Has the COVID-19 pandemic lockdown worsened eating disorders symptoms among patients with eating disorders? A systematic review

OBJECTIVE: During the coronavirus pandemic lockdowns, general medical complications have received the most attention, and few studies have examined the association between the COVID-19 lockdown and eating disorders (ED). This study aimed to investigate the impact of the coronavirus lockdowns on ED symptoms severity and summarize factors associated with lockdowns that led to changes in eating disorders. METHOD: PubMed, Scopus, and Cochrane Library databases were searched for studies measuring the impact of coronavirus lockdowns on ED symptoms. RESULTS: A total of 132 studies were retrieved, after abstract screening and removal of duplicates, 21 papers were full-text screened, and 11 eligible papers were identified. Factors associated with symptomatic deterioration in ED patients during COVID-19 lockdowns included disruption of lifestyle routine, social isolation, reduced access to usual support networks, limited or no access to healthcare and mental care services, and social anxiety. DISCUSSION: Overall, the pandemic lockdowns were associated with worsening of eating disorders. This triggering environment can lead to increased anxiety and depression symptoms, change in dietary habits, and eventually result in worsening eating disorder symptoms

Assessing the risk of angiotensin receptor blockers on major cardiovascular events: a systematic review and meta-analysis of randomized controlled trials.

Angiotensin receptor blockers (ARBs) are commonly used as a treatment for many cardiovascular diseases, but their safety has been called into question. The VALUE trial found an increased risk of myocardial infarction in participants receiving ARBs compared to other antihypertensive. The aim of the meta-analysis was to synthetize the available evidence of randomised controlled trials (RCTs) and elucidate if ARBs increase the risk of cardiovascular events. A comprehensive search was conducted to identify RCTs that assessed the safety of ARBs. Titles and abstracts of all papers were independently screened by two authors. Data extraction and quality assessment were also performed independently. The relative risk (RR) of all-cause mortality, myocardial infarction, and stroke were pooled using the IVhet model. Multiple sensitivity analyses were conducted to assess the effect of ARBs by restricting the analysis to different participants' characteristics. Forty-five RCTs comprising of 170,794 participants were included in the analysis. The pooled estimates revealed that ARBs do not increase the risk of all-cause mortality (RR 1.00; 95%CI 0.97-1.04), myocardial infarction (RR 1.01; 95%CI 0.96-1.06), and stroke (RR 0.92; 95%CI 0.83-1.01). The sensitivity analysis did not yield a particular group of patients at increased risk of cardiovascular events with ARBs. Risk of all-cause mortality and stroke decreased with ARB when the proportion of smokers in a population was < 25% (RR 0.91; 95%CI 0.84-0.98) and in females (RR 0.76; 95%CI 0.68-0.84), respectively. ARBs do not increase the risk of major cardiovascular events and are safe for use in patients

Risk of wheezing and asthma exacerbation in children treated with paracetamol versus ibuprofen: a systematic review and meta-analysis of randomised controlled trials

Background Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of wheezing and asthma among children taking paracetamol compared to ibuprofen, remain unsettled. Methods We conducted a meta-analysis of randomized controlled trials (RCTs) that compared wheezing and asthma exacerbations in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of wheezing or asthma exacerbations in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the Peto’s odds ratio. Results Five RCTs with 85,095 children were included in the analysis. The pooled estimate (OR 1.05; 95%CI 0.76–1.46) revealed no difference in the odds of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma exacerbation or wheezing, the pooled estimate remained similar (OR 1.01; 95%CI 0.63–1.64). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84–1.28). Conclusion Although, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma exacerbations in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive findingThe publication of this article was funded by the Qatar National Library. The funding body had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript

Drug-free holidays: Compliance, tolerability, and acceptability of a 3-day atovaquone/proguanil schedule for pre-travel malaria chemoprophylaxis in Australian travellers

