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8. Prescribing Nirmatrelvir-Ritonavir: How to Recognize and Manage Drug-Drug Interactions

Author

Marzolini, C., Kuritzkes, D.R., Marra, F., Boyle, A., Gibbons, S., Flexner, C., Pozniak, A., Boffito, M., Waters, L., Burger, D.M., Back, D., Khoo, S., Marzolini, C., Kuritzkes, D.R., Marra, F., Boyle, A., Gibbons, S., Flexner, C., Pozniak, A., Boffito, M., Waters, L., Burger, D.M., Back, D., and Khoo, S.

Abstract

Item does not contain fulltext, Nirmatrelvir–ritonavir (NMV/r) is now being used to treat high-risk patients with mild to moderate COVID-19. This article provides advice to clinicians regarding recognition of medications likely to interact with NMV/r and suggests approaches to managing such drug–drug interactions. An algorithm is provided to assist in decision making.

Published
2022

11. Students’ and lecturers’ perspective on the implementation of online learning 'Sport medicine' in medical education due to COVID-19: a longitudinal study

Author

Hertling, SF, Back, D, Matziolis, G, Hofmann, G, Loos, F, and Graul, I

Subjects
ddc: 610, sports medicine, Medicine and health, e-learning, digital teaching
Abstract

Objectives: With the advent of the COVID-19 pandemic, the challenge is to transform medical teaching into digital medical teaching in a short period of time. Therefore, this study investigated an evaluation of an elective module by medical students and teachers in the traditional form in person and [for full text, please go to the a.m. URL]

Published
2021
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14. Extreme blazars under the eyes of MAGIC

Author

Arbet-Engels, A., Prandini, E., Ventura, S., Fallah Ramazani, V., Cerruti, M., Arcaro, C., Asano, K., Dorner, D., Manganaro, M., Bonnoli, G., D’ammando, F., Foffano, L., Tavecchio, F., Becerra-Gonzalez, J., Jormanainen, J., Da Vela, P., Acciari, V. A., Ansoldi, S., Antonelli, L. A., Rugliancih, B., Artero, M., Asaoo, K., Back, D., Babić, A., Baquero, A., Barres Almeida, U., Barrio, J. A., Batković, I., Becerra González, J., Bednarek, W., Bellizzi, L., Bernardini, E., Bernardos, M., Berti, A., Besenrieder, J., Bhattacharyya, W., Bigongiari, C., Bilaud, A., Blanch, O., Bökenkamp, H., Bonoli, G., Bošnjak, Ž, Busetto, G., Carosi, R., Ceribella, G., Ceruti, M., Chai, Y., Chilingarian, A., Cikota, S., Colak, S. M., Colombo, E., Contreras, J. L., Cortina, J., Covino, S., D’amico, G., D’elia, V., Da Vala, P., Dazzi, F., Angelis, A., Lotto, B., Delfino, M., Delgado, J., Delgado Mendez, C., Depaoli, D., Di Pierro, F., Di Venere, L., Do Souto Espiñeira, E., Dominis Prester, D., Donini, A., Doner, D., Doro, M., Elsaeser, D., Falah Ramazani, V., Fattorini, A., Fonseca, M. V., Font, L., Fruck, C., Fukami, S., Fukazawa, Y., García López, R. J., Garczarczyk, M., Gasparyan, S., Gaug, M., Giglietto, N., Giordano, F., Gliwny, P., Godinović, N., Green, J. G., Green, D., Hadasch, D., Hahn, A., Heckmann, L., Herrera, J., Hoang, J., Hrupec, D., Hütten, M., Inada, T., Ishio, K., Iwamura, Y., Jiménez Martínez, I., Jormaninen, J., Jouvin, L., Karjalainen, M., Kerszberg, D., Kobayashi, Y., Kubo, H., Kushida, J., Lamastra, A., Lelas, D., Leone, F., Lindfors, E., Linhoff, L., Lombardi, S., Longo, F., López-Coto, R., López-Moya, M., López-Oramas, A., Loporchio, S., Machado Oliveira Fraga, B., Maggio, C., Majumdar, P., Makariev, M., Mallamaci, M., Maneva, G., Manganro, M., Manheim, K., Maraschi, L., Mariotti, M., Martínez, M., Mazin, D., Menchiari, S., Mender, S., Mićanović, S., Miceli, D., Miener, T., Miranda, J. M., Mirzoyan, R., Molina, E., Moralejo, A., Morcuende, D., Moreno, V., Moretti, E., Nakamori, T., Nava, L., Neustroev, V., Nigro, C., Nilsson, K., Nishijima, K., Noda, K., Nozaki, S., Ohtani, Y., Oka, T., Otero-Santos, J., Paiano, S., Palatiello, M., Paneque, D., Paoletti, R., Paredes, J. M., Pavletić, L., Peñil, P., Persic, M., Pihet, M., Prada Moroni, P. G., Walter, R., Priyadarshi, C., Puljak, I., Rhade, W., Ribó, M., Rico, J., Righi, C., Rugliancich, A., Sahakyan, N., Saito, T., Sakurai, S., Satalecka, K., Saturni, F. G., Schlaicher, B., Schmidt, K., Schweizer, T., Sitarek, J., Šnidarić, I., Dorota Sobczynska, Spolon, A., Stamerra, A., Strišković, J., Strom, D., Strzys, M., Suda, Y., Surić, T., Takahashi, M., Takeishi, R., Tavechio, F., Temnikov, P., Terzić, T., Teshima, M., Tosti, L., Truzzi, S., Tutone, A., Ubach, S., Scherpenberg, J., Vanzo, G., Vazquez Acosta, M., Sliusar, V., Verguilov, V., Vigorito, C. F., Vitale, V., Vovk, I., Will, M., Wunderlich, C., Yamamoto, T., Zarić, D., Schleicher, B., Baack, D., Balbo, M., Biland, A., Bretz, T., Buss, J., Donor, D., Eisenberger, L., Elsaesser, D., Hildebrand, D., Iotov, R., Kalenski, A., Mannheim, K., Mitchell, A., Neise, D., Noethe, M., Paravac, A., and Rhode, W.

