Systematic Review Of Current Evidence Research Articles

Multiorgan manifestations of COL4A1 and COL4A2 variants and proposal for a clinical management protocol.

COL4A1/2 variants are associated with highly variable multiorgan manifestations. Depicting the whole clinical spectrum of COL4A1/2-related manifestations is challenging, and there is no consensus on management and preventative strategies. Based on a systematic review of current evidence on COL4A1/2-related disease, we developed a clinical questionnaire that we administered to 43 individuals from 23 distinct families carrying pathogenic variants. In this cohort, we extended ophthalmological and cardiological examinations to asymptomatic individuals and those with only limited or mild, often nonspecific, clinical signs commonly occurring in the general population (i.e., oligosymptomatic). The most frequent clinical findings emerging from both the literature review and the questionnaire included stroke (203/685, 29.6%), seizures or epilepsy (199/685, 29.0%), intellectual disability or developmental delay (168/685, 24.5%), porencephaly/schizencephaly (168/685, 24.5%), motor impairment (162/685, 23.6%), cataract (124/685, 18.1%), hematuria (63/685, 9.2%), and retinal arterial tortuosity (58/685, 8.5%). In oligosymptomatic and asymptomatic carriers, ophthalmological investigations detected retinal vascular tortuosity (5/13, 38.5%), dysgenesis of the anterior segment (4/13, 30.8%), and cataract (2/13, 15.4%), while cardiological investigations were unremarkable except for mild ascending aortic ectasia in 1/8 (12.5%). Our multimodal approach confirms highly variable penetrance and expressivity in COL4A1/2-related conditions, even at the intrafamilial level with neurological involvement being the most frequent and severe finding in both children and adults. We propose a protocol for prevention and management based on individualized risk estimation and periodic multiorgan evaluations.

Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers.

There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews. Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer. This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.

Effect of Foot Reflexology on Patients With Multiple Sclerosis: A Systematic Review of Current Evidence.

Individuals with multiple sclerosis (MS) commonly experience fatigue, discomfort, sleep problems, anxiety, and reduced quality of life. Studies have shown that foot reflexology can help relieve these symptoms. The objective of this current study is to systematically review the effects of foot reflexology on patients with MS. We conducted a systematic review of published literature in many databases, including PubMed, EMBASE, and Cochrane Library, from January 1, 2000, to January 27, 2022. With language restrictions, we included randomized controlled trials of foot reflexology interventions for MS that had any clinical or psychological symptom measurements as outcomes. The Cochrane risk-of-bias tool was used to assess evidence quality. Two authors independently screened titles and abstracts. Potential eligible articles were retrieved for full-text review. A third author checked for excluded records. All discrepancies were resolved through a discussion among the 4 reviewing authors. A total of 154 studies were identified; 9 studies with 545 MS patients were included in this review. The most frequently reported findings of foot reflexology intervention in individuals with MS were reductions in fatigue, pain, muscle spasms, stiffness, and psychological symptoms and improvement in bowel and bladder functions and quality of life. The findings suggest that foot reflexology could be a safe and effective modality to reduce the physical and psychological symptoms and also improve the quality of life for individuals with MS; however, well-designed, large-scale trials are required to confirm the effect.

Intravitreous aflibercept or vitrectomy for initial treatment of diabetic vitreous hemorrhage? A Systematic Review of Current Evidence

Introduction & Objectives : To assess the efficacy and safety of intravitreous aflibercept versus vitrectomy in patients with diabetic vitreous hemorrhage (VH)
 Methods : Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE database were searched. No constraints based on language or publication date were applied. Only randomized controlled trials (RCTs) comparing intravitreal aflibercept injection with vitrectomy procedure were included. Search results were screened independently by two authors. Data extraction and synthesis were performed according to The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome measures were best-corrected visual acuity obtained at least 6 months following interventions, rate of recurrent hemorrhage, and periprocedural ocular adverse events. The quality of evidence was assessed using the GRADE tools.
 Results : Two clinical trials that randomized 239 eyes were included in this review. There was no evidence ofa difference in primary outcome of mean visual acuity at six months between randomized groups. However, patients receiving intravitreous aflibercept were more likely to experience recurrent VH than those undergoing vitrectomy (RR 3.12 95% CI 1.95 - 4.99, absolute effect of 32 more people with recurrent VH per 100 people treated with aflibercept). Rates of periprocedural ocular complications were similar in both groups.
 Conclusion : Intravitreous aflibercept safety and efficacy appear to be non-inferior compared to vitrectomy for initial management of diabetic VH. Further well-designed studies are needed to investigate the long- term effects of treatments.

