Electrocardiogram abnormalities in residents in cold homes: a cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan

Abstract Background Excess winter mortality caused by cardiovascular disease is particularly profound in cold houses. Consistent with this, accumulating evidence indicates that low indoor temperatures at home increase blood pressure. However, it remains unclear whether low indoor temperatures affect other cardiovascular biomarkers. In its latest list of priority medical devices for management of cardiovascular diseases, the World Health Organization (WHO) included electrocardiography systems as capital medical devices. We therefore examined the association between indoor temperature and electrocardiogram findings. Methods We collected electrocardiogram data from 1480 participants during health checkups. We also measured the indoor temperature in the living room and bedroom for 2 weeks in winter, and divided participants into those living in warm houses (average exposure temperature ≥ 18 °C), slightly cold houses (12–18 °C), and cold houses (< 12 °C) in accordance with guidelines issued by the WHO and United Kingdom. The association between indoor temperature (warm vs. slightly cold vs. cold houses) and electrocardiogram findings was analyzed using multivariate logistic regression models, with adjustment for confounders such as demographics (e.g., age, sex, body mass index, household income), lifestyle (e.g., eating habit, exercise, smoking, alcohol drinking), and region. Results The average temperature at home was 14.7 °C, and 238, 924, and 318 participants lived in warm, slightly cold, and cold houses, respectively. Electrocardiogram abnormalities were observed in 17.6%, 25.4%, and 30.2% of participants living in warm, slightly cold, and cold houses, respectively (p = 0.003, chi-squared test). Compared to participants living in warm houses, the odds ratio of having electrocardiogram abnormalities was 1.79 (95% confidence interval: 1.14–2.81, p = 0.011) for those living in slightly cold houses and 2.18 (95% confidence interval: 1.27–3.75, p = 0.005) for those living in cold houses. Conclusions In addition to blood pressure, living in cold houses may have adverse effects on electrocardiogram. Conversely, keeping the indoor thermal environment within an appropriate range through a combination of living in highly thermal insulated houses and appropriate use of heating devices may contribute to good cardiovascular health. Trial registration The trial was retrospectively registered on 27 Dec 2017 to the University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, https://www.umin.ac.jp/ctr/, registration identifier number UMIN000030601).

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Vascular Overload Index Predicts Cerebral Small Vessel Disease in a Neurologically Healthy Population

Journal of Neurosonology and Neuroimaging ◽

10.31728/jnn.2021.00105 ◽

2021 ◽

Vol 13 (2) ◽

pp. 55-63

Author(s):

Ki-Woong Nam ◽

Hyung-Min Kwon ◽

Jin-Ho Park ◽

Hyuktae Kwon

Keyword(s):

Blood Pressure ◽

Regression Analysis ◽

Arterial Stiffness ◽

Confidence Interval ◽

Linear Regression Analysis ◽

University Hospital ◽

Small Vessel ◽

White Matter Hyperintensity ◽

Multivariable Logistic Regression Analysis ◽

Healthy Population

Background: Arterial stiffness has been suggested as one of the major pathological mechanisms of cerebral small vessel diseases (cSVDs). In this study, we confirmed this hypothesis by evaluating the association between vascular overload index (VOI), which is a physiologically good indicator of arterial stiffness, and cSVD.Methods: We evaluated participants who visited Seoul National University Hospital Health Promotion Center for health check-ups between 2006 and 2013. VOI was calculated by the following formula: VOI (mmHg)=1.33×systolic blood pressure -0.33×diastolic blood pressure-133.3. cSVDs were measured including white matter hyperintensity (WMH), lacunes, and cerebral microbleeds (CMBs). We quantitatively measured the WMH volume and rated the presence and number of lacunes and CMBs qualitatively.Results: A total of 3,231 participants were evaluated (mean age 57±9 years, male sex 53.9%). In multivariable linear regression analysis, VOI was significantly associated with WMH volume after adjusting confounders (β=0.004, 95% confidence interval=0.002–0.006). VOI also showed a close association with lacunes in multivariable logistic regression analysis (adjusted odds ratio=1.01, 95% confidence interval=1.00–1.02). There was no statistical association with CMBs. In subgroup analysis according to the presence of hypertension, VOI was closely associated with WMH volume/lacunes only in patients without hypertension. In patients with hypertension, these statistical associations disappeared.Conclusion: A high VOI was associated with cSVD in a neurologically healthy population, especially in patients without hypertension. This marker of arterial stiffness could be convenient and useful predictor of cSVD.

