Comparison of the Discrimination Performance of AI Scoring and the Brixia Score in Predicting COVID-19 Severity on Chest X-Ray Imaging: Diagnostic Accuracy Study.

BACKGROUND: The artificial intelligence (AI) analysis of chest x-rays can increase the precision of binary COVID-19 diagnosis. However, it is unknown if AI-based chest x-rays can predict who will develop severe COVID-19, especially in low- and middle-income countries. OBJECTIVE: The study aims to compare the performance of human radiologist Brixia scores versus 2 AI scoring systems in predicting the severity of COVID-19 pneumonia. METHODS: We performed a cross-sectional study of 300 patients suspected with and with confirmed COVID-19 infection in Jakarta, Indonesia. A total of 2 AI scores were generated using CAD4COVID x-ray software. RESULTS: The AI probability score had slightly lower discrimination (area under the curve [AUC] 0.787, 95% CI 0.722-0.852). The AI score for the affected lung area (AUC 0.857, 95% CI 0.809-0.905) was almost as good as the human Brixia score (AUC 0.863, 95% CI 0.818-0.908). CONCLUSIONS: The AI score for the affected lung area and the human radiologist Brixia score had similar and good discrimination performance in predicting COVID-19 severity. Our study demonstrated that using AI-based diagnostic tools is possible, even in low-resource settings. However, before it is widely adopted in daily practice, more studies with a larger scale and that are prospective in nature are needed to confirm our findings.

Derivation and validation of novel integrated inpatient mortality prediction score for COVID-19 (IMPACT) using clinical, laboratory, and AI-processed radiological parameter upon admission: a multicentre study.

Limited studies explore the use of AI for COVID-19 prognostication. This study investigates the relationship between AI-aided radiographic parameters, clinical and laboratory data, and mortality in hospitalized COVID-19 patients. We conducted a multicentre retrospective study. The derivation and validation cohort comprised of 512 and 137 confirmed COVID-19 patients, respectively. Variable selection for constructing an in-hospital mortality scoring model was performed using the least absolute shrinkage and selection operator, followed by logistic regression. The accuracy of the scoring model was assessed using the area under the receiver operating characteristic curve. The final model included eight variables: anosmia (OR: 0.280; 95%CI 0.095-0.826), dyspnoea (OR: 1.684; 95%CI 1.049-2.705), loss of consciousness (OR: 4.593; 95%CI 1.702-12.396), mean arterial pressure (OR: 0.928; 95%CI 0.900-0.957), peripheral oxygen saturation (OR: 0.981; 95%CI 0.967-0.996), neutrophil % (OR: 1.034; 95%CI 1.013-1.055), serum urea (OR: 1.018; 95%CI 1.010-1.026), affected lung area score (OR: 1.026; 95%CI 1.014-1.038). The Integrated Inpatient Mortality Prediction Score for COVID-19 (IMPACT) demonstrated a predictive value of 0.815 (95% CI 0.774-0.856) in the derivation cohort. Internal validation resulted in an AUROC of 0.770 (95% CI 0.661-0.879). Our study provides valuable evidence of the real-world application of AI in clinical settings. However, it is imperative to conduct prospective validation of our findings, preferably utilizing a control group and extending the application to broader populations.

Machine learning-based COVID-19 acute respiratory distress syndrome phenotyping and clinical outcomes: A systematic review.

COVID-19-related acute respiratory distress syndrome (CARDS) has been suggested to differ from the typical ARDS. While distinct phenotypes of ARDS have been identified through latent class analysis (LCA), it is unclear whether such phenotypes exist for CARDS and how they affect clinical outcomes. To address this question, we conducted a systematic review of the current evidence.We searched several, including PubMed, EBSCO Host, and Web of Science, from inception to July 1, 2022. Our exposure and outcome of interest were different CARDS phenotypes identified and their associated outcomes, such as 28-day, 90-day, 180-day mortality, ventilator-free days, and other relevant outcomes.We identified four studies comprising a total of 1776 CARDS patients.Of the four studies, three used LCA to identify subphenotypes (SPs) of CARDS. One study based on longitudinal data identified two SPs, with SP2 associated with worse ventilation and mechanical parameters than SP1. The other two studies based on baseline data also identified two SPs, with SP2 and SP1 were associated with hyperinflammatory and hypoinflammatory CARDS, respectively. The fourth study identified three SPs primarily stratified by comorbidities using multifactorial analysis.All studies identified a subphenotype associated with poorer outcomes, including mortality, ventilator-free days, multiple-organ injury, and pulmonary embolism. Two studies reported differential responses to corticosteroids among the SPs, with improved mortality in the hyperinflammatory and worse in the hypoinflammatory SPs.Overall, our review highlights the importance of phenotyping in understanding CARDS and its impact on disease management and prognostication. However, a consensus approach to phenotyping is necessary to ensure consistency and comparability across studies. We recommend that randomized clinical trials stratified by phenotype should only be initiated after such consensus is reached. Short title: COVID-19 ARDS subphenotypes and outcomes.

