Abstract Background: To access the effect of Intravenous immunoglobulin ‎‎(IVIG) in critically ill corona virus disease 2019 (COVID-19) patients. Method: In this retrospective matched cohort study, records of three tertiary centers with large number of COVID-19 admissions were evaluated and used. Based on treatment options, ‎patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of ‎low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using independent t-test and ‎One-way analysis of variance (ANOVA) to compare the ‎outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.‎ Result: The duration of hospitalization in the IVIG group ‎were significantly longer than standard treatment (13.74 days vs. 11.10 days, p<0.05). There was not a significant difference between the two groups in ICU length of stay, number of intubated patients and duration of mechanical ventilation (P>0.05).‎ Also initial ‎outcomes in IVIG subgroups were compared separately with the standard ‎treatment group. The results indicated that only the duration of hospitalization ‎in the IVIG subgroup with medium dose is significantly longer than the standard ‎treatment group (P<0.01). Conclusion: Using IVIG is not beneficial for COVID-19 patients based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation and even mortality rate.

Introduction: After emerging the global pandemic of SARS-CoV2 some preliminary studies demonstrated the efficacy of antiviral treatments. But shortly thereafter, inconsistencies in the results of further clinical trials raised doubts on the efficacy of these agents. In this study, we aimed to evaluate the effect of Remdesivir on hospitalized COVID-19 patients’ outcomes. Material and methods: This study was an open-label, single-armed, clinical trial on hospitalized patients diagnosed with COVID-19 who had progressive respiratory symptoms despite receiving standard care. All patients received Remdesivir and their characteristics, outcomes, time of treatment initiation, and respiratory support stages during hospitalization were registered and followed up for 14 days. Results: 145 patients with the mean age of 52.89 ± 1.12 years enrolled in this study, 38 (26.2%) died at the end of 14 days period. The mean time interval from the onset of the symptoms to antiviral treatment was 10.63±0.56 days. Thirty deceased patients (78.9%) were men, showing 2.8 times higher mortality chance compared to women (ORadj=2.77; 95%CI=1.08-7.09). The type of respiratory support on the first day of treatment initiation showed a significantly lower mortality chance in patients receiving O2 only than those who needed non-invasive and/or mechanical ventilation (ORadj=3.91; 95%CI=1.64-9.32). The start time (early vs late administration) and duration (less or more than 7 days) of antiviral treatment had no statistically significant association with mortality or ventilation escalation among the patients (p-value > 0.05). Conclusion: In this study, we showed that Remdesivir probably is not effective on the outcome of hospitalized COVID-19 patients.

Abstract Introduction Severe COVID-19 management is still challenging. Having a laboratory factor to predict the severity of a patient’s condition can be very useful in how to approach each patient. There have been studies concentrating on the correlation between serum C-reactive protein (CRP) level and COVID-19 severity but we aim to reach a threshold for CRP in disease severity determination. Methods We conducted a thorough search on PubMed, Web of Science and Google Scholar databases, and 323 studies were assessed for eligibility in three phases. The T-test was applied for the CRP level cutoffs. Results Eventually, 11 articles and 1615 patients were included in this systematic review. Our analysis evaluated combined mean, median, and standard deviation of severe patients’ CRP to be respectively 73.37, 53.80 and 47.936. Based on the combined mean, 75mg/dl was suggested as an initial threshold for baseline CRP in hospitalized patients for developing severe conditions. Conclusion This study recommends that COVID-19 patients with on-admission serum CRP levels of 75 mg/dl and more are likely associated with severe conditions. Thus, anti-inflammatory agents and further following may be helpful in these patients.

Objectives Possibility of reinfection with SARS-CoV-2 changes our view on herd immunity and vaccination, and can impact worldwide quarantine policies. We performed RT-PCR follow-up studies on recovered patients to assess possible development of reinfections and re-positivity. Method During a 6-month period, 202 PCR-confirmed recovering COVID-19 patients entered this study. Follow-up RT-PCR tests and symptoms assessment were performed one month after the initial Positive results. patients who tested negative were tested again one and three months later. The Serum IgG and IgM levels were measured in the last follow-up session. Results In the first two follow-up sessions, 82 patients continued their participation, of which four patients tasted positive. In the second follow-up 44 patients participated, three of whom tested positive. None of the patients who tested positive in the first and second follow-up session were symptomatic. In the last session, 32 patients were tested and four patients were positive, three of them were mildly symptomatic and all of them were positive for IgG. Conclusion A positive RT-PCR in a recovering patient may represent reinfection. While we did not have the resources to prove reinfection by genetic sequencing of the infective viruses, we believe presence of mild symptoms in the three patients who tested positive over 100 days after becoming asymptomatic, can be diagnosed as reinfection. The IgG may have abated the symptoms of the reinfection, without providing complete protection.