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2.
Ars pharm ; 61(2): 63-79, abr.-jun. 2020. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-188101

RESUMO

INTRODUCCIÓN: En diciembre de 2019, se detectaron los primeros casos de enfermedad respiratoria causada por un coronavirus emergente, al que se denominó SARS-CoV-2, que en los primeros meses de 2020 se ha extendido por todo el mundo con características de pandemia. MÉTODO: Se examinaron las publicaciones más relevantes en relación con los objetivos de la revisión. RESULTADOS: La enfermedad, conocida como COVID-19, cursa con tos, fiebre y dificultad respiratoria. Las formas más graves, que afectan principalmente a personas de edad avanzada y con determinadas comorbilidades, se manifiestan por afectación de la función respiratoria, que requiere ventilación mecánica, y síndrome de respuesta inflamatoria sistémica, que puede conducir a un choque séptico con fallo multiorgánico, y altas tasas de mortalidad. En esta revisión se examina el estado actual de conocimientos sobre las características y origen del SARS-CoV-2, su replicación, y la patogénesis, clínica, diagnóstico, tratamiento y prevención de COVID-19. CONCLUSIONES: Las características del SARS-CoV-2 y la clínica de COVID-19 son bien conocidas. La PCR es la técnica de referencia para el diagnóstico de laboratorio; se dispone de ensayos para detección de antígenos y de anticuerpos, con margen de optimización. Los protocolos de tratamiento incluyen la corrección de la respuesta inflamatoria sistémica y administración de agentes antivirales. Existen vacunas en desarrollo


INTRODUCTION: In December 2019, the first cases of respiratory disease caused by an emerging coronavirus were detected. The causative agento f the outbreak was called SARS-CoV-2, and in the first months of 2020 it spread throughout the world as a pandemic. METHOD: The most relevant publications concerned with the aims of the review were examined. RESULTS: The disease, known as COVID-19. Patients show cough, fever, and respiratory distress. The most severe forms, mainly affecting the elderly and associated with various comorbidities, are manifested by impaired respiratory function, requiring mechanical ventilation, and systemic inflammatory response syndrome, which can lead to septic shock with multi-organ failure and high mortality rates. This review examines the current state of knowledge about the characteristics and origin of SARS-CoV-2, its replication, and the pathogenesis, clinical, diagnosis, treatment, and prevention of COVID-19. CONCLUSIONS: The characteristics of SARS-CoV-2 and the clinical manifestations of COVID-19 are well known. PCR is the reference technique for laboratory diagnosis; assays for the detection of antigens and antibodies are available, with optimization possibilities. Treatment protocols include attenuation of the systemic inflammatory response and administration of antiviral agents. There are vaccines in development


Assuntos
Humanos , Infecções por Coronavirus , Pneumonia Viral , Betacoronavirus/patogenicidade , Pandemias , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia
3.
Ars pharm ; 61(2): 145-148, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-188102

RESUMO

El coronavirus 2019 (SARS-CoV-2) ha sido declarado una emergencia de salud pública de impacto internacional por la Organización Mundial de la Salud. Debido a la aparición repentina de este proceso pandémico asociado con alta morbilidad y la mortalidad en todo el mundo, se han implementado varios tratamientos en los pacientes aquejados con esta dolencia. En este marco, comenzaron a usarse en pacientes críticos altas dosis de vitamina C. En este trabajo, analizamos los ensayos clínicos y / o trabajos de investigación disponibles en la literatura. Aunque se necesita más evidencia sobre su efectividad, es importante que el especialista comprenda la lógica clínica de este uso para determinar si es correcto como tratamiento concomitante. Conclusiones: El uso de altas dosis de vitamina C por vía parenteral parece ser una alternativa segura, disponible y económica, especialmente para pacientes críticos


The 2019 coronavirus (SARS-CoV-2) has been declared a public health emergency of international concern by the World Health Organization. Due to the sudden appearance of this pandemic process associated with increasing morbidity and mortality worldwide, various treatments have been implemented. In this framework, high doses of vitamin C began to be used in critically ill patients. We analyze the clinical trials and/or research papers available in the literature. Although more evidence on its effectiveness is needed is important for the specialist to understand the clinical logic of this use to determine if it is correct as a concomitant treatment. Conclusions: It seems that using high doses of vitamin C parenterally is a safe, available and economical alternative especially for critically ill patients


Assuntos
Humanos , Ácido Ascórbico/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Betacoronavirus , Pandemias , Medicina Baseada em Evidências , Ensaios Clínicos como Assunto , Infusões Parenterais , Estado Terminal
4.
Am J Chin Med ; : 1-15, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349517

