The COVID-19 pandemic: is our medicine still evidence-based?

Deana, Cristian

doi:10.1007/s11845-020-02258-8

Cited by 14 publications

(13 citation statements)

References 3 publications

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“…It is essential for clinicians in the front lines and public health decision makers to use the best available evidence for effective management of COVID-19 [6,7]. The hectic, rapidly changing, and labor-intensive environment in COVID-19 pandemic might hinder clinicians' ability to follow updated literature and/or to critically appraise the manuscripts they read.…”

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confidence: 99%

A novel approach to managing COVID-19 patients; results of lopinavir plus doxycycline cohort

Çakır

2021

Eur J Clin Microbiol Infect Dis

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Cag et al. have recently published their work entitled "A novel approach to managing COVID-19 patients; results of lopinavir plus doxycycline cohort." We congratulate the authors for their precious efforts in handling COVID-19 patients working on a step-wise approach for the best benefit of the patients, while minimizing the hospital's workload. Given the absence of any specific treatment for COVID-19, various drug combinations have been in use in several countries, and any successful regimen/algorithm is of interest to clinicians worldwide. Unfortunately, the majority of treatment-related studies published so far are observational in nature, with potential for selection and information biases; confounding control is often insufficient due to missing data on several variables of interest; and inadequate discussion of intrinsic limitations of the studies may evoke confusion among clinicians. In this respect, the manuscript needs clarification on some issues and opens a floor for discussion on the context, effectiveness, and safety of home-based treatment for COVID-19 [1].The title and the conclusion mainly focus on the results of a unique combination of lopinavir and doxycycline use in 161 PCR-positive hospitalized COVID-19 cases. We understand on reading that these 161 were members of a subgroup of 2043 "suspected" COVID-19 patients admitted to the emergency department of a specific hospital. The authors conducted a 3-step management plan for all 2043 (only 475 were positive in molecular tests) with doxycycline in different comb i n a t i o n s : t h o s e i s o l a t e d a t h o m e w e r e g i v e n hydroxychloroquine plus doxycycline for 3-5 days, moderate-to-severe cases were hospitalized and treated with lopinavir plus doxycycline plus ceftriaxone for 5 days, and favipiravir was added for salvage therapy. The authors concluded that "home isolation of mild cases is an effective means * Banu Cakir

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confidence: 99%

A novel approach to managing COVID-19 patients; results of lopinavir plus doxycycline cohort

Çakır

2021

Eur J Clin Microbiol Infect Dis

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“…The above findings can be explained, only partially, by the small sample size. In fact, ECMO is a dynamic process and so are the changes in pulmonary and cardiovascular systems during COVID-19 [40]. Further studies with larger cohorts of patients are, thus, required to investigate this topic and identify the predictors for ECMO configuration changes.…”

Section: Discussionmentioning

confidence: 99%

Transition from Simple V-V to V-A and Hybrid ECMO Configurations in COVID-19 ARDS

et al. 2021

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In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine (p = 0.007) and a shorter ICU duration (p = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank p = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.

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“…The COVID-19 pandemic raises important questions regarding the treatment of coronaviruses. To the best of our knowledge, no single drug has been demonstrated to be effective in critically ill patients, and more evidence is required [ 6 , 7 ]. Many drugs and treatments (e.g.…”

Section: Discussionmentioning

confidence: 99%