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1.
Drug Discov Ther ; 15(5): 278-280, 2021 Nov 21.
Article in English | MEDLINE | ID: covidwho-1542929

ABSTRACT

To help stop the coronavirus disease 2019 (COVID-19) pandemic, vaccines are currently the most critical tool. However, the COVID-19 mRNA vaccines frequently cause systemic side effects shortly after the injection, such as fever, headache and generalized fatigue. In our survey, after receiving the second dose of the COVID-19 vaccine, 80% developed fever, 62% headache and 69% generalized fatigue. Among people who required antipyretics, the average durations of fever and headache were significantly shorter in those who took non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, loxoprofen and ibuprofen, than those who took acetaminophen. In our patch-clamp studies, NSAIDs effectively suppressed the delayed rectifier K+-channel (Kv1.3) currents in T-lymphocytes and thus exerted immunosuppressive effects. Because of this pharmacological property, the use of NSAIDs should be more effective in reducing the vaccine-induced systemic side effects that are caused primarily by the enhanced cellular immunity.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19 Vaccines/adverse effects , Immunosuppressive Agents/therapeutic use , Acetaminophen/therapeutic use , Adolescent , Aspirin/therapeutic use , Fatigue/drug therapy , Fatigue/etiology , Fever/drug therapy , Fever/etiology , Headache/drug therapy , Headache/etiology , Humans , Ibuprofen/therapeutic use , Patch-Clamp Techniques , Phenylpropionates/therapeutic use , Young Adult
2.
PLoS One ; 16(11): e0259317, 2021.
Article in English | MEDLINE | ID: covidwho-1496536

ABSTRACT

BACKGROUND: Previous studies have assessed the prevalence and characteristics of self-medication in COVID-19. However, no systematic review has summarized their findings. OBJECTIVE: We conducted a systematic review to assess the prevalence of self-medication to prevent or manage COVID-19. METHODS: We used different keywords and searched studies published in PubMed, Scopus, Web of Science, Embase, two preprint repositories, Google, and Google Scholar. We included studies that reported original data and assessed self-medication to prevent or manage COVID-19. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies. RESULTS: We identified eight studies, all studies were cross-sectional, and only one detailed the question used to assess self-medication. The recall period was heterogeneous across studies. Of the eight studies, seven assessed self-medication without focusing on a specific symptom: four performed in the general population (self-medication prevalence ranged between <4% to 88.3%) and three in specific populations (range: 33.9% to 51.3%). In these seven studies, the most used medications varied widely, including antibiotics, chloroquine or hydroxychloroquine, acetaminophen, vitamins or supplements, ivermectin, and ibuprofen. The last study only assessed self-medication for fever due to COVID-19. Most studies had a risk of bias in the "representativeness of the sample" and "assessment of outcome" items of the NOS. CONCLUSIONS: Studies that assessed self-medication for COVID-19 found heterogeneous results regarding self-medication prevalence and medications used. More well-designed and adequately reported studies are warranted to assess this topic.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/prevention & control , Self Medication/statistics & numerical data , Cross-Sectional Studies , Fever/drug therapy , Humans , Prevalence
3.
Rev Med Virol ; 31(6): e2288, 2021 11.
Article in English | MEDLINE | ID: covidwho-1384306

ABSTRACT

SARS Coronavirus-2 is one of the most widespread viruses globally during the 21st century, whose severity and ability to cause severe pneumonia and death vary. We performed a comprehensive systematic review of all studies that met our standardised criteria and then extracted data on the age, symptoms, and different treatments of Covid-19 patients and the prognosis of this disease during follow-up. Cases in this study were divided according to severity and death status and meta-analysed separately using raw mean and single proportion methods. We included 171 complete studies including 62,909 confirmed cases of Covid-19, of which 148 studies were meta-analysed. Symptoms clearly emerged in an escalating manner from mild-moderate symptoms, pneumonia, severe-critical to the group of non-survivors. Hypertension (Pooled proportion (PP): 0.48 [95% Confident interval (CI): 0.35-0.61]), diabetes (PP: 0.23 [95% CI: 0.16-0.33]) and smoking (PP: 0.12 [95% CI: 0.03-0.38]) were highest regarding pre-infection comorbidities in the non-survivor group. While acute respiratory distress syndrome (PP: 0.49 [95% CI: 0.29-0.78]), (PP: 0.63 [95% CI: 0.34-0.97]) remained one of the most common complications in the severe and death group respectively. Bilateral ground-glass opacification (PP: 0.68 [95% CI: 0.59-0.75]) was the most visible radiological image. The mortality rates estimated (PP: 0.11 [95% CI: 0.06-0.19]), (PP: 0.03 [95% CI: 0.01-0.05]), and (PP: 0.01 [95% CI: 0-0.3]) in severe-critical, pneumonia and mild-moderate groups respectively. This study can serve as a high evidence guideline for different clinical presentations of Covid-19, graded from mild to severe, and for special forms like pneumonia and death groups.