Subjects
Physics, Astrophysics::High Energy Astrophysical Phenomena, media_common.quotation_subject, Astronomy, Blazar, Magic (paranormal), media_common
Abstract

Extreme high-frequency-peaked BL Lac objects (EHBLs) are the most energetic persistent sources in the universe. This contribution reports on long-term observing campaigns of tens of EHBLs that have been organized by the MAGIC collaboration to enlarge their population at VHE and understand the origin of their extreme properties. EHBLs are characterized by a spectral energy distribution (SED) featuring a synchrotron peak energy above 1 keV. Several EHBLs display a hard spectral index at very high energies (VHE; E>100 GeV), suggesting a gamma-ray SED component peaking significantly above 1 TeV. Such extreme properties are challenging current standard emission and acceleration mechanisms. Recent studies have also unveiled intriguing disparities in the temporal characteristics of EHBLs. Some sources seem to display a persistent EHBL behaviour, while others belong to the EHBL family only temporarily. We will focus on the recent results of the first hard-TeV EHBL catalog. The MAGIC observations are accompanied by an extensive multi-wavelength coverage to obtain an optimal determination of the SED. This allow us to investigate leptonic and hadronic scenarios for the emission. We will also present the recent detection of the EHBL 1RXS0812.0+0237 in the VHE band by MAGIC. Finally, we will discuss a broad multi-wavelength campaign on the BL Lac type object 1ES2344+514, which showed intermittent EHBL characteristics in August 2016., PoS: Proceedings of Science, 395, ISSN:1824-8039, 37th International Cosmic Ray Conference (ICRC 2021)

Published
2021

18. Recommendations for Dosing of Repurposed COVID-19 Medications in Patients with Renal and Hepatic Impairment

Author

Marra, F., Smolders, E.J., El-Sherif, O., Boyle, A., Davidson, K, Sommerville, A.J., Marzolini, C., Siccardi, M., Burger, D.M., Gibbons, S., Khoo, S., Back, D., Marra, F., Smolders, E.J., El-Sherif, O., Boyle, A., Davidson, K, Sommerville, A.J., Marzolini, C., Siccardi, M., Burger, D.M., Gibbons, S., Khoo, S., and Back, D.

