Systematic reviews and/or meta-analyses generally provide the best evidence for medical research. Authors are recommended to use flow diagrams to present the review process, allowing for better understanding among readers. However, no studies as of yet have assessed the quality of flow diagrams in systematic review/meta-analyses. Our study aims to evaluate the quality of systematic review/meta-analyses over a period of ten years, by assessing the quality of the flow diagrams, and the correlation to the methodological quality. Two hundred articles of “systematic review” and/or “meta-analysis” from January 2004 to August 2015 were randomly retrieved in Pubmed to be assessed for the flow diagram and methodological qualities. The flow diagrams were evaluated using a 16-grade scale corresponding to the four stages of PRISMA flow diagram. It composes four parts: Identification, Screening, Eligibility and Inclusion. Of the 200 articles screened, 154 articles were included and were assessed with AMSTAR checklist. Among them, 78 articles (50.6%) had the flow diagram. Over ten years, the proportion of papers with flow diagram available had been increasing significantly with regression coefficient beta = 5.649 (p = 0.002). However, the improvement in quality of the flow diagram increased slightly but not significantly (regression coefficient beta = 0.177, p = 0.133). Our analysis showed high variation in the proportion of articles that reported flow diagram components. The lowest proportions were 1% for reporting methods of duplicates removal in screening phase, followed by 6% for manual search in identification phase, 22% for number of studies for each specific/subgroup analysis, 27% for number of articles retrieved from each database, and 31% for number of studies included in qualitative analysis. The flow diagram quality was correlated with the methodological quality with the Pearson’s coefficient r = 0.32 (p = 0.0039). Therefore, this review suggests that the reporting quality of flow diagram is less satisfactory, hence not maximizing the potential benefit of the flow diagrams. A guideline with standardized flow diagram is recommended to improve the quality of systematic reviews, and to enable better reader comprehension of the review process.

Since warning signs and signs of severe dengue are defined differently between studies, we conducted a systematic review on how researchers defined these signs. We conducted an electronic search in Scopus to identify relevant articles, using key words including dengue, "warning signs," "severe dengue," and "classification." A total of 491 articles were identified through this search strategy and were subsequently screened by 2 independent reviewers for definitions of any of the warning or severe signs in the 2009 WHO dengue classification. We included all original articles published in English after 2009, classifying dengue by the 2009 WHO classification or providing the additional definition or criterion of warning signs and severity (besides the information of 2009 WHO). Analysis of the extracted data from 44 articles showed wide variations among definitions and cutoff values used by physicians to classify patients diagnosed with dengue infection. The establishment of clear definitions for warning signs and severity is essential to prevent unnecessary hospitalization and harmonizing the interpretation and comparability of epidemiological studies dedicated to dengue infection.

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In this study, we aim to assess the association of dengue viremia with dengue severity. The study protocol was developed and registered in PROSPERO (CRD42016039864). We searched nine databases to find potential papers. Studies meeting the inclusion criteria were included. We, based our analysis on three outcomes which are disease severity, dengue serotype and disease infection type. Thirty studies with 3316 patients were included. Our analysis revealed that viremia is significantly higher in dengue hemorrhagic fever patients than dengue fever in days 5 to 6. Regarding the serotype of dengue, the maximum viremia titre of serotype 1 was significantly higher than serotype 3 and the viremia in dengue serotype 2 was significantly higher than serotype 4 in days 2 to 4. However, comparison of the daily viremia level between the primary and secondary dengue infection revealed that secondary infection was

Background/Objective. Since the start of the pandemic, COVID-19 has been associated with several postinfection complications. Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid that has been reported in the literature following COVID-19 infection. We report a case of SAT following COVID-19 infection. Case Report. A 33-year-old female presented with neck pain two weeks after resolution of COVID-19 infection. Her thyroid function tests together with ultrasonographic pictures were consistent with SAT. She was treated with three rounds of medrol dose pack without relief. She then required oral prednisone 40 mg per day and ibuprofen 800 mg once daily for another several weeks that eventually resulted in improvement of her symptoms. Discussion. SAT most commonly occurs in females during or after viral infection. The usual course of the disease is hyperthyroidism then hypothyroidism followed by resolution. SAT is clinically diagnosed by lab findings of decreased TSH in the setting of negative thyroid-stimulating and thyroid peroxidase antibodies. All these data are consistent with our case. Conclusion. SAT following COVID-19 infection presents with a similar clinical presentation and course as the classic form of SAT, but we should consider the fact that a high-dose corticosteroid treatment might be necessary for such patients.