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2.
J Health Soc Sci ; 5(2): 231-240, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1989939

ABSTRACT

Recent media articles have suggested that women-led countries are doing better in terms of their responses to the COVID-19 pandemic. We examine an ensemble of public health metrics to assess the control of COVID-19 epidemic in women-versus men-led countries worldwide based on data available up to June 3. The median of the distribution of median time-varying effective reproduction number for women- and men-led countries were 0.89 and 1.14 respectively with the 95% two-sample bootstrap-based confidence interval for the difference (women - men) being [-0.34, 0.02]. In terms of scale of testing, the median percentage of population tested were 3.28% (women), 1.59% (men) [95% CI: (-1.29%, 3.60%)] with test positive rates of 2.69% (women) and 4.94% (men) respectively. It appears that though statistically not significant, countries led by women have an edge over countries led by men in terms of public health metrics for controlling the spread of the COVID-19 pandemic worldwide.

3.
Am J Med Case Rep ; 8(10): 350-357, 2020.
Article in English | MEDLINE | ID: covidwho-1989679

ABSTRACT

COVID-19 is a pandemic that started in Wuhan city, Hubei province in China in December 2019 and is associated with high morbidity and mortality. It is characterized by a heightened inflammatory and prothrombotic state that are known to cause various cardiovascular manifestations such as thromboembolism, acute coronary syndrome and stroke. We here present a 72-year-old woman with multiple cardiovascular risk factors and COVI 19 pneumonia who presented with acute ischemic stroke. She was also noted to have ST segment elevation myocardial infarction (STEMI) on the electrocardiogram however the imaging and clinical presentation was consistent with apical takotsubo cardiomyopathy. We here discuss the various pathophysiologic mechanisms by which COVID-19 can result in acute stroke. The patient likely developed takotsubo cardiomyopathy because of stroke and acute COVID-19 induced sympathetic stimulation and catecholamine surge. To the best of our knowledge this is the first case of apical variant of takotsubo cardiomyopathy in a COVID-19 report.

4.
J Matern Fetal Neonatal Med ; 35(15): 2965-2968, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1900901

ABSTRACT

BACKGROUND: COVID-19 has rapidly spread worldwide, with severe complications affecting particularly elderly and compromised subjects. Less information about COVID-19 in pregnancy has been reported so far in the literature. METHODS: Case series on pregnancies complicated by COVID-19. All cases were diagnosed at Bolognini Hospital, Seriate, Italy. These cases are presented to clarify the features of COVID-19 occurring in pregnancy. RESULTS: Four women had symptoms of COVID-19 during pregnancy or immediately after delivery. All cases were confirmed by oropharyngeal swab. All patients presented with fever and low saturation levels at the diagnosis. One case was transferred after diagnosis to a tertiary referral center and delivered the day after for worsening clinical conditions. In the other three cases, bilateral pneumonia was documented at the admission. Antithrombotic therapy was used in most cases. No cases of the infected neonate was reported. At 2 month follow-up, all patients were alive, three were asymptomatic while one presented neurological complication. One more case was described because suspicious for COVID-19, however, it was not confirmed by oropharyngeal swab. CONCLUSIONS: In pregnant women, the peripheral nervous system could be affected. No case of trans-placental passage was reported. The swab could be helpful in diagnosis. The antithrombotic therapy could play a role in the positive course of COVID-19 also in pregnant women.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Aged , COVID-19/complications , COVID-19/epidemiology , Disease Outbreaks , Female , Fibrinolytic Agents , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Placenta , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , SARS-CoV-2
5.
Crit Care Explor ; 2(9): e0218, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1795068

