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1.
Int Forum Allergy Rhinol ; 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1756550

ABSTRACT

BACKGROUND: The aim of this study was to estimate the prevalence of self-reported chemosensory dysfunction in a study cohort of subjects who developed a mild-to-moderate coronavirus disease 2019 (COVID-19) in the period from January 17, 2022, to February 4, 2022 (Omicron proxy period) and compared that with a historical series of patients testing positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection between March and April, 2020 (comparator period). METHODS: Prospective study based on the 22-item Sino-Nasal Outcome Tool (SNOT-22), item "sense of smell or taste" and additional outcomes. RESULTS: Patients' characteristics and clinical presentations of COVID-19 were evaluated and compared in 779 patients, 338 of the study cohort and 441 of the historical series. The prevalence of self-reported chemosensory dysfunction during the proxy Omicron period (32.5%; 95% confidence interval [CI], 27.6-37.8) was significantly lower from that during the comparator period (66.9%; 95% CI, 62.3-71.3) (p < 0.001). Nearly one-quarter of patients (24.6%; 95% CI, 20.1-29.5) reported an altered sense of smell during the proxy Omicron period compared to 62.6% (95% CI, 57.9-67.1) during the comparator period (p < 0.001). Similarly, the prevalence of an altered sense of taste dropped to 26.9% (95% CI, 22.3-32.0) during the proxy Omicron period from 57.4% (95% CI, 52.6-62.0) during the comparator period (p < 0.001). The severity of chemosensory dysfunction was lower in the proxy Omicron period compared to the comparator period (p < 0.001). CONCLUSION: The prevalence and the severity of COVID-19-associated smell and taste dysfunction has dropped significantly with the advent of the Omicron variant but it still remains above 30%.

2.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-327748

ABSTRACT

Background The aim of this study was to estimate the prevalence of self-reported chemosensory dysfunction in a study cohort of subjects who developed a mild-to-moderate COVID-19 in the period from January 17, 2022 to February 4, 2022 (Omicron proxy period) and compared that with a historical series of patients tested positive for SARS-CoV-2 infection between March and April, 2020 (comparator period). Methods Prospective study based on the sinonasal outcome tool 22 (SNOT-22), item “sense of smell or taste” and additional outcomes. Results Patients’ characteristics and clinical presentations of COVID-19 were evaluated and compared in 779 patients, 338 of the study cohort and 441 of the historical series. The prevalence of self-reported chemosensory dysfunction during the proxy Omicron period (32.5%;95% CI, 27.6-37.8) was significantly lower from that during the comparator period (66.9%;95% CI, 62.3-71.3) ( p <.001). 24.6% (95% CI, 20.1-29.5) of patients reported an altered sense of smell during the proxy Omicron period compared to 62.6% (95% CI, 57.9-67.1) during the comparator period ( p <.001). Similarly, the prevalence of an altered sense of taste dropped from 57.4% (95% CI, 52.6-62.0) during the comparator period to 26.9% (95% CI, 22.3-32.0) during the proxy Omicron period ( p <.001). The severity of chemosensory dysfunction was lower in proxy Omicron period compared to comparator period ( p <.001). Conclusions The prevalence and the severity of COVID-19 associated smell and taste dysfunction has dropped significantly with the advent of the Omicron variant.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-323144

