Treatment with Hydroxychloroquine vs Hydroxychloroquine + Nitazoxanide in COVID-19 patients with risk factors for poor prognosis: A structured summary of a study protocol for a randomised controlled trial.

Objectives: To determine the efficacy of Hydroxychloroquine vs. Hydroxychloroquine + Nitazoxanide in reducing the need for invasive mechanical ventilatory support for patients with COVID-19. Hydroxychloroquine is currently being used in multiple trials with varying doses in an attempt to treat COVID-19. Nitazoxanide has powerful antiviral effects and proven efficacy against a range of viruses including SARS and MERS. Dual therapy by combining appropriate doses of these two medications with diverse activities against COVID-19 is expected to be better than monotherapy with hydroxychloroquine. Trial design: This is a single centre, randomized, controlled, single blinded, 2 arm (ratio 1:1) parallel group trial

Complications in pregnant women with autoimmune diseases

BACKGROUND: Autoimmune diseases complicate pregnancy in several manners. This study aimed at describing the most common complications in pregnant women with autoimmune diseases. METHODS: This was a descriptive and retrospective study. Two groups of pregnant women with autoimmune diseases were included: 1) Those who since the beginning of gestation received obstetrical care at a tertiary-level hospital and 2) Women who were treated first in a medical unit not specialized in rheumatological diseases. Odds ratio, logistic regression and multinomial logistic regression were used to determine risk of complicated pregnancy. RESULTS: The distribution of autoimmune diseases in our sample is as follows: systemic lupus erythematosus (SLE): 6, rheumatoid arthritis (RA): 4, primary anti-phospholipid syndrome (APS): 4, systemic sclerosis (SS): 2, mixed connective tissue disease (MCTD): 1. Eight patients were seen throughout their gestation at a tertiary-level hospital and nine were referred from other non-specialized hospitals. Patients in the first group had four complications, and those of the second group, 28. The Odds Ratio (OR) of having a complication in the hospitals of reference compared to the “Mónica Pretelini Sáenz” Maternal-Perinatal Hospital (HMPMPS) was of 29.8 (95% CI: 1.29-692.46; Z statistic 2.11, p = 0.03). In relation to the logistic regression, this test was not significant neither for the group nor the treatment scheme for the presence of at least one complication. The multinomial logistic regression did not show significant predictive probabilities of the different possible outcomes for the group and drug treatment scheme. CONCLUSION: Pregnant women with autoimmune diseases can have an OR up to 29.8 to develop complications when they are not cared for by specialized personnel

COVID-19 lung lesion treated with pirfenidone and effective rehabilitation: A Case Report

SARS-CoV-2 leads to an inflammatory and fibrotic state in the lungs which can be the cause of death and even in those who survive cause a functional limitation. A male patient of 28 years with COVID-19 was treated with nitazoxanide 500 mg 6 hourly, ibuprofen 500 mg 8 hourly, levofloxacin 500 mg and vitamin D 4,000 IU 24 hourly, and pirfenidone (K-LP) 1,200 mg 12 hourly. The patient was ventilated and extubated after 13 days in the intensive care unit. He was then immersed in a strict rehabilitation programme based on re-teaching the diaphragmatic respiratory pattern. Pirfenidone at a dose of 1,200 mg twice a day could be considered as a valid option to reduce lung fibrosis caused by the SARS-CoV-2 virus. To ensure optimal recovery, pulmonary rehabilitation therapy should be added to the management

Phototherapy induces an improvement in clinical and biochemical scores in rheumatoid arthritis

