NSAIDs/Nitazoxanide/Azithromycin Immunomodulatory Protocol Used in Adult, Geriatric, Pediatric, Pregnant, and Immunocompromised COVID-19 Patients: A Real-World Experience

COVID-19 management still lacks a protocol of proven efficacy, and we present a novel COVID-19 immunomodulatory protocol based on our early pioneering article, re-purposing nitazoxanide/azithromycin combination for early COVID-19 diseases. Our findings were followed by two articles to justify the addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin. Furthermore, another recent article of ours illustrated the potential immunomodulatory mechanisms by which all the drugs used in this manuscript might be beneficial for COVID-19 patients. We presented a case series of 34 confirmed and highly suspected COVID-19 patients. It is noteworthy that 13 PCR-confirmed COVID-19 patients were included while the others were diagnosed by other measures and all cases were managed by telemedicine. The patients included adult males and females as well as children. All patients have received a short 5-day-regimen of NSAIDs / nitazoxanide/ azithromycin +/- cefoperazone either in full or in part. The primary endpoint of this protocol was a full relief of all debilitating COVID-19 clinical manifestations, and it was fully achieved within two weeks. Most of the patients who were treated early have fully recovered during their described five days; the leucocytic/lymphocytic counts were significantly improved for those with prior abnormalities. Neither significant adverse effects nor post/para COVID-19 syndrome was reported. In conclusion, we present a pioneering 5-day protocol for the safe and effective treatment of COVID-19 using economic FDA-approved immunomodulatory drugs. We recommend conducting double-blind, randomized clinical trials with sufficient strength at the earliest opportunity.

NSAIDs/Nitazoxanide/Azithromycin Immunomodulatory Protocol Used in Adults, Geriatric, Pediatric, Pregnant, and Immunocompromised COVID-19 Patients: A Prospective Observational Study and Case-Series

Introduction: COVID-19 management still lacks a protocol of proven efficacy and we present a novel COVID-19 immunomodulatory protocol basing on our early pioneering article that justified repurposing nitazoxanide/azithromycin combination for early COVID-19 which was followed by two articles to justify addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin as well as by our recent article that illustrates the potential immunomodulatory mechanisms by which all the drugs used in this manuscript might benefit COVID-19 patients. Methods: We present a case series of 38 confirmed and highly suspected COVID-19 consented native Arabic speaking patients, including 12 confirmed by PCR, and the others diagnosed by other measures who were managed by telemedicine. The patients included 15 adult males including an immunocompromised patient, 16 adult females including one lactating, 3 pregnant patients including one confirmed by PCR as well as 4 children. All patients have received a short 5-day-regimen of NSAIDs / nitazoxanide/ azithromycin +/- cefoperazone either in full or in part. The primary endpoint of this protocol was a full relief of all serious COVID-19 clinical manifestations. Results: The primary endpoint was fully achieved within two weeks. Most of the patients who were treated early, have fully recovered during its described five days; the leucocytic/lymphocytic count was significantly improved for those with prior leucopenia or leucocytosis/lymphopenia. Neither significant adverse effects, nor post/para COVID syndrome was reported. Conclusions: a novel 5-day-protocol to safely and effectively cure COVID-19 using repurposed immunomodulatory safe and inexpensive FDA approved drugs is illustrated and we recommend performing sufficiently powered double-blind randomized clinical trials.

NSAIDs/Nitazoxanide/Azithromycin Immunomodulatory Protocol Used in Adults, Geriatric, Pediatric, Pregnant, and Immunocompromised COVID-19 Patients: A Prospective Observational Study and Case-Series

