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1.
Artículo en Inglés | MEDLINE | ID: mdl-32730915

RESUMEN

In December 2019, the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) infection was reported. In only few weeks it has caused a global pandemic, with mortality reaching 3.4%, mostly due to a severe pneumonia. However, the impact of SARS-CoV-2 virus on the central nervous system (CNS) and mental health outcomes remains unclear. Previous studies have demonstrated the presence of other types of coronaviruses in the brain, especially in the brainstem. There is evidence that the novel coronavirus can penetrate CNS through the olfactory or circulatory route as well as it can have an indirect impact on the brain by causing cytokine storm. There are also first reports of neurological signs in patients infected by the SARS-Cov-2. They show that COVID-19 patients have neurologic manifestations like acute cerebrovascular disease, conscious disturbance, taste and olfactory disturbances. In addition, there are studies showing that certain psychopathological symptoms might appear in infected patients, including those related to mood and psychotic disorders as well as post-traumatic stress disorder. Accumulating evidence also indicates that the pandemic might have a great impact on mental health from the global perspective, with medical workers being particularly vulnerable. In this article, we provide a review of studies investigating the impact of the SARS-CoV-2 on the CNS and mental health outcomes. We describe neurobiology of the virus, highlighting the relevance to mental disorders. Furthermore, this article summarizes the impact of the SARS-CoV-2 from the public health perspective. Finally, we present a critical appraisal of evidence and indicate future directions for studies in this field.


Asunto(s)
Infecciones por Coronavirus/psicología , Trastornos Mentales/psicología , Salud Mental , Neumonía Viral/psicología , Betacoronavirus , Encéfalo/virología , Infecciones por Coronavirus/complicaciones , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/etiología , Enfermedades del Sistema Nervioso/etiología , Pandemias , Neumonía Viral/complicaciones , Resultado del Tratamiento
4.
Biomed Res Int ; 2020: 2606058, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029499

RESUMEN

On March 11th, 2020, the World Health Organization declared COVID-19 infection as a pandemic. Since it is a novel virus, there are basically no proven drugs or therapies; although many laboratories in different countries are working to develop a vaccine, it will take time to make it available. Passive immunization is the therapy born from the intuition of Behring and Kisato in the late 19th century. It was widely used for the treatment of bacterial infections until the discovery of antibiotics, as well as during the viral pandemics of the 20th century and of the beginning of the 21st; it still has clinical applications (e.g., tetanus prevention). This paper summarizes the basic principles of passive immunization, with particular reference to convalescent plasma. The literature concerning its use during past epidemics and the results of the first clinical studies concerning its use during the current pandemic are discussed too. A large section is dedicated to the analysis of the possible, although rare, side effects. Recently, in 2017, the WHO Blood Regulators Network (BRN) published a position paper, recommending convalescent plasma as the first-choice treatment to be tested in the absence of authorized drugs; however, this strategy has not been followed. In the current epidemic, the principle of passive immunization through convalescent plasma has been applied in several circumstances and particularly in patients with serious complications. The first reported results are encouraging and confirm the effectiveness of plasma therapy and its safety. Also, the FDA has proposed plasma treatment in order to face the increasingly complex situation and manage patients with serious or immediately life-threatening COVID-19 disease. Several studies and clinical programs are still ongoing.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Betacoronavirus/inmunología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Humanos , Inmunización Pasiva/efectos adversos , Inmunización Pasiva/métodos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Seguridad , Resultado del Tratamiento , Estados Unidos , United States Food and Drug Administration , Organización Mundial de la Salud
5.
Medicine (Baltimore) ; 99(41): e22697, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031341

RESUMEN

BACKGROUND: The study aims to evaluate the effectiveness and safety of acupuncture therapy for asymptomatic infection of COVID-19. METHODS: The following electronic databases will be searched from December 2019 to December 2020: MEDLINE, PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wan-fang database, Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Databases (CBM), and other databases. All published randomized controlled trials (RCTs) about this topic will be included. Two independent researchers will operate article retrieval, duplication removing, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyses, subgroup analysis, and/or descriptive analysis will be performed based on the included data conditions. RESULTS: High-quality synthesis and/or descriptive analysis of current evidence will be provided from the time of negative nucleic acid detection for 2 consecutive times (not on the same day), cure rate, converting to clinical diagnosis rate, and side effects of acupuncture. CONCLUSION: This study will provide the evidence of whether acupuncture is an effective and safe intervention for asymptomatic infection of COVID-19. PROSPERO REGISTRATION NUMBER: CRD 42020179729.


