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Featured Posts

Do media reports on the COVID-19 crisis accurately reflect your experience in your home country?

Dear physicians, 

From media outlets and social media, we are all overwhelmed with reports and news about the coronavirus crisis around the world. 

Do media reports accurately reflect your experience in your home country? 

COVID-19 Medical Societies Recommendations on Biologic use

Read the main recommendations of the major global Rheumatology & Dermatologic societiesץ

See file attached

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  •  · G-Med Desk
  •  · 1032 views

Mechanical ventilation survival rate in COVID-19: What's the scenario in your country?

What percentage of COVID-19 patients in mechanical ventilation in the ICU survived?
What are you seeing in your own country?
What are the measures being taken to increase survival rate?

Top COVID-19 Discussions: Case reports

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  •  · G-Med Desk
  •  · 33052 views

Top COVID-19 Discussions: Medication Recommendation

Top COVID-19 Discussions: Best Practices and General Questions

COVID-19 Mechanism hypotheses- What do you think?

Recent physicians’ posts in this group suggested different hypotheses for the mechanism of the COVID-19:

  • The  infected patients are, in fact, suffering from carbon monoxide poisoning, given that the virus could have been leading to endogenous carbon monoxide production. (You can read the post here: https://www.g-med.com/page/view-post?id=67735)
  • Another hypothesis concerns the idea that the virus could be destroying hemoglobin, given the low oxygen levels and high levels of ferritin in infected patients. (Read the post and comments here: https://www.g-med.com/page/view-post?id=67439)

What’s your opinion about it? 

G-Med Survey: more than 80% of COVID-19 infected patients in the U.S. died after mechanical ventilation, 40% worldwide


Results from the last survey you took part in here on G-Med showed that more than 80% of COVID-19 infected patients in the U.S. died after mechanical ventilation while the rate worldwide was 40%.

Using crowdsourcing tools while maintaining the anonymity of your response, G-Med’s findings support those of research being published on the issue during the last days, showing the importance of your participation in these discussions.

Here are more relevant results obtained from our analysis: 93% of your colleagues on G-Med claimed that the mortality rate of patients who had been submitted to mechanical ventilation was higher than 40%, while 10% claimed to have observed that 95% of the patients succumbed to the disease after being under mechanical ventilation. 

Countries such as France, Spain, Belgium reported a survival rate of 60%, while most physicians from the United States reported 20% survival rate. In other words, most of US physicians in the survey claimed that 80% of the patients who were submitted to mechanical ventilation succumbed. 

The results of this survey are also presented in an interactive dashboard powered by Sisense, making data/insights available to you and our medical community. (You can find the full results in the following link: https://www.clkmg.com/G-Med/1zhaey)

We would like to emphasize the importance of your participation in the discussion and to invite you to post other pertinent surveys and questions of your interest. 

Best regards from the G-Med Team

Do you think COVID-19 will have an impact on the public’s mindset toward vaccination?

Are you planning to attend your society’s physical conferences?

Coronavirus Second Wave: Which resource is most essential?

Are you prepared for another outbreak? What did/didn't work during the first wave?

Coronavirus Second Wave: What would be the best policy to prevent/control it?

Is your government prepared for another outbreak? What did/didn't work during the first wave?

What contributes to your feelings of burnout as you face the second wave of COVID-19?

Telemedicine and virtual consultation: What's your experience?

Segunda Onda do Coronavírus: Qual recurso é o mais essencial para enfrentar o próximo surto?

Você está preparado para outro surto? O que funcionou / não funcionou durante a primeira onda?


Segunda ola de coronavirus: ¿Qué recurso es más esencial para hacer frente al próximo brote?

¿Está preparado para otro brote? ¿Qué funcionó / no funcionó durante la primera ola?

Deuxième vague de coronavirus: quelle ressource est la plus essentielle pour faire face à la prochaine épidémie?

Êtes-vous prêt pour une autre épidémie? Qu'est-ce qui a / n'a pas fonctionné pendant la première vague?

Seconda ondata di coronavirus: quale risorsa è più essenziale per affrontare un altro focolaio?

Lei è pronto per un altro focolaio? Cosa ha funzionato / non ha funzionato durante la prima ondata?

What is the key point of consideration concerning mRNA vaccines in this stage?

Qu'est-ce qui contribue à vos sentiments d'épuisement lorsque vous faites face à la deuxième vague de COVID-19?