Introduction: No treatment protocol of proven efficacy was approved to manage COVID-19 and we present a novel COVID-19 immunomodulatory protocol basing on our early pioneering article that justified repurposing nitazoxanide/azithromycin combination for early cases of COVID-19 which was followed by two articles to justify addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin and recently an article that illustrates the potential immunomodulatory mechanisms by which all the drugs used might benefit COVID-19 patients has been published. Methods: We present a case series of 37 confirmed and highly suspected COVID-19 consented Arab patients including 12 confirmed by PCR and 23 diagnosed by other measures who were managed by telemedicine only to be noted that the same results were repeated with other patients when we resumed our classic medical examination. The patients included 14 adult males including an immunocompromised patient, 16 adult females including one lactating, 3 pregnant patients including one confirmed by PCR as well as 4 children. All patients have received a short 5-day-regimen of NSAIDs (diclofenac potassium in most of cases, ibuprofen, lornoxicam, meloxicam, celecoxib, naproxen, ketoprofen or ketorolac)/nitazoxanide/azithromycin +/- cefoperazone either in full or in part as illustrated in the manuscript. The primary endpoint of this protocol was full relief of all serious COVID-19 clinical manifestations. Results: The primary endpoint was fully achieved in all patients within two weeks. Most of the patients treated early have fully recovered during its described five days; the leucocytic/lymphocytic count was significantly improved for those with prior leucopenia or leucocytosis/lymphopenia. Neither significant adverse effects, nor post/para COVID syndrome were reported. In Conclusions: a novel 5-day-protocol to safely and effectively cure COVID-19 using repurposed immunomodulatory safe and inexpensive FDA approved drugs is illustrated and we recommend performing sufficiently powered double blind randomized clinical trials against any current standard protocol.

NSAIDs/Nitazoxanide/Azithromycin Immunomodulatory Protocol Used in Adults, Geriatric, Pediatric, Pregnant, and Immunocompromised COVID-19 Patients: A Prospective Observational Study and Case-Series

No treatment protocol of proven efficacy was approved to manage COVID-19 and we present a novel COVID-19 immunomodulatory protocol basing on our early pioneering article that justified repurposing nitazoxanide/azithromycin combination for early cases of COVID-19 which was followed by two articles to justify addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin and recently an article that illustrates the potential immunomodulatory mechanisms by which all the drugs used might benefit COVID-19 patients has been published. We have managed more than 50 confirmed and highly suspected COVID-19 patients, mostly via telemedicine, while fully presenting a case series of 37 COVID-19 Arab patients including 12 confirmed by PCR and 23 diagnosed by other measures. The patients included 14 adult males including an immunocompromised patient, 16 adult females including one lactating, 3 pregnant patients including one confirmed by PCR as well as 4 children. All patients have received a short 5-day-regimen of NSAIDs (diclofenac potassium in most of cases, ibuprofen, lornoxicam, meloxicam, celecoxib, naproxen, ketoprofen or ketorolac)/nitazoxanide/azithromycin +/- cefoperazone either in full or in part as illustrated in the manuscript. The primary endpoint of this protocol was full relief of all serious COVID-19 clinical manifestations, and it was fully achieved in all patients within two weeks. Most of the patients treated early have fully recovered during its described five days; the leucocytic/lymphocytic count was significantly improved for those with prior leucopenia or leucocytosis/lymphopenia. No significant adverse effects were reported. In conclusion, a novel 5-day-protocol to safely and effectively cure COVID-19 using repurposed immunomodulatory safe and inexpensive FDA approved drugs is illustrated and we recommend performing sufficiently powered double blind randomized clinical trials against any current standard protocol.

NSAIDs/Nitazoxanide/Azithromycin Immunomodulatory Protocol Used in Adults, Geriatric, Pediatric, Pregnant, and Immunocompromised COVID-19 Patients: A Prospective Observational Study and Case-Series

