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Hydroxychloriquine - HCQ

Published: 2021
SYNOPSIS

The COVID-19 pandemic caused increased mortality in nursing homes due to its quick spread and the age-related high lethality.

TITLE

Mortality in an Italian nursing home during COVID-19 pandemic: correlation with gender, age, ADL, vitamin D supplementation, and limitations of the diagnostic tests

CITATION

Cangiano, B., Fatti, L. M., Danesi, L., Gazzano, G., Croci, M., Vitale, G., Gilardini, L., Bonadonna, S., Chiodini, I., Caparello, C. F., Conti, A., Persani, L., Stramba-Badiale, M., & Bonomi, M. (2020). Mortality in an Italian nursing home during COVID-19 pandemic: correlation with gender, age, ADL, vitamin D supplementation, and limitations of the diagnostic tests. Aging, 12(24), 24522–24534. https://doi.org/10.18632/aging.202307

SUMMARY

Results: We observed two-month mortality of 40%, compared to 6.4% in the previous year. This increase was seen in both COVID-19 positive (43%) and negative (24%) residents, but 8 patients among those testing negative on the swab, tested positive on serological tests. Increased mortality was associated with male gender, older age, no previous vitamin D supplementation, and worse “activities of daily living (ADL)” scores, such as Barthel index, Tinetti scale, and S.OS.I.A. classification.

Conclusion: Our data confirm a higher geriatric mortality due to COVID-19. Negative residents also had higher mortality, which we suspect is secondary to preanalytical error and low sensitivity of the swab test in poorly compliant subjects. Male gender, older age, and low scores on ADL scales (probably due to immobility) are risk factors for COVID-19 related mortality. Finally, mortality was inversely associated with vitamin D supplementation.

Design: In this observational study, we described the two-month mortality among the 157 residents (age 60-100) of a nursing home after Sars-CoV-2 spreading, reporting the factors associated with the outcome. We also compared the diagnostic tests for Sars-CoV-2.

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TAGS
Published: 2021
SYNOPSIS

The high proportion of asymptomatic COVID-19 patients and independent factors for mortality suggest that early diagnosis and treatment of COVID-19 patients in LTCFs may be effective in saving lives.

TITLE

Pattern of SARS-CoV-2 infection among dependent elderly residents living in long-term care facilities in Marseille, France, March–June 2020

CITATION

Ly, T., Zanini, D., Laforge, V., Arlotto, S., Gentile, S., Mendizabal, H., Finaud, M., Morel, D., Quenette, O., Malfuson-Clot-Faybesse, P., Midejean, A., Le-Dinh, P., Daher, G., Labarriere, B., Morel-Roux, A. M., Coquet, A., Augier, P., Parola, P., Chabriere, E., Raoult, D., … Gautret, P. (2020). Pattern of SARS-CoV-2 infection among dependant elderly residents living in long-term care facilities in Marseille, France, March-June 2020. International journal of antimicrobial agents, 56(6), 106219. https://doi.org/10.1016/j.ijantimicag.2020.106219

SUMMARY

Objectives: This study aimed to report the results of SARS-CoV-2 PCR-based screening campaigns conducted on dependent elderly residents (compared with staff members) in long-term care facilities (LTCFs) in Marseille, France, and the follow-up of positive cases.

Methods: Data from 1691 elderly residents and 1000 members of staff were retrospectively collected through interviewing the medical teams in 24 LTCFs and using the hospitals’ electronic health record systems.

Results: Elderly residents were predominantly female (64.8%) with a mean age of 83.0 years. SARS-CoV-2 detection among residents (226, 13.4%) was significantly higher than among staff members (87, 8.7%) (P < 0.001). Of the 226 infected residents, 37 (16.4%) were detected on a case-by-case basis due to their COVID-19 symptoms and 189 (83.6%) were detected through mass screening. Most (77.0%) had possible COVID-19 symptoms, including respiratory symptoms and signs (44.5%) and fever (46.5%); 23.0% were asymptomatic. A total of 116 (51.4%) patients received a course of oral hydroxychloroquine and azithromycin (HCQ-AZM) for ≥ 3 days; 47 (20.8%) died. Through multivariate analysis, the death rate was positively associated with being male (30.7% vs. 14.0%, OR = 3.95, P = 0.002), aged > 85 years (26.1% vs. 15.6%, OR = 2.43, P = 0.041) and receiving oxygen therapy (39.0% vs. 12.9%, OR = 5.16, P < 0.001) and negatively associated with being diagnosed through mass screening (16.9% vs. 40.5%, OR = 0.20, P= 0.001) and receiving HCQ-AZM treatment ≥ 3 days (15.5% vs. 26.4%, OR = 0.37, P = 0.02).

