RESUMEN
The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.
Asunto(s)
Acetazolamida/uso terapéutico , Antivirales/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Anhidrasas Carbónicas/sangre , Equilibrio Ácido-Base/efectos de los fármacos , Mal de Altura/sangre , Mal de Altura/tratamiento farmacológico , Anticonvulsivantes/uso terapéutico , Bicarbonatos/sangre , COVID-19/sangre , COVID-19/diagnóstico por imagen , COVID-19/virología , Dióxido de Carbono/sangre , Tos/sangre , Tos/tratamiento farmacológico , Tos/patología , Tos/virología , Reposicionamiento de Medicamentos , Disnea/sangre , Disnea/tratamiento farmacológico , Disnea/patología , Disnea/virología , Fiebre/sangre , Fiebre/tratamiento farmacológico , Fiebre/patología , Fiebre/virología , Humanos , Concentración de Iones de Hidrógeno , Hipertensión Pulmonar/sangre , Hipertensión Pulmonar/tratamiento farmacológico , Hipoxia/sangre , Hipoxia/tratamiento farmacológico , Hipoxia/patología , Hipoxia/virología , Oximetría , Proyectos de Investigación , SARS-CoV-2/patogenicidad , SARS-CoV-2/fisiología , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The diagnostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure has been documented. However, most of the data were derived from countries with high healthcare resource use, and randomized evidence for utility of NT-proBNP was lacking. METHODS AND RESULTS: We tested the hypothesis that NT-proBNP testing improves the management of patients presenting with dyspnea to emergency departments in Canada by prospectively comparing the clinical and economic impact of a randomized management strategy either guided by NT-proBNP results or without knowledge of NT-proBNP concentrations. Five hundred patients presenting with dyspnea to 7 emergency departments were studied. The median NT-proBNP level among the 230 subjects with a final diagnosis of heart failure was 3697 compared with 212 pg/mL in those without heart failure (P<0.00001). Knowledge of NT-proBNP results reduced the duration of ED visit by 21% (6.3 to 5.6 hours; P=0.031), the number of patients rehospitalized over 60 days by 35% (51 to 33; P=0.046), and direct medical costs of all ED visits, hospitalizations, and subsequent outpatient services (US $6129 to US $5180 per patient; P=0.023) over 60 days from enrollment. Adding NT-proBNP to clinical judgment enhanced the accuracy of a diagnosis; the area under the receiver-operating characteristic curve increased from 0.83 to 0.90 (P<0.00001). CONCLUSIONS: In a universal health coverage system mandating judicious use of healthcare resources, inclusion of NT-proBNP testing improves the management of patients presenting to emergency departments with dyspnea through improved diagnosis, cost savings, and improvement in selected outcomes.