The COVID-19 pandemic has strained the healthcare system. It is important to consider forensic and pharmaceutical risks in the organization of vaccination practices and pharmacotherapy of covid, post-covid and long-covid disorders. Scientific sources on the clinical characteristics of SARS-CoV-2, COVID-19 have been systematized. The standards of vaccination practice (immunization, vaccination) of different age categories of the population in Ukraine, England, USA, Belgium, Greece, Japan, and Portugal were analyzed. Proven that the organization of pharmacotherapy schemes is difficult due to the presence of mixed infections, comorbid and complicated forms of diseases, the formation of virus resistance to drugs, and the development of secondary immunological insufficiency. The risks of pharmacotherapy with regard to mortality in patients with COVID-19 due to the development of severe lung lesions and systemic multiorgan pathology are indicated. Schemes of combined pharmacotherapy including antiviral, anti-inflammatory drugs, glucocorticosteroids, genetically engineered biological drugs and "targeted" basic anti-inflammatory drugs were analyzed. The theoretical prerequisites for "repositioning" (drug repurposing) for the treatment of COVID-19 and ego complications are indicated. New directions of anti-inflammatory pharmacotherapy of COVID-19 Janus kinase with a range of anti-inflammatory and antiviral effects were noted. Emphasis was placed on the importance of informing health care professionals about forensic pharmaceutical risks in pharmacotherapy and vaccination practices. The relevance of legal support for medical activity in the conditions of a pandemic was noted. Further research is ongoing.

/pdf/forensic-and-pharmaceutical-risks-in-the-organization-of-20wbhr5p.pdf

Forensic and Pharmaceutical Risks in the Organization of Pharmacotherapy of Covid, Post-Covid and Long-Covid Disorders. COVID-19 and Vaccination Practice Standards.

Intravenous immunoglobulin (IVIg) therapy has been suggested as a potential treatment option for hospitalised COVID‐19 patients. The aim of this systematic review and meta‐analysis was to investigate the potential impact of IVIg on mortality and length of hospitalisation in adult COVID‐19 patients. PubMed, Scopus, Web of Science and medRxiv were searched in the week of 20.12.2021 for English language, prospective trials, and retrospective studies with control groups, reporting on the use of intravenous immunoglobulin therapy in adult hospitalised COVID‐19 patients. Exclusion criteria were: studies evaluating the use of IVIg in paediatric COVID‐19 cases, trials using convalescent anti‐SARS‐CoV‐2 plasma or immunoglobulins derived from convalescent anti‐SARS‐CoV‐2 plasma. A random effects meta‐analysis with subgroup analyses regarding study design and patient disease severity according to WHO criteria was also performed. A total of 13 studies were included, of which 6 were prospective, on a total of 2313 (IVIg = 1104, control = 1209) patient outcomes. Meta‐analysis results indicated that IVIg therapy had no statistically significant effect on mortality (RR 0.91 [0.59; 1.39], p = 0.65, I2 = 69% [46%; 83%]) or length of hospital stay (MD 0.51 [−2.80; 3.81], p = 0.76, I2 = 96% [94%; 98%]). Subgroup analyses indicated no statistically significant impact on either outcome, but prospective studies' results suggested that IVIg may increase the length of hospitalisation in the severe COVID‐19 patient group (MD 2.66 [1.43; 3.90], p < 0.01, I2 = 0% [0%; >90%]). The results of this meta‐analysis do not support use of IVIg in hospitalised adult COVID‐19 patients.

Intravenous immunoglobulin (IVIg) therapy in hospitalised adult COVID‐19 patients: A systematic review and meta‐analysis

Abstract Patients with SLE are at high risk of various infections as evidenced by a number of studies. The main determinants of infection in SLE are disease activity, organ damage, and often inevitable medication. The molecular and cellular mechanisms underlying infection remain unclear. Impaired immunity, immunosuppressants and corticosteroids clearly increase the risk of infection, whereas some medications, such as low-dose IL-2, hydroxychloroquine and IVIG are safe in SLE patients with substantial evidence. It is important to balance the immunosuppression and infection risks in practice. This article focuses on medication-related infections in SLE and discusses the therapeutic options for the disease in clinical practice.

