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1.
Glob Heart ; 16(1): 42, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1285504

ABSTRACT

Background: QTc prolongation is an adverse effect of COVID-19 therapies. The use of a handheld device in this scenario has not been addressed. Objectives: To evaluate the feasibility of QTc monitoring with a smart device in COVID-19 patients receiving QTc-interfering therapies. Methods: Prospective study of consecutive COVID-19 patients treated with hydroxychloroquine ± azithromycin ± lopinavir-ritonavir. ECG monitoring was performed with 12-lead ECG or with KardiaMobile-6L. Both registries were also sequentially obtained in a cohort of healthy patients. We evaluated differences in QTc in COVID-19 patients between three different monitoring strategies: 12-lead ECG at baseline and follow-up (A), 12-lead ECG at baseline and follow-up with the smart device (B), and fully monitored with handheld 6-lead ECG (group C). Time needed to obtain an ECG registry was also documented. Results: One hundred and eighty-two COVID-19 patients were included (A: 119(65.4%); B: 50(27.5%); C: 13(7.1%). QTc peak during hospitalization did significantly increase in all groups. No differences were observed between the three monitoring strategies in QTc prolongation (p = 0.864). In the control group, all but one ECG registry with the smart device allowed QTc measurement and mean QTc did not differ between both techniques (p = 0.612), displaying a moderate reliability (ICC 0.56 [0.19-0.76]). Time of ECG registry was significantly longer for the 12-lead ECG than for handheld device in both cohorts (p < 0.001). Conclusion: QTc monitoring with KardiaMobile-6L in COVID-19 patients was feasible. Time of ECG registration was significantly lower with the smart device, which may offer an important advantage for prevention of virus dissemination among healthcare providers.


Subject(s)
COVID-19/drug therapy , Electrocardiography/methods , Long QT Syndrome/diagnosis , Aged , Aged, 80 and over , Anti-Bacterial Agents/adverse effects , Antiviral Agents/adverse effects , Azithromycin/adverse effects , Drug Combinations , Electrocardiography/instrumentation , Enzyme Inhibitors/adverse effects , Feasibility Studies , Female , Humans , Hydroxychloroquine/adverse effects , Long QT Syndrome/chemically induced , Lopinavir/adverse effects , Male , Middle Aged , Point-of-Care Systems , Prospective Studies , Reproducibility of Results , Ritonavir/adverse effects , SARS-CoV-2
2.
Eur J Pharmacol ; 906: 174233, 2021 Sep 05.
Article in English | MEDLINE | ID: covidwho-1260717

ABSTRACT

Dihydroorotate dehydrogenase (DHODH) is rate-limiting enzyme in biosynthesis of pyrimidone which catalyzes the oxidation of dihydro-orotate to orotate. Orotate is utilized in the biosynthesis of uridine-monophosphate. DHODH inhibitors have shown promise as antiviral agent against Cytomegalovirus, Ebola, Influenza, Epstein Barr and Picornavirus. Anti-SARS-CoV-2 action of DHODH inhibitors are also coming up. In this review, we have reviewed the safety and efficacy of approved DHODH inhibitors (leflunomide and teriflunomide) against COVID-19. In target-centered in silico studies, leflunomide showed favorable binding to active site of MPro and spike: ACE2 interface. In artificial-intelligence/machine-learning based studies, leflunomide was among the top 50 ligands targeting spike: ACE2 interaction. Leflunomide is also found to interact with differentially regulated pathways [identified by KEGG (Kyoto Encyclopedia of Genes and Genomes) and reactome pathway analysis of host transcriptome data] in cogena based drug-repurposing studies. Based on GSEA (gene set enrichment analysis), leflunomide was found to target pathways enriched in COVID-19. In vitro, both leflunomide (EC50 41.49 ± 8.8 µmol/L) and teriflunomide (EC50 26 µmol/L) showed SARS-CoV-2 inhibition. In clinical studies, leflunomide showed significant benefit in terms of decreasing the duration of viral shredding, duration of hospital stay and severity of infection. However, no advantage was seen while combining leflunomide and IFN alpha-2a among patients with prolonged post symptomatic viral shredding. Common adverse effects of leflunomide were hyperlipidemia, leucopenia, neutropenia and liver-function alteration. Leflunomide/teriflunomide may serve as an agent of importance to achieve faster virological clearance in COVID-19, however, findings needs to be validated in bigger sized placebo controlled studies.


