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Shamshirian A, Hessami A, Heydari K, Alizadeh-Navaei R, Ebrahimzadeh MA, Yip GW, Ghasemian R, Sedaghat M, Baradaran H, Mohammadi Yazdii S, Aboufazeli E, Jafarpour H, Dadgostar E, Tirandazi B, Sadeghnezhad R, Karimifar K, Eftekhari A, Shamshirian D. The Role of Hydroxychloroquine in COVID-19 Treatment: A Systematic Review and Meta-Analysis. Ann Acad Med Singap 2020. [DOI: 10.47102/annals-acadmedsg.2020370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: A systematic review and meta-analysis was carried out to examine the role of hydroxychloroquine (HCQ) in the treatment of COVID-19. Methods: We performed a systematic search in PubMed, Scopus, Embase, Cochrane- Library, Web of Science, Google Scholar, and medRxiv pre-print databases using available MeSH terms for COVID-19 and hydroxychloroquine. Data from all studies that focused on the effectiveness of HCQ with or without the addition of azithromycin (AZM) in confirmed COVID-19 patients, which were published up to 12 September 2020, were collated for analysis using CMA v.2.2.064. Results: Our systematic review retrieved 41 studies. Among these, 37 studies including 45,913 participants fulfilled the criteria for subsequent meta-analysis. The data showed no significant difference in treatment efficacy between the HCQ and control groups (RR: 1.02, 95% CI, 0.81–1.27). Combination of HCQ with AZM also did not lead to improved treatment outcomes (RR: 1.26, 95% CI, 0.91–1.74). Furthermore, the mortality difference was not significant, neither in HCQ treatment group (RR: 0.86, 95% CI, 0.71–1.03) nor in HCQ plus AZM treatment group (RR: 1.28, 95% CI, 0.76–2.14) in comparison to controls. Meta-regression analysis showed that age was the factor that significantly affected mortality (P<0.00001). Conclusion: The meta-analysis found that there was no clinical benefit of using either HCQ by itself or in combination with AZM for the treatment of COVID-19 patients. Hence, it may be prudent for clinicians and researchers to focus on other therapeutic options that may show greater promise in this disease. Keywords: Azithromycin, coronavirus outbreaks, pandemic, SARS-CoV-2 disease
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Affiliation(s)
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- Halal research center of Islamic Republic of Iran, FDA, Tehran, Iran
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Shamshirian A, Heydari K, Shams Z, Aref AR, Shamshirian D, Tamtaji OR, Asemi Z, Shojaie L, Mirzaei H, Mohammadi N, Zibaee B, Karimifar K, Zarandi B, Hedayatizadeh-Omran A, Alizadeh-Navaei R. Breast cancer risk factors in Iran: a systematic review & meta-analysis. Horm Mol Biol Clin Investig 2020; 41:/j/hmbci.ahead-of-print/hmbci-2020-0021/hmbci-2020-0021.xml. [PMID: 33079703 DOI: 10.1515/hmbci-2020-0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Breast cancer is known as one of the deadliest forms of cancer, and it is increasing globally. There are a variety of proven and controversial risk factors for this malignancy. Herein, we aimed to undertake a systematic review and meta-analysis focus on the epidemiology of breast cancer risk factors in Iran. METHODS We performed a systematic search via PubMed, Scopus, Web of Science, and Persian databases for identifying studies published on breast cancer risk factors up to March 2019. Meta-analyses were done for risk factors reported in more than one study. We calculated odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using a fixed/random-effects models. RESULTS Thirty-nine studies entered into the meta-analysis. Pooling of ORs showed a significant harmful effect for risk factors including family history (OR: 1.80, 95%CI 1.47-2.12), hormonal replacement therapy (HRT) (OR: 5.48, 95%CI 0.84-1.74), passive smokers (OR: 1.68, 95%CI 1.34-2.03), full-term pregnancy at age 30 (OR: 3.41, 95%CI 1.19-5.63), abortion (OR: 1.84, 95%CI 1.35-2.33), sweets consumption (OR: 1.71, 95%CI 1.32-2.11) and genotype Arg/Arg (crude OR: 1.59, 95%CI 1.07-2.10), whereas a significant protective effect for late menarche (OR: 0.58, 95%CI 0.32-0.83), nulliparity (OR: 0.68, 95%CI 0.39-0.96), 13-24 months of breastfeeding (OR: 0.68, 95%CI 0.46-0.90), daily exercise (OR: 0.59, 95%CI 0.44-0.73) and vegetable consumption (crude OR: 0.28, 95%CI 0.10-0.46). CONCLUSIONS This study suggests that factors such as family history, HRT, passive smokers, late full-term pregnancy, abortion, sweets consumption and genotype Arg/Arg might increase risk of breast cancer development, whereas late menarche, nulliparity, 13-24 months breastfeeding, daily exercise and vegetable consumption had an inverse association with breast cancer development.
