Racial and ethnic variation in COVID-19 care, treatment, and outcomes: A retrospective cohort study from the MiCOVID-19 registry

BACKGROUND

Racial and ethnic disparities in COVID-19 outcomes exist, but whether in-hospital care explains this difference is not known. We sought to determine racial and ethnic differences in demographics, comorbidities, in-hospital treatments, and in-hospital outcomes of patients hospitalized with COVID-19.

METHODS AND FINDINGS

This was a cohort study using MiCOVID-19, a multi-center, retrospective, collaborative quality improvement registry, which included data on patients hospitalized with COVID-19 across 38 hospitals in the State of Michigan. 2,639 adult patients with COVID-19 hospitalized at a site participating in the MiCOVID-19 Registry were randomly selected. Outcomes included in-hospital mortality, age at death, intensive care unit admission, and need for invasive mechanical ventilation by race and ethnicity. Baseline comorbidities differed by race and ethnicity. In addition, Black patients had higher lactate dehydrogenase, erythrocyte sedimentation rate, C-reactive protein, creatine phosphokinase, and ferritin levels. Black patients were less likely to receive dexamethasone and remdesivir compared with White patients (4.2% vs 14.3% and 2.2% vs. 11.8%, p < 0.001 for each). Black (18.7%) and White (19.6%) patients experienced greater mortality compared with Asian (13.0%) and Latino (5.9%) patients (p < 0.01). The mean age at death was significantly lower by 8 years for Black patients (69.4 ± 13.3 years) compared with White (77.9 ± 12.6), Asian (77.6 ± 6.6), and Latino patients (77.4 ± 15.5) (p < 0.001).

CONCLUSIONS

COVID-19 mortality appears to be driven by both pre-hospitalization clinical and social factors and potentially in-hospital care. Policies aimed at population health and equitable application of evidence-based medical therapy are needed to alleviate the burden of COVID-19.

Early Benchmarking Total Hip Arthroplasty Implants Using Data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI)

BACKGROUND

Benchmarking arthroplasty implant revision risk is an informative way to address implant performance. National benchmarking efforts exist in the United Kingdom, Netherlands, and Australia. Recently, the International Prosthesis Benchmarking Working Group, including representatives from industry, academia, and national registries, produced a guideline describing arthroplasty benchmarking methodology. The proposal was applied to data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) to assess its feasibility for benchmarking implants in the United States.

METHODS

Primary elective total hip arthroplasty procedures performed for osteoarthritis between 2/15/2012 and 12/31/2018 and their associated revisions were identified in the MARCQI registry. The guidelines recommend that all prostheses combinations receive an early benchmark if they have at least 250 procedures at risk and the revision rate does not exceed the pre-determined standard of 2% at 2 years and 3% at 5 years.

RESULTS

A total of 72,949 primary cases met the inclusion criteria. Of these, 1369 had revisions. Twenty-nine and six stem/cup combinations satisfied the minimum case requirement at 2 and 5 years, respectively. Three implant combinations would not receive a benchmark at 2 years: Secur-Fit/Trident, Anthology/Reflection 3, Taperloc 133/G7.

CONCLUSION

The guideline can be implemented in the United States by a regional registry. Moreover, not all hip implants currently in use would receive an early benchmark. This raises concern as these implant combinations represent a significant number of cases in Michigan, some with increasing utilization.

Diffusion tensor imaging reveals microstructural differences between subtypes of trigeminal neuralgia

OBJECTIVE

Trigeminal neuralgia (TN) is an uncommon idiopathic facial pain syndrome. To assist in diagnosis, treatment, and research, TN is often classified as type 1 (TN1) when pain is primarily paroxysmal and episodic or type 2 (TN2) when pain is primarily constant in character. Recently, diffusion tensor imaging (DTI) has revealed microstructural changes in the symptomatic trigeminal root and root entry zone of patients with unilateral TN. In this study, the authors explored the differences in DTI parameters between subcategories of TN, specifically TN1 and TN2, in the pontine segment of the trigeminal tract.

METHODS

The authors enrolled 8 patients with unilateral TN1, 7 patients with unilateral TN2, and 23 asymptomatic controls. Patients underwent DTI with parameter measurements in a region of interest within the pontine segment of the trigeminal tract. DTI parameters were compared between groups.

RESULTS

In the pontine segment, the radial diffusivity (p = 0.0049) and apparent diffusion coefficient (p = 0.023) values in TN1 patients were increased compared to the values in TN2 patients and controls. The DTI measures in TN2 were not statistically significant from those in controls. When comparing the symptomatic to asymptomatic sides in TN1 patients, radial diffusivity was increased (p = 0.025) and fractional anisotropy was decreased (p = 0.044) in the symptomatic sides. The apparent diffusion coefficient was increased, with a trend toward statistical significance (p = 0.066).

CONCLUSIONS

Noninvasive DTI analysis of patients with TN may lead to improved diagnosis of TN subtypes (e.g., TN1 and TN2) and improve patient selection for surgical intervention. DTI measurements may also provide insights into prognosis after intervention, as TN1 patients are known to have better surgical outcomes than TN2 patients.

Hypo-collagenesis in photoaged skin predicts response to anti-aging cosmeceuticals

BACKGROUND

Chronic sun exposure causes photoaging, the appearance of prematurely aged skin. This phenomenon is characterized by progressive alteration of the dermal extracellular matrix, including elastin and collagen fibers. While many cosmeceuticals claim to improve the appearance of photoaged skin, data are lacking regarding their ability to induce molecular responses associated with wrinkle effacement, particularly increased collagen production.

AIMS

To conduct a meta-analysis to determine whether there was a factor(s) that could predict response to various cosmeceuticals.

PATIENTS/METHODS

Hundred subjects enrolled in five separate studies of cosmeceuticals containing: L-ascorbic acid, pentapeptide, α-lipoic acid, yeast extract, or 1% idebenone. Five groups consisting of 16-20 volunteers applied one cosmeceutical to their photodamaged forearms for several weeks. Punch biopsies were obtained pretreatment and post-treatment and analyzed for type I procollagen by ELISA.

RESULTS

Analysis of basal collagenesis reinforced the notion that hypo-collagenesis is associated with photoaging severity, independent of age or gender. Treatment outcome varied greatly among subjects, ranging from no improvement to a 7-fold increase in collagenesis. Retrospective statistical meta-analysis was conducted to determine whether age, gender, type of cosmeceutical, or evidence of hypo-collagenesis in untreated skin could predict responsiveness to cosmeceuticals. Our analysis revealed that subjects with hypo-collagenesis responded 6.4 times more often than subjects with normo-collagenesis.

DISCUSSION

Hypo-collagenesis was the only factor that influenced treatment outcome. This study therefore identifies hypo-collagenesis as the unique parameter predicting anti-aging cosmeceutical treatment outcome. These findings provide a basis for future cosmetic testing and the potential development of custom formula skin care.