Psychotropic drug repurposing for COVID-19: a systematic review

Introduction: Recently, several antidepressants, mood stabilizers, and antipsychotics have been suggested to have favorable effects in the treatment of COVID-19. Objective(s): The aim of this systematic review was to collect evidence from preclinical and clinical studies concerning the scientific evidence for the repurposing of psychotropic drugs in COVID-19 treatment. Method(s): Two independent authors searched PubMed-MEDLINE, Scopus, PsycInfo, Clinical Trial Registration Site US (ClinicalTrials. gov) databases, and reviewed the reference lists of articles for eligible articles published up to May 31st, 2021. All preclinical and clinical studies on the effect of any psychotropic drug on Sars-CoV-2 or patients with COVID-19 were included. The Newcastle-Ottawa scale was used for the quality assessment of clinical studies. This systematic review adheres to the PRISMA guidelines. Result(s): 22 studies were included in the synthesis: 9 clinical studies, 9 preclinical studies, and 4 computational studies. The use of antidepressants, both SSRI and non-SSRI, was associated with a reduced risk of severe complications of COVID-19. Several antipsychotics showed an increased risk for both Sars-CoV-2 infection and severe complications during COVID-19. Conclusion(s): The current evidence supports a potential anti- SARS-CoV-2 role for several antidepressants, while the evidence on mood stabilizers or antipsychotics remains controversial. Drug repurposing proved highly successful in response to the current pandemic and psychotropic medications are widely used in clinical practice with well-known safety and tolerability profiles, showing antiviral, immunomodulatory, and anti-inflammatory properties, being perfect candidates for possible treatment of COVID-19. Further research will deliver optimized and specific therapeutic tools that will increase the preparedness of health systems for possible future epidemics.

HAVE TREATMENTS for AUTOIMMUNE DISEASES WORSENED the PROGNOSIS of COVID-19 INFECTION?

Background: According to the literature patients with autoimmune diseases (AID) have a high risk of develop serious infections due to the use of immunosuppressive treatment. In published clinical trials neither the risk nor the severity of COVID-19 infection in patients with AID seem to be higher than in the general population. Objectives: The objective of our study is to analyse the clinical course in patients with AID undergoing immunosuppressive treatments and infected by COVID-19. Methods: Patients were included after reviewing four rheumatology outpatient clinics from Ciudad Real University General Hospital between November 2020 and February 2021. The inclusion criteria were being older than 18 years and being positive for COVID-19 by epidemiological (positive molecular and/or antigen test) or clinical criteria (symptoms compatible between March and May 2020). We collected demographic data, cardiovascular comorbidities, AID, treatment with synthetic or biological DMARDs, immunomodulators or glucocor-ticoids;and progression of infection COVID-19. Results: We found a total of 210 patients that had suffered from SARS-COV2 of which 95 patients were affected by AID. The most prevalent pathology in our sample was spondylarthritis followed by arthritis rheumatoid and systemic lupus ery-thematosus of which 81.82%, 100% and one 92.86% respectively were receiving treatment to control the disease. Among the 95 patients suffering from COVID and AID a small number of patients did not follow any immunosuppressive treatment regimen (n=25) but most of our patients were undergoing immunosuppressors (n=70);the most used drugs were prednisone and methotrexate. No statistically signifcant differences were found between the treated versus untreated group in the studied variables, being similar the results relative to mean age, sex, presence of cardiovascular risk factors, absence of symptoms, number of admissions to hospital ward or in Intensive Care Unit, or complications during COVID-19 infection (Table 1). Conclusion: Patients treated with synthetic or biologicals DMARDs, immunomodulators or glucocorticoids do not seem have a higher rate of death or hospital admission respect to patients diagnosed of AID without such treatments.

[Prevalence of SARS-CoV-2 infection during the first wave of the pandemic among health and non-health personnel of the General Hospital of Segovia, Castilla y León]. / Prevalencia de infección por SARS-CoV-2 durante la primera oleada de la pandemia entre personal sanitario y no sanitario del Hospital General de Segovia, Castilla y León.

OBJECTIVE: Health and non-health workers (HNH-W) in a hospital are more exposed to SARS-CoV-2 infection than the general population. We studied the prevalence of this infection in these workers of Segovia´s Hospital after the first epidemic wave. METHODS: Monocentric, observational, cross-sectional study, carried out between April 29 and May 14, 2020. The infection was diagnosed by capillary immunochromatography test for IgG and / or IgM antibodies, or PCR. Work, health, and exposure variables were studied. RESULTS: A total of 1,335 HNH-W participated in the study out of a total of 1,667 (80.1%), 79.3% women, with a mean age of 47.3 years, and 47.1 for men. The prevalence of infected was 21.95%, 24.7% asymptomatic. Age presented a significant OR of 1.02/year. Exposure outside of work increased the prevalence by 16.8%. The continued use of Personal Protective Equipment (PPE) and the administration of nebulizations presented an OR of 0.54 and 0.46 respectively. The symptoms associated with the highest prevalence were anosmia (OR 9.31), ageusia (OR 3.05), and fever (OR 1.94). Today, about 75% of HNH-W were infected in the first wave. CONCLUSIONS: The prevalence is higher among healthcare workers than the population they serve. Age is associated with a higher prevalence of infection. Almost a quarter of those infected were asymptomatic. The continuous use of PPE was associated with a lower prevalence, for that the administration of nebulisations could be safe. The symptoms with the greatest association were fever, anosmia, and ageusia.

Early palliative supportive care within the lung cancer committee (LCC): Descriptive study of the patient's characteristics after one year experience in a tertiary hospital

Background: Many studies have shown benefits of early Palliative Care(PC)in advanced lung cancer patients. There's increasing evidence about better symptom control and survival. A PC physician joined the multidisciplinary LCC last year. Despite the SARS-CoV2 pandemic,472 cases were presented to the LCC in 2020. 470 cases were presented in 2018, so his activity remains stable. Aims: To describe clinical profile of the patients presented to the LCC and early referred to PC. To compare patient's survival when referred from ambulatory setting or when they are admitted in hospital. Methods: Descriptive study.DATA:Age, Gender, Comorbilities, Cancer Histology Tobacco exposure, TNM, Oncology Therapy, Survival time, Barthel, Charlson, Time to first PC consultation. ANALYSIS:T test to compare means of continuous variables and Chi-squared to compare proportions of categorical variables. Kaplan-Meier curve for survival analysis. Results: 41patients of 472(9%) were referred to PC. Males(75%),Median Age 72,87 years old(DS 11,95) no age differences by gender. Current Smokers 25%,Former smokers 65%.Hypertension 70%,Diabetes 45%,Dyslipemia 60%,Heart Failure45%, Renal impairment 35%. Barthel:mean 63,6(DS:22,7) Charlson:mean 6,5(DS2,35) Cancer Histology: Squamous55%, Adenocarcinome35%, Small Cell 7,5%,Other Neuroendocrine2,5%, Disease Stage: StageIV 65%, StageIII 55%, Cancer therapy: Chemotherapy 44%,Radiotherapy 56%, Immunotherapy 30%.PC exclusive follow-up:24,4%, PC and shared follow-up:75,6%. Setting: Refered to Ambulatory PC: 44%, Refered to PC when admitted in an hospital ward: 56%. Time from LCC to PC visit: Ambulatory setting: mean 27,7 days, median 14. Admitted hospital ward: mean 63,14 days(p=0,036), Survival: Ambulatory: mean 142,12 days (DS 90,9), Admitted Hospital ward 59,68 days (DS 59,1)p=0,002. Conclusion: Patients referred from LCC to Ambulatory PC showed an early intervention and better survival profile. Collaboration between LCC and the PC team can improve the early PC support.

COVID-19 and home confinement: data on physical activity

In March 14th 2020, the Spanish Government declared the“State of Emergency”due to the pandemic caused by the COVID-19 and all the population was forced to “shelter-at-home” for two weeks. Citizens had less than 24 hours to prepare for the self-quarantine. The goal of the present was to assess Spanish citizens’ physical activity practice at the end of the first week of the home quarantine. A total of 1858 Spanish citizens, 674 males and 1184 females (M = 40.18, SD = 15.84 years) agreed to participate. The study is descriptive in nature, based on an on-line questionnaire conducted seven days after the mandatory shelter-at-home health order issued by the Spanish Government. It included The International Physical Activity Questionnaire, Anthropometric parameters, Sociometric and COVID-19 information. Global results showed that the vast majority of the confined population was below the World Health Organization recommendations on Vigorous Physical Activity, Moderate Physical Activity or a combination. Physical activity practice was dependent on personal factors such as gender, age or weight, but also on contextual factors such as living with a dependent person or the type of house (square meters, having a balcony or a backyard). Insufficient physical activity has been considered a prominent risk factor for non-communicable diseases, mental health and, consequently, quality of life. Mandatory shelter-at home orders like the ones issued due to COVID-19 could be repeated in the future. National authorities should consider the findings from the present study to prevent citizens from putting their health at jeopardy while in confinement. © The Author(s), 2021.

[Safe surgery and COVID-19: A narrative review]. / Cirugía segura y COVID-19: una revisión narrativa.

BACKGROUND: The interruption of surgical care in Spain caused by the pandemic must end. Recovery from this activity must be carried out on an elective basis and in conjunction with possible cases of COVID-19. The objective of this review was to incorporate good practice criteria related to COVID-19 into the context of safe surgery, which would make it possible to develop a proposed surgical safety checklist adapted to patients with this disease. METHODS: Narrative literature review, following the PRISMA protocol, in the Medline and Cochrane directories, using the MeSH terms (coronavirus, infections, safety, surgical procedures, operative, checklist) and the Boolean operator AND. In addition, recommendations from scientific bodies and societies were reviewed (grey literature). RESULTS: Thirty-three final studies were included with recommendations for safe surgery and surgical safety checklist adapted for COVID-19, the most frequent being aspects related to treatment (41.3%) and prevention and control measures (27.6%). CONCLUSIONS: The existence of a broad consensus on good practices recommended for COVID surgical patients makes it possible to make a proposal for surgical safety checklist to these patients.

COVID-19: A challenge for the personal data protection

COVID-19 is allowing the adoption of all kinds of exceptional measures that would not be justified in a normal state situation, provided that a correct balance is maintained between the prevention of infections and the collection, treatment and transfer of personal data that can promote the identification of specific people. Personal data protection is not, can't and shouldn't be an obstacle to the most effective fight against the Coronavirus, but, in this scenario, the measures adopted in the field of protection of personal data must be adopted from "legal normality". © 2020 Ibero-American Law Institute. All rights reserved.