Mortality Predictors Among COVID-19 Elderly in Taif, Saudi Arabia.

Background: By December 2021, the COVID-19 pandemic had caused more than 266 million cases and 5 million deaths, especially among geriatric patients. Objective: To identify determinants of COVID-19-related death in geriatric patients. Methods: This is a comparative retrospective study involving 145 COVID-19 hospitalized patients who are more than 60 years old, conducted at King Faisal Medical Complex in Taif, Saudi Arabia, from June 2020 to August 2020. The main outcome studied was COVID-19-related death. Results: Out of 145 elderly COVID-19 patients, 11% have died. There was a significant difference between those who died and the surviving group regarding hospital stay duration, with a higher duration median among those who died (22 days vs 12 day respectively, p=0.002). Transfer to ICU, mechanical ventilation, low oxygen saturation, shortness of breath, respiratory support, x-ray trend, and prolonged QT interval showed significant statistical differences between them (p<0.001, <0.001, 0.017, 0.045, <0.001, <0.001, 0.004, respectively). After doing logistic regression of predictors for progression to death, putting patients on oxygen only vs mechanical ventilation was statistically significant, with an adjusted odds ratio (AOR) of 0.038 (p=0.012). Worse x-rays vs constant also were statistically significant and had AOR of 23.459 (p=0.001). There was a significant moderate positive correlation between duration of hospital stay and duration from admission to medication start (SP=0.336 and p<0.001). Conclusion: We recommend accurately monitoring patients using x-rays to determine which patients have worse x-rays. However, the cost-benefit of using radiation must be well assessed and needs further research to determine if its benefit outweighs its risks, especially in high-risk patients. Furthermore, mechanically ventilated patients must be carefully monitored. Finally, the duration of hospital stay was highly correlated with the duration from admission to medication start. Therefore, proper treatment must be started as early as possible.

Pharmacological basis for the potential role of Azithromycin and Doxycycline in management of COVID-19.

A novel corona virus SARS-CoV-2 has led to an outbreak of the highly infectious pandemic COVID-19 complicated viral pneumonia. Patients with risk factors frequently develop secondary infections where the role of appropriate antibiotics is mandatory. However, the efforts of drug repurposing lead to recognizing the role of certain antibiotics beyond the management of infection. The current review provided the detailed antiviral, immunomodulatory effect, unique pharmacokinetic profile of two antibiotics namely azithromycin (AZ) and doxycycline (DOX). It summarizes current clinical trials and concerns regarding safety issues of these drugs. Azithromycin (AZ) has amazing lung tissue access, wide range antibacterial efficacy, conceivable antiviral action against COVID-19. It also showed efficacy when combined with other antiviral drugs in limited clinical trials, but many clinicians raise concerns regarding cardiovascular risk in susceptible patients. DOX has a considerable role in the management of pneumonia, it has some advantages including cardiac safety, very good access to lung tissue, potential antiviral, and immunomodulation impact by several mechanisms. The pharmacological profiles of both drugs are heightening considering these medications for further studies in the management of COVID-19.

Successive waves of COVID 19: confinement effects on virus-prevalence with a mathematical model.