Subject(s)
Antiviral Agents/pharmacology , COVID-19/drug therapy , Crotonates/pharmacology , Enzyme Inhibitors/pharmacology , Hydroxybutyrates/pharmacology , Leflunomide/pharmacology , Nitriles/pharmacology , Oxidoreductases Acting on CH-CH Group Donors/antagonists & inhibitors , Toluidines/pharmacology , Animals , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use , Crotonates/adverse effects , Crotonates/therapeutic use , Drug Repositioning , Enzyme Inhibitors/adverse effects , Enzyme Inhibitors/therapeutic use , Humans , Hydroxybutyrates/adverse effects , Hydroxybutyrates/therapeutic use , Leflunomide/adverse effects , Leflunomide/therapeutic use , Nitriles/adverse effects , Nitriles/therapeutic use , Toluidines/adverse effects , Toluidines/therapeutic use
3.
Epilepsy Res ; 174: 106675, 2021 08.
Article in English | MEDLINE | ID: covidwho-1233420

ABSTRACT

In regard to the global pandemic of COVID-19, it seems that persons with epilepsy (PWE) are not more vulnerable to get infected by SARS-CoV-2, nor are they more susceptible to a critical course of the disease. However, management of acute seizures in patients with COVID-19 as well as management of PWE and COVID-19 needs to consider potential drug-drug interactions between antiseizure drugs and candidate drugs currently assessed as therapeutic options for COVID-19. Repurposing of several licensed and investigational drugs is discussed for therapeutic management of COVID-19. While for none of these approaches, efficacy and tolerability has been confirmed yet in sufficiently powered and controlled clinical studies, testing is ongoing with multiple clinical trials worldwide. Here, we have summarized the possible mechanisms of action of drugs currently considered as potential therapeutic options for COVID-19 management along with possible and confirmed drug-drug interactions that should be considered for a combination of antiseizure drugs and COVID-19 candidate drugs. Our review suggests that potential drug-drug interactions should be taken into account with drugs such as chloroquine/hydroxychloroquine and lopinavir/ritonavir while remdesivir and tocilizumab may be less prone to clinically relevant interactions with ASMs.


Subject(s)
Anti-Inflammatory Agents/adverse effects , Anticonvulsants/adverse effects , Antiviral Agents/adverse effects , COVID-19/drug therapy , Enzyme Inhibitors/adverse effects , Epilepsy/drug therapy , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Alanine/adverse effects , Alanine/analogs & derivatives , Amides/adverse effects , Antibodies, Monoclonal, Humanized/adverse effects , COVID-19/complications , Chloroquine/adverse effects , Cytochrome P-450 CYP3A Inducers/adverse effects , Dexamethasone/adverse effects , Drug Combinations , Drug Interactions , Epilepsy/complications , Glucocorticoids/adverse effects , Humans , Hydroxychloroquine/adverse effects , Interleukin 1 Receptor Antagonist Protein/adverse effects , Ivermectin/adverse effects , Lopinavir , Pyrazines/adverse effects , Ritonavir , SARS-CoV-2
4.
J Clin Pharm Ther ; 46(5): 1308-1311, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1220012

