scholarly journals Is Hydroxychloroquine with Azithromycin a Good Combination in COVID-19 Compared to Hydroxychloroquine Alone from Cardiac Perspective? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 19 (1) ◽  
pp. 1-9
Author(s):  
Pravash Budhathoki ◽  
Dhan Bahadur Shrestha ◽  
Sitaram Khadka ◽  
Era Rawal
Keyword(s):  
Meta Analysis ◽  
Statistical Significance ◽  
World Health ◽  
Cochrane Library ◽  
Cardiac Events ◽  
Clinical Trial Registry ◽  
Risk Of Mortality ◽  
Adverse Cardiac Events ◽  
Quantitative Synthesis ◽  
Health Organization

Background: The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to hydroxychloroquine alone for COVID-19 treatment.Methods: PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, and World Health Organization clinical trial registry were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed or random effects for the pooling of studies based on heterogeneities.Results: The risk of mortality (RR=1.16; CI: 0.92-1.46) and adverse cardiac events (OR=1.06; CI: 0.82-1.37) demonstrated a small increment though of no significance. There were no increased odds of mechanical ventilation (OR=0.84; CI: 0.33-2.15) and significant QTc prolongation (OR=0.84, CI: 0.59-1.21). Neither the critical QTc threshold (OR=1.92, CI: 0.81-4.56) nor absolute ?QTc ?60ms (OR=1.95, CI:0.55-6.96) increased to the level of statistical significance among hydroxychloroquine and azithromycin arm compared to hydroxychloroquine alone, but the slightly increased odds need to be considered in clinical practice. Conclusions: The combination of hydroxychloroquine and azithromycin leads to small increased odds of mortality and cardiac events compared to hydroxychloroquine alone. The use of hydroxychloroquine and azithromycin led to increased odds of QT prolongation, although not statistically significant.Keywords: COVID-19; COVID-19 drug treatment; hydroxychloroquine; macrolides; severe acute respiratory syndrome coronavirus 2 

scholarly journals Is hydroxychloroquine with macrolide a good combination in COVID-19 compared to hydroxychloroquine alone from cardiac perspective? A systematic review and meta-analysis

2020 ◽  
Author(s):  
Sitaram Khadka ◽  
Pravash Budhathoki ◽  
Dhan Bahadur Shrestha ◽  
Era Rawal
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Cardiac Events ◽  
Level Of Evidence ◽  
Risk Of Mortality ◽  
Adverse Cardiac Events ◽  
Fixed And Random Effects ◽  
Quantitative Synthesis

Abstract Background: The global spread of COVID-19 and the lack of definite treatment has caused an alarming crisis in the world. Hydroxychloroquine (HCQ) and azithromycin (AZT) are considered a possible treatment option. We aimed to evaluate the outcome and potential harmful cardiac effects of AZT+HCQ compared to HCQ alone for COVID-19 treatment.Methods: Pubmed, Medline, Google Scholar, Cochrane Library, and clinicaltrials.gov were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed and random effects for the pooling of studies. Result: In this systematic review and meta-analysis, the risk of mortality (RR 1.16; 0.92-1.46) and adverse cardiac events (OR 1.06; 0.82-1.37) demonstrated a small increment though of no significance. There are no increased odds of mechanical ventilation (OR 0.84; 0.33-2.15) and significant QTc prolongation (OR 0.84, 0.59-1.21). Neither the critical QTc threshold (OR 1.92, CI 0.81-4.56) nor absolute ΔQTc ≥60ms (OR 1.95, CI 0.55-6.96) is increased to the level of statistical significance among HCQ+AZT arm compared to HCQ alone; but its slightly increased odds need to be considered in clinical practice. Conclusion: The combination of AZT+HCQ leads to small increased odds of mortality and cardiac events compared to HCQ alone. It is of no statistical significance for the critical QTc threshold and absolute ΔQTc ≥60ms, but increased odds with HCQ+AZT arm need to be considered in clinical relevance. Our result does not guide against the use of combination or HCQ alone based on the present level of evidence.

