Remdesivir for the treatment of COVID-19: a living systematic review

Objective Provide a timely, rigorous and continuously updated summary of the evidence on the role of remdesivir in the treatment of patients with COVID-19. Methods Eligible studies were randomized trials evaluating the effect of remdesivir versus placebo or no treatment. We conducted searches in the special L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs regular searches in databases, trial registries, preprint servers and websites relevant to COVID-19. All the searches covered the period until 25 August 2020. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardized form. We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach. A living, web-based version of this review will be openly available during the COVID-19 pandemic. Results Our search strategy yielded 574 references. Finally, we included threerandomized trials evaluating remdesivir in addition to standard care versus standard care alone. The evidence is very uncertain about the effect of remdesivir on mortality (RR 0.7, 95% CI 0.46 to 1.05; very low certainty evidence) and the need for invasive mechanical ventilation (RR 0.69, 95% CI 0.39 to 1.24; very low certainty evidence). On the other hand, remdesivir likely results in a large increase in the incidence of adverse effects in patients with COVID-19 (RR 1.29, 95% CI 0.58 to 2.84; moderate certainty evidence). Conclusions The evidence is insufficient for the outcomes critical for making decisions on the role of remdesivir in the treatment of patients with COVID-19, so it is impossible to balance potential benefits, if there are any, with the adverse effects and costs. PROSPERO Registration number: CRD42020183384.

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Remdesivir for the treatment of COVID-19: A living systematic review

10.1101/2020.09.27.20202754 ◽

2020 ◽

Author(s):

Francisca Verdugo-Paiva ◽

Maria Paz Acuna ◽

Ivan Sola ◽

Gabriel Rada

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

Standard Care ◽

Invasive Mechanical Ventilation ◽

Random Effect ◽

Randomised Trials ◽

Registration Number ◽

Study Characteristics ◽

Meta Analyses

Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of remdesivir in the treatment of patients with COVID-19 Methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. Eligible studies were randomised trials evaluating the effect of remdesivir versus placebo or no treatment. We conducted searches in the LOVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. All the searches covered the period until 25 August 2020. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardised form. We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. Results Our search strategy yielded 574 references. Finally, we included 3 randomised trials evaluating remdesivir in addition to standard care versus standard care alone. The evidence is very uncertain about the effect of remdesivir on mortality (RR 0.7, 95% CI 0.46 to 1.05; very low certainty evidence) and the need for invasive mechanical ventilation (RR 0.69, 95% CI 0.39 to 1.24; very low certainty evidence). On the other hand, remdesivir likely results in a large reduction in the incidence of adverse effects in patients with COVID-19 (RR 1.29, 95% CI 0.58 to 2.84; moderate certainty evidence). Conclusions The evidence is insufficient for the outcomes critical for making decisions about the role of remdesivir in the treatment of patients with COVID-19, so it is not possible to balance the potential benefits, if any, with the adverse effects and costs. PROSPERO Registration number CRD42020183384 Keywords COVID-19, Coronavirus disease, Severe Acute Respiratory Syndrome Coronavirus 2, Coronavirus Infections, Systematic Review, Remdesivir, Antivirals

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Macrolides for the treatment of COVID-19: a living, systematic review

Medwave ◽

10.5867/medwave.2020.11.8073 ◽

2020 ◽

Vol 20 (11) ◽

pp. e8073-e8073

Author(s):

Catalina Verdejo ◽

Laura Vergara-Merino ◽

Nicolás Meza ◽

Javier Pérez-Bracchiglione ◽

Natalia Carvajal-Juliá ◽

...

Keyword(s):

