array:23 [
  "pii" => "S2254887420300813"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2020.07.002"
  "estado" => "S300"
  "fechaPublicacion" => "2020-10-01"
  "aid" => "1832"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2020"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Rev Clin Esp. 2020;220:461-2"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256520301107"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2020.04.004"
      "estado" => "S300"
      "fechaPublicacion" => "2020-10-01"
      "aid" => "1832"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Rev Clin Esp. 2020;220:461-2"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Correspondencia</span>"
        "titulo" => "Tomar o no tomar &#171;decisiones en caliente&#187; respecto al tratamiento de la infecci&#243;n por SARS-CoV-2"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "461"
            "paginaFinal" => "462"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Whether to make decisions &#171;on the fly&#187; regarding treatment for SARS-CoV-2 infection"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46; Abril L&#243;pez de Medrano, E&#46; Merino de Lucas, M&#46; Salavert Llet&#237;"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Abril L&#243;pez de Medrano"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Merino de Lucas"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Salavert Llet&#237;"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887420300813"
          "doi" => "10.1016/j.rceng.2020.07.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300813?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301107?idApp=WRCEE"
      "url" => "/00142565/0000022000000007/v1_202009260731/S0014256520301107/v1_202009260731/es/main.assets"
    ]
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887420300746"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2020.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2020-10-01"
    "aid" => "1861"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Rev Clin Esp. 2020;220:459-61"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>"
      "titulo" => "Pulmonary embolism and COVID-19&#58; A paradigm change"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "459"
          "paginaFinal" => "461"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Tromboembolismo pulmonar y COVID-19&#58; un cambio de paradigma"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Franco-Moreno, N&#46; Mu&#241;oz-Rivas, B&#46; Mestre-G&#243;mez, J&#46; Torres-Macho"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Franco-Moreno"
            ]
            1 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Mu&#241;oz-Rivas"
            ]
            2 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Mestre-G&#243;mez"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Torres-Macho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256520301405"
        "doi" => "10.1016/j.rce.2020.05.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301405?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300746?idApp=WRCEE"
    "url" => "/22548874/0000022000000007/v2_202010040643/S2254887420300746/v2_202010040643/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>"
    "titulo" => "Whether to make decisions &#34;on the fly&#34; regarding treatment for SARS-CoV-2 infection"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Director&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "461"
        "paginaFinal" => "462"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46; Abril L&#243;pez de Medrano, E&#46; Merino de Lucas, M&#46; Salavert Llet&#237;"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "V&#46;"
            "apellidos" => "Abril L&#243;pez de Medrano"
            "email" => array:1 [
              0 => "vicente.abril.lopezdemedrano@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Merino de Lucas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Salavert Llet&#237;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Consorcio Hospital General Universitario de Valencia&#44; Valencia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital General Universitario de Alicante&#44; Alicante&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tomar o no tomar &#171;decisiones en caliente&#187; respecto al tratamiento de la infecci&#243;n por SARS-CoV-2"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The outbreak of the COVID-19 pandemic is a challenge of enormous dimensions for healthcare professionals&#44; public health&#44; and politicians&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As of April 5&#44; 2020&#44; official figures revealed that there were 135&#44;032 people infected&#44; 13&#44;055 deaths&#44; and 59&#44;662 patients hospitalized &#40;<a href="https://covid19.isciii.es/">https&#58;&#47;&#47;covid19&#46;isciii&#46;es&#47;</a>&#41;&#46; We lived through convulsive days in which treatment protocols for COVID-19 infection were modified practically daily based on new evidence and the need to optimize the scarce therapeutic arsenal available&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Just three weeks ago&#44; we learned the results of a clinical trial that compared lopinavir&#47;ritonavir to supportive treatment in severe patients hospitalized with COVID-19 infection whose primary outcome was time until clinical improvement&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The poor overall results in terms of clinical response and mortality led&#44; in just a few hours&#44; to a rare wave of pessimism among the groups of professionals in charge of making decisions in many hospitals&#46; This was reflected in heated