Safety and Efficacy of Imatinib, Nilotinib, and Artesunate in COVID-19 Patients: A Systematic Review of Current Evidence

Introduction: There is a need for better treatment options against COVID-19. This systematic review aimed to assess the safety and efficacy of imatinib and nilotinib, two tyrosine kinase inhibitors (TKIs), as well as artesunate (an anti-malarial agent), whose multilayer activ-ities against SARS, MERS, and SARS-CoV-2 pathogenesis have been suggested in laboratory and observational studies. Methods: A comprehensive search strategy targeting relevant literature on PubMed, Scopus, and Web of Science online databases was constructed. The retrieved records were reviewed and screened by title/abstract and full text with eligibility criteria, and the most pertinent articles were included in the final qualitative synthesis. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to ensure the reliability of the results. Results: This systematic review assessed the safety and applicability of imatinib, nilotinib, and artesunate in COVID-19 patients. The results showed not only possible anti-COVID-19 effects but also acceptable safety for both generic users with comorbidities with COVID-19 and off-label use in other COVID-19 patients. Promising results were also reported enhancing the sur-vival of COVID-19 patients. Conclusion: A double-blinded multicenter randomized controlled trial found survival benefits for imatinib with no significant treatment-related adverse events. However, no clinical trials or large observational studies exist for artesunate and nilotinib, and the evidence relies only on case reports and case series. Molecular mechanisms revealed in preclinical studies support the possible benefits of these medications in COVID-19 treatment. However, the scarcity of reliable evidence requires further studies on possible COVID-19 treatments, including but not limited to artesunate, nilotinib, and imatinib. Nevertheless, these drugs' lack of serious adverse events suggests their safe use for other indications during the COVID-19 pandemic.

Is There a Causal Link Between Acute Myocarditis and COVID-19 Vaccination: An Umbrella Review of Published Systematic Reviews and Meta-Analyses.

A few months after the beginning of the coronavirus disease of 2019 (COVID-19) vaccination, several reports of myocarditis secondary to the vaccines were published, sometimes with fulminant cases, but until today there is no proven causal link between these 2 events, but with many hypotheses proposed. A systematic review of current evidence regarding myocarditis after COVID-19 vaccination was performed by searching several databases including PubMed/Medline and Web of Science. The quality of Meta-analysis was assessed using the AMSTAR-2 tool as well as other qualitative criteria. Our umbrella review appraised 4 Meta-analysis of retrospective studies (range: 5-12), The number of vaccine doses included ranged from 12 to 179 million, with the number of myocarditis cases observed ranging from 343 to 1489. All types of vaccines were evaluated, with no exclusions. The overall incidence ranged from 0.89 to 2.36 cases of myocarditis per 100 000 doses of vaccine received. Heterogeny was assessed in 3 of the Meta-analysis, and was highly significant (>75%) in all included studies, and with a significant P-value (P < .05). Regarding publication bias, 3 of the Meta-analysis conducted the egger and begg regression, with a significant result in only 1. Regarding the assessment of the methodology by the AMSTAR-2 scale indicating that the quality was very critical in 1, low in 2, and moderate in 1 Meta-analysis. The quality of current non-randomized evidence on real causality and incidence of myocarditis after COVID-19 vaccine is still low.

Exploring the transformative influence of neuroplasticity on stroke rehabilitation: A systematic review of current evidence

Exploring the transformative influence of neuroplasticity on stroke rehabilitation: A systematic review of current evidence

Myocarditis after vaccination against COVID-19: an umbrella review of systematic review and meta-analysis

