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Wu Y, Li Y, Zhou Y, Bai X, Liu Y. Bioinformatics and systems-biology approach to identify common pathogenic mechanisms for COVID-19 and systemic lupus erythematosus. Autoimmunity 2024; 57:2304826. [PMID: 38332666 DOI: 10.1080/08916934.2024.2304826] [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: 07/06/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has brought a heavy burden to the world, interestingly, it shares many clinical symptoms with systemic lupus erythematosus (SLE). It is unclear whether there is a similar pathological process between COVID-9 and SLE. In addition, we don't know how to treat SLE patients with COVID-19. In this study, we analyse the potential similar pathogenesis between SLE and COVID-19 and explore their possible drug regimens using bioinformatics and systems biology approaches. METHODS The common differentially expressed genes (DEGs) were extracted from the COVID-19 datasets and the SLE datasets for functional enrichment, pathway analysis and candidate drug analysis. RESULT Based on the two transcriptome datasets between COVID-19 and SLE, 325 common DEGs were selected. Hub genes were identified by protein-protein interaction (PPI) analysis. few found a variety of similar functional changes between COVID-19 and SLE, which may be related to the pathogenesis of COVID-19. Besides, we explored the related regulatory networks. Then, through drug target matching, we found many candidate drugs for patients with COVID-19 only or COVID-19 combined with SLE. CONCLUSION COVID-19 and SLE patients share many common hub genes, related pathways and regulatory networks. Based on these common targets, we found many potential drugs that could be used in treating patient with COVID-19 or COVID-19 combined with SLE.
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Affiliation(s)
- Yinlan Wu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yanhong Li
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhou
- Department of Respiratory and Critical Care Medicine, Chengdu First People's Hospital, Chengdu, China
| | - Xiufeng Bai
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Human Disease and Immunotherapies, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Akpoviroro O, Sauers NK, Uwandu Q, Castagne M, Akpoviroro OP, Humayun S, Mirza W, Woodard J. Severe COVID-19 infection: An institutional review and literature overview. PLoS One 2024; 19:e0304960. [PMID: 39163410 PMCID: PMC11335168 DOI: 10.1371/journal.pone.0304960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 05/21/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes. METHODS A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality. RESULTS Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%. CONCLUSION Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.
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Affiliation(s)
- Ogheneyoma Akpoviroro
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Nathan Kyle Sauers
- Department of Engineering, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Myriam Castagne
- Clinical & Translational Science Institute, Boston University, Boston, Massachusetts, United States of America
| | | | - Sara Humayun
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Wasique Mirza
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Jameson Woodard
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
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Wang H, Li X, Zhang Q, Fu C, Jiang W, Xue J, Liu S, Meng Q, Ai L, Zhi X, Deng S, Liang W. Autophagy in Disease Onset and Progression. Aging Dis 2024; 15:1646-1671. [PMID: 37962467 PMCID: PMC11272186 DOI: 10.14336/ad.2023.0815] [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: 05/03/2023] [Accepted: 08/15/2023] [Indexed: 11/15/2023] Open
Abstract
Autophagy is a biological phenomenon whereby components of cells can self-degrade using autophagosomes. During this process, cells can clear dysfunctional organelles or unwanted elements. Autophagy can recycle unnecessary biomolecules into new components or sometimes, even destroy the cells themselves. This cellular process was first observed in 1962 by Keith R. Porter et al. Since then, autophagy has been studied for over 60 years, and much has been learned on the topic. Nevertheless, the process is still not fully understood. It has been proven, for example, that autophagy can be a positive force for maintaining good health by removing older or damaged cells. By contrast, autophagy is also involved in the onset and progression of various conditions caused by pathogenic infections. These diseases generally involve several important organs in the human body, including the liver, kidney, heart, and central nervous system. The regulation of the defects of autophagy defects may potentially be used to treat some diseases. This review comprehensively discusses recent research frontiers and topics of interest regarding autophagy-related diseases.
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Affiliation(s)
- Hao Wang
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China.
| | - Xiushen Li
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China.
| | - Qi Zhang
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China.
| | - Chengtao Fu
- School of Medicine, Huzhou University, Zhejiang, China.
| | - Wenjie Jiang
- Department of Artificial Intelligence and Data Science, Hebei University of Technology, Tianjin, China.
| | - Jun Xue
- Department of General Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China.
| | - Shan Liu
- Bioimaging Core of Shenzhen Bay Laboratory Shenzhen, China.
| | - Qingxue Meng
- Technology Department, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China.
| | - Lisha Ai
- Department of Teaching and Research, Shenzhen University General Hospital, Shenzhen, Guangdong, China.
| | - Xuejun Zhi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China.
| | - Shoulong Deng
- National Health Commission of China (NHC) Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China.
| | - Weizheng Liang
- Central Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China.
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Garcia MC, Tsang KL, Lohit S, Deng J, Schneider T, Matos Silva J, Mbuagbaw L, Holbrook A. Hydroxychloroquine-Chloroquine, QT-Prolongation, and Major Adverse Cardiac Events: A Meta-analysis and Scoping Review. Ann Pharmacother 2024; 58:742-755. [PMID: 37881891 DOI: 10.1177/10600280231204969] [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] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the high-quality literature on the frequency and nature of major adverse cardiac events (MACE) associated with either hydroxychloroquine (HCQ) or chloroquine (CQ). DATA SOURCES We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central from 1996 onward using search strategies created in collaboration with medical science librarians. STUDY SELECTION AND DATA EXTRACTION Randomized controlled trials (RCTs) published in English language from January 1996 to September 2022, involving adult patients at least 18 years of age, were selected. Outcomes of interest were death, arrhythmias, syncope, and seizures. Random-effects meta-analyses were performed with a Treatment Arm Continuity Correction for single and double zero event studies. DATA SYNTHESIS By study drug, there were 31 HCQ RCTs (n = 6677), 9 CQ RCTs (n = 622), and 1 combined HCQ-CQ trial (n = 105). Mortality was the most commonly reported MACE at 220 of 255 events (86.3%), with no reports of torsades de pointes or sudden cardiac death. There was no increased risk of MACE with exposure to HCQ-CQ compared with control (risk ratio [RR] = 0.90, 95% CI = 0.69-1.17, I2 = 0%). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE These findings have important implications with respect to patient reassurance and updated guidance for prescribing practices of these medications. CONCLUSIONS Despite listing as QT-prolonging meds, HCQ-CQ did not increase the risk of MACE.
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Affiliation(s)
- Michael Cristian Garcia
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kai La Tsang
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Simran Lohit
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jiawen Deng
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tyler Schneider
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jessyca Matos Silva
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Anne Holbrook
- Clinical Pharmacology & Toxicology Research Group, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, St. Joseph's Healthcare, Hamilton, ON, Canada
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Pacheco G, Lopes ALF, Oliveira APD, Corrêa WDRM, Lima LDB, Souza MHLPD, Teles AS, Nicolau LAD, Medeiros JVR. Comprehensive analysis of gastrointestinal side effects in COVID-19 patients undergoing combined pharmacological treatment with azithromycin and hydroxychloroquine: a systematic review and network meta-analysis. Crit Rev Toxicol 2024; 54:345-358. [PMID: 38860720 DOI: 10.1080/10408444.2024.2348169] [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: 01/29/2024] [Accepted: 04/22/2024] [Indexed: 06/12/2024]
Abstract
During the COVID-19 pandemic, several drugs were repositioned and combined to quickly find a way to mitigate the effects of the infection. However, the adverse effects of these combinations on the gastrointestinal tract are unknown. We aimed investigate whether Hydroxychloroquine (HD), Azithromycin (AZ), and Ivermectin (IV) used in combination for the treatment of COVID-19, can lead to the development of gastrointestinal disorders. This is a systematic review and network meta-analysis conducted using Stata and Revman software, respectively. The protocol was registered with PROSPERO (CRD42023372802). A search of clinical trials in Cochrane Library databases, Embase, Web of Science, Lilacs, PubMed, Scopus and Clinicaltrials.gov conducted on November 26, 2023. The eligibility of the studies was assessed based on PICO criteria, including trials that compared different treatments and control group. The analysis of the quality of the evidence was carried out according to the GRADE. Six trials involving 1,686 COVID-19 patients were included. No trials on the association of HD or AZ with IV met the inclusion criteria, only studies on the association between HD and AZ were included. Nausea, vomiting, diarrhea, abdominal pain and increased transaminases were related. The symptoms of vomiting and nausea were evaluated through a network meta-analysis, while the symptom of abdominal pain was evaluated through a meta-analysis. No significant associations with these symptoms were observed for HD, AZ, or their combination, compared to control. Low heterogeneity and absence of inconsistency in indirect and direct comparisons were noted. Limitations included small sample sizes, varied drug dosages, and potential publication bias during the pandemic peak. This review unveils that there are no associations between gastrointestinal adverse effects and the combined treatment of HD with AZ in the management of COVID-19, as compared to either the use of a control group or the administration of the drugs individually, on the other hand, highlighting the very low or low certainty of evidence for the evaluated outcomes. To accurately conclude the absence of side effects, further high-quality randomized studies are needed.
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Affiliation(s)
- Gabriella Pacheco
- Medicinal Plants Research Center (NPPM), Post-graduation Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil
| | - André Luis Fernandes Lopes
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | | | | | - Lucas Daniel Batista Lima
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | | | - Ariel Soares Teles
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
- Federal Institute of Maranhão (IFMA), Araioses, MA, Brazil
| | - Lucas Antonio Duarte Nicolau
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | - Jand Venes Rolim Medeiros
- Medicinal Plants Research Center (NPPM), Post-graduation Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
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Bhimraj A, Morgan RL, Shumaker AH, Baden L, Cheng VCC, Edwards KM, Gallagher JC, Gandhi RT, Muller WJ, Nakamura MM, O’Horo JC, Shafer RW, Shoham S, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (September 2022). Clin Infect Dis 2024; 78:e250-e349. [PMID: 36063397 PMCID: PMC9494372 DOI: 10.1093/cid/ciac724] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023] Open
Abstract
There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. The objective was to develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Based on the most recent search conducted on 31 May 2022, the IDSA guideline panel has made 32 recommendations for the treatment and management of the following groups/populations: pre- and postexposure prophylaxis, ambulatory with mild-to-moderate disease, and hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were conducted that provided much-needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved, which we hope future trials can answer.
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Affiliation(s)
- Adarsh Bhimraj
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Amy Hirsch Shumaker
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | | | - Vincent Chi Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center,Nashville, Tennessee
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania
| | - Rajesh T Gandhi
- Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - William J Muller
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, Chicago, Illinois
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John C O’Horo
- Division of Infectious Diseases, Joint Appointment Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert W Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
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Rana G, Dhiman P, Kumar A, Chauhan A, Sharma G. Recent advances in photocatalytic removal of antiviral drugs by Z-scheme and S-scheme heterojunction. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:40851-40872. [PMID: 38837030 DOI: 10.1007/s11356-024-33876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
The possible impact of antivirals on ecosystems and the emergence of antiviral resistance are the reasons for concern about their environmental release. Consequently, there has been a significant increase in curiosity regarding their presence in both organic and synthetic systems in recent years. The primary objective of this review is to address the void of information regarding the global presence of antiviral drugs in both wastewater and natural water sources. Photocatalytic degradation of pollutants is an eco-friendly, cost-effective method that effectively addresses environmental degradation. The development of efficient photocatalysts remains a significant issue in accelerating the degradation of pollutants, especially when employing solar light. Thus, the development of Z-scheme and S-scheme semiconductor heterojunctions has emerged as a viable method to improve light absorption and enhance the redox capability of photocatalysts. The principles of Z-scheme and S-scheme are reviewed extensively. The degradation route and occurrence of antiviral are discussed briefly. Finally, a short preview of the degradation of antiviral using Z-scheme and S-scheme is also highlighted.
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Affiliation(s)
- Garima Rana
- International Research Centre of Nanotechnology for Himalayan Sustainability (IRCNHS), Shoolini University, Solan, India.
| | - Pooja Dhiman
- International Research Centre of Nanotechnology for Himalayan Sustainability (IRCNHS), Shoolini University, Solan, India
| | - Amit Kumar
- International Research Centre of Nanotechnology for Himalayan Sustainability (IRCNHS), Shoolini University, Solan, India
| | - Ankush Chauhan
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, 603103, India
- Centre for Herbal Pharmacology and Environmental Sustainability, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, 603103, India
| | - Gaurav Sharma
- International Research Centre of Nanotechnology for Himalayan Sustainability (IRCNHS), Shoolini University, Solan, India
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8
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Zhaori G. Importance of sample size determination for randomized controlled clinical trials for coronavirus disease 2019 antiviral therapies. Pediatr Investig 2024; 8:7-11. [PMID: 38516140 PMCID: PMC10951484 DOI: 10.1002/ped4.12415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 03/23/2024] Open
Abstract
For the calculation of sample size for a randomized controlled clinical trial, choosing a proper, medium clinically meaningful difference in the size of the effect of the test and control interventions is important for avoiding too small or too large sample sizes.
