Clinico-epidemiological characteristics of Kawasaki-like disease in paediatric patients with COVID-19: a protocol for rapid living systematic review

IntroductionThe COVID-19 outbreak has posed a major challenge to healthcare providers. Due to its communicable nature, very stringent public health interventions have been put in place worldwide; yet, it still poses new emerging challenges, one of the most recent being a multisystem inflammatory condition with clinical features resembling Kawasaki-like disease and toxic shock syndrome in children and adolescents. The data on this novel condition are scarce which need to be reported to identify its clinico-epidemiological and geographical distribution. There is an urgent need to generate evidence for diagnosis and management of this condition in the midst of a pandemic.Methods and analysisThis systematic review will be conducted using Medline database searched through PubMed, Embase, Ovid; and Google Scholar, ProQuest and EBSCO databases will also be searched along with grey literature with the aim to identify the clinical features, aetiopathology, laboratory findings, treatment modes and outcomes of Kawasaki-like disease among paediatric patients suffering from COVID-19. Original articles reporting Kawasaki-like disease in paediatric patients with COVID-19 will be retrieved after screening by two independent reviewers. Data will be extracted in a specially designed form and studies will be assessed independently for risk of bias. Data will be extracted for the following: author, journal title, publication year, study design, study setting, demographic characteristics, sample size, clinical features, aetiopathology, laboratory findings, modes and doses of treatment given, strength and weakness of studies. A descriptive and quantitative analysis will be completed.Ethics and disseminationThis is a literature-based review study with no ethical concerns. We will publish the results in a peer-reviewed journal and present at a conference.PROSPERO registration numberCRD42020187427.

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Clinical presentations, laboratory and radiological findings, and treatments for 11,028 COVID-19 patients: a systematic review and meta-analysis

10.21203/rs.3.rs-30388/v1 ◽

2020 ◽

Author(s):

Carlos K.H. Wong ◽

Janet Y. Wong ◽

Eric H.M. Tang ◽

Chi Ho Au ◽

Abraham K. Wai

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Healthcare Providers ◽

Original Data ◽

Epidemiological Studies ◽

Laboratory Findings ◽

Non Invasive ◽

Clinical Presentations ◽

Registration Number

Abstract Objective: To conduct a systematic review and meta-analysis on the comorbidities, symptoms, clinical characteristics and treatment of COVID-19 patients.Method: Epidemiological studies published in 2020 (from January-March) on the clinical presentation, laboratory findings and treatments of COVID-19 patients were identified from PubMed/MEDLINE and Embase databases. Studies published in English by 27th March, 2020 with original data were included. A random-effects model was used to aggregate estimates across eligible studies and produce meta-analytic estimates. Primary outcomes included comorbidities of COVID-19 patients, their symptoms presented on hospital admission, laboratory results and radiological outcomes, and pharmacological and in-patient treatments.Results: 77 studies were included in this meta-analysis, accounting for a total of 11,028 COVID- 19 patients in multiple countries. The most common comorbidities were hypertension (18.1%, 95%CI: 15.4-20.8%). The most frequently identified symptoms were fever (72.4%, 95%CI: 67.2-77.7%) and cough (55.5%, 95%CI: 50.7-60.3%). For pharmacological treatment, 63.9% (95%CI: 52.5-75.3%), 62.4% (95%CI: 47.9-76.8%) and 29.7% (95%CI: 21.8-37.6%) of patients were given antibiotics, antiviral, and corticosteroid, respectively. Notably, 62.6% (95%CI: 39.9- 85.4%) and 20.2% (95%CI: 14.6-25.9%) of in-patients received oxygen therapy and non- invasive mechanical ventilation, respectively.Conclusions: This meta-analysis informed healthcare providers about the timely status of characteristics and treatments of COVID-19 patients across different countries.PROSPERO Registration Number: CRD42020176589

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Clinical presentations, laboratory and radiological findings, and treatments for 11,028 COVID-19 patients: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-74988-9 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Carlos K. H. Wong ◽

