Management Of Coronavirus Disease-19 Research Articles

High Resolution Computed Tomography chest findings among people affected by corona virus disease in a tertiary hospital of Nepal

Clinical assessment, chest X-ray (CXR) and chest high-resolution computed tomography (HRCT) are used in the management of Corona virus disease-19 (COVID-19). This retrospective cross sectional study included 251 patients admitted to Nepal Medical College Teaching Hospital (NMCTH) with a diagnosis of COVID‑19 infection confirmed by Reverse Transcriptase- Polymerase Chain Reaction (RT‑PCR). These patients underwent chest HRCT within the first two weeks of hospital admission. Images were evaluated for various HRCT findings & semi- quantitative CT Severity Score (CT –SS) was calculated based on the extent of lobar involvement. Out of 251 patients with positive RT PCR test, 127 were male (50.6%) and 124 female (49.4%). Typical bilateral peripheral subpleural ground glass opacities were demonstrated in 98.8% of patients; followed by thoracic lymphadenopathy (80.8%), interlobular septal thickening (80.4%),vascular changes (44.2%), focal consolidation (28.6%), consolidation with ground glass opacity (15%), pleural effusion (13.1%) bronchiectasis (3.8%), fibrotic changes (3.1%) and reversed halo pattern (0.7%). Calculated CT- SS showed moderate score in 130 patients (51.7%) followed by severe score in 67 patients (26.6%) and mild score in 51 patients (20.3%). HRCT can be used as a one stop radiological investigation for the diagnosis and prognosis of corona virus disease and CT -SS might be beneficial for diagnostic workflow in symptomatic cases.

Convalescent Plasma Therapy against COVID-19: An Update on the Changing Facets of the ongoing Pandemic.

The severe respiratory infections in the current pandemic coronavirus disease-19 (COVID-19) have influenced more or less every human life. The first person to get infected with this virus was reported in the capital of Hubei province (Wuhan), China, in late December 2019. Since the disease has been declared a pandemic, research scholars and experts have been manufacturing new vaccines or targeted therapies to curb the spread of SARS-CoV-2. However, only limited options have emerged so far, which yet require complete scientific validation by long-term data collection regarding safety and efficacy. In the wake of the recent emerging wave of the pandemic viz omicron variant, changing facets of the viral genome and dearth of preventative and therapeutic possibilities for the management of COVID-19, the usage of Convalescent Plasma Therapy (CPT) may be looked at as a potentially viable option of treatment in the existing situation. Earlier, immune plasma has been used with success in the management of H1N1 influenza virus, MERS-CoV, and SARS-CoV-1 epidemics. In the present unpredictable situation created by the COVID-19 pandemic, the CPT is used with a positive outcome amongst many infected individuals in different parts of the world with acceptable efficacy. This article aimed to present an up-to-date evaluation of existing literature on the efficacy of convalescent plasma as a potential therapy, its safety and effectiveness and the challenges in treating COVID-19.

Drug-Induced Acute Pancreatitis in Hospitalized COVID-19 Patients.

Coronavirus disease-19 (COVID-19), caused by SARS-CoV-2, is a systemic disease that affects not only the respiratory system, but also other systems, including gastrointestinal. A great number of different drugs have been used on hospitalized patients for the management of COVID-19, and acute pancreatitis (AP) has been reported as a complication or side effect of these drugs. The development of drug-induced acute pancreatitis (DIAP) follows a complex of pathophysiological mechanisms, and particular risk factors play a key role. Diagnosis of DIAP depends on specific criteria, and based on these, a drug may be characterized as having a definite, probable or possible connection with AP. The aim of this review is to present the medications that are used for COVID-19 management and are associated with AP in hospitalized patients. The list of these drugs mainly includes corticosteroids, glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), antiviral agents, antibiotics, monoclonal antibodies, estrogens and anesthetic agents. Moreover, the prevention of the development of DIAP is vital, especially for critically ill patients who may receive multiple drugs. DIAP management is mainly non-invasive and the first step concerns the exception of the suspicious drug from patients therapy.

Recommendations and guidelines for the diagnosis and management of Coronavirus Disease-19 (COVID-19) associated bacterial and fungal infections in Taiwan.

