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| Name | Class |
|---|---|
| Direccion General de Calidad y Educacion en Salud | UNKNOWN |
| Instituto Mexicano del Seguro Social | OTHER_GOV |
| Hospital Regional de Alta Especialidad Juan Graham Tabasco | UNKNOWN |
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The etiological agent of the current pandemic is a (+)ssRNA virus. SARS-CoV-2 is infecting thousands of people in the world with a fatality rate that varies from 0.1 to 5% in affected countries, thereby causing enormous economic losses. Few antibiotics have shown any efficacy in their combat, but have not yet proven adequate to stop the spread of the disease, nor are there any approved vaccines at the moment. From experiments in plants ongoing infections by RNA viruses, using thermotherapy, which is the application of heat at a temperature between 35-43 °C, the investigators know that raising the temperature affects the transcription of viral proteins due to the formation of small RNA molecules that interrupt the replication process by grouping in specific regions of the RNA molecule, preventing and inhibiting transcription. These small molecules are called small interfering RNAs (siRNAs). This feature has been used through thermotherapy in humans to combat the rapid replication of cells (i.e. cancer cells), attack cells infected by RNA viruses, and in the treatment of some parasitic infections.There are various commercially available devices for thermotherapy use in humans; they are mainly being used to ease muscle pain. They work by increasing the temperature in the range recommended for thermotherapy in humans 39-43 ° C. Therefore, the investigators consider this treatment modality can be used to aid in the elimination of SARS-CoV-2 from the human body, decreasing viral load, which could allow the immune system time for its control and elimination.
Considering the nature of the causative agent of COVID-19, a (+)ssRNA virus, the investigators propose the use of thermotherapy as a modality for viral containment, thereby preventing the progression of the infection to severe cases. The investigators consider applying the intervention with thermotherapy mainly as an adjuvant therapy in high-risk patients. The most accessible thermotherapy delivery method the investigators have identified is the use of an electric chest pad for its wide and known clinical use, including its recommended use for patients with arthritis. The intensity of temperature delivered by the electric cushion should be placed on the first level (lowest level), to avoid discomfort to the patient. The electric cushion provides a continuous hour of regulated heat, with enough penetration to raise the external temperature of the area to 40-42 ° C, a temperature range at which facilitation of elimination of the virus is expected.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Thermotherapy | Experimental | Electric heat pad applied in the thorax for 90 minutes, twice daily, for 5 days. + Usual in-hospital care |
|
| Control | No Intervention | Usual in-hospital care |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Electric pad for human external pain therapy | Device | An electric pad for local heat production will be put on the back of the patient for two hours |
|
| Measure | Description | Time Frame |
|---|---|---|
| Progression of disease (composite outcome) | Progression to any of the following:
| 28 days |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality at day 15 | Proportion of participants deceased by day 15 after enrollment | 15 days |
| Mortality at day 28 | Proportion of participants deceased by day 28 after enrollment |
| Measure | Description | Time Frame |
|---|---|---|
| Comparison of laboratory parameters with respect to baseline (units: 10^3/microliter) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: total leucocytes, neutrophils, lymphocytes, monocytes, and platelets | Days 1, 5, 15, and 28 |
Inclusion Criteria:
Patient with symptoms of COVID-19 (fever, headache, cough, sore throat, myalgias, arthralgias, shortness of breath, anosmia, fatigue, diarrhea, vomit, or conjunctivitis) meeting criteria for mild or moderate COVID-19 according to the following criteria:
Patient with less than or equal to 5 days from symptom onset
Participant understands the intervention and procedures and accepts randomization.
Exclusion Criteria:
Suspected or confirmed pregnancy at evaluation
Severe decompensation of any of the patient's underlying diseases
Previous diagnosis of COVID-19 with complete resolution of symptoms for at least 2 days.
