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1.
Journal of clinical medicine research ; 12(8):483-491, 2020.
Artículo | WHO COVID | ID: covidwho-732647

RESUMEN

BACKGROUND: During the initial phases of the coronavirus disease 2019 (COVID-19) epidemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ);however, recently, the Centers for Disease Control and Prevention (CDC) has recommended against routine use of HCQ outside of study protocols citing possible adverse outcomes METHODS: Multiple databases were searched to identify articles on COVID-19 An unadjusted odds ratio (OR) was used to calculate the safety and efficacy of HCQ on a random effect model RESULTS: Twelve studies comprising 3,912 patients (HCQ 2,512 and control 1400) were included The odds of all-cause mortality (OR: 2 23, 95% confidence interval (CI): 1 58 - 3 13, P value < 0 00001) were significantly higher in patients on HCQ compared to patients on control agent The response to therapy assessed by negative repeat polymerase chain reaction (PCR) (OR: 1 83, 95% CI: 0 50 - 6 75, P = 0 36), radiological resolution (OR: 1 98, 95% CI: 0 47 - 8 36, P value = 0 36) and the need for invasive mechanical ventilation (IMV) (OR: 1 21, 95% CI: 0 34 - 4 33, P value = 0 76) were identical between the two groups Overall, four times higher odds of net adverse events (NAEs) were observed in the HCQ group (OR: 4 59, 95% CI 1 73 - 12 20, P value = 0 02) The measures for individual safety endpoints were also numerically lower in the control arm;however, none of these values reached the level of statistical significance CONCLUSIONS: HCQ might offer no benefits in terms of decreasing the viral load and radiological improvement in patients with COVID-19 HCQ appears to be associated with higher odds of all-cause mortality and NAEs

2.
J. Community Hosp. Intern. Med. Perspect. ; 4(10): 306-309, 20200703.
Artículo en Inglés | ELSEVIER | ID: covidwho-725436

RESUMEN

We present three patients with COVID-19 who developed acute renal failure during hospitalization and were seen to have an improvement in their kidney function after being started on therapeutic anticoagulation with heparin (Target PTT 58–93 seconds) for varying indications (atrial fibrillation, popliteal vein thrombosis and a pulmonary embolism). Their kidney functions improved significantly following anticoagulation with a clear temporal relationship between the former and latter. Anticoagulation was held for one patient due to concern of gastrointestinal bleeding and his kidney functions worsened a day after stopping anticoagulation. D-dimer levels also improved with anticoagulation but the trend of other inflammatory markers remained unpredictable.

3.
J Med Internet Res ; 22(9): e21758, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-714139

RESUMEN

BACKGROUND: During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. OBJECTIVE: The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. METHODS: A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. RESULTS: The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. CONCLUSIONS: In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria , Hidroxicloroquina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/mortalidad , Anciano , Anticuerpos Monoclonales Humanizados/farmacología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hidroxicloroquina/efectos adversos , Hidroxicloroquina/farmacología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Estudios Retrospectivos , Resultado del Tratamiento
4.
Int J Cardiol Heart Vasc ; 30: 100620, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-712880
5.
Int J Cardiol Heart Vasc ; 30: 100613, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-696633
6.
Int J Cardiol Heart Vasc ; 29: 100589, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-642152

RESUMEN

Coronavirus Disease 2019 (COVID-19) is a rapidly progressing global pandemic that may present with a variety of cardiac manifestations including, but not limited to, myocardial injury, myocardial infarction, arrhythmias, heart failure, cardiomyopathy, shock, thromboembolism, and cardiac arrest. These cardiovascular effects are worse in patients who have pre-existing cardiac conditions such as coronary artery disease, hypertension, diabetes mellitus, and coagulation abnormalities. Other predisposing risk factors include advanced age, immunocompromised state, and underlying systemic inflammatory conditions. Here we review the cellular pathophysiology, clinical manifestations and treatment modalities of the cardiac manifestations seen in patients with COVID-19.

8.
Journal of clinical medicine research ; 12(7):415-422, 2020.
Artículo | WHO COVID | ID: covidwho-643282

RESUMEN

Background: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19) This study aims to assess the validity and clinical utility of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR), typically used for gastric carcinoma prognostication, versus the neutrophil-to-lymphocyte ratio (NLR) for predicting in-hospital outcomes in COVID-19 Methods: A retrospective cohort study was performed to determine the association of LCR and NLR with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aORs) with its 95% confidence interval (CI), respectively Results: The mean age for NLR patients was 63 6 versus 61 6, and for LCR groups, it was 62 6 versus 63 7 years, respectively The baseline comorbidities across all groups were comparable except that the higher LCR group had female predominance The mean NLR was significantly higher for patients who died during hospitalization (19 vs 7, P 10), the unadjusted odds of mortality (odds ratios (ORs) 11 0, 3 6 - 33 0, P < 0 0001) and need for IMV (OR 3 3, 95% CI 1 4 - 7 7, P = 0 008) were significantly higher compared to patients with lower NLR By contrast, for patients with lower LCR (< 100), the odds of in-hospital all-cause mortality were significantly higher compared to patients with a higher LCR (OR 0 2, 0 06 - 0 47, P = 0 001) The aORs controlled for baseline comorbidities and medications mirrored the overall results, indicating a genuinely significant correlation between these biomarkers and outcomes Conclusions: A high NLR and decreased LCR value predict higher odds of in-hospital mortality A high LCR at presentation might indicate impending clinical deterioration and the need for IMV

9.
Cardiology Research ; 11(3):196-199, 2020.
Artículo | WHO COVID | ID: covidwho-459301

RESUMEN

A 67-year-old man with a prior heart failure presented with fever, cough and dyspnea for 4 days Physical examination showed bilateral rales on the lung exam, yet no lower extremity edema The combination of symptoms, elevated inflammatory markers, normal baseline pro-B-type natriuretic peptide, PaO2/FiO(2) < 300 and positive swab suggested coronavirus disease 2019 (COVID-19) with acute respiratory distress syndrome (ARDS) rather than heart failure exacerbation We discuss the challenges in management of ARDS in COVID-19 patients that may initially mimic as acute exacerbation of heart failure

11.
Am. J. Infect. Dis. ; 2(16): 73-76, 2020.
Artículo en Inglés | ELSEVIER | ID: covidwho-381531

RESUMEN

The COVID-19 outbreak is an unprecedented global public health challenge. It has a myriad of clinical presentations including fever, cough, vomiting, and diarrhea. Here, we present a unique case of COVID-19, with an atypical presentation of arthralgias and false-positive results for the chikungunya virus. By highlighting the importance of this rare association, we want physicians to be vigilant in the time of this pandemic and to have a high suspicion for this novel disease.

13.
JACC Case Rep ; 2020 Apr 17.
Artículo en Inglés | MEDLINE | ID: covidwho-72215

RESUMEN

A patient with Coronavirus Disease-2019 (COVID-19) developed sudden shortness of breath and hypoxia. She was diagnosed with a massive pulmonary embolism (PE) complicated by right sided heart failure, which was successfully managed conservatively. This marks the first report of COVID-19 induced PE in association with acute heart failure.

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