About Journal

Canadian Journal of Medicine (CJM) is an open-access and peer-reviewed journal available in print and online published by the Canadian Institute for Knowledge Development (CIKD). CJM considers papers for publication in any aspect of experimental medicine and clinical research. CJM is devoted to original reports of clinical and basic research, review articles, letters to the editor, case reports, and short articles on all aspects of the prevention, diagnosis, and management of medical diseases in the broadly defined fields of Medicine. As such, the journal is interested in laboratory and animal...
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Pulmonary Embolism, the Only Demonstration of Covid-19 in a 53-year-old Patient

Sina Imanizadeh; Mohammad Rezapour; Hoorolnesa Ameli; Farzaneh Bolouki Moghaddam

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 162-166
DOI: 10.33844/cjm.2021.60601

On March 30, 2021, a 53-year-old man was hospitalized, complaining of breath shortness, chest pain, and pain in his right leg from 2 weeks ago when he went mountain climbing. His symptoms did not improve, and his shortness of breath worsened. Therefore, he went to a hospital and was hospitalized to investigate the possibility of Deep Vein Thrombosis (DVT) and Pulmonary Thromboembolism (PTE) further. At admission, O2 sat was 91, followed by Respiratory Rate (RR) of 18 and White Blood Cell (WBC) of 9.6. The patient was admitted to Coronary Care Unite (CCU), and color Doppler sonography, echocardiography, and pulmonary angiography were conducted.

Autophagy and Coronavirus Interaction: Its Significance for COVID-19 Treatment

Pallab Chakraborty

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 167-170
DOI: 10.33844/cjm.2021.60596

In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province, China [1, 2]. According to the literature, the coronavirus was found to interact with autophagy pathways [3–6]. The autophagy process (recycling pathway) is very important for the degradation of cytosolic compounds and the creation of building blocks in cells [7]. During starvation conditions, this process can be activated. It delivers the cytosolic components, including the damaged cellular organelles and mis-folded proteins, into lysosomes by establishing autophagosomes, where the degradation takes place [3, 8]. It is reported to have a paradoxical role in protecting cells from viral and bacterial infections, depending on the types of pathogens and the host cells [3, 9]. Commonly known processes are xenophagy (viral particle degraded) and virophagy (degradation of neosynthesized components from virus), and innate- adaptive immune induction, by which autophagy contributes to the antiviral response [8, 10, 11].

Evaluating and Mitigating the Challenges of International Students Amidst the COVID-19 Pandemic: An Overview

Daivat Bhavsar; Peter Anto Johnson; John Christy Johnson; Jasrita Singh; Austin Albert Mardon

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 171-175
DOI: 10.33844/cjm.2021.60597

International students are one of the most vulnerable social groups during the COVID-19 pandemic, ignored by social and financial welfare programs. The use of statistics, governmental statements, and academic literature outline the additional hardships faced by post-secondary international students to propose interventions to reduce precarity. The hospitality of educational institutions and response programs towards international students would be crucial for upholding commitments to social justice during these challenging times. This paper can contribute to understanding the role of social work in serving groups most vulnerable to COVID-19.

Pitfalls in Interpretation of SARS-CoV-2 Infection-related Neurological Complications

Seraph Shi Kei Wu; Sunny Chi Lik Au

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 176-178
DOI: 10.33844/cjm.2021.60602

Coronavirus disease (COVID-19) is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many systematic reviews and meta-analyses discussed the correlation of COVID-19 with a different disease. Given the urgent need for data, some meta-analyses containing datasets included many manuscripts, but their providence was not clearly reported. The possible overlap between some of the studies included in the analyses is a significant issue for conducting systematic reviews during the COVID-19 pandemic.

How will the COVID-19 Pandemic Change Dermatology Services over the next Five Years?

