Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective:To explore the effect of nirmatrelvir/ritonavir (Paxlovid) on renal function in patients with coronavirus disease 2019 (COVID-19) and renal insufficiency.Methods:Clinical data of renal insufficiency patients with COVID-19, who were hospitalized at Beijing Ditan Hospital, Capital Medical University from March 23, 2022 to April 30, 2023 and received Paxlovid treatment, were collected. A retrospective analysis was conducted on the incidence of Paxlovid-related acute kidney injury (AKI) and changes of blood urea, serum creatinine (Scr), blood uric acid, and estimated glomerular filtration rate (eGFR) in patients before and after Paxlovid treatment.Results:A total of 386 patients were included in the analysis, including 220 males (57.0%) and 166 females (43.0%), with a median age of 79 years. COVID-19 was classified as asymptomatic in 42 patients (10.9%), mild in 175 patients (45.4%), moderate in 126 patients (32.6%), severe in 34 patients (8.8%), and critical in 9 patients (2.3%). The renal insufficiency was mild in 246 patients (63.7%), moderate in 110 patients (28.5%), and severe in 30 patients (7.8%). Among 386 patients, 16 (4.1%) developed AKI during Paxlovid treatment or within 48 hours after withdrawal, 5 (1.3%) of which were judged to be related to Paxlovid. The 5 patients aged 70 years and above, and all used nephrotoxic drugs. After Paxlovid treatment, the blood urea, Scr, blood uric acid, and eGFR in the 386 patients were all improved compared to before, and the differences were statistically significant [Scr: (133.8±9.3) μmol/L vs. (111.7±6.6) μmol/L; blood uric acid: (335.9±7.1) μmol/L vs. (291.9±5.8) μmol/L; eGFR: (63.4±1.1) ml/(min·1.73 m 2) vs. (69.1±1.2) ml/(min·1.73 m 2); all P<0.05]. Conclusions:The overall safety of Paxlovid treatment for COVID-19 in patients with renal insufficiency is good, and it has no significant impact on the renal function in the vast majority of patients. However, for elderly people aged 70 years and above, especially for those who have combination medications of nephrotoxic drugs, the occurrence of AKI should still be vigilant.

The pharmacy department of medical institutions assumes important responsibilities in the emergency response work.The standard of pharmacy administration in emergencies is formulated based on the principles of scientificity,versatility,instructiveness,and operability,through sorting out problems,collecting opinions and expert argumentation.This standard has 49 standards of 9 key elements from three aspects:emergency mechanism,emergency support,and emergency services.This article aims to introduce the construction method and formulation process of the pharmacy administration in emergency standards,and analyzes the content,to guide for improving emergency response ability of the medical institutions'pharmacy department in emergency events.

Objective:To explore the effect of nirmatrelvir/ritonavir (Paxlovid) on renal function in patients with coronavirus disease 2019 (COVID-19) and renal insufficiency.Methods:Clinical data of renal insufficiency patients with COVID-19, who were hospitalized at Beijing Ditan Hospital, Capital Medical University from March 23, 2022 to April 30, 2023 and received Paxlovid treatment, were collected. A retrospective analysis was conducted on the incidence of Paxlovid-related acute kidney injury (AKI) and changes of blood urea, serum creatinine (Scr), blood uric acid, and estimated glomerular filtration rate (eGFR) in patients before and after Paxlovid treatment.Results:A total of 386 patients were included in the analysis, including 220 males (57.0%) and 166 females (43.0%), with a median age of 79 years. COVID-19 was classified as asymptomatic in 42 patients (10.9%), mild in 175 patients (45.4%), moderate in 126 patients (32.6%), severe in 34 patients (8.8%), and critical in 9 patients (2.3%). The renal insufficiency was mild in 246 patients (63.7%), moderate in 110 patients (28.5%), and severe in 30 patients (7.8%). Among 386 patients, 16 (4.1%) developed AKI during Paxlovid treatment or within 48 hours after withdrawal, 5 (1.3%) of which were judged to be related to Paxlovid. The 5 patients aged 70 years and above, and all used nephrotoxic drugs. After Paxlovid treatment, the blood urea, Scr, blood uric acid, and eGFR in the 386 patients were all improved compared to before, and the differences were statistically significant [Scr: (133.8±9.3) μmol/L vs. (111.7±6.6) μmol/L; blood uric acid: (335.9±7.1) μmol/L vs. (291.9±5.8) μmol/L; eGFR: (63.4±1.1) ml/(min·1.73 m 2) vs. (69.1±1.2) ml/(min·1.73 m 2); all P<0.05]. Conclusions:The overall safety of Paxlovid treatment for COVID-19 in patients with renal insufficiency is good, and it has no significant impact on the renal function in the vast majority of patients. However, for elderly people aged 70 years and above, especially for those who have combination medications of nephrotoxic drugs, the occurrence of AKI should still be vigilant.

