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1.
JMIR Public Health Surveill ; 6(3): e21163, 2020 07 17.
Artículo en Inglés | MEDLINE | ID: covidwho-690445

RESUMEN

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. OBJECTIVE: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. METHODS: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase-polymerase chain reaction; absence of symptoms for ≥14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. RESULTS: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for ≥14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). CONCLUSIONS: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Hogares para Ancianos , Aplicaciones Móviles , Casas de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Anciano , Infecciones por Coronavirus/epidemiología , Difusión de Innovaciones , Humanos , Cuidados a Largo Plazo , Neumonía Viral/epidemiología , España/epidemiología
3.
Med Sci Monit ; 26: e925047, 2020 Jul 28.
Artículo en Inglés | MEDLINE | ID: covidwho-689085

RESUMEN

BACKGROUND The aim of this study was to describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and compare these parameters in an elderly group with those in a younger group. MATERIAL AND METHODS This retrospective, single-center observational study included 69 hospitalized patients with laboratory-confirmed COVID-19 from a tertiary hospital in Wuhan, China, between January 14, 2020, and February 26, 2020. Epidemiological, demographic, clinical, and laboratory data, as well as treatments, complications, and outcomes were extracted from electronic medical records and compared between elderly patients (aged ≥60 years) and younger patients (aged <60 years). Patients were followed until March 19, 2020. RESULTS Elderly patients had more complications than younger patients, including acute respiratory distress syndrome (ARDS; 9/25, 36% vs. 5/44, 11.4%) and cardiac injury (7/25, 28% vs. 1/44, 2.3%), and they were more likely to be admitted to the intensive care unit (6/25, 24% vs. 2/44, 4.5%). As of March 19, 2020, 60/69 (87%) of the patients had been discharged, 6/69 (8.7%) had died, and 3/69 (4.3%) remained in the hospital. Of those who were discharged or died, the median duration of hospitalization was 13.5 days (interquartile range, 10-18 days). CONCLUSIONS Elderly patients with confirmed COVID-19 were more likely to develop ARDS and cardiac injury than younger patients and were more likely to be admitted to the intensive care unit. In addition to routine monitoring and respiratory support, cardiac monitoring and supportive care should be a focus in elderly patients with COVID-19.


Asunto(s)
Factores de Edad , Infecciones por Coronavirus/epidemiología , Cardiopatías/epidemiología , Pandemias , Neumonía Viral/epidemiología , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , China/epidemiología , Terapia Combinada , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/terapia , Cardiopatías/etiología , Humanos , Pacientes Internos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/etiología , Cuidados Paliativos/estadística & datos numéricos , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Síndrome de Dificultad Respiratoria del Adulto/etiología , Estudios Retrospectivos , Centros de Atención Terciaria , Resultado del Tratamiento , Adulto Joven
4.
J Infect ; 80(6): 639-645, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-688316

RESUMEN

OBJECTIVE: To investigate the characteristics and prognostic factors in the elderly patients with COVID-19. METHODS: Consecutive cases over 60 years old with COVID-19 in Renmin Hospital of Wuhan University from Jan 1 to Feb 6, 2020 were included. The primary outcomes were death and survival till March 5. Data of demographics, clinical features, comorbidities, laboratory tests and complications were collected and compared for different outcomes. Cox regression was performed for prognostic factors. RESULTS: 339 patients with COVID-19 (aged 71±8 years,173 females (51%)) were enrolled, including 80 (23.6%) critical, 159 severe (46.9%) and 100 moderate (29.5%) cases. Common comorbidities were hypertension (40.8%), diabetes (16.0%) and cardiovascular disease (15.7%). Common symptoms included fever (92.0%), cough (53.0%), dyspnea (40.8%) and fatigue (39.9%). Lymphocytopenia was a common laboratory finding (63.2%). Common complications included bacterial infection (42.8%), liver enzyme abnormalities (28.7%) and acute respiratory distress syndrome (21.0%). Till Mar 5, 2020, 91 cases were discharged (26.8%), 183 cases stayed in hospital (54.0%) and 65 cases (19.2%) were dead. Shorter length of stay was found for the dead compared with the survivors (5 (3-8) vs. 28 (26-29), P < 0.001). Symptoms of dyspnea (HR 2.35, P = 0.001), comorbidities including cardiovascular disease (HR 1.86, P = 0.031) and chronic obstructive pulmonary disease (HR 2.24, P = 0.023), and acute respiratory distress syndrome (HR 29.33, P < 0.001) were strong predictors of death. And a high level of lymphocytes was predictive of better outcome (HR 0.10, P < 0.001). CONCLUSIONS: High proportion of severe to critical cases and high fatality rate were observed in the elderly COVID-19 patients. Rapid disease progress was noted in the dead with a median survival time of 5 days after admission. Dyspnea, lymphocytopenia, comorbidities including cardiovascular disease and chronic obstructive pulmonary disease, and acute respiratory distress syndrome were predictive of poor outcome. Close monitoring and timely treatment should be performed for the elderly patients at high risk.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Anciano , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/patología , Pronóstico , Análisis de Supervivencia
5.
J Infect Dis ; 221(11): 1762-1769, 2020 05 11.
Artículo en Inglés | MEDLINE | ID: covidwho-688308

