Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 1.140
Filter
Add filters

Document Type
Year range
1.
Brain Sciences ; 12(12) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2199778

ABSTRACT

Calcitonin gene-related peptide (CGRP) antagonists are a class of medications that act as antagonists of the CGRP receptor or ligand. They can be divided into monoclonal antibodies and non-peptide small molecules, also known as gepants. CGRP antagonists were the first oral agents specifically designed to prevent migraines. The second generation of gepants includes rimegepant (BHV-3000, BMS-927711), ubrogepant (MK-1602), and atogepant (AGN-241689, MK-8031). Zavegepant (BHV-3500, BMS-742413) belongs to the third generation of gepants characterized by different administration routes. The chemical and pharmacological properties of this new generation of gepants were calculated. The clinical trials showed that the new generation of CGRP antagonists is effective for the acute and/or preventive treatment of migraines. No increased mortality risks were observed to be associated with the second- and third-generation gepants. Moreover, the majority of the serious adverse events reported probably occurred unrelated to the medications. Interesting facts about gepants were highlighted, such as potency, hepatotoxicity, concomitant use with monoclonal antibodies targeting the CGRP, comparative analysis with triptans, and the "acute and preventive" treatment of migraine. Further studies should include an elderly population and compare the medications inside this class and with triptans. There are still concerns regarding the long-term side effects of these medications, such as chronic vascular hemodynamic impairment. Meanwhile, careful pharmacovigilance and safety monitoring should be performed in the clinical practice use of gepants. Copyright © 2022 by the authors.

2.
Frontiers in Immunology ; 13, 2022.
Article in English | Web of Science | ID: covidwho-2198863

ABSTRACT

Asthma is a complex and heterogeneous disease with multicellular involvement, and knowledge gaps remain in our understanding of the pathogenesis of asthma. Efforts are still being made to investigate the immune pathogenesis of asthma in order to identify possible targets for prevention. Single cell RNA sequencing (scRNA-seq) technology is a useful tool for exploring heterogeneous diseases, identifying rare cell types and distinct cell subsets, enabling elucidation of key processes of cell differentiation, and understanding regulatory gene networks that predict immune function. In this article, we provide an overview of the importance of scRNA-seq for asthma research, followed by an in-depth discussion of the results in recent years, in order to provide new ideas for the pathogenesis, drug development and treatment of asthma.

3.
Current Respiratory Medicine Reviews ; 18(4):247-258, 2022.
Article in English | EMBASE | ID: covidwho-2197747

ABSTRACT

In India, asthma is a prevalent respiratory condition marked by frequent blowouts and a distinctive spread pattern. Respiratory diseases are the main cause of death globally. In India, asthma is more common, particularly in the North Indian states of Delhi and Uttar Pradesh. Our primary objective in this review is to study asthma medication therapy and its associated complications. The epidemiology, etiology, pathophysiology, mechanism of airway inflammation, classification, and diagnosis of asthma are all illustrated in the current work. Additionally, we have gathered state-by-state information on asthma for the last five years in Northern India. Asthma diagnosis and management are also discussed in accordance with the guidelines of many agencies, including NICE, BTS, SIGN, and WHO. Copyright © 2022 Bentham Science Publishers.

4.
Orv Hetil ; 164(2):51-56, 2023.
Article in Hungarian | PubMed | ID: covidwho-2197425

ABSTRACT

INTRODUCTION: SARS-CoV-2 has defined our everyday lives over the past three years and by constituting a serious risk factor for patients with pre-existing respiratory illnesses, it placed an unexpected burden on the health care systems worldwide. OBJECTIVE: The aim of this study was to explore the association between COVID-19 and pre-existing respiratory comorbidities such as chronic obstructive pulmonary disease (COPD) and asthma. METHOD: In our current study, we retrospectively processed the data of nearly 29 000 Hungarian patients. RESULTS: We found that COPD was directly associated with the severity of COVID-19 and slightly increased the risk of intensive care unit admission and the need for mechanical ventilation during the SARS-CoV-2 infection. On the other hand, the presence of asthma influenced neither the severity of COVID-19 nor the need for intensive care unit admission or mechanical ventilation significantly. DISCUSSION: International studies suggest that COPD does not significantly increase the risk of SARS-CoV-2 infection. However, the likelihood of hospitalization due to COVID-19 is much higher in COPD patients and the presence of COPD is associated with a more severe disease course. Given the structural alterations and abnormal regeneration processes of the airways that occur during lung injury in COPD patients, these individuals require increased attention and personalized rehabilitation protocols after the onset of the viral infection. CONCLUSION: Altogether, the assessment of clinical manifestations associated with different COPD phenotypes (as well as other chronic lung diseases) and SARS-CoV-2 infection is essential for the implementation of personalized therapeutic approach in the future. Orv Hetil. 2023;164(2): 51-56.