Abstract

Contains fulltext : 232502.pdf (Publisher’s version ) (Open Access), INTRODUCTION: In December 2019, an outbreak of a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began, resulting in a number of antivirals and immune modulators being repurposed to treat the associated coronavirus disease 2019 (COVID-19). Many patients requiring treatment for COVID-19 may have either pre-existing renal or hepatic disease or experience acute renal/hepatic injury as a result of the acute infection. Altered renal or hepatic function can significantly affect drug concentrations of medications due to impaired drug metabolism and excretion, resulting in toxicity or reduced efficacy. The aim of this paper is to review the pharmacokinetics and available study data for the experimental COVID-19 therapies in patients with any degree of renal or hepatic impairment to make recommendations for dosing. METHODS: COVID-19 agents included in these recommendations were listed as primaries on the University of Liverpool COVID-19 drug interaction website ( www.covid19-druginteractions.org ), initially identified from Clinicialtrials.gov and ChicCTR.org.cn. A literature search was performed using PubMed and EMBASE as well as product licences and pharmacokinetic databases. FINDINGS: Remdesivir, dexamethasone, azithromycin, favipiravir, lopinavir/ritonavir, atazanavir, hydroxychloroquine, interferon beta, ribavirin, tocilizumab, anakinra and sarilumab were identified as experimental drugs being used in COVID-19 trials as of November 2020. Limited study data was found for these drugs in patients with renal or hepatic impairment for COVID-19 or other indications. Recommendations were made based on available data, consideration of pharmacokinetic properties (including variability), the dosing and anticipated treatment duration of each regimen in COVID-19 and known toxicities. CONCLUSION: Dosing of drugs used to treat COVID-19 in patients with renal or hepatic impairment is complex. These recommendations were produced to provide guidance to clinicians worl

Published
2021

25. Implementation of online video consultations in a regional health network: a management feasibility analysis from an orthopedic perspective.

Author

Back, DA, Estel, K, Pförringer, D, Tsitsilonis, S, Bachner, J, Willy, C, Becker, HP, Back, D A, working group digitalization (DGOU), and Becker, H P

Subjects
PILOT projects, ORTHOPEDICS, TELEMEDICINE, MEDICAL referrals
Abstract

Introduction: Regional health care networks with interfaces between clinics, general practitioners and patients can act faster when utilizing digital measures. This manuscript describes the establishment of an online video consultation service in a clinic and its broad health care region to exemplify challenges and solutions for potential future approaches from a management perspective.Method: The underlying pilot project was planned and implemented for follow-up monitoring and consultative presentation of orthopedic and trauma patients within the Bundeswehr Medical Service from 2018 to 2020. With predominantly positive evaluation results regarding quality and acceptance among users, this research investigated organizational and processual aspects including total quality management, strategic control and change management approaches.Results: The affected main and subprocesses of patient treatment could be streamlined by the project, as physician recommendations and arrangements could be accelerated and patient travel could be significantly reduced. A SWOT and portfolio analysis showed a high potential for improving existing patient treatment processes for health care enterprises via the use of digital technology. The involved staff should be strategically included at an early stage and continuously involved. By means of a PDCA cycle, the processes of the given project could be exemplarily illustrated with an outlook in the future.Discussion: It has proven successful to consciously use management approaches to establish telemedical integrated care structures in a health region. Recommendations for the strategic introduction of an online video consultation for regional network strengthening and care development for a patient-oriented increase in efficiency could be compiled. [ABSTRACT FROM AUTHOR]

Published
2022
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26. Drug interactions: a review of the unseen danger of experimental COVID-19 therapies

Author

Hodge, C., Marra, F., Marzolini, C., Boyle, A., Gibbons, S., Siccardi, M., Burger, D.M., Back, D., Khoo, S., Hodge, C., Marra, F., Marzolini, C., Boyle, A., Gibbons, S., Siccardi, M., Burger, D.M., Back, D., and Khoo, S.

