Moderate Pneumonia Research Articles

Evaluation of Respiratory Functions with Spirometry in Patients with SARS-CoV-2 Pneumonia

Objective: This study aims to evaluate respiratory functions in patients Coronavirus disease-2019 (COVID-19) with and without pneumonia.
 Material and Methods: This single-center, prospective study included a total of 72 patients who were diagnosed with COVID-19 infection as confirmed by real-time reverse transcriptase polymerase chain reaction (rtPCR). The patients were divided into two groups according to the physical and thoracic computed tomography (CT) findings as mild symptomatic patients without COVID-19 pneumonia (n=26) and symptomatic cases with COVID-19 pneumonia (n=46). Respiratory functions were evaluated by spirometry in the second and fourth months of the disease onset.
 Results: The average age of 72 patients, 41 of whom were men, was 40.5±12.27 years. Thoracic CT revealed infiltrations compatible with COVID-19 pneumonia in 46 (63.9%) patients. Hypertension (12.5%) and diabetes (5.6%) were the most common comorbidities. When the results of the patients with and without pneumonia at the second and fourth months were compared, there was no significant difference between the forced expiratory volume in the first second (FEV1) (p1=0,975, p2=0,291), forced vital capacity (FVC) (p1=0,668,p2=0,481) and FEV1/FVC ratio (FER) (p1=0,378, p2=0,980) values. When the repeated anova test was used in the comparison of the two visit differences between the groups, it was seen that there was no difference in any heading (FVC: p=0.077; FEV1: p=0.150; FER: p=0.355).
 Conclusions: Our study results show no significant difference in the pulmonary function tests of patients with mild and moderate COVID-19 pneumonia at two and four months, compared to those without pneumonia However, additional studies are needed for severe and critical cases.

Dexamethasone or methylprednisolone therapy in covid-19 pneumonia: A retrospective and comparative study of 513 cases

BackgroundsCorona virus disease 19 (Covid-19) affects especially the respiratory tract, and induces lung injury which may progress to the acute respiratory distress syndrome (ARDS). Various treatment options were tried all over the world, corticosteroids had showed beneficial effects.The Objective of this study, is to compare the safety and efficiency of two corticosteroids: dexamethasone and prednisolone in the treatment of Covid-19 infection. MethodsThis retrospective and comparative study included 513 patients diagnosed with Covid-19 infection and were admitted to intensive care unit of our university hospital center of MOHAMMED VI Oujda from March 1, 2020, to December 31st, 2020. ResultsIn this study, 513 cases were included, 230 patients were received methylprednisolone, and 283 were treated with dexamethasone. The median age in methylprednisolone group was 64 years, and 63 years in the second group treated with dexamethasone. Patients treated with dexamethasone had more critically lesions compared to patients treated with methylprednisolone (67.6%), these patients had a good evolution with a significant reduction of oxygen supplementation, lower use of invasive ventilation and a significant improvement in biological parameters. The difference in outcome between the two groups in terms of mortality was significantly reduced in the second group. ConclusionBoth steroids are efficient in the management of mild, moderate and severe Covid-19 pneumonia with a clear superiority of dexamethasone especially in severe forms.

Ashwagandha-Induced Gastric Upset in Post-Covid Patient-A Case Report and Brief Review of the Literature

Adverse drug reporting of herbal drugs is less common as they are generally considered as safe. It is also very common to use self-medication by people in the case of herbal drugs. But many times, mild to severe events have been seen with the use of herbal or ayurvedic medicines. We have reported a case of post-covid patient, who was having complained of headache, body ache, lethargy, backache, generalized weakness and excessive sweating since one weak. Patient had past history of hospitalization due to COVID-19 moderate pneumonia one month back. Patient also had history of type-2 diabetes mellitus, hypertension and dyslipidemia and was taking anti-diabetic and anti-hypertensive medications continuously. Ashwagandha powder (Withania somnifera), Maha yogaraj guggulu (herbal anti-inflammatory) and Syrup Amynity Plus (herbal immune-booster) were prescribed for these complain. Conversely, moderate severity adverse reaction like nausea, vomiting, diarrhea, and abdominal cramps were noted after the intake of suspected drug i.e. ashwagandha powder. Nevertheless, symptoms were relieved after the de-challenge. This shows a temporal relation of the event with the suspected drug. One more possibility of drug-drug interaction in this case cannot be ruled out completely. Causality assessment was done for this adverse event and it was considered as the “probable” category of the adverse event in WHO causality classification.

