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1.
Medicine (Baltimore) ; 100(7): e24668, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1091183

ABSTRACT

ABSTRACT: We aimed to retrospectively analyze the clinical and computed tomography (CT) characteristics of young adults with Coronavirus Disease 2019 (COVID-19) pneumonia who were critically ill and to identify the features associated with non-survival.Thirty-eight COVID-19 patients (20-45 years old, 28 men) who had been admitted in the intensive care unit were included, including 18 non-survivors (group 1) and 20 survivors (group 2). Their clinical characteristics and initial and follow-up CT were compared between groups.In group 1, the days from illness onset to death were 21.1 ±â€Š10.3 days; 7 patients had underlying comorbidities. At admission, group 1 exhibited higher serum ferritin and interleukin-6 (IL-6) levels (1142.6 ±â€Š242.4 mg/L and 33.8 ±â€Š18.6 mmol/L) compared with group 2 (728.3 ±â€Š150.9 mg/L and 15.2 ±â€Š6.9 mmol/L, P < .01). Group 1 exhibited more rapidly progressive opacities and consolidation in follow-up CT (16.7 ±â€Š3.1 scores, 15.7 ±â€Š3.1 segments) than group 2 (11.4 ±â€Š4.0 scores, 10.3 ±â€Š4.6 segments, P < .01). The oxygenation index was lower (87.6 ±â€Š19.2 vs 99.1 ±â€Š20.4 mm Hg) and the mechanical ventilation duration was longer (14.7 ±â€Š6.9 vs 9.7 ±â€Š3.7 days) in group 1 compare with group 2 (P < .01).Compared with the survivors, the non-survivors showed higher serum ferritin and IL-6 levels, more rapidly progressive opacities in CT, lower oxygenation index, and longer mechanical ventilation durations. Special attention to ferritin/IL-6 levels and oxygenation index as well as early CT application and timely reexaminations are important to identify the individuals who may be at risk of becoming critically ill.


Subject(s)
/diagnosis , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Tomography, X-Ray Computed/methods , Adult , Critical Illness , Disease Progression , Female , Humans , Male , Pneumonia, Viral/virology , Retrospective Studies , Survival Analysis
2.
Rev. chil. pediatr ; 91(4): 623-630, ago. 2020.
Article in Spanish | LILACS (Americas) | ID: covidwho-1070235

ABSTRACT

Resumen: SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARS- CoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se en cuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gas trointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las caracte rísticas de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmón- intestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede per manecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enferme dad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.


Abstract: SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.


Subject(s)
Humans , Child , Pneumonia, Viral/complications , Coronavirus Infections/complications , Gastrointestinal Diseases/virology , Liver Diseases/virology , Pneumonia, Viral/diagnosis , Severity of Illness Index , Cytokines/metabolism , Coronavirus Infections/diagnosis , Peptidyl-Dipeptidase A/metabolism , Clinical Laboratory Techniques , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/physiopathology , Liver Diseases/diagnosis , Liver Diseases/physiopathology
3.
Rev. chil. pediatr ; 91(4): 623-630, ago. 2020.
Article in Spanish | LILACS (Americas) | ID: covidwho-1070104

ABSTRACT

Resumen: SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARS- CoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se en cuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gas trointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las caracte rísticas de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmón- intestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede per manecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enferme dad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.


Abstract: SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.


Subject(s)
Humans , Child , Pneumonia, Viral/complications , Coronavirus Infections/complications , Gastrointestinal Diseases/virology , Liver Diseases/virology , Pneumonia, Viral/diagnosis , Severity of Illness Index , Cytokines/metabolism , Coronavirus Infections/diagnosis , Peptidyl-Dipeptidase A/metabolism , Clinical Laboratory Techniques , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/physiopathology , Liver Diseases/diagnosis , Liver Diseases/physiopathology
4.
Iran J Allergy Asthma Immunol ; 19(5): 471-477, 2020 Oct 18.
Article in English | MEDLINE | ID: covidwho-1068113

ABSTRACT

The emergence of a highly pathogenic virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) accounts for severe pneumonia throughout the world. More than 7 million world population have been infected with SARS-CoV-2, and the number of deaths is increasing every day. This study aimed to evaluate the frequency of SARS-CoV-2 in hospitalized patients with an acute respiratory infection (ARI). During an outbreak of the SARS-CoV-2, the nasopharyngeal and oropharyngeal swabs were collected from 909 hospitalized patients with severe pneumonia, including 517 (56.9%) males and 392 (43.1%) females. All the collected samples were from different cities of Khuzestan province from 19 February to- 27 March 2020. The RNA was extracted from samples and subjected to real-time polymerase chain reaction (PCR) tests for the detection of the SARS-CoV-2. Simultaneously, the computerized tomography (CT) scan was tested for the presence of ground-glass opacity in the lung among the patients. Of the total number of 909 specimens, 328 (36.08%) cases, including 185 (20.35%) females and 143 (15.73%) males, were positive for the SARS-CoV-2 while, 581 (63.9%) cases, including 374 (41.14%) males and 207 (22.77%) were negative for the SARS-CoV-2 by real-time PCR (p=0.001).Four hundred sixteen (45.76%) cases were positive for ground-glass opacity in the lung by CT scan, while 328/909 (36.08%) trials proved positive for SARS-CoV-2 by the real-time PCR (p=0.003).  In this study, 36.08% of patients were positive for SARS-CoV-2. Although the results of positive cases by CT scan showed higher than real-time PCR, screening the SARS-COV-2 with a real-time PCR method is the first line of choice.


Subject(s)
/epidemiology , Hospitalization , Lung/diagnostic imaging , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , C-Reactive Protein/metabolism , Child , Child, Preschool , Female , Humans , Infant , Iran/epidemiology , Lymphopenia/epidemiology , Male , Middle Aged , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Prevalence , Severity of Illness Index , Tomography, X-Ray Computed , Young Adult
5.
Medwave ; 20(11)31-12-2020.
Article in English, Spanish | LILACS (Americas) | ID: covidwho-1067938

ABSTRACT

INTRODUCCIÓN: El SARS-CoV-2 tiene una rápida expansión por todo el mundo, sin embargo, su capacidad para causar enfermedad grave no es homogénea según sexo y edad. OBJETIVO: Determinar las características perinatales, morbilidad, mortalidad y resultados serológicos en neonatos de gestantes seropositivas para SARS-CoV-2. MÉTODOS: Estudio transversal, descriptivo y retrospectivo. Participaron todos los neonatos cuyas madres presentaron resultado seropositivo para SARS-CoV-2 antes del parto, entre el 15 de abril y 10 de mayo de 2020 en el Instituto Nacional Materno Perinatal de Perú. Se recogió información materna y neonatal a partir de sus historias clínicas. En el análisis se usó estadística descriptiva y prueba exacta de Fisher. RESULTADOS: Se identificaron 114 neonatos, el 36,8% presentó inmunoglobulinas M y G positivas para SARS-CoV-2; el 7% inmunoglobulinas G y 56,2% fue no reactivo. Las complicaciones obstétricas más frecuentes fueron rotura prematura de membranas (14,9%) y parto pretérmino (8,8%). El 8,8% de los neonatos presentaron un puntaje Apgar al minuto menor o igual a seis, y de ellos solo uno persistió a los cinco minutos; tres neonatos fallecieron. Se evidenció asociación entre el tipo de inmunoglobulina materna y la serología de su recién nacido (p < 0,05). No se observó asociación entre resultados perinatales y el tipo de inmunoglobulinas materna (p > 0,05), ni con los resultados serológicos en el neonato para SARS-CoV-2 (p > 0,05). CONCLUSIÓN: El 43,9% de neonatos de madre seropositiva a SARS-CoV-2 tuvo un resultado serológico positivo, siendo más frecuente de tipo Inmunoglobulinas M e Inmunoglobulinas G. El 10,5% de los neonatos presentó alguna morbilidad, siendo más frecuente prematuridad y bajo peso al nacer y el 2,6% falleció. Los resultados perinatales no estuvieron asociadas al tipo de inmunoglobulina de las madres seropositivas a SARS-CoV-2. De igual modo, los resultados perinatales no estuvieron asociados a los resultados serológicos en el neonato.


