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1.
Front Immunol ; 12: 741765, 2021.
Article in English | MEDLINE | ID: covidwho-1441111

ABSTRACT

The long-term impact of COVID-19 on transplant recipients remains unknown. We describe the case of a 30-year-old male kidney transplant recipient from Wuhan, China that was treated for severe COVID-19 in February 2020. He suffered an acute lung and renal injury and required systemic treatment including adjustment of his immunosuppressant regime. He was followed up to 1-year after discharge. No chronic lung fibrosis or deterioration of his pulmonary function was observed. Despite COVID-19 mediated damage to his renal tubular cells, no transplant rejection occurred. His immunological profile demonstrated both cellular anti-SARS-CoV-2 reactivity and specific humoral immunity, indicating that it is beneficial for the transplanted patients to be immunized with SARS-CoV-2 virus vaccine. This case will help guide clinical decision making for immunocompromised individuals that become infected with SARS-CoV-2.


Subject(s)
COVID-19 , Kidney Transplantation , SARS-CoV-2 , Adult , COVID-19/blood , COVID-19/diagnosis , COVID-19/therapy , Cytokines/blood , Humans , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/therapy , Leukocyte Count , Male , Oxygen/therapeutic use , RNA, Viral/analysis , SARS-CoV-2/genetics , Transplant Recipients
2.
Cytokine ; 148: 155719, 2021 12.
Article in English | MEDLINE | ID: covidwho-1433128

ABSTRACT

Effective therapies for coronavirus disease 2019 (COVID-19) are urgently needed. Maladaptive hyperinflammation and excessive cytokine release underlie the disease severity, with antiinflammatory and cytokine inhibiting agents expected to exert therapeutic effects. A major present challenge is identification of appropriate phase of the illness for a given intervention to yield optimum outcomes. Considering its established disease biomarker and drug discovery potential, a compendious analysis of existing transcriptomic data is presented here toward addressing this gap. The analysis is based on COVID-19 data related to intensive care unit (ICU) and non-ICU admissions, discharged and deceased patients, ventilation and non-ventilation phases, and high oxygen supplementation. It integrates transcriptomic data related to the effects of, in various cellular treatment models, the COVID-19 randomized clinical trial (RCT) successful drug dexamethasone, and the failed drug, with a potential to harm, hydroxychloroquine/chloroquine. Similarly, effects of various COVID-19 candidate drugs/anticytokines as well as proinflammatory cytokines implicated in the illness are also examined. The underlying assumption was that compared to COVID-19, an effective drug/anticytokine and a disease aggravating agent would affect gene regulation in opposite and same direction, in that order. Remarkably, the assumption was supported with respect to both the RCT drugs. With this control validation, etanercept, followed by tofacitinib and adalimumab, showed transcriptomic effects predictive of benefits in both ventilation and non-ventilation ICU stages as well as in non-ICU phase. On the other hand, canakinumab showed potential for effectiveness in high oxygen supplementation phase. These findings may inform experimental and clinical studies toward drug repurposing in COVID-19.


Subject(s)
COVID-19/drug therapy , COVID-19/genetics , Gene Expression Profiling , COVID-19/physiopathology , Humans , Intensive Care Units , Oxygen/therapeutic use , Patient Discharge , Proof of Concept Study , Respiration, Artificial
3.
Int J Med Sci ; 18(15): 3395-3402, 2021.
Article in English | MEDLINE | ID: covidwho-1409696

ABSTRACT

Computed tomography (CT) of the chest is one of the main diagnositic tools for coronavirus disease 2019 (COVID-19) infection. To document the chest CT findings in patients with confirmed COVID-19 and their association with the clinical severity, we searched related literatures through PubMed, MEDLINE, Embase, Web of Science (inception to May 4, 2020) and reviewed reference lists of previous systematic reviews. A total of 31 case reports (3768 patients) on CT findings of COVID-19 were included. The most common comorbid conditions were hypertension (18.4%) and diabetes mellitus (8.3%). The most common symptom was fever (78.7%), followed by cough (60.2%). It took an average of 5.6 days from symptom onset to admission. The most common chest CT finding was vascular enlargement (84.8%), followed by ground-glass opacity (GGO) (60.1%), air-bronchogram (47.8%), and consolidation (41.4%). Most lung lesions were located in the lung periphery (72.2%) and involved bilateral lung (76%). Most patients showed normal range of laboratory findings such as white blood cell count (96.4%) and lymphocyte (87.2%). Compared to previous published meta-analyses, our study is the first to summarize the different radiologic characteristics of chest CT in a total of 3768 COVID-19 patients by compiling case series studies. A comprehensive diagnostic approach should be adopted for patients with known COVID-19, suspected cases, and for exposed individuals.


Subject(s)
COVID-19/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , COVID-19/blood , Humans , Lung/diagnostic imaging , Lung Diseases/diagnostic imaging , Lymphocyte Count , Oxygen/therapeutic use , Prognosis
6.
Nutrients ; 13(8)2021 Aug 23.
Article in English | MEDLINE | ID: covidwho-1367879

ABSTRACT

BACKGROUND: We previously reported that severe COVID-19 patients had higher chances of survival and a reduced risk of developing respiratory failure when administered with the probiotic formulation SLAB51. This study aimed to investigate further bacteriotherapy mechanisms and how early they are activated. METHODS: We performed an analysis on the blood oxygenation parameters collected in sixty-nine severe COVID-19 patients requiring non-invasive oxygen therapy and presenting a CT lung involvement ≥50%. Twenty-nine patients received low-molecular-weight heparin, azithromycin and Remdesivir. In addition, forty subjects received SLAB51. Blood gas analyses were performed before the beginning of treatments and at 24 h. RESULTS: The patients receiving only standard therapy needed significantly increased oxygen amounts during the 24 h observation period. Furthermore, they presented lower blood levels of pO2, O2Hb and SaO2 than the group also supplemented with oral bacteriotherapy. In vitro data suggest that SLAB51 can reduce nitric oxide synthesis in intestinal cells. CONCLUSIONS: SARS-CoV-2 infected patients may present lesions in the lungs compromising their gas exchange capability. The functionality of the organs essential for these patients' survival depends mainly on the levels of pO2, O2Hb and SaO2. SLAB51 contains enzymes that could reduce oxygen consumption in the intestine, making it available for the other organs.


Subject(s)
COVID-19/therapy , Oxygen/therapeutic use , Probiotics/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Aged , Alanine/analogs & derivatives , Alanine/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , Blood Gas Analysis , Cell Line , Female , Heparin , Humans , Hypoxia , Italy , Lung , Male , Middle Aged , Prospective Studies
7.
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
8.
J Asthma ; 58(8): 1128-1131, 2021 08.
Article in English | MEDLINE | ID: covidwho-1317831

ABSTRACT

Seven species of coronavirus cause acute respiratory illness in humans. Coronavirus HKU 1 (CoV HKU 1) was first described in 2005 in an adult patient with pneumonia in Hong Kong. Although it is a well-known respiratory tract pathogen, there is not much information about its role in hospitalized adults, especially in southern Europe. Here, we describe a case of radiologically demonstrated CoV HKU 1-related bronchiolitis with acute respiratory failure in an adult female without significant comorbidities except obesity.


Subject(s)
Bronchiolitis/etiology , Coronavirus Infections/complications , Coronavirus , Pericardial Effusion/etiology , Respiratory Insufficiency/etiology , Anti-Bacterial Agents/therapeutic use , Bronchiolitis/therapy , Bronchodilator Agents/therapeutic use , Ceftriaxone/therapeutic use , Coronavirus Infections/therapy , Female , Humans , Methylprednisolone/therapeutic use , Middle Aged , Obesity, Morbid/therapy , Oxygen/therapeutic use , Pericardial Effusion/therapy , Respiratory Insufficiency/therapy
9.
Am J Trop Med Hyg ; 105(3): 727-730, 2021 07 16.
Article in English | MEDLINE | ID: covidwho-1317304

ABSTRACT

Intensive care is expensive, and availability is limited. Low- and middle-income countries in particular have struggled to cope with the large influx of critically ill patients during the COVID-19 pandemic. Noninvasive respiratory support devices delivering continuous positive airways pressure (CPAP) require less resource and staff expertise compared with invasive mechanical ventilators and can be routinely used outside of intensive care units. This study assessed the use of the UCL-Ventura Wayrachi CPAP device in hospitalized patients with COVID-19 in Peru. A secondary analysis of data collected for a feasibility study commissioned by the Peruvian Ministry of Health was conducted. Data were collected from three hospitals, including patient demographics, clinical data, and outcomes. Forty-five patients were enrolled from July 16 to September 1, 2020. Eight patients (18%) were intolerant of the CPAP mask. Of the remainder, 18 (48.7%) improved and were discharged from hospital after 6 days. Eight (21.6%) died while on CPAP and 11 (29.7%) were eventually intubated, of whom two died. In total, 27 (60%) survived to hospital discharge. Participating physicians noted the device was easy to use and provided patient benefit, though voiced concerns about the strain on hospital oxygen supplies. In conclusion, the UCL Ventura Wayrachi CPAP device proved feasible in COVID-19 patients in Peru, and offered a bridging therapy for patients who required a ventilator when none were available.


Subject(s)
COVID-19/therapy , Continuous Positive Airway Pressure , Noninvasive Ventilation , Oxygen/therapeutic use , SARS-CoV-2 , Adult , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged , Young Adult
10.
Strahlenther Onkol ; 197(11): 1010-1020, 2021 11.
Article in English | MEDLINE | ID: covidwho-1298545

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of lung low-dose radiation therapy (LD-RT) for pneumonia in patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Inclusion criteria comprised patients with COVID-19-related moderate-severe pneumonia warranting hospitalization with supplemental O2 and not candidates for admission to the intensive care unit because of comorbidities or general status. All patients received single lung dose of 0.5 Gy. Respiratory and systemic inflammatory parameters were evaluated before irradiation, at 24 h and 1 week after LD-RT. Primary endpoint was increased in the ratio of arterial oxygen partial pressure (PaO2) or the pulse oximetry saturation (SpO2) to fractional inspired oxygen (FiO2) ratio of at least 20% at 24 h with respect to the preirradiation value. RESULTS: Between June and November 2020, 36 patients with COVID-19 pneumonia and a mean age of 84 years were enrolled. Seventeen were women and 19 were men and all of them had comorbidities. All patients had bilateral pulmonary infiltrates on chest X­ray. All patients received dexamethasone treatment. Mean SpO2 pretreatment value was 94.28% and the SpO2/FiO2 ratio varied from 255 mm Hg to 283 mm Hg at 24 h and to 381 mm Hg at 1 week, respectively. In those who survived (23/36, 64%), a significant improvement was observed in the percentage of lung involvement in the CT scan at 1 week after LD-RT. No adverse effects related to radiation treatment have been reported. CONCLUSIONS: LD-RT appears to be a feasible and safe option in a population with COVID-19 bilateral interstitial pneumonia in the presence of significant comorbidities.


Subject(s)
COVID-19/radiotherapy , Radiotherapy, Conformal/methods , SARS-CoV-2 , Aged , Aged, 80 and over , Anti-Inflammatory Agents/therapeutic use , C-Reactive Protein/analysis , COVID-19/diagnostic imaging , COVID-19/mortality , COVID-19/therapy , Cause of Death , Combined Modality Therapy , Comorbidity , Dexamethasone/therapeutic use , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/analysis , Hospital Mortality , Humans , Interleukin-6/blood , L-Lactate Dehydrogenase/blood , Lung/diagnostic imaging , Lung/radiation effects , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/radiotherapy , Lung Diseases, Interstitial/therapy , Male , Oxygen/blood , Oxygen/therapeutic use , Oxygen Inhalation Therapy , Partial Pressure , Prospective Studies , Radiotherapy Dosage , Severity of Illness Index , Tomography, X-Ray Computed , Treatment Outcome
11.
Aging (Albany NY) ; 12(12): 11224-11237, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-1251837

ABSTRACT

With the outbreak of coronavirus disease-19 (COVID-19), Changsha faced an increasing burden of treating the Wuhan migrants and their infected patients. This study is a retrospective, single-center case series of the 238 consecutive hospitalized patients with confirmed COVID-19 at the First Hospital of Changsha city, China, from 01/21 to 02/14, 2020; the final date of follow-up was 02/27, 2020. Of 238 patients 43.7% visited Wuhan, 58.4% got in touch with Wuhan people, and 47.5% had contacted with diagnosed patients. 37.8% patients had family members infected. 190 cases had mild / general disease, and 48 cases had severe / critical disease. Compared to mild or general patients, more severe or critical patients visited Wuhan (59.6% vs 40.2%; P=0.02) and contacted with Wuhan people (74.5% vs 55.0%; P=0.02). All patients received antiviral treatment, including Lopinavir / Ritonavir (29.3%), Interferon (14.6%) and their combination (40.6%), Arbidol (6.7%), Xuebijing (7.1%) and Chloroquine phosphate (1.3%). Severe and critical patients received glucocorticoid, Gamma-globulin and oxygen inhalation. Some received mechanic ventilation support. As of 02/27, 161 patients discharged. The median length of hospital stay was 13 days. The 10-, 14-, 20- and 28-day discharge rate was 19.1%, 42.8%, 65.0% and 76.4%, respectively. No hospital-related transmission was observed.


Subject(s)
Antiviral Agents/therapeutic use , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Respiration, Artificial , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19 , China/epidemiology , Chloroquine/analogs & derivatives , Chloroquine/therapeutic use , Drug Combinations , Drugs, Chinese Herbal/therapeutic use , Female , Glucocorticoids/therapeutic use , Hospitalization , Humans , Immunologic Factors/therapeutic use , Indoles/therapeutic use , Interferons/therapeutic use , Lopinavir/therapeutic use , Male , Middle Aged , Oxygen/therapeutic use , Pandemics , Retrospective Studies , Ritonavir/therapeutic use , SARS-CoV-2 , gamma-Globulins/therapeutic use
12.
Acad Radiol ; 28(8): 1151-1158, 2021 08.
Article in English | MEDLINE | ID: covidwho-1240127

ABSTRACT

RATIONALE AND OBJECTIVES: The clinical prognosis of outpatients with coronavirus disease 2019 (COVID-19) remains difficult to predict, with outcomes including asymptomatic, hospitalization, intubation, and death. Here we determined the prognostic value of an outpatient chest radiograph, together with an ensemble of deep learning algorithms predicting comorbidities and airspace disease to identify patients at a higher risk of hospitalization from COVID-19 infection. MATERIALS AND METHODS: This retrospective study included outpatients with COVID-19 confirmed by reverse transcription-polymerase chain reaction testing who received an ambulatory chest radiography between March 17, 2020 and October 24, 2020. In this study, full admission was defined as hospitalization within 14 days of the COVID-19 test for > 2 days with supplemental oxygen. Univariate analysis and machine learning algorithms were used to evaluate the relationship between the deep learning model predictions and hospitalization for > 2 days. RESULTS: The study included 413 patients, 222 men (54%), with a median age of 51 years (interquartile range, 39-62 years). Fifty-one patients (12.3%) required full admission. A boosted decision tree model produced the best prediction. Variables included patient age, frontal chest radiograph predictions of morbid obesity, congestive heart failure and cardiac arrhythmias, and radiographic opacity, with an internally validated area under the curve (AUC) of 0.837 (95% CI: 0.791-0.883) on a test cohort. CONCLUSION: Deep learning analysis of single frontal chest radiographs was used to generate combined comorbidity and pneumonia scores that predict the need for supplemental oxygen and hospitalization for > 2 days in patients with COVID-19 infection with an AUC of 0.837 (95% confidence interval: 0.791-0.883). Comorbidity scoring may prove useful in other clinical scenarios.


Subject(s)
COVID-19 , Deep Learning , Oxygen/therapeutic use , Adult , COVID-19/diagnostic imaging , COVID-19/therapy , Female , Hospitalization , Humans , Male , Middle Aged , Radiography, Thoracic , Retrospective Studies
13.
JAMA Netw Open ; 4(4): e213990, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1162459

ABSTRACT

Importance: To optimize patient outcomes and preserve critical acute care access during the COVID-19 pandemic, the Los Angeles County Department of Health Services developed the SAFE @ HOME O2 Expected Practice (expected practice), enabling ambulatory oxygen management for COVID-19. Objective: To assess outcomes of patients with COVID-19 pneumonia discharged via the expected practice approach to home or quarantine housing with supplemental home oxygen. Design, Setting, and Participants: This retrospective cohort study included 621 adult patients with COVID-19 pneumonia who were discharged from 2 large urban public hospitals caring primarily for patients receiving Medicaid from March 20 to August 19, 2020. Patients were included in the analysis cohort if they received emergency or inpatient care for COVID-19 and were discharged with home oxygen. Interventions: Patients receiving at least 3 L per minute of oxygen, stable without other indication for inpatient care, were discharged from either emergency or inpatient encounters with home oxygen equipment, educational resources, and nursing telephone follow-up within 12 to 18 hours of discharge. Nurses provided continued telephone follow up as indicated, always with physician back-up. Main Outcomes and Measures: All-cause mortality and all-cause 30-day return admission. Results: A total of 621 patients with COVID-19 pneumonia (404 male [65.1%] and 217 female [34.9%]) were discharged with home oxygen. Median age of these patients was 51 years (interquartile range, 45-61 years), with 149 (24.0%) discharged from the emergency department and 472 (76%) discharged from inpatient encounters. The all-cause mortality rate was 1.3% (95% CI, 0.6%-2.5%) and the 30-day return hospital admission rate was 8.5% (95% CI, 6.2%-10.7%) with a median follow-up time of 26 days (interquartile range, 15-55 days). No deaths occurred in the ambulatory setting. Conclusions and Relevance: In this cohort study, patients with COVID-19 pneumonia discharged on home oxygen had low rates of mortality and return admission within 30 days of discharge. Ambulatory management of COVID-19 with home oxygen has an acceptable safety profile, and the expected practice approach may help optimize outcomes, by ensuring right care in the right place at the right time and preserving access to acute care during the COVID-19 pandemic.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Home Care Services , Oxygen/therapeutic use , Pandemics , Patient Discharge , Patient Readmission , Ambulatory Care , Critical Care , Emergency Service, Hospital , Female , Health Care Rationing , Humans , Length of Stay , Male , Middle Aged , Oxygen Inhalation Therapy , Quarantine , Retrospective Studies , SARS-CoV-2
14.
Am J Case Rep ; 22: e929948, 2021 Mar 09.
Article in English | MEDLINE | ID: covidwho-1168168

ABSTRACT

BACKGROUND The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which manifests mainly as a respiratory condition, has become a global pandemic that causes coronavirus disease-2019 (COVID-19). Although the symptoms remain mild in most patients, the elderly and patients with previous comorbidities have higher rates of morbidity and mortality. Patients with liver cirrhosis, especially after decompensation, may be more susceptible to SARS-CoV-2 infection due to systemic immune dysfunction. CASE REPORT The patient was a 51-year-old man who was hypertensive, an ex-alcoholic abstinent for 6 months, and a smoker. He was diagnosed with alcoholic liver cirrhosis in July 2019, and was using norfloxacin at home for secondary prophylaxis of bacterial peritonitis. He was also using furosemide and spironolactone to control ascites and propranolol for primary prophylaxis of esophageal varices. The patient entered our hospital in July 2020 with cough, dyspnea, runny nose, diarrhea, and fever. During hospitalization, we confirmed infection by COVID-19 and secondary nosocomial pulmonary infection. Chest tomography compatible with ground-glass standard was performed. The patient developed the need for auxiliary oxygen but without invasive mechanical ventilation. The patient received dexamethasone 6 mg/day and broad-spectrum antibiotic therapy (he was started on cefepime but switched to meropenem). At the end of the 14-day isolation period, he was discharged with improved respiratory status. CONCLUSIONS Despite high mortality rates in patients with advanced cirrhosis who become infected with COVID-19, we report a case with a favorable outcome. Success has been achieved with the use of medications in studies of broad-spectrum antibiotics and the rapid detection of complications caused by the virus. Further studies in SARS-CoV-2 patients with chronic liver disease are needed.


Subject(s)
COVID-19/diagnosis , COVID-19/therapy , Liver Cirrhosis, Alcoholic/complications , Anti-Bacterial Agents/therapeutic use , Cough , Dexamethasone/therapeutic use , Diarrhea , Dyspnea , Fever , Hospitalization , Humans , Male , Middle Aged , Oxygen/therapeutic use , Smokers
15.
Endocr J ; 68(7): 849-856, 2021 Jul 28.
Article in English | MEDLINE | ID: covidwho-1150573

ABSTRACT

At the current time of rising demand for hospital beds, it is important to triage COVID-19 patients according to the treatment needed during hospitalization. The need for oxygen therapy is an important factor determining hospital admission of these patients. Our retrospective study was designed to identify risk factors associated with the progression to oxygen requirement in COVID-19 patients. A total of 133 patients with laboratory-confirmed COVID-19 were admitted to our hospital from February 22, 2020, to August 23. After excluding asymptomatic, non-Japanese, pediatric, pregnant patients and also those who needed oxygen immediately at admission, data of the remaining 84 patients were analyzed. The patients were separated into those who required oxygen after admission and those who did not, and their characteristics were compared. Age, body mass index (BMI), lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase, estimated glomerular filtration rate, glucose intolerance, hypertension, and dyslipidemia were significantly different between the two groups. Multivariate analysis identified four significant and independent risk factors of oxygen requirement, including advanced age, obesity, glucose intolerance and lymphocytopenia. Dividing the patients into subgroups according to the number of these risk factors found in each patient indicated that the need for oxygen increased with higher number of these risk factors in the same individual. Our results suggest that the presence of higher number of these risk factors in COVID-19 patients is associated with future oxygen requirement and that this index can be potentially useful in triaging COVID-19 patients staying home in the context of need for hospitalization.


Subject(s)
COVID-19/complications , Glucose Intolerance/complications , Lymphopenia/complications , Obesity/complications , Oxygen/therapeutic use , Respiratory Distress Syndrome/etiology , Adult , Age Factors , Aged , Aged, 80 and over , Aging/physiology , Body Mass Index , COVID-19/epidemiology , COVID-19/pathology , COVID-19/therapy , Cohort Studies , Female , Glucose Intolerance/epidemiology , Hospitalization/statistics & numerical data , Humans , Japan/epidemiology , Lymphopenia/epidemiology , Male , Middle Aged , Obesity/epidemiology , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index , Young Adult
16.
Braz J Anesthesiol ; 71(3): 292-294, 2021.
Article in English | MEDLINE | ID: covidwho-1144515

ABSTRACT

Catatonic patients may develop deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged periods of immobility. These life-threatening conditions demand prompt recognition and management. We describe the case of a patient with catatonia who presented to anesthesia for electroconvulsive therapy (ECT) at the outset of the current coronavirus disease 2019 pandemic. She complained of breathing difficulty and was suspected to have COVID-19 infection. On further evaluation, she was found to have DVT and PE and required oxygen therapy and intensive care management. The diagnostic delay in our patient would have probably not occurred, had it not been for the existing pandemic situation.


Subject(s)
COVID-19/diagnosis , Catatonia/complications , Delayed Diagnosis , Electroconvulsive Therapy , Pulmonary Embolism/diagnosis , Venous Thrombosis/diagnosis , Anesthesia , Catatonia/therapy , Diagnosis, Differential , Female , Humans , Middle Aged , Oxygen/therapeutic use , Pulmonary Embolism/therapy , Tomography, X-Ray Computed , Venous Thrombosis/therapy
17.
Cancer Biol Med ; 17(3): 519-527, 2020 08 15.
Article in English | MEDLINE | ID: covidwho-1068173

ABSTRACT

A novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread across the world, prompting the World Health Organization to declare the coronavirus disease of 2019 (COVID-19) a public health emergency of international concern. Cancer patients are regarded as a highly vulnerable population to SARS-CoV-2 infection and development of more severe COVID-19 symptoms, which is possibly due to the systemic immunosuppressive state caused directly by tumor growth and indirectly by effects of anticancer treatment. Currently, much effort has been directed toward studying the pathogenesis and treatment of COVID-19, but the risk profiles, prognoses, and treatment outcomes in cancer patients remain unclear. Based on the current literature, we summarize the risk profiles, clinical and biochemical characteristics, and therapy outcomes of COVID-19 infections in cancer patients. The challenges in the clinical care of cancer patients with COVID-19 are discussed. The goal of this review is to stimulate research to better understand the biological impact and prognoses of COVID-19 infections in cancer patients, thus facilitating improvement of the clinical management of these patients.


Subject(s)
COVID-19/complications , COVID-19/therapy , Neoplasms/complications , Neoplasms/immunology , Anti-Inflammatory Agents/therapeutic use , Antineoplastic Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , Disease Progression , Female , Humans , Immunization, Passive , Immunocompromised Host/immunology , Immunoglobulins, Intravenous/therapeutic use , Male , Neoplasms/therapy , Neoplasms/virology , Oxygen/therapeutic use , Prognosis , Risk Assessment , Risk Factors , SARS-CoV-2/genetics , Severity of Illness Index
18.
Wounds ; 32(11): 294-298, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1063724

ABSTRACT

INTRODUCTION: Calciphylaxis is a rare, highly morbid pathological syndrome of vascular calcification and tissue necrosis. It is predominantly seen in patients with end-stage renal disease (ESRD) on chronic dialysis. There is no definitive standard of care for calciphylaxis, and the overall prognosis for patients, particularly those with ulcerated lesions, is bleak. One important role of wound care clinicians during the COVID-19 pandemic is to ensure that the continuity of care of an at-risk population is maintained while limiting the patient's potential exposure to the virus. Innovative therapies paired with alternative treatment sites of service are one such method. CASE REPORT: A 56-year-old female with ESRD on at-home peritoneal dialysis (PD) presented to the outpatient wound clinic with a punch biopsy-proven calciphylaxis lesion. Within days, state-wide "shelter-at-home" orders due to the COVID-19 pandemic went into effect. To prevent disruption in care and to minimize risk to the patient, the lesion was treated with bi-weekly self-application of a continuous topical oxygen therapy (cTOT) device paired with weekly telemedicine visits. The wound completely resolved after 9 weeks of topical oxygen therapy with no complications or device malfunctions. CONCLUSIONS: This case, to the authors' knowledge, is the first to document healing in a calciphylaxis wound with the use of cTOT. Topical oxygen therapy may be a beneficial adjunctive therapy in the treatment of wounds caused by calciphylaxis. Finding creative ways to navigate this current health care crisis is essential to help mitigate risk for vulnerable patients with advanced comorbidities.


