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1.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(2): 216-221, 2021 Apr 28.
Artículo en Chino | MEDLINE | ID: covidwho-1225868

RESUMEN

Objective To analyze the CT characteristics of consolidation type of pulmonary cryptococcosis in immunocompetent patients,and thus improve the diagnosis of this disease. Methods A total of 20 cases with consolidation-type pulmonary cryptococcosis confirmed by pathological examinations were studied.Each patient underwent breath-hold multislice spiral CT,and 10 patients underwent contrast enhanced CT.The data including lesion number,lesion distribution,lesion density,performance of enhanced CT scan,accompanying signs,and prognosis were analyzed. Results The occurrence rates of single and multiple lesions were 80.0%(n=16)and 20.0%(n=4),respectively.In all the 16 multiple-lesion patients,the occurrence rate of unilateral lobar distribution was 56.0%(n=9).The 76 measurable lesions mainly presented subpleural distribution(71.1%,n=54)and lower pulmonary distribution(75.0%,n=57).A total of 39 lesions were detected in the 10 patients received contrast enhanced CT,in which 31 lesions(79.5%)showed homogeneous enhancement,34 lesions(87.2%)showed moderate enhancement,and all the lesions manifested angiogram sign.Consolidation lesions were accompanied by many CT signs,of which air bronchogram sign had the occurrence rate of 63.2%(n=48),including types Ⅲ(n =37)and Ⅳ(n=11).Other signs included halo signs(43/76,56.6%),vacuoles or cavities(9/76,11.8%),pleural thickening(14/20,70.0%),and pleural effusion(2/20,10.0%).After treatment,the lesions of 7 patients were basically absorbed and eventually existed in the form of fibrosis. Conclusions The lesions in the immunocompetent patients with consolidation type of pulmonary cryptococcosis usually occur in the lower lobe and close to the pleura,mainly presenting unilateral distribution.The CT angiogram signs,proximal air bronchogram signs,and halo signs are the main features of this disease,which contribute to the diagnosis.


Asunto(s)
Criptococosis , Enfermedades Pulmonares Fúngicas , Criptococosis/diagnóstico por imagen , Humanos , Pulmón , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
2.
BMJ Case Rep ; 14(5)2021 May 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1223562

RESUMEN

We describe the case of a 31-year-old man who presented with a 3-day history of right iliac fossa pain with associated nausea and vomiting. He denied any previous incidents of abdominal pain and had no relevant medical history or family history to note. Given the typical history, examination findings of localised peritonism and infection risk, he was taken to theatre for laparoscopic appendicectomy without diagnostic imaging. Intraoperatively, we noted gut malrotation and an inflammatory jejunal mass which was resected after converting to a mini-laparotomy. The inflammatory mass was reported to be an ectopic pancreatic tissue from histology. Given that this patient had tested positive for SARS-CoV-2 on admission, we propose a possible case of SARS-CoV-2 infection triggering inflammation of the ectopic pancreatic tissue.


Asunto(s)
Vólvulo Intestinal , Adulto , Humanos , Ilion , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/diagnóstico por imagen , Masculino , Páncreas/diagnóstico por imagen , Páncreas/cirugía
3.
JAMA ; 325(15): 1525-1534, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: covidwho-1222575

RESUMEN

Importance: Little is known about long-term sequelae of COVID-19. Objective: To describe the consequences at 4 months in patients hospitalized for COVID-19. Design, Setting, and Participants: In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit. Exposures: Survival of hospitalization for COVID-19. Main Outcomes and Measures: Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography. Results: Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%). Conclusions and Relevance: Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.


Asunto(s)
/complicaciones , Hospitalización , Enfermedades Pulmonares/etiología , Pulmón/patología , Anciano , Ansiedad/etiología , Trastornos del Conocimiento/etiología , Estudios de Cohortes , Depresión/etiología , Disnea/etiología , Fatiga/etiología , Femenino , Estudios de Seguimiento , Humanos , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
4.
Ann Am Thorac Soc ; 18(5): 799-806, 2021 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1219727

RESUMEN

Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment.Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone.Methods: A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms.Results: At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, P < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, P = 0.014), with significant symptomatic and radiological improvement.Conclusions: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.


