Early hydroxychloroquine and azithromycin as combined therapy for COVID-19: a case series

Coronavirus disease 2019 (COVID-19) is a worldwide outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) has declared it as a public health emergency of international concern (PHEIC) and eventually a pandemic. Many clinical trials have been conducted to investigate potential and effective therapies for COVID-19. Here we reported the outcome of three COVID-19 cases treated early with the combination of hydroxychloroquine and azithromycin. Early treatments of suspected or confirmed positive COVID-19 cases with this combination therapy is to avoid disease progressions into a more severe and irreversible state. In these cases, clinical, radiological, and laboratory features were followed up. No complications were observed. The COVID-19 patients treated with this early combination therapy showed good clinical and virological responses

Current understanding of the origin, molecular biology and continuing evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Recent outbreaks of human coronaviruses, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have put health authorities worldwide on a high alert. Firstly emerged in the city of Wuhan, China, SARS-CoV-2 infection is rapidly escalating into a global pandemic. It is first thought as the result of a zoonotic transmission event, similar to the previous epidemic of coronaviruses. However, a continuously increasing number of confirmed cases indicates that the virus gains capacity of efficient human-to-human transmission. Soon after the pandemic is arising, many efforts are focused on identifying the origin of SARS-CoV-2 infection in the human population. Current evidence suggests that the virus is probably derived from bat or pangolin coronaviruses as the natural host. Whether intermediate host(s) exist in the transmission cascade from bat or pangolin to humans is, to a great extent, elusive. This information is essential as the basis for infection prevention and control measures. In this review, we discuss our recent understanding of SARS-CoV-2 biology, highlighting its origin and molecular evolution

Prognostic factors for the outcomes of COVID-19 patients infected with SARS-CoV-2 Omicron and Delta variants

Background The SARS-CoV-2 Omicron variant has replaced the previously dominant Delta variant because of high transmissibility. However, studies on the impact of the Omicron variant on the severity of COVID-19 are still limited in developing countries. Our study aimed to determine the prognostic factors for the outcomes of patients infected with SARS-CoV-2 Omicron and Delta variants, including age, sex, comorbidities, and smoking. Methods In this retrospective cross-sectional study, we involved 352 patients with COVID-19 from Yogyakarta and Central Java provinces, Indonesia, from May 2021 to February 2022, consisting of 164 males and 188 females. We included all patients with the PCR’s Ct value of less than 30 for further whole-genome sequencing. Results Ct value and mean age of COVID-19 patients were not significantly different between both groups (p = 0.146 and 0.273, respectively). Patients infected with Omicron (n = 139) and Delta (n = 213) variants showed similar hospitalization (p = 0.396) and mortality rates (p = 0.565). Multivariate analysis of both groups showed that older age (≥ 65 years) had a higher risk for hospitalization (OR = 3.86 [95% CI = 1.29–11.5]; p = 0.015) and fatalities (OR = 3.91 [95% CI = 1.35–11.42]; p = 0.012). In both groups, patients with cardiovascular disease had a higher risk for hospitalization (OR = 5.36 [95% CI = 1.08–26.52]; p = 0.039), whereas patients with diabetes revealed a higher risk for fatalities (OR = 9.47 [95% CI = 3.23–27.01]; p = < 0.001). Conclusions Our study shows that patients infected with Omicron and Delta variants reveal similar clinical outcomes, including hospitalization and mortality. Our findings further confirm that older age, cardiovascular disease, and diabetes are substantial prognostic factors for the outcomes of COVID-19 patients. Our findings imply that COVID-19 patients with older age, cardiovascular disease, or diabetes should be treated comprehensively and cautiously to prevent further morbidity and mortality. Furthermore, incomplete data on vaccination status hampered us from analyzing further its impact on hospitalization and mortality in our patients

The effectivity of banana leaf-filtered cloth face masks as an alternative protection during the pandemic

The main transmission route of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is through individual droplets of respiratory secretions. Accordingly, the most basic preventive measure is wearing a face mask. Since the issue of medical waste during the pandemic is concerning, developing face masks made of reusable and biodegradable materials is necessary. This study aimed to develop "do-it-yourself" face masks and test the effectiveness of banana leaf-filtered cloth face masks. The design development was conducted by a series of trials for making a mask pattern that can be applied to the cloth. Then, we performed bacterial filtration efficiency (BFE) and water resistance tests to investigate the effectiveness of banana leaf-filtered cloth-based face masks. The dimensions of the developed face mask are 20x18 cm, with a semi-duckbill model, consisting of three layers of washable cotton cloth and a pocket designed for the banana leaf filter. Among 34 leaf-filtered face masks, 61.8% showed water resistance abilities. Based on the BFE test, the leaf-filtered face masks contained significantly fewer bacteria (the average of 0.417x103 cfu/cm2) compared to the cloth face masks without additional leaf filter (30x103 cfu/cm2). Thus, banana leaf-filtered cloth face masks could be considered as alternative protection during the pandemic