Janet Y. H. Wong ◽

Eric H. M. Tang ◽

C. H. Au ◽

Abraham K. C. Wai

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Healthcare Providers ◽

Original Data ◽

Epidemiological Studies ◽

Laboratory Findings ◽

Non Invasive ◽

Clinical Presentations ◽

Registration Number

AbstractThis systematic review and meta-analysis investigated the comorbidities, symptoms, clinical characteristics and treatment of COVID-19 patients. Epidemiological studies published in 2020 (from January–March) on the clinical presentation, laboratory findings and treatments of COVID-19 patients were identified from PubMed/MEDLINE and Embase databases. Studies published in English by 27th March, 2020 with original data were included. Primary outcomes included comorbidities of COVID-19 patients, their symptoms presented on hospital admission, laboratory results, radiological outcomes, and pharmacological and in-patient treatments. 76 studies were included in this meta-analysis, accounting for a total of 11,028 COVID-19 patients in multiple countries. A random-effects model was used to aggregate estimates across eligible studies and produce meta-analytic estimates. The most common comorbidities were hypertension (18.1%, 95% CI 15.4–20.8%). The most frequently identified symptoms were fever (72.4%, 95% CI 67.2–77.7%) and cough (55.5%, 95% CI 50.7–60.3%). For pharmacological treatment, 63.9% (95% CI 52.5–75.3%), 62.4% (95% CI 47.9–76.8%) and 29.7% (95% CI 21.8–37.6%) of patients were given antibiotics, antiviral, and corticosteroid, respectively. Notably, 62.6% (95% CI 39.9–85.4%) and 20.2% (95% CI 14.6–25.9%) of in-patients received oxygen therapy and non-invasive mechanical ventilation, respectively. This meta-analysis informed healthcare providers about the timely status of characteristics and treatments of COVID-19 patients across different countries.PROSPERO Registration Number: CRD42020176589

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Predictors of discharge destination from acute care in patients with traumatic brain injury

BMJ Open ◽

10.1136/bmjopen-2017-016694 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016694 ◽

Cited By ~ 3

Author(s):

Sareh Zarshenas ◽

Laetitia Tam ◽

Angela Colantonio ◽

Seyed Mohammad Alavinia ◽

Nora Cullen

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Acute Care ◽

English Language ◽

Healthcare Providers ◽

Trial Registration ◽

Future Research ◽

Reference List ◽

Registration Number

IntroductionMany studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of survival after TBI, more attention has been given to discharge destinations from acute care as an important measure of clinical priorities. This study describes the design of a systematic review compiling and synthesising studies on the prognostic factors of discharge settings from acute care in patients with TBI.Methods and analysisThis systematic review will be conducted on peer-reviewed studies using seven databases including Medline/Medline in-Process, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PsycINFO, CINAHL and Supplemental PubMed. The reference list of selected articles and Google Scholar will also be reviewed to determine other relevant articles. This study will include all English language observational studies that focus on adult patients with TBI in acute care settings. The quality of articles will be assessed by the Quality in Prognostic Studies tool.Ethics and disseminationThe results of this review will provide evidence that may guide healthcare providers in making more informed and timely discharge decisions to the next level of care for patient with TBI. Also, this study will provide valuable information to address the gaps in knowledge for future research.Trial registration numberTrial registration number (PROSPERO) is CRD42016033046.

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Case Report: Case Series of Children With Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Switzerland

Frontiers in Pediatrics ◽

10.3389/fped.2020.594127 ◽

2021 ◽

Vol 8 ◽

Author(s):

Athina Fouriki ◽

Yves Fougère ◽

Caroline De Camaret ◽

Géraldine Blanchard Rohner ◽

Serge Grazioli ◽

...

