Similitudes y diferencias entre el síndrome respiratorio agudo severo causado por SARS-CoV y la COVID-19 / Similarities and differences among COVID-19 and the severe acute respiratory syndrome caused by SARS-CoV

Introducción: De manera epidémica, en los años 2003, 2012 y 2019, han ocurrido eventos caracterizados por tener una elevada morbilidad y mortalidad poblacional y ser originados por tres nuevos Beta-CoV denominados: SARS-CoV, MERS-CoV y SARS-CoV-2 (este último comparte una identidad de 82 por ciento en su secuencia génica con el SARS-CoV), causantes del síndrome respiratorio agudo severo, el síndrome respiratorio del Medio Oriente y la COVID -19, respectivamente. Objetivo: Examinar las principales similitudes y diferencias entre el síndrome respiratorio agudo severo causado por el SARS-CoV y la COVID-19. Métodos: Se realizó la búsqueda en las bases de datos Medline, Scielo y Google académico. Se seleccionaron artículos en inglés y en español y las palabras clave: utilizadas fueron: infecciones por coronavirus, COVID-19, SARS-CoV, SARS-CoV-2. Resultados: Una similitud importante entre ambas afecciones es que tienen igual vía de transmisión y periodo de incubación; sin embargo, la letalidad en el SRAS duplicó la de la COVID-19. Existen diferencias estructurales entre el SARS-CoV y el SARS-CoV-2 pero ambos se fijan al receptor de la enzima convertidora de angiotensina 2. Las manifestaciones clínicas y exámenes complementarios son similares, pero existen diferencias relacionadas con el inicio de los síntomas respiratorio, su frecuencia y orden de aparición. Consideraciones finales: Existen similitudes entre las enfermedades causadas por el SARS-CoV y el SARS-CoV 2; pero también existen diferencias en sus características epidemiológicas, clínicas y de laboratorio que nos podrían permitir hacer un diagnóstico diferencial y garantizar un tratamiento y seguimiento adecuado en situaciones específicas(AU)

Introduction: In the years 2003, 2012 and 2019 have happened epidemic events characterized with a high population morbidity and mortality and originated by three new Beta-CoV called: SARS-CoV, MERS-CoV and SARS-CoV-2 (this last one shares with SARS-CoV an identity of 82 percent in its gene sequence) which cause the severe acute respiratory syndrome, the Middle East respiratory syndrome and COVID-19, respectively. Objective: To assess the main similarities and differences among COVID-19 and the severe acute respiratory syndrome caused by SARS-CoV. Methods: It was carried out the search in Medline, Scielo and Google Scholar databases. The requirements used were that the articles were in English or Spanish language and the keywords were: infections by coronavirus, COVID-19, SARS-CoV, SARS-CoV-2. Results: An important similarity among both conditions is that they have the same transmission way and incubation period; however, lethality in the SARS doubled the COVID-19 one. There are structural differences among SARS-CoV and SARS-CoV-2 but both are fixed to the recipient of the angiostensina 2 converter´s enzyme. Clinical manifestations and complementary exams are similar but there are differences related to the onset of respiratory symptoms, their frequence and the order of appareance. Final considerations: There are similarities among the diseases caused by SARS-CoV and SARS-CoV-2; but also there are differences in their epidemiological, clinical and laboratory characteristics that can allow to do a differencial diagnosis and to guarantee an adequate treatment and follow-up in specific situations(AU)

Alternativas terapéuticas para el manejo de la COVID-19 / Therapeutic alternatives for the management of COVID-19

