Inefficacious drugs against covid-19: analysis of sales, tweets, and search engines / Medicamentos ineficazes contra covid-19: análise de vendas, tweets e mecanismos de busca

ABSTRACT OBJECTIVE Assess the correlation between the sales of two drugs with no proven efficacy against covid-19, ivermectin and chloroquine, and other relevant variables, such as Google® searches, number of tweets related to these drugs, number of cases and deaths resulting from covid-19. METHODS The methodology adopted in this study has four stages: data collection, data processing, exploratory data analysis, and correlation analysis. Spearman's method was used to obtain cross-correlations between each pair of variables. RESULTS The results show similar behaviors between variables. Peaks occurred in the same or near periods. The exploratory data analysis showed shortage of chloroquine in the period corresponding to the beginning of advertising for the application of these drugs against covid-19. Both drugs showed a high and statistically significant correlation with the other variables. Also, some of them showed a higher correlation with drug sales when we employed a one-month lag. In the case of chloroquine, this was observed for the number of deaths. In the case of ivermectin, this was observed for the number of tweets, cases, and deaths. CONCLUSIONS The results contribute to decision making in crisis management by governments, industries, and stores. In times of crisis, as observed during the covid-19 pandemic, some variables can help sales forecasting, especially Google® and tweets, which provide a real-time analysis of the situation. Monitoring social media platforms and search engines would allow the determination of drug use by the population and better prediction of potential peaks in the demand for these drugs.

RESUMO OBJETIVO Investigar a correlação entre as vendas de dois medicamentos sem eficácia comprovada no tratamento de covid-19, ivermectina e cloroquina, e outras variáveis relevantes: pesquisas no Google®, número de tweets relacionados aos medicamentos, casos e óbitos decorrentes da covid-19. MÉTODOS A metodologia adotada neste estudo se divide em quatro partes: coleta de dados; processamento dos dados; análise exploratória; e análise de correlação. Foi utilizado o método de Spearman para obter as correlações cruzadas entre cada par de variáveis. RESULTADOS Os resultados mostram similaridade entre os comportamentos das variáveis. Os picos ocorreram em períodos iguais ou próximos. A análise exploratória dos dados apontou que houve falta de cloroquina no período correspondente ao início das divulgações sobre a aplicação desses medicamentos para o tratamento da covid-19. Ambos os medicamentos apresentaram correlação alta e estatisticamente significativa com as demais variáveis analisadas. Também foi observado que algumas delas apresentaram maior correlação com as vendas de medicamentos quando assumiram defasagem temporal de um mês. No caso da cloroquina, isso ocorreu com a variável óbitos. No caso da ivermectina, ocorreu com as variáveis número de tweets, casos e óbitos. CONCLUSÕES Os resultados observados contribuem para a tomada de decisão durante a gestão de crises por parte de governo, indústrias e comércios. Em momentos de crises, como observado durante a pandemia, as variáveis mostraram que são capazes de auxiliar na previsão de vendas, em especial o Google® e os tweets, que proporcionam uma análise em tempo real da situação. Acompanhar as redes sociais e mecanismos de busca permitiria detecção de uso pela população e melhor previsão de potenciais picos de demanda desses medicamentos.

Eficácia da ivermectina e atazanavir no tempo de recuperação dos sintomas de covid-19: uma coorte prospectiva / Effectiveness of ivermectin and atazanavir on time to resolution from covid-19 symptoms: a prospective cohort / Eficacia de ivermectina y atazanavir en el tiempo hasta lá resolución de los síntomas de covid-19: una cohorte prospectiva

Objetivo: avaliar a eficácia da Ivermectina e do Atazanavir em comparação com placebo no tempo de resolução dos sintomas e no tempo de duração da doença por COVID-19. Método: estudo observacional, de coorte prospectivo, longitudinal, descritivo e analítico com pacientes sintomáticos ambulatoriais, acompanhados por 06 meses em duas Unidades Básicas de Saúde para atendimento de COVID-19 em Teresina- Piauí, Brasil, no período de novembro a abril de 2021 identificados por amostragem aleatória 1:1:1. Foram realizados exames Reverse transcription polymerase chain reaction (RT-PCR) para confirmação laboratorial da suspeita de infecção pelo novo coronavírus e avaliação sociodemográfica e clínica. Resultados: dos 87 pacientes randomizados, 62,1% (n=54) eram do sexo masculino, com média de idade de 35,1 anos, possuíam companheira (53,9%), baixa renda (50,6%), eutróficos (40,7%) e sem comorbidades de saúde (78,2%). Não houve diferença entre o tempo médio para resolução dos sintomas, que foi de 21 dias (IQR, 8-30) no grupo atazanavir, 30 dias (IQR, 5-90) no grupo ivermectina em comparação com 14 dias (IQR, 9-21) no grupo controle. No dia 180, houve resolução dos sintomas em 100% no grupo placebo, 93,9% no grupo atazanavir e 95% no grupo ivermectina. A duração mediana da doença foi de 08 dias em todos os braços do estudo. Conclusão: o tratamento com atazanavir (6 dias) e ivermectina (3 dias) não reduziu o tempo de resolução dos sintomas e nem o tempo de duração da doença entre os pacientes ambulatoriais com COVID-19 leve em comparação com o grupo placebo. Os resultados não suportam o uso de ivermectina e atazanavir para tratamento de COVID-19 leve a moderado.

Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piauí, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5- 90) in the ivermectin group compared with 14 days (IQR, 9- 21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.

Objetivo: evaluar la efectividad de Ivermectina y Atazanavir en comparación con placebo en el tiempo de resolución de los síntomas y duración de la enfermedad por COVID-19. Método: estudio de cohorte observacional, prospectivo, longitudinal, descriptivo y analítico con pacientes ambulatorios sintomáticos, seguidos durante 06 meses en dos Unidades Básicas de Salud para atención de COVID-19 en Teresina-Piauí, Brasil, de noviembre a abril de 2021 identificados por 1:1:1 muestreo aleatorio. Se realizaron pruebas de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para confirmación de laboratorio de sospecha de infección por el nuevo coronavirus y evaluación sociodemográfica y clínica. Resultados: de los 87 pacientes aleatorizados, 62,1% (n=54) eran del sexo masculino, con una edad media de 35,1 años, tenían pareja (53,9%), bajos ingresos (50,6%), eutróficos (40,7%) y sin comorbilidades de salud (78,2%). No hubo diferencia entre la mediana de tiempo hasta la resolución de los síntomas, que fue de 21 días (RIC, 8-30) en el grupo de atazanavir, 30 días (RIC, 5- 90) en el grupo de ivermectina en comparación con 14 días (RIC, 9 - 21) en el grupo control. En el día 180, hubo una resolución de los síntomas del 100 % en el grupo de placebo, del 93,9 % en el grupo de atazanavir y del 95 % en el grupo de ivermectina. La mediana de duración de la enfermedad fue de 8 días en todos los brazos del estudio. Conclusión: El tratamiento con atazanavir (6 días) e ivermectina (3 días) no redujo el tiempo de resolución de los síntomas ni la duración de la enfermedad entre los pacientes ambulatorios con COVID-19 leve en comparación con el grupo placebo. Los resultados no respaldan el uso de ivermectina y atazanavir para el tratamiento de la COVID-19 de leve a moderada.

