Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 71
Filter
Add filters

Document Type
Year range
1.
Endocrinol Diabetes Nutr (Engl Ed) ; 68(9): 621-627, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1575090

ABSTRACT

INTRODUCTION: COVID-19 is characterized by various clinical manifestations, mainly respiratory involvement. Disease-related malnutrition is associated with impaired respiratory function and increased all-cause morbidity and mortality. Patients with COVID-19 infection carry a high nutritional risk. After designing a specific nutritional support protocol for this disease, we carried out a retrospective study on malnutrition and on the use of nutritional support in patients with COVID-19. METHODS: We performed a retrospective study to determine whether nutritional support positively affected hospital stay, clinical complications, and mortality in patients with COVID-19. We compared the results with those of standard nutritional management. Our secondary objectives were to determine the prevalence of malnutrition in patients with COVID-19 and the value of nutritional support in the hospital where the study was performed. RESULTS: At least 60% of patients with COVID-19 experience malnutrition (up to 78.66% presented at least 1 of the parameters studied). The specialized nutritional support protocol was indicated in only 21 patients (28%) and was started early in only 12 patients (16%). Hospital stay was significantly shorter in patients managed with the early protocol (5.09 days, 95% CI, 1.338-8.853, p<0.01). Similarly, in this group, respiratory distress was less severe and less frequent (41% vs 82.5%, p<0.007), and statistically significantly fewer complications were recorded (9/12 vs 91/63; p<0.001). CONCLUSIONS: COVID-19 is associated with high rates of disease-related malnutrition. Early implementation of a specialized nutritional support plan can improve the prognosis of these patients by reducing hospital stay, the possibility of more severe respiratory distress, and complications in general.


Subject(s)
COVID-19 , Malnutrition , Nutritional Support , COVID-19/complications , COVID-19/mortality , Dyspnea/virology , Humans , Length of Stay , Malnutrition/epidemiology , Retrospective Studies
3.
Ghana Med J ; 54(4 Suppl): 117-120, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436205

ABSTRACT

This is a case report of a 55-year-old man with Type 2 Diabetes Mellitus who presented with progressive breathlessness, chest pain and hyperglycaemia. An initial impression of a chest infection was made. Management was initiated with antibiotics, but this was unsuccessful, and he continued to desaturate. A screen for Coronavirus Disease of 2019 (COVID-19) returned positive. There was no prodrome of fever or flu-like illness or known contact with a patient known to have COVID-19. This case is instructive as he didn't fit the typical case definition for suspected COVID-19. There is significant community spread in Ghana, therefore COVID-19 should be a differential diagnosis in patients who present with hyperglycaemia and respiratory symptoms in the absence of a febrile illness. Primary care doctors must have a high index of suspicion in cases of significant hyperglycaemia and inability to maintain oxygen saturation. Patients known to have diabetes and those not known to have diabetes may develop hyperglycaemia subsequent to COVID-19. A high index of suspicion is crucial for early identification, notification for testing, isolation, treatment, contact tracing and possible referral or coordination of care with other specialists. Early identification will protect healthcare workers and patients alike from cross-infection.


Subject(s)
COVID-19 Testing , COVID-19/diagnosis , Diabetes Mellitus, Type 2/virology , SARS-CoV-2 , COVID-19/virology , Chest Pain/diagnosis , Chest Pain/virology , Diagnosis, Differential , Dyspnea/diagnosis , Dyspnea/virology , Ghana , Humans , Hyperglycemia/diagnosis , Hyperglycemia/virology , Male , Middle Aged , Primary Health Care , Urban Health Services
4.
Ghana Med J ; 54(4 Suppl): 39-45, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436193

ABSTRACT

Background: In high-income countries, mortality related to hospitalized patients with the Coronavirus disease 2019 (COVID-19) is approximately 4-5%. However, data on COVID-19 admissions from sub-Saharan Africa are scanty. Objective: To describe the clinical profile and determinants of outcomes of patients with confirmed COVID-19 admitted at a hospital in Ghana. Methods: A prospective study involving 25 patients with real time polymerase chain reaction confirmed COVID-19 admitted to the treatment centre of the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana from 1st June to 27th July, 2020. They were managed and followed up for outcomes. Data were analysed descriptively, and predictors of mortality assessed using a multivariate logistic regression modelling. Results: The mean age of the patients was 59.3 ± 20.6 years, and 14 (56%) were males. The main symptoms at presentation were breathlessness (68%) followed by fever (56%). The cases were categorized as mild (6), moderate (6), severe (10) and critical (3). Hypertension was the commonest comorbidity present in 72% of patients. Medications used in patient management included dexamethasone (68%), azithromycin (96%), and hydroxychloroquine (4%). Five of 25 cases died (Case fatality ratio 20%). Increasing age and high systolic blood pressure were associated with mortality. Conclusion: Case fatality in this sample of hospitalized COVID-19 patients was high. Thorough clinical assessment, severity stratification, aggressive management of underlying co-morbidities and standardized protocols incountry might improve outcomes. Funding: None declared.


