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3.
BMC Int Health Hum Rights ; 20(1): 22, 2020 08 28.
Article in English | MEDLINE | ID: covidwho-733043

ABSTRACT

Notwithstanding COVID-19, non-communicable diseases (NCDs) will be the leading cause of death in every region in the world by 2030. This contribution, which forms an introduction to our collection of articles in this journal, identifies elements for a transdisciplinary research agenda between law, public health, health economics and international relations aimed at designing concrete interventions to curb the NCD pandemic, both globally and domestically.


Subject(s)
Interdisciplinary Research/organization & administration , Noncommunicable Diseases/prevention & control , Pandemics/prevention & control , Cause of Death/trends , Global Health/statistics & numerical data , Humans , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/mortality
10.
G Ital Cardiol (Rome) ; 21(8): 575-583, 2020 Aug.
Article in Italian | MEDLINE | ID: covidwho-680054

ABSTRACT

The new coronavirus disease 2019 (COVID-19), which is causing hundreds of thousands of deaths worldwide, is complex and can present with a multi-organ localization. One of its worst complications is an interstitial pneumonia with acute respiratory failure also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which requires non-invasive or invasive ventilation. A severe coagulopathy with poor prognosis is found in 5-10% of cases. SARS-CoV-2 is manifesting as a multi-dimensional disease and, recently, unique co-existing pathophysiological and clinical aspects are being defined: (i) an increased immune and inflammatory response with the activation of a cytokine storm and consequent coagulopathy, which promote both venous thromboembolic events and in situ thrombosis localized in small arterioles and pulmonary alveolar capillaries; (ii) a high intrapulmonary shunt, which often accounts for the severity of respiratory failure, due to reduced hypoxic pulmonary vasoconstriction with pulmonary neo-angiogenetic phenomena. Furthermore, the high incidence of venous thromboembolism in COVID-19 patients admitted to the intensive care unit and the autoptic findings of in situ micro-thrombosis at the pulmonary vascular level, suggest that in this disease coagulopathy, unlike septic disseminated intravascular coagulation, is driven towards a hyper-thrombogenic state, giving rise to a debate (with ongoing studies) about the preventive use of anticoagulant doses of heparin to reduce mortality. The aim of this position paper from the Italian Association of Hospital Cardiologists (ANMCO) is to highlight the main implications that COVID-19 infection has on the pulmonary circulation from a pathophysiological, clinical and management point of view.


Subject(s)
Cause of Death , Coronavirus Infections/epidemiology , Lung Diseases, Interstitial/mortality , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Venous Thromboembolism/etiology , Cardiology , Communicable Diseases, Emerging/epidemiology , Coronavirus Infections/diagnosis , Disease Progression , Female , Humans , Incidence , Italy/epidemiology , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Male , Pneumonia, Viral/diagnosis , Pulmonary Circulation/physiology , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Societies, Medical , Survival Analysis , Venous Thromboembolism/mortality , Venous Thromboembolism/physiopathology
11.
G Ital Cardiol (Rome) ; 21(8): 570-574, 2020 Aug.
Article in Italian | MEDLINE | ID: covidwho-680052

ABSTRACT

Several important gender differences in susceptibility, clinical manifestation and response to treatments for a number of diseases are known since a long time, although they continue to be underestimated by a multiplicity of operators, especially men. The recent COVID-19 pandemic has provided a further evidence of the importance of gender medicine. The epidemiological analysis of COVID-19 data has highlighted the presence of multiple and important gender differences, with more unfavourable scenarios for the male gender. The mechanisms underlying these gender differences are varied (including socio-behavioral, immune and viral factors) and not yet fully clarified. A gender-based approach to clinical practice also in the context of this pandemic seems to be mandatory, as it could significantly contribute to health promotion by improving the effectiveness of diagnostic and/or therapeutic approaches and, therefore, leading to important benefits primarily for the patients but also for the sustainability of the National Health System.


