Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 676
Filter
Add filters

Year range
3.
Endocr Relat Cancer ; 27(9): R357-R374, 2020 09.
Article in English | MEDLINE | ID: covidwho-693491

ABSTRACT

Substantial management changes in endocrine-related malignancies have been required as a response to the COVID-19 pandemic, including a draconian reduction in the screening of asymptomatic subjects, delay in planned surgery and radiotherapy for primary tumors deemed to be indolent, and dose reductions and/or delays in initiation of some systemic therapies. An added key factor has been a patient-initiated delay in the presentation because of the fear of viral infection. Patterns of clinical consultation have changed, including a greater level of virtual visits, physical spacing, masking, staffing changes to ensure a COVID-free population and significant changes in patterns of family involvement. While this has occurred to improve safety from COVID-19 infection, the implications for cancer outcomes have not yet been defined. Based on prior epidemics and financial recessions, it is likely that delayed presentation and treatment of high-grade malignancy will be associated with worse cancer outcomes. Cancer patients are also at increased risk from COVID-19 infection compared to the general population. Pandemic management strategies for patients with tumors of breast, prostate, thyroid, parathyroid and adrenal gland are reviewed.

4.
Infect Control Hosp Epidemiol ; : 1-8, 2020 Aug 03.
Article in English | MEDLINE | ID: covidwho-693374

ABSTRACT

Facemask use may promote face touching. We recorded patients with possible COVID-19 awaiting evaluation in an ambulatory clinic. Patients with a facemask touched their face 11.41 times on average and ranged up to 80 times. Mask use should be accompanied by hand hygiene and reminders not to touch one's face.

5.
Lancet Gastroenterol Hepatol ; 5(8): 765-775, 2020 08.
Article in English | MEDLINE | ID: covidwho-692971

ABSTRACT

Around the world, recommendations for cancer treatment are being adapted in real time in response to the pandemic of COVID-19. We, as a multidisciplinary team, reviewed the standard management options, according to the Barcelona Clinic Liver Cancer classification system, for hepatocellular carcinoma. We propose treatment recommendations related to COVID-19 for the different stages of hepatocellular carcinoma (ie, 0, A, B, and C), specifically in relation to surgery, locoregional therapies, and systemic therapy. We suggest potential strategies to modify risk during the pandemic and aid multidisciplinary treatment decision making. We also review the multidisciplinary management of intrahepatic cholangiocarcinoma as a potentially curable and incurable diagnosis in the setting of COVID-19.


Subject(s)
Carcinoma, Hepatocellular/therapy , Coronavirus Infections/epidemiology , Liver Neoplasms/therapy , Pandemics , Pneumonia, Viral/epidemiology , Betacoronavirus , Bile Duct Neoplasms/therapy , Carcinoma, Hepatocellular/pathology , Cholangiocarcinoma/therapy , Clinical Decision-Making , Humans , Liver Neoplasms/pathology , Neoplasm Staging , Patient Care Team , Risk Factors
7.
Clini. Ethics ; 2020.
Article in English | ELSEVIER | ID: covidwho-692332

ABSTRACT

A new Clinical Ethics Advisory Group (CEAG) was created to contribute to NHS Trust policies and guidelines in response to ethical issues arising from the COVID-19 pandemic. An ethical analysis framework used in medical education, the CoRE-Values Compass and Grid, was adapted to form a step-wise ‘ABC’ decision-making process. CEAG members found the framework simple to understand and use and the model facilitated time-efficient decisions that were explicitly justifiable on moral, ethical, professional and legal grounds. The adapted CoRE-Values framework might help facilitate decision-making processes for similar new clinical ethics advisory or support committees.

8.
Cities Health ; 2020.
Article in English | ELSEVIER | ID: covidwho-691905

ABSTRACT

The lockdown enforced by the UK Government to prevent the spread of the SARS-CoV-2 virus has led to an unparalleled reduction in traffic volumes and significant drop in nitrogen dioxide concentrations in most cities, although the picture emerging from residential emissions of particulate matter (PM 10and PM 2.5) is more complex. The scale and degree of the intervention have exposed the level of change required to reduce pollution. Learning from the COVID-19 crisis, we identify three challenges that must be overcome to improve air quality in cities. First, what measures would be effective that balance civil liberties with enforcement action on air pollution? Second, how do we consolidate the cultural change needed to retain and normalise the social practices driving the observed pollution reduction? Third, how do we tackle these challenges in a way that breaks current patterns of socio-economic, health and environmental inequality?.

