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Cancer remains one of the most prevalent diseases in the United States and a leading cause of death. Large prospective studies have found significant correlations between dietary intake and cancer. Chronic inflammation promotes pro-cancer inflammatory environments and nutrition can influence inflammation, with the intake of certain food items increasing inflammatory biomarkers. The objective of this research was to explore the relationship between inflammatory diet score measured by the Dietary Inflammatory index and all-cause mortality, cancer-specific mortality, and cancer recurrence among cancer survivors. Web of Science, Medline, CINHAL, and PsycINFO databases were searched to collect potentially eligible sources that focus on dietary inflammation and cancer outcomes. All sources were uploaded to Covidence software and screened by two independent blinded reviewers. The quality of the sources was assessed using the Newcastle Ottawa scale and relevant data was extracted and transferred to the Comprehensive Meta Analysis software and a random effects model was used to perform meta-analysis. Of the 1444 studies imported into the Covidence software, 13 passed all the screening stages and were included in the final analysis. Eight studies reported on pre-diagnosis diet while five others reported on postdiagnosis diet. Five studies reported on colorectal cancer, four on breast cancer, two on ovarian cancer, one on endometrial cancer and one on prostate cancer. Meta-analysis of the studies found that being in the highest postdiagnosis DII score indicating pro-inflammatory diet significantly increased the risk of all-cause death among cancer survivors by 33.5% (HR = 1.335, 95% CI = 1.049, 1.698, n = 6). Analysis did not show a statistically significant association between DII score and cancer mortality or recurrence (HR = 1.097, 95% CI = 0.939, 1.281, n = 6). Analysis by cancer subtype found a significant correlation between postdiagnosis DII score and all-cause mortality among the breast cancer survivors (HR = 1.335, 95% CI = 1.041, 1.711, n = 3) though there were no significant associations between DII and the outcomes of interest from the other cancer types. The meta-analysis concludes that being in the highest postdiagnosis DII score group significantly increased the risk of all-cause death among cancer survivors. This suggests that risk of all-cause mortality could be reduced for cancer survivors by consuming more anti-inflammatory food components and reducing consumption of pro-inflammatory foods. These findings also warrant more research in this field to clarify the relationship between dietary inflammation as measured by the DII and cancer outcomes, particularly cancer-specific mortality.
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Introduction/Aim: Ecological studies indicate ambient particulate matter >=2.5 mm (PM 2.5) air pollution is associated with poorer COVID-19 outcomes. However, these studies cannot account for individual heterogeneity and often lack precision in estimates of PM 2.5 exposure. We summarise evidence relating on individual-level data to determine whether PM 2.5 exposure increases the risk of COVID-19 infection, severe disease and death. Method(s): We conducted a systematic review of relevant case-control and cohort studies, searching Medline, Embase and the WHO COVID-19 databases. Study quality was evaluated using the Newcastle-Ottawa Scale. Result(s): N = 18 studies met the inclusion criteria. Generally, PM 2.5 exposure was significantly associated with higher rates of COVID-19 infection (all 7 studies positive) and severe COVID-19 disease (8 of 9 studies positive, 1 null). The effects on mortality were mixed but indicative of a positive association (4 of 6 studies positive, 2 null). Most studies were rated 'good' quality (13 of 18 studies), though there were still methodological issues;few used individual-level data to adjust for important confounders like socioeconomic status (3 of 18 studies), instead using area-based indicators (12 of 18 studies) or not adjusting for it at all (3 of 18 studies). Most studies with severe disease (9 of 10 studies) and mortality outcomes (5 of 6 studies) were based on people already diagnosed COVID-19, potentially introducing collider bias. Conclusion(s): There is strong evidence that ambient particulate matter air pollution increases the risk of COVID-19 infection, and weaker evidence of increases in risk of severe disease and mortality.
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Thromboembolism is a major cause of death in patients who suffer from COVID-19. Studies examining the effects of aspirin (ASA) on mortality relating to this phenomenon have showed conflicting results with varying degrees and certainties of evidence. We performed an aggregate data meta-analysis of fourteen studies encompassing 164,539 COVID-19 patients, which showed a reduced risk of in-hospital mortality associated with ASA use in eight studies that reported risk ratios (RR 0.90; 95 % CI 0.82-0.98; I2 = 27.33 %, P = 0.01), six studies that reported hazard ratios (HR 0.56; 95 % CI 0.41-0.76, P ≤ 0.01; I2 = 85.92 %) and pooled effect size (0.71; 95 % CI 0.59-0.85, P = 0.00, I2 = 91.51 %). The objective of this study is to report the association between low dose ASA and a reduced risk of in-hospital mortality in patients with COVID-19.