Objective:To explore the safety of nirmatrelvir/ritonavir (Paxlovid) in the treatment of coronavirus disease 2019 (COVID-19).Methods:Medical records of adult patients with COVID-19 who were hospitalized and treated with Paxlovid in Beijing Ditan Hospital, Capital Medical University between March 23 and May 31, 2022 were collected through the hospital electronic medical record system. The occurrence (time of occurrence, clinical manifestations, severity, etc.) and outcomes of adverse reactions were analyzed retrospectively and the clinical characteristics of patients with or without adverse reactions were compared. Paxlovid was administered orally with nirmatrelvir 300 mg and ritonavir 100 mg every 12 hours for 5 consecutive days.Results:Three hundred and sixty-four patients were entered in the analysis, including 200 males (54.9%) and 164 females (45.1%), with a median age of 60 (19, 92) years. The incidence of adverse reactions of Paxlovid was 13.2% (48/364), and the adverse reactions occurred 1 to 7 days after taking Paxlovid. Among the 48 patients, 37 patients had digestive system symptoms (mainly manifested as diarrhea in 17 patients, bitter mouth in 14 patients, etc.), 7 patients had nervous system symptoms (dizziness in 5 patients, headache in 2 patients), 4 patients had respiratory system symptoms (pharyngalgia in 3 patients, pharyngeal itching in 1 patient), 2 patients had kidney injury, 1 patient had elevated blood uric acid, 1 patient had myalgia, and 1 patient had rash. Of them, 2 patients had digestive and neurological symptoms at the same time, 1 patient had digestive and respiratory symptoms at the same time, and 1 patient had digestive, neurological, and respiratory symptoms at the same time. The severity of adverse reactions was grade 1 in 33 patients (68.8%) and grade 2 in 15 patients (31.2%), and no serious adverse reactions of grade 3 and above occurred. All patients completed 5 days of treatment except 1 patient who discontinued the drug because of intolerance to grade 2 digestive symptoms (nausea and bitter mouth). There were no significant differences in gender, age, body mass index, smoking status, underlying diseases, and COVID-19 clinical classification between the patients with and without adverse reactions (all P>0.05). Conclusions:Paxlovid has a good safety in the treatment of COVID-19. The main adverse reaction is digestive system symptoms, mainly diarrhea and bitter mouth. Most of the symptoms are mild and the patient′s tolerance is good.

Objective:To explore the safety of nirmatrelvir/ritonavir (Paxlovid) in the treatment of coronavirus disease 2019 (COVID-19).Methods:Medical records of adult patients with COVID-19 who were hospitalized and treated with Paxlovid in Beijing Ditan Hospital, Capital Medical University between March 23 and May 31, 2022 were collected through the hospital electronic medical record system. The occurrence (time of occurrence, clinical manifestations, severity, etc.) and outcomes of adverse reactions were analyzed retrospectively and the clinical characteristics of patients with or without adverse reactions were compared. Paxlovid was administered orally with nirmatrelvir 300 mg and ritonavir 100 mg every 12 hours for 5 consecutive days.Results:Three hundred and sixty-four patients were entered in the analysis, including 200 males (54.9%) and 164 females (45.1%), with a median age of 60 (19, 92) years. The incidence of adverse reactions of Paxlovid was 13.2% (48/364), and the adverse reactions occurred 1 to 7 days after taking Paxlovid. Among the 48 patients, 37 patients had digestive system symptoms (mainly manifested as diarrhea in 17 patients, bitter mouth in 14 patients, etc.), 7 patients had nervous system symptoms (dizziness in 5 patients, headache in 2 patients), 4 patients had respiratory system symptoms (pharyngalgia in 3 patients, pharyngeal itching in 1 patient), 2 patients had kidney injury, 1 patient had elevated blood uric acid, 1 patient had myalgia, and 1 patient had rash. Of them, 2 patients had digestive and neurological symptoms at the same time, 1 patient had digestive and respiratory symptoms at the same time, and 1 patient had digestive, neurological, and respiratory symptoms at the same time. The severity of adverse reactions was grade 1 in 33 patients (68.8%) and grade 2 in 15 patients (31.2%), and no serious adverse reactions of grade 3 and above occurred. All patients completed 5 days of treatment except 1 patient who discontinued the drug because of intolerance to grade 2 digestive symptoms (nausea and bitter mouth). There were no significant differences in gender, age, body mass index, smoking status, underlying diseases, and COVID-19 clinical classification between the patients with and without adverse reactions (all P>0.05). Conclusions:Paxlovid has a good safety in the treatment of COVID-19. The main adverse reaction is digestive system symptoms, mainly diarrhea and bitter mouth. Most of the symptoms are mild and the patient′s tolerance is good.

