Hydroxychloroquine: A review of its safety and efficacy in COVID-19

Antimalarial Drugs at the Intersection of SARS-CoV-2 and Rheumatic Diseases: What Are the Potential Opportunities?

Background and Objectives: The coronavirus disease of 2019 (COVID-19) pandemic has posed a serious threat to humanity and is considered a global health emergency. Antimalarial drugs (ADs) have been used in the treatment of immuno-inflammatory arthritis (IIA) and coronavirus infection (COVID-19). The aim of this review is to analyze the current knowledge about the immunomodulatory and antiviral mechanisms of action, characteristics of use, and side effects of antimalarial drugs. Material and Methods: A literature search was carried out using PubMed, MEDLINE, SCOPUS, and Google Scholar databases. The inclusion criteria were the results of randomized and cohort studies, meta-analyses, systematic reviews, and original full-text manuscripts in the English language containing statistically confirmed conclusions. The exclusion criteria were summary reports, newspaper articles, and personal messages. Qualitative methods were used for theoretical knowledge on antimalarial drug usage in AIRDs and SARS-CoV-2 such as a summarization of the literature and a comparison of the treatment methods. Results: The ADs were considered a "candidate" for the therapy of a new coronavirus infection due to mechanisms of antiviral activity, such as interactions with endocytic pathways, the prevention of glycosylation of the ACE2 receptors, blocking sialic acid receptors, and reducing the manifestations of cytokine storms. The majority of clinical trials suggest no role of antimalarial drugs in COVID-19 treatment or prevention. These circumstances do not allow for their use in the treatment and prevention of COVID-19. Conclusions: The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for COVID-19. Furthermore, the need for high doses in the treatment of viral infections increases the likelihood of gastrointestinal side effects, the prolongation of QT, and retinopathy. Large randomized clinical trials (RCTs) have refuted the fact that there is a positive effect on the course and results of COVID-19.

Sudden Sensorineural Hearing Loss in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

INTRODUCTION

Accumulating data indicate that patients with COVID-19 could be affected by sudden sensorineural hearing loss (SSNHL). The aim of the study was to analyze the epidemiological and clinical trend of SSNHL occurrence during the COVID-19 pandemic by applying a systematic review and meta-analysis approach.

METHODS

PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane databases were searched.

RESULTS

The seven included studies had adequate relevance to the topic and the quality was fair. The mean age at SSNHL onset ranged from 39.23 to 62.18 years during the pandemic year period (PYP); a meta-analysis of four studies comparing these data with those of previous periods in the same institutions found a younger age during the PYP (pooled mean -0.2848). The heterogeneity was high (76.1935%) and no frank asymmetry was observed in the funnel plot. The SARS-CoV-2 positivity rate of SSNHL patients ranged from 0% to 57.53%. Standard steroid treatments were applied without significant adverse effects. Comprehensively, hearing improvement was achieved for more than half of the cases. No studies reported long-term follow-up data.

CONCLUSIONS

Further prospective analyses on large series and a long-term follow up on COVID-related SSNHL cases are necessary to address the open questions regarding the causative link between COVID-19 infection and SSNHL.

Evolution of incidence of audiovestibular disorders during the pandemic COVID-19 period

Purpose

Despite sporadic case reports describing hearing problems in patients with coronavirus disease 2019 (COVID-19), whether COVID-19 affects the audiovestibular system remains unclear. This study assessed the evolution of incidence of audiovestibular disorders during the pandemic COVID-19 period.

Method

Three audiovestibular disorders namely, sudden sensorineural hearing loss (SSHL), autonomic dysfunction, and Meniere’s disease (MD) were analyzed and compared from 2016 to 2020.

Results

The annual new cases at our clinic comprised overall 2107, 1997, 1984, 2068, and 1829 from 2016 to 2020, respectively, and the respectively annual cases of SSHL were 54, 46, 42, 45 and 38. Accordingly, annual incidences of SSHL in relation to overall cases of audiovestibular disorders were 2.6%, 2.3%, 2.1%, 2.2% and 2.1% from 2016 to 2020, respectively, exhibiting a non-significant difference (p > 0.05). In contrast, incidence of autonomic dysfunction in the year 2020 was 15.3%, which revealed significantly higher than 8.5–13.1% from 2016 to 2019 (p < 0.001). Restated, the incidence of autonomic dysfunction in 2020 displayed a significantly higher percentage than the other 4 years. Conversely, the incidence of MD in 2020 was 9.8%, showing a significant decline compared with the other 4 years (12.6–15.6% from 2016 to 2019, p < 0.001),

Conclusion

Evolution of incidence of audiovestibular disorders during the pandemic COVID-19 period revealed increase in the incidence of autonomic dysfunction and decrease in that of MD, while incidence of SSHL remained unchanged from 2016 to 2020. Thus, the SARS-CoV-2 may less affect the audiovestibular system.