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1.
Medicina (Kaunas) ; 58(9)2022 Aug 27.
Статья в английский | MEDLINE | ID: covidwho-2006132

Реферат

Background and Objectives: Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular disease. Arterial stiffness is an independent prognostic marker for cardiovascular disease development. We aimed at determining the effect of two different sodium-glucose co-transporter-2 (SGLT-2) inhibitors on ambulatory arterial stiffness in individuals with T2DM. Materials and Methods: In this single-center, single-arm, prospective study performed from January 2020 to August 2021, we planned to enroll adult subjects with T2DM and stable antidiabetic and antihypertensive treatment, assigned either to empagliflozin or dapagliflozin for 6 months. All eligible subjects underwent ambulatory blood pressure monitoring. We set as the primary efficacy outcome the change in ambulatory pulse wave velocity (PWV) from baseline to week 24. Results: We finally enrolled 46 diabetic subjects, with a mean age of 62.89 (8.53) years and mean T2DM duration of 9.72 (6.37) years. Thirty patients received dapagliflozin, while sixteen patients received empagliflozin. Due to COVID-19 pandemic restrictive measures during the study, the mean follow-up period extended from 6 months to 9.98 (3.27) months. Regarding the prespecified primary efficacy outcome, we found that the SGLT-2 inhibitor treatment did not have a significant effect on PWV (p = 0.65). Prior history of cardiovascular disease did not significantly affect the observed effects. Other indices of arterial stiffness, such as augmentation index and central pulse pressure, were not significantly affected, neither by empagliflozin nor by dapagliflozin. Conclusions: SGLT-2 inhibitor treatment with empagliflozin or dapagliflozin in subjects with T2DM failed to improve ambulatory PWV over a mean follow-up of 10 months. Registration number: ISRCTN88851713.


Тема - темы
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Sodium-Glucose Transporter 2 Inhibitors , Symporters , Vascular Stiffness , Antihypertensive Agents/pharmacology , Benzhydryl Compounds , Blood Pressure Monitoring, Ambulatory , Cardiovascular Diseases/chemically induced , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Glucose , Glucosides , Humans , Hypoglycemic Agents/adverse effects , Middle Aged , Morbidity , Pandemics , Prospective Studies , Pulse Wave Analysis , Sodium , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Symporters/pharmacology , Treatment Outcome
2.
Can J Cardiol ; 38(9): 1342-1351, 2022 Sep.
Статья в английский | MEDLINE | ID: covidwho-1926297

Реферат

Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine, and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early-onset CVD. While this remains a global phenomenon, the epicentre of substance abuse is rooted in North America, where it has been exacerbated by the response to the COVID-19 pandemic. For the first time in history, the United States crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death, and early mortality.


Тема - темы
COVID-19 , Cannabis , Cardiovascular Diseases , Cocaine , Amphetamines/adverse effects , Cannabis/adverse effects , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Cocaine/adverse effects , Ethanol , Humans , Middle Aged , Pandemics , United States
4.
Clin Transl Sci ; 15(2): 501-513, 2022 02.
Статья в английский | MEDLINE | ID: covidwho-1494654

Реферат

On October 2020, the US Food and Drug Administration (FDA) approved remdesivir as the first drug for the treatment of coronavirus disease 2019 (COVID-19), increasing remdesivir prescriptions worldwide. However, potential cardiovascular (CV) toxicities associated with remdesivir remain unknown. We aimed to characterize the CV adverse drug reactions (ADRs) associated with remdesivir using VigiBase, an individual case safety report database of the World Health Organization (WHO). Disproportionality analyses of CV-ADRs associated with remdesivir were performed using reported odds ratios and information components. We conducted in vitro experiments using cardiomyocytes derived from human pluripotent stem cell cardiomyocytes (hPSC-CMs) to confirm cardiotoxicity of remdesivir. To distinguish drug-induced CV-ADRs from COVID-19 effects, we restricted analyses to patients with COVID-19 and found that, after adjusting for multiple confounders, cardiac arrest (adjusted odds ratio [aOR]: 1.88, 95% confidence interval [CI]: 1.08-3.29), bradycardia (aOR: 2.09, 95% CI: 1.24-3.53), and hypotension (aOR: 1.67, 95% CI: 1.03-2.73) were associated with remdesivir. In vitro data demonstrated that remdesivir reduced the cell viability of hPSC-CMs in time- and dose-dependent manners. Physicians should be aware of potential CV consequences following remdesivir use and implement adequate CV monitoring to maintain a tolerable safety margin.


