scholarly journals Bacterial Co-infection among COVID-19 patient groups: an update Systematic review and Meta-analysis

2021 ◽  
pp. 100910
Author(s):  
Saber Soltani ◽  
Samireh Faramarzi ◽  
Milad Zandi ◽  
Ramin Shahbahrami ◽  
Ali Jafarpour ◽  
...  
2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Whittaker ◽  
M Abdelrazek ◽  
A Fitzpatrick ◽  
J Froud ◽  
J Kelly ◽  
...  

Abstract Aim The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS). Method A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs). Results Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis. Conclusions This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.


2019 ◽  
Vol 23 (9) ◽  
pp. 3613-3621 ◽  
Author(s):  
Anna Paola Strieder ◽  
Thaís Marchini Oliveira ◽  
Daniela Rios ◽  
Agnes Fátima Pereira Cruvinel ◽  
Thiago Cruvinel

Viruses ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 566 ◽  
Author(s):  
Angelos G. Rigopoulos ◽  
Bianca Klutt ◽  
Marios Matiakis ◽  
Athanasios Apostolou ◽  
Sophie Mavrogeni ◽  
...  

Background: Diverse viral infections have been associated with myocarditis (MC) and dilated cardiomyopathy (DCM). In this meta-analysis, we summarize the published results on the association of parvovirus B19 (B19V) genomes with human MC/DCM versus controls. Methods: n = 197 publications referring to B19V and MC or DCM were retrieved using multiple PubMed search modes. Out of these, n = 29 publications met the inclusion criteria with data from prospective analyses on >10 unselected patients presenting with MC or DCM (dataset: MA01). Data retrieved simultaneously from both controls and MC/DCM patients were available from n = 8 from these publications (dataset: MA02). Results: In the dataset MA01 B19V genomes were detected in 42.6% of the endomyocardial biopsies (EMB) in this cohort by PCR. In the dataset MA02 comprising n = 638 subjects, there was no statistically significant different rate of B19V positivity in myocardial tissues comparing controls (mean: 38.8 + 24.1%) versus the MC/DCM-patients (45.5 + 24.3%; p = 0.58). There was also no statistical difference between the positivity rate of B19V genomes in myocardial tissues of MA01 (46.0 + 19.5%) and the two patient groups of MA02 (p > 0.05). Conclusions: This systematic review reveals that the mean rate of PCR detected B19V genomes in patients presenting with MC/DCM does not differ significantly from the findings in control myocardial tissues. These data imply pathogenetically insignificant latency of B19V genomes in a proportion of myocardial tissues, both in MC-/DCM-patients and in controls. More information (i.e., replicative status, viral protein expression) is pertinent to achieve a comprehensive workup of myocardial B19V infection.


2021 ◽  
Author(s):  
Joanne S.K. Teh ◽  
Julien Coussement ◽  
Zoe C.F. Neoh ◽  
Tim Spelman ◽  
Smaro Lazarakis ◽  
...  

The objectives of this study were to assess the immunogenicity and safety of COVID-19 vaccines in patients with haematological malignancy. A systematic review and meta-analysis of clinical studies of immune responses to COVID-19 vaccination stratified by underlying malignancy and published from 1 January 2021 to 31 August 2021 was conducted using MEDLINE, EMBASE and CENTRAL. Primary outcome was the rate of seropositivity following 2 doses of COVID-19 vaccine with rates of seropositivity following 1 dose, rates of positive neutralising antibody (nAb), cellular responses and adverse events as secondary outcomes. Rates were pooled from single arm studies while rates of seropositivity were compared against the rate in healthy controls for comparator studies using a random effects model and expressed as a pooled odds ratio with 95% confidence intervals. Forty-four studies (16 mixed group, 28 disease specific) with 7064 patients were included in the analysis (2331 following first dose, 4733 following second dose). Overall seropositivity rates were 61-67% following 2 doses and 37-51% following 1 dose of COVID-19 vaccine. The lowest seropositivity rate was 51% in CLL patients and was highest in patients with acute leukaemia (93%). Following 1 dose, nAb and cellular response rates were 18-63% and 33-86% respectively. Active treatment, ongoing or recent treatment with targeted and CD-20 monoclonal antibody therapies within 12 months was associated with poor COVID-19 vaccine immune responses. New approaches to prevention are urgently required to reduce COVID-19 infection morbidity and mortality in high-risk patient groups that respond poorly to COVID-19 vaccination.


