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1.
JNMA J Nepal Med Assoc ; 60(247): 329-330, 2022 Mar 11.
Article in English | MEDLINE | ID: covidwho-1754235

ABSTRACT

The COVID-19 vaccination campaign is going on in Nepal through different phases of immunisation. It has been observed that people are misusing antipyretics and analgesics with the fear of adverse events following immunisation. The possibility of antipyretics and analgesics blunting the antibody response of the human body can be a potential cause for lower immune response and thus a reason for lower efficacy of the vaccine. Prophylactic use of over-the-counter analgesics and antipyretics is to be discouraged until the data for or against its use is available. Keywords: antipyretics; COVID-19 vaccine; drug misuse; vaccine immunogenicity.


Subject(s)
Antipyretics , COVID-19 , Analgesics , Antipyretics/therapeutic use , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Fear , Humans
2.
Br J Clin Pharmacol ; 88(7): 3114-3131, 2022 07.
Article in English | MEDLINE | ID: covidwho-1714131

ABSTRACT

Understanding how pharmaceutical opioids and antipyretic analgesics interact with the immune system potentially has major clinical implications for management of patients with infectious diseases and surgical and critical care patients. An electronic search was carried out on MEDLINE, EMBASE, PsycINFO, CENTRAL and the Cochrane library to identify reports describing the immunomodulatory effects of opioid analgesics and antipyretic analgesics, and their effects in infectious diseases. In adaptive immunity, nonsteroidal anti-inflammatory drugs have divergent effects: augmenting cell-mediated immunity but inhibiting humoral immunity. Nonsteroidal anti-inflammatory drugs have demonstrated a beneficial role in Mycobacterium tuberculosis infection and histoplasmosis in animals, and may be plausible adjuvants to antimicrobial agents in these diseases. There is a need to evaluate these findings rigorously in human clinical trials. There is preliminary evidence demonstrating antiviral effects of indomethacin in SARS CoV-2 in vitro; however, uncertainty regarding its clinical benefit in humans needs to be resolved in large clinical trials. Certain opioid analgesics are associated with immunosuppressive effects, with a developing understanding that fentanyl, morphine, methadone and buprenorphine suppress innate immunity, whilst having diverse effects on adaptive immunity. Morphine suppresses key cells of the innate immunity and is associated with greater risk of infection in the postsurgical setting. Efforts are needed to achieve adequate analgesia whilst avoiding suppression of the innate immunity in the immediate postoperative period caused by certain opioids, particularly in cancer surgery.


Subject(s)
Antipyretics , COVID-19 , Communicable Diseases , Analgesics , Analgesics, Opioid/pharmacology , Analgesics, Opioid/therapeutic use , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antipyretics/pharmacology , Antipyretics/therapeutic use , COVID-19/drug therapy , Humans , Morphine , Pharmaceutical Preparations
3.
J Evid Based Integr Med ; 26: 2515690X211020685, 2021.
Article in English | MEDLINE | ID: covidwho-1691167

ABSTRACT

The retrospective cohort study aimed to evaluate the clinical outcomes of Ayurveda treatment exposure as an add-on to conventional care in early stage COVID-19 patients admitted at Samaras COVID care center, Ahmedabad, India. Conventional care included Vitamin-c, Azithromycin, and Paracetamol. Ayurveda formulations used as add-on were Dashamula and Pathyadi decoctions along with Trikatu powder, Sanshamani tablet, AYUSH-64 tablet AND Yastimadhu Ghana tablet for oral administration. Considering Add-on Ayurveda medicines as exposure of interest, patients who received Add-on Ayurveda medicines at least for 7 days were included in the exposed group while those who received only conventional care in unexposed group. Data was collected through record review and telephonic interviews. The outcomes of interest were the development of symptoms, duration of symptomatic phase in those progressing to symptomatic stage and mortality. Total 762 participants were included-[541 (71%) in the exposed group and 221 (29%) in the unexposed. Progression to symptomatic phase did not differ significantly between groups [27.6% in exposed, 24.6% in unexposed, adjusted RR 0.85; 95% CI 0.6-1.2]. The total duration of symptomatic phase among those progressing to the symptomatic stage was significantly decreased in the exposed group (x¯ = 3.66 ± 1.55 days in exposed (n = 133); x¯ = 5.34 ± 3.35 days in unexposed (n = 61), p < 0.001). No mortality was observed in either of the groups. Ayurveda Treatment as adjunctive to conventional care reduced the duration of symptomatic phase in early stage COVID-19 as compared to standalone conventional care. Add-on Ayurveda treatment has promising potential for management of early stage COVID-19.