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Affiliation(s)
- Getu Zhaori
- Editorial Office of Pediatric Investigation, Beijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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González R, Goncé A, Gil MDM, Mazarico E, Ferriols‐Pérez E, Toro P, Llurba E, Saéz E, Rodríguez‐Zambrano MÁ, García‐Otero L, López M, Santacruz B, Román MÁ, Payà A, Alonso S, Cruz‐Lemini M, Pons‐Duran C, Herrera LB, Chen H, Bardají A, Quintó L, Menendez C. Efficacy and safety of hydroxychloroquine for treatment of mild SARS-CoV-2 infection and prevention of COVID-19 severity in pregnant and postpartum women: A randomized, double-blind, placebo-controlled trial. Acta Obstet Gynecol Scand 2024; 103:602-610. [PMID: 38098221 PMCID: PMC10867357 DOI: 10.1111/aogs.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Pregnant women have an increased risk of severe COVID-19. Evaluation of drugs with a safety reproductive toxicity profile is a priority. At the beginning of the pandemic, hydroxychloroquine (HCQ) was recommended for COVID-19 treatment. MATERIAL AND METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted in eight teaching hospitals in Spain to evaluate the safety and efficacy of HCQ in reducing viral shedding and preventing COVID-19 progression. Pregnant and postpartum women with a positive SARS-CoV-2 PCR (with or without mild COVID-19 signs/symptoms) and a normal electrocardiogram were randomized to receive either HCQ orally (400 mg/day for 3 days and 200 mg/day for 11 days) or placebo. PCR and electrocardiogram were repeated at day 21 after treatment start. Enrollment was stopped before reaching the target sample due to low recruitment rate. Trial registration EudraCT #: 2020-001587-29, on April 2, 2020. CLINICAL TRIALS gov # NCT04410562, registered on June 1, 2020. RESULTS A total of 116 women (75 pregnant and 41 post-partum) were enrolled from May 2020 to June 2021. The proportion of women with a positive SARS-CoV-2 PCR at day 21 was lower in the HCQ group (21.8%, 12/55) than in the placebo group (31.6%, 18/57), although the difference was not statistically significant (P = 0.499). No differences were observed in COVID-19 progression, adverse events, median change in QTc, hospital admissions, preeclampsia or poor pregnancy and perinatal outcomes between groups. CONCLUSIONS HCQ was found to be safe in pregnant and postpartum women with asymptomatic or mild SARS-CoV-2 infection. Although the prevalence of infection was decreased in the HCQ group, the statistical power was insufficient to confirm the potential beneficial effect of HCQ for COVID-19 treatment.
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Affiliation(s)
- Raquel González
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
| | - Anna Goncé
- BCNATAL | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic de BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Mª. del Mar Gil
- Obstetrics and Gynecology DepartmentHospital Universitario de TorrejónMadridSpain
- School of MedicineUniversidad Francisco de VitoriaMadridSpain
| | - Edurne Mazarico
- BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
| | | | - Paloma Toro
- Obstetrics and Gynecology DepartmentHospital General de SegoviaSegoviaSpain
| | - Elisa Llurba
- Women and Perinatal Health Research Group, Department of Obstetrics and GynecologyInstitut d'Investigació Biomèdica Sant Pau‐IIB Sant Pau, Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Elisa Saéz
- Obstetrics and Gynecology DepartmentHospital Universitario Infanta LeonorMadridSpain
| | | | | | - Marta López
- BCNATAL | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic de BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Belén Santacruz
- Obstetrics and Gynecology DepartmentHospital Universitario de TorrejónMadridSpain
- School of MedicineUniversidad Francisco de VitoriaMadridSpain
| | - Mª. Ángeles Román
- BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
| | - Antoni Payà
- Obstetrics and Gynecology DepartmentHospital del MarBarcelonaSpain
| | - Sofia Alonso
- Obstetrics and Gynecology DepartmentHospital General de SegoviaSegoviaSpain
| | - Mónica Cruz‐Lemini
- Women and Perinatal Health Research Group, Department of Obstetrics and GynecologyInstitut d'Investigació Biomèdica Sant Pau‐IIB Sant Pau, Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Clara Pons‐Duran
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
| | | | - Haily Chen
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
| | - Azucena Bardají
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
| | - Clara Menendez
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
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10
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Pradelle A, Mainbourg S, Provencher S, Massy E, Grenet G, Lega JC. Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate. Biomed Pharmacother 2024; 171:116055. [PMID: 38171239 DOI: 10.1016/j.biopha.2023.116055] [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: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to estimate the number of HCQ-related deaths worldwide. METHODS AND FINDINGS We estimated the worldwide in-hospital mortality attributable to HCQ use by combining the mortality rate, HCQ exposure, number of hospitalised patients, and the increased relative risk of death with HCQ. The mortality rate in hospitalised patients for each country was calculated using pooled prevalence estimated by a meta-analysis of published cohorts. The HCQ exposure was estimated using median and extreme estimates from the same systematic review. The number of hospitalised patients during the first wave was extracted from dedicated databases. The systematic review included 44 cohort studies (Belgium: k = 1, France: k = 2, Italy: k = 12, Spain: k = 6, Turkey: k = 3, USA: k = 20). HCQ prescription rates varied greatly from one country to another (range 16-84%). Overall, using median estimates of HCQ use in each country, we estimated that 16,990 HCQ-related in-hospital deaths (range 6267-19256) occurred in the countries with available data. The median number of HCQ-related deaths in Belgium, Turkey, France, Italy, Spain, and the USA was 240 (range not estimable), 95 (range 92-128), 199 (range not estimable), 1822 (range 1170-2063), 1895 (range 1475-2094) and 12739 (3244- 15570), respectively. CONCLUSIONS Although our estimates are limited by their imprecision, these findings illustrate the hazard of drug repurposing with low-level evidence.
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Affiliation(s)
- Alexiane Pradelle
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France
| | - Sabine Mainbourg
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Unité bases de données cliniques et épidémiologiques, Hospices Civils de Lyon, Lyon F-69310, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France
| | - Steeve Provencher
- Pulmonary Hypertension Research Group (http://phrg.ca), Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Department of medicine, Université Laval, Québec City, Canada
| | - Emmanuel Massy
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France
| | - Guillaume Grenet
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France
| | - Jean-Christophe Lega
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France.
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11
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Girma A. The Many Mutations of the COVID-19 Variant: Current Perspectives on EG.5/Eris. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231217805. [PMID: 38084254 PMCID: PMC10710748 DOI: 10.1177/11786302231217805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 02/05/2024]
Abstract
Viral diseases pose a significant threat to public health around the world. SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) was originally identified in Wuhan, China, in 2019. Throughout the epidemic, SARS-CoV-2 has continually changed genetically, giving rise to variants that are distinct from the original virus. SARS-CoV-2 has a high-frequency mutation rate, resulting in more genetic diversity. EG.5/Eris is a subvariant and descendant of Omicron, which remains the world's most prevalent coronavirus strain of current concern. The percentage of EG.5 recorded has steadily increased across the board. Epidemiological week 29 (17-23 July 2023) saw a 17.4% global prevalence of EG.5. Mutations in the virus's genome can cause false-negative results in molecular detection and cause increased transmissibility, morbidity, and mortality due to a reduction in vaccine efficiency. Furthermore, these changes in S-protein structure alter the neutralising ability of neutralising antibodies (Nabs), resulting in a reduction in vaccine efficiency. Therefore, all countries should take efficient infection prevention and control measures as per the guidelines of the world, continental, and their country's health organisations, along with vaccine and treatment investigations.
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Affiliation(s)
- Abayeneh Girma
- Department of Biology, College of Natural and Computational Science, Mekdela Amba University, Tulu Awuliya, Ethiopia
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12
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Wei D, Xie Y, Liu X, Chen R, Zhou M, Zhang X, Qu J. Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China. Front Med 2023; 17:1030-1046. [PMID: 38157194 DOI: 10.1007/s11684-023-1043-5] [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: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages, which was defined by the World Health Organization as coronavirus disease 2019 (COVID-19). The pandemic is considered a significant threat to global public health till now. In this review, we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2, including its prototype and variants. The overall clinical features of variants of concern (VOC), heterogeneity in the clinical manifestations, radiology and pathology of COVID-19 patients are also discussed, along with advances in therapeutic agents.
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Affiliation(s)
- Dong Wei
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yusang Xie
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Xuefei Liu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Rong Chen
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Xinxin Zhang
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China.
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13
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Vieux N, Perrier Q, Bedouch P, Epaulard O. Much ado about nothing? Discrepancy between the available data on the antiviral effect of hydroxychloroquine in March 2020 and its inclusion in COVID-19 clinical trials and outpatient prescriptions. Public Health 2023; 225:35-44. [PMID: 37918175 DOI: 10.1016/j.puhe.2023.09.018] [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: 03/22/2023] [Revised: 07/10/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Many of the 2020 COVID-19 clinical trials included an (hydroxy)chloroquine ((H)CQ) arm. We aimed to juxtapose the state of science before April 2020 regarding the benefits of (H)CQ for viral infections with the number and size of the clinical trials studying (H)CQ and the volume of (H)CQ dispensed in France. STUDY DESIGN We identified and analysed published scientific material regarding the antiviral activity of (H)CQ and publicly available data regarding clinical trials and drug dispensation in France. METHODS We conducted a review of scientific publications available before April 2020 and a systematic analysis of COVID-19 clinical trials featuring (H)CQ registered on clinicaltrials.gov. RESULTS Before April 2020, 894 scientific publications mentioning (H)CQ for viruses other than coronaviruses were available, including 35 in vitro studies (reporting an inconstant inhibition of viral replication), 11 preclinical studies (reporting no or disputable positive effects), and 32 clinical trials (reporting no or disputable positive effects). Moreover, 67 publications on (H)CQ and coronavirus infections were available, including 12 in vitro studies (reporting an inconstant inhibition of viral replication), two preclinical studies (reporting contradictory results), and no clinical trials. Meanwhile, 253 therapeutic clinical trials featuring an HCQ arm were registered in 2020, intending to enrol 246,623 patients. CONCLUSIONS The number and size of (H)CQ clinical trials for COVID-19 launched in 2020 were not supported by the literature published before April 2020.
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Affiliation(s)
- N Vieux
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Q Perrier
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetic (LBFA), INSERM U1055, Grenoble, France
| | - P Bedouch
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | - O Epaulard
- Infectious Disease Department, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC-1406, INSERM-UGA-CHUGA, France.
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14
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Khalil A, Mohamed A, Hassan M, Magboul S, Ali H, Elmasoudi AS, Ellithy K, Qusad M, Alhothi A, Al Maslamani E, Al Amri M, Soliman A. Efficacy and Safety of Remdesivir in Hospitalized Pediatric COVID-19: A Retrospective Case-Controlled Study. Ther Clin Risk Manag 2023; 19:949-958. [PMID: 38023628 PMCID: PMC10680468 DOI: 10.2147/tcrm.s432565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction While most children experience mild coronavirus disease 2019 (COVID-19) infections, a minority of cases progress to severe or critical illness. This study aimed to assess the efficacy and safety of Remdesivir (RDV) therapy in children with moderate to severe COVID-19, enhancing clinical decision-making and expanding our understanding of antiviral treatments for pediatric patients. Methods The study included 60 patients, 38 receiving RDV treatment and 22 serving as the control group. Data was collected retrospectively from January 2021 to January 2022 through electronic hospital records. Results Regarding the main clinical symptoms reported, most patients experienced Upper Respiratory Tract Infections (93.3%), indicating respiratory involvement. Additional symptoms included Central Nervous System (11.7%) and Gastrointestinal (10.0%). Among the 38 cases in the RDV group included in the study, the adverse effects associated with using RDV: Hypoalbuminemia in 19 cases (50.0%) and anemia in 18 cases (47.4%), making them the most common adverse effects. Only one case in the RDV group experienced non-RDV-related death with a different clinical diagnosis. The results showed that RDV treatment was well-tolerated in pediatric patients, with no significant differences in hospital stay and oxygen treatment compared to the control group with P values (0.2, 0.18), respectively. Conclusion The outcomes indicate that Remdesivir may represent a safe and therapeutic choice for children with coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Ahmed Khalil
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Asmaa Mohamed
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Manasik Hassan
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Samar Magboul
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Hossamaldein Ali
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Ahmed Salah Elmasoudi
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Khaled Ellithy
- Section of Pediatric Intensive Care Unit, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Mohammad Qusad
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Abdulla Alhothi
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Eman Al Maslamani
- Section of Infectious Diseases, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | | | - Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
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15
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Ho QY, Sultana R, Lee TL, Thangaraju S, Kee T, Htay H. Coronavirus disease 2019 in kidney transplant recipients: a systematic review and meta-analysis. Singapore Med J 2023; 64:593-602. [PMID: 34688231 PMCID: PMC10645004 DOI: 10.11622/smedj.2021171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
Introduction The clinical presentation and outcomes of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTRs) have not been well studied. Methods We performed a meta-analysis to examine the presenting features, outcomes and the effect of treatment on outcomes of KTRs with COVID-19. Database search was performed up to 5 September 2020 through PubMed, Embase, Web of Science, Scopus and CENTRAL. Results Overall, 23 studies (1,373 patients) were included in the review and meta-analysis. The most common presenting symptoms included fever (74.0%, 95% confidence interval [CI] 65.3-81.1), cough (63.3%, 95% CI 56.5-69.6) and dyspnoea (47.5%, 95% CI 39.6-55.6). Pooled rates of mortality and critical illness were 21.1% (95% CI 15.3-28.4) and 27.7% (95% CI 21.5-34.8), respectively. Acute kidney injury occurred in 38.9% (95% CI 30.6-48.1) and dialysis was required in 12.4% (95% CI 8.3-18.0) of the cases. Conclusion Kidney transplant recipients with COVID-19 have a similar clinical presentation as the general population, but they have higher morbidity and mortality. It is uncertain whether high-dose corticosteroid or hydroxychloroquine reduces the risks of mortality in KTRs with COVID-19.
