Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

AbstractThe escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case–control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger’s test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.

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Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.557 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R Mahendran ◽

S Puthussery ◽

M Amalan

Keyword(s):

Systematic Review ◽

Sri Lanka ◽

Pregnant Women ◽

South Asia ◽

South Asian ◽

Meta Analysis ◽

Antenatal Depression ◽

Diagnosis And Treatment ◽

Asian Countries ◽

Pooled Prevalence

Abstract Background Antenatal depression carries significant adverse implications for the health and well-being of women, babies and their families. While prevalence of perinatal mental disorders in low-and lower-middle-income countries tends to be higher compared to high-income countries, rates tend to vary widely among countries in certain regions such as South Asia. This study estimated the pooled prevalence of antenatal depression in South Asia and examined variations in individual countries. Methods We conducted a systematic review and meta-analysis. A comprehensive search was conducted on thirteen electronic databases and grey sources for articles published between 1·1·2007 and 31·5·2018 from South Asian countries including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Studies reporting quantitative prevalence estimates of antenatal depression using a validated diagnostic/ screening tool identified, screened and appraised using a two-stage process. A meta-analysis was conducted using the proportion (%) of pregnant women identified as having antenatal depression as the primary outcome. Results Thirty-three studies involving 13,087 pregnant women were included in the meta-analysis. Overall pooled prevalence was 24·57% (95% CI: 19·34, 30·69). Prevalence rates for India (17·74%, 95% CI: 11·19, 26·96) and Sri Lanka (15·87%, 95% CI: 14·04, 17·88) were lower compared to the overall prevalence whereas the rates for Pakistan (32·2%, 95% CI: 23·11, 42·87) and Nepal (50%, 95% CI: 35·64,64·36) were higher. Conclusions While robust prevalence studies are sparse in most South Asian countries, one in four pregnant women is likely to experience antenatal depression in the region. The issue needs to be recognised in health policy and practice for resource allocation and capacity building at regional and national levels for prevention, diagnosis and treatment. Key messages One in four pregnant women is likely to experience antenatal depression in South Asia region. Targeted efforts are needed at national and regional levels for prevention, diagnosis and treatment.

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Magnitude and determinants of neural tube defect in Africa: a systematic review and meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03848-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel Atlaw ◽

Yohannes Tekalegn ◽

Biniyam Sahiledengle ◽

Kenbon Seyoum ◽

Damtew Solomon ◽

...

Keyword(s):

Systematic Review ◽

Neural Tube ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Folic Acid Supplementation ◽

Maternal Exposure ◽

X Ray ◽

Effect Model ◽

Pooled Prevalence

Abstract Background Neural tube defects (NTDs) are a group of disorders that arise from the failure of the neural tube close between 21 and 28 days after conception. About 90% of neural tube defects and 95% of death due to these defects occurs in low-income countries. Since these NTDs cause considerable morbidity and mortality, this study aimed to determine the prevalence and associated factors of NTDs in Africa. Methods The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO number: CRD42020149356). All major databases such as PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, African Journals Online (AJOL), and Google Scholar search engine were systematically searched. A random-effect model was used to estimate the pooled prevalence of NTDs in Africa, and Cochran’s Q-statistics and I2 tests were used to assess heterogeneity between included studies. Publication bias was assessed using Begg ’s tests, and the association between determinant factors and NTDs was estimated using a random-effect model. Results Of the total 2679 articles, 37 articles fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. The pooled prevalence of NTDs in Africa was 50.71 per 10,000 births (95% CI: 48.03, 53.44). Folic acid supplementation (AOR: 0.40; 95% CI: 0.19–0.85), maternal exposure to pesticide (AOR: 3.29; 95% CI: 1.04–10.39), mothers with a previous history of stillbirth (AOR: 3.35, 95% CI: 1.99–5.65) and maternal exposure to x-ray radiation (AOR 2.34; 95% CI: 1.27–4.31) were found to be determinants of NTDs. Conclusions The pooled prevalence of NTDs in Africa was found to be high. Maternal exposure to pesticides and x-ray radiation were significantly associated with NTDs. Folic acid supplementation before and within the first month of pregnancy was found to be a protective factor for NTDs.

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Post-Stroke Psychiatric and Cognitive Symptoms in West Asia, South Asia and Africa: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10163655 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3655

Author(s):

Sangeetha Mahadevan ◽

Moon Fai Chan ◽

Marzieh Moghadas ◽

Maithili Shetty ◽

David T. Burke ◽

...

