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1.
Investigación Clínica ; 62(Suplemento 2):27-42, 2021.
Article in Spanish | CAB Abstracts | ID: covidwho-1818974

ABSTRACT

Hyperglycemia, with or without diabetes, is associated with complications in hospitalized patients with COVID-19. There is no informa- tion regarding this problem in our region. This study was aimed to compare the characteristics and in-hospital clinical course of patients with a probable diagnosis of COVID-19, with and without hyperglycemia during the hospital- ization. This is a retrospective, observational study of clinical records review of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data collection. Hyperglycemia was defined as a fasting value 140 mg/dL ac- cording to standard glycaemia targets in hospitalized patients. A total of 148 patients were included, 97 (65.5%) men and 51 (34.5%) women, with a mean age of 64.1..16.1 years;of which 42/148 (28.4%) patients reported previous diabetes, 60/148 (40.5%) patients had hyperglycemia during the hospitaliza- tion and 32/60 (53.3%) of these cases did not report previous diabetes. The patients with hyperglycemia were older, received more frequently systemic cor- ticosteroids (96.6 vs 82.6%;p=0.01), and antibiotics (68.3 vs 44.3%;p=0.01), had worse baseline oxygenation parameters (SpO 2 88.1..11.7%;vs 92.8..5.5%;p=0.02, PaO 2 /FiO 2, 194.4..119.7 vs 270.9..118.3;p<0.001), higher total lung severity score in the chest CT (14.9..5.7 vs 11.1..6.3;p<0.001) and higher lev- els of baseline inflammatory markers (CRP 6.73..3.61 vs 5.08..4.21;p<0.01, LDH 342.9..118.4 vs 296.5..161.4;p=0.01 and Ferritin 687.7..373.2 vs 542.6..395.3;p=0.01). Mortality (34.5 vs 10.7%;p<0.001) and admission to ICU (43.3 vs 7.9%;p<0.001) were higher in patients with hyperglycemia. Hyperglycemia in hospitalized patients with COVID-19 is a marker of seve- re disease and poor prognosis.

2.
Chinese Journal of Evidence-Based Medicine ; 22(4):438-443, 2022.
Article in Chinese | EMBASE | ID: covidwho-1818644

ABSTRACT

Objective To systematically review the impact of ACEI/ARB (angiotensin converting enzyme inhibitor/angiotensin receptor antagonist) treatment on the clinical outcomes of Chinese patients with COVID-19 infections. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, and VIP databases were electronically searched to collect cohort studies on the impact of the treatment with ACEI/ARB on the clinical outcomes of Chinese patients with COVID-19 infections from January 2020 to January 2022. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 17 cohort studies involving 4 912 subjects were included. The results of meta-analysis showed that patients who were prescribed ACEI/ARB had shorter hospital stays (SMD=-0.28, 95%CI -0.46 to -0.11, P=0.002) and a lower mortality rate (OR=0.47, 95%CI 0.36 to 0.62, P<0.000 01) than patients who did not take ACEI/ARB. Conclusion Current evidence shows that the use of ACEI/ARB drugs can improve the clinical prognosis of Chinese patients with COVID-19 infections. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

3.
Palliative Medicine in Practice ; 15(4):303-305, 2021.
Article in English | EMBASE | ID: covidwho-1818598

ABSTRACT

We present a case of a 62-year-old female patient with advanced sigmoid colon cancer and co-occurring respiratory failure due to COVID-19. The patient required CPAP therapy, however, due to bad tolerance of this treatment method sedation was required. As the respiratory failure progressed the patient was disqualified from invasive mechanical ventilation and treatment in ICU on account of her underlying condition and inauspicious prognosis. Therefore, it was decided to continue sedation as palliative means of dyspnea management.

4.
Tuberculosis and Respiratory Diseases ; 85(2):122-136, 2022.
Article in English | EMBASE | ID: covidwho-1818324

ABSTRACT

Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.

