Immune-related therapeutics: an update on antiviral drugs and vaccines to tackle the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic rapidly spread globally. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is a positive-sense single-stranded RNA virus with a reported fatality rate ranging from 1% to 7%, and people with immune-compromised conditions, children, and older adults are particularly vulnerable. Respiratory failure and cytokine storm-induced multiple organ failure are the major causes of death. This article highlights the innate and adaptive immune mechanisms of host cells activated in response to SARS-CoV-2 infection and possible therapeutic approaches against COVID-19. Some potential drugs proven to be effective for other viral diseases are under clinical trials now for use against COVID-19. Examples include inhibitors of RNA-dependent RNA polymerase (remdesivir, favipiravir, ribavirin), viral protein synthesis (ivermectin, lopinavir/ritonavir), and fusion of the viral membrane with host cells (chloroquine, hydroxychloroquine, nitazoxanide, and umifenovir). This article also presents the intellectual groundwork for the ongoing development of vaccines in preclinical and clinical trials, explaining potential candidates (live attenuated-whole virus vaccines, inactivated vaccines, subunit vaccines, DNA-based vaccines, protein-based vaccines, nanoparticle-based vaccines, virus-like particles and mRNA-based vaccines). Designing and developing an effective vaccine (both prophylactic and therapeutic) would be a long-term solution and the most effective way to eliminate the COVID-19 pandemic.

Hepatic encephalopathy; Precipitating factors in patients with cirrhosis

gujri@hotmail.com Hepatic encephalopathy is a common complication of cirrhosis. Its development heralds a poor prognosis. Hepatic encephalopathy is often precipitated by an identifiable factor. Prompt diagnosis of precipitating factors is the key to management of this reversible complication of cirrhosis. To determine the frequency of precipitating factors for hepatic encephalopathy in patients diagnosed with cirrhosis. Descriptive Study. The study was carried out at Combined Military Hospital Lahore from 18.6.07 to 18.12.2007. Eighty Consecutive patients, 18 years and above of both genders suffering from hepatic encephalopathy were included in the study. Precipitating factors of hepatic encephalopathy were identified with the help of clinical examination and investigations. Majority of patients [63.8%] had one precipitating factor; more than one factor was found in 27.5%. Upper gastrointestinal bleed [56%] and infections [27%] [spontaneous bacterial peritonitis and urinary tract infections] were the leading precipitating factors. Use of diuretics/ electrolyte imbalance and constipation were found in 19% and 7% of patients respectively. No precipitating factor was detected in 9% of patients. In majority of patients with hepatic encephalopathy, precipitating factor/ factors could be easily identified

Frequency of metabolic bone disease in hemodialysis patients

The frequency of metabolic bone disease related to secondary hyperparathyroidism was studied in 47 haemodialysis patients, using biochemical, radiological parameters and bone biopsy [30 males, 17 females; mean age 48 years]. The duration on dialysis ranged from 1-5 years. Hypocalcemia was found in 47% while 62% had raised phosphorus levels and 49% raised alkaline phosphatase. Serum parathyroid hormone was elevated in 86%, while in 13% it was markedly raised. On radiological examination there was generalized osteopenia in 49% and decreased bone density in 21%. In 30% no radiological abnormality was detected. In 40% bone biopsy revealed osteomalacia, mixed osteodystrophy 21%, osteoporosis 8.5% and in 25% no histological abnormality was observed

Once weekly subcutaneous administration of erythropoietin in haemodialysis patient

Twenty-five anaemic patients of End Stage Renal Disease [ESRD] on maintenance haemodialysis at the Kidney Centre were studied. Recombinant human erythropoietin [EPO] 50-units/kg body weight was given once a week subcutaneously to see the response to therapy. In 21 cases haemoglobin increased significantly from 7.5 to 9.5 g/dl and haematocrit from 23 to 30.5 L/L with success rate of 84% and marked improvement in their quality of life. Once a week subcutaneous administration of erythropoietin is convenient and cost effective in reversing renal anaemia with minimal complications

Experience of erythropoietin in anemia of end stage renal disease

Recombinant human erythropoietin 50 units/kg intravenous twice a week was given to 9 anemic patients and end stage renal disease [ESRD] who were undergoing dialysis at the Kidney Centre. Of the total, 8 required no transfusion since the initiation of therapy and their haematocrit increased to approximately 29% or more with the improvement in general condition, sense of well being and exercise tolerance. One patient showed an increase in serum creatinine and two iron deficiency during therapy. In all cases blood pressure remained adequately controlled. No organ dysfunction or any other complication was observed