discussions via WhatsApp and other forums&#44; leading to the abrupt removal of lopinavir&#47;ritonavir from the treatment protocols of several large centers in our country&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nevertheless&#44; the result of the information from a trial such as that one must be taken cautiously and analyzed with a critical&#44; rigorous eye&#46; The work suffers from various methodological problems in the design and in patient recruitment related to the urgent nature of the work&#46; The authors themselves recognize these aspects in the discussion&#46; Patient assignment was not blind and the desirable placebo control was not able to be established for patients who did not receive the drug in said study&#46; Likewise&#44; plasma levels of lopinavir&#47;ritonavir were not able to be determined and could have been compromised in critical patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand&#44; the study lacks power for outcomes that are secondary in the design&#44; but which are important&#44; such as mortality&#46; Assuming the same premises as for the principal variable&#44; between 200 and 860 additional patients would have been needed in each arm to demonstrate differences&#46; In addition&#44; although the overall benefit was weak&#44; a close reading allows for observing how the use of lopinavir&#47;ritonavir could point towards a trend in mortality reduction if it is used in the first 12 days&#46; Among patients treated earlier&#44; the primary objective was indeed achieved&#44; with respective mortality of 15&#37; versus 27&#37; in each arm&#46; What&#8217;s more&#44; the other secondary aims&#44; such as a stay in the intensive care unit &#40;5 days of difference&#41; and the percentage of patients who developed ARDS &#40;12&#37; versus 24&#37;&#41;&#44; were also improved&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our opinion&#44; the fundamental issue is that patients were treated too late &#40;median of 13 days from onset of symptoms&#41; and in monotherapy&#46; Therefore&#44; although it did not achieve the primary aim&#44; the results indicate that the treated group could progress better&#46; Therefore&#44; it remains to be determined if the use of lopinavir&#47;ritonavir in the earliest phases and&#47;or in combination with other potentially active drugs would benefit patients or not&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Nevertheless&#44; we are aware of the lack of trust that protease inhibitors and their limited in vitro activity generate and in their clinical efficacy in this novel coronavirus and in others &#40;SARS-CoV&#44; MERS-CoV&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The controversial results of this study had already in part been anticipated in another Chinese study&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> which did not demonstrate a benefit to treatment with lopinavir&#47;ritonavir and abidol&#46; Furthermore&#44; Janssen has reported unpublished data on the inefficacy of darunavir&#47;cobicistat in the treatment of 30 patients with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Even so&#44; while awaiting new evidence or consolidated alternative therapies&#44; it seems prudent to continue using the optimize form of the few drugs we do have available&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In catastrophic times&#44; it is important to keep a cool head and even keel when it comes to making decisions that may determine a patient&#8217;s prognosis&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Abril L&#243;pez de Medrano V&#44; Merino de Lucas E&#44; Salavert Llet&#237; M&#46; Tomar o no tomar &#171;decisiones en caliente&#187; respecto al tratamiento de la infecci&#243;n por SARS-CoV-2&#46; Rev Clin Esp&#46; 2020&#59;220&#58;461&#8211;462&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trial of lopinavir-ritonavir in adults hospitalized with severe covid-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Cao"
                            1 => "Y&#46; Wang"
                            2 => "D&#46; Wen"
                            3 => "W&#46; Liu"
                            4 => "J&#46; Wang"
                            5 => "G&#46; Fan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa2001282"
                      "Revista" => array:3 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2020"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32222134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;C&#46;C&#46; Cheng"
                            1 => "S&#46;K&#46;P&#46; Lau"
                            2 => "P&#46;C&#46;Y&#46; Woo"
                            3 => "K&#46;Y&#46; Yuen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2007"
                        "volumen" => "20"
                        "paginaInicial" => "660"
                        "paginaFinal" => "694"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "From SARS to MERS&#44; thrusting coronaviruses into the spotlight"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Song"
                            1 => "Y&#46; Xu"
                            2 => "L&#46; Bao"
                            3 => "L&#46; Zhang"
                            4 => "P&#46; Yu"
                            5 => "Y&#46; Qu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/v11010059"
                      "Revista" => array:6 [
                        "tituloSerie" => "Viruses"
                        "fecha" => "2019"
                        "volumen" => "11"
                        "paginaInicial" => "E59"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30646565"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1878875018313068"
