Chloroquine as chemoprophylaxis for COVID-19: Will this work?

Do Zinc Supplements Enhance the Clinical Efficacy of Hydroxychloroquine?: a Randomized, Multicenter Trial

No specific treatment for COVID-19 infection is available up till now, and there is a great urge for effective treatment to reduce morbidity and mortality during this pandemic. We aimed to evaluate the effect of combining chloroquine/hydroxychloroquine (CQ/HCQ) and zinc in the treatment of COVID-19 patients. This was a randomized clinical trial conducted at three major University hospitals in Egypt. One hundred ninety-one patients with a confirmed diagnosis of COVID-19 infection were randomized into two groups: group I (96) patients received both HCQ and zinc, and group II (95) received HCQ only. The primary endpoints were the recovery within 28 days, the need for mechanical ventilation, and death. The two groups were matched for age and gender. They had no significant difference regarding any of the baseline laboratory parameters or clinical severity grading. Clinical recovery after 28 days was achieved by 79.2% in the zinc group and 77.9% in zinc-free treatment group, without any significant difference (p = 0.969). The need for mechanical ventilation and the overall mortality rates did not show any significant difference between the 2 groups either (p = 0.537 and 0.986, respectively). The age of the patient and the need for mechanical ventilation were the only risk factors associated with the patients' mortality by the univariate regression analysis (p = 0.001 and < 0.001, respectively). Zinc supplements did not enhance the clinical efficacy of HCQ. More randomized studies are needed to evaluate the value of adding zinc to other therapies for COVID 19. ClinicalTrials.gov Identifier: NCT04447534.

Covid-19: Urgent Call to Action

Novel Corona Virus 2019 (COVID-19) is a new virus spread rapidly all over the world. It has specific respiratory or gastrointestinal tract symptoms. Its reported complications include respiratory distress, systemic inflammatory response syndrome, and septic shock. Due to heavy cytokines released by the virus; corticosteroids (40-120 mg / day) were given to severe cases to reduce pneumonia. It's a difficult task to control the spread of SARS-CoV-2, and to invent proper vaccines and treatments. In this review, the existing understanding of fatal, pandemic human coronavirus SARS-Cov2 (COVID-19), with special reference to its diagnosis, origin, transmission, and different approaches to develop its therapeutics, will be discussed.

Reimagining Innovation Amid the COVID-19 Pandemic: Insights From the WISH Innovation Programme

The World Innovation Summit for Health (WISH) hosts two innovation competitions as part of its biennial healthcare conference. During the COVID-19 pandemic, WISH received more than 350 applications for both competitions, of which 31 were shortlisted to showcase at the WISH 2020 virtual summit. Of the 31 showcasing innovations, 11 (35.5%) had suggested an alternative use to their innovation as a contribution to the global fight against COVID-19. As such, this article explores the apparent and urgent need for the repurposing of healthcare innovations to reduce the costs and time associated with the conventional approach, in order to best respond to the demands of the global pandemic.

Utility of Lung Ultrasound in Decision making to prioritize hospital admission for COVID-19 patients: A Developing Country Perspective

BACKGROUND & AIMS

In healthcare settings with limited resources, it is crucial to make a plan to prioritize hospital admission for patients affected by COVID-19. So, we tried to develop a novel approach for triaging COVID-19 patients and deciding the priority for hospital admission using Lung Ultrasound. In this study, we aimed to evaluate the efficacy of lung ultrasound in triaging suspected COVID-19 patients and assessment of the severity of COVID-19 pneumonia and its comparison with CT chest as the gold standard.

METHOD

This was a multicenter cross-sectional study enrolled on 243 COVID-19 confirmed patients presented to the emergency department in three major University hospitals in Egypt. Lung ultrasound was done by an experienced emergency physician or chest physician according to the local protocol of each hospital. Demographic, clinical, and laboratory data were collected from each patient. Each patient was subjected to CT chest and lung ultrasound.

RESULTS

A total of 243 confirmed COVID-19 patients were enrolled in this study, with a mean age of 46.7+10.4 years. Ground glass opacity (GGO), subpleural consolidation, trans-lobar consolidation, and crazy paving were reported in chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of patients, respectively. B-line artifacts were found in 81.1% of COVID-19 patients, which was of confluent pattern in 18.9% of patients. The lung ultrasound findings of 197 patients (81.1%) were completely coincident with those of CT with a Kappa agreement value of 0.77, and this offered a diagnostic sensitivity of 74 %, a diagnostic specificity of 97.9 %, positive predictive value (PPV) of 90.2% and negative predictive value (NPV) of 93.6 % for lung ultrasound in triaging COVID-19 patients. Adding O2 saturation to the findings of lung imaging, the accuracy of evaluation of lung ultrasound to differentiate between severe and non-severe lung diseases showed that ultrasound had 100% sensitivity and specificity.

CONCLUSION

Lung Ultrasound with Oxygen saturation is a very efficient tool for decision-making to prioritize hospital admission for patients affected by COVID-19 in healthcare settings with limited resources.

A mini review on the pathogenesis, diagnosis and treatment options for COVID-19

Coronavirus disease 2019 (COVID-19) is a serious viral disease caused by SARS-CoV-2, associated with a high morbidity and mortality, and represents the greatest public health crisis worldwide. Despite recent efforts for developing novel antiviral agents, no specific drugs are approved for management and treatment of COVID-19. The immune responses to viral infection followed by cytokine storm and acute respiratory distress syndrome are serious issues that may cause death in patients with severe COVID-19. Therefore, developing a novel therapeutic strategy for management of COVID-19 is urgently needed to control the virus spread and improving patient survival rate and clinical outcomes. In this mini review, we summarize the symptoms, pathogenesis and therapeutic approaches that are currently being used to managing the spread of SARS-CoV-2.

Coumarins and Quinolones as Effective Multiple Targeted Agents Versus Covid-19: An in Silico Study

BACKGROUND

The Covid-19 virus emerged a few months ago in China and infections rapidly escalated into a pandemic.

OBJECTIVE

To date, there is no selective antiviral agent for the management of pathologies associated with covid-19 and the need for an effective agent against it is essential.

METHOD

In this work two home-made databases from synthetic quinolines and coumarins were virtually docked against viral proteases (3CL and PL), human cell surface proteases (TMPRSS2 and furin) and spike proteins (S1 and S2). Chloroquine, a reference drug without a clear mechanism against coronavirus was also docked on mentioned targets and the binding affinities compared with title compounds.

RESULT

The best compounds of synthetic coumarins and quinolines for each target were determined. All compounds against all targets showed binding affinity between -5.80 to -8.99 kcal/mol in comparison with the FDA-approved drug, Chloroquine, with binding affinity of -5.7 to -7.98 kcal/mol. Two compounds, quinoline-1 and coumarin-24, were found to be effective on three targets - S2, TMPRSS2 and furin - simultaneously, with good predicted affinity between -7.54 to -8.85 kcal/mol. In silico ADME studies also confirmed good oral absorption for them. Furthermore, PASS prediction was calculated and coumarin-24 had higher probable activity (Pa) than probable inactivity (Pi) with acceptable protease inhibitory as well as good antiviral activity against Hepatitis C virus (HCV), Human immunodeficiency virus (HIV) and influenza.

CONCLUSION

Quinoline-1 and Coumarin-24 have the potential to be used against Covid-19. Hence these agents could be useful in combating covid-19 infection after further in vitro and in vivo studies.

Efficacy of favipiravir in COVID-19 treatment: a multi-center randomized study

No specific antiviral drugs have been approved for the treatment of COVID-19. This study aimed to evaluate the efficacy of favipiravir in treatment of COVID-19. This was a multicenter randomized controlled study including 96 patients with COVID- 19 who were randomly assigned into a chloroquine (CQ) group and a favipiravir group. None of the patients in the favipiravir group needed mechanical ventilation (p = 0.129). One patient (2.3%) in the favipiravir group and two patients (4.2%) in the CQ group died (p = 1.00). Favipiravir is a promising drug for COVID-19 that decreases the hospital stay and the need for mechanical ventilation.

ClinicalTrials.gov Identifier NCT04351295.

Pharmacological Inhibition of MMP3 as a Potential Therapeutic Option for COVID-19 Associated Acute Respiratory Distress Syndrome

The high mortality of coronavirus disease 2019 (COVID-19) patients is due to their progression to cytokine-associated organ injuries, primarily the acute respiratory distress syndrome (ARDS). The uncertainties in the molecular mechanisms leading to the switch from the early virus infection to the advanced stage ARDS is a major gridlock in therapeutic development to reduce mortality. Previous studies in our laboratory have identified matrix metalloprotease-3 (MMP3) as an important mediator of bacterial lipopolysaccharide (LPS)-induced ARDS, particularly in the exudative phase. Our studies have also reported elevated plasma MMP3 activity levels in the ARDS patients and that inhibition of MMP3 can reduce the severity of LPS-induced ARDS in mice. Given these observations, targeting MMP3 could be a potential option to treat COVID-19 patients with ARDS, and measurement of MMP3 activity in the plasma may serve as a biomarker for the early detection of ARDS in COVID-19 patients.

COVID-19 in Pediatrics: A Diagnostic Challenge

Most pediatric patients with COVID-19 described in the literature have unusual or mild respiratory symptoms. Fever is usually a prominent feature. Cough is described frequently. Less common are sore throat, headache, productive cough, nausea, and diarrhea. Some studies estimate that children made up about 2% of the affected population. Nearly 1.2% of infected children need hospital treatment and some children require mechanical ventilation. The immune system in children is in its development stage, therefore the immune response to pathogens is different from adults.

Hydroxychloroquine in the Treatment of COVID-19: A Multicenter Randomized Controlled Study

The COVID-19 pandemic is showing an exponential growth, mandating an urgent need to develop an effective treatment. Indeed, to date, a well-established therapy is still lacking. We aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) added to standard care in patients with COVID-19. This was a multicenter, randomized controlled trial conducted at three major university hospitals in Egypt. One hundred ninety-four patients with confirmed diagnosis of COVID-19 were included in the study after signing informed consent. They were equally randomized into two arms: 97 patients administrated HCQ plus standard care (HCQ group) and 97 patients administered only standard care as a control arm (control group). The primary endpoints were recovery within 28 days, need for mechanical ventilation, or death. The two groups were matched for age and gender. There was no significant difference between them regarding any of the baseline characteristics or laboratory parameters. Four patients (4.1%) in the HCQ group and 5 (5.2%) patients in the control group needed mechanical ventilation (P = 0.75). The overall mortality did not differ between the two groups, as six patients (6.2%) died in the HCQ group and 5 (5.2%) died in the control group (P = 0.77). Univariate logistic regression analysis showed that HCQ treatment was not significantly associated with decreased mortality in COVID-19 patients. So, adding HCQ to standard care did not add significant benefit, did not decrease the need for ventilation, and did not reduce mortality rates in COVID-19 patients.