Association of D-dimer with short-term risk of venous thromboembolism in acutely ill medical patients: A systematic review and meta-analysis.

BACKGROUND: D-dimer, a marker of ongoing procoagulant activity, has been widely used for the diagnosis of venous thromboembolism (VTE). The prognostic significance of D-dimer in stratifying VTE risk for acutely ill medical patients has not been well-established. METHODS: A literature search was performed to collect studies that compared the incidence of short-term VTE between acutely ill medical patients with elevated or nonelevated D-dimer levels. The cutoff of D-dimer was 0.5 µg/mL or otherwise defined by included studies. The study endpoint was any occurrence of VTE (inclusive of deep vein thrombosis [DVT], pulmonary embolism, or VTE-related death) within 90 days of hospital presentation. A meta-analytic approach was employed to estimate the odds ratio (OR) with 95% CI by fitting random-effects models using the generic inverse variance weighted approach. RESULTS: A total of 10 studies representing 31,119 acutely ill medical patients were included. Compared to those with nonelevated D-dimer levels, patients with elevated D-dimer had approximately threefold greater odds for short-term VTE within 90 days (OR, 3.28; 95% CI, 2.44 to 4.40; p < 0.0001). The association of elevated D-dimer with VTE composite (OR, 3.33; 95% CI, 2.20 to 5.02) and with DVT (OR, 3.26; 95% CI, 2.32 to 4.58) was comparable. The association was significant among patients who presented various acute medical illness (OR, 2.68; 95% CI, 2.01 to 3.58) and those who presented with acute stroke (OR, 3.25; 95% CI, 2.31 to 4.58). CONCLUSION: Elevation of D-dimer was predictive of the occurrence of VTE within 90 days among acutely ill medical patients.

Evaluation of Cardiac Troponin and Adverse Outcomes After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

Several studies have demonstrated the usefulness of cardiac troponin I (cTn) levels in predicting adverse clinical outcomes of patients with anerusmal subarachnoid hemorrhage (aSAH). However, it remains unclear whether cTn levels can be a useful factor in predicting adverse neurologic and cardiovascular outcomes regarding follow-up duration. The study aimed to evaluate the clinical value of cTn elevation among patients with aSAH. A systematic literature search was performed in PubMed and Cochrane to collect original studies that compared the adverse outcomes in patients with aSAH who had elevated cTn levels and those who did not have elevated cTn levels. Data on patient demographics and outcome measurements (mortality, major disability, delayed cerebral ischemia, cardiac dysfunction, and pulmonary edema) were extracted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were computed by fitting a random effects model. A total of 4,117 patients with aSAH were included in the meta-analysis. Elevated cTn levels was associated with a higher all-cause mortality (OR 3.64; 95% CI 2.68-4.94; I2 = 22.05%), poor major disability (OR 2.27; 95% CI 1.5-3.37; I2 = 52.07%), delayed cerebral ischemia (OR 2.10; 95% CI 1.46-3.03; I2 = 13.80%), cardiac dysfunction (OR 9.20; 95% CI 4.31-19.60; I2 = 39.89), and pulmonary edema (OR 10.32; 95% CI 5.64-18.90; I2 = 0.00%). Additionally, elevated cTn levels was associated with higher mortality in prospective studies (OR 3.66; 95% CI 2.61-5.14) as well as when compared with studies with short-term and long-term follow-up periods. Patients with aSAH who had elevated cTn levels also tended to experience poor short-term major disability (OR 2.36; 95% CI 1.48-3.76). Among patients with aSAH, elevated cTn levels was associated with higher mortality and adverse neurologic and cardiovascular outcomes. Given its clinical value, cardiac troponin levels may be included in the assessment of patients withs aSAH.

Association between red blood cell distribution width and mortality and severity among patients with COVID-19: A systematic review and meta-analysis.

