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Objectives: Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US. Method(s): In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805 Results: Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (p <= 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence;with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses. Conclusion(s): Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.Copyright © 2023
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INTRODUCTION AND OBJECTIVE: Telemedicine has gained wide acceptance during the COVID-19 pandemic. Worldwide lockdowns made this interface an indispensable one for patient care. Recent evidence suggests that urology patients were receptive to telemedicine;however, no systematic review has been done to date on andrology patients in particular and their perception of telemedicine. METHOD(S): Three electronic databases: PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed s and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". RESULT(S): Of the 1128 retrieved s, 56 underwent fulltext review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. All 8 studies that assessed perception of andrology patients to telemedicine showed that most patients had "positive perception". Telemedicine was shown to save an average cost of $149-252/patient. Pooled analyses of positive response to telemedicine were 68.7% (95% CI = 49.4-83.1%, p=0.057) and of patients who recommended telemedicine were 65.1% (95% CI = 18.4-93.9%, p=0.577). 84.6% pooled proportion for recommending video compared to 38.9 % pooled proportion for recommending telephone practice, p=0.035. In the telephone-only encounters, 27.1% of patients preferred in-person visits as security and privacy of any mode of telecommunication were of concern. CONCLUSION(S): Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. Telemedicine will plausibly continue to be integral in andrology practice.
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Introduction: The number of review papers on coronavirus disease (COVID-19) related topics are on a sharp rise due to the abundance of new literature over the past two years. Objective(s): This review aimed to provide an overview of the attributes and quality of systematic synthesis research on COVID-19 pertaining to herbal medicine. Material(s) and Method(s): We performed a systematic search and screen on electronic databases to include articles of systematic synthesis research on herbal medicine for COVID-19. Information on review characteristics including review type, topic, and details of herbal interventions were extracted for descriptive and numerical analysis while quality of reviews was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool. Result(s) and Conclusion(s): Forty-eight reviews were included, half (n=23) were on Chinese Herbal Medicine while the remaining (n=25) were overall reviews on herbal medicine in general and phytoconstituents. Most were scoping reviews (n=23) and systematic reviews and/or meta-analyses (SR/MA) (n=21). All reviews address use of herbal medicine for acute phases of COVID-19. For AMSTAR-2 critical domains, only one third (n=15) had a protocol registered prior to commencement of the review while 21% (n=10) reported comprehensive literature search. When narrowed down to SR/MA, almost all (n=20) had an a priori protocol and 45% (n=9) reported comprehensive literature search. Risk of bias assessment was performed in almost all SR/MA while source of heterogeneity was not sufficiently addressed. The bulk of the evidence available on herbal medicine and COVID-19 are for its use during acute phases of COVID-19. Published SR/MA have lesser limitations than scoping reviews in critical domains of high-quality reviews but are highly concentrated on Chinese Herbal Medicine. This may be due to small number of clinical trials on other modalities of herbal medicine suitable to be pooled for SR/MA while there is no systematic synthesis research on post-COVID-19 complications, highlighting the research gaps.
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BACKGROUND: Many systematic reviews (SRs) and meta-analyses (MAs) have been published regarding the incidence of venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19) patients, which is acknowledged as high. Therefore, we aimed to assess the methodological quality of any SR/MA involving VTE and COVID-19. METHOD(S): This is a meta-epidemiological study evaluating the methodological quality of SR/MA. A structured search in PubMed and Web of Science was done for all SRs/MAs in VTE and COVID-19 from inception till April 29, 2021. We evaluated the methodological quality using A Measurement Tool to Assess SRs-2 (AMSTAR-2) checklist. RESULT(S): We included 29 SRs/MAs where only one SR/MA was rated as high (3.44%), 12 (41.37%) were rated as moderate, and the rest were rated as low/critically low (55.17%). No statistical significance was observed in Spearman's correlation analysis between the rate of methodological quality and the number of authors, searching period, publication month, and publishing journal's impact factor. CONCLUSION(S): The number of published SRs/MAs in the VTE and COVID-19 subject is rising rapidly. The readers should pay attention to the low methodological quality of most published SRs/MAs. Copyright © 2022 Journal of Applied Hematology.
