This study evaluated the effects of renin-angiotensin system (RAS) inhibitors on COVID-19 patients with hypertension. The study found that:
1) Patients receiving ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) had lower rates of severe disease and lower levels of the inflammatory marker IL-6 compared to those receiving other hypertension drugs.
2) ACEI/ARB therapy was associated with higher CD3 and CD8 T cell counts and lower peak viral loads.
3) The results suggest that continuing or prioritizing ACEIs/ARBs for hypertension treatment may improve clinical outcomes for COVID-19 patients with hypertension by reducing inflammation and modulating
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
The document discusses kidney involvement in COVID-19 patients. It notes that acute kidney injury (AKI) occurs in 3-9% of early COVID-19 patients, rising to 19-50% of ICU patients. AKI is associated with higher mortality, between 35-90% among those with COVID-19. Pathological findings include collapsing glomerulopathy and acute tubular injury. Viral particles have been found in podocytes and tubular cells on postmortem and kidney biopsy studies.
- The document provides guidelines for diagnosing and treating acute myocardial infarction (AMI) and protecting cardiologists during the COVID-19 outbreak.
- It outlines five general principles for AMI treatment, including near local treatment and safe protection of patients. It also provides flowcharts for diagnosing and managing STEMI and NSTEMI patients.
- Advice is given for outpatient management, including screening for fever and respiratory symptoms. Designated hospitals and isolation are recommended for suspected or confirmed COVID-19 patients needing intervention.
- Detailed prevention and control procedures are described for consultation of patients in fever clinics and emergency interventional procedures. Personal protective equipment and designated pathways are emphasized to protect cardiologists.
Evaluation of Cardiac Complications in Pateint Undergoing COVID 19 Treatment:...DrHeena tiwari
This study evaluated cardiac complications in 45 COVID-19 patients admitted to the intensive care unit. Electrocardiography and Holter monitoring found various arrhythmias in patients, with atrial fibrillation, premature ventricular contraction, and tachycardia being most common. The mortality rate of arrhythmias in COVID-19 patients was 17.77%. Although arrhythmias are not very frequent in COVID-19, they can be fatal and have a high mortality rate. Early detection of arrhythmias can help prevent deaths.
The document summarizes the link between hypertension (HTN) and COVID-19. It finds that approximately 22.5% of COVID-19 patients have HTN, making it the most common comorbidity. Patients with HTN who contract COVID-19 have a higher risk of severe outcomes like intensive care unit admission and death. The document also discusses how the renin-angiotensin-aldosterone system, which HTN medications target, may impact the interaction of the COVID-19 virus with the body. Specifically, angiotensin-converting enzyme 2 is utilized by the COVID-19 virus to enter cells and HTN medications like ACE inhibitors may alter ACE2 expression levels.
Ομιλία – Παρουσίαση: «Ρεμδεσιβίρη- η εμπειρία με την αντι-ιική θεραπεία στην πανδημία COVID-19»
Ιωάννης Κατσαρόλης, MD, PhD, Παθολόγος-Λοιμωξιολόγος, Associate Director Medical Affairs, HIV-Antifungals-COVID19, Gilead Sciences Hellas and Cyprus
Diabetes care in the time of Covid 19 2021 Prof Vinod PatelVinod0901
The document discusses diabetes care during the COVID-19 pandemic. It begins with the professor declaring interests and conflicts of interest. The rest of the document covers:
- Background on COVID-19 virus and global prevalence data
- Infection control strategies like masks and symptoms
- Risk factors for COVID-19 death like age, diabetes, and comorbidities
- Treatments for COVID-19 including dexamethasone and remdesivir
- Strategies for virtual consultations and protecting communities
- Coping strategies to reduce stress during the pandemic
It aims to inform healthcare professionals about caring for diabetes patients during the COVID-19 crisis.
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
The document discusses kidney involvement in COVID-19 patients. It notes that acute kidney injury (AKI) occurs in 3-9% of early COVID-19 patients, rising to 19-50% of ICU patients. AKI is associated with higher mortality, between 35-90% among those with COVID-19. Pathological findings include collapsing glomerulopathy and acute tubular injury. Viral particles have been found in podocytes and tubular cells on postmortem and kidney biopsy studies.
- The document provides guidelines for diagnosing and treating acute myocardial infarction (AMI) and protecting cardiologists during the COVID-19 outbreak.
- It outlines five general principles for AMI treatment, including near local treatment and safe protection of patients. It also provides flowcharts for diagnosing and managing STEMI and NSTEMI patients.
- Advice is given for outpatient management, including screening for fever and respiratory symptoms. Designated hospitals and isolation are recommended for suspected or confirmed COVID-19 patients needing intervention.
- Detailed prevention and control procedures are described for consultation of patients in fever clinics and emergency interventional procedures. Personal protective equipment and designated pathways are emphasized to protect cardiologists.
Evaluation of Cardiac Complications in Pateint Undergoing COVID 19 Treatment:...DrHeena tiwari
This study evaluated cardiac complications in 45 COVID-19 patients admitted to the intensive care unit. Electrocardiography and Holter monitoring found various arrhythmias in patients, with atrial fibrillation, premature ventricular contraction, and tachycardia being most common. The mortality rate of arrhythmias in COVID-19 patients was 17.77%. Although arrhythmias are not very frequent in COVID-19, they can be fatal and have a high mortality rate. Early detection of arrhythmias can help prevent deaths.
The document summarizes the link between hypertension (HTN) and COVID-19. It finds that approximately 22.5% of COVID-19 patients have HTN, making it the most common comorbidity. Patients with HTN who contract COVID-19 have a higher risk of severe outcomes like intensive care unit admission and death. The document also discusses how the renin-angiotensin-aldosterone system, which HTN medications target, may impact the interaction of the COVID-19 virus with the body. Specifically, angiotensin-converting enzyme 2 is utilized by the COVID-19 virus to enter cells and HTN medications like ACE inhibitors may alter ACE2 expression levels.