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HEARTS in the Americas Regulatory Pathway to the Exclusive Use of Validated Blood Pressure Measuring Devices

10.37774/9789275124864 ◽

2021 ◽

Keyword(s):

Blood Pressure ◽

Medical Devices ◽

Regulatory System ◽

World Health ◽

Middle Income ◽

Medical Products ◽

Measuring Devices ◽

World Health Assembly Resolution ◽

Technical Specifications ◽

Health Organization

Cardiovascular disease (CVD) is the leading cause of disease burden globally. According to the 2017 Global Burden of Disease estimates, there were 14 million new cases of CVD, 80 million people living with this condition, and nearly 1 million deaths attributed to CVD in the Americas. Hypertension is the major risk factor for CVD, causing half of the cases, and is highly prevalent, affecting one in four adults, including 40% of those over age 25 years.To appropriately detect hypertension, accurate measurement of blood pressure is critical, and inaccurate measurement of BP has important consequences for policies to address hypertension, as well as for patient safety and quality of care. The Fourth World Health Organization (WHO) Global Forum on Medical Devices identified several critical issues related to medical devices. Among those issues were recommendations for increased regulation of medical devices in low- and middle-income countries and development of technical specifications to optimize procurement of priority medical devices. World Health Assembly Resolution 67.20 (Regulatory system strengthening for medical products) stresses the importance of regulation of medical devices for better public health outcomes and to increase access to safe, effective, and quality medical products. This publication seeks to contribute to meeting these recommendations by providing a practical tool for governments to improve their national regulatory frameworks to improve accuracy of blood pressure measuring devices (BPMDs), in turn contributing to the exclusive use of accuracy validated automated BPMDs in primary health care (PHC) facilities by 2025. This publication can also guide the development of procurement mechanisms that will ensure exclusive availability of BPMDs in PHC facilities. Specifically, this publication will provide a brief background on the importance of using validated BPMDs and highlight key elements of regulations related to pre-market approvals to promote accurate BPMDs.

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Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults—A Systematic Review and Meta-Analysis

Canadian Respiratory Journal ◽

10.1155/2019/5271982 ◽

2019 ◽

Vol 2019 ◽

pp. 1-16 ◽

Cited By ~ 2

Author(s):