Emerging evidence has underscored the potential usefulness of red blood cell distribution width (RDW) measurement in predicting the mortality and disease severity of COVID-19. This study aimed to assess the association of the plasma RDW levels with adverse prognosis in COVID-19 patients. A comprehensive literature search from inception to September 2020 was performed to harvest original studies reporting RDW on admission and clinical outcomes among patients hospitalized with COVID-19. RDW levels were compared between cases (patients who died or developed more severe symptoms) and controls (patients who survived or developed less severe symptoms). A total of 14,866 subjects from 10 studies were included in the meta-analysis. Higher levels of RDW were associated with adverse outcomes in COVID-19 patients (mean differences = 0.72; 95% CI = 0.47-0.97; I2 = 89.51%). Deceased patients had higher levels of RDW compared to patients who survived (mean differences = 0.93; 95% CI = 0.63-1.23; I2 = 85.58%). Severely ill COVID-19 patients showed higher levels of RDW, as opposed to patients classified to have milder symptoms (mean differences = 0.61; 95% CI = 0.28-0.94; I2 = 82.18%). Elevated RDW levels were associated with adverse outcomes in COVID-19 patients. This finding warrants further research on whether RDW could be utilized as a simple and reliable biomarker for predicting COVID-19 severity and whether RDW is mechanistically linked with COVID-19 pathophysiology.

Legumes Protease Inhibitors as Biopesticides and Their Defense Mechanisms against Biotic Factors.

Legumes are affected by biotic factors such as insects, molds, bacteria, and viruses. These plants can produce many different molecules in response to the attack of phytopathogens. Protease inhibitors (PIs) are proteins produced by legumes that inhibit the protease activity of phytopathogens. PIs are known to reduce nutrient availability, which diminishes pathogen growth and can lead to the death of the pathogen. PIs are classified according to the specificity of the mechanistic activity of the proteolytic enzymes, with serine and cysteine protease inhibitors being studied the most. Previous investigations have reported the efficacy of these highly stable proteins against diverse biotic factors and the concomitant protective effects in crops, representing a possible replacement of toxic agrochemicals that harm the environment.

Non-vitamin K antagonist oral anticoagulants for the treatment of intracardiac thrombosis.

Intracardiac thrombus most commonly develops in the left atrial appendage (LAA) and left ventricle (LV) in the setting of atrial fibrillation (AF) and post-myocardial fibrillation (MI), respectively. Current guidelines recommend that patients with post-MI LV or LAA thrombus should be treated with vitamin K antagonist (VKA). However, the use of VKA may be limited by bleeding complications, interactions with various food and drugs, and a narrow therapeutic window requiring frequent monitoring. Thus, non-VKA oral anticoagulants (NOACs) have been attempted as an off-label use for the treatment of intracardiac thrombosis in light of their favorable pharmacologic profile. Until now, therapeutic effect of NOACs on intracardiac thrombosis has not been formally studied in large randomized controlled trials. This article aims to systematically review the literature regarding efficacy and safety outcome of NOACs in the management of intracardiac thrombus. Considering the high rate of complete thrombus resolution and low rate of thromboembolic or hemorrhagic complications, preliminary evidence from case series and reports indicate that NOACs (including factor Xa inhibitors and direct thrombin inhibitors) may be a safe and effective therapeutic option for intracardiac thrombosis, particularly in cases resistant to VKA therapy.

Effect of intensive versus standard blood pressure control on major adverse cardiac events and serious adverse events: A bivariate analysis of randomized controlled trials.