Ομιλία – Παρουσίαση: «Ρεμδεσιβίρη- η εμπειρία με την αντι-ιική θεραπεία στην πανδημία COVID-19»
Ιωάννης Κατσαρόλης, MD, PhD, Παθολόγος-Λοιμωξιολόγος, Associate Director Medical Affairs, HIV-Antifungals-COVID19, Gilead Sciences Hellas and Cyprus
Diabetes care in the time of Covid 19 2021 Prof Vinod PatelVinod0901
The document discusses diabetes care during the COVID-19 pandemic. It begins with the professor declaring interests and conflicts of interest. The rest of the document covers:
- Background on COVID-19 virus and global prevalence data
- Infection control strategies like masks and symptoms
- Risk factors for COVID-19 death like age, diabetes, and comorbidities
- Treatments for COVID-19 including dexamethasone and remdesivir
- Strategies for virtual consultations and protecting communities
- Coping strategies to reduce stress during the pandemic
It aims to inform healthcare professionals about caring for diabetes patients during the COVID-19 crisis.
1) Diabetes is identified as a risk factor for worse outcomes from COVID-19 based on studies from China. Mortality was 10% in COVID-19 patients with diabetes versus 2.5% for non-diabetic patients.
2) People with diabetes have an increased risk of severe COVID-19 infection due to defects in innate immunity from hyperglycemia and an increased inflammatory response.
3) The interaction between the SARS-CoV-2 virus and the renin-angiotensin-aldosterone system, which regulates blood pressure and fluid balance, may help explain the link between diabetes, hypertension, and increased COVID-19 severity. The virus relies on binding to ACE2 receptors to infect
This document discusses cytokine storm syndrome in patients with COVID-19. It defines cytokine storm as an uncontrolled release of inflammatory cytokines that can lead to organ damage. COVID-19 is proposed to progress through four stages, with stage II involving an excessive immune response and cytokine release. Cytokine storm is associated with acute respiratory distress syndrome and multi-organ failure in COVID-19 patients. The document outlines treatments for cytokine storm including immunomodulators, anticoagulants, antivirals, and extracorporeal therapies.
Γρηγόριος Γεροτζιάφας, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση:“Artificial intelligence and personalised medicine for patients at high risk of severe COVID-19”
Γρηγόριος Γεροτζιάφας, Καθηγητής Αιματολογίας, Ιατρική σχολή της Σορβόνης, Υπεύθυνος, Τμήμα Θρόμβωσης, Νοσοκομείο Tenon, Παρίσι & Διευθυντής, Ερευνητική Ομάδα Καρκίνος και Θρόμβωση INSERM U938
Network pharmacology studies on the effect of Chai-Ling decoction in coronavi...LucyPi1
Abstract Background: Chai-Ling decoction (CLD), derived from a modification of Xiao-Chai-Hu (XCH) decoction and Wu-Ling-San (WLS) decoction, has been used to treat the early-stage of coronavirus disease 2019 (COVID-19). However, the mechanisms of CLD in COVID-19 remain unknown. In this study, the potential mechanisms of CLD in COVID-19 were preliminarily investigated based on network pharmacology and molecular docking method. Methods: Initially, the active components and targets of CLD were screened based on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and PharmMapper database. The targets of COVID-19 were obtained from GeneCards database. The protein-protein interaction network was established using STRING database to analyze the key targets. Gene Oncology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes analysis were also conducted to evaluate the pathways related to the targets of CLD on COVID-19. Moreover, the compound-target-pathway network was established using Cytoscape 3.2.7. Subsequently, the molecular docking method was performed to select the active compounds with high binding affinity on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and angiotensin-converting enzyme 2 (ACE2), which is the key target of SARS-CoV-2 in entering target cells. The possible binding sites were also visualized by a three-dimensional graph. Results: Network pharmacology analysis showed that there were 106 active components and 160 targets of CLD. Additionally, 251 targets related to COVID-19 were identified, and 24 candidates of CLD on COVID-19 were selected. A total of 283 GO terms of CLD on COVID-19 were identified, and 181 pathways were screened based on GO and Kyoto Encyclopedia of Genes and Genomes analyses. CLD might alleviate the inflammatory response and improve lung injury to treat COVID-19 through interleukin 17 signaling, T helper cell 17 differentiation, tumor necrosis factor signaling, and hypoxia inducible factor-1 signaling. Besides, molecular docking indicated that beta-sitosterol, kaempferol, and stigmasterol were the top three candidates in CLD with the highest affinity to SARS-CoV-2 and ACE2. Conclusion: Our study identifies the potential mechanisms of CLD on COVID-19 and beta-sitosterol, kaempferol, and stigmasterol may be the key compounds that exert antiviral effects against SARS-CoV-2.
This document provides guidelines for managing dialysis and kidney transplant patients who are infected with COVID-19. It finds that these patients are at high risk for severe illness due to common comorbidities. Based on initial experience in Brescia, Italy, the disease progression can be severe, especially in transplant patients. The document establishes 7 categories of infected patients and outlines treatment plans depending on their symptoms and test results. It aims to help nephrology teams safely treat these high-risk patients during the COVID-19 pandemic.
The document describes a study on the effectiveness of tocilizumab in treating severe COVID-19 patients. 20 severe or critical COVID-19 patients were given tocilizumab in addition to routine therapy. Within days of treatment, patients saw improved symptoms, reduced oxygen needs, and absorption of lung lesions on CT scans. Inflammatory markers decreased and 19 of the 20 patients were discharged within about two weeks. The study provides evidence that tocilizumab is an effective treatment for severe COVID-19 patients by reducing the cytokine storm.
