COVID-19 is a highly contagious respiratory disease which has reached pandemic levels worldwide in 2020, and it is caused by the SARS-Cov-2 virus. The mechanism of transmission of this virus is from person to person, via droplets that are released by an infected person through sneezing, coughing or even during normal conversation (National Cancer Institute, 2020).
The transmission can also occurred when touching any kind of surface that has received an infected droplet and then touching one's eyes, mouth of nose if no sanitization through washing the hands or using alcohol hand sanitizer with a minimum of 70% of alcohol content.
Signs and Symptoms of COVID-19 commonly appear between 2 and 14 days after being exposed to the virus. These symptoms include troubled breathing, cough, fever, as well as headaches, muscle pain and chills. Many patients also report a loss of the sense of smell and taste.
Empirical evidence shows that COVID-19 tends to have more serious consequences among the older population, and although some patients are asymptomatic or present very mild symptoms, they can still spread the disease. Although some patients can recover quickly and easily, other patients such as the elderly and people with chronic conditions may be at a much higher risk, and could develop life-threatening conditions such as pneumonia and general organ failure (National Cancer Institute, 2020).
SARS-Cov-2 may cause widespread infection and even possibly the destruction of lung cells, which in turn triggers a local response from the immunity system using different mechanisms such as the release of cytokines and adaptive T and B cell responses. Often times this response resolves the problems but other times a dysfunctional immune response is observed, which leads to the most severe complications observed in patients with COVID-19. The most common approach used to control the disease is the use of therapies that have the objective of inhibiting the viral infection as well as regulating any potential dysfunctional immune responses, as well as controlling the inflammatory response observed among patients (Tay, Poh, Rénia, MacAry & Ng, 2020).
Although some patients may have COVID-19 and have no symptoms, a relatively percentage of patients will need some degree of hospital intervention, and in some cases some urgent care is needed. This hospital intervention serves as a controlled setting for keeping inflammation at bay and monitoring the evolution of the condition.
No effective vaccine or proven effective antiviral therapy has been approved as of yet. Still, most patients with medium to severe conditions will receive some sort of therapeutic antibody treatment. A commonly used antibody therapy is the monclonal therapy, which has been used commonly for other acute respiratory conditions (Shanmugaraj, Siriwattananon, Wangkanont & Phoolcharoen, 2020).
While an effective vaccine or treatment is not yet approved, the intervention consists of using some type of monoclonal therapy and to keep inflammation under control. The selection of the therapy is associated to the specific patient, due to the potential existence of harmful side effects.
Are any of the existing antiviral treatments and antibody therapies effective at treating COVID-19 and safe for its use in humans?
• Only Randomised controlled trials were included.
• Studied that had maximum comparison of two methods.
• Patients with COVID-19 with no previous terminal diseases or asymptomatic subjects with exposure to a confirmed COVID-19 case.
• Patients older than 18 years of age.
• Only studies no older than 2 years were used.
• Only cases were intervention was needed were included
• Only articles with literature in English were included.
For this review any study that was a reviews or a letters was excluded. Also, the following elements were excluded as well.
• Multiple methods
• Studies that included subjects under the age of 18
• Studies that were more than 2 years old.
• Articles that were of poor evidence and/poor methodological approach.
• Literature written in a language other than English.
The COVID-19 pandemic has taken the world by storm, causing havoc in all aspects of life. Confinement, dramatic economic slowdown, COVID-19 came to put an halt to all of the world's daily common activities: commerce, schools, entertainment, sports and essentially the way humans relate. Covid-19 proved to be extremely easy to spread and it showed rapid exponential growth, until epidemiological measures were taken.
A race for the production of a vaccine and an effective treatment has been on since the beginning of the pandemic, in China, while the emergency rooms in the world keep being saturated with Covid-19 patients (although the pressure of emergency rooms beds due to Covid has somewhat decreased in many countries, thanks to the measures of social distancing taken).
Results from the database searched were analysed were screened and the four ones that best represent the topic being study and those which had potential to provide sufficient information to answer the PICO questions were selected. Due to the recent nature of this phenomenon, only articles from years 2019 and 2020 were considered, because that short span is the time period of the pandemic.
The study of (Cao, Wang, Wen, et al, 2020) was published on March 18, 2020. The paper describes the results of a randomized controlled trials of Lopinavir-Ritonavir in adults who were hospitalized, who were presenting severe Covid-19 symptoms. For a total of 199 patients, randomization was conducted to assign 99 to the lopinavir–ritonavi, and 100 to the standard care group. Notice that the lopinavir–ritonavi group had this treatment (400 mg and 100 mg respectively) plus the standard care. The output to be measured was the time to clinical improvement, from the time of the randomization. Results did not show significant difference between the treatment and control group. Indeed, the hazard ratio for clinical improvement was 1.31, with a 95% confidence interval of (0.95, 1.80). Since 1 is contained by the 95% interval, then there is not a significant difference between the Lopinavir-Ritonavir group and the standard care group.
The study of (Plaze, Attali, Petit, et al., 2020) is based on a clinical observation from Sainte-Anne Hospital, Paris, France, a hospital specialized in Psychiatric and Neuroscience, with a very large prevalence of patients using psychotropic drugs. It has been observed in recent months that there is a clear lower incidence of COVID-19 forms among patients than among staff of clinic. This suggests that psychotropic drugs may be some sort of prophylactic effect against the SARS-CoV-2 virus, which leads to a lower incidence of COVID-19 symptoms among patients. Indeed, this hypotheses is supported by the fact that Chlorpromazine (one of the active ingredients of many psychotropic drugs) has been shown to have certain antiviral effects (diverse studies have shown it provides a degree of inhibition of viral replication in an in-vitro setting). A RCT was proposed to repurpose Chlorpromazine (CPZ) as a potential Covid-19 therapy, due to its good tolerance profile and it antiviral properties . For the RCT, subjects are randomized to the CPZ + standard care group, or to the standard care group. The output to measure and compare between the treatment and standard groups is degree of clinical improvement and level of decrease in the biological markers of viral attack by SARS-CoV-2 (Plaze, Attali, Petit, et al, 2020). Overall, the design includes a randomized, single-blinded, controlled trial. This trial is still being conducted.
Randomisation is one of the key elements to reduce biases and allows to attribute any potential effects (if any) to the treatment and not to any lurking variable. Randomisation serves as a way of balancing the different characteristics of both groups in a controlled trial. In the case of this analysis, all four studies had randomisation.
Only the Hydroxychloroquine therapy study and the Lopinavir-Ritonavir treatment used concealment. The other two studies did not report concealment, as far as it can be read in the corresponding papers.
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