Subject(s)
COVID-19/pathology , Cough/pathology , Dyspnea/pathology , Fatigue/pathology , Fever/pathology , SARS-CoV-2/pathogenicity , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/mortality , COVID-19/virology , Comorbidity , Cough/drug therapy , Cough/mortality , Cough/virology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Dyspnea/drug therapy , Dyspnea/mortality , Dyspnea/virology , Fatigue/drug therapy , Fatigue/mortality , Fatigue/virology , Fever/drug therapy , Fever/mortality , Fever/virology , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Immunologic Factors/therapeutic use , Prognosis , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology , Severity of Illness Index , Smoking/physiopathology , Survival Analysis
4.
Molecules ; 25(21)2020 Nov 02.
Article in English | MEDLINE | ID: covidwho-1389462

ABSTRACT

Zebrafish has been a reliable model system for studying human viral pathologies. SARS-CoV-2 viral infection has become a global chaos, affecting millions of people. There is an urgent need to contain the pandemic and develop reliable therapies. We report the use of a humanized zebrafish model, xeno-transplanted with human lung epithelial cells, A549, for studying the protective effects of a tri-herbal medicine Coronil. At human relevant doses of 12 and 58 µg/kg, Coronil inhibited SARS-CoV-2 spike protein, induced humanized zebrafish mortality, and rescued from behavioral fever. Morphological and cellular abnormalities along with granulocyte and macrophage accumulation in the swim bladder were restored to normal. Skin hemorrhage, renal cell degeneration, and necrosis were also significantly attenuated by Coronil treatment. Ultra-high-performance liquid chromatography (UHPLC) analysis identified ursolic acid, betulinic acid, withanone, withaferine A, withanoside IV-V, cordifolioside A, magnoflorine, rosmarinic acid, and palmatine as phyto-metabolites present in Coronil. In A549 cells, Coronil attenuated the IL-1ß induced IL-6 and TNF-α cytokine secretions, and decreased TNF-α induced NF-κB/AP-1 transcriptional activity. Taken together, we show the disease modifying immunomodulatory properties of Coronil, at human equivalent doses, in rescuing the pathological features induced by the SARS-CoV-2 spike protein, suggesting its potential use in SARS-CoV-2 infectivity.


Subject(s)
Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Plant Extracts/therapeutic use , Pneumonia, Viral/drug therapy , Spike Glycoprotein, Coronavirus/antagonists & inhibitors , Air Sacs/drug effects , Air Sacs/virology , Animals , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19 , Chromatography, High Pressure Liquid/methods , Coronavirus Infections/pathology , Coronavirus Infections/physiopathology , Disease Models, Animal , Fever/drug therapy , Fever/etiology , Hemorrhage/prevention & control , Humans , Interleukin-6/metabolism , Kidney/drug effects , Necrosis/pathology , Necrosis/prevention & control , Pandemics , Phytotherapy , Pneumonia, Viral/pathology , Pneumonia, Viral/physiopathology , Respiratory Mucosa/transplantation , Transcriptional Activation/drug effects , Tumor Necrosis Factor-alpha/metabolism , Zebrafish
5.
PLoS One ; 16(8): e0256429, 2021.
Article in English | MEDLINE | ID: covidwho-1367707

