Management Of Coronavirus Disease 2019 Patients Research Articles

Tocilizumab demonstrates superiority in decreasing C-reactive protein levels in hospitalized COVID-19 patients, compared to standard care treatment alone.

Severe acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crisis. The virus triggers the activation of inflammatory reactants including interleukin-6 (IL-6), ferritin, and C-reactive protein (CRP), causing multiorgan damage, particularly affecting the lungs. Tocilizumab, an IL-6 receptor blocker, has the potential to diminish the progression of the disease and reduce organ damage and long-term complications. The aim of this observational retrospective cohort study was to evaluate the efficacy of tocilizumab in decreasing CRP levels in hospitalized coronavirus disease 2019 (COVID-19) patients compared to standard care without the drug. The study included 141 patients during their Hospital Stay (HS), with 100 in the Tocilizumab group and 41 in the non-Tocilizumab group. Clinical information was collected from the electronic clinical record, analyzed using statistical software, and homogenized the CRP levels from the severe group to the levels of the less complicated group at 48 h of hospitalization. The results showed a statistically significant greater decrease in CRP levels in the Tocilizumab group at 48 h after the use of the treatment, with no differences in mortality or length of stay between the groups. In conclusion, tocilizumab accelerates the diminishing of CRP levels compared to standard treatment alone, and its use may have potential benefits in the management of severe COVID-19 patients when used alongside with follow-up quantification of CRP levels reduction.IMPORTANCESevere acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crises. International guidelines for managing coronavirus disease 2019 (COVID-19) give recommendations according to the severity of the disease and the level of oxygen therapy needed. Tocilizumab is an option for the therapeutic management of hospitalized patients with any level of oxygen therapy; IL-6 serum level is the parameter for the follow-up on the efficacy, but it is not available at many hospitals. In this study, we demonstrate that C-reactive protein determination can predict the response to tocilizumab in severe COVID-19, the target patients for treatment with this drug. The use of this affordable and extensively available biomarker supports clinical decisions for the early escalation of the therapy and for the rational use of this drug on those prone to improve with the use of it.

Clinical and diagnostic utility of platelet count and its parameters in COVID-19

The majority of the published studies have described the alterations in platelet count and platelet indices in both severe and non-severe Coronavirus Disease 2019 (COVID-19). However, their association with COVID-19 mortality remains unclear. In the present study, our aim is to determine the temporal evolution of platelet count and its parameters between survivors and non-survivors, as well as their potential association with clinical outcomes. This cross-sectional study included 1118 inpatients (≥18 years old) diagnosed as SARS-CoV-2 positive by a Real-Time Polymerase Chain Reaction (RT-PCR) and hospitalized between May 1st, 2020 and November 1st, 2020. Data of complete blood count (CBC) parameters evaluated on different days after admission was gathered and the median value of each CBC parameter was considered for assessing the difference between survivors and non-survivors. There was statistically significant variation between survivors and non-survivors for platelet count [p<0.001, mean difference-80 x 109/L], mean platelet volume [p<0.001, mean difference- 0.7 fL], platelet distribution width [p<0.001, mean difference-2.5%] and platelet-lymphocyte ratio [p<0.001, mean difference-123.8]. Thrombocytopenia occurred more commonly in deceased patients compared to survivors. Platelet count, Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) differed significantly between survivors and non-survivors, revealing distinct trends indicating their importance in the management of COVID-19 patients. These cost-effective parameters can be easily obtained from a CBC.

Expert consensus on the management of interstitial lung disease during the COVID-19 epidemic

Expert consensus on the management of interstitial lung disease during the COVID-19 epidemic

Leukopenia and leukocytosis as strong predictors of COVID-19 severity: A cross-sectional study of the hematologic abnormalities and COVID-19 severity in hospitalized patients.