9.
Ann Otol Rhinol Laryngol ; : 3489420947767, 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-691916

ABSTRACT

OBJECTIVES: To describe Otolaryngologists' perspective in managing COVID-19 patients with acute respiratory distress syndrome (ARDS) requiring tracheostomy in the ICUs during the pandemic peak in a dramatic scenario with limited resources. SETTING: Tertiary referral university hospital, regional hub in northern Italy during SARS CoV 2 pandemic peak (March 9th to April 10th, 2020). METHODS: Technical description of open bedside tracheostomies performed in ICUs on COVID-19 patients during pandemic peak with particular focus on resource allocation and healthcare professionals coordination. A dedicated "airway team" was created in order to avoid transportation of critically ill patients and reduce facility contamination. RESULTS: During the COVID-19 pandemic, bedside minimally invasive tracheostomy in the ICU was selected by the Authors over conventional surgical technique or percutaneous procedures for both technical and operational reasons. Otolaryngologists' experience derived from direct involvement in 24 tracheostomies is reported. CONCLUSIONS: Tracheostomies on COVID-19 patients should be performed in a safe and standardized setting. The limited resources available in the pandemic peak required meticulous organization and optimal allocation of the resources to grant safety of both patients and healthcare workers.

10.
J Transl Med ; 18(1): 299, 2020 08 03.
Article in English | MEDLINE | ID: covidwho-691901

ABSTRACT

BACKGROUND: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between Percentage of Fat Mass (FM%) and immune-inflammatory response, after 10 days in Intensive Care Unit (ICU). METHODS: Prospective observational study of 22 adult patients, affected by COVID-19 pneumonia and admitted to the ICU and classified in two sets: (10) lean and (12) obese, according to FM% and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day. RESULTS: Obese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients. CONCLUSION: This is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.

11.
Dimens Crit Care Nurs ; 39(5): 239-241, 2020.
Article in English | MEDLINE | ID: covidwho-691718
13.
Clinical and experimental rheumatology ; 38(4):748-753, 2020.
Article | WHO COVID | ID: covidwho-691084

ABSTRACT

OBJECTIVES: Italy was one of the first countries significantly affected by the coronavirus disease 2019 (COVID-19) epidemic The Italian Society for Rheumatology promptly launched a retrospective and anonymised data collection to monitor COVID-19 in patients with rheumatic and musculoskeletal diseases (RMDs), the CONTROL-19 surveillance database, which is part of the COVID-19 Global Rheumatology Alliance METHODS: CONTROL-19 includes patients with RMDs and proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) updated until May 3rd 2020 In this analysis, only molecular diagnoses were included The data collection covered demographic data, medical history (general and RMD-related), treatments and COVID-19 related features, treatments, and outcome In this paper, we report the first descriptive data from the CONTROL-19 registry RESULTS: The population of the first 232 patients (36% males) consisted mainly of elderly patients (mean age 62 2 years), who used corticosteroids (51 7%), and suffered from multi-morbidity (median comorbidities 2) Rheumatoid arthritis was the most frequent disease (34 1%), followed by spondyloarthritis (26 3%), connective tissue disease (21 1%) and vasculitis (11 2%) Most cases had an active disease (69 4%) Clinical presentation of COVID-19 was typical, with systemic symptoms (fever and asthenia) and respiratory symptoms The overall outcome was severe, with high frequencies of hospitalisation (69 8%), respiratory support oxygen (55 7%), non-invasive ventilation (20 9%) or mechanical ventilation (7 5%), and 19% of deaths Male patients typically manifested a worse prognosis Immunomodulatory treatments were not significantly associated with an increased risk of intensive care unit admission/mechanical ventilation/death CONCLUSIONS: Although the report mainly includes the most severe cases, its temporal and spatial trend supports the validity of the national surveillance system More complete data are being acquired in order to both test the hypothesis that RMD patients may have a different outcome from that of the general population and determine the safety of immunomodulatory treatments

14.
Microorg. ; 8(8): 1-10, 20200801.
Article in English | ELSEVIER | ID: covidwho-690398

ABSTRACT

Since February 2020, Italy has been seriously affected by the SARS-CoV-2 pandemic. To support the National Health Care system, naso-pharyngeal/oropharyngeal swabs collected from suspected cases of Teramo province, Abruzzo region, are tested at Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise G. Caporale, for the presence of SARS-CoV-2 RNA. Out of 12,446 tested individuals, 605 returned positive results at least once, with prevalence significantly higher in men. A reduction of the level of viral RNA in the first swabs per each positive patient collected over time was also observed. Moreover, 81 patients had at least one positive sample and two final negative tests: positivity in swabs lasted from 14 to 63 days, with a median value of 30 days. This shows the potential for the virus to coexist with patients for a long time, although we highlighted intermittent positivity in several cases. The evolution of the SARS-CoV-2 epidemiological situation and knowledge on viral shedding should be closely monitored, to interpret the findings correctly and adjust accordingly the surveillance activities.

