Breastfeeding of Infants Born to Mothers with COVID-19: A Rapid Review

AbstractBackgroundExisting recommendations on whether mothers with COVID-19 should continue breastfeeding are still conflicting. We aimed to conduct a rapid review of mother-to-child transmission of COVID-19 during breastfeeding.MethodsWe systematically searched Medline, Embase, Web of Science, Cochrane library, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang, and preprint articles up to March 2020. We included studies relevant to transmission through milk and respiratory droplets during breastfeeding of mothers with COVID-19, SARS, MERS and influenza. Two reviewers independently screened studies for eligibility, extracted data, assessed risk of bias and used GRADE to assess certainty of evidence.ResultsA total of 4481 records were identified in our literature search. Six studies (five case reports and one case series) involving 58 mothers (16 mothers with COVID-19, 42 mothers with influenza) and their infants proved eligible. Five case reports showed that the viral nucleic acid tests for all thirteen collected samples of breast milk from mothers with COVID-19 were negative. A case series of 42 influenza infected postpartum mothers taking precautions (hand hygiene and wearing masks) before breastfeeding showed that no neonates were infected with influenza during one-month of follow-up.ConclusionsThe current evidence indicates that SARS-CoV-2 viral nucleic acid has not been detected in breast milk. The benefits of breastfeeding may outweigh the risk of SARS-CoV-2 infection in infants. Mothers with COVID-19 should take appropriate precautions to reduce the risk of transmission via droplets and close contact during breastfeeding.

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Nosocomial Infections Among Patients with COVID-19, SARS and MERS: A Rapid Review and Meta-Analysis

10.1101/2020.04.14.20065730 ◽

2020 ◽

Cited By ~ 8

Author(s):

Qi Zhou ◽

Yelei Gao ◽

Xingmei Wang ◽

Rui Liu ◽

Peipei Du ◽

...

Keyword(s):

Nosocomial Infection ◽

Nosocomial Infections ◽

Medical Staff ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Index Patient ◽

Rapid Review ◽

China National Knowledge Infrastructure ◽

Hospital Acquired

AbstractBackgroundCOVID-19, a disease caused by SARS-CoV-2 coronavirus, has now spread to most countries and regions of the world. As patients potentially infected by SARS-CoV-2 need to visit hospitals, the incidence of nosocomial infection can be expected to be high. Therefore, a comprehensive and objective understanding of nosocomial infection is needed to guide the prevention and control of the epidemic.MethodsWe searched major international and Chinese databases Medicine, Web of science, Embase, Cochrane, CBM(China Biology Medicine disc), CNKI (China National Knowledge Infrastructure) and Wanfang database)) for case series or case reports on nosocomial infections of COVID-19, SARS(Severe Acute Respiratory Syndromes) and MERS(Middle East Respiratory Syndrome) from their inception to March 31st, 2020. We conducted a meta-analysis of the proportion of nosocomial infection patients in the diagnosed patients, occupational distribution of nosocomial infection medical staff and other indicators.ResultsWe included 40 studies. Among the confirmed patients, the proportions of nosocomial infections were 44.0%, 36.0% and 56.0% for COVID-19, SARS and MERS, respectively. Of the confirmed patients, the medical staff and other hospital-acquired infections accounted for 33.0% and 2.0% of COVID-19 cases, 37.0% and 24.0% of SARS cases, and 19.0% and 36.0% of MERS cases, respectively. Nurses and doctors were the most affected among the infected medical staff. The mean numbers of secondary cases caused by one index patient were 29.3 and 6.3 for SARS and MERS, respectively.ConclusionsThe proportion of nosocomial infection in patients with COVID-19 was 44%. Patients attending hospitals should take personal protection. Medical staff should be awareness of the disease to protect themselves and the patients.

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Effectiveness of mud-therapy in rheumatic and dermatologic diseases: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1173 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

