scholarly journals Early Treatment of COVID-19 Pneumonia with Anakinra Guided by Urokinase Plasminogen Receptor

2021 ◽  
Author(s):  
Evangelos Giamarellos-Bourboulis ◽  
Evdoxia Kyriazopoulou ◽  
Garyfallia Poulakou ◽  
Haralampos Milionis ◽  
Simeon Metallidis ◽  
...  
Keyword(s):  
Early Recognition ◽  
Severe Disease ◽  
World Health ◽  
Clinical Progression ◽  
Urokinase Plasminogen Activator Receptor ◽  
Double Blind ◽  
Respiratory Dysfunction ◽  
Once Daily ◽  
Plasminogen Activator Receptor ◽  
Health Organization

Abstract Early recognition of risk and start of treatment may improve unfavorable outcome of COVID-19. In the SAVE-MORE double-blind randomized trial, 594 patients with pneumonia without respiratory dysfunction at risk as defined by plasma suPAR (soluble urokinase plasminogen activator receptor) ≥ 6 ng/ml were 1:2 randomized to subcutaneous placebo or 100 mg anakinra once daily for 10 days; 85.9% were co-administered dexamethasone. After 28 days, anakinra-treated patients were distributed to lower strata of the 11-point World Health Organization ordinal Clinical Progression Scale (WHO-CPS) (adjusted odds ratio-OR 0.36; 95%CI 0.26–0.50; P < 0.001); anakinra protected from severe disease or death (≥ 6 points of WHO-CPS) (OR: 0.46; P: 0.010). The median WHO-CPS decrease in the placebo and anakinra groups was 3 and 4 points (OR 0.40; P < 0.0001); the median decrease of SOFA score was 0 and 1 points (OR 0.63; P: 0.004). 28-day mortality decreased (hazard ratio: 0.45; P: 0.045) and hospital stay was shorter. (Sponsored by the Hellenic Institute for the Study of Sepsis ClinicalTrials.gov identifier, NCT04680949)

scholarly journals Significance of cutaneous manifestations of COVID-19

2021 ◽  
Vol 1 ◽  
pp. 5
Author(s):  
Malathi M ◽  
Devinder Mohan Thappa
Keyword(s):  
Early Recognition ◽  
Severe Disease ◽  
World Health ◽  
Disease Stage ◽  
Cutaneous Lesions ◽  
Cutaneous Manifestations ◽  
Diagnosis And Prognosis ◽  
Viral Particles ◽  
Tract Disease ◽  
Health Organization

The COVID-19 pandemic has brought the whole world to a grinding halt. With the pandemic still ongoing, it is worthwhile to recapitulate the cutaneous manifestations for dermatologists, their significance, and spectrum of COVID-19 disease. COVID-19 is a highly contagious respiratory tract disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first reported on December 1, 2019, from Wuhan, China and was declared a pandemic by the World Health Organization on March 11, 2020. COVID-19 indirectly involves the skin just like any other viral infection and is independent of the disease stage or severity. Cutaneous manifestations of COVID-19 may present a few days before or after the first general symptoms of the disease. The appearance of cutaneous manifestations before early respiratory symptoms can promote early recognition of COVID-19 in such cases. The pathophysiology of cutaneous lesions in COVID-19 is still unclear. It is attributed to immune dysregulation, vasculitis, vessel thrombosis, neogenesis, hypercoagulable states, or simple hypersensitivity in COVID-19. Endothelial swelling with the presence of SARS-CoV-2 viral particles in the endothelial cells has also been seen on electron microscopy. Thus, the clinical features indicative of viral exanthems/enanthems which can be found in other diseases therefore fail to provide specific clues for diagnosis and prognosis of COVID-19. On the other hand, vasculopathy-related skin manifestations may provide prognostic values by indicating severe complications due to COVID-19 and may help in monitoring disease severity. Early detection of cutaneous signs associated with severe disease is crucial to improve patient outcomes.