Objective:To examine the relationship between subcortical volumes and ketamine’s antidepressant effects.Methods:Forty-five depressive patients with treatment resistance or suicide ideation were involved and received six infusions of ketamine for two weeks（0.5 mg/kg，thrice-weekly）. Depressive symptoms were assessed by Montgomery-?sberg Depression Rating Scale (MADRS) and suicide ideation was assessed by Beck Scale for Suicide Ideation-part one (SSI-Ⅰ). Subcortical volumes underwent 3.0T-weighted MRI. The Freesurfer software was used to process the T 1 images, which used a set of automated sequences to analyze subcortical volumes. Forty-five healthy controls were collected and their subcortical volumes were compared with the patients’ volumes. Linear regression analysis was used to determine the association between pre-treatment subcortical volumes and change in MADRS score as well as SSI scores after ketamine treatment (change=pre-treatment scores minus post-treatment scores). Results:In comparison to the healthy controls, depressive patients had decreased bilateral hippocampal volumes (Left:(2 993±276) mm 3vs. (2 785±263) mm 3， F=12.928， P=0.001； Right: (3 117±254) mm 3vs. (2 949±270) mm 3, F=8.217， P=0.005). Pre-treatment volumes of right thalamus were positively correlated with change in MADRS scores after six infusions in patients with treatment resistance （ B=0.009， t=3.434, P=0.002）. Conclusion:Six ketamine infusions exerted enhanced antidepressant effects in treatment-resistant depression patients with relatively larger thalamus. Volume of thalamus could be used as a biomarker of six ketamine’s antidepressants treatment outcome.

Objective:To examine the relationship between subcortical volumes and ketamine’s antidepressant effects.Methods:Forty-five depressive patients with treatment resistance or suicide ideation were involved and received six infusions of ketamine for two weeks（0.5 mg/kg，thrice-weekly）. Depressive symptoms were assessed by Montgomery-?sberg Depression Rating Scale (MADRS) and suicide ideation was assessed by Beck Scale for Suicide Ideation-part one (SSI-Ⅰ). Subcortical volumes underwent 3.0T-weighted MRI. The Freesurfer software was used to process the T 1 images, which used a set of automated sequences to analyze subcortical volumes. Forty-five healthy controls were collected and their subcortical volumes were compared with the patients’ volumes. Linear regression analysis was used to determine the association between pre-treatment subcortical volumes and change in MADRS score as well as SSI scores after ketamine treatment (change=pre-treatment scores minus post-treatment scores). Results:In comparison to the healthy controls, depressive patients had decreased bilateral hippocampal volumes (Left:(2 993±276) mm 3vs. (2 785±263) mm 3， F=12.928， P=0.001； Right: (3 117±254) mm 3vs. (2 949±270) mm 3, F=8.217， P=0.005). Pre-treatment volumes of right thalamus were positively correlated with change in MADRS scores after six infusions in patients with treatment resistance （ B=0.009， t=3.434, P=0.002）. Conclusion:Six ketamine infusions exerted enhanced antidepressant effects in treatment-resistant depression patients with relatively larger thalamus. Volume of thalamus could be used as a biomarker of six ketamine’s antidepressants treatment outcome.

