Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
1.
Frontiers in microbiology ; 13, 2022.
Article in English | EuropePMC | ID: covidwho-1837640

ABSTRACT

The severity, disabilities, and lethality caused by the coronavirus 2019 (COVID-19) disease have dumbfounded the entire world on an unprecedented scale. The multifactorial aspect of the infection has generated interest in understanding the clinical history of COVID-19, particularly the classification of severity and early prediction on prognosis. Metabolomics is a powerful tool for identifying metabolite signatures when profiling parasitic, metabolic, and microbial diseases. This study undertook a metabolomic approach to identify potential metabolic signatures to discriminate severe COVID-19 from non-severe COVID-19. The secondary aim was to determine whether the clinical and laboratory data from the severe and non-severe COVID-19 patients were compatible with the metabolomic findings. Metabolomic analysis of samples revealed that 43 metabolites from 9 classes indicated COVID-19 severity: 29 metabolites for non-severe and 14 metabolites for severe disease. The metabolites from porphyrin and purine pathways were significantly elevated in the severe disease group, suggesting that they could be potential prognostic biomarkers. Elevated levels of the cholesteryl ester CE (18:3) in non-severe patients matched the significantly different blood cholesterol components (total cholesterol and HDL, both p < 0.001) that were detected. Pathway analysis identified 8 metabolomic pathways associated with the 43 discriminating metabolites. Metabolomic pathway analysis revealed that COVID-19 affected glycerophospholipid and porphyrin metabolism but significantly affected the glycerophospholipid and linoleic acid metabolism pathways (p = 0.025 and p = 0.035, respectively). Our results indicate that these metabolomics-based markers could have prognostic and diagnostic potential when managing and understanding the evolution of COVID-19.

2.
16th Multidisciplinary International Congress on Science and Technology, CIT 2021 ; 406 LNNS:259-272, 2022.
Article in English | Scopus | ID: covidwho-1729260

ABSTRACT

As the Covid pandemic forced educational institutions to close their doors and transit to an online mode, little is known of how children learnt under such conditions. This article reports on the learning behaviors displayed by 377 children aged 5–12 in a technology-mediated course on science and arts. Using an ex post facto design, we employed a multivariate analysis to unveil hidden factors in the learning processes of participants. Results show traces of theoretical constructs linked to the stages of development supported by Piaget which are presented in descending order of predominance. In the Science module, Practical Knowledge and Verbal reasoning stand out above others while in the Arts module, Reasoning and Creativity surpass other features of the same category. From a practical stance, these findings may have implications on future course designs where it is desirable to develop other abilities related to science and arts. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

3.
16th Multidisciplinary International Congress on Science and Technology, CIT 2021 ; 406 LNNS:42-54, 2022.
Article in English | Scopus | ID: covidwho-1729254

ABSTRACT

The main purpose of this study is to identify the factors that contribute to teachers’ burnout during the COVID 19 pandemic in Ecuador. Additionally, the research aims to analyze teachers’ working conditions, determine the teachers’ health problems associated with the new working conditions, and establish the complementary activities that affect male and female teachers. This is stratified descriptive research based on a survey applied to 843 individuals who belong to different educational levels (preschool, elementary, secondary, technological institute, and university). As a result of the analysis, some significant findings are that teachers are working more hours with undefined schedules. Additionally, a percentage of teachers claimed to have some ailments. For instance, 38,2% have had neck pain and 32% have one or more ailments similar to those of carpal tunnel syndrome. Interestingly, women are more affected than men in relation to workload, housework, and childcare. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