5.
Orv Hetil ; 164(2):43-50, 2023.
Article in Hungarian | PubMed | ID: covidwho-2197424

ABSTRACT

INTRODUCTION: Literature data show an increased severity of SARS-CoV-2 infection in patients with cardiovascular, renal comorbidities, chronic obstructive pulmonary disease (COPD), asthma, obesity, diabetes, tumors and immunosuppression. METHOD: This retrospective study includes 90 patients with SARS-CoV-2 infection associated with COPD or asthma exacerbations from 303 patients hospitalized during a 7-month period (29.7%). The clinical aspect of COPD/asthma exacerbations overlapped to the one by SARS-CoV-2 infection, therefore, we compared our group with 90 patients with SARS-CoV-2 without obstructive disease. We excluded from both groups the patients with known severe cardiac impairment, diabetes, or tumors in order to not having interference with other unfavorable prognostic factors. We assessed the cases severity on clinical basis, pulzoximetry, CT/chest x-ray, and inflammatory markers. RESULTS: 72.2% of our group (48/52 with COPD and 17/38 with asthma) had moderate/severe pneumonia (bilateral interstitial-alveolar infiltrates, increased inflammatory markers, respiratory dysfunction) compared with 56.6% from the nonobstructive group. 14 patients required intensive therapy (including mechanical ventilation). We recorded 4 deaths in COPD group, 1 in asthma group, compared to 2 in non-obstructive patients (fatality 7.6% in COPD compared to 2.2% in nonobstructive group). Treatment included maximized inhaled bronchodilators ± corticosteroids, oxygen, antivirals, anticoagulants, corticosteroids, symptomatic. All patients were referred for clinical-functional and CT scan reassessment 2 months after discharge. CONCLUSION: The association of SARS-CoV-2 infection in patients with COPD or asthma was common, leading to exacerbation with significant severity. Fatality increased in COPD. Outpatient follow-up aims to restage adjust the treatment and monitor post-COVID-19 possible sequels. Orv Hetil. 2023;164(2): 43-50.

6.
Drugs of the Future ; 47(12):887-892, 2022.
Article in English | Web of Science | ID: covidwho-2196788

ABSTRACT

Granulocyte-macrophage colony-stimulating factor (GM-CSF) plays a central role in immune response;it is a key mediator of inflammation and tissue injury. Lenzilumab, a humanized anti-GM-CSF monoclonal antibody directly binds to GM-CSF and prevents signaling through its receptor;it is being eval-uated for its efficacy and safety in treating COVID-19 as well as several inflammatory and autoimmune conditions. The purpose of this review was to summarize available data on the clinical safety and efficacy of lenzilumab for the treat- ment of inflammatory and autoimmune diseases as well as COVID-19. In a phase II study of patients with chronic myelo- monocytic leukemia, lenzilumab was associated with a dura- ble clinical benefit in a third of participants. In patients with inadequately controlled asthma, lenzilumab improved FEV1 in eosinophilic asthmatics, but did not improve asthma con-trol. In patients with severe COVID-19 pneumonia, lenzilu-mab significantly improved survival without ventilation over and above current supportive treatments, including remde-sivir and corticosteroids. Among these patients, those with baseline C-reactive protein (CRP) values less than 150 mg/L derived the greatest benefit from lenzilumab. Lenzilumab was safe and well tolerated. In the clinical trials conducted to date, no deaths, drug-related serious adverse events or withdraw- als due to adverse events were noted.

