Hospital-Based Quasi-Experimental Study on Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Providers with Its Potential Side-Effects
Abstract
:1. Background
2. Methods
2.1. Setting and Study Type
2.2. Participants
2.3. Ethical Approval
2.4. Randomization and Blinding
2.5. Intervention
2.6. Recruitment and Discontinuation Procedure
2.7. Evaluation of Toxicity
2.8. Patient and Public Involvement
2.9. Statistical Analysis
3. Results
3.1. Primary Outcome
3.2. Subgroup Analysis-1
3.3. Subgroup Analysis-2
3.4. Dose–Response Analysis
3.5. Evaluation of Toxicity
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Zhu, N.; Zhang, D.; Wang, W.; Li, X.; Yang, B.; Song, J.; Tan, W. China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China. N. Engl. J. Med. 2019, 382, 727–733. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-nCoV); World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Director, W. General’s Opening Remarks at the Media Briefing on COVID-19—11 March 2020; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- World Health Organization. Coronavirus Disease 2019 (COVID-19): Situation Report; World Health Organization: Geneva, Switzerland, 2020; Volume 94. [Google Scholar]
- Miller, M. 2019 Novel Coronavirus COVID-19 (2019-nCoV) Data Repository: Johns Hopkins University Center for Systems Science and Engineering. Bull.-Assoc. Can. Map Libr. Arch. 2020, 164, 47–51. [Google Scholar] [CrossRef]
- Dong, E.; Du, H.; Gardner, L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect. Dis. 2020, 20, 533–534. [Google Scholar] [CrossRef] [PubMed]
- Lai, C.-C.; Shih, T.-P.; Ko, W.-C.; Tang, H.-J.; Hsueh, P.-R. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int. J. Antimicrob. Agents 2020, 55, 105924. [Google Scholar] [CrossRef] [PubMed]
- Iacobucci, G. COVID-19: Doctors sound alarm over hospital transmissions. Br. Med. J. Publ. Group 2020, 369, 2013. [Google Scholar] [CrossRef] [PubMed]
- Jones, N.K.; Rivett, L.; Sparkes, D.; Forrest, S.; Sridhar, S.; Young, J.; CITIID-NIHR COVID-19 BioResource Collaboration. Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19. Elife 2020, 9, e59391. [Google Scholar] [CrossRef]
- Sherzad, A.G.; Tu, Y.; Liu, W.; Azimee, M.A.; Arash, N.; Assady, A.; Raufi, N.; Huang, Y.; Xu, X.; Alsarhang, O.; et al. The Situation and Preventive Measures Related to COVID-19 Infection for Medical Staff. J. Pharm. Res. Int. 2021, 33, 180–198. [Google Scholar] [CrossRef]
- Cohen, M.S. Hydroxychloroquine for the prevention of COVID-19—Searching for evidence. Mass Med. Soc. 2020, 383, 585–586. [Google Scholar] [CrossRef]
- Yao, X.; Ye, F.; Zhang, M.; Cui, C.; Huang, B.; Niu, P.; Liu, D. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin. Infect. Dis. 2020, 71, 732–739. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shah, S.; Das, S.; Jain, A.; Misra, D.P.; Negi, V.S. A systematic review of the prophylactic role of chloroquine and hydroxychloroquine in coronavirus disease-19 (COVID-19). Int. J. Rheum. Dis. 2020, 23, 613–619. [Google Scholar] [CrossRef]
