No abstract

Ivermectin inhibits the replication of SARS-CoV-2 in vitro at concentrations not readily achievable with currently approved doses. There is limited evidence to support its clinical use in COVID-19 patients. We conducted a Pilot, randomized, double-blind, placebo-controlled trial to determine the efficacy of a single dose of ivermectin to reduce the proportion of PCR positives, viral load at day 7 post treatment.Consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mild COVID-19 (no pneumonia) and no risk factors for complicated disease attending the emergency room of the Clínica Universidad de Navarra. Patients were randomized 1:1 to receive ivermectin, 400 mcg/kg, single dose (n = 12) or placebo (n = 12). The primary outcome measure was the proportion of patients with detectable SARS-CoV-2 RNA by PCR from nasopharyngeal swab at day 7 post-treatment. The primary outcome was supported by determination of the viral load and infectivity of each sample. The differences between ivermectin and placebo were calculated using Fisher’s exact test and presented as a relative risk ratio.All patients recruited completed the trial (median age, 26 [range, 18-54] years; 12 [50%] women; 100% had symptoms at recruitment, 70% reported headache, 62% reported fever, 50% reported general malaise and 25% reported cough). At day 7, there was no difference in the proportion of PCR positive patients (RR 0.92, 95% CI: 0.77-1.09, p = 1.0). The ivermectin group had lower median viral loads at days 4 and 7 post treatment as well as lower median IgG titers at day 21 post treatment. Hyposmia/anosmia (76 vs 158 patient-days) and cough (68 vs 97 patient-days) were less frequent in the ivermectin group.Among patients with mild COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 48 hours of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials.Trial registration ClinicalTrials.gov Identifier: NCT04390022 https://clinicaltrials.gov/ct2/show/NCT04390022

BackgroundThe term ‘triple whammy’ (TW) refers to the risk of acute kidney injury when an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARA) is combined with a diuretic and non-steroidal anti-inflammatory drugs (NSAID). Different mechanisms are probably involved; ACEIs and NSAIDs adversely affect renal blood flow and diuretics have the potential to cause dehydration. Further, NSAIDs antagonise the beneficial antihypertensive effects of ACEIs and diuretics in patients with heart failure. There are also a number of commonly used medicines that can impair renal function, for example digoxinPurposeTo evaluate the frequency of TW in patients with therapeutic drug monitoring (TDM) of digoxin and the possibility of developing renal disorders and to analyse the acceptability of clinical pharmacist interventions.Material and methodsProspective observational study of non-hospitalised patients with any TDM for digoxin. A review of pharmacotherapeutic treatment, serum creatinine (Cr) and serum digoxin concentrations (SDCs) obtained in routine digoxin monitoring was performed between September and October 2014. Pharmacist interventions were performed when TW was detected and doctors were informed about this interaction. The following variables were recorded: demographics (age and gender) and evolution of renal function (Cr).Results90 patients were studied (68.9% women and 31.1% men, average age 81 ± 10.1 years and average serum creatinine 1.07 mg/dL). TW was observed in 16 patients (17.8%) with 2 TW patients with acute renal failure who were hospitalised (creatinine concentrations were 3.75 mg/dL and 2.07 mg/dL, respectively).6 of 16 pharmacist interventions performed were approved: 4 NSAIDs were switched to paracetamol, 1 changed treatment from ARA II to calcium channel blockers and 1 diuretic was withdrawn.Average TDM was 0.95 ng/mL (0.19–3.61 ng/mL). No significant differences existed between TW patients and the rest of the patients.ConclusionTW is a well known interaction and it is documented in the retrieved bibliography. Nonetheless, this association appears frequently in chronic treatments and therefore it is necessary to implement processes with the aim of avoiding TW potential problems. Routine TDM of digoxin may be a tool to detect potential drug related problems as TW associated.This differentiated pharmaceutical intervention contributed to improved health outcomes and strengthened the regulatory framework in multidisciplinary health teams.No conflict of interest.

The control of humidity between certain limits is essential to avoid the alteration of historical objects, such as unstable historical glasses. However, the usual limits can be altered due to the presence of volatile organic compounds. This work presents the results of the exposure of soda, potash, and mixed‐alkali silicate glasses to neutral and acidic (formic) atmospheres with ∼30, ∼70, and ∼100% relative humidity. The hygroscopic capacity of the glass was analyzed by gravimetry, and the surface alteration was evaluated by infrared spectroscopy, optical microscopy, and ion chromatography.In all glasses, the alteration begins with alkali ions' lixiviation followed by the silica network's hydrolytic attack. The results showed that soda and mixed‐alkali silicate glasses exhibit similar behavior, while the potash‐lime one experienced the fastest degradation due to its composition. Results also confirmed that high humidity increased the alteration rate causing a higher hygroscopicity and reactivity of glasses. Finally, acidic environments promoted the ion‐exchange reaction at high humidity, accelerating the lixiviation of alkaline ions and promoting the diffusion of water into the glass network.This article is protected by copyright. All rights reserved