7.
Egyptian Journal of Bronchology ; 16(1), 2022.
Article in English | Web of Science | ID: covidwho-2196579

ABSTRACT

Background: WHO recognized the COVID-19 outbreak in China as a pandemic crisis on March 11, 2020. Patients with chronic respiratory diseases (CRDs) have limited physiological reserve;this lead to the assumption that COVID-19 infection in such patients could carry worse prognosis. Aim of study: To detect the prevalence and prognostic significance of CRDs among hospitalized patients with COVID-19 infection. Methods: The study was carried out at Minia Cardiothoracic University Hospital;all hospitalized COVID-19 patients during the period from January 2021 to August 2021 were included. Patients were subjected to full medical history taking, full blood count, inflammatory markers (CRP, serum ferritin, serum lactate dehydrogenase (LDH), serum D-dimer, PCR for COVID-19 infection), and HRCT chest. Need for and duration of mechanical ventilation whether invasive or non-invasive, duration of hospital stay, and condition at hospital discharge were recorded. Diagnosis for chronic respiratory disease was considered when patients have documented previous history and investigations compatible with the diagnosis, e.g., previous pulmonary function tests, chest CT, or sleep study. Results: Comorbid chronic respiratory diseases were present in 57 patients (17.6%). Regarding presenting symptoms, no significant difference exists between patients with and without CRDs except for sputum production which was more frequent among patients with underlying CRDs. Elevated inflammatory markers (ferritin, D-dimer, and LDH) were more frequently observed in patients without CRDs (p < 0.0001, 0.033, and 0.008, respectively). COVID-19 with comorbid CRDs patients were more hypoxemic at presentation than other patients (p = 0.032). There was significant number of COVID-19 patients with CRDs were discharged on home oxygen therapy (p = 0.003). Regarding mortality in our cohort of patients, no significant difference exist between patients with and without CRDs (p 0.374) Among patients with comorbid CRDs, the highest mortality was observed on patients with OSA followed by ILDS and then COPD. Conclusion: The presence of CRD was not found to be a poor prognostic value of COVID-19. Inflammatory markers (ferritin, D-dimer, and LDH) were significantly higher in COVID-19 patients without CRD than COVID-19 with CRD.

8.
Allergy Asthma Clin Immunol ; 18(1):113, 2022.
Article in English | PubMed | ID: covidwho-2196430

ABSTRACT

Anxiety and depression can negatively affect the management of asthma. The study aimed to assess the psychosocial effects of asthma patients during COVID-19 and analyze potential risk factors and interventions.In June 2022, the "Questionnaire Star" electronic questionnaire system was used to collect data. A total of 98 asthma patients from the affiliated hospital of the medical school of Ningbo University were invited to complete the questionnaires. According to our study, the prevalence of symptoms of anxiety and depression in the asthma patients in the institution was 91.8 and 77.6%, respectively. Patients who had an asthma exacerbation in the previous two months were more likely to have anxiety symptoms (OR = 0.142 95%CI 0.025-0.820), while patients who did not participate in asthma day activities were more likely to have anxiety symptoms than those who did (OR = 0.130 95%CI 0.022-0.762).This study found that routine disease educational lectures on asthma day can successfully alleviate asthma sufferers' anxiety and depression.

9.
Cell Communication & Signaling [Electronic Resource]: CCS ; 20(1):201, 2022.
Article in English | MEDLINE | ID: covidwho-2196331

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 19 (COVID-19). The number of confirmed cases of COVID-19 is also rapidly increasing worldwide, posing a significant challenge to human safety. Asthma is a risk factor for COVID-19, but the underlying molecular mechanisms of the asthma-COVID-19 interaction remain unclear.

