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Broad synthesis / Overview of systematic reviews

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Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study.

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Journal Heart & lung : the journal of critical care
Year 2022
Links Pubmed DOI PubMed Central

This article includes 28 Systematic reviews Systematic reviews (28 references) 9 Primary studies Primary studies (9 references)

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BACKGROUND: COVID-19 causes fatal cardiac damages. Despite many overwhelming meta-analysis related to cardiac complications following COVID-19 disease, no umbrella meta-analysis study has been conducted. OBJECTIVES: We aimed to report the summarized pooled incidences of cardiac complications in the overall, critically ill, and deceased patients, compare the cardiac complications between the severe/non-severe or deceased/non-deceased patients, and also compare poor outcomes between patients with/without acute myocardial injury (AMI). METHODS: PubMed, Scopus, web of science, Cochrane, ProQuest, Springer, Sage journals were searched before April 2021. After assessing the quality and duplicate data, data were run by the random/fixed-effect models, I2 heterogeneity index, Egger's test, and sensitivity analysis. RESULTS: After removing duplicate data, in the overall COVID-19 patients, the pooled incidence of AMI, heart failure, arrhythmia, cardiac arrest, and acute coronary syndrome (ACS) were 21%, 14%, 16%, 3.46%, and 1.3%, respectively. In the patients with severe disease, the pooled incidence of AMI and shock were 33 and 35%, respectively. Similarly, in the deceased COVID-19 patients, the pooled incidence rate of AMI and arrhythmia were 56% and 47.5%, respectively. The patients with severe disease were at higher risk of AMI (RR = 5.27) and shock (OR = 20.18) compared with the non-severe cases. Incidence of AMI was associated with transfer to the intensive care units (ICU) (RR = 2.92) and mortality (RR = 2.57, OR = 8.36), significantly. CONCLUSION: Cardiac complications were found to be increased alarmingly in COVID-19 patients. Baseline and during hospitalization checking with electrocardiography, echocardiography, and measuring of cardiac biomarkers should be applied.

Broad synthesis

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Relevant mechanisms and pathways in the transmission of SARS-CoV-2 infection

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Journal Acta otorrinolaringol. cir. cabeza cuello
Year 2021
Links DOI LILACS

This article includes 19 Primary studies Primary studies (19 references)

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Introduction: The type of betacoronavirus that causes the disease COVID-19 is called SARS-CoV-2, it has presented a rapid expansion worldwide, currently generating a public health emergency. Different causes can explain this behavior, such as the type of transmission, which has been debated, with different positions regarding the involvement of aerosol and extrapulmonary pathways. Objective: Consolidate information of the different mechanisms and transmission routes of SARS-CoV-2. Methodology: A narrative review of the literature was carried out with a systematic search in databases such as Pubmed, Embase, ScienceDirect, MEDLINE, CENTRAL and Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). With MeSH terms "Transmission", "Aerosol", "Betacoronavirus" applying inclusion and exclusion criteria, as well as critical reading with the CASPe tool, 31 articles were selected. Results: The transmission of the virus occurs by contact with drops, fomites and aerosolization, favoring air infection and its permanence even up to 8 hours, being a propagator of the disease. The transmission by blood and fecal contact, is not frequent, but in cases such as performing procedures or requiring a transfusion, are relevant and measures must be taken. Conclusions: All patients should be considered potential transmitting and both mechanical and self-induced aerosol induction should be considered, without requiring an important manipulation of the airway for virus aerosolization and transmission. The measures for the management of the environment must be considered, as well as the possibility of transmission by extrapulmonary route, such as blood and orofecal route.

Broad synthesis

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Ocular Findings in COVID-19 Patients: A Review of Direct Manifestations and Indirect Effects on the Eye.

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Journal Journal of ophthalmology
Year 2020
Links Pubmed DOI PubMed Central

This article includes 20 Primary studies Primary studies (20 references) 2 Systematic reviews Systematic reviews (2 references)

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The novel pandemic coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has challenged the medical community. While diagnostic and therapeutic efforts have been focused on respiratory complications of the disease, several ocular implications have also emerged. SARS-CoV-2 RNA has been found in tears of the infected patients, and reports suggest that the ocular surface could serve as a portal of entry and a reservoir for viral transmission. Clinically, COVID-19 has been associated with mild conjunctivitis, which can be the first and only symptom of the disease. Subtle retinal changes like hyperreflective lesions in the inner layers on optical coherence tomography (OCT), cotton-wool spots, and microhemorrhages have also been reported. In addition, COVID-19 has been associated with an increased incidence of systemic diseases like diabetes mellitus and Kawasaki disease, which are particularly relevant for ophthalmologists due to their potentially severe ocular manifestations. Several treatment strategies are currently under investigation for COVID-19, but none of them have been proved to be safe and effective to date. Intensive care unit patients, due to risk factors like invasive mechanical ventilation, prone position, and multiresistant bacterial exposure, may develop ocular complications like ocular surface disorders, secondary infections, and less frequently acute ischemic optic neuropathy and intraocular pressure elevation. Among the array of drugs that have shown positive results, the use of hydroxychloroquine and chloroquine has raised a concern due to their well-known retinal toxic effects. However, the risk of retinal toxicity with short-term high-dose use of antimalarials is still unknown. Ocular side effects have also been reported with other investigational drugs like lopinavir-ritonavir, interferons, and interleukin-1 and interleukin-6 inhibitors. The aim of this review was to summarize ophthalmological implications of SARS-CoV-2 infection to serve as a reference for eye care and other physicians for prompt diagnosis and management.

