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1.
ATS Sch ; 1(4): 416-435, 2020 Oct 08.
Article in English | MEDLINE | ID: covidwho-1191227

ABSTRACT

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine in a 3- to 4-year recurring cycle of topics. The topics of the 2020 Pulmonary Core Curriculum include pulmonary vascular disease (submassive pulmonary embolism, chronic thromboembolic pulmonary hypertension, and pulmonary hypertension) and pulmonary infections (community-acquired pneumonia, pulmonary nontuberculous mycobacteria, opportunistic infections in immunocompromised hosts, and coronavirus disease [COVID-19]).

2.
Dtsch Med Wochenschr ; 146(3): 162-166, 2021 Feb.
Article in German | MEDLINE | ID: covidwho-1054084

ABSTRACT

Corticosteroids have been found as useful adjunctive therapy in patients with various infections and hyperinflammation-associated disease. They are recommended in practice guidelines for patients with tuberculous and pneumococcal meningitis and patients with immune reconstitution syndrome associated with antiretroviral therapy. A new indication is severe COVID-19. Evidence from clinical trials is insufficient to allow the routine use of steroids among patients with septic shock, community-acquired pneumonia or tuberculous pericarditis.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/drug therapy , HIV Infections/complications , Immune Reconstitution Inflammatory Syndrome/drug therapy , Meningitis, Pneumococcal/drug therapy , Tuberculosis, Meningeal/drug therapy , Brain Abscess/drug therapy , Chemotherapy, Adjuvant , HIV Infections/drug therapy , Humans , Sepsis/drug therapy , Severity of Illness Index , Shock, Septic/drug therapy , Spirochaetales Infections/drug therapy , Tuberculosis/drug therapy
3.
Am Fam Physician ; 102(11): 673-678, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1001150

ABSTRACT

In this article, we discuss the POEMs (patient-oriented evidence that matters) of 2019 judged to be most consistent with the principles of Choosing Wisely, an international campaign to reduce unnecessary testing and treatments. We selected these POEMs through a crowdsourcing strategy of the daily POEMs information service for the Canadian Medical Association's physician members. We present recommendations from these top POEMs of primary research or meta-analysis that identify interventions to encourage or consider avoiding in practice. The recommendations cover musculoskeletal conditions (e.g., do not recommend platelet-rich plasma injections for rotator cuff disease or knee osteoarthritis), respiratory disease (e.g., in clinically stable patients with community-acquired pneumonia, antibiotics can be stopped after five days), screening or preventive care (e.g., patients who take their blood pressure at home or in a pharmacy should know what to do when they have an elevated reading), and miscellaneous topics (e.g., in healthy adults treated for dermatophyte infection, do not obtain baseline or follow-up alanine transaminase level, aspartate transaminase level, or complete blood count). These POEMs describe interventions whose benefits are not superior to other options, are sometimes more expensive, or put patients at increased risk of harm. Knowing more about these POEMs and their connection with the Choosing Wisely campaign will help clinicians and patients engage in conversations better informed by high-quality evidence.


Subject(s)
COVID-19/therapy , Evidence-Based Medicine/methods , Primary Health Care/standards , Unnecessary Procedures/statistics & numerical data , Crowdsourcing , Humans , Physician's Role , Physician-Patient Relations , Quality Improvement/organization & administration
4.
Epidemiol Infect ; 148: e164, 2020 07 27.
Article in English | MEDLINE | ID: covidwho-679966

ABSTRACT

The emergence of 2019 novel coronavirus disease (COVID-19) is currently a global concern. In this study, our goal was to explore the changing expression levels of acute-phase reaction proteins (APRPs) in the serum of COVID-19 patients and to elucidate the immunological characteristics of COVID-19. In the study design, we recruited 72 COVID-19 patients, including 22 cases of mild degree, 38 cases of moderate degree and 12 cases of severe degree. We also recruited 20 patients with community-acquired pneumonia (CAP) and 20 normal control subjects as a comparison. Fasting venous blood was taken to detect the content of complement 3 (C3), complement 4 (C4), C-reactive protein (CRP), serum amyloid A (SAA) and prealbumin (PA). When compared the COVID-19 group with the CAP and normal control groups, respectively, the mean value of CRP and SAA in the COVID-19 group (including mild, moderate and severe patients) had increased significantly (P < 0.01), whereas the mean values of C3, C4 and PA decreased (P < 0.01). For the asymptomatic or mild symptomatic patients with COVID-19, the actual aggravation of disease may be more advanced than the clinical appearances. Meanwhile, the statistical analyses indicated that the development of COVID-19 brought about a significant increase in the content of CRP and SAA (P < 0.01), and a decline in the content of C3, C4 and PA (P < 0.01). These findings suggested that the changes in the level of APRPs could be used as indicators to identify the degree and progression of COVID-19, and the significant changes might demonstrate the aggravation of disease. This study provided a new approach to improve the clinical management plan and prognosis of COVID-19.


Subject(s)
Acute-Phase Proteins/analysis , Acute-Phase Proteins/biosynthesis , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Adult , Aged , C-Reactive Protein/analysis , C-Reactive Protein/biosynthesis , COVID-19 , Case-Control Studies , Community-Acquired Infections/blood , Community-Acquired Infections/immunology , Complement C3/analysis , Complement C3/biosynthesis , Complement C4/analysis , Complement C4/biosynthesis , Coronavirus Infections/blood , Coronavirus Infections/immunology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia/blood , Pneumonia/immunology , Pneumonia, Viral/blood , Pneumonia, Viral/immunology , Prealbumin/analysis , Prealbumin/biosynthesis , Prognosis , Serum Amyloid A Protein/analysis , Serum Amyloid A Protein/biosynthesis , Severity of Illness Index , Young Adult
6.
Cell Host Microbe ; 27(6): 883-890.e2, 2020 06 10.
Article in English | MEDLINE | ID: covidwho-165371

ABSTRACT

The outbreaks of 2019 novel coronavirus disease (COVID-19) caused by SARS-CoV-2 infection have posed a severe threat to global public health. It is unclear how the human immune system responds to this infection. Here, we used metatranscriptomic sequencing to profile immune signatures in the bronchoalveolar lavage fluid of eight COVID-19 cases. The expression of proinflammatory genes, especially chemokines, was markedly elevated in COVID-19 cases compared to community-acquired pneumonia patients and healthy controls, suggesting that SARS-CoV-2 infection causes hypercytokinemia. Compared to SARS-CoV, which is thought to induce inadequate interferon (IFN) responses, SARS-CoV-2 robustly triggered expression of numerous IFN-stimulated genes (ISGs). These ISGs exhibit immunopathogenic potential, with overrepresentation of genes involved in inflammation. The transcriptome data was also used to estimate immune cell populations, revealing increases in activated dendritic cells and neutrophils. Collectively, these host responses to SARS-CoV-2 infection could further our understanding of disease pathogenesis and point toward antiviral strategies.


Subject(s)
Bronchoalveolar Lavage Fluid/immunology , Coronavirus Infections/immunology , Immunity, Innate , Pneumonia, Viral/immunology , Respiratory System/immunology , Bronchoalveolar Lavage Fluid/cytology , COVID-19 , Coronavirus Infections/pathology , Cytokine Release Syndrome , Cytokines/analysis , Host-Pathogen Interactions , Humans , Interferons/metabolism , Pandemics , Pneumonia, Viral/pathology , Respiratory System/pathology
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