Arm 1: infected patients will receive the standard therapy for COVID-19 (Paracetamol 500 mg /6h, Hydroxychloroquine 500 mg/ 12h, Oseltamivir 150 mg /12 h for 5 days, Azithromycin 1 gm first day then 500 mg/day for 1st line or Clarithromycin 500 mg/12 h for 7-14 days, Ascorbic acid 500 mg/12 h and Cyanocobalamin IV once daily plus Lopinavir 400mg/Ritonavir 100 mg caps 2 capsules twice daily in severe cases) and after three days of the standard therapy the infected patients will receive 13 cis retinoic acid (0.5 mg/kg/day in 2 divided doses orally for 14 days combined with the standard therapy . All subjects were encouraged to complete the full course of treatment and common side effects were explained. Side effects and compliance will be documented.

Arm 2: infected patients will receive the standard therapy for COVID-19 (Paracetamol 500 mg /6h, Hydroxychloroquine 500 mg/ 12h, Oseltamivir 150 mg /12 h for 5 days, Azithromycin 1 gm first day then 500 mg/day for 1st line or Clarithromycin 500 mg/12 h for 7-14 days, Ascorbic acid 500 mg/12 h and Cyanocobalamin IV once daily plus Lopinavir 400mg/Ritonavir 100 mg caps 2 capsules twice daily in severe cases) and after three days of the standard therapy the infected patients will receive Aerosolized 13 cis retinoic acid in gradual in 2 divided doses increases froms 0.2 mg/kg/day to 4 mg/kg/day as inhaled 13 cis retinoic acid therapy for 14 days

Arm 3:infected patients will receive the standard therapy for COVID-19 for 14 days

COVID19

After three days of randomization and standard treatment , 13 cis retinoic acid (0.5 mg/kg/day in 2 divided doses orally for 14 days.+standard treatment
Standard treatment is according to the protocol of treatment of 2019-nCoV infection

Drug Isotretinoin (13 cis retinoic acid ) capsules+standard treatment

Drug: After three days of randomization and standard treatment , Aerosolized 13 cis retinoic acid in gradual two doses increase froms 0.2 mg/kg/day to 4 mg/kg/day as inhaled 13 cis retinoic acid therapy for 14 days +standard treatment
Standard treatment is according to the protocol of treatment of 2019-nCoV infection

Isotretinoin(Aerosolized 13 cis retinoic acid) +standard treatment

Standard treatment is according to the protocol of treatment of 2019-nCoV infection

Standard treatment

Faculty of Medicine, Kafr El-sheikh University

Assessment the Activity Value of Isotretinoin (13- Cis-Retinoic Acid ) in the Treatment of COVID-19 (Randomized)

Isotretinoin in Treatment of COVID-19 (Randomized)

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

Mahmoud Ramadan mohamed Elkazzaz

Sponser Investigator

Kafrelsheikh University

Patients and method :
This study will performed on 1000 patients tested positive for the presence of COVID-19 RNA by RT-PCR kit for RNA detection will randomly divided into 3 equal groups

Patients
This study will performed on 1000 patients tested positive for the presence of COVID-19 RNA by RT-PCR kit for RNA detection will randomly divided into 3 equal groups

Patients will receive insulin therapy with sitagliptin.

Patients will receive insulin therapy without sitagliptin.

Type 1 Diabetes

sitagliptin

Insulin

Diabetes Center, Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University

Protective Effects of Sitagliptin on β Cell Function in Patients With Adult-onset Latent Autoimmune Diabetes (LADA)

The assessment of the change of β cell function in patients with LADA treated with sitagliptin plus insulin by the standardized mixed meal stimulation test and insulin sensitivity by HOMA-IR.
The assessment of the change of insulin sensitivity in LADA patients by sequential insulin infusion with the euglycemic glucose clamp technique.

The change of the frequency of pathogenic Teff (CD4+Th1, Th2, Th17 and CD8+) cells and CD4+CD25+Foxp3+Treg cells before and after sitagliptin treatment in LADA patients.

Effect of sitagliptin on cytokine production of Teff and Treg cells before and after sitagliptin treatment in LADA patients.

Effect of sitagliptin on Foxp3 mRNA expression of Treg cells and RORγT mRNA expression of Th17 cells before and after sitagliptin treatment in LADA patients.

The comparison of glutamic acid decarboxylase 65 (GAD65) reactive interferon-γ-Th1, IL-4-Th2, IL-17-Th17 and IL-10-Treg cells detected by enzyme-linked immunospot (ELISPOT) before and after sitagliptin treatment in LADA patients.

The change of the adiponectin, IL-6, IL-17 and CRP etc. before and after the sitagliptin treatment in LADA patients.

glutamic acid/nekróza

Assessment the Activity Value of Isotretinoin (13- Cis-Retinoic Acid ) in the Treatment of COVID-19 (Randomized)

Protective Effects of Sitagliptin on β Cell Function in Patients With Adult-onset Latent Autoimmune Diabetes (LADA)

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