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Objective: To systematically evaluate the efficacy and safety of arbidol in the treatment of novel coronavirus pneumonia (COVID-19). Method(s): Randomized controlled trials (RCTs), cohort studies, and case-control studies on the efficacy and safety of arbidol for COVID-19, influenza, andother respiratory virus infections were collected by searching related database at home and abroad and network platform for preprint of Health Science Papers (medRxiv) (up to April 25, 2020). Quality of the enrolled studies was evaluated by bias risk assessment tool of Cochrane collaboration network and Newcastle-Ottawa Scale (NOS). Meta-analysis and descriptive analysis of relevant outcome indicators were performed using RevMan 5.3 software. Result(s): A total of 15 studies were enrolled in the study, including 7 cohort studies with high-quality and 8 RCTs, 6 of which were with low bias risk and the other 2 of which were with medium bias risk. Among these studies, 8 were on arbidol treatment for COVID-19, including 5 retrospective cohort studies, 2 prospective cohort studies, and 1 RCT, and involving 809 patients (479 patients in the arbidol group and 330 in the control group);7 were RCTs on arbidol treatment for influenza or other respiratory virus infections, involving 1 471 patients (745 patients in the arbidol group and 726 in the control group).In these studies, patients were treated with arbidol (0.15-1.2 g daily for 5-21 d) in the arbidol group while with the other antiviral agents or without any antiviral drug in the control group. Meta analysis on the efficacy and safety of arbidol in treatment for COVID-19 showed that the novel coronavirus (2019-nCoV) nucleic acid negative conversion rate in the arbidol group was significantly higher than that in the control group [71.7% (109/152) vs. 58.8% (94/160), relative risk (RR)=1.30, 95% confidence interval (CI): 1.01-1.67, P=0.04];the difference of time taken for 2019-nCoV nucleic acid negative conversion between the 2 groups was not statistically significant (standardized mean difference=-0.17, 95%CI: -0.72-0.38, P=0.55);the difference of disease improvement rate shown by chest CT on day 7 after treatment between the 2 groups was not statistically significant [46.2% (30/65) vs. 50.7% (36/71), RR=0.88, 95%CI: 0.39-1.98, P=0.76];and the difference of incidence of adverse reactions between the 2 groups was not statistically significant [16.9% (39/231) vs. 19.2% (47/245), risk difference (RD)=-0.03, 95%CI: -0.10-0.04, P=0.44]. Meta analysis on the safety of arbidol in treatment for influenza and other respiratory virus infections showed that the incidence of adverse reactions in the arbidol group was significantly lower than that in the control group [5.9% (44/745) vs. 11.3% (82/726), RR=0.52, 95%CI: 0.37-0.74, P<0.01]. Conclusion(s): Arbidol could effectively increase the 2019-nCoV nucleic acid negative conversion rate and it might be safe to treat COVID-19 using arbidol.Copyright © 2020 by the Chinese Medical Association.
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Background: Inflammatory bowel diseases (IBDs) are chronic diseases that require routine hospital visits and long-term medical treatment for control of disease activity. Factors such as gender may impact the use and need for healthcare. This systematic review aimed to summarize what is known about sex differences in the risk of bowel surgery in patients with IBD Methods: Embase, Medline, CINAHL, and Web of Science abstracts (January 2012 to January 2022) were searched systematically for observational studies examining associations between sex and risk of bowel surgery. Screening and data extraction were performed independently by two reviewers using Covidence. Study data were analysed and reported in accordance with the PRISMA guidelines. Quality assessment of included studies was conducted using the Newcastle- Ottawa Scale for cohort studies. Pooled hazard ratios (HRs) were calculated using random effects model meta-analysis for the risk of surgery In addition, meta-analysis was undertaken to assess the risk of surgery by IBD subtype. The between-study heterogeneity was assessed by calculating the tau-squared and the I-squared statistics Results: Of 9,902 screened articles, 36 studies were included in the review Most studies were retrospective by design (74.6%). In total, 21 of 36 studies found statistically significant sex-based differences in the risk of bowel surgery for IBD patients. A pooled estimate of HRs for the 13 studies eligible for meta-analysis showed a statistically significant increased risk of bowel surgery among male patients (HR: 1.43 [95% confidence interval (CI): 1.09;1.86]) compared to female patients. The between-study heterogeneity was high (I2=88.60 [60.60;96.33] and tau2=0.17 [0.03;0.58]) indicating that the pooled estimate should be interpreted with caution. These findings were consistent with the subgroup analysis for ulcerative colitis (HR: 1.78 [1.16;2.72]), but no statistically significant sex difference in the risk of surgery in Crohn's disease patients was found (HR: 1.26 [0.82;1.93]) Conclusion(s): Sex differences exist in the risk of bowel surgery in IBD patients, and further research is needed to address the underlying causes and consequences of these disparities. It is unclear whether differences are due to underlying biologic mechanisms or are associated with healthcare system related factors such as differential access to care. Surgical procedures or the lack or delay thereof, will have consequences for the further disease trajectory.
