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1.
J Clin Endocrinol Metab ; 105(8)2020 08 01.
Article in English | MEDLINE | ID: covidwho-621873

ABSTRACT

CONTEXT: The potential for endocrine care via telemedicine has been recognized since the early 2000s when clinical outcome data demonstrated improvements in glycemic control with telemedicine. The widespread use of telemedicine during the COVID-19 pandemic has pushed telemedicine beyond diabetes care and into clinical areas with a paucity of published data. The evaluation and treatment of thyrotoxicosis heavily relies on laboratory assessment and imaging with physical exam playing a role to help differentiate the etiology and assess the severity of thyrotoxicosis. CASE DESCRIPTION: We describe a patient presenting for evaluation of new thyrotoxicosis via telemedicine, and describe modifications to consider for thorough, safe evaluation via telemedicine. CONCLUSION: Telemedicine may be an ideal way to assess and treat patients with thyrotoxicosis who are not able to physically attend a visit with an endocrinologist but still have access to a laboratory for blood draws. Potential challenges include access to imaging and high-volume surgeons if needed. Clinical and economic outcomes of telemedicine care of thyrotoxicosis should be studied so that standards of care for endocrine telemedicine can be established.


Subject(s)
Coronavirus Infections/prevention & control , Endocrinology/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Symptom Assessment/methods , Telemedicine/methods , Thyrotoxicosis/diagnosis , Adult , Betacoronavirus , Female , Humans
2.
Eur Respir J ; 56(2)2020 08.
Article in English | MEDLINE | ID: covidwho-744959

ABSTRACT

BACKGROUND: Timely diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a prerequisite for treatment and prevention. The serology characteristics and complement diagnosis value of the antibody test to RNA test need to be demonstrated. METHOD: Serial sera of 80 patients with PCR-confirmed coronavirus disease 2019 (COVID-19) were collected at the First Affiliated Hospital of Zhejiang University, Hangzhou, China. Total antibody (Ab), IgM and IgG antibodies against SARS-CoV-2 were detected, and the antibody dynamics during the infection were described. RESULTS: The seroconversion rates for Ab, IgM and IgG were 98.8%, 93.8% and 93.8%, respectively. The first detectible serology marker was Ab, followed by IgM and IgG, with a median seroconversion time of 15, 18 and 20 days post exposure (d.p.e.) or 9, 10 and 12 days post onset (d.p.o.), respectively. The antibody levels increased rapidly beginning at 6 d.p.o. and were accompanied by a decline in viral load. For patients in the early stage of illness (0-7 d.p.o), Ab showed the highest sensitivity (64.1%) compared with IgM and IgG (33.3% for both; p<0.001). The sensitivities of Ab, IgM and IgG increased to 100%, 96.7% and 93.3%, respectively, 2 weeks later. When the same antibody type was detected, no significant difference was observed between enzyme-linked immunosorbent assays and other forms of immunoassays. CONCLUSIONS: A typical acute antibody response is induced during SARS-CoV-2 infection. Serology testing provides an important complement to RNA testing in the later stages of illness for pathogenic-specific diagnosis and helpful information to evaluate the adapted immunity status of patients.


Subject(s)
Betacoronavirus , Clinical Laboratory Techniques , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Adult , Aged , China , Coronavirus Infections/complications , Female , Hospitalization , Humans , Infectious Disease Incubation Period , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Sensitivity and Specificity , Seroconversion , Symptom Assessment , Time Factors , Viral Load
4.
J Bras Nefrol ; 42(2 suppl 1): 44-46, 2020 Aug 26.
Article in English, Portuguese | MEDLINE | ID: covidwho-740466

ABSTRACT

INTRODUCTION: Palliative care is an approach aimed at relieving suffering, controlling symptoms and seeking to improve quality of life. It must be offered in conjunction with standard treatment for any disease that threatens the continuation of life, such as a Covid-19 infection. DISCUSSION: The bioethical principles and strategies used by palliative medicine can assist nephrologists in the care of patients with renal dysfunction, who face the difficulties of isolation at the beginning and follow-up of dialysis in outpatient treatment, and those who are at risk for a more serious disease progress. Some of them: - a Shared decision making, which enables the patient and family to participate as facilitators in the systematization of the team's reasoning, in addition to respecting the principle of autonomy; - Symptom Management: which should be a priority to ensure relief of suffering even in times of social isolation; - Communication skills: making it possible to alleviate suffering in announcing bad news or complex decisions through communication techniques;; - Bereavement assistance: which in acute situations such as the pandemic, causing unexpected losses, the importance of sympathy from healthcare professionals becomes even greater. CONCLUSION: The principles of palliative care are essential to face the challenges of a planet-wide crisis, which raises human suffering in all dimensions, and which requires the construction of strategies that can keep patients assisted, comfortable and with measures proportional to their clinical condition and preferences.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Palliative Care/methods , Pneumonia, Viral/epidemiology , Renal Replacement Therapy/standards , Bereavement , Communication , Decision Making, Shared , Humans , Nephrology/standards , Pandemics , Renal Replacement Therapy/methods , Symptom Assessment/methods
5.
J Bras Nefrol ; 42(2 suppl 1): 36-40, 2020 Aug 26.
Article in English, Portuguese | MEDLINE | ID: covidwho-740464

ABSTRACT

During the Covid-19 pandemic, the issue is how to maintain adequate care for people with other diseases. In this document, the SBN Rare Diseases Committee (COMDORA) gives some guidelines on the care of patients with rare kidney diseases. These patients should follow the recommendations for the general population, bearing in mind that, as they have chronic kidney disease, they are included in the risk group for more serious outcomes if they develop Covid-19. Non-essential decision-making procedures should be postponed. In stable cases under appropriate treatment, we must choose to contact our patients remotely, using teleconsultations and home exam collections (if possible). In the presence of a symptom or sign of decompensation of the underlying disease, or infection with Sars-cov-2, advise the patient to seek medical assistance. The patient should not be waiting to get worse. Changes to the prescription should only be made on a scientific basis. Dosage suspension or change is not recommended, even in cases in which the patient needs to go to a center to receive his medication; in this case, the infusion center must follow the recommendations of the Ministry of Health. If the patient develops Covid-19 and uses any drugs, check the need for dose adjustment of the routine medications. Avoid the use of antimetabolics and anti-CD20 in patients with Covid-19, as they reduce viral clearance and predispose to bacterial infections. Contact between the patient and the medical team is essential; changes are recommended only with specialized medical guidance.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Kidney Diseases/therapy , Pneumonia, Viral/epidemiology , Rare Diseases/therapy , Brazil , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Drug Interactions , Humans , Pandemics , Patient Acceptance of Health Care , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Symptom Assessment
6.
J Bras Nefrol ; 42(2 suppl 1): 32-35, 2020 Aug 26.
Article in English, Portuguese | MEDLINE | ID: covidwho-740463

ABSTRACT

INTRODUCTION: The impact of the new coronavirus (SARS-COV-2) and its worldwide clinical manifestations (COVID-19) imposed specific regional recommendations for populations in need of specialized care, such as children and adolescents with kidney diseases, particularly in renal replacement therapies (RRT). We present the recommendations of the Brazilian Society of Nephrology regarding the treatment of pediatric patients with kidney diseases during the COVID-19 pandemic. METHODS: Articles and documents from medical societies and government agencies on specific recommendations for children on RRT in relation to COVID-19 as well as those focused on epidemiological aspects of this condition in Brazil Were evaluated and analyzed. RESULTS: We present recommendations on outpatient care, transportation to dialysis centers, peritoneal dialysis, hemodialysis, and kidney transplantation in children and adolescents during the COVID-19 pandemic in Brazil. DISCUSSION: Despite initial observations of higher mortality rates in specific age groups (the elderly) and with comorbidities (obese, diabetics, and those with cardiovascular diseases), patients with chronic kidney disease (CKD) on RRT are particularly prone to develop COVID-19. Specific measures must be taken to reduce the risk of contracting SARS-CoV-2 and developing COVID-19, especially during transport to dialysis facilities, as well as on arrival and in contact with other patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Kidney Diseases/therapy , Pneumonia, Viral/epidemiology , Renal Replacement Therapy/standards , Adolescent , Ambulatory Care , Brazil/epidemiology , Child , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Hygiene/standards , Kidney Transplantation , Masks , Nephrology/standards , Occupational Diseases/prevention & control , Pandemics/prevention & control , Patient Isolation , Pediatrics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Renal Replacement Therapy/methods , Societies, Medical , Symptom Assessment , Transportation of Patients
7.
J Bras Nefrol ; 42(2 suppl 1): 15-17, 2020 Aug 26.
Article in English, Portuguese | MEDLINE | ID: covidwho-740460

ABSTRACT

Dialysis units are environments potentially prone to the spread of Covid-19. Patients cannot suspend treatment, and they often have comorbidities, which assigns them a higher risk and worse prognosis. The Brazilian Society of Nephrology prepared this document of good practices, whose technical recommendations deal with general measures that can be implemented to reduce the risk of transmission and prevent the spread of the disease in the unit.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Renal Dialysis/standards , Urology Department, Hospital/standards , Brazil , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disinfection/methods , Disinfection/standards , Humans , Masks , Nephrology/standards , Patient Isolation/methods , Patient Isolation/standards , Personal Protective Equipment , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Renal Insufficiency, Chronic , Societies, Medical/standards , Symptom Assessment
8.
J Bras Nefrol ; 42(2 suppl 1): 12-14, 2020 Aug 26.
Article in English, Portuguese | MEDLINE | ID: covidwho-740459

ABSTRACT

Patients with Chronic Kidney Disease are among those individuals at increased risk for developing more serious forms of Covid-19. This increased risk starts in the pre-dialysis phase of the disease. Providing useful information for these patients, in language that facilitates the understanding of the disease, can help nephrologists and other healthcare professionals to establish a more effective communication with these patients and help minimize contagion and the risks of serious illness in this population.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Patient Education as Topic/standards , Pneumonia, Viral/prevention & control , Renal Insufficiency, Chronic/complications , Activities of Daily Living , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Elective Surgical Procedures , Hand Hygiene/methods , Hand Hygiene/standards , Health Facilities , Health Personnel , Humans , Nephrology/standards , Personal Space , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Renal Dialysis , Risk Factors , Symptom Assessment
9.
Medicine (Baltimore) ; 99(35): e21810, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-740205

ABSTRACT

RATIONALE: The clinical manifestations of the SARS-CoV-2 infection are mainly respiratory but the virus can cause a variety of symptoms. Dermatological findings are less well-characterized. Data is scarce on their timing, type and correlation with the immune response. PATIENT CONCERNS: We present the case of SARS-CoV-2 infection in a previously healthy woman who presented with respiratory symptoms and developed anosmia, diarrhea, and an erythematous maculo-papular rash on day 15 from symptom onset. DIAGNOSIS: The nasopharyngeal swab tested by real time PCR for COVID-19 was positive. We interpreted this as a viral exanthema likely caused by an immune response to SARS-CoV-2 nucleotides. INTERVENTIONS: She was treated with Hydroxychloroquine, Azithromycin and Lopinavir/Ritonavir, and the rash with topical corticosteroids. OUTCOMES: All symptoms resolved except for anosmia which persisted for 6 weeks. At the 4- and 6-weeks follow-up the IgG titers for SARS-CoV-2 were high. LESSONS: We must consider that SARS-CoV-2 has a multi-organ tropism. In our case, the SARS-CoV-2 infection had lung, nasopharyngeal, neurological, digestive, and skin manifestations. Identifying the different manifestations is useful for understanding the extent of SARS-CoV-2 infection. We not only present a rare manifestation but also suggest that cutaneous manifestations may correlate with immunity.


Subject(s)
Azithromycin/administration & dosage , Betacoronavirus , Coronavirus Infections , Exanthema , Glucocorticoids/administration & dosage , Hydroxychloroquine/administration & dosage , Lopinavir/administration & dosage , Pandemics , Pneumonia, Viral , Ritonavir/administration & dosage , Administration, Topical , Adult , Antiviral Agents/administration & dosage , Betacoronavirus/immunology , Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Drug Combinations , Exanthema/diagnosis , Exanthema/drug therapy , Exanthema/etiology , Exanthema/immunology , Female , Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Symptom Assessment/methods , Treatment Outcome
10.
Medicine (Baltimore) ; 99(35): e21699, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-740199

ABSTRACT

The aim of this study was to survey the prevalence of dry eye symptoms (DES) among doctors and nurses in the period of 2019, novel coronavirus (COVID-19) outbreak.To evaluate the DES of doctors and nurses worked at front-line hospitals with protective glasses for a mean time of 4 to 6 hours, a questionnaire developed by the researchers with the Ocular Surface Disease Index (OSDI) was used. These data were evaluated using descriptive statistics and correlation test with SPSS 22.0.The study included 13 doctors and 40 nurses, among which 16 were male and 37 were female, and the mean age of the participants was 32.43 ±â€Š5.15 years old. According to the OSDI scores, 64.15, 24.52, 7.54, and 3.77% of the participants experienced occasional, mild, moderate, and severe DES, respectively. The factors significantly correlated with OSDI scores were age and duration of wearing protective glasses, while the duration of wearing protective glasses may be a protective factor of dry eye symptoms.Our study showed that most of the doctors and nurses worked at the front-line of combating COVID-19 did not experience DES, while the symptoms of those who experienced DES might be improved by wearing protective glasses.


Subject(s)
Coronavirus Infections , Dry Eye Syndromes , Eye Protective Devices , Infection Control , Occupational Exposure/prevention & control , Pandemics , Pneumonia, Viral , Adult , Age Factors , Betacoronavirus , China , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Cross-Sectional Studies , Dry Eye Syndromes/diagnosis , Dry Eye Syndromes/etiology , Dry Eye Syndromes/prevention & control , Female , Humans , Infection Control/instrumentation , Infection Control/methods , Male , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Severity of Illness Index , Surveys and Questionnaires , Symptom Assessment , Time Factors
11.
Medicine (Baltimore) ; 99(33): e21618, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-740197

ABSTRACT

BACKGROUND: Coronavirus disease 2019, (COVID-19) is a major problem in public health in the world. Up to June, 2020, the number of infections arising to 8,690,000 and cause 410,000 deaths all over the world. Identification the clinical symptoms from non-severe to severe is important for clinician. This meta-analysis aimed to compare the clinical symptoms between severe and non-severe COVID-19 pneumonia. METHODS: Electronic databases including PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure database, Wanfang Database and Chinese Biomedical Literature Database were searched from its inception to June 21, 2020. We only included severe versus non-severe COVID-19 pneumonia patients and pooled results were summarized by STATA 12.0 software.Two researchers independently selected the study and assessed the quality of the included studies. The heterogeneity was measured by I tests (I < 50 indicates little heterogeneity, I≥50 indicates high heterogeneity). Publication bias was ruled out by funnel plot and statistically assessed by Begg test (P > .05 as no publication bias). RESULTS: Results will be published in relevant peer-reviewed journals. CONCLUSION: Our study aims to systematically present the clinical symptoms between non-severe and severe of COVID-19 patients, which will be provide clinical guidance for COVID-19 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Severity of Illness Index , Symptom Assessment/methods , Cohort Studies , Female , Humans , Male , Meta-Analysis as Topic , Pandemics , Randomized Controlled Trials as Topic , Research Design , Systematic Reviews as Topic
12.
Crit Care Nurs Q ; 43(4): 338-342, 2020.
Article in English | MEDLINE | ID: covidwho-729214

ABSTRACT

COVID-19 is caused by the coronavirus known as SARS-CoV2. This virus may lead to asymptomatic cases, mild illness, or acute respiratory distress syndrome. Here we describe the epidemiology, pathophysiology, transmission, and symptoms of the virus.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/transmission , Symptom Assessment
13.
JMIR Public Health Surveill ; 6(3): e19399, 2020 08 13.
Article in English | MEDLINE | ID: covidwho-713604

ABSTRACT

BACKGROUND: Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of cases of coronavirus disease (COVID-19) in the United States has exponentially increased. Identifying and monitoring individuals with COVID-19 and individuals who have been exposed to the disease is critical to prevent transmission. Traditional contact tracing mechanisms are not structured on the scale needed to address this pandemic. As businesses reopen, institutions and agencies not traditionally engaged in disease prevention are being tasked with ensuring public safety. Systems to support organizations facing these new challenges are critically needed. Most currently available symptom trackers use a direct-to-consumer approach and use personal identifiers, which raises privacy concerns. OBJECTIVE: Our aim was to develop a monitoring and reporting system for COVID-19 to support institutions conducting monitoring activities without compromising privacy. METHODS: Our multidisciplinary team designed a symptom tracking system after consultation with experts. The system was designed in the Georgetown University AvesTerra knowledge management environment, which supports data integration and synthesis to identify actionable events and maintain privacy. We conducted a beta test for functionality among consenting Georgetown University medical students. RESULTS: The symptom tracker system was designed based on guiding principles developed during peer consultations. Institutions are provided access to the system through an efficient onboarding process that uses clickwrap technology to document agreement to limited terms of use to rapidly enable free access. Institutions provide their constituents with a unique identifier to enter data through a web-based user interface to collect vetted symptoms as well as clinical and epidemiologic data. The website also provides individuals with educational information through links to the COVID-19 prevention recommendations from the US Centers for Disease Control and Prevention. Safety features include instructions for people with new or worsening symptoms to seek care. No personal identifiers are collected in the system. The reporter mechanism safeguards data access so that institutions can only access their own data, and it provides institutions with on-demand access to the data entered by their constituents, organized in summary reports that highlight actionable data. Development of the system began on March 15, 2020, and it was launched on March 20, 2020. In the beta test, 48 Georgetown University School of Medicine students or their social contacts entered data into the system from March 31 to April 5, 2020. One of the 48 users (2%) reported active COVID-19 infection and had no symptoms by the end of the monitoring period. No other participants reported symptoms. Only data with the unique entity identifier for our beta test were generated in our summary reports. CONCLUSIONS: This system harnesses insights into privacy and data sharing to avoid regulatory and legal hurdles to rapid adaption by entities tasked with maintaining public safety. Our pilot study demonstrated feasibility and ease of use. Refinements based on feedback from early adapters included release of a Spanish language version. These systems provide technological advances to complement the traditional contact tracing and digital tracing applications being implemented to limit SARS-CoV-2 transmission during reopening.


Subject(s)
Commerce/organization & administration , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health Surveillance/methods , Safety , Contact Tracing/economics , Coronavirus Infections/epidemiology , Feasibility Studies , Humans , Pilot Projects , Pneumonia, Viral/epidemiology , Privacy , Symptom Assessment , United States/epidemiology
15.
Medwave ; 20(6): e7950, 2020 Jul 02.
Article in Spanish, English | MEDLINE | ID: covidwho-696250

ABSTRACT

The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.


Subject(s)
Anesthesiology/standards , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Occupational Diseases/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Aerosols , Anesthesia, Conduction/methods , Anesthesia, Epidural/methods , Anesthesia, General/methods , Anesthesia, Spinal/methods , Anesthesiology/organization & administration , Betacoronavirus/genetics , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Elective Surgical Procedures , Humans , Intensive Care Units , Intubation, Intratracheal/methods , Intubation, Intratracheal/standards , Nerve Block/methods , Pandemics , Personal Protective Equipment , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Respiration, Artificial/methods , Respiration, Artificial/standards , Surgical Procedures, Operative , Symptom Assessment/methods
16.
MMWR Morb Mortal Wkly Rep ; 69(31): 1026-1030, 2020 Aug 07.
Article in English | MEDLINE | ID: covidwho-694883

ABSTRACT

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is spread from person to person (1-3). Quarantine of exposed persons (contacts) for 14 days following their exposure reduces transmission (4-7). Contact tracing provides an opportunity to identify contacts, inform them of quarantine recommendations, and monitor their symptoms to promptly identify secondary COVID-19 cases (7,8). On March 12, 2020, Maine Center for Disease Control and Prevention (Maine CDC) identified the first case of COVID-19 in the state. Because of resource constraints, including staffing, Maine CDC could not consistently monitor contacts, and automated technological solutions for monitoring contacts were explored. On May 14, 2020, Maine CDC began enrolling contacts of patients with reported COVID-19 into Sara Alert (MITRE Corporation, 2020),* an automated, web-based, symptom monitoring tool. After initial communication with Maine CDC staff members, enrolled contacts automatically received daily symptom questionnaires via their choice of e-mailed weblink, text message, texted weblink, or telephone call until completion of their quarantine. Epidemiologic investigations were conducted for enrollees who reported symptoms or received a positive SARS-CoV-2 test result. During May 14-June 26, Maine CDC enrolled 1,622 contacts of 614 COVID-19 patients; 190 (11.7%) eventually developed COVID-19, highlighting the importance of identifying, quarantining, and monitoring contacts of COVID-19 patients to limit spread. In Maine, symptom monitoring was not feasible without the use of an automated symptom monitoring tool. Using a tool that permitted enrollees to specify a method of symptom monitoring was well received, because the majority of persons monitored (96.4%) agreed to report using this system.


Subject(s)
Contact Tracing , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Epidemiological Monitoring , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Automation , Child , Child, Preschool , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Humans , Infant , Infant, Newborn , Maine/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Program Evaluation , Symptom Assessment/methods , Young Adult
18.
Acta Clin Belg ; 75(5): 348-356, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-684589

ABSTRACT

OBJECTIVES: To recognise clinical features of COVID-19 pneumonia and its differences from influenza pneumonia. METHODS: 246 patients were enrolled into COVID-19 cohort and 120 patients into influenza cohort. All data were collected and analysed retrospectively. The variables under focus included demographic, epidemiological, clinical, laboratory and imaging characteristics of COVID-19 pneumonia and comparison were made with influenza pneumonia. RESULTS: The COVID-19 cohort included 53.25% female and 46.75% male. Their main symptom was fever; while 28.05% of patients had only initially fever; 21.54% of them remained feverless. After excluding prior kidney diseases, some patients showed abnormal urinalysis (32.11%), elevated blood creatinine (15.04%) and blood urea nitrogen (19.11%). Typical CT features included ground glass opacity, consolidation and band opacity, which could present as characteristic 'bat wing sign'. Our data showed that male, aged 65 or above, smoking, with comorbidities including diabetes, cardiovascular and kidney diseases, would experience more severe COVID-19 pneumonia. In comparison, COVID-19 cohort showed significantly higher incidence of clustering; the influenza cohort showed higher rate of fever. Both cohorts showed reduced lymphocyte numbers; however, 6 influenza patients showed lymphocytes increased, which was statistical significant compared with COVID-19 cohort. Also, influenza cohort displayed higher white blood cell counts and PCT values. CONCLUSION: There is no significant gender difference in the incidence of COVID-19 pneumonia. It predominantly affects the lung as well as the kidney. Age, smoking and comorbidities could contribute to disease severity. Although COVID-19 is more infectious, the rate of secondary bacterial infection is lower than influenza.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Influenza, Human/diagnosis , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Adolescent , Adult , Aged , Coronavirus Infections/complications , Diagnosis, Differential , Female , Humans , Influenza, Human/complications , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Retrospective Studies , Symptom Assessment , Tomography, X-Ray Computed , Young Adult
19.
Clin Transl Gastroenterol ; 11(7): e00215, 2020 07.
Article in English | MEDLINE | ID: covidwho-681344

ABSTRACT

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic of coronavirus disease 2019 (COVID-19) is a global health crisis. Possible pancreatic involvement has recently been observed in these patients; however, its significance is unclear. The aim of this study was to evaluate the association of significantly elevated lipase with disease outcomes. METHODS: Data about demographics, symptoms, laboratory values, and clinical outcomes were collected for 1,003 consecutive patients testing positive for COVID-19. Elevated lipase was defined as greater than 3 times the upper limit of normal (>3 × ULN). Baseline characteristics among patients with or without elevated lipase were compared using Fisher exact test or Student t-test for categorical or numerical variables, respectively. Logistic regression was used to evaluate the association of lipase levels with primary clinical outcomes (intensive care unit admission and intubation) adjusted for age, sex, body mass index, history of diabetes, and hypertension. RESULTS: Of 1,003 patients with COVID-19, 83 had available lipase levels and were all admitted to the hospital. Of 83, 14 (16.8%) had elevated lipase (>3 × ULN), which was associated with higher rates of leukocytosis (P < 0.001) and abnormal liver enzymes (P < 0.01). Compared with lower lipase levels (<3 × ULN), patients with elevated lipase had higher rates of ICU admission (92.9% vs 32.8%; P < 0.001) and intubation (78.6% vs 23.5%; P 0.002). In a multivariable-adjusted model, higher lipase levels were significantly associated with admission to the ICU and rate of intubation. DISCUSSION: Lipase elevation is seen in COVID-19 and is associated with worse disease outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections , Lipase/blood , Obesity , Pancreas , Pandemics , Pneumonia, Viral , Aged , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , Body Mass Index , Cohort Studies , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Female , Humans , Male , Middle Aged , Obesity/diagnosis , Obesity/epidemiology , Pancreas/metabolism , Pancreas/physiopathology , Pancreas/virology , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Risk Factors , Severity of Illness Index , Sex Factors , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , United States/epidemiology
20.
Neurologia ; 35(6): 357-362, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-680554

ABSTRACT

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.


Subject(s)
Algorithms , Betacoronavirus/isolation & purification , Coronavirus Infections/prevention & control , Immunosuppressive Agents/administration & dosage , Multiple Sclerosis/drug therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Ambulatory Care , Asymptomatic Diseases , Checklist , Clinical Laboratory Techniques , Contraindications, Drug , Coronavirus Infections/diagnosis , Disease Susceptibility , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Mass Screening/methods , Nasopharynx/virology , Pneumonia, Viral/diagnosis , Polymerase Chain Reaction , Pulse Therapy, Drug , Quarantine , Risk Assessment , Symptom Assessment , Telemedicine
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