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1.
Laryngo- Rhino- Otologie ; 101:S321, 2022.
Article in English | EMBASE | ID: covidwho-1967683

ABSTRACT

Unquestionably the SARS-CoV-2 pandemic has become the biggest health concern globally for the past two years and an end to it is not in sight. The disease has a plethora of clinical features, but we decided to concentrate on a particular one-anosmia. The aim of this paper is to give a general introduction of the symptom-its prevalence, diagnostic significance, clinical outlines, management issues and financial and quallity of life impact and share our own experience managing 52 patients with similar symptoms using intranasal or oral corticosteroids and olfactory training. A comprehensive search was conducted using several electronic databases extracting relevant information regarding Covid-19 positive patients with anosmia. The included studies were published between March 2021 and October 2021. We found out that Covid-associated loss of smell is more frquent in females and an age under the age of 30. Ressolution of long term anosmia is achieved in over 80 % of cases. As newer information shines light on this topic it gives a better understanding of the pandemic. Introducing it in the general clinical presentation may help to curb the pandemic progression and present an understanding of long-term consequences of Covid-19.

2.
Am J Med ; 2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1956061

ABSTRACT

BACKGROUND: We systematically assessed beneficial and harmful effects of monoclonal antibodies for COVID-19 treatment, and prophylaxis in exposed to SARS-CoV-2. METHODS: We searched five engines and three registries until November 3, 2021 for randomized controlled trials evaluating monoclonal antibodies vs. control in hospitalized or non-hospitalized adults with COVID-19, or as prophylaxis. Primary outcomes were all-cause mortality, COVID-19 related death, and serious adverse events; hospitalization for non-hospitalized; and development of symptomatic COVID-19 for prophylaxis. Inverse variance random effects models were used for meta-analyses. GRADE methodology was used to assess certainty of evidence. RESULTS: Twenty-seven randomized controlled trials were included: 20 in hospitalized (n=8253), five in non-hospitalized (n=2922), and two in prophylaxis (n=2680). In hospitalized patients, monoclonal antibodies slightly reduced mechanical ventilation (relative risk [RR] 0.74, 95%CI 0.60-0.9, I2=20%, low certainty of evidence) and bacteremia (RR 0.77, 95%CI 0.64-0.92, I2=7%, low certainty of evidence); evidence was very uncertain about the effect on adverse events (RR 1.31, 95%CI 1.02-1.67, I2=77%, very low certainty of evidence). In non-hospitalized patients, monoclonal antibodies reduced hospitalizations (RR 0.30, 95%CI 0.17-0.53, I2=0%, high certainty of evidence) and may slightly reduce serious adverse events (RR 0.47, 95%CI 0.22-1.01, I2=33%, low certainty of evidence). In prophylaxis studies, monoclonal antibodies probably reduced viral load slightly (Mean difference [MD] -0.8 log10, 95%CI -1.21 to -0.39, moderate certainty of evidence). There were no effects on other outcomes. CONCLUSIONS: Monoclonal antibodies had limited effects on most of the outcomes in COVID-19 patients, and when used as prophylaxis. Additional data is needed to determine their efficacy and safety.

3.
PLoS One ; 17(6): e0269368, 2022.
Article in English | MEDLINE | ID: covidwho-1879321

ABSTRACT

INTRODUCTION: We systematically assessed benefits and harms of tocilizumab (TCZ), which is an antibody blocking IL-6 receptors, in hospitalized COVID-19 patients. METHODS: Five electronic databases and two preprint webpages were searched until March 4, 2021. Randomized controlled trials (RCTs) and inverse probability treatment weighting (IPTW) cohorts assessing TCZ effects in hospitalized, COVID-19 adult patients were included. Primary outcomes were all-cause mortality, clinical worsening, clinical improvement, need for mechanical ventilation, and adverse events (AE). Inverse variance random-effects meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology. RESULTS: Nine RCTs (n = 7,021) and nine IPTW cohorts (n = 7,796) were included. TCZ significantly reduced all-cause mortality in RCTs (RR 0.89, 95%CI 0.81-0.98, p = 0.03; moderate QoE) and non-significantly in cohorts (RR 0.67, 95%CI 0.44-1.02, p = 0.08; very low QoE) vs. control (standard of care [SOC] or placebo). TCZ significantly reduced the need for mechanical ventilation (RR 0.80, 95%CI 0.71-0.90, p = 0.001; moderate QoE) and length of stay (MD -1.92 days, 95%CI -3.46 to -0.38, p = 0.01; low QoE) vs. control in RCTs. There was no significant difference in clinical improvement or worsening between treatments. AEs, severe AEs, bleeding and thrombotic events were similar between arms in RCTs, but there was higher neutropenia risk with TCZ (very low QoE). Subgroup analyses by disease severity or risk of bias (RoB) were consistent with main analyses. Quality of evidence was moderate to very low in both RCTs and cohorts. CONCLUSIONS: In comparison to SOC or placebo, TCZ reduced all-cause mortality in all studies and reduced mechanical ventilation and length of stay in RCTs in hospitalized COVID-19 patients. Other clinical outcomes were not significantly impacted. TCZ did not have effect on AEs, except a significant increased neutropenia risk in RCTs. TCZ has a potential role in the treatment of hospitalized COVID-19 patients.


