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1.
Psychiatr Prax ; 47(6): 308-318, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-657524

ABSTRACT

OBJECTIVE: To assess the impact of the Corona pandemic and related restrictions on going out on social participation, social inclusion and well-being in adults with and without current or chronic mental health problems METHODS: Follow-up survey (n = 132) using the Measure of Participation and Social Inclusion for Use in People with a Chronic Mental Disorder (F-INK), the Index for the Assessment of Health Impairments (IMET), and the Brief Symptom Inventory (BSI-18). RESULTS: The impact on social participation capabilities and social participation differed depending on the participants' mental health status at the first assessment. Independent of this, we found no detrimental effect on the mental health status four weeks after the enactment of restrictions on going-out. CONCLUSION: Findings imply a general resilience in well-being in the preliminary stages of the Corona pandemic.


Subject(s)
Coronavirus Infections/psychology , Mental Health , Pneumonia, Viral/psychology , Social Participation , Adult , Betacoronavirus , Communicable Disease Control , Coronavirus Infections/prevention & control , Follow-Up Studies , Germany , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Resilience, Psychological
2.
Kardiol Pol ; 78(7-8): 725-731, 2020 08 25.
Article in English | MEDLINE | ID: covidwho-761291

ABSTRACT

BACKGROUND: In the midst of the SARS­CoV­2 pandemic, basic healthcare challenges arise as lockdowns and social isolation are implemented to prevent the spread of the virus. In order to overcome these challenges, the Polish National Health Fund has facilitated telemedical consultations. AIMS: The aim of this study was to compare teleconsultations with regular visits at ambulatory clinic of implantable devices and to assess whether teleconsultations would be an adequate replacement during times of limited face­to­face contact. METHODS: Teleconsultations in the clinic were introduced for patients without the possibility of remote control of cardiac implantable electronic devices. Prior to planned visits, physicians phoned patients and interviewed them about their health. Further treatment decisions were made based on the interview and available medical records. RESULTS: Teleconsultations were carried out over 3.5 weeks (March 13 to April 1, 2020). Out of 400 patients who had visits planned at the clinic, 349 were consulted by phone. A total of 299 patients confirmed stable health status, 14 reported some symptoms, and 4 were hospitalized; 2 patients changed their primary clinic and were no longer under our care, 1 was undergoing quarantine, 15 required additional intervention, and 15 had died prior to contact. In general, patients gave positive feedback on their teleconsultations. CONCLUSIONS: Teleconsultations are a much­needed option during the SARS­CoV­2 pandemic. They are an effective way to decrease interpersonal contact and to overcome sudden changes to the ambulatory visit plan, which may otherwise put an overwhelming burden on the clinic.


Subject(s)
Cardiac Resynchronization Therapy Devices/statistics & numerical data , Coronavirus Infections , Defibrillators, Implantable/statistics & numerical data , Monitoring, Ambulatory/methods , Pandemics , Pneumonia, Viral , Remote Consultation/methods , Remote Sensing Technology/methods , Female , Follow-Up Studies , Humans , Male
3.
Eur J Cardiothorac Surg ; 58(3): 598-604, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-733389

ABSTRACT

OBJECTIVES: There is currently a lack of clinical data on the novel beta-coronavirus infection [caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and concomitant primary lung cancer. Our goal was to report our experiences with 5 patients treated for lung cancer while infected with SARS-CoV-2. METHODS: We retrospectively evaluated 5 adult patients infected with SARS-CoV-2 who were admitted to our thoracic surgery unit between 29 January 2020 and 4 March 2020 for surgical treatment of a primary lung cancer. Clinical data and outcomes are reported. RESULTS: All patients were men with a mean age of 74.0 years (range 67-80). Four of the 5 patients (80%) reported chronic comorbidities. Surgery comprised minimally invasive lobectomy (2 patients) and segmentectomy (1 patient), lobectomy with en bloc chest wall resection (1 patient) and pneumonectomy (1 patient). Mean chest drain duration was 12.4 days (range 8-22); mean hospital stay was 33.8 days (range 21-60). SARS-CoV-2-related symptoms were fever (3 patients), persistent cough (3 patients), diarrhoea (2 patients) and syncope (2 patients); 1 patient reported no symptoms. Morbidity related to surgery was 60%; 30-day mortality was 40%. Two patients (1 with a right pneumonectomy, 74 years old; 1 with a lobectomy with chest wall resection and reconstruction, 70 years old), developed SARS-CoV-2-related lung failure leading to death 60 and 32 days after surgery, respectively. CONCLUSIONS: Lung cancer surgery may represent a high-risk factor for developing a severe case of coronavirus disease 2019, particularly in patients with advanced stages of lung cancer. Additional strategies are needed to reduce the risk of morbidity and mortality from SARS-CoV-2 infection during treatment for lung cancer.


Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Coronavirus Infections/diagnosis , Cross Infection/prevention & control , Lung Neoplasms/surgery , Pneumonia, Viral/diagnosis , Severe Acute Respiratory Syndrome/diagnosis , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/mortality , Clinical Laboratory Techniques , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/mortality , Elective Surgical Procedures/methods , Female , Follow-Up Studies , Hospital Mortality , Humans , Italy , Length of Stay , Lung Neoplasms/complications , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Pandemics , Pneumonectomy/methods , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Retrospective Studies , Sampling Studies , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/mortality , Thoracic Surgery, Video-Assisted/methods , Treatment Outcome
4.
J Exp Clin Cancer Res ; 39(1): 171, 2020 Aug 27.
Article in English | MEDLINE | ID: covidwho-733038

ABSTRACT

The Covid-19 pandemic has challenged hard the national health systems worldwide. According to the national policy issued in March 2020 in response to the evolving Covid-19 pandemic, several hospitals were re-configured as Covid-19 centers and elective surgery procedures were rescheduled according to the most recent recommendations. In addition, Covid-19 protected cancer hubs were established, including the Regina Elena National Cancer Institute of Rome, Central Italy. At our Institute, the Breast Surgery Department continued working under the sign of a multidisciplinary approach. The number of professional figures involved in case evaluation was reduced to a minimum and interactions took place in the full respect of the required safety measures. Treatments for benign disease, pure prophylactic surgery and elective reconstructive procedures were all postponed and priority was assigned to the histologically-proven malignant breast tumors and highly suspicious lesions. From March 15th though April 30th 2020, we treated a total of 79 patients. This number is fully consistent with the average quantitative standards reached by our Department under ordinary circumstances. Patients were mostly discharged the day after surgery and none was readmitted due to surgery-related late complications. More generally, post-operative complications rates were unexpectedly low, particularly in light of the relatively high number of reconstructive procedures performed in this emergency situation. A strict follow up was performed based on the close contact with the surgical staff by telephone, messaging apps and telemedicine.Patients ascertainment for their Covid-19 status prior to hospital admission and hospital discharge allowed to maintain the "no-Covid-19" status at our Institution. In addition, during the aforementioned time window, none of the care providers developed SARS-CoV-2 infection or disease, as shown by the results of anti-SARS-CoV-2 immunoglobulin M and G profiling. In conclusions, elective breast cancer surgery procedures were successfully performed in a lockdown situation due to a novel viral pandemic. The well-coordinated regional and hospital efforts in terms of medical resource re-allocation and definition of clinical priorities allowed to maintain high quality standards of breast cancer care while ensuring safety to the cancer patients and care providers involved.


Subject(s)
Betacoronavirus/isolation & purification , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Carcinoma, Lobular/surgery , Coronavirus Infections/prevention & control , Mastectomy/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Patterns, Physicians'/standards , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/virology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/virology , Carcinoma, Lobular/pathology , Carcinoma, Lobular/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Follow-Up Studies , Humans , Italy/epidemiology , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Prognosis , Receptor, ErbB-2/metabolism , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism
5.
Infect Dis Poverty ; 9(1): 118, 2020 Aug 26.
Article in English | MEDLINE | ID: covidwho-730582

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is currently the most serious infectious disease in the world. An accurate diagnosis of this disease in the clinic is very important. This study aims to improve the differential ability of computed tomography (CT) to diagnose COVID-19 and other community-acquired pneumonias (CAPs) and evaluate the short-term prognosis of these patients. METHODS: The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province, China from January 21 to February 28, 2020 were retrospectively analysed. The CT manifestations of the two groups were recorded and compared. A correlation analysis was used to examine the relationship between COVID-19 and age, size of lung lesions, number of involved lobes, and CT findings of patients. The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity. RESULTS: The typical CT findings of COVID-19 are simple ground-glass opacities (GGO), GGO with consolidation or grid-like changes. The sensitivity and specificity of the combination of age, white blood cell count, and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%, respectively. Pulmonary consolidation, fibrous cords, and bronchial wall thickening were used as indicators to exclude COVID-19. The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%, respectively. The follow-up results showed that 67.8% (112/165) of COVID-19 patients had abnormal changes in their lung parameters, and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age. CONCLUSIONS: Age, white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP. Patients aged over 60 years with COVID-19 have a poor prognosis. This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.