Keyword(s):

Systematic Review ◽

South Asia ◽

Rating Scale ◽

Meta Analysis ◽

Grey Literature ◽

Depression Scale ◽

Stroke Survivors ◽

Cognitive Symptoms ◽

Post Stroke ◽

Pooled Prevalence

Recent research has shown that the prevalence of stroke incidents and the number of survivors in developing countries surpass those from developed countries. This study aimed to enumerate the prevalence of post-stroke psychiatric and cognitive symptoms among stroke survivors from West and South Asia and Africa through a systematic review and meta-analysis. Data from each country was systematically acquired from five major databases (PsycINFO, Web of Science, Scopus, PubMed/Medline, and Google Scholar (for any missing articles and grey literature)). Meta-analytic techniques were then used to estimate the prevalence of various post-stoke psychiatric and cognitive symptoms. A total of 36 articles were accrued from 11 countries, of which 25 were evaluated as part of the meta-analysis. The pooled prevalence of post-stroke depression as per the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale, Patient Health Questionnaire, Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Geriatric Depression Scale, and the Montgomery–Asberg Depression Rating Scale ranged from 28.00 to 50.24%. Pooled prevalence of post-stroke anxiety based on the HADS and SCAN was 44.19% and 10.96%, respectively. The pooled prevalence of post-stroke cognitive impairment as per the Mini-Mental Status Examination was 16.76%. This present review has suggested that both psychiatric and cognitive symptoms are common among stroke survivors. Concerted efforts are needed to institute robust studies using culturally sensitive measures to contemplate mechanisms that address the unmet needs of this vulnerable population.

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Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-020991 ◽

2018 ◽

Vol 8 (2) ◽

pp. e020991 ◽

Cited By ~ 9

Author(s):

Wen Wang ◽

Wenwen Chen ◽

Yanmei Liu ◽

Reed Alexander C Siemieniuk ◽

Ling Li ◽

...

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Meta Analysis ◽

Late Recurrence ◽

Controlled Trials ◽

Cochrane Central Register ◽

High Quality ◽

Moderate Quality ◽

The Impact ◽

Risk Of Treatment

ObjectiveTo assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.Study selectionA BMJ Rapid Recommendation panel provided input on design, important outcomes and the interpretation of the results. Eligible randomised controlled trials (RCTs) included a comparison of antibiotics against no antibiotics or a comparison of different antibiotics in patients with uncomplicated skin abscesses, and reported outcomes prespecified by the linked guideline panel.Review methodsReviewers independently screened abstracts and full texts for eligibility, assessed risk of bias and extracted data. We performed random-effects meta-analyses that compared antibiotics with no antibiotics, along with a limited number of prespecified subgroup hypotheses. We also performed network meta-analysis with a Bayesian framework to compare effects of different antibiotics. Quality of evidence was assessed with The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsFourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95% CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). However, relative to no use, antibiotics probably increase the risk of gastrointestinal side effects (trimethoprim and sulfamethoxazole (TMP-SMX): OR 1.28, 95% CI 1.04 to 1.58; moderate quality; clindamycin: OR 2.29, 95% CI 1.35 to 3.88; high quality) and diarrhoea (clindamycin: OR 2.71, 95% CI 1.50 to 4.89; high quality). Cephalosporins did not reduce the risk of treatment failure compared with placebo (moderate quality).ConclusionsIn patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective.

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The impact of smoking on tuberculosis treatment outcomes: a meta-analysis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0002 ◽

2020 ◽

Vol 24 (2) ◽

pp. 170-175 ◽

Cited By ~ 3

Author(s):

E. Y. Wang ◽

R. A. Arrazola ◽

B. Mathema ◽

I. B. Ahluwalia ◽

S. R. Mase

Keyword(s):

Cigarette Smoking ◽

Treatment Outcomes ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Loss To Follow Up ◽

Tb Treatment ◽

The Impact ◽

Culture Conversion

BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14–1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04–2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21–1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts.

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Impact of surgical margin status on the survival outcome after surgical resection of gastric cancer: a protocol for systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-040282 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040282

Author(s):

Zhiyuan Jiang ◽

Zhaolun Cai ◽

Yuan Yin ◽

Chaoyong Shen ◽

Jinming Huang ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Curative Intent ◽

