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Article ; Online: Risk of using hydroxychloroquine as a treatment of COVID-19.

Alanagreh, Lo'ai / Alzoughool, Foad / Atoum, Manar

The International journal of risk & safety in medicine

2020 Volume 31, Issue 3, Page(s) 111–116

Abstract: ... much attention as a treatment for COVID-19. However, there are limited and uncertain clinical data ... to support the beneficial effect of this drug in COVID-19 treatment. HCQ has several side effects and ... usage outcomes are needed to make the final decision. In this paper, we aim to discuss the risk of using ...

Abstract	The emerging COVID-19 pandemic poses a threat to the global health care system. Given the lack of antiviral therapies or vaccines for the disease, the antimalarial drug hydroxychloroquine (HCQ) obtained much attention as a treatment for COVID-19. However, there are limited and uncertain clinical data to support the beneficial effect of this drug in COVID-19 treatment. HCQ has several side effects and warnings, including blindness, heart failure, and renal toxicity, even with recommended doses. For severe cases of COVID-19 or in patients with preexisting conditions, administering such a drug could be fatal, particularly when taken at high doses or in combination with other antibiotics. However, further well-designed studies that would address the optimal dose, duration of treatment, possible side effects, and long-term usage outcomes are needed to make the final decision. In this paper, we aim to discuss the risk of using HCQ in treating COVID-19 patients, including its possible side effects.
MeSH term(s)	Antimalarials/adverse effects ; Antimalarials/pharmacology ; Antimalarials/therapeutic use ; Betacoronavirus ; Coronavirus Infections/drug therapy ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Humans ; Hydroxychloroquine/adverse effects ; Hydroxychloroquine/pharmacology ; Hydroxychloroquine/therapeutic use ; Pandemics ; Pneumonia, Viral/drug therapy
Chemical Substances	Antimalarials ; Hydroxychloroquine (4QWG6N8QKH)
Keywords	covid19
Language	English
Publishing date	2020-05-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1055458-0
ISSN	1878-6847 ; 0924-6479
ISSN (online)	1878-6847
ISSN	0924-6479
DOI	10.3233/JRS-200024
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Article: Risk versus Benefit of Using Hydroxychloroquine to Treat Patients with COVID-19.

Zhanel, George G / Zhanel, Michael A / Boreskie, Kevin F / Lynch, Joseph P / Karlowsky, James A

The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale

2021 Volume 2021, Page(s) 5942366

Abstract: ... as a treatment for malaria, systemic lupus erythematosus, and rheumatoid arthritis. As the COVID-19 pandemic ... treatment and as prophylaxis against COVID-19. Preliminary data indicated that HCQ as well as chloroquine ... in the treatment or prevention of COVID-19. ...

Abstract	Hydroxychloroquine (HCQ), also known by its trade name Plaquenil®, has been used for over 50 years as a treatment for malaria, systemic lupus erythematosus, and rheumatoid arthritis. As the COVID-19 pandemic emerged in the United States and globally in early 2020, HCQ began to garner attention as a potential treatment and as prophylaxis against COVID-19. Preliminary data indicated that HCQ as well as chloroquine (CQ) possessed in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early clinical data from China and France reported that HCQ and CQ were associated with viral load reduction and clinical improvement in patients with COVID-19 compared to control groups; however, an overwhelming number of randomized controlled trials, meta-analyses, and systematic reviews have since concluded that HCQ used alone, or in combination with azithromycin (AZ), provides no mortality or time-to-recovery benefit in hospitalized patients with COVID-19. Additionally, these same trials reported adverse events including cardiac, neuropsychiatric, hematologic, and hepatobiliary manifestations in patients with COVID-19 whom had been treated with HCQ. This review article summarizes the available data pertaining to the adverse events associated with HCQ use, alone or in combination with azithromycin, in patients with COVID-19 in order to fully assess the risk versus benefit of treating COVID-19 patients with these agents. The results of this review lead us to conclude that the risks of adverse events associated with HCQ use (with or without AZ) outweigh the potential clinical benefits and thus recommend against its use in the treatment or prevention of COVID-19.
Language	English
Publishing date	2021-09-15
Publishing country	Egypt
Document type	Journal Article ; Review
ZDB-ID	1057056-1
ISSN	1712-9532 ; 1180-2332
ISSN	1712-9532 ; 1180-2332
DOI	10.1155/2021/5942366
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Article: Risk of using hydroxychloroquine as a treatment of COVID-19

