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1.
Eur J Endocrinol ; 183(2): G79-G88, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-701828

ABSTRACT

In viral pandemics, most specifically Covid-19, many patients with neuroendocrine neoplasms (NENs), including phaeochromocytomas, paragangliomas and medullary thyroid carcinoma, may develop Covid-19 in a mild or severe form, or be concerned about the influence of viral infection relative to their anti-tumoral therapy. In general, newly presenting patients should be assessed, and patients recently receiving chemotherapy, targeted therapy or radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any Covid-19 illness, tumour grade, and the immunosuppressant effects of any planned chemotherapy, immunotherapy (e.g. interferon-alpha), targeted therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of Covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Disease Management , Neuroendocrine Tumors/therapy , Pneumonia, Viral/therapy , Telemedicine/trends , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endocrinology/methods , Endocrinology/trends , Humans , Neoplasm Grading/methods , Neoplasm Grading/trends , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Telemedicine/methods
2.
Neurologia ; 35(4): 252-257, 2020 May.
Article in English, Spanish | MEDLINE | ID: covidwho-700407

ABSTRACT

INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic.


Subject(s)
Coronavirus Infections , Health Care Surveys , Nervous System Diseases/therapy , Neurology/trends , Pandemics , Pneumonia, Viral , Administrative Personnel/psychology , Clinical Laboratory Techniques , Clinical Trials as Topic/methods , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Management , Distance Counseling , Forecasting , Hospital Departments/organization & administration , Humans , Nervous System Diseases/diagnosis , Neurologic Examination , Neurology/methods , Neurology/organization & administration , Pandemics/prevention & control , Patient Isolation , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Spain/epidemiology
5.
Stroke ; 51(8): 2593-2596, 2020 08.
Article in English | MEDLINE | ID: covidwho-680787

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per hospital per 2-week interval and mean stroke onset-to-groin puncture time were calculated before confinement measures and after confinement measures. Distributions (non-normal) between the 2 groups (before COVID-19 confinement versus after COVID-19 confinement) were compared using 2-sample Wilcoxon rank-sum test. The results show a significant decrease in mean number of EVTs performed per hospital per 2-week interval between before COVID-19 confinement (9.0 [95% CI, 7.8-10.1]) and after COVID-19 confinement (6.1 [95% CI, 4.5-7.7]), (P<0.001). In addition, there is a significant increase in mean stroke onset-to-groin puncture time (P<0.001), between before COVID-19 confinement (300.3 minutes [95% CI, 285.3-315.4]) and after COVID-19 confinement (354.5 minutes [95% CI, 316.2-392.7]). Our preliminary analysis indicates a 32% reduction in EVT procedures and an estimated 54-minute increase in symptom onset-to-groin puncture time after confinement measures for COVID-19 pandemic were put into place.


Subject(s)
Coronavirus Infections , Disease Management , Endovascular Procedures/statistics & numerical data , Pandemics , Pneumonia, Viral , Quarantine , Stroke/therapy , Brain Ischemia/therapy , Eligibility Determination , Female , Humans , Male , Middle Aged , Retrospective Studies , Spain , Time-to-Treatment , Treatment Outcome
7.
Eur J Endocrinol ; 183(2): G79-G88, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-656176

ABSTRACT

In viral pandemics, most specifically Covid-19, many patients with neuroendocrine neoplasms (NENs), including phaeochromocytomas, paragangliomas and medullary thyroid carcinoma, may develop Covid-19 in a mild or severe form, or be concerned about the influence of viral infection relative to their anti-tumoral therapy. In general, newly presenting patients should be assessed, and patients recently receiving chemotherapy, targeted therapy or radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any Covid-19 illness, tumour grade, and the immunosuppressant effects of any planned chemotherapy, immunotherapy (e.g. interferon-alpha), targeted therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of Covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Disease Management , Neuroendocrine Tumors/therapy , Pneumonia, Viral/therapy , Telemedicine/trends , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endocrinology/methods , Endocrinology/trends , Humans , Neoplasm Grading/methods , Neoplasm Grading/trends , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Telemedicine/methods
8.
J Am Med Dir Assoc ; 21(7): 888-892, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-653598

