Human menstrual blood-derived stem cells as immunoregulatory therapy in COVID-19: A case report and review of the literature

BACKGROUNDThe coronavirus disease 2019 (COVID-19) caused by novel coronavirus 2019 in December 2019 has spread all around the globe and has caused a pandemic. There is still no current effective guidance on the clinical management of COVID-19. Mesenchymal stem cell therapy has been shown to be one of the therapeutic approaches to alleviate pneumonia and symptoms through their immunomo-dulatory effect in COVID-19 patients.CASE SUMMARYWe describe the first confirmed case of COVID-19 in Hangzhou to explore the role of human menstrual blood-derived stem cells (MenSCs) in the treatment of COVID-19. Moreover, we review the immunomodulation effect including non-specific and specific immune functions of MenSCs for the therapy of COVID-19.CONCLUSIONMenSCs can be helpful to find a promising therapeutic approach for COVID-19.     

Amyloid β-related angiitis of the central nervous system occurring after COVID-19 vaccination: A case report

BACKGROUNDAlthough coronavirus disease 2019 (COVID-19) vaccines have been effective in controlling the COVID-19 pandemic, a variety of post-vaccination neurological complications have been reported worldwide. Amyloid β-related angiitis (ABRA) is a rare neurological disease. The underlying cause of ABRA is unknown, but several studies suggest that it is caused by an excessive immune response to amyloid-β deposited in blood vessels. In addition, limited attention has been paid to potential triggers of ABRA, such as infection or vaccination.CASE SUMMARYWe report a case of ABRA that developed 2 wk after COVID-19 vaccination. A 75-year-old woman developed a frontal headache after receiving a second dose of COVID-19 BNT162b2 vaccine (Pfizer-BioNTech). Diffusion-weighted magnetic resonance imaging (DW-MRI) of the head showed abnormal hyperintensity, suggesting cerebral infarctions in the left parietal and occipital lobes. We diagnosed her condition as ABRA based on a brain biopsy. We administered steroid pulse therapy and the patient’s symptoms and DW-MRI abnormalities improved. This case had a good outcome due to prompt diagnosis and treatment.CONCLUSIONWe report a case of ABRA that may have been triggered by COVID-19 vaccination.     

Acute Cerebellar Ataxia in COVID-19 Infection: A Case Report

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has been widely reported to cause symptoms such as fever, cough, sore throat, fatigue, and shortness of breath. Neurologic complications have not been widely reported without associated respiratory symptoms. These neurologic manifestations have been found mostly in the elderly. There has been no report of ataxia or COVID-19 cerebellitis in the young adult population without associated respiratory symptoms.Case ReportHere we report the case of a 30-year-old patient who presented with isolated cerebellar symptoms and was diagnosed with COVID-19 cerebellitis.Why Should an Emergency Physician Be Aware of This?It is important for emergency physicians to know that COVID-19 can have many clinical manifestations and to have a high level of suspicion with acute neurologic symptoms.     

The combined therapy of a traditional Chinese medicine formula and Western medicine for a critically ill case infected with COVID-19

ObjectivePresentation of a case illustrating the benefits of traditional Chinese medicine (TCM) for treatment of Coronavirus disease 2019 (COVID-19) in critically ill patients.Clinical features and outcomeA 58-year-old woman presented with cough, fever, dizziness, chest tightness, polypnea and poor appetite. She was admitted to Guizhou Provincial People’s hospital, and diagnosed with critically ill type of COVID-19 in February 2020. According to the patient's symptoms and signs, the TCM syndrome differentiation was qi deficiency, dampness-stasis and toxin accumulation. Then she received the combined therapy of a modified Chinese herbal formula and Western medicine. During a twelve-day period of treatment, her respiratory distress and appetite quickly improved. Abnormal laboratory indicators were resumed in time and lung lesions in CT scan largely absorbed. No side effects associated with this Chinese herbal formula were found. Before discharge, two consecutive nasopharyngeal swabs were shown to be negative for severe acute respiratory coronavirus 2 (SARS-CoV-2).ConclusionsOur case report suggests that collaborative treatments with traditional Chinese medicine prove beneficial in the management of COVID-19 in critically ill patients. In order to give optimal care for this COVID-19 crisis for the whole world, Chinese medicine practitioners and Western medical doctors should work together in frontline.     

Efficacy of arbidol in COVID-19 patients: A retrospective study

BACKGROUNDTo date, no treatment has proven to be absolutely effective for coronavirus disease 2019 (COVID-19) patients, and further research is necessary. As a traditional antiviral drug, arbidol was widely used in Wuhan at the beginning of the COVID-19 epidemic and is of increasing interest for treating COVID-19 based on in vitro data suggesting activity against severe acute respiratory syndrome (SARS). Although arbidol has been widely used in China to treat COVID-19 patients, clinical trials to date have not clearly substantiated this approach.AIMTo evaluate the efficacy of arbidol for COVID-19.METHODSA retrospective study was conducted on 132 moderate and severe COVID-19 patients admitted to Jinyintan Hospital and Huoshenshan Hospital (officially designated for COVID-19 treatment) from February to March 2020 in Wuhan, China. This study mainly evaluated the efficacy of arbidol in patients with COVID-19 in the early stage of the SARS coronavirus 2 epidemic. Arbidol was administered at a dose of 200 mg, three times a day, with a 10-d course to adults not receiving any other drugs. Due to the shortage of beds at the time, not every patient could be admitted immediately. We looked for the early stages of the sudden outbreak, places of limited medical resources, limited ward beds, and delayed admission; thus, some patients naturally fit into the control group who did not receive any antiviral drugs. Out of the 132 patients, 72 received arbidol treatment, and 60 did not. We compared the disease course of the two groups and explored the predictors of extended disease duration.RESULTSSeventy-two patients commenced arbidol, and 60 patients did not receive arbidol treatment. The disease duration in the former group was shorter (23.42 ± 6.92 vs 29.60 ± 6.49, P < 0.001). Multivariate regression analysis showed that the risk of a prolonged course of disease increased by 7.158 times in the non-arbidol treatment group. Ferritin > 483.0 ng/mL and lactate dehydrogenase (LDH) > 237.5 U/L were found to be independent risk factors for protracted cases, with the risk of an extended disease duration increasing to 2.852 times and 5.946 times, respectively.CONCLUSIONThe duration course of moderate and severe COVID-19 patients is reduced by 6.183 d when arbidol is administered. Ferritin > 486.5 ng/mL and LDH > 239.5 U/L are independent risk factors for delayed recovery from COVID-19. Early oral administration of arbidol 200 mg t.i.d. with a 10-d course of treatment may be an effective management strategy in COVID-19 patients, particularly those with increased serum ferritin or elevated LDH.     

Intraoperative care of elderly patients with COVID-19 undergoing double lung transplantation: Two case reports

BACKGROUNDLung transplantation is considered an effective method for treating patients with end-stage coronavirus disease 2019 (COVID-19). The nurses play a pivotal role in lung transplantation for COVID-19 patients.CASE SUMMARYTwo elderly patients were admitted to the emergency department due to cough, and the nucleic acid test was positive. The patients were preliminarily diagnosed with COVID-19. The chest computed tomography scan revealed massive lung consolidation, and the patients did not improve after treatment with antiviral drugs, glucocorticoids, antibiotics, and other drugs. Under the support of pure oxygen in extracorporeal membrane oxygenation, the patients’ oxygen levels were still poor, indicating that they were in the terminal stage of viral pneumonia. The patients underwent double-lung transplantation and received intraoperative care. The extracorporeal membrane oxygenation device was removed within a week of the surgical procedure, and the respiratory circulation of the patients were stabilized.CONCLUSIONHigh-quality care for COVID-19 patients undergoing lung transplantation ensures patient safety during operation while protecting the safety of the medical staff.     

Prone position combined with high-flow nasal oxygen could benefit spontaneously breathing,severe COVID-19 patients: A case report

BACKGROUNDSince the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China in December 2019, the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited. CASE SUMMARYIn this case report, we describe a case of the successful combination of the prone position (PP) and high-flow nasal oxygen (HFNO) therapy in a spontaneously breathing, severe COVID-19 patient who presented with fever, fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing. The therapy significantly improved the patient''s clinical symptoms, oxygenation status, and radiological characteristics of lung injury during hospitalization, and the patient showed good tolerance and avoided intubation. Additionally, we did not find that medical staff wearing optimal airborne personal protective equipment (PPE) were infected by the new coronavirus in our institution.CONCLUSIONWe conclude that the combination of PP and HFNO could benefit spontaneously breathing, severe COVID-19 patients. The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.     

REGN-COV2 antibody cocktail in patients with SARS-CoV-2: Observational study from a single institution in Japan

IntroductionA new treatment for coronavirus disease (COVID-19), REGN-COV2, a cocktail consisting of two neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been approved for patients at a risk of developing more severe disease.MethodsWe retrospectively reviewed patients recently diagnosed with COVID-19 with risk factors for severe infection, who were treated with the REGN-COV2 antibody cocktail between July and September 2021. The REGN-COV2 antibody cocktail was administered to patients within 7 days of disease onset, with an oxygen saturation of >93%, and with at least one comorbidity. We investigated the percentage of patients with COVID-19-related hospitalization or death, the duration of symptoms after treatment, and the adverse effects of treatment.ResultsA total of 108 patients were reviewed. Of them, 64% were aged ≥50 years, 31% had obesity, 36% had hypertension, and 18% had diabetes. In addition, 49% had multiple risk factors for severe COVID-19. Overall, 12 patients (11%) needed COVID-19-related hospitalization. No adverse effects of treatment were observed.ConclusionsThis study shows that treatment with the REGN-COV2 antibody cocktail is safe and beneficial in patients at a risk of developing severe COVID-19.     

Delayed Spontaneous Bilateral Pneumothorax in a Previously Healthy Nonventilated COVID-19 Patient

BackgroundThe novel coronavirus disease 2019 (COVID-19) is a recent viral outbreak that has rapidly spread to multiple countries worldwide. Little is known about COVID-19 infection-related complications.Case ReportWe report a patient who developed spontaneous bilateral pneumothorax after a recent COVID-19 infection. To our knowledge, this is the first reported case of spontaneous bilateral pneumothorax in a patient with recent confirmed severe acute respiratory syndrome coronavirus-2 infection without any risk factors for pneumothorax and who had not received positive pressure ventilation.Why Should an Emergency Physician Be Aware of This?There may be a possible correlation between a recent COVID-19 infection and the development of spontaneous pneumothorax. The diagnosis of spontaneous pneumothorax should be considered in any patient with known or suspected recent COVID-19 infection who presents with new acute symptoms consistent with pneumothorax or sudden clinical deterioration.     

Bell’s palsy after inactivated COVID-19 vaccination in a patient with history of recurrent Bell’s palsy: A case report

BACKGROUNDWith rapid and extensive administration of inactivated coronavirus disease 2019 (COVID-19) vaccine to the general population in China, it is crucial for clinicians to recognize neurological complications or other side effects associated with COVID-19 vaccination.CASE SUMMARYHere we report the first case of Bell’s palsy after the first dose of inactivated COVID-19 vaccine in China. The patient was a 36-year-old woman with a past history of Bell’s palsy. Two days after receiving the first dose of the Sinovac Life Sciences inactivated COVID-19 vaccine, the patient developed right-side Bell’s palsy and binoculus keratoconjunctivitis. Prednisone, artificial tears and fluorometholone eye drops were applied. The patient’s symptoms began to improve by day 7 and resolved by day 54.CONCLUSIONAs mRNA COVID-19 vaccine trials reported cases of Bell’s palsy as adverse events, we should pay attention to the occurrence of Bell’s palsy after inactivated COVID-19 vaccination. A history of Bell’s palsy, rapid increase of immunoglobulin M and immunoglobin G-specific antibodies to severe acute respiratory syndrome coronavirus 2 may be risk factors for Bell‘s palsy after COVID-19 vaccination.     

The effectiveness of high-dose intravenous vitamin C for patients with coronavirus disease 2019: A systematic review and meta-analysis

ObjectivesVitamin C has anti-inflammatory effects. This review aimed to investigate the therapeutic effect of high-dose intravenous vitamin C (HDIVC) in patients with coronavirus disease 2019 (COVID-19).MethodsThe following key phrases were searched for article inclusion: “Vitamin C OR ascorbic acid” AND “COVID-19 OR coronavirus disease 2019 OR severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2″. Articles that utilized HDIVC for the management of patients with COVID-19 were included, whereas review articles and case reports were excluded from this review. Moreover, we performed a meta-analysis to evaluate whether HDIVC can reduce the length of hospital stay and in-hospital mortality rate of patients with severe COVID-19.ResultsIn total, eight articles were included in this review, and five studies were included in the meta-analysis. The length of hospital stay was not significantly different between the HDIVC and control groups. Also, although our meta-analysis showed a tendency for HDIVC to reduce the in-hospital mortality rate in patients with severe COVID-19, the in-hospital mortality rate was not significantly different between patients treated with HDIVC and those who did not receive HDIVC.ConclusionsEvidence supporting the therapeutic use of HDICV in COVID-19 patients is lacking. Further studies are required for drawing a clear conclusion on this topic.     

Management of neonatal sepsis with COVID-19 infection in a premature newborn - A case report

IntroductionNeonates appear to be less affected by COVID-19 than adults, yet COVID-19 has been a challenge for all medical specialties, including neonatal intensive care unit (NICU) specialists. Unfortunately, current knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is limited. This case report explains how COVID-19 neonatal sepsis was treated with immunomodulatory agents.Case presentationIn this case, we present a premature male newborn who was ill. He was born to a mother with a negative nasopharyngeal swab test for SARS-CoV-2. On the fifth day of life, the baby developed respiratory distress, and a nasopharyngeal swab test for SARS-CoV-2 tested positive. The baby was Intubated, and intratracheal surfactant was administered. The infant was treated with intravenous immunoglobulin (IVIg) and corticosteroids for 14 days.Patient's demographicsAge: under 1 month, Sex: Male, Ethnicity: Iranian.ConclusionThe basics of treatment for neonatal COVID-19 is supportive care. Some studies have treated infants with various drugs such as Hydroxychloroquine, Favipiravir, and Remedsivir; however, in our case, a 5-day-old baby boy was treated with corticosteroids and IVIg. We achieved good outcomes after 2 weeks of treatment with dexamethasone 0.3 mg/kg per day and IVIg 2 g/kg/day (for 3 days). It appears that these treatments, along with adjuvant ventilation and the administration of endotracheal surfactant, can improve a patient's general condition.     

Concurrent coronavirus disease 2019 and primary syphilis in a young man: A rare case report

IntroductionThe global rise of syphilis infections and the ongoing coronavirus disease 2019 (COVID-19) pandemic are causes for concern. We herein report a rare case of concurrent primary syphilis and COVID-19.Case reportA 29-year-old man was admitted with a diagnosis of COVID-19. Although COVID-19 pneumonia appeared during ciclesonide and favipiravir treatment, his symptoms improved without developing severe hypoxemia. A small, red ulcer on the left-side of his glans penis was noted and left inguinal lymph node swellings were detected on computed tomography (CT). He reported that his last engagement in sexual intercourse had been 3 months previously, and that his partner had subsequently been diagnosed with syphilis. Although both serum Treponema pallidum (TP) antibody and rapid plasma reagin (RPR) quantitative tests were negative on the day of admission, we clinically diagnosed a suspected case of primary syphilis and started treatment with amoxicillin (1500 mg/day). We subsequently learned that the TP antibody and RPR quantitative tests had been positive 4 days before starting syphilis treatment. Amoxicillin treatment was continued for 61 days, and the ulcer gradually improved. One year later, the RPR quantitative test was negative, and CT revealed a reduction in size of the inguinal lymph nodes and no residual signs of COVID-19 pneumonia.ConclusionThe prevalence of syphilis has been increasing even during the COVID-19 pandemic, and the incidence of concurrent syphilis and COVID-19 might be higher than is recognized. Asking patients with COVID-19 about high-risk sexual behavior and genital lesions could help with early diagnosis of syphilis.     

Efficacy and safety of three new oral antiviral treatment (molnupiravir,fluvoxamine and Paxlovid) for COVID-19：a meta-analysis

BackgroundThe coronavirus disease (COVID-19) epidemic has not been completely controlled. Although great achievements have been made in COVID-19 research and many antiviral drugs have shown good therapeutic effects against COVID-19, a simple oral antiviral drug for COVID-19 has not yet been developed. We conducted a meta-analysis to investigate the improvement in mortality or hospitalization rates and adverse events among COVID-19 patients with three new oral antivirals (including molnupiravir, fluvoxamine and Paxlovid).MethodsWe searched scientific and medical databases, such as PubMed, Web of Science, Embase and Cochrane Library for relevant articles and screened the references of retrieved studies on COVID-19.ResultsA total of eight studies were included in this study. The drug group included 2440 COVID-19 patients, including 54 patients who died or were hospitalized. The control group included a total of 2348 COVID-19 patients, including 118 patients who died or were hospitalized. The overall odds ratio (OR) of mortality or hospitalization was 0.33 (95% confidence interval [CI], 0.22–0.49) for COVID-19 patients in the drug group and placebo group, indicating that oral antiviral drugs were effective for COVID-19 patients and reduced the mortality or hospitalization by approximately 67%.ConclusionsThis study showed that three novel oral antivirals (molnupiravir, fluvoxamine and Paxlovid) are effective in reducing the mortality and hospitalization rates in patients with COVID-19. In addition, the three oral drugs did not increase the occurrence of adverse events, thus exhibiting good overall safety. These three oral antiviral drugs are still being studied, and the available data suggest that they will bring new hope for COVID-19 recovery and have the potential to be a breakthrough and very promising treatment for COVID-19.

KEY MESSAGES

• Many antiviral drugs have shown good therapeutic effects, and there is no simple oral antiviral drug for COVID-19 patients.
• Meta-analysis was conducted for three new oral antivirals to evaluate the improvement in mortality or hospitalization rates and adverse events among COVID-19 patients.
• We focussed on three new oral Coronavirus agents (molnupiravir, fluvoxamine and Paxlovid) and hope to provide guidance for the roll-out of oral antivirals.

     

Timing of convalescent plasma therapy-tips from curing a 100-year-old COVID-19 patient using convalescent plasma treatment: A case report

BACKGROUNDConvalescent plasma therapy is used for the treatment of critically ill patients for newly discovered infectious diseases, such as coronavirus disease 2019 (COVID-19) pneumonia, under the premise of lacking specific treatment drugs and corresponding vaccines. But the best timing application of plasma therapy and whether it is effective by antiviral and antibiotic treatment remain unclear. CASE SUMMARYWe describe a patient with COVID-19, a 100-year-old, high-risk, elderly male who had multiple underlying diseases such as stage 2 hypertension (very high-risk group) and infectious pneumonia accompanied by chronic obstructive pulmonary disease and emphysema. We mainly describe the diagnosis, clinical process, and treatment of the patient, including the processes of two plasma transfusion treatments.CONCLUSIONThis provides a reference for choosing the best timing of convalescent plasma treatment and highlights the effectiveness of the clinical strategy of plasma treatment in the recovery period of patients with COVID-19 pneumonia.