Background: Coronavirus disease (COVID-19) is the current global public health concern. Till date no specific, effective, and approved treatment available. With the rapid increase in rate of infection, repurposing use of anti- viral like remdesivir and favipiravir were considered as an option to find the promising anti-COVID therapeutics. In this study, we aim to observe hepato-renal safety concerns related to these drugs. Method: A retrospective study done from May 17 to September 9, 2020 on total 1348 hospital records. 182 patients were included in the study, devided into two groups who recieved remdesivir only (RO) and favipiravir only (FO). Result: Mean age of respective groups are 59.42 (RO) and 54.64 (FO). Average duration of hospital stay was 11 to 12 days. Mortality rate (28.39%) was higher in RO group. Mean± SD of both ALT (70.65± 50.25) and AST (62.25± 25.46) level was increased in RO group than FO group. On the other hand, Blood urea (56.67± 38.40) and serum creatinine (01.70± 02.41) level was higher in FO group. Hematuria was absent in both group, proteinuria was also unremarkable. Conclusion: In patients with Covid-19 receive remdesivir and favipiravir, showed elevation in the level of hepato- renal markers.
Since the first detection of a cluster of COVID-19 patients in China in late 2019, it becomes a global concern due to its transmissibility and ability to progress patients in severe respiratory failure and acute respiratory distress syndrome, which need intensive care unit support for a long time. We observed the repurposing use of remdesivir and favipiravir whether considered as a therapeutic option or not through survival rate and changes in biomarker during 10-day treatment stay in ICU. The retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done at the peak of COVID-19 pandemic in Bangladesh. The mortality rate, length of ICU stays and eight prognostic biomarkers of patients treated with remdesivir and favipiravir was observed as one of the first ever reported experience in Bangladesh. Among the critically ill patients in ICU, 26 (44.8%) died and 32 (55.2%) were cured during the study period and highest mean duration of stay in ICU was observed (14.33 days and 18.13 days) in FPV-treated patients. Mean of means for all biomarkers CRP (26.0) and d-Dimer (2.64) was recorded higher in favipiravir treated patients in death cases, but NLR, d-NLR, platelet, PLR was much higher in remdesivir treated patient of both death and improved cases. Though overall outcome variables between death and improved cases were not statistically significant (p<0.39) The severity of disease progression in critically ill COVID-19 patients in ICU depends on comorbidities and hyper-responsive inflammatory or immunological biomarkers to predict. Though the emergency use authorization and repurposing use of different antivirals are still on trial, but remdesivir and favipiravir revealed not much hope in improving prognostic biomarkers, survival rate and disease progression at the peak of pandemic in Bangladesh.
Background: The outbreak of coronavirus disease-2019 is putting a massive strain on vulnerable healthcare system in low and middle-income countries like Bangladesh. Inequitable access to healthcare is further widened by the socio-economic gap and sense of insecurity during this pandemic. Self-medication is a common practice in Bangladesh as it provides a low-cost alternative for people, which involves inappropriate and injudicious use of medicines to treat self-recognized symptoms by the people. During the outbreak of COVID-19 in Dhaka city, the tendency of taking medicines by own decision was thought to be increased alarmingly due to unusual distress, caused by high self-awareness of their health and buying capacity of medication. Objectives: To observe the prevalence, pattern, sources and impact of self-medication practice among the respondents with high socio-economic standings and education. Setting: Citizens living in Dhaka city, Bangladesh during COVID-19 outbreak from April 2020 to May 2020. Method: Cross sectional online survey conducted on 626 citizens without having background of medical knowledge or related to any healthcare services (doctors, nurses, pharmacist, medical students) by structured questionnaires during COVID-19 outbreak. Outcome measures: Frequency of self-medication, commonly used antimicrobial agents, symptoms causing self-medication, sources of inspiration, relation with COVID-19 test results, economic burden involved in self-medication during outbreak. Results: The prevalence of self-medication amid the outbreak of COVID-19 was 88.33% and only 179 (28.59%) took medication with doctors’ advice and remaining 447 (71.40%) respondents took the drugs as “self-medication” by other sources. The most frequently used anti-infective drugs during the outbreak were ivermectine (77.15%), azithromycin (54.15%), doxycycline (40.25%). The common symptoms were fever, throat pain, dry-cough and total 105 (16.77%) respondents took medications without having any symptoms. Almost 355 (85.33%) had taken medication without doing any test for COVID-19. The causes of self-medication as news of spread, effects and remedies in media channels, internet; mental stress of lockdown and isolation, insecurity and panic about scarcity of drug and healthcare support. Conclusion: High risks of developing antibiotic resistance, adverse drug reactions and financial loss was predictable with absence of strict regulatory enforcement to protect people and proper utilization resources during COVID-19 outbreak in Dhaka city.
