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1.
J Diabetes Complications ; 34(9): 107637, 2020 09.
Article in English | MEDLINE | ID: covidwho-1828813

ABSTRACT

BACKGROUND: The novel coronavirus SARS-CoV-2 has taken the world by storm. Alongside COVID-19, diabetes is a long-standing global epidemic. The diabetes population has been reported to suffer adverse outcomes if infected by COVID-19. The aim was to summarise information and resources available on diabetes and COVID-19, highlighting special measures that individuals with diabetes need to follow. METHODS: A search using keywords "COVID-19" and "Diabetes" was performed using different sources, including PubMed and World Health Organization. RESULTS: COVID-19 may enhance complications in individuals with diabetes through an imbalance in angiotension-converting enzyme 2 (ACE2) activation pathways leading to an inflammatory response. ACE2 imbalance in the pancreas causes acute ß-cell dysfunction and a resultant hyperglycemic state. These individuals may be prone to worsened COVID-19 complications including vasculopathy, coagulopathy as well as psychological stress. Apart from general preventive measures, remaining hydrated, monitoring blood glucose regularly and monitoring ketone bodies in urine if on insulin is essential. All this while concurrently maintaining physical activity and a healthy diet. Different supporting entities are being set up to help this population. CONCLUSION: COVID-19 is a top priority. It is important to remember that a substantial proportion of the world's population is affected by other co-morbidities such as diabetes. These require special attention during this pandemic to avoid adding on to the burden of countries' healthcare systems.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , COVID-19 , Humans , SARS-CoV-2
2.
Rev Esp Cardiol ; 74(7): 608-615, 2021 Jul.
Article in Spanish | MEDLINE | ID: covidwho-1805063

ABSTRACT

INTRODUCTION AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Atrial fibrillation (AF) is common in acute situations, where it is associated with more complications and higher mortality. METHODS: Analysis of the international HOPE registry (NCT04334291). The objective was to assess the prognostic information of AF in COVID-19 patients. A multivariate analysis and propensity score matching were performed to assess the relationship between AF and mortality. We also evaluated the impact on mortality and embolic events of the CHA2DS2-VASc score in these patients. RESULTS: Among 6217 patients enrolled in the HOPE registry, 250 had AF (4.5%). AF patients had a higher prevalence of cardiovascular risk factors and comorbidities. After propensity score matching, these differences were attenuated. Despite this, patients with AF had a higher incidence of in-hospital complications such as heart failure (19.3% vs 11.6%, P = .021) and respiratory insufficiency (75.9% vs 62.3%, P = .002), as well as a higher 60-day mortality rate (43.4% vs 30.9%, P = .005). On multivariate analysis, AF was independently associated with higher 60-day mortality (hazard ratio, 1.234; 95%CI, 1.003-1.519). CHA2DS2-VASc score acceptably predicts 60-day mortality in COVID-19 patients (area ROC, 0.748; 95%CI, 0.733-0.764), but not its embolic risk (area ROC, 0.411; 95%CI, 0.147-0.675). CONCLUSIONS: AF in COVID-19 patients is associated with a higher number of complications and 60-day mortality. The CHA2DS2-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk.

