Utility of chest radiograph severity scoring in emergency department for predicting outcomes in COVID-19: A study of 1275 patients.

OBJECTIVE: To measure the reliability and reproducibility of a chest radiograph severity score (CSS) in prognosticating patient's severity of disease and outcomes at the time of disease presentation in the emergency department (ED) with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: We retrospectively studied 1275 consecutive RT-PCR confirmed COVID-19 adult patients presenting to ED from March 2020 through June 2020. Chest radiograph severity score was assessed for each patient by two blinded radiologists. Clinical and laboratory parameters were collected. The rate of admission to intensive care unit, mechanical ventilation or death up to 60 days after the baseline chest radiograph were collected. Primary outcome was defined as occurrence of ICU admission or death. Multivariate logistic regression was performed to evaluate the relationship between clinical parameters, chest radiograph severity score, and primary outcome. RESULTS: CSS of 3 or more was associated with ICU admission (78 % sensitivity; 73.1 % specificity; area under curve 0.81). CSS and pre-existing diabetes were independent predictors of primary outcome (odds ratio, 7; 95 % CI: 3.87, 11.73; p < 0.001 & odds ratio, 2; 95 % CI: 1-3.4, p 0.02 respectively). No significant difference in primary outcome was observed for those with history of hypertension, asthma, chronic kidney disease or coronary artery disease. CONCLUSION: Semi-quantitative assessment of CSS at the time of disease presentation in the ED predicted outcomes in adults of all age with COVID-19.

Potential antiviral efficacy of herbal drugs to fight against COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered virus named as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that belongs to the coronavirus family. It was immersed in December, 2019 and has become a pandemic. Thousands of clinical treatments are undergoing to cure the disease. There is an urgent need to explore the available antiviral drugs which are used to treat different viral infections. Herbal medicines are reported to fight against viruses by boosting the immune system. This article summarised some of available drugs from herbal medicines which could be useful for treatment of COVID-19.

Diagnostic accuracy and inter-observer agreement with the CO-RADS lexicon for CT chest reporting in COVID-19.

PURPOSE: To measure the diagnostic accuracy and inter-observer agreement with the use of COVID-19 Reporting and Data System (CO-RADS) for detection of COVID-19 on CT chest imaging. METHODS: This retrospective study included 164 consecutive patients with clinical suspicion of COVID-19 in whom a CT chest examination was performed at a single institution between April 2020 and July 2020. Of them, 101 patients was RT-PCR positive for COVID-19. Six readers with varying radiological experience (two each of chest radiologists, general radiologists, and radiologists in training) independently assigned a CO-RADS assessment category for each CT chest study. The Fleiss' K was used to quantify inter-observer agreement. The inter-observer agreement was also assessed based on the duration of onset of symptoms to CT scan. ROC curve analysis was used to determine the diagnostic accuracy of CO-RADS. The area under curve was calculated to determine the reader accuracy for detection of COVID-19 lung involvement with RT-PCR as reference standards. The data sets were plotted in ROC space, and Youden's J statistic was calculated to determine the threshold cut-off CO-RADS category for COVID-19 positivity. RESULTS: There was overall moderate inter-observer agreement between all readers (Fleiss' K 0.54 [95% CI 0.54, 0.54]), with substantial agreement among chest radiologists (Fleiss' K 0.68 [95% CI 0.67, 0.68]), general radiologists (Fleiss' K 0.61 [95% CI 0.61, 0.61]), and moderate agreement among radiologists-in-training (Fleiss' K 0.56 [95% CI 0.56, 0.56]). There was overall moderate inter-observer agreement in early disease (stages 1 and 2), with cumulative Fleiss' K 0.45 [95% CI 0.45, 0.45]). The overall AUC for CO-RADS lexicon scheme to accurately diagnose COVID-19 yielded 0.92 (95% CI 0.91, 0.94) with strong concordance within and between groups, of chests radiologists with AUC of 0.91 (95% CI 0.88, 0.94), general radiologists with AUC 0.96 (95% CI 0.94, 0.98), and radiologists in training with AUC of 0.90 (95% CI 0.87, 0.94). For detecting COVID-19, ROC curve analysis yielded CO-RADS > 3 as the cut-off threshold with sensitivity 90% (95% CI 0.88, 0.93), and specificity of 87% (95% CI 0.83, 0.91). CONCLUSION: Readers across different levels of experience could accurately identify COVID-19 positive patients using the CO-RADS lexicon with moderate inter-observer agreement and high diagnostic accuracy.

Disease-drug and drug-drug interaction in COVID-19: Risk and assessment.

COVID-19 is announced as a global pandemic in 2020. Its mortality and morbidity rate are rapidly increasing, with limited medications. The emergent outbreak of COVID-19 prompted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) keeps spreading. In this infection, a patient's immune response plays pivotal role in the pathogenesis. This inflammatory factor was shown by its mediators that, in severe cases, reach the cytokine at peaks. Hyperinflammatory state may sparks significant imbalances in transporters and drug metabolic machinery, and subsequent alteration of drug pharmacokinetics may result in unexpected therapeutic response. The present scenario has accounted for the requirement for therapeutic opportunities to relive and overcome this pandemic. Despite the diminishing developments of COVID-19, there is no drug still approved to have significant effects with no side effect on the treatment for COVID-19 patients. Based on the evidence, many antiviral and anti-inflammatory drugs have been authorized by the Food and Drug Administration (FDA) to treat the COVID-19 patients even though not knowing the possible drug-drug interactions (DDI). Remdesivir, favipiravir, and molnupiravir are deemed the most hopeful antiviral agents by improving infected patient's health. Dexamethasone is the first known steroid medicine that saved the lives of seriously ill patients. Some oligopeptides and proteins have also been using. The current review summarizes medication updates to treat COVID-19 patients in an inflammatory state and their interaction with drug transporters and drug-metabolizing enzymes. It gives an opinion on the potential DDI that may permit the individualization of these drugs, thereby enhancing the safety and efficacy.