Тема - темы
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/adverse effects , COVID-19/drug therapy , Cardiovascular Diseases/chemically induced , Pharmacovigilance , SARS-CoV-2 , Adenosine Monophosphate/adverse effects , Alanine/adverse effects , Databases, Factual , Humans , Myocytes, Cardiac/drug effects , Retrospective Studies , World Health Organization
5.
Curr Treat Options Oncol ; 22(7): 58, 2021 06 07.
Статья в английский | MEDLINE | ID: covidwho-1258267

Реферат

OPINION STATEMENT: Cardio-oncology is a field dedicated to the prevention, diagnosis, and management of cardiovascular disease in cancer patients before, during, and after cancer therapy. It is an emerging field with limited opportunities for structured education and training. In the year 2021, we cannot define the requirements of cardio-oncology training without acknowledging the impact of the global coronavirus disease 19 (COVID-19) pandemic. While this pandemic poses significant health risks to patients with cancer and cardiovascular disease as well as the providers who care for them, it also allows novel opportunities for the nascent field of cardio-oncology to readily adapt. In this article, we detail how the COVID-19 pandemic has impacted all aspects of cardio-oncology training, how programs and trainees can adapt to these challenges, and how lessons learned from the COVID-19 era can continue to positively impact cardio-oncology training for the foreseeable future.


Тема - темы
COVID-19/complications , Cardiovascular Diseases/prevention & control , Neoplasms/drug therapy , COVID-19/virology , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/complications , Cardiovascular Diseases/virology , Humans , Medical Oncology/trends , Neoplasms/complications , Neoplasms/pathology , Neoplasms/virology , SARS-CoV-2/pathogenicity
6.
Minerva Med ; 113(2): 300-308, 2022 Apr.
Статья в английский | MEDLINE | ID: covidwho-1249753

Реферат

BACKGROUND: The aim of this open supplement study was to evaluate the effects of Pycnogenol® in comparison with controls on symptoms of post-COVID-19 syndrome and in improving endothelial function, microcirculation, inflammatory markers and oxidative stress over 3 months in symptomatic subjects recovering from COVID-19. METHODS: Sixty subjects recovering from symptomatic COVID-19 were included. One group of 30 followed a standard recovery management while 30 comparable subjects received a supplement of 150 mg Pycnogenol® daily (in 3 doses of 50 mg) in addition to standard management. RESULTS: Two groups of selected subjects were comparable at baseline. The groups progressively improved both with the SM (standard management) and with the SM in combination with the supplement. Patients, supplemented with Pycnogenol® showed significantly better improvement compared to the control group patients. No side effects from the supplementation were observed; tolerability was optimal. The progressive evolution over time was visible in all target measurements. Physiological tests: endothelial function, low in all subjects at inclusion was assessed by flow mediated dilation (FMD) and finger reactive hyperemia in the microcirculation (laser Doppler measurements) after the release of an occluding suprasystolic cuff. It was significantly improved in the Pycnogenol® group after one month and after 3 months (P<0.05 vs. controls). The rate of ankle swelling (RAS) by strain gauge decreased significantly in the supplemented group (P<0.05) in comparison with controls showing an improvement of the capillary filtration rate. At inclusion, the kidney cortical flow velocity indicated a decrease in perfusion (lower systolic and diastolic flow velocity) in all patients. Kidney cortical flow velocity increased significantly with the supplement (P<0.05) in comparison with controls with improvement in systolic velocity and in diastolic component. High sensitivity CRP (hs-CRP) and Il-6 plasma levels decreased progressively over 3 months with a significant more pronounced decrease in the supplement group (P<0.05). The number of patients with normal plasma IL-6 levels at the end of the study was higher (P<0.05) with the supplement. ESR followed the same pattern with a progressive and a more significant decrease in the supplemented subjects (P<0.02). Oxidative stress decreased significantly in the supplemented group (P<0.05) compared with the control group. Systolic blood pressure was significantly lower in the supplemented group (P<0.05) at the end of the study. Finally, the scores of Quality-of-life, mood and fatigue questionnaire and the Karnofsky Scale Performance Index significantly improved in the supplement group (P<0.05) compared to controls after 1 and 3 months. All other blood parameters (including platelets and clotting factors) were within normal values at the end of the study. CONCLUSIONS: In conclusion, Pycnogenol® may offer a significant option for managing some of the signs and symptoms associated with post-COVID-19 syndrome. This pilot evaluation offers some potential rationale for the use of Pycnogenol® in this condition that will have significant importance in the coming years.