Objective: Rheumatoid arthritis is a common autoimmune disease for which there is no known cure. Ultraviolet light can induce immunosuppressive effects. Our main objective was to ascertain whether a complementary treatment with phototherapy improves changes in functional scales in patients with rheumatoid arthritis. Methods: Seven women with rheumatoid arthritis were enrolled for this study and submitted to phototherapy sessions with a 425 to 650 nm lamp. Results: The Karnofsky scale changed from requiring frequent medical care to being capable of normal activity with few symptoms or signs of disease (p = 0.018), the RaQol questionnaire decreased abruptly from 29 to zero points (p = 0.018), the Steinbrocker Functional Capacity Rating changed from limited to little or none of the duties of usual occupation or self-care to complete ability to carry out all the usual duties without handicaps (p = 0.017). The pain was remitted after the treatment period. The acute inflammation variables showed a significant decrease after the indicated sessions, C-reactive protein (p = 0.042), erythrocyte sedimentation rate (p = 0.018). Conclusion: The evaluated scales clearly show a benefit with the phototherapy in rheumatoid arthritis patients. Thus, phototherapy seems to be a plausible complementary option to reduce the symptoms in rheumatoid arthritis

Ankylosing Spondylitis Treated with Phototherapy

Ankylosing spondylitis is a chronic rheumatic disease that affects the spine and sacroiliac joints, causing pain and inflammation. We presented a case of a 61 years old male with ankylosing spondylitis that, despite being receiving Nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics and prednisone showed clinical deterioration. The patient received phototherapy within a range from 425 to 650 nm and a cytokine profile was measured at previous to the therapy and after 48 sessions. The clinical improvement was evident with pain remission and mobility recovery, as well as reduction in the proinflammatory cytokine profile

Evolution of COVID-19 pregnancies treated with nitazoxanide in a third-level hospital.

Background Nitazoxanide shows adequate in vitro activity against coronavirus. The aim of this study was to describe the behavior of coronavirus disease 2019 (COVID-19) in pregnant women treated with nitazoxanide. Methodology This cross-sectional study included the files of COVID-19 positive pregnant women treated with nitazoxanide 500 mg every 6 hours, levofloxacin every 12 hours, and clarithromycin 500 mg every 12 hours. Results The data of 51 women (mean age: 27.4 ± 7.2 years) were analyzed. Eleven (21.56%) patients had to receive medical attention in the intensive care unit. There were 22 (43.13%) preterm deliveries, 21 by cesarean and one by vaginal delivery. The medical attention of this population was as follows: 31 cesareans, five vaginal deliveries, nine still pregnant, two requiring manual vacuum aspiration, two ectopic pregnancies, one requiring curettage, and one requiring hysterotomy. There were seven (13.72%) cases of preeclampsia, and there were two (3.92%) deaths. Conclusion Nitazoxanide prescription could be an option against COVID-19 in pregnancy due to its safety profile

Nitazoxanide as an early treatment to reduce the intensity of COVID‑19 outbreaks among health personnel

The use of nitazoxanide has previously yielded successful results in vitro against the coronavirus. The aim of the present study was to examine the efficacy of the use of nitazoxanide at an early stage among healthcare workers exhibiting symptoms of COVID‑19. This was a prospective study carried out in 2020. Healthcare personnel who presented with COVID‑19 symptoms, in different 3 hospitals were invited to take Paramix (nitazoxanide), 500 mg orally, every 6 h for 2 days and then 500 mg twice a day for 4 days. To compare the hospitalization percentage, a group of healthcare workers with a respiratory viral infection without COVID‑19 criteria were also followed‑up. Over a period of 3 months, 150 healthcare workers (111 women and 39 men) presented respiratory symptoms with COVID‑19 criteria (mean age, 36±10.6 years; range, 18‑68 years). Only one female medical doctor, one nurse and one male from the auxiliary services had to be hospitalized and one death was registered It was thus concluded that nitazoxanide yielded successful results in vitro against previous coronavirus and may prove to be useful against SARS‑CoV‑2 as an early intervention to avoid complications, decreasing the expected number of hospitalizations among infected healthcare workers.Liomont Laboratories S.A. de C.V. kindly provided the drug Paramix (nitazoxanide

