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1.
BMC Pregnancy Childbirth ; 20(1): 580, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008308

RESUMEN

BACKGROUND: During the ongoing global outbreak of COVID-19, pregnant women who are susceptible to COVID-19 should be highly concerned. The issue of vertical transmission and the possibility of neonatal infection is a major concern. CASE PRESENTATION: Case 1: A 35-year-old pregnant woman with a gestational age of 37 weeks and 6 days was admitted to our hospital at the point of giving birth. Except for the abnormalities in her chest CT image, she was asymptomatic. She had an uncomplicated spontaneous vaginal delivery, and her infant was discharged home for isolation. Because of the positive result of the maternal swabs for SARS-CoV-2 obtained on the 2nd day after sampling, we transferred the mother to the designated hospital and followed up with her by telephone interviews. Luckily, it was confirmed on February 23 that the newborn did not develop any COVID-19 symptoms after observation for 14 days after birth. Case 2: Another pregnant woman, with a gestational age of 38 weeks and 2 days, was also admitted to our hospital because of spontaneous labor with cervical dilation of 5 cm. Since she had the typical manifestations of COVID-19, including cough, lymphopenia, and abnormal chest CT images, she was highly suspected of having COVID-19. Based on the experience from case 1, we helped the mother deliver a healthy baby by vaginal delivery. On the 2nd day after delivery, the maternal nasopharyngeal swab result was positive, while the infant's result was negative. CONCLUSION: There is still insufficient evidence supporting maternal-fetal vertical transmission for COVID-19-infected mothers in late pregnancy, and vaginal delivery may not increase the possibility of neonatal infection.


Asunto(s)
Infecciones Asintomáticas , Infecciones por Coronavirus/diagnóstico , Parto Obstétrico/métodos , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Lactancia Materna , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/terapia , Tos , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Edad Gestacional , Humanos , Linfopenia , Máscaras , Terapia por Inhalación de Oxígeno , Pandemias , Aislamiento de Pacientes , Equipo de Protección Personal , Neumonía Viral/terapia , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Pruebas Serológicas , Tomografía Computarizada por Rayos X
2.
Folia Med (Plovdiv) ; 62(3): 592-596, 2020 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-33009760

RESUMEN

INTRODUCTION: Despite clinical trials, there are still no approved specific therapies or any vaccine against COVID-19. The only option available is using investigational drugs for compassionate use. The update of the existing regulation regarding compassionate use is to ensure the effective and sustainable development of health policies and technologies over the COVID-19 pandemic and beyond. AIM: The present short communication aimed to highlight the need for early and expanded access to investigational drugs for compassionate use as well as a call for an update of the existing regulation in Bulgaria concerning compassionate use in the era of COVID-19. MATERIALS AND METHODS: In EU and Bulgaria as well, the legal framework for compassionate use was introduced by Article 83 (1) of Regulation (EC) No 726/2004 of the European Parliament and of the Council; in principle, Regulations of the European Parliament and of the Council are mandatory for all Member States. Remdesivir appears to have a favorable clinical and safety profile, as reported in a case involving patients with severe COVID-19 through a compassionate use programme. RESULTS: The overall probability of clinical improvement observed in 36 of 53 COVID-19 patients received intravenous remdesivir as part of a compassionate use programme was 68% (95% CI 40% to 80%). Thirty two patients (60%) demonstrated at least one adverse event, twelve 12 patients (23%) experienced serious adverse events and seven patients (13%) died. CONCLUSION: The global pandemic mandates Bulgarian Drug Agency for a reasonable update of the existing national regulation concerning compassionate use and off-label therapies. In the era of COVID-19, it is important for Bulgarian patients to have early and expanded access to investigational drugs for compassionate use.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , Ensayos de Uso Compasivo/legislación & jurisprudencia , Infecciones por Coronavirus/tratamiento farmacológico , Política de Salud/legislación & jurisprudencia , Neumonía Viral/tratamiento farmacológico , Adenosina Monofosfato/uso terapéutico , Alanina/uso terapéutico , Betacoronavirus , Bulgaria , Drogas en Investigación , Humanos , Pandemias
3.
Curr Opin HIV AIDS ; 15(6): 336-340, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33002954

