A randomized controlled clinical trial on efficacy and safety of anakinra in patients with severe COVID-19.

INTRODUCTION: Hyperinflammatory state has a role in the pathogenesis of COVID-19. Anakinra could reduce inflammation and help to combat the condition. In this study, we aimed to assess the safety and efficacy of anakinra (PerkinRA®) in severe COVID-19. METHOD: The study was an open-label, randomized, controlled trial conducted in Imam Hossein Medical Center from May to July 2020. Patients with a confirmed diagnosis of COVID-19 were included in this study. We administered anakinra 100 mg daily intravenously. All patients received COVID-19 pharmacotherapy based on the represented national guideline. The need for invasive mechanical ventilation is considered the primary outcome. RESULTS: Thirty patients were included in this study, and 15 of them received Anakinra. Nineteen patients were male (63.3%), and 11 were female (36.7%). The mean age of patients was 55.77 ± 15.89 years. In the intervention group, the need for invasive mechanical ventilation was significantly reduced compared to the control group (20.0% vs. 66.7%, p = .010). Also, these patients had a significantly lower length of hospital stay (p = .043). No significant higher rate of infection was recorded. CONCLUSION: Anakinra as an immunomodulatory agent has been associated with the reduced need for mechanical ventilation in patients admitted to intensive care units because of severe COVID-19. The medication reduced the hospital length of stay. Furthermore, no increased risk of infection was observed. Further randomized placebo-controlled trials with a larger sample size are needed to confirm these findings.

Orthopedic Trauma Surgeries in COVID-19 Pandemic; A Trauma Management Algorithm.

After the COVID-19 outbreak worldwide, we will sooner or later encounter trauma patients with COVID-19 in the developing countries. It is a challenging decision-making process for an orthopedic surgeon to provide the patients with the best practice in the crisis. Here we discuss the issue in terms of clinical severity of COVID-19 pneumonia, priority of orthopedic surgical trauma procedures and standard of care for the treatment of trauma injuries. We finally propose an algorithm for better management of trauma patients in the setting of COVID-19 mass spread.

Fracture Surgery in Known COVID-19 Infected Patients: What Are the Challenges?

BACKGROUND: Surgery in the time of COVID-19 pandemic is a challenging issue while treatment of affected fracture patients is inevitable. The present study summarizes the challenges that an orthopedic surgeon is confronting during the surgical treatment of fracture patients with concomitant COVID-19 infection. METHODS: Demographic and fracture related data of 13 fracture patients with concomitant COVID-19 infection who were treated with surgery was collected from three trauma centers in Tehran and Kermanshah cities from 21, February 2020 to April 3, 2020. RESULTS: All patients were male with mean age of 38.6±19.5 years. Eight patients had high energy fracture and seven patients had multiple fractures and trauma. Wrist and hand were the common sites of fracture following hip and pelvis. The mean interval time period between the diagnosis of COVID-19 infection and surgery was 2.3±1.5 days. Before surgery, all patients except one had been admitted to the corona dedicated wards, while two patients were admitted to the intensive care unit (ICU). One of the ICU admitted patients died. All the 12 alive patients remained in home isolation after discharge. CONCLUSION: Fracture surgery in COVID-19 patients has many challenges such as lack of medical resources, delay of surgery, medial staff fear, and patient isolation. However, a multidisciplinary approach using all potential hospital resources would lead to successful operation and acceptable outcome.