V M Mingrone ◽

S Paduano ◽

F Venturelli ◽

I Marchesi ◽

F Valeriani ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Full Text ◽

Muscle Tone ◽

Case Reports ◽

Case Series ◽

Current Evidence ◽

Cochrane Library ◽

Mud Therapy

Abstract Background Thermal mud therapy alone or in combination with thermal water baths is widely used in clinical practice for the management of rheumatic and dermatologic diseases in many countries. Despite its long history and tradition, its biological action and its clinical effectiveness are still not clear. The aim of this systematic review is to synthetize the current evidence on the mud therapy effects on pain, function and quality of life in patients with rheumatic and dermatologic diseases. Methods PubMed/Medline, Embase, and Cochrane Library were searched for articles about the comparative effectiveness of mud therapy alone or combined with other therapies on pain, function and quality of life in adults with rheumatic or dermatological diseases without any restrictions of severity. Studies were searched up to 15 October 2019. We included randomized and non-randomized trials and comparative cohort studies, as well as non-comparative case series and case reports only for safety outcomes. The following outcomes were considered: pain assessed by validated scales or through painkillers drugs consumption, function (i.e. muscle tone, joint motility and stiffness) assessed by validated scores, quality of life and autonomy assessed by validated scales and adverse events. Laboratory inflammation parameters were investigated as secondary outcomes. Results A total of 2,455 articles were retrieved through database search, remaining 1,914 records after duplicates removed. The selection by title and abstract led to include 140 studies for full-text evaluation. The screening of full-text is still being carried out. The majority of 140 records assess the effects of mud therapy in patients with osteoarthritis (51 articles), osteoarthrosis (12) and psoriasis (10). Conclusions Our results will provide a synthesis of the current evidence on the mud therapy effectiveness, useful to evaluate its inclusion within clinical protocols for the treatment of rheumatic and dermatologic diseases. Key messages The majority of studies report the treatment with mud for rheumatic diseases. The synthesis of the evidence is useful to evaluate the mud therapy as treatment for rheumatic and dermatologic diseases.

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Vitamin C in the Treatment of COVID-19

Nutrients ◽

10.3390/nu13041172 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1172

Author(s):

Gregorio Paolo Milani ◽

Marina Macchi ◽

Anat Guz-Mark

Keyword(s):

Clinical Trials ◽

Vitamin C ◽

Respiratory Infections ◽

Medical Condition ◽

Case Reports ◽

Case Series ◽

Theoretical Background ◽

Current Evidence ◽

Vitamin C Supplementation ◽

Essential Nutrient

Vitamin C is an essential nutrient that serves as antioxidant and plays a major role as co-factor and modulator of various pathways of the immune system. Its therapeutic effect during infections has been a matter of debate, with conflicting results in studies of respiratory infections and in critically ill patients. This comprehensive review aimed to summarize the current evidence regarding the use of vitamin C in the prevention or treatment of patients with SARS-CoV2 infection, based on available publications between January 2020 and February 2021. Overall, 21 publications were included in this review, consisting of case-reports and case-series, observational studies, and some clinical trials. In many of the publications, data were incomplete, and in most clinical trials the results are still pending. No studies regarding prevention of COVID-19 with vitamin C supplementation were found. Although some clinical observations reported improved medical condition of patients with COVID-19 treated with vitamin C, available data from controlled studies are scarce and inconclusive. Based on the theoretical background presented in this article, and some preliminary encouraging studies, the role of vitamin C in the treatment of patients with SARS-CoV-2 infection should be further investigated.

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Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00322-3 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Nikita Mohan ◽

Muhammad Ali Fayyaz ◽

Christopher del Rio ◽

Navpreet Kaur Rajinder Singh Khurana ◽

Sampada Sandip Vaidya ◽

...

Keyword(s):

Neurological Diseases ◽

Case Reports ◽

Healthcare Providers ◽

Case Series ◽

Altered Mental Status ◽

Common Finding ◽

Cochrane Library ◽

Neurological Manifestations ◽

The Cochrane Library ◽

Ct And Mri

Abstract Background The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. Objective To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2. To identify neuro-invasive pathways of COVID infection. Methods Relevant studies were identified through four databases—the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords—“COVID-19,” “SARS-CoV2,” “neurological manifestations,” “neuroimaging,” “CT,” and “MRI.” Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. Results Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. Conclusion The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.

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The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/6137450 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17

Author(s):

Lu Wang ◽

Mingmin Xu ◽

Qianhua Zheng ◽

Wei Zhang ◽

Ying Li

Keyword(s):

Quality Of Life ◽

Meta Analysis ◽

Safety Evaluation ◽

Functional Constipation ◽

Responder Rate ◽

Current Evidence ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Increased Risk