Cosa contribuisce ai vostri sentimenti di burnout mentre affronti la seconda ondata di COVID-19?

Qual è il punto chiave da considerare riguardo ai vaccini a mRNA in questa fase?

Quel est le point clé à considérer concernant les vaccins ARNm à ce stade?

The opioid epidemic: Who is responsible for the opioid crisis?

If it's possible to pinpoint the main players, who in your opinion hold the main responsibility for the opioid crisis in the United States?

Neglected dermatological infection with atypical presentation

A 35-year-old African male refugee from Eritrea complained of a soft and slightly painful tissue swelling in his right buttock, localized on a previous scar. He mentioned that in 2001 in Eritrea he submitted to surgery several times for recurrent abscess on his right buttock. He was otherwise in good health, had no tobacco smoking or drinking habits, and no regular treatment.

On physical examination, he had a visible scar approximately 20 cm on the lateral side of his right buttock. On the medial level, the presence of deep indurated exophytic nodules with some visible openings and spontaneous drainage were noted, which suggested an abscess. He was afebrile and no lymphadenopathy was found.

A punch biopsy was performed and during that procedure a sanguinolent discharge was witnessed with conglomerates of small and rather firm blackish pellets. Tissue and black grain samples were sent for biological and histological evaluation. These revealed chronic suppurative inflammation in the presence of histologic fungal aspects. The infectious agent could not be determined exactly at that time; however, there were black colored grains.

To determine the precise depth of the buttock lesions, a magnetic resonance imaging examination of his pelvic area was performed. This examination identified a pseudotumoral infiltration of the cutaneous and subcutaneous tissue into the gluteal muscular plane of the paramedian part of his left buttock compatible with a mycetoma without bone extension.

What is the causative organism and how could the condition be managed? 

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Severe chest pain and dysnea?

43-year-old woman with no known history of CAD was presented to our hospital’s cardiology clinic with a six-hour history of severe central chest pain and dyspnea.
She does not have any known traditional CAD risk factors, arrhythmias, and was haemodynamically relatively stable at the time of admission.
Cardiac auscultation revealed a grade 2-3/6 systolic murmur that was the loudest at the apex (fifth left intercostal space, midclavicular line). Lungs were clear to auscultation.
Electrocardiography demonstrated sinus tachycardia (105/beats/minute) and ST-segment depression of approximately 3 mm in leads V1 to V6.
Her cardiac markers were elevated (troponin I: 14.6 ng/L; normal range: 0.0–0.01 ng/L and creatinine kinase-MB mass: 53.9 ng/mL; normal range: 0.0–3.6 ng/mL)
What's the diagnose? Thank you. 


A case of persistent post-herpetic pain not responsive to ordinary analgesics

Female patient, 64 year old, history of depression, migraine, gastroesophageal reflux disease, carpal tunnel syndrome and benign breast mass removal initially presented with right facial pain following a V1 trigeminal herpes zoster eruption approximately 4 weeks earlier. The acute infection was complicated by an anterior uveitis and altered mental status associated with an abnormal MRI, specifically high T2 signal in bilateral superficial occipital lobes. Although cerebrospinal fluid was normal, the patient was treated with high dose IV acyclovir for 10 days for a suspected herpes zoster encephalitis. She rapidly improved, clinically and radiographically, and was switched to oral valacyclovir for a brief additional period.

Pain persisted after the acute infection resolved. Trials of an opioid, pregabalin, and a combination product containing butalbital, acetaminophen, and caffeine were ineffective. At the time of presentation to the pain practice, the patient complained of continuous severe pain in the right upper cheek, eye, and forehead, with radiation to the right temporal region. 

The pain was described as a constant burning with intermittent electrical shock-like painful sensations occurring approximately every 10 min, each lasting several seconds. The burning pain was rated as an 8/10 on an 11-point verbal numerical pain rating scale. The affected area was sensitive to touch, heat (e.g., when washing hair with hot water), and combing hair. The patient had difficulty with opening her right eye. The pain greatly interfered with her ability to function and she was very dysphoric.

On the initial examination, the skin was discolored and erythematous in the right V1 distribution. The affected area demonstrated hyperalgesia and allodynia. Otherwise, the neurological examination was normal.

Management suggestions for this case?

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A pregnant woman - fever and a bleeding tendency - next steps?

