Objective: To assess the association between D-dimer and clinical outcomes in adults with COVID-19. Methods: We reviewed published articles and preprints from MEDLINE, Cochrane Library, Cornell Open Access Publication (COAP), MedRxiv, and BioRxiv databases. We included cohort studies on the association between D-dimer and the outcomes of thromboembolism, mortality, and worsening severity among hospitalized adults with COVID-19. Results: We found 25 observational studies on the association between D-dimer and the outcomes of thromboembolism, mortality, or worsening severity. There was an increased risk of thromboembolism (OR 5.61 [95% CI 3.97, 7.94]) with higher D-dimer levels across different COVID-19 severities. D-dimer levels are associated with higher in-hospital mortality (OR 5.57 [95% CI 2.74, 11.31]) and worsening severity manifesting as critical illness (OR 1.91 [95% CI 1.05, 3.48] to 2.58 [95% CI 1.57, 4.24]), disease progression (HR 2.846 [95% CI 2.10, 3.85]), or need for mechanical ventilation (HR 3.28 [95% CI 1.07, 10.10]). However, some methodological flaws, such as incomplete laboratory or follow-up data and concern on varied D-dimer cut-offs and definitions of worsening disease, raise some uncertainty in the widespread use of D-dimer as a prognostic marker. Conclusion A higher D-dimer value is associated with worse clinical outcomes among hospitalized adults with COVID-19 and may be a useful prognostic indicator.
COVID-19

Background: Pooled data from observational studies suggest that patients with serum vitamin D levels below 30 ng/mL had an increased risk of infection and mortality from COVID-19. This rapid review aimed to determine the efficacy and safety of vitamin D as an adjunct treatment for COVID-19. Methods: We searched MEDLINE (PubMed) and CENTRAL up to July 18, 2021. We also searched trial registries, gray literature, and reference lists of included and excluded studies in the search as well as COVID-19 guidelines. Two reviewers independently screened titles and abstracts, collected data, and assessed for risk of bias. Meta-analysis was conducted, and an evidence profile table using GRADEpro was generated. Outcomes included were mortality, need for mechanical ventilator or progression of oxygen support, duration of mechanical ventilation, ICU admission, hospital length of stay, SARS-CoV-2 positivity at day 21, and adverse events. Results: We found four RCTs (3 low risk of bias and 1 high risk of bias). The sources of bias among the RCTs were unclear allocation, lack of blinding of patients, caregivers, and outcome assessors, and high drop-out rate. This rapid review found that the effects of vitamin D are inconclusive for the following outcomes: mortality (pooled RR 0.62, 95% CI [0.16 to 2.41], I2=49%; n=443, 3 RCTs, very low certainty of evidence), need for mechanical ventilator or progression of oxygen support (RR 0.52, 95% CI [0.24 to 1.13], n=237, 1 RCT, low certainty of evidence), and ICU admission (pooled RR 0.37, 95% CI [0.09 to 1.61], I2=78%; n=443, 3 RCTs, very low certainty of evidence. No significant reduction in hospital length of stay was found among those treated with vitamin D (MD 0 days, 95% CI [-1.19 to 1.09], low certainty of evidence). The duration of mechanical ventilation was also was also not significantly shortened in the treatment group (15 days) compared with placebo (12.8 days), MD 2.2 days, 95% CI [-8.4 to 12.8], low certainty of evidence. Interestingly, a higher proportion of those supplemented with vitamin D showed virologic clearance for COVID-19 on day 21 (RR 3.0, 95% CI [1.26 to 7.14], n=40, 1 RCT). At dosages between 60,000 to 200,000 IU of cholecalciferol, only one episode of vomiting (0.8%) was reported. Conclusion Based on the evidence found, we are uncertain whether vitamin D is beneficial or harmful for patients with COVID-19. There is very low certainty of evidence to recommend the use of vitamin D supplements as an adjunct treatment for patients with COVID-19. Vitamin D supplementation for patients with COVID-19 should be limited to clinical trials or among those with proven vitamin D deficiency. More published studies are awaited to explore the benefit or harm of vitamin D for COVID-19.
Vitamin D ; COVID-19 ; SARS-CoV-2 ; Therapeutics

