Assessing the Clinical Improvement in Patients with COVID-19 using Lopinavir-Ritonavir: A Systematic Review

Aims: Globally the focus is towards finding an effective treatment for COVID-19 patients in order to suppress the spread of this pandemic disease. An antiviral combination of lopinavir-ritonavir is considered to be effective in treating COVID-19 patients. Therefore, the present study aims to assess the clinical improvements of lopinavir-ritonavir in COVID-19 patients. Study Design: a systematic review study was conducted and articles published since December 2019 were included. The statistical analysis of quantitative data was performed using Review Manager (RevMan) to generate forest plots. Results: The study showed that there was no significant difference in COVID-19 patients treated with lopinavir-ritonavir or in combination with anti-viral therapy or other conventional methods. Conclusion: the use of lopinavir-ritonavir resulted in greater adverse consequences among COVID-19 patients. It further recommends conducting meta-analysis studies with a greater number of studies to highlight the clinical improvement associated with the use of Lopinavir-ritonavir.

Retrospective review of 27 European cases of fatal elephant endotheliotropic herpesvirus-haemorrhagic disease reveals evidence of disseminated intravascular coagulation

Elephant endotheliotropic herpesvirus haemorrhagic disease (EEHV-HD) is widely acknowledged as the most common cause of mortality in young Asian elephants (Elephas maximus) in captivity. The objective of the current study was to perform a blinded, retrospective pathology review of European EEHV-HD fatalities, constituting the largest systematic assessment of EEHV-HD pathology to date. Findings between viral genotypes were compared with the aim to investigate if disseminated intravascular coagulation (DIC) could be substantiated as a significant complicating factor, thereby increasing the understanding of disease pathophysiology. Immunohistochemical staining confirmed endothelial cell (EC) damage and the presence of EC intranuclear inclusion bodies, demonstrating a direct viral cytopathic effect. Microthrombi were observed in 63% of cases in several organs, including lungs, which, together with widespread haemorrhage and thrombocytopenia reported in EEHV-HD case reports, supports the presence of overt DIC as a serious haemostatic complication of active EEHV infection. Death was attributed to widespread vascular damage with multi-organ dysfunction, including severe acute myocardial haemorrhage and subsequent cardiac failure. Systemic inflammation observed in the absence of bacterial infection may be caused by cytokine release syndrome. Findings reinforce the necessity to investigate cytokine responses and haemostatic status during symptomatic and asymptomatic EEHV viraemia, to potentially support the use of anti-inflammatory treatment in conjunction with anti-viral therapy and cardiovascular support.

Cytomegalovirus (CMV) Infection in Infants: Two Case Reports and Review of Literature

Cytomegalovirus (CMV) is a virus under the Herpesviridae family. We describe two case reports on different manifestations of infants with CMV infection presented with neonatal jaundice, small for gestational age (SGA) and congenital cataract. Congenital CMV (cCMV) was diagnosed in a neonate presented with jaundice and SGA. cCMV cannot be excluded in another case as no CMV PCR done within 3 weeks of life. Only one cCMV infection was treated with 6 weeks of ganciclovir anti-viral therapy, which presented with neonatal jaundice, SGA with a very high CMV viral load. All cases were under multidisciplinary follow[1]up, including pediatric for developmental assessments, audiologist for hearing assessment, and ophthalmology for vision assessment. These case reports describe the importance of thorough clinical examination and early screening of CMV infection in infants to rule out cCMV as CMV is the commonest congenital treatable viral infection in Malaysia. Early treatment and intervention can be planned for child wellbeing.

EFFECTIVENESS AND SAFETY OF SOFOSBUVIR AND VELPATASVIR IN HEMODIALYSIS PATIENTS SUFFERING WITH HEPATITIS C INFECTION

BACKGROUND & OBJECTIVE: There is scantiness of evidence-based knowledge of anti-viral therapy with sofosbuvir (SOF) and velpatasvir (VLP) in patients on maintenance haemodialysis. This report is an attempt to rationalise the safety and effectiveness of SOF and VLP in haemodialysis patients in Pakistan. METHODOLOGY: Twenty treatment-naïve patients were incorporated in this study. Patients on maintenance haemodialysis are being administered SOF and VLP. Before initiation of treatment, all necessary investigations such as viral load, liver fibro scan, genotyping and upper GI endoscopy were made. Patients received 400 mg/day and 100 mg/day dose of SOF and VLP, respectively. RESULTS: Mean age was 25 to 53 years; 30% were male and 70% were female as categorized. No one of these has clinical affirmation of progression of cirrhosis. The most prevalent genotype was genotype 4 that was found in 45% of cases and the second most evident was genotype 1 in 25% of cases and genotype 5 in 30% of cases. Time span of antiviral therapy was 12 weeks. CONCLUSION: SOF and VLP based direct antiviral agents were effectual, puissant and were aptly tolerated in patients on MHD. This drug combination was well tolerated in haemodialysis patients. Not a single patient discontinued this combination therapy due to severe complications.