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic since its outbreak in Wuhan, China. It is an urgent task to prevent and treat COVID-19 effectively early. In China's experience combating the COVID-19 pandemic, Chinese herbal medicine (CHM) has played an indispensable role. A large number of epidemiological investigations have shown that mild to moderate COVID-19 accounts for the largest proportion of cases. It is of great importance to treat such COVID-19 cases, which can help control epidemic progression. Many trials have shown that CHM combined with conventional therapy in the treatment of mild to moderate COVID-19 was superior to conventional therapy alone. This review was designed to evaluate the add-on effect of CHM in the treatment of mild to moderate COVID-19. METHODS: Eight electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the Clinical Trials.gov website, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database and China Biology Medicine (CBM) were searched from December 2019 to March 2021 without language restrictions. Two reviewers searched and selected studies, and extracted data according to inclusion and exclusion criteria independently. Cochrane Risk of Bias (ROB) tool was used to assess the methodological quality of the included RCTs. Review Manager 5.3.0 software was used for statistical analysis. RESULTS: Twelve eligible RCTs including 1393 participants were included in this meta-analysis. Our meta-analyses found that lung CT parameters [RR = 1.26, 95% CI (1.15, 1.38), P<0.00001] and the clinical cure rate [RR = 1.26, 95%CI (1.16, 1.38), P<0.00001] of CHM combined with conventional therapy in the treatment of mild to moderate COVID-19 were better than those of conventional therapy. The rate of conversion to severe cases [RR = 0.48, 95%CI (0.32, 0.73), P = 0.0005], TCM symptom score of fever [MD = -0.62, 95%CI (-0.79, -0.45), P<0.00001], cough cases [RR = 1.43, 95%CI (1.16, 1.75), P = 0.0006], TCM symptom score of cough[MD = -1.07, 95%CI (-1.29, -0.85), P<0.00001], TCM symptom score of fatigue[MD = -0.66, 95%CI (-1.05, -0.28), P = 0.0007], and CRP[MD = -5.46, 95%CI (-8.19, -2.72), P<0.0001] of combination therapy was significantly lower than that of conventional therapy. The WBC count was significantly higher than that of conventional therapy[MD = 0.38, 95%CI (0.31, 0.44), P<0.00001]. Our meta-analysis results were robust through sensitivity analysis. CONCLUSION: Chinese herbal medicine combined with conventional therapy may be effective and safe in the treatment of mild to moderate COVID-19. More high-quality RCTs are needed in the future.


Subject(s)
COVID-19/drug therapy , Drugs, Chinese Herbal/adverse effects , Drugs, Chinese Herbal/therapeutic use , COVID-19/diagnostic imaging , COVID-19/etiology , Cough/drug therapy , Cough/virology , Diarrhea/chemically induced , Drugs, Chinese Herbal/chemistry , Fever/drug therapy , Fever/virology , Humans , Lung/diagnostic imaging , Lung/virology , Nausea/chemically induced , Tomography, X-Ray Computed , Treatment Outcome , Vomiting/chemically induced
6.
Sci Rep ; 11(1): 16361, 2021 08 11.
Article in English | MEDLINE | ID: covidwho-1354119

ABSTRACT

Evidence on the efficacy of adding macrolides (azithromycin or clarithromycin) to the treatment regimen for COVID-19 is limited. We testify whether adding azithromycin or clarithromycin to a standard of care regimen was superior to standard of supportive care alone in patients with mild COVID-19.This randomized trial included three groups of patients with COVID-19. The azithromycin group included, 107 patients who received azithromycin 500 mg/24 h for 7 days, the clarithromycin group included 99 patients who received clarithromycin 500 /12 h for 7 days, and the control group included 99 patients who received standard care only. All three groups received only symptomatic treatment for control of fever and cough .Clinical and biochemical evaluations of the study participants including assessment of the symptoms duration, real-time reverse transcription-polymerase chain reaction (rRT-PCR), C-reactive protein (CRP), serum ferritin, D-dimer, complete blood count (CBC), in addition to non-contrast chest computed tomography (CT), were performed. The overall results revealed significant early improvement of symptoms (fever, dyspnea and cough) in patients treated with either azithromycin or clarithromycin compared to control group, also there was significant early conversion of SARS-CoV-2 PCR to negative in patients treated with either azithromycin or clarithromycin compared to control group (p < 0.05 for all).There was no significant difference in time to improvement of fever, cough, dyspnea, anosmia, gastrointestinal tract "GIT" symptoms and time to PCR negative conversion between patients treated with azithromycin compared to patients treated with clarithromycin (p > 0.05 for all). Follow up chest CT done after 2 weeks of start of treatment showed significant improvement in patients treated with either azithromycin or clarithromycin compared to control group (p < 0.05 for all).Adding Clarithromycin or azithromycin to the therapeutic protocols for COVID-19 could be beneficial for early control of fever and early PCR negative conversion in Mild COVID-19.Trial registration: (NCT04622891) www.ClinicalTrials.gov retrospectively registered (November 10, 2020).


