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1.
Gastroenterology ; 162(7):S-459-S-460, 2022.
Article in English | EMBASE | ID: covidwho-1967306

ABSTRACT

Background and aims: Micronutrient supplements such as vitamin D, vitamin C, and zinc have been used in managing viral illnesses. However, the role of these micronutrients in reducing mortality in patients with Coronavirus disease 2019 (COVID-19) remains unclear. We conducted this meta-analysis to provide a quantitative assessment of the effect of these individual micronutrients on mortality in COVID-19. Methods: We performed a comprehensive literature search using MEDLINE, Embase, and Cochrane databases through November 5th, 2021. All individual micronutrients reported by ≥3 studies and compared with standardof- care (SOC) were included. The outcome was mortality. All statistical analyses were performed using the Review Manager. Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were calculated using the random-effects model. Results: We involving 5573 COVID-19 patients that compared three individual micronutrient supplements (vitamin C, vitamin D, and zinc) with SOC. Eight studies evaluated vitamin C in 1338 patients (530 in vitamin C and 808 in SOC). Vitamin C supplementation had no significant effect on the risk of mortality (RR 1.06, 95% CI 0.63-1.80, P=0.82, Figure 1A). Fourteen studies assessed the impact of vitamin D supplementation on mortality risk among 3497 patients (927 in vitamin D and 2570 in SOC). Vitamin D did not reduce the mortality risk in patients (RR 0.75, 95% CI 0.49-1.17, P=0.21, Figure 1B). Subgroup analysis showed that vitamin D supplementation was not associated with a mortality benefit in patients receiving vitamin D pre or post COVID-19 diagnosis (Figure 1B). Five studies, including 738 patients, compared zinc intake with SOC (447 in zinc and 291 in SOC). Zinc supplementation was not associated with a significant reduction of mortality (RR 0.79, 95% CI 0.60- 1.03, P=0.08, Figure 1C). Subgroup analyses of RCTs for all three micronutrient supplements showed consistent findings (Figure 2). Conclusions: Individual micronutrient supplementations, including vitamin C, vitamin D, and zinc, did not reduce mortality in patients with COVID-19. Further research is needed to validate our findings. (Figure Presented)

2.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880009
3.
Open Forum Infectious Diseases ; 8(SUPPL 1):S322, 2021.
Article in English | EMBASE | ID: covidwho-1746556

ABSTRACT

Background. A naive Bayes classifier is a popular tool used in assigning variables an equal and independent contribution to a binary decision. With respect to COVID-19 severity, the naive Bayes classifier can consider different variables, such as age, gender, race/ethnicity, comorbidities, and initial laboratory values to determine the probability a patient may need to be admitted or transferred to an intensive care unit (ICU). The aim of this study was to develop a screening tool to detect COVID-19 patients that may require escalation to ICU status. Methods. Patients hospitalized with COVID-19 were gathered from the end of March 2020 to the end of May 2020 from four hospitals in our metropolitan area. We began searching for potential variables to include in the classification model using chi-square analysis or calculating the optimal cutpoint to separate ICU and non-ICU status. After identifying significant variables, we began using standard procedures to construct a classifier. The dataset was split 7:3 to create samples for training and testing. To appraise the model's performance, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC), and the Matthew's correlation coefficient (MCC) were calculated. Results. A total of 574 COVID-19 patients were included in the study. There were 402 patients in the training sample and 172 patients in the testing sample. The naive Bayes classifier demonstrated an overall accuracy result of 75.6% (95% CI;68.5% - 81.8%) using the 14 variables listed in Table 1. The model was able to correctly classify 84.9% of ICU status patients (sensitivity), but only 54.7% of non-ICU status patients (specificity). The PPV and the NPV were 80.1% and 61.7%, respectively. The AUC was 0.717 (95% CI;0.629 - 0.805) and the MCC was 0.410. Conclusion. Our naive Bayes classifier operates by recognizing certain aspects of severe COVID-19 cases and looking for the probability of the variables in said patients. We present a classification model that potentially could be used alongside other tools to screen patients with COVID-19 early in their hospital course to identify those needing escalation to ICU level care.

