Hydroxychloroquine in Treatment of Asymptomatic and Mildly Symptomatic COVID-19: A Multi-Centre Cohort Study.

BACKGROUND: Although hydroxychloroquine (HCQ) lacks benefit in patients with moderate-to-severe COVID-19, its role in asymptomatic and mildly symptomatic disease needs better elucidation. METHODS: This multi-centre cohort study included asymptomatic and mildly symptomatic, RT-PCR confirmed COVID-19 cases between 30 March and 20 May, 2020. Patients were categorized into two groups (HCQ-treated and untreated) based on exposure to HCQ. Dose of HCQ used was 400 mg twice daily (day one) followed by once daily for seven days. HCQ-untreated patients were managed supportively without any active antiviral or immunomodulatory therapy. Nasopharyngeal SARS-CoV-2 clearance by RT-PCR (primary outcome) was compared between HCQ-treated and untreated patients using Kaplan-Meier analysis and Cox proportional-hazards regression. Clinical efficacy and safety profile of HCQ were assessed (secondary outcomes). RESULTS: 162 patients [84 (51·9%) males; mean age 38·2 (15·2) years] were included. Forty-four (27·2%) patients had mild disease, rest 118 (72·8%) were asymptomatic. Seventy-five (46·3%) patients received HCQ. Median time to virological negativity was lesser in HCQ-treated (13 days) versus untreated patients (15 days) (logrank<0·001) in both asymptomatic and mildly symptomatic patients. Treatment with HCQ was the only independent predictor of virological negativity (hazardratio=2·24; adjusted p-value<0·001). Two (5·4%) mildly symptomatic patients progressed to severe disease within 24 hours (two doses) of HCQ initiation, compared to none in the HCQ-untreated group. Five HCQ-treated patients developed minor gastrointestinal side effects, not requiring drug discontinuation. CONCLUSION: HCQ reduced the time to virologic negativity (by 2 days) in asymptomatic and mildly symptomatic COVID-19, without any serious adverse events. However, no obvious clinical benefit was noted.

A Cross-Sectional Study to Evaluate Cardiovascular Risk Score in Type 2 Diabetes Mellitus.

BACKGROUND: Cardiovascular disease is the leading cause of mortality worldwide, including in low- and middle-income countries. Cardiovascular risk assessment is essential to prevent the mortality caused by diabetes. AIM: The current study was conducted to assess the prevalence of cardiovascular risk factors in type 2 diabetes and to compare the United Kingdom Prospective Diabetes Study (UKPDS) and World Health Organization (WHO)/International Society of Hypertension (ISH) chart in assessing cardiovascular risk score. MATERIALS AND METHODS: Cardiac risk assessments were done in fifty patients attending the medicine outpatient department in an institutional hospital after ethical clearance and taking informed consent from patients. Two assessment tools were applied on the same patient. RESULTS: Overall, 10% of people were obese (body mass index >30). Smoking was prevalent in 20% (10/50) of patients. Hypertension was observed in 60% (30/50) of patients. Raised total cholesterol (TC) was the most common lipid abnormality affecting 94% of patients. The WHO/ISH prediction charts identified 14% and 10% of patients with cardiovascular risk category <10 and 10-20, whereas the UKPDS engine predicted 24% and 38% in the same category. In high-risk categories 30-40 and >40, the WHO/ISH score predicted a higher proportion of patients (18% and 32%) than the UKPDS engine (8% and 4%, respectively). Kappa value was calculated to calculate the degree of agreement between two tools, and it was found to be 0.781 (P < 0.01). CONCLUSION: Raised TC and hypertension were the most prevalent risk factors. There was no significant discrepancy between two assessment tools in predicting cardiovascular risk score among type 2 diabetes mellitus patients in our study.