RESUMO

The outbreak caused by COVID-19 is causing a major challenge to clinical management and a worldwide threat to public health. So far, there is no specific anti-coronavirus therapy approved for the treatment of COVID-19. Recently, as the efficacy and safety of traditional Chinese medicine (TCM) is widely acknowledged, it has been brought to a crucial status by the public, governments, and World Health Organization (WHO). For a better popularization of TCM, governments have made several advances in regulations and policies for treatment and measures of novel coronavirus pneumonia (NCP). Therefore, on the basis of epidemiology and virology information, we reviewed relevant meta-analysis and clinical studies of anti-coronavirus therapeutics by TCM, in the aspect of mortality, symptom improvement, duration and dosage of corticosteroid, incidence of complications and the like. In addition, we also summarized preclinical rationale for anti-coronavirus activity by TCM in terms of virion assembly and release, as well as viral entry and replication, which could be a useful contribution for figuring out effective Chinese herbal medicine (CHM) for coronavirus, including ingredients from single monomeric compounds, Chinese herbs, Chinese herb extracts and Chinese herb formulas, or potential targets for medicine. We would like to see these relevant studies, ranging from basic researches to clinical application, could provide some idea on effects of CHM to combat COVID-19 or other coronaviruses, and also offer new thinking for the exploration of therapeutic strategies under the guidance of TCM.

6.
Inform Med Unlocked ; : 100338, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32352026

RESUMO

A new virus termed SARS-COV-2 (causing COVID-19 disease) can exhibit a progressive, fatal impact on individuals. The World Health Organization (WHO) has declared the spread of the virus to be a global pandemic. Currently, there are over 1 million cases and over 100,000 confirmed deaths due to the virus. Hence, prophylactic and therapeutic strategies are promptly needed. In this study we report an epitope, ITLCFTLKR, which is biochemically fit to HLA allelic proteins. We propose that this could be used as a potential vaccine candidate against SARS-COV-2. A selected putative epitope and HLA-allelic complexes show not only better binding scores, but also RMSD values in the range of 0-1 Å. This epitope was found to have a 99.8% structural favorability as per Ramachandran-plot analysis. Similarly, a suitable range of IC50 values and population coverage was obtained to represent greater validation of T-cell epitope analysis. Stability analysis using MDWeb and half-life analysis using the ProtParam tool has confirmed that this epitope is well-selected. This new methodology of epitope-based vaccine prediction is fundamental and fast in application, ad can be economically beneficial and viable.

8.
10.
Artigo em Inglês | MEDLINE | ID: mdl-32352633

RESUMO

Important health resources are dedicated worldwide to the management of COVID-19. This new disease, due to its large diffusion, may significantly hamper the prognosis of other pathologies, such as ST-segment elevation myocardial infarction (STEMI) because of (a) a possible direct negative impact and (b) shortage of first response medical resources and increased delays to reperfusion. We report the case of a 68-year-old man admitted for anterior STEMI and asymptomatic COVID-19. Due to extended transportation delays to a cathlab, he received intravenous fibrinolytic therapy, which failed. Reperfusion was achieved with rescue coronary angioplasty, but the patient experienced two episodes of acute stent thrombosis at 2- and 36-hr following admission and despite optimal medical therapy. He finally died because of cardiogenic shock. This raises concerns about a possible increase in platelet aggregability associated with COVID-19 leading to an increased risk of stent thrombosis, particularly in the context of STEMI. This pleads for the promotion of primary coronary angioplasty as the first-choice revascularization technique in this population and the use of new generation P2Y12 inhibitors. In addition, the use of GPIIb/IIIa inhibitors may be considered in every STEMI patient with COVID-19 to prevent the risk of acute stent thrombosis.

11.
Radiat Res ; 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32352871
12.
Acta Med Port ; 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32352913

RESUMO

We report the first cesarean delivery in a woman with COVID-19 in a level III hospital in Portugal. It refers to a healthy woman with a term pregnancy that tested positive for COVID-19 on the day of labor induction. Given a Bishop score < 4 and the prior history of a cesarean section, the team decided to perform a surgical delivery. Appropriate personal protective equipment and safety circuits were employed, as described in more detail in the case report. Both the mother and the newborn are well. With this report we aimed to share our concerns, clinical management, maternal and neonatal outcomes, and to present our current circuits and adjustments regarding the COVID-19 pandemic in our maternity hospital.