Μαρία Χριστοπούλου, MD, MSc, MBA, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση: «Αντιμετωπίζοντας την Covid 19 ως λοίμωξη, και πέρα από τη λοίμωξη»
Μαρία Χριστοπούλου, MD, MSc, MBA, Παθολόγος-Εντατικολόγος, Medical Advisor Pharmaserve-Lilly
Outcome of 16 years of hemodialysis infection controlJAFAR ALSAID
The study analyzed the outcomes of a tight infection control protocol over 16 years in a hemodialysis unit. The protocol was successful in limiting hemodialysis-related bloodstream infections and admissions. Specifically:
- The rate of hemodialysis-related bloodstream infections was 0.003 per 100 patient months, far below the international reported rate of 0.75-4.4 infections per 100 patient months.
- The admission rate for hemodialysis-related bloodstream infections was 0.4 per 1000 patient years, much lower than the international rate of 108 admissions per 1000 patient years.
- Only 12 patients experienced hemodialysis-related bloodstream infections over nearly 19 years and
Co-morbidities in AHF : Pulmonary disease.drucsamal
This document discusses the diagnostic challenges of distinguishing between heart failure and COPD based on symptoms and spirometry results. It notes that many patients diagnosed with COPD are later found to have undiagnosed heart failure, and that short-term use of short-acting beta-agonists in acute heart failure patients with wheezing may provide benefits. The case study describes an elderly patient referred for respiratory symptoms who is ultimately diagnosed with acute heart failure based on echocardiogram and biomarker results. The document cautions against overdiagnosing COPD and notes heart failure should be the primary treatment focus over inhalers.
PCR Assay Turned Positive in 25 Discharged COVID-19 PatientsValentina Corona
1) The study found that 14.5% (25/172) of discharged COVID-19 patients in China later tested positive again for the virus based on RT-PCR testing after being discharged from the hospital.
2) These patients met criteria for discharge but tested positive again within 2-13 days without worsening symptoms.
3) The study suggests that more than two negative RT-PCR tests separated by 48 hours or combining RT-PCR tests with antibody and other immunological markers may be needed to confirm viral clearance before discharge.
Nejm clinical outcomes of hydroxychlorquine in patients with covid19.pdf.pdfgisa_legal
This study evaluated the effects of hydroxychloroquine treatment in 63 hospitalized patients with COVID-19. Patients were divided into a hydroxychloroquine treatment group (32 patients) and a supportive care only group (31 patients). The primary outcomes measured were need for escalation of respiratory support, change in lymphocyte count, and change in neutrophil-to-lymphocyte ratio. The results showed that hydroxychloroquine treatment was associated with a higher need for escalation of respiratory support compared to the supportive care only group. There were no significant benefits of hydroxychloroquine treatment on lymphocyte counts or neutrophil-to-lymphocyte ratios. The study concludes that hydroxychloroquine did not provide benefits and
1. The document discusses SARS-CoV-2, the virus that causes COVID-19, including its transmission, clinical manifestations, risk factors, investigations, and management guidelines.
2. Key points include that SARS-CoV-2 is transmitted via droplets or contact and may cause asymptomatic to critical illness. Common symptoms include fever, cough and shortness of breath.
3. Older adults and those with pre-existing medical conditions are at higher risk for severe illness. Diagnosis is confirmed via RT-PCR testing of respiratory samples, while chest imaging may show pneumonia.
Mass general covid 19 treatment guideline july012020Adiel Ojeda
This document provides guidance for clinicians at Massachusetts General Hospital (MGH) on the treatment of COVID-19. It summarizes recommended diagnostic testing and risk stratification for hospitalized patients. It also provides guidance on therapeutic considerations, including anti-infectives, cardiovascular medications, antithrombotics, and COVID-19 specific treatments such as remdesivir. The document is regularly updated as new data emerges on the management of COVID-19.
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
Chair, Jamie E. Chaft, MD, and Jonathan D. Spicer, MD, PhD, FRCSC, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC/CC/NCPD activity titled “Marking New Milestones With Immunotherapy in Locally Advanced and Early Lung Cancer: Latest Data Informing Best Practices for Multimodal Management of Stage I-III NSCLC.” For the full presentation, downloadable Practice Aids and complete CME/MOC/CC/NCPD information, and to apply for credit, please visit us at https://bit.ly/3fcc3qs. CME/MOC/CC/NCPD credit will be available until July 11, 2022.
Constance Benson, MD
Professor of Medicine and Director of the UC San Diego
AntiViral Research Center
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This document summarizes clinical data from 53 patients with severe Covid-19 who were treated with the investigational antiviral remdesivir through a compassionate use program. Key findings include:
- 68% (36 patients) showed improvement in oxygen support needs, including 57% of those on mechanical ventilation being extubated.
- 47% (25 patients) were discharged from the hospital, and 13% (7 patients) died, with a higher mortality among those receiving invasive ventilation.
- Remdesivir appeared to have a favorable safety profile based on previous experience in Ebola patients, though efficacy will need to be determined through ongoing randomized controlled trials.
This document summarizes the impacts of COVID-19 on the cardiovascular system based on current literature. It discusses the pathophysiology of COVID-19 and how it interacts with the cardiovascular system via ACE2 receptors. Common cardiac manifestations include myocardial injury, myocarditis, acute coronary syndrome, arrhythmias, heart failure, and cardiogenic shock. Pre-existing cardiovascular disease is a risk factor for worse outcomes. Treatment focuses on supportive care and antiviral therapies, while preventive measures center on social distancing and protective equipment for healthcare workers. Ongoing research is exploring new treatments targeting the virus and inflammatory response.
This document discusses "long haulers" or patients experiencing persistent symptoms after acute COVID-19 infection. It provides epidemiological data showing a significant portion of patients reporting ongoing symptoms weeks or months after initial infection. Two case presentations are provided - one with a 73F experiencing dyspnea, fatigue and loss of taste months after hospitalization and found to have diastolic dysfunction. The second case is a 51F with intermittent cough and dyspnea for months with abnormal CT findings suggestive of organizing pneumonia. Management strategies are discussed for post-COVID headaches.
