Hyponatremia and SARS-CoV-2 infection: A narrative review

A novel rapid spreading and changing virus called SARS-CoV-2 appeared in Wuhan city in December 2019. It was announced by the World Health Organization (WHO) as a pandemic disease in March 2020. It commonly presents with respiratory symptoms; however, it may be asymptomatic. Electrolyte abnormalities are not uncommon features of SARS-CoV-2 infection. Hyponatremia is one of these electrolyte disturbances among SARS-CoV-2 patients, and it may produce symptoms such as weakness and seizure as the initial presenting symptoms. The underlying mechanism(s) of hyponatremia due to SARS-CoV-2 infection is (are) not established.The aim of this review is to evaluate the possible mechanism of hyponatremia in patients with COVID-19. Understanding and categorizing the hyponatremia in these patients will lead to better treatment and correction of the hyponatremia.A review of the literature between December 2019 and March 2022 was conducted searching for the possible reported mechanism(s) of hyponatremia in SARS-CoV-2.Although SIADH is the commonly reported cause of hyponatremia in SARS-CoV-2 infection, other causes such as diarrhea, vomiting, and kidney salt loss must be considered before SIADH.     

Beta‐lactam plus macrolides or beta‐lactam alone for community‐acquired pneumonia: A systematic review and meta‐analysis

It is unclear whether in the treatment of community‐acquired pneumonia (CAP) beta‐lactam plus macrolide antibiotics lead to better survival than beta‐lactam alone. We report a systematic review and meta‐analysis. Trials and observational studies published in English were included, if they provided sufficient data on odds ratio for all‐cause mortality for a beta‐lactam plus macrolide regimen compared with beta‐lactam alone. Two investigators independently searched for eligible articles. Of 514 articles screened, 14 were included: two open‐label randomized controlled trials (RCTs) comprising 1975 patients, one non‐RCT interventional study comprising 1011 patients and 11 observational studies comprising 33 332 patients. Random‐model meta‐analysis yielded an odds ratio for all‐cause death for beta‐lactam plus macrolide compared with beta‐lactam alone of 0.80 (95% CI 0.69–0.92, P = 0.002) with substantial heterogeneity (I² = 59%, P for heterogeneity = 0.002). Severity‐based subgroup analysis and meta‐regression revealed that adding macrolide had a favourable effect on mortality only for severe CAP. Of the two RCTs, one suggested that macrolide plus beta‐lactam lead to better outcome compared with beta‐lactam alone, while the other did not. Subgrouping based on study design, that is, RCT versus non‐RCT, which was almost identical to subgrouping based on severity, revealed substantial inter‐subgroup heterogeneity. Compared with beta‐lactam alone, beta‐lactam plus macrolide may decrease all‐cause death only for severe CAP. However, this conclusion is tentative because this was based mainly on observational studies.     

Antibiotic exposure in early life and childhood overweight and obesity: A systematic review and meta‐analysis

We conducted a systematic review and meta‐analysis of observational studies investigating the association between antibiotic exposure in infancy and risk of childhood overweight and obesity. Thirteen studies, including a total of 527 504 children, were included in the systematic review and 8 were included in meta‐analyses. Exposure to antibiotics in infancy was associated with an increased odds ratio (OR) of childhood overweight and obesity (OR 1.11, 95% confidence interval [CI] 1.02‐1.20). Whereas exposure to 1 treatment only and exposure between 6 and 24 months were not associated with increased risk of childhood overweight and obesity, exposure to >1 treatment was associated with an OR of 1.24 (95% CI 1.09‐1.43) and exposure within the first 6 months of life was associated with an OR of 1.20 (95% CI 1.04‐1.37). In conclusion, antibiotic exposure in infancy was associated with a slightly increased risk of childhood overweight and obesity, mainly if children were exposed to repeated treatments or treatment within the first 6 months of life. It is unclear whether this association is mediated via direct effects of antibiotics on the gut microbiota.     

Short‐term effect of low‐intensity,pulsed, electromagnetic fields on gait characteristics in older adults with low bone mineral density: A pilot randomized‐controlled trial

Aim: To evaluate the short‐term effects of a 10‐min exposure to low‐intensity, pulsed, electromagnetic fields (PEF) on gait characteristics in older adults with low bone mineral density. Methods: In a single‐center, double‐blind, randomized‐controlled trial, community‐dwelling older adults aged ≥70 years were randomized (3:2 ratio) to receive a 10‐min treatment with PEF (mean intensity 1.5 mW) or placebo. The following gait parameters were assessed at baseline and just after the intervention/placebo with the GAITRite Portable Walkway system: self‐selected gait speed (cm/s), stride length (cm), support base (cm) and double support phase (s). Results: In the intervention group (25 patients), both self‐selected gait speed and stride length increased significantly from baseline, whereas the double support phase decreased. In the placebo group, all gait parameters except for support base remained unchanged. The mean percent increase (±standard deviation) of self‐selected gait speed was significantly (P = 0.010) greater in the intervention group (20.1 ± 15.6) compared with the placebo group (10.5 ± 13.1), whereas no significant difference in the mean percent variation of the other parameters was found between the two groups. During the intervention, no adverse event was observed. A similar proportion of patients in the two groups reported one fall in the 30 days after the intervention/placebo. Conclusions: This is the first randomized‐controlled trial showing the potential beneficial effects of PEF on gait characteristics in older adults. Further phase III randomized trials are warranted to establish their potential benefits (e.g. fall prevention) on fall‐related health outcomes in elderly patients. Geriatr Gerontol Int 2013; 13: 393–397 .     

