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1.
Revista Colombiana de Gastroenterologia ; 35(2):187-195, 2020.
Article | WHO COVID | ID: covidwho-782611

ABSTRACT

Abstract The economic and social repercussions and the enormous commitment required of health care systems by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (coronavirus disease [COVID-19]) has completely altered world reality The disease has affected all countries on all five continents In Colombia, from diagnosis of the very first case, measures have been taken to better prepare ourselves for this crisis Although it is a respiratory virus, its presence in various human tissues and organs has been documented Despite the fact that its clinical presentation is most often in the form of mild symptoms, a significant percentage of those infected have severe manifestations that can lead to serious complications and death Colorectal cancer is a prevalent tumor in our population, and this pandemic forces to prepare ourselves better to treat it during this period The Colombian Coloproctology Association has reviewed reports in the literature and recommendations of various international associations and on our own experience with colorectal cancer during the COVID-19 pandemic We present our recommendations for management of patients with this pathology and review management options according to disease presentation

3.
Anesthesia and analgesia ; 2020.
Article | WHO COVID | ID: covidwho-781617

ABSTRACT

BACKGROUND: In the treatment for severe acute respiratory distress syndrome (ARDS) from Coronavirus Disease 2019 (COVID-19), the World Health Organization (WHO) recommends prone positioning (PP) during mechanical ventilation for periods of 12-16 hours per day to potentially improve oxygenation and survival In this prospective observational study, we evaluated the ability of long PP sessions to improve oxygenation in awake ICU patients with moderate or severe ARDS due to COVID-19 METHODS: The study was approved by the ethics committee of Galicia (code No 2020-188), and all patients provided informed consent In this case series, awake patients with moderate or severe ARDS by COVID-19 admitted to the Intensive Care Unit (ICU) at University Hospital of Santiago from March 21 to April 5, 2020 were prospectively analyzed Patients were instructed to remain in PP as long as possible, until the patient felt too tired to maintain that position Light sedation was administered with dexmedetomidine The following information were collected: number and duration of PP sessions, StO2 and blood gases before, during and following a PP session, need of mechanical ventilation, duration of ICU admission and ICU outcome Linear mixed effects models (LMM) were fit to estimate changes from baseline with a random effect for patient RESULTS: Seven patients with moderate or severe ARDS by COVID 19 were included All patients received at least one PP session A total of 16 PP sessions were performed in the 7 patients during the period study The median duration of PP sessions was 10 hours Dexmedetomidine was used in all PP sessions Oxygenation increased in all sixteen sessions performed in the seven patients The ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) significantly increased during PP (change from baseline and CI 97 5%: 110 [19;202]) and after PP, albeit not significantly (change from baseline and CI 97 5%: 38 [-9 2;85]) compared with previous supine position Similarly, tissue oxygenation underwent a small improvement during PP (change from baseline and CI 97 5%: 2 6% [0 69;4 6]) without significant changes after PP Two patients required intubation All patients were discharged from the ICU CONCLUSIONS: We found that PP improved oxygenation in ICU patients with COVID-19 and moderate or severe ARDS PP was relatively well tolerated in our patients and may be a simple strategy to improve oxygenation trying to reduce patients in mechanical ventilation and the length of stay in the ICU, especially in COVID-19 pandemic

4.
Transplantation ; 2020.
Article | WHO COVID | ID: covidwho-780621

ABSTRACT

BACKGROUND: The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management METHODS: Adult SOT recipients with laboratory PCR-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11th to April 25th 2020, were matched to controls (1:4) on the basis of sex, age and age-adjusted Charlson's Index Patients were followed for up to 28 days from admission or until censored Primary endpoint was mortality at 28 days Secondary endpoints included admission to the intensive care unit (ICU) and secondary complications Drug-drug interactions (DDI) between immunosuppressants and COVID-19 management medication were collected RESULTS: Forty-six transplant recipients and 166 control patients were included Mean (SD) age of transplant recipients and controls was 62 7 (12 6) and 66 0 (12 7) years, 33 (71 7%) and 122 (73 5%) were male, and median (IQR) Charlson's Index was 5 (3-7) and 4 (2-7), respectively Mortality was 37 0% in SOT recipients and 22 9% in controls (p=0 51) Thirty-three (71 7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI CONCLUSIONS: In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared to controls, although it was not statistically significant, and a notable propensity for DDI