5.
World Journal of Gastroenterology ; 28(15):1526-1535, 2022.
Article in English | EMBASE | ID: covidwho-1818246

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field. Patients with COVID-19 usually have respiratory symptoms. However, liver dysfunction is not an uncommon presentation. Additionally, the degree of liver dysfunction is associated with the severity and prognosis of COVID-19. Prevention, diagnosis, and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19, especially in those with liver dysfunction. Recently, a large number of studies have reported that nutrition therapy measures, including natural dietary supplements, vitamins, minerals and trace elements, and probiotics, might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant, antiviral, anti-inflammatory, and positive immunomodulatory effects. This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction, nutritional and metabolic characteristics, nutritional status assessment, and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.

6.
Journal of Clinical Medicine ; 11(9), 2022.
Article in English | EMBASE | ID: covidwho-1818162

ABSTRACT

We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies having the same observation period for the comparison between SARS-CoV-2 outbreak in 2020 versus control period in 2019 were included. Primary endpoints were the relative variation of hospital admissions, the difference of in-hospital mortality for STEMI and NSTEMI. Secondary were: mortality according to countries, income levels and data quality;cardiogenic shock, mechanical complications, door-to-balloon time, time from symptom onset to first medical contact, left ventricular ejection fraction (LVEF) and troponin. In total, 61 observational studies with 125,346 patients were included. Compared with 2019, during the pandemic for STEMI were observed: a 24% reduction of hospitalizations with an impact on early survival (OR = 1.33 in-hospital mortality);the time from symptom onset to first medical contact was 91.31 min longer, whereas door-to-balloon time was increased (+5.44 min);after STEMI, the rate of cardiogenic shock was 33% higher;LVEF at discharge was decreased (−3.46);elevated high-sensitivity troponin levels (1.52) on admission. For NSTEMI, in the COVID-19 period, we observed a 31% reduction of hospitalizations and higher in-hospital deaths (OR = 1.34). The highest mortality rates among countries were: Italy OR = 3.71 (high income), Serbia OR = 2.15 (upper middle) and Pakistan OR = 1.69 (lower middle). Later hospital presentation was associated with larger infarctions, as well as with increased cardiogenic shock and in-hospital mortality.

7.
Journal of Clinical Medicine ; 11(9), 2022.
Article in English | EMBASE | ID: covidwho-1818161

ABSTRACT

This study estimated the outcome of delayed intravitreal anti-vascular endothelial growth factor (VEGF) therapy due to the coronavirus (COVID-19) disease pandemic on the prognosis of patients with neovascular age-related macular degeneration (nAMD). This study retrospectively enrolled 57 nAMD patients whose intravitreal anti-VEGF injections were delayed for >2 weeks between February and June 2020. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and anatomical characteristics were evaluated before (baseline), on the day, and at 2, 4, and 6 months after the delayed injection, and risk factors were identified. The average injection interval before and after treatment delay was 3.05 ± 1.45 and 2.41 ± 1.46 months, respectively (p = 0.002). The CST at baseline and on the day of delayed injection was 227.82 ± 62.46 and 267.26 ± 77.74 µm, respectively (p < 0.001). The average BCVA decreased from 0.29 ± 0.29 logMAR (baseline) to 0.38 ± 0.31 logMAR (6 months) (p = 0.001). The maximum subretinal fluid (SRF) height increased from 84.32 ± 89.33 µm (baseline) to 121.38 ± 103.36 µm (6 months) (p = 0.027). A higher baseline maximum SRF height was associated with less SRF height deterioration 6 months later (p < 0.001). Delayed intravitreal anti-VEGF therapy caused by the COVID-19 pandemic has worsened BCVA and residual SRF in nAMD patients after a temporary recovery. The baseline SRF reduce the degree of SRF height deterioration.

8.
Future Oncology ; 18(13):1531-1534, 2022.
Article in English | EMBASE | ID: covidwho-1817854
9.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816939

