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1.
Rheumatology (Oxford) ; 60(1): 399-407, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1388014

ABSTRACT

OBJECTIVES: The Janus kinase (JAK) inhibitor baricitinib may block viral entry into pneumocytes and prevent cytokine storm in patients with SARS-CoV-2 pneumonia. We aimed to assess whether baricitinib improved pulmonary function in patients treated with high-dose corticosteroids for moderate to severe SARS-CoV-2 pneumonia. METHODS: This observational study enrolled patients with moderate to severe SARS-CoV-2 pneumonia [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2) <200 mmHg] who received lopinavir/ritonavir and HCQ plus either corticosteroids (CS group, n = 50) or corticosteroids and baricitinib (BCT-CS group, n = 62). The primary end point was the change in oxygen saturation as measured by pulse oximetry (SpO2)/FiO2 from hospitalization to discharge. Secondary end points included the proportion of patients requiring supplemental oxygen at discharge and 1 month later. Statistics were adjusted by the inverse propensity score weighting (IPSW). RESULTS: A greater improvement in SpO2/FiO2 from hospitalization to discharge was observed in the BCT-CS vs CS group (mean differences adjusted for IPSW, 49; 95% CI: 22, 77; P < 0.001). A higher proportion of patients required supplemental oxygen both at discharge (62.0% vs 25.8%; reduction of the risk by 82%, OR adjusted for IPSW, 0.18; 95% CI: 0.08, 0.43; P < 0.001) and 1 month later (28.0% vs 12.9%, reduction of the risk by 69%, OR adjusted for IPSW, 0.31; 95% CI: 0.11, 0.86; P = 0.024) in the CS vs BCT-CS group. CONCLUSIONS: . In patients with moderate to severe SARS-CoV-2 pneumonia a combination of baricitinib with corticosteroids was associated with greater improvement in pulmonary function when compared with corticosteroids alone. TRIAL REGISTRATION: European Network of Centres for Pharmacoepidemiology and Pharmacovigilance, ENCEPP (EUPAS34966, http://www.encepp.eu/encepp/viewResource.htm? id = 34967).


Subject(s)
Azetidines/therapeutic use , COVID-19/drug therapy , Glucocorticoids/therapeutic use , Hypoxia/therapy , Janus Kinase Inhibitors/therapeutic use , Methylprednisolone/therapeutic use , Oxygen Inhalation Therapy/statistics & numerical data , Purines/therapeutic use , Pyrazoles/therapeutic use , Sulfonamides/therapeutic use , Aged , Antiviral Agents/therapeutic use , COVID-19/metabolism , COVID-19/physiopathology , Cohort Studies , Drug Combinations , Drug Therapy, Combination , Endothelium, Vascular , Enzyme Inhibitors/therapeutic use , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Hydroxychloroquine/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Interferon beta-1b/therapeutic use , Lopinavir/therapeutic use , Lung/blood supply , Male , Middle Aged , Oximetry , Prospective Studies , Ritonavir/therapeutic use , SARS-CoV-2 , Severity of Illness Index
2.
Cytometry A ; 97(9): 887-890, 2020 09.
Article in English | MEDLINE | ID: covidwho-1384155

ABSTRACT

In patients with severe SARS-CoV-2 infection, the development of cytokine storm induces extensive lung damage, and monocytes play a role in this pathological process. Non-classical (NC) and intermediate (INT) monocytes are known to be involved during viral and bacterial infections. In this study, 30 patients with different manifestations of acute SARS-CoV-2 infection were investigated with a flow cytometric study of NC, INT, and classical (CL) monocytes. Significantly reduced NC and INT monocytes and a downregulated HLA-DR were found in acute patients with severe SARS-CoV-2 symptoms. Conversely in patients with moderate symptoms NC and INT monocytes and CD11b expression were increased. © 2020 International Society for Advancement of Cytometry.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/immunology , Monocytes/immunology , Pneumonia, Viral/immunology , Aged , Betacoronavirus/pathogenicity , Biomarkers/analysis , CD11b Antigen/analysis , COVID-19 , Cell Separation , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Flow Cytometry , Host Microbial Interactions , Humans , Leukocytes , Male , Middle Aged , Monocytes/virology , Pandemics , Phenotype , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , SARS-CoV-2 , Severity of Illness Index
3.
Pharmacol Res ; 157: 104866, 2020 07.
Article in English | MEDLINE | ID: covidwho-1318930