Abstract Introduction A few months after the beginning of the COVID-19 vaccination, several reports of myocarditis secondary to the vaccines were published, sometimes with fulminant cases, but until today there is no proven causal link between these two events, but with many hypotheses proposed. Purpose We conducted an umbrella review of all systematic reviews with meta-analyses published in this sense, in order to carry out a critical review to be able to draw relevant conclusions for our practice. Methods A systematic review of current evidence regarding myocarditis after COVID-19 vaccination was performed by searching several databases including PubMed/Medline and Web of Science. The quality of MAs was assessed using the AMSTAR-2 tool as well as other qualitative criteria. The evidence was graded from convincing (Class I) to weak (Class IV), according to the type of studies included (prospective or retrospective), p-value of the overall effect, level of heterogenicity, sample size, or inclusion or not of the null value in the 95% confidence interval. Results Our umbrella review appraised 4 MAs of retrospective studies (range: 5–12), The number of vaccine doses included ranged from 12 to 179 million, with the number of myocarditis cases observed ranging from 343 to 1489. All types of vaccines were evaluated, with no exclusions. The overall incidence ranged from 0.89 to 2.36 cases of myocarditis per 100,000 doses of vaccine received (Figure 1). Heterogeny was assessed in 3 of the MAs, and was highly significant (&amp;gt;75%) in all included studies, and with a significant p-value (p &amp;lt;0.05). Regarding publication bias, three of the MAs conducted the egger and begg regression, with a significant result in only one. Of the 4 MAs included, only one was not registered in the PROSPERO database. Writing guidelines and reporting, including Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), were used in all included Mas. Regarding the assessment of the methodology by the AMSTAR-2 scale indicating that the quality was very critical in one, low in 2 MAs, and moderate in one MA. All MAs were classified as level IV evidence except one, which was classified as level III, and this was due to the retrospective nature of the included studies and the failure to report the p-value of the overall effect. Conclusion Despite the power of meta-analysis to increase sampling and precision, the quality of current non-randomized evidence on real causality and real incidence of myocarditis after COVID-19 vaccine is still low.

Probiotics in prevention and treatment of COVID-19: a systematic review of current evidence

Introduction. Clinical evidence suggests that certain probiotics may help treat and prevent viral infections. To date, the effectiveness of probiotics in the alleviation of COVID-19 has not been established. The aim of this systematic review was to assess the role of probiotics in the prevention and treatment of COVID-19.&#x0D; Materials and methods. An extensive search of four electronic databases was performed which included Embase, Scopus, Web of Science, and PubMed from November 2019 to June 2022. After reviewing the references list of related articles additional studies were identified. A multiple combination of keywords validated by MESH were used to search the databases. Study selection was performed according to an inclusion and exclusion criteria.&#x0D; Results. Twenty-three articles met the study inclusion criteria. Six articles were conducted in vitro while the remaining studies were conducted in the human population (in vivo). The type of probiotic was defined in eighteen studies. There were two studies that used supplements (vitamins, herbals, minerals, etc.) in addition to probiotics. The largest sample size was 445 850 participants which were from a study that used an application-based survey. The majority of studies found that probiotics had a positive effect on the COVID-19 disease. The benefits included early remission of COVID-19 symptoms and a shorter duration of sickness (10 studies), lower mortality rates (3 studies), and decreased hospitalization and length of stay (3 studies). Six in vitro studies found that probiotics were beneficial against SARS-CoV-2 through antiviral effects. There were only two studies that found probiotics to be ineffective or caused negative effects when consumed in COVID-19 patients.&#x0D; Conclusion. Available evidence supports the antiviral role of probiotics on prevention and treatment of COVID-19. The antiviral potential of Lactobacillus paracasei metabolite PlnE and PlnF against SARS-CoV-2 may explain the effectiveness of probiotics on COVID-19.

Efficacy and safety of parenteral and local application of tramadol in mandibular third molar extraction: a qualitative systematic review of current evidence.

To assess the efficacy and safety of perioperative parenteral administration or submucosal infiltration of tramadol for perioperative pain control on the basis of pain intensity or analgesics consumption and perioperative outcomes in mandibular third molar surgery. An electronic database search was conducted up to 10 November 2022 to retrieve all randomized controlled trials (RCTs), assessing the analgesic efficacy of parenteral use of tramadol implemented as an adjunct to local anesthesia or intraoperative sedation/general anesthesia, in surgical extraction of mandibular third molars. Modified Jadad scale and Cochrane bias tool were used for the qualitative appraisal. Nineteen RCTs were selected for qualitative analysis. Nine studies involved intravenous, and 5 intramuscular administration of tramadol, while 5 evaluated submucosal infiltration with tramadol. Intravenous or intramuscular tramadol provided a weaker analgesic effect compared with non-steroidal anti-inflammatory drugs (NSAIDs), while intravenous tramadol induced an enhanced analgesic effect than oral tramadol. Parenteral administration of tramadol improved the quality of postoperative analgesia versus placebo. No notable adverse effects were recorded. Parenteral or submucosal infiltration of tramadol constitutes an effective and safe alternative analgesic approach in surgical extraction of mandibular third molars, yet the nociceptive effect of this analgesic modality could not supersede that of NSAIDs. PROSPERO No CRD42021227574.

Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study.

Although the incidence of pressure injury in the prone position is high for the mechanically ventilated patients in the intensive care unit, evidence-based strategies are still lacking. To conduct a systematic review of current evidence, and to propose a series of strategies to prevent pressure injuries among mechanically ventilated patients with prone position in the intensive care unit. The study was guided by the Medical Research Council framework. After a systematic review of current evidence of original articles, guidelines, expert consensus and theories, a strategy draft was developed. Then we invited 20 experts to modify and refine these strategies through two rounds of Delphi consensus method. After two rounds of Delphi process, the importance of coefficient of variation (Cv) and Kendall's coefficient of concordance in the strategies repository were 0.067 and 0.311, respectively. And the operability of Cv and Kendall's coefficient of concordance in the strategy draft was 0.055 and 0.294, respectively. Ultimately, we established 31 strategies for including 7 themes (assess risk factors, assess skin and tissue, body position management, skin care, nutrition, preventing medical device-related pressure injuries, education and supervision). In addition, we also developed a strategy framework to clarify our strategies. According to the Medical Research Council framework, we developed 7 themes and 31 strategies to prevention prone-position pressure injuries among the intensive care unit mechanically ventilated patients. This study was considered to improve the clinical management of pressure injuries among prone position patients in the intensive care unit settings.

MSR93 A Systematic Review of Current Evidence and Gaps on the Impact of Oral Antipsychotic Treatments in Schizophrenia

Schizophrenia, a complex disease with no current cure, affects about 1% of the US population. The burden of schizophrenia is significantly impacted due to heterogeneity observed across medications’ adherence, efficacy, safety, economic, and effectiveness outcomes. The study goal is to provide an in-depth review of studies that describe the clinical, economic, and humanistic outcomes associated with oral medications in schizophrenia.

Genetic polymorphisms of ACE1, ACE2, IFTM3, TMPRSS2 and TNFα genes associated with susceptibility and severity of SARS-CoV-2 infection: a systematic review and meta-analysis.

Some human polymorphisms of ACE1, ACE2, IFITM3, TMPRSS2 and TNFα genes may have an effect on the susceptibility to SARS-CoV-2 infection and increase the risk to develop severe COVID-19. We conducted a systematic review of current evidence to investigate the association of genetic variants of these genes with the susceptibility to virus infection and patient prognosis. We systematically searched Medline, Embase and The Cochrane Library for articles published until May 2022, and included observational studies covering genetic association of ACE1, ACE2, IFITM3, TMPRSS2 and TNFα genes with COVID-19 susceptibility or prognosis. We evaluated the methodological quality of included studies, and pooled data as convenient in meta-analysis (MA). Odds ratio (OR) values and 95% confidence intervals were calculated. We included 35 studies (20 on ACE, 5 each on IFITM3, TMPRSS2, TNFα), enrolling 21,452 participants, of them 9401 were COVID-19 confirmed cases. ACE1 rs4646994 and rs1799752, ACE2 rs2285666, TMPRSS2 rs12329760, IFITM3 rs12252 and TNFα rs1800629 were identifies as common polymorphisms. Our MA showed an association between genetic polymorphisms and susceptibility to SARS-CoV-2 infection for IFITM3 rs12252 CC (OR 5.67) and CT (OR 1.64) genotypes. Furthermore, MA uncovered that both ACE DD (OR 1.27) and IFITM3 CC (OR 2.26) genotypes carriers had a significantly increased risk of developing severe COVID-19. These results provide a critical evaluation of genetic polymorphisms as predictors in SARS-CoV-2 infection. ACE1 DD and IFITM3 CC polymorphisms would lead to a genetic predisposition for severe lung injury in patients with COVID-19.

Use of therapeutic plasma exchange in COVID-19: A systematic review of current evidence.

Current knowledge related to employment of plasma exchange for treatment in COVID-19 is predominantly based on casuistic evidence in the form of single-center case-series. Published data encompass reports from a total of approximately 225 patients. Based on published reports, therapeutic plasma exchange has generally been employed as rescue or adjunctive therapy in patients with critical illness, with proposed benefit attributed possible effects on mitigation and amelioration of cytokine storm syndrome. Treatment effects remain uncertain, with the impact of plasma exchange on critical illness in COVID inconclusive with regard to both efficacy and safety.

