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Komissarov A, Molodtsov I, Ivanova O, Maryukhnich E, Kudryavtseva S, Mazus A, Nikonov E, Vasilieva E. High SARS-CoV-2 load in the nasopharynx of patients with a mild form of COVID-19 is associated with clinical deterioration regardless of the hydroxychloroquine administration. PLoS One 2021; 16:e0246396. [PMID: 33513195 PMCID: PMC7846025 DOI: 10.1371/journal.pone.0246396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/16/2021] [Indexed: 12/27/2022] Open
Abstract
Because of the constantly growing numbers of COVID-19 infections and deaths, attempts were undertaken to find drugs with anti-SARS-CoV-2 activity among ones already approved for other pathologies. In the framework of such attempts, in a number of in vitro, as well as in vivo, models it was shown that hydroxychloroquine (HCQ) has an effect against SARS-CoV-2. While there were not enough clinical data to support the use of HCQ, several countries including Russia have included HCQ in treatment protocols for infected patients and for prophylaxis. In the current non-randomized, observational study we evaluated the SARS-CoV-2 RNA in nasopharynx swabs from infected patients 7–10 days post symptoms with clinically mild disease and compared the viral RNA load dynamics between patients receiving HCQ (200 mg twice per day according to the Ministry of Health of Russian Federation treatment instructions, n = 33) and a control group without antiviral pharmacological therapy (n = 12). We found a statistically significant relationship between maximal RNA quantity and deterioration of patients’ medical conditions, and as well we confirmed arterial hypertension to be a risk factor for people with COVID-19. However, we showed that at the dose used in the study HCQ therapy neither shortened the viral shedding period nor reduced the virus RNA load.
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Affiliation(s)
- Alexey Komissarov
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Ivan Molodtsov
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- N.F. Gamaleya Federal National Research Centre for Epidemiology and Microbiology, Moscow, Russia
| | - Oxana Ivanova
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Elena Maryukhnich
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Svetlana Kudryavtseva
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
| | - Alexey Mazus
- Moscow City Center for AIDS Prevention and Control, Moscow Department of Healthcare, Moscow, Russia
| | | | - Elena Vasilieva
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
- * E-mail:
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Bhandari P, Subramaniam S, Bourke MJ, Alkandari A, Chiu PWY, Brown JF, Keswani RN, Bisschops R, Hassan C, Raju GS, Muthusamy VR, Sethi A, May GR, Albéniz E, Bruno M, Kaminski MF, Alkhatry M, Almadi M, Ibrahim M, Emura F, Moura E, Navarrete C, Wulfson A, Khor C, Ponnudurai R, Inoue H, Saito Y, Yahagi N, Kashin S, Nikonov E, Yu H, Maydeo AP, Reddy DN, Wallace MB, Pochapin MB, Rösch T, Sharma P, Repici A. Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus. Gut 2020; 69:1915-1924. [PMID: 32816921 DOI: 10.1136/gutjnl-2020-322329] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.
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Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK .,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Sharmila Subramaniam
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Asma Alkandari
- Department of Gastroenterology, Al Jahra Hospital, Kuwait City, Al Jahra, Kuwait
| | - Philip Wai Yan Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - James F Brown
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Rajesh N Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Raf Bisschops
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Vlaams Brabant, Belgium
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology and Nutrition, Universidad of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - V Raman Muthusamy
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Gary R May
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michal Filip Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Centre for Postgraduate Medical Education, Warsaw, Poland.,Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Instytute of Oncology, Warsaw, Poland
| | - Maryam Alkhatry
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates
| | - Majid Almadi
- Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia
| | - Mostafa Ibrahim
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Giza, Egypt
| | - Fabian Emura
- Gastroenterology Division, Universidad de La Sabana, Chia, Colombia.,Department of Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogota, Colombia
| | - Eduardo Moura
- Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | | | - Adolfo Wulfson
- Department of Gastroenterology, Hospital de Emergencias Dr Clemente Alvarez, Rosario, Rosario, Argentina
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Ryan Ponnudurai
- Department of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Naohisa Yahagi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.,Cancer Center, Keio University, Tokyo, Japan
| | - Sergey Kashin
- Department of Endoscopy, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation
| | - Evgeniy Nikonov
- Department of Gastroenterology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Amit P Maydeo
- Department of Surgery, Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - D Nageshwar Reddy
- Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - Michael B Wallace
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Prateek Sharma
- Endoscopy Unit, Veteran Affairs Medical Center and University of Kansas, Kansas City, Kansas, USA
| | - Alessandro Repici
- Gastroenterology and Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
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Kalinskaya A, Dukhin O, Molodtsov I, Maltseva A, Sokorev D, Elizarova A, Sapozhnikova O, Glebova K, Stonogina D, Shakhidzhanov S, Nikonov E, Mazus A, Spiridonov I, Ataullakhanov F, Margolis L, Shpektor A, Vasilieva E. Dynamics of coagulopathy in patients with different COVID-19 severity. medRxiv 2020:2020.07.02.20145284. [PMID: 32637973 PMCID: PMC7340199 DOI: 10.1101/2020.07.02.20145284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the progress of COVID-19 studies, it became evident that SARS-CoV-2 infection is often associated with thrombotic complications. The goal of our present study was to evaluate which component of clot formation process including endothelial function, platelets aggregation and plasma coagulation, as well as endogenous fibrinolysis in patients with COVID-19 correlates with the severity of the disease. We prospectively included 58 patients with COVID-19 and 47 healthy volunteers as a control group that we recruited before the pandemic started. It turns out that plasma coagulation with subsequent platelet aggregation, but not endothelial function, correlates with the severity of the COVID-19. IL-6 blockade may play a beneficial role in COVID-19 induced coagulopathy.
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Affiliation(s)
- Anna Kalinskaya
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Oleg Dukhin
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Ivan Molodtsov
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
| | - Alexandra Maltseva
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Denis Sokorev
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Antonina Elizarova
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Olga Sapozhnikova
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Ksenia Glebova
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Daria Stonogina
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Soslan Shakhidzhanov
- Center for Theoretical Problems of Physico-Chemical Pharmacology RAS, Moscow, Russia
| | - Evgeniy Nikonov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Alexey Mazus
- Moscow City Center for AIDS Prevention and Control, Moscow Department of Healthcare, Moscow, Russia
| | - Ilia Spiridonov
- Center for Theoretical Problems of Physico-Chemical Pharmacology RAS, Moscow, Russia
| | - Fazly Ataullakhanov
- Center for Theoretical Problems of Physico-Chemical Pharmacology RAS, Moscow, Russia
- University of Pennsylvania, Philadelphia, USA
| | - Leonid Margolis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - Alexander Shpektor
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Elena Vasilieva
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow, Russia
- Laboratory of Atherothrombosis, Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
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