Moderate COVID-19 Patients Research Articles

Clinical analysis of COVID-19 in patients with preexisting interstitial lung abnormalities

Objective: To describe the clinical characteristics of SARS-CoV-2 infected patients with interstitial lung abnormalities (ILA) during the COVID-19 pandemic. Methods: We respectively enrolled ILA patients who had been regularly followed up in Peking Union Medical College Hospital for more than six months since January 2021. Clinical data of these ILA patients were collected after the outbreak of COVID-19 pandemic (from December 2022 to January 2023), thirty-eight patients with preexisting ILA were enrolled. Among them, there were 34 ILA patients (20 males and 14 females) who were infected with SARS-CoV-2 during this period, with an average age of (64.0±8.8) years old (range: 41-80). There were 12 (35.3%) ILA patients who were suffered from COVID-19(pneumonia group) and others were the non-pneumonia group. The clinical characteristics, including vaccination status, features of COVID-19 and outcomes of the two groups were compared. Results: Regarding the subcategories of ILA, there were 7 cases of subpleural fibrotic ILA, 10 cases of subpleural non-fibrotic ILA, and 17 cases of non-subpleural ILA. Before SARS-CoV-2 infection, the average pulse oxygen saturation at rest was (97.38±0.87)% (range: 96%-99%); average forced vital capacity (FVC) was (97.6±18.1)% predicted (range: 65%-132%); and average diffusion capacity for carbon monoxide (DLCO) was (76.2±16.3)% predicted (range: 53%-108%). Nineteen patients had been vaccinated with 3 doses of SARS-CoV-2 vaccines, and 5 of them developed COVID-19. One patient had received one dose of vaccine and did not develop COVID-19. The other 14 patients had not been vaccinated, and seven of them developed COVID-19. Of the 12 patients with COVID-19, six were diagnosed with severe COVID-19, and the other 6 ILA patients were diagnosed with moderate COVID-19. Among them, 1 patient was complicated by deep vein thrombosis of left lower limb. All 6 patients with severe COVID-19 who were cured after systemic corticosteroids. As for the other six moderate COVID-19 patients, all were cured and/or improved greatly: two were treated with short-term oral corticosteroids, one was prescribed a dose of compound betamethasone, and the other two were not treated with systemic corticosteroids. Conclusion: Patients with ILA were predisposed to develop COVID-19 after infection with SARS-CoV-2, and more than half of them had severe COVID-19.

Study of Levofloxacin and Cefoperazone-Sulbactam Utilization Cost on Patients with Mild and Moderate Corona Virus Disease-2019

Covid-19 is a highly infectious disease caused by SARS Cov-2. Antibiotics are sometimes given as therapy to patients when there is a secondary bacterial infection. The purpose of this study was to determine the treatment costs associated with using antibiotics Levofloxacin and Cefoperazone Sulbactam for mild to moderate COVID-19 patients at Bhayangkara H.S Samsoeri Mertojoso Hospital in Surabaya. For mild COVID-19 patients who receive levofloxacin antibiotic therapy, the total cost of treatment is IDR. 66,648,632 with a length of stay of 9 days. For patients with moderate degrees of COVID-19, the total cost of treatment is Rp. 81,339,295 with 10 days of hospitalization. For mild COVID-19 patients who receive cefoperazone sulbactam antibiotic therapy, the total cost of treatment is IDR. 81,401,005 with a length of stay of 11 days. For patients with moderate degrees of COVID-19, the total medical costs are Rp. 71,613,107 with 9 days of hospitalization. Based on the evaluation of research results, mild COVID-19 patients can receive levofloxacin antibiotic therapy, while moderate COVID-19 patients can receive cefoperazone sulbactam antibiotic therapy because it is cheaper and results in a shorter length of stay.

Changes in lung function and dyspnea perception in Colombian Covid-19 patients after a 12-week pulmonary rehabilitation program.