- Zhou, D.; Dai, S.-M.; Tong, Q. COVID-19: A recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J. Antimicrob. Chemother. 2020, 75, 1667–1670. [Google Scholar] [CrossRef] [PubMed]
- Hernandez, A.V.; Roman, Y.M.; Pasupuleti, V.; Barboza, J.J.; White, C.M. Hydroxychloroquine or chloroquine for treatment or prophylaxis of COVID-19: A living systematic review. Ann. Intern. Med. 2020, 173, 287–296. [Google Scholar] [CrossRef]
- Boulware, D.R.; Pullen, M.F.; Bangdiwala, A.S.; Pastick, K.A.; Lofgren, S.M.; Okafor, E.C.; Hullsiek, K.H. A randomized trial of hydroxychloroquine as postexposure prophylaxis for COVID-19. N. Engl. J. Med. 2020, 383, 517–525. [Google Scholar] [CrossRef] [PubMed]
- Rojas-Serrano, J.; Portillo-Vásquez, A.M.; Vázquez-Pérez, J.; Ramírez-Venegas, F.M.-N.A.; Pérez-Kawabe, K.M.; Pérez-Padilla, R. Hydroxychloroquine for Prophylaxis of COVID-19 in Health Workers: A Randomized Clinical Trial. PLoS ONE 2022, 17, e0261980. [Google Scholar] [CrossRef]
- Selection WECot; Medicines UoE; World Health Organization. The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2013 (Including the 18th WHO Model List of Essential Medicines and the 4th WHO Model List of Essential Medicines for Children); World Health Organization: Geneva, Switzerland, 2014. [Google Scholar]
- Lu, R.; Zhao, X.; Li, J.; Niu, P.; Yang, B.; Wu, H.; Tan, W. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020, 395, 565–574. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vincent, M.J.; Bergeron, E.; Benjannet, S.; Erickson, B.R.; Rollin, P.E.; Ksiazek, T.G.; Nichol, S.T. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol. J. 2005, 2, 69. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wang, M.; Cao, R.; Zhang, L.; Yang, X.; Liu, J.; Xu, M.; Xiao, G. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020, 30, 269–271. [Google Scholar] [CrossRef]
- Perrone, C.; Schilling, W.; Callery, J.J.; Ashley, E.A.; Chambers, M.; Chase, H.; Dahal, P.; Kanthawang, N.; Nedsuwan, S.; Hanboonkunupakarn, B.; et al. Good participatory practice for coronavirus disease 2019 (COVID-19) research: The case of a COVID-19 prevention study. Wellcome Open Res. 2021, 6, 216. [Google Scholar] [CrossRef]
- Niriella, M.A.; Ediriweera, D.S.; De Silva, A.P.; Premarathne, R.; Balasooriya, P.; Duminda, K.D.; Jayasinghe, S. Hydroxychloroquine for post-exposure prophylaxis of COVID-19 among naval personnel in Sri Lanka: Study protocol for a randomized, controlled trial. Trials 2020, 21, 748. [Google Scholar] [CrossRef] [PubMed]
- Fang, F.C.; Benson, C.A.; Del Rio, C.; Edwards, K.M.; Fowler, V.G., Jr.; Fredricks, D.N.; Schooley, R.T. COVID-19—Lessons learned and questions remaining. Clin. Infect. Dis. 2021, 72, 2225–2240. [Google Scholar] [CrossRef]