Immanuel Sani; Damilola Agboluaje

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 179-181
DOI: 10.33844/cjm.2021.60605

The advent of COVID-19 has radically transformed conventional affairs in numerous facets of life across the world. The reverberation of such alterations has presented a myriad of challenges to dermatology services worldwide. Dermatology services have attempted to suppress the dissemination of COVID-19 by reducing in-person consultations and non-essential procedures. Teledermatology has been utilised to mediate patient triage to ensure patients are promptly referred to the appropriate service. Additionally, a plethora of cutaneous sequelae of COVID-19 have been identified and exhibit considerable heterogeneity in skin inflammatory findings compared to viral infections with known cutaneous effects. There has been a longstanding demand to efficiently capitalise on limited expertise allied to dermatology services. The COVID-19 pandemic has illuminated the urgent need to extend the dermatological competence of several primary care clinicians. Ultimately, the developing COVID-19 pandemic may provide the impetus to revolutionise dermatology services in the next five years to transcend current challenges in clinical practice. 

Oncogenic Role of Cancer Stem Cell LGR5 in Colorectal Cancer Progression

Sourena Ghorbani Kalkhajeh; Alireza Parsanezhad; Mahdieh Banoei; Maryam Vahidi; Maziar Malekzadeh Kebria; Zahra Pezeshkian; Noshad Peyravian

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 182-190
DOI: 10.33844/cjm.2021.60609

Colorectal Cancer (CRC) is the second most common cancer in women and the third most common cancer in men. There is strong evidence for the role of Cancer Stem Cells (CSCs) in cancer progression. The identification and understanding CSCs genes such as LGR5 involved in the induction of cancer development is crucial in the prognosis of CRC. LGR5 is a membrane protein involved in several molecular signaling pathways, such as the Wnt signaling and NOTCH pathways. It has been shown that the LGR5 gene was overexpressed in CRC and is associated with the worst outcomes in patients with CRC, but molecular mechanisms of LGR5 in CRC development have been poorly identified. This review has summarized current studies about the role of stem cell marker of LGR5 in CRC progression. Future research in this area may improve the early detection of CRC, new therapies, and monitoring of CRC.

Presentation of Varicella-Zoster Virus Infection with Bladder Mass and Gross Hematuria

Mosa Asadi; Mohammad Reza Fattahi; Somayeh Mohammadi

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 191-194
DOI: 10.33844/cjm.2022.60610

Varicella-zoster virus reactivation can cause painful and vesicular rashes involving some dermatomes, which is defined as herpes zoster. We reported a 68 years old man who had come to the clinic with a complaint of hematuria. In the examination, varicella-zoster lesions were visible on the left buttock. After beginning valacyclovir for the patient, cystoscopy was done due to the existing polypoid mass in sonography. Red patches, fragile and bleeding places were seen in the cystoscopy on the left bladder wall without any evidence of any mass. This patient was managed conservatively. One week after the first ultrasonography, new sonography by the same radiologist showed no evidence of bladder mass.

Cerebral Methanol Intoxication: A Case Report with Literature Review

Mehdi Mesri; Mohammad Javad Behzadnia; Mohammad Nikpoor; Ali Ghazvini

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 195-201
DOI: 10.33844/cjm.2022.60611

We report the case of a 24-year-old man admitted to the emergency room with a history of headache exacerbated. At the emergency room, he was unresponsive to drug or alcohol consumption. At this time, computed tomography (CT) did not detect the brain and abdomen lesions. At the intensive care unit (ICU), 6h later, he suddenly developed shallow respirations, followed by loss of consciousness, hypotension, and blurred vision. He was intubated immediately and underwent mechanical ventilation. Arterial blood gases and biochemical analyses indicated intense metabolic acidosis (Day1: pH 7.25, PCO2 49 mmHg, PO2 65 mmHg, HCO3 15 mmol/L and day 2, pH 7.32, PCO2 45 mmHg, PO2 60 mmHg, and HCO3=19 mmol/L) and elevated liver enzymes. The clinical diagnosis of toxic alcohol ingestion was based on the history, arterial blood gases results, and significant biochemical changes. In ICU, the patient underwent ethanol infusion and hemodialysis and the impression of methanol intoxication. He underwent redialysis with a minimal dose of heparin (5000 IU/mL). A second CT scan revealed basal ganglia ischemia, and an MRI scan exhibited clear abrasion and basal ganglia necrosis. Finally, he died  due to severe methanol intoxication, but the probability of cerebral hemorrhage may be the cause of the patient death associated with heparin.