Systematic Review ◽

Randomized Trials ◽

Invasive Mechanical Ventilation ◽

Length Of Hospital Stay ◽

Standard Of Care ◽

Serious Adverse Events ◽

Web Based ◽

Beneficial Effects ◽

Registration Number

Objective This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of macrolides for treating patients with COVID-19. Design A living, systematic review. Database We conducted searches in the centralized repository L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. Today it is maintained through regular searches in 39 databases. Methods We included randomized trials evaluating the effect of macrolides — as monotherapy or in combination with other drugs — versus placebo or no treatment in patients with COVID-19. Randomized trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 were searched in case we found no direct evidence from randomized trials. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included all-cause mortality; the need for invasive mechanical ventilation; extracorporeal membrane oxygenation, length of hospital stay, respiratory failure, serious adverse events, time to SARS-CoV-2 RT-PCR negativity. We applied the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. Results The search in the L·OVE platform retrieved 424 references. We considered 260 as potentially eligible and were reviewed in full texts. We included one randomized clinical trial that evaluated the use of azithromycin in combination with hydroxychloroquine compared to hydroxychloroquine alone in hospitalized patients with COVID 19. The estimates for all outcomes evaluated resulted in insufficient power to draw conclusions. The quality of the evidence for the main outcomes was low to very low. Conclusions Macrolides in the management of patients with COVID 19 showed no beneficial effects compared to standard of care. The evidence for all outcomes is inconclusive. Larger trials are needed to determine the effects of macrolides on pulmonary and other outcomes in COVID-19 patients. Systematic review registration PROSPERO Registration number: CRD42020181032 Protocol preprint DOI: 10.31219/osf.io/rvp59

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The Role of Fructose, Sucrose, and High-fructose Corn Syrup in Diabetes

US Endocrinology ◽

10.17925/use.2013.09.02.128 ◽

2013 ◽

Vol 09 (02) ◽

pp. 128 ◽

Cited By ~ 1

Author(s):

Adrian I Cozma ◽

John L Sievenpiper ◽

◽

...

Keyword(s):

Adverse Effects ◽

Excess Energy ◽

Metabolic Effects ◽

High Fructose Corn Syrup ◽

Corn Syrup ◽

Obesity And Diabetes ◽

High Fructose ◽

Show Evidence ◽

Meta Analyses

Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. High-fructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecologic studies have linked the rise in fructose availability with the increases in obesity and diabetes worldwide. This link has been largely underpinned by animal models and select human trials of fructose overfeeding at high levels of exposure. Although prospective cohort studies have shown significant associations comparing the highest with the lowest levels of intake sugar-sweetened beverages, these associations are small, do not hold at moderate levels of intake, and are subject to collinearity effects from related dietary and lifestyle factors. Most systematic reviews and meta-analyses from controlled feeding trials have shown that fructosecontaining sugars in isocaloric exchange for other carbohydrates do not show evidence of harm and, in the case of fructose, may even have advantages for glycemic control, especially at small doses. Nevertheless, trials in which fructose-containing sugars supplement diets with excess energy have shown adverse effects, effects that appear more attributable to the excess energy than the sugar. There is no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects, although there is potentially cause for concern where fructose is provided at high doses or contributes excess energy to diets. Further investigation is warranted due to the significant knowledge gaps and weaknesses in existing research.

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The Relationship Between Gratitude and Loneliness: The Potential Benefits of Gratitude for Promoting Social Bonds

Europe’s Journal of Psychology ◽

10.5964/ejop.v11i2.826 ◽

2015 ◽

Vol 11 (2) ◽

pp. 323-334 ◽

Cited By ~ 13

Author(s):

Andrea Caputo

Keyword(s):

Potential Role ◽

Well Being ◽

Online Questionnaire ◽

Convenience Sample ◽

Web Based ◽

Factors Affecting ◽

Total Variability ◽

Potential Benefits ◽

The Relationship

This paper explores the potential role of gratitude on the reduction of loneliness feelings, even controlling for several variables related to social desirability, well-being (subjective happiness and life satisfaction) and socio-demographic characteristics. Through a web-based survey a convenience sample of 197 participants completed an online questionnaire including these measures. Correlation analyses and four-step hierarchical multiple regression analyses were conducted. The results show a negative correlation between gratitude and loneliness; specifically, gratitude succeeds in accounting for up to almost one-fifth of the total variability of loneliness even controlling for further variables. Being female, not having a stable and consolidated relationship and not participating in the labor force represent some risk factors affecting loneliness which should be taken into account in further research.

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Serum Homocysteine Levels in Men with and without Erectile Dysfunction: A Systematic Review and Meta-Analysis

International Journal of Endocrinology ◽

10.1155/2018/7424792 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Andrea Sansone ◽

Angelo Cignarelli ◽

Massimiliano Sansone ◽

Francesco Romanelli ◽

Giovanni Corona ◽

...