/pdf/dilemma-of-immunosuppression-and-infection-risk-in-systemic-1r09pafw.pdf

Dilemma of immunosuppression and infection risk in systemic lupus erythematosus

Epidemiologic studies have documented lower rates of active smokers compared to former or non-smokers in symptomatic patients affected by coronavirus disease 2019 (COVID-19). We assessed the efficacy and safety of nicotine administered by a transdermal patch in critically ill patients with COVID-19 pneumonia.In this multicentre, double-blind, placebo-controlled trial conducted in 18 intensive care units in France, we randomly assigned adult patients (non-smokers, non-vapers or who had quit smoking/vaping for at least 12 months) with proven COVID-19 pneumonia receiving invasive mechanical ventilation for up to 72 h to receive transdermal patches containing either nicotine at a daily dose of 14 mg or placebo until 48 h following successful weaning from mechanical ventilation or for a maximum of 30 days, followed by 3-week dose tapering by 3.5 mg per week. Randomization was stratified by centre, non- or former smoker status and Sequential Organ Function Assessment score (< or ≥ 7). The primary outcome was day-28 mortality. Main prespecified secondary outcomes included 60-day mortality, time to successful extubation, days alive and free from mechanical ventilation, renal replacement therapy, vasopressor support or organ failure at day 28.Between November 6th 2020, and April 2nd 2021, 220 patients were randomized from 18 active recruiting centers. After excluding 2 patients who withdrew consent, 218 patients (152 [70%] men) were included in the analysis: 106 patients to the nicotine group and 112 to the placebo group. Day-28 mortality did not differ between the two groups (30 [28%] of 106 patients in the nicotine group vs 31 [28%] of 112 patients in the placebo group; odds ratio 1.03 [95% confidence interval, CI 0.57-1.87]; p = 0.46). The median number of day-28 ventilator-free days was 0 (IQR 0-14) in the nicotine group and 0 (0-13) in the placebo group (with a difference estimate between the medians of 0 [95% CI -3-7]). Adverse events likely related to nicotine were rare (3%) and similar between the two groups.In patients having developed severe COVID-19 pneumonia requiring invasive mechanical ventilation, transdermal nicotine did not significantly reduce day-28 mortality. There is no indication to use nicotine in this situation. 

/pdf/nicotine-patches-in-patients-on-mechanical-ventilation-for-3h7c7daw.pdf

Nicotine patches in patients on mechanical ventilation for severe COVID-19: a randomized, double-blind, placebo-controlled, multicentre trial

Despite the progress of its management, COVID-19 maintains an ominous condition which constitutes a threat, especially for the susceptible population. The cardiac injury occurs in approximately 30% of COVID-19 infections and is associated with a worse prognosis. The clinical presentation of cardiac involvement can be COVID-19-related myocarditis. Our review aims to summarise current evidence about that complication. The research was registered at PROSPERO (CRD42022338397). We performed a systematic analysis using five different databases, including i.a. MEDLINE. Further, the backward snowballing technique was applied to identify additional papers. Inclusion criteria were: full-text articles in English presenting cases of COVID-19-related myocarditis diagnosed by the ESC criteria and patients over 18 years old. The myocarditis had to occur after the COVID-19 infection, not vaccination. Initially, 1588 papers were screened from the database search, and 1037 papers were revealed in the backward snowballing process. Eventually, 59 articles were included. Data about patients’ sex, age, ethnicity, COVID-19 confirmation technique and vaccination status, reported symptoms, physical condition, laboratory and radiological findings, applied treatment and patient outcome were investigated and summarised. COVID-19-related myocarditis is associated with the risk of sudden worsening of patients’ clinical status, thus, knowledge about its clinical presentation is essential for healthcare workers.

https://www.mdpi.com/2077-0383/11/19/5519/pdf?version=1664037610

COVID-19 Related Myocarditis in Adults: A Systematic Review of Case Reports

Intravenous immunoglobulins in patients with COVID-19-associated moderate-to-severe acute respiratory distress syndrome (ICAR): multicentre, double-blind, placebo-controlled, phase 3 trial.

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Intravenous immunoglobulins in patients with COVID-19-associated moderate-to-severe acute respiratory distress syndrome (ICAR): multicentre, double-blind, placebo-controlled, phase 3 trial.