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Introduction: The respiratory tract infections (RTIs), including pneumonia, influenza and Coronavirus Disease 2019 (COVID-19), are the leading cause of hospitalization and mortality worldwide, contributing to elevated healthcare and societal costs. There is conflicting evidences about the effects of angiotensin converting enzyme inhibitor (ACEIs) or angiotensin II receptor blockers (ARBs) on the susceptibility of RTIs. Method(s): Systematic review of interventional and observational studies that reported use of ACEI or/and ARB on incidence of pneumonia or influenza or COVID-19. Searching was conducted in the databases of PubMed, Excerpta Medica Database (Embase), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), including the Cochrane Library until April 2022, and references of retrieved relevant articles. We assessed the quality of included studies by using Cochrane Collaboration Risk of Bias tool for Randomized Controlled Trials and Newcastle-Ottawa Scale for observational studies. DerSimonian Laird random-effects meta-analysis was conducted to pool effects for the incidence of pneumonia, influenza and COVID-19. Subgroup analyses were carried according to baseline morbidities (hypertension or cardiovascular diseases, cerebrovascular diseases, chronic kidney disease (CKD) and other non-communicable diseases). Pooled estimates of odds ratios (OR) and corresponding 95% confidence intervals (95% CI) were computed, and heterogeneity among studies was assessed using Cochran's Q test and the I2 metrics, with two tailed P values. Result(s): 73 studies met the inclusion criteria, of which 38 studies assessed the odds of pneumonia, 32 studies assessed Covid-19 and 3 studies assessed influenza. The quality of included studies was moderate. Use of ACEIs was associated with a significantly reduced odds of pneumonia (23 studies: OR 0.74, 95% CI 0.64 to 0.85;I2=76.8%), of COVID-19 (24 studies: OR 0.87, 95% CI 0.82 to 0.92;I2=81.9%) and influenza (3 studies: OR 0.75, 95% CI 0.57 to 0.98, I2=97.7%), compared with control treatment. Use of ARBs was also associated with reduced odds of COVID-19 (25 studies: OR 0.90, 95% CI 0.83 to 0.97;I2=91.9%), but not with odds of pneumonia or influenza. These findings remain consistent in the community population, patients with history of cerebrovascular diseases or cardiovascular diseases, but not in those with CKD, diabetes and chronic obstructive pulmonary diseases. Conclusion(s): The current evidence favours a putative protective role of ACEIs, not ARB in odds of pneumonia, COVID-19 and influenza. Patient populations that may benefit most are those within the community, history of cerebrovascular diseases and cardiovascular diseases. No conflict of interestCopyright © 2023
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Background and objectives: COVID-19 pandemic had quite a significant impact on a number of obstetric outcomes. This is often directly attributed to complications of COVID-19. This article is a systematically review literature on the epidemiology, clinical features, maternal and perinatal outcomes of COVID-19 in pregnancy. Materials and methods. A PRISMA methodology search was conducted on the databases of PubMed, Scopus, Medline, Google Scholar, Web of Science and Central BMJ using MeSH keywords or combinations of the words"COVID-19", "SARS-CoV-2", "pregnancy", "epidemiology", "comorbid disease", "pregnancy and childbirth outcome", "preeclampsia", "fetus". Only articles published between December 1, 2019 to February 28, 2022 were considered. After preliminary analysis of more than 600 publications, 21 articles were short-listed for final processing. The studies were selected using a Newcastle-Ottawa scale style questionnaire. The clinical features, risk factors, co-morbid conditions, maternal and neonatal outcomes were presented in two separate tables respectively. Results. COVID-19 incidence in pregnancy ranged from 4.9% to 10.0%. Such women were 5.4 times more likely to be hospitalized and 1.5 times more to need ICU care. Dyspnoea and hyperthermia were associated with a high risk of severe maternal (OR 2.56;95% CI 1.92-3.40) and neonatal complications (OR 4.97;95% CI 2.11-11.69). One in ten of neonates had a small weight for gestational age (9.27 +/- 3.18%) and one in three required intensive care unit observation. Conclusions. Despite the increasingly emerging evidence on the associations between pregnancy and COVID-19 infection, the data is sometimes contradictory necessitating further studies.Copyright © 2022 Trylyst. All rights reserved.
