ABSTRACT
Background: Hesperidin is a secondary metabolite of the flavonoid group. Due to its antioxidant, anti-inflammatory and anti-viral properties, it can be helpful as a treatment option for patients with COVID 19. Methods: This study was conducted as a clinical trial in Masih Daneshvari Hospital in Tehran. After providing complete explanations and obtaining written consent, patients with new coronavirus (COVID-19) were included in the study if they met the inclusion criteria. 20 patients with the new coronavirus (COVID-19) were included in the study. Patients were then randomly divided into hesperidin and control groups. Patients in the hesperidin group received 1 mg of hesperidin orally intravenously every 6 hours for 5 days, whereas in the control group, they did not. Then, the desired variables were measured during the research period. Patients were monitored for adverse drug reactions based on clinical symptoms and signs. The results were evaluated with regard to the design of the questionnaire and its completion using t-test and SPSS16 software. Results: Patients with equal gender ratio were studied and diabetes mellitus with a prevalence of 60% had the highest prevalence among patients. On the other hand, 85% of these patients presented with bilateral lung involvement. Using hesperidin decreased lymphocytes, CRP, ESR, LDH, D-dimer, and IL-6 and increased WBC, Hb and Plt. None of the mentioned changes were significant (p>0.05). Conclusion: Utilizing hesperidin could not cause significant changes in the level of immunological and inflammatory factors in patients with COVID 19. © 2022 by the Author(s).
ABSTRACT
The severity of COVID-19 disease and its mortality may be due to a localized vascular problem owing to the activation of bradykinin B1 receptors on endothelial cells in the lungs that occur following inflammation. Bromelain acts as an anti-inflammatory factor and can lower the level of bradykinin in the serum and tissues. Patients with the novel coronavirus (COVID-19) referred to Masih Daneshvari Hospital in Tehran were included in the study after providing full explanations and obtaining written consent. The 40 patients with mild to moderate symptoms were randomly divided into the control group (No: 20) and sample (No: 20). In the sample group, a dose of 200 mg bromelain was given to patients every 8 hours. In the control group, placebo capsules were administered exactly at the above intervals. Clinical and paraclinical factors (including SaO2, RR body temperature, MAP, HR, CRP, ESR, AST, ALT, Bil, BUN, Cr, WBC, Lymph, LDH, Plt were evaluated on a regular basis for up to five days. The results were evaluated using t-test and SPSS21 software. After treatment, the sample (Bromelain) group indicated significant improvement in SaO2, RR, HR, AST, ALT, BUN, ESR, LDH, and WBC and Lymphocyte count (P<0.05). Other factors did not have a significant difference with the control group. Bromelain causes improvement in some clinical symptoms such as respiratory parameters and para clinical items of mild to moderate hospitalized COVID-19 patients, so it can be a promising treatment. Furthered evaluation of larger groups is recommended.
ABSTRACT
Background: Sustained inflammation has been observed in the majority of severe COVID-19 cases. The impact of choice of opioid on perioperative inflammatory processes has not been assessed in the clinical setting. Materials and Methods: Patients with novel coronavirus (COVID-19) who referred to Masih Daneshvari and Noor-Afshar Hospitals in Tehran were included in the study after providing full explanations and obtaining written consent. Patients were then randomly divided into three groups: morphine, fentanyl and control. Patients in the morphine group received 3 mg of morphine intravenously every 6 hours for 5 days, whereas in the fentanyl group, 1.5 mcg / kg / h of fentanyl was infused for 2 hours on 5 consecutive days. The results were evaluated based on the design of the questionnaire and its completion using t-test and SPSS25 software. Results: A total of 127 participants responded to the survey between 20 April and 20 June 2020, of whom 90 (70.86%) with the average age 65.2 years, provided complete data on variables included in the present analyses. 53 (58.33%) of all individuals were men and 37 (41.12%) were women. Accordingly, 22 (24.4%) patients had a history of hypertension. However, diabetes with 16 (17.77%) cases and kidney diseases with 12 (13.33%), were the next most common underlying diseases. Evaluation of patients' clinical, laboratory and inflammatory conditions at different time intervals in both fentanyl and morphine groups did not show significant changes between these groups and the patients in the control one. Conclusion: The results of this study did not show any significant change in the use of fentanyl and morphine compared to patients with COVID 19. This may be due to the use of these drugs in the viral phase of the disease. The use of morphine and fentanyl in the viral phase of COVID 19 disease do not show significant benefits.
ABSTRACT
The coronavirus 2019 disease (COVID-19) is an ongoing outbreak of respiratory disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus can invade various tissues and organs, causing multiple organ dysfunctions. Critically ill COVID-19 patients may develop acute respiratory distress syndrome and pneumonia, which are the major causes of hypoxemic respiratory failure and death due to SARS-CoV-2 infection. Thus, ventilation support (invasive or noninvasive), has become a common practice in respiratory treatment of COVID-19 patients. Patients receiving mechanical ventilation usually require sedation to alleviate anxiety, pain and discomfort. On the other hand, current clinical reports have indicated that a significant number of COVID-19 patients require prolonged intensive care unit (ICU) care and ventilation, which increases the risk of delirium. Thus, selection of appropriate sedative medications during this period is of utmost importance. Dexmedetomidine (DEX) is a sedative, anxiolytic and analgesic agent that acts through the α2-adrenoceptor. Its sedative property is notable due to the lack of respiratory depression. In addition, its cytoprotective, immunoregulatory and anti-inflammatory properties have been well established in preclinical settings. Based on these features, a number of recent studies have proposed DEX as a beneficial sedative agent that simultaneously mitigates the excessive inflammation and protects vital body organs in patients with severe COVID-19. In current brief review, we aimed to discuss the therapeutic benefits of DEX in managing different indications of COVID-19. ©2021 The Author(s).
ABSTRACT
Background: A heterogeneous pattern was detected in COVID-19 severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to define special features and individualized treatment modalities for this fatal infectious disease. Methods: Thirty-six patients diagnosed as COVID-19 severe ARDS were chosen. Lung mechanics (compliance), the extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI), and serum concentrations of immunology markers (interleukin [IL]-1β, IL-6, IL-8, ferritin, and C-reactive protein) were measured. Accordingly, individualized treatment consisting of Actemra, hemoperfusion (HP), continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) was implemented for each patient. Results: Patients were categorized according to the lung compliance: 18 in 'L type' with compliance >40 cc/cmH2O and 18 in 'H type' with compliance ≤40 cc/cmH2O. In 16 patients, standard mechanical ventilation management and antiviral therapy were unsuccessful;therefore, hemodynamic and immunity responses were evaluated. Results of transpulmonary thermodilution in L-type patients surprisingly showed EVLWI = 8.8 ± 1.3 (6.9-9.7) and PVPI = 2.4 ± 0.1 (2.2-2.6). In the H-type patients, five cases showed EVLWI = 8.7 ± 0.8 (7.5-9.8) and PVPI = 2.6 ± 0.3 (2.1-2.8) which were subclassified as 'Ha type' and five cases with EVLWI = 17.5 ± 1.9 (15.7-20.6) and PVPI = 3.9 ± 0.4 (3.5-4.5) were named 'Hb type'. By measuring immunologic markers, these two groups were subdivided into high and low marker groups. Individualized treatment resulted in 2 survivals with Actemra, 1 with HP, 2 with HP + CRRT, and 1 with ECMO. Conclusion: According to the heterogeneity of COVID-19 severe ARDS presentation, which is due to various immunologic and hemodynamic responses, a systematic approach is an important and relatively successful strategy in choosing the appropriate treatment modality. © 2020 Medknow.