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Affiliation(s)
- Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | | | - Tung Lin Lee
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Sobhana Thangaraju
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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16
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Poncelet C, Porcher R, Nguyen YL. The COVID-19 and chloroquine infodemic: Cross-sectional observational study of content analysis on YouTube. PLoS One 2023; 18:e0286964. [PMID: 37768899 PMCID: PMC10538733 DOI: 10.1371/journal.pone.0286964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/25/2023] [Indexed: 09/30/2023] Open
Abstract
The objective of this study is to evaluate the association between quality and features related to internet users of the most viewed YouTube videos about COVID-19 and chloroquine, during the first wave of the pandemic. We conducted a cross-sectional observational study focusing on the most viewed YouTube videos on COVID-19 and chloroquine treatment, in French and English. The primary outcome was the association between video quality as assessed by DISCERN and modified JAMA scores, and video features related to internet users as assessed by number of viewership and likes. By June 2020, 168 videos accumulating more than 57 million views and nearly 2 million reactions from Internet users, were included. Most of the videos did not support or oppose the treatment and came from news channels (N = 100; 60%). Videos taking sides were mostly pro-chloroquine (N = 69; 89%). The number of non-factual videos analyzed was very low (N = 3; 2%). The quality of the videos was average (mean DISCERN score = 2.4 (DS 1.0) and mean modified JAMA score = 2.6 (DS 0.6)) and declined over time. The best quality videos were those published by health care professionals or those from educational channels. Most experts interviewed were men (N = 136; 81%). More than 1 in 5 videos featured a political figure (N = 35; 21%), and these were mostly pro-chloroquine with lower DISCERN or modified JAMA scores (p<0.001). We found an association between the number of likes and the quality of the videos evaluated by the DISCERN score (rho = 0.29; p<0.001) and the modified JAMA score (rho = 0.30; p<0.001). The association observed between the quality of the videos and the number of likes suggests a better health literacy and critical thinking of lay internet users. Although YouTube has become a major player in the dissemination of medical information, more involvement of health professionals and governmental organizations is needed.
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Affiliation(s)
- Cynthia Poncelet
- Department of Anesthesiology and Intensive Care, Cochin Hospital, Paris, France
| | - Raphaël Porcher
- Centre of Research in Epidemiology and Statistics (CRESS-UMR1153), National Institute of Health and Medical Research, Paris, France
| | - Yên-Lan Nguyen
- Department of Anesthesiology and Intensive Care, Cochin Hospital, Paris, France
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17
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Bostanghadiri N, Ziaeefar P, Mofrad MG, Yousefzadeh P, Hashemi A, Darban-Sarokhalil D. COVID-19: An Overview of SARS-CoV-2 Variants-The Current Vaccines and Drug Development. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1879554. [PMID: 37674935 PMCID: PMC10480030 DOI: 10.1155/2023/1879554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/07/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
The world is presently in crisis facing an outbreak of a health-threatening microorganism known as COVID-19, responsible for causing uncommon viral pneumonia in humans. The virus was first reported in Wuhan, China, in early December 2019, and it quickly became a global concern due to the pandemic. Challenges in this regard have been compounded by the emergence of several variants such as B.1.1.7, B.1.351, P1, and B.1.617, which show an increase in transmission power and resistance to therapies and vaccines. Ongoing researches are focused on developing and manufacturing standard treatment strategies and effective vaccines to control the pandemic. Despite developing several vaccines such as Pfizer/BioNTech and Moderna approved by the U.S. Food and Drug Administration (FDA) and other vaccines in phase 4 clinical trials, preventive measures are mandatory to control the COVID-19 pandemic. In this review, based on the latest findings, we will discuss different types of drugs as therapeutic options and confirmed or developing vaccine candidates against SARS-CoV-2. We also discuss in detail the challenges posed by the variants and their effect on therapeutic and preventive interventions.
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Affiliation(s)
- Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morvarid Golrokh Mofrad
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Parsa Yousefzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Chaudhary S, Joshi A, Sesham K, Rai P, Kumar S, Mridha AR, Baitha U, Nag TC, Yadav SC. Impact of prophylactic hydroxychloroquine on ultrastructural impairment and cellular SARS-CoV-2 infection in different cells of bronchoalveolar lavage fluids of COVID-19 patients. Sci Rep 2023; 13:12733. [PMID: 37543667 PMCID: PMC10404249 DOI: 10.1038/s41598-023-39941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 08/02/2023] [Indexed: 08/07/2023] Open
Abstract
Many drugs were recommended as antiviral agents for infection control and effective therapy to reduce the mortality rate for COVID-19 patients. Hydroxychloroquine (HCQ), an antimalarial drug, has been controversially recommended for prophylactic use in many countries, including India, to control SARS-CoV-2 infections. We have explored the effect of prophylactic HCQ from the cells of bronchoalveolar lavage fluids from COVID-19-induced acute respiratory distress syndrome patients to determine the level of infection and ultrastructural alterations in the ciliated epithelium, type II pneumocytes, alveolar macrophages, neutrophils, and enucleated granulocytes. Ultrastructural investigation of ciliated epithelium and type II pneumocytes showed lesser infections and cellular impairment in the prophylactic HCQ+ group than HCQ- group. However, macrophages and neutrophils displayed similar infection and ultrastructural alterations in both patient groups. The enucleated fragments of granulocytes showed phagocytosis of the matured virus in HCQ+ groups. The present report unveils the ultrastructural proof to complement the paradox regarding the role of prophylactic HCQ in COVID-19 patients.
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Affiliation(s)
- Shikha Chaudhary
- Electron Microscope Facility, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Arti Joshi
- Electron Microscope Facility, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Kishore Sesham
- Electron Microscope Facility, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Preeti Rai
- Electron Microscope Facility, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Shailendra Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Tapas Chandra Nag
- Electron Microscope Facility, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India
| | - Subhash Chandra Yadav
- Electron Microscope Facility, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, Delhi, 110029, India.
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19
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Anesi GL, Degnan K, Dutcher L, Saw S, Maguire C, Binkley A, Patel S, Athans V, Barton TD, Binkley S, Candeloro CL, Herman DJ, Kasbekar N, Kennedy L, Millstein JH, Meyer NJ, Talati NJ, Patel H, Pegues DA, Sayre PJ, Tebas P, Terico AT, Murphy KM, O’Donnell JA, White M, Hamilton KW. The Penn Medicine COVID-19 Therapeutics Committee-Reflections on a Model for Rapid Evidence Review and Dynamic Practice Recommendations During a Public Health Emergency. Open Forum Infect Dis 2023; 10:ofad428. [PMID: 37663091 PMCID: PMC10468749 DOI: 10.1093/ofid/ofad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
The Penn Medicine COVID-19 Therapeutics Committee-an interspecialty, clinician-pharmacist, and specialist-front line primary care collaboration-has served as a forum for rapid evidence review and the production of dynamic practice recommendations during the 3-year coronavirus disease 2019 public health emergency. We describe the process by which the committee went about its work and how it navigated specific challenging scenarios. Our target audiences are clinicians, hospital leaders, public health officials, and researchers invested in preparedness for inevitable future threats. Our objectives are to discuss the logistics and challenges of forming an effective committee, undertaking a rapid evidence review process, aligning evidence-based guidelines with operational realities, and iteratively revising recommendations in response to changing pandemic data. We specifically discuss the arc of evidence for corticosteroids; the noble beginnings and dangerous misinformation end of hydroxychloroquine and ivermectin; monoclonal antibodies and emerging viral variants; and patient screening and safety processes for tocilizumab, baricitinib, and nirmatrelvir-ritonavir.
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Affiliation(s)
- George L Anesi
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kathleen Degnan
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lauren Dutcher
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen Saw
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christina Maguire
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Amanda Binkley
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Sonal Patel
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Vasilios Athans
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Todd D Barton
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shawn Binkley
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christina L Candeloro
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David J Herman
- Division of Infectious Diseases, Penn Medicine Princeton Medical Center, University of Pennsylvania Health System, Princeton, New Jersey, USA
| | - Nishaminy Kasbekar
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Leigh Kennedy
- Division of Infectious Diseases, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jeffrey H Millstein
- Regional Physician Practices of Penn Medicine, Woodbury Heights, New Jersey, USA
| | - Nuala J Meyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Naasha J Talati
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hinal Patel
- Department of Pharmacy, Penn Medicine Princeton Medical Center, University of Pennsylvania Health System, Princeton, New Jersey, USA
| | - David A Pegues
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Patrick J Sayre
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adrienne T Terico
- Department of Pharmacy, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kathleen M Murphy
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Judith A O’Donnell
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Melissa White
- Department of Pharmacy, Penn Medicine Lancaster General Health, University of Pennsylvania Health System, Lancaster, Pennsylvania, USA
| | - Keith W Hamilton
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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20
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Neves FS. Does Widespread Use of Hydroxychloroquine Reduce the Transmissibility of SARS-CoV-2 / COVID-19? An Ecological Correlational Study. Infect Disord Drug Targets 2023; 23:IDDT-EPUB-131973. [PMID: 37218196 PMCID: PMC10682993 DOI: 10.2174/1871526523666230522114836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND At the beginning of the coronavirus disease (COVID-19) pandemic, hydroxychloroquine (HCQ) was widely used as a possible antiviral agent. Current knowledge indicates that HCQ has little or no effect on individual clinical outcomes of COVID-19, but populational effects on disease transmissibility are still unknown. OBJECTIVE This study investigates the hypothesis that massive HCQ consumption by a population may contribute to reducing the transmissibility of SARS-CoV-2 and COVID-19 spread by reducing the viral load of infected individuals. METHODS Public database of seven states from Brazil in 2020 were assessed, before the start of COVID-19 vaccination. The daily values of the COVID-19 effective reproduction number (Rt) were obtained. Associations between Rt values and the proposed predictor variables (prevalence of COVID-19 as a marker of collective immunity; social isolation indices; consumption of HCQ) were tested using multiple linear regression analysis. RESULTS In all seven states, consumption of HCQ was a significant negative predictor of Rt (β ranged from -0.295 to -0.502, p = 0.001). Furthermore, the mean derivative of Rt during the declining period of the COVID-19 incidence (the mean rate of variation) was also significantly negatively related to the mean HCQ consumption in that period (R2 = 0.895; β = -0.783; p = 0.011), meaning that the higher the HCQ consumption, the faster the decline of COVID-19 Rt. It suggests a dose-response phenomenon and a causal relationship in this association. CONCLUSION The results of this study are compatible with the hypothesis that HCQ has small but significant in vivo antiviral effects that are able to reduce SARS-CoV-2 transmissibility at the populational level.
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Affiliation(s)
- Fabricio Souza Neves
- Department of Internal Medicine, Health Sciences Center, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
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21
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Xu Y, Huang Z, Wu G, Jin F, Lin S, Zhang C, Zheng J, Liu W, Hou J, Lu YJ. Bioinformatic assay reveal the potential mechanism of Guizhi-Shaoyao-Zhimu decoction against rheumatoid arthritis and mild-to-moderate COVID-19. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 238:107584. [PMID: 37207464 DOI: 10.1016/j.cmpb.2023.107584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 04/23/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with rheumatoid arthritis (RA) are more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than healthy population, but there is still no therapeutic strategy available for RA patients with corona virus disease 2019 (COVID-19). Guizhi-Shaoyao-Zhimu decoction (GSZD), Chinese ancient experience decoction, has a significant effect on the treatment of Rheumatism and gout. To prevent RA patients with mild-to-moderate COVID-19 from developing into severe COVID-19, this study explored the potential possibility and mechanism of GSZD in the treatment of this population. METHODS In this study, we used bioinformatic approaches to explore common pharmacological targets and signaling pathways between RA and mild-to-moderate COVID-19, and to assess the potential mechanisms of in the treatment of patients with both diseases. Beside, molecular docking was used to explore the molecular interactions between GSZD and SARS-CoV-2 related proteins. RESULTS Results showed that 1183 common targets were found in mild-to-moderate COVID-19 and RA, of which TNF was the most critical target. The crosstalk signaling pathways of the two diseases focused on innate immunity and T cells pathways. In addition, GSZD intervened in RA and mild-to-moderate COVID-19 mainly by regulating inflammation-related signaling pathways and oxidative stress. Twenty hub compounds in GSZD exhibited good binding potential to SARS-CoV-2 spike (S) protein, 3C-like protease (3CLpro), RNA-dependent RNA polymerase (RdRp), papain-like protease (PLpro) and human angiotensin-converting enzyme 2 (ACE2), thereby intervening in viral infection, replication and transcription. CONCLUSIONS This finding provides a therapeutic option for RA patients against mild-to-moderate COVID-19, but further clinical validation is still needed.