2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S217-S217
Author(s):  
Kira Griffiths ◽  
James MacCabe ◽  
Alice Egerton

Abstract Background Approximately one third of patients with schizophrenia display suboptimal response to two trials of non-clozapine antipsychotic medication and may be termed treatment resistant. Clozapine is the only licensed pharmacotherapy for treatment resistant schizophrenia, but response to clozapine is variable and can only be determined through a trial of treatment. Understanding demographic and clinical sources of varied response to clozapine may be useful in the optimisation of clinical treatment algorithms and stratification of patient groups for clinical trials of early use of clozapine. Methods We systematically reviewed literature to investigate clinical and demographic factors associated with variation in clozapine response. Articles were eligible for review if they reported differences in clozapine response as a function of baseline variables within patient samples of schizophrenia spectrum disorders. In a second step, a random-effects meta-analysis to study group mean differences in age, age of onset and duration of illness between clozapine responders and non-responders was performed. Results Thirty-one articles were eligible for qualitative review. The systematic review found that a poorer response to clozapine was associated with older age at clozapine initiation, younger age at illness onset and longer delay in clozapine initiation. A higher number of previous hospitalisations and antipsychotic trials prior to treatment with clozapine were also associated with poorer outcomes. Both systematic review and meta-analysis identified that longer durations of illness before clozapine initiation were associated with worse clinical outcomes. In a total sample of 313 participants (n = 158 responders), clozapine responders had a significantly shorter duration of illness than non-responders (g = - 0.31; 95% CI, 0.06 - 0.56; p = 0.02). Analysis was then limited to studies with a minimum follow-up period of 12 weeks to align with the recommended amount of time to monitor clozapine response. The difference in duration of illness between responder versus non-responder groups remained significant and overall effect size increased (g = - 0.42; 95% CI, 0.17 – 0.67; p < 0.001). Between study heterogeneity was low (Q = 3.59, I2 = 0%, P = 0.61). Discussion The results imply that delay in clozapine treatment is associated with worse response and support the view that initiation of clozapine earlier in illness may be beneficial. Although we cannot make causal assertions from the data presented, poor response to clozapine when prescribed after a longer delay is likely due to a combination of factors; including the effects of sustained active symptoms on neurobiological integrity, social functioning and self-care. Given evidence that early non-response to conventional antipsychotics predicts a later diagnosis of treatment resistance and poorer outcomes, identifying treatment resistance and prescribing clozapine earlier in the illness course would prevent unnecessary loss of time in the treatment of refractory psychosis. Current research into clinical variables associated with clozapine response is limited to few studies but future investigation into the predictive value of these variables is warranted. This is important given the relative ease and low-cost clinical information can be obtained from acutely unwell patient groups who may poorly tolerate more invasive research and clinical procedures.


Author(s):  
Joanne S.K. Teh ◽  
Julien Coussement ◽  
Zoe C.F. Neoh ◽  
Tim Spelman ◽  
Smaro Lazarakis ◽  
...  

The objectives of this study were to assess the immunogenicity and safety of COVID-19 vaccines in patients with haematological malignancy. A systematic review and meta-analysis of clinical studies of immune responses to COVID-19 vaccination stratified by underlying malignancy and published from 1 January 2021 to 31 August 2021 was conducted using MEDLINE, EMBASE and CENTRAL. Primary outcome was the rate of seropositivity following 2 doses of COVID-19 vaccine with rates of seropositivity following 1 dose, rates of positive neutralising antibody (nAb), cellular responses and adverse events as secondary outcomes. Rates were pooled from single arm studies while rates of seropositivity were compared against the rate in healthy controls for comparator studies using a random effects model and expressed as a pooled odds ratio with 95% confidence intervals. Forty-four studies (16 mixed group, 28 disease specific) with 7064 patients were included in the analysis (2331 following first dose, 4733 following second dose). Overall seropositivity rates were 61-67% following 2 doses and 37-51% following 1 dose of COVID-19 vaccine. The lowest seropositivity rate was 51% in CLL patients and was highest in patients with acute leukaemia (93%). Following 2 doses, nAb and cellular response rates were 57-60% and 40-75% respectively. Active treatment, ongoing or recent treatment with targeted and CD-20 monoclonal antibody therapies within 12 months was associated with poor COVID-19 vaccine immune responses. New approaches to prevention are urgently required to reduce COVID-19 infection morbidity and mortality in high-risk patient groups that respond poorly to COVID-19 vaccination.


BMJ ◽  
2020 ◽  
pp. l6925 ◽  
Author(s):  
Alice Fabbri ◽  
Lisa Parker ◽  
Cinzia Colombo ◽  
Paola Mosconi ◽  
Giussy Barbara ◽  
...  

AbstractObjectiveTo investigate pharmaceutical or medical device industry funding of patient groups.DesignSystematic review with meta-analysis.Data sourcesOvid Medline, Embase, Web of Science, Scopus, and Google Scholar from inception to January 2018; reference lists of eligible studies and experts in the field.Eligibility criteria for selecting studiesObservational studies including cross sectional, cohort, case-control, interrupted time series, and before-after studies of patient groups reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups that disclosed information about this funding; and association between industry funding and organisational positions on health and policy issues. Studies were included irrespective of language or publication type.Review methodsReviewers carried out duplicate independent data extraction and assessment of study quality. An amended version of the checklist for prevalence studies developed by the Joanna Briggs Institute was used to assess study quality. A DerSimonian-Laird estimate of single proportions with Freeman-Tukey arcsine transformation was used for meta-analyses of prevalence. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to assess the quality of the evidence for each outcome.Results26 cross sectional studies met the inclusion criteria. Of these, 15 studies estimated the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). Among patient organisations that received industry funding, 27% (175/642; 95% confidence interval 24% to 31%) disclosed this information on their websites. In submissions to consultations, two studies showed very different disclosure rates (0% and 91%), which appeared to reflect differences in the relevant government agency’s disclosure requirements. Prevalence estimates of organisational policies that govern corporate sponsorship ranged from 2% (2/125) to 64% (175/274). Four studies analysed the relationship between industry funding and organisational positions on a range of highly controversial issues. Industry funded groups generally supported sponsors’ interests.ConclusionIn general, industry funding of patient groups seems to be common, with prevalence estimates ranging from 20% to 83%. Few patient groups have policies that govern corporate sponsorship. Transparency about corporate funding is also inadequate. Among the few studies that examined associations between industry funding and organisational positions, industry funded groups tended to have positions favourable to the sponsor. Patient groups have an important role in advocacy, education, and research, therefore strategies are needed to prevent biases that could favour the interests of sponsors above those of the public.Systematic review registrationPROSPERO CRD42017079265.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Veerle Wijtvliet ◽  
Philip Plaeke ◽  
Steven Abrams ◽  
Niel Hens ◽  
Els Gielis ◽  
...  

