Scientific letter
Prescription profile of medication in patients with SARS-CoV-2 infection hospitalized in Aragón, Spain
Perfil de prescripción de los pacientes con infección por SARS-CoV-2 hospitalizados en Aragón
Adriana Álvarez Nonay, Laura Cabia Fernández
, Ana Bandrés Liso
Corresponding author
Unidad Autonómica de Uso Racional del Medicamento y Productos Sanitarios, Dirección General de Asistencia Sanitaria, Departamento de Sanidad del Gobierno de Aragón, Zaragoza, Spain
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After 12 weeks since the beginning of the pandemic, confirmed cases in Aragon reached 5,781, 46% requiring hospitalisation, 5% admission to ICU and 15% died.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The rapid progression of the pandemic and the absence of effective treatment and clinical trials prompted the initiation of multiple therapeutic combinations. Most of the prescription proposals were based on Chinese publications, after their experience in patients with COVID-19.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although there is currently no effective treatment for COVID-19 infection, different therapeutic approaches have been proposed since the beginning of the pandemic: antivirals that inhibit enzyme systems with the aim of reducing viral replication, those that inhibit SARS-CoV-2 entry in the cell, and immunomodulators that try to reduce the cytokine storm and associated lung damage.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">With the “evidence generated” in clinical practice and with data from ongoing studies, the Ministry of Health issues, and updates recommendations for the treatment of patients with the infection.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Likewise, in Aragon, a regional protocol for pharmacological management has been established incorporating these recommendations for use.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In order to have a clear picture of the treatments used during the pandemic, the most common combinations and whether they were in line with the recommendations based on the available evidence, a retrospective descriptive study in the consumption and dispensing of in-hospital drugs was carried out in a sample of patients admitted for COVID- 19 (PCR positive), covering all of Aragon’s Health Service hospitals, between 1st March to 8th May 2020 (phases 0–1). Data from 1,482 patients admitted with confirmed infection (60% of hospitalized COVID-19 patients) were analysed: 813 (54.9%) men and 669 (45.1%) women, with a median age of 75 years IQR (62–85). No statistically significant differences were observed in sex according to province, except in Huesca (39% women and 61% men, p = 0.04). 12% required ICU admission.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The behaviour of the analysed sample is similar to the reports from other national hospitals during the study period.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> 46% of patients required hospitalization (45% Spain), predominantly males (54% Aragon, 57% Spain), and a median age above the national level (75 years IQR 62–85, compared to 70 IQR 55–81 in Spain).</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 456 different drug substances were prescribed, with a median of 13 drug substances per patient (IQR 9–19). 73% (1,093) of patients received hydroxychloroquine, lopinavir/ritonavir, or azithromycin. 81% in combination (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Hydroxychloroquine and lopinavir/ritonavir were among the options recommended in the protocol, alone or in combination, while the lack of results of the hydroxychloroquine and azithromycin combination, and the risk of QT prolongation of both drugs, were reported.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The recommendation to use combination therapies is based on the possible synergistic action of their different mechanisms of action. However, there is no evidence about their benefit, and they present a risk of cardiac complications, as the three drugs increase the QT interval.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The prescription profiles against the virus used in clinical practice are unknown. In a recent systematic review,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the drug most frequently administered was lopinavir/ritonavir (21.9%), with hydroxychloroquine (1.2%) and azithromycin (1.4%) with a much lower frequency. These data contrast with those observed in the study sample.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The immunosuppressive treatments recommended to act on the progression of the disease<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> were prescribed in 48% of the patients, with corticosteroids being the most widely used: 84% methylprednisolone (with a more powerful immunosuppression profile), 8.7% dexamethasone, 3.8% associated both corticosteroids, and 3.5% associated with tocilizumab (methylprednisolone 84%), in line with the recommendations of some studies.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There is currently insufficient quality evidence to recommend any treatment, and safety alerts are issued regarding the use of combinations that put patients at risk without obtaining any benefit. More randomised and controlled clinical studies are needed to clarify the optimal treatment for SARS-CoV-2 infection.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">This article has not received any type of funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Álvarez Nonay A, Cabia Fernández L, Bandrés Liso A. Perfil de prescripción de los pacientes con infección por SARS-CoV-2 hospitalizados en Aragón. Med Clin (Barc). 2021;156:88–89.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drug combination administered \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of patients (n°) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage of patients (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N (%) Men \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N (%) Women \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median age (IQR) (years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydroxychloroquine + Lopinavir + Ritonavir \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">307 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.09% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">191 (62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116 (38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 (57–77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydroxychloroquine + Lopinavir/Ritonavir + Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">302 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.63% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">181 (60%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">121 (43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 (57–77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydroxychloroquine + Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">266 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.34% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 (49%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">136 (51%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (61–84) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azithromycin + Lopinavir/Ritonavir \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.64% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 (76–91) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.52% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 (78–93) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydroxychloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.05% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (53%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (64–83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lopinavir/Ritonavir \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.74% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (63%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (37%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (59–85) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1093 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">616 (56%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">477 (44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (59–80) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2532257.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Profile of the most common antibiotic, antiviral and immunomodulatory treatments prescribed (combined or alone) during the study period.</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:1 [ "referenciaCompleta" => "ASHP. Assessment of Evidence for COVID-19-Related Treatments: Updated 6/11/2020 [Internet]. Available from: <a target="_blank" href="https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx">https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx</a> [Cited 13 June 2020]." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Agencia Española de Medicamentos y Productos Sanitarios. Tratamientos disponibles sujetos a condiciones especiales de acceso para el manejo de la infección respiratoria por SARS-CoV-2 [Internet]. Available from: <a target="_blank" href="https://www.aemps.gob.es/la-aemps/ultima-informacion-de-la-aemps-acerca-del-covid-19/tratamientos-disponibles-para-el-manejo-de-la-infeccion-respiratoria-por-sars-cov-2/?lang=en">https://www.aemps.gob.es/la-aemps/ultima-informacion-de-la-aemps-acerca-del-covid-19/tratamientos-disponibles-para-el-manejo-de-la-infeccion-respiratoria-por-sars-cov-2/?lang=en</a> [Cited 13 June 2020]." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => """ Informe sobre la situación de COVID-19 en España. Red Nacional de Vigilancia Epidemiológica (RENAVE). Centro Nacional de epidemiología (CNE). CNM (ISCIII). [Accessed 21 June 2020]. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/INFORMES/Informes%20COVID-19/Informe%20COVID-19.%20N%c2%ba%20111febrero2020 ISCIII.pdf\n <https: nam03.safelinks.protection.outlook.com="" url="https%3A%2F%2Fwww.isciii.es%2FQueHacemos%2FServicios%2FVigilanciaSaludPublica-RENAVE%2FEnfermedadesTransmisibles%2FDocuments%2FINFORMES%2FInformes%2520COVID-19%2FInforme%2520COVID-19.%2520N%25C2%25BA%25201" 11febrero2020="" isciii.pdf&data="02%7C01%7Cc.arora%40elsevier.com%7Cbefea01cbf8444b0a4b308d86a292bc6%7C9274ee3f94254109a27f9fb15c10675d%7C0%7C0%7C637376072777705542&sdata=YSDXeTXjY4yqLP%2BFyTQt0ap1wEMpyMDI104PJWy23ZQ%3D&reserved=0">\n .\n </https:> """ ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Agencia Española de Medicamentos y Productos Sanitarios. Cloroquina/Hidroxicloroquina: precauciones y vigilancia de posibles reacciones adversas en pacientes con COVID-19 [Internet]. Available from: <a target="_blank" href="https://www.aemps.gob.es/informa/notasinformativas/medicamentosusohumano-3/seguridad-1/2020-seguridad-1/cloroquina-hidroxicloroquina-precauciones-y-vigilancia-de-posibles-reacciones-adversas-en-pacientes-con-covid-19/">https://www.aemps.gob.es/informa/notasinformativas/medicamentosusohumano-3/seguridad-1/2020-seguridad-1/cloroquina-hidroxicloroquina-precauciones-y-vigilancia-de-posibles-reacciones-adversas-en-pacientes-con-covid-19/</a> [Cited 21 June 2020]." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatments administered to the first 9152 reported cases of COVID-19: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.C. Fajgenbaum" 1 => "J.S. Khor" 2 => "A. Gorzewski" 3 => "M.-A. Tamakloe" 4 => "V. Powers" 5 => "J.J. Kakkis" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Infect Dis Ther [Internet]" "fecha" => "2020" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://link.springer.com/10.1007/s40121-020-00303-8" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000002/v2_202102250946/S2387020620306197/v2_202102250946/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000002/v2_202102250946/S2387020620306197/v2_202102250946/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306197?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 13 | 0 | 13 |
| 2024 September | 27 | 2 | 29 |
| 2024 August | 21 | 4 | 25 |
| 2024 July | 10 | 3 | 13 |
| 2024 June | 16 | 0 | 16 |
| 2024 May | 14 | 3 | 17 |
| 2024 April | 21 | 4 | 25 |
| 2024 March | 19 | 3 | 22 |
| 2024 February | 10 | 5 | 15 |
| 2024 January | 17 | 1 | 18 |
| 2023 December | 24 | 4 | 28 |
| 2023 November | 10 | 1 | 11 |
| 2023 October | 18 | 9 | 27 |
| 2023 September | 12 | 1 | 13 |
| 2023 August | 9 | 5 | 14 |
| 2023 July | 5 | 3 | 8 |
| 2023 June | 5 | 2 | 7 |
| 2023 May | 11 | 6 | 17 |
| 2023 April | 9 | 1 | 10 |
| 2023 March | 7 | 2 | 9 |
| 2023 February | 8 | 9 | 17 |
| 2023 January | 16 | 3 | 19 |
| 2022 December | 12 | 3 | 15 |
| 2022 November | 14 | 3 | 17 |
| 2022 October | 15 | 4 | 19 |
| 2022 September | 19 | 5 | 24 |
| 2022 August | 12 | 5 | 17 |
| 2022 July | 23 | 7 | 30 |
| 2022 June | 13 | 9 | 22 |
| 2022 May | 12 | 4 | 16 |
| 2022 April | 12 | 2 | 14 |
| 2022 March | 18 | 4 | 22 |
| 2022 February | 11 | 5 | 16 |
| 2022 January | 10 | 3 | 13 |
| 2021 December | 14 | 11 | 25 |
| 2021 November | 19 | 4 | 23 |
| 2021 October | 20 | 7 | 27 |
| 2021 September | 12 | 5 | 17 |
| 2021 August | 25 | 4 | 29 |
| 2021 July | 18 | 2 | 20 |
| 2021 June | 17 | 4 | 21 |
| 2021 May | 10 | 5 | 15 |
| 2021 April | 40 | 17 | 57 |
| 2021 March | 11 | 8 | 19 |
| 2021 February | 19 | 8 | 27 |
| 2021 January | 8 | 2 | 10 |
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