Keyword(s):

Clinical Features ◽

Toxic Shock Syndrome ◽

Case Series ◽

Serum Levels ◽

Intravenous Immunoglobulins ◽

Toxic Shock ◽

Laboratory Findings ◽

First Line Therapy ◽

Ivig Resistance ◽

Inflammatory Syndrome

Since the beginning of the severe SARS-CoV-2 pandemic, an increasing number of countries reported cases of a systemic hyperinflammatory condition defined as multi-system inflammatory syndrome in children (MIS-C). The clinical features of MIS-C can be an overlap of Kawasaki Disease (KD), Toxic Shock Syndrome (TSS), Macrophage Activation Syndrome (MAS), or have often an acute abdominal presentation. Intravenous immunoglobulin (IVIG) is recommended as first line therapy in KD. Recent evidence suggests intravenous immunoglobulins (IVIG) resistance in some cases of SARS-CoV-2 related MIS-C, thereby questioning the benefit of immunomodulators such as IL-1 or IL-6 blocking agents. We report on a cohort of 6 Swiss children with SARS-CoV2 related MIS-C presenting with clinical features compatible with Incomplete KD and Toxic Shock Syndrome associated to a cytokine storm. Serum cytokine profile investigations showed increased IL1RA levels (8 to 22-fold) in 5 of the 6 patients (one patient had not been tested), whereas, IL-6 serum levels were increased only in the 3 patients of the 6 who were tested. With exception of one patient who had only benefited by Anakinra, all patients received at least one dose of IVIG. One patient has only received Anakinra with favorable evolution, and three patients had also a steroid treatment. In addition to all this anti-inflammatory medication two patients have also received one dose of anti-IL6. In conclusion, our case series reports on clinical and laboratory findings of most of Swiss cases with MIS-C and suggests the use of Anakinra as an alternative to steroids in these children, most of whom presented with high IL-1RA levels.

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Epidemiological and clinical features of 201 COVID-19 patients in Changsha, China

10.21203/rs.3.rs-17313/v1 ◽

2020 ◽

Author(s):

Jian Zhou ◽

Jing-jing Sun ◽

Zi-qin Cao ◽

Wan-chun Wang ◽

Kang Huang ◽

...

Keyword(s):

Creatine Kinase ◽

Clinical Features ◽

City Government ◽

Disease Spread ◽

Laboratory Findings ◽

Icu Patients ◽

Number Of Patients ◽

Creatine Kinase Mb ◽

Changsha City ◽

Epidemiological Characteristics

Abstract Background In December 2019, a cluster of coronavirus Disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China. With the advent of the Chinese Spring Festival, this disease spread rapidly throughout the country. The information about the clinical characteristics of COVID-19 patients outside of Wuhan is limited. Methods All of the patients with confirmed COVID-19 were admitted to the First Hospital of Changsha City, the designated hospital for COVID-19 assigned by the Changsha City Government. The clinical and epidemiological characteristics, data of laboratory, radiological picture, treatment, and outcomes records of 201 COVID-19 patients were collected using electronic medical records. Results This study population consisted of 201 hospitalized patients with laboratory-confirmed COVID-19 in Changsha by February 15, 2020. The median age of the patients was 45 years (IQR 34–59). About half (50.7%) of the patients were male, and most of the infected patients were staff (96 [47.8%]). Concerning the epidemiologic history, the number of patients linked to Wuhan was 92 (45.8%). The most common symptoms were fever (125 [62.2%]), dry cough (118 [58.7%]), fatigue (65 [32.3%]), and pharyngalgia (31 [15.4%]). One hundred and forty-four (71.6%) enrolled patients showed bilateral pneumonia. Fifty-four (26.9%) patients showed unilateral involvement, and three (1.5%) patients showed no abnormal signs or symptoms. The laboratory findings differed significantly between the Intensive Care Unit (ICU) and non-ICU groups. Compared with non-ICU patients, ICU patients had depressed white blood cell (WBC), neutrocytes, lymphocytes, and prolonged prothrombin time (PT). Moreover, higher plasma levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), alanine aminotransferase (ALA), aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase-MB (CK-MB), creatinine (CREA), and lactate dehydrogenase (LDH) were detected in the ICU group. Conclusions In this single-center study of 201 COVID-19 patients in Changsha, China, 22.4% of patients were admitted to ICU. Based on our findings, we propose that the risk of cellular immune deficiency, hepatic injury, and kidney injury should be monitored. Previous reports focused on the clinical features of patients from Wuhan, China. With the global epidemic of COVID-19, we should pay more attention to the clinical and epidemiological characteristics of patients outside of Wuhan.