Subject(s)
Azithromycin/therapeutic use , COVID-19/drug therapy , Clarithromycin/therapeutic use , Adult , COVID-19/physiopathology , Female , Fever/drug therapy , Fever/etiology , Humans , Male , Middle Aged , Patient Acuity , Treatment Outcome
8.
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.
Int J Nanomedicine ; 16: 4063-4072, 2021.
Article in English | MEDLINE | ID: covidwho-1278261

ABSTRACT

Background: Ivermectin is an FDA-approved broad-spectrum anti-parasitic agent that has been shown to inhibit SARS-CoV-2 replication in vitro. Objective: We aimed to assess the therapeutic efficacy of ivermectin mucoadhesive nanosuspension intranasal spray in treatment of patients with mild COVID-19. Methods: This clinical trial included 114 patients diagnosed as mild COVID-19. Patients were divided randomly into two age and sex-matched groups; group A comprising 57 patients received ivermectin nanosuspension nasal spray twice daily plus the Egyptian protocol of treatment for mild COVID-19 and group B comprising 57 patients received the Egyptian protocol for mild COVID-19 only. Evaluation of the patients was performed depending on improvement of presenting manifestations, negativity of two consecutive pharyngeal swabs for the COVID-19 nucleic acid via rRT-PCR and assessments of hematological and biochemical parameters in the form of complete blood counts, C-reactive protein, serum ferritin and d-dimer which were performed at presentation and 7 days later. Results: Of the included patients confirmed with mild COVID-19, 82 were males (71.9%) and 32 females (28.1%) with mean age 45.1 ± 18.9. In group A, 54 patients (94.7%) achieved 2 consecutive negative PCR nasopharyngeal swabs in comparison to 43 patients (75.4%) in group B with P = 0.004. The durations of fever, cough, dyspnea and anosmia were significantly shorter in group A than group B, without significant difference regarding the duration of gastrointestinal symptoms. Duration taken for nasopharyngeal swab to be negative was significantly shorter in group A than in group B (8.3± 2.8 days versus 12.9 ± 4.3 days; P = 0.0001). Conclusion: Local use of ivermectin mucoadhesive nanosuspension nasal spray is safe and effective in treatment of patients with mild COVID-19 with rapid viral clearance and shortening the anosmia duration. Clinicaltrialsgov Identifier: NCT04716569; https://clinicaltrials.gov/ct2/show/NCT04716569.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Ivermectin/therapeutic use , Respiratory Tract Diseases/drug therapy , Adult , Antiviral Agents/administration & dosage , COVID-19/etiology , COVID-19 Nucleic Acid Testing , Cough/drug therapy , Cough/virology , Egypt , Female , Fever/drug therapy , Fever/virology , Humans , Ivermectin/administration & dosage , Ivermectin/adverse effects , Male , Middle Aged , Nanostructures/administration & dosage , Nanostructures/chemistry , Nasal Sprays , Nasopharynx/virology , Prospective Studies , Respiratory Tract Diseases/etiology , Respiratory Tract Diseases/virology , Treatment Outcome
10.
J Enzyme Inhib Med Chem ; 36(1): 1230-1235, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1254219

ABSTRACT

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.