ABSTRACT

OBJECTIVES: To describe three coronavirus disease 2019 patients suffering from acute respiratory distress syndrome under venovenous extracorporeal membrane oxygenation therapy and tight anticoagulation monitoring presenting a novel pattern of multifocal brain hemorrhage in various degrees in all cerebral and cerebellar lobes. DESIGN: Clinical observation of three patients. Post mortem examinations. SETTING: Two ICUs at the University Hospital Erlangen. PATIENTS: Three patients (medium age 56.6 yr, two male with hypertension and diabetes, one female with no medical history) developed severe acute respiratory distress syndrome on the basis of a severe acute respiratory syndrome coronavirus 2 infection. All required mechanical ventilation and venovenous extracorporeal membrane oxygenation support. INTERVENTIONS: Clinical observation, CT, data extraction from electronic medical records, and post mortem examinations. MAIN RESULTS: We report on an unusual multifocal bleeding pattern in the white matter in three cases with severe acute respiratory distress syndrome due to coronavirus disease 2019 undergoing venovenous extracorporeal membrane oxygenation therapy. Bleeding pattern with consecutive herniation was found in CT scans as well as in neuropathologic post mortem examinations. Frequency for this unusual brain hemorrhage in coronavirus disease 2019 patients with extracorporeal membrane oxygenation therapy at our hospital is currently 50%, whereas bleeding events in extracorporeal membrane oxygenation patients generally occur at 10-15%. CONCLUSIONS: Multifocality and high frequency of the unusual white matter hemorrhage pattern suggest a coherence to coronavirus disease 2019. Neuropathological analyses showed circumscribed thrombotic cerebrovascular occlusions, which eventually led to microvascular and later on macrovascular disseminated bleeding events. However, signs of cerebrovascular inflammation could not be detected. Polymerase chain reaction analyses of brain tissue or cerebrospinal fluid remained negative. Increased susceptibility for fatal bleeding events should be taken into consideration in terms of systemic anticoagulation strategies in coronavirus disease 2019.

6.
Mediterr J Hematol Infect Dis ; 12(1): e2020046, 2020.
Article in English | MEDLINE | ID: covidwho-1792270

ABSTRACT

OBJECTIVES: This study aims to investigate, retrospectively, the epidemiological and clinical characteristics, laboratory results, radiologic findings, and outcomes of COVID-19 in patients with transfusion-dependent ß thalassemia major (TM), ß-thalassemia intermedia (TI) and sickle cell disease (SCD). DESIGN: A total of 17 Centers, from 10 countries, following 9,499 patients with hemoglobinopathies, participated in the survey. MAIN OUTCOME DATA: Clinical, laboratory, and radiologic findings and outcomes of patients with COVID-19 were collected from medical records and summarized. RESULTS: A total of 13 patients, 7 with TM, 3 with TI, and 3 with SCD, with confirmed COVID-19, were identified in 6 Centers from different countries. The overall mean age of patients was 33.7±12.3 years (range:13-66); 9/13 (69.2%) patients were females. Six patients had pneumonia, and 4 needed oxygen therapy. Increased C-reactive protein (6/10), high serum lactate dehydrogenase (LDH; 6/10), and erythrocyte sedimentation rate (ESR; 6/10) were the most common laboratory findings. 6/10 patients had an exacerbation of anemia (2 with SCD). In the majority of patients, the course of COVID-19 was moderate (6/10) and severe in 3/10 patients. A 30-year-old female with TM, developed a critical SARS-CoV-2 infection, followed by death in an Intensive Care Unit. In one Center (Oman), the majority of suspected cases were observed in patients with SCD between the age of 21 and 40 years. A rapid clinical improvement of tachypnea/dyspnea and oxygen saturation was observed, after red blood cell exchange transfusion, in a young girl with SCD and worsening of anemia (Hb level from 9.2 g/dl to 6.1g/dl). CONCLUSIONS: The data presented in this survey permit an early assessment of the clinical characteristics of COVID 19 in different countries. 70% of symptomatic patients with COVID- 19 required hospitalization. The presence of associated co-morbidities can aggravate the severity of COVID- 19, leading to a poorer prognosis irrespective of age.

7.
Eur J Case Rep Intern Med ; 7(5): 001656, 2020.
Article in English | MEDLINE | ID: covidwho-1791771

ABSTRACT

COVID-19, also called severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), originated in Wuhan, China. It has caused significant morbidity and mortality worldwide and has been declared a global pandemic by the WHO. Influenza occurs mainly during the winter, with the burden of disease determined by several factors, including the effectiveness of the vaccine that season, the characteristics of the circulating viruses, and how long the season lasts. We describe the case of a 66-year-old woman who was diagnosed with influenza A and COVID-19 co-infection. LEARNING POINTS: COVID-19 can co-occur with other viral infections.Some of these co-infections have active treatments, while supportive treatment is the mainstay of treatment for others.

