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1.
Eur Rev Med Pharmacol Sci ; 25(22): 7115-7126, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1552078

ABSTRACT

COVID-19 is to date a global pandemic that can affect all age groups; gastrointestinal symptoms are quite common in patients with COVID-19 and a new clinical entity defined as Multisystem Inflammatory Syndrome in Children (MIS-C) has been described in children and adolescents previously affected by COVID-19. Presenting symptoms of this new disease include high fever and severe abdominal pain that can mimic more common causes of abdominal pain; patients can rapidly deteriorate presenting severe cardiac dysfunction and multiorgan failure. Some fatalities due to this serious illness have been reported. We describe the case of a ten-year-old patient presenting with persistent high fever associated with continuous and worsening abdominal pain. Various hypotheses were performed during his diagnostic workup and an initial appendectomy was performed in the suspect of acute appendicitis. As his clinical picture deteriorated, the child was subsequently diagnosed and successfully treated as a case of MIS-C. The objective of this case report and brief review of abdominal pain in children throughout the age groups is to provide the emergency pediatrician with updated suggestions in diagnosing abdominal pain in children during the COVID-19 pandemic.


Subject(s)
Abdominal Pain/etiology , COVID-19/complications , Pediatric Emergency Medicine/statistics & numerical data , Systemic Inflammatory Response Syndrome/diagnosis , Abdominal Pain/diagnosis , Acute Disease , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/surgery , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/pathology , COVID-19/therapy , COVID-19/virology , Combined Modality Therapy , Conjunctivitis/etiology , Dyspnea/diagnosis , Dyspnea/therapy , Fever/diagnosis , Fever/etiology , Humans , Immunoglobulins, Intravenous/administration & dosage , Immunoglobulins, Intravenous/therapeutic use , Male , Mucositis/etiology , Oxygen/therapeutic use , Pediatric Emergency Medicine/trends , Platelet Aggregation Inhibitors/therapeutic use , SARS-CoV-2/genetics , Steroids/therapeutic use , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
2.
J Prim Care Community Health ; 12: 21501327211035094, 2021.
Article in English | MEDLINE | ID: covidwho-1329103

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health crisis. During huge surge in COVID-19 cases, most of the patient arrived at Rajiv Gandhi Government General Hospital, Chennai were severe due to late presentation and also available evidence demonstrating that the delay in treatment is directly associated with increased mortality or poor patient outcome. As an innovative concept of Zero Delay COVID-19 Ward were set up to provide the required critical care for all severe COVID-19 cases. The experience of setting up of such Zero Delay COVID-19 Ward and profile of admitted COVID-19 patients were described in this paper. METHODS: A total of 4515 laboratory-confirmed COVID-19 patients admitted at Zero Delay COVID-19 Ward was analyzed retrospectively from 7th July to 31st December 2020. RESULTS: At the time of admission the frequency of dyspnea were 85.6% among them 99.1% recovered from dyspnea after the oxygen therapy and other management at Zero Delay COVID-19 Ward. Of the 4515 COVID-19 individuals, about 1829 (40.5%) had comorbidity, 227 (5%) had died. Multivariable logistic regression analysis, COVID-19 death was more likely to be associated with comorbidity (OR: 18.687; 95% CI: 11.229-31.1) than other variables. CONCLUSIONS: Comorbidity is an independent high risk factor for mortality of COVID-19 patients. From our observation, it is strongly recommended that effective zero delay covid-19 ward model will help for the prevention of mortality in current/expected waves of COVID-19.


Subject(s)
COVID-19 , COVID-19/mortality , COVID-19/therapy , Comorbidity , Dyspnea/therapy , Dyspnea/virology , Hospitalization , Humans , India/epidemiology , Oxygen/therapeutic use , Retrospective Studies , Tertiary Care Centers , Time-to-Treatment
3.
Age Ageing ; 50(6): 1886-1887, 2021 11 10.
Article in English | MEDLINE | ID: covidwho-1316793

ABSTRACT

An 89-year-old woman was admitted to hospital with a fall, general malaise and low oxygen saturations. She tested positive for SARS-CoV-2 and commenced on standard therapy for COVID-19 pneumonia. She improved initially but reported ongoing dyspnoea exacerbated by position. Following investigations to rule out other causes, she was given a diagnosis of platypnoea-orthodeoxia syndrome (POS). She was treated with gradual verticalization therapy with supplemental oxygen and subsequently discharged to an intermediate care bed (ICB).