Severe Malaria in an Adult Patient from Low-Endemic Area in Flores Island, East Nusa Tenggara.

Malaria is an infection caused by protozoa of the genus Plasmodium, commonly found in tropical and subtropical regions worldwide. Plasmodium falciparum causes the most severe form of the disease and may progress to life-threatening manifestations. This case describes a 26-year-old man who suffered cerebral malaria with multiple organ dysfunction and successfully recovered despite poor initial prognosis. Negligent and late diagnosis of malaria leads to severe complications and a worse prognosis. This case emphasizes despite living in a low-endemic malaria area, physicians should remain meticulous and consider malaria as differential diagnosis even after initially presenting with nonspecific symptoms. Consequently, malarial screening should be performed to modify the risk of mortality. Furthermore, close monitoring and early administration of intravenous artesunate are also particularly critical.

Síndrome inflamatorio multisistémico en adultos: revisión sistemática y metaanálisis del espectro reumatológico de las complicaciones postinfecciosas de la COVID-19

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe complication in adults infected with SARS-CoV-2. However, the pathophysiology remains elusive, as the limited number of reports preclude a broader understanding of this syndrome. We conducted this systematic review to explore the clinical spectrum of MIS-A, in particular its rheumato-logical manifestations. Meta-analyses of case-series were also performed. We identified 28 patients from 14 case reports and two case series of MIS-A. This disease occurred equally in both genders, with a mean age of 33 + 10 years old, and predominantly in those of African descent (40%). Rheumatological manifestations consisted of Kawasaki Disease (KD)-like symptoms. Ninety percent of patients had positive COVID-19 serology tests, while 48% of patients were negative for COVID-19 RT-PCR test. Twelve patients were admitted to ICU and unfortunately two died. Although the signs and symptoms of MIS mimicked KD, the gastrointestinal findings were more prominent in the former group. The demographic make-up was also different, with MIS-A occurring mostly in those of African descent. Importantly, unlike their paediatric counterparts, the adult group did not have coronary artery abnormalities. Long-term monitoring is needed as safety data is scarce. Of note, although the prognosis of MIS-A is excellent, the life-threatening nature of this syndrome demands intensive care unit level of care and mechanical support. During the COVID-19 pandemic, a constellation of KD symptoms in an adult patient should alert the clinician to the possibility of MIS-A. © 2021 Asociación Colombiana de Reumatología. Published by Elsevier Espafña, S.L.U. All rights reserved.

El espectro clínico del síndrome inflamatorio multisistémico en adultos (MIS-A) es una complicación rara, pero grave en adultos infectados por el coronavirus del síndrome respiratorio agudo grave de tipo 2. Realizamos una búsqueda bibliográfica en varias bases de datos, y también se hizo en metanálisis. Identificamos 28 pacientes de 14 informes de casos y 2 series de casos de MIS-A. Esta enfermedad se manifestó por igual en ambos sexos, con una edad media de 33 + 10 anos, y se presentó predominantemente en afrodescendientes (40%). Las manifestaciones reumatológicas consistieron en síntomas similares a la enfermedad de Kawasaki (EK). El 90% de los pacientes tuvo pruebas positivas de serología de la enfermedad por el coronavirus de 2019 (COVID-19), mientras que el 48% dio negativo para la prueba de reacción en cadena de la polimerasa con transcriptasa inversa de la COVID-19. Doce pacientes ingresaron en la unidad de cuidados intensivos y, lamentablemente, 2 fallecieron. Encontramos que, si bien los signos y los síntomas de MIS imitaban a EK, los hallazgos gastrointestinales eran más prominentes en el primer grupo. Además, la composición demográfica fue asimismo diferente, con MIS-A que se presentó principalmente en afrodescendientes. Es importante destacar que, a diferencia de sus homólogos pediátricos, el grupo de los adultos no experimentó anomalías en las arterias coronarias. Se necesita un seguimiento a largo plazo, ya que los datos de seguridad son escasos. Es de destacar que, aun cuando el pronóstico de MIS-A es excelente, la naturaleza potencialmente mortal de este síndrome exige el nivel de atención y el soporte mecánico de la unidad de cuidados intensivos. Durante la pandemia por la COVID-19, una constelación de síntomas de EK en un paciente adulto debe alertar al médico sobre la posibilidad de MIS-A.

