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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus that emerged in late 2019 and has caused a pandemic of acute respiratory disease, named ‘coronavirus disease 2019’ (COVID-19), which has threatened human health and public safety. Objectives: Hydroxychloroquine (HCQ) is an anti-malaria drug with controversial antiviral properties. Some in vitro studies have approved its antiviral effects. Many efforts have been made to prevent and treat COVID-19, but effective drugs for complete eradication of COVID-19 have not been found yet and all available drugs are supportive. Methods: We tried to review some new aspects of HCQ efficacy in the prevention and treatment of COVID-19 infection. Also, some data from recent clinical trials were studied. It has been shown that HCQ may improve some symptoms of patients, but in severe or critical stages, it did not have significant therapeutic effects and did not reduce the rate of mortality. Results: In this review article, we explained some results of recent studies, including clinical trials on the effects of HCQ on the prevention and treatment of COVID-19 infection. Some studies have revealed HCQ’s beneficial effects in outpatients, and some data showed its hazardous impacts on the heart. The available evidence suggests that CQ or HCQ does not improve clinical outcomes in COVID-19. Well-designed randomized trials are required for assessing the efficacy and safety of HCQ and CQ for COVID. Conclusion: It was suggested that the dose of HCQ administration must be adjusted and monitored correctly;furthermore, the levels of some myocardial biomarkers, such as troponin must be measured in mild to moderate, severe, and critical infection. Also, combination therapy with other drugs, such as azithromycin may have better anti-inflammatory and antiviral effects
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The novel coronavirus infection involves both the Central and Peripheral Nervous systems. Some of the presentations include acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis, and epilepsy. Our patient was a 78-year-old man with dementia and diabetic nephropathy who was admitted two times for possibly COVID-19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and Kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID-19. After the negative RT-PCR test of the nasopharyngeal sample for COVID-19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever, and hypoxemia in the physical exam;he had neck stiffness in all directions, So the central nervous system (CNS) infection was suspected, the cerebrospinal fluid (CSF) sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID-19 was positive, but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet been reported. Our patient is the first one, so we decided to share it. This case showed a different presentation of COVID-19 without typical lung involvement. So, we must pay attention to any signs and symptoms in a patient suspected of having a COVID-19.
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Background: Patients with hematologic malignancies are considered particularly vulnerable to COVID 19 infection due to their underlying malignancy and their anticancer therapy. However, there are still few data on risk factors of mortality in this population. Aims: This study aimed to determine the clinical and biological caracteristics of COVID-19 infection in hematologic patients and the risk factors of COVID-19 severity and mortality Methods: This prospective study included all consecutives COVID 19 infected patients, treated for hematologic malignancies in the clinical hematology department of Aziza Othmana Hospital, between October 2020 and January 2021. Covid 19 infection was confirmed by PCR or rapid antigenic analysis of a nasopharyngal swab. We collected clinical, biological, radiological and outcomes data Results: No cases of COVID 19 infection was diagnosed in our departement during the first COVID 19 wave. The first confirmed case was diagnosed on 12th october 2020. A total of 68 patients was included. Median age was 47 years with a sex ratio of 1.5. Twenty-nine (43%) patients were treated for acute leukemia, 24 (37%) for lymphoma, 6 (9%) for chronic lymphocytic leukemia, 6 (9%) for multiple myeloma and 3 (4%) for myelodysplastic syndrome. Forty-three patients (63%) had active disease (AD) while 37% were in remission (RD). Thirty-three patients (46%) had at last 1 comorbidity including diabetes (16%) and obesity (9%). The main symptoms of the infection were fever (63%), cough (49%), dyspnea (40%) and diarrhea (30%). Seventeen patients had a chest scanning, 12 of them (70%) had a damage greater than 25% of the surface area of the lungs (60% and 85% in the AD and RD groups respectively [p=0.15]). During the infection, 44% of patients had lymphopenia and 21% grade 4 neutropenia. Median dosage of C reactive Protein was of 154 mg/l [1.9-658]. Twenty (29%) patients developped severe infection (37% and 16% in the AD and RD groups respectively [p=0.09]). Seven (10%) of them required admission in an intensive care unit (14% and 4% of the AD and RD groups respectively[p=0.14]). Significant risk factors of the severity of the infection were: age >45 years (p= 0.008), the presence of at least 1comorbidity (p=0.009), dyspnea (p< 0.0001) and a dosage of C reactive protein superior to 150 mg/l (p =0.033). Twelve patients (18%) died from COVID19 infection (23% and 8% in the AD and RD groups respectively[p=0.11]). Dyspnea and grade 4 neutropenia were the independent risk factors of death (p=0.011 and p=0.049 respectively). Summary/Conclusion: In this study of patients with hematological malignancies, high rates of COVID19 infection severity and associated mortality was noted especially in neutropenic patients. Although no difference was observed in the radiological severity between AD and RD groups, there was a trend to a more clinically severe infection in the AD group.
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Purpose Despite numerous studies, our understanding of the determinants of disability insurance (DI) claim rates in the USA is clouded. When the unemployment (UE) rate soars during an economic downturn such as the spread of COVID-19, assuming a linear positive relationship between the two variables, as the prior literature has suggested, forewarns a large spike in DI claim rates. Yet, if the model is misspecified, it can lead to misinformed decisions such as reducing DI awards during an economic downturn when such awards are needed the most. This study aims to improve the accuracy of the DI claims' prediction. Design/methodology/approach This study suggests that the relationship between the UE rate and DI claim rate is nonlinear and examines this hypothesis using a panel dataset of 866 state-year observations from 2002-2018. Findings The results provided compelling evidence in support of the proposed quadratic relationship between the UE rate and DI claim rate and revealed that compared to a quadratic model, the linear model overestimated the DI claim rate by approximately 18 percent or 172,000 claims per year. Practical implications Given that DI awards represent hundreds of thousands of dollars in present value terms, the impact of increase in DI claims on the Social Security Disability Fund during an economic downturn might not be as high as some model might forecast. Originality/value To our knowledge, no other studies have examined a quadratic relationship between the UE rate and the DI claim rate. This study is especially relevant during the coronavirus (COVID-19) pandemic and its aftermath. In April 2020, the UE rate spiked to nearly 15 percent nationwide, with Nevada and Michigan at 28 percent and 22.7 percent, respectively. The nonlinear model used in this study suggests that, as the UE increases, DI claims increase, albeit at a decreasing rate. On the contrary, a linear relationship between the UE rate and DI claim rates implies that the increase in the DI claim rate would be constant regardless of the UE rate. This misspecification can result in misinformed decisions, such as the reduction of DI awards because of the overestimation of claims during economic downturns. This can lead to lower award rates during economic turmoil when this assistance is most needed.