COVID-19 is a fatal, universal pandemic caused by the SARS-CoV-2 virus that has directly caused at least 95,235 deaths in the US by May 2020. It has a poor prognosis with a mortality rate as high as 21% in the general population at the height of the pandemic, a rate that is much higher in elderly patients, as well as those requiring intensive care unit (ICU) care. The role of inflammation in symptomatic COVID-19 is being studied, and it is hypothesized that hyperinflammation is a causative factor in severe COVID-19 disease. Treatment options are limited and mostly rely on supportive care. Icosapent ethyl (IPE) is an Omega-3 fatty acid derivative that has been shown to significantly reduce cardiovascular mortality and is used as an adjunct to statin therapy. Though it has been shown to act as an anti-inflammatory, it is not currently indicated for that purpose. Here, we describe, for the first time, the successful treatment of a COVID-19 patient with IPE.

In India, the private sector provides 70% of the total outpatient medical care. This study describes the Mumbai Hypertension Project, which aimed to deliver a standard hypertension management package in private sector clinics situated in urban slums. The project was conducted in two wards (one “lean” and one “intensive”) with 82 private providers in each. All hypertensive patients received free drug vouchers, baseline serum creatinine, adherence support, self-management counseling and follow-up calls. In the intensive-ward, project supported hub agents facilitated uptake of services. A total of 13,184 hypertensive patients were registered from January 2019 to February 2020. Baseline blood pressure (BP) control rates were higher in the intensive-ward (30%) compared with the lean-ward (13%). During the 14-month project period, 6752 (51%) patients followed-up, with participants in the intensive-ward more likely to follow-up (aOR: 2.31; p < 0.001). By project end, the 3–6-month cohort control rate changed little from baseline—29% for intensive ward and 14% for lean ward. Among those who followed up, proportion with controlled BP increased 13 percentage points in the intensive ward and 16 percentage points in the lean ward; median time to BP control was 97 days in the intensive-ward and 153 days in lean-ward (p < 0.001). Despite multiple quality-improvement interventions in Mumbai private sector clinics, loss to follow-up remained high, and BP control rates only improved in patients who followed up; but did not improve overall. Only with new systems to organize and incentivize patient follow-up will the Indian private sector contribute to achieving national hypertension control goals.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is a rapidly escalating global health burden. It is not only restricted to patients in the hospital settings but has also rooted deeply in the community settings. With increasing prevalence of life style and kidney diseases, the prevalence of MRSA infections is also expected to rise. MRSA infection plays a major role in renal disorders due to its direct vascular access (VA) thereby making patients undergoing dialysis and renal transplant more vulnerable to infections. Prolonged hospital stay, close proximity to MRSA-infected individual, exposure to broad-spectrum antibiotics, surgery and presence of foreign bodies such as central venous catheters predispose an individual to MRSA infection. Current panel of antibiotic treatment includes vancomycin, teicoplanin, linezolid, daptomycin, tigecycline and ceftaroline. However, emergence of resistant strains and several undesirable features pertaining to safety and tolerability of these drugs have led to limited options available for the management of multidrug-resistant MRSA infection in patients with renal disorders. Therefore, there is an increasing need for developing a new potent antibacterial agent with established renal safety that decreases the mortality and morbidity rates in MRSA-infected renal patients.

Case series Patients: Male, 75-year old • Male, 23-year old • Male, 24-year old Final Diagnosis: COVID-19 pneumonia Symptoms: Fever • hypoxia • respiratory failure Medication: — Clinical Procedure: — Specialty: Anesthesiology • Critical Care Medicine • Infectious Diseases Objective: Unusual or unexpected effect of treatment Background: Icosapent ethyl, a form of eicosapentaenoic acid with anti-inflammatory activity, has been approved as an adjunctive treatment with statins in patients with hypertriglyceridemia. Icosapent ethyl is currently undergoing clinical trials to determine its anti-inflammatory effects in patients with coronavirus disease 2019 (COVID-19). This report describes 3 intensive care unit (ICU) patients with moderate to severe COVID-19 pneumonia treated with icosapent ethyl as part of their supportive care who had favorable outcomes. Case Reports: Case 1 was a 75-year-old man with a past medical history of hyperlipidemia, hypertension, type 2 diabetes mellitus, obesity, and benign prostatic hyperplasia. Case 2 was a 23-year old man with a past medical history of type 2 diabetes mellitus and obesity. Case 3 was a 24-year old man with a history of autism. All cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were confirmed from a nasopharyngeal swab using the Becton Dickinson nasopharyngeal reverse-transcription polymerase chain reaction. All patients in these cases were treated with a course of 2 g of icosapent ethyl twice a day by nasogastric tube. Conclusions: This report of 3 cases describes the use of icosapent ethyl as a component of supportive treatments in ICU patients with moderate to severe COVID-19 pneumonia. However, as of yet there are no evidence-based treatments for SARS-CoV-2 infection from controlled clinical trials. The outcomes of ongoing clinical trials are awaited to determine whether icosapent ethyl has anti-inflammatory effects in patients with SARS-CoV-2 infection and which patients might benefit from the use of this adjunctive treatment.

Despite the availability of effective medication, blood pressure control rates are low, particularly in low‐ and middle‐income countries. Adherence to medication and follow‐up visits are important factors in blood pressure control. This study assessed the effectiveness of reminder telephone calls on follow‐up visits and blood pressure control among hypertensive patients as part of the Mumbai Hypertension Project. This project was initiated by PATH with the support from Resolve to Save Lives from January 2019 to February 2020. The study included hypertensive patients attending 164 private practices in Mumbai, India; practitioners screened all adults visiting their clinic during the project period. Among 13 184 hypertensive patients registered, the mean age was 53 years (SD = 12.38) and 52% were female. Among the 11 544 patients that provided phone numbers and gave consent for follow‐up calls, 9528 responded to phone calls at least once and 5250 patients followed up at least once. Of the 5250 patients, 82% visited the clinic for follow‐up visit within one month after receiving the phone call. The blood pressure control rate among those who answered phone calls and who did not answer phone calls increased from 23.6% to 48.8% (P <.001) and 21.0% to 44.3% (P <.001), respectively. The blood pressure control rate at follow‐up was significantly associated with phone calls (OR: 1.51, 95% CI: 1.34 ‐ 1.71). The study demonstrates that telephone call intervention and follow‐up visits can improve patient retention in care and, subsequently, blood pressure control among hypertensive patients attending urban private sector clinics in India.