key: cord-0771638-195e18sg authors: Boschiero, Matheus Negri; Carvalho, Tatiana Aline; Marson, Fernando Augusto de Lima title: Retraction in the era of COVID-19 and its influence on evidence-based medicine: is science in jeopardy? date: 2020-11-25 journal: Pulmonology DOI: 10.1016/j.pulmoe.2020.10.011 sha: bc56a8576a201ceafb600e515ba77e3c1d3787cd doc_id: 771638 cord_uid: 195e18sg nan In order to keep the scientific community well informed about the SARS-CoV-2, a great number of articles have been published 1 . Up to July 14, 2020 a total of 31,360 documents were indexed on Pubmed, according to the LitCovid-NCBI 2,3 . The USA is the country with most articles published (5,033), followed by China (3, 511) and Italy (2, 590) . The journals with most publications were: BMJ (BMJ Publishing Group Ltd.) In this context, a search was carried out using the PubMed-Medline database on October 12, 2020 and using the following descriptors "coronavirus disease-19 OR coronavirus disease OR corona virus OR COVID-19 OR COVID19 OR SARS-CoV-2" and the following filters were applied in the data search: "Retracted Publication, Retraction of Publication". Retraction Watch was used to identify retracted articles in preprint services. Table 1 shows the data related to retracted articles in Pubmed database and pre-print services [Bioxviv and medRxivpreprint server operated by Cold Harbor Laboratory Spring] 4-25 . The first author's countries with most retraction were the USA and China with 3 articles, perhaps due to the large amount of publications from these countries. Also, a huge variety of SJR indicators was observed, ranging from low SJR indicator, such as Annals of Clinical & Laboratory Science (0.36) to those with the highest SJR indicator among medicine journals, such as New England Journal of Medicine (18.29) and Lancet (14.55 ). There were countless reasons for retraction, from duplicates and plagiarism to methodological issues and data misinterpretation. Duplication, ethical issues and plagiarism were more frequent in journals with low SJR indicator, whereas journals with high SJR indicator mostly reported methodological issues as the reason for retraction. The majority of the studies retracted were observational (4) followed by experimental (3) . A great variation was found in the study area, which included epidemiology, treatment, experimental and analysis. The pre-peer-review databases presented the same amount of retractions as the journals, totaling 11 studies [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] . However, most of the reasons for retractions were related to ethical issues, including objectives of the studies not being approved by the institutional review board (IRB), absence of consent from all the authors and lack of experiments to confirm the results. Most of the reasons for retractions in these databases might have been prevented by the reviewers' careful analysis, which could have contributed to a more accurate paper. Retraction should be avoided by using the maximum number of tools available, such as plagiarism identification by computational software and by improving the efficacy of the peer-review process 26 . Also, researchers should be more cautious when submitting data for publication, in order to avoid the problems related to data analysis or ethical issues, such as lack of authorization by the IRB. However, in several studies, it was not possible to determine the tenuous threshold between honest mistake and bad faith due to the author's desire to publish in high impact factor journals. Perhaps, retractions in high impact factor journals are more noticeable due to the greater number of readers, contrasting with low impact factor journals, where retraction is not as evident and does not cause as much "fuss" as in high impact journals. Misconduct in science can cause serious consequences for society, health policy and other matters. During the COVID-19 pandemic the best example was the publication of the article entitled "Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis" 7 . The article demonsrated no benefits on in-hospital mortality for COVID-19 treatment with hydroxychloroquine or chloroquine (with or without a macrolide), instead, a higher risk of ventricular J o u r n a l P r e -p r o o f arrhythmias and greater hazard for in-hospital death was found. The study was based on observational data from an analytics company known as "Surgisphere". No author evaluated the data included in the article and they were unable to access the full data to perform the statistical analysis. Following the publication, several groups identified database errors and the study was retracted. WHO denied that hydroxychloroquine or chloroquine had value in the treatment of COVID-19, based on its findings. The consequence of this retraction was discontinuation by the WHO and hydroxychloroquine, or chloroquine, were reallocated as drugs in test. Moreover, the Lancet changed its publication protocol and policy following this tragic episode. To avoid publication of articles like the one in the Lancet, it