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Rasul HO, Thomas NV, Ghafour DD, Aziz BK, Salgado M G, Mendoza-Huizar LH, Candia LG. Searching possible SARS-CoV-2 main protease inhibitors in constituents from herbal medicines using in silico studies. J Biomol Struct Dyn 2024; 42:4234-4248. [PMID: 37349945 DOI: 10.1080/07391102.2023.2220040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
The largest threat to civilization since the Second World War is the spread of the new coronavirus disease (COVID-19). Therefore, there is an urgent need for innovative therapeutic medicines to treat COVID-19. Reusing bio-actives is a workable and efficient strategy in the battle against new epidemics because the process of developing new drugs is time-consuming. This research aimed to identify which herbal remedies had the highest affinity for the receptor and assess a variety of them for potential targets to suppress the SARS-CoV-2 Mpro. The use of AutoDock Vina for structure-based virtual screening was done first due to the importance of protein interactions in the development of drugs. Molecular docking was used in the comparative study to assess 89 different chemicals from medicinal herbs. To anticipate their effectiveness against the primary protease of SARS-CoV-2, more analysis was done on the ADMET profile, drug-likeness, and Lipinski's rule of five. The next step involved three replicas of 100 ns-long molecular dynamics simulations on the potential candidates, which were preceded by calculations of the binding free energy of MM-GBSA. The outcomes showed that Achyrodimer A, Cinchonain Ib, Symphonone F, and Lupeol acetate all performed well and had the highest 6LU7 binding affinities. Using RMSD, RMSF, and protein-ligand interactions, the stability of the protein-ligand complex was assessed. The studies indicate that bioactive substances obtained from herbal medicines may function as a COVID-19 therapeutic agent, necessitating additional wet lab research to confirm their therapeutic potential, efficacy, and pharmacological capacity against the condition.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Hezha O Rasul
- Department of Pharmaceutical Chemistry, College of Science, Charmo University, Chamchamal, Sulaimani, Iraq
| | - Noel Vinay Thomas
- Department of BioMedical Science, College of Science, Komar University of Science and Technology, Sulaimani, Iraq
| | - Dlzar D Ghafour
- Department of Medical Laboratory Science, College of Science, Komar University of Science and Technology, Sulaimani, Iraq
- Department of Chemistry, College of Science, University of Sulaimani, Sulaimani, Iraq
| | - Bakhtyar K Aziz
- Department of Nanoscience and Applied Chemistry, College of Science, Charmo University, Chamchamal, Sulaimani, Iraq
| | | | - L H Mendoza-Huizar
- Academic Area of Chemistry, Mineral de la Reforma, Autonomous University of Hidalgo State, Hidalgo, México
| | - Lorena Gerli Candia
- Departamento de Química Ambiental, Facultad de Ciencias, Universidad Católica de la Santísima Concepción, Concepción, Chile
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Kooshki A, Mehrpour O, Nakhaee S. Azathioprine and hydroxychloroquine overdose in Sjögren's syndrome patient with hypocalcemia: a case report. J Med Case Rep 2024; 18:76. [PMID: 38409169 PMCID: PMC10897995 DOI: 10.1186/s13256-024-04390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/17/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Hydroxychloroquine and azathioprine have been routinely used to control and treat primary and secondary Sjögren's syndrome, which potentially triggered some overdoses by these drugs. Toxicity from hydroxychloroquine and azathioprine manifests in the form of cardiac conduction abnormalities, nausea, vomiting, and muscle weakness. Recognizing these unique drug overdoses and management of these toxicities is important. This case report aims to expand our current understanding of these drug overdoses and their management and also underscores the importance of anticipating and identifying fewer common complications, such as hypocalcemia. CASE REPORT A 34-year-old Persian woman with a history of Sjögren's syndrome presented to the emergency department 3.5-4 hours after an intentional overdose of hydroxychloroquine and azathioprine and severe hypotension and loss of consciousness. Although the patient was regularly taking other medications, such as fluoxetine, naproxen, and prednisolone, she explicitly clarified that these were not the substances involved in her overdose. Early investigations showed hypokalemia (2.4 mEq/L), hypocalcemia (7.5 mg/dL), and hypoglycemia (65 mg/dL). She was also diagnosed with metabolic acidosis and respiratory alkalosis. The electrocardiogram showed changes in favor of hypokalemia; other lab tests were run on the patient. Supportive treatments were applied, including rapid intravenous fluid dextrose 5%, normal saline, potassium chloride 30 mEq, and calcium gluconate 100 mg. The patient was managed and monitored overnight in the emergency room and recovered without residual side effects. CONCLUSION Hydroxychloroquine and azathioprine toxicity are considered rare, but it is likely to increase in frequency given the prevalence and increase in autoimmune diseases and the increasing usage of these drugs in treating such diseases. We found hypocalcemia as the presentation to this patient, which needs further investigation into the probable mechanism. Clinicians need to consider the unique effects of hydroxychloroquine and azathioprine poisoning and initiate appropriate emergency interventions to improve the outcomes in similar patients.