Subject(s)
COVID-19 , Foramen Ovale, Patent , Hypotension, Orthostatic , Aged, 80 and over , Dyspnea/diagnosis , Dyspnea/etiology , Dyspnea/therapy , Female , Hospitals , Humans , Hypoxia/diagnosis , Hypoxia/etiology , Hypoxia/therapy , SARS-CoV-2
4.
Int Arch Allergy Immunol ; 182(10): 989-996, 2021.
Article in English | MEDLINE | ID: covidwho-1282178

ABSTRACT

INTRODUCTION: There are a limited number of studies about the clinical findings of coronavirus infection in pediatric patients with asthma. We aimed to evaluate the clinical and laboratory characteristics of pediatric patients with asthma and healthy children without chronic disease who infected with SARS-CoV-2. METHODS: This is a retrospective, case-control study comparing the asthma diagnosed and healthy children who were diagnosed as COVID-19 in our hospital between March 11 and November 10, 2020. RESULTS: During the study period, 6,205 children were diagnosed with CO-VID-19 in our hospital. Only 54 (0.87%) patients had a diagnosis of asthma. The mean of the age was 10.5 years and 53.7% (n:29) of the patients with asthma were male. Cough, shortness of breath, emesis, and diarrhea were found to be significantly higher in asthma group than in the control group (respectively p = 0.002, 0.000, 0.002, 0.019, 0.015). Patients who were given SABA was significantly higher in asthma diagnosed patients (p = 0.000). Hospitalization was significantly higher in asthma group (p = 0.025), and the duration of hospitalization was significantly higher in control group (p = 0.034). There was no significant difference between the 2 groups in terms of requiring oxygen treatment and in laboratory findings between groups. CONCLUSION: This study revealed that pediatric patients diagnosed with asthma were in a mild clinic. According to these findings, asthma may not affect the course of the COVID-19 in children.


Subject(s)
Asthma/epidemiology , COVID-19/epidemiology , SARS-CoV-2 , Adolescent , Adrenergic beta-Agonists/therapeutic use , Anti-Asthmatic Agents/therapeutic use , Asthma/diagnosis , Asthma/therapy , COVID-19/diagnosis , COVID-19/therapy , Child , Cough/diagnosis , Cough/epidemiology , Cough/therapy , Diarrhea/diagnosis , Diarrhea/epidemiology , Diarrhea/therapy , Dyspnea/diagnosis , Dyspnea/epidemiology , Dyspnea/therapy , Female , Hospitalization/statistics & numerical data , Humans , Male , Oxygen Inhalation Therapy , Retrospective Studies , Vomiting/diagnosis , Vomiting/epidemiology , Vomiting/therapy
5.
NPJ Prim Care Respir Med ; 31(1): 25, 2021 05 10.
Article in English | MEDLINE | ID: covidwho-1243300

ABSTRACT

Chronic breathlessness is a distressing symptom that is challenging to manage. The Breathing, Thinking, Functioning clinical model is an educational tool developed to support breathlessness management. Health professionals report that the model increases clinician and patient understanding of this complex symptom, and provides a simple and structured approach to personalised self-management.


Subject(s)
Dyspnea , Self-Management , Dyspnea/etiology , Dyspnea/therapy , Health Services , Humans
6.
Phys Ther ; 101(6)2021 06 01.
Article in English | MEDLINE | ID: covidwho-1140006

ABSTRACT

OBJECTIVE: The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post-COVID syndrome. METHODS (CASE DESCRIPTION): A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). RESULTS: The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient's muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. CONCLUSION: This case report described the clinical presentation and physical therapist management of a person with post-COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post-COVID syndromes. IMPACT: This case alerts physical therapists to post-COVID syndrome-which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction-and to the role that therapists can play in assessing these symptoms and managing these patients.