RESUMEN

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) is a highly contagious and potentially lethal pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No specific antiviral treatment is currently available. The purpose of this review is to highlight the main repurposed drug treatments with in-vitro or in-vivo efficacy against the SARS-CoV-2. RECENT FINDINGS: Recent clinical trials suggested remdesivir, IFN-ß-1b and favipiravir have potential clinical and/or virological benefits on patients with COVID-19. Short course of stress dose of corticosteroids might be used as adjunctive treatment to patients who are late presenters with cytokine storm. Convalescent plasma from recovered COVID-19 patients with high neutralizing antibody might also be beneficial in the treatment of severe disease. SUMMARY: Early effective antiviral therapy in COVID-19 patients will suppress the SARS-CoV-2 viral load. Adjunctive therapy with corticosteroid and convalescent plasma might further ameliorate the cytokine response. Further randomized clinical trials of combination therapy are needed.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Antivirales/uso terapéutico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/terapia , Humanos , Inmunización Pasiva , Interferón beta/uso terapéutico , Pandemias , Neumonía Viral/inmunología
4.
Trials ; 21(1): 827, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008479

RESUMEN

OBJECTIVES: We aimed to test our hypothesis that additional administration of traditional Japanese (Kampo) medicine, kakkonto (kakkon-to: KT) and shosaikotokakikyosekko (sho-saiko-to-ka-kikyo-sekko: SSKKS), is more effective in relieving symptoms and preventing the onset of severe infection in mild-to-moderate COVID-19 patients compared to those treated only with conventional treatment. TRIAL DESIGN: The study is designed as a multi-center, interventional, parallel-group, randomized (1:1 ratio), investigator-sponsored, two-arm study. PARTICIPANTS: Patients and inpatients will be recruited from 8 Japanese academic and non-academic hospitals. The inclusion and exclusion criteria are as follows: Inclusion criteria: 1. Diagnosed as positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 2. Clinical stages of mild-to-moderate COVID-19 3. Symptomatic 4. ≥ 20 years of age 5. Male or female 6. Ability to communicate in Japanese 7. Outpatients and inpatients 8. Provided informed consent Exclusion criteria: 1. Difficulty in providing informed consent due to dementia, psychosis, or psychiatric symptoms 2. Allergic to Kampo or Western medicines used in this study 3. Pregnant and lactating 4. Unable to follow up 5. Participating in another clinical trial or interventional study 6. Hypokalemic or taking oral furosemide or steroids 7. Determined unsuitable for this study by the physician INTERVENTION AND COMPARATOR: Patients in the control group will receive conventional treatment with antipyretics, painkillers, or antitussives for symptoms that occurred after they contracted the SARS-CoV-2 infection. Patients in the Kampo group will receive 2.5 g of KT (TJ-1@TSUMURA and Co.) and 2.5 g of SSKKS (TJ-109@TSUMURA and Co.) 3 times a day, orally, for 14 days in addition to the conventional treatment as mentioned above. MAIN OUTCOMES: The number of days till at least one of the symptoms (fever, cough, sputum, malaise, shortness of breath) improves in the first 14 days of treatment. To assess the cough, sputum, malaise, and shortness of breath, a numeric rating scale will be used to define improvement in terms of a 2-point decrease in the number of days from the start of treatment for at least 2 days. Fever will be defined as an improvement when the temperature is less than 37 °C. RANDOMIZATION: Patients are randomized (1:1 ratio) to each group using the minimization method, with balancing of the arms with severity of disease stage and patient age (< 65, 65 to < 75, or ≥ 75 years). Computer-generated random numbers will be used for the minimization method. BLINDING (MASKING): Open-label with no blinding NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): The main research hypothesis of this study is that the combination of Kampo medicine and conventional treatment will significantly improve the patients' symptoms (fever, fatigue, cough, sputum, and shortness of breath) during the first 14 days of treatment as compared with conventional treatment alone. Concerning the analysis of the primary endpoint, the duration of time before improvement of at least one of the common cold-like symptoms (fever, malaise, cough, sputum, and shortness of breath) will be estimated using the Kaplan-Meier method, and the survival curves will be compared between groups using the log-rank test. Assuming this method of analysis and based on previous studies reporting the efficacy of Kampo medicine for COVID-19 and H1N1 influenza patients, the median survival time in the Kampo medicine group is estimated as 3 days; this time will be 1.5 times longer in the control group. Assuming a one-sided significance level of 5%, a power of 70%, and an allocation ratio of 1:1, the required sample size is calculated as 126 cases. To compensate for a loss in follow-up, we plan to include 150 cases in both groups (Kampo group = 75, control group = 75). TRIAL STATUS: Protocol version 1.2 as of August 20, 2020 Recruitment start (expected): October 1, 2020 Recruitment finish (expected): October 31, 2023 TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT) jRCTs021200020 . Registered on August 25, 2020 FULL PROTOCOL: The full protocol is attached as an additional file and is accessible from the Trials website (Additional file 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Medicina Kampo , Neumonía Viral/tratamiento farmacológico , Antivirales/efectos adversos , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Quimioterapia Combinada , Medicamentos Herbarios Chinos/efectos adversos , Femenino , Interacciones Huésped-Patógeno , Humanos , Japón , Masculino , Estudios Multicéntricos como Asunto , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
7.
J Drugs Dermatol ; 19(9): 889-892, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-33026746

