3- Wednesday Research News – 25th August

1 – Cognitive deficits in people who have recovered from COVID-19

• There is growing concern about possible cognitive consequences of COVID-19, with reports of ‘Long COVID’ symptoms persisting into the chronic phase and case studies revealing neurological problems in severely affected patients.
• However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of disease severity.
• People who had recovered from COVID-19, including those no longer reporting symptoms, exhibited significant cognitive deficits versus controls when controlling for age, gender, education level, income, racial-ethnic group, pre-existing medical disorders, tiredness, depression and anxiety.

Source: The Lancet

2- A multi-center phase II randomized clinical trial of losartan on symptomatic outpatients with COVID-19

• The SARS-CoV-2 virus enters cells via Angiotensin-converting enzyme 2 (ACE2), disrupting the renin-angiotensin-aldosterone axis, potentially contributing to lung injury.
• Treatment with angiotensin receptor blockers (ARBs), such as losartan, may mitigate these effects, though induction of ACE2 could increase viral entry, replication, and worsen disease.
• This study represents a placebo-controlled blinded randomized clinical trial (RCT) to test the efficacy of losartan on outpatients with COVID-19 across three hospital systems.
• Patients were randomized to 1:1 losartan (25 mg orally twice daily unless estimated glomerular filtration rate, eGFR, was reduced, when dosing was reduced to once daily) versus placebo for 10 days, and all patients and outcome assesors were blinded.
• The primary outcome was all-cause hospitalization within 15 days.
• Secondary outcomes included functional status, dyspnea, temperature, and viral load.

Source: The Lancet

3- Antiviral effect of high-dose ivermectin in adults with COVID-19: A proof-of-concept randomized trial

• There are limited antiviral options for the treatment of patients with COVID-19.
• Ivermectin (IVM), a macrocyclic lactone with a wide anti-parasitary spectrum, has shown potent activity against SARS-CoV-2 in vitro.
• This study aimed at assessing the antiviral effect of IVM on viral load of respiratory secretions and its relationship with drug concentrations in plasma.
• 45 participants were recruited (30 to IVM and 15 controls) between May 18 and September 9, 2020.
• There was no difference in viral load reduction between groups but a significant difference was found in patients with higher median plasma IVM levels versus untreated controls.
• Mean ivermectin plasma concentration levels correlated with viral decay rate.
• Adverse events were similar between groups.
• No differences in clinical evolution at day-7 and day-30 between groups were observed.

Source: The Lancet

4- Telmisartan for treatment of Covid-19 patients: An open multicenter randomized clinical trial

• Angiotensin receptor blockers (ARBs), such as telmisartan, have been postulated to treat Covid-19-induced lung inflammation.
• This study suggests that the ARB telmisartan, a widely used antihypertensive drug, is safe and could reduce morbidity and mortality in hospitalized patients infected with SARS -CoV-2 by anti-inflammatory effects.
• Further studies employing telmisartan are needed for confirmation of our results and to define its true therapeutic value as a tool against Covid-19.

Source: The Lancet

5- Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review

• The aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt.
• Future research should focus on staff and patient experiences of care and inequalities in patients’ access to care.
• Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools.

Source: The Lancet

6- Opioid use disorder and health service utilization among COVID-19 patients in the US: A nationwide cohort from the Cerner Real-World Data

• Both opioid use and COVID-19 affect respiratory and pulmonary health, potentially putting individuals with opioid use disorders (OUD) at risk for complications from COVID-19.
• This study examined the relationship between OUD and subsequent hospitalization, length of stay, risk for invasive ventilator dependence (IVD), and COVID-19 mortality.
• This study suggests people with OUD and COVID-19 often require higher levels of care, and OUD patients who are younger or not using medication treatment for OUDs are particularly vulnerable to death due to COVID-19.

Source: The Lancet

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