5.
American Journal of Kidney Diseases ; 2020.
Article | WHO COVID | ID: covidwho-780044

ABSTRACT

Rationale & Objective Underlying kidney disease is an emerging risk factor for more severe COVID-19 illness We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing kidney disease and investigated the association between degree of underlying kidney disease and in-hospital outcomes Study Design Retrospective cohort study Settings & Participants 4,264 critically ill COVID-19 patients (143 dialysis patients, 521 chronic kidney disease [CKD] patients, and 3,600 patients without CKD) admitted to ICUs at 68 hospitals in the United States Predictor(s) Presence (versus absence) of pre-existing kidney disease Outcome(s) In-hospital mortality (primary);respiratory failure, shock, ventricular arrhythmia/ cardiac arrest, thromboembolic event, major bleed, and acute liver injury (secondary) Analytical Approach We used standardized differences to compare patient characteristics (values >0 10 indicate a meaningful difference between groups) and multivariable adjusted Fine and Gray survival models to examine outcome associations Results Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median [quartile 1-quartile 3] days: 4 [2-9] for dialysis patients;7 [3-10] for CKD patients;7 [4-10] for patients without pre-existing kidney disease) More dialysis patients (25%) reported altered mental status than those with CKD (20%, standardized difference = 0 12) and no kidney disease (12%, standardized difference = 0 36) Half of dialysis and CKD patients died within 28-days of ICU admission versus 35% of patients without pre-existing kidney disease Compared to patients without pre-existing kidney disease, dialysis patients had a higher risk of 28-day in-hospital death (adjusted HR 1 41;95% CI 1 09, 1 81), while patients with CKD had an intermediate risk (adjusted HR 1 25;95% CI 1 08, 1 44) Limitations Potential residual confounding Conclusions Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies for this vulnerable population

6.
Rheumatology international ; 2020.
Article | WHO COVID | ID: covidwho-777775

ABSTRACT

The objective of this study is to describe the characteristics and outcomes of rheumatic and musculoskeletal disease (RMD) patients who were treated with rituximab and had suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection In this descriptive study, RMD patients who were treated with rituximab in the last 12months at the Rheumatology Department of our hospital were screened for SARS-CoV-2 infection via telephone interview and a comprehensive review of clinical health records (01/02/2020-26/05/2020) Those with probable or confirmed SARS-CoV-2 infection were included In total, 76 patients were screened Of these, 13 (17 1%) had suspected or confirmed SARS-CoV-2 infection With regard to these 13 patients, the median age at coronavirus disease (COVID-19) diagnosis was 68years (range 28-76years) and 8 (61 5%) were female Five patients had rheumatoid arthritis, three had systemic vasculitis, two had Sjogren syndrome, and two had systemic lupus erythematosus Additionally, seven patients (53 8%) had pulmonary involvement secondary to RMD Eight patients (61 5%) developed severe disease leading to hospitalization, and seven developed bilateral pneumonia and respiratory insufficiency Of the eight hospitalized patients, five (62 5%) fulfilled the acute respiratory distress syndrome criteria and three developed a critical disease and died Our cohort had a high rate of severe disease requiring hospitalization (61 5%), with bilateral pneumonia and hyperinflammation leading to a high mortality rate (23 1%) Treatment with rituximab should be considered a possible risk factor for unfavorable outcomes in COVID-19 patients with RMD However, further study is required to confirm this association

7.
Preprint | bioRxiv | ID: ppbiorxiv-308023

ABSTRACT

COVID-19 is a zoonotic disease originated by SARS-CoV-2. Infection of animals with SARS-CoV-2 are being reported during last months, and also an increase of severe lung pathologies in domestic dogs has been detected by veterinarians in Spain. Therefore it is necessary to describe the pathological processes in those animals that show symptoms similar to those described in humans affected by COVID-19. The potential for companion animals contributing to the continued human-to-human disease, infectivity, and community spread is an urgent issue to be considered. Forty animals with pulmonary pathologies were studied by chest X-ray, ultrasound study, and computed tomography. Nasopharyngeal and rectal swab were analyzed to detect canine pathogens, including SARS-CoV-2. Twenty healthy dogs living in SARS-CoV-2 positive households were included. Immunoglobulin detection by different immunoassays was performed. Our findings show that sick dogs presented severe alveolar or interstitial pattern, with pulmonary opacity, parenchymal abnormalities, and bilateral lesions. Forty dogs were negative for SARS-CoV-2 but Mycoplasma spp. was detected in 26 of 33 dogs. Five healthy and one pathological dog presented IgG against SARS-CoV-2. Here we report that despite detecting dogs with IgG -SARS-CoV-2, we never obtained a positive RT-qPCR, not even in dogs with severe pulmonary disease; suggesting that even in the case of a canine infection transmission would be unlikely. Moreover, dogs living in COVID-19 positive households could have been more exposed to be infected during outbreaks.