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Objective: The last retrospective systematic review on Miller Fisher syndrome (MFS) took place in 1992. To understand the evolving nature of the disease and to update the clinical picture, diagnostic testing, treatment, and prognosis, a retrospective systematic review of 174 cases of MFS published in the last three decades was performed. Method(s): We screened 1034 articles on the PUBMED search engine. Out of these articles, 153 met the inclusion criteria of case reports/series published in English after 1992. Each case contained at least two signs of the triad, with the presence or absence of GQ1B antibodies. The Chi-square test or Fisher's exact test was used for data analysis. Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) was used to assess the quality of the systematic reviews. Finding(s): 174 cases were included, with five case series. Sinopulmonary infection (60%) and gastrointestinal infection (18%) were the most common preceding illnesses, while eight cases occurred after the onset of a COVID-19 infection, and seven had recent exposure to monoclonal antibodies. We found that misdiagnosis was seen in 13.8% of cases, stroke being the most common misnomer. Residual symptoms were reported in 30% of cases, death in three and recurrence in twelve. IVIG was the most frequently used treatment option (51.1%). Severity score was significantly associated with treatment (p=0.0195);however, it was not associated with age (p=0.4255), gender (p=0.7893), GQ1b antibody presence/level (p=0.3870/ p=0.6891), or non-GQ1B (p=0.5426) status. The outcome with residual symptoms was favorable for younger patients (Age 1-18: p=0.0223) and not associated with treatment. Mechanical ventilation (13.8%), feeding tube placement (9.8%), autonomic insufficiency (8.6%), and a patient requiring a cardiac pacemaker were the top three complications. Conclusion(s): Physicians should recognize the protean clinical manifestation of MFS and recognize the various recent preceding factors like COVID-19 and monoclonal antibodies. The benefit provided by the treatment is unclear. Therefore, further studies will be required to identify patients who should be treated and the appropriate treatment to maximize patient outcomes.
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Objective: Overview the systematic review/Meta analysis of Lianhua Qingwen (连花清瘟) combined with conventional western medicine in the treatment of coronavirus disease 2019 (COVID-19). Methods: Systematic reviews/Meta-analysis of Lianhua Qingwen combined with western conventional in the treatment of COVID-19 from CNKI, Wanfang, CBM, VIP, PubMed, Embase, Cochrane Library, and Web of Sciencewere search, retrieved as of October 1, 2021. Two investigators screened the literature according to the inclusion and exclusion criteria, and determined the final inclusion of the literature. AMSTAR-2 scale, GRADE system, and PRISMA statements were used to evaluate the methodological quality and GRADE the evidence quality. Results: A total of eight systematic reviews/Meta analyses were included, including six in Chinese and four in English. The quality evaluation and evidence quality classification results show that the quality of the literature and the level of evidence were low. Conclusion: The existing evidence shows that Lianhua Qingwen combined with conventional western has a good effectin the treatment of COVID-19. However, due to the low methodological quality and evidence quality level of the systematic review/Meta analysis and the low level of evidence quality, more high-quality researchs are needed to obtain high-quality research results for verification.
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Introduction: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and commonly presents with fever, loss of smell/taste, and a persistent cough;in severe cases, patients require hospitalisation and external ventilation. Advanced age and pre-existing conditions such as cardiovascular diseases and diabetes have been associated with an increased risk of COVID-19 related mortality. Based on their mechanisms of action and widespread use among patients at high risk of poor disease outcomes, the impact of renin-angiotensin-aldosterone system (RAAS) inhibitors - including angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) - on COVID-19 related outcomes has become a topic of interest, resulting in rapid dissemination of a large number of predominantly retrospective, observational studies since early 2020. Since many of these studies were limited in scope and results were inconclusive, systematic reviews and meta-analyses of published and unpublished findings swiftly followed. Aim: To assess the effect of ACEIs and ARBs on COVID-19 related outcomes by summarising the currently available evidence. Methods: Umbrella review of systematic reviews and subsequent meta-analysis. Eligible for inclusion were systematic reviews with meta-analysis focusing on patients with or without COVID-19 exposed to ACEIs and/or ARBs compared to patients not exposed to the medication. Outcomes of interest included risk of infection;hospitalisation;severity;and death. Reviews were identified through a literature search in Medline, EMBASE, Scopus, the Cochrane database of systematic reviews, and medRxiv, from 2019 until 1st of February 2021. Data was extracted using a standardised extraction sheet;the AMSTAR 2 Critical Appraisal Tool for systematic reviews was used for quality assessment. Heterogeneity between studies was evaluated using I2 statistics, and findings of included meta-analyses were summarised using random-effects models. The protocol was registered with PROSPERO (CRD42021233398). Results: Out of an initial 157 publications, 66 systematic reviews underwent full text screening;after further exclusions based on pre-specified criteria, 47 studies were identified to be relevant. The number of included studies as well as the outcomes of interest varied widely between reviews, with death being the most common. Odds ratio for risk of COVID-19 infection among patients treated with ACEIs/ARBs versus patients not on treatment was 0.99 (95% Confidence Interval (CI) 0.97 - 1.02;19 studies, I2 = 24.7%);and for hospitalisation among COVID-19 patients treated with ACEIs/ARBs versus not on treatment, 1.23 (95% CI 1.04 - 1.46;11 studies, I2 = 76.4%);severe disease 0.86 (95% CI 0.78 - 0.95;28 studies, I2 = 68%);and death, 0.80 (95% CI 0.75 - 0.86;47 studies, I2 = 51.9%). Conclusion: While treatment with ACEIs or ARBs does not appear to impact the risk of COVID-19 infection, it appears that patients on treatment have lower risks of severe disease and mortality compared to patients not on ACEIs/ARBS treatment. Findings should be interpreted cautiously as the systematic reviews/meta-analyses included in this study were of variable quality, and there was high heterogeneity among studies for most outcomes. Findings will inform evidenced-based guidelines on the appropriate measures for patients at risk of COVID-19 infection and prescribed RAAS inhibitors.