Subject(s)
Acetazolamide/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Carbonic Anhydrase Inhibitors/therapeutic use , Carbonic Anhydrases/blood , Acid-Base Equilibrium/drug effects , Altitude Sickness/blood , Altitude Sickness/drug therapy , Anticonvulsants/therapeutic use , Bicarbonates/blood , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/virology , Carbon Dioxide/blood , Cough/blood , Cough/drug therapy , Cough/pathology , Cough/virology , Drug Repositioning , Dyspnea/blood , Dyspnea/drug therapy , Dyspnea/pathology , Dyspnea/virology , Fever/blood , Fever/drug therapy , Fever/pathology , Fever/virology , Humans , Hydrogen-Ion Concentration , Hypertension, Pulmonary/blood , Hypertension, Pulmonary/drug therapy , Hypoxia/blood , Hypoxia/drug therapy , Hypoxia/pathology , Hypoxia/virology , Oximetry , Research Design , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Severity of Illness Index , Tomography, X-Ray Computed
11.
Phytother Res ; 35(4): 1925-1938, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1173847

ABSTRACT

Arisen in China, COVID-19 (SARS-CoV-II) is a novel coronavirus that has been expanding fast worldwide. Till now, no definite remedial drug or vaccine has been identified for COVID-19 treatment. Still, for a majority of infected patients, supportive therapy is the cornerstone of the management plan. To the importance of managing the COVID-19 pandemic, this article proposed to collecting capable medicinal plants and bioactive components in both treat and supportive therapy of this novel viral infection. Clinical points in the pathogenesis, symptoms, and complications of COVID-19 were considered. The effective plants and bioactives that may play a role in supportive therapy/management of COVID-19 were searched, collected through the "Scopus" database and listed in three sections. Numerous medicinal plants such as Citrus Spp., Camellia sinensis, and Glycyrrhiza glabra can interference with COVID-19 pathogenesis via inhibition of virus replication and entry to its host cells. Also, some anti-inflammatory herbal medicine such as Andrographis paniculata, Citrus spp., and Cuminum cyminum can relieve fever and cough in COVID-19 patients. Medicinal plants such as G. glabra, Thymus vulgaris, Allium sativum, Althea officinalis, and Panax ginseng may modulate the immune system and possess prevention and supportive therapy. However, more clinical data are required to confirm these hypotheses.


Subject(s)
COVID-19/drug therapy , Phytotherapy , Plant Preparations/therapeutic use , Plants, Medicinal/chemistry , Anti-Inflammatory Agents/therapeutic use , Cough/drug therapy , Cough/virology , Fever/drug therapy , Fever/virology , Humans , Pandemics , Virus Replication/drug effects
12.
Indian J Med Microbiol ; 39(3): 320-322, 2021 07.
Article in English | MEDLINE | ID: covidwho-1091810

ABSTRACT

A 52 year old previously healthy woman from Mumbai presented with fever and jaundice of 10 days duration. At admission, she was jaundiced with tachycardia, tachypnea, hypoxia, hypotension, conjunctival congestion and mild erythematous flush over the skin. She had very high WBC counts and CRP's with direct hyperbilirubinemia and azotemia. Investigations for infectious causes of fever were negative. RT-PCR for SARS-CoV-2 in the nasopharynx was negative. However her SARS-CoV-2 antibodies were reactive. She also had echocardiographic and biochemical evidence of cardiac dysfunction. The diagnosis of Multisystem inflammatory syndrome-Adult (MIS-A) was thus established. She rapidly improved with intravenous immunoglobulin (2 gm/kg) and high dose steroids.


Subject(s)
Fever/etiology , Jaundice/etiology , Azotemia/drug therapy , Azotemia/metabolism , Azotemia/microbiology , COVID-19/microbiology , Echocardiography , Fever/drug therapy , Fever/metabolism , Humans , Hyperbilirubinemia/drug therapy , Hyperbilirubinemia/metabolism , Hyperbilirubinemia/microbiology , Immunoglobulins/therapeutic use , Jaundice/drug therapy , Jaundice/metabolism , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity , Steroids/metabolism
13.
Clin J Oncol Nurs ; 25(1): 23-26, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1080876

ABSTRACT

Febrile neutropenia, a serious complication of cytotoxic chemotherapy, is an oncologic emergency associated with high rates of morbidity and mortality. Fever is often the only clinical sign of an underlying infection in neutropenic patients with cancer. Prompt treatment with empiric broad-spectrum antibiotics is crucial to ensuring best outcomes for patients; practice guidelines recommend antibiotic administration within one hour of fever onset. A quality improvement initiative to improve time to antibiotic administration among patients with febrile neutropenia presenting to a community hospital emergency department is described in this article.