8.
Preprint | medRxiv | ID: ppmedrxiv-20196832

ABSTRACT

Introduction: Severe COVID-19 is infrequent in children, with a lethality rate of about 0.08%. This study aims to explore differences in the pediatric mortality rate between countries. Methods: Countries with populations over 5 million that report COVID-19 deaths disaggregated data by quinquennial or decennial age groups were analyzed. Data were extracted from COVID-19 Cases and Deaths by Age Database, national ministries of health, and the World Health Organization. Results: 23 countries were included in the analysis. Pediatric mortality varied from 0 to 12.1 deaths per million people of the corresponding age group, with the highest rate in Peru. In most countries, deaths were more frequent in the 0-4 years old age group, except for Brazil. The pediatric/ general COVID-19 mortality showed a great variation between countries and ranged from 0 (Republic of Korea) to 10.4% (India). Pediatric and Pediatric/general COVID mortality have a strong correlation with 2018 neonatal mortality (r=0.77, p<0.001 and r= 0.88, p<0.001 respectively), while it has a moderate or absent (r=0.47, p=0.02 and r=0.19, p=0.38, respectively) correlation with COVID-19 mortality in the general population. Conclusions: There is an important heterogenicity in pediatric COVI-19 mortality between countries that parallels historical neonatal mortality. Neonatal mortality is a known index of the quality of a country s Health System which points to the importance of social determinants of health in pediatric COVID-19 mortality disparities, an issue which should be further explored.

12.
Curr Opin Obstet Gynecol ; 32(5): 322-334, 2020 10.
Article in English | MEDLINE | ID: covidwho-629087

ABSTRACT

PURPOSE OF REVIEW: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy complications. Accurate screening and diagnosis of gestational diabetes are critical to treatment, and in a pandemic scenario like coronavirus disease 2019 needing a simple test that minimises prolonged hospital stay. We undertook a meta-analysis on the screening and diagnostic accuracy of the haemoglobin A1c (HbA1c) test in women with and without risk factors for gestational diabetes. RECENT FINDINGS: Unlike the oral glucose tolerance test, the HbA1c test is simple, quick and more acceptable. There is a growing body of evidence on the accuracy of HbA1c as a screening and diagnostic test for GDM. We searched Medline, Embase and Cochrane Library and selected relevant studies. Accuracy data for different thresholds within the final 23 included studies (16 921 women) were pooled using a multiple thresholds model. Summary accuracy indices were estimated by selecting an optimal threshold that optimises either sensitivity or specificity according to different scenarios. SUMMARY: HbA1c is more useful as a specific test at a cut-off of 5.7% (39 mmol/mol) with a false positive rate of 10%, but should be supplemented by a more sensitive test to detect women with GDM.


Subject(s)
Diabetes, Gestational/diagnosis , Glycated Hemoglobin A/analysis , Case-Control Studies , Female , Humans , Predictive Value of Tests , Pregnancy , Risk Factors
13.
EBioMedicine ; 60:102999, 2020.
Article | WHO COVID | ID: covidwho-764522

ABSTRACT

Background The virological and immunological effects of the immunomodulatory drugs used for COVID-19 remain unknown We evaluated the impact of interleukin (IL)-6 blockade with tocilizumab on SARS-CoV-2 viral kinetics and the antibody response in patients with COVID-19 Methods Prospective cohort study in patients admitted with COVID-19 Serial nasopharyngeal and plasma samples were measured for SARS-CoV-2 RNA and S-IgG/N-IgG titers, respectively Findings 138 patients with confirmed infection were included;76 (55%) underwent IL-6 blockade Median initial SOFA (p = 0•016) and SARS-CoV-2 viral load (p<0•001, Mann-Whitney-Wilcoxon test) were significantly higher among anti-IL-6 users Patients under IL-6 blockade showed delayed viral clearance in the Kaplan-Meier curves (HR 0•35 [95%CI] [0•15–0•81], log-rank p = 0•014), but an adjusted propensity score matching model did not demonstrate a significant relationship of IL-6 blockade with viral clearance (HR 1•63 [0•35–7•7]) Cox regression showed an inverse association between SARS-CoV-2 RNA clearance and the initial viral load (HR 0•35 [0•11–0•89]) Patients under the IL-6 blocker showed shorter median time to seropositivity, higher peak antibody titers, and higher cumulative proportion of seropositivity in the Kaplan Meier curves (HR 3•1 [1•9–5] for S-IgG;and HR 3•0 [1•9–4•9] for N-IgG;log-rank p<0•001 for both) However, no significant differences between groups were found in either S-IgG (HR 1•56 [0•41–6•0]) nor N-IgG (HR 0•96 [0•26–3•5]) responses in an adjusted propensity score analysis Interpretation Our results suggest that in patients infected with SARS-CoV-2, IL-6 blockade does not impair the viral specific antibody responses Although a delayed viral clearance was observed, it was driven by a higher initial viral load The study supports the safety of this therapy in patients with COVID-19 Funding Instituto de salud Carlos III (Spain)

