Assessment and management of asymptomatic COVID-19 infection: A systematic review

Abstract

Background COVID-19 can be asymptomatic in a substantial proportion of patients. The assessment and management of these patients constitute a key element to stop dissemination. Aim To describe the assessment and treatment of asymptomatic infection in patients with a confirmed diagnosis of COVID-19. Methods We searched five databases and search engines for preprints/preproofs, up to August 22, 2020. We included cohort, cross-sectional, and case series studies, reporting the assessment and management of asymptomatic individuals. We extracted data on total discharges with negative PCR, length of hospitalization, treatment, and number of patients who remained asymptomatic. A random-effects model with inverse variance method was used to calculate the pooled prevalence. Results 41 studies (nine cross-sectional studies, five retrospective studies and 27 reports/case series; 647 asymptomatic individuals), were included, of which 47% were male (233/501). The age of patients was between 1month and 73 years. In patients who became symptomatic, length of hospitalization mean was 13.6 days (SD 6.4). Studies used lopinavir/ritonavir, hydroxychloroquine plus ritonavir/lopinavir, hydroxychloroquine with and without azithromycin, ribavirin plus interferon and interferon alfa. The proportion of individuals who remained asymptomatic was 91% (463/588 patients; 95%CI: 78.3%–98.7%); and asymptomatic individuals discharged with negative PCR was 86% (102/124 individuals; 95%CI: 58.4%–100%). Conclusions There is no standard treatment for asymptomatic COVID-19 individuals. There are no studies of adequate design to make this decision. It has been shown that most asymptomatic individuals who were followed have recovered, but this cannot be attributed to standard treatment.

Cytokine response over the course of COVID-19 infection in pregnant women

“…This may be related to the link between IL-18 and IP-10 via IFNγ. As mentioned earlier, the majority of young or pregnant patients are asymptomatic, not just pre-symptomatic [56] , [58] , which may affect the generalizability of earlier studies which used symptom onset to define temporal response. By assessing cytokine levels according to serology status, researchers may be able to stratify the immune response to SARS-CoV-2 for all infected patients.…”

Efficacy of Liraglutide in Non-Diabetic Obese Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Most of the included studies had a follow-up time longer than 17 weeks, and our subgroup analyses showed no difference between shorter and longer follow up times. Third, the risk of bias in most studies was high, which may compromise the true effect of most of the outcomes described, as in other studies that applied meta-analysis with included studies and high risk of bias [ 31 , 32 , 33 , 34 ]. Finally, in the evaluation of the QoE using GRADE methodology, we found low and very low quality of evidence for most outcomes, which should be considered when interpreting the significant effects that may favor the treatment.…”

Síndrome de kawasaki en la población pediátrica por covid -19. Artículo de revisión

“…La elevación de los reactantes de fase aguda, como la velocidad de sedimentación globular (VSG) y la proteína C reactiva (PCR), está siempre presente y se considera un criterio clave, especialmente en los casos de EK "incompleta". El EK se asocia con altos niveles de varias citoquinas, tales como IL-2, IFN-y, IL-6, e IL-8 (Barboza et al, 2022) La trombocitosis puede ser impresionante y presentarse con picos de hasta 700 × 103/mL. También es frecuente la piuria estéril.…”