To date no treatment protocol of proven efficacy was approved to manage COVID-19. We have developed a novel COVID-19 immunomodulatory protocol basing on our early pioneering article that justified repurposing of nitazoxanide/azithromycin combination for early cases of COVID-19 which was followed by two articles to justify addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin. We are presenting a prospective telemedicine protocol that managed more than 50 documented COVID-19 patients while fully presenting a case series of 36 patients/legal guardians COVID-19 Arab patients including 12 confirmed by PCR and 23 diagnosed by other measures. The patients included 14 adult males including an immunocompromised patient, 15 adult females including one lactating, 3 pregnant patients including one confirmed by PCR as well as 4 children. All patients have received a short 5-day-regimen of NSAIDs (diclofenac potassium in most of cases, ibuprofen, lornoxicam, meloxicam, celecoxib, naproxen, ketoprofen or ketorolac)/nitazoxanide/azithromycin +/- cefoperazone either in full or in part as illustrated in the manuscript. The primary endpoint of this protocol was full relief of all serious COVID-19 clinical manifestations and it was fully achieved in all patients within two weeks. Most of the patients treated early have fully recovered during its described five days; the leucocytic/lymphocytic count was significantly improved for those with prior leucopenia/lymphopenia. No significant adverse effects were reported. A novel 5-day-protocol to safely and effectively cure COVID-19 using repurposed immunomodulatory safe and inexpensive FDA approved drugs is illustrated and we recommend performing sufficiently powered double blind randomized clinical trials against any current standard protocol.

NSAIDs/Nitazoxanide/Azithromycin Immunomodulatory Protocol Used in Adults, Children and Pregnant COVID-19 Patients: An Egyptian Prospective Observational Study.

Objectives: To date no treatment protocol of proven efficacy was approved to manage COVID-19. We have developed a novel COVID-19 immunomodulatory protocol basing on our early pioneering article that justified repurposing of nitazoxanide/azithromycin combination for early cases of COVID-19 which was followed by two articles to justify addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin. Patients and methods: We are presenting a prospective telemedicine protocol that managed more than 50 documented COVID-19 patients while fully presenting a case series of 35 patients/legal guardians COVID-19 Arab patients (34 Egyptian patients living in Egypt and KSA and one citizen of Jordan) including 12 confirmed by PCR and 23 diagnosed by other measures. The patients included 14 adult males including an immunocompromised patient with autoimmune CNS vasculitis vs multiple sclerosis unsettled diagnosis who was on a chronic maintenance dose of azathioprine, 14 adult females including one lactating, 3 pregnant patients including one confirmed by PCR as well as 4 children. All patients have received a short 5-day-regimen of NSAIDs (diclofenac potassium in most of cases, ibuprofen, lornoxicam, meloxicam, celecoxib, naproxen, ketoprofen or ketorolac)/nitazoxanide/azithromycin +/- cefoperazone either in full or in part as illustrated in the manuscript. The primary endpoint of this protocol was full relief of all serious COVID-19 clinical manifestations. Results: The primary endpoint was fully achieved in all patients within two weeks. Most of the patients treated early with the protocol have fully recovered during its described five days; the leucocytic/lymphocytic count was significantly improved for those with prior leucopenia/lymphopenia. No significant adverse effects were reported. Conclusion: A novel 5-day-protocol to safely and effectively cure COVID-19 using repurposed immunomodulatory safe and inexpensive FDA approved drugs is illustrated and we recommend performing sufficiently powered double blind randomized clinical trials against any current standard protocol.

Diclofenac potassium/Nitazoxanide/Azithromycin Used in Adults, Children and Pregnant Patients: A Novel Potential Game Changer COVID-19 Protocol.

Background: The current pandemic of coronavirus disease 2019 has necessitated trial of several drugs searching for a potential cure. We developed a novel protocol basing on our early pioneering article that recommended and justified repurposing of nitazoxanide/azithromycin combination for early cases of COVID-19 which was followed by two published articles to justify addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin. Notably, nitazoxanide/azithromycin is currently being proven clinically beneficial by other researchers and NSAIDs are currently included to manage COVID-19 patients in some countries. Methods: The author is presenting his COVID-19 management protocol that evolved through a prospective telemedicine case series involving consented 30 patients including 10 confirmed by PCR and 20 highly suspected COVID-19 Egyptian patients. The patients included 14 adult males, 10 adult females, 2 pregnant patients as well as 4 children. All patients have received a 5-day-regimen of NSAIDs (mostly diclofenac potassium or ibuprofen)/nitazoxanide/azithromycin +/- cefoperazone either in full or in part as illustrated in the manuscript. The primary endpoint of this protocol was full relief of all serious COVID-19 symptoms and signs. Results: The primary endpoint was fully achieved in all patients within two weeks. Most of the patients treated early with the protocol have fully recovered during its described five days; the leucocytic/lymphocytic count was significantly improved for those with prior leucopenia/lymphopenia. No significant adverse effects were reported. Conclusion: A novel 5-day-protocol to safely and effectively manage COVID-19 repurposed inexpensive FDA approved drugs is illustrated providing a potential readily available COVID-19 cure.

