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Introduction: Loop diuretics are the first-line treatment for volume overload in acute decompensation of congestive heart failure (AHF). Loop diuretic resistance is common due to pharmacologic tachyphylaxis. Therefore, thiazide and thiazide-like diuretics are often used as add-on therapy to combine two different pharmacologic mechanisms. This systemic review and meta-analysis aimed to synthesize the current evidence on the efficacy and safety of metolazone and other thiazide-like diuretics in AHF. Method(s): PRISMA guidelines were followed in conducting this systematic review. PubMed, Scopus, PubMed Central, and Embase databases were searched using relevant keywords for studies published before 5 Jan 2022. and title screening was performed, followed by full-text screening using the Covidence software. Data were extracted, and analysis was done using Cochrane Review Manager (RevMan v5.1). The results were reported in odds ratio and mean difference with 95% confidence intervals. Result(s): Out of 2999 studies identified by database search, eight studies met the inclusion criteria (2 RCTs and 6 cohort studies). Pooled analysis using a random-effects model showed no difference in mean difference among the metolazone group and control group for 24 hours total urine output (MD 69.32, 95% CI -638.29 to 776.94;n = 551;I2 = 84%), change in urine output in 24 hours (MD -284.09, 95% CI -583.99 to 15.81;n = 345;I2 = 0%), 48 hours total urine output (MD -465.62, 95% CI -1302.22 to 370.99;n = 242;I2 = 0%) and urine output at 72 hours (MD -13.24, 95% CI -90.88 to 64.40;n = 205;I2 = 0%). However, studies with furosemide only in the comparator arm, 24 hours of total urine outcome favored metolazone (MD 692.70, 95% CI 386.59 to 998.82;n = 334;I2 = 0%). There was no difference between the two groups in the rate of adverse events, loss of weight, mortality, or readmission rates. Conclusion(s): Metolazone therapy in diuretic resistant AHF may improves urine output and facilitates achieving a net negative balance. Thus, metolazone and thiazide-like diuretics can be used as add-on therapy in acute decompensation of heart failure, especially in diuretic resistance.Copyright © 2023 The Author(s)
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Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.
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Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Purpose of study The efficacy of facemasks in prevention of disease transmission is widely debated with a paucity of underlying evidence. In the face of COVID-19, officials began considering potential benefits of facemask use, such as preventing transmission to others or protecting health care workers interacting with infected individuals. However, the efficacy of facemasks in the context of COVID-19 is not well studied and its impact on transmission has not yet been fully elucidated. Methods used A systematic review was conducted in Pubmed, Web of Science, Embase and Cochrane library from database inception up until August 2020 to analyze the efficacy of facemasks, regardless of type, on the prevention of SARS-CoV-2 transmission in both healthcare and communal settings. Only English language articles were retrieved, and conference proceedings were omitted. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) criteria. Summary of results Of the 2720 articles that were identified, 27 studies were included based on predetermined criteria. Of these, ten had complete data. Of 1200 subjects, 953 (79.4%) reported wearing masks while 246 (20.5%) did not. Of the 228 (19.0%) who received a positive COVID test, 73 (32.0%) wore masks and 155 (68.0%) did not. Health care settings comprised 829 subjects, 692 (83.5%) reported wearing masks while 136 (16.4%) did not, and 114 (13.8%) received a positive COVID test. Of these, 50 (43.9%) wore masks and 64 (56.1%) did not. In 371 subjects in non health care settings, 261 (70.4%) reported wearing masks while 110 (29.7%) did not. Of these, 114 (30.7%) received a positive COVID test, while 23 (20.2%) wore masks and 91 (79.8%) did not. Conclusions Wearing a facemask was associated with lower COVID-19 rates in both healthcare settings and non-healthcare settings. From the current data, it appears that a lower percentage of healthcare workers tested positive for COVID-19 compared to subjects in non-healthcare settings, regardless of mask usage. Study limitations include limited data regarding the types of mask worn, level of exposure risk, and other personal protective measures taken.