Diabetes and Mortality among Patients with Chronic Kidney Disease and COVID-19: A Systematic Review, Meta-analysis, and Meta-regression.

Introduction: Patients with kidney disease and COVID-19, whether on hemodialysis (HD) or not, have a higher risk of contracting COVID-19 accompanied by a higher mortality rate due to suppressed immune functions. Diabetes, one of the ubiquitous etiology of kidney disease, is also associated with a composite of poor outcomes. Methods: Meta-analysis and meta-regression of 13 articles on COVID-19 patients with chronic kidney disease, with information on diabetes and mortality were performed using Review Manager 5.4 and OpenMetaAnalyst. Results: The meta-analysis of a pooled subject of 18,822 patients showed that the presence of diabetes in CKD patients with COVID-19 was associated with an increased risk of mortality (RR 1.41 (1.15, 1.72); P < 0.001; I2 70%, P < 0.001). Subgroup analysis showed that diabetes was not associated with mortality in the HD group (RR 1.27 (1.06, 1.54); P = 0.01; I2 0%, P = 0.70) but showed a significant association in the non-HD group (RR 1.66 (1.59, 1.73); P < 0.001; I2 85%, P < 0.001). Male gender (P = 0.070) contributed to the effect size differences (age: P < 0.001; hypertension: P = 0.007; CVD: P < 0.001; lung disease: P < 0.001). Conclusions: Diabetes was associated with higher mortality risk among CKD patients, primarily those who did not need RRT.

Cardiometabolic risk factors in adults with normal weight obesity: A systematic review and meta-analysis.

Normal weight obesity (NWO) is a new emerging phenotype of obesity, defined as a normal body mass index with a high body fat percentage. While several studies have described the impact of NWO on cardiometabolic risk factors, the association between them remains uncertain. This meta-analysis systematically evaluated cardiometabolic risk factors in adults with NWO compared to adults with normal weight lean (NWL). A systematic literature search was performed from the inception until September 21, 2021 in order to comprehensively search for all observational studies that had three important variables, including adults (age ≥18 years old), NWO and cardiometabolic risk factors including metabolic syndrome, hypertension, diabetes mellitus, dyslipidaemia or all laboratory findings related to cardiometabolic risk factors. Twenty-four cross-sectional studies with a total of 75 201 subjects are included in the qualitative and quantitative analysis. Overall, older age and female sex are more likely in NWO population. Compared to NWL, NWO is significantly associated with cardiometabolic risk factors, including metabolic syndrome (OR = 2.24 [1.74, 2.89]; p < .001; I2  = 76%, Pheterogeneity < 0.001), hypertension (OR = 1.60[1.36, 1.89]; p < .001; I2  = 76%, Pheterogeneity < 0.001), diabetes mellitus (OR = 1.72[1.54, 1.92]; p < .001; I2  = 47%, Pheterogeneity < 0.001), dyslipidaemia (OR = 1.50 [1.03, 2.18]; p = .03; I2  = 94%, Pheterogeneity < 0.001) and other laboratory findings, except for C-reactive protein in both sexes group; and adiponectin levels in female group. Our meta-analysis showed that NWO was associated with cardiometabolic risk factors. Thus, the traditional definition of obesity using the BMI criteria should be challenged, as those with NWO might still be exposed to a heightened risk of cardiometabolic disorders. Nonetheless, further prospective cohort studies are needed better to understand this syndrome.

Chronic Heart Failure: Clinical Implications of Iron Homeostasis Disturbances Revisited.