ABSTRACT

Background: Previous reports indicate that lung cancer patients are at an increased risk of severe COVID-19 disease and higher mortality rate compared to general population. However, prognostic factors are not yet clearly identified. The LunG canceR pAtients coVid19 Disease (GRAVID) study aimed to describe clinical characteristics, outcomes and predictors of poor prognosis in patients with lung cancer and COVID-19. Methods: In this large nationwide prospective study, medical records of lung cancer patients with COVID-19 diagnosis from 65 spanish hospitals were included. Clinical features, treatments and disease outcomes were collected. The primary endpoint was to determine any-cause mortality;secondary endpoints were hospitalization and admission at intensive care units (ICU). Risk factors of poor prognosis were identified by univariable and multivariable logistic regression models. Results: Overal, 447 patients were analysed. Mean age was 67.1 ± 9.8 years, and the majority were men (332, 74.3%) and current/former smokers (383 (85.7%). NSCLC was the most frequent cancer type (377, 84.5%), being adenocarcinoma (228, 51.0%) the predominant histology. 354 patients (79.2%) had unresectable stage III or metastatic disease, and 266 (59.5%) where receiving anticancer treatment, mostly first-line chemotherapy. 350 (78.3%) patients were hospitalized for a mean of 13.4 ± 11.4 days, 9 (2.0%) patients were admitted to ICU, and 146 (32.7%) patients died. Advanced disease and corticosteroid treatment at hospitalization were predictors of mortality. Non-terminal stage hospitalized patients with lymphocytopenia and high LDH showed an increased risk of death. Severity of COVID-19 correlated to mortality, admission at ICU and mechanical ventilation. Conclusion: With underlying comorbidities and immunocompromised status, patients with lung cancer and COVID-19 present high hospitalization and mortality rates. These outcomes, alongside the identification of prognostic factors, may inform physicians on risks and benefits for this population to provide individualized oncological care.

10.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816914

ABSTRACT

We sought to determine parameters of the acute phase response, a feature of innate immunity activated by infectious noxae and cancer, deranged by Covid-19 and establish oncological indices' prognostic potential for patients with concomitant cancer and Covid-19. Between 27/02 and 23/06/2020, OnCovid retrospectively accrued 1,318 consecutive referrals of patients with cancer and Covid-19 aged 18 from the U.K., Spain, Italy, Belgium, and Germany. Patients with myeloma, leukemia, or insufficient data were excluded. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and prognostic index (PI) were evaluated for their prognostic potential, with the NLR, PLR, and PNI risk stratifications dichotomized around median values and the pre-established risk categorizations from literature utilized for the mGPS and PI. 1,071 eligible patients were randomly assorted into a training set (TS, n=529) and validation set (VS, n=542) matched for age (67.9±13.3 TS, 68.5±13.5 VS), presence of 1 comorbidity (52.1% TS, 49.8% VS), development of 1 Covid-19 complication (27% TS, 25.9% VS), and active malignancy at Covid-19 diagnosis (66.7% TS, 61.6% VS). Among all 1,071 patients, deceased patients tended to categorize into poor risk groups for the NLR, PNI, mGPS, and PI (P<0.0001) with a return to pre-Covid-19 diagnosis NLR, PNI, and mGPS categorizations following recovery (P<0.01). In the TS, higher mortality rates were associated with NLR>6 (44.6% vs 28%, P<0.0001), PNI<40 (46.6% vs 20.9%, P<0.0001), mGPS (50.6% for mGPS2 vs 30.4% and 11.4% for mGPS1 and 0, P<0.0001), and PI (50% for PI2 vs 40% for PI1 and 9.1% for PI0, P<0.0001). Findings were confirmed in the VS (P<0.001 for all comparisons). Patients in poor risk categories had shorter median overall survival [OS], (NLR>6 30 days 95%CI 1-63, PNI<40 23 days 95%CI 10-35, mGPS2 20 days 95%CI 8-32, PI2 23 days 95%CI 1-56) compared to patients in good risk categories, for whom median OS was not reached (P<0.001 for all comparisons). The PLR was not associated with survival. Analyses of survival in the VS confirmed the NLR (P<0.0001), PNI (P<0.0001), PI (P<0.01), and mGPS (P<0.001) as predictors of survival. In a multivariable Cox regression model including all inflammatory indices and pre-established prognostic factors for severe Covid-19 including sex, age, comorbid burden, malignancy status, and receipt of anti-cancer therapy at Covid-19 diagnosis, the PNI was the only factor to emerge with a significant hazard ratio [HR] in both TS and VS analysis (TS HR 1.97, 95%CI 1.19-3.26, P=0.008;VS HR 2.48, 95%CI 1.47- 4.20, P=0.001). We conclude that systemic inflammation drives mortality from Covid-19 through hypoalbuminemia and lymphocytopenia as measured by the PNI and propose the PNI as the OnCovid Inflammatory Score (OIS) in this context.