Subject(s)
Acetaminophen/therapeutic use , COVID-19 , Medicine, Ayurvedic/methods , Plant Extracts/therapeutic use , Plant Preparations/therapeutic use , Antipyretics/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/epidemiology , Complementary Therapies/methods , Drug Therapy, Combination/methods , Female , Hospitalization/statistics & numerical data , Humans , India/epidemiology , Male , Middle Aged , Patient Acuity , Retrospective Studies , SARS-CoV-2/isolation & purification , Treatment Outcome
5.
J Korean Med Sci ; 36(27): e196, 2021 Jul 12.
Article in English | MEDLINE | ID: covidwho-1308263

ABSTRACT

BACKGROUND: This is an observational study to analyze an emergency department (ED) utilization pattern of coronavirus disease 2019 (COVID-19) vaccinated in-hospital healthcare workers (HCWs). METHODS: We included 4,703 HCWs who were administered the first dose of the COVID-19 vaccine between March 4 and April 2, 2021, in a tertiary hospital in Korea where fast-track and post-vaccination cohort zone (PVCZ) were introduced in ED. We analyzed data of participants' age, sex, occupation, date and type of vaccination, and their clinical information using SPSS v25.0. RESULTS: The sample comprised HCWs, who received either the ChAdOx1 (n = 4,458) or the BNT162B2 (n = 245) vaccines; most participants were female (73.5%), and 81.1% were under 50 years old. Further, 153 (3.3%) visited the ED and reported experiencing fever (66.9%) and myalgia (56.1%). Additionally, 91 (59.5%) of them were in their 20s, and 106 (67.5%) were assigned to the PVCZ. Lastly, 107 (68.2%) of the patients received parenteral management. No patient required hospitalization. CONCLUSION: In conclusion, vaccinated HCWs who visited the ED with adverse events had a high incidence of fever and a low likelihood of developing serious illnesses. As the COVID-19 vaccination program for Korean citizens continues to expand, strategies to minimize unnecessary ED overcrowding should be put into effect.


Subject(s)
COVID-19 Vaccines/adverse effects , Emergency Service, Hospital/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Personnel, Hospital/statistics & numerical data , Vaccination/adverse effects , Adult , Antiemetics/therapeutic use , Antipyretics/therapeutic use , COVID-19 Testing/statistics & numerical data , Chills/chemically induced , Chills/epidemiology , Clinical Protocols , Emergency Service, Hospital/organization & administration , Female , Fever/chemically induced , Fever/drug therapy , Fever/epidemiology , Headache/chemically induced , Headache/epidemiology , Humans , Male , Middle Aged , Myalgia/chemically induced , Myalgia/epidemiology , Nausea/chemically induced , Nausea/drug therapy , Nausea/epidemiology , Patient Readmission/statistics & numerical data , Republic of Korea , Retrospective Studies , Software Design , Tertiary Care Centers/statistics & numerical data , Triage , Young Adult
9.
Am J Med Sci ; 361(4): 420-426, 2021 04.
Article in English | MEDLINE | ID: covidwho-1014309

ABSTRACT

With mortality rising from the COVID-19 pandemic, we may be overlooking a key aspect of the immunological response. Fever is a cardinal sign of this rampant infection; however, little attention has been paid towards how a fever may work in our favor in overcoming this disease. Three key aspects of patient care - fever, fluid, and food - can be harmonized to overcome COVID-19 infection. Both animal and human studies have demonstrated that fever suppression during viral infections, either through low ambient temperatures or antipyretic use, may increase morbidity and prolong the illness. As fever rises, so do antidiuretic hormone levels, leading to solute-free water retention - making conservative fluid management essential. Finally, fever inhibits gastrointestinal function as energy is reallocated to the immunological response, underscoring the need to work in concert with these physiological changes. An opportunity awaits to investigate this natural barrier to infection, let us not pass it by.


Subject(s)
COVID-19/mortality , Fever/physiopathology , Antipyretics/therapeutic use , COVID-19/physiopathology , COVID-19/virology , Fever/drug therapy , Humans , SARS-CoV-2/isolation & purification
10.
West J Emerg Med ; 21(6): 32-44, 2020 Sep 25.
Article in English | MEDLINE | ID: covidwho-869239

ABSTRACT

The novel coronavirus, SARs-CoV-2, causes a clinical disease known as COVID-19. Since being declared a global pandemic, a significant amount of literature has been produced and guidelines are rapidly changing as more light is shed on this subject. Decisions regarding disposition must be made with attention to comorbidities. Multiple comorbidities portend a worse prognosis. Many clinical decision tools have been postulated; however, as of now, none have been validated. Laboratory testing available to the emergency physician is nonspecific but does show promise in helping prognosticate and risk stratify. Radiographic testing can also aid in the process. Escalating oxygen therapy seems to be a safe and effective therapy; delaying intubation for only the most severe cases in which respiratory muscle fatigue or mental status demands this. Despite thrombotic concerns in COVID-19, the benefit of anticoagulation in the emergency department (ED) seems to be minimal. Data regarding adjunctive therapies such as steroids and nonsteroidal anti-inflammatories are variable with no concrete recommendations, although steroids may decrease mortality in those patients developing acute respiratory distress syndrome. With current guidelines in mind, we propose a succinct flow sheet for both the escalation of oxygen therapy as well as ED management and disposition of these patients.