Coronavirus disease-19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 that has rapidly evolved into a pandemic to cause over 600 million infections and more than 6.6 million deaths up to Nov 25, 2022. COVID-19 carries a high mortality rate in severe cases. Co-infections and secondary infections with other micro-organisms, such as bacterial and fungus, further increases the mortality and complicates the diagnosis and management of COVID-19. The current guideline provides guidance to physicians for the management and treatment of patients with COVID-19 associated bacterial and fungal infections, including COVID-19 associated bacterial infections (CABI), pulmonary aspergillosis (CAPA), candidiasis (CAC) and mucormycosis (CAM). Recommendations were drafted by the 7th Guidelines Recommendations for Evidence-based Antimicrobial agents use Taiwan (GREAT) working group after review of the current evidence, using the grading of recommendations assessment, development, and evaluation (GRADE) methodology. A nationwide expert panel reviewed the recommendations in March 2022, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes the epidemiology, diagnostic methods and treatment recommendations for COVID-19 associated infections. The aim of this guideline is to provide guidance to physicians who are involved in the medical care for patients with COVID-19 during the ongoing COVID-19 pandemic.

Redefying the therapeutic strategies against cardiorenal morbidity and mortality: Patient phenotypes.

Chronic kidney disease (CKD) patients face an unacceptably high morbidity and mortality, mainly from cardiovascular diseases. Diabetes mellitus, arterial hypertension and dyslipidemia are highly prevalent in CKD patients. Established therapeutic protocols for the treatment of diabetes mellitus, arterial hypertension, and dyslipidemia are not as effective in CKD patients as in the general population. The role of non-traditional risk factors (RF) has gained interest in the last decades. These entail the deranged clinical spectrum of secondary hyperparathyroidism involving vascular and valvular calcification, under the term "CKD-mineral and bone disorder" (CKD-MBD), uremia per se, inflammation and oxidative stress. Each one of these non-traditional RF have been addressed in various study designs, but the results do not exhibit any applied clinical benefit for CKD-patients. The "crusade" against cardiorenal morbidity and mortality in CKD-patients is in some instances, derailed. We propose a therapeutic paradigm advancing from isolated treatment targets, as practiced today, to precision medicine involving patient phenotypes with distinct underlying pathophysiology. In this regard we propose two steps, based on current stratification management of corona virus disease-19 and sepsis. First, select patients who are expected to have a high mortality, i.e., a prognostic enrichment. Second, select patients who are likely to respond to a specific therapy, i.e., a predictive enrichment.

Differences in Clinical Course and Management of Sars-CoV2 Infection in Patients with Chronic Lymphocytic Leukemia between the Sequential Pandemic Phases: An Eric Study

