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The Advisory Committee on Immunization Practices (ACIP) released preliminary data from the CDC v-safe registry on mRNA COVID-19 vaccines and pregnancy. In this podcast episode, we discuss the mechanisms of the vaccines, what we know, and this new data. If you’re looking for the pregnancy decision aids, they’re available here.
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This viral vector is currently going before the FDA, and more data was released in this briefing document here (a summary of all vaccines in the US can be found here).
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In this episode we cover the literature on tranexamic acid (TXA) in epistaxis, including a new trial in Annals of Emergency Medicine by Reuben et al, the NoPac trial.
Other references include:
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There’s been a lot of excitement over various drugs for COVID-19, including anti-inflammatory drugs. Colchicine, a medication long used for gout, fits that bill. In this podcast, we review 3 trials of colchicine including COLCORONA, GRECCO-19, and a study by Lopes et al.
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In this episode, we cover the latest trial on tocilizumab, the preliminary analysis of the RECOVERY trial. While early trials were disappointing, REMAP-CAP and the RECOVERY trial have signaled mortality benefits when combined with steroids. Other tocilizumab trials include EMPACTA, TOCIBRAS, COR-IMUNO-TOCI, BACC Bay, RCT-TCZ-COVID
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In this podcast, we cover a new article on convalescent plasma – this time, one that is promising! We cover Libster et al in NEJM, an RCT that administered placebo or plasma to older outpatients with mild COVID-19.
We have covered convalescent plasma multiple times before, including this introduction in May 2020, an RCT in June 2020, and another update in August 2020.
In December 2020, the CDC released updated treatment recommendations for gonococcal infections.
Pulse oximetry is one of the key vital signs that we use to triage patients and make treatment and disposition decisions. Especially during the COVID-19 pandemic, when hospitals are full, many hospitals are using pulse oximetry thresholds to determine outpatient versus inpatient management. Despite the ubiquity of pulse oximetry, prior studies have found that the devices might not be as accurate in patients with different skin pigmentation. In this podcast we review a new article in NEJM.
Despite multiple Phase II/III vaccine trials of >30,000 participants, pregnant patients or those who are lactating have been largely excluded. In this podcast, we cover what we know (and what we don’t know thus far). The Pfizer BNT162b2 trial data submitted for FDA Emergency Use Authorization does include information on a minuscule number of patients who were immunized and became pregnant, as does the Moderna briefing. Although the risk of the vaccine in pregnancy is thought to be very low, the decision to receive the vaccine during pregnancy should balance the risks of the pregnant individual (to their health/family etc) and their comfort. At the University of Massachusetts Medical School – Baystate, we created a decision aid to help.
The biggest potential risk appears to stem from the reactogenicity of the vaccine – specifically the development of fever. However, the evidence on the harms from maternal fever during pregnancy is variable. Regardless, individuals who are pregnant and receive the vaccine, should probably take acetaminophen if they develop fever.
The Society for Maternal and Fetal Medicine has released statements on vaccines in SARS-CoV-2.
In the United Kingdom, Public Health England has released guidance for their population on vaccination in pregnancy and breastfeeding which are rooted in the lack of data