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With the advent of the COVID-19 pandemic, the level of concern regarding employee digital competence has increased significantly. Several studies provide different surveys, but they cannot describe the relationship between digital autonomy and innovative work behaviour concerning the impact of employee digital competence. Hence, it is necessary to conduct a survey that provides a deeper understanding of these concerns and suggests a suitable study for other researchers. Using scientific publication databases and adhering to the PRISMA statement, this systematic literature review aims to offer a current overview of employee digital competence impact on the relationship between digital autonomy and innovative work behaviour from 2015 to 2022, covering definitions, research purposes, methodologies, outcomes, and limitations. When reviewing the selected articles, 18 articles were examined under relationship topics, and 12 articles reported on impact topics under different tasks. The main findings highlight the significance of digital competence and autonomy in promoting employee creativity, learning, and sharing knowledge. According to the review findings, employees with greater digital autonomy are more likely to engage in innovative work, leading to improved job performance and empowerment. Therefore, the development of digital autonomy prioritizes organizations by providing access to digital tools, training, and a supportive work environment. Overall, the current review indicates a strong positive correlation between digital autonomy, innovative work behaviour, and employee impact. This underscores the importance for organizations to not only participate in digital competence and skills, but also to create a culture that values autonomy, creativity, and innovation among its employees.
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Background: Fever is a common clinical manifestation of COVID-19 infection. Fever has also been associated with unmasking Brugada pattern ECG in patients and may result in life-threatening arrhythmia. Little is known regarding COVID-19 associated Brugada pattern ECG. There is paucity of data and guidance in how to manage these patients. Method(s): To identify all published case reports, the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. A literature search was conducted using PubMed, EMBASE, and Scopus through September 2021. A systematic review was performed to identify the incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG. Result(s): A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patient had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow up, thirteen patients (72.2%) had resolution of type 1 Brugada pattern ECG. Conclusion(s): COVID-19 associated Brugada pattern ECG is rare. Most patients may see resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.
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Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening drug-induced condition presenting with skin rash, fever, lymphadenopathy, systemic involvement and hematological (eosinophilia, atypical lymphocytes) findings. Although DRESS syndrome is frequently associated with reactivation of herpesviruses, the link between DRESS and COVID-19 has not been systematically analyzed. Method(s): A systematic search using PubMed and Google Scholar was conducted following the PRISMA guidelines to identify all reported DRESS cases associated with COVID-19 published between January 2020 and January 2022 using the keywords "COVID-19" AND "DRESS syndrome" OR "drug reaction with eosinophilia and systemic symptoms" OR "drug-induced hypersensitivity syndrome" OR "eosinophilia" AND "SARS-CoV- 2" OR "coronavirus". The identified DRESS cases were evaluated using the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring system [Kardaun et al, 2007]. Result(s): We identified twelve published DRESS cases associated with COVID-19 (Table 1). Eleven patients presented with severe COVID-19 disease complicated by DRESS syndrome that developed several days after initial COVID-19 clinical presentation (ARDS n5;multiorgan failure n1;pneumonia requiring mechanical ventilation, n4), one patient was asymptomatic. The culprit drugs included piperacillin-tazobactam (n4), hydroxychloroquine (n5), vancomycin (n2), ceftriaxone (n1), midazolam (n1), sulphasalazine (n1), azithromycin (n1), esomeprazole (n1), cefepime (n1), levofloxacin (n1), and meropenem (n1). The latency between the onset of treatment with culprit drug(s) and the onset of symptoms ranged from 9 to 42 days. All patients presented with widespread maculopapular rash, affecting > 50% of body surface area;five patients also had facial edema. Systemic involvement included liver (n8), renal abnormalities (n8), and heart involvement (n4). All patients had elevated body temperature (fever > = 38.5degreeC, n6) and blood eosinophilia, five patients had lymphadenopathy. Atypical lymphocytes were a rare laboratory finding (n2). Systemic corticosteroids were used in all patients;three patients received benralizumab for DRESS syndrome. Nine patients recovered, two patients died and the outcome was not reported in one case Conclusion(s): DRESS syndrome in COVID-19 patients is associated with multiple drugs, most notably with hydroxychloroquine and a variety of antibiotics. An early recognition may improve management of DRESS syndrome in COVID-19 patients.
