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Public Health Feb 2022Countries throughout the world are experiencing COVID-19 viral load in their populations, leading to potential transmission and infectivity of asymptomatic COVID-19... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Countries throughout the world are experiencing COVID-19 viral load in their populations, leading to potential transmission and infectivity of asymptomatic COVID-19 cases. The current systematic review and meta-analysis aims to investigate the role of asymptomatic infection and transmission reported in family clusters, adults, children and health care workers, globally.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
An online literature search of PubMed, Google Scholar, medRixv and BioRixv was performed using standard Boolean operators and included studies published up to 17 August 2021. For the systematic review, case reports, short communications and retrospective studies were included to ensure sufficient asymptomatic COVID-19 transmission data were reported. For the quantitative synthesis (meta-analysis), participant data from a collection of cohort studies focusing on groups of familial clusters, adults, children and health care workers were included. Inconsistency among studies was assessed using I statistics. The data synthesis was computed using the STATA 16.0 software.
RESULTS
This study showed asymptomatic transmission among familial clusters, adults, children and health care workers of 15.72%, 29.48%, 24.09% and 0%, respectively. Overall, asymptomatic transmission was 24.51% (95% confidence interval [CI]: 14.38, 36.02) among all studied population groups, with a heterogeneity of I = 95.30% (P < 0.001). No heterogeneity was seen in the population subgroups of children and health care workers. The risk of bias in all included studies was assessed using the Newcastle Ottawa Scale.
CONCLUSIONS
For minimising the spread of COVID-19 within the community, this study found that following the screening of asymptomatic cases and their close contacts for chest CT scan (for symptomatic patients), even after negative nucleic acid testing, it is essential to perform a rigorous epidemiological history, early isolation, social distancing and an increased quarantine period (a minimum of 14-28 days). This systematic review and meta-analysis supports the notion of asymptomatic COVID-19 infection and person-to-person transmission and suggests that this is dependent on the varying viral incubation period among individuals. Children, especially those of school age (i.e. <18 years), need to be monitored carefully and follow mitigation strategies (e.g. social distancing, hand hygiene, wearing face masks) to prevent asymptomatic community transmission of COVID-19.
Topics: Adult; Asymptomatic Infections; COVID-19; Child; Humans; Quarantine; Retrospective Studies; SARS-CoV-2
PubMed: 35038628
DOI: 10.1016/j.puhe.2021.12.003 -
BMJ Clinical Evidence Oct 2010Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood... (Review)
Review
INTRODUCTION
Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood samples and expressed as a percentage of carboxyhaemoglobin, or indirectly using the carbon monoxide in expired breath. Carboxyhaemoglobin percentage is the most frequently used biomarker of carbon monoxide exposure. Although the diagnosis of carbon monoxide poisoning can be confirmed by detecting elevated levels of carboxyhaemoglobin in the blood, the presence of clinical signs and symptoms after known exposure to carbon monoxide should not be ignored.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of oxygen treatments for acute carbon monoxide poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 100% hyperbaric oxygen, oxygen 28%, and oxygen 100% by non-re-breather mask.
Topics: Carbon Monoxide; Carbon Monoxide Poisoning; Carboxyhemoglobin; Humans; Oxygen; Respiration
PubMed: 21418677
DOI: No ID Found -
Frontiers in Public Health 2023As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation. (Meta-Analysis)
Meta-Analysis
BACKGROUND
As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.
METHODS
A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on = 8,641, = 2,482, = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.
RESULTS
We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO (overall Standard Mean Difference, SMD = -0.24, 95% CI = -0.38 to -0.11, < 0.001) and minute ventilation (SMD = -0.72, 95% CI = -0.99 to -0.46, < 0.001), simultaneous increased in blood-CO (SMD = +0.64, 95% CI = 0.31-0.96, < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03-0.41, = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03-0.39, = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23-1.38, = 0.006) and humidity (SMD +2.24, 95% CI = 1.32-3.17, < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in = 373 with a robust relationship to mask wearing ( < 0.006 to < 0.001). Pooled symptom prevalence ( = 8,128) was significant for: headache (62%, < 0.001), acne (38%, < 0.001), skin irritation (36%, < 0.001), dyspnoea (33%, < 0.001), heat (26%, < 0.001), itching (26%, < 0.001), voice disorder (23%, < 0.03), and dizziness (5%, = 0.01).