Asunto(s)
Cuidados Posteriores/métodos , Glucocorticoides/uso terapéutico , Enfermedades Pulmonares Intersticiales , Pulmón , Pruebas de Función Respiratoria/métodos , /mortalidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Pulmón/virología , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/fisiopatología , Enfermedades Pulmonares Intersticiales/terapia , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Sobrevivientes/estadística & datos numéricos , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Reino Unido/epidemiología
5.
J Med Internet Res ; 23(4): e27468, 2021 04 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1219288

RESUMEN

BACKGROUND: Owing to the COVID-19 pandemic and the imminent collapse of health care systems following the exhaustion of financial, hospital, and medicinal resources, the World Health Organization changed the alert level of the COVID-19 pandemic from high to very high. Meanwhile, more cost-effective and precise COVID-19 detection methods are being preferred worldwide. OBJECTIVE: Machine vision-based COVID-19 detection methods, especially deep learning as a diagnostic method in the early stages of the pandemic, have been assigned great importance during the pandemic. This study aimed to design a highly efficient computer-aided detection (CAD) system for COVID-19 by using a neural search architecture network (NASNet)-based algorithm. METHODS: NASNet, a state-of-the-art pretrained convolutional neural network for image feature extraction, was adopted to identify patients with COVID-19 in their early stages of the disease. A local data set, comprising 10,153 computed tomography scans of 190 patients with and 59 without COVID-19 was used. RESULTS: After fitting on the training data set, hyperparameter tuning, and topological alterations of the classifier block, the proposed NASNet-based model was evaluated on the test data set and yielded remarkable results. The proposed model's performance achieved a detection sensitivity, specificity, and accuracy of 0.999, 0.986, and 0.996, respectively. CONCLUSIONS: The proposed model achieved acceptable results in the categorization of 2 data classes. Therefore, a CAD system was designed on the basis of this model for COVID-19 detection using multiple lung computed tomography scans. The system differentiated all COVID-19 cases from non-COVID-19 ones without any error in the application phase. Overall, the proposed deep learning-based CAD system can greatly help radiologists detect COVID-19 in its early stages. During the COVID-19 pandemic, the use of a CAD system as a screening tool would accelerate disease detection and prevent the loss of health care resources.


Asunto(s)
/diagnóstico por imagen , Aprendizaje Profundo , Diagnóstico por Computador , Pulmón/diagnóstico por imagen , Pulmón/virología , /aislamiento & purificación , Conjuntos de Datos como Asunto , Diagnóstico Precoz , Humanos , Pandemias , Tomografía Computarizada por Rayos X
7.
Unfallchirurg ; 124(5): 358-361, 2021 May.
Artículo en Alemán | MEDLINE | ID: covidwho-1217422

RESUMEN

The coronavirus disease 2019 (COVID-19) has spread rapidly worldwide and leads to high morbidity and mortality. Clinical experience regarding the surgical management in COVID-19 patients is limited. We report the interdisciplinary approach in a COVID-19 patient with severe thoracic trauma and pulmonary symptoms, who was admitted to the emergency unit after blunt chest trauma with dislocated serial rib fractures and concomitant hemothorax.


