This document discusses using convalescent plasma therapy to treat critically ill COVID-19 patients. It provides background on using convalescent plasma to treat emerging infectious diseases. Limited data from China suggests convalescent plasma therapy provided clinical benefits for COVID-19 patients, including reduced viral loads and improved survival. However, there are challenges in recruiting eligible donors and ensuring the plasma contains sufficient neutralizing antibodies against SARS-CoV-2.
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
Treatment of COVID-19; old tricks for new challengesLuisaSarlat
Coronavirus disease (COVID-19), which appeared in December 2019, presents a global challenge, particularly in the rapid increase of critically ill patients with pneumonia and absence of definitive treatment. To date, over 81,000 cases have been confirmed, with over 2700 deaths. The mortality appears to be around 2%; early published data indicate 25.9% with SARS-CoV-2 pneumonia required ICU admission and 20.1% developed acute respiratory distress syndrome
To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
Treatment of COVID-19; old tricks for new challengesLuisaSarlat
Coronavirus disease (COVID-19), which appeared in December 2019, presents a global challenge, particularly in the rapid increase of critically ill patients with pneumonia and absence of definitive treatment. To date, over 81,000 cases have been confirmed, with over 2700 deaths. The mortality appears to be around 2%; early published data indicate 25.9% with SARS-CoV-2 pneumonia required ICU admission and 20.1% developed acute respiratory distress syndrome
To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
O ptimization of hyrozycloroquine in mangement of covid 19Ahmed Ali
A published article which explains in details why hydroxychloroquine provided conflicting results in Covid-19. This because reflection of its pharmacokinetics, especially ion traping.
Should All Patients Having Planned Procedures or Surgeries Be Tested for COVI...JohnJulie1
The current pandemic of Corona Virus Disease-2019 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) has resulted in lockdown in many countries culminating in a major socio-economic crisis globally. COVID-19 can remain asymptomatic and so is crucial for early diagnosis to prevent further spread of this pandemic.
Should All Patients Having Planned Procedures or Surgeries Be Tested for COVI...suppubs1pubs1
The current pandemic of Corona Virus Disease-2019 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) has resulted in lockdown in many countries culminating in a major socio-economic crisis globally. COVID-19 can remain asymptomatic and so is crucial for early diagnosis to prevent further spread of this pandemic. Here we highlight the importance of screening asymptomatic patients prior to elective surgery, procedure or scheduled hospital admission. This analysis was done for the month of July 2020 during which 261 asymptomatic people were screened for COVID-19. Out of this, 6 patients (2.29%) were diagnosed to have COVID-19 on nasopharyngeal/ oropharyngeal swabs and subsequently had to delay their elective procedure or surgery. This clearly shows how important it is to screen this cohort of asymptomatic people who could potentially have spread the virus to other patients as well as healthcare professionals.
A broad perspective on COVID-19: a global pandemic and a focus on preventive ...LucyPi1
Abstract Coronavirus 2019 has become a highly infectious disease caused by severe acute respiratory syndrome coronavirus-2, a strain of novel coronavirus, which challenges millions of global healthcare facilities. Coronavirus are sub-microscopic, single stranded positive sense RNA viruses that leads to multi organ dysfunction syndrome, severe acute and chronic respiratory distress syndrome and pneumonia. The spike glycoprotein structure of the virus causes the viral protein to bind with the receptors on the lung and gut through angiotensin-converting enzyme 2. In some cases, the infected patients become hyper to the immune system because of the uncontrolled production of cytokines resulting in “cytokine storm”, a devastating consequence of coronavirus disease 2019. Due to the rapid mutant strain and infective nature of severe acute respiratory syndrome coronavirus-2, discovering a drug or developing a vaccine remains a global challenge. However, some anti-viral agents, certain protease inhibitor drugs, non-steroidal inflammatory drugs and convalescent plasma treatment were suggested. The containment and social distancing measures only aim at reducing the rate of new infections. In this view, we suggest certain traditional herbs and complementary and alternative medicine as a supporting public healthcare measure to boost the immune system and also may provide some lead to treat and prevent this infection.