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: A pandemic can strain all aspects of the healthcare system, including the ability to monitor the safety of medication use. Reviewing the adequacy of medication safety practices during the COVID-19 pandemic is critical to informing responses to future pandemics. The purpose of this study was to evaluate medication safety practices at a height of both COVID-19 cases and hydroxychloroquine use. METHODS: This was a multicentre observational point prevalence study. Adult inpatients receiving hydroxychloroquine for COVID-19 between March 22 and 28, 2020 were included. The primary outcome was the percentage of patients receiving appropriate QTc monitoring. Secondary outcomes included QTc prolongation, early discontinuation of hydroxychloroquine and ventricular arrhythmias. RESULTS AND DISCUSSION: A total of 59% (167/284) of patients treated with hydroxychloroquine received appropriate QTc monitoring. QTc prolongation occurred in 25%. Hydroxychloroquine was prematurely discontinued in 1.4% of patients, all due to QTc prolongation. Ventricular arrhythmia occurred in 1.1%. WHAT IS NEW AND CONCLUSION: Medication safety practices were suboptimal with regard to hydroxychloroquine monitoring at the height of the COVID-19 pandemic. Preparation for future pandemics should devote considerable attention to medication safety.


Subject(s)
Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/diagnosis , COVID-19/drug therapy , Electrocardiography/methods , Hydroxychloroquine/adverse effects , Patient Safety/statistics & numerical data , Enzyme Inhibitors/adverse effects , Enzyme Inhibitors/therapeutic use , Female , Humans , Hydroxychloroquine/therapeutic use , Male , Middle Aged , Pandemics , Prevalence , SARS-CoV-2
5.
J Clin Pharm Ther ; 46(3): 800-806, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1153524

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Hydroxychloroquine and protease inhibitors were widely used as off-label treatment options for COVID-19 but the safety data of these drugs among the COVID-19 population are largely lacking. Drug-induced QTc prolongation is a known adverse reaction of hydroxychloroquine, especially during chronic treatment. However, when administered concurrently with potential pro-arrhythmic drugs such as protease inhibitors, the risk of QTc prolongation imposed on these patients is not known. We aim to investigate the incidence of QTc prolongation events and potential factors associated with its occurrence in COVID-19 population. METHODS: We included 446 SARS-CoV-2 RT-PCR-positive patients taking at least one treatment drug for COVID-19 within a period of one month (March-April 2020). In addition to COVID-19-related treatment (HCQ/PI), concomitant drugs with risks of QTc prolongation were considered. We defined QTc prolongation as QTc interval of ≥470 ms in postpubertal males, and ≥480 ms in postpubertal females. RESULTS AND DISCUSSION: QTc prolongation events occurred in 28/446 (6.3%) patients with an incidence rate of 1 case per 100 person-days. A total of 26/28 (93%) patients who had prolonged QTc intervals received at least two pro-QT drugs. Multivariate analysis showed that HCQ and PI combination therapy had five times higher odds of QTc prolongation as compared to HCQ-only therapy after controlling for age, cardiovascular disease, SIRS and the use of concurrent QTc-prolonging agents besides HCQ and/or PI (OR 5.2; 95% CI, 1.11-24.49; p = 0.036). Independent of drug therapy, presence of SIRS resulted in four times higher odds of QTc prolongation (OR 4.3; 95% CI, 1.66-11.06; p = 0.003). In HCQ-PI combination group, having concomitant pro-QT drugs led to four times higher odds of QTc prolongation (OR 3.8; 95% CI, 1.53-9.73; p = 0.004). Four patients who had prolonged QTc intervals died but none were cardiac-related deaths. WHAT IS NEW AND CONCLUSION: In our cohort, hydroxychloroquine monotherapy had low potential to increase QTc intervals. However, when given concurrently with protease inhibitors which have possible or conditional risk, the odds of QTc prolongation increased fivefold. Interestingly, independent of drug therapy, the presence of systemic inflammatory response syndrome (SIRS) resulted in four times higher odds of QTc prolongation, leading to the postulation that some QTc events seen in COVID-19 patients may be due to the disease itself. ECG monitoring should be continued for at least a week from the initiation of treatment.