scholarly journals Men and COVID-19: A Pathophysiologic Review

2020 ◽  
Vol 14 (5) ◽  
pp. 155798832095402 ◽  
Author(s):  
Martin S. Lipsky ◽  
Man Hung
Keyword(s):  
Early Recognition ◽  
Severe Disease ◽  
Health Policies ◽  
World Health ◽  
Angiotensin Converting Enzyme 2 ◽  
Public Health Policies ◽  
Animal Data ◽  
The Common ◽  
Novel Coronavirus ◽  
Health Organization

Coronaviruses are single-stranded ribonucleic acid viruses that can cause illnesses in humans ranging from the common cold to severe respiratory disease and even death.In March 2020, the World Health Organization declared the 2019 novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the first pandemic. Compared to women, most countries with available data report that men with COVID-19 have greater disease severity and higher mortality. Lab and animal data indicate that men respond differently to the SARS-CoV-2 infection, offering possible explanations for the epidemiologic observations. The plausible theories underlying these observations include sex-related differences in angiotensin-converting enzyme 2 receptors, immune function, hormones, habits, and coinfection rates.In this review we examine these factors and explore the rationale as to how each may impact COVID-19. Understanding why men are more likely to experience severe disease can help in developing effective treatments, public health policies, and targeted strategies such as early recognition and aggressive testing in subgroups.

scholarly journals Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial

2021 ◽  
Author(s):  
Evdoxia Kyriazopoulou ◽  
Garyfallia Poulakou ◽  
Haralampos Milionis ◽  
Simeon Metallidis ◽  
Georgios Adamis ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Controlled Trial ◽  
Clinical Status ◽  
Serum Levels ◽  
World Health ◽  
Urokinase Plasminogen Activator Receptor ◽  
Double Blind ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Health Organization

AbstractEarly increase of soluble urokinase plasminogen activator receptor (suPAR) serum levels is indicative of increased risk of progression of coronavirus disease 2019 (COVID-19) to respiratory failure. The SAVE-MORE double-blind, randomized controlled trial evaluated the efficacy and safety of anakinra, an IL-1α/β inhibitor, in 594 patients with COVID-19 at risk of progressing to respiratory failure as identified by plasma suPAR ≥6 ng ml−1, 85.9% (n = 510) of whom were receiving dexamethasone. At day 28, the adjusted proportional odds of having a worse clinical status (assessed by the 11-point World Health Organization Clinical Progression Scale (WHO-CPS)) with anakinra, as compared to placebo, was 0.36 (95% confidence interval 0.26–0.50). The median WHO-CPS decrease on day 28 from baseline in the placebo and anakinra groups was 3 and 4 points, respectively (odds ratio (OR) = 0.40, P < 0.0001); the respective median decrease of Sequential Organ Failure Assessment (SOFA) score on day 7 from baseline was 0 and 1 points (OR = 0.63, P = 0.004). Twenty-eight-day mortality decreased (hazard ratio = 0.45, P = 0.045), and hospital stay was shorter.

scholarly journals Comparative Analysis of Pediatric COVID-19 Infection in Southeast Asia, South Asia, Japan, and China

2021 ◽  
Author(s):  
Judith Ju Ming Wong ◽  
Qalab Abbas ◽  
Soo Lin Chuah ◽  
Ririe Fachrina Malisie ◽  
Kah Min Pon ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Asia ◽  
Cultural Practices ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
World Health ◽  
Logistic Regression Models ◽  
Clinical Presentations ◽  
The Common ◽  
Health Organization

