Efficacy and safety of chloroquine and hydroxychloroquine for the treatment of COVID19 infection: An umbrella review

Introduction: Among all therapeutic approaches for COVID-19, most controversies have been raised about the efficacy and safety hydroxychloroquine (HCQ) and chloroquine. We conducted an umbrella review to assess any potential benefits of hydroxychloroquine and chloroquine in treating COVID-19.Methods: We searched the Cochrane Database of Systematic Reviews, PubMed and covid-evidence.org from December 2019 until July 2022. Time to viral clearance, need for mechanical ventilation and mortality were assessed as main efficacy outcomes. The analysis was performed using R package version 4.1.2.Result : Hydroxychloroquine had no benefit in decreasing time to viral clearance at days 7 (RR 0.81; 95% CI 0.63, 1.03) and 14 (RR 1.00; 95% CI 0.90, 1.139). Chloroquine has no statistically significant effect in decreasing the time of viral negativity at days 7 (RR 1.20; 95%CI 0.64, 2.25) and 14 (RR 1.08; 95%CI 0.85, 1.36). There is no difference in the need for mechanical ventilation among hydroxychloroquine plus azithromycin versus standard of care groups. Hydroxychloroquine marginally increased the mortality rate compared to placebo but not statistically significant (RR 1.09; P-value 0.05). Adding azithromycin to hydroxychloroquine had no statistically significant effect of decreasing mortality (RR 0.52; 95%CI 0.13, 2.07). Treatments with hydroxychloroquine increased the risk of adverse effects (RR 2.71; 95%CI 1.66, 4.43; p-value <0.0001). Adding azithromycin to hydroxychloroquine increased the adverse events (RR 1.74; 95% CI 1.27, 2.38). Conclusion: Though access to antivirals is an important challenge in developing countries, the decision to sus-pend hydroxychloroquine and chloroquine in treating COVID-19 appears right

Automédication et conseil pharmaceutique en période de pandémie de COVID-19 à Oran / Self-medication and pharmaceutical advice during the COVID-19 pandemic in Oran

Introduction : L'épidémie de Covid-19 a créé une psychose et une anxiété généralisées. Cela pourrait être lié, d'une part, à la mortalité élevée observée dans le monde, et d'autre part, à l'absence d'une thérapie spécifique. Face à cette situation, de nombreuses substances ont été utilisées sans avis médical. L'objectif de cette étude était d'évaluer les pratiques de l'automédication en situation de Covid-19 à Oran. Matériel et méthodes : Il s'agit d'une enquête transversale observationnelle réalisée par questionnaire électronique anonyme (googleforms) et distribué, par e-mail, à des pharmaciens adhérents à la section ordinale régionale des pharmaciens d'Oran. Les réponses ont été analysées par le logiciel Statistical Package for the Social Sciences (SPSS). Résultats : Au total, 69 réponses ont été obtenues. La proportion de pharmaciens ayant perçu une tendance à la hausse de l'automédication était de 58,0%. Environ le quart des pharmaciens (22,9%) avaient constaté une augmentation de l'automédication à l'hydroxychloroquine ; néanmoins, aucune toxicité secondaire à l'usage de ce médicament n'a été observée. En cette situation d'épidémie de Covid-19, 91.3% de l'échantillon d'étude avaient constaté une augmentation du recours aux vitamines et compléments alimentaires, avec une consommation fréquente de la vitamine C à 1gr/j ainsi que d'autres complexes vitaminiques à base de vitamine D, vitamine B9 et fer chez la femme enceinte ou allaitante. Conclusion : Notre étude a montré qu'en période de Covid - 19 la tendance à l'automédication a augmenté. L'automédication à l'hydroxychloroquine a été observée durant cette pandémie néanmoins l'usage d'autres substances telles que les vitamines et les compléments alimentaires était plus fréquent.