Subject(s)
COVID-19/drug therapy , COVID-19/mortality , Hospitalization/statistics & numerical data , SARS-CoV-2 , Adult , Age Factors , Aged , Blood Pressure , COVID-19/virology , Comorbidity , Dyspnea/mortality , Dyspnea/virology , Female , Fever/mortality , Fever/virology , Ghana/epidemiology , Humans , Hypertension/mortality , Logistic Models , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Tertiary Care Centers
5.
Ghana Med J ; 54(4 Suppl): 33-38, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436192

ABSTRACT

The study examined the clinical characteristics and outcomes of 2019 novel coronavirus disease (COVID-19) infections among hospitalized patients. Design: Study design was a retrospective single-center review of hospital data. Setting: The study was conducted at the COVID-19 Treatment Center of the Department of Medicine and Therapeutics of the Korle-Bu Teaching hospital in Accra, Ghana. Participants and study tools: A total of fifty patients with laboratory (rRT-PCR) confirmed COVID-19 infection were involved in the study. A chart review of the medical records of the patients was conducted and the data obtained was documented using a data extraction form. Results: The median age was 53 years and most (36% (18/50)) of the patients were at least 60 years of age. Eighty percent (40/50) of the patients were symptomatic, with cough and difficulty in breathing being the commonest presenting symptoms. The mean duration of hospitalization was 12.3 ± 7.3 days. Hypertension and Diabetes Mellitus were the commonest co-morbidities occurring in 52% (26/50) and 42% (21/50) of patients respectively. Fifty percent of patients developed COVID-19 pneumonia as a complication. The mortality rate was 12% (6/50). Conclusion: In this study, SARS-CoV2 infection affected older adults with hypertension and diabetes mellitus being the common comorbidities. Patients with these comorbid conditions should be counselled by their clinicians to strictly observe the COVID-19 prevention protocols to reduce their risk of acquiring the infection. There is a need to pay critical and prompt attention to the management of patients with COVID-19 pneumonia particularly among people with diabetes to improve outcomes. Funding: None declared.


Subject(s)
COVID-19/epidemiology , Hospitalization/statistics & numerical data , SARS-CoV-2 , COVID-19/virology , Comorbidity , Cough/epidemiology , Cough/virology , Diabetes Mellitus/epidemiology , Dyspnea/epidemiology , Dyspnea/virology , Female , Ghana/epidemiology , Hospitals, Teaching , Humans , Hypertension/epidemiology , Male , Middle Aged , Retrospective Studies
6.
Ann Intern Med ; 174(9): 1252-1260, 2021 09.
Article in English | MEDLINE | ID: covidwho-1431108

ABSTRACT

BACKGROUND: With millions of SARS-CoV-2 infections worldwide, increasing numbers of patients are coming forward with long-term clinical effects of the disease lasting several weeks to months. OBJECTIVE: To characterize symptoms 7 to 9 months after diagnosis of COVID-19. DESIGN: Self-reported surveys and semistructured telephone interviews at enrollment and 30 to 45 days and 7 to 9 months from diagnosis. SETTING: From 18 March to 15 May 2020, symptomatic persons who tested positive for SARS-CoV-2 at the Geneva University Hospitals were followed by CoviCare, a virtual, clinical, outpatient follow-up program. Persons were contacted again at 30 to 45 days and 7 to 9 months from diagnosis. PARTICIPANTS: Persons who were a part of the CoviCare program from 18 March to 15 May 2020. MEASUREMENTS: A standardized interview of symptoms consistent with COVID-19, with grading of intensity. RESULTS: Of the 629 participants in the study who completed the baseline interviews, 410 completed follow-up at 7 to 9 months after COVID-19 diagnosis; 39.0% reported residual symptoms. Fatigue (20.7%) was the most common symptom reported, followed by loss of taste or smell (16.8%), dyspnea (11.7%), and headache (10.0%). LIMITATION: Limitations include generalizability and missing data for 34.8% of participants. CONCLUSION: Residual symptoms after SARS-CoV-2 infection are common among otherwise young and healthy persons followed in an outpatient setting. These findings contribute to the recognition of long-term effects in a disease mostly counted by its death toll to date by promoting communication on postacute sequelae of SARS-CoV-2 and encouraging physicians to continue long-term monitoring of their patients. PRIMARY FUNDING SOURCE: None.