Renin - Angiotensin - Aldosterone System Inhibitors in Patients with Covid-19Valentina Corona
This document summarizes the current understanding of how medications that inhibit the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors and angiotensin receptor blockers (ARBs), may impact COVID-19. It notes that while animal studies have found mixed results on how these drugs affect ACE2 levels, human studies provide little evidence they increase ACE2. It also raises the possibility that ACE2 may be beneficial rather than harmful for lung injury in COVID-19. The document concludes more research is needed to understand the complex interactions between SARS-CoV-2 and the RAAS system in humans before making recommendations about RAAS inhibitor use in COVID-19 patients.
This document reviews potential pharmacologic treatments for COVID-19. It summarizes the virology of SARS-CoV-2 and potential drug targets. It reviews the in vitro activity and clinical experiences of repurposed drugs including chloroquine/hydroxychloroquine, lopinavir/ritonavir, and umifenovir. It also discusses investigational agents such as remdesivir. Over 300 clinical trials are evaluating potential COVID-19 treatments but currently no therapies have proven effective based on randomized clinical trial data.
1) Diabetes is identified as a risk factor for worse outcomes from COVID-19 based on studies from China. Mortality was 10% in COVID-19 patients with diabetes versus 2.5% for non-diabetic patients.
2) People with diabetes have an increased risk of severe COVID-19 infection due to defects in innate immunity from hyperglycemia and an increased inflammatory response.
3) The interaction between the SARS-CoV-2 virus and the renin-angiotensin-aldosterone system, which regulates blood pressure and fluid balance, may help explain the link between diabetes, hypertension, and increased COVID-19 severity. The virus relies on binding to ACE2 receptors to infect
This document discusses cytokine storm syndrome in patients with COVID-19. It defines cytokine storm as an uncontrolled release of inflammatory cytokines that can lead to organ damage. COVID-19 is proposed to progress through four stages, with stage II involving an excessive immune response and cytokine release. Cytokine storm is associated with acute respiratory distress syndrome and multi-organ failure in COVID-19 patients. The document outlines treatments for cytokine storm including immunomodulators, anticoagulants, antivirals, and extracorporeal therapies.
Γρηγόριος Γεροτζιάφας, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση:“Artificial intelligence and personalised medicine for patients at high risk of severe COVID-19”
Γρηγόριος Γεροτζιάφας, Καθηγητής Αιματολογίας, Ιατρική σχολή της Σορβόνης, Υπεύθυνος, Τμήμα Θρόμβωσης, Νοσοκομείο Tenon, Παρίσι & Διευθυντής, Ερευνητική Ομάδα Καρκίνος και Θρόμβωση INSERM U938
Network pharmacology studies on the effect of Chai-Ling decoction in coronavi...LucyPi1
Abstract Background: Chai-Ling decoction (CLD), derived from a modification of Xiao-Chai-Hu (XCH) decoction and Wu-Ling-San (WLS) decoction, has been used to treat the early-stage of coronavirus disease 2019 (COVID-19). However, the mechanisms of CLD in COVID-19 remain unknown. In this study, the potential mechanisms of CLD in COVID-19 were preliminarily investigated based on network pharmacology and molecular docking method. Methods: Initially, the active components and targets of CLD were screened based on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and PharmMapper database. The targets of COVID-19 were obtained from GeneCards database. The protein-protein interaction network was established using STRING database to analyze the key targets. Gene Oncology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes analysis were also conducted to evaluate the pathways related to the targets of CLD on COVID-19. Moreover, the compound-target-pathway network was established using Cytoscape 3.2.7. Subsequently, the molecular docking method was performed to select the active compounds with high binding affinity on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and angiotensin-converting enzyme 2 (ACE2), which is the key target of SARS-CoV-2 in entering target cells. The possible binding sites were also visualized by a three-dimensional graph. Results: Network pharmacology analysis showed that there were 106 active components and 160 targets of CLD. Additionally, 251 targets related to COVID-19 were identified, and 24 candidates of CLD on COVID-19 were selected. A total of 283 GO terms of CLD on COVID-19 were identified, and 181 pathways were screened based on GO and Kyoto Encyclopedia of Genes and Genomes analyses. CLD might alleviate the inflammatory response and improve lung injury to treat COVID-19 through interleukin 17 signaling, T helper cell 17 differentiation, tumor necrosis factor signaling, and hypoxia inducible factor-1 signaling. Besides, molecular docking indicated that beta-sitosterol, kaempferol, and stigmasterol were the top three candidates in CLD with the highest affinity to SARS-CoV-2 and ACE2. Conclusion: Our study identifies the potential mechanisms of CLD on COVID-19 and beta-sitosterol, kaempferol, and stigmasterol may be the key compounds that exert antiviral effects against SARS-CoV-2.
This document provides guidelines for managing dialysis and kidney transplant patients who are infected with COVID-19. It finds that these patients are at high risk for severe illness due to common comorbidities. Based on initial experience in Brescia, Italy, the disease progression can be severe, especially in transplant patients. The document establishes 7 categories of infected patients and outlines treatment plans depending on their symptoms and test results. It aims to help nephrology teams safely treat these high-risk patients during the COVID-19 pandemic.
The document describes a study on the effectiveness of tocilizumab in treating severe COVID-19 patients. 20 severe or critical COVID-19 patients were given tocilizumab in addition to routine therapy. Within days of treatment, patients saw improved symptoms, reduced oxygen needs, and absorption of lung lesions on CT scans. Inflammatory markers decreased and 19 of the 20 patients were discharged within about two weeks. The study provides evidence that tocilizumab is an effective treatment for severe COVID-19 patients by reducing the cytokine storm.