Hamid Dahmarde ◽

Fateme Parooie ◽

Morteza Salarzaei

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Odds Ratio ◽

English Language ◽

Meta Analysis ◽

Diagnostic Odds Ratio ◽

World Health ◽

Cochrane Library ◽

Chest Ultrasonography ◽

Link Type

Objective. The present systematic review and meta-analysis were conducted to investigate the accuracy of ultrasound in the diagnosis of pneumothorax in neonates and adults. Method. The searches were conducted by two independent researchers (MS and HD) to find the relevant studies published from 01/01/2009 until the end of 01/01/2019. We searched for published literature in the English language in MEDLINE via PubMed, Embase™ via ovid, the Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS, and we searched OpenGrey (http://www.opengrey.eu/) and the World Health Organization Clinical Trials Registry (http://who.int/ictrp) for unpublished literature and ongoing studies. The keywords used in the search strategy were pneumothorax or ultrasound or chest ultrasonography or neonate or adult or aerothorax or sensitivity or specificity or diagnostic accuracy. The list of previous study resources and systematic reviews was also searched for identifying the published studies (MS and HD). Analyses were performed using Meta-Disc 1.4. Results. In total, 1,565 patients (255 neonates, 1212 adults, and 101 pediatrics suspected of pneumothorax) were investigated in 10 studies. The overall specificity of chest ultrasound in the diagnosis of pneumothorax in both populations of adults and neonates was 85.1% at the confidence interval of 95 percent (95% CI 81.1%–88.5%). At the confidence interval of 95 percent, the sensitivity was 98.6% (95% CI 97.7%–99.2%). The diagnostic odds ratio was 387.72 (95% CI 76.204–1972.7). For the diagnosis of pneumothorax in neonates, the ultrasound sensitivity was 96.7% at the confidence interval of 95 percent (95% CI 88.3%–99.6%). At the confidence interval of 95 percent, the specificity was 100% (95% CI 97.7%–100%). For the diagnosis of pneumothorax in adults, the ultrasound sensitivity was 82.9% at the confidence interval of 95 percent (95% CI 78.3–86.9%). At the confidence interval of 95 percent, the specificity was 98.2% (95% CI 97.0%–99.0%). The diagnostic odds ratio was 423.13 (95% CI 45.222–3959.1). Analyzing studies indicated that the sensitivity of “absence lung sliding” sign for the diagnosis of pneumothorax was 87.2% (95% CI 77.7–93.7), and specificity was 99.4% (95% CI 96.5%–100%). DOR was 556.74 (95% CI 100.03–3098.7). The sensitivity of “lung point” sign for the diagnosis of pneumothorax was 82.1% (95% CI 71.7%–89.8%), and the specificity was 100% (at the confidence interval of 95% CI 97.6%–100%). DOR was 298.0 (95% CI 58.893–1507.8). Conclusion. The diagnosis of pneumothorax using ultrasound is accurate and reliable; additionally, it can result in timely diagnoses specifically in neonatal pneumothorax. Using this method facilitates the therapy process; lack of ionizing radiation and easy operation are benefits of this imaging technique.

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Effects of the Modified DASH Diet on Adults With Elevated Blood Pressure or Hypertension: A Systematic Review and Meta-Analysis

Frontiers in Nutrition ◽

10.3389/fnut.2021.725020 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ru Guo ◽

Nian Li ◽

Rong Yang ◽

Xiao-Yang Liao ◽

Yu Zhang ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Body Mass Index ◽

Waist Circumference ◽

Confidence Interval ◽

Body Mass ◽

World Health ◽

Concentration Difference ◽

Dash Diet ◽

Triglyceride Concentration

Background: The modified Dietary Approaches to Stop Hypertension (DASH) diet was a potentially effective treatment for pre-hypertensive and hypertensive patients. The evidence for the effect of the modified DASH diet on blood pressure reduction was inconsistent. The study was designed to assess the effects of the modified DASH diet on blood pressure (BP) in hypertensive and pre-hypertensive adults.Methods: We searched Medline, Embase, CENTRAL, CNKI, VIP, Wanfang Data, SINOMED, Google Scholar, the World Health Organization's International Clinical Trials Registry Platform, and Clinicaltrials.gov from inception to July 1st, 2021. Randomized controlled trials (RCTs) assessing the effects of the modified DASH diet on systolic and diastolic BP, cardiovascular risk factors (body weight, body mass index, waist circumference, fasting glucose, blood lipids), cardiovascular events, and all-cause mortality were included. Statistical analysis was performed using Stata software. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE.Results: A total of 10 RCTs were included. Compared with control diet, the modified DASH diet could reduce mean systolic (−3.26 mmHg; 95% confidence interval −5.58, −0.94 mmHg; P = 0.006) and diastolic (−2.07 mmHg; 95% confidence interval −3.68, −0.46 mmHg; P = 0.01) BP. Compared with the controlling diet, the modified DASH diet could reduce systolic BP to a greater extent in trials with a mean baseline BP ≥ 140/90 mmHg compared with <140/90 mmHg. Diastolic BP reduction was greater when the mean body mass index was ≥30 kg/m2 than <30 kg/m2. Diastolic BP reduction was more marked in trials with a follow-up time of >8 weeks compared with ≤8 weeks. The modified DASH diet could affect mean waist circumference (difference: 1.57 cm; 95% confidence interval −2.98, −0.15) and triglyceride concentration (difference: 1.04 mol/L; 95% confidence interval −1.47, −0.60).Conclusions: The modified DASH diet can reduce BP, waist circumference, and triglyceride concentration in hypertension patients. A higher baseline BP is associated with more marked systolic and diastolic BP reduction.Systematic Review Registration: PROSPERO registration number: CRD42020190860.

