Use of cidofovir in a patient with severe mpox and uncontrolled HIV infection.

A 48-year-old man with poorly controlled HIV presented with severe human monkeypox virus (hMPXV) infection, having completed 2 weeks of tecovirimat at another hospital. He had painful, ulcerating skin lesions on most of his body and oropharyngeal cavity, with subsequent Ludwig's angina requiring repeated surgical interventions. Despite commencing a second, prolonged course of tecovirimat, he did not objectively improve, and new lesions were still noted at day 24. Discussion at the UK National Health Service England High Consequence Infectious Diseases Network recommended the use of 3% topical and then intravenous cidofovir, which was given at 5 mg/kg; the patient made a noticeable improvement after the first intravenous dose. He received further intravenous doses at 7 days and 21 days after the dose and was discharged at day 52. Cidofovir is not licensed for use in treatment of hMPXV infection. Data for cidofovir use in hMPXV are restricted to studies in animals. Four other documented cases of cidofovir use against hMPXV have been reported in the USA in 2022, but we present its first use in the UK. The scarcity of studies into the use of cidofovir in this condition clearly shows the need for robust studies to assess efficacy, optimum dosage, timing, and route of administration.

Body Mass Index and Clinical Outcomes in Adult COVID-19 Patients of Diverse Ethnicities.

(1) Background: Body mass index (BMI) was observed to affect COVID-19 outcomes; however, the complete spectrum of clinical outcomes concerning BMI remains unexplored. The current study aimed to investigate the correlation between BMI and the severity and mortality of COVID-19, as well as ICU admission, radiological findings, clinical presentation, and time to viral clearance. (2) Methods: This retrospective study included 1796 multiethnic patients with COVID-19 treated at NMC Royal Hospital, Abu Dhabi, UAE. (3) Results: COVID-19's adjusted odds of severity increased by 3.7- and 21.5-fold in classes I and III, respectively (p = 0.001). The odds of mortality were not significantly different after adjustment for age, sex, and race. The adjusted odds of ICU admission increased significantly by 3-fold and non-significantly by 4-fold in obesity classes I and II, respectively. Pneumonia was significantly higher in patients who were overweight and class I, II, and III obese. Furthermore, class III obese patients had a greater risk of presenting with combined respiratory and gastrointestinal manifestations (p < 0.001). The median time to viral clearance with a BMI > 40 kg/m2 was moderately higher than that with a BMI < 40 kg/m2. (4) Conclusions: High BMI was associated with pneumonia, ICU admission, severity, and mortality due to COVID-19.

Correlation Between Plasma Vitamin C Concentration and COVID-19 Outcomes among Patients Seen at a Major Hospital in the United Arab Emirates.

Background and Objective: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a newly emerged coronavirus that causes coronavirus disease-2019 (COVID-19) with varying degrees of disease manifestations. Vitamin C is an essential water-soluble vitamin with anti-inflammatory, antioxidant, antiviral, and immunomodulatory functions. The study aimed to investigate the association between serum vitamin C concentration and outcomes of COVID-19 among adults in the United Arab Emirates (UAE). Methods: This retrospective observational study included 67 COVID-19 patients aged 30-59 years old. Measurement of vitamin C levels was performed at the National Reference Laboratory, UAE using liquid chromatography-tandem mass spectrometry (LC/MS-MS). The cut-off value was 0.4 mg/dl; plasma levels that ranged from 0.4 to 2 mg/dl were defined as sufficient. Values above 2 mg/dl were recognized as high and values less than 0.4 mg/dl are considered low or deficient. Results: Among the included patients, 58.2% suffered from vitamin C deficiency. We found a statistically significant correlation between the concentration of serum vitamin C and age (p=0.03), the presence of hypertension (p=0.013), diabetes (p=0.01), and the development of pneumonia (p=0.012). There was no significant correlation between the concentration of serum vitamin C and the need for mechanical ventilation, Intensive Care Unit (ICU) admission, COVID-19 severity, or mortality. The risk of COVID-19 severity decreased in patients with sufficient vitamin C levels by 52% compared to patients with vitamin C deficiency (p=0.177). There was a statistically significant correlation between vitamin C sufficiency and low lactate dehydrogenase, C-reactive protein (CRP), and fibrinogen. However, the odds of vitamin C sufficiency in COVID-19 patients were significantly associated with lowering CRP levels (OR=0.99, 95% CI (0.98-1.00), p=0.024). Conclusion and Global Health Implications: Low serum vitamin C concentrations were associated with several demographic characteristics of patients, the presence of pneumonia, and inflammation. Furthermore, improving our social determinants, such as how we live, eat, drink, and vitamin C supplementation could positively impact the future health of the individual, community, and population.

Vitamin C as a Potential Interplaying Factor between Obesity and COVID-19 Outcome.

(1) Background: Obesity is a risk factor for severe COVID-19 outcomes. Obesity can interfere with the action of vitamin C. The study aimed to investigate the association between BMI and severe outcomes of COVID-19 while considering vitamin C levels; (2) Methods: This was a retrospective study of 63 COVID-19 patients treated at the NMC Royal Hospital, United Arab Emirates; (3) Results: There was no significant difference in vitamin C levels among patients in all BMI categories (p > 0.05). The risk of severe COVID-19 significantly increased by 5.4 times among class 1 obese patients compared with normal BMI (OR = 5.40, 95%CI: (1.54−21.05), p = 0.010). Vitamin C did not affect the risk of COVID-19 severity or mortality across BMI categories (p = 0.177, p > 0.05, respectively). The time till viral clearance was significantly different among patients in different BMI categories when vitamin C levels were considered (p = 0.02). Although there was no significant difference in vitamin C levels across BMI categories, there was a significant interaction between vitamin C levels and viral clearance rate in obese patients; (4) Conclusions: Given the safety of vitamin C supplements and our findings, proper vitamin C uptake and supplementation for patients of various BMI levels are encouraged.