Alanagreh, Lo039 / ai, / Alzoughool, Foad / Atoum, Manar

Int J Risk Saf Med

Abstract	The emerging COVID-19 pandemic poses a threat to the global health care system. Given the lack of antiviral therapies or vaccines for the disease, the antimalarial drug hydroxychloroquine (HCQ) obtained much attention as a treatment for COVID-19. However, there are limited and uncertain clinical data to support the beneficial effect of this drug in COVID-19 treatment. HCQ has several side effects and warnings, including blindness, heart failure, and renal toxicity, even with recommended doses. For severe cases of COVID-19 or in patients with preexisting conditions, administering such a drug could be fatal, particularly when taken at high doses or in combination with other antibiotics. However, further well-designed studies that would address the optimal dose, duration of treatment, possible side effects, and long-term usage outcomes are needed to make the final decision. In this paper, we aim to discuss the risk of using HCQ in treating COVID-19 patients, including its possible side effects.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #442989
Database	COVID19

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Article ; Online: G6PD distribution in sub-Saharan Africa and potential risks of using chloroquine/hydroxychloroquine based treatments for COVID-19.

da Rocha, Jorge E B / Othman, Houcemeddine / Tiemessen, Caroline T / Botha, Gerrit / Ramsay, Michèle / Masimirembwa, Collen / Adebamowo, Clement / Choudhury, Ananyo / Brandenburg, Jean-Tristan / Matshaba, Mogomotsi / Simo, Gustave / Gamo, Francisco-Javier / Hazelhurst, Scott

The pharmacogenomics journal

2021 Volume 21, Issue 6, Page(s) 649–656

Abstract: Chloroquine/hydroxychloroquine have been proposed as potential treatments for COVID-19. These drugs ... have warning labels for use in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency ...

Abstract	Chloroquine/hydroxychloroquine have been proposed as potential treatments for COVID-19. These drugs have warning labels for use in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Analysis of whole genome sequence data of 458 individuals from sub-Saharan Africa showed significant G6PD variation across the continent. We identified nine variants, of which four are potentially deleterious to G6PD function, and one (rs1050828) that is known to cause G6PD deficiency. We supplemented data for the rs1050828 variant with genotype array data from over 11,000 Africans. Although this variant is common in Africans overall, large allele frequency differences exist between sub-populations. African sub-populations in the same country can show significant differences in allele frequency (e.g. 16.0% in Tsonga vs 0.8% in Xhosa, both in South Africa, p = 2.4 × 10
MeSH term(s)	Africa South of the Sahara/epidemiology ; COVID-19/epidemiology ; COVID-19/genetics ; Chloroquine/adverse effects ; Databases, Genetic ; Genetic Variation/genetics ; Glucosephosphate Dehydrogenase/genetics ; Glucosephosphate Dehydrogenase Deficiency/drug therapy ; Glucosephosphate Dehydrogenase Deficiency/epidemiology ; Glucosephosphate Dehydrogenase Deficiency/genetics ; Humans ; Hydroxychloroquine/adverse effects ; Mutation, Missense/genetics ; Risk Factors ; COVID-19 Drug Treatment
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH) ; Chloroquine (886U3H6UFF) ; Glucosephosphate Dehydrogenase (EC 1.1.1.49)
Language	English
Publishing date	2021-07-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2106831-8
ISSN	1473-1150 ; 1470-269X
ISSN (online)	1473-1150
ISSN	1470-269X
DOI	10.1038/s41397-021-00242-8
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Article: Mitigating arrhythmia risk in Hydroxychloroquine and Azithromycin treated COVID-19 patients using arrhythmia risk management plan.

Maneikis, Kazimieras / Ringeleviciute, Ugne / Bacevicius, Justinas / Dieninyte-Misiune, Egle / Burokaite, Emilija / Kazbaraite, Gintare / Monika Janusaite, Marta / Dapkeviciute, Austeja / Zucenka, Andrius / Peceliunas, Valdas / Kryzauskaite, Lina / Kasiulevicius, Vytautas / Ringaitiene, Donata / Zablockiene, Birute / Zvirblis, Tadas / Marinskis, Germanas / Jancoriene, Ligita / Griskevicius, Laimonas

International journal of cardiology. Heart & vasculature

2020 Volume 32, Page(s) 100685

Abstract: ... patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan. ... of Hydroxychloroquine and Azithromycin using arrhythmia risk management plan.: Methods and results ... We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting ...

