pneumonia" OR " coronavirus"), AND " Myocarditis" OR " Cycle threshold (Ct)" OR " Altitude". We found that one article analyzed the risk factors affecting the prognosis of adult patients with COVID-19 in terms of survivorship, without considering Ct values as extrinsic factors.Moreover, there are no reported studies on viral myocarditis caused by COVID-19 and the relationship between the altitude and COVID-19. Added value of this studyWe retrospectively analyzed the clinical data, Ct values, laboratory indicators and imaging findings of 84 adult patients with confirmed COVID-19. Three key-independent risk factors of COVID-19 were identified in our study, including age [OR 2.350; 95% CI (1.206 to 4.580); p=0.012], Ct value [OR 0.158; 95% CI (0.025 to 0.987); p=0.048] and PII [OR 1.912; 95% CI (1.187 to 3.079); p=0.008]. Amongst 84 patients, 13 patients (15.48%) were noted with abnormal electrocardiograms (ECGs) and serum myocardial enzyme levels; whereas 4 (4.8%) were clinically diagnosed as SARS-CoV-2 myocarditis. Moreover, altitude should be considered for COVID-19 severity classification, given that oxygen partial pressure and blood oxygen saturation of regional patients vary with altitudes.

(1) Background: The efficiency of balneotherapy (BT) for fibromyalgia syndrome (FMS) remains elusive. (2) Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO were searched from inception to 31 May 2020. Randomized controlled trials (RCTs) with at least one indicator were included, i.e., pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), and Beck’s Depression Index (BDI). The outcome was reported as a standardized mean difference (SMD), 95% confidence intervals (CIs), and I2 for heterogeneity at three observational time points. GRADE was used to evaluate the strength of evidence. (3) Results: Amongst 884 citations, 11 RCTs were included (n = 672). Various BT regimens were reported (water types, duration, temperature, and ingredients). BT can benefit FMS with statistically significant improvement at different time points (pain of two weeks, three and six months: SMD = −0.92, −0.45, −0.70; 95% CI (−1.31 to −0.53, −0.73 to −0.16, −1.34 to −0.05); I2 = 54%, 51%, 87%; GRADE: very low, moderate, low; FIQ: SMD = −1.04, −0.64, −0.94; 95% CI (−1.51 to −0.57, −0.95 to −0.33, −1.55 to −0.34); I2 = 76%, 62%, 85%; GRADE: low, low, very low; TPC at two weeks and three months: SMD = −0.94, −0.47; 95% CI (−1.69 to −0.18, −0.71 to −0.22); I2 = 81%, 0; GRADE: very low, moderate; BDI at six months: SMD = −0.45; 95% CI (−0.73 to −0.17); I2 = 0; GRADE: moderate). There was no statistically significant effect for the TPC and BDI at the remaining time points (TPC at six months: SMD = −0.89; 95% CI (−1.85 to 0.07); I2 = 91%; GRADE: very low; BDI at two weeks and three months: SMD = −0.35, −0.23; 95% CI (−0.73 to 0.04, −0.64 to 0.17); I2 = 24%, 60%; GRADE: moderate, low). (4) Conclusions: Very low to moderate evidence indicates that BT can benefit FMS in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. Established BT regimens with a large sample size and longer observation are needed.

Objective To assess the effectiveness of balneotherapy (BT) in the management of fibromyalgia syndrome (FMS). Methods The Cochrane Library, EMBASE, MEDLINE, and PubMed were thoroughly searched for relevant studies with a pre-specified searching strategy (from their inception to May 31 st , 2019), to identify randomized controlled trials (RCTs) evaluating BT in FMS management. The primary outcomes were pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), Beck's Depression Index (BDI). A meta-analysis was performed to identify risk ration (RR) or standardized mean difference (SMD) where appropriate, 95%CI with random-effect and consistent models. Results Ten RCT studies with 611 participants were included. Pooled results showed that BT can benefit FMS with significant improvement reflected as, pain (SMD= -0.90, 95%CI [−1.37 to −0.42] I 2 =86%), FIQ (SMD= −0.81, 95% CI [−1.24 to −0.38] I 2 =84%), TPC (SMD= −0.88, 95% CI [−1.63 to −0.14] I 2 =91%) and BDI (SMD= −0.29, 95% CI [−0.53 to −0.05] I 2 =22%) at the end of treatment. However, there was no significant effect on BDI (SMD= −0.57, 95% CI [−1.40 to 0.26]) at follow up. Conclusion Based on 12 to 48 weeks observation, pooled evidence from RCTs indicates BT may reduce pain and improve the quality of life of patients with FMS. Definitive, large-sample studies are needed, with focus on long-term results and maintenance of the beneficial effects.