10.
BMC Oral Health ; 22:1-8, 2022.
Article in English | ProQuest Central | ID: covidwho-2196213

ABSTRACT

Aims & background Pilocarpine is an accepted treatment for xerostomia, but limited research has been conducted on the oral, topical form. The present study aimed to compare the effects of 1 and 2% pilocarpine mouthwash on xerostomic participants. Methods In this double-blind clinical trial study, 48 subjects with xerostomia were randomly divided into three groups to measure the effects of 1 and 2% pilocarpine and placebo mouthwashes on saliva levels. The amount of saliva in the 1st and 14th days was measured at 0, 45, 60, and 75 mins, while participants used their mouthwash three times a day for 14 days. On the 1st and 14th days, they filled out the information forms on xerostomia and the medicine's side effects before and after the intervention. Results On the 1st day, the mean salivary flow at 45, 60, and 75 mins in the 2 and 1% pilocarpine mouthwash were significantly higher than in the placebo mouthwash group (p < 0.05). On the 14th day, the mean salivary flow time at 45 mins in the 2% pilocarpine mouthwash group was significantly higher than in the placebo mouthwash group (p = 0.007). Furthermore, the mean salivary flow at 60 and 75 mins in the 2% (p < 0.001) and 1% pilocarpine mouthwash (p = 0.028) was significantly higher than in the placebo group. Moreover, the salivary flow in the 2% pilocarpine mouthwash group was significantly higher than the 1% pilocarpine mouthwash (p < 0.05) during these two times. No side effects were observed in any of the subjects. Conclusions The study showed that 5 ml of 2 and 1% pilocarpine mouthwash for 2 weeks increased salivary flow in xerostomic participants compared to placebo without any side effects.

11.
BMC Prim Care ; 24(1):9, 2023.
Article in English | PubMed | ID: covidwho-2196055

ABSTRACT

BACKGROUND: The incidence of chronic diseases during the COVID-19 pandemic has drastically been reduced worldwide due to disruptions in healthcare systems. The aim of our study is to analyse the trends in the incidence of 7 commonly managed primary care chronic diseases during the last 2 years of the COVID-19 pandemic in Catalonia. METHODS: We performed an observational retrospective population-based study using data from primary care electronic health records from January 2018 to August 2022 (5.1 million people older than 14 years). We divided the study period into two: a pre-pandemic period (before 14 March 2020) and a pandemic period. We performed a segmented regression analysis of daily incidence rates per 100,000 inhabitants of 7 chronic diseases: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), heart failure (HF), hypertension and hypercholesterolemia. In addition, we compared annual incidence between pandemic years (2020, 2021 and 2022) and 2019. Associated incidence rate ratios (IRR) were also calculated. Finally, we estimated the number of expected diagnoses during the pandemic period using data from 2019 and we compared it with the observed data. RESULTS: We analysed 740,820 new chronic diseases' diagnoses. Daily incidence rates of all 7 chronic diseases were drastically interrupted on 14 March 2020, and a general upward trend was observed during the following months. Reductions in 2020 were around 30% for all conditions except COPD which had greater reductions (IRR: 0.58 [95% CI: 0.57 to 0.6]) and HF with lesser drops (IRR: 0.86 [95% CI: 0.84 to 0.88]). Some of the chronic conditions have returned to pre-pandemic diagnosis levels, except asthma, COPD and IHD. The return to pre-pandemic diagnosis levels compensated for the drops in 2020 for T2DM and HF, but not for hypertension which presented an incomplete recovery. We also observed an excess of hypercholesterolemia diagnoses of 8.5% (95%CI: 1.81% to 16.15%). CONCLUSIONS: Although primary care has recovered the pre-pandemic diagnosis levels for some chronic diseases, there are still missing diagnoses of asthma, COPD and IHD that should be addressed.

12.
Thorax ; 02, 2023.
Article in English | EMBASE | ID: covidwho-2193942

ABSTRACT

We previously reported a decreasing incidence of paediatric asthma hospitalisations in Finland, but a rather stable trend in Sweden, between 2005 and 2014. We now aimed to investigate the incidence of paediatric asthma hospitalisations in these countries between 2015 and 2020, using Finland's National Hospital Discharge Register and Sweden's National Patient Register, which cover all hospitalisations in the respective countries. From 2015 to 2019, the incidence of paediatric asthma hospitalisations decreased by 36.7% in Finland and by 39.9% in Sweden and are increasingly approaching parity. In 2020, despite differences in COVID-19-related restrictions, asthma hospitalisations decreased by over 40%, thus warranting future research on the subject. Copyright © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

13.
Acta Physiologica Conference: 5th Congress of Physiology and Integrative Biology and 89th Congress of French Physiological Society Lyon France ; 236(Supplement 726), 2022.
Article in English | EMBASE | ID: covidwho-2192376