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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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Background: In the context of aphasia rehabilitation, there is a perceived need for interventions with a reduced linguistic demand targeting well-being. Mind-body and creative arts approaches are holistic and person-centred approaches, primarily relying on means other than verbal exchanges and promoting self-regulation strategies. Aim(s): This mixed-method systematic review aimed to evaluate the availability, feasibility and effectiveness of mind-body and creative arts therapies in promoting well-being for people with aphasia. Eight databases were searched using subject headings and keywords. Full-text screening, critical appraisal and data extraction were conducted independently by two reviewers. A segregated synthesis approach was used (i.e., Revised Effect Direction Plot technique and Thematic Synthesis approach). Findings are presented in a narrative and visual form. Main Contribution: Twenty-two studies were included (Mind-body: n = 11;Creative arts: n = 11). Heterogeneity of study design and quality, intervention type, procedures and dosage, outcomes, and level of offered communication support were identified. Improvements were noted across a wide range of well-being outcomes with more consistent positive results for anxiety and communication. One hundred and twenty-eight findings were extracted and synthesised in three broad themes: positive impact on self, empowering multifaceted experience, and relevance of needs-centred adjustments. Conclusion(s): Provisional findings about the benefits of mind-body and creative arts interventions on aspects of well-being for some individuals with aphasia were identified. However, findings are complex and need to be interpreted cautiously. Facilitators and barriers to these therapies are highlighted with related recommendations for practice. This review poses a demand for further research in the field, implementing rigorous methodology and aphasia-specific support to facilitate inclusion and engagement.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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The emergence of new pathogenic viruses and the constant outbreak of viral diseases have created an upsurge in novel antiviral agents. Marine natural products are the most unexplored reservoir of novel, biologically active, chemically diverse compounds. A systematic literature review was conducted using PRISMA guidelines, accessing four major databases;PubMed, Science Direct, Scopus, and Google Scholar. Numerous studies supported the robust antiviral activity of marine resources against drug-resistant viruses such as SARS, Ebola, Influenza, and HIV. However, adequate research on marine resources for developing anti-covid therapy is lacking. The aim of the review was to explore the marine resources and their compounds that could lead to developing an effective antiviral drug. We also highlighted the current status of novel compounds against different species of corona family and discussed the future prospects of marine resources against COVID-19 management.Copyright © 2023 the authors.
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Introduction: Coronaviruses (CoV) is a diverse group of viruses that has been described in the literature since 1960, SARS, MERS, and the most recent SARS-CoV-2. This new virus is causing a worldwide pandemic outbreak in the first half of 2020, thousands of deaths, and a signifi-cant economic crisis. Objective(s): Due to this new context, the present study aimed to conduct a systematic study review of the new Coronavirus's global status (COVID-2019) and its aspects compared to the previous SARS-CoV infections MERS-CoV. Method(s): The study was conducted from January to September 2020, 89 clinical cases were sub-mitted to further analysis, and 77 studies were selected for systematic review under the PRISMA guidelines. Conclusion(s): In some countries, the SARS-CoV-2 pandemic appears to be out of control. In case of suspicion, tests are essential to identify the early stages of infection. If necessary, patients need to go into quarantine, and other public health measures should be taken following the World Health Organization guidelines. Advanced support is needed to identify and isolate infected patients, espe-cially vaccines and medicines that help control the virus and the epidemiological situation in each country. These measures are expected to reduce the rate of new cases of SARS-CoV-2.Copyright © 2021 Bentham Science Publishers.
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Introduction Post-diagnostic support is key to ensuring the well-being of people with dementia and unpaid carers. The COVID-19 pandemic has caused a shift from in-person to remote service delivery, often with the use of information communication technologies (ICT) formats. This systematic review examined how ICT has been used to access remote post-diagnostic support services that address the needs people with dementia, or those of dyad, and explored care recipients' views on accessing dementia-related support remotely. Method Concepts relating to dementia and ICT were searched across six databases (PsychInfo, PubMed, Cochrane Library, CINAHL, Social Care Online, and Web of Science) in March 2021 and updated in March 2022. Studies published from 1990 and written in English, German or French were considered for inclusion. Methodological quality was appraised using the Hawker quality assessment tool and reporting structured according to PRISMA guidelines. Results The search yielded 8,485 citations. Following the removal of duplicates and two screening processes, 18 papers were included. Papers described a range of post-diagnostic support, including exercise classes and therapeutic sessions, which were largely delivered remotely on a one-to-one basis. Videoconferencing software was the most employed ICT format, and people with dementia were directly engaging with ICT to access post-diagnostic support in 13 studies. Whilst studies demonstrated the feasibility of accessing post-diagnostic service remotely, overall, care recipients' views were mixed. Conclusions Following the increased reliance on ICT during the pandemic, it is likely that service delivery will continue with a hybrid approach. Accessing post-diagnostic support remotely is likely to benefit some care recipients. However, to prevent widening inequalities in access, service provision is required to accommodate to people with dementia and unpaid carers who are digitally excluded. Future research should capture the support provided by unpaid carers facilitating the engagement of the person with dementia when accessing remote post-diagnostic support.
