scholarly journals Risk factors for adverse clinical outcomes in patients with COVID-19: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Vanesa Bellou ◽  
Ioanna Tzoulaki ◽  
Evangelos Evangelou ◽  
Lazaros Belbasis
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Statistical Significance ◽  
Specific Effect ◽  
Chronic Obstructive ◽  
P Value ◽  
Meta Analyses

Importance: COVID-19 is a clinically heterogeneous disease of varying severity and prognosis. Clinical characteristics that impact disease course could offer guidance for clinical decision making and future research endeavors and unveil disease pathways. Objective: To examine risk factors associated with adverse clinical outcomes in patients with COVID-19. Data sources: We performed a systematic review in PubMed from January 1 until April 19, 2020. Study selection: Observational studies that examined the association of any clinical characteristic with an adverse clinical outcome were considered eligible. We scrutinized studies for potential overlap. Data extraction and synthesis: Information on the effect of clinical factors on clinical endpoints of patients with COVID-19 was independently extracted by two researchers. When an effect size was not reported, crude odds ratios were calculated based on the available information from the eligible articles. Study-specific effect sizes from non-overlapping studies were synthesized applying the random-effects model. Main outcome and measure: The examined outcomes were severity and progression of disease, admission to ICU, need for mechanical ventilation, mortality, or a composite outcome. Results: We identified 88 eligible articles, and we performed a total of 256 meta-analyses on the association of 98 unique risk factors with five clinical outcomes. Seven meta-analyses presented the strongest epidemiological evidence in terms of statistical significance (P-value <0.005), between-study heterogeneity (I2 <50%), sample size (more than 1000 COVID-19 patients), 95% prediction interval excluded the null value, and absence of small-study effects. Elevated C-reactive protein (OR, 6.46; 95% CI, 4.85 - 8.60), decreased lymphocyte count (OR, 4.16; 95% CI, 3.17 - 5.45), cerebrovascular disease (OR, 2.84; 95% CI, 1.55 - 5.20), chronic obstructive pulmonary disease (OR, 4.44; 95% CI, 2.46 - 8.02), diabetes mellitus (OR, 2.04; 95% CI, 1.54 - 2.70), hemoptysis (OR, 7.03; 95% CI, 4.57 - 10.81), and male sex (OR, 1.51; 95% CI, 1.30 - 1.75) were associated with risk of severe COVID-19. Conclusions and relevance: Our results highlight factors that could be useful for prognostic model building, help guide patients' selection for randomized clinical trials, as well as provide alternative treatment targets by shedding light to disease pathophysiology.

scholarly journals Incidence, risk factors and outcomes of early postoperative hyperglycemia in surgical patients: a protocol for a systematic review and meta-analysis

2020 ◽  
Author(s):  
Paddy Ssentongo ◽  
Joseph A. Lewcun ◽  
Anna E. Ssentongo ◽  
David I. Soybel
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Postoperative Outcomes ◽  
Cochrane Library ◽  
Logit Transformation ◽  
Incidence Risk ◽  
Meta Analyses

Abstract Background Early postoperative hyperglycemia is common and associated with poor postoperative outcomes. We aimed to estimate the pooled incidence, risk factors and clinical outcomes of early postoperative hyperglycemia in men and women globally. Method and analysis We will conduct a systematic review and meta-analysis of cohort studies published before January 1, 2020, reporting the incidence of postoperative hyperglycemia. We will search the following databases: PubMed (MEDLINE), Scopus, EMBASE, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE), Joana Briggs Institute EBF Database and Web of Science. No age, geographical location, study-design or language limits will be applied. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Two reviewers (JAL, AES) will independently screen citations, abstracts and will identify full-text articles for inclusion, extract data and evaluate the quality and bias of included studies. Discrepancies will be resolved by consensus or consultation with a third researcher (PS). The risk of bias of included studies will be evaluated by the appropriate Cochrane risk of bias tool. The primary outcome will be the overall incident rate of postoperative hyperglycemia. Secondary outcomes are the risk factors and clinical outcomes of postoperative hyperglycemia. We will use the random-effects model with a logit transformation of proportions for the pooling of studies. We will assess the between-study heterogeneity using the I 2 statistic, and Cochrane’s Q statistic (significance level < 0.05). We will perform subgroup meta-analyses to look at geographical differences in the incidence of postoperative hyperglycemia and conduct a meta-regression analysis, using study level median age, year of publication, study level gender proportions, the proportion of type 2 diabetes, mean body mass index, American Society of Anesthesiologists and type of surgical procedure. We will report the probability of postoperative hyperglycemia as a measure of incidence rate, relative risk ratios (RR) and 95% confidence intervals to report the effects of the risk factors and postoperative outcomes. The Egger’s test and funnel plots will be used to assess publication bias.

