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Esmaeili A, Niazkhani Z, Makhdoomi K, Mohebbi I, Aghazadeh-Attari J, Hassani E, Mousavi SJ, Gharebaghi N, Nejadrahim R, Mirza-Aghzadeh M, Esmaeili A, Cheshmekaboodi M, Nader-Babaei Y, Pirnejad H. Potential drug-drug interactions in a multi-center study of death cases of COVID-19: The significance of appropriate drug choice. Int J Clin Pharmacol Ther 2023; 61:531-542. [PMID: 37877293 DOI: 10.5414/cp204469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVES The prevalence, types, severity, risk ratings, and common pairs of involved drugs, and the most important potential drug-drug interactions (pDDIs) in coronavirus disease 2019 (-COVID-19) deceased cases were evaluated. MATERIALS AND METHODS We reviewed the medical records of 157 confirmed COVID-19 deceased cases hospitalized in 27 province-wide hospitals. Patients' demographics and clinical data (including comorbidities, vital signs, length of in-hospital survival, electrocardiograms (ECGs), medications, and lab test results) were extracted. The online Lexi-interact database and Stockley's drug interactions reference were used to detect pDDIs retrospectively. The QTc interval and total Tisdale risk score were also calculated. Descriptive analysis, analysis of variance, Fisher exact test, and multivariate analysis were conducted for data analysis. RESULTS Of 157 study cases, 63% were male, had a mean age of 68 years, and 55.7% had one or more underlying diseases. All patients had polypharmacy, with 69.2% having ≥ 15 drugs/day. We detected 2,416 pDDIs in patients' records, of which 658 (27.2%) were interactions with COVID drugs. Lopinavir/ritonavir among -COVID drugs and fentanyl among non-COVID drugs were commonly involved in the interactions. pDDIs was significantly higher in the polypharmacy group of ≥ 15 medications (p < 0.001). A majority (83%) had received drug(s) with the QTc prolongation effect, of whom 67% had actual QTc prolongations in their ECGs. The regression analysis showed that by increasing 6.7% in polypharmacy, one day increase in-hospital survival can be expected. Moreover, an increase of 2.3% in white blood cells or 10.5% in serum potassium level decreased in-hospital survival by 1%. CONCLUSION The findings underscored the importance of careful drug choice, especially in the hectic search for early treatments in pandemics of novel diseases. Close monitoring of patients' drug choice is warranted for reducing pDDIs and their adverse effects in any new disease outbreak.
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Barania Adabi S, Daneghian S, Khalkhali H, Nejadrahim R, Shivappa N. The association between inflammatory and immune system biomarkers and the dietary inflammatory index in patients with COVID-19. Front Nutr 2023; 10:1075061. [PMID: 37063325 PMCID: PMC10103612 DOI: 10.3389/fnut.2023.1075061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/07/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundInflammation and cytokine storm have been reported to be the main cause of acute symptoms of coronavirus disease (COVID-19). Diet-induced inflammation may affect the condition of patients with COVID-19. Therefore, this study aimed to investigate the relationship between disease severity, inflammatory and immune system biomarkers, and the dietary inflammatory index (DII) in patients with COVID-19.MethodsThis cross-sectional study was conducted on 500 adult patients with COVID-19. Patients were divided into mild, moderate, and severe conditions based on clinical and laboratory evidence. A validated food frequency questionnaire (FFQ) was used to determine DII and energy-adjusted DII (E-DII) scores. The serum C-reactive protein (CRP) level and blood cell count were measured for all patients. Multiple linear regression was used to explore the association between DII and E-DII and CRP, blood cell counts, and hospitalization in patients with COVID-19.ResultsCoronavirus disease (COVID-19) patients with higher DII had higher consumption of fat and carbohydrate and lower intakes of protein, anti-inflammatory nutrients, garlic, caffeine, tea, onion, and fiber (P < 0.05). There was a positive association between DII and CRP (β = 1.024, P < 0.001), hospitalization (β = 1.062, P < 0.001), WBC count (β = 0.486, P < 0.009), neutrophil count (β = 0.565, P < 0.001), and neutrophil-to-lymphocyte ratio (β = 0.538, P < 0.001) and a negative association between DII and the lymphocyte count (β = −0.569, P < 0.001). There was a positive association between E-DII and hospitalization (β = 1.645, P < 0.001), WBC count (β = 0.417, P < 0.02), and neutrophil-to-lymphocyte ratio (β = 0.35, P < 0.03).ConclusionThere is a positive correlation between DII and inflammation, immune hyperactivation, and length of hospital stay in patients with COVID-19. Further longitudinal studies are necessary.