Μαρία Χριστοπούλου, MD, MSc, MBA, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση: «Αντιμετωπίζοντας την Covid 19 ως λοίμωξη, και πέρα από τη λοίμωξη»
Μαρία Χριστοπούλου, MD, MSc, MBA, Παθολόγος-Εντατικολόγος, Medical Advisor Pharmaserve-Lilly
Outcome of 16 years of hemodialysis infection controlJAFAR ALSAID
The study analyzed the outcomes of a tight infection control protocol over 16 years in a hemodialysis unit. The protocol was successful in limiting hemodialysis-related bloodstream infections and admissions. Specifically:
- The rate of hemodialysis-related bloodstream infections was 0.003 per 100 patient months, far below the international reported rate of 0.75-4.4 infections per 100 patient months.
- The admission rate for hemodialysis-related bloodstream infections was 0.4 per 1000 patient years, much lower than the international rate of 108 admissions per 1000 patient years.
- Only 12 patients experienced hemodialysis-related bloodstream infections over nearly 19 years and
Co-morbidities in AHF : Pulmonary disease.drucsamal
This document discusses the diagnostic challenges of distinguishing between heart failure and COPD based on symptoms and spirometry results. It notes that many patients diagnosed with COPD are later found to have undiagnosed heart failure, and that short-term use of short-acting beta-agonists in acute heart failure patients with wheezing may provide benefits. The case study describes an elderly patient referred for respiratory symptoms who is ultimately diagnosed with acute heart failure based on echocardiogram and biomarker results. The document cautions against overdiagnosing COPD and notes heart failure should be the primary treatment focus over inhalers.
PCR Assay Turned Positive in 25 Discharged COVID-19 PatientsValentina Corona
1) The study found that 14.5% (25/172) of discharged COVID-19 patients in China later tested positive again for the virus based on RT-PCR testing after being discharged from the hospital.
2) These patients met criteria for discharge but tested positive again within 2-13 days without worsening symptoms.
3) The study suggests that more than two negative RT-PCR tests separated by 48 hours or combining RT-PCR tests with antibody and other immunological markers may be needed to confirm viral clearance before discharge.
Nejm clinical outcomes of hydroxychlorquine in patients with covid19.pdf.pdfgisa_legal
This study evaluated the effects of hydroxychloroquine treatment in 63 hospitalized patients with COVID-19. Patients were divided into a hydroxychloroquine treatment group (32 patients) and a supportive care only group (31 patients). The primary outcomes measured were need for escalation of respiratory support, change in lymphocyte count, and change in neutrophil-to-lymphocyte ratio. The results showed that hydroxychloroquine treatment was associated with a higher need for escalation of respiratory support compared to the supportive care only group. There were no significant benefits of hydroxychloroquine treatment on lymphocyte counts or neutrophil-to-lymphocyte ratios. The study concludes that hydroxychloroquine did not provide benefits and
1. The document discusses SARS-CoV-2, the virus that causes COVID-19, including its transmission, clinical manifestations, risk factors, investigations, and management guidelines.
2. Key points include that SARS-CoV-2 is transmitted via droplets or contact and may cause asymptomatic to critical illness. Common symptoms include fever, cough and shortness of breath.
3. Older adults and those with pre-existing medical conditions are at higher risk for severe illness. Diagnosis is confirmed via RT-PCR testing of respiratory samples, while chest imaging may show pneumonia.
Mass general covid 19 treatment guideline july012020Adiel Ojeda
This document provides guidance for clinicians at Massachusetts General Hospital (MGH) on the treatment of COVID-19. It summarizes recommended diagnostic testing and risk stratification for hospitalized patients. It also provides guidance on therapeutic considerations, including anti-infectives, cardiovascular medications, antithrombotics, and COVID-19 specific treatments such as remdesivir. The document is regularly updated as new data emerges on the management of COVID-19.
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
Chair, Jamie E. Chaft, MD, and Jonathan D. Spicer, MD, PhD, FRCSC, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC/CC/NCPD activity titled “Marking New Milestones With Immunotherapy in Locally Advanced and Early Lung Cancer: Latest Data Informing Best Practices for Multimodal Management of Stage I-III NSCLC.” For the full presentation, downloadable Practice Aids and complete CME/MOC/CC/NCPD information, and to apply for credit, please visit us at https://bit.ly/3fcc3qs. CME/MOC/CC/NCPD credit will be available until July 11, 2022.
Constance Benson, MD
Professor of Medicine and Director of the UC San Diego
AntiViral Research Center
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This document summarizes clinical data from 53 patients with severe Covid-19 who were treated with the investigational antiviral remdesivir through a compassionate use program. Key findings include:
- 68% (36 patients) showed improvement in oxygen support needs, including 57% of those on mechanical ventilation being extubated.
- 47% (25 patients) were discharged from the hospital, and 13% (7 patients) died, with a higher mortality among those receiving invasive ventilation.
- Remdesivir appeared to have a favorable safety profile based on previous experience in Ebola patients, though efficacy will need to be determined through ongoing randomized controlled trials.
This document summarizes the impacts of COVID-19 on the cardiovascular system based on current literature. It discusses the pathophysiology of COVID-19 and how it interacts with the cardiovascular system via ACE2 receptors. Common cardiac manifestations include myocardial injury, myocarditis, acute coronary syndrome, arrhythmias, heart failure, and cardiogenic shock. Pre-existing cardiovascular disease is a risk factor for worse outcomes. Treatment focuses on supportive care and antiviral therapies, while preventive measures center on social distancing and protective equipment for healthcare workers. Ongoing research is exploring new treatments targeting the virus and inflammatory response.