Iron deficiency is prevalent in chronic heart failure (CHF) patients. Nonetheless, the diagnosis is often overlooked and, often, the treatment is commenced just when overt anemia has ensued. Therefore, a better appreciation of this disease is needed, and all seasoned cardiologists should know how to approach CHF patients with iron deficiency correctly, as mandated by clinical practice guidelines. In this comprehensive review, we describe iron homeostasis, the pathophysiologic changes of iron homeostasis, and the clinical implications of iron deficiency on CHF patients. In addition, we delineate the evolution of clinical trials, ranging from the inception to the ongoing clinical trials of iron deficiency treatment in CHF patients. Iron deficiency contributes to the worse clinical outcome of the patients. Numerous studies have reported the clinical benefit of iron supplementation, particularly in intravenous preparation, in heart failure patients regarding symptoms, functional capacity, and quality of life (QoL) improvement. Therefore, the current guidelines recommend routine screening of iron status in all newly diagnosed heart failure patients. Eventually, intravenous iron replacement is recommended for symptomatic heart failure patients with iron deficiency, irrespective of anemia.

Coffee and tea consumption and the risk of glioma: a systematic review and dose-response meta-analysis.

In this systematic review and dose-response meta-analysis, we aimed to assess whether coffee and tea consumption is related to the risk of glioma. We performed a systematic literature search using PubMed, Embase, Scopus and the EuropePMC from the inception of database up until 1 October 2020. Exposures in the present study were coffee and tea consumption, the main outcome was the incidence of glioma. The present study compares the association between the exposure of coffee and tea with the incidence of glioma, and the results are reported in relative risks (RR). There are 12 unique studies comprising of 1 960 731 participants with 2987 glioma cases. Higher coffee consumption was associated with a statistically non-significant trend towards lower risk of glioma (RR 0·77 (95 % CI 0·55, 1·03), P= 0·11; I2:75·27 %). Meta-regression showed that the association between coffee and glioma was reduced by smoking (P= 0·029). Higher tea consumption was associated with a lower risk of glioma (RR 0·84 (95 % CI 0·71, 0·98), P= 0·030; I2:16·42 %). Sensitivity analysis by removal of case-control studies showed that higher coffee consumption (RR 0·85 (95 % CI 0·72, 1·00), P= 0·046; I2:0 %) and higher tea consumption (RR 0·81 (95 % CI 0·70, 0·93), P= 0·004; I2:0 %, Pnon-linearity = 0·140) were associated with lower risk of glioma. Dose-response meta-analysis showed that every one cup of coffee per day decreases the risk of glioma by 3 % (RR 0·97 (95 % CI 0·94, 0·99), P= 0·016, Pnon-linearity = 0·054) and every one cup of tea per day decreases the risk of glioma by 3 % (RR 0·97 (95 % CI 0·94, 1·00), P= 0·048). This meta-analysis showed apparent association between coffee and tea intake and risk of glioma.

Tachycardia and Pre-existing Chronic Kidney Disease Are Predictors of the Worse Clinical Outcomes in Patients Recently Hospitalized With Acute Heart Failure.

BACKGROUND: This study aimed to assess the factors contributing to the outcomes of recently hospitalized patients with heart failure (HF). METHODS: A prospective data of 76 adults who were admitted due to acute HF between October 1, 2019 and June 30, 2020 at our center were analyzed. Endpoints included survival and rehospitalization within six months after discharge. RESULTS: The mean age was 64.9 ± 13.8 years, with a male preponderance (68.4%). Approximately 60.5% of patients had the left ventricular ejection fraction (LVEF) <40%, whereas 26.3% of patients had LVEF ≥50%. Coronary artery disease (75%), arterial hypertension (72.4%), chronic kidney disease (46.1%), and diabetes mellitus (46.1%) were the most frequent comorbidities. Poor compliance (40.8%) and non-cardiac infection (21.1%) were the common precipitating factors for hospitalization. The majority of subjects had severe symptoms, indicated by the frequent need of intensive care unit (43%), high N-terminal prohormone brain natriuretic peptide levels [NT-proBNP; median, 4765 (1539.7-11782.2) pg/mL], and presence of either atrial fibrillation, severe mitral regurgitation, or significant pulmonary hypertension in approximately one-third of cases. Even though in-hospital mortality was relatively low (2.6%), the all-cause mortality and rehospitalization rates in the next six months after discharge were still high, reaching 22.54% and 19.72%, respectively. Further survival analysis showed that tachycardia on admission and pre-existing chronic kidney disease (CKD) resulted in low six-month survival rates among these patients. CONCLUSION: After hospital discharge, patients with HF were still exposed to higher risks of death and readmission albeit with the medication addressed. Tachycardia on admission and pre-existing CKD might predict worse outcomes.