14.
Journal of Infectious Diseases ; 222(Supplement_1):S20-S30, 2020.
Article | WHO COVID | ID: covidwho-662390

ABSTRACT

BACKGROUND: Reproductive aging may contribute to cardiometabolic comorbid conditions We integrated data on gynecologic history with levels of an ovarian reserve marker (anti-müllerian hormone [AMH)] to interrogate reproductive aging patterns and associated factors among a subset of cisgender women with human immunodeficiency virus (WWH) enrolled in the REPRIEVE trial METHODS: A total of 1449 WWH were classified as premenopausal (n = 482) (menses within 12 months;AMH level &#8805;20 pg/mL;group 1), premenopausal with reduced ovarian reserve (n = 224) (menses within 12 months;AMH <20 pg/mL;group 2), or postmenopausal (n = 743) (no menses within12 months;AMH <20 pg/mL;group 3) Proportional odds models, adjusted for chronologic age, were used to investigate associations of cardiometabolic and demographic parameters with reproductive aging milestones (AMH <20 pg/mL or >12 months of amenorrhea) Excluding WWH with surgical menopause, age at final menstrual period was summarized for postmenopausal WWH (group 3) and estimated among all WWH (groups 1-3) using an accelerated failure-time model RESULTS: Cardiometabolic and demographic parameters associated with advanced reproductive age (controlling for chronologic age) included waist circumference (>88 vs &#8804;88 cm) (odds ratio [OR], 1 38;95% confidence interval, 1 06-1 80;P = 02), hemoglobin (&#8805;12 vs <12 g/dL) (2 32;1 71-3 14;P < 01), and region of residence (sub-Saharan Africa [1 50;1 07-2 11;P = 02] and Latin America and the Caribbean [1 59;1 08-2 33;P = 02], as compared with World Health Organization Global Burden of Disease high-income regions) The median age (Q1, Q3) at the final menstrual period was 48 (45, 51) years when described among postmenopausal WWH, and either 49 (46, 52) or 50 (47, 53) years when estimated among all WWH, depending on censoring strategy CONCLUSIONS: Among WWH in the REPRIEVE trial, more advanced reproductive age is associated with metabolic dysregulation and region of residence Additional research on age at menopause among WWH is needed CLINICAL TRIALS REGISTRATION: NCT0234429

15.
Remote Sensing ; 12(14):2210, 2020.
Article | WHO COVID | ID: covidwho-651913

ABSTRACT

The disease caused by SARS-CoV-2 has affected many countries and regions In order to contain the spread of infection, many countries have adopted lockdown measures As a result, SARS-CoV-2 has negatively influenced economies on a global scale and has caused a significant impact on the environment In this study, changes in the concentration of the pollutant Nitrogen Dioxide (NO2) within the lockdown period were examined as well as how these changes relate to the Spanish population NO2 is one of the reactive nitrogen oxides gases resulting from both anthropogenic and natural processes One major source in urban areas is the combustion of fossil fuels from vehicles and industrial plants, both of which significantly contribute to air pollution The long-term exposure to NO2 can also cause severe health problems Remote sensing is a useful tool to analyze spatial variability of air quality For this purpose, Sentinel-5P images registered from January to April of 2019 and 2020 were used to analyze spatial distribution of NO2 and its evolution under the lockdown measures in Spain The results indicate a significant correlation between the population’s activity level and the reduction of NO2 values