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Affiliation(s)
- Yongyu Xu
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Zebin Huang
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Guangping Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Fujun Jin
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Shuojia Lin
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Chuang Zhang
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Jie Zheng
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Wenjie Liu
- Department of Chemistry, Lakehead University and Thunder Bay Regional Health Research Institute, 980 Oliver Road, Thunder Bay, ON, Canada
| | - Jinqiang Hou
- Department of Chemistry, Lakehead University and Thunder Bay Regional Health Research Institute, 980 Oliver Road, Thunder Bay, ON, Canada
| | - Yu-Jing Lu
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China; Golden Health (Guangdong) Biotechnology Co., Ltd, 99 Taoyuan East Road, Shishan, District, Foshan 528225 China.
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22
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Million M, Lagier JC, Hourdain J, Franceschi F, Deharo JC, Parola P, Brouqui P. Cardiovascular Safety of Hydroxychloroquine-Azithromycin in 424 COVID-19 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050863. [PMID: 37241095 DOI: 10.3390/medicina59050863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely administered to patients with COVID-19 despite scientific controversies. In particular, the potential of prolong cardiac repolarization when using this combination has been discussed. Materials and Methods: We report a pragmatic and simple safety approach which we implemented among the first patients treated for COVID-19 in our center in early 2020. Treatment contraindications were the presence of severe structural or electrical heart disease, baseline corrected QT interval (QTc) > 500 ms, hypokalemia, or other drugs prolonging QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and re-evaluated after 48 h of the initial prescription. Results: Among the 424 consecutive adult patients (mean age 46.3 ± 16.1 years; 216 women), 21.5% patients were followed in conventional wards and 78.5% in a day-care unit. A total of 11 patients (2.6%) had contraindications to the HCQ-AZ combination. In the remaining 413 treated patients, there were no arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but statistically significantly prolonged by 3.75 ± 25.4 ms after 2 days of treatment (p = 0.003). QTc prolongation was particularly observed in female outpatients <65 years old without cardiovascular disease. Ten patients (2.4%) developed QTc prolongation > 60 ms, and none had QTc > 500 ms. Conclusions: This report does not aim to contribute to knowledge of the efficacy of treating COVID-19 with HCQ-AZ. However, it shows that a simple initial assessment of patient medical history, electrocardiogram (ECG), and kalemia identifies contraindicated patients and enables the safe treatment of COVID-19 patients with HCQ-AZ. QT-prolonging anti-infective drugs can be used safely in acute life-threatening infections, provided that a strict protocol and close collaboration between infectious disease specialists and rhythmologists are applied.
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Affiliation(s)
- Matthieu Million
- IHU-Méditerranée Infection, 13005 Marseille, France
- Unité MEPHI (Microbes, Evolution, Phylogénies et Infection), Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, 13005 Marseille, France
| | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, 13005 Marseille, France
- Unité MEPHI (Microbes, Evolution, Phylogénies et Infection), Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, 13005 Marseille, France
| | - Jérôme Hourdain
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, 13005 Marseille, France
- C2VN, Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, 13005 Marseille, France
| | - Frédéric Franceschi
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, 13005 Marseille, France
- C2VN, Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, 13005 Marseille, France
| | - Jean-Claude Deharo
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, 13005 Marseille, France
- C2VN, Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, 13005 Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, 13005 Marseille, France
- VITROME, AP-HM, SSA, IRD, Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, 13005 Marseille, France
| | - Philippe Brouqui
- IHU-Méditerranée Infection, 13005 Marseille, France
- Unité MEPHI (Microbes, Evolution, Phylogénies et Infection), Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, 13005 Marseille, France
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23
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Hashem M, El-Kassas M. Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19. World J Clin Cases 2023; 11:2140-2159. [PMID: 37122505 PMCID: PMC10131019 DOI: 10.12998/wjcc.v11.i10.2140] [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: 09/02/2022] [Revised: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019 (COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions, among those who need immunosuppression after solid organ transplantation (SOT), are at an increased risk of developing severe illness from COVID-19. Liver transplantation is the second most prevalent SOT globally. Due to their immunosuppressed state, liver transplant (LT) recipients are more susceptible to serious infections. Therefore, comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19. It is crucial to comprehend the clinical picture, immunosuppressive management, prognosis, and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients. This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group. In the following sections, we discussed current COVID-19 therapy choices, reviewed standard practice in modifying immunosuppressant regimens, and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management. Additionally, we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.
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Affiliation(s)
- Mai Hashem
- Fellow of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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24
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Zeng Z. Assessment of the potential value of combining western medicine therapies with traditional chinese medicine in the treatment of COVID-19: Mechanistic perspectives. Technol Health Care 2023; 31:169-184. [PMID: 37038790 DOI: 10.3233/thc-236015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND The pandemic caused by the novel coronavirus disease (COVID-19) since early 2020 is one of the most significant global health issues in history. Although there is currently no specific treatment for COVID-19, researchers have provided a whole array of potential treatments, both from the Western medicine approach, which is molecular target and pathogenesis based, and from the traditional Chinese medicine (TCM) approach, which is based on the exposure to toxins/pathogens and the balance of the body to combat them for recovery. OBJECTIVE The aim of this research is to find combinations of Western medicine and TCM that may offer better therapeutic efficacy synergystically with a better adverse events profile. The findings of the research may provide a new insight in the development of the treatment of COVID-19. METHODS From the Western medicine perspective, drugs target the mechanisms of viral infection, including the stages of viral entry (Arbidol, Camostat Mesylate, Convalescent Plasma therapy) and viral replication (Lopinavir/Ritonavir, Redemsivir, Ribavirin). Additional therapies target host defenses, preventing cytokine storms (Tocilizumab) and stimulating the immune system (Interferons). On the other hand, TCM also proposed a number of treatment methods for COVID-19 with new scientific approaches identifying their antiviral and immunomodulatory activities. The novel combination of Western medicine and TCM can be proposed by analyzing their respective molecular targets. RESULTS Although TCM is not generally accepted in the Western community because of the general lack of knowledge on their detailed mechanisms, studies and clinical trials suggest that TCM could be beneficial in combating COVID-19. CONCLUSION Based on the principle of combining TCM and Western medicine, two combinations are tested effective in clinical trials, and three possible combinations that might be effective are proposed in the paper.
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Affiliation(s)
- Zirui Zeng
- International Department, The Affiliated High School of South China Normal University, Guangzhou, Guangdong, China
- University of California, Santa Barbara, CA 93106, USA
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25
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Sun Q, Li X, Kuang E. Subversion of autophagy machinery and organelle-specific autophagy by SARS-CoV-2 and coronaviruses. Autophagy 2023; 19:1055-1069. [PMID: 36005882 PMCID: PMC10012907 DOI: 10.1080/15548627.2022.2116677] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/09/2022] Open
Abstract
As a new emerging severe coronavirus, the knowledge on the SARS-CoV-2 and COVID-19 remains very limited, whereas many concepts can be learned from the homologous coronaviruses. Macroautophagy/autophagy is finely regulated by SARS-CoV-2 infection and plays important roles in SARS-CoV-2 infection and pathogenesis. This review will explore the subversion and mechanism of the autophagy-related machinery, vacuoles and organelle-specific autophagy during infection of SARS-CoV-2 and coronaviruses to provide meaningful insights into the autophagy-related therapeutic strategies for infectious diseases of SARS-CoV-2 and coronaviruses.
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Affiliation(s)
- Qinqin Sun
- Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiaojuan Li
- College of Clinic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Ersheng Kuang
- Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Ministry of Education, Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Guangzhou, Guangdong, China
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26
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Talarico F, Chakravarty S, Liu YS, Greenshaw AJ, Passos IC, Cao B. Systematic Review of Psychiatric Adverse Effects Induced by Chloroquine and Hydroxychloroquine: Case Reports and Population Studies. Ann Pharmacother 2023; 57:463-479. [PMID: 35927939 DOI: 10.1177/10600280221113572] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To perform a systematic review on the psychiatric adverse effects of chloroquine (CQ) and hydroxychloroquine (HCQ); to summarize what is known about psychiatric adverse effects of these drugs; to compare clinical trials, populational studies, and case report studies; and to increase awareness of the potential psychiatric adverse effects of these drugs. DATA SOURCES A literature search of PubMed, Scopus, and Web of Science was performed to identify manuscripts published between December 1962 and June 2022. Search terms included CQ, HCQ, psychiatry, psychosis, depression, anxiety, bipolar disorder, delirium, and psychotic disorders. STUDY SELECTION AND DATA EXTRACTION Relevant studies included reports of adverse effects after CQ or HCQ ingestion. DATA SYNTHESIS The current literature presents evidence for a risk of short-term psychiatric adverse effects induced by either CQ or HCQ. However, the populational-level studies presented some limitations regarding the voluntary response in survey data, self-report adverse effects, and placebo group reporting similar symptoms to the case group. Thus, populational-level studies addressing the discussed limitations and the nature and extent of possible psychiatric adverse effects are needed. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Most of the patients who developed such adverse effects did not report a family history of psychiatric disease. The frequency of psychiatric adverse effects depends on the patient's biological sex, age, and body mass index, but not on the drug dosage. CONCLUSIONS Based on clinical trials and case reports, the current literature presents evidence for a risk of short-term psychiatric adverse effects induced by either drug.
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Affiliation(s)
- Fernanda Talarico
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Ives Cavalcante Passos
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Laboratory of Molecular Psychiatry and Bipolar Disorder Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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27
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Sandhu HS, Lambert J, Steckler Z, Park L, Stromberg A, Ramirez J, Yang CFJ. Outpatient medications associated with protection from COVID-19 hospitalization. PLoS One 2023; 18:e0282961. [PMID: 37000808 PMCID: PMC10065249 DOI: 10.1371/journal.pone.0282961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/28/2023] [Indexed: 04/01/2023] Open
Abstract
The COVID-19 pandemic remains the pre-eminent global health problem, and yet after more than three years there is still no prophylactic agent against the disease aside from vaccines. The objective of this study was to evaluate whether pre-existing, outpatient medications approved by the US Food and Drug Administration (FDA) reduce the risk of hospitalization due to COVID-19. This was a retrospective cohort study of patients from across the United States infected with COVID-19 in the year 2020. The main outcome was adjusted odds of hospitalization for COVID-19 amongst those positive for the infection. Outcomes were adjusted for known risk factors for severe disease. 3,974,272 patients aged 18 or older with a diagnosis of COVID-19 in 2020 met our inclusion criteria and were included in the analysis. Mean age was 50.7 (SD 18). Of this group, 290,348 patients (7.3%) were hospitalized due to COVID-19, similar to the CDC's reported estimate (7.5%). Four drugs showed protective effects against COVID-19 hospitalization: rosuvastatin (aOR 0.91, p = 0.00000024), empagliflozin-metformin (aOR 0.69, p = 0.003), metformin (aOR 0.97, p = 0.017), and enoxaparin (aOR 0.88, p = 0.0048). Several pre-existing medications for outpatient use may reduce severity of disease and protect against COVID-19 hospitalization. Well-designed clinical trials are needed to assess the efficacy of these agents in a therapeutic or prophylactic setting.
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Affiliation(s)
- Harpal Singh Sandhu
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY, United States of America
| | - Joshua Lambert
- University of Cincinnati College of Nursing, Cincinnati, OH, United States of America
| | - Zach Steckler
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY, United States of America
| | - Lee Park
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY, United States of America
| | - Arnold Stromberg
- Norton Infectious Diseases Institute, Norton Hospital, Louisville, KY, United States of America
| | - Julio Ramirez
- Norton Infectious Diseases Institute, Norton Hospital, Louisville, KY, United States of America
| | - Chi-fu Jeffrey Yang
- Department of Surgery, Harvard Medical School, Boston, MA, United States of America
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28
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Fedorchenko Y, Zimba O. Long COVID in autoimmune rheumatic diseases. Rheumatol Int 2023; 43:1197-1207. [PMID: 36995436 PMCID: PMC10061411 DOI: 10.1007/s00296-023-05319-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
Consequences of Corona Virus Disease-19 (COVID-19) in patients with rheumatic diseases (RDs) are clinically diverse. SARS-CoV-2 infection has been associated with various autoimmune and rheumatic manifestations over the past three years. Emerging evidence points to the possibility of Long COVID predisposition in rheumatic patients due to the changes in immune regulatory response. The aim of this article was to overview data on the pathobiology of Long COVID in patients with RDs. Related risk factors, clinical characteristics, and prognosis of Long COVID in RDs were analyzed. Relevant articles were retrieved from Medline/PubMed, Scopus, and Directory of Open Access Journals (DOAJ). Diverse mechanisms of viral persistence, chronic low-grade inflammation, lasting production of autoantibodies, endotheliopathy, vascular complications, and permanent tissue damage have been described in association with Long COVID. Patients with RDs who survive COVID-19 often experience severe complications due to the immune disbalance resulting in multiple organ damage. Regular monitoring and treatment are warranted in view of the accumulating evidence.
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Affiliation(s)
- Yuliya Fedorchenko
- Department of Pathophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76018, Ukraine.