8.
Rev Panam Salud Publica ; 44: e47, 2020.
Article in Spanish | MEDLINE | ID: covidwho-1791386

ABSTRACT

OBJECTIVE: To evaluate and report the clinical characteristics and outcomes of SARS-CoV-2 infection in pregnant women and newborns in Latin America. METHODS: Descriptive study based on the prospective report of the units of the Ibero-American Society of Neonatology Network. RESULTS: Of 86 pregnant women with COVID-19 confirmed by RT-PCR in seven countries (6 from Latin America, and Equatorial Guinea) 68% (59) were asymptomatic. Of 32% of symptomatic women, 89% (24) had mild symptoms and 3.5% (3) had severe respiratory symptoms. No women died. The cesarean section rate was 38%; gestational age was < 37 weeks in 6% of cases. RT-PCR was performed on all newborns between 16 and 36 hours of age; 6 (7%) were positive. All of them presented mild and transient respiratory distress; none died. Two newborns with negative RT-PCR died from other causes. Breastfeeding was authorized in only 24% of mothers; in 13% milk was expressed and 63% of newborns were fed with formula. In 76% of cases the motherchild pair was separated, and in 95% of cases the mother could not be accompanied at delivery or during the postpartum period. CONCLUSIONS: The lack of maternal accompaniment, the low rate of breastfeeding and the frequent separation of the mother-child dyad are of concern. The health care team must reflect on the need to defend humanized and family-centered care during this pandemic.

9.
Cardiol Young ; 31(6): 1021-1023, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1701004

ABSTRACT

A 12-year-old girl presented with fever and signs of systemic inflammation, and was found to have junctional tachycardia. She was subsequently diagnosed with Multisystem Inflammatory Syndrome in Children and treated with intravenous immunoglobulin and steroids, which led to resolution of the arrhythmia.


Subject(s)
COVID-19 , Child , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , Tachycardia/diagnosis , Tachycardia/etiology
10.
Scand J Public Health ; 49(7): 681-688, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1633178

ABSTRACT

BACKGROUND: In mid-March 2020, the Norwegian government implemented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, and hospitals prepared to handle an unpredictable inflow of patients with COVID-19. AIM: The study was performed to describe the changes in hospital admissions during the first phase of the pandemic. METHODS: The Norwegian Institute of Public Health established a national preparedness register with daily updates on COVID-19 cases and the use of health services. We used individual-level information on inpatients from the electronic journal systems for all hospitals in Norway to estimate daily hospital admissions. RESULTS: Before the onset of the pandemic in March, there was an average of 2400 inpatient admissions per day in Norway, which decreased to approximately 1500 in the first few days after lockdown measures were implemented. The relative magnitudes of the decreases were similar in men and women and across all age groups. The decreases were substantial for both elective (54%) and emergency (29%) inpatient care. The admission rate gradually increased and reached pre-pandemic levels in June. However, the reductions in admissions for pneumonia and chronic obstructive pulmonary disease seemed to persist. CONCLUSIONS: The elective and emergency inpatient admission rates were substantially reduced a few days after the pandemic response measures were implemented. The ways in which the lack or postponement of care may have affected the health and well-being of patients is an important issue to be addressed in future research.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Female , Hospitals , Humans , Male , SARS-CoV-2
11.
J Pediatr Hematol Oncol ; 44(1): e134-e137, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1632085

ABSTRACT

To this day, there are limited data about the effects and management of coronavirus disease infection in pediatric patients with sickle cell disease. We present the management and successful clinical course of an 8-year-old female with homozygous sickle cell disease (SS) and severe acute chest syndrome secondary to coronavirus disease 2019 infection, complicated by cortical vein thrombosis.


Subject(s)
Anemia, Sickle Cell/complications , COVID-19/complications , Systemic Inflammatory Response Syndrome/complications , Anemia, Sickle Cell/pathology , Anemia, Sickle Cell/therapy , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/pathology , COVID-19/therapy , Ceftriaxone/therapeutic use , Child , Erythrocyte Transfusion , Female , Humans , Intensive Care Units , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/therapy
12.
Telemed J E Health ; 26(12): 1461-1465, 2020 12.
Article in English | MEDLINE | ID: covidwho-1639432

