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Background The COVID-19 causing coronavirus is an enveloped RNA virus that utilizes an enzyme RNA dependent RNA polymerase for its replication. Favipiravir (FVP) triphosphate, a purine nucleoside analog, inhibits that enzyme. We have conducted this systematic review and meta-analysis on efficacy and safety of the drug FVP as a treatment for COVID-19. Methods Databases like Pubmed, Pubmed Central, Scopus, Embase, Google Scholar, preprint sites, and clinicaltirals.gov were searched. The studies with the standard of care (SOC) and FVP as a treatment drug were considered as the treatment group and the SOC with other antivirals and supportive care as the control group. Quantitative synthesis was done using RevMan 5.4. Clinical improvement, negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), adverse effects, and oxygen requirements were studied. Results We identified a total of 1798 studies after searching the electronic databases. Nine in the qualitative studies and four studies in the quantitative synthesis met the criteria. There was a significant clinical improvement in the FVP group on the 14th day compared to the control group (RR 1.29, 1.08–1.54). Clinical deterioration rates were less likely in the FVP group though statistically not significant (OR 0.59, 95% CI 0.30–1.14) at the endpoint of study (7–15 days). The meta-analysis showed no significant differences between the two groups on viral clearance (day 14: RR 1.06, 95% CI 0.84–1.33), non-invasive ventilation or oxygen requirement (OR 0.76, 95% CI 0.42–1.39), and adverse effects (OR 0.69, 0.13–3.57). There are 31 randomized controlled trials (RCTs) registered in different parts of the world focusing FVP for COVID-19 treatment. Conclusion There is a significant clinical and radiological improvement following treatment with FVP in comparison to the standard of care with no significant differences on viral clearance, oxygen support requirement and side effect profiles.

Background An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data. Methods A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3. Results We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4–7.3%) among hospitalized patients; 15.6% (11–21.8%) among critically ill patients; and 18.4% (13–25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS. Conclusion COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies.

Background COVID-19 pandemic has provoked a wide variety of psychological problems such as anxiety, depression, and panic disorders, especially among health service providers. Due to a greater risk of exposure to the virus, increased working hours, and fear of infecting their families, health service providers are more vulnerable to emotional distress than the general population during this pandemic. This online survey attempts to assess the psychological impact of COVID-19 and its associated variables among healthcare workers in Nepal. Materials and methods For data collection purposes, Covid-19 Peritraumatic Distress Index (CPDI) Questionnaire, was used whose content validity was verified by Shanghai mental health center. Data for the survey were collected from 11 to 24 October 2020 which was extracted to Microsoft Excel-13 and analyzed. Results A total of 254 health care workers from different provinces of the country participated in this study with a mean age of 26.01(± 4.46) years. A majority 46.9% (n = 119) of the participants were not distressed (score ≤28) while 46.5% (n = 118) were mild to moderately distressed (score >28 to ≤51) and 6.7% (n = 17) were severely distressed (score ≥52) due to the current COVID-19 pandemic. Female participants (p = 0.004) and participants who were doctors by profession (p = 0.001) experienced significantly more distress. Conclusions COVID-19 pandemic has heightened the psychological distress amongst health care service providers. The findings from the present study may highlight the need for constructing and implementing appropriate plans and policies by relevant stakeholders that will help to mitigate the distress among health service providers in the current pandemic so that we can have an efficient frontline health workforce to tackle this worse situation.

IntroductionThe COVID-19 pandemic has caused discrimination and social stigma among healthcare workers (HCW) causing psychological problems due to prolonged work shifts, uncertain pay, lack of personal protective equipment (PPE), added fear of infection to self or family, and so on. This online survey is directed towards the determination of anxiety, depression, and stigma among healthcare providers in Nepal during the later phase of the first wave of the COVID-19 pandemic.