BACKGROUND: Intensive blood pressure (BP) lowering may offer protective effects against major adverse cardiac event (MACE) but is also associated with a greater risk of a serious adverse event (SAE). The risk-benefit profile of intensive versus standard BP control has not been comprehensively assessed. METHODS: Four studies were identified from a systematic literature search for randomized controlled trials comparing intensive versus standard BP lowering that reported both MACE and SAE endpoints. A previously described statistical approach was applied to characterize the efficacy-safety tradeoff of BP control. The bivariate outcome was computed to quantitatively assess the net clinical benefit (NCB) of intensive BP lowering as compared to standard treatment, with positive values indicating increased risks and negative values indicating decreased risks. RESULTS: Data from the SPRINT trial demonstrated that intensive strategy was superior in MACE but inferior in SAE, thereby eroding the NCB (bivariate outcome: 0.33% [-0.50% to 1.21%]). Intensive strategy from the SPS3 trial fulfilled non-inferiority in both MACE and SAE but did not reach a favorable NCB (-1.31% [-2.25% to 0.01%]). The ACCORD trial suggested that intensive strategy was non-inferior in MACE but inferior in SAE (-0.19% [-0.79% to 1.37%]). Results from the VALISH trial were inconclusive for SAE but suggested non-inferiority in MACE (-1.19% [-3.24% to 0.68%]). CONCLUSIONS: Compared to the standard blood pressure target, pooled data from randomized controlled trials suggest that intensive strategy did not achieve a net clinical benefit when weighing the benefit of MACE reduction against the risk of SAE under the bivariate framework. ABBREVIATIONS: Blood pressure (BP), diastolic blood pressure (DBP), major adverse cardiac event (MACE), net clinical benefit (NCB), serious adverse event (SAE), systolic blood pressure (SBP).

Evaluation of Game Performance in Elite Male Sitting Volleyball Players.

The aims of the current study were (a) to analyze the differences in game performances of sitting volleyball athletes representing the different types of disabilities and (b) to assess whether the seated position vertical reach is one of the crucial factors in the game performance level of sitting volleyball athletes. One hundred male athletes from various national teams participating in the European Championships in Sitting Volleyball (2009) took part in this study. The athletes were categorized according to type of disability and the results of the vertical reach in a seated position. Thirtysix games were analyzed using the Game Performance Sheet for Sitting Volleyball. Twenty-three game performance parameters were studied. In addition, the sum and effectiveness of attacks, blocks, block services, services, ball receiving, and defensive actions were calculated. The main results indicated significant differences between athletes with minimal disability and athletes with single amputations from above the knee in the level of defensive performances and the summation of defensive actions. There was also a significant difference between athletes in relation to their vertical reach during activity and attacking actions, blocks, and ball receiving. In addition, there were strong relationships between the players' vertical reach scores and their activity and effectiveness in sitting volleyball. In conclusion, the accuracy of the World Organization Volleyball for Disabled classification systems for sitting volleyball players was confirmed. There is a strong relationship between players' vertical reach and their effectiveness in sitting volleyball.

Sports Performance Tests for Amputee Football Players: A Scoping Review.

BACKGROUND: This scoping review aims to identify sports performance tests for amputee football players and to critically analyze the methodological quality, validation data, reliability, and standardization of sport-specific tests to indicate the best-fitting tests. METHODS: Electronic database searches were conducted between January 2019 and October 2021. Twelve articles met the inclusion criteria. Qualitative assessment of each study was conducted by STROBE checklist. RESULTS: Twenty-nine sports performance tests were identified. No sports performance test fully met all three criteria associated with the qualitative assessment of tests. The critical appraisal of the articles demonstrates a gap in study design, settings, and main results description. Some inconsistencies were found in the methodological descriptions of tests assessing the same motor skill. A STROBE score of 13 points was considered a satisfactory score for the article (it was obtained by 8 of the 12 studies). The weakest point of the analyzed studies was the description of how the test group size was accessed and later obtained. CONCLUSIONS: No test was found that was simultaneously presented as valid, reliable, and standardized. The authors can recommend the use of the two-sports performance tests that are the closest to ideal: the L test and the YYIRT1.

Prognostic value of hemoglobin-to-red cell distribution width ratio in cancer: a systematic review and meta-analysis.

