Efficacy of therapeutic plasma exchange in patients with severe COVID-19: A systematic review and meta-analysis.

We conducted this systematic review and meta-analysis to evaluate the existing evidence and to quantitatively synthesise evidence on the impact of therapeutic plasma exchange (TPE) on severe COVID-19 patients. This systematic review and meta-analysis protocol was prospectively registered on PROSPERO (CRD42022316331). We systemically searched six electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, clinicaltrial.gov, and Cochrane Central Register of Controlled Trials) from inception until 1 June 2022. We included studies comparing patients who received TPE versus those who received the standard treatment. For risk of bias assessment, we used the Cochrane risk of bias assessment tool, the ROBINS1 tool, and the Newcastle Ottawa scale for RCTs, non-RCTs, and observational studies, respectively. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as risk ratio in the random effect model with the corresponding 95% confidence intervals (CI). Thirteen studies (one randomized controlled trials (RCT) and 12 non-RCTs) were included in the meta-analysis, with a total of 829 patients. There is a moderate-quality evidence from one RCT that TPE reduces the lactic dehydrogenase (LDH) levels (SMD -1.09, 95% CI [-1.59 to -0.60]), D-dimer (SMD -0.86, 95% CI [-1.34 to -0.37]), and ferritin (SMD -0.70, 95% CI [-1.18 to -0.23]), and increases the absolute lymphocyte count (SMD 0.54, 95% CI [0.07-1.01]), There is low-quality evidence from mixed-design studies that TPE was associated with lower mortality (relative risk 0.51, 95% CI [0.35-0.74]), lower IL-6 (SMD -0.91, 95% CI [-1.19 to -0.63]), and lower ferritin (SMD -0.51, 95% CI [-0.80 to -0.22]) compared to the standard control. Among severely affected COVID-19 patients, TPE might provide benefits such as decreasing the mortality rate, LDH, D-dimer, IL-6, and ferritin, in addition to increasing the higher absolute lymphocyte count. Further well-designed RCTs are needed.

The Management of Wrist Fractures During COVID-19: A Preliminary Report.

Background Due to the current COVID-19 pandemic, there has been an increase in the need for the virtual follow-up of patients. These innovations in clinical care have helped to reduce hospital attendance of patients and the spread of the virus. Injuries such as wrist fractures that are non-obligatory are increasingly being followed up virtually. This paper compares the early experience of management of wrist fractures in a District General Hospital in the United Kingdom during the COVID-19 pandemic lockdown with a similar period before. Methods A retrospective study of the management and clinical follow-up of all skeletally mature patients seen in the Accident and Emergency (A&E) department with a radiologically confirmed distal radius fracture after imposition of COVID-19 lockdown measures in the United Kingdom (between March 23, 2020 and May 24, 2020), and comparison with a control group of patients with distal radius fractures seen within a similar time frame the previous year (March 23, 2019 to May 24, 2019). Results During the COVID-19 lockdown, a total of 39 skeletally mature patients (85% females; average age of 70.4 years [SD: 14.6]) who had suffered a wrist fracture were seen. A total of 23% of the patients had surgical fixation. The others were managed conservatively and followed up regularly in the fracture clinic and by virtual telephone consultation in 15% (p > 0.05) compared to the previous year. Three patients who had an AO/OTA Type-C fracture were not keen on surgery, citing the COVID-19 pandemic. Patients had their operations at 5.2 days post-injury on average compared to the pre-COVID average of 6.4 days post-injury. Conclusion This preliminary study showed that patients considered "high risk" (as per the UK government guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19) with low functional demands who had suffered fractures of the distal radius were followed up mostly virtually after their first A&E attendance, thereby eliminating unnecessary hospital attendances. There was no difference in the epidemiology of wrist fractures pre- and post-COVID-19 lockdown. No COVID-positive patients were treated. The limitations of this study are the fact that it is cross-sectional with a lack of patient-reported outcome measures (PROM). As this was only a preliminary study to assess initial results, it will be followed up by a full report assessing outcomes at defined intervals.