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Objective: Despite the worldwide spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an effective specific antiviral treatment for coronavirus disease of 2019 (COVID-19) is yet to be identified.We did this study to investigate the safety and efficacy of sofosbuvir as antiviral therapy among hospitalized adult patients with SARS-CoV-2. Methods: Patients were randomized into intervention arm receiving sofosbuvir or comparison arm receiving usual antiviral agents in addition to standard of care. The primary end point of the study was clinical recovery as defined by normal body temperature and normal oxygen saturation. The main secondary outcome was all-cause mortality during the admission in hospital or within 14 days after discharge if applicable. Reports of severe adverse events were observed in the intervention arm. Results: Fifty-seven patients enrolled into either the clinical trial arm (n=27) or the comparison arm (n=30). Primary outcome was achieved by 24 (88.9%) and 10 (33.3%) in the intervention and comparison arms, respec-tively. Median hospital length of stay was significantly shorter in the intervention arm (10 days [IQR: 5-12] vs. 11.5 days [IQR: 8.5-17.75], P = 0.016). All-cause mortality was two and thirteen in intervention and comparison groups, respectively. No serious adverse events were reported by the patients receiving sofosbuvir during the study. Conclusion: Among patients hospitalized with SARS-CoV-2, those who received sofosbuvir had more clinical recovery rate and had a shorter hospital length of stay than those who received usual antiviral agents in the study and these differences were statistically significant. © 2023 Tehran University of Medical Sciences.
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Background: Limited medications are available for post-exposure prophylaxis of coronavirus disease 2019 (COVID-19) infection. Whether bromhexine can prevent or mitigate symptomatic infection after virus exposure is undetermined. Objective(s): We aimed to evaluate bromhexine's effect on preventing COVID-19 after close contact exposure. Method(s): A multi-center randomized, double-blind, placebo-controlled clinical trial was conducted on 372 adults (>= 18 years) who had close contact within four days with a household member with confirmed COVID-19. They were randomly assigned to receive bromhexine 8 mg (n = 187) or placebo (n = 185) three times a day for two weeks. The primary outcome was the incidence of symptomatic COVID-19. Secondary outcomes included hospitalization or death, confirmed COVID-19 by Polymerase Chain Reaction (PCR) in symptomatic patients, and adverse drug reactions. Result(s): The incidence of symptomatic COVID-19 was significantly lower in individuals who received bromhexine than in those who received the placebo (16 [8.6%] vs. 34 [18.4%], relative risk = 0.47, P = 0.005). PCR confirmation was reported in 13 (7.0%) and 26 (14.1%) individuals in the bromhexine and placebo groups, respectively (P = 0.025), with a relative risk reduction of 50%. The hospitalization rate, death, and medication side effects did not vary significantly between the bromhexine and placebo arms. Conclusion(s): Bromhexine is an effective, non-invasive, affordable agent with a low side-effect profile to prevent symptomatic COVID-19. Early use of bromhexine potentially provides another layer of protection;hence, it can play a role in controlling the pan-demic. Copyright © 2022, Author(s).
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Objective: In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients. Methods: This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission, and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed. Results: Most common cardiac dysrhythmias on admission were sinus tachycardia (64.8%), atrial fibrillation (13.5%), and sinus bradycardia (11.3%). Multivariate regression analysis showed that a history of metformin use (RR=0.83;P=0.042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1.16;P=0.018), history of cardiovascular diseases (RR=1.16;P=0.017), history of cancer (RR=1.40;P=0.004) and QT interval prolongation on ECG (RR=1.18;P=0.017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, among the 328 patients that had a second ECG, 185 (56.4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1.85;95% CI: 1.49,2.35;P<0.001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. No significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias. Conclusion: The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, and QT interval prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and kaletra (lopinavir-ritonavir) had no association with the development of cardiac dysrhythmias during hospitalization. © 2022 Tehran University of Medical Sciences.
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Background: Coronavirus disease 2019 (COVID -19), characterized by a mild to severe respiratory illness, has been affecting the world since late 2019 and leading to an increase in hospitalizations and deaths. There is still no specific, highly effective treatment for this disease. This study aimed to compare the efficacy of the eight treatment regimens for hospitalized patients with COVID-19. Materials and Methods: This retrospective cohort study was conducted on hospitalized patients with laboratory-confirmed COVID-19 by a real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) of nasopharyngeal samples. Results: Among all patients hospitalized with COVID-19 between March to September 2020, 861 patients were included in the study. This study indicated that treatment protocols included either remdesivir or favipiravir were superior to hydroxychloroquine in reducing the risk of in-hospital mortality of the patients with confirmed COVID-19, especially in critical patients defined as those who were ICU admitted or under mechanical ventilation (HR, 0.43;95% CI, 0.23 to 0.82;P=0.011 and HR, 0.45;95% CI, 0.22 to 0.90;P=0.024, respectively). Whereas receiving lopinavir/ritonavir in combination with either hydroxychloroquine plus interferon β and corticosteroids (HR, 1.85;95% CI, 1.17 to 2.94;P=0.009), hydroxychloroquine plus interferon β (HR, 1.66;95% CI, 1.01 to 2.74;P=0.046), or interferon β (HR, 1.80;95% CI, 1.12 to 2.89;P=0.015) was associated with a significant increase in this risk. Conclusion: Our findings indicate that using remdesivir and favipiravir in combination with interferon β and corticosteroids might be beneficial in hospitalized patients with COVID-19, especially critical ones. © 2021 Shahid Beheshti University of Medical Sciences, Anesthesiology Research Center. All rights reserved.
