Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread personto-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. MethodsWe did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-toperson virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects metaregressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FindingsOur search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0•18, 95% CI 0•09 to 0•38; risk difference [RD] -10•2%, 95% CI -11•5 to -7•5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2•02 per m; p interaction =0•041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0•15, 95% CI 0•07 to 0•34, RD -14•3%, -15•9 to -10•7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; p interaction =0•090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0•22, 95% CI 0•12 to 0•39, RD -10•6%, 95% CI -12•5 to -7•7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.Funding World Health Organization.

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Objective: The innominate artery is considered an alternative site for establishing cardiopulmonary bypass in surgical procedures involving the thoracic aorta. This systematic review examines the use of innominate artery cannulation in aortic surgery.Methods: A systematic literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all studies that utilized innominate artery cannulation for establishing cardiopulmonary bypass and providing cerebral perfusion in thoracic aortic surgery. The data were reviewed up to September 2018.Results: Acute type A aortic dissection contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719) underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending and hemi-arch replacement, while 11.5% had total aortic arch replacement and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111). All-cause 30-day mortality rate was 2.7% (n = 61).Conclusion: Innominate artery cannulation is a safe technique in patients who undergo thoracic aortic surgery. It can be utilized, in selected cases, as a reliable route for establishing cardiopulmonary bypass and maintaining cerebral perfusion. K E Y W O R D S aorta, aortic surgery, cannulation, innominate artery

The SARS-CoV-2, the causative agent of COVID-19, has been established to gain access to human cells via the ACE2 receptor, similar to the related coronavirus SARS-CoV which led to an outbreak in 2003.A concern with the newer 2019 coronavirus is its 10 to 20-fold higher affinity to the ACE2 receptor that of SARS-CoV-2, aiding its effective human-to-human transmission. ACE2 receptor expression is thought to be upregulated in ACE inhibitors (ACEI) users. As ACEI are used extensively in the treatment of hypertension, there has been concern regarding the risk of using these medications in patients with COVID-19, and whether the use of such ACEI predisposes to COVID-19. ACEI are also used in the treatment regime of other common conditions including diabetes. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. Therefore, it may be hypothesized that diabetes and hypertension treatment with ACE2-stimulating drugs would increase the risk of developing severe and fatal COVID-19. The recent Chinese clinical studies detailing the clinical characteristics of patients infected by the novel coronavirus disease-19 (COVID-19) infection have confirmed many of these concerns. 1 A study included 1099 patient's laboratory-confirmed COVID-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through 29 January 2020, of which 261 had associated comorbidity. 2 Hypertension yet again was the most common comorbidity with 165 patients, followed by 81 patients with diabetes. A meta-analysis 3 evaluating the comorbidities associated with COVID-19 found similar results. These statistics raise the question of whether hypertension itself is a high-risk comorbidity or is the use of angiotensin-converting-enzyme inhibitor (ACEI) specifically as treatment responsible for these statistics.Despite coronary heart disease (CHD) being the most common chronic condition worldwide, a small percentage of COVID-19 patients suffered from the condition. The lower rates of CHD could be due to the lower ACE2 receptor expression in patients with CAD and heart failure, 4 there by reducing the likelihood of contracting COVID-19. Large cohort studies factoring in ACE2 expression as a variable while comparing the progression of COVID-19 infection in patients would indicate the relevance of ACE2 receptor in COVID-19 mortality and fatality.According to data from the above study, 23.7% of patients with hypertension had a severe COVID-19 infection, followed by diabetes mellitus (16.2%), CHDs (5.8%), and cerebrovascular disease (2.3%).A high percentage (35.9%) of those who had hypertension died or required mechanical ventilation at the intensive care unit, while the same occured in 26.9% of diabetic patients. As ACEIs are predominantly used in hypertension this could potentially explain the high percentage of COVID-19 positive patients who develop a severe infection. Diabetic patients could also be on ACEIs to slow down the progression of vascular complications associated with diabetes, hence t...

In light of the recent safety concerns relating to NSAID use in COVID-19, we sought to evaluate cardiovascular and respiratory complications in patients taking NSAIDs during acute lower respiratory tract infections. Methods: We carried out a systematic review of randomised controlled trials and observational studies. Studies of adult patients with short-term NSAID use during acute lower respiratory tract infections, including bacterial and viral infections, were included. Primary outcome was all-cause mortality. Secondary outcomes were cardiovascular, renal and respiratory complications. Results: In total, eight studies including two randomised controlled trials, three retrospective and three prospective observational studies enrolling 44 140 patients were included. Five of the studies were in patients with pneumonia, two in patients with influenza, and one in a patient with acute bronchitis. Meta-analysis was not possible due to significant heterogeneity. There was a trend towards a reduction in mortality and an increase in pleuro-pulmonary complications. However, all studies exhibited high risks of bias, primarily due to lack of adjustment for confounding variables. Cardiovascular outcomes were not reported by any of the included studies. Conclusion: In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution. Mechanistic and clinical studies addressing the captioned subject are urgently needed, especially in relation to COVID-19.

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