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OBJECTIVES: To describe the demographics and evaluate the clinical outcomes of hypoxic coronavirus disease-2019 (COVID-19) patients treated with different immunomodulatory (IM) drugs in a resource-limited setting. MATERIALS AND METHODS: We conducted a retrospective cohort study of these patients admitted to our hospital between March 22 and May 31, 2020. Data were abstracted from multiple electronic data sources or patient charts to provide information on patient characteristics, clinical, laboratory variables, and outcomes. RESULTS: A total of 134 patients met the inclusion criteria and were followed up till June 7, 2020. The median age of the patients was 55.6 years (range 20-89 years) and 68% were men. At least one comorbidity was seen in 72% of the patients with diabetes (44%) and hypertension (46%) being the most common. At triage, fever (82%), shortness of breath (77%), and cough (61%) were the most common presenting symptoms. A PaO2/FiO2 ratio less than 300 was seen in 60%, and 4.5% required invasive mechanical ventilation within 72 hours of hospital admission. Five immunomodulatory agents (hydroxychloroquine, methylprednisolone, colchicine, etoricoxib, and tocilizumab) were administered in different combinations. Overall, in-hospital mortality was 26.9%, and 32% required mechanical ventilation. Around 69% of patients were discharged home. Five variables (SpO2, PaO2/FiO2 ratio, leucocytosis, lymphopenia, and creatinine) on admission were found to be significant in the patients who died. CONCLUSION: Our study provides the characteristics and outcomes of hypoxic COVID-19 patients treated with IM drugs in varied combination. Five independent variables were strong predictors of mortality. HOW TO CITE THIS ARTICLE: Mahale N, Rajhans P, Godavarthy P, Narasimhan VL, Oak G, Marreddy S, et al. A Retrospective Observational Study of Hypoxic COVID-19 Patients Treated with Immunomodulatory Drugs in a Tertiary Care Hospital. Indian J Crit Care Med 2020;24(11):1020-1027.
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Natural products such as plant extracts and complex microbial secondary metabolites have recently attracted the attention of scientific world for their potential use as drugs for treating chronic diseases such as Type II diabetes. Non-Insulin-Dependent Diabetes Mellitus (NIDDM) or Type II diabetes has complicated basis and has various treatment options, each targeting different mechanism of action. One such option relies on digestive enzyme inhibition. Almost all of the currently used clinically digestive enzyme inhibitors are bacterial secondary metabolites. However in most cases understanding of their complete biosynthetic pathways remains a challenge. The currently used digestive enzyme inhibitors have significant side effects that have restricted their usage. Hence, many active plant metabolites are being investigated as more effective treatment with fewer side effects. Flavonoids, terpenoids, glycosides are few to name in that class. Many of these are proven inhibitors of digestive enzymes but their large scale production remains a technical conundrum. Their successful heterologous production in simple host bacteria in scalable quantities gives a new dimension to the continuously active research for better treatment for type II diabetes. Looking at existing and new methods of mass level production of digestive inhibitors and latest efforts to effectively discover new potential drugs is the subject of this book chapter.