BACKGROUND. Infection by SARS-CoV2 remains a worldwide health burden. Previous studies by the ERIC (European Research Initiative on CLL) showed that patients with chronic lymphocytic leukemia (CLL) have a very-high risk of severe Coronavirus disease 19 (COVID19). In particular, age, CLL-directed treatment, and cardiac failure were identified as significant risk factors of overall survival (OS). Since the beginning of 2020 different treatment strategies have been used to fight COVID19 and different SARS-CoV2 variants alternated during the pandemic, however very few studies analyzed their impact on patients with CLL. AIMS. The aims of this study were to investigate different manifestations, treatments and outcome of COVID19 in patients with CLL/SLL (small lymphocytic lymphoma), and MBL (monoclonal B-cell lymphocytosis). METHODS. This is a retrospective international multicenter ERIC study from Jan 2020 till May 2022. CLL diagnosis, COVID-19 management, review of medical history, and assessment of patient status were performed by local investigators following international guidelines. Ninety institutions participated in the study. Statistical analyses were conducted using R software. During the pandemic we identified 4 phases: 1st Jan 2020 - Jun 2020, 2nd Jul 2020 - Feb 2021, 3rd Mar 2021 - Dec 2021 and 4th Jan 2022 - May 2022. RESULTS. We gathered data from 1540 patients (93.8% CLL, 4.1% SLL and 2.1% MBL), 65% males, the median age at COVID19 was 69 years, median CIRS score was 4 (IQR 2-7), 49.6% were treated in the last 12 months before COVID19, 38.8% was on treatment at COVID19 onset (BTK inhibitor-based 51.1%, BCL2 inhibitor-based 20.7%, chemo/chemoimmunotherapy 21.5%, 6.7% others). Overall, 34.4% of patients was managed at home, 49.9% needed hospitalization and 15.7% was admitted to the intensive care unit (ICU). After a median follow-up of 2.7 months, the infection was resolved in 1124/1540 (73%) cases, while 23% died and 3.6% were still under medical observation. Distribution of patients among time is shown in Fig. 1A. Three hundred and four (19.8%) patients were infected during the 1st, 737 (48%) during the 2nd, 137 (8.9%) during the 3rd and 357 (23.3%) during the last 4th phase. Comparing the features of patients infected in different phases, age at COVID19 and distribution of biological markers were similar, but more patients in the latter phases suffered from arrhythmias (8.2% vs 10.5% vs 16.1% vs 14.2%, p=0.01), chronic renal disease (3.9% vs 5.9% vs 8.9% and 11.1%, p=0.003) and other malignancies (0.3% vs 1.8% vs 2.2% vs 3.6%, p=0.04). Vaccinated patients (0% vs 0.4% vs 45.7% vs 89.1%, p<0.001) and those treated for CLL in the last 12 months (44.1% vs 44.1% vs 55.7% vs 66.1%, p<0.001) were also more common in the last phases. COVID19 signs and symptoms differed between early and late phases, with less fever (p<0.001) and dyspnea (p=0.028) but more fatigue (p<0.001), cough (p<0.001), headache (p<0.001), anosmia/ageusia (p<0.001) and myalgia/arthralgia (p<0.001) in the later phases. COVID19 management also changed over time, with less patients receiving a SARS-CoV2 therapy (87.6% vs 74.7% vs 78.1% vs 67.9%, p<0.001). In particular, hydroxychloroquine, azithromycin, steroids and anti-IL6/IL6R were more commonly used in the first 2 phases while antiviral and monoclonal antibodies (mAb) were mainly employed in the last 2 phases. Less patients were hospitalized (84.5% vs 67.3% vs 60.3% vs 45.8%, p<0.001), needed ICU admission (20.6% vs 17.2% vs 13.3% vs 8.1%, p<0.001) or died (29.8% vs 25.5% vs 21.8% vs 15.8%, p=0.002) through these phases. These improvements in patients' management led to an increase of OS, with 2-month OS of 70%, 74%, 81% and 83% for patients diagnosed during the 1st, 2nd,3rd and 4th phase (p=0.0015, Fig. 1B). CONCLUSION. We analyzed one of the largest series of patients with CLL infected by SARS-CoV2 over more than 2 years of COVID19 pandemic. Patients infected during the most recent phases, though carrying a higher comorbidity burden, were less frequently hospitalized, only rarely needed ICU admission and died due to the SARS-CoV2 infection in a lower proportion compared to initial phases. The improvement in COVID-19 management with effective antiviral drugs, mAb and the high rate of vaccination together with the change in SARS-CoV2 variants over time may have played an important role in this outcome. AV, LS, TC, AK, CD and GK equally contributed. KS and PG are both last authors. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy.

Long coronavirus disease 19 (COVID-19) is the designation given to a novel syndrome that develops within a few months after infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and that is presenting with increasing incidence because of the numerous cases of infection. Long COVID-19 is characterized by a sequela of clinical symptoms that concern different organs and tissues, from nervous, respiratory, gastrointestinal, and renal systems to skeletal muscle and cardiovascular apparatus. The main common molecular cause for all long COVID-19 facets appears to be related to immune dysregulations, the persistence of inflammatory status, epigenetic modifications, and alterations of neurotrophin release. The prevention and management of long COVID-19 are still inappropriate because many aspects need further clarification. Exercise is known to exert a deep action on molecular dysfunctions elicited by long COVID-19 depending on training intensity, duration, and continuity. Evidence suggests that it could improve the quality of life of long COVID-19 patients. This review explores the main clinical features and the known molecular mechanisms underlying long COVID-19 in the perspective of considering exercise as a co-medication in long COVID-19 management.