4.
Chest ; 160(4):A521, 2021.
Article in English | EMBASE | ID: covidwho-1457613

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Exaggerated inflammatory response with cytokine storm is the hallmark of moderate to severe cases of COVID-19. Several studies have investigated the use of colchicine in COVID-19 due to its anti-inflammatory effects. However, the data regarding its efficacy is still limited and conflicting. This meta-analysis aimed to evaluate the impact of colchicine on mortality and the risk of mechanical ventilation in patients with COVID-19. METHODS: We performed a comprehensive literature search of electronic databases from inception through April 10, 2021, for all peer-reviewed studies that evaluated the clinical benefits of colchicine COVID-19 patients. The primary outcome was the mortality rate. The secondary outcomes included the risk of mechanical ventilation, improvement in systematic inflammation as indicated by changes in serum C-reactive protein, and the risk of adverse events. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of eight studies involving 926 COVID-19 patients (406 patients received colchicine along with standard-of-care (SOC) therapy and 520 received SOC therapy alone) were included. The mean age was 63.7±14.7 years, and males represented 63.3%. Mortality rate was significantly lower in the colchicine group compared to SOC (RR 0.49 (95% CI: 0.34-0.72, P = 0.0002). However, there was no statistically significant difference in the risk of mechanical ventilation (RR 0.69, 95% CI: 0.31-1.57, P = 0.38). Furthermore, colchicine significantly lowered serum CRP levels (MD -0.40, 95% CI -0.77 to -0.03, P = 0.03). CONCLUSIONS: Our meta-analysis demonstrated that colchicine showed improvement in mortality in COVID-19 patients. However, there was no significant improvement in the risk of mechanical ventilation. CLINICAL IMPLICATIONS: Colchicine may be a potential therapeutic option for COVID-19. Even though the results are encouraging, we need more large-scale RCTs to better characterize the clinical benefits of colchicine in COVID-19 patients. DISCLOSURES: No relevant relationships by Nezam Altorok, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Muhamad Kalifa, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by WAHOOD Waseem, source=Web Response

5.
Chest ; 160(4):A558, 2021.
Article in English | EMBASE | ID: covidwho-1457612

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) has become a leading cause of mortality globally. Inhaled pulmonary vasodilators, epoprostenol (iEPO) and nitric oxide (iNO), are used as adjunctive therapies for the treatment of refractory hypoxemia in patients with acute respiratory distress syndrome (ARDS). Hypoxemia in COVID-19 patients is mainly caused by ventilation-perfusion mismatch, which might be improved by inhaled pulmonary vasodilators. However, the effects of inhaled pulmonary vasodilator therapy on the clinical outcomes of COVID-19 remain unclear. Therefore, we conducted this meta-analysis to evaluate the impact of pulmonary vasodilators, iNO and iEPO, on the oxygenation parameters in COVID-19 patients with refractory hypoxemia. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021, to include all published studies. All statistical analyses were performed using the Review Manager software (RevMan 5.3). The weighted mean difference (MD) with corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. The primary outcome measure was the change in oxygenation parameter (PaO2/FiO2) pre and post pulmonary vasodilators. RESULTS: A total of seven studies (three and four studies for iEPO and iNO, respectively) involving 211 patients with COVID-19 (140 patients in iEPO group and 71 in iNO) were included. Overall, pulmonary vasodilators showed significant improvement in oxygenation: PaO2/FiO2 (MD: 12.48, 95% CI: 4.51, 20.44, P = 0.002, I2 = 0%). On subgroup analysis, iEPO showed significant improvement in oxygenation: PaO2/FiO2 (MD: 13.39, 95% CI: 2.84, 23.94, P = 0.01, I2 = 0%), however, iNO showed no improvement in oxygenation: PaO2/FiO2 (MD: 12.80, 95% CI: -4.82, 30.42, P = 0.15, I2 = 47%). CONCLUSIONS: Our meta-analysis showed that inhaled epoprostenol improved oxygenation in COVID-19 patients. However, inhaled nitric oxide therapy was not associated with improvement in oxygenation. Major limitation being lack of control arm and adjustment for confounders. Clinical trials are needed to determine the effect of inhaled pulmonary vasodilators on oxygenation parameters and clinical outcomes of COVID-19 patients. CLINICAL IMPLICATIONS: Inhaled pulmonary vasodilators may play a role as rescue therapy in COVID-19 patients with refractory hypoxemia. DISCLOSURES: No relevant relationships by Ziad Abuhelwa, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Rami Musallam, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response

6.
Chest ; 160(4):A502, 2021.
Article in English | EMBASE | ID: covidwho-1457611

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Prone positioning (PP) in awake patients has been recently proposed as an adjunctive treatment for spontaneously breathing non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to reduce the risk of intubation. However, the magnitude of the effect of PP on clinical outcomes (e.g., the risk of endotracheal intubation, intensive care unit [ICU] admission, or mortality) in these patients remains uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the effectiveness of PP to improve the clinical outcomes in non-intubated patients with COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through February 24, 2020 for all the studies all studies that all compared PP versus no PP in non-intubated patients with COVID-19. The primary outcome of interest was the rate of endotracheal intubation. The secondary outcomes were in-hospital mortality and intensive care unit (ICU) rates. Pooled odds risk (OR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of five studies (two randomized controlled trials and three observational studies), involving 470 non-intubated patients with COVID-19 (185 patients received PP and 285 did not) were included. The mean age was 59.82 years, and males represented 67% of total patients. The follow-up period ranged from 14 to 30 days. The endotracheal intubation rate was similar between PP and control groups (OR 0.75, 95% CI 0.41-1.35, P = 0.33, I2 = 20%). There was no difference in the in-hospital mortality rate between the two groups (OR 0.68, 95% CI 0.16-2.85, P = 0.60, I2 = 60%). Four studies reported the risk of ICU admission and demonstrated no difference between the two groups (OR 0.77, 95% CI 0.30-1.95, P = 0.58, I2 = 37%). CONCLUSIONS: Our meta-analysis demonstrated that prone positioning in non-intubated COVID-19 patients did not reduce the risk of endotracheal intubation. Furthermore, PP failed to reduce in-hospital mortality and ICU admission rates. CLINICAL IMPLICATIONS: Although our meta-analysis showed that prone positioning might not reduce the risks of intubation, in-hospital mortality, or ICU admission rate in spontaneously breathing non-intubated COVID-19 patients, more large-scale trials with a standardized protocol for prone positioning are needed to better evaluate the effectiveness of prone positioning in this select population. DISCLOSURES: No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Saif-Eddin Malhas, source=Web Response No relevant relationships by Aadil Maqsood, source=Web Response No relevant relationships by Reem Matar, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response

