ABSTRACT
Novel coronavirus infection is a disease caused by severe acute respiratory syndrome coronavirus 2 and named as coronavirus disease 2019. First confirmed case in adult was reported in December 2019 in China. Since then, research is being conducted in multiple sites in order to better define the epidemiology, clinical characteristics, prevention and treatment of severe acute respiratory syndrome-coronavirus-2 infection in adults. Few cases have been observed in children and newborn infants who seem to have a milder form of clinical disease than other age groups. The purpose of this review is to summarize the available evidence on severe acute respiratory syndromecoronavirus- 2 transmission, the associated clinical presentation, outcomes and treatment in newborn infants with the aim to provide adequate information to neonatologists, pediatricians and obstetricians for managing such patients.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a highly hypercoagulable viral infection complicated as COVID-inflicted coagulopathy (CIC), that is associated with increased risk of morbidity and mortality. International guidelines recommend low molecular weight heparin (LMWH) to treat CIC in both in-hospital and in-home settings. However, in India, using subcutaneous LMWH may not be a feasible option for a vast majority of patients under home management. Additionally, while some evidence advocates the use of novel oral anticoagulants (NOACs), in hospitalized settings, most guidelines find no role of NOACs in hospital settings. On the other hand, the resource crunch faced in recent COVID-19 pandemic in India forced physicians to treat many patients in home settings. These patients had been usually prescribed NOACs for ease of administration and adherence. Therefore, there is a need to form a consensus on the use of NOACs to manage CIC in India. © 2021 Journal of Association of Physicians of India. All rights reserved.
ABSTRACT
During the COVID-19 pandemic the health authorities at airports and train stations try to screen and identify the travellers possibly exposed to the virus. However, many individuals avoid getting tested and hence may misreport their travel history. This is a challenge for the health authorities who wish to ascertain the truly susceptible cases in spite of this strategic misreporting. We investigate the problem of questioning travellers to classify them for further testing when the travellers are strategic or are unwilling to reveal their travel histories. We show there are fundamental limits to how many travel histories the health authorities can recover.
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Acute undifferentiated febrile illnesses (AUFIs) are associated with specific characterizations like fever of less than two weeks' duration with no organ-specific symptoms at onset. These range from mild and self-limiting disease to progressive, life-threatening illness. Acute undifferentiated febrile illnesses are classified into malaria and non-malarial illnesses on the basis of microscopy or malariadiagnostic tests. Various challenges, such as comorbidities, geriatrics, pregnancy, and immune-compromised profile of the patient, impede the treatment regimen. Identifying the root cause of undifferentiated fever becomes critical and involves correct diagnostic tests along with empirical treatment initiation. Doxycycline, being a broad-spectrum antibiotic, confers activity against many Gram-positive, Gram-negative, and "atypical" bacteria. Apart from antimicrobial activity, Doxycycline demonstrates the potential to inhibit dengue virus replication and exhibits anti-inflammatory activity by down-regulating proinflammatory cytokine levels. As coronavirus disease 2019 (COVID-19) spreads, the clinical management of associated cytokine storm remains unanswered. Considering the probable beneficial effect of doxycycline, it has been recommended by the national and international experts for the empirical management of COVID-19. © Journal of the Association of Physicians of India 2011.
ABSTRACT
India has a disproportionately high burden of acute and chronic pulmonary diseases. In India, 65 million suffer from non-communicable respiratory diseases. The outbreak of the novel coronavirus disease 2019 (COVID-19) had worsened the situation. Patients affected with COVID-19 with a previous history of comorbidities, such as COPD and chronic lung diseases, had the worst prognosis, resulting in adverse outcomes, such as acute respiratory distress syndrome (ARDS) and pneumonia. Immune modulation strategies have since gained a lot of traction amongst practitioners. Modulation of the immune system with Pidotimod along with standard-of–care (SOC) treatment has proven efficacious in the past two decades in patients with recurrent respiratory tract infections (RRTIs), bronchitis, COPD, and pneumonia. In this article, we have reviewed the current unmet needs in the management of COPD in India and evaluated the usage of Pidotimod in adult COPD patients based on expert panel discussion © 2021 Journal of Association of Physicians of India. All rights reserved.
