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1.
PLoS One ; 16(3): e0248675, 2021.
Article in English | MEDLINE | ID: covidwho-1574573

ABSTRACT

BACKGROUND: In December 2019, a new disease named coronavirus disease 2019 (COVID-19) was occurred. Patients who are critically ill with COVID-19 are more likely to die, especially elderly patients. We aimed to describe the effect of age on the clinical and immune characteristics of critically ill patients with COVID-19. METHODS: We retrospectively included 32 patients with COVID-19 who were confirmed to have COVID-19 by the local health authority and who were admitted to the first affiliated hospital of Zhengzhou University in Zhengzhou, China between January 3 and March 20, 2020. Clinical information and experimental test data were retrospectively collected for the patients. The 32 patients in this study were all in a critical condition and were classified as severe, according to the guidelines of 2019-nCoV infection from the National Health Commission of the People's Republic of China. Data were compared between those <60 years old and ≥60 years old. RESULTS: Of 32 patients, 13 were under 60 years old, and 19 patients were ≥60 years old. The most common symptom among all patients upon admission was fever (93.8%, 30/32). Compared to younger patients, older patients exhibited increased comorbidities. Among patients who were 60 years and older, platelet count, direct bilirubin (DBIL), indirect bilirubin(IBIL), lactate dehydrogenase (LDH), B-type natriuretic peptide (BNP), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-10 (IL-10) were significantly higher than in younger patients who were less than 60 years old. CD4+ T lymphocytes, CD8+ T lymphocytes, and NKT lymphocytes were decreased, CD4+/CD8+ T lymphocytes were significantly increased in all 32 patients, while there were no evident differences between younger and older patients. The CURB-65 (confusion, urea, respiratory, rate, blood pressure plus age ≥65 years), Acute Physiology and Chronic Health Evaluation (APACHE) II and pH value were significantly higher in older patients than in patients who were under 60 years old. However, the PaO2 and PaO2:FiO2 were lower in older patients than the younger. Compared to patients under 60 years old, patients who were 60 years and older tended to develop ARDS (15 [78.9%] vs 5 [38.5%]), septic shock (7 [36.8%] vs 0 [0.0%]) and were more likely to receive mechanical ventilation (13 [68.4%] vs 3[23.1%]). Dynamic trajectories of seven laboratory parameters were tracked on days 1, 3, 5 and 7, and significant differences in lymphocyte count (P = 0.026), D-dimer (P = 0.010), lactate dehydrogenase (P = 0.000) and C-reactive protein (P = 0.000) were observed between the two age groups. CONCLUSIONS: A high proportion of critically ill patients were 60 or older. Furthermore, rapid disease progression was noted in elderly patients. Therefore, close monitoring and timely treatment should be performed in elderly COVID-19 patients.


Subject(s)
COVID-19/epidemiology , Age Factors , Aged , CD4-CD8 Ratio , COVID-19/blood , COVID-19/diagnosis , COVID-19/immunology , Critical Illness , Female , Humans , Immunity , Lymphocyte Count , Male , Middle Aged , Preliminary Data , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index
2.
Front Pharmacol ; 12: 610745, 2021.
Article in English | MEDLINE | ID: covidwho-1554748

