Effect of Hydroxychloroquine and Azithromycin Combination Use in COVID-19 Patients - An Umbrella Review

Background

Hydroxychloroquine and Azithromycin combination was used rampantly in management of COVID-19 patients in different countries. Present review was conducted to evaluate the efficacy of Hydroxychloroquine and Azithromycin combination compared to the control (standard care) and any adverse effect following this combination use in COVID-19 patients if any.

Material and Methods

We included all the systematic review with or without meta-analysis reporting the effect of Hydroxychloroquine (HCQ) and Azithromycin (AZM) combination use in COVID-19 patient using three databases namely PubMed, medline, CINHAL, Web of Science from July 2020 till Jan 2022.

Results

The systematic search strategy has identified 104 studies in total, after removal of duplicates only 4 systematic reviews were included in the qualitative synthesis. The various tools for assessing and reporting the data in the reviews were PRISMA, ROBINS-I, Robs2, AMSTAR, MASTER checklists. Mortality among the hydroxychloroquine with azithromycin combination group was significantly higher than among the Standard Care group. The duration of hospital stay in days was shorter in the Standard Care group in comparison with the hydroxychloroquine group or the hydroxychloroquine and azithromycin combination group. Of the 4 systematic reviews included, 3 had low risk of bias and one had unclear risk of bias using the ROBIS tool. Chloroquine or Hydroxychloroquine combination did not shorten the duration of hospital stay.

Conclusion

Rampant use of Chloroquine or Hydroxychloroquine alone or with Azithromycin combination caused adverse effects like QT prolongation. Finally, there is no evidence to support use of either Hydroxychloroquine with or without Azithromycin, for the treatment of COVID-19.

Isolated choroid plexus cysts and health and developmental outcomes in childhood and adolescence - A systematic review

OBJECTIVES

Choroid plexus cysts (CPCs) are incidental findings on ultrasound examination of the fetal brain. It is not known if isolated CPCs are associated with any adverse health or neurodevelopmental outcomes during the life course. This systematic review aimed to collate and synthesize the evidence on whether or not isolated choroid plexus cysts are associated with an increased risk of adverse health or developmental outcomes during childhood and adolescence.

METHODS

A search strategy was developed specifically for this study and applied to four electronic databases Medline (Ovid), Embase (Ovid), Web of Science, and Google Scholar. Studies were assessed and selected for inclusion if there was a measurement of CPC (including single or multiple; unilateral or bilateral; isolated or presenting alongside other markers) during the antenatal or early neonatal period (<7 days) with follow-up of children and adolescents for health and developmental outcomes measured at any time from age 1 month onwards. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Due to heterogeneity in the types of outcome measures included and the timing of measurement of outcomes across the studies, it was not possible to pool data across studies and a narrative description of findings was presented.

RESULTS

Eight studies (three cohorts and five case series) met the inclusion criteria. Different methods were used for outcome assessment, such as in-person assessment, parent questionnaires, medical records, and telephone interviews with parents. Six studies measured outcomes only once during the specified duration of follow-up; two studies carried out paediatric reviews of the children several times during follow-up. There were no differences in developmental outcomes or physical health between babies with CPCs reported in the three cohort studies, and no abnormalities were detected in the children that were followed up in four of the five case series studies. Most of the included studies were graded as low quality due to the small sample size, high risk of selection bias, unclear definitions of CPC or lack of a comparison group.

CONCLUSIONS

The studies conducted to date do not provide evidence of adverse physical health outcomes or neurodevelopmental delays in babies with CPCs. However, most of these studies were small and included a narrow range of outcomes. Further research is needed to explore the relative incidence of outcomes such as ASD, ADHD, epilepsy and educational attainment in children with CPCs.

Prevalence of Polycystic Ovarian Syndrome in India: A Systematic Review and Meta-Analysis