4.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-329041

ABSTRACT

Objectives: Home working has increased due to COVID-19, but little is known about how this change has impacted the health risk behaviour of elevated sedentary time. The aim of this study was to assess occupational sitting behaviour when working at home, and use the Capability Opportunity Motivation-Behaviour (COM-B) model to identify influences on this behaviour. Design: Cross-sectional Methods: : University staff (n=267;69% female;92% white) who were predominantly working from home completed a questionnaire to assess sitting time, sitting breaks, demographic and occupational characteristics, and a 7-item COM-B questionnaire and open-ended questions to assess influences on time spent sitting whilst working from home. Data were analysed descriptively, a repeated measures ANOVA was used to determine differences in the COM-B items, and binary logistic regression was used to examine predictors of sitting time. Results: Staff spent on average 89.5% (SD=17.1) of their time sitting whilst working at home, and took an average of 1.36 (1.38) sitting breaks per hour. There were significant and meaningful differences in the influence of the COM factors on ability and willingness to reduce sitting behaviour (p<.0001;η p 2 =.38), and the open-ended responses added further context. The included variables accounted for 19.6% of variance in sitting behaviour, with age, sitting breaks, motivation-automatic, and opportunity-physical contributing significantly. Conclusions: : Working from home leads to elevated levels of sitting, and the COM-B provides a useful model to identify key influences on ability and willingness to reduce sitting. Strategies incorporating regular breaks, habit formation/reversal, and restructuring the physical environment may be beneficial.

5.
EuropePMC;
Preprint in Portuguese | EuropePMC | ID: ppcovidwho-328141

ABSTRACT

Este artigo objetivou realizar uma análise dos casos confirmados e óbitos por COVID-19 em profissionais de enfermagem do estado do Amazonas. Trata-se de um estudo epidemiológico, que se valeu dos dados obtidos no Observatório da Enfermagem do Conselho Federal de Enfermagem (COFEN), analisando-se os números de casos e óbitos no período de abril de 2020 a abril de 2021. Foi implementada análise estatística do tipo descritiva e utilizados o teste qui-quadrado. Foram notificados 286 casos suspeitos, 148 confirmados e 79 óbitos, com taxa de incidência de 278,31, mortalidade de 148,55 e letalidade de 53,4%. A categoria de técnicos de enfermagem foi a mais acometida, 62,8% (n = 93), a faixa etária mais relevante variou de 41 - 50 anos e o gênero feminino representa 74,3% (n = 110). Somente a variável gênero esteve significativamente associada aos óbitos por COVID-19. Foi evidenciado oscilações entre as series temporais de incidência e mortalidade. Conclui-se que os profissionais de enfermagem do Amazonas se encontram em uma situação de alto risco para a doença e óbito, o que requer uma atenção mais criteriosa por parte dos gestores, COFEN e Conselho Regional ao campo laboral e suporte ao exercício da enfermagem.

6.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):465-466, 2021.
Article in English | EMBASE | ID: covidwho-1570398

ABSTRACT

Background: Dupilumab has been recently approved for treatment in patients with severe AD in Portugal-until now there is no published data regarding Portuguese experience in Allergy centers. Method: Cross sectional clinical and laboratory assessment of 33 patients (pts) with moderate to severe AD treated with dupilumab (dupi) for at least 16 weeks (W): prospective evaluation of severity scores (SCORAD-Scoring Atopic Dermatitis, EASI-Eczema Area and Severity Index, P-VAS-Pruritus Visual Analogic Scale), report of adverse events up to 52 weeks of treatment. SCORAD and EASI were assessed in 23 pts at W52, P-VAS in 21 pts at W52. Results: Of the 33 pts, 18 were female (55%) with a mean age (SD, range) of 35.3 years (13.2, 15-60). In 16 pts the age of onset was before 2 years old, mean (SD) disease duration 28.1 years (12);94% patients had a diffuse pattern of skin lesions;97% of pts had allergic rhinitis, 82% asthma, 52% conjunctivitis and 30% food allergy. Median total IgE at baseline was of 6313 U/ml (P25-P75: 2842-12491) with a 76% reduction at W52 in 16 pts. Median eosinophil count at baseline was 520 eosinophils/mm3 (P25-P75: 270-740). Before starting dupi 29 pts had been treated with cyclosporine. At the beginning, 15 pts were under oral corticosteroids, 14 under oral systemic immunosuppressive drugs (all pts but two stopped both until W12 of dupi) and 5 switched from omalizumab. At baseline, median SCORAD and EASI were 69.3 and 24.2 points. At W16, W36 and W52, median SCORAD was 27.4, 22.3 and 21.5, and median EASI 5.3, 4.1 and 2.1. At W16, the EASI-50, EASI-75 and EASI-90 were achieved by 91%, 61% and 18% pts, and at W52, by 87%, 70% and 52% pts. The mean percentage of SCORAD reduction at W16 and W52 was 55% and 73%;and of EASI was 76% and 82%. At W16 and W52, an improvement of ≥4 points in P-VAS was achieved by 77% and 95% pts. There was a mean reduction of P-VAS at W2, W4, W16 and W52 of 2.6;3.6;4.7 and 6.3 points, respectively. Conjunctivitis was reported in 10 (30%) pts, two of them with keratoconjunctivitis and blepharitis, without needing to interrupt treatment;two pts also had facial erythema. One patient had COVID, and dupilumab scheme treatment was maintained. Conclusion: The majority of AD patients had a significant and consistent improvement in all the severity scores, after one year of treatment with dupilumab. No relevant adverse events were reported.