ABSTRACT

Background: Pneumonia is a prevalent and complicated disease among adults, elderly people in particular, and the debate on the optimal Chinese herbal injections (CHIs) is ongoing. Our objective is to investigate the comparative effectiveness of various CHIs strategies for elderly patients with pneumonia. Methods: A comprehensive search strategy was executed to identify relevant randomized controlled trials (RCTs) by browsing through several databases from their inception to first, Feb 2020; All of the direct and indirect evidence included was rated by Network meta-analysis under a Bayesian framework. Results: We ultimately identified 34 eligible randomized controlled trials that involved 3,111 elderly participants and investigated 4 CHIs combined with Western medicine (WM) (Xiyanping injection [XYP]+WM, Yanhuning injection [YHN]+WM, Tanreqing injection [TRQ]+WM, Reduning injection [RDN]+WM), contributing 34 direct comparisons between CHIs. Seen from the outcome of Clinical effective rate and time for defervescence, patients taking medicine added with CHIs [Clinical effective rate, XYP + WM(Odd ratio (OR): 0.74, 95%Credible intervals (CrIs):0.55-0.98), YHN + WM(OR: 0.66, 95%CrI: 0.45-0.95), TRQ + WM(OR: 0.65, 95%CrI: 0.50-0.83), RDN + WM(OR: 0.60, 95%CrI: 0.40-0.89); Time for defervescence, YHN + WM(Mean difference (MD): -2.11, 95%CrI: -3.26 to -0.98), XYP + WM(MD: -2.06, 95%CrI: -3.08 to -1.09), RDN + WM(MD: -1.97, 95%CrI: -3.61 to -0.35), TRQ + WM(MD: -1.69, 95%CrI: -2.27 to -1.04)] showed statistically better effect compared with participants in the Control group (CG) who only took WM. Meanwhile, based on the time for disappearance of cough, 3 out of 4 CHIs [TRQ + WM(MD: -2.56, 95%CrI: -3.38 to -1.54), YHN + WM(MD: -2.36, 95%CrI: -3.86 to -1.00) and XYP + WM(MD: -2.21, 95%CrI: -3.72 to -1.10)] strategies indicated improvement of clinical symptoms. Only XYP + WM(MD -1.78, 95%CrI: -3.29 to -0.27) and TRQ + WM (MD: -1.71, 95%CrI: -2.71 to -0.73) could significantly shorten the time for disappearance of pulmonary rales. Conclusion: According to the statistical effect size (The surface under the cumulative ranking), we found that XYP + WM was presumably to be the preferable treatment for treating elderly patients with pneumonia compared with WM alone in terms of clinical effective rate. Our findings were based on very limited evidence and thus should be interpreted with caution. The application of the findings requires further research.

3.
World J Clin Cases ; 9(16): 3919-3926, 2021 Jun 06.
Article in English | MEDLINE | ID: covidwho-1554422

ABSTRACT

BACKGROUND: Open reduction and internal fixation (ORIF) is the traditional surgical treatment for patellar fractures, and unicompartmental knee arthroplasty (UKA), especially Oxford UKA, has been increasingly used in patients with medial knee osteoarthritis (OA). However, the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear. We present the case of a patient with a patellar fracture and anteromedial OA. CASE SUMMARY: We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA. She also experienced a recent left patellar fracture. ORIF and Oxford UKA were performed in a single stage. The patient showed excellent postoperative clinical results. CONCLUSION: ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.

4.
Mediterr J Rheumatol ; 31(Suppl 2): 259-267, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1543143

ABSTRACT

SARS-CoV-2 is a positive-sense single-stranded RNA virus that causes the COVID-19 infection. Spike proteins are the most important proteins found on its capsule using the host's ACE2 receptors to invade respiratory cells. The natural course of the COVID-19 infection is variable, from asymptomatic to severe and potentially fatal. A small percentage of the severely infected patients will end up in an intensive care unit for ventilatory support. Elderly male patients with pre-existing medical conditions and smokers are at a disproportionate high risk to develop severe complications. Studies have shown that deaths occur due to a dysregulated immune system that overreacts, producing a plethora of cytokines, leading to the so-called "cytokine storm" phenomenon. In this direction, many drugs that are used in the everyday practice of Rheumatologists have been used. Indeed, pro-inflammatory cytokines such as the IL-1 and IL-6 have been shown to be the pivotal cytokines expressed, and anti-cytokine treatment has been tried so far with various results. In addition, hydroxychloroquine, an antimalarial drug, has been shown to reduce COVID-19 symptoms. Other drugs have also been used, such as intravenous pulses of immunoglobulins, and colchicine. Robust clinical trials are needed in order to find the suitable treatment. Current data indicate that hydroxychloroquine and cytokine targeting therapies may prove helpful in the fight of SARS-CoV-2 in appropriately selected patients.

