Chloroquine and hydroxychloroquine are now being widely used for treatment of COVID-19. Both medications prolong the QT interval and accordingly may put patients at increased risk for torsades de pointes and sudden death. Published guidance documents vary in their recommendations for monitoring and managing these potential adverse effects. Accordingly, we set out to conduct a systematic review of the arrhythmogenic effect of short courses of chloroquine or hydroxychloroquine. We searched on MEDLINE and Embase, as well as in the gray literature up to April 17, 2020, for the risk of QT prolongation, torsades, ventricular arrhythmia, and sudden death with short-term chloroquine and hydroxychloroquine usage. This search resulted in 390 unique records, of which 41 were ultimately selected for qualitative synthesis and which included data on 1515 COVID-19 patients. Approximately 10% of COVID-19 patients treated with these drugs developed QT prolongation. We found evidence of ventricular arrhythmia in 2 COVID-19 patients from a group of 28 treated with high-dose chloroquine. Limitations of these results are unclear follow-up and possible publication/reporting bias, but there is compelling evidence that chloroquine and hydroxychloroquine induce significant QT-interval prolongation and potentially increase the risk of arrhythmia. Daily electrocardiographic monitoring and other risk mitigation strategies should be considered in order to prevent possible harms from what is currently an unproven therapy.

Prior use of antiplatelet agents was associated with a survival benefit in sepsis patients.

Spirometry is a well-known technique for evaluating pulmonary function, but few studies have focused on preschool children. The aim of this study was to determine reference values of forced spirometric parameters in young Chinese children, aged 3-6 years, in Taiwan. Spirometric measurements were performed at day care centers by experienced pediatricians. Of 248 children without a history of chronic respiratory illness, at least two valid spirometric attempts were obtained from 214 children (109 boys and 105 girls; age: 36-83 [mean = 61] months; height: 90-131 [mean = 111] cm). Values of forced expiratory volume in 1 sec (FEV1) and 0.5 sec (FEV(0.5)), forced vital capacity (FVC), peak expiratory flow rate (PEF), forced expiratory between 25% and 75% FVC (FEF(25-75)), and forced expiratory flow rate at 25%, 50%, and 75% of FVC (FEF(25), FEF(50), and FEF(75)) were derived and analyzed. There were significant positive correlations between study parameters and body height, body weight, and age. Height was the most consistently correlated measurement in both boys and girls. Although boys tended to have higher spirometric values than girls, we found significant differences only in FVC and FEV1 between boys and girls aged 6 years. The regression equations of each parameter were obtained. In conclusion, spirometric pulmonary function tests are feasible in 3- to 6-year-old children. The obtained values and regression equations provide a reference for Chinese preschool children and may be of value in evaluating pulmonary function of children with respiratory problems in this age group.

No abstract

Objective The primary objective was to conduct a meta-analysis on published observational cohort data describing the association between acetyl-salicylic acid (aspirin) use prior to the onset of sepsis and mortality in hospitalized patients. Study Selection Studies which reported mortality in patients on aspirin with sepsis with a comparison group of patients with sepsis not on prior aspirin therapy were included. Data sources Fifteen studies described hospital-based cohorts (n=17,065), while one was a large insurance-based database (n=683,421). Individual-level patient data were incorporated from all selected studies. Data Extraction Propensity analyses with 1:1 propensity score matching at the study level were performed, using the most consistently available covariates judged to be associated with aspirin. Meta-analyses were performed to estimate the pooled average treatment effect of aspirin on sepsis-related mortality. Data Synthesis Use of aspirin was associated with a 7% (95%CI, 2% to 12%, p=0.005) reduction in the risk of death as shown by meta-analysis with considerable statistical heterogeneity (I2=61.6%). Conclusions These results are consistent with effects ranging from a 2% to 12% reduction in mortality risk in patients taking aspirin prior to sepsis onset. This association anticipates results of definitive studies of the use of low-dose aspirin as a strategy for reduction of deaths in patients with sepsis.