Although moderate and severe Covid-19 patients have shown obstructive and restrictive disorders in pulmonary function after recovery from the disease, studies evaluating the effectiveness of rehabilitation programs that seek to improve lung function are scarce. Herein, we evaluate changes in lung function and perceived dyspnea in Covid-19 patients after undergoing 12 weeks of a pulmonary rehabilitation (PR) program. Retrospective observational study. Cesar, Colombia Neumocesar Pneumological Center. 100 outpatients with a history of Covid-19. Respiratory function using spirometry parameters, as well as perceived dyspnea, measured by the modified Medical Research Council (mMRC) dyspnea scale, was evaluated in 100 patients with a history of Covid-19. We used univariate and multivariate statistical approaches to assess changes in lung function and perceived dyspnea before and after a PR program to determine whether gender, age, height, weight, comorbidities, and oxygen delivery system affects the recovery of lung function and perceived dyspnea. It was found that PR treatment has positive effects on respiratory pathologies caused by SARS-CoV-2 infection regardless of patient gender (S = 0,029), indicating that rehabilitation provided benefits regardless of the physical characteristics of the patients. Both univariate and multivariate statistical analyses indicated that FVC (P = 0,0001), FEV1(P = 0,0001), and mMRC (P = 0,0001) are robust diagnostic indicators of lung function recovery and perceived dyspnea. Both invasive and non-invasive positive pressure ventilatory support had deleterious effects on lung function prolongating patient recovery (P = 0,0001). Rehabilitation programs can benefit patients facing respiratory pathologies caused by SARS-CoV-2 infection. Additional research on the long-term effects of the sequelae of Covid-19 is needed. PR programs have positive effects on patients facing respiratory pathologies caused by SARS-CoV-2 infection.

Evaluating therapeutic potential of AYUSH-64 constituents against omicron variant of SARS-CoV-2 using ensemble docking and simulations

The COVID-19 pandemic in the later phase showed the presence of the B.1.1.529 variant of the SARS-CoV-2 designated as Omicron. AYUSH-64 a poly herbal drug developed by Central Council for Research in Ayurvedic Sciences (CCRAS) has been recommended by Ministry of Ayush in asymptomatic, mild to moderate COVID-19 patients. One of the earlier, in-silico study has shown the binding of the constituents of AYUSH-64 to the main protease (Mpro) of the SARS-CoV-2. This study enlisted four phytochemicals of AYUSH-64, which were found to have significant binding with the Mpro. In continuation to the same, the current study proposes to understand the binding of these four phytochemicals to main protease (Mpro) and receptor binding domain (RBD) of spike protein of the Omicron variant. An enhanced molecular docking methodology, namely, ensemble docking has been used to find the most efficiently binding phytochemical. Using molecular dynamics (MD) simulations and clustering approach it was observed that the Mpro and RBD Spike of Omicron variant of SARS-CoV-2 in complex with human ACE2 tends to attain 4 and 8 conformational respectively. Based on the docking studies, the best binding phytochemical of the AYUSH-64, akummicine N-oxide was selected for MD simulations. MD simulations of akummicine N-oxide bound to omicron variant of Mpro and RBD Spike-ACE complex was performed. The conformational, interaction and binding energy analysis suggested that the akummicine N-oxide binds well with Mpro and RBD Spike-ACE2 complex. The interaction between RBD Spike and ACE2 was observed to weaken in the presence of akummicine N-oxide. Hence, it can be inferred that, these phytochemicals from AYUSH-64 formulation may have the potential to act against the Omicron variant of SARS-CoV-2.

Validity Test For C-Reactive Protein and Ferritin Level in Moderate and Severe Covid-19 Patients

Mild, moderate, severe, and critical COVID-19 are associated with hyperinflammation. The CRP and ferritin are acute phase proteins that marks incidence of inflammation and used as the paramaters of hyperinflammation. This study aimed to determine the validity of CRP and ferritin level examination in moderate and severe COVID-19 since the time of admission. This was a cross-sectional analytical retrospective study with on moderate and severe COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of March 2020 to December 2020. The CRP and ferritin levels were obtained since the beginning of admission to the fourth day since admission on patients without any history of anemia. Subjects in this study were divided into moderate and severe COVID-19 groups based on the 3rd edition of COVID-19 Prevention and Control Guideline issued by the Ministry of Health Republic of Indonesia. Each group consisted of 30 subjects. The cut-off value was 7.65 mg/dL (AUC 0.698) for CRP and 963.1 mcg/L (AUC 0.938) for ferritin. The validity of ferritin vs CRP were reflected respectively as follows: 93.3% vs 76.7% sensitivity; 80.0% vs 63.3% specificity; 82.4% vs 67.6% PPV; and 92.3% vs 73.1% NPV. The validity of ferritin was proven to be superior as it significantly increases since day one, persisted longer and reaches its peak on the16th day. Meanwhile, CRP increases within 6-8 hours and reaches its peak within 48 hours after inflammation, then declines soon afterwards.

Association of Serum Krebs von den Lungen-6 (KL-6) Levels and Disease Severity in Patients Hospitalized with COVID-19.