ABSTRACT

COVID-19 is a medical emergency, with 20 % of patients presenting with severe clinical manifestations. From the pathogenetic point of view, COVID-19 mimics two other well-known diseases characterized by cytokine storm and hyper-activation of the immune response, with consequent organ damage: acute graft-versus-host disease (aGVHD) and macrophage activation syndrome (MAS). Hematologists are confident with these situations requiring a prompt therapeutic approach for switching off the uncontrolled cytokine release; here, we discuss pros and cons of drugs that are already employed in hematology in the light of their possible application in COVID-19. The most promising drugs might be: Ruxolitinib, a JAK1/2 inhibitor, with a rapid and powerful anti-cytokine effect, tyrosine kinase inhibitors (TKIs), with their good anti-inflammatory properties, and perhaps the anti-Cd26 antibody Begelomab. We also present immunological data from gene expression experiments where TKIs resulted effective anti-inflammatory and pro-immune drugs. A possible combined treatment algorithm for COVID-19 is here proposed.


Subject(s)
Coronavirus Infections/drug therapy , Hematology/methods , Pneumonia, Viral/drug therapy , Betacoronavirus/drug effects , COVID-19 , Graft vs Host Disease/drug therapy , Humans , Macrophage Activation Syndrome/drug therapy , Pandemics , SARS-CoV-2
4.
Cureus ; 13(6): e15604, 2021 Jun 11.
Article in English | MEDLINE | ID: covidwho-1271055

ABSTRACT

Coronavirus disease 2019 (COVID-19) is associated with various cardiovascular manifestations, including myocarditis, myocardial infarction, and arrhythmias. A prothrombotic state is the primary underlying pathogenic mechanism. While cardiac arrhythmias manifest more commonly amongst critically ill COVID-19 populations, ventricular arrhythmias have been reported only in few cases. This report describes a case of a 95-year-old African American man with COVID-19, who developed sustained monomorphic ventricular tachycardia, which progressed to an electrical storm. The case highlights the importance of high clinical suspicion, early recognition of electrical abnormalities in patients with active COVID-19 infection, and its ability to precipitate fatal ventricular arrhythmia. Also, we provide a literature review on the electrical storm in COVID-19 patients, highlighting the pathophysiologic mechanisms and the management of this deadly arrhythmia.

5.
FASEB J ; 35(6): e21666, 2021 06.
Article in English | MEDLINE | ID: covidwho-1242109

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 is responsible for coronavirus disease 2019 (COVID-19). While COVID-19 is often benign, a subset of patients develops severe multilobar pneumonia that can progress to an acute respiratory distress syndrome. There is no cure for severe COVID-19 and few treatments significantly improved clinical outcome. Dexamethasone and possibly aspirin, which directly/indirectly target the biosynthesis/effects of numerous lipid mediators are among those options. Our objective was to define if severe COVID-19 patients were characterized by increased bioactive lipids modulating lung inflammation. A targeted lipidomic analysis of bronchoalveolar lavages (BALs) by tandem mass spectrometry was done on 25 healthy controls and 33 COVID-19 patients requiring mechanical ventilation. BALs from severe COVID-19 patients were characterized by increased fatty acids and inflammatory lipid mediators. There was a predominance of thromboxane and prostaglandins. Leukotrienes were also increased, notably LTB4 , LTE4 , and eoxin E4 . Monohydroxylated 15-lipoxygenase metabolites derived from linoleate, arachidonate, eicosapentaenoate, and docosahexaenoate were also increased. Finally yet importantly, specialized pro-resolving mediators, notably lipoxin A4 and the D-series resolvins, were also increased, underscoring that the lipid mediator storm occurring in severe COVID-19 involves pro- and anti-inflammatory lipids. Our data unmask the lipid mediator storm occurring in the lungs of patients afflicted with severe COVID-19. We discuss which clinically available drugs could be helpful at modulating the lipidome we observed in the hope of minimizing the deleterious effects of pro-inflammatory lipids and enhancing the effects of anti-inflammatory and/or pro-resolving lipid mediators.


Subject(s)
COVID-19 , Leukotriene B4/metabolism , Leukotriene E4/analogs & derivatives , Leukotriene E4/metabolism , Lipoxins/metabolism , Lung , SARS-CoV-2/metabolism , Adult , COVID-19/metabolism , COVID-19/pathology , COVID-19/therapy , Female , Humans , Lung/metabolism , Lung/pathology , Lung/virology , Male , Middle Aged
6.
Clin Infect Dis ; 72(7): 1247-1250, 2021 04 08.
Article in English | MEDLINE | ID: covidwho-1174886

ABSTRACT

Hyperinflammation is associated with increased mortality in coronavirus disease 2019 (COVID-19). In this retrospective, uncontrolled patient cohort with moderate -severe COVID-19, treatment with baricitinib plus hydroxychloroquine was associated with recovery in 11 of 15 patients. Baricitinib for the treatment of COVID-19 should be further investigated in randomized, controlled clinical trials.