scholarly journals Benefits of Qigong as an integrative and complementary practice for health: a systematic review

2020 ◽  
Vol 28 ◽  
Author(s):  
Bruna Francielle Toneti ◽  
Rafael Fernando Mendes Barbosa ◽  
Leandro Yukio Mano ◽  
Luana Okino Sawada ◽  
Igor Goulart de Oliveira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Cochrane Collaboration ◽  
The Elderly ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Meta Analyses

Objective: to analyze, in the literature, evidence about the benefits of the integrative and complementary practice of Qigong with regard to the health of adults and the elderly. Method: a systematic review by searching for studies in the PubMed, CINAHL, LILACS, EMBASE and Cochrane Library databases. Randomized and non-randomized clinical trials were included; in Portuguese, English and Spanish; from 2008 to 2018. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses strategy was adopted, as well as the recommendation of the Cochrane Collaboration for assessing the risk of bias in the clinical trials analyzed. Results: 28 studies were selected that indicated the benefit of the practice to the target audience, which can be used for numerous health conditions, such as: cancer; fibromyalgia; Parkinson’s disease; Chronic Obstructive Pulmonary Disease; Burnout; stress; social isolation; chronic low back pain; cervical pain; buzz; osteoarthritis; fatigue; depression; and cardiovascular diseases. However, there was a great risk of bias in terms of the blinding of the research studies. Conclusion: the practice of Qigong produces positive results on health, mainly in the medium and long term. This study contributes to the advancement in the use of integrative and complementary practices in nursing, since it brings together the scientific production in the area from the best research results available.

scholarly journals Regenerative Treatment of Peri-implantitis: A Systematic Review

2021 ◽  
Author(s):  
Khadija Amine ◽  
Youssef Radaj ◽  
Amina Gharibi ◽  
Jamila Kissa
Keyword(s):  
Systematic Review ◽  
Bone Regeneration ◽  
Randomized Clinical Trials ◽  
Smoking Status ◽  
Case Series ◽  
Risk Of Bias ◽  
P Value ◽  
Pocket Depth ◽  
Bone Gain ◽  
Meta Analyses

Objectives: The aim of this systematic review was to assess the clinical efficacy of bone regeneration for treatment of peri-implantitis. Materials and Methods: Electronic search of the literature was performed to identify randomized clinical trials (RCTs) and case series on treatment of peri-implantitis using bone regeneration procedures with at least 6 months of follow-up. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) were applied. The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Results: Two RCTs and 16 case series with a total of 520 treated patients (2002 implants) were included. Bone regenerative procedures showed controversial results regarding bone fill. Two studies reported statistically significant bone gain while four studies reported insignificant bone gain. Other studies reported bone gain with no P value. Pocket depth (PD) reduction varied among the studies since four studies reported a significant reduction in PD while four others reported insignificant reduction in PD. Other studies reported a reduction in PD with no P value. Bone regeneration procedures seemed to decrease bleeding on probing (BOP) but they did not seem conducive to increase the width of keratinized gingiva. Increased keratinized gingiva was noted in cases with subepithelial grafts. Conclusion: Evaluation of the effectiveness of bone regeneration techniques in this systematic review presented limitations related to heterogeneity in patient selection (age, history of periodontitis, smoking status and implant system), means of disinfection and decontamination, and variability of the materials used for treatment.