Myocarditis Associated with Covid-19 Pneumonia

Alireza Soleymanitabar; Fakhri Allahyari; Somayeh Mohammadi; Sina Imanizadeh

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 202-204
DOI: 10.33844/cjm.2022.60612

The covid-19 pandemic is one of the most serious worldwide concerns, which has created many problems in health, economics, and other aspects of human life around the world. Coronavirus has shown to have a lot of manifestations during the infection, among which some of them are more critical. Cardiac complications can be considered one of the major and serious problems caused by coronavirus infection… .

The Health of Companions: Evaluation of Care Burden, Psychological Distress and Psychiatric Disorders of the Companions of Patients in the Medical Ward of a University Hospital

Elif Duman Acar; Melahat Akdeniz; Ethem Kavukcu; Esma Eseroglu; Hasan Hüseyin Avcı

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 205-219
DOI: 10.33844/cjm.2021.60613

The aim of this study was to evaluate the care burden, psychological distress, and psychiatric disorders of the companions of adult patients in the hospital. This study is a cross-sectional descriptive study. The study questionnaire included a sociodemographic information form, the Zarit Caregiver Burden Scale (ZCBS), and the Brief Symptom Inventory (BSI) were administered to the companions. Simple descriptive and inferential statistics were performed. The Mann-Whitney U test was used when there was no normal distribution. Correlation coefficients and statistical significance were calculated by using the Spearman test for at least one non-normal distributed relationship. A multiple linear regression analysis was performed for determining factors associated with BSI scores. The type 1 error level was used as 5% for statistical significance. All p-values of less than .05 were considered significant. Three hundred companions were included in the study. An emotional commitment was the leading cause of companionship. The mean values of the companions’ ZCBS and BSI scores were 20.2 and 34.4, respectively. There was a moderately positive correlation (r = .50) between the ZCBS and BSI scores, and it was found to be statistically significant. ZCBS scores were positively associated with BSI scores. Psychological distress increases as the care burden of companions increases. Companions need more assistance from health care institutions, family members, and the community. The support of health workers and family members reduced the companions’ care burden and psychological distress. Physicians working in the hospital should take into account that companions may be hidden patients.

NSAIDs/Nitazoxanide/Azithromycin Immunomodulatory Protocol Used in Adult, Geriatric, Pediatric, Pregnant, and Immunocompromised COVID-19 Patients: A Real-World Experience

Mina T. Kelleni

Canadian Journal of Medicine, 2021, Volume 3, Issue Issue 3, Pages 121-143
DOI: 10.33844/cjm.2021.60511

COVID-19 management still lacks a protocol of proven efficacy, and we present a novel COVID-19 immunomodulatory protocol based on our early pioneering article, re-purposing nitazoxanide/azithromycin combination for early COVID-19 diseases. Our findings were followed by two articles to justify the addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin. Furthermore, another recent article of ours illustrated the potential immunomodulatory mechanisms by which all the drugs used in this manuscript might be beneficial for COVID-19 patients. We presented a case series of 34 confirmed and highly suspected COVID-19 patients. It is noteworthy that 13 PCR-confirmed COVID-19 patients were included while the others were diagnosed by other measures and all cases were managed by telemedicine. The patients included adult males and females as well as children. All patients have received a short 5-day-regimen of NSAIDs / nitazoxanide/ azithromycin +/- cefoperazone either in full or in part. The primary endpoint of this protocol was a full relief of all debilitating COVID-19 clinical manifestations, and it was fully achieved within two weeks. Most of the patients who were treated early have fully recovered during their described five days; the leucocytic/lymphocytic counts were significantly improved for those with prior abnormalities. Neither significant adverse effects nor post/para COVID-19 syndrome was reported. In conclusion, we present a pioneering 5-day protocol for the safe and effective treatment of COVID-19 using economic FDA-approved immunomodulatory drugs.  We recommend conducting double-blind, randomized clinical trials with sufficient strength at the earliest opportunity.

