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3.
Med Klin Intensivmed Notfmed ; 115(5): 390-392, 2020 Jun.
Article in German | MEDLINE | ID: covidwho-1384336

ABSTRACT

Pregnant employees should be protected, particularly in crisis situations. The Maternity Protection Act states that employees are not allowed to have contact with infectious people, including people with SARS-CoV-2 infections; no new regulation is required here.


Subject(s)
Betacoronavirus , Coronavirus Infections , Health Personnel , Pandemics , Pneumonia, Viral , Pregnant Women , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Female , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pregnancy , SARS-CoV-2
4.
Viruses ; 13(7)2021 07 12.
Article in English | MEDLINE | ID: covidwho-1308454

ABSTRACT

The SARS-CoV-2 virus causing COVID-19 disease has emerged expeditiously in the world and has been declared pandemic since March 2020, by World Health Organization (WHO). The destructive effects of SARS-CoV-2 infection are increased among the patients with pre-existing chronic conditions and, in particular, this review focuses on patients with underlying cardiovascular complications. The expression pattern and potential functions of SARS-CoV-2 binding receptors and the attributes of SARS-CoV-2 virus tropism in a physio-pathological state of heart and blood vessel are precisely described. Of note, the atheroprotective role of ACE2 receptors is reviewed. A detailed description of the possible detrimental role of SARS-CoV-2 infection in terms of vascular leakage, including endothelial glycocalyx dysfunction and bradykinin 1 receptor stimulation is concisely stated. Furthermore, the potential molecular mechanisms underlying SARS-CoV-2 induced clot formation in association with host defense components, including activation of FXIIa, complements and platelets, endothelial dysfunction, immune cell responses with cytokine-mediated action are well elaborated. Moreover, a brief clinical update on patient with COVID-19 disease with underlying cardiovascular complications and those who had new onset of cardiovascular complications post-COVID-19 disease was also discussed. Taken together, this review provides an overview of the mechanistic aspects of SARS-CoV-2 induced devastating effects, in vital organs such as the heart and vessels.


Subject(s)
COVID-19/immunology , COVID-19/metabolism , Cardiovascular Diseases/virology , SARS-CoV-2/metabolism , Angiotensin-Converting Enzyme 2/metabolism , Blood Vessels/metabolism , Blood Vessels/pathology , Blood Vessels/virology , Cardiovascular Diseases/metabolism , Heart/virology , Humans , Pandemics
5.
ERJ Open Res ; 7(2)2021 Apr.
Article in English | MEDLINE | ID: covidwho-1286808

ABSTRACT

This correspondence argues that data presented previously cannot justify a novel approach for treating hypoxic patients with severe #COVID19 https://bit.ly/3dLaPlk.

7.
Membranes (Basel) ; 11(3)2021 Feb 27.
Article in English | MEDLINE | ID: covidwho-1121711

ABSTRACT

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. METHODS: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V­V ECMO (PRESERVE) Score, and 30-day survival. RESULTS: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic-AUROC) ranged between 0.548 and 0.605. CONCLUSIONS: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V­V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

9.
Dtsch Med Wochenschr ; 146(5): e30-e38, 2021 03.
Article in German | MEDLINE | ID: covidwho-1054086

ABSTRACT

BACKGROUND: We assessed the prevalence of SARS-CoV-2 in the staff of a general hospital in North-Rhine-Westphalia in a cross-sectional study. METHOD: Employees (n = 1363) were offered a nasopharyngeal swab and serology for SARS-CoV-2. Additionally, employees completed a questionnaire about preexisting conditions, contacts with SARS-CoV-2-positive individuals and COVID-19-specific symptoms. RESULTS: 1212 employees participated. 19 of 1363 (1.4 %) employees tested positive by PCR (3 within and 16 before the study). 40 (3.3 %) and 105 (8.6 %) had IgG and IgA, respectively, 32 (2.6 %) both IgG and IgA. Overall, 47 employees tested positive. In this group, most frequently reported symptoms were headache (56 %), fatigue (49 %), sore throat (49 %), and cough (46 %); fever was reported by 33 %. SARS-CoV-2-positive employees reported more frequently contact with COVID-19 cases (60.5 % vs. 37.3 %, p = 0.006). Employees testing positive only for IgA reported less symptoms. CONCLUSION: Between 27.04. and 20.05.2020, 3.9 % of the employees working in a general hospital were tested positive for SARS-CoV-2. This proportion was lower than expected; possible explanations are the low level of endemic infection and the extensive, uniform in-house preventative measures.


Subject(s)
COVID-19/epidemiology , Health Personnel/statistics & numerical data , Adolescent , Adult , Aged , Antibodies, Viral/blood , COVID-19/diagnosis , Female , Germany/epidemiology , Hospitals, General , Humans , Male , Middle Aged , Nasopharynx/virology , RNA, Viral/analysis , SARS-CoV-2 , Young Adult
10.
Med Klin Intensivmed Notfmed ; 115(Suppl 3): 115-122, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1029344

ABSTRACT

In view of the globally evolving coronavirus disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary group of authors with the support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethicolegal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supraindividual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. The assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.


Subject(s)
COVID-19 , Coronavirus , Critical Care , Humans , Methacrylates , Pandemics , Resource Allocation , SARS-CoV-2
12.
Med Klin Intensivmed Notfmed ; 115(8): 654-667, 2020 Nov.
Article in German | MEDLINE | ID: covidwho-932492

ABSTRACT

Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV­2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , COVID-19 , Humans , Lung/diagnostic imaging , SARS-CoV-2 , Ultrasonography
13.
Med Klin Intensivmed Notfmed ; 115(6): 477-485, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-700035

ABSTRACT

In view of the globally evolving Coronavirus Disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary authors group with support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethico-legal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supra-individual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. Assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.


Subject(s)
Coronavirus Infections/epidemiology , Critical Care/ethics , Health Care Rationing/ethics , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Clinical Decision-Making , Humans , Pandemics/ethics , Practice Guidelines as Topic , SARS-CoV-2 , Societies, Medical
14.
Med Klin Intensivmed Notfmed ; 115(6): 486-487, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-616527

ABSTRACT

Continued employment of pregnant women related to COVID (Corona Virus Disease) should only be considered if the risk of infection in the workplace is not higher than that of the general population. This option should therefore be carried out after an individual risk assessment with a precise description of the patient clientele and definition of the activities to be performed.


Subject(s)
Coronavirus Infections/epidemiology , Employment , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/prevention & control , Betacoronavirus , COVID-19 , Female , Humans , Pandemics , Pregnancy , Risk Assessment , SARS-CoV-2
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