Introducción: La COVID-19 es una pandemia causada por el Coronavirus 2 del Síndrome Respiratorio Agudo Severo (SARS-CoV-2); no existe hasta el momento tratamiento específico completamente eficaz para esta enfermedad, pero el mundo está trabajando incesantemente para buscar una cura. Objetivo: Describir las alternativas terapéuticas de la COVID-19, según los mecanismos fisiopatológicos descritos hasta el momento. Material y Método: Se realizó una revisión bibliográfica a partir de un total de 31 referencias bibliográficas. Se revisaron artículos, en idioma inglés y español, en revistas nacionales e internacionales en bases de datos como Pubmed/Medline, y Elsevier. Se analizó la calidad, fiabilidad y validez de los artículos seleccionados para realizar una adecuada revisión. Desarrollo: La aparición de la COVID-19 ha causado revuelo internacional por la necesidad de encontrar tratamientos efectivos. Debido a que es una enfermedad frecuentemente autolimitada, se vuelve difícil probar si una estrategia terapéutica es eficaz o la enfermedad ha seguido su curso. Las fases del ciclo de vida viral del SARS-COV proporcionan los objetivos potenciales para la terapia con medicamentos, como son: los inhibidores de la fusión de membrana de la envoltura viral, inhibidores de la proteasa similar a la 3-quimotripsina, inhibidores de la ARN polimerasa dependiente de ARN viral, inhibidores de la entrada y endocitosis y otros medicamentos con alguna función inmunomuduladora. Conclusiones: La pandemia actual representa un desafío para la comunidad médica internacional. Aunque no hay tratamiento específico recomendado, se utilizan diversos medicamentos con cierta efectividad como la hidroxicloroquina, azitromicina, kaletra y el remdesivir con sus respectivas combinaciones(AU)

Introduction: COVID-19 is a pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), so far there is no fully effective specific treatment for this disease, but worldwide effort is incessant in the search for a cure. Objective: To describe the therapeutic alternatives for COVID-19 according to the pathophysiological mechanisms described up until now. Material and Method: A bibliographic review was made from a total of 31 bibliographic references. Articles, in English and Spanish, from national and international journals were searched over on-line databases such as Pubmed/Medline and Elsevier. The quality, reliability and validity of the selected articles were analyzed to carry out an adequate review. Development: The appearance of COVID-19 has caused an international stir due to the need to find effective treatments. Because it is a frequently self-limited disease, it becomes difficult to prove whether a therapeutic strategy is effective or the disease has run its course. The SARS-CoV viral life cycle phases provide potential targets for drug therapy, such as: viral envelope membrane fusion inhibitors, 3-chymotrypsin-like protease inhibitors, virus RNA-dependent RNA polymerase, endocytosis and entry inhibitors, and other medications with some immunomodulatory function. Conclusions: The current pandemic represents a challenge for the international medical community. Although there is no specific recommended treatment, various drugs are used with some effectiveness such as hydroxychloroquine, azithromycin, kaletra and remdesivir with their respective combinations(AU)

A systematic review on the efficacies and therapeutic interventions of homoeopathic medicines in combating viral disorders with implications in the currently undergoinghomoeopathic treatment efforts for SARS-CoV-2 infection (COVID-19)

The prevalence of Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) has undergone a historic transition from December 2019 to June 2020. Under the current circumstances, SARS-CoV-2 has become a key problem for the public health and economic steadiness of the global fraternity. Based on ample evidences from the global epidemiology of SARS-CoV-2 and MERS-CoV (Middle EastRespiratory Syndrome-Corona virus) scientists and physicians strappingly consider these viruses share structural and functional similarities of selected biologically active enzymes namely, 3CLpro, PLproand RdRp. Ultra-diluted homoeopathic medicine has the legacy to combat infectious as well as viral diseases since last two centuries. Thus, a systematic review on existing antiviral homoeopathic therapies was done in the current study and the need of appropriate clinical validation with proper in vitroas well as in vivostudies prior to make clinical endorsements in treating COVID-19 patients with homoeopathic medicines has been explained. A brief summary of the currently undergoing or recently completed homoeopathic treatments of COVID-19 has also been provided to attract many more similar homoeopathic treatment attempts to combat COVID-19.(AU)

Clinical research protocol to evaluate the effectiveness and safety of individualized homeopathic medicine in the treatment and prevention of the COVID-19 epidemic

In addition to the recognized application in chronic diseases, individualized homeopathy can also act in a resolutive or complementary way in acute cases, including epidemic diseases. However, to achieve this intent, it presents a specific semiologic and therapeutic methodology that must be followed and respected, with the risk of not presenting the desired efficacy and safety. In the case of epidemic diseases, which due to the virulence of their agents causes a common symptomatological picture in most susceptible individuals, the individualized homeopathic medicine (homeopathic medicine of the epidemic genius) should present similarity with the set of characteristic symptoms and signs of the patients affected in the different stages of each epidemic outbreak. Studies show the efficacy and safety of this prophylactic and/or therapeutic practice in several epidemics of the past. Therefore, after the survey of possible homeopathic drugs individualized from the epidemic genius of each epidemic, its prophylactic and/or large-scale therapeutic application should be supported by previous clinical trials that demonstrate its efficacy and safety, in line with the ethical and bioethical aspects of research involving human beings. Fulfilling these premises of good clinical practice, we developed the current protocol with the objective of investigating, in a randomized, double-blind and placebo-controlled clinical trial, the effectiveness and safety of possible individualized homeopathic drugs of epidemic genius of COVID-19, in adjuvant and complementary treatment of patients affected by the disease. If effectiveness and safety are confirmed, and only in this condition, the medicine may be used in a generalized and collective manner in the treatment and prevention of the current epidemic. (AU)