Introduction : the epidemic of Covid-19 has created generalized psychosis and anxiety. This could be linked, on the one hand to the high mortality observed in the word, and the other hand to the absence of specific therapy. Faced with this situation, many substances have been used without medical advice. The objective of this study was to evaluate the practice of self-medication in COVID-19 situation in Oran. Materials and methods : this is an observational cross sectional survey carried out by an anonymous electronic questionnaire and distributed, by email, to pharmacist belonging to the regional ordinal section of pharmacist in Oran. The answers were analysed by the software Statistical Package for the Social Sciences (SPSS). Results : A total of 69 responses were obtained. The proportion of pharmacists who noticed an increasing trend in self-medication was 58,0%. About a quarter of pharmacist had observed an increase in selfmedication with hydroxychloroquin, at least no toxicity secondary to the use of this drug was observed. In this COVID19 epidemic situation, 91.3% of the study sample noted an increase in the use of vitamins and food supplements with frequent consumption of vitamin C at 1g/day as well as other vitamin comlexes based on vitamin D, vitamin B9 and iron for pregnant or breastfeeding women. Conclusion : Our study showed that during COVID-19 the tendency to self-medication increased. Self-medication with hydroxychloroquin was observed during this pandemic, although the use of other substances such as vitamins and food supplements was more frequent.

COVID-19: Guidelines for pharmacists in South Africa

Since the outbreak of COVID-19, and its declaration as a pandemic by the World Health Organization (WHO), the reliance on pharmacists as one of the first points of contact within the healthcare system has been highlighted. This evidence-based review is aimed at providing guidance for pharmacists in community, hospital and other settings in South Africa, on the management of patients with suspected or confirmed coronavirus disease 2019, or COVID-19. The situation is rapidly evolving, and new evidence continues to emerge on a daily basis. This guidance document takes into account and includes newly available evidence and recommendations, particularly around the following aspects relating to COVID-19: • Epidemiology • The virus, its modes of transmission and incubation period • Symptom identification, including the differentiation between influenza, allergic rhinitis, sinusitis and COVID-19 • Social media myths and misinformation • Treatment guidelines and medicines that may need to be kept in stock • Treatment and prevention options, including an update on vaccine development • The case for and against the use of NSAIDs, ACE-inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19 • Interventions and patient counselling by the pharmacist. It is critical, though, that pharmacists access the most recent and authoritative information to guide their practice. Key websites that can be relied upon are: • World Health Organization (WHO): https://www.who.int/emergencies/diseases/novelcoronavirus-2019 • National Institute for Communicable Diseases (NICD): https://www.nicd.ac.za/diseasesa-z-index/covid-19/ • National Department of Health (NDoH): http://www.health.gov.za/index.php/ outbreaks/145-corona-virus-outbreak/465-corona-virus-outbreak; https://sacoronavirus. co.za/

Ocular manifestations of rheumatoid arthritis and complications of hydroxychloroquine treatment

Background: Rheumatoid arthritis (RA) is the most common autoimmune disease. Ocular manifestations of RAvary and are mainly keratoconjunctivitis sicca, episcleritis, scleritis and keratitis. Antimalarial drugs [hydroxychloroquine (HCQ) and chloroquine (CQ)] have been used for the treatment of RA. Objective: The aim of this study was to study the ocular manifestations of rheumatoid arthritis and the complications of the use of hydroxychloroquine in treatment. Patients and methods: A prospective study that was conducted at Al-Zahraa University Hospital. The study included a total of 80 eyes of 40 patients. Patients were divided into two groups: Group (1) 20 RA patients not using HCQ treatment and group (2) 20 RA patients using HCQ treatment. All patients underwent complete ophthalmic examination including SD-OCT. Results: the most ocular manifestations found in patients were keratoconjunctivitis sicca (KCS) 93.8%, scleritis and episcleritis 2.5%, acute anterior uveitis (AAU) and sclerosing keratitis 1.3%. Regarding SD-OCT finding comparing between the two groups, we found signs of early HCQ retinopathy in patients of group 2 in the form of parafoveal and perifoveal thining compared to group 1. Conclusion: RA is associated with many extra-articular manifestations, HCQ and CQ used in treatment of RA have significant efficacy and safety, but with long duration of using can cause retinopathy, and follow up of patients is necessary to detect early retinopathy