scholarly journals Efficacy and Safety of Indomethacin in Covid -19 patients

Author(s):  
Rajan Ravichandran ◽  
Prasanna Purna ◽  
Sivakumar Vijayaraghavalu ◽  
Ravi Kalavakollu ◽  
Shilpa Gaidhane ◽  
...  

Background Indomethacin, a well-known non-steroidal anti-inflammatory drug (NSAID), with effective broad spectrum anti-viral activity, was evaluated for efficacy and safety of indomethacin in treating RT-PCR positive covid-19 patients Materials and Methods Patients with RT-PCR positive covid-19 who were admitted to hospital were offered the option to receive indomethacin 50 to 75mg daily in addition to the Indian council of medical research (ICMR) standard covid-19 treatment. Patients who declined the indomethacin option were offered paracetamol for pain and fever. The endpoint was the development of hypoxia. Secondary endpoints were time to become afebrile and time to resolution of cough and myalgia. Propensity Score Matching was used to compare indomethacin and paracetamol treatments. A separate group of severely ill patients who were admitted with hypoxia were treated with indomethacin 75mg; the endpoint was the requirement for mechanical ventilation or admission to the intensive care unit (ICU). Blood chemistry was collected before and after the treatment. The patients were monitored every day for clinical parameters. . Results A total of 104 patients received indomethacin, 82 with mild-moderate disease and 22 with severe disease. Matching reduced the number of patients to 72. In the indomethacin mild-moderate disease group, one patient out of 72 in the matched group developed hypoxia and required oxygen compared with 28 out of 72 patients in the matched group who received paracetamol. Patients who received indomethacin also experienced more rapid symptomatic relief compared to paracetamol arm. In the indomethacin severe disease group no patient deteriorated enough to require mechanical ventilation. There were no adverse reactions to indomethacin or deterioration of renal or liver function. Conclusion The use of indomethacin compared with paracetamol, in addition to the standard ICMR treatment in hospitalised covid-19 patients was associated with marked reductions in the severity and duration of illness, without any adverse effects.

2020 ◽  
Author(s):  
Rajan Ravichandran ◽  
Prassana Purna ◽  
Sivakumar Vijayaragavan ◽  
Ravi Teja Kalavakollu ◽  
Shilpa Gaidhane ◽  
...  

Abstract Background Indomethacin, a well-known non-steroidal anti-inflammatory drug (NSAID), has in addition broad spectrum anti-viral activity in the laboratory including on SARS-Cov-2 virus. This trial is to observe the likelihood of efficacy and safety of Indomethacin in treating RT-PCR positive Covid patients Materials and Methods The study was done in two groups. In the first group of the study, where mild and moderate patients were involved, Propensity Score Matching was used as a methodology to compare Indomethacin and paracetamol based treatments in addition to the standard protocol for treating covid-19 patients.. Blood chemistry was collected before and after the treatment. The patients were monitored every day for clinical parameters. In this part, a patient developing hypoxia was the end point. In the second group, severe patients admitted with hypoxia were treated with Indomethacin in addition to Remdesivir, and the end point was the requirement of mechanical ventilation/admission to ICU. Results It was observed that patients treated with Indomethacin had a reduction in the number of days to become afebrile, reduction in cough and myalgia by half compared to the paracetamol set. Only one out of 72 patients in the Indomethacin arm of the first group required supplementary oxygen while 28 of the 72 patients required supplementary oxygen in the paracetamol arm. No one in the second group deteriorated enough to require mechanical ventilation. There wea no evidence of adverse reaction to indomethacin or deterioration of renal or liver function. Conclusion Indomethacin, along with standard care, seems to provide faster symptomatic relief and prevent progression of pneumonia in Covid-19 patients. It should be considered to replace paracetamol when there is no contraindication for its use.


Author(s):  
Faizan Younus Shah ◽  
Ifrah Shafat Kitab ◽  
Aaqib Aslam Shah ◽  
Faisal Younis Shah ◽  
Mohd Younus Shah ◽  
...  

