The Study of Traditional Medicine for the Treatment of COVID-19

SARS-CoV-2 is a novel virus communicable disease affected by serious acute respiratory condition coronavirus 2 (SARS-CoV-2) which goes to the family of coronavirus. December 2019, in Wuhan, China, the first case of novel coronavirus was reported, and this widespread virus globally became a pandemic. Various studies show that drug applicants are used as antivirals or immune modulators. Yet, the outcome of this examination reported the drug applicants were not ominously operative in contrast to the infection. In the interim, it's believed that taking herbal immune-modulators can avoid and/or resist COVID-19. Unluckily, definite clinical and preclinical trials to assess the special herbal immune regulators' effects have not been directed. Specific natural elements might be actual for treating COVID-19 built on universal thoughts from former tests. Though there are no exact anti-COVID-19 medicines as well as a drugs until now, the use of traditional medicine and epidemiology of novel coronavirus disease will be discussed for COVID-19 treatment.

Burden of Care for Children with Bronchiectasis from Parents/Carers Perspective

Bronchiectasis is a neglected chronic respiratory condition. In children optimal appropriate management can halt the disease process, and in some cases reverse the radiological abnormality. This requires many facets, including parental/carer bronchiectasis-specific knowledge, for which there is currently no such published data. Further, the importance of patient voices in guiding clinical research is becoming increasingly appreciated. To address these issues, we aimed to describe the voices of parents of children with bronchiectasis relating to (a) burden of illness and quality of life (QoL), (b) their major worries/concerns and (c) understanding/management of exacerbations. The parents of 152 children with bronchiectasis (median age = 5.8 years, range 3.5–8.4) recruited from the Queensland Children’s Hospital (Australia) completed questionnaires, including a parent-proxy cough-specific QoL. We found that parents of children with bronchiectasis had impaired QoL (median 4.38, range 3.13–5.63) and a high disease burden with median 7.0 (range 4.0–10.0) doctor visits in 12-months. Parental knowledge varied with only 41% understanding appropriate management of an exacerbation. The highest worry/concern expressed were long-term effects (n = 42, 29.8%) and perceived declining health (n = 36, 25.5%). Our study has highlighted the need for improved education, high parental burden and areas of concern/worry which may inform development of a bronchiectasis-specific paediatric QoL tool.

Blood lactate concentration in COVID-19: a systematic literature review

Coronavirus disease 2019 (COVID-19) is an infectious respiratory condition sustained by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which manifests prevalently as mild to moderate respiratory tract infection. Nevertheless, in a number of cases the clinical course may deteriorate, with onset of end organ injury, systemic dysfunction, thrombosis and ischemia. Given the clinical picture, baseline assessment and serial monitoring of blood lactate concentration may be conceivably useful in COVID-19. We hence performed a systematic literature review to explore the possible association between increased blood lactate levels, disease severity and mortality in COVID-19 patients, including comparison of lactate values between COVID-19 and non-COVID-19 patients. We carried out an electronic search in Medline and Scopus, using the keywords “COVID-19” OR “SARS-CoV-2” AND “lactate” OR “lactic acid” OR “hyperlactatemia”, between 2019 and present time (i.e. October 10, 2021), which allowed to identify 19 studies, totalling 6,459 patients. Overall, we found that COVID-19 patients with worse outcome tend to display higher lactate values than those with better outcome, although most COVID-19 patients in the studies included in our analysis did not have sustained baseline hyperlactatemia. Substantially elevated lactate values were neither consistently present in all COVID-19 patients who developed unfavourable clinical outcomes. These findings suggest that blood lactate monitoring upon admission and throughout hospitalization may be useful for early identification of higher risk of unfavourable COVID-19 illness progression, though therapeutic decisions based on using conventional hyperlactatemia cut-off values (i.e., 2.0 mmol/L) upon first evaluation may be inappropriate in patients with SARS-CoV-2 infection.

In silico drug repurposing for the identification of antimalarial drugs as candidate inhibitors of SARS-CoV-2

: Coronavirus disease (COVID-19) is a severe acute respiratory condition that affected millions of populations worldwide in early 2020, indicating for a global health emergency.As regards the deteriorating trends in COVID-19, none of the drugs were confirmed to have substantial efficacy in the potential treatment of COVID-19 patients in large-scale trials.The purpose of this research was to identify potential antimalarial candidate molecules for the treatment of COVID and to evaluate the possible mechanism of action by in silico screening method. Insilicoscreening study of various antimalarial compounds like Amodiaquine, Chloroquine, Hydroxychloroquine, Mefloquine, Primaquine, and Atovaquone were conducted with PyRx and AutoDoc 1.5.6 tools on ACE 2 receptor, 3CL protease, Hemagglutinin esterase, Spike protein SARS HR1 motif and Papain like protease virus proteins.Based on PyRx results, Mefloquine and Atovaquone have higher docking affinity scores against virus proteins compared to other antimalarial compounds. Screening report of Atovaquone exhibited affirmative inhibition constant on Spike protein SARS HR1 motif, 3CL and Papain like protease. In silico analysis reported Atovaquone as a promising candidate for COVID 19 therapy.

Treatment and outcome of COVID-19 patients in a specialized hospital during the third wave: advance of age and increased mortality compared with the first/second waves

Purpose To elucidate the clinical course of patients with coronavirus disease 2019 (COVID-19) treated at a specialized hospital mainly for those with mild and moderate severity during the third wave, and to compare that with the first and second (1st/2nd) waves. Methods We retrospectively reviewed the severity on admission, treatment, and outcome of a total of 581 patients from September, 2020, to March, 2021, and examined the risk factors for deterioration of respiratory condition, defined as requiring oxygen ≥ 7 L/min for 12 h. Results The median age was 78 (interquartile range 62−83) years, older than in the 1st/2nd waves (53 years), and 50% of the patients was male. The number of patients classified as mild (peripheral oxygen saturation (SpO2) ≥ 96%), moderate I, II, and severe (requiring admission to the ICU or mechanical ventilation) was 121, 324, 132, and 4, respectively. Favipiravir, ciclesonide, dexamethasone, and/or heparin were administered for treatment. Respiratory condition recovered in 496 (85%) patients. It worsened in 81 patients (14%); 51 (9%) of whom were transferred to tertiary hospitals and 30 (5%) died. Mortality rate increased by fivefold compared during the 1st/2nd waves. Age, male sex, increased body mass index, and C-reactive protein (CRP) on admission were responsible for worsening of the respiratory condition. Conclusion Patients were older in the third wave compared with the 1st/2nd waves. Respiratory condition recovered in 85%; whereas 5% of the patients died. Old age, male sex, increased body mass index, and CRP would be responsible for worsening of the respiratory condition.

Does the Implementation of Children's Hospital in the Home affect Health Outcomes for Children with Chronic Respiratory Conditions? A non-contemporary retrospective cohort comparison study

Objective To investigate whether the implementation of a Children’s Hospital in the Home (CHITH) service affects clinical and service outcomes for children with chronic respiratory conditions including cystic fibrosis and non-CF bronchiectasis. Study Design A non-contemporary retrospective cohort comparison study. Setting/Patients Children aged between 1 and 17.99 years who were admitted to Gold Coast University Hospital (GCUH) with a chronic respiratory condition for pulmonary optimisation were eligible. Methods A clinical audit was utilised to compare children with chronic respiratory conditions who were admitted to GCUH in (a) the 12 months prior to implementation of CHITH and (b) the 12-month period following the implementation of CHITH. Outcomes of interest included lung function; inpatient length of stay (days); duration on intravenous antibiotics and weight gain. Normally distributed data was compared using the t-test, while non-parametric data was analysed with the Mann-Whitney test. Results Data was analysed from 58 admissions, 27 (46.55%) of which occurred in the 12 months of traditional management and 31 (53.45%) in the 12 months following the implementation of the CHITH service. A statistically significant reduction in inpatient length of stay was noted following implementation of the CHITH service: 14.25 versus 6.0 days (p-value=0.0001). The pre-CHITH cohort had a non-significant mean improvement of 7.625% in their FEV1 (pred%) compared to 9.75% in the CHITH cohort (p-value=0.44). There was no significant difference in the secondary clinical outcomes. Conclusion The CHITH service provided equitable clinical outcomes for children with a chronic respiratory condition whilst significantly reducing inpatient length of stay.

