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1.
Inserto BEN Bollettino Epidemiologico Nazionale ; 2(4):39-45, 2021.
Article in Italian | GIM | ID: covidwho-1864119

ABSTRACT

Introduction: Obesity is a complex condition, now recognized as a pathology, as well as being a risk factor for other noninfectious diseases (diabetes, cardiovascular diseases, tumours etc.) The data from the COVID-19 pandemic demonstrate that obesity can also be an important factor for the development of complications in infectious diseases. International studies have shown that the prevalence of obesity has increased in many countries from about 1975, especially among youngsters, which threatens a new emergency for public health. With the encouragement of the WHO and the National Program Guardagnare Salute, the surveillance system OKkio alla SALUTE was launched in Italy in 2007, and since then, has collected data to estimate the prevalence of childhood overweight and obesity and its associated risk factors. Materials and methods: Between 2008 and 2019 data were collected on children aged 8-9 years, on six occasions using samples that were representative at regional level (and sometimes at local health service level) using personnel who were trained using methods and instruments that were validated and the same throughout the country. Other information on possible associated variables was collected using four questionnaires which were completed by the children, their parents, their teachers and the head-teachers of the selected classes. Participation in the Childhood Obesity Surveillance Initiative of the WHO European Region makes international comparisons possible. On the basis of the results obtained so far, a series of initiatives for communication and activities for prevention have been developed at national and local level.

2.
BJOG ; 129(2): 221-231, 2022 01.
Article in English | MEDLINE | ID: covidwho-1840295

ABSTRACT

OBJECTIVE: The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes. DESIGN: National population-based prospective cohort study. SETTING: A total of 315 Italian maternity hospitals. SAMPLE: A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission. METHODS: Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses. MAIN OUTCOME MEASURES: COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality. RESULTS: We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28). CONCLUSIONS: Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.


Subject(s)
COVID-19 , Intensive Care Units/statistics & numerical data , Pregnancy Complications, Infectious , Premature Birth/epidemiology , SARS-CoV-2 , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Comorbidity , Female , Hospitalization/statistics & numerical data , Hospitals, Maternity/statistics & numerical data , Humans , Italy/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome/epidemiology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Severity of Illness Index
3.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333774

ABSTRACT

IMPORTANCE: As the United States continues to accumulate COVID-19 cases and deaths, and disparities persist, defining the impact of risk factors for poor outcomes across patient groups is imperative. OBJECTIVE: Our objective is to use real-world healthcare data to quantify the impact of demographic, clinical, and social determinants associated with adverse COVID-19 outcomes, to identify high-risk scenarios and dynamics of risk among racial and ethnic groups. DESIGN: A retrospective cohort of COVID-19 patients diagnosed between March 1 and August 20, 2020. Fully adjusted logistical regression models for hospitalization, severe disease and mortality outcomes across 1-the entire cohort and 2-within self-reported race/ethnicity groups. SETTING: Three sites of the NewYork-Presbyterian health care system serving all boroughs of New York City. Data was obtained through automated data abstraction from electronic medical records. PARTICIPANTS: During the study timeframe, 110,498 individuals were tested for SARS-CoV-2 in the NewYork-Presbyterian health care system;11,930 patients were confirmed for COVID-19 by RT-PCR or covid-19 clinical diagnosis. MAIN OUTCOMES AND MEASURES: The predictors of interest were patient race/ethnicity, and covariates included demographics, comorbidities, and census tract neighborhood socio-economic status. The outcomes of interest were COVID-19 hospitalization, severe disease, and death. RESULTS: Of confirmed COVID-19 patients, 4,895 were hospitalized, 1,070 developed severe disease and 1,654 suffered COVID-19 related death. Clinical factors had stronger impacts than social determinants and several showed race-group specificities, which varied among outcomes. The most significant factors in our all-patients models included: age over 80 (OR=5.78, p= 2.29x10 -24 ) and hypertension (OR=1.89, p=1.26x10 -10 ) having the highest impact on hospitalization, while Type 2 Diabetes was associated with all three outcomes (hospitalization: OR=1.48, p=1.39x10 -04 ;severe disease: OR=1.46, p=4.47x10 -09 ;mortality: OR=1.27, p=0.001). In race-specific models, COPD increased risk of hospitalization only in Non-Hispanics (NH)-Whites (OR=2.70, p=0.009). Obesity (BMI 30+) showed race-specific risk with severe disease NH-Whites (OR=1.48, p=0.038) and NH-Blacks (OR=1.77, p=0.025). For mortality, Cancer was the only risk factor in Hispanics (OR=1.97, p=0.043), and heart failure was only a risk in NH-Asians (OR=2.62, p=0.001). CONCLUSIONS AND RELEVANCE: Comorbidities were more influential on COVID-19 outcomes than social determinants, suggesting clinical factors are more predictive of adverse trajectory than social factors. KEY POINTS: QUESTION: What is the impact of patient self-reported race, ethnicity, socioeconomic status, and clinical profile on COVID-19 hospitalizations, severity, and mortality?FINDINGS: In patients diagnosed with COVID-19, being over 50 years of age, having type 2 diabetes and hypertension were the most important risk factors for hospitalization and severe outcomes regardless of patient race or socioeconomic status. MEANING: In this large sample pf patients diagnosed with COVID-19 in New York City, we found that clinical comorbidity, more so than social determinants of health, was associated with important patient outcomes.