Background: The hemoglobin-to-red cell distribution width ratio (HRR) has emerged as a novel integrative biomarker predictive of overall and disease-free survival in cancer patients. This study aimed to investigate the prognostic significance of HRR in the cancer population. Methods: A literature search was performed in PubMed/MEDLINE from inception to 1 July 2021, to collect studies assessing the prognostic value of HRR in cancer patients. The primary and secondary end points were all-cause mortality and occurrence of disease progression or relapse, respectively. A meta-analytic approach was employed to estimate the pooled hazard ratio with 95% CI by fitting random-effects models. Results: A total of 11 retrospective cohort studies representing 2985 cancer patients were included. Compared with patients with high HRR, patients with low HRR had a twofold risk of all-cause mortality (hazard ratio: 2.29; 95% CI: 1.76-2.98; p < 0.0001). There was substantial heterogeneity in the association of HRR with mortality across the studies (I2: 66.8%; 95% CI: 35.3-82.9%; p = 0.0014). Similarly, low HRR was associated with a twofold risk of disease progression or relapse (hazard ratio: 2.19; 95% CI: 1.74-2.76; p < 0.0001). No significant heterogeneity was observed (I2: 16.8%; 95% CI: 0.0-60.7%; p = 0.30). Conclusion: Low HRR was associated with mortality and disease progression or relapse in patients with cancer. Further studies are required to standardize the HRR cutoff value and investigate whether HRR can be incorporated into risk assessment models for predicting adverse prognosis in cancer patients.

Hemoglobin and red cell distribution width are both widely available and routinely measured in blood tests. The hemoglobin-to-red cell distribution width ratio has recently been introduced as a new potential marker for predicting the clinical course and outcome in patients with various types of cancer. In the present meta-analysis of 11 studies representing 2985 cancer patients, the authors showed that cancer patients with a lower hemoglobin-to-red cell distribution width ratio were more likely to experience disease progression or relapse and had a greater mortality risk.

Systematic Review and Meta-Analysis of Thromboprophylaxis with Heparins Following Intracerebral Hemorrhage.

BACKGROUND: The efficacy and safety of pharmacological thromboprophylaxis in patients with intracerebral hemorrhage (ICH) remains unclear. METHODS: A literature search was performed to collect studies comparing the effect of thromboprophylaxis in patients with ICH. The primary endpoints were deep vein thrombosis (DVT), pulmonary embolism (PE), and hematoma expansion or rebleeding. A meta-analytic approach was employed to estimate the relative risk (RR) by fitting fixed-effects (FE) and random-effects (RE) models. RESULTS: A total of 28 studies representing 3,697 hospitalized patients with ICH were included. Thromboprophylaxis was initiated within 4 days following hospital presentation and continued for 10 to 14 days in most of studies. Compared with control, thromboprophylaxis was associated with a reduced risk of DVT (47/1,399 [3.4%] vs. 202/1,377 [14.7%]; FE: RR, 0.24; 95% CI, 0.18-0.32; RE: RR, 0.27; 95% CI, 0.19-0.39) as well as PE (9/953 [0.9%] vs. 37/864 [4.3%]; FE: RR, 0.33; 95% CI, 0.19-0.57; RE: RR, 0.37; 95% CI, 0.21-0.66). Thromboprophylaxis was not associated with increased risk of hematoma expansion or rebleeding (32/1,319 [2.4%] vs. 37/1,301 [2.8%]; FE: RR, 0.75; 95% CI, 0.48-1.18; RE: RR, 0.80; 95% CI, 0.49-1.30) or mortality (117/925 [12.6%] vs. 139/904 [15.4%]; FE: RR, 0.82; 95% CI, 0.65-1.03; RE: RR, 0.83; 95% CI, 0.66-1.04). CONCLUSION: Thromboprophylaxis was effective in preventing DVT and PE without increasing the risk of hematoma expansion or bleeding among ICH patients. Future studies should explore the long-term effects of thromboprophylaxis in this population, particularly on the functional outcomes.

Nutraceutical Quality and Soluble Solids of Cucumis melo Developed in Vermicompost-River Sand Mixtures, Under Shade Mesh Conditions.

