The landscape of development of treatment modalities and preventive measures for COVID-19 has progressed expeditiously since the beginning of the pandemic. However, low cost-effectiveness and availability, and the requirement of parenteral administration by trained medical personnel in an in-hospital setting may limit the use of these therapeutic agents in clinical practice. 1 Thus, the development of safe and efficacious oral agents that can be administered on an outpatient basis is warranted. On December 22, 2021, the US Food and Drug Administration (FDA) issued an emergency use authorization for an oral antiviral, nirmatrelvir-ritonavir (Paxlovid™), for the treatment of patients with mild-to-moderate COVID-19 and at high risk for progression to severe disease, including hospitalization or death. 2 Therefore, we conducted this meta-analysis to address these limitations and evaluate the efficacy and safety of nirmatrelvir-ritonavir in COVID-19 patients, and explore the role of previous immunity to SARS-CoV-2 and age as potential effect modifiers.Our meta-analysis was performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Intervention and the protocol was registered with PROSPERO (CRD42022364219). We searched PubMed, Embase, the Cochrane Library, medRxiv, and ClinicalTrials.gov from inception to October 10, 2022, using a search strategy consisting of terms related to "nirmatrelvir-ritonavir" and

Epiglottitis is an uncommon, potentially fatal infection of the epiglottis that can lead to complete upper airway obstruction. Isolated pathogens are usually nasopharyngeal bacteria, most commonly Haemophilus influenzae type b (Hib). While the incidence of epiglottitis has diminished significantly over the years due to widespread vaccination against Hib, the proportion of epiglottitis caused by other pathogens has increased. In this report, we introduce an unseen presentation of acute epiglottitis associated with severe acute respiratory distress syndrome--coronavirus2 (SARS-CoV-2), who presented to the emergency department with throat pain and odynophagia that quickly resulted in respiratory distress. Clinicians should be aware of airway edema's concomitant presence in patients with acute epiglottitis and COVID-19 and maintain a low threshold for intubation. The rapidly progressive nature of COVID-19 and its complications may preclude intubation later on in the patient’s clinical course, potentially necessitating an emergent surgical airway.

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Clinical rationale for study: Despite advancements in critical care, the mortality rate of sepsis remains high, with an overall poor prognosis. There is a complex pathophysiology of a lethal cascade of cytokines and inflammatory proteins underlying sepsis. The use of vitamin C can theoretically suppress the inflammatory cascade but remains a questionable practice due to a lack of conclusive evidence. Aims of the study: To appraise the therapeutic role of vitamin C in sepsis. Materials and methods: A systematic review was conducted on PubMed, Embase, and the Central Cochrane Registry. The study included randomized clinical trials (RCTs) with vitamin C as an intervention arm in the septic patient population. For continuous variables, the difference in means (MD) and for discrete variables, the odds ratio (OR) was used. For effect sizes, a confidence interval of 95% was used. A p-value of less than 0.05 was used for statistical significance. The analysis was performed using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: 23 studies were included with the total sample size of 2712 patients. In patients treated with vitamin C, there was a statistically significant reduction in the mortality: OR = 0.778 (0.635 to 0.954), p = 0.016; the sequential organ failure assessment score (SOFA): MD = −0.749 (−1.115 to −0.383), p < 0.001; and the duration of vasopressor requirement: MD = −1.034 days (−1.622 to −0.445), p = 0.001. No significant difference was found in the hospital or ICU length of stay. Conclusions and clinical implications: Vitamin C treatment regimens were associated with reduced mortality, SOFA score, and vasopressor requirement compared to the control in sepsis. Given its low cost and minimal adverse effects, we strongly encourage further large, randomized trials to establish vitamin C as a standard of care in sepsis management.