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1.
; Fiocruz.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47624

RESUMEN

O Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos/Fiocruz) está conduzindo um projeto brasileiro para o desenvolvimento de uma vacina sintética para o novo coronavírus (Sars-CoV-2)


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Vacunas , Betacoronavirus , Coronavirus
4.
BMJ Open ; 10(6): e039159, 2020 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-32503874

RESUMEN

BACKGROUND: Despite global containment measures to fight the coronavirus disease 2019 (COVID-19), the pandemic continued to rise, rapidly spread across the world, and resulting in 2.6 million confirmed cases and 185 061 deaths worldwide as of 23 April 2020. Yet, there are no approved vaccines or drugs to make the disease less deadly, while efforts are underway. Remdesivir, a nucleotide-analogue antiviral drug developed for Ebola, is determined to prevent and stop infections with COVID-19, while results are yet controversial. Here, we aim to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) to evaluate the efficacy of remdesivir in patients with COVID-19. METHOD AND ANALYSIS: We will search MEDLINE-PubMed, Embase, Cochrane Library, ClinicalTrials.gov and Google scholar databases for articles published as of 30 June 2020 and we will complete the study on 30 August 2020. We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines for the design and reporting of the results. We will include RCTs that assessed the efficacy of remdesivir versus placebo or standard of care. The primary endpoint will be time to clinical recovery. The secondary endpoints will be proportion of participants relieved from clinical symptoms defined at the time (in hours) from initiation of the study treatment, all-cause mortality, discharged date, frequency of respiratory progression and treatment-emergent adverse events. RevMan V.5.3 software will be used for statistical analysis. Random effects model will be carried out to calculate mean differences for continuous outcome data and risk ratio for dichotomous outcome data between remdesivir and placebo or standard of care. ETHICS AND DISSEMINATION: There are no ethical considerations associated with this study as we will use publicly available data from previously published studies. We plan to publish results in open-access peer-reviewed journals and present at international and national conferences. PROSPERO REGISTRATION NUMBER: CRD42020177953.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Betacoronavirus , Infecciones por Coronavirus , Control de Infecciones/métodos , Pandemias , Neumonía Viral , Proyectos de Investigación , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/efectos adversos , Alanina/administración & dosificación , Alanina/efectos adversos , Antivirales/administración & dosificación , Antivirales/efectos adversos , Betacoronavirus/efectos de los fármacos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Humanos , Metaanálisis como Asunto , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
5.
J Pak Med Assoc ; 70(Suppl 3)(5): S69-S73, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32515383

RESUMEN

Novel coronavirus disease (COVID-19) infection is a global pandemic, of high infectivity, variable mortality, with currently no established treatment. This review summarizes different molecules which are being evaluated for COVID19 treatment. PubMed and Medline, search for articles published to March 2020 was done using terms "COVID19" OR "corona-virus 2019" OR "2019-nCoV" or "severe acute respiratory syndrome coronavirus" AND "treatment". As of today, we have >350 RCTs happening with different agents. COVID19 treatment agents can be broadly classified into immuno-modulators (prevent hyperimmune-activation and cytokine storm) and anti-viral therapies (prevent virus entry, replication or viricidal). Hydroxychloroquine/chloroquine, Interferon-l, glucocorticoids, interleukin antagonists, Ulinastatin, intravenous immunoglobulins, plasmapheresis are main immunomodulators showing initial positive outcomes. Umifenovir. Lopinavir/Ritonavir, Ribavirin, remdesivir and Ravipiravir are some of the major antiviral agents showing initial encouraging results. It may be concluded that the most successful regimen is going to be multi-drug therapy, a combination of immunomodulatory agent with anti-viral agent.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Antivirales/uso terapéutico , Terapia por Quelación , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Pandemias
6.
J Pak Med Assoc ; 70(Suppl 3)(5): S64-S68, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32515388