RESUMEN

Early December 2019 witnessed an international outbreak of a novel coronavirus (COVID 19) designated severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Since then, a number of therapeutic molecules have been explored to have potential efficacy against the SARS-Cov-2 per se or its sequelae. There are no Food and Drug Administration specific therapies approved so far; however, numerous drugs based on varying levels of evidence, in vitro studies and compassionate drug trials are being established as therapeutic agents, especially drugs approved for previous emergence of the severe acute respiratory syndrome (SARS-CoV-1) and Middle east respiratory syndrome coronavirus (MERS-Cov). Numerous active clinical trials for COVID-19 with more than 150 drugs and products are under study. Needless to say, many dermatological drugs are being employed to mitigate this pandemic threat. We aim to review drugs with potential against SARS-Cov-2 widely used in dermatology practice. Additionally, rampant and overzealous use of these drugs as well as introduction of new molecules might lead to emergence of adverse effects associated with these agents. Dermatologists must be on lookout for any cutaneous adverse effects of these drugs. J Drugs Dermatol. 2020;19(9):889-892. doi:10.36849/JDD.2020.5323.


Asunto(s)
Antivirales/efectos adversos , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Fármacos Dermatológicos/efectos adversos , Erupciones por Medicamentos/etiología , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/efectos adversos , Adenosina Monofosfato/análogos & derivados , Alanina/administración & dosificación , Alanina/efectos adversos , Alanina/análogos & derivados , Antivirales/uso terapéutico , Productos Biológicos/administración & dosificación , Productos Biológicos/efectos adversos , Fármacos Dermatológicos/uso terapéutico , Erupciones por Medicamentos/epidemiología , Erupciones por Medicamentos/fisiopatología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Humanos , Incidencia , Masculino , Pandemias , Pronóstico , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/epidemiología
8.
J Card Surg ; 35(10): 2500-2505, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33043651

RESUMEN

BACKGROUND: The disturbance in the international normalized ratio (INR) in patients receiving warfarin therapy is of concern. We aimed to evaluate coagulation features in hospitalized patients under warfarin treatment for prosthetic heart valves during the novel coronavirus disease 2019 (COVID-19) pneumonia pandemic. METHODS: Between 20 February and 28 March 2020, 10 patients (7 males) who were under warfarin therapy for prosthetic heart valves were hospitalized after a diagnosis of COVID-19 in Tehran Heart Center, Tehran, Iran. The clinical, paraclinical, and in-hospital outcomes were described. The patients were followed for 4 weeks. RESULTS: The median age was 62 years. All the patients received antiviral treatment, either lopinavir/ritonavir or oseltamivir. The serum level of high-sensitivity C-reactive protein ranged between 0.24 and 15.24 mg/dL. Alanine aminotransaminase was normal in all the patients except for two, with levels 1.6 and 4.2 times above normal values. The INR increased in all the patients. One (10%) patient died in the hospital. No bleeding, ischemic, or thrombotic events occurred during the hospital stay and within the 4-week follow-up. CONCLUSIONS: Antiviral therapy in patients with COVID-19 with prosthetic heart valves might be an issue responsible for an uncontrolled INR. Liver injury may happen in a minority of patients. Bridging in these patients during the antiviral treatment might be required and because of significant INR fluctuations, it might be safer to prescribe antiviral treatment in an inpatient setting.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Pandemias , Neumonía Viral/epidemiología , Tromboembolia/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Comorbilidad , Infecciones por Coronavirus/tratamiento farmacológico , Femenino , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Viral/tratamiento farmacológico , Estudios Retrospectivos
11.
Int J Med Sci ; 17(16): 2468-2476, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029089

