Background: Hydroxychloroquine (HCQ) has been used against SARS-CoV-2, but large non randomized studies failed to show any clinical benefit. However, in these studies the drug was started in the ...hospital setting, a significant time after the onset of symptoms.
Aim of the Study: to verify if HCQ, given early after the onset of symptoms and in the outpatient setting, can reduce hospital admissions and improve clinical outcomes of COVID-19
Methods: We performed a retrospective study on 824 patients with COVID-19 pneumonia in the Bergamo province (Lombardy, Italy). Patients were divided in 2 cohorts: the first included 354 outpatients attended by Primary Care Physicians (PCP), the second included 470 patients admitted to an Emergency Department (ED) during the same period. We compared rate of hospital admission and clinical outcomes in patients treated with HCQ within 6 days from the onset of symptoms, with all other patients. Clinical outcomes were evaluated at a 1-month time-point.
Results: Patients who received early treatment with HCQ showed a lower rate of hospital admissions (p<0.0001), mechanical ventilation (p<0.0022) and need for oxygen supplementation at home (p=0.002) in the first cohort and improved survival in the second (p=0.03). Early treatment with HCQ was the only independent variable influencing all predefined outcomes on multivariate analysis.
Conclusions: Treatment with HCQ, initiated within 6 days from the onset of COVID-19 may improve both clinical outcome and rate of hospital admissions.
To determine whether early and more frequent mobilization after stroke affects health-related quality of life.
A Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), ...phase 3 randomized controlled trial, spanning 2006-2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from -0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0.
No significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range IQR 0.07-0.81) and usual care (median 0.49, IQR 0.08-0.81) groups was identified (
= 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all
< 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age.
Earlier and more frequent mobilization after stroke did not influence quality of life.
anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.
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