16.
Int J Environ Res Public Health ; 17(18)2020 09 10.
Article in English | MEDLINE | ID: covidwho-769345

ABSTRACT

The novel coronavirus disease (COVID-19) pandemic has brought a great deal of pressure for medical students, who typically show elevated anxiety rates. Our aim is to investigate the prevalence of anxiety in medical students during this pandemic. This systematic review and mini meta-analysis has been conducted following the PRISMA guidelines. Two researchers independently searched PubMed on 26 August 2020 for cross-sectional studies on medical students during the COVID-19 outbreak, with no language restrictions applied. We then performed a manual search to detect other potentially eligible investigations. To the 1361 records retrieved in the initial search, 4 more were added by manual search on medRxiv. Finally, eight studies were finally included for qualitative and quantitative analysis, which yielded an estimated prevalence of anxiety of 28% (95% CI: 22-34%), with significant heterogeneity between studies. The prevalence of anxiety in medical students is similar to that prior to the pandemic but correlates with several specific COVID-related stressors. While some preventive and risk factors have been previously identified in a non-pandemic context, knowledge and cognitions on COVID-19 transmission, treatment, prognosis and prevention negatively correlate with anxiety, emerging as a key preventive factor that may provide a rationale for why the levels of anxiety have remained stable in medical students during the pandemic while increasing in their non-medical peers and the general population. Other reasons for the invariability of anxiety rates in this population are discussed. A major limitation of our review is that Chinese students comprised 89% the total sample, which could compromise the external validity of our work.


Subject(s)
Anxiety/epidemiology , Coronavirus Infections/psychology , Pneumonia, Viral/psychology , Students, Medical/psychology , Betacoronavirus , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Humans , Pandemics , Pneumonia, Viral/epidemiology , Prevalence
18.
Preprint | bioRxiv | ID: ppbiorxiv-300335

ABSTRACT

The yeast Pichia pastoris is a cost-effective and easily scalable system for recombinant protein production. In this work we compared the conformation of the receptor binding domain (RBD) from SARS-CoV-2 Spike protein expressed in P. pastoris and in the well established HEK-293T mammalian cell system. RBD obtained from both yeast and mammalian cells was properly folded, as indicated by UV-absorption, circular dichroism and tryptophan fluorescence. They also had similar stability, as indicated by temperature-induced unfolding (observed Tm were 50 {degrees}C and 52 {degrees}C for RBD produced in P. pastoris and HEK-293T cells, respectively). Moreover, the stability of both variants was similarly reduced when the ionic strength was increased, in agreement with a computational analysis predicting that a set of ionic interactions may stabilize RBD structure. Further characterization by HPLC, size-exclusion chromatography and mass spectrometry revealed a higher heterogeneity of RBD expressed in P. pastoris relative to that produced in HEK-293T cells, which disappeared after enzymatic removal of glycans. The production of RBD in P. pastoris was scaled-up in a bioreactor, with yields above 45 mg/L of 90% pure protein, thus potentially allowing large scale immunizations to produce neutralizing antibodies, as well as the large scale production of serological tests for SARS-CoV-2.

19.
World J Pediatr Congenit Heart Surg ; : 2150135120949455, 2020 Sep 10.
Article in English | MEDLINE | ID: covidwho-760520

ABSTRACT

We describe a seven-year-old female with acute pericarditis presenting with pericardial tamponade, who screened positive for coronavirus disease 2019 (COVID-19 [SARS-CoV-2]) in the setting of cough, chest pain, and orthopnea. She required emergent pericardiocentesis. Due to continued chest pain and orthopnea, rising inflammatory markers, and worsening pericardial inflammation, she underwent surgical pericardial decortication and pericardiectomy. Her symptoms and pericardial effusion resolved, and she was discharged to home 3 days later on ibuprofen and colchicine with instruction to quarantine at home for 14 days from the date of her positive testing for COVID-19.

20.
Int J Clin Pract ; : e13707, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-760138

ABSTRACT

OBJECTIVE: To describe the incidence and fatality of COVID-19 and identify risk factors to fatality in patients with inflammatory articular diseases (IAD). METHODS: This is a cross-sectional observational study of IAD patients and COVID-19 with controls matched for age, sex, and RT-PCR. A control group was used to compare the cumulative incidence (CI) and case fatality rate (CFR). The main outcomes of the study were CI and CFR. Other variables included comorbidities, treatments, and characteristics of the COVID-19. Multiple logistic regression analysis was performed to investigate risk factors for fatality in patients with IAD. RESULTS: Of the 1537 patients who fulfilled the inclusion criteria, 23/1537 (1.49 %) had IAD 13(0.8%) had rheumatoid arthritis (RA), 5 psoriatic arthritis (PsA) (0.3%) and 5 axial spondyloarthritis (SPA) (0.3%). There were no significant differences in CI of COVID-19 and CFR in patients with IAD compared to COVID-19 patients without IAD. In RT-PCR positive patients the CI of COVID-19 in PsA and AS was higher. Of the 23 IAD patients, 2 RA patients (8.6%) died. The patients not showed characteristics of the COVID-19 disease different from population. In multivariate analysis, the factor associated with fatality in patients with IAD was older age (OR [95%CI], 1.1 [1.0-1.2]). CONCLUSION: COVID-19 CI, fatality rate and other features do not seem to be increased in IAD patients. Older age was associated with fatality in patients with IAD.

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