INTRODUCTION: Chronically-ill patients are known to pose an impact on the family function (FF) and quality of life (QoL) of their family caregivers and pediatric siblings. However, there is limited literature on the relationship between FF and QoL. This study aimed to determine the correlation of FF and QoL among healthy young adults with siblings with chronic diseases. METHODS: This was an analytical cross-sectional study among young adults, selected by purposive sampling, with chronically-ill siblings. The CAPGAR and WHOQOL-BREF questionnaires were used for data collection. Spearman’s correlation coefficient r was used to determine the correlation between FF and QoL. RESULTS: More than half (53.9%) of the respondents had highly functional families. Majority of the participants (66.5%) had fair QoL. There was a weak but significant positive correlation (r = 0.27, p < 0.001) between FF and QoL. CONCLUSION There is a weak but significant positive correlation between family function and quality of life among healthy young adults with a sibling suffering from a chronic debilitating illness.
quality of life ; Siblings ;

Objective: To present the current evidence on the effect of zinc as adjunct therapy on COVID-19 related outcomes. Methods: A literature search among peer-reviewed, non-peer-reviewed, and guideline practice databases was done until December 26, 2020, with an updated search done on February 13, 2021. Evidence was synthesized among studies that fulfilled the inclusion criteria, and the quality of evidence was determined using GRADEpro. Results: This review used two randomized controlled trials and three retrospective cohort studies. Pooling of the retrospective cohort studies showed that adjunct zinc therapy significantly reduces the risk of mortality or transition to hospice care among COVID-19 patients (OR 0.56, 95% CI 0.38-0.81; I2=p=0.002; very low quality of evidence). However this was not supported by one RCT (N=191) which showed no significant difference in death (RR 0.99, 95% CI, 0.30-3.31; p=0.99], need for mechanical ventilation (RR 0.66, 96% CI, 0.19-2.26; p=0.58] and recovery after 28 days (RR 0.94, 95% CI 0.55-1.62; p=0.83) in patients with COVID-19 given zinc as adjunct treatment together with hydroxychloroquine (HCQ) and azithromycin (AZT) versus HCQ and AZT alone (moderate quality of evidence). A second RCT (N=108) showed no significant difference in the hospitalizations (RR 1.44, 95% CI 0.36, 5.71; p=0.61) and meant several days needed to reach a 50% reduction in symptoms in ambulatory patients with COVID-19 given adjunct zinc gluconate versus standard of care alone (mean difference of -0.80, 95% CI, -2.55-0.95, p=0.37; low quality of evidence). In this study, there were 10 participants in the zinc group with adverse effects, mostly gastrointestinal in origin. Conclusion There is still insufficient evidence to support the use of Zinc as an adjunct therapy in patients with COVID-19 both in inpatient and outpatient settings due to inconsistent benefits and potential adverse effects.
COVID-19 ; Coronavirus ; Zinc

Background: The benefits of infant massage in hospital and community settings have been documented in literature: better weight gain of preterm and low birthweight infants, shortened hospital stay, slightly better scores on developmental tests, fewer postnatal complications, and effects on physical and mental health. Objectives: This study described the perceptions and experiences of infant massage among caregivers of infants 2-6 months old consulting in two public health centers in Quezon City before and after infant massage training. Methods: This qualitative study assessed perceptions and experiences at baseline and after infant massage training of mothers and caregivers taking care of infants 2-6 months old. Pre-training interviews were conducted, as well as immediately after, and seven days after training on infant massage delivered by the Philippine League of Government and Private Midwives, Inc. (PLGPMI). Training consisted of lectures and demonstrations, after which mothers/caregivers gave their babies the massage under the trainer's supervision. Post-training interviews were conducted immediately after the training and seven days after. Responses to the interviews were transcribed. The transcripts and interview notes were analyzed independently by two research team members. Qualitative Content Analysis (QCA) was done. Disagreements were settled by discussion. Results: The infant’s mother was identified as the best person to perform infant massage. Infant massage was a new concept to many participants before the training. In general, the perception was positive. It was believed to promote the baby's physical development and bonding with the mother/caregiver. These same benefits were reported after the training. Post-training, all 11 participants who returned for follow-up interviews reported having massaged their babies at home. They were also able to describe the process and timing of massage as taught to them. The participants’ responses centered on seven (7) identified themes, identified at baseline and after training: 1) general concepts of infant massage, 2) benefits of infant massage, 3) methodologies, materials, and considerations, 4) persons credible to perform infant massage, 5) application/performance of infant massage, 6) intentions and 7) infant massage as a public health measure. Conclusion There was a positive perception of infant massage among mothers and caregivers of infants 2-6 months old, whether or not they had prior knowledge. The sharing of information and the training given enhanced this. Participants showed good reception and retention of infant massage's basic concepts and process and improved their confidence in handling their babies and massaging them.
Mother-Child Relations ; Caregivers ; Health Education ; Community Health Centers