Asian Pacific Journal of Tropical Medicine

241-253

Authors: Wei Song, Jie Wei, Xiangdong Jian, Deren Wang, Yanhong Ouyang, Yuanshui Liu, Xianjin Du, Ying Chen, Yingqi Zhang, Heping Xu, Shuming Xianyu, Qiong Ning, Xiang Li, Xiaotong Han, Feng Zhan, Tao Yu, Wenteng Chen, Jun Zhang, Wenwei Cai, Sheng’ang Zhou, Shengyang Yi, Yu Cao, Xiaobei Chen, Shunjiang Xu, Zong’an Liang, Duohu Wu, Fen Ai, Zhong Wang, Qingyi Meng, Yuhong Mi, Sisen Zhang, Rongjia Yang, Shouchun Yan, Wenbin Han, Yong Lin, Chuanyun Qian, Wenwu Zhang, Yan Xiong, Jun Lv, Baochi Liu, Yan Cao, Xiaojun He, Xuelian Sun, Yufang Cao, Tian’en Zhou

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID- 19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

266-273

Authors: Morteza Shakhsi Niaee, Peyman Namdar, Abbas Allami, Leila Zolghadr, Amir Javadi5 , Amin Karampour3 , Mehran Varnaseri6 , Behzad Bijani7 , Fatemeh Cheraghi1 , Yazdan Naderi8 , Fatemeh Amini9 , Masoumeh Karamyan, Mohammad Jafar YadYad, Ramin Jamshidian, Nematollah Gheibi

Objective: To evaluate different doses of ivermectin in adult patients with mild COVID-19 and to evaluate the effect of ivermectin on mortality and clinical consequences. Methods: A randomized, double-blind, placebo-controlled, multicenter clinical trial was performed at five hospitals. A total of 180 mild hospitalized patients with COVID-19 confirmed by PCR or chest image tests were enrolled and allocated to six arms including hydroxychloroquine 200 mg twice per day, placebo plus hydroxychloroquine 200 mg twice per day, single dose ivermectin (200 µg/kg), three low interval doses of ivermectin (200, 200, 200 µg/kg), single dose ivermectin (400 µg/kg), and three high interval doses of ivermectin (400, 200, 200 µg/kg). The primary endpoint of this trial was all-cause of mortality or clinical recovery. The radiographic findings, hospitalization and low O2 saturation duration, and hematological variables of blood samples were analyzed. Results: A total of 16.7% (5/30) and 20.0% (6/30) patients died in arms treated with hydroxychloroquine 200 mg twice per day and placebo plus hydroxychloroquine 200 mg twice per day, respectively, and a reduction in mortality rate in patients receiving ivermectin treatment to 0%, 10%, 0% and 3.3% for arms 1-4 were observed. Risk of mortality was also decreased about 15% in the ivermectin treated arms. Conclusions: Ivermectin as an adjunct reduces the rate of mortality, time of low O2 saturation, and duration of hospitalization in adult COVID-19 patients. The improvement of other clinical parameters shows that ivermectin, with a wide margin of safety, had a high therapeutic effect on COVID-19.

281-284

Authors: Camila F Araújo, Iara B N Oliveira, Murilo B Silveira, Fátima Ribeiro-Dias

Rationale: Co-infection of human immunodeficiency virus (HIV) and Leishmania spp. has impact on clinical and therapeutic outcomes of leishmaniases. Most studies do not present the identification of Leishmania species causing American tegumentary leishmaniasis in co-infections. In the Americas, Leishmania (L.) Viannia (V.) braziliensis and L. (V.) guyanensis have been identified. Patient concerns: In this study, two cases of American tegumentary leishmaniasis in patients infected with HIV are described. Patients presented several lesions with rapid dissemination and mucosal involvement. Diagnosis: Disseminated cutaneous leishmaniasis caused by L. amazonensis was identified by molecular test. Interventions: The patients were treated with conventional therapies for HIV infection and American tegumentary leishmaniasis. Outcomes: In co-infection, the clinical manifestations are atypical and the treatment response can be impaired. Lessons: These cases show that HIV infection impacts L. amazonensis infection and point to the relevance of identifying Leishmania species, which can lead to a better patient management.