Subject(s)
Cause of Death , Communicable Disease Control/methods , Coronavirus Infections/epidemiology , Disease Susceptibility/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Coronavirus Infections/diagnosis , Delivery of Health Care/organization & administration , Female , Health Promotion , Humans , Italy/epidemiology , Male , Pneumonia, Viral/diagnosis , Prevalence , Risk Assessment , Sex Distribution , Survival Analysis
12.
Can J Cardiol ; 36(7): 1068-1080, 2020 07.
Article in English | MEDLINE | ID: covidwho-679669

ABSTRACT

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock. The cardiac manifestations of COVID-19 might be related to the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications. COVID-19 has profoundly reshaped usual care of both ambulatory and acute cardiac patients, by leading to the cancellation of elective procedures and by reducing the efficiency of existing pathways of urgent care, respectively. Decreased use of health care services for acute conditions by non-COVID-19 patients has also been reported and attributed to concerns about acquiring in-hospital infection. Innovative approaches that leverage modern technologies to tackle the COVID-19 pandemic have been introduced, which include telemedicine, dissemination of educational material over social media, smartphone apps for case tracking, and artificial intelligence for pandemic modelling, among others. This article provides a comprehensive overview of the pathophysiology and cardiovascular implications of COVID-19, its impact on existing pathways of care, the role of modern technologies to tackle the pandemic, and a proposal of novel management algorithms for the most common acute cardiac conditions.


Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cause of Death , Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Cardiovascular Diseases/therapy , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Global Health , Hospital Mortality/trends , Humans , Male , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prevalence , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Survival Analysis
13.
Ann Transplant ; 25: e925755, 2020 Jul 24.
Article in English | MEDLINE | ID: covidwho-676253

ABSTRACT

Kidney transplantation at the time of the COVID-19 pandemic is challenging. Modifying the immunosuppression protocols is controversial and not evidence based. In this study, we aim to review the published literature of kidney transplant recipients who encountered COVID-19. A literature review was performed using PubMed, ScienceDirect, and World Health Organization databases to identify relevant English-language articles published up to May 7, 2020. There were 24 articles that reported 129 kidney transplant recipients who encountered COVID-19. The age mean was 54.2 years with 73.7% as males. The most commonly reported presentations in order were fever (82.3%), cough (58%), shortness of breath (33.2%), and fatigue (30.7%). Acute kidney injury was observed in 34.1% of patients. Kidney transplant patients encountered COVID-19 were maintained on tacrolimus (Tac, 92%), mycophenolate mofetil (MMF, 78.8%), and prednisone (Pred, 77%) and were manage by holding MMF in 79.1% of patients and holding Tac in 34.4% of patients. In all, 20% of patients needed Intensive Care Unit (ICU) admission and 24.6% of patients required mechanical ventilation. In all, 18.8% of patients had died compared to the reported general population COVID-19 mortality of 3.4%. The clinical presentation of COVID-19 in kidney transplant recipients may be different from the general population with a higher rate of severe disease, complications including renal failure, and mortality.


Subject(s)
Cause of Death , Coronavirus Infections/epidemiology , Global Health , Infection Control/methods , Kidney Transplantation/statistics & numerical data , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Acute Kidney Injury/diagnosis , Acute Kidney Injury/surgery , Adult , Databases, Factual , Female , Graft Survival , Humans , Immunosuppression/methods , Incidence , Kidney Failure, Chronic/surgery , Kidney Transplantation/methods , Kidney Transplantation/mortality , Male , Middle Aged , Patient Selection , Prognosis , Risk Assessment , Survival Analysis , World Health Organization
15.
Cochrane Database Syst Rev ; 7: CD013600, 2020 07 10.
Article in English | MEDLINE | ID: covidwho-651065