3.
Psychol Res Behav Manag ; 13: 701-704, 2020.
Article in English | MEDLINE | ID: covidwho-1793274

ABSTRACT

BACKGROUND: Corona virus (COVID-19) is an outbreak of respiratory disease caused by a novel corona virus and declared to be a global health emergency and a pandemic by the World Health Organization (WHO) on March 11, 2020. Prevention strategies to control the transmission of the COVID-19 pandemic, such as closing of schools, refraining from gathering, and social distancing, have direct impacts on mental well-being. SARS-CoV-2 has a devastating psychological impact on the mental health status of the community and, particularly when associated with psychotic symptoms, it could affect the overall quality-of-life. The virus also has the potential to enter and infect the brain. As a result, psychosis symptoms could be an emerging phenomenon associated with the corona virus pandemic. The presence of psychotic symptoms may complicate the management options of patients with COVID-19. OBJECTIVE: The aim of this article review is to elaborate the relationships between COVID-19 and psychotic symptoms. METHODOLOGY: We independently searched different electronic databases, such as Google scholar, PubMed, Medline, CINAHL, EMBASE, PsychInfo, and other relevant sources published in English globally, by using the search terms "psychosis and COVID-19", "corona virus", "brief psychotic", "schizophrenia", "organic psychosis", "infectious disease", "mental illness", "pandemics", and "psychiatry" in various permutations and combinations. RESULTS: The results of the included studies revealed that patients with a novel corona virus had psychotic symptoms, including hallucination in different forms of modality, delusion, disorganized speech, and grossly disorganized or catatonic behaviors. The patients with COVID-19-related psychotic symptoms had responded with a short-term administration of the antipsychotic medication. CONCLUSION AND RECOMMENDATION: A corona virus-related psychosis has been identified in different nations, but it is difficult to conclude that a novel corona virus has been biologically related to psychosis or exacerbates psychotic symptoms. Therefore, to identify the causal relationships between COVID-19 and psychosis, the researchers should investigate the prospective study on the direct biological impacts of COVID-19 and psychosis, and the clinicians should pay attention for psychotic symptoms at the treatment center and isolation rooms in order to reduce the complication of a novel corona virus.

4.
Arch Pathol Lab Med ; 146(4): 433-439, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1753892

ABSTRACT

CONTEXT.­: From the onset of the human immunodeficiency virus (HIV) pandemic in the 1980s to the recent coronavirus disease 2019 (COVID-19) pandemic, multiple viral pandemics have occurred and all have been associated with hematologic complications of varying severity. OBJECTIVE.­: To review the hematologic complications associated with the HIV and other viral pandemics, the current theories regarding their causation, and the incidence and clinical impact of these complications on infected patients. DATA SOURCES.­: Peer-reviewed medical literature and the author's personal experience. CONCLUSIONS.­: The HIV and other viral pandemics have been associated with a variety of hematologic complications that often cause significant morbidity and mortality in affected patients. HIV infection is associated with multiple hematologic disorders, many of which have a lower incidence in the era of highly active antiretroviral therapy but still represent a major clinical problem for HIV-infected patients. Our understanding of the pathogenesis of HIV-related hematologic complications, including HIV-associated lymphoproliferative disorders, has evolved in recent years. Other viral pandemics, including H1N1 influenza, severe acute respiratory syndrome (SARS) coronavirus, Middle East respiratory syndrome (MERS) coronavirus, and COVID-19, have also been associated with hematologic complications of varying severity. Our emerging understanding of the pathogenesis of the hematologic complications of HIV, COVID-19, and other viral pandemics may help in prevention, correct diagnosis, and treatment of these complications in current and future pandemics.


Subject(s)
COVID-19 , HIV Infections , Influenza A Virus, H1N1 Subtype , Middle East Respiratory Syndrome Coronavirus , COVID-19/complications , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , SARS-CoV-2
5.
Chin Med J (Engl) ; 133(11): 1261-1267, 2020 Jun 05.
Article in English | MEDLINE | ID: covidwho-1722623