is crucial to identify problematic articles, and it should not be totally the responsibility of the journal editorial staff and/or reviewers and/or tools; it is mainly up to the integrity and the ethics of the researcher who conducted the study. For example, the Brazilian government advocated in favor of the drug use and several governmental attitudes during the COVID-19 pandemic were contrary to the WHO recommendation. Following the retraction of that paper 7 , the Government and some citizens openly criticized the WHO as to the credibility of their recommendations. The COVID-19 pandemic was associated with a high index of publication "paperdemic" 27 and it favored the high level of retractions, including journals with the highest SJR and credibility in health science. Retractions can have consequences for health policies, mainly public ones, and can result in the rejection of evidence-based medicine by the government, like the Brazilian government and its hydroxychloroquine or chloroquine passion. Funding: Not applicable. Ethics approval: Not applicable. Consent for publication: All the authors have approved the manuscript and agreed with its submission. Code availability: Not applicable. All the authors contributed equally to this study. To discuss the noninvasive ventilation in patients with COVID-19. (i) To avoid intubation and, in this case, to reduce the risk of the mortality; (ii) The potential to generate aerosol and to transmit the SARS-CoV-2 virus using non-invasive ventilation has not been confirmed yet; (iii) There is a poor lung retractability in patients with COVID-19 because a massive alveolar damage was evident due to the release of inflammatory exudates in the alveoli and infiltrates in the interstitial, thus, leading to the development of acute respiratory distress syndrome; (iv) Non-invasive ventilation avoids the disadvantages associated with invasive ventilation. A certain demographic profile of patients with COVID-19 and with acute respiratory distress syndrome (those with lesser comorbidities and younger) may benefit from noninvasive ventilation instead of intubation. To evaluate whether 5G millimeter waves may act favoring the production of Coronaviruses in biological cells. The article described that, by decreasing the wavelength, waves emitted from towers in 5G could be more effective in evolutions of DNAs within cells. It was proposed that a new generation mobile technology could play the main role in constructing several types of viruses, such as Coronaviruses within a cell. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis 7 The authors were unable to validate the veracity of the data described in the study. To evaluate chloroquine or hydroxychloroquine alone or associated with a macrolide for treatment of patients with COVID-19 using as main outcomes the occurrence of de-novo clinically significant ventricular arrhythmias and in-hospital mortality. (i) Ventricular arrhythmias were more frequent in the treatment groups when compared with the control population; (ii) The treatment group presented a higher mortality when compared to the control population; (iii) Increase in hospital death was associated with age, body mass index, black race or Hispanic ethnicity, coronary artery disease, congestive heart failure, history of arrhythmia, diabetes, hypertension, hyperlipidemia, chronic pulmonary obstructive disease, being a current smoker, and immunosuppressed condition; (iv) Lower in-hospital mortality risk was associated with use of statin, female sex, ethnicity of Asian origin, use of angiotensin-converting enzyme inhibitors (but not angiotensin receptor blockers). There were no benefits in-hospital mortality for the treatment of COVID-19 with hydroxychloroquine or chloroquine (with or without a macrolide), instead, a higher risk of ventricular arrhythmias and greater hazard for in hospital death with COVID-19 was found. Clinical characteristics and blood test results in COVID-19 patients 10 The authors identified errors in the laboratory data from patients with COVID-19. Also, the data was imputed in the statistical software. (i) 47 (73.4%) study participants were exposed to a confirmed source of COVID-19 transmission; (ii) The most common symptoms were fever (75%) and cough (76.6%); (iii) 28 (43.8%) patients with COVID-19 presented leukopenia, 10 (15.6%) lymphopenia, 47 (73.4%) elevated high-sensitivity C-reactive protein, 41 (64.1%) elevated erythrocyte sedimentation rate, and 30 (46.9%) had increased fibrinogen concentration; (iv) The counts of white blood cells and platelets, and the level of prealbumin increased significantly after treatment while aspartate aminotransferase, lactate dehydrogenase, and high-sensitivity C-reactive protein decreased; Blood test results were associated with the clinical data and with the disease evolution in patients with COVID-19. (v) Patients with COVID-19 who stayed more than 12 days in hospital presented higher body mass index and increased levels of aspartate aminotransferase, lactate dehydrogenase, fibrinogen, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate. Cardiovascular