Drug repurposing in the treatment of COVID-19: A review

The first outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was in Wuhan, Hubei, China in December 2019 and declared as a pandemic by the World Health Organization. Currently, there is no proven effective vaccine or therapeutic agent to combat the deadly coronavirus disease. Currently, prevention from the infection, control measures and supportive care help to treat against COVID-19. Until an effective vaccine is available for COVID-19 infection, one can repurpose known therapeutic agents that block the entry of the virus into the host cell and control the COVID-19 infection. Drug repurposing is the new use of old drugs. In this review, the most common and possible drug treatment for COVID-19 is highlighted. The therapeutic agents include antiviral drugs like Remdesivir, chloroquine, hydroxychloroquine, lopinavir/ritonavir, umifenovir, favipiravir and oseltamivir and other agents. Clinical trials are ongoing to evaluate the safety and efficacy of these therapeutic agents in COVID-19 patients

Epidemiology of Distal Renal Tubular Acidosis: A Study Using Linked UK Primary Care and Hospital Data

Introduction: Distal renal tubular acidosis (dRTA), or RTA type 1, a rare inherited or acquired disease, is a disorder of the distal tubule caused by impaired urinary acid secretion. Due to associated conditions and nonspecific symptoms, dRTA may go undetected. This analysis aims to estimate the prevalence of dRTA in the UK Clinical Practice Research Datalink (CPRD) databases and extrapolate it to European Union Five (EU5) populations. Methods: A retrospective analysis was conducted using the CPRD GOLD database and linked Hospital Episode Statistics (HES) data to identify diagnosed and potentially undiagnosed or miscoded patients (suspected patients). Patients’ records with at least one diagnosis code for dRTA, RTA, specific autoimmune diseases, or renal disorders recorded between January 1987 and November 2017 were obtained and analyzed. An algorithm was developed to detect potentially undiagnosed/miscoded dRTA, based on associated conditions and prescriptions. Results: A total of 216 patients with diagnosis of RTA or dRTA were identified (with 98 linked to hospital data), and 447 patients were identified as having suspected dRTA. dRTA prevalence for 2017 was estimated between 0.46 (recorded cases, of which 22.1% were considered primary) and 1.60 when including suspected cases (7.6% primary) per 10,000 people. Prescription and clinical records of diagnosed patients revealed a wide range of comorbidities and a need for pharmacological treatment to manage associated symptoms. Conclusion: The study provides new estimates of dRTA prevalence in Europe and suggests that patients may often be unreported or miscoded, potentially confounding appropriate disease management

A case report: primary CNS angiitis

The primary angiitis of the central nervous system (PACNS) is an entity with a very low incidence and prevalence. It affects small and medium sized arteries of the brain parenchyma, spinal cord and leptomeniges resulting in CNS dysfunction. It is defined by inflammation of the cerebral vasculature without angiitis of other organ. Its clinical manifestations are very heterogeneous and make clinical diagnosis difficult. In most cases, a brain biopsy is required. Only the clinical suspicion and the ability to recognize the possible clinical and imagenological patterns of presentation make an accurate diagnosis possible.We hereby report a case of Primary angiitis of CNS in 35 year old right handed male who presented with ischemic stroke with Left Hemiplegia. The diagnosis of PACNS was made after ruling out most of the causes of secondary CNS angiitis

Disproportionate rise in serum CA 125 in case of budd chiari syndrome: an unusual presentation

Ca 125 is used as a diagnostic and prognostic biomarker for ovarian cancer. The level of CA 125 is also elevated in benign conditions like Budd Chiari syndrome, liver cirrhosis and heart failure. But very high level of CA 125 is rarely associated with benign conditions and this can mislead the physician. Here we present a case of budd chiari syndrome in postpartum period associated with very high level of CA 125 which is an unusual presentation

