OBSERVATIONAL STUDY ON CLINICAL FEATURES, TREATMENT AND OUTCOME OF COVID 19 IN A TERTIARY CARE CENTRE IN INDIA -A RETROSPECTIVE CASE SERIES
Dr Raja Bhattacharya, Dr Indranil Ray, Dr Rishav Mukherjee, Dr Sampurna Chowdhury, Dr Manish Kulasreshtha
INTRODUCTION Since December 2019, the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which started as an outbreak in Wuhan, China has spread rapidly as a pandemic around the world, causing (1) multi organ dysfunction most prominent of which are coronavirus disease 19 (COVID-19) pneumonia, acute respiratory distress syndrome (ARDS), cardiac injury, liver and renal injury, thrombosis including Pulmonary Embolism and Stroke, and death (2) Although the exact pathophysiology behind COVID19 infection is still unknown, it is primarily known to affect the Respiratory System although other systems including Neurological manifestation are recently coming to light. Structural and functional analysis showed (3) that the spike for SARS-CoV-2 also bound to ACE2 whose (4)(5)(6)
References
Atri, Siddiqi, Lang, COVID-19 for the Cardiologist: A Current Review of the Virology, Clinical Epidemiology, Cardiac and Other Clinical Manifestations and Potential Therapeutic Strategies, JACC Basic Transl Sci,
doi:10.1016/j.jacbts.2020.04.002Caly, Druce, Catton, Jans, Wagstaff The FDAapproved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro; Antiviral Re-search
Fedson, Opal, Rordam, Hiding in plain sight: an approach to treating
Gavriilaki, Brodsky, Severe COVID-19 infection and thrombotic microangiopat h y : s u c c e s s d o e s n o t c o m e e a s i l, B r J H a e m a t,
doi:10.1111/bjh.16783Gotz, Inuenza A viruses escape from MxA restriction at the expense of ef-cient nuclear vRNP import, Sci. Rep
Hagiwara, Ishii, Kitamura, Aerosolized administration of N-acetylcysteine attenuates lung brosis induced by bleomycin in mice, Am J Respir Crit Care Med
Letko, Marzi, Munster, Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses, Journal
Lundberg, Nuclear import and export inhibitors alter capsid protein distribution in mammalian cells and reduce Venezuelan Equine Encephalitis Virus replication Antivir, Res
Mark A Ellul, Benjamin, Singh, Lant, Michael et al., Neurological associations of COVID, Lancet Neurol
Masoompour, Anushiravani, Tafaroj Norouz, Evaluation of the effect of nebulized N-acetylcysteine on respiratory secretions in mechanically ventilated patients: ran-domized clinical trial, Iran J Med Sci
Miller, Rivero, Ziad, Smith, Elamin, Inuence of nebulized unfractionated heparin and N-acetylcysteine in acute lung injury after smoke inhalation injury, J Burn Care Res
Peter Horby, Wei Shen Lim, Emberson, Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report The RECOVERY Collaborative Group* The new england journal of medicine
Qin, Zhou, Hu, Zhang, Yang et al., Dysregulation of immune response in patients with COVID-19 in Wuhan, Chi, Journal,
doi:10.1093/cid/ciaa248Radtke, Coles, Mishra, Orchard, Holmay et al., Interaction of N-acetylcysteine and cysteine in human plasma, J Pharm Sci
Siang, Kow & Hasan, Syed, Use of low-molecular-weight heparin in COVID-19 patients, Journal of Vascular Surgery
Tay, Nuclear localization of dengue virus (DENV) 1-4 non-structural protein 5; protection against all 4 DENV serotypes by the inhibitor Ivermectin Antivir, Res
Ueno, Lee, Wagner, Effect of N-acetylcysteine on gas exchange after methacholine challenge and isoprenaline inhalation in the dog, Eur Respir J
Wagstaff, Ivermectin is a specic inhibitor of importin alpha/beta-mediated nuclear import able to inhibit replication of HIV-1 and dengue virus, Biochem. J