An Overview of COVID-19 Treatment: Possible Candidates Based on Drug Repurposing and Molecular Docking

Mai Abdelgawad; Sahar Allam; Maha Abdelmonaem Shaheen; Mohamed Ali Hussein; Hoda Azmy Elkot; Aya A. Gaber; Khaled A. Marghany; Asmaa A. Abdelwahab; Rewan H. Alashrey; Hoda Y. Abdallah

Canadian Journal of Medicine, 2021, Volume 3, Issue 1, Pages 10-35
DOI: 10.33844/cjm.2021.60499

The current pandemic of COVID-19 is considered a worldwide threat to public health caused
by a novel type of coronaviridae family called SARS-CoV-2. Owing to the urge of finding a
treatment for this virulent virus, many aspects of drug development are swept aside. This
review aimed to clarify the double-edged sword of drug repurposing in COVID-19 via
summarizing the available treatment options and promising candidates for COVID-19 based
on drug repurposing preclinical studies and in-silico approach. Different drugs target SARS
CoV-2 main structures under clinical investigation; some showed limited efficacy and severe
side effects, while others can be promising solutions. Some drugs suppress the cytokine storm
and modulate immune response during viral infection, including anti-interleukin and
glucocorticoids. Antiparasitic agents are repurposed for SARS-CoV-2 infection management.
Various vaccines and monoclonal antibodies are designed against SARS-CoV-2 and are being
evaluated in different preclinical and clinical stages. However, none of them is approved yet.
Convalescent Plasma Transfusion is a promising strategy against SARS-CoV-2 infection,
where impressive results are reported in clinical trials, requiring more validation. Furthermore,
anticoagulant therapy exhibited better disease outcomes in patients admitted to the ICU.
Finally, in-silico studies suggested several potential compounds or FDA-approved drugs
targeting various viral structure subunits. In conclusion, although many clinical trials were
launched to examine potential therapies based on drug repurposing for COVID-19, there is no
definitive treatment till now. Moreover, computational approaches identified several
compounds and FDA-approved drugs with potential inhibitory effects.

Coronavirus [COVID-19] and IgA Deficiency:Mini Review Article

Hossein Pakzad; Zahra Sadeghi; Massoud Houshmand; Farzaneh Rahvar

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 13-16
DOI: 10.33844/cjm.2020.60494

Spread of COVID-19 in all of the world caused the warning alert from WHO. It began from China and was the reason of many death through the world since 2019 December. Elders and people with previous diseases such as IgA deficiency [IgAD] are more susceptible to get COVID family. Also, higher level of IgA can combat with infectious disease.

Analysis and Prediction of Heart Disease Using Machine Learning and Data Mining Techniques

Md. Murad Hossain; Salman Khurshid; K. Fatema; M. Zahid Hasan; Mohammad Kamal Hossain

Canadian Journal of Medicine, 2021, Volume 3, Issue 1, Pages 36-44
DOI: 10.33844/cjm.2021.60500

In clinical, sciences expectation of heart malady is one of the foremost troublesome
undertakings. Nowadays, coronary illness may be a significant reason for bleakness and
mortality in present-day society. Coronary illness could be a term that doles intent on countless
ailments identified with the heart. Clinical determination is incredibly a big, however entangled
errand that must be performed precisely, effectively, and unequivocally. Although huge
advancement has been imagined within the finding and treatment of coronary illness, further
examination is required. The accessibility of enormous measures of clinical information
prompts the requirement for amazing information examination instruments to get rid
of valuable information. Coronary illness determination is one in all the applications where
information mining and AI instruments have demonstrated victories. This study used the
machine learning algorithms KNN, Naïve Bayes, Random forest, Logistic regression, Support
vector machine, J48, and Decision tree by WEKA software to spot which method provides
maximum performance and accuracy. Using these algorithms with WEKA software, we made
an ensemble (Vote) hybrid model by combining individual methods. Our research aims to
access the effectiveness of various machine learning algorithms to diagnose the center disease
and find the feasible algorithm, which is that the best for a heart condition

Two-Phase Immune Responses of COVID-19 and Therapeutic Approaches

Seyed Hassan Saadat

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 0-0
DOI: 10.33844/cjm.2020.60492

