1.
Antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin usage in 1142 patients with coronavirus disease 2019: a systematic review and meta-analysis
Pei L, Zhang S, Huang L, Geng X, Ma L, Jiang W, Li W, Chen D
Pol Arch Intern Med. 2020
Abstract
INTRODUCTION Treatment effects of antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin are controversial in patients with Coronavirus disease 2019 (COVID-19). OBJECTIVES To evaluate the impact of drug therapy on the risk of death in patients with COVID-19. PATIENTS AND METHODS The PubMed, EMBASE, Web of Science, Cochrane Library, and major preprint platforms were searched to retrieve articles till 7 April 2020. The effects of specific drug interventions on mortality were assessed in COVID-19 patients. Odds ratios (ORs) and Risk Ratios (RRs) with corresponding 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS Of 3421 references, six studies were included. Pooled results from retrospective studies revealed that antiviral agents may contribute to survival benefit (OR, 0.42, 95% CI, 0.17-0.99, p=0.048, I2=82.8%), while the RCT found no effects of antiviral agent on mortality (RR 0.77, 95% CI, 0.45-1.30, p=0.33). Glucocorticoids usage leads to an increased risk of death (OR 2.43, 95% CI, 1.44-4.10, p=0.001, I2=61.9%). Antibiotics intervention did not significantly affect mortality (OR 1.13, 95% CI, 0.67-1.89, p=0.64, I2=0%). Likewise, intravenous immunoglobulin had non-significant effects on mortality (OR 2.66, 95% CI, 0.72-9.89, p=0.14, I2=93.1%). CONCLUSIONS With the varied heterogeneities across interventions, the current evidence indicated a probable survival benefit of antiviral agent usage and a harmful effect of glucocorticoids in patients with COVID-19. None of antibiotics or intravenous immunoglobulin usage was associated with survival benefit in patients with COVID-19.
2.
Autologous platelet-rich gel treatment for diabetic chronic cutaneous ulcers: a meta-analysis of randomized controlled trials
Li Y, Gao Y, Gao Y, Chen D, Wang C, Liu G, Yang X, Ran X
Journal of Diabetes. 2018
Abstract
BACKGROUND Recent years, many studies have reported that autologous platelet-rich gel (APG) is an effective adjunctive method to promote chronic cutaneous ulcers in diabetics. The aim of the present study was to explore the efficacy and safety of APG for the topical treatment of diabetic chronic cutaneous ulcers. METHODS The Chinese CBM, CNKI, VIP, Wanfang databases, Cochrane Library databases, EBSCOhost, Embase and PubMed on October 18, 2017 were systematically searched. The fixed/random-effect models were used to calculate the risk ratio (RR)/odds ratio (OR)/mean difference (MD) with the 95% confidence interval (95%CI) as the effect analysis statistics. Subgroup analyses were conducted according to the Diabetic Foot Wagner Classification. RESULTS Fifteen RCTs with 829 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG significantly improved the healing rate (RR=1.39, 95% CI 1.29 to 1.50, P < 0.00001), shortened the healing time (MD= -9.18, 95% CI -11.32 to -7.05, P < 0.00001), reduced the incidence of infection (OR= 0.34, 95% CI 0.15 to 0.77, P = 0.009). CONCLUSIONS Current evidence suggests that APG is effective and safe, and it's probable to be used as an adjuvant treatment for diabetic ulcers, especially for the chronic refractory ulcers. But more RCTs with good design and high quality are needed before it can be implemented widely.