Hydroxychloroquine and COVID-19 story: is the low-dose treatment the missing link? A comprehensive review and meta-analysis.

Hydroxychloroquine (HCQ) has been repurposed and used for the treatment of COVID-19 patients; however, its efficacy remains controversial, maybe partly due to the dosage, ranging from 200 to 800 mg/day, reported in different studies. Indeed, HCQ low dose (≤ 2.4 g/5 days) showed a lower risk of side effects compared to high doses. In this study, we performed a systematic review and meta-analysis to investigate the effect of low-dose HCQ used alone on three outcomes including in-hospital mortality, the need for mechanical ventilation, and ICU admission in COVID-19 patients. A systematic review of English literature was conducted from January 2020 to April 2022, in PubMed, Cochrane Library, and Google Scholar. Studies reporting a dosage of 400 mg twice the first day, followed by 200 mg twice for four days were included. Pooled odds ratios and 95% confidence intervals were calculated using random-effects models. Eleven studies (12,503 patients) were retained in the quantitative analysis, four observational cohort studies, and seven RCTs. When pooling both observational and RCTs, low-dose HCQ was associated with decreased mortality (OR = 0.73, 95% CI: [0.55-0.97], I2 = 58%), but not with mechanical ventilation need (OR = 1.03, 95% CI: [0.56-1.89], I2 = 67%) and ICU admission rate (OR = 0.70, 95% CI: [0.42-1.17], I2 = 47%). However, no effect was observed when pooling only RCTs. Despite RCTs limitations, treatment with low-dose HCQ was not associated with improvement in mortality, mechanical ventilation need and ICU admission rate in COVID-19 patients.

Causes of hospitalization and characteristics of Algerian chronic obstructive pulmonary disease patients in Tizi-Ouzou: a retrospective study.

Chronic obstructive pulmonary disease (COPD) is a progressive chronic inflammatory disease and the third cause of death worldwide in 2016. COPD epidemiology is well documented in high-income countries where the disease is well managed. However, the disease is neglected in low-income countries and there is lack of data. Our study aims to identify COPD patients' characteristics and hospital admission causes, and to determine disease etiologies and associated factors. A retrospective study was conducted in COPD Algerian patients using medical record data collected from January 2007 to May 2017 at the pulmonology department of the Belloua Hospital of Tizi-Ouzou city. Out of 133 hospital admissions for COPD during the study period, only 120 records were found and analyzed. Most of the admitted patients were men (96%) and the mean age was 74.29±9.56 years. Among them, 78.7% were in the GOLD stage III or IV and 9 deaths (7.5%) were recorded during the study period. Interestingly, disease severity is associated with increasing age of the patients and mortality (p=0.01 and p=0.02, respectively). Risk factors include cigarette smoking (93%), history of medical conditions (36.66%) with the most prevalent conditions being emphysema (38.63%) and asthma (27.27%), the cold season (47%), and occupational exposures (58%). Most of the admissions (64.16%) were due to acute dyspnea and 21.66 % to respiratory infections, however, 34.16 % of patients were readmitted at least one time. Comorbidities were observed in 57.5% of the patients, including cardiovascular diseases (63.76%) and diabetes (18.84%). These results show that COPD severity is associated with age and mortality. Better understanding of the COPD etiologies and the causes of hospital admission will lead to more effective management of the disease.