RESUMEN

BACKGROUND: In December 2019, novel coronavirus (SARS-CoV-2) pneumonia (COVID-19) was reported in Wuhan and has since rapidly spread throughout China. We aimed to clarify the characteristics and clinical significance of peripheral lymphocyte subset alteration in COVID-19. METHODS: The levels of peripheral lymphocyte subsets were measured by flow cytometry in 60 hospitalized COVID-19 patients before and after treatment, and their association with clinical characteristics and treatment efficacy was analyzed. RESULTS: Total lymphocytes, CD4+ T cells, CD8+ T cells, B cells, and natural killer (NK) cells decreased in COVID-19 patients, and severe cases had a lower level than mild cases. The subsets showed a significant association with inflammatory status in COVID-19, especially CD8+ T cells and CD4+/CD8+ ratio. After treatment, 37 patients (67%) showed clinical response, with an increase in CD8+ T cells and B cells. No significant change in any subset was detected in nonresponsive cases. In multivariate analysis, posttreatment decrease in CD8+ T cells and B cells and increase in CD4+/CD8+ ratio were indicated as independent predictors of poor efficacy. CONCLUSIONS: Peripheral lymphocyte subset alteration was associated with clinical characteristics and treatment efficacy of COVID-19. CD8+ T cells tended to be an independent predictor for COVID-19 severity and treatment efficacy.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Subgrupos Linfocitarios , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía/etiología , Neumonía/fisiopatología , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , China , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Citometría de Flujo , Humanos , Recuento de Linfocitos , Subgrupos Linfocitarios/inmunología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía/diagnóstico , Neumonía/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Pronóstico , Resultado del Tratamiento
6.
Lancet Infect Dis ; 20(6): 669-677, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-688245

RESUMEN

BACKGROUND: In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring and ascertainment biases. METHODS: We collected individual-case data for patients who died from COVID-19 in Hubei, mainland China (reported by national and provincial health commissions to Feb 8, 2020), and for cases outside of mainland China (from government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, until Feb 25, 2020). These individual-case data were used to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the case fatality ratio by relating the aggregate distribution of cases to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for demography and age-based and location-based under-ascertainment. We also estimated the case fatality ratio from individual line-list data on 1334 cases identified outside of mainland China. Using data on the prevalence of PCR-confirmed cases in international residents repatriated from China, we obtained age-stratified estimates of the infection fatality ratio. Furthermore, data on age-stratified severity in a subset of 3665 cases from China were used to estimate the proportion of infected individuals who are likely to require hospitalisation. FINDINGS: Using data on 24 deaths that occurred in mainland China and 165 recoveries outside of China, we estimated the mean duration from onset of symptoms to death to be 17·8 days (95% credible interval [CrI] 16·9-19·2) and to hospital discharge to be 24·7 days (22·9-28·1). In all laboratory confirmed and clinically diagnosed cases from mainland China (n=70 117), we estimated a crude case fatality ratio (adjusted for censoring) of 3·67% (95% CrI 3·56-3·80). However, after further adjusting for demography and under-ascertainment, we obtained a best estimate of the case fatality ratio in China of 1·38% (1·23-1·53), with substantially higher ratios in older age groups (0·32% [0·27-0·38] in those aged <60 years vs 6·4% [5·7-7·2] in those aged ≥60 years), up to 13·4% (11·2-15·9) in those aged 80 years or older. Estimates of case fatality ratio from international cases stratified by age were consistent with those from China (parametric estimate 1·4% [0·4-3·5] in those aged <60 years [n=360] and 4·5% [1·8-11·1] in those aged ≥60 years [n=151]). Our estimated overall infection fatality ratio for China was 0·66% (0·39-1·33), with an increasing profile with age. Similarly, estimates of the proportion of infected individuals likely to be hospitalised increased with age up to a maximum of 18·4% (11·0-37·6) in those aged 80 years or older. INTERPRETATION: These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death. FUNDING: UK Medical Research Council.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Pandemias/estadística & datos numéricos , Neumonía Viral/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Niño , Preescolar , China/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Persona de Mediana Edad , Modelos Estadísticos , Adulto Joven
7.
JCI Insight ; 5(10)2020 05 21.
Artículo en Inglés | MEDLINE | ID: covidwho-687860