ABSTRACT

To provide policy recommendations for managing Coronavirus 19 (COVID-19) in skilled nursing facilities, a group of certified medical directors from several facilities in New York state with experience managing the disease used e-mail, phone, and video conferencing to develop consensus recommendations. The resulting document provides recommendations on screening, protection of staff, screening of residents, management of Coronavirus 19 positive and presumed positive cases, communication during an outbreak, management of admissions and readmissions, and providing emotional support for staff. These consensus guidelines have been endorsed by the Executive Board of the New York Medical Directors Association and the Board of the Metropolitan Area Geriatrics Society.


Subject(s)
Communicable Diseases, Emerging/therapy , Coronavirus Infections/epidemiology , Long-Term Care/organization & administration , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Skilled Nursing Facilities/organization & administration , Subacute Care/organization & administration , Aged , Communicable Diseases, Emerging/epidemiology , Coronavirus Infections/therapy , Disease Management , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , New York , Pandemics/statistics & numerical data , Pneumonia, Viral/therapy , Policy Making , Public Policy/legislation & jurisprudence
10.
Curr Oncol ; 27(3): e332-e335, 2020 06.
Article in English | MEDLINE | ID: covidwho-646931

ABSTRACT

The emergence of the covid-19 disease pandemic caused by the 2019 novel coronavirus has required a re-evaluation of treatment practices for clinicians caring for patients with chronic lymphocytic leukemia (cll). The American Society for Hematology (ash) has provided a series of recommendations for the treatment of patients with cll during the pandemic, covering a range of topics, including testing for covid-19, cll treatment initiation and selection, use of immunoglobulin therapy, in-person monitoring, and treatment of patients with cll and covid-19. We summarize the ash recommendations and discuss their applicability as guidelines for the treatment of cll during the covid-19 pandemic in Canada.


Subject(s)
Antineoplastic Agents/therapeutic use , Coronavirus Infections/epidemiology , Immunologic Factors/therapeutic use , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Pneumonia, Viral/epidemiology , Ambulatory Care/methods , Appointments and Schedules , Betacoronavirus , Canada/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Disease Management , Hospitalization , Humans , Immunoglobulins, Intravenous/therapeutic use , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Pyrazoles/therapeutic use , Pyrimidines/therapeutic use
11.
Curr Oncol ; 27(3): e313-e317, 2020 06.
Article in English | MEDLINE | ID: covidwho-646169

ABSTRACT

Background: The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non-covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services in the province of Quebec under the direction of the Ministère de la Santé et des Services sociaux, convened to develop recommendations to deal with the potential disruption of services in thoracic oncology in the province of Quebec. The summary provided here has been adapted from the original document posted on the Programme québécois du cancer Web site at: https://www.msss.gouv.qc.ca/professionnels/documents/coronavirus-2019-ncov/PJ1_Recommandations_oncologie-thoracique-200415.pdf. Methods: Plans to optimize the health care system and potentially to prioritize services were discussed with respect to various levels of activity. For each level-of-activity scenario, suggestions were made for the services and treatments to prioritize and for those that might have to be postponed, as well as for potential alternatives to care. Results: The principal recommendation is that the cancer centre executive committee and the multidisciplinary tumour board always try to find a solution to maintain standard-of-care therapy for all patients with thoracic tumours, using novel approaches to treatment and the adoption of a network approach to care, as needed. Conclusions: The effect of the covid-19 pandemic on the health care system remains unpredictable and requires that cancer teams unite and offer the most efficient and innovative therapies to all patients under the various conditions that might be forced upon them.