Background Poor compliance with chemoprophylaxis is a major contributing factor to the risk of malaria in travellers. Pre-travel chemoprophylaxis may improve compliance by enabling ‘drug-free holidays’. The standard treatment dose of atovaquone/proguanil (250mg/100mg, 4 tablets/day for 3 days) provides protection against malaria for at least 4 weeks, and could therefore potentially be used for pre-travel chemoprophylaxis. In this study, we assessed the compliance, tolerability, and acceptability of the 3-day atovaquone/proguanil schedule for malarial chemoprophylaxis. Methods 233 participants were recruited from four specialised travel medicine clinics in Australia. Adults travelling to malaria-endemic areas with low/medium risk for ≤4 weeks were enrolled, and prescribed the 3-day schedule of atovaquone/proguanil, completed at least one day before departure. Questionnaires were used to collect data on demographics, travel destination, medication compliance, side effects, and reasons for choosing the 3-day schedule. The study was registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12616000640404 Results Overall, 97.7% of participants complied with the 3-day schedule. Although side effects were reported in 43.3% of the participants, these were well tolerated, and mainly occurred during the first and second day. None of the participants developed malaria. The main reasons for choosing the 3-day schedule over standard chemoprophylaxis options were that it was easier to remember (72.1%), required taking fewer tablets (54.0%), and to help scientific research (54.0%). Conclusions The 3-day atovaquone/proguanil schedule had an impressively high compliance rate, and was well tolerated and accepted by travellers. Further studies are required to assess the effectiveness of this schedule for chemoprophylaxis in travellers.C. L. L. was supported by a fellowship from the Australian National Health and Medical Research Council (grant number 1109035). This study was conducted as part of everyday clinical practice, and participants or their employers paid for the medications

Optimising systemic insecticide use to improve malaria control.

BACKGROUND: Long-lasting insecticidal nets and indoor residual sprays have significantly reduced the burden of malaria. However, several hurdles remain before elimination can be achieved: mosquito vectors have developed resistance to public health insecticides, including pyrethroids, and have altered their biting behaviour to avoid these indoor control tools. Systemic insecticides, drugs applied directly to blood hosts to kill mosquitoes that take a blood meal, offer a promising vector control option. To date, most studies focus on repurposing ivermectin, a drug used extensively to treat river blindness. There is concern that overdependence on a single drug will inevitably repeat past experiences with the rapid spread of pyrethroid resistance in malaria vectors. Diversifying the arsenal of systemic insecticides used for mass drug administration would improve this strategy's sustainability. METHODS: Here, a review was conducted to identify systemic insecticide candidates and consolidate their pharmacokinetic/pharmacodynamic properties. The impact of alternative integrated vector control options and different dosing regimens on malaria transmission reduction are illustrated through mathematical model simulation. RESULTS: The review identified drugs from four classes commonly used in livestock and companion animals: avermectins, milbemycins, isoxazolines and spinosyns. Simulations predicted that isoxazolines and spinosyns are promising candidates for mass drug administration, as they were predicted to need less frequent application than avermectins and milbemycins to maintain mosquitocidal blood concentrations. CONCLUSIONS: These findings will provide a guide for investigating and applying different systemic insecticides to achieve more effective and sustainable control of malaria transmission

The effect of right ventricular apical and non-apical pacing on the short- and long-term changes in left ventricular ejection fraction: a systematic review and meta-analysis of randomized-controlled trials