Subject(s)
COVID-19/complications , Physical Therapy Modalities , Adult , COVID-19/therapy , Cognitive Dysfunction/therapy , Cognitive Dysfunction/virology , Dyspnea/therapy , Dyspnea/virology , Female , Humans , Pandemics , Quality of Life , SARS-CoV-2 , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/virology , Surveys and Questionnaires , Syndrome , Walk Test
7.
Acta Biomed ; 92(1): e2021020, 2020 11 10.
Article in English | MEDLINE | ID: covidwho-1121822

ABSTRACT

New coronavirus disease 2019 (COVID-19) has succeeded in surprising the world with infecting more than 12 million people and claiming 560,000 lives in only six months. COVID-19 is associated with a spectrum of respiratory symptoms, especially dyspnea. Patients who progress to severe or critical condition display peripheral and posterior lung lesions bilaterally. These patients require admission to the intensive care unit (ICU); therefore, they are prone to ICU-related complications during disease and after recovery. Respiratory physiotherapy techniques, in particular, active techniques, might help the improvement of airway clearance and lung capacity in addition to the reduction of breathing effort during the active disease. In parallel, it might lead to the prevention of disabilities, resulting from infection and extended hospitalization in patients who recovered from COVID-19. This supports physiotherapy both as a prophylactic and therapeutic strategy for COVID-19.


Subject(s)
COVID-19/therapy , Physical Therapy Modalities , SARS-CoV-2 , Dyspnea/therapy , Humans
8.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 05 21.
Article in English | MEDLINE | ID: covidwho-1073588

ABSTRACT

The novel coronavirus (NCOVID-19) has quickly become a public health concern globally and needs urgent attention. While there is no current evidence of vaccines and specific drugs to prevent and treat the ailments emanating from NCOVID-19 infections, complementary and conventional medical treatments could prove beneficial in ameliorating some of the respiratory difficulties, especially in countries in sub-Saharan Africa. These treatments include specific breathing exercises, a diet that strengthens the immune system, as well as avoiding tobacco smoking and alcohol consumption. On the other hand, for those who have not contracted the virus, participation in indoor and within-the-yard physical activity could be beneficial in preventing unwanted weight gain as well as associated conditions such as anxiety and depression.


Subject(s)
Coronavirus Infections/therapy , Exercise , Pneumonia, Viral/therapy , Africa South of the Sahara , Anxiety/prevention & control , Betacoronavirus , Breathing Exercises , COVID-19 , Coronavirus , Coronavirus Infections/complications , Coronavirus Infections/psychology , Coronavirus Infections/virology , Depression/prevention & control , Diet , Dyspnea/therapy , Exercise/psychology , Healthy Lifestyle , Humans , Immunity , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/psychology , Pneumonia, Viral/virology , SARS-CoV-2
9.
Am J Case Rep ; 22: e928421, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1068018

ABSTRACT

BACKGROUND High-frequency percussive ventilation (HFPV) is a method that combines mechanical ventilation with high-frequency oscillatory ventilation. This report describes 3 cases of patients with severe COVID-19 pneumonia who received intermittent adjunctive treatment with HFPV at a single center without requiring admission to the Intensive Care Unit (ICU). CASE REPORT Case 1 was a 60-year-old woman admitted to the hospital 14 days after the onset of SARS-CoV-2 infection symptoms, and cases 2 and 3 were men aged 65 and 72 years who were admitted to the hospital 10 days after the onset of SARS-CoV-2 infection symptoms. All 3 patients presented with clinical deterioration accompanied by worsening lung lesions on computed tomography (CT) scans after 21 days from the onset of symptoms. SARS-CoV-2 infection was confirmed in all patients by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay from nasal swabs. All 3 patients had impending respiratory failure when non-invasive intermittent HFPV therapy was initiated. After therapy, the patients had significant clinical improvement and visibly decreased lung lesions on followup CT scans performed 4-6 days later. CONCLUSIONS The 3 cases described in this report showed that the use of intermittent adjunctive treatment with HFPV in patients with severe pneumonia due to infection with SARS-CoV-2 improved lung function and may have prevented clinical deterioration. However, recommendations on the use of intermittent HFPV as an adjunctive treatment in COVID-19 pneumonia requires large-scale controlled clinical studies. In the pandemic context, with a shortage of ICU beds, avoiding ICU admission by using adjunctive therapies on the ward is a useful option.