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Cold New Zealand Council Housing Getting an Upgrade

Policy Quarterly ◽

10.26686/pq.v14i2.5096 ◽

2018 ◽

Vol 14 (2) ◽

Cited By ~ 4

Author(s):

Lara Rangiwhetu ◽

Nevil Pierse ◽

Helen Viggers ◽

Philippa Howden-Chapman

Keyword(s):

Central Government ◽

Thermal Conditions ◽

Evidence Base ◽

High Rate ◽

World Health ◽

Winter Mortality ◽

Indoor Temperature ◽

Temperature Requirements ◽

Health Organization ◽

Council Housing

As people spend most of their time at home, residential thermal conditions are important. Central government debate about minimum temperature requirements for rental properties requires an evidence base of indoor temperature data. We collected temperature, humidity and energy data from 49 council housing dwellings in Wellington over winter, and self-reported thermal comfort and heating behaviour. Mean indoor temperature was 14.9°C, colder than the national average, with 67% of readings under 16°C, which the World Health Organization associates with health implications. With New Zealand’s high rate of excess winter mortality and children hospitalised for housing-related diseases, cold housing should be addressed.

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Impact of an Innovative Equipment to Monitor and Control Salt Usage during Cooking at Home on Salt Intake and Blood Pressure—Randomized Controlled Trial iMC SALT

Nutrients ◽

10.3390/nu14010008 ◽

2021 ◽

Vol 14 (1) ◽

pp. 8

Author(s):

Tânia Silva-Santos ◽

Pedro Moreira ◽

Olívia Pinho ◽

Patrícia Padrão ◽

Sandra Abreu ◽

...

Keyword(s):

Blood Pressure ◽

Salt Intake ◽

Intervention Group ◽

World Health ◽

Salt Consumption ◽

Urinary Potassium ◽

And Control ◽

The Impact ◽

Monitor And Control ◽

At Home

(1) Background: Excessive salt consumption is associated with an increased risk of hypertension and cardiovascular disease, and it is essential to reduce it to the level recommended by the World Health Organization (<5 g/day). The main objective of this study is to verify the impact of an intervention, which used the Salt Control H equipment to reducing salt consumption; (2) Methods: The study was an 8-week randomized control trial with 114 workers from a public university. The intervention group (n = 57) used the equipment to monitor and control the use of salt during cooking (Salt Control H) at home for 8 weeks. The primary outcome was 24 h urinary sodium excretion as a proxy of salt intake. Secondary outcomes included changes in 24 h urinary potassium excretion, sodium to potassium ratio (Na:K), and blood pressure. (3) Results: There was a decrease in sodium intake after the intervention but with no statistical significance. When analyzing the results by sex and hypertension status, there was a reduction in sodium (−1009 (−1876 to −142), p = 0.025) and in Na:K ratio (−0.9 (−1.5 to −0.3), p = 0.007) in hypertensive men in the intervention group. (4) Conclusions: Interventions with dosage equipment can be valid approaches in individual salt reduction strategies, especially in hypertensive men.

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Seasonal Variation in Blood Pressure in Normotensive Women Studied by Home Measurements

Clinical Science ◽

10.1042/cs0900055 ◽

1996 ◽

Vol 90 (1) ◽

pp. 55-60 ◽

Cited By ~ 61

Author(s):

Yutaka Imai ◽

Masanori Munakata ◽

Ichiro Tsuji ◽

Takayoshi Ohkubo ◽

Hiroshi Satoh ◽

...

Keyword(s):

