Potential therapeutic options for COVID-19: an update on current evidence

SARS-CoV-2, a novel coronavirus, is the agent responsible for the COVID-19 pandemic and is a major public health concern nowadays. The rapid and global spread of this coronavirus leads to an increase in hospitalizations and thousands of deaths in many countries. To date, great efforts have been made worldwide for the efficient management of this crisis, but there is still no effective and specific treatment for COVID-19. The primary therapies to treat the disease are antivirals, anti-inflammatories and respiratory therapy. In addition, antibody therapies currently have been a many active and essential part of SARS-CoV-2 infection treatment. Ongoing trials are proposed different therapeutic options including various drugs, convalescent plasma therapy, monoclonal antibodies, immunoglobulin therapy, and cell therapy. The present study summarized current evidence of these therapeutic approaches to assess their efficacy and safety for COVID-19 treatment. We tried to provide comprehensive information about the available potential therapeutic approaches against COVID-19 to support researchers and physicians in any current and future progress in treating COVID-19 patients.

LESSONS AND NEW PERSPECTIVES: IS CONVALESCENT PLASMA THERAPY EFFECTIVE ON COVID-19 PATIENTS?

Objective: Recently, convalescent plasma (CP) therapy has shown promising evidence in the treatment of several serious contagious diseases, including SARS-CoV, Influenza and Ebola. We conducted a systematic review to extract data about using CP treatment for COVID-19 patients and it’s effectively. Methods: The retrieval of studies was conducted according to Cochrane Collaboration and from electronic databases including PubMed, Medline, and others (medRxiv and BioRxiv). Searching of the available evidence concerning CP treatment of COVID-19 patients was conducted in journal articles published between December 2019 and October 2020. The articles were further screened based on inclusion and exclusion criteria to identify the high-quality studies for analysis. Results: A total of 18 CP studies were included in this review. We found variance regarding the effectiveness of CP in the reduction of mortality rate, length of stay, and increased discharging rate. Several findings show CP therapy is effective in increasing viral negativity, neutralizing antibodies to recipients, does not cause harmful adverse reactions and in some cases can improve clinical symptoms. This therapy is presently considered effective for generating good clinical outcomes when given early in the course of the disease. Conclusion: The effectiveness of CP in terms of mortality, length of stay, and increased discharging patients is still debatable. However, CP therapy is effective in increasing the negativity of SARS-CoV-2 test, neutralizing antibody titer and is safe so it can be considered for COVID-19 patients. CP should not be given in the initial disease course but is recommended for the early disease course.

A Comparative Study of Efficacy of Miniature Punch Grafting and Platelet Rich Plasma Therapy in Treatment of Focal Stable Vitiligo in 50 Cases

Introduction: Vitiligo, a depigmented skin disorder is characterized by selective loss of melanocytes, which in turn leads to pigment dilution in the affected areas of the skin. The characteristic lesion is a totally amelanotic, non scaly, chalky white macule with distinct margins. If the disease is not progressing for the past one year it is described as stable vitiligo. There are various treatment options available for the treatment of focal stable vitiligo. It can be safely treated with miniature punch grafting as well as platelet rich plasma therapy. Aims and Objectives: Aim of this study is to compare efficacy of miniature punch grafting and platelet rich plasma therapy and to evaluate the outcome of treatment of focal stable vitiligo. Materials and Methods: Total 50 patients were selected and divided into two groups. One group was treated with miniature punch grafting while the other group underwent platelet rich plasma therapy. Pre-treatment and post treatment assessment was done by VASI (Vitiligo area scoring index) score. Result: A total of 25 patients were selected for grafting. Perigraft pigmentation was evident from 3rd week of grafting steadily increasing up to the end point of record i.e 6months. 17 patients showed good response, 4 patients showed average response while 4 patients showed poor or no response at all. Out of the 25 patients taken for platelet rich plasma therapy, 7 patients showed good response, 7 patients showed average response while 11 patients showed poor or no response at all. Conclusion: Miniature punch grafting showed better response as compared to platelet rich plasma therapy but both the therapies have their pros and shortcomings. Keywords: Vitiligo, miniature punch grafting, platelet rich plasma, VASI.