Subject(s)
Febrile Neutropenia , Neoplasms , Anti-Bacterial Agents/therapeutic use , Emergency Service, Hospital , Febrile Neutropenia/chemically induced , Febrile Neutropenia/drug therapy , Fever/drug therapy , Hospitals, Community , Humans , Neoplasms/complications , Neoplasms/drug therapy
14.
JAMA Netw Open ; 4(2): e210369, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1084243

ABSTRACT

Importance: There is limited evidence regarding early treatment of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to mitigate symptom progression. Objective: To examine whether high-dose zinc and/or high-dose ascorbic acid reduce the severity or duration of symptoms compared with usual care among ambulatory patients with SARS-CoV-2 infection. Design, Setting, and Participants: This multicenter, single health system randomized clinical factorial open-label trial enrolled 214 adult patients with a diagnosis of SARS-CoV-2 infection confirmed with a polymerase chain reaction assay who received outpatient care in sites in Ohio and Florida. The trial was conducted from April 27, 2020, to October 14, 2020. Intervention: Patients were randomized in a 1:1:1:1 allocation ratio to receive either 10 days of zinc gluconate (50 mg), ascorbic acid (8000 mg), both agents, or standard of care. Outcomes: The primary end point was the number of days required to reach a 50% reduction in symptoms, including severity of fever, cough, shortness of breath, and fatigue (rated on a 4-point scale for each symptom). Secondary end points included days required to reach a total symptom severity score of 0, cumulative severity score at day 5, hospitalizations, deaths, adjunctive prescribed medications, and adverse effects of the study supplements. Results: A total of 214 patients were randomized, with a mean (SD) age of 45.2 (14.6) years and 132 (61.7%) women. The study was stopped for a low conditional power for benefit with no significant difference among the 4 groups for the primary end point. Patients who received usual care without supplementation achieved a 50% reduction in symptoms at a mean (SD) of 6.7 (4.4) days compared with 5.5 (3.7) days for the ascorbic acid group, 5.9 (4.9) days for the zinc gluconate group, and 5.5 (3.4) days for the group receiving both (overall P = .45). There was no significant difference in secondary outcomes among the treatment groups. Conclusions and Relevance: In this randomized clinical trial of ambulatory patients diagnosed with SARS-CoV-2 infection, treatment with high-dose zinc gluconate, ascorbic acid, or a combination of the 2 supplements did not significantly decrease the duration of symptoms compared with standard of care. Trial Registration: ClinicalTrials.gov Identifier: NCT04342728.


Subject(s)
Ascorbic Acid/therapeutic use , COVID-19/drug therapy , Dietary Supplements , Zinc/therapeutic use , Adult , Ambulatory Care , Antioxidants/therapeutic use , COVID-19/complications , Cough/drug therapy , Cough/etiology , Dyspnea/drug therapy , Dyspnea/etiology , Fatigue/drug therapy , Fatigue/etiology , Female , Fever/drug therapy , Fever/etiology , Gluconates/therapeutic use , Humans , Male , Middle Aged , SARS-CoV-2 , Severity of Illness Index , Standard of Care , Trace Elements/therapeutic use , Treatment Outcome
15.
J Med Virol ; 93(7): 4446-4453, 2021 07.
Article in English | MEDLINE | ID: covidwho-1064383