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Introduction & Objectives: During the COVID-19 pandemic, medical students across the globe were temporarily dismissed from clinical placements. In the field of urology, prevocational exposure is closely linked to medical students' interest in pursuing urology as a career and their confidence in dealing with urological conditions post-graduation. This systemic review evaluates the emerging educational interventions to improve urological knowledge and urology exposure among medical students in the context of a global pandemic. Method(s): A modified PRISMA (Preferred Reporting Items for Systematic Review and Meta- Analyses) search was conducted using MEDLINE and EMBASE were searched with keywords related to urology education, medical education, and medical students. The inclusion criteria were all English language articles in peer-reviewed publications from January 2020- current. Full-text articles were retrieved, evaluated, and included in the final analysis. Result(s): In total, 1255 records were identified through the initial literature search, and 21 full-text articles were reviewed for eligibility. Eight studies met the selection criteria and were included in this review. Most studies were conducted in the United States. All studies utilised online learning platforms or videoconferencing applications as part of their interventions. All studies implemented a combination of interventions, including case-based learning, didactic lectures, and online discussion boards. All studies reported at least one positive finding on Kirkpatrick level 1 or 2. (See table 1 for complete data extraction). Conclusion(s): A wide variety of effective educational interventions has been implemented since 2020 to ensure adequate urology education for medical students. The pandemic largely drove the broad adoption of online learning, and these online resources should be incorporated into pre-existing Australian and New Zealand urology curricula post- COVID, given their effectiveness and popularity among medical students internationally. There was, however, a lack of educational outcomes assessed at higher Kirkpatrick levels. A robust methodology and a larger sample size are needed for future studies.
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Since the COVID-19 pandemic, international higher education and student mobility have faced tremendous pressure and challenges. To address COVID-induced challenges and stress, higher education institutions and host governments undertook responses. This article has humanistically looked into the institutional responses of host universities and governments to international higher education and student mobilities during the COVID-19 pandemic. Informed by a systematic literature review of publications released between 2020 and 2021 in a wide range of academic sources, we argue that many of these responses were problematic and did not adequately maintain student well-being and fairness; instead, international students were treated to some extent with poor services in the host countries. To situate our comprehensive overview and propose ideas for forward-thinking conceptualisation, policy, and practice in higher education in the context of the ongoing pandemic, we engage with the literature on ethical and humanistic internationalisation of higher education and (international) student mobilities.
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The imminent threat to food security requires immediate intervention toward ensuring societal sustainability especially in combating the pandemic. The rapid spread of COVID-19 cases has caused concern for food security. A recent outlook report produced by Food Agricultural Organization and World Food Programme (FAO-WTP) highlights that there are at least 20 countries that are faced with a looming threat of food availability between the period of March-July 2021. Other factors that pose a significant threat to food security include climate change and natural disasters which could significantly reduce the yield. It is hence imperative to gain an in-depth understanding of factors that influence farmers' choices in innovation adoption for increased yield. A line of research has been conducted across the globe on new technology adoption and effect of innovation that aims to increase productivity and yield. This study examined the key factors, that lead farmers to the adoption of new technology and innovation, reported in studies over the past 15 years. PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was employed based on the SCOPUS and Web of Science database. In creating the main dataset, a protocol was developed in advance to document the analysis method. Several inclusion (eligibility) and exclusion criteria were set to select related articles from a total of 2,136 papers. The thematic and content analyses were subsequently performed on 392 research articles. The findings indicate 4 over-arching segments, and 12 major determinants, that comprise 62 associate determinants. The paper concludes with the identification of critical factors for innovation adoption amongst farmers.