Broad synthesis / Scoping review

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Efficacy and safety of traditional Chinese medicine in COVID-19: a scoping review

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Journal Revista Internacional De Acupuntura
Year 2020
Links DOI

This article includes 94 Primary studies Primary studies (94 references) 2 Systematic reviews Systematic reviews (2 references)

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INTRODUCTION: In the absence of a vaccine or specific treatment to control the current pandemic, it is necessary to continue investigating potential therapeutic agents against COVID-19 Traditional Chinese medicine (TCM) has been used in the treatment of patients with SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome coronavirus), and may have a role in the prevention, treatment, or rehabilitation of patients with COVID-19 OBJECTIVE: Describe the current state of the scientific literature published until May 17, 2020 about TCM in the management of patients with COVID-19 Material and METHODS: Scoping review that included PubMed, Embase, Scopus and 18 databases of the World Health Organization International Registry of Clinical Trials Platforms Empirical and theoretical publications in English and Spanish were included RESULTS: A total of 35 documents and 93 clinical trial records (n = 128) were included;46 clinical trials evaluated decoctions, capsules, granules, injections, and oral solutions based on herbal agents The documents are narrative reviews (n = 9), letters to the editor (n = 6), editorials (n = 3), systematic reviews (n = 4), in silico studies (n = 4), comments (n = 2), case series (n = 2), and position articles as guidelines to clinical practice (n = 2), clinical practice guidelines (n = 1), in vitro studies (n = 1), and opinion article (n = 1) CONCLUSIONS: Only two case series studies using herbal remedies reported benefits for patients with mild and severe SARS-CoV-2 pneumonia There are 78 ongoing randomized controlled trials that will soon provide evidence on the efficacy and safety of MTC in patients with COVID-19

Broad synthesis / Scoping review

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Identifying common baseline clinical features of COVID-19: a scoping review

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Journal BMJ open
Year 2020
Links Pubmed DOI PubMed Central

This article includes 56 Primary studies Primary studies (56 references)

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OBJECTIVES: Our research question was: what are the most frequent baseline clinical characteristics in adult patients with COVID-19? Our major aim was to identify common baseline clinical features that could help recognise adult patients at high risk of having COVID-19. DESIGN: We conducted a scoping review of all the evidence available at LitCovid, until 23 March 2020. SETTING: Studies conducted in any setting and any country were included. PARTICIPANTS: Studies had to report the prevalence of sociodemographic characteristics, symptoms and comorbidities specifically in adults with a diagnosis of infection by SARS-CoV-2. RESULTS: In total, 1572 publications were published on LitCovid. We have included 56 articles in our analysis, with 89% conducted in China and 75% containing inpatients. Three studies were conducted in North America and one in Europe. Participants' age ranged from 28 to 70 years, with balanced gender distribution. The proportion of asymptomatic cases were from 2% to 79%. The most common reported symptoms were fever (4%-99%), cough (4%-92%), dyspnoea/shortness of breath (1%-90%), fatigue (4%-89%), myalgia (3%-65%) and pharyngalgia (2%-61%), while regarding comorbidities, we found cardiovascular disease (1%-40%), hypertension (0%-40%) and cerebrovascular disease (1%-40%). Such heterogeneity impaired the conduction of meta-analysis. CONCLUSIONS: The infection by COVID-19 seems to affect people in a very diverse manner and with different characteristics. With the available data, it is not possible to clearly identify those at higher risk of being infected with this condition. Furthermore, the evidence from countries other than China is, at the moment, too scarce.

Broad synthesis / Scoping review

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Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis.

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Journal Journal of clinical medicine
Year 2020
Links Pubmed DOI PubMed Central

This article includes 59 Primary studies Primary studies (59 references)

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A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%-99%; n = 4410), cough (61%, 95% CI 39%-81%; n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%-55%; n = 3778), dyspnea (26%, 95% CI 12%-41%; n = 3700), headache in 12% (95% CI 4%-23%, n = 3598 patients), sore throat in 10% (95% CI 5%-17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%-17%, n = 1744). Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 × 109/L, 95% CI 0.83-1.03 × 109/L, n = 464) and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54-45.91 mg/dL; n = 1637). Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%-1.0%; n = 53,631). Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.