4.
Inserto BEN Bollettino Epidemiologico Nazionale ; 2(3):17-25, 2021.
Article in Italian | GIM | ID: covidwho-1651847

ABSTRACT

Introduction: Since the beginning of the pandemic, the Italian Obstetric Surveillance System (ItOSS) coordinated research activities to support health professionals and decision makers. The aim of this paper is to describe the results of the populationbased prospective study on SARS-CoV-2 infection among pregnant women during the first pandemic wave. Materials and methods: From the end of February 2020, ItOSS launched a prospective population-based cohort study enrolling all SARSCoV- 2 pregnant women admitted to any Italian hospital. Anamnestic and clinical information was collected in a structured form and entered in a web-based secure system by trained clinicians of any maternity unit.

5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-296897

ABSTRACT

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus has infected over 115 million people and caused over 2.5 million deaths worldwide. Yet, the molecular mechanisms underlying the clinical manifestations of COVID-19, as well as what distinguishes them from common seasonal influenza virus and other lung injury states such as Acute Respiratory Distress Syndrome (ARDS), remains poorly understood. To address these challenges, we combined transcriptional profiling of 646 clinical nasopharyngeal swabs and 39 patient autopsy tissues, matched with spatial protein and expression profiling (GeoMx) across 357 tissue sections. These results define both body-wide and tissue-specific (heart, liver, lung, kidney, and lymph nodes) damage wrought by the SARS-CoV-2 infection, evident as a function of varying viral load (high vs. low) during the course of infection and specific, transcriptional dysregulation in splicing isoforms, T cell receptor expression, and cellular expression states. In particular, cardiac and lung tissues revealed the largest degree of splicing isoform switching and cell expression state loss. Overall, these findings reveal a systemic disruption of cellular and transcriptional pathways from COVID-19 across all tissues, which can inform subsequent studies to combat the mortality of COVID-19, as well to better understand the molecular dynamics of lethal SARS-CoV-2 infection and other viruses.

6.
PUBMED; 2021.
Preprint in English | PUBMED | ID: ppcovidwho-293385

ABSTRACT

Metagenomic DNA sequencing is a powerful tool to characterize microbial communities but is sensitive to environmental DNA contamination, in particular when applied to samples with low microbial biomass. Here, we present contamination-free metagenomic DNA sequencing (Coffee-seq), a metagenomic sequencing assay that is robust against environmental contamination. The core idea of Coffee-seq is to tag the DNA in the sample prior to DNA isolation and library preparation with a label that can be recorded by DNA sequencing. Any contaminating DNA that is introduced in the sample after tagging can then be bioinformatically identified and removed. We applied Coffee-seq to screen for infections from microorganisms with low burden in blood and urine, to identify COVID-19 co-infection, to characterize the urinary microbiome, and to identify microbial DNA signatures of inflammatory bowel disease in blood.