ABSTRACT

Background: Interleukin 6 (IL-6) is a proinflammatory cytokine that is secreted by cells infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and it is widely recognized as a negative prognostic factor. The purpose of this study was to analyze the correlations between the olfactory scores determined by psychophysical tests and the serum levels of IL-6 in patients affected by coronavirus disease 2019 (COVID-19) Methods: : Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and IL-6 plasma level determination within 10 days of the clinical onset of COVID-19. Results: : Seventy-four COVID-19 patients were included in this study. COVID-19 staged as mild in 34 patients, moderate in 26 and severe in 14 cases. There were no significant differences in olfactory scores across the different COVID-19 severity groups In the patient series, the median plasma level of IL-6 was 7.7 pg/mL (IQR 3.7 – 18.8). The concentration of IL-6 was found to be significantly correlated with the severity of COVID-19 with a directly proportional relationship. The correlation between IL-6 plasma concentrations and olfactory scores was weak (r s =0.182) and not significant (p=0.12). Conclusions: : In COVID-19 patients, psychophysical olfactory scores did not show significant correlations with the plasma levels of a well-recognized negative prognostic factor such as IL-6. This observation casts some shadows on the positive prognostic value of olfactory dysfunctions

4.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-309041

ABSTRACT

Since no effective therapy exists, we aimed to test existing HIV antivirals for combination treatment of Coronavirus disease 19 (COVID-19). Our molecular docking findings suggest that lopinavir, ritonavir, darunavir, and atazanavir activated interactions with the key binding sites of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) protease with a better Ki for lopinavir, ritonavir, and darunavir. Furthermore, we evidenced the ability of remdesivir, tenofovir, emtricitabine, and lamivudine to be incorporated in SARS-CoV-2 RNA-dependent RNA polymerase in the same protein pocket where poses the corresponding natural nucleoside substrates with comparable Ki and activating similar interactions. In principle, the four antiviral nucleotides might be used effectively against SARS-CoV-2. The combination of a protease inhibitor and two nucleoside analogues should be evaluated in clinical trials for the treatment of COVID-19.

5.
Front Med (Lausanne) ; 8: 779118, 2021.
Article in English | MEDLINE | ID: covidwho-1674348

ABSTRACT

Introduction: SARS-CoV-2 is fundamentally a respiratory pathogen with a wide spectrum of symptoms. The COVID-19 related pancreatitis is less considered than other clinical features. The purpose is to describe two cases of pancreatitis associated with COVID-19. Methodology: Patients' demographics, clinical features, laboratory, and instrumental findings were collected. Results: Two patients admitted to the hospital were diagnosed with COVID-19 and severe acute pancreatitis, according to the Atlanta criteria. Other causes of acute pancreatitis were excluded. Treatment included broad-spectrum antibiotics, proton pump inhibitors, and low molecular weight heparin. Steroids, oxygen, antifungal treatment, and pain killers were administered when appropriate. Both patients were asymptomatic, with normal vital parameters and blood exams, and were discharged in a good condition. Conclusion: It is recommendable to include lipase and amylase on laboratory routine tests in order to evaluate the need for the abdominal CT-scan and specific therapy before hospital admission of the patients with COVID-19 related life-threatening acute pancreatitis.

6.
PLoS One ; 16(3): e0248009, 2021.
Article in English | MEDLINE | ID: covidwho-1575841

ABSTRACT

INTRODUCTION: Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. METHODS AND FINDINGS: We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab's positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients' autonomy and early heparin treatment were related to lower mortality risk. CONCLUSIONS: We evidenced factors associated with infection's risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.


Subject(s)
COVID-19/pathology , Aged , Aged, 80 and over , Angiotensin Receptor Antagonists/administration & dosage , COVID-19/complications , COVID-19/mortality , COVID-19/virology , Dyspnea/etiology , Female , Fever/etiology , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Male , Mental Disorders/complications , Mental Disorders/pathology , Neoplasms/complications , Neoplasms/pathology , Nursing Homes , Proportional Hazards Models , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Sex Factors , Survival Rate
7.
Laryngoscope ; 132(2): 419-421, 2022 02.
Article in English | MEDLINE | ID: covidwho-1527451

