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1.
Journal of Association of Physicians of India ; 69(12):32-36, 2021.
Article in English | Scopus | ID: covidwho-1695239

ABSTRACT

Introduction: Favipiravir has shown promising results for COVID-19 globally. Though many Indian patients have received favipiravir, there is a lack of realworld data for its clinical use by the practicing physicians. Hence, a qualitative survey was conducted to understand real-world use of favipiravir in management of COVID-19. Methods: A cross-sectional, web-based, qualitative survey was conducted between September 2020 to October 2020, among Indian physicians from various specialties involved in COVID-19 care and using favipiravir in their practice. Physicians were provided survey link having a structured questionnaire with 32 questions. They were enquired on- 1) demographics,practice information, 2) place of favipiravir in clinical practice, 3) treatment protocol for mild to moderate COVID-19, 4) dosage and duration of favipiravir, 5) effectiveness of favipiravir, 6) tolerability of favipiravir 7) global efficacy and safety assessment of favipiravir. Results: A total of 500 physicians were contacted, of which 50 physicians completed the questionnaire. 25(50.0%) were from south zone followed by 12(24.0%) from west. . Majority physicians (47, 97.9%) stated that favipiravir was used for COVID-19 in outpatient setting. Favipiravir was considered as the current drug of choice for ' mild COVID-19 with fever(86.6%). All physicians agreed that favipiravir was being used as per the recommended dose.. A total of 75% & 62.5% physicians agreed to observed clinical improvement by around 3-5 days & 5-7 days in symptomatic mild & moderate COVID-19 respectively. Conclusion: Majority of the physicians considered favipiravir to be safe and effective in treatment of mild to moderate COVID-19. © 2021 Journal of Association of Physicians of India. All rights reserved.

2.
The Journal of the Association of Physicians of India ; 69(9):11-12, 2021.
Article in English | Scopus | ID: covidwho-1481612

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 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.

3.
Journal of Association of Physicians of India ; 69(9):11-12, 2021.
Article in English | Scopus | ID: covidwho-1404486
4.
Journal of Association of Physicians of India ; 69(9):70-77, 2021.
Article in English | Scopus | ID: covidwho-1404468

ABSTRACT

SARS-CoV-2 virus spread rapidly all over the globe in 2020 and the second wave has taken our nation, India by storm. The pandemic has posed unique challenges in people with metabolic disorders, including diabetes, hypertension, obesity, pulmonary, cardiovascular, kidney and non-alcoholic fatty liver disease. Uncontrolled diabetes, in conjunction with endocrine, inflammatory and metabolic effects of the infection itself has made management of hyperglycemia in COVID-19 infection particularly challenging. Furthermore, the post-COVID-19 syndrome has also emerged as a sequela in COVID-19 survivors, increasing the risk of death, complications and adding further burden on the health care system. With more than a year of experience, we have gained substantial insight;and now provide practical recommendations on the management of hyperglycemia in COVID-19 as well as post COVID-19 syndrome. © 2021 Journal of Association of Physicians of India. All rights reserved.

5.
Journal of Association of Physicians of India ; 69(9):78-84, 2021.
Article in English | Scopus | ID: covidwho-1404455

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.

6.
Journal of the Association of Physicians of India ; 68(August):91-92, 2020.
Article in English | GIM | ID: covidwho-984930

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.

7.
Journal of the Indian Medical Association ; 118(9):70-76, 2020.
Article in English | EMBASE | ID: covidwho-875422

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.

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