DISCUSSION
Masks interfered with O-uptake and CO-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.
CONCLUSION
Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.
Topics: Humans; Young Adult; Adult; Middle Aged; COVID-19; Masks; SARS-CoV-2; Pandemics; Carbon Dioxide; Post-Acute COVID-19 Syndrome; Respiratory Protective Devices; Dyspnea
PubMed: 37089476
DOI: 10.3389/fpubh.2023.1125150 -
BMJ Clinical Evidence Jul 2008Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood... (Review)
Review
INTRODUCTION
Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood samples and expressed as a percentage of carboxyhaemoglobin, or indirectly using the carbon monoxide in expired breath. Carboxyhaemoglobin percentage is the most frequently used biomarker of carbon monoxide exposure. Although the diagnosis of carbon monoxide poisoning can be confirmed by detecting elevated levels of carboxyhaemoglobin in the blood, the presence of clinical signs and symptoms after known exposure to carbon monoxide should not be ignored.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of oxygen treatments for acute carbon monoxide poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 100% hyperbaric oxygen, oxygen 28%, and oxygen 100% by non-re-breather mask.
Topics: Carbon Monoxide; Carbon Monoxide Poisoning; Carboxyhemoglobin; Humans; Oxygen; Respiration
PubMed: 19445736
DOI: No ID Found -
Journal of Education and Health... 2020Novel coronavirus is believed to be tiny enough (0.08-0.14 μm) to penetrate through face mask, thus protection offered by cloth mask may be too low. However, the use of... (Review)
Review
INTRODUCTION
Novel coronavirus is believed to be tiny enough (0.08-0.14 μm) to penetrate through face mask, thus protection offered by cloth mask may be too low. However, the use of cloth face mask in community has been recommended by the United States Centre for Disease Control and Prevention and regulatory bodies of other countries. There is paucity of literature on efficacy of cloth face mask in preventing SARS-CoV-2 infection transmission; thus, this review aims to update the available most recent evidences on efficacy of cloth face masks in prevention of viral infection transmission.
METHODS
We searched MEDLINE, EMBASE, and Clinical Trials Register for identifying studies related to this review using free-text terms and MeSH terms. Both experimental and observational studies on efficacy of cloth masks which were published in English language have been included in this review except expert opinions, commentaries, editorials, and review articles. Twelve studies were eligible to be included in review for data extraction and qualitative synthesis was carried out from extracted data but quantitative analysis (meta-analysis) could not be performed because of serious heterogeneity between the studies.
RESULTS
Cloth face masks show minimum efficacy in source control than the medical grade mask. The efficacy of cloth face masks filtration varies and depends on the type of material used, number of layers, and degree of moisture in mask and fitting of mask on face.
CONCLUSION
Cloth face masks have limited efficacy in combating viral infection transmission. However, it may be used in closed, crowded indoor, and outdoor public spaces involving physical proximity to prevent spread of SARS-CoV-2 infection.
PubMed: 33015206
DOI: 10.4103/jehp.jehp_533_20 -
Resuscitation Plus Dec 2022Positive pressure ventilation via a facemask is critical in neonatal resuscitation, but frequently results in mask leak, obstruction, and inadequate respiratory support.... (Review)
Review
AIM
Positive pressure ventilation via a facemask is critical in neonatal resuscitation, but frequently results in mask leak, obstruction, and inadequate respiratory support. This systematic review aimed to determine whether the display of respiratory function monitoring improved resuscitation or clinical outcomes.
METHODS
Randomized controlled trials comparing outcomes when respiratory function monitoring was displayed versus not displayed for newborns requiring positive pressure ventilation at birth were selected and from databases (last search August 2022), and assessed for risk of bias using Cochrane Risk of Bias Tools for randomized control trials. The study was registered in the Prospective Register of Systematic Reviews. Grading of Recommendations, Assessment, Development and Evaluations was used to assess the certainty of evidence. Treatment recommendations were approved by the Neonatal Life Support Task Force of the International Liaison Committee on Resuscitation. Results reported primary and secondary outcomes and included resuscitation and clinical outcomes.
RESULTS
Of 2294 unique articles assessed for eligibility, three randomized controlled trials were included (observational studies excluded) (n = 443 patients). For predefined resuscitation and clinical outcomes, these studies either did not report the primary outcome (time to heart rate ≥ 100 bpm from birth), had differing reporting methods (achieving desired tidal volumes, significant mask leak) or did not find significant differences (intubation rate, air leaks, death before hospital discharge, severe intraventricular hemorrhage, chronic lung disease). Limitations included limited sample size for critical outcomes, inconsistent definitions amongst studies and unreported long-term outcomes.