We aimed to evaluate Krebs von den Lungen-6 (KL-6) as a possible biomarker in determining disease severity in patients with moderate and severe COVID-19. This cross-sectional study included moderate or severe COVID-19 patients; critically ill patients who were followed up in the intensive care unit were not included. KL-6 level and routine laboratory test measurements were performed on the first day of admission. The patients were also categorized according to their hyperinflammatory state. The study included 92 patients, 56 (61%) women. The National Institutes of Health (NIH) score was 2 in 52.2% of the patients and 3 in 47.8%. KL-6 levels did not significantly differ in disease severity (NIH score 2 vs. 3; p=0.15). Median KL-6 values were 52.7 (29.1) in patients with <2 COVID-19 hyperinflammatory syndrome score (cHIS) and 61.7 (32.2) in patients with cHIS ≥ 2 (p= 0.077). KL-6 values tended to be higher among the patients with lower lymphocyte counts, but the difference was not statistically significant (<1000 mm³/L p=0.006 and higher cHIS scores ≥2 p=0.07). KL-6 values were also higher in the patients with diabetes mellitus compared to the remaining patients (p =0.036). There was no significant association between the serum KL-6 measured at admission and the severity of COVID-19.

A Prospective, Controlled, Pilot Study of Personalised Add-on Ayurveda Treatment in High-Risk Type II Diabetes COVID-19 Patients

IntroductionIn hospitalised mild to moderate COVID-19 patients with pre-existing type 2 diabetes, we evaluated the efficacy of add-on customised Ayurveda intervention as compared to standard of care (SOC) in ameliorating symptoms, avoiding the need for ICU admission and ventilator support plus bringing down interleukin-6 (IL-6), and C-reactive protein (CRP) over 15 days. MethodsIn this quasi-experimental trial, 24 participants per arm diagnosed with COVID-19 by RT-PCR, aged 18–75 years, fulfilling the inclusion/exclusion criteria, were inducted. The subjects were allocated, depending on their own voluntary choice, to SOC plus Ayurveda (group 1) or SOC alone (group 2) for 15 days. The analyses used the Cochran-Mantel-Haenszel test, multivariate ANOVA plus within-group repeated measures ANOVA, and Cochran’s Q test. ResultsOf the 13 symptoms, cough (P = 0.04), general weakness (P = 0.02), and sore throat (P = 0.02) were statistically significantly different across the groups, with group I (add-on) improving better than group II (SOC). IL-6 dropped rapidly in group 1 by 7 days (P = 0.006) group 2 caught up by day 15 (P = 0.001). CRP improved slower than IL-6. The time to maximum change was not statistically different for IL-6 and CRP between the groups at day 15. There were no differences in random blood sugar and adverse events to Ayurveda-added SOC group. ConclusionsIn this quasi-experimental cough, weakness, and sore throat improved more in the add-on Ayurveda than in the SOC. IL-6 concentrations are declining more rapidly in the add-on Ayurveda. Clinical and laboratory adverse events suggested no additional toxicity of add-on Ayurveda treatments. This study supports the need for a randomised, double-blind trial.

Role of biomarkers in prognostication of moderate and severe COVID-19 cases.

COVID-19 pandemic demanded upgrading of laboratory medicine to limit morbidity, disability and mortality from moderate and severe SARS-COV-2 infections. To assess among moderate and severe COVID-19 patients, C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, interleukin 6 (IL-6), lactate dehydrogenase (LDH), total and differential leucocyte count (TLC and DLC), neutrophil-to-lymphocyte ratio (NLR), absolute platelet count (APC), prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) to find their interdependence and role in prognosis. This open label analytical cross-sectional noninterventional study evaluated array of independent biochemical, haematological and coagulopathy markers, viz. CRP, PCT, ferritin, D-dimer, IL-6, LDH, TLC, DLC, NLR, absolute platelet count, PT, APTT and INR on consecutive 100 patients with diagnosis of moderate and severe COVID-19 from July to August 2021. In our study, on consecutive designated 100 cases (55 cases moderate and 45 cases severe), more severity were reported as the age progressed; gender difference was not noted. Among independent markers, CRP, PCT, ferritin, D-dimer, IL-6 and LDH had statistically significant relation in comparison with severity of the disease as Chi-square calculated value (P < 0.05). TLC, DLC and APC showed no significant relation in comparison with severity of the disease; NLR had highly significant relation. PT showed significant relation in comparison with severity, though APTT and INR did not show significant relation. Our research group felt that CRP, PCT, ferritin, D-dimer, IL-6, LDH and NLR should be in included in clinical practice guidelines to prognosticate COVID-19 cases. Furthermore, translational researches are needed at all levels of healthcare to improve validity for practices of primary care physicians.

