Standard Treatment For COVID-19 Research Articles

Efficacy of Quinine Sulfate in Patients with Mild-To-Moderate COVID-19: A Randomized Controlled Trial

BACKGROUND: Before WHO revoked the emergency use authorization for Chloroquine (CQ) and Hydroxychloroquine (HCQ) because of their side effects, it was suggested to use these two drugs for COVID-19 therapy. In addition, another derivate of quinine, namely Quinine Sulfate (QS), showed good in silico and in vitro antiviral activity against SARS-CoV-2. Prior the WHO revocation, this study was conducted to evaluate the efficacy of QS in mild-to-moderate COVID-19 patients.METHODS: This was an adaptive, controlled, multicenter, randomized, double-blind clinical trial involving mild-to-moderate COVID-19 patients in Indonesia. The participants were divided into 2 groups: the control group (standard COVID-19 treatment + placebo) and the treatment group (standard COVID-19 treatment + QS). The primary outcome was the efficacy of QS based on clinical status using a 7-point ordinal scale. The secondary outcomes were the efficacy of QS in terms of the incidence and duration of oxygen supplementation, incidence of mechanical ventilation, and length of stay.RESULTS: No significant difference in the efficacy parameters studied was found between the control group and the treatment group. The difference in the mean oxygen saturation was also measured and the results showed a significant difference where the treatment group had higher mean oxygen saturation than the control group (p=0.001).CONCLUSION: Although not significant, the treatment group showed better therapy outcomes compared to the control group.KEYWORDS: clinical trials, efficacy, quinine, chloroquine, hydroxychloroquine

EFFICACY EVALUATION OF BD ORAL SPRAY ON THE SYMPTOMS AND COURSE OF COVID-19 PATIENTS IN THE CLINICAL HOSPITAL

A prospective randomized, open-label, single-blinded clinical trial was conducted to evaluate the efficacy of BD on the symptoms and course of the disease in patients with moderate and severe Covid-19 in the field hospital. 200 hospitalized patients with Covid-19 diagnosis were enrolled. The patients were randomized into 100 patients in the interventional group (BD group) and 100 in the control group. The BD group patients were treated with BD oral spray in conjunction with standard Covid-19 treatment protocol. The control group patients were treated with standard of care without BD. Patients of the BD group demonstrated a significantly faster improvement in all Covid-19 related symptoms, resulting in a shorter time for complete recovery than the control group. More remarkably, patients in the BD group showed a shorter time for complete viral clearance. The addition of BD to the standard of care protocol also resulted in significant improvement in the restoration of taste and smell and reduction of lung infiltration. The patients in the BD group also exhibited fewer adverse events related to treatment. BD is a simple-to-use, safe, and effective adjunctive treatment for moderate and severe Covid-19 cases. BD might be effective for Covid-19 symptoms. 

The effect of adding ivermectin to the standard COVID-19 treatment in intubated patients

Introduction: Effective antiviral medications with minimal side effects has received scholarly attention since the start of the COVID-19 pandemic. Ivermectin, a long-time anti-parasitic drug, has been proven through laboratory tests to have anti-COVID-19 effects. Objectives: This study investigated the effects of inclusion of ivermectin to the standard treatment of mechanically ventilated patients. Patients and Methods: This study is a double-blinded, randomized, placebo-controlled clinical trial that was conducted on COVID-19 patients, in Ahvaz, Iran, from March 2020 to September 2021. Intubated COVID-19 patients who met the inclusion criteria were randomly allocated into two groups, placebo (n = 29) and the ivermectin-treated (n = 31). The primary outcome was the mortality, and the secondary outcomes were pulmonary compliance and vital signs. Results: Two groups were similar regarding demographic characteristics such as age, gender, the length of time since the onset of symptoms before intubation, the level of lactate dehydrogenase (LDH) in the blood. Moreover, the difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, and interleukin 6 (IL-6) was not significant between the two groups. Regarding mortality rate, no significant difference between the two groups was detected. Furthermore, O2 saturation on day 5 was significantly higher in the ivermectin group as opposed to the control group (P=0.008). No statistically significant difference was found between the two groups regarding respiratory rate, heart rate, systolic and diastolic blood pressure, and lung compliance (dynamic and static). Conclusion: Regarding the importance of blood oxygen saturation in COVID-19 patients, our results showed no significant effect of ivermectin in the treatment of ventilated COVID-19 patients, suggesting that its addition to the standard COVID-19 treatment either is ineffective or has no synergistic effect. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (Identifier: IRCT20190417043295N2; https://www.irct.ir/trial/57603, ethical code#IR.AJUMS. REC.1400.234).