A comprehensive design for prevention and management of COVID-19 in a tertiary medical institution in Bangladesh

Containment of the further spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reducing fatality due to coronavirus disease 19 (COVID-19) represent a pressing challenge to global health services. Here, we present a management blueprint for both the containment of SARS-CoV-2 and treatment of COVID-19 through a comprehensive approach. A cohort of 130 consecutive patients identified as positive for SARS-CoV-2 by testing of nasal swab by polymerase chain reaction were managed at a peripheral city of Bangladesh between 1 April and 31 May, 2020. Based on their clinical status, 64 of them were initially selected for isolation (Isolation Group) and 66 recommended for hospitalization (Hospital Group) as per the direction of the "Central COVID-19 Control" Center. Both groups of patients were allocated to receive standard of care management and oxygen inhalation, and intensive care unit management as and when necessary. Based on the conditions of the COVID-19 patients, there was an active system of patients being transferred from the "Isolation Group" to "Hospital Group" and vice versa. Twelve patients of the "Isolation Group" were transferred to the hospital, as they exhibited symptoms of deterioration. Four patients of the "Hospital Group" died during the observation period of two months in the intensive care unit. However, there has been no fatality among the patients of the "Isolation Group". The concept of "Isolation" and "Hospital Management" with the participation of the community seems to be an effective management strategy for COVID-19 in developing countries.

Dose Descriptors and Assessment of Risk of Exposure-Induced Death in Patients Undergoing COVID-19 Related Chest Computed Tomography.

For more than two years, coronavirus disease 19 (COVID-19) has represented a threat to global health and lifestyles. Computed tomography (CT) imaging provides useful information in patients with COVID-19 pneumonia. However, this diagnostic modality is based on exposure to ionizing radiation, which is associated with an increased risk of radiation-induced cancer. In this study, we evaluated the common dose descriptors, CTDIvol and DLP, for 1180 adult patients. This data was used to estimate the effective dose, and risk of exposure-induced death (REID). Awareness of the extensive use of CT as a diagnostic tool in the management of COVID-19 during the pandemic is vital for the evaluation of radiation exposure parameters, dose reduction methods development and radiation protection.

Role of the Unani System of Medicine in Countering Epidemic Diseases, Considering Coronavirus Pandemic -19

Published on:June 2022Journal of Young Pharmacists, 2022; 14(2):140-155Review Article | doi:10.5530/jyp.2022.14.28 Authors: MD Aftab Alam1, Mohammad Zakir1,*, Ahmed Minhajuddin1, Uzma Viquar1, Tasleem Ahmad2, Kuna Lahari2 1Department of Ilmul Advia (Unani Pharmacology), National Research Institute of Unani Medicine for Skin Disorders (NRIUMSD), AG Colony Road, Hyderabad, Telangana, INDIA.2Department of Biochemistry, National Research Institute of Unani Medicine for Skin Disorders (NRIUMSD), AG Colony Road, Erragadda, Hyderabad, Telangana, INDIA. Abstract: Since December 2019 world faces a respiratory pandemic named Coronavirus disease-19 (COVID-19). COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The term epidemic was coined by Hippocrates who is considered the father of Unani medicine which is based on four humours. In the Unani System of Medicine (USM) equivalent term for the epidemic is Wabā’. In classical Unani literature symptoms of Nazla-i-Wabā’iyya and Humma-i-Wabā’iyya closely resemble the symptoms of COVID-19. Major manifestations of this outbreak are cough, fever, headache, nausea, and breathlessness. This pandemic takes place due to a change in the quality of the surrounding air. We searched different databases electronically using the terms “COVID-19 or Coronavirus”, “Wabā› or infectious disease”, “Unani immunomodulators”, ‘’Herbal immunomodulators’’, ‘’Anti-viral herbal drugs’’, Herbal fumigation and “Nazla-i-Wabā’iyya or Nazla Wabā’ī”. We also gone through different classical textbooks of USM available in the NRIUMSD library. We reviewed the concept of Wabā’, its prevention, and management strategies available in USM. We also searched antiviral, immunomodulation, fumigation activities of Unani drugs. Unani physicians advocated general measures of physical distancing, health hygiene, isolation, quarantine, and immunomodulation. As a preventive measure, various immunomodulatory drugs like Asgandh, Aam, Babuna, Gilo, Satawar, and Kalonji and antidotes such as Tiryāq Wabā’i have been described in the literature. The ingredients of Tiryāqi- Wabā’i include Aloe barbedensis, Crocus sativus, and Commiphora myrrha. Several fumigants like Sandal, Ood, Kafoor, Loban, and Jhau are also mentioned in the management of the epidemic. For symptomatic management various antiviral, antipyretic and antitussive drugs are described well. Many evidence-based studies have already been reported for single drugs and formulations used in the USM. The Khamira Marwareed possesses antiviral, cardiotonic, and immunomodulatory activity. Single drugs such as Khaksi, Asgandh, Adusa, Chiriata, and Zanjabeel possess antipyretic, immunomodulatory, antitussive, antibacterial, and antiviral activities respectively. The knowledge from classical Unani literature and scientific researches may be useful in the prevention and management of COVID-19 like epidemic diseases. This review article aims to find out the concept of the pandemic, prevention, and management strategies existing in the USM.Key words: Amrād Wabā’ī, COVID-19, Epidemic, Humours, Kaifyat, Unani medicine, Wabā.