CONCLUSION
Although respiratory function monitoring has been utilized in clinical care, there is currently insufficient evidence to suggest its benefit for newborn infants receiving respiratory support for resuscitation at birth.
REGISTRATION
PROSPERO CRD42021278169 (registered November 27, 2021).
FUNDING
The International Liaison Committee on Resuscitation provided support that included access to software platforms and teleconferencing.
PubMed: 36425449
DOI: 10.1016/j.resplu.2022.100327 -
Sports Medicine (Auckland, N.Z.) Jan 2023Wearing face masks in public is an effective strategy for preventing the spread of viruses; however, it may negatively affect exercise responses. Therefore, this review... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Wearing face masks in public is an effective strategy for preventing the spread of viruses; however, it may negatively affect exercise responses. Therefore, this review aimed to explore the effects of wearing different types of face masks during exercise on various physiological and psychological outcomes in healthy individuals.
METHODS
A literature search was conducted using relevant electronic databases, including Medline, PubMed, Embase, SPORTDiscus, Web of Science, and Cochrane Central Register of Controlled Trials on April 05, 2022. Studies examining the effect of mask wearing (surgical mask, cloth mask, and FFP2/N95 respirator) during exercise on various physiological and psychological parameters in apparently healthy individuals were included. For meta-analysis, a random effects model was used. Mean difference (MD) or standardized MD (SMD) with 95% confidence intervals (CI) were calculated to analyze the total effect and the effect in subgroups classified based on face mask and exercise types. The quality of included studies was examined using the revised Cochrane risk-of-bias tool.
RESULTS
Forty-five studies with 1264 participants (708 men) were included in the systematic review. Face masks had significant effects on gas exchange when worn during exercise; this included differences in oxygen uptake (SMD - 0.66, 95% CI - 0.87 to - 0.45), end-tidal partial pressure of oxygen (MD - 3.79 mmHg, 95% CI - 5.46 to - 2.12), carbon dioxide production (SMD - 0.77, 95% CI - 1.15 to - 0.39), and end-tidal partial pressure of carbon dioxide (MD 2.93 mmHg, 95% CI 2.01-3.86). While oxygen saturation (MD - 0.48%, 95% CI - 0.71 to - 0.26) decreased slightly, heart rate was not affected. Mask wearing led to higher degrees of rating of perceived exertion, dyspnea, fatigue, and thermal sensation. Moreover, a small effect on exercise performance was observed in individuals wearing FFP2/N95 respirators (SMD - 0.42, 95% CI - 0.76 to - 0.08) and total effect (SMD - 0.23, 95% CI - 0.41 to - 0.04).
CONCLUSION
Wearing face masks during exercise modestly affected both physiological and psychological parameters, including gas exchange, pulmonary function, and subjective discomfort in healthy individuals, although the overall effect on exercise performance appeared to be small. This review provides updated information on optimizing exercise recommendations for the public during the COVID-19 pandemic.
SYSTEMATIC REVIEW REGISTRATION NUMBER
This study was registered in the International Prospective Register of Systematic Review (PROSPERO) database (registration number: CRD42021287278).
Topics: Male; Humans; COVID-19; Pandemics; Carbon Dioxide; Exercise; Oxygen
PubMed: 36001290
DOI: 10.1007/s40279-022-01746-4 -
PloS One 2016Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This... (Comparative Study)
Comparative Study Meta-Analysis Review
Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes.
OBJECTIVE
Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials.
METHODS
A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data.
RESULTS
Ten RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70-4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13-6.18) and RR = 0.95, 95% CI = (0.81-1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27-1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58-14.33)]; aspiration [RR = 0.76, 95% CI = (0.06-8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10-1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15-0.62)]; coughing [RR = 0.28, 95% CI = (0.15-0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26-0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44-11.18)].
