COVID-19 and Cutaneous Disorders: What’s Being Reported? A Meta-Analysis from Observational Studies and Case Reports

Background: Coronavirus disease (COVID-19) is related to several extrapulmonary disorders; however, little is known about the skin disorders characteristics and prevalence. Objetive: Summarize and evaluate the skin disorders’ characteristics and prevalence reported in the literature. Methods: We conducted a search on PubMed, SciELO and ScienceDirect between 01/01/2020 to 09/28/2020. The target population was patients with skin disorder and a positive diagnosis for COVID-19. All observational studies, research letters, case series and case reports were selected. We evaluated observational studies using Random- effects models to calculate the weighted mean prevalence and 95% confidence interval (CI). We evaluated the case studies using the chi-square test for dichotomous variables and the Mann-Whitney test for continuous variables. Results: Eighty-seven patients from case reports and six observational studies with 363 patients were selected. Eleven types of skin disorders in COVID-19 confirmed patients are described. Skin disorder weighted mean prevalence was 9.9% (95% CI: 3.7-24.1). Maculopapular rash was the most prevalent disorder (37.5%; 95% CI: 21-57%). Latency was significantly lower in patients over 60 years old (p=0.041). Conclusion: Each cutaneous manifestation has its particularities and may or may not accompany other signs and symptoms. It is possible for the elderly to have COVID-19- related skin disorders early.

Download Full-text

Assessment of the possibility of vertical transmission of COVID-19: A systematic review and meta-analysis protocol

10.21203/rs.3.rs-18035/v1 ◽

2020 ◽

Author(s):

Sareh Dashti ◽

Tahereh Fathi Najafi ◽

Hamid Reza Tohidinik ◽

Narjes Bahri

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Vertical Transmission ◽

Observational Studies ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

World Health ◽

Free Text ◽

Care Providers

Abstract BackgroundThe novel coronavirus 2019 (COVID-19) outbreak has put a great burden on global health and healthcare systems. One of the vulnerable groups to COVID-19 infection and complications is the pregnant women. There is controversy regarding the possibility of vertical transmission of COVID-19 from mother to infant. The aim of this systematic review and meta-analysis was to assess the possibility of vertical transmission of COVID-19 based on currently published literature including observational studies. All published articles including case reports, case series,MethodsThis study will be conducted on all published observational studies, including cross-sectional studies, cohort, case-control, case reports, and case series, in peer reviewed journals in any language until the end of March 2020. Editorials, commentaries and letter to editors will be excluded from the review. Search will be conducted in international bibliographic databases including PubMed, Embase, and Web of Science based on preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Primary search will be performed in PubMed and Embase using the Coronavirus 2019 and vertical transmission keywords based on medical subject heading (MeSH) terms along with free text searching in combination with Boolean operations. The search strategy will be improved and finalized based on the results of the primary search. The World Health Organization (WHO) and google scholar websites will be searched as grey literature. Articles will be reviewed by two authors independently for the relevance of titles and abstracts. Data extraction of the included articles will be performed by two researchers using the Zotero and review manager (revMan) software. Heterogeneity of the articles will be assessed using DerSimonian & Laird Q test and I 2 statistic. The pooled estimated prevalence of vertical transmission of COVID-19 will be performed using the Metaprop command. Publication bias will be assessed using the Begg's rank correlation and the Egger weighted regression methods.DiscussionThe findings of this systematic review and meta-analysis will help practitioners and health care providers in decision making for the care and management of COVID-19 infected pregnant women. Systematic review registration In process

Download Full-text

Effectiveness and Safety of MSC Cell Therapies for Hospitalized Patients with COVID-19: A Systematic Review and Meta-analysis

10.1101/2021.10.05.21264559 ◽

2021 ◽

Author(s):

Wenchun Qu ◽

Zhen Wang ◽

Erica Engelberg Cook ◽

Abu Bakar Siddik ◽

Guojun Bu ◽

...

Keyword(s):

Adverse Events ◽

Cell Therapy ◽

Pulmonary Function ◽

Observational Studies ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Cell Therapies ◽