Тема - темы
COVID-19 , Cardiovascular Diseases , COVID-19/complications , COVID-19/drug therapy , Cardiovascular Diseases/chemically induced , Dietary Supplements , Flavonoids/pharmacology , Flavonoids/therapeutic use , Heart Disease Risk Factors , Humans , Interleukin-6 , Microcirculation , Oxidative Stress , Plant Extracts/pharmacology , Plant Extracts/therapeutic use , Registries , Risk Factors
7.
J Nepal Health Res Counc ; 19(1): 1-9, 2021 Apr 23.
Статья в английский | MEDLINE | ID: covidwho-1209433

Реферат

BACKGROUND: The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to hydroxychloroquine alone for COVID-19 treatment. METHODS: PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, and World Health Organization clinical trial registry were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed or random effects for the pooling of studies based on heterogeneities. RESULTS: The risk of mortality (RR=1.16; CI: 0.92-1.46) and adverse cardiac events (OR=1.06; CI: 0.82-1.37) demonstrated a small increment though of no significance. There were no increased odds of mechanical ventilation (OR=0.84; CI: 0.33-2.15) and significant QTc prolongation (OR=0.84, CI: 0.59-1.21). Neither the critical QTc threshold (OR=1.92, CI: 0.81-4.56) nor absolute ?QTc ?60ms (OR=1.95, CI:0.55-6.96) increased to the level of statistical significance among hydroxychloroquine and azithromycin arm compared to hydroxychloroquine alone, but the slightly increased odds need to be considered in clinical practice. CONCLUSIONS: The combination of hydroxychloroquine and azithromycin leads to small increased odds of mortality and cardiac events compared to hydroxychloroquine alone. The use of hydroxychloroquine and azithromycin led to increased odds of QT prolongation, although not statistically significant.


Тема - темы
Azithromycin/therapeutic use , COVID-19/drug therapy , Cardiovascular Diseases/chemically induced , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Azithromycin/adverse effects , COVID-19/mortality , Cardiovascular Diseases/mortality , Drug Therapy, Combination , Humans , Hydroxychloroquine/adverse effects , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , SARS-CoV-2
8.
Curr Treat Options Oncol ; 22(6): 47, 2021 04 17.
Статья в английский | MEDLINE | ID: covidwho-1188176

Реферат

OPINION STATEMENT: Prostate cancer is the second leading cause of cancer death in men, and cardiovascular disease is the number one cause of death in patients with prostate cancer. Androgen deprivation therapy, the cornerstone of prostate cancer treatment, has been associated with adverse cardiovascular events. Emerging data supports decreased cardiovascular risk of gonadotropin releasing hormone (GnRH) antagonists compared to agonists. Ongoing clinical trials are assessing the relative safety of different modalities of androgen deprivation therapy. Racial disparities in cardiovascular outcomes in prostate cancer patients are starting to be explored. An intriguing inquiry connects androgen deprivation therapy with reduced risk of COVID-19 infection susceptibility and severity. Recognition of the cardiotoxicity of androgen deprivation therapy and aggressive risk factor modification are crucial for optimal patient care.