ABSTRACT

Introduction: Wearing a mask is one of the least costly measures for containing the spread of the Covid-19. This is one of the protective measures put in place by the coordinating team of the inter-university diploma on Antibiology and Antibiotic Therapy in Sub-Saharan Africa for its 2021 session. The objective of our study was to evaluate the acceptability of wearing a mask by health personnel from sub-Saharan Africa during the 05-week training course. Method(s): A descriptive cross-sectional study was conducted from July 15 to November 15, 2021. The survey was the study method, using individual interview and observation as study techniques. During the individual interview it was administered a semi-structured questionnaire including the aspects related to observation. Result(s): A total of 58 people were interviewed (35 +/- 0.83 years, 75.86% males). The most represented professions were medical specialists 31.03%, biologists 29.31% and general practitioners 18.27%. 56.90% of the participants wore the mask systematically, 34.48% wore it often with an average of 7 h24 of daily wear and 58.6% respected the instructions on the proper use of masks. The main inconvenience of wearing the mask was the problem of comfort for 46.55%. For 12.07%, the respiratory history (asthma, pneumonia, tuberculosis) contributed to the discomfort of wearing the mask, with respiratory difficulty being the discomfort felt. Conclusion(s): The wearing of masks during the 5-week training in the context of Covid-19 is globally accepted by the health personnel. The health personnel have a fairly good knowledge of the interest of this measure.

14.
Pediatric Critical Care Medicine Conference: 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, WFPICCS ; 23(11 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2190769

ABSTRACT

BACKGROUND AND AIM: Multisystem inflammatory syndrome (MIS-C) associated to SARS-CoV-2, has significant morbidity in children. The aim was to assess clinical and outcomes patients admitted Ecuadorian Pediatric Intensive Care Units (PICUs), to stablish some information about this pathology in our country. METHOD(S): An observational, retrospective cohort study with 3 institutions. Between August 2020 and June 2021. 108 patients met the WHO criteria for diagnosis. Children from 1 month to 15 years old were included. The sample distribution was Hospital Pediatrico Baca Ortiz (HPBO, n=98), Hospital Metropolitano (HM, n=7), and Hospital Ingles (HI, n=3). Demographic data, clinical presentation, laboratory test, treatment, morbidity, and mortality were obtained. RESULT(S): From the 108 patients included, 34% were infants, 64% male, and 47.3% with comorbidities. Epilepsy was found in 17.3%, asthma in 2.94%, and diabetes 2%. Polymerase chain reaction for SARS-CoV-2 was negative in 82%. All children received methylprednisolone at different dosing protocols, 48% received intravenous immunoglobulin (IVIG);from the 108 patients, 33% had dilatation of the coronary arteries, respiratory compromise in 50%, and 0,9 % present neurological signs. Shock was present on 88%. CONCLUSION(S): Shock was the complication most frequently involve on MIS-C. Despite the use of IVIG, one third of the patients who receive this treatment present coronary artery dilation, more research is needed to determine predisposing factors. Methylprednisolone was used on different dosing without relationship with favorable outcome. Epilepsy was the major mortality. Institutions had the same diagnostic criteria for MIS-C, but a standardized protocol of treatment is needed to improve the general outcome. (Table Presented).

15.
Pediatric Critical Care Medicine Conference: 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, WFPICCS ; 23(11 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2190755

ABSTRACT

BACKGROUND AND AIM: In the context of the current SARS-COV2 pandemic, multiple complications derived from infection have been described in the pediatric population;however, neurological involvement is rare. The objective is to describe two pediatric patients hospitalized during the SARS COV2 pandemic, who were admitted due to unspecified neurological symptoms, with a subsequent institutional diagnosis of Guillain Barre syndrome (GBS). METHOD(S): Description of two cases of pediatric patients with a diagnosis of SARS-COV2 infection and neurological symptoms treated at Fundacion Valle del Lili, with an inhospital diagnosis of Guillain Barre syndrome. Demographic data, clinical and pathological variables, treatment, and outcomes were collected and analyzed to describe the cases. RESULT(S): Male patients, 8 and 10 years old respectively, the first patient with no relevant history, patient # 2 with a history of asthma. Patient # 1 with respiratory symptoms associated with marked neurological symptoms, with sudden and progressive deterioration, clinical and electromyographic diagnosis of GBS managed with immunoglobulin and subsequent plasmapheresis. Patient # 2 with intense respiratory symptoms, requiring orotracheal intubation and vasoactive support, with subsequent neurological involvement, diagnosis of GBS, management with plasmapheresis. Both patients with recovery of mobility, rehabilitation and outpatient follow-up. CONCLUSION(S): In summary, these are the first reported cases of GBS associated with SARS-CoV-2 infection in Colombia and the first case report in Latin America describing atypical GBS presentation. Although neurological manifestations of SARS-CoV-2 infection are infrequent, physicians must be aware to establish early diagnostic suspicion of SARS-CoV-2 infection in children with neurological symptoms.

