COVID-19 associated with cryptococcosis: a scoping review.

Background: There is growing evidence of fungal infections associated with COVID-19. The development of cryptococcosis in these patients has been infrequently reported. However, it can be life-threatening. Objective: To identify cases of COVID-19 patients who developed cryptococcosis and to compare baseline characteristics and management between those who survived and those who died. Methods: We conducted a scoping review using PubMed, Scopus, Web of Science, and Embase to identify studies that reported patients with COVID-19 and cryptococcosis. No language restriction was applied. Single case reports, case series, and original articles were included. It is important to note that 'n' refers to the total number of individuals with the specified variable. Results: A total of 58 studies were included. Among these studies, 51 included individual patient data, detailing information on a total of 65 patients, whereas eight studies reported the proportion of cryptococcosis in COVID-19 patients. One study provided both individual and aggregate case information. From individual patient data, the majority were male (73.9%; n = 48) with a median age of 60 years (range: 53-70). Severe COVID-19 and multiple comorbidities, led by arterial hypertension and diabetes mellitus, were frequently reported, but few had classic immunosuppression factors. On the other hand, HIV status, either negative or positive, was reported in just over half of the patients (61.5%; n = 40). Most were admitted to the intensive care unit (ICU) (58.5%; n = 31), received mechanical ventilation (MV) (50.0%; n = 26), and developed disseminated cryptococcosis (55.4%; n = 36). Secondary infection, mainly bacterial, was reported in 19 patients (29.2%). Mortality was 47.7% (n = 31). Of the studies that reported the proportion of cryptococcosis in COVID-19 cases, the majority were descriptive studies published as conference abstracts. Conclusion: Cryptococcosis in COVID-19 patients has been reported more frequently. However, it is still not as common as other fungal infections associated with COVID-19. Few patients have some classic immunosuppression factors. The factors associated with mortality were male sex, age, ICU admission, MV, secondary infections, and lymphopenia.

Prevalence of and factors associated with childhood anaemia in remote villages of the Peruvian Amazon: a cross-sectional study and geospatial analysis.

BACKGROUND: Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages. METHODS: To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1-9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran's I and Ripley's K function. RESULTS: Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking water was surface water (prevalence ratio [PR] 1.26 [95% CI 1.14 to 1.40], p<0.001) and who were in the lowest SES tercile (PR 1.16 [95% CI 1.02 to 1.32], p=0.021). Moderate-or-worse anaemia was more common among boys (PR 1.32 [95% CI 1.09 to 1.60], p=0.005). No evidence of geospatial clustering was found. CONCLUSIONS: Remote villages of the Amazon would benefit from interventions for childhood anaemia and the poorest households would have the most to gain. Integrating anaemia screening into neglected tropical diseases surveys is an opportunity to use public health resources more efficiently.

Association of vision impairment and blindness with socioeconomic status in adults 50 years and older from Alto Amazonas, Peru.

OBJECTIVE: To determine the relationship between socioeconomic status (SES) and visual impairment (VI) or blindness in the rural Peruvian Amazon, hypothesizing that higher SES would have a protective effect on the odds of VI or blindness. METHODS: In this cross-sectional study of 16 rural communities in the Peruvian Amazon, consenting adults aged ≥ 50 years were recruited from ~30 randomly selected households per village. Each household was administered a questionnaire and had a SES score constructed using principal components analysis. Blindness and VI were determined using a ministry of health 3-meter visual acuity card. RESULTS: Overall, 207 adults aged ≥ 50 were eligible; 146 (70.5%) completed visual acuity screening and answered the questionnaire. Of those 146 participants who completed presenting visual acuity screening, 57 (39.0%, 95% CI 30.2-47.1) were classified as visually impaired and 6 (4.1%, 95% CI 0.9-7.3) as blind. Belonging to the highest SES tercile had a protective effect on VI or blindness (OR 0.29, 95% CI 0.09 to 0.91, p = 0.034), with a linear trend across decreasing levels of SES (p = 0.019). This observed effect remained significant regardless of how SES groups were assigned. CONCLUSION: Belonging to a higher SES group resulted in a lower odds of VI or blindness compared to those in the lowest SES group. The observation of a dose response provides confidence in the observed association, but causality remains unclear. Blindness prevention programs could maximize impact by designing activities that specifically target people with lower SES.

Stroke imaging modality for endovascular therapy in the extended window: systematic review and meta-analysis.