This document discusses "long haulers" or patients experiencing persistent symptoms after acute COVID-19 infection. It provides epidemiological data showing a significant portion of patients reporting ongoing symptoms weeks or months after initial infection. Two case presentations are provided - one with a 73F experiencing dyspnea, fatigue and loss of taste months after hospitalization and found to have diastolic dysfunction. The second case is a 51F with intermittent cough and dyspnea for months with abnormal CT findings suggestive of organizing pneumonia. Management strategies are discussed for post-COVID headaches.
Renin - Angiotensin - Aldosterone System Inhibitors in Patients with Covid-19Valentina Corona
This document summarizes the current understanding of how medications that inhibit the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors and angiotensin receptor blockers (ARBs), may impact COVID-19. It notes that while animal studies have found mixed results on how these drugs affect ACE2 levels, human studies provide little evidence they increase ACE2. It also raises the possibility that ACE2 may be beneficial rather than harmful for lung injury in COVID-19. The document concludes more research is needed to understand the complex interactions between SARS-CoV-2 and the RAAS system in humans before making recommendations about RAAS inhibitor use in COVID-19 patients.
This document reviews potential pharmacologic treatments for COVID-19. It summarizes the virology of SARS-CoV-2 and potential drug targets. It reviews the in vitro activity and clinical experiences of repurposed drugs including chloroquine/hydroxychloroquine, lopinavir/ritonavir, and umifenovir. It also discusses investigational agents such as remdesivir. Over 300 clinical trials are evaluating potential COVID-19 treatments but currently no therapies have proven effective based on randomized clinical trial data.
Three studies found that patients with severe COVID-19 often had pre-existing conditions like hypertension and diabetes. These conditions are often treated with ACE inhibitors and ARBs, which increase levels of ACE2 - the receptor that SARS-CoV-2 uses to enter cells. This suggests that medications like ACE inhibitors and ARBs, which are used to treat hypertension and diabetes, may increase the risk of severe COVID-19 by upregulating ACE2. More research is needed to confirm this hypothesis and determine if alternative treatments could reduce this potential risk.
This document reviews potential pharmacologic treatments for COVID-19. It summarizes the virology of SARS-CoV-2 and potential drug targets, including viral entry proteins and immune pathways. Several repurposed drugs are discussed, including chloroquine/hydroxychloroquine which may inhibit viral entry and immune responses. Over 300 clinical trials are investigating potential COVID-19 treatments but currently no therapies have proven effective. The most promising is remdesivir, which has strong antiviral activity but requires further clinical trial evaluation.
This document reviews potential pharmacologic treatments for COVID-19. It summarizes the virology of SARS-CoV-2 and potential drug targets. Currently, there are no proven effective therapies but remdesivir shows promise based on in vitro activity. Over 300 clinical trials are investigating potential treatments including repurposed drugs like chloroquine/hydroxychloroquine and lopinavir/ritonavir. The review summarizes the mechanisms and pharmacology of select proposed treatments and provides an overview of ongoing clinical trials.
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.
This document discusses the relationship between COVID-19 and diabetes based on clinical observations from China, Italy, and the United States. Emerging evidence shows that diabetes is a common comorbidity in patients with severe COVID-19 and may increase the risk of mortality. The document then reviews the pathogenesis and immune response to SARS-CoV-2 before discussing potential mechanisms by which diabetes could increase susceptibility to infection and severe disease. It concludes by highlighting areas for further investigation and management considerations for clinicians.
Triglytza: Counter-Regulation of RAAS and COVID-19 TreatmentRavi Kumar, Ph.D.
TriGlytza is a proprietary dual combination product of ARKAY Therapeutics. It is custom-designed for treatment and mitigation of ARDS and MODS associated with COVID-19.
article 4.pdf about CAP pneumonia communitysakirhrkrj
This document analyzes factors influencing the development of deep venous thrombosis (DVT) in elderly patients with community-acquired pneumonia (CAP). The study examined 505 elderly CAP patients, of which 133 were diagnosed with DVT. Severe pneumonia and septic shock were associated with higher rates of DVT. Central venous catheterization, higher D-dimer levels, and higher Padua scores (indicating higher risk of thrombosis) were significantly correlated with the development of DVT. Logistic regression identified central venous catheterization, D-dimer level, and Padua score as significant risk factors for DVT in elderly CAP patients.
This study analyzed the relationship between D-dimer levels and the progression of COVID-19 in 279 patients over 10 days. The results showed that D-dimer levels were positively correlated with disease severity and progression. D-dimer levels were higher in patients whose condition worsened initially then improved compared to those whose condition remained mild or moderate. D-dimer levels remained elevated in patients whose condition deteriorated. The study suggests that monitoring D-dimer levels can help predict COVID-19 progression and that anticoagulant treatment may benefit severe patients, especially those without pre-existing cardiovascular disease.
Epidemiology and outcomes of hospital-acquired bloodstream infections in inte...Ahmad Ozair
Tabah A, Buetti N, Staiquly Q … EUROBACT-2 Study Group (including Ozair A). Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Medicine. 2023;1-13. doi:10.1007/s00134-022-06944-2. Published online 2023 Feb 10. (PMID: 36764959, I.F. = 41.7, Available from: https://link.springer.com/article/10.1007/s00134-022-06944-2)
The Efficacy and Safety of Convalescent Plasma for COVID-19 Patients: A Meta-...semualkaira
Convalescent plasma (CP) was demonstrated
promising benefit for clinical practice involved in efficacy and
safety in previous coronavirus pandemics, however, the efficacy of
CP from COVID-19 sufferers are still controversial and unascertainable based on current randomized controlled trials (RCTs). The
urgent needs for affirmative replies on the efficacy and safety of
CP for COVID-19 patients must be developed as soon as possible.
