Hydroxychloroquine in COVID-19 Patients: Pros and Cons

Younis, Nour K.; Zareef, Rana; Hassan, Sally N. Al; Bitar, Fadi; Eid, Ali H.; Arabi, Mariam

doi:10.3389/fphar.2020.597985

Cited by 25 publications

(28 citation statements)

References 106 publications

(284 reference statements)

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“…During this time, thanks to lock-down measures, the contagion curve progressively decreased and enrolment was mainly carried out throughout the second Italian wave of COVID-19 pandemics (September and October 2020). This had major consequences on the best available therapy due to the controversies relatively to HCQ use [36] when steroid therapy was confirmed to be effective, according to this the attending physicians started steroids in case of clinical deterioration, more frequent in SOC arm [26] , [27] . These conditions had consequences on the full comparability of the two study arms and may have masked the positive effect of O 3 -AHT yielding partially discordant results with the other case-control studies.…”

Section: Discussionmentioning

confidence: 99%

CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial

Sozio¹,

Monte

Sermann

et al. 2021

International Immunopharmacology

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Background Following positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR randomized trial was designed to evaluate the adjuvant role of oxygen/ozone therapy in mild to moderate SARS-CoV-2 pneumonia. Methods The trial (ClinicalTrial.gov NCT04388514) was conducted in four different Italian centers (April-October 2020). Patients were treated according to best available standard of care (SoC) therapy, with or without O3-autohemotherapy (O3-AHT). Results A total of 92 patients were enrolled: SoC + O3-AHT (48 patients) were compared to the SoC treatment (44 patients). The two groups differed in steroids therapy administration (72.7% in SoC arm vs. 50.0% in O3-AHT arm; p= 0.044). Steroid therapy was routinely started when it was subsequently deemed as effective for the treatment of COVID-19 disease. No significant differences in mortality rates, length of hospital stay, mechanical ventilation requirement and ICU admission were observed. Clinical improvement in patients with pneumonia was assessed according to a specifically designed score (decrease in SIMEU class, improvement in radiology imaging, improvement in PaO2/FiO2, reduction in LDH and requirement of oxygen therapy ≤5 days). Score assessment was performed on day-3 (T3) and day-7 (TEnd) of O3-AHT treatment. A significant increase in the score was reported at TEnd, in the O3-AHT treatment arm (0 [0-1] in the SoC arm vs. 2 [1] , [2] , [3] the O3-AHT arm; p= 0.018). No adverse events related O3-AHT treatment was observed. Conclusion In mild-to-moderate pneumonia due to SARS-CoV-2, adjuvant oxygen/ozone therapy did not show any effect on mortality, or mechanical intubation but show a clinical improvement a day 7 from randomization in a composite clinical endpoint. Larger Randomized prospective studies alone or in combination with steroids are needed to confirm our results.

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Section: Discussionmentioning

confidence: 99%

CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial

Sozio¹,

Monte

Sermann

et al. 2021

International Immunopharmacology

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“…By early May 2020, the virus had already reached over 200 countries worldwide afflicting at least 4 million victims. As of February 10, 2021, there have been more than 106 million confirmed cases of COVID-19 and more than 2 million deaths around the globe [3,4].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Manifestations in COVID-19 Patients: A Focus on the Pediatric Population

Nassif

Fakhri

Younis

et al. 2021

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Background. SARS-CoV-2 is a new strain of the coronavirus family that emerged by the end of 2019 and led to the unpreceded COVID-19 pandemic. The virus affects multiple organs simultaneously and leads to a high rate of morbidity and mortality in all age groups. The cardiovascular system is one of the major affected organ systems. Various mechanisms including direct myocardial injury contribute to the cardiac manifestations of COVID-19 patients. Methods. We performed a comprehensive and updated search on the cardiac manifestations of COVID-19. Our search included laboratory and imaging evaluations. In addition, we added a unique section on the effect of SARS-CoV-2 on the cardiovascular system in the pediatric population. Results. COVID-19 might have an effect on the cardiovascular system at various levels leading to myocardial ischemia, arrhythmia, heart failure, myocarditis, and multisystem inflammatory syndrome in children. The incidence of cardiovascular complications varies among patients. This paper also provides a comprehensive summary of all the reported pediatric cases with cardiac manifestations. Conclusion. Multidisciplinary teams are crucial for adequate management of patients with COVID-19 regardless of age. Timely diagnosis is critical in reducing mortality.

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“…Summary of proposed COVID-19 therapies and their potential cardiovascular complications[8,57,[60][61][62][63][64][65][66].…”

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confidence: 99%

COVID-19-Associated Cardiovascular Complications

et al. 2021

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Coronavirus disease 2019 (COVID-19) has been reported to cause cardiovascular complications such as myocardial injury, thromboembolic events, arrhythmia, and heart failure. Multiple mechanisms—some overlapping, notably the role of inflammation and IL-6—potentially underlie these complications. The reported cardiac injury may be a result of direct viral invasion of cardiomyocytes with consequent unopposed effects of angiotensin II, increased metabolic demand, immune activation, or microvascular dysfunction. Thromboembolic events have been widely reported in both the venous and arterial systems that have attracted intense interest in the underlying mechanisms. These could potentially be due to endothelial dysfunction secondary to direct viral invasion or inflammation. Additionally, thromboembolic events may also be a consequence of an attempt by the immune system to contain the infection through immunothrombosis and neutrophil extracellular traps. Cardiac arrhythmias have also been reported with a wide range of implicated contributory factors, ranging from direct viral myocardial injury, as well as other factors, including at-risk individuals with underlying inherited arrhythmia syndromes. Heart failure may also occur as a progression from cardiac injury, precipitation secondary to the initiation or withdrawal of certain drugs, or the accumulation of des-Arg9-bradykinin (DABK) with excessive induction of pro-inflammatory G protein coupled receptor B1 (BK1). The presenting cardiovascular symptoms include chest pain, dyspnoea, and palpitations. There is currently intense interest in vaccine-induced thrombosis and in the treatment of Long COVID since many patients who have survived COVID-19 describe persisting health problems. This review will summarise the proposed physiological mechanisms of COVID-19-associated cardiovascular complications.

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Hydroxychloroquine in COVID-19 Patients: Pros and Cons

Cited by 25 publications

References 106 publications

CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial

CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial

Cardiac Manifestations in COVID-19 Patients: A Focus on the Pediatric Population

COVID-19-Associated Cardiovascular Complications

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