Asunto(s)
Terapia por Acupuntura , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Enfermedades Asintomáticas , Humanos , Metaanálisis como Asunto , Pandemias , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
6.
Khirurgiia (Mosk) ; (9): 38-42, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33030000

RESUMEN

OBJECTIVE: To report treatment outcomes in patients with congenital aortic arch disease. MATERIAL AND METHODS: There were 65 patients (45 boys and 20 girls) for the period from 2005 to 2019. Mean age of patients was 53±12 days (range 1-98), weight - 3,3±1,3 kg (range 2.2-4.6). All patients were divided into 2 groups depending on the method of surgical repair. The 1st group included 33 patients who underwent patch repair, the 2nd group (n=32) - anastomosis in end-to-side fashion. RESULTS: In group I, recurrent aortic arch coarctation was observed in 16.8% of cases, in group II - only in 4% of cases (p=0.02). Analysis of systolic pressure in both groups revealed that arterial hypertension was detected in 39% of cases in group I and only in 9,1% of cases in group II (p=0,0025). CONCLUSION: Surgical treatment of aortic arch disease using anastomosis in end-to-side fashion is associated with reduced risk of recurrent aortic arch coarctation and residual arterial hypertension in long-term postoperative period.


Asunto(s)
Aorta Torácica , Coartación Aórtica , Anastomosis Quirúrgica , Presión Sanguínea , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Resultado del Tratamiento
7.
Khirurgiia (Mosk) ; (9): 51-58, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33030002

RESUMEN

OBJECTIVE: Was to evaluate the effectiveness of anti-scar treatment with Contractubex gel in children and adults. MATERIAL AND METHODS: A group of researchers based on clinical hospitals and university medical clinics carry out the multicenter study to evaluate the effectiveness of anti-scar treatment with Contractubex gel containing cepalin, allantoin and heparin, with its early appointment in groups of children from 12 to 18 years old and adults from 21 to 35 years old. The study included data from 216 patients. Patients of both age groups were initially divided into two: the main and control ones with an equal distribution according to the type of surgical intervention (hernia repair and appendectomy), age, gender, and anamnestic data. The dynamic observation was carried out using two rating scales - filled out by a doctor (Vancouver scale) and a patient (author's rating scale in the Scar Diary mobile application). RESULTS: Based on the results of the analysis of the data obtained, a high efficiency of the use of Contractubex gel at the early stages of scar formation among patients of the main group in comparison with the control was revealed. By 90 days, the treatment result according to the Vancouver scale was 0,16±0,1 points in the main group and 0,39±0,2 points in the control group. At the same time, with a dynamic scale for assessing the cicatricial process, there was a significant (p<0.05) improvement in the main group (0,2±0,06 points) compared with the control group (0,6±0,17 points). In addition, was noticed the strong commitment to anti-scar treatment in pediatric patients. CONCLUSIONS: The work confirms the undoubted need for anti-scar treatment in the early stages of scar formation after surgical interventions, which accelerates the psychophysical rehabilitation of patients after surgery and improves the quality of life.


Asunto(s)
Calidad de Vida , Adolescente , Adulto , Apendicectomía , Niño , Cicatriz , Humanos , Resultado del Tratamiento , Heridas y Traumatismos , Adulto Joven
8.
Khirurgiia (Mosk) ; (9): 59-68, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33030003