- Consortium, W.S.T. Repurposed antiviral drugs for COVID-19—Interim WHO SOLIDARITY trial results. N. Engl. J. Med. 2021, 384, 497–511. [Google Scholar] [CrossRef]
- Revollo, B.; Tebe, C.; Peñafiel, J.; Blanco, I.; Perez-Alvarez, N.; Lopez, R.; Llibre, J.M. Hydroxychloroquine pre-exposure prophylaxis for COVID-19 in healthcare workers. J. Antimicrob. Chemother. 2020. [Google Scholar] [CrossRef]
- Ramireddy, A.; Chugh, H.; Reinier, K.; Ebinger, J.; Park, E.; Thompson, M.; Chugh, S.S. Experience with hydroxychloroquine and azithromycin in the coronavirus disease 2019 pandemic: Implications for QT interval monitoring. J. Am. Heart Assoc. 2020, 9, e017144. [Google Scholar] [CrossRef] [PubMed]
- Meyerowitz, E.A.; Vannier, A.G.L.; Friesen, M.G.N.; Schoenfeld, S.; Gelfand, J.A.; Callahan, M.V.; Kim, A.Y.; Reeves, P.M.; Poznansky, M.C. Rethinking the role of hydroxychloroquine in the treatment of COVID-19. FASEB J. 2020, 34, 6027–6037. [Google Scholar] [CrossRef]
- Infante, M.; Ricordi, C.; Alejandro, R.; Caprio, M.; Fabbri, A. Hydroxychloroquine in the COVID-19 pandemic era: In pursuit of a rational use for prophylaxis of SARS-CoV-2 infection. Expert Rev. Anti-Infect. Ther. 2021, 19, 5–16. [Google Scholar] [CrossRef] [PubMed]
- Chahla, R.E.; Ruiz, L.M.; Ortega, E.S.; Morales, M.F.; Barreiro, F.; George, A.; Goroso, D.G. A randomized trial-intensive treatment based in Ivermectin and Iota-Carrageenan as pre-exposure prophylaxis for COVID-19 in healthcare agents. medRxiv 2021. [Google Scholar] [CrossRef]
- Elgazzar, A.; Hany, B.; Youssef, S.A.; Hafez, M.; Moussa, H.; Eltaweel, A. Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic. Europe PMC 2020. [Google Scholar] [CrossRef]
- World Health Organization. Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations: Scientific Brief, 29 March 2020; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Ingram, C.; Downey, V.; Roe, M.; Chen, Y.; Archibald, M.; Kallas, K.-A.; Perrotta, C. COVID-19 prevention and control measures in workplace settings: A rapid review and meta-analysis. Int. J. Environ. Res. Public Health 2021, 18, 7847. [Google Scholar] [CrossRef] [PubMed]
Variable | Overall (n = 336) | Control (n = 106) | Prophylaxis (n = 230) | p-Value |
---|---|---|---|---|
Age, median (IQR) | 35 (26.8, 48.3) | 40 (29, 55) | 34 (25, 43) | <0.001 |
Female sex, n (%) | 203 (60.4%) | 64 (60.4%) | 139 (60.4%) | 0.992 |
Employment Type, n (%) | ||||
Cleaning Staff | 73 (21.7%) | 10 (9.4%) | 63 (27.4%) | <0.001 |
Doctor | 58 (17.3%) | 28 (26.2%) | 30 (13.1%) | |
Health Worker | 75 (22.3%) | 36 (33.6%) | 39 (17.0%) | |
Nurse | 100 (29.8%) | 26 (24.3%) | 74 (32.3%) | |
Other | 30 (8.9%) | 6 (5.6%) | 24 (10.5%) | |
Hypertension, n/N (%) | 54/307 (17.6%) | 20/88 (22.7%) | 34/219 (15.5%) | 0.134 |
Bronchial asthma/COPD, n/N (%) | 29/307 (9.5%) | 9/88 (10.2%) | 20/219 (9.1%) | 0.767 |
Smoking habit, n/N (%) | 27/306 (8.8%) | 7/88 (7.9%) | 20/218 (9.2%) | 0.733 |
Total days of work, median (IQR) | 19 (9.8, 33) | 9 (0, 16) | 23 (16, 41) | <0.001 |