There is a scarcity of data regarding coronavirus disease 2019 (COVID-19) infection in children from southeast and south Asia. This study aims to identify risk factors for severe COVID-19 disease among children in the region. This is an observational study of children with COVID-19 infection in hospitals contributing data to the Pediatric Acute and Critical Care COVID-19 Registry of Asia. Laboratory-confirmed COVID-19 cases were included in this registry. The primary outcome was severity of COVID-19 infection as defined by the World Health Organization (WHO) (mild, moderate, severe, or critical). Epidemiology, clinical and laboratory features, and outcomes of children with COVID-19 are described. Univariate and multivariable logistic regression models were used to identify risk factors for severe/critical disease. A total of 260 COVID-19 cases from eight hospitals across seven countries (China, Japan, Singapore, Malaysia, Indonesia, India, and Pakistan) were included. The common clinical manifestations were similar across countries: fever (64%), cough (39%), and coryza (23%). Approximately 40% of children were asymptomatic, and overall mortality was 2.3%, with all deaths reported from India and Pakistan. Using the multivariable model, the infant age group, presence of comorbidities, and cough on presentation were associated with severe/critical COVID-19. This epidemiological study of pediatric COVID-19 infection demonstrated similar clinical presentations of COVID-19 in children across Asia. Risk factors for severe disease in children were age younger than 12 months, presence of comorbidities, and cough at presentation. Further studies are needed to determine whether differences in mortality are the result of genetic factors, cultural practices, or environmental exposures.

scholarly journals A PROSPECTIVE OBSERVATIONAL STUDY ON PATTERN OF ADVERSE DRUG REACTION TO ANTIBIOTICS COMMONLY PRESCRIBED IN THE HOSPITALIZED PEDIATRIC PATIENTS

2018 ◽  
Vol 11 ◽  
Author(s):  
Malarkodi Velraj,
Keyword(s):  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Early Recognition ◽  
Pediatric Population ◽  
Onset Time ◽  
World Health ◽  
Beta Lactams ◽  
Medication Information ◽  
Set Up ◽  
Health Organization

Objective: Antibiotics are the almost usually specified or authorized medication in hospitals, and antibiotics were found to be the almost bothersome classes of drugs providing or endowing to adverse drug reactions (ADRs). Therefore, the present study was conducted to check or regulate the precautions (ADRs) of antibiotics usually specified or authorized in the pediatrics unit. Methods: A potential, experimental, non-interventionist study was conducted or executed in the Department of Pediatrics for a time of 6 months to analyze the ADRs reported spontaneously from the hospital using patient statistics, objective and medication information, data of ADRs, onset time, causal drug details, outcome, and severity. Results: Among 72 ADRs observed, beta-lactams and quinolones were set up to be contributing the highest number of ADRs. The duct or abdominal system was the almost commonly affected organ, followed by respiratory system and the cardiovascular system. The assessment by the World Health Organization causation estimation scale demonstrated that 5.56% ADRs were certain, 55.56% were possible, 30.56% were probable, and 8.33% were unlikely. Conclusion: Thus, the pattern of ADRs occurring in the pediatric population was observed and assessed. Early recognition and management of ADRs are essential to reduce the burden of ADRs

scholarly journals SARS-CoV-2 ve İnfluenza Virüs Birlikteliği

2020 ◽  
Vol 25 (4) ◽  
pp. 457-463
Author(s):  
Figen Kaptan
Keyword(s):  
Severe Disease ◽  
World Health ◽  
Respiratory Syndrome Virus ◽  
Chinese City ◽  
Modes Of Transmission ◽  
The World ◽  
Influenza Transmission ◽  
Health Organization ◽  
Nonpharmaceutical Interventions ◽  
Improve Clinical Outcome

Severe acute respiratory syndrome virus 2 was initially identified in the Chinese city Wuhan on 29 December 2019. The infection has rapidly spread all over the world, and the World Health Organization declared the infection a pandemic on 11 March 2020. The disease, named coronavirus disease 19, has similar modes of transmission and clinical features with influenza, and coinfections have also been reported during the course of coronavirus disease 19. Studies have shown that the ratio of coinfections ranged widely among studies, and the clinical presentation in coinfections has varied from mild to severe disease leading to death. Detection of coinfection is important in order to plan the optimal treatment and improve clinical outcome. Studies reveal that nonpharmaceutical interventions such as social distancing and changes in population behavior implemented for coronavirus disease 19 have also reduced influenza transmission.