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Affiliation(s)
- Somayyeh Barania Adabi
- Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Nutrition, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Sevana Daneghian
- Department of Nutrition, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
- *Correspondence: Sevana Daneghian
| | | | - Rahim Nejadrahim
- Department of Infectious Diseases and Dermatology, Urmia University of Medical Sciences, Urmia, Iran
| | - Nitin Shivappa
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Diba K, Makhdoomi K, Nejadrahim R, Namaki A. P183 Monitoring of candida colonization in the respiratory tract of COVID-19 cases. Med Mycol 2022. [PMCID: PMC9494494 DOI: 10.1093/mmy/myac072.p183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Opportunistic yeasts potentially cause infection or colonization in the lower respiratory tract. Candida albicans is a common agent of yeast infections but other yeasts such as non-albicans Candida are important as resistant fungi to antifungal drugs. The predisposing factors for the overgrowth and invasion by Candida species include corticosteroid therapies, long-time hospitalization, antibiotic therapies, and primary infections by Mycobacterium tuberculosis and viral agents. The screening of Candida colonization in the lower respiratory tract of the cases with a history of COVID-19 was performed in this study at a great training hospital in Northwest of Iran. Methods During the pandemic COVID-19, about 445 cases with severe COVID-19 hospitalized and used dexamethasone were investigated for Candida infections and colonization by the laboratory data of Medical Mycology Center, UMS University, Urmia, Iran. Our subjects were sputum, bronco-alveolar and bronchial specimens. Candida elements including pseudo-hypha and blasto-spores microscopically were investigated. Differential cultures and PCR-RFLP were used for the identification of Candida yeasts at the level of species. Results Totally, 54 yeast overgrowth was detected in the clinical specimens including Candida albicans 28 (51.8%), non-albicans Candida species 24 (44.4%) and a case of Pneumocystis jirovecci. All of the cases with Candida detections were Covid-19 positive. Moreover, two cases of rhino-cerebral Mucomycosis, two cases of TB, two cases of asthma, and one case of cystic fibrosis were included. Conclusion As a conclusion, Fungi especially Candida yeasts be considered as the potential pathogens in cases with a history of severe COVID-19 and corticosteroid therapy during stay at the hospital.
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Affiliation(s)
- Kambiz Diba
- School of Medicine , Urmia University of Medical Sciences, Urmia , Iran
| | - Khadige Makhdoomi
- Khomeini Training Hospital , Urmia University of Medical sciences, Urmia , Iran
| | - Rahim Nejadrahim
- Taleqani Training Hospital , Urmia University of Medical sciences, Urmia , Iran
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Diba K, Samarei R, Nejadrahim R, Namaki A. P182 Mucormycosis in Northwest Iranian cases with a history of delta COVID-19, a brief report. Med Mycol 2022. [PMCID: PMC9494501 DOI: 10.1093/mmy/myac072.p182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Mucoral fungi are the opportunistic organisms causing invasive or localized infections in persons with conditions such as diabetes mellitus, immune suppression, and corticosteroid therapy. During the recent surge of delta-type Coronavirus disease 2019 (COVID-19) in Iran, the rate of invasive mucormycosis considerably increased as a cluster in society. COVID-19-associated mucormycosis (CAM) immerged as a severe and life-threatening infection. The present report includes demographic, clinical and laboratory diagnostic information about newly emerged CAM in Northwest of Iran. Methods During three months, from August to October 2021, about 65 cases with clinical manifests suspected of mucormycosis and a history of recent severe COVID-19 and corticosteroid therapy with dexamethasone were studied. Clinical specimens obtained from sinuses and upper respiratory tract, transported to Clinical Mycology Center, UMS