Efficacy and safety of convalescent plasma therapy for severe COVID-19 patients：case series study and literature review

Background Coronavirus disease 2019 (COVID-19) is a new acute respiratory infectious disease which can lead to multiple organ dysfunction in severe patients. However, it is still a lack of effective antiviral drugs for COVID-19. Herein we investigated the efficacy and safety of convalescent plasma (CP) in the treatment of severe COVID-19, with an attempt to explore new therapeutic method. Methods Clinical data of three imported severe COVID-19 patients with CP treatment, who were under quarantine and treated in a designated COVID-19 hospital from March 2020 to April 2020, were collected and analyzed. Results The three patients were clinically classified as severe type, including one male and two females, aged 57, 59 and 65 years old, respectively. The main underling diseases included hypertension, diabetes, sequela of cerebral infarction and postoperative thyroid adenoma. The common symptoms included cough, fever and short of breath. All the patients received antiviral drugs and other supportive treatments. Additionally, CP treatment was also administrated for them. Forty-eight to seventy-two hours after CP transfusion, all the patients improved with alleviated symptoms, elevated arterial oxygen saturation, decreased C-reactive protein and interleukin-6 markers. And the total lymphocytes, T lymphocytes (CD3+) and their subsets (CD4+, CD8+) also obviously increased. Repeated chest CTs also showed obvious absorption of lesions in bilateral lung. Only one patient had mild allergic reaction during CP infusion, but no severe adverse reactions were found. Conclusions The early application of CP for severe COVID-19 patients can improve the condition rapidly, and the therapy is generally effective and safe.

COMPREHENSIVE PREOPERATIVE APPROACH AND ENDOVENOUS ELECTRIC WELDING IN THE TREATMENT OF CHRONIC VENOUS INSUFFICIENCY C6 CLINICAL CLASS

The evaluation was done in the sphere of preoperative preparation trophic ulcer in patients with CVI using the proposed tactics of mechanochemical debridement and elimination of vertical venous reflux EVEZ method, in comparison with standard preoperative management tactics and EVLT of saphenous veins. It is established that the proposed tactics of preoperative preparation are more effective than classical approaches. Purpose. The use of the EVEZ method in combination with the proposed preoperative preparation of trophic ulcers in the treatment of CVI was determined to be effective. Materials and methods. An analysis of the treatment of 68 patients with CVI C6 clinical class was performed. The patient of the main group received the EVEZ treatment tributaries and perforating veins with preoperative trophic preparation ulcers, which includes: active mechanochemical debridement and control moisture balance in the wound, installation of negative pressure wound therapy system, platelet rich plasma therapy, application drugs based on diosmin and hesperidin. The proposed scheme of preoperative preparation has the following algorithm: Taking a smear from the sore to determine the bacterial spectrum and subsequent rational antibacterial therapy following the results of the antibioticogram; Active mechanochemical debridement with solutions of 0.1% polyaminopropyl biguanide + 0.1% surfactant, povidone-iodine + ethanol + glycerin + laureate 9 and control of moisture balance in the wound with modern hydrogel sore dressings; Installation of VAC system with a constant negative pressure of 120 mm Hg for 3 days for the first 3 performances of the system. Subsequently, VAC therapy was performed in a constant mode with a pressure of 80-120 mm Hg. in patients with insufficient wound cleanliness; After active cleaning, PRP therapy was performed, which involves the introduction of platelet-enriched plasma along the edge of the wound to a depth of 3 to 5 mm. The amount of PRP used depended on the size of the defect and ranged from 1 to 2 ml. All patients of the main group underwent correction of concomitant pathology with systemic use of capillary stabilizing drugs based on diosmin / hesperidin. Patients in the comparison group received standard preoperative preparation and EVLT. Patients of both groups were outpatient for 6 months. 39 of them (57.35%) were women and 29 (42.65%) were men aged 36 to 78 years. The duration of ulcers ranged from 3 months to 7 years. The following localization of venous trophic ulcers was observed: in the area of the medial bone - in 49 (72%) patients, 10 (14.7%) - on the anterior surface, 9 (13.3%) - on the lateral, posterior, anterior medial or anterolateral surface of the tibia. Results. Tactics of preoperative preparation that is offered allowed to achieve: reduction of redness and swelling in the main group on 7.3 ± 0.8 days (comparison group 10.2 ± 0.7 days); complete cleaning of the wound from fibrin and necrotic tissues at 9.1 ± 0.5 days (15.0 ± 1.1); the appearance of granulation tissues at day 12.6 ± 0.9 (18 ± 0.7); the appearance of marginal epithelialization at 15.3 ±0.7 days (20 ± 1.1). Conclusions. The proposed tactics can reduce the term by 1.7 times the preparation of the ulcer for surgery and 1.6 times the healing time of ulcers. The EVEZ method allows performing ablation efficiently and safely trunk great saphenous vein. The use of phlebotonic drugs, which is called Normoven, allows you to accelerate the healing of ulcers and prevent their recurrence.