Subject(s)
Ambulatory Care , COVID-19/complications , COVID-19/diagnosis , Adolescent , Adult , COVID-19/epidemiology , Dyspnea/virology , Fatigue/virology , Female , Headache/virology , Health Surveys/methods , Humans , Interviews as Topic , Male , Middle Aged , Olfaction Disorders/virology , Prevalence , SARS-CoV-2 , Self Report , Telephone , Time Factors , Young Adult
7.
Rev Med Virol ; 31(6): e2288, 2021 11.
Article in English | MEDLINE | ID: covidwho-1384306

ABSTRACT

SARS Coronavirus-2 is one of the most widespread viruses globally during the 21st century, whose severity and ability to cause severe pneumonia and death vary. We performed a comprehensive systematic review of all studies that met our standardised criteria and then extracted data on the age, symptoms, and different treatments of Covid-19 patients and the prognosis of this disease during follow-up. Cases in this study were divided according to severity and death status and meta-analysed separately using raw mean and single proportion methods. We included 171 complete studies including 62,909 confirmed cases of Covid-19, of which 148 studies were meta-analysed. Symptoms clearly emerged in an escalating manner from mild-moderate symptoms, pneumonia, severe-critical to the group of non-survivors. Hypertension (Pooled proportion (PP): 0.48 [95% Confident interval (CI): 0.35-0.61]), diabetes (PP: 0.23 [95% CI: 0.16-0.33]) and smoking (PP: 0.12 [95% CI: 0.03-0.38]) were highest regarding pre-infection comorbidities in the non-survivor group. While acute respiratory distress syndrome (PP: 0.49 [95% CI: 0.29-0.78]), (PP: 0.63 [95% CI: 0.34-0.97]) remained one of the most common complications in the severe and death group respectively. Bilateral ground-glass opacification (PP: 0.68 [95% CI: 0.59-0.75]) was the most visible radiological image. The mortality rates estimated (PP: 0.11 [95% CI: 0.06-0.19]), (PP: 0.03 [95% CI: 0.01-0.05]), and (PP: 0.01 [95% CI: 0-0.3]) in severe-critical, pneumonia and mild-moderate groups respectively. This study can serve as a high evidence guideline for different clinical presentations of Covid-19, graded from mild to severe, and for special forms like pneumonia and death groups.


Subject(s)
COVID-19/pathology , Cough/pathology , Dyspnea/pathology , Fatigue/pathology , Fever/pathology , SARS-CoV-2/pathogenicity , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/mortality , COVID-19/virology , Comorbidity , Cough/drug therapy , Cough/mortality , Cough/virology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Dyspnea/drug therapy , Dyspnea/mortality , Dyspnea/virology , Fatigue/drug therapy , Fatigue/mortality , Fatigue/virology , Fever/drug therapy , Fever/mortality , Fever/virology , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Immunologic Factors/therapeutic use , Prognosis , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology , Severity of Illness Index , Smoking/physiopathology , Survival Analysis
8.
BMC Pulm Med ; 21(1): 241, 2021 Jul 17.
Article in English | MEDLINE | ID: covidwho-1369491

ABSTRACT

INTRODUCTION: The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values. METHOD: Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20). RESULTS: On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p < 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p < 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F. CONCLUSION: Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization.


Subject(s)
COVID-19/physiopathology , Pneumonia, Viral/physiopathology , Aged , Blood Gas Analysis , COVID-19/complications , Carbon Monoxide , Dyspnea/virology , Exercise Tolerance , Female , Humans , Male , Middle Aged , Oxygen/blood , Partial Pressure , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Pulmonary Diffusing Capacity , Residual Volume , SARS-CoV-2 , Severity of Illness Index , Walk Test
9.
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
10.
Medwave ; 21(6): e8231, 2021 Jul 05.
Article in Spanish, English | MEDLINE | ID: covidwho-1320619

ABSTRACT

Objectives: To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru. Methods: We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results: A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively. Conclusion: We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.