ABSTRACT

Objective: During the current coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been brought to the forefront of attention. This report aimed to assess psychiatric comorbidities in COVID-19 patients by utilizing telepsychiatry. Methods: COVID-19 patients admitted in Fasa University Hospital and nonhospitalized outpatients of Fasa city were interviewed by a psychiatrist through video chat for a 1-month period (March-April, 2020). Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Assessment (GAD-7), and Perceived Stress Scale-14 (PSS 14) questionnaires were administered for all patients. Each patient's mental status was recorded, and if any psychiatric problem was diagnosed, supportive psychotherapy, pharmacotherapy, and follow-up visits based on the patient's condition were started. Result: From a total of 82 COVID-19 patients who entered the study, 32 (39.03%) and 50 (60.97%) subjects were inpatients and outpatients, respectively. Moreover, 32 (39.03%) subjects were male and 50 (60.97%) were female. Insomnia seen in 24 (29.3%) patients and adjustment disorder in 13 (15.9%) patients were the most common psychiatric disorders among a total of 33 (40.2%) patients suffering from mental illness. Female and hospitalized patients presented significantly more frequent comorbidities than males and outpatients. Conclusions: Psychiatric disorders were significantly more common in patients with hospital admission than those without and more frequent in female versus male subjects. There were no significant differences between male and female subjects with and without admission according to the PHQ-9, GAD-7, and PSS-14 scores. It was concluded that telepsychiatry in the early stages of mental problems during a catastrophic event like the coronavirus pandemic, can be an efficient instrument for the screening of psychosomatic comorbidities, so that pharmacological treatment (considering possible drug interactions with COVID-19 medications) and psychotherapeutic intervention can be optimized by psychiatrists.


Subject(s)
Anxiety Disorders/diagnosis , COVID-19/diagnosis , COVID-19/psychology , Inpatients/statistics & numerical data , Outpatients/statistics & numerical data , Telemedicine/methods , Telemedicine/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Humans , Iran/epidemiology , Male , Middle Aged , Pandemics/statistics & numerical data , Sex Factors , Video Recording/statistics & numerical data
13.
J Med Internet Res ; 23(2): e23400, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1575940

ABSTRACT

BACKGROUND: The rapid spread of the COVID-19 pandemic in the United States has made people uncertain about their perceptions of the threat of COVID-19 and COVID-19 response measures. To mount an effective response to this epidemic, it is necessary to understand the public's perceptions, behaviors, and attitudes. OBJECTIVE: We aimed to test the hypothesis that people's perceptions of the threat of COVID-19 influence their attitudes and behaviors. METHODS: This study used an open dataset of web-based questionnaires about COVID-19. The questionnaires were provided by Nexoid United Kingdom. We selected the results of a questionnaire on COVID-19-related behaviors, attitudes, and perceptions among the US public. The questionnaire was conducted from March 29 to April 20, 2020. A total of 24,547 people who lived in the United States took part in the survey. RESULTS: In this study, the average self-assessed probability of contracting COVID-19 was 33.2%, and 49.9% (12,244/24,547) of the respondents thought that their chances of contracting COVID-19 were less than 30%. The self-assessed probability of contracting COVID-19 among women was 1.35 times that of males. A 5% increase in perceived infection risk was significantly associated with being 1.02 times (OR 1.02, 95% CI 1.02-1.02; P<.001) more likely to report having close contact with >10 people, and being 1.01 times (OR 1.01, 95% CI 1.01-1.01; P<.001) more likely to report that cohabitants disagreed with taking steps to reduce the risk of contracting COVID-19. However, there was no significant association between participants who lived with more than 5 cohabitants or less than 5 cohabitants (P=.85). Generally, participants who lived in states with 1001-10,000 COVID-19 cases, were aged 20-40 years, were obese, smoked, drank alcohol, never used drugs, and had no underlying medical conditions were more likely to be in close contact with >10 people. Most participants (21,017/24,547, 85.6%) agreed with washing their hands and maintaining social distancing, but only 20.2% (4958/24,547) of participants often wore masks. Additionally, male participants and participants aged <20 years typically disagreed with washing their hands, maintaining social distancing, and wearing masks. CONCLUSIONS: This survey is the first attempt to describe the determinants of the US public's perception of the threat of COVID-19 on a large scale. The self-assessed probability of contracting COVID-19 differed significantly based on the respondents' genders, states of residence, ages, body mass indices, smoking habits, alcohol consumption habits, drug use habits, underlying medical conditions, environments, and behaviors. These findings can be used as references by public health policy makers and health care workers who want to identify populations that need to be educated on COVID-19 prevention and health.


Subject(s)
COVID-19/epidemiology , Disease Outbreaks/prevention & control , Pandemics/prevention & control , Adult , Cross-Sectional Studies , Female , Humans , Male , Perception , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , United States , Young Adult
14.
Infect Dis Now ; 51(5): 435-439, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1574384

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has spread rapidly across the world. Given the sharply increased infection rate, the number of pregnant women and children with COVID-19 is correspondingly on the rise. SARS-CoV-2 infection is transmitted through droplets; though hypothesized, other transmission routes have not been confirmed. As of now, it remains unclear whether and how SARS-CoV-2 can possibly be transmitted from the mother to the fetus. METHOD: This study examines the medical records of 30 neonates born to women with COVID-19, the objective being to provide documented information on maternal-child transmission and infant outcomes. RESULTS: Out of the 30 newborns, 28 had negative PCR test results for SARS-CoV-2; among their mothers, fifteen had fever, nine had cough and twenty had delivered by cesarean section. The median birth term was 37wk2dy, and twenty of the neonates were male. Most of them were asymptomatic, except for the three who presented with shortness of breath. Two of them were intubated and both died, the first because of severe sepsis and the second due to severe hyaline membrane disease. As regards the two infected neonates, the first represents a probable case of congenital SARS-CoV-2 infection, which appears unlikely in the second case. The outcome for both of them was good, without any complications. CONCLUSION: Maternal-fetal transmission of the SARS- CoV-2 virus was not detected in the majority of the reported cases, although two of 30 neonates had positive qRT-PCR test results. Our study supports the hypothesis that though it seldom actually occurs, in utero SARS-CoV-2 vertical transmission is possible.


Subject(s)
COVID-19/transmission , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/virology , Adult , COVID-19/diagnosis , Cesarean Section/statistics & numerical data , Female , Fever/epidemiology , Humans , Infant, Newborn , Male , Mothers , Polymerase Chain Reaction , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , Pregnant Women , SARS-CoV-2/isolation & purification
15.
Clin Infect Dis ; 73(11): e3970-e3973, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1559838

ABSTRACT

A woman with mild coronavirus disease 2019 developed cervical adenopathy, being diagnosed of Epstein-Barr virus infectious mononucleosis. We performed fine needle aspiration, and demonstrate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in lymph nodes even in mild disease along with a strong expansion of terminally differentiated effector memory CD4+ T cells, a cell population that is practically absent in lymph nodes.


Subject(s)
COVID-19 , Epstein-Barr Virus Infections , CD4-Positive T-Lymphocytes , Female , Herpesvirus 4, Human , Humans , Lymph Nodes , SARS-CoV-2
16.
Clin Infect Dis ; 73(10): 1768-1775, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1522134

ABSTRACT

BACKGROUND: We performed a population-based study to describe the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on pregnancy outcomes. METHODS: This prospective, population-based study included pregnant women who consecutively presented at first/second trimester visits or at delivery at 3 hospitals in Barcelona, Spain. SARS-CoV-2 antibodies (immunoglobulin [Ig] G and IgM/IgA) were measured in all participants, and nasopharyngeal real-time polymerase chain reaction (RT-PCR) was performed at delivery. The primary outcome was a composite of pregnancy complications in SARS-CoV-2-positive vs negative women that included miscarriage, preeclampsia, preterm delivery, perinatal death, small-for-gestational-age newborn, or neonatal admission. Secondary outcomes were components of the primary outcome plus abnormal fetal growth, malformation, or intrapartum fetal distress. Outcomes were also compared between positive symptomatic and positive asymptomatic SARS-CoV-2 women. RESULTS: Of 2225 pregnant women, 317 (14.2%) were positive for SARS-CoV-2 antibodies (n = 314, 99.1%) and/or RT-PCR (n = 36, 11.4%). Among positive women, 217 (68.5%) were asymptomatic, 93 (29.3%) had mild coronavirus disease 2019 (COVID-19), and 7 (2.2%) had pneumonia, of whom 3 required intensive care unit admission. In women with and without SARS-CoV-2 infection, the primary outcome occurred in 43 (13.6%) and 268 (14%), respectively (risk difference, -0.4%; 95% confidence interval, -4.1% to 4.1). Compared with noninfected women, those with symptomatic COVID-19 had increased rates of preterm delivery (7.2% vs 16.9%, P = .003) and intrapartum fetal distress (9.1% vs 19.2%, P = .004), while asymptomatic women had rates that were similar to those of noninfected cases. Among 143 fetuses from infected mothers, none had anti-SARS-CoV-2 IgM/IgA in cord blood. CONCLUSIONS: The overall rate of pregnancy complications in women with SARS-CoV-2 infection was similar to that of noninfected women. However, symptomatic COVID-19 was associated with modest increases in preterm delivery and intrapartum fetal distress.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Prospective Studies , SARS-CoV-2
17.
Clin Infect Dis ; 73(7): e1762-e1765, 2021 10 05.
Article in English | MEDLINE | ID: covidwho-1455264