Background: Psoriasis affects nearly 1% of the world population. It can be a source of significant morbidity and psychological stress to the patient but is not lethal under ordinary circumstances. Patients suffering from the disease feel a lack of empathy on part of care-givers, family members, healthcare professionals as well as society in general. Dermatology life quality index (DLQI) is a questionnaire-based assessment of health related quality of life in patients suffering from skin disorders and has been seen to correlate well with the impact of the disease on a patient. This study was done to understand the impact of psoriasis on the overall well-being of patients using DLQI as the tool of assessment.Methods: The study included 40 cases of psoriasis that were assessed for the severity of the disease based on percentage body surface area involvement. The impact of disease severity and other factors on the quality of life of the patient was assessed using DLQI.Results: Out of 35 patients with BSA involvement <50% (mild and moderate disease), 28.6% (n=10/35) showed a very large or extremely large effect on the quality of life while no patient with a BSA involvement >50% (severe and very severe disease) reported the same. A small, moderate or no effect on the DLQI was seen in 71.4% (n=25/35) of cases from the mild and moderate disease group while 100% (n=5/5) of cases from severe and very severe disease group reported a similar effect. Thus, DLQI was not directly related to the extent of BSA involvement and was dependent on other factors as well.Conclusion: Age had a correlation with the effect of the disease on the quality of life of psoriasis cases. Patients who were younger were more likely to report stress and anxiety related to the recurrences seen with the disease. Patients with lesions on sites that are socially exposed like face, hands, scalp, etc. were more likely to feel embarrassed about their condition. Younger age, female gender, lesions on exposed sites and recently diagnosed patients (<12 months) were factors which had a significant impact on the health-related quality of life of patients. The severity of disease and extent of involvement were not always directly related to extent of impact on the quality of life.


2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Heba Wagih Abdelwahab ◽  
Shaker Wagih Shaltout ◽  
Ahmed Mohamed Fouda ◽  
Raed Elmetwally Ali ◽  
Nesrein M. Shalaby ◽  
...  

The pandemic of COVID-19 infection is rapidly progressing to one of the most severe threats to human health. The different responses of the immune system in females and males to a range of infectious and inflammatory stimuli were investigated. We aimed to explore the association of sex with the course of infection among the hospitalized COVID-19 patients. This Comparative cross-sectional study was conducted on RT- PCR positive COVID-19 patients. Severe and critical patients who required hospital or ICU admission were included in the study. The total number of patients was 150 (75 males and 75 females) with mean age of 57Y±14.7. There was a statistical significance in age between both groups [mean ± SD: males 60.5 (12.2), females 54 (15.3) (p=0:0.007)]. The prevalence of diabetes mellitus, hypertension, chronic kidney disease and ischemic heart disease was higher among males but without statistical significance. Consolidation was significantly more prevalent in female group (85.3% vs 61.3% in male group). The need of mechanical ventilation was higher in men, but with no statistical significance (44% Vs 32%, p=0.302). Also, mortality rate was higher (48%) in males than in females (37.3%), but with no statistical significance (p=0.262). During the COVID-19 infection, the risk factors of severe disease and progression to the need of mechanical ventilation support in addition to mortality rate are more prevalent among males. However, radiological patterns apart from consolidation, distribution of radiological abnormalities and CT severity score in both groups did not show significant sex difference.


Author(s):  
Tobias Herold ◽  
Vindi Jurinovic ◽  
Chiara Arnreich ◽  
Johannes C. Hellmuth ◽  
Michael von Bergwelt-Baildon ◽  
...  

The pandemic Coronavirus-disease 19 (COVID-19) is characterized by a heterogeneous clinical course. While most patients experience only mild symptoms, a relevant proportion develop severe disease progression with increasing hypoxia up to acute respiratory distress syndrome. The substantial number of patients with severe disease have strained intensive care capacities to an unprecedented level. Owing to the highly variable course and lack of reliable predictors for deterioration, we aimed to identify variables that allow the prediction of patients with a high risk of respiratory failure and need of mechanical ventilation Patients with PCR proven symptomatic COVID-19 infection hospitalized at our institution from 29th February to 27th March 2020 (n=40) were analyzed for baseline clinical and laboratory findings. Patients requiring mechanical ventilation 13/40 (32.5%) did not differ in age, comorbidities, radiological findings, respiratory rate or qSofa score. However, elevated interleukin-6 (IL-6) was strongly associated with the need for mechanical ventilation (p=1.2.10-5). In addition, the maximal IL-6 level (cutoff 80 pg/ml) for each patient during disease predicted respiratory failure with high accuracy (p=1.7.10-8, AUC=0.98). The risk of respiratory failure for patients with IL-6 levels of >; 80 pg/ml was 22 times higher compared to patients with lower IL-6 levels. In the current situation with overwhelmed intensive care units and overcrowded emergency rooms, correct triage of patients in need of intensive care is crucial. Our study shows that IL-6 is an effective marker that might be able to predict upcoming respiratory failure with high accuracy and help physicians correctly allocate patients at an early stage.