Significant Difference ◽

All Cause Mortality

ABSTRACT MSC (a.k.a. mesenchymal stem cell or medicinal signaling cell) cell therapies have shown promise in decreasing mortality in ARDS and suggest benefits in treatment of COVID-19 related ARDS. We performed a meta-analysis of published trials assessing the effectiveness and adverse events (AE) of MSC cell therapy in individuals hospitalized for COVID-19. Systematic searches were performed in multiple databases through April 8th, 2021. Reports in all languages including randomized clinical trials (RCTs), comparative observational studies, and case series/case reports were included. Random effects model was used to pool outcomes from RCTs and comparative observational studies. Outcome measures included all-cause mortality, serious adverse events (SAEs), AEs, pulmonary function, laboratory and imaging findings. A total of 413 patients were identified from 25 studies, which included 8 controlled trials (3 RCTs), 5 comparative observational studies, (n=300) and 17 case-series/case reports (n=113). The patients age was 60.5 years (mean), 33.7% were women. When compared with the control group, MSC cell therapy was associated with reduction in all-cause mortality (RR=0.31, 95% CI: 0.12 to 0.75, I2=0.0%; 3 RCTs and 5 comparative observational studies, 300 patients), reduction in SAEs (IRR=0.36, 95% CI: 0.14 to 0.90, I2=0.0%; 3 RCTs and 2 comparative studies, n=219), no significant difference in AE rate. A sub-group with pulmonary function studies suggested improvement in patients receiving MSC. These findings support the potential for MSC cell therapy to decrease all-cause mortality, reduce SAEs, and improve pulmonary function compared to conventional care. Large scale double-blinded, well-powered RCTs should be conducted to further explore these results.

Download Full-text

Impact of achondroplasia on Latin American patients: a systematic review and meta-analysis of observational studies

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-02142-3 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Virginia Fano ◽

Chong A. Kim ◽

Pablo Rosselli ◽

Regina El Dib ◽

Renée Shediac ◽

...

Keyword(s):

Latin American ◽

Observational Studies ◽

Medical Literature ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Growth Factor Receptor ◽

Speech Disorders ◽

Cross Sectional ◽

The Impact

Abstract Background Achondroplasia (ACH), the most common form of disproportionate short stature, is caused by a pathogenic variant in the fibroblast growth factor receptor 3 gene. Recent advances in drug therapy for ACH have highlighted the importance of elucidating the natural history and socioeconomic burden of this condition. Recognition that there are many potential issues for the patient with ACH is the first step in planning cost-effective interventions in Latin America (LATAM), a vast geographic territory comprising countries with multicultural characteristics and wide socioeconomic differences. We conducted a systematic literature review to characterize the impact of ACH on affected individuals and on healthcare resources in LATAM countries. Methods Searches of the global medical literature as well as regional and local medical literature up to August 2020. Observational studies on patients with ACH from any LATAM country. Pairs of reviewers independently screened eligible articles, extracted data from included studies, and assessed their risk of bias. Results Fifty-three unique studies (28 case series and cross-sectional studies and 25 case reports) including data on 1604 patients were eligible. Of these studies, 11 had data available for meta-analysis. Both premature mortality and all-cause mortality in the pooled studies was 15% [95% Confidence Interval (CI) 1.0E−3 to 0.47; I2 = 82.9%, p = 0.0029; three studies, n = 99 patients]. Frequency of cardio-respiratory-metabolic disorders was 17% [95% CI 0.04–0.37; I2 = 90.3%, p < 0.0001; four studies, n = 230 patients]; nervous system disorders was 18% [95% CI 0.07–0.33; I2 = 84.6%, p < 0.0001; six studies, n = 262 patients]; ear, nose, throat and speech disorders was 32% [95% CI 0.18–0.48; I2 = 73.4%, p = 0.0046; five studies, n = 183 patients]; and spinal issues including stenosis, compression and associated pain was 24% [95% CI 0.07–0.47; I2 = 91.3%, p < 0.0001; five studies, n = 235 patients]. Conclusions There is currently evidence of high clinical burden in ACH patients in LATAM countries. Establishing the impact of ACH provides the necessary foundation for planning tailored and effective public health interventions.

Download Full-text

Thrombosis in Cancer Patients Treated with Hematopoietic Growth Factors - A Meta-Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650276 ◽

1996 ◽

Vol 75 (02) ◽

pp. 368-371 ◽

Cited By ~ 51

Author(s):

T Barbul ◽

G Finazzi ◽

A Grassi ◽

R Marchioli

Keyword(s):

Cancer Patients ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Hematopoietic Growth Factors ◽

Patients With Cancer ◽

Cytotoxic Treatment ◽

Pertinent Data ◽

Thrombotic Complications ◽

Vascular Occlusions

SummaryHematopoietic colony-stimulating factors (CSFs) are largely used in patients with cancer undergoing cytotoxic treatment to accelerate neutrophil recovery and decrease the incidence of febrile neutropenia. Clinical practice guidelines for their use have been recently established (1), taking into account clinical benefit, but also cost and toxicity. Vascular occlusions have been recently reported among the severe reactions associated with the use of CSFs, in anedoctal case reports (2, 3), consecutive case series (4) and randomized clinical trial (5, 6). However, the role of CSFs in the pathogenesis of thrombotic complications is difficult to ascertain, because pertinent data are scanty and widely distributed over a number of heterogenous investigations. We report here a systematic review of relevant articles, with the aims to estimate the prevalence of thrombosis associated with the use of CSFs and to assess if this rate is significantly higher than that observed in cancer patients not receiving CSFs.