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help
clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale
for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
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263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
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In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
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3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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NVBDCP.pptx Nation vector borne disease control program
167th publication jamdsr- 7th name
1. Khanna SS et al. Convalescent plasma therapy for coronavirus in critically ill patients.
57
Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 4| April 2020
Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 82.06
Review Article
Convalescent Plasma Therapy for Coronavirus in Critically ill Patients
Shilpa Sunil Khanna1
, Mohd Abdul Qayyum2
, Rashmi Banjare Patley3
, Abhishek Patley4
, Dhananjay Rathod5
,
Rishabh Shah6
, Rahul Vinay Chandra Tiwari7
1
M.D.S, Department of Oral and Maxillofacial Surgery, Senior Lecturer, Sri Ramakrishna Dental College and
Hospital, Coimbatore, Tamil Nadu;
2
Dental Surgeon, Pro Dent Advanced Dental Care, Hyderabad, Telangana;
3
BDS, Dental surgeon, District Hospital, Mungeli, Chhattisgarh;
4
PG FELLOW, Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research
Institute, Bilaspur, Chhattisgarh;
5
Assistant professor, Department of Orthodontics, Hazaribagh college of Dental Sciences, Hazaribagh,
Jharkhand;
6
Senior Lecturer , Department of Oral & Maxillofacial Surgery, K. M. Shah Dental College & Hospital,
Sumandeep Vidyapeeth, Pipariya, Waghodia, Vadodara, Gujarat;
7
FOGS, MDS, Consultant Oral & Maxillofacial Surgeon, CLOVE Dental & OMNI Hospitals, Visakhapatnam,
Andhra Pradesh, India
ABSTRACT:
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease (COVID-19), has
spurred a global health crisis. To date, there are no proven options for prophylaxis for those who have been exposed to
SARS-CoV-2, nor therapy for those who develop COVID-19. Immune (i.e. “convalescent”) plasma refers to plasma that is
collected from individuals, following resolution of infection and development of antibodies. Passive antibody administration
through transfusion of convalescent plasma may offer the only short-term strategy to confer immediate immunity to
susceptible individuals. Convalescent plasma has also been used in the COVID-19 pandemic; limited data from China
suggest clinical benefit, including radiological resolution, reduction in viral loads and improved survival. Globally, blood
centers have robust infrastructure to undertake collections and construct inventories of convalescent plasma to meet the
growing demand. Nonetheless, there are nuanced challenges, both regulatory and logistical, spanning donor eligibility, donor
recruitment, collections and transfusion itself.
Keywords Coronavirus, Convalescent plasma therapy, neutralizing antibodies.
Received: 23 March, 2020 Accepted: 3 April, 2020
Corresponding author: Dr. Shilpa Sunil Khanna, M.D.S, Department of Oral and Maxillofacial Surgery,
Senior Lecturer, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India
This article may be cited as: Khanna SS, Qayyum MA, Patley RB, Patley A, Rathod D, Shah R, Tiwari RVC.
Convalescent Plasma Therapy for Coronavirus in Critically ill Patients. J Adv Med Dent Scie Res 2020;8(4):57-
60.