RESUMEN

OBJECTIVE: To evaluate an effectiveness of a single intra-articular injection of a new cross-linked hyaluronic acid by measuring thickness of the quadriceps muscle and femoral intercondylar cartilage in addition to subjective assessment. MATERIAL AND METHODS: There were 49 patients with gonarthrosis (Kellgren-Lawrence grade II-III) who underwent a single intra-articular injection of Flexotron Cross into the knee joint with higher grade of arthrosis. The scores were assessed at baseline, after 1, 3 and 6 months using: 1) visual analogue scale (VAS) of pain syndrome, 2) Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 3) Lequesne Index, 4) duration of standing on one leg, 5) thigh circumference, 6) thickness of quadriceps muscle and femoral intercondylar cartilage according to ultrasound data. RESULTS: A 6-month follow-up comprised 46 patients. HA administration significantly improved all parameters (p <0.001). VAS and WOMAC pain scores were significantly improved after 1, 3 and 6 months (p <0.01). Thickness of the quadriceps muscle and femoral intercondylar cartilage was increased after 3 and 6 months (p <0.05). Lequesne Index, duration of standing on one leg and thigh circumference were also increased in 6 months after HA administration (p <0.01). CONCLUSION: Flexotron Cross is effective subjectively and objectively for at least 6 months and safe for the treatment of gonarthrosis.


Asunto(s)
Músculo Cuádriceps , Biónica , Cartílago , Humanos , Ácido Hialurónico , Inyecciones Intraarticulares , Articulación de la Rodilla , Resultado del Tratamiento
9.
Khirurgiia (Mosk) ; (9): 75-79, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33030005

RESUMEN

Surgical treatment of post-traumatic right-sided phrenic hernia is associated with certain technical difficulties due to topographic and anatomical features. Morbid obesity combined with diabetes mellitus type II is one of the main factors complicating any surgical thoracic or abdominal surgery and further rehabilitation. We report simultaneous surgery for complicated post-traumatic right-sided phrenic hernia in a patient with morbid obesity and diabetes mellitus type II. Surgical correction of giant phrenic hernia facilitated further effective treatment of morbid obesity and concomitant diabetes mellitus type II.


Asunto(s)
Diabetes Mellitus Tipo 2 , Herniorrafia , Obesidad Mórbida , Diabetes Mellitus Tipo 2/complicaciones , Hernia/complicaciones , Humanos , Obesidad Mórbida/complicaciones , Resultado del Tratamiento
10.
Z Gastroenterol ; 58(10): 971-974, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33036050

RESUMEN

BACKGROUND: Verrucous carcinoma of the esophagus is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult because even repeated biopsies are often without tumor evidence. We present a patient with verrucous carcinoma of the esophagus and a literature review. CASE REPORT: A 64-year-old patient with dysphagia and sore throat received esophagogastroduodenoscopy illustrating segmental circumferential verrucous inflammation and Candida esophagitis in the middle part of the esophagus. Repeated mucosal biopsies revealed reactive hyperkeratosis of the squamous epithelium with minimal atypia but without ulcera, eosinophilic esophagitis, or suspicion of cancer. Mucosal infection with adenovirus, herpes simplex virus 1, human papilloma virus types, and cytomegaly virus was ruled out. Veruccous carcinoma was detected finally by endoscopic mucosal resection. The patient was successfully treated by esophageal resection. Tumor stage was G1, pT1b, pN0, L0, V0, Pn0, R0. CONCLUSION: The results suggest that macroscopic suspicion of verrucous esophageal carcinoma should lead to resections of larger tissue specimens by EMR to confirm the diagnosis.


Asunto(s)
Carcinoma Verrugoso/patología , Trastornos de Deglución/etiología , Neoplasias Esofágicas/patología , Faringitis/etiología , Biopsia , Carcinoma Verrugoso/cirugía , Resección Endoscópica de la Mucosa , Endoscopía del Sistema Digestivo , Neoplasias Esofágicas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
12.
Lancet Respir Med ; 8(10): 975-986, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33007285