ABSTRACT
Acute undifferentiated febrile illnesses (AUFIs) are associated with specific characterizations like fever of less than two weeks’duration with no organ-specific symptoms at onset. These range from mild and self-limiting disease to progressive, life-threatening illness. Acute undifferentiated febrile illnesses are classified into malaria and non-malarial illnesses on the basis of microscopy or malaria-diagnostic tests. Various challenges, such as comorbidities, geriatrics, pregnancy, and immune-compromised profile of the patient, impede the treatment regimen. Identifying the root cause of undifferentiated fever becomes critical and involves correct diagnostic tests along with empirical treatment initiation. Doxycycline, being a broad-spectrum antibiotic, confers activity against many Gram-positive, Gram-negative, and “atypical” bacteria. Apart from antimicrobial activity, Doxycycline demonstrates the potential to inhibit dengue virus replication and exhibits anti-inflammatory activity by down-regulating proinflammatory cytokine levels. As coronavirus disease 2019 (COVID-19) spreads, the clinical management of associated cytokine storm remains unanswered. Considering the probable beneficial effect of doxycycline, it has been recommended by the national and international experts for the empirical management of COVID-19. © 2021 Journal of Association of Physicians of India. All rights reserved.
ABSTRACT
Introduction: Favipiravir, a broad-spectrum antiviral agent, acts by inhibiting RNA-dependent RNA polymerase. It is approved in India in the management of mild-moderate COVID-19. It has shown potent in vitro activity against SARS-CoV-2. It has a wide therapeutic safety margin indicated by a wide CC50/EC50 ratio for a high dose. It has shown promising results in clinical studies conducted in China, Russia, Japan, and India. Treatment guidelines from many countries and some states from India have included favipiravir in the treatment protocol. A recently published phase III trial on favipiravir in India has shown early clinical resolution and acceptable safety in mild-moderate COVID-19 infection. Objectives: The primary objective of the study was to evaluate the effectiveness of favipiravir in moderate COVID-19 patients, while the secondary objective was to determine the safety of favipiravir. Materials and methods: We retrospectively analyzed medical records of favipiravir-treated COVID-19 cases from 3 centers to capture key details of moderate COVID-19 patients including medical history, symptoms, supportive treatment, and clinical outcome. The protocol of the study was approved by Independent Ethics Committee. Results: Data from medical records of 193 patients was available for analysis, including 54 patients of moderate severity. The mean age was 59.94 ± 13.18 years. 58.92% of the patients were male. Hypertension (78.57%) and diabetes (55.35%) were the two most prevalent comorbidities. Majority (85.71%) of patients had at least one comorbidity, while 66.07% had ≥2 comorbidities. Mean SpO2 was 92.83 ± 1.88% with a median of 93% (90-98). The most common clinical features were fever (87.5%), cough (80.35%), dyspnoea (57.14%) and myalgia (48.12%). The mean CRP was 65.58 ± 34.74 with a median of 57.85 (1.20 to 151) and the mean d-Dimer was 1082.95 ± 1129.7 with a median of 815 (156-7435). Favipiravir has been used for an average duration of 12.30 ± 3.99 days, with median duration of 14 days (1-14 days). The rate of clinical improvement on days 3, 5, 7 and 10 was 30.35%, 75%, 89.29% and 96.42%. Fever and dyspnoea were fully resolved by day 7 in all enrolled patients, while myalgia was resolved by day 10 in all patients and cough was resolved by day 10 in 97.77% of patients. Corticosteroid was used in 37.5% patients. Oxygen requirements on days 3, 5, 7 and 10 were 28.57%, 14.28%, 8.92% and 7.14% patients respectively. Progression of the disease was seen in 10.71% of cases. Overall favipiravir was well tolerated with few commonly reported adverse events like diarrhoea and nausea, which does not require drug discontinuation. 