Term Survival ◽

Effect Model ◽

Statistical Heterogeneity ◽

The Impact

IntroductionGenerally, complete resection with cancer cell negative (R0) margin has been accepted as the most effective treatment of gastric cancer and positive resection (R1/R2) margin has been associated with decreased survival to varied degrees. However, the independent impact of microscopical positive (R1) margin on long-term survival may be confounded. No meta-analysis has worked at the association between R1 margin and outcomes of gastric cancer and the available evidence are scant. Therefore, we plan to conduct a systematic review and meta-analysis to quantitatively explore the role of R1 margin on gastric (including oesophagogastric junction) cancer survival after curative intent resection.Methods and analysisThe protocol was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search of PubMed, Embase and the Cochrane Central Register of Controlled Trials databases will be performed from their inceptions to 30 April 2020 to identify randomised controlled trials (RCTs), cohort studies and case–control studies focusing on the impact of R1 margin on survival of gastric cancer after curative intent resection. The primary outcome will be the overall survival (OS) and disease-free survival (DFS) and the secondary outcomes will be 5-year OS rate and 5-year DFS rate. The Cochrane tool for bias assessment in randomised trials and Risk Of Bias In Non-randomised Studies-I for the assessment of bias in non-randomised studies (NRS) will be used. Statistical heterogeneity will be assessed by visual inspection of forest plots and measured using the I2 statistics. A fixed-effect model will be used when heterogeneity is low, otherwise, a random-effect model will be chosen. Publication bias will be assessed by funnel plots, subgroup analysis and sensitivity analysis will be performed in the right context. For each outcome, we will perform data synthesis separately for RCTs and NRS using Rev Man V.5.3 software and compile ‘summary of findings’ tables separately for RCTs and NRS using GRADEpro software. Grading of Recommendations, Assessment, Development and Evaluations considerations will also be used to make an overall assessment of the quality of evidence.Ethics and disseminationThere is no requirement for ethics approval because no patient data will be collected at an individual level in this systematic review and meta-analysis.The results of this systematic review will be published in a peer-reviewed journal and presented at relevant conferences, any deviations from the protocol will be clearly documented and explained in its final report.PROSPERO registration numberCRD42020165110.

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Influenza A and D Viruses in Non-Human Mammalian Hosts in Africa: A Systematic Review and Meta-Analysis

Viruses ◽

10.3390/v13122411 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2411

Author(s):

Annie Kalonda ◽

Marvin Phonera ◽

Ngonda Saasa ◽

Masahiro Kajihara ◽

Catherine G. Sutcliffe ◽

...

Keyword(s):

Systematic Review ◽

Influenza A ◽

Current Knowledge ◽

Meta Analysis ◽

Animal Health ◽

Small Ruminants ◽

Influenza Surveillance ◽

Analysis Model ◽

Pooled Prevalence ◽

The Impact

We conducted a systematic review and meta-analysis to investigate the prevalence and current knowledge of influenza A virus (IAV) and influenza D virus (IDV) in non-human mammalian hosts in Africa. PubMed, Google Scholar, Wiley Online Library and World Organisation for Animal Health (OIE-WAHIS) were searched for studies on IAV and IDV from 2000 to 2020. Pooled prevalence and seroprevalences were estimated using the quality effects meta-analysis model. The estimated pooled prevalence and seroprevalence of IAV in pigs in Africa was 1.6% (95% CI: 0–5%) and 14.9% (95% CI: 5–28%), respectively. The seroprevalence of IDV was 87.2% (95% CI: 24–100%) in camels, 9.3% (95% CI: 0–24%) in cattle, 2.2% (95% CI: 0–4%) in small ruminants and 0.0% (95% CI: 0–2%) in pigs. In pigs, H1N1 and H1N1pdm09 IAVs were commonly detected. Notably, the highly pathogenic H5N1 virus was also detected in pigs. Other subtypes detected serologically and/or virologically included H3N8 and H7N7 in equids, H1N1, and H3N8 and H5N1 in dogs and cats. Furthermore, various wildlife animals were exposed to different IAV subtypes. For prudent mitigation of influenza epizootics and possible human infections, influenza surveillance efforts in Africa should not neglect non-human mammalian hosts. The impact of IAV and IDV in non-human mammalian hosts in Africa deserves further investigation.

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Sex differences in TB treatment outcomes: Retrospective cohort study and meta-analysis

10.1101/2021.04.26.21256155 ◽

2021 ◽

Author(s):

Vignesh Chidambaram ◽

Nyan Lynn Tun ◽

Marie Gilbert Majella ◽

Jennie Ruelas Castillo ◽

Samuel K. Ayeh ◽

...

Keyword(s):