ABSTRACT

The aim of this study is to investigate the clinical profile of patients who developed coronavirus disease 2019 (COVID-19) after full vaccination. Demographic, epidemiological and clinical data were collected through medical records and online patient-reported outcome questionnaire from patients who developed symptomatic SARS-CoV-2 infection, confirmed by nasopharyngeal swab, at least 2 weeks after completion of vaccination. A total of 153 subjects were included. The most frequent symptoms were: asthenia (82.4%), chemosensory dysfunction (63.4%), headache (59.5%), runny nose (58.2%), muscle pain (54.9%), loss of appetite (54.3%), and nasal obstruction (51.6%). Particularly, 62.3% and 53.6% of subjects reported olfactory and gustatory dysfunction, respectively. Symptom severity was mild or moderate in almost all cases. Chemosensory dysfunctions have been observed to be a frequent symptom even in subjects who contracted the infection after full vaccination. For this reason, the sudden loss of smell and taste could continue to represent a useful and specific diagnostic marker to raise the suspicion of COVID-19 even in vaccinated subjects. In the future, it will be necessary to establish what the recovery rate is in these patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:419-421, 2022.


Subject(s)
Ageusia/epidemiology , Anosmia/epidemiology , COVID-19 Vaccines , COVID-19/physiopathology , SARS-CoV-2 , Adult , Ageusia/virology , Anosmia/virology , COVID-19/complications , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , Patient Reported Outcome Measures , Smell/drug effects , Surveys and Questionnaires , Taste/drug effects , Vaccination
8.
Med Princ Pract ; 30(6): 535-541, 2021.
Article in English | MEDLINE | ID: covidwho-1484145

ABSTRACT

OBJECTIVE: We aimed to investigate the presence and severity of depressive symptoms among coronavirus disease 2019 (COVID-19) inpatients and any possible changes after their discharge. SUBJECT AND METHODS: We collected data of patients admitted to the Infectious Disease Unit in Sassari, Italy, for COVID-19, from March 8 to May 8, 2020. The Beck Depression Inventory-II (BDI-II) was performed 1 week after admission (T0) and 1 week after discharge (T1). The cutoff point chosen to define the clinical significance of depressive symptoms was 20 (at least moderate). RESULTS: Forty-eight subjects were included. Mean age was 64.3 ± 17.6 years, and 32 (66.7%) were male. Most frequent comorbidities were cardiovascular diseases (19; 39.6%) and hypertension (17; 35.4%). When performing BDI-II at T0, 21 (43.7%) patients reported depressive symptoms at T0, according to the chosen cutoff point (BDI-II = 20). Eight (16.7%) patients had minimal symptoms. Mild mood disturbance and moderate and severe depressive symptoms were found in 24 (50%), 14 (29.2%), and 2 (4.2%) patients, respectively, at T0. The comparison of the BDI-II questionnaire at T0 with T1 showed a significant improvement in the total score (p < 0.0001), as well as in 4 out of the 5 selected questions of interest (p < 0.05). Univariate analysis showed that kidney failure and the death of a roommate were significantly associated with severity of mood disorders. CONCLUSION: Mood disturbances and depressive symptoms commonly occur among COVID-19 inpatients. Our results show that COVID-19 inpatients might be at higher risk for developing depressive reactive disorders and could benefit from an early psychological evaluation and strategies improving sleep quality.


Subject(s)
COVID-19/psychology , Depression/epidemiology , Inpatients/psychology , Mood Disorders/epidemiology , Sleep/physiology , Adjustment Disorders , Aged , Aged, 80 and over , COVID-19/complications , Depression/diagnosis , Female , Humans , Male , Mental Health , Middle Aged , Mood Disorders/diagnosis , Psychiatric Status Rating Scales , SARS-CoV-2
9.
J Infect Dev Ctries ; 15(3): 353-359, 2021 Mar 31.
Article in English | MEDLINE | ID: covidwho-1444370