2019 ◽  
Vol 29 (6) ◽  
pp. 867-875
Author(s):  
Tarcisio A Reis ◽  
Daniele C Cataneo ◽  
Antônio Jose Maria Cataneo

Abstract OBJECTIVES Our goal was to evaluate, through a systematic review, the efficacy of plasmapheresis in the preoperative preparation of the patient for a thymectomy for the treatment of myasthenia gravis. METHODS MEDLINE, Embase, LILACS, Scopus and CENTRAL databases were searched. The following outcomes were evaluated: myasthenic crisis, mortality, pneumonia, bleeding, use of mechanical ventilation, length of hospital stay and intensive care unit (ICU) stay. RevMan 5.3 software provided by the Cochrane Collaboration was used for the meta-analysis. RESULTS The total number of patients evaluated in the 7 included studies was 360. Plasmapheresis during the preoperative period did not decrease the myasthenic crisis [risk ratio (RR) 0.36, 95% confidence interval (CI) 0.08–1.66; I2 = 44%; 5 studies, 243 patients]. There was also no change in the mortality rate (RR 0.7, 95% CI 0.11–4.62; I2 = 0%; 3 studies, 172 patients) or pneumonia cases (RR 0.28, 95% CI 0.07–1.09; I2 = 27%; 5 studies, 272 patients). Bleeding was greater in patients who underwent plasmapheresis (mean difference 34.34 ml; 95% CI 24.93–43.75; I2 = 0%). We evaluated the following outcomes: need for mechanical ventilation, hospital stay, ICU stay and mechanical ventilation, but these outcomes were not adequate to perform the meta-analysis due to the high heterogeneity among the studies. Subgroup analysis showed that plasmapheresis performed during the preoperative period in patients with severe disease (Osserman III and IV) decreased the myasthenic crisis postoperatively (RR 0.12, 95% CI 0.02–0.65; I2 = 63%). CONCLUSIONS Plasmapheresis may reduce the myasthenic crisis during the postoperative period in patients with severe disease but may produce little or no difference in patients with mild clinical expression of the disease.


2021 ◽  
Vol 15 (10) ◽  
pp. 2783-2786
Author(s):  
Ameenah Khan ◽  
Saira Ahmed ◽  
Khushboo Fatima ◽  
Usman Ali

Objective: To analyze CTSS score in clinically symptomatic COVID-19 patients having initial negative RT-PCR report. Design of the Study: It’s a retrospective cross sectional descriptive study. Study Settings: This study was carried out at Radiology Department, CMH Lahore from July to December 2021. Material and Methods: A total of 1000 patients presented with suspected clinical symptoms of covid-19. 770 were male patients (average of 52±15yrs) and 230 were female patients (49±15 years).Out of which 235 (23.5%) patients had initial negative PCR report & 765 patients had initial PCR positive report. 235 initial PCR negative patients got positive PCR report on subsequent repeat testing. All the patients underwent HRCT chest. Results of the Study: CTSS score of 765 PCR positive patients was determined as 545 (71.2%) having mild to moderate disease (<19.5 CTSS) and 220 (28.7%) as having severe disease (>19.5 CTSS).CTSS score of 235 PCR negative patients was determined on HRCT chest and classified as 210 (89.3%) having mild to moderate disease (<19.5 CTSS) and 25 (10.6%) as having severe disease (>19.5 CTSS). CO-RADS scoring were done and HRCT pattern analyzed in all the patients according to the standard protocol. Multivariate analysis was performed and showed significant correlation between CTSS score and initial PCR negative patients. Sensitivity and specificity of CT chest in determining covid-19 findings was 89.3% and 28.7%.PPV was 89.8% and NPV was 27.8%. Conclusion: HRCT with CTSS scoring is an important tool for diagnosis of COVID-19 infection despite initial negative PCR, having sensitivity and specificity of 89.3% and 28.7% respectively. Timely identification and isolation of COVID-19 patients is helpful in preventing the spread of infection and also aid in prompt symptomatic management. Keywords: COVID-19, Computed Tomography, Ground-Glass Opacity, Reverse Transcriptase Polymerase Chain Reaction.