Spontaneous alveolo-pleural fistula in a case of COVID-19 pneumonia-challenges and solutions: case report

COVID-19 pneumonia has demonstrated a wide spectrum of clinical presentations that have yet to be completely uncovered. As this pandemic progresses, uncommon presentations of this disease have come into light. Development of broncho/alveolo-pleural fistula in a patient with COVID-19 pneumonia is a rare phenomenon with only 4 cases reported in literature till date. A 61-year-old gentleman presented to the emergency department with fever, cough, and shortness of breath. His initial chest X-ray was suggestive of a viral pneumonia that was later confirmed to be due to COVID-19. The patient was put on non-invasive ventilator support and treated with empirical antibiotics, glucocorticoids, anti-viral medications and convalescent plasma therapy. Four weeks into the patient’s hospital course, his vital parameters suddenly deteriorated with a subsequent chest X-ray showing a tension pneumothorax, for which a chest tube insertion was done. However, when the air leak did not resolve by the 3rd day, a chest computed tomography (CT) was planned which showed a spontaneous alveolo-pleural fistula (APF). The patient was managed with conservative treatment using negative suction applied to an underwater seal, had his chest tube removed 10 days later and was discharged subsequently. Spontaneous fistulisation between broncho-alveolar tree and pleura can occur rarely in patients with COVID-19 pneumonia and can be managed using underwater seal with negative suction, insertion of endobronchial valves or surgical closure, and needs to be individualised.

Convalescent Plasma Therapy: The Early Use in Moderate to Severe COVID-19 Patients in Hospitals with Limited Resources

COVID-19 cases in Indonesia in the period of June-July 2021 showed a catastrophic spike. During this period, a recently discovered variant, the delta variant, appeared to be one of the sources of COVID-19 infection. Treatment modalities are limited due to reduced stock of drugs. A case of a 63-year-old man has been reported, with a history of having been vaccinated with two doses of Sinovac, experiencing moderate-to-severe symptoms of COVID-19 infection then given convalescent plasma therapy since his initial admission to the hospital. Three days after being given convalescent plasma therapy, the improvement was noticeable. Shortness of breath, cough, fever, and weakness were less complained. On the seventh day the patient fully recovered and got discharged. Convalescent plasma therapy was e ective in early stage and was able to improve outcomes. Indonesia needs sucient stocks of convalescent plasma as a therapy to overcome the limitations of medicines.

The mechanism of action of platelet-rich plasma – composition analysis and safety assessment

Aesthetic medicine is an intensively developing field, more and more focused on stimulating and regenerating the skin, rather than on emergency treatment. There are many methods used by doctors for biostimulating therapies, but the most popular procedure in recent years is the implantation of platelet-rich plasma (PRP) used to date successfully in ophthalmology, dermatology, surgery, dentistry and even in orthopedics. The procedure uses autologous material, and its essence is a repair action on damaged cells of the patient as well as the activation of healthy cells and their stimulation for more effective work. The aim of the paper is to present current knowledge about platelet-rich plasma therapy in anti-aging treatment, the effectiveness of therapy with its use, and the mechanism and safety of PRP. The composition of the autologous preparation and its use in aesthetic medicine were also analyzed. PRP is a procedure that uses the patient’s own cells, and growth factors are of key importance in the process of skin regeneration and biostimulation. The correctly performed procedure, including the appropriate collection and administration of a buffy coat to the patient and compliance with all the rules of sterility, results in positive effects of the therapy. Numerous studies prove the effectiveness and safety of the platelet-rich plasma treatment. Highly concentrated platelets in the deposited preparation stimulate the surrounding cells to angiogenesis, differentiation, proliferation and synthesis of components essential for remodeling of the treated area. The therapy is highly effective and safe to use.

CONVALESCENT PLASMA TRANSFUSION FOR THE TREATMENT CRIMEAN-CONGO HEMORRHAGIC FEVER (REVIEW)

Проведен анализ литературных данных о применении плазменной терапии при лечении Конго-Крымской геморрагической лихорадки в мире. Данный обзор проведен для оценки эффективности плазменной терапии у пациентов с Конго-Крымской геморрагической лихорадкой на основе научных данных, опубликованных до настоящего времени. В последние годы отмечается определенный интерес к изучению плазменной терапии при лечении пациентов с Конго-Крымской геморрагической лихорадкой, хотя в литературе имеются лишь ограниченные данные по эффективности иммунотерапии и применения рибавирина при Конго-Крымской геморрагической лихорадке, при этом действенность рибавирина остается еще не доказанной. Однако можно предположить, что помимо противовирусных препаратов, применение плазменной терапии у больных с Конго-Крымской геморрагической лихорадкой может быть эффективным способом лечения, улучшающим клинические симптомы у пациентов, прогноз и снижающим смертность. The analysis of the literature data on the using of plasma therapy in the treatment of Congo-Crimean hemorrhagic fever was carried out. This review was conducted to evaluate the effectiveness of plasma therapy in patients with Congo-Crimean hemorrhagic fever on the basis of publications published so far. In recent years, there has been some interest in studying plasma therapy in the treatment of patients with Congo-Crimean hemorrhagic fever, although there are only limited data in the literature on the effectiveness of immunotherapy and the use of ribavirin in therapy, while the effectiveness of ribavirin remains not yet proven. However, it can be assumed that in addition to antiviral and antibacterial drugs, the use of plasma therapy in patients with Congo-Crimean hemorrhagic fever can be an effective treatment method that improves clinical symptoms in patients and reduces mortality.