7.
Health ; 13(8):830-838, 2021.
Article in English | CAB s | ID: covidwho-1547588

ABSTRACT

In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.

8.
Rev. Soc. Bras. Med. Trop ; 54: e0210, 2021. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1346347

ABSTRACT

Abstract INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.

9.
HOLOS ; 37(2):1-17, 2021.
Article in Portuguese | ProQuest Central | ID: covidwho-1302823

ABSTRACT

According to data from the Brazilian Association of Cotton Producers, Brazil occupies 4th place in the ranking of cotton production according to the 18/19 harvest. Because of this importance, this review aimed to carry out a bibliometric survey on cotton oil and flour and their applications. The results showed that there were a total of 1525 research and reviews articles in the Scopus and Web of Science databases in the last three decades, and, based on the entire analysis, it was noticed that the studies of the last three decades are focused on separation area and biofuels, as well as that the Republic of China stands out among the most cited countries besides its universities. According to these results, it can be concluded that the Republic of China has a lot of influence in studies with cotton and more research is needed to use cotton and its derivatives in the food industry. Bibliometric analysis, Biofuels, Gossypium hirsutum L., VOSviewer 1INTRODUÇAO O algodao (Gossypium hirsutum L.) pertence a família das malváceas e é umas das fibras mais conhecidas no mundo.

11.
International Journal of Dairy Science ; 16(2):67-74, 2021.
Article in English | Scopus | ID: covidwho-1264590

ABSTRACT

Background and Objective: The pandemic created by the new coronavirus (COVID-19) has resulted in several economic, political, environmental and social changes around the world. To understand the possible change in the behaviour of consumers of dairy products (at home) during the pandemic COVID-19 in Brazil, the responses of various people through an online questionnaire sent by social networks were analyzed. Materials and Methods: To assess the consumer profile, age, sex, residence and family income were asked. It was also asked if the consumer was aware of the benefits of eating milk and if it was common practice to encourage the consumption of dairy products. The questionnaire was disseminated throughout all five Brazilian regions and to the most diverse audiences, accounting for a total of 1,002 respondents. Results: Dairy products are commonly purchased, being consumed and valued by most respondents (>80%). The most observed requirement when purchasing these products was the price factor, followed by physical and hygienic conditions and the product brand. Among the dairy products most consumed during the pandemic are cheeses, butter, milk, condensed milk, sour cream, yoghurt and ice cream. Conclusion: Most respondents are aware of the benefits that the intake of milk and dairy products provides to the body and even with an increase in prices, demand and consumption increased during the survey period within the COVID-19 pandemic in Brazil. © 2021 Eistys M.T.C. Almeida and Marco T.C. Almeida.