Stein-Leventhal syndrome, often known as polycystic ovarian syndrome (PCOS), is a syndrome that affects women's reproductive health. PCOS is one of the most common endocrine and metabolic disorders in women of reproductive age. The etiology of PCOS remains unknown mainly, and the estimation of PCOS burden in a specific geographical location will impact disease control strategies. Hence, this study estimated the pooled prevalence of PCOS in Indian women. Databases such as PubMed, CINHAL, Scopus, and Google Scholar were thoroughly searched. Only those published Indian studies that reported the prevalence of PCOS from 2010 to 2021 and had at least one of the following diagnostic PCOS criteria were included in the systematic review: the National Institutes of Health (NIH), Rotterdam's criteria, or/and Androgen Excess Society (AES). MetaXL version 5.3 software was used for data analysis. The risk of bias was assessed using modified Joanna Briggs Institute criteria for cross-sectional studies. Out of 17132 articles, 11 articles were selected for systematic review and meta-analysis. The pooled prevalence of PCOS was 11.33(7.69-15.59) using the random effect. The proportion of Hirsute using the Ferriman-Gallwey score was highly variable, ranging from 1.6% to 37.9% (n=6). The prevalence rate of PCOS is high among Indian women. The pooled prevalence of PCOS was close to 10% using Rotterdam's criteria and AES criteria, while it was 5.8% using NIH criteria. The study's overall finding emphasizes the need for more acceptable and uniform diagnostic criteria for screening PCOS. At the same time, policy-makers should consider giving more importance to PCOS in their effort to control non-communicable diseases.

Role of environmental lead in the occurrence of anemia in Indian children: a systematic review and meta-analysis

Exposure to lead among children, as well as adults, is a major global health issue. With diverse routes of exposure (e.g., food, air, and water) either environmentally or occupationally, lead among children can cause mild, moderate, to severe health complications in the later stages of life. The average blood lead level reported by CDC in 2021 is 3.5 µg/dL, and the level of blood lead toxicity is ≥ 10 μg/dL. In this study, we planned to systematically analyze the association between blood lead levels (BLLs) (≥ 10 μg/dL and < 10 μg/dL) and the risk of anemia (hemoglobin level < 11 g/dL) among Indian children aged between ≥ 1 and ≤ 18 years. An online literature search of 5 databases, PubMed, Ovid, EMBASE, Web of Science, and Google Scholar was accomplished with a search updated until 8^th March 2021. Study designs included cohort, cross-sectional, and case-control studies that have evaluated the association of lead toxicity or exposure with anemia (Hb < 11 g/dL) reported in urban and/or rural Indian children. Meta-analysis was performed among a total of 864 children from 4 cross-sectional studies. The association between lead toxicity (BLLs ≥ 10 μg/dL) and the risk of being anemic was not statistically significant (RR = 1.15 (95% CI: 0.86-1.55, I² = 77%). The risks of bias in all included studies were low according to the Newcastle Ottawa Scale. Increased blood lead levels did not appear to be the major contributor to anemia in Indian Children. We need to focus primarily on improving the nutritional quality, fortified food supplements, and a balanced diet for children to reduce the anemia burden in India. Lead toxicity should be sought as an etiological factor only in areas of high environmental risk factors which were leaded paints, leaded batteries, a house near major road/traffic areas, and pesticide exposure.

Soil as a tool of revelation in forensic science: a review

Soil contains diverse and complex natural elements having physical, chemical, mineralogical and biological components. Soil being a transferable physical component (it can be transferred from one location to another with the help of shoes, tires, clothes, tools etc.), acts as a tool of forensic investigation to correlate a specific crime scene with criminal suspects. A variety of techniques and combinations of methods can be used to discriminate soil from different geographical locations. The present review highlights various analytical techniques (ATR-FTIR, pyGC-MS, SEM-EDX, ICP-MS/OES and XRD) for soil analysis (colour comparison, texture and particle size determination, density gradient methods and organic matter estimation) and discusses some of the famous cases solved with soil trace evidence. The objective of the present study is to provide an overview of the importance of soil as physical evidence in forensic science based on literature analysis that will help forensic scientists and researchers to select appropriate methods to discriminate different soil samples. This article reviews various analytical techniques used to differentiate soils and provides compiled information regarding soil as trace evidence in order to help academicians, researchers and forensic soil scientists.

A data-based study in support of Blackbuck related cases from Haryana

Haryana State (located in the northern part of India), is lacking in natural forest, but it has rich biodiversity of some wild animals, especially the Blackbuck antelopes. The maximum population of Blackbucks in the state is living in open cultivated fields. Blackbucks were once found abundantly throughout Haryana, but now they are limited to the south–west part of the state, driven almost to extinction in the rest of Haryana, mainly because of habitat destruction and wildlife crime. This data report is an outcome of six years (January 2012–September 2017), based on assessment of records in terms of location, year and month wise frequency of death and rescued cases related to Blackbuck reported, as registered by the State Wildlife Department. It is envisioned that this data report will provide appropriate information for the conservationist to plan future conservation strategy for Blackbucks in Haryana.