Blood Pressure ◽

Body Weight ◽

Seasonal Variation ◽

Diastolic Blood Pressure ◽

Environmental Temperature ◽

Seasonal Effect ◽

Circannual Rhythm ◽

Indoor Temperature ◽

Meteorological Observatory ◽

At Home

1. The factors influencing the seasonal variation in blood pressure measured at home in normotensive women were examined. 2. Sixteen female subjects (56.3 ± 7.9 years old, mean ± SD) measured their blood pressure and pulse rate at home each morning for more than 20 times per month for at least 1.5 years. Blood pressure and body weight were also determined in the office once or twice a month in that period. Monthly means of outdoor and indoor temperatures and daytime length were obtained from the Meteorological Observatory. The single cosinor method was used to evaluate circannual rhythm. 3. We observed a biphasic seasonal variation in self-recorded blood pressure measured at home, environmental temperature and daytime length but found no apparent seasonal variation in body weight and blood pressure measured in the office. The lowest levels of systolic and diastolic blood pressure measured at home were observed in July. The longest daytime length was recorded in June, while the highest outdoor temperature and indoor temperature were recorded in August, indicating that the longest daytime length preceded and the highest environmental temperature lagged behind the lowest level of blood pressure. The shortest daytime length is in December. The lowest outdoor and indoor temperature were observed in January, while the highest levels of self-recorded systolic blood pressure and diastolic blood pressure were in January and December, respectively. Half-amplitudes of self-recorded systolic and diastolic blood pressure were 2.6 ± 1.0 mmHg and 2.0 ± 0.8 mmHg, respectively. 4. These findings indicate the importance of a seasonal effect, i.e. daytime length and the environmental temperature, on the blood pressure of individuals.

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HIPEREMESIS GRAVIDARUM PADA IBU HAMIL DI KLINIK BIDAN SUPRIYATI SRIBIT BERBAH SLEMAN

Surya Medika: Jurnal Ilmiah Ilmu Keperawatan dan Ilmu Kesehatan Masyarakat ◽

10.32504/sm.v14i1.108 ◽

2019 ◽

Vol 14 (1) ◽

pp. 51

Author(s):

Pramukti Dian Setianingrum ◽

Farah Irmania Tsani

Keyword(s):

Blood Pressure ◽

Pregnant Women ◽

Hyperemesis Gravidarum ◽

Unwanted Pregnancy ◽

The Body ◽

Nausea And Vomiting ◽

Daily Activities ◽

World Health ◽

The World

Backgroud: The World Health Organization (WHO) explained that the number of Hyperemesis Gravidarum cases reached 12.5% of the total number of pregnancies in the world and the results of the Demographic Survey conducted in 2007, stated that 26% of women with live births experienced complications. The results of the observations conducted at the Midwife Supriyati Clinic found that pregnant women with hyperemesis gravidarum, with a comparison of 10 pregnant women who examined their contents there were about 4 pregnant women who complained of excessive nausea and vomiting. Objective: to determine the hyperemesis Gravidarum of pregnant mother in clinic. Methods: This study used Qualitative research methods by using a case study approach (Case Study.) Result: The description of excessive nausea of vomiting in women with Hipermemsis Gravidarum is continuous nausea and vomiting more than 10 times in one day, no appetite or vomiting when fed, the body feels weak, blood pressure decreases until the body weight decreases and interferes with daily activities days The factors that influence the occurrence of Hyperemesis Gravidarum are Hormonal, Diet, Unwanted Pregnancy, and psychology, primigravida does not affect the occurrence of Hyperemesis Gravidarum. Conclusion: Mothers who experience Hyperemesis Gravidarum feel nausea vomiting continuously more than 10 times in one day, no appetite or vomiting when fed, the body feels weak, blood pressure decreases until the weight decreases and interferes with daily activities, it is because there are several factors, namely, hormonal actors, diet, unwanted pregnancy, and psychology.

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THE USE OF MEDICINES IN TREATING HYPERTENSION IN HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.2.11 ◽

2016 ◽

pp. 76-84

Author(s):

Khoa Bao Chau Thai ◽

Thi Hong Phuong Vo

Keyword(s):