Patients meeting criteria for severe or critical COVID-19 at evaluation:
Elimination Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Norma del Carmen Galindo Sevilla, PhD | Contact | +525539968217 | ngalindosevilla@gmail.com | |
| Javier Mancilla-Galindo, MBBS | Contact | javimangal@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Norma del Carmen Galindo Sevilla, PhD | Instituto Nacional de Perinatologia | Principal Investigator |
| Javier Mancilla-Galindo, MBBS | Instituto Nacional de Cardiología | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Dr. Ángel Leaño | Recruiting | Guadalajara | Jalisco | 45200 | Mexico |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26573813 | Background | Liu J, Zhang X, Zhang F, Hong N, Wang G, Wang A, Wang L. Identification and characterization of microRNAs from in vitro-grown pear shoots infected with Apple stem grooving virus in response to high temperature using small RNA sequencing. BMC Genomics. 2015 Nov 16;16:945. doi: 10.1186/s12864-015-2126-8. | |
| 30323856 | Background |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Oct 11, 2023 | Nov 3, 2023 | 3 |
| ID | Term |
|---|---|
| D000086382 | COVID-19 |
| D000084462 | Hyperthermia |
| ID | Term |
|---|---|
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
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| Hospital Dr. Ángel Leaño |
| UNKNOWN |
| National Polytechnic Institute, Mexico | OTHER |
| Universidad Juárez Autónoma de Tabasco | OTHER |
The application of an electric chest pad. The use of an electric cushion was chosen because it is designed to be used in human thermal therapy. The electric cushion provides continuous 90 minutes of regulated heat, with enough penetration to raise the external temperature of the area to 40-42 ° C.
It is a therapy designed to detain disease progression. It is not expected to have an effect on concomitant microorganisms such as bacteria or opportunists such as Candida albicans, so that when the concomitant infection is suspected, the antibiotic of choice should be given or continued, depending on the nature of the infection.
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| 28 days |
| Time to progression to severe COVID-19 | Days from symptom onset to progression to severe COVID-19 | Up to 33 days |
| Time to progression to critical COVID-19 | Days from symptom onset to progression to critical COVID-19 | Up to 33 days |
| Hospitalization time | In-hospital stay in days | Up to 33 days |
| Percentage of participants at each clinical status in the Ordinal Scale at Day 15 | Ordinal scale of 7 categories: 1) Not hospitalized, without limitations on daily activities; 2) Not hospitalized, with limitations on daily activities; 3) Hospitalized, not requiring supplementary oxygen; 4) Hospitalized, requiring low-flow supplementary oxygen; 5) Hospitalized, requiring supplementary oxygen with high-flow nasal cannula or non-invasive ventilation; 6) Hospitalized, under invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 7) Death | 15 days |
| Percentage of participants at each clinical status in the Ordinal Scale at Day 28 | Ordinal scale of 7 categories: 1) Not hospitalized, without limitations on daily activities; 2) Not hospitalized, with limitations on daily activities; 3) Hospitalized, not requiring supplementary oxygen; 4) Hospitalized, requiring low-flow supplementary oxygen; 5) Hospitalized, requiring supplementary oxygen with high-flow nasal cannula or non-invasive ventilation; 6) Hospitalized, under invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 7) Death | 28 days |
| Time (days) to last requiring supplementary oxygen according to modality | Modalities: 1) Simple nasal cannula or face mask; 2) Face mask with reservoir; 3) High-flow nasal cannula; 4) Non-invasive mechanical ventilation; 5) Invasive mechanical ventilation | 28 days |
| Change in National Early Warning Score 2 (NEWS-2) with respect to baseline | Change in the National Early Warning Score 2 (NEWS-2) with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. This score evaluates 7 parameters (respiratory rate, peripheral arterial oxygen saturation, supplementary oxygen requirements, systolic arterial blood pressure, heart rate, consciousness, and body temperature). Assigned values for every parameter may range from 0 to 3 points, except for supplementary oxygen for which possible values are 0 (not requiring supplementary oxygen) and 2 (requiring supplementary oxygen). The total sum of points for this score may range from 0 to 20 points. Higher scores reflect increasing clinical deterioration. | Days 1, 5, 15, and 28 |