1345. Clinical Characteristics and Outcomes of Mild to Moderate COVID-19 Patients with Abnormal Chest Radiologic Findings Treated in the Hospitels in Thailand

Abstract Background Hospitels are the hotels converted into the healthcare facilities extension in areas with limited resources including hospital beds during the peak of COVID-19 pandemic in Thailand. This study aimed to determine the clinical features and outcomes of asymptomatic and mild to moderate COVID-19 patients who were treated in these facilities. Methods We conducted a retrospective study by reviewing the medical records of adult COVID-19 patients who were admitted to Siriraj Hospital’s affiliated hospitels in Bangkok between June and October 2021. Patients’ characteristics, vaccination status, treatment data, and clinical outcomes were collected. Results We compared baseline characteristics and clinical features of COVID-19 patients based on their initial chest x-ray (CXR) findings. Of 1,729 patients, 644 (37.2%) had an abnormal baseline CXR, and these patients were older (49.2 vs. 42.2 years, p &amp;lt; 0.001), had higher body weight (68.1 vs. 64.7 kg, p &amp;lt; 0.001) and BMI (26.3 vs. 24.9 kg/m², p &amp;lt; 0.001), and were more likely to have underlying diseases such as diabetes (p = 0.002), hypertension (p &amp;lt; 0.001), obesity (p &amp;lt; 0.001), chronic lung disease (p = 0.029), and autoimmune disease (p = 0.028). They were also more likely to have a risk of disease progression (p &amp;lt; 0.001) and were less likely to be fully vaccinated (p &amp;lt; 0.001). They were more likely to be referred back to the hospital (p &amp;lt; 0.001). We found no significant differences in sex or COVID-19 symptoms between the two groups, except cough and fatigue. The total cost of admission was significantly higher for referred patients than discharged patients (70,545 vs. 12,010 Thai baht, p &amp;lt; 0.001). Conclusion A significant proportion of COVID-19 patients with abnormal CXR findings who were admitted to the hospitels had underlying diseases and higher risk of disease progression. Additionally, they were more likely to be referred back to the hospital and had higher healthcare costs. Continued surveillance and monitoring of high-risk COVID-19 patients in hospitels to ensure efficient management and resource utilization were needed. Disclosures All Authors: No reported disclosures

Beneficial effects of the combination of BCc1 and Hep-S nanochelating-based medicines on IL-6 in hospitalized moderate COVID-19 adult patients: a randomized, double-blind, placebo-controlled clinical trial

BackgroundIn the severe forms of COVID-19 and many other infectious diseases, the patients develop a cytokine storm syndrome (CSS) where pro-inflammatory cytokines such as IL-6 and TNF-α play a key role in the development of this serious process. Selenium and iron are two important trace minerals, and their metabolism is tightly connected to immune system function. Numerous studies highlight the role of selenium and iron metabolism changes in the procedure of COVID-19 inflammation. The immunomodulator effect of nanomedicines that are synthesized based on nanochelating technology has been proved in previous studies. In the present study, the effects of the combination of BCc1(with iron-chelating property) and Hep-S (containing selenium) nanomedicines on mentioned cytokines levels in hospitalized moderate COVID-19 patients were evaluated.MethodsLaboratory-confirmed moderate COVID-19 patients were enrolled to participate in a randomized, double-blind, placebo-controlled study in two separate groups: combination of BCc1 and Hep-S (N = 62) (treatment) or placebo (N = 60) (placebo). The blood samples were taken before medications on day zero, at discharge, and 28 days after consumption to measure hematological and biochemical parameters and cytokine levels. The clinical symptoms of all the patients were recorded according to an assessment questionnaire before the start of the treatment and on days 3 and discharge day.ResultsThe results revealed that consumption of the nanomedicines led to a significant decrease in the mean level of IL-6 cytokine, and at the end of the study, there was a 77% downward trend in IL-6 in the nanomedicine group, while an 18% increase in the placebo group (p < 0.05). In addition, the patients in the nanomedicines group had lower TNF-α levels; accordingly, there was a 21% decrease in TNF-α level in the treatment group, while a 31% increase in this cytokine level in the placebo was observed (p > 0.05). On the other hand, in nanomedicines treated groups, clinical scores of coughing, fatigue, and need for oxygen therapy improved.ConclusionsIn conclusion, the combination of BCc1 and Hep-S inhibits IL-6 as a highly important and well-known cytokine in COVID-19 pathophysiology and presents a promising view for immunomodulation that can manage CSS.Trial registrationIranian Registry of Clinical Trials RCT20170731035423N2. Registered on June 12, 2020.