RESUMEN

Coronavirus disease (COVID-19) has grasped the world including Pakistan. Clinical features of this disease are variable, ranging from asymptomatic to critical disease. In this unprecedented global war, the Pakistan Chest Society has written a guideline for quick review for the specialists providing care to suspected or confirmed patients. This review highlights the approach to a patient with COVID-19, including definition of the various syndromes of the disease, the abnormal laboratory parameters and outlines the therapeutic measures which are currently under investigation.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Antivirales/efectos adversos , Antivirales/uso terapéutico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Monitoreo Fisiológico , Pakistán , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Guías de Práctica Clínica como Asunto , Síndrome de Dificultad Respiratoria del Adulto , Sepsis
8.
Iran J Allergy Asthma Immunol ; 19(S1): 13-17, 2020 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-32534506

RESUMEN

The new virus SARS-CoV-2 is savagely spreading out over the world. The biologic studies show that the target receptor for the virus might be angiotensin-converting enzyme 2 (ACE2). This peptide is responsible for converting angiotensin II (Ang II), which is a profoundly active peptide, into Ang 1-7 with quite a balancing barbell function. It is emphasized that the direct target of the virus is ACE2 underlining the obvious difference with ACE. Nevertheless, we hypothesized that a back load build up effect on Ang II may usurp the ACE capacity and subsequently leave the bradykinin system unabated. We think there are clinical clues for dry cough and the presumed aggravating role of ACE inhibitors like captopril on the disease process. Thereby, we speculated that inhibition of bradykinin synthesis and/or blockade of bradykinin B2 receptor using Aprotinin/ecallantide and Icatibant, respectively, may hold therapeutic promise in severe cases and these molecules can be advanced to clinical trials.


Asunto(s)
Betacoronavirus/metabolismo , Antagonistas del Receptor de Bradiquinina B2/farmacología , Bradiquinina/metabolismo , Infecciones por Coronavirus/metabolismo , Neumonía Viral/metabolismo , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Pandemias , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/tratamiento farmacológico , Receptores de Bradiquinina/efectos de los fármacos , Receptores de Bradiquinina/metabolismo , Transducción de Señal/efectos de los fármacos , Transducción de Señal/fisiología
11.
Mol Med ; 26(1): 58, 2020 06 16.
Artículo en Inglés | MEDLINE | ID: mdl-32546125

RESUMEN

In light of the present therapeutic situation in COVID-19, any measure to improve course and outcome of seriously affected individuals is of utmost importance. We recap here evidence that supports the use of human recombinant erythropoietin (EPO) for ameliorating course and outcome of seriously ill COVID-19 patients. This brief expert review grounds on available subject-relevant literature searched until May 14, 2020, including Medline, Google Scholar, and preprint servers. We delineate in brief sections, each introduced by a summary of respective COVID-19 references, how EPO may target a number of the gravest sequelae of these patients. EPO is expected to: (1) improve respiration at several levels including lung, brainstem, spinal cord and respiratory muscles; (2) counteract overshooting inflammation caused by cytokine storm/ inflammasome; (3) act neuroprotective and neuroregenerative in brain and peripheral nervous system. Based on this accumulating experimental and clinical evidence, we finally provide the research design for a double-blind placebo-controlled randomized clinical trial including severely affected patients, which is planned to start shortly.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/tratamiento farmacológico , Síndrome de Liberación de Citoquinas/prevención & control , Eritropoyetina/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Fármacos del Sistema Respiratorio/uso terapéutico , Tronco Encefálico/efectos de los fármacos , Tronco Encefálico/inmunología , Tronco Encefálico/virología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/inmunología , Síndrome de Liberación de Citoquinas/patología , Síndrome de Liberación de Citoquinas/virología , Método Doble Ciego , Humanos , Pulmón/efectos de los fármacos , Pulmón/inmunología , Pulmón/virología , Pandemias , Nervio Frénico/efectos de los fármacos , Nervio Frénico/inmunología , Nervio Frénico/virología , Neumonía Viral/inmunología , Neumonía Viral/patología , Neumonía Viral/virología , Prueba de Estudio Conceptual , Ensayos Clínicos Controlados Aleatorios como Asunto , Proteínas Recombinantes/uso terapéutico , Músculos Respiratorios/efectos de los fármacos , Músculos Respiratorios/inmunología , Músculos Respiratorios/virología , Índice de Severidad de la Enfermedad , Médula Espinal/efectos de los fármacos , Médula Espinal/inmunología , Médula Espinal/virología
12.
PLoS One ; 15(6): e0235248, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32579597

