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 Treatment , 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-2ABSTRACT
BACKGROUND: Administration of Hydroxychloroquine and Azithromycin in patients with coronavirus disease 2019 (COVID-19) prolongs QTc corrected interval (QTc). The effect and safety of Lopinavir/Ritonavir in combination with these therapies have seldom been studied. OBJECTIVES: Our aim was to evaluate changes in QTc in patients receiving double (Hydroxychloroquine + Azithromycin) and triple therapy (Hydroxychloroquine + Azithromycin + Lopinavir/Ritonavir) to treat COVID-19. Secondary outcome was the incidence of in-hospital all-cause mortality. METHODS: Patients under treatment with double (DT) and triple therapy (TT) for COVID-19 were consecutively included in this prospective observational study. Serial in-hospital electrocardiograms were performed to measure QTc at baseline and during therapy. RESULTS: 168 patients (±66.2 years old) were included: 32.1% received DT and 67.9% received TT. The mean baseline QTc was 410.33 ms. Patients under DT and TT prolonged QTc interval respect baseline values (p < 0.001), without significant differences between both therapy groups (p = 0.748). Overall, 33 patients (19.6%) had a peak QTc and/or an increase QTc 60 ms from baseline, with a higher prevalence among those with hypokalemia (p = 0.003). All-cause mortality was similar between both strategy groups (p = 0.093) and high risk QTc prolongation was no related to clinical events in this series. CONCLUSIONS: DT and TT prolong the QTc in patients with COVID-19. Addition of Lopinavir/Ritonavir on top of Hydroxychloroquine and Azithromycin did not increase QTc compared to DT.
Subject(s)
Azithromycin/pharmacology , COVID-19/physiopathology , Electrocardiography/drug effects , Hydroxychloroquine/pharmacology , Lopinavir/pharmacology , Ritonavir/pharmacology , Aged , Anti-Infective Agents/pharmacology , Anti-Infective Agents/therapeutic use , Azithromycin/therapeutic use , Drug Therapy, Combination , Female , HIV Protease Inhibitors/pharmacology , HIV Protease Inhibitors/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Kaplan-Meier Estimate , Lopinavir/therapeutic use , Male , Middle Aged , Prospective Studies , Ritonavir/therapeutic use , COVID-19 Drug TreatmentABSTRACT
Carboprost metil se ha evaluado clínicamente en la inducción del aborto por vía intravaginal en el primer trimestre y en el pretratamiento de la inducción del aborto en el segundo mes de gestación. También durante el segundo trimestre es eficaz para terminar el embarazo cuando se administra por vía intraamniótica. Por vía intramuscular su administración se hace impracticable dada su toxicidad gastrointestinal; sin embargo, muchos autores recomiendan esta vía en los casos de aborto diferido, en la muerte fetal intrauterina y en otros tipos de embarazos anormales, y se ha utilizado en el control de la hemorragia postparto por vía intravenosa. Por administración intravesical se ha empleado en el tratamiento de la cistitis hemorrágica inducida por ciclofosfamida, donde parece constituir una terapia efectiva segura(AU)
Subject(s)
Humans , Female , Pregnancy , Carboprost/therapeutic use , Abortion, Induced , Cystitis/drug therapy , Postpartum Hemorrhage/drug therapyABSTRACT
Carboprost metil es una prostaglandina de actividad biológica de 10 a 20 veces superior a la PGR(2Ó). Es un potente estimulador de la actividad contráctil del miometrio e induce dilatación cervical. Su uso se ha sugerido desde los años 70, a pesar de los efectos secundarios que produce. La presencia de un grupo metilo en el carbono 15 bloquea la acción de la enzima 15-hidroxi-prostaglandina dehidrogenasa, por lo cual se incrementa el tiempo de vida media: este hecho provoca que la duración de la acción farmacológica sea de 2 a 3 veces mayor que el desarrollado por la PGF(2Ó)(AU)ÿ
Subject(s)
Carboprost/metabolism , Carboprost/pharmacology , Cervix UteriABSTRACT
Carboprost metil es una prostaglandina de actividad biologica de 10 a 20 veces superior a la PGR(2a). Es un potente estimulador de la actividad contractil del miometrio e induce dilatacion cervical. Su uso se ha sugerido desde los anos 70, a pesar de los efectos secundarios que produce. La presencia de un grupo metilo en el carbono 15 bloquea la accion de la enzima 15-hidroxi-prostaglandina dehidrogenasa, por lo cual se incrementa el tiempo de vida media: este hecho provoca que la duracion de la accion farmacologica sea de 2 a 3 veces mayor que el desarrollado por la PGF(2a)
Subject(s)
Carboprost/metabolism , Carboprost/pharmacology , Cervix Uteri/drug effectsABSTRACT
Carboprost metil se ha evaluado clinicamente en la induccion del aborto por via intravaginal en el primer trimestre y en el pretratamiento de la induccion del aborto en el segundo mes de gestacion. Tambien durante el segundo trimestre es eficaz para terminar el embarazo cuando se administra por via intraamniotica. Por via intramuscular su administracion se hace impracticable dada su toxicidad gastrointestinal; sin embargo, muchos autores recomiendan esta via en los casos de aborto diferido, en la muerte fetal intrauterina y en otros tipos de embarazos anormales, y se ha utilizado en el control de la hemorragia postparto por via intravenosa. Por administracion intravesical se ha empleado en el tratamiento de la cistitis hemorragica inducida por ciclofosfamida, donde parece constituir una terapia efectiva segura