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered virus for which remdesivir is the only antiviral available. We report the occurrence of a mutation in RdRP (D484Y) following treatment with remdesivir in a 76-year-old female with post-rituximab B-cell immunodeficiency and persistent SARS-CoV-2 viremia. A cure was achieved after supplementation with convalescent plasma.


Subject(s)
COVID-19 , RNA-Dependent RNA Polymerase , Adenosine Monophosphate/analogs & derivatives , Aged , Alanine/analogs & derivatives , B-Lymphocytes , COVID-19/drug therapy , COVID-19/therapy , Female , Humans , Immunization, Passive , Mutation , SARS-CoV-2
18.
Eur J Phys Rehabil Med ; 57(4): 653-662, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1406909

ABSTRACT

BACKGROUND: Although there are some retrospective studies to present musculoskeletal findings of the COVID-19, still the muscle strength and fatigue has not been studied in detail. AIM: To reveal the symptoms of musculoskeletal system in COVID-19 patients, to evaluate myalgia, arthralgia and physical/mental fatigue, to assess handgrip muscle strength, and to examine the relations of these parameters with the severity and laboratory values of the disease. DESIGN: This study was designed as a cross-sectional, single-center case series. SETTING: This study took place from May 15, 2020, to June 30, 2020 at the Istanbul University-Cerrahpasa, Cerrahpasa Pandemia Services. POPULATION: Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study. METHODS: The disease severity 2007 IDSA/ATS guidelines for community acquired pneumonia was used. Myalgia severity was assessed by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer. RESULTS: One hundred three patients (68.7%) were non-severe, and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue (133 [85.3%]), followed by myalgia (102 [68.0%]), arthralgia (65 [43.3%]) and back pain (33 [22.0%]). Arthralgia, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, was significantly higher among the severe group. Severe myalgia was prevalent among myalgia sufferers regardless of COVID-19 severity. The physical fatigue severity score was significantly higher in severe cases, whereas this difference was not significant in mental fatigue score. Female patients with severe infection had "lower" grip strength, whereas grip strength among males did not differ significantly between non-severe and severe COVID-19 cases. Nevertheless, the mean values in both genders and in age decades were below the specified normative values. CRP, ferritin, and LDH levels were significantly higher in women with "lower" grip strength compared to the "normal" group. CONCLUSIONS: Aside from other multisystemic symptoms, musculoskeletal symptoms are quite common in patients with COVID-19. Patients have severe ischemic myalgia regardless of disease activity. Although there is a muscle weakness in all patients, the loss of muscle function is more of a problem among women in connection with disease severity. Muscular involvement in Coronavirus disease is a triangle of myalgia, physical fatigue, and muscle weakness. CLINICAL REHABILITATION IMPACT: Muscle involvement in COVID-19 patients does not mean only myalgia but also a combination of physical fatigue and muscle weakness, and this should be considered in planning the rehabilitation strategies of COVID-19 patients.


