A novel coronavirus has had global impact on individual health and health care delivery. In this C4 article, contributors discuss various aspects of transplantation including donor and recipient screening, management of infected patients, and prevention of coronavirus disease (COVID). Donor screening with SARS‐CoV‐2 nucleic acid testing (NAT) close to the time of procurement is recommended. Many programs are also screening all potential recipients at the time of admission. The management of COVID has evolved with remdesivir emerging as a new potential option for transplant recipients. Dexamethasone has also shown promise and convalescent plasma is under study. Prevention strategies for transplant candidates and recipients are paramount. Pediatric‐specific issues are also discussed. Strategies for the psychological well‐being of patients and providers are also imperative, in addition to future research priorities for transplantation.
In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) became evident in Wuhan, China, and then spread rapidly worldwide. Numerous drugs and vaccines are under clinical trial pipeline for investigation against coronavirus disease 2019 (COVID-19) infection. The aim of this systematic review was to discuss about investigational new as well as repurposed drugs currently under trial for COVID-19 infection. An exhaustive search was carried out for this review article including scientific databases of PubMed, Embase, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Web of Science, ScienceDirect, ProQuest, Google Scholar, and Scopus search engines using keywords of “Coronavirus,” “COVID-19,” “MERS-CoV,” “MERS,” “SARS-CoV-2,” and “SARS-CoV-1” and “Solidarity trial” and their Persian-equivalent keywords from inception until May 2020. After screening the 296 articles searched from different databases (PubMed = 97 and other search engines = 199), 52 articles were included in the final systematic review. It was found that the World Health Organization introduced a Solidarity international clinical trial to discover an effectual treatment of COVID-19. Based on established in vitro and in vivo activity against different strains of coronaviruses, four repurposed drugs – remdesivir, lopinavir/ ritonavir combination, lopinavir/ritonavir with beta-1a, chloroquine, and hydroxychloroquine – were considered for clinical trial against COVID-19. A number of other drugs and vaccines are under clinical trial pipeline for investigation against COVID-19 infection. Despite multitude of treatment options available, treatment of choice is still not well established. Moreover, optimum supportive care and monitoring of seriously ill patients is the need of the hour.
Background There is a growing population of palliated and unpalliated single ventricle physiology patients for whom heart transplantation is the only treatment option available. There is a paucity of reports of heart transplantation in this challenging and growing subset of patients from our part of the world. The purpose of the article is to briefly review our experience in the subgroup and compare it with the available literature. Methods This was a single-institution retrospective observational study of 16 patients with single ventricle physiology who were transplanted between 2016 and 2019 and their outcomes. The study groups were divided into those with ventricular dysfunction (group 1), who fare substantially better than those with normal ventricular function (group 2) whose short-term outcomes were poorer. Worsening cyanosis, poor candidature for completion Fontan procedure due to severe atrioventricular valve regurgitation or pulmonary artery anatomy, protein-losing enteropathy, plastic bronchitis, and worsening systemic venous congestion are indications in those with normal ventricular function. Results Patients with ventricular dysfunction as the main indication had excellent early survival with no early mortality compared to 40% mortality in patients with normal ventricular function. Patients who survived to leave the hospital had however similar long-term outcomes. Two patients with protein-losing enteropathy resolved completely by one month. Normal ventricular function, pulmonary artery stenting, early Fontan failure (6 months), ascites, and need for desensitization were risk factors for early mortality. After the early acute phase of increased risk, the mortality risk plateaued off. Conclusion Transplantation in patients with single ventricle and ventricular dysfunction can be offered with a good early and late outcome. There is a need to have multi-institutional and multi-disciplinary collaboration along with work in basic sciences to better understand the effects of failed Fontan physiology with normal ventricular function.
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