[Obesity, CKD and gender on the 30-day in-hospital mortality risk in adults with COVID-19]. / Obesidad, ERC y género en el riesgo de mortalidad hospitalaria a 30 días en adultos con COVID-19.

Background: The coronavirus disease 2019 (COVID-19) pandemic is a serious health problem. The Mexican adult population has a high prevalence of obesity and chronic diseases that increase the risk of dying from this disease. Objective: To identify comorbidities predicting the risk of mortality at 30 days in hospitalized adult subjects with positive laboratory COVID-19 test and to evaluate the interaction between chronic diseases and gender. Material and methods: A retrospective cohort study was conducted in 2020, in a western region of the Mexican Pacific. Data from 51,135 hospitalized patients with positive COVID-19 test were analyzed and were retrieved from a normative system for the epidemiological surveillance of viral respiratory diseases (SINOLAVE, according to its initials in Spanish). Death within the first 30 days from hospital admission was the main outcome and risk ratios (RR) with 95% confidence intervals (95% CI) were calculated. Results: The overall mortality rate was 49.6% and most of the comorbidities analyzed were associated with a higher risk of death. There were significant interactions between gender and obesity (p = 0.003) and chronic kidney disease (p = 0.019). The effect of obesity on the risk of a fatal outcome varied by gender: female, RR = 1.04 (95% CI 1.03-1.07); male, RR = 1.07 (95% CI: 1.06-1.09). Conclusions: A high mortality was observed among the hospitalized patients analyzed and statistically significant factors associated with their risk were identified (gender, obesity, and kidney disease).

Introducción: la pandemia de la enfermedad por coronavirus 2019 (COVID-19) es un problema serio de salud. La población adulta mexicana tiene una alta prevalencia de obesidad y de enfermedades crónicas que incrementan el riesgo de morir por esta enfermedad. Objetivo: identificar comorbilidades predictoras del riesgo de mortalidad a 30 días en sujetos adultos hospitalizados con COVID-19 demostrado por laboratorio y evaluar la interacción entre enfermedades crónicas y el género del paciente. Material y métodos: se hizo un estudio de cohorte retrospectivo en el 2020, en una región del occidente del pacífico mexicano. Se analizaron los datos de 51,135 pacientes hospitalizados con COVID-19, los cuales fueron extraídos de un sistema normativo para la vigilancia epidemiológica de enfermedades respiratorias virales (SINOLAVE). La muerte dentro de los primeros 30 días desde la admisión hospitalaria fue el evento principal y fueron estimadas razones de riesgo (RR) con intervalos de confianza del 95% (IC 95%). Resultados: la mortalidad global fue del 49.6% y la mayoría de las comorbilidades analizadas se asociaron con un mayor riesgo de muerte. Hubo interacciones significativas entre el género y la obesidad (p = 0.003) y la enfermedad renal crónica (p = 0.019). El efecto de la obesidad sobre el riesgo de un desenlace fatal varió en función del género: mujeres, RR = 1.04 (IC 95% 1.03-1.07); hombres, RR = 1.07 (IC 95% 1.06-1.09). Conclusiones: se observó una alta mortalidad entre los pacientes hospitalizados analizados y se identificaron factores asociados a su riesgo (género, obesidad y enfermedad renal).

Efficacy of the use of mefenamic acid combined with standard medical care vs. standard medical care alone for the treatment of COVID­19: A randomized double­blind placebo­controlled trial.

Mefenamic acid is a non­steroidal anti­inflammatory drug exhibiting a wide range of anti­inflammatory, antipyretic, analgesic and probable antiviral activities. The present study evaluated the efficacy of treatment with mefenamic acid combined with standard medical care vs. standard medical care plus a placebo in ambulatory patients with coronavirus disease 2019 (COVID­19; nasal/oropharyngeal swabs reverse transcription­PCR test results positive for severe acute respiratory syndrome coronavirus 2). The present study is a phase II prospective, two­arm, parallel­group, randomized, double­blind placebo­controlled clinical trial which analyzed 36 patients. Two aspects were evaluated during the 14­day follow­up period: i) The time for reaching a patient acceptable symptom state (PASS), and ii) the last day of each COVID­19 symptom presentation. Adverse effects were evaluated. The clinical severity for all the patients in the study was mild (88.9%) and moderate (11.1%). The control (placebo) group achieved PASS on day 8.0±1.3, compared with day 4.4±0.8 in the mefenamic acid group (P=0.020, Kaplan­Meier analyses using log­rank tests). Patients that received mefenamic acid plus standard medical care had a ~16­fold higher probability of achieving PASS on day 8 (adjusted RR, 15.57; 95% CI, 1.22­198.71; P=0.035), compared with the placebo plus standard medical care group. All symptoms lasted for fewer days in the mefenamic acid group, compared with the placebo group; however, only the symptoms of headache (P=0.008), retro­orbital eye pain (P=0.049), and sore throat (P=0.029) exhibited statistically significant differences. The experimental treatment produced no severe adverse effects. On the whole, the present study demonstrates that the administration of mefenamic acid markedly reduced the symptomatology and time to reach PASS in ambulatory patients with COVID­19. Due to its probable antiviral effects and potent anti­inflammatory mechanisms, mefenamic acid may prove to be useful in the treatment of COVID­19, in combination with other drugs, including the new antivirals (remdesivir, molnupiravir, or favipiravir). However, future studies are also required to confirm these findings.