Risk factors for the delayed viral clearance in COVID-19 patients

Time to recovery and its determinant factors among patients with COVID-19 in Assosa COVID-19 treatment center, Western Ethiopia

BACKGROUND

The Novel Coronavirus disease (COVID-19) pandemic has become a global threat. Determining the time to recovery from COVID-19 is intended to assist healthcare professionals in providing better care, and planning logistics. So, the study aimed to identify the factors that affect the time to recovery from COVID-19 for patients treated at Assosa COVID-19 treatment center, Benishangul Gumuz Regional State, Western Ethiopia.

METHODS

A retrospective study design was conducted on 334 randomly selected COVID-19 patients at Assosa COVID-19 treatment center from February 2021 to July 2021. The median survival time, Kaplan-Meier survival estimate, and Log-Rank test were used to describe the data and compare the survival time between groups. The study used the Cox PH model to analyze the time to the first recovery of COVID-19 patients, where hazard ratio, p-value, and 95% CI for hazard ratio were used for testing significance. Schoenfeld and Cox-Snell residuals were used for checking the model assumption.

RESULTS

The overall incidence rate was 13.79 per 100 (95% CI: 10.04, 18.95) person-days observations. The median time to recovery was 16 days. At the end of the follow-up, 77.2% of the patients had developed an event of recovery, and the rest 22.8% were censored. The mean age of patients was 45.22 years. Severe COVID-19 patients (AHR = 0.7876, 95% CI: 0.7090, 0.8748), presence of symptoms (AHR = 0.2814, 95% CI: 0.1340, 0.5914), comorbidity (AHR = 0.1627, 95% CI: 0.1396, 0.1897), ≥ 90 oxygen saturation (AHR = 3.2370, 95% CI: 2.161, 4.848), and being older age (AHR = 0.9840, 95% CI: 0.971, 0.9973) were found to have statistically significant association with the time to recovery from COVID-19.

CONCLUSION

The study concludes that severe COVID-19 patients, male patients, patients having comorbidity, older age, and patients having symptoms as poor prognostic factors of COVID-19 disease and also prolonged recovery time. Therefore, health providers in treatment centers should give strict follow-up and priority to older patients, severe COVID-19 patients, and patients having another co-morbid illness by focusing on respiratory difficulties and underlying pre-existing medical conditions to manage the disease severity and recover quickly.

SARS-CoV-2 neutralising antibody therapies: Recent advances and future challenges

The COVID-19 pandemic represents an unparalleled global public health crisis. Despite concerted research endeavours, the repertoire of effective treatment options remains limited. However, neutralising-antibody-based therapies hold promise across an array of practices, encompassing the prophylaxis and management of acute infectious diseases. Presently, numerous investigations into COVID-19-neutralising antibodies are underway around the world, with some studies reaching clinical application stages. The advent of COVID-19-neutralising antibodies signifies the dawn of an innovative and promising strategy for treatment against SARS-CoV-2 variants. Comprehensively, our objective is to amalgamate contemporary understanding concerning antibodies targeting various regions, including receptor-binding domain (RBD), non-RBD, host cell targets, and cross-neutralising antibodies. Furthermore, we critically examine the prevailing scientific literature supporting neutralising antibody-based interventions, and also delve into the functional evaluation of antibodies, with a particular focus on in vitro (vivo) assays. Lastly, we identify and consider several pertinent challenges inherent to the realm of COVID-19-neutralising antibody-based treatments, offering insights into potential future directions for research and development.

The effect of oseltamivir use in critically ill patients with COVID-19: A multicenter propensity score-matched study

Background

Oseltamivir has been used as adjunctive therapy in the management of patients with COVID-19. However, the evidence about using oseltamivir in critically ill patients with severe COVID-19 remains scarce. This study aims to evaluate the effectiveness and safety of oseltamivir in critically ill patients with COVID-19.

Methods

This multicenter, retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care unit (ICU). Patients were categorized into two groups based on oseltamivir use within 48 hours of ICU admission (Oseltamivir vs. Control). The primary endpoint was viral load clearance.

Results

A total of 226 patients were matched into two groups based on their propensity score. The time to COVID-19 viral load clearance was shorter in patients who received oseltamivir (11 vs. 16 days, p = 0.042; beta coefficient: -0.84, 95%CI: (-1.33, 0.34), p = 0.0009). Mechanical ventilation (MV) duration was also shorter in patients who received oseltamivir (6.5 vs. 8.5 days, p = 0.02; beta coefficient: -0.27, 95% CI: [-0.55,0.02], P = 0.06). In addition, patients who received oseltamivir had lower odds of hospital/ventilator-acquired pneumonia (OR:0.49, 95% CI:(0.283,0.861), p = 0.01). On the other hand, there were no significant differences between the groups in the 30-day and in-hospital mortality.

