During the first year of the COVID-19 pandemic, unauthorized drugs were widely used. Ivermectin and hydroxychloroquine are drugs that inhibit viral replication in vitro and that have been used in several medical centers. This clinical trial analyzes their efficacy in hospitalized patients with moderate COVID-19. Methods: This a controlled, clinical, randomized, double-blind trial that included hospitalized patients with COVID-19-induced pneumonia, without severe respiratory failure. Patients were randomized to one of three groups: Group 1—hydroxychloroquine, 400 mg every 12 h on the first day and, subsequently, 200 mg every 12 h for 4 days; Group 2—ivermectin, 12 mg or 18 mg, according to patient weight; and Group 3—placebo. At inclusion, blood samples for arterial blood gases and biochemical markers were obtained. The primary outcome was established as the length of stay due to patient improvement and the rate of respiratory deterioration or death. Results: During the month of August 2020, the admission of patients requiring hospitalization mostly encompassed cases with severe respiratory failure, so we ended the recruitment process and analyzed the data that was available at the time. One hundred and six (106) patients with an average age of 53 yrs (±16.9) were included, with a greater proportion of males (n = 66, 62.2%). Seventy-two percent (72%) (n = 76) had an associated comorbidity. Ninety percent (90%) of patients were discharged due to improvement (n = 96). The average duration of hospitalization was 6 days (IQR, 3–10). No difference in hospitalization duration was found between the treatment groups (Group1: 7 vs. Group 2: 6 vs. Group 3: 5, p = 0.43) nor in respiratory deterioration or death (Group 1: 18% vs. Group 2: 22.2% vs. Group 3: 24.3%, p = 0.83). Conclusions: In non-critical hospitalized patients with COVID-19 pneumonia, neither ivermectin nor hydroxychloroquine decreases the number of in-hospital days, respiratory deterioration, or deaths.

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BACKGROUND The lethality rate of COVID-19 in Mexico is one of the highest worldwide, but in-hospital factors associated with this increased rate have yet to be explored. This study aims to evaluate those factors that could be associated with mortality at 28 days in critically ill COVID-19 patients in Mexico. METHODS This is a retrospective post hoc analysis of the clinical trial (NCT04381858) comparing the safety and efficacy of administering convalescent plasma from COVID-19 patients or human immunoglobulin. The primary outcome, death at 28 days, was analyzed. Results Between May and October 2020, 196 predominantly male patients (n=122, 62.2%) with an average of 58.1 years (plus-or-minus sign 15.5), were included in the cohort. Mortality at 28 days was 44.3 % (n = 84). Patients included in the second trimester had a greater mortality rate when compared with those recruited in the first trimester (54.1 vs 32.1, p < 0.01). On multivariate analysis, the detected protective factors were the use of fentanyl HR 0.51 (95%CI 0.31 - 0.85, p=0.01), the use of antibiotics HR 0.22 (95% CI 0.13 - 0.36, p < 0.01), and a previously healthy state (no comorbidities other than obesity) HR 0.58 (95%CI 0.35 - 0.94, p = 0.03); risk factors were severe kidney injury (AKIN3) HR 1.74 (95%CI 1.04 - 2.9, p=0.035), elevated D-Dimer levels HR 1.02 (95%CI 1.007 - 1.04, p=0.005), shock OR 5.8 (2.4 - 13.8, p < 0.01), and recruitment in the second trimester OR 2.3 (95%CI 1.1 - 4.8, p=0.02). Conclusion In-hospital mortality in critically ill COVID-19 patients has increased in our center. The appropriate use of antibiotics, the type of sedation, and AKIN3 are modifiable factors directly related to this increased mortality. The increase in mortality observed in the second trimester is explained by hospital overcrowding that began in August 2020.

Introducción: Las infecciones asociadas con un implante ortopédico son un desafío poco frecuente pero grave en la práctica ortopédica diaria, ocasionando discapacidad prolongada, pérdida de bienestar y alto costo de atención. Es necesario conocer integralmente la patología para prevenirla adecuadamente, optimizar el diagnóstico y el tratamiento médico y quirúrgico. Objetivo: Identificar las características de presentación y evolución clínica de los pacientes con diagnóstico de infección asociada a implante ortopédico en el período mayo-octubre 2018. Material y métodos: estudio retrospectivo de serie de casos. Se revisaron los expedientes de pacientes diagnosticados con infección asociada a implante ortopédico en el período mayo-octubre de 2018, obteniendo los datos demográficos, presentación y evolución de cada paciente. Resultados: Se incluyeron cinco pacientes, edad media 67 años, tres del sexo femenino, cuatro con el antecedente de osteosíntesis y uno de cura de pseudoartrosis aséptica, el principal motivo de consulta fue dolor intenso y exudado de la herida, con presentación temprana en cuatro pacientes y mediata en una paciente, en cuatro casos se aisló microorganismo patógeno, evolucionando a la defunción tres pacientes y a la curación dos pacientes. Conclusiones: Este trabajo describe las características clínicas de un grupo de pacientes con infección asociada a implante ortopédico, y aunque se trata de una muestra pequeña, parece mostrar comportamiento clínico similar a los de los pacientes occidentales de series mayores descritas en otros países. LUXMÉDICA, AÑO 14, NÚMERO 41, MAYO-AGOSTO 2019, PP 59-66.