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Unbalanced magnesium levels in the body, like other minerals, are a factor that is important in the severity and mortality of COVID-19. This study was designed to investigate the relationship between serum magnesium levels and clinical outcomes in COVID-19 patients. In this systematic review, a comprehensive search was performed in PubMed, Scopus, and Web of Science databases until September 2021 by using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2, coronavirus disease, SARS- COV-infection 2, SARS-COV-2, COVID 19, and magnesium. End-Note X7 software was used to manage the studies. Articles that evaluated effect of magnesium on COVID-19 were included in the analysis. After reviewing several articles,12 studies were finally included in the ultimate analysis. The studies show that hypomagnesemia and hypermagnesemia are both factors that increase mortality in patients with COVID-19, even in one study, hypomagnesemia is the cause of doubling thedeaths in COVID-19 patients. Some studies have also found a negative correlation between magnesium deficiency and infectionseverity, while some others have reported no correlation between magnesium level and disease severity. According to the important role of magnesium in the body and its involvement in many physiological reactions, as well as differences in physical and physiological conditions of COVID-19 patients, in addition to the need for studies with larger sample sizes, monitoring and maintaining normal serum magnesium levels during the disease seems necessary as a therapeutic target, especially in patients admitted to the intensive care unit.
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Background: Opportunistic and chronic infections can arise in the context of treatment used for Autoimmune Rheumatic Diseases (ARDs). Although it is recognized that screening procedures and prophylactic measures must be followed, clinical practice is largely heterogeneous, with relevant recommendations not currently developed or disparately located across the literature. Objectives: To conduct a systematic literature review (SLR) focusing on the screening and prophylaxis of opportunistic and chronic infections in ARDs. This is preparatory work done by members of the respective EULAR task force (TF). Methods: Following the EULAR standardised operating procedures, we conducted an SLR with the following 5 search domains;1) Infection: infectious agents identifed by a scoping review and expert opinion (TF members), 2) Rheumatic Diseases: all ARDs, 3) Immunosuppression: all immunosuppressives/immunomodulators used in rheumatology, 4) Screening: general and specifc (e.g mantoux test) terms, 5) Prophylaxis: general and specifc (e.g trimethop-rim) terms. Articles were retrieved having the terms from domains 1 AND 2 AND 3, plus terms from domains 4 OR 5. Databases searched: Pubmed, Embase, Cochrane. Exclusion criteria: post-operative infections, pediatric ARDs, not ARDs (e.g septic arthritis), not concerning screening or prophylaxis, Covid-19 studies, articles concerning vaccinations and non-Εnglish literature. Quality of studies included was assessed as follows: Newcastle Ottawa scale for non-randomized controlled trials (RCTs), RoB-Cochrane tool for RCTs, AMSTAR2 for SLRs. Results: 5641 studies were initially retrieved (Figure 1). After title and screening and removal of duplicates, 568 full-text articles were assessed for eligibility. Finally, 293 articles were included in the SLR. Most studies were of medium quality. Reasons for exclusion are shown in Figure 1. Results categorized as per type of microbe, are as follows: For Tuberculosis;evidence suggests that tuberculin skin test (TST) is affected by treatment with glucocorticoids and conventional synthetic DMARDs (csDMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. Conversion of TST/IGRA occurs in about 10-15% of patients treated with biologic DMARDs (bDMARDs). Various prophylactic schemes have been used for latent TB, including isoniazide for 9 months, rifampicin for 4 months, isoniazide/rifampicin for 3-4 months. For hepatitis B (HBV): there is evidence that risk of reactivation is increased in patients positive for hepatitis B surface antigen. These patients should be referred for HBV treatment. Patients who are positive for anti-HBcore antibodies, are at low risk for reactivation when treated with glucocorticoids, cDMARDs and bDMARDs but should be monitored periodically with liver function tests and HBV-viral load. Patients treated with rituximab display higher risk for HBV reactivation especially when anti-HBs titers are low. Risk for reactivation in hepatitis C RNA positive patients, treated with bDMARDs is low. However, all patients should be referred for antiviral treatment and monitored periodically. For pneumocystis jirovecii: prophylaxis with trimeth-oprim/sulfamethoxazole (alternatively with atovaquone or pentamidine) should be considered in patients treated with prednisolone: 15-30mg/day for more than 4 weeks. Few data exist for screening and prophylaxis from viruses like E B V, CMV and Varicella Zoster Virus. Expert opinion supports the screening of rare bugs like histoplasma and trypanosoma in patients considered to be at high risk (e.g living in endemic areas). Conclusion: The risk of chronic and opportunistic infections should be considered in all patients prior to treatment with immunosuppressives/immunomod-ulators. Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics. Collaboration between different disciplines is important.