Gravida 1,31 weeks, 26 years, complaints of epigastric pain, bleeding per gum and petechiae hemorrhage for 1 day; high-grade fever for 5 days prior to admission, first seen at antenatal clinic (12 weeks pregnancy), no abnormality detected. Nothing history. 37°c, bp110/80 mmHg, pulse 80/mim and respiratory rate 20/min. Mild dehydration. Liver enlarged 1 cm below the right costal margin with mild tenderness. Fundal height - 31 weeks' gestation, fetal heart rate 144 beats/min, Petechiae1–2 mm d. found on face, forearms and both pretibial areas.

Labs: hgb 11.9 g/dl, hematocrit 35%, white blood cells 7,440/mm3 50% neutrophil, 45% lymphocytes; 3% atypical lymphocytes; platelet 10,100 /mm3. Intravenous fluid replacement, under close observation bleeding precaution. After 24h, epigastric pain disappeared, vital signs normal. Hematocrit 30% , platelet  6,320 /mm3. Day 3, gradually recovered and had an itching convalescent rash on both pretibial areas. Hematocrit 31%, platelet 15,000 /mm3. She was discharged day 4. After 1 week, she was healthy and hematocrit 32% with platelet 354,000 /mm3. After that, she had an uneventful antenatal care. At the 39 weeks' gestation, she delivered a healthy female baby weighing 2,630 grams by vaginal route with APGAR scores 9 and 10 at 1 and 5 minutes, respectively. No abnormality in newborn was detected.

Most likely diagnosis of this condition?


A known case of SLE presented with complaints of pain, restriction of movements and difficulty to bear weight on left hip, how can you proceed?

A 40-year-old male patient was admitted to the orthopedic ward with chief complaints of pain, restriction of movements, and difficulty to bear weight on the left hip. The patient was a known case of SLE and on treatment with prednisolone 40 mg twice daily over the previous 6 years. In addition, he also had complaints of rashes over the trunk and pain in small joints of both hands for 2 months. The patient did not report any episode of fever over the preceding months. There was no history of trauma, prior surgery, or abdominal discomfort.

Tenderness in left hip and the movements were painfully restricted. 

Haemoglobin 9.8 gm%, white blood cell  13,180 cells/cu.mm with neutrophilic leukocytosis. Peripheral smear: microcytic normochromic anemia. Pus aspirated from the hip joint was inoculated in brain heart infusion broth, nutrient agar, 5% sheep blood agar, and MacConkey agar and incubated for 24 hours at 37°C.The gram stained smear of the pus showed plenty of polymorphonuclear leucocytes and gram negative bacilli. 

The culture yielded nonlactose fermenting colonies which was confirmed as Salmonella typhi by biochemical methods and serological typing. It was susceptible to ampicillin, trimethoprim-sulphamethoxazole, chloramphenicol, ciprofloxacin, cefotaxime, and ceftriaxone and resistant to nalidixic acid by disc diffusion method. The blood culture was found to be sterile. 

Fecal culture done on 3 consecutive days to detect carrier state or subclinical infection was negative. The radiograph and the magnetic resonance imaging of the left hip showed evidence of avascular necrosis of the neck of femur.

What are your thoughts on it? I appreciate it in advance

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Intacerebral haemorrhage vs. ischemic stroke; what do you suspect in this patient?


A 38-year-old male presented with a sudden onset of weakness of the left limb that lasted for four hours as well as a mild generalized headache with no alarming symptoms. He had been diagnosed with essential hypertension one year prior to presentation and was being treated with 25 mg of hydrochlorothiazide and was fairly controlled on that. 

Click here to see the discussion on the first part of the case (9 comments) 

Plain computed tomography of the brain showed intra-cerebral hemorrhage. After a neurosurgical assessment, he was deemed suitable for non-operative conservative management, and he was admitted to the intensive care unit and treated with intravenous labetalol. No further neurological deficit developed, and he was shifted to the general medical ward after 36 hours of monitoring in the ICU.On further questioning, he complained of joints pain, mainly involving the metacarpophalangeal and proximal interphalangeal joints and wrists bilaterally, which started six months prior and had worsened over three weeks prior to admission. He also reported shoulder and knee arthralgia. He reported aching and stiffening of his hands, wrists, and shoulder joints that would be partially relieved after taking a hot shower. He had sought medical attention for the joint symptoms and was given nonsteroidal anti-inflammatory drugs, with no definitive diagnosis or indication for further evaluation and follow-up in the clinic.