ABSTRACT

INTRODUCTION: The early identification of factors that predict the length of hospital stay (HS) in patients affected by coronavirus desease (COVID-19) might assist therapeutic decisions and patient flow management. METHODOLOGY: We collected, at the time of admission, routine clinical, laboratory, and imaging parameters of hypoxia, lung damage, inflammation, and organ dysfunction in a consecutive series of 50 COVID-19 patients admitted to the Respiratory Disease and Infectious Disease Units of the University Hospital of Sassari (North-Sardinia, Italy) and alive on discharge. RESULTS: Prolonged HS (PHS, >21 days) patients had significantly lower PaO2/FiO2 ratio and lymphocytes, and significantly higher Chest CT severity score, C-reactive protein (CRP) and lactic dehydrogenase (LDH) when compared to non-PHS patients. In univariate logistic regression, Chest CT severity score (OR = 1.1891, p = 0.007), intensity of care (OR = 2.1350, p = 0.022), PaO2/FiO2 ratio (OR = 0.9802, p = 0.007), CRP (OR = 1.0952, p = 0.042) and platelet to lymphocyte ratio (OR = 1.0039, p = 0.036) were significantly associated with PHS. However, in multivariate logistic regression, only the PaO2/FiO2 ratio remained significantly correlated with PHS (OR = 0.9164; 95% CI 0.8479-0.9904, p = 0.0275). In ROC curve analysis, using a threshold of 248, the PaO2/FiO2 ratio predicted PHS with sensitivity and specificity of 60% and 91%, respectively (AUC = 0.780, 95% CI 0.637-0.886 p = 0.002). CONCLUSIONS: The PaO2/FiO2 ratio on admission is independently associated with PHS in COVID-19 patients. Larger prospective studies are needed to confirm this finding.


Subject(s)
COVID-19/diagnosis , COVID-19/physiopathology , Hypoxia/diagnosis , Length of Stay/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Hypoxia/virology , Italy/epidemiology , Male , Middle Aged , Prospective Studies , Retrospective Studies
10.
11.
Laryngoscope ; 131(10): 2312-2318, 2021 10.
Article in English | MEDLINE | ID: covidwho-1318729

ABSTRACT

OBJECTIVES/HYPOTHESIS: The aim of this study was to evaluate the correlations between the severity and duration of olfactory dysfunctions (OD), assessed with psychophysical tests, and the viral load on the rhino-pharyngeal swab determined with a direct method, in patients affected by coronavirus disease 2019 (COVID-19). STUDY DESIGN: Prospective cohort study. METHODS: Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and determination of the normalized viral load on nasopharyngeal swab within 10 days of the clinical onset of COVID-19. RESULTS: Sixty COVID-19 patients were included in this study. On psychophysical testing, 12 patients (20% of the cohort) presented with anosmia, 11 (18.3%) severe hyposmia, 13 (18.3%) moderate hyposmia, and 10 (16.7%) mild hyposmia with an overall prevalence of OD of 76.7%. The overall median olfactory score was 50 (interquartile range [IQR] 30-72.5) with no significant differences between clinical severity subgroups. The median normalized viral load detected in the series was 2.56E+06 viral copies/106 copies of human beta-2microglobulin mRNA present in the sample (IQR 3.17E+04-1.58E+07) without any significant correlations with COVID-19 severity. The correlation between viral load and olfactory scores at baseline (R2  = 0.0007; P = .844) and 60-day follow-up (R2  = 0.0077; P = .519) was weak and not significant. CONCLUSIONS: The presence of OD does not seem to be useful in identifying subjects at risk for being super-spreaders or who is at risk of developing long-term OD. Similarly, the pathogenesis of OD is probably related to individual factors rather than to viral load and activity. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2312-2318, 2021.


