Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory dataThe COVID-19 pandemic caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2) has become a serious challenge for health systems worldwide. Despite the favorable clinical course for most cases, a mortality rate of 30-70% is expected for COVID-19 patients treated on intensive care unit (ICU) [1]. Reports have shown an increased risk of death for older patients with existing comorbidities and potential biomarkers associated with severity for COVID-19 patients [2,3].Because of the complexity and the limited evidence on the pathogenesis of COVID-19, the management of critically ill patients has been challenging. Multiple recent studies have provided valuable clinical and laboratory features of hospitalized patients with COVID-19, but in many of them the information is not complete and there is a potential for overlapping data. Therefore, findings from a comprehensive systematic review can help physicians to understand the disease and make decisions for critically ill patients. In this study, we performed a quantitative evidence synthesis of clinical and laboratory factors associated with mortality in patients with COVID-19.We searched the peer-reviewed (PubMed, Web of Science, Scopus, Embase) and gray (Google Scholar, bioRxiv, medRxiv) literature to identify studies comparing clinical data, laboratory parameters (hematological, biochemical, inflammatory markers, coagulation factors, and blood gas analysis) and complications between non-survivors and survivors of COVID-19. We included only studies providing clinical data and at least one of the laboratory parameters previously mentioned. We excluded publications with potential overlapping reports, and studies from which data extraction was not possible. In case of potential overlapping data, we selected the study with most complete information.Reports were screened in two stages: screening of titles and abstracts followed by the retrieval and screening of full-text articles. Searches were performed from January 1, 2020 up to April 06, 2020, without language restrictions. The reference lists of all eligible studies and reviews were also evaluated to identify additional studies for inclusion. The following search terms were used: "COVID-19″, "severe acute respiratory syndrome coronavirus 2″, "SARS-CoV-2″, "2019-nCoV", "coronavirus" and "coronaviruses".Data from publications were extracted by two authors and crosschecked for accuracy. Our outcome of interest was in-hospital death. Clinical data, laboratory parameters, and complications were considered predictor variables. Effect sizes were reported as mean difference (MD) or standardized mean difference (SMD) for continuous variables and risk ratio (RR) for dichotomous variables with 95% confidence intervals (CI). Not all studies reported data on all predictor variables, and the pooled analysis was estimated from the data available for each variable. A random-effects model was used to poo...

A rapid systematic review was carried out to evaluate the current evidence related to the presence of SARS-CoV-2 in breast milk from pregnant women with COVID-19. Eight studies analyzing the presence of SARS-CoV-2 RNA in the breast milk of 24 pregnant women with COVID-19 during the third trimester of pregnancy were found. All patients had fever and/or symptoms of acute respiratory illness and chest computed tomography images indicative of COVID-19 pneumonia. Most pregnant women had cesarean delivery (91.7%) and two neonates had low birthweight (< 2 500 g). Biological samples collected immediately after birth from upper respiratory tract (throat or nasopharyngeal) of neonates and placental tissues showed negative results for the presence SARS-CoV-2 by RT-PCR test. No breast milk samples were positive for SARS-CoV-2 and, to date, there is no evidence on the presence of SARS-CoV-2 in breast milk of pregnant women with COVID-19. However, data are still limited and breastfeeding of women with COVID-19 remains a controversial issue. There are no restrictions on the use of milk from a human breast milk bank.

BackgroundFew studies have evaluated the association between quality of life (QoL) and functional activity limitations (FAL) of leprosy patients as determined by the Screening of Activity Limitation and Safety Awareness scale (SALSA).AimTo identify the association between FALs and the QoL of patients during and post leprosy treatment.Materials and MethodsCross-sectional survey of 104 patients with leprosy followed in specialist reference centres in Sergipe, Brazil, between June and October 2014. QoL was evaluated using the World Health Organization-QoL-BREF (WHOQoL-BREF) questionnaire. The SALSA scale was used to measure FALs.ResultsLow SALSA scores were present in 76% of patients. QoL scores were lower for the physical and environmental domains, with median (interquartile range (IQR)) scores of 53.6 (32.1–67.9) and 53.1 (46.9–64.8), respectively. There was a statistical association between increasing SALSA scores and lower QoL as measured by the WHOQoL-BREF.ConclusionFunctional limitations are associated with lower QoL in leprosy patients, especially in the physical and environmental WHOQoL-BREF domains.

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All authors contributed equally to his work. AbstractIntroduction: The clinical outcomes of leprosy include complications such as physical disabilities and deformities that vary according to the degree of impairment of nerve trunks. Knowledge of the factors that lead to the development of these complications is important for disability prevention programs. This study aimed to evaluate clinical factors associated with the occurrence of physical disability in leprosy cases. Methodology: This was a retrospective study of 2,358 cases of leprosy in Aracaju, northeast Brazil, between 2001 and 2011. Analysis was done using the Chi-square test and logistic regression model. Results: Significant factors associated with disability were found to be male gender, having more than two affected nerves, multibacillary leprosy classification, leprosy reaction, and lepromatous leprosy. The multivariate analysis revealed that the associated factors included having more than two affected nerves, leprosy reaction (adjusted odds ratio [aOR]: 2.02, 95% confidence interval [CI]: 1.36 to 3.01), the multibacillary form (aOR: 2.74, 95% CI: 1.84 to 4.08), and lepromatous leprosy (aOR: 4.87, 95% CI: 2.86 to 16.08). Conclusions: The number of affected nerves, leprosy reaction, operational classification, and clinical presentation were identified as the main factors associated with the development of disability in leprosy patients.

BackgroundRotavirus was the leading cause of childhood diarrhoea-related hospitalisations and death before the introduction of rotavirus vaccines.MethodsWe describe the effectiveness of rotavirus vaccines to prevent rotavirus infections and hospitalizations and the main rotavirus strains circulating before and after vaccine introduction through a systematic review and meta-analysis of studies published between 1990 and 2014. 203 studies were included to estimate the proportion of infections due to rotavirus and 10 to assess the impact of the vaccines. 41 of 46 studies in the post-vaccination period were used for meta-analysis of genotypes, 20 to calculate VE against infection, eight for VE against hospitalisation and seven for VE against severe rotavirus-diarrhoea.Results24.3 % (95 % CI 22.1–26.5) and 16.1 % (95 % CI 13.2–19.3) of cases of diarrhoea were due to rotavirus before and after vaccine introduction, respectively. The most prevalent G types after vaccine introduction were G2 (51.6 %, 95 % CI 38–65), G9 (14.5 %, 95 % CI 7–23) and G1 (14.2 %, 95 % CI 7–23); while the most prevalent P types were P[4] (54.1 %, 95 % CI 41–67) and P[8] (33 %, 95 % CI 22–46). G2P[4] was the most frequent genotype combination after vaccine introduction. Effectiveness was 53 % (95 % CI 46–60) against infection, 73 % (95 % CI, 66–78) against hospitalisation and 74 % (95 % CI, 68.0–78.0) against severe diarrhoea. Reductions in hospitalisations and mortality due to diarrhoea were observed in countries that adopted universal rotavirus vaccination.ConclusionsRotavirus vaccines are effective in preventing rotavirus-diarrhoea in children in Latin America. The vaccines were associated with changes in genotype distribution.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0173-2) contains supplementary material, which is available to authorized users.