ABSTRACT
RationaleCoronavirus disease 2019 (COVID-19) leads to hospitalization and death, especially in elderly and those with comorbidities. There are evidences showing that sitagliptin and spironolactone can potentially improve the clinical outcomes of COVID-19 cases. ObjectiveIn this observational study on acutely symptomatic outpatient COVID-19 cases, we investigated the effects of spironolactone and sitagliptin on the outcomes of the disease. MethodsThis prospective cohort study was conducted at Shiraz University of Medical Sciences Clinics during the fifth wave of the COVID-19 pandemic between July 2021 and September 2021. We followed mild to moderate symptomatic COVID-19 patients, who were treated with either combination (spironolactone 100 mg daily and sitagliptin 100 mg daily) or standard (steroid, antiviral and/or supportive care) therapy up to 30 days. Our primary outcome was hospitalization rate. The secondary outcomes included ER visit, duration of disease, and complications, such as hypoglycemia, low blood pressure or altered mental status. ResultsOf the 206 patients referred to clinics, 103 received standard therapy and 103 treated with combination therapy. There were no significant differences in baseline characteristics, except for slightly higher clinical score in control group (6.92 {+/-} 4.01 control, 4.87 {+/-} 2.92 combination; P <0.0001). Treatment with combination therapy was associated with lower admission rate (5.8% combination, 22.3% control; P = 0.0011), ER visits (7.8% combination, 23.3% control; P = 0.0021) and average duration of symptoms (6.67 {+/-} 2.30 days combination, 18.71 {+/-} 6.49 days control; P =<0.0001). ConclusionIn this prospective cohort study of acutely ill outpatients with COVID-19, the combination of sitagliptin and spironolactone reduced duration of COVID infection and hospital visits better than standard therapeutic approaches. The effects of combination of sitagliptin and spironolactone in COVID-19 patients should be further verified in a double blind, randomized, placebo-controlled trial. Iranian Registry of Clinical TrialsIRCT registration number: IRCT20201003048904N2, Registration date: December 10, 2020.
ABSTRACT
ImportanceSince late 2019, the novel coronavirus SARS-CoV-2 has given rise to a global pandemic and introduced many health challenges with economic, social, and political consequences. In addition to a complex acute presentation that can affect multiple organ systems, there is mounting evidence of various persistent long-term sequelae. The worldwide scientific community is characterizing a diverse range of seemingly common long-term outcomes associated with SARS-CoV-2 infection, but the underlying assumptions in these studies vary widely making comparisons difficult. Numerous publications describe the clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC or "long COVID"), but they are difficult to integrate because of heterogeneous methods and the lack of a standard for denoting the many phenotypic manifestations of long COVID. ObservationsWe identified 303 articles published before April 29, 2021, curated 59 relevant manuscripts that described clinical manifestations in 81 cohorts of individuals three weeks or more following acute COVID-19, and mapped 287 unique clinical findings to Human Phenotype Ontology (HPO) terms. Conclusions and RelevancePatients and clinicians often use different terms to describe the same symptom or condition. Addressing the heterogeneous and inconsistent language used to describe the clinical manifestations of long COVID combined with the lack of standardized terminologies for long COVID will provide a necessary foundation for comparison and meta-analysis of different studies. Translating long COVID manifestations into computable HPO terms will improve the analysis, data capture, and classification of long COVID patients. If researchers, clinicians, and patients share a common language, then studies can be compared or pooled more effectively. Furthermore, mapping lay terminology to HPO for long COVID manifestations will help patients assist clinicians and researchers in creating phenotypic characterizations that are computationally accessible, which may improve the stratification and thereby diagnosis and treatment of long COVID.
ABSTRACT
Withdrawal StatementThe authors have withdrawn this version of the manuscript to correct errors in Figure 1, Table 1, and Supplementary Table 1. Therefore, the authors do not wish this version of the work to be cited, please see version 2. If you have any questions, please contact the corresponding author.
ABSTRACT
BackgroundAn unproven "nicotine hypothesis" that indicates nicotines therapeutic potential for COVID-19 has been proposed in recent literature. This study is about Twitter posts that misinterpret this hypothesis to make baseless claims about benefits of smoking and vaping in the context of COVID-19. We quantify the presence of such misinformation and characterize the tweeters who post such messages. MethodsTwitter premium API was used to download tweets (n = 17,533) that match terms indicating (a) nicotine or vaping themes, (b) a prophylactic or therapeutic effect, and (c) COVID-19 (January-July 2020) as a conjunctive query. A constraint on the length of the span of text containing the terms in the tweets allowed us to focus on those that convey the therapeutic intent. We hand-annotated these filtered tweets and built a classifier that identifies tweets that extrapolate the nicotine hypothesis to smoking/vaping with a positive predictive value of 85%. We analyzed the frequently used terms in author bios, top Web links, and hashtags of such tweets. Results21% of our filtered COVID-19 tweets indicate a vaping or smoking-based prevention/treatment narrative. Qualitative analyses show a variety of ways therapeutic claims are being made and tweeter bios reveal pre-existing notions of positive stances toward vaping. ConclusionThe social media landscape is a double-edged sword in tobacco communication. Although it increases information reach, consumers can also be subject to confirmation bias when exposed to inadvertent or deliberate framing of scientific discourse that may border on misinformation. This calls for circumspection and additional planning in countering such narratives as the COVID-19 pandemic continues to ravage our world. Our results also serve as a cautionary tale in how social media can be leveraged to spread misleading information about tobacco products in the wake of pandemics.