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Objective: Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients. Methods: Data related to clinical characteristics and cost of hospitalized COVID-19 patients from February 2020 until July 2020, in a public teaching hospital in Tehran, Iran was gathered in a retrospective cohort study. The corresponding factors influencing the diagnostic and therapeutic costs were evaluated, using a generalized linear model. Results: The median COVID-19 related diagnostic and therapeutic costs in a public teaching hospital in Iran, for one hospitalized COVID-19 patient was equal to 271.1 US dollars (USD). In patients who were discharged alive from the hospital, the costs increased with patients’ pregnancy (P<0.001), loss of consciousness during hospitalization (P<0.001), a history of drug abuse (P=0.006), history of chronic renal disease (P<0.001), end stage renal disease (P=0.002), history of brain surgery (P=0.001), history of migraine (P=0.001), cardiomegaly (P=0.033) and occurrence of myocardial infarction during hospitalization (P<0.001). In deceased patients, low age P<0.001), history of congenital disease (P=0.024) and development of cardiac dysrhythmias during hospitalization (P=0.044) were related to increase in therapeutic costs. Conclusion: Median diagnostic and therapeutic costs in COVID-19 patients, hospitalized in a public teaching hospital in Iran were 271.1 USD. Hoteling and medications made up most of the costs. History of cardiovascular disease and new onset episodes of such complications during hospitalization were the most important factors contributing to the increase of therapeutic costs. Moreover, pregnancy, loss of consciousness, and renal diseases are of other independent factors affecting hospitalization costs in COVID-19 patients. © 2022 Tehran University of Medical Sciences.
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Introduction: The correlation between echocardiographic findings and the outcome of COVID-19 patients is still under debate. Objective: In the present study it has been endeavored to evaluate the cardiovascular condition of COVID-19 patients using echocardiography and to assess the association of these findings with in-hospital mortality. Methods: In this retrospective cohort study, hospitalized COVID-19 patients from February to July 2020 with at least one echocardiogram were included. Data were extracted from patients’ medical records and the association between echocardiographic findings and in-hospital mortality was assessed using a multivariate model. The findings were reported as relative risk (RR) and 95% confidence interval (95% CI). Results: Data from 102 COVID-19 hospitalized patients were encompassed in the present study (63.7±15.7 mean age;60.8% male). Thirty patients (29.4%) died during hospitalization. Tricuspid regurgitation (89.2%), mitral valve regurgitation (89.2%), left ventricular (LV) diastolic dysfunction (67.6%), pulmonary valve insufficiency (PI) (45.1%) and LV systolic dysfunction (41.2%) were the most common findings on patients’ echocardiogram. The analyses of data showed that LV systolic (p=0.242) and diastolic (p=0.085) dysfunction was not associated with in-hospital mortality of COVID-19 patients, while the presence of PI (RR=1.85;95% CI: 1.02 to 3.33;p=0.042) and patients’ age (RR=1.03;95% CI: 1.01 to 1.08;p=0.009) were the two independent prognostic factors of in-hospital mortality. Conclusions: It seems that LV systolic and diastolic dysfunction was not associated with in-hospital mortality of COVID-19 patients. However, presence and PI and old age are possible prognostic factors of COVID-19 in-hospital mortality. Therefore, using echocardiography might be useful in management of COVID-19. © 2021 Tehran University of Medical Sciences.
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In late December 2019, a cluster of unexplained pneumonia cases has been reported in Wuhan, China, named coronavirus disease 2019 (COVID -19) which has been spreading in 204 countries. To date no pharmaceutical products have been approved for the treatment of this viral pneumonia. Based on rapid spread of the disease and high disease burden, several agents have been proposed for treatment of this viral pneumonia, mainly antivirals and immunomodulator agents and underwent in-vitro, animal and clinical trials. Some of these agents have been revealed promising preclinical results but, non of them approved yet. This review aims to summarize the current knowledge about the mechanism and considerations of widely used investigational agents that are used in the treatment of COVID-19 as off-label.
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A pregnant woman (Gravida 2, Abortion 1, twin pregnancy with microinjection, Gestational Age: 23 weeks and 3 days) was referred to a tertiary referral hospital with complaints of fever, dry cough and dyspnea. She was admitted with a diagnosis of COVID-19. During her hospitalization, O2 saturation progressively declined, which required acute respiratory care and support leading to intubation and mechanical ventilation. Gradual recovery occurred through treatment processes and finally the patient was extubated. However, there was another episode of respiratory failure leading to reintubation after 5 days. Meanwhile, serum liver enzymes increased significantly and leaded to intrauterine death of both fetus followed by a critical decline in cardiac output to less than 10% and cardiac arrest followed by unsuccessful resuscitation within hours.