Walls, Park, Tortorici, Wall, Mcguire et al., Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein, Journal,
doi:10.1016/j.cell.2020.02.058Zhang, Ding, Li, Wang, Chen et al., Effects of N-acetylcysteine treatment in acute respiratory distress syndrome: a meta-analysis, Exp Ther Med
Zhou, Fu, Zheng, Wnag, Zhao et al., Pathogenic T cells and inammatory monocytes incite inammatory storm in severe COVID-19 patients, Journal
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'abstract': '<jats:p>Till date, no proven therapy exists for treatment of SARS-coV-2 infections which has '
'been de-clared a pandemic by WHO in March, 2020. Objective: This study will attempt to '
'explore the demographic profile and outcome in the pa-tients receiving multidisciplinary, '
'personalised approach including use of Broad Spectrum Antivi-rals - Ivermectin, '
'anti-inflammatory and antioxidants roles of Statins and N-acetyl-cysteine along with Standard '
'of Care (SOC) in hospitalised COVID19 patients in a tertiary care centre. Setting: Inpatient '
'department (designated COVID ward) Participants: COVID-19 patients with laboratory confirmed '
'severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the year 2020 '
'between June 14- 28, 2020. Main outcome measures: The outcome of Interests are : a. Studying '
'the demographic profile of COVID 19 cases b. Study the treatment outcomes in terms of death '
'or discharge in patients receiving Ivermectin+N-acetyl-cysteine+Statin along with Standard of '
'care. Results: 148 patients were included in the study. All of them had confirmed COVID19 '
'infec-tion by the rtPCR method. Average age of the patients was 57.57 years ( Range = 17 - '
'88), 49% were male, 51% female. 81% of the patients had at least one or more comorbidities. '
'Most com-mon comorbidities included diabetes( 32%), Hypertension (27%),Ischaemic Heart '
'Disease (8%). More comorbidities. The in hospital, Case Fatality Rate was 1.35 %. The '
'remaining 146 were dis-charged from the facility after an average 12 days duration of stay. '
'Conclusions:. Triple therapy with Ivermectin, N-acetyl-cysteine and Atorvastatin along with '
'standard of care is safe and effective in SARS-coV-2 infection.</jats:p>',
'DOI': '10.36106/ijsr/7232245',
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'title': 'OBSERVATIONAL STUDY ON CLINICAL FEATURES, TREATMENT AND OUTCOME OF COVID 19 IN A TERTIARY CARE '
'CENTRE IN INDIA - A RETROSPECTIVE CASE SERIES',
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'J Infect Dis 2020;94:44-48. https://doi.org/10.1016/j.ijid.2020.03.004 '
'[published Online First: 2020/03/17]',
'DOI': '10.1016/j.ijid.2020.03.004'},
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'unstructured': '2. Atri D, Siddiqi HK, Lang J, et al. COVID-19 for the Cardiologist: A '
'Current Review of the Virology, Clinical Epidemiology, Cardiac and Other '
'Clinical Manifestations and Potential Therapeutic Strategies. JACC Basic '
'Transl Sci 2020;5(5):518-36. doi: 10.1016/j.jacbts.2020.04.002 '
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'DOI': '10.1016/j.jacbts.2020.04.002'},
{ 'key': 'ref2',
'doi-asserted-by': 'publisher',
'unstructured': '3. Neurological associations of COVID-19 Mark A Ellul, Laura Benjamin, '
'Bhagteshwar Singh, Suzannah Lant, Benedict Daniel Michael, Ava Easton, '
'Rachel Kneen, Sylviane Defres, Jim Sejvar, Tom Solomon Lancet Neurol '
'2020',
'DOI': '10.2139/ssrn.3589350'},
{ 'key': 'ref3',
'doi-asserted-by': 'crossref',
'unstructured': '4. Chen Y., Guo Y., Pan Y., Zhao Z.J. Structure analysis of the receptor '