Predicting severe disease is important in provocative decision-making for the management of patients with the coronavirus disease 2019 (COVID-19); However, there are still some controversies about the COVID-19's severity predicting factors. This study aimed to investigate the relationships between clinical and laboratory findings regarding COVID-19's severity in patients admitted to a tertiary hospital in Mashhad, Iran. A cross-sectional study was conducted on patients with documented COVID-19 infection based on the reverse transcription-polymerase chain reaction test. Clinical symptoms, vital signs, and medical history of the patients were recorded from their medical records. Laboratory findings and computed tomography (CT) study findings were documented. Disease severity was defined based on CT scan findings. A total of 564 patients (58.8 ± 16.8 years old) were evaluated. The frequency of severe disease was 70.4%. There was a significant difference in heart rate (p = 0.0001), fever (p = 0.002), dyspnea (p = 0.0001), chest pain (p = 0.0001), diarrhea (p = 0.021), arthralgia (p = 0.0001), and chills (p = 0.044) as well as lymphopenia (p = 0.014), white blood cell count (p = 0.001), neutrophil count (p < 0.0001), lymphocyte count (p < 0.0001), and prothrombin time (p = 0.001) between disease severity groups. Predictors of severe COVID-19 were pulse rate (crude odds ratio [cOR] = 1.014, 95% confidence interval [CI] for cOR: 1.001, 1.027) and leukopenia (cOR = 3.910, 95% CI for cOR: 1.294, 11.809). Predictors for critical COVID-19 were pulse rate (cOR = 1.075, 95% CI for cOR: 1.046, 1.104), fever (cOR = 2.516, 95%CI for cOR: 1.020, 6.203), dyspnea (cOR = 4.190, 95% CI for cOR: 1.227, 14.306), and leukocytosis (cOR = 3.866, 95% CI for cOR: 1.815, 8.236). Leukopenia and leukocytosis have the strongest correlation with the COVID-19 severity. These findings could be a valuable guild for clinicians in COVID-19 patient management in the inpatient setting.

A Review of Crucial Radiological Investigations in the Management of COVID-19 Cases.

Chest X-ray, chest CT, and lung ultrasound are the most common radiological interventions used in the diagnosis and management of coronavirus disease 2019 (COVID-19) patients. The purpose of this literature review, which was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is to determine which radiological investigation is crucial for that purpose.PubMed, Medline, American Journal of Radiology (AJR), Public Library of Science (PLOS), Elsevier, National Center for Biotechnology Information (NCBI), and ScienceDirect were explored. Seventy-two articles were reviewed for potential inclusion, including 50 discussing chest CT, 15 discussing chest X-ray, five discussing lung ultrasound, and two discussing COVID-19 epidemiology. The reported sensitivities and specificities for chest CT ranged from 64 to 98% and 25 to 88%, respectively. The reported sensitivities and specificities for chest X-rays ranged from 33 to 89% and 11.1 to 88.9%, respectively. The reported sensitivities and specificities for lung ultrasound ranged from 93 to 96.8% and 21.3 to 95%, respectively. The most common findings on chest CT include ground glass opacities and consolidation. The most common findings on chest X-rays include opacities, consolidation, and pleural effusion. The data indicate that chest CT is the most effective radiological tool for the diagnosis and management of COVID-19 patients. The authors support the continued use of reverse transcription polymerase chain reaction (RT-PCR), along with physical examination and contact history, for such diagnosis. Chest CT could be more appropriate in emergency situations when quick triage of patients is necessary before RT-PCR results are available. CT can also be used to visualize the progression of COVID-19 pneumonia and to identify potential false positive RT-PCR results. Chest X-ray and lung ultrasound are acceptable in situations where chest CT is unavailable or contraindicated.

SARS-CoV-2 Testing Strategies in the Diagnosis and Management of COVID-19 Patients in Low-Income Countries: A Scoping Review.

The accuracy of diagnostic laboratory tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can impact downstream clinical procedures in managing and controlling the outbreak of coronavirus disease 2019 (COVID-19). To assess the effectiveness of laboratory tools for managing COVID-19 patients in low-income countries (LICs), we systematically searched the PubMed, Embase, Scopus and CINHAL databases for reports published between January 2020 and June 2022. We found that 22 of 1303 articles reported the performance of various SARS-CoV-2 detection tools across 10 LICs. These tools were (1) real-time reverse transcriptase polymerase chain reaction (RT-PCR); (2) reverse transcription loop-mediated isothermal amplification (RT-LAMP); (3) rapid diagnostic tests (RDTs); (4) enzyme-linked immunosorbent assay (ELISA); and (5) dot-blot immunoassay. The detection of COVID-19 is largely divided into two main streams-direct virus (antigen) detection and serology (immunoglobulin)-based detection. Point-of-care testing using antigen-based RDTs is preferred in LICs because of cost effectiveness and simplicity in the test procedures. The nucleic acid amplification technology (RT-PCR and RT-LAMP) has the highest diagnostic performance among the available tests, but it is not broadly used in this context due to costs and shortage of facilities/trained staff. The serology-based test method is affected by antibody interferences and varying amounts of SARS-CoV-2 immunoglobulins expressed at different stages of disease onset. We further discuss the effectiveness and shortcomings of each of these tools in the diagnosis and management of COVID-19. Using the LICs as the study model, our findings highlight ways to improve the quality and turnaround time of COVID-19 testing in resource-constrained settings, notably through local/international collaborative efforts to refine the molecular-based or immunoassay-based testing technologies.