Subject(s)
COVID-19 , Neutropenia , Adult , Antibodies, Monoclonal, Humanized/adverse effects , COVID-19/drug therapy , Humans , Neutropenia/drug therapy , Randomized Controlled Trials as Topic
4.
Journal of Risk and Financial Management ; 15(4), 2022.
Article in English | Scopus | ID: covidwho-1875674

ABSTRACT

There are diverging results in the literature on whether engaging in ESG related activities increases or decreases the financial and systemic risks of firms. In this study, we explore whether maintaining higher ESG ratings reduces the systemic risks of firms in a stock market context. For this purpose we analyse the systemic risk indicators of the constituent stocks of S&P Europe 350 for the period of January 2016–September 2020, which also partly covers the COVID-19 period. We apply a VAR-MGARCH model to extract the volatilities and correlations of the return shocks of these stocks. Then, we obtain the systemic risk indicators by applying a principle components approach to the estimated volatilities and correlations. Our focus is on the impact of ESG ratings on systemic risk indicators, while we consider network centralities, volatilities and financial performance ratios as control variables. We use fixed effects and OLS methods for our regressions. Our results indicate that (1) the volatility of a stock’s returns and its centrality measures in the stock network are the main sources contributing to the systemic risk measure, (2) firms with higher ESG ratings face up to 7.3% less systemic risk contribution and exposure compared to firms with lower ESG ratings and (3) COVID-19 augmented the partial effects of volatility, centrality measures and some financial performance ratios. When considering only the COVID-19 period, we find that social and governance factors have statistically significant impacts on systemic risk. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

5.
Hematology, Transfusion and Cell Therapy ; 43:S284-S285, 2021.
Article in Portuguese | EMBASE | ID: covidwho-1859628

ABSTRACT

Objetivo: Avaliar o primeiro hemograma realizado de crianças entre zero a 10 anos de idade com COVID-19 e relacionar seus parâmetros com a gravidade clínica. Materiais e métodos: Estudo de coorte retrospectivo (15/03/2020 a 15/09/2020) com dados do hemograma e PCR do prontuário à admissão hospitalar em dois hospitais na cidade de São Paulo, um privado e um hospital universitário. Foram avaliados, além de valores numéricos, dados categóricos quanto a presença ou não de alterações respeitando as referências para cada faixa etária. Feita avaliação das razões entre as células do leucograma e plaquetas: razão plaquetas/linfócitos, razão neutrófilos/linfócitos (NLR), razão neutrófilos/monócitos, razão linfócitos/neutrófilos, razão linfócitos/monócitos, razão monócitos/neutrófilos e razão monócitos/linfócitos. Resultados: Foram incluídas 93 crianças (idade entre 0,30–126 meses, mediana 19 meses), sendo destes 56 meninos (60,2%). Receberam alta após avaliação no pronto-socorro 24/93 (25,8%) pacientes, ficando internados 69 (74,2%). Não houve associação entre idade, sexo e valor de PCR com internação ou com a gravidade clínica. Doença de base esteve presente em 29/69 (42%) pacientes internados, enquanto que nos 24 que não internaram, esteve presente em 3 (12,5%). As crianças com alguma doença de base têm 5,08 (95% IC 1,56–22,9) vezes mais chance de internar em relação àquelas sem doença de base;no modelo ajustado para a idade, a OR foi de 4,63 (95% IC 1,36–21,59). As crianças com NLR maior (média 2,42 para o grupo internado contra 1,20 para o grupo não internado) tem 54% mais chance de internação (OR 1,54, 95% IC 1,10–2,41). Do total das crianças internadas, 21/69 (30,4%) evoluíram para uma condição crítica (sepse, síndrome inflamatória multissistêmica pediátrica – SIM-P, suporte ventilatório avançado ou óbito). A proporção de crianças críticas com eosinopenia é 3,05 vezes maior que aquelas sem eosinopenia (OR 3,05, 95% IC 1,07–9,39);ajustando o modelo para a idade, houve aumento para 5,27 (95% IC 1,62–19,35). Um óbito ocorreu nessa população por SIM-P em criança com neuropatia de base. Discussão: O conhecimento das alterações no hemograma de crianças entre 0 e 10 anos de idade ainda é escasso e possíveis fatores preditivos para gravidade que sejam de fácil acesso aos sistemas de saúde devem ser investigados. A NLR é um fator preditivo importante para doença grave e mortalidade em adultos com COVID-19. Neste estudo, na avaliação inicial no pronto socorro, as crianças com NLR maior têm maior probabilidade de apresentar um quadro clínico que exija internação. Os eosinófilos, por sua vez, têm papel na resposta imune adaptativa e na imunidade inata, com capacidade pro-inflamatória e destrutiva, estando sua presença no hemograma inicial relacionada como marcador infeccioso. A eosinopenia foi descrita em adultos com COVID-19 como um fator de pior prognóstico, sendo frequente nos pacientes com êxito letal. Este estudo demonstrou que, uma vez internadas, a eosinopenia também esteve relacionada com a gravidade da COVID-19 em crianças. Conclusão: Crianças com COVID-19 e doença de base ou NLR maior no pronto socorro são mais propensas a internar. Existe relação entre eosinopenia no hemograma à admissão hospitalar como fator preditivo de gravidade para crianças internadas com COVID-19.

