Tofacitinib in Patients Hospitalized With Moderate and Severe COVID-19: Not Just Another Kinase Inhibitor.

Background There has been an intense search for pharmacological agents that can complement corticosteroid therapy in the treatment of severe coronavirus disease 2019 (COVID-19). The Janus kinase inhibitor tofacitinib has shown promise in this regard. This study aimed to determine the impact of adding tofacitinib to standard care on the mortality and total duration of hospital stay in severe COVID-19. Methodology This retrospective study compared the mortality and total duration of hospital stay among patients admitted with severe COVID-19 to a designated COVID-19 hospital in south India who had received tofacitinib in addition to standard care versus standard care alone. Medical case records of severe COVID-19 patients were retrieved and screened for inclusion. Categorical variables such as mortality were expressed as proportions and compared using the chi-square test, while continuous variables such as total duration of hospital stay were compared via the independent t-test. The odds ratio (OR) was calculated for the mortality difference between the two groups. P-values ≤0.05 were considered significant. Results Following the initial screening of 250 medical records, 186 patients were included in the final analysis, of whom 103 had received tofacitinib and 83 had received standard care. There was no significant difference in mortality between the two groups (OR = 1.58 (95% confidence interval = 0.71 to 3.51); p = 0.26). The total duration of hospital stay was significantly longer among those in the tofacitinib group (17.14 ± 8.85 days vs. 14.04 ± 5.48 days; p = 0.01). Conclusions Tofacitinib did not improve the clinical outcomes when used to supplement corticosteroids in the treatment of severe COVID-19.

A study to evaluate the role of eosinophil count as a prognostic marker for assessing the outcome in patients with COVID-19 infection.

Background and Objectives: The triaging of COVID-19 patients is of paramount importance to plan further management. There are several clinical and laboratory parameters that help in categorizing the disease severity, triaging, and prognostication. Little is known about the prognostic significance of eosinopenia in predicting the severity of COVID-19 from large hospital data, especially from low- and middle-income countries. The objective of this study is to evaluate the level of eosinopenia as an early prognostic marker for assessing the outcomes in COVID-19 patients and to assess the superiority of eosinopenia as a prognostic marker for assessing the outcomes in COVID-19 patients compared to lymphopenia and neutrophil-to-lymphocyte ratio (NLR). Methods: The study was carried out in a tertiary care hospital. A retrospective longitudinal approach was adopted wherein the hospital records of COVID-19 patients were analyzed. In our study, two separate groups of patients were included for analysis to describe the association between initial eosinophil counts of the patients and the clinical outcomes. In the first group, the disease severity in terms of clinical and radiological parameters was compared in patients of COVID-19 presenting with and without the presence of initial eosinopenia. Commonly used markers for triage, namely lymphopenia and NLR, were compared with the presence of initial eosinopenia among the patients who progressed to moderate and severe disease. In the second group, an analysis of eosinopenia was made among the patients who succumbed to the illness. Results: It was seen that 29.6% of patients with eosinopenia had moderate and severe disease compared to those without eosinopenia where only 10.8% had moderate disease, none had severe disease. It was seen that 19.7% of patients with eosinopenia but no lymphopenia had more severe disease compared to patients with lymphopenia but no eosinopenia where 10.8% of the patients had moderate disease, none had severe disease. In patients younger than 60 years who died of COVID-19, it was found that initial eosinopenia was found in 86%, whereas a high NLR >17 was seen in only 25.6% of patients who died, thus implying that is eosinopenia is an important marker of disease severity in COVID-19. Conclusions: Eosinopenia is an important parameter in the evaluation of COVID-19 and the presence of it should alert the clinicians regarding the further progression of the disease. It is not only an important marker but also an early marker for severe disease.

Clinical and Laboratory Profile of Patients Visiting the Post-COVID-19 Clinic at a Tertiary Care Hospital: A Cross-Sectional Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) survivors may continue experiencing diverse symptoms. This study portrays the clinical and laboratory profile of patients with post-acute sequelae of COVID-19'(PASC) at a tertiary care hospital in India.  Methodology: This cross-sectional study enrolled patients visiting the post-COVID-19 clinic three weeks after their acute COVID-19 illness. Their clinical, serological, and radiological characteristics were collected and analyzed. RESULTS: Of the 259 participants (age: 48.02±15.27 years; 62.25% men), 168 had PASC manifestations. The most frequently reported symptoms were fatigue (n=71(42.26%)), breathlessness (n=38(22.61%)), and cough (n=35(20.83%)). Patients with PASC had higher body mass index (28.24±5.02 vs. 26.26±3.65; p=0.002), history of hypertension (52 (30.95%) vs. 17 (18.6%); p=0.039), uncontrolled systolic blood pressure (37 (22.03) vs. 14 (15.38); p=0.042), and persistent chest x-ray abnormalities (34 (20.23) vs. 10 (10.98); p=0.048). CONCLUSION: Fatigue, breathlessness, and cough are common PASC symptoms. Hypertension, obesity, and abnormal chest x-ray findings at follow-up are potential risk factors for developing PASC.

Emerging SARS-CoV-2 Variants: A Review of Its Mutations, Its Implications and Vaccine Efficacy.

The widespread increase in multiple severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants is causing a significant health concern in the United States and worldwide. These variants exhibit increased transmissibility, cause more severe disease, exhibit evasive immune properties, impair neutralization by antibodies from vaccinated individuals or convalescence sera, and reinfection. The Centers for Disease Control and Prevention (CDC) has classified SARS-CoV-2 variants into variants of interest, variants of concern, and variants of high consequence. Currently, four variants of concern (B.1.1.7, B.1.351, P.1, and B.1.617.2) and several variants of interests (B.1.526, B.1.525, and P.2) are characterized and are essential for close monitoring. In this review, we discuss the different SARS-CoV-2 variants, emphasizing variants of concern circulating the world and highlight the various mutations and how these mutations affect the characteristics of the virus. In addition, we discuss the most common vaccines and the various studies concerning the efficacy of these vaccines against different variants of concern.