Subject(s)
COVID-19/mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Age Factors , Aged , COVID-19/epidemiology , Cohort Studies , Cough/epidemiology , Cough/virology , Dyspnea/epidemiology , Dyspnea/virology , Female , Hospitals , Humans , Male , Middle Aged , Peru/epidemiology , Prospective Studies , Risk Factors
11.
BMC Palliat Care ; 20(1): 102, 2021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1295461

ABSTRACT

BACKGROUND: At the time of the first wave of the COVID-19 pandemic in Sweden, little was known about how effective our regular end-of-life care strategies would be for patients dying from COVID-19 in hospitals. The aim of the study was to describe and evaluate end-of-life care for patients dying from COVID-19 in hospitals in Sweden up until up until 12 November 2020. METHODS: Data were collected from the Swedish Register of Palliative Care. Hospital deaths during 2020 for patients with COVID-19 were included and compared to a reference cohort of hospital patients who died during 2019. Logistic regression was used to compare the groups and to control for impact of sex, age and a diagnosis of dementia. RESULTS: The COVID-19 group (1476 individuals) had a lower proportion of women and was older compared to the reference cohort (13,158 individuals), 81.8 versus 80.6 years (p < .001). Breathlessness was more commonly reported in the COVID-19 group compared to the reference cohort (72% vs 43%, p < .001). Furthermore, anxiety and delirium were more commonly and respiratory secretions, nausea and pain were less commonly reported during the last week in life in the COVID-19 group (p < .001 for all five symptoms). When present, complete relief of anxiety (p = .021), pain (p = .025) and respiratory secretions (p = .037) was more often achieved in the COVID-19 group. In the COVID-19 group, 57% had someone present at the time of death compared to 77% in the reference cohort (p < .001). CONCLUSIONS: The standard medical strategies for symptom relief and end-of-life care in hospitals seemed to be acceptable. Symptoms in COVID-19 deaths in hospitals were relieved as much as or even to a higher degree than in hospitals in 2019. Importantly, though, as a result of closing the hospitals to relatives and visitors, patients dying from COVID-19 more frequently died alone, and healthcare providers were not able to substitute for absent relatives.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Palliative Care , Terminal Care , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety/epidemiology , Anxiety/virology , COVID-19/psychology , Cohort Studies , Delirium/epidemiology , Delirium/virology , Dyspnea/epidemiology , Dyspnea/virology , Female , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Nausea/epidemiology , Nausea/virology , Pain/epidemiology , Pain/virology , Registries , Sweden/epidemiology , Symptom Assessment , Young Adult
12.
Nat Med ; 27(9): 1607-1613, 2021 09.
Article in English | MEDLINE | ID: covidwho-1290003

ABSTRACT

Long-term complications after coronavirus disease 2019 (COVID-19) are common in hospitalized patients, but the spectrum of symptoms in milder cases needs further investigation. We conducted a long-term follow-up in a prospective cohort study of 312 patients-247 home-isolated and 65 hospitalized-comprising 82% of total cases in Bergen during the first pandemic wave in Norway. At 6 months, 61% (189/312) of all patients had persistent symptoms, which were independently associated with severity of initial illness, increased convalescent antibody titers and pre-existing chronic lung disease. We found that 52% (32/61) of home-isolated young adults, aged 16-30 years, had symptoms at 6 months, including loss of taste and/or smell (28%, 17/61), fatigue (21%, 13/61), dyspnea (13%, 8/61), impaired concentration (13%, 8/61) and memory problems (11%, 7/61). Our findings that young, home-isolated adults with mild COVID-19 are at risk of long-lasting dyspnea and cognitive symptoms highlight the importance of infection control measures, such as vaccination.


Subject(s)
Antibodies, Viral/blood , COVID-19/complications , COVID-19/pathology , Cognitive Dysfunction/virology , Dyspnea/virology , Fatigue/virology , Adolescent , Adult , Ageusia/virology , Anosmia/virology , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Norway , Patient Isolation , Prospective Studies , SARS-CoV-2 , Severity of Illness Index , Young Adult
13.
J Enzyme Inhib Med Chem ; 36(1): 1230-1235, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1254219

ABSTRACT

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.