Asunto(s)
Fracturas de las Costillas , Traumatismos Torácicos , Heridas no Penetrantes , Anciano , Humanos , Fracturas de las Costillas/complicaciones , Fracturas de las Costillas/diagnóstico por imagen , Fracturas de las Costillas/cirugía , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/cirugía
8.
Ideggyogy Sz ; 74(3-4): 129-134, 2021 Mar 30.
Artículo en Húngaro | MEDLINE | ID: covidwho-1212100

RESUMEN

In SARS-CoV-2 positive patients with corresponding neurological symptoms the presence of carotid bifurcation macrothrombus should always be considered. Hypercoagulopathy caused by viral endotheliitis, systemic inflammation and cytokine storm play an important role in its development. Here we present two patients treated with different treatment strategies because of carotid bifurcation macrothrombus as a complication of SARS-CoV-2 infection. In both cases, the soft macrothrombus was eliminated and the patients' neurological condition were improved. Intravenous thrombolysis, acute carotid stenting with embolic filter protection device and mechanical thrombectomy with aspiration are effective treatments.


Asunto(s)
Accidente Cerebrovascular , Trombosis , Humanos , Stents , Trombectomía , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/terapia , Resultado del Tratamiento
9.
JAMA Netw Open ; 4(5): e218828, 2021 05 03.
Artículo en Inglés | MEDLINE | ID: covidwho-1210568

RESUMEN

Importance: In-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted. Objective: To describe changing in-hospital mortality rates over time after accounting for individual patient characteristics. Design, Setting, and Participants: This was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site. Main Outcomes and Measures: In-hospital death adjusted for exposures for 4 periods in 2020. Results: The registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73). Conclusions and Relevance: In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.


Asunto(s)
Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía Viral/diagnóstico por imagen , Factores de Tiempo , Factores de Edad , /terapia , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación del Resultado de la Atención al Paciente , Neumonía Viral/etiología , Sistema de Registros , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Estados Unidos/epidemiología , Signos Vitales
10.
AJR Am J Roentgenol ; 215(1): 121-126, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1211773

RESUMEN

OBJECTIVE. Confronting the new coronavirus infection known as coronavirus disease 2019 (COVID-19) is challenging and requires excluding patients with suspected COVID-19 who actually have other diseases. The purpose of this study was to assess the clinical features and CT manifestations of COVID-19 by comparing patients with COVID-19 pneumonia with patients with non-COVID-19 pneumonia who presented at a fever observation department in Shanghai, China. MATERIALS AND METHODS. Patients were retrospectively enrolled in the study from January 19 through February 6, 2020. All patients underwent real-time reverse transcription-polymerase chain reaction (RT-PCR) testing. RESULTS. Eleven patients had RT-PCR test results that were positive for severe acute respiratory syndrome coronavirus 2, whereas 22 patients had negative results. No statistical difference in clinical features was observed (p > 0.05), with the exception of leukocyte and platelet counts (p < 0.05). The mean (± SD) interval between onset of symptoms and admission to the fever observation department was 4.40 ± 2.00 and 5.52 ± 4.00 days for patients with positive and negative RT-PCR test results, respectively. The frequency of opacifications in patients with positive results and patients with negative results, respectively, was as follows: ground-glass opacities (GGOs), 100.0% versus 90.9%; mixed GGO, 63.6% versus 72.7%; and consolidation, 54.5% versus 77.3%. In patients with positive RT-PCR results, GGOs were the most commonly observed opacification (seen in 100.0% of patients) and were predominantly located in the peripheral zone (100.0% of patients), compared with patients with negative results (31.8%) (p = 0.05). The median number of affected lung lobes and segments was higher in patients with positive RT-PCR results than in those with negative RT-PCR results (five vs 3.5 affected lobes and 15 vs nine affected segments; p < 0.05). Although the air bronchogram reticular pattern was more frequently seen in patients with positive results, centrilobular nodules were less frequently seen in patients with positive results. CONCLUSION. At the point during the COVID-19 outbreak when this study was performed, imaging patterns of multifocal, peripheral, pure GGO, mixed GGO, or consolidation with slight predominance in the lower lung and findings of more extensive GGO than consolidation on chest CT scans obtained during the first week of illness were considered findings highly suspicious of COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Brotes de Enfermedades , Pulmón/diagnóstico por imagen , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Adulto , Anciano , China , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
11.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 38(2): 379-386, 2021 Apr 25.
Artículo en Chino | MEDLINE | ID: covidwho-1207916