5.
Ann Surg ; 274(6): e829-e830, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1522435
6.
Influenza Other Respir Viruses ; 14(5): 530-540, 2020 09.
Article in English | MEDLINE | ID: covidwho-1452864

ABSTRACT

BACKGROUND: Influenza is an acute infection affecting all age groups; however, elderly patients are at an increased risk. We aim to describe the clinical characteristics and the circulation of influenza virus types in elderly patients admitted for severe acute respiratory infection (SARI) to a tertiary care hospital in Bucharest, Romania, part of the I-MOVE+ hospital network. METHODS: We conducted an active surveillance study at the National Institute for Infectious Diseases "Prof. Dr Matei Balș," Bucharest, Romania, during three consecutive influenza seasons: 2015/16, 2016/17, and 2017/18. All patients aged 65 and older admitted to our hospital for SARI were tested for influenza by PCR. RESULTS: A total of 349 eligible patients were tested during the study period, and 149 (42.7%) were confirmed with influenza. Most patients, 321 (92.5%) presented at least one underlying condition at the time of hospital admission, the most frequent being cardiovascular disease, 270 (78.3%). The main influenza viral subtype circulating in 2015/16 was A(H1N1)pdm09, followed by A(H3N2) in 2016/17 and B influenza in 2017/18. Case fatality was highest in the 2015/16 season (3.7%), 0% in 2016/17, and 1.0% in 2017/18. Vaccination coverage in elderly patients with SARI from our study population was 22 (6.3%) over the three seasons. CONCLUSIONS: Our study has highlighted a high burden of comorbidities in elderly patients presenting with SARI during winter season in Romania. The influenza vaccine coverage rate needs to be substantially increased in the elderly population, through targeted interventions.


Subject(s)
Influenza, Human/epidemiology , Sentinel Surveillance , Age Factors , Aged , Aged, 80 and over , Female , Hospitalization/statistics & numerical data , Humans , Influenza A Virus, H1N1 Subtype/genetics , Influenza A Virus, H1N1 Subtype/immunology , Influenza A Virus, H3N2 Subtype/genetics , Influenza A Virus, H3N2 Subtype/immunology , Influenza B virus/genetics , Influenza B virus/immunology , Influenza Vaccines/immunology , Male , Romania/epidemiology , Seasons , Tertiary Healthcare
8.
J Bone Joint Surg Am ; 102(12): e58, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-1409847

ABSTRACT

BACKGROUND: From February 20 to April 2020, the coronavirus SARS (severe acute respiratory syndrome)-CoV-2 spread in northern Italy, drastically challenging the care capacities of the national health care system. Unprepared for this emergency, hospitals have quickly reformulated paths of assistance in an effort to guarantee treatment for infected patients. Orthopaedic departments have been focused on elderly traumatology, especially the treatment of femoral neck fractures in patients with coronavirus disease-2019 (COVID-19). The purpose of the present study was to evaluate the orthopaedic management strategy for femoral fragility fractures in COVID-19-positive patients with the hypothesis that operative treatment may contribute to the overall stability of the patient. METHODS: Sixteen patients affected by proximal femoral fracture and a recent history of fever, shortness of breath, and desaturation were admitted to the emergency room. Thoracic computed tomography (CT) and oropharyngeal swabs confirmed that they were positive for COVID-19, requiring hospitalization and prophylaxis with low-molecular-weight heparin. RESULTS: Three patients died before surgery because of severe respiratory insufficiency and multiple-organ-failure syndrome. Ten patients underwent surgery on the day after admission, whereas 3 patients had suspended their use of direct thrombin inhibitors and needed surgery to be delayed until the third day after admission. In all patients except 1, we noted an improvement in terms of O2 saturation and assisted respiration. In 9 patients, hemodynamic and respiratory stability was observed at an average of 7 days postoperatively. Four patients who underwent surgical treatment died of respiratory failure on the first day after surgery (1 patient), the third day after surgery (2 patients), or the seventh day after surgery (1 patient). CONCLUSIONS: We noted a stabilization of respiratory parameters in 12 COVID-19-positive patients who underwent surgery treatment of proximal femoral fractures. We believe that in elderly patients with COVID-19 who have proximal femoral fractures, surgery may contribute to the overall stability of the patient, seated mobilization, improvement in physiological ventilation, and general patient comfort in bed. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Betacoronavirus , Coronavirus Infections/epidemiology , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/adverse effects , Frailty/complications , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , COVID-19 , Disease Outbreaks , Female , Femoral Fractures/mortality , Femoral Fractures/virology , Frailty/mortality , Hospitalization , Humans , Italy , Male , Pandemics , SARS-CoV-2
9.
Memo ; 14(1): 1-2, 2021.
Article in English | MEDLINE | ID: covidwho-1401094
11.
Sci Adv ; 7(1)2021 01.
Article in English | MEDLINE | ID: covidwho-1388432