BACKGROUND The right ventricular apex (RVA) is the traditional lead site for chronic pacing but in some patients may cause impaired left ventricular (LV) systolic function over time. Comparisons with non-apical (RVNA) pacing sites have generated inconsistent results and recent meta-analyses have demonstrated unclear benefit due to heterogeneity across studies. METHODS AND RESULTS A systematic search for randomized controlled trials that compared LVEF outcomes between RVNA and RVA pacing was performed up to October 2014. Twenty four studies (n = 1628 patients) met the inclusion criteria. To avoid between study heterogeneity two homogenous groups were created; group one where studies reported a difference (in favor of RVNA pacing) and group two where studies reported no difference between pacing sites. For group one weighted mean difference (WMD) between RVNA and RVA pacing in terms of LVEF at follow-up was 5.40% (95% CI: 3.94 to 6.87), related in part to group one's RVA arm demonstrating a significant reduction (mean loss -3.31%; 95% CI: -6.19 to -0.43) in LVEF between study baseline and end of follow-up. Neither of these finding were seen in group two. Weighted regression modeling demonstrated that inclusion of poor baseline LVEF (<40%) in combination with greater than 12 months follow-up was three times more common in group one compared to group two (weighted RR 2.82; 95% CI 1.03 - 7.72; P = 0.043). CONCLUSIONS In patients requiring chronic right ventricular pacing where there is inclusion of impaired baseline LVEF (<40%), RVA pacing is associated with deterioration in LV function relative to RVNA pacing. This article is protected by copyright. All rights reserved

Medical and psychological problems faced by young Australian gap year travellers

Background: Gap year travellers can potentially be exposed to many infectious diseases and other travel-related health problems including injuries and psychological problems. Currently, there is little information on health and wellbeing of this particular group of travellers. Methods: Participants were recruited from an organization that specialized in organising international gap year placements. Gap year travellers were asked to complete a pre-departure survey on demographics, placement destination and duration, previous travel experience, hobbies, risk taking behaviour, anticipated problems during the placement, and pre-travel preparations. After the placement, participants were asked to complete a post-trip survey on their experiences, problems, health issues, and medical treatment required. Results: The 88 and 34 gap year travellers aged 17–23 years completed pre- and post-placement surveys respectively. The duration of placements ranged from 3 to 12 months. Psychological stressors were frequently reported [n = 26 (76.5%) felt home sick; n = 18 (52.9%) experienced culture shock; n = 17 (50.0%) had difficulty communicating with the locals]. The majority of participants (91.2%) tried to work out a solution for the stressor on their own. Twenty-eight (82.4%) participants reported medical problems during their placement; the most common problems were sunburn (n = 19; 55.9%), respiratory infections (n = 15; 44.1%), weight change (n = 14; 41.2%), and diarrhoea/food poisoning (n = 13; 38.2%). Three participants (3.4%) were admitted to hospital; for a muscle injury, head injury and skin infection after getting a tribal tattoo. Conclusions: Psychological stressors were common, but most did not seek help. Some medical problems encountered during their placement may have been preventable with improved pre-departure preparation.C.L. was funded by an National Health and Medical Research Council Early Career Fellowship (1109035)

Hospital effect on infections after four major surgeries: Outlier and volume-outcome analysis using all-inclusive state data

Hospital volume is known to have a direct impact on outcomes of major surgeries. However, it is unclear if the evidence applies specifically to surgical site infections. To determine if there are procedure-specific hospital outliers (with higher surgical site infection rates [SSIR]) for four major surgical procedures, and to examine if hospital volume is associated with SSIR in the context of outlier performance in New South Wales (NSW), Australia. Adults who underwent one of four surgical procedures (colorectal, joint replacement, spinal and cardiac procedures) at a NSW healthcare facility from 2002 through 2013 were included. The hospital volume for each of the four surgical procedures was categorised into tertiles (low, medium and high). Multivariable logistic regression models were built to estimate the expected SSIR for each procedure. The expected SSIR were used to compute an indirect standardised SSIR which was then plotted in funnel plots to identify hospital outliers. One hospital was identified to be an overall outlier (higher SSIR for 3 out of the 4 procedures performed in its facilities); whereas two hospitals were outliers for one specific procedure throughout the entire study period. Low-volume facilities performed the best for colorectal surgery and worst for joint replacement and cardiac surgery. One high-volume facility was an outlier for spinal surgery. Surgical site infections seem to be mostly a procedure-specific as opposed to a hospital-specific phenomenon in NSW. The association between hospital volume and SSIRs differs for different surgical procedures.ACAC is funded by an Australian National Health and Medical Research Council Senior Research Fellowship (#1058878)