Rapid review on the use of oral fatty acid supplements in the prevention or as adjunct treatment of COVID-19

Key Findings@#There is lack of clinical evidence supporting the role of oral fatty acid supplements as prevention and adjunctive therapy for COVID-19. Long-chain polyunsaturated fatty acids (PUFAs) mediate inflammation and adaptive immune responses. Omega-3 fatty acids promote anti‐inflammatory effects and reduce influenza virus replication. No clinical evidence supporting the use of oral fatty acid supplements as prevention and adjunctive therapy of COVID-19 was found. We found indirect evidence from one systematic review on acute respiratory distress syndrome (ARDS) and two longitudinal cohort studies on community-acquired pneumonia that showed non-significant and inconsistent results. The most common known side effects of omega-3-fatty acids are gastrointestinal in nature. They may also cause allergy and affect blood clotting if taken with other medications that affect clotting. There are 2 ongoing clinical trials on eicosapentaenoic fatty acids as an adjunctive therapy to standard oral nutrition supplements or standard of care in COVID-19 patients. WHO Interim guidelines, CDC interim guidelines, Infectious Diseases Society of America COVID-19 treatment guidelines, and the American Thoracic Society did not give any recommendation on the use of nutritional supplements in patients with COVID-19.

Use of Renin-Angiotensin System Antagonists in patients with hypertension and COVID-19 infection: A rapid review and meta-analysis

Key Findings@#Among patients with confirmed COVID-19 infection and hypertension, there is insufficient evidence that RAS antagonists are associated with mortality or severe COVID-19 disease. • There is uncertainty with regards to the safe use of renin-angiotensin system (RAS) antagonists, such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), for COVID-19 patients with hypertension and other comorbidities (heart failure, chronic kidney disease) because of two possible contradictory mechanisms 1) upregulation of ACE2 receptors that may facilitate the virus entry into the lung. and 2) control of unabated angiotensin II levels reducing acute lung injury. • Based on very low-quality retrospective cohort studies, there is insufficient evidence that RAS antagonists are associated with increased mortality (6 studies) or severe disease (10 studies) among patients with confirmed COVID-19 infection and hypertension. • There are 36 ongoing studies (21 RCTs, 1 single-arm trial, 4 prospective cohorts, 4 retrospective cohorts, 4 casecontrol, and 2 cross-sectional) on this topic. • The European Society of Cardiology (ESC) Council on Hypertension, the International Society of Hypertension (ISH) and the joint statement by the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) all caution against discontinuing RAS-related treatments in patients with hypertension who become infected with COVID-19.

Senna alata (akapulko) extract versus topical antifungals for treatment of superficial fungal skin infections: A systematic review and meta-analysis

@#<p style="text-align: justify;"><b>OBJECTIVE:</b> The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections.</p><p style="text-align: justify;"><br /><b>METHODS:</b> A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible.</p><p style="text-align: justify;"><br /><b>RESULTS:</b> We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild.</p><p style="text-align: justify;"><br /><b>CONCLUSION:</b> S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion.</p>

Assessing quality of systematic reviews in dermatology from the Philippines using AMSTAR 2 Part 1: Methodologic quality of dermatological systematic reviews from the Philippines

@#BACKGROUND: Quality systematic reviews (SRs) are essential in the practice of evidence-based dermatology. We assessed the methodologic quality of SRs in dermatology from the Philippines. METHODS: We searched databases (MEDLINE, CDSR, PROSPERO, HERDIN; from inception until June 30, 2019), and secondary sources. We included SRs, authored by Filipino primary authors, which included clinical trials on any intervention for the treatment or prevention of a dermatologic disease or for maintenance of healthy skin, hair or nails. Two reviewers independently extracted data and appraised the methodological quality of each included SR using the AMSTAR 2. The 16-item AMSTAR 2 has 7 critical items and 9 non-critical items. The number of critical items mainly determine the overall confidence in the results of the review. Descriptive analysis using means and standard deviation for continuous data, and frequency and percentage distribution for categorical data were employed. RESULTS: Twenty SRs were included in this review, and were mostly published in the 2010s. Majority of SRs had three authors, who belonged to a single institution, with at least one dermatologist. The most common topic was infections and both oral and topical interventions were used. Majority had 5 included studies in the SRs, with a median number of 425 participants. The median number of critical flaws in the included SRs was 4.5, and non-critical flaws, 5. Overall confidence was critically low in majority (19/20 ) of included reviews, with only one review rated as low. CONCLUSION: The methodologic quality of the dermatology SRs from the Philippines based on the AMSTAR 2 tool was poor with a rating of critically low in majority. There is a need to improve quality of conduct and reporting through dissemination of the reporting guidelines such as the PRISMA

Assessment of quality of systematic reviews in dermatology using AMSTAR 2 Part 2 of 2. Validity and reliability testing of AMSTAR 2 (UP-PGH)