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Aim Elevated Interleukin-6 (IL-6) is associated with the pathogenesis of various chronic inflammation and autoimmune conditions. 1 Currently, only three IL-6 inhibitors, tocilizumab, siltuximab and sarilumab, are approved for a limited number of conditions in adults, and only tocilizumab is licensed in children.2 However, off-label use of these drugs has been reported in paediatrics. This review aimed to summarise the evidence base for the off-label use of these three IL-6 inhibitors in children, the indications for off-label use, and the doses prescribed. The nature of adverse events associated with the off-label use of these drugs and the clinical effectiveness were also identified. Method A systematic search was conducted on EMBASE, Medline, and PubMed;studies published in the English language between 2009-2020, reporting the off-label use of tocilizumab, siltuximab and sarilumab in children aged 18 years or under were included. Data screening and extraction were performed independently by two reviewers. The quality of included studies was assessed using the Newcastle-Ottawa quality assessment scale for cohort and cross-sectional studies, and the National Institutes of Health quality assessment tool for case series. The review was conducted and reported in accordance with the PRISMA guidelines for systematic reviews3 and was registered on PROSPERO with registration number CRD42021221631. Results In total 81 studies were included in the systematic review, with 18.5% (15/81) studies deemed of good quality, 24.7% (20/81) studies of fair quality, and 56.8% (46/81) studies of poor quality. Almost all of the studies (99%, 80/81) were on tocilizumab. Only one study investigated siltuximab and none were found for sarilumab. The total number of patients included in the identified studies was 211 (210-tocilizumab, 1 siltuximab). For tocilizumab, the most frequently reported clinical indication was the management of complications associated with hematopoietic stem cell transplantation (24.3%, 51/210) followed by its use in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) (17.5%, 14/80). Overall, tocilizumab was prescribed for 28 unlicensed indications, and the dose varied from 4 to 12 mg/kg. Dosing frequency was reported in 98.7% (79/80) of tocilizumab studies, with 'every two weeks' prescribed most often (53.2%, 72/79). Adverse events were reported in 20.4% (43/211) of patients of which 32.6% (14/43) experienced adverse events, e.g. respiratory tract infections (n=2) and low platelet counts (n=2). The clinical outcome of the off-label use of tocilizumab was described to be successful in 55% (44/80) of studies, with reported success in the treatment of SARS-COV-2 and uveitis (13.6%, 6/44, each). The article on siltuximab reported no clinical outcomes. Conclusion This is the first systematic review of the off-label use of IL-6 directed therapies in children. The limited data suggest that tocilizumab may be effective in a number of offlabel indications, but the quality of available evidence is low and there remains the need for adequately powered and welldesigned studies to support its use in clinical practice. The findings of this review should be used as a basis to inform future clinical trials in paediatrics.