Subject(s)
Antineoplastic Agents/administration & dosage , Carcinoma, Non-Small-Cell Lung/therapy , Coronavirus Infections/epidemiology , Lung Neoplasms/therapy , Pneumonia, Viral/epidemiology , Radiotherapy , Small Cell Lung Carcinoma/therapy , Thoracic Surgical Procedures , Triage , Administration, Oral , Antineoplastic Agents/therapeutic use , Betacoronavirus , Carcinoma, Non-Small-Cell Lung/diagnosis , Disease Management , Humans , Lung Neoplasms/diagnosis , Mediastinoscopy , Medical Oncology , Molecular Diagnostic Techniques , Neoplasm Staging , Pandemics , Quebec/epidemiology , Radiosurgery , Small Cell Lung Carcinoma/diagnosis , Thoracoscopy
12.
Intern Med J ; 50(7): 798-804, 2020 07.
Article in English | MEDLINE | ID: covidwho-639949

ABSTRACT

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has emerged as a public health emergency and challenged healthcare systems globally. In a minority of patients, SARS-CoV-2 manifests with a severe acute respiratory illness and currently there is insufficient data regarding the virulence of COVID-19 in inflammatory bowel disease patients taking immunosuppressive therapy. This review aims to summarise the current literature and provide guidance on the management of inflammatory bowel disease patients in the context of the COVID-19 pandemic in the Australasian setting.


Subject(s)
Coronavirus Infections , Gastroenterology , Immunologic Factors/pharmacology , Inflammatory Bowel Diseases , Pandemics , Patient Care Management , Pneumonia, Viral , Australia , Betacoronavirus/isolation & purification , Change Management , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Management , Gastroenterology/organization & administration , Gastroenterology/trends , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/therapy , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Risk Management
13.
Clin Appl Thromb Hemost ; 26: 1076029620936350, 2020.
Article in English | MEDLINE | ID: covidwho-639157

ABSTRACT

This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , Practice Guidelines as Topic , Thrombophilia/therapy , Thrombosis/prevention & control , Anticoagulants/therapeutic use , Biomarkers , Clinical Trials as Topic , Coronavirus Infections/blood , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/etiology , Disease Management , Endothelium, Vascular/physiopathology , Endothelium, Vascular/virology , Evidence-Based Medicine , Fibrin Fibrinogen Degradation Products/analysis , Humans , Lung Diseases/etiology , Lung Diseases/prevention & control , Pneumonia, Viral/blood , Pulmonary Veins , Thrombophilia/etiology , Thrombophlebitis/etiology , Thrombophlebitis/prevention & control , Thrombosis/etiology , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control
14.
16.
RMD Open ; 6(2)2020 06.
Article in English | MEDLINE | ID: covidwho-625595

ABSTRACT

A few weeks after the peak of the global 2019 novel coronavirus disease pandemic, cases of shock, multisystem inflammation and severe myocarditis have occurred in children and adolescents, generating some concerns and above all many questions. An almost immediate association raised with shock syndrome related to Kawasaki disease (KD). However, in light of bo/th experience and literature have taught us about severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, and what already known on the epidemiology of KD, we suggest here the hypothesis of a new 'post-viral' systemic inflammatory disease related to excessive adaptive immune response rather than a form of KD caused by SARS-COV-2. We discuss analogies and differences between the two forms.


Subject(s)
Coronavirus Infections , Mucocutaneous Lymph Node Syndrome , Pandemics , Pneumonia, Viral , Systemic Vasculitis , Betacoronavirus/isolation & purification , Child , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Diagnosis, Differential , Disease Management , Humans , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/immunology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Systemic Vasculitis/immunology , Systemic Vasculitis/physiopathology , Systemic Vasculitis/therapy , Terminology as Topic
17.
Diabetes Metab J ; 44(3): 372-381, 2020 06.
Article in English | MEDLINE | ID: covidwho-622859

ABSTRACT

Diabetes has been associated with more severe outcomes and higher mortality in coronavirus disease 2019 (COVID-19) patients compare to morbidity and mortality in patients without diabetes. Several mechanisms may play a role in this greater morbidity and mortality, especially uncontrolled hyperglycemia, an impaired immune system, pre-existing proinflammatory states, multiple comorbidities, and dysregulated angiotensin-converting enzyme 2 signaling. Thus, the diabetes medical community emergently needs to know about COVID-19 and its effects on patients with diabetes, as they must take precautions to carefully manage these patients during the COVID-19 pandemic. The Korean Diabetes Association provides some guidance and practical recommendations for the management of diabetes during the pandemic. This report provides insight into the association between diabetes and COVID-19, proper management of diabetes in patients with COVID-19 and an official suggestion by the Korean Diabetes Association for managing the COVID-19 outbreak.


