Epstein–Barr virus (EBV) reactivation in acute-phase of COVID-19 disease was recently discovered but it is not clear in terms of degree of mortality caused, and this was the aim of the current study. Six databases and three non‐databases were thoroughly searched, independently. The articles related to non‐human study (abstract, in vitro, in vivo, in silico, case study, poster, and review articles) were excluded for main analysis. Four articles related to mortality linked to EBV reactivation were systematically identified and included in the qualitative and quantitative analyses. Based on proportional meta-analysis of 4 studies, 34.3% or 0.343 (95% CI: 0.189–0.516; I2 = 74.6) mortality related to EBV reactivation was identified. To address high heterogeneity, subgroup meta-analysis was carried out. Based on subgroup analysis, 26.6% or 0.266 (95% CI: 0.191–0.348; I2 = 0) with no heterogeneity was identified. Interestingly, in comparative meta-analysis, EBV(−)/SARS-CoV-2(+) patients had statistically lesser mortality (9.9%) than EBV(+)/SARS-CoV-2(+) patients (23.6%) where RR = 2.31 (95% CI: 1.34–3.99; p = 0.003 ; I2 = 6%). This finding is equivalent to the absolute mortality effect of 130 more per 1000 COVID-19 patients (95% CI: 34–296). Furthermore, based on statistical analysis, D-dimer was not statistically significantly different ( p > 0.05 ) between the groups although studies have shown that D-dimer was statistically significantly different ( p < 0.05 ) between these groups. Based on the inclusion and analysis of low risk of bias and high quality of articles graded with Newcastle–Ottawa Scale (NOS), when COVID-19 patients’ health state is gradually worsening, EBV reactivation needs to be suspected because EBV reactivation is a possible marker for COVID-19 disease severity.
Baricitinib is known to reduce mortality and disease progression in COVID-19 patients; however, the data are inconsistent. Therefore, it needs to be explored to further understand the clinical benefits of this drug in the management of COVID-19 patients. Does baricitinib statistically significantly reduce mortality and disease progression in COVID-19 patients? To answer these questions, three databases known as ScienceDirect, PubMed/MEDLINE, and Scopus and other sources, such as preprint (medRxiv) and reference lists, were thoroughly searched. Four randomised controlled trials (RCTs) were included. Based on the meta-analysis, baricitinib statistically significantly reduced mortality with the risk ratio (RR) of RR = 0.74 [95% CI: 0.58 to 0.94; p = 0.01 ] and moderately high heterogeneity, where I2 = 62% and p = 0.05 . On the other hand, RR = 0.84 [95% CI: 0.75 to 0.95; p = 0.005 ] with insignificant heterogeneity of I2 = 20% and p = 0.28 was found for disease progression. Cochrane risk of bias (RoB) analysis revealed that three out of four articles were ranked as high-quality articles with low RoB. Based on the evidence grading, the overall certainty of evidences was moderate. In conclusion, baricitinib statistically significantly reduced mortality and disease progression in COVID-19 patients when the patients were treated with baricitinib at a dosage of 2 mg or 4 mg for a maximum duration of 14 days.
Background: Due to high heterogeneity and risk of bias (RoB) in previously published meta-analysis, a concrete conclusion on the efficacy of baricitinib in reducing mortality in COVID-19 patients was unable to form. Methods: Search engines PubMed/MEDLINE, ScienceDirect and other sources like preprints and reference lists were searched with appropriate keywords. The included evidence was graded with GRADEpro. The RoB, heterogeneity and meta-analysis were studied through RevMan 5.4.1 software. The heterogeneity was evaluated based on the generated p-value or I2 test. Results: Eight (8) RCTs were included in current analysis. Five studies had low RoB. Based on grading the evidence, the inclusion and exclusion of high RoB articles led to moderate and high certainty of evidence, respectively. Based on 8 RCTs (with high RoB), baricitinib statistically significantly reduced mortality where the risk ratio (RR) = 0.84 [95% CI: 0.76 to 0.92; p = 0.0002; I2 = 23%; p = 0.25]. The heterogeneity was insignificant but the RoB was high. We did subgroup analysis of low and high RoB articles and found out baricitinib statistically significantly reduced mortality with the RR = 0.68 [95% CI: 0.56 to 0.82; p < 0.0001; I2 = 0%; p = 0.85] and RR = 0.89 [95% CI: 0.80 to 0.99; p = 0.04; I2 = 0%; p = 0.43], respectively. The heterogeneity was 0% with insignificant p-values in both subgroup analyses. The percentage of mortality reduction was 31.31% and 7.79%, respectively whereas it was 13.95% in main group analysis. Conclusion: With the presence of optimal sample size of 3944 from 5 low RoB studies which represents a minimum of 300 million population of people and with 0% of heterogeneity, the effectiveness of baricitinib in reducing the mortality in COVID-19 patients is concretely proven.
Background: Chronic conditions are a leading cause of death and disability worldwide and respective data on dietary patterns remain scant. The present study aimed to investigate dietary patterns and identify sociodemographic factors associated with Dietary Approach to Stop Hypertension (DASH) scores within a multi-ethnic population with various chronic conditions. Method: The present study utilised data from the Knowledge, Attitudes, and Practices on diabetes study in Singapore – a nationwide survey conducted to track the knowledge, attitudes, and practices pertaining to diabetes. The study analysed data collected from a sample of 2,895 Singapore residents, with information from the sociodemographic section, DASH diet screener, and the modified version of the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0 checklist of chronic medical conditions. Results: Respondents with no chronic condition had a mean DASH score of 18.5 (±4.6), those with one chronic condition had a mean DASH score of 19.2 (±4.8), and those with two or more chronic conditions had a mean DASH score of 19.8 (±5.2). Overall, the older age groups [35– 49 years (B = 1.78, 95% CI: 1.23 – 2.33, p <0.001), 50–64 years (B = 2.86, 95% CI: 22.24 – 3.47, p <0.001) and 65 years and above (B = 3.45, 95% CI: 2.73 – 4.17, p <0.001)], Indians (B = 2.54, 95% CI: 2.09 – 2.98, p <0.001) reported better diet quality, while males (B = -1.50, 95% CI: -1.87 – -1.14, p <0.001) reported poorer diet quality versus females. Conclusion: Overall, respondents with two or more chronic conditions reported better quality of diet while the sociodemographic factors of age, gender and ethnicity demonstrated a consistent pattern in correlating with diet quality, consistent with the extant literature. Results provide further insights for policymakers to refine ongoing efforts in relation to healthy dietary practices for Singapore.
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