ABSTRACT

BACKGROUND: The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan, Hubei Province of China since December 2019. This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease (COVID-19). METHODS: Clinical data were collected from two tertiary hospitals in Wuhan. A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19 (death group) and we compare them with recovered patients (recovered group). Continuous variables were analyzed using the Mann-Whitney U test. Categorical variables were analyzed by χ test or Fisher exact test as appropriate. RESULTS: Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients. The median age of the death group was older than the recovered group (69 [62, 74] vs. 40 [33, 57] years, Z = 9.738, P < 0.001). More patients in the death group had underlying diseases (72.5% vs. 41.4%, χ = 22.105, P < 0.001). Patients in the death group had a significantly longer time of illness onset to hospitalization (10.0 [6.5, 12.0] vs. 7.0 [5.0, 10.0] days, Z = 3.216, P = 0.001). On admission, the proportions of patients with symptoms of dyspnea (70.6% vs. 19.0%, χ = 60.905, P < 0.001) and expectoration (32.1% vs. 12.1%, χ = 13.250, P < 0.001) were significantly higher in the death group. The blood oxygen saturation was significantly lower in the death group (85 [77, 91]% vs. 97 [95, 98]%, Z = 10.625, P < 0.001). The white blood cell (WBC) in death group was significantly higher on admission (7.23 [4.87, 11.17] vs. 4.52 [3.62, 5.88] ×10/L, Z = 7.618, P < 0.001). Patients in the death group exhibited significantly lower lymphocyte count (0.63 [0.40, 0.79] vs. 1.00 [0.72, 1.27] ×10/L, Z = 8.037, P < 0.001) and lymphocyte percentage (7.10 [4.45, 12.73]% vs. 23.50 [15.27, 31.25]%, Z = 10.315, P < 0.001) on admission, and the lymphocyte percentage continued to decrease during hospitalization (7.10 [4.45, 12.73]% vs. 2.91 [1.79, 6.13]%, Z = 5.242, P < 0.001). Alanine transaminase (22.00 [15.00, 34.00] vs. 18.70 [13.00, 30.38] U/L, Z = 2.592, P = 0.010), aspartate transaminase (34.00 [27.00, 47.00] vs. 22.00 [17.65, 31.75] U/L, Z = 7.308, P < 0.001), and creatinine levels (89.00 [72.00, 133.50] vs. 65.00 [54.60, 78.75] µmol/L, Z = 6.478, P < 0.001) were significantly higher in the death group than those in the recovered group. C-reactive protein (CRP) levels were also significantly higher in the death group on admission (109.25 [35.00, 170.28] vs. 3.22 [1.04, 21.80] mg/L, Z = 10.206, P < 0.001) and showed no significant improvement after treatment (109.25 [35.00, 170.28] vs. 81.60 [27.23, 179.08] mg/L, Z = 1.219, P = 0.233). The patients in the death group had more complications such as acute respiratory distress syndrome (ARDS) (89.9% vs. 8.6%, χ = 148.105, P < 0.001), acute cardiac injury (59.6% vs. 0.9%, χ = 93.222, P < 0.001), acute kidney injury (18.3% vs. 0%, χ = 23.257, P < 0.001), shock (11.9% vs. 0%, χ = 14.618, P < 0.001), and disseminated intravascular coagulation (DIC) (6.4% vs. 0%, χ = 7.655, P = 0.006). CONCLUSIONS: Compared to the recovered group, more patients in the death group exhibited characteristics of advanced age, pre-existing comorbidities, dyspnea, oxygen saturation decrease, increased WBC count, decreased lymphocytes, and elevated CRP levels. More patients in the death group had complications such as ARDS, acute cardiac injury, acute kidney injury, shock, and DIC.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19 , Coronavirus Infections/mortality , Female , Humans , Male , Middle Aged , Oxygen/blood , Pandemics , Pneumonia, Viral/mortality , Retrospective Studies , SARS-CoV-2
6.
Disaster Med Public Health Prep ; : 1-5, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1704036

ABSTRACT

OBJECTIVE: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been discovered in Wuhan and spread rapidly across China and worldwide. Characteristics of infected patients are needed to get insight into the full spectrum of the disease. METHODS: Epidemiological and clinical information of 1738 diagnosed patients during February 7-26, 2020 in Wuhan Dongxihu Fangcang Hospital were analyzed. A total of 709 patients were followed up on symptom, mental health, isolation site, and medication after discharge. RESULTS: There were 852 males and 886 females in the cohort. The average age of the patients was 48.8 y. A total of 79.98% of the patients were from Wuhan, Hubei Province. The most common initial symptoms were fever, cough, and shortness of breath. Among all the patients, 1463 had complications, with respiratory distress as the most common complication. The average duration of hospitalization was 15.95 ± 14.69 d. The most common postdischarge symptom is cough. After discharge, most patients were full of energy and chose hotel as their self-isolation site. Coronavirus disease 2019 (COVID-19) Chinese medicine No.2 prescription is the medication used most commonly by the patients after discharge. CONCLUSIONS: The population is generally susceptible to SARS-CoV-2. After receiving aggressive treatment of combined Chinese and Western medicine, most patients had a good prognosis and mental health after discharge.