RESUMEN

Lung diseases such as lung cancer and COVID-19 seriously endanger human health and life safety, so early screening and diagnosis are particularly important. computed tomography (CT) technology is one of the important ways to screen lung diseases, among which lung parenchyma segmentation based on CT images is the key step in screening lung diseases, and high-quality lung parenchyma segmentation can effectively improve the level of early diagnosis and treatment of lung diseases. Automatic, fast and accurate segmentation of lung parenchyma based on CT images can effectively compensate for the shortcomings of low efficiency and strong subjectivity of manual segmentation, and has become one of the research hotspots in this field. In this paper, the research progress in lung parenchyma segmentation is reviewed based on the related literatures published at domestic and abroad in recent years. The traditional machine learning methods and deep learning methods are compared and analyzed, and the research progress of improving the network structure of deep learning model is emphatically introduced. Some unsolved problems in lung parenchyma segmentation were discussed, and the development prospect was prospected, providing reference for researchers in related fields.


Asunto(s)
Humanos , Pulmón/diagnóstico por imagen , Aprendizaje Automático , Tomografía Computarizada por Rayos X
12.
BMJ Case Rep ; 14(4)2021 Apr 27.
Artículo en Inglés | MEDLINE | ID: covidwho-1206018

RESUMEN

A middle-aged woman with diabetes presented with left-sided facial pain, complete ptosis and fever of short duration. On presentation, she had hyperglycaemia without ketosis. There was total ophthalmoplegia of the left eye with a visual acuity of 6/36. She incidentally tested positive for COVID-19. CT paranasal sinus and MRI brain revealed left-sided pansinusitis with acute infarct in the left parieto-occipital region without angioinvasion. An emergency functional endoscopic sinus procedure was done, which confirmed mucormycosis on histopathological examination. After 1 week of conventional amphotericin B and antibiotics, repeat CT brain showed improvement in mucosal thickening and sinusitis. This case is a rare presentation of mucormycosis associated with rapid progression to orbital apex syndrome with brain infarction in a patient with non-ketotic diabetes and COVID-19. Early diagnosis and treatment are essential to prevent further end-organ damage. It is also interesting that there was no angioinvasion and transient periarterial inflammation was attributed to brain infarction.


Asunto(s)
Blefaroptosis/complicaciones , Complicaciones de la Diabetes , Mucormicosis/diagnóstico , Oftalmoplejía/complicaciones , Enfermedades Orbitales/complicaciones , Enfermedades de los Senos Paranasales/complicaciones , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Encéfalo/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Mucormicosis/tratamiento farmacológico , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/etiología , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
13.
BMC Pulm Med ; 21(1): 136, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1204068

RESUMEN

BACKGROUND: All over the world, SARS-CoV-2 pneumonia is causing a significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients are still unknown. METHODS: In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. At three months patients underwent radiological and functional follow-up through CT scan, lung function tests, and 6 min walking test. Furthermore, quality of life was assessed through self-reported questionnaires. RESULTS: Among 39 patients with SARS-CoV-2 pneumonia, 32 (82% of all participants) presented abnormalities in CT scan and 25 (64.1%) had lung function tests impairment at three months. Moreover, 31 patients (79.5%) reported a perception of poor health due to respiratory symptoms and all 39 patients showed an overall decreased quality of life. CONCLUSIONS: Medium-term follow up at three months of patients diagnosed with SARS-CoV-2 pneumonia shows the persistence of abnormalities in CT scans, a significant functional impairment assessed by lung function tests and a decreased quality of life in affected patients. Further studies evaluating the long-term impact are warranted to guarantee an appropriate follow-up to patients recovering from SARS-CoV-2 pneumonia.