Morphological Changes in Red Blood Cells, White Blood Cells, and Platelets in COVID-19 Infected Patients: A Cross-sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) is a highly infectious virus that mutates rapidly. This has led to the emergence of newer variants that can spread more easily and may be more resistant to current treatments and vaccines. It is possible that new variants could emerge in the future that could be even more dangerous than the current ones. Aim: To identify and describe characteristic changes in peripheral smears of COVID-19 patients. Materials and Methods: A cross-sectional study was conducted at Government Medical Hospital Nizamabad, Telangana, India from March 20, 2021, to June 10, 2021. A total of 600 COVID-19 patients who were tested positive via Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) were included, and blood tests were performed on the day of admission before any prior intervention. Samples were analysed using a Complete Blood Count (CBC) analyser, and peripheral smears were examined to identify the morphological changes of Red Blood Cells (RBCs), White Blood Cells (WBCs), and Platelets in COVID-19-affected patients. These changes help assess the disease process, its severity, and aid in its proper management. Results: Out of the 600 cases, 384 (64%) were males, and 216 (36%) were females. The study showed the following RBC changes: microcytic hypochromic RBCs 333 (55.5%), macrocytic RBCs 66 (11%), dimorphic picture 33 (5.5%); WBCs showed neutrophilia 535 (89.17%), lymphopenia 535 (89.17%), pseudo Pelger-Huët cells 468 (78%), smudge cells 360 (60%), reactive lymphocytes 360 (60%), large granular lymphocytes 72 (12%), and large giant platelets 444 (74%) in peripheral smears of COVID-19 patients. Conclusion: As COVID-19 patients showed specific morphological changes in RBCs, WBCs, and Platelets, CBC and peripheral smear analysis can be interpreted in conjunction with other clinical and confirmatory tests for prognostication and management of COVID-19 patients.

Predictors of Length of Hospital Stay in Patients with COVID-19: A Retrospective Study

Introduction: Known independent predictors of extended Length Of Stay (LOS) in Coronavirus Disease 2019 (COVID-19) included older age, chronic kidney disease, elevated maximum temperature, and low minimum oxygen saturation. Additional known predictors of prolonged hospitalisation included male sex, chronic obstructive pulmonary disease, hypertension, and diabetes. Elevated levels of C-Reactive Protein (CRP), creatinine, and ferritin are proven determinants of hospitalisation and LOS. Determining predictors of LOS will aid in triaging and management of COVID-19 patients. Aim: To assess the clinical, biochemical and radiological profile of admitted COVID-19 patients and determine the predictors of prolonged length of stay at hospital. Materials and Methods: It was a retrospective, cross-sectional observational, record-based study included hospital records of 544 confirmed COVID-19 patients, above age of 18 years admitted at Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India, during February 2021 to June 2021. Possible determinants of LOS were studied including their demographic, epidemiological, clinical and radiological characteristics. The patients were divided into two groups as per median LOS i.e, group I with LOS &lt;10 days (n=277) and group II with LOS ≥10 days (n=267). Statistical analysis was done using Chi-square test, proportion test, Z test, MannWhitney U test, regression analysis by Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: Mean age in group I and II was 47.83±16.34 years and 53.21±15.63 years (p-value &lt;0.0001), respectively. The fatigue was significantly more in group II than group I (p-value=0.018). Diabetes mellitus was more (p-value=0.026) and severity of illness (p-value&lt;0.0001) was significantly higher in group II than group I. In univariate analysis, mean Neutrophil/Lymphocyte ratio (p-value&lt;0.0001), serum LDH (p-value&lt;0.018), blood urea level (p-value&lt;0.0001), random blood sugar (p-value=0.003), glycated haemoglobin (HbA1c) (p-value=0.072) and serum creatinine (p-value=0.41) were significantly more in group II. Median CRP (p-value&lt;0.0001), D-dimer (p-value&lt;0.0001), serum ferritin (p-value&lt;0.0001), procalcitonin (p-value&lt;0.0001), Serum Glutamic Oxaloacetic Transaminase (SGOT) (p-value=0.002) was significantly higher in group II. Lung involvement {chest radiograph or High-Resolution Computed Tomography (HRCT) chest} was significantly (p-value&lt;0.0001) more in group II. Conclusion: Fatigue, older age, diabetes mellitus, severity of illness, mean neutrophil/lymphocyte ratio, CRP, D-dimer, serum ferritin, serum Lactate Dehydrogenase (LDH), procalcitonin, blood urea, SGOT were associated with prolonged LOS among hospitalised COVID-19 patients.