16.
Critical Care Medicine ; 51(1 Supplement):390, 2023.
Article in English | EMBASE | ID: covidwho-2190606

ABSTRACT

INTRODUCTION: Studies of hospitalized patients with COVID-19 have found varying clinical outcomes associated with underlying respiratory conditions and inhaled corticosteroid use. We performed a systematic review to summarize the effect of the pre-hospital use of inhaled corticosteroids on the clinical outcomes in patients with COVID-19. METHOD(S): A comprehensive literature accrual was conducted across the WHO, CDC, and LitCovid PubMed COVID-19 databases from inception until June 30th, 2022. The Overall mortality was the primary outcome, and the secondary outcomes were the need for intensive care unit (ICU) admission and the need for invasive mechanical ventilation (IMV). All included studies were observational and reported the desired outcomes with pre-hospital use of ICS in COVID-19 patients. Data analysis was performed using Review Manager Software, version 5.2 to evaluate the combined odds ratio (OR) with respective 95% confidence intervals (CI) using a random-effects model. RESULT(S): Nineteen studies assessed mortality and were included in the meta-analysis. A total of 1,122,329 patients were included, of which 10,466 patients died (2,289 out of 824,005 in ICS arm patients and 8,177 out of 298,324 in the non-ICS arm), resulting in the unadjusted odds of death (OR 1.36, 95% CI 1.09-1.70, I2=82%). However, In the subgroups analyses of COPD patients (8 studies;598 out of 106,659 in the ICS arm and 353 out of 44,496 in the non-ICS arm) and Asthma patients (7 studies;705 out of 714,126 in the ICS arm and 179 out of 222,577 in the non-ICS arm), significantly increased risk of death was not shown (OR 1.20, 95% CI 0.93-1.57, I2=32%, OR 1.61, 95% CI 0.97-2.66, I2=82% respectively). There were no significantly increased odds in the assessed secondary outcomes;ICU admission (13 studies, OR 1.11, 95% CI 0.82-1.51, I2=84%), need for mechanical ventilation (7 studies, OR 1.21, 95% CI 1.00-1.45, I2=0%). CONCLUSION(S): Prehospital use of ICS in COVID-19 patients is associated with higher odds of overall mortality in unadjusted analysis. However, this was not shown in the subgroup of patients with a history of COPD or Asthma. Other clinical outcomes such as the need for ICU admission and mechanical ventilation show similar trends. Future research with well-designed clinical trials is needed to validate our findings.

