5. Effectiveness? Although molnupiravir is not substitute in patients for whom COVID-19 vaccination and booster are recommended, it can be used for treatment of non-hospitalized patients with COVID-19 who have a high risk of progression to severe disease.  In, MOVe-OUT, a randomized, double-blind, placebo-controlled clinical trial, almost 7% of about 700 individuals who received molnupiravir were hospitalized compared to almost 10% of 700 individuals who received the placebo. During the follow up period, one person who received molnupiravir died compared to 9 people who received the placebo. The safety and effectiveness of molnupiravir continues to be studied.  Availability and pricing?Not available in pharmacies yet, and preliminary pricing for a 5-day course of molnupiravir was about $700. Conclusion of episode:Now we conclude our episode number 80 “Oral Meds for COVID-19.” We hope you got enough information about these two medications: Pax-lovid and Mol-nu-pira-vir. Remember that they are authorized (not approved yet) by the FDA for the treatment of COVID-19. They are both oral medications, taken twice a day for 5 days. Their use in pregnant patients is not recommended yet. Paxlovid can be used in patients older than 12 years old, and molnupiravir in patients older than 18 years old. We'll keep learning together about these medications in the future. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Arti Patel and Yasmin Fazli. Audio edition: Suraj Amrutia. See you next week! _____________________References:F.D.A. Approves Remdesivir for Patients Not Hospitalized, The New York Times, nytimes.com, January, 21, 2022, https://www.nytimes.com/2022/01/21/world/remdesivir-fda-approval-expanded-covid.html. “Frequently Asked Questions on the Emergency Use Authorization for Paxlovid for Treatment of COVID-19”, U.S. Food and Drug, December 22, 2021, https://www.fda.gov/media/155052/download. Accessed on Jan 24, 2022. “Pfizer Receives U.S. FDA Emergency Use Authorization for Novel COVID-19 Oral Antiviral Treatment,” pfizer.com, December 22, 2021. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-receives-us-fda-emergency-use-authorization-novel.  Ahmad, B., Batool, M., Ain, Q. U., Kim, M. S., & Choi, S. (2021). Exploring the Binding Mechanism of PF-07321332 SARS-CoV-2 Protease Inhibitor through Molecular Dynamics and Binding Free Energy Simulations. International journal of molecular sciences, 22(17), 9124. https://doi.org/10.3390/ijms22179124 Coronavirus (COVID-19) Update: FDA Authorizes Additional Oral Antiviral for Treatment of COVID-19 in Certain Adults, fda.gov, December 23, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-oral-antiviral-treatment-covid-19-certain. Accessed on January 24, 2022. Fact Sheet for Healthcare Providers: Emergency Use Authorization for Molnupiravir, fad.gov, December 23, 2021, https://www.fda.gov/media/155054/download, accessed on January 24, 2022. 

Quadro resumo dos ensaios clínicos - Link EPIC-HR Trial - Link

The SARS-CoV-2 omicron variant has affected which of our COVID-19 treatment strategies are currently effective, with some expected to maintain their efficacy and some expected to lose their efficacy. In this episode, Arthur Kim, MD, discusses the effects of the SARS-CoV-2 omicron variant on many of the COVID-19 approved, authorized, and investigational treatment options, including:Direct-acting, small-molecule antiviral agents such as   molnupiravir, nirmatrelvir + ritonavir, and remdesivirMonoclonal antibody treatments such as bamlanivimab + etesevimab, casirivimab + imdevimab, cilgavimab + tixagevimab, regdanvimab, and sotrovimabPresenter:Arthur Kim, MDAssociate ProfessorDepartment of MedicineHarvard Medical SchoolDirector, Viral Hepatitis ClinicDivision of Infectious DiseasesMassachusetts General HospitalBoston, MassachusettsReview the downloadable slidesets at:https://bit.ly/3FXc90whttps://bit.ly/32tp2BTLink to full program: https://bit.ly/3Ix8uZg

Here are the links for everything discussed in Episode 74. Times are also below so feel free to skip around and get to the updates that interest you.  (1:12) New EUA issued for Pfizers Paxlovid, and new COVID antiviral treatment (7:25) FDA makes several update to Pfizers COVID vaccine EUA CDC website for COVID information - get boosted!Connect with The Rx Daily Dose:Twitter      Instagram      YouTube      Linkedin       WebsiteEmail: therxdailydose@gmail.comConnect with Ian Parnigoni PharmD. on social media:Twitter       Instagram       Linkedin  ★ Support this podcast on Patreon ★

Looking at the new Covid treatment Paxlovid (nirmatrelvir + ritonavir), how does it work and can we work out summary statistics? Then, can we compare them to the ones we worked out for molnupiravir last time? What are the problems with this approach, and why do we need to be cautious comparing outcomes between different trials? (Note: at the time of recording, there wasn't much guidance on how to pronounce nirmatrelvir, so I've gone for NIR-ma-TREL-vir rather than NIR-MAT-rel-vir or any other version. It's a best guess, so sorry if I've gone for the protease inhibitor version of CLO-pi-DOG-rel. Only time will tell)

In this episode, Renslow Sherer, MD, discusses key data on COVID-19 oral antiviral agents—molnupiravir and nirmatrelvir (PF-07321332) plus ritonavir—for nonhospitalized adults with mild to moderate COVID-19, including:EPIC-HR study of nirmatrelvir (PF-07321332) plus ritonavirSafety dataEfficacy dataMOVe-OUT study of molnupiravirSafety dataEfficacy dataRoles in treatment of COVID-19Timing of treatmentPresenter:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisReview the downloadable slideset at:https://bit.ly/31wi1QiLink to full program:https://bit.ly/3EH2485

Overview: In this podcast, Dr. Christopher Crnich has an insightful conversation with Dr. Monica Mahoney and Dr. Jason Pogue around outpatient COVID-19 oral treatments and other therapeutics. They discuss monoclonal antibodies, including the current treatments and what is to potentially come, recently released Molnupiravir and Nirmatrelvir, and the impacts, challenges, and best practices around administering these to patients. Speakers: Christopher Crnich, MD, PhD (moderator) Monica Mahoney, PharmD, BCPS, BCIDP, FCCP Jason Pogue, PharmD, BCPS, BCIDP What do you think of our podcasts? Do you have topic or speaker suggestions? Let us know at https://learningce.shea-online.org/content/shea-podcast-feedback