Prevalence of Hepatitis in Prisoners: A Systematic Review of Current Evidence.

Prisoners represent high-risk behaviors such as injecting drug use, sharing syringes, tattooing, and unprotected sexual intercourse. The authors aimed to study the prevalence of hepatitis B, hepatitis C, and hepatitis D in the prisoners. We conducted a systematic search using the keywords in online databases of PubMed, Web of Science, Scopus, and Science Direct. Two independent researchers examined the quality of the articles and the probable risk of bias. The most relevant articles by title and abstract were retrieved. Finally, the full text of selected articles was read, and the critical findings were extracted. Reviews of 23 studies showed that most prisoners are susceptible to hepatitis B and hepatitis C. One study also indicated that prisoners could be infected with hepatitis A and hepatitis E. The most common routes of hepatitis transmission in prisons were intravenous drug use, needle sharing, tattooing, and unsafe sex with multiple sexual partners. High-risk sexual behaviors, shared contaminated needles for IV drug injection, and tattooing are the principal routes of hepatitis transmission among prison inmates. Hepatitis treatment is feasible and could be useful for infected prisoners undergoing a well-designed treatment program.

Cannabis in Palliative Care: A Systematic Review of Current Evidence.

Palliative care aims to improve the quality of life in patients with incurable illness. Medicinal cannabis (MC) has been used in the palliative care setting to address multiple symptoms in patients. To evaluate the full scope of available literature investigating the effects and potential harms of MC on symptom management and quality of life in palliative care. PubMed, Embase, The Cochrane Library and clinicaltrials.gov were searched for eligible articles, published between 1960 and September 9, 2021. Quality of the evidence was assessed in accordance with Grading of Recommendations, Assessment, Development and Evaluations. Risk of bias was assessed using the RoB 2 tool for randomised controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized trials. Fifty-two studies (20 randomised; 32 non-randomised) with 4786 participants diagnosed with cancer (n=4491), dementia (n=43), AIDS (n=235), spasticity (n=16), NORSE syndrome (n=1) were included. The quality of evidence was 'very low' or 'low' for all studies, and low for only two randomised controlled trials. Positive treatment effects (statistical significance with P < 0.05) were seen for some MC products in pain, nausea and vomiting, appetite, sleep, fatigue, chemosensory perception and paraneoplastic night sweats in patients with cancer, appetite and agitation in patients with dementia and appetite, nausea and vomiting in patients with AIDS. Meta-analysis was unable to be performed due to the wide range of cannabis products used and the heterogeneity of the study outcomes. While positive treatment effects have been reported for some MC products in the palliative care setting, further high quality evidence is needed to support recommendations for its use in clinical practice.

The effects of astaxanthin supplementation on expression of microRNAs involved in cardiovascular diseases: a systematic review of current evidence

MicroRNAs (miRNAs) have biological roles in controlling oxidative stress. Astaxanthin (AST) may regulate circulating miRNAs in cardiovascular diseases (CVDs); therefore, our study aimed to evaluate the effect of AST on miRNA involved in CVDs. A systematic literature search from inception to August 2022 resulted in 80 preliminary studies; 15 articles were included. In vitro studies indicated that AST up-regulated miRNAs compromised miR-138, miR-7, miR-29a-3p, and miR-200a, while down-regulated miR-382-5p, miR-31-5p, and miR-21. In vivo articles revealed that AST increased the expression of miR-124, miR-7, miR-29a-3p, and miR-200a but decreased miR-21 and miR-31-5p and the only clinical study showed a drop in miR-146a. The findings indicate that AST regulated different pathways of miRNAs implicated in various conditions. Therefore AST as a new therapeutic strategy could be essential in preventing and controlling CVDs. However, more studies, including clinical trials, are needed to determine the influence of AST on miRNAs associated with CVDs.

What Makes Urban Communities More Resilient to COVID-19? A Systematic Review of Current Evidence.

It has been more than two years since the outbreak of the COVID-19 epidemic at the end of 2019. Many scholars have introduced the “resilience” concept into COVID-19 prevention and control to make up for the deficiencies in traditional community governance. This study analyzed the progress in research on social resilience, which is an important component of community resilience, focusing on the current literature on the impact of social resilience on COVID-19, and proposed a generalized dimension to integrated previous relevant literature. Then, VOSviewer was used to visualize and analyze the current progress of research on social resilience. The PRISMA method was used to collate studies on social resilience to the pandemic. The result showed that many current policies are effective in controlling COVID-19, but some key factors, such as vulnerable groups, social assistance, and socioeconomics, affect proper social functioning. Some scholars have proposed effective solutions to improve social resilience, such as establishing an assessment framework, identifying priority inoculation groups, and improving access to technology and cultural communication. Social resilience to COVID-19 can be enhanced by both external interventions and internal regulation. Social resilience requires these two aspects to be coordinated to strengthen community and urban pandemic resilience.