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Anticholinergic burden and fractures: a protocol for a methodological systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-030205 ◽

2019 ◽

Vol 9 (8) ◽

pp. e030205 ◽

Cited By ~ 2

Author(s):

Jonas Reinold ◽

Wiebke Schäfer ◽

Lara Christianson ◽

Francesco Barone-Adesi ◽

Oliver Riedel ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Original Data ◽

Anticholinergic Activity ◽

Hand Search ◽

Conference Presentations ◽

Registration Number ◽

Methodological Aspects ◽

Anticholinergic Burden

IntroductionMedications with anticholinergic activity are used in the treatment of many diseases common in old age, including depression, psychosis, Parkinson’s disease, allergies, pain and urinary incontinence. A high anticholinergic burden (ACB) is considered a major risk factor for fractures in older adults but recent studies reported inconsistent results. These inconsistencies may partly be due to differences in methodological aspects. However, no systematic review so far has addressed this association and considered study methods. Thus, we aim to conduct a systematic review and meta-analysis of observational studies addressing the association of ACB with fractures and to provide a methodological appraisal of the included studies.Methods and analysisWe will search MEDLINE, EMBASE, the Science Citation Index, CENTRAL and grey literature using a strategy that combines the terms anticholinergic and fractures. We will hand search reference lists of articles. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Newcastle-Ottawa Quality Assessment Scale and RTI item bank. Discrepancies will be resolved by consensus or consultation with a third researcher. We will conduct a meta-analysis, either for the overall population or for specific and more homogeneous subgroups, if the number of studies retrieved and their heterogeneity allows it.Ethics and disseminationNo ethics approval will be sought, as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations.PROSPERO registration numberCRD42018116737.

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Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis—protocol

BMJ Open ◽

10.1136/bmjopen-2019-035360 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035360

Author(s):

Britzer Paul Vincent ◽

Gurch Randhawa ◽

Erica Cook

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Grey Literature ◽

Secondary Data ◽

Organ Donor ◽

Indian Origin ◽

Ethical Approval ◽

Registration Number ◽

End Stage

IntroductionThe need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally.Methods and analysisA systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made.Ethics and disseminationAs this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy.PROSPERO registration numberCRD42019155274.

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Fifty years of imported Lassa fever: a systematic review of primary and secondary cases

Journal of Travel Medicine ◽

10.1093/jtm/taaa035 ◽

2020 ◽

Vol 27 (4) ◽

Cited By ~ 1

Author(s):

Timo Wolf ◽

Regina Ellwanger ◽

Udo Goetsch ◽

Nils Wetzstein ◽

Rene Gottschalk

Keyword(s):

Systematic Review ◽

Early Diagnosis ◽

West Africa ◽

Clinical Features ◽

Case Fatality Rate ◽

Case Fatality ◽

Lassa Fever ◽

Fatality Rate ◽

Imported Cases ◽

Epidemiological Characteristics

Abstract Rationale for Systematic Review Lassa fever is the most common cause of imported haemorrhagic fevers cases in non-endemic countries. As a disease with a high case fatality rate that has regularly caused clusters of nosocomial transmission in endemic areas, prompt diagnosis is vital. We conducted a systematic review of imported cases of the last 50 years with the aim of defining the clinical and epidemiological characteristics that will enhance early diagnosis, prompt initiation of treatment and an appropriate public health response to Lassa fever cases. Methods We performed a retrospective, systematic review of 36 primary and two secondary cases of Lassa fever in non-endemic countries outside West Africa by searching the PubMed database. This yielded 56 relevant publications that were included in our analysis. Results The case fatality rate of 35.1% for imported cases was higher than that reported for endemic countries. The majority of patients showed clinical features consistent with Lassa fever and had a typical exposure. There was a considerable delay in diagnosis in imported cases with high associated numbers of contacts. Ribavirin was rarely used for post-exposure prophylaxis. Only two secondary transmissions occurred. Thirty-one percent of patients received Lassa fever-specific treatment and five required intensive care. Conclusions Although importation of Lassa fever to non-endemic countries is a rare event, it has repeatedly happened over five decades. Suspicion of Lassa fever should be based on careful consideration of clinical features and exposure history in order to assist early diagnosis in returning travellers from West Africa.