Subject(s)
COVID-19/drug therapy , Enzyme Inhibitors/adverse effects , Hydroxychloroquine/adverse effects , Long QT Syndrome/chemically induced , Protease Inhibitors/adverse effects , Adult , Cohort Studies , Electrocardiography , Female , Humans , Malaysia , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
7.
JACC Clin Electrophysiol ; 7(1): 16-25, 2021 01.
Article in English | MEDLINE | ID: covidwho-1023623

ABSTRACT

OBJECTIVES: This study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized patients with coronavirus disease-2019 (COVID-19) who were treated with hydroxychloroquine and azithromycin (HCQ/AZM). BACKGROUND: HCQ/AZM is being widely used to treat COVID-19 despite the known risk of QT interval prolongation and the unknown risk of arrhythmogenesis in this population. METHODS: A retrospective cohort of COVID-19 hospitalized patients treated with HCQ/AZM was reviewed. The QTc interval was calculated before drug administration and for the first 5 days following initiation. The primary endpoint was the magnitude of QTc prolongation, and factors associated with QTc prolongation. Secondary endpoints were incidences of sustained ventricular tachycardia or ventricular fibrillation and all-cause mortality. RESULTS: Among 415 patients who received concomitant HCQ/AZM, the mean QTc increased from 443 ± 25 ms to a maximum of 473 ± 40 ms (87 [21%] patients had a QTc ≥500 ms). Factors associated with QTc prolongation ≥500 ms were age (p < 0.001), body mass index <30 kg/m2 (p = 0.005), heart failure (p < 0.001), elevated creatinine (p = 0.005), and peak troponin (p < 0.001). The change in QTc was not associated with death over the short period of the study in a population in which mortality was already high (hazard ratio: 0.998; p = 0.607). No primary high-grade ventricular arrhythmias were observed. CONCLUSIONS: An increase in QTc was seen in hospitalized patients with COVID-19 treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.


Subject(s)
Anti-Bacterial Agents/adverse effects , Azithromycin/adverse effects , COVID-19/drug therapy , Enzyme Inhibitors/adverse effects , Hydroxychloroquine/adverse effects , Long QT Syndrome/chemically induced , Age Factors , Aged , Aged, 80 and over , Body Mass Index , COVID-19/epidemiology , Comorbidity , Creatinine/blood , Drug Therapy, Combination , Electrocardiography , Female , Heart Failure/epidemiology , Hospitalization , Humans , Long QT Syndrome/epidemiology , Male , Middle Aged , Mortality , Proportional Hazards Models , Risk Factors , SARS-CoV-2 , Troponin I/blood
8.
J Clin Pharm Ther ; 46(3): 724-730, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-991463

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Initial treatment recommendations of COVID-19 were based on the use of antimicrobial drugs and immunomodulators. Although information on drug interactions was available for other pathologies, there was little evidence in the treatment of COVID-19. The objective of this study was to analyse the potential drug-drug interactions (pDDIs) derived from the medication used in COVID-19 patients in the first pandemic wave and to evaluate the real consequences of such interactions in clinical practice. METHODS: Cohort, retrospective and single-centre study carried out in a third-level hospital. Adult patients, admitted with suspected COVID-19, that received at least one dose of hydroxychloroquine, lopinavir/ritonavir, interferon beta 1-b or tocilizumab and with any pDDIs according to "Liverpool Drug Interaction Group" between March and May 2020 were included. The possible consequences of pDDIs at the QTc interval level or any other adverse event according to the patient's medical record were analysed. A descriptive analysis was carried out to assess possible factors that may affect the QTc interval prolongation. RESULTS AND DISCUSSION: Two hundred and eighteen (62.3%) patients of a total of 350 patients admitted with COVID-19 had at least one pDDI. There were 598 pDDIs. Thirty-eight pDDIs (6.3%) were categorized as not recommended or contraindicated. The mean value difference between baseline and pDDI posterior ECG was 412.3 ms ± 25.8 ms vs. 426.3 ms ± 26.7 ms; p < 0.001. Seven patients (5.7%) had a clinically significant alteration of QTc. A total of 44 non-cardiological events (7.3%) with a possible connection to a pDDI were detected. WHAT IS NEW AND CONCLUSION: The number of pDDIs in patients admitted for COVID-19 in the first pandemic wave was remarkably high. However, clinical consequences occurred in a low percentage of patients. Interactions involving medications that would be contraindicated for concomitant administration are rare. Knowledge of these pDDIs and their consequences could help to establish appropriate therapeutic strategies in patients with COVID-19 or other diseases with these treatments.


Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , COVID-19/drug therapy , Hydroxychloroquine/adverse effects , Interferon beta-1b/adverse effects , Lopinavir/adverse effects , Ritonavir/adverse effects , Adjuvants, Immunologic/adverse effects , Aged , COVID-19/complications , Cohort Studies , Cytochrome P-450 CYP3A Inhibitors/adverse effects , Drug Interactions , Enzyme Inhibitors/adverse effects , Female , Humans , Male , Prevalence , Retrospective Studies , Risk Factors , SARS-CoV-2
9.
Perm J ; 242020.
Article in English | MEDLINE | ID: covidwho-922950

ABSTRACT

INTRODUCTION: The growing coronavirus disease 2019 (COVID-19) pandemic initially led to widespread use of hydroxychloroquine sulfate as an off-label experimental treatment of this disease. CASE PRESENTATION: Acute hemolytic anemia developed in an African American man with COVID-19-related pneumonia and glucose-6-phosphate dehydrogenase (G6PD) deficiency who completed the standard 5-day experimental course of hydroxychloroquine. Although the trigger leading to our patient's hemolytic sequelae will never be known with certainty, his clinical course suggests that hydroxychloroquine use and/or COVID-19 infection may trigger hemolysis in susceptible patients with G6PD deficiency. DISCUSSION: This case confirms recent findings that the potential risks of hydroxychloroquine therapy for COVID-19 may outweigh the benefits.


Subject(s)
Anemia, Hemolytic/complications , COVID-19/complications , Enzyme Inhibitors/therapeutic use , Glucosephosphate Dehydrogenase Deficiency/complications , Hydroxychloroquine/therapeutic use , Anemia, Hemolytic/therapy , COVID-19/drug therapy , Enzyme Inhibitors/adverse effects , Erythrocyte Transfusion , Humans , Hydroxychloroquine/adverse effects , Male , Middle Aged
11.
Ir J Med Sci ; 190(1): 403-409, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-629552

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease 19 (COVID-19), has rapidly spread since December 2019 to become the focus of healthcare systems worldwide. Its highly contagious nature and significant mortality has led to its prioritization as a public health issue. The race to prevent and treat this disease has led to "off-label" prescribing of medications such as hydroxychloroquine, azithromycin, and Kaletra (lopinavir/ritonavir). Currently, there is no robust clinical evidence for the use of these drugs in the treatment of COVID-19, with most, if not all of these medications associated with the potential for QT interval prolongation, torsades de pointes, and resultant drug-induced sudden cardiac death. The aim of this document is to help healthcare providers mitigate the potential deleterious effects of drug-induced QTc prolongation.


Subject(s)
Anti-Bacterial Agents/adverse effects , Antiviral Agents/adverse effects , Azithromycin/adverse effects , COVID-19/drug therapy , Hydroxychloroquine/adverse effects , Long QT Syndrome/chemically induced , Lopinavir/adverse effects , Ritonavir/adverse effects , Torsades de Pointes/chemically induced , Drug Combinations , Electrocardiography , Enzyme Inhibitors/adverse effects , Humans , Long QT Syndrome/blood , Long QT Syndrome/diagnosis , Long QT Syndrome/prevention & control , Magnesium/blood , Pandemics , Potassium/blood , Practice Guidelines as Topic , Risk Assessment , Risk Factors , SARS-CoV-2
12.
Ann Saudi Med ; 40(4): 273-280, 2020.
Article in English | MEDLINE | ID: covidwho-612198