Abstract	Aims: To assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using arrhythmia risk management plan. Methods and results: We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined arrhythmia risk management plan. The data was analyzed using R statistical package version 4.0.0. A two-tailed p-value<0.05 was considered significant. 81 patients were included from March 23rd to May 10th 2020. The median age was 59 years, 58.0% were female. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia. Fourteen patients (17.3%) experienced QTc ≥ 480 ms and 16 patients (19.8%) had an increase of QTc ≥ 60 ms. Seven patients (8.6%) had QTc prolongation of ≥ 500 ms. The treatment was discontinued in 4 patients (4.9%). None of the patients developed ventricular tachycardia. The risk factors significantly associated with QTc ≥ 500 ms were hypokalemia (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients (3.7%) died, the cause of death was bacterial superinfection with septic shock in two patients, and disseminated intravascular coagulation with multiple organ failure in one patient. None of these deaths were associated with cardiac arrhythmias. Conclusion: We recorded a low incidence of QTc prolongation ≥ 500 ms and no ventricular tachycardia events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan.
Language	English
Publishing date	2020-12-11
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	2818464-6
ISSN	2352-9067
ISSN	2352-9067
DOI	10.1016/j.ijcha.2020.100685
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Article ; Online: Systematic benefit-risk assessment for the use of chloroquine or hydroxychloroquine as a treatment for COVID-19: Establishing a framework for rapid decision-making

Osborne, V. / Davies, M. / Dhanda, S. / Roy, D. / Lane, S. / Evans, A. / Shakir, S. A.

Abstract: ... hydroxychloroquine in COVID-19 treatment. Methods: The overall benefit-risk of the use of chloroquine or ... of hydroxychloroquine or chloroquine in COVID-19 treatment. For the benefit of virological clearance, three studies were ... hydroxychloroquine as a treatment for COVID-19 compared to standard of care, placebo or other treatments was assessed ...

Abstract	Objectives: Given the current pandemic, there is an urgent need to identify effective, safe treatments for COVID-19 (coronavirus disease). A systematic benefit-risk assessment was designed and conducted to strengthen the ongoing monitoring of the benefit-risk balance for chloroquine and hydroxychloroquine in COVID-19 treatment. Methods: The overall benefit-risk of the use of chloroquine or hydroxychloroquine as a treatment for COVID-19 compared to standard of care, placebo or other treatments was assessed using the Benefit-Risk Action Team (BRAT) framework. We searched PubMed and Google Scholar to identify literature reporting clinical outcomes in patients taking chloroquine or hydroxychloroquine for COVID-19. A value tree was constructed and key benefits and risks were ranked by two clinicians in order of considered importance. Results: Several potential key benefits and risks were identified for use of hydroxychloroquine or chloroquine in COVID-19 treatment. For the benefit of virological clearance, three studies were identified. A significant risk difference (RD) between hydroxychloroquine and the comparator group (standard of care) was found for only one study (RD=0.58, 95% CI: 0.17, 0.98). The risk difference was not significant for the other two studies (RD=-0.07, 95% CI:-0.75, 0.61 and RD=0.08, 95% CI:-0.74, 0.91). In addition, no significant risk difference between hydroxychloroquine and the comparator group (standard of care) was identified for the risk of abnormal liver function tests (LFTs) (RD=0.07, 95% CI: -0.28, 0.41). Conclusions: Overall, no conclusion can be made on the benefit-risk profile of hydroxychloroquine or chloroquine in the treatment of COVID-19 compared to standard of care, placebo or other treatments at this time. Whilst the availability of comparative data are limited, the current framework summarises the key anticipated benefits and risks. As further data from clinical trials and real world use on these benefits and risks becomes available, this can be incorporated into the framework for an ongoing benefit-risk assessment.
Keywords	covid19
Publisher	MedRxiv; WHO
Document type	Article ; Online
DOI	10.1101/2020.05.07.20093989
Database	COVID19

