Outcomes of COVID-19 manuscripts submitted to the Canadian Journal of Anesthesia: a retrospective audit of author gender and person of colour status.

PURPOSE: We aimed to evaluate the representation of women and persons of colour (POC) authors of COVID-19 manuscripts submitted to, accepted in, and rejected from the Journal and to evaluate trends in their representation during the pandemic. METHODS: All COVID-19 manuscripts submitted to the Journal between 1 February 2020 and 30 April 2021 were included. Manuscript data were retrieved from Editorial Manager, and gender and POC status were obtained through: 1) e-mail communication with corresponding authors; 2) e-mail queries to other coauthors; 3) NamSor software, and 4) Internet searches. The data were described using percentages and summary statistics. A two-sample test of proportions was used for comparisons and trends were analyzed with linear regression. RESULTS: We identified 314 manuscripts (1,555 authors), 95 (461 authors) of which were accepted for publication. Of all authors, 515 (33%) were women, and women were the lead and senior authors of 101 (32%) and 69 (23%) manuscripts, respectively. There were no differences in women's representation as authors between accepted and rejected manuscripts. Overall, 923/1,555 (59%) authors were identified as POC, with a significantly lower proportion of POC authors among accepted vs rejected manuscripts (41%, 188/461 vs 67%, 735/1,094; difference, -26%; 95% CI, -32 to -21; P < 0.001). We did not observe significant trends in the proportion of women and POC authors over the study period. CONCLUSION: The proportion of women authors of COVID-19 manuscripts was lower than men's representation. Further research is required to determine the factors that account for the higher proportion of POC authors across rejected manuscripts.

RéSUMé: OBJECTIF: Nous avions pour objectif d'évaluer la représentation des femmes et des personnes de couleur ayant rédigé des manuscrits portant sur la COVID-19 soumis, acceptés et rejetés au Journal et d'évaluer les tendances concernant leur représentation pendant la pandémie. MéTHODE: Tous les manuscrits portant sur la COVID-19 soumis au Journal entre le 1er février 2020 et le 30 avril 2021 ont été inclus. Les données des manuscrits ont été extraites de la plateforme de gestion des manuscrits Editorial Manager, et le sexe et le statut de personne de couleur ont été obtenus par : 1) la communication par courrier électronique avec les auteurs et autrices correspondant·es; 2) des requêtes par courrier électronique envoyées à d'autres coautrices et coauteurs; 3) le logiciel NamSor, et 4) des recherches sur Internet. Les données ont été décrites à l'aide de pourcentages et de statistiques sommaires. Un test de proportions à deux échantillons a été utilisé pour les comparaisons et les tendances ont été analysées par régression linéaire. RéSULTATS: Nous avons identifié 314 manuscrits (1555 auteurs et autrices), dont 95 (461 autrices et auteurs) ont été acceptés pour publication. Parmi tou·tes les auteurs/autrices, 515 (33 %) étaient des femmes, et les femmes étaient les autrices principales et senior de 101 (32 %) et 69 (23 %) manuscrits, respectivement. Il n'y avait aucune différence dans la représentation des femmes en tant qu'autrices entre les manuscrits acceptés et rejetés. Dans l'ensemble, 923/1555 (59 %) auteurs et autrices ont été identifié·es comme étant des personnes de couleur, avec une proportion significativement plus faible d'autrices et d'auteurs de couleur parmi les manuscrits acceptés vs rejetés (41 %, 188/461 vs 67 %, 735/1094; différence, -26 %; IC 95 %, -32 à -21; P < 0,001). Nous n'avons pas observé de tendances significatives dans la proportion d'auteurs et d'autrices femmes et de couleur au cours de la période à l'étude. CONCLUSION: La proportion de femmes autrices de manuscrits sur la COVID-19 était inférieure à celle des hommes. D'autres recherches sont nécessaires pour déterminer les facteurs qui expliquent la plus grande proportion d'autrices et d'auteurs de couleur parmi les manuscrits rejetés.

Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis.