Download Full-text

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.5.peds19126 ◽

2019 ◽

Vol 24 (5) ◽

pp. 558-571 ◽

Cited By ~ 3

Author(s):

Kartik Bhatia ◽

Hans Kortman ◽

Christopher Blair ◽

Geoffrey Parker ◽

David Brunacci ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Download Full-text

Risk of colectomy after conservative treatment of diverticulitis of the left hemicolon complicated by abdominal or pelvic abscess: protocol of a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-042350 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042350

Author(s):

Maximilian Sohn ◽

Ayman Agha ◽

Igors Iesalnieks ◽

Anna Tiefes ◽

Alfred Hochrein ◽

...

Keyword(s):

Systematic Review ◽

Emergency Surgery ◽

Case Reports ◽

Acute Diverticulitis ◽

Meta Analysis ◽

Case Series ◽

Pelvic Abscess ◽

Risk Of Bias ◽

Cochrane Central Register ◽

Review Manager

IntroductionAcute diverticulitis of the sigmoid colon is increasingly treated by a non-operative approach. The need for colectomy after recovery from a flare of acute diverticulitis of the left colon, complicated diverticular abscess is still controversial. The primary aim of this study is to assess the risk of interval emergency surgery by systematic review and meta-analysis.Methods and analysisThe systematic review and meta-analysis will be conducted in accordance to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE will be screened for the predefined searching term: (Diverticulitis OR Diverticulum) AND (Abscess OR pelvic abscess OR pericolic abscess OR intraabdominal abscess) AND (surgery OR operation OR sigmoidectomy OR drainage OR percutaneous drainage OR conservative therapy OR watchful waiting). All studies published in an English or German-speaking peer-reviewed journal will be suitable for this analysis. Case reports, case series of less than five patients, studies without follow-up information, systematic and non-systematic reviews and meta-analyses will be excluded. Primary endpoint is the rate of interval emergency surgery. Using the Review Manager Software (Review Manager/RevMan, V.5.3, Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2012) meta-analysis will be pooled using the Mantel-Haenszel method for random effects. The Risk of Bias in Non-randomized Studies of Interventions tool will be used to assess methodological quality of non-randomised studies. Risk of bias in randomised studies will be assessed using the Cochrane developed RoB 2-tool.Ethics and disseminationAs no new data are being collected, ethical approval is exempt for this study. This systematic review is to provide a new insight on the need for surgical treatment after a first attack of acute diverticulitis, complicated by intra-abdominal or pelvic abscesses. The results of this study will be presented at national and international meetings and published in a peer-reviewed journal.PROSPERO registration numberCRD42020164813.

Download Full-text

The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-86079-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Claudia Cristina Biguetti ◽

Joel Ferreira Santiago Junior ◽

Matthew William Fiedler ◽

Mauro Toledo Marrelli ◽

Marco Brotto

Keyword(s):

Systematic Review ◽

Quantitative Analysis ◽

Qualitative Analysis ◽

Observational Studies ◽

Skeletal Muscles ◽

Case Reports ◽

Meta Analysis ◽

Toxic Effects ◽

Drug Induced ◽

Qualitative And Quantitative

AbstractThe aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.

Download Full-text

Neuroendocrine Testicular Tumors: A Systematic Review and Meta-Analysis

Current Urology ◽

10.1159/000447146 ◽

2016 ◽

Vol 10 (1) ◽

pp. 15-25 ◽

Cited By ~ 7

Author(s):

Mseddi M. Amine ◽

Bouzguenda Mohamed ◽

Hadjslimane Mourad ◽

Hamza Majed ◽

Charfi Slim ◽

...

Keyword(s):

Survival Rate ◽

Neuroendocrine Tumors ◽

Carcinoid Syndrome ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Palpable Mass ◽