91.07% patients and physician rated favipiravir as good or very good on global assessment scale. Discussions: An open-labeled nonrandomized study1 from China compared the effect of favipiravir (day 1: 1,600 mg twice daily;days 2-14: 600 mg twice daily) vs lopinavir/ritonavir (day 1-14: 400/100 twice daily) in the treatment of COVID-19. Compared with the lopinavir/ritonavir arm, however, patients in the favipiravir arm showed a statistically significant shorter median length of time to viral clearance (4 vs 11 days, p < 0.001), improvement in chest CT findings at day 14 after randomization (91.4 vs 62.2%, p = 0.004), and lower incidence of adverse effects (11.43 vs 55.56%, p < 0.001). Chen et al.2 had conducted a prospective, open-label multicentric trial in China to compare two treatment arms in the management of clinically confirmed COVID-19 (maximum duration of symptom onset before randomization: 12 days). Post hoc analysis demonstrated that favipiravir-treated patients showed a trend toward clinical improvement at day 7 among those with moderate COVID-19 (71.43 vs 55.86%, 95% CI: 0.0271 to 0.2843, p = 0.0199) and earlier resolution of fever and cough (p < 0.0001). A Japanese observational study group recorded the details of hospitalized COVID-19 patients in Japan to assess the safety and efficacy of favipiravir. In >90% of cases, favipiravir was administered at a dose of 1,800 mg orally on ay 1 followed by 800 mg twice daily on subsequent days. The median duration of therapy was 11 days. Rates of clinical improvement at 7 and 14 days were 73.8 and 87.8%, 66.6 and 84.5%, and 40.1 and 60.3% for mild, moderate, and severe disease, respectively. Thus, the vast majority of patients with mild and moderate disease recovered from the illness. Conclusion: Approximately 90% clinical resolution rate in moderate COVID-19 patients in real-world settings supports its role in the management of hospitalized patients. Reduction in the oxygen requirement highlights its protective role against disease progression. Overall favipiravir was found to be effective and safe in the management of moderate COVID-19.
ABSTRACT
Favipiravir (6-Fluoro-3-hydroxypyrazine-2-carboxamide), a purine nucleic acid analog that has been developed by Toyama Chemical in Japan for a treatment of viral infections including influenza.3 This has recently been evaluated and was found to be a promising choice in management of COVID-19. It works by inhibiting RNA dependent RNA polymerase (RdRp) enzyme, a key enzyme impeding replication of RNA viruses. Favipiravir is a pro-drug that is ribosylated and phosphorylated intracellularly to form the active metabolite Favipiravir ribofuranosyl-5'-triphosphate (Favipiravir- RTP). Favipiravir -RTP competes with purine nucleosides and interferes with viral replication by incorporating into the nascent viral RNA triggering inhibition of error-prone viral RdRp, leading to Chain termination and Viral mutagenesis. Favipiravir is a pro-drug that is ribosylated and phosphorylated intracellularly to form the active metabolite Favipiravir ribofuranosyl-5'-triphosphate (Favipiravir- RTP). Majority (~ 80-85%) of COVID-19 patients suffer from mild to moderate illness and continue to spread the virus. Favipiravir which is indicated in treatment of mild to moderate cases promises to reduce the burden of this ongoing pandemic.
ABSTRACT
The COVID-19 pandemic continues to have a serious impact on the lives of millions of people worldwide. Empirical therapy is being used to reduce morbidity and mortality of COVID-19 patients. Favipiravir, which is an oral broad-spectrum anti-viral agent with proven efficacy against various RNA viruses, acceptable tolerability profile and favorable benefit-risk ratio in short term use, has got an emergency use authorization in many countries including India for the treatment of mild to moderate cases of COVID-19. It has demonstrated promising results in terms of rapid viral clearance, quick symptom control, and pulmonary radiographic improvement. Due to reasons such as lockdown, isolation, diagnostic delays, fear of quarantine or getting tested, cost, etc., the golden time period (first 24-48 hrs) is lost in COVID-19 patients which is crucial for initiating antiviral therapy. Therefore, the panel members of ‘Academy of Advanced Medical Education’ propose that favipiravir can be recommended in confirmed, early probable and possible cases of mild and moderate severity as an empirical therapy during current pandemic. It is important to counsel the patients and explain to them about the limited clinical evidences with favipiravir, therefore, a signed consent form from patient must be kept before initiating treatment. Well-designed double-blind controlled trials are urgently required to understand this further.