Hydroxychloroquine-azithromycin,doubase C,and QTc prolongation in congolese patients with COVID-19:Myth or reality?

BACKGROUND QTc interval prolongation with an increased risk of torsade de pointes(Tsd)has been described in coronavirus disease 2019(COVID-19)patients treated with hydroxychloroquine(HCQ)and azithromycin(AZI)in Western countries.In the DR Congo,few studies have evaluated the safety of this association or proposed new molecules.AIM To determine the incidence of QTc prolongation and Tsd in COVID-19 patients treated with HCQ-AZIs vs doubase C(new molecule).METHODS In present randomized clinical trial,we have included patients with mild or moderate COVID-19 treated with either HCQ-AZI or doubase C.Electrocardiogram(ECG)changes on day 14 of randomization were determined based on pretreatment tracing.Prolonged QTc was defined as≥500 ms on day 14 or an increase of≥80 ms compared to pretreatment tracing.Patients with cardiac disease,those undergoing other treatments likely to prolong QTc,and those with disturbed ECG tracings were excluded from the study.RESULTS The study included 258 patients(mean age 41±15 years;52%men;3.4%diabetics,11.1%hypertensive).Mild and moderate COVID-19 were found in 93.5%and 6.5%of patients,respectively.At baseline,all patients had normal sinus rhythm,a mean heart rate 78±13/min,mean PR space 170±28 ms,mean QRS 76±13 ms,and mean QTc 405±30 ms.No complaints suggesting cardiac involvement were reported during or after treatment.Only four patients(1.5%)experienced QTc interval prolongation beyond 500 ms.Similarly,only five patients(1.9%)had an increase in the QTc interval of more than 80 ms.QTc prolongation was more significant in younger patients,those with high viral load at baseline,and those receiving HCQ-AZI(P<0.05).None of the patients developed Tsd.CONCLUSION QTc prolongation without Tsd was observed at a lower frequency in patients treated with HCQ-AZI vs doubase C.The absence of comorbidities and concurrent use of other products that are likely to cause arrhythmia may explain our results.

Happy Hypoxia in COVID-19 Patients at Kinshasa University Hospital (Democratic Republic of the Congo): Frequency and Vital Outcome

Background: Happy hypoxia is a new feature found in COVID-19 patients. It consists of the presence of severe hypoxemia but normal breathing rate. Failure to identify this hypoxia may have negative consequences on the survival of the patient. The objective of the present study was to measure the frequency of patients with happy hypoxia and to evaluate their survival at the Kinshasa University Hospital (KUH). Methods: This was a historical cohort of 141 hospitalized patients with COVID-19 at KUH from March 23 to June 15, 2020. Happy hypoxia was defined as oxygen saturation below 90% without dyspnea. Socio-demographic data, co-morbidities, follow up time of hospitalization and outcomes were studied. Survival was assessed using the Kaplan Meier curve. Results: Out of 141 hospitalized patients with COVID-19, 79 (56%) patients were at the severe or critical stage and 9 (6.4%) had a happy hypoxia on admission. Patients who had happy hypoxia on admission were generally older than 60 years of age (55.6%) (p = 0.023). Comparison of survival curves, based on the presence or absence of happy hypoxia, shows a statistically significant difference (p = 0.001). The presence of happy hypoxia reduces survival. Conclusion: The frequency of happy hypoxia among COVID-19 patients was low. Survival was reduced in patients with happy hypoxia. Prehospital pulse oximetry could serve as an early warning signal for the detection of happy hypoxemia in COVID-19 patients.