2021 ◽  
Author(s):  
Aurema Otero González ◽  
Pierre Malchair ◽  
Jordi Giol ◽  
Xavier Solanich ◽  
Thiago Carnaval ◽  
...  

Abstract Background: COVID-19 has quickly become a global pandemic with a substantial number of deaths and a substantial burden for healthcare systems worldwide. Although most cases are paucisymptomatic and limited to the viral infection related symptoms, some patients evolve to a second phase, with an impaired inflammatory response (cytokine storm) that may lead to acute respiratory distress syndrome and death. This is thought to be caused by an increased bradykinin synthesis. Methods: ICAT-COVID is a multicenter, randomized, open-label, proof-of-concept phase II clinical trial assessing the clinical efficacy and safety of adding Icatibant on the standard of care in patients hospitalized with COVID-19 without invasive mechanical ventilation. Patients hospitalized with a confirmed COVID-19 pneumonia diagnosis (RT-PCR or antigen test ≤ 10 days prior to randomization, and radiographic evidence of pulmonary infiltrates), rated ‘4’ or ‘5’ on the WHO’s clinical status scale are eligible. Patients will be randomized on a 1:1 ratio to either standard of care-plus-Icatibant (experimental group) or to standard of care alone (control group). The experimental group will receive 30 mg of Icatibant subcutaneously 3 times a day for 3 days (for a total of 9 doses). The expected sample size is of 120 patients (60 per group) gathered from 2 centers in Spain. Primary outcomes are Icatibant’s efficacy and safety. The main efficacy outcome is the number of patients reaching grades ‘2’ or ‘1’ on the WHO Scale within 10 days of treatment start. Among the secondary outcomes are ‘long-term efficacy’: number of patients discharged who do not present any COVID-19-related relapse or comorbidity up until 28 days after discharging, and mortality. Discussion: Icatibant, a bradykinin type 2 receptor antagonist with proven effectiveness and safety against hereditary angioedema attacks, may be beneficial for COVID-19 patients by inhibiting bradykinin’s action on endothelial cells and by inhibiting the SARS-CoV-2 M protease. Our working hypothesis is that treatment with Standard of Care-plus-Icatibant is effective and safe to treat patients infected with SARS-CoV-2 admitted to hospital for pneumonia without invasive mechanical ventilation.Trial registration: EudraCT: 2020-002166-13; ClinicalTrials.gov: NCT04978051


2021 ◽  
Author(s):  
ravichandran rajan ◽  
Krishna Mohan Surapaneni ◽  
Suresh Kumar Sukumaran ◽  
Devakumar Kamaraj ◽  
Sumetha Suga Devisuga ◽  
...  