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Affiliation(s)
- Alireza Kooshki
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Michigan Poison & Drug Information Center, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.
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Bhargava J, Viswanathan S. Incidence, Risk Factors and Prognosis of Hypokalaemia in Patients with Normokalaemia at Hospital Admission. Indian J Endocrinol Metab 2023; 27:537-543. [PMID: 38371186 PMCID: PMC10871015 DOI: 10.4103/ijem.ijem_159_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/11/2023] [Accepted: 06/25/2023] [Indexed: 02/20/2024] Open
Abstract
Background Hypokalaemia (K+<3.5 mmol/L) is observed in 20% of hospitalised patients. Previous studies have often dealt with the symptoms, prevalence and risk factors in hospitalised patients. Very few studies have dealt with hospital-induced hypokalaemia. The aim was to determine the incidence, predisposing risk factors and prognosis of patients developing hypokalaemia after admission. Materials and Methods A prospective observational study was performed for two months. Patients with at least two potassium values after admission and normal K values at admission were considered for inclusion. Clinical features, diagnoses, laboratory reports and treatment details, including antibiotics, were noted. Results A total of 653 patients were studied; 138 (21.1%) developed hypokalaemia. Diabetes, ischaemic heart disease (IHD), heart failure, chronic kidney disease, hypertension, chronic liver disease and chronic obstructive pulmonary disease (COPD) were the most associated comorbidities. Urea, creatinine, transaminases and neutrophilia at admission differed significantly between those with and without hypokalaemia groups. Most patients developed mild hypokalaemia (78.2%). Hypokalaemia developed mostly on the second (22.4%) and third (24.6%) days of hospitalisation. Antibiotics were used in 60% of patients. The potassium values returned to normal within 2.5 ± 1.9 days. Three patients subsequently developed hyperkalaemia. Conclusion Patients admitted under general medicine mostly developed mild hypokalaemia, even if they had multiple risk factors for developing hypokalaemia. Inpatient hypokalaemia had an incidence of 21%. An overwhelming majority (~88%) had at least one risk factor. Hypokalaemia was not attributed to causing mortality in any patient.
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Affiliation(s)
- Jakka Bhargava
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry, India
| | - Stalin Viswanathan
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry, India
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Pejčić AV. Acute Hydroxychloroquine Overdose: A Review of Published Pediatric Cases With Confirmed Hydroxychloroquine Exposure. Pediatr Emerg Care 2022; 38:174-182. [PMID: 34570079 DOI: 10.1097/pec.0000000000002547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This review aimed to explore and summarize information from available cases of pediatric acute hydroxychloroquine overdose with confirmed hydroxychloroquine exposure to give the clinicians a helpful perspective for its better recognition and management. METHODS Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, EBSCO and Serbian Citation Index. The abstracts from 2 toxicology conferences were manually checked for additional relevant publications, as well as reference lists of the retrieved publications. Descriptive statistics, narrative summation, and tabulation of the extracted data were made. RESULTS Nine publications and a total of 9 patients were included in the review. Reported age of the patients varied from 2.5 to 16 years (median, 16 years). There were more female patients (77.8%). Estimated total ingested hydroxychloroquine dose was reported in 7 cases (77.8%), and it ranged from 4.0 to 20.0 g (median: 12.0 g). Four patients (44.4%) ingested hydroxychloroquine with a coingestant. Altered mental status (100.0%), cardiotoxicity (88.9%), hypotension (77.8%), and hypokalemia (55.6%) were the most commonly reported clinical manifestations. The majority of the patients were hospitalized (88.9%). More than half of the patients (55.6%) were reported to be treated in the intensive care unit. Most frequently reported therapeutic measures were the following: administration of intravenous fluids/infusions (77.8%), vasopressors (77.8%), bicarbonate therapy-sodium bicarbonate (66.7%), potassium replacement (55.6%), and intubation/ventilation (55.6%). Three patients (33.3%) died. CONCLUSIONS Management of acute hydroxychloroquine overdose in children should be symptomatic and tailored to observed clinical manifestations. There is a need for additional investigations to better understand the impact and effectiveness of various treatment options.
