Реферат
Why do some populations display a higher attack and mortality rate from the current coronavirus disease 2019 (COVID-19) pandemic than others? Are there geographic, environmental, behavioral, genetic, and comorbidity differences that influence spatial dynamics of COVID-19 transmission and outcomes? Where are the regional and country-level hotspots, and what drives those hotspots? These are some of the questions the current chapter strives to answer. The dynamics of transmission and consequences of COVID-19 are not homogeneous but instead have a geographical and spatial clustering. Population-level genetic, vaccination rates, health care disparities, SARS-CoV-2 variants, and meteorological factors are all underlying determinants of the disease dynamics globally, regionally, nationally, and locally. Disease surveillance frameworks to control, mitigate, and prevent the SARS- CoV-2 infections, particularly in low- and middle-income countries, are critical. Lastly, we highlight the spatial differences in the consequences of the pandemic focusing on behavioral and post-acute sequelae of SARS-CoV-2 infection. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Background. Corticosteroids confer a survival benefit in hospitalized COVID-19 patients requiring oxygen, but optimal treatment duration remains uncertain. The goal of this meta-analysis is to determine the optimal duration of corticosteroids in the treatment of severe COVID-19. (Figure Presented) The greatest survival benefit was observed for the treatment duration of up to 6 days (A). No survival benefit was observed beyond 7 days of treatment (B). Methods. Electronic databases (MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, the World Health Organization Global Literature on Coronavirus Disease, CoronaCentral, and Web of Science) and trial registries were searched to March 9, 2022, for randomized controlled trials and observational cohort studies reporting corticosteroid versus no corticosteroid treatment in hospitalized COVID-19 patients. Risk of bias was assessed using the Cochrane Risk of Bias tool (randomized controlled trials) or the Newcastle-Ottawa Scale (observational studies). We estimated the effect of corticosteroids on mortality by random-effects meta-analyses using the generic inverse variance method. Subgroup analyses and meta-analyses were conducted to assess the optimal duration of corticosteroid treatment. Results. We identified 28 eligible studies consisting of 13,404 hospitalized COVID-19 patients. Median age was 62 years (interquartile range: 59 - 67), and 65% weremale. Eight randomized controlled trials and 20 observational studieswere included in the meta-analysis of mortality, which suggested a protective association with corticosteroid therapy (risk ratio, 0.75;95% CI: 0.64;0.87). Pooled analysis of 19 studies showed the greatest survival benefit for a treatment duration up to 6 days (risk ratio, 0.54;95% CI, 0.39;0.74). Survival benefit was 0.68 (95% CI, 0.57;0.82) up to 7 days, and no survival benefit was observed beyond 7 days of treatment (risk ratio, 0.71;95% C: 0.51;1.01). Conclusion. In this meta-analysis, the optimal duration of corticosteroid treatment for hospitalized COVID-19 patients was up to 6 days, with no additional survival benefit with > 7 days of treatment. Future analyses should stratify survival benefit by baseline disease severity to see if subgroups of patients derive greater benefit from longer courses of steroids.
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Background: As of June 3rd, 2020, the number of confirmed cases of novel SARSCoV- 2, the causative agent of COVID-19, was approximately 6,538,456, with 386,503 deaths globally. Individuals with pre-existing conditions are particularly susceptible to and more likely to die from Covid-19. However, individuals with human immunodeficiency virus (HIV) are unique due to their use of antiretroviral therapy, including protease inhibitors, which have been used to treat COVID-19. We aimed to conduct a systematic review and meta-analysis exploring the prevalence and prevalence of HIV in patients hospitalized for COVID-19 and delineating the mortality rates. Methods: MEDLINE, SCOPUS, and Cochrane Library databases and medrxiv. org were searched from January 1st, 2020, to June 15th, 2020. Studies reporting on the prevalence of HIV among hospitalized COVID-19 patients among and outcome of mortality were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified. Results: A total of 144,795 hospitalized COVID-19 patients were identified from 14 studies (United States 8, Spain 3, China 1, Italy1, and Germany 1). The pooled prevalence of HIV in COVID-19 patients was 1.22 % [95% confidence interval (CI): 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI: 0.48%-0.89%. When we stratified the analysis by country, pooled HIV prevalence among COVID- 19 patients in United States (1.43%, 95% CI: 0.98% -2.07%) was significantly higher compared to Spain (0.26%, 95% CI: 0.23%-0.29%) but not different from China (0.99 %, 95% CI: 0.25 %-3.85%). The pooled mortality rates in HIV-positive patients hospitalized for COVID-19 was 14.1 % 95% CI: 5.78%-30.50% and was substantially higher in the United States compared to other countries. Conclusion: The prevalence of HIV among COVID-19 patients may be higher compared to the general population, suggesting higher susceptibility to COVID-19. The mortality rates are high but vary significantly across countries.