RESUMEN

BACKGROUND: Chronic pulmonary infection with Pseudomonas aeruginosa is one of the most important causes of mortality and morbidity in cystic fibrosis. If antibiotics are commenced promptly, infection can be eradicated. The aim of the trial was to compare the effectiveness and safety of intravenous ceftazidime and tobramycin versus oral ciprofloxacin in the eradication of P aeruginosa. METHODS: We did a multicentre, parallel group, open-label, randomised controlled trial in 72 cystic fibrosis centres (70 in the UK and two in Italy). Eligible participants were older than 28 days with an isolate of P aeruginosa (either the first ever isolate or a new isolate after at least 1 year free of infection). Participants were excluded if the P aeruginosa was resistant to, or they had a contraindication to, one or more of the trial antibiotics; if they were already receiving P aeruginosa suppressive therapy; if they had received any P aeruginosa eradication therapy within the previous 9 months; or if they were pregnant or breastfeeding. We used web-based randomisation to assign patients to 14 days intravenous ceftazidime and tobramycin or 12 weeks oral ciprofloxacin. Both were combined with 12 weeks inhaled colistimethate sodium. Randomisation lists were generated by a statistician, who had no involvement in the trial, using a computer-generated list. Randomisation was stratified by centre and because of the nature of the interventions, blinding was not possible. Our primary outcome was eradication of P aeruginosa at 3 months and remaining free of infection to 15 months. Primary analysis used intention to treat (powered for superiority). Safety analysis included patients who received at least one dose of study drug. TORPEDO-CF was registered on the ISRCTN register, ISRCTN02734162, and EudraCT, 2009-012575-10. FINDINGS: Between Oct 5, 2010, and Jan 27, 2017, 286 patients were randomly assigned to treatment: 137 to intravenous antibiotics and 149 to oral antibiotics. 55 (44%) of 125 participants in the intravenous group and 68 (52%) of 130 participants in the oral group achieved the primary outcome. Participants randomly assigned to the intravenous group were less likely to achieve the primary outcome, although the difference between groups was not statistically significant (relative risk 0·84, 95% CI 0·65-1·09; p=0·18). 11 serious adverse events occurred in ten (8%) of 126 participants in the intravenous antibiotics group and 17 serious adverse events in 12 (8%) of 146 participants in the oral antibiotics group. INTERPRETATION: Compared with oral therapy, intravenous antibiotics did not achieve sustained eradication of P aeruginosa in a greater proportion of patients with cystic fibrosis and was more expensive. Although there were fewer hospitalisations in the intravenous group than the oral group during follow-up, this confers no advantage over oral treatment because intravenous eradication frequently requires hospitalisation. These results do not support the use of intravenous antibiotics to eradicate P aeruginosa in cystic fibrosis. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Asunto(s)
Antibacterianos/administración & dosificación , Ceftazidima/administración & dosificación , Fibrosis Quística/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa , Tobramicina/administración & dosificación , Administración Intravenosa , Administración Oral , Adolescente , Adulto , Niño , Preescolar , Fibrosis Quística/tratamiento farmacológico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/complicaciones , Resultado del Tratamiento , Adulto Joven
13.
Artículo en Inglés | MEDLINE | ID: mdl-33013686

RESUMEN

Coronavirus diseases (COVID-19) is associated with high rates of morbidity and mortality and worse outcomes have been reported for various morbidities. The impact of pre-existing hypothyroidism on COVID-19 outcomes remains unknown. The aim of the present study was to identify a possible association between hypothyroidism and outcomes related to COVID-19 including hospitalization, need for mechanical ventilation, and all-cause mortality. All patients with a laboratory confirmed COVID-19 diagnosis in March 2020 in a large New York City health system were reviewed. Of the 3703 COVID-19 positive patients included in present study, 251 patients (6.8%) had pre-existing hypothyroidism and received thyroid hormone therapy. Hypothyroidism was not associated with increased risk of hospitalization [Adjusted Odds Ratio (ORadj): 1.23 (95% Confidence Interval (CI): 0.88- 1.70)], mechanical ventilation [ORadj: 1.17 (95% CI: 0.81-1.69)] nor death [ORadj: 1.07 (95% CI: 0.75-1.54)]. This study provides insight into the role of hypothyroidism on the outcomes of COVID-19 positive patients, indicating that no additional precautions or consultations are needed. However, future research into the potential complications of COVID-19 on the thyroid gland and function is warranted.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Hipotiroidismo/complicaciones , Hipotiroidismo/terapia , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Infecciones por Coronavirus/mortalidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipotiroidismo/mortalidad , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/mortalidad , Respiración Artificial , Estudios Retrospectivos , Riesgo , Hormonas Tiroideas/uso terapéutico , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 99(40): e22231, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019397