Impact of co-infection of streptococcus pneumoniae and pneumococcal vaccination on the clinical outcomes of coronavirus disease 19

Coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has spread all over the world. Streptococcus pneumoniae as a common pathogen of community-acquired pneumonia shares similar high-risk susceptible populations with COVID-19. Streptococcus pneumoniae co-infection is a key risk factor for severe COVID-19 and death. Pneumococcal vaccination has a beneficial impact on reducing the incidence and mortality of COVID-19. The vaccination rate of streptococcus pneumoniae is still low in China. Streptococcus pneumoniae vaccination may be one of effective strategies in the management of COVID-19 for high-risk population such as the elderly and those who have underlying chronic diseases.

MO292: Clinical Characteristics, Management and Outcomes of Critically ill COVID-19 Patients Undergoing CRRT: Comparison Between the First Two Pandemic Waves

BACKGROUND AND AIMSAcute kidney injury (AKI) is a common complication of coronavirus disease-19 (COVID-19), which, particularly in critically ill patients requiring continuous renal replacement therapy (CRRT), is associated with an elevated mortality risk [1, 2]. However, knowledge about COVID-19 pathogenesis and management is evolving, and clinical practice is changing rapidly. Here, we evaluated if this process had an impact on the management and outcome of AKI patients.METHODSWe performed a retrospective observational study on critically ill adult COVID-19 patients who received CRRT in the intensive care unit (ICU) during the first two pandemic waves before the availability of COVID-19 vaccines: the first one from March to August 2020 (first) and the second one (second) from September to December 2020.RESULTSOverall, we considered 63 patients, aged 65 (60–69) years, 76.2% males. The main comorbidities were diabetes (DM), cardiovascular disease (CVD) and chronic kidney disease (CKD). Among them, 28 (44%) were in the first group and 35 (66%) in the second group. There were no significant differences in general characteristics, such as in comorbidities, except for a higher prevalence of CVD in the first group (Fig. 1). Lab examinations at ICU admission, including serum creatinine level (sCr), were not different between the two groups. While all patients required respiratory support, non-invasive ventilation was more prevalent in the second wave. Notably, during this period, decapneization combined with CRRT was introduced. Regarding drugs, we found that in the second group, hydroxychloroquine was abandoned, tocilizumab use was reduced and heparin administration significantly increased. The AKI time course was similar between the patients of the two waves (Fig. 2). There were no significant differences in CRRT techniques. However, in the second, the use of additional CRRT-devices, in particular adsorption-based filters, significantly increased. In most cases, citrate anticoagulation was used in both groups. Looking at the outcomes, we found no significant difference between the two waves. Indeed, 17 (60.2%) and 22 (62.8%) patients died in the ICU in the first and second groups, respectively. The length of ICU hospitalization, days on CRRT, invasive ventilation and DM were significantly related to overall mortality; time of ICU hospitalization was the only remaining significant at multivariate Cox regression. Overall, 21 (33%) patients survived hospitalization. At the 6 months after the discharge, 3 of them died, 3 were on HD and 15 were dialysis-free, even if 6 of them presented CKD.FIGURE 1:Clinical characteristics and ICU management of critically ill COVID-19 patients undergoing CRRT.FIGURE 2:Kidney function and management of critically ill COVID-19 patients undergoing CRRT.CONCLUSIONOur data confirm the high complexity and mortality of COVID-19 patients undergoing CRRT. Comparing the first two pandemic waves, we found that the patients also presented similar characteristics in terms of renal function and AKI time course. Regarding treatments, we observed some significant modifications in the management of ventilation, drug administration and dialysis membranes, mainly because of the results of ongoing clinical trials. However, these changes did not impact patients’ outcomes.These data support the view that only game-change strategies, such as vaccination or infection-specific drugs, may impact the presentation and outcome of COVID-19 patients undergoing CRRT.Finally, patients surviving this condition deserve special attention in the follow-up.