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Spivak AM, Barney BJ, Greene T, Holubkov R, Olsen CS, Bridges J, Srivastava R, Webb B, Sebahar F, Huffman A, Pacchia CF, Dean JM, Hess R. A Randomized Clinical Trial Testing Hydroxychloroquine for Reduction of SARS-CoV-2 Viral Shedding and Hospitalization in Early Outpatient COVID-19 Infection. Microbiol Spectr 2023; 11:e0467422. [PMID: 36861976 PMCID: PMC10101001 DOI: 10.1128/spectrum.04674-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
Early in the COVID-19 pandemic, no effective treatment existed to prevent clinical worsening of COVID-19 among recently diagnosed outpatients. At the University of Utah, Salt Lake City, Utah, we conducted a phase 2 prospective parallel group randomized placebo-controlled trial (NCT04342169) to determine whether hydroxychloroquine given early in disease reduces the duration of SARS-CoV-2 shedding. We enrolled nonhospitalized adults (≥18 years of age) with a recent positive diagnostic test for SARS-CoV-2 (within 72 h of enrollment) and adult household contacts. Participants received either 400 mg hydroxychloroquine by mouth twice daily on day 1 followed by 200 mg by mouth twice daily on days 2 to 5 or oral placebo with the same schedule. We performed SARS-CoV-2 nucleic acid amplification testing (NAAT) on oropharyngeal swabs on days 1 to 14 and 28 and monitored clinical symptomatology, rates of hospitalization, and viral acquisition by adult household contacts. We identified no overall differences in the duration of oropharyngeal carriage of SARS-CoV-2 (hazard ratio of viral shedding time comparing hydroxychloroquine to placebo, 1.21; 95% confidence interval [CI], 0.91, 1.62). Overall, 28-day hospitalization incidence was similar between treatments (4.6% hydroxychloroquine versus 2.7% placebo). No differences were seen in symptom duration, severity, or viral acquisition in household contacts between treatment groups. The study did not reach the prespecified enrollment target, which was likely influenced by a steep decline in COVID-19 incidence corresponding to the initial vaccine rollout in the spring of 2021. Oropharyngeal swabs were self-collected, which may introduce variability in these results. Placebo treatments were not identical to hydroxychloroquine treatments (capsules versus tablets) which may have led to inadvertent participant unblinding. In this group of community adults early in the COVID-19 pandemic, hydroxychloroquine did not significantly alter the natural history of early COVID-19 disease. (This study has been registered at ClinicalTrials.gov under registration no. NCT04342169). IMPORTANCE Early in the COVID-19 pandemic, no effective treatment existed to prevent clinical worsening of COVID-19 among recently diagnosed outpatients. Hydroxychloroquine received attention as a possible early treatment; however, quality prospective studies were lacking. We conducted a clinical trial to test the ability of hydroxychloroquine to prevent clinical worsening of COVID-19.
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Affiliation(s)
- Adam M. Spivak
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Bradley J. Barney
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Cody S. Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jordan Bridges
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Raj Srivastava
- Senior Medical Executive Director, Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Brandon Webb
- Division of Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Frances Sebahar
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Ainsley Huffman
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - J. Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Hewitt J, McDonald S, Poole A, White H, Turner S, Turner T. Weekly updating of guideline recommendations was feasible: the Australian National COVID-19 clinical evidence Taskforce. J Clin Epidemiol 2023; 155:131-136. [PMID: 36813003 PMCID: PMC9939393 DOI: 10.1016/j.jclinepi.2023.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To investigate how quickly evidence was incorporated into the Australian living guidelines for COVID-19 during the first 12 months of the pandemic. STUDY DESIGN AND SETTING For each study concerning drug therapies included in the guideline from April 3, 2020 to April 1, 2021, we extracted the publication date of the study, and the guideline version the study was included in. We analyzed two subgroups of studies as follows: those published in high impact factor journals and those with 100 or more participants. RESULTS In the first year, we published 37 major versions of the guidelines, incorporating 129 studies that investigated 48 drug therapies informing 115 recommendations. The median time from first publication of a study to incorporation in the guideline was 27 days (interquartile range [IQR], 16 to 44), ranging from 9 to 234 days. For the 53 studies in the highest impact factor journals, the median was 20 days (IQR 15 to 30), and for the 71 studies with 100 or more participants the median was 22 days (IQR 15 to 36). CONCLUSION Developing and sustaining living guidelines where evidence is rapidly incorporated is a resource- and time-intensive undertaking; however, this study demonstrates that it is feasible, even over a long period.
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Affiliation(s)
- Jessie Hewitt
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Alex Poole
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA 5000, Australia
| | - Heath White
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Simon Turner
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, 553 Street Kilda Road, Melbourne, VIC 3004, Australia.
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Catano-Lopez A, Rojas-Diaz D, Lizarralde-Bejarano DP, Puerta Yepes ME. A discrete model for the evaluation of public policies: The case of Colombia during the COVID-19 pandemic. PLoS One 2023; 18:e0275546. [PMID: 36787303 PMCID: PMC9928135 DOI: 10.1371/journal.pone.0275546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/19/2022] [Indexed: 02/15/2023] Open
Abstract
In mathematical epidemiology, it is usual to implement compartmental models to study the transmission of diseases, allowing comprehension of the outbreak dynamics. Thus, it is necessary to identify the natural history of the disease and to establish promissory relations between the structure of a mathematical model, as well as its parameters, with control-related strategies (real interventions) and relevant socio-cultural behaviors. However, we identified gaps between the model creation and its implementation for the use of decision-makers for policy design. We aim to cover these gaps by proposing a discrete mathematical model with parameters having intuitive meaning to be implemented to help decision-makers in control policy design. The model considers novel contagion probabilities, quarantine, and diffusion processes to represent the recovery and mortality dynamics. We applied mathematical model for COVID-19 to Colombia and some of its localities; moreover, the model structure could be adapted for other diseases. Subsequently, we implemented it on a web platform (MathCOVID) for the usage of decision-makers to simulate the effect of policies such as lock-downs, social distancing, identification in the contagion network, and connectivity among populations. Furthermore, it was possible to assess the effects of migration and vaccination strategies as time-dependent inputs. Finally, the platform was capable of simulating the effects of applying one or more policies simultaneously.
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Affiliation(s)
| | - Daniel Rojas-Diaz
- Department of Mathematical Sciences, Universidad EAFIT, Medellín, Colombia
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Panahi Y, Gorabi AM, Talaei S, Beiraghdar F, Akbarzadeh A, Tarhriz V, Mellatyar H. An overview on the treatments and prevention against COVID-19. Virol J 2023; 20:23. [PMID: 36755327 PMCID: PMC9906607 DOI: 10.1186/s12985-023-01973-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 01/14/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to plague the world. While COVID-19 is asymptomatic in most individuals, it can cause symptoms like pneumonia, ARDS (acute respiratory distress syndrome), and death in others. Although humans are currently being vaccinated with several COVID-19 candidate vaccines in many countries, however, the world still is relying on hygiene measures, social distancing, and approved drugs. RESULT There are many potential therapeutic agents to pharmacologically fight COVID-19: antiviral molecules, recombinant soluble angiotensin-converting enzyme 2 (ACE2), monoclonal antibodies, vaccines, corticosteroids, interferon therapies, and herbal agents. By an understanding of the SARS-CoV-2 structure and its infection mechanisms, several vaccine candidates are under development and some are currently in various phases of clinical trials. CONCLUSION This review describes potential therapeutic agents, including antiviral agents, biologic agents, anti-inflammatory agents, and herbal agents in the treatment of COVID-19 patients. In addition to reviewing the vaccine candidates that entered phases 4, 3, and 2/3 clinical trials, this review also discusses the various platforms that are used to develop the vaccine COVID-19.
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Affiliation(s)
- Yunes Panahi
- grid.411705.60000 0001 0166 0922Pharmacotherapy Department, Faculty of Pharmacy, Bagyattallah University of Medical Sciences, Tehran, Iran
| | - Armita Mahdavi Gorabi
- grid.411705.60000 0001 0166 0922Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sona Talaei
- grid.449862.50000 0004 0518 4224Department of Basic Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Fatemeh Beiraghdar
- grid.411521.20000 0000 9975 294XNephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abolfazl Akbarzadeh
- grid.412888.f0000 0001 2174 8913Department of Medical Nanotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahideh Tarhriz
- grid.412888.f0000 0001 2174 8913Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Mellatyar
- grid.411705.60000 0001 0166 0922Pharmacotherapy Department, Faculty of Pharmacy, Bagyattallah University of Medical Sciences, Tehran, Iran
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Gong X, Khan A, Wani MY, Ahmad A, Duse A. COVID-19: A state of art on immunological responses, mutations, and treatment modalities in riposte. J Infect Public Health 2023; 16:233-249. [PMID: 36603376 PMCID: PMC9798670 DOI: 10.1016/j.jiph.2022.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Over the last few years, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) unleashed a global public health catastrophe that had a substantial influence on human physical and mental health, the global economy, and socio-political dynamics. SARS-CoV-2 is a respiratory pathogen and the cause of ongoing COVID-19 pandemic, which testified how unprepared humans are for pandemics. Scientists and policymakers continue to face challenges in developing ideal therapeutic agents and vaccines, while at the same time deciphering the pathology and immunology of SARS-CoV-2. Challenges in the early part of the pandemic included the rapid development of diagnostic assays, vaccines, and therapeutic agents. The ongoing transmission of COVID-19 is coupled with the emergence of viral variants that differ in their transmission efficiency, virulence, and vaccine susceptibility, thus complicating the spread of the pandemic. Our understanding of how the human immune system responds to these viruses as well as the patient groups (such as the elderly and immunocompromised individuals) who are often more susceptible to serious illness have both been aided by this epidemic. COVID-19 causes different symptoms to occur at different stages of infection, making it difficult to determine distinct treatment regimens employed for the various clinical phases of the disease. Unsurprisingly, determining the efficacy of currently available medications and developing novel therapeutic strategies have been a process of trial and error. The global scientific community collaborated to research and develop vaccines at a neck-breaking speed. This review summarises the overall picture of the COVID-19 pandemic, different mutations in SARS-CoV-2, immune response, and the treatment modalities against SARS-CoV-2.
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Affiliation(s)
- Xiaolong Gong
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amber Khan
- Department of Clinical Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohmmad Younus Wani
- Department of Chemistry, College of Science, University of Jeddah, P.O. Box 80327, Jeddah 21589, Kingdom of Saudi Arabia
| | - Aijaz Ahmad
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Division of Infection Control, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa,Corresponding author at: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adriano Duse
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Division of Infection Control, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
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34
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Peng W, Xu Y, Han D, Feng F, Wang Z, Gu C, Zhou X, Wu Q. Potential mechanism underlying the effect of matrine on COVID-19 patients revealed through network pharmacological approaches and molecular docking analysis. Arch Physiol Biochem 2023; 129:253-260. [PMID: 32915649 PMCID: PMC7544918 DOI: 10.1080/13813455.2020.1817944] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The clinical efficacy of matrine in treating coronavirus disease (COVID-19) has been confirmed; however, its underlying mechanism of action remains unknown. METHODS TCMSP, SwissTargetPrediction, SEA, GeneCards, CTD, and TTD were used to identify potential targets for matrine in SARS-CoV-2. Cytoscape software was used to determine the target-pathway network for topographical analysis. The online STRING analysis platform and Cytoscape were together used to generate a PPI network and for GO and KEGG pathway enrichment analysis. Finally, molecular docking simulations were performed to study matrine-Mpro, matrine-ACE2, and matrine-RdRp interactions. RESULTS Ten common matrine targets were obtained, particularly including TNF-α, IL-6, and CASP3. GO and KEGG pathway enrichment analysis revealed five significantly enriched signalling pathways involved in cell proliferation, apoptosis, programmed cell death, and immune responses. CONCLUSIONS During COVID-19 treatment, matrine regulates viral replication, host cell apoptosis, and inflammation by targeting the TNF-α, IL-6, and CASP3 in the TNF signalling pathway.
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Affiliation(s)
- Wenpan Peng
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yong Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Di Han
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Fanchao Feng
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Zhichao Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Gu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xianmei Zhou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- CONTACT Xianmei Zhou Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China; Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Qi Wu
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
- Qi Wu Department of Physiology, Xuzhou Medical University, Xuzhou, 221009, China
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35
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El Hennawy HM, Safar O, Elatreisy A, Al Faifi AS, Shalkamy O, Hadi SA, Alqahtani M, Alkahtani SA, Alqahtani FS, El Nazer W, Al Atta E, Ibrahim AT, Abdelaziz AA, Mirza N, Mahedy A, Tom NM, Assiri Y, Al Fageeh A, Elgamal G, Al Shehri AA, Zaitoun MF. The Outcome of COVID-19 Infection on Kidney Transplantation Recipients in Southern Saudi Arabia: Single-Center Experience. Transplant Proc 2023; 55:521-529. [PMID: 36681582 PMCID: PMC9826984 DOI: 10.1016/j.transproceed.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/27/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND To report the incidence, risk factors, and outcome of severe COVID-19 disease in kidney transplant recipients attending a Saudi hospital at a single center in the Kingdom of Saudi Arabia. METHODS A retrospective chart-based cohort study involving all kidney transplant recipients tested for COVID-19 in the Armed Forces Hospital Southern Region, KSA. RESULTS Of 532 kidney transplant recipients who reported to the center, from March 2020 to June 2022, 180 were tested for COVID-19. Of these recipients, 31 (17%) tested positive. Among the 31 positive recipients, 11 were treated at home, 15 were admitted to the noncritical isolation ward, and 5 were admitted to the intensive care unit (ICU). Older age (P = .0001), higher body mass index (P = .0001), and history of hypertension (P = .0023) were more frequent in the COVID-19-positive recipients. Admission to the ICU was more frequent in older recipients (P = .0322) with a history of ischemic heart disease (P = .06) and higher creatinine baseline (P = .08) presenting with dyspnea (P = .0174), and acute allograft dysfunction (P = .002). In the ICU group, 4 (80%) patients required hemodialysis, and 4 (80%) died. CONCLUSIONS Kidney transplant recipients with COVID-19 could have a higher risk for developing acute kidney injury, dialysis, and mortality than the general population. ICU admission and renal replacement therapy were more evident in older recipients with a history of ischemic heart disease, presenting with shortness of breath (P = .017) and a higher serum creatinine baseline. Acute allograft dysfunction was the independent predictor of mortality among patients admitted to the ICU.