Effects of Anticoagulants and Corticosteroids Therapy in Patients Affected by Severe COVID-19 Pneumonia

Background: In the absence of a standard of treatment for COVID-19, the combined use of anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs may be more effective than using either modality alone in the treatment of COVID-19.
 Methods: Patients hospitalized between April 10th, 2020, through May 10th, 2020, who had confirmed COVID-19 infection with clinical or radiographic evidence of pneumonia, in which 65 patients have moderate COVID-19 pneumonia, and 63 patients have severe COVID-19 pneumonia. All patients received early combination therapy of anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs. They assessed for type and duration of treatment, and days need to wean from oxygen therapy, length of stay, virus clearance time, and complication or adverse events. All patients had more than 28 days follow up after discharge from the hospital.
 Results: Moderate COVID-19 pneumonia group were 65 patients who received Enoxaparin, antiviral drugs, empirical antibiotics for pneumonia, and standard treatment for comorbidity. Male patients were 50 (76.9%) and female patients were 15 (23.1%). 34 (52.3%) patients have comorbidity, 25 (38.5%) patients have Diabetes Mellitus and 2 (3.1%) pregnant ladies. 19 (29.2%) patients were on low flow oxygen therapy, 3L oxygen or less to maintain oxygen saturation more than 92%. All patients discharged home with no major or minor bleeding complications or significant complications. Severe COVID-19 pneumonia group were 63 patients who received methylprednisolone, enoxaparin, antiviral drugs, empirical antibiotics for pneumonia, and standard treatment for comorbidity. Male patients were 55 (87.3%) and female patients were 8 (12.7%). 37 (58.7%) patients have comorbidity, and 24 (38.1%) patients have Diabetes Mellitus. 32 (50.8%) patients were on low flow oxygen therapy, 4-9L oxygen, and 31 (49.2%) patients were on low flow oxygen therapy, 10L oxygen or more, including 12 patients on a non-rebreathing mask. Patients received methylprednisolone were 37 (58.7%) for 3 days, 16 (25.4%) for 5 days and 10 (15.9%) for more than 5 days. Sixty-two patients discharged home with one patient had a long stay, and the other two transferred to ICU. One long-stay patient transferred to ICU on low flow oxygen therapy.
 Conclusion: Early use of a combined anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs treatment in patients with moderate to severe COVID-19 pneumonia prevent complications of the disease and improve clinical outcomes.

Fatal Hymenolepis nana cestodiasis in a ring-tailed lemur (Lemur catta).

The cestode Hymenolepis nana is a common parasite of humans and mice. Fecal shedding in the absence of clinical disease has previously been reported in ring-tailed lemurs (Lemur catta). This report describes fatal, disseminated H. nana cestodiasis infection in an aged ring-tailed lemur in a zoological collection. The parasites were associated with severe multifocal to coalescing and regionally extensive pyogranulomatous hepatitis and moderate multifocal pneumonia. The morphology of the parasites was highly unusual. Profiles were variably sized, ellipsoid to irregularly serpiginous, lined by a thin tegument, and filled with lightly eosinophilic fibrillar stroma and numerous, round basophilic cells. Polymerase chain reaction targeting a portion of the 18S rRNA gene and DNA sequencing of the amplicon showed 100% homology with H. nana.