COVID-19 in Pediatrics: A Systematic Review of Current Knowledge and Practice.

SARS-CoV-2 is the novel coronavirus that causes severe acute respiratory syndrome and could afflict individuals from all walks of life. Children are usually asymptomatic or represent non-specific mild to moderate symptoms; therefore, they often remain undiagnosed and could be potential reservoirs and silent carriers of the virus. Despite the global attention to COVID-19 and its importance in public health, some clinical and paraclinical aspects of this disease in children are still unclear. Thus, we conducted a comprehensive systematic review of available literature to reflect on the current knowledge and practice of the disease among children. This study was a systematic review of current evidence conducted in October 2020. We performed a systematic search using the keywords in online databases. The investigation adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the reliability and validity of extracted literature and results. We selected and reviewed 23 most related studies out of 1744 identified papers in an initial online search based on the inclusion and exclusion criteria of the present review; of whom 13 were original research studies, and 10 were letters to the editors, commentaries, viewpoints, consensus statements, and perspectives. Although due to the origin of the current pandemic, China was the country with the most publications (12 articles), data from several countries have been included in this review. COVID-19 can also affect children and cause systemic disease with several internal organ involvements. However, the prevalence, severity, and diversity of the symptoms in children are less than in adults. Cough and fever appear to be some of the most common symptoms, followed by other symptoms such as gastrointestinal manifestations. Comorbidities increase the risk of severe COVID-19 in children, and those without underlying conditions are very unlikely to suffer from severe disease. Mental health issues such as anxiety and depression due to the isolated situation caused by pandemics are common findings in children of early ages and should be seriously considered in current practice.

COVID-19 Case Fatality Rate and Factors Contributing to Mortality in Ethiopia: A Systematic Review of Current Evidence

BackgroundThe ongoing novel coronavirus disease 2019 (COVID-19) is triggering significant morbidity and mortality due to its contagious nature and absence of definitive management. In Ethiopia, despite a number of primary studies have been conducted to estimate the case fatality rate (CFR) of COVID-19, no review study has attempted to summarize the findings to better understand the nature of pandemics and the virulence of the disease.ObjectiveTo summarize the CFR of COVID-19 and factors contributing to mortality in Ethiopia.MethodsPRISMA guideline was followed. PubMed, Science Direct, CINAHL, SCOPUS, Hinari, and Google Scholar were systematically searched using pre-specified keywords. Observational studies ie, cohort, cross-sectional, and case-control studies were included. The Newcastle-Ottawa scale adapted for observational studies was used to assess the quality of included studies. CFR was defined as the proportion of COVID-19 cases with the outcome of death within a given period. Factors contributing to COVID-19 mortality at p-value <0.05 were described narratively from the eligible articles.ResultsA total of 13 observational studies were included in this study. Consequently, this review confirmed the CFR of COVID-19 in Ethiopia ranges between 1–20%. Additionally, comorbid conditions, older age group, male sex, substance use, clinical manifestations (abnormal oxygen saturation level, atypical lymphocyte count, fever, and shortness of breath), disease severity, and history of surgery/trauma increased the likelihood of death from COVID-19 death.ConclusionThis study shows that the range of CFR of COVID-19 in Ethiopia is almost equivalent to other countries, despite the country’s low testing capacity and case detection rate in reference to its total population. Comorbid diseases, older age group, male sex, cigarette smoking, alcohol drinking, clinical manifestations and disease severity, and history of surgery/trauma were factors contributing to COVID-19 mortality in Ethiopia. Therefore, given the alarming global situation and rapidly evolving large-scale pandemics, urgent interdisciplinary interventions should be implemented in those vulnerable groups to lessen the risk of mortality. Furthermore, the CFR of COVID-19 should be estimated from all treatment and rehabilitation centers in the country, as underestimation could be linked to a lack of preparedness and mitigation. A large set of prospective studies are also compulsory to better understand the CFR of COVID-19 in Ethiopia.