Тема - темы
Antineoplastic Agents, Hormonal/adverse effects , Cardiovascular Diseases/epidemiology , Prostatic Neoplasms/drug therapy , Androstenes/therapeutic use , Antineoplastic Agents, Hormonal/therapeutic use , COVID-19/epidemiology , COVID-19/pathology , Cardiotoxicity , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/ethnology , Disease Susceptibility , Gonadotropin-Releasing Hormone/agonists , Gonadotropin-Releasing Hormone/antagonists & inhibitors , Health Status Disparities , Humans , Male , Prostatic Neoplasms/ethnology , SARS-CoV-2
9.
Encephale ; 46(3S): S14-S34, 2020 Jun.
Статья в французский | MEDLINE | ID: covidwho-1065047

Реферат

The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.


Тема - темы
Betacoronavirus , Coronavirus Infections , Mental Disorders/drug therapy , Pandemics , Pneumonia, Viral , Psychotropic Drugs/therapeutic use , Age Factors , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use , Biotransformation , COVID-19 , Cardiovascular Diseases/chemically induced , Comorbidity , Continuity of Patient Care , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Cytochrome P-450 CYP1A2/metabolism , Drug Interactions , Fever/chemically induced , France/epidemiology , Gastrointestinal Diseases/chemically induced , Humans , Mental Disorders/chemically induced , Mental Disorders/epidemiology , Pharmaceutical Preparations/supply & distribution , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Psychotropic Drugs/administration & dosage , Psychotropic Drugs/adverse effects , Psychotropic Drugs/pharmacokinetics , Respiration Disorders/chemically induced , Risk Assessment , SARS-CoV-2 , Smoking Cessation , Symptom Assessment
10.
J Cardiovasc Med (Hagerstown) ; 22(3): 190-196, 2021 03 01.
Статья в английский | MEDLINE | ID: covidwho-1054967

Реферат

AIM: The aim of this study was to detect predisposing CV risks factors and ECGs changes in COVID-19 patients. METHODS: The study population included 60 noncritically ill patients with COVID-19 pneumonia admitted to our hospital between 16 March and 11 May 2020. Electrographic changes, evaluated from ECGs acquired at admission and at 7 days after starting COVID-19 therapy, were analysed. We also compared 45 patients without CV involvement with 15 patients with new onset of cardiac adverse events during hospitalization. RESULTS: ECGs under treatment showed a lower heart rate (HR) (69.45 ±â€Š8.06 vs 80.1 ±â€Š25.1 beats/min, P = 0,001) and a longer QRS (102.46 ±â€Š15.08 vs 96.75 ±â€Š17.14, P = 0.000) and QT corrected (QTc) interval (452.15 ±â€Š37.55 vs 419.9 ±â€Š33.41, P = 0,000) duration than ECGs before therapy. Fifteen patients (25%) showed clinical CV involvement. Within this group, female sex, lower ejection fraction (EF), low serum haemoglobin, high Troponin I levels (TnI), low lymphocytes count, high serum IL-6 levels, or use of Tocilizumab (TCZ) were more represented. CONCLUSIONS: Patients admitted for SARS-CoV2 infection and treated with anti-COVID-19 drug therapy develop ECG changes such as reduction in HR and increase in QRS duration and QTc interval. One in four patients developed CV events. Gender, EF, heamoglobin values, TnI, lymphocytes count, IL-6 and use of TCZ can be considered as predisposing factors for CV involvement.


