Investigating placental pathologies in pregnant women with SARS-CoV-2: Systematic Review and Meta-analysis Protocol

An investigation into placental pathology in pregnant women with SARS-CoV-2 has not yet been examined extensively; however, this knowledge would be beneficial in understanding the potential for vertical transmission of SARS-CoV-2 during pregnancy, via the placenta. Currently, results are conflicting, with some evidence suggesting rare placental infection. Conversely, compared to controls, one study determined that third trimester placentas were significantly more likely to show one feature of maternal vascular malperfusion (MVM), and intervillous thrombi, fetal vascular malperfusion or fetal vascular thrombosis, and increased perivillous fibrin deposition and intervillositis. In contrast, another study reported no significant differences in individual or group gross or microscopic pathological features. As well, no ACE2 expression has yet been detected in villous stroma, Hofbauer cells, or endothelial cells, and TMPRSS2 expression is only weakly present in villous endothelium. In light of the inconclusive evidence, the burden of placental pathologies potentially related to SARS-CoV-2 in pregnant women and their neonates or infants, remains at the forefront of medical attention, particularly among pathologists, and obstetricians worldwide. This protocol describes the steps of our systematic review, which aims to investigate differences in placental pathologies in pregnant women with SARS-CoV-2 versus pregnant women without the virus. Our study will identify case series, case-control and cohort studies of asymptomatic and symptomatic pregnant women, who test positive for SARS-CoV-2 during any stage of their pregnancy, as validated by laboratory confirmed positive antibody testing or using real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR). Studies examining pregnant women who test positive during the first, second or third trimester, are eligible. Only articles written in English or French will be included. Literature reviews, systematic reviews, editorials, letters to the editor, conference abstracts, and commentaries will be excluded. The following databases will be searched: MEDLINE including Epub Ahead of Print, In-Process & Other Non-Indexed Citations (1946- November 17, 2020) and Embase (1980- November 17, 2020). Two specialized COVID-19 resources will also be searched November 18, 2020; Cochrane Covid-19 study register which indexes according to study design, and the WHO Covid-19 Collection which includes material from numerous sources including preprint servers. Primary outcomes of interest are: retroplacental hematoma, diffuse parenchymal consolidation, maternal vascular malperfusion, fetal vascular malperfusion, and other diseases of the placenta as detailed in this protocol. Observational studies will be assessed using the Ottawa-Newcastle scale. Data will be aggregated or synthesized at the level of individual participants. Tables will be used to summarize the general characteristics of the studies included. Depending on the data and the level of variation between studies, a meta-analysis will be used to synthesize data. Count and dichotomous data will be expressed as odds ratios with 95% confidence intervals, while continuous data will be expressed as a mean or standardized mean difference with 95% confidence intervals. Statistical heterogeneity of the included studies will be assessed using the I-squared test with 95% confidence intervals, and publication bias will be determined using a funnel plot and Egger’s test when possible (>10 included studies). This review will ultimately aid in informing pathologists, obstetricians, and gynecologists when managing and treating pregnant women with SARS-CoV-2. If no evidence of vertical transmission or changes to placenta can be elucidated, then this work can inform future research investigating alternate routes of SARS-CoV-2 transmission.

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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

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Epidemiology of gastric cancer in Africa: a systematic review and meta-analysis protocol

Systematic Reviews ◽

10.1186/s13643-019-1214-2 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Celestin Danwang ◽