Broad synthesis

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Sex-Bias in COVID-19: A Meta-Analysis and Review of Sex Differences in Disease and Immunity

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Pre-print SSRN
Year 2020
Links DOI https://ssrn.com/abstract=3572881

This article includes 2 Primary studies Primary studies (2 references)

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BACKGROUND: There have been anecdotal reports of a male sex bias in COVID-19. We aimed to perform a meta-analysis of available case reports to investigate whether there was a difference in the proportion of males and females infected with COVID-19 and whether sex associated with a difference in risk of ITU admission or death. METHODS: We performed a meta-analysis of 29 reports. An internet search was performed for reports in any language that included sex as a variable when describing case numbers, ITU admissions or death between 01.01.20-30.03.20. Reports were excluded if they did not reported the sex difference in overall case numbers or where there was possible duplication. Summary level data were extracted from reports. Meta-analyses were used to assess the proportion of males and females in total numbers of confirmed cases, to estimate odds ratios (ORs) with 95% CI associated with sex for ITU admission and death based on pooled average effect measures that were weighted according to the size and precision of each report. Fixed and random effects models were estimated. FINDINGS: 29 studies were eligible with a total of 206,128 cases. The proportion of male cases with COVID-19 was 0.52 (95% CI=0.50,0.53, p=0.12 for random effects model). Male sex associated with an increased risk of ITU admission (OR=2.50, 95% CI=2.25,2.78; 7.3e-64 for random effects model; n=43,075). Male sex associated with an increased risk of mortality (OR=1.60, 95% CI=1.41, 1.82, p=7.4e-13 for random effects model; n=170,983).

Broad synthesis

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Tobacco smoking and COVID-19 pandemic: old and new issues. A summary of the evidence from the scientific literature.

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Journal Acta bio-medica : Atenei Parmensis
Year 2020
Links Pubmed DOI PubMed Central

This article includes 11 Primary studies Primary studies (11 references) 7 Systematic reviews Systematic reviews (7 references)

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INTRODUCTION: COVID-19 pandemic burst onto the international scene as a new disease not affecting patients uniformly; hence it has risen many questions yet to be clarified. The aim of this study was to outline the main issues that led tobacco smoking being discussed as a potential risk factor associated with COVID-19. METHODS: articles from MEDLINE and pre-prints published from January to April 2020 were identified. RESULTS: data from China showed that men had more severe outcomes of COVID-19 than women. Since smoking prevalence is very high among Chinese men in comparison to women, it was hypothesized that smoking could be a risk factor for poor prognosis. This was also supported by the higher prevalence of comorbidities, many of which are tobacco-related diseases, in patients with severe COVID-19, who were also more likely to have a smoking history. A meta-analysis confirmed these results reporting an OR=2.25 (95% CI: 1.49-3.39) for developing severe Covid-19 among patients with a smoking history. Some authors, noticing that reported smoking prevalence among hospitalized patients was substantially below smoking prevalence in the corresponding populations, speculated a protective role of nicotine. However, it is likely that low prevalence among hospitalized patients are partially due to many smokers misclassified as nonsmokers. Tobacco smoking seems to cause a dose-dependent upregulation of the angiotensin-converting- enzyme-2 (ACE2), the virus cellular entry receptor, which could explain the higher risk of severe COVID-19 in smokers. CONCLUSIONS: There is need for further independent studies to clarify the role of smoking on COVID-19 incidence, progression and mortality.

Broad synthesis

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Healthcare workers issues and COVID-19 pandemic: A review

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Journal Gazi Med. J.
Year 2020
Links DOI

This article includes 13 Primary studies Primary studies (13 references)

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Broad synthesis

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Pharmacological therapies for patients with human coronavirus infections: a rapid systematic review

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Journal Ciênc. Saúde Colet
Year 2020
Links LILACS

This article includes 17 Primary studies Primary studies (17 references)

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Abstract This work aimed to evaluate the effects of drug therapies for coronavirus infections. Rapid systematic review with search in the MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov and International Clinical Trials Registry Platform databases. Thirty-six studies evaluating alternative drugs against SARS, SARS-CoV-2 and MERS were included. Most of the included studies were conducted in China with an observational design for the treatment of COVID-19. The most studied treatments were with antimalarials and antivirals. In antimalarial, the meta-analysis of two studies with 180 participants did not identify the benefit of hydroxychloroquine concerning the negative viral load via real-time polymerase chain reaction, and the use of antivirals compared to standard care was similar regarding outcomes. The available scientific evidence is preliminary and of low methodological quality, which suggests caution when interpreting its results. Research that evaluates comparative efficacy in randomized, controlled clinical trials, with adequate follow-up time and with the methods properly disclosed and subject to scientific peer review is required. A periodic update of this review is recommended.