RESUMEN

Rationale: Coronavirus disease 2019 (COVID-19) was first announced in Wuhan, and has rapidly evolved into a pandemic. However, the risk factors associated with the severity and mortality of COVID-19 are yet to be described in detail. Methods: We retrospectively reviewed the information of 1525 cases from the Leishenshan Hospital in Wuhan. Univariate and multivariate Cox regression analyses were generated to explore the relationship between procalcitonin (PCT) level and the progression and prognosis of COVID-19. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity in hospitalized patients and their PCT levels. Survival curves and the cumulative hazard function for COVID-19 progression were conducted in the two groups. To further detect the relationship between the computed tomography score and survival days, curve-fitting analyses were performed. Results: Patients in the elevated PCT group had a higher incidence of severe and critical severity conditions (P < 0.001), death, and higher computed tomography (CT) scores. There was an association between elevated PCT levels and mortality in the univariate ((hazard ratio [1], 3.377; 95% confidence interval [2], 1.012-10.344; P = 0.033) and multivariate Cox regression analysis (HR, 4.933; 95% CI, 1.170-20.788; P = 0.030). Similarly, patients with elevated PCT were more likely to have critically severe disease conditions in the univariate (odds ratio [2], 7.247; 95% CI, 3.559-14.757; P < 0.001) and multivariate logistic regression analysis (OR, 10.679; 95% CI, 4.562-25.000; P < 0.001). Kaplan-Meier curves showed poorer prognosis for patients with elevated PCT (P = 0.024). The CT score 1 for patients with elevated PCT peaked at day 40 following the onset of symptoms then decreased gradually, while their total CT score was relatively stable. Conclusion: PCT level was shown as an independent risk factor of in-hospital mortality among COVID-19 patients. Compared with inpatients with normal PCT levels, inpatients with elevated PCT levels had a higher risk for overall mortality and critically severe disease. These findings may provide guidance for improving the prognosis of patients with critically severe COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/etiología , Infecciones por Coronavirus/mortalidad , Neumonía Viral/etiología , Neumonía Viral/mortalidad , Polipéptido alfa Relacionado con Calcitonina/sangre , Anciano , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/tratamiento farmacológico , Progresión de la Enfermedad , Femenino , Hospitalización , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico por imagen , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
12.
PLoS One ; 15(10): e0240149, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33006999

RESUMEN

From January 2020, COVID-19 is spreading around the world producing serious respiratory symptoms in infected patients that in some cases can be complicated by the severe acute respiratory syndrome, sepsis and septic shock, multiorgan failure, including acute kidney injury and cardiac injury. Cost and time efficient approaches to reduce the burthen of the disease are needed. To find potential COVID-19 treatments among the whole arsenal of existing drugs, we combined system biology and artificial intelligence-based approaches. The drug combination of pirfenidone and melatonin has been identified as a candidate treatment that may contribute to reduce the virus infection. Starting from different drug targets the effect of the drugs converges on human proteins with a known role in SARS-CoV-2 infection cycle. Simultaneously, GUILDify v2.0 web server has been used as an alternative method to corroborate the effect of pirfenidone and melatonin against the infection of SARS-CoV-2. We have also predicted a potential therapeutic effect of the drug combination over the respiratory associated pathology, thus tackling at the same time two important issues in COVID-19. These evidences, together with the fact that from a medical point of view both drugs are considered safe and can be combined with the current standard of care treatments for COVID-19 makes this combination very attractive for treating patients at stage II, non-severe symptomatic patients with the presence of virus and those patients who are at risk of developing severe pulmonary complications.