ABSTRACT

Using AI, we identified baricitinib as having antiviral and anticytokine efficacy. We now show a 71% (95% CI 0.15 to 0.58) mortality benefit in 83 patients with moderate-severe SARS-CoV-2 pneumonia with few drug-induced adverse events, including a large elderly cohort (median age, 81 years). An additional 48 cases with mild-moderate pneumonia recovered uneventfully. Using organotypic 3D cultures of primary human liver cells, we demonstrate that interferon-α2 increases ACE2 expression and SARS-CoV-2 infectivity in parenchymal cells by greater than fivefold. RNA-seq reveals gene response signatures associated with platelet activation, fully inhibited by baricitinib. Using viral load quantifications and superresolution microscopy, we found that baricitinib exerts activity rapidly through the inhibition of host proteins (numb-associated kinases), uniquely among antivirals. This reveals mechanistic actions of a Janus kinase-1/2 inhibitor targeting viral entry, replication, and the cytokine storm and is associated with beneficial outcomes including in severely ill elderly patients, data that incentivize further randomized controlled trials.


Subject(s)
Antiviral Agents/pharmacology , Azetidines/pharmacology , COVID-19/mortality , Enzyme Inhibitors/pharmacology , Janus Kinases/antagonists & inhibitors , Liver/virology , Purines/pharmacology , Pyrazoles/pharmacology , SARS-CoV-2/pathogenicity , Sulfonamides/pharmacology , Adult , Aged , Aged, 80 and over , COVID-19/drug therapy , COVID-19/metabolism , COVID-19/virology , Cytokine Release Syndrome , Cytokines/metabolism , Drug Evaluation, Preclinical , Female , Gene Expression Profiling , Humans , Interferon alpha-2/metabolism , Italy , Janus Kinases/metabolism , Liver/drug effects , Male , Middle Aged , Patient Safety , Platelet Activation , Proportional Hazards Models , RNA-Seq , Spain , Virus Internalization/drug effects
12.
Eur J Prev Cardiol ; 28(1): 87-97, 2021 03 23.
Article in English | MEDLINE | ID: covidwho-1387867

ABSTRACT

Along with epidemiologic transitions of the global population, the burden of aortic stenosis (AS) is rapidly increasing and transcatheter aortic valve replacement (TAVR) has quickly spread; indeed, it is nowadays also employed in treating patients with AS at intermediate operative risk. Nonetheless, the less invasive interventional strategy still carries relevant issues concerning post-procedural optimal antithrombotic strategy, given the current indications provided by guidelines are not completely supported by evidence-based data. Geriatric patients suffer from high bleeding and thromboembolic risks, whose balance is particularly subtle due to the presence of concomitant conditions, such as atrial fibrillation and chronic kidney disease, that make the post-TAVR antithrombotic management particularly insidious. This scenario is further complicated by the lack of specific evidence regarding the 'real-life' complex conditions typical of the geriatric syndromes, thus, the management of such a heterogeneous population, ranging from healthy ageing to frailty, is far from being defined. The aim of the present review is to summarize the critical points and the most updated evidence regarding the post-TAVR antithrombotic approach in the geriatric population, with a specific focus on the most frequent clinical settings.