INTRODUCTION
Convalescent blood product therapy has been
introduced since early 1900s to treat emerging
infectious disease based on the evidence that
polyclonal neutralizing antibodies can reduce duration
of viremia. Recent large outbreaks of viral diseases
for whom effective antivirals or vaccines are still
lacking has revamped the interest in convalescent
plasma as life-saving treatments. Recent viruses with
pandemic potential include flaviviruses (e.g. West
Nile virus, dengue virus, Zika virus), chikungunya
virus, influenza viruses A, e.g. H1N1, H5N1, Ebola
virus, and respiratory beta coronaviruses (SARS-CoV,
MERS-CoV, and SARS-CoV2). Transfusion of
convalescent blood products (CBP), especially
convalescent plasma (CP), are useful against
emerging infectious agents if the latter induces
neutralizing antibodies.1
(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805
2. Khanna SS et al. Convalescent plasma therapy for coronavirus in critically ill patients.
58
Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 4| April 2020
Since December 2019, a pneumonia associated with
severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), named as coronavirus disease 2019
(COVID-19) by World Health Organization (WHO),
emerged in Wuhan, China.2
The epidemic spread
rapidly worldwide within 3 months and was
characterized as a pandemic by WHO on March 11,
2020. As of April 16th, 2020, a total of 20,83,913
confirmed cases and 1,34,658 deaths had been
reported worldwide and the count is still up as each
day passes on. Currently, there are no approved
specific antiviral agents targeting the novel virus,
while some drugs are still under investigation,
including Remdesivir and Lopinavir/Ritonavir.3
Moreover, the corticosteroid treatment for COVID-19
lung injury remains controversial, due to delayed
clearance of viral infection and complications.4
Since
the effective vaccine and specific antiviral medicines
are unavailable, it is an urgent need to look for an
alternative strategy for COVID-19 treatment,
especially among severe patients.5
A meta-analysis from 32 studies of SARS coronavirus
infection and severe influenza showed a statistically
significant reduction in the pooled odds of mortality
following CP therapy, compared with placebo or no
therapy (odds ratio, 0.25; 95% confidence interval,
0.14–0.45).6
However, the CP therapy was unable to
significantly improve the survival in the Ebola virus
disease, probably due to the absence of data of
neutralizing antibody titration for stratified analysis.7
Since the virological and clinical characteristics share
similarity among SARS, Middle East Respiratory
Syndrome (MERS), and COVID-19,8
CP therapy
might be a promising treatment option for COVID-19
rescue.9
Patients who have recovered from COVID-19
with a high neutralizing antibody titer may be a
valuable donor source of CP.5
Ideally in plasma therapy, the donors will donate
plasma by plasmapheresis, but where that is not
possible, whole blood can also be collected, with
plasma separation in the blood establishment. Plasma
obtained by plasmapheresis should be split before
freezing into 2-3 separate units (e.g. 3x200 ml). Final
products should be specifically labeled as COVID-19
Convalescent Plasma/Blood and stored in a dedicated
location. Any serious adverse reactions in the donor
should be notified to the competent authority without
delay. It is strongly recommended that defined SARS-
CoV-2 neutralizing antibody titers be measured in the
donated plasma. It is suggested that neutralizing
antibody titers should optimally be greater than 1:320,
but lower thresholds might also be effective. Clinical
symptoms and laboratory parameters– according to
the disease progression scale by WHO (Table 1)
should be noted especially during transfusion, after 5
days and after discharge from the hospital.10
Table 1: WHO Progression scale
OMS progression
scale
Descriptor Score
Uninfected Uninfected, No Viral RNA detected 0
Ambulatory Asymptomatic, Viral RNA detected 1
Ambulatory Symptomatic, Independent 2
Ambulatory Symptomatic Assistance needed 3
Hospitalized: Mild
disease
Hospitalized; no oxygen therapy 4
Hospitalized: Mild
disease
Hospitalized; Oxygen by mask or nasal prongs 5
Hospitalized: Severe
disease
Hospitalized; Oxygen by NIV or High flow 6
Hospitalized: Severe
disease
Intubation and Mechanical Ventilation 7
Hospitalized: Severe
disease
Mechanical Ventilation (conditional use of vasopressors like
norepinephrine)
8
Hospitalized: Severe
disease
Mechanical Ventilation+ vasopressors or Dialysis or ECMO 9
Death Dead 10
NIV-Non-Invasive Ventilation, ECMO-Extracorporeal membrane oxygenation
3. Khanna SS et al. Convalescent plasma therapy for coronavirus in critically ill patients.
59
Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 4| April 2020
DISCUSSION
Severe pneumonia caused by human coronavirus was
characterized by rapid viral replication, massive
inflammatory cell infiltration, and elevated
proinflammatory cytokines or even cytokine storm in
alveoli of lungs, resulting in acute pulmonary injury
and acute respiratory distress syndrome (ARDS).11
Recent studies on COVID-19 demonstrated that the
lymphocyte counts in the peripheral blood were
remarkably decreased and the levels of cytokines in
the plasma from patients requiring intensive care unit
(ICU) support, including IL-6, IL-10, TNF-ɑ, and
granulocyte-macrophage colony-stimulating factor,
were significantly higher than in those who did not
require ICU conditions.12
CP, obtained from
recovered COVID-19 patients who had established
humoral immunity against the virus, contains a large
quantity of neutralizing antibodies capable of
neutralizing SARS-CoV-2 and eradicating the
pathogen from blood circulation and pulmonary
tissues.13
The key factors associated with CP therapy is the
neutralizing antibody titer as well as efficacy. A small
sample study in MERS-CoV infection showed that the
neutralizing antibody titer should exceed 1:80 to
achieve effective CP therapy.14
To find eligible
donors who have high levels of neutralizing antibody
is a prerequisite. Cao et al. showed that the level of
specific neutralizing antibody to SARS-CoV
decreased gradually 4 months after the disease
process, reaching undetectable levels in 25.6% (IgG)
and 16.1% (neutralizing antibodies) of patients at 36
months after disease status.15
A study from the
MERS-CoV−infected patients and the exposed
healthcare workers showed that the prevalence of
MERS-CoV IgG sero-reactivity was very low (2.7%),
and the antibodies titer decreased rapidly within 3
months.16
These studies suggested that the
neutralizing antibodies represented short lasting
humoral immune response, and plasma from recently
recovered patients should be more effective.5
Studies have shown that viral loads are highly
correlated with disease severity and progression.17
Fatal outcome of human influenza A(H5N1) has been
associated with high viral load and
hypercytokinemia.18
Apart from antiviral treatment,
virus specific neutralizing antibody, which could
accelerate virus clearance and prevent entry into target
cells, serves as the main mechanism for the restriction
and clearance of the viruses by the host.19
Notably, a small retrospective case-comparison study
(19 vs 21 patients) showed a case fatality rate
reduction after convalescent plasma treatment of 23%
(95% CI: 6%-42%, p=0,049)16. Each patient received
200 to 400 ml of plasma. Also, a case series including
80 treated patients reported an overall mortality rate
of 12,5% in severe deteriorating SARS-CoV -
infected patients while the overall SARS-related
mortality rate in Hong-Kong was 17% during the
SARS epidemic in 2003.20
The mean volume of
plasma infused was 279 + 127 ml (range 160-640 ml).
Interestingly, a subgroup analysis found that those
treated with a PCR positive but seronegative for
SARS-CoV-1 has a significantly better outcome (i.e.
discharge by day 22 vs after day 22 or death) than
those who were seropositive at the time of plasma
infusion (61% vs 21%, p<0.001). Similarly, those
receiving convalescent plasma before (versus after) 14
days after onset of symptoms were found to have a
better outcome. In multivariate analysis, the time of
convalescent plasma was reported to stay
significant.21
In a convalescent plasma trial for Ebola disease we
contributed to in 2015, no serious adverse events were
reported in 99 patients (minor adverse events were
observed 8% of patients, mostly an increase in
temperature (5%) and/or itching or skin rash (4%)).
Notably, 2 case reports of possible transfusion-related
acute lung injury (TRALI) following convalescent
plasma have been reported in a patient with Ebola
disease19 and patient with MERS-CoV20. In both
cases, transfused plasma were found free of anti-HLA
or anti-HNA Ab. 21
Peak in viral load in SARS patients has been reported
to coincide with the first appearance of an Ab
response. In vitro, higher concentration of Ab
collected from SARS-CoV(1) -infected patients (i.e.
non-convalescent) facilitated SARS-CoV(1) infection
and induced higher levels of virus-induced
apoptosis.22
Importantly, this phenomenon occurred
via anti-spike (S) Ab that mediated ADE, but not via
anti-nucleocapsid (N) Ab21,28. A possibly relevant
observation is that temporal changes in S-specific and
N-specific neutralizing Ab responses may differ
significantly in patients who have either recovered
from or succumbed to SARS-CoV(1) infection. In
comparison to patients who subsequently died,
recovered patients had a delayed but sustained
increase in (serum) neutralizing Ab titers with an
increasing contribution of anti N Ab (not observed in
patients that subsequently died). Increasing Ab
affinity is most probably occurring as well. Lastly,
long-term persistence of robust Ab (and cytotoxic T
cell responses) has been reported in patients infected
with SARS CoV-1. Interestingly, very recent data in
COVID-19 patients indicates seroconversion
occurring after 6-12 days, but not followed by rapid
decline in viral load. This later finding is compatible
with a suboptimal endogenous early Ab response with
regard to SARS-CoV-2 replication.21
CONCLUSION
COVID-19 requires urgent development of successful
curative treatment modalities. Convalescent plasma
may be one of them. Making such plasma available
and rigorous clinical evaluation of such an approach is
a priority in a number of jurisdictions.
4. Khanna SS et al. Convalescent plasma therapy for coronavirus in critically ill patients.
60
Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 4| April 2020
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