Subject(s)
Community-Acquired Infections/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus/isolation & purification , Child , Child, Preschool , China/epidemiology , Clinical Laboratory Techniques/methods , Community-Acquired Infections/virology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed/methods , Young Adult
7.
PLoS One ; 15(8): e0237831, 2020.
Article in English | MEDLINE | ID: covidwho-725099

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can lead to respiratory failure due to severe immune response. Treatment targeting this immune response might be beneficial but there is limited evidence on its efficacy. The aim of this study was to determine if early treatment of patients with COVID-19 pneumonia with tocilizumab and/or steroids was associated with better outcome. METHODS: This observational single-center study included patients with COVID-19 pneumonia who were not intubated and received either standard of care (SOC, controls) or SOC plus early (within 3 days from hospital admission) anti-inflammatory treatment. SOC consisted of hydroxychloroquine 400mg bid plus, in those admitted before March 24th, also darunavir/ritonavir. Anti-inflammatory treatment consisted of either tocilizumab (8mg/kg intravenously or 162mg subcutaneously) or methylprednisolone 1 mg/kg for 5 days or both. Failure was defined as intubation or death, and the endpoints were failure-free survival (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HROW). RESULTS: Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO2/FiO2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HROW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HROW 0.41, 95%CI: 0.19-0.89, p = 0.025. CONCLUSION: Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Coronavirus Infections/drug therapy , Methylprednisolone/therapeutic use , Pneumonia, Viral/drug therapy , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents/administration & dosage , Antibodies, Monoclonal, Humanized/administration & dosage , Antimalarials/administration & dosage , Antimalarials/therapeutic use , Betacoronavirus , Coronavirus Infections/virology , Darunavir/therapeutic use , Female , Follow-Up Studies , HIV Protease Inhibitors/therapeutic use , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/therapeutic use , Male , Methylprednisolone/administration & dosage , Middle Aged , Pandemics , Pneumonia, Viral/virology , Ritonavir/therapeutic use , Treatment Outcome
8.
Acta Derm Venereol ; 100(15): adv00249, 2020 Aug 19.
Article in English | MEDLINE | ID: covidwho-722469

ABSTRACT

Only recently histopathological studies of patients with dermatosis and concomitant SARS-Cov-2 viral infection were published. Seven months into the COVID-19 pandemic, more skin biopsies of COVID-19 positive patients are taking place. We examined the histological features of 30 skin biopsies from two groups of patients: Ten specimens of patients tested positive for COVID-19 with an active systemic infection and associated dermatosis. Twenty specimens were from patients not considered COVID-positive (due to PCR swab negativity or not tested at all) with cutaneous lesions either showing viral infection symptoms (fever, cough, ageusia and severe immunocompromised condition due to HIV infection and malignancies), or presented a high risk of being infected (such as cohabitation with COVID-19 positive parents and siblings with simultaneous chilblains). This study analyses the histological and immunohistochemical (SARS-CoV-2 2019-nCoV nucleocapsid antibody) characteristics of the two groups and identifies 4 histopathological patterns. The histopathological features of the two groups present similar features that may help to identify an ongoing COVID-19 infection even in asymptomatic carriers with dermatosis.


Subject(s)
Asymptomatic Diseases/epidemiology , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Skin Diseases/pathology , Biopsy, Needle , Cohort Studies , Comorbidity , Female , Follow-Up Studies , Humans , Immunohistochemistry , Male , Pandemics , Polymerase Chain Reaction/methods , Reference Values , Retrospective Studies , Risk Assessment , Severity of Illness Index , Skin Diseases/epidemiology , Specimen Handling
9.
Ann R Coll Surg Engl ; 102(7): e176-e179, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-721361