Methadone dose and neonatal abstinence syndrome—systematic review and meta‐analysis

Aim To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). Methods PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966–2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut‐off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta‐analysis. Sensitivity analyses explored the impact of limiting meta‐analyses to prospective studies or studies using an objective scoring system to diagnose NAS. Results A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta‐analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non‐significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. Conclusions Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high‐ or low‐dose methadone maintenance therapy.     

Effect of TNF‐inhibitor therapy on spinal structural progression in ankylosing spondylitis patients: A systematic review and meta‐analysis

To review the effect of tumor necrosis factor‐alpha inhibitor (TNFi) therapies on radiographic progression in ankylosing spondylitis (AS) patients as evaluated by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Pubmed, MEDLINE, EMBASE, and the Cochrane Library databases were searched from inception to August 2019. All comparative and non‐comparative studies that evaluated the clinical effectiveness of TNFi on radiographic progression as assessed by mSASSS change at a minimum follow‐up of 1 year were included. The Newcastle–Ottawa Scale and Cochrane Collaboration Risk of Bias Tool were utilized to assess the methodological quality. Pooled analysis was performed for continuous and binomial variables where appropriate. Inter‐rater reliability of mSASSS status and change scores were assessed with intra‐class coefficients (ICC). Twenty‐one studies were identified with a total of 4460 patients (mean age: 40.4 years [range 25.3‐50 years]; 76% male; mean baseline mSASSS: 12.7 units [range 5.5‐19.8 units]). All studies (3 randomized and 18 observational studies) were considered to have moderate‐to‐high methodological quality. The inter‐rater reliability of mSASSS status and change scores from 14 of the 21 studies were excellent (ICC ranges, 0.91‐0.99) and moderate‐to‐excellent (ICC ranges, 0.58‐0.90), respectively. From the 21 studies, 11/21 (50%) demonstrated a delayed effect in mSASSS in AS patient administered TNFi. When stratifying these studies into those with ≤4 years of follow‐up and >4 years follow‐up, 3/11 (27%) and 8/10 (80%) studies respectively indicated a delayed effect of mSASSS with TNFi in AS patients. Pooling for meta‐analysis from 3 studies (1159 patients) with study durations ranging 4‐8 years, indicated that TNFi‐treated patients had reduced odds of structural progression (odds ratio 0.81; 95% CI 0.68‐0.96; P = .01; I² = 0%). Mean rate of mSASSS change from 16 studies ranged from ?0.15 to 7.3 mSASSS units for all AS patients. Meta‐analysis indicated a numerical, but statistically non‐significant, reduction in the rate of mSASSS change with TNFi treatment (7 studies [1438 patients]; mean difference, ?0.24; 95% CI, ?0.49‐0.01; P = .06; I² = 0%). This systematic review and meta‐analysis indicated that >4 years of TNFi usage was associated with delayed structural progression by mSASSS. The narrative analysis of the data from 21 studies further confirmed that studies with >4 years of follow‐up had delayed structural progression with TNFi use in AS patients. The systematic review also confirmed that mSASSS has good‐to‐excellent inter‐rater reliability in AS.     

Prevalence of influenza A infection in the Middle‐East: A systematic review and meta‐analysis

Objective

This systematic review and meta‐analysis was performed to determine the prevalence rate of influenza virus from different parts of Middle East region, and present an overall relative frequency (RF) for this region.

Methods

The authors performed a systematic literature review from several reliable databases such as PubMed, ISI Web of Science and Scopus during 2000–2016. Furthermore, the keywords of this research were ‘Influenza’, ‘Subtype’, ‘Seroprevalence’, ‘Incidence’, ‘Seroepidemiology’, ‘H1N1’, ‘H3N2’, ‘H5N1’, ‘H9N2’, ‘Middle‐East’ and ‘Meta‐analysis’. The reported data were selected according to inclusion and exclusion criteria.

Results

The authors selected 71 studies out of 1147 for the present review. The overall estimation of the prevalence of influenza virus was 10.2% [95% confidence interval (CI): 10.1%–10.3%]. However, based on our records, the evident heterogeneity of influenza virus was observed among the studies (Cochran Q test, P value <.001 and I‐squared = 100%). It should be noted that influenza virus infection's RF varied from 0.5% in Qatar to 70% in Syria.

Conclusions

The results of this review are remarkable, they show that influenza infection RF is variable due to several factors. Thus, further researches should be taken to minimize the emergence and transmission of influenza virus.