6.
Hematology, Transfusion and Cell Therapy ; 43:S277, 2021.
Article in Portuguese | EMBASE | ID: covidwho-1859627

ABSTRACT

Objetivo: Descrever e comparar as características epidemiológicas, clínicas e laboratoriais dos pacientes < 18 anos com doença falciforme (DF)infectados ou não por SARS-CoV-2 e identificar alterações do hemograma (HMG) daqueles infectados no momento da admissão comparado ao último exame antes da internação. Método: Estudo de coorte, unicêntrico, retrospectivo-prospectivo, com dados de prontuário de pacientes internados (março a novembro de 2020), com SARS-CoV-2 positivo (GP) ou SARS-CoV-2 negativo (GN) de acordo com PCR-RT. Foram coletados: idade, sexo, raça, índice de massa corpórea (IMC), genótipo da DF, uso de hidroxiuréia (HU), transfusão crônica (TC), presença de comorbidades, sintomas e complicações, uso de antibiótico, antiviral e anticoagulante, necessidade de oxigênio (O2), UTI, ventilação mecânica (VM) e ventilação não invasiva (VNI), HMG da internação e de antes da admissão para o GP. Resultados: Foram internados 57 pacientes, dos quais 11 (19,3%) tiveram resultado positivo. O genótipo HbSS foi o mais comum e as características: idade, IMC, sexo e raça foram semelhantes (p>0,05). No GP, 81,8% estavam recebendo HU ou TC e no GN, 63%. Durante a internação, o uso de antibiótico, O2 e Oseltamivir foi semelhante. Comorbidades foram identificadas em 63,6% dos pacientes do GP e em 30,4% do GN (p = 0,046– Fisher).A média de dias de internação foi 6 para o GP e 7 para o GN. Em relação aos sintomas e complicações, não houve diferença estatisticamente significativa, porém febre durante a internação foi mais frequente no GP (90,9% vs. 60,9;p = 0,055-Fisher).Um paciente do GP recebeu anticoagulação profilática devido a suspeita de embolia pulmonar, que foi descartada com exame de imagem. Nenhum paciente do GP e um paciente do GN necessitou de UTI por síndrome torácica aguda grave e necessidade de VNI. Nenhum paciente precisou de VM ou teve óbito como desfecho. O resultado dos HMGs foi semelhante e no GP a contagem de eosinófilos foi menor na admissão quando comparada ao último exame ambulatorial(p=0,008-Wilcoxon). Discussão: Os pacientes com DF e infecção pelo SARS-CoV-2 podem evoluir com desfecho desfavorável e dados de revisão em hemoglobinopatia em pacientes pediátricos com DF e COVID-19 apontam maior prevalência de necessidade de UTI neste grupo (Vilella TS et al., 2020). Neste estudo, SARS-CoV-2 demonstrou causar infecção leve e nenhum paciente necessitou de UTI. Quando comparados com adultos, a COVID-19 se mostrou menos agressiva em crianças. No GP houve diminuição significativa da contagem de eosinófilos no HMG antes e após a admissão. Esse achado sugere que a contagem de eosinófilos possa ser um marcador biológico potencial para COVID-19. A eosinopenia também foi evidenciada em estudos em pacientes adultos com COVID-19 (Li Q et al. 2020;Jafarzadeh A et al. 2020). Uma das principais limitações deste estudo foi o pequeno número de pacientes infectados. Até o presente momento, não havia na literatura estudos que comparassem simultaneamente pacientes pediátricos com DF internados com e sem COVID-19 e o HMG no GP antes e após a admissão hospitalar. Conclusão: Os pacientes com DF infectados por SARS-CoV-2 apresentaram quadro leve mesmo apresentando maior prevalência de comorbidades do que os não infectados. Não foram observadas diferenças clínicas ou laboratoriais entre os dois grupos.