A Case of COVID-19 with No Pulmonary Involvement; but with Mediastinal and Subcutaneous Emphysema

Spontaneous pneumomediastinum (SPM) is a rare clinical entity. In the normal population, it is more likely to occur in people with conditions including chronic obstructive pulmonary diseases and asthma. In the context of COVID-19 few cases of SPM have been reported which most of them were patients with severe lung parenchymal inflammation or patients under mechanical ventilation. In this case, we report a young male with a history of minor childhood asthma who presented with acute dyspnea, forceful coughs, and subcutaneous emphysema. Chest computed tomography had no clues for COVID-19, however, pneumomediastinum and subcutaneous emphysema were obvious. He was primarily diagnosed with acute asthma exacerbation causing SPM but eventually, he tested positive for SARS-COV-2, therefore, he underwent the standard treatment for COVID-19 and the SPM was managed conservatively. Finally, after 12 days of hospitalization, he was discharged in favorable clinical condition.

Efficacy of enterosorption in treatment of Covid-19 in pregnant women

Objective. To optimize the treatment of pregnant women with a moderate form of COVID-19 by including a sorbent in complex therapy.
 Materials and methods. Pregnant women (n = 87) with a gestational term of 30 weeks or more were divided into 2 groups. Group 1 (n = 42) received standard treatment for COVID-19. Group 2 (n = 45) received an additional preparation of colloidal silicon dioxide. The following endotoxemia indicators were assessed: concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), medium mass molecules (MМM). The course of pregnancy and complications of childbirth were evaluated.
 Results. At the peak stage of the disease, in patients of group 2 the level of МММ was 0,43 opt. units lower, CRP 7.1 mg / l lower, IL-6 2.3 ng / ml lower than in women of group 1.
 Anemia, fetal growth retardation, threatening preterm birth, fetoplacental insufficiency, polyhydramnios and oligohydramnios was diagnosed rarely in group 2; the average fetal weight was 256 g more, the average fetal height was 2.4 cm more than in group 1. In group 2, there were fewer children with moderate and severe asphyxia.
 Conclusions. The addition of colloidal silicon dioxide to the standard treatment of pregnant women with a moderate form of COVID-19 helps to reduce the level of endogenous intoxication, which is manifested by positive dynamics.

Fenofibrate and Statins in Patients with COVID-19

Statins, which are widely used to treat hypercholesterolemia, have anti-inflammatory and antioxidant effects, upregulate angiotensin-converting enzyme 2 (ACE2) receptors, which happen to be SARS-CoV-2’s gateway into cells. This study aims to analyse the effects of Fenofibrate in comparison to Statins and a control group in patients with COVID-19. This is a retrospective open blind observational study of cohort of 300 patients experienced COVID-19 (symptoms’ severity varied between patients). The participants were divided into three cohorts; a control group received standard COVID-19 treatment (n=100); a second group (n=100) of patients who were on Statins, in addition they received the standard treatment; and a third cohort for patients who were already taking Fenofibrate (TRICOR®) as a medication to treat hyperlipidemia (n=100). Most symptoms (including cough, exertional dyspnoea, SOB, sore throat, sneezing, headache, tiredness, agitation, diarrhoea, joint pain, insomnia, myalgia, and fatigue) were less prevalent for patients who administered antihyperlipidemic drugs compared to the control group. Patients who were already taking Cholesterol-lowering medication presented with symptoms varied between mild to severe. Patients on Statins or Fenofibrate also showed less tachycardia and tachypnoea compared to those who were not on antihyperlipidemic drugs, and also the need for oxygen and ICU admission were less frequent. The length of stay in hospital was shorter in patients who were already on Statins or Fenofibrate. Both Statins and Fenofibrate have improved the outcome and the severity of symptoms for patients with Covid 19 infection.