Keyword(s):

Erectile Dysfunction ◽

Meta Analysis ◽

Random Effect ◽

Cochrane Library ◽

Serum Homocysteine ◽

Registration Number ◽

The Cochrane Library ◽

Time Restriction ◽

Random Effect Models

Objectives. Elevated levels of serum homocysteine (Hcy) have been associated with cardiovascular diseases and endothelial dysfunction, conditions closely associated with erectile dysfunction (ED). This meta-analysis was aimed to assess serum Hcy levels in subjects with ED compared to controls in order to clarify the role of Hcy in the pathogenesis of ED. Methods. Medline, Embase, and the Cochrane Library were searched for publications investigating the possible association between ED and Hcy. Results were restricted by language, but no time restriction was applied. Standardized mean difference (SMD) was obtained by random effect models. Results. A total of 9 studies were included in the analysis with a total of 1320 subjects (489 subjects with ED; 831 subjects without ED). Pooled estimate was in favor of increased Hcy in subjects with ED with a SMD of 1.00, 95% CI 0.65–1.35, p<0.0001. Subgroup analysis based on prevalence of diabetes showed significantly higher SMD in subjects without diabetes (1.34 (95% CI 1.08–1.60)) compared to subjects with diabetes (0.68 (95% CI 0.39–0.97), p<0.0025 versus subgroup w/o diabetes). Conclusions. Results from our meta-analysis suggest that increased levels of serum Hcy are more often observed in subjects with ED; however, increase in Hcy is less evident in diabetic compared to nondiabetic subjects. This study is registered with Prospero registration number CRD42018087558.

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The Role of Fructose, Sucrose, and High-fructose Corn Syrup in Diabetes

European Endocrinology ◽

10.17925/ee.2014.10.01.51 ◽

2010 ◽

Vol 10 (1) ◽

pp. 51

Author(s):

Adrian I Cozma ◽

John L Sievenpiper ◽

◽

...

Keyword(s):

Adverse Effects ◽

Excess Energy ◽

Metabolic Effects ◽

High Fructose Corn Syrup ◽

Corn Syrup ◽

Obesity And Diabetes ◽

High Fructose ◽

Show Evidence ◽

Meta Analyses

Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. High-fructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecological studies have linked the rise in fructose availability with the increases in obesity and diabetes worldwide. This link has been largely underpinned by animal models and select human trials of fructose overfeeding at high levels of exposure. Although prospective cohort studies have shown significant associations comparing the highest with the lowest levels of intake sugar-sweetened beverages, these associations are small, do not hold at moderate levels of intake and are subject to collinearity effects from related dietary and lifestyle factors. Most systematic reviews and meta-analyses from controlled feeding trials have shown that fructose-containing sugars in isocaloric exchange for other carbohydrates do not show evidence of harm and, in the case of fructose, may even have advantages for glycaemic control, especially at small doses. Nevertheless, trials in which fructose-containing sugars supplement diets with excess energy have shown adverse effects, effects that appear more attributable to the excess energy than the sugar. There is no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects, although there is potentially cause for concern where fructose is provided at high doses or contributes excess energy to diets. Further investigation is warranted due to the significant knowledge gaps and weaknesses in existing research.

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Gloves for COVID-19: A living systematic review

10.31219/osf.io/uz4rs ◽

2021 ◽

Author(s):

Belén Morales Ferrer ◽

Luis E. Ortiz-Muñoz ◽

Giuliano Duarte-Anselmi ◽

Daniel Riquelme-Uribe ◽

Gabriel Rada

Keyword(s):

Search Strategy ◽

Preventive Measures ◽

Decision Makers ◽

Healthy Population ◽

Web Based ◽

Randomised Study ◽

All Cause Mortality ◽

Study Characteristics ◽

Meta Analyses ◽

Near Future

Methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We searched for studies evaluating the effect of glove use in healthy population to prevent COVID-19. We conducted searches using the special L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository, maintained through regular searches in electronic databases, preprint servers, trial registries and websites relevant to COVID-19. All the searches covered the period until November 30, 2020. No date or language restrictions were applied.Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardised form.A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.ResultsOur search strategy yielded 362 references. Finally, only 1 non-randomised study evaluating the use of gloves among other preventive measures was considered eligible. We were not able to perform a meta-analyses, thus the results were presented as a narrative synthesis.In healthy population, the evidence is very uncertain about the effect of the use of gloves on COVID-19 cases, hospitalizations for COVID-19, respiratory failure and all cause-mortality. Conclusions The evidence is insufficient to support or refute the use of gloves in healthy population to prevent COVID-19. There should appear well designed studies addressing the question of this review to provide valuable evidence to inform researchers and decision makers in the near future.

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Infectious Diseases Data Observatory (IDDO) Visceral Leishmaniasis Library of Clinical Therapeutic Studies: A Protocol for a Living Systematic Review of Clinical Studies

10.21203/rs.3.rs-1159661/v1 ◽

2021 ◽

Author(s):

sauman Singh-Phulgenda ◽

Sumayyah Rashan ◽

Eli Harriss ◽

Prabin Dahal ◽

Caitlin Naylor ◽

...