Protocolo de pesquisa clínica para avaliar a eficácia e a segurança de medicamento homeopático individualizado no tratamento e na prevenção da epidemia de COVID-19 / Clinical research protocol to evaluate the efficacy and safety of individualized homeopathic medicine in the treatment and prevention of the COVID-19 epidemic

Além da reconhecida aplicação nas doenças crônicas, a homeopatia individualizada também pode atuar de forma resolutiva ou complementar nos casos agudos, incluindo as doenças epidêmicas. No entanto, para atingir esse intento, apresenta uma metodologia semiológica e terapêutica específica que deve ser seguida e respeitada, com o risco de não apresentar a eficácia e a segurança desejada. No caso das doenças epidêmicas, que pela virulência dos seus agentes provoca um quadro sintomatológico comum na maioria dos indivíduos suscetíveis, o medicamento homeopático individualizado (medicamento homeopático do gênio epidêmico) deve apresentar semelhança com o conjunto de sinais e sintomas característicos dos pacientes acometidos nos diferentes estágios de cada surto epidêmico. Estudos evidenciam a eficácia e a segurança desta prática profilática e/ou terapêutica em diversas epidemias do passado. Assim sendo, após o levantamento dos possíveis medicamentos homeopáticos individualizados do gênio epidêmico de cada epidemia, sua aplicação profilática e/ou terapêutica em larga escala deve ser sustentada por ensaios clínicos prévios que demonstrem sua eficácia e segurança, em consonância com os aspectos éticos e bioéticos da pesquisa envolvendo seres humanos. Cumprindo essas premissas da boa prática clínica, elaboramos o atual protocolo com o objetivo de investigar, em ensaio clínico randomizado, duplo-cego e placebo-controlado, a eficácia e a segurança de possíveis medicamentos homeopáticos individualizados do gênio epidêmico da COVID-19, em tratamento adjuvante e complementar de pacientes acometidos pela doença. Caso a a eficácia e a segurança se confirme, e tão somente, o(s) medicamento(s) poderão ser utilizado de forma generalizada e coletiva no tratamento e na prevenção da atual epidemia. (AU)

In addition to the recognized application in chronic diseases, individualized homeopathy can also act in a resolutive or complementary way in acute cases, including epidemic diseases. However, to achieve this intent, it presents a specific semiological and therapeutic methodology that must be followed and respected, with the risk of not presenting the desired efficacy and safety. In the case of epidemic diseases, which due to the virulence of their agents causes a common symptomatological picture in most susceptible individuals, the individualized homeopathic medicine (homeopathic medicine of the epidemic genius) should present similarity with the set of characteristic symptoms and signs of the patients affected in the different stages of each epidemic outbreak. Studies show the efficacy and safety of this prophylactic and/or therapeutic practice in several epidemics of the past. Therefore, after the survey of possible homeopathic drugs individualized from the epidemic genius of each epidemic, its prophylactic and/or large-scale therapeutic application should be supported by previous clinical trials that demonstrate its efficacy and safety, in line with the ethical and bioethical aspects of research involving human beings. Fulfilling these premises of good clinical practice, we developed the current protocol with the objective of investigating, in a randomized, double-blind and placebo-controlled clinical trial, the efficacy and safety of possible individualized homeopathic drugs of epidemic genius of COVID-19, in adjuvant and complementary treatment of patients affected by the disease. If efficacy and safety are confirmed, and only in this condition, the medicine may be used in a generalized and collective manner in the treatment and prevention of the current epidemic. (AU)

Resultados terapêuticos da homeopatia em pacientes suspeitos ou confirmados de COVID-19 no Brasil: Protocolo para estudo observacional prospectivo / Outcomes research of homeopathic treatment in suspected or confirmed patients with COVID-19 IN Brazil: Clinical research protocol