Lung Function, Radiological Findings and Biomarkers of Fibrogenesis in a Cohort of COVID-19 Patients Six Months After Hospital Discharge

IntroductionImpairment in pulmonary function tests and radiological abnormalities are a major concern in COVID-19 survivors. Our aim is to evaluate functional respiratory parameters, changes in chest CT, and correlation with peripheral blood biomarkers involved in lung fibrosis at two and six months after SARS-CoV-2 pneumonia. MethodsCOVID-FIBROTIC (clinicaltrials.gov NCT04409275) is a multicenter prospective observational cohort study aimed to evaluate discharged patients. Pulmonary function tests, circulating serum biomarkers, chest radiography and chest CT were performed at outpatient visits. ResultsIn total, 313, aged 61.12±12.26 years, out of 481 included patients were available. The proportion of patients with DLCO<80% was 54.6% and 47% at 60 and 180 days. Associated factors with diffusion impairment at 6 months were female sex (OR: 2.97, 95%CI 1.74–5.06, p=0.001), age (OR: 1.03, 95% CI: 1.01–1.05, p=0.005), and peak RALE score (OR: 1.22, 95% CI 1.06–1.40, p=0.005). Patients with altered lung diffusion showed higher levels of MMP-7 (11.54±8.96 vs 6.71±4.25, p=0.001), and periostin (1.11±0.07 vs 0.84±0.40, p=0.001). 226 patients underwent CT scan, of whom 149 (66%) had radiological sequelae of COVID-19. In severe patients, 68.35% had ground glass opacities and 38.46% had parenchymal bands. Early fibrotic changes were associated with higher levels of MMP7 (13.20±9.20 vs 7.92±6.32, p=0.001), MMP1 (10.40±8.21 vs 6.97±8.89, p=0.023), and periostin (1.36±0.93 vs 0.87±0.39, p=0.001). ConclusionAlmost half of patients with moderate or severe COVID-19 pneumonia had impaired pulmonary diffusion six months after discharge. Severe patients showed fibrotic lesions in CT scan and elevated serum biomarkers involved in pulmonary fibrosis.

Pharmacotherapy of atrial fibrillation in COVID-19 patients.

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases - especially ones as common as atrial fibrillation (AF) - and the possible interactions between patients' chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients.

Prevalence, molecular detection, and pathological characterization of small ruminant lentiviruses in goats from Mexico

Small ruminant lentiviruses (SRLVs) are one of the main viral agents affecting goats worldwide. They cause a systemic, chronic, incurable, degenerative disease. In Mexico, the B1 genotype of SRLV has been detected as endemic in goats and sheep; however, its pathological characteristics have not yet been evaluated. In this study, sampling was performed to identify the percentage of SRLV positivity in different farms in Mexico. Prevalence rates of 19.6 % and 11.6 % were detected through PCR and serology, respectively. Through a real-time PCR differential test, the prevalence of genotype B was identified. From a chosen case, an SRLV strain was isolated (which was called SRLV/B1/Goat/Mx/INIFAP-1/2013). The phylogenetic analysis revealed that the strain SRLV/B1/Goat/Mx/INIFAP-1/2013 shares a great homology with an American and Asiatic strains of the B1 genotype. Virulence of the isolated strain was analyzed during an experimental infection in kids. The kids did not present clinical disease after the experimental infection. The high viral load values persisted throughout the entire experiment (90 days), and no seroconversion was detected. At necropsy, macroscopic alterations were not observed, except in the lungs. The microscopic lesions in the respiratory tract consisted of moderate interstitial pneumonia, peribronchial lymphoid hyperplasia, and bronchial exudate. In the central nervous system, moderate gliosis, meningeal congestion, lymphocyte infiltration, satellitosis, and demyelination were observed. The virus was systemically distributed among organs; the cerebellum and carpal synovial fluid samples were those with the highest viral load, 5.73 copies of virus per ng of total DNA (log10) and 5.07 log10, respectively. In this study, we identified a strain with high homology to Asiatic strains that manifested low virulence in kids during short infection. Understanding the strains that circulate in the goat population will allow implementing better diagnostic methodologies to propose disease control alternatives for this emerging animal production system in Mexico.

Efficacy and Safety of Favipiravir in Moderate COVID-19 Pneumonia Patients without Oxygen Therapy: A Randomized, Phase III Clinical Trial.