Application of ordinal logistic=China.pdfHenokBuno
This study aimed to identify determinants of illness severity for COVID-19 patients in China. Medical records from 598 COVID-19 patients admitted to four hospitals in China between January and March 2020 were analyzed. Patients were divided into moderate (n=400), severe (n=85), and critical (n=113) illness groups based on their condition. Ordinal logistic regression was used to identify predictors of more severe illness. The analysis found that older age, hypertension, abnormal liver enzymes and cardiac markers, longer time from illness onset to diagnosis and admission were associated with increased risk of more severe illness.
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
This article is a preprint and has not been peer-reviewed.
Twitter: @MattisVollan
Investigation of Long term Hazards and Multi organ Impact of SARS COV-2 in Po...Jagruti Marathe
Introduction
Background
Burden of COVID 19
Need of the study
Rationale of the study
Review of literature
Epidemiology
Hypothesis
Aim and objective
Material and Method
Criteria
Study design
Outcome
Result
Analysis
Discussion
Coronavirus are a large family of viruses that causes illness ranging from the common cold to more serve disease such as middle east respiratory syndrome(MERS-COV) and sever acute respiratory syndrome (SARS-COV).
A novel corona virus (nCOV) is a new strain that has not been previously identified in humans.
SARS-CoV-2 belongs to the Single Standing RNA Viruses class of coronaviruses, but the infection had been rapidly spreading around the world and World Health Organization (WHO) declared a pandemic .
Elevated level of c reactive protein may predict risk for worsening covid 19 ...JA Larson
This document summarizes a study that found elevated levels of C-reactive protein (CRP) may predict the risk of COVID-19 worsening from a mild to severe case. The study looked at 209 patients in China with mild COVID-19. 16 patients saw their condition worsen, with higher CRP levels and older age as distinguishing factors. CRP levels over 26.9 mg/L had the best accuracy at predicting worsening, which could help identify patients for early treatment.
This document provides a summary of articles across various medical specialties discussed in the April 2015 edition of the UTSW Journal Watch. In the Hepatology section, an article is summarized that finds corticosteroids may be safely used in patients with severe alcoholic hepatitis who present with an upper GI bleed after bleeding is controlled. In Pulmonary/Critical Care, a summary is provided of a trial finding no difference in mortality between early goal-directed therapy and usual care for treating septic shock. The study suggests protocols for goals of care are less important than early antibiotics and fluids. In Nephrology, a meta-analysis summary indicates preoperative use of renin-angiotensin system inhibitors may be linked to
Four Unique Laboratory Characteristics Applied to Assess the Severity of COVI...semualkaira
The sudden outbreaking of COVID-19 worldwide has
brought into sharp increased burden of economic and treatment.
How to simply, quickly and accurately assess the severity of patients with COVID-19 in the early stage after hospital admission is
essential for healthcare systems
Four Unique Laboratory Characteristics Applied to Assess the Severity of COVI...komalicarol
The sudden outbreaking of COVID-19 worldwide has
brought into sharp increased burden of economic and treatment.
How to simply, quickly and accurately assess the severity of patients with COVID-19 in the early stage after hospital admission is
essential for healthcare systems.
Similar to Renin angiotensin system inhibitors improve the clinical outcomes of covid 19 patients with hypertension (20)
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
3. and laboratory findings. A commercial real-time PCR
kit (GeneoDX Co., Ltd., Shanghai, China) was used
to detect SARS-CoV-2. Samples were considered posi-
tive if the cycle threshold value (Ct-value) less than 37
and negative if Ct-value more than 40. Samples with a
Ct-value between 37 and 40 require confirmation by
retesting. Samples identified as positive by the local lab-
oratory were further validated by the key laboratory of
the Shenzhen CDC. The severity of COVID-19 wasi-
dentified during the hospitalization according to the
guidelines established by the National Health Commis-
sion of the People’s Republic of China. Therapeutic regi-
mens for COVID-19 patients complied with guidelines
established by the National Health Commission of the
People’s Republic of China. Hypertension was classified
as Grade 1, Grade 2 and Grade 3 according to 2018
guidelines of the European Society of Hypertension
(ESH). Hypertensive patients with COVID-19 were
divided into two subgroups based on antihypertensive
drug treatments. Detailed information on the enrolled
patients is shown in supplementary Table S1. The
SPSS 18.0 software package was used for statistical
analysis. Measurement data are expressed as the median
and interquartile range (IQR), and the difference
between groups was compared by an unpaired t test.
Count data are expressed as percentages, and the differ-
ence between groups was tested by the Chi-square test.
P < 0.05 was considered statistically significant.
Results
A total of 417 COVID-19 patients were admitted to the
Shenzhen Third People’s Hospital as of 23 February
2020. Among these patients, 51 (12.23%) had hyper-
tension. Nine patients (17.6%) with Grade 1hyperten-
sion did not take any antihypertensive drugs during
hospitalization and were excluded from the subsequent
analysis. The other 42 patients (82.4%) receiving anti-
hypertensive therapy were included in further studies.
The 42 analyzed patients were divided into two groups
based on antihypertensive therapies: the ACEI/ARB
group (17 patients) included patients treated with
ACEI or ARB drugs, and the non-ACEI/ARB group
(25 patients) included patients treated with other anti-
hypertensive drugs, including calcium channel block-
ers (CCBs), β-blockers and diuretics. Eight patients
(32%) in the non-ACEI/ARB group and 5 patients
(29.41%)in the ACEI/ARB group had other comorbid-
ities, such as type 2 diabetes (T2D) and coronary heart
disease (CHD). The vast majority of hypertensive
patients had received the current therapeutic regimens
shown in supplementary Table S1 for over one year.
The blood pressure of patients was well-controlled
with the above therapeutic regimens during
hospitalization.