                          "estado" => "S300"
                          "issn" => "18788750"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacies of lopinavir&#47;ritonavir and abidol in the treatment of novel coronavirus pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Jun"
                            1 => "L&#46; Yun"
                            2 => "X&#46; Xiuhong"
                            3 => "L&#46; Ping"
                            4 => "L&#46; Feng"
                            5 => "L&#46; Tao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3760/cma.j.cn311365-20200210-00050"
                      "Revista" => array:3 [
                        "tituloSerie" => "Chin J Infect Dis"
                        "fecha" => "2020"
                        "volumen" => "38"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Results from a single center&#44; open label&#44; randomized&#44; and controlled trial conducted at Shanghai Public Health Clinical Center &#40;SPHCC&#41; of darunavir and cobicistat &#40;DRV&#47;c&#41; in treating laboratory-confirmed 30 COVID-19 patients showed that DRV&#47;c was not effective&#46; Available in&#58; <a target="_blank" href="https://www.jnj.com/lack-of-evidence-to-support-darunavir-based-hiv-treatments-for-coronavirus">https&#58;&#47;&#47;www&#46;jnj&#46;com&#47;lack-of-evidence-to-support-darunavir-based-hiv-treatments-for-coronavirus</a>&#46; &#91;Accessed 6 April 2020&#93;&#46;"
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022000000007/v2_202010040643/S2254887420300813/v2_202010040643/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "71813"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Correspondence"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000007/v2_202010040643/S2254887420300813/v2_202010040643/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300813?idApp=WRCEE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Correspondence
Whether to make decisions "on the fly" regarding treatment for SARS-CoV-2 infection
Tomar o no tomar «decisiones en caliente» respecto al tratamiento de la infección por SARS-CoV-2
V. Abril López de Medranoa,
Corresponding author
, E. Merino de Lucasb, M. Salavert Lletíc
a Consorcio Hospital General Universitario de Valencia, Valencia, Spain
b Hospital General Universitario de Alicante, Alicante, Spain
c Hospital Universitario y Politécnico La Fe, Valencia, Spain
Read
860
Times
was read the article
189
Total PDF
671
Total HTML
Share statistics
 array:23 [
  "pii" => "S2254887420300813"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2020.07.002"
  "estado" => "S300"
  "fechaPublicacion" => "2020-10-01"
  "aid" => "1832"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
  "copyrightAnyo" => "2020"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Rev Clin Esp. 2020;220:461-2"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256520301107"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2020.04.004"
      "estado" => "S300"
      "fechaPublicacion" => "2020-10-01"
      "aid" => "1832"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Rev Clin Esp. 2020;220:461-2"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Correspondencia</span>"
        "titulo" => "Tomar o no tomar &#171;decisiones en caliente&#187; respecto al tratamiento de la infecci&#243;n por SARS-CoV-2"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "461"
            "paginaFinal" => "462"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Whether to make decisions &#171;on the fly&#187; regarding treatment for SARS-CoV-2 infection"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46; Abril L&#243;pez de Medrano, E&#46; Merino de Lucas, M&#46; Salavert Llet&#237;"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Abril L&#243;pez de Medrano"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Merino de Lucas"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Salavert Llet&#237;"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887420300813"
          "doi" => "10.1016/j.rceng.2020.07.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300813?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301107?idApp=WRCEE"
      "url" => "/00142565/0000022000000007/v1_202009260731/S0014256520301107/v1_202009260731/es/main.assets"
    ]
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887420300746"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2020.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2020-10-01"
    "aid" => "1861"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Rev Clin Esp. 2020;220:459-61"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>"
      "titulo" => "Pulmonary embolism and COVID-19&#58; A paradigm change"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "459"
          "paginaFinal" => "461"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Tromboembolismo pulmonar y COVID-19&#58; un cambio de paradigma"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Franco-Moreno, N&#46; Mu&#241;oz-Rivas, B&#46; Mestre-G&#243;mez, J&#46; Torres-Macho"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Franco-Moreno"
            ]
            1 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Mu&#241;oz-Rivas"
            ]
            2 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Mestre-G&#243;mez"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Torres-Macho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256520301405"
        "doi" => "10.1016/j.rce.2020.05.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301405?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300746?idApp=WRCEE"