17.
Critical Care Medicine ; 51(1 Supplement):343, 2023.
Article in English | EMBASE | ID: covidwho-2190590

ABSTRACT

INTRODUCTION: Asthma exacerbations in children have historically been attributed to a combination of viral infection, environmental exposures, and individual patient attributes. The COVID-19 pandemic has provided a unique opportunity to evaluate variations in asthma severity during a time of changing viral exposure patterns and patient behaviors. This study describes the trends in pediatric critical asthma severity during the COVID-19 pandemic. METHOD(S): We performed a retrospective analysis of the Virtual Pediatric Systems (VPS) database. Inclusion criteria were: patients admitted to a pediatric intensive care unit in the United States from 2014-2021 with a discharge diagnosis of "asthma with acute exacerbation" or "asthma with status asthmaticus." Asthma severity was determined by the maximum level of respiratory support required during the admission, from lowest to highest: 1-Heated high flow nasal cannula;2-Non-invasive positive pressure;3-Endotracheal intubation;4-Inhaled anesthetics or ECMO. Patients were divided into Pre-COVID, Pandemic Era 2020, and 2021 groups based on the date of admission, with the start of the COVID-19 pandemic defined as April 1, 2020. Subgroup analysis was performed based on race/ethnic group. RESULT(S): A total of 51,746 patients were identified in the VPS database that met the stated criteria. The average number of admissions per month was 713 and 206 in the Pre-COVID and Pandemic groups, respectively. Patients categorized as "Severe" (severity levels 3 & 4) represented 3.8% and 4.7% of admissions, respectively (p< 0.05). Patients categorized as "Moderate" (severity level 2) represented 16.9% and 21.7% of admissions, respectively (p< 0.05). Asthma mortality rates were found to be 0.3% and 0.7%, respectively (p< 0.05). Subgroup analysis by race/ ethnic group found that asthma severity by race/ethnicity was unchanged from the pre-COVID baseline. CONCLUSION(S): During the COVID-19 pandemic, the number of critical asthma admissions decreased while the average severity and mortality rate in those patients increased. Further study is needed to determine whether these findings are due to delayed presentation to healthcare, changes in viral exposure patterns, or other factors.

18.
Critical Care Medicine ; 51(1 Supplement):297, 2023.
Article in English | EMBASE | ID: covidwho-2190582

ABSTRACT

INTRODUCTION: A patient with presumed status asthmaticus, treated with beta-agonist and fluid resuscitation, developed flash pulmonary edema and respiratory failure in the setting of undiagnosed cor triatriatum. DESCRIPTION: A teen male with history of asthma developed dyspnea and chest pain at work. At a local emergency room (ER), he received albuterol, steroid, magnesium sulfate, and 2 liters (L) of fluid. Chest X-ray (CXR) and computed tomography of the chest were normal. He was transferred with a diagnosis of status asthmaticus. On exam in the pediatric ER, he had tachycardia, tachypnea and diffuse wheezing. He received albuterol 20mg/hour and 3L of fluid boluses over several hours. Despite improvement in wheezing, the patient had ongoing tachycardia and chest pain. He was placed on oxygen by high-flow nasal cannula. Repeat CXR exhibited new diffuse airspace opacities, and a focused cardiac ultrasound showed a hyperdynamic left ventricle (LV) with normal function. The patient began to expectorate pink frothy fluid, with hypoxemia, requiring intubation. Covid-19 PCR, Troponin-I and B-Type Natriuretic peptide were negative. An echocardiogram revealed a dilated left atrium (LA) with an echogenic membrane within the LA, separating the pulmonary venous chamber from the LA and restricting blood flow into the LV. The LV was small in size with normal function. The right heart was normal. These findings were consistent with diagnosis of cor triatriatum sinister, whereby the LA is divided into two compartments by a membrane that can variably obstruct flow into the LV. For this patient, treatment with beta-agonist caused tachycardia and decreased LV filling. Fluid resuscitation increased intravascular volume. This combination worsened obstruction of blood flow from the LA to the LV, leading to flash pulmonary edema, respiratory failure, and shock. In the ICU, the patient underwent diuresis, and the cor triatarium membrane was later surgically resected. DISCUSSION: Asthma is encountered commonly in children. Patients not responsive to treatment for respiratory distress should have alternative diagnoses considered. Multiple cognitive biases led to delayed recognition of cardiac etiology as the cause for this patient's respiratory failure, including anchoring bias with premature closure.

19.
Paediatrics and Child Health (Canada) ; 27(Supplement 3):e43, 2022.
Article in English | EMBASE | ID: covidwho-2190154