7.
Open Forum Infectious Diseases ; 8(SUPPL 1):S22-S23, 2021.
Article in English | EMBASE | ID: covidwho-1746807

ABSTRACT

Background. Accurately identifying COVID-19 patients at-risk to deteriorate remains challenging. Dysregulated immune responses impact disease progression and development of life-threatening complications. Tools integrating host immune-protein expression have proven useful in determining infection etiology and hold potential for prognosticating disease severity. Methods. Adults with COVID-19 were enrolled at medical centers in Israel, Germany, and the United States (Figure 1). Severe outcome was defined as intensive care unit admission, non-invasive or invasive ventilation, or death. Tumor necrosis factor related apoptosis inducing ligand (TRAIL), interferon gamma inducible protein-10 (IP-10) and C-reactive protein (CRP) were measured using an analyzer providing values within 15 minutes (MeMed Key®). A signature indicating the likelihood of severe outcome was derived generating a score (0-100). Description of derivation cohort RT-PCR, reverse transcription polymerase chain reaction. Results. Between March and November 2020, 518 COVID-19 patients were enrolled, of whom 394 were eligible, 29% meeting a severe outcome. Age ranged between 19-98 (median 61.5), with 59.1% male. Patients meeting severe outcomes exhibited higher levels of CRP and IP-10 and lower levels of TRAIL (Figure 2;p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The signature's area under the receiver operating characteristic curve (AUC) was 0.86 (95% confidence interval: 0.81-0.91). Performance was not confounded by age, sex, or comorbidities and was superior to IL-6 (AUC 0.77;p = 0.033) and CRP (AUC 0.78;p < 0.001). Clinical deterioration proximal to blood draw was associated with higher signature score. Scores of patients meeting a first outcome over 3 days after blood draw were significantly (p < 0.001) higher than scores of non-severe patients (Figure 3). Moreover, the signature differentiated patients who further deteriorated after meeting a severe outcome from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001;Figure 4). TRAIL, IP-10, CRP and the severity signature score are differentially expressed in severe and non-severe COVID-19 infection Dots represent patients and boxes denote median and interquartile range (IQR) The signature score of patients meeting a severe outcome on or after the day of blood draw is significantly (p < 0.001) higher than the signature score of non-severe patients. Dots represents patients and boxes denote median and IQR Kaplan-Meier survival estimates for signature score bins Conclusion. The derived signature combined with a rapid measurement platform has potential to serve as an accurate predictive tool for early detection of COVID-19 patients at risk for severe outcome, facilitating timely care escalation and de-escalation and appropriate resource allocation.

8.
Mathematics ; 10(5):830, 2022.
Article in English | ProQuest Central | ID: covidwho-1736982

ABSTRACT

In the context of the DigiLab4U international project, this paper describes a simulation-based serious game that can be used as a virtual teaching lab in higher education courses, especially in Industrial and Systems Engineering, Data Science, Management Science and Operations Research, as well as Computer Science. The learning activity focuses on understanding distribution logistics problems related to transportation optimization using different techniques. These optimization challenges include the vehicle routing problem, the arc routing problem, and the team orienteering problem. As a result of the learning process in the virtual lab, it is expected that students acquire competencies and skills related to logistics and transportation challenges as well as problem-solving. These competencies and skills can be precious for students’ future careers, since they increase students’ analytical skills, capacity to understand heuristic-based algorithms, teamwork and interdisciplinary communication skills, programming skills, and statistical abilities. A preliminary version of this training activity has already been used in MSc and PhD courses held at universities in Spain, Italy, Ireland, and Portugal.