Preferred practice patterns and review on rosacea

Rosacea is a chronic, inflammatory facial dermatosis commonly found in fair skin tone population. Recent studies have shown the increasing prevalence in the dark skin tone population as well. Ocular involvement is very common and can occur without cutaneous features. Common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring, and rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. The management ranges from local therapy to systemic treatment, depending on the severity of the disease. There is a positive association between demodicosis and rosacea; however, causality is always argued. In this review, we describe the epidemiology, clinical features, and treatment of rosacea and ocular rosacea.

Caracterización de eventos adversos a hidroxicloroquina, ivermectina, azitromicina y tocilizumab en pacientes hospitalizados por COVID-19 en un hospital del Seguro Social de Salud del Perú / Characterization of adverse events to hydroxychloroquine, ivermectin, azithromycin and tocilizumab in patients hospitalized due to COVID-19 in a Peruvian Social Health Insurance hospital

Objetivos. Caracterizar los eventos adversos (EA) asociados a hidroxicloroquina (HQ), azitromicina (AZI), tocilizumab (TOB) e ivermectina (IVM) prescritos como «fuera de etiqueta» en el tratamiento de pacientes hospitalizados por la COVID-19. Materiales y métodos. Se realizó un análisis secundario transversal de la base de datos del sistema de farmacovigilancia del Seguro Social de Salud del Perú (EsSalud) de las notificaciones de EA a HQ, AZI, TOB e IVM provenientes del Hospital Nacional Edgardo Rebagliati Martins de abril a octubre del 2020. Se revisaron las historias clínicas digitales, se estimaron las tasas de reporte de EA y se evaluaron sus características por tipo de fármaco, tiempo de aparición, tipo por órgano-sistema afectado, gravedad y causalidad. Resultados. Se identificaron 154 notificaciones que describen un total de 183 EA posiblemente relacionados con HQ, AZI, TOB e IVM, siendo 8% la tasa de reporte de EA. La mediana de tiempo de aparición de EA fue de 3 días (RIC: 2-5). La mayoría fueron cardiovasculares, destacándose la prolongación del intervalo QT. Se observaron EA hepatobiliares principalmente asociados a TOB. La mayoría de los casos fueron moderados, no obstante, el 10,4% fue grave. Conclusiones. Se identificaron EA potencialmente asociados al uso de HQ, AZI, TOB e IVM contra la COVID-19, siendo los más frecuentes los de tipo cardiovasculares. A pesar de que la AZI, HQ e IVM poseen perfiles conocidos de seguridad, su empleo en la COVID-19 podría incrementar la aparición de EA por los factores de riesgo propios de esta infección. Se sugiere reforzar la vigilancia, especialmente, de TOB.

Objective. To characterize the adverse events (AEs) related to the off-label use of hydroxychloroquine (HQ), azithromycin (AZI), tocilizumab (TOB) and ivermectin (IVM) for the treatment of COVID-19 in hospitalized patients. Materials and Methods. We conducted a secondary cross-sectional analysis of the Peruvian Social Health Insurance (EsSalud) pharmacovigilance system database of AE notifications to HQ, AZI, TOB and IVM in the Edgardo Rebagliati Martins National Hospital from April to October 2020. Information was collected from digital medical records. We estimated AE reporting rates and evaluated their characteristics by drug type, time of occurrence, type by the affected organ-system, severity and causality. Results. We identified 154 notifications describing a total of 183 AE possibly related to HQ, AZI, TOB and IVM; the reporting rate was 8%. The median time of AE occurrence was 3 days (IQR: 2-5). Most were cardiovascular events; prolongation of the QT interval was the most frequent. Hepatobiliary AEs were mainly associated with TOB. Most cases were moderate, however, 10.4% were severe. Conclusions. We found AEs potentially associated with the use of HQ, AZI, TOB and IVM against COVID-19; cardiovascular events were the most frequent. Although AZI, HQ and IVM have known safety profiles, their use against COVID-19 could increase the occurrence of AE due to the risk factors inherent to this infection. Surveillance systems must be improved, especially those for TOB.

Prevalence of Ivermectin use to prevent COVID-19 during the pandemic in Mato Grosso: cross-sectional home-based study / Prevalência do uso de ivermectina para prevenir COVID-19 durante a pandemia em Mato Grosso: estudo transversal de base domiciliar

ABSTRACT Objective: To analyze the use of ivermectin as COVID-19 prevention method by the population of Mato Grosso in 2020. Methods: This is a home-based survey, carried out between September and October 2020, in 10 pole cities of the socioeconomic regions of State. The use of ivermectin was evaluated through the question: "Did you take ivermectin to prevent COVID-19?". Sociodemographic variables (sex, age group, education, family income), current work situation, being benefitted by government financial programs, as well as symptoms, seroprevalence of antibodies against SARS-CoV-2, and previous diagnosis of COVID-19 were evaluated. Prevalence and their associations were estimated using the chi-square test. Results: 4.206 individuals were evaluated for prevalence of ivermectin use; 58.3% of the individuals responded positively, this rate being higher in the municipalities of the western region of the state (66.6%). There was no significant difference between sexes, but the prevalence was higher among people aged 50-59 years (69.7%), who were white (66.5%), with complete higher education or more (68.8%) and higher family income (≥3 minimum wages-64.2%). The use of this drug was even higher among participants who considered their knowledge of the disease good or very good (65.0%), who reported having symptoms of COVID-19 (75.3%), and who had been previously diagnosed with the disease (91.2%). Conclusion: There was a high prevalence of use of ivermectin as a method to prevent covid-19 by the population of Mato Grosso, indicating the need for strategies to inform the population about the risks of off-label use of drugs and to combat the advertising of drugs that are ineffective against COVID-19.

RESUMO Objetivo: Analisar a utilização de ivermectina como prevenção da COVID-19 pela população de Mato Grosso em 2020. Métodos: Trata-se de um inquérito de base domiciliar, realizado entre setembro e outubro de 2020, em dez municípios-polos das regiões socioeconômicas do estado. O uso da ivermectina foi avaliado por meio da pergunta: "Tomou ivermectina para prevenir a COVID-19?". Foram avaliadas as variáveis sociodemográficas (sexo, faixa etária, escolaridade, renda familiar), a situação de trabalho atual, o recebimento de benefícios financeiros governamentais, bem como sintomas, a soroprevalência de anticorpos contra SARS-CoV-2 e o diagnóstico prévio de COVID-19. As estimativas de prevalência e suas associações foram realizadas por meio do teste χ2. Resultados: Foram analisados 4.206 indivíduos, e a prevalência de uso de ivermectina foi de 58,3%, sendo maior nos municípios da região Oeste (66,6%). Não houve diferença significativa entre os sexos, a prevalência foi maior na da faixa etária de 50-59 anos (69,7%), em pessoas brancas (66,5%), com ensino superior completo ou mais (68,8%) e maior renda familiar (≥3 salários-mínimos — 64,2%). A utilização do medicamento ainda foi maior entre os que consideraram seu conhecimento sobre a doença como bom ou muito bom (65,0%), entre os que referiram ter apresentado sintomas de COVID-19 (75,3%) e que foram diagnosticados com a doença previamente (91,2%). Conclusão: Verifica-se a elevada a prevalência do uso de ivermectina para a prevenção da COVID-19 pela população de Mato Grosso, indicando a necessidade de estratégias para informar a população sobre os riscos do uso off-label de medicamentos e combater a publicidade de medicamentos sem eficácia contra COVID-19.