Objective. The purpose of this study was to assess the effectiveness and safety of acupuncture for functional constipation (FC). Methods. A rigorous literature search was performed in English (PubMed, Web of Science, the Cochrane Library, and EMBASE) and Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang database, and China Science and Technology Journal (VIP)) electronic databases from their inception to October 2019. Included randomized controlled trials (RCTs) compared acupuncture therapy with sham acupuncture or pharmacological therapies. The outcome measures were evaluated, including the primary outcome of complete spontaneous bowel movement (CSBM) and secondary outcomes of Bristol Stool Form Scale (BSFS), constipation symptoms scores (CSS), responder rate, the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, and safety evaluation. Meta-analysis was performed by using RevMan5.3. Results. The merged data of 28 RCTs with 3525 participants indicated that acupuncture may be efficient for FC by increasing CSBMs (p<0.00001; MD = 0.84 [95% CI, 0.65 to 1.03]; I2 = 0%) and improving constipation symptoms (p=0.03; SMD = −0.4 [95% CI, −0.78 to −0.03]; I2 = 74%), stool formation (p<0.00001; MD = 0.24 [95% CI, 0.15 to 0.34]; I2 = 0%), quality of life (p<0.00001; N = 1, MD = −0.33 [95% CI, −0.45 to −0.21]), and responder rates (p=0.02; RR = 2.16; [95% CI, 1.1 to 4.24]; I2 = 69%) compared with the effects of sham treatment. No increased risk of adverse events was observed (p=0.44; RR = 1.18; [95% CI, 0.77 to 1.81]; I2 = 0%). With regard to medication comparisons, the pooled data indicated that acupuncture was more effective in increasing CSBMs (p=0.004; MD = 0.53 [95% CI, 0.17 to 0.88]; I2 = 88%) and improving patients’ quality of life (p<0.00001; SMD = −0.73 [95% CI, −1.02 to −0.44]; I2 = 64%), with high heterogeneity. However, there were no significant differences in responder rate (p=0.12; RR = 1.31; [95% CI, 0.94 to 1.82]; I2 = 53%), BSFS (p=0.5; MD = 0.17 [95% CI, −0.33 to 0.68]; I2 = 93%), or CSS (p=0.05; SMD = −0.62 [95% CI, −1.23 to −0.01]; I2 = 89%). Regarding safety evaluation, acupuncture was safer than medications (p<0.0001; RR = 0.3; [95% CI, 0.18 to 0.52]; I2 = 30%). Conclusions. Current evidence suggests that acupuncture is an efficient and safe treatment for FC. Acupuncture increased stool frequency, improved stool formation, alleviated constipation symptoms, and improved quality of life. However, the evidence quality was relatively low and the relationship between acupuncture and drugs is not clear. More high-quality trials are recommended in the future. PROSPERO registration number: CRD42019143347.

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Department of Internal Medicine. University Hospital of Patras. Patras.

Acta Médica Portuguesa ◽

10.20344/amp.16686 ◽

2022 ◽

Vol 35 (13) ◽

Author(s):

Themistoklis Paraskevas ◽

Eleousa Oikonomou ◽

Maria Lagadinou ◽

Vasileios Karamouzos ◽

Nikolaos Zareifopoulos ◽

...

Keyword(s):

Oxygen Therapy ◽

Case Series ◽

High Flow ◽

University Hospital ◽

Current Evidence ◽

Cochrane Library ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

High Flow Oxygen

Introduction: Oxygen therapy remains the cornerstone for managing patients with severe SARS-CoV-2 infection and several modalities of non-invasive ventilation are used worldwide. High-flow oxygen via nasal canula is one therapeutic option which may in certain cases prevent the need of mechanical ventilation. The aim of this review is to summarize the current evidence on the use of high-flow nasal oxygen in patients with severe SARS-CoV-2 infection.Material and Methods: We conducted a systematic literature search of the databases PubMed and Cochrane Library until April 2021 using the following search terms: “high flow oxygen and COVID-19” and “high flow nasal and COVID-19’’.Results: Twenty-three articles were included in this review, in four of which prone positioning was used as an adjunctive measure. Most of the articles were cohort studies or case series. High-flow nasal oxygen therapy was associated with a reduced need for invasive ventilation compared to conventional oxygen therapy and led to an improvement in secondary clinical outcomes such as length of stay. The efficacy of high-flow nasal oxygen therapy was comparable to that of other non-invasive ventilation options, but its tolerability is likely higher. Failure of this modality was associated with increased mortality.Conclusion: High flow nasal oxygen is an established option for respiratory support in COVID-19 patients. Further investigation is required to quantify its efficacy and utility in preventing the requirement of invasive ventilation.

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Improving palliative and end-of-life care with machine learning and routine data: a rapid review

HRB Open Research ◽

10.12688/hrbopenres.12923.1 ◽

2019 ◽

Vol 2 ◽

pp. 13 ◽

Cited By ~ 1

Author(s):

Virginia Storick ◽

Aoife O’Herlihy ◽

Sarah Abdelhafeez ◽

Rakesh Ahmed ◽

Peter May

Keyword(s):