ABSTRACT

Spain has been one of the most affected countries by the COVID-19 outbreak. After the high impact of the pandemic, a wide clinical spectrum of late complications associated with COVID-19 are being observed. We report a case of a severe Clostridium difficile colitis in a post-treatment and recovered COVID-19 patient. A 64-year-woman with a one-month hospital admission for severe bilateral pneumonia associated with COVID-19 and 10 days after discharge presented with diarrhoea and abdominal pain. Severe C. difficile-associated colitis is diagnosed according to clinical features and CT findings. An urgent pancolectomy was performed due to her bad response to conservative treatment. Later evolution slowly improved to recovery. C. difficile-associated colitis is one of the most common hospital-acquired infections. Significant patient-related risk factors for C. difficile infection are antibiotic exposure, older age, and hospitalisation. Initial therapeutic recommendations in our country included administration broad-spectrum antibiotics to all patients with bilateral pneumonia associated with SARS-CoV-2. These antibiotics are strongly associated with C. difficile infection. Our patient developed a serious complication of C. difficile due to the use of broad-spectrum antibiotics. The appearance of late digestive symptoms in patients diagnosed and treated for COVID-19 should alert clinicians to the possibility of C. difficile infection. The updated criteria for severe colitis and severe C. difficile infection should be considered to ensure an early effective treatment for the complication.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Betacoronavirus , Clostridium difficile/isolation & purification , Colitis/etiology , Coronavirus Infections/complications , Cross Infection/etiology , Pneumonia, Viral/complications , Colitis/drug therapy , Colitis/microbiology , Coronavirus Infections/epidemiology , Cross Infection/diagnosis , Cross Infection/drug therapy , Female , Follow-Up Studies , Humans , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Risk Factors , Time Factors , Tomography, X-Ray Computed
10.
Sci Rep ; 10(1): 13908, 2020 08 17.
Article in English | MEDLINE | ID: covidwho-720846

ABSTRACT

Isolation and loneliness are related to various aspects of health. Physical performance is a central component of health. However, its relationship with isolation and loneliness is not well understood. We therefore assessed the relationship between loneliness, different aspects of social isolation, and physical performance over time. 8,780 participants from the English Longitudinal Study of Ageing, assessed three times over 8 years of follow-up, were included. Measures included physical performance (Short Physical Performance Battery), loneliness (modified UCLA Loneliness Scale), and isolation considered in three ways (domestic isolation, social disengagement, low social contact). Fixed effects regression models were used to estimate the relationship between changes in these parameters. Missing data were imputed to account for variable response and ensure a representative sample. Loneliness, domestic isolation and social disengagement were longitudinally associated with poorer physical performance when accounting for both time-invariant and time-variant confounders (loneliness: coef = - 0.06, 95% CI - 0.09 to - 0.02; domestic isolation: coef = - 0.32, 95% CI - 0.46 to - 0.19; social disengagement: coef = - 0.10, 95% CI - 0.12 to - 0.07). Low social contact was not associated with physical performance. These findings suggest social participation and subjectively meaningful interpersonal interactions are related to physical performance, and highlight additional considerations regarding social distancing related to COVID-19 control measures.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Loneliness/psychology , Physical Functional Performance , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Quarantine/psychology , Social Isolation/psychology , Aged , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , England/epidemiology , Female , Follow-Up Studies , Humans , Interpersonal Relations , Longitudinal Studies , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology
12.
PLoS One ; 15(8): e0237693, 2020.
Article in English | MEDLINE | ID: covidwho-713539

ABSTRACT

Hydroxychloroquine has been touted as a potential COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has also been proposed as a treatment of critically ill patients. In this retrospective observational cohort study drawn from electronic health records we sought to describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients. Patients were hospitalized at a 13-hospital network spanning New Jersey USA between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020. Among 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80-1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83-1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75-1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57-1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%. This observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials. Trial Registration: Clinicaltrials.gov Identifier: NCT04347993.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antimalarials/therapeutic use , Betacoronavirus , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized/pharmacology , Azithromycin/therapeutic use , Child , Child, Preschool , Coronavirus Infections/mortality , Coronavirus Infections/virology , Drug Therapy, Combination , Female , Follow-Up Studies , Hospitalization , Humans , Infant , Infant, Newborn , Intensive Care Units , Interleukin-6/antagonists & inhibitors , Kaplan-Meier Estimate , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Retrospective Studies , Treatment Outcome , Young Adult
13.
PLoS One ; 15(8): e0237298, 2020.
Article in English | MEDLINE | ID: covidwho-712951