    "url" => "/22548874/0000022000000007/v2_202010040643/S2254887420300746/v2_202010040643/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>"
    "titulo" => "Whether to make decisions &#34;on the fly&#34; regarding treatment for SARS-CoV-2 infection"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Director&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "461"
        "paginaFinal" => "462"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46; Abril L&#243;pez de Medrano, E&#46; Merino de Lucas, M&#46; Salavert Llet&#237;"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "V&#46;"
            "apellidos" => "Abril L&#243;pez de Medrano"
            "email" => array:1 [
              0 => "vicente.abril.lopezdemedrano@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Merino de Lucas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Salavert Llet&#237;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Consorcio Hospital General Universitario de Valencia&#44; Valencia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital General Universitario de Alicante&#44; Alicante&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tomar o no tomar &#171;decisiones en caliente&#187; respecto al tratamiento de la infecci&#243;n por SARS-CoV-2"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The outbreak of the COVID-19 pandemic is a challenge of enormous dimensions for healthcare professionals&#44; public health&#44; and politicians&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As of April 5&#44; 2020&#44; official figures revealed that there were 135&#44;032 people infected&#44; 13&#44;055 deaths&#44; and 59&#44;662 patients hospitalized &#40;<a href="https://covid19.isciii.es/">https&#58;&#47;&#47;covid19&#46;isciii&#46;es&#47;</a>&#41;&#46; We lived through convulsive days in which treatment protocols for COVID-19 infection were modified practically daily based on new evidence and the need to optimize the scarce therapeutic arsenal available&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Just three weeks ago&#44; we learned the results of a clinical trial that compared lopinavir&#47;ritonavir to supportive treatment in severe patients hospitalized with COVID-19 infection whose primary outcome was time until clinical improvement&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The poor overall results in terms of clinical response and mortality led&#44; in just a few hours&#44; to a rare wave of pessimism among the groups of professionals in charge of making decisions in many hospitals&#46; This was reflected in heated discussions via WhatsApp and other forums&#44; leading to the abrupt removal of lopinavir&#47;ritonavir from the treatment protocols of several large centers in our country&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nevertheless&#44; the result of the information from a trial such as that one must be taken cautiously and analyzed with a critical&#44; rigorous eye&#46; The work suffers from various methodological problems in the design and in patient recruitment related to the urgent nature of the work&#46; The authors themselves recognize these aspects in the discussion&#46; Patient assignment was not blind and the desirable placebo control was not able to be established for patients who did not receive the drug in said study&#46; Likewise&#44; plasma levels of lopinavir&#47;ritonavir were not able to be determined and could have been compromised in critical patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand&#44; the study lacks power for outcomes that are secondary in the design&#44; but which are important&#44; such as mortality&#46; Assuming the same premises as for the principal variable&#44; between 200 and 860 additional patients would have been needed in each arm to demonstrate differences&#46; In addition&#44; although the overall benefit was weak&#44; a close reading allows for observing how the use of lopinavir&#47;ritonavir could point towards a trend in mortality reduction if it is used in the first 12 days&#46; Among patients treated earlier&#44; the primary objective was indeed achieved&#44; with respective mortality of 15&#37; versus 27&#37; in each arm&#46; What&#8217;s more&#44; the other secondary aims&#44; such as a stay in the intensive care unit &#40;5 days of difference&#41; and the percentage of patients who developed ARDS &#40;12&#37; versus 24&#37;&#41;&#44; were also improved&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our opinion&#44; the fundamental issue is that patients were treated too late &#40;median of 13 days from onset of symptoms&#41; and in monotherapy&#46; Therefore&#44; although it did not achieve the primary aim&#44; the results indicate that the treated group could progress better&#46; Therefore&#44; it remains to be determined if the use of lopinavir&#47;ritonavir in the earliest phases and&#47;or in combination with other potentially active drugs would benefit patients or not&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Nevertheless&#44; we are aware of the lack of trust that protease inhibitors and their limited in vitro activity generate and in their clinical efficacy in this novel coronavirus and in others &#40;SARS-CoV&#44; MERS-CoV&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The controversial results of this study had already in part been anticipated in another Chinese study&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> which did not demonstrate a benefit to treatment with lopinavir&#47;ritonavir and abidol&#46; Furthermore&#44; Janssen has reported unpublished data on the inefficacy of darunavir&#47;cobicistat in the treatment of 30 patients with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Even so&#44; while awaiting new evidence or consolidated alternative therapies&#44; it seems prudent to continue using the optimize form of the few drugs we do have available&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In catastrophic times&#44; it is important to keep a cool head and even keel when it comes to making decisions that may determine a patient&#8217;s prognosis&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Abril L&#243;pez de Medrano V&#44; Merino de Lucas E&#44; Salavert Llet&#237; M&#46; Tomar o no tomar &#171;decisiones en caliente&#187; respecto al tratamiento de la infecci&#243;n por SARS-CoV-2&#46; Rev Clin Esp&#46; 2020&#59;220&#58;461&#8211;462&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trial of lopinavir-ritonavir in adults hospitalized with severe covid-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Cao"
