Attenuated effects of rivastigmine in induced cytokine storm in mice

Background: A cytokine storm is a serious clinical condition that complicates infectious diseases, for example, coronavirus disease 2019 (COVID-19), and non-infectious diseases such as autoimmune diseases and cancer and may often lead to death. The patients who are affected by the cytokine storm are almost always severe/critical and at risk for acute respiratory distress syndrome or eventually death. Pro-inflammatory cytokines such as interleukin 6 (IL-6), IL-1 beta, and tumor necrosis factor alpha (TNF-alpha) have been repeatedly shown to be related to the COVID-19 disease severity and mortality. In this study, our objective was to evaluate the attenuated effect of rivastigmine (RA) in a cytokine storm in Swiss Albino mice in which the cytokine storm was induced by lipopolysaccharide (LPS) and to explore their effects on IL-1 beta, IL-6, and TNF-alpha levels. Method(s): This study was carried with 60 male Swiss albino mice that were divided equally and randomly into six groups as follows: *Group AH: Apparently healthy control group which received no induction, not treated. *Group LPS: Induced using LPS at 5 mg/kg and no treatment administered. *Group DMSO: Induced and treated with 1% dimethyl sulfoxide (DMSO). *Group RA: Induced and treated with 0.5 mg/kg RA. *Group MPA: Induced and treated with 50 mg/kg methylprednisolone (MPA). *Group RMPA: Induced and treated with 0.25 mg/kg rivastigmine and 25 mg/kg of methylprednisolone. All the mice were treated with drugs or vehicles for three consecutive days before LPS induction. The mice were then injected with LPS intraperitoneally at a dosage of 5 mg/kg for systematic inflammatory stimulation. After 48 hours of LPS induction, all the mice were euthanized by light anesthesia with chloroform, and blood was collected for the quantitative determination of IL-1beta, IL-6, and TNF-alpha levels using the enzyme-linked immunosorbent assay (ELISA) technique. Result(s): Administration of LPS to Swiss albino mice caused a significant elevation of IL-1beta, IL-6, and TNF-alpha levels than in the healthy control group. Significant reduction of these parameters were observed in the RA and MPA groups when compared with those in the non-treated group. Conclusion(s): RA was found to be effective in attenuating the induced cytokine storm by suppressing IL-1beta, IL-6, and TNF-alpha levels, and the results with RA were comparable to that of MPA. A combination of half-doses of both RA and MPA administered together shows no obvious advantage when compared with that of each of them alone.Copyright © 2022 Mansoor, Raghif, licensee HBKU Press

Knowledge, beliefs and practices about COVID-19 infection and vaccination in healthcare personnel at non-acute care facilities

Background. The objective of this study is to characterize the experiences, knowledge, beliefs, and perceptions of risk related to COVID-19, infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at three non-acute care facilities. Methods. The study protocol was approved by the Washington University IRB. Between April-May 2021, anonymous surveys were distributed to HCP at three nonacute care facilities in St. Louis, MO. Data was collected on demographics, experience working in healthcare, COVID-19 exposures, knowledge and beliefs about infection prevention policies and procedures, PPE use, perception of risk of acquiring COVID-19, and COVID-19 vaccination status. Results. There were 156 respondents;78% were female, and 53% reported >10 years of healthcare experience. The largest proportion (32%) were in direct patient care as nurses or nurses' aides. A majority (97%) reported adequate knowledge of how to protect themselves from COVID-19 at work, and most (95%) reported access to adequate PPE supplies. HCP (58.7%) reported that wearing a mask or face shield made communication difficult, 56% stated they had taken on additional responsibilities due to staff shortages, and 53% indicated that their job became more stressful because of COVID-19. More than a quarter (28%) had considered quitting their job due to COVID-19. HCPs were more concerned about acquiring COVID-19 in the community than at work (47 vs 33%). When asked about the COVID-19 vaccine, 78% of respondents reported receiving at least one dose of vaccine and 72% had completed a primary vaccine series. The most common reasons given for deciding to get vaccinated were a desire to protect family and friends (84%) and wanting to help stop the spread of COVID-19 (82%). For unvaccinated respondents (29%), the most common reasons for not receiving vaccination were concern for side effects (53%) and belief that the vaccine was not tested well enough (50%). Conclusion. A significant proportion of HCP reported stress and increased responsibilities at work due to COVID-19, and 1 in 4 considered leaving their job. A majority were vaccinated, with concerns about side effects or inadequate vaccine testing cited as the most common concerns by unvaccinated HCPs.

Comparison of Different Treatment Strategies Combating COVID-19 in Pakistan

Objective: To compare different treatment strategies for patients of COVID-19 in Pakistan. Study Design: Retrospective longitudinal study. Place and Duration of Study: Abbas Medical Hospital, Muzaffarabad Pakistan, during Apr 2021. Methodology: One hundred and twenty, COVID-19-positive patients between 31-45 years of age were admitted to Abbas hospital after carrying out the rRT-PCR test. Group-A was administered Azithromycin, while Group-B was treated with Azithromycin in combination with Hydroxychloroquine. Group-C was given a combination of oral Ivermectin and Doxycy-cline, and Group-D was treated with Lopinavir. Diagnostic tests include rRT-PCR, blood parameters such as creatinine, random blood sugar, alanine aminotransferase, complete blood count, ECG, chest x-ray and blood biomarkers including procalcitonin, C-reactive protein, lactate dehydrogenase and ferritin were performed at Day 1, 5, 7, 14 and 30. Results: Patients treated with Azithromycin revealed the highest recovery of about (77.80%) among COVID-19 patients, followed by the combination of Azithromycin and Hydroxychloroquine which was (65.56%), the combination of Ivermectin and Doxycycline was (19.63%), and Lopinavir was (9.06%) displayed minimum potency in recovering the COVID-19 positive patients (p-value <0.001). Conclusions: Azithromycin was most effective in helping patients recover from COVID-19, followed by a combination of azithromycin and Hydroxychloroquine. Patients who recovered after treatment with Ivermectin Doxycycline were lower, followed by those who recovered with Lopinavir only. © 2022, Army Medical College. All rights reserved.