scholarly journals Maximising uptake and utilization of molecular diagnostics: lessons from implementation evaluation of tuberculosis diagnostics

2020 ◽  
Author(s):  
Nyanda Elias Ntinginya ◽  
Fred Orina ◽  
Ivan Mwebaza ◽  
Alphonce Liyoyo ◽  
Barbara Miheso ◽  
...  
Keyword(s):  
Molecular Diagnostics ◽  
Test Performance ◽  
Severe Disease ◽  
Healthcare Facility ◽  
World Health ◽  
Hospital Level ◽  
African Countries ◽  
Factors Affecting ◽  
Health Technologies ◽  
Health Organization

Abstract Background: Tuberculosis (TB), a treatable disease claims over a million lives every year. Accurate rapid diagnosis is crucial for early treatment initiation and prevention of severe disease. Despite over 10 years approval of molecular diagnostics for routine use, an estimated 3 million TB cases go undetected per year. We investigated the barriers and opportunities to maximise uptake and utilization of molecular diagnostics in routine healthcare settings. Methods: We deployed surveys, healthcare facility audits, focus group discussions, in-depth interviews, and policymaker dialogues to unravel factors affecting the uptake and utilization of TB molecular diagnostics in three East African countries. The benchmark was the World Health Organization approved Xpert MTB/RIF and Line Probe Assay (LPA) implemetation at district and regional hospital level respectively. Results: 190 district and county health officers participated in the survey. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policymaker engagement workshops. At 66% coverage, Xpert MTB/RIF fell behind microscopy and clinical diagnosis by 33% and 1% respectively across 190 districts/counties. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district-, regional- and national referral- hospital level. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) utilized it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA test performance was at level five HCFs. Underutilization of Xpert MTB/RIF and LPA was mainly attributed to inadequate- human resource, 22% and utilities, 26% respectively. Absence of the diagnostic services was attributed to under financing. Lack of awareness was second to underfinancing as reason underlying absence of LPA service. Creation of a health tax and decentralising collection and management of this tax to district/county level was proposed by policymakers as means to boost domestic financing for uptake of health technologies. Conclusion Our findings show higher uptake and utilization of molecular and other diagnostics at tertiary- than primary-secondary- level HCFs. Innovative implementation models to ensure quality access at lower level HCFs are urgently needed.

scholarly journals Analysis of SARS-CoV-2 genomes from across Africa reveals potentially clinically relevant mutations

2020 ◽  
Author(s):  
Modeline N. Longjohn ◽  
Olivia S. Egbule ◽  
Samuel O. Danso ◽  
Eugene E. Akujuru ◽  
Victor T. Ibubeleye ◽  
...  
Keyword(s):  
Vaccine Coverage ◽  
Phylogenetic Analyses ◽  
Severe Disease ◽  
Case Fatality ◽  
Climatic Conditions ◽  
Etiologic Agent ◽  
World Health ◽  
Sequence Alignments ◽  
Novel Coronavirus ◽  
Health Organization