Subject(s)
Anosmia/diagnosis , COVID-19/complications , SARS-CoV-2/physiology , Severity of Illness Index , Viral Load/statistics & numerical data , Aged , Anosmia/virology , COVID-19/virology , Female , Humans , Male , Middle Aged , Prevalence , Prospective Studies
12.
Eur Arch Otorhinolaryngol ; 279(2): 811-816, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1226215

ABSTRACT

BACKGROUND: Interleukin 6 (IL-6) is a proinflammatory cytokine that is secreted by cells infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and it is widely recognized as a negative prognostic factor. The purpose of this study was to analyze the correlations between the olfactory scores determined by psychophysical tests and the serum levels of IL-6 in patients affected by coronavirus disease 2019 (COVID-19) METHODS: Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and IL-6 plasma level determination within 10 days of the clinical onset of COVID-19. RESULTS: Seventy-four COVID-19 patients were included in this study. COVID-19 staged as mild in 34 patients, moderate in 26 and severe in 14 cases. There were no significant differences in olfactory scores across the different COVID-19 severity groups. In the patient series, the median plasma level of IL-6 was 7.7 pg/mL (IQR 3.7-18.8). The concentration of IL-6 was found to be significantly correlated with the severity of COVID-19 with a directly proportional relationship. The correlation between IL-6 plasma concentrations and olfactory scores was weak (rs = 0.182) and not significant (p = 0.12). CONCLUSIONS: In COVID-19 patients, psychophysical olfactory scores did not show significant correlations with the plasma levels of a well-recognized negative prognostic factor such as IL-6. This observation casts some shadows on the positive prognostic value of olfactory dysfunctions.


Subject(s)
COVID-19 , Olfaction Disorders , Humans , Interleukin-6 , Olfaction Disorders/diagnosis , Olfaction Disorders/etiology , SARS-CoV-2 , Smell
13.
J. bras. pneumol ; 46(5):e20200226-e20200226, 2020.
Article in English | LILACS (Americas), Grey literature | ID: grc-742173

ABSTRACT

ABSTRACT Objective: To investigate the diagnostic accuracy of a chest X-ray (CXR) score and of clinical and laboratory data in predicting the clinical course of patients with SARS coronavirus 2 (SARS-CoV-2) infection. Methods: This is a pilot multicenter retrospective study including patients with SARS-CoV-2 infection admitted to the ERs in three hospitals in Italy between February and March of 2020. Two radiologists independently evaluated the baseline CXR of the patients using a semi-quantitative score to determine the severity of lung involvement: a score of 0 represented no lung involvement, whereas scores of 1 to 4 represented the first (less severe) to the fourth (more severe) quartiles regarding the severity of lung involvement. Relevant clinical and laboratory data were collected. The outcome of patients was defined as severe if noninvasive ventilation (NIV) or intubation was necessary, or if the patient died. Results: Our sample comprised 140 patients. Most of the patients were symptomatic (132/138;95.7%), and 133/140 patients (95.0%) presented with opacities on CXR at admission. Of the 140 patients, 7 (5.0%) showed no lung involvement, whereas 58 (41.4%), 31 (22.1%), 26 (18.6%), and 18 (12.9%), respectively, scored 1, 2, 3, and 4. In our sample, 66 patients underwent NIV or intubation, 37 of whom scored 1 or 2 on baseline CXR, and 28 patients died. Conclusions: The severity score based on CXR seems to be able to predict the clinical progression in cases that scored 0, 3, or 4. However, the score alone cannot predict the clinical progression in patients with mild-to-moderate parenchymal involvement (scores 1 and 2). RESUMO Objetivo: Investigar a acurácia diagnóstica de um escore de radiografia de tórax (RxT) e também de dados clínicos e laboratoriais na previsão da evolução clínica de pacientes com infecção por SARS coronavirus 2 (SARS-CoV-2). Métodos: Estudo piloto multicêntrico retrospectivo incluindo pacientes com infecção por SARS-CoV-2 internados nos PSs de três hospitais na Itália entre fevereiro e março de 2020. Dois radiologistas avaliaram as RxT iniciais dos pacientes de forma independente utilizando um escore semiquantitativo para determinar a gravidade do comprometimento pulmonar: escore 0 representava ausência de comprometimento pulmonar, enquanto escores de 1 a 4 representavam o primeiro (menos grave) ao quarto (mais grave) quartil de gravidade do comprometimento pulmonar. Coletaram-se dados clínicos e laboratoriais relevantes. O desfecho dos pacientes foi definido como grave se foi necessária ventilação não invasiva (VNI) ou intubação ou se o paciente faleceu. Resultados: Nossa amostra foi composta por 140 pacientes. A maioria era sintomática (132/138;95,7%), e 133/140 (95,0%) apresentavam opacidades na RxT da admissão. Dos 140 pacientes, 7 (5,0%) não apresentavam comprometimento pulmonar, enquanto 58 (41,4%), 31 (22,1%), 26 (18,6%) e 18 (12,9%), respectivamente, receberam escore 1, 2, 3 e 4. Em nossa amostra, 66 pacientes foram submetidos a VNI ou intubação, 37 dos quais receberam escore 1 ou 2 na RxT inicial, e 28 pacientes faleceram. Conclusões: O escore de gravidade baseado em RxT parece ser capaz de prever a evolução clínica em casos com escore 0, 3 ou 4. No entanto, o escore isoladamente não consegue prever a evolução clínica de pacientes com comprometimento leve a moderado do parênquima (escores 1 e 2).