                            1 => "Y&#46; Wang"
                            2 => "D&#46; Wen"
                            3 => "W&#46; Liu"
                            4 => "J&#46; Wang"
                            5 => "G&#46; Fan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa2001282"
                      "Revista" => array:3 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2020"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32222134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;C&#46;C&#46; Cheng"
                            1 => "S&#46;K&#46;P&#46; Lau"
                            2 => "P&#46;C&#46;Y&#46; Woo"
                            3 => "K&#46;Y&#46; Yuen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2007"
                        "volumen" => "20"
                        "paginaInicial" => "660"
                        "paginaFinal" => "694"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "From SARS to MERS&#44; thrusting coronaviruses into the spotlight"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Song"
                            1 => "Y&#46; Xu"
                            2 => "L&#46; Bao"
                            3 => "L&#46; Zhang"
                            4 => "P&#46; Yu"
                            5 => "Y&#46; Qu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/v11010059"
                      "Revista" => array:6 [
                        "tituloSerie" => "Viruses"
                        "fecha" => "2019"
                        "volumen" => "11"
                        "paginaInicial" => "E59"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30646565"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1878875018313068"
                          "estado" => "S300"
                          "issn" => "18788750"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacies of lopinavir&#47;ritonavir and abidol in the treatment of novel coronavirus pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Jun"
                            1 => "L&#46; Yun"
                            2 => "X&#46; Xiuhong"
                            3 => "L&#46; Ping"
                            4 => "L&#46; Feng"
                            5 => "L&#46; Tao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3760/cma.j.cn311365-20200210-00050"
                      "Revista" => array:3 [
                        "tituloSerie" => "Chin J Infect Dis"
                        "fecha" => "2020"
                        "volumen" => "38"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Results from a single center&#44; open label&#44; randomized&#44; and controlled trial conducted at Shanghai Public Health Clinical Center &#40;SPHCC&#41; of darunavir and cobicistat &#40;DRV&#47;c&#41; in treating laboratory-confirmed 30 COVID-19 patients showed that DRV&#47;c was not effective&#46; Available in&#58; <a target="_blank" href="https://www.jnj.com/lack-of-evidence-to-support-darunavir-based-hiv-treatments-for-coronavirus">https&#58;&#47;&#47;www&#46;jnj&#46;com&#47;lack-of-evidence-to-support-darunavir-based-hiv-treatments-for-coronavirus</a>&#46; &#91;Accessed 6 April 2020&#93;&#46;"
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022000000007/v2_202010040643/S2254887420300813/v2_202010040643/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "71813"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Correspondence"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000007/v2_202010040643/S2254887420300813/v2_202010040643/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300813?idApp=WRCEE"
]
Article information
ISSN: 22548874
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 1 0 1
2024 October 26 1 27
2024 September 18 0 18
2024 August 24 0 24
2024 July 14 2 16
2024 June 9 1 10
2024 May 15 0 15
2024 April 12 0 12
2024 March 15 0 15
2024 February 4 0 4
2024 January 12 0 12
2023 December 17 0 17
2023 November 16 0 16
2023 October 12 0 12
2023 September 19 1 20
2023 August 12 0 12
2023 July 17 0 17
2023 June 18 0 18
2023 May 15 3 18
2023 April 12 0 12
2023 March 27 5 32
2023 February 10 1 11
2023 January 13 3 16
2022 December 15 3 18
2022 November 16 1 17
2022 October 15 3 18
2022 September 15 2 17
2022 August 10 4 14
2022 July 20 10 30
2022 June 14 2 16
2022 May 15 4 19
2022 April 14 5 19
2022 March 20 9 29
2022 February 15 5 20
2022 January 17 7 24
2021 December 10 5 15
2021 November 5 4 9
2021 October 0 2 2
2021 September 1 3 4
2021 August 1 4 5
2021 July 2 4 6
2021 June 0 4 4
2021 May 1 4 5
2021 April 1 0 1
2021 March 5 5 10
2021 February 8 3 11
2021 January 9 13 22
2020 December 10 11 21
2020 November 15 12 27
2020 October 15 13 28
2020 September 63 29 92
2020 August 1 1 2
Show all

Follow this link to access the full text of the article

Idiomas
Revista Clínica Española (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?