University, Urmia, Iran for the detection of and molecular identifications of mucoral and other agents. Our subjects were the clinical specimens including 31 nasal biopsies, 24 paranasal sinus biopsies, 2 facial and palate biopsies, skin and sutures, one each. Also, two samples of bronco-alveolar lavage were used for investigating fungi in the respiratory tract. Results More than 52% of the patients were men and the most frequent age range was 50-60 years. Most frequent clinical specimens were sent from ENT wards and ICUs, 22 (33.8%) and 12 (18.5%) respectively. Among all confirmed cases of CAM, 18 (27.7%) suffered from a background of diabetes but 46 (70.8%) had no underlying diseases. Our findings of direct examination showed 55 (84.6%) mucoral elements. The suspected cases of CAM showed clinical manifests including acute sinusitis, rhino-sino-cerebral 25 (38.5%), rhino-sino-orbital 7 (10.8%), and sino-facial 3 (4.6%), involvements. The culture and identification resulted in Rhizopus oryzae as the most frequent isolate (44.6%) and Candida yeasts (albicans and non-albicans Candida species) 6.2%-7.7% respectively. Aspergillus species were detected 5 (7.7%) as well. A considerable number of cultures, 20 (30.8%) could result no growth for any fungi. Conclusion As a conclusion, delta-type Coronavirus causing a considerable increased invasive Mucormycosis in the recorded COVID-19 cases in the north west of Iran. Although, opportunistic candida and aspergillus were identified in lower frequencies as well.
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Affiliation(s)
- Kambiz Diba
- School of Medicine , Urmia University of Medical Sciences, Urmia , Iran
| | - Reza Samarei
- Khomeini Training Hospital , Urmia University of Medical sciences, Urmia , Iran
| | - Rahim Nejadrahim
- Taleqani Training Hospital , Urmia University of Medical sciences, Urmia , Iran
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Elieh Ali Komi D, Rahimi Y, Asghari R, Jafari R, Rasouli J, Mohebalizadeh M, Abbasi A, Nejadrahim R, Rezazadeh F, Shafiei-Irannejad V. Investigation of the Molecular Mechanism of Coagulopathy in Severe and Critical Patients With COVID-19. Front Immunol 2021; 12:762782. [PMID: 34975853 PMCID: PMC8716500 DOI: 10.3389/fimmu.2021.762782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/26/2021] [Indexed: 01/22/2023] Open
Abstract
Coagulopathy is a frequently reported finding in the pathology of coronavirus disease 2019 (COVID-19); however, the molecular mechanism, the involved coagulation factors, and the role of regulatory proteins in homeostasis are not fully investigated. We explored the dynamic changes of nine coagulation tests in patients and controls to propose a molecular mechanism for COVID-19-associated coagulopathy. Coagulation tests including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FIB), lupus anticoagulant (LAC), proteins C and S, antithrombin III (ATIII), D-dimer, and fibrin degradation products (FDPs) were performed on plasma collected from 105 individuals (35 critical patients, 35 severe patients, and 35 healthy controls). There was a statically significant difference when the results of the critical (CRT) and/or severe (SVR) group for the following tests were compared to the control (CRL) group: PTCRT (15.014) and PTSVR (13.846) (PTCRL = 13.383, p < 0.001), PTTCRT (42.923) and PTTSVR (37.8) (PTTCRL = 36.494, p < 0.001), LACCRT (49.414) and LACSVR (47.046) (LACCRL = 40.763, p < 0.001), FIBCRT (537.66) and FIBSVR (480.29) (FIBCRL = 283.57, p < 0.001), ProCCRT (85.57%) and ProCSVR (99.34%) (ProCCRL = 94.31%, p = 0.04), ProSCRT (62.91%) and ProSSVR (65.06%) (ProSCRL = 75.03%, p < 0.001), D-dimer (p < 0.0001, χ2 = 34.812), and FDP (p < 0.002, χ2 = 15.205). No significant association was found in the ATIII results in groups (ATIIICRT = 95.71% and ATIIISVR = 99.63%; ATIIICRL = 98.74%, p = 0.321). D-dimer, FIB, PT, PTT, LAC, protein S, FDP, and protein C (ordered according to p-values) have significance in the prognosis of patients. Disruptions in homeostasis in protein C (and S), VIII/VIIIa and V/Va axes, probably play a role in COVID-19-associated coagulopathy.