7.
BJOG ; 129(2): 221-231, 2022 01.
Article in English | MEDLINE | ID: covidwho-1528341

ABSTRACT

OBJECTIVE: The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes. DESIGN: National population-based prospective cohort study. SETTING: A total of 315 Italian maternity hospitals. SAMPLE: A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission. METHODS: Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses. MAIN OUTCOME MEASURES: COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality. RESULTS: We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28). CONCLUSIONS: Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.


Subject(s)
COVID-19 , Intensive Care Units/statistics & numerical data , Pregnancy Complications, Infectious , Premature Birth/epidemiology , SARS-CoV-2 , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Comorbidity , Female , Hospitalization/statistics & numerical data , Hospitals, Maternity/statistics & numerical data , Humans , Italy/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome/epidemiology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Severity of Illness Index
8.
Journal of Maternal-Fetal and Neonatal Medicine ; 34(SUPPL 1):83, 2021.
Article in English | EMBASE | ID: covidwho-1517728

ABSTRACT

INTRODUCTION The COVID pandemic has widely affected the pregnancy experience, being a novel risk factor for maternalfetal morbidity/mortality, preterm birth and, as recently hypothesized, preeclampsia. The aim of our study was to investigate the impact of COVID in pregnancy on fetal growth. METHODS Data from ultrasound reports of 73 consecutive pregnancies enrolled in the local ItOSS surveillance on COVID and pregnancy were analyzed. All patients had experienced COVID in pregnancy at various stages of severity. Eight cases were excluded as they did not fit the aim of the study. Fetal abdominal circumference (AC) in 2nd and 3rd trimester were compared for each case, and then with the neonatal birthweight, in order to clarify the possible presence of growth defects/accelerations. RESULTS No case of AC <10° centile was reported neither in the 2nd nor in the 3rd trimester. Interestingly, the percentage of SGA at birth was 5.6%. The same percentage of neonates had pH <7.10 at birth. Only one case presented an AC drop >40 centiles. LGA neonates, with AC >90° centile, accounted for 22.5%, including 8.4% of cases that presented an acceleration of growth velocity from 2nd to 3rd trimester. During the 3rd trimester to birth interval, we observed 8.4% of decrease and 2.8% increase of growth velocity, respectively, in terms of percentiles of expected birthweight vs neonatal birthweight. CONCLUSIONS Data about fetal growth in COVID pregnancies are overall encouraging. No case of defined FGR was observed. Conversely, acceleration of growth from 2nd to 3rd trimester was higher than expected. This may be accountable on poor metabolic status due to the prolonged use of corticosteroids or on lack of regular glycemic screening/nutrition due to pandemic.

9.
International Journal of Radiation Oncology Biology Physics ; 111(3):e237, 2021.
Article in English | EMBASE | ID: covidwho-1433380