Subject(s)
COVID-19/complications , Fatigue/physiopathology , Hand Strength/physiology , Muscle Weakness/physiopathology , Musculoskeletal Pain/physiopathology , Adult , Aged , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
19.
Eur J Endocrinol ; 185(2): 299-311, 2021 Jul 05.
Article in English | MEDLINE | ID: covidwho-1398974

ABSTRACT

OBJECTIVE: Male sex is one of the determinants of severe coronavirus diseas-e-2019 (COVID-19). We aimed to characterize sex differences in severe outcomes in adults with diabetes hospitalized for COVID-19. METHODS: We performed a sex-stratified analysis of clinical and biological features and outcomes (i.e. invasive mechanical ventilation (IMV), death, intensive care unit (ICU) admission and home discharge at day 7 (D7) or day 28 (D28)) in 2380 patients with diabetes hospitalized for COVID-19 and included in the nationwide CORONADO observational study (NCT04324736). RESULTS: The study population was predominantly male (63.5%). After multiple adjustments, female sex was negatively associated with the primary outcome (IMV and/or death, OR: 0.66 (0.49-0.88)), death (OR: 0.49 (0.30-0.79)) and ICU admission (OR: 0.57 (0.43-0.77)) at D7 but only with ICU admission (OR: 0.58 (0.43-0.77)) at D28. Older age and a history of microvascular complications were predictors of death at D28 in both sexes, while chronic obstructive pulmonary disease (COPD) was predictive of death in women only. At admission, C-reactive protein (CRP), aspartate amino transferase (AST) and estimated glomerular filtration rate (eGFR), according to the CKD-EPI formula predicted death in both sexes. Lymphocytopenia was an independent predictor of death in women only, while thrombocytopenia and elevated plasma glucose concentration were predictors of death in men only. CONCLUSIONS: In patients with diabetes admitted for COVID-19, female sex was associated with lower incidence of early severe outcomes, but did not influence the overall in-hospital mortality, suggesting that diabetes mitigates the female protection from COVID-19 severity. Sex-associated biological determinants may be useful to optimize COVID-19 prevention and management in women and men.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Sex Characteristics , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Female , France/epidemiology , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Incidence , Inpatients , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Prognosis , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index
20.
MMWR Morb Mortal Wkly Rep ; 69(38): 1355-1359, 2020 Sep 23.
Article in English | MEDLINE | ID: covidwho-1389855

ABSTRACT

Pregnant women might be at increased risk for severe coronavirus disease 2019 (COVID-19), possibly related to changes in their immune system and respiratory physiology* (1). Further, adverse birth outcomes, such as preterm delivery and stillbirth, might be more common among pregnant women infected with SARS-CoV-2, the virus that causes COVID-19 (2,3). Information about SARS-CoV-2 infection during pregnancy is rapidly growing; however, data on reasons for hospital admission, pregnancy-specific characteristics, and birth outcomes among pregnant women hospitalized with SARS-CoV-2 infections are limited. During March 1-May 30, 2020, as part of Vaccine Safety Datalink (VSD)† surveillance of COVID-19 hospitalizations, 105 hospitalized pregnant women with SARS-CoV-2 infection were identified, including 62 (59%) hospitalized for obstetric reasons (i.e., labor and delivery or another pregnancy-related indication) and 43 (41%) hospitalized for COVID-19 illness without an obstetric reason. Overall, 50 (81%) of 62 pregnant women with SARS-CoV-2 infection who were admitted for obstetric reasons were asymptomatic. Among 43 pregnant women hospitalized for COVID-19, 13 (30%) required intensive care unit (ICU) admission, six (14%) required mechanical ventilation, and one died from COVID-19. Prepregnancy obesity was more common (44%) among pregnant women hospitalized for COVID-19 than that among asymptomatic pregnant women hospitalized for obstetric reasons (31%). Likewise, the rate of gestational diabetes (26%) among pregnant women hospitalized for COVID-19 was higher than it was among women hospitalized for obstetric reasons (8%). Preterm delivery occurred in 15% of pregnancies among 93 women who delivered, and stillbirths (fetal death at ≥20 weeks' gestation) occurred in 3%. Antenatal counseling emphasizing preventive measures (e.g., use of masks, frequent hand washing, and social distancing) might help prevent COVID-19 among pregnant women,§ especially those with prepregnancy obesity and gestational diabetes, which might reduce adverse pregnancy outcomes.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Hospitalization/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Adolescent , Adult , COVID-19 , Coronavirus Infections/epidemiology , Female , Health Facilities/statistics & numerical data , Humans , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Risk Assessment , Risk Factors , United States/epidemiology , Young Adult
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