Asunto(s)
/fisiopatología , Pulmón/fisiopatología , Calidad de Vida , Anciano , Convalecencia , Femenino , Volumen Espiratorio Forzado , Estado de Salud , Humanos , Tiempo de Internación , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Capacidad de Difusión Pulmonar , Recuperación de la Función , Pruebas de Función Respiratoria , Suiza , Tomografía Computarizada por Rayos X , Capacidad Vital , Prueba de Paso
14.
BMC Pregnancy Childbirth ; 21(1): 326, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1204051

RESUMEN

BACKGROUND: Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS: Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS: A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS: Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.


Asunto(s)
/epidemiología , Portador Sano/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , /fisiopatología , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Comorbilidad , Tos/fisiopatología , Diabetes Gestacional/epidemiología , Disnea/fisiopatología , Femenino , Fiebre/fisiopatología , Edad Gestacional , Humanos , Hipertensión/epidemiología , Hipotiroidismo/epidemiología , Factores Inmunológicos/uso terapéutico , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pulmón/diagnóstico por imagen , Masculino , Obesidad Materna/epidemiología , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Radiografía Torácica , Respiración Artificial , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiología
16.
Radiology ; 299(2): E230-E240, 2021 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1203991

RESUMEN

Background It is unknown if there are cardiac abnormalities in persons who have recovered from coronavirus disease 2019 (COVID-19) without cardiac symptoms or in those who have normal biomarkers and normal electrocardiograms. Purpose To evaluate cardiac involvement in participants who had recovered from COVID-19 without clinical evidence of cardiac involvement by using cardiac MRI. Materials and Methods This prospective observational cohort study included 40 participants who had recovered from COVID-19 with moderate (n = 24) or severe (n = 16) pneumonia and who had no cardiovascular medical history, were without cardiac symptoms, had normal electrocardiograms, had normal serologic cardiac enzyme levels, and had been discharged for more than 90 days between May and September 2020. Demographic characteristics were recorded, serum cardiac enzyme levels were measured, and cardiac MRI was performed. Cardiac function, native T1, extracellular volume fraction (ECV), and two-dimensional (2D) strain were quantitatively evaluated and compared with values in control subjects (n = 25). Comparisons among the three groups were performed by using one-way analysis of variance with Bonferroni-corrected post hoc comparisons (for normal distribution) or Kruskal-Wallis tests with post hoc pairwise comparisons (for nonnormal distribution). Results Forty participants (mean age, 54 years ± 12 [standard deviation]; 24 men) were enrolled; participants had a mean time between admission and cardiac MRI of 158 days ± 18 and between discharge and cardiac MRI examination of 124 days ± 17. There were no left or right ventricular size or functional differences between participants who had recovered from COVID-19 and healthy control subjects. Only one (3%) participant had positive late gadolinium enhancement located at the mid inferior wall. Global ECV values were elevated in participants who had recovered from COVID-19 with moderate or severe pneumonia compared with those in healthy control subjects (median ECV, 29.7% vs 31.4% vs 25.0%, respectively; interquartile range, 28.0%-32.9% vs 29.3%-34.0% vs 23.7%-26.0%, respectively; P < .001 for both). The 2D global left ventricular longitudinal strain was reduced in both groups of participants (moderate COVID-19 group, -12.5% [interquartile range, -15.5% to -10.7%]; severe COVID-19 group, -12.5% [interquartile range, -15.4% to -8.7%]) compared with the healthy control group (-15.4% [interquartile range, -17.6% to -14.6%]) (P = .002 and P = .001, respectively). Conclusion Cardiac MRI myocardial tissue and strain imaging parameters suggest that a proportion of participants who had recovered from COVID-19 had subclinical myocardial abnormalities detectable months after recovery. © RSNA, 2021 Online supplemental material is available for this article.