Variable | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|
Prophylaxis | 1.99 (0.98, 4.03) | 0.057 | 2.09 (0.90, 4.85) | 0.088 |
Age (years) | 1.01 (0.99, 1.04) | 0.332 | 0.96 (0.92, 1.00) | 0.065 |
Female sex | 1.14 (0.62, 2.07) | 0.676 | 1.24 (0.61, 2.52) | 0.557 |
Employment Type | ||||
Doctor | Ref | Ref | ||
Cleaning staff | 0.50 (0.13, 1.87) | 0.305 | 0.65 (0.13, 3.37) | 0.611 |
Health worker | 2.94 (1.09, 7.93) | 0.033 | 3.43 (1.09, 10.82) | 0.036 |
Nurse | 1.18 (0.42, 3.34) | 0.752 | 0.87 (0.30, 2.57) | 0.803 |
Other | 6.63 (2.18, 20.14) | 0.001 | 6.18 (1.74, 21.97) | 0.005 |
Hypertension | 2.32 (1.16, 4.63) | 0.017 | 2.07 (0.85, 5.05) | 0.109 |
Bronchial asthma/COPD | 2.08 (0.87, 5.00) | 0.101 | 1.43 (0.52, 3.89) | 0.486 |
Smoking habit | 0.86 (0.28, 2.60) | 0.787 | ||
Total days of work | 0.98 (0.96, 0.99) | 0.011 | 0.98 (0.95, 1.01) | 0.294 |
Variable | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|
Prophylaxis | 0.77 (0.27, 2.22) | 0.631 | 0.92 (0.28, 3.01) | 0.894 |
Age (years) | 1.02 (0.99, 1.06) | 0.229 | 0.96 (0.91, 1.01) | 0.142 |
Female sex | 1.04 (0.46, 2.35) | 0.925 | 1.16 (0.43, 3.15) | 0.765 |
Employment Type | ||||
Doctor | Ref | Ref | ||
Cleaning staff | 0.18 (0.03, 1.05) | 0.057 | 0.14 (0.02, 0.92) | 0.041 |
Health worker | 2.91 (0.76, 11.09) | 0.117 | 3.89 (0.74, 20.29) | 0.107 |
Nurse | 0.58 (0.16, 2.18) | 0.423 | 0.45 (0.11, 1.79) | 0.255 |
Other | 4.13 (0.92, 18.52) | 0.064 | 4.94 (0.87, 28) | 0.071 |
Hypertension | 1.83 (0.62, 5.43) | 0.276 | ||
Bronchial asthma/COPD | 2.98 (0.85, 10.46) | 0.089 | 4.21 (0.88, 20.24) | 0.073 |
Smoking habit | 0.6 (0.13, 2.75) | 0.512 |
Variable | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|
Prophylaxis | 1.75 (0.86, 3.59) | 0.123 | 1.74 (0.74, 4.09) | 0.207 |
Age (years) | 1.01 (0.99, 1.04) | 0.273 | 0.97 (0.93, 1.01) | 0.107 |
Female sex | 1.52 (0.79, 2.91) | 0.212 | 1.7 (0.77, 3.72) | 0.187 |
Employment Type | ||||
Doctor | Ref | Ref | ||
Cleaning staff | 0.25 (0.05, 1.3) | 0.099 | 0.25 (0.04, 1.74) | 0.161 |
HW-A | 2.63 (0.96, 7.18) | 0.059 | 3.04 (0.95, 9.75) | 0.061 |
Nurse | 1.18 (0.42, 3.34) | 0.752 | 0.84 (0.28, 2.47) | 0.748 |
Other | 6.12 (1.99, 18.8) | 0.002 | 6.55 (1.81, 23.68) | 0.004 |
Hypertension | 2.19 (1.06, 4.53) | 0.034 | 1.93 (0.77, 4.83) | 0.161 |
Bronchial Asthma/COPD | 2.01 (0.8, 5.04) | 0.137 | 1.4 (0.5, 3.96) | 0.522 |
Smoking habit | 0.7 (0.2, 2.45) | 0.581 | ||
Total days of work | 0.98 (0.96, 0.99) | 0.015 | 0.99 (0.97, 1.03) | 0.835 |
Variable | Unadjusted HR (95% CI) | p-Value | Adjusted HR (95% CI) | p-Value |
---|---|---|---|---|
Total number of doses | 0.83 (0.72, 0.96) | 0.012 | 0.85 (0.72, 0.99) | 0.042 |
Age (years) | 1.03 (0.99, 1.06) | 0.057 | 0.97 (0.93, 1.01) | 0.184 |
Female sex | 0.79 (0.41, 1.53) | 0.484 | 0.76 (0.37, 1.59) | 0.472 |
Employment Type | ||||
Doctor | ||||
Cleaning staff | 0.96 (0.18, 5.24) | 0.963 | 1.44 (0.21, 9.95) | 0.712 |