Subject(s)
Aortic Valve Stenosis/drug therapy , Aortic Valve Stenosis/surgery , COVID-19/complications , Fibrinolytic Agents/therapeutic use , Transcatheter Aortic Valve Replacement , Age Factors , Aged , Aortic Valve Stenosis/complications , Humans , Risk Factors
13.
Healthcare (Basel) ; 9(1)2020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1389338

ABSTRACT

In Poland, there is a lack of documented data on the use of medical and non-medical services by the elderly during the SARS-CoV-2 pandemic. The FIMA questionnaire assesses the use of medical and non-medical services by the elderly. The authors compared the demand for these services during the ongoing pandemic with similar months in 2017. It was confirmed that in the group of 61 surveyed elderly people, the number of individuals who had a medical visit decreased significantly in the three-month period. In the analyzed pandemic period, patients had significantly fewer visits to their general practitioner only. The pandemic had no significant impact on the use of other medical and non-medical services analyzed by FIMA. The limitations may include the small number of respondents, the relatively short period from the beginning of the pandemic covered by the survey, and the nature of the studied patients' diseases. Further observation of elderly patients' access to the abovementioned services can improve the efforts of governments and caregivers in this field, which is of particular importance in the group of chronically ill elderly patients.

14.
Int J Clin Pract ; 75(3): e13632, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1343867

ABSTRACT

BACKGROUND: The profiles of liver function abnormalities in COVID-19 patients need to be clarified. METHODS: In this retrospective study, consecutive COVID-19 patients over 60 years old in Renmin Hospital of Wuhan University from January 1 to February 6 were included. Data of demographics, clinical characteristics, comorbidities, laboratory tests, medications and outcomes were collected and analysed. Sequential alterations of serum alanine aminotransferase (ALT) were monitored. RESULTS: A total of 330 patients were included and classified into two groups with normal (n = 234) or elevated ALT (n = 96). There were fewer females (40.6% vs 54.7%, P = .020) and more critical cases (30.2% vs 19.2%, P = .026) in patients with elevated ALT compared with the normal group. Higher levels of bacterial infection indices (eg, white blood cell count, neutrophil count, C-reactive protein and procalcitonin) were observed in the elevated group. Spearman correlation showed that both ALT and AST levels were positively correlated with those indices of bacterial infection. No obvious effects of medications on ALT abnormalities were found. In patients with elevated ALT, most ALT elevations were mild and transient. 59.4% of the patients had ALT concentrations of 41-100 U/L, while only a few patients (5.2%) had high serum ALT concentrations above 300 U/L. ALT elevations occurred at 13 (10-17) days and recovered at 28 (18-35) days from disease onset. For most patients, the elevation of serum ALT levels occurred at 6-20 days after disease onset and reached their peak values within a similar time frame. The recovery of serum ALT levels to normal frequently occurred at 16-20 days or 31-35 days after disease onset. CONCLUSIONS: Liver function abnormalities were observed in 29.1% of elderly people COVID-19 patients, which were slightly and transient in most cases. Liver function abnormalities in COVID-19 may be correlated with bacterial infection.


Subject(s)
COVID-19 , Liver Diseases , Aged , Female , Humans , Liver , Liver Function Tests , Middle Aged , Retrospective Studies , SARS-CoV-2
16.
Geroscience ; 43(1): 19-29, 2021 02.
Article in English | MEDLINE | ID: covidwho-1290415

ABSTRACT

Coronavirus disease 2019 (COVID-19) has a high mortality in elderly patients with pre-existing cardiovascular diseases. The cellular receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the angiotensin-converting enzyme 2 (ACE2), thereby implicating a link between cardiovascular diseases and SARS-CoV-2 susceptibility. Aortic stenosis (AS) represents a chronic inflammatory state with severe cardiovascular complications in the elderly, a prime condition for COVID-19 mortality. The circulating ACE2 levels were measured in 111 patients with severe AS and compared to patients with hypertension and healthy individuals. About 4 times higher circulating ACE2 activity was found in patients with severe AS than in hypertensives or healthy individuals (88.3 ± 61.6., n = 111, 20.6 ± 13.4, n = 540, and 16.1 ± 7.4 mU/L, n = 46, respectively). Patients with severe AS were older than patients with hypertension (80 ± 6 years vs. 60 ± 15 years, P < 0.05). Serum ACE2 activity correlated negatively with the left ventricular ejection fraction, aortic root area, TAPSE, and positively with the right ventricular systolic pressure, cardiac diameters in patients with AS. In contrast, circulating ACE2 activity was independent of the blood pressure, peak flow velocity at the aortic root, kidney function (GFR), and inflammatory state (CRP). We found no effect of RAAS inhibitory drugs on the serum ACE2 activity in this group of patients. Our results illustrate circulating ACE2 as a potential interface between chronic inflammation, cardiovascular disease, and COVID-19 susceptibility. Elderly patients with AS have markedly elevated ACE2 levels together with altered left and right ventricular functions, which may pose higher risks during COVID-19. Our clinical data do not support a role for RAAS inhibitors in regulating circulating ACE2 levels.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Aged , Angiotensin-Converting Enzyme 2 , Biomarkers , Humans , Middle Aged , Peptidyl-Dipeptidase A , Renin-Angiotensin System , SARS-CoV-2 , Stroke Volume , Ventricular Function, Left
17.
Int J Infect Dis ; 106: 265-268, 2021 May.
Article in English | MEDLINE | ID: covidwho-1279605

ABSTRACT

INTRODUCTION: Use of hydroxychloroquine in patients with coronavirus disease 2019 (COVID-19) was widespread and uncontrolled until recently. Patients vulnerable to severe COVID-19 are at risk of hydroxychloroquine interactions with co-morbidities and co-medications contributing to detrimental, including fatal, adverse treatment effects. METHODS: A retrospective survey was undertaken of health conditions and co-medications of patients with COVID-19 who were pre-screened for enrolment in a randomized, double-blind, placebo-controlled hydroxychloroquine multi-centre trial. RESULTS: The survey involved 305 patients [median age 71 (interquartile range 59-81) years]. The majority of patients (n = 279, 92%) considered for inclusion in the clinical trial were not eligible, mainly due to safety concerns caused by health conditions or co-medications. The most common were QT-prolonging drugs (n = 188, 62%) and haematologic/haemato-oncologic diseases (n = 39, 13%) which prohibited the administration of hydroxychloroquine. In addition, 165 (54%) patients had health conditions and 167 (55%) patients were on co-medications that did not prohibit the use of hydroxychloroquine but had a risk of adverse interactions with hydroxychloroquine. The most common were diabetes (n = 86, 28%), renal insufficiency (n = 69, 23%) and heart failure (n = 58, 19%). CONCLUSION: The majority of hospitalized patients with COVID-19 had health conditions or took co-medications precluding safe treatment with hydroxychloroquine. Therefore, hydroxychloroquine should be administered with extreme caution in elderly patients with COVID-19, and only in clinical trials.


Subject(s)
COVID-19/drug therapy , Hydroxychloroquine/adverse effects , SARS-CoV-2 , Aged , Aged, 80 and over , Comorbidity , Contraindications, Drug , Drug Interactions , Female , Germany/epidemiology , Humans , Male , Middle Aged , Retrospective Studies
18.
J Prim Care Community Health ; 12: 21501327211025385, 2021.
Article in English | MEDLINE | ID: covidwho-1277898

ABSTRACT

BACKGROUND: Older adults often have atypical presentations of common diseases and COVID-19 is no exception. Presentations range from asymptomatic to overwhelming symptoms that result in hospitalization, intubation, or death. The number of COVID-19 related deaths among older adults in the outpatient practice during the peak of the pandemic is unclear. METHODS: The objective is to describe the COVID-19 status and clinical characteristics of patients in a Geriatrics Ambulatory Practice who died during the peak of the COVID-19 pandemic. Design: Retrospective chart review Participants: 54 adults age 65 years and older. Methods: COVID-19 status defined by positive test result and presumed COVID-19 status based upon clinical presentation. RESULTS: Out of 1200 active patients in the Geriatrics Ambulatory Practice, 54 (4.5%) died between January 1st, 2020 and June 30th, 2020. The study sample was 63% female, 33% Hispanic/Latino, 27% Black/African American, and 22% white. The mean (SD) age was 86(8.6) years, range (72-107 years). The most prevalent medical comorbidities in decreasing order of frequency were hypertension (88.9%), diabetes (51.9%), and cognitive impairment (51.9%). Nineteen (35%) were COVID-19 positive and 8 had presumed COVID-19. There were no statistically significant differences in age, gender, race/ethnicity, and medical comorbidities between the COVID-19 or presumed COVID-19 group compared to those with No COVID-19. CONCLUSION: Approximately 35% of Geriatric patients who died during the first 6 months of 2020 had confirmed COVID-19 and an additional 15% had presumed COVID-19. The actual number of COVID-19 related deaths among older adults in the ambulatory practice during the peak of the pandemic is difficult to estimate and likely underestimated.


Subject(s)
COVID-19 , Geriatrics , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2
20.
Med Hypotheses ; 153: 110622, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1270617

ABSTRACT

The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including initial viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic anti-blood clotting agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found hydroxychloroquine-based multidrug regimens were associated with a statistically significant > 60% reduction in mortality. Going forward, we conclude that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients e.g. LTF or ALF) has a reasonable probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus prior to symptoms worsening. Given the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of acute COVID-19 patients is a reasonable strategy to reduce the risks of hospitalization and death. If elderly high-risk patients in such congregated nursing home type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. The issue is timing of therapeutics, and we argue that early treatment before hospitalization, is the right time and can potentially save lives, especially among our higher-risk elderly populations hit hardest by severe illness and death from COVID-19. We must reiterate, we are talking about 'early' treatment before the disease is far along in the disease sequelae where the patient then needs hospitalization and aggressive interventions. We are referring to the initial days e.g. day one, post infection when symptoms emerge or there is strong clinical suspicion. This early therapeutic option deserves serious and urgent consideration by the medical establishment and respective decision-makers. Doctors must be allowed their clinical discretion in how they optimally treat their patients. Doctors must be brave and trust their skilled judgements and do all to save the lives of their patients. We therefore hypothesize that early outpatient ambulatory treatment, once initiated as soon as symptoms begin in high-risk positive persons, would significantly reduce hospitalizations and prevent deaths. Specifically, the provision of early multi-drug sequenced therapy with repurposed drugs will reduce hospitalization and death in elderly patients being cared for in long-term-care facilities. The most important implications of our hypothesis are: 1) hospitalizations and deaths would be reduced 2) transmission would be reduced due to the mitigation of symptoms and 3) recovery following infection and treatment provides for natural exposure immunity that is broad based, durable, and robust (helping towards natural immunity within the population). The end result is reduced strain on hospitals and systems that would allow for other non-COVID illnesses to receive care.


Subject(s)
COVID-19 , SARS-CoV-2 , Aged , Humans , Hydroxychloroquine , Nursing Homes , Outpatients
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