A Wildlife Forensic Study for the Species Identification of Indian Blackbuck through Forensically Informative Nucleotide Sequencing (FINS)

Identification of exhibits obtained in wildlife cases usually presents challenging tasks for the forensic science investigators. This study describes a casework, where a degraded tissue sample was recovered from pathology department LUVAS University Hisar, Haryana to resolve the identity of the questioned sample. The mitochondrial DNA region of the questioned sample was amplified and sequenced using universal primers of cytochrome b gene to determine the forensically informative nucleotide sites to find the species identity. The obtained sequencing results were compared with the most homologous sequences extracting from NCBI-GenBank database and a phylogenetic tree was done with the aligned sequences to determine the species identity with strong bootstrap support. The informative sites generated revealed that the degree of sequence similarity showed maximum homology (100%) with the sequence obtained from the database. Based on the FINS analysis the recovered sample related to Antilope cervicapra (family Bovidae).

Development and Experimental Validation of A Handheld Noninvasive Sensor for the Measurement of Compartment Pressures

Compartment syndrome is a major concern in cases of extremity trauma, which occur in over 70% of military combat casualty. Without treatment, compartment syndrome can lead to paralysis, loss of limb, or death. This paper focuses on the development of a handheld sensor that can be used for the noninvasive diagnosis of compartment syndrome. Analytical development of the sensing principle is first presented in which a relation is obtained between the pressure in a fluid compartment and the stiffness experienced by a handheld probe pushing on the compartment. Then a handheld sensor that can measure stiffness of an object without requiring the use of any inertial reference is presented. The handheld sensor consists of an array of three miniature force-sensing spring loaded pistons placed together on a probe. The center spring is chosen to be significantly stiffer than the side springs. The ratio of forces between the stiff and soft springs is proportional to the stiffness of the soft object against which the probe is pushed. Small millimeter-sized magnets on the pistons and magnetic field measurement chips are used to measure the forces in the individual pistons. Experimental results are presented using both an in vitro pneumatic test rig and a compliant agarose gel chamber that replicates a fluid pressure compartment. The sensor is shown to measure pressure accurately with a resolution of 0.1 psi over the range 0.75–2.5 psi. The developed sensor has the potential to be useful for convenient handheld diagnosis of compartment syndrome in traumatic extremity injuries.

Subclinical left ventricular abnormalities in young diabetics

Twenty young asymptomatic diabetic patients were evaluated for left ventricular dysfunction by determining the radionuclide ejection fraction response to supine bicycle ergometry. The double product at peak exercise (28,743 +/- 3,314 vs 29,007 +/- 3,625, p greater than .05) was not significantly different between the two groups. Seven of 20 diabetics had either no change or a drop in their ejection fraction during exercise while 1 of 20 control subjects had no change in ejection fraction. There was no correlation between the FBS (r = .26) and HbA1c (r = .32) and ejection fraction change during exercise, although those diabetics with LV dysfunction tended to have a higher HbA1c level as compared to diabetics with a normal response (16.8 +/- 3.1 percent vs 12.5 +/- 3.8 percent respectively, p greater than .05). The LV systolic dysfunction in young asymptomatic diabetic subjects does not appear to correlate with the degree of acute or chronic hyperglycemia, and therefore, is not a direct function of the dynamic metabolic state of diabetes.

Genital edema in patients on continuous ambulatory peritoneal dialysis. Report of 3 cases and review of the literature

Severe genital edema is a well-described complication of continuous ambulatory peritoneal dialysis (CAPD). Leakage of dialysate fluid from defects in the peritoneum may occur from clinically detectable and undetectable inguinal hernias, defects at the catheter insertion site, or other defects in the peritoneal membrane. We describe 3 patients (who underwent five surgical procedures), illustrating the complexity of the problem. In 2 patients, unsuccessful surgical repairs (1 catheter replacement, 1 hernia repair) were performed based on misleading radiologic findings using intraperitoneal contrast without computerized tomography (CT) scanning. The use of CT scanning with intraperitoneal contrast led to the correct diagnosis and prompt surgical correction in both patients so studied. One patient had leakage from a clinically undetectable inguinal hernia, and the other had a peritoneal defect at the Tenckhoff insertion site which was only demonstrated following a period of upright posture with a 3-liter exchange. Our experience and a review of the literature convinces us that a CT scan of the abdomen utilizing radiocontrast material added to the dialysate accurately identifies the site of leakage in CAPD patients who develop genital edema. Thus, the CT scan can help avoid unnecessary surgery and prolonged hospitalization in CAPD patients who develop genital edema.