BACKGROUND: A pandemic outbreak of severe acute respiratory syndrome coronavirus 2 (COVID 19) incidence data are largely available online. Until August 17, COVID 19 has hit more than 22 million individuals all over the globe. So, it is urged to get clear information about the prevalence of the virus. Therefore, one can manipulate easily a suitable mathematical model to fit these published data. METHODS: We propose a mathematical model that considers the total population, in 25 countries, either infected by COVID 19 or confined (safe) during the period from November 17, 2019, to August 17, 2020. The model considers the total population as a complex number; the imaginary part is the number of infected individuals and the real part is the number of confined individuals. This classification combined with mathematical treatments leads to a transmission dynamics of the virus to be as wave-like motion. The virus can hit any country either by one wave or by successive waves (up to 11 waves). FINDINGS: We find net discrimination between the 25 countries investigated in this report. The immediate response to the first attack is a substantial parameter to determine whether the epidemic attack will be in one wave or it can be in successive waves. For example, the best case was such as individuals in China hit by one wave while the individuals in the USA were attacked by nine waves; it is the worst case all over the globe. In addition, the model differentiates between the daily reproduction numbers (Rd0) and the median reproduction number (R0). We have found that Rd0 decreases exponentially with time from high values down to zero at the wave maximum point; and R0 varies from a country to another. For example, the virus hit individuals in Germany in R0 = 1.39 (96% CI 1.01-3.87) and in the USA R0 = 3.81 (91% CI 1.71-5.15). We have found that twice the virus has hit both the USA and Iran. The great protestation of black matter lives in the USA and the great assemblage of the new Iranian year, on March 21, 2020, have been the cause of the second epidemic attack in both countries. INTERPRETATION: Our results show that COVID 19 transmission depends on the prompt reaction against the first viral-wave. The reaction depends on both the social behaviour of individuals and on the swift system-decision by the governmental decision-maker(s). The Chinese strictly follow the decision-maker and therefore the virus hit by only one wave; while in the USA, the system-decision was different and the American-responses were different, therefore ten waves followed the first wave.

Effectiveness and Safety of Favipiravir Compared to Hydroxychloroquine for Management of Covid-19: A Retrospective Study.

BACKGROUND: Coronavirus disease (COVID-19) is an infectious disease due to SARS-COV-2. Patients with risk factors are vulnerable to severe morbidity and mortality. Favipiravir (FPV) and hydroxychloroquine (HCQ) are considered possible COVID-19 treatments. OBJECTIVE: To investigate the effectiveness and safety of FPV compared to HCQ in patients with COVID-19 as the standard of care approved by the national protocol there. METHODS: This is a retrospective cohort study on patients with COVID-19 who were administered either FPV or HCQ at King Faisal Medical Complex, Taif, Saudi Arabia, from June 2020 to August 2020. RESULTS: In total, 508 patients were included in the analysis. Patients were categorized into three groups by medication. Patients enrolled in this study were 244 (55.8%) on FPV, 193 (44.2%) on HCQ and 71 (13.81%) on neither medication. Patients who received FPV had higher age and greater comorbidity. Most of the patients were discharged on day 14 (n = 303, 59.6%), 26 (36.6%) in neither med, 154 (63.1%) in FPV and 123 (63.7%) in HCQ groups with significant difference between groups (P < 0.0001). Mortality rate was 8.2% (n = 20) in FPV and 7.3% (n = 14) in HCQ groups with significant difference between groups (P = 0.048). Regarding drug safety, 19.7% of patients treated with FPV vs 7.8% HCQ have adverse effects with significant difference between groups (P < 0.0001). Most of the side effects were increase ALT and AST. Meanwhile, prolonged Q-T interval was reported only in the HCQ group (2.6%). From Cox regression modeling, only mechanical ventilation due to Covid 19 was predictive for mortality (HR: 16.598, 95% CI: 7.095-38.828, P < 0.0001). Meanwhile, there was no significant difference in the prediction of discharge of FPV (vs HCQ) (HR: 0.933, 95% CI: 0.729-1.195, P = 0.5843), predictors of mortality were HCQ (vs FPV) (HR: 2.3, 95% CI: 0.994-5.487, P = 0.0518). Kaplan-Meier survival curves showed improved survival time and discharged time among patients in the HCQ versus FPV group with an insignificant difference between them (P = 0.85, P = 0.06, respectively). CONCLUSION: The present study concluded that FPV and HCQ showed comparable efficacy in decrease mortality and oxygen requirements. FPV likely has a more favorable safety profile regarding cardiac toxicity. A randomized clinical trial with large patient numbers is recommended to confirm the effectiveness of these drugs in COVID-19 patients.