Recommendations for the management of COVID-19 in patients with haematological malignancies or haematopoietic cell transplantation, from the 2021 European Conference on Infections in Leukaemia (ECIL 9).

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel virus that spread worldwide from 2019 causing the Coronavirus disease 19 (COVID-19) pandemic. SARS-CoV-2 infection is characterised by an initial viral phase followed in some patients by a severe inflammatory phase. Importantly, immunocompromised patients may have a prolonged viral phase, shedding infectious viral particles for months, and absent or dysfunctional inflammatory phase. Among haematological patients, COVID-19 has been associated with high mortality rate in acute leukaemia, high risk-myelodysplastic syndromes, and after haematopoietic cell transplant and chimeric-antigen-receptor-T therapies. The clinical symptoms and signs were similar to that reported for the overall population, but the severity and outcome were worse. The deferral of immunodepleting cellular therapy treatments is recommended for SARS-CoV-2 positive patient, while in the other at-risk cases, the haematological treatment decisions must be weighed between individual risks and benefits. The gold standard for the diagnosis is the detection of viral RNA by nucleic acid testing on nasopharyngeal-swabbed sample, which provides high sensitivity and specificity; while rapid antigen tests have a lower sensitivity, especially in asymptomatic patients. The prevention of SARS-CoV-2 infection is based on strict infection control measures recommended for aerosol-droplet-and-contact transmission. Vaccinations against SARS-CoV-2 has shown high efficacy in reducing community transmission, hospitalisation and deaths due to severe COVID-19 disease in the general population, but immunosuppressed/haematology patients may have lower sero-responsiveness to vaccinations. Moreover, the recent emergence of new variants may require vaccine modifications and strategies to improve efficacy in these vulnerable patients. Beyond supportive care, the specific treatment is directed at viral replication control (antivirals, anti-spike monoclonal antibodies) and, in patients who need it, to the control of inflammation (dexamethasone, anti-Il-6 agents, and others). However, the benefit of all these various prophylactic and therapeutic treatments in haematology patients deserves further studies.

Clinical progress of therapeutics and vaccines: Rising hope against COVID-19 treatment

Cases of deaths due to COVID-19 (COrona VIrus Disease-19) infection are increasing gradually worldwide. Immense research is ongoing to control this pandemic condition. Continual research outcomes are indicating that therapeutic and prophylactic agents are the possible hope to prevent the pandemic from spreading and to combat this increasing death count. Experience gained from previous coronavirus infections (eg., SARS (Severe Acute Respiratory Syndrome), MERS (Middle Ease Respiratory Syndrome), accumulated clinical knowledge during this pandemic, and research helped to identify a few therapeutic agents for emergency treatment of COVID-19. Thereby, monoclonal antibodies, antivirals, broad-spectrum antimicrobials, immunomodulators, and supplements are being suggested for treatment depending on the stage of the disease. These recommended treatments are authorized under medical supervision in emergency conditions only. Urgent need to control the pandemic condition had resulted in various approaches of repurposing the existing drugs, However, poorly designed clinical trials and associated outcomes do not provide enough evidence to fully approve treatments against COVID-19. So far, World Health Organization (WHO) authorized three vaccines as prophylactic against SARS-CoV-2. Here, we discussed about various therapeutic agents, their clinical trials, and limitations of trials for the management of COVID-19. Further, we have also spotlighted different vaccines in research in combating COVID-19.