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Background: The long-term prognosis of COVID-19 survivors remains poorly understood. It is evidenced that the lung is the main damaged organ in COVID-19 survivors, most notably in impairment of pulmonary diffusion function. Hence, we conducted a meta-analysis of the potential risk factors for impaired diffusing capacity for carbon monoxide (DLCO) in convalescent COVID-19 patients. Methods: We performed a systematic search of PubMed, Web of Science, Embase, and Ovid databases for relevant studies from inception until January 7, 2022, limited to papers involving human subjects. Studies were reviewed for methodological quality. Fix-effects and random-effects models were used to pool results. Heterogeneity was assessed using I2. The publication bias was assessed using the Egger's test. PROSPERO registration: CRD42021265377. Findings: A total of eighteen qualified articles were identified and included in the systematic review, and twelve studies were included in the meta-analysis. Our results showed that female (OR: 4.011; 95% CI: 2.928-5.495), altered chest computerized tomography (CT) (OR: 3.002; 95% CI: 1.319-6.835), age (OR: 1.018; 95% CI: 1.007-1.030), higher D-dimer levels (OR: 1.012; 95% CI: 1.001-1.023) and urea nitrogen (OR: 1.004;95% CI: 1.002-1.007) were identified as risk factors for impaired DLCO. Interpretation: Pulmonary diffusion capacity was the most common impaired lung function in recovered patients with COVID-19. Several risk factors, such as female, altered chest CT, older age, higher D-dimer levels and urea nitrogen are associated with impairment of DLCO. Raising awareness and implementing interventions for possible modifiable risk factors may be valuable for pulmonary rehabilitation. Funding: This work was financially supported by Emergency Key Program of Guangzhou Laboratory (EKPG21-29, EKPG21-31), Incubation Program of National Science Foundation for Distinguished Young Scholars by Guangzhou Medical University (GMU2020-207).
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Introduction: Despite COVID-19 being a viral illness, antibiotic use has been more prevalent. In addition, co-infection (3.5%) and secondary infection (14.3%) were relatively low in hospitalised patients with COVID-19. A major concern is the increased risk of antimicrobial resistance (AMR) due to inappropriate antibiotic consumption (1). Aim: This review aims to evaluate antimicrobial consumption (excluding repurposed drugs such as remdesivir) in hospitals and determine the prevalence of COVID-19 patients who received antibiotic therapy using meta-analysis. Methods: The review was conducted according to PRISMA guidelines (2). The two investigators independently developed and applied eligibility criteria to examine original articles. Studies were eligible for inclusion if they met the following criteria: (i) original research studies with a minimum sample of 50 patients;(ii) focussed on antibiotic consumption (AMC);(iii) patients with COVID-19 or consumption amid COVID-19 pandemic;(iv) any age group or gender;and (v) reported in the English language. The included articles were retrieved from MEDLINE, CINAHL, WHO COVID-19 databases, including studies published in EMBASE, Scopus, WHO-COVID, and LILACS between December 2019 to July 2021. The modified version of Newcastle-Ottawa Scale (NOS) was used to measure biases in included studies after the consensus by both authors. The random-effects model was used to estimate the pooled prevalence or proportion of AMC among hospitalized COVID-19 patients. Results: A total of 34 studies conducted among hospitalised COVID-19 patients were included. The extracted studies presented AMC in defined daily doses (DDD) or frequency and percentages. Azithromycin was the most frequently prescribed antibiotic in almost all studies. The meta-analysis that examined overall AMC using data from 25 studies (17 studies from high income countries and eight from low-middle income countires) revealed 69% (95% CI:63%-74%) of hospitalized COVID-19 received at least one course of antibiotics. The sub-group analysis of studies from high income countries (HICs) revealed 59% (95% CI: 51%-66%) consumed antibiotics compared with 89% (95% CI: 82% to 94%) among hospitalised COVID-19 patients in low-middle income countries (LMICs). Conclusion: This review highlights the trend of antibiotic consumption in hospitalised COVID-19 patients. A significant rise in antibiotic consumption was observed in LMICs and increased antibiotic consumption in the first few months of the COVID-19 pandemic in HIC. The review outcomes emphasised the importance of rational and judicious use of antimicrobial therapy as well as to strenghting the antimicrobial stewardship policies and activities, particularly during a global pandemic. The limitation of the review undertaken was not identified incidence of co-infection and don't include studies on reported AMC in immunocompromised patients.