7.
Cardiol Young ; 32(1): 138-141, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1655373

ABSTRACT

A 17-year-old adolescent with severe multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease-2019 developed reduced left ventricular function and left ventricular thrombus. With treatment, his condition improved and the thrombus was dissolved. This case illustrates the risk of severe intra-cardiac thrombotic complications in patients with MIS-C.


Subject(s)
COVID-19 , Thrombosis , Adolescent , COVID-19/complications , Child , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , Thrombosis/diagnosis , Thrombosis/etiology
8.
Clin Infect Dis ; 74(1): 127-132, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1621567

ABSTRACT

Hospitalized patients with coronavirus disease 2019 (COVID-19) experiencing respiratory symptoms have different complications (inflammatory, co-infection, and thrombotic) that are identifiable by analytics patterns. Personalized treatment decisions decreased early mortality (odds ratio [OR] .144; 95% confidence interval [CI] .03-.686; P = .015). Increasing age (OR 1.06; P = .038) and therapeutic effort limitation (OR 9.684; P < .001) were associated with higher mortality.


Subject(s)
COVID-19 , Hospitalization , Humans , Odds Ratio , SARS-CoV-2
10.
Eur J Neurol ; 28(10): 3339-3347, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1607258

ABSTRACT

OBJECTIVE: To describe the spectrum of neurological complications observed in a hospital-based cohort of COVID-19 patients who required a neurological assessment. METHODS: We conducted an observational, monocentric, prospective study of patients with a COVID-19 diagnosis hospitalized during the 3-month period of the first wave of the COVID-19 pandemic in a tertiary hospital in Madrid (Spain). We describe the neurological diagnoses that arose after the onset of COVID-19 symptoms. These diagnoses could be divided into different groups. RESULTS: Only 71 (2.6%) of 2750 hospitalized patients suffered at least one neurological complication (77 different neurological diagnoses in total) during the timeframe of the study. The most common diagnoses were neuromuscular disorders (33.7%), cerebrovascular diseases (CVDs) (27.3%), acute encephalopathy (19.4%), seizures (7.8%), and miscellanea (11.6%) comprising hiccups, myoclonic tremor, Horner syndrome and transverse myelitis. CVDs and encephalopathy were common in the early phase of the COVID-19 pandemic compared to neuromuscular disorders, which usually appeared later on (p = 0.005). Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction was negative in 15/15 samples. The mortality was higher in the CVD group (38.1% vs. 8.9%; p = 0.05). CONCLUSIONS: The prevalence of neurological complications is low in patients hospitalized for COVID-19. Different mechanisms appear to be involved in these complications, and there was no evidence of direct invasion of the nervous system in our cohort. Some of the neurological complications can be classified into early and late neurological complications of COVID-19, as they occurred at different times following the onset of COVID-19 symptoms.


Subject(s)
COVID-19 , Nervous System Diseases , Neurology , COVID-19 Testing , Humans , Nervous System Diseases/epidemiology , Pandemics , Prospective Studies , Registries , SARS-CoV-2
11.
Eur J Neurol ; 28(10): 3303-3323, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1603795

ABSTRACT

The COVID-19 pandemic is a global public health issue. Neurological complications have been reported in up to one-third of affected cases, but their distribution varies significantly in terms of prevalence, incidence and phenotypical characteristics. Variability can be mostly explained by the differing sources of cases (hospital vs. community-based), the accuracy of the diagnostic approach and the interpretation of the patients' complaints. Moreover, after recovering, patients can still experience neurological symptoms. To obtain a more precise picture of the neurological manifestations and outcome of the COVID-19 infection, an international registry (ENERGY) has been created by the European Academy of Neurology in collaboration with European national neurological societies and the Neurocritical Care Society and Research Network. ENERGY can be implemented as a stand-alone instrument for patients with suspected or confirmed COVID-19 and neurological findings or as an addendum to an existing registry not targeting neurological symptoms. Data are also collected to study the impact of neurological symptoms and neurological complications on outcomes. The variables included in the registry have been selected in the interests of most countries, to favour pooling with data from other sources and to facilitate data collection even in resource-poor countries. Included are adults with suspected or confirmed COVID-19 infection, ascertained through neurological consultation, and providing informed consent. Key demographic and clinical findings are collected at registration. Patients are followed up to 12 months in search of incident neurological manifestations. As of 19 August, 254 centres from 69 countries and four continents have made requests to join the study.