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Healthcare provider characteristics that influence the implementation of individual-level patient-centered outcome measure (PROM) and patient-reported experience measure (PREM) data across practice settings: a protocol for a mixed methods systematic review with a narrative synthesis

Systematic Reviews ◽

10.1186/s13643-021-01725-2 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Angela C. Wolff ◽

Andrea Dresselhuis ◽

Samar Hejazi ◽

Duncan Dixon ◽

Deborah Gibson ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Point Of Care ◽

Data Extraction ◽

Grey Literature ◽

Healthcare Providers ◽

Influential Factors ◽

Narrative Synthesis ◽

Individual Level ◽

Patient Reported

Abstract Background Substantial literature has highlighted the importance of patient-reported outcome and experience measures (PROMs and PREMs, respectively) to collect clinically relevant information to better understand and address what matters to patients. The purpose of this systematic review is to synthesize the evidence about how healthcare providers implement individual-level PROMs and PREMs data into daily practice. Methods This mixed methods systematic review protocol describes the design of our synthesis of the peer-reviewed research evidence (i.e., qualitative, quantitative, and mixed methods), systematic reviews, organizational implementation projects, expert opinion, and grey literature. Keyword synonyms for “PROMs,” PREMs,” and “implementation” will be used to search eight databases (i.e., MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, SPORTDiscus, Evidence-based Medicine Reviews, and ProQuest (Dissertation and Theses)) with limiters of English from 2009 onwards. Study selection criteria include implementation at the point-of-care by healthcare providers in any practice setting. Eligible studies will be critically appraised using validated tools (e.g., Joanna Briggs Institute). Guided by the review questions, data extraction and synthesis will occur simultaneously to identify biographical information and methodological characteristics as well as classify study findings related to implementation processes and strategies. As part of the narrative synthesis approach, two frameworks will be utilized: (a) Consolidated Framework for Implementation Research (CFIR) to identify influential factors of PROMs and PREMs implementation and (b) Expert Recommendations for Implementing Change (ERIC) to illicit strategies. Data management will be undertaken using NVivo 12TM. Discussion Data from PROMs and PREMs are critical to adopt a person-centered approach to healthcare. Findings from this review will guide subsequent phases of a larger project that includes interviews and a consensus-building forum with end users to create guidelines for implementing PROMs and PREMs at the point of care. Systematic review registration PROSPERO CRD42020182904.

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Does pain influence force steadiness? A protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-042525 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042525

Author(s):

Michail Arvanitidis ◽

Deborah Falla ◽

Andy Sanderson ◽

Eduardo Martinez-Valdes

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Meta Analysis ◽

Grey Literature ◽

Force Steadiness ◽

Assessment Development ◽

Ethical Approval ◽

Registration Number ◽

Meta Analyses

IntroductionPerforming contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of experimental or clinical musculoskeletal pain on force steadiness but with conflicting findings. The aim of this systematic review is to summarise the current literature to determine whether pain, whether it be clinical or experimental, influences force steadiness.Methods and analysisThis protocol for a systematic review was informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Handbook for Systematic Reviews of Interventions. Key databases will be searched from inception to 31 August 2020, including MEDLINE, EMBASE, PubMed, CINAHL Plus, ZETOC and Web of Science. Grey literature and key journals will be also reviewed. Risk of bias will be assessed with the Newcastle-Ottawa tool, and the quality of the cumulative evidence assessed with the Grading of Recommendations, Assessment, Development and Evaluation guidelines. If homogeneity exists between groups of studies, meta-analysis will be conducted. Otherwise, a narrative synthesis approach and a vote-counting method will be used, while the results will be presented as net increases or decreases of force steadiness.Ethics and disseminationThe findings will be presented at conferences and the review will be also submitted for publication in a refereed journal. No ethical approval was required.PROSPERO registration numberCRD42020196479

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