ABSTRACT

Purpose/Objective(s): Whole Lung Low-Dose Radiation Therapy (LDRT) is currently being tested as a treatment for SARS-CoV-2. Whether LDRT alters the natural history of viral infection, lung microenvironment or host immunity is currently unknown. We developed a preclinical model of severe viral pneumonia using pandemic-strain influenza A virus (IAV) to evaluate potential immunomodulation and treatment efficacy of LDRT. Materials/Methods: Female BALB/c mice were infected with an intranasal challenge of 2 × 102–2 × 104 PFU of 2009/H1N1 IAV. LDRT was administered at 0.5 Gy or 1.5 Gy x 1 (or sham) 72 hours after IAV challenge. Mice were serially monitored for survival and morbidity (raw lung weight, % weight loss, disease severity index). Acute changes in the lung microenvironment were assayed 72hrs post-LDRT (day 6) with profiling of myeloid/T-cell subsets by cytometry, gene expression by qRT-PCR and histological evaluation of H&E-stained lung sections. Results: LDRT did not extend survival in lethally challenged (2 × 104 PFU) mice relative to non-irradiated controls [median survival(days): 7 IAV/sham vs 8 IAV/0.5 Gy vs 8 IAV/1.5 Gy;P = 0.24], with 100% mortality in all IAV groups. In a less virulent model (2 × 103 PFU), LDRT did not extend survival with significantly shorter survival observed in the IAV/1.5 Gy group [median survival (% mortality): NR (30%) IAV/sham vs 10d (53%) IAV/0.5 Gy vs 9d (87%) IAV/1.5 Gy;P < 0.001]. Raw lung weight was ∼2-fold higher in IAV mice [mean weight: 0.17g PBS/sham vs 0.31g IAV/sham vs 0.30g IAV/0.5 Gy vs 0.31g IAV/1.5 Gy;P < 0.01 all IAV groups]. Percentage change in body weight was -20.8% (IAV/sham), -21.7% (IAV/0.5 Gy) and -22.5% (IAV/1.5 Gy) compared to PBS-control mice on day 6. Immune profiling demonstrated monocytic and neutrophilic lung infiltrate in response to IAV, with significant increases in CD11b+Ly6G+ neutrophils (P = 0.02) and Ly6C+CD11b+ classical monocytes (P = 0.02). Relative to PBS-challenge, bulk RNA analysis demonstrated robust interferon expression (Ifnb1, Ifng) and upregulation of myeloid/T-cell chemotaxis (Ccl2, Cxcl10) [P < 0.05 in all IAV groups]. A mixed inflammatory response was noted with significant increase in pro- and anti-inflammatory cytokines (Il6, Il10) and M1 markers (Inos2, Cd80) [P < 0.05 in all IAV groups]. Arg1 expression was increased in IAV mice treated with 1.5 Gy LDRT relative to IAV/0.5 Gy (P = 0.02) and IAV/sham (P = 0.02). Histological evidence of alveolar septum rupture, peri-bronchial infiltration, lung parenchyma destruction and vascular congestion was consistent with severe acute lung injury;similar changes were observed in LDRT and non-irradiated lungs of IAV mice. Conclusion: In this preclinical IAV model of severe viral pneumonia we did not observe a therapeutic effect of LDRT on survival and morbidity. LDRT did not appear to consistently reduce or reverse IAV-induced inflammatory changes in the lung microenvironment.

11.
Respir Care ; 66(5): 814-821, 2021 May.
Article in English | MEDLINE | ID: covidwho-1395146

ABSTRACT

BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).


Subject(s)
Critical Illness , Respiration, Artificial , Aged , Humans , Intensive Care Units , Retrospective Studies , Risk Factors , Simplified Acute Physiology Score
12.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-290406

ABSTRACT

The influenza A non-structural protein 1 (NS1) is known for its ability to hinder the synthesis of type I interferon (IFN) during viral infection. Influenza viruses lacking NS1 (DELTANS1) are under clinical development as live attenuated human influenza virus vaccines and induce potent influenza virus-specific humoral and cellular adaptive immune responses. Attenuation of DELTANS1 influenza viruses is due to their high IFN inducing properties, that limit their replication in vivo. This study demonstrates that pre-treatment with a DELTANS1 virus results in an immediate antiviral state which prevents subsequent replication of homologous and heterologous viruses, preventing disease from virus respiratory pathogens, including SARS-CoV-2. Our studies suggest that DELTANS1 influenza viruses could be used for the prophylaxis of influenza, SARS-CoV-2 and other human respiratory viral infections, and that an influenza virus vaccine based on DELTANS1 live attenuated viruses would confer broad protection against influenza virus infection from the moment of administration, first by non-specific innate immune induction, followed by specific adaptive immunity.