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Affiliation(s)
- Ana V Pejčić
- From the Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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In silico detection of potential inhibitors from vitamins and their derivatives compounds against SARS-CoV-2 main protease by using Molecular Docking, Molecular Dynamic simulation and ADMET profiling. J Mol Struct 2022; 1258:132652. [PMID: 35194243 PMCID: PMC8855669 DOI: 10.1016/j.molstruc.2022.132652] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/25/2022]
Abstract
COVID-19 is a new infectious disease caused by SARS-COV-2 virus of the coronavirus Family. The identification of drugs against this serious infection is a significant requirement due to the rapid rise in the positive cases and deaths around the world. With this concept, a molecular docking analysis for vitamins and their derivatives (28 molecules) with the active site of SARS-CoV-2 main protease was carried out. The results of molecular docking indicate that the structures with best binding energy in the binding site of the studied enzyme (lowest energy level) are observed for the compounds; Folacin, Riboflavin, and Phylloquinone oxide (Vitamin K1 oxide). A Molecular Dynamic simulation was carried out to study the binding stability for the selected vitamins with the active site of SARS-CoV-2 main protease enzyme. Molecular Dynamic shows that Phylloquinone oxide and Folacin are quite unstable in binding to SARS-CoV-2 main protease, while the Riboflavin is comparatively rigid. The higher fluctuations in Phylloquinone oxide and Folacin indicate that they may not fit very well into the binding site. As expected, the Phylloquinone oxide exhibits small number of H-bonds with protein and Folacin does not form a good interaction with protein. Riboflavin exhibits the highest number of Hydrogen bonds and forms consistent interactions with protein. Additionally, this molecule respect the conditions mentioned in Lipinski's rule and have acceptable ADMET proprieties which indicates that Riboflavin (Vitamin B2) could be interesting for the antiviral treatment of COVID-19.
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Monteil-Ganière C, Le Carpentier E, Deslandes G, Bellouard R. Interférence analytique de l’hydroxychloroquine dans la recherche qualitative de la buprénorphine dans les urines. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oliveira S. Silva J, Sant'Anna MVS, Gevaerd A, Lima JBS, Monteiro MDS, Carvalho SWMM, Midori Sussuchi E. A Novel Carbon Nitride Nanosheets‐based Electrochemical Sensor for Determination of Hydroxychloroquine in Pharmaceutical Formulation and Synthetic Urine Samples. ELECTROANAL 2021. [DOI: 10.1002/elan.202100170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jonatas Oliveira S. Silva
- Grupo de Pesquisa em Sensores Eletroquímicos e (nano)Materiais (SEnM) Laboratório de Corrosão e Nanotecnologia (LCNT) Núcleo de Competência em Petróleo e Gás de Sergipe (NUPEG) Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
| | - Mércia V. S. Sant'Anna
- Grupo de Pesquisa em Sensores Eletroquímicos e (nano)Materiais (SEnM) Laboratório de Corrosão e Nanotecnologia (LCNT) Núcleo de Competência em Petróleo e Gás de Sergipe (NUPEG) Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
- Programa de Pós-Graduação em Química Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
| | - Ava Gevaerd
- Hilab Rua José Altair Possebom, 800 CEP 81.270-185 Curitiba PR Brazil
| | - Jéssica B. S. Lima
- Grupo de Pesquisa em Sensores Eletroquímicos e (nano)Materiais (SEnM) Laboratório de Corrosão e Nanotecnologia (LCNT) Núcleo de Competência em Petróleo e Gás de Sergipe (NUPEG) Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
- Departamento de Ciências Exatas Universidade Estadual de Feira de Santana – UEFS CEP 44.036-900 Feira de Santana BA Brazil
| | - Michael D. S. Monteiro
- Grupo de Pesquisa em Sensores Eletroquímicos e (nano)Materiais (SEnM) Laboratório de Corrosão e Nanotecnologia (LCNT) Núcleo de Competência em Petróleo e Gás de Sergipe (NUPEG) Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
- Programa de Pós-Graduação em Química Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
| | - Sanny W. M. M. Carvalho
- Grupo de Pesquisa em Sensores Eletroquímicos e (nano)Materiais (SEnM) Laboratório de Corrosão e Nanotecnologia (LCNT) Núcleo de Competência em Petróleo e Gás de Sergipe (NUPEG) Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
| | - Eliana Midori Sussuchi
- Grupo de Pesquisa em Sensores Eletroquímicos e (nano)Materiais (SEnM) Laboratório de Corrosão e Nanotecnologia (LCNT) Núcleo de Competência em Petróleo e Gás de Sergipe (NUPEG) Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
- Programa de Pós-Graduação em Química Universidade Federal de Sergipe – UFS CEP 49.100-000 São Cristóvão SE Brazil
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Khodashahi R, Naderi H, Bojdy A, Khodashahi M. Effectiveness of Antiviral and Immunomodulatory Agents in the Treatment of COVID-19: A Systematic Review. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x16999201202121247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) posed a severe threat to global health. Therefore, new findings on effective
treatment for symptomatic patients with COVID-19 are considered among emergency issues.