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), is an enveloped, single-stranded RNA virus. Favipiravir is an orally administrable antiviral drug whose mechanism of action is to selectively inhibit RNA-dependent RNA polymerase. A preliminary trial in COVID-19 patients reported significant improvements across a multitude of clinical parameters, but these findings have not been confirmed in an adequate well-controlled trial. We conducted a randomized, single-blind, placebo-controlled Phase III trial assessing the efficacy and safety of favipiravir in patients with moderate pneumonia not requiring oxygen therapy.MethodsCOVID-19 patients with moderate pneumonia (SpO2 ≥ 94%) within 10 days of onset of fever (temperature ≥ 37.5 °C) were assigned to receive either placebo or favipiravir (1800 mg twice a day on Day 1, followed by 800 mg twice a day for up to 13 days) in a ratio of 1:2. An adaptive design was used to re-estimate the sample size. The primary endpoint was a composite outcome defined as the time to improvement in temperature, oxygen saturation levels (SpO2), and findings on chest imaging, and recovery to SARS-CoV-2-negative. This endpoint was re-examined by the Central Committee under blinded conditions.ResultsA total of 156 patients were randomized. The median time of the primary endpoint was 11.9 days in the favipiravir group and 14.7 days in the placebo group, with a significant difference (p = 0.0136). Favipiravir-treated patients with known risk factors such as obesity or coexisting conditions provided better effects. Furthermore, patients with early-onset in the favipiravir group showed higher odds ratio. No deaths were documented. Although adverse events in the favipiravir group were predominantly transient, the incidence was significantly higher.ConclusionsThe results suggested favipiravir may be one of options for moderate COVID-19 pneumonia treatment. However, the risk of adverse events, including hyperuricemia, should be carefully considered.Trial registrationClinicaltrials.jp number: JapicCTI-205238.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00517-4.

X-linked recessive TLR7 deficiency in ~1% of men under 60 years old with life-threatening COVID-19.

Autosomal inborn errors of type I IFN immunity and autoantibodies against these cytokines underlie at least 10% of critical COVID-19 pneumonia cases. We report very rare, biochemically deleterious X-linked TLR7 variants in 16 unrelated male individuals aged 7 to 71 years (mean: 36.7 years) from a cohort of 1,202 male patients aged 0.5 to 99 years (mean: 52.9 years) with unexplained critical COVID-19 pneumonia. None of the 331 asymptomatically or mildly infected male individuals aged 1.3 to 102 years (mean: 38.7 years) tested carry such TLR7 variants (p = 3.5 × 10-5). The phenotypes of five hemizygous relatives of index cases infected with SARS-CoV-2 include asymptomatic or mild infection (n=2, 5 and 38 years), or moderate (n=1, 5 years), severe (n=1, 27 years), or critical (n=1, 29 years) pneumonia. Two boys (aged 7 and 12 years) from a cohort of 262 male patients with severe COVID-19 pneumonia (mean: 51.0 years) are hemizygous for a deleterious TLR7 variant. The cumulative allele frequency for deleterious TLR7 variants in the male general population is < 6.5x10-4 We also show that blood B cell lines and myeloid cell subsets from the patients do not respond to TLR7 stimulation, a phenotype rescued by wild-type TLR7 The patients' blood plasmacytoid dendritic cells (pDCs) produce low levels of type I IFNs in response to SARS-CoV-2. Overall, X-linked recessive TLR7 deficiency is a highly penetrant genetic etiology of critical COVID-19 pneumonia, in about 1.8% of male patients below the age of 60 years. Human TLR7 and pDCs are essential for protective type I IFN immunity against SARS-CoV-2 in the respiratory tract.

The role of angiopoietin-2 and surfactant protein-D levels in SARS-CoV-2-related lung injury: A prospective, observational, cohort study.

