BackgroundNitazoxanide exerts antiviral activity in vitro and in vivo and anti-inflammatory effects, but its impact on patients hospitalized with COVID-19 pneumonia is uncertain.MethodsA multicentre, randomized, double-blind, placebo-controlled trial was conducted in 19 hospitals in Brazil. Hospitalized adult patients requiring supplemental oxygen, with COVID-19 symptoms and a chest computed tomography scan suggestive of viral pneumonia or positive RT-PCR test for COVID-19 were enrolled. Patients were randomized 1:1 to receive nitazoxanide (500 mg) or placebo, 3 times daily, for 5 days, and were followed for 14 days. The primary outcome was intensive care unit admission due to the need for invasive mechanical ventilation. Secondary outcomes included clinical improvement, hospital discharge, oxygen requirements, death, and adverse events within 14 days.ResultsOf the 498 patients, 405 (202 in the nitazoxanide group and 203 in the placebo group) were included in the analyses. Admission to the intensive care unit did not differ between the groups (hazard ratio [95% confidence interval], 0.68 [0.38–1.20], p = 0.179); death rates also did not differ. Nitazoxanide improved the clinical outcome (2.75 [2.21–3.43], p < 0.0001), time to hospital discharge (1.37 [1.11–1.71], p = 0.005), and reduced oxygen requirements (0.77 [0.64–0.94], p = 0.011). C-reactive protein, D-dimer, and ferritin levels were lower in the nitazoxanide group than the placebo group on day 7. No serious adverse events were observed.ConclusionsNitazoxanide, compared with placebo, did not prevent admission to the intensive care unit for patients hospitalized with COVID-19 pneumonia.Clinical Trial RegistrationBrazilian Registry of Clinical Trials (REBEC) RBR88bs9x; ClinicalTrials.gov, NCT04561219.

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Protecting immunosuppressed patients during infectious disease outbreaks is crucial. During this novel coronavirus disease 2019 pandemic, preserving “clean areas” in hospitals assisting organ transplant recipients is key to protect them and to preserve transplantation activity. Evidence suggests that asymptomatic carriers might transmit the SARS‐CoV‐2, challenging the implementation of transmission preventive strategies. We report a single‐center experience using universal SARS‐CoV‐2 screening for all inpatients and newly admitted patients to an Organ Transplant Unit located in a region with significantly high community‐based transmission.

Introduction: Head and neck cancer is one the most prevalent forms of cancer in Brazil and worldwide. Immunomodulating enteral nutrition therapy (ENT) can benefit head and neck cancer patients by modulating immune and inflammatory response. Objective: The purpose of this study was to draw a biochemical, cellular and proteomic profile of plasma from head and neck cancer patients submitted to postoperative immunomodulating ENT for 3-5 days. Material and Methods: The cohort was predominantly male, elderly and malnourished. Plasma proteins were quantified and submitted to electrophoresis, depletion chromatography and mass spectrometry. Results: The most highly expressed proteins were C-reactive protein and serum amyloid A1 and A2 (before ENT) and Factor B of the complement system (after ENT). Six protein tumor markers were identified: AAS, plasmin, zinc-α2-glycoprotein, α-1 antichymotrypsin, leucine-rich α-2 glycoprotein 1 and 2, and heavy chain of IgM. Conclusion: In conclusion, the most highly expressed protein in response to postoperative immunomodulating ENT was Factor B of the complement system.