Subject(s)
COVID-19/therapy , High-Frequency Ventilation , Aged , COVID-19/complications , Clinical Deterioration , Cough/therapy , Cough/virology , Dyspnea/therapy , Dyspnea/virology , Female , Hospitalization , Humans , Lung/diagnostic imaging , Lung/virology , Male , Middle Aged , Oxygen Inhalation Therapy , Respiratory Insufficiency/prevention & control , Tomography, X-Ray Computed
10.
Rev Mal Respir ; 38(1): 114-121, 2021 Jan.
Article in French | MEDLINE | ID: covidwho-1065568

ABSTRACT

The French-speaking Respiratory Medicine Society (SPLF) proposes a guide for the management of possible respiratory sequelae in patients who have presented with SARS-CoV-2 pneumonia (COVID-19). The proposals are based on known data from previous epidemics, preliminary published data on post COVID-19 follow-up and on expert opinion. The proposals were developed by a group of experts and then submitted, using the Delphi method, to a panel of 22 pulmonologists. Seventeen proposals were validated ranging from additional examinations after the minimum assessment proposed in the SPLF monitoring guide, to inhaled or systemic corticosteroid therapy and antifibrotic agents. These proposals may evolve over time as knowledge accumulates. This guide emphasizes the importance of multidisciplinary discussion.


Subject(s)
COVID-19/complications , Cough/therapy , Dyspnea/therapy , Lung/diagnostic imaging , Administration, Inhalation , Bronchial Hyperreactivity/diagnosis , Bronchial Hyperreactivity/therapy , Cough/etiology , Delphi Technique , Dyspnea/etiology , Glucocorticoids/therapeutic use , Humans , Lung/virology , Nebulizers and Vaporizers , Oxygen Inhalation Therapy , Patient Care Team , Protein Kinase Inhibitors/therapeutic use , Respiratory Therapy , SARS-CoV-2 , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Time Factors , Tomography, X-Ray Computed
11.
Sci Rep ; 11(1): 2256, 2021 01 26.
Article in English | MEDLINE | ID: covidwho-1049970

ABSTRACT

Patients suffering from CVOID-19 mostly experience a benign course of the disease. Approximately 14% of SARS-CoV2 infected patients are admitted to a hospital. Cohorts exhibiting severe lung failure in the form of acute respiratory distress syndrome (ARDS) have been well characterized. Patients without ARDS but in need of supplementary oxygen have received much less attention. This study describes the diagnosis, symptoms, treatment and outcomes of hospitalized patients with COVID-19 needing oxygen support during their stay on regular ward. All 133 patients admitted to the RWTH Aachen university hospital with the diagnosis of COVID-19 were included in an observational registry. Clinical data sets were extracted from the hospital information system. This analysis includes all 57 patients requiring supplemental oxygen not admitted to the ICU. 57 patients needing supplemental oxygen and being treated outside the ICU were analyzed. Patients exhibited the typical set of symptoms for COVID-19. Of note, hypoxic patients mostly did not suffer from clinically relevant dyspnea despite oxygen saturations below 92%. Patients had fever for 7 [2-11] days and needed supplemental oxygen for 8 [5-13] days resulting in an overall hospitalization time of 12 [7-20] days. In addition, patients had persisting systemic inflammation with CRP levels remaining elevated until discharge or death. This description of COVID-19 patients requiring oxygen therapy should be taken into account when planning treatment capacity. Patients on oxygen need long-term inpatient care.


Subject(s)
COVID-19/therapy , Oxygen Inhalation Therapy/methods , Oxygen/therapeutic use , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology , Aged , Aged, 80 and over , Dyspnea/therapy , Female , Hospitalization , Humans , Hypoxia/therapy , Inflammation , Inpatients , Intensive Care Units , Length of Stay , Male , Middle Aged , RNA, Viral , Registries
13.
Chest ; 159(1): e35-e38, 2021 01.
Article in English | MEDLINE | ID: covidwho-1002398

ABSTRACT

CASE PRESENTATION: A 28-year-old man presented with shortness of breath, chest pain, and scant hemoptysis. Three weeks previously, he was admitted for coronavirus disease 2019 pneumonia that had been diagnosed by nasal swab polymerase chain reaction. Chest CT imaging demonstrated bilateral ground-glass opacities without evidence of VTE. He was treated with hydroxychloroquine, up to 7 L/min oxygen, and self-proning. After 8 days of hospitalization, he was discharged on 4 L/min oxygen. After discharge, his symptoms and hypoxia resolved.