Abstract Background Indomethacin has shown to be a broad spectrum anti-viral agent apart from it being a non-steroidal anti-inflammatory drug (NSAID). This randomized clinical trial in a hospital setting is to evaluate the efficacy and safety of this drug in RT-PCR positive Covid patients. Materials and Methods RT-PCR positive Covid-19 patients, who gave the consent for the trial, were allotted to a control, or case, arm based on block randomization procedure. The control arm received the standard care consisting of paracetamol, ivermectin and other adjuvant therapy. The case arm had indomethacin instead of paracetamol, retaining the other medications. The endpoint was the development of hypoxia/desaturation. Secondary endpoints were time to become afebrile and time to resolution of cough and myalgia. The results of 210 patients were available at this point, with 102 patients in the indomethacin arm and 108 in the paracetamol arm. The complete patient profile along with everyday clinical parameters were monitored. Blood chemistry at the time of admission and discharge were also carried out. Results As no one required high-flow oxygen, desaturation with an SpO2 level of 93 and below was considered an important goal. In the indomethacin group, no one out of the 102 patients developed desaturation. On the other hand, 20 of the 108 patients in the paracetamol arm developed desaturation. Patients who received indomethacin also experienced more rapid symptomatic relief compared to those in the paracetamol arm, with most symptoms disappearing in half the time. A total of 56 patients out of 108 in the paracetamol arm had fever on the seventh day, while no one recorded fever in the indomethacin arm. No adverse event was reported in either arms. A fourteenth day follow up revealed that the paracetamol arm patients had several discomforts including myalgia, joint pain and tiredness while the indomethacin arm patients complained only of tiredness. Conclusion Indomethacin is a safe and effective drug for the treatment of mild and moderate Covid-19 patients.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1227.3-1228
Author(s):  
M. E. Tezcan ◽  
N. Şen ◽  
M. Yilmaz ◽  
Ö. Volkan ◽  
E. Tükel ◽  
...  

Background:Familial Mediterranean fever (FMF) is an auto inflammatory disease with recurrent attacks of serositis. Frequent attacks and disease related sequels may be associated with co-morbidities in FMF patients.Objectives:One of the tools for evaluating the FMF severity is the international severity scoring system for FMF (ISSF)1. This score includes disease related sequels, acute phase measurements, attack features and exertional leg pain. Therefore, more severe disease may be link with subclinical inflammation, amyloidosis and frequent, prolonged and widespread attacks. All these components may augment the frequency of non-disease related co-morbidities.Methods:We enrolled 158 FMF patients who fulfilled modifiedTel-HashomerDiagnosisCriteria2. The patients dichotomized based upon disease severity (mild disease or severe disease). Patients with ISSF scores lower or equal to 2 were accepted to have mild disease. Then, we compared frequency of non-disease related co-morbidities between the groups. These co-morbidities arehypertension, hypothyroidism, hyperthyroidism cardiovascular diseases, coronary artery diseases, cerebrovascular diseases, chronic renal disease (non-FMF related), chronic obstructive pulmonary diseases, and diabetes mellitus. This study was approved by the Local Research Ethics Committee and carried out in compliance with the Helsinki Declaration. All the patients gave written informed consent. P-value lower than 0.05 was considered as statistically significant.Results:Demographic features, disease duration, smoking history and body mass index (BMI) were similar between the groups. Frequency of co-morbidity in severe disease group was statistically higher than mild disease group (p=0.02). Most frequent co-morbidity was hypertension in both groups.Table.Features of mild and severe FMF groupsMild (n=135)Severe (n=23)pGender (M/F)47/8811/120.23Age36.4±11.336.5±14.30.68Smoking (%)38 (28.1)5 (21.7)0.52BMI (kg/m2)24.3±9.224.0±8.90.34Disease duration (year)7.7±11.38.6±14.30.09Amyloidosis (%)2 (1.4)3 (13.0)0.02Exon 10 homozygote (%)35 (25.9)9 (39.1)0.19Colchicine dosage (mg/day)1.2±0.41.4±0.50.02ISSF scores0.7 ±0.73.4±0.5<0.001Co-morbidity (%)25 (18.5)9 (39.1)0.02Conclusion:In our FMF patient cohort, we found that severity of the disease may be associated with higher frequency of co-morbidities. Therefore, clinicians should be aware of the high possibility of co-morbidities in patients with more severe FMF and addressed these co-morbidities timely and properly.References:[1]Demirkaya E, et al. Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF). Ann Rheum Dis 2016;75:1051-6.[2]Berkun Y, et al. Diagnostic criteria of familial Mediterranean fever. Autoimmun Rev 2014;13:388-90.Acknowledgments:NoneDisclosure of Interests:None declared


2021 ◽  
Vol 60 (4-5) ◽  
pp. 247-251
Author(s):  
Ameer Hassoun ◽  
Nessy Dahan ◽  
Christopher Kelly

The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.


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