scholarly journals Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies

2020 ◽  
Author(s):  
Jishnu Malgie ◽  
Jan W Schoones ◽  
Bart G Pijls
Keyword(s):  
Side Effects ◽  
Meta Analysis ◽  
Risk Difference ◽  
World Health ◽  
Cochrane Library ◽  
Control Group ◽  
Number Needed To Treat ◽  
Receptor Antagonists ◽  
Increased Risk ◽  
Health Organization

Abstract Background We systematically reviewed the literature to answer the following research questions: (1) Does interleukin 6 (IL-6) (receptor) antagonist therapy reduce mortality in coronavirus disease 2019 (COVID-19) patients compared to patients not treated with IL-6 (receptor) antagonists; and (2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) antagonists compared to patients not treated with IL-6 (receptor) antagonists? Methods We systematically searched PubMed, PMC PubMed Central, Medline, World Health Organization COVID-19 Database, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier (through 30 June 2020). Random effects meta-analysis was used to pool the risk ratios and risk differences of individual studies. Risk of bias was appraised using the Methodological Index for Non-randomized Studies (MINORS) checklist. Results The search strategy retrieved 743 unique titles, of which 10 studies (all on tocilizumab [TCZ]) comprising 1358 patients were included. Nine of 10 studies were considered to be of high quality. Meta-analysis showed that the TCZ group had lower mortality than the control group. The risk ratio was 0.27 (95% confidence interval [CI], .12–.59) and the risk difference was 12% (95% CI, 4.6%–20%) in favor of the TCZ group. With only a few studies available, there were no differences observed regarding side effects. Conclusions Our results showed that mortality was 12% lower for COVID-19 patients treated with TCZ compared with those not treated with TCZ. The number needed to treat was 11, suggesting that for every 11 (severe) COVID-19 patients treated with TCZ, 1 death is prevented. These results require confirmation by randomized controlled trials.

scholarly journals Does aerobic exercise reduce postpartum depressive symptoms? a systematic review and meta-analysis

2017 ◽  
Vol 67 (663) ◽  
pp. e684-e691 ◽  
Author(s):  
Ruth Victoria Pritchett ◽  
Amanda J Daley ◽  
Kate Jolly
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Aerobic Exercise ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
World Health ◽  
Cochrane Library ◽  
Group Exercise ◽  
Postpartum Depressive Symptoms ◽  
Health Organization

BackgroundThere is currently no specific guidance on the role of exercise in managing postpartum depression in the UK and US, and international guidance is inconsistent.AimTo assess the effectiveness of aerobic exercise on postpartum depressive symptoms.Design and settingSystematic review and meta-analysis. There was no restriction to study site or setting.MethodThe databases MEDLINE, EMBASE, Cochrane Library, PsycINFO, SportDiscus, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform were searched. Titles and abstracts, then full-text articles, were screened against inclusion criteria: RCTs measuring depressive symptoms in mothers ≤1 year postpartum; and interventions designed to increase aerobic exercise compared with usual care or other comparators. Included studies were assessed using the Cochrane Collaboration’s risk of bias tool. Meta-analysis was conducted. Pre-planned subgroup analyses explored heterogeneity.ResultsThirteen RCTs were included, with 1734 eligible participants. Exercise significantly reduced depressive symptoms when all trials were combined (standardised mean difference −0.44; 95% confidence interval = −0.75 to −0.12). Exploration of heterogeneity did not find significant differences in effect size between women with possible depression and in general postpartum populations; exercise only and exercise with co-interventions; and group exercise and exercise counselling.ConclusionThis systematic review provides support for the effectiveness of exercise in reducing postpartum depressive symptoms. Group exercise, participant-chosen exercise, and exercise with co-interventions all may be effective interventions. These results should be interpreted with caution because of substantial heterogeneity and risk of bias.

scholarly journals Cerebral function imaging of acupuncture treatment for stroke: A protocol for systematic review and meta-analysis

2021 ◽  
Author(s):  
Yihao Zhou ◽  
Jing Shi ◽  
Gan Huang ◽  
Zhilin Huang ◽  
Sifeng Feng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acupuncture Treatment ◽  
Meta Analysis ◽  
Brain Regions ◽  
Scientific Basis ◽  
World Health ◽  
Cochrane Library ◽  
Action Mechanism ◽  
Stroke Treatment ◽  
Health Organization