ABSTRACT

This study aims to comparatively analyze the therapeutic efficacy upon multiple medication plans over lopinavir/ritonavir (LPV/r), arbidol (ARB), and methylprednisolone on patients with coronavirus disease 2019 (COVID-19). Totally, 75 COVID-19 patients admitted to The First Affiliated Hospital, Zhejiang University School of Medicine from January 22, 2020 to February 29, 2020 were recruited and grouped based on whether or not LPV/r and ARB were jointly used and whether or not methylprednisolone was used. Indexes including body temperature, time for nucleic acid negative conversion, hospital stays, and laboratory indexes were examined and compared. For all patients, there were no significant differences in the change of body temperature, the time for negative conversion, and hospital stays whether LPV/r and ARB were jointly used or not. While for severe and critically severe patients, methylprednisolone noticeably reduced the time for negative conversion. Meanwhile, the clinical efficacy was superior on patients receiving methylprednisolone within 3 days upon admission, and the duration of hospital stays was much shorter when methylprednisolone was given at a total dose of 0-400 mg than a higher dose of >400 mg if all patients received a similar dose per day. Nonetheless, no significant changes across hepatic, renal, and myocardial function indexes were observed. LPV/r combined with ARB produced no noticeably better effect on COVID-19 patients relative to the single-agent treatment. Additionally, methylprednisolone was efficient in severe and critically severe cases, and superior efficacy could be realized upon its early, appropriate, and short-term application.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Indoles/therapeutic use , Lopinavir/therapeutic use , Methylprednisolone/therapeutic use , Ritonavir/therapeutic use , China , Drug Combinations , Female , Fever/drug therapy , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/drug effects
17.
J Neurovirol ; 27(1): 154-159, 2021 02.
Article in English | MEDLINE | ID: covidwho-1059492

ABSTRACT

As the SARS-COV-2 becomes a global pandemic, many researchers have a concern about the long COVID-19 complications. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a persistent, debilitating, and unexplained fatigue disorder. We investigated psychological morbidities such as CFS and post-traumatic stress disorder (PTSD) among survivors of COVID-19 over 6 months. All COVID-19 survivors from the university-affiliated hospital of Tehran, Iran, were assessed 6 months after infection onset by a previously validated questionnaire based on the Fukuda guidelines for CFS/EM and DSM-5 Checklist for PTSD (The Post-traumatic Stress Disorder Checklist for DSM-5 or PCL-5) to determine the presence of stress disorder and chronic fatigue problems. A total of 120 patients were enrolled. The prevalence rate of fatigue symptoms was 17.5%. Twelve (10%) screened positive for chronic idiopathic fatigue (CIF), 6 (5%) for CFS-like with insufficient fatigue syndrome (CFSWIFS), and 3 (2.5%) for CFS. The mean total scores in PCL-5 were 9.27 ± 10.76 (range:0-44), and the prevalence rate of PTSD was 5.8%. There was no significant association after adjusting between CFS and PTSD, gender, comorbidities, and chloroquine phosphate administration. The obtained data revealed the prevalence of CFS among patients with COVID-19, which is almost similar to CFS prevalence in the general population. Moreover, PTSD in patients with COVID-19 is not associated with the increased risk of CFS. Our study suggested that medical institutions should pay attention to the psychological consequences of the COVID-19 outbreak.


Subject(s)
COVID-19/psychology , Cough/psychology , Dementia/psychology , Dyspnea/psychology , Fatigue Syndrome, Chronic/psychology , Fever/psychology , Stress Disorders, Post-Traumatic/psychology , Adult , Aged , Antiviral Agents/therapeutic use , COVID-19/complications , COVID-19/drug therapy , COVID-19/virology , Cough/complications , Cough/drug therapy , Cough/virology , Dementia/complications , Dementia/drug therapy , Dementia/virology , Drug Combinations , Dyspnea/complications , Dyspnea/drug therapy , Dyspnea/virology , Fatigue Syndrome, Chronic/complications , Fatigue Syndrome, Chronic/drug therapy , Fatigue Syndrome, Chronic/virology , Female , Fever/complications , Fever/drug therapy , Fever/virology , Humans , Hydroxychloroquine/therapeutic use , Lopinavir/therapeutic use , Male , Middle Aged , Oseltamivir/therapeutic use , Research Design , Ritonavir/therapeutic use , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity , Severity of Illness Index , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/drug therapy , Stress Disorders, Post-Traumatic/virology , Surveys and Questionnaires , Survivors/psychology
18.
J Neurovirol ; 27(1): 26-34, 2021 02.
Article in English | MEDLINE | ID: covidwho-1046668