12.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200660, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1197422

ABSTRACT

OBJECTIVE: To analyze nurses' experiences in the front line of the fight against the COVID-19 pandemic regarding the performance of emotional labor (EL), aiming at its characterization and identification of support strategies and development opportunities of nurses and practices. METHODS: Qualitative, descriptive, and exploratory study, with content analysis of eleven written narratives and reports from a focus group composed of nurses with experience in caring for patients with COVID-19 from different Hospital Centers in Lisbon, Portugal. RESULTS: Five themes were extracted: 1) Challenges experienced by nurses in the frontline; 2) Emotions experienced by nurses in service care; 3) Emotional responses of nurses and patients: impact on care; 4) EL of nurses in the patient care process; 5) Opportunities for development in the face of the emotional challenge required of nurses in combating COVID-19. FINAL CONSIDERATIONS: The nurses demonstrated the ability to transform this profoundly emotional experience positively.


Subject(s)
COVID-19 , Emotions , Nursing Staff, Hospital , Humans , Pandemics , Portugal , SARS-CoV-2
13.
Nat Commun ; 12(1): 2349, 2021 04 15.
Article in English | MEDLINE | ID: covidwho-1189222

ABSTRACT

Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/ ). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.


Subject(s)
COVID-19/drug therapy , COVID-19/mortality , Chloroquine/adverse effects , Hydroxychloroquine/adverse effects , Pregnancy Complications, Infectious/mortality , Adult , COVID-19/complications , COVID-19/virology , Child , Chloroquine/administration & dosage , Combined Modality Therapy/adverse effects , Combined Modality Therapy/methods , Comorbidity , Female , Humans , Hydroxychloroquine/administration & dosage , International Cooperation , Odds Ratio , Patient Participation/statistics & numerical data , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/virology , Randomized Controlled Trials as Topic/statistics & numerical data , SARS-CoV-2
14.
J Otol ; 16(3): 158-164, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1062490

ABSTRACT

PURPOSE: COVID-19 associated hearing loss is still an ongoing matter of debate. No original studies exist on audiological effects of SARS-CoV-2 infection in hospitalized patients. The main objective was to determine whether SARS-CoV-2 may affect auditory function in clinically ill COVID-19 patients. MATERIALS AND METHODS: COVID-19 patients with moderate-severe disease and without prior history of hearing abnormalities were enrolled from a tertiary referral center, and matched with controls. Participants performed an audiometric evaluation, and thresholds were compared. RESULTS: 120 ears from 60 patients were enrolled. Patients with COVID-19 showed worse mean auditory thresholds starting from 1000 Hz through higher frequencies, when compared to controls (1000 Hz: 18.52 ± 5.49 dB HL in controls vs 25.36 ± 6.79 dB HL in COVID-19, p < 0.001; 2000Hz: 17.50 ± 5.57 dB HL in controls vs 21.96 ± 7.05 dB HL in COVID-19, p = 0.010; 3000Hz: 17.97 ± 8.07 dB HL in controls vs 25 ± 9.38 dB HL in COVID-19, p = 0.003; 4000 Hz: 20.16 ± 10.12 dB HL in controls vs 29.55 ± 11.26 dB HL in COVID-19, p = 0.001; 8000 Hz: 31.09 ± 12.75 dB HL in controls vs 40.71 ± 19.40 dB HL in COVID-19, p = 0.030; Pure Tone Average: 20.42 ± 4.29 dB HL in controls vs 24.85 ± 5.62 dB HL in COVID-19, p = 0.001). Statistical significance persisted after adjusting for confounders such as age, gender and various comorbidities (p < 0.05). CONCLUSIONS: SARS-CoV-2 may affect hearing in COVID-19 patients with moderate-severe disease. Results are in line with the previous suggested effects of COVID-19 on auditory system. This study is expected to encourage further research on this topic.

15.
Estudos Teologicos ; 60(2):446-465, 2020.
Article in Portuguese | Web of Science | ID: covidwho-1005331

ABSTRACT

The current context raises different theological interpretations about the presence of God in the midst of the suffering caused by the pandemic cycle that we are experiencing. Such interpretations include concepts related to God, suffering, evil, judgment, sin and salvation. Theodicy has been the predominant interpretative paradigm of these metaphysically apathetic, omnipotent relationships and divine goodness amid suffering. A theopathy represents a second form of theological interpretation of this relationship with a proportion of radical questions about metaphysical statements about divine impassibility and omnipotence and God's approach to the suffering and death of the innocent. We propose that the inversion of omnipotence operated by theopathy, in the form of the omnipotence of love, still operates in the logic of theodicy and points to a theorevolt as a possibility of overcoming theodicy and transfiguring the theopathy to think about the theological experience of God and evil in times of Covid-19.

