Background The use of rosuvastatin plus colchicine and emtricitabine/tenofovir in hospitalized patients with SARS-CoV-2 disease (COVID-19) has not been assessed. The objective of this study was to assess the effectiveness and safety of rosuvastatin plus colchicine, emtricitabine/tenofovir, and their combined use in these patients. Methods This was a randomized, controlled, open-label, multicentre, parallel, pragmatic study conducted in six referral hospitals in Bogotá, Colombia. The study enrolled hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 complicated with pneumonia, not on chronic treatment with the study medications, and with no contraindications for their use. Patients were assigned 1:1:1:1. 1) emtricitabine with tenofovir disoproxil fumarate (FTC/TDF, 200/300 mg given orally for 10 days); 2) colchicine plus rosuvastatin (COLCH+ROSU, 0.5 mg and 40 mg given orally for 14 days); 3) emtricitabine with tenofovir disoproxil plus colchicine and rosuvastatin at the same doses and for the same period of time (FTC/TDF+COLCH+ROSU); or 4) the Colombian consensus standard of care, including a corticosteroid (SOC). The primary endpoint was 28-day all-cause mortality. A modified intention-to-treat analysis was used together with a usefulness analysis to determine which could be the best treatment. The trial was registered at ClinicalTrials.gov: NCT04359095 Findings Out of 994 candidates considered between August 2020 and March 2021, 649 (65.3%) patients agreed to participate and were enrolled in this study; among them, 633 (97.5%) were included in the analysis. The mean age was 55.4 years (SD ± 12.8 years), and 428 (68%) were men; 28-day mortality was significantly lower in the FTC/TDF+COLCH+ROSUV group than in the SOC group, 10.7% (17/159) vs. 17.4% (28/161) (hazard ratio [HR] 0.53; 95% CI 0.29 to 0.96). Mortality in the FTC/TDF group was 13.8% (22/160, HR 0.68, 95% CI 0.39 to 1.20) and 14.4% in the COLCH+ROSU group (22/153) (HR 0.78, 95% CI 0.44 to 1.36). A lower need for invasive mechanical ventilation was observed in the FTC/TDF+COLCH+ROSUV group than in the SOC group (risk difference [RD] - 0.08, 95% CI 0.11 to 0.04). Three patients presented severe adverse events, one severe diarrhoea in the COLCH+ROSU and one in the FTC/TDF+COLCH+ROSU group and one general exanthema in the FTC/TDF group. Interpretation The combined use of FTC/TDF+COLCH+ROSU reduces the risk of 28-day mortality and the need for invasive mechanical ventilation in hospitalized patients with pulmonary compromise from COVID-19. More randomized controlled trials are needed to compare the effectiveness and cost of treatment with this combination versus other drugs that have been shown to reduce mortality from SARS-CoV-2 infection and its usefulness in patients with chronic statin use.

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Purpose: The location of actors and production, transformation, commercialization and distribution facilities generate the configuration of the perishable food supply chain (PFSC). The logistics network design (LND) lead to different supply, storage and distribution environments and result in flows, these logistics operations have an impact on the performance of the chain of fresh agricultural products. Specifically, in the PFSC with seasonality, a temporary imbalance between supply and demand is generated, which affects the balance in the flows and affects the losses, costs and response capacity. This research study that problem.Design/methodology/approach: A multi-echelon, multi-objective and multi-product model is established that determines the configuration of the logistics network of the PFSC with seasonally and allows actors to approach efficiency frontiers, which contribute to their permanence in the markets. The model was applied to the case of the perishable fruit supply chain, in a developing country, Colombia. The population information was taken from government surveys and studies, which allowed parameterizing the model.Findings: The application of model permitted to answer the next questions: How does improve the performance from PFSC through logistics network design? And, How the existence of smallholdings in food production and from retail merchants is preserved? In the perishable food supply chain.Social implications: Where the perishable food supply chain actors are located in non-efficient borders and their sustainability may be affected by competition factors, the stakeholders should focus on increasing food availability and reducing losses to improve access and therefore food security.Originality/value: A new model for the logistics network configurations of seasonal perishable fruit supply chain was development, the optimizing from five objectives with two sub-models is obtained, one for surplus and the other for the deficit moments. The model includes real conditions, such as, fruit loss due T0 and RH by different thermal floors and the means used for the transport of fruits in mountain areas at countries in route of development. The impact over the small producers, retailers and consumers in the times of scarcity or surplus was analyzed.

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The evaluation of the strategic supply chain configuration is considered one of the strategic logistics decisions, especially in food assistance supply chains focused on generating better nutritional conditions in vulnerable populations. In Colombia, there is a social program called Bienestarina, which aims to promote food and nutritional security in a vulnerable population. Although the government supports the program for improving nutritional support, there are currently inconsistencies in freight flows, lack of coverage in some areas, and delivery delays. Therefore, this work aims to evaluate the current configuration of the supply chain and propose improvements related to the facility location. Such advances would enable the increase in the efficacy of the network and the reduction of malnutrition in the country. For this purpose, a mixed-integer mathematical programming model is presented, which considers the weighted distance criterion for different demand scenarios and supports the location-allocation decision in a social assistance supply chain. The current network configuration was compared with the optimal proposed structure. The comparisons show highly potential improvements in freight flow allocation, suggests several variations in the existing warehouses emplacement, and generates public policy implications to reduce the logistic cost in the system, prioritizing in turn the demand covering.