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Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia,Address correspondence to Hany M El Hennawy, MD, Department of Surgery, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, 101, KSA
| | - Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Adel Elatreisy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Osama Shalkamy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sara Abdullah Hadi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Mofareh Alqahtani
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Sultan Ahmad Alkahtani
- Pathology and Laboratory Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Faisal Saeed Alqahtani
- Adult Infectious Diseases Section, Internal Medicine Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Weam El Nazer
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Eisa Al Atta
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Asad Taha Ibrahim
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Abdelaziz a Abdelaziz
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Naveed Mirza
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ahmed Mahedy
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Nayana Mary Tom
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Yahya Assiri
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ali Al Fageeh
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Galal Elgamal
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ali Amer Al Shehri
- Adult Infectious Diseases Section, Internal Medicine Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
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Peretti M, Rebaudet S, Chiche L, Pegliasco H, Coquet E. Concerted and multidisciplinary management of COVID-19 drug therapies during the first two epidemic waves in a tertiary hospital in Marseille, France: Results of the PHARMA-COVID study. PLoS One 2023; 18:e0283165. [PMID: 36930624 PMCID: PMC10022761 DOI: 10.1371/journal.pone.0283165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To evaluate the impact of local therapeutic recommendation updates made by the COVID multidisciplinary consultation meeting (RCP) at the Hôpital Européen Marseille (HEM) through the description of the drug prescriptions for COVID-19 during the first two waves of the epidemic. METHODS This retrospective observational study analysed data from the hospital's pharmaceutical file. We included all patients hospitalized for COVID-19 between February 1, 2020 and January 21, 2021 and extracted specific anti-COVID-19 therapies (ST) from computerized patient record, as well as patients' demographic characteristics, comorbidities and outcome. The evolution of ST prescriptions during the study period was described and put into perspective with the updates of local recommendations made during the first (V1, from 2/24/2020 to 7/27/2020), and second (V2, from 7/28/2020 to 1/21/2021) epidemic waves. RESULTS A total of 607 COVID-19 hospitalized patients, 197 during V1 and 410 during V2. Their mean age was 65 years-old, and they presented frequent comorbidities. In total, 93% of hospitalized patients received ST: anticoagulants (90%), glucocorticoids (39%) mainly during V2 (49% vs 17%, P<0.001), and azithromycin (30%) mainly during V1 (71% vs 10%, P<0.001). Lopinavir/ritonavir and hydroxychloroquine were prescribed to 17 and 7 inpatients, respectively, and only during V1. Remdesivir was never administered. A total of 22 inpatients were enrolled into clinical trials. CONCLUSIONS The effective dissemination of evidence-based and concerted recommendations seems to have allowed an optimized management of COVID-19 drug therapies in the context of this emerging infection with rapidly evolving therapeutic questions.
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Affiliation(s)
| | - Stanislas Rebaudet
- Service d’Infectiologie et de Médecine Interne, Hôpital Européen, Marseille, France
- UMR1252 SESSTIM, Aix-Marseille Univ, Inserm, IRD, ISSPAM, Marseille, France
| | - Laurent Chiche
- Service d’Infectiologie et de Médecine Interne, Hôpital Européen, Marseille, France
- * E-mail:
| | | | - Emilie Coquet
- Service de Pharmacie, Hôpital Européen, Marseille, France
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Nascimento BR, Paixão GMM, Tonaco LAB, Alves ACD, Peixoto DC, Ribeiro LB, Mendes MS, Gomes PR, Pires MC, Ribeiro ALP. Clinical and electrocardiographic outcomes evaluated by telemedicine of outpatients with clinical suspicion of COVID-19 treated with chloroquine compounds in Brazil †. Front Cardiovasc Med 2023; 10:1028398. [PMID: 36873415 PMCID: PMC9978955 DOI: 10.3389/fcvm.2023.1028398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Aims To evaluate clinical and electrocardiographic outcomes of patients with COVID-19, comparing those using chloroquine compounds (chloroquine) to individuals without specific treatment. Methods Outpatients with suspected COVID-19 in Brazil who had at least one tele-electrocardiography (ECG) recorded in a telehealth system were enrolled in two arms (Group 1: chloroquine and Group 2: without specific treatment) and one registry (Group 3: other treatments). Outcomes were assessed through follow-up calls (phone contact, days 3 and 14) and linkage to national mortality and hospitalization databases. The primary outcome was composed of: hospitalization, intensive care admission, mechanical ventilation, and all-cause death, and the ECG outcome was the occurrence of major abnormalities by the Minnesota code. Significant variables in univariable logistic regression were included in 4 models: 1-unadjusted; 2-adjusted for age and sex; 3-model 2 + cardiovascular risk factors and 4-model 3 + COVID-19 symptoms. Results In 303 days, 712 (10.2%) patients were allocated in group 1, 3,623 (52.1%) in group 2 and 2,622 (37.7%) in group 3; 1,969 had successful phone follow-up (G1: 260, G2: 871, and G3: 838). A late follow-up ECG was obtained for 917 (27.2%) patients [group 1: 81 (11.4%), group 2: 512 (14.1%), group 3: 334 (12.7%)]. In adjusted models, chloroquine was independently associated with greater chance of the composite clinical outcome: phone contact (model 4): OR = 3.24 (95% CI 2.31-4.54), p < 0.001. Chloroquine was also independently associated with higher mortality, assessed by phone + administrative data (model 3): OR = 1.67 (95% CI 1.20-2.28). However, chloroquine did not associate with the occurrence of major ECG abnormalities [model 3; OR = 0.80 (95% CI 0.63-1.02, p = 0.07)]. Abstracts with partial results of this work was accepted in the American Heart Association Scientific Sessions, November 2022, in Chicago, IL, USA. Conclusion Chloroquine was associated with a higher risk of poor outcomes in patients suspected to have COVID-19 when compared to those who received standard care. Follow-up ECGs were obtained in only 13.2% of patients and did not show any significant differences in major abnormalities amongst the three groups. In the absence of early ECG changes, other side effects, late arrhythmias or deferral of care may be hypothesized to explain the worse outcomes.
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Affiliation(s)
- Bruno R Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gabriela M M Paixão
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luìs Antônio B Tonaco
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil
| | - Ana Carolina D Alves
- Curso de Medicina, Faculdade de Saúde e Ecologia Humana (FASEH), Belo Horizonte, MG, Brazil
| | - David C Peixoto
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Leonardo B Ribeiro
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil
| | - Mayara S Mendes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil
| | - Paulo R Gomes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil
| | - Magda C Pires
- Departamento de Estatística, Instituto de Ciências Exatas (ICEX) da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Antonio Luiz P Ribeiro
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Said ASA, Hussein RRS, Khalil DM, Fahmy AM, Hassanein AHA, Abdelaty LN. Monotherapy versus polytherapy of enoxaparin and hydroxychloroquine for the treatment of COVID-19: A randomized controlled clinical trial. Pharm Pract (Granada) 2023; 21:2777. [PMID: 37090452 PMCID: PMC10117317 DOI: 10.18549/pharmpract.2023.1.2777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 04/08/2023] Open
Abstract
Objectives The current study aims to assess the efficacy and safety of Enoxaparin and hydroxychloroquine (HCQ) used as monothrapy or polytherapy versus standard care alone in Coronavirus 2019 (COVID-19) infected patients. Methods The current study included two hundred patients with laboratory confirmed COVID-19 infection. Patients admitted to hospital were randomly allocated into four groups: group I: received standard COVID-19 therapy, group II: received Enoxaparin 40mg/day subcutaneously (SC) plus standard therapy, group III: received 400 mg/day HCQ plus standard therapy & group IV: received a combination of 400 mg/day HCQ and Enoxaparin plus standard COVID-19 therapy. The disease progression was evaluated by duration to a negative polymerase chain reaction (PCR), length of hospital or Intensive Care Unit (ICU) stay, and mortality rate. The safety of treatments was evaluated by measuring adverse effects. Results The length of hospital stay, ICU admission and mortality were significantly decreased in Enoxaparin plus standard COVID-19 therapy group versus other groups. Conclusion These findings suggest that Enoxaparin was safe, effective, and well tolerated and has a role in decreasing the progression of the disease and its complications while HCQ did not discover any evidence of extra therapeutic benefits.
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Affiliation(s)
- Amira S A Said
- PhD. Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE. Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Egypt.
| | - Raghda R S Hussein
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Egypt. Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Egypt.
| | - Doaa Mahmoud Khalil
- MD. Department of Public Health & Community Medicine, Faculty of Medicine, Beni-Suef University, Egypt.
| | - Alzhraa M Fahmy
- MD. Department of Tropical Medicine & Infectious Diseases, Faculty of Medicine, Beni-Suef University, Egypt.
| | - Ahmed H A Hassanein
- PhD. Phd of Biotechnology, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Egypt.
| | - Lamiaa N Abdelaty
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Egypt.
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Lyashchenko AK, Yu Y, McMahon DJ, Bies R, Yin MT, Cremers S. Systemic exposure to hydroxychloroquine and its relationship with outcome in severely ill COVID-19 patients in New York City. Br J Clin Pharmacol 2023; 89:299-315. [PMID: 35961374 PMCID: PMC9538656 DOI: 10.1111/bcp.15489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/12/2022] [Accepted: 08/06/2022] [Indexed: 01/08/2023] Open
Abstract
AIM To investigate the relationship between systemic exposure to hydroxychloroquine (HCQ) and its metabolite desethylhydroxychloroquine (DHCQ) and clinical outcome in severely ill patients treated with a standard oral dose regimen of HCQ during the first wave of COVID-19 in New York City. METHODS We correlated retrospective clinical data with drug exposure prospectively assessed from convenience samples using population pharmacokinetics and Bayesian estimation. Systemic exposure was assessed in 215 patients admitted to ICU or COVID-ward for whom an interleukin-6 level was requested and who were still alive 24 hours after the last dose of HCQ. Patients received oral HCQ 600 mg twice daily on day 1 followed by 4 days of 400 mg daily. RESULTS Fifty-three precent of the patients were intubated at 5.4 ± 6.4 days after admission and 26.5% died at an average of 32.2 ± 19.1 days. QTc at admission was 448 ± 34 ms. Systemic exposure to HCQ and DHCQ demonstrated substantial variability. Cumulative area under the serum concentration-time curve up to infinity for HCQ was 71.4 ± 19.3 h mg/L and for DHCQ 56.5 ± 28.3 h mg/L. Variability in systemic exposure was not clearly explained by renal function, liver function or inflammatory state. In turn, systemic exposure did not correlate with intubation status, survival or QTc prolongation. CONCLUSION This study in severely ill patients was not able to find any relationship between systemic exposure to HCQ and DHCQ and clinical outcome at a routine dose regimen and adds to the growing body of evidence that oral HCQ does not alter the course of disease in COVID-19 patients.
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Affiliation(s)
- Alex K. Lyashchenko
- Department of Pathology and Cell Biology, Vagelos College of Physicians and SurgeonsColumbia University Irving Medical CenterNew YorkNYUSA
| | - Yifan Yu
- Department of Pharmaceutical SciencesUniversity at BuffaloBuffaloNYUSA
| | - Donald J. McMahon
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia University Irving Medical CenterNew YorkNYUSA
| | - Robert Bies
- Department of Pharmaceutical SciencesUniversity at BuffaloBuffaloNYUSA
| | - Michael T. Yin
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia University Irving Medical CenterNew YorkNYUSA
| | - Serge Cremers
- Department of Pharmaceutical SciencesUniversity at BuffaloBuffaloNYUSA
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia University Irving Medical CenterNew YorkNYUSA
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CENGİZ G, ŞAŞ S. Evaluation of COVID-19 clinical features and outcomes in individuals with rheumatic disease. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1097052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
features and course of coronavirus disease 2019 (COVID-19) in individuals with rheumatic disease.
Materials and Methods: This retrospective study was carried out at the Erciyes University rheumatology outpatient clinic from July 1 to August 1, 2021. The demographic and clinical data and summarized COVID-19 history, clinical course of COVID-19, fatigue, and pain levels of patients with rheumatic disease were obtained from our institutional electronic registration database and patient files.
Results: Recruited participants were 106 individuals (83% female, %17 male) with rheumatic disease who had been confirmed by laboratory tests to have COVID-19 and recovered from the COVID-19 infection. Their mean age and body mass index (BMI) were 48.69±11.5 years and 29.89±6.76 kg/m2, respectively. Additionally, 21 (19.8%) had been hospitalized, and five (4.7%) had been admitted to the intensive care unit. The most common rheumatic diseases were axial spondyloarthritis (40; 37.7%) and rheumatoid arthritis (26 cases; 24.5%). Patients who received conventional synthetic disease-modifying drugs (csDMARDs) reportedly experienced more pain, fatigue, and headaches than those in the biologic agent and non-steroidal anti-inflammatory drug (NSAID) groups.
