Standard of care plus telmisartan on respiratory failure due to COVID-19 (STAR-COVID trial).

BACKGROUND: The potential influence of renin-angiotensin inhibitors on the severity of SARS-CoV-2 infection has been considered in preclinical and observational studies with contradictory results. Therefore, we investigated the effect of telmisartan in reducing lung injury among hospitalized COVID-19 patients. METHODS: The STAR-COVID trial was conducted as a prospective, parallel-group, randomized, open-label study involving hospitalized adult patients with severe COVID-19 (NCT04510662). Sixty-six patients were enrolled: 33 were assigned to the telmisartan group and 33 to the control group. The mean age of participants was 48.8 years, with 62.5% being male. Participants were randomly assigned in a 1:1 ratio to receive either telmisartan (40 mg daily for 14 days or until discharge) plus standard of care or standard of care alone. The primary outcome assessed was the initiation of mechanical ventilation within 14 days. Secondary outcomes included 30-day mortality, the need for vasopressors, hemodialysis requirements, and length of hospital stay. RESULTS: Comparison between the telmisartan group and the control group revealed no significant difference in the occurrence of mechanical ventilation at 14 days (25% with telmisartan vs. 18.7% with control, P=0.579). Additionally, there were no significant differences observed in terms of mortality (25% vs. 21.9%, P=0.768), the need for vasopressors (18.8% in both groups, P=1.000), hemodialysis requirements (6.3% vs. 3.1%, P=0.500), and length of hospital stay (median of 7 days in both groups, P=0.962). CONCLUSIONS: Compared with the standard of care, telmisartan therapy demonstrated no significant impact on respiratory failure in hospitalized patients with severe COVID-19.

Wide complex tachycardia in a patient with COVID-19 treated with chloroquine/azithromycin.

Azithromycin and chloroquine/hydroxychloroquine are being used internationally off-label to treat patients with coronavirus disease 2019 (COVID-19) based on in vitro and weak studies involving humans. However, the evidence about the benefit of these drugs is very uncertain and on the other hand, information regarding possible harms is on the rise. There are increasing reports associating chloroquine/hydroxychloroquine with/without azithromycin with prolonged QT and ventricular arrhythmias (monomorphic or polymorphic ventricular tachycardia) in COVID-19 patients. We present the case of a severe acute respiratory syndrome coronavirus 2-infected kidney transplant patient for which he received treatment with chloroquine plus azithromycin and on Day 4 of therapy, the patient suddenly developed a wide complex tachycardia. Because of the increasing reports of adverse effects related to these drugs, their use should be avoided until further evidence of clinical benefit is available.

Parasistolia ventricular / Ventricular parasistolia

Se presenta el caso de un hombre de 54 años de edad con historia de un infarto del miocardio inferior antiguo y función ventricular izquierda normal, cuya atención en la consulta externa de nuestra institución se inició por palpitaciones frecuentes. El electrocardiograma mostró extrasístoles ventriculares de una morfología y en el monitoreo Holter se documentó extrasístoles ventriculares frecuentes de una morfología con periodos de acoplamiento variable y con latidos de fusión. Se concluyó la presencia de un foco parasistólico ventricular.

We present a case of a 54 years old male who had had an inferior myocardial infarction previously, with normal ejection fraction of the left ventricle whose care in the autopatient clinic of our institution started by frequent palpitations. The electrocardiogram showed premature ventricular contractions and Holter monitoring documented frequent premature ventricular contractions with periods of variable coupling and fusion beats. It was concluded the presence of ventricular parasystole.