Diabetes and COVID-19: The past, the present, and the future.

Diabetes, one of the most prevalent chronic diseases in the world, is strongly associated with a poor prognosis in COVID-19. Scrupulous blood sugar management is crucial, since the worse outcomes are closely associated with higher blood sugar levels in COVID-19 infection. Although recent observational studies showed that insulin was associated with mortality, it should not deter insulin use in hospitalized patients requiring tight glucose control. Back and forth dilemma in the past with regards to continue/discontinue certain medications used in diabetes have been mostly resolved. The initial fears of consequences related to continuing certain medications have been largely dispelled. COVID-19 also necessitates the transformation in diabetes care through the integration of technologies. Recent advances in health-related technologies, notably telemedicine and remote continuous glucose monitoring, have become essential in the management of diabetes during the pandemic. Today, these technologies have changed the landscape of medicine and become more important than ever. Being a high-risk population, patients with type 1 or type 2 diabetes, should be prioritized for vaccination. In the future, as the pandemic fades, the prevalence of non-communicable diseases is expected to rise due to lifestyle changes and medical issues/dilemma encountered during the pandemic.

CrossFit-Induced Rhabdomyolysis in a Young Healthy Indonesian Male.

CrossFit, a high-intensity interval training, keeps growing in trend and is one of the most favorable types of fitness, after wearable technology. However, an excessive workout is detrimental to the human body, particularly the muscle tissue. CrossFit is known to cause exercise-induced rhabdomyolysis, a concerning disease with potentially devastating consequences. Nevertheless, only a few case reports have described this disease, and this is the first case report of such disease in Indonesia to the best of our knowledge. A 27-year-old, previously healthy and active Indonesian male presented with dark urine and myalgia in lower extremities after 720 repetitions of squats three days before admission. His urinalysis showed +1 blood, 2-7 red blood cells/high power field (HPF), but negative protein. Laboratory results showed an increase in creatine phosphokinase (CPK) (54,250 U/L) and LDH (1,670 U/L) levels, consistent with exercise-induced rhabdomyolysis, and serum calcium of 1.87 mmol/L, with normal serum creatinine and BUN level. He was hospitalized for two days and was treated with intravenous hydration therapy. CrossFit-induced rhabdomyolysis is a potentially devastating disease. Apart from prompt diagnosis and treatment, further research regarding the safe number of repetitions for CrossFit training, particularly for lower extremities are needed. Predictors of CrossFit-induced rhabdomyolysis must be sought throughout, and participants' awareness should be increased.

Comparing Lung CT in COVID-19 Pneumonia and Acute Heart Failure: An Imaging Conundrum.

Background Chest computed tomography (CT) provides an effective modality to evaluate patients with suspected coronavirus disease 2019 (COVID-19). However, overlapping imaging findings with cardiogenic pulmonary edema is not uncommon. Reports comparing the chest CT features of these diseases have not been elaborated. Thus, we aimed to show the difference between the low-dose lung CT findings of COVID-19 pneumonia and comparing them to those with acute heart failure (HF). Methods This retrospective analysis enrolled hospitalized patients with COVID-19 (n=10) and acute heart failure (n=9) that exclusively underwent low-dose chest CT scans within 24 hours of admission. Clinical and lung CT characteristics were collected and analyzed. Results The appearance of ground-glass-opacities (GGOs) has been recorded in all individuals in the HF and COVID-19 groups. There was no significant statistical difference between the two groups for rounded morphology, consolidation, crazy paving pattern, lesion distribution, and parenchymal band (P> 0.05). However, diffuse lesions were more frequent in HF cases (55.6% vs. 0%) than in COVID-19 pneumonia, which had a predominantly multifocal pattern. Notably, CT images in HF patients were more likely to have signs of interstitial tissue thickening, such as the interlobular septums, fissures, and peribronchovascular interstitium (55.6% vs 0%, 88.9% vs 20% and 44.4% vs 0%, respectively), as well as cardiomegaly (77.8% vs 0%), increased artery to bronchus ratio (55.6% vs 0%), and pleural effusions (77.8% vs 0%). Conclusions Major overlaps of lung CT imaging features existed between COVID-19 pneumonia and acute HF cases. However, signs of fluid redistribution are clues that favor HF over COVID-19 pneumonia.

