The Effectiveness of Face Masks in Preventing COVID-19 Transmission: A Systematic Review.

INTRODUCTION: Since the beginning of the COVID-19 pandemic, face masks have been among the cornerstones of COVID-19 prevention. Therefore, evaluating their preventive effects against COVID-19 is crucial. This review aimed to systematically search for the systematic review articles that explored the role of various types of face masks in preventing COVID-19. METHODS: We browsed the keywords of this study in the online databases of Scopus, Web of Science, PubMed, and Cochrane on 10th January 2023 and retrieved all the relevant systematic review articles. The records were downloaded into an Endnote file, and the duplicates were removed. A two-step screening process consisting of title/abstract and full-text screenings was conducted to select the most relevant articles. To ensure the validity and reliability of the results, this study adhered to the PRISMA protocol. RESULTS: A total of 28 systematic reviews were included in this review. Most studies found that face masks are beneficial against viral respiratory infections, such as COVID-19. Different types of masks were evaluated in included studies. It appeared that mask efficacy depends on the material, layers, fitting on the face and user compliance. N 95 respirator had maximum efficacy, especially when used continuously. CONCLUSION: Face masks have a beneficial effect against COVID-19. Home masks are less protective than surgical masks or N95 personal breathing masks. Besides, the use of masks may elicit a false sense of security in people, which may lead to poor hand hygiene and violation of social distancing. Therefore, the necessary training should be provided to the public to increase awareness and encourage the right practice of using the mask, emphasizing the preventive effects of washing hands, social distancing, and using a face mask against COVID-19.

SARS-CoV-2 Infection and Severity in Patients with Hematologic Malignancies: A Systematic Review.

INTRODUCTION: Earlier reports described the possibility of higher SARS-CoV-2 infection and severity in patients with hematological malignancies. Given the importance and incidence of these malignancies, we aimed to systematically review SARS-CoV-2 infection and severity in patients with hematologic cancers. METHODS: We retrieved the relevant records by searching the keywords in online databases of PubMed, Web of Science, Cochrane, and Scopus on December 31st, 2021. A two-step screening; title/abstract and full-text screening, was employed to select the eligible studies. These eligible studies entered the final qualitative analysis. The study is adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the reliability and validity of the results. RESULTS: Forty studies concerning different hematologic malignancies and the effect of COVID-19 infection on them were included in the final analysis. The findings showed that in general, the prevalence of SARS-CoV-2 infection and the severity of the disease are often higher in hematologic malignancies and the patients could experience higher morbidity and mortality compared to general populations. CONCLUSION: It appeared that individuals with hematologic malignancies are more vulnerable to COVID-19 infection and they experience more severe disease with higher mortality rates. The presence of other comorbidities could also deteriorate this situation. Further investigation is recommended to evaluate the outcome of COVID-19 infection in different subtypes of hematologic malignancies.

Effects of Smoking on COVID-19 Management and Mortality: An Umbrella Review.

Introduction: Smoking status appears to lead to a poor prognosis in COVID-19 patients. However, findings from the studies conducted on this topic have not been consistent, and further exploration is required. Methods: The objective of this umbrella review was to examine the effects of smoking on COVID-19 management and mortality. Online databases that included PubMed, Embase, Scopus, and Web of Science were searched using relevant keywords up to July 27, 2022. Articles were restricted to the English language, and the PRISMA protocol was followed. Results: A total of 27 systematic reviews, published from 2020 to 2022, were included. Individual studies included in the systematic reviews ranged from 8 to 186, with various population sizes. The consensus from the majority of systematic reviews was that COVID-19 smoker patients experience greater disease severity, disease progression, hospitalization rate, hospital admission duration, mechanical ventilation, ICU admission, and mortality rate. Conclusions: COVID-19 patients with a history of smoking (current and former) are vulnerable to adverse hospital outcomes and worse COVID-19 progression. Effective preventive and supportive approaches are required to decrease the risk of COVID-19 morbidity and mortality in patients with a history of smoking.

Late Complications of COVID-19; An Umbrella Review on Current Systematic Reviews.