Subject(s)
COVID-19/therapy , Emergency Service, Hospital , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anticoagulants/therapeutic use , Antipyretics/therapeutic use , Biomarkers/blood , Bronchodilator Agents/therapeutic use , COVID-19/diagnosis , Glucocorticoids/therapeutic use , Humans , Infection Control , Lung/diagnostic imaging , Nitric Oxide/therapeutic use , Oxygen Inhalation Therapy , Respiration, Artificial , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology , SARS-CoV-2 , Severity of Illness Index , Thromboembolism/diagnosis , Thromboembolism/prevention & control , Thromboembolism/virology , Vasoconstrictor Agents/therapeutic use
11.
Am J Case Rep ; 21: e925779, 2020 Aug 13.
Article in English | MEDLINE | ID: covidwho-713485

ABSTRACT

BACKGROUND Coronavirus disease 2019 (COVID-19) infection commonly presents as fever, cough, and shortness of breath in adults. Children are thought to have milder respiratory symptoms and to recover more quickly. We describe a new presentation of COVID-19 infection in children consisting of multisystem inflammation with decreased left ventricular function and evidence of lung disease. CASE REPORT Three children presented with fever, conjunctivitis, dry and cracked lips, rash, and/or cervical lymphadenopathy for at least 5 days. Two of these children required mechanical ventilation, and 1 of the 2 needed extracorporeal membrane oxygenation (ECMO) to support cardiorespiratory function. All of these children had moderate to severe hyponatremia and lymphopenia, which is usually seen in COVID-19. They were treated with intravenous immunoglobulin and high-dose aspirin. All of the children recovered. CONCLUSIONS Early recognition of children with multisystem inflammation is important because they are at increased risk for deterioration. Treatment with intravenous immunoglobulin and aspirin was used because this regimen has been shown to be beneficial in vasculitis of Kawasaki disease. The development of shock due to cardiac involvement may require ECMO.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Systemic Inflammatory Response Syndrome/virology , Antipyretics/therapeutic use , Aspirin/therapeutic use , COVID-19 , Child , Child, Preschool , Conjunctivitis/therapy , Conjunctivitis/virology , Coronavirus Infections/therapy , Exanthema/therapy , Exanthema/virology , Extracorporeal Membrane Oxygenation , Female , Fever/therapy , Fever/virology , Heart Failure/therapy , Heart Failure/virology , Humans , Hyponatremia/therapy , Hyponatremia/virology , Immunoglobulins, Intravenous , Lymphadenopathy/therapy , Lymphadenopathy/virology , Lymphopenia/therapy , Lymphopenia/virology , Male , Pandemics , Pneumonia, Viral/therapy , Respiration, Artificial , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Vasculitis/therapy , Vasculitis/virology
12.
Int J Cardiol ; 323: 29-33, 2021 01 15.
Article in English | MEDLINE | ID: covidwho-710666

ABSTRACT

The pandemic of Novel Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has provoked hundreds of thousands of deaths, resulting in catastrophe for humans. Although some insights have been garnered in studies on women, children and young adults infected with COVID-19, these often remain fragmented in literature. Therefore, we discussed the impact of COVID-19 pandemic on women, children and young patients, particularly those with underlying cardiovascular comorbidities or congenital heart disease. Furthermore, we gathered and distilled the existing body of literature that describes their cardiovascular complications and the recommended actions in favour of those patients toward the post-peak pandemic period. Although many questions still require answers, this article is sought to help the practicing clinician in the understanding and management of the threatening disease in special populations.


Subject(s)
COVID-19/therapy , COVID-19/transmission , Women's Health , Antipyretics/therapeutic use , Antiviral Agents/therapeutic use , Cardiomyopathies/virology , Child , Communicable Disease Control , Female , Heart Defects, Congenital/complications , Humans , Pandemics , Pregnancy , Pregnancy Complications, Cardiovascular/virology , Pregnancy Complications, Infectious , Sex Distribution , Takotsubo Cardiomyopathy/virology
15.
Clin Microbiol Infect ; 26(9): 1259.e5-1259.e7, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-597470