11.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816909

ABSTRACT

COVID-19 is leading to a global pandemic and invades human cells via ACE2. ACE2 was found to abundantly expressed in many organs and cells. However, there is no evidence about the potential risk of various types of cancer patients vulnerable to the infection of COVID-19. To obtain a risk map which indicating the novel coronavirus vulnerability of different types of cancer, so in this work we analyzed the RNA sequencing datasets of cancer patient. By interrogating the datasets, we not only identified the cancer types which vulnerable to COVID-19 attacks, but also we reported that variations in the mRNA expression level of ACE2 correlate to various prognosis phenomenon in different types of cancer cohorts and illustrated the underlying mechanism involved in may be related to lymphocytes infiltration. From these discoveries, we constructed an infection risk map which indicate the vulnerability of different types of cancer to COVID-19 infection, also elucidated the correlationship between ACE2 and the prognosis of cancer. We found that high ACE2 expression levels leading high risk of COVID-19 infection and poor prognosis of BRCA while better prognosis in OV patient cohorts. Moreover, our study demonstrated that this different pattern may correlate with the immune infiltration level. Note: This was not presented at the conference.

12.
Revista Portuguesa de Cardiologia ; 2022.
Article in English | ScienceDirect | ID: covidwho-1815117

ABSTRACT

Introduction: Epicardial adipose tissue serves as a source of inflammatory cytokines and mediators. Cytokine storm is an important cause of morbidity and mortality in coronavirus disease 2019 (COVID-19). Objectives: To investigate the association between epicardial fat volume (EFV), inflammatory biomarkers and clinical severity of COVID-19. Methods: This retrospective study included 101 patients who were infected with COVID-19. Serum inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and ferritin levels were measured. Computed tomography images were analyzed and semi-automated measurements for EFV were obtained. The primary composite endpoint was admission to the intensive care unit (ICU) or death. Results: The primary composite endpoint occurred in 25.1% (n=26) of patients (mean age 64.8±14.8 years, 14 male). A total of 10 patients died. EFV, CRP, PCT, ferritin and IL-6 levels were significantly higher in ICU patients. Moreover, a positive correlation was determined between EFV and CRP (r: 0.494, p<0.001), PCT (r: 0.287, p=0.005), ferritin (r: 0.265, p=0.01) and IL-6 (r: 0.311, p=0.005). On receiver operating characteristic analysis, patients with EFV >102 cm3 were more likely to have severe complications. In multivariate logistic regression analysis, EFV independently predicted admission to the ICU at a significant level (OR: 1.02, 95% CI: 1.01-1.03, p=0.025). Conclusion: EFV and serum CRP, IL-6, PCT and ferritin levels can effectively assess disease severity and predict the outcome in patients with COVID-19. EFV is an independent predictor of admission to the ICU in hospitalized COVID-19 patients. Resumo Introdução: O tecido adiposo epicárdico é fonte de citocinas inflamatórias e mediadores. A tempestade de citocinas é uma importante causa de morbilidade e mortalidade na doença coronavírus 2019 (COVID-19). Objetivos: Investigar a associação entre volume adiposo epicárdico (VAE), biomarcadores inflamatórios e gravidade clínica da COVID-19. Métodos: Este estudo retrospetivo incluiu 101 doentes infetados com COVID-19. Foram avaliados biomarcadores inflamatórios séricos, incluindo os níveis de proteína C-reativa (PCR), de interleucina-6 (IL-6), de procalcitonina (PCT) e de ferritina. Foram analisadas imagens de tomografia computorizada (TC) e foram obtidas medições semi-automáticas do VAE. O endpoint primário composto foi a admissão na unidade de cuidados intensivos (UCI) ou morte. Resultados: O endpoint primário ocorreu em 25,1% (n = 26) dos doentes (idade média 64,8±14,8 anos, 14 homens). Um total de 10 doentes morreu. Os níveis de VAE, PCR, PCT, ferritina e IL-6 foram significativamente superiores nos doentes internados na UCI. Além disso, verificou-se uma correlação positiva entre o VAE e a PCR (r: 0,494, p < 0,001), PCT (r: 0,287, p = 0,005), ferritina (r: 0,265, p = 0,01) e IL-6 (r: 0,311, p= 0,005). Na análise de regressão logistica multivariada, os doentes com VAE > 102 cm3 tinham maior probabilidade de ter complicações graves. Conclusão: O VAE e os níveis séricos de PCR, IL-6, PCT e ferritina podem avaliar a gravidade da doença e prever o resultado em doentes com COVID-19. O VAE constitui um fator preditivo na admissão dos doentes hospitalizados com COVID-19 numa UCI.