'binding of 2019-nCoV. Journal. 2020 doi: 10.1016/j.bbrc.2020.02.071.',
'DOI': '10.1016/j.bbrc.2020.02.071'},
{ 'key': 'ref4',
'doi-asserted-by': 'publisher',
'unstructured': '5. Walls A.C., Park Y.J., Tortorici M.A., Wall A., McGuire A.T., Veesler '
'D. Structure, function, and antigenicity of the SARS-CoV-2 spike '
'glycoprotein. Journal. 2020 doi: 10.1016/j.cell.2020.02.058.',
'DOI': '10.1101/2020.02.19.956581'},
{ 'key': 'ref5',
'doi-asserted-by': 'publisher',
'unstructured': '6. Letko M., Marzi A., Munster V. Functional assessment of cell entry '
'and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. '
'Journal. 2020;5:562–569.',
'DOI': '10.1038/s41564-020-0688-y'},
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'doi-asserted-by': 'publisher',
'unstructured': '7. Zhou Y., Fu B., Zheng X., Wnag D., Zhao C., Qi Y., Sun R., Tian Z., '
'Xu X., Wei H. Pathogenic T cells and inflammatory monocytes incite '
'inflammatory storm in severe COVID-19 patients. Journal. 2020',
'DOI': '10.1093/nsr/nwaa041'},
{ 'key': 'ref7',
'doi-asserted-by': 'crossref',
'unstructured': '8. Qin C., Zhou L., Hu Z., Zhang S., Yang S., Tao Y., Xie C., Ma K., '
'Shang K., Wang W., Tian D.S. Dysregula-tion of immune response in '
'patients with COVID-19 in Wuhan, China. Journal. 2020 doi: '
'10.1093/cid/ciaa248.',
'DOI': '10.1093/cid/ciaa248'},
{ 'key': 'ref8',
'doi-asserted-by': 'crossref',
'unstructured': '9. Peter Horby, F.R.C.P., Wei Shen Lim, F.R.C.P., Jonathan R. Emberson, '
'Ph.D. Dexamethasone in Hospital-ized Patients with Covid-19 — '
'Preliminary Report The RECOVERY Collaborative Group* The new eng-land '
'journal of medicine, 2020',
'DOI': '10.1101/2020.06.22.20137273'},
{ 'key': 'ref9',
'doi-asserted-by': 'publisher',
'unstructured': '10. Chia Siang, Kow & Hasan, Syed. (2020). Use of low-molecular-weight '
'heparin in COVID-19 patients. Journal of Vascular Surgery. '
'10.1016/j.jvsv.2020.06.006',
'DOI': '10.1016/j.jvsv.2020.06.006'},
{ 'key': 'ref10',
'doi-asserted-by': 'publisher',
'unstructured': '11. V. Gotz, et al. Influenza A viruses escape from MxA restriction at '
'the expense of efficient nuclear vRNP import; Sci. Rep., 6 (2016), p. '
'23138',
'DOI': '10.1038/srep25428'},
{ 'key': 'ref11',
'unstructured': '12. L. Lundberg, et al.Nuclear import and export inhibitors alter capsid '
'protein distribution in mammalian cells and reduce Venezuelan Equine '
'Encephalitis Virus replication Antivir. Res., 100 (3) (2013), pp. '
'662-672'},
{ 'key': 'ref12',
'unstructured': '13. M.Y. Tay, et al.Nuclear localization of dengue virus (DENV) 1-4 '
'non-structural protein 5; protection against all 4 DENV serotypes by the '
'inhibitor Ivermectin Antivir. Res., 99 (3) (2013), pp. 301-306'},
{ 'key': 'ref13',
'doi-asserted-by': 'publisher',
'unstructured': '14. K.M. Wagstaff, et al.Ivermectin is a specific inhibitor of importin '
'alpha/beta-mediated nuclear import able to inhibit replication of HIV-1 '
'and dengue virus;Biochem. J., 443 (3) (2012), pp. 851-856',
'DOI': '10.1042/bj20120150'},
{ 'key': 'ref14',
'doi-asserted-by': 'publisher',
'unstructured': '15. Leon Caly,Julian D. Druce,Mike G. Catton,David A. Jans,Kylie M. '
'Wagstaff The FDA-approved drug ivermectin inhibits the replication of '
'SARS-CoV-2 in vitro; Antiviral Research June 2020',
'DOI': '10.1016/j.antiviral.2020.104787'},
{ 'key': 'ref15',
'doi-asserted-by': 'crossref',
'unstructured': '16. '
'RelloJ.etal.ClinicalphenotypesofSARS-CoV-2:Implicationsforcliniciansandresearchers.EurRespirJ.2020552001028https://doi.org/10.1183/13993003.01028-2020',
'DOI': '10.1183/13993003.01028-2020'},