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Affiliation(s)
- Amir Shamshirian
- Department of Medical Laboratory Sciences, Student Research Committee, School of Allied Medical Science, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Keyvan Heydari
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Zahra Shams
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran
| | - Amir Reza Aref
- Department of Medical Oncology, Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Danial Shamshirian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Omid Reza Tamtaji
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Layla Shojaie
- Department of Medicine, Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Neda Mohammadi
- Student Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Behdad Zibaee
- Student Research Committee, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Islamic Republic of Iran
| | - Keyvan Karimifar
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Bahman Zarandi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Akbar Hedayatizadeh-Omran
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
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Shamshirian A, Hessami A, Heydari K, Navaei RA, Ebrahimzadeh MA, Yip GW, Ghasemian R, Sedaghat M, Baradaran H, Yazdi SM, Aboufazeli E, Jafarpour H, Dadgostar E, Tirandazi B, Sadeghnezhad R, Karimifar K, Eftekhari A, Shamshirian D. The Role of Hydroxychloroquine in COVID-19: A Systematic Review and Meta-Analysis. Ann Acad Med Singap 2020; 49:789-800. [PMID: 33283842 DOI: pmid/33283842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis was carried out to examine the role of hydroxychloroquine (HCQ) in the treatment of COVID-19. METHODS We performed a systematic search in PubMed, Scopus, Embase, CochraneLibrary, Web of Science, Google Scholar, and medRxiv pre-print databases using available MeSH terms for COVID-19 and hydroxychloroquine. Data from all studies that focused on the effectiveness of HCQ with or without the addition of azithromycin (AZM) in confirmed COVID-19 patients, which were published up to 12 September 2020, were collated for analysis using CMA v.2.2.064. RESULTS Our systematic review retrieved 41 studies. Among these, 37 studies including 45,913 participants fulfilled the criteria for subsequent meta-analysis. The data showed no significant difference in treatment efficacy between the HCQ and control groups (RR: 1.02, 95% CI, 0.81-1.27). Combination of HCQ with AZM also did not lead to improved treatment outcomes (RR: 1.26, 95% CI, 0.91-1.74). Furthermore, the mortality difference was not significant, neither in HCQ treatment group (RR: 0.86, 95% CI, 0.71-1.03) nor in HCQ plus AZM treatment group (RR: 1.28, 95% CI, 0.76-2.14) in comparison to controls. Meta-regression analysis showed that age was the factor that significantly affected mortality (P<0.00001). CONCLUSION The meta-analysis found that there was no clinical benefit of using either HCQ by itself or in combination with AZM for the treatment of COVID-19 patients. Hence, it may be prudent for clinicians and researchers to focus on other therapeutic options that may show greater promise in this disease.