Objective To explore the etiology,clinical features and outcome of drug-induced liver failure (DILF)for reference to safe drug use in clinical practice. Methods The information of patients with DILF,who were admitted to the Department of Liver Disease in Beijing Ditan Hospital Capital Medical University from January 1,2007 to December 31,2016 was collected using hospital information system and analyzed retrospectively. Results A total of 108 patients were entered investigation,including 46 males (42.6% )and 62 females (57.4% ),aged 11 to 81 years with a median age 48 (35,61)years. Of the 108 patients with DILF,48 patients (44.4% )received Western medicines,43 patients (39.8% )received traditional Chinese medicines,13 patients (12.0% )received Western medicines combined with traditional Chinese medicines,and 4 patients (3. 7% )received medicines with no definite classifications. In 61 patients receiving Western medicines or Western medicines plus traditional Chinese medicines,the top 3 Western medicines were antituberculosis drugs (29. 5% ,18/61 ),nonsteroidal anti-inflammatory drugs (18.0% ,11/61)and anti-infective agents except antituberculosis drugs (14.7% ,9/61). Of 56 patients receiving traditional Chinese medicines or traditional Chinese medicines plus Western medicines,15 had osteoarthrosis,15 had skin diseases(53.6% in total,30/56). Ten patients had no definite diseases,who only took traditional Chinese medicine for recuperation or health care,accounting for 23.3% of the 43 patients receiving traditional Chinese medicines. Among the 108 DILF patients,44 patients (40.7% )were diagnosed as having subacute liver failure,41 patients(38% )as acute liver failure,21 patients(19.4% ) as acute-on-chronic liver failure,and 2 patients (1. 9% ) as chronic liver failure;according to their pathologic features,66 patients(63.4% )had hepatocyte liver injury,6 patients(5.8% )had cholestasis liver injury,and 32 patients (30.8% )had mixed type liver injury. The length of hospitalization of 108 patients was 1-183 days,and the medium length of hospitalization was 22 (10,44)days. In addition,33 patients (30.6% )died during their hospitalization,3 patients (2. 8% )were judged to be cured,40 patients(37.0% )were improved,and 32 patients(29.6% )were invalid at the time of their discharge. The MELD scores of patients in the effective treatment group (cure and improvement)and ineffective treatment group (ineffectiveness and death)were (24.2 ± 6.7)and (36.4 ± 12.3),respectively. And the difference was statistically significant(t＝ －5.9245,P＜0.001). A MELD score cut-off values of≥32.3 (sensitivity 60.0% ,specificity 93. 0% )was determined as having invalid or death risk for patients with DILF. Conclusions Western medicines that might induce liver failure mainly include anti-infective drugs (especially antituberculous drugs)and nonsteroidal anti-inflammatory drugs. Traditional Chinese medicines and their preparations as well as heath care products were also an important cause of DILF. The major pathological features of DILF were hepatocyte liver injury. The prognosis of patients with DILF is poor. MELD score might be used to predict the prognosis of DILF.

Objective To explore the etiology,clinical features and outcome of drug-induced liver failure (DILF)for reference to safe drug use in clinical practice. Methods The information of patients with DILF,who were admitted to the Department of Liver Disease in Beijing Ditan Hospital Capital Medical University from January 1,2007 to December 31,2016 was collected using hospital information system and analyzed retrospectively. Results A total of 108 patients were entered investigation,including 46 males (42.6% )and 62 females (57.4% ),aged 11 to 81 years with a median age 48 (35,61)years. Of the 108 patients with DILF,48 patients (44.4% )received Western medicines,43 patients (39.8% )received traditional Chinese medicines,13 patients (12.0% )received Western medicines combined with traditional Chinese medicines,and 4 patients (3. 7% )received medicines with no definite classifications. In 61 patients receiving Western medicines or Western medicines plus traditional Chinese medicines,the top 3 Western medicines were antituberculosis drugs (29. 5% ,18/61 ),nonsteroidal anti-inflammatory drugs (18.0% ,11/61)and anti-infective agents except antituberculosis drugs (14.7% ,9/61). Of 56 patients receiving traditional Chinese medicines or traditional Chinese medicines plus Western medicines,15 had osteoarthrosis,15 had skin diseases(53.6% in total,30/56). Ten patients had no definite diseases,who only took traditional Chinese medicine for recuperation or health care,accounting for 23.3% of the 43 patients receiving traditional Chinese medicines. Among the 108 DILF patients,44 patients (40.7% )were diagnosed as having subacute liver failure,41 patients(38% )as acute liver failure,21 patients(19.4% ) as acute-on-chronic liver failure,and 2 patients (1. 9% ) as chronic liver failure;according to their pathologic features,66 patients(63.4% )had hepatocyte liver injury,6 patients(5.8% )had cholestasis liver injury,and 32 patients (30.8% )had mixed type liver injury. The length of hospitalization of 108 patients was 1-183 days,and the medium length of hospitalization was 22 (10,44)days. In addition,33 patients (30.6% )died during their hospitalization,3 patients (2. 8% )were judged to be cured,40 patients(37.0% )were improved,and 32 patients(29.6% )were invalid at the time of their discharge. The MELD scores of patients in the effective treatment group (cure and improvement)and ineffective treatment group (ineffectiveness and death)were (24.2 ± 6.7)and (36.4 ± 12.3),respectively. And the difference was statistically significant(t＝ －5.9245,P＜0.001). A MELD score cut-off values of≥32.3 (sensitivity 60.0% ,specificity 93. 0% )was determined as having invalid or death risk for patients with DILF. Conclusions Western medicines that might induce liver failure mainly include anti-infective drugs (especially antituberculous drugs)and nonsteroidal anti-inflammatory drugs. Traditional Chinese medicines and their preparations as well as heath care products were also an important cause of DILF. The major pathological features of DILF were hepatocyte liver injury. The prognosis of patients with DILF is poor. MELD score might be used to predict the prognosis of DILF.