What is the final diagnosis?

A 17 year old male presented painless paratesticular mass on routine examination

A 17-year-old male was referred for urologic evaluation of a right paratesticular mass noted on routine physical examination by his pediatrician. The patient had a history of congenital adrenal hyperplasia, treated with dexamethasone. He had not noticed any scrotal masses and denied any scrotal pain, swelling, or discomfort. The patient denied any history of dysuria, hematuria, urinary tract infection, or sexually transmitted diseases. No history of trauma, fevers, or any other constitutional symptoms was elicited.

Physical examination revealed Tanner stage 5 genitalia with a circumcised phallus and normal urethral meatus. Both testes were descended and were symmetric and nontender, with no intratesticular masses.
A nontender, firm 0.8 cm mobile mass was palpated superior to the right testicle and was noted to be completely separate from the testis. Scrotal examination was otherwise normal. The patient had no inguinal lymphadenopathy bilaterally, and his abdominal examination was normal.

Scrotal sonography confirmed a 0.7 × 0.8 × 0.6 cm hypoechoic, vascular, slightly heterogeneous lesion superior to the right testicle. The testes and epididymides were normal bilaterally. Quantitative serum beta-human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase were within normal limits.

What is your differential diagnosis? 

I appreciate your insights.

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Complaints of lumbago and diffuse arthralgia: What diagnosis do you suggest?

Our patient is a 37-year-old gentleman without significant past medical history who initially presented to his primary care physician with complaints of lumbago and diffuse arthralgias.
An X-ray of his L spine was concerning for decreased bone mass and a DEXA scan was notable for a -score of −3.6.Intact neurologic function.
Secondary workup was significant for normal renal and liver function. Celiac disease, multiple myeloma, and glucocorticoid excess were excluded with tissue transglutaminase and anti-endomysial antibodies, SPEP/UPEP, and 24-hour urine cortisol and dexamethasone suppression test, respectively. Normal thyroid function.
Calcium and phosphorus were normal, vitamin D deficient (25-OH-Vitamin D level was 20.7 ng/mL). His prolactin was elevated to 974 ng/mL (normal 2–17), with low FSH and low-normal LH and testosterone. We did an MRI of the brain that illustrated a pituitary macroadenoma measuring up to 3.2 cm with extension into the sphenoid sinuses and mild superior mass effect upon the optic nerves. Formal ophthalmologic examination revealed normal visual fields.

How to proceed?

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Why did symptoms of parathyroid crisis appear after prescribing Vitamin D replacement to a depressed patient?

A 55 year old lady had history of depression and acid peptic disease for last eight years. Her serum calcium was 11.4 mg/dL (8.6-10.2) eight months ago, but she was never worked up. She complained of generalized body aches, lethargy and worsening epigastric discomfort for last three months. Her Vitamin D level was found to be <4.0 ng/mL. Her general practitioner prescribed her two injections of Vitamin D3 600,000 I.U. IM over a period of two weeks.

Few days after receiving last Vitamin D3 injection, she developed increased thirst, increased urinary frequency, reduced appetite, severe nausea, vomiting and constipation. She presented with these complains to our emergency department. On examination, she was awake, alert and oriented, but she was dehydrated. A 3 x 3 cm, firm, non-tender, smooth mass was felt at the lower pole of left lobe of thyroid gland. 

Her serum calcium was 22.0 mg/dL (8.6-10.2), phosphorus was 2.6 mg/dL (2.5-4.5), albumin was 2.7 g/dL (3.2-5.5), and corrected calcium was 23.0 mg/dL. She had high BUN of 26 mg/dL (6–20), high serum creatinine of 1.4 mg/dL (0.6-1.1), and low serum potassium of 2.9 mmol/L (3.5-5.1). Vitamin D was 119 ng/mL (Vitamin D sufficiency: >30, Vitamin D intoxication >150), Intact PTH (Parathyroid Hormone) level was 1182 pg/mL (16–87) and TSH was 0.88 uIU/mL (0.5-8.9). Serum potassium remained <3.5 mmol/L (3.5-5.1) during hospital stay, despite being replaced time and again. Her 24-hour urinary calcium was 397 mg (100–300) at corrected serum calcium of 13.94 mg/dL (8.6-10.2); and her 24-hour urinary potassium was 18 mmol (26–123) at serum potassium of 2.6 mmol/L (3.5-5.1). Her symptoms, together with very high serum calcium, high BUN and creatinine, suggested that she was in parathyroid crisis. She was initially medically managed with intravenous fluids, intravenous Pamidronate and intramuscular Calcitonin.