RESUMEN

AIMS: This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). METHODS AND RESULTS: All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50-1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40-2.23), diabetes (AOR: 1.52; 1.05-2.18), CVD (AOR: 1.88; 1.32-2.70) and COPD (AOR: 1.88; 1.11-3.20). Only gender, age and diabetes also predicted very severe/lethal disease. CONCLUSION: No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Antagonistas de Receptores de Angiotensina/efectos adversos , Betacoronavirus/fisiología , Estudios de Casos y Controles , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Femenino , Guías como Asunto , Humanos , Hipertensión/tratamiento farmacológico , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
13.
Drug Des Devel Ther ; 14: 2159-2164, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32581514

RESUMEN

Objective: This study aimed to evaluate the fundamental characteristics of coronavirus disease (COVID-19) clinical trials registered in China. Methods: COVID-19 clinical trials registered in China were analyzed from databases on ChiCTR and ClinicalTrials.gov. The study designs, samples, primary end points, and intervention measures were evaluated. Results: In total, 262 intervention clinical trials were retrieved on March 10, 2020. Overall, 181 (69.1%) trials involved two groups, 200 (76.3%) trials were randomized parallel trials, 24 (9.2%) trials were double blind, and 60.3% of trials included ≤100 participants. Sixty (22.9%) trials considered symptom improvement as the primary endpoint and 43 (16.4%) trials considered the rate or time at which the subjects became virus-free as the primary endpoint. Of 262 intervention studies, chemical drugs and biological products were studied in 105 (40.1%) intervention studies, of which antiviral drugs accounted for 15.3% and malaria drugs accounted for 8.4% of the studies. Among all trials, 27.9% of the studies used traditional Chinese medicine (TCM), 10.3% used cell therapy, and 5.0% used plasma therapy. Conclusion: This study is the first snapshot of the landscape of COVID-19 clinical trials registered in China and provided the basic features of clinical trial designs for the treatment and prevention of COVID-19 to offer useful information to guide future clinical trials on COVID-19 in other countries.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Ensayos Clínicos como Asunto , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Proyectos de Investigación/tendencias , Antivirales/efectos adversos , Betacoronavirus/patogenicidad , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Interacciones Huésped-Patógeno , Humanos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/virología , Inducción de Remisión , Factores de Tiempo , Resultado del Tratamiento , Carga Viral/tendencias
14.
Isr Med Assoc J ; 22(6): 335-339, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32558435

RESUMEN

BACKGROUND: In the absence of definitive anti-viral therapy, there is considerable interest in mitigating against severe inflammatory reactions in coronavirus disease-2019 (COVID-19) pneumonia to improve survival. These reactions are sometimes termed cytokine storm. PDE4 inhibitors (PDE4i) have anti-inflammatory properties with approved indications in inflammatory skin and joint diseases as well as chronic obstructive pulmonary disease (COPD). Furthermore, multiple animal models demonstrate strong anti-inflammatory effects of PDE4i in respiratory models of viral and bacterial infection and also after chemically mediated lung injury. The rationale for PDE4i use in COVID-19 patients comes from the multimodal mechanism of action with cytokine, chemokine, and other key pathway inhibition all achieved with an excellent safety profile. We highlight how PDE4i could be an overlooked treatment from the rheumatologic and respiratory armamentarium, which has potential beneficial immune-modulation for treating severe COVID-19 pneumonia associated with cytokine storms. The proposed use of PDE4i is also supported by age-related immune changes in inflammation severity in PDE4i modifiable pathways in primate coronavirus disease. In conclusion, over-exuberant anti-viral immune responses in older patients with COVID-19 may pose a substantial risk to patient survival and mitigation against such hyper-inflammation with PDE4i, especially with anti-viral agents, is a strategy that need to be pursed, especially in older patients.