Comparative Analysis of Hematological and Inflammatory Biomarkers in Moderate and Severe COVID-19 Patients

In COVID-19 patients, abnormal blood clotting is common, characterized by elevated D-dimer and fibrinogen levels, reduced platelets, and prolonged clotting times. The second week of infection can trigger a cytokine storm, marked by heightened proinflammatory Interleukin-6 (IL-6) levels, associated with Acute Respiratory Distress Syndrome (ARDS) and organ failure. This study compared hematological biomarkers, D-dimer, and IL-6 in moderate and severe COVID-19 cases. In a cross-sectional study, 81 patients meeting inclusion criteria were examined at a leading private COVID-19 referral hospital in Malang Regency. Data from clinical records and lab results encompassing blood counts, D-dimer, and IL-6 levels were collected. D-dimer was assessed through immunoturbidimetry (STA-Procoag-PPL, Diagnostica Stago S.A.S.), while IL-6 was measured using a chemiluminescent immunoassay (Cobas e411 Elecsys, Roche). Data distribution normality was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Non-normally distributed data were analyzed using the Mann-Whitney U test for numerical data and the Fisher exact test for comorbidity-severity correlation. Moderate COVID-19 cases disproportionately affected females, while severe cases had an even gender distribution. The median age was comparable, but mild cases were typically younger. Hemoglobin, hematocrit, leukocyte, neutrophil, platelet, and procalcitonin levels were normal in both groups, with lowered lymphocyte counts. Severe cases displayed a higher Neutrophil-to-Lymphocyte Ratio (NLR). D-dimer and IL-6 were significantly elevated in extreme cases. This study underscores potential gender and age-related discrepancies in COVID-19 severity, emphasizing the significance of monitoring specific blood parameters for disease progression indicators. Further investigation is vital to unveil underlying mechanisms and clinical implications, aiding the management of COVID-19 patients.

Genotyping of rs228666 SNP of the human gene ACE2 in mild, moderate and severe COVID-19 patients.

The ACE2-converting enzyme has been identified as the specific receptor for coronavirus, but the effect of the ACE2 gene polymorphism is still unknown, so the expression of human ACE2 independently may affect the susceptibility to infection with COVID-19. Coronavirus is an infectious and pandemic disease caused by it. To evaluate the association between the ACE2 gene polymorphism and the severity of COVID-19 infection, we used PCR polymerase reaction and polymorphism methods to examine 80 patients classified into severe infection based on symptoms and 80 control factors. Results demonstrated statistical significance in this high-risk group and the function of rs228666 SNP in the risk of infection with the independent ACE2 gene rs228666. Individuals who have the variation A allele may be more vulnerable to infection than those who carry G in a condition with the GA genotype when compared to other genotypes GG and GA. In contrast, the AA genotype was not significant. Coronavirus susceptibility and disease severity were related to inflammation and genetic polymorphism, while there was no clear evidence linking this rs228666 SNP to the severity of COVID19 infection. At the 0.01 % probability level, the prediction of the GG genotype for control was not significant. In the case of mild infections, the ACE2 rs228666 SNP genotype was found to be a protective factor for infection with COVID-19 illness in Iraqi patients. Furthermore, patients with this GA genotype are more likely to develop COVID-19 illness than the other genotypes, although the AA genotype had no significant effect on this disease. Individuals with the A allele are also more likely to be infected with COVID-19 than those with the G allele, according to the findings. The GG genotype of the ACE2 rs228666 SNP was substantially more significant at the 0.01 % probability level in the medium cases compared to the control group, showing that the GG genotype of the ACE2 rs228666 SNP is a protective factor against the incidence of infection. With COVID-19 in Iraqi patients, however, the values of the AA genotype are not significant, implying that an individual who carries the A allele is more likely to get COVID-19 disease than those who possess the GG allele. Keywords: Coronavirus, SNP, ACE2.

A - 72 Neuropsychological Test Performance in Mild to Moderate COVID-19 Patients with and without Subjective Cognitive Complaints.