9.
Epidemiologiya i Vaktsinoprofilaktika ; 20(6):81-87, 2021.
Article in Russian | Scopus | ID: covidwho-1698680

ABSTRACT

Relevance. The rapid spread of new pathogens inevitably leads to the occurrence of joint circulation with already known infectious agents, leading to the development of mixed infections. The simultaneous circulation of the pandemic coronavirus SARS-CoV-2 with a highly contagious measles virus leads to the development of mixed infections in people who have not been sick or vaccinated against measles. Aims. Review cases of co-infection with measles and COVID-19 in Moscow. Material and methods. A retrospective study of cases of measles and COVID-19 co-infection in three children with a description of the epidemiological and clinical picture of the disease. Results. In all observed children, the manifestation of the disease was typical for measles, the diagnosis of COVID-19 was established based on a laboratory study carried out in a hospital, which gave reason to count. That the infection with SARS-CoV-2 occurred after the infection of children with measles. Conclusions. Different incubation periods can lead to several options for the development of co-infection. The similarity of clinical symptoms at the onset of the disease does not allow excluding a certain infection clinically, without laboratory verification. © Zvereva NN et al.

10.
Computers & Industrial Engineering ; : 107869, 2021.
Article in English | ScienceDirect | ID: covidwho-1568572

ABSTRACT

Society is facing a series of challenges, as the growth in urban population, the expansion of e-commerce, the pandemic moment (COVID-19), and many others leading to changes in companies’ supply chain, like reducing product delivery time and attention to consumer welfare, the environmental impact, to mention a few. The efficient management of logistic solutions such as cross-docking can contribute to improving the supply chain performance. Here we focus on the integration of scheduling of trucks and routing decisions;the integration of these strategies can significantly reduce costs and help organize the distribution centers and the customers’ services. This article analyzes the integrated problem in which trucks’ scheduling in a cross-docking center with multiple docks is combined with the associated open vehicle routing problem, called Open Vehicle Routing Problem With Cross-Docking (OVRPCD). This approach aims to minimize penalties caused by delays in servicing customers. First, a mixed-integer linear programming model is proposed to solve small instances optimally. Next, two heuristics are proposed to contribute to the solution of the two problems in an integrated way. These heuristics are: the Vehicle Routing Cross-Docking Heuristic (VRCDH) and the Cross-Docking Vehicle Routing Heuristic (CDVRH), each focusing on one of the problems. We also propose a Prioritization Lagrangian Heuristic (PLH) based on a model decomposition to improve the solutions found. These three heuristics are compared, considering two search approaches (i) a constructive version (HC) using the swap heuristic;and (ii) a version using the Variable Neighborhood Search (VNS) metaheuristic framework. The VNS-enhanced versions of the heuristics outperform the previous ones. Still, the same relation holds regarding the three heuristics, i.e.: the PLH heuristic outperforms the VRCDH one, while the latter outperforms the CDVRH one. Finally, we propose a polynomial-time framework, called Robust Dynamic Prioritization Lagrangian Heuristic (RDPLH), which extends PLH, considering trucks’ release dates and travel times uncertainties, approximating our problem to a real cross-docking center. The framework’s simplicity and the quality of the results allow us to assert that this approach can be used in real cross-docking centers (CDCs).

11.
Proc Natl Acad Sci U S A ; 118(51)2021 12 21.
Article in English | MEDLINE | ID: covidwho-1569345

ABSTRACT

The COVID-19 pandemic presented enormous data challenges in the United States. Policy makers, epidemiological modelers, and health researchers all require up-to-date data on the pandemic and relevant public behavior, ideally at fine spatial and temporal resolution. The COVIDcast API is our attempt to fill this need: Operational since April 2020, it provides open access to both traditional public health surveillance signals (cases, deaths, and hospitalizations) and many auxiliary indicators of COVID-19 activity, such as signals extracted from deidentified medical claims data, massive online surveys, cell phone mobility data, and internet search trends. These are available at a fine geographic resolution (mostly at the county level) and are updated daily. The COVIDcast API also tracks all revisions to historical data, allowing modelers to account for the frequent revisions and backfill that are common for many public health data sources. All of the data are available in a common format through the API and accompanying R and Python software packages. This paper describes the data sources and signals, and provides examples demonstrating that the auxiliary signals in the COVIDcast API present information relevant to tracking COVID activity, augmenting traditional public health reporting and empowering research and decision-making.