ABSTRACT

Opsoclonus-myoclonus-ataxia syndrome is a heterogeneous constellation of symptoms ranging from full combination of these three neurological findings to varying degrees of isolated individual sign. Since the emergence of coronavirus disease 2019 (COVID-19), neurological symptoms, syndromes, and complications associated with this multi-organ viral infection have been reported and the various aspects of neurological involvement are increasingly uncovered. As a neuro-inflammatory disorder, one would expect to observe opsoclonus-myoclonus syndrome after a prevalent viral infection in a pandemic scale, as it has been the case for many other neuro-inflammatory syndromes. We report seven cases of opsoclonus-myoclonus syndrome presumably parainfectious in nature and discuss their phenomenology, their possible pathophysiological relationship to COVID-19, and diagnostic and treatment strategy in each case. Finally, we review the relevant data in the literature regarding the opsoclonus-myoclonus syndrome and possible similar cases associated with COVID-19 and its diagnostic importance for clinicians in various fields of medicine encountering COVID-19 patients and its complications.


Subject(s)
Ataxia/physiopathology , COVID-19/physiopathology , Cough/physiopathology , Fever/physiopathology , Myalgia/physiopathology , Opsoclonus-Myoclonus Syndrome/physiopathology , SARS-CoV-2/pathogenicity , Adult , Anticonvulsants/therapeutic use , Ataxia/diagnostic imaging , Ataxia/drug therapy , Ataxia/etiology , Azithromycin/therapeutic use , COVID-19/complications , COVID-19/diagnostic imaging , COVID-19/drug therapy , Clonazepam/therapeutic use , Cough/diagnostic imaging , Cough/drug therapy , Cough/etiology , Dyspnea/diagnostic imaging , Dyspnea/drug therapy , Dyspnea/etiology , Dyspnea/physiopathology , Female , Fever/diagnostic imaging , Fever/drug therapy , Fever/etiology , Humans , Hydroxychloroquine/therapeutic use , Levetiracetam/therapeutic use , Male , Middle Aged , Myalgia/diagnostic imaging , Myalgia/drug therapy , Myalgia/etiology , Opsoclonus-Myoclonus Syndrome/diagnostic imaging , Opsoclonus-Myoclonus Syndrome/drug therapy , Opsoclonus-Myoclonus Syndrome/etiology , Oseltamivir/therapeutic use , SARS-CoV-2/drug effects , Valproic Acid/therapeutic use
19.
J Neuroimmune Pharmacol ; 16(1): 59-70, 2021 03.
Article in English | MEDLINE | ID: covidwho-1018438

ABSTRACT

COVID-19 is an infectious respiratory illness caused by the virus strain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and until now, there is no effective therapy against COVID-19. Since SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) for entering into host cells, to target COVID-19 from therapeutic angle, we engineered a hexapeptide corresponding to the ACE2-interacting domain of SARS-CoV-2 (AIDS) that inhibits the association between receptor-binding domain-containing spike S1 and ACE-2. Accordingly, wild type (wt), but not mutated (m), AIDS peptide inhibited SARS-CoV-2 spike S1-induced activation of NF-κB and expression of IL-6 in human lungs cells. Interestingly, intranasal intoxication of C57/BL6 mice with recombinant SARS-CoV-2 spike S1 led to fever, increase in IL-6 in lungs, infiltration of neutrophils into the lungs, arrhythmias, and impairment in locomotor activities, mimicking some of the important symptoms of COVID-19. However, intranasal treatment with wtAIDS, but not mAIDS, peptide reduced fever, protected lungs, improved heart function, and enhanced locomotor activities in SARS-CoV-2 spike S1-intoxicated mice. Therefore, selective targeting of ACE2-to-SARS-CoV-2 interaction by wtAIDS may be beneficial for COVID-19.


Subject(s)
Angiotensin-Converting Enzyme 2/therapeutic use , COVID-19/complications , COVID-19/drug therapy , Fever/drug therapy , Fever/etiology , Heart Diseases/etiology , Heart Diseases/prevention & control , Inflammation/drug therapy , Inflammation/etiology , Lung Diseases/etiology , Lung Diseases/prevention & control , Peptide Fragments/therapeutic use , Administration, Intranasal , Animals , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/prevention & control , COVID-19/pathology , Female , Heart Diseases/pathology , Interleukin-6/metabolism , Lung Diseases/pathology , Male , Mice , Mice, Inbred C57BL , Motor Activity/drug effects , Neutrophil Infiltration/drug effects , Spike Glycoprotein, Coronavirus/toxicity
20.
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
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