Jean Joel Bigna

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Random Effect ◽

Case Series ◽

Case Fatality ◽

Cross Sectional ◽

Statistical Heterogeneity ◽

The Usa

Abstract Background Gastric cancer is actually known as the sixth most frequent cancer and the second cancer-related cause of death worldwide. If studies giving an overview of current epidemiology of gastric cancer in Europe, Asia, and the USA are available, in Africa, studies reporting recent data on gastric cancer are sparse. This systematic review and meta-analysis aim therefore to provide relevant data on contemporary epidemiology of gastric cancer in Africa in terms of prevalence, incidence, and case fatality rate. Methods and design We will include cohort, case-control, cross-sectional studies, and case series with more than 30 participants. EMBASE, PubMed, Africa Index Medicus, Africa Journals Online, and Web of Science will be searched for relevant abstracts of studies published and unpublished between January 1, 2000, and April 30, 2019, without language restriction. The review will be reported according to the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) guideline. After screening of abstracts, study selection, data extraction, and risk of bias assessment, we shall assess the studies individually for clinical and statistical heterogeneity. Random-effect meta-analysis will be used to pool studies judged to be clinically homogenous. The Egger test and visual inspection of funnel plots will be used to assess publication bias. Discussion This review will provide relevant data on the current burden of gastric cancer in Africa. Systematic review registration PROSPERO CRD42019130348.

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Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies

10.1101/2020.05.02.20088484 ◽

2020 ◽

Cited By ~ 1

Author(s):

Juan Juan ◽

María M. Gil ◽

Zhihui Rong ◽

Yuanzhen Zhang ◽

Huixia Yang ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Vertical Transmission ◽

Case Reports ◽

Case Series ◽

Severe Pneumonia ◽

Outcome Data ◽

Neonatal Outcomes ◽

Eligibility Criteria ◽

Maternal Deaths

ABSTRACTObjectiveTo perform a systematic review of available published literature on pregnancies affected by COVID-19 to evaluate the effects of COVID-19 on maternal, perinatal and neonatal outcomes.MethodsWe performed a systematic review to evaluate the effects of COVID-19 on pregnancy, perinatal and neonatal outcomes. We conducted a comprehensive literature search using PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure Database and Wan Fang Data until April 20, 2020 (studies were identified through PubMed alert after April 20, 2020). For the research strategy, combinations of the following keywords and MeSH terms were used: SARS-CoV-2, COVID-19, coronavirus disease 2019, pregnancy, gestation, maternal, mothers, vertical transmission, maternal-fetal transmission, intrauterine transmission, neonates, infant, delivery. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient was pregnant on admission, availability of clinical characteristics, including maternal, perinatal or neonatal outcomes. Exclusion criteria were unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, and unreported maternal or perinatal outcomes. No language restrictions were applied.ResultsWe identified several case-reports and case-series but only 19 studies, including a total of 266 pregnant women with COVID-19, met eligibility criteria and were finally included in the review. In the combined data from seven case-series, the maternal age ranged from 20 to 41 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath and fatigue. The rate of severe pneumonia was relatively low, with the majority of the cases requiring intensive care unit admission. Almost all cases from the case-series had positive computer tomography chest findings. There were six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, which were negative for SARS-CoV-2. Only a few cases had spontaneous miscarriage or abortion. 177 cases had delivered, of which the majority by Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at 1 and 5 minutes ranged from 7 to 10 and 8 to 10, respectively. A few neonates had birthweight less than 2500 grams and over one-third of cases were transferred to neonatal intensive care unit. There was one case each of neonatal asphyxia and neonatal death. There were 113 neonates that had nucleic-acid testing in throat swab, which was negative for SARS-CoV-2. From the case-reports, two maternal deaths among pregnant women with COVID-19 were reported.ConclusionsThe clinical characteristics of pregnant women with COVID-19 are similar to those of nonpregnant adults with COVID-19. Currently, there is no evidence that pregnant women with COVID-19 are more prone to develop severe pneumonia, in comparison to nonpregnant patients. The subject of vertical transmission of SARS-CoV-2 remains controversial and more data is needed to investigate this possibility. Most importantly, in order to collect meaningful pregnancy and perinatal outcome data, we urge researchers and investigators to reference previously published cases in their publications and to record such reporting when the data of a case is being entered into a registry or several registries.ContributionWhat are the novel findings of this work?Amongst a few cases from the case-series that had qRT-PCR testing in vaginal mucus and breast milks, the results were negative for SARS-CoV-2. Similarly, some of the cases from the case-series had qRT-PCR testing in amniotic fluid, cord blood, neonatal throat swab and neonatal feces, and the results were negative for SARS-CoV-2. Amongst the case-reports, there were two maternal deaths and two neonates tested positive for SARS-CoV-2 at 16 / 24 hours of life.What are the clinical implications of this work?The subject of vertical transmission of SARS-CoV-2 remains controversial and more data is needed to investigate this possibility. In order to collect meaningful pregnancy and perinatal outcome data, we urge researchers and investigators to reference previously published cases in their publications and to record such reporting when the data of a case is being entered into a registry or several registries.