Asunto(s)
Antiinflamatorios/administración & dosificación , Enfermedades Transmisibles Emergentes/tratamiento farmacológico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Inhibidores de Fosfodiesterasa 4/administración & dosificación , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Adulto , Factores de Edad , Anciano , Animales , Betacoronavirus , Enfermedades Transmisibles Emergentes/mortalidad , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Pandemias , Inhibidores de Fosfodiesterasa 4/farmacología , Neumonía Viral/diagnóstico , Pronóstico , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento , Reino Unido
15.
Molecules ; 25(12)2020 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-32560203

RESUMEN

BACKGROUND: In recent decades, several viruses have jumped from animals to humans, triggering sizable outbreaks. The current unprecedent outbreak SARS-COV-2 is prompting a search for new cost-effective therapies to combat this deadly pathogen. Suitably functionalized polysubstituted quinoxalines show very interesting biological properties (antiviral, anticancer, and antileishmanial), ensuring them a bright future in medicinal chemistry. OBJECTIVES: Focusing on the promising development of new quinoxaline derivatives as antiviral drugs, this review forms part of our program on the anti-infectious activity of quinoxaline derivatives. METHODS: Study compiles and discusses recently published studies concerning the therapeutic potential of the antiviral activity of quinoxaline derivatives, covering the literature between 2010 and 2020. RESULTS: A final total of 20 studies included in this review. CONCLUSIONS: This review points to a growing interest in the development of compounds bearing a quinoxaline moiety for antiviral treatment. This promising moiety with different molecular targets warrants further investigation, which may well yield even more encouraging results regarding this scaffold.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Quinoxalinas/uso terapéutico , Virus ADN/efectos de los fármacos , Humanos , Pandemias , Quinoxalinas/química , Relación Estructura-Actividad
16.
Indian J Pharmacol ; 52(2): 117-129, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32565599

RESUMEN

In December 2019, severe acute respiratory syndrome-coronavirus-2, a novel coronavirus, initiated an outbreak of pneumonia from Wuhan in China, which rapidly spread worldwide. The clinical characteristics of the disease range from asymptomatic cases or mild symptoms, which include nonspecific symptoms such as fever, cough, sore throat, headache, and nasal congestion to severe cases such as pneumonia, respiratory failure demanding mechanical ventilation to multi-organ failure, sepsis, and death. As the transmission rate is quite alarming, we require an effective therapeutic strategy to treat symptomatic patients and adopt the preventive measures in order to contain the infection and prevent community transmission. Coronavirus disease 2019 (COVID-19) pandemic is a public health emergency of international concern, hence repurposing of the drugs is an attractive and a feasible option because PK/PD profile, toxicity profile, and drug interactions are already known. This review emphasizes on the different aspects of COVID-19 such as the epidemiology, etiopathogenesis, diagnosis, and preventive measures to be adopted in order to fight this pandemic. It also highlights upon the ethics preparedness and challenges faced by a developing country like India during such an outbreak. The review focuses on the various approaches adopted till date for developing effective therapeutic strategies including combination of drugs, vaccine therapy, and convalescent plasma therapy to combat this viral outbreak.


Asunto(s)
Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Países en Desarrollo , Brotes de Enfermedades , Reposicionamiento de Medicamentos , Quimioterapia Combinada , Humanos , India/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Vacunas Virales/administración & dosificación
17.
Indian J Pharmacol ; 52(2): 142-149, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32565603

RESUMEN

Knowledge of structural details is very much essential from the drug-design perspective. In the systematic review, we systematically reviewed the structural basis of different target proteins of SARS-corona virus (CoV2) from a viral life cycle and from drug design perspective. We searched four literature (PubMed, EMBASE, NATURE, and Willey online library) databases and one structural database (RCSB.org) with appropriate keywords till April 18, and finally, 26 articles were included in the systematic review. The published literature mainly centered upon the structural details of "spike protein," "main protease/M Pro/3CL pro," "RNA-dependent RNA polymerase," and "nonstructural protein 15 Endoribonuclease" of SARS-CoV-2. However, inhibitor bound structures were very less. We need better structures elucidating the interactions between different targets and their inhibitors which will help us in understanding the atomic level importance of different amino acid residues in the functionality of the target structures. To summarize, we need structures with fine resolution, co-crystallized structures with biologically validated inhibitors, and functional characterization of different target proteins. Some other routes of entry of SARS-CoV-2 are also mentioned (e.g., CD147); however, these findings are not structurally validated. This review may pave way for better understanding of SARS-CoV-2 life cycle from structural biology perspective.