Subject(s)
COVID-19 , Antiviral Agents/therapeutic use , Azetidines , COVID-19/drug therapy , Humans , Purines , Pyrazoles , Retrospective Studies , SARS-CoV-2 , Sulfonamides , Treatment Outcome
7.
J Intern Med ; 289(1): 97-115, 2021 01.
Article in English | MEDLINE | ID: covidwho-1153555

ABSTRACT

BACKGROUND: SARS-CoV-2 coronavirus infection ranges from asymptomatic through to fatal COVID-19 characterized by a 'cytokine storm' and lung failure. Vitamin D deficiency has been postulated as a determinant of severity. OBJECTIVES: To review the evidence relevant to vitamin D and COVID-19. METHODS: Narrative review. RESULTS: Regression modelling shows that more northerly countries in the Northern Hemisphere are currently (May 2020) showing relatively high COVID-19 mortality, with an estimated 4.4% increase in mortality for each 1 degree latitude north of 28 degrees North (P = 0.031) after adjustment for age of population. This supports a role for ultraviolet B acting via vitamin D synthesis. Factors associated with worse COVID-19 prognosis include old age, ethnicity, male sex, obesity, diabetes and hypertension and these also associate with deficiency of vitamin D or its response. Vitamin D deficiency is also linked to severity of childhood respiratory illness. Experimentally, vitamin D increases the ratio of angiotensin-converting enzyme 2 (ACE2) to ACE, thus increasing angiotensin II hydrolysis and reducing subsequent inflammatory cytokine response to pathogens and lung injury. CONCLUSIONS: Substantial evidence supports a link between vitamin D deficiency and COVID-19 severity but it is all indirect. Community-based placebo-controlled trials of vitamin D supplementation may be difficult. Further evidence could come from study of COVID-19 outcomes in large cohorts with information on prescribing data for vitamin D supplementation or assay of serum unbound 25(OH) vitamin D levels. Meanwhile, vitamin D supplementation should be strongly advised for people likely to be deficient.


Subject(s)
Angiotensin-Converting Enzyme 2/metabolism , COVID-19/ethnology , Ethnicity , SARS-CoV-2 , Thrombosis/etiology , Vitamin D Deficiency/ethnology , COVID-19/metabolism , Comorbidity , Global Health , Humans , Risk Factors , Thrombosis/ethnology , Thrombosis/metabolism , Vitamin D Deficiency/metabolism
9.
Nurs Leadersh (Tor Ont) ; 33(4): 1-3, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1094395

ABSTRACT

The intensity of the COVID-19 pandemic has tested the mettle of political, healthcare and public health leaders over the past year. Amid the unfolding events, healthcare leaders, including many nurses, have been pivoting, innovating, collaborating, safeguarding, inspiring and navigating - all the while informing the creation of an effective playbook to wage a counterassault for all of us. Despite all efforts, this previously unseen opponent has been unrelenting. Having been in the eye of the storm during the severe acute respiratory syndrome (SARS) outbreak, my memories of the events remain vivid. It was a time rife with uncertainty and fear, forcing the creation of a playbook on the basis of the best evidence and common sense but without the benefit of a precedent. Over the course of several months, our leadership was challenged by efforts to contain the virus and mitigate the very real possibility of a globally emerging pandemic. However, SARS was but a microcosm of the present situation. The COVID-19 pandemic is not like any other crisis we have experienced in our collective lifetime. We can only imagine the toll of this pandemic when it is finally over. It will be measured in terms of post-pandemic posttraumatic stress disorder, deaths from COVID-19 and delayed care, and deaths by suicide among healthcare workers and citizens; in the end, it will not be trivial. Those contributing to the COVID-19 playbook have given their all, and we should be eternally grateful to every single one of them.


Subject(s)
Leadership , Nurse Administrators/psychology , Organizational Culture , COVID-19/prevention & control , COVID-19/transmission , Humans , Nurse Administrators/trends , Pandemics/prevention & control
10.
PLoS One ; 16(2): e0247121, 2021.
Article in English | MEDLINE | ID: covidwho-1088765

ABSTRACT

OBJECTIVE: In 2020, the COVID-19 appeared in Italy with an exponential transmission capacity and serious consequences for the whole population. To counter the spread of the virus, the Italian government has adopted an extensive lockdown, forcing citizens to stay at home and avoid social contact. The COVID-19 quarantine represents a unique phenomenon in the recent centuries, and its long-term consequences on people's lives and mental health are still to be understood. This study aimed to explore significant experiences of people who did not contract the virus, yet experienced the quarantine as a potentially stressful condition. METHODS: Italians who did not contract the COVID-19 were invited to participate in semi-structured interviews employing the Critical Incident Technique. Interviews were designed to capture the significant experiences related to the lockdown period in Italy. Participants were asked to describe the most significant (1) negative and (2) positive critical events that they personally experienced during the ongoing quarantine. Such events were meant to provide information on their experience of the quarantine as a whole. The audio-taped interviews were transcribed verbatim and analyzed following Critical Incident Technique's indications. RESULTS: Twenty two participants described a total of 43 critical events, including 22 negative episodes and 21 positive events experienced during the COVID-19 quarantine. Three categories emerged from the negative episodes and four categories emerged from the positive events described by the participants. Relevant themes both positive and negative concerned mostly relationships (with partners, family, and friends), and the alteration of everyday activities, Also a specific "sensation of emergency" that the participants felt during the pandemic emerged, as an emotionally-charged response to quarantine-related external stimuli. CONCLUSIONS: To our knowledge this is the first in-depth qualitative study investigating the significant negative and positive events that people experienced during the COVID-19 quarantine. Future research could employ analogous event recollection methods but focus on other populations (e.g., fragile subjects or on other national contests), in order to extend the information on the quarantine experience and its possible long-lasting effects.


Subject(s)
COVID-19/psychology , Quarantine/psychology , Adult , COVID-19/epidemiology , COVID-19/immunology , COVID-19/transmission , Communicable Disease Control/methods , Coronavirus Infections/epidemiology , Female , Humans , Italy/epidemiology , Longitudinal Studies , Male , Mental Health/trends , Pandemics , Physical Distancing , Qualitative Research , Quarantine/trends , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity
11.
Dermatol Ther (Heidelb) ; 11(2): 339-345, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1083623

ABSTRACT

INTRODUCTION: The inflammation storm involved in coronavirus disease 2019 (COVID-19) infection and worsening and the psychological stress derived from current quarantine conditions can affect the course of many skin and scalp conditions. This study examined the possible effects of COVID-19 on alopecia areata (AA) relapse in patients suffering from these scalp conditions during the pandemic. METHODS: The study was carried out in the form of an observational cross-sectional type using a questionnaire sent by mail to a cohort of patients affected by AA during the pandemic from March 2020 to October 2020. RESULTS: During the pandemic, AA relapse was reported in 42.5% of the participants who also declared COVID-19 infection, confirmed by nasopharyngeal swab or hematological analysis. The relapse was reported about 2 months later COVID-19 infection (median of 2.14 months) and 74.0% of these participants continue to experience AA symptoms when the survey was proposed. Only 12.5% of participants reported AA relapse in the absence of COVID-19 infection. CONCLUSIONS: The present study reported a significant relapse in patients suffering from AA and infected by COVID-19. This phenomenon could be attributed to the inflammation storm typical of COVID-19 infection and the psychological stress derived from quarantine conditions.

12.
Front Psychiatry ; 12: 638866, 2021.
Article in English | MEDLINE | ID: covidwho-1080439
13.
Chest ; 159(3): 933-948, 2021 03.
Article in English | MEDLINE | ID: covidwho-1064923

ABSTRACT

BACKGROUND: Cytokine storm is a marker of coronavirus disease 2019 (COVID-19) illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes. RESEARCH QUESTION: Do immunomodulatory therapies improve survival in patients with COVID-19 cytokine storm (CCS)? STUDY DESIGN AND METHODS: We conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020, and April 24, 2020, were included. CCS was defined by inflammatory markers: ferritin, > 700 ng/mL; C-reactive protein (CRP), > 30 mg/dL; or lactate dehydrogenase (LDH), > 300 U/L. Patients were subdivided into six groups: no immunomodulatory treatment (standard of care) and five groups that received either corticosteroids, anti-IL-6 antibody (tocilizumab), or anti-IL-1 therapy (anakinra) alone or in combination with corticosteroids. The primary outcome was hospital mortality. RESULTS: Five thousand seven hundred seventy-six patients met the inclusion criteria. The most common comorbidities were hypertension (44%-59%), diabetes (32%-46%), and cardiovascular disease (5%-14%). Patients most frequently met criteria with high LDH (76.2%) alone or in combination, followed by ferritin (63.2%) and CRP (8.4%). More than 80% of patients showed an elevated D-dimer. Patients treated with corticosteroids and tocilizumab combination showed lower mortality compared with patients receiving standard-of-care (SoC) treatment (hazard ratio [HR], 0.44; 95% CI, 0.35-0.55; P < .0001) and with patients treated with corticosteroids alone (HR, 0.66; 95% CI, 0.53-0.83; P = .004) or in combination with anakinra (HR, 0.64; 95% CI, 0.50-0.81; P = .003). Corticosteroids when administered alone (HR, 0.66; 95% CI, 0.57-0.76; P < .0001) or in combination with tocilizumab (HR, 0.43; 95% CI, 0.35-0.55; P < .0001) or anakinra (HR, 0.68; 95% CI, 0.57-0.81; P < .0001) improved hospital survival compared with SoC treatment. INTERPRETATION: The combination of corticosteroids with tocilizumab showed superior survival outcome when compared with SoC treatment as well as treatment with corticosteroids alone or in combination with anakinra. Furthermore, corticosteroid use either alone or in combination with tocilizumab or anakinra was associated with reduced hospital mortality for patients with CCS compared with patients receiving SoC treatment.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Antibodies, Monoclonal, Humanized/administration & dosage , COVID-19 , Cytokine Release Syndrome , Immunomodulation , Interleukin 1 Receptor Antagonist Protein/administration & dosage , COVID-19/immunology , COVID-19/mortality , COVID-19/therapy , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/therapy , Cytokine Release Syndrome/virology , Drug Repositioning , Drug Therapy, Combination/methods , Electronic Health Records/statistics & numerical data , Humans , Immunosuppressive Agents/administration & dosage , Medication Therapy Management/statistics & numerical data , Middle Aged , Outcome and Process Assessment, Health Care , Retrospective Studies , SARS-CoV-2/immunology , Severity of Illness Index , Survival Analysis , United States/epidemiology
14.
Chest ; 159(1): e7-e11, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064922

ABSTRACT

Coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality because of a lack of effective therapies. Therapeutic strategies under investigation target the overactive cytokine response with anti-cytokine or immunomodulators therapies. We present a unique case of severe cytokine storm resistant to multiple anti-cytokine therapies, but eventually responsive to etoposide. Thus, etoposide may have a role as salvage therapy in treatment of cytokine storm in COVID-19. To our knowledge, this is the first reported case of use of etoposide in COVID-19.


Subject(s)
COVID-19/complications , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/etiology , Etoposide/therapeutic use , Aged , Female , Humans , Salvage Therapy/methods , Severity of Illness Index
15.
Adv Ther ; 38(1): 782-791, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064616

ABSTRACT

INTRODUCTION: The COVID-19 global pandemic caused by the novel coronavirus, SARS-CoV-2, and the consequent morbidity and mortality attributable to progressive hypoxemia and subsequent respiratory failure threaten to overrun hospital critical care units globally. New agents that address the hyperinflammatory "cytokine storm" and hypercoagulable pathology seen in these patients may be a promising approach to treat patients, minimize hospital stays, and ensure hospital wards and critical care units are able to operate effectively. Dociparstat sodium (DSTAT) is a glycosaminoglycan derivative of heparin with robust anti-inflammatory properties, with the potential to address underlying causes of coagulation disorders with substantially reduced risk of bleeding compared to commercially available heparin. METHODS: This study is a randomized, double-blind, placebo-controlled, phase 2/3 trial to determine the safety and efficacy of DSTAT added to standard of care in hospitalized adults with COVID-19 who require supplemental oxygen. Phase 2 will enroll 12 participants in each of two dose-escalating cohorts to confirm the safety of DSTAT in this population. Following review of the data, an additional 50 participants will be enrolled. Contingent upon positive results, phase 3 will enroll approximately 450 participants randomized to DSTAT or placebo. The primary endpoint is the proportion of participants who survive and do not require mechanical ventilation through day 28. DISCUSSION: Advances in standard of care, recent emergency use authorizations, and positive data with dexamethasone have likely contributed to an increasing proportion of patients who are surviving without the need for mechanical ventilation. Therefore, examining the time to improvement in the NIAID score will be essential to provide a measure of drug effect on recovery. Analysis of additional endpoints, including supportive biomarkers (e.g., IL-6, HMGB1, soluble-RAGE, D-dimer), will be performed to further define the effect of DSTAT in patients with COVID-19 infection. TRIAL REGISTRATION: ClinicalTrials.gov identifier; NCT04389840, Registered 13 May 2020.


Subject(s)
Acute Lung Injury/drug therapy , Anti-Inflammatory Agents/therapeutic use , COVID-19/complications , COVID-19/drug therapy , Heparin/therapeutic use , Respiratory Insufficiency/drug therapy , Acute Lung Injury/etiology , Adult , Aged , Aged, 80 and over , Double-Blind Method , Female , Humans , Male , Middle Aged , Respiratory Insufficiency/etiology , SARS-CoV-2/drug effects , Treatment Outcome
16.
Lancet Infect Dis ; 21(1): 25-26, 2021 01.
Article in English | MEDLINE | ID: covidwho-1059342
17.
Can J Respir Ther ; 56: 25-31, 2020.
Article in English | MEDLINE | ID: covidwho-1060415

ABSTRACT

The global pandemic COVID-19 is a contagious disease and its mortality rates ranging from 1% to 5% are likely due to acute respiratory distress syndrome (ARDS), and cytokine storm. A significant proportion of patients who require intubation succumb to the disease, despite the availability of ventilators and the best treatment practices. Researchers worldwide are in search of anti-inflammatory medicines in the hope of finding a cure for COVID-19. Low-level laser therapy (LLLT) has strong, anti-inflammatory effects confirmed by meta-analyses, and it may be therapeutic to ARDS. LLLT has been used for pain management, wound healing, and other health conditions by physicians, physiotherapists, and nurses worldwide for decades. In addition, it has been used in veterinary medicine for respiratory tract disease such as pneumonia. Laser light with low-power intensity is applied to the surface of the skin to produce local and systemic effects. Based on the clinical experience, peer-reviewed studies, and solid laboratory data in experimental animal models, LLLT attenuates cytokine storm at multiple levels and reduces the major inflammatory metabolites. LLLT is a safe, effective, low-cost modality without any side-effects that may be combined with conventional treatment of ARDS. We summarize the effects of LLLT on pulmonary inflammation and we provide a protocol for augmenting medical treatment in COVID-19 patients. LLLT combined with conventional medical therapy has the potential to prevent the progression of COVID-19, minimize the length of time needed on a ventilator, enhance the healing process, and shorten recovery time.

18.
J Clin Med ; 9(9)2020 Sep 14.
Article in English | MEDLINE | ID: covidwho-1021973

ABSTRACT

The repurposing of colchicine for the treatment of COVID-19 was suggested based in its immunomodulatory, anti-inflammatory, and anti-viral properties. We performed a single-center propensity score matched cohort study, including all consecutive COVID-19 patients admitted to a community hospital between 1 March 2020 and 30 May 2020. Patients were stratified according to the receipt of colchicine. The primary endpoint was defined as in-hospital death within 28-days follow-up. Secondary endpoints included favorable change in the Ordinal Scale for Clinical Improvement on days 14 and 28 versus baseline, proportion of patients not requiring supplemental oxygen on days 14 and 28, and proportion of patients discharged by day 28. In total data for 303 PCR positive COVID-19 patients were extracted and 66 patients were included in the 1:1 matched cohort study. At the end of the 28 day follow-up, patients receiving colchicine were approximately five times more likely to be discharged (odds ratio, 5.0; 95% confidence interval, 1.25-20.1; p = 0.023) and when comparing mortality, there were 3 deaths (9.1%) in patients receiving colchicine versus 11 deaths (33.3%) in the groups receiving standard of care (odds ratio, 0.20; 95% confidence interval, 0.05-0.80; p = 0.023). These observations warrant further investigation in large controlled clinical trials.

20.
J Microsc Ultrastruct ; 8(4): 141-145, 2020.
Article in English | MEDLINE | ID: covidwho-1000436

ABSTRACT

COVID-19 pathology is mainly associated to a pulmonary disease which sometimes might result in an uncontrollable storm related to inflammatory diseases which could be fatal. It is well known that phosphodiesterase enzyme type 5 inhibitors (PDE5Is), such as sildenafil, have been successfully developed for the treatment of pulmonary arterial hypertension; interestingly, more recently, it was shown that PDE5Is might be also anti-inflammatory. Therefore, it would be of interest to question about the use of PDE5Is to overcome the COVID-19 storm, as much as PDE5 is mainly present in the lung tissues and vessels.

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