The comparison of baseline characteristics between
the two groups is summarized in supplementary Table
S2. The median age of the analyzed subjects was 64.5
years (IQR, 55.8–69.0 years), and 57.1% of them were
males. No significant differences in hypertension
grades were observed between the ACEI/ARB group
and the non-ACEI/ARB group. Both groups showed
similar signs and symptoms. The median number of
days from the onset of symptoms to hospital admission
was 2.0 in the non-ACEI/ARB group and 3.0 in the
ACEI/ARB group. Meanwhile, the median number of
days from symptom onset to hospital discharge was
16.5 days in the non-ACEI/ARB group and 20.0 days
in the ACEI/ARB group. The median heart rate and
respiratory rate from the non-ACEI/ARB group were
90.5 bpm and 20.0, respectively. In comparison, the
median heart rate and respiratory rate from the non-
ACEI/ARB group were 80.0 bmp and 20.0, respectively.
All baseline characteristics shown in Table S2 were not
significantly different between the two groups.
During hospitalization, 12 patients in the non-
ACEI/ARB group (48%) were categorized into severe
subgroups and one patient died. In contrast, in the
ACEI/ARB group, only 4 patients (23.5%) were cate-
gorized into severe subgroups and no patients died
(Figure 1(A)). The percentage of severe cases in the
ACEI/ARB group was higher than that in the non-
ACEI/ARB group, but this difference was not signifi-
cant, possibly due to the small number of clinical
cases. We next examined the effects of taking ACEI
or ARB drugs on laboratory findings of COVID-19
patients with hypertension. As shown in Figure 1(B),
there was a trend toward lower IL-6 levels in patients
from the ACEI/ARB group. No marked variation in
C-reactive protein (CRP) was observed between the
two groups (Figure 1(B)). The absolute number of
CD3+ and CD8+ T cells in the ACEI/ARB group was
significantly higher than that in the non-ACEI/ARB
group. There were no significant changes in CD4+ T
cell counts between the two groups (Figure 1(C)). In
addition, although the viral load was not different
between the two groups at hospital admission, the
peak viral load during hospitalization in the ACEI/
ARB group was significantly lower than that in the
non-ACEI/ARB group (Figure 1(D)). Other laboratory
findings, such as white blood cell counts, neutrophil
counts, platelet counts, and lactate dehydrogenase,
are shown in supplementary Table S3, and no
significant differences were observed between the
two groups.
Discussion
It was reported that the RAS plays a critical role in reg-
ulating hypertension and acute lung injury caused by
viruses, such as SARS and H7N9 [5,7]. Changes in
RAS activity are related to the pathogenesis of hyper-
tension and inflammatory lung disease. Targeting
RAS is an effective antihypertension therapeutic
758 J. Meng et al.
4. strategy. ACEIs and ARB, which inhibit the ACE/Ang
II/AT1R system, are commonly used drugs for hyper-
tensive patients. Recent evidence suggests that hyper-
tensive COVID-19 patients are predisposed to
develop severe cases [1]. Thus, it is important to deter-
mine the effect of RAS inhibitors on COVID-19
patients with hypertension.
Studies have suggested that COVID-19 patients
have increased Angiotensin II compared to healthy
people [8]. The abnormal increase in Angiotensin II
was related to hypertension and lung failure. In
addition, RAS inhibitors have been shown to be
associated with reduced mortality in patients with sep-
sis [9]. Angiotensin II positively regulates the
expression of inflammatory cytokines through the
activation of AT1R [10]. Excessively high levels of
inflammatory cytokines are harmful to the outcomes
of COVID-19 patients. Thus, it was suggested that it
is beneficial for COVID-19 patients to use ACEIs/
ARBs to inhibit the RAS. However, until now, no
confirmed clinical evidence has been available. In
this study, COVID-19 patients with hypertension
were enrolled, and we found that ACEI/ARB therapy
attenuated the inflammatory response, potentially
through the inhibition of IL-6 levels, which is consist-
ent with the findings that ACEI and ARB therapy alle-
viated LPS-induced pneumonic injury [11]. For
patients with chronic heart failure, it has been proven
that ACEI therapy was associated with decreased Th1/
Th2 cytokine ratios and inflammatory cytokine pro-
duction [12]. This study also suggests that ACEI/
ARB therapy had a beneficial effect on the immune
system by avoiding peripheral T cell depletion. Fur-
thermore, the viral load was reported to be highly cor-
related with severe lung injury [8]. It was also
observed that ACEI/ARB therapy decreased the viral
load, but we hypothesize that RAS inhibitors do not
directly inhibit viral replication; rather, they play an
indirect antiviral role by regulating immune function
and inhibiting inflammatory responses, and the mech-
anism needs to be clarified through in vitro and in
vivostudies in the future.
Taken together, this is the first clinical evidence
demonstrating that RAS inhibitors improve the clinical
outcomes of COVID-19 patients with hypertension,
suggesting that these patients could benefit from the
persistent or preferential usage of ACEI/ARB for anti-
hypertensive treatment.
Figure 1. Summarized clinical, inflammatory, immunological, and viral findings in the non-ACEI/ARB group and the ACE/ARB group.
(A) The disease severity distribution of the two groups during hospitalization. (B) The levels of IL-6 and CRP in peripheral blood. (C)
Absolute numbers of CD3+, CD4+, and CD8+ T cells in peripheral blood. (D) Viral load on hospital admission and maximum value
during hospitalization. The data are expressed as the median and IQR. An unpaired t test was used, and P < 0.05 was considered
significant.
Emerging Microbes & Infections 759
5. Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This work was supported by the National Natural Science
Foundation of China (No. 81873958), the China Postdoc-
toral Science Foundation (No. 2019M653108), the National
Science and Technology Major Project for Control and Pre-
vention of Major Infectious Diseases of China (No.
2017ZX10103004), the State Key Laboratory of Respiratory
Diseases Open Project (No. SKLRD-OP-201919), and the
Sanming Project of Medicine in Shenzhen (No.
SZSM201911009).
ORCID
Guoliang Zhang http://orcid.org/0000-0002-3617-5449
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