In view of the above, what is the probable diagnosis?

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Reason for constant left lower abdominal pain in pregnant woman? A Summary

34 year old, woman, gravida 3, para 2, at 28 weeks gestation complains of constant left lower abdominal pain, cramping that had been radiating to her left flank for 2 days. It happened after changing the position. She also had nausea and vomiting.

Read the first part of the case here (16 comments, 516 votes)

Laparotomy was performed for the diagnosis of the twisted left ovarian cyst. A gangrenous, 6 × 6cm paratubal cystic mass was found during the exploration. The cystic mass and the distal two third of the left fallopian tube had twisted 3 times around themselves. The most presenting symptom is sudden and cramp-like pain, which begins in the affected lower abdomen or pelvis but may radiate to the flank or thigh. Also: nausea, vomiting, bowel and bladder complaints, and scant uterine bleeding. 

Pelvic examination revealed a tender, tense adnexal mass associated with cervical tenderness.  The ultrasonographic appearance includes an elongated, convoluted cystic mass, tapering as it nears the uterine cornu and demonstration of the ipsilateral ovary. We performed Laparotomy because of the enlarged 28-week uterus-- and Salpingectomy for the gangrenous fallopian tube.

A 73 year old female presented with epigastric and right hypochondrium pain

A 73-year-old female patient, presented in the emergency room for recent onset of epigastric and right hypochondrium pain associated with nausea, vomiting, dark urine, grey feces, and scleroskin jaundice.

Blood tests showed:
Serum total bilirubin 10.23 mg/dL, Direct bilirubin 8.62 mg/dL, Alanine transaminase (ALT) 190 U/L, Aspartate transaminase (AST) 64 U/L, Glutamyltransferase (GGT) 299 U/L, Lactate dehydrogenase (LDH) 334 U/L, and Alkaline phosphatase (ALP) 367 U/L.

Abdominal ultrasound showed a gallbladder with thick walls, one large gallstone (50 mm) entrapped into the Hartmann pouch and compressing the common hepatic duct which was dilated (8 mm) in its extrahepatic tract above the level of the obstruction and not sonographically observable under the level of obstruction. Intrahepatic biliary ducts were dilated. Neither pancreatic nodules nor Wirsung dilatation was seen.

An abdominal computed tomography was then performed and confirmed the ultrasound findings, furthermore excluding malignancy in the porta hepatis area, in the liver and in the pancreas.

Magnetic resonance cholangiography (MRC) showed presence of one large stone (45 mm) in a gallbladder with thick walls and one smaller stone (12 mm) in the cystic duct with a fistula involving the common bile duct which was dilated above the fistula level and normal below.

What would you say it is the diagnose in this case?

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Disturbed consciousness, hypothermia, elevated blood glucose, and ketonuria - What do you suggest?

25-year-old man consulted the local hospital for disturbed consciousness. His medical and family histories were unremarkable, except for glaucoma during childhood. He had been healthy until an episode of flu-like symptoms that occurred 5 days before admission. He lived alone, and had not been in touch with anybody for days. At the time of admission, he had hypothermia (27.8°C), elevated blood glucose (1049 mg/dl), and ketonuria. Blood gas analysis revealed an acidic pH (6.972), likely due to long-lasting metabolic abnormalities.

Diagnosis? Further tests? Recommended treatment?

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Intermittent abdominal pain, diarrhea and lost 70 pound weight

A 36-year-old woman who emigrated from the Ecuador presented to the emergency department with a one-year history of intermittent abdominal pain, diarrhea, and a 70-pound weight loss. She had no reported medical history or known sick contacts. She appeared cachectic with diffuse muscle wasting and had a body mass index (BMI) of 14.
Initial labs were notable - WBC count 4.5 k/mm hemoglobin 8.8 g/dL iron 17 mcg/dL
TIBC 47 mcg/dL, ferritin 123 g/L, C-reactive protein 9.4 mg/dL, HIV negative, Anti-nuclear antibody screen negative Anti-myeloperoxidase antibody negative, Anti-perinuclear-3-antibody negative Albumin 1.8 g/dL.