The effectivity of banana leaf-filtered cloth face masks as an alternative protection during the pandemic

The main transmission route of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is through individual droplets of respiratory secretions. Accordingly, the most basic preventive measure is wearing a face mask. Since the issue of medical waste during the pandemic is concerning, developing face masks made of reusable and biodegradable materials is necessary. This study aimed to develop "do-it-yourself" face masks and test the effectiveness of banana leaf-filtered cloth face masks. The design development was conducted by a series of trials for making a mask pattern that can be applied to the cloth. Then, we performed bacterial filtration efficiency (BFE) and water resistance tests to investigate the effectiveness of banana leaf-filtered cloth-based face masks. The dimensions of the developed face mask are 20x18 cm, with a semi-duckbill model, consisting of three layers of washable cotton cloth and a pocket designed for the banana leaf filter. Among 34 leaf-filtered face masks, 61.8 showed water resistance abilities. Based on the BFE test, the leaf-filtered face masks contained significantly fewer bacteria (the average of 0.417x103 cfu/cm2) compared to the cloth face masks without additional leaf filter (30x103 cfu/cm2). Thus, banana leaf-filtered cloth face masks could be considered as alternative protection during the pandemic. © 2022, Intelektual Pustaka Media Utama. All rights reserved

Pharmacoeconomic Rationale of Zinc Supplementation In The Management of Acute Diarrhea In Children With Rotavirus Infection In Indonesia

Rotavirus is one of the most important causative agents of gastroenteritis in both infants and children worldwide, resulting in a high mortality and burden of disease, mainly in low-income, developing countries. Oral rehydration therapy with zinc supplementation is currently the recommended way to prevent death from diarrheal dehydration. In this study, we aimed to estimate the effectiveness of zinc supplementation in combination therapy of patients with suspected rotavirus infection in Indonesia. The perspective of this pharmacoeconomic study refer to the economic vantage point of cost-of-illness analysis. Achievement of this goal was possible with the construction of a decision tree model and determination of decision rules for inclusion of zinc supplementation into the combination therapy. The input parameters of the model were hospitalization days of patients stratified by the presence or absence of rotavirus infection as well as the additional inclusion of zinc supplementation. The criterion for prediction and decision making was the global rotavirus prevalence. The feature of the simulation was that the costs were expressed as relative to each other, which allowed to unify the proposed methodology. Retrospective analysis of clinical database of Indonesian patients with acute diarrhea has shown that zinc supplementation would be rational in case of rotavirus prevalence among these patients is higher than 81.5%. It was shown that additional zinc supplementation would be costeffective with probability of 0.62 and 0.53 – in the positive range of cost ratio variation or if costs for less than 43% of baseline therapy per day costs on an average

A Comparison of Bioinformatics Pipelines for Enrichment Illumina Next Generation Sequencing Systems in Detecting SARS-CoV-2 Virus Strains

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a newly emerging virus well known as the major cause of the worldwide pandemic due to Coronavirus Disease 2019 (COVID-19). Major breakthroughs in the Next Generation Sequencing (NGS) field were elucidated following the first release of a full-length SARS-CoV-2 genome on the 10 January 2020, with the hope of turning the table against the worsening pandemic situation. Previous studies in respiratory virus characterization require mapping of raw sequences to the human genome in the downstream bioinformatics pipeline as part of metagenomic principles. Illumina, as the major player in the NGS arena, took action by releasing guidelines for improved enrichment kits called the Respiratory Virus Oligo Panel (RVOP) based on a hybridization capture method capable of capturing targeted respiratory viruses, including SARS-CoV-2; therefore, allowing a direct map of raw sequences data to SARS-CoV-2 genome in downstream bioinformatics pipeline. Consequently, two bioinformatics pipelines emerged with no previous studies benchmarking the pipelines. This study focuses on gaining insight and understanding of target enrichment workflow by Illumina through the utilization of different bioinformatics pipelines named as &lsquo;Fast Pipeline&rsquo; and &lsquo;Normal Pipeline&rsquo; to SARS-CoV-2 strains isolated from Yogyakarta and Central Java, Indonesia. Overall, both pipelines work well in the characterization of SARS-CoV-2 samples, including in the identification of major studied nucleotide substitutions and amino acid mutations. A higher number of reads mapped to the SARS-CoV-2 genome in Fast Pipeline and merely were discovered as a contributing factor in a higher number of coverage depth and identified variations (SNPs, insertion, and deletion). Fast Pipeline ultimately works well in a situation where time is a critical factor. On the other hand, Normal Pipeline would require a longer time as it mapped reads to the human genome. Certain limitations were identified in terms of pipeline algorithm, whereas it is highly recommended in future studies to design a pipeline in an integrated framework, for instance, by using NextFlow, a workflow framework to combine all scripts into one fully integrated pipeline