This systematic review investigated the effectiveness of pharmacologic interventions in the
management of patients with COVID-19. All the articles published in three electronic databases, including
Google Scholar, PubMed, and Web of Science, were searched from September 15 to
September 30, 2020. Eventually, 24 papers published till September 30 remained to be included in
this review. The effectiveness of immunomodulatory and antiviral agents in the treatment of patients
with COVID-19 was assessed in this review. The obtained results of the current review rejected
the potential of HCQ for the treatment of COVID; however, there was a clinical improvement in
patients treated with ruxolitinib in comparison to that reported for the control group. Methylprednisolone,
dexamethasone, and calcifediol were suggested as beneficial treatments for patients with
COVID-19. The potential efficacy of these antiviral drugs against the SARS-CoV-2 virus is controversial;
nevertheless, the triple combination of antiviral and immunomodulatory agents is effective
in suppressing the shedding of SARS-CoV-2. There have been no supportive data on the superiority
of favipiravir and LPV/r to standard care in the treatment of COVID-19. In addition, no difference
was observed between favipiravir and arbidol for the treatment of these patients. There was an
association between remdesivir treatment and a reduction of 5 days in clinical improvement among
COVID-19 patients. It is required to carry out further RCTs with an in-depth research basis on
COVID-19.
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Affiliation(s)
- Rozita Khodashahi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Naderi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Bojdy
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mandana Khodashahi
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Fram G, Wang DD, Malette K, Villablanca P, Kang G, So K, Basir MB, Khan A, McKinnon JE, Zervos M, O’Neill WW. Cardiac Complications Attributed to Hydroxychloroquine: A Systematic Review of the Literature Pre-COVID-19. Curr Cardiol Rev 2021; 17:319-327. [PMID: 33059567 PMCID: PMC8640856 DOI: 10.2174/1573403x16666201014144022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Hydroxychloroquine has been used for rheumatological diseases for many decades and is considered a safe medication. With the COVID-19 outbreak, there has been an increase in reports associating cardiotoxicity with hydroxychloroquine. It is unclear if the cardiotoxic profile of hydroxychloroquine is previously underreported in the literature or is it a manifestation of COVID-19 and therapeutic interventions. This manuscript evaluates the incidence of cardiotoxicity associated with hydroxychloroquine prior to the onset of COVID-19. METHODS PubMED, EMBASE, and Cochrane databases were searched for keywords derived from MeSH terms prior to April 9, 2020. Inclusion eligibility was based on appropriate reporting of cardiac conditions and study design. RESULTS A total of 69 articles were identified (58 case reports, 11 case series). The majority (84%) of patients were female, with a median age of 49.2 (range 16-92) years. 15 of 185 patients with cardiotoxic events were in the setting of acute intentional overdose. In acute overdose, the median ingestion was 17,857 ± 14,873 mg. 2 of 15 patients died after acute intoxication. In patients with long-term hydroxychloroquine use (10.5 ± 8.9 years), new onset systolic heart failure occurred in 54 of 155 patients (35%) with median cumulative ingestion of 1,493,800 ± 995,517 mg. The majority of patients improved with the withdrawal of hydroxychloroquine and standard therapy. CONCLUSION Millions of hydroxychloroquine doses are prescribed annually. Prior to the COVID-19 pandemic, cardiac complications attributed to hydroxychloroquine were uncommon. Further studies are needed to understand the impact of COVID-19 on the cardiovascular system to understand the presence or absence of potential medication interactions with hydroxychloroquine in this new pathophysiological state.
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Affiliation(s)
- Georgi Fram
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - Dee D. Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - Kelly Malette
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - Pedro Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - Guson Kang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - Kent So
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - Mir B. Basir
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - Arfaat Khan
- Section of Cardiac Electrophysiology, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
| | - John E. McKinnon
- Divison of Infectious Disease, Henry Ford Health System, Detroit, MMichigan, MI 48202, USA
| | - Marcus Zervos
- Divison of Infectious Disease, Henry Ford Health System, Detroit, MMichigan, MI 48202, USA
| | - William W. O’Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, MI 48202, USA
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Sadr MS, Heydarinasab A, Panahi HA, Javan RS. Production and characterization of biocompatible nano‐carrier based on
Fe
3
O
4
for magnetically hydroxychloroquine drug delivery. POLYM ADVAN TECHNOL 2020. [DOI: 10.1002/pat.5110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mahshad Sadat Sadr
- Department of Petroleum and Chemical Engineering, Science and Research Branch Islamic Azad University Tehran Iran
| | - Amir Heydarinasab
- Department of Petroleum and Chemical Engineering, Science and Research Branch Islamic Azad University Tehran Iran
| | - Homayon Ahmad Panahi
- Department of Chemistry, Central Tehran Branch Islamic Azad University Tehran Iran
| | - Raheleh Safaie Javan
- Department of Biology, Varamin‐Pishva Branch Islamic Azad University Varamin Iran
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Wang M, Wu T, Zuo Z, You Y, Yang X, Pan L, Hu Y, Luo X, Jiang L, Xia Z, Deng M. Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis. BMJ Support Palliat Care 2020; 11:45-52. [PMID: 32958501 DOI: 10.1136/bmjspcare-2020-002554] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Because of the lack of vaccination, it is urgent to find effective antiviral agents for COVID-19 treatment. METHOD Online databases were searched for articles published before or on 22 June 2020. Studies reporting the effectiveness and safety of antiviral agents for COVID-19 were analysed. RESULTS A total of 42 studies were included in this analysis. Hydroxychloroquine (HCQ) was not associated with the incidence of death (risk ratio (RR)=1.08; 95% CI 0.81 to 1.44) and severe cases (RR=1.05; 95% CI 0.61 to 1.81). Patients treated with HCQ obtained few benefits with respect to the clearance of viral RNA and were more likely to have adverse reactions. HCQ treatment could shorten the body temperature recovery time (weighted mean difference = -1.04; 95% CI -1.64 to -0.45). Lopinavir/ritonavir (LPV/r) (RR=0.90; 95% CI 0.76 to 1.07) and Arbidol (RR=1.09; 95% CI 0.92 to 1.29) were not associated with the negative conversion rate. Integrative Chinese-Western medicine alleviated clinical symptoms and decreased the incidence of severe cases (RR=0.38; 95% CI 0.25 to 0.59). Remdesivir treatment reduced the 14-day mortality rate of patients with severe COVID-19 (RR=0.64; 95% CI 0.44 to 0.94). Convalescent plasma (CP) tended to increase the negative conversion rate (RR=2.47; 95% CI 1.70 to 3.57). CONCLUSION HCQ, LPV/r and Arbidol bring little benefit in COVID-19 treatment. Integrative Chinese-Western medicine improved the clinical symptoms of patients with COVID-19. Remdesivir and CP might be the potential treatments for patients with severe COVID-19. However, large-scale clinical randomised trials are needed to validate our conclusions.