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Introduction: The COVID-19 pandemic has led to rising demand for hospital beds and the shortage of medical equipment and supplies. It is necessary to identify the factors that influence the length of stay of COVID-19 patients to accurately predict the number of beds needed at each level of care. This study systematically reviewed influential factors on the hospitalization of COVID-19 patients to provide evidence for risk classification and improvement of clinical outcomes and recommendation solutions for reducing the length of stay. Methods: With the appropriate keywords and a clearly defined search strategy, relevant databases such as PubMed, Embase, and Cochrane Library were searched for cohort studies and randomized control trials to November 10, 2020. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of studies. Data including influencing factors length of stay, age, sex, country were extracted based on a checklist developed by the researchers. Data obtained due to differences in measurement criteria were qualitatively analyzed. Results: The systematic search resulted in 48 relevant studies. Dependence of the severity of disease on age and comorbidities is the principal determinant of increased length of stay. Secondary bacterial infections, obesity, diabetes, and uncontrolled hyperglycemia in COVID-19 patients are likely to increase their length of stay. Special attention to liver damage has also been recommended in SARS-CoV-2 infections since pharmacological factors are independent risk factors for liver damage in non-severe patients. Neurological complications at presentation or during the hospital stay significantly increase the risk of prolonged hospitalization. Shortage of re-sources could decrease stay among COVID-19 patients, which indicates that intensive care is either delayed, deferred, or abbreviated. Conclusion: Overall, demographic and epidemiological factors, dietary factors and diabetes, neurological conditions, liver damage, acute cardiovascular diseases, and social factors contribute to the length of hospital stay in COVID-19 patients. The present results can provide insights for policymakers regarding the factors that influence the length of stay of COVID-19 patients and practical solutions that can be employed to manage these factors.
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Background: Accumulating evidence suggests a beneficial effect of tumor necrosis factor-alpha (TNF-α) inhibitors on the outcomes of COVID-19 disease, which, however, is not validated by all studies. We aimed to perform a systematic review and meta-analysis of existing reports to investigate the impact of anti-TNF treatments on the clinical outcomes of COVID-19 patients. Methods: A systematic search at PubMed and SCOPUS databases using specific keywords was performed. All reports of COVID-19 outcomes for patients receiving anti-TNF therapy by September-2021 were included. Pooled effect measures were calculated using a randomeffects model. The Newcastle Ottawa Scale for observational studies was used to assess bias. Studies that were not eligible for meta-analysis were described qualitatively. Results: In total, 84 studies were included in the systematic review, and 31 were included in the meta-analysis. Patients receiving anti-TNF treatment, compared to non-anti-TNF, among confirmed COVID-19 cases had a lower probability of hospitalisation (25 studies, pooled OR=0.34, 95%CI:0.30-0.38, I2=0) and severe disease defined as intensive care unit admission or death (eight studies, pooled OR=0.38, 95%CI: 0.27-0.55, I2=0). After adjustment for validated predictors of adverse disease outcomes, patients receiving anti-TNF treatment, compared to non-anti-TNF, among confirmed COVID-19 cases preserved a lower probability of hospitalisation (eight studies, pooled OR=0.53, 95%CI:0.42-0.67, I2=0) and severe disease (two studies, pooled OR=0.63, 95%CI: 0.41-0.96, I2=0). No difference was found for the risk for hospitalisation due to COVID-19 in populations without COVID-19 for patients receiving anti-TNF treatment compared to non-anti-TNF (three studies, 5,994,958 participants, pooled Risk Ratio=0.97, 95%CI: 0.68-1.39, I2=20) adjusted for age, sex and comorbidities. Conclusion: TNF-α inhibitors are associated lower probability of hospitalisation and severe COVID-19 when compared to any other treatment for an underlying inflammatory disease.
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Current available data regarding antiviral treatment for pregnant women with COVID-19 are scarce. Therefore, this systematic review is created to collect and review various available data regarding the use of antivirals for treating pregnant women with COVID-19. Literature search was performed on PubMed and Cochrane databases, selecting studies which evaluated the efficacy and safety of antivirals on pregnant women with COVID-19 from inception to June 27, 2021. The Newcastle-Ottawa scale was used to assess cohort and case series studies. A total of 9 studies were included in this study with 2 being prospective cohort studies and 7 case series, and 3 kinds of antivirals remdesivir, nitazoxanide, and lopinavir-ritonavir. Of all the 9 studies, a total of 98 pregnant women, 19 postpartum women, and 3 immediate puerperium women were included. The use of remdesivir showed promising outcome with 74/79 (93.7%) patients fully recovered and 33/33 (100%) successful delivery and live neonates. Nitazoxanide with a smaller sample size reported 18/20 (90%) patients fully recovered, 12/12 (100%) successful deliveries, and 12/15 (80%) live neonates. Limited data were provided for lopinavir-ritonavir with only 2 patients included and all of them fully recovered. To date, the use of remdesivir seems promising with reassuring clinical, pregnancy, and neonates’ outcome. However, as data are still scarce, larger studies, especially clinical trials, are required as most of the clinical trials exclude pregnant women as subjects.
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BACKGROUND: The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. OBJECTIVE: This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. METHODS: We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. RESULTS: Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of <3 points, which suggests that these studies are of very low quality for inclusion in a meta-analysis. CONCLUSIONS: The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies.