The novel coronavirus disease 2019 spread rapidly worldwide and disease was announced a pandemic by the WHO. Standard therapeutic strategy against COVID-19 is lacking. Regarding to the two-phase pathogenesis of the COVID-19 (immune defense-based protective and postinitial inflammation-driven damaging phases, different therapeutic regimens including antiviral agents (e.g., lopinavir/ritonavir, remdesivir, ribavirin, oseltamivir, and sofosbuvir, etc.), some antibiotics and immunomodulatory (chloroquine/hydroxychloroquine) and anti inflammatory agents (corticosteroids) have been considered in hospitals for COVID-19 patients, but balancing their
benefits and potential risk is of great importance [1-7].
Immune-boosting strategies (e.g., anti-sera or pegylated IFNα) and antiviral therapy may be of great importance in the initial phase or non-severe stages, while immunosuppressive or immunomodulatory approaches can be used for halting tissue damage and managing the symptoms in the inflammatory phase. There are conflicting results in prescribing corticosteroids or immunomodulation for COVID-19 patients due to paradoxical negative effects (risk of death, secondary bacterial infections and longer hospitalization) [8-9]. Activation of coagulation pathways
is also associated with increased proinflammatory cytokines, resulting in multiorgan injury. Severe COVID‐19 had disseminated intravascular coagulation, leading to the risk of venous thromboembolism [10], where naproxen (for antiplatelet and anti-inflammatory and anticoagulative effects) and low molecular weight heparin (LMWH; anti-inflammatory properties) may be considered for patients. It has been suggested that LMWH is contemplated because of concerns because of the presence of thrombi in the pulmonary circulation for those in patients with
raised d-dimer.
However, effective therapeutic approach requires balancing harmful and beneficial effects of regimens, to be prescribed by precision. Also, two-phase pathophysiology and immune responses of COVID-19 should not be underemphasized for treatment of patients.

Coronavirus [COVID-19] and IgA Deficiency:Mini Review Article

Hossein Pakzad; Zahra Sadeghi; Massoud Houshmand; Farzaneh Rahvar

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 13-16
DOI: 10.33844/cjm.2020.60494

Spread of COVID-19 in all of the world caused the warning alert from WHO. It began from China and was the reason of many death through the world since 2019 December. Elders and people with previous diseases such as IgA deficiency [IgAD] are more susceptible to get COVID family. Also, higher level of IgA can combat with infectious disease.

Pitfalls in Interpretation of SARS-CoV-2 Infection-related Neurological Complications

Seraph Shi Kei Wu; Sunny Chi Lik Au

Canadian Journal of Medicine, 2021, Volume 3, Issue 4, Pages 176-178
DOI: 10.33844/cjm.2021.60602

Coronavirus disease (COVID-19) is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many systematic reviews and meta-analyses discussed the correlation of COVID-19 with a different disease. Given the urgent need for data, some meta-analyses containing datasets included many manuscripts, but their providence was not clearly reported. The possible overlap between some of the studies included in the analyses is a significant issue for conducting systematic reviews during the COVID-19 pandemic.

An Overview of COVID-19 Treatment: Possible Candidates Based on Drug Repurposing and Molecular Docking

Mai Abdelgawad; Sahar Allam; Maha Abdelmonaem Shaheen; Mohamed Ali Hussein; Hoda Azmy Elkot; Aya A. Gaber; Khaled A. Marghany; Asmaa A. Abdelwahab; Rewan H. Alashrey; Hoda Y. Abdallah

Canadian Journal of Medicine, 2021, Volume 3, Issue 1, Pages 10-35
DOI: 10.33844/cjm.2021.60499

The current pandemic of COVID-19 is considered a worldwide threat to public health caused
by a novel type of coronaviridae family called SARS-CoV-2. Owing to the urge of finding a
treatment for this virulent virus, many aspects of drug development are swept aside. This
review aimed to clarify the double-edged sword of drug repurposing in COVID-19 via
summarizing the available treatment options and promising candidates for COVID-19 based
on drug repurposing preclinical studies and in-silico approach. Different drugs target SARS
CoV-2 main structures under clinical investigation; some showed limited efficacy and severe
side effects, while others can be promising solutions. Some drugs suppress the cytokine storm
and modulate immune response during viral infection, including anti-interleukin and
glucocorticoids. Antiparasitic agents are repurposed for SARS-CoV-2 infection management.
Various vaccines and monoclonal antibodies are designed against SARS-CoV-2 and are being
evaluated in different preclinical and clinical stages. However, none of them is approved yet.
Convalescent Plasma Transfusion is a promising strategy against SARS-CoV-2 infection,
where impressive results are reported in clinical trials, requiring more validation. Furthermore,
anticoagulant therapy exhibited better disease outcomes in patients admitted to the ICU.
Finally, in-silico studies suggested several potential compounds or FDA-approved drugs
targeting various viral structure subunits. In conclusion, although many clinical trials were
launched to examine potential therapies based on drug repurposing for COVID-19, there is no
definitive treatment till now. Moreover, computational approaches identified several
compounds and FDA-approved drugs with potential inhibitory effects.

Phytochemical Screening and Antimicrobial Activity of Mentha Arvensis L. [Pudina]: A Medicinal Plant

Disha Patel; Vijay Upadhye; Tarun K Upadhyay; Esha Rami; Rakeshkumar Panchal

Canadian Journal of Medicine, 2021, Volume 3, Issue Issue 2, Pages 67-76
DOI: 10.33844/cjm.2021.60506

Mentha arvensis is an essential aromatic, energizer restorative, and medicinal plant in the mint family Lamiaceae. Mentha arvensis is found in rugged areas or cold climates of India. Herein, we studied the presence of different dynamic metabolites like- Flavonoids, Saponins, Tannins, terpenoids, steroids, Carb, anthraquinones, Heart glycosides, and alkaloid. In the given study, the phytochemical and antimicrobial action of leaves concentrates on pudina (Mentha arvensis L.). The broth dilution method has been used to check the antimicrobial activity of Mentha arvensis. In vitro antimicrobial movement was studied against pathogenic microbes such as Escherichia coli, Staphylococcus aureus, Streptococcus Pyogenes, Pseudomonas aeruginosa, Candida albicans, Aspergillus Niger, Aspergillus clavatus by agar well dispersion method. When used on bacterial colonies and fungal colonies, the separated extract showed the maximum zone of inhibition against Staphylococcus aureus, Escherichia coli, Streptococcus Pyogenes, Pseudomonas aeruginosa, Candida albicans, Aspergillus Niger, Aspergillus clavatus over the control. The maximum zone of inhibition was found in Methanolic extracts against Pseudomonas aeruginosa and Aspergillus clavatus over the control. Thus, the present approach can be useful to find new bioactive segments to improve new drugs. Our findings showed that the Mentha arvensis plant gives 25- 100 MIC (ug/ml) to inhibit the growth of the mentioned microorganisms. Thus, it can be used as a strong antimicrobial agent against pathogens, mainly Aspergillus Clavatus.

Re-evaluating the Effectiveness of Hydroxychloroquine on Urticaria: A Systematic Review

Immanuel Sani; Muambo Eko; Youssef Chedid; Yaser Hamza; Jubilent Amalendran

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 23-32
DOI: 10.33844/cjm.2020.60496

Urticaria is a common disease characterised by transient erythematous, oedematous, pruritic
wheals in the dermis due to the release of various inflammatory mediators from mast cells.
There was previously limited evidence on the effectiveness of hydroxychloroquine (HCQ) in
the literature but there is now emerging evidence that warrants further investigation. This
review aims to appraise the current literature and propose contemporary evidence
recommendations for hydroxychloroquine treatment of patients with urticaria by performing
a systematic review. The MEDLINE, Embase and Cochrane databases were searched from
inception to 12 June 2020 in accordance with the PRISMA guidelines. We also examined the
reference lists of the retrieved studies. Texts were reviewed independently by two authors.
The risk of bias and quality of the studies was assessed using the Critical Appraisal Skills
Programme for systematic reviews. A total of 7 studies were included, involving 211 pooled
trial participants. There was moderate-quality evidence from two RCTs that revealed the
effectiveness of HCQ in the subjective improvement of urticarial symptoms. Two case reports
and one case series also demonstrated the therapeutic benefit of HCQ for urticaria. There was
considerable heterogeneity of outcome variables and trial designs which did not permit a meta
analysis of the results. The limited available evidence reveals that HCQ is effective for the
resolution of urticaria. Further multi-centred, placebo-controlled, RCTs are required in order
to reveal the relative effectiveness of HCQ in comparison to current second-line treatment
modalities








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