13.
Journal of Infection ; 84(3):329-336, 2022.
Article in English | Web of Science | ID: covidwho-1814745

ABSTRACT

This study aimed to analyse the diversity and taxonomic composition of the nasopharyngeal microbiota, to determine its association with COVID-19 clinical outcome. To study the microbiota, we utilized 16S rRNA sequencing of 177 samples that came from a retrospective cohort of COVID-19 hospitalized patients. Raw sequences were processed by QIIME2. The associations between microbiota, invasive mechanical ventilation (IMV), and all-cause mortality were analysed by multiple logistic regression, adjusted for age, gender, and comorbidity. The microbiota adiversity indexes were lower in patients with a fatal outcome, whereas the beta diversity analysis showed a significant clustering in these patients. After multivariate adjustment, the presence of Selenomonas spp., Filifactor spp., Actinobacillus spp., or Chroococcidiopsis spp., was associated with a reduction of more than 90% of IMV. Higher diversity and the presence of certain genera in the nasopharyngeal microbiota seem to be early biomarkers of a favourable clinical evolution in hospitalized COVID-19 patients. (C) 2022 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

14.
Med Clin (Engl Ed) ; 157(6): 274-280, 2021 Sep 24.
Article in English | MEDLINE | ID: covidwho-1814942

ABSTRACT

BACKGROUND: Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19. METHODS: Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied. RESULTS: A total of 918 patients (mean age 63.2 ± 15.5 years, 60.1% male) with a median follow-up of 57 (49-63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7-18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57-4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates. CONCLUSION: Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.


ANTECEDENTES: El daño miocárdico parece una complicación frecuente en pacientes con COVID-19. Sin embargo, la literatura al respecto presenta serias limitaciones, como definiciones incorrectas, heterogeneidad de las determinaciones de troponina o seguimientos cortos. Utilizando datos de una cohorte amplia, el objetivo del trabajo fue caracterizar adecuadamente el daño miocárdico en pacientes con COVID-19 utilizando una metodología adecuada. MÉTODOS: Se estudió a pacientes consecutivos con infección confirmada y determinaciones disponibles de troponina I de alta sensibilidad (hs-TnI), desde el 1 de marzo hasta el 20 de abril del 2020, que hubieran completado al menos un mes de seguimiento o fallecieran durante el periodo de estudio. RESULTADOS: Se incluyó a 918 pacientes (edad 63,2 ± 15,5 años, 60,1% varones) con un seguimiento mediano de 57 (49-63) días. De estos, 190 (20,7%) cumplían criterios estrictos de lesión miocárdica (21,1% crónica, 76,8% aguda no isquémica, 2,1% aguda isquémica). El tiempo desde el inicio de los síntomas hasta la hs-TnI máxima fue de 11 (7-18) días. Los eventos trombóticos y hemorrágicos, las arritmias, la insuficiencia cardíaca, la necesidad de ventilación mecánica y la muerte fueron significativamente más frecuentes en pacientes con concentraciones elevadas de hs-TnI, incluso por debajo del nivel de lesión miocárdica. La hs-TnI resultó un predictor independiente de mortalidad (HR 2,52 [(1,57-4,04] por cada 5 unidades logarítmicas). CONCLUSIÓN: La hs-TnI elevada es altamente prevalente entre los pacientes con COVID-19. Elevaciones leves muy por debajo del límite para definir lesión miocárdica se asociaron con más complicaciones y mayor mortalidad. La determinación protocolizada de hs-TnI en estos enfermos podría mejorar su estratificación pronóstica y los resultados clínicos.