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BACKGROUND: Coronavirus disease 19 (COVID-19) infection has been a global pandemic since late 2019. Even though most COVID-19 patients recover fully from the disease, approximately 5–10% experience prolonged symptoms for several months following the acute COVID-19 phase, defined as long COVID-19 syndrome. Most of the sequelae are respiratory sequelae. Rehabilitation therapy is needed to overcome their respiratory sequelae and to improve their functional capacity. AIM: This systematic review discusses rehabilitation therapy for long COVID-19 syndrome with respiratory sequelae. METHODS: Using PubMed and Cochrane library, a systematic review was conducted based on PRISMA guidelines. The subject of this research was long COVID syndrome with respiratory sequelae. For rehabilitation therapy for long COVID-19 patients with respiratory sequelae, inclusion criteria were studied. Exclusion criteria were letters to the editor, editorial or commentary reports, and studies not available in full-text and not in English or Bahasa. RESULTS: Nine studies are included in this systematic review comprising two consensus statements or recommendations, one cohort retrospective study, two case studies or case reports, one review, and three experimental studies. The recommended rehabilitation program pathway using a three-tier model depends on the severity of the disease. Several rehabilitation exercises for long COVID patients with respiratory sequelae include cardiorespiratory exercise, breathing exercise, therapeutic exercise, and even traditional Chinese fitness models such as Liuzijue exercise. CONCLUSION: Rehabilitation therapy exercise helps to improve the breathing effort, improving dyspnea, and respiratory muscle strength in long COVID patients with respiratory sequelae.
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Aims Paediatric populations are generally considered to be at a lower risk of mortality from COVID-19 infection compared with adult populations. Regardless, a notable number of deaths from COVID-19 have been reported in paediatric populations. Therefore, the purpose of our work was to conduct a scoping review of the literature to assess the risk factors for COVID-19 mortality among paediatric populations. Methods Our review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Searches were performed in PubMed, Scopus, medRxiv, and WHO Coronavirus Database. There were no restrictions placed for searches based on date. Papers that were written in English, included at least one paediatric death from COVID-19, and described at least one risk factor for the death and/or clinical presentation of the child(ren) were eligible for inclusion. The paediatric population was defined as children aged 18 years and younger. Results Searches generated a total of 5828 papers and, of those, 75 were eligible for inclusion. There was a pooled total of 876 paediatric deaths. Significant risk factors for paediatric mortality included having co-infection of other pathogens, and at least one comorbidity;the comorbidities most frequently associated with mortality were malignancies, heart conditions, kidney disease, and genetic disorders such as Down Syndrome. The development of Paediatric Multisystem Inflammatory Syndrome (PMIS) was also consistently demonstrated to be a risk factor. Common clinical complications associated with paediatric COVID-19 infection resulting in mortality were sepsis, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). Conclusion Our review has highlighted prominent risk factors for mortality from COVID-19 amongst paediatric populations. It is vital to consider the risk factors in order to assist prognostication and clinical decisions for severe paediatric infections of COVID-19. Our findings also highlight the importance of COVID-19 vaccination in paediatric populations.
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SESSION TITLE: Medications and Pulmonary Rehabilitation in COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: JAK-antagonists and IL-6 inhibitors are immunomodulators indicated for inflammatory pathologies. With the COVID pandemic, these drugs have been utilized in management of hospitalized patients with SARS-CoV-2. Selection between the two drug classes has been attributed to availability and physician comfort. No existing comparative randomized trial to date. METHODS: We performed a systematic review and network meta-analysis using PRISMA guidelines. Randomized controlled trials evaluating various IL-6 inhibitors and JAK-antagonists were included. Outcomes were 28-day mortality and progression, defined as advancement to mechanical ventilation or ECMO. Subgroup analysis of concomitant steroid and remdesivir usage was also analyzed. P-scores were used to rank treatment groups in class and drug specific classifications. RESULTS: We identified 33 RCTs with 13,680 patients that met our selection criteria. Our analysis revealed that IL-6 inhibitor versus JAK antagonists, IL-6 was associated with greater odds of mortality (OR = 1.23 (1.13, 1.34), p = 0.01). This finding was also evident in the subgroup receiving concomitant steroids and remdesivir (OR = 1.41 (1.00, 2.00), p = 0.049) but no significant differences observed for the outcome of progression in this group. Baricitinib is associated with a significant 30% reduction in 28-day mortality compared to Tocilizamab CONCLUSIONS: JAK-a vs control