15.
Nat Struct Mol Biol ; 2020 Jul 31.
Article in English | MEDLINE | ID: covidwho-691288

ABSTRACT

The spike (S) protein of SARS-CoV-2 mediates receptor binding and cell entry and is the dominant target of the immune system. It exhibits substantial conformational flexibility. It transitions from closed to open conformations to expose its receptor-binding site and, subsequently, from prefusion to postfusion conformations to mediate fusion of viral and cellular membranes. S-protein derivatives are components of vaccine candidates and diagnostic assays, as well as tools for research into the biology and immunology of SARS-CoV-2. Here we have designed mutations in S that allow the production of thermostable, disulfide-bonded S-protein trimers that are trapped in the closed, prefusion state. Structures of the disulfide-stabilized and non-disulfide-stabilized proteins reveal distinct closed and locked conformations of the S trimer. We demonstrate that the designed, thermostable, closed S trimer can be used in serological assays. This protein has potential applications as a reagent for serology, virology and as an immunogen.

16.
Nature ; 2020 Jul 29.
Article in English | MEDLINE | ID: covidwho-691112

ABSTRACT

The papain-like protease PLpro is an essential coronavirus enzyme required for processing viral polyproteins to generate a functional replicase complex and enable viral spread1,2. PLpro is also implicated in cleaving proteinaceous post-translational modifications on host proteins as an evasion mechanism against host anti-viral immune responses3-5. Here, we provide biochemical, structural and functional characterization of the SARS-CoV-2 PLpro (SCoV2-PLpro) and outline differences to SARS-CoV PLpro (SCoV-PLpro) in controlling host interferon (IFN) and NF-κB pathways. While SCoV2-PLpro and SCoV-PLpro share 83% sequence identity, they exhibit different host substrate preferences. In particular, SCoV2-PLpro preferentially cleaves the ubiquitin-like protein ISG15, whereas SCoV-PLpro predominantly targets ubiquitin chains. The crystal structure of SCoV2-PLpro in complex with ISG15 reveals distinctive interactions with the amino-terminal ubiquitin-like domain of ISG15, highlighting this high affinity and specificity. Furthermore, upon infection, SCoV2-PLpro contributes to the cleavage of ISG15 from interferon responsive factor 3 (IRF3) and attenuates type I interferon responses. Importantly, inhibition of SCoV2-PLpro with GRL-0617 impairs the virus-induced cytopathogenic effect, fosters the anti-viral interferon pathway and reduces viral replication in infected cells. These results highlight a dual therapeutic strategy in which targeting of SCoV2-PLpro can suppress SARS-CoV-2 infection and promote anti-viral immunity.

17.
Arthritis Rheumatol ; 2020 Aug 02.
Article in English | MEDLINE | ID: covidwho-690992

ABSTRACT

OBJECTIVE: Antirheumatic disease therapies have been used to treat coronavirus disease 2019 (COVID-19) and its complications. We conducted a systematic review and meta-analysis to describe the current evidence. METHODS: A search of published and preprint databases in all languages was performed. Included studies described one or more relevant clinical outcomes in five or more people who were infected with SARS-CoV-2 and were treated with antirheumatic disease therapy between 01/01/2019 and 05/29/2020. Pairs of reviewers screened articles and extracted data and assessed risk of bias. A meta-analysis of effect sizes using the random-effects models was performed when possible. RESULTS: The search identified 3,935 articles, of which 45 were included (4 randomized controlled trials, 29 cohort studies, and 12 case series). All studies evaluated hospitalized patients and 29 out of 45 had been published in a peer-reviewed journal. In a meta-analysis of three cohort studies with a low risk of bias, hydroxychloroquine use was not significantly associated with mortality (pooled hazard ratio (HR) 1.41, 95% confidence interval (CI) 0.83-2.42). In a meta-analysis of two cohort studies with some concerns/high risk of bias, anakinra use was associated with lower mortality (pooled HR 0.2, 95% CI 0.1-0.4). Evidence was inconclusive with regard to other antirheumatic disease therapies and the majority of other studies had a high risk of bias. CONCLUSION: In this systematic review and meta-analysis, hydroxychloroquine use was not associated with benefit or harm with regard to COVID-19 mortality. The evidence supporting the effect of other antirheumatic disease therapies in COVID-19 is currently inconclusive.

