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  • Open Access English
    Borges do Nascimento, Israel Júnior et al.;

    A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-e ects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%–99%; n = 4410), cough (61%, 95% CI 39%–81%; n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%–55%; n = 3778), dyspnea (26%, 95% CI 12%–41%; n = 3700), headache in 12% (95% CI 4%–23%, n = 3598 patients), sore throat in 10% (95% CI 5%–17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%–17%, n=1744). Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 109/L, 95% CI 0.83–1.03 109/L, n = 464) and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54–45.91 mg/dL; n = 1637). Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%–1.0%; n = 53,631). Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.

  • Open Access
    Mammen MJ. Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA;

    Introduction: Acute respiratory distress syndrome (ARDS) is a rapidly progressing inflammatory lung disease with a high mortality rate without specific pharmacological therapy. Objective: We conducted a systematic review and meta-analysis on corticosteroid use in ARDS. Methods: A search of four medical literature databases was conducted. We retained randomized trials (RCTs) of corticosteroids in hospitalized adults with ARDS in a search up to February, 2020. Two reviewers identified eligible studies, independently extracted data, and assessed risk of bias. Authors assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: We included seven RCTs (n=851 patients). Corticosteroids reduced all-cause mortality (risk ratio [RR] 0.75, 95% CI: 0.59 to 0.95, p=0.02, moderate certainty) and duration of mechanical ventilation (mean difference [MD] -4.93 days, 95% CI: -7.81 days to -2.06 days, p<0.001, low certainty), and increased ventilator-free days (VFD) (MD 4.28 days, 95% CI: 2.67 days to 5.88 days, p<0.001, moderate certainty), when compared to placebo. Corticosteroids also increased the risk of hyperglycemia (RR 1.12%, 95% CI: 1.01 to 1.24, p=0.03, moderate certainty), and the effect on neuromuscular weakness was unclear (RR 1.30, 95% CI 0.80 to 2.11, p=0.28, low certainty). Corticosteroids for patients with acute respiratory distress syndrome: a rapid update systematic review and meta-analysis of randomized trials. Conclusions: These results suggest that systemic corticosteroids may potentially improve mortality, ventilator duration, and VFD in patients with ARDS. However, the studies included different corticosteroid classes and initiated the corticosteroid doses at different times, as well as different dosing regimens. Thus caution in the actual clinical application of these results is recommended.

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