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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A Beginner’s Guide to Clinical Trials

Sarah Keyes; Philippa Hawley

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 4-12
DOI: 10.33844/cjm.2022.60615

Evidence-based medicine rests upon the pillars of scientific evidence, clinical expertise, and patient values. Evidence comes from various avenues including clinical trials; a branch of experimental research studying interventions in human participants. Clinical trials evaluate the safety and efficacy of interventions, including medications, devices, and procedures that are administered according to a detailed plan. A control group such as no-treatment, placebo, or standard-of-care is used for comparison. A clinical trial determines whether one intervention is better, worse, or no different than another in the specific context and demographics of enrolled participants. Safety and efficacy are established by measuring clinically significant outcomes. Ultimately, the goals of clinical research are to advance medical knowledge and improve patient care through the development of preventative measures, diagnostic and screening tools, treatments, and supportive care. In the rapidly evolving landscape of medical literature, clinicians increasingly consult clinical trials to guide their practice. As such, medical students and trainees stand to benefit from developing a strong understanding of research design and logistics during their training. This article presents a general overview of key elements and practical considerations in clinical trials.

A Chart Review of Emergency Department Visits Following Implementation of the Cannabis Act in Canada

Marisa O’Brien; Peter Rogers; Eric Smith

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 13-21
DOI: 10.33844/cjm.2022.6016

The legalization of cannabis for recreational use remains a controversial topic today. There are multiple known benefits of cannabis which include pain relief and treatment of epilepsy syndromes. However, there are also many associated risks. Shorter-term health consequences include cannabinoid hyperemesis syndrome and cannabis-induced psychosis. These conditions directly impact the influx of patients presenting to emergency departments (ED). This study aims to examine the impact of cannabis legalization on ED presentations. We performed a descriptive study via a retrospective chart review of cannabis-related ED visits in St. John’s, Newfoundland (NL), ranging from six months prior to the date of legalization of cannabis for recreational use, to six months after. We searched the hospital ED visit records using keywords to identify patients who have symptoms relating to cannabis use. We manually reviewed all visit records that included one or more of these terms to distinguish true positives from false-positive cases unrelated to cannabis use. The number of cannabis-related visits increased from 2.56 per 1000 ED visits prior to legalization to 3.56 per 1000 ED visits post legalization (p < 0.01). There was no difference in the age of users between the two groups. Additionally, the most common presenting complaint due to cannabis use was nausea/vomiting (47.7%), followed by anxiety (12.2%). Following the implementation of the Cannabis Act in Canada, the EDs in St. John’s, NL had a significant increase in the number of ED visits related to cannabis use. It is important to determine such consequences to ensure hospitals and public health are prepared to treat the influx of visits and are better equipped to manage the associated symptoms

Immunosenescence, COVID-19, and Vaccine Efficacy in the Elderly

Fariha Khan; Peter Anto Johnson; John Christy Johnson; Jasrita Singh; Austin Mardon

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 22-25
DOI: 10.33844/cjm.2022.6017

Recent research has unveiled and confirmed the deleterious age-related changes of the immune system which result in diminished ability of older adults to effectively respond to pathogens and infection. This degradation is defined by the term immunosenescence. Immunosenescence can also bring with it reduced vaccine efficacy. In an era where the population of older adults is growing exponentially, it is apparent why such dysfunction is concerning. Adding even more pertinence is the COVID-19 pandemic. Since March of 2020, older adults across the globe have borne witness to the disproportional effects of COVID-19 infection on their mortality rates versus younger adults and children. In order to bring the pandemic to an end, the global population must be inoculated. However, concerns have been raised about the effectiveness of the COVID-19 vaccines on the elderly. This article aims to provide a brief overview of immunosenescence, the COVID-19 pandemic, and what research has shown thus far about vaccine efficacy for older adults. As well, potential methods to combat immunosenescence will be explored.

Sickness, Social Isolation, and a Solution: A Brief Exploration of COVID-19 Related Depression and Transcranial Direct Current Stimulation

Fariha Khan; Peter Anto Johnson; John Christy Johnson; Jasrita Singh; Austin Mardon

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 26-31
DOI: 10.33844/cjm.2022.6018

The COVID-19 pandemic has illuminated a need for accessible, home-based therapies for mental health. In an era of social distancing, lockdowns, and declining global mental health, one promising candidate is transcranial Direct Current Stimulation (tDCS). tDCS is a non-invasive, portable, targeted brain stimulation technique that uses electrical currents to modulate cortical excitability. It has been heavily explored as a treatment for major depressive disorder (MDD) and other mental health issues in recent years. However, before such a treatment may become widespread, certain research questions must be addressed, and safety outcomes must be thoroughly evaluated. This article aims to provide a brief overview of tDCS, the COVID-19 pandemic’s impact on mental health, and tDCS’ potential to be used in such a situation. The article also explores some of the drawbacks and challenges that lie in the way of tDCS being normalized as a mental health therapeutic.