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TAGS
Published: 2021
SYNOPSIS

The clinical experience of this case series indicates DOXY-HCQ treatment in high-risk COVID-19 patients is associated with a reduction in clinical recovery, decreased transfer to hospital, and decreased mortality were observed after treatment with DOXY-HCQ.

TITLE

Doxycycline and Hydroxychloroquine as Treatment for High-Risk COVID-19 Patients: Experience from Case Series of 54 Patients in Long-Term Care Facilities

CITATION

Imtiaz Ahmad, Mohammud Alam, Ryan Saadi, Saborny Mahmud, Emily Saadi. (2020). Doxycycline and Hydroxychloroquine as Treatment for High-Risk COVID-19 Patients: Experience from Case Series of 54 Patients in Long-Term Care Facilities, medRxiv: 20066902. doi: https://doi.org/10.1101/2020.05.18.20066902

SUMMARY

Importance: Patients in long-term care facilities (LTCF) are at a high risk of contracting COVID-19 due to advanced age and multiple comorbidities. Without effective treatments, outbreaks in such facilities will become commonplace and will result in severe morbidity and mortality. The effectiveness of doxycycline (DOXY) and hydroxychloroquine (HCQ) combination therapy in high-risk COVID-19 patients in long-term care facilities are not yet understood.

Objective: The goal of this analysis is to describe outcomes after the use of DOXY-HCQ combination in high-risk COVID-19 patients in LTCF.

Design: Case-series analysis.

Setting: Three (3) LTCFs in New York.

Participants: From March 19 to March 30, 2020, fifty-four (54) patients, residents of three (3) LTCFs in New York and diagnosed (confirmed or presumed) with COVID-19, were included in this analysis.

Exposure: All patients who were diagnosed (confirmed or presumed) with COVID-19 received DOXY-HCQ combination therapy along with the standard of care.

Main Outcomes and Measures: Patients characteristics, clinical recovery, radiological improvements, medication side-effects, hospital transfer, and death were assessed as outcome measures.

Results: A series of fifty-four (54) high-risk patients, who developed a sudden onset of fever, cough, and shortness of breath (SOB) and were diagnosed or presumed to have COVID-19, were started with a combination of DOXY-HCQ and 85% (n=46) patients showed clinical recovery defined as the resolution of fever and SOB, or a return to baseline setting if patients are ventilator-dependent. A total of 11% (n=6) patients were transferred to acute care hospitals due to clinical deterioration and 6% (n=3) patients died in the facilities. Naive Indirect Comparison suggests these data were significantly better outcomes than the data reported in MMWR (reported on March 26, 2020) from a long-term care facility in King County, Washington where 57% of patients were hospitalized, and 22% patients died.

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TAGS
Published: 2021
SYNOPSIS

Male gender, low Barthel index, and lymphocytopenia are independent risk factors for COVID-19 mortality in institutionalized older patients in long-term care nursing homes. Treatment with hydroxychloroquine and azithromycin was associated with lower mortality in these patients.

TITLE

COVID-19 mortality risk factors in older people in a long-term care center

CITATION

Heras E, Garibaldi P, Boix M, Valero O, Castillo J, Curbelo Y, Gonzalez E, Mendoza O, Anglada M, Miralles JC, Llull P, Llovera R, Piqué JM. (2021). COVID-19 mortality risk factors in older people in a long-term care center. Eur Geriatr Med. 12(3):601-607. doi: 10.1007/s41999-020-00432-w. Epub 2020 Nov 27. PMID: 33245505; PMCID: PMC7693854.

SUMMARY

Purpose: Despite high rates of COVID-19 infection and increased related mortality have been reported among older adults admitted in long-term care facilities, a limited amount of information is available about the natural course of this pandemic and prognostic factors in such population. In the current study, we aimed to investigate the epidemiologic, demographics, clinical, or therapeutic factors that may predict the prognosis in a cohort of COVID-19 infected institutionalized older in a nursing home.

Methods: We conducted a retrospective analysis of all COVID-19 confirmed institutionalized older in a nursing home from March 15 to June 5, 2020. Epidemiological, demographic, and frailty status before infection, and clinical, laboratory, treatment, and outcome data during infection were collected. We used bivariate analysis and multivariate logistic regression to identify risk factors for mortality.