Keyword(s):

Systematic Review ◽

Visceral Leishmaniasis ◽

Drug Efficacy ◽

Cochrane Central Register ◽

Central Register ◽

Medical Librarian ◽

Registration Number ◽

Study Characteristics ◽

Vector Borne ◽

Meta Analyses

Abstract Introduction: Visceral Leishmaniasis (VL) is a vector-borne disease caused by protozoan parasites of the genus Leishmania. The disease is endemic in parts of South Asia, East Africa, South America and the Mediterranean region, with an estimated 50,000 to 90,000 cases occurring annually. A living systematic review of existing scientific literature is proposed to identify clinical drug efficacy studies against VL, conducted following the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines. Methods and analysis: The proposed living systematic review builds on a previous systematic review first carried out in 2016, and the current protocol is designed to capture any published or registered VL clinical study from Nov-2021 onwards. The following databases will be searched by a medical librarian: PubMed, Ovid Embase, Scopus, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, WHO ICTRP, as well as IMEMR, IMSEAR, and LILACS from the WHO Global Index Medicus. The systematic review will consider both randomised and non-randomised interventional studies, including single-armed studies. Ethics and dissemination: A database of eligible studies, including study characteristics, is openly available (https://www.iddo.org/tool/vl-surveyor) and will be continually updated every six months. All findings will be published in a peer reviewed journal.PROSPERO registration number: CRD42021284622

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Cell-based therapies for COVID-19: A living, systematic review

Medwave ◽

10.5867/medwave.2020.11.8078 ◽

2020 ◽

Vol 20 (11) ◽

pp. e8078-e8078

Author(s):

Gabriel Rada ◽

Javiera Corbalán ◽

Patricio Rojas

Keyword(s):

Systematic Review ◽

Randomized Trials ◽

Grey Literature ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Web Based ◽

Central Register ◽

Registration Number ◽

Near Future

Objective This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the available evidence on the role of cell-based therapies in the treatment of patients with COVID-19. Data sources We conducted searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature, and in a centralized repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. All the searches covered the period until 23 April 2020 (one day before submission). Eligibility criteria for selecting studies and methods We adapted an already published standard protocol for multiple parallel systematic reviews to the specificities of this question. We searched for randomized trials evaluating the effectiveness and safety of cell-based therapies versus placebo or no treatment in patients with COVID-19. Anticipating the lack of randomized trials directly addressing this question, we also searched for trials evaluating other coronavirus infections, such as MERS-CoV and SARS-CoV, and nonrandomized studies in COVID-19. Two reviewers independently screened each study for eligibility. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit this review to a peer-reviewed journal every time the conclusions change or whenever there are substantial updates. Results We screened 1 043 records, but no study was considered eligible. We identified 61 ongoing studies, including 39 randomized trials evaluating different types of cell-based therapies in COVID-19. Conclusions We did not find any studies that met our inclusion criteria, and hence there is no evidence to support or refute the use of cell-based therapies for treating patients with COVID-19. A substantial number of ongoing studies should provide valuable evidence to inform researchers and decision-makers in the near future. PROSPERO Registration number CRD42020179711

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Pediatric Acupuncture: A Review of Clinical Research

Evidence-based Complementary and Alternative Medicine ◽

10.1093/ecam/nem181 ◽

2009 ◽

Vol 6 (4) ◽

pp. 429-439 ◽

Cited By ~ 23

Author(s):

Jeffrey I. Gold ◽

Colette D. Nicolaou ◽

Katharine A. Belmont ◽

Aaron R. Katz ◽

Daniel M. Benaron ◽

...

Keyword(s):

United States ◽

Adverse Effects ◽

Alternative Treatment ◽

Standard Care ◽

Treatment Approach ◽

The United States ◽

Great Promise ◽

Potential Benefits ◽

Pediatric Populations ◽

Systematic Appraisal

Practiced in China for more than 2000 years, acupuncture has recently gained increased attention in the United States as an alternative treatment approach for a variety of medical conditions. Despite its growing prevalence and anecdotal reports of success among pediatric populations, few empirically based studies have assessed the efficacy of acupuncture for children and adolescents. This article presents a review of the current literature, including a systematic appraisal of the methodological value of each study and a discussion of potential benefits and adverse effects of acupuncture. While acupuncture holds great promise as a treatment modality for diverse pediatric conditions, a significant amount of additional research is necessary to establish an empirical basis for the incorporation of acupuncture into standard care.

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