Asunto(s)
Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Reposicionamiento de Medicamentos , Melatonina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Piridonas/uso terapéutico , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Síndrome de Liberación de Citoquinas/virología , Bases de Datos Farmacéuticas , Furina/metabolismo , Humanos , Melatonina/farmacología , Pandemias , Piridonas/farmacología
13.
Discov Med ; 29(158): 145-157, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33007190

RESUMEN

Coronavirus disease 2019 (COVID-19), a newly identified acute respiratory disease caused by a strain of novel coronavirus (SARS-CoV-2), has become a worldwide pandemic. From December 2019 to present, millions of cases have been reported, bringing unprecedented pressure on both health and epidemic prevention services in every country. As frontline healthcare workers, ophthalmologists face an increased threat of viral infection, not only because of close contact with patients during examinations or operations, but also due to evidence showing that ocular fluids such as tears or conjunctival secretions may carry the virus. The risk that healthcare workers face is emphasized by the loss of our colleagues who have sacrificed themselves in combating the virus. As a result, it is necessary to have a comprehensive understanding of the threats that we face. In the first part of this review, we start by explaining the structure of SARS-CoV-2 and examining its transmission and means of infection. Next, we summarize the latest scientific advancements of epidemiology, clinical presentations, and current treatments of COVID-19. In the second half of the review, we emphasize the ocular transmission, symptomatic manifestations, and the essential knowledge in an ophthalmology clinic setting. As the pandemic of COVID-19 continues to pose a threat to global health, we hope that this review makes a contribution to combating COVID-19.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/complicaciones , Oftalmopatías/virología , Neumonía Viral/complicaciones , Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Betacoronavirus/inmunología , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Reposicionamiento de Medicamentos , Oftalmopatías/diagnóstico , Oftalmopatías/inmunología , Oftalmopatías/terapia , Humanos , Inmunización Pasiva/métodos , Factores Inmunológicos/uso terapéutico , Medicina China Tradicional/métodos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/transmisión
15.
Front Immunol ; 11: 2167, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33013911

RESUMEN

The inflammatory response to and the subsequent development of Adult Respiratory Distress Syndrome (ARDS) is considered to underpin COVID-19 pathogenesis. With a developing world catastrophe, we need to examine our known therapeutic stocks, to assess suitability for prevention and/or treatment of this pro-inflammatory virus. Analyzing commonly available and inexpensive immunomodulatory and anti-inflammatory medications to assess their possible effectiveness in improving the host response to COVID-19, this paper recommends the following: (1) optimize current health-cease (reduce) smoking, ensure adequate hypertension and diabetes control, continue exercising; (2) start on an HMG CoA reductase inhibitor "statin" for its immunomodulatory and anti-inflammatory properties, which may reduce the mortality associated with ARDS; and (3) consider using Diclofenac (or other COX-2 inhibition medications) for its anti-inflammatory and virus toxicity properties. For purposes of effectiveness, this needs to be in the early course of the disease (post infection and/or symptom presentation) and given in a high dose. The downsides to these recommended interventions are considered manageable at this stage of the pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Síndrome de Dificultad Respiratoria del Adulto/complicaciones , Síndrome de Dificultad Respiratoria del Adulto/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Animales , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Diclofenaco/efectos adversos , Diclofenaco/uso terapéutico , Interacciones Huésped-Patógeno/efectos de los fármacos , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/virología , Síndrome de Dificultad Respiratoria del Adulto/prevención & control , Síndrome de Dificultad Respiratoria del Adulto/virología , Internalización del Virus/efectos de los fármacos
16.
Signal Transduct Target Ther ; 5(1): 219, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33024082