Diclofenac potassium/nitazoxanide/azithromycin novel COVID-19 protocol used in adults, children and pregnant patients: could it be the magic bullet?

Background: The current pandemic of coronavirus disease 2019 has necessitated trial of several drugs searching for a potential cure. We have published an article to justify adoption of nitazoxanide/azithromycin for early cases of COVID-19 followed by two other articles providing the theoretical basis to add non-steroidal anti-inflammatory drugs to the protocol which is described in this manuscript. Patients and methods: Twenty-two consented confirmed and highly suspected COVID-19 Egyptian patients including 11 adult males, 6 adult females, 2 pregnant patients as well as 3 children. All patients have received a 5-day-regimen of NSAIDs (diclofenac potassium, ibuprofen or ketoprofen)/nitazoxanide/azithromycin either in full or in part as illustrated in the manuscript. The primary endpoint of this protocol was full relief of all significant/hazardous COVID-19 symptoms and signs like fever, progressive cough, moderate/severe dyspnea or disturbed level of consciousness. Results: The primary endpoint of this protocol was fully achieved in all patients within two weeks. Most of the patients treated early with the protocol have recovered during the five days; the lymphocytic count was significantly improved for those with prior lymphopenia. No significant adverse effects were reported. Conclusion: A novel short course COVID-19 protocol using inexpensive FDA approved drugs is illustrated.

Case report: atypical recurrent painful ophthalmoplegic neuropathy

IntroduccionRecurrent painful ophthalmoplegic neuropathy (RPON) is a rare disorder with repeated episodes of ocular cranial nerve neuropathy associated with ipsilateral headache in which secondary causes have first been excluded.Case ReportWoman, 52 years old, no comorbidity. In 2001 she presented sudden onset intense (8-10) throbbing left-sided unilateral headache that irradiated to the ipsilateral eye. The crisis lasted for 04 days, without nausea, vomit, photophobia or phonophobia. The intensity of the pain was alleviated with 1g of dipyrone and sodium naproxen in one daily oral dose of 550 mg, without analgesics excess. About two days after the end of the crisis the patient noticed left-sided palpebral ptosis and vertical diplopy preceded by retro-orbital ipsilateral twinge pain. The neurological exam showed fixed mydriasis, left-sided hypotropia and exotropia, compatible with the compromising of the 3rd ipsilateral nerve CN III. At the occasion, the patient was submitted to laboratorial exams of the cerebrospinal fluid, CT scan of the orbit and the skull, digital cerebral angiography of the four vessels, with no abnormalities. Cranial MRI showed enhanced cisternal segment of the left side third nerve. In 2004, 2006, 2008 and 2010 the patient presented the same clinical manifestations, having been treated with 1mg/kg methylprednisolone with full relief in 15 days. However, on the last episode in june of 2019, the patient presented only leftsided oculomotor manifestation, showing residual vertical diplopy after 06 months of pulse therapy. At the moment, she is taking 5 mg of Prednisone, via oral, in protocol of weaning off and ambulatorial follow up at the specialized center of cephalalgy.CommentsA case of RPON was described, diagnosed according to the ICHD-3. However, the patient presented unusual clinical aspects and age of symptoms onset. Unlike the descripitions found in literature, the first crisis occurred at the age 33. Besides, in the last event, only ocular manifestation ocurred, without cephalalgy, with persistent vertical diplopya, after pulse therapy and treatment with via oral steroids and 06 month- follow up. A case of RPON with atypical clinical manifestations and incomplete response to the treatment with steroids must be pointed out.