Co-infection of COVID-19 and recurrent malaria.

In tropical countries, endemic diseases such as malaria can be challenging to distinguish from COVID-19 because of the similarities in presenting symptoms. Here we reported a case of a young soldier with fever and myalgia six days before admission, with non-productive cough, chills, nausea and vomiting, dizziness, and headache for two days. Previously, he had experienced four times of malaria infection. He had a history of positive non-falciparum malaria rapid diagnostic test (RDT) two days before admission. Significant findings were epigastric tenderness, splenomegaly, and severe thrombocytopenia of 36×103 cells / µL. A naso-oropharyngeal swab examination revealed a positive SARS-CoV-2 infection. Consequently, he was hospitalized for 12 days, successfully treated, and discharged without sequelae. Thus, in light of a pandemic, physicians need to raise the suspicion of concurrent COVID-19 infection with other tropical diseases, especially at-risk patients, because malaria and COVID-19 may share similar manifestations. Moreover, further ancillary testing, such as RDT, may be warranted.

Visceral adiposity, subcutaneous adiposity, and severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis.

BACKGROUND AND AIMS: Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19. METHODS: We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR). RESULTS: There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm2 [27.0, 56.4], p < 0.001; I2: 0%) and TFA (mean difference 64.6 cm2 [26.2, 103.1], p = 0.001; I2: 0%). There was no significant difference in terms of SFA between patients with severe and non-severe COVID-19 (mean difference 9.3 cm2 [-4.9, 23.4], p = 0.199; I2: 1.2%). Pooled ORs showed that VTA was associated with severe COVID-19 (OR 1.9 [1.1, 2.2], p = 0.002; I2: 49.3%). CONCLUSION: Visceral adiposity was associated with increased COVID-19 severity, while subcutaneous adiposity was not. PROSPERO ID: CRD42020215876.

Proton pump inhibitor on susceptibility to COVID-19 and its severity: a systematic review and meta-analysis.

BACKGROUND: The negative impacts of proton pump inhibitor (PPI), including the risk of pneumonia and mortality, have been reported previously. This meta-analysis aimed to address the current interest of whether the administration of PPI could increase the susceptibility and risk of poor outcome in COVID-19. METHODS: We performed a systematic literature search from PubMed, Embase, EBSCOhost, and EuropePMC databases up until 3 December 2020. The main outcome was composite poor outcome which comprised of mortality and severe COVID-19. Severe COVID-19 in this study was defined as patients with COVID-19 that fulfill the criteria for severe CAP, including the need for intensive unit care or mechanical ventilation. The secondary outcome was susceptibility, based on cohort comparing COVID-19 positive and COVID-19 negative participants. RESULTS: There were a total of 290,455 patients from 12 studies in this meta-analysis. PPI use was associated with increased composite poor outcome (OR 1.85 [1.13, 3.03], p = 0.014; I2 90.26%). Meta-regression analysis indicate that the association does not vary by age (OR 0.97 [0.92, 1.02], p = 0.244), male (OR 1.05 [0.99, 1.11], p = 0.091), hypertension (OR 9.98 [0.95, 1.02], p = 0.317), diabetes (OR 0.99 [0.93, 1.05], p = 0.699), chronic kidney disease (OR 1.01 [0.93, 1.10], p = 0.756), non-steroidal anti-inflammatory drug use (OR 1.02 [0.96, 1.09], p = 0.499), and pre-admission/in-hospital PPI use (OR 0.77 [0.26, 2.31], p = 0.644). PPI use was not associated with the susceptibility to COVID-19 (OR 1.56 [0.48, 5.05], p = 0.46; I2 99.7%). CONCLUSION: This meta-analysis showed a potential association between PPI use and composite poor outcome, but not susceptibility. PROSPERO ID: CRD42020224286.

Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association. METHODS: A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19. RESULTS: There were 9 studies with 3,663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], p=0.010; I2: 56.7%, p=0.018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], p=0.008; I2: 57.4%, p=0.029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, p=0.033), male gender (coefficient: -0.03, p=0.042), and hypertension (coefficient: -0.02, p=0.033), but not diabetes (coefficient: -0.24, p=0.135) and cardiovascular diseases (coefficient: -0.01, p=0.506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (p=0.206). CONCLUSION: Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension. PROSPERO REGISTRATION NUMBER: CRD42020213491.

Cardiac manifestations, treatment characteristics, and outcomes of paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2: A systematic review.

BACKGROUND: Paediatric inflammatory multisystem syndrome (PIMS) temporally associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (PIMS-TS) is a rare clinical syndrome associated with a multiorgan system dysfunction, especially acute cardiac injury, and mandates a higher level of care. AIM OF REVIEW: To investigate cardiac manifestations, treatment characteristics, and outcomes of PIMS-TS. KEY SCIENTIFIC CONCEPTS OF REVIEW: Twenty-six studies were included with 1228 pooled subjects, with a mean age of 8.6 years, which were dominated by male gender (53%), and African ethnicity (31%). 732 (38%) patients were reactive on a serological test, and 457 patients (45%) were positive on SARS-CoV-2 RT-PCR. ST-segment abnormalities were the most common ECG findings (16%, n/N: 34/212). Various markers of troponin and the pooled mean of BNP and NT-pro-BNP levels were elevated. Cardiomegaly and pericardial effusion (21.8%, n/N: 164/751) were the most common chest X-ray findings. In echocardiography, the majority of patients' left ventricular ejection fraction was reduced (59.0%, n/N: 180/305), with pericardial effusion/ pericarditis seen the most (17.44%, n/N: 221/1267), and Z score ≥ 2 in 28% (n/N: 42/139). Cardiac MRI findings were consistent with acute myocarditis. Intravenous immunoglobulin, corticosteroids, and vasoactive drugs were frequently utilized. The mean length of stay was 6 days, with most patients (71%, n/N: 834/1163) were admitted to the ICU. However, the overall prognosis was favorable, with 98% alive (n/N: 1235/1260), and more than 50% of patients experienced recovery of left ventricular systolic functions at discharge (116 out of 206 patients).

BMI and atrial fibrillation recurrence post catheter ablation: A dose-response meta-analysis.

INTRODUCTION: The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. We aimed to evaluate the dose-response relationship between body mass index (BMI) and AF recurrence and adverse events. METHODS: A systematic literature search was conducted using PubMed, Europe PMC, EBSCO, ProQuest and Cochrane Library. Obesity was defined as BMI ≥28 kg/m2 . The primary outcome was AF recurrence, and the secondary outcome was adverse events. Adverse events were defined as procedure-related complications and cardio-cerebrovascular events. RESULTS: There were a total of 52,771 patients from 20 studies. Obesity was associated with higher AF recurrence (Odds ratio [OR] 1.30 [95% confidence interval [CI] 1.16-1.47], P < .001; I2 : 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P = .264; I2 : 23.9%). Meta-regression showed that the association varies by age (coefficient: -0.03, P = .024). Meta-analysis of highest versus lowest BMI showed that the highest group had higher AF recurrence (OR 1.37 [95% CI 1.18-1.58], P < .001; I2 : 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P = .028; I2 : 49.5%). The linear association analysis for AF recurrence was not significant (P = .544). The dose-response relationship for BMI and AF recurrence was nonlinear (pnonlinearity  < 0.001), the curve became steeper at 30-35 kg/m2 . For adverse events, an increase of 1% for every 1 kg/m2 increase in BMI (OR 1.01 [95% CI 1.00-1.02], P = .001), the relationship was nonlinear (pnonlinearity  = 0.001). CONCLUSION: Obesity was associated with higher AF recurrence in patients undergoing catheter ablation. High BMI might be associated with a higher risk for adverse events. PROSPERO ID: CRD42020198787.

Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association. METHODS: A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19. RESULTS: There were 9 studies with 3663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], P = .010; I 2: 56.7%, P = .018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], P = .008; I 2: 57.4%, P = .029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, P = .033), male gender (coefficient: -0.03, P = .042), and hypertension (coefficient: -0.02, P = .033), but not diabetes (coefficient: -0.24, P = .135) and cardiovascular diseases (coefficient: -0.01, P = .506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (P = .206). CONCLUSION: Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension.PROSPERO Registration Number: CRD42020213491.