Subject(s)
COVID-19/epidemiology , Databases, Factual , Health Status Indicators , Ambulatory Care/trends , Epidemiologic Methods , Humans , Internet/statistics & numerical data , Physical Distancing , Surveys and Questionnaires , Travel , United States/epidemiology
12.
Sustainability ; 13(17):9776, 2021.
Article in English | MDPI | ID: covidwho-1390754

ABSTRACT

A Virtual Reality application was developed to be used as an immersive virtual learning strategy for Oculus Rift S Virtual Reality glasses and through Leap Motion Controller™ infrared sensors, focused on students of the Automotive Systems Engineering academic program, as a practical teaching-learning tool in the context of Education 4.0 and the pandemic caused by COVID-19 that has kept schools closed since March 2020. The technological pillars of Industry 4.0 were used to profile students so that they can meet the demands of their professional performance at the industrial level. Virtual Reality (VR) plays a very important role for the production-engineering sector in areas such as design and autonomous cars, as well as in training and driving courses. The VR application provides the student with a more immersive and interactive experience, supported by 3D models of both the main parts that make up the four-stroke combustion engine and the mechanical workshop scenario;it allows the student to manipulate the main parts of the four-stroke combustion engine through the Oculus Rift S controls and the Leap Motion Controller™ infrared sensors, and relate them to the operation of the engine, through the animation of its operation and the additional information shown for each part that makes it up in the application.

13.
Hematology, Transfusion and Cell Therapy ; 42:305-305, 2020.
Article in Portuguese | PMC | ID: covidwho-1385627

ABSTRACT

Objetivo: Descrever as caracteristicas clinicas e laboratoriais dos pacientes abaixo dos 18 anos de idade com diagnostico de doenca falciforme (DF) infectados por SARS-CoV-2. Metodos: Estudo do tipo coorte, unicentrico e misto, com avaliacao de prontuario eletronico dos pacientes pediatricos com diagnostico de DF e infeccao pelo novo coronavirus confirmada por RT-PCR atendidos no hospital de referencia no periodo de marco de 2020 a julho de 2020. Resultados: Foram identificados seis pacientes com resultado positivo para SARS-CoV-2 dos quais tres eram do sexo feminino, cinco possuiam genotipo SS e cinco eram portadores de alguma comorbidade sendo asma a mais comum, presente em dois pacientes. A idade media foi de 11,4 anos (6,6-16,8) e o IMC medio foi de 17,9 kg/m2 (12,5-27,5). A duracao media do tempo de internacao foi de oito dias (2-24). A principal queixa na entrada foi dor, presente em cinco pacientes. Em relacao as demais queixas, um paciente apresentava febre e sintomas respiratorios, um apenas sintomas respiratorios e um somente febre. O valor medio do d-dimero nos exames de entrada foi de 2,84 mcg/mL (2,08-5,99) e do d-dimero maximo foi de 5,85 mcg/mL (3,61-12,93). Das cinco tomografias realizadas, duas apresentavam padrao em vidro fosco tipico de infeccao viral. Durante a internacao, todos os pacientes apresentaram febre e dessaturacao, tres apresentaram sindrome toracica aguda (STA), todos receberam antibiotico e necessitaram de oxigenio suplementar, um fez uso de anticoagulacao e nenhum necessitou de UTI ou foi a obito. Discussao: Na nossa casuistica a asma foi a comorbidade mais comum nos pacientes infectados pelo novo coronavirus. Na literatura a asma e descrita como um fator de risco para o desenvolvimento de STA e, ate o presente momento, tambem foi identificada como fator preditivo de pior prognostico na evolucao da infeccao. No grupo de pacientes em questao, o paciente portador de asma foi o que apresentou evolucao mais prolongada. A dor foi a queixa inicial mais frequente entre os pacientes. Ainda nao esta clara a associacao entre COVID-19 e dor em pediatria, porem em adultos ja ha relatos de crise vaso oclusiva (CVO) como manifestacao inicial da doenca. Durante a evolucao a dessaturacao e a febre foram os sinais mais frequentes e que podem ser encontrados tanto na STA quanto na COVID-19. Na literatura a STA e descrita como uma complicacao de COVID-19, tendo sido identificada em metade dos nossos pacientes. Todos os pacientes necessitaram de suporte com oxigenio e antibioticoterapia, tratamento utilizado tanto na infeccao pelo novo coronavirus quanto na STA. Ainda nao e bem estabelecido o uso de anticoagulacao em pediatria nos casos de COVID-19, porem deve-se ter em mente que os pacientes com DF podem apresentar rotineiramente valores mais elevados de d-dimero durante CVO e STA. O paciente que recebeu anticoagulacao evoluiu com maior tempo de internacao. Os achados radiograficos de vidro fosco sao compativeis com os descritos ate o momento. Comparado com a literatura, nossos pacientes nao diferiram em termos de sexo, genotipo, duracao de internacao e desfecho. Conclusao: A infeccao causada pelo SARS-CoV-2 pode ser um fator de risco para CVO e STA no paciente com DF. Semelhante a outros relatos em pacientes pediatricos com DF e COVID-19, nossos pacientes evoluiram bem e sem nenhum caso de obito.Copyright © 2020