The evaluation of effect of ivermectin in addition to standard COVID-19 treatment in intubated patients

Introduction: Since the introduction of the Corona pandemic, the use of appropriate antivirals with minimal side effects has been the most important research topic. Laboratory evidence has shown that ivermectin, which has long been available as an anti-parasitic drug market, has anti-COVID19 properties. Therefore, in this study, we investigated the outcomes of this agent administration in patients undergoing mechanical ventilation. Material and method: Intubated patients with Covid 19 who were eligible for the study were randomly divided into two groups: 1) ivermectin recipient (n = 31) and 2) placebo group (n = 29). This study was performed in Center Corona hospitals in Ahvaz from March 2020 to September 2021. Mortality event was Primary outcome; vital signs and pulmonary Compliance were as secondary outcomes of the study. Results: The results of the study did not show a significant difference between the two groups in demographic data including: age, sex, and time of intubation after the onset of symptoms, plasma levels of LDH, ESR, CRP, D-Dimer and IL-6. Survival analysis did not show a significant difference between the mortality event in the two groups. 

Evaluation and comparison of vitamin A supplementation with standard therapies in the treatment of patients with COVID-19.

Incomplete data are often presented for determining the role of vitamin A supplement therapy for improving treatment outcomes in patients with COVID-19. We compared treatment effects between a group that received vitamin A added to the standard COVID-19 treatment and another group that received the standard drug treatment alone. Participants in this triple-blind controlled trial comprised 182 COVID-19 outpatients in Saveh City, Markazi Province, Islamic Republic of Iran, in 2020. Patients were randomly divided into experimental (n = 91) and control (n = 91) groups. Patients in the control group received the national standard treatment for COVID-19 (hydroxychloroquine), and those in the intervention group received 25 000 IU/d oral vitamin A for 10 days in addition to the standard treatment recommended by the national protocol. We evaluated the clinical symptoms, paraclinical criteria, and hospitalization status before and after 10 days of interventions. The treatment groups did not differ significantly in clinical and paraclinical symptoms before the intervention. However, clinical symptoms such as fever, body ache, weakness and fatigue, paraclinical symptoms, white blood cell count, and C-reactive protein showed significantly greater decreases in the experimental group 10 days post-intervention compared with the standard treatment alone (P < 0.05). Vitamin A supplementation demonstrated efficacy in improving some clinical and paraclinical symptoms in patients with COVID-19. Future studies should evaluate vitamin A supplementation with a larger sample size and compare different dosages, especially in hospitalized patients.

Does ivermectin reduce COVID-19 mortality and progression of disease severity? – A retrospective study.

Objective: To investigate the efficacy of ivermectin in the treatment of mild, moderate, and severe COVID-19 infection. Study Design: Retrospective Cohort study. Setting: COVID-19 Treatment Centre, Dr. Ruth K M Pfau Civil Hospital Karachi. Period: July 2020 to December 2020. Material &amp; Methods: Medical records of 423 patients during a selected duration of 6 months were reviewed. Patients were stratified into two groups based on whether or not they received a 6-day course of ivermectin in addition to the standard treatment for COVID-19. Primary outcome measures were rate of mortality, days from the start of treatment to negative SARS-CoV-2 PCR, and rate of step-up to the intensive care unit. Results: Patients who received ivermectin required a lesser number of days (8.39 days ± 2.04) to become COVID negative than the patients who didn't receive ivermectin (20.38 days ± 6.32), (p &lt; 0.001). Multinomial logistic regression showed that the patients who were given ivermectin for COVID 19 infection were four times more likely to be discharged home than stepping up to ICU. The ICU step-up rate in the ivermectin group was found to be 3.7% compared to 13.04% in the non-ivermectin group. No significant differences in mortality were found. Conclusion: Treatment with ivermectin in COVID-19 infection is associated with improved outcomes in terms of reduction in duration of illness as well as the progression of disease severity.

MRI spectrum of avascular necrosis of femoral head in patients treated for COVID-19

Objectives: The objectives of the study were to analyze the spectrum of avascular necrosis (AVN) of the femoral head as seen in MRI images of patients treated for COVID-19. Material and Methods: The different patterns of the findings of AVN of the femoral head as seen in MRI images in 200 patients who received standard treatment for COVID-19 in the recent past and presented with hip pain were analyzed retrospectively. Results: No positive findings to suggest any femoral head AVN as per the Ficat and Arlet classification were seen in 94% of cases. Stage IV AVN was seen in 0 cases (0%). Stage I AVN was seen in 6 cases (3%). Stage II AVN was seen in 4 cases (2%). Stage III AVN was seen in 2 cases (1%). Conclusion: In patients who have received standard treatment for COVID-19 and who later developed hip pain, the incidence of AVN was seen in 6% of cases. It was mainly seen more in the younger population (&lt;40 years of age) probably due to quick ambulation and return to daily work. Elderly patients were rarely affected. Normal MRI findings were more common in these cases. Among the positive MRI scans of such cases, mild findings of AVN (Stage I) were the most predominant.

