Summary
Ivermectin is an FDA‐approved drug for a parasitic disease that has broad antiviral activity. This study aims to analyse the efficacy of ivermectin in improving the Covid‐19 outcomes. We systematically searched the PubMed, Europe PMC and ClinicalTrials.gov database using specific keywords related to our aims until 10th May 2021. All published randomized clinical trial studies on Covid‐19 and ivermectin were retrieved. The quality of the study was assessed using Jadad scale assessment tool for clinical trial studies. Statistical analysis was done using Review Manager 5.4 software. A total of 19 studies with 2768 Covid‐19 patients were included in this meta‐analysis. This meta‐analysis showed that ivermectin was associated with reduction in severity of Covid‐19 (RR 0.43 [95% CI 0.23–0.81],
p
= 0.008), reduction of mortality (RR 0.31 [95% CI 0.15–0.62],
p
= 0.001), higher negative RT‐PCR test results rate (RR 1.23 [95% CI 1.01–1.51],
p
= 0.04), shorter time to negative RT‐PCR test results (mean difference [MD] −3.29 [95% CI −5.69, −0.89],
p
= 0.007), higher symptoms alleviations rate (RR 1.23 [95% CI 1.03−1.46],
p
= 0.02), shorter time to symptoms alleviations (MD −0.68 [95% CI −1.07, −0.29],
p
= 0.0007) and shorter time to hospital discharge (MD −2.66 [95% CI −4.49, −0.82],
p
= 0.004). Our study suggests that ivermectin may offer beneficial effects towards Covid‐19 outcomes. More randomized clinical trial studies are still needed to confirm the results of our study.
Coronavirus Disease 2019 (COVID‐19) is a public health emergency of international concern with increasing cases globally, including in Indonesia. COVID‐19 clinical manifestations ranging from asymptomatic, acute respiratory illness, respiratory failure that necessitate mechanical ventilation and support in an intensive care unit (ICU), to multiple organ dysfunction syndromes. Some patients might present with happy hypoxia, a condition where patients have low oxygen saturations (S
pO2
< 90%), but are not in significant respiratory distress and often appear clinically well, which is confusing for the doctors and treatment strategies. Most infections are mild in nature and have a relatively low case fatality rate (CFR); however, critical COVID‐19 patients who need support in ICU have high CFR. We would like to report a case of happy hypoxia in a critical COVID‐19‐positive ICU hospitalized patient who survived from Indonesia.
We have read with great interest the articles regarding cutaneous manifestations in Coronavirus Disease 2019 (COVID-19) infection. Studies showed 20.4% of COVID-19 patients developed cutaneous manifestations. COVID-19 causes vascular endothelial injury, vasculitis and prothrombotic state which might be the underlying cause of hemorrhagic cutaneous manifestations, disseminated intravascular coagulation (DIC), and multiple organ failures. To date, hemorrhagic cutaneous manifestations reported are chilblain-like lesion, purpura to ecchymosis, livedo reticularis, and dry gangrene. We present a case of ecchymosis in COVID-19-positive ICU hospitalized patient.
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