and IL-6 inhibitors vs control exhibit mortality reducation but JAKs did so at a greater rate. Similarly, for drug specific comparisons, Baricitinib reduced mortality by the greatest amount. Only IL-6 inhibitors seemed to have a significant effect on preventing progression. Siltuximab and Tocilizumab were both effective against control but Tocilizumab reduced progression the best. As a secondary goal, a sub-group analysis on concomitant steroid and Remdesivir usage demonstrated that for drug specific comparisons, Baricitinib performed better for reducing mortality & Tocilizumab continued to be the most effective in preventing progression. However, with Remdesivir and steroids, there was no significant difference between Baricitinib and Tocilizumab in decreasing mortality. This is contrary to the findings without steroids. CLINICAL IMPLICATIONS: We hope to use this data to help clinical decision making between JAK-a and IL-6 inhibitors which are currently being used interchangeably for the management of COVID-19 in hospitalized patients. Through our study results and analysis, we recommend that Baricitinib be used to decrease mortality rates and disease progression for the treatment of COVID-19 with concomitant therapy corticosteroids and Remdesivir. Moving forward with this data, we aim to help restructure COVID-19 treatment algorithms regarding IL-6 and JAK antagonists. DISCLOSURES: No relevant relationships by Monica Bhagavan No relevant relationships by rukhsaar khanam No relevant relationships by Anant Naik No relevant relationships by Aashka Shah
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The front-line health care workers faced many challenges and risks during this COVID-19 pandemic. The HCWs has a direct effect and carried a major burden and consequences in the control of this virus. Apart from physical stress the HCW suffering from psychological complications. This systemic review highlights the adverse mental health outcomes and other identifiable risk factors that affect their psychological behaviour during this COVID-19 pandemic. In this review, three databases were reviewed in different time points and literature have done according to WHO guidelines and PRISMA guidelines. In this review, we included various observational, experimental, and published articles that reported the mental health or psychological affects of the COVID-19 pandemic on HCWs. This study indicates that the COVID 19 pandemic has a potential effect on front-line HCWs in their psychological well-being. The data obtained from 24 studies in this review mainly from HCWs working at urban hospitals in China. Till now there is no evidence comparison with primary care workers. Whereas nurses are at high risk of adverse mental health outcomes compared to other health care workers. Other factors like gender, socioeconomic factors, underlying illness, lack of systemic support were the risk factors of adverse mental health outcomes. Furthermore, it is evident that PPE, exposure, workplace setting, testing have an impact on HCWs with COVID 19 infection and affect their mental health outcomes. It was observed that the maximum number of HCWs reported this COVID 19 infection during the first six months of the pandemic. The prevalence of hospitalization is 15% and with psychological problems of 1.5%. Still, extensive data is needed to observe the mental health problems among HCWs.
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Introduction COVID-19 is a global pandemic caused by the SARS-CoV-2 virus. Although most COVID-19 cases are asymptomatic or mild, a significant number of patients experienced adverse outcomes. In addition, studies have shown that cardiac abnormalities are associated with increased mortality in hospitalised patients with COVID-19. This finding sets a precedent for the potential use of ECG tracing as an indicator of patient mortality and morbidity. This study aims to determine associations between the 12-lead ECG findings and various clinical outcomes of hospitalised patients with COVID-19, measured as incidence of endotracheal intubation, intensive care unit (ICU) admission and mortality rate. Methods and analysis An electronic literature search will identify all potentially relevant articles using specific databases and websites. The search will be limited to studies published from December 2019 to May 2021. In addition, studies will include hospitalised patients with COVID-19 with normal and abnormal 12-lead ECG findings assessed for clinical outcomes, including the incidence of endotracheal intubation, ICU admission and mortality rate. The risk of bias in individual studies will be evaluated using the Quality in Prognostic Studies tool or the Cochrane risk of bias tool. A meta-analysis will be conducted if at least two studies indicate a prognostic factor's effect. Moreover, subgroup and sensitivity analyses will be performed accordingly to address heterogeneity. Reporting the review results will comply with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The quality of evidence generated will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation system. Ethics and dissemination This study has been exempted from ethics review. There will be no patient or public involvement in this study. Furthermore, the findings will be disseminated via conferences, seminars, symposia and congresses on top of peer-reviewed journals. PROSPERO registration number CRD42021257155.