ABSTRACT
Background: COVID-19 is a relatively new disease that can progress to ARDS, respiratory failure and death. Identifying specific morphological lung injury in COVID-19 patients, can give a better understanding of subjacent physiopathology.Our aim is to provide a rigorous summary of the evidence available of lung histological findings in COVID-19 patients.Methods:Eligibility criteria: Any quantitative design, reporting raw data of lung histological findings in COVID-19 patients. Reviews, guidelines, other organs’ histological features were excluded.Information sources: The centralized repository L·OVE (Living OVerview of Evidence), PubMed/Medline, Cochrane Central Register of Controlled Trials (CENTRAL), LitCovid, WHO Covid-19 Database, and medRxiv. The search covered the period from January 1, 2020 until April 3, 2021.Risk of bias: was assessed using Joanna Briggs Institute tools, by four observers and consensus.Synthesis of Results: Each and every lung histopathological finding was extracted. Frequencies for each finding were calculated, and then data from the two most frequent findings were pooled by meta-analysis using a Der Simmonian-Liard model with random-effects model. Heterogeneity was measured.Results:Included studies: From 252 references, 69 articles fulfilled inclusion criteria, summarizing 594 subjects.Synthesis of results: Demographic: 381 men, 179 female and 34 not specified. Mean age in case series was 87.57 years (SD+ 1.57), and in case reports 61.85 years (SD + 1.51). Fourteen case series (45.16%), and 21 case reports (55.26%) presented low risk of bias. Meta-analysis of proportions showed DAD in 0.62 (CI 95% 0.51-0.72), I2 59% (p<0.01), in its early phase (85.14%).Discussion: The limitations of the evidence included in the review was a relative selection bias for included subjects. Interpretation: Early DAD was the most frequent histopathological finding in lung samples from severe COVID-19 patients. Registration Details: Study’s registration number PROSPERO CRD4202018936.Funding Information: There was no source of funding.Declaration of Interests: We all declare no conflict of interest.
Subject(s)
COVID-19 , Lung Injury , Respiratory InsufficiencyABSTRACT
Objective To assess the efficacy and safety of lopinavir/ritonavir for the treatment of patients with COVID-19. Design This is the protocol of a living systematic review. Data sources We will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L-OVE (Living OVerview of Evidence). L-OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L-OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomised trials evaluating the effect of lopinavir/ritonavir - as monotherapy or in combination with other drugs - versus placebo or no treatment in patients with COVID-19. Randomised trials evaluating lopinavir/ritonavir in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case no direct evidence from randomised trials is found, or if the direct evidence provides low- or very low-certainty for critical outcomes. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will perform random-effects meta-analyses and use GRADE to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it if the conclusions change or there are substantial updates. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.
Subject(s)
COVID-19 , Severe Acute Respiratory SyndromeABSTRACT
OBJECTIVE: To determine the relative impact of the use of chloroquine and hydroxychloroquine on outcomes important to patients with COVID 19. DESIGN: This is the protocol of a living systematic review. DATA SOURCES: We will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, grey literature and in a centralised repository in L-OVE (Living OVerview of Evidence). L-OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L-OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We will follow a common protocol for multiple parallel systematic reviews, already published and submitted to PROSPERO (awaiting ID allocation). We will include randomised controlled trials evaluating the effect of chloroquine and hydroxychloroquine - as monotherapy or in combination with other drugs - versus placebo or no treatment in patients with COVID-19. Randomised trials evaluating chloroquine and hydroxychloroquine in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case no direct evidence from randomised trials is found, or if the direct evidence provides low- or very low-certainty for critical outcomes. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will perform random-effects meta-analyses and use GRADE to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it if the conclusions change or there are substantial updates. ETHICS AND DISSEMINATION: No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.