Introduction: Several clinical manifestations have been discovered for COVID-19 since the emergence of SARS-CoV-2, which can be classified into early, medium, and long-term complications. However, late complications can be present after recovery from acute COVID-19 illness. The present study aims to comprehensively review the available evidence of late complications related to COVID-19. Method: A search was conducted, using keywords, through electronic databases, which included Scopus, Web of Science, PubMed, and Embase up to August 29, 2022. Study selection was performed according to a strict inclusion and exclusion criteria. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was followed, and studies were appraised using the National Institute of Health (NIH) quality assessment and risk of bias tool. Results: In total, 50 studies were included, and nine distinct COVID-19 late complication categories were identified. A review of these studies revealed that neurologic and psychiatric (n=41), respiratory (n=27), musculoskeletal and rheumatologic (n=22), cardiovascular (n=9), and hepatic and gastrointestinal (n=6) complications were the most prevalent complications of long COVID-19. Conclusion: Almost all human body systems are affected by late complications of COVID-19 with different severity and prevalence. Fatigue and some other neuropsychiatric symptoms are the most common late complications among long COVID-19 patients. Respiratory symptoms including dyspnea (during exercise), cough, and chest tightness were the next most prevalent long-term complications of COVID-19. Since these complications are persistent and late, being aware of the signs and symptoms is essential for the healthcare providers and patients.

Gut microbiota and COVID-19: A systematic review.

Background and Aims: Alteration in humans' gut microbiota was reported in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The gut and upper respiratory tract (URT) microbiota harbor a dynamic and complex population of microorganisms and have strong interaction with host immune system homeostasis. However, our knowledge about microbiota and its association with SARS-CoV-2 is still limited. We aimed to systematically review the effects of gut microbiota on the SARS-CoV-2 infection and its severity and the impact that SARS-CoV-2 could have on the gut microbiota. Methods: We searched the keywords in the online databases of Web of Science, Scopus, PubMed, and Cochrane on December 31, 2021. After duplicate removal, we performed the screening process in two stages; title/abstract and then full-text screening. The data of the eligible studies were extracted into a pre-designed word table. This study adhered to the PRISMA checklist and Newcastle-Ottawa Scale Bias Assessment tool. Results: Sixty-three publications were included in this review. Our study shows that among COVID-19 patients, particularly moderate to severe cases, the gut and lung microbiota was different compared to healthy individuals. In addition, the severity, and viral load of COVID-19 disease would probably also be influenced by the gut, and lung microbiota's composition. Conclusion: Our study concludes that there was a significant difference in the composition of the URT, and gut microbiota in COVID-19 patients compared to the general healthy individuals, with an increase in opportunistic pathogens. Further, research is needed to investigate the probable bidirectional association of COVID-19 and human microbiome.

Complications of COVID-19 Vaccines during Pregnancy; a Systematic Review.

Introduction: Rare serious complications have been documented after COVID-19 vaccination as clinical research proceeded and new target populations, such as children and pregnant women, were included. In this study, we attempted to review the literature relevant to pregnancy complications and maternal outcomes of COVID-19 immunization in pregnant women. . Methods: We searched the databases of PubMed, Scopus, Cochrane, and Web of Science on 31 August 2022. The records were downloaded and underwent a two-step screening; 1) title/abstract and then 2) full-text screening to identify the eligible studies. We included English original studies that evaluated the adverse effects of COVID-19 vaccines during pregnancy. Information such as the type of study, geographical location, type of vaccine injected, gestational age, maternal underlying diseases, and complications following the vaccination were extracted into pre-designed tables. Results: According to the findings of included studies, in most of them vaccination had a positive impact and no negative effects were observed. Also, no medical history was reported in 11 articles, and pregnant women had no underlying diseases. Some serious adverse events were reported after vaccination, including miscarriage, paresthesia, uterine contraction, vaginal bleeding, preterm birth, major congenital anomalies, intrauterine growth restriction, and seizure. . Conclusion: Because of limited data availability and the cross-sectional design of most studies, we could neither infer causation between vaccines and incidence of adverse effects nor comment with certainty about any possible adverse outcome of COVID-19 vaccines in vaccinated pregnant women. Consequently, more longitudinal and experimental studies are needed to define the exact adverse effects of COVID-19 vaccines in pregnant women.