Incidence, risk factors and outcomes of acute kidney injury among COVID-19 patients: A systematic review of systematic reviews.

The COVID-19 associated acute kidney injury (CAKI) has emerged as a potential intricacy during the management of patients. Navigating the rapidly growing body of scientific literature on CAKI is challenging, and ongoing critical appraisal of this complication is essential. This study aimed to summarize and critically appraise the systematic reviews (SRs) on CAKI to inform the healthcare providers about its prevalence, risk factors and outcomes. All the SRs were searched in major databases (PubMed, EMBASE, Web of Science) from inception date to December 2021. This study followed SR of SRs methodology, all the records were screened, extracted and subjected to quality assessment by assessing the methodological quality of systematic reviews (AMSTAR-2). The extracted data were qualitatively synthesized and tabulated. This review protocol was registered in PROSPERO (CRD42022299444). Of 3,833 records identified; 42 SRs were included in this overview. The quality appraisal of the studies showed that 17 SRs were of low quality, while 8 moderate and 17 were of high-quality SRs. The incidence of CAKI ranged from 4.3% to 36.4% in overall COVID-19 patients, 36%-50% in kidney transplant recipients (KTRs), and up to 53% in severe or critical illness. Old age, male gender, cardiovascular disease, chronic kidney disease, diabetes mellitus and hypertension were frequently reported risk factors of CAKI. The need of renal replacement therapy (RRT) was up to 26.4% in overall COVID-19 patients, and 39% among those having CAKI. The occurrence of acute kidney injury (AKI) was found independent predictor of death, where mortality rate among CAKI patients ranged from 50% to 93%. This overview of SRs underscores that CAKI occurs frequently among COVID-19 patients and associated with high mortality, need of RRT and adverse outcomes. However, the confidence of these results is moderate to low which warrants the need of more SRs having established methodological standards. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299444], identifier [CRD42022299444].

Attenuated effects of rivastigmine in induced cytokine storm in mice

Background: A cytokine storm is a serious clinical condition that complicates infectious diseases, for example, coronavirus disease 2019 (COVID-19), and non-infectious diseases such as autoimmune diseases and cancer and may often lead to death. The patients who are affected by the cytokine storm are almost always severe/critical and at risk for acute respiratory distress syndrome or eventually death. Pro-inflammatory cytokines such as interleukin 6 (IL-6), IL-1 beta, and tumor necrosis factor alpha (TNF-α) have been repeatedly shown to be related to the COVID-19 disease severity and mortality. In this study, our objective was to evaluate the attenuated effect of rivastigmine (RA) in a cytokine storm in Swiss Albino mice in which the cytokine storm was induced by lipopolysaccharide (LPS) and to explore their effects on IL-1 β, IL-6, and TNF-α levels. Methods: This study was carried with 60 male Swiss albino mice that were divided equally and randomly into six groups as follows: •Group AH: Apparently healthy control group which received no induction, not treated. •Group LPS: Induced using LPS at 5 mg/kg and no treatment administered. •Group DMSO: Induced and treated with 1% dimethyl sulfoxide (DMSO). •Group RA: Induced and treated with 0.5 mg/kg RA. •Group MPA: Induced and treated with 50 mg/kg methylprednisolone (MPA). •Group RMPA: Induced and treated with 0.25 mg/kg rivastigmine and 25 mg/kg of methylprednisolone. All the mice were treated with drugs or vehicles for three consecutive days before LPS induction. The mice were then injected with LPS intraperitoneally at a dosage of 5 mg/kg for systematic inflammatory stimulation. After 48 hours of LPS induction, all the mice were euthanized by light anesthesia with chloroform, and blood was collected for the quantitative determination of IL-1β, IL-6, and TNF-α levels using the enzyme-linked immunosorbent assay (ELISA) technique. Results: Administration of LPS to Swiss albino mice caused a significant elevation of IL-1β, IL-6, and TNF-α levels than in the healthy control group. Significant reduction of these parameters were observed in the RA and MPA groups when compared with those in the non-treated group. Conclusion: RA was found to be effective in attenuating the induced cytokine storm by suppressing IL-1β, IL-6, and TNF-α levels, and the results with RA were comparable to that of MPA. A combination of half-doses of both RA and MPA administered together shows no obvious advantage when compared with that of each of them alone.

Prevalence and characteristics of abnormalities on cardiac MRI in primary care following recovery from acute SARS-CoV-2 infection and correlation with markers of immunity and coagulation: primary results of the setanta study

32 Figure 1ConclusionThe SETANTA study will evaluate the prevalence and characteristics of abnormalities on cardiac MRI in primary care patients in Ireland following recovery from acute SARS-CoV-2 infection and assess correlation with immune response and coagulopathy. Data from the study will help inform the long-term management of patients recovered from SARS-CoV-2 and assist in planning of health care service provision.

Acute Myocardial Infarction and Papillary Muscle Rupture in the COVID-19 Era.

Mechanical complications of acute myocardial infarction are infrequent in the modern era of primary percutaneous coronary intervention, but they are associated with high mortality rates. Papillary muscle rupture with acute severe mitral regurgitation is one such life-threatening complication that requires early detection and urgent surgical intervention. (Level of Difficulty: Beginner.).