Subject(s)
COVID-19/complications , Calciphylaxis/therapy , Oxygen/therapeutic use , Peritoneal Dialysis/adverse effects , Wounds and Injuries/therapy , Administration, Topical , Calciphylaxis/complications , Calciphylaxis/etiology , Female , Humans , Middle Aged , Oxygen/administration & dosage , Quarantine , Wound Healing , Wounds and Injuries/etiology
19.
PLoS Negl Trop Dis ; 15(1): e0009051, 2021 01.
Article in English | MEDLINE | ID: covidwho-1067384

ABSTRACT

BACKGROUND: Until now, no antiviral treatment has been proven to be effective for the coronavirus disease 2019 (COVID-19). The timing of oxygen therapy was considered to have a great influence on the symptomatic relief of hypoxemia and seeking medical intervention, especially in situations with insufficient medical resources, but the evidence on the timing of oxygen therapy is limited. METHODS AND FINDINGS: Medical charts review was carried out to collect the data of hospitalized patients with COVID-19 infection confirmed in Tongji hospital, Wuhan from 30th December 2019 to 8th March 2020. In this study, the appropriate timing of oxygen therapy and risk factors associated with severe and fatal illness were identified and the effectiveness of antivirus on disease progression was assessed. Among 1362 patients, the prevalence of hypoxia symptoms was significantly higher in those patients with severe and fatal illness than in those with less severe disease. The onset of hypoxia symptoms was most common in the second to third week after symptom onset, and patients with critical and fatal illness experienced these symptoms earlier than those with mild and severe illness. In multivariable analyses, the risk of death increased significantly when oxygen therapy was started more than 2 days after hypoxia symptoms onset among critical patients (OR, 1.92; 95%CI, 1.20 to 3.10). Compared to the critically ill patients without IFN-a, the patients who were treated with IFN-a had a lower mortality (OR, 0.60; 95%CI, 0.39 to 0.91). CONCLUSIONS: Early initiation of oxygen therapy was associated with lower mortality among critical patients. This study highlighted the importance of early oxygen therapy after the onset of hypoxia symptoms. Our results also lend support to potentially beneficial effects of IFNα on critical illness.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/therapy , Oxygen/therapeutic use , Adolescent , Adult , Aged , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/pathology , China/epidemiology , Critical Illness/epidemiology , Disease Progression , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Young Adult
20.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 03.
Article in English | MEDLINE | ID: covidwho-1060455

ABSTRACT

The novel coronavirus (SARS-CoV-2) has distinct clinical manifestations that can vary from an asymptomatic condition to severe acute respiratory failure. Phenotypes are attributable to different pathophysiological mechanisms and require different treatment strategies. The assessment and identification of different phenotypes can guide therapy configurations such as oxygen therapy, non-invasive ventilation, airway management, and tracheal intubation. Further studies are essential to provide information on the influence of phenotypes in the decision of rehabilitation strategies. The sequelae left in the respiratory system of COVID-19 survivors and its limitations will be a challenge for rehabilitation services worldwide. Lung injuries are directly related to the phenotypes presented, and depending on the degree of these injuries, rehabilitation strategies can be targeted. We believe that differentiating patients, according to their respective phenotypes, can improve decision-making in treatment and individualized rehabilitation.


Subject(s)
COVID-19/epidemiology , COVID-19/rehabilitation , Physical and Rehabilitation Medicine/methods , SARS-CoV-2/genetics , Airway Management/methods , COVID-19/therapy , COVID-19/virology , Clinical Decision-Making , Humans , Intubation, Intratracheal/methods , Noninvasive Ventilation/methods , Oxygen/therapeutic use , Phenotype , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/therapy , Severe Acute Respiratory Syndrome/virology
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