Subject(s)
Coronavirus Infections/complications , Diabetes Complications/virology , Pneumonia, Viral/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Management , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control
18.
J Neurol Sci ; 415: 116935, 2020 08 15.
Article in English | MEDLINE | ID: covidwho-626763

ABSTRACT

Here, in Part II of a duology on the characterization and potential treatment for COVID-19, we characterize the application of an innovative treatment regimen for the prevention of the transition from mild to severe COVID-19, as well as detail an intensive immunotherapy intervention hypothesis. We propose as a putative randomized controlled trial that high-dose methotrexate with leucovorin (HDMTX-LR) rescue can abolish 'PANIC', thereby 'left-shifting' severe COVID-19 patients to the group majority of those infected with SARS-CoV-2, who are designated as having mild, even asymptomatic, disease. HDMTX-LR is endowed with broadly pleiotropic properties and is a repurposed, generic, inexpensive, and widely available agent which can be administered early in the course of severe COVID-19 thus rescuing the critical and irreplaceable gas-exchange alveoli. Further, we describe a preventative treatment intervention regimen for those designated as having mild to moderate COVID-19 disease, but who exhibit features which herald the transition to the severe variant of this disease. Both of our proposed hypothesis-driven questions should be urgently subjected to rigorous assessment in the context of randomized controlled trials, in order to confirm or refute the contention that the approaches characterized herein, are in fact capable of exerting mitigating, if not abolishing, effects upon SARS-CoV-2 triggered 'PANIC Attack'. Confirmation of our immunotherapy hypothesis would have far-reaching ramifications for the current pandemic, along with yielding invaluable lessons which could be leveraged to more effectively prepare for the next challenge to global health.


Subject(s)
Betacoronavirus/drug effects , Clinical Trial Protocols as Topic , Coronavirus Infections/drug therapy , Leucovorin/therapeutic use , Methotrexate/therapeutic use , Pneumonia, Viral/drug therapy , Disease Management , Humans , Immunosuppressive Agents/therapeutic use , Immunotherapy/methods , Pandemics
20.
Indian J Ophthalmol ; 68(7): 1306-1311, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-615747

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has disrupted our society on an unprecedented scale since its inception in December 2019. As the health-care system is finally re-organizing to mitigate the impact of the pandemic, it was necessary to re-structure primary eye care (PEC) activities as well on the same lines. A consensus meeting was held with leading eye-care experts on 2nd May 2020 to prepare a roadmap for PEC in the days to come. Guidelines are needed for PEC activities like vision testing, refraction, optical dispensing, counseling, etc., Some of the activities at vision centers (VCs) may be postponed or modified in light of the current pandemic situation. PEC workers need to strictly follow social distancing norms (minimum 3 feet) for minimizing risk of exposure and need access to appropriate personal protective equipment (PPE), like gloves, masks and shields while examining beneficiaries. For optometrists, sterilization of instruments and encouraging the people to remain silent during the examination is recommended. Because conjunctivitis may be an early sign which can present at VCs, extra precautions in the form of PPE has to be ensured while examining such patients. This is also an opportunity to start running telemedicine clinics for all emergent cases that cannot be managed at the primary level. The guidelines also need to be updated based on the context of the working environment and changes in government directives from time to time.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Management , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , Vision Disorders/diagnosis , Coronavirus Infections/transmission , Humans , India/epidemiology , Ophthalmology/standards , Pneumonia, Viral/transmission , Public Health , Vision Disorders/therapy
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