RESUMEN

BACKGROUND: There is a worldwide outbreak of coronavirus disease 2019 (COVID-19), at present, accumulative attention has been paid to COVID-19 due to its global prevalence. Acupuncture may play a beneficial role in patients who suffer from COVID-19. In China and East Asia, acupuncture has been widely used to treat diverse diseases for thousands of years, as an important method of treatment now, it plays an indispensable role in the treatment of respiratory diseases in China. This study is designed to determine the efficacy and safety of acupuncture in COVID-19. METHODS: We will search the following sources for the Randomized controlled trials (RCT): The Cochrane Library, PubMed, EMBASE, Web of Science, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science, and the Wanfang Database. All the above databases will be searched from the available date of inception until the latest issue. No language or publication restriction will be used. Primary outcomes will include chest CT and nucleic acid detection of respiratory samples. RESULTS: The results will provide a high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION: The conclusion of our study will provide evidence to evaluate whether acupuncture is an effective treatments for patients suffering from COVID-19. PROSPERO REGISTRATION NUMBER: CRD42020180875.


Asunto(s)
Terapia por Acupuntura/métodos , Betacoronavirus , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Femenino , Humanos , Masculino , Metaanálisis como Asunto , Pandemias , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
15.
Artículo en Inglés | MEDLINE | ID: mdl-33027392

RESUMEN

Tuberculosis of the skull or calvarial tuberculosis (CTB) is rare. The literature until 2019 reported less than 60 cases of CTB in childhood. The authors describe two patients with CTB associated with other manifestations of TB, such as: spine and rib injuries, peripheral adenopathy, hepatic and splenic involvement who improved with chemotherapy. The patients were a four-year-old and an eight-year-old child, whose diagnoses were confirmed by histopathological, bacteriological or molecular investigation. Both were not infected with the human immunodeficiency virus (HIV) and did not need orthopedic treatment.


Asunto(s)
Cráneo/diagnóstico por imagen , Prueba de Tuberculina/métodos , Tuberculosis/diagnóstico , Antituberculosos/uso terapéutico , Niño , Preescolar , Humanos , Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis/tratamiento farmacológico
16.
Medicina (B Aires) ; 80(5): 417-424, 2020.
Artículo en Español | MEDLINE | ID: mdl-33048783

RESUMEN

This is a preliminary, multicenter, retrospective cohort study, including 272 consecutive patients with COVID-19 admitted to hospitals in Buenos Aires Province, between May 15th and July 1st, 2020, included in an expanded access program to convalescent plasma. Our objectives were to analyze mortality and its independent risk factors, and to assess the occurrence of a favorable evolution, defined as hospital discharge, or stay at the ward, or transfer from ICU to ward. Patients were stratified int o 4 subgroups: admission to the ward with pneumonia and/or oxygen requirement (WARD; n = 100); ICU admission (ICU; n = 87); ICU admission with requirement of mechanical ventilation (ICU-MV; n = 56), and ICU-MV plus septic shock (ICU-MV-SS; N = 29). Mortality at 28 days was 26.1% for the entire group, 14.0% for WARD group, 18.4% for ICU, 44.6% for ICU-MV, and 55.2% for ICU-MV-SS. Mean survival time (days) was 25.6 ± 0.6 (WARD); 25.3 ± 0.7 (ICU); 20.8 ± 1.2 (ICU-MV) and 18.2 ± 1.8 (ICU-MV-SS). Independent predictors of mortality were MV, septic shock and weight. A favorable evolution occurred in 81.4% of WARD patients; in 70.9% of ICU; in 39.6% of ICU-MV and in 27.6% of ICU-MV-SS patients. Severity of illness on admission, age, weight and heart rate were independently associated with evolution. No major adverse effects were recorded. The lack of a control group precluded the estimation of efficacy. However, our 26% mortality rate was higher than that of the treatment arm of clinical trials comparing plasma with usual treatment, which might be ascribed to higher proportion of patients with MV and septic shock in our cohort.