RESUMEN

Convalescent plasma (CP) transfusion has been indicated as a promising therapy in the treatment for other emerging viral infections. However, the quality control of CP and individual variation in patients in different studies make it rather difficult to evaluate the efficacy and risk of CP therapy for coronavirus disease 2019 (COVID-19). We aimed to explore the potential efficacy of CP therapy, and to assess the possible factors associated with its efficacy. We enrolled eight critical or severe COVID-19 patients from four centers. Each patient was transfused with 200-400 mL of CP from seven recovered donors. The primary indicators for clinical efficacy assessment were the changes of clinical symptoms, laboratory parameters, and radiological image after CP transfusion. CP donors had a wide range of antibody levels measured by serology tests which were to some degree correlated with the neutralizing antibody (NAb) level. No adverse events were observed during and after CP transfusion. Following CP transfusion, six out of eight patients showed improved oxygen support status; chest CT indicated varying degrees of absorption of pulmonary lesions in six patients within 8 days; the viral load was decreased to a negative level in five patients who had the previous viremia; other laboratory parameters also tended to improve, including increased lymphocyte counts, decreased C-reactive protein, procalcitonin, and indicators for liver function. The clinical efficacy might be associated with CP transfusion time, transfused dose, and the NAb levels of CP. This study indicated that CP might be a potential therapy for severe patients with COVID-19.


Asunto(s)
Anticuerpos Neutralizantes/administración & dosificación , Anticuerpos Antivirales/administración & dosificación , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Adulto , Anciano , Antivirales/uso terapéutico , Betacoronavirus/inmunología , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/patología , Progresión de la Enfermedad , Femenino , Humanos , Inmunización Pasiva/métodos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/inmunología , Neumonía Viral/patología , Polipéptido alfa Relacionado con Calcitonina/sangre , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Carga Viral
17.
Cir Cir ; 88(5): 569-575, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33064694

RESUMEN

Objective: To describe the clinical characteristics and management of severe COVID-19 patients. Method: Observational, descriptive, longitudinal, and retrospective study. Results: 56 patients were admitted, of whom 80.3% (n = 45) were males with a mean age of 58 years [46-67]. The main comorbidities were obesity, high blood pressure, and diabetes. Symptoms onset time at admittance to the ICU was 9 [7-14] days, of which the most frequent were dyspnea, fever, and dry cough. Laboratory data were lymphopenia; elevation of LDH, fibrinogen, D-dimer, ferritin and CRP. 100% of the patients required mechanical ventilation, the median mechanical ventilation time was 12 [6-17] days, and 66% (n= 37) required a prone position. The pharmacological treatment was mainly based on azithromycin, hydroxychloroquine, tocilizumab and steroids. The most frequent complications were acute kidney injury, venous thromboembolism and acute myocardial infarction. Mortality rate was 17.8% (n = 10). Conclusion: The characteristics of the critically ill patients in our hospital were mostly elderly and obese, with the variables of higher SOFA score and acute kidney injury associated with higher mortality.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Unidades de Cuidados Intensivos , Pandemias , Neumonía Viral/terapia , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Corticoesteroides/uso terapéutico , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/uso terapéutico , Azitromicina/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Terapia Combinada , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Femenino , Mortalidad Hospitalaria , Hospitales Universitarios/organización & administración , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , México/epidemiología , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Respiración Artificial , Evaluación de Síntomas
18.
Monaldi Arch Chest Dis ; 90(4)2020 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-33059413

RESUMEN

Knowledge of treatment regimens and outcomes for novel coronavirus disease 2019 (COVID-19) is evolving. Recent studies have reported mortality rates ranging from 39-50% among hospitalized patients with COVID-19. We report our experience ofmanagement and outcomes of hospitalized patients with COVID-19 at a large tertiary-care center in Midwestern United States. Of 658 patients presenting to our tertiary care center, 217 needed hospitalization, majority (77%) of whom were severely sick requiring admission to the intensive care unit (ICU). All received corticosteroids, and 78% of the patients received tocilizumab. More than two-thirds of the patients received anticoagulation and 80% of patients in the ICU had prone-positioning. The median duration of hospitalization was 12 days (interquartile range, 8 to16), median duration of intensive care unit stay was 7 days (interquartile range, 5 to 9) and requirement of mechanical ventilation was 6 days (interquartile range, 5 to 8) in our cohort. Of the 217 patients, 27 died (12% mortality). The majority of our patients received corticosteroids, tocilizumab, anticoagulation and prone positioning. While higher mortality rates of >30% have been reported in various studies among hospitalized patients with COVID-19, the majority of hospitalized patients in our cohort survived with a low mortality rate. The majority of our patients received corticosteroids, tocilizumab, anticoagulation and prone positioning. While higher mortality rates of >30% have been reported in various studies among hospitalized patients with COVID-19, the majority of hospitalized patients in our cohort survived with a low mortality rate.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Cuidados Críticos , Hospitalización , Neumonía Viral/terapia , Atención Terciaria de Salud , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Glucocorticoides/uso terapéutico , Humanos , Inmunización Pasiva , Medio Oeste de Estados Unidos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Respiración Artificial , Estudios Retrospectivos , Centros de Atención Terciaria
19.
Eur Rev Med Pharmacol Sci ; 24(18): 9739-9743, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33015819