Тема - темы
Antiviral Agents/therapeutic use , COVID-19/complications , COVID-19/drug therapy , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/virology , Electrocardiography , Adult , Aged , Antiviral Agents/adverse effects , Biomarkers/blood , Female , Humans , Italy , Male , Middle Aged , Pneumonia, Viral/virology , Risk Factors , SARS-CoV-2 , Sex Factors , Stroke Volume
11.
Am J Trop Med Hyg ; 104(1): 35-38, 2021 Jan.
Статья в английский | MEDLINE | ID: covidwho-946095

Реферат

The efficacy and safety of hydroxychloroquine (HCQ) for the prevention and treatment of COVID-19 has received great attention, and most notably, the enthusiasm for HCQ has been one of politicization rather than science. Laboratory studies and case series published early in the pandemic supported its efficacy. The scientific community raced to conduct observational and randomized evaluations of the drug in all stages of the disease, including prophylaxis, early treatment, and advanced disease. Yet a divisive media response affected recruitment, funding, and subsequent enthusiasm for continuing scientific investigations. Of the more than 300 HCQ trials registered, fewer than 50% report having recruited any patients, and most trials might fail to achieve any useful portions of their intended sample size. Multiple observational studies and two large randomized trials have demonstrated HCQ does not offer efficacy against COVID-19 in hospitalized patients. Prophylaxis studies and early treatment studies provided heterogeneous results and are plagued by low event rates and poor study outcome monitoring. Emerging high-quality evaluations of prophylaxis and early treatment do not support a role for HCQ in these populations. The story of HCQ for COVID-19 has followed a pattern of initial enthusiasm supported by poor quality evidence, followed by disappointment based on more rigorous evaluations. The experience of HCQ in the COVID-19 era calls for the depoliticization of science away from media glare.


Тема - темы
Antimalarials/therapeutic use , COVID-19/drug therapy , Hydroxychloroquine/therapeutic use , SARS-CoV-2 , Antimalarials/adverse effects , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use , COVID-19/prevention & control , Cardiovascular Diseases/chemically induced , Humans , Hydroxychloroquine/adverse effects , Politics , Treatment Outcome
13.
Br J Clin Pharmacol ; 87(3): 1432-1442, 2021 03.
Статья в английский | MEDLINE | ID: covidwho-787556

Реферат

AIM: There is a clinical need for safety data regarding hydroxychloroquine (HCQ) and chloroquine (CQ) during the coronavirus (COVID-19) pandemic. We analysed real-world data using the U.S. Food and Drug Administration Adverse Events Reporting System (FAERS) database to assess HCQ/CQ-associated cardiovascular adverse events (CVAEs) in pre-COVID-19 reports. METHODS: We conducted disproportionality analysis of HCQ/CQ in the FAERS database (07/2014-9/2019), using reporting odds ratio (ROR) and the lower bound of the information component 95% credibility interval (IC025 ). RESULTS: The full database contained 6 677 225 reports with a mean (±SD) age of 53 (±17) years and 74% females. We identified 4895 reports of HCQ/CQ related adverse events, of which 696 (14.2%) were CVAEs. Compared with the full database, HCQ/CQ use was associated with a higher reporting rate of major CVAEs, including cardiomyopathy (n = 86 [1.8%], ROR = 29.0 [23.3-35.9]), QT prolongation (n = 43 [0.9%], ROR = 4.5 [3.3-6.1]), cardiac arrhythmias (n = 117 [2.4%], ROR = 2.2 [1.8-2.7]) and heart failure (n = 136 [2.8%], ROR = 2.2 [1.9-2.7], all IC025 > 0). No statistically significant differences were observed between sex and age groups. CVAEs were reported more often in patients with systemic lupus erythematosus and Sjogren's syndrome. HCQ/CQ-associated CVAEs demonstrated subsequent hospitalization and mortality rates of 39% and 8%, respectively. Overdose reports demonstrated an increased frequency of QT prolongation and ventricular arrhythmias (35% and 25%, respectively). CONCLUSION: In a real-world setting, HCQ/CQ treatment is associated with higher reporting rates of various CVAEs, particularly cardiomyopathy, QT prolongation, cardiac arrhythmias and heart failure. HCQ/CQ-associated CVAEs result in high rates of severe outcomes and should be carefully considered as an off-label indication, especially for patients with cardiac disorders.