RESUMEN

BACKGROUNDThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a novel viral pneumonia (COVID-19), which is rapidly spreading throughout the world. The positive result of nucleic acid test is a golden criterion to confirm SARS-CoV-2 infection, but the detection features remain unclear.METHODSWe performed a retrospective analysis in 5630 high-risk individuals receiving SARS-CoV-2 nucleic acid tests in Wuhan, China, and investigated their characteristics and diagnosis rates.RESULTSThe overall diagnosis rate was 34.7% (1952/5630). Male (P = 0.025) and older populations (P = 2.525 × 10-39) were at significantly higher risk of SARS-CoV-2 infection. People were generally susceptible, and most cases concentrated in people of 30-79 years. Furthermore, we investigated the association between diagnosis rate and the amount of testing in 501 subjects. Results revealed a 1.27-fold improvement (from 27.9% to 35.5%) of diagnosis rate from testing once to twice (P = 5.847 × 10-9) and a 1.43-fold improvement (from 27.9% to 39.9%) from testing once to 3 times (P = 7.797 × 10-14). More than 3 testing administrations was not helpful for further improvement. However, this improvement was not observed in subjects with pneumonia (P = 0.097).CONCLUSIONAll populations are susceptible to SARS-CoV-2 infection, and male and older-aged populations are at significantly higher risk. Increasing the amount of testing could significantly improve diagnosis rates, except for subjects with pneumonia. It is recommended to test twice in those high-risk individuals whose results are negative the first time, and performing 3 tests is better, if possible.FUNDINGThis work was supported by National Mega Project on Major Infectious Disease Prevention (no. 2017ZX10103005-007) and National Key Research and Development Program of China (no. 2018YFE0204500).


Asunto(s)
Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China/epidemiología , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Técnicas de Diagnóstico Molecular , Pandemias , Neumonía Viral/epidemiología , ARN Viral/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Factores Sexuales , Adulto Joven
8.
Eur Rev Med Pharmacol Sci ; 24(9): 5186-5188, 2020 05.
Artículo en Inglés | MEDLINE | ID: covidwho-687446

RESUMEN

From two COVID-19-related deaths, samples of lung, heart and kidney were collected and processed for Transmission and Scanning Electron Microscopy (TEM and SEM) with the aim of identifying the virus. Virions of SARS-CoV-2 were found in all tissues by TEM and SEM, corroborating the hypothesis that the virus enters the cells of different organs. This is the first report identifying SARS-CoV-2 in different human tissues by TEM and SEM.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Betacoronavirus/ultraestructura , Infecciones por Coronavirus/virología , Corazón/virología , Riñón/virología , Pulmón/virología , Neumonía Viral/virología , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/patología , Femenino , Humanos , Riñón/patología , Pulmón/patología , Masculino , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Pandemias , Neumonía Viral/patología
10.
Acad Emerg Med ; 27(6): 461-468, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-686322

RESUMEN

OBJECTIVES: Rapid and early severity-of-illness assessment appears to be important for critically ill patients with novel coronavirus disease (COVID-19). This study aimed to evaluate the performance of the rapid scoring system on admission of these patients. METHODS: A total of 138 medical records of critically ill patients with COVID-19 were included in the study. Demographic and clinical characteristics on admission used for calculating Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) and outcomes (survival or death) were collected for each case and extracted for analysis. All patients were divided into two age subgroups (<65 years and ≥65 years). The receiver operating characteristic (ROC) curve analyses were performed for overall patients and both subgroups. RESULTS: The median [25th quartile, 75th quartile] of MEWS of survivors versus nonsurvivors were 1 [1, 2] and 2 [1, 3] and those of REMS were 5 [2, 6] and 7 [6, 10], respectively. In overall analysis, the area under the ROC curve for the REMS in predicting mortality was 0.833 (95% confidence interval [CI] = 0.737 to 0.928), higher than that of MEWS (0.677, 95% CI = 0.541 to 0.813). An optimal cutoff of REMS (≥6) had a sensitivity of 89.5%, a specificity of 69.8%, a positive predictive value of 39.5%, and a negative predictive value of 96.8%. In the analysis of subgroup of patients aged <65 years, the area under the ROC curve for the REMS in predicting mortality was 0.863 (95% CI = 0.743 to 0.941), higher than that of MEWS (0.603, 95% CI = 0.462 to 0.732). CONCLUSION: To our knowledge, this study was the first exploration on rapid scoring systems for critically ill patients with COVID-19. The REMS could provide emergency clinicians with an effective adjunct risk stratification tool for critically ill patients with COVID-19, especially for the patients aged <65 years. The effectiveness of REMS for screening these patients is attributed to its high negative predictive value.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Presión Sanguínea , Trastornos Cerebrovasculares/epidemiología , China , Comorbilidad , Coronavirus , Enfermedad Crítica , Puntuación de Alerta Temprana , Medicina de Emergencia , Femenino , Escala de Coma de Glasgow , Humanos , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Oxígeno/metabolismo , Pandemias , Pronóstico , Curva ROC , Frecuencia Respiratoria , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad
11.
Circulation ; 142(2): 114-128, 2020 07 14.
Artículo en Inglés | MEDLINE | ID: covidwho-684109

