Vasculitis is one of the complications of COVID-19. We conducted a systematic review analysing the association of COVID-19 with vasculitis. We searched Google Scholar and PubMed from December 1, 2019, to October 11, 2021. The review included 8 studies (7 case reports and 1 case series) reporting 9 cases of vasculitis secondary to COVID-19. The mean age was 29.17 ± 28.2 years, ranging from 6 months to 83 years. The male to female ratio was 4:5. Maculopapular, violaceous, papular and erythematous rash were common. Heparin(n = 2), corticosteroids (n = 6) (methylprednisolone) and intravenous immunoglobulin (n = 4) were prescribed in these patients. Significant clinical improvement was observed in 8 out of 9 patients. One person died during treatment. Our study discusses vasculitis as one of the complications of COVID-19. Furthermore, the pathophysiology, clinical presentation, and management of COVID-19 associated vasculitis is discussed. 

https://doi.org/10.1016/j.amsu.2022.103249

COVID-19 associated vasculitis: A systematic review of case reports and case series

There is increasing information available about the effects of the SARS-CoV-2 virus on the systemic and ocular health of patients, as well as the effects of delayed health care. This mini-review summarizes the potential complications and treatments of COVID-19. Systemic findings include respiratory illness, risk of thromboembolic events, and neurologic findings. Some patients may develop persistent symptoms even after the infection resolves. Effective treatment options include glucocorticoids, antivirals, interleukin-6 antagonists, monoclonal antibodies, Janus kinase inhibitors and vaccines. Potential ocular findings of COVID-19 include conjunctivitis, cranial nerve palsies, and microvascular changes in the retina; most symptoms resolved over time. During the lockdown periods, teleophthalmology was utilized to triage non-urgent issues; patients who did present to emergency departments tended to have more severe disease with worse visual prognoses. While transient delays in outpatient ophthalmic care may be tolerated in some patients, others experienced significant vision loss with interruptions in treatments. Resumption of ophthalmic care as soon as possible may help mitigate the effects of delayed care due to the pandemic. 

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

Chinese guidelines prioritize the use of Azvudine and nirmatrelvir–ritonavir in COVID‐19 patients. Nevertheless, the real‐world effectiveness of Azvudine versus nirmatrelvir–ritonavir is still lacking, despite clinical trials showing their effectiveness compared with matched controls. To compare the effectiveness of Azvudine versus nirmatrelvir–ritonavir treatments in real‐world clinical practice, we identified 2118 hospitalized COVID‐19 patients, with a follow‐up of up to 38 days. After exclusions and propensity score matching, we included 281 Azvudine recipients and 281 nirmatrelvir–ritonavir recipients who did not receive oxygen therapy at admission. The lower crude incidence rate of composite disease progression outcome (7.83 vs. 14.83 per 1000 person‐days, p = 0.026) and all‐cause death (2.05 vs. 5.78 per 1000 person‐days, p = 0.052) were observed among Azvudine recipients. Azvudine was associated with lower risks of composite disease progression outcome (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.32–0.94) and all‐cause death (HR: 0.40; 95% CI: 0.16–1.04). In subgroup analyses, the results of composite outcome retained significance among patients aged <65 years, those having a history of disease, those with severe COVID‐19 at admission, and those receiving antibiotics. These findings suggest that Azvudine treatment showed effectiveness in hospitalized COVID‐19 patients compared with nirmatrelvir–ritonavir in terms of composite disease progression outcome.

Real‐world effectiveness of Azvudine versus nirmatrelvir–ritonavir in hospitalized patients with COVID‐19: A retrospective cohort study

Current guidelines prioritize the use of the Azvudine in coronavirus disease 2019 (COVID-19) patients. However, the clinical effectiveness of Azvudine in real-world studies was lacking, despite the clinical trials showed shorter time of nucleic acid negative conversion. To evaluate the clinical effectiveness following Azvudine treatment in hospitalized COVID-19 patients, we identified 1505 hospitalized COVID-19 patients during the study period, with a follow-up of up to 29 days. After exclusions and propensity score matching, we included 226 Azvudine recipients and 226 matched controls. The lower crude incidence rate of composite disease progression outcome (4.21 vs. 10.39 per 1000 person-days, P=0.041) and all-cause mortality (1.57 vs. 6.00 per 1000 person-days, P=0.027) were observed among Azvudine recipients compared with matched controls. The incidence rates of initiation of invasive mechanical ventilation were also statistically different between the groups according to the log-rank tests (P=0.020). Azvudine treatment was associated with significantly lower risks of composite disease progression outcome (hazard ratio [HR]: 0.43; 95% confidence interval [CI]: 0.18 to 0.99) and all-cause death (HR: 0.26; 95% CI: 0.07 to 0.94) compared with matched controls. Subgroup analyses indicated robustness of the point estimates of HRs (ranged from 0.14 to 0.84). Notably, male Azvudine recipients had a stronger effectiveness than female recipients with respect to both composite outcome and all-cause death. These findings suggest that Azvudine treatment showed substantial clinical benefits in hospitalized COVID-19 patients, and should be considered for use in this population of patients.

