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1.
BMC Anesthesiol ; 22(1): 46, 2022 02 14.
Article in English | MEDLINE | ID: covidwho-1690973

ABSTRACT

BACKGROUND: There are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected. METHODS: An observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020. RESULTS: A total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% (n = 91) with 40.4% (n = 21) and 51.9% (n = 70) in the SARS-CoV-2-negative and -positive groups, respectively (p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications (p < 0.01 and p = 0.1, respectively). DISCUSSION: When comparing SARS-COV-2-positive and -negative patients, no significant difference was found regarding the rate of postoperative complications, while baseline characteristics strongly impact these outcomes. This finding suggests that patients should be scheduled for anesthetic procedures based on their overall risk of postoperative complication, and not just based on their SARS-CoV-2 status.


Subject(s)
Anesthesia , COVID-19/complications , Aged , Anesthesia/adverse effects , Cohort Studies , Elective Surgical Procedures , Emergency Medical Services , Female , Humans , Male , Middle Aged , Perioperative Care , Postoperative Complications/epidemiology , Registries , Respiratory Tract Diseases/complications , Respiratory Tract Diseases/epidemiology , Risk Assessment , Risk Factors , Treatment Outcome
2.
Ital J Pediatr ; 47(1): 220, 2021 Nov 06.
Article in English | MEDLINE | ID: covidwho-1505868

ABSTRACT

Coronavirus disease 2019 (COVID-19) affects all components of the respiratory system, including the neuromuscular breathing apparatus, conducting and respiratory airways, pulmonary vascular endothelium, and pulmonary blood flow. In contrast to other respiratory viruses, children have less severe symptoms when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A minority of children experience a post-infectious inflammatory syndrome, the pathology and long-term outcomes of which are poorly understood. The reason for the lower burden of symptomatic disease in children is not yet clear, but several pathophysiological characteristics are postulated. The SARS-CoV-2 pandemic has brought distinct challenges to the care of children globally. Proper recommendations have been proposed for a range of non-asthmatic respiratory disorders in children, including primary ciliary dyskinesia and cystic fibrosis. These recommendations involve the continuation of the treatment during this period and ways to maintain stability. School closures, loss of follow-up visit attendance, and loss of other protective systems for children are the indirect outcomes of measures to mitigate the COVID-19 pandemic. Moreover, COVID-19 has reshaped the delivery of respiratory care in children, with non-urgent and elective procedures being postponed, and distancing imperatives have led to rapid scaling of telemedicine. The pandemic has seen an unprecedented reorientation in clinical trial research towards COVID-19 and a disruption in other trials worldwide, which will have long-lasting effects on medical science. In this narrative review, we sought to outline the most recent findings on the direct and indirect effects of SARS-CoV-2 pandemic on pediatric respiratory chronic diseases other than asthma, by critically revising the most recent literature on the subject.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/organization & administration , Delivery of Health Care/organization & administration , Respiratory Tract Diseases/therapy , Adolescent , COVID-19/prevention & control , COVID-19/transmission , Child , Child, Preschool , Chronic Disease , Humans , Infant , Infant, Newborn , Respiratory Tract Diseases/complications
3.
Pediatr Infect Dis J ; 40(9): e323-e332, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1358506

ABSTRACT

BACKGROUND: Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem. METHODS: Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution. RESULTS: SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS. CONCLUSIONS: COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.


Subject(s)
COVID-19/mortality , SARS-CoV-2/isolation & purification , Adolescent , COVID-19/complications , COVID-19/pathology , COVID-19/therapy , Child , Child, Preschool , Female , Gastroenteritis/complications , Humans , Infant , Infant, Newborn , Male , Respiration, Artificial , Respiratory Tract Diseases/complications , Seizures/complications , South Africa/epidemiology
6.
Ann Agric Environ Med ; 28(1): 27-43, 2021 Mar 18.
Article in English | MEDLINE | ID: covidwho-1156233

ABSTRACT

INTRODUCTION AND OBJECTIVE: The course of COVID-19 caused by the SARS-CoV-2 may be aggravated by bioaerosols containing other viruses, bacteria, and fungi, occurring mainly in the occupational environment. Hence, the diagnostics and treatment of COVID-19 should address such a possibility in the anamnesis, treatment and final recommendations for avoiding of adverse exposure. ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE: As SARS-CoV-2 attacks primarily the respiratory system and the severe manifestation of COVID-19 is interstitial pneumonia, diagnostics should include the following clinical and laboratory examinations: chest X-ray; high resolution computed tomography (HRCT); pulmonary function tests; arterial-blood gas test; genetic tests for the presence of SARS-CoV-2, in the future with the use of highly specific and sensitive nano-based biosensors; tests for the presence of specific immunity against the antigens of microorganisms causing other infectious or allergic pulmonary diseases (in the case of anamnestic indications). Because an universally accepted treatment for COVID-19 does not exist, the hitherto prescribed antiviral and immune-modulating drugs should be used be with caution. In many cases, a better alternative could be a safe supportive therapy, such as supplementation of the diet with probiotics, prebiotics, vitamins and microelements. SUMMARY: The most important preventive measures against COVID-19 should include: vaccination; the use of filter or surgical masks; disinfection and sterilization; maintaining of well-functioning ventilation and air conditioning systems; reduction of the community air pollution which has been identified as an important factor increasing the COVID-19 severity. In the choice of preventive measures, the above should be considered for their potential efficacy against other bioaerosols as potential disease-aggravating agents.


Subject(s)
COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/therapy , Aerosols/adverse effects , Humans , Occupational Diseases/complications , Occupational Diseases/prevention & control , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Respiratory Tract Diseases/complications , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
7.
Aging (Albany NY) ; 13(1): 27-60, 2020 12 31.
Article in English | MEDLINE | ID: covidwho-1068117

ABSTRACT

The COVID-19 pandemic causes severe morbidity and mortality. This multi-country study aimed to explore risk factors that drive mortality in COVID-19 patients who received neither dexamethasone nor remdesivir. We analyzed a cohort of 568 survivors and 507 non-survivors from China, European regions, and North America. Elderly males ≥70 years accounted for only 25% of survivors, but this rate was significantly higher in non-survivors from China (55%), European regions (63%), and North America (47%). Compared with survivors, non-survivors had more incidences of comorbidities such as cerebrovascular disease and chronic obstructive pulmonary disease (COPD, p-values<0.05). Survival analyses revealed age, male gender, shortness of breath, cerebrovascular disease, and COPD as mortality-associated factors. Survival time from symptom onset was significantly shorter in elderly versus young patients (median: 29 versus 62 days), males versus females (median: 46 versus 59 days), and patients with versus without comorbidities (mean: 41 versus 61 days). Mortality risk was higher in elderly males with comorbidities than in young females without comorbidities (p-value<0.01). Elderly male survivors with comorbidities also had longer hospital stays than other survivors (25 versus 18.5 days, p-value<0.01). Overall, the high mortality risk in elderly males with COVID-19-associated comorbidities supports early prevention and critical care for elderly populations.


Subject(s)
Aging , COVID-19/complications , COVID-19/mortality , Cardiovascular Diseases/complications , SARS-CoV-2 , Tuberculosis/complications , Adolescent , Adult , Aged , COVID-19/epidemiology , Cerebrovascular Disorders/complications , Child , Child, Preschool , Cohort Studies , Comorbidity , Female , Global Health , Humans , Infant , Liver Diseases/complications , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/complications , Respiratory Tract Diseases/complications , Risk Factors , Young Adult
8.
Chest ; 158(6): 2270-2274, 2020 12.
Article in English | MEDLINE | ID: covidwho-654747
9.
Nutrients ; 12(8)2020 Aug 18.
Article in English | MEDLINE | ID: covidwho-721514

ABSTRACT

The COVID-19 pandemic goes along with increased mortality from acute respiratory disease. It has been suggested that vitamin D3 supplementation might help to reduce respiratory disease mortality. We assessed the prevalence of vitamin D insufficiency and deficiency, defined by 25-hydroxyvitamin D (25(OH)D) blood levels of 30-50 and <30 nmol/L, respectively, and their association with mortality from respiratory diseases during 15 years of follow-up in a cohort of 9548 adults aged 50-75 years from Saarland, Germany. Vitamin D insufficiency and deficiency were common (44% and 15%, respectively). Compared to those with sufficient vitamin D status, participants with vitamin D insufficiency and deficiency had strongly increased respiratory mortality, with adjusted hazard ratios (95% confidence intervals) of 2.1 (1.3-3.2) and 3.0 (1.8-5.2) overall, 4.3 (1.3-14.4) and 8.5 (2.4-30.1) among women, and 1.9 (1.1-3.2) and 2.3 (1.1-4.4) among men. Overall, 41% (95% confidence interval: 20-58%) of respiratory disease mortality was statistically attributable to vitamin D insufficiency or deficiency. Vitamin D insufficiency and deficiency are common and account for a large proportion of respiratory disease mortality in older adults, supporting the hypothesis that vitamin D3 supplementation could be helpful to limit the burden of the COVID-19 pandemic, particularly among women.


Subject(s)
Cholecalciferol/administration & dosage , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Respiratory Tract Diseases/mortality , Vitamin D Deficiency/mortality , Vitamins/administration & dosage , Aged , Betacoronavirus , COVID-19 , Cohort Studies , Coronavirus Infections/blood , Coronavirus Infections/complications , Dietary Supplements , Female , Germany/epidemiology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Prevalence , Proportional Hazards Models , Respiratory Tract Diseases/blood , Respiratory Tract Diseases/complications , Risk Factors , SARS-CoV-2 , Vitamin D/analogs & derivatives , Vitamin D/blood , Vitamin D Deficiency/complications , Vitamin D Deficiency/therapy
10.
Int J Antimicrob Agents ; 55(5): 105950, 2020 May.
Article in English | MEDLINE | ID: covidwho-65371

ABSTRACT

Viral respiratory diseases such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) always pose a severe threat to people. First identified in late December 2019, a novel coronavirus (2019-nCoV; SARS-CoV-2) has affected many provinces in China and multiple countries worldwide. The viral outbreak has aroused panic and a public-health emergency around the world, and the number of infections continues to rise. However, the causes and consequences of the pneumonia remain unknown. To effectively implement epidemic prevention, early identification and diagnosis are critical to disease control. Here we scrutinise a series of available studies by global scientists on the clinical manifestations, detection methods and treatment options for the disease caused by SARS-CoV-2, named coronavirus disease 2019 (COVID-19), and also propose potential strategies for preventing the infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Respiratory Tract Diseases/complications , Betacoronavirus/chemistry , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Humans , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/chemistry
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