Results: The analysis comprised all 100 COVID-19 confirmed cases during the study period. The median age was 85 years; 62% were female. The case fatality rate was 20%. In the bivariate analysis, male gender, fever, respiratory symptoms, severe cognitive decline, a low Barthel index, and lymphocytopenia were significantly associated with mortality. Patients treated with hydroxychloroquine plus azithromycin were related to a higher chance of survival than those without pharmacological treatment. Multivariate logistic regression analysis identified male gender, low Barthel index, no pharmacological treatment, and lymphocytopenia as independent risk factors associated with mortality.

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TAGS
Published: 2021
SYNOPSIS

A coordinated on-site MP of nursing homes with COVID-19 outbreaks achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.

TITLE

Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks

CITATION

M Bernabeu-Wittel, MD, PhD, J E Ternero-Vega, MD, M D Nieto-Martín, MD, PhD, L Moreno-Gaviño, MD, PhD, C Conde-Guzmán, MD, PhD, J Delgado-Cuesta, MD, PhD, M Rincón-Gómez, MD, PhD, P Díaz-Jiménez, MD, L Giménez-Miranda, MD, J M Lomas-Cabezas, MD, PhD, M M Muñoz-García, MD, S Calzón-Fernández, MD, PhD, M Ollero-Baturone, MD, PhD. (2021). Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks, The Journals of Gerontology: Series A, Volume 76, Issue 3, Pages e19–e27. https://doi.org/10.1093/gerona/glaa192. Epub ahead of print. PMID: 32738140; PMCID: PMC7454360.

SUMMARY

Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

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TAGS
Published: 2021
SYNOPSIS

Chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2 and reported to be efficient in Chinese COV-19 patients. We evaluate the effect of hydroxychloroquine on respiratory viral loads.

TITLE

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial

CITATION

Philippe Gautret, Jean-Christophe Lagier, Philippe Parola, Van Thuan Hoang, Line Meddeb, Morgane Mailhe, Barbara Doudier, Johan Courjon, Valérie Giordanengo, Vera Esteves Vieira, Hervé Tissot Dupont, Stéphane Honoré, Philippe Colson, Eric Chabrière, Bernard La Scola, Jean-Marc Rolain, Philippe Brouqui, Didier Raoult. (2020). Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, International Journal of Antimicrobial Agents, Volume 56, Issue 1, 105949. ISSN 0924-8579. https://doi.org/10.1016/j.ijantimicag.2020.105949. Epub 2020 Mar 20. PMID: 32205204; PMCID: PMC7102549.

SUMMARY

Patients and Methods
French Confirmed COVID-19 patients were included in a single-arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. The presence and absence of virus at Day6-post inclusion was considered the endpoint.

Results
Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms.

Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and a much lower average carrying duration than reported in the literature for untreated patients. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.

Conclusion
Despite its small sample size, our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.

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TAGS
Published: 2021
SYNOPSIS

This natural trial showed that the COVID-19 regimen containing both HCQ and azithromycin can be helpful to promote the recovery of most patients and reduced their signs and symptoms significantly.

TITLE

Assessment of COVID-19 Treatment containing both Hydroxychloroquine and Azithromycin: A natural clinical trial

CITATION

Abbas HM, Al-Jumaili AA, Nassir KF, Al-Obaidy MW, Al Jubouri AM, Dakhil BD, Abdulelah MM, Al Khames QA. (2021). Assessment of COVID-19 Treatment containing both Hydroxychloroquine and Azithromycin: A natural clinical trial. Int J Clin Pract. 75(4):e13856. doi: 10.1111/ijcp.13856. Epub 2020 Dec 5. PMID: 33231925; PMCID: PMC7744890.

SUMMARY

The goal of this study was to assess the clinical effectiveness and safety profile of the COVID-19 treatment protocol (containing both hydroxychloroquine (HCQ) and azithromycin) in an Iraqi specialised hospital.

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TAGS
Published: 2021
SYNOPSIS

We examined whether existing licensed pharmacotherapies could reduce the spread of coronavirus disease 2019 (COVID-19).

TITLE

Positive impact of oral hydroxychloroquine and povidone-iodine throat spray for COVID-19 prophylaxis: An open-label randomized trial

CITATION

Seet RCS, Quek AML, Ooi DSQ, et al.  Int J Infect Dis. 2021;106:314-322. doi:10.1016/j.ijid.2021.04.035 https://pubmed.ncbi.nlm.nih.gov/33864917/

SUMMARY

Chemoprophylaxis with either oral hydroxychloroquine or povidone-iodine throat spray was superior to oral vitamin C in reducing SARS-CoV-2 infection in young and healthy men.

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