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1.
Biomedica ; 42:1-46, 2022.
Article in English | Web of Science | ID: covidwho-2003382

ABSTRACT

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis (MS), therapeutic recommendations in MS in light of the SARS-CoV2 pandemic, evidence of vaccination in MS and other demyelinating diseases, overview current situation of isolated clinical and radiological syndrome, therapeutic failure in MS as well as criteria for suspension of disease-modifying therapies, evidence of the management of mild relapses in MS, recommendations for prophylaxis against strongyloides stercolaris, usefulness of a second course of immunoglobulin in the syndrome Guillain-Barre (GBS), criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus GBS and the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented and specific recommendations are offered that can be adopted in daily clinical practice.

2.
Revista Gerencia y Politicas de Salud ; 20, 2021.
Article in Spanish | Scopus | ID: covidwho-1716144

ABSTRACT

Introduction. In the context of the health emergency, there has been an increase in the number of critical cases of COVID-19 in the Intensive and Intermediate Care Units (ICU, IMCU), indicating the need to develop strategies for coordination. Objective. To describe the approach implemented in Bogotá for the bed occupancy coordination on the ICU and IMCU, facing an increase in critical COVID-19 cases. Methods. We conducted a descriptive study using Emergency Division databoards and SaluData indicators. Additionally, we made a comparison between the essential points of the Capital's strategy and the bed occupancy rate in ICU and IMCU services at 12-hour intervals. Results. We described the design and implementation of the strategy, the bed occupancy rate indicators for COVID-19 cases, the hospitalization indicators for COVID-19 and non-COVID-19 cases, and the parameters of high demand (adult ICU beds occupancy percentage 50% or highest) for more than 24 hours. Taking into account these percentages we determined the alerts levels. Procedures, instruments, and channels of communication necessaries for supplying beds were considered as well. Conclusion. Centralized management of ICU beds by the Regulation Center has been favorable for the health services provided to patients in a critical state. © 2021 Pontificia Universidad Javeriana. All rights reserved.

3.
Revista Espanola De Comunicacion En Salud ; 12(2):118-120, 2021.
Article in Spanish | Web of Science | ID: covidwho-1579537
6.
Nephrology Dialysis Transplantation ; 36(SUPPL 1):i19-i20, 2021.
Article in English | EMBASE | ID: covidwho-1402538

ABSTRACT

BACKGROUND AND AIMS: Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in hemodialysis are elderly. This study aimed to investigate the impact of COVID-19 in this population and to determine risk factors associated with mortality. METHOD: Data was obtained from the Spanish COVID-19 CKD Working Group Registry, that included patients in renal replacement therapy (dialysis and kidney transplantation) infected by COVID-19. From March 18, 2020, to August 27, 2020, 1165 patients on hemodialysis affected by COVID-19 were included in the Registry. A total of 328 patients were under 65 years-old and 837 were 65 years old or older (elderly group). RESULTS: Mortality was 18.6% higher (95% confidence interval (CI): 13.8%-23.4%) in the elderly hemodialysis patients compared to the non-elderly group (see figure). Death from COVID-19 infection was increased 5.5-fold in hemodialysis patients compared to mortality in the general population for a similar period, and there was an age-associated mortality increase in both populations (see figure 1). In multivariate Cox regression analysis, age (hazard ratio (HR) 1.58, 95% CI: 1.31-1.92), dyspnea at presentation (HR 1.61, 95% CI: 1.20-2.16), pneumonia (HR 1.76, 95% CI: 1.12-2.75) and admission to hospital (HR 4.13, 95% CI: 1.92-8.88) were identified as independent mortality risk factors in the elderly hemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.71, 95% CI: 0.51-0.98) in aged patients on hemodialysis. CONCLUSION: Mortality is dramatically increased in elderly hemodialysis patients affected by COVID-19. Age, dyspnea at presentation, pneumonia or hospitalization are factors associated with a worse prognosis, after adjusting dialysis population to other confounding factors. Treatment with glucocorticoids could be a therapeutic option for this specific population. (Table Presented).

7.
Nephrology Dialysis Transplantation ; 36(SUPPL 1):i539, 2021.
Article in English | EMBASE | ID: covidwho-1402527

ABSTRACT

BACKGROUND AND AIMS: Remdesivir is the only treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Kidney transplant (KT) patients were not included in these studies, therefore, its effects in this population is limited to some published cases. METHOD: We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and November 17, 2020 with SARS-CoV-2 pneumonia who received treatment with remdesivir. Patients received a 200mg loading dose followed by 100 mg/day maintenance dose for 5 days. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir. RESULTS: A total of 36 KT patients developed SARS-CoV-2 infection, 6 of them received treatment with remdesivir. The rest of the patients did not receive the drug due to either CKD-EPI less than 30 mL/min or they did not present clinical criteria. In addition to remdesivir, all pacients received dexamethasone and anticoagulation therapy. Immunosuppression was suspended in all patients, maintaining only dexamethasone. 50% were men, the median age was 58.5 (52.75-68) years. 67% had unknown underlying kidney disease, 83% were hypertensive and 33% had diabetes. All patients received KT from deceased brain donor and 50% received thymoglobulin as induction treatment. Median time from transplantation was 49 (20.5-135.5) months, with median glomerular filtration at admission of 47.5 (42.25-63.25) mL/min. The most frequent clinical manifestation was dry cough and dyspnea (83%), followed by tachypnea and fever (67%). Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 33% of cases during admission. Only 17% of the cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. No patient died or required admission to the critical care unit. Median days of admission was 12 (10-18) days. CONCLUSION: KT patients with SARS-CoV-2 pneumonia under treatment with remdesivir have a good clinical course, with few cases of renal function deterioration and a low mortality rate. Additional studies are necessary with a larger number of patients to improve the knowledge of remdesivir in KT with SARS-CoV-2 infection.

9.
Transplant International ; 34:264-264, 2021.
Article in English | Web of Science | ID: covidwho-1396035
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