Health worker | 7.12 (1.63, 31.14) | 0.009 | 7.92 (1.67, 37.54) | 0.009 |
Nurse | 1.00 (0.19, 5.17) | 0.997 | 0.99 (0.19, 5.19) | 0.993 |
Other | 7.13 (1.56, 32.57) | 0.011 | 6.21 (1.29, 29.76) | 0.022 |
Hypertension | 2.50 (1.19, 5.22) | 0.015 | 1.68 (0.70, 3.99) | 0.243 |
Bronchial asthma/COPD | 1.40 (0.49, 3.97) | 0.529 | ||
Smoking habit | 1.40 (0.49, 3.98) | 0.526 | ||
Total days of work | 0.95 (0.93, 0.98) | <0.001 | 0.98 (0.95, 1.01) | 0.267 |
Side Effect | n (%) |
---|---|
No problems | 208 (90.83) |
Palpitation | 1 (0.44) |
Neurological problem | 5 (2.18) |
Skin problem | 3 (1.31) |
Visual problem | 1 (0.44) |
Weakness | 1 (0.44) |
Feverish | 1 (0.44) |
GI problem | 7 (3.06) |
Anxiety | 1 (0.44) |
Weakness and neurological problem | 1 (0.44) |
Corrected QT Interval | First Time ECG | Second Time ECG | ||||
---|---|---|---|---|---|---|
Overall (n = 229) | Control (n = 12) | Prophylaxis (n = 217) | Overall (n = 105) | Control (n = 0) | Prophylaxis (n = 105) | |
Corrected QT interval | ||||||
<450 | 209 (91.27%) | 11 (91.67%) | 198 (91.24%) | 99 (94.29%) | - | 99 (94.29%) |
450 to 480 | 18 (7.86%) | 1 (8.33%) | 17 (7.83%) | 6 (5.71%) | - | 6 (5.71%) |
>480 | 2 (0.87%) | 0 (0%) | 2 (0.92%) | 0 (0%) | - | 0 (0%) |
Findings | ||||||
Atrial fibrillation, Ischemia | 1 (0.44%) | 0 (0%) | 1 (0.44%) | 0 (0%) | - | 0 (0%) |
Bradycardia | 2 (0.87%) | 0 (0%) | 2 (0.87%) | 1 (0.95%) | - | 1 (0.95%) |
Ischemia | 1 (0.44%) | 0 (0%) | 1 (0.44%) | 4 (3.81%) | - | 4 (3.81%) |
Ischemia, Tachycardia | 1 (0.44%) | 0 (0%) | 1 (0.44%) | 0 (0%) | - | 0 (0%) |
Normal | 210 (91.7%) | 9 (75%) | 201 (92.63%) | 88 (83.81%) | - | 88 (83.81%) |
Tachycardia | 1 (0.44%) | 0 (0%) | 1 (0.44%) | 0 (0%) | - | 0 (0%) |
Uncorrected prolonged QT, Irregular heart rate | 1(0.44%) | 0 (0%) | 1 (0.44%) | 0 (0%) | - | 0 (0%) |
Uncorrected prolonged QT | 5(2.18%) | 0 (0%) | 5 (2.18%) | 1(0.95%) | - | 1 (0.95%) |
Uncorrected prolonged QT, Bradycardia | 0 (0%) | 0 (0%) | 0 (0%) | 1(0.95%) | - | 1 (0.95%) |
Irregular heart rate | 7(3.06%) | 3 (25%) | 4 (1.84%) | 10 (9.52) | - | 10 (9.52) |
Control | Prophylaxis | Both Groups | ||
---|---|---|---|---|
106 | 230 | 336 | ||
Participants eligible for eye check-up | 45 (42%) | 73 (32%) | 118 | |
Participants who completed eye check-up | 7 (16%) | 46 (63%) | 53 | |
Visual acuity (VA) | ||||
Aided (spectacles) | 5 (71%) | 21 (46%) | 26 (49%) | 0.218 |
Visual acuity in right eye | ||||
6/6 (Normal) | 4 (57%) | 28 (61%) | 32 (80%) | 0.840 |
6/9 | 2 (29%) | 12 (26%) | 14 (26%) | 0.867 |
6/12 | 0 (0%) | 6 (13%) | 6 (11%) | 0.311 |
6/18 | 1 (14%) | 0 (0%) | 1 (2%) | 0.010 |
Abnormal VA in right eye | 3 (43%) | 18 (39%) | 21 (40%) | 0.840 |
Visual acuity in left eye | ||||
6/6 (Normal) | 4 (57%) | 31 (67%) | 35 (66%) | 0.604 |
6/9 | 2 (29%) | 13 (28%) | 15 (28%) | 0.956 |
6/12 | 0 (0%) | 1 (2%) | 1 (2%) | 0.706 |
6/18 | 1 (14%) | 1 (2%) | 2 (4%) | 0.117 |