<b>Background and Objective:</b> There is ample evidence that the consumption of fruits and vegetables, with a high content of secondary metabolites, favours better human health. In the same sense, the application of organic fertilizers has favoured the content of phenolic compounds and a greater antioxidant capacity in various crops. Factoring that the application of Vermicompost (VC) increases the nutritional quality of plants. This research determined the content of soluble solids, biochemical components and the antioxidant capacity of the melon fruits (<i>Cucumis melo</i> L.) developed under shade net conditions with VC as a source of fertilization. <b>Materials and Methods:</b> During the 2020 spring-summer season, a hybrid melon Honeydew type was grown under five mixtures of VC: River sand (RS), with ratios 0:1, 1:1, 1:2, 1:3 and 1:4. Nutrient Steiner solution was applied only in the first mixture (control) while VC was used as an organic nutrient for all other mixtures. The five formulated mixtures, with five replications, were randomly distributed. The total phenolic content, total flavonoids, antioxidant capacity and the total soluble solids of the melon fruit were determined. Data obtained were statistically analyzed by analysis of variance and means were compared by Tukey 0.05 test. <b>Results:</b> The ANOVA indicates that no statistical differences were registered for any of the variables under study, however, the levels of the parameters were high. <b>Conclusion:</b> VC treatment of melon fruit is proven to be a promising source of nutrients to plants increasing their natural antioxidants and content of soluble solids.

Anaerobic Variables As Specific Determinants of Functional Classification in Wheelchair Basketball.

Every parasport is currently encouraged to consider evidence-based classification to develop their respective classification system. Therefore, the aims of this study were to: (1) assess the relationship between trunk function and anaerobic power determining proficiency in wheelchair basketball, and (2) define "natural classes" in wheelchair basketball based on anaerobic power. Fifty-nine elite players (representing five national teams) were divided into four main functional classes: Group 1 (n=17), Group 2 (n=14), Group 3 (n=16), Group 4 (n=12). They performed the 6x10s Anaerobic Power Test using an arm crank ergometer. Average values of mean power, peak power, relative mean power, relative peak power, and power decrement were calculated for the 6x10s and 3x10s tests. The Spearman's correlation matrix revealed significant correlations between classes and values recorded in the 6x10s test. This confirmation between anaerobic power and players' classification endorses the division of players into different classes. Furthermore, cluster analysis (with fair quality) divided players into two "natural classes". The first resulting class was mainly formed of participants from Group 1 (71%). An important complement to this research could be to consider wheelchair acceleration and the volume of trunk action in wheelchair basketball classification.

Clinical outcomes of pharmacological thromboprophylaxis among patients with intracerebral hemorrhage: Systematic review and meta-analysis.

OBJECTIVE: Efficacy and safety of pharmacologic thromboprophylaxis after an episode of intracerebral hemorrhage remains unclear. This meta-analysis aimed at comparing the clinical outcomes of intracerebral hemorrhage patients with or without pharmacologic thromboprophylaxis. METHODS: We performed a comprehensive literature review of PubMed to identified relevant studies. The primary and secondary endpoints included venous thromboembolism, deep venous thrombosis, pulmonary emboli, rebleeding, hematoma enlargement (defined as increase in hematoma volume of ≥33%), major disability (defined as modified Rankin score of 3-5), and death. Pooled outcomes were estimated by fitting random effects model with restricted maximum likelihood method. A total of 8 original studies including 3893 patients were analyzed. RESULT: Compared to the control group, pharmacologic thromboprophylaxis was associated with a lower risk of pulmonary embolism (odds ratio [OR]: 0.34, 95% CI: 0.15-0.80, P = 0.01). There was no significant difference in the risk of DVT (OR: 0.75; [95% CI: 0.37-1.53], P = 0.44) and VTE (OR: 0.65; [95% CI: 0.34-1.25], P = 0.20). Finally, anticoagulation was not associated with an increase rate of major disability (OR:1.36; [95% CI: 0.57 - 3.23], P = 0.48), rebleeding (OR: 0.35; [95% CI: 0.10-1.19], P = 0.09), hematoma enlargement (OR:1.34; [95% CI: 0.58-3.12], P = 0.49), or death (OR:0.90; [95% CI: 0.68-1.19], P = 0.46). CONCLUSION: Among patients with intracerebral hemorrhage, pharmacologic thromboprophylaxis was associated with a significant reduction in pulmonary embolism, without an increase in rebleeding or hematoma enlargement. The results of this meta-analysis need to be further validated in large scale clinical trials.