14.
Preprint in English | medRxiv | ID: ppmedrxiv-21259660

ABSTRACT

The COVID-19 pandemic presented enormous data challenges in the United States. Policy makers, epidemiological modelers, and health researchers all require up-to-date data on the pandemic and relevant public behavior, ideally at fine spatial and temporal resolution. The COVIDcast API is our attempt to fill this need: operational since April 2020, it provides open access to both traditional public health surveillance signals (cases, deaths, and hospitalizations) and many auxiliary indicators of COVID-19 activity, such as signals extracted from de-identified medical claims data, massive online surveys, cell phone mobility data, and internet search trends. These are available at a fine geographic resolution (mostly at the county level) and are updated daily. The COVIDcast API also tracks all revisions to historical data, allowing modelers to account for the frequent revisions and backfill that are common for many public health data sources. All of the data is available in a common format through the API and accompanying R and Python software packages. This paper describes the data sources and signals, and provides examples demonstrating that the auxiliary signals in the COVIDcast API present information relevant to tracking COVID activity, augmenting traditional public health reporting and empowering research and decision-making.

17.
Open Forum Infectious Diseases ; 7(SUPPL 1):S279-S280, 2020.
Article in English | EMBASE | ID: covidwho-1185790

ABSTRACT

Background: It is estimated that up to 10% of SARS-CoV-2 patients progress from early and pulmonary stages to the most severe stage of illness, which manifests as an extra-pulmonary systemic hyperinflammatory syndrome. Interferon gamma-induced protein 10 (IP-10) is an inflammatory marker that plays a role in the dysregulated host response of COVID-19 infected patients. Clinical monitoring of IP-10 has been restricted in the absence of a rapid diagnostic test. MeMed KeyTM is a novel platform recently cleared to provide IP-10 measurements in 15 minutes. We hypothesized that providing physicians with real time IP-10 measurements would support detection and continuous monitoring of patients with a dysregulated immune response and potentially allow personalized immunomodulation to improve patient outcome. IP-10 levels reflect corticosteroid treatment Methods: From 7th April 2020 to 10th May 2020 blood was routinely collected serially from 52 SARS-CoV-2 positive patients hospitalized at a COVID-19 dedicated medical center. A clinical decision support protocol was in place focused on managing viral response, oxygenation and inflammatory state (NCT04389645). Results: The median age of the 52 patients was 69, 69% were male, 21% were ventilated, 4 died, 2 due to non-COVID-19 related complications. The most common comorbidities were Diabetes 40% and Hypertension 46%. IP-10 >1000 pg/ml correlated with ICU admission (p< 0.05) and increased COVID-19 severity score (p< 0.01). 19 of the 52 patients had IP-10 >1000 pg/ml, of these 12 were treated with corticosteroids. Monitoring IP-10 within the clinical decision support protocol assisted with personalized corticosteroid regimens with the aim of reducing IP-10 < 1000 pg/ml. The 10 patients that survived exhibited IP-10 levels >1000 pg/ml for 2.6 days on average. In contrast, the 2 patients that died of COVID-19 related complications displayed an average of 7.5 days with IP-10 >1000 pg/ml (p< 0.05). Conclusion: Providing physicians with real time measurements of IP-10 in COVID-19 patients proved a useful tool as part of the clinical decision support protocol. Timely identification, monitoring and personalized treatment of COVID-19 patients exhibiting a dysregulated immune response may aid in improving patient outcome. Further studies are warranted.

18.
Pediatriya. Zhurnal im. G.N. Speranskogo ; 99(6):119-126, 2020.
Article in Russian | Russian Science Citation Index | ID: covidwho-1094692

ABSTRACT

Multisystem Inflammatory Syndrome in Children (MIS-C) associated with new coronavirus infection (COVID-19), with signs of Kawasaki disease (KD) and toxic shock syndrome, well-defined diagnostic criteria, is the most severe manifestation of COVID-19 in pediatric patients. MIS-C is analogous to the cytokine storm in children with COVID-19. The article presents a clinical observation of a child with MIS-C with a lethal outcome. Clinical and anamnestic data, the results of laboratory and instrumental research allowed to diagnose MIS-C in a 2-year-old girl with full KD form. Autopsy results, detailed microscopic examination, which revealed systemic vasculitis of small and mediumsized vessels, inflammatory infiltrates in different organs, are presented, clinical and morphological comparisons are made. Детский мультисистемный воспалительный синдром (ДМВС), ассоциированный с новой коронавирусной инфекцией (COVID-19), имеющий признаки болезни Кавасаки (БК) и синдрома токсического шока, четко очерченные диагностические критерии, - самое тяжелое проявление COVID-19 в детском возрасте. ДМВС является аналогом цитокинового шторма при COVID-19 у детей. В статье представлено клиническое наблюдение ребенка с ДМВС с летальным исходом. Клинико-анамнестические данные, результаты лабораторно-инструментальных методов исследования позволили диагностировать ДМВС у девочки 2 лет с полной формой БК. Приведены результаты аутопсии, подробного микроскопического исследования, выявившего системный васкулит сосудов мелкого и среднего калибра, воспалительные инфильтраты в разных органах, проведены клинико-морфологические сопоставления.