Curious thing, an artificial intelligence (AI)-based conversational agent for COVID-19 patient management.

There are no clear guidelines or validated models for artificial intelligence (AI)-based approaches in the monitoring of coronavirus disease 2019 (COVID-19) patients who were isolated in the community, in order to identify early deterioration of their health symptoms. Developed in partnership with Curious Thing (CT), a Sydney-based AI conversational technology, a new care robot technology was introduced in South Western Sydney (SWS) in September 2021 to manage the large numbers of low-to-medium risk patients with a COVID-19 diagnosis and who were isolating at home. The CT interface made contact with patients via their mobile phone, following a locally produced script to obtain information recording physical condition, wellness and support. The care robot has engaged over 6323 patients between 2 September to 14 December 2021. The AI-assisted phone calls effectively identified the patients requiring further support, saved clinician time by monitoring less ailing patients remotely, and enabled them to spend more time on critically ill patients, thus ensuring that service and supply resources could be directed to those at greatest need. Engagement strategies had ensured stakeholders support of this technology to meet clinical and welfare needs of the identified patient group. Feedback from both the patients and healthcare staff was positive and had informed the ongoing formulation of a more patient-centred model of virtual care.

Highlighting the Treatment Regimens used in COVID-19 epidemic in Iraq with Special Regards to Vitamin D

Coronavirus disease 2019 (COVID-19) is a flu-like infection caused by a novel virus known as Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). After the widespread around the world, it was announced by the World Health Organization (WHO) as a global pandemic. The symptoms of COVID-19 may arise within 2 weeks and the severity ranged from mild with signs of respiratory infection to severe cases of organ failure and even death. Management of COVID-19 patients includes supportive treatment and pharmacological medications expected to be effective with no definitive cure of the disease. The aims of this study are highlighting the management protocol and supportive therapy especially vitamin D and manifesting the clinical symptoms by patients in Iraq. An observational study was conducted on 200 patients and descriptive parameters for data were calculated to analyze the results. The mean age was 42.56±17.49 years and the majority of patients were presented with mild to moderate symptoms (78%). There were many different pharmacological treatment regimens and random doses and duration of vitamin D were taken by the patients. In conclusion, a non-specific treatment protocol was used for the patients without compliance to the national guidelines for management and treatment of COVID-19 patients in Iraq with the administration of a wide range of pharmaceutical agents that required monitoring for their safety and efficacy. Vitamin D is administered in different doses and duration without depending on the basal serum concentration.

Liver injury induced by COVID 19 treatment - what do we know?

The severity of coronavirus disease 2019 (COVID-19) may be correlated with the risk of liver injury development. An increasing number of studies indicate that degrees of hepatotoxicity have been associated with using some medications in the management of COVID-19 patients. However, limited studies have systematically investigated the evidence of drug-induced liver injury (DILI) in COVID-19 patients. An increasing number of studies indicate that degrees of hepatotoxicity have been associated with using some of these medications in the management of COVID-19 patients. Significantly, it was relieved after the cessation of these agents. However, to our knowledge, no studies have systematically investigated the evidence of DILI in COVID-19 patients. In this review, we discussed the association between hepatotoxicity in COVID-19 patients and the drugs used in these patients and possible mechanisms of hepatotoxicity. The currently available evidence on the association of different therapeutic agents with hepatotoxicity in COVID-19 patient was systematically reviewed.

Problems Associated with Co-Infection by Multidrug-Resistant Klebsiella pneumoniae in COVID-19 Patients: A Review.