Treatment of oral myiasis in a patient with implant-supported fixed prosthesis

ABSTRACT Oral myiasis is a rare parasitic disease that requires immediate treatment once diagnosed. However, no standard treatment protocol can be found in the literature. Through a clinical-surgical report, we present the case of an 82-year-old man with lesions extending through the vestibule and alveolar ridge of the maxilla on both sides, in addition to occupying a large part of the palate, with a considerable number of larvae. The patient was initially treated with a single dose of systemic ivermectin (6 mg orally) and topical application of a tampon soaked in ether. The larvae were then surgically removed and debridement of the wound was performed. A crushed tablet of ivermectin 6 mg was applied topically for 2 days, the remaining larvae were again mechanically removed, and the patient received intravenous antimicrobial therapy. Treatment with systemic and topical ivermectin combined with antibiotic therapy and debridement proved to be effective in treating oral myiasis.

Uso de Ivermectina e Atazanavir no tratamento da Covid-19: uma revisão de escopo / Use of Ivermectin and Atazanavir in the treatment of Covid-19: a scoping review / Uso de Ivermectina y Atazanavir en el tratamiento de Covid-19: una revisión de alcance

Objetivo: Examinar e mapear as evidências científicas sobre a eficácia do uso de ivermectina e atazanavir no tratamento de COVID-19. Metodologia: Scoping Review, baseado nos procedimentos recomendados pelo Instituto Joanna Briggs. Estabeleceu-se a pergunta norteadora: "Quais são as evidências científicas sobre o uso de ivermectina e atazanavir no tratamento de pacientes com sintomas leves de COVID-19?". Foram realizadas buscas em seis bases de dados nacionais e internacionais, sobre trabalhos publicados até dezembro de 2022. Dos 357 estudos encontrados, 22 foram selecionados para leitura na íntegra, resultando em uma amostra final de 11 estudos analisados. Resultados: As 11 publicações analisadas foram publicadas de 2020 a 2022 durante período pandêmico, de âmbito nacional e internacional com delineamento de estudos experimentais, do tipo ensaio clínico com randomização. Apenas 03 estudos (25%) testaram o atazanavir como intervenção conjugada a outras drogas, não evidenciando melhorias significativas em relação ao seu uso. Já no tratamento com Ivermectina, dos oito (75%) estudos que a testaram, apenas três (37,5%) recomendaram seu uso e cinco (62,5%) não suportam seu uso para tratamento de COVID-19 leve. O tempo de resolução dos sintomas variou de 8 a 10 dias nos braços tratados com ivermectina e em média 07 dias no tratamento com atazanavir. Não se detectou eventos adversos graves relacionados ao uso das duas drogas. Conclusão: As evidências que recomendavam o uso de ivermectina datam do início do período pandêmico, 2020, mas posteriormente, com a realização de ensaios clínicos robustos e controlados, novas evidências não suportam o uso de ivermectina e atazanavir no tratamento de COVID-19 leve mostrando que não houve diferença no tempo de resolução dos sintomas, na taxa de mortalidade, taxa de internação na UTI e tempo de hospitalização.

Objective: To examine and map the scientific evidence on the effectiveness of using ivermectin and atazanavir in the treatment of COVID-19. Methodology: Scoping Review, based on the procedures recommended by the Joanna Briggs Institute. The guiding question was established, "What is the scientific evidence on the use of ivermectin and atazanavir in the treatment of patients with mild symptoms of COVID-19?" Searches were conducted in six national and international databases on papers published until December 2022. Of the 357 studies found, 22 were selected for reading in full, resulting in a final sample of 11 studies analyzed. Results: The 11 publications analyzed were published from 2020 to 2022 during pandemic period, of national and international scope with experimental study design, of clinical trial type with randomization. Only 03 studies (25%) tested atazanavir as a combined intervention with other drugs, showing no significant improvements in relation to its use. As for the treatment with Ivermectin, of the eight (75%) studies that tested it, only three (37.5%) recommended its use and five (62.5%) did not support its use for treating mild COVID-19. The time to symptom resolution ranged from 8 to 10 days in the ivermectin-treated arms and on average 07 days in the atazanavir treatment. No serious adverse events related to the use of the two drugs were detected. Conclusion: evidence recommending the use of ivermectin dates back to the beginning of the pandemic period, 2020, but subsequently, with robust controlled clinical trials, new evidence does not support the use of ivermectin and atazanavir in the treatment of mild COVID-19 showing that there was no difference in time to symptom resolution, mortality rate, ICU admission rate, and length of hospital stay.

Objetivo: Examinar y mapear la evidencia científica sobre la eficacia del uso de ivermectina y atazanavir en el tratamiento de COVID-19. Metodología: Scoping Review, basada en los procedimientos recomendados por el Instituto Joanna Briggs. La pregunta guía era: "¿Cuál es la evidencia científica sobre el uso de ivermectina y atazanavir en el tratamiento de pacientes con síntomas leves de COVID-19? Se realizaron búsquedas en seis bases de datos nacionales e internacionales, en artículos publicados hasta diciembre de 2022. De los 357 estudios encontrados, se seleccionaron 22 para su lectura completa, lo que dio lugar a una muestra final de 11 estudios analizados. Resultados: Las 11 publicaciones analizadas fueron publicadas entre 2020 y 2022 durante el periodo pandémico, de ámbito nacional e internacional con diseño de estudio experimental, de tipo ensayo clínico con aleatorización. Apenas 03 estudios (25%) probaron el atazanavir como intervención combinada con otras drogas, sin evidenciar mejoras significativas en relación con su uso. En cuanto al tratamiento con Ivermectina, de los ocho (75%) estudios que la probaron, sólo tres (37,5%) recomendaron su uso y cinco (62,5%) no apoyaron su uso para tratar la COVID-19 leve. El tiempo transcurrido hasta la resolución de los síntomas osciló entre 8 y 10 días en los brazos tratados con ivermectina y una media de 07 días en el tratamiento con atazanavir. No se detectaron acontecimientos adversos graves relacionados con el uso de los dos fármacos. Conclusión: las pruebas que recomiendan el uso de ivermectina se remontan al inicio del periodo pandémico, 2020, pero posteriormente, con ensayos clínicos controlados sólidos, las nuevas pruebas no apoyan el uso de ivermectina y atazanavir en el tratamiento de la COVID-19 leve, lo que demuestra que no hubo diferencias en el tiempo hasta la resolución de los síntomas, la tasa de mortalidad, la tasa de ingreso en la UCI y la duración de la estancia hospitalaria.