COVID-19 Vaccines' Protection Over Time and the Need for Booster Doses; a Systematic Review.

Introduction: Controversies existed regarding the duration of COVID-19 vaccines' protection and whether receiving the usual vaccine doses would be sufficient for long-term immunity. Therefore, we aimed to systematically review the studies regarding the COVID-19 vaccines' protection three months after getting fully vaccinated and assess the need for vaccine booster doses. Methods: The relevant literature was searched using a combination of keywords on the online databases of PubMed, Scopus, Web of Science, and Cochrane on September 17th, 2021. The records were downloaded and the duplicates were removed. Then, the records were evaluated in a two-step process, consisting of title/abstract and full-text screening processes, and the eligible records were selected for the qualitative synthesis. We only included original studies that evaluated the efficacy and immunity of COVID-19 vaccines three months after full vaccination. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement to ensure the reliability of results. Results: Out of the 797 retrieved records, 12 studies were included, 10 on mRNA-based vaccines and two on inactivated vaccines. The majority of included studies observed acceptable antibody titers in most of the participants even after 6 months; however,it appeared that the titers could also decrease in a considerable portion of people. Due to the reduction in antibody titers and vaccine protection, several studies suggested administering the booster dose, especially for older patients and those with underlying conditions, such as patients with immunodeficiencies. Conclusion: Studies indicated that vaccine immunity decreases over time, making people more susceptible to contracting the disease. Besides, new variants are emerging, and the omicron variant is continuing to spread and escape from the immune system, indicating the importance of a booster dose.

The clinical outcomes of COVID-19 in HIV-positive patients: A systematic review of current evidence.

INTRODUCTION: Patients with chronic underlying diseases are more susceptible to coronavirus disease 2019 (COVID-19) complications. Recent studies showed people living with HIV (PLWH) are not at greater risk than the general population. Few studies have reviewed the impacts of COVID-19 on PLWH. The purpose of this systematic review was to investigate the impact of COVID-19 on patients infected with HIV. METHODS: We executed a systematic search using four databases of PubMed, Scopus, Science Direct, and Web of Science and screened the records in two steps based on their title/abstract and full text. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to elevate the validity and reliability of its results. RESULTS: We reviewed 36 studies. The patients' age was above 20 years in all studies. In almost all studies, the inflammatory parameters were reported high. In most of the studies, all HIV patients completely recovered from the COVID 19 infection. Although CD4 count was not recorded in all studies, the minimum level was reported as 12 cells/µl. CONCLUSION: Based on the current review, we concluded that HIV patients at advanced stages (3 or 4) of the disease, whose CD4 counts are low, may show less severe COVID-19 infection symptoms. Similarly, Interference can reduce the severity of immune reactions and subsequent cytokine storms and consequently mitigate the symptoms. Therefore, in most of the studies, the majority of HIV patients showed no severe symptoms and completely recovered from COVID 19 infection.

Influence of body mass indexes on response to treatment in acute asthma.

Increases in body mass index (BMI) are reported to influence asthma response to treatment. The aim of this study was to investigate the relationship between BMI and response to treatment in a group of patients that were referred for asthma control. Effectiveness measurements in this analysis included percentage of changes in forced volume in 1 second (FEV1), forced volume capacity (FVC), FEV1/FVC, and forced expiratory flow between 25% and 75% of FVC (FEF25-75%). A total of 293 subjects with asthma of both genders and above 18 years of age were divided into the following BMI categories: 107 (36.5%) non-obese (BMI < 25), 186 (63.5%) overweight and obese (BMI ≥ 25). Percentage of change was defined as change in variable between baseline and end-of-treatment. Analyses of non-obese vs. overweight/obese asthmatics demonstrated non-significant differences in baseline FEV1 (1.62 ± 0.56 Lit vs. 1.63 ± 0.56 Lit L, P = 0.89); FVC (2.58 ± 0.73 Lit vs. 2.47 ± 0.82 Lit, P = 0.25); and FEF25-75% (1.04 ± 0.55 ml/sec vs. 1.05 ± 0.50 ml/sec, P = 0.47) respectively. Compared with non-obese subjects, in overweight/obese subjects with asthma were less responded to treatment. Percentage changes of FEV1, FVC, FEF25-75%, and FEV1/FVC in non-obese versus obese/overweight patients were: 79.57 ± 55.14 % vs. 62.13 ± 41.72%, P = 0.005; 47.71 ± 33.76% vs. 39.93 ± 28.30%, P = 0.036; 151.98 ± 127.82% vs. 123 ± 91.12%, P = 0.041; 20.54 ± 15.63% vs. 15.63 ± 11.32%, P = 0.005; respectively. Percentage changes of spirometric values to treatment in over weight/obese asthmatic patient were lesser in compared with non-obese subjects.