To date, coronavirus disease 2019 (COVID-19) and its variants have been reported as a novel public health concern threatening us worldwide. The presence of Klebsiella pneumoniae in COVID-19-infected patients is a major problem due to its resistance to multiple antibiotics, and it can possibly make the management of COVID-19 in patients more problematic. The impact of co-infection by K. pneumoniae on COVID-19 patients was explored in the current review. The spread of K. pneumoniae as a co-infection among critically ill COVID-19 patients, particularly throughout hospitalization, was identified and recorded via numerous reports. Alarmingly, the extensive application of antibiotics in the initial diagnosis of COVID-19 infection may reduce bacterial co-infection, but it increases the antibiotic resistance of bacteria such as the strains of K. pneumoniae. The correct detection of multidrug-resistant K. pneumoniae can offer a supportive reference for the diagnosis and therapeutic management of COVID-19 patients. Furthermore, the prevention and control of K. pneumoniae are required to minimize the risk of COVID-19. The aim of the present review is, therefore, to report on the virulence factors of the K. pneumonia genotypes, the drug resistance of K. pneumonia, and the impact of K. pneumoniae co-infection with COVID-19 on patients through a study of the published scientific papers, reports, and case studies.

GENETIC VARIANTS AND SERUM PROFILES OF CYTOKINES IN COVID-19 SEVERITY.

Background: Patients with severe coronavirus disease 2019 (COVID-19) are at an increased risk of acute respiratory distress syndrome and mortality. This is due to the increased levels of pro-inflammatory cytokines that amplify downstream pathways that are controlled by immune regulators. Objective: This study aimed to investigate the association between cytokine genetic variants, cytokine serum levels/profiles, and disease severity in critically and noncritically ill COVID-19 patients. Methods: This cross-sectional study recruited 646 participants who tested positive for severe acute respiratory syndrome coronavirus 2 from six collection sites across the United Arab Emirates. Medical files were accessed to retrieve clinical data. Blood samples were collected from all participants. Patients were divided into two clinical groups, noncritical (n = 453) and critical (n = 193), according to World Health Organization classification guidelines for COVID-19 patients. Cytokine analyses were conducted on serum of a subset of the cohort, specifically on 426 participants (noncritical, 264; critical, 162). Candidate gene analyses of 33 cytokine-related genes (2,836 variants) were extracted from a genome-wide association study to identify genetic variants with pleiotropic effects on a specific cytokine and the severity of COVID-19 disease. Results: Age, body mass index (BMI), and pre-existing medical conditions were found to be significant risk factors that contribute to COVID-19 disease severity. After correcting for age, sex, and BMI, IP-10 ( P < 0.001), IFN ( P = 0.001), IL-6 ( P < 0.001), and CXCL-16 ( P < 0.001) serum levels were significantly higher among critical COVID-19 cases, when compared with noncritically ill patients. To investigate if the genetic variants involved in the serum cytokine levels are associated with COVID-19 severity, we studied several genes. Single nucleotide polymorphisms in IL6 (rs1554606; odd ratio (OR) G = 0.67 [0.66, 0.68]; P = 0.017), IFNG (rs2069718; OR G = 0.63 [0.62, 0.64]; P = 0.001), MIP (rs799187; OR A = 1.69 [1.66, 1.72]; P = 0.034), and CXCL16 (rs8071286; OR A = 1.42 [1.41, 1.44]; P = 0.018) were found to be associated with critically ill patients. Polymorphisms in the CXCL10 , CCL2 , IL1 , CCL7 , and TNF genes were not associated with the COVID-19 critical phenotype. The genotypes of IL-6 (gene, IL6 [7p15.3]) and CXCL-16 (gene, CXCL16 [17p13.2]) were significantly associated with the serum levels of the respective cytokine in critical cases of COVID-19. Conclusion: Data obtained from measuring cytokine levels and genetic variant analyses suggest that IL-6 and CXCL-16 could potentially be used as potential biomarkers for monitoring disease progression of COVID-19 patients. The findings in this study suggest that specific cytokine gene variants correlate with serum levels of the specific cytokine. These genetic variants could be of assistance in the early identification of high-risk patients on admission to the clinic to improve the management of COVID-19 patients and other infectious diseases.

Plasma exchange and COVID 19

Plasma exchange and COVID 19

The effect of Ni gella sativa and vitamin D3 supplementation on the clinical outcome in COVID-19 patients: A randomized controlled clinical trial.