15.
Journal of Parenteral and Enteral Nutrition ; 46(SUPPL 1):S76-S77, 2022.
Article in English | EMBASE | ID: covidwho-1813565

ABSTRACT

Background: Several international guidelines have highlighted the importance of ensuring the energy and protein intake of people with COVID- 19, but little is known about the nutritional risks for patients in critical conditions. There is still controversy if the modified Nutric score (mNUTRIC) is associated with higher mortality in patients with COVID-19 in the intensive care unit (ICU). Therefore, this study aims to investigate the applicability of the mNUTRIC score to assess nutritional risks and mortality in these critically ill patients with COVID-19 to improve prognosis and clinical results. Methods: This is a retrospective, observational study carried out in three ICU specially equipped for COVID-19 at the Hospital Clinica San Francisco, Guayaquil, Ecuador. Critically ill COVID-19 patients admitted in these ICUs between March and May 2020 were the study population. The exclusion criteria were those under 18 years of age or with a length of stay in the ICU of less than 24 hours. The nutritional risk of each patient was assessed upon admission to the ICU using the mNUTRIC score, and a score ≥of 5 indicates a high nutritional risk. Mortality was calculated according to the results of the patients after 30 days of ICU hospitalization. The results were presented by descriptive statistical analysis. Results: A total of 97 COVID-19 patients were admitted to the ICU with a median age of 64 years, 68 men (70%). Based on the mNutric score at ICU admission, a low nutritional risk (< 4 points) was observed in 65% of critically ill patients with COVID-19, while a high nutritional risk (≥5 points) was observed in 34%. The ICU mortality at 30 days was significantly higher in the high nutritional risk group than the survivors (40% vs. 15%) Also this group was associated with more days in mechanical ventilation (median 11 days) and more days in ICU w(mean 13 days). Furthermore, it was observed that the patients who survived the ICU had a much higher nutritional risk than those who did not survive (84% vs 59%). Conclusion: A large percentage of critically ill COVID-19 patients were at low nutritional risk, as evidenced by the mNUTRIC score. However, patients at high nutritional risk at ICU admission showed significantly higher ICU mortality at 30 days than those who survived. Therefore, the mNUTRIC score may be an appropriate tool for assessing nutritional risk and prognosis for critically ill COVID-19 patients.

16.
Revista de la Federacion Argentina de Cardiologia ; 51(1):32-36, 2022.
Article in Spanish | EMBASE | ID: covidwho-1813131

ABSTRACT

Background: Coronavirus disease (COVID-19) is one of the largest pandemics known to date. Elevated troponin can be caused by multiple factors, but its increase is related to adverse outcomes and higher mortality. In the First Argentine Registry of Cardiac Complications in patients with CO-VID-19 (RACCOVID-19) the Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC) data were analyzed. Objectives: The aim of this study was to learn the troponin elevation rate and its relationship with the prognosis of patients included into the RACCOVID-19. Methods: A total of 2750 patients were included in 50 centers in 11 provinces of the country from May 18 to October 31, 2020. Results: Troponin samples were taken from 2378 patients. The positivity rate was 15.2%. The most common cause of troponin elevation was related to infection (inflammatory) followed by heart failure. The group of patients with elevated troponin showed a higher age, predominant male sex, higher rate of history of asthma/COPD, diabetes mellitus, kidney failure and/or dialysis, and more severe forms of COVID-19. Mortality in the registry was 19.3% and 43.3% in patients with troponin elevation (43.8% vs. 13.9%, p < 0.001). Troponin elevation was independently associated with mortality. Conclusions: The RACCOVID-19 registry showed a troponin positivity rate of 15.2%. These patients presented more comorbidities and more severe forms of the disease. The increase in troponin during hospitalization for COVID-19 is independently associated with higher mortality.