Analysis and Dynamics of Fractional Order Covid-19 Model with Memory Effect

The present article attempts to examine fractional order Covid-19 model by employing an efficient and powerful analytical scheme termed as q-homotopy analysis Sumudu transform method (q-HASTM). The q-HASTM is the hybrid scheme based on q-HAM and Sumudu transform technique. Liouville-Caputo approach of the fractional operator has been employed. The proposed modelis also examined numerically via generalized Adams-Bashforth-Moulton method. We determined model equilibria and also give their stability analysis by employing next generation matrix and fractional Routh-Hurwitz stability criterion.

Utility of visual coronary artery calcification on non-cardiac gated thoracic CT in predicting clinical severity and outcome in COVID-19.

BACKGROUND: Assessment of visual-coronary artery calcification on non-cardiac gated CT in COVID-19 patients could provide an objective approach to rapidly identify and triage clinically severe patients for early hospital admission to avert worse prognosis. PURPOSE: To ascertain the role of semi-quantitative scoring in visual-coronary artery calcification score (V-CACS) for predicting the clinical severity and outcome in patients with COVID-19. MATERIALS AND METHODS: With institutional review board approval this study included 67 COVID-19 confirmed patients who underwent non-cardiac gated CT chest in an inpatient setting. Two blinded radiologist (Radiologist-1 &2) assessed the V-CACS, CT Chest severity score (CT-SS). The clinical data including the requirement for oxygen support, assisted ventilation, ICU admission and outcome was assessed, and patients were clinically subdivided depending on clinical severity. Logistic regression analyses were performed to identify independent predictors. ROC curves analysis is performed for the assessment of performance and Pearson correlation were performed to looks for the associations. RESULTS: V-CACS cut off value of 3 (82.67% sensitivity and 54.55% specificity; AUC 0.75) and CT-SS with a cut off value of 21.5 (95.7% sensitivity and 63.6% specificity; AUC 0.87) are independent predictors for clinical severity and also the need for ICU admission or assisted ventilation. The pooling of both CT-SS and V-CACS (82.67% sensitivity and 86.4% specificity; AUC 0.92) are more reliable in terms of predicting the primary outcome of COVID-19 patients. On regression analysis, V-CACS and CT-SS are individual independent predictors of clinical severity in COVID-19 (Odds ratio, 1.72; 95% CI, 0.99-2.98; p = 0.05 and Odds ratio, 1.22; 95% CI, 1.08-1.39; p = 0.001 respectively). The area under the curve (AUC) for pooled V-CACS and CT-SS was 0.96 (95% CI 0.84-0.98) which correctly predicted 82.1% cases. CONCLUSION: Logistic regression model using pooled Visual-Coronary artery calcification score and CT Chest severity score in non-cardiac gated CT can predict clinical severity and outcome in patients with COVID-19.

Fractional Optimal Control Dynamics of Coronavirus Model with Mittag–Leffler Law

Most countries around the world are battling to limit the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). As the world strives to get an effective medication to control the disease, appropriate control measures for now remains one of the effective measures to reduce the spread of the disease. In this study, a fractional optimal control model is formulated in Atangana-Baleanu-Caputo derivative sense. The reproduction number and steady state of disease free of the Coronavirus model are examined and found to be globally stable. The existence and uniqueness of solution of the fractional Coronavirus model is established by using the Banach fixed point theorem approach. Three controls are considered in the model and Pontryagins Maximum Principle is used to establish the necessary conditions for optimal control solution. The numerical solution suggests that the best strategy is found to be the utilization of all three controls at the same time.

A perspective on potential target proteins of COVID-19: Comparison with SARS-CoV for designing new small molecules.

SARS-CoV-2 (COVID-19) epidemic has created an unprecedented medical and economic crisis all over the world. SARS-CoV-2 is found to have more contagious character as compared to MERS-CoV and is spreading in a very fast manner all around the globe. It has affected over 31 million people all over the world till date. This virus shares around 80% of genome similarity with SARS-CoV. In this perspective, we have explored three major targets namely; SARS-CoV-2 spike (S) protein, RNA dependent RNA polymerase, and 3CL or Mpro Protease for the inhibition of SARS-CoV-2. These targets have attracted attention of the medicinal chemists working on computer-aided drug design in developing new small molecules that might inhibit these targets for combating COVID-19 disease. Moreover, we have compared the similarity of these target proteins with earlier reported coronavirus (SARS-CoV). We have observed that both the coronaviruses share around 80% similarity in their amino acid sequence. The key amino acid interactions which can play a crucial role in designing new small molecule inhibitors against COVID-19 have been reported in this perspective. Authors believe that this study will help the medicinal chemists to understand the key amino acids essential for interactions at the active site of target proteins in SARS-CoV-2, based on their similarity with earlier reported viruses. In this review, we have also described the lead molecules under various clinical trials for their efficacy against COVID-19.