/pdf/real-world-effectiveness-of-azvudine-in-hospitalized-29ah52ec.pdf

Real-world effectiveness of Azvudine in hospitalized patients with COVID-19: a retrospective cohort study

https://doi.org/10.1016/j.ajoc.2022.101669

Consecutive central and branch retinal vein occlusions in the same eye of a young healthy COVID-19 patient: A unique case report

Nirmatrelvir-ritonavir (Paxlovid™) is an oral antiviral that has been approved for the treatment of mild-to-moderate COVID-19. We aimed to conduct a meta-analysis to evaluate the efficacy and safety of nirmatrelvir-ritonavir in COVID-19 patients. Various databases including PubMed, the Cochrane Library, medRxiv and Embase were searched from inception till 10 October 2022 and results from 12 studies (two randomized controlled trials (RCTs) and 10 observational studies) were pooled using a random-effects model with risk ratio (RR) as the effect measure. Nirmatrelvir-ritonavir reduced the risk of mortality (RR 0.24; 95% CI:0.15-0.37, I2 =48%; moderate certainty) and hospitalization (RR 0.41; 95% CI:0.29-0.59, I2 =90%; low certainty) in both patients with or without previous immunity to SARS-CoV-2 without an increased risk of adverse events. Our study provides encouraging evidence for nirmatrelvir-ritonavir as a safe and efficacious agent for COVID-19 but large-scale RCTs are needed to confirm these findings. This article is protected by copyright. All rights reserved.

Nirmatrelvir–ritonavir for the treatment of COVID‐19 patients: A systematic review and meta‐analysis

This systematic review summarizes the evidence on patients diagnosed with central retinal vein occlusion (CRVO) secondary to COVID-19. We searched PubMed and Google Scholar from its inception till June 2021. From an initial 55 publications, 10 studies provided specific information on COVID-19 patients with CRVO. Studies described 10 patients, 60% were male and the mean age was 39.3 ± 11.6 years. Blurred vision (40%) and decreased vision (50%) were the most common presenting complain. Symptom onset ranged from 5 days to 6 weeks after initial complaint of fever. Laboratory results showed elevated inflammatory markers and D-dimers in 60% of patients included in our review. Common treatment options were intravitreal anti-VEGF injections, steroids, and anticoagulants. Traditional co-morbidities like diabetes mellites, hypertension, and morbid obesity (hyperlipidemia) were observed in only 3/10 patients. The prognosis was excellent as all patients saw improvement in their condition. Our findings highlight the importance of identifying CRVO as an important complication of COVID-19 infection. Thus, physicians should not overlook the likelihood of CRVO in patients with COVID-19 infection and offer prompt treatment.

Central Retinal Vein Occlusion in patients with COVID-19 infection: A systematic review.

This cross-sectional study evaluates the representation of women as authors of pivotal trials of novel cardiovascular drugs approved by the US Food and Drug Administration between 2008 and 2020.

/pdf/evaluation-of-representation-of-women-as-authors-in-pivotal-2tkq8mtn.pdf

Evaluation of Representation of Women as Authors in Pivotal Trials Supporting US Food and Drug Administration Approval of Novel Cardiovascular Drugs

Facial palsy is a rare complication of the COVID‐19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post‐COVID‐19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID‐19 patients, its detection, effective treatment plan, and prognosis of the condition.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/hsr2.887

Facial palsy as a manifestation of COVID‐19: A systematic review of cases

Currently approved therapies for COVID‐19 are mostly limited by their low availability, high costs or the requirement of parenteral administration by trained medical personnel in an in‐hospital setting. Quercetin is a cheap and easily accessible therapeutic option for COVID‐19 patients. However, it has not been evaluated in a systematic review until now. We aimed to conduct a meta‐analysis to assess the effect of quercetin on clinical outcomes in COVID‐19 patients. Various databases including PubMed, the Cochrane Library and Embase were searched from inception until 5 October 2022 and results from six randomized controlled trials (RCTs) were pooled using a random‐effects model. All analyses were conducted using RevMan 5.4 with odds ratio (OR) as the effect measure. Quercetin decreased the risk of intensive care unit admission (OR = 0.31; 95% confidence interval (CI) 0.10–0.99) and the incidence of hospitalisation (OR = 0.25; 95% CI 0.10–0.62) but did not decrease the risk of all‐cause mortality and the rate of no recovery. Quercetin may be of benefit in COVID‐19 patients, especially if administered in its phytosome formulation which greatly enhances its bioavailability but large‐scale RCTs are needed to confirm these findings.

Aruba Sohail

Papers

Nirmatrelvir–ritonavir for the treatment of COVID‐19 patients: A systematic review and meta‐analysis

Central Retinal Vein Occlusion in patients with COVID-19 infection: A systematic review.

Evaluation of Representation of Women as Authors in Pivotal Trials Supporting US Food and Drug Administration Approval of Novel Cardiovascular Drugs

Facial palsy as a manifestation of COVID‐19: A systematic review of cases

Quercetin for the treatment of COVID‐19 patients: A systematic review and meta‐analysis