ABSTRACT

OBJECTIVE: It was recently suggested that ibuprofen might increase the risk for severe and fatal coronavirus disease 2019 (COVID-19) and should therefore be avoided in this patient population. We aimed to evaluate whether ibuprofen use in individuals with COVID-19 was associated with more severe disease, compared with individuals using paracetamol or no antipyretics. METHODS: In a retrospective cohort study of patients with COVID-19 from Shamir Medical Centre, Israel, we monitored any use of ibuprofen from a week before diagnosis of COVID-19 throughout the disease. Primary outcomes were mortality and the need for respiratory support, including oxygen administration and mechanical ventilation. RESULTS: The study included 403 confirmed cases of COVID-19, with a median age of 45 years. Of the entire cohort, 44 patients (11%) needed respiratory support and 12 (3%) died. One hundred and seventy-nine (44%) patients had fever, with 32% using paracetamol and 22% using ibuprofen, for symptom-relief. In the ibuprofen group, 3 (3.4%) patients died, whereas in the non-ibuprofen group, 9 (2.8%) patients died (p 0.95). Nine (10.3%) patients from the ibuprofen group needed respiratory support, compared with 35 (11%) from the non-ibuprofen group (p 1). When compared with exclusive paracetamol users, no differences were observed in mortality rates or the need for respiratory support among patients using ibuprofen. CONCLUSIONS: In this cohort of COVID-19 patients, ibuprofen use was not associated with worse clinical outcomes, compared with paracetamol or no antipyretic.


Subject(s)
COVID-19/drug therapy , COVID-19/mortality , Fever/drug therapy , Ibuprofen/therapeutic use , Acetaminophen/adverse effects , Acetaminophen/therapeutic use , Adult , Antipyretics/adverse effects , Antipyretics/therapeutic use , Female , Fever/virology , Humans , Ibuprofen/adverse effects , Israel , Male , Middle Aged , Retrospective Studies
16.
Liver Int ; 40(10): 2394-2406, 2020 10.
Article in English | MEDLINE | ID: covidwho-593274

ABSTRACT

BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) has emerged as a relevant threat for humans worldwide. Abnormality in liver function tests (LFTs) has been commonly observed in patients with COVID-19, but there is controversy on its clinical significance. The aim of this study was to assess the prevalence, the characteristics and the clinical impact of abnormal LFTs in hospitalized, non-critically ill patients with COVID-19. METHODS: In this multicentre, retrospective study, we collected data about 565 inpatients with COVID-19. Data on LFTs were collected at admission and every 7 ± 2 days during the hospitalization. The primary outcome was a composite endpoint of death or transfer to intensive care unit (ICU). RESULTS: Upon admission 329 patients (58%) had LFTs abnormality. Patients with abnormal LFTs had more severe inflammation and higher degree of organ dysfunction than those without. During hospitalization, patients with abnormal LFTs had a higher rate of transfer to ICU (20% vs 8%; P < .001), acute kidney injury (22% vs 13%, P = .009), need for mechanical ventilation (14% vs 6%; P = .005) and mortality (21% vs 11%; P = .004) than those without. In multivariate analysis, patients with abnormal LFTs had a higher risk of the composite endpoint of death or transfer to ICU (OR = 3.53; P < .001). During the hospitalization, 86 patients developed de novo LFTs abnormality, which was associated with the use of tocilizumab, lopinavir/ritonavir and acetaminophen and not clearly associated with the composite endpoint. CONCLUSIONS: LFTs abnormality is common at admission in patients with COVID-19, is associated with systemic inflammation, organ dysfunction and is an independent predictor of transfer to ICU or death.


Subject(s)
Acetaminophen/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , COVID-19 , Intensive Care Units/statistics & numerical data , Liver Diseases , Liver Function Tests , Antipyretics/therapeutic use , COVID-19/complications , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Critical Care/methods , Female , Humans , Italy/epidemiology , Liver Diseases/blood , Liver Diseases/epidemiology , Liver Diseases/etiology , Liver Function Tests/methods , Liver Function Tests/statistics & numerical data , Male , Middle Aged , Mortality , Predictive Value of Tests , Prevalence , Prognosis , Retrospective Studies , Risk Assessment/methods , SARS-CoV-2/isolation & purification
17.
Med Hypotheses ; 144: 109880, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-361316

ABSTRACT

Fever has been reported as a common symptom occurring in COVID-19 illness. Over the counter antipyretics such as ibuprofen and acetaminophen are often taken by individuals to reduce the discomfort of fever. Recently, the safety of ibuprofen in COVID-19 patients has been questioned due to anecdotal reports of worsening symptoms in previously healthy young adults. Studies show that ibuprofen demonstrates superior efficacy in fever reduction compared to acetaminophen. As fever may have benefit in shortening the duration of viral illness, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response when taken during the early stages of COVID-19 illness.


Subject(s)
Antipyretics/adverse effects , Antipyretics/therapeutic use , COVID-19/drug therapy , Fever/drug therapy , Ibuprofen/adverse effects , Ibuprofen/therapeutic use , Acetaminophen/therapeutic use , Fever/physiopathology , Humans , Models, Theoretical , Patient Safety , Treatment Outcome
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