Comparing the Effectiveness and Safety of Remdesivir and Molnupiravir in COVID‐19: A Systematic Review and Meta‐Analysis

Better design leads to better results - Importance of virological outcome design in clinical trials for antiviral treatment of coronavirus disease 2019.

The effectiveness and safety of mRNA (BNT162b2) and inactivated (CoronaVac) COVID-19 vaccines among individuals with chronic kidney diseases

Remdesivir-Induced Bradycardia in COVID-19: A Single Center Prospective Study.

Objective To identify whether thymosin-α-1 (Tα1) is effective in patients with Coronavirus disease 2019 (COVID-19) and to determine a suitable population for Tα1 treatment. Methods We included studies with ≥10 cases and adults (aged ≥18 years) with laboratory-confirmed SARS-CoV-2 infection, data on mortality or length of hospitalization, disease severity, and study location, while excluded pregnant and breastfeeding women and minors. Publications were searched from November 1, 2019, to July 5, 2023, in six databases, including PubMed, Web of Science, Embase, Cochrane Library, China Knowledge Resource Integrated Database, and Wanfang Database. We separately utilized Newcastle-Ottawa Scale and Cochrane handbook methodology to evaluate risk of bias and used Review Manager (version 5.4, Cochrane Collaboration, Copenhagen, Denmark) to present and synthesize results. Relative risks (RR) and Standardized Mean Difference (SMD) with 95% confidence intervals (CI) were analyzed for dichotomous variables and continuous variables, respectively. Results Nine studies (participants = 5417) were included. No significant differences were found in mortality (nine studies; n = 5417; RR = 0.95; 95% CI: 0.56, −1.60; p = .84; I2 = 90%) or length of hospitalization (four studies; n = 3688; SMD = 0.16; 95% CI: −0.38, −0.69; p = .57; I2 = 96%) between patients with COVID-19 who did and did not receive Tα1. Participants were divided by the severity of the disease (serious and non-serious) and study location. Among the serious group, the incidence of death among patients who received Tα1 treatment was 0.67 times that of patients who did not receive Tα1 treatment (four studies; n = 1230; RR: 0.67; 95% CI: 0.58, −0.77; p < .00,001; I2 = 0%). There was no significant difference in length of hospitalization between the groups (two studies; n = 410; SMD = 0.66; 95% CI: −0.06, −1.38; p = .07; I2 = 87%). Among the non-serious group, compared to not having Tα1 treatment, receiving Tα1 treatment reduced hospitalization length (two studies; n = 3670; SMD = −0.28; 95% CI: −0.41, −0.14; p < .0001; I2 = 51%), while no significant difference in mortality (three studies; n = 3775; RR = 1.06; 95% CI: 0.22, −5.03; p = .94; I2 = 89%). Moreover, there was no significant difference between subgroups when divided by study locations (Studies within China: seven studies; n = 5263; RR = 1.14; 95% CI: 0.64, −2.04; p = .65; I2=92%; Studies outside of China: two studies; n = 154; RR = 0.41; 95% CI: 0.14, −1.24; p = .11; I2 = 51%). Discussion For patients with serious types of COVID-19, Tα1 significantly decreased mortality, which supports the utilization of Tα1 in patients with severe and critical types of COVID-19. Moreover, regarding hospitalization length, patients with non-serious COVID-19 who used Tα1 reduced their hospitalization length compared to those that did not use Tα1. However, these results have high heterogeneity and limited generalizability.

Interleukin-1 blocking agents for treating COVID-19.

Evidence of potent humoral immune activity in COVID-19-infected kidney transplant recipients.

Pre-admission anticoagulant therapy and mortality in hospitalized COVID-19 patients: A retrospective cohort study

Risk of new-onset type 2 diabetes in 600 055 people after COVID-19: A cohort study.

BackgroundOlder adults are more susceptible to severe health outcomes for coronavirus disease 2019 (COVID-19). Universal vaccination has become a trend, but there are still doubts and research gaps regarding the COVID-19 vaccination in the elderly. This study aimed to investigate the efficacy, immunogenicity, and safety of COVID-19 vaccines in older people aged ≥ 55 years and their influencing factors.MethodsRandomized controlled trials from inception to April 9, 2022, were systematically searched in PubMed, EMBASE, the Cochrane Library, and Web of Science. We estimated summary relative risk (RR), rates, or standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects meta-analysis. This study was registered with PROSPERO (CRD42022314456).ResultsOf the 32 eligible studies, 9, 21, and 25 were analyzed for efficacy, immunogenicity, and safety, respectively. In older adults, vaccination was efficacious against COVID-19 (79.49%, 95% CI: 60.55−89.34), with excellent seroconversion rate (92.64%, 95% CI: 86.77−96.91) and geometric mean titer (GMT) (SMD 3.56, 95% CI: 2.80−4.31) of neutralizing antibodies, and provided a significant protection rate against severe disease (87.01%, 50.80−96.57). Subgroup and meta-regression analyses consistently found vaccine types and the number of doses to be primary influencing factors for efficacy and immunogenicity. Specifically, mRNA vaccines showed the best efficacy (90.72%, 95% CI: 86.82−93.46), consistent with its highest seroconversion rate (98.52%, 95% CI: 93.45−99.98) and GMT (SMD 6.20, 95% CI: 2.02−10.39). Compared to the control groups, vaccination significantly increased the incidence of total adverse events (AEs) (RR 1.59, 95% CI: 1.38−1.83), including most local and systemic AEs, such as pain, fever, chill, etc. For inactivated and DNA vaccines, the incidence of any AEs was similar between vaccination and control groups (p > 0.1), while mRNA vaccines had the highest risk of most AEs (RR range from 1.74 to 7.22).ConclusionCOVID-19 vaccines showed acceptable efficacy, immunogenicity and safety in older people, especially providing a high protection rate against severe disease. The mRNA vaccine was the most efficacious, but it is worth surveillance for some AEs it caused. Increased booster coverage in older adults is warranted, and additional studies are urgently required for longer follow-up periods and variant strains.