IntroductionCoronavirus disease‐2019 (COVID‐19) is a respiratory disease whose clinical manifestation ranges from asymptomatic to severe respiratory failure. The purpose of this study was to investigate the place of serum surfactant‐D (SP‐D) and angiopoetin‐2 (Ang‐2) levels in predicting severity of disease in patients diagnosed with COVID‐19.MethodsSixty‐four patients diagnosed with COVID‐19 between September 2020 and February 2021, 50 patients diagnosed with community‐acquired pneumonia and a 50‐member healthy control group were included in the study. Plasma samples and clinical data were collected within 72 h after admission, during hospital stay. Serum SP‐D and Ang‐2 concentrations were measured using the enzyme‐linked immunosorbent assay.ResultsSP‐D and Ang‐2 levels were significantly higher in the mild–moderate pneumonia and severe/critical patient groups compared to the asymptomatic and noncomplicated COVID‐19 patients (p < 0.001 for all groups). Serum SP‐D and Ang‐2 levels of severe‐critical COVID‐19 patients were significantly higher than CAP patients (p < 0.001). Powerful correlation was present between clinical severity of COVID‐19 and SP‐D and Ang‐2 levels (r = 0.885 p < 0.001 and r = 0.913 p < 0.001, respectively). Cut‐off values of 37.7 ng/ml (AUC = 0.763, p < 0.001, 95% confidence interval [CI] = 0.667–0.860) for SP‐D and 4208.3 pg/ml (AUC = 0.659, p = 0.004, 95% CI = 0.554–0.763) for Ang‐2 were identified as predictors of COVID‐19 disease at receiver operating characteristic curve analysis.ConclusionSP‐D and Ang‐2 are predictive factors in differentiating COVID‐19 patients and determining severity of disease. These data may be important for the initiation of treatment in the early stage of the disease in patients with COVID‐19.

Antiviral drugs arbidol and interferon alpha-1b contribute to reducing the severity of COVID-19 patients: a retrospective cohort study

ObjectivesThe aim of this study was to evaluate the role of antiviral drugs in reducing the risk of developing severe illness in patients with moderate COVID-19 pneumonia.MethodsThis retrospective cohort study included 403 adult patients with moderate COVID-19 pneumonia who were admitted to Shenzhen Third People’s Hospital, China. The antiviral drugs arbidol, interferon alpha-1b, lopinavir–ritonavir and ribavirin were distributed to the patients for treatment. The primary endpoint of this study was the time to develop severe illness.ResultsOf the 462 patients admitted, 403 had moderate COVID-19 symptoms at hospital admission and were included in this study. 90 of the 403 (22.3%) patients progressed to severe illness. The use of arbidol was associated with a lower severity rate 3.5% compared to control group 30.5%, p-value < 0.0001; the adjusted hazard ratio was 0.28 (95% CI: 0.084–0.90, p = 0.033). The use of interferon alpha-1b was associated with a lower severity rate 15.5% compared to control group 29.3%, with p-value < 0.0001; the adjusted hazard ratio was 0.30 (95% CI: 0.15–0.58, p = 0.0005). The use of lopinavir–itonavir and ribavirin did not show significant differences in adjusted regression models. Early use of arbidol within 7 days of symptom onset was significantly associated with a reduced recovery time of − 5.2 days (IQR − 3.0 to − 7.5, p = 4e−06) compared with the control group.ConclusionTreatment with arbidol and interferon alpha-1b contributes to reducing the severity of illness in patients with moderate COVID-19 pneumonia. Early use of arbidol may reduce patients’ recovery time.

Plain Chest Radiographic Findings Among COVID-19 Patients in Sub-Saharan Africa

Background: Coronavirus disease (COVID-19) is a pandemic that is ravaging the world. Chest imaging plays an important role in the diagnosis and management of patients with COVID-19-related chest infections. This study determined the pattern of chest radiographic features among confirmed COVID-19 patients in Abuja, Nigeria. Materials and Methods: Chest radiographs (CXR) of COVID-19 patients were reviewed, and the radiological features of the lesions were recorded based on the type of opacities, pattern of distribution in the lung fields, side of lesions, and severity of pulmonary abnormalities. Results: The radiographs of 77 patients were analyzed. Their age range was 15–88 years with a mean of 47.4 years and peak age group of 51–60 years. Gender distribution of the patients was 58 (75.3%) males and 19 (24.7%) females giving a male-to-female ratio of 3.1: 1. Fifty-five (71.4%) of the patients had normal CXRs, whereas 22 (28.6%) patients had abnormal pulmonary appearances. Seven (58.3%) out of 12 patients with mild interstitial pneumonia had unilateral disease, whereas 5 (41.7%) had bilateral disease. Combined total of ten patients with moderate and severe interstitial pneumonia all had bilateral disease. Conclusion: Plain CXR gives reliable diagnosis about the presence and degree of interstitial pneumonia in COVID-19 patients. CXR should be routinely done as a baseline diagnostic tool in patients positive for reverse-transcription polymerase chain reaction test. The findings in the CXRs of COVID-19 patients in sub-Saharan Africa are similar to those reported from the other parts of the world.

