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1.
J Pediatr ; 224: 141-145, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-727666

RESUMEN

We report on the presentation and course of 33 children with multisystem inflammatory syndrome in children and confirmed severe acute respiratory syndrome coronavirus 2 infection. Hemodynamic instability and cardiac dysfunction were prominent findings, with most patients exhibiting rapid resolution following anti-inflammatory therapy.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Adolescente , Antiinflamatorios/uso terapéutico , Betacoronavirus , Niño , Preescolar , Aneurisma Coronario , Infecciones por Coronavirus/tratamiento farmacológico , Femenino , Fiebre , Humanos , Inflamación , Masculino , Síndrome Mucocutáneo Linfonodular/diagnóstico , Ciudad de Nueva York , Pandemias , Estudios Retrospectivos , Choque/complicaciones , Resultado del Tratamiento , Disfunción Ventricular Izquierda/complicaciones
3.
Am J Transplant ; 20(7): 1819-1825, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-642184

RESUMEN

There is minimal information on coronavirus disease 2019 (COVID-19) in immunocompromised individuals. We have studied 10 patients treated at 12 adult care hospitals. Ten kidney transplant recipients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, and 9 were admitted. The median age was 57 (interquartile range [IQR] 47-67), 60% were male, 40% Caucasian, and 30% Black/African American. Median time from transplant to COVID-19 testing was 2822 days (IQR 1272-4592). The most common symptom was fever, followed by cough, myalgia, chills, and fatigue. The most common chest X-ray and computed tomography abnormality was multifocal patchy opacities. Three patients had no abnormal findings. Leukopenia was seen in 20% of patients, and allograft function was stable in 50% of patients. Nine patients were on tacrolimus and a mycophenolic antimetabolite, and 70% were on prednisone. Hospitalized patients had their antimetabolite agent stopped. All hospitalized patients received hydroxychloroquine and azithromycin. Three patients died (30%), and 5 (50%) developed acute kidney injury. Kidney transplant recipients infected with COVID-19 should be monitored closely in the setting of lowered immunosuppression. Most individuals required hospitalization and presenting symptoms were similar to those of nontransplant individuals.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Neumonía Viral/complicaciones , Receptores de Trasplantes , Anciano , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Cuidados Críticos , Registros Electrónicos de Salud , Femenino , Hospitalización , Humanos , Huésped Inmunocomprometido , Inmunosupresión/efectos adversos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/virología , Masculino , Persona de Mediana Edad , New York/epidemiología , Pandemias , Neumonía Viral/mortalidad
4.
Clin Infect Dis ; 2020 Jul 08.
Artículo en Inglés | MEDLINE | ID: covidwho-637669

RESUMEN

BACKGROUND: In March 2020, the greater New York metropolitan area became an epicenter for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The initial evolution of case incidence has not been well characterized. METHODS: Northwell Health Laboratories tested 46,793 persons for SARS-CoV-2 from March 4 through April 10. The primary outcome measure was a positive reverse-transcription-polymerase-chain-reaction (RT-PCR) test for SARS-CoV-2. The secondary outcomes included patient age, sex, and race if stated; dates the specimen was obtained and the test result; clinical practice site sources; geo-location of patient residence; and hospitalization. RESULTS: From March 8 through April 10, a total of 26,735 of 46,793 persons (57.1%) tested positive for SARS-CoV-2.  Males of each race were disproportionally more affected than females above age 25, with a progressive male predominance as age increased. Of the positive persons, 7,292 were hospitalized directly upon presentation; an additional 882 persons tested positive in an ambulatory setting before subsequent hospitalization, a median of 4.8 days later. Total hospitalization rate was thus 8,174 persons (30.6% of positive persons). There was a broad range (greater than 10-fold) in the cumulative number of positive cases across individual zip codes following documented first case incidents. Test positivity was greater for persons living in zip codes with lower annual household income. CONCLUSIONS: Our data reveal that SARS-CoV-2 incidence emerged rapidly and almost simultaneously across a broad demographic population in the region. These findings support the hypothesis that SARS-CoV-2 infection was widely distributed prior to virus testing availability.

5.
J Pediatr ; 224: 141-145, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-597862

RESUMEN

We report on the presentation and course of 33 children with multisystem inflammatory syndrome in children and confirmed severe acute respiratory syndrome coronavirus 2 infection. Hemodynamic instability and cardiac dysfunction were prominent findings, with most patients exhibiting rapid resolution following anti-inflammatory therapy.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Adolescente , Antiinflamatorios/uso terapéutico , Betacoronavirus , Niño , Preescolar , Aneurisma Coronario , Infecciones por Coronavirus/tratamiento farmacológico , Femenino , Fiebre , Humanos , Inflamación , Masculino , Síndrome Mucocutáneo Linfonodular/diagnóstico , Ciudad de Nueva York , Pandemias , Estudios Retrospectivos , Choque/complicaciones , Resultado del Tratamiento , Disfunción Ventricular Izquierda/complicaciones
6.
Eur J Prev Cardiol ; : 2047487320928175, 2020 Jun 02.
Artículo en Inglés | MEDLINE | ID: covidwho-459463
7.
JAMA ; 323(20): 2052-2059, 2020 May 26.
Artículo en Inglés | MEDLINE | ID: covidwho-101977

RESUMEN

Importance: There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19). Objective: To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system. Design, Setting, and Participants: Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. Exposures: Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission. Main Outcomes and Measures: Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected. Results: A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/min, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1). Conclusions and Relevance: This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.

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