This cross-sectional study measured cognitive performance in mild-moderate COVID-19 patients with and without self-reported persistent cognitive complaints, while accounting for demographic variables, cardiovascular (CVD) risk factors, and mood symptoms. We hypothesized that individuals with persistent cognitive complaints would demonstrate lower global cognitive composite scores compared to those without. 67 adults aged 24-83 completed in-person neuropsychological testing in a hospital setting in Phoenix, Arizona. PCR-confirmed COVID-19 within 24months before evaluation and no pre-existing neurological conditions. The Long COVID (LC) group included those with persistent cognitive symptoms 4+ weeks after infection; COVID-positive Controls (CC) included those with prior infection but without persistent cognitive symptoms. Demographic information, CVD risk factors, and psychiatric history were collected. Neuropsychological evaluation included performance validity testing and validated measures of attention, language, visuospatial ability, executive function, and memory. T-scores from each domain were averaged to create a global cognitive composite score. Gender, age, race (white/non-white), mood disorder, and CVD were equivalent across groups. Education was significantly higher in the LC group, t(65) = 2.737, p = 0.008, and was included as a covariate in the model to account for differences in cognitive reserve. With this adjustment, there was not a statistically significant difference in global composite scores between groups, F(1, 64) = 0.13, p = 0.911, partial η2 = 0.000. Cognitive performance did not differ between LC and CC groups when demographics, cardiovascular risk, and mood symptoms were held constant, suggesting that other factors influence the development of persistent cognitive complaints in mild-moderate COVID-19 patients.

The real-world effectiveness of fluvoxamine therapy in mild to moderate COVID-19 patients; A historical cohort study (Fluvoxa Trial)

BackgroundFluvoxamine (FVX) has been proposed as a potential treatment for severe COVID-19 by the σ-1 receptor agonist, which can reduce cytokine production. However, the efficacy of FVX remains controversial. MethodsA historical retrospective cohort study was conducted in mild to moderate COVID-19 patients, 2:1 ratio of standard of care (SOC) and FVX treatments to assess the effectiveness of FVX in preventing deterioration by the fifth day of treatment. ResultsOf 752 eligible patients, 234 received FVX while 518 received SOC, and there was no significant difference in the effectiveness of FVX and SOC in preventing clinical deterioration. On the fifth day after treatment, 86.1 % of patients in the FVX-treated group did not experience clinical deterioration compared to 78.7 % in the SOC group. Notably, the FVX group had higher rates of pneumonia development and hospitalization, requiring more oxygen supplementation while showing less reduction in viral shedding than the SOC group. However, no difference in mechanical ventilation use, ICU admission, and survival was observed. ConclusionFluvoxamine treatment is failed to demonstrate effectiveness in preventing deterioration in mild to moderate COVID-19 and may lead to a higher incidence of pneumonia, hospitalization, and oxygen supplementation, necessitating careful consideration before prescribing the drug for COVID-19.

The Difference of Survival Rate COVID-19 in Patients with Initiated Hemodialysis and Regularly Hemodialysis

Background: Since December 2019, a novel coronavirus called SARSCoV-2 (severe acute respiratory syndrome coronavirus) has caused an international outbreak of respiratory illness described as COVID-19. This study aimed to describe the difference in the survival rate of COVID-19 induced AKI with hemodialysis and COVID-19 in patients with CKD on hemodialysis in Dr. M Djamil General Hospitals. Also, in this review, we provide a comprehensive overview of data on the factors that may be affected by COVID-19 survival rates in patients with COVID-19 induced AKI with hemodialysis and COVID-19 in patients with CKD on hemodialysis. This study was conducted to analyze the survival of COVID-19 with initiated or regular HD patients in Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This study was conducted from January 2021 to July 2021 in Dr. M. Djamil General Hospital, Padang, West Sumatera, Indonesia. Data for this study was collected through medical records of patients admitted for COVID-19 with CKD in hemodialysis and acute renal failure induced by COVID-19 to show the demographics, comorbidities, and survival rates of the patients who underwent hemodialysis.&#x0D; Results: Factors associated with survival in COVID-19 with hemodialysis were COVID-19 severity and abnormal potassium serum level (Table 3). Moderate COVID-19 patients tend to survive than severe COVID-19 patients (OR 60; 95% CI 16.034 – 224.525). There was no significant difference in survival between initiated and regular HD (p = 0.829).&#x0D; Conclusion: There is no difference in clinical outcome from patients with COVID-19 who initiated hemodialysis or regularly HD to the survival rates.