Infección pulmonar por Strongyloides stercoralis en paciente inmunocomprometido. Reporte de caso / Pulmonary infection caused by Strongyloides stercoralis in an immunocompromised patient. Case report

El Strongyloides stercoralis es un nemátodo intestinal capaz de completar su ciclo de vida dentro del huésped humano. Se presenta el caso clínico de una mujer de 57 años con residencia en la zona amazónica por 10 años, la que presenta antecedentes patológicos personales de hiperten-sión arterial, osteoporosis y diabetes mellitus tipo 2, lo que la cataloga como inmunocomprome-tida. Esta asiste a servicios de emergencia con cuadro agudo característico de infección de vías urinarias, recibe tratamiento en la unidad de cuidados intensivos por shock séptico de origen urinario versus pulmonar. La prueba de laboratorio clínico mediante muestra tomada a través de broncoaspiración arroja la existencia de larvas activas de Strongyloides stercoralis. La paciente mejoró sus condiciones de salud luego de un mes de evolución, respondiendo satisfactoriamente a la antibioticoterapia con carbapenémicos y el antiparasitario ivermectina. Los pacientes con factores de riesgo subyacentes tienen alta probabilidad a este tipo de infección agravada. La estrongiloidásis grave tiene una alta tasa de mortalidad, por lo que un diagnóstico temprano es indispensable para mejorar el pronóstico.

Strongyloides stercoralis is an intestinal nematode capable of completing its life cycle within the human host. The clinical case of a 57-year-old woman who has lived in the Amazon region for 10 years is presented. She has a personal pathological history of arterial hypertension, osteopo-rosis, and type 2 diabetes mellitus, which classifies her as immunocompromised. She attends emergency services with acute symptoms characteristic of urinary tract infection, receives treat-ment in the intensive care unit for septic shock of urinary versus pulmonary origin. The clinical laboratory test using a sample taken through bronchial aspiration shows the existence of active larvae of Strongyloides stercoralis. The patient's health conditions improved after a month of evolution, responding satisfactorily to antibiotic therapy with carbapenems and the antiparasitic ivermectin. Patients with underlying risk factors are at high risk for this type of aggravated infection. Severe strongyloidiasis has a high mortality rate, so early diagnosis is essential to improve prognosis

Asociación del uso de ivermectina en la mortalidad de pacientes con la COVID-19 / Association of Ivermectin use on mortality in patients with COVID-19

RESUMEN Introducción: La ivermectina ha sido utilizada para prevenir y tratar pacientes con la COVID-19, sin embargo, investigaciones han demostrado que su eficacia no justifica el uso. Objetivo: Determinar la asociación del uso de ivermectina, mortalidad y otros 3 indicadores en pacientes con la COVID-19. Métodos: Estudio observacional de cohorte retrospectiva. Se revisaron las historias clínicas que estuvieron hospitalizados entre abril y octubre de 2020, quienes además del tratamiento estándar (oxigenoterapia, corticoide y enoxaparina), recibieron tratamiento con ivermectina por neumonía grave o crítica por la COVID-19. Se midieron 4 variables resultado: mortalidad, indicación de pase a la unidad de cuidados intensivos, días de hospitalización y tiempo de requerimiento de oxigenoterapia a alto flujo. Resultados: El 42 % (126) de los pacientes falleció y el 52 % (159) tuvo indicación de pase a la unidad de cuidados intensivos. En el análisis multivariado, quienes tomaron una mayor dosis tuvieron mayor indicación de pase a cuidados intensivos (RRa: 1,10; IC 95 %: 1,01-1,20; valor p= 0,035), días de hospitalización (coeficiente: 5,07; IC 95 %: 2,15-11,92; valor p< 0,001) y tiempo de requerimiento de oxigenoterapia con alto flujo (coeficiente: 3,33; IC 95 %: 1,56-7,09; valor p= 0,002). Conclusión: Los pacientes que recibieron ivermectina tuvieron mayor probabilidad de indicación de pase a la unidad de cuidados intensivos, mayor tiempo de hospitalización y mayor tiempo de requerimiento de oxígeno a alto flujo, sin hallar relación con la mortalidad de los pacientes hospitalizados por la COVID-19. La administración de ivermectina antes o durante la hospitalización no tuvo beneficios.

ABSTRACT Introduction: Ivermectin has been used to prevent and treat COVID-19 patients, however, research has shown that its efficacy does not justify its use. Objective: To determine the association between the use of Ivermectin, mortality and 3 other indicators in patients with COVID-19. Methods: Observational retrospective cohort study. We reviewed the medical records of patients who were hospitalized between April and October 2020, who in addition to standard treatment (oxygen therapy, corticosteroid and enoxaparin), received treatment with Ivermectin for severe or critical COVID-19 pneumonia. Four outcome variables were measured: mortality, indication for transfer to the Intensive Care Unit days of hospitalization and time required for high-flow oxygen therapy. Results: Of patients, 42 % (126) died and 52 % (159) had indication for transfer to the Intensive Care Unit. In the multivariate analysis those who took a higher dose had a greater indication for transfer to Intensive Care Unit (RRa: 1.10; IC 95 %: 1.01-1.20; p-value= 0.035), days of hospitalization (coefficient: 5,07; IC 95 %: 2.15-11.92; p-value< 0.001) and time requiring high-flow oxygen therapy (coefficient: 3.33; IC 95 %: 1.56-7.09; p-value= 0.002). Conclusion: Patients who received Ivermectin were more likely to be referred to the Intensive Care Unit, had a longer hospital stay, and required more time on high-flow oxygen, without finding a relationship with mortality in patients hospitalized for SARS-CoV-2. The administration of Ivermectin before or during hospitalization had no benefit.

Efectos colaterales del uso de la ivermectina en ganadería: comunidad de las boñigas en Colombia / Side effects of ivermectin use in livestock: dung community in Colombia / Efeitos colaterais do uso de ivermectina na pecuária: comunidade boñigas na Colômbia

Resumen La ivermectina es el antiparasitario más usado en veterinaria a nivel mundial desde que entró al mercado en 1981. La U.S. Food and Drug Administration (FDA) americana en su valoración de riesgos determinó que, si bien es muy tóxica para organismos acuáticos, es improbable que, con las aplicaciones registradas para uso animal y por sus propiedades fisicoquímicas, se lleguen a contaminar cursos de agua. Sin embargo, los efectos de la ivermectina (IVM) sobre la fauna de invertebrados no blanco si pueden tener gran repercusión en la ecología de los pastizales por los costes asociados a la presencia de las boñigas no degradadas. De hecho, las pérdidas económicas por disminuir la calidad de los pastizales y reducir la superficie de los pastos disponible y apetecibles al ganado se han calculado en hasta 380 millones de dólares para la economía americana. La ivermectina afecta a un grupo muy beneficioso y diverso taxonómicamente que habita las boñigas, incluyendo a moscas coprófagas, avispas parasíticas, y escarabajos coprófagos y depredadores. Algunos estudios muestran que las boñigas de animales tratados con IVM pueden permanecer en los pastizales sin muestras apreciables de degradación hasta 340 días, mientras que las de animales no tratados son degradadas casi totalmente después de 80 días. Además, estudios de campo y laboratorio han mostrado que la sensibilidad de muchos insectos ocurre a concentraciones muy por debajo de las que se excretan con las heces de bovinos tratados con IVM. Los efectos sobre la reproducción y desarrollo de larvas de coleópteros ocurren incluso a concentraciones que son de hasta 10 veces por debajo de las que producen mortalidad. En Colombia se han identificado al menos 68 especies de la subfamilia Scarabaeinae que integran la comunidad de las boñigas del bovino. La mayor diversidad de escarabajos estercoleros se ha asociado a bosques y sistemas silvopastoriles que incorporan arboles nativos y proveen hábitats favorables para su supervivencia.