CONCLUSION
This systematic review showed that the FLMA has some advantages over ETT because it results in a lower incidence of hoarseness, coughing and oxygen desaturation. There were no statistically significant differences in the difficulty of intubation or in the occurrence of laryngospasms, postoperative sore throat, airway displacement, aspiration or laryngotracheal soiling. However, there was a higher incidence of partial upper airway obstruction in the FLMA than in the ETT group. We conclude that the FLMA has some advantages over ETT, but surgeons and anesthesiologists should be cautious when applying the mouth gag, moving the head and neck, or performing oropharyngeal procedures to avoid partial upper airway obstruction and airway displacement. The FLMA should not be used on patients at high risk for aspiration.
Topics: Anesthesia, General; Cough; Hoarseness; Humans; Incidence; Intubation, Intratracheal; Laryngeal Masks; Pharyngitis; Postoperative Complications
PubMed: 27414807
DOI: 10.1371/journal.pone.0158137 -
Cureus Jul 2021COVID-19 is a novel coronavirus that represents a great global health concern. It is transmitted between individuals through respiratory particles, and as there is no... (Review)
Review
The Association of the Prolonged Use of Personal Protective Equipment and Face Mask During COVID-19 Pandemic With Various Dermatologic Disease Manifestations: A Systematic Review.
COVID-19 is a novel coronavirus that represents a great global health concern. It is transmitted between individuals through respiratory particles, and as there is no established effective treatment currently for the virus, it is necessary to use protective strategies such as face masks. Healthcare providers and individuals serving outdoors are required to work for long durations wearing personal protective equipment (PPE). Wearing such protective equipment may have short- or long-term effects on the skin health of these individuals. We aim to assess the prevalence and types of dermatological manifestations associated with wearing PPE for a long time during the COVID-19 pandemic period by reviewing the previous studies conducted on this subject. The medical literature, including the databases of PubMed and Google Scholar, from 2019 to 2021 was explored. The search terms included a combination of "Impact of PPE and dermatological outcome," "Wearing PPE for a long time and dermatological manifestations," "Face mask-wearing and dermatological complications," and "Wearing PPE and dermatological manifestations." The inclusion criteria are original full-text articles that reported the association of wearing PPE and dermatological manifestations and outcomes. A total of 70 articles were obtained, among which only 10 articles were eligible for the inclusion criteria. These 10 studies included a total number of 7,643 participants and covered different countries of the world. The extracted data were summarized in a table to facilitate the collection of the important findings. Dermatological complications are frequently reported in people wearing PPE and face masks, especially the ones caused due to PPE among healthcare providers as they tend to use these protective measures for longer durations.
PubMed: 34430151
DOI: 10.7759/cureus.16544 -
The Journal of Allergy and Clinical... Apr 2024There is insufficient systematized evidence on the effectiveness of individual intranasal medications in allergic rhinitis (AR).
BACKGROUND
There is insufficient systematized evidence on the effectiveness of individual intranasal medications in allergic rhinitis (AR).
OBJECTIVES
We sought to perform a systematic review to compare the efficacy of individual intranasal corticosteroids and antihistamines against placebo in improving the nasal and ocular symptoms and the rhinoconjunctivitis-related quality of life of patients with perennial or seasonal AR.
METHODS
The investigators searched 4 electronic bibliographic databases and 3 clinical trials databases for randomized controlled trials (1) assessing adult patients with seasonal or perennial AR and (2) comparing the use of intranasal corticosteroids or antihistamines versus placebo. Assessed outcomes included the Total Nasal Symptom Score, the Total Ocular Symptom Score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire. The investigators performed random-effects meta-analyses of mean differences for each medication and outcome. The investigators assessed evidence certainty using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.
RESULTS
This review included 151 primary studies, most of which assessed patients with seasonal AR and displayed unclear or high risk of bias. Both in perennial and seasonal AR, most assessed treatments were more effective than placebo. In seasonal AR, azelastine-fluticasone, fluticasone furoate, and fluticasone propionate were the medications with the highest probability of resulting in moderate or large improvements in the Total Nasal Symptom Score and Rhinoconjunctivitis Quality-of-Life Questionnaire. Azelastine-fluticasone displayed the highest probability of resulting in moderate or large improvements of Total Ocular Symptom Score. Overall, evidence certainty was considered "high" in 6 of 46 analyses, "moderate" in 23 of 46 analyses, and "low"/"very low" in 17 of 46 analyses.
CONCLUSIONS
Most intranasal medications are effective in improving rhinitis symptoms and quality of life. However, there are relevant differences in the associated evidence certainty.
PubMed: 38685482
DOI: 10.1016/j.jaci.2024.04.016