Conclusion: Our study results reveal similar symptoms and hospitalization rates among patients with rheumatic disease who recovered from COVID-19 and received either csDMARDs, biologic agents, or NSAIDs. However, patients in the csDMARD group reported more pain, fatigue, and headache compared to the other groups.
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Wang J, Jing X, Hua L, Zheng Y, Hu S, Xiao J, Guo D, Wu W, Ji H, Peng L, Jiang S, Gao X. Hypertension related toxicity of chloroquine explains its failure against COVID-19: Based on rat model. Front Pharmacol 2022; 13:1051694. [DOI: 10.3389/fphar.2022.1051694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Chloroquine was once thought to be a promising treatment for COVID-19 but it quickly failed due to its inefficiency and association with increased mortality. Further, comorbidities such as hypertension may have contributed this failure. The safety and toxicity of chloroquine at doses required for treating SARS-CoV-2 infection in hypertensive patients remain unknown. Herein, to investigate these effects, we performed a safety evaluation of chloroquine at the approved dose (63 mg/kg) and at a high dose (126 mg/kg) in hypertensive rats. We found that chloroquine increased the mortality of hypertensive rats to 18.2% and 100%, respectively, after 7 days. During the chloroquine exposure period, the bodyweight, feed, and water consumption of hypertensive rats were decreased significantly. In addition, we show that chloroquine induces prolongation of QTc interval, elevation of LDH and CK, and histopathological damage of the myocardium in hypertensive rats. Ocular toxicity was observed in hypertensive rats in the form of hemorrhage in the eyes and retinal damage. Furthermore, we also observed intestinal toxicity in hypertensive rats, which presented as thinning intestinal walls with hemorrhagic contents, and histopathological changes of the jejunum. Hepatotoxicity was also evidenced by elevated ALT, and vacuolization of hepatocytes was also observed. Nephrotoxicity was observed only in high dose chloroquine-treated hypertensive rats, presenting as alterations of urinalysis and renal function. Immune alterations were also found in high-dose chloroquine-treated hypertensive rats with elevation of serum IL-10, IL-1β and GRO, and moderate damage to the spleen. In summary, this study partially explains the reason for the failure of chloroquine as a COVID-19 therapy, and underlines the importance of safety evaluation and medical supervision of chloroquine to avoid patient harm, especially to those with hypertension.
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de Moraes VY, Marra AR, Matos LL, Serpa A, Rizzo LV, Cendoroglo M, Lenza M. Hydroxychloroquine for treatment of COVID-19 patients: a systematic review and meta-analysis of randomized controlled trials. EINSTEIN-SAO PAULO 2022; 20:eRW0045. [PMID: 36477526 PMCID: PMC9744433 DOI: 10.31744/einstein_journal/2022rw0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis on the efficacy and safety of hydroxychloroquine to treat COVID-19 patients. METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and LILACS (January 2019 to March 2021) for patients aged 18 years or older, who had COVID-19 and were treated with hydroxychloroquine versus placebo or standard of care. We also searched the WHO Clinical Trials Registry for ongoing and recently completed studies, and the reference lists of selected articles and reviews for possible relevant studies, with no restrictions regarding language or publication status. Random-effects models were used to obtain pooled mean differences of treatment effect on mortality, and serious adverse effects between hydroxychloroquine and the Control Group (standard of care or placebo); heterogeneity was assessed using the I2 and the Cochran´s Q statistic. RESULTS Nine studies met the inclusion criteria and were included in the meta-analysis. There was no significant difference in mortality rate between patients treated with hydroxychloroquine compared to standard of care or placebo (16.7% versus 18.5%; pooled risk ratio 1.09; 95% confidence interval: 0.99-1.19). Also, the rate of serious adverse effects was similar between both Groups, Hydroxychloroquine and Control (3.7% versus 2.9%; pooled risk ratio 1.22; 95% confidence interval: 0.76-1.96). CONCLUSION Hydroxychloroquine is not efficacious in reducing mortality of COVID-19 patients. PROSPERO DATABASE REGISTRATION (www.crd.york.ac.uk/prospero) under number CRD42020197070.
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Affiliation(s)
- Vinícius Ynoe de Moraes
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Alexandre Rodrigues Marra
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Leandro Luongo Matos
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Ary Serpa
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Luiz Vicente Rizzo
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Miguel Cendoroglo
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Mario Lenza
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Corresponding author: Mario Lenza, Avenida Albert Einstein, 627/701, 3th floor, building E - Morumbi, Zip code: 05652-900 - São Paulo, SP, Brazil, Phone: (55 11) 2151-1443, E-mail:
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Zhang X, Yang Z, Pan T, Long X, Sun Q, Wang PH, Li X, Kuang E. SARS-CoV-2 ORF3a induces RETREG1/FAM134B-dependent reticulophagy and triggers sequential ER stress and inflammatory responses during SARS-CoV-2 infection. Autophagy 2022; 18:2576-2592. [PMID: 35239449 PMCID: PMC9629087 DOI: 10.1080/15548627.2022.2039992] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
SARS-CoV-2 infections have resulted in a very large number of severe cases of COVID-19 and deaths worldwide. However, knowledge of SARS-CoV-2 infection, pathogenesis and therapy remains limited, emphasizing the urgent need for fundamental studies and drug development. Studies have shown that induction of macroautophagy/autophagy and hijacking of the autophagic machinery are essential for the infection and replication of SARS-CoV-2; however, the mechanism of this manipulation and the function of autophagy during SARS-CoV-2 infection remain unclear. In the present study, we identified ORF3a as an inducer of autophagy (in particular reticulophagy) and revealed that ORF3a localizes to the ER and induces RETREG1/FAM134B-related reticulophagy through the HMGB1-BECN1 (beclin 1) pathway. As a consequence, ORF3a induces ER stress and inflammatory responses through reticulophagy and then sensitizes cells to the acquisition of an ER stress-related early apoptotic phenotype and facilitates SARS-CoV-2 infection, suggesting that SARS-CoV-2 ORF3a hijacks reticulophagy and then disrupts ER homeostasis to induce ER stress and inflammatory responses during SARS-CoV-2 infection. These findings reveal the sequential induction of reticulophagy, ER stress and acute inflammatory responses during SARS-CoV-2 infection and imply the therapeutic potential of reticulophagy and ER stress-related drugs for COVID-19.Abbreviations: CQ: chloroquine; DEGs: differentially expressed genes; ER: endoplasmic reticulum; GSEA: gene set enrichment analysis; HMGB1: high mobility group box 1; HMOX1: heme oxygenase 1; MERS-CoV: Middle East respiratory syndrome coronavirus; RETREG1/FAM134B: reticulophagy regulator 1; RTN4: reticulon 4; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; TN: tunicamycin.
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Affiliation(s)
- Xiaolin Zhang
- Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou, China,Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangzhou, Guangdong, China
| | - Ziwei Yang
- Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou, China,Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangzhou, Guangdong, China
| | - Ting Pan
- Center for Infection and Immunity Studies, School of Medicine, Sun Yat-Sen University, Guangdong, Shenzhen, China
| | - Xubing Long
- Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou, China,Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangzhou, Guangdong, China
| | - Qinqin Sun
- Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou, China,Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangzhou, Guangdong, China
| | - Pei-Hui Wang
- Key Laboratory for Experimental Teratology of Ministry of Education and Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Shandong, Jinan, China
| | - Xiaojuan Li
- College of Clinic Medicine, Hubei University of Chinese Medicine, Hubei, Wuhan, China,CONTACT Xiaojuan Li College of Clinic Medicine, Hubei University of Chinese Medicine, Hubei, Wuhan430061, China
| | - Ersheng Kuang
- Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou, China,Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangzhou, Guangdong, China,Ersheng Kuang Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou, 510080, China
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White H, McDonald SJ, Barber B, Davis J, Burr L, Nair P, Mukherjee S, Tendal B, Elliott J, McGloughlin S, Turner T. Care for adults with
COVID
‐19: living guidelines from the National
COVID
‐19 Clinical Evidence Taskforce. Med J Aust 2022; 217:368-378. [PMID: 36150213 PMCID: PMC9538623 DOI: 10.5694/mja2.51718] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022]
Abstract
Introduction The Australian National COVID‐19 Clinical Evidence Taskforce was established in March 2020 to maintain up‐to‐date recommendations for the treatment of people with coronavirus disease 2019 (COVID‐19). The original guideline (April 2020) has been continuously updated and expanded from nine to 176 recommendations, facilitated by the rapid identification, appraisal, and analysis of clinical trial findings and subsequent review by expert panels. Main recommendations In this article, we describe the recommendations for treating non‐pregnant adults with COVID‐19, as current on 1 August 2022 (version 61.0). The Taskforce has made specific recommendations for adults with severe/critical or mild disease, including definitions of disease severity, recommendations for therapy, COVID‐19 prophylaxis, respiratory support, and supportive care. Changes in management as a result of the guideline The Taskforce currently recommends eight drug treatments for people with COVID‐19 who do not require supplemental oxygen (inhaled corticosteroids, casirivimab/imdevimab, molnupiravir, nirmatrelvir/ritonavir, regdanvimab, remdesivir, sotrovimab, tixagevimab/cilgavimab) and six for those who require supplemental oxygen (systemic corticosteroids, remdesivir, tocilizumab, sarilumab, baricitinib, casirivimab/imdevimab). Based on evidence of their achieving no or only limited benefit, ten drug treatments or treatment combinations are not recommended; an additional 42 drug treatments should only be used in the context of randomised trials. Additional recommendations include support for the use of continuous positive airway pressure, prone positioning, and endotracheal intubation in patients whose condition is deteriorating, and prophylactic anticoagulation for preventing venous thromboembolism. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- Heath White
- Cochrane Australia Monash University Melbourne VIC
| | | | | | - Joshua Davis
- John Hunter Hospital Newcastle NSW
- The University of Newcastle Newcastle NSW
| | - Lucy Burr
- Mater Hospital Brisbane Brisbane QLD
- Mater Research Institute University of Queensland Brisbane QLD
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Pereira RA, Sousa M, Cidade JP, Melo L, Lopes D, Ventura S, Aragão I, Lima Neto RMDF, Molinos E, Marques A, Cardoso N, Marino F, Monteiro FB, Oliveira AP, Silva RC, Real AMN, Banheiro BS, Reis R, Adão-Serrano M, Cracium A, Valadas A, Ribeiro JM, Póvoa P, Tapadinhas C, Mendes V, Coelho L, Maia R, Freitas PT, Ferreira IA, Ramires T, Val-Flores LS, Cascão M, Alves R, Rodeia SC, Barrigoto C, Cardiga R, da Silva MJF, Vale B, Fonseca T, Rios AL, Camões J, Pérez D, Cabral S, Ribeiro MI, Mendes JJ, Gouveia J, Fernandes SM. What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care. Rev Bras Ter Intensiva 2022; 34:433-442. [PMID: 36888823 PMCID: PMC9987006 DOI: 10.5935/0103-507x.20210037-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/27/2022] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. METHODS This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. RESULTS Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. CONCLUSION There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.
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Affiliation(s)
- Rui Antunes Pereira
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Marta Sousa
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - José Pedro Cidade
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Melo
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Diogo Lopes
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Sara Ventura
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Irene Aragão
- Hospital de Santo António, Centro Hospitalar do Porto -
Porto, Portugal
| | | | - Elena Molinos
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Ana Marques
- Centro Hospitalar Universitário de Coimbra - Coimbra,
Portugal
| | | | - Flávio Marino
- Hospital de Vila Franca de Xira - Vila Franca de Xira, Portugal
| | - Filipa Brás Monteiro
- Hospital de Egas Moniz, Centro Hospitalar Universitário
Lisboa Oriental - Lisboa, Portugal
| | | | - Rogério C Silva
- Hospital de Santa Luzia, Unidade Local de Saúde Alto Minho
- Viana do Castelo, Portugal
| | | | | | - Renato Reis
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Maria Adão-Serrano
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Ana Cracium
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Ana Valadas
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - João Miguel Ribeiro
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Camila Tapadinhas
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Vítor Mendes
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Coelho
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Raquel Maia
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | | | | | - Tiago Ramires
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Luís Silva Val-Flores
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Mariana Cascão
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Rita Alves
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Simão C Rodeia
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Cleide Barrigoto
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Rosa Cardiga
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | | | - Bruno Vale
- Hospital de Santo António, Centro Hospitalar do Porto -
Porto, Portugal
| | - Tatiana Fonseca
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - Ana Lúcia Rios
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - João Camões
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Danay Pérez
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Susana Cabral
- Centro Hospitalar Universitário de Coimbra - Coimbra,
Portugal
| | | | - João João Mendes
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
| | - João Gouveia
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
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Pereira RA, Sousa M, Cidade JP, Melo L, Lopes D, Ventura S, Aragão I, Lima Neto RMDF, Molinos E, Marques A, Cardoso N, Marino F, Monteiro FB, Oliveira AP, Silva RC, Real AMN, Banheiro BS, Reis R, Adão-Serrano M, Cracium A, Valadas A, Ribeiro JM, Póvoa P, Tapadinhas C, Mendes V, Coelho L, Maia R, Freitas PT, Ferreira IA, Ramires T, Val-Flores LS, Cascão M, Alves R, Rodeia SC, Barrigoto C, Cardiga R, da Silva MJF, Vale B, Fonseca T, Rios AL, Camões J, Pérez D, Cabral S, Ribeiro MI, Mendes JJ, Gouveia J, Fernandes SM. What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care. Rev Bras Ter Intensiva 2022; 34:433-442. [PMID: 36888823 PMCID: PMC9987006 DOI: 10.5935/0103-507x.20210037-pt] [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: 02/01/2022] [Accepted: 08/27/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. METHODS This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. RESULTS Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. CONCLUSION There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.