Spontaneous esophageal perforation presenting as a right-sided pleural effusion: a case report.

Spontaneous esophageal perforation or Boerhaave's syndrome is an uncommon condition that may occur following forceful vomiting and lead to mediastinitis. It is associated with high mortality and morbidity in absence of therapy. We present a case of spontaneous esophageal perforation in a 63 year-old man who developed a right-sided effusion, an unusual presentation. This case report and the relevant literature reveal that delay in prompt surgical repair is associated with a high morbidity and mortality.

Evaluation of high-sensitivity C-reactive protein in acute asthma.

BACKGROUND: High sensitivity C-reactive protein (hs-CRP) is an inflammatory marker known to be related to inflammation, infection, and cardiovascular diseases. The aim of this study was to evaluate hs-CRP level in serum of asthmatics and its relationship with pulmonary function tests, serum IgE levels, and peripheral blood white blood cell (WBC) counts. MATERIALS AND METHODS: The under study subjects were 108 patients with acute asthma and 93 healthy volunteers. The levels of hs-CRP of 108 patients with acute bronchial asthma and 93 non-asthmatic control subjects were measured. Spirometry, serum immunoglobulin-E (IgE) measurement, and WBC counts were done for patient and control groups. RESULTS: The mean serum hs-CRP levels were significantly higher in patients with acute asthma compared with controls (5.47±7.33 mg/l versus 1.46± 1.89 mg/l, p < 0.001). Among asthmatic patients, mean hs-CRP levels were not correlated with indices of pulmonary function tests (forced expiratory volume in one second, forced vital capacity and forced mid-expiratory flow), serum IgE level, eosinophil count or WBC count. CONCLUSION: Serum C-reactive protein levels measured by high-sensitivity assays increase in acute asthma and may be useful as a diagnostic tool for detecting and monitoring inflammation in these patients. In our study on patients with acute asthma, no significant correlation was revealed between hs-CRP and pulmonary function tests, total serum IgE, or peripheral blood white blood cell counts.

Effect of age on response to treatment in adult patients with severe persistent asthma.

BACKGROUND: Due to current controversies regarding the effect of age on response to treatment in asthmatic patient, the present study was performed on patients referred with acute asthma attack for further evaluation of this matter. MATERIALS AND METHODS: In this study 138 patients with severe persistent asthma were enrolled and divided into two categories of young (age ≤35 yrs; 82 cases, mean age = 25.2±7.3 years) and elderly subjects (≥50 yrs; 56 cases, mean age 57.4±6.4 years). Response to treatment was determined by pulmonary function tests. RESULTS: The mean percentage change of FEV1 from baseline in male and female patients of young and old age was 75.05±46.61 and 71.39±41.30%, (P = 0.721) and 100.79±51.34% and 69±37.39% (P = 0.015), respectively. The mean percentage of possible improvement of FEV1 among male and female patients of young and old age was 62.81±25.67% and 54.46±23.82% (P = 0.148), and 78±24.04% and 63.58±41.24% (P = 0.087); respectively. CONCLUSION: Response to treatment was significant in both young and old age groups suffering from acute asthmatic attack except for young female patients in which, percentage change of FEV1 increased compared to older patients. Among other patients this value and percentage of possible improvement of FEV1 between the 2 groups did not change significantly and age did not play a significant role in assessing the response to treatment in acute asthmatic attack.