13.
Journal of Cystic Fibrosis ; 20:S65, 2021.
Article in English | EMBASE | ID: covidwho-1361553

ABSTRACT

Objectives: As the novel coronavirus (SARS-CoV-2) pandemic continues, people with cystic fibrosis (CF) have been identified as being a vulnerable group. It is essential that people with CF, their families and their clinical teams have the most up-to-date information on the impact of SARS-CoV-2 on their health. This study aims to characterise the impact of SARS-CoV-2 infection in people with CF throughout 2020, identify factors that predict clinical progression of COVID-19, and to describe medium-term follow-up of people who have been infected. Methods: The ‘Cystic Fibrosis Registry Global Harmonization Group’ is a worldwide network of CF Registries that each contributed data on people with CF diagnosed with SARS-CoV-2 infection. In this analysis, we will report on cases contributed from 22 countries diagnosed between 1st February and 13th December 2020. We will present demographic, pre-infection clinical characteristics, symptoms, infection management and outcomes. We will use multivariable logistic regression to assess predictors for hospitalisation with respiratory support and intensive care admission as the outcomes of interest representing clinical progression of COVID-19. Descriptive analysis of medium-term follow-up BMI and FEV1% predicted values will also be undertaken. Results: Results pending. Expected cohort size >1,000, including the 181 previously reported in our paper “The global impact of SARS-CoV-2 in 181 people with cystic fibrosis.” Conclusion: It is expected that the findings of this study will have important implications for shielding advice, clinical care and vaccine prioritisation for people with CF.

14.
Trauma Surg Acute Care Open ; 5(1): e000557, 2020.
Article in English | MEDLINE | ID: covidwho-1318215

ABSTRACT

BACKGROUND: Reported characteristics and outcomes of critically ill patients with COVID-19 admitted to the intensive care unit (ICU) are widely disparate with varying mortality rates. No literature describes outcomes in ICU patients with COVID-19 managed by an acute care surgery (ACS) division. Our ACS division manages all ICU patients at a community hospital in New Jersey. When that hospital was overwhelmed and in crisis secondary to COVID-19, we sought to describe outcomes for all patients with COVID-19 admitted to our closed ICU managed by the ACS division. METHODS: This was a prospective case series of the first 120 consecutive patients with COVID-19 admitted on March 14 to May 10, 2020. Final follow-up was May 27, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded. RESULTS: One hundred and twenty patients were included (median age 64 years (range 25-89), 66.7% men). The most common comorbidities were hypertension (75; 62.5%), obesity (61; 50.8%), and diabetes (50; 41.7%). One hundred and thirteen (94%) developed acute respiratory distress syndrome, 89 (74.2%) had shock, and 76 (63.3%) experienced acute kidney injury. One hundred (83.3%) required invasive mechanical ventilation (IMV). Median ICU length of stay (LOS) was 8.5 days (IQR 9), hospital LOS was 14.5 days (IQR 13). Mortality for all ICU patients with COVID-19 was 53.3% and 62% for IMV patients. CONCLUSIONS: This is the first report of patients with COVID-19 admitted to a community hospital ICU managed by an ACS division who also provided all surge care. Mortality of critically ill patients with COVID-19 admitted to an overwhelmed hospital in crisis may not be as high as initially thought based on prior reports. While COVID-19 is a non-surgical disease, ACS divisions have the capability of successfully caring for both surgical and medical critically ill patients, thus providing versatility in times of crisis. LEVEL OF EVIDENCE: Level V.