Conclusion

Oseltamivir was associated with faster viral clearance and shorter MV duration without safety concerns in critically ill COVID-19 patients.

Review of therapeutic mechanisms and applications based on SARS-CoV-2 neutralizing antibodies

COVID-19 pandemic is a global public health emergency. Despite extensive research, there are still few effective treatment options available today. Neutralizing-antibody-based treatments offer a broad range of applications, including the prevention and treatment of acute infectious diseases. Hundreds of SARS-CoV-2 neutralizing antibody studies are currently underway around the world, with some already in clinical applications. The development of SARS-CoV-2 neutralizing antibody opens up a new therapeutic option for COVID-19. We intend to review our current knowledge about antibodies targeting various regions (i.e., RBD regions, non-RBD regions, host cell targets, and cross-neutralizing antibodies), as well as the current scientific evidence for neutralizing-antibody-based treatments based on convalescent plasma therapy, intravenous immunoglobulin, monoclonal antibodies, and recombinant drugs. The functional evaluation of antibodies (i.e., in vitro or in vivo assays) is also discussed. Finally, some current issues in the field of neutralizing-antibody-based therapies are highlighted.

Association of underlying comorbidities and progression of COVID-19 infection amongst 2586 patients hospitalised in the National Capital Region of India: a retrospective cohort study

This study is conducted to observe the association of diabetes (DM), hypertension (HTN) and chronic kidney disease (CKD) on the prognosis and mortality of COVID-19 infection in hospital admitted patients with above mentioned comorbidities. This is a single centre, observational, retrospective study carried out at Sir Ganga Ram Hospital, Delhi, India. The burden of comorbidities on the prognosis and clinical outcome of COVID-19 patients admitted patients from April 8, 2020, to October 4, 2020. Chi-square and relative risk test were used to observe the association of comorbidities and disease prognosis. A total of 2586 patients were included in the study consisting of 69.6% of male patients. All the comorbidities were significantly associated with ICU admission and mortality. The relative risk showed that CKD is most prone to severity as well as mortality of the COVID-19 infection followed by HTN and DM. Further with the increase in number of underlying comorbidities, the risk of ICU admission and mortality also increases. Relative risk of the severity of COVID-19 infection in younger patients with underlying comorbidities are relatively at higher risk of severity of disease as well as to mortality compared to the elderly patients with similar underlying condition. Similarly, it is found that females are relatively at higher risk of mortality as compared to the males having same comorbid conditions except for the hypertensive patients. Diabetes, hypertension and CKD, all are associated with progression of COVID-19 disease to severity and higher mortality risk. The number of underlying comorbid condition is directly proportional to the progression of disease severity and mortality.

Admission Hyperglycemia as a Predictor of COVID-19 Pneumonia, Cytokine Release Syndrome Progression, and Clinical Outcomes in a Tertiary Care Hospital

Introduction Diabetes and coronavirus disease 2019 (COVID-19) are interrelated. The presence of hyperglycemia per se during COVID-19 infection regardless of diabetes status has been associated with poor prognosis and increased risk of mortality. Objectives The main aim of the current study was to assess the association between admission hyperglycemia and COVID-19 outcomes. Methods This is a retrospective cohort study including 315 patients, mainly employed in the facility, who presented to the emergency department or were admitted with confirmed COVID-19 infection from April 2020 to August 2021. Results The mean age of the studied cohort was 40.2±12.5 years, where 59.68% were males and 37.7% were symptomatic. Older age, male gender, history of diabetes and hypertension, and elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels were associated with a significantly increased risk of developing cytokine release syndrome (CRS). Admission hyperglycemia was significantly associated with poor outcomes. The time to negativity was 9.30±0.1 days for asymptomatic patients; however, it increased significantly according to clinical presentation, presence of comorbidities, and severe outcomes, in patients with cytokine release syndrome. Conclusions Admission hyperglycemia was associated with an increased risk of progression to critical condition in patients hospitalized with COVID-19 independent of the history of diabetes. Therefore, it should not be overlooked but instead should be detected and appropriately treated to improve outcomes. In addition, post-COVID-19 care should be individualized, where severe cases require almost double the time needed by mild cases to convert to negative.