COVID 19 infected patients will receive one dose daily of Aerosolized 13 cis retinoic acid in gradual doses increases froms 0.2 mg/kg/day to 4 mg/kg/day as inhaled 13 cis retinoic acid therapy for 14 days

COVID 19 infected patients will receive one dose daily of Aerosolized All trans retinoic acid in gradual doses increases froms 0.2 mg/kg/day to 4 mg/kg/day as inhaled All trans retinoic acid therapy for 14 days

4 Placebo tablets twice daily by mouth for 2 weeks

COVID -19

The infected patients will receive Aerosolized 13 cis retinoic acid in gradual in one dose increases froms 0.2 mg/kg/day to 4 mg/kg/day as inhaled 13 cis retinoic acid therapy for 14 days

Aerosolized 13 cis retinoic acid

The infected patients will receive Aerosolized All trans retinoic acid in gradual one dose increases froms 0.2 mg/kg/day to 4 mg/kg/day as inhaled all trans retinoic acid therapy for 14 days

Aerosolized All trans retinoic acid

Placebo is a pill or tablet that does not contain any study drug.

Placebo

Combination With Inhibitor of Neutrophil Elastase (All-trans Retinoic Acid ) and Isotretinoin May Enhances Neutralizing Antibodies in COVID -19 Infected Patients Better Than COVID-19 Inactivated Vaccines

Proportion of lung injury score decreased or increased after treatment

Serum levels of CRP, ESR ,IL-1,IL-6,TNF and Type I interferon

less than 250 ng/mL, or less than 0.4 mcg/mL of blood sample

To determine the immune correlates of viral clearance (Antibody Titres sufficient for viral clearance and neutralizing ) against future exposure to SARS-CoV-2

Number of CD4 HLA-DR+ and CD38+, CD8 lymphocytes

Kidney failure, hypersensitivity with cutaneous or hemodynamic manifestations, aseptic meningitis, hemolytic anemia, leuko-neutropenia, transfusion related acute lung injury (TRALI)

serum levels of IgG and IgM against COVID-19

ACE2 expression in patients with COVID-19 infection

Mahmoud Ramadan mohamed Elkazzaz

Principal Investigator

Kafrelsheikh University

Damietta University

Acute Respiratory Distress Syndrome, ARDS

Neutrophil Elastase and Elafin as Prognostic Biomarker for Acute Respiratory Distress Syndrome

Xi Zhu

Professor

Peking University Third Hospital

Beijing Friendship Hospital

Beijing Shijitan Hospital

Beijing Xiyuan Hospital

China-Japan Friendship Hospital

patients receive 4 grams of IV alpha 1 antitrypsin preoperatively

10 patients will randomely receive placebo

Post Cardiac Surgery Systemic Inflammatory Response

Alpha 1-Antitrypsin

Single Dose Administration of Alpha-1 Anti-Trypsin for the Amelioration of Organ Injury in Patients Undergoing Cardiac Surgery

Single Dose Administration of Alpha-1 Anti-Trypsin for the Amelioration of Organ Injury and Post Operative Bleeding in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: Double-blind, Placebo-controlled Pilot Study

1. The occurrence and magnitude of systemic inflammatory response and organ dysfunction will be recorded and quantified by laboratory markers. Related laboratory markers will be monitored on a daily basis during the recovery period (in the intensive care unit and at the ward).

Pulmonary function will be evaluated by measured overall mechanical ventilation time, peak inspiratory pressures (PIP), plateau pressures, physiologic dead space and static and dynamic lung compliance. Bronchoalveolar lavage (BAL) will be performed 3 hours after operation (while the patient is anesthetised and intubated) and extracted fluid will be analyzed for inflammatory markers. A-a DO2 calculation [AaDO2 = (713 x FiO2) - (pCO2 / 0.8) - (paO2)] will be measured daily.
Complete pulmonary function test will be performed before and 4 days after the operation. Chest radiographs will be evaluated and quantified by an independent radiologist for the occurrence of atelectasis, pulmonary edema, or pleural changes.

Daily measurements of urine output, serum creatinine levels, creatinine clearance and urinary albumin levels. Acute kidney injury (AKI) markers will be sampled in the ICU.

The degree of insult to the brain will be measured by plasma S-100 proteinlevels. Assessment of damage to the blood-brain barrier (BBB) will be performed by magnetical resonance imaging (MRI) modality

Daily measurements of serum hepatic enzymes levels.

Monitoring of cardiac enzymes levels; need and magnitude of required inotrope treatment; occurrence of low cardiac output syndrome (defined as systolic blood pressure of 90 mmHg or less coupled with central venous pressure (CVP) of 15 mmHg or more) and incidence of cardiac arrhythmias. Transthoracic echocardiography examination will be performed on postoperative day 5 and assessed by an independent cardiologist.

Operative and postoperative blood loss will be monitored as well as daily hemoglobin levels. Daily platelet counts and thromboelastograms will be performed. The distribution of blood products and total administered will be recorded daily. Postoperative CRP levels will be evaluated daily.

Dan Abramov

Soroka University Medical Center

sequential changes before and after cardiopulmonary bypass including ROS, antioxidant status, leukocyte elastase, complements, inflammatory cytokines

Heart Valve Diseases

sequential changes of oxidative injuries before and after cardiopulmonary bypass

elastase/ødem

Combination With Inhibitor of Neutrophil Elastase (All-trans Retinoic Acid ) and Isotretinoin May Enhances Neutralizing Antibodies in COVID -19 Infected Patients Better Than COVID-19 Inactivated Vaccines

Neutrophil Elastase and Elafin as Prognostic Biomarker for Acute Respiratory Distress Syndrome

Single Dose Administration of Alpha-1 Anti-Trypsin for the Amelioration of Organ Injury in Patients Undergoing Cardiac Surgery

Anesthetic Management and Remote Reperfusion Injuries

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