19.
Clin Immunol ; 225: 108682, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062286

ABSTRACT

COVID-19 can range from asymptomatic to life-threatening. Early identification of patients who will develop severe disease is crucial. A number of scores and indexes have been developed to predict severity. However, most rely on measurements not readily available. We evaluated hematological and biochemical markers taken on admission and determined how predictive they were of development of critical illness or death. We observed that higher values of readily available tests, including neutrophil:lymphocyte ratio; derived neutrophil index; and troponin I were associated with a higher risk of death or critical care admission (P < 0.001). We show that common hematological tests can be helpful in determining early in the course of illness which patients are likely to develop severe forms, as well as allocating resources to those patients early, while avoiding overuse of limited resources in patients with reduced risk of progression to severe disease.


Subject(s)
Biomarkers/blood , COVID-19/blood , COVID-19/virology , SARS-CoV-2 , Adult , Blood Cell Count , COVID-19/diagnosis , COVID-19/mortality , Cohort Studies , Disease Progression , Female , Hematologic Tests , Hospitalization , Humans , Male , Middle Aged , Polymerase Chain Reaction , Prognosis , Proportional Hazards Models , ROC Curve , SARS-CoV-2/genetics , Severity of Illness Index
20.
Cir Cir ; 88(5): 654-663, 2020.
Article in English | MEDLINE | ID: covidwho-1011871

ABSTRACT

The disease caused by a new coronavirus, which started in 2019, was named COVID-19 and declared a pandemic on March 11, 2020 by the World Health Organization. Although it is true that the first reports emphasized the respiratory manifestations of this disease as an initial clinical presentation, little by little cases with different initial manifestations began to appear, involving other systems. In cases where central nervous system involvement was identified, the most frequent findings were dizziness, headache, and alteration of alertness. Regarding the cardiovascular system, elevation of cardiac biomarkers and myocarditis are one of the most frequent findings. The main gastrointestinal symptoms described so far are: anorexia, nausea, vomiting, diarrhea, abdominal pain and/or discomfort. Venous thromboembolism is a frequent complication and a public health problem. Skin manifestations remain a field of investigation. Maculopapular rashes, reticular livedo, acral gangrene, among others, have been identified. Health personnel must be updated on new clinical findings and the forms of presentation of this partially known disease, which will make it possible to make more accurate and timely diagnoses, thus impacting the prognosis of these patients.


La enfermedad causada por un nuevo coronavirus, que inició en 2019, fue denominada COVID-19 y declarada pandemia el 11 de marzo de 2020 por la Organización Mundial de la Salud. Si bien es cierto que los primeros reportes enfatizaron las manifestaciones respiratorias de esta enfermedad como presentación clínica inicial, poco a poco empezaron a aparecer casos con manifestaciones iniciales distintas, involucrando otros sistemas. En los casos en los que se identificó afectación del sistema nervioso central, los hallazgos más frecuentes fueron mareo, cefalea y alteración del estado de alerta. Respecto al sistema cardiovascular, la elevación de biomarcadores cardiacos y la miocarditis son unos de los hallazgos más frecuentes. Los principales síntomas gastrointestinales descritos hasta el momento son anorexia, náuseas, vómitos, diarrea y dolor o disconfort abdominal. La tromboembolia venosa es una complicación frecuente y un problema de salud pública. Las manifestaciones cutáneas siguen siendo un campo de investigación. Se han identificado exantemas maculopapulares, livedo reticular y gangrena acral, entre otros. El personal sanitario debe estar actualizado sobre los nuevos hallazgos clínicos y las formas de presentación de esta enfermedad solo parcialmente conocida, lo que permitirá hacer diagnósticos más precisos y oportunos, y así impactar en el pronóstico de estos enfermos.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , COVID-19 , Cardiovascular Diseases/etiology , Central Nervous System Diseases/etiology , Cytokine Release Syndrome/etiology , Gastrointestinal Diseases/etiology , Humans , Kidney Diseases/etiology , SARS-CoV-2 , Skin Diseases/etiology
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