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Prevalence of maternal Group B Streptococcus rectovaginal colonization among pregnant women in Ethiopia: protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-406725/v1 ◽

2021 ◽

Author(s):

Delayehu Bekele ◽

Dawit Getachew Assefa ◽

Wondimu Gudu ◽

Mekitie Wondafrash ◽

Lemi Belay Tolu

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Vertical Transmission ◽

Meta Analysis ◽

National Level ◽

Group B Streptococcus ◽

Cochrane Library ◽

Resistance Pattern ◽

Reference List ◽

Group B

Abstract Background: Rectovaginal colonization with Group B streptococcus (GBS) during pregnancy is an important risk factor for serious infections including neonatal sepsis, pneumonia, and meningitis. It is also associated with stillbirth and preterm birth. Since globally rates of GBS colonization, as well as rates of vertical transmission to the newborn, differ broadly, having national data is important for implementing strategies to reduce neonatal morbidity and mortality as a result of GBS infection. We propose this systematic review and meta-analysis to describe the prevalence of rectovaginal GBS colonization, rate of vertical transmission, and the antibiotic resistance pattern among third trimester pregnant women in Ethiopia.Methods: A systematic search will be done of PubMed (MEDLINE), EMBASE, CINHAL, and Cochrane Library. In addition, google scholar will be searched, and a reference list of the already identified articles will be checked to find additional eligible articles that were missed during the initial search. Two reviewers will screen all retrieved articles and assess the methodological quality of included studies using the Newcastle-Ottawa Scale (NOS) checklist. Any disagreement between two reviewers will be resolved by a third reviewer. We will extract data using the JBI data extraction tool for the systematic review of prevalence studies. The data analysis will be conducted using Stata Statistical Software: Release 15. We will present pooled estimates of the prevalence of GBS colonization and rates of vertical transmission with a 95% confidence interval.Discussion: This will be the first synthesis of data on GBS during pregnancy at a national level. It will inform decision-makers in determining whether a universal or a risk-based screening strategy is most appropriate, as well as guiding them in adopting an intrapartum antibiotic protocol.Registration: Submitted to PROSPERO on 18/03/2021

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Adult Craniopharyngioma: Case Series, Systematic Review, and Meta-Analysis

Neurosurgery ◽

10.1093/neuros/nyx570 ◽

2017 ◽

Vol 83 (4) ◽

pp. 631-641 ◽

Cited By ~ 17

Author(s):

Charlotte Dandurand ◽

Amir Ali Sepehry ◽

Mohammad Hossein Asadi Lari ◽

Ryojo Akagami ◽

Peter Gooderham

Keyword(s):