Тема - темы
Antimalarials/adverse effects , COVID-19/drug therapy , Cardiovascular Diseases/chemically induced , Chloroquine/adverse effects , Hydroxychloroquine/adverse effects , Pharmacovigilance , Adult , Aged , Antimalarials/therapeutic use , COVID-19/complications , Cardiovascular Diseases/epidemiology , Chloroquine/therapeutic use , Databases, Factual , Drug Overdose , Female , Humans , Hydroxychloroquine/therapeutic use , Male , Middle Aged , Odds Ratio , Treatment Outcome
14.
Autophagy ; 16(12): 2273-2275, 2020 12.
Статья в английский | MEDLINE | ID: covidwho-671715

Реферат

Coronavirus disease 2019 (COVID-19) has attracted worldwide attention due to its speed of progression and elevated mortality rate. Amid the rush to develop treatments, recent hopes have focused on the anti-malarial drug chloroquine or the derivative hydroxychloroquine. Here, we briefly discuss the evidence for the potential use of these drugs with regard to the current pandemic.


Тема - темы
COVID-19/drug therapy , Chloroquine/adverse effects , Chloroquine/therapeutic use , SARS-CoV-2/drug effects , Autophagy/drug effects , COVID-19/epidemiology , COVID-19/pathology , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , China/epidemiology , Chloroquine/analogs & derivatives , Chloroquine/pharmacology , Clinical Trials as Topic/statistics & numerical data , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drug-Related Side Effects and Adverse Reactions/etiology , France/epidemiology , Humans , Hydroxychloroquine/adverse effects , Hydroxychloroquine/pharmacology , Hydroxychloroquine/therapeutic use , Italy/epidemiology , Pandemics , SARS-CoV-2/physiology , Severity of Illness Index
15.
Vascular ; 29(2): 220-227, 2021 Apr.
Статья в английский | MEDLINE | ID: covidwho-660824

Реферат

BACKGROUND: The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-19). It is important to accurately analyze the available evidence to provide correct clinical guidance for optimal patient care. We aim to discuss current clinical evidence regarding chloroquine, hydroxychloroquine, azithromycin, remdesivir, and the cardiovascular burden of COVID-19. METHODS: A literature review was performed using PubMed and Google Scholar. Additional clinical trials were identified through the "TrialsTracker" project. RESULTS: We found conflicting evidence of chloroquine, hydroxychloroquine plus azithromycin, and remdesivir in COVID-19 despite promising early reports of in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2. Some of the current studies have demonstrated adverse drug reactions to chloroquine and hydroxychloroquine + azithromycin. Widespread systemic inflammation and procoagulant/hypercoagulable state, including thrombotic microangiopathy, endothelial dysfunction, bleeding disorder, and thrombosis are increasingly being witnessed in COVID-19. Evidence of cardiac injury and stroke is mostly reported in hospitalized patients; however, large specialized studies that focus on cardiac or neuropathology are lacking. DISCUSSION: There is no convincing clinical evidence of chloroquine, hydroxychloroquine with or without azithromycin, and remdesivir use in COVID-19. As evidence of systemic inflammation is rapidly unfolding, there is a dire need to maximize our resources to find the best possible solutions to the current crisis while conclusive evidence from clinical trials emerges.


Тема - темы
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Azithromycin/pharmacology , COVID-19/drug therapy , Cardiovascular Diseases , Chemically-Induced Disorders , Chloroquine/pharmacology , Adenosine Monophosphate/pharmacology , Alanine/pharmacology , Antiviral Agents/pharmacology , COVID-19/epidemiology , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/prevention & control , Chemically-Induced Disorders/etiology , Chemically-Induced Disorders/prevention & control , Drug Therapy, Combination/adverse effects , Drug Therapy, Combination/methods , Humans , SARS-CoV-2
16.
Pharmacotherapy ; 40(9): 978-983, 2020 09.
Статья в английский | MEDLINE | ID: covidwho-648736

