Risk factors for pulmonary embolism in patients with COVID-19: a systemic review and meta-analysis.

PURPOSE: To detect the risk factors for pulmonary embolism (PE) in patients with COVID-19. METHODS: Studies were searched for in PubMed, Cochrane Library, Web of Science, and EMBASE. Two authors independently screened articles and extracted data. The data were pooled by meta-analysis and three subgroup analyses were performed. RESULTS: Of the 2210 articles identified, 27 studies were included. Pooled analysis suggested that males (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.26-1.75, P = 0.000), obesity (OR 1.37, 95% CI 1.03-1.82, P = 0.033), mechanical ventilation (OR 3.34, 95% CI 1.90-5.86, P = 0.000), severe parenchymal abnormalities (OR 1.92, 95% CI 1.43-2.58, P = 0.000), ICU admission (OR 2.44, 95% CI 1.48-4.03, P = 0.000), and elevated D-dimer and white blood cell values (at two time points: hospital admission or closest to computed tomography pulmonary angiography) (P = 0.000) correlated with a risk for PE occurrence in COVID-19 patients. However, age and common comorbidities had no association with PE occurrence. Computed tomography pulmonary angiography, unclear-ratio/low-ratio, and hospitalization subgroups had consistent risk factors with all studies; however, other subgroups had fewer risk factors for PE. CONCLUSIONS: Risk factors for PE in COVID-19 were different from the classic risk factors for PE and are likely to differ in diverse study populations.

Effectiveness of cloud-based rehabilitation in children with developmental language disorder during the COVID-19 pandemic: A prospective cohort study.

During the coronavirus disease 2019 pandemic, we considered the case of a child with developmental language disorder (DLD) who could not go to the hospital on time to receive timely rehabilitation treatment due to disrupted hospital operations. The application of cloud-based rehabilitation platforms has provided significant advantages and convenience for children with DLD in-home remote rehabilitation. Among them, the JingYun Rehab Cloud Platform is the most widely used in mainland China. It is an interactive telerehabilitation system developed by Weixin Huang that delivers personalized home rehabilitation for special education children. In this study, we used the JingYun Rehab Cloud Platform to investigate the extent to which cloud-based rehabilitation is effective for children with DLD in terms of language and cognitive outcomes. This was a prospective cohort study including all children who were evaluated and diagnosed with DLD through Sign-Significant Relations and were followed up at the rehabilitation clinic of our institute. We followed 162 children with DLD for 3 months, including 84 children with DLD who participated in remote cloud-based rehabilitation on the JingYun Rehab Cloud Platform and 78 children with DLD as the control group who underwent home-based rehabilitation. Language abilities of both groups were assessed using the Chinese version of the Peabody Picture Vocabulary Test-Revised. Several measures of training performance (language, memory, and cognition tasks) were assessed before and after cloud-based rehabilitation in the remote cloud-based rehabilitation group. Children with DLD in the cloud-based rehabilitation group performed significantly better in language abilities, as assessed by the Peabody Picture Vocabulary Test-Revised, than children with DLD in the control group. Furthermore, for children who participated in remote cloud-based rehabilitation, the frequency of training sessions was proportional to their performance on language, memory, and cognition tasks. This study demonstrated the effectiveness of cloud-based rehabilitation on the JingYun Rehab Cloud Platform in treating children with DLD.

Efficacy and Safety of Corticosteroid Treatment in Patients With COVID-19: A Systematic Review and Meta-Analysis.

BACKGROUND: COVID-19 is a type of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that was identified in December 2019. Corticosteroid therapy was empirically used for clinical treatment in the early stage of the disease outbreak; however, data regarding its efficacy and safety are controversial. The aim of this study was to evaluate the efficacy and safety of corticosteroid therapy in patients with COVID-19. METHODS: The PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal (VIP) databases were searched for studies. Data on clinical improvement, mortality, virus clearance time, adverse events (AEs), utilization of mechanical ventilation, length of intensive care unit (ICU) hospitalization, and hospital stay were extracted by two authors independently. Study quality was assessed by the Newcastle Ottawa Scale (cohort studies). The pooled data were meta-analyzed using a random effects model, and the quality of evidence was rated using the GRADE approach. RESULTS: Eleven cohort studies (corticosteroid group vs control group), two retrospective cohort studies (without control group), and seven case studies were identified. A total of 2840 patients were included. Compared with the control treatments, corticosteroid therapy was associated with clinical recovery (RR = 1.30, 95% CI [0.98, 1.72]) and a significantly shortened length of ICU hospitalization (RR = -6.50; 95% CI [-7.63 to -5.37]), but it did not affect the mortality ((RR = 1.59; 95% CI [0.69-3.66], I2 = 93.5%), utilization of mechanical ventilation (RR = 0.35; 95% CI [0.10, 1.18]), duration of symptoms (WMD = 1.69; 95% CI [-0.24 to 3.62]) or virus clearance time (RR = 1.01; 95% CI [-0.91 to 2.92], I2 = 57%) in COVID-19 patients. Treatment with corticosteroids in patients with COVID-19 may cause mild adverse outcomes. The quality of evidence was low or very low for all outcomes. CONCLUSION: The findings of our study indicate that corticosteroid therapy is not highly effective, but it appears to improve prognosis and promote clinical recovery in patients with severe COVID-19.