Asunto(s)
/complicaciones , Cardiopatías/etiología , Cardiopatías/fisiopatología , Imagen por Resonancia Magnética/métodos , China , Estudios de Cohortes , Femenino , Corazón/diagnóstico por imagen , Corazón/fisiopatología , Cardiopatías/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
17.
Nat Commun ; 12(1): 2417, 2021 04 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1203428

RESUMEN

SARS-CoV-2 uses ACE2, an inhibitor of the Renin-Angiotensin-Aldosterone System (RAAS), for cellular entry. Studies indicate that RAAS imbalance worsens the prognosis in COVID-19. We present a consecutive retrospective COVID-19 cohort with findings of frequent pulmonary thromboembolism (17%), high pulmonary artery pressure (60%) and lung MRI perfusion disturbances. We demonstrate, in swine, that infusing angiotensin II or blocking ACE2 induces increased pulmonary artery pressure, reduces blood oxygenation, increases coagulation, disturbs lung perfusion, induces diffuse alveolar damage, and acute tubular necrosis compared to control animals. We further demonstrate that this imbalanced state can be ameliorated by infusion of an angiotensin receptor blocker and low-molecular-weight heparin. In this work, we show that a pathophysiological state in swine induced by RAAS imbalance shares several features with the clinical COVID-19 presentation. Therefore, we propose that severe COVID-19 could partially be driven by a RAAS imbalance.


Asunto(s)
/fisiopatología , Pulmón/fisiopatología , Sistema Renina-Angiotensina/fisiología , /aislamiento & purificación , Angiotensina II/administración & dosificación , Angiotensina II/metabolismo , Antagonistas de Receptores de Angiotensina/administración & dosificación , /metabolismo , Animales , /virología , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/virología , Imagen por Resonancia Magnética/métodos , Unión Proteica/efectos de los fármacos , Estudios Retrospectivos , /fisiología , Glicoproteína de la Espiga del Coronavirus/metabolismo , Porcinos , Internalización del Virus/efectos de los fármacos
18.
Heart Surg Forum ; 24(2): E372-E374, 2021 04 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1199988

RESUMEN

The world has suffered over the past year under COVID-19. Unfortunately, people still are getting sick from other, also severe, diseases. Although the COVID-19 infection is present, patients need treatment for other life-threatening conditions. We present the case of a 36-year-old patient with severe infective endocarditis with a large abscess of the aortic root, who also is COVID-19 positive. Definitive diagnostics and treatment were avoided due to COVID-19 infection. In the end, emergent surgery was indicated due to acute cardiac decompensation and the development of heart failure symptoms, and the patient recovered uneventfully after surgery.


Asunto(s)
Absceso/microbiología , Absceso/cirugía , Enfermedades de la Aorta/microbiología , Enfermedades de la Aorta/cirugía , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/terapia , Absceso/diagnóstico por imagen , Adulto , Enfermedades de la Aorta/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Masculino , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/microbiología , Derrame Pleural/cirugía , Neumonía Viral/complicaciones , Neumonía Viral/virología , Respiración Artificial
20.
Skelet Muscle ; 11(1): 10, 2021 04 21.
Artículo en Inglés | MEDLINE | ID: covidwho-1197351

RESUMEN

BACKGROUND: SARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure. CASE PRESENTATION: We addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis. CONCLUSION: We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.


Asunto(s)
/fisiopatología , Creatina Quinasa/sangre , Músculo Esquelético/fisiopatología , Enfermedades Musculares/fisiopatología , Cuadriplejía/fisiopatología , /fisiopatología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Adulto , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , /terapia , Enfermedad Crítica , Dexametasona/uso terapéutico , Electromiografía , Glucocorticoides/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Unidades de Cuidados Intensivos , Imagen por Resonancia Magnética , Masculino , Staphylococcus aureus Resistente a Meticilina , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Enfermedades Musculares/sangre , Enfermedades Musculares/diagnóstico , Enfermedades Musculares/etiología , Conducción Nerviosa , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Embolia Pulmonar/fisiopatología , Cuadriplejía/etiología , Respiración Artificial , /terapia , Índice de Severidad de la Enfermedad , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Desconexión del Ventilador
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