Blood Pressure ◽

Channel Blocker ◽

Enzyme Inhibitor ◽

Antihypertensive Drugs ◽

Good Prognosis ◽

Target Blood Pressure ◽

University Hospital ◽

Key Words Hypertension ◽

Cross Sectional ◽

Positive Effects

Background: Hypertension is a common condition in the world as well as in Viet Nam. If hypertension isn’t treated well, it can cause many serious complications. Controlling target blood pressure will bring positive effects on reducing mortality rate and also disabilities caused by diseases related to hypertension. Objectives: (1) Analyzing the use of medicines in treating hypertension. (2) Evaluating the effects of medicine usage in treating hypertension at the hospital of Hue University of Medicine and Pharmacy. Materials and methods: 388 patients were diagnosed as having hypertension with inpatient care at the Cardiovascular Department of Hue University of Medicine and Pharmacy’s hospital, using cross-sectional descriptive study methods. Results: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. Angiotensin converting enzyme inhibitor and calcium channel blocker were the two most popular drug groups (96.6% and 71.4%, respectively). The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens in both initial therapies (64.7%>35.3%) and final therapies (61.9%>38.1%). The rate of patients having interactions between antihypertensive drugs and the other kinds of drugs was 7.5%. The rate of patients having reasonable prescriptions was 84.3%. Evaluating the effects of medicine usage in treatments showed that the rate of patients reaching target blood pressure before leaving the hospital was 67.3%. Most patients were evaluated as having good prognosis after treatment, up to 81.7%. Conclusions: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens. The rate of drug interactions was quite low; most patients were evaluated as having good prognosis after treatment. Key words: hypertension, antihypertensive drugs.

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Impact of hydroxychloroquin/azithromycin protocol on COVID-19 case-fatality rate reduction in Algeria. (Preprint)

10.2196/preprints.20886 ◽

2020 ◽

Author(s):

Ahmed Youssef Kada

Keyword(s):

Case Fatality Rate ◽

Doubling Time ◽

Case Fatality ◽

World Health ◽

Fatality Rate ◽

Therapeutic Protocol ◽

First Case ◽

The World ◽

The Impact ◽

At Home

BACKGROUND Covid-19 is an emerging infectious disease like viral zoonosis caused by new coronavirus SARS CoV 2. On December 31, 2019, Wuhan Municipal Health Commission in Hubei province (China) reported cases of pneumonia, the origin of which is a new coronavirus. Rapidly extendable around the world, the World Health Organization (WHO) declares it pandemic on March 11, 2020. This pandemic reaches Algeria on February 25, 2020, date on which the Algerian minister of health, announced the first case of Covid-19, a foreign citizen. From March 1, a cluster is formed in Blida and becomes the epicentre of the coronavirus epidemic in Algeria, its total quarantine is established on March 24, 2020, it will be smoothly alleviated on April 24. A therapeutic protocol based on hydroxychloroquine and azithromycin was put in place on March 23, for complicated cases, it was extended to all the cases confirmed on April 06. OBJECTIVE This study aimed to demonstrate the effectiveness of hydroxychloroquin/azithromycin protocol in Algeria, in particular after its extension to all patients diagnosed COVID-19 positive on RT-PCR test. We were able to illustrate this fact graphically, but not to prove it statistically because the design of our study, indeed in the 7 days which followed generalization of therapeutic protocol, case fatality rate decrease and doubling time increase, thus confirming the impact of wide and early prescription of hydroxychloroquin/azithromycin protocol. METHODS We have analyzed the data collected from press releases and follow-ups published daily by the Ministry of Health, we have studied the possible correlations of these data with certain events or decisions having a possible impact on their development, such as confinement at home and its reduction, the prescription of hydroxychloroquine/azithromycin combination for serious patients and its extension to all positive COVID subjects. Results are presented in graphics, the data collection was closed on 31/05/2020. RESULTS Covid-19 pandemic spreads from February 25, 2020, when a foreign citizen is tested positive, on March 1 a cluster is formed in the city of Blida where sixteen members of the same family are infected during a wedding party. Wilaya of Blida becomes the epicentre of coronavirus epidemic in Algeria and lockdown measures taken, while the number of national cases diagnosed begins to increases In any event, the association of early containment measures combined with a generalized initial treatment for all positive cases, whatever their degree of severity, will have contributed to a reduction in the fatality rate of COVID 19 and a slowing down of its doubling time. CONCLUSIONS In Algeria, the rapid combination of rigorous containment measure at home and early generalized treatment with hydroxychloroquin have demonstrated their effectiveness in terms of morbidity and mortality, the classic measures of social distancing and hygiene will make it possible to perpetuate these results by reducing viral transmission, the only unknown, the reopening procedure which can only be started after being surrounded by precautions aimed at ensuring the understanding of the population. CLINICALTRIAL Algeria, Covid-19, pandemic, hydroxychloroquin, azithromycin, case fatality rate

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