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Affiliation(s)
- Meng Wang
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.,Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China.,Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Ting Wu
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.,Hunan Province Key Laboratory of Basic and Applied Hematology, Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.,Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Zhihong Zuo
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.,Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Yaxian You
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
| | - Xinyuan Yang
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.,Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Liangyu Pan
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
| | - Ying Hu
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
| | - Xuan Luo
- Hunan Yuanpin Cell Biotechnology Co., Ltd, Changsha, Hunan 410129, China
| | - Liping Jiang
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Zanxian Xia
- Hunan Province Key Laboratory of Basic and Applied Hematology, Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.,Department of Cell Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
| | - Meichun Deng
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China .,Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China.,Hunan Province Key Laboratory of Basic and Applied Hematology, Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
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Belhassan A, En-Nahli F, Zaki H, Lakhlifi T, Bouachrine M. Assessment of effective imidazole derivatives against SARS-CoV-2 main protease through computational approach. Life Sci 2020; 262:118469. [PMID: 32956664 PMCID: PMC7499150 DOI: 10.1016/j.lfs.2020.118469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
Because of the fast increase in deaths due to Corona Viral Infection in majority region in the world, the detection of drugs potent of this infection is a major need. With this idea, docking study was executed on eighteen imidazole derivatives based on 7-chloro-4-aminoquinoline against novel Coronavirus (SARS-CoV-2). In this study, we carried out a docking study of these molecules in the active site of SARS-CoV-2 main protease. The result indicate that Molecules N° 3, 7 and 14 have more binding energy with SARS-CoV-2 main protease recently crystallized (pdb code 6LU7) in comparison with the other imidazole derivatives and the two drug; Chloroquine and hydroxychloroquine. Because of the best energy of interaction, these three molecules could have the most potential antiviral treatment of COVID-19 than the other studied compounds. The structures with best affinity in the binding site of the protease have more than 3 cycles and electronegative atoms in the structure. This may increase the binding affinity of these molecules because of formation of π-bonds, halogen interactions and/or Hydrogen bond interactions between compounds and the enzyme. So, compounds with more cycles and electronegative atoms could have a potent inhibition of SARS-CoV-2 main protease.
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Affiliation(s)
- Assia Belhassan
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco
| | - Fatima En-Nahli
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco
| | - Hanane Zaki
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco
| | - Tahar Lakhlifi
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco
| | - Mohammed Bouachrine
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco; EST Khenifra, Sultan Moulay Sliman University, Benimellal, Morocco.
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13
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Nicol MR, Joshi A, Rizk ML, Sabato PE, Savic RM, Wesche D, Zheng JH, Cook J. Pharmacokinetics and Pharmacological Properties of Chloroquine and Hydroxychloroquine in the Context of COVID-19 Infection. Clin Pharmacol Ther 2020; 108:1135-1149. [PMID: 32687630 PMCID: PMC7404755 DOI: 10.1002/cpt.1993] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Chloroquine and hydroxychloroquine are quinoline derivatives used to treat malaria. To date, these medications are not approved for the treatment of viral infections, and there are no well‐controlled, prospective, randomized clinical studies or evidence to support their use in patients with coronavirus disease 2019 (COVID‐19). Nevertheless, chloroquine and hydroxychloroquine are being studied alone or in combination with other agents to assess their effectiveness in the treatment or prophylaxis for COVID‐19. The effective use of any medication involves an understanding of its pharmacokinetics, safety, and mechanism of action. This work provides basic clinical pharmacology information relevant for planning and initiating COVID‐19 clinical studies with chloroquine or hydroxychloroquine, summarizes safety data from healthy volunteer studies, and summarizes safety data from phase II and phase II/III clinical studies in patients with uncomplicated malaria, including a phase II/III study in pediatric patients following administration of azithromycin and chloroquine in combination. In addition, this work presents data describing the proposed mechanisms of action against the severe acute respiratory distress syndrome coronavirus–2 and summarizes clinical efficacy to date.