Systematic Review ◽

Adjuvant Radiotherapy ◽

Meta Analysis ◽

Case Series ◽

Extent Of Resection ◽

Treatment Modalities ◽

Future Research ◽

Subtotal Resection ◽

Risk Of Recurrence ◽

Institutional Experience

Abstract BACKGROUND The optimal therapeutic approach for adult craniopharyngioma remains controversial. Some advocate for gross total resection (GTR), while others advocate for subtotal resection followed by adjuvant radiotherapy (STR + XRT). OBJECTIVE To conduct a systematic review and meta-analysis assessing the rate of recurrence in the follow-up of 3 yr in adult craniopharyngioma stratified by extent of resection and presence of adjuvant radiotherapy. METHODS MEDLINE (1946-July 1, 2016) and EMBASE (1980-June 30, 2016) were systematically reviewed. From1975 to 2013, 33 patients were treated with initial surgical resection for adult onset craniopharyngioma at our center and were reviewed for inclusion in this study. RESULTS Data from 22 patients were available for inclusion as a case series in the systematic review. Eligible studies (n = 21) were identified from the literature in addition to a case series of our institutional experience. Three groups were available for analysis: GTR, STR + XRT, and STR. The rates of recurrence were 17%, 27%, and 45%, respectively. The risk of developing recurrence was significant for GTR vs STR (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.15-0.38) and STR + XRT vs STR (OR: 0.20, 95% CI: 0.10-0.41). Risk of recurrence after GTR vs STR + XRT did not reach significance (OR: 0.63, 95% CI: 0.33-1.24, P = .18). CONCLUSION This is the first and largest systematic review focusing on the rate of recurrence in adult craniopharyngioma. Although the rates of recurrence are favoring GTR, difference in risk of recurrence did not reach significance. This study provides guidance to clinicians and directions for future research with the need to stratify outcomes per treatment modalities.

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531 COVID-19 and Patients with Congenital Heart Disease: Are the Risk Higher? A Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab134.063 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Haiduc ◽

M Ogunjimi ◽

R Shammus ◽

S Mahmood ◽

A Harky

Keyword(s):

Systematic Review ◽

Case Reports ◽

Data Extraction ◽

Meta Analysis ◽

Case Series ◽

Future Research ◽

Extensive Literature ◽

Mesh Terms ◽

Extensive Literature Search ◽

Poor Outcomes

Abstract Introduction We aimed to determine if patients with CHD are at a higher risk of poor outcomes if they have COVID-19, compared to those without CHD. Method A systematic review was executed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. To identify articles related to COVID-19 and CHD, an extensive literature search was performed on EMBASE, Medline, Scopus and Global Health databases using keywords and MeSH terms. Results 12 articles met the inclusion criteria and were included for analysis in this systematic review. Two themes were identified for data extraction: [1] evidence supporting higher risks in CHD patients and [2] evidence against higher risks in CHD patients. After combining the data, there were 99 patients with CHDs out of which 12 required admission to ICU. Conclusions This systematic review suggests that CHD may increase the risk of poor outcomes for those with COVID-19, but also highlights the necessity for more research with larger sample sizes in order to make a more justified conclusion, as the majority of papers that were analysed were case series and case reports. Future research should aim to quantify the risks if possible while accounting for various confounding factors such as age and treatment history.

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SARS-CoV-2 and the role of vertical transmission from infected pregnant women to their fetuses: systematic review.

10.1101/2021.06.30.21259750 ◽

2021 ◽

Author(s):

Annette Pluddemann ◽

Elizabeth A Spencer ◽

Carl Heneghan ◽

Jon Brassey ◽

Igho J Onakpoya ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Vertical Transmission ◽

Case Reports ◽

Mode Of Delivery ◽

Hospital Setting ◽

Case Series ◽

Risk Of Bias ◽

Improvement Project

Background Vertical transmission of SARS-CoV-2 has been reported but does not appear to be common. This study aims to systematically review the evidence for vertical transmission of SARS-CoV-2. Methods This review is part of an Open Evidence Review on the transmission dynamics of SARS-CoV-2 and the role of intrauterine mother to fetus transmission. Literature searches were performed in the WHO Covid-19 Database, LitCovid, medRxiv, and Google Scholar for SARS-CoV-2 using keywords and associated synonyms, search date up to 20 December 2020, no language restrictions. Results We included 106 studies assessing vertical transmission of SARS-CoV-2 from pregnant women to their neonates: these studies comprised 40 reviews (21 fulfilled systematic review methodology, including risk of bias assessment of included studies) and 66 primary studies including 32 case reports (of up to two cases) and 34 prospective and retrospective cohort studies, prospective and retrospective case series, observational studies (including asymptomatic screening), database studies and a quality improvement project. Almost all were conducted in a hospital setting. The 32 case reports were considered to be at high risk of bias, due to the study design; across the 34 remaining primary studies, risk of bias was low to moderate. Sixteen case reports examined vertical transmission, which was not related to maternal symptomatology. For the cohort and case series studies, the percentage of positive neonates ranged from 0% to 22% across the studies. Twenty studies reported no positive vertical transmission. Three studies that reported the highest positivity rates of 11%, 15% and 22% had specifically selected neonates with a positive test (within up to 35 days) within the study population and were therefore more selective populations. Across the cohort and case series studies there were 65/2391 (2.7%) neonates born to mothers with a diagnosis of COVID-19 tested positive for SARS-CoV-2 within 24 hours of birth. No evidence correlated maternal symptomatology to vertical transmission. Mode of delivery did not correlate with rates of vertical transmission. Of 25 studies, 7 identified SARS-CoV-2 in placental tissue; some of these did not demonstrate vertical transmission to the neonate. No study reported the results of viral culture to detect SARS-CoV-2. Conclusions The results of these studies indicate that vertical transmission is possible, but is not frequent, and factors that influence when vertical transmission occurs are unknown. Further studies using standardised methods to establish viral infection are needed to establish vertical transmission rates and to assess clinical and other conditions affecting transmission.