ABSTRACT

In December 2019, a novel coronavirus was identified in patients in Wuhan, China. The virus, subsequently named severe acute respiratory syndrome coronavirus-2, spread worldwide and the disease (coronavirus disease 2019 or COVID-19) was declared a global pandemic by the World Health Organization in March 2020. Older adults and individuals with comorbidities have been reported as being more vulnerable to COVID-19. Patients with chronic liver disease (CLD) have compromised immune function due to cirrhosis and are more susceptible to infection. However, it is unclear if patients with CLD are more vulnerable to COVID-19 and its complications than other populations. The high number of severe cases of COVID-19 has placed an unusual burden on health systems, compromising their capacity to provide the regular care that patients with CLD require. Hence, it is incredibly crucial at this juncture to provide a set of interim recommendations on the management of patients with CLD during the current COVID-19 outbreak.


Subject(s)
Coronavirus Infections/epidemiology , Liver Diseases/epidemiology , Pneumonia, Viral/epidemiology , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Adrenal Cortex Hormones/adverse effects , Alanine/adverse effects , Alanine/analogs & derivatives , Amides/adverse effects , Antiviral Agents/therapeutic use , Azetidines/adverse effects , Betacoronavirus , Biopsy/methods , COVID-19 , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/therapy , Comorbidity , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Drug Combinations , Drug Interactions , Enzyme Inhibitors/adverse effects , Hepatitis, Autoimmune/epidemiology , Hepatitis, Autoimmune/therapy , Hepatitis, Viral, Human/epidemiology , Hepatitis, Viral, Human/therapy , Humans , Hydroxychloroquine/adverse effects , Immunosuppressive Agents/therapeutic use , Janus Kinase Inhibitors/adverse effects , Liver Cirrhosis/epidemiology , Liver Cirrhosis/therapy , Liver Diseases/therapy , Liver Neoplasms/epidemiology , Liver Neoplasms/therapy , Liver Transplantation , Lopinavir/adverse effects , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/therapy , Pandemics/prevention & control , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Purines , Pyrazines/adverse effects , Pyrazoles , Ritonavir/adverse effects , SARS-CoV-2 , Saudi Arabia/epidemiology , Sulfonamides/adverse effects , Ultrasonography/methods
13.
Circ Heart Fail ; 13(7): e007220, 2020 07.
Article in English | MEDLINE | ID: covidwho-546317

ABSTRACT

The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.


Subject(s)
Acute Coronary Syndrome/therapy , Arrhythmias, Cardiac/therapy , Coronavirus Infections/therapy , Heart Failure/therapy , Myocarditis/therapy , Pneumonia, Viral/therapy , Acute Coronary Syndrome/complications , Anti-Bacterial Agents/adverse effects , Antiviral Agents/therapeutic use , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/complications , Azithromycin/adverse effects , Betacoronavirus , COVID-19 , Cardiotonic Agents/therapeutic use , Chronic Disease , Coronavirus Infections/complications , Cytokine Release Syndrome/complications , Cytokine Release Syndrome/therapy , Enzyme Inhibitors/adverse effects , Extracorporeal Membrane Oxygenation , Heart Failure/etiology , Heart-Assist Devices , Humans , Hydroxychloroquine/adverse effects , Intra-Aortic Balloon Pumping , Myocardial Infarction/complications , Myocardial Infarction/therapy , Myocarditis/complications , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral/complications , SARS-CoV-2 , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Thromboembolism
14.
Infect Dis (Lond) ; 52(9): 659-661, 2020 09.
Article in English | MEDLINE | ID: covidwho-526880