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Affiliation(s)
- Melanie R Nicol
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abhay Joshi
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Matthew L Rizk
- Quantitative Pharmacology and Pharmacometrics, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Philip E Sabato
- Quantitative Pharmacology and Pharmacometrics, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Radojka M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Jenny H Zheng
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jack Cook
- Clinical Pharmacology Department, Global Product Development, Pfizer Inc, Groton, Connecticut, USA
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14
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Heron RC, Chiu WW. Hydroxy-chloroquine Interference in Common Biochemistry Laboratory Assays. J Appl Lab Med 2020; 5:1130-1137. [PMID: 32602897 DOI: 10.1093/jalm/jfaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | - Wai Weldon Chiu
- LabPLUS, Auckland City Hospital, Auckland DHB, Auckland, New Zealand.,Middlemore Hospital Lab, Counties Manukau Health, Auckland, New Zealand
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15
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Eljaaly K, Alireza KH, Alshehri S, Al-Tawfiq JA. Hydroxychloroquine safety: A meta-analysis of randomized controlled trials. Travel Med Infect Dis 2020; 36:101812. [PMID: 32645478 PMCID: PMC7342171 DOI: 10.1016/j.tmaid.2020.101812] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 12/23/2022]
Abstract
Background Hydroxychloroquine (HCQ) is currently being examined for COVID-19. No previous meta-analysis has evaluated its side effects versus placebo. We conducted this meta-analysis to compare the safety of HCQ versus placebo. Methods Two authors independently searched PubMed and EMBASE databases for randomized controlled trials (RCTs) of adults comparing the adverse events (AEs) of HCQ versus placebo for any indication. Peto odds ratios (Peto ORs) and 95% confidence intervals (CIs) were calculated based on random-effects models. The heterogeneity (I2) was assessed using Cochran's Q test. Results Nine RCTs (eight were double-blind) with a total of 916 patients were included. HCQ caused significantly more skin pigmentation than placebo (Peto OR, 4.64; 95% CI, 1.13 to 19.00; P-value = 0.033; I2 = 0%). The increase in other AEs did not reach statistical significance: rash (Peto OR, 1.11; 95% CI, 0.3 to 3.77; P-value = 0.03; I2 = 0%); gastrointestinal AEs (Peto OR, 1.43; 95% CI, 0.55 to 3.72; P-value = 0.46; I2 = 15.17%); headache (Peto OR, 1.94; 95% CI, 0.65 to 5.78; P-value = 0.23; I2 = 9.99%); dizziness (Peto OR, 1.32; 95% CI, 0.49 to 3.52; P-value = 0.58; I2 = 0%); fatigue (Peto OR, 2.13; 95% CI, 0.76 to 5.98; P-value = 0.15; I2 = 0%); and visual AEs (Peto OR, 1.61; 95% CI, 0.76 to 3.41; P-value = 0.22; I2 = 0%). Cardiac toxicity was not reported. Conclusions This meta-analysis of RCTs found a significantly higher risk of skin pigmentation in HCQ users versus placebo. More data are needed to evaluate HCQ in the context of COVID-19 treatment.
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Affiliation(s)
- Khalid Eljaaly
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | | | - Samah Alshehri
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Wu T, Zuo Z, Kang S, Jiang L, Luo X, Xia Z, Liu J, Xiao X, Ye M, Deng M. Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis. Aging Dis 2020; 11:874-894. [PMID: 32765952 PMCID: PMC7390520 DOI: 10.14336/ad.2020.0520] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023] Open
Abstract
This study aimed to provide systematic evidence for the association between multiorgan dysfunction and COVID-19 development. Several online databases were searched for articles published until May 13, 2020. Two investigators independently selected trials, extracted data, and evaluated the quality of individual trials. Single-arm meta-analysis was performed to summarize the clinical features of confirmed COVID-19 patients. Fixed effects meta-analysis was performed for clinically relevant parameters that were closely related to the patients' various organ functions. A total of 73 studies, including 171,108 patients, were included in this analysis. The overall incidence of severe COVID-19 and mortality were 24% (95% confidence interval [CI], 20%-28%) and 2% (95% CI, 1%-3%), respectively. Patients with hypertension (odds ratio [OR] = 2.40; 95% CI, 2.08-2.78), cardiovascular disease (CVD) (OR = 3.54; 95% CI, 2.68-4.68), chronic obstructive pulmonary disease (COPD) (OR=3.70; 95% CI, 2.93-4.68), chronic liver disease (CLD) (OR=1.48; 95% CI, 1.09-2.01), chronic kidney disease (CKD) (OR = 1.84; 95% CI, 1.47-2.30), chronic cerebrovascular diseases (OR = 2.53; 95% CI, 1.84-3.49) and chronic gastrointestinal (GI) disease (OR = 2.13; 95% CI, 1.12-4.05) were more likely to develop severe COVID-19. Increased levels of lactate dehydrogenase (LDH), creatine kinase (CK), high-sensitivity cardiac troponin I (hs-cTnI), myoglobin, creatinine, urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin were highly associated with severe COVID-19. The incidence of acute organ injuries, including acute cardiac injury (ACI); (OR = 11.87; 95% CI, 7.64-18.46), acute kidney injury (AKI); (OR=10.25; 95% CI, 7.60-13.84), acute respiratory distress syndrome (ARDS); (OR=27.66; 95% CI, 18.58-41.18), and acute cerebrovascular diseases (OR=9.22; 95% CI, 1.61-52.72) was more common in patients with severe COVID-19 than in patients with non-severe COVID-19. Patients with a history of organ dysfunction are more susceptible to severe conditions. COVID-19 can aggravate an acute multiorgan injury.