Background: The coronavirus disease 2019 (COVID-19) is a novel coronavirus that causes severe infection in the respiratory system. Since the immune status plays an essential role in combating COVID-19, herbal medicines, which have an immunomodulatory effect, may help prevent and even treat COVID-19. Nigella sativa is one of the herbal medicines with antiviral and immunomodulatory activities, and its therapeutic effectiveness makes it a promising add-on therapy for COVID-19. In addition, vitamin D3 has an immunomodulatory role, but the effect of therapeutic vitamin D3 supplementation in SARS-CoV-2 infection is still not well-known. Objective: This study aims to investigate the effects of Nigella sativa and vitamin D3 as single supplemental therapies and in combination on viral clearance indicated by a negative polymerase chain reaction and the alleviation of symptoms during the study follow-up duration of 14days. Patients and Methods: The study design was an open-label randomized controlled clinical trial conducted at the Respiratory Hospital at the Kobry El Qobba Armed Forces Medical Complex. In total, 120 COVID-19 patients with mild to moderate symptoms were randomly assigned to four groups, with thirty patients each, as follows: Group 1 received an oral dose of 900mg Nigella sativa through 450mg soft gelatin capsules twice daily for two weeks; Group 2 received 2,000 IU of vitamin D3 through 1000-IU tablets given as two tablets, once daily; Group 3 received 900mg of Nigella sativa and 2,000 IU of vitamin D3 in the same manner of dosing as in the previous groups; and Group 4 was the control group. All groups received standard therapy for COVID-19 infections and clinical management of COVID-19's clinical symptoms. Results: The Nigella sativa-vitamin D3 combination in addition to the standard therapy for COVID-19 infections significantly contributed to the alleviation of most COVID-19 symptoms: 50% of patients were free of cough after 7days, 70% showed an absence of fatigue after 4days, 80% had no headache after 5days, 90% were free of rhinorrhea after 7days, and 86.7% of the patients had no dyspnea after 7days. Moreover, patients in the four studied groups showed a reduced median temperature after 3days of treatment. Negative results of the polymerase chain reaction (PCR) test recorded on the 7th and 14thday of therapy were superior in the Nigella sativa and vitamin D3 combination arm compared to those of the other studied arms where the value of the odds ratio (OR) on the 7thday was 0.13 with 95% CI: 0.03-0.45 and that of the 14th day was 0.09 with 95% CI: 0.02-0.3. Conclusion: The results of this study showed a promising therapeutic benefit of the administration of Nigella sativa and vitamin D3 combination in COVID-19 patients with mild to moderate symptoms. Additionally, the remarkable viral clearance in a short time interval and reduction in the severity and progression of symptoms recommended the use of this combination as an add-on therapy for the management of COVID-19 patients. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT04981743.

Role of high dose vitamin C in management of hospitalised COVID-19 patients: A minireview.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the most dreadful viruses the mankind has witnessed. It has caused world-wide havoc and wrecked human life. In our quest to find therapeutic options to counter this threat, several drugs have been tried, with varying success. Certain agents like corticosteroids, some anti-virals and immunosuppressive drugs have been found useful in improving clinical outcomes. Vitamin C, a water-soluble vitamin with good safety profile, has been tried to reduce progression and im-prove outcomes of patients with coronavirus disease 2019 (COVID-19). Because of its anti-oxidant and immunomodulatory properties, the role of vitamin C has expanded well beyond the management of scurvy and it is increasingly been employed in the treatment of critically ill patients with sepsis, septic shock, acute pancreatitis and even cancer. However, in spite of many case series, observational studies and even randomised control trials, the role of vitamin C remains ambiguous. In this review, we will be discussing the scientific rationale and the current clinical evidence for using high dose vitamin C in the management of COVID-19 patients.

An Insight of Clinical Evidence of Ayurveda Interventions in the Management of COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) was caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and patients with COVID-19 may be treated with traditional medicine like Ayurveda alone or in combination with standard allopathic treatment, as Ayurveda is one of the oldest traditional medicinal systems followed by millions around the world. The literature was searched in databases such as LitCOVID, Google Scholar, Science Direct, EBSCO, Scopus, Web of Science, EMBASE, and reference lists to identify articles relevant to the use of Ayurvedic medicines in the management of COVID-19. Several clinical studies have determined the efficacy of Ayurvedic medicines and formulations in the management of patients with COVID-19. The Ayurvedic medicines and formulations with antiviral, antioxidant, anti-inflammatory, and immunomodulatory properties could be used along with standard allopathic medicines to assist in the earlier detection of virus, speedy recovery of patients with COVID-19, faster discharge from hospitals, and the prevention of further deterioration.