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Affiliation(s)
- Rui Antunes Pereira
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Marta Sousa
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - José Pedro Cidade
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Melo
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Diogo Lopes
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Sara Ventura
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Irene Aragão
- Hospital de Santo António, Centro Hospitalar do Porto -
Porto, Portugal
| | | | - Elena Molinos
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Ana Marques
- Centro Hospitalar Universitário de Coimbra - Coimbra,
Portugal
| | | | - Flávio Marino
- Hospital de Vila Franca de Xira - Vila Franca de Xira, Portugal
| | - Filipa Brás Monteiro
- Hospital de Egas Moniz, Centro Hospitalar Universitário
Lisboa Oriental - Lisboa, Portugal
| | | | - Rogério C Silva
- Hospital de Santa Luzia, Unidade Local de Saúde Alto Minho
- Viana do Castelo, Portugal
| | | | | | - Renato Reis
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Maria Adão-Serrano
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Ana Cracium
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Ana Valadas
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - João Miguel Ribeiro
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Camila Tapadinhas
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Vítor Mendes
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Coelho
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Raquel Maia
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | | | | | - Tiago Ramires
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Luís Silva Val-Flores
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Mariana Cascão
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Rita Alves
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Simão C Rodeia
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Cleide Barrigoto
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Rosa Cardiga
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | | | - Bruno Vale
- Hospital de Santo António, Centro Hospitalar do Porto -
Porto, Portugal
| | - Tatiana Fonseca
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - Ana Lúcia Rios
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - João Camões
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Danay Pérez
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Susana Cabral
- Centro Hospitalar Universitário de Coimbra - Coimbra,
Portugal
| | | | - João João Mendes
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
| | - João Gouveia
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
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Di Stefano L, Ogburn EL, Ram M, Scharfstein DO, Li T, Khanal P, Baksh SN, McBee N, Gruber J, Gildea MR, Clark MR, Goldenberg NA, Bennani Y, Brown SM, Buckel WR, Clement ME, Mulligan MJ, O’Halloran JA, Rauseo AM, Self WH, Semler MW, Seto T, Stout JE, Ulrich RJ, Victory J, Bierer BE, Hanley DF, Freilich D. Hydroxychloroquine/chloroquine for the treatment of hospitalized patients with COVID-19: An individual participant data meta-analysis. PLoS One 2022; 17:e0273526. [PMID: 36173983 PMCID: PMC9521809 DOI: 10.1371/journal.pone.0273526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Results from observational studies and randomized clinical trials (RCTs) have led to the consensus that hydroxychloroquine (HCQ) and chloroquine (CQ) are not effective for COVID-19 prevention or treatment. Pooling individual participant data, including unanalyzed data from trials terminated early, enables more detailed investigation of the efficacy and safety of HCQ/CQ among subgroups of hospitalized patients. METHODS We searched ClinicalTrials.gov in May and June 2020 for US-based RCTs evaluating HCQ/CQ in hospitalized COVID-19 patients in which the outcomes defined in this study were recorded or could be extrapolated. The primary outcome was a 7-point ordinal scale measured between day 28 and 35 post enrollment; comparisons used proportional odds ratios. Harmonized de-identified data were collected via a common template spreadsheet sent to each principal investigator. The data were analyzed by fitting a prespecified Bayesian ordinal regression model and standardizing the resulting predictions. RESULTS Eight of 19 trials met eligibility criteria and agreed to participate. Patient-level data were available from 770 participants (412 HCQ/CQ vs 358 control). Baseline characteristics were similar between groups. We did not find evidence of a difference in COVID-19 ordinal scores between days 28 and 35 post-enrollment in the pooled patient population (odds ratio, 0.97; 95% credible interval, 0.76-1.24; higher favors HCQ/CQ), and found no convincing evidence of meaningful treatment effect heterogeneity among prespecified subgroups. Adverse event and serious adverse event rates were numerically higher with HCQ/CQ vs control (0.39 vs 0.29 and 0.13 vs 0.09 per patient, respectively). CONCLUSIONS The findings of this individual participant data meta-analysis reinforce those of individual RCTs that HCQ/CQ is not efficacious for treatment of COVID-19 in hospitalized patients.
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Affiliation(s)
- Leon Di Stefano
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth L. Ogburn
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Daniel O. Scharfstein
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Tianjing Li
- University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado, United States of America
| | - Preeti Khanal
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Sheriza N. Baksh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nichol McBee
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Joshua Gruber
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Marianne R. Gildea
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Megan R. Clark
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Neil A. Goldenberg
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins All Children’s Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, United States of America
| | - Yussef Bennani
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- University Medical Center, New Orleans, New Orleans, Louisiana, United States of America
| | - Samuel M. Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States of America
- University of Utah, Salt Lake City, Utah, United States of America
| | - Whitney R. Buckel
- Pharmacy Services, Intermountain Healthcare, Murray, Utah, United States of America
| | - Meredith E. Clement
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- University Medical Center, New Orleans, New Orleans, Louisiana, United States of America
| | - Mark J. Mulligan
- Department of Medicine, Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, United States of America
- Vaccine Center, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jane A. O’Halloran
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Adriana M. Rauseo
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Wesley H. Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Matthew W. Semler
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Todd Seto
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Jason E. Stout
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Robert J. Ulrich
- Department of Medicine, Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jennifer Victory
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, United States of America
| | - Barbara E. Bierer
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Daniel Freilich
- Department of Internal Medicine, Division of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, United States of America
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Gagnon LR, Sadasivan C, Yogasundaram H, Oudit GY. Review of Hydroxychloroquine Cardiotoxicity: Lessons From the COVID-19 Pandemic. Curr Heart Fail Rep 2022; 19:458-466. [PMID: 36167917 PMCID: PMC9514702 DOI: 10.1007/s11897-022-00581-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review The coronavirus disease 2019 (COVID-19) pandemic has popularized the usage of hydroxychloroquine and chloroquine (HCQ/CQ) as treatments for COVID-19. Previously used as anti-malarial and now commonly used in rheumatologic conditions, preliminary in vitro studies have demonstrated these medications also have anti-viral properties. Retinopathy and neuromyopathy are well recognized complications of using these treatments; however, cardiotoxicity is under-recognized. This review will discuss the implications and cardiotoxicity of HCQ/CQ, their mechanisms of action, and their utility in COVID-19. Recent Findings Early clinical trials demonstrated a modest benefit of HCQ in COVID-19, causing a push for the usage of it. However, further large multi-center randomized control centers, demonstrated no benefit, and even a trend towards worse outcomes. The predominant cardiac complication observed with HCQ in COVID-19 was cardiac arrhythmias and prolonging of the QT interval. However, with chronic usage of HCQ/CQ, the development of heart failure (HF) and cardiomyopathy (CM) can occur. Summary Although, most adverse cardiac events related to HCQ/CQ usage in COVID-19 were secondary to conduction disorders given the short duration of treatment, HCQ/CQ can cause CM and HF, with chronic usage. Given the insufficient evidence, HCQ/CQ usage in COVID-19 is not routinely recommended, especially with novel therapies now being developed and used. Additionally, usage of HCQ/CQ should prompt initial cardiac evaluation with ECG, and yearly monitoring, with consideration for advanced imaging if clinically warranted. The diagnosis of HCQ/CQ cardiomyopathy is important, as prompt cessation can allow for recovery when these changes are still reversible.
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Affiliation(s)
- Luke R Gagnon
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Chandu Sadasivan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. .,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. .,Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada.
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Identification of Suitable Drug Combinations for Treating COVID-19 Using a Novel Machine Learning Approach: The RAIN Method. Life (Basel) 2022; 12:life12091456. [PMID: 36143492 PMCID: PMC9505329 DOI: 10.3390/life12091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary This study follows an improved approach to systematic reviews, called the Systematic Review and Artificial Intelligence Network Meta-Analysis (RAIN), registered within PROSPERO (CRD42021256797), in which, the PRISMA criterion is still considered. Drugs used in the treatment of COVID-19 were searched in the databases of ScienceDirect, Web of Science (WoS), ProQuest, Embase, Medline (PubMed), and Scopus. In addition, using artificial intelligence and the measurement of the p-value between human genes affected by COVID-19 and drugs that have been suggested by clinical experts, and reported within the identified research papers, suitable drug combinations are proposed for the treatment of COVID-19. During the systematic review process, 39 studies were selected. Our analysis shows that most of the reported drugs, such as azithromycin and hydroxyl-chloroquine on their own, do not have much of an effect on the recovery of COVID-19 patients. Based on the result of the new artificial intelligence, on the other hand, at a significance level of less than 0.05, the combination of the two drugs therapeutic corticosteroid + camostat with a significance level of 0.02, remdesivir + azithromycin with a significance level of 0.03, and interleukin 1 receptor antagonist protein + camostat with a significance level 0.02 are considered far more effective for the treatment of COVID-19 and are therefore recommended. Abstract COVID-19 affects several human genes, each with its own p-value. The combination of drugs associated with these genes with small p-values may lead to an estimation of the combined p-value between COVID-19 and some drug combinations, thereby increasing the effectiveness of these combinations in defeating the disease. Based on human genes, we introduced a new machine learning method that offers an effective drug combination with low combined p-values between them and COVID-19. This study follows an improved approach to systematic reviews, called the Systematic Review and Artificial Intelligence Network Meta-Analysis (RAIN), registered within PROSPERO (CRD42021256797), in which, the PRISMA criterion is still considered. Drugs used in the treatment of COVID-19 were searched in the databases of ScienceDirect, Web of Science (WoS), ProQuest, Embase, Medline (PubMed), and Scopus. In addition, using artificial intelligence and the measurement of the p-value between human genes affected by COVID-19 and drugs that have been suggested by clinical experts, and reported within the identified research papers, suitable drug combinations are proposed for the treatment of COVID-19. During the systematic review process, 39 studies were selected. Our analysis shows that most of the reported drugs, such as azithromycin and hydroxyl-chloroquine on their own, do not have much of an effect on the recovery of COVID-19 patients. Based on the result of the new artificial intelligence, on the other hand, at a significance level of less than 0.05, the combination of the two drugs therapeutic corticosteroid + camostat with a significance level of 0.02, remdesivir + azithromycin with a significance level of 0.03, and interleukin 1 receptor antagonist protein + camostat with a significance level 0.02 are considered far more effective for the treatment of COVID-19 and are therefore recommended. Additionally, at a significance level of less than 0.01, the combination of interleukin 1 receptor antagonist protein + camostat + azithromycin + tocilizumab + oseltamivir with a significance level of 0.006, and the combination of interleukin 1 receptor antagonist protein + camostat + chloroquine + favipiravir + tocilizumab7 with corticosteroid + camostat + oseltamivir + remdesivir + tocilizumab at a significant level of 0.009 are effective in the treatment of patients with COVID-19 and are also recommended. The results of this study provide sets of effective drug combinations for the treatment of patients with COVID-19. In addition, the new artificial intelligence used in the RAIN method could provide a forward-looking approach to clinical trial studies, which could also be used effectively in the treatment of diseases such as cancer.
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Battaglini D, Cruz F, Robba C, Pelosi P, Rocco PRM. Failed clinical trials on COVID-19 acute respiratory distress syndrome in hospitalized patients: common oversights and streamlining the development of clinically effective therapeutics. Expert Opin Investig Drugs 2022; 31:995-1015. [PMID: 36047644 DOI: 10.1080/13543784.2022.2120801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has put a strain on global healthcare systems. Despite admirable efforts to develop rapidly new pharmacotherapies, supportive treatments remain the standard of care. Multiple clinical trials have failed due to design issues, biased patient enrollment, small sample sizes, inadequate control groups, and lack of long-term outcomes monitoring. AREAS COVERED This narrative review depicts the current situation around failed and success COVID-19 clinical trials and recommendations in hospitalized patients with COVID-19, oversights and streamlining of clinically effective therapeutics. PubMed, EBSCO, Cochrane Library, and WHO and NIH guidelines were searched for relevant literature up to 5 August 2022. EXPERT OPINION The WHO, NIH, and IDSA have issued recommendations to better clarify which drugs should be used during the different phases of the disease. Given the biases and high heterogeneity of published studies, interpretation of the current literature is difficult. Future clinical trials should be designed to standardize clinical approaches, with appropriate organization, patient selection, addition of control groups, and careful identification of disease phase to reduce heterogeneity and bias and should rely on the integration of scientific societies to promote a consensus on interpretation of the data and recommendations for optimal COVID-19 therapies.
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Affiliation(s)
- Denise Battaglini
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa, Italy
| | - Fernanda Cruz
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chiara Robba
- Policlinico San Martino, IRCCS per l'Oncologia e Neuroscienze, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Paolo Pelosi
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa, Italy.,Policlinico San Martino, IRCCS per l'Oncologia e Neuroscienze, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,COVID-19 Virus Network from Ministry of Science, Technology, and Innovation, Brazilian Council for Scientific and Technological Development, and Foundation Carlos Chagas Filho Research Support of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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