| Proportion of patients requiring invasive mechanical ventilation | Proportion of patients requiring invasive mechanical ventilation during the entire follow-up period | 28 days |
| Proportion of patients requiring admission to intensive care unit (ICU) | Proportion of patients requiring admission to intensive care unit (ICU) during the entire follow-up period | 28 days |
| Time to requiring invasive mechanical ventilation | Days from symptom onset to progression to requiring invasive mechanical ventilation | Up to 33 days |
| Time to requiring admission to intensive care unit (ICU) | Days from symptom onset to requiring admission to intensive care unit (ICU) | Up to 33 days |
| Proportion of patients with adverse events according to outcome |
| 28 days |
| Proportion of patients with adverse events according to severity |
| 28 days |
| Proportion of patients with adverse events according to causality |
| 28 days |
| Proportion of patients tolerating the intervention (no comparison) | Proportion of patients tolerating the intervention (number of sessions and minutes per session). | 5 days |
| Comparison of laboratory parameters with respect to baseline (units: milligrams/deciliter) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: glucose, urea, blood urea nitrogen, creatinine, total bilirubin, direct bilirubin, and indirect bilirubin. | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (units: grams/deciliter) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: hemoglobin, and albumin | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (units: milligrams/liter) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: C-reactive protein | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (units: nanograms/milliliter) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: D-dimer, and procalcitonin | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (units: International Units/liter) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and creatinine phosphokinase (CPK). | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (ratio: no units) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: neutrophil-to-lymphocyte ratio, and international normalized ratio (INR). | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (units: percent) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: hematocrit | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (units: seconds) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: prothrombin time (PT), and partial thromboplastin time (PTT) | Days 1, 5, 15, and 28 |
| Comparison of laboratory parameters with respect to baseline (units: millimeters/hour) | Change in laboratory parameters with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. Parameters to be included are: erythrocyte sedimentation rate (ESR) | Days 1, 5, 15, and 28 |
| Comparison of cytokine levels with respect to baseline | Change in cytokine levels with respect to baseline (Day 1), measured at day 5 for all patients, and days 15 & 28 only for patients that remain hospitalized. | Days 1, 5, 15, and 28 |
| Hospital Regional de Alta Especialidad "Dr. Juan Graham Casasus" | Recruiting | Villahermosa | Tabasco | 86126 | Mexico |
|
| Unidad Temporal Movil COVID-19 Autódromo Hermanos Rodríguez IMSS | Recruiting | Mexico City | 08400 | Mexico |
|
| Wang MR, Cui ZH, Li JW, Hao XY, Zhao L, Wang QC. In vitro thermotherapy-based methods for plant virus eradication. Plant Methods. 2018 Oct 6;14:87. doi: 10.1186/s13007-018-0355-y. eCollection 2018. |
| 20797409 | Background | Zhu LL, Gao XH, Qi R, Hong Y, Li X, Wang X, McHepange UO, Zhang L, Wei H, Chen HD. Local hyperthermia could induce antiviral activity by endogenous interferon-dependent pathway in condyloma acuminata. Antiviral Res. 2010 Nov;88(2):187-92. doi: 10.1016/j.antiviral.2010.08.012. Epub 2010 Aug 24. |
| 38188344 | Derived | Mancilla-Galindo J, Kammar-Garcia A, Mendoza-Gertrudis ML, Garcia Acosta JM, Nava Serrano YS, Santiago O, Torres Vasquez MB, Martinez Martinez D, Fernandez-Urrutia LA, Robledo Pascual JC, Narvaez Morales ID, Velasco-Medina AA, Mancilla-Ramirez J, Figueroa-Damian R, Galindo-Sevilla N. Regional moderate hyperthermia for mild-to-moderate COVID-19 (TherMoCoV study): a randomized controlled trial. Front Med (Lausanne). 2023 Dec 22;10:1256197. doi: 10.3389/fmed.2023.1256197. eCollection 2023. |
| D014777 |
| Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D001832 | Body Temperature Changes |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D018882 | Heat Stress Disorders |
| D014947 | Wounds and Injuries |