Background: Healthcare professionals (HCPs) are one of the vital and persuading means of information, prevention and control, and incentive of vaccination to content a pandemic. Therefore, knowing the status of HCPs' perception about symptoms, transmission, preventive measures, and attitudes towards a vaccine against COVID-19 is crucial. Methods: This multi-center cross-sectional descriptive study was one of the first and foremost ones in Bangladesh among the HCPs -doctors, nurses, and other subordinates (MLSS) engaged at COVID-dedicated hospitals. The study was conducted from February 5, 2021, to March 7, 2021, using a convenience sampling method among 550 HCPs using structured questionnaire with twenty-five questions on a three-point scale of responses. Results: The age range of the respondents were 18 to 64 years with the mean 36.17 ±10.94 years of 524 HCPs, of which the majority of the respondents were female 323 (61.6%) and 201 (38.4%) were male with the 95.27% response rate. Almost all participants had "high" or more than sufficient perception (94.34%) about the symptoms of COVID-19. But all categories of HCPs expressed their poor or fair practice about restraining from shaking hands, and only 6.84% of nurses, 8.33% doctors, and 11.59% of MLSS avoided crowded public gatherings as a practice of prevention. A majority (95.99%) of the HCPs showed positive attitudes about the availability of vaccines free of cost, and 87.40% showed trust in the efficacy and safety of the vaccine against COVID-19. Conclusion:The majority of the HCPs from the COVID-dedicated hospitals have a good perception and positive attitude towards vaccination; nevertheless, have a poor practice of prevention toward COVID-19. This may play a vital role in motivation and wide acceptance of vaccine among the general population and contribute in comprehensive strategic planning to fight back against the pandemic in the country with the restricted resource.
Background: The study aimed to analyze the demographic, comorbidities, biomarkers, pharmacotherapy, and ICU-stay with the mortality outcome of COVID-19 patients admitted in the intensive care unit of a tertiary care hospital in a low-middle income country, Bangladesh. Methods: The retrospective cohort study was done in Holy Family Red Crescent Medical College Hospital from May to September 2020. All 112 patients who were admitted to ICU as COVID-19 cases (confirmed by RT-PCR of the nasopharyngeal swab) were included in the study. Demographic data, laboratory reports of predictive biomarkers, treatment schedule, and duration of ICU-stay of 99 patients were available and obtained from hospital records (non-electronic) and treatment sheets, and compared between the survived and deceased patients. Results: Out of 99 patients admitted in ICU with COVID-19, 72 were male and 27 were female. The mean age was 61.08 years. Most of the ICU patients were in the 60 - 69 years of age group and the highest mortality rates (35.89%) were observed in this age range. Diabetes mellitus and hypertension were the predominant comorbidities in the deceased group of patients. A significant difference was observed in neutrophil count, creatinine and, NLR, d-NLR levels that raised in deceased patients. There was no significant difference as a survival outcome of antiviral drugs remdesivir or favipiravir, while the use of cephalosporin was found much higher in the survived group than the deceased group (46.66% vs 20.51%) in ICU. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males aged more than 60 years. There were wide variations of the biomarkers in critical COVID-19 patients in a different population, which put the healthcare workers into far more challenge to minimize the mortality in ICU in Bangladesh and around the globe during the peak of the pandemic.
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