Features of Extrinsic Plantar Muscles in Patients with Plantar Fasciitis by Ultrasound Imaging: A Retrospective Case Control Research.

The present study aimed to compare by ultrasound imaging (USI) the tibial posterior (TP), medial gastrocnemius (MG) and soleus muscle in patients with and without plantar fasciitis (PF). A sample of 42 individuals was recruited and divided into two groups: PF and a healthy group. The thickness, cross-sectional area (CSA), echointensity and echovariation were assessed in both groups by USI. TP, soleus and MG variables did not report differences (p > 0.05) for thickness and CSA. For the echotexture parameters significant differences were found for MG echointensity (p = 0.002), MG echovariation (p = 0.002) and soleus echointensity (p = 0.012). Non-significant differences (p > 0.05) were reported for soleus echovariation, TP echointensity and TP echovariation variables. The thickness and CSA of the TP, GM and soleus muscle did not show significant differences between individuals with and without PF measured by USI. Muscle quality assessment reported an increase of the MG echointensity and echovariation, as well as a decrease of echointensity of the soleus muscle in the PF group with respect to the healthy group. Therefore, the evaluation of the structure and muscle quality of the extrinsic foot muscles may be beneficial for the diagnosis and monitoring the physical therapy interventions.

Application of the arm-cranking 30-second Wingate Anaerobic Test (the WAnT) to assess power in amputee football players.

PURPOSE: The aim of this work was to determine anaerobic performance in male amputee football players considering types and levels of limb impairment, playing position, anthropometric parameters, and comparing the findings to reference values. Relationship between parameters in the laboratory anaerobic test and the handgrip test was checked. METHODS: The 30-second Wingate Anaerobic Test (peak power, mean power, relative peak power, relative mean power, time to achieve peak power, fatigue index) on the arm-crank ergometer (LODE ANGIO), the FUTREX 6100 (Futrex, Gaithersburg, USA) and the handgrip test were used in amputee football players (n = 23). Anthropometric measurements were collected. RESULTS: There were no differences in anaerobic results between players considering types and levels of limb impairment. Forwards had significantly higher relative mean and peak power ( p = 0.049, d = 0.82; p = 0.049, d = 0.81), and lower amputation-adjusted body mass index ( p = 0.001, d = 1.50) than defenders. For peak power, 19 out 23 achieved, and for relative peak power, 22 out 23 achieved results from "average" to "elite". Peak power strongly correlated to handgrip strength results. CONCLUSIONS: Amputee football requires a high level of power from players. Maintaining appropriate body composition is important for amputee football players to have better anaerobic performance during the game. The 30-second Wingate Anaerobic Test can be used to assess anaerobic performance in AF players. Sport-specific anaerobic performance laboratory tests and field-based tests using in indirect upper limbs' peak power monitoring would be beneficial for coaches.

Anaerobic performance among children with spina bifida.