Subject(s)
COVID-19/complications , Chest Pain/etiology , Dyspnea/etiology , Hemoptysis/etiology , Adult , Chest Pain/therapy , Dyspnea/therapy , Hemoptysis/therapy , Humans , Male
14.
Otolaryngol Head Neck Surg ; 163(1): 170-178, 2020 07.
Article in English | MEDLINE | ID: covidwho-913962

ABSTRACT

OBJECTIVE: To identify risk factors associated with intubation and time to extubation in hospitalized patients with coronavirus disease 2019 (COVID-19). STUDY DESIGN: Retrospective observational study. SETTING: Ten hospitals in the Chicago metropolitan area. SUBJECTS AND METHODS: Patients with laboratory-confirmed COVID-19 admitted between March 1 and April 8, 2020, were included. We evaluated sociodemographic and clinical characteristics associated with intubation and prolonged intubation for acute respiratory failure secondary to COVID-19 infection. RESULTS: Of the 486 hospitalized patients included in the study, the median age was 59 years (interquartile range, 47-69); 271 (55.8%) were male; and the median body mass index was 30.6 (interquartile range, 26.5-35.6). During the hospitalization, 138 (28.4%) patients were intubated; 78 (56.5%) were eventually extubated; 21 (15.2%) died; and 39 (28.3%) remained intubated at a mean ± SD follow-up of 19.6 ± 6.7 days. Intubated patients had a significantly higher median age (65 vs 57 years, P < .001) and rate of diabetes (56 [40.6%] vs 104 [29.9%], P = .031) as compared with nonintubated patients. Multivariable logistic regression analysis identified age, sex, respiratory rate, oxygen saturation, history of diabetes, and shortness of breath as factors predictive of intubation. Age and body mass index were the only factors independently associated with time to extubation. CONCLUSION: In addition to clinical signs of respiratory distress, patients with COVID-19 who are older, male, or diabetic are at higher risk of requiring intubation. Among intubated patients, older and more obese patients are at higher risk for prolonged intubation. Otolaryngologists consulted for airway management should consider these factors in their decision making.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Dyspnea/therapy , Inpatients , Intubation, Intratracheal/methods , Pneumonia, Viral/complications , Respiration, Artificial/methods , Aged , COVID-19 , Coronavirus Infections/epidemiology , Dyspnea/etiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Time Factors
15.
Am J Otolaryngol ; 42(2): 102779, 2021.
Article in English | MEDLINE | ID: covidwho-885171

ABSTRACT

PURPOSE: Upper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency endonasal endotracheal intubation under videoendoscopic observation. METHODS: Transnasal endoscopic observation was done, and the region of airway stenosis was detected. Then, the endotracheal tube was prepared and the endoscope was inserted into the tube. The endoscope with tube was inserted up to the larynx. Immediately after the administration of lidocaine to the larynx, the endoscope with tube was inserted to the endolarynx and then to the trachea. The endotracheal tube was tightly held in the nostril, and the endoscope was removed. RESULTS: We have encountered four cases this year. The primary disease developing airway stenosis was acute epiglottitis due to pharyngeal and deep neck abscesses in three cases and laryngeal edema due to Ludwig's angina. All patients underwent uneventful intubation, and dyspnea was immediately ceased. CONCLUSION: In cases showing severe suffocation, the clinician should perform airway maintenance even in an outpatient setting apart from a more monitored setting like the operation room. This technique resembles the usual nasal endoscopic laryngeal observation and is done even in the usual ENT office and/or emergency room. The supine position tends to worsen airway stenosis in patients with upper airway stenosis; however, this technique can be performed in a sitting or semi-sitting position. This method is less invasive for patients and also reduces the risk to the medical staff, especially in this COVID-19 era.