N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study

Background N-acetyl-cysteine (NAC) has been previously shown to exert beneficial effects in diverse respiratory diseases, through antioxidant and anti-inflammatory actions. Our aim was to evaluate NAC potential impact in hospitalised patients with COVID-19 pneumonia, in terms of progression to severe respiratory failure (SRF) and mortality. Patients and Methods This retrospective, two-centre cohort study included consecutive patients hospitalised with moderate or severe COVID-19 pneumonia. Patients who received standard of care were compared with patients who additionally received NAC 600 mg bid orally for 14 days. Patients’ clinical course was recorded regarding (i) the development of SRF (PO2/FiO2 <150) requiring mechanical ventilation support and (ii) mortality at 14 and 28 days. Results A total of 82 patients were included, 42 in the NAC group and 40 in the control group. Treatment with oral NAC led to significantly lower rates of progression to SRF as compared to the control group (p < .01). Patients in the NAC group presented significantly lower 14- and 28-day mortality as compared to controls (p < .001 and p < .01 respectively). NAC treatment significantly reduced 14- and 28-day mortality in patients with severe disease (p < .001, respectively). NAC improved over time the PO2/FiO2 ratio and decreased the white blood cell, CRP, D-dimers and LDH levels. In the multivariable logistic regression analysis, non-severe illness and NAC administration were independent predictors of 28-days survival. Conclusion Oral NAC administration (1200 mg/d) in patients with COVID-19 pneumonia reduces the risk for mechanical ventilation and mortality. Our findings need to be confirmed by properly designed prospective clinical trials.

Diabetes Mellitus as the Major Factor of Prolonged Hospitalisation in Mild or Moderate COVID-19 Pneumonia.

Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been declared by the World Health Organization (WHO) as a pandemic [1]. Diabetes mellitus (DM) belongs to the comorbidities increasing the risk of severe COVID-19 pneumonia [2]. Notably, in our department among those who died from severe pneumonia, 71% had DM [3].

CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial

BackgroundFollowing positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR randomized trial was designed to evaluate the adjuvant role of oxygen/ozone therapy in mild to moderate SARS-CoV-2 pneumonia. MethodsThe trial (ClinicalTrial.gov NCT04388514) was conducted in four different Italian centers (April-October 2020). Patients were treated according to best available standard of care (SoC) therapy, with or without O3-autohemotherapy (O3-AHT). ResultsA total of 92 patients were enrolled: SoC + O3-AHT (48 patients) were compared to the SoC treatment (44 patients).The two groups differed in steroids therapy administration (72.7% in SoC arm vs. 50.0% in O3-AHT arm; p = 0.044). Steroid therapy was routinely started when it was subsequently deemed as effective for the treatment of COVID-19 disease.No significant differences in mortality rates, length of hospital stay, mechanical ventilation requirement and ICU admission were observed. Clinical improvement in patients with pneumonia was assessed according to a specifically designed score (decrease in SIMEU class, improvement in radiology imaging, improvement in PaO2/FiO2, reduction in LDH and requirement of oxygen therapy ≤ 5 days). Score assessment was performed on day-3 (T3) and day-7 (TEnd) of O3-AHT treatment. A significant increase in the score was reported at TEnd, in the O3-AHT treatment arm (0 [0–1] in the SoC arm vs. 2 [1–3] the O3-AHT arm; p = 0.018). No adverse events related O3-AHT treatment was observed. ConclusionIn mild-to-moderate pneumonia due to SARS-CoV-2, adjuvant oxygen/ozone therapy did not show any effect on mortality, or mechanical intubation but show a clinical improvement a day 7 from randomization in a composite clinical endpoint. Larger Randomized prospective studies alone or in combination with steroids are needed to confirm our results.

Association between the peripheral blood eosinophil counts and COVID-19: A meta-analysis.

Background:The conclusions about the relationship between eosinophil counts and the severity of coronavirus disease 2019 (COVID-19) were controversial, so we updated the evidences and reassessed it.Methods:We searched the PubMed, Cochrane library, Excerpta Medica Database, and Web of Science to compare the eosinophil counts about non-severe disease group (mild pneumonia, moderate pneumonia, non-critical disease and recovery group) and severe disease group (severe pneumonia, critical pneumonia, critical disease and death group) in COVID-19.Results:A total of 1228 patients from 10 studies were included. Compared with non-severe group, severe group had strikingly lower average eosinophil counts (SMD 0.65, 95% confidence intervals [CI] 0.29–1.01; P < .001). The result of subgroup analysis of different countries showed SMD 0.66, 95% CI 0.26–1.06; P < .001. Another subgroup analysis between mild-moderate pneumonia versus severe-critical pneumonia showed SMD 0.69, 95% CI 0.25–1.13; P < .001, and no significant risk of publication bias (Begg test 0.063 and Egger test 0.057) in this subgroup. The heterogeneity was substantial, but the sensitivity analyses showed no significant change when individual study was excluded, which suggested the crediblity and stablity of our results.Conclusions:The eosinophil counts had important value as an indicator of severity in patients with COVID-19.PROSPERO registration number:CRD42020205497.

The administration of interferon-beta1b and favipiravir in patients with COVID-19 pneumonia

Purpose: To assess the efficacy of interferon-beta1b (INF-beta1b) in combination with favipiravir in early treatment of patients with COVD-19 pneumonia. Methods: This prospective non-controlled study was performed on admitted patients with moderate to severe COVID-19 disease to Amir-Alam hospital. The diagnosis of COVID-19 pneumonia was based on positive RT-PCR test from nasopharyngeal samples and typical spiral chest CT scan findings. At the time of this study, there was the shortage of efficient anti-COVID drugs especially “Remdesivir” due to sanction of Iran. All the patients received subcutaneous IFN-beta1b plus favipiravir. The patients with severe infection received intravenous dexamethasone. Those who underwent invasive or noninvasive mechanical ventilation, at the admission onset, were excluded from the study. Results: One hundred and eighty-two patients with moderate to severe COVID-19 pneumonia were included in this study. Among182 patients, 90 cases had moderate and 92 had severe pneumonia. Twenty-one cases with severe pneumonia and 14 cases with moderate pneumonia were transferred to ICU to receive invasive or non-invasive mechanical ventilation. The mean duration of hospital ward admission and ICU stay was 10.69±7.54 and 5.45±2.72 days, respectively. One hundred and seventy-four patients (80.7 %) recovered completely and discharged without need to ICU admission. The response rate was the same in patients with moderate and severe pneumonia. Nine cases (4.9 %) were passed away. Diabetic patients had higher mortality rates. Conclusion: This study showed the efficacy of IFN-beta1b plus favipiravir in early treatment of patients with moderate to severe COVID-19 pneumonia who did not need to mechanical ventilation.

Coronavirus Disease 2019 and Antibiotic Stewardship-Antibiotic Usage in Adult Patients: Is It Necessary? When Should It be Concerned?

Antibiotic consumption rates were quite high in number, although the bacterial coinfection rates were low in coronavirus disease 2019 pneumonia. Generally, empirical antibiotic treatment is not recommended for uncomplicated coronavirus disease 2019 mild to moderate pneumonia cases. On the other hand, antibiotic treatment and de-escalation are recommended for intubated intensive care unit patients or critical patients with sepsis, septic shock, or acute respiratory distress syndrome. The presentation of patients with severe coronavirus disease 2019 pneumonia can direct the clinicians to use antibiotics. We believe that wait and watch strategy can be preferred in such cases without sepsis, secondary bacterial infection findings, or procalcitonin < 0.5 ng/ mL. We think that a new wave of resistance will occur inevitably if we cannot perform the antibiotic stewardship properly.

Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO2/FiO2 ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO2/FiO2 ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO2/FiO2 > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed.