Emerging therapeutics in the management of COVID-19

THE ROLE OF AGE AND COMORBIDITIES ON THE OUTCOME OF CONFIRMED CLINICALLY CRITICAL COVID-19 PATIENTS TREATED WITH REMDESIVIR AT INDONESIA'S NATIONAL REFERRAL HOSPITAL

Background

There is currently no viable pharmaceutical therapy for COVID-19 illness that has been validated. The use of remdesivir is one of the medications for which there is no consistent evidence of a significant therapeutic benefit or a meaningful effect on survival.

Aim

The aim of this study was to determine the role of age and comorbidities on the outcome of confirmed clinically critical COVID-19 patients treated with remdesivir at Indonesia's National Referral Hospital.

Methods

A retrospective cohort study was used in this study. The subjects in this study were confirmed clinically critical COVID-19 patients who were treated at Dr. M Djamil Hospital Padang, one of Indonesia's national referral hospitals, from January 2 to June 30, 2021. The number of sample size in this study was 90 patients. The variables of this study were divided into three independent variables (age, comorbidities, and a number of comorbidities). A dependent variable was the outcome of confirmed clinically critical COVID-19 patients. The Chi-square test was performed in bivariate analysis, and the odds ratio was calculated. SPSS version 17.0 was used to analyze the data.

Results

The results of this study found that there was an association between ages 50-59 years (OR = 10.23, 95% CI 1.89-55.53), 60-69 years (OR = 4.58, 95% CI 1.25-16.76), and > 70 years (OR = 1.91, 95% CI 1.38 -9.59), comorbid diabetes mellitus (OR = 9.78, 95% CI 1.23-77.66), the number of comorbid > 1 (OR = 10.97, 95% CI 2.19-54.96, and the number of comorbid 1 (OR = 5.69, 95% CI 1.59- 20.41) with the outcome of confirmed clinically critical COVID-19 patients treated with remdesivir.

Conclusion

The significance of age and comorbidities on the outcome of COVID-19 patients treated with remdesivir at Indonesia's national referral hospital was confirmed in this study. This study could assist in the management of patient therapy, potentially decreasing morbidity and even patient mortality.

Auswirkungen der COVID-19-Pandemie auf die Herzchirurgie

Seit Anfang des Jahres 2020 die COVID-19-Pandemie weltweit das Leben massiv beeinflusst und auch verändert hat, lassen sich naturgemäß gerade im Gesundheitssektor schwerwiegende Konsequenzen beobachten. Diese betreffen Patienten in gleichem Maß wie medizinisches Personal aller Berufsgruppen, sowohl im ambulanten als auch im stationären Bereich. Die Herzchirurgie als eine Disziplin, die wie keine zweite von der vorhandenen Kapazität auf Intensivstationen abhängig ist, war erwartungsgemäß von den Auswirkungen der Pandemie schwer betroffen. Dieser Beitrag gibt einen Überblick über die Konsequenzen für die klinische Versorgung, die Forschung und die Lehre sowie für die herzchirurgische Weiterbildung

ECMO-Kanülierung bei COVID-19

Hintergrund

Die Coronavirus Disease 2019 (COVID-19) kann zu einem schwerem therapierefraktären Lungenversagen führen. Die temporäre venovenöse extrakorporale Membranoxygenierung (v.v.-ECMO) stellt hierbei eine etablierte supportive Therapie dar, ist jedoch weiterhin mit einer sehr hohen Mortalität verbunden.

Fragestellung

In dieser Arbeit soll erforscht werden, ob die Kanülierungsstrategie der v.v.-ECMO einen Einfluss auf das Therapieergebnis bei COVID-19 hat.

Material und Methoden

Alle Patienten, die zwischen März 2020 und November 2021 bei COVID-19 in einem universitären Zentrum mit einer v.v.-ECMO behandelt wurden (n = 75), wurden prospektiv in eine Datenbank eingeschlossen. Die Patienten wurden hinsichtlich der Kanülierung der ECMO (femorofemoral: n = 20, femorojugulär: n = 55) in 2 Gruppen unterteilt und das Therapieergebnis retrospektiv verglichen.

Ergebnisse

In beiden Gruppen traten bei mehr als 70 % der Patienten während der ECMO-Therapie Komplikationen auf, wobei am häufigsten eine Sepsis (> 50 % der Patienten) beobachtet wurde. Hinsichtlich des Therapieergebnisses (ECMO-Entwöhnung, Tod im Krankenhausaufenthalt und 6‑Monate-Überleben) ergaben sich keine Unterschiede in Bezug auf die Kanülierungsstrategie der ECMO. Insgesamt beobachteten wir eine Krankenhausmortalität von rund 70 %. Die Dauer der komplikationsfreien ECMO-Therapie erschien in der femorojugulären Gruppe jedoch verlängert.

Diskussion

Die ECMO-Therapie bei COVID-19 zeigt neben der Notwendigkeit einer langen Therapiedauer eine hohe Mortalität. Die Kanülierungsstrategie scheint keinen direkten Einfluss auf das Therapieergebnis zu haben, eine femorojuguläre Kanülierung könnte aber insbesondere die Mobilisierung der Patienten sowie die komplikationsfreie Therapiedauer positiv beeinflussen.

Challenges of rapamycin repurposing as a potential therapeutic candidate for COVID-19: implications for skeletal muscle metabolic health in older persons

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic that has spread worldwide, resulting in over 6 million deaths as of March 2022. Older people have been disproportionately affected by the disease, as they have a greater risk of hospitalization, are more vulnerable to severe infection, and have higher mortality than younger patients. Although effective vaccines have been rapidly developed and administered globally, several clinical trials are ongoing to repurpose existing drugs to combat severe infection. One such drug, rapamycin, is currently under study for this purpose, given its immunosuppressant effects that are mediated by its inhibition of the mechanistic target of rapamycin (mTOR), a master regulator of cell growth. Consistent with this premise, acute rapamycin administration in young healthy humans blocks or attenuates mTOR and its downstream effectors, leading to the inhibition of muscle protein synthesis (MPS). Skeletal muscle mass declines when MPS is chronically lower than muscle protein breakdown. This is consequential for older people who are more susceptible to anabolic resistance (i.e., the blunting of MPS) due to reduced activity, sedentariness, or bed rest such as that associated with COVID-19 hospitalization, and who have also demonstrated a delayed or blunted ability to regain inactivity-induced muscle loss. The lack of studies investigating rapamycin administration on skeletal muscle in older people, and the emergence of effective antiviral medications against severe infection, may indicate the reduced relevance of drug repurposing for present or future pandemics.

Immunological map in COVID-19

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2, a newly discovered coronavirus that exhibits many similarities with the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses (SARS-CoV and MERS-CoV, respectively). The definite pathogenesis and immunological influences of SARS-CoV-2 have not been fully elucidated. Therefore, we constructed a brief summary comparison of SARS-CoV-2, SARS-CoV, and MERS-CoV infections regarding their immunological changes. In addition, we further investigated the immunological differences between severe and nonsevere COVID-19 cases, and we searched for possible immunological predictors of the patient outcome by reviewing case series studies to date. Possible immunological predictors of a poor outcome are leukocytosis, neutrophilia, lymphopenia (both CD4 and CD8 T cells), an increased neutrophil-to-lymphocyte ratio (NLR), and increased levels of pro-inflammatory cytokines (IL-6 and TNF-α), Th1 cytokines (IL-2 and IFN-γ), regulatory T cell cytokines (IL-10) and Th17 cytokines (IL-17). A more precise immunological map needs to be established, which may assist in diagnosing this disease and facilitate immunological precision medicine treatment.