Реферат

Hydroxychloroquine combined with azithromycin has been investigated for activity against coronavirus disease 2019 (COVID-19), but concerns about adverse cardiovascular (CV) effects have been raised. This study evaluated claims data to determine if risks for CV events were increased with hydroxychloroquine alone or combined with azithromycin. We identified data from 43,752 enrollees that qualified for analysis. The number of CV events increased by 25 (95% confidence interval [CI]: 8, 42, p=0.005) per 1000 people per year of treatment with hydroxychloroquine alone compared with pretreatment levels and by 201 (95% CI: 145, 256, p<0.001) events per 1000 people per year when individuals took hydroxychloroquine and azithromycin. These rates translate to an additional 0.34 (95% CI: 0.11, 0.58) CV events per 1000 patients placed on a 5-day treatment with hydroxychloroquine monotherapy and 2.75 (95% CI: 1.99, 3.51) per 1000 patients on a 5-day treatment with both hydroxychloroquine and azithromycin. The rate of adverse events increased with age following exposure to hydroxychloroquine alone and combined with azithromycin. For females aged 60 to 79 years prescribed hydroxychloroquine, the rate of adverse CV events was 0.92 per 1000 patients on 5 days of therapy, but it increased to 4.78 per 1000 patients when azithromycin was added. The rate of adverse CV events did not differ significantly from zero for patients 60 years of age or younger. These data suggest that hydroxychloroquine with or without azithromycin is likely safe in individuals under 60 years of age if they do not have additional CV risks. However, the combination of hydroxychloroquine and azithromycin should be used with extreme caution in older patients.


Тема - темы
Azithromycin/adverse effects , COVID-19/drug therapy , Cardiotoxicity/etiology , Hydroxychloroquine/adverse effects , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Azithromycin/administration & dosage , Cardiotoxicity/epidemiology , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Child , Child, Preschool , Databases, Factual , Drug Therapy, Combination , Female , Humans , Hydroxychloroquine/administration & dosage , Infant , Infant, Newborn , Male , Middle Aged , Risk Factors , Sex Factors , Young Adult
17.
Heart Lung Circ ; 29(7): 973-987, 2020 Jul.
Статья в английский | MEDLINE | ID: covidwho-619098

Реферат

Coronavirus disease (COVID-19) is a serious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The symptoms of the disease range from asymptomatic to mild respiratory symptoms and even potentially life-threatening cardiovascular and pulmonary complications. Cardiac complications include acute myocardial injury, arrhythmias, cardiogenic shock and even sudden death. Furthermore, drug interactions with COVID-19 therapies may place the patient at risk for arrhythmias, cardiomyopathy and sudden death. In this review, we summarise the cardiac manifestations of COVID-19 infection and propose a simplified algorithm for patient management during the COVID-19 pandemic.


Тема - темы
Cardiovascular Diseases , Coronavirus Infections , Pandemics , Patient Care Management/methods , Pneumonia, Viral , Algorithms , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , COVID-19 , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/classification , Cardiovascular Diseases/therapy , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2
19.
Am J Cardiol ; 128: 147-150, 2020 08 01.
Статья в английский | MEDLINE | ID: covidwho-277078

Реферат

Coronavirus disease 2019 (COVID-19) has become a global pandemic. It is still uncontrolled in most countries and no therapies are currently available. Various drugs are under investigation for its treatment. The disease is known to have worse outcomes in patients who have underlying cardiovascular disease. Chloroquine/hydroxychloroquine, azithromycin, remdesivir and lopinavir/ritonavir are currently being studied in trials and show some promise. Conduction disorders, heart failure, and mortality have been reported with the use of these drugs. It is important to have knowledge of potential cardiotoxic effects of these drugs before using them for COVID-19 patients for better allocation of healthcare resources and improvement in clinical outcomes.


Тема - темы
Anti-Infective Agents/adverse effects , Betacoronavirus , Cardiovascular Diseases/chemically induced , Coronavirus Infections/drug therapy , Enzyme Inhibitors/adverse effects , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Alanine/administration & dosage , Alanine/adverse effects , Alanine/analogs & derivatives , Anti-Infective Agents/administration & dosage , Azithromycin/administration & dosage , Azithromycin/adverse effects , COVID-19 , Drug Combinations , Enzyme Inhibitors/administration & dosage , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Lopinavir/therapeutic use , Pandemics , Ritonavir/therapeutic use , SARS-CoV-2
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