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Handling neurological COVID in ICU: REM to impair the viral load, DEX to extinguish the fire roar

Acute COVID-19 illness complications include stroke, encephalopathies, neuropsychiatric and inflammatory syndromes, whereas non-severe cases may suffer from longitudinal brain structure and cognition changes. Long COVID is among these and scientists deem that they might represent a future challenge for public health. Attention, memory impairments, the so-called “brain fog” and chronic fatigue may ruin daily activities and work/job performances as well. Intensive care units (ICU)-admitted patients have been treated with dexamethsone and/or remdesivir and antibiotic coverage, like azithromicycin to improve or stabilize clinical conditions. In certain clinical ssettings, most likely due to heterogeneity of factors, these drug have not achieved the hoped results, while in others they worked well. Condifering the neurological sequelae of COVID and their backlashes on people, researchers investigated the potential of therapeutic drugs dexamethasone and remdesivir alone or in combination, on neurological complications that arise in COVID-19 affected individuals.

Participants were treated with either remdesivir or dexamethasone or both. Treatment comparison groups included remdesivir alone vs. standard of care, dexamethasone alone vs. standard of care, and combined treatment vs. standard of care. Treatment groups included under both severe COVID-19 and non-hypoxic were no treatment, dexamethasone alone, remdesivir on day 1, remdesivir at any time, combined treatment on day 1, and combined treatment at any time.The researchers studied the effects of treatment groups on mortality in severely infected patients. Dexamethasone treatment reduced mortality, while it was found that remdesivir failed in reducing mortality. However, the combined treatment led to a significant reduction in mortality. ICU admissions were also reduced with the dexamethasone, whereas they increased when treated with remdesivir. This increase in ICU admission probably reflected the increased likelihood of its prescription to the sickest patients requiring higher levels of care.

Both the treatments were not associated with worse self-care at discharge. With both the treatment strategies, either with dexamethasone or remdesivir, the incidence of neurological complications with increased mortality, ICU admission, worse self-care at discharge, and increased recovery time was reduced. Combined treatment showed a larger reduction in complications. In non-hospitalized patients (50% male, 72% white), the treatment reduced ICU admission (0.9%), mortality (9.2%) worse self-care at discharge (13%), length of inpatient stay (5 days).  Neurological complications were associated with increased mortality, ICU admission, worse self-care on discharge, and recovery time. This may be attributed to the possibility that patients with non-hypoxic COVID-19 had severe disease affecting organs outside the respiratory system. Treatment with dexamethasone reduced neurological complications. However, the combined treatment led to higher reductions.

This strenghtens the previous data concerning these drugs (especially dexamethasone) in the clinical handling of the coronavirus infection in a ICU setting. Bothe these drugs mat pass the blood-brain barrier and work in concert: DEX would interfere against the inflammatory environment (microglìa) triggered by the SARS-CoV2; remdesivir would limit the viral replication and cellular load. For DEX, a very recent research sterted to explore the intranasal administration to speed up the absorption the drug inside the brain for patients with mild and moderate COVID-19. This could allow lower oses of the molecule, as much as is strictly needed to preferentially reach the brain tissue. Beside brainstem, a region critical for the cardio-respiratory control, SARS-CoV2 infect the olfactory mucosae and may lead to smell loss. Therefore, intranasal administration my represent the oopotunity to catch “two brids with one shot”. Scientist do not know this yet and they are eager to collect data.

  • Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

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Scientific references

Selvarajan S et al. Brit J Clin Pharmacol. 2022 Mar 31.

Yasuda Y et al. Respir Med Res. 2022 Mar; 81:100903.

Larson DT et al. Military Med. 2022 Mar 12:usac052.

Cárdenas G et al. Trials. 2022 Feb 14; 23(1):148.

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Dott. Gianfrancesco Cormaci

Medico Chirurgo, Specialista; PhD. a CoFood s.r.l.
- Laurea in Medicina e Chirurgia nel 1998 (MD Degree in 1998) - Specialista in Biochimica Clinica nel 2002 (Clinical Biochemistry residency in 2002) - Dottorato in Neurobiologia nel 2006 (Neurobiology PhD in 2006) - Ha soggiornato negli Stati Uniti, Baltimora (MD) come ricercatore alle dipendenze del National Institute on Drug Abuse (NIDA/NIH) e poi alla Johns Hopkins University, dal 2004 al 2008. - Dal 2009 si occupa di Medicina personalizzata. - Guardia medica presso strutture private dal 2010 - Detentore di due brevetti sulla preparazione di prodotti gluten-free a partire da regolare farina di frumento immunologicamente neutralizzata (owner of patents concerning the production of bakery gluten-free products, starting from regular wheat flour). - Responsabile del reparto Ricerca e Sviluppo per la società CoFood s.r.l. (leader of the R&D for the partnership CoFood s.r.l.) - Autore di un libro riguardante la salute e l'alimentazione, con approfondimenti su come questa condizioni tutti i sistemi corporei. - Autore di articoli su informazione medica e salute sui siti web salutesicilia.com, medicomunicare.it e in lingua inglese sul sito www.medicomunicare.com
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