disease, drug therapy, and mortality in COVID-19 11 Mehra MR United States of America The authors were not granted access to the raw data to validate the findings. (i) Factors associated with in hospital death included age over 65 years, coronary artery disease, heart failure, cardiac arrhythmia, chronic obstructive pulmonary disease, current smoking; (ii) Angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers were not associated with in hospital death. Patients with COVID-19 and cardiovascular disease had an increased risk of in hospital death; however, no association between in hospital death and use of Angiotensinconverting-enzyme inhibitors and angiotensin-receptor blockers was found. Effectiveness of surgical and cotton masks in blocking SARS-CoV-2 12 Bae S South of Korea The authors did not recognize the concept of limit of detection for in-house reverse transcriptase polymerase chain reaction, which made some of the data unreliable and uninterpretable. To associate the effectiveness of two types of masks (surgical and cotton masks) to filter the SARS-CoV-2 virus. The median viral loads (log copies/mL) for SARS-CoV-2 virus were described for nasopharyngeal (5.66) samples, saliva (4.00) samples, after coughs without a mask (2.56), after coughs with a surgical mask (2.42), and coughs with a cotton mask (1.85). Neither of the masks (surgical and cotton) was able to prevent the dissemination of SARS-CoV-2 virus to the environment and external mask surface. Chinese medical staff request international medical assistance in fighting against COVID-19 13 Zeng Y and Zeng Y China The account described therein was not a first-hand account. To discuss the findings and limitations of the "Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis" study. The comment highlighted the main findings of the original study and discussed its limitations. The comment demonstrated that more studies should be carried out to understand the relationship between death and ventricular tachycardia regarding the drug therapy to treat patients with COVID-19. The causes of deaths (i.e., arrhythmic vs non-arrhythmic) were not adjudicated in the study and should be better evaluated. Comparison of COVID-19 pandemic and SARS (i) Super spreader emerged early; (ii) SARS-COV-2 virus has a highly capability of human-to-human transmission; (iii) Medical staff was highly infected (iv) Discovery of human-to-human transmission in SARS-CoV-2 virus was late, compared do SARS-CoV virus; (v) The daily counts of COVID-19 cases were higher than the daily counts of SARS virus cases in 2003; (vi) Large-scale migration made the spread of disease favorable; (vii) The authors predicted that cumulative cases of SARS-CoV-2 virus might be 2 to 3 times the total of SARS; (viii) The infection peak will be in February. The COVID-19 pandemic and SARS-CoV outbreaks were very similar, even though the Chinese government is taking very efficient decisions, the lack of awareness of the human-to-human transmission by the SARS-CoV-2 earlier, a super spreader may exist, contributes to the pandemic. Analysis of ten microsecond simulation data of SARS-CoV-2 dimeric main protease 19 Parves R Bangladesh Ethics violation Biorxiv -Experimental Bioinformatics Apr 12 Not applied Apr 16 The study carried out basic structural analysis, advanced flexibility and conformational analysis, for revealing out the regions and residues, which are mostly flexible and likely to be responsible for conformation of protease protein. The scientific production during Publishing volumes in major databases related to Covid-19 Online ahead of print Keep up with the latest coronavirus research Noninvasive versus invasive ventilation: one modality cannot fit all during COVID-19 outbreak No deleterious effect of lockdown due to COVID-19 pandemic on glycaemic control, measured by glucose monitoring, in adults with type 1 diabetes 5G Technology and induction of coronavirus in skin cells Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis SARS-CoV-2 infects T lymphocytes through its spike protein-mediated membrane fusion A mechanistic analysis placental intravascular thrombus formation in COVID-19 patients Clinical characteristics and blood test results in COVID-19 patients Cardiovascular disease, drug therapy, and mortality in Covid-19 Effectiveness of surgical and cotton masks in blocking SARS-CoV-2: a controlled comparison in 4 patients Chinese medical staff request international medical assistance in fighting against COVID Epub ahead of print Chloroquine or hydroxychloroquine for COVID-19: why might they be hazardous? Lancet Uncanny similarity of unique inserts in the 2019-nCoV spike protein to HIV-1 gp120 and Gag All authors have approved the manuscript and agreed with its submission to the journal. Also, all authors wrote and revised the manuscript.The authors were unable to understand the study findings and the techniques performed.The authors were unable to understand the study's findings and the techniques performed. J o u r n a l P r e -p r o o f