Role of Ivermectin in Management of COVID-19

The pandemic corona virus disease 19 (COVID-19), caused by (SARS-CoV-2) a single stranded-RNA virus, has been spread rapidly worldwide with high rate of morbidity and mortality. Few months after the spread of the pandemic, few medications have proven to be efficient in human clinical trials. Several antiviral drugs have been used outside the scope of their initial medical use, such as lopinavir, hydroxychloroquine or azithromycin. Recent researches were done to show the efficacy of ivermectin in reducing SARS-CoV-2 viral RNA within 2 days. The use of ivermectin in in vitro studies has proven its efficacy against Corona virus. Based on the potency of ivermectin in in vitro studies, various clinical trials including patients infected with COVID-19 have been started; most of them have not been completed yet. Since the way how the virus infects the cells in vitro and in vivo is different, a decisive comment about how the ivermectin could exactly be beneficial to the patients has not been proven yet. Nevertheless, if ivermectin is compared to the other therapeutic treatments available for COVID-19 management, ivermectin has proved to have leverage over them. New randomized controlled clinical trials to assess the effectiveness of ivermectin the management of COVID-19 are strongly and urgently needed.

STUDY OF OXYGEN DELIVERY METHODS USE IN THE COVID-19 PATIENTS

Background: The oxygen crisis globally during the Corona virus disease-19 (COVID-19) pandemic reflected the need of appropriate and economic use of oxygen in its management. There is scarce report of the use of different oxygen delivery methods (ODMs) in COVID-19 patients in our region. Methods: This was a hospital-based observational study conducted from July 2021 to October 2021. We studied various ODMs used by 100 COVID-19 patients, aged 18 years or above admitted to Chitwan Medical College and Teaching Hospital during July to October 2021 and the trend of how the ODMs changed during the hospital stay. Data analysis was done by SPSS version 20 for Windows. Fisher’s exact and Kruskal Wallis tests were used to analyze the data of the participants. Results: In our study, oxygen supplementation at presentation using nasal cannula was required by 74% of patients, face mask by 13%, Venturi mask 34%, non-rebreathing mask 25%, high-flow nasal cannula 27%, non-invasive ventilation 6%, and invasive mechanical ventilation by 21%. There was significant difference in the use of ODMs at presentation among the moderate, severe and critical COVID-19 groups (P&lt;0.001). There was a wide range of switching between various ODMs during the treatment course. Conclusions: Nasal cannula was the most common ODM followed by venturi devices and invasive mechanical ventilation. Despite varying oxygen flow requirements, aerosol risks, merits and limitations of different ODMs, they can be appropriately used in various COVID-19 management situations. Besides inspired oxygen concentration and oxygen flow, patients’ condition, tolerance and availability of the resource also affected the choices of ODMs to achieve the correction of hypoxemia.

Association of Post-COVID Fatigue, Dyspnea, and Functional State with Sociodemographic Variable among the COVID-19 Sufferer of an Urban Section in Northeast India

Coronavirus disease-19 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 a global pandemic, has many non-respiratory symptoms which persist for several months after the initial infection. The presence of post-COVID-19 conditions may affect the functional state and quality of life in COVID-19 patients who were recovered in either home isolation or acute care hospital settings. The present study is a community-based cross-sectional survey undertaken during the devastating second wave of COVID-19 and the subjects recruited were ≥ 18 years with more than 3 weeks of post-COVID state selected from the municipality areas of Guwahati Urban, Northeast India. All the participants were screened for their sociodemographic characteristics, fatigue with Chalder fatigue scale (CFS), dyspnea, and functional state with MRC dyspnea grade and post-COVID functional scale (PCFS). Descriptive statistics and Pearson product-moment correlation coefficient analysis were used for statistical analysis where the fatigue total score and variable such as smoking status (P = 0.050) and time since symptom onset of COVID-19 (P = 0.046) in weeks showing a statistical significant relationship. There is a significant association between CFS and MRC grade with PCFS with P = 0.000 and 0.008, respectively. The study concluded that post-COVID conditions such as fatigue are more prevalent among the all individuals irrespective of their COVID-19 management in either home isolation or acute hospital care settings.

