ABSTRACT
ObjectiveTo analyze the efficacy of Hydroxychloroquine (HCQ) plus standard of care (SOC) compared with SOC alone in reducing disease progression in Mild COVID-19 DesignA single centre, open label randomized controlled trial Place and DurationPulmonology department, Pak emirates Military Hospital (PEMH) from 10 April 2020 to 31 May 2020. MethodologyFive hundred patients of both genders having age between 18-50 years who were PCR positive and had Mild COVID-19 were selected. Patients assigned to standard dose of HCQ (400mg 12 hourly day 1 then 200mg 12 hrly for next 4 days) plus SOC were 349 while 151 patients received SOC comprising of Vit C, Vit D, and Zinc only (control group). Primary outcome was progression of disease while secondary outcome was PCR negativity on day 7 and 14. The results were analyzed on SPSS version 23. P value <0.05 was considered significant. ResultsMedian age of intervention group (34 {+/-} 11.778 years) and control group (34 {+/-} 9.813 years). Disease progressed in 16 patients, 11 (3.15%) were in intervention group as compared to 5 (3.35%) in control group, (p value = 0.865). PCR negativity in intervention and control groups were (day 7, 182 (52.1%) vs. 54 (35.7%) (p value = 0.001), (day 14, 244 (69.9%) vs. 110 (72.8%) (p value = 0.508). Consecutive PCR negativity at day 7 and 14 was observed in 240 (68.8%) in intervention group compared to 108 (71.5%) in control group. (p value = 0.231). ConclusionAddition of HCQ to standard of care treatment in Mild COVID-19 neither prevents disease progression nor is it significantly associated with successive PCR negativity on day 7 and 14. Trial registrationNCT04491994 Ethical review of research projectThe research project titled "Clearing the fog: Is HCQ effective in reducing COVID-19 progression" has been reviewed by ethical review committee of Pak Emirates Military Hospital (PEMH) Rawalpindi and got legal and ethical approvals prior to initiation of the research work carried out on subject. All experiments were performed in accordance with the relevant guidelines and regulation. Grant of approval is attached as separate file.
ABSTRACT
PurposeTo evaluate the outcome of patients with COVID-19 triggered CRS treated with Therapeutic Plasma Exchange (TPE) as compared to propensity score matched (PSM)-controls not receiving TPE. Material and methodsUsing PS 1:1 matching, 90 patients were assigned 2 groups (45 receiving TPE and 45 controls). Forced matching and covariate matching was done to overcome bias between two groups. ResultsMedian age was 60 years (range 32-73 in TPE and 37-75 in non-TPE group), p= 0.325. Median duration of symptoms 7 days (range 3-22 days in TPE and 3-20 days in non-TPE), p=0.266. Disease severity in both groups was 6.6% moderate, 44.4% severe and 49% critical. Twenty-eight-day survival was significantly superior in TPE group (91.1%) as compared to PS-matched controls (61.5%), HR 0.21, 95% CI for HR 0.09-0.53, log rank 0.002. Median duration of hospitalization was significantly reduced in TPE treated group as compared to non-TPE controls 10 days and 15 days respectively (p< 0.01). CRS resolution time was also significantly reduced in TPE treated group (6 days vs. 12 days) (p< 0.001). ConclusionUse of TPE is associated with superior overall survival, early resolution of CRS and time to discharge as compared to standard therapy for COVID-19 triggered CRS. Highlights{square} Cytokine release syndrome (CRS) plays a pivotal role in pathophysiology and progression to severe and critical disease in patients with COVID-19. {square}Beyond supportive care, there are currently no proven effective treatment options (including Tocilizumab) for coronavirus disease (COVID-19) {square}Therapeutic plasma exchange (TPE) may dampen CRS of COVID-19 by removing circulating cytokines and toxins {square}TPE is the cheapest of all novel treatments available so far to treat severe to critical COVID-19 {square}By intervening early with TPE, mortality and morbidity associated with COVID-19 triggered CRS can be reduced
ABSTRACT
With the rising incidence of chronic liver disease caused by viral hepatitis, hepatocellular carcinoma is showing a corresponding rise worldwide. Surgery remains the mainstay of treatment, but patients unfit for surgery or liver transplantation form the bulk of those presenting with this disease. Palliative treatments are being used to treat those and radiological modalities form the mainstay of the treatment. Radiology plays a major role in the diagnosis, treatment and follow-up of hepatocellular carcinoma. Current radiological treatment modalities include percutaneous ethanol ablation, radiofrequency ablation and trans-arterial chemoembolization. This update highlights the recent advancements in the field and compares their relative merits and demerits.