Changing Attitudes Toward Specialty Choice and the CaRMS Residency Match During COVID-19: A Cross-sectional Pilot Study of Canadian Medical Students

Stuti M. Tanya; Maia Idzikowski; Bonnie He; Joshua Lakoff; Sanjay Sharma

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 32-37
DOI: 10.33844/cjm.2022.6019

The Canadian residency match process has been dramatically restructured due to COVID-19. The impact of these changes on specialty choice and access to career-development opportunities among Canadian medical students remains largely unknown. The objective of this study was to assess whether students’ strategy and level of confidence entering the Canadian residency match have changed as a result of the pandemic. A 28-item online survey was distributed to Canadian medical students from the classes of 2021-2024, as well as the class of 2020 graduates planning to enter the 2021 CaRMS (Canadian Resident Matching Service) match. The survey was developed based on existing literature and included questions on demographics, access to educational opportunities, and personal strategies for matching. Descriptive statistics, t-tests, and Spearman’s correlations were used to analyze the data. Eleven percent of respondents reported a change in specialty preference due to COVID-19. Forty-three percent of respondents reported changing their strategy for the CaRMS match. Respondents interested in a surgical specialty were more likely to report a change in their match strategy (p = .0150), including applying to more programs (p = .0012) and exploring other specialties (p = .0118). Clerks were also more likely to report a change in their matching strategy (p = .0195) and specialty choice (p = .0194) compared to pre-clerks. Medical students felt that COVID-19 negatively impacted their ability to access scholarly opportunities and confidence regarding the match, which may have long-term implications for trainee well-being, residency match logistics, and long-term physician resource planning.
©CIKD Publishing

Association between Negatively Impacted Wellbeing and Alcohol Consumption during the COVID-19 Pandemic

Jiyeon Park; Peter Anto Johnson; John Johnson; Austin Albert Mardon

Canadian Journal of Medicine, In Press
DOI: 10.33844/cjm.2022.6020

Uncertainty about the future, fear of losing a loved one, and countless lockdowns and social distancing restrictions have created great stress for almost everyone during the COVID-19 pandemic. As a result, the wellbeing of individuals has been negatively impacted. Maintaining stable wellbeing is important as is an avoidance of excessive alcohol use, as both factors can potentially harm individual health and lead to death. However, an increase in alcohol purchases and alcohol consumption has been noted globally during the COVID-19 pandemic. Thus, this article explores the possible connections between affected wellbeing and alcohol usage during the COVID-19 pandemic.  

An Investigation into the Association of COVID-19 and Viral Myocarditis: A Literature Review

Zara Hasan; Parmin Rahimpoor-Marnani; Vivek Kannan; Shruti Misra; Austin Albert Mardon

Canadian Journal of Medicine, In Press
DOI: 10.33844/cjm.2022.6021

Myocarditis, or inflammation of the muscle layer in the heart wall, is caused by several factors including viral infection. Although the literature briefly alludes to a method of viral entry into cardiomyocytes, this work provides further detail into subsequent novel mechanisms leading to the development of myocarditis following infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The keywords "COVID-19”, “SARS-CoV-2”, “Myocarditis”, “viruses”, and “human” were used to run searches on OVID Medline, as well as Google Scholar. Resulting papers were subject to further analysis. SARS-CoV-2 binds to the angiotensin-converting enzyme 2 (ACE2) receptor which is found on type 2 pneumocytes and cardiomyocytes. Infection of cardiomyocytes can overregulate the immune response resulting in a cytokine storm: an uncontrolled increase of proinflammatory cytokines, as is commonly seen in respiratory infections. Cytokines can enter established biological pathways, creating positive feedback, which causes increased inflammation leading to myocarditis. SARS-CoV-2 viral envelope (E) proteins present an alternate association with myocarditis. Less severe myocarditis manifests common symptoms, and detecting it before it worsens may be difficult. Understanding the pathogenesis of myocarditis in COVID-19 could help find and implement preventative measures during future treatment.

Importance of Music Participation on Mental Health and Wellbeing Among Senior Citizens during the COVID-19 Pandemic

Jiyeon Park; Peter Anto Johnson; John Johnson; Austin Albert Mardon

Canadian Journal of Medicine, In Press
DOI: 10.33844/cjm.2022.6022

As life expectancy continues to increase, it is critical to investigate ways to age successfully physically, mentally, and socially. Senior citizens (65 years and older) tend to struggle with lower mental health and wellbeing and suffer higher incidences of loneliness compared to the younger population. As a result, the COVID-19 pandemic has put them at higher risk, not only of contracting the virus, but also of experiencing feelings of loneliness and depression. Music participation, specifically music therapy, has been known to be an effective tool to promote wellbeing and mental health, especially among the elderly. Thus, this article investigates the changes in mental health and wellbeing among elderly people when participating in music to explore the importance of conducting virtual music participation programs during the COVID-19 pandemic.   

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

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.

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.

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.

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.

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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