Subject(s)
Dyspnea/therapy , Endoscopy/methods , Intubation, Intratracheal/methods , Laryngostenosis/therapy , Tracheal Stenosis/therapy , Video Recording , Aged , Aged, 80 and over , Dyspnea/etiology , Epiglottitis/complications , Female , Humans , Laryngeal Edema/complications , Laryngostenosis/etiology , Male , Tracheal Stenosis/etiology
16.
Hum Antibodies ; 29(1): 49-54, 2021.
Article in English | MEDLINE | ID: covidwho-807231

ABSTRACT

Coronavirus disease 2019 (COVID-19) has caused a global pandemic in early 2020. This infectious disorder has a heterogeneous course ranging from asymptomatic disorder to a critical situation needing intensive cares. In the current study, we present a report of affected patients admitted in a single hospital in Iran. Eighty-two hospitalized patients with COVID-19 were assessed. Demographic, clinical, and paraclinical parameters were gathered and statistically analyzed. The median age (IQR) of the patients was 57.32 (45.75, 70) years. At primary evaluation, fever was present in 45.12% of the affected individuals. The most common clinical symptoms were dyspnea (81.71%) and cough (65.85%). Totally, 12 (14.63%) and 14 (17.07%) of patients had low and high WBC counts, respectively. Lymphopenia was detected in 36 (43.9%) of patients, while 6 (7.32%) of patients had lymphocytosis. High levels of Il-6 were detected in 4 (4.88%) of patients. CRP levels were elevated in 69 (84.1%) of patients. The median (IQR) of hospitalization was 7 (5, 9) days. Totally, 26 patients (31%) were hospitalized in ICU. All patients were discharged with good health conditions except for one patient who died. The current study shows the heterogeneous clinical manifestations and paraclinical parameters of COVID-19 patients.


Subject(s)
COVID-19/physiopathology , Cough/physiopathology , Dyspnea/physiopathology , Fever/physiopathology , Lymphocytosis/physiopathology , Lymphopenia/physiopathology , Aged , C-Reactive Protein/metabolism , COVID-19/mortality , COVID-19/therapy , COVID-19/virology , Cough/mortality , Cough/therapy , Cough/virology , Diabetes Mellitus/mortality , Diabetes Mellitus/physiopathology , Diabetes Mellitus/therapy , Diabetes Mellitus/virology , Dyspnea/mortality , Dyspnea/therapy , Dyspnea/virology , Female , Fever/mortality , Fever/therapy , Fever/virology , Hospitals , Humans , Hypertension/mortality , Hypertension/physiopathology , Hypertension/therapy , Hypertension/virology , Iran , Leukocyte Count , Lymphocytosis/mortality , Lymphocytosis/therapy , Lymphocytosis/virology , Lymphopenia/mortality , Lymphopenia/therapy , Lymphopenia/virology , Male , Middle Aged , Obesity/mortality , Obesity/physiopathology , Obesity/therapy , Obesity/virology , Oxygen/therapeutic use , Respiration, Artificial/methods , Retrospective Studies , SARS-CoV-2/pathogenicity , Severity of Illness Index , Survival Analysis
17.
Clin Microbiol Infect ; 27(1): 89-95, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-803353

ABSTRACT

OBJECTIVES: To describe the prevalence, nature and risk factors for the main clinical sequelae in coronavirus disease 2019 (COVID-19) survivors who have been discharged from the hospital for more than 3 months. METHODS: This longitudinal study was based on a telephone follow-up survey of COVID-19 patients hospitalized and discharged from Renmin Hospital of Wuhan University, Wuhan, China before 1 March 2020. Demographic and clinical characteristics and self-reported clinical sequelae of the survivors were described and analysed. A cohort of volunteers who were free of COVID-19 and lived in the urban area of Wuhan during the outbreak were also selected as the comparison group. RESULTS: Among 538 survivors (293, 54.5% female), the median (interquartile range) age was 52.0 (41.0-62.0) years, and the time from discharge from hospital to first follow-up was 97.0 (95.0-102.0) days. Clinical sequelae were common, including general symptoms (n = 267, 49.6%), respiratory symptoms (n = 210, 39%), cardiovascular-related symptoms (n = 70, 13%), psychosocial symptoms (n = 122, 22.7%) and alopecia (n = 154, 28.6%). We found that physical decline/fatigue (p < 0.01), postactivity polypnoea (p= 0.04) and alopecia (p < 0.01) were more common in female than in male subjects. Dyspnoea during hospitalization was associated with subsequent physical decline/fatigue, postactivity polypnoea and resting heart rate increases but not specifically with alopecia. A history of asthma during hospitalization was associated with subsequent postactivity polypnoea sequela. A history of pulse ≥90 bpm during hospitalization was associated with resting heart rate increase in convalescence. The duration of virus shedding after COVID-19 onset and hospital length of stay were longer in survivors with physical decline/fatigue or postactivity polypnoea than in those without. CONCLUSIONS: Clinical sequelae during early COVID-19 convalescence were common; some of these sequelae might be related to gender, age and clinical characteristics during hospitalization.