Systematic Review ◽

Sex Differences ◽

Cohort Study ◽

Treatment Outcomes ◽

Odds Ratio ◽

Retrospective Cohort ◽

Meta Analysis ◽

Sputum Smear ◽

Intensive Phase ◽

Tb Treatment

AbstractRationaleAlthough the incidence of tuberculosis (TB) is higher in males compared to females, the relationship of sex with TB treatment outcomes has not been adequately studied.Objectives and MethodsWe performed a retrospective cohort study and a systematic review and meta-analysis of observational studies during the last 10 years to assess the sex differences in clinical and microbiological outcomes in tuberculosis.Measurements and Main ResultsIn our cohort of 2,894 patients with drug-susceptible pulmonary TB (1,975 males and 919 females), males had higher adjusted hazards of mortality due to all causes (HR 1·43,95%CI 1.03-1.98) and infections (HR 1.70, 95%CI 1.09-2.64) at 9 months and higher adjusted odds ratio for sputum culture (OR 1.56,95%CI 1.05-2.33) and similar odds ratio for smear positivity (OR 1.27, 0.71-2.27) at 2 months compared to females. Among 7896 articles retrieved, 398 articles were included in our systematic review with a total of 3,957,216 patients. The odds of all-cause mortality was higher in males compared to females in the pooled unadjusted (OR 1.26, 95%CI 1.19-1.34) and adjusted (OR 1.31, 95%CI 1.18-1.45) analyses. Relative to females, males had higher pooled odds of sputum culture (OR 1.44,95% CI 1.14-1.81) and sputum smear (OR 1.58,95%CI 1.41-1.77) positivity at the end of the intensive phase, and upon completion of treatment.ConclusionsDuring TB treatment, males have higher all-cause-, infection- and TB-related mortality, as well as higher rates of sputum smear and culture positivity, both after the intensive phase and at the completion of TB treatment, after adjusting for confounding factors.

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A systematic review to explore the impact of anxiety on quality of life and treatment outcomes in rheumatoid arthritis

British Journal of General Practice ◽

10.3399/bjgp18x697181 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697181

Author(s):

Annabelle Machin ◽

Randula Haththotuwa ◽

Opeyemi Babatunde ◽

Ian Scott ◽

Nadia Corp ◽

...

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Systematic Review ◽

Treatment Outcomes ◽

Treatment Response ◽

Data Extraction ◽

Meta Analysis ◽

Past Research ◽

The Impact

BackgroundRheumatoid arthritis (RA) is the commonest inflammatory arthritis. Comorbid anxiety and depression are common, but under-recognised and under-treated. Depression in RA has been linked to reduced quality of life and treatment response and increased mortality. Past research into co-morbid mood problems in RA has mainly focused on the prevalence and impact of depression.AimTo complete a systematic review to explore the impact of anxiety on QOL and treatment outcomes in RA.MethodThe systematic review has been registered on PROSPERO. Databases (Web of Science, PsycINFO, CINAHL, Embase and Medline) have been systematically searched for relevant studies. Titles and abstracts have been independently screened by two reviewers. Data extraction and quality appraisal of studies will be carried out using a customized and piloted data extraction tool and the Newcastle-Ottawa Scale. Disagreements will be resolved through discussion or by a third reviewer. A narrative synthesis framework will be used to develop a theory of how anxiety impacts on QOL and treatment response and a meta-analysis performed.ResultsThe search has identified 6404 articles. After title screening, 284 abstracts have been reviewed and 48 full texts are being reviewed for inclusion. Full text review is ongoing, and results of the analysis will be presented.ConclusionHighlighting the impact of anxiety on outcomes in RA may suggest areas for future implementation studies to improve patient outcomes, potentially reducing associated morbidity and mortality.

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The D614G virus mutation enhances anosmia in COVID-19 patients: Evidence from a systematic review and meta-analysis of studies from South Asia

10.1101/2021.08.11.21261934 ◽

2021 ◽

Author(s):

Christopher S von Bartheld ◽

Molly M Hagen ◽

Rafal Butowt

Keyword(s):

Systematic Review ◽

South Asia ◽

South Asian ◽

Virus Entry ◽

Meta Analysis ◽

Virus Binding ◽

Asian Populations ◽

Ethnic Populations ◽

Pooled Prevalence ◽

Virus Strains

The prevalence of chemosensory dysfunction in patients with COVID-19 varies greatly between populations. It is unclear whether such differences are due to factors at the level of the human host, or at the level of the coronavirus, or both. At the host level, the entry proteins which allow virus binding and entry have variants with distinct properties, and the frequency of such variants differs between ethnicities. At the level of the virus, the D614G mutation enhances virus entry to the host cell. Since the two virus strains (D614 and G614) co-existed in the first six months of the pandemic in most populations, it has been difficult to distinguish between contributions of the virus and contributions of the host for anosmia. To answer this question, we conducted a systematic review and meta-analysis of studies in South Asian populations when either the D614 or the G614 virus was dominant. We show that populations infected predominantly with the G614 virus had a much higher prevalence of anosmia (pooled prevalence of 31.8%) compared with the same ethnic populations infected mostly with the D614 virus strain (pooled anosmia prevalence of 5.3%). We conclude that the D614G mutation is a major contributing factor that increases the prevalence of anosmia in COVID-19, and that this enhanced effect on olfaction constitutes a previously unrecognized phenotype of the D614G mutation. The new virus strains that have additional mutations on the background of the D614G mutation can be expected to cause a similarly increased prevalence of chemosensory dysfunctions.

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