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Affiliation(s)
- Ting Wu
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
| | - Zhihong Zuo
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
| | - Shuntong Kang
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
| | - Liping Jiang
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
| | - Xuan Luo
- Hunan Yuanpin Cell Biotechnology Co., Ltd, Hunan 410129, China.
| | - Zanxian Xia
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha 410013, China.
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha 410013, China.
| | - Jing Liu
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
| | - Xiaojuan Xiao
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
| | - Mao Ye
- Molecular Science and Biomedicine Laboratory, State Key Laboratory for Chemo/Biosensing and Chemometrics, College of Biology, College of Chemistry and Chemical Engineering, Collaborative Innovation Center for Molecular Engineering for Theranostics, Hunan University, Changsha, China
| | - Meichun Deng
- Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
- Xiangya School of Medicine, Central South University, Hunan 410013, China.
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha 410013, China.
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17
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Aksel G, Islam MM, Aslan T, Eroglu SE. Prolongation of QT interval due to hydroxychloroquine overdose used in COVID-19 treatment. Turk J Emerg Med 2020; 20:149-151. [PMID: 32832735 PMCID: PMC7416852 DOI: 10.4103/2452-2473.290063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022] Open
Abstract
Hydroxychloroquine is one of the most commonly used drugs in COVID-19 treatment. In this case report, we aimed to present a young patient whose QT interval was prolonged due to hydroxychloroquine overdose which was given for COVID-19 treatment. This is the first reported case of QT interval prolongation at a low dose of 1.600 mg in the literature. A 28-year-old male patient was admitted to the emergency department with the complaints of nausea, diarrhea, and weakness. The patient was diagnosed with COVID-19 a day prior and home isolation was recommended with hydroxychloroquine and oseltamivir P. O. treatment. His complaints started 6 h after accidentally taking 1.600 mg of hydroxychloroquine P. O. at the same time. On physical examination, the Glasgow Coma Scale was 15, and neurological, respiratory, and abdominal examinations were normal. His pulse was 54 beats/min, oxygen saturation was 99%, arterial blood pressure was 122/82 mmHg, and fever was 36.5°C. Electrocardiography (ECG) showed sinus bradycardia and corrected QT interval was calculated as 510 ms. The QT interval prolongation and bradycardia persisted, and the patient was hospitalized for follow-up and treatment. He was discharged on the 3rd day of his hospitalization after the corrected QT interval was detected to be 420 ms and his bradycardia improved. Due to the potential cardiac side effects, patients who are sent to home isolation with treatment should be educated about the use, dosage, and possible side effects of this medicine, and serial ECG monitoring should be provided to patients who are hospitalized.
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Affiliation(s)
- Gökhan Aksel
- Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Muzaffer Islam
- Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Tuncay Aslan
- Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Serkan Emre Eroglu
- Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
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18
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Belhassan A, Chtita S, Zaki H, Lakhlifi T, Bouachrine M. Molecular docking analysis of N-substituted Oseltamivir derivatives with the SARS-CoV-2 main protease. Bioinformation 2020; 16:404-410. [PMID: 32831522 PMCID: PMC7434956 DOI: 10.6026/97320630016404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022] Open
Abstract
The identification of chemotherapeutic drugs against Novel Coronavirus (2019-nCoV) is a significant requirement due to the rapid rise in deaths due to Corona Viral Infection all
around the world. Therefore, it is of interest to document the molecular docking analysis data of 32 N-substituted Oseltamivir derivatives inhibitors of influenza virus H5N1 with the
Novel Coronavirus main protease (2019-nCoV). We describe the optimal binding features of Oseltamivir derivatives with the SARS-Cov-2 main protease (Code PDB: 6LU7) for further consideration.