ABSTRACT

BACKGROUND: Convalescent plasma and hyperimmune immunoglobulin may reduce mortality in patients with viral respiratory diseases, and are currently being investigated in trials as potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks is required.  OBJECTIVES: To continually assess, as more evidence becomes available, whether convalescent plasma or hyperimmune immunoglobulin transfusion is effective and safe in treatment of people with COVID-19. SEARCH METHODS: We searched the World Health Organization (WHO) COVID-19 Global Research Database, MEDLINE, Embase, Cochrane COVID-19 Study Register, Centers for Disease Control and Prevention COVID-19 Research Article Database and trial registries to identify completed and ongoing studies on 4 June 2020. SELECTION CRITERIA: We followed standard Cochrane methodology. We included studies evaluating convalescent plasma or hyperimmune immunoglobulin for people with COVID-19, irrespective of study design, disease severity, age, gender or ethnicity. We excluded studies including populations with other coronavirus diseases (severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS)) and studies evaluating standard immunoglobulin. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methodology. To assess bias in included studies, we used the Cochrane 'Risk of bias' tool for randomised controlled trials (RCTs), the Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool for controlled non-randomised studies of interventions (NRSIs), and the assessment criteria for observational studies, provided by Cochrane Childhood Cancer for non-controlled NRSIs.  MAIN RESULTS: This is the first living update of our review. We included 20 studies (1 RCT, 3 controlled NRSIs, 16 non-controlled NRSIs) with 5443 participants, of whom 5211 received convalescent plasma, and identified a further 98 ongoing studies evaluating convalescent plasma or hyperimmune immunoglobulin, of which 50 are randomised. We did not identify any completed studies evaluating hyperimmune immunoglobulin. Overall risk of bias of included studies was high, due to study design, type of participants, and other previous or concurrent treatments. Effectiveness of convalescent plasma for people with COVID-19  We included results from four controlled studies (1 RCT (stopped early) with 103 participants, of whom 52 received convalescent plasma; and 3 controlled NRSIs with 236 participants, of whom 55 received convalescent plasma) to assess effectiveness of convalescent plasma. Control groups received standard care at time of treatment without convalescent plasma. All-cause mortality at hospital discharge (1 controlled NRSI, 21 participants) We are very uncertain whether convalescent plasma has any effect on all-cause mortality at hospital discharge (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.61 to 1.31; very low-certainty evidence). Time to death (1 RCT, 103 participants; 1 controlled NRSI, 195 participants) We are very uncertain whether convalescent plasma prolongs time to death (RCT: hazard ratio (HR) 0.74, 95% CI 0.30 to 1.82; controlled NRSI: HR 0.46, 95% CI 0.22 to 0.96; very low-certainty evidence). Improvement of clinical symptoms, assessed by need for respiratory support (1 RCT, 103 participants; 1 controlled NRSI, 195 participants) We are very uncertain whether convalescent plasma has any effect on improvement of clinical symptoms at seven days (RCT: RR 0.98, 95% CI 0.30 to 3.19), 14 days (RCT: RR 1.85, 95% CI 0.91 to 3.77; controlled NRSI: RR 1.08, 95% CI 0.91 to 1.29), and 28 days (RCT: RR 1.20, 95% CI 0.80 to 1.81; very low-certainty evidence). Quality of life No studies reported this outcome.  Safety of convalescent plasma for people with COVID-19 We included results from 1 RCT, 3 controlled NRSIs and 10 non-controlled NRSIs assessing safety of convalescent plasma. Reporting of adverse events and serious adverse events was variable. The controlled studies reported on adverse events and serious adverse events only in participants receiving convalescent plasma. The duration of follow-up varied. Some, but not all, studies included death as a serious adverse event.  Grade 3 or 4 adverse events (13 studies, 201 participants) The studies did not report the grade of adverse events. Thirteen studies (201 participants) reported on adverse events of possible grade 3 or 4 severity. The majority of these adverse events were allergic or respiratory events. We are very uncertain whether or not convalescent plasma therapy affects the risk of moderate to severe adverse events (very low-certainty evidence).  Serious adverse events (14 studies, 5201 participants)  Fourteen studies (5201 participants) reported on serious adverse events. The majority of participants were from one non-controlled NRSI (5000 participants), which reported only on serious adverse events limited to the first four hours after convalescent plasma transfusion. This study included death as a serious adverse event; they reported 15 deaths, four of which they classified as potentially, probably or definitely related to transfusion. Other serious adverse events reported in all studies were predominantly allergic or respiratory in nature, including anaphylaxis, transfusion-associated dyspnoea, and transfusion-related acute lung injury (TRALI). We are very uncertain whether or not convalescent plasma affects the number of serious adverse events. AUTHORS' CONCLUSIONS: We are very uncertain whether convalescent plasma is beneficial for people admitted to hospital with COVID-19. For safety outcomes we also included non-controlled NRSIs. There was limited information regarding adverse events. Of the controlled studies, none reported on this outcome in the control group. There is only very low-certainty evidence for safety of convalescent plasma for COVID-19.  While major efforts to conduct research on COVID-19 are being made, problems with recruiting the anticipated number of participants into these studies are conceivable. The early termination of the first RCT investigating convalescent plasma, and the multitude of studies registered in the past months illustrate this. It is therefore necessary to critically assess the design of these registered studies, and well-designed studies should be prioritised. Other considerations for these studies are the need to report outcomes for all study arms in the same way, and the importance of maintaining comparability in terms of co-interventions administered in all study arms.  There are 98 ongoing studies evaluating convalescent plasma and hyperimmune immunoglobulin, of which 50 are RCTs. This is the first living update of the review, and we will continue to update this review periodically. These updates may show different results to those reported here.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Cause of Death , Coronavirus Infections/immunology , Coronavirus Infections/mortality , Early Termination of Clinical Trials , Humans , Immunization, Passive/adverse effects , Immunization, Passive/methods , Immunization, Passive/mortality , Immunization, Passive/statistics & numerical data , Non-Randomized Controlled Trials as Topic/mortality , Non-Randomized Controlled Trials as Topic/statistics & numerical data , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Randomized Controlled Trials as Topic/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Selection Bias , Severity of Illness Index , Treatment Outcome
17.
Euro Surveill ; 25(28)2020 Jul.
Article in English | MEDLINE | ID: covidwho-647503