Abnormal VA in left eye | 3 (43%) | 15 (32%) | 18 (34%) | 0.566 |
Intra-ocular pressure, mean (sd) | ||||
Right eye (mm Hg) | 18.4 (2.5) | 19.0 (3.7) | 18.9 (3.6) | 0.594 |
Left eye (mm Hg) | 18.0 (2.8) | 19.5 (3.7) | 19.3 (3.7) | 0.238 |
Central corneal thickness (CCT) Mean (sd) | n = 7 | n = 43 | n = 50 | |
Right eye (µm), | 554.3 (20.1) | 554.7 (26.2) | 554.6 (25.3) | 0.964 |
Left eye (µm) | 561.4 (22.7) | 554.4 (27.8) | 555.4 (27.2) | 0.483 |
Visual field analysis: | n = 7 | n = 46 | n = 53 | |
Scotoma in right eye | 2 (29%) | 20 (44%) | 22 (44%) | 0.454 |
Scotoma in left eye | 2 (29%) | 16 (35%) | 18 (34%) | 0.755 |
Over all comments: | n = 7 | n = 46 | n = 53 | |
Early lenticular opacity (cataract) | 3 (14%) | 5 (11%) | 8 (15%) | 0.816 |
Suspected glaucomatous change | 1 (14%) | 2 (4%) | 3 (6%) | 0.272 |
Ocular hypertension/raised intraocular pressure | 0 (0%) | 2 (4%) | 2 (4%) | 0.590 |
Scotoma (any eye, central/peripheral) | 2 (29%) | 23 (50%) | 25 (47%) | 0.300 |
Changes due to HCQ prophylaxis | ||||
Humphrey visual field | ||||
Superonasal visual field loss | 0 | 0 | 0 | |
Pericentral deficits | 0 | 0 | 0 | |
Ring scotomas | 0 | 0 | 0 | |
Fundus photo | ||||
Hyperfluorescence (early sign) | 0 | 0 | 0 | |
Hypofluorescence (late sign) | 0 | 0 | 0 | |
Optical coherence tomography | 0 | 0 | 0 | |
Morphological changes due to HCQ retinopathy | 0 | 0 | 0 |
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Shahrin, L.; Mahfuz, M.; Rahman, M.W.; Hossain, M.R.; Khandaker, A.M.; Alam, M.A.; Osmany, D.M.M.F.; Islam, M.M.; Chisti, M.J.; Ahmed, C.M.; et al. Hospital-Based Quasi-Experimental Study on Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Providers with Its Potential Side-Effects. Life 2022, 12, 2047. https://doi.org/10.3390/life12122047
Shahrin L, Mahfuz M, Rahman MW, Hossain MR, Khandaker AM, Alam MA, Osmany DMMF, Islam MM, Chisti MJ, Ahmed CM, et al. Hospital-Based Quasi-Experimental Study on Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Providers with Its Potential Side-Effects. Life. 2022; 12(12):2047. https://doi.org/10.3390/life12122047
Chicago/Turabian StyleShahrin, Lubaba, Mustafa Mahfuz, Md. Waliur Rahman, Md. Rezaul Hossain, Afsana Mim Khandaker, Md. Ashraful Alam, Din M. M. F. Osmany, Md. Munirul Islam, Mohammod Jobayer Chisti, Chaudhury Meshkat Ahmed, and et al. 2022. "Hospital-Based Quasi-Experimental Study on Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Providers with Its Potential Side-Effects" Life 12, no. 12: 2047. https://doi.org/10.3390/life12122047
APA StyleShahrin, L., Mahfuz, M., Rahman, M. W., Hossain, M. R., Khandaker, A. M., Alam, M. A., Osmany, D. M. M. F., Islam, M. M., Chisti, M. J., Ahmed, C. M., & Ahmed, T. (2022). Hospital-Based Quasi-Experimental Study on Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Providers with Its Potential Side-Effects. Life, 12(12), 2047. https://doi.org/10.3390/life12122047