Subject(s)
COVID-19 , Neurology , Adult , Humans , Pandemics , Registries , SARS-CoV-2
12.
J Investig Med High Impact Case Rep ; 9: 23247096211013215, 2021.
Article in English | MEDLINE | ID: covidwho-1598539

ABSTRACT

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.


Subject(s)
Bronchial Fistula/surgery , Bronchoscopy , COVID-19/complications , Empyema, Pleural/surgery , Pleural Diseases/surgery , Surgical Instruments , Bronchial Fistula/etiology , Chest Tubes , Empyema, Pleural/etiology , Humans , Male , Middle Aged , Pleural Diseases/etiology , SARS-CoV-2 , Thoracostomy
13.
Turk J Med Sci ; 51(6): 2822-2826, 2021 12 13.
Article in English | MEDLINE | ID: covidwho-1580296

ABSTRACT

Background/aim: As the number of case reports related to the new type of coronavirus (COVID-19) increases, knowledge of and experience with the virus and its complications also increase. Pleural complications are one relevant issue. We aimed in this study to analyze pleural complications, such as pneumothorax, pneumomediastinum, and empyema, in patients hospitalized with the diagnosis of COVID-19 pneumonia. Materials and methods: The files of patients who have pleural complications of COVID-19 pneumonia and were consulted about thoracic surgery between March 2020 and December 2020 were retrospectively reviewed. The data of the patients were analyzed according to age, sex, length of stay, treatment method for pleural complications, mortality, severity of COVID-19 pneumonia, tube thoracostomy duration, and presence of a mechanical ventilator. Results: A total of 31 patients fulfilling the inclusion criteria were included in the study. There were 11 female (35.5%) and 20 male (65.5%) patients. The most common complication was pneumothorax in 20 patients (65%). The median duration of hospitalization was 22 days and the mortality rate was 71%. Mortality was significantly higher in patients on mechanical ventilation (p = 0.04). Conclusion: The mortality rate is very high in patients with pleural complications of COVID-19 pneumonia. Pneumothorax is a fatal complication in critically ill patients with COVID-19 pneumonia.


Subject(s)
COVID-19/complications , Length of Stay/statistics & numerical data , Pneumothorax/etiology , Adult , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Mediastinal Emphysema , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/mortality , Retrospective Studies , SARS-CoV-2
14.
Ann Med ; 53(1): 295-301, 2021 12.
Article in English | MEDLINE | ID: covidwho-1575822

ABSTRACT

INTRODUCTION: Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment. MATERIALS AND METHODS: We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy. RESULTS: Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis. CONCLUSIONS: Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.


Subject(s)
Anticoagulants/adverse effects , COVID-19/complications , Hematoma/epidemiology , Psoas Muscles/diagnostic imaging , Thrombophilia/drug therapy , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/virology , Critical Illness/mortality , Critical Illness/therapy , Female , Glucocorticoids/therapeutic use , Hematoma/chemically induced , Hematoma/diagnosis , Hematoma/drug therapy , Heparin, Low-Molecular-Weight , Hospital Mortality , Humans , Incidence , Intensive Care Units , Italy/epidemiology , Magnetic Resonance Imaging , Male , Middle Aged , Muscular Diseases , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Severity of Illness Index , Thrombophilia/etiology , Tomography, X-Ray Computed , Treatment Outcome
16.
Clin Infect Dis ; 73(11): e4113-e4123, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1561415

