Objectives: To the best of our knowledge, there is no published study regarding use of IFN β-1a in the treatment of severe COVID-19. In this randomized clinical trial efficacy and safety of IFN β-1a has been evaluated in patients with severe COVID-19. Methods: Forty-two patients in the interferon group received IFN β-1a in addition to the national protocol medications (hydroxychloroquine plus lopinavir/ritonavir or atazanavir/ritonavir). Each 44 micrograms/ml (12 million IU/ml) of interferon β-1a was subcutaneously injected three times weekly for two consecutive weeks. The control group consisted 39 patients that received only the national protocol medications. Primary outcome of study was time to reach clinical response. Secondary outcomes were duration of hospital stay, length of ICU stay, 28-day mortality, effect of early or late administration of IFN on mortality, adverse effects and complications during the hospitalization. Results: Between 29th February to 3rd April 2020, 92 patients were recruited that finally 42 patients in the IFN group and 39 patients in the control group completed the study. As primary outcome, time to the clinical response was not significantly different between the IFN and the control groups (9.7 ± 5.8 vs. 8.3 ± 4.9 days respectively, P=0.95). On day 14, 66.7% vs. 43.6% of patients in the IFN group and the control group were discharged, respectively (OR= 2.5; 95% CI: 1.05- 6.37). The 28-day overall mortality was significantly lower in the IFN than the control group (19% vs. 43.6% respectively, p= 0.015). Early administration significantly reduced mortality (OR=13.5; 95% CI: 1.5-118). Conclusion: Although IFN did not change time to reach the clinical response, adding it to the national protocol significantly increased discharge rate on day 14 and decreased 28-day mortality.

Introduction It is reported that coronavirus disease (COVID-19) can affect the sense of smell and taste of infected people. The pathobiology of this virus is still incompletely known, and it is therefore important to explore the impact of COVID-19 infections on olfactory and gustatory functions. We aimed to review current evidence on olfactory and gustatory dysfunctions caused by COVID-19. Methods This study was a narrative review performed in 2020 to investigate the olfactory and gustatory dysfunctions of the COVID-19. We searched eight keywords in six databases to determine the related documents on the main objective of the study. To discover studies meeting the inclusion criteria, the authors screened the titles and abstracts of the identified articles. The appropriate studies were included and their results were discussed to make the final selection. Results We have studied 24 current articles on the olfactory and gustatory dysfunctions due to COVID-19. A review of current studies has shown that we have a surge in the spread of olfactory and gustatory dysfunctions that happened during the epidemic of COVID-19 infection. Most studies (95.8%) have confirmed the symptoms of anosmia in patients with SARS-CoV-2 infection. A review of current studies showed that, in addition to anosmia, evidence of ageusia and dysgeusia (parageusia) was also seen in patients with COVID-19. Conclusion The results of our study support recent reports that SARS-CoV-2 may infect oral and nasal tissues and cause olfactory and gustatory dysfunctions. These findings may aid future research on the diagnosis, prevention, and treatment of COVID-19 consequences.

Background Vitamin C is an essential water-soluble nutrient that functions as a key antioxidant and has been proven to be effective for boosting immunity. In this study, we aimed to assess the efficacy of adding high-dose intravenous vitamin C (HDIVC) to the regimens for patients with severe COVID-19 disease. Methods An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received HDIVC (6 g daily) added to the same regimen. Results There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. The mean body temperature was significantly lower in the case group on the 3rd day of hospitalization (p = 0.001). Peripheral capillary oxygen saturations (SpO2) measured at the 3rd day of hospitalization was also higher in the case group receiving HDIVC (p = 0.014). The median length of hospitalization in the case group was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in SpO2 levels at discharge time, the length of intensive care unit (ICU) stay, and mortality between the two groups. Conclusions We did not find significantly better outcomes in the group who were treated with HDIVC in addition to the main treatment regimen at discharge. Trial registration irct.ir (IRCT20200411047025N1), April 14, 2020

Highlights Ventricular arrhythmias can occur with concurrent use of azithromycin (AZM) and hydroxychloroquine (HCQ). Combination therapy with HCQ+AZM can reduce the hospital length of stay in COVID-19 patients. Preparatory risk assessment can limit the risk of arrhythmia in patients receiving HCQ+AZM combination therapy.

Objectives: To the best of our knowledge, there is no published study regarding use of IFN beta-1a in the treatment of severe COVID-19. In this randomized clinical trial efficacy and safety of IFN β-1a has been evaluated in patients with severe COVID-19. Methods: Forty-two patients in the interferon group received IFN beta-1a in addition to the standard of care. Each 44 micrograms/ml (12 million IU/ml) of interferon beta-1a was subcutaneously injected three times weekly for two consecutive weeks. The control group received only the standard of care. Primary outcome of study was time to reach clinical response. Secondary outcomes duration of hospital stay, length of ICU stay, 28-day mortality, effect of early or late administration of IFN on mortality, adverse effects and complications during the hospitalization. Results: As primary outcome, time to the clinical response was not significantly different between the IFN and the control groups (9.7 +/- 5.8 vs. 8.3 +/- 4.9 days respectively, P=0.95). On day 14, 66.7% vs. 43.6% of patients in the IFN group and the control group were discharged, respectively (OR= 2.5; 95% CI: 1.05- 6.37). The 28-day overall mortality was significantly lower in the IFN then the control group (19% vs. 43.6% respectively, p= 0.015). Early administration significantly reduced mortality (OR=13.5; 95% CI: 1.5-118). Conclusion: Although did not change time to reach the clinical response, adding to the standard of care significantly increased discharge rate on day 14 and decreased 28-day mortality. Clinical Trial Registration ID #IRCT20100228003449N28.

Coronavirus disease reached pandemic proportions at the beginning of 2020 and continues to be a worldwide concern. End organ damage and acute respiratory distress syndrome are the leading causes of death in severely or critically ill patients. The elevated cytokine levels in severe patients in comparison with mildly affected patients suggest that cytokine release syndrome (CRS) occurs in the severe form of the disease. In this paper, the significant role of pro-inflammatory cytokines, including IL-1, IL-6, and TNF-alpha, and their mechanism of action in the CRS cascade is explained. Potential therapeutic approaches involving anti-IL-6 and anti-TNF-alpha antibodies to fight COVID-19 and reduce mortality rate in severe cases are also discussed.

Introduction: Many potential vaccines for COVID-19 are being studied, and several studies have reported the results of these vaccines. We aimed to review the current evidence of the feasibility and effectiveness of Vaccines for COVID-19. Methods: A search was carried out utilizing the keywords in the online databases, including Scopus,Web of Science, PubMed, Embase, and Cochrane. We included both human and non-human studies because of the vaccine novelty, which could limit our ability to include sufficient human studies. Results: The review of studies showed that several SARS-CoV-2 vaccines are under development; different platforms are being used, including eight vaccines are adenovirus-based vectors, six vaccines are RNA-based formulations, one vaccine is DNA-based formulations, and other vaccines are using other platforms, including lipid nano particles. Conclusion: It is crucial to gather as much clinically relevant evidence as possible regarding the immunogenicity, efficacy, and safety profiles of these vaccines and adhere wisely to CDC protocols and guidelines of vaccine production.

Twenty-four months after Ahmed valve or Molteno implant, statistically significant quantitative (cell density) and minor qualitative (cell area) changes in central CEC were observed. Both groups appeared to have similar CEC damage.