BACKGROUND: In anterior circulation large vessel occlusion (LVO) in the extended time window, the guidelines recommend advanced imaging (ADVI) to select patients for endovascular therapy (EVT). However, questions remain regarding its availability and applicability in the real world. It is unclear whether an approach to the extended window EVT that does not use ADVI would be equivalent. METHODS: In April 2022, a literature search was performed to identified randomized controlled trials (RCT) and observational studies describing 90-day outcomes. We performed a meta-analysis of the proportion of aggregate using a random effect to estimate rates of functional independence, defined as modified Rankin Scale (mRS) score ≤2 at 90 days, mean mRS, mortality and symptomatic intracranial hemorrhage (sICH) stratified by imaging modality. RESULTS: Four RCTs and 28 observational studies were included. The pooled proportion of functional independence among patients selected by ADVI was 44% (95% CI 39% to 48%; I2=80%) and 48% (95% CI 41% to 55%; I2=75%) with non-contrast CT/CT angiography (NCCT/CTA) (p=0.36). Mean mRS with ADVI was 2.88 (95% CI 2.36 to 3.41; I2=0.0%) and 2.79 (95% CI 2.31 to 3.27; I2=0.0%) with NCCT (p=0.79). Mortality in patients selected by ADVI was 13% (95% CI 10% to 17%; I2=81%) and 16% (95% CI 12% to 22%; I2=69%) with NCCT (p=0.29). sICH with ADVI was 4% (95% CI 3% to 7%; I2=73%) and 6% with NCCT/CTA (95% CI 4% to 8%; I2=6%, p=0.27). CONCLUSIONS: Our study suggests that, in anterior circulation LVO, the rates of functional independence may be similar when patients are selected using ADVI or NCCT for EVT in the extended time window. A simplified triage protocol does not seem to increase mortality or sICH. PROTOCOL REGISTRATION NUMBER: (PROSPERO ID: CRD42021236092).

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score.

Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

Characteristics and conflicting recommendations of clinical practice guidelines for COVID-19 management in children: A scoping review.

BACKGROUND: Clinical practice guidelines (CPGs) are statements that should be rigorously developed to guide clinicians' decision-making. However, given the scarce evidence for certain vulnerable groups like children, CPGs' recommendations formulation could be challenging. METHODS: We conducted a scoping review of CPGs for COVID-19 management in children. Documents were included if they claimed to be a "clinical practice guideline", published between January and October 2021, and described the process followed to issue their recommendations. We assessed the quality using the "Appraisal of Guidelines for Research and Evaluation II" (AGREE-II) and described how the recommendations were reached. RESULTS: We found five CPGs that fulfilled our inclusion criteria. The median score on the overall AGREE-II evaluation was 61% (range: 49%-72%), and the score on the third domain referred to the rigor of methodological development was 52% (range: 25%-88%). Recommendations for remdesivir, tocilizumab, and intravenous immunoglobulin were heterogeneous across CPGs (in favor, against, no recommendation), as well as the methodologies used to present the evidence, perform the benefits/harms balance, and issue the recommendation. CONCLUSIONS: Heterogeneous recommendations and justifications across CPGs were found in the three assessed topics. Future CPGs should describe in detail their evidence-to-decision process to issue reliable and transparent recommendations.

Drug reaction with eosinophilia and systemic symptoms (DRESS) induced by phenytoin re-exposure: case report and systematic review.

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse and severe skin reaction due to patients' susceptibility to medications, including phenytoin. The objective was to explore the characteristics of patients with DRESS secondary to phenytoin through a systematic review.Methods: We describe a case of DRESS syndrome secondary to phenytoin in a patient with previous exposure to this drug. A systematic literature review of cases of phenytoin-induced DRESS syndrome was conducted in PubMed/Medline, Scopus and Web of Science until May 2019.Results: 37 articles describing 40 cases of DRESS syndrome were selected. Mean age of onset was 33 years, without gender difference. Symptoms started between two and 90 days (mean ± 23 days). Liver and respiratory tract were most frequently involved, and eosinophilia was a common feature, it was presented with an average value of 9.7%. A discussion of the case and qualitative synthesis of the evidence reported in the literature were made.Conclusion: Patients and presentation characteristics will mostly be presented according to the criteria used by RegiSCAR. It is recommended to consider adequate monitoring of adverse reactions to antiepileptic drugs such as DRESS syndrome, given its severity and high lethality.

Research Trends and Collaboration Patterns on Polymyxin Resistance: A Bibliometric Analysis (2010-2019).

