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1.
Journal of Investigative Medicine ; 70(7):1643, 2022.
Article in English | EMBASE | ID: covidwho-2114804

ABSTRACT

Introduction/Background COVID-19 and influenza typically present in a very similar clinical picture. The co-infection of influenza among COVID-19 patients (i.e., flurona) can occur in the fall and winter of the year. The prevalence of flurona was estimated to be 0.4% and 4.5% in America and Asia, respectively. The damage of respiratory ciliated cells by the influenza virus can facilitate COVID-19 infection. Few studies reported COVID-19 co-infection with influenza virus. The majority of flurona cases affected older patients with co-morbidities. The co-infection of influenza among COVID-19 patients was associated with more severe disease, especially among older patients with co-morbidities. Young and healthy adults are less likely to develop severe COVID-19 leading to ARDS even with co-infection. However, severe COVID-19 can still occur regardless of age and co-morbidities. Herein, we report a case of severe ARDS in a young and previously healthy adult secondary to flurona that was successfully treated with targeted combination therapy with oseltamivir and remdesivir. Objective(s) A 21-year-old Caucasian male patient without significant past medical history presented the ED with a chief complaint of fatigue, cough, and generalized body aches. The patient mentioned that symptoms started a few days before his presentation. He suspected it was the flu, so he did not seek medical care initially. However, his symptoms continued to worsen, to the point that he could not move without getting severely out of breath. He was tachycardic, tachypneic in the emergency department (ED). His COVID-19 swab returned positive, and a respiratory pathogen panel was also positive for influenza A infection. Initial CTA was negative for PE but showed extensive multifocal bilateral infiltrates consistent with viral pneumonia. He was started on a high-flow nasal cannula. Still, his oxygen was peaking around 85% with increased work of breathing. The patient also did not tolerate BiPAP. Therefore, the patient was intubated in the ED and admitted to the intensive care unit (ICU). He was started on a five-day course of oseltamivir, remdesivir, and intravenous methylprednisolone. The patient remained intubated and mechanically ventilated on the next day, and PaO2/FIO2 ratio was 100. He was started on ARDS treatment protocol, and daily prone positioning was initiated. Gradually the patient started to improve. On day nine, he successfully passed a CPAP trial and was extubated. His ICU stay was complicated by the development of a small segmental PE that was treated with IV heparin. He also had upper GI bleeding, and esophagogastroduodenoscopy revealed a bleeding gastric ulcer, which was successfully managed with endoscopic clipping. The patient gradually improved, and his oxygen requirements decreased significantly over the next few days. He was discharged home with no supplemental oxygen on apixaban and pantoprazole. Methods Our study highlights the importance of screening for co-infecting influenza virus in COVID-19 patients, which could be the leading cause of disease severity. Early detection of flurona can play an important role in managing these patients, especially if they develop ARDS. Targeted combined therapy against influenza and COVID-19 with oseltamivir and remdesivir may effectively mitigate the morbidity and mortality of these patients. Improving compliance with flu vaccination is highly recommended to reduce influenza virus transmission during this long COVID-19 pandemic and reduce the risk of COVID-19 severity.

2.
Gastroenterology ; 162(7):S-459-S-460, 2022.
Article in English | EMBASE | ID: covidwho-1967306

ABSTRACT

Background and aims: Micronutrient supplements such as vitamin D, vitamin C, and zinc have been used in managing viral illnesses. However, the role of these micronutrients in reducing mortality in patients with Coronavirus disease 2019 (COVID-19) remains unclear. We conducted this meta-analysis to provide a quantitative assessment of the effect of these individual micronutrients on mortality in COVID-19. Methods: We performed a comprehensive literature search using MEDLINE, Embase, and Cochrane databases through November 5th, 2021. All individual micronutrients reported by ≥3 studies and compared with standardof- care (SOC) were included. The outcome was mortality. All statistical analyses were performed using the Review Manager. Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were calculated using the random-effects model. Results: We involving 5573 COVID-19 patients that compared three individual micronutrient supplements (vitamin C, vitamin D, and zinc) with SOC. Eight studies evaluated vitamin C in 1338 patients (530 in vitamin C and 808 in SOC). Vitamin C supplementation had no significant effect on the risk of mortality (RR 1.06, 95% CI 0.63-1.80, P=0.82, Figure 1A). Fourteen studies assessed the impact of vitamin D supplementation on mortality risk among 3497 patients (927 in vitamin D and 2570 in SOC). Vitamin D did not reduce the mortality risk in patients (RR 0.75, 95% CI 0.49-1.17, P=0.21, Figure 1B). Subgroup analysis showed that vitamin D supplementation was not associated with a mortality benefit in patients receiving vitamin D pre or post COVID-19 diagnosis (Figure 1B). Five studies, including 738 patients, compared zinc intake with SOC (447 in zinc and 291 in SOC). Zinc supplementation was not associated with a significant reduction of mortality (RR 0.79, 95% CI 0.60- 1.03, P=0.08, Figure 1C). Subgroup analyses of RCTs for all three micronutrient supplements showed consistent findings (Figure 2). Conclusions: Individual micronutrient supplementations, including vitamin C, vitamin D, and zinc, did not reduce mortality in patients with COVID-19. Further research is needed to validate our findings. (Figure Presented)