Asunto(s)
Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Antivirales/farmacología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/virología , Diseño de Fármacos , Humanos , Pandemias , Neumonía Viral/virología
18.
J Korean Med Sci ; 35(24): e224, 2020 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-32567260

RESUMEN

Coronavirus disease 2019 (COVID-19) has resulted in an ongoing pandemic; however, the socioeconomic burden of COVID-19 treatment in the pediatric population remains unclear. Thus, the aim of this study was to determine the hospitalization periods and medical costs among children with COVID-19. In total, 145 billing statements for pediatric patients receiving healthcare services because of COVID-19 from February 1, 2020 to March 31, 2020 were used. The study showed that individual treatment costs for children with COVID-19 are approximately USD 2,192 under the Korean National Health Insurance Service System. This study revealed the differences in cost among age groups, determined by the type of hospital wherein admission occurred, as a trend of increasing age, increasing hospitalization time, and increasing cost was observed. Tailored COVID-19 treatment strategies by age group may lower costs and increase the effectiveness of resource allocation.


Asunto(s)
Infecciones por Coronavirus/economía , Hospitalización/economía , Pandemias/economía , Neumonía Viral/economía , Adolescente , Betacoronavirus , Niño , Preescolar , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Lactante , Recién Nacido , Tiempo de Internación/economía , Programas Nacionales de Salud/economía , Neumonía Viral/tratamiento farmacológico , República de Corea/epidemiología , Adulto Joven
19.
J Korean Med Sci ; 35(24): e231, 2020 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-32567262

RESUMEN

There have been controversies on the prophylactic effect of hydroxychloroquine against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We describe a patient, 60-year old Korean woman, with coronavirus disease 2019 (COVID-19) who had been taking hydroxychloroquine for 6 months. Her serum and saliva concentrations of hydroxychloroquine were 280 µg/L and 4,890 µg/L, respectively. The present case raises concerns on hydroxychloroquine's role as a prophylactic agent for COVID-19.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/prevención & control , Hidroxicloroquina/uso terapéutico , Pandemias/prevención & control , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/prevención & control , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Azitromicina/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Prevención Primaria/métodos
20.
R I Med J (2013) ; 103(6): 39-43, 2020 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-32570995

RESUMEN

BACKGROUND: Dexamethasone, a synthetic glucocorticoid, has anti-inflammatory and immunosuppressive properties. There is a hyperinflammatory response involved in the clinical course of patients with pneumonia due to SARS-CoV-2. To date, there has been no definite therapy for COVID-19. We reviewed the charts of SARS-CoV-2 patients with pneumonia and moderate to severely elevated CRP and worsening hypoxemia who were treated with early, short-term dexamethasone. METHODS: We describe a series of 21 patients who tested positive for SARS-CoV-2 and were admitted to The Miriam Hospital in Providence, RI, and were treated with a short course of dexamethasone, either alone or in addition to current investigative therapies. RESULTS: CRP levels decreased significantly following the start of dexamethasone from mean initial levels of 129.52 to 40.73 mg/L at time of discharge. 71% percent of the patients were discharged home with a mean length of stay of 7.8 days. None of the patients had escalation of care, leading to mechanical ventilation. Two patients were transferred to inpatient hospice facilities on account of persistent hypoxemia, in line with their documented goals of care. CONCLUSIONS: A short course of systemic corticosteroids among inpatients with SARS-CoV-2 with hypoxic respiratory failure was well tolerated, and most patients had improved outcomes. This limited case series may not offer concrete evidence towards the benefit of corticosteroids in COVID-19. However, patients' positive response to short-term corticosteroids demonstrates that they may help blunt the severity of inflammation and prevent a severe hyperinflammatory phase, in turn reducing the length of stay, ICU admissions, and healthcare costs.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Dexametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Virus del SRAS , Adulto , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Factores de Tiempo , Esparcimiento de Virus/efectos de los fármacos
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