Traditional Chinese medicine (Lianhua Qingwen) as an add-on to Western medicine for mild to moderate COVID-19 patients: A meta-analysis

Abstract Background: Proprietary traditional Chinese medicine (TCM) such as Lianhua Qingwen (LQ) has been promoted to be an over-the-counter product for treating infectious diseases including COVID-19. This meta-analysis aimed to evaluate the efficacy of LQ in adults with mild or moderate COVID-19 diseases. Materials and Methods: The authors conducted the literature search using six electronic databases (Chinese and English) from the inception dates of the different database to October 31, 2022, using search for relevant keywords, that is, “severe acute respiratory syndrome coronavirus 2,” “COVID-19,” “Lianhuaqingwen,” and “Lianhua Qingwen” to identify randomized controlled trials (RCTs). Three reviewers independently identified studies, extracted the data, and assessed study quality. All analyses were conducted on RevMan 5.3. Results: A total of 6 RCT studies involving patients with COVID-19 were identified according to the inclusion and exclusion criteria. The quality of included studies was moderate. LQ was effective in improving overall clinical efficacy (RR = 1.25; 95% CI: 1.14–1.36; P &lt; 0.001), and relieved three features, that is, cough (WMD = –2.04; 95% CI: –3.92 to –0.17; P = 0.03), fatigue (WMD= –2.58; 95% CI: –3.45 to –1.71; P &lt; 0.001), and chest CT resolution (RR = 1.21; 95% CI: 1.02–1.43; P = 0.03) but not resolution of fever (WMD = –0.46; 95% CI: –1.54 to 0.62; P = 0.40) among adults with mild or moderate COVID-19. LQ was also effective in reducing the rate of conversion to severe cases (RR = 0.57; 95% CI: 0.37–0.86; P = 0.007). The adverse events rate (RR = 0.74; 95% CI: 0.40–1.37; P = 0.35) were similar between LQ group and the control group. Conclusion: This meta-analysis of six RCT shows that the Lianhua Qingwe (LQ) as an add-on to Western medicine achieves a higher overall clinical efficacy, faster resolution of cough, fatigue and chest CT changes than Western medicine alone in COVID patients. LQ is also effective in reducing the rate of conversion to severe cases. Further double-blinded placebo-controlled randomized studies are warranted for LQ as a stand-alone treatment for the “heat” subtype of mild to moderate COVID diseases.

The role of IL-6, ferritin, and coagulopathy in Covid-19 clinical progression.

Background In COVID-19, the release of pro-inflammatory mediators in the cytokine storm, primarily interleukin-6 (IL-6), has been hypothesized to induce pulmonary intravascular coagulation. However, the relationship between IL-6 and coagulopathy remains unclear in COVID-19 progression. We aimed to investigate the correlation of IL-6 with D-dimer, fibrinogen, prothrombin time (PT), and ferritin. Furthermore, we also analyzed the effect of those parameters on the worsening of COVID-19 patients. Methods A prospective cohort study was conducted in moderate and severe COVID-19 patients from June 2020 to January 2021. A serial evaluation of IL-6, D-dimer, fibrinogen, ferritin, and PT was performed and correlated with the patient's condition at admission and on the 14th day. The outcomes (improvement, worsening, or discharged patients) were recorded during the study. Results Of 374 patients, 73 study subjects (61 severe and 12 moderate COVID-19) were included in this study. A total of 35 out of 61 severe and one out of 12 moderate illness subjects had experienced worsening. Spearman-rank correlation of IL-6 with with ferritin, D-dimer, fibrinogen, and PT was 0.08 ( p=0.5), -0.13 ( p=0.27), 0.01 ( p=0.91), and 0.03 ( p=0.77), respectively. In ROC analysis, D-dimer (74,77%) and IL-6 (71,32%) were the highest among other variables (>60%). Conclusions In COVID-19 patients, there was a correlation between elevated IL-6 and D-dimer levels with disease deterioration. There was no correlation between elevated IL-6 levels with ferritin, D-dimer, fibrinogen, and PT levels. Therefore, changes in IL-6 and D-dimer can predict worsening in moderate and severe COVID-19 patients.

A double-blind, placebo-controlled, randomized clinical trial to evaluate the efficacy and safety of Virulina® along with standard treatment as per hospital protocol for the treatment of novel coronavirus (COVID-19)

Background: There is a high priority for the treatment of mild or moderate COVID-19 in an outpatient setting.&#x0D; Objective: To test the efficacy, safety and tolerability of Virulina® in mild or moderate COVID-19 patients.&#x0D; Methods: We carried out a double-blind, placebo-controlled, randomized clinical trial involving adult (18-70yrs) mild or moderate COVID-19 patients, randomized 1:1 on Virulina® (3 gm, maximum 14 days) or placebo respectively along with standard-of-care. The primary endpoint was the time taken for nasopharyngeal swab RT-PCR to test negative. And the average change in the ordinal scale from the baseline scores on the eight-point WHO ordinal scale was assessed.&#x0D; Results: 30 outpatients were selected between 13 July 2020 to 13 August 2020. 93.33% of Virulina® treated patients were virologically cured compared to 53.33% in the placebo group (p= 0.001). The disappearance rates of major symptoms were significantly high in Virulina® plus standard treatment group compared with standard treatment alone.&#x0D; Conclusion: Virulina® meets the primary and secondary endpoint criteria and exhibits statistically significant efficacy for mild or moderate COVID-19 patients. It is efficacious, safe, and well-tolerated at the tested dosage of 3gm for a maximum of 14 days.&#x0D; Keywords: COVID-19; herbal medicine; immunomodulation; clinical trial.

Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience.

Data on the characteristics of acute kidney injury (AKI) in pediatric COVID-19 and MIS-C are limited. We aimed to define the frequency, associated factors and early outcome of AKI in moderate, severe or critical COVID-19 and MIS-C; and to present a tertiary referral center experience from Türkiye. Hospitalized patients ≤ 18years of age with confirmed COVID-19 or MIS-C at İhsan Doğramacı Children's Hospital, Hacettepe University, between March 2020-December 2021 were enrolled. The characteristics of AKI in the COVID-19 group were investigated in moderate, severe and critically ill patients; patients with mild COVID-19 were excluded. The median (Q1-Q3) age in theCOVID-19 (n = 66) and MIS-C (n = 111) groups was 10.7years (3.9-15.2) and 8.7years (4.5-12.7), respectively. The frequency of AKI was 22.7% (15/66) in COVID-19 and 15.3% (17/111) in MIS-C; all MIS-C patients with AKI and 73.3% (11/15) of COVID-19 patients with AKI had AKI at the time of admission. Multivariate analyses revealed need for vasoactive/inotropic agents [Odds ratio (OR) 19.233, p = 0.002] and presence of vomiting and/or diarrhea (OR 4.465, p = 0.036) as independent risk factors of AKI in COVID-19 patients; and need for vasoactive/inotropic agents (OR 22.542, p = 0.020), procalcitonin and ferritin levels as independent risk factors of AKI in theMIS-C group. Age was correlated with lymphocyte count (r = -0.513, p < 0.001) and troponin level (r = 0.518, p < 0.001) in MIS-C patients. Length of hospital stay was significantly longer in both groups with AKI, compared to those without AKI. Mortality was 9.1% in theCOVID-19 group; and was associated with AKI (p = 0.021). There was no mortality in MIS-C patients. AKI recovery at discharge was 63.6% in COVID-19 survivors and 100% in MIS-C patients. Independent risk factors for AKI were need for vasoactive/inotropic agents and vomiting/diarrhea in moderate, severe or critical COVID-19 patients; and need for vasoactive/inotropic agents and severe inflammation in MIS-C patients. Our findings suggest that inflammation and cardiac dysfunction are associated with AKI in MIS-C patients; and the association with age in this group merits further studies in larger groups. Early outcome is favorable; long-term follow-up for kidney functions is needed.

Evaluation of cardiovascular autonomic dysfunction in symptomatic post-COVID-19 patients using the heart rate variability (HRV) and detection of subtle LV dysfunction using 2D global longitudinal strain (GLS)

AimThe COVID-19 disease primarily affects the respiratory system; however, cardiac involvement has been documented in the acute phase. We aimed to evaluate the cardiac autonomic function and subtle left ventricular dysfunction in those subjects recovered from mild to moderate acute COVID-19 patients but still symptomatic.Methods and resultsThe study group was composed of 50 subjects with confirmed mild to moderate COVID-19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 h Holter monitoring for HRV analysis. The mean age of the study population was 42 ± 18 years; symptoms were reported as follows 27 (54%) had dyspnoea, 17 (34%) had palpitation, and 7 (14%) had dizziness. Time domain parameters Standard Deviation of NN intervals (SDNN), Standard Deviation of the Average NN intervals for each 5 min segment of a 24 h HRV recording (SDANN), and Root Mean Square of Successive RR interval Differences (rMSSD) were diminished with mean SDNN value being markedly impaired in 12 (24%) patients, while frequency domain parameters as assessed by the ratio of the Low-Frequency band power to the High-Frequency band power (LF/HF) with the mean of 1.837 with 8% of the patients being impaired. SDNN was significantly reduced in patients with impaired global longitudinal strain (p 0.000). The global longitudinal strain was diminished in 10 patients (20%); also, 80% of the patients with impaired GLS had decreased SDNN.ConclusionOur study targeted patients experiencing prolonged symptoms after COVID-19 illness. We detected a high incidence of GLS impairment using Speckle Tracking Echocardiography (STE) and a significant prevalence of diminished HRV. HRV (especially SDNN) and GLS were found to be significantly correlated.Graphical abstract