Abstract Ivermectin (IVM) has been the world most widely used antiparasitic agent in veterinary medicine since it came to the market in 1981. The U.S. Food and Drug Administration (FDA) in its risk assessment determined that, although it is very toxic to aquatic organisms, it is unlikely to contaminate water courses from current applications registered for animal use. However, the effects of IVM on non-target invertebrate fauna can have great impact on grassland ecology due to the costs associated with the presence of undegraded dung. In fact, the economic losses from lowering the quality of pastures and reducing the area of pasture available and palatable to livestock have been estimated in $380 million for the American economy. Ivermectin affects a highly beneficial and taxonomically diverse group that inhabits dung, including dung flies, parasitic wasps, and coprophilus and predatory dung beetles. Some studies show that dung from IVM-treated animals can remain in pasture without appreciable signs of degradation for up to 340 days, while those from untreated animals are almost completely degraded after 80 days. In addition, field and laboratory studies have shown the susceptibility of many insects to occur at concentrations well below those excreted in the feces of cattle treated with IVM. Effects on reproduction and development of coleopteran larvae occur at concentrations that can be 10 times lower of those causing mortality. In Colombia, at least 68 species of the subfamily Scarabaeinae have been identified in dung communities. The greater diversity of dung beetles has been associated with forests and silvopastoral systems that incorporate native trees and provide favorable habitats for their survival.

Resumo A ivermectina (IVM) tem sido o agente antiparasitário mais utilizado no mundo na medicina veterinária desde que chegou ao mercado em 1981. A US. Food and Drug Administration (FDA) em sua avaliação de risco determinou que, embora seja muito tóxico para organismos aquáticos, é improvável que contamine cursos d'água a partir de aplicações atuais registradas para uso animal. No entanto, os efeitos do IVM na fauna de invertebrados não-alvo podem ter grande impacto na ecologia das pastagens devido aos custos associados à presença de esterco não degradado. De fato, as perdas econômicas decorrentes da redução da qualidade das pastagens e da redução da área de pastagem disponível e palatável para o gado foram estimadas em US$ 380 milhões para a economia americana. A ivermectina afeta um grupo altamente benéfico e taxonomicamente diverso que habita o esterco, incluindo moscas do esterco, vespas parasitas e coprófilos e escaravelhos predadores. Alguns estudos mostram que o esterco de animais tratados com MIV pode permanecer no pasto sem sinais apreciáveis de degradação por até 340 dias, enquanto os de animais não tratados são quase completamente degradados após 80 dias. Além disso, estudos de campo e de laboratório mostraram que a suscetibilidade de muitos insetos ocorre em concentrações bem abaixo daquelas excretadas nas fezes de bovinos tratados com MIV. Os efeitos sobre a reprodução e desenvolvimento de larvas de coleópteros ocorrem em concentrações que podem ser 10 vezes menores daquelas que causam mortalidade. Na Colômbia, pelo menos 68 espécies da subfamília Scarabaeinae foram identificadas em comunidades de esterco. A maior diversidade de escaravelhos tem sido associada a florestas e sistemas silvipastoris que incorporam árvores nativas e proporcionam habitats favoráveis à sua sobrevivência.

COVID Management Strategy for Third Wave / Omicron Variant in India

COVID-19, the worst Pandemic of this decade caused significant morbidity and mortality in the past 3 years and still continue to hit the human kind with it’s evil skills. After the first and second COVID-19 wave the third wave has emerged with new variants and with high transmission rate and reduced efficiency of treatments and vaccines. The main treatment strategy remain same as symptomatic and supportive treatments. Oxygen therapy, Steroid, Antivirals and some repurposed drugs like Ivermectin and newer drugs including monoclonal antibodies are used in this fight against COVID-19. Ivermectin is being the game changer in many states of India, they kept this medicine in their new treatment protocol also. Vaccination including additional Booster/Precautionary Dose along with the COVID appropriate behaviours, if we are able to maintain Physical distance, Wear mask properly, Wash our hands and Prevent crowd from gathering then we will not allow the virus to spread and prevent the emergence of another wave

Miasis en pacientes con cáncer en el Instituto Nacional de Cancerología entre 2008 y 2018: Serie de Casos / Myiasis in cancer patients receiving medical care at a reference center in Bogotá, Colombia: 2008-2018. A case series

Resumen Introducción: La miasis puede ser considerada una enfermedad desatendida; corresponde a la infestación de larvas de dípteros en piel, heridas o cavidades naturales. La literatura para pacientes oncológicos con infestación es limitada para Colombia. Métodos: Se realizó una serie de casos de miasis en pacientes atendidos en el Instituto Nacional de Cancerología de 2008 a 2018; se obtuvieron datos de las historias clínicas con el fin de caracterizar variables sociodemográficas, oncológicas y tratamiento recibido. Resultados: Se encontraron 32 registros: 27 cumplieron con los criterios de inclusión, mediana de edad 69 años, 74% fueron hombres, 48% procedían de área rural, 33,3% de áreas con alturas superiores a 2000 msnm, 70% presentaban cáncer de cabeza y cuello, seguidos por cáncer de mama 14%; 40% ECOG 2-3; 77% visualizaron larvas antes de consultar; ningún paciente presentó sepsis al momento de consultar, 29% presentaban secreción en zona infestada, 85% recibieron ivermectina y curaciones por parte de enfermería; 70% recibió antibióticos sistémicos, y 60% otros tratamientos además de la remoción mecánica e ivermectina, la mediana de leucocitos al ingreso fue de 10280 y de eosinófilos 110. Conclusión: Ésta es la primera serie de casos informada de miasis en pacientes oncológicos para América. Es más frecuente en pacientes con neoplasias en áreas expuestas, aunque se puede presentar en zonas no expuestas; la infestación por larvas tiende a no ser purulenta. Se deben hacer estudios sobre el uso de ivermectina, otros antibióticos y las implicaciones pronósticas de esta patología en los pacientes con cáncer avanzado.

Abstract Introduction: Myiasis can be considered a neglected disease; it corresponds to the infestation of dipteran larvae in skin, wounds, or natural cavities. Literature for oncological patients with this infestation is limited for Colombia. Methods: A case series of myiasis was carried out in patients treated at the National Cancer Institute of Colombia from 2008 to 2018. Data were obtained from medical records in order to characterize sociodemographic and oncological variables and the treatment received. Results: Thirty-two records were found, 27 of them met the inclusion criteria. Median age was 69 years, 74% were men, 48% came from rural areas, 33.3% from areas with altitudes greater than 2,000 meters above sea level, 70% had head and neck cancer, followed by breast cancer in 14%; 40% had ECOG 2-3, and 77% visualized larvae before consulting. No patient presented with sepsis at the time of consultation, 29% presented with discharge in the infested area, 85% received ivermectin and treatment by the nursing staff; 70% received systemic antibiotics, and 60% other treatments in addition to mechanical removal and ivermectin. Median of leukocytes at admission was 10,280, while median of eosinophils was 110. Conclusion: This is the first reported case series of myiasis in cancer patients for Latin America. It is more common in patients with neoplasms in exposed areas, although it can occur in unexposed areas too. Larval infestation tends not to be purulent. Further studies are needed on the use of ivermectin, other antibiotics, and the prognostic implications of this pathology in patients with advanced cancer.