Wheezing-Related Relevant Factors and the Role of Viral Bronchiolitis

Bronchiolitis is a virus-associated infection of the lower respiratory tract exhibiting signs and symptoms of airway obstruction. Respiratory Syncytial Virus (RSV) is responsible in most cases; however, different rhinoviruses have also been implicated. Specific viruses and time until the first infection, severity of the respiratory condition, and atopic status have a determinant role in the recurrence of wheezing and asthma development. Genetics, lung function, atopic condition, the role of microbiota and environment, pollution, and obesity are considered in the present review. Emergency room visits and hospitalizations because of severe wheezing and smoking during pregnancy among others were identified as risk factors for significant morbidity in our population. Approaching determinant conditions like genetics, allergy, antiviral immunity, and environmental exposures such as farm vs. urban and viral virulence provides an opportunity to minimize morbidity of viral illness and asthma in children.

Mallory–Weiss syndrome complicated by severe aspiration pneumonitis in an infant

ABSTRACT A 1-month-old girl presented with hematemesis and dyspnea. A large amount of blood was aspirated through a nasogastric tube, and chest computed tomography showed bilateral centrilobular opacified lesions, which suggested aspiration pneumonitis due to upper gastrointestinal bleeding. Her respiratory condition exacerbated, and we initiated nitric oxide (NO) therapy. Bleeding stopped with conservative treatment. She was weaned off mechanical ventilation and extubated on Day 6 after admission. Afterward, upper gastrointestinal endoscopy showed a longitudinal linear scar indicative of Mallory–Weiss syndrome (MWS). MWS is rarely reported in early infancy since many of the risk factors are absent in infants. Patients with aspiration pneumonitis usually recover respiratory function within 24 h and severe respiratory failure is rare in aspiration pneumonitis. There are no pediatric case reports describing MWS with severe aspiration pneumonitis. Although MWS is a rare cause of neonatal hematemesis, patients can become severely ill and require multidisciplinary treatment.

Case Report: Successful Treatment of Five Critically Ill Coronavirus Disease 2019 Patients Using Combination Therapy With Etoposide and Corticosteroids

Acute respiratory distress syndrome (ARDS) is the leading cause of mortality in hospitalized patients with coronavirus disease 2019 (COVID-19) because of limited effective therapies. During infection, the accumulation and activation of macrophages and monocytes in the lungs induce inflammatory mediators and contribute to tissue injury, leading to ARDS. However, therapeutic strategies that directly target activated macrophage and monocytes have not been reported. Combination treatment with etoposide (a cytotoxic agent) and a corticosteroid has been widely used for treating hemophagocytic lymphohistiocytosis characterized by the systemic activation of macrophages with overwhelming inflammation. Herein, we present five cases of COVID-19-associated ARDS treated with etoposide and corticosteroids. Three of the five patients were over 65 years of age and had various underlying diseases, including multiple myeloma. Four patients required invasive mechanical ventilation (MV), and one patient refused to be placed on MV due to underlying diseases. All patients were pre-treated with antiviral and/or other anti-inflammatory agents, but their condition deteriorated and hyperinflammation was noted. All five patients responded well to treatment and had an immediate response, as reflected by improvement in their respiratory condition and inflammatory marker levels and rapid resolution of fever after etoposide administration; however, some patients required a second dose of etoposide and longer course of steroids. All patients recovered, and there were no severe adverse events related to the drugs. Following successful treatment in these five patients, we plan to conduct a clinical trial to evaluate the efficacy and safety of combination therapy with etoposide and corticosteroid for treating COVID-19 patients in Japan.