The COVID-19 pandemic and its accompanying infection control measures introduced sudden and significant disruptions to the lives of children and adolescents around the world. Given the potential for negative impacts on the mental health of youths as a result of these changes, we conducted a systematic review and meta-analysis to examine the prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances in children and adolescents during the pandemic. We searched major literature databases for relevant cross-sectional or longitudinal studies that included primary and secondary school students or children and adolescents ≤18 years of age. Prevalence values were extracted, logit-transformed, and pooled. Based on 191 included studies with 1,389,447 children and adolescents, we found the pooled prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances to be 31%, 31%, and 42%, respectively. Age, grade levels, education levels, gender, geographical regions, and electronics use were correlated with the prevalence of mental health symptoms. The prevalence of mental health symptoms also increased with time, although signs of recovery and stabilization were also observed. Overall, the results from this review demonstrate the need for increased mental health research, monitoring, and intervention for children and adolescents during the current and future pandemics.

Differential efficacy and safety of anti-SARS-CoV-2 antibody therapies for the management of COVID-19: a systematic review and network meta-analysis.

PURPOSE: To assess and compare the relative efficacy and safety of anti-SARS-CoV-2 antibody regimens for COVID-19. METHODS: This systematic review and random-effects network meta-analysis was conducted according to PRISMA-NMA. Literature searches were conducted across MEDLINE, EMBASE, PubMed, Web of Science, CENTRAL, and CNKI up to February 20th, 2022. Interventions were ranked using P scores. RESULTS: Fifty-five RCTs (N = 45,005) were included in the review. Bamlanivimab + etesevimab (OR 0.13, 95% CI 0.02-0.77) was associated with a significant reduction in mortality compared to standard of care/placebo. Casirivimab + imdevimab reduced mortality (OR 0.67, 95% CI 0.50-0.91) in baseline seronegative patients only. Four different regimens led to a significant decrease in the incidence of hospitalization compared to standard of care/placebo with sotrovimab ranking first in terms of efficacy (OR 0.20, 95% CI 0.08-0.48). No treatment improved incidence of mechanical ventilation, duration of hospital/ICU stay, and time to viral clearance. Convalescent plasma and anti-COVID IVIg both led to a significant increase in adverse events compared to standard of care/placebo, but no treatment increased the odds of serious adverse events. CONCLUSION: Anti-SARS-CoV-2 mAbs are safe, and could be effective in improving mortality and incidence of hospitalization. Convalescent plasma and anti-COVID IVIg were not efficacious and could increase odds of adverse events. Future trials should further examine the effect of baseline seronegativity, disease severity, patient risk factors, and SARS-CoV-2 strain variation on the efficacy of these regimes. REGISTRATION: PROSPERO-CRD42021289903.

Efficacy and safety of selective serotonin reuptake inhibitors in COVID-19 management: a systematic review and meta-analysis.

BACKGROUND: The efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of acute COVID-19 is still under investigation, with conflicting results reported from randomized controlled trials (RCTs). Different dosing regimens may have contributed to the contradictory findings. OBJECTIVES: To evaluate the efficacy and safety of SSRIs and the effect of different dosing regimens on the treatment of acute COVID-19. DATA SOURCES: Seven databases were searched from January 2020 to December 2022. Trial registries, previous reviews, and preprint servers were hand-searched. STUDY ELIGIBILITY CRITERIA: RCTs and observational studies with no language restrictions. PARTICIPANTS: COVID-19 inpatients/outpatients. INTERVENTIONS: SSRIs prescribed after diagnosis were compared against a placebo or standard of care. ASSESSMENT OF RISK OF BIAS: Risk of bias was rated using the revised Cochrane Risk of Bias Tool for Randomized Trials version 2.0 and Risk of Bias in Non-Randomized Studies of Interventions. METHODS OF DATA SYNTHESIS: Outcomes were mortality, hospitalization, composite of hospitalization/emergency room visits, hypoxemia, requirement for supplemental oxygen, ventilator support, and serious adverse events. RCT data were pooled in random-effects meta-analyses. Observational findings were narratively described. Subgroup analyses were performed on the basis of SSRI dose, and sensitivity analyses were performed excluding studies with a high risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the quality of evidence. RESULTS: Six RCTs (N = 4197) and five observational studies (N = 1156) were included. Meta-analyses associated fluvoxamine with reduced mortality (risk ratio, 0.72; 95% CI, 0.63-0.82) and hospitalization (risk ratio, 0.79; 95% CI, 0.64-0.99) on the basis of moderate quality of evidence. Medium-dose fluvoxamine (100 mg twice a day) was associated with reduced mortality, hospitalization, and composite of hospitalization/emergency room visits, but low-dose fluvoxamine (50 mg twice a day) was not. Fluvoxamine was not associated with increased serious adverse events. Observational studies support the use of fluvoxamine and highlight fluoxetine as a possible alternative to SSRIs for the treatment of COVID-19. DISCUSSION: Fluvoxamine remains a candidate pharmacotherapy for treating COVID-19 in outpatients. Medium-dose fluvoxamine may be preferable over low-dose fluvoxamine.

Efficacy and safety of corticosteroid regimens for the treatment of hospitalized COVID-19 patients: a meta-analysis.

Aim: To evaluate the efficacy and safety of corticosteroids for treating hospitalized COVID-19 patients. Materials & methods: Efficacy outcomes included time to negative SARS-CoV-2 tests, length of stay, duration and incidence of intensive unit care stay, incidence of mortality and duration and incidence of mechanical ventilation. Safety outcomes included the incidence of adverse events and severe adverse events, incidence of hyperglycemia and incidence of nosocomial infections. Results: Ninety-five randomized controlled trials (RCTs) and observational studies (n = 42,205) were included. Corticosteroids were associated with increased length of stay (based on RCT only), increased time to negative tests, decreased length of mechanical ventilation and increased odds of hyperglycemia. Conclusion: Corticosteroids should be considered in patients requiring mechanical ventilation, and glycemic monitoring may be needed when administering corticosteroids.

Efficacy of lopinavir–ritonavir combination therapy for the treatment of hospitalized COVID-19 patients: a meta-analysis

Aim: To evaluate the efficacy and safety of lopinavir–ritonavir (LPV/r) therapy in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in meta-analyses. Primary outcomes were length of stay, time for SARS-CoV-2 test conversion, mortality, incidence of mechanical ventilation, time to body temperature normalization and incidence of adverse events. Results: Twenty-four studies (n = 10,718) were included. LPV/r demonstrated no significant benefit over the control groups in all efficacy outcomes. The use of LPV/r was associated with a significant increase in the odds of adverse events. Conclusion: Given the lack of efficacy and increased incidence of adverse events, the clinical use of LPV/r in hospitalized COVID-19 patients is not recommended.

Efficacy of lopinavir-ritonavir combination therapy for the treatment of hospitalized COVID-19 patients: a meta-analysis.

Aim: To evaluate the efficacy and safety of lopinavir-ritonavir (LPV/r) therapy in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in meta-analyses. Primary outcomes were length of stay, time for SARS-CoV-2 test conversion, mortality, incidence of mechanical ventilation, time to body temperature normalization and incidence of adverse events. Results: Twenty-four studies (n = 10,718) were included. LPV/r demonstrated no significant benefit over the control groups in all efficacy outcomes. The use of LPV/r was associated with a significant increase in the odds of adverse events. Conclusion: Given the lack of efficacy and increased incidence of adverse events, the clinical use of LPV/r in hospitalized COVID-19 patients is not recommended.

Efficacy of chloroquine and hydroxychloroquine for the treatment of hospitalized COVID-19 patients: a meta-analysis.

Aims: To evaluate the efficacy and safety of hydroxychloroquine/chloroquine, with or without azithromycin, in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in a random-effects meta-analysis. Primary outcomes included time to negative conversion of SARS-CoV-2 tests, length of stay, mortality, incidence of mechanical ventilation, time to normalization of body temperature, incidence of adverse events and incidence of QT prolongations. Results: Fifty-one studies (n = 61,221) were included. Hydroxychloroquine/chloroquine showed no efficacy in all primary efficacy outcomes, but was associated with increased odds of QT prolongations. Conclusion: Due to a lack of efficacy and increased odds of cardiac adverse events, hydroxychloroquine/chloroquine should not be used for treating hospitalized COVID-19 patients.