Pubmed Database ◽

Evolutionary Features ◽

Radical Orchiectomy

Purpose: The purpose of this study is to study the main epidemiological, clinical, para clinical, pathological, therapeutic, and evolutionary features of patients with testicular neuroendocrine tumors (TNET). Materials and Methods: Nine case series and sixteen case reports were identified by searching PubMed database and qualified for inclusion in this study. We added the data of one case treated in the department of urology in Habib Bourguiba Hospital in Sfax, to the published cases. Results: A total of 132 cases were collected. Median age at diagnosis was 39 years old (range 10- 83 years). The most common presenting symptom was either a testicular mass or a swelling in 38.46% of cases. Carcinoid syndrome was documented in 10.60% of patients. The clinical examination revealed a palpable mass in 44.70% of patients. This mass was painless and firm in most cases. Serum tumor markers (β-gonadotrophine chorionique humaine, α-feto protein, and lactate dehydrogenase) were within normal limits in all patients except in one case. Most testicular neuroendocrine tumors (76.52%) were primary and pure. The tumors were positive for chromogranin (100%), synaptophysin (100%) and cytokeratin (93.10%). Metastases were detected at time of diagnosis in eight cases (6.06%). The main treatment was radical orchiectomy performed in 127 patients (96.21%). The 5-year overall survival rate was 78.70% and the 5-year specific survival rate was 84.30%. Conclusion: The diagnosis of testicular carcinoids is based on the immunohistochemistry study. The treatment of choice for these tumors is radical orchiectomy. Somatostatin analogues were reported to be effective in patients with carcinoid syndrome.

Download Full-text

Malignant thyroid teratoma: an integrated analysis of case series and case reports

Endocrine Related Cancer ◽

10.1530/erc-21-0142 ◽

2021 ◽

Author(s):

Huy Gia Vuong ◽

Truong P.x. Nguyen ◽

Hanh T.t. Ngo ◽

Lewis Hassell ◽

Kennichi Kakudo

Keyword(s):

Clinical Course ◽

Case Reports ◽

Case Series ◽

Seer Program ◽

Integrated Analysis ◽

Continuous Variables ◽

Chi Square ◽

Large Tumor ◽

Exact Test

Malignant thyroid teratoma (MTT) is a very rare thyroid malignancy. These neoplasms have been reported only in case reports and small-sized case series so far. In this study, we searched for MTTs in the Surveillance, Epidemiology, and End Result (SEER) program during 1975-2016. Subsequently, we incorporated the SEER data with published MTT cases in the literature to analyze the characteristics and prognostic factors of MTTs. Integrated data were analyzed using Chi-square or Fisher’s exact test for categorical covariates, and t-test or Mann-Whitney test for continuous variables. We included 28 studies with 36 MTT cases and found additional 8 cases from the SEER program for final analyses. Our results showed that MTT is typically seen in adult females. These neoplasms were associated with an aggressive clinical course with high rates of extrathyroidal extension (80%) and nodal involvement (62%). During follow-up, the development of recurrence and metastases were common (42% and 46%, respectively), and one-third of patients died at the last follow-up. Large tumor size (p = 0.022) and the presence of metastases during follow-up (p = 0.008) were associated with a higher mortality rate. In conclusion, our study demonstrated the characteristic features of MTT patients and outlined some parameters associated with a negative outcome which could help clinicians better predict the clinical course of these neoplasms.

Download Full-text

Treatment of Pyodermatitis-Pyostomatitis Vegetans: A Systematic Review and Meta-analysis

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.5.4.1 ◽

2021 ◽

Vol 5 (4) ◽

pp. 333-346

Author(s):

Landon Kaleb Hobbs ◽

Alina Zufall ◽

Shadi Khalil ◽

Richard Flowers

Keyword(s):

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Calcineurin Inhibitors ◽

Additional Patient ◽

Aminosalicylic Acid ◽

First Line Therapy ◽

Pyostomatitis Vegetans ◽

Oral Corticosteroids ◽

Topical Medications

Background: Pyodermatitis-pyostomatitis vegetans (PDV-PSV) is a rare muco-cutaneous disorder characterized by vegetating and pustular plaques and is often associated with inflammatory bowel disease (IBD). The purpose of this study was to systematically identify and analyze reports of PDV-PSV to determine the most effective treatment. Methods: Reports of PDV-PSV were identified using the OVID-Medline database from inception through November 2019. Publications were excluded if no new patient case was included, if there was not clinical and histological evidence of PDV, PSV, or PDV-PSV, or if no treatment was discussed. Results: The final sample was comprised of 74 publications plus an additional patient from the authors’ institution, corresponding to 95 total patients. The basis of the review and analysis is limited to case reports and case series, which likely only report the cases with positive outcomes. Statistical analysis revealed that oral corticosteroids (OCS), 6-mercaptopurine/azathioprine, oral calcineurin inhibitors (OCNI), 5-aminosalicylic-acid (5-ASA), and biologics (BIO) were the most effective treatments for PDV-PSV. Topical medications, colchicine, oral dapsone, and other antibiotics were ineffective treatments, with topical medications being the least effective option. When OCS are used, they work best when used as initial treatment to induce remission. 5-ASA and BIO are most effective when used as maintenance therapies after initial remission. Conclusions: Thus, first line therapy for PDV-PSV should begin with OCS with transition to steroid-sparing agents including OCNI, BIO, and 5-ASA if indicated.

Download Full-text