{ 'key': 'ref16',
'doi-asserted-by': 'crossref',
'unstructured': '17. Varga Z. et al.Endothelial cell infection and endotheliitis '
'inCOVID-19.Lancet.2020;395:1417-1418 '
'https://doi.org/10.1016/S0140-6736(20)30937-5',
'DOI': '10.1016/S0140-6736(20)30937-5'},
{ 'key': 'ref17',
'doi-asserted-by': 'publisher',
'unstructured': '18. Gavriilaki E. Brodsky R.A. Severe COVID-19 infection and thrombotic '
'microangiopathy: success does not come easily. Br J Haematol. 2020; '
'https://doi.org/10.1111/bjh.16783',
'DOI': '10.1111/bjh.16783'},
{ 'key': 'ref18',
'doi-asserted-by': 'crossref',
'unstructured': '19. Fogarty H. et al.COVID-19 coagulopathy in Caucasian patients.Br J '
'Haematol. 2020; https://doi.org/10.1111/bjh.16749',
'DOI': '10.1111/bjh.16749'},
{ 'key': 'ref19',
'doi-asserted-by': 'publisher',
'unstructured': '20. Fedson D.S. Rordam O.M. Treating Ebola patients: a ‘bottom up’ '
'approach using generic statins and angi-otensin receptor blockers.Int J '
'Infect Dis. 2015; 36: 80-84https://doi.org/10.1016/j.ijid.2015.04.019',
'DOI': '10.1016/j.ijid.2015.04.019'},
{ 'key': 'ref20',
'doi-asserted-by': 'publisher',
'unstructured': '21. Fedson D.S. Opal S.M. Rordam O.M. Hiding in plain sight: an approach '
'to treating patients with severe COVID-19 infection.mBio. 2020; '
'11e00398-20https://doi.org/10.1128/mBio.00398-20',
'DOI': '10.1128/mbio.00398-20'},
{ 'key': 'ref21',
'doi-asserted-by': 'publisher',
'unstructured': '22. Radtke K.K., Coles L.D., Mishra U., Orchard P.J., Holmay M., Cloyd '
'J.C. Interaction of N-acetylcysteine and cysteine in human plasma. J '
'Pharm Sci. 2012;101:4653–4659',
'DOI': '10.1002/jps.23325'},
{ 'key': 'ref22',
'doi-asserted-by': 'crossref',
'unstructured': '23. Zhang Y., Ding S., Li C., Wang Y., Chen Z., Wang Z. Effects of '
'N-acetylcysteine treatment in acute respira-tory distress syndrome: a '
'meta-analysis. Exp Ther Med. 2017;14:2863–2868.',
'DOI': '10.3892/etm.2017.4891'},
{ 'key': 'ref23',
'doi-asserted-by': 'crossref',
'unstructured': '24. Ueno O., Lee L.N., Wagner P.D. Effect of N-acetylcysteine on gas '
'exchange after methacholine challenge and isoprenaline inhalation in the '
'dog. Eur Respir J. 1989;2:238–246.',
'DOI': '10.1183/09031936.93.02030238'},
{ 'key': 'ref24',
'unstructured': '25. Masoompour S.M., Anushiravani A., Tafaroj Norouz A. Evaluation of '
'the effect of nebulized N-acetylcysteine on respiratory secretions in '
'mechanically ventilated patients: randomized clinical trial. Iran J Med '
'Sci. 2015;40:309–315.'},
{ 'key': 'ref25',
'doi-asserted-by': 'publisher',
'unstructured': '26. Hagiwara S.I., Ishii Y., Kitamura S. Aerosolized administration of '
'N-acetylcysteine attenuates lung fibrosis induced by bleomycin in mice. '
'Am J Respir Crit Care Med. 2000;162:225–231.',
'DOI': '10.1164/ajrccm.162.1.9903129'},
{ 'key': 'ref26',
'doi-asserted-by': 'publisher',
'unstructured': '27. Miller A.C., Rivero A., Ziad S., Smith D.J., Elamin E.M. Influence '
'of nebulized unfractionated heparin and N-acetylcysteine in acute lung '
'injury after smoke inhalation injury. J Burn Care Res. 2009;30:249–256.',
'DOI': '10.1097/bcr.0b013e318198a268'},
{ 'key': 'ref27',
'unstructured': '28. CLINICAL MANAGEMENT PROTOCOL:COVID-19Government of India Ministry of '
'Health and Family Welfare Directorate General of Health Services(EMR '
'Division)Version 4 27.06.20 Retrieved from https://www.mohfw.gov.in'},
{ 'key': 'ref28',
'unstructured': '29. COVID-19 INDIA as on : 05 August 2020, 08:00 IST (GMT+5:30) '
'Retrieved from https://www.mohfw.gov.in'}],
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