A infecção humana causada pelo vírus SARS-CoV-2 (COVID-19), diagnosticada como pneumonia de causa desconhecida originalmente na cidade de Wuhan (China), foi considerada como pandemia pela Organização Mundial da Saúde. Sua transmissibilidade parece ser bastante elevada, tendo afetado quase dois milhões de pessoas em todo o mundo e provocado mais de 130 mil mortes. Surgiu no Brasil em fevereiro de 2020, inicialmente na cidade de São Paulo. Afeta de forma mais grave os idosos e portadores de algumas comorbidades (tais como doenças cardiovasculares, hipertensão arterial, diabetes, câncer, DPOC e doenças cerebrovasculares, entre outras), tendo uma sintomatologia variável e tratamentos empíricos que estão sendo testados de forma mais rigorosa desde o seu aparecimento. Na ausência de vacina para proteção dos sadios, tem sido adotada a estratégia de isolamento social e tratamento com medidas de suporte geral e/ou avançado. Neste contexto, cabe investigar a contribuição da terapêutica homeopática no enfrentamento da doença, notadamente no alívio dos sintomas desconfortáveis por ela provocados em sua fase inicial, com acompanhamento e registro dos resultados obtidos pelos médicos homeopatas. Este estudo nacional pretende coletar, durante o período em que durar a pandemia da COVID-19 no Brasil, informações de pacientes diagnosticados com a doença, tratados com medicamentos homeopáticos escolhidos de acordo com a sintomatologia apresentada pelo paciente, por experientes médicos homeopatas. Todos os medicamentos homeopáticos estão descritos na Farmacopéia Homeopática Brasileira, não envolvendo qualquer medicamento que não tenha sido anteriormente aprovado para uso homeopático. Serão avaliados os efeitos no estado de saúde do paciente, por meio de escores e escalas clínicas, bem como aspectos relacionados à segurança do medicamento, variação na duração da doença e medicamentos mais associados a eventuais sucessos terapêuticos. Questionário padronizado e específico para a COVID-19 foi elaborado e disponibilizado em formulários google para preenchimento dos médicos colaboradores do estudo durante o acompanhamento dos pacientes. Os dados serão armazenados em planilhas eletrônicas e serão analisados com técnicas estatísticas descritivas e inferenciais. Todos os dados dos pacientes serão coletados de forma totalmente anonimizada para proteger a privacidade dos pacientes, que serão identificados no formulário eletrônico, única e exclusivamente, por um código alfanumérico, escolhido pelo seu médico homeopata e registrado no seu prontuário médico. Dada a situação pandêmica, nos casos em que não for possível o atendimento presencial será enviado uma folha de informações sobre o estudo e TCLE para preenchimento pelo paciente, bem como feitas as teleconsultas de seguimento para acompanhamento do caso. Além de gerar o desenvolvimento de novas aplicações da telemedicina na área homeopática, o projeto visa também a coleta de informações úteis que poderão ser utilizadas em futuros estudos multicêntricos randomizados e controlados para tratamento com medicamentos homeopáticos de quadros epidêmicos, podendo servir também de modelo para novos estudos clínicos de avaliação dos benefícios do tratamento homeopático em outras doenças ou agravos à saúde. (AU)

