ABSTRACT
Features of variation of peripheral blood leukocyte formula parameters in 86 patients with coronavirus pneumonia with leukocytosis with a background of glucocorticoid treatment were investigated. All patients were divided into 2 groups. Group 1 was 22 individuals who showed clinical signs of the bacterial infection (purulent sputum cough in combination with neutrophilic leukocytosis at hospital the admission). The 2nd group was made up of 64 patients with the glucocorticoids developed against the background of treatment with glucocorticoids (dexamethasone 20 mg/day or prednisolone 150 mg/day, intravenously for 3 days) leukocytosis >10 x109/l without signs of a bacterial infection. It was found that in patients of the 1st group compared to the 2nd group, levels of the white blood cells and neutrophils were significantly (p < 0.001) exceeded the reference values in the absence of a significant change in the number of monocytes. In patients of the 2nd group after a three-day intravenous application of the glucocorticoids on the 4th day of hospitalization, a statistically significant (p < 0.001) increase in the number of neutrophils and monocytes was established. When comparing the quantitative parameters of the leukocyte formula between the 2nd group on the 4th day of the hospitalization and the 1st group at admission, there were no differences in the level of leukocytes and neutrophils. Number of monocytes in group 2 (1.11 (0.90;1.34) x 109/l), on the contrary, statistically significantly (p < 0.001) exceeded their level in the 1st group (0.59 (0.50;0.77) x 109/l). Thus, an indicator of the number of monocytes in the peripheral blood could be a promising differential diagnostic criterion for the genesis of the leukocytosis in patients with the COVID-19. This parameter may be one of the factors influencing the decision to prescribe the antibacterial therapy.
ABSTRACT
Objective: Though systemic corticosteroid is used for treatment of COVID 19, questions regarding the appropriate dose, duration and type of corticosteroid use still remain unanswered. This study aimed to address, whether choice of systemic corticosteroid significantly influences the clinical outcome of COVID 19 patients. Materials and Methods: Studies reporting the comparison between clinical outcome of dexamethasone and methylprednisolone in treatment of COVID 19 were searched from inception till April, 2021. Random-effect model was used. Odd's ratio (OR) and 95% confidence interval was expressed. I2 statistics used for test of heterogeneity. Result: Three studies with 373 patients (160 in dexamethasone group and 213 in methyl prednisolone group) were included. Though, statistically significant reduction in all-cause mortality with methyl prednisolone group in comparison to dexamethasone group (OR=1.80, 95%CI: 1.08 to 3.01, P=0.02) estimated, sub group analysis of observational studies did not support the finding (OR=1.60, 95% CI: 0.88 to 2.92, P=0.12). No significant difference in terms of need for invasive ventilator or intensive care unit (ICU) between the 2 groups. The grade of evidence was very low for both the outcomes. Conclusion and Relevance: In the present context, both dexamethasone and methyl prednisolone are equally effective in the management of COVID 19.
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Introduction. The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-COV-2), was reported in Wuhan, China, in early December 2019 and spread rapidly worldwide. In the COVID-19 era, Kidney transplantation recipients (KTRs) are at high risk due to using immunosuppressive drugs. Therefore, finding an efficient treatment for the management of COVID-19 in KTR patients is crucial due to its poor prognosis. Despite the use of various antiviral and anti-inflammatory drugs, there is yet no definitive cure for Covid-19. Repurposing existing pharmaceuticals is a way to find an immediate medication. Thus, we assessed the antiviral treatment efficacy of Sofosbuvir combined with Daclatasvir on KTRs with SARS-COV-2 infection. Methods. We conducted a single-center retrospective cross-sectional study of all adult kidney transplant recipients with COVID-19, admitted to Shariati Hospital, Tehran, Iran, from October to December 2020. All the patients received a once-daily combination pill of SOF and DAC at a dose of 400/60 mg for 10 days. The study protocol was approved by the Ethical Committee of the Tehran University of Medical Sciences under ID: IR. TUMS. DDRI. REC.1399.028. Statistical analysis was performed using IBM SPSS version 26.0. A P value less than 0.05 was considered statistically significant for all tests. Results. From October to December 2020, 12 adult KTR patients were recruited;four patients (33.3%) died and eight patients survived (66.7%). The dead patients were older than those who survived. However, it was not statistical significance (53.67 .. 3.786 vs. 47.63 .. 11.868, P = 0.422). Acute kidney injury (AKI) due to COVID-19 infection was seen in 11 patients of the study population (91.7%) and all four dead KTRs. Also, three patients underwent dialysis, which two died (50%). The most common comorbidities were hypertension (6 patients, 50%) and diabetes mellitus (4 patients, 33.3%), while no significant correlation was seen between comorbidities and mortality (P > 0.05). About the immunosuppressive drugs, of four dead patients, three (75%) used Mycophenolate, and all of them used Prednisolone. The laboratory results showed that the mean level of each parameter WBC, INR, CRP, Ferritin, D-Dimer on the last day of hospital stay was significantly different between two groups of survived and dead patients at a 95% confidence level (P < 0.05). Conclusion. Sofosbuvir combined with Daclatasvir for treatment of KTRs with SARS-COV-2 infection showed efficacy by reducing the mortality rate. Also, the medication was safe. Patients tolerated it well, and no serious adverse effects were observed. Larger studies are needed to validate these results.
ABSTRACT
Introduction. The novel coronavirus disease 2019 (COVID-19) is a respiratory infection that has received much attention due to its rapid expansion. Currently, it has been revealed that patients with underlying disease, especially those with kidney disease are more prone to develop complications. Some studies associate kidney transplantation as a risk factor for COVID-19 progression;however, epidemiologic data that demonstrate this are amazingly rare. Methods. we report on six kidney transplant recipients (median age 47 [41-55]) with confirmed or clinically suspected COVID-19 Results. The most common admission presentations were fever (83.3%), dyspnea, and myalgia. At baseline, immunosuppressive therapy was ceased, prednisolone dose was increased, and all patients received antiviral treatment including hydroxychloroquine and umifenovir. After a median follow-up of 11.5 days from admission, six patients (100%) developed acute kidney injury (AKI), 50% required intensive care unit (ICU) admission, and two patients (33.3%) deceased as a result of deterioration in respiratory status. Conclusion. These findings demonstrate that respiratory involvement may be a risk indicator of in-hospital mortality in kidney recipients with COVID-19. In addition, AKI development in kidney recipients with COVID-19 is of utmost importance given the higher AKI occurrence in these patients compared with others. Therefore, more intensive attention should be paid to kidney transplant recipients with COVID-19.