Machine Learning ◽

End Of Life ◽

Full Text ◽

Clinical Decision Making ◽

Grey Literature ◽

Routine Data ◽

Rapid Review ◽

Current Evidence ◽

Cochrane Library ◽

Eol Care

Introduction: Improving end-of-life (EOL) care is a priority worldwide as this population experiences poor outcomes and accounts disproportionately for costs. In clinical practice, physician judgement is the core method of identifying EOL care needs but has important limitations. Machine learning (ML) is a subset of artificial intelligence advancing capacity to identify patterns and make predictions using large datasets. ML approaches have the potential to improve clinical decision-making and policy design, but there has been no systematic assembly of current evidence. Methods: We conducted a rapid review, searching systematically seven databases from inception to December 31st, 2018: EMBASE, MEDLINE, Cochrane Library, PsycINFO, WOS, SCOPUS and ECONLIT. We included peer-reviewed studies that used ML approaches on routine data to improve palliative and EOL care for adults. Our specified outcomes were survival, quality of life (QoL), place of death, costs, and receipt of high-intensity treatment near end of life. We did not search grey literature and excluded material that was not a peer-reviewed article. Results: The database search identified 426 citations. We discarded 162 duplicates and screened 264 unique title/abstracts, of which 22 were forwarded for full text review. Three papers were included, 18 papers were excluded and one full text was sought but unobtainable. One paper predicted six-month mortality, one paper predicted 12-month mortality and one paper cross-referenced predicted 12-month mortality with healthcare spending. ML-informed models outperformed logistic regression in predicting mortality but poor prognosis is a weak driver of costs. Models using only routine administrative data had limited benefit from ML methods. Conclusion: While ML can in principle help to identify those at risk of adverse outcomes and inappropriate treatment near EOL, applications to policy and practice are formative. Future research must not only expand scope to other outcomes and longer timeframes, but also engage with individual preferences and ethical challenges.

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Rituximab for Eosinophilic Granulomatosis with Polyangiitis: a Systematic Review of Observational Studies

Rheumatology ◽

10.1093/rheumatology/keab046 ◽

2021 ◽

Author(s):

Vincenzo G Menditto ◽

Giulia Rossetti ◽

Diletta Olivari ◽

Alessia Angeletti ◽

Marco Rocchi ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Granulomatosis With Polyangiitis ◽

Case Reports ◽

Case Series ◽

Biologic Agents ◽

Cochrane Library ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Extensive Literature ◽

Eosinophilic Granulomatosis

Abstract Objective to analyze the available evidence about the use of rituximab (RTX) and other biologic agents in Eosinophilic Granulomatosis with Polyangiitis (EGPA) patients and to provide useful findings to inform the design of future, reliable clinical trials. Methods A systematic review was performed. A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science and the Cochrane library databases and an extensive literature search on other biologic agents. Results 45 papers pertinent to our questions were found: 16 retrospective cohort studies, 8 case series, 3 prospective cohort studies and 18 single case reports, for a total of 368 EGPA patients. More than 80% of evaluable patients achieved complete or partial remission with a tendency towards a higher rate of complete response in pANCA positive subgroup. Conclusion Although the majority of the evaluable EGPA patients treated with RTX appears to achieve complete remission, we strongly believe that a number of sources of heterogeneity impairs a clear interpretation of results and limits their transferability in clinical practice. Differences in design, enrollment criteria, outcome definition and measurement make a comparison among data obtained from studies on RTX and other biologic agents unreliable.

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Z-drugs and Falls: A Focused Review of the Literature

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.549 ◽

2020 ◽

Vol 35 (12) ◽

pp. 549-554

Author(s):

Nicole Ryba ◽

Rebecca Rainess

Keyword(s):

Primary Outcome ◽

Case Reports ◽

Inappropriate Medication ◽

Case Series ◽

Cochrane Library ◽

Inpatient Setting ◽

Care Hospital ◽

Review Of The Literature ◽

Increased Risk ◽

Risk Of Falls

OBJECTIVE: To provide a focused review of the literature related to the association between exposure to Z-drugs and the risk of falls, especially in the older population. DATA SOURCES: A literature search was conducted using Medline, PsychInfo, and the Cochrane Library database for all clinical trials, case series, and case reports published in English up to May 2020. The search terms used consisted of each Z-drug, including "zolpidem," "zopiclone," "eszopiclone," and "zaleplon," matched with "falls." STUDY SELECTION: The search yielded 295 studies. After review of abstracts, content and references were reviewed, and duplicates removed, a total of 9 articles met inclusion of exposure to at least 1 Z-drug and a primary outcome of falls. DATA EXTRACTION: The American Geriatrics Society 2019 Beers Criteria Update for Potentially Inappropriate Medication Use in Older Adults recommends to avoid using nonbenzodiazepine hypnotics in this patient population because of the risk of adverse events. DATA SYNTHESIS: A majority of the literature suggests an increased risk of falls with exposure to Z-drug use, especially zolpidem. Eight trials examined falls as a primary outcome in non-elderly (n=3) and elderly (n=5) patients in different settings, mostly in an inpatient setting (nursing facility or acute care hospital). CONCLUSION: Exposure to Z-drugs, especially zolpidem, should be evaluated and counseled on continuously as these medications put patients at an increased risk for falls and other complications.

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