13.
14.
Artigo em Francês | MEDLINE | ID: mdl-32355509

RESUMO

The massive inflow of patients with COVID-19 requiring urgent care has overloaded hospitals in France and impacts the management of other patients. Deferring hospitalization and non-urgent surgeries has become a priority for surgeons today in order to relieve the health care system.It is obviously not simple to reduce emergency surgery without altering the quality of care or leading to a loss of chance for the patient. Acute appendicitis is a very specific situation and the prevalence of this disease leads us to reconsider this particular disease in the context of the COVID-19 crisis. Indeed, while the currently recommended treatment for uncomplicated acute appendicitis is surgical appendectomy, the non-surgical alternative of medical management by antibiotic therapy alone has been widely evaluated by high-quality studies in the literature. Insofar as the main limitation of exclusively medical treatment of uncomplicated acute appendicitis is the risk of recurrent appendicitis, this treatment option represents an alternative of choice to reduce the intra-hospital overload in this context of health crisis.The aim of this work is therefore to provide physicians and surgeons with a practical guide based on a review of the literature on the medical treatment of uncomplicated acute appendicitis in adults, to offer this alternative treatment to the right patients and under good conditions, especially when access to the operating room is limited or impossible.

15.
Artigo em Inglês | MEDLINE | ID: mdl-32386431

RESUMO

We have read with great interest the letter of the European Task Force on Atopic Dermatitis (ETFAD) on SARS-CoV-2-infection and atopic dermatitis published in JEADV (March 2020)1 in which the authors state: "Targeted treatment selectively interfering with type-2 inflammation such as dupilumab is not considered to increase the risk for viral infections and might thus be preferred …in a situation such as COVID-19 pandemic".1.

16.
Artigo em Inglês | MEDLINE | ID: mdl-32386438

RESUMO

Since the new fatal pneumonia was identified in December 2019 in Wuhan, China, the WHO declared the infection a health emergency of international concern. The novel ss-RNA ß-coronavirus (SARS-CoV-2) spreads through airborne and direct contagion; virulence is high in the elderly and in patients with diabetes, chronic pulmonary, cardiovascular and neoplastic diseases. SARS-CoV-2 ssRNA is recognized by intracellular Pattern Recognition Receptors (PRRs), which trigger NF-kB - the master regulator of inflammation - and Interferon Regulatory Factors (IRFs)1 .

17.
18.
Acad Emerg Med ; 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32359203

RESUMO

BACKGROUND: The emergence of SARS-CoV-2 has presented clinicians with a difficult therapeutic dilemma. With supportive care as the current mainstay of treatment, the fatality rate of COVID-19 is 6.9%. There are currently several trials assessing the efficacy of different antivirals as treatment. Of these, Chloroquine (CQ) and derivative, Hydroxychloroquine (HCQ), have garnered the most attention. METHODS: In this study, the literature currently available on CQ and HCQ as treatment of COVID-19 was surveyed using EMBASE, PubMed, Cochrane Librar, MedRxiv and 1 clinical trial registry. Upon gathering published and preprint trials, risk of bias was assessed using Cochrane Risk of Bias Tool 2.0. RESULTS: There are currently 7 completed clinical trials and 29 registered clinical trials focusing on HCQ or CQ as a therapeutic avenue for COVID-19. Of these, 5/7 trials have shown favorable outcomes for patients using CQ or HCQ and 2/7 have shown no change compared to control. However, all 7 trials carried varying degrees of bias and poor study design. CONCLUSION: There is currently not enough data available to support the routine use of HCQ and CQ as therapies for COVID-19. Pending further results from more extensive studies with more stringent study parameters, clinicians should defer from routine use of HCQ and CQ. There are several clinical trials currently underway with results expected soon.

20.
J Med Virol ; 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32369191

RESUMO

Tocilizumab, an interleukin-6 inhibitor, may ameliorate the inflammatory manifestations associated with severe coronavirus disease 2019 (COVID-19) and thus improve clinical outcomes. This was a retrospective review of patients with laboratory-confirmed severe COVID-19 who received tocilizumab and completed 14 days of follow up. Twenty-five patients were included, median age was 58 years (interquartile range, 50-63) and the majority were males (92%). Co-morbidities included diabetes mellitus (48%), chronic kidney disease (16%), and cardiovascular disease (12%). Fever (92%), cough (84%), and dyspnea (72%) were the commonest presenting symptoms. All patients received at least two concomitant investigational antiviral agents. Median oral temperature was on day 1, 3, and 7 was 38.0°C, 37.3°C (P = .043), and 37.0°C (P = .064), respectively. Corresponding median C-reactive protein was 193 and 7.9 mg/L (P < .0001) and <6 mg/L (P = .0001). Radiological improvement was noted in 44% of patients by day 7% and 68% by day 14. Nine patients (36%) were discharged alive from intensive care unit and three (12%) died. The proportion of patients on invasive ventilation declined from (84%) at the time of tocilizumab initiation to 60% on day 7 (P = .031) and 28% on day 14 (P = .001). The majority (92%) of patients experienced at least one adverse event. However, it is not possible to ascertain which adverse events were directly related to tocilizumab therapy. In patients with severe COVID-19, tocilizumab was associated with dramatic decline in inflammatory markers, radiological improvement and reduced ventilatory support requirements. Given the study's limitations, the results require assessment in adequately powered randomized controlled trials.

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