14.
Eur J Clin Invest ; 51(1): e13427, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-846927

ABSTRACT

Increased concentrations of serum aspartate transaminase (AST) and alanine transaminase (ALT) are common in COVID-19 patients. However, their capacity to predict mortality, particularly the AST/ALT ratio, commonly referred to as the De Ritis ratio, is unknown. We investigated the association between the De Ritis ratio on admission and in-hospital mortality in 105 consecutive patients with coronavirus disease of 2019 (COVID-19) admitted to three COVID-19 referral centres in Sardinia, Italy. The De Ritis ratio was significantly lower in survivors than nonsurvivors (median: 1.25; IQR: 0.91-1.64 vs 1.67; IQR: 1.38-1.97, P = .002) whilst there were no significant between-group differences in ALT and AST concentrations. In ROC curve analysis, the AUC value of the De Ritis ratio was 0.701 (95% CI 0.603-0.787, P = .0006) with sensitivity and specificity of 74% and 70%, respectively. Kaplan-Meier survival curves showed a significant association between the De Ritis ratio and mortality (logrank test P = .014). By contrast, no associations were observed between the ALT and AST concentrations and mortality (logrank test P = .83 and P = .62, respectively). In multivariate Cox regression analysis, the HR in patients with De Ritis ratios ≥1.63 (upper tertile of this parameter) remained significant after adjusting for age, gender, smoking status, cardiovascular disease, intensity of care, diabetes, respiratory diseases, malignancies and kidney disease (HR: 2.46, 95% CI 1.05-5.73, P = .037). Therefore, the De Ritis ratio on admission was significantly associated with in-hospital mortality in COVID-19 patients. Larger studies are required to confirm the capacity of this parameter to independently predict mortality in this group.


Subject(s)
Alanine Transaminase/blood , Aspartate Aminotransferases/blood , COVID-19/blood , Hospital Mortality , Aged , Aged, 80 and over , C-Reactive Protein/metabolism , COVID-19/mortality , COVID-19/therapy , Cardiovascular Diseases/epidemiology , Comorbidity , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Italy/epidemiology , L-Lactate Dehydrogenase/blood , Leukocyte Count , Male , Middle Aged , Multivariate Analysis , Noninvasive Ventilation , Oxygen Inhalation Therapy , Prognosis , Proportional Hazards Models , ROC Curve , Respiration, Artificial , SARS-CoV-2
15.
J. bras. pneumol ; 46(5): e20200226, 2020. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-790252