ABSTRACT

OBJECTIVES: We aimed to model the impact of coronavirus (COVID-19) on the clinical academic response in England, and to provide recommendations for COVID-related research. DESIGN: A stochastic model to determine clinical academic capacity in England, incorporating the following key factors which affect the ability to conduct research in the COVID-19 climate: (i) infection growth rate and population infection rate (from UK COVID-19 statistics and WHO); (ii) strain on the healthcare system (from published model); and (iii) availability of clinical academic staff with appropriate skillsets affected by frontline clinical activity and sickness (from UK statistics). SETTING: Clinical academics in primary and secondary care in England. PARTICIPANTS: Equivalent of 3200 full-time clinical academics in England. INTERVENTIONS: Four policy approaches to COVID-19 with differing population infection rates: "Italy model" (6%), "mitigation" (10%), "relaxed mitigation" (40%) and "do-nothing" (80%) scenarios. Low and high strain on the health system (no clinical academics able to do research at 10% and 5% infection rate, respectively. MAIN OUTCOME MEASURES: Number of full-time clinical academics available to conduct clinical research during the pandemic in England. RESULTS: In the "Italy model", "mitigation", "relaxed mitigation" and "do-nothing" scenarios, from 5 March 2020 the duration (days) and peak infection rates (%) are 95(2.4%), 115(2.5%), 240(5.3%) and 240(16.7%) respectively. Near complete attrition of academia (87% reduction, <400 clinical academics) occurs 35 days after pandemic start for 11, 34, 62, 76 days respectively-with no clinical academics at all for 37 days in the "do-nothing" scenario. Restoration of normal academic workforce (80% of normal capacity) takes 11, 12, 30 and 26 weeks respectively. CONCLUSIONS: Pandemic COVID-19 crushes the science needed at system level. National policies mitigate, but the academic community needs to adapt. We highlight six key strategies: radical prioritisation (eg 3-4 research ideas per institution), deep resourcing, non-standard leadership (repurposing of key non-frontline teams), rationalisation (profoundly simple approaches), careful site selection (eg protected sites with large academic backup) and complete suspension of academic competition with collaborative approaches.


Subject(s)
Betacoronavirus , Biomedical Research/methods , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Coronavirus Infections/virology , Delivery of Health Care/methods , England/epidemiology , Follow-Up Studies , Health Personnel/organization & administration , Health Workforce/organization & administration , Humans , Models, Statistical , Pandemics , Pneumonia, Viral/virology , Prospective Studies , Public Health/methods
14.
Sci Rep ; 10(1): 13689, 2020 08 13.
Article in English | MEDLINE | ID: covidwho-711912

ABSTRACT

To describe the epidemiological and clinical characteristics of patients with Corona Virus Disease 2019 (COVID-19) in Beijing. To analyze the application of corticosteroids in patients with severe pneumonia. We collected information on demographic characteristics, exposure history, clinical characteristics, corticosteroids use, and outcomes of the 65 confirmed cases of COVID-19 at Fifth Medical Center of PLA General Hospital from Jan 20 to Feb 23, 2020. The final follow-up date observed was April 15th, 2020. The number of patients with mild, general, severe, and critical type were 10 (15.38%), 32 (49.23%), 8 (12.31%), and 15 (23.08%), respectively. The median incubation period was 6 days. Notable outliers were 1 patient at 16 days and 1 patient at 21 days. In lymphocyte subgroup analysis, decreases in total, T, CD4, and CD8 lymphocytes were more common as the disease worsened (All P < 0.05). Methylprednisolone (mPSL) was applied to 31 (47.69%) patients with pneumonia, including 10 (31.25%) general, 8 (100%) severe, and 13 (86.67%) critical patients, respectively. Corticosteroids inhibited Interleukin-6(IL-6) production (P = 0.0215) but did not affect T lymphocyte (P = 0.0796). There was no significant difference between patients using lower dose (≤ 2 mg/kg day) and higher dose (> 2 mg/kg day) mPSL in inhibiting IL-6 production (P = 0.5856). Thirty of 31 patients (96.77%) had stopped mPSL due to improvement of pneumonia. Virus RNA clearance time lengthened with disease progression (P = 0.0001). In general type, there was no significant difference in virus clearance time between patients with (15, 12-19 days) and without (14.5, 11-18 days) (P = 0.7372) mPSL use. Lymphocyte, especially T lymphocyte, in severe and critical patients showed a dramatic decrease. Application of lower dose corticosteroids (≤ 2 mg/kg day) could inhibit IL-6 production (a representative of cytokines) as effectively as a higher dose. Proper use corticosteroids in general type patients did not delay virus clearance.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Glucocorticoids/therapeutic use , Methylprednisolone/therapeutic use , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Beijing/epidemiology , CD4-Positive T-Lymphocytes , CD8-Positive T-Lymphocytes , Child , Child, Preschool , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Female , Follow-Up Studies , Glucocorticoids/administration & dosage , Glucocorticoids/pharmacology , Humans , Interleukin-6/antagonists & inhibitors , Lymphocyte Count , Male , Methylprednisolone/administration & dosage , Methylprednisolone/pharmacology , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , RNA, Viral/drug effects , Treatment Outcome , Young Adult
17.
Medicine (Baltimore) ; 99(32): e21547, 2020 Aug 07.
Article in English | MEDLINE | ID: covidwho-707528

ABSTRACT

This study aimed to evaluate the onset characteristics of patients with uremia undergoing maintenance hemodialysis complicated with COVID-19, so as to improve the understanding, diagnosis, and treatment.26 cases were confirmed cases of COVID-19. Confirmed patients with COVID-19 undergoing maintenance hemodialysis in the blood purification center were recruited. The general data of patients, including age, sex, duration of dialysis, and basic diseases, were analyzed. The clinical features included fever, respiratory symptoms, and gastrointestinal symptoms. The items for laboratory tests included blood routine examination, liver function, C-reactive protein, procalcitonin, creatine kinase, creatine kinase-MB, markers of myocardial injury, B-type natriuretic peptide, D-dimer, and so forth. The imaging examinations referred mainly to computed tomography imaging findings of the lungs.Twenty-one cases were complicated with chronic basic diseases, such as hypertension or diabetes. In terms of clinical manifestations, 13 cases had fever, which was close to the number of cases without fever (13 cases). The respiratory symptoms included dry cough (19 cases), shortness of breath (9 cases), fatigue (11 cases), and so forth. Further, 15 patients had hypoxemia, indicating more severe patients. Sore throat (2 cases) was not significant, and a few patients reported gastrointestinal symptoms (3 cases). The results of blood routine examination showed decreased absolute lymphocyte count (0.7 ±â€Š0.4 × 10∼9/L), lower hemoglobin level (105.2 ±â€Š20 g/L), and normal absolute neutrophil count 4.2 (3.0, 5.9) × 10∼9/L. Of the inflammatory indexes, procalcitonin was 0.69 (0.24, 2.73) ng/mL; C reactive protein was 17.2 (5.2, 181.6) mg/L, which was higher than normal. Blood biochemistry revealed lower albumin level (38.0 ±â€Š4.0 g/L) and higher troponin 0.11(0.035, 6.658) ng/mL and myoglobin levels (538.5 ±â€Š240.5 ng/mL), suggesting myocardial injury.The patients with uremia and confirmed COVID-19 undergoing maintenance hemodialysis are more common in males. Although the proportion of fever patients is 50%, the proportion of hypoxemia patients is high (58%). With poor cardiac function. They were prone to respiratory failure complicated with heart failure. According to the onset characteristics of this population, early diagnosis and treatment could help reduce the risk of developing a critical illness and control the spread of the COVID-19 epidemic.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Hospitalization/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Renal Dialysis/methods , Uremia/epidemiology , Aged , China/epidemiology , Comorbidity , Cross Infection/prevention & control , Databases, Factual , Female , Follow-Up Studies , Hospitals, University , Humans , Incidence , Male , Middle Aged , Pandemics , Patient Isolation , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment Outcome , Uremia/diagnosis , Uremia/therapy
18.
Medicine (Baltimore) ; 99(32): e21570, 2020 Aug 07.
Article in English | MEDLINE | ID: covidwho-706114

ABSTRACT

RATIONALE: Macrophage activation syndrome (MAS) is a rare life-threatening condition characterized by cytokine-mediated tissue injury and multiorgan dysfunction. PATIENT CONCERNS: We describe the unique case of young man who developed MAS as the sole manifestation of an otherwise paucisymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DIAGNOSES: Clinical and biological criteria led to the diagnosis of MAS; cytokine profile was highly suggestive reverse transcription polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swabs was negative, but serum anti-SARS-CoV-2 immunoglobulin A and immunoglobulin G resulted positive leading to the diagnosis of SARS-CoV-2 infection. INTERVENTIONS: The patient was treated with empiric antibiotic and hydroxychloroquine. OUTCOMES: Clinical improvement ensued. At follow-up, the patient is well. LESSON: SARS-CoV-2 infection may trigger develop life-threatening complications, like MAS. This can be independent from coronavirus disease 2019 gravity.


Subject(s)
Ceftriaxone/administration & dosage , Coronavirus Infections/diagnosis , Hospitalization , Hydroxychloroquine/administration & dosage , Macrophage Activation Syndrome/diagnosis , Pneumonia, Viral/diagnosis , Adolescent , Blood Chemical Analysis , China , Clinical Laboratory Techniques/methods , Coronavirus Infections/drug therapy , DNA, Viral/analysis , Diagnosis, Differential , Disease Progression , Drug Therapy, Combination , Electrocardiography/methods , Follow-Up Studies , Humans , Macrophage Activation Syndrome/therapy , Male , Pandemics , Patient Discharge , Pneumonia, Viral/drug therapy , Radiography, Thoracic/methods , Real-Time Polymerase Chain Reaction/methods , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed/methods , Treatment Outcome
19.
Eur J Heart Fail ; 22(6): 967-974, 2020 06.
Article in English | MEDLINE | ID: covidwho-702780

ABSTRACT

AIMS: The SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. It has been suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID-19 infection. METHODS AND RESULTS: We evaluated this hypothesis in a consecutive cohort of 1200 acute inpatients with COVID-19 at two hospitals with a multi-ethnic catchment population in London (UK). The mean age was 68 ± 17 years (57% male) and 74% of patients had at least one comorbidity. Overall, 415 patients (34.6%) reached the primary endpoint of death or transfer to a critical care unit for organ support within 21 days of symptom onset. A total of 399 patients (33.3%) were taking ACEi or ARB. Patients on ACEi/ARB were significantly older and had more comorbidities. The odds ratio for the primary endpoint in patients on ACEi and ARB, after adjustment for age, sex and co-morbidities, was 0.63 (95% confidence interval 0.47-0.84, P < 0.01). CONCLUSIONS: There was no evidence for increased severity of COVID-19 in hospitalised patients on chronic treatment with ACEi or ARB. A trend towards a beneficial effect of ACEi/ARB requires further evaluation in larger meta-analyses and randomised clinical trials.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Betacoronavirus , Coronavirus Infections/epidemiology , Heart Failure/drug therapy , Pneumonia, Viral/epidemiology , Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Comorbidity , Coronavirus Infections/drug therapy , Disease Progression , Female , Follow-Up Studies , Heart Failure/epidemiology , Humans , Male , Pandemics , Pneumonia, Viral/drug therapy , Severity of Illness Index , Treatment Outcome , United Kingdom/epidemiology
20.
Front Endocrinol (Lausanne) ; 11: 478, 2020.
Article in English | MEDLINE | ID: covidwho-697904

ABSTRACT

Aims: This study aimed to investigate the clinical courses and outcomes of diabetes mellitus patients with coronavirus disease 2019 (COVID-19) in Wuhan. Methods: This study enrolled 1,880 consecutive patients with confirmed COVID-19 in Leishenshan Hospital. We collected and analyzed their data, including demographic data, history of comorbidity, clinical symptoms, laboratory tests, chest computed tomography (CT) images, treatment options, and survival. Results: The percentages of patients with diabetes among the severe and critical COVID-19 cases were higher than those among the mild or general cases (89.2%, 10.8 vs. 0%, p = 0.001). However, patients with and without diabetes showed no difference in the follow-up period (p = 0.993). The mortality rate in patients with or without diabetes was 2.9% (n = 4) and 1.1% (n = 9), respectively (p = 0.114). Univariate and multivariate Cox regression analyses and the Kaplan-Meier curves did not show any statistically significant differences between patients with and without diabetes (all p > 0.05). Conclusions: Our study results suggested that diabetes had no effect on the prognosis of COVID-19 patients but had a negative association with their clinical courses. These results may be useful for clinicians in the management of diabetic patients with COVID-19.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Diabetes Mellitus/physiopathology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Adult , China/epidemiology , Comorbidity , Coronavirus Infections/complications , Diabetes Complications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Prognosis , Retrospective Studies , Risk Factors
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