Computed tomography (CT) of the chest and abdomen showed several right-sided pulmonary nodules, a large left-sided pleural effusion, and diffuse small and large bowel wall thickening with enlarged mesenteric lymph nodes.

What could it be? Thank you for your insights

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HTN Visits Vary for Adults Living in Urban, Rural Residences

THURSDAY, Nov. 12, 2020 (HealthDay News) -- The percentage of physician visits by adults with diagnosed hypertension varies by patient residence, according to a study published online Nov. 12 in the National Health Statistics Reports, a publication from the U.S. Centers for Disease Control and Prevention.

Danielle Davis, M.P.H., and Pinyao Rui, M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, used data from the 2014 to 2016 National Ambulatory Medical Care Survey to describe urban-rural differences in office-based physician visits by adults with documented hypertension.

The researchers found that the percentage of visits by adults aged 18 years and older with diagnosed hypertension was lower for those who lived in large metro suburban areas versus small-medium metro areas and rural areas (34.2 percent versus 37.9 and 40.1 percent, respectively). The percentage of visits was higher for men versus women with hypertension overall (41.0 versus 33.5 percent) and in large metro suburban areas (38.7 versus 31.0 percent), small-medium metro areas (43.5 versus 33.8 percent), and rural areas (44.9 versus 36.5 percent). With age, there was an increase in the percentage of visits by adults with hypertension, from 10.3 to 58.6 percent for adults aged 18 to 44 years and those aged 75 years and older, respectively; this pattern was seen in all residence areas.

"During 2014 to 2016, in all areas, approximately 36 percent of visits by adults included diagnosed hypertension documented in the medical record," the authors write.

Abstract/Full Text

Statins Tied to Lower In-Hospital COVID-19 Mortality Risk

FRIDAY, Nov. 13, 2020 (HealthDay News) -- Treatment with statins prior to and during a COVID-19-related hospitalization is associated with lower COVID-19-related in-hospital mortality, according to a study published online Nov. 2 in the European Heart Journal: Cardiovascular Pharmacotherapy.

Lluís Masana, M.D., Ph.D., from Universitat Rovira i Virgili in Reus, Spain, and colleagues used clinical records to assess the effect of statin therapy at hospital admission for COVID-19 on in-hospital mortality among 2,157 patients (1,234 men; mean age, 67 years) with confirmed COVID-19 infection.

The researchers found that overall, there were 353 deaths and 581 patients were taking statins. There was a significantly lower mortality rate in patients on statin therapy versus the matched nonstatin group (19.8 versus 25.4 percent). Among the 336 patients who maintained their statin treatment during hospitalization, the mortality rate was even lower (17.4 percent). For cause-specific hazard, statins were associated with reduced COVID-19-related mortality (hazard ratio, 0.58).

"Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text

Targeted Efforts Do Not Alter Outcomes in Healthy Elderly

FRIDAY, Nov. 13, 2020 (HealthDay News) -- In elderly adults, vitamin D supplementation, omega-3 supplementation, and strength training, individually or in combination, do not improve clinical outcomes, according to a study published in the Nov. 10 issue of the Journal of the American Medical Association.

Heike A. Bischoff-Ferrari, M.D., from the University Hospital Zurich, and colleagues conducted a double-blind, placebo-controlled, 2 x 2 x 2 factorial randomized clinical trial among 2,157 adults aged 70 years or older with no major health events in the previous five years. Participants were randomly assigned to three years of intervention in one of the following: 2,000 IU/day vitamin D3, 1 g/day omega-3, and a strength-training exercise program; vitamin D3 and omega-3; vitamin D3 and exercise; vitamin D3 alone; omega-3 and exercise; omega-3 alone; exercise alone; or placebo. The primary outcomes were change in systolic and diastolic blood pressure, the Short Physical Performance Battery, Montreal Cognitive Assessment, and incidence rates of nonvertebral fractures and infections during a three-year follow-up.

The researchers found that at three years, there were no statistically significant benefits for any interventions individually or in combination. Twenty-five deaths occurred, with similar numbers in all treatment groups.

"In this five-country European trial of 2,157 adults aged 70 years or older without major comorbidities, vitamin D, omega-3s, and a strength-training exercise program, individually or in combination, did not improve six primary health end points," the authors write.

Several authors disclosed financial ties to pharmaceutical and nutrition companies, some of which provided funding for the study.

Abstract/Full Text (subscription or payment may be required)

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