ABSTRACT

ABSTRACT Objective: To investigate the diagnostic accuracy of a chest X-ray (CXR) score and of clinical and laboratory data in predicting the clinical course of patients with SARS coronavirus 2 (SARS-CoV-2) infection. Methods: This is a pilot multicenter retrospective study including patients with SARS-CoV-2 infection admitted to the ERs in three hospitals in Italy between February and March of 2020. Two radiologists independently evaluated the baseline CXR of the patients using a semi-quantitative score to determine the severity of lung involvement: a score of 0 represented no lung involvement, whereas scores of 1 to 4 represented the first (less severe) to the fourth (more severe) quartiles regarding the severity of lung involvement. Relevant clinical and laboratory data were collected. The outcome of patients was defined as severe if noninvasive ventilation (NIV) or intubation was necessary, or if the patient died. Results: Our sample comprised 140 patients. Most of the patients were symptomatic (132/138; 95.7%), and 133/140 patients (95.0%) presented with opacities on CXR at admission. Of the 140 patients, 7 (5.0%) showed no lung involvement, whereas 58 (41.4%), 31 (22.1%), 26 (18.6%), and 18 (12.9%), respectively, scored 1, 2, 3, and 4. In our sample, 66 patients underwent NIV or intubation, 37 of whom scored 1 or 2 on baseline CXR, and 28 patients died. Conclusions: The severity score based on CXR seems to be able to predict the clinical progression in cases that scored 0, 3, or 4. However, the score alone cannot predict the clinical progression in patients with mild-to-moderate parenchymal involvement (scores 1 and 2).


RESUMO Objetivo: Investigar a acurácia diagnóstica de um escore de radiografia de tórax (RxT) e também de dados clínicos e laboratoriais na previsão da evolução clínica de pacientes com infecção por SARS coronavirus 2 (SARS-CoV-2). Métodos: Estudo piloto multicêntrico retrospectivo incluindo pacientes com infecção por SARS-CoV-2 internados nos PSs de três hospitais na Itália entre fevereiro e março de 2020. Dois radiologistas avaliaram as RxT iniciais dos pacientes de forma independente utilizando um escore semiquantitativo para determinar a gravidade do comprometimento pulmonar: escore 0 representava ausência de comprometimento pulmonar, enquanto escores de 1 a 4 representavam o primeiro (menos grave) ao quarto (mais grave) quartil de gravidade do comprometimento pulmonar. Coletaram-se dados clínicos e laboratoriais relevantes. O desfecho dos pacientes foi definido como grave se foi necessária ventilação não invasiva (VNI) ou intubação ou se o paciente faleceu. Resultados: Nossa amostra foi composta por 140 pacientes. A maioria era sintomática (132/138; 95,7%), e 133/140 (95,0%) apresentavam opacidades na RxT da admissão. Dos 140 pacientes, 7 (5,0%) não apresentavam comprometimento pulmonar, enquanto 58 (41,4%), 31 (22,1%), 26 (18,6%) e 18 (12,9%), respectivamente, receberam escore 1, 2, 3 e 4. Em nossa amostra, 66 pacientes foram submetidos a VNI ou intubação, 37 dos quais receberam escore 1 ou 2 na RxT inicial, e 28 pacientes faleceram. Conclusões: O escore de gravidade baseado em RxT parece ser capaz de prever a evolução clínica em casos com escore 0, 3 ou 4. No entanto, o escore isoladamente não consegue prever a evolução clínica de pacientes com comprometimento leve a moderado do parênquima (escores 1 e 2).