ABSTRACT

BACKGROUND: The relationship between common patient characteristics, such as sex and metabolic comorbidities, and mortality from coronavirus disease 2019 (COVID-19) remains incompletely understood. Emerging evidence suggests that metabolic risk factors may also vary by age. This study aimed to determine the association between common patient characteristics and mortality across age-groups among COVID-19 inpatients. METHODS: We performed a retrospective cohort study of patients discharged from hospitals in the Premier Healthcare Database between April-June 2020. Inpatients were identified using COVID-19 ICD-10-CM diagnosis codes. A priori-defined exposures were sex and present-on-admission hypertension, diabetes, obesity, and interactions between age and these comorbidities. Controlling for additional confounders, we evaluated relationships between these variables and in-hospital mortality in a log-binomial model. RESULTS: Among 66 646 (6.5%) admissions with a COVID-19 diagnosis, across 613 U.S. hospitals, 12 388 (18.6%) died in-hospital. In multivariable analysis, male sex was independently associated with 30% higher mortality risk (aRR, 1.30, 95% CI: 1.26-1.34). Diabetes without chronic complications was not a risk factor at any age (aRR 1.01, 95% CI: 0.96-1.06), and hypertension without chronic complications was a risk factor only in 20-39 year-olds (aRR, 1.68, 95% CI: 1.17-2.40). Diabetes with chronic complications, hypertension with chronic complications, and obesity were risk factors in most age-groups, with highest relative risks among 20-39 year-olds (respective aRRs 1.79, 2.33, 1.92; P-values ≤ .002). CONCLUSIONS: Hospitalized men with COVID-19 are at increased risk of death across all ages. Hypertension, diabetes with chronic complications, and obesity demonstrated age-dependent effects, with the highest relative risks among adults aged 20-39.


Subject(s)
COVID-19 , Adult , COVID-19 Testing , Hospitals , Humans , Inpatients , Male , Retrospective Studies , SARS-CoV-2
17.
Clin Infect Dis ; 73(11): e4179-e4188, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1561122

ABSTRACT

BACKGROUND: Nonsteroidal antiinflammatory drugs (NSAIDs) may exacerbate coronavirus disease 2019 (COVID-19) and worsen associated outcomes by upregulating the enzyme that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to in order to enter cells. METHODS: We conducted a cohort study using South Korea's nationwide healthcare database, which contains data for all individuals who received a COVID-19 test (n = 69 793) as of 8 April 2020. We identified adults hospitalized with COVID-19, where cohort entry was the date of hospitalization. NSAID users were those prescribed NSAIDs in the 7 days before and including cohort entry, and nonusers were those not prescribed NSAIDs during this period. Our primary outcome was a composite of in-hospital death, intensive care unit admission, mechanical ventilation use, and sepsis; our secondary outcomes were cardiovascular complications and acute renal failure. We conducted logistic regression analysis to estimate odds ratio (OR) with 95% confidence intervals (CIs) using inverse probability of treatment weighting to minimize confounding. RESULTS: Of 1824 adults hospitalized with COVID-19 (mean age, 49.0 years; female, 59%), 354 were NSAID users and 1470 were nonusers. Compared with nonuse, NSAID use was associated with increased risks of the primary composite outcome (OR, 1.54; 95% CI, 1.13-2.11) but insignificantly associated with cardiovascular complications (OR, 1.54; 95% CI, 0.96-2.48) or acute renal failure (OR, 1.45; 95% CI, 0.49-4.14). CONCLUSIONS: While awaiting the results of confirmatory studies, we suggest NSAIDs be used with caution for COVID-19 patients as the harms associated with their use may outweigh their benefits.


Subject(s)
COVID-19 , Pharmaceutical Preparations , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cohort Studies , Female , Hospital Mortality , Hospitalization , Humans , Middle Aged , SARS-CoV-2
18.
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.

19.
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.

20.
Pediatr Ann ; 50(6): e259-e263, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1534305

ABSTRACT

Neurological complications of coronavirus disease 2019 (COVID-19) are highly variable and can be quite severe, but they are rare in children. A careful understanding of the variety of presentations of neurological symptoms related to COVID-19 is critical for the effective management of these patients. Given the smaller numbers of children with these complications, a comprehensive review of neurological presentations in adults with COVID-19 may help facilitate the understanding of those complications that may present in children and how these presentations may be similar. [Pediatr Ann. 2021;50(6):e259-e263.].


Subject(s)
COVID-19/complications , COVID-19/psychology , Nervous System Diseases/etiology , Nervous System Diseases/microbiology , Child , Humans , SARS-CoV-2
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