RESUMEN

OBJECTIVE: Remdesivir is a nucleotide analogue prodrug that inhibits viral RNA polymerases. It has been recognized recently as a promising antiviral drug against a wide array of RNA viruses (including SARS/MERS-CoV5). We aimed at determining which drugs used in dentistry interact with Remdesivir in order to avoid adverse reactions that may worsen the condition of patients with COVID-19. MATERIALS AND METHODS: A literature review was conducted to identify potential drug interactions between remdesivir (used in the treatment of COVID-19) and drugs prescribed in dentistry. The search was made in the databases PubMed and MEDLINE and official websites using key terms remdesivir, drug interactions and dentistry for articles published up to 31st July 2020. RESULTS: According to the articles reviewed, a total of 279 drugs interact with Remdesivir. Two major interactions have been reported, 277 moderate drug interactions, and one with alcohol/food. The drug interactions involving drugs prescribed in dentistry are all moderate drug interactions and are (according to drug group): (1) antibiotics: azithromycin, clavulanate, doxycycline, erythromycin, levofloxacin; (2) antifungals: clotrimazole, fluconazole, itraconazole, ketoconazole; (3) non-steroidal anti-inflammatories (NAIDS): celecoxib diclofenac, etodolac, flurbiprofen, ibuprofen, ketoprofen, ketorolac, mefenamic acid, naproxen, piroxicam. CONCLUSIONS: It is clinically necessary for oral health professionals to be aware of possible drug interactions that may occur between remdesivir and drugs commonly prescribed in dentistry in order to prevent adverse reactions that may even endanger the life of a patient with COVID-19.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Infecciones por Coronavirus , Odontología , Interacciones Farmacológicas , Pandemias , Neumonía Viral , Adenosina Monofosfato/efectos adversos , Adenosina Monofosfato/uso terapéutico , Alanina/efectos adversos , Alanina/uso terapéutico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Neumonía Viral/tratamiento farmacológico
20.
Medicine (Baltimore) ; 99(40): e22435, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019424

RESUMEN

Given that evidence supporting chronic hepatitis C (CHC) infection developed chance for hepatocellular carcinoma (HCC) following antiviral agents therapy is controversial. We conducted a meta-analysis to examine the risk.We evaluated 20 retrospective and prospective cohort studies published up to 31 December 2017 which investigated the association between sustained virological response (SVR) and incidence of HCC patients treated with monotherapy interferon (IFN) or IFN plus ribavirin (RBV) therapy. The primary outcome of the study was the cumulative incidence of HCC. Odds ratio (OR) was used to evaluate the index of effect size for the association between SVR and treatment with IFN alone or IFN/RBV in CHC patients.SVR patients demonstrated a lower incidence of HCC compared to non-SVR patients. Non-SVR patients had greater odds of HCC incidence compared to SVR patients in the treatment of IFN plus RBV (pooled OR = 7.405, 95% CI = 4.689 to 11.694, P < .001). Non-SVR patients had greater odds of HCC incidence compared to SVR patients in the treatment of IFN monotherapy (pooled OR = 4.135, 95% CI = 3.009 to 5.682, P < .001). Lack of SVR to IFN therapy was significantly associated with greater risk of HCC incidence (pooled OR = 5.035, 95% CI = 3.915 to 6.474, P < .001).SVR could be as a predictor of HCC in CHC patients treated with IFN or IFN plus RBV, and have important implications during HCC screening, whereby patients who fail to achieve SVR need to be screened more rigorously.


Asunto(s)
Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Respuesta Virológica Sostenida , Carcinoma Hepatocelular/virología , Femenino , Humanos , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto
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