BACKGROUND: Children and adolescents with spina bifida demonstrate less physical activity. Most of them are wheelchair users. It is important to control their physical fitness for instance their anaerobic performance. They need anaerobic performance to daily activities like transfers that require short and high intensity movements. The aim of this study was to assess anaerobic performance among children with spina bifida and to evaluate their results in relation to normative values from able-bodied peers, as well as to find appropriate, easy and feasible field-based tests measuring anaerobic performance of children with spina bifida in non-laboratory settings. METHODS: Ninety-five children and adolescents with spina bifida were divided according to gender and age (four male and four female groups) and performed the 30-second Wingate Anaerobic Test (WAnT), the handgrip test and the chest pass test. The Kolmogorov-Smirnov test, the Kruskal-Wallis test, the Mann-Whitney U-test, the Pearson correlation (P<0.05) and Effect Size were applied in this study. RESULTS: Differences in MP, PP, rMP and rPP between age groups were found. A significant and strong correlation of the 30-second WAnT results (MP, PP) with the handgrip test and the chest pass test was found (P<0.01; r>0.7). CONCLUSIONS: In conclusion, anaerobic performance of children with spina bifida varies depending on the age group and is "very poor" compared to anaerobic performance of their able-bodied peers. The chest pass test may be a good non-laboratory test to be used to indirectly assess anaerobic performance of children with spina bifida.

Physiological parameters depending on two different types of manual wheelchair propulsion.

OBJECTIVE: The purpose of this study was to compare aerobic parameters in the multistage field test (MFT) in hand rim wheelchair propulsion and lever wheelchair propulsion. METHODS: Twenty-one men performed MFT using two different types of propulsion, i.e., lever and hand rim wheelchair propulsion. The covered distance and physiological variables (oxygen uptake (VO2), minute ventilation (VE), carbon dioxide output (VCO2), respiratory coefficient (RQ), and heart rate (HR)) were observed. Physiological variables were measured with Cosmed K5 system. Kolmogorov-Smirnov test, t-test, Wilcoxon test and effect sizes (ESs) were used to assess differences. Statistical significance was set at p < .05. RESULTS: A significantly longer distance was observed in lever wheelchair propulsion than in hand rim wheelchair propulsion (1,194 and 649 m, respectively). VO2max and RQ were higher in hand rim wheelchair propulsion. All physiological variables for the last (fifth) level of the test in hand rim propulsion were significantly higher than in lever wheelchair propulsion. ES was large for each observed difference. CONCLUSION: The lever wheelchair propulsion movement is less demanding than hand rim wheelchair propulsion and longer distances can be achieved by the user. There is a need to check lever wheelchair propulsion in different types of field tests.

Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis.

BACKGROUND: Preliminary evidence indicates that prophylactic-dose thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in patients hospitalized for coronavirus disease 2019 (COVID-19) infection. Additionally, it remains unclear whether the D-dimer measurement is useful for VTE risk stratification among COVID-19 patients. This study aimed to offer benchmark data on the incidence of VTE and to examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident. METHODS: A comprehensive literature review of PubMed from inception to May 2020 was performed for original studies that reported the frequency of VTE and death among COVID-19 patients who received thromboprophylaxis on hospitalization. The endpoints included VTE (a composite of pulmonary embolism (PE) or deep vein thrombosis (DVT)), PE, DVT, and mortality. RESULTS: A total of 11 cohort studies were included. Among hospitalized COVID-19 patients, 23.9% (95% confidence interval (CI), 16.2% to 33.7%; I2 = 93%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%; I2 = 92%) and 11.9% (95% CI, 6.3% to 21.3%; I2 = 93%) of patients, respectively. Patients in the intensive care unit (ICU) had a higher risk for VTE (30.4% )95% CI, 19.6% to 43.9%)) than those in the ward (13.0% (95% CI, 5.9% to 26.3%)). The mortality was estimated at 21.3% (95% CI, 17.0% to 26.4%; I2 = 53%). COVID-19 patients who developed VTE had higher D-dimer levels than those who did not develop VTE (mean difference, 2.05 µg/mL; 95% CI, 0.30 to 3.80 µg/mL; P = 0.02). CONCLUSIONS: The heightened and heterogeneous risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on the pathogenesis of thromboembolic complications and strategy of thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.