15.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277801

ABSTRACT

Introduction:Lung cancer is the leading cause of cancer death and the second most common cancer. Non-small cell lung cancer (NSCLC) is most common type, with adenocarcinoma and squamous cell carcinoma representing the most prevalent subtypes. Here, we present a case of a large lung mass which underscores the importance of considering rare types of lung cancer when formulating a differential diagnosis.Case Report:The patient was 78-year-old man presenting one month after mild COVID-19 infection with persistent chest heaviness felt to be the sequalae of COVID-19. A review of symptoms was significant for appetite change, fatigue, cough, chest tightness, and unexpected weight change. Physical exam showed diminished left breath sounds. Pulmonary function tests showed an FEV1 of 54%;DLCO was not obtained. CT of the chest demonstrated an 11.3 x 7.2 x 15.6 cm necrotic mass of the left upper lobe. Further characterization with MRI demonstrated an 11.8 x 7.9 x 17.5 cm heterogeneously enhancing mixed signal mass with areas of either cystic degeneration or necrosis in the left hemithorax with loss of mediastinal and pericardial fat planes, suggestive of invasion (Figure 1, arrow). Prominent mediastinal lymph nodes and chest wall invasion were also identified. A small pleural effusion was present at that time (dashed arrow). MRI of the brain was negative for metastases. A biopsy was consistent with pulmonary sarcomatoid carcinoma, a rare type of NSCLC. The patient was treated with radiation.Importance:Pulmonary sarcomatoid carcinoma is a rare type of non-small cell lung cancer accounting for 0.4% of cases which carries a poor prognosis and is not sensitive to chemotherapy, rendering surgery the best treatment option. Given that it is poorly differentiated, it is likely to present as a large mass with heterogenous signal and enhancement. Closely related differential considerations include diffuse sarcomatoid malignant mesothelioma and sarcomatoid carcinoma metastatic to lung. Other rare types of lung cancer include adenosquamous carcinoma, large cell neuroendocrine carcinoma, adenoid cystic and mucoepidermoid carcinomas of the lung, granular cell lung cancer, typical and atypical carcinoids. While rare, it is important to consider these less common types of non-small cell lung cancer in the differential diagnosis given differences in treatment options and prognosis.

16.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277613

ABSTRACT

Rationale: Over 60 million people have had coronavirus disease 2019 (COVID-19), but consequences of severe infection are unknown. We sought to characterize interstitial lung abnormalities (ILA) after COVID-19, and to identify risk factors for the development of lung fibrosis.Methods: We performed a prospective single-center cohort study with 4-month follow-up after COVID-19 hospitalization. We sequentially enrolled 76 community-dwelling adults who were hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and required supplemental oxygen between March and May 2020. Participants had no prior history of interstitial lung disease and were discharged to acute rehabilitation or home, with sampling weighted to include half who were mechanically ventilated. We used a radiologic scoring system to quantify non-fibrotic ILA (ground glass opacities alone) and fibrotic ILA (defined as presence of reticulations, traction bronchiectasis, or honeycombing) on chest high-resolution computed tomography scans four months after hospital admission. We assessed measures of severity of illness during hospitalization, as well as pulmonary function and leukocyte telomere length at followup. Results: Participants had a mean age of 54 (SD14) years;most were male (61%) and Hispanic (57%). Thirty-two (43%) required mechanical ventilation. After a median (IQR) of 4.4 (4.0-4.8) months following hospital admission, the most common ILAs were ground glass opacities, reticulations, and traction bronchiectasis, which correlated with lower diffusion capacity (ρ -0.34, - 0.64, and -0.49, respectively, all p<0.01). A total of 31 participants (41%) had no ILA, 13 (17%) had only non-fibrotic ILA, and 32 (42%) had fibrotic ILA. Fibrotic ILA was more common in mechanically ventilated patients (72%) than non-mechanically ventilated patients (20%), (p=0.001). In adjusted analyses, each 1 point increase in admission SOFA score, additional day of ventilator support, and 10% decrease in blood leukocyte telomere length were associated with fibrotic ILA [OR 1.49 (95%CI 1.17 - 1.89), 1.07 (95%CI 1.03-1.12), and 1.35 (95%CI 1.06 - 1.72), respectively].Conclusions: Radiographic evidence of lung fibrosis four months after severe COVID-19 infection is associated with initial severity of illness, duration of mechanical ventilation, and telomere length.