Hacia un estilo de nutrición saludable

PublishedEn la región de las Américas las enfermedades no transmisibles causaron en el 2010 el 77% del total de defunciones y en el año 2016 un 81%; esta cifra aumentará en los próximos decenios como consecuencia del crecimiento y envejecimiento de la población, la urbanización y la exposición de factores de riesgo (1). Entre los riesgos para enfermedades cardiovasculares se encuentran: altos niveles de colesterol total, LDL elevado, incremento en los triglicéridos, disminución de los niveles de HDL, índice de masa corporal (IMC) elevado, alteración en la presión arterial, sedentarismo, una dieta aterogénica y tabaquismo (2). En Colombia estos factores de riesgo se pueden evidenciar en un estudio en pacientes con enfermedad cardiovascular donde el 55.5% tenía dislipidemia, el 78.6% hipertensión arterial y 9.54% obesidad (3)

Trends of inflammatory markers and cytokines after one month of phototherapy in patients with rheumatoid arthritis

Objective. to evaluate changes in the expression of tumor necrosis factor-α in patients with rheumatoid arthritis submitted to phototherapy. Materials and methods. This was an open label study, enrolling ten patients. The phototherapy scheme within a range of 425 to 650 nm, 11.33 Joules/cm2, 30 cm above the chest was as follows: a) 45-min daily sessions from Monday to Friday for 2 to 3 months; b) three, 45-min weekly sessions for 1 to 2 months; c) twice weekly 45-min sessions for 1 to 2 months, and d) one weekly session for 1 to 2 months until completion. Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor were measured in peripheral blood and tumor necrosis factor-α, interleukin-1β, and interleukin-10 in leukocytes by quantitative real-time Reverse transcriptase-Polymerase chain reaction. In all the patients the next indexes: Karnofsky scale, Rheumatoid Arthritis-specific quality of life instrument, Steinbrocker Functional Capacity Rating and the Visual Analog Scale were evaluated. Results. Erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor declined notoriously after the indicated sessions. In gene expression, there was a tendency in tumor necrosis factor-α to decrease after 1 month, from 24.5±11.4 to 18±9.2 relative units, without reaching a significant statistical difference. The four tested indexes showed improvement. Conclusion. Phototherapy appears to be a plausible complementary option to reduce the inflammatory component in rheumatoid arthritis

Treatment with hydroxychloroquine vs nitazoxanide in patients with COVID-19. Brief report

Introduction: coronavirus pandemic has led to 1.8 million deaths worldwide as of May 1st, 2021. Nitazoxanide (NTZ) is currently being studied in several ambulatory clinical trials to control viral infections including SARS-CoV-2. This study evaluates the effect of treatment with NTZ compared to Hydroxychloroquine (HCQ) in hospitalized patients. Methods: in this clinical study performed from May to August 2020, two groups of COVID-19 patients were compared: A) a control group treated with HCQ 200 mg PO twice a day for seven days and B) an experimental group treated with NTZ 500 mg PO every 6 hours for seven days. Student's t-test between the two groups and Relative Risk (RR) with a 95% confidence interval (CI), were calculated. In all cases a P<0.05 was considered statistically significant. Results: twenty-seven (27) patients (females 17, males 10) treated with HCQ and 17 patients (females 8, males 9) administered NTZ were included in the study (mean age 44.6 ± 14.4 years old). At the moment of hospital admission, the following variables were statistically significant: BMI (P=0.0225) and leucocyte counts (P=0.069). In the follow-up period, the statistically significant variables were hospital length of stay (P=0.003257) and Intensive Care Units (ICU) admission with a lower RR in the group taking NTZ vs HCQ of 0.4074 (95% CI: 0.2451 to 0.5927, attributable risk (P1 - P2): 0.5926, P≤0.0001, NNT: 1.688). Conclusion: in comparison to HCQ, NTZ significantly reduces the risk to be hospitalized in the ICU and this approach could be replicated easily in any hospital