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Coronavirus Infections/diagnostic imaging , Pandemics , Lung/diagnostic imaging , X-Rays , Retrospective Studies , Severe Acute Respiratory Syndrome , Betacoronavirus , SARS-CoV-2 , COVID-19 , Italy/epidemiology
16.
Mediterr J Hematol Infect Dis ; 12(1): e2020056, 2020.
Article in English | MEDLINE | ID: covidwho-760987

ABSTRACT

The purpose of the present review is to give an update regarding the classification, epidemiology, clinical manifestation, diagnoses, and treatment of the Rickettsial diseases present in the Mediterranean area. We performed a comprehensive search, through electronic databases (Pubmed - MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles, reviews, and books). The availability of new diagnostic tools, including Polymerase Chain Reaction and nucleotide sequencing has significantly modified the classification of intracellular bacteria, including the order Rickettsiales with more and more new Rickettsia species recognized as human pathogens. Furthermore, emerging Rickettsia species have been found in several countries and are often associated with unique clinical pictures that may challenge the physician in the early detection of the diseases. Rickettsial infections include a wide spectrum of clinical presentations ranging from a benign to a potentially life treating disease that requires prompt recognition and proper management. Recently, due to the spread of SARS-CoV-2 infection, the differential diagnosis with COVID-19 is of crucial importance. The correct understanding of the clinical features, diagnostic tools, and proper treatment can assist clinicians in the management of Rickettsioses in the Mediterranean area.

17.
Head Neck ; 42(7): 1560-1569, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-327366

ABSTRACT

BACKGROUND: Objective data on chemosensitive disorders during COVID-19 are lacking in the Literature. METHODS: Multicenter cohort study that involved four Italian hospitals. Three hundred and forty-five COVID-19 patients underwent objective chemosensitive evaluation. RESULTS: Chemosensitive disorders self-reported by 256 patients (74.2%) but the 30.1% of the 89 patients who did not report dysfunctions proved objectively hyposmic. Twenty-five percentage of patients were seen serious long-lasting complaints. All asymptomatic patients had a slight lowering of the olfactory threshold. No significant correlations were found between the presence and severity of chemosensitive disorders and the severity of the clinical course. On the contrary, there is a significant correlation between the duration of the olfactory and gustatory symptoms and the development of severe COVID-19. CONCLUSIONS: Patients under-report the frequency of chemosensitive disorders. Contrary to recent reports, such objective testing refutes the proposal that the presence of olfactory and gustatory dysfunction may predict a milder course, but instead suggests that those with more severe disease neglect such symptoms in the setting of severe respiratory disease.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Olfaction Disorders/diagnosis , Pneumonia, Viral/complications , Sensory Thresholds , Taste Disorders/diagnosis , Adult , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Female , Humans , Italy , Male , Middle Aged , Olfaction Disorders/virology , Pandemics , SARS-CoV-2 , Severity of Illness Index , Taste Disorders/virology , Young Adult
18.
Head Neck ; 42(6): 1252-1258, 2020 06.
Article in English | MEDLINE | ID: covidwho-133571

ABSTRACT

BACKGROUND: The first European case series are detecting a very high frequency of chemosensitive disorders in COVID-19 patients, ranging between 19.4% and 88%. METHODS: Olfactory and gustatory function was objectively tested in 72 COVID-19 patients treated at University Hospital of Sassari. RESULTS: Overall, 73.6% of the patients reported having or having had chemosensitive disorders. Olfactory assessment showed variable degree hyposmia in 60 cases and anosmia in two patients. Gustatory assessment revealed hypogeusia in 33 cases and complete ageusia in one patient. Statistically significant differences in chemosensitive recovery were detected based on age and distance from the onset of clinical manifestations. CONCLUSION: Olfactory and gustatory dysfunctions represent common clinical findings in COVID-19 patients. Otolaryngologists and head-neck surgeons must by now keep this diagnostic option in mind when evaluating cases of ageusia and nonspecific anosmia that arose suddenly and are not associated with rhinitis symptoms.


Subject(s)
Ageusia/diagnosis , Ageusia/epidemiology , Betacoronavirus , Coronavirus Infections/complications , Olfaction Disorders/diagnosis , Olfaction Disorders/epidemiology , Pneumonia, Viral/complications , Aged , COVID-19 , Cohort Studies , Female , Hospitalization , Humans , Italy , Male , Middle Aged , Pandemics , SARS-CoV-2 , Symptom Assessment , Time Factors
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