16.
Rev. Soc. Bras. Med. Trop ; 53:e20200619-e20200619, 2020.
Article in English | LILACS (Americas), Grey literature | ID: grc-742197

ABSTRACT

With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19.

17.
Hematology, Transfusion and Cell Therapy ; 42:535, 2020.
Article in Portuguese | ScienceDirect | ID: covidwho-893865
18.
Rev. Soc. Bras. Med. Trop ; 53: e20200619, 2020. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-788944

ABSTRACT

Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19.


Subject(s)
Humans , Female , Young Adult , Pneumonia, Viral/diagnosis , Recurrence , Coronavirus Infections/diagnosis , Brazil , RNA, Viral/isolation & purification , Coronavirus Infections , Reverse Transcriptase Polymerase Chain Reaction , Pandemics , Betacoronavirus , Antibodies, Viral/blood
19.
Cathrine Axfors; Andreas M Schmitt; Perrine Janiaud; Janneke van 't Hooft; Sherief Abd-Elsalam; Ehab F Abdo; Benjamin S Abella; Javed Akram; Ravi K Amaravadi; Derek C Angus; Yaseen M Arabi; Shehnoor Azhar; Lindsey R Baden; Arthur W Baker; Leila Belkhir; Thomas Benfield; Marvin A H Berrevoets; Cheng-Pin Chen; Tsung-Chia Chen; Shu-Hsing Cheng; Chien-Yu Cheng; Wei-Sheng Chung; Yehuda Z Cohen; Lisa N Cowan; Olav Dalgard; Fernando F de Almeida e Val; Marcus V G de Lacerda; Gisely C de Melo; Lennie Derde; Vincent Dubee; Anissa Elfakir; Anthony C Gordon; Carmen M Hernandez-Cardenas; Thomas Hills; Andy I M Hoepelman; Yi-Wen Huang; Bruno Igau; Ronghua Jin; Felipe Jurado-Camacho; Khalid S Khan; Peter G Kremsner; Benno Kreuels; Cheng-Yu Kuo; Thuy Le; Yi-Chun Lin; Wu-Pu Lin; Tse-Hung Lin; Magnus Nakrem Lyngbakken; Colin McArthur; Bryan McVerry; Patricia Meza-Meneses; Wuelton M Monteiro; Susan C Morpeth; Ahmad Mourad; Mark J Mulligan; Srinivas Murthy; Susanna Naggie; Shanti Narayanasamy; Alistair Nichol; Lewis A Novack; Sean M O'Brien; Nwora Lance Okeke; Lena Perez; Rogelio Perez-Padilla; Laurent Perrin; Arantxa Remigio-Luna; Norma E Rivera-Martinez; Frank W Rockhold; Sebastian Rodriguez-Llamazares; Robert Rolfe; Rossana Rosa; Helge Rosjo; Vanderson S Sampaio; Todd B Seto; Muhammad Shehzad; Shaimaa Soliman; Jason E Stout; Ireri Thirion-Romero; Andrea B Troxel; Ting-Yu Tseng; Nicholas A Turner; Robert J Ulrich; Stephen R Walsh; Steve A Webb; Jesper M Weehuizen; Maria Velinova; Hon-Lai Wong; Rebekah Wrenn; Fernando G Zampieri; Wu Zhong; David Moher; Steven N Goodman; John P A Ioannidis; Lars G Hemkens.
Preprint in English | medRxiv | ID: ppmedrxiv-20194571

ABSTRACT

Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aimed to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We conducted a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality was extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses included patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine was 1.11 (95% CI: 1.02, 1.20; I2=0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I2=0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine was associated with increased mortality in COVID-19 patients, and there was no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.

SELECTION OF CITATIONS
SEARCH DETAIL