Abstract Background: Stroke is one of the most common causes of death and is the main cause of persistent and acquired disability in adults worldwide. Acupuncture is recommended as an alternative and complementary strategy for stroke treatment by the World Health Organization as it can significantly improve patients' quality of life. However, the central nervous system (CNS) mechanism of acupuncture treatment of stroke is unclear. The aim of this study is explore the effective pathway and action mechanism of acupuncture treatment for stroke on the CNS.Methods: The following databases will be searched by electronic methods: PubMed; Medline; Embase; Cochrane Library; Chinese National Knowledge Infrastructure; VIP Database; Wan-fang Data; Chinese Biomedical Database. All of them will be retrieved from the establishment date of the electronic database to December 2020, all included studies will be evaluated risk of bias by the Cochrane Handbook. Spatial coordinates of the Montreal Neurological Institute of activated brain regions will be the primary outcome. The systematic review will be conducted with the use of SDM v5.141 software for voxel meta-analysis in this study.Results: This study will obtain the correlation between the activated brain regions of acupuncture treatment for stroke.Conclusion: This study will explore the effective pathway and action mechanism of acupuncture, and provide a reliable scientific basis for the treatment of stroke by acupuncture.PROSPERO registration number: CRD42021231329.

scholarly journals Horticultural Therapy in Patients With Dementia: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 35 ◽  
pp. 153331751988349 ◽  
Author(s):  
Li-Chin Lu ◽  
Shao-Huan Lan ◽  
Yen-Ping Hsieh ◽  
Yea-Yin Yen ◽  
Jong-Chen Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psychological Health ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
World Health ◽  
Cochrane Library ◽  
Horticultural Therapy ◽  
Dementia Patients ◽  
Standard Mean Difference ◽  
Health Organization

Background: World Health Organization has communicated that dementia as a public health priority in 2012. Behavioral and psychological symptoms of dementia are the main reason results in hospitalization of dementia patients. Horticulture is one of the favorite activity for many peoples to relax their minds. Objectives: To investigate psychological health benefits of horticulture intervention in dementia patients. Methods: The databases including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, and Ovid Medline were searched up to August 2017. Results: Twenty-three articles for systematic review, whereas 8 articles were included in meta-analysis. Meta-analysis verified the beneficial effect of horticultural therapy (HT) on agitation level (standard mean difference: −0.59; P < .00001); increase time spent on activity engagement (mean differences [MD]: 45.10%, P < .00001); decrease time for doing nothing (MD: −29.36%, P = .02). Conclusions: Patients with dementia benefit from horticultural by alleviating their degrees of agitate behaviors, increasing time of engaging in activities and decrease time of doing nothing.

scholarly journals Air-travel related TB incident follow up – effectiveness and outcomes: a systematic review

2020 ◽  
pp. 2000013
Author(s):  
Laura Maynard-Smith ◽  
Colin Stewart Brown ◽  
Ross Jeremy Harris ◽  
Peter Hodkinson ◽  
Surinder Tamne ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Positive Tuberculin Skin Test ◽  
Air Travel ◽  
World Health ◽  
Contact Tracing ◽  
Cochrane Library ◽  
Publication Date ◽  
Single Positive ◽  
Latent Tb ◽  
Health Organization

