Aim. Repurposing strategies to address the COVID-19 pandemic have been accelerated. As both pregnant and pediatric patients are likely to be excluded from most planned investigations, the list of repurposed options and the available data on these drugs and vaccines provides a baseline risk assessment and identifies gaps for targeted investigation. Methods. Clinical trials have been searched and reviewed; twenty-three repurposed drugs and drug combinations and 9 candidate vaccines have been assessed regarding the availability of relevant data in pediatrics and pregnant women and to evaluate expected or unanticipated risk. Results. Thirteen of the repurposed drugs or drug combinations are indicated for use in pediatrics in some age category albeit for indications other than COVID-19; 10 of these are indicated for use in pregnant women. Even in cases where these drugs are indicated in the populations, source data from which safety and or dosing could be extrapolated for use in COVID-19 is sparse. Vaccine trials are ongoing and generally exclude pregnant women; only in a few instances have pediatric subgroups been planned for enrollment. Data from individual case studies and RWD may suggest that subpopulations of both pediatric patients and pregnant women may be more at risk, particularly those in an increased inflammatory state. Conclusion. In conjunction with more prospective collaboration, plans are evolving to ensure that we will be better prepared to address similar situations especially in pediatrics and pregnant women where experience is limited and actual practice relies heavily on leveraging data from other populations and indications.

Five patients presented with infection and an exposed cochlear implant and we decided to salvage them by attempting use of new antimicrobial treatment for biofilms using betaine surfactant and polyhexanide along with wound debridement and double layered vascularized flap. This is the first study demonstrating the use of betaine surfactant and polyhexanide in the management of biofilm in cochlear implants and we could salvage four infected cochlear implants by the aforementioned method. Early intervention can significantly improve salvage outcomes in cochlear implants infected with biofilms.

A 30-year-old man, who had no travel history to COVID-19 prone areas whereas he had the characteristics signs and symptoms of COVID-19. Chest X-ray and rRT-PCR revealed his confirmed COVID-19. This study recommends the early identification and management of COVID-19.

Three COVID-19 cases were simultaneously confirmed as deep venous thrombosis (DVT). Ultrasound-guided IVCF implantation is an effective method that can be considered as a precautionary strategy for preventing lethal pulmonary embolism occurrence, especially for critical DVT-COVID-19 patients who are not suitable to be transferred to a routine X-ray operation room.

Three COVID-19 patients who were received lopinavir/ritonavir plus favipiravir got to improved without any severe adverse events. Two patients harboring high fever, severe pneumonia and respiratory failure obtained dramatic improvement. The combination therapy might be a treatment option; earlier therapy onset may have needed to avoid lung sequela.

Coronavirus disease of 2019 (COVID-19) is a public health emergency of international concern caused by a novel coronavirus, i.e., Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2). Since it is a new virus, an effective remedy against the virus is yet unknown. SARS-CoV-2 is a member of order nidovirales, family coronaviridae. Previously known treatment strategies against Middle East Respiratory Syndrome and Severe Acute Respiratory Syndromes are being tested for their effectiveness against SARS-CoV-2. Thus, various clinical and observational studies aimed at identifying potential therapies against the disease. In our study, we reviewed various drugs along with their mechanism of action including anti-virals, anti-bacterials, glucocorticoids, ACE inhibitors, anti retrovirals, anti-malarials, monoclonal antibodies, plasma and many more. Individual drugs are described and evaluated for their potential to treat SARS-CoV-2 infection. This study offers a brief review of the findings of trials conducted so far. Dexamethasone, convalescent plasma therapy, tocilizumab, remdesivir and combination therapies are found to be beneficial against SARS-CoV-2.

Initially, Coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2 virus is strikingly thought to be manifested by respiratory illness such as cough, chest tightness, and dysponea. Therefore, we are presenting a confirmed case of COVID-19 who developed acute pancreatitis-a rare manifestation during disease process without any known aggravating factors

Coronavirus disease (COVID-19) is a highly contagious disease with a rapid increase in cases and mortality all over the world. We report a neonate born to the pregnant woman with COVID tested positive for SARS-CoV-2 infection just 24 hours after its birth.