3.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880651
4.
Journal of the American College of Cardiology ; 79(9):2060-2060, 2022.
Article in English | Web of Science | ID: covidwho-1848375
5.
Chest ; 160(4):A521, 2021.
Article in English | EMBASE | ID: covidwho-1457613

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Exaggerated inflammatory response with cytokine storm is the hallmark of moderate to severe cases of COVID-19. Several studies have investigated the use of colchicine in COVID-19 due to its anti-inflammatory effects. However, the data regarding its efficacy is still limited and conflicting. This meta-analysis aimed to evaluate the impact of colchicine on mortality and the risk of mechanical ventilation in patients with COVID-19. METHODS: We performed a comprehensive literature search of electronic databases from inception through April 10, 2021, for all peer-reviewed studies that evaluated the clinical benefits of colchicine COVID-19 patients. The primary outcome was the mortality rate. The secondary outcomes included the risk of mechanical ventilation, improvement in systematic inflammation as indicated by changes in serum C-reactive protein, and the risk of adverse events. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of eight studies involving 926 COVID-19 patients (406 patients received colchicine along with standard-of-care (SOC) therapy and 520 received SOC therapy alone) were included. The mean age was 63.7±14.7 years, and males represented 63.3%. Mortality rate was significantly lower in the colchicine group compared to SOC (RR 0.49 (95% CI: 0.34-0.72, P = 0.0002). However, there was no statistically significant difference in the risk of mechanical ventilation (RR 0.69, 95% CI: 0.31-1.57, P = 0.38). Furthermore, colchicine significantly lowered serum CRP levels (MD -0.40, 95% CI -0.77 to -0.03, P = 0.03). CONCLUSIONS: Our meta-analysis demonstrated that colchicine showed improvement in mortality in COVID-19 patients. However, there was no significant improvement in the risk of mechanical ventilation. CLINICAL IMPLICATIONS: Colchicine may be a potential therapeutic option for COVID-19. Even though the results are encouraging, we need more large-scale RCTs to better characterize the clinical benefits of colchicine in COVID-19 patients. DISCLOSURES: No relevant relationships by Nezam Altorok, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Muhamad Kalifa, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by WAHOOD Waseem, source=Web Response

6.
Chest ; 160(4):A558, 2021.
Article in English | EMBASE | ID: covidwho-1457612

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) has become a leading cause of mortality globally. Inhaled pulmonary vasodilators, epoprostenol (iEPO) and nitric oxide (iNO), are used as adjunctive therapies for the treatment of refractory hypoxemia in patients with acute respiratory distress syndrome (ARDS). Hypoxemia in COVID-19 patients is mainly caused by ventilation-perfusion mismatch, which might be improved by inhaled pulmonary vasodilators. However, the effects of inhaled pulmonary vasodilator therapy on the clinical outcomes of COVID-19 remain unclear. Therefore, we conducted this meta-analysis to evaluate the impact of pulmonary vasodilators, iNO and iEPO, on the oxygenation parameters in COVID-19 patients with refractory hypoxemia. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021, to include all published studies. All statistical analyses were performed using the Review Manager software (RevMan 5.3). The weighted mean difference (MD) with corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. The primary outcome measure was the change in oxygenation parameter (PaO2/FiO2) pre and post pulmonary vasodilators. RESULTS: A total of seven studies (three and four studies for iEPO and iNO, respectively) involving 211 patients with COVID-19 (140 patients in iEPO group and 71 in iNO) were included. Overall, pulmonary vasodilators showed significant improvement in oxygenation: PaO2/FiO2 (MD: 12.48, 95% CI: 4.51, 20.44, P = 0.002, I2 = 0%). On subgroup analysis, iEPO showed significant improvement in oxygenation: PaO2/FiO2 (MD: 13.39, 95% CI: 2.84, 23.94, P = 0.01, I2 = 0%), however, iNO showed no improvement in oxygenation: PaO2/FiO2 (MD: 12.80, 95% CI: -4.82, 30.42, P = 0.15, I2 = 47%). CONCLUSIONS: Our meta-analysis showed that inhaled epoprostenol improved oxygenation in COVID-19 patients. However, inhaled nitric oxide therapy was not associated with improvement in oxygenation. Major limitation being lack of control arm and adjustment for confounders. Clinical trials are needed to determine the effect of inhaled pulmonary vasodilators on oxygenation parameters and clinical outcomes of COVID-19 patients. CLINICAL IMPLICATIONS: Inhaled pulmonary vasodilators may play a role as rescue therapy in COVID-19 patients with refractory hypoxemia. DISCLOSURES: No relevant relationships by Ziad Abuhelwa, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Rami Musallam, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response