BackgroundThe World Health Organization (WHO) recommends following up passengers following possible exposure to a case of infectious tuberculosis (TB) during air travel. This is known to be time consuming and difficult, and increasingly so with higher numbers of flights and passengers to and from countries with high TB endemicity each year.ObjectivesThis paper systematically reviews the literature on contact tracing investigations following a plane exposure to active pulmonary TB. Evidence for in-flight transmission was assessed by reviewing the positive results of contacts without prior risk factors for latent TB.Data sources & EligibilityA search of Medline, EMBASE, BIOSIS, Cochrane Library and Database of Systematic Reviews was carried out, with no restrictions on study design, index case characteristics, duration of flight or publication date.ResultsTwenty-two papers were included, with a total of 469 index cases and 15 889 contacts. Only 26.4% of all contacts identified completed screening following exposure. The yield of either a single positive tuberculin skin test (TST) or a TST conversion attributable to in-flight transmission is between 0.19% (95%CI 0.13–0.27) and 0.74% (95%CI 0.61–0.88) of all contacts identified (0.00%, 95%CI 0.00–0.00 and 0.13%, 95%CI 0.00–0.61 in random effects meta-analysis).LimitationsThe main limitation is heterogeneity of reporting.Conclusions and implications of key findingsThe evidence behind the criteria for initiating investigations is weak and it has been widely demonstrated that active screening of contacts is labour intensive and unlikely to be effective. Based on our findings, formal comprehensive contact tracing may be of limited utility following a plane exposure.

scholarly journals Prevalence and determinants of alcohol use among adults living with HIV/AIDS in Ethiopia: a systematic review protocol

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Birhanie Mekuriaw ◽  
Zelalem Belayneh ◽  
Alemayehu Molla ◽  
Tsegaye Mehare
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Associated Factors ◽  
Meta Analysis ◽  
Geographical Location ◽  
World Health ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Health Organization ◽  
Hiv Aids

Abstract Background Alcohol use is a challenging problem which attributes to more than 5% of the overall global burden of disease. It is more common among persons with HIV infection than the general population. Although there are separate studies regarding people with HIV/AIDS in Ethiopia, their results are highly variable and discrepant. The objectives of this study will be to evaluate the prevalence of alcohol use and to identify its associated factors among people with HIV/AIDS in Ethiopia. Methods A systematic search of electronic databases (from inception onwards) of PubMed/MEDLINE, Embase, PsycINFO, and Cochrane Library will be conducted. Moreover, grey literatures will be searched from different sources (such as Google Scholar, OpenGrey, and World Health Organization websites). Reference lists of the selected articles will also be searched manually. Observational studies (cross-sectional, case-control, cohort) reporting the prevalence of alcohol use and/or its associated factors among adults with HIV/AIDS in Ethiopia will be included. The primary outcomes will be the prevalence of alcohol use among HIV/AIDS population. Secondary outcomes will be the determinants of alcohol use described in the included studies. Two reviewers will independently screen all citations and full-text articles and extract data. The studies’ methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct a random effects meta-analysis of observational data. Heterogeneity of primary studies will be assessed using the I2 test. Prevalence estimates will be stratified according to gender, age, and geographical location. Small-study effects (publication bias) also will be examined. Discussion Our systematic review and meta-analysis will prevail the pooled prevalence of alcohol use and its determinants among people with HIV/AIDS in Ethiopia. The finding of this study will be helpful to design appropriate preventive and interventional strategies for alcohol use among people with HIV/AIDS. This can have direct or indirect policy responses and clinical implications. Systematic review registration PROSPERO CRD42019132524

scholarly journals Recurrent SARS-CoV-2 RNA positivity after COVID-19: a systematic review and meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mahalul Azam ◽  
Rina Sulistiana ◽  
Martha Ratnawati ◽  
Arulita Ika Fibriana ◽  
Udin Bahrudin ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Severe Disease ◽  
Disease Onset ◽  
World Health ◽  
Cochrane Library ◽  
Younger Age ◽  
Patients With Diabetes ◽  
Health Organization ◽  
The Cochrane Library ◽  
Clinical Trials Registry

AbstractPresent study aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity. We searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was assessed using I2. Fourteen studies of 2568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.8% (95% confidence interval [CI] 11.44–18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.4 days (95% CI 32.65–38.24 days), and from the last negative to the recurrent positive result was 9.8 days (95% CI 7.31–12.22 days). Patients with younger age and a longer initial illness were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes, severe disease, and a low lymphocyte count were less likely to experience. Present study concluded that the incidence of recurrent SARS-CoV-2 positivity was 14.8% suggesting further studies must be conducted to elucidate the possibility of infectious individuals with prolonged or recurrent RNA positivity.

