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Rev Invest Clin ; 2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1022353


In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated disease coronavirus disease 2019 (COVID-19), hypoxemia mechanisms differ from those observed in acute respiratory distress syndrome. Hypoxemia and respiratory failure in COVID- 19 are attributed to pulmonary angiopathy, increasing physiological pulmonary shunting1-3.

Neurology ; 95(24): e3373-e3385, 2020 12 15.
Article in English | MEDLINE | ID: covidwho-977693


OBJECTIVES: To investigate the hypothesis that strokes occurring in patients with coronavirus disease 2019 (COVID-19) have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population. METHODS: We performed a systematic search resulting in 10 studies reporting stroke frequency among patients with COVID-19, which were pooled with 1 unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in patients with COVID-19 (n = 125), and we pooled these data with 35 unpublished cases from Canada, the United States, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50-70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death. RESULTS: The proportions of patients with COVID-19 with stroke (1.8%, 95% confidence interval [CI] 0.9%-3.7%) and in-hospital mortality (34.4%, 95% CI 27.2%-42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years of age relative to those >70 years of age (odds ratio [OR] 0.33, 95% CI 0.12-0.94, p = 0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbid conditions. A clinical phenotype characterized by older age, a higher burden of comorbid conditions, and severe COVID-19 respiratory symptoms was associated with the highest in-hospital mortality (58.6%) and a 3 times higher risk of death than the rest of the cohort (OR 3.52, 95% CI 1.53-8.09, p = 0.003). CONCLUSIONS: Stroke is relatively frequent among patients with COVID-19 and has devastating consequences across all ages. The interplay of older age, comorbid conditions, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.

/mortality , Hospital Mortality/trends , Phenotype , Stroke/mortality , Stroke/physiopathology , Humans , Mortality/trends , Risk Factors
Gac Med Mex ; 156(4)2020 May 14.
Article in English | MEDLINE | ID: covidwho-269294


The COVID-19 pandemic, which started in China, has spread rapidly to affect the entire world in a matter of months. Main manifestations of the disease include a febrile syndrome accompanied by respiratory symptoms; however, cases of systemic involvement are increasingly being reported, including cardiac and central nervous system compromise. In the series by Ling M. et al., 214 patients with COVID-19 were studied; 78 (36.4 %) had neurologic manifestations, which were classified into four main groups: acute cerebrovascular disease, impaired consciousness, peripheral nervous system involvement and muscular manifestations. Another report published by Li et al. describes that, out of 221 patients with COVID-19, 13 developed acute cerebrovascular disease with cerebral infarction, venous thrombosis and intracerebral hemorrhage.