Otologic and vestibular symptoms in COVID-19: A scoping review.

BackgroundOtologic and vestibular symptoms have been seen in patients confirmed to have COVID‐19 disease. Further discussion of these symptoms may provide insight into short‐ and long‐term management for these patients.ObjectiveThe aim of this review was to describe the otologic and vestibular symptoms that present in patients with COVID‐19. The primary outcomes of this review were onset, duration and clinical outcomes of these symptoms.Sources of EvidencePub Med, APAMed Central, Herdin, CINAHL, Scopus, Springer Link, ProQuest Coronavirus Research Database, and Google Scholar were searched for the articles to be included.Eligibility CriteriaStudies included were those involving adult patients diagnosed with COVID‐19 who experienced hearing loss, ear pain, ear discharge, otitis media, vertigo, or tinnitus. Studies were eligible for inclusion if there was a description of the otologic dysfunction, specifically onset, duration, or clinical outcomes.ResultsThe majority of patients who experienced hearing loss (68%), tinnitus (88%), vertigo/dizziness (30%), ear pain (8%), and discharge (100%) did so within a month of experiencing the typical symptoms of COVID‐19. A majority also experienced complete resolution of their symptoms within 2 weeks. Standard treatment for COVID‐19 was usually provided but when specific diagnoses are made for these symptoms (e.g., sudden sensorineural hearing loss, otitis media, vestibular neuritis), they are treated in the same manner as one would for non‐COVID‐19 cases, in addition to the management for COVID‐19. In certain cases, there may be a need for additional work‐up to rule out other causes.ConclusionsOtologic and vestibular symptoms were present in COVID‐19 patients, majority as part of the systemic nature of the disease. The onset, duration, and course were consistent with the natural history of a systemic viral infection. COVID‐19 should be considered in any patient with a new‐onset hearing loss, tinnitus, or vertigo/dizziness, even in the absence of infectious or respiratory symptoms.

Gut microbiota-derived synbiotic formula (SIM01) as a novel adjuvant therapy for COVID-19: An open-label pilot study.

Background and AimGut dysbiosis is associated with immune dysfunction and severity of COVID‐19. Whether targeting dysbiosis will improve outcomes of COVID‐19 is unknown. This study aimed to assess the effects of a novel gut microbiota‐derived synbiotic formula (SIM01) as an adjuvant therapy on immunological responses and changes in gut microbiota of hospitalized COVID‐19 patients.MethodsThis was an open‐label, proof‐of‐concept study. Consecutive COVID‐19 patients admitted to an infectious disease referral center in Hong Kong were given a novel formula of Bifidobacteria strains, galactooligosaccharides, xylooligosaccharide, and resistant dextrin (SIM01). The latter was derived from metagenomic databases of COVID‐19 patients and healthy population. COVID‐19 patients who were admitted under another independent infectious disease team during the same period without receiving SIM01 acted as controls. All patients received standard treatments for COVID‐19 according to the hospital protocol. We assessed antibody response, plasma proinflammatory markers, nasopharyngeal SARS‐CoV‐2 viral load, and fecal microbiota profile from admission up to week 5.ResultsTwenty‐five consecutive COVID‐19 patients received SIM01 for 28 days; 30 patients who did not receive the formula acted as controls. Significantly more patients receiving SIM01 than controls developed SARS‐CoV‐2 IgG antibody (88% vs 63.3%; P = 0.037) by Day 16. One (4%) and 8 patients (26.7%) in the SIM01 and control group, respectively, failed to develop positive IgG antibody upon discharge. At week 5, plasma levels of interleukin (IL)‐6, monocyte chemoattractant protein‐1 (MCP‐1), macrophage colony‐stimulating factor (M‐CSF), tumor necrosis factor (TNF‐α), and IL‐1RA reduced significantly in the SIM01 but not in the control group. There was a significant negative correlation of nasopharyngeal SARS‐CoV‐2 viral load and SIM01 intervention. Metagenomic analysis showed that bacterial species in SIM01 formula were found in greater abundance leading to enrichment of commensal bacteria and suppression of opportunistic pathogens in COVID‐19 patients by week 4 and week 5.ConclusionsThis proof‐of‐concept study suggested that the use of a novel gut microbiota‐derived synbiotic formula, SIM01, hastened antibody formation against SARS‐CoV‐2, reduced nasopharyngeal viral load, reduced pro‐inflammatory immune markers, and restored gut dysbiosis in hospitalised COVID‐19 patients.