Infection in humans caused by the SARS-CoV-2 virus (COVID-19), diagnosed as pneumonia of unknown cause originally in the city of Wuhan (China) in December 2019, was considered a pandemic by the World Health Organization. Its transmissibility seems to be quite high, affecting almost two million people worldwide and causing more than 130 thousand deaths. It appeared in Brazil in February 2020, initially in the city of São Paulo. It affects more severely the elderly and people with some comorbidities (such as cardiovascular diseases, high blood pressure, diabetes, malignancy, chronic obstructive pulmonary disease and cerebrovascular disease, among others), with a rich clinical symptomatology. Empirical treatments are being tested in more rigorous clinical trials. In the absence of a vaccine to protect the healthy, the strategy of social isolation and treatment with general and / or advanced support measures has been adopted. In this context, it is worth investigating the potential contribution of homeopathy for relieving the distressing symptoms caused by coronavirus in its initial phase, together with monitoring and recording outcomes collected by homeopathic doctors. This national study intends to collect information from suspected or confirmed cases of COVID-19 patients, during the current pandemic in Brazil. The patients will be attended by experienced homeopathic doctors with the prescription of remedies according to the symptoms presented by the patient in the pandemic. All homeopathic medicines are described in the Brazilian Homeopathic Pharmacopoeia. The effects on patients' health status will be evaluated by means of scores and clinical scales, together with measures on safety, duration of the disease and medicines better related with good results. A standardized and specific questionnaire for COVID-19 had been designed and will be available on google forms to be filled out by doctors during the study. The data will be stored in electronic spreadsheets and will be analyzed using descriptive and inferential statistical techniques. All patient data will be collected in a completely anonymous way to protect patients' privacy. Patients will be identified exclusively by an alphanumeric code, to be registered in doctors' medical records. Given the pandemic situation, in cases in which face-to-face health care is not obligatory, an information sheet about the study will be sent to the patient in order to get the informed consent. Teleconsultations will take place in some cases for follow-up of patients. In addition to enlarge telemedicine applications for homeopathy, this project also aims to collect useful information that could be used in future randomized and controlled multicenter trials to evaluate the role of homeopathy in epidemic or transmissible diseases. It could also be helpful for designing clinical studies using homeopathic medicines in other diseases or health problems. (AU)

La infección en humanos causada por el virus SARS-CoV-2 (COVID-19), diagnosticada como neumonía de causa desconocida originalmente en la ciudad de Wuhan (China) en diciembre de 2019, fue considerada una pandemia por la Organización Mundial de la Salud. Su transmisibilidad parece ser bastante alta, afectando a casi dos millones de personas en todo el mundo y causando más de 130 mil muertes. Apareció en Brasil en febrero de 2020, inicialmente en la ciudad de São Paulo. Afecta más severamente a los ancianos y personas con algunas comorbilidades (como enfermedades cardiovasculares, presión arterial alta, diabetes, malignidad, enfermedad pulmonar obstructiva crónica y enfermedad cerebrovascular, entre otros), con una rica sintomatología clínica. Los tratamientos empíricos se están probando en ensayos clínicos más rigurosos. En ausencia de una vacuna para proteger a los sanos, se ha adoptado la estrategia de aislamiento social y tratamiento con medidas de apoyo generales y / o avanzadas. En este contexto, se puede investigar la contribución potencial de la homeopatía para aliviar los síntomas causados por el coronavirus en su fase inicial, junto con el monitoreo y registro de los resultados recopilados por los médicos homeópatas. Este estudio nacional tiene la intención de recopilar información de casos sospechosos o confirmados de pacientes con COVID-19, durante la pandemia actual en Brasil. Los pacientes serán atendidos por médicos homeópatas experimentados con la prescripción de remedios de acuerdo con los síntomas presentados por el paciente en la pandemia. Todos los medicamentos homeopáticos se describen en la Farmacopea Homeopática Brasileña. Los efectos sobre el estado de salud de los pacientes se evaluarán mediante puntajes de síntomas y escalas clínicas, junto con medidas de seguridad, duración de la enfermedad y revelación de medicamentos más asociados con buenas respuestas clínicas. Se diseñó un cuestionario estandarizado y específico para COVID-19, que estará disponible en los formularios de Google para que los médicos lo completen durante el estudio. Los datos se almacenarán en hojas de cálculo electrónicas y se analizarán mediante técnicas estadísticas descriptivas e inferenciales. Todos los datos del paciente se recopilarán de forma completamente anónima para proteger la privacidad de los pacientes. Los pacientes serán identificados exclusivamente por un código alfanumérico, que se registrará en los registros médicos de los médicos. Dada la situación de pandemia, en los casos en que la atención médica presencial no es obligatoria, se enviará una hoja de información sobre el estudio al paciente para obtener el consentimiento informado. Se realizarán teleconsultas en algunos casos para el seguimiento de los pacientes. Además de ampliar las aplicaciones de telemedicina para la homeopatía, este protocolo también tiene como objetivo recopilar información útil que podría utilizarse en futuros ensayos multicéntricos controlados y aleatorizados para evaluar el papel de la homeopatía en enfermedades epidémicas o transmisibles. También podría ser útil para diseñar estudios clínicos con medicamentos homeopáticos en otras enfermedades o problemas de salud.(AU)