ABSTRACT
We report three cases of coronavirus disease 2019 (COVID-19) pneumonia treated with ivermectin monotherapy. The patients included two men (aged 40 and 49 years) and a woman (aged 53 years), all of whom had high fever and bilateral pneumonia. We administered 0.2 mg/kg of ivermectin orally every alternate day. They defervesced soon after, the blood inflammatory markers and chest radiographic findings improved and the patients were discharged. There was no need for additional therapy. These three patients improved following ivermectin administration. Oral ivermectin may have a role to play in the home treatment of COVID-19 patients.
ABSTRACT
Background: A strategy for maintaining and/or improving cardiorespiratory fitness (CRF) in the growing population of cancer survivors is of major clinical importance in the COVID-19 era. With the aim of increasing CRF, recent studies have focused on the use of high-intensity interval training (HIIT) in supervised experimental settings, which appeared to be more beneficial than usual care in cancer survivors at all stages of treatment and aftercare. However, the effect of unsupervised HIIT on increasing CRF in breast cancer survivors is not known. Purpose: To determine whether the newly developed habit-B program, which involves home-based smartphone-supported HIIT using body-weight exercises, improves CRF in early-stage breast cancer survivors. We hypothesized that the habit-B program would improve VO2peak compared with a control group. Methods: This single-center, 12-week, parallel-group, single-blind, randomized controlled trial involved 50 women with stage I-IIa breast cancer, aged 20 to 59 years, who had completed initial treatment except for hormone therapy. Participants wore a smartwatch and were randomized to either the exercise or control group from May 27, 2019 through November 30, 2020. The planned sample size was 60 Spatients to detect the increase of 2.0 ml/kg/min change in VO2peak with a standard deviation of 2.6 ml/kg/min, one-sided significance level of 2.5% and 80% power. The exercise group underwent home-based HIIT using a smartphone and a Fitbit Versa thrice weekly for 12 weeks (three times per week). The primary outcome was the 12-week change in peak oxygen uptake (VO2peak;mL/kg/min) between the groups. Other outcomes included muscle strength, 6-min walk test, resting heart rate, physical activity, fatigue, safety, and quality of life. Results: Of the 50 participants, 44 (exercise group, n=23;control group, n=21) completed the CRF assessment and 6 did not because of issues related to the COVID-19 pandemic. The change in VO2peak increased significantly in the exercise group (0.9 [95%CI, 0.1 to 1.7]) compared with the control group (-0.8 [95%CI,-1.5 to-0.1]) (mean difference, 1.7 [95% CI, 0.7 to 2.7], p <.01). Leg strength also increased significantly in the exercise group compared with the control group (mean difference, 13.5 [95% CI, 2.9 to 24.1], p <.01). Changes in other outcomes were not significantly different between the groups. Conclusion: A home-based HIIT intervention can lead to improved cardiorespiratory fitness and muscle strength in early-stage breast cancer survivors;however, a multicenter pragmatic clinical trial is required to confirm the benefits of the habit-B program.
ABSTRACT
Background: An emergency framework was set to confront the first wave COVID-19 pandemic at the medical oncology division for breast cancer at the Cancer Institute Hospital of JFCR, Tokyo, in March 2020. Medical therapy was classified into two phases in our guideline. In the initial phase, workload or patients' visit was to be reduced without impairing disease control and survival. In the successive phase under restriction of medical resources, only therapies with higher priority and alternate therapies were to be practiced. Whereas no significant effect on medical practice was observed during first wave pandemic, actual impact was evaluated in this study. Methods: Among patients in our division from April to May 2020, cases of treatment change, postponement of treatment introduction, treatment interruption, long-term prescription, telephone consultation, postponement of visit, reference to other hospital, and COVID-19 diagnosis were retrospectively searched from medical records. Results: There were estimated 984 patients, 389 perioperative and 595 metastatic, of whom 119(12%) were affected by COVID-19. The breakdown is 7 cases of treatment changes, 7 cases of postponements of introduction, 20 cases of interruptions, 12 cases of long-term prescriptions of oral chemotherapy and molecular targeted therapy, 36 cases of prescriptions by telephone consultation, 94 cases of postponements of visit, 3 cases of reference to other hospital, and 4 cases of fever for which COVID-19 infection could not be denied. Conclusion: 12% of patients in the division of medical oncology at the breast center changed their treatment or schedule of visit. Treatment change that could affect breast cancer survival were 2 cases of cancellation of adjuvant chemotherapy. The effect might have been minimized by formulation of a COVID-19 guideline prior to the pandemic.