Abstract

Contains fulltext : 229144.pdf (Publisher’s version ) (Closed access), As global health services respond to the coronavirus pandemic, many prescribers are turning to experimental drugs. This review aims to assess the risk of drug-drug interactions in the severely ill COVID-19 patient. Experimental therapies were identified by searching ClinicalTrials.gov for 'COVID-19', '2019-nCoV', '2019 novel coronavirus' and 'SARS-CoV-2'. The last search was performed on 30 June 2020. Herbal medicines, blood-derived products and in vitro studies were excluded. We identified comorbidities by searching PubMed for the MeSH terms 'COVID-19', 'Comorbidity' and 'Epidemiological Factors'. Potential drug-drug interactions were evaluated according to known pharmacokinetics, overlapping toxicities and QT risk. Drug-drug interactions were graded GREEN and YELLOW: no clinically significant interaction; AMBER: caution; RED: serious risk. A total of 2378 records were retrieved from ClinicalTrials.gov, which yielded 249 drugs that met inclusion criteria. Thirteen primary compounds were screened against 512 comedications. A full database of these interactions is available at www.covid19-druginteractions.org. Experimental therapies for COVID-19 present a risk of drug-drug interactions, with lopinavir/ritonavir (10% RED, 41% AMBER; mainly a perpetrator of pharmacokinetic interactions but also risk of QT prolongation particularly when given with concomitant drugs that can prolong QT), chloroquine and hydroxychloroquine (both 7% RED and 27% AMBER, victims of some interactions due to metabolic profile but also perpetrators of QT prolongation) posing the greatest risk. With management, these risks can be mitigated. We have published a drug-drug interaction resource to facilitate medication review for the critically ill patient.

Published
2020

43. Design, fabrication, and characterization of a compact hierarchical manifold microchannel heat sink array for two-phase cooling

Author

Back, D., Drummond, K. P., Sinanis, M. D., Weibel, J. A., Garimella, S V, Peroulis, D., and Janes, D. B.

Subjects
microheater, Microchannel heat sink, microfluidics, volumetric heat density, resistance temperature detector (RTD)
Abstract

High-heat-flux removal is critical for the nextgeneration electronic devices to reliably operate within their temperature limits. A large portion of the thermal resistance in a traditional chip package is caused by thermal resistances at interfaces between the device, heat spreaders, and the heat sink; embedding the heat sink directly into the heat-generating device can eliminate these interface resistances and drastically reduce the overall thermal resistance. Microfluidic cooling within the embedded heat sink improves the heat dissipation, with two-phase operation offering the potential for dissipation of very high heat fluxes while maintaining moderate chip temperatures. To enable multichip stacking and other heterogeneous packaging approaches, it is important to densely integrate all fluid flow paths into the device; volumetric heat dissipation emerges as a performance metric in this new heat sinking paradigm. In this paper, a compact hierarchical manifold microchannel design is presented that utilizes an integrated multilevel manifold distributor to feed coolant to an array of microchannel heat sinks. The flow features in the manifold layers and microchannels are fabricated in silicon wafers using deep reactive-ion etching. The heat source is simulated via Joule heating using thin-film platinum heaters. The on-chip spatial temperature measurements are made using four-wire resistance temperature detectors. The individual manifold layers and the microchannel-bearing wafers are diced and bonded into a sealed stack via thermocompression bonding using gold layers at the mating surfaces. Thermal and hydrodynamic testing is performed by pumping the dielectric fluid HFE-7100 through the device at a known flow rate

Published
2019

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