Background: Antimicrobial resistance is a serious public health problem that has become a global threat. Special attention should be given to polymyxins (polymyxin B and colistin) which, since their reintroduction into clinical practice, are considered "last resort" drugs. The objective of this study is to perform a bibliometric analysis of scientific research on polymyxin resistance. Methods: Scopus was used to retrieve documents relevant to polymyxin resistance from 2010 to 2019. Data was exported to Microsoft Excel for table presentation. SciVal was used for volume and citation analysis as well as collaboration patterns. Also, we extracted data regarding the top documents, authors, countries, institutions, and the metrics of journals. VantagePoint and VOSviewer were used for geographical distribution of worldwide research and keyword co-occurrence analysis, respectively. Results: A total of 1,409 documents were retrieved. The retrieved documents received 25.0 citations per document. Articles (73.88%) and letters (18.09%) were the most frequent types of documents. During 2010-2019, there was a significant growth in publications (p-value < 0.001). The received citations were 35,209 with a peak in 2016 (11,250 citations). China and the United States led the scientific production with 299 (21.2%) and 238 (16.9%) publications, respectively. Little or no contribution came from central Asia, Sub-Saharan Africa, and Latin America. Chinese institutions have caused the greatest impact, with University of Zhejiang (China) being the most prolific institution on the subject (88 documents). In terms of the most productive journals, Antimicrobial Agents and Chemotherapy ranked first with 196 (13.9%) documents. Most of the documents were published in quartile one journals and only had national collaboration (43.2%). Analysis of keyword co-occurrence revealed that research on polymyxin resistance during the last decade has focused on its relationship with public health, pharmacology, and genetics. Conclusion: The number of documents on polymyxin resistance has increased significantly in the recent years, with a steep growth from 2016 onwards. China and the United States led the scientific production. Most of the documents were published in high-quality journals. Greater joint efforts and more contribution from central Asia, Sub-Saharan Africa, and Latin America are still needed to tackle this global problem.

Self-medication practices to prevent or manage COVID-19: A systematic review.

BACKGROUND: Previous studies have assessed the prevalence and characteristics of self-medication in COVID-19. However, no systematic review has summarized their findings. OBJECTIVE: We conducted a systematic review to assess the prevalence of self-medication to prevent or manage COVID-19. METHODS: We used different keywords and searched studies published in PubMed, Scopus, Web of Science, Embase, two preprint repositories, Google, and Google Scholar. We included studies that reported original data and assessed self-medication to prevent or manage COVID-19. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies. RESULTS: We identified eight studies, all studies were cross-sectional, and only one detailed the question used to assess self-medication. The recall period was heterogeneous across studies. Of the eight studies, seven assessed self-medication without focusing on a specific symptom: four performed in the general population (self-medication prevalence ranged between <4% to 88.3%) and three in specific populations (range: 33.9% to 51.3%). In these seven studies, the most used medications varied widely, including antibiotics, chloroquine or hydroxychloroquine, acetaminophen, vitamins or supplements, ivermectin, and ibuprofen. The last study only assessed self-medication for fever due to COVID-19. Most studies had a risk of bias in the "representativeness of the sample" and "assessment of outcome" items of the NOS. CONCLUSIONS: Studies that assessed self-medication for COVID-19 found heterogeneous results regarding self-medication prevalence and medications used. More well-designed and adequately reported studies are warranted to assess this topic.

Cryptococcal infection of the colon in a patient without concurrent human immunodeficiency infection: a case report and literature review.

Cryptococcosis is a fungal infection that is rarely reported in patients without human immunodeficiency virus (HIV) infection, especially when the central nervous system (CNS) or pulmonary system is not involved. We report a case of isolated colonic cryptococcosis without disseminated disease in a 64-year-old immunocompetent woman without HIV infection who presented with chronic diarrhea and no episodes of fever or weight loss. The diagnosis was based on histopathology examination. Furthermore, we performed a literature review showing that few reports have been published so far and in the case of colonic cryptococcal infection, the prognosis is favorable among HIV-uninfected patients.

Colonic cryptococcosis as a rare presentation in HIV infection: a case report and review of the literature.

Colonic cryptococcal infection is unusual in people living with HIV (PLWH) and even more so without concomitant neurological compromise. Published case reports describe diarrhea and other intestinal manifestations that are often confused with systemic tuberculosis infection. We describe an Peruvian woman living with HIV on antiretroviral therapy who presented hypotensive with a 6-month history of fever and epigastric pain, in addition to episodes of sporadic diarrhea. Due to the suspicion of systemic tuberculosis, antituberculosis treatment was started. Days later, without clinical improvement, colonoscopy revealed ulcers in the transverse colon. Histopathological examination of biopsied tissue was compatible with Cryptococcus spp. She received antifungal therapy with amphotericin B and fluconazole. Despite the treatment, the patient died six days later from multiple organ failure.

Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia-Literature Review.

As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumothorax and pneumomediastinum. Recent evidence suggested that these can occur in the context of COVID-19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. We present two patients with COVID-19 pneumonia complicated by pneumomediastinum. The first patient was a 55-year-old woman who developed COVID-19 pneumonia. Her clinical course was complicated by pneumothorax and pneumomediastinum, and, unfortunately, she died 2 days following the admission. The second patient was a 31-year-old man who developed a small pneumomediastinum and was managed conservatively. He had a spontaneous resolution of the pneumomediastinum and was discharged 19 days later. None of our patients required invasive or noninvasive positive pressure ventilation. We performed a literature review of COVID-19 pneumonia cases that developed pneumothorax, pneumomediastinum, or both. The analysis showed that the latter had high mortality (60%). Thus, it is necessary to pay attention to these complications as early identification and management can reduce the associated morbidity and mortality.