7.
Chest ; 160(4):A564, 2021.
Article in English | EMBASE | ID: covidwho-1457610

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a worldwide pandemic and leading cause morbidity and mortality globally. Due to their immunomodulatory functions, micronutrient supplements such as vitamin D, vitamin C, and zinc have been used for the management of viral illnesses. Furthermore, recent studies have shown low serum vitamin C, vitamin D, and zinc levels in critically ill patients with COVID-19. However, the role of these micronutrients in reducing mortality in patients with COVID-19 remains unclear. Therefore, we conducted this meta-analysis to provide a quantitative assessment of the effect of vitamin D, vitamin C, and zinc on mortality in COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021. All the studies that compared adding micronutrient supplements such as vitamin C, vitamin D, and zinc versus standard-of-care (SOC) in patients with COVID-19 were included. The outcome of interest was the mortality rate. All statistical analyses were performed using the Review Manager software (RevMan 5.3). Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. RESULTS: Four studies evaluated vitamin C in 390 patients (201 in vitamin C and 189 in SOC). Seven studies assessed vitamin D in 1251 patients (457 in vitamin D and 794 in SOC). Five evaluated zinc in 1506 patients (776 in zinc and 730 in SOC). Both vitamin C (RR 0.60, 95% CI 0.27-1.36, P = 0.22) and vitamin D (RR 0.94, 955 CI 0.46-1.94, P = 0.87) did not significantly reduce mortality. However, zinc was associated with an 33% reduction in mortality compared to SOC (RR 0.67, 95% CI 0.54-0.84, P = 0.0005). CONCLUSIONS: Our meta-analysis demonstrated that zinc reduced mortality in COVID-19 patients. However, vitamin C and D did not show significant improvemnt in mortality. CLINICAL IMPLICATIONS: Micronutrient supplements, especially zinc, may play a role in the treatment of COVID-19. However, it is unclear whether the magnitude of the effects of these micronutrients are clinically meaningful. Further research is needed to better evaluate the utility of these micronutrient supplements in the management of COVID-19. DISCLOSURES: No relevant relationships by Waleed Abdulsattar, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Wasef Sayeh, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by Jamie Stewart, source=Web Response

8.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407422
9.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277114

ABSTRACT

Introduction Continuous positive airway pressure (CPAP) is currently the treatment of choice for patients with obstructive sleep apnea (OSA);however, adherence is often thought to be suboptimal, especially in patients with anxiety. Due to the 2019 novel coronavirus disease (COVID-19) outbreak, it was suggested that difficulties in accessing the healthcare system and the anxiety produced by the situation could have a negative impact on adherence to treatment. The main objective of the study was to compare compliance and adherence of patients in a home CPAP monitoring program before and during the pandemic. Methods Patients diagnosed with OSA treated with CPAP participating in a telemonitoring program were included in the study. The pre-pandemic period was March to August 2019. Using data collected from the Ohio Department of Health, we identified two peaks in 2020. The pre-peak period was defined as March 1st to April 15th;the 1st peak as April 16th to July 12th, and the 2nd peak as July 13th to August 31st. Study variables included the mean hourly usage over each time period and the number of patients identified as low adherers, which was defined as a mean CPAP usage of less than 10 minutes. CPAP compliance was analyzed using repeated measures ANOVA. CPAP adherence was analyzed using Cochran's Q test with post-hoc testing using McNemar's tests to determine group differences. Results The study sample consisted of 418 patients using CPAP, which were measured multiple times throughout the study period. Patient compliance and adherence are summarized in Table 1. There was not a statistically significant effect of time on CPAP compliance over the four time periods, F (3, 1251) = 0.747, p = 0.524. There was a statistically significant difference in the proportion of CPAP users with low adherence, χ2 (3) = 16.69, p = 0.001. Subsequently, post-hoc testing revealed there were statistically significant differences in the proportion of low adherence CPAP users in 2019 compared to the pre-peak, 1st peak, and 2nd peak periods. Conclusion Recent studies in Europe and New York City have indicated CPAP compliance and adherence was not adversely affected during the COVID-19 lockdowns. While our study found mean CPAP compliance above 6 hours across the study periods, there were a significant proportion of low CPAP adherers during the pre-peak and peak periods during the pandemic. The reasons for low adherence should be ascertained by a follow-up study.

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