The outcome of using intravenous immunoglobulin (IVIG) in critically ill COVID-19 patients\u2019: a retrospective, multi-centric cohort study

BackgroundDuring the COVID-19 pandemic, different treatments have been used in critically ill patients. Using intravenous immunoglobulin (IVIG) has been suggested in various studies as an effective option. Our study aims to access the efficacy of IVIG in critically ill COVID-19 patients.MethodsIn this retrospective matched cohort study, records of three tertiary centers with a large number of COVID-19 admissions were evaluated and used. Based on treatment options, patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using an independent t test and one-way analysis of variance (ANOVA) to compare the outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.ResultsThe duration of hospitalization in the IVIG group was significantly longer than standard treatment (13.74 days vs. 11.10 days, p < 0.05). There was no significant difference between the two groups in ICU length of stay, the number of intubated patients, and duration of mechanical ventilation (p > 0.05). Also, initial outcomes in IVIG subgroups were compared separately with the standard treatment group. The results indicated that only the duration of hospitalization in the IVIG subgroup with medium dose is significantly longer than the standard treatment group (p < 0.01).ConclusionOur data indicate that the use of IVIG in critically ill COVID-19 patients could not be beneficial, based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation, and even mortality rate.

Chronic anticoagulant treatment and risk of mortality in SARS-Cov2 patients: a large population-based study.

Hypercoagulability is often seen in Covid-19 patients and thromboembolic events appear frequent; antithrombotic treatment has been proposed therefore as part of standard treatment for Covid-19. Under these premises, prior-to-infection antithrombotic treatment may have a protective effect with respect to Covid-19 related thromboembolic events. Aim of the present work was to evaluate the impact of prior-to-infection anticoagulant or antiplatelet treatment on Covid-19 outcomes. Beneficiaries of the Regional Health Service of the Lombardy region of Italy aged ≥40 years with a Covid-19 diagnosis made between February 21st and July 18th, 2020 were included in the present study. The impact on Covid-19 mortality of pre-existing and chronic therapy with anticoagulant drugs (vitamin-K antagonist or New Oral Anticoagulants) was evaluated. Analyses were repeated with antiplatelets drugs. Among 79,934 Sars-cov-2 patients beneficiaries of the Regional Healthcare System of the Lombardy Region who received a diagnosis between February 21st and July 18th, 2020, chronic preexisting anticoagulant assumption was present in 6.0% and antiplatelets in 12.7%. The overall unadjusted mortality rate was 20.6%, with male sex, age category and comorbidity burden being significantly associated to increased mortality risk. Anticoagulant chronic treatment was not associated with a reduction in mortality. Similar results were observed when repeating the analyses for pre-existing oral anti-platelet treatment. In a large population-based study evaluating more than 79,000 Covid-19 patients, pre-existing antithrombotic therapy was not associated to a benefit in terms of mortality. Further studies are needed to evaluate the role of antithrombotic therapy as standard treatment among Covid-19 patients.

The use of low dose methylprednisolone in severe Covid-19 induced ARDS to facilitate oxygen weaning: Results from a case series and mini review

We describe 8 patients with confirmed Covid-19 infection requiring high flow oxygen and respiratory support for adult Respiratory distress syndrome (ARDS) for a mean duration of 12 days. These patients had already received standard treatments for Covid-19, including broad spectrum antibiotics, dexamethasone, heparin and remdesivir along with entry to the recovery trial according to patient choice. Due to on-going high oxygen demands and respiratory support, these patients were at increasing risk of significant lung injury and the development of fibrotic lung changes. Intravenous low dose methylprednisolone was therefore given in an attempt to assist resolution of the ARDS. The low dose was chosen to reduce the cytokine storm and minimise the risk of a super-infection. This led to improvement in 6 out of 8 patients allowing oxygen weaning (mean duration 4.5 days) and discharge home within a mean duration of 11 days. Five patients were discharge home with low flow oxygen (mean 2.8 L/min) with community based weaning. The 2 non-responders subsequently deteriorated further and were managed palliatively. We describe the cases and discuss the current literature with regard to the use of methylprednisolone in Covid-19 ARDS. Keywords: ARDS; Covid 19; methylprednisolone; respiratory failure; fibrotic lung injury.