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Affiliation(s)
- Amir Shamshirian
- Department of Medical Laboratory Sciences, Student Research Committee, School of Allied Medical Science, Mazandaran University of Medical Sciences, Sari, Iran
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Shamshirian A, Alizadeh-Navaei R, Abedi S, Jafarpour H, Fazli H, Hosseini S, Hessami A, Karimifar K, Yosefi S, Zahedi M, Motamen S, Ghorbanpour A, Zarandi B, Esfahani A, Rostamian-Moghaddam Y, Mehdipour S, Heydari K, Aghajanian S, Mehdi SP, Azad A, Azizi S. Levels of Blood Biomarkers among Patients with Myocardial Infarction in Comparison to Control Group. Ethiop J Health Sci 2020; 30:5-12. [PMID: 32116427 PMCID: PMC7036464 DOI: 10.4314/ejhs.v30i1.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/24/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Myocardial infarction (MI) as a term for a heart attack happens due to reduced blood flow to heart myocardium and lack of oxygen supply caused by plaques in the interior walls of coronary arteries. With respect to the importance of MI etiology, we aimed to study the relationship of MI and blood examination variables. METHODS This study was conducted in Mazandaran Heart Center as a hospital-based case-control Comprising 894 participants including 465 cases and 429 controls, individually matched by sex and age. Considered blood markers were analyzed using routine laboratory methods and equipment. RESULTS Of all participants, 64.3% of the cases and 51.0% of the controls were males with a mean age of 61.2 (±13.8) in cases and 62.4 (±14.) in controls. We could not find any differences between cases and controls for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and alkaline-phosphatase (ALP) (P>0.05). However, levels of creatine-kinase-muscle/brain (CK-MB) (P<0.0001), fasting-blood-sugar (FBS) (P<0.0001), aspartate-aminotransferase (AST) (P<0.0001), alanine-transferase (ALT) (P<0.0001) and erythrocyte sedimentation rate (ESR) (P=0.001) were significantly higher in cases compared to the controls (P<0.05). Multivariable analyses revealed that the risk of MI was associated with high levels of AST (adjusted OR=24.3, 95%CI=3.5±165.6, P=0.001) and LDL (adjusted OR=7.4, 95%CI=1.0±51.8, P=0.001). CONCLUSION Our investigation indicated that the levels of CK-MB, FBS, AST, ALT and ESR were significantly higher in patients with MI. Besides, our findings showed that the risk of MI in cases with high levels of AST and LDL was about 24 and 7 times more than the control group respectively.
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Affiliation(s)
- Amir Shamshirian
- Department of Medical Laboratory Sciences, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Iran
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Iran
- Mazandaran Heart Center, Mazandaran University of Medical Sciences, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Iran
| | - Samira Abedi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Iran
| | - Hamed Jafarpour
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Iran
| | - Hanieh Fazli
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Iran
| | - Samira Hosseini
- Department of Medical Laboratory Sciences, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Iran
| | - Amirhossein Hessami
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Iran
| | - Keyvan Karimifar
- Student Research committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sedighe Yosefi
- Department of Biochemistry, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Zahedi
- Department of Medical Laboratory Sciences, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Iran
| | - Sepideh Motamen
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Iran
| | - Atiyeh Ghorbanpour
- Department of Hematology, Student Research Committee, Iran University of Medical Sciences, Iran
| | - Bahman Zarandi
- Department of Hematology, Student Research Committee, Iran University of Medical Sciences, Iran
| | - Aliakbar Esfahani
- Student Research committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Shirin Mehdipour
- Mazandaran Heart Center, Mazandaran University of Medical Sciences, Iran
| | - Keyvan Heydari
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Iran
| | - Sedigheh Aghajanian
- Department of Medical Laboratory Sciences, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Iran
| | - Somayeh Pour Mehdi
- Mazandaran Heart Center, Mazandaran University of Medical Sciences, Iran
| | - Alireza Azad
- Mazandaran Heart Center, Mazandaran University of Medical Sciences, Iran
| | - Soheil Azizi
- Department of Medical Laboratory Sciences, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Iran
- Mazandaran Heart Center, Mazandaran University of Medical Sciences, Iran
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