Subject(s)
COVID-19 , Data Collection/standards , Health Surveys/standards , Mental Health , Cross-Sectional Studies , Data Collection/methods , Humans , Pandemics , SARS-CoV-2ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) brought the majority of the world into a halt when it started to spread outside the virus epicenter in Wuhan, China. With the alarming increase in the number of cases and deaths worldwide, the possible risk factors should be determined in order to have a general idea on those who are more susceptible to have this disease. Hypertension, being one of the world's leading causes of noncommunicable diseases, was identified by the CDC to be one of underlying medical conditions that might pose an increased risk for severe illness from COVID-19. Objective: The aim of this study is to determine the predictive value of hypertension as a comorbidity in COVID-19 mortality. Materials and methods: Participants included all patients clinically diagnosed with COVID-19, and have hypertension as their pre-existing medical condition. Studies were selected based on study design, participants, exposure, outcome, timing, setting and language. The following databases were searched from June to August 2020 for case control and cohort studies on MEDLINE and CINAHL, ScienceDirect, Clinical Key, OVID database, Wiley Online library, and UpToDate. The criteria for evaluation of risk of bias were based on the selection bias, comparability bias and outcome bias. All information gathered were collated and evaluated using the Newcastle- Ottawa Quality Assessment Scale and CEBM. Results: Individual studies all showed a significant relationship between hypertension and mortality in COVID-19 patients. Odds ratio ranging from 1.75 to 28.88, and hazard ratio ranging from 1.49 to 3.32 are present in the studies. For the data analysis, Mantel Haenszel method and random effects model was used for case control studies with odds ratio as effect measure;while Inverse variance method and fixed model was used for cohort studies with hazard ratio as effect measure. Both groups showed significant positive association between mortality and hypertension as a prognostic factor. Overall odds ratio is 5.25 (2.42-11.40) with a p value of <0.00001, and the pooled hazard ratio is 2.21 (1.75-2.80) with a p value of <0.00001. This shows that there is an increased risk of mortality among COVID-19 patients with hypertension as a comorbid condition. Conclusions: Hypertension as a comorbid condition is a prognostic factor in the prediction of mortality in hospitalized COVID-19 patients. The ten included studies showed that there is a significant positive association suggesting an increased risk of mortality in COVID-19 patients with hypertension. (Figure Presented).
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Background: Coronavirus disease 2019 (COVID-19) remains a public health problem worldwide. There is conflicting evidence about the impact of statins use on clinical outcomes in patients with COVID-19. Purpose: We performed a systematic review and meta-analysis to assess the effect of statins use on mortality in these patients. Methods: We searched electronic databases from inception to March 3, 2021 for cohort studies evaluating the association between chronic and/or inpatient use of statins and mortality. Risk of bias was assessed using the Newcastle-Ottawa Scale. We pooled unadjusted and adjusted effect estimates with their 95% confidence intervals (95% CI) using random-effects models. Results: A total of 25 cohort studies involving 147824 patients were included. The mean age ranged from 44.9 to 70.9 years and 57% of patients were men. The use of statins was not associated with mortality according to the unadjusted risk ratio (uRR, 1.16;95% CI, 0.86-1.57, 19 studies). In contrast, meta-analyses of adjusted odds ratio (aOR, 0.67;95% CI, 0.52- 0.86, 11 studies) and adjusted hazard ratio (aHR, 0.73;95% CI, 0.58-0.91, 10 studies) showed that the use of statins was independently associated with a significant reduction of mortality. Adjusted confounders included age, sex, and cardiovascular comorbidities in most of cohorts. Eighteen studies were scored as low risk of bias, six studies as moderate risk of bias, and one study as high risk of bias. Conclusion: The use of statins was associated with lower mortality in patients with COVID-19 based on adjusted effects of cohort studies. However, randomized controlled trials are needed to confirm these findings.
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OBJECTIVE: This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association. METHODS: A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19. RESULTS: There were 9 studies with 3,663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], p=0.010; I2: 56.7%, p=0.018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], p=0.008; I2: 57.4%, p=0.029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, p=0.033), male gender (coefficient: -0.03, p=0.042), and hypertension (coefficient: -0.02, p=0.033), but not diabetes (coefficient: -0.24, p=0.135) and cardiovascular diseases (coefficient: -0.01, p=0.506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (p=0.206). CONCLUSION: Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension. PROSPERO REGISTRATION NUMBER: CRD42020213491.