Subject(s)
Alopecia/epidemiology , COVID-19/epidemiology , Dyspnea/epidemiology , Fatigue/epidemiology , Survivors , Tachycardia/epidemiology , Adult , Alopecia/complications , Alopecia/physiopathology , Alopecia/therapy , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , China/epidemiology , Convalescence , Dyspnea/complications , Dyspnea/physiopathology , Dyspnea/therapy , Fatigue/complications , Fatigue/physiopathology , Fatigue/therapy , Female , Humans , Length of Stay/statistics & numerical data , Longitudinal Studies , Male , Middle Aged , Patient Discharge , Risk Factors , SARS-CoV-2/pathogenicity , Severity of Illness Index , Tachycardia/complications , Tachycardia/physiopathology , Tachycardia/therapy
18.
JAMA Netw Open ; 3(9): e2022310, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-784192

ABSTRACT

Importance: Identifying independent risk factors for adverse outcomes in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can support prognostication, resource utilization, and treatment. Objective: To identify excess risk and risk factors associated with hospitalization, mechanical ventilation, and mortality in patients with SARS-CoV-2 infection. Design, Setting, and Participants: This longitudinal cohort study included 88 747 patients tested for SARS-CoV-2 nucleic acid by polymerase chain reaction between Feburary 28 and May 14, 2020, and followed up through June 22, 2020, in the Department of Veterans Affairs (VA) national health care system, including 10 131 patients (11.4%) who tested positive. Exposures: Sociodemographic characteristics, comorbid conditions, symptoms, and laboratory test results. Main Outcomes and Measures: Risk of hospitalization, mechanical ventilation, and death were estimated in time-to-event analyses using Cox proportional hazards models. Results: The 10 131 veterans with SARS-CoV-2 were predominantly male (9221 [91.0%]), with diverse race/ethnicity (5022 [49.6%] White, 4215 [41.6%] Black, and 944 [9.3%] Hispanic) and a mean (SD) age of 63.6 (16.2) years. Compared with patients who tested negative for SARS-CoV-2, those who tested positive had higher rates of 30-day hospitalization (30.4% vs 29.3%; adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08-1.13), mechanical ventilation (6.7% vs 1.7%; aHR, 4.15; 95% CI, 3.74-4.61), and death (10.8% vs 2.4%; aHR, 4.44; 95% CI, 4.07-4.83). Among patients who tested positive for SARS-CoV-2, characteristics significantly associated with mortality included older age (eg, ≥80 years vs <50 years: aHR, 60.80; 95% CI, 29.67-124.61), high regional COVID-19 disease burden (eg, ≥700 vs <130 deaths per 1 million residents: aHR, 1.21; 95% CI, 1.02-1.45), higher Charlson comorbidity index score (eg, ≥5 vs 0: aHR, 1.93; 95% CI, 1.54-2.42), fever (aHR, 1.51; 95% CI, 1.32-1.72), dyspnea (aHR, 1.78; 95% CI, 1.53-2.07), and abnormalities in the certain blood tests, which exhibited dose-response associations with mortality, including aspartate aminotransferase (>89 U/L vs ≤25 U/L: aHR, 1.86; 95% CI, 1.35-2.57), creatinine (>3.80 mg/dL vs 0.98 mg/dL: aHR, 3.79; 95% CI, 2.62-5.48), and neutrophil to lymphocyte ratio (>12.70 vs ≤2.71: aHR, 2.88; 95% CI, 2.12-3.91). With the exception of geographic region, the same covariates were independently associated with mechanical ventilation along with Black race (aHR, 1.52; 95% CI, 1.25-1.85), male sex (aHR, 2.07; 95% CI, 1.30-3.32), diabetes (aHR, 1.40; 95% CI, 1.18-1.67), and hypertension (aHR, 1.30; 95% CI, 1.03-1.64). Notable characteristics that were not significantly associated with mortality in adjusted analyses included obesity (body mass index ≥35 vs 18.5-24.9: aHR, 0.97; 95% CI, 0.77-1.21), Black race (aHR, 1.04; 95% CI, 0.88-1.21), Hispanic ethnicity (aHR, 1.03; 95% CI, 0.79-1.35), chronic obstructive pulmonary disease (aHR, 1.02; 95% CI, 0.88-1.19), hypertension (aHR, 0.95; 95% CI, 0.81-1.12), and smoking (eg, current vs never: aHR, 0.87; 95% CI, 0.67-1.13). Most deaths in this cohort occurred in patients with age of 50 years or older (63.4%), male sex (12.3%), and Charlson Comorbidity Index score of at least 1 (11.1%). Conclusions and Relevance: In this national cohort of VA patients, most SARS-CoV-2 deaths were associated with older age, male sex, and comorbidity burden. Many factors previously reported to be associated with mortality in smaller studies were not confirmed, such as obesity, Black race, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking.