SpO2/FiO2 ratio: a prognostic marker for influenza patients

Background: The objective of the study was to study the utility of SpO2 /FiO2 ratio for monitoring and predicting the outcome of   H1N1 positive patients of category C.Methods: This study is a hospital based observational study done at Government Medical College, Nagpur, Maharashtra, India from 14th January to 15th April 2015.  In this study, 156 H1N1 positive patients of category C were included.Results: 156 Patients were included. 96 were female and 60 were male patients. SpO2/FiO2 ratio was calculated on day one and values were used to divide patients into 5 groups. Highest mortality (70%) is seen in a group with SpO2/FiO2 ratio < 150. SpO2/FiO2 ratio progressively dropped in patients who died. SpO2/FiO2 ratio gradually improved in patients who survived.Conclusions: SpO2/FiO2 ratio on day 1 can be used as a prognostic marker in H1N1 positive patients. SpO2/FiO2 ratio was found to be a reliable marker to monitor the patients

Social support for and through exercise and sport in a sample of men with serious mental illness.

Social support is important for people experiencing serious mental illness and is also important during the initiation and maintenance of exercise. In this article we draw on interpretive research into the experiences of 11 men with serious mental illness to explore four dimensions of social support both for and through exercise. Our findings suggest that informational, tangible, esteem, and emotional support were both provided for and given by participants through exercise. We conclude that experiences of both receiving and giving diverse forms of support in this way are significant for some people living with and recovering from serious mental illness

Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist led telephone support for psychological distress in patients undergoing haemodialysis

Introduction: Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis. Methods: Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation. Ethics and dissemination: A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis. Any amendments to the protocol will be submitted to the NHS committee and study sponsor<br/

5 year retrospective follow-up of new cases of Charcot neuroarthropathy - A single centre experience

Background: Few data describe the natural history of Charcot neuroarthropathy treated with a total contact plaster cast (TCC). Methods: A 5 year retrospective analysis of 50 patients presenting with an acute CN, Assessing time to clinical resolution into appropriate footwear and assessing if initial immobilisation device influenced resolution time. Results: During the study period 42 patients (84%) of patients went into remission, 2 died during their treatment, 4 had major amputations, in 2 patients treatment was ongoing. 36 patients were treated with combination offloading devices, 6 were treated with one modality only. Median time to resolution for patients initially treated with a TCC was not significantly shorter than for those treated with a removable below knee boot. 34.9% required re-casting due to clinical deterioration in the removable device. Conclusions: More precise measures of resolution of CN are needed to assess the impact of initial treatment modality on time to resolution

Chromatic Weibull Tone Mapping for Underwater Image Enhancement

Image enhancement is often used to alleviate the low contrast, blurring and colour reduction effects, common in underwater imagery. Tone Mapping, a particularly simple yet elegant enhancement technique improves image quality by modifying image histograms to a more desirable tonal distribution. In previous work, we presented our novel chromaticity-preserving algorithm, Weibull Tone Mapping (WTM), that can simplify custom tonal manipulations, to increase conspicuousness of image features. In this paper, we present a natural non-chromaticity preserving counterpart, in which the WTM tone map is applied to all colour channels (R,G,B). We demonstrate, as before, that user's prefer WTM to unenhanced images. However, contrary to prior work, our non-chromaticity preserving WTM is less preferred to custom tonal manipulations. Thus, how we map the colour aspect of images (given a brightness only tonal adjustment) has a significant impact on users' subjective preference judgements

Weibull Tone Mapping for Underwater Imagery

Imagery is a preferred tool for environmental surveys within marine environments, particularly in deeper waters, as it is non-destructive compared to traditional sampling methods. However, underwater illumination effects limit its use by causing extremely varied and inconsistent image quality. Therefore, it is often necessary to pre-process images to improve visibility of image features and textures, and standardize their appearance. Tone mapping is a simple and effective technique to improve contrast and manipulate the brightness distributions of images. Ideally, such tone mapping would be automated, however we found that existing techniques are inferior when compared to custom manipulations by image annotators (biologists). Our own work begins with the observation that these user-defined tonal manipulations are quite variable, though on average, are fairly smooth, gentle waving operations. To predict user-defined tone maps we found it sufficed to approximate the brightness distributions of input and user adjusted images by Weibull distributions and then solve for the tone curve which matched these distributions from input to output. Experiments demonstrate that our Weibull Tone Mapping (WTM) method is strongly preferred over traditional automated tone mappers and weakly preferred over the users' own tonal adjustments