scholarly journals Digital Interventions for Psychological Comorbidities in Chronic Diseases—A Systematic Review

2021 ◽  
Vol 11 (1) ◽  
pp. 30
Author(s):  
Marta Maisto ◽  
Barbara Diana ◽  
Sonia Di Tella ◽  
Marta Matamala-Gomez ◽  
Jessica Isbely Montana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Design Elements ◽  
Digital Interventions ◽  
Digital Contents ◽  
Psychological Comorbidities ◽  
Quantitative Synthesis ◽  
Meta Analyses

Chronic diseases represent one of the main causes of death worldwide. The integration of digital solutions in clinical interventions is broadly diffused today; however, evidence on their efficacy in addressing psychological comorbidities of chronic diseases is sparse. This systematic review analyzes and synthesizes the evidence about the efficacy of digital interventions on psychological comorbidities outcomes of specific chronic diseases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of PubMed, PsycInfo, Scopus and Web of Science databases was conducted. Only Randomized Controlled Trials (RCTs) were considered and either depression or anxiety had to be assessed to match the selection criteria. Of the 7636 identified records, 17 matched the inclusion criteria: 9 digital interventions on diabetes, 4 on cardiovascular diseases, 3 on Chronic Obstructive Pulmonary Disease (COPD) and one on stroke. Of the 17 studies reviewed, 14 found digital interventions to be effective. Quantitative synthesis highlighted a moderate and significant overall effect of interventions on depression, while the effect on anxiety was small and non-significant. Design elements making digital interventions effective for psychological comorbidities of chronic diseases were singled out: (a) implementing a communication loop with patients and (b) providing disease-specific digital contents. This focus on “how” to design technologies can facilitate the translation of evidence into practice.

scholarly journals Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis

2021 ◽  
Vol 18 (5) ◽  
pp. 2385
Author(s):  
Carlo Lajolo ◽  
Rupe Cosimo ◽  
Schiavelli Anna ◽  
Gioco Gioele ◽  
Metafuni Elisabetta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Acute Myeloid Leukemia ◽  
Differential Diagnosis ◽  
Myeloid Leukemia ◽  
Oral Manifestation ◽  
First Case ◽  
Immunosuppressed Patients ◽  
Meta Analyses ◽  
Acute Myeloid

Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.

scholarly journals Chronic obstructive pulmonary disease and malnutrition: why are we not winning this battle?

2003 ◽  
Vol 29 (2) ◽  
pp. 107-115 ◽  
Author(s):  
Ivone Martins Ferreira
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Statistical Significance ◽  
Nutritional Therapy ◽  
Nutritional Supplementation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled Studies ◽  
Cytokine Inhibitors

OBJECTIVES: To review the mechanisms involved in the origin of malnutrition in patients with chronic obstructive pulmonary disease (COPD), and to make a systematic review of randomized controlled studies, to clarify the contribution of nutritional supplementation in patients with stable COPD. METHOD: A systematic review of articles published in the field of nutrition, in any language and from several sources, including Medline, Embase, Cinahl, and the Cochrane Registry on COPD, as well as studies presented at congresses in the US and Europe. RESULTS: Studies on nutritional supplementation for more than two weeks showed a very small effect, not reaching statistical significance. A linear regression study found that old age, relative anorexia, and high inflammatory response are associated with non-response to nutritional therapy. CONCLUSION: Currently, there is no evidence that nutritional supplementation is truly effective in patients with COPD. Factors associated with non-response suggest a relationship with the degree of inflammation, including high TNF-alpha levels. Measuring inflammation markers may be useful to determine prognosis and adequate therapy. Treatment with anti-inflammatory cytokines or cytokine inhibitors seems promising for the future.

scholarly journals Can reducing the number of stitches compromise the outcome of laparoscopic Burch surgery in the treatment of stress urinary incontinence? Systematic review and meta-analysis