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Affiliation(s)
- Daniel Elieh Ali Komi
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Yaghoub Rahimi
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Asghari
- Hematology, Immune Cell Therapy, and Stem Cells Transplantation Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Reza Jafari
- Hematology, Immune Cell Therapy, and Stem Cells Transplantation Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
- Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Rasouli
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mehdi Mohebalizadeh
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Ata Abbasi
- Department of Pathology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Nejadrahim
- Department of Infectious Diseases, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Farzin Rezazadeh
- Department of Emergency Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Vahid Shafiei-Irannejad
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
- *Correspondence: Vahid Shafiei-Irannejad,
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Gharebaghi N, Farshid S, Boroofeh B, Nejadrahim R, Mousavi J, Dindarian S, Mohammadi S. Evaluation of epidemiology, clinical features, prognosis, diagnosis and treatment outcomes of patients with COVID-19 in West Azerbaijan Province. Int J Clin Pract 2021; 75:e14108. [PMID: 33626210 PMCID: PMC7995141 DOI: 10.1111/ijcp.14108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/08/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 is considered a widespread concern in global public health. Diagnoses of COVID-19 in some cases are necessary because of severe prognosis. In this study, epidemiologies, clinical and demographic characteristics of patients with COVID-19 were studied in Taleghani Hospital, Urmia, Iran. METHODS This descriptive-analytical cross-sectional study was carried out on 215 patients with COVID-19 during March and April 2020. Approved COVID-19 case was considered as a person with a positive respiratory sample performed by at least one of two RT-PCR methods or genetic sequencing. ANOVA repeated measure, independent t-test and logistic regression were done. A P < .05 was considered significant. RESULTS The mean age of patients was 50.93 ± 17.92 years. Regarding gender, there were 91 females (42.3%) and 124 males (57.7%). The mean hospital stay, the temperature at admission, and onset of symptoms were 4.91 ± 3.68 days, 37.40 ± 0.96°C and 5.88 ± 4.80 days, respectively. Close contact with suspected people was found in 10.2% of patients. Additionally, 44 patients (20.5%) were smokers. Shortness of breath and cough were found in 62.8% and 49.3% of patients. Diabetes mellitus and hypertension were the most common comorbidities of patients. Regarding lung involvement, 33 patients (33%) were normal, most of the patients (n = 71) had 5%-25% involvement in their lung and a minority of patients (n = 13) had a severe condition of 50%-75% lung involvement. The association between smoking and mortality was tested using chi-square showing no significant difference (X2 :2.959, P = .085). There was no significant difference between AST, ALT, ALP, total, direct Bilirubin, lung involvement and suffering from fever (P > .05). High Spo2 can increase the chance of recovery by 24% with each unit reduction. Kidney involvement increases the chance of death by about 80% (95% CI: 0.104-0.013). The odds ratio of spo2 for recovery of COVID-19 was 1.24 (95% CI: 1.014-1.528; P = .037). Kaletra with odds ratio of 31.960 had the most highest effect on recovery following COVID-19 (P = .043). CONCLUSION COVID-19 involves different organs of the body with different severity. In the meantime, smoking was not a risk factor for the virus or associated with severe manifestations of the disease. Patients with high creatinine and CPK, pulmonary involvement above 25%, and hypoxemia had a higher mortality rate. Increase of Spo2 by 1% can improve the patients by 24%. The results indicated that Kaletra had the most highest effect on improvement following COVID-19.
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Affiliation(s)
- Naser Gharebaghi
- Department of Infectious Diseases and DermatologyUrmia University of Medical SciencesUrmiaIran
| | - Saman Farshid
- Department of Urology and NephrologyUrmia University of Medical SciencesUrmiaIran
| | - Behdad Boroofeh
- Department of PulmonologyUrmia University of Medical SciencesUrmiaIran
| | - Rahim Nejadrahim
- Department of Infectious Diseases and DermatologyUrmia University of Medical SciencesUrmiaIran
| | - Jalil Mousavi
- Department of Infectious Diseases and DermatologyUrmia University of Medical SciencesUrmiaIran
| | - Sina Dindarian
- Student Research CommitteeUrmia University of Medical SciencesUrmiaIran
| | - Sedra Mohammadi
- Student Research CommitteeUrmia University of Medical SciencesUrmiaIran
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Nejadrahim R, Khademolhosseini S, Kavandi H, Hajizadeh R. Severe acute respiratory syndrome coronavirus-2- or pregnancy-related cardiomyopathy, a differential to be considered in the current pandemic: a case report. J Med Case Rep 2021; 15:143. [PMID: 33741059 PMCID: PMC7978166 DOI: 10.1186/s13256-021-02751-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Background There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. Case presentation In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. Conclusions The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.
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Affiliation(s)
- Rahim Nejadrahim
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Hadiseh Kavandi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Hajizadeh
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran.
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Gharebaghi N, Nejadrahim R, Mousavi SJ, Sadat-Ebrahimi SR, Hajizadeh R. Correction to: The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: a randomized placebo-controlled double-blind clinical trial. BMC Infect Dis 2020; 20:895. [PMID: 33243191 PMCID: PMC7689645 DOI: 10.1186/s12879-020-05628-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Naser Gharebaghi
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Nejadrahim
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | - Seyed Jalil Mousavi
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Reza Hajizadeh
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran.
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Gharebaghi N, Nejadrahim R, Mousavi SJ, Sadat-Ebrahimi SR, Hajizadeh R. The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: a randomized placebo-controlled double-blind clinical trial. BMC Infect Dis 2020; 20:786. [PMID: 33087047 PMCID: PMC7576972 DOI: 10.1186/s12879-020-05507-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has infected people in many countries worldwide. Discovering an effective treatment for this disease, particularly in severe cases, has become the subject of intense scientific investigation. Therefore, the objective of this study was to evaluate the efficacy of intravenous immunoglobulin (IVIg) in patients with severe COVID-19 infection. METHODS This study was conducted as a randomized placebo-controlled double-blind clinical trial. Fifty-nine patients with severe COVID-19 infection who did not respond to initial treatments were randomly assigned into two groups. One group received IVIg (human)-four vials daily for 3 days (in addition to initial treatment), while the other group received a placebo. Patients' demographic, clinical, and select laboratory test results, as well as the occurrence of in-hospital mortality, were recorded. RESULTS Among total study subjects, 30 patients received IVIg and 29 patients received a placebo. Demographics, clinical characteristics, and laboratory tests were not statistically different (P > 0.05) between the two groups. The in-hospital mortality rate was significantly lower in the IVIg group compared to the control group (6 [20.0%] vs. 14 [48.3%], respectively; P = 0.022). Multivariate regression analysis demonstrated that administration of IVIg did indeed have a significant impact on mortality rate (aOR = 0.003 [95% CI: 0.001-0.815]; P = 0.042). CONCLUSIONS Our study demonstrated that the administration of IVIg in patients with severe COVID-19 infection who did not respond to initial treatment could improve their clinical outcome and significantly reduce mortality rate. Further multicenter studies with larger sample sizes are nonetheless required to confirm the appropriateness of this medication as a standard treatment. TRIAL REGISTRATION A study protocol was registered at the Iranian Registry of Clinical Trials ( www.IRCT.ir ), number IRCT20200501047259N1 . It was registered retrospectively on May 17th, 2020.
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Affiliation(s)
- Naser Gharebaghi
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Nejadrahim
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | - Seyed Jalil Mousavi
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Reza Hajizadeh
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran.
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