COVID-19 MANIFESTATION IN A CHILD WITH LUNG METASTASES OF OSTEOSARCOMA: A CASE REPORT

Background: COVID-19 (Corona virus disease-19) is an infectious disease caused by a new type of corona virus which in the same group of the virus that causes Severe Acute Respiratory Syndrome (SARS), where the incubation period for infection is 1-14 days or up to 24 days, accompanied by symptoms of a respiratory tract infection and other organ systems. The number of recent cases in November 2020 was 59.8 million worldwide. Elderly patients and people with comorbid diseases are at high risk of developing severe manifestations of this viral infection. Osteosarcoma is a deadly bone cancer that often causes patients to die from metastases to the lungs Purpose: The purpose of this study is to report cases of COVID-19 in a 9-year old child patient with a history of osteosarcoma at Bethesda Hospital Yogyakarta. Case Description: A 9-year old female patient came to the emergency room complaining of fever, cough, severe chest pain, and shortness of breath since 3 weeks before being admitted to the hospital. The patient had a past medical history of osteosarcoma since 1.5 years before being admitted to the hospital and an amputation procedure on the right arm was carried out, no specific illness in the family history was found. The general condition of the patient appears to be moderate with delirium consciousness (E4V6M1). Vital sign examination showed a pulse rate of 130 beats per minute, an oxygen saturation of 85% and a breath rate of 30 beats per minute. CT scan without contrast shows a massive left pleural effusion, malignancy/metastatic mass of the left lung, with pneumonic opacity in the right lung. Conclusion: COVID-19 is an infectious disease caused by SARS-CoV-2 and causes severe manifestations in patients with comorbid diseases including pulmonary metastases. CT-Scan modalities are used as a basis for diagnosis other than RT-PCR. Management of COVID-19 is in the form of supportive therapy based on the degree of disease severity.

Unique presentations of aspergillosis endogenous endophthalmitis in two hospitalized patients with severe COVID-19

We present two ICU-hospitalized patients with coronavirus disease-19 (COVID-19) presenting with endogenous endophthalmitis in one eye and variable manifestations of chorioretinitis in the fellow eye. Two diabetic patients (57 and 62 years old) showed anterior uveitis and yellowish-white subretinal infiltrations. The fellow eye of one patient showed patches of choroiditis, while the other showed full retinal thickness infiltrations. A workup yielded high serum titers of galactomannan, diagnostic of aspergillosis. The widespread use of high doses of corticosteroids in the management of COVID-19 may predispose to various secondary fungal opportunistic infections and may manifest in different forms of chorioretinal infiltration.

A Review on the Anti-Viral Activity of Houttuynia cordata: A Possible Herb for the Management and Treatment of COVID-19

Plants are an important source of natural products and they play a vital role in the field of medicinal chemistry and pharmaceutical science. Traditional medicines have been practiced and used for thousands of years, mostly in Asian countries, where plants are the main sources of medicine. Houttuynia cordata, a herb that belongs to the family Saururaceae, has a wide range of pharmacological activities and is used traditionally in conditions like anisolobis sores, heatstroke, lung carbuncles, malaria, scrotal abscess, tonsillitis, salammoniac poison and has also been widely accepted to possess anti-cancer, anti-oxidant, anti-hypertension, anti-inflammatory, anti-mutagenic, antibacterial, anti-viral and anti-purulent activity. Moreover, it is one of the herbs that was recognized during pandemic outbreaks, such as Severe Acute Respiratory Syndrome Coronavirus (SARS CoV) in China, virulent Newcastle Disease Virus (VNDV) in Java (Indonesia) and Newcastle (England). In this review, we briefly discuss the role of H. cordata as an anti-viral agent and the possibility of developing a dosage form against Coronavirus disease-19 (COVID-19).