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Article ; Online: Systematic benefit-risk assessment for the use of chloroquine or hydroxychloroquine as a treatment for COVID-19: Establishing a framework for rapid decision-making

Osborne, Vicki / Davies, Miranda / Dhanda, Sandeep / Roy, Debabrata / Lane, Samantha / Evans, Alison / Shakir, Saad AW

medRxiv

Abstract	Objectives: Given the current pandemic, there is an urgent need to identify effective, safe treatments for COVID-19 (coronavirus disease). A systematic benefit-risk assessment was designed and conducted to strengthen the ongoing monitoring of the benefit-risk balance for chloroquine and hydroxychloroquine in COVID-19 treatment. Methods: The overall benefit-risk of the use of chloroquine or hydroxychloroquine as a treatment for COVID-19 compared to standard of care, placebo or other treatments was assessed using the Benefit-Risk Action Team (BRAT) framework. We searched PubMed and Google Scholar to identify literature reporting clinical outcomes in patients taking chloroquine or hydroxychloroquine for COVID-19. A value tree was constructed and key benefits and risks were ranked by two clinicians in order of considered importance. Results: Several potential key benefits and risks were identified for use of hydroxychloroquine or chloroquine in COVID-19 treatment. For the benefit of virological clearance, three studies were identified. A significant risk difference (RD) between hydroxychloroquine and the comparator group (standard of care) was found for only one study (RD=0.58, 95% CI: 0.17, 0.98). The risk difference was not significant for the other two studies (RD=−0.07, 95% CI:−0.75, 0.61 and RD=0.08, 95% CI:−0.74, 0.91). In addition, no significant risk difference between hydroxychloroquine and the comparator group (standard of care) was identified for the risk of abnormal liver function tests (LFTs) (RD=0.07, 95% CI: −0.28, 0.41). Conclusions: Overall, no conclusion can be made on the benefit-risk profile of hydroxychloroquine or chloroquine in the treatment of COVID-19 compared to standard of care, placebo or other treatments at this time. Whilst the availability of comparative data are limited, the current framework summarises the key anticipated benefits and risks. As further data from clinical trials and real world use on these benefits and risks becomes available, this can be incorporated into the framework for an ongoing benefit-risk assessment.
Keywords	covid19
Language	English
Publishing date	2020-05-12
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.05.07.20093989
Database	COVID19

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Article: Hydroxychloroquine, QTc prolongation and risk of torsades de pointes.

Subhan, Sarah / Wang, Andy / Dey, Subo / Tang, Wei / Aronow, Wilbert S

Archives of medical sciences. Atherosclerotic diseases

2023 Volume 8, Page(s) e75–e80

Abstract: Hydroxychloroquine (HCQ) is a common medication used for the treatment of rheumatic diseases ... As a result of its widespread use during COVID-19, there are increasing concerns about its cardiotoxicity. HCQ ... conduction abnormalities. Despite reports of ventricular arrhythmia in COVID-19 patients taking HCQ, there ...

Abstract	Hydroxychloroquine (HCQ) is a common medication used for the treatment of rheumatic diseases. As a result of its widespread use during COVID-19, there are increasing concerns about its cardiotoxicity. HCQ is known to cause QTc prolongation, and its long-term use has been associated with cardiomyopathy and conduction abnormalities. Despite reports of ventricular arrhythmia in COVID-19 patients taking HCQ, there have been reassuring data in approved indications. HCQ has been in use for several decades with a good safety profile. In addition to better disease control and prevention of flares, it is associated with decreased risk of cardiovascular diseases. But given its small risk of cardiotoxicity, clinicians should be aware of this effect and monitor patients for developing cardiac symptoms.
Language	English
Publishing date	2023-08-17
Publishing country	Poland
Document type	Journal Article
ISSN	2451-0629
ISSN	2451-0629
DOI	10.5114/amsad/169982
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Article ; Online: Post-COVID-19 cryptosporidiosis: A serious risk or mere association?