Decision letter: SARS-CoV-2 shedding dynamics across the respiratory tract, sex, and disease severity for adult and pediatric COVID-19

The risk of methicillin-resistant Staphylococcus aureus infection following COVID-19 and influenza: A retrospective cohort study from the TriNetX network

Coronavirus disease 2019 (COVID-19) is the etiology of acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is used to support gas exchange in patients who have failed conventional mechanical ventilation. However, there is no clear consensus on the timing of ECMO use in severe COVID-19 patients. The aim of this study is to compare the differences in pre-ECMO time and ECMO duration between COVID-19 survivors and non-survivors and to explore the association between them. PubMed, the Cochrane Library, Embase, and other sources were searched until 21 October 2022. Studies reporting the relationship between ECMO-related time and COVID-19 survival were included. All available data were pooled using random-effects methods. Linear regression analysis was used to determine the correlation between pre-ECMO time and ECMO duration. The meta-analysis was registered with PROSPERO under registration number CRD42023403236. Out of the initial 2473 citations, we analyzed 318 full-text articles, and 54 studies were included, involving 13,691 patients. There were significant differences between survivors and non-survivors in the time from COVID-19 diagnosis (standardized mean difference (SMD) = -0.41, 95% confidence interval (CI): [-0.53, -0.29], p < 0.00001), hospital (SMD = -0.53, 95% CI: [-0.97, -0.09], p = 0.02) and intensive care unit (ICU) admission (SMD = -0.28, 95% CI: [-0.49, -0.08], p = 0.007), intubation or mechanical ventilation to ECMO (SMD = -0.21, 95% CI: [-0.32, -0.09], p = 0.0003) and ECMO duration (SMD = -0.18, 95% CI: [-0.30, -0.06], p = 0.003). There was no statistical association between a longer time from symptom onset to ECMO (hazard ratio (HR) = 1.05, 95% CI: [0.99, 1.12], p = 0.11) or time from intubation or mechanical ventilation (MV) and the risk of mortality (highest vs. lowest time groups odds ratio (OR) = 1.18, 95% CI: [0.78, 1.78], p = 0.42; per one-day increase OR = 1.14, 95% CI: [0.86, 1.52], p = 0.36; HR = 0.99, 95% CI: [0.95, 1.02], p = 0.39). There was no linear relationship between pre-ECMO time and ECMO duration. There are differences in pre-ECMO time between COVID-19 survivors and non-survivors, and there is insufficient evidence to conclude that longer pre-ECMO time is responsible for reduced survival in COVID-19 patients. ECMO duration differed between survivors and non-survivors, and the timing of pre-ECMO does not have an impact on ECMO duration. Further studies are needed to explore the association between pre-ECMO and ECMO time in the survival of COVID-19 patients.

Targeting the Gut Microbiota in Coronavirus Disease 2019: Hype or Hope?

Lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) are important indicators of cardiovascular, muscle and liver lesions, and can be used as prognostic indicators for infectious diseases, such as coronavirus disease 2019 (COVID-19). The present systematic review and meta-analysis assessed the prognostic value of LDH and AST levels for COVID-19 severity. Ovid-Medline, PubMed, Embase and The Cochrane Library were used to search for articles, according to the inclusion and exclusion criteria, until July 2022. The meta-analysis was performed using Revman5.3 and Stata15.1. Standardized mean difference (SMD) and 95% confidence intervals (CIs) of LDH and AST concentrations were analyzed using a random-effects model. Heterogeneity was investigated using meta-regression and subgroup methods. A total of 4,342 patients with COVID-19 in 23 articles were included in the present study. LDH (SMD=1.21; 95% CI: 0.98, 1.44) and AST (SMD=0.68; 95% CI: 0.54, 0.81) were significantly higher in patients with severe COVID-19 compared with in those with non-severe COVID-19. Serum LDH and AST levels in critically ill patients with COVID-19 were increased, suggesting a correlation between the levels of LDH and AST and the severity of COVID-19. These findings may help to develop a risk-stratified approach to the care of patients with this disease.

Retraction and republication: cardiac toxicity of hydroxychloroquine in COVID-19