Therapeutic safety and efficacy of triple-immunosuppressants versus dual-immunosuppressants in severe-to-critical COVID-19: a prospective cohort study in Bangladesh

Background: Hyperinflammation-induced respiratory failure is a leading cause of mortality in COVID-19 infection. Immunosuppressants such as, Baricitinib and interleukin inhibitors are the drug-of-choice to suppress cytokine storm in COVID-19. Here, we compared the therapeutic safety and efficacy of triple-immunosuppressants with dual-immunosuppressants in patients with severe-to-critical COVID-19. Methods: This study was conducted on 103 confirmed COVID-19 patients. Of 103 patients, 49 (N) and 54 (N) patients received dual-immunosuppressants (baricitinib plus two doses of secukinumab) and triple immunosuppressants (baricitinib plus single dose of tocilizumab and secukinumab) in group A and group B, respectively. Groups were compared in terms of clinical outcome, critical support-requirement, survival, re-hospitalisation, and adverse events (AEs). Results: Patients in group B achieved normal blood oxygen saturation level (SpO2) earlier than the patients of group A [4 day (IQR: 3–12) vs 5 day (IQR: 5–14), p .05]. The 60-day re-hospitalisation rate was two-fold high in group A than group B (p =.024). Immunosuppressant-associated adverse events and secondary bacterial/fungal infections were relative high in patients of group B. Conclusions: Triple-immunosuppressants in severe-to-critical COVID-19 infection exhibited better clinical outcome; reduced ICU and MV requirement; shorter hospital stay with deceased 60-day all cause mortality and re-hospitalisation compared to dual-immunosuppressants

Impact of high dose of baricitinib in severe COVID-19 pneumonia: a prospective cohort study in Bangladesh

Purpose: Hyperinflammation in severe COVID-19 infection increases the risk of respiratory failure and one of the cogent reasons of mortality associated with COVID-19. Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia. Methods: The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4 mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14 days, and clinical outcomes were compared among the groups. Results: Blood oxygen saturation level was stabilized (≥94% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4–5)/8 (IQR: 6–9), P 0.05; N = 116/122, respectively]. The 30-day mortality and 60-day rehospitalization rate were higher in the UD group than the HD group [6%/3.3%, P 0.05; N = 116/122, respectively]. Conclusion: The daily high dose of baricitinib in severe COVID-19 results in early stabilization of the respiratory functions, declined requirements of critical care supports, reduced rehospitalization with mortality rate compared to its daily usual dose

Climate change impacts from the global scale to the regional scale : Bangladesh

Bangladesh is a beautiful nation. Sadly, it is facing multiple impacts of global warming. The most prominent issues are increased risks of drought, hurricanes, and cyclones; and salt intrusion due to sea level rise and storm surges. Adaptation is difficult and expensive. The Swedish scientist Svante Arrhenius has already warned that an increase in carbon dioxide concentrations in the atmosphere could lead to worldwide temperature increases. Because of various development activities leading to greenhouse gas emissions, the world climate is changing rapidly. Climate change is found in both developing and developed countries, but many developing countries are more affected by climate change and can do less about it. Many poor tropical countries do not have the means to improve their resilience against the effects of climate change. Many island states in the Pacific present examples of this dilemma. Bangladesh is an example of a large country with a large and dense population and is recognized worldwide as being extremely vulnerable to the impacts of global warming and climate change. It is a large delta area vulnerable to sea level rise. Global climate change has already vastly impacted the climate of Bangladesh, as is described in this book. The climate of Bangladesh is heating up and is also changing rapidly because of developments in the rural and urban landscapes. It is unclear if and when this could lead to massive climate change–related migration because of failed crops and failed governance. The designs of embankments, roads, and drainage schemes have already been altered by the government and various agencies. But are these alterations enough in the light of the developments that have occurred rapidly within the last few years? Should not these adaptations be thoroughly evaluated in the light of these new developments?</p