Abstract Background and Aims Donor-derived cell-free DNA (dd-cfDNA) is actively studied as a non-invasive biomarker for the diagnosis of kidney allograft rejection, with conflicting results being reported. Therefore, we conducted a systematic review and meta-analysis to provide a clear overview of the potential value of dd-cfDNA to diagnose kidney rejection, and specifically antibody-mediated rejection (ABMR). Method A systematic literature search was performed in Pubmed, Web of Science, and the Cochrane library using the search terms: “cell free DNA AND kidney transplantation”. We included studies that 1) described dd-cfDNA fractions in blood of kidney allograft recipients; and 2) were published as English original research papers between January 1, 1994 and November 26, 2019. The methodological quality was assessed by the Methodological Index for Non-Randomized Studies (MINORS). Out of 287 hits, 55 duplicates were removed. 232 remaining abstracts were screened, leaving 36 articles for full-text review, of which 11 were included in a systematic review and data from 7 articles were synthesized in a meta-analysis. A weighted median of medians (WMM) (median with 95% confidence interval (CI) in squared brackets) was computed as a pooled estimate for the median dd-cfDNA fractions in different groups of patients. A meta-analysis was prespecified to be performed among following patient groups: 1) ABMR patients; 2) T-cell-mediated rejection (TCMR) patients; 3) stable patients; 4) patients without rejection at indication biopsy. The pooled ABMR group consisted of patient groups with pure ABMR and/or mixed ABMR/TCMR. Weighted median differences of medians (WMDM) were estimated for pairwise comparisons among the aforementioned groups, according to the approach proposed by McGrath et al. (2019). Results A large heterogeneity was observed between the selected studies in 1) study design; 2) inclusion criteria (consecutively transplanted patients versus patients with an acute kidney event); 3) statistical reporting (mean ± SD versus median with IQR or min-max); and 4) the definition of study groups. This made the results of the selected studies only partially comparable or suitable for further meta-analysis. Three studies calculated the fraction of dd-cfDNA in stable patients, resulting in a WMM of 0.29% [0.26-0.45]. In the ABMR group, a remarkably higher WMM (2.5% [1.4-2.9]) was observed, when combining the data from five separate studies. Four of those five studies also described dd-cfDNA levels in TCMR patients and patients without rejection at indication biopsy, resulting in a WMM of 0.27% [0.26-2.69] and 0.57% [0.3-0.67], respectively. As presented in Figure 1, median dd-cfDNA fractions were significantly higher in patients with ABMR vs. patients without rejection at indication biopsy (Figure 1A). As compared to patients with TCMR, a tendency to higher median dd-cfDNA fractions was observed in patients with ABMR (Figure 1B). Patients with TCMR had no higher median dd-cfDNA fractions than patients without rejection at indication biopsy. Conclusion Despite the large heterogeneity between the selected studies, our results point towards higher median dd-cfDNA fractions in patients with ABMR vs. patients without rejection at indication biopsy. Furthermore, a tendency to lower median dd-cfDNA fractions was noted in patients with TCMR compared to ABMR. dd-cfDNA might be useful in the diagnosis of ABMR if confirmed in further studies.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Thomas Whittaker ◽  
Mohamed Abdelrazek ◽  
Aran Fitzpatrick ◽  
Joseph Froud ◽  
Jeremy Williamson ◽  
...  

Abstract Aim The ongoing Covid-19 pandemic has interrupted surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS). Methods A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Patients over 18 with a diagnosis of colon or rectal cancer who received elective surgery as primary treatment were included. Delay was defined as the period between CRC diagnosis and day of surgery. Metanalyses of the outcomes OS and DFS were conducted. Forest plots, funnel plots, tests of heterogeneity, and estimated Number Needed to Harm (NNHs) were produced. Results Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed a delay to elective resection was associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on metanalysis. Conclusions This review recommends elective surgery for CRC patients is not postponed longer than four weeks, as evidence suggests extended delays from diagnosis are associated with poorer outcomes. Focused research is essential so patient groups can be prioritized based on risk-factors for future pandemics.


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