Subject(s)
Acetazolamide/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Carbonic Anhydrase Inhibitors/therapeutic use , Carbonic Anhydrases/blood , Acid-Base Equilibrium/drug effects , Altitude Sickness/blood , Altitude Sickness/drug therapy , Anticonvulsants/therapeutic use , Bicarbonates/blood , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/virology , Carbon Dioxide/blood , Cough/blood , Cough/drug therapy , Cough/pathology , Cough/virology , Drug Repositioning , Dyspnea/blood , Dyspnea/drug therapy , Dyspnea/pathology , Dyspnea/virology , Fever/blood , Fever/drug therapy , Fever/pathology , Fever/virology , Humans , Hydrogen-Ion Concentration , Hypertension, Pulmonary/blood , Hypertension, Pulmonary/drug therapy , Hypoxia/blood , Hypoxia/drug therapy , Hypoxia/pathology , Hypoxia/virology , Oximetry , Research Design , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Severity of Illness Index , Tomography, X-Ray Computed
14.
Lung ; 199(3): 249-253, 2021 06.
Article in English | MEDLINE | ID: covidwho-1227841

ABSTRACT

This multicenter study presents prevalence data and associated risk factors of post-COVID-19 cough one year after hospital discharge in COVID-19 survivors. Individuals recovered from COVID-19 at three public hospitals in Madrid (Spain) were scheduled for a telephonic interview. They were systematically asked about the presence of respiratory symptoms, e.g., fatigue, dyspnea, chest pain, and cough after hospital discharge. Clinical and hospitalization data were collected from hospital records. Overall, 1,950 patients (47% women, mean age:61, SD:16 years) were assessed at 11.2 months (SD 0.5) after hospital discharge. Just 367 (18.8%) were completely free of any respiratory post-COVID -19 symptom. The prevalence of long-term cough, chest pain, dyspnea, and fatigue was 2.5%, 6.5%, 23.3%, and 61.2%, respectively. Clinical and hospitalization factors were not associated with long-term post-COVID-19 cough. In conclusion, the prevalence of post-COVID-19 cough one year after SARS-CoV-2 infection was 2.5% in subjects who had survived hospitalization for COVID-19. No clear risk factor associated to long-term post-COVID-19 cough was identified.


Subject(s)
COVID-19/complications , Cough/epidemiology , Cough/virology , Aged , Chest Pain/epidemiology , Chest Pain/virology , Dyspnea/epidemiology , Dyspnea/virology , Fatigue/epidemiology , Fatigue/virology , Female , Follow-Up Studies , Hospitalization , Humans , Male , Middle Aged , Prevalence , Risk Factors , SARS-CoV-2 , Spain/epidemiology , Time Factors
15.
BMJ Case Rep ; 14(4)2021 Apr 19.
Article in English | MEDLINE | ID: covidwho-1194194

ABSTRACT

SARS-CoV-2 has resulted in a global pandemic and an unprecedented public health crisis. Recent literature suggests the emergence of a novel syndrome known as 'long COVID', a term used to describe a diverse set of symptoms that persist after a minimum of 4 weeks from the onset of a diagnosed COVID-19 infection. Common symptoms include persistent breathlessness, fatigue and cough. Other symptoms reported include chest pain, palpitations, neurological and cognitive deficits, rashes, and gastrointestinal dysfunction. We present a complex case of a previously well 28-year-old woman who was diagnosed with COVID-19. After resolution of her acute symptoms, she continued to experience retrosternal discomfort, shortness of breath, poor memory and severe myalgia. Investigations yielded no significant findings. Given no alternative diagnosis, she was diagnosed with 'long COVID'.


Subject(s)
COVID-19/complications , Adult , COVID-19/diagnosis , Cough/virology , Dyspnea/virology , Fatigue/virology , Female , Humans , Memory Disorders/virology , Myalgia/virology
16.
Clin Infect Dis ; 71(16): 2243-2245, 2020 11 19.
Article in English | MEDLINE | ID: covidwho-1153147

ABSTRACT

We report 2 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) in infants presenting with fever in the absence of respiratory distress who required hospitalization for evaluation of possible invasive bacterial infections. The diagnoses resulted from routine isolation and real-time reverse-transcription polymerase chain reaction-based testing for SARS-CoV-2 for febrile infants in an outbreak setting.