Correlation of arterial blood gas measurements with venous blood gas values in mechanically ventilated patients.

BACKGROUND: Arterial blood gas (ABG) analysis is useful in evaluation of the clinical condition of critically ill patients; however, arterial puncture or insertion of an arterial catheter may cause many complications. The aim of this study was to determine whether venous blood gas (VBG) values can be used as an alternative to arterial blood gas measurements in patients under mechanical ventilation. MATERIALS AND METHODS: This study was carried out on patients admitted to the Intensive Care Unit of Kashan Beheshti Hospital. Blood for VBG analysis was obtained from the cubital vein, while for ABG analysis blood was taken simultaneously from the radial artery. ABG and VBG samples were obtained simultaneously, and indexes of pH, PCO2, HCO3, base excess (BE), PO2 and O2 saturation level were analyzed. RESULTS: A total of 102 pair of simultaneous venous and arterial blood samples were obtained from 102 patients (mean age 58.4±21.5 years). Seventy (69%) were males. The mean difference between arterial and venous values was 0.04 for pH, 5.6 mm/Hg for PCO2, -0.32 mmol/l for HCO3, -1.03 mmol/l for BE, 53.6 mm/Hg for PO2, and 23.5% for O2 saturation. The Pearson correlation coefficients between arterial and venous values for pH, PCO2, HCO3, BE, PO2 and O2 saturation were 0.874, 0.835, 0.768, 0.810, 0.287, and 0.310, respectively. Linear regression equations for the estimation of pH, PCO2, HCO3, BE, PO2 and O2 saturation were as follows: arterial pH=1.927+0.745×venous pH [r=0.801, p<0.001]; PCO2=6.470+0.706×venous PCO2 [r=0.835, p<0.001]; arterial HCO3=7.455+0.681×venous HCO3 [r=0.768, p<0.001]; arterial BE=-0.952+0.736×venous BE [r=0.810, p<0.001]; arterial PO2=70.374+0.620×venous PO2 [r=0.287, p=0.003]; arterial venous saturation= 89.753+0.082×venous O2 saturation [r=0.317, p=0.001]. CONCLUSION: Venous blood gases, especially pH, Base excess, and PCO2 levels have relatively good correlation with ABG values. Because this correlation is not close, VBG cannot substitute ABG in mechanically ventilated patients.

Correlation of end-tidal carbon dioxide with arterial carbon dioxide in mechanically ventilated patients.

BACKGROUND: Patients undergone mechanical ventilation need rapid and reliable evaluation of their respiratory status. Monitoring of End-tidal carbon dioxide (ETCO2) as a surrogate, noninvasive measurement of arterial carbon dioxide (PaCO2) is one of the methods used for this purpose in intubated patients. OBJECTIVES: The aim of the present trial was to study the relationship between end-tidal CO2 tensions with PaCO2 measurements in mechanically ventilated patients. MATERIALS AND METHODS: End-tidal carbon dioxide levels were recorded at the time of arterial blood gas sampling. Patients who were undergoing one of the mechanical ventilation methods such as: synchronized mandatory mechanical ventilation (SIMV), continuous positive airway pressure (CPAP) and T-Tube were enrolled in this study. The difference between ETCO2 and PaCO2 was tested with a paired t-test. The correlation of end-tidal carbon dioxide to (ETCO2) CO2 was obtained in all patients. RESULTS: A total of 219 arterial blood gases were obtained from 87 patients (mean age, 71.7 ± 15.1 years). Statistical analysis demonstrated a good correlation between the mean of ETCO2 and PaCO2 in each of the modes of SIMV, CPAP and T-Tube; SIMV (42.5 ± 17.3 and 45.8 ± 17.1; r = 0.893, P < 0.0001), CPAP (37 ± 9.7 and 39.4 ± 10.1; r = 0.841, P < 0.0001) and T-Tube (36.1 ± 9.9 and 39.4 ± 11; r = 0.923, P < 0.0001), respectively. CONCLUSIONS: End-tidal CO2 measurement provides an accurate estimation of PaCO2 in mechanically ventilated patients. Its use may reduce the need for invasive monitoring and/or repeated arterial blood gas analyses.