7.
Chest ; 160(4):A502, 2021.
Article in English | EMBASE | ID: covidwho-1457611

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Prone positioning (PP) in awake patients has been recently proposed as an adjunctive treatment for spontaneously breathing non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to reduce the risk of intubation. However, the magnitude of the effect of PP on clinical outcomes (e.g., the risk of endotracheal intubation, intensive care unit [ICU] admission, or mortality) in these patients remains uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the effectiveness of PP to improve the clinical outcomes in non-intubated patients with COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through February 24, 2020 for all the studies all studies that all compared PP versus no PP in non-intubated patients with COVID-19. The primary outcome of interest was the rate of endotracheal intubation. The secondary outcomes were in-hospital mortality and intensive care unit (ICU) rates. Pooled odds risk (OR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of five studies (two randomized controlled trials and three observational studies), involving 470 non-intubated patients with COVID-19 (185 patients received PP and 285 did not) were included. The mean age was 59.82 years, and males represented 67% of total patients. The follow-up period ranged from 14 to 30 days. The endotracheal intubation rate was similar between PP and control groups (OR 0.75, 95% CI 0.41-1.35, P = 0.33, I2 = 20%). There was no difference in the in-hospital mortality rate between the two groups (OR 0.68, 95% CI 0.16-2.85, P = 0.60, I2 = 60%). Four studies reported the risk of ICU admission and demonstrated no difference between the two groups (OR 0.77, 95% CI 0.30-1.95, P = 0.58, I2 = 37%). CONCLUSIONS: Our meta-analysis demonstrated that prone positioning in non-intubated COVID-19 patients did not reduce the risk of endotracheal intubation. Furthermore, PP failed to reduce in-hospital mortality and ICU admission rates. CLINICAL IMPLICATIONS: Although our meta-analysis showed that prone positioning might not reduce the risks of intubation, in-hospital mortality, or ICU admission rate in spontaneously breathing non-intubated COVID-19 patients, more large-scale trials with a standardized protocol for prone positioning are needed to better evaluate the effectiveness of prone positioning in this select population. DISCLOSURES: No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Saif-Eddin Malhas, source=Web Response No relevant relationships by Aadil Maqsood, source=Web Response No relevant relationships by Reem Matar, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response

8.
Chest ; 160(4):A564, 2021.
Article in English | EMBASE | ID: covidwho-1457610

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a worldwide pandemic and leading cause morbidity and mortality globally. Due to their immunomodulatory functions, micronutrient supplements such as vitamin D, vitamin C, and zinc have been used for the management of viral illnesses. Furthermore, recent studies have shown low serum vitamin C, vitamin D, and zinc levels in critically ill patients with COVID-19. However, the role of these micronutrients in reducing mortality in patients with COVID-19 remains unclear. Therefore, we conducted this meta-analysis to provide a quantitative assessment of the effect of vitamin D, vitamin C, and zinc on mortality in COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021. All the studies that compared adding micronutrient supplements such as vitamin C, vitamin D, and zinc versus standard-of-care (SOC) in patients with COVID-19 were included. The outcome of interest was the mortality rate. All statistical analyses were performed using the Review Manager software (RevMan 5.3). Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. RESULTS: Four studies evaluated vitamin C in 390 patients (201 in vitamin C and 189 in SOC). Seven studies assessed vitamin D in 1251 patients (457 in vitamin D and 794 in SOC). Five evaluated zinc in 1506 patients (776 in zinc and 730 in SOC). Both vitamin C (RR 0.60, 95% CI 0.27-1.36, P = 0.22) and vitamin D (RR 0.94, 955 CI 0.46-1.94, P = 0.87) did not significantly reduce mortality. However, zinc was associated with an 33% reduction in mortality compared to SOC (RR 0.67, 95% CI 0.54-0.84, P = 0.0005). CONCLUSIONS: Our meta-analysis demonstrated that zinc reduced mortality in COVID-19 patients. However, vitamin C and D did not show significant improvemnt in mortality. CLINICAL IMPLICATIONS: Micronutrient supplements, especially zinc, may play a role in the treatment of COVID-19. However, it is unclear whether the magnitude of the effects of these micronutrients are clinically meaningful. Further research is needed to better evaluate the utility of these micronutrient supplements in the management of COVID-19. DISCLOSURES: No relevant relationships by Waleed Abdulsattar, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Wasef Sayeh, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by Jamie Stewart, source=Web Response

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