Subject(s)
COVID-19/diagnosis , Fever/virology , Hospitalization/statistics & numerical data , Dyspnea/virology , Humans , Infant , Infant, Newborn , Male , Nasopharynx/virology , Respiratory Distress Syndrome, Newborn , SARS-CoV-2
17.
Phys Ther ; 101(6)2021 06 01.
Article in English | MEDLINE | ID: covidwho-1140007

ABSTRACT

OBJECTIVE: The aim of this pilot study was to assess physical fitness and its relationship with functional dyspnea in survivors of COVID-19 6 months after their discharge from the hospital. METHODS: Data collected routinely from people referred for cardiopulmonary exercise testing (CPET) following hospitalization for COVID-19 were retrospectively analyzed. Persistent dyspnea was assessed using the modified Medical Research Council dyspnea scale. RESULTS: Twenty-three people with persistent symptoms were referred for CPET. Mean modified Medical Research Council dyspnea score was 1 (SD = 1) and was significantly associated with peak oxygen uptake (VO2peak; %) (rho = -0.49). At 6 months, those hospitalized in the general ward had a relatively preserved VO2peak (87% [SD = 20]), whereas those who had been in the intensive care unit had a moderately reduced VO2peak (77% [SD = 15]). Of note, the results of the CPET revealed that, in all individuals, respiratory equivalents were high, power-to-weight ratios were low, and those who had been in the intensive care unit had a relatively low ventilatory efficiency (mean VE/VCO2 slope = 34 [SD = 5]). Analysis of each individual showed that none had a breathing reserve <15% or 11 L/min, all had a normal exercise electrocardiogram, and 4 had a heart rate >90%. CONCLUSION: At 6 months, persistent dyspnea was associated with reduced physical fitness. This study offers initial insights into the mid-term physical fitness of people who required hospitalization for COVID-19. It also provides novel pathophysiological clues about the underlaying mechanism of the physical limitations associated with persistent dyspnea. Those with persistent dyspnea should be offered a tailored rehabilitation intervention, which should probably include muscle reconditioning, breathing retraining, and perhaps respiratory muscle training. IMPACT: This study is the first, to our knowledge, to show that a persistent breathing disorder (in addition to muscle deconditioning) can explain persistent symptoms 6 months after hospitalization for COVID-19 infection and suggests that a specific rehabilitation intervention is warranted.


Subject(s)
COVID-19/complications , Dyspnea/physiopathology , Fatigue/physiopathology , Oxygen Consumption/physiology , Physical Fitness/physiology , Dyspnea/virology , Exercise Test , Fatigue/virology , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Pilot Projects , Recovery of Function , Retrospective Studies , SARS-CoV-2
18.
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
19.
Biomed Res Int ; 2021: 8840835, 2021.
Article in English | MEDLINE | ID: covidwho-1133375

ABSTRACT

This study established an interpretable machine learning model to predict the severity of coronavirus disease 2019 (COVID-19) and output the most crucial deterioration factors. Clinical information, laboratory tests, and chest computed tomography (CT) scans at admission were collected. Two experienced radiologists reviewed the scans for the patterns, distribution, and CT scores of lung abnormalities. Six machine learning models were established to predict the severity of COVID-19. After parameter tuning and performance comparison, the optimal model was explained using Shapley Additive explanations to output the crucial factors. This study enrolled and classified 198 patients into mild (n = 162; 46.93 ± 14.49 years old) and severe (n = 36; 60.97 ± 15.91 years old) groups. The severe group had a higher temperature (37.42 ± 0.99°C vs. 36.75 ± 0.66°C), CT score at admission, neutrophil count, and neutrophil-to-lymphocyte ratio than the mild group. The XGBoost model ranked first among all models, with an AUC, sensitivity, and specificity of 0.924, 90.91%, and 97.96%, respectively. The early stage of chest CT, total CT score of the percentage of lung involvement, and age were the top three contributors to the prediction of the deterioration of XGBoost. A higher total score on chest CT had a more significant impact on the prediction. In conclusion, the XGBoost model to predict the severity of COVID-19 achieved excellent performance and output the essential factors in the deterioration process, which may help with early clinical intervention, improve prognosis, and reduce mortality.


Subject(s)
COVID-19/diagnostic imaging , COVID-19/etiology , Diagnosis, Computer-Assisted/methods , Adult , Aged , Blood Cell Count , COVID-19/blood , Dyspnea/virology , Female , Fever/virology , Humans , Machine Learning , Male , Models, Biological , Neutrophils , Severity of Illness Index , Tomography, X-Ray Computed
20.
BMC Infect Dis ; 21(1): 255, 2021 Mar 11.
Article in English | MEDLINE | ID: covidwho-1127690

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. METHODS: An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. RESULTS: A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28). CONCLUSION: The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. TRIAL REGISTRATION: Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082 .


Subject(s)
COVID-19/diagnosis , Symptom Assessment , Adult , Anosmia/virology , Cough/virology , Cross-Sectional Studies , Dyspnea/virology , Female , Fever/virology , Headache/virology , Humans , Male , Mexico , Middle Aged , Pandemics , Prospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL
...