RESUMEN

BACKGROUND: To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center. METHODS: We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT. RESULTS: Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 µg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 µg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010). CONCLUSIONS: The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Trombosis de la Vena/diagnóstico , Adulto , Anciano , Anticoagulantes/uso terapéutico , Betacoronavirus/aislamiento & purificación , Presión Sanguínea , China/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Estimación de Kaplan-Meier , Extremidad Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Prevalencia , Pronóstico , Frecuencia Respiratoria , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/epidemiología
12.
Invest Radiol ; 55(5): 257-261, 2020 05.
Artículo en Inglés | MEDLINE | ID: covidwho-684015

RESUMEN

OBJECTIVES: The aim of this study was to investigate the chest computed tomography (CT) findings in patients with confirmed coronavirus disease 2019 (COVID-19) and to evaluate its relationship with clinical features. MATERIALS AND METHODS: Study sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, and the relationship between them was analyzed. RESULTS: Totally, 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58 (73%) of the 80 patients had cough, and 61 (76%) of the 80 patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (73/80 cases, 91%), consolidation (50/80 cases, 63%), and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12 ± 6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%), and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index value was (34% ± 20%) for all the patients. Correlation analysis showed that the pulmonary inflammation index value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset, and body temperature (P < 0.05). CONCLUSIONS: The common chest CT findings of COVID-19 are multiple ground glass opacity, consolidation, and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. Computed tomography plays an important role in the diagnosis and evaluation of this emerging global health emergency.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/patología , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/patología , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/virología , Tos/virología , Femenino , Fiebre/virología , Humanos , Pulmón/patología , Pulmón/virología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Estudios Retrospectivos , Tórax/diagnóstico por imagen , Tórax/virología , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
13.
Radiology ; 296(2): E97-E104, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-683271

RESUMEN

Background A categorical CT assessment scheme for suspicion of pulmonary involvement of coronavirus disease 2019 (COVID-19 provides a basis for gathering scientific evidence and improved communication with referring physicians. Purpose To introduce the COVID-19 Reporting and Data System (CO-RADS) for use in the standardized assessment of pulmonary involvement of COVID-19 on unenhanced chest CT images and to report its initial interobserver agreement and performance. Materials and Methods The Dutch Radiological Society developed CO-RADS based on other efforts for standardization, such as the Lung Imaging Reporting and Data System or Breast Imaging Reporting and Data System. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients with moderate to severe symptoms of COVID-19. The system was evaluated by using 105 chest CT scans of patients admitted to the hospital with clinical suspicion of COVID-19 and in whom reverse transcription-polymerase chain reaction (RT-PCR) was performed (mean, 62 years ± 16 [standard deviation]; 61 men, 53 with positive RT-PCR results). Eight observers used CO-RADS to assess the scans. Fleiss κ value was calculated, and scores of individual observers were compared with the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared with results from RT-PCR and clinical diagnosis of COVID-19. Results There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss κ value was 0.47 (95% confidence interval [CI]: 0.45, 0.47), with the highest κ value for CO-RADS categories 1 (0.58, 95% CI: 0.54, 0.62) and 5 (0.68, 95% CI: 0.65, 0.72). The average AUC was 0.91 (95% CI: 0.85, 0.97) for predicting RT-PCR outcome and 0.95 (95% CI: 0.91, 0.99) for clinical diagnosis. The false-negative rate for CO-RADS 1 was nine of 161 cases (5.6%; 95% CI: 1.0%, 10%), and the false-positive rate for CO-RADS category 5 was one of 286 (0.3%; 95% CI: 0%, 1.0%). Conclusion The coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) is a categorical assessment scheme for pulmonary involvement of COVID-19 at unenhanced chest CT that performs very well in predicting COVID-19 in patients with moderate to severe symptoms and has substantial interobserver agreement, especially for categories 1 and 5. © RSNA, 2020 Online supplemental material is available for this article.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/normas , Adulto , Anciano , Comunicación , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Países Bajos , Variaciones Dