The effects of probiotic Lactobacillus acidophilus and colchicine on the control of symptoms, duration, and disease progression of mild and moderate cases of COVID-19: A randomized controlled clinical trial (preprint)

Background Coronavirus disease 2019 (COVID-19) is a newly emerging human disease caused by a novel coronavirus, causing a global pandemic crisis. Probiotics and/or colchicine may be considered as options for treatment since they have anti-viral, anti-inflammatory, and immunomodulatory effects.Objective To assess the effectiveness of probiotic supplements (Lactobacillus acidophilus) and colchicine on symptoms, duration, and progression of mild and moderate cases of COVID-19 infection.Methods A three-arm randomized controlled clinical trial was carried out in the triage clinic of the family medicine department at Ain Shams University Hospitals on 150 participants who had been diagnosed as COVID-19 patients with mild and moderate severity. Patients aged below 18 years or above 65 years with any co-morbidities, pregnant or lactating females, and severe COVID-19 confirmed cases were excluded. Randomization was done by using sealed envelopes containing codes for intervention or control. Patients are followed up for improvement of their symptoms with no development of new symptoms over the course of two weeks.Results A total of 150 patients with mild and moderate severity of COVID-19 were enrolled in the study, 50 patients in each arm; around one third (34.7%) of the participants were aged between 29 and 39 years; one-quarter (24.7%) were aged between 18 and 28 years and 40.6% were aged 40 years and above. The mean duration of symptoms improvement was 12, 11 and 12 in the colchicine, probiotic, and control groups, respectively. Improvement of inflammatory markers over time occurred in each of the three groups, with no statistically significant difference between them.Conclusion Probiotic Lactobacillus acidophilus and colchicine shows no significant effect on the symptoms, duration, and progression of mild and moderate cases of COVID-19.

Thiazole-based SARS-CoV-2 protease (COV Mpro ) inhibitors: Design, synthesis, enzyme inhibition, and molecular modeling simulations.

As an attempt to contribute to the efforts of combating the pandemic virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for COVID-19, new analogs of the repurposed drug nitazoxanide which showed promising inhibitory efficacy on a viral protease enzyme were designed, synthesized and evaluated for their inhibitory activity on the main protease of the SARS-CoV-2 virus, using the COV2-3CL protease inhibition assay. The obtained results showed that the N-(substituted-thiazol-2-yl)cinnamamide analogs 19, 20, and 21 were the most active compounds with IC50 values of 22.61, 14.7, 21.99 µM, respectively, against the viral protease compared to the reference drugs, nitazoxanide, and lopinavir. Molecular modeling studies showed binding interactions of 19, 20, and 21 with hydrogen bonds to Gln189 and Glu166, arene-arene interaction between the thiazole moiety and His41, and other hydrophobic interactions between the ethene spacer moiety and Asn142. Moreover, an extra arene-arene interaction between substituted benzo[d]thiazole and His41 was observed regarding compounds 19 and 21. Surface mapping and flexible alignment proved the structural similarity between the new drug candidates and nitazoxanide. Compliance of the new compounds to Lipinski's rule of five was investigated and absorption, distribution, metabolism, excretion, and toxicology data were predicted. The newly synthesized compounds are promising template ligands for further development and optimization.

A superior extension for the Lomax distribution with application to Covid-19 infections real data

We present a new continuous lifetime model with four parameters by combining the Lomax and the Weibull distributions. The extended odd Weibull Lomax (EOWL) distribution is what we’ll call it. This new distribution possesses several desirable properties thanks to the simple linear representation of its hazard rate function, moments, and moment -generating function, with stress-strength reliability that are provided in a simple closed forms. The parameters of the EOWL model are estimated using classical methods such as the maximum likelihood (MLE) and the maximum product of spacing (MPS) and estimated also but using a non-classical method such as Bayesian analytical approaches. Bayesian estimation is performed using the Monte Carlo Markov Chain method. Monte Carlo simulation are used to assess the effectiveness of the estimation methods throughout the Metropolis Hasting (MH) algorithm. To illustrate the suggested distribution’s effectiveness and suitability for simulating real-world pandemics, we used three existing COVID-19 data sets from the United Kingdom, the United States of America, and Italy which are studied to serve as illustrative examples. We graphed the P-P plots and TTT plots for the proposed distribution proving its superiority in a graphical manner for modelling the three data sets in the paper.

Infective endocarditis following COVID-19 pneumonia: about two cases.

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis across the world. The severity of this situation is escalating in certain populations, particularly when the COVID-19 diagnosis may delay the recognition of more dramatic illnesses such as infective endocarditis, which is a dreaded complication in patients with cardiac disease. We report the case of two patients who presented with infective endocarditis initially mistaken for COVID-19 pneumonia, which was responsible for a delay in diagnosis. We discuss the diagnostic difficulties as well as the management of this complication in the COVID-19 era. As a physician, one must remain alert to this dreaded complication, especially in patients with a cardiac history, in order to prevent it, detect it early, and manage it in time.

Ovarian vein thrombosis after coronavirus disease (COVID-19) mimicking acute abdomen: two case reports.

Coronavirus is a source of deep venous thrombosis (DVT) due to complications such as over-coagulation, blood stasis, and endothelial damage. Ovarian vein thrombosis (OVT) is a very serious and rare disease. In this study, we report tow rare case of women with coronavirus who were hospitalized with a right ovarian vein thrombosis mimicking acute abdomen who progressed well on anticoagulation. Our report adds further document in Side effects and rare localisation of obstruction of veins and arteries in patient with corona virus.

Elevated levels of D-dimer in patients with COVID-19: prognosis value.

INTRODUCTION: coronavirus disease is now a global pandemic due to rapid human-to-human transmission. It can cause mild to fatal respiratory, cardiovascular, and neurological diseases. We aimed to find out whether elevated D-dimer levels are a predictor of the bad progression of COVID-19 to help reducing the mortality. METHODS: the data of COVID-19 patients from March 21, 2020 to April 24, 2020 were retrieved from the Cheick Khalifa Hospital database. We used the receiver operating characteristic (ROC) curve to get the optimum cutoff value of D-dimer levels on admission and after 5 days. We used these cutoffs to divide patients into two groups and compare the in-hospital mortality between them to assess the prognosis value of D-dimer levels. RESULTS: the data of COVID-19 patients from March 21, 2020 to April 24, 2020 were retrieved from the Cheick Khalifa Hospital database. We used the receiver operating characteristic (ROC) curve to get the optimum cutoff value of D-dimer levels on admission and after 5 days. We used these cutoffs to divide patients into two groups and compare the in-hospital mortality between them to assess the prognosis value of D-dimer levels. 89 patients were included in this study, of whom 79 were discharged and 10 died in hospital. The optimum cutoff value to predict mortality in patient using D-dimer levels on admission was 668 ng/ml (sensitivity 90%, specificity 63.3%, Areas under the ROC curve 0,775). As for D-dimer levels on day 5, it was 1360 ng/ml (sensitivity 100%, specificity 88,6%, Areas under the ROC curve 0.946). The group with D-dimer levels on day 5 > 1360 ng/ml (19 patients) had a worst evolution and a higher incidence of mortality compared to the group with D-dimer < 1360 ng/ml (69 patients) (10/19 vs 0/69, P = 0,0002). CONCLUSION: D-dimer greater than 1360 ng/ml on day 5 could help clinicians identify patients with poor prognosis at an early stage of COVID-19.

Mental health of frontline healthcare workers exposed to COVID-19 in Egypt: A call for action.

BACKGROUND: World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) as a pandemic in March 2020. Such widespread outbreaks are associated with adverse mental health consequences. AIMS: To evaluate mental health outcomes among Egyptian healthcare workers (HCW) treating patients with confirmed or suspected Coronavirus Disease 2019 (COVID-19) to direct the promotion of mental wellbeing, by screening for symptoms of anxiety, insomnia, depression and stress, and analyzing potential risk factors. METHODS: This cross-sectional, hospital-based survey study collected demographic data and mental health measurements from 502 HCW dealing with COVID-19. HCW were surveyed in 20 hospitals (Fever, Chest, and Quarantine hospitals) in different parts of Egypt, in April and May 2020. RESULTS: Among the 502 HCW surveyed; 60.0% were physicians, 16.1% were specialized nurses, and 23.9% were non-specialized nurses. About 35.3% worked in chest hospitals, 17.5% in fever hospitals, and 47.2% in quarantine hospitals. A considerable proportion of HCW had symptoms of anxiety, insomnia, depression, and stress. Females were at higher risk of experiencing symptoms of severe anxiety (odds ratio [OR], 1.85; 95% CI, 1.12-3.05; p = .016), severe depression (OR, 2.013; 95% CI, 1.17-3.4; p = .011), and severe stress (OR, 2.68; 95% CI, 1.5-4.6; p < .001). Fever hospital workers were at higher risk of severe depression (OR, 1.52; 95% CI, 1.11-2.09; p < .01), compared to Quarantine hospital workers. CONCLUSION: Ensuring proper mental health support for HCW is an important component of public health measures for addressing the COVID-19 epidemic and safeguarding the continuity of appropriate medical service.

Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability.

During the COVID-19 pandemic, the effectiveness of the combination of hydroxychloroquine and azithromycin is widely discussed. This treatment can cause many severe cardiac side effects that makes us discuss its utility. The aim of this study is to describe the cardiovascular effect of hydroxychloroquine and azithromycin by analyzing surface ECG in patients with COVID-19. This observational cohort study included Moroccan patients with COVID-19 diagnosis and were hospitalized in Cheikh Khalifa International University Hospital, Casablanca, Morocco between March 26 and April 20, 2020. Patients were treated with a combination of hydroxychloroquine and azithromycin over a period of at least ten days. We were interested in the effects of this combination on the electrocardiogram. A total of 118 eligible patients were enrolled in the study. QT interval prolongation was observed in 19% of patients under the treatment. Only 5 patients required discontinuation of treatment. The factors associated with QT prolongation are male gender (P value 0,043), age over 68 years (P value 0,09), cardiovascular comorbidity (P value 0,013), tisdale score ≥11 (P value < 0,001), and a severe form of COVID-19 (P value < 0,001). First degree atrioventricular block was observed in 2 patients. No serious rhythm or conduction disorders were observed in this study. QT prolongation is a real risk with the combination of hydroxychloroquine and azithromycin. In the current context, it is necessary to select patients at high risk of severe rhythm disturbances that require closer ECG monitoring. Treatment should be discontinued if there are alarming signs such as QTc prolongation beyond 550 ms and the development of ventricular extrasystole or torsade de pointe.

A misleading CMV myocarditis during the COVID-19 pandemic: case report.

Coronavirus disease 2019 (COVID-19) has been reported as the possible cause of acute myocarditis. Myocarditis is an inflammatory heart disease mostly caused by viral infections. Cytomegalovirus (CMV) primary infection is often not suspected as a cause of myocarditis in immune-competent adults. We report the case of a 37-year-old male admitted with fever, cough and dyspnea. Chest CT showed typical ground-glass changes indicative of viral pneumonia. He was tested negative for COVID-19 but had biological markers that made us still suspect it. He had elevated troponin I level (up to 111.5 ng/mL) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF). He was diagnosed with CMV myocarditis with cardiac insufficiency and totally recovered without antiviral therapy. During the COVID-19 pandemic patients may develop myocarditis, still every myocarditis is not a COVID infection. Myocarditis linked to CMV infection may be rare, but life-threatening.