A Newly Developed Interprofessional In-Situ Simulation-Based Training for Airway Management of COVID-19 Patients: Identification of Challenges and Safety Gaps, and Assessment of the Participants' Reaction.

BackgroundHealthcare providers performing aerosol-generating procedures like airway management are at the highest risk for contamination with coronavirus disease 2019 (COVID-19). We developed an in-situ simulation (ISS) airway management training in confirmed or suspected COVID-19 patients for emergency and anesthesiology staff, evaluated participants’ reactions, and identified perceived challenges.MethodsWe used a cross-sectional study design incorporating a quantitative questionnaire to describe participants’ reaction to the ISS and a qualitative group interview using the plus-delta debriefing modality to explore participants’ challenges in acquiring the knowledge and skills required for each learning objective. Data were analyzed using descriptive statistics and deductive content analysis.ResultsTwo hundred and ninety-nine healthcare providers participated in 62 ISS training sessions. Over 90% of our study participants agreed or strongly agreed that: they understood the learning objectives; the training material appropriately challenged them; the course content was relevant, easy to navigate, and essential; the facilitators’ knowledge, teaching, and style were appropriate; the simulation facilities were suitable; and they had ample opportunities to practice the learned skills. The main challenges identified were anticipating difficult airways, preparing intubation equipment, minimizing the number of personnel inside the room, adhering to the proper doffing sequence, preparing needed equipment outside the intubation room, speaking up, and ensuring closed-loop communication.ConclusionThe newly developed ISS training was feasible for busy healthcare practitioners to safely perform airway management procedures for suspected or confirmed COVID-19 patients without affecting bedside care. Anticipation of difficult airways and speaking up were the most frequent challenges identified across all specialties in this study.

Detection of Viral Infection and Bacterial Coinfection and Superinfection in Coronavirus Disease 2019 Patients Presenting to the Emergency Department Using the 29-mRNA Host Response Classifier IMX-BVN-3: A Multicenter Study.

BackgroundIdentification of bacterial coinfection in patients with coronavirus disease 2019 (COVID-19) facilitates appropriate initiation or withholding of antibiotics. The Inflammatix Bacterial Viral Noninfected (IMX-BVN) classifier determines the likelihood of bacterial and viral infections. In a multicenter study, we investigated whether IMX-BVN version 3 (IMX-BVN-3) identifies patients with COVID-19 and bacterial coinfections or superinfections.MethodsPatients with polymerase chain reaction–confirmed COVID-19 were enrolled in Berlin, Germany; Basel, Switzerland; and Cleveland, Ohio upon emergency department or hospital admission. PAXgene Blood RNA was extracted and 29 host mRNAs were quantified. IMX-BVN-3 categorized patients into very unlikely, unlikely, possible, and very likely bacterial and viral interpretation bands. IMX-BVN-3 results were compared with clinically adjudicated infection status.ResultsIMX-BVN-3 categorized 102 of 111 (91.9%) COVID-19 patients into very likely or possible, 7 (6.3%) into unlikely, and 2 (1.8%) into very unlikely viral bands. Approximately 94% of patients had IMX-BVN-3 unlikely or very unlikely bacterial results. Among 7 (6.3%) patients with possible (n = 4) or very likely (n = 3) bacterial results, 6 (85.7%) had clinically adjudicated bacterial coinfection or superinfection. Overall, 19 of 111 subjects for whom adjudication was performed had a bacterial infection; 7 of these showed a very likely or likely bacterial result in IMX-BVN-3.ConclusionsIMX-BVN-3 identified COVID-19 patients as virally infected and identified bacterial coinfections and superinfections. Future studies will determine whether a point-of-care version of the classifier may improve the management of COVID-19 patients, including appropriate antibiotic use.

Prolonged Viral Shedding in Three Young Adult Cases of COVID-19.

Severe acute respiratory syndrome coronavirus-2 infection is usually self-limited, with a short duration for viral shedding within several weeks. However, prolonged viral shedding has been observed in severe or immune-compromised coronavirus disease 2019 (COVID-19) cases. Here, we reported that three young adult cases of COVID-19 patients, who were either immunosuppressed nor severe, showed prolonged viral RNA shedding from the upper respiratory tract for 58, 81, and 137 days since initial diagnosis. To our knowledge, this is the longest duration of viral shedding reported to date in young adult patients. Further studies on factors relevant to prolonged viral positivity, as well as the correlation between viral positivity and transmission risk are needed for the optimal management of COVID-19 patients with prolonged nucleic acid positive.