Ivermectin treatment response in two rural villages with a high prevalence of onchocerciasis and epilepsy, Mahenge Tanzania

Background: Despite 20 years of ivermectin mass distribution in the Mahenge area, Tanzania, the prevalence of onchocerciasis and epilepsy has remained high in rural villages. Objectives: We investigated the efficacy of ivermectin in reducing Onchocerca volvulus microfilariae and predictors for parasitic load following ivermectin treatment in persons with (PWE) and without epilepsy (PWOE). Methods: Between April and September 2019, 50 PWE and 160 randomly selected PWOE from Msogezi and Mdindo villages participated in a follow-up study. Skin snips were obtained pre (baseline) and three months post-ivermectin treatment. Results: The overall prevalence of O. volvulus positive skin snips at baseline was 49% (103/210), with no significant difference between PWE (58.0%) and PWOE (46.3%); p=0.197. The overall mean micro filarial density was significantly higher at baseline 1.45(95%CI:0.98-2.04)) than three-month post-ivermectin treatment (0.23(95%CI:0.11-0.37), p<0.001. Three months after ivermectin, the micro filarial density had decreased by ≥80% in 54 (81.8%, 95%CI: 72.3-91.4) of the 66 individuals with positive skin snips at baseline. High micro filarial density at baseline was the only significant predictor associated with higher micro filarial density in the post-ivermectin skin snips. Conclusion: Our study reports a decrease in micro filarial density following ivermectin treatment in most individuals. Optimizing ivermectin coverage will address the ongoing onchocerciasis transmission in Mahenge

COVID-19 incidence, severity, medication use, and vaccination among dentists: survey during the second wave in Brazil

Abstract Objective This cross-sectional study with dentists in Brazil assessed the COVID-19 incidence and severity, its vaccination status, and the level of confidence in vaccines in May 2021 (COVID-19 second wave). The medications used to prevent or treat COVID-19, including controversial substances (vitamin D, ivermectin, zinc, and chloroquine), were analyzed. Methodology Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence ratios were calculated for the association between professional characteristics and two outcomes: SARS-CoV-2 infection and use of controversial substances. Results In total, 1,907 responses were received (return rate of 21.2%). One third of dentists reported intermediate levels of confidence in the safety and efficacy of COVID-19 vaccines, but 96% had received at least one vaccine dose, mainly CoronaVac. The effect of the pandemic on dental practice was classified as lower/much lower, in comparison with the first wave, by 46% of participants. Moreover, 27% of dentists had already tested positive for SARS-CoV-2 and about 50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of participants and 43% used two or more substances. Vitamin D (41%), ivermectin (35%), and zinc (29%) were the most frequent substances. More experienced dentists (≥21 years of professional experience) were 42% more likely to use controversial substances than less experienced dentists. The prevalence of use of controversial substances was 30% higher among dentists with residency or advanced training, such as postgraduate degrees, in comparison with participants holding MSc or PhD degrees. Participants with low confidence in vaccines were 2.1 times more likely to use controversial substances than participants with a very high confidence. Conclusion The results of this study show the high severity of the COVID-19 pandemic in Brazil and raised questions about the use of scientific evidence by dentists in their decision to use controversial substances.

Análisis de publicaciones y comentarios sobre la ivermectina en Facebook durante la pandemia del COVID-19 en Perú / Analysis of Facebook publications and comments about ivermectin during the COVID-19 pandemic in Peru

Los datos de acceso público en plataformas de redes sociales se pueden utilizar para identificar percepciones, actitudes y sentimientos en relación con la COVID-19; ello puede ser útil para formular políticas de estado y enfrentar adecuadamente la emergencia. El presente trabajo tuvo por objetivo analizar las publicaciones y percepciones de los usuarios a través de sus comentarios en Facebook sobre el fármaco ivermectina durante la pandemia de COVID-19 en Perú. Las publicaciones y sus comentarios fueron seleccionados mediante búsqueda manual, utilizando los términos: ivermectina e #ivermectina, en julio de 2020. Su interpretación se efectuó por análisis de contenido cualitativo convencional, con proceso inductivo y apoyado por literatura científica. Se encontraron 17 publicaciones realizadas entre el 18 de mayo y 7 de julio del 2020, clasificadas en 5 temáticas: rumores (58,8 por ciento), basadas en evidencia científica (11,8 por ciento), precaución (11,8 por ciento), producción del fármaco (11,8 por ciento) y confrontación (5,9 por ciento). El 70,0 por ciento de los rumores surgieron de páginas de medios de comunicación. Los comentarios se clasificaron, según percepciones de los usuarios hacia la ivermectina, en cuatro temas: ivermectina como cura efectiva (64,8 por ciento), solicitud de información (25,3 por ciento), en contra del consumo de ivermectina (6,3 por ciento) y otros tratamientos (3,6 por ciento). Más de la mitad de la información sobre ivermectina en Facebook aparece en rumores, en su mayoría originados por páginas de medios de comunicación. Entre los comentarios se destaca la percepción de los usuarios que la consideran cura efectiva contra la COVID-19(AU)

The purpose of the study was to analyze Facebook publications and perceptions of users, expressed in their comments, about the drug ivermectin during the COVID-19 pandemic in Peru. The publications and their comments were selected by manual search using the terms ivermectin and #ivermectin in July 2020. Interpretation of publications and their comments was performed by conventional qualitative content analysis with inductive processing and supported by scientific literature. A total 17 publications were retrieved from the period extending from 18 May to 7 July 2020. These were classified into five topics: rumors (58.8percent), based on scientific evidence (11.8percent), caution (11.8percent), production of the drug (11.8percent) and confrontation (5.9percent). Paradoxically, 70.0percent of the rumors were spread by mass media pages. Comments, on the other hand, were classified into four topics based on user perceptions: ivermectin as effective cure (64.8percent), request for information about ivermectin (25.3percent), against the use of ivermectin (6.3percent) and other treatments (3.6percent). As a conclusion, it was found that more than half of the information about ivermectin circulating in Facebook publications is classified as rumors, and most is spread by mass media pages. Analysis of the comments found that user perception considers ivermectin to be the effective cure against COVID-19(AU)

Sales of "COVID kit" drugs and adverse drug reactions reported by the Brazilian Health Regulatory Agency / Vendas de "kit-COVID" e reações adversas a esses medicamentos relatadas pela Agência Nacional de Vigilância Sanitária / Ventas de medicamentos del "kit-COVID" y reacciones adversas a los medicamentos notificadas por la Agencia Nacional de Vigilancia Sanitaria

Off-label use of azithromycin, hydroxychloroquine, and ivermectin (the "COVID kit") has been suggested for COVID-19 treatment in Brazil without clinical or scientific evidence of efficacy. These drugs have known adverse drug reactions (ADR). This study aimed to analyze if the sales of drugs in the "COVID kit" are correlated to the reported number of ADR after the COVID-19 pandemic began. Data was obtained from the Brazilian Health Regulatory Agency (Anvisa) website on reported sales and ADRs for azithromycin, hydroxychloroquine, and ivermectin for all Brazilian states. The period from March 2019 to February 2020 (before the pandemic) was compared to that from March 2020 to February 2021 (during the pandemic). Trend adjustment was performed for time series data and cross-correlation analysis to investigate correlation between sales and ADR within the same month (lag 0) and in the following months (lag 1 and lag 2). Spearman's correlation coefficient was used to assess the magnitude of the correlations. After the pandemic onset, sales of all investigated drugs increased significantly (69.75% for azithromycin, 10,856,481.39% for hydroxychloroquine, and 12,291,129.32% for ivermectin). ADR levels of all medications but azithromycin were zero before the pandemic, but increased after its onset. Cross-correlation analysis was significant in lag 1 for all drugs nationwide. Spearman's correlation was moderate for azithromycin and hydroxychloroquine but absent for ivermectin. Data must be interpreted cautiously since no active search for ADR was performed. Our results show that the increased and indiscriminate use of "COVID kit" during the pandemic correlates to an increased occurrence of ADRs.

No Brasil, o uso off label de azitromicina, hidroxicloroquina e ivermectina (o "kit-COVID") foi sugerido para tratar COVID-19 sem que tivéssemos evidências clínicas ou científicas de sua eficácia. Estas drogas têm causado reações adversas (RA) em quem as tomam. Este estudo almejou analisar se a venda dos medicamentos que compõem o "kit-COVID" correlaciona-se com o número relatado de RAs após o início da pandemia da COVID-19. Os dados sobre vendas e RA associados a azitromicina, hidroxicloroquina e ivermectina foram obtidos no site da Agência Nacional de Vigilância Sanitária (Anvisa) para todos os estados brasileiros. Comparamos o período entre março de 2019 e fevereiro de 2020 (antes da pandemia) ao de março de 2020 a fevereiro de 2021 (durante a pandemia). Ajustamos tendências para os dados de séries temporais e as análises de correlação cruzada para investigar a correlação entre vendas e RA em um mesmo mês (lag 0) e nos seguintes (lag 1 e 2). O coeficiente de correlação de Spearman foi utilizado para avaliar a magnitude das correlações. Após o início da pandemia, as vendas de todos os medicamentos investigados aumentaram significativamente (69,75% para azitromicina, 10.856.481,39% para hidroxicloroquina e 12.291.129,32% para ivermectina). Os níveis de RAs de todos os medicamentos (com exceção de azitromicina) eram zero antes da pandemia mas aumentaram após seu início. A análise de correlação cruzada foi significativa no lag 1 para todas as drogas em todo o país. A correlação de Spearman foi moderada para azitromicina e hidroxicloroquina, mas ausente para ivermectina. Os dados devem ser interpretados com cautela, uma vez que não realizamos uma busca ativa por RA. Nossos resultados mostram que o uso aumentado e indiscriminado do "kit-COVID" durante a pandemia se correlaciona com uma ocorrência aumentada de RAs.

Se ha sugerido el uso fuera de lo establecido de azitromicina, hidroxicloroquina e ivermectina (el "kit-COVID") para el tratamiento de la COVID-19 en Brasil sin evidencia clínica o científica de su eficacia. Estos medicamentos tienen reacciones adversas (RAM) conocidas. Este estudio pretendía analizar si las ventas de medicamentos del "kit-COVID" están correlacionadas con el número de reacciones adversas notificadas tras el inicio de la pandemia de COVID-19. Los datos se obtuvieron del sitio web de la Agencia Nacional de Vigilancia Sanitaria (Anvisa) sobre las ventas y las RAM notificadas para la azitromicina, la hidroxicloroquina y la ivermectina para todos los estados brasileños. Se comparó el periodo de marzo de 2019 a febrero de 2020 (antes de la pandemia) con el de marzo de 2020 a febrero de 2021 (durante la pandemia). Se realizó un ajuste de tendencia para los datos de las series de tiempo y un análisis de correlación cruzada para investigar la correlación entre las ventas y la RAM dentro del mismo mes (lag 0) y en los meses siguientes (lag 1 y lag 2). Se utilizó el coeficiente de correlación de Spearman para evaluar la magnitud de las correlaciones. Tras el inicio de la pandemia, las ventas de todos los medicamentos investigados aumentaron significativamente (69,75% para la azitromicina, 10.856.481,39% para la hidroxicloroquina y 12.291.129,32% para la ivermectina). Los niveles de RAM de todos los medicamentos, excepto la azitromicina, eran nulos antes de la pandemia, pero aumentaron tras su inicio. El análisis de correlación cruzada fue significativo en el lag 1 para todos los medicamentos a nivel nacional. La correlación de Spearman fue moderada para la azitromicina y la hidroxicloroquina, pero no para la ivermectina. Los datos deben interpretarse con cautela, ya que no se realizó una búsqueda activa de RAM. Nuestros resultados muestran que el uso creciente e indiscriminado del "kit-COVID" durante la pandemia se correlaciona con una mayor aparición de las RAM.

Factores asociados a letalidad por COVID-19 en un hospital de la región Cajamarca en Perú / Factors associated with COVID-19 lethality in a hospital in the Cajamarca region in Peru

RESUMEN Objetivo. Identificar las características clínicas y epidemiológicas relacionadas a la letalidad en pacientes hospitalizados por COVID-19 en el Hospital Simón Bolívar de Cajamarca, durante junio-agosto de 2020. Materiales y métodos. Cohorte retrospectiva, con información recolectada de historias clínicas y sistemas oficiales de vigilancia epidemiológica (NOTIWEB, SISCOVID y SINADEF), sobre pacientes hospitalizados con diagnóstico confirmado de COVID-19. Se recolectó información sobre factores sociodemográficos y clínicos, considerando como desenlace el egreso (fallece/sobrevive) y los días de hospitalización. Resultados. La tasa de letalidad intrahospitalaria fue 39,6%, encontrándose diferencias significativas entre el tiempo de hospitalización y la condición de egreso en las personas mayores de 60 años (p<0,001). La edad mayor de 60 años (HR: 2,87; IC95%: 1,76-4,68),) solicitud de cama UCI no atendida (HR: 3,49; IC95%: 2,02-6,05), saturación de oxígeno menor a 80% al ingreso (HR: 2,73; IC95%: 1,35-5,53) y el uso de ivermectina (HR: 1,68; IC95% 1,06-2,68) fueron factores asociados a letalidad. El modelo de Machine Learning (ML) elegido consideró que las variables con mayor importancia fueron la saturación de oxígeno, la edad mayor de 60 años, tiempo de hospitalización y tiempo de síntomas. Conclusión. Los factores que podrían incrementar la letalidad en pacientes hospitalizados por COVID-19 fueron la edad, saturación de oxígeno menor a 80%, uso de ivermectina en la terapéutica hospitalaria y la solicitud no atendida de camas UCI. Futuros estudios con una mejor representatividad podrían confirmar estas posibles relaciones a nivel regional o nacional.