18.
J Eur Acad Dermatol Venereol ; 2020 Jul 31.
Article in English | MEDLINE | ID: covidwho-690575

ABSTRACT

Skin rashes associated with COVID-19 include eruptions induced by drugs prescribed for management of this infection. We report a case of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a patient with COVID-19. A 50-year-old man was admitted to the intensive care unit for pneumonia with acute respiratory distress syndrome. COVID-19 was confirmed by positive RT-PCR SARS-CoV-2 on nasopharyngeal swabs and later by positive IgM and IgG antibodies against SARS-CoV-2 (114,5 AU/mL). In the context of fever >38,5°C, nine days after admission, the patient developed a generalized maculopapular rash on more than 70% of his body surface area with oedema of hands and face (Fig.1). Azithromycin and hydroxychloroquine had been initiated 18 and 17 days respectively prior to the skin eruption.

19.
Rev Esp Geriatr Gerontol ; 2020 Jul 16.
Article in Spanish | MEDLINE | ID: covidwho-690543

ABSTRACT

OBJECTIVE: The SARS-CoV-2 pandemic conditions high mortality rates in hospitalized elderly. Currently, a few studies include octogenarian patients and none of them analyze the impact of functional status on this health outcome. Our objective is to describe the characteristics of patients older than 80 years hospitalized for coronavirus disease 2019 (COVID-19), to determine the mortality rate and to identify associated factors. MATERIAL AND METHODS: Prospective observational study carried out on patients over 80 years admitted for COVID-19 in a Geriatrics Service. Sociodemographic, clinical, functional, mental, analytical, radiological, therapeutic and healthcare variables were collected. The factors associated with in-hospital lethality were analyzed by bivariate analysis. RESULTS: 58 cases with laboratory-confirmed COVID-19 were included, mean age 88.3 ± 5.4 years, 69% women, 65.5% moderate-severe cognitive impairment and previous Barthel index 40.66 ± 36. The main symptoms were fever (60,3%), dyspnea (53.4%) and deterioration of functional condition (50%). The most frequent comorbidities were cardiovascular disease (75.9%), hypertension (HT) (74.1%) and chronic kidney disease (CKD) (50%). A mortality rate of 41,4% was detected and the associated factors were: severe functional dependence (OR = 3.8 [1.2-12.2]), moderate-severe cognitive impairment (OR = 4.9 [1-25.4]) and CKD (OR = 3.2 [1.1-9.7]). CONCLUSION: High mortality rates are observed in older patients hospitalized for COVID-19, with a higher risk of dying in those with severe functional dependence or cognitive impairment. These findings reinforce the value of Geriatric Assessment to develop strategies to adapt diagnostic and therapeutic decision-making and to optimize care for elderly patients in the event of a new epidemic outbreak.

20.
Sci Immunol ; 5(49)2020 07 29.
Article in English | MEDLINE | ID: covidwho-690482

ABSTRACT

Limited data are available for pregnant women affected by SARS-CoV-2. Serological tests are critically important for determining SARS-CoV-2 exposures within both individuals and populations. We validated a SARS-CoV-2 spike receptor binding domain serological test using 834 pre-pandemic samples and 31 samples from COVID-19 recovered donors. We then completed SARS-CoV-2 serological testing of 1,293 parturient women at two centers in Philadelphia from April 4 to June 3, 2020. We found 80/1,293 (6.2%) of parturient women possessed IgG and/or IgM SARS-CoV-2-specific antibodies. We found race/ethnicity differences in seroprevalence rates, with higher rates in Black/non-Hispanic and Hispanic/Latino women. Of the 72 seropositive women who also received nasopharyngeal polymerase chain reaction testing during pregnancy, 46 (64%) were positive. Continued serologic surveillance among pregnant women may inform perinatal clinical practices and can potentially be used to estimate exposure to SARS-CoV-2 within the community.

SELECTION OF CITATIONS
SEARCH DETAIL