AbstractSARS-CoV-2 is a betacoronavirus, the etiologic agent of the novel Coronavirus disease 2019 (COVID-19). The World Health Organization officially declared COVID-19 as a pandemic in March 2020 after the outbreak in Wuhan, China, in late 2019. Across the continents and specifically in Africa, all index cases were travel-related. Understanding how the virus’s transportation across continents and different climatic conditions affect the genetic composition and the consequent effects on transmissibility, infectivity, and virulence of the virus is critical. Thus, it is crucial to compare COVID-19 genome sequences from the African continent with sequences from selected COVID-19 hotspots/countries in Asia, Europe, North and South America and Oceania.To identify possible distinguishing mutations in the African SARS-CoV-2 genomes compared to those from these selected countries, we conducted in silico analyses and comparisons. Complete African SARS-CoV-2 genomes deposited in GISAID and NCBI databases as of June 2020 were downloaded and aligned with genomes from Wuhan, China and other SARS-CoV-2 hotspots. Using phylogenetic analysis and amino acid sequence alignments of the spike and replicase (NSP12) proteins, we searched for possible vaccine coverage targets or potential therapeutic agents. Identity plots for the alignments were created with BioEdit software and the phylogenetic analyses with the MEGA X software.Our results showed mutations in the spike and replicate proteins of the SARS-Cov-2 virus. Phylogenetic tree analyses demonstrated variability across the various regions/countries in Africa as there were different clades in the viral proteins. However, a substantial proportion of these mutations (90%) were similar to those described in all the other settings, including the Wuhan strain. There were, however, novel mutations in the genomes of the circulating strains of the virus in African. To the best of our knowledge, this is the first study reporting these findings from Africa. However, these findings’ implications on symptomatic or asymptomatic manifestations, progression to severe disease and case fatality for those affected, and the cross efficacy of vaccines developed from other settings when applied in Africa are unknown.

scholarly journals Ultrasound-Guided Pectoral Nerve Block With Tr Ansverse Thoracic Muscle Plane Block Enhanced World Health Organization on Quality of Life Brief Scale Scores 6 Months After M Odified Radical Mastectomy : A Randomized, Placebo-controlled and Double-Blind Clinical Trial

2021 ◽  
Author(s):  
Tianxiao Liu ◽  
Lina Chen ◽  
Min Shi ◽  
Weixin Dai ◽  
Jing Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
World Health Organization ◽  
Radical Mastectomy ◽  
World Health ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Thoracic Muscle ◽  
Health Organization

Abstract Background Modified radical mastectomy (MRM) has a large incision range and can cause strong intraoperative stress, a high incidence of postoperative acute pain, and chronic pain. There are few studies on the objective evaluation of the perioperative stress response by some stress-related serological indicators and on the long-term follow-up evaluation of postoperative quality of life and the incidence of chronic pain. This study aimed to evaluate the efficacy of ultrasound guided type Ⅰ Pecs block (Pecs Ⅰ), type Ⅱ Pecs block (Pecs Ⅱ) and transverse thoracic muscle plane block (TTP) on reducing CRP, IL-6, and WBC values during surgery and on enhancing World Health Organization on Quality of Life Brief Scale (QOL) scores 6 months after MRM.Methods The randomized, placebo-controlled and double-blind study was conducted in 76 patients assigned to two groups that received either ultrasound guided Pec Ⅰ + Pec Ⅱ +TTP block with 40 ml of 0.25% ropivacaine (group PT) or saline (group C). The primary outcomes were the changes in CRP, IL-6 and WBC values on the first day before surgery and the first and third days after surgery, the changes in blood glucose levels before and after surgery, and the QOL scores evaluated 6 months after surgery.Results The median (IQR) CRP, IL-6, and WBC values were significantly reduced in group PT on the first day compared with those in group C (12 (10-13.25) mg/l, 10.45 (9.575-11.65) pg/ml, 9 (7.75-9.25)×109/ l, vs 24 (20.75-26.25) mg/l, 25.35 (19.3-29.675) pg/ml, 12 (11-13) ×109/l, respectively, p< 0.001). The median (IQR) QOL was significantly higher in group PT 6 months after surgery than in group C (53(51.75-55) vs 43 (41-51.5), p< 0.001). The incidence of chronic pain was significantly lower, n/all was 4/33 vs 0/34, p< 0.001. Conclusions Ultrasound guided Pecs I, II and TTP block, significantly reduced the CRP, IL-6 and WBC values on the first day; increased the QOL scores and the incidence of chronic pain 6 months after surgery; and promoted the rapid recovery of patients.Trial registration: chictr.org.cn ChiCTR2000033275. Registered on 26 May 2020

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