Enas, A E / Hadel, M A / Emad, A A / Ibrahim, B E / Morsy, S / Noha, M A

Tropical biomedicine

2023 Volume 40, Issue 2, Page(s) 199–207

Abstract: ... Cryptosporidium spp. genotypes were molecularly characterized among post-COVID-19 patients using RFLP. Preliminary ... Post-COVID-19 conditions encompass a wide range of health problems, including enteritis ... symptoms, medical histories, fecal Cryptosporidium oocysts, and the history of COVID-19 infection ...

Abstract	Post-COVID-19 conditions encompass a wide range of health problems, including enteritis, but their association with parasitic infections has not yet been investigated. This study analyzed gastrointestinal symptoms, medical histories, fecal Cryptosporidium oocysts, and the history of COVID-19 infection in patients who attended the Faculty of Medicine, Cairo University, from January to July 2021. Fecal biomarkers, including H. pylori, occult blood, fecal calprotectin (FCAL), and TNF-a, were measured, and Cryptosporidium spp. genotypes were molecularly characterized among post-COVID-19 patients using RFLP. Preliminary results from 210 post-COVID-19 patients revealed that group 1 (Cryptosporidiumpositive) (n = 49) and group 2 (Cryptosporidium-negative) (n = 161) showed no significant difference in the prevalence rate of diabetes mellitus (DM). While group 2 was linked to diarrhea, only infections with Cryptosporidium post-COVID-19 were related to chronic diarrhea, vomiting, and weight loss. A total of 220 healthy subjects served as negative controls. Administering azithromycin, hydroxychloroquine, and ivermectin was significantly related to an increased risk of Cryptosporidium infection in group 1, whereas only azithromycin was more frequently recorded in group 2. Antioxidant supplementation insignificantly affected the incidence of cryptosporidiosis. Cryptosporidiosis with a history of COVID-19 was linked to H. pylori infections, increased inflammatory biomarkers (FCAL and TNF-a), and occult blood when compared with group 2. Cryptosporidium genotype 1 was the most commonly occurring subset in individuals with post-COVID-19. The findings demonstrated that aggravating gastrointestinal manifestations, increased fecal biomarkers and anti-COVID-19 therapeutic interventions are significantly related to the existence of Cryptosporidium oocysts in patients with post-COVID-19, indicating the predominance of.
MeSH term(s)	Humans ; Cryptosporidiosis/epidemiology ; Cryptosporidium ; Azithromycin/therapeutic use ; COVID-19 ; Diarrhea
Chemical Substances	Azithromycin (83905-01-5)
Language	English
Publishing date	2023-08-31
Publishing country	Malaysia
Document type	Journal Article
ZDB-ID	1068371-9
ISSN	2521-9855 ; 0127-5720
ISSN (online)	2521-9855
ISSN	0127-5720
DOI	10.47665/tb.40.2.012
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Article ; Online: Revisiting the cardiovascular risk of hydroxychloroquine in RA.

Pers, Yves-Marie / Padern, Guillaume

Nature reviews. Rheumatology

2020 Volume 16, Issue 12, Page(s) 671–672

MeSH term(s)	Anti-Bacterial Agents/adverse effects ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents/adverse effects ; Anti-Infective Agents/therapeutic use ; Antimalarials/adverse effects ; Antimalarials/therapeutic use ; Antimalarials/toxicity ; Arthritis, Rheumatoid/drug therapy ; Azithromycin/adverse effects ; Azithromycin/therapeutic use ; COVID-19/drug therapy ; COVID-19/epidemiology ; COVID-19/virology ; Cardiovascular Diseases/chemically induced ; Cardiovascular Diseases/physiopathology ; Drug Therapy, Combination ; Heart Disease Risk Factors ; Humans ; Hydroxychloroquine/adverse effects ; Hydroxychloroquine/therapeutic use ; Hydroxychloroquine/toxicity ; SARS-CoV-2/isolation & purification ; Safety ; Sulfasalazine/adverse effects ; Sulfasalazine/therapeutic use ; Time Factors
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents ; Antimalarials ; Sulfasalazine (3XC8GUZ6CB) ; Hydroxychloroquine (4QWG6N8QKH) ; Azithromycin (83905-01-5)
Keywords	covid19
Language	English
Publishing date	2020-09-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2491532-4
ISSN	1759-4804 ; 1759-4790
ISSN (online)	1759-4804
ISSN	1759-4790
DOI	10.1038/s41584-020-00521-x
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