ABSTRACT Objective. To identify the clinical and epidemiological characteristics related to lethality in patients hospitalized for COVID-19 at the Simón Bolívar Hospital in Cajamarca, during June-August 2020. Materials and Methods. This was a retrospective cohort, that used information collected from clinical records and official epidemiological surveillance systems (NOTIWEB, SISCOVID and SINADEF), on hospitalized patients with confirmed COVID-19 diagnosis. Information was collected on sociodemographic and clinical factors, considering discharge (death/survival) and days of hospitalization as outcomes. Results. The in-hospital fatality rate was 39.6%, and significant differences were found between hospitalization time and status at discharge in people over 60 years of age (p<0.001). Age older than 60 years (HR: 2.87; 95% CI: 1.76-4.68),) unattended ICU bed request (HR: 3.49; 95% CI: 2.02-6.05), oxygen saturation less than 80% at admission (HR: 2.73; 95% CI: 1.35-5.53) and the use of ivermectin (HR: 1.68; 95%CI 1.06-2.68) were factors associated with lethality. The chosen ML model considered that the most important variables were oxygen saturation, age over 60 years, time of hospitalization and time of the onset of symptoms. Conclusion. The factors that could increase lethality in patients hospitalized for COVID-19 were age, oxygen saturation less than 80%, use of ivermectin as part of hospital treatment and unattended request for ICU beds. Future studies with better representativeness could confirm these possible relationships at the regional or national level.

Outcomes associated with Hydroxychloroquine and Ivermectin in hospitalized patients with COVID-19: a single-center experience

SUMMARY OBJECTIVE: Hydroxychloroquine and Ivermectin are advocated as potential treatments for coronavirus disease 2019 (COVID-19) despite the lack of supportive clinical evidence. In this study, outcomes associated with Hydroxychloroquine and/or Ivermectin were determined in a series of patients with confirmed COVID-19 from a single institution in Brazil. METHODS: Consecutive patients admitted between March and July 2020 were retrospectively analyzed and divided into four treatment categories: no treatment (Group 0), Ivermectin only (Group I), Hydroxychloroquine only (Group II), and Hydroxychloroquine and Ivermectin (Group III). Intensive care unit admission, mechanical ventilation, and death were compared between the Groups. RESULTS: A total of 230 patients were included, with the following treatment distribution: 35.2% (0), 9.1% (I), 48.3% (II), and 7.4% (III). Groups I, II, and III had the higher rates of Intensive care unit admission, mechanical ventilation, or death (0: 23.5% versus I: 38.1% versus II: 37.8% versus III: 70.6%, p=0.002), and the greatest mortality was found in Group III (0 versus III: 13.6% versus 35.3%, p=0.03). In the multivariate analysis, Hydroxychloroquine remained significantly associated with death (OR 3.3, 95%CI 1.1-9.6, p=0.03). CONCLUSION: In a series of consecutive hospitalized patients with COVID-19, Ivermectin was not associated with improved outcomes and Hydroxychloroquine may have resulted in a harmful effect.

Ivermectina: ¿Un antiparasitario frente a SARS-CoV-2? / Ivermectin: an antiparasitic drug to fight SARS-CoV-2?

RESUMEN La capacidad de propagación y letalidad del SARS-CoV-2 en todo el mundo motiva la urgente necesidad de desarrollar una estrategia terapéutica apropiada para controlar los casos de COVID-19. El desarrollo de nuevos fármacos frente a este nuevo virus es apremiante debido a su rápida diseminación. Se han propuesto alternativas paralelas empleando fármacos ya disponibles para fines similares. Esta revisión describe el potencial antiviral de la ivermectina, así como sus mecanismos de acción frente a algunos virus, y discute su probable aplicación contra el SARS-CoV-2.

ABSTRACT The global spread and lethality of SARS-CoV-2 prompt the urgent need to develop an appropriate therapeutic strategy to control COVID-19 cases. The development of new drugs to fight this novel virus is urgent due to its rapid spread. Parallel alternatives have been proposed by using drugs already available for similar purposes. This review article describes the antiviral potential of ivermectin as well as its mechanisms of action against some viruses, and discusses its probable use to fight SARS-CoV-2.

Children hospitalized for myiasis in a reference center in Uruguay / Niños hospitalizados por miasis en un centro de referencia de Uruguay

Abstract Background: Myiasis is an emerging disease caused by tissue invasion of dipteran larvae. In Uruguay, Cochliomyia hominivorax and Dermatobia hominis are the most frequent species. This study aimed to describe the epidemiological and clinical characteristics and the follow-up of children < 15 years hospitalized for myiasis in a reference center in Uruguay between 2010 and 2019. Methods: We conducted a descriptive and retrospective study by reviewing medical records. We analyzed the following variables: age, sex, comorbidities, origin, the month at admission, clinical manifestations, other parasitoses, treatments, complications, and larva species identified. Results: We found 63 hospitalized children: median age of 7 years (1 month-14 years), 68% of females. We detected risk comorbidities for myiasis (33%), of which chronic malnutrition was the most frequent (n = 6); 84% were from the south of the country; 76% were hospitalized during the summer. Superficial and multiple cutaneous involvements were found in 86%: of the scalp 50, furunculoid type 51, secondary to C. hominivorax 98.4%, and to D. hominis in 1.6%. As treatments, larval extraction was detected in all of them, surgical in 22%. Asphyctic products for parasites were applied in 94%, ether in 49. Antimicrobials were prescribed in 95%; cephradine and ivermectin were the most frequent. About 51% presented infectious complications: impetigo was found in 29, cellulitis in 2, and abscess in 1. Conclusions: Myiasis predominantly affected healthy schoolchildren during the summer months and was frequently associated with ectoparasites. Superficial infestation of the furuncle-like scalp by C. hominivorax was the most frequent form. Infectious complications motivated hospitalizations.

Resumen Introducción: La miasis es una enfermedad emergente producida por la invasión tisular por larvas de dípteros. En Uruguay, Cochliomyia hominivorax y Dermatobia hominis son las especies más frecuentes. El objetivo de este estudio fue describir las características epidemiológicas y clínicas, y el seguimiento, de niños menores de 15 años hospitalizados por miasis en un centro de referencia del Uruguay entre 2010 y 2019. Métodos: Se llevó a cabo un estudio descriptivo y retrospectivo mediante la revisión de las historias clínicas. Se analizaron las siguientes variables: edad, sexo, comorbilidad, procedencia, mes al ingreso, cuadro clínico, otras parasitosis, tratamientos, complicaciones y especie de larva identificada. Resultados: Se encontraron 63 casos de niños hospitalizados, con una mediana de edad de 7 años (rango: 1 mes a 14 años) y el 68% de sexo femenino. Se identificó comorbilidad de riesgo para miasis (33%), siendo la desnutrición crónica la más frecuente (n = 6). El 84% eran procedentes del sur del país y el 76% fueron hospitalizados en los meses estivales. Se encontró afectación cutánea superficial y múltiple en el 86%: de cuero cabelludo en 50, de tipo forunculoide en 51, secundaria a C. hominivorax en el 98.4% y a D. hominis en el 1.6%. Se realizó extracción larvaria en todos los casos, que fue quirúrgica en el 22%. Se aplicaron productos asfícticos para parásitos en el 94%, con éter en 49 niños. Se prescribieron antimicrobianos en el 95%; los más usados fueron cefradina e ivermectina. El 51% presentaron complicaciones infecciosas: 29 impétigo, 2 celulitis y 1 absceso. Conclusiones: La miasis afectó predominantemente a escolares sanos y durante los meses estivales, y se encontró frecuentemente asociada con ectoparasitosis. La infestación superficial del cuero cabelludo de tipo forunculoide por C. hominivorax fue la forma más frecuente. Las complicaciones infecciosas motivaron las hospitalizaciones.