Fitoterapia w zapobieganiu, leczeniu i przeciwdziałaniu objawom ubocznym po przebyciu COVID-19

Plant extracts and natural compounds show scientifically proven activity against numerous viruses, including the SARS-CoV-2 virus, responsible for causing COVID-19. Among plant constituents, polyphenolic compounds (flavonoids, phenolic acids, proanthocyanidins, catechins) show the greatest potential. Characteristic for plant extracts containing a mixture of secondary metabolites is the multidirectional action and improvement of the functioning of numerous tissues and organs. As a result, in addition to their antimicrobial activity, they alleviate a number of side effects caused by infection. They show anti-inflammatory properties and stimulate the immune system. Few clinical trials of the use of herbs, bee products, natural compounds, and vitamin D as an adjunct to standard therapies have confirmed their beneficial effects, both in patients with moderate and severe disease. Herbal preparations should be recommended both for prophylaxis and as an adjunct to standard COVID-19 treatment.

Oxygen-Helium Gas Mixture «Heliox» for the Treatment of Respiratory Failure in Patients with New Coronavirus Infection Covid-19 (Randomized Single-Center Controlled Trial)

Introduction. Treatment of respiratory failure in pneumonia caused by coronavirus infection (COVID-19) is still an unsolved problem that requires a comprehensive approach and the development of new methods that expand the range of possibilities of modern therapy. There is evidence that the heated oxygenhelium mixture has a positive effect on gas exchange in the infiltration zone by improving both ventilation and diffusion.AIM of study. To evaluate the effectiveness of the inclusion of a heated oxygen-helium mixture HELIOX (70% Helium/ 30% Oxygen) in the complex intensive care of respiratory failure of pneumonia caused by SARS-CoV-2 infection.Material and methods. The study included 60 patients with confirmed viral pneumonia caused by COVID-19. The patients were randomized into two groups: group 1 (n=30) — patients who were treated with the standard COVID-19 treatment protocol with the heated oxygen-helium mixture HELIOX, and group 2 (control) (n=30) — patients who received standard therapy. Lethality was studied for 28 days, the time in days until a steady increase in SpO2&gt;96% was achieved when breathing atmospheric air; the time until the patient is transferred from the intensive care unit (ICU) to the general department.Results. Inhalation of the HELIOX mixture (70% Helium / 30% Oxygen) resulted in a faster recovery of the hemoglobin oxygen saturation index (SpO2). Starting from day 3, these differences became statistically significant. The time in days from inclusion in the study to a persistent increase in the degree of oxygen saturation of hemoglobin (SpO2&gt;96%) when breathing atmospheric air in the group with inhalation of the HELIOX mixture was less — 8 (7; 10), compared to 10 (8;13) in the control group (p=0.006). In the group with inhaled HELIOX mixture, the median treatment time in the ICU was 8 (7; 9.5) days vs 13 (8; 17) days (p&lt;0.001) in the comparison group.Conclusions. Inhalation of the HELIOX mixture (70% Helium / 30% Oxygen) led to a faster recovery of the hemoglobin oxygen saturation index SpO2, which contributed to reduction in the duration of oxygen therapy and a decrease in mortality.