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The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature

Journal of Clinical Medicine ◽

10.3390/jcm10020360 ◽

2021 ◽

Vol 10 (2) ◽

pp. 360

Author(s):

Yolanda Cuñarro-López ◽

Pilar Pintado-Recarte ◽

Ignacio Cueto-Hernández ◽

Concepción Hernández-Martín ◽

María Pilar Payá-Martínez ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Country Of Origin ◽

Medical Attention ◽

The Novel ◽

Limited Data ◽

Third Trimester ◽

Chest X Ray ◽

Worse Prognosis

SARS-CoV-2 is the novel member of coronavirus responsible for the worldwide pandemic COVID-19, affecting all types of people. In this context, established research identified pregnant women as a susceptible group of SARS-CoV-2 infection, although there is still limited data regarding the real impact of COVID-19 in this group. With that purpose, we conducted a systematic review describing the maternal-fetal results of pregnant women infected by SARS-CoV-2, in aim to analyze the profile of the obstetric patients according to the country of origin of the publication. A total of 38 articles were included in this systematic review with 2670 patients from 7 countries, with 20 works published from China (52.6%). We reported significative differences according to the median maternal age, with Spain as the country with the highest age (34.6 years); The percentage of tabaquism; proportion of symptomatic patients in the triage; type of radiological exam (China and France conduct CT scans on all their patients in comparison to the use of chest X-Ray in the rest of the countries studied); percentages of C-sections (83.9% in China; 35.9% Spain, p < 0.001); maternal mortality rate, proportion of patients who need treatments, the use of antivirals, antibiotics, and anticoagulants as well as measurements of the newborns. Perinatal results are favorable in the majority of countries, with very low rates of vertical transmission in the majority of works. The studies collected in this review showed moderate to high index of quality. The different works describe the affectation during the first wave of the pandemic, where the pregnant woman with SARS-CoV-2 infection is generally symptomatic during the third trimester of gestation along with other factors associated with worse prognosis of the disease, such as higher age, body mass index, and further comorbidities developed during pregnancy. In the obstetric patient, proportion of C-sections are elevated together with prematurity, increasing maternal perinatal morbimortality. Differences found between countries could be based on the proper profile of the patient in each region, the period of the pandemic directly affecting how it was managed, and the variations regarding in situ medical attention.

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A Comparison of Antifungal Drugs and Traditional Antiseptic Medication for Otomycosis Treatment: A Systematic Review and Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.739360 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shunyu Wu ◽

Yin Cheng ◽

Shunzhang Lin ◽

Huanhai Liu

Keyword(s):

