Clinical medicine (London, England)
-
Here, we advocate a highly favourable opportunity for the treatment of COVID-19 disease by repurposing a long-serving medical agent with an excellent history of clinical use, namely heparin. Heparin is best known as an anticoagulant, but it also exhibits direct antiviral activity against many enveloped viruses and has anti-inflammatory activity. The high incidence of thromboembolic events in COVID-19 patients suggests that coagulopathy plays an important role in the SARS-CoV-2 pathogenesis. ⋯ We demonstrate here in vitro that heparin does indeed inhibit SARS-CoV-2 infection. The three concurrent modes of activity of heparin (antiviral, anticoagulant and anti-inflammatory) against SARS-CoV-2/COVID-19 form a unique therapeutic combination. Thus, repurposing of heparin to fight SARS-CoV-2 and COVID-19 appears to be a powerful, readily available measure to address the current pandemic.
-
Observational Study
How COVID-19 has changed the unselected medical take: an observational study.
COVID-19 has had a profound effect on the NHS. Little information has been published as to how the unselected medical take has been affected. ⋯ COVID-19 patients had worse clinical outcomes and increased healthcare use compared to non-COVID-19 patients. Our study highlights some of the challenges in healthcare provision faced during this pandemic.
-
The clinical spectrum of rheumatoid arthritis (RA) presentation is heterogeneous, with wide variation in age of onset, degree of joint involvement and severity. Delayed rheumatological referral is associated with less favourable long-term outcomes. ⋯ Pharmacological treatment of early RA aims to optimally suppress the inflammatory component of the disease with an ideal treatment target of remission. The overarching aim of management of early RA is to achieve a quality of life that permits the individual to pursue normal work, domestic and social activity.
-
Primary systemic vasculitides (PSV) are multisystem diseases associated with high morbidity and mortality, particularly if not treated in a timely manner. In recent decades, clinical trials have delivered considerable evidence to underpin optimal diagnostic and therapeutic approaches. This article provides a brief overview of PSV in adults, focusing on the latest updates and recommendations for the management of antineutrophil cytoplasmic antibody-associated vasculitis and giant cell arteritis.
-
Observational Study
Coronavirus in the elderly: a late lockdown UK cohort.
To identify the source of ongoing coronavirus disease 2019 (COVID-19) infections after 4 weeks of lockdown and to characterise the presentation of COVID-19 in the elderly, who represent the highest risk group. ⋯ COVID-19 can present differently in the elderly, overlapping with many common presentations, so focusing testing on those with a cough or fever will miss at least 1 in 3 cases in those over the age of 70. A high degree of vigilance, suspicion and repeated testing is required if streaming into high and low risk areas is to succeed, allowing safe restarting of services such as elective surgery and cancer care.