S1622 Acute Acalculous Cholecystitis: An Unusual First Manifestation of COVID-19

Introduction: COVID-19 pandemic has become a major global health challenge, with more than 178 million confirmed cases and over 3.86 million deaths to date. While general and respiratory symptoms are common, it may have atypical GI involvement. We chronicle here an extremely rare case of acute acalculous cholecystitis (AAC) in a patient with COVID-19. Case Description/Methods: A previously healthy 35-year-old male presented to the emergency room with abdominal pain and non-biliary vomiting. He was nonsmoker, nonalcoholic, and drug-free. His vitals revealed: temperature 37.1°C, heart rate 82 bpm, blood pressure 114/72 mm Hg, respiratory rate 16/minute, and an oxygen saturation of 99% in room air. Physical examination revealed a positive Murphy's sign. Laboratory parameters revealed leukocytosis and high CRP level. Abdominal ultrasound showed marked gallbladder wall thickening, normal CBD, with no cholelithiasis or sludge formation. EUS also ruled out stones in the gallbladder. Therein, coronavirus rRT-PCR came back positive. CT chest revealed bilateral patchy peripheral ground-glass opacities in the lungs, consistent with COVID-19. Based on these findings and exclusion of probable causes of AAC, COVID-19-related AAC was diagnosed. The patient was initiated on standard COVID-19 treatment for the mild disease and conservative treatment for AAC. His hospital course remained unremarkable, except for fever and dyspnea on day 4 of admission. He remained hemodynamically stable. On day 7 of admission, his abdominal pain, vomiting, and fever disappeared with treatment. On day 9 of admission, he was afebrile, dyspnea had resolved, and had no abdominal pain. He was then discharged home in a stable condition. He continues to do well for 2 months now. Discussion: Published medical literature is bereft of reports on the association between AAC and COVID-19. A PubMed search was conducted for all case reports of AAC amidst COVID-19 till June 2021. Search terms included ‘’acalculus cholecystitis’’ and ‘’COVID-19’’. The search resulted in only 4 case reports to date. This case highlights that the GI symptoms may precede the pulmonary manifestations of COVID-19. It further provides the clinical evidence behind a causal relationship between SARS-CoV-2 infection and biliary involvement. The extrapulmonary symptomology of this infection has not been extensively studied, warranting a high index of suspicion for rare manifestations like AAC. Thus, new-onset GI symptoms may indicate COVID-19, requiring prompt testing for SARS-CoV-2.

Use of convalescent plasma in the treatment of critically ill COVID-19 patients: a study protocol

Use of convalescent plasma (CP) has shown promising results during early studies of COVID-19 patients. This study aims to prepare a protocol for the use of CP to treat critically ill COVID-19 patients. This will be a multicentre, double-blinded, controlled randomised trial. Subjects will be randomly assigned to the treatments, and evaluations will be taken at baseline and at intervals according to the protocol. Only those subjects who meet all inclusion criteria will be enrolled in the study. The experimental treatment group will receive CP at volume of 6 mL/kg divided into two doses separated by 24 hours, in addition to the standard treatment for COVID-19. The control group will receive only the standard treatments. The result assessed at the end of this trial will be the primary and secondary endpoints. The primary endpoints (efficacy indicators) will be the discharge from the ICU, discharge from the hospital, days of hospitalisation, days on mechanical ventilation and death. The main secondary endpoints (safety indicators) will be the severe transfusion reactions and transfusion-transmitted diseases. The authors developed the study protocol using standardised criteria for the development of a clinical trial protocol. This study protocol addressed all aspects that are necessary for the standardised implementation of CP for the treatment of COVID-19 patients, including CP collection, administration, evaluation, and follow up.

Specific Treatment Exists for SARS-CoV-2 ARDS.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), seems to be difficult to overcome. A pandemic of such a scale has not been seen since the 1918 influenza pandemic. Although the predominant clinical presentation is respiratory disease, neurological manifestations and sequelae are increasingly being recognized. We observed a case series of rapid recovery of ARDS within 24 h in the preliminary clinical features of COVID-19 ARDS-associated neurological disease. It was also noted that by 15 April, 2021, there was no SARS-CoV-2 ARDS on Sorok Island in South Korea, where lepers had been living together. We compared each of dapsone’s effects on humans and considered those of SARS-CoV-2. Dapsone showed different effects in the brain. The Sorokdo National Hospital reported a relationship between dapsone and the neuroinflammasome of Alzheimer’s disease (AD) in Sorok Island from January 2005 to June 2020. AD prevalence was low in the leprosy patient group who took dapsone regularly. The preliminary cross-sectional study of the trial group (22 subjects) and the control group (22 subjects) in the Hunt Regional Hospital reported the following results: The chi-square statistic is 5.1836. The p-value is 0.022801. The result is considered significant at p < 0.05. The results from the medical treatment from 21 December to 29 December 2020 were considered. The mortality rates at the ARDS onset stage were 0% with dapsone administered as a standard COVID-19 treatment and 40% without dapsone administered as a standard COVID-19 treatment, respectively. Based on the respiratory failure and sudden high death rate originating from the involvement of the brainstem, especially the pre-Bötzinger complex, dapsone can be used to significantly reduce the incidence of the cases of acute respiratory distress syndrome and other illnesses caused by SARS-CoV-2.