Systematic Review ◽

Literature Review ◽

Meta Analysis ◽

Case Series ◽

Antifungal Drugs ◽

Cochrane Library ◽

Future Research ◽

Research Subjects ◽

Full Text Review ◽

Meta Analyses

Objectives/Hypothesis: To perform a systematic review and meta-analysis to compare the efficacy of and complications associated with antifungal drugs and traditional antiseptic medication for the treatment of otomycosis.Data Sources: The PubMed, EMBASE, GeenMedical, Cochrane Library, CBM, CNKI, VIP and other databases were searched from January 1991 to January 2021.Methods: The systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) and non-randomized studies (case-control, cohort, and case series) were included to assess the topical use of antifungal drugs and traditional antiseptic medication in patients with otomycosis. The research subjects were patients who were clinically diagnosed with otomycosis and whose external auditory canal secretions were positive for fungi. Funnel plots were used to detect bias, and the Q test was used to assess heterogeneity. The random-effects model was used for meta-analysis. The t-test was used to assess significance.Results: Of the 324 non-duplicate studies screened, 16 studies met the criteria for full-text review, and 7 were included in the meta-analysis. Four studies reported recovery conditions (P = 0.01). Six common complications after medication use were compared, and there were no significant differences. The authors further conducted subgroup analysis according to complications. The differences in the rates of ear distension (P = 0.007), earache (P = 0.03) and tinnitus (P = 0.003) were statistically significant.Conclusion: The results of this meta-analysis and literature review showed that antifungal drugs and traditional antiseptic medication were effective in relieving symptoms in patients with otomycosis, and the two treatments were associated with different complications. Otolaryngologists have the option to use one medication or a combination of two drugs on the basis of the condition. Future research in this area should include RCTs with long-term follow-up to guide the development of otomycosis guidelines to overcome some of the weaknesses found in the literature.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#myprospero.

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Convalescent Plasma for the Prevention and Treatment of COVID-19: A Systematic Review and Quantitative Analysis (Preprint)

10.2196/preprints.25500 ◽

2020 ◽

Author(s):

Henry Peng

Keyword(s):

Systematic Review ◽

Clinical Studies ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Future Research ◽

In Vitro Testing ◽

Screening Process ◽

Prevention And Treatment

BACKGROUND The coronavirus disease (COVID-19) pandemic caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly worldwide. Currently, no vaccine or specific therapeutics are available to prevent and/or treat COVID-19. Convalescent plasma (CP) obtained from patients following resolution of COVID-19 infection and development of antibodies against the virus is an attractive option for either prophylactic or therapeutic treatment, since antibodies may have direct or indirect antiviral activities and immunotherapy has proven effective in principle, and in many clinical reports. OBJECTIVE We sought to characterize the latest advances and evidence in the use of CP for COVID-19 through a systematic review and quantitatively analysis, identify knowledge gaps in this setting, and offer recommendations and directives for future research. METHODS PubMed, Web of Science and Embase were continuously searched for studies assessing the use of CP for COVID-19 including clinical studies, commentaries, reviews, guidelines/protocols and in vitro testing of CP antibodies. Screening process and data extraction were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality appraisal of all clinical studies was conducted using an universal tool independent on study designs. Meta-analysis of case-controlled and randomized controlled trials (RCTs) was conducted using a random-effects model. RESULTS Substantial literature has been published covering various aspects of CP therapy for COVID-19. Of the references included in this review, a total of 243 eligible studies including 64 clinical studies, 79 commentary articles, 46 reviews, 19 guidance and protocols, 35 in vitro testing of CP antibodies, matched the criteria. Positive results have been mostly observed so far when utilising CP for the treatment of COVID-19. There are remarkable heterogeneities in the CP therapy with respect to patient demographics, donor antibody titers, time and dose of CP administration. The studies assessing the safety of CP treatment reported low incidence of adverse events. Most clinical studies in particular case reports and case series had poor quality. Only one RCT was of high quality. Randomized and non-randomized data were found in two and 11 studies, respectively and included for meta-analysis suggesting that CP could reduce mortality and increase viral clearance. Despite promising pilot studies, the benefits of CP treatment can only be clearly established through carefully designed RCTs. CONCLUSIONS There is developing support for CP therapy particularly for patients who are critically ill or mechanically ventilated and resistant to antivirals and supportive care. These studies provide important lessons that should inform the planning of well-designed RCTs to generate more robust knowledge for the efficacy of CP in COVID-19 patients. Future research is necessary to fill the knowledge gap regarding prevention and treatment of COVID-19 patients with CP while vaccines and other treatment are being developed.

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