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Affiliation(s)
- Assia Belhassan
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco
| | - Samir Chtita
- Laboratory of physical chemistry and materials, Faculty of science Ben M'Sik, Hassan II University of Casablanca, Casablanca, Morocco
| | - Hanane Zaki
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco
| | - Tahar Lakhlifi
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco
| | - Mohammed Bouachrine
- Molecular Chemistry and Natural Substances Laboratory, Faculty of Science, Moulay Ismail University of Meknes, Morocco.,EST Khenifra, Sultan Moulay Sliman University, Benimellal, Morocco
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19
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Bauman JL, Tisdale JE. Chloroquine and Hydroxychloroquine in the Era of SARS – CoV2: Caution on Their Cardiac Toxicity. Pharmacotherapy 2020; 40:387-388. [DOI: 10.1002/phar.2387] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jerry L. Bauman
- Pharmacotherapy Publications and University of Illinois College of Pharmacy Chicago Illinois
| | - James E. Tisdale
- Purdue University College of Pharmacy and Indiana University School of Medicine Indianapolis Indiana
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20
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Xu L, Chockalingam A, Stewart S, Shea K, Matta MK, Narayanasamy S, Pilli NR, Volpe DA, Weaver J, Zhu H, Davis MC, Rouse R. Developing an animal model to detect drug-drug interactions impacting drug-induced respiratory depression. Toxicol Rep 2020; 7:188-197. [PMID: 32021808 PMCID: PMC6994827 DOI: 10.1016/j.toxrep.2020.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/28/2022] Open
Abstract
Opioids and benzodiazepines were frequently co-prescribed to patients with pain and psychiatric or neurological disorders; however, co-prescription of these drugs increased the risk for severe respiratory depression and death. Consequently, the U.S. Food and Drug Administration added boxed label warnings describing this risk for all opioids and benzodiazepines. Sedating psychotropic drugs with differing mechanisms of action (e.g., antipsychotics, antidepressants, non-benzodiazepine sedative-hypnotics, etc.) may be increasingly prescribed in place of benzodiazepines. Despite being marketed for years, many sedating psychotropic drugs have neither human nor animal data that quantify or qualify the potential for causing respiratory depression, either alone or in combination with an opioid. In this study, diazepam was selected as the benzodiazepine to detect any additive or synergistic effects on respiratory depression caused by the opioid, oxycodone. Pharmacokinetic studies were conducted at three doses with oxycodone (6.75, 60, 150 mg/kg) and with diazepam (2, 20, 200 mg/kg). Dose dependent decrease in arterial partial pressure of oxygen and increase in arterial partial pressure of carbon dioxide were observed with oxycodone. Diazepam caused similar partial pressure changes only at the highest dose. Further decreases in arterial partial pressure of oxygen and increases in arterial partial pressure of carbon dioxide consistent with exacerbated respiratory depression were observed in rats co-administered oxycodone 150 mg/kg and diazepam 20 mg/kg. These findings confirm previous literature reports of exacerbated opioid-induced respiratory depression with benzodiazepine and opioid co-administration and support the utility of this animal model for assessing opioid-induced respiratory depression and its potential exacerbation by co-administered drugs.
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Affiliation(s)
- Lin Xu
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Ashok Chockalingam
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Sharron Stewart
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Katherine Shea
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Murali K. Matta
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Suresh Narayanasamy
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Nageswara R. Pilli
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Donna A. Volpe
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - James Weaver
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Hao Zhu
- Division of Pharmacometrics, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Michael C. Davis
- Division of Psychiatry Products, Office of Drug Evaluation I, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
| | - Rodney Rouse
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Silver Spring, Maryland, USA
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21
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Kingery JM, Radke JB, Maakestad J, Krasowski MD. Data on hydroxychloroquine interference with urine laboratory testing. Data Brief 2019; 27:104781. [PMID: 31799344 PMCID: PMC6881646 DOI: 10.1016/j.dib.2019.104781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 11/16/2022] Open
Abstract
Hydroxychloroquine is a medication used to treat rheumatoid arthritis, systemic lupus erythematosus, and other autoimmune disorders. Previous studies have shown that hydroxychloroquine and the structurally related drug chloroquine have the potential to interfere with some common urine chemistry tests, especially at high concentrations. In the related research article, we observed suspected interference with urine drug of abuse testing in a patient who ingested approximately 12 g of hydroxychloroquine in an acute overdose, with urine hydroxychloroquine concentrations exceeding 500 mg/L. This case prompted a more detailed investigation of the effects of hydroxychloroquine spiked into pooled de-identified urine specimens from a hospital clinical laboratory. The data in this article provides the raw data for 24 urine assays that were investigated. The analyzed data is provided in the tables included in this article. The dataset reported is related to the research article entitled “Diagnostic Pitfalls and Laboratory Test Interference After Hydroxychloroquine Intoxication: A Case Report” [1].
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Affiliation(s)
- Jennie M Kingery
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Joshua B Radke
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jon Maakestad
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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