@#BACKGROUND AMSTAR 2 enables a more detailed assessment of systematic reviews and includes non-randomised studies of healthcare interventions, compared to its earlier version, AMSTAR. We validated AMSTAR 2 in a group of systematic reviews in dermatology in the Philippines. METHODS We used a cohort of systematic reviews (SRs) in dermatology from the Philippine that were previously described in Part 1 of this 2-part series. The SRs included clinical trials on any intervention for the treatment or prevention of a dermatologic disease or for maintenance of healthy skin, hair or nails. Two reviewers independently extracted data and used AMSTAR 2 to appraise the methodological quality of each included SR. We determined construct validity by comparing the number of critical flaws between a set of non-Cochrane and matched Cochrane reviews, using Wilcoxon rank sum test. We tested for interrater reliability of the AMSTAR 2 tool using Gwet’s AC1 statistic. RESULTS: We included 20 non-Cochrane systematic reviews in dermatology by Philippine-based authors, and a set of 20 reviews from the Cochrane skin group, matched by year and randomly chosen. Construct validity testing showed a significantly greater number of AMSTAR 2 critical flaws (median 4.5 vs 0.0; z=3.64; P=0.000) and non-critical weaknesses (5 vs 2.0; z-score=3.10; P-value=0.001) by non-Cochrane reviews compared to a matched set of Cochrane skin group reviews. There was good interrater reliability (average Gwet’s AC1 statistic = 0.87) with the lowest agreement (0.62) for discussion of heterogeneity (item 14), and the highest agreement (0.97) for study selection criteria (item 3). CONCLUSION The AMSTAR 2 was a valid and reliable tool for assessing systematic reviews using a cohort of reviews by dermatology reviews, both non-Cochrane and Cochrane. Further validation of the AMSTAR 2 is needed to determine if it can be applied to a wide variety of systematic reviews.

Assessing quality of reporting of herbal dermatology trials from the Philippines using the hCONSORT Checklist: A systematic review

Background@#Herbal medicine is a growing and innovative field in Philippine dermatology. There is a need to assess the quality of reporting of published herbal randomized controlled trials (RCTs) in dermatology since these will serve to guide rational development and use of medicinal plants in the Philippines.@*Objective@#The study aimed to assess the quality of reporting of published herbal RCTs in dermatology from the Philippines based on the hCONSORT checklist.@*Methods@#We searched MEDLINE, CENTRAL, HERDIN (from inception to 20 September 2018), and other secondary sources for published randomized controlled trials that used any herbal preparation as intervention for the treatment or prevention of a dermatologic disease or for maintenance of healthy skin, hair, or nails. We determined the percentage of reported items based from the hCONSORT checklist. @*Results@#We included 41 trials, majority of which were on infections, infestations, and bites (66%). The three most common families of herbs used were Fabaceae/Leguminosae (22%) (Gliricidia sepium (Jacq.) Walp. [kakawati]; Senna alata (L.) Roxb. / Cassia alata (L.) [akapulko]); Arecaceae (12%) (Cocos nucifera L. [coconut]); and Myrtaceae (12%) (Eucalyptus sp [eucalyptus], Psidium guajava L.[guava], and Melaleuca alternifolia (Maiden & Betche) Cheel [tea tree]). Most of the trials (27/41, 66%) were conducted in accredited dermatology training programs of the Philippine Dermatological Society. Only 11 trials (27%) were published in PubMED-indexed journals. More than half of articles were published after the CONSORT publication in 2006 (59%). The mean percentage of reported hCONSORT checklist items in included studies was 39.6% (SD 9.9), with only seven studies reporting more than 50% of the hCONSORT checklist items.@*Conclusion@#Published herbal RCTs in dermatology from the Philippines are poorly reported based on the hCONSORT checklist. There is a need for dissemination of the hCONSORT to local researchers and journal editors to ensure thorough and quality reporting.

Systematic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor

@#<p style="text-align: justify;"><strong>Background:</strong> Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis Versicolor.</p><p style="text-align: justify;"><strong>Methods</strong>: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis Versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, time-to-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess the risk of bias, pool studies, and calculate for treatment effects.</p><p style="text-align: justify;"><strong>Results:</strong> We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient.</p><p style="text-align: justify;"><strong>Conclusions:</strong> Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.</p>

Systemic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor

Background: Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear.Objectives: To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis versicolor.Methods: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, timeto- cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess risk of bias, pool studies, and calculate for treatment effects.Results: We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality.Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence). There were few adverse effects and were mostly minor and transient.Conclusions: Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.

Content analysis of complementary and alternative medicine literature in the Journal of the Philippine Dermatological Society

Background@#Complementary and alternative medicine (CAM) is a popular treatment option among patients. There is a need to assess the content of published local literature on complementary and alternative medicine in dermatology in the Journal of the Philippine Dermatological Society (JPDS) to provide evidence for its integration into clinical practice and to guide future research.@*Objective@#To analyze the content of published literature on complementary and alternative medicine published in the JPDS@*Method@#We screened the titles and abstracts of all published articles in the JPDS from 1992-2017 and included articles on any aspect of complementary and alternative medicine. We extracted relevant characteristics such as study design, disease, type and details of CAM therapies, from the included articles. We summarized data using descriptive statistics for continuous data, and frequency distribution for ordinal data.@*Results@#CAM articles accounted for 4% of all published articles in the JPDS over the past 25 years of its existence. Most were RCTs (22%) (mean size=69), with the greatest number being on herbal medicine (66%), and for the treatment of infections, infestations and bites (46%). Majority of articles were primarily authored by resident trainees (87%) and the most common institutional affiliation was UP-PGH (24%). Among the herbal articles, the most common herb family was Fabaceae (9%), while coconut had the highest number of articles. Leaves were the most common plant part used (40%), and creams were the predominant type of formulation (29%). Other CAM interventions included were animal products, dietary supplements, and lifestyle modification.@*Conclusion@#The poor representation of CAM in the JPDS may reflect the lack of integration of this field in the local practice of dermatology. There is a need to increase awareness and gather more evidence on the application of CAM in the maintenance of healthy skin as well as prevention and treatment of skin diseases.