scholarly journals Maternal immune activation generates anxiety in offspring: A translational meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laiana A. Quagliato ◽  
Ursula de Matos ◽  
Antonio E. Nardi
Keyword(s):  
Anxiety Disorders ◽  
Immune Activation ◽  
Synapse Formation ◽  
Meta Analysis ◽  
Fetal Brain ◽  
World Health ◽  
Cochrane Library ◽  
Future Research ◽  
Maternal Immune Activation ◽  
Health Organization

AbstractMaternal immune activation (MIA) during pregnancy is recognized as an etiological risk factor for various psychiatric disorders, such as schizophrenia, major depressive disorder, and autism. Prenatal immune challenge may serve as a “disease primer” for alteration of the trajectory of fetal brain development that, in combination with other genetic and environmental factors, may ultimately result in the emergence of different psychiatric conditions. However, the association between MIA and an offspring’s chance of developing anxiety disorders is less clear. To evaluate the effect of MIA on offspring anxiety, a systematic review and meta-analysis of the preclinical literature was conducted. We performed a systematic search of the PubMed, Web of Science, PsycINFO, and Cochrane Library electronic databases using the PRISMA and World Health Organization (WHO) methodologies for systematic reviews. Studies that investigated whether MIA during pregnancy could cause anxiety symptoms in rodent offspring were included. Overall, the meta-analysis showed that MIA induced anxiety behavior in offspring. The studies provide strong evidence that prenatal immune activation impacts specific molecular targets and synapse formation and function and induces an imbalance in neurotransmission that could be related to the generation of anxiety in offspring. Future research should further explore the role of MIA in anxiety endophenotypes. According to this meta-analysis, MIA plays an important role in the pathophysiological mechanisms of anxiety disorders and is a promising therapeutic target.

scholarly journals COVID-19 clinical characteristics, and sex-specific risk of mortality: Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Mohammad Javad Nasiri ◽  
Sara Haddadi ◽  
Azin Tahvildari ◽  
Yeganeh Farsi ◽  
Mahta Arbabi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Clinical Laboratory ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
World Health ◽  
Laboratory Findings ◽  
Risk Of Mortality ◽  
Health Organization

Objectives: The rapidly evolving coronavirus disease 2019 (COVID-19), was declared a pandemic by the World Health Organization on March 11, 2020. It was first detected in the city of Wuhan in China and has spread globally resulting in substantial health and economic crisis in many countries. Observational studies have partially identified the different aspects of this disease. Up to this date, no comprehensive systematic review for the clinical, laboratory, epidemiologic and mortality findings has been published. We conducted this systematic review and meta-analysis for a better understanding of COVID-19. Methods: We reviewed the scientific literature published from January 1, 2019 to March 3, 2020. Statistical analyses were performed with STATA (version 14, IC; Stata Corporation, College Station, TX, USA). The pooled frequency with 95% confidence intervals (CI) was assessed using random effect model. Publication bias was assessed and p <0.05 was considered a statistically significant publication bias. Results: Out of 1102 studies, 32 satisfied the inclusion criteria. A total of 4789 patients with a mean age of 49 years were evaluated. Fever (83.0%, CI 77.5 to 87.6), cough (65.2%, CI 58.6 to 71.2) and myalgia/fatigue (34.7, CI 26.0 to 44.4) were the most common symptoms. The most prevalent comorbidities were hypertension (18.5 %, CI 12.7 to 24.4) and Cardiovascular disease (14.9 %, CI 6.0 to 23.8). Among the laboratory abnormalities, elevated C-Reactive Protein (CRP) (72.0% (CI 54.3 to 84.6) and lymphopenia (50.1%, CI 38.0 to 62.4) were the most common findings. Bilateral ground-glass opacities (66.0%, CI 51.1 to 78.0) was the most common CT-Scan presentation. Pooled mortality rate was 6.6%, with males having significantly higher mortality compared to females (OR 3.4; 95% CI 1.2 to 9.1, P = 0.01). Conclusion: COVID-19 commonly presented with a progressive course of cough and fever with more than half of hospitalized patients showing leukopenia or a high CRP on their laboratory findings. Mortality associated with COVID19 was higher than that reported in studies in China with Males having a 3-fold higher risk of mortality in COVID19 compared to females.

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