Asunto(s)
Infecciones por Coronavirus/terapia , Pandemias , Neumonía Viral/terapia , Adulto , Anciano , Argentina/epidemiología , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Inmunización Pasiva/métodos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Estudios Retrospectivos , Resultado del Tratamiento
17.
Medicina (B Aires) ; 80(5): 439-441, 2020.
Artículo en Español | MEDLINE | ID: mdl-33048786

RESUMEN

During the SARSCoV-2 pandemic many drugs have been used as potential treatments in order to improve the clinical outcome and reduce the mortality. But since it is a currently unknown disease, the evidence about efficacy and safety is built as the drugs are prescribed. In this context, intensive pharmacovigilance allows early detection of adverse events, and thereby infer the safety profile of the indication. We conducted an observational, retrospective, single-center study involving adult patients with severe SARS-CoV-2 infection. All adverse events detected in 23 patients in the Intensive Care Unit between March 15 and June 15, 2020 were registered. We describe type and severity of the adverse events and if treatment suspension was needed. The results show a high rate of adverse events (10/23, 43%) in treatment with lopinavir/ritonavir. In most cases early treatment suspension was required. Even though the limitations of our study derived from the small sample size, these results could help in building evidence about the safety of using lopinavir/ritonavir for severe SARS-CoV-2 infection.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Inhibidores del Citocromo P-450 CYP3A/efectos adversos , Lopinavir/efectos adversos , Neumonía Viral/tratamiento farmacológico , Ritonavir/efectos adversos , Adulto , Anciano , Argentina/epidemiología , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica , Inhibidores del Citocromo P-450 CYP3A/uso terapéutico , Femenino , Humanos , Lopinavir/uso terapéutico , Masculino , Pandemias , Neumonía Viral/epidemiología , Estudios Retrospectivos , Ritonavir/uso terapéutico , Resultado del Tratamiento
18.
Artículo en Ruso | MEDLINE | ID: mdl-33081446

RESUMEN

OBJECTIVE: To compare the efficacy and tolerability of different combinations of domestic generics meloxicam (amelotex), tolperisone (calmirex) and B vitamins (compligam B) in the treatment of acute low-back pain. MATERIAL AND METHODS: Ninety patients with acute low-back pain (ICD-10 M54.5) were studied. Indications and prescribing of the drugs was carried out under the international generic name. Pain was assessed using a visual analog pain scale in mm (VAS). To relieve pain, all patients received the non-steroidal anti-inflammatory drug with a favorable safety profile meloxicam (amelotex). With the aim of optimization, 3 therapy regimens were proposed: group 1 (n=30) received amelotex, calmirex, and B vitamins (compligam B). Group 2 (n=30) received amelotex and calmirex. Group 3 (n=30) was treated with amelotex and compligam B. With a decrease in pain by 50% or more from the baseline level and a VAS <40 mm, patients could reduce the dose of amelotex from 15 to 7.5 mg or stop taking it. RESULTS: During treatment, all groups showed a significant regression of pain according to VAS: in group 1 from 77 to 9 mm, in group 2 from 74 to 12 mm, in group 3 from 69 to 14 mm. The maximum statistically significant reduction in pain and the degree of muscle tone was observed in group 1. Adverse reactions occurred in all groups, but they were weak and transient, and did not require correction or discontinuation of therapy. Only one patient from group 3 had a persistent rise in blood pressure. The average duration of temporary disability was 5.8 days in group 1, 7.4 in group 2, and 9.5 days in group 3. High efficacy and good tolerability of all 3 therapy regimens were noted. The combination of amelotex, calmirex and compligam B received the highest rating in the opinion of doctors and patients. CONCLUSION: All 3 treatment regimens optimize therapy in patients with acute low-back pain, reduce the dose and timing of the NSAID administration as well as the risk of adverse reactions. The results indicate that the combination of amelotex, calmirex and compligam B is a synergy of three pain relief systems due to the effect on different pathogenetic mechanisms, thereby providing the maximum analgesic effect, shortening the course of treatment and duration of temporary disability, reducing the risk of relapse and chronicity of pain.