ABSTRACT

England has experienced one of the highest excess in all-cause mortality in Europe during the current COVID-19 pandemic. As COVID-19 emerged, the excess in all-cause mortality rapidly increased, starting in March 2020. The excess observed during the pandemic was higher than excesses noted in the past 5 years. It concerned all regions and all age groups, except the 0-14 year olds, but was more pronounced in the London region and in those aged ≥ 85 years.


Subject(s)
Betacoronavirus , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Algorithms , Cause of Death , England/epidemiology , Humans , Middle Aged , Pandemics , Poisson Distribution , Young Adult
18.
Methodist Debakey Cardiovasc J ; 16(2): 146-154, 2020.
Article in English | MEDLINE | ID: covidwho-647027

ABSTRACT

Since early 2020, the world has been facing a pandemic caused by the novel coronavirus SARS-CoV-2. Although this positive single-stranded RNA virus primarily causes pulmonary infection and failure, it has been associated with multiple cardiovascular diseases including troponin elevation, myocarditis, and cardiac arrhythmias. Cardiac patients are susceptible to developing more severe infection from SARS-COV-2, making management complicated. In this review we discuss the cardiac manifestations of COVID-19 infections as well as considerations for the management of primary cardiac pathologies during this pandemic.


Subject(s)
Cardiovascular Diseases/epidemiology , Cause of Death , Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Adult , Age Factors , Aged , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/epidemiology , Cardiovascular Diseases/diagnostic imaging , China/epidemiology , Comorbidity , Coronavirus Infections/prevention & control , Female , Global Health , Humans , Magnetic Resonance Imaging, Cine/methods , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocarditis/diagnosis , Myocarditis/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Prevalence , Risk Assessment , Severity of Illness Index , Sex Factors , Survival Analysis , Tomography, X-Ray Computed/methods , Troponin T/blood , Vulnerable Populations/statistics & numerical data
20.
Euro Surveill ; 25(26)2020 07.
Article in English | MEDLINE | ID: covidwho-639161

ABSTRACT

A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March-April 2020. Excess mortality particularly affected ≥ 65 year olds (91% of all excess deaths), but also 45-64 (8%) and 15-44 year olds (1%). No excess mortality was observed in 0-14 year olds.


Subject(s)
Cause of Death/trends , Coronavirus Infections/mortality , Coronavirus/isolation & purification , Influenza, Human/mortality , Pneumonia, Viral/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , Coronavirus Infections/diagnosis , Disease Outbreaks , Europe/epidemiology , Female , Humans , Infant , Infant, Newborn , Influenza, Human/diagnosis , Male , Middle Aged , Mortality/trends , Pandemics , Pneumonia, Viral/diagnosis , Population Surveillance , Preliminary Data , Young Adult
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