ABSTRACT

BACKGROUND: In response to the COVID-19 pandemic, jurisdictions around the world implemented policies to reduce COVID-19 transmission through public masking, travel restrictions, and closure of non-essential businesses. Collectively known as non-pharmaceutical interventions (NPI), these strategies reliably reduce the spread of COVID-19. International data suggests NPI also reduce hospitalizations for pediatric respiratory infections and their consequences, particularly asthma exacerbation. However, few Canadian studies have examined the impact of NPI on hospitalizations for common causes of pediatric respiratory distress. OBJECTIVE(S): This study describes the impact of NPI on admissions for bronchiolitis, pneumonia, and asthma at a Canadian pediatric tertiary care centre. DESIGN/METHODS: A retrospective chart review was conducted including all pediatric patients <18 years admitted to the general pediatric and pediatric intensive care units with bronchiolitis, pneumonia, or asthma. Data regarding diagnosis, length of hospitalization, and mortality were collected before (September 2016-March 2020) and in the 6 months after provincial NPI implementation (March 2020-September 2020). NPI were present throughout this period, however, specific measures varied due to evolving public health orders. Chi-squared testing was conducted to describe the impact of NPI on number of admissions, length of hospitalization, and mortality. RESULT(S): Participants (n=1631) included 111 (6.8%) patients <1 month, 878 (53.8%) patients 1-23 months, 331 (20.3%) patients 24 months-4 years, and 311 (19.1%) patients >=5 years. A mean of 205 patients were admitted every 6 months with respiratory distress (bronchiolitis, pneumonia, and/or asthma) prior to NPI implementation. During this timeframe, the 6-month mean admissions due to asthma, pneumonia, and bronchiolitis were 48, 56, and 101, respectively. In the 6 months following NPI implementation, there were 56 admissions for respiratory distress, including 15 for asthma, 19 for pneumonia, and 22 for bronchiolitis. Mean length of stay increased following the implementation of NPI from 8.49 to 11.68 days, whereas 6-month mean mortality decreased from two to zero deaths. Results did not attain statistical significance (p>0.05). CONCLUSION(S): Results suggest NPI reduce hospitalizations and mortality from bronchiolitis, pneumonia, and asthma. Given the similar seasonality of these conditions, periodic use of NPI beyond the COVID-19 pandemic may reduce pediatric morbidity and mortality from common causes of respiratory distress. However, additional research is needed to describe the relationship between NPI and length of hospitalization. Future studies should also examine the impact of NPI on other pediatric infectious diseases to better characterize their utility.

20.
Paediatrics and Child Health (Canada) ; 27(Supplement 3):e23-e24, 2022.
Article in English | EMBASE | ID: covidwho-2190144

ABSTRACT

BACKGROUND: Children living with chronic comorbid conditions are at increased risk for severe COVID-19 disease, though there is limited evidence regarding the risks associated with specific conditions and which children may benefit from targeted COVID-19 therapies. Age-specific baseline indicators of COVID-19 severity are also needed to evaluate the effectiveness of SARS-CoV-2 vaccination strategies in the paediatric population. OBJECTIVE(S): In this study, we aimed to 1) identify factors associated with severe COVID-19 in children, and 2) describe rates of hospitalization, intensive care unit (ICU) admission, and severe COVID-19 within specific pediatric age groups. DESIGN/METHODS: We conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Cases were reported voluntarily by a network of >2800 paediatricians and paediatric subspecialists. SARS-CoV-2 hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease was defined as intensive care, ventilatory or hemodynamic requirements, select organ system complications, or death. Outcomes were described among children aged <6 months, 6-23 months, 2-4 years, 5-11 years, and 12-17 years. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for child age and sex, coinfections, and timing of hospitalization. RESULT(S): We identified 541 children hospitalized with SARS-CoV-2 infection, including 329 (60.8%) with COVID-19-related disease. Median age at admission was 2.8 years (IQR 0.3-13.5) and 42.9% (n=232) had at least one comorbidity. Among COVID-19-related hospitalizations, severe disease occurred in 29.5% of children (n=97/329), including a higher proportion of children aged 2-4 years (48.7%) and 12-17 years (41.3%) (Table 1). Comorbidities associated with severe disease are described in Figure 1, and included technology dependence (adjusted risk ratio [aRR] 1.96, 95% confidence interval [CI] 1.31-2.95), neurologic conditions (e.g. epilepsy and chromosomal/genetic conditions) (aRR 1.87, 95% CI 1.34-2.61), and pulmonary conditions (e.g. bronchopulmonary dysplasia and uncontrolled asthma) (aRR 1.66, 95% CI 1.13-2.42). CONCLUSION(S): While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. Children aged 2-4 years more commonly experienced severe COVID-19 in this study, which was conducted at a time when no children were eligible for SARS-CoV-2 vaccines. Notably, this high-risk group remains without access to approved vaccines. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children.

SELECTION OF CITATIONS
SEARCH DETAIL