Asunto(s)
Dolor de la Región Lumbar , Tolperisona , Antiinflamatorios no Esteroideos/efectos adversos , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Meloxicam , Tolperisona/uso terapéutico , Resultado del Tratamiento
19.
Am J Case Rep ; 21: e927812, 2020 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-33009361

RESUMEN

BACKGROUND This is a case report of an immunocompromised patient with a history of non-Hodgkin lymphoma and persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who was seronegative and successfully treated with convalescent plasma. CASE REPORT A 63-year-old woman with a past medical history of non-Hodgkin lymphoma in remission while on maintenance therapy with the anti-CD20 monoclonal antibody, obinutuzumab, tested positive for SARS-CoV-2 via nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) testing over 12 weeks and persistently tested seronegative for immunoglobulin G (IgG) antibodies using SARS-CoV-2 IgG chemiluminescent microparticle immunoassay technology. During this time, the patient experienced waxing and waning of symptoms, which included fever, myalgia, and non-productive cough, but never acquired severe respiratory distress. She was admitted to our hospital on illness day 88, and her symptoms resolved after the administration of convalescent plasma. CONCLUSIONS As the understanding of the pathogenesis of SARS-CoV-2 continues to evolve, we can currently only speculate about the occurrence of chronic infection vs. reinfection. The protective role of antibodies and their longevity against SARS-CoV-2 remain unclear. Since humoral immunity has an integral role in SARS-CoV-2 infection, various phase 3 vaccine trials are underway. In the context of this pandemic, the present case demonstrates the challenges in our understanding of testing and treating immunocompromised patients.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Huésped Inmunocomprometido , Linfoma no Hodgkin/inmunología , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Antineoplásicos Inmunológicos/administración & dosificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/terapia , Femenino , Estudios de Seguimiento , Humanos , Inmunización Pasiva/métodos , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/tratamiento farmacológico , Persona de Mediana Edad , Pandemias , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Pruebas Serológicas/métodos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
20.
Nat Commun ; 11(1): 4965, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33009371

RESUMEN

Next-generation sequencing (NGS) can identify novel cancer targets. However, interpreting the molecular findings and accessing drugs/clinical trials is challenging. Furthermore, many tumors show resistance to monotherapies. To implement a precision strategy, we initiated a multidisciplinary (basic/translational/clinical investigators, bioinformaticians, geneticists, and physicians from multiple specialties) molecular tumor board (MTB), which included a project manager to facilitate obtaining clinical-grade biomarkers (blood/tissue NGS, specific immunohistochemistry/RNA expression including for immune-biomarkers, per physician discretion) and medication-acquisition specialists/clinical trial coordinators/navigators to assist with medication access. The MTB comprehensively reviewed patient characteristics to develop N-of-One treatments implemented by the treating physician's direction under the auspices of a master protocol. Overall, 265/429 therapy-evaluable patients (62%) were matched to ≥1 recommended drug. Eighty-six patients (20%) matched to all drugs recommended by MTB, including combinatorial approaches, while 38% received physician's choice regimen, generally with unmatched approach/low degree of matching. Our results show that patients who receive MTB-recommended regimens (versus physician choice) have significantly longer progression-free (PFS) and overall survival (OS), and are better matched to therapy. High (≥50%) versus low (<50%) Matching Score therapy (roughly reflecting therapy matched to ≥50% versus <50% of alterations) independently correlates with longer PFS (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.50-0.80; P < 0.001) and OS (HR, 0.67; 95% CI, 0.50-0.90; P = 0.007) and higher stable disease ≥6 months/partial/complete remission rate (52.1% versus 30.4% P < 0.001) (all multivariate). In conclusion, patients who receive MTB-based therapy are better matched to their genomic alterations, and the degree of matching is an independent predictor of improved oncologic outcomes including survival.


Asunto(s)
Neoplasias/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Niño , Preescolar , ADN Tumoral Circulante/genética , Supervivencia sin Enfermedad , Femenino , Genoma Humano , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Medicina de Precisión , Resultado del Tratamiento , Adulto Joven
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