Subject(s)
Cause of Death , Coronavirus Infections , Hospitalization , Pandemics , Pneumonia, Viral , Respiration, Artificial , Veterans , Aged , Betacoronavirus , COVID-19 , Cohort Studies , Comorbidity , Coronavirus , Coronavirus Infections/blood , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Coronavirus Infections/virology , Dyspnea/etiology , Dyspnea/therapy , Female , Fever/etiology , Humans , Longitudinal Studies , Male , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Proportional Hazards Models , Risk Factors , SARS-CoV-2 , Severe Acute Respiratory Syndrome , Severity of Illness Index , United States , United States Department of Veterans Affairs
20.
Trials ; 21(1): 751, 2020 Aug 27.
Article in English | MEDLINE | ID: covidwho-733026

ABSTRACT

BACKGROUND: In December 2019, pneumonia associated with the 2019 novel coronavirus (COVID-19) emerged in Wuhan, China. The number of cases has increased rapidly. Patients with severe disease have a poor prognosis, and there are no effective therapies for COVID-19. Only rapid advice guidelines for symptomatic supportive care have been used. A traditional Chinese medicine rehabilitation (TCMR) program consisting of acupressure therapy and Liu Zi Jue Qigong can be used as a complementary therapy for COVID-19. Hence, we designed a randomized trial to evaluate the efficacy and advantages of TCMR for treating patients with severe COVID-19. METHODS/DESIGN: This is a parallel-design, two-arm, analyst assessor-blinded, randomized controlled trial. A total of 128 patients with COVID-19 aged from 20 to 80 years will be recruited and assigned randomly into a guideline therapy group and a guideline therapy plus TCMR group at a 1:1 ratio. Patients in both groups will receive guideline therapy. The patients in the intervention group will perform acupressure therapy and Liu Zi Jue Qigong exercises in addition to conventional treatments twice a day and will be persistent from admission to discharge. The primary outcome will be measured with the Modified Medical Research Council Dyspnea Scale, and the secondary outcomes will include the Activities of Daily Living Barthel Index Scale, Patient Health Questionnaire-9 Scale, and the Respiratory Symptoms Scale. The assessments of the clinical scales will be performed at three points (before treatment, the 7th day during hospitalization, and the discharge day). Adverse events will be noted and recorded for the safety evaluation. DISCUSSION: This trial will provide high-quality evidence of the value of TCMR, which consists of acupressure therapy and Liu Zi Jue Qigong exercises, for treating patients with severe COVID-19. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000029994 . Registered on 18 February 2020.


Subject(s)
Acupressure/methods , Coronavirus Infections/therapy , Dyspnea/therapy , Pneumonia, Viral/therapy , Qigong/methods , Activities of Daily Living , Betacoronavirus , COVID-19 , Complementary Therapies , Coronavirus Infections/physiopathology , Dyspnea/physiopathology , Humans , Medicine, Chinese Traditional , Pandemics , Patient Health Questionnaire , Pneumonia, Viral/physiopathology , Quality of Life , SARS-CoV-2
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