2017 ◽  
Vol 44 (6) ◽  
pp. 649-654 ◽  
Author(s):  
RICARDO JOSÉ SOUZA ◽  
JOSÉ ANACLETO DUTRA RESENDE JÚNIOR ◽  
CLARICE GUIMARÃES MIGLIO ◽  
LEILA CRISTINA SOARES BROLLO ◽  
MARCO AURÉLIO PINHO OLIVEIRA ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
P Value ◽  
Open Technique ◽  
Control Series ◽  
One Year ◽  
Cure Rates

ABSTRACT The retropubic colposuspension in the treatment of stress urinary incontinence has been rescued with the laparoscopic route. Some authors have reduced the number of stitches, from two to one, due to the difficulty of suturing by this route. To what extent can this modification compromise outcome? To answer this question, we performed a systematic review and meta-analysis on the MEDLINE/PubMed and LILACS/SciELO databases between 1990 and 2015. We included randomized clinical trials, cohort studies and case-control series comparing laparoscopic versus open Burch, and two versus one stitch in laparoscopic Burch, with a minimum follow-up of one year. Fourteen studies compared laparoscopic versus open Burch, in which we found no differences between the two techniques using one stitch (Relative Risk - RR - of 0.94, 95% CI 0.79-1.11) and two stitches (RR of 1.03, 95% CI 0.97-1.10). Only one study compared one stitch versus two stitches in laparoscopic Burch, with cure rates of 68% versus 87%, respectively (p-value= 0.02). We did not identify differences when compared open technique with two stitches versus laparoscopic with one stitch and open technique with two stitches versus laparoscopic with two. The study comparing one versus two laparoscopic stitches demonstrated superior results with the latter. Although there is no robust evidence, when Burch surgery is performed laparoscopically, the use of two stitches seems to be the best option.

scholarly journals Systematic Review and Meta-Analysis of Linezolid and Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bloodstream Infections

2013 ◽  
Vol 57 (10) ◽  
pp. 5013-5018 ◽  
Author(s):  
Donald W. Whang ◽  
Loren G. Miller ◽  
Neil M. Partain ◽  
James A. McKinnell
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Fixed Effects ◽  
Randomized Clinical Trials ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Bloodstream Infections ◽  
Small Sample ◽  
Antibiotic Selection ◽  
Vancomycin Resistant

ABSTRACTBloodstream infections due to vancomycin-resistant enterococci (VRE-BSI) result in substantial patient mortality and cost. Daptomycin and linezolid are commonly prescribed for VRE-BSI, but there are no clinical trials to determine optimal antibiotic selection. We conducted a systematic review for investigations that compared daptomycin and linezolid for VRE-BSI. We searched Medline from 1966 through 2012 for comparisons of linezolid and daptomycin for VRE-BSI. We included searches of EMBASE, clinicaltrials.gov, and national meetings. Data were extracted using a standardized instrument. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using a fixed-effects model. Our search yielded 4,243 publications, of which 482 contained data on VRE treatment. Most studies (452/482) did not present data on BSI or did not provide information on linezolid or daptomycin. Among the remaining 30 studies, 9 offered comparative data between the two agents. None were randomized clinical trials. There was no difference in microbiologic (n= 5 studies, 517 patients; OR, 1.0; 95% CI, 0.4 to 1.7;P= 0.95) and clinical (n= 3 studies, 357 patients; OR, 1.2; 95% CI, 0.7 to 2.0;P= 0.7) cures between the two antibiotics. There was a trend toward increased survival with linezolid compared to daptomycin treatment (n= 9 studies, 1,074 patients; OR, 1.3; 95% CI, 1.1 to 1.8;I2= 0 [whereI2is a measure of inconsistency]), but this did not reach statistical significance (P= 0.054). There are limited data to inform clinicians on optimal antibiotic selection for VRE-BSI. Available studies are limited by small sample size, lack of patient-level data, and inconsistent outcome definitions. Additional research, including randomized clinical trials, is needed before conclusions can be drawn about treatment options for VRE therapy.

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