17.
Infectious Diseases: News, Opinions, Training ; 11(1):47-56, 2022.
Article in Russian | Scopus | ID: covidwho-1812110

ABSTRACT

Objective: assessment of the efficacy and safety of the use of anticoagulant, glucocorticosteroid, metabolic therapy in patients with COVID-19 at the inpatient stage of treatment. Material and methods. In February 2021, a prospective, randomized, single-center, continuous comparative study was organized on the basis of the Gomel City Clinical Hospital No. 3, which included 827 patients with moderate and severe clinical course of COVID-19. Results. Stratification of the risks of an unfavorable outcome in patients with moderate and severe clinical course of COVID-19 made it possible to optimize treatment, with the selection of optimal doses of anticoagulant and glucocorticosteroid therapy, which led to an increase in patient survival. A high level of blood lactate reflects the degree of damage to the lung tissue, the severity of the course of the disease and requires an increase in the dose of anticoagulant therapy. The use of thiotriazoline effectively reduces the level of lactate, which makes it possible to restore the energy balance of the cell. Conclusion. The use of therapeutic (intermediate) doses of anticoagulant and optimal glucorticosteroid therapy in patients at high risk of poor outcomes with moderate and severe clinical course of COVID-19, can increase the survival rate from 82.1 to 96.8%, p<0.0001. The appointment of anticoagulant therapy was complicated by “minor” bleeding in 2.13% in the main group, in 2.11% in the control group, p>0.05, and the use of glucocorticosteroids was complicated by newly diagnosed diabetes mellitus (2.13% in the main group, 1.81% in the control group, p>0.05), which allows us to consider the therapy used is safe. The use of the metabolic, antioxidant agent thiotriazoline in patients with an LDH level of more than 800 U/L and with a high risk of an unfavorable outcome led to a decrease in LDH within five days of treatment by 447.9 U/L in the main group compared with the control group by 124.0 U/L (p=0.0001), which was accompanied by an improvement in the general condition, increased physical activity, and an earlier start of rehabilitation. © 2022 by the authors.

18.
Arch Cardiol Mex ; 2022.
Article in Spanish | PubMed | ID: covidwho-1811938

ABSTRACT

OBJECTIVE: From the onset of COVID-19 pandemic, the presence of previous cardiopathy was thought to be related with a worse prognosis of the disease. We aimed to analyse that theoretical adverse impact in a large cohort of patients. METHOD: We selected 1065 patients admitted for SARS-CoV-2 pneumonia between March and June 2020, divided in three groups according to (1) absence of cardiopathy, (2) presence of valvular heart disease or ischemic heart disease, or (3) presence of heart failure. We analysed the differences between groups regarding the need for admission in intensive care unit for mechanical ventilation or mortality during admission, or mortality during admission or in the next 6 months. RESULTS: The factors that were associated with a worse prognosis both in acute phase and in the next 6 months were age, male gender, obesity and oncologic disease. The presence of previous cardiopathy did not have an adverse prognostic impact neither initially nor in the short term, in our study. CONCLUSIONS: We did not obtain significative association of the presence of cardiopathy with a worse medical evolution, neither in acute phase nor in the short term, of patients admitted for SARS-CoV-2 pneumonia.

20.
Medicina ; 58(4):511, 2022.
Article in English | ProQuest Central | ID: covidwho-1810018

ABSTRACT

Dabrafenib and trametinib are two available molecules that have been approved for the treatment of metastatic melanoma with BRAF-V600E or V600K mutations. Their combined therapy has led to long-lasting survival benefits and substantially improved outcomes. Until now, only a few cases of severe hypersensitivity reactions to dabrafenib and vemurafenib have been reported, and even fewer desensitization protocols to these molecules have been documented. We report the case of a 71-year-old female patient with metastatic melanoma harboring a BRAF-V600E mutation undergoing targeted therapy with dabrafenib and trametinib. Two weeks after the initiation of the combined treatment, she developed a hypersensitivity reaction. The cause–effect relationship between dabrafenib and the hypersensitivity reaction was demonstrated twice, when symptoms recurred upon dabrafenib reintroduction. We started a rapid 3-day dabrafenib desensitization protocol, which was well tolerated. When the patient discontinued the drug administration, we decided on a longer protocol that included more steps and more days in order to prevent the occurrence of other hypersensitivity reactions. Our patient tolerated both rapid and slow-going schedules, the first one reaching the final dose within 3 days and the second one reaching the total daily dose within 14 days. Depending on the patient’s needs, the severity of the hypersensitivity reaction and the hospital’s availability, the doctor may choose either the rapid or slow-going desensitization protocol.

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