ABSTRACT

While the COVID-19 epidemic occurred since December 2019, as of end April 2020, no treatment has been validated or invalidated by accurate clinical trials. Use of hydroxychloroquine has been popularised on mass media and put forward as a valid treatment option without strong evidence of efficacy. Hydroxychloroquine (HCQ) has its own side effects, some of which are very serious like acute haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. Side effects may be worse than the disease itself. Belgian national treatment guidelines recommend the use of HCQ in mild to severe COVID-19 disease. As opinions, politics, media and beliefs are governing COVID-19 therapy, performance of randomised controlled blinded clinical trials became difficult. Results of sound clinical trials are eagerly awaited. We report a case of acute haemolysis leading to admission in intensive care unit and renal failure in a patient with uncovered G6PD deficiency.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Enzyme Inhibitors/adverse effects , Glucosephosphate Dehydrogenase Deficiency/complications , Hemolysis , Hydroxychloroquine/adverse effects , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Aged , Azithromycin/therapeutic use , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , Blood Transfusion , COVID-19 , Continuous Renal Replacement Therapy , Drug Therapy, Combination , Enzyme Inhibitors/therapeutic use , Haptoglobins/analysis , Humans , Hydroxychloroquine/therapeutic use , Hypoxia/chemically induced , Hypoxia/complications , Male , Nasopharynx/virology , Pandemics , Respiratory Distress Syndrome/complications , SARS Virus/genetics , SARS Virus/isolation & purification , SARS-CoV-2
15.
Am J Cardiol ; 128: 147-150, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-277078

ABSTRACT

Coronavirus disease 2019 (COVID-19) has become a global pandemic. It is still uncontrolled in most countries and no therapies are currently available. Various drugs are under investigation for its treatment. The disease is known to have worse outcomes in patients who have underlying cardiovascular disease. Chloroquine/hydroxychloroquine, azithromycin, remdesivir and lopinavir/ritonavir are currently being studied in trials and show some promise. Conduction disorders, heart failure, and mortality have been reported with the use of these drugs. It is important to have knowledge of potential cardiotoxic effects of these drugs before using them for COVID-19 patients for better allocation of healthcare resources and improvement in clinical outcomes.


Subject(s)
Anti-Infective Agents/adverse effects , Betacoronavirus , Cardiovascular Diseases/chemically induced , Coronavirus Infections/drug therapy , Enzyme Inhibitors/adverse effects , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Alanine/administration & dosage , Alanine/adverse effects , Alanine/analogs & derivatives , Anti-Infective Agents/administration & dosage , Azithromycin/administration & dosage , Azithromycin/adverse effects , COVID-19 , Drug Combinations , Enzyme Inhibitors/administration & dosage , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Lopinavir/therapeutic use , Pandemics , Ritonavir/therapeutic use , SARS-CoV-2
16.
Neurology ; 94(22): 959-969, 2020 06 02.
Article in English | MEDLINE | ID: covidwho-52532

ABSTRACT

The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.


Subject(s)
Coronavirus Infections/therapy , Immunosuppressive Agents/adverse effects , Neuromuscular Diseases/therapy , Pneumonia, Viral/therapy , Antiviral Agents/adverse effects , COVID-19 , COVID-19 Vaccines , Chloroquine/adverse effects , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Delivery of Health Care , Deprescriptions , Disease Progression , Drug Development , Enzyme Inhibitors/adverse effects , Guillain-Barre Syndrome/etiology , House Calls , Humans , Hydroxychloroquine/adverse effects , Immunologic Factors/adverse effects , Immunologic Factors/therapeutic use , Immunosuppressive Agents/therapeutic use , Infusions, Subcutaneous , Macrolides/adverse effects , Muscular Diseases/etiology , Myasthenia Gravis/chemically induced , Neurology/education , Neuromuscular Diseases/complications , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Research , Risk Reduction Behavior , Self Administration , Telemedicine , Viral Vaccines/therapeutic use
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