17.
Thorax ; 29:29, 2021.
Article in English | MEDLINE | ID: covidwho-1209856

ABSTRACT

The risk factors for development of fibrotic-like radiographic abnormalities after severe COVID-19 are incompletely described and the extent to which CT findings correlate with symptoms and physical function after hospitalisation remains unclear. At 4 months after hospitalisation, fibrotic-like patterns were more common in those who underwent mechanical ventilation (72%) than in those who did not (20%). We demonstrate that severity of initial illness, duration of mechanical ventilation, lactate dehydrogenase on admission and leucocyte telomere length are independent risk factors for fibrotic-like radiographic abnormalities. These fibrotic-like changes correlate with lung function, cough and measures of frailty, but not with dyspnoea.

18.
International Journal of Environmental Research & Public Health [Electronic Resource] ; 18(8):16, 2021.
Article in English | MEDLINE | ID: covidwho-1208611

ABSTRACT

The new coronavirus emergency spread to Italy when little was known about the infection's impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother-child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother-newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room;the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother's milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to "better safe than sorry" care choices. An improvement of the peripartum care indicators was observed over time.

19.
Open Forum Infectious Diseases ; 7(SUPPL 1):S325, 2020.
Article in English | EMBASE | ID: covidwho-1185880

ABSTRACT

Background: The coronavirus-19-disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to >200 countries and surpassed 7 million cases. There is a broad range of COVID-19 illness, ranging from milder disease to a rapidly progressive respiratory disease and ARDS. The causes of this different clinical course and the drivers for severe disease are currently unknown. A fulminant increase of pro-inflammatory cytokines is thought to play a role in causing a rapid disease evolution, however the immune correlates of severe COVID-19 remain unclear. Methods: To gain insight into relationship between immune responses and disease severity we built a longitudinal cohort of 40 adult patients with known COVID- 19. Samples were collected at diagnosis and every 7 days until hospital discharge or death. As controls we also included a group of convalescent patients, and subjects who tested negative for COVID-19 by PCR. Clinical and laboratory data and were also collected. Multicolor flow cytometry was used to determine the presence and phenotype of B, T and natural killer (NK) cells. We also identified specific sub-populations (Tfh, activated/cytotoxic CD8 and NK) and assessed lymphoid exhaustion of different cell types such as naïve, memory T cells, or NK over time. Anti-Sars-CoV2 IgG and IgM antibody were detected using lateral flow method. Results: We found that the absolute number of lymphocytes and monocytes was decreased starting at diagnosis and correlated with disease severity. Disease severity correlated with decreased NK and T cell. In severe COVID-19 cases, NK cell populations were strongly decreased over time in intubated patients while they recovered in patients who improved and were discharged. CD8+ were also decreased at disease onset and seemed to correlate with disease severity. A high percentage of CD4+ and CD8+ T cells showed an exhausted phenotype. All patients tested at admission had IgM antibody responses irrespective of the course of the disease. Further analyses are ongoing. Conclusion: The characterization and role of the immune responses in COVID- 19 evolution is still under investigation. Further characterization of viral and immune factors will help in identifying subjects at high risk of severe disease and targets for intervention.

20.
Acad Radiol ; 28(5): 595-607, 2021 05.
Article in English | MEDLINE | ID: covidwho-1062192

ABSTRACT

BACKGROUND: COVID-19 commonly presents with upper respiratory symptoms; however, studies have shown that SARS-CoV-2 infection affects multiple organ systems. Here, we review the pathophysiology and imaging characteristics of SARS-CoV-2 infection in organ systems throughout the body and explore commonalities. OBJECTIVE: Familiarity with the underlying pathophysiology and imaging characteristics is essential for the radiologist to recognize these findings in patients with COVID-19 infection. Though pulmonary findings are the most prevalent presentation, COVID-19 may have multiple manifestations and recognition of the extrapulmonary manifestations is especially important because of the potential serious and long-term effects of COVID-19 on multiple organ systems.


Subject(s)
COVID-19 , Humans , Peptidyl-Dipeptidase A , SARS-CoV-2
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