INTRODUCTION: SARS-CoV-2 has spread rapidly throughout the world. However, its ability to cause severe disease is not homogeneous according to sex and the different age groups. OBJECTIVE: To determine perinatal characteristics, morbidity, mortality, and serological results in neonates from seropositive pregnant women to SARS-CoV-2. METHODS: We did a retrospective, descriptive, cross-sectional study. We included all newborns from positive pregnant women to SARS-CoV-2, between April 15 and May 10, 2020, who delivered in the National Perinatal Maternal Institute of Peru. The study extracted maternal and neonatal variables collected from the medical charts. The data were analyzed using descriptive statistics and Fischer's exact test. RESULTS: One hundred fourteen neonates were identified, 36.8% IgM/IgG positive for SARS-CoV-2, 7% IgG, and 56.2% had negative serology. The obstetric complications were premature rupture of membranes (14.9%) and preterm birth (8,8%). 8.8% of newborns had an Apgar score of less than or equal to six minutes, and of those, only one persisted after five minutes; three newborns died. There was an association between the type of maternal immunoglobulin and the serology of the newborn (p < 0.05). No association was observed between perinatal results and maternal immunoglobulin type (p > 0.05) or serological results in the newborn for SARS-CoV-2 (p > 0.05). CONCLUSION: 43.9% of seropositive mothers' neonates to SARS-CoV-2 had a positive serological result, more frequently type IgM/IgG. 10.5% of the neonates had some morbidity, more frequent prematurity, low birth weight, and 2.6% died. Perinatal results were not associated with the type of immunoglobulin of mothers seropositive to SARS-CoV-2; similarly, perinatal results were not associated with serological results in the newborn.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Adolescent , Adult , Young Adult , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies , Clinical Laboratory Techniques
6.
J Transl Med ; 19(1): 29, 2021 01 07.
Article in English | MEDLINE | ID: covidwho-1059725

ABSTRACT

BACKGROUND: Limited data was available for rapid and accurate detection of COVID-19 using CT-based machine learning model. This study aimed to investigate the value of chest CT radiomics for diagnosing COVID-19 pneumonia compared with clinical model and COVID-19 reporting and data system (CO-RADS), and develop an open-source diagnostic tool with the constructed radiomics model. METHODS: This study enrolled 115 laboratory-confirmed COVID-19 and 435 non-COVID-19 pneumonia patients (training dataset, n = 379; validation dataset, n = 131; testing dataset, n = 40). Key radiomics features extracted from chest CT images were selected to build a radiomics signature using least absolute shrinkage and selection operator (LASSO) regression. Clinical and clinico-radiomics combined models were constructed. The combined model was further validated in the viral pneumonia cohort, and compared with performance of two radiologists using CO-RADS. The diagnostic performance was assessed by receiver operating characteristics curve (ROC) analysis, calibration curve, and decision curve analysis (DCA). RESULTS: Eight radiomics features and 5 clinical variables were selected to construct the combined radiomics model, which outperformed the clinical model in diagnosing COVID-19 pneumonia with an area under the ROC (AUC) of 0.98 and good calibration in the validation cohort. The combined model also performed better in distinguishing COVID-19 from other viral pneumonia with an AUC of 0.93 compared with 0.75 (P = 0.03) for clinical model, and 0.69 (P = 0.008) or 0.82 (P = 0.15) for two trained radiologists using CO-RADS. The sensitivity and specificity of the combined model can be achieved to 0.85 and 0.90. The DCA confirmed the clinical utility of the combined model. An easy-to-use open-source diagnostic tool was developed using the combined model. CONCLUSIONS: The combined radiomics model outperformed clinical model and CO-RADS for diagnosing COVID-19 pneumonia, which can facilitate more rapid and accurate detection.


Subject(s)
/methods , /diagnosis , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/diagnosis , Tomography, X-Ray Computed/methods , Adult , Aged , /statistics & numerical data , China/epidemiology , Female , High-Throughput Screening Assays/methods , High-Throughput Screening Assays/statistics & numerical data , Humans , Machine Learning , Male , Middle Aged , Models, Statistical , Nomograms , Pandemics , Pneumonia, Viral/epidemiology , Radiographic Image Interpretation, Computer-Assisted/methods , Radiographic Image Interpretation, Computer-Assisted/statistics & numerical data , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed/statistics & numerical data , Translational Medical Research
7.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1042105

ABSTRACT

We report the case of a man affected by cystic fibrosis who developed a severe SARS-CoV-2 related pneumonia in March 2020. In addition to lopinavir/ritonavir and hydroxychloroquine, he was treated with two doses of tocilizumab, displaying a significant clinical improvement. This is the first case described in the literature of an adult patient affected by cystic fibrosis who received tocilizumab for COVID-19, with documented total recovery, also assessed by a spirometry.


Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Cystic Fibrosis , Hydroxychloroquine/administration & dosage , Lopinavir/administration & dosage , Pneumonia, Viral , Respiratory Tract Infections/microbiology , Ritonavir/administration & dosage , /isolation & purification , Adult , Antiviral Agents/administration & dosage , /diagnosis , /physiopathology , Cystic Fibrosis/complications , Cystic Fibrosis/immunology , Cystic Fibrosis/physiopathology , Drug Combinations , Humans , Lung/diagnostic imaging , Lung/physiopathology , Male , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Pneumonia, Viral/etiology , Receptors, Interleukin-6/antagonists & inhibitors , Respiratory Function Tests/methods , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/etiology , Tomography, X-Ray Computed/methods , Treatment Outcome
9.
Jpn J Infect Dis ; 73(5): 377-380, 2020 Sep 24.
Article in English | MEDLINE | ID: covidwho-1034439

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a severe infectious disease of the respiratory tract caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2, and has a high mortality rate. The disease emerged from Wuhan, China, in late 2019, and spread to Japan, including Hokkaido, in January 2020. In February 2020, 3 children were diagnosed with COVID-19 in Furano, Hokkaido, Japan. During this period, influenza and human metapneumovirus infections were prevalent among children in the Furano region. Two of the 3 patients experienced co-infection with other respiratory viruses, including influenza virus A or human metapneumovirus. To the authors' knowledge, the cases described in the present report were the first pediatric patients with COVID-19 in Japan. In children with COVID-19, the possibility of co-infection with other respiratory pathogens should be considered.


Subject(s)
Coinfection/diagnosis , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Respiratory Tract Infections/diagnosis , Betacoronavirus/isolation & purification , Child , Child, Preschool , Coinfection/pathology , Coinfection/virology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Humans , Japan/epidemiology , Lung/diagnostic imaging , Lung/pathology , Male , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Respiratory Tract Infections/pathology , Respiratory Tract Infections/virology
14.
Medicine (Baltimore) ; 100(1): e24108, 2021 Jan 08.
Article in English | MEDLINE | ID: covidwho-1024160

ABSTRACT

BACKGROUND: This meta-analysis aimed to compare the clinical symptoms of COVID-19 pneumonia in children. METHODS AND ANALYSIS: Electronic databases including PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI) database, Wanfang Database, and Chinese Biomedical Literature Database (CBM) were searched from its inception to June 21, 2020. We only included studies that reported clinical symptoms of COVID pneumonia in children. Quality of the included studies was assessed by 2 authors. Pooled results were summarized by STATA 12.0 software.The heterogeneity was measured by I2 tests (I2 < 50 indicates little heterogeneity, I2≥50 indicates high heterogeneity). Publication bias was performed by funnel plot and statistically assessed by Begg test (P > .05 as no publication bias). RESULTS: Results will be shown as figures or tables. CONCLUSION: Our study aims to systematically present the clinical symptoms of COVID-19 pneumonia patients in children, so as to further provide guidance for clinical management.


Subject(s)
/diagnosis , Pneumonia, Viral/diagnosis , Research Design , Child , Humans , Meta-Analysis as Topic , Pneumonia, Viral/virology , Systematic Reviews as Topic
15.
Adv Ther ; 37(11): 4538-4548, 2020 11.
Article in English | MEDLINE | ID: covidwho-775209

ABSTRACT

The coronavirus disease (COVID-19) pandemic has highlighted the importance of reducing occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The reprocessing procedure for reusable flexible bronchoscopes (RFBs) involves multiple episodes of handling of equipment that has been used during an aerosol-generating procedure and thus is a potential source of transmission. Single-use flexible bronchoscopes (SUFBs) eliminate this source. Additionally, RFBs pose a risk of nosocomial infection transmission between patients with the identification of human proteins, deoxyribonucleic acid (DNA) and pathogenic organisms on fully reprocessed bronchoscopes despite full adherence to the guidelines. Bronchoscopy units have been hugely impacted by the pandemic with restructuring of pre- and post-operative areas, altered patient protocols and the reassessment of air exchange and cleaning procedures. SUFBs can be incorporated into these protocols as a means of improving occupational safety. Most studies on the efficacy of SUFBs have occurred in an anaesthetic setting so it remains to be seen whether they will perform to an acceptable standard in complex respiratory procedures such as transbronchial biopsies and cryotherapy. Here, we outline their potential uses in a respiratory setting, both during and after the current pandemic.


Subject(s)
Bronchoscopes/trends , Bronchoscopy/trends , Coronavirus Infections/diagnosis , Equipment Contamination/prevention & control , Pneumonia, Viral/diagnosis , Betacoronavirus , Disposable Equipment , Humans , Microbiological Techniques/trends , Pandemics
16.
J Nanobiotechnology ; 18(1): 130, 2020 Sep 10.
Article in English | MEDLINE | ID: covidwho-755216

ABSTRACT

Fast point-of-care (POC) diagnostics represent an unmet medical need and include applications such as lateral flow assays (LFAs) for the diagnosis of sepsis and consequences of cytokine storms and for the treatment of COVID-19 and other systemic, inflammatory events not caused by infection. Because of the complex pathophysiology of sepsis, multiple biomarkers must be analyzed to compensate for the low sensitivity and specificity of single biomarker targets. Conventional LFAs, such as gold nanoparticle dyed assays, are limited to approximately five targets-the maximum number of test lines on an assay. To increase the information obtainable from each test line, we combined green and red emitting quantum dots (QDs) as labels for C-reactive protein (CRP) and interleukin-6 (IL-6) antibodies in an optical duplex immunoassay. CdSe-QDs with sharp and tunable emission bands were used to simultaneously quantify CRP and IL-6 in a single test line, by using a single UV-light source and two suitable emission filters for readout through a widely available BioImager device. For image and data processing, a customized software tool, the MultiFlow-Shiny app was used to accelerate and simplify the readout process. The app software provides advanced tools for image processing, including assisted extraction of line intensities, advanced background correction and an easy workflow for creation and handling of experimental data in quantitative LFAs. The results generated with our MultiFlow-Shiny app were superior to those generated with the popular software ImageJ and resulted in lower detection limits. Our assay is applicable for detecting clinically relevant ranges of both target proteins and therefore may serve as a powerful tool for POC diagnosis of inflammation and infectious events.


Subject(s)
Biomarkers/analysis , C-Reactive Protein/analysis , Immunoassay/methods , Interleukin-6/analysis , Quantum Dots/chemistry , Sepsis/diagnosis , Antibodies/immunology , Betacoronavirus/isolation & purification , C-Reactive Protein/immunology , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Humans , Interleukin-6/immunology , Limit of Detection , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Point-of-Care Systems , Sepsis/metabolism , Software , Ultraviolet Rays
17.
Eur J Phys Rehabil Med ; 56(5): 652-657, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1024859

ABSTRACT

INTRODUCTION: This paper is the first update of the second edition of the rapid living systematic review on the latest scientific literature informing rehabilitation of patients with COVID-19 and/or describing consequences of the disease and its treatment, as they relate to limitations in functioning of rehabilitation interest. The aim of this study was to report data of a systematic search performed on papers published in July 2020. EVIDENCE ACQUISITION: The methodology described in the second edition of the rapid living systematic review was applied to search eligible papers included in the databases between July 1, 2020 and July 31, 2020. EVIDENCE SYNTHESIS: Eight-hundred-ninety-two papers were identified through database searching (after removal of duplicates); of these, only 23 studies were included. According to OCEBM 2011 Levels of Evidence Table, they were level 3 in 30.5% cases and level 4 in 69.5%. No RCT was found. Nineteen papers studied COVID-19 patients, assessed in the acute (10 studies), post-acute (8 studies) and chronic phase (one study). Four studies reported data on the impact of COVID-19 on subjects with pre-existing health conditions. CONCLUSIONS: The current literature production still focuses more on describing all the possible aspects and complications of the pathology than on interventions or new organization models to deal with it. Albeit evidence on handling COVID-19 from a rehabilitative point of view is improving each month, further studies are still mandatory to report the role of rehabilitation in this scenario.


Subject(s)
Coronavirus Infections/rehabilitation , Critical Illness/rehabilitation , Exercise Therapy/methods , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Severe Acute Respiratory Syndrome/rehabilitation , Adult , Aged , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Databases, Factual , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prognosis , Rehabilitation Centers/statistics & numerical data , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/epidemiology , Treatment Outcome
18.
Eur J Phys Rehabil Med ; 56(5): 642-651, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1024858

ABSTRACT

INTRODUCTION: This paper improves the methodology of the first edition of the rapid living systematic review started in April 2020, with the aim to gather and present the current evidence informing rehabilitation of patients with COVID-19 and/or describing the consequences due to the disease and its treatment. EVIDENCE ACQUISITION: The Cochrane methodology for a rapid living systematic review was applied. Primary research papers, published from 1 January to 30 June 2020, reporting patients' data, with no limits of study design were included. Studies were categorized for study design, research question, COVID-19 phase, limitations of functioning (disability) of rehabilitation interest and type of rehabilitation service involved. Methodological quality assessment was based on the Cochrane Risk of Bias tools, and the level of evidence table (OCEBM 2011) for all the other studies. EVIDENCE SYNTHESIS: Thirty-six, out of 3703 papers, were included. One paper was of level 2 (RCT), 7 were of level 3 (2 cohort studies, 2 cross-sectional studies and 3 case-control studies), and 28 papers of level 4 (descriptive studies); 61% of papers reported epidemiological data on clinical presentations, 5 investigated natural history/determining factors, 1 searched prevalence, 2 studies reported on intervention efficacy (though not on harms), and 5 studies looked at health service organization. CONCLUSIONS: Main issues emerging from the review: it is advised to test for COVID-19 people with neurological disorders presenting with symptom changes; dysphagia is a frequent complication after oro-tracheal intubation in COVID-19 patients admitted to the ICU; after discharge, COVID-19 survivors may report persistent restrictive ventilatory deficits regardless of disease severity; there is only sparse and low quality evidence concerning the efficacy of any rehabilitation intervention to promote functional recovery; a substantial increase in resource (staff and equipment) is needed for rehabilitation.


Subject(s)
Coronavirus Infections/rehabilitation , Critical Illness/rehabilitation , Exercise Therapy/methods , Pneumonia, Viral/rehabilitation , Rehabilitation Centers/statistics & numerical data , Respiratory Therapy/methods , Case-Control Studies , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Early Ambulation/methods , Female , Humans , Intensive Care Units/statistics & numerical data , Italy , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prognosis , Randomized Controlled Trials as Topic , Recovery of Function , Risk Assessment , Treatment Outcome
20.
Eur J Phys Rehabil Med ; 56(5): 633-641, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1024855

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial role in reducing disability in order to reintroduce patients in the community. AIM: The aim of this study is to characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit. DESIGN: Cross-sectional observational study. SETTING: Inpatients Rehabilitation Unit. POPULATION: Post-acute COVID-19 patients. METHODS: Demographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FiO2), partial pressure of oxygen (PaO2), FiO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2. RESULTS: We included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FiO2 (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters. CONCLUSIONS: Taken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients. CLINICAL REHABILITATION IMPACT: This study could provide an accurate description of COVID-19 sub-acute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.


Subject(s)
Coronavirus Infections/rehabilitation , Critical Illness/rehabilitation , Early Ambulation/methods , Pneumonia, Viral/rehabilitation , Rehabilitation Centers/statistics & numerical data , Aged , Aged, 80 and over , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Databases, Factual , Exercise Therapy/methods , Female , Follow-Up Studies , Humans , Intensive Care Units/statistics & numerical data , Italy , Male , Middle Aged , Pandemics/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Recovery of Function , Respiratory Therapy/methods , Treatment Outcome
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