We suggest that patients with COVID-19 may be at higher risk for selenium deficiency and, therefore, their selenium status should be assessed. Moreover, we suggest incorporating selenium supplementation to enhance their immune response and reduce the SARS-CoV-2 virulence.

As of March, 2020, Corona Virus disease 2019 (COVID-19) has catapulted to the status of a pandemic. Its rapid spread has initiated a worldwide search for appropriate therapeutics targeting the causative SARS-CoV-2 virus. Till now, the management of critical COVID-19 patients mainly revolves around the supportive therapies of supplemental oxygen and ventilatory support. However, pharmacotherapy and immunotherapy specifically intended to halt SARS-CoV-2 from exerting its effects are increasingly being incorporated into treatment regimens. COVID-19 patient care continues to evolve as the available drugs are being thoroughly investigated for their potential antiviral effects and new therapies, such as vaccines, are being developed. The list of pre-existing therapeutics that show promise against SARS-CoV-2 includes anti-virals like Remdesivir, plasma therapy, traditional Chinese medicine (TCM), anticoagulants, antibiotics, corticosteroids and several other investigational agents such as vitamin supplements and thymosin alpha one. In this comprehensive, updated review we will highlight the major prospective therapies that are currently in the arsenal against COVID-19 and where they stand in the treatment recommendations as well as a brief look at the challenges faced in Pakistan. With this review we not only hope to disseminate the accurate, recent information regarding these therapies, but also discuss the reliability of the clinical trials that have designated them to be useful against COVID-19.

Introduction: Though there is currently no approved treatment for COVID-19, potential medications include lopinavir and doxycycline. Lopinavir is a broad-spectrum protease inhibitor successfully used during the SARS outbreak. Doxycycline is an antibiotic with immunomodulatory effects, which successfully treats dengue hemorrhagic fever. Comparing lopinavir combined with doxycycline with other commonly implemented COVID-19 treatment regimens is of medical significance. Methods: We conducted a retrospective study comparing two cohorts. One cohort strictly adhered to a treatment protocol of lopinavir combined with doxycycline (Lop/Dox), while the other cohort (Others) applied protocols based on combinations of favipiravir, hydroxychloroquine, and azithromycin. The outcomes evaluated were death from coronavirus and intubation. Results: During the study period, 161 and 114 patients were followed in the Lop/Dox cohort and the Others cohort, respectively. The Lop/Dox cohort was older and had lower O2 saturation at admission. The proportion of patients needing intubation did not differ between the cohorts (Lop/Dox, 15∙5%; Others, 16∙7%). The overall fatality rate likewise did not differ (12∙4%) in Lop/Dox and 8∙7% in the Others cohort). Older age and elapsed time between the onset of symptoms and hospitalization, O2 saturation at admission, and the lymphocyte to white blood cell ratio were independent risk factors for poor outcomes of the illness. Conclusion: This study showed that lopinavir plus doxycycline therapy is an effective treatment amongst moderate to severe COVID-19 patients.

The guidelines recommend surgical treatment for fulminant Clostridium difficile infection (CDI). However, mortality remains high, and patients with severe condition are not considered for surgical treatment because of poor post-surgical outcomes. Moreover, delayed diagnosis of fulminant CDI may induce intestinal necrosis. Thus, early diagnosis is crucial.

Background and Purpose: Patients with community acquired pneumonia (CAP) may suffer from myocardial injury, which is associated with increased risk of major adverse cardiovascular events (MACE). Corticosteroids are often prescribed to CAP patients, but the relationship between their use, myocardial injury and outcomes in these patients is unknown. Experimental Approach: 541 CAP patients were recruited (334 males; mean age: 71.9±16.2 years). High-sensitivity troponin T (hs-cTnT) was measured at admission, during the hospital stay and at discharge. MACE occurrence was registered during a long-term follow-up. Key Results: Overall, 318 patients (59%) showed hs-cTnT elevation > 99th percentile (>0.014 µg/L). Patients with hs-cTnT elevation were older, more likely to be former smokers, and with a higher prevalence of cardiovascular comorbidities. In a median follow-up of 22.7 months, a multivariable Cox proportional hazard regression analysis showed age, heart failure and the increasing quintiles of hs-cTnT (HR: 2.16; 95% CI: 1.82-2.58; p<0.001) predicted MACE. In-hospital corticosteroid use was found in 137 (25%) patients. Among patients with hs-cTnT >0.014 µg/L at admission, 102 patients (31%) were on corticosteroids and showed lower intra-hospital hs-cTnT increase compared to untreated ones (p=0.003). Among patients with hs-cTnT >0.014 µg/L, corticosteroid-treated patients showed a lower incidence of MACE than untreated ones [29% (27/99) vs. 43% (92/213); p value =0.042]; no effect of corticosteroids on MACE was observed in CAP patients with normal troponin. Conclusion and Implications: The study provides evidence that corticosteroid use is associated with lower increase of hs-cTnT and incidence of MACE in CAP patients.

Background: We described the QTc interval prolongation and related adverse cardiac events during the administration of hydroxychloroquine (HCQ) and its combinations for treatment of COVID-19. Methods: The hospitalized patients who were infected with SARS-CoV-2 and received HCQ with initial and follow up ECGs from March 10th to May 30th were included. The critical QTc prolongation was accepted as QTc >500 ms if QRS<120ms and >550 ms if QRS >120 ms or ∆QTc levels >60 ms when compared with the initial ECG. Primary outcomes were critical QTc prolongation, ventricular tachyarrhythmia, and sudden cardiac arrest. Results: Out of 336 hospitalized patients with suspected or confirmed COVID-19, 297 received HCQ, and 94 met the inclusion criteria, and 66 cases were included in final analysis. The mean baseline QTc was 444.5 (sd= 39.5) ms. In total, 63% of the patients’ QTc levels increased under HCQ treatment and critical QTc prolongation occurred in 8 cases (12%) all of whom were male. The male gender (p=0.033), DM (p=0.035) and oseltamivir use (p=0.047) were significantly associated with critical QTc prolongation. In multivariate analysis, DM (OR:5.8, %95 Cl:1.11-30.32, p:0.037), and concomitant use of oseltamivir (OR:5.3, %95 Cl:1,02-28, p:0.047) were found to be associated with critical QTc prolongation. Conclusion: Critical QTc prolongation was detected in 12% of the patients. The DM and concomitant oseltamivir use were associated with critical QTc prolongation. The use of concurrent drugs that have potential to enhance QTc interval should be kept in mind and special attention should be paid for ECG monitoring.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continue to expand worldwide. The article focused on the broad spectrum antifungal itraconazole as antiviral prodrug with its possible role against SARS-CoV-2, via immunomodulation, anti-inflammatory actions, and direct role on the virus non-structural proteins

Olfactory and gustatory dysfunctions are common presentations in COVID-19 patients. We present three patients who received smell and taste tests after recovery. The smell test suspected persistent impairment of olfactory function in these patients. The report proposes continued evaluation of olfactory function by a smell test in COVID-19 patients.

Coronavirus disease 2019, an infectious viral disease caused by severe acute respiratory syndrome coronavirus 2 has been declared a global pandemic by World Health Organisation. The race to find an effective cure for it is on. Most of the candidate drugs in various clinical trials are being re-purposed but none has been approved as at date. It is pertinent for the bedside physicians to understand the mechanisms of action of these agents and their peculiar adverse effects so they are properly guided on the risk/benefit of the drugs they choose in managing COVID-19 patients. In this review, we aimed to review the mechanisms of action and adverse effects of the major drugs in clinical trials for COVID-19 therapeutics. Clinicaltrials.gov, the international clinical trials platform of the WHO, the EU clinical trials register and the Cochrane Central Register of Controlled Trials were searched for registered clinical trials. Studies in therapeutic trials were considered eligible for the work. Frequency table was made for the most common trialled drugs and the mechanisms of actions and adverse effects of the selected drugs were reviewed. 10 studies were selected for review in a descending order of their frequency in different therapeutic trials and these are ritonavir, lopinavir, chloroquine/hydroxychloroquine, interferon, remdesvir, favipravir, umifenovir, darunavir, tocilizumab and methylprednisolone. The bedside physicians need to understand the mechanisms of action of these agents and their peculiar adverse effects so they are properly guided on the risk/benefit of the drugs they choose in managing COVID-19 patients.

Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED) pocket infections and may lead to device-related endocarditis, so preventing them is key. Diagnosis is by presence of acid-fast bacilli on smears and culture takes around 3-7 days on grow on standard agar media.

Several strains of the novel Coronavirus have been identified and countries around the world are conducting research to identify, map and compare each type. Its infection can manifest with symptoms ranging from uncomplicated non-specific illness to a more damaging syndrome that include mild to moderate pneumonia (Co-vid 19 pneumonia broadly categorised into the phenotypes: L-type and H-type); Acute Respiratory Distress Syndrome; Sepsis and Septic shock. Although, this virus has a low mortality rate, the danger lies in its virulence and transmission dynamics. With more and more cases being reported, researchers and clinicians are promptly identifying and triaging the cases for treatment. Till date, there has been no drug identified to be efficacious cure for this infection. Using the WHO guidelines as a base, various medical institutions are continuously updating their guidelines for the identification and therapeutic management of persons infected with Co-vid 19, with a strong emphasis on IPC measures. The guidelines also highlight detailed supportive treatment including supplemental oxygen therapy, ventilation, intubation and management of specific complications. The current treatment is tailored to patient centred management for the existing co-morbidities and appreciate a progress in the prognosis. What is needed at this hour however, is a definitive drug therapy or vaccine. Different countries are rushing to find this and various trials are already underway. The aim of this article is thus to review salient features of specific therapies being used now and summarise the different clinical trials being conducted so as to stay abreast of the possible treatment modalities.

A patient with dacryocystitis who had a regular ophthalmology visit canceled the regular visit with a COVID-19 pandemic. After that, serious deterioration was observed and emergency evisceration was performed. Even during COVID-19 pandemic, so it is necessary to continue regular eye examinations and infection treatment.

Corona virus spread easily and rapidly over countries and caused COVID-19 disease with several organ damage. Lymphopenia and elevation NLR, LDH and CRP in covid 19 patients could be a predictive factor, and when they become deeper during hospitalization show the patients to need ICU admission.

Rhombencephalitis refers to inflammatory diseases of the rhombencephalon. The encephalitic processes located to the rhombencephalon are frequently associated with Listeria monocytogenes and enterovirus infections. We report a case of community-acquired Klebsiella Pneumoniae systemic infection with CNS involvement in an adult patient without significant comorbidities.

Through this case, we present the thought process, team-based strategy and sequel of managing a complex, critically ill pregnant with ARDS and COVID-19 pneumonia. This case also confirms the feasibility of using convalescent plasma and ECMO during early postnatal period in acutely ill parturient with respiratory failure.

Objective: This prospective observational study aims to measure the epiglottic thickness by ultrasonography (US) in healthy volunteers. Methods: Healthy adult volunteers were recruited from the National Taiwan University Hospital between October and November 2019. Exclusion criteria included preexisting airway diseases, neck tumors, and a history of neck operation. Epiglottic thickness was measured at the midpoint, right and left edges of the epiglottis. Age, sex, height, weight, and body mass index (BMI) were collected. The linear regression model was employed to identify parameters to be associated with the epiglottic thickness. Coefficients and 95% confidence intervals (CIs) were computed. The literature was also reviewed. Results: There were 124 Chinese adults and 63 were men. The average age was 32.5±10.4 years. The midpoint, right edge and left edge of the epiglottic thickness was 2.03±0.42 mm, 2.14±0.42 mm and 2.21±0.42 mm, respectively. Male gender (midpoint, coefficient, 0.38, 95% CI, 0.35-0.43; right edge, coefficient, 0.33, 95% CI, 0.31-0.35; left edge, coefficient, 0.31, 95% CI, 0.29-0.35) and BMI (midpoint, coefficient, 0.02, 95% CI, 0.019-0.021; right edge, coefficient, 0.02, 95% CI, 0.019-0.022; left edge, coefficient, 0.02, 95% CI, 0.018-0.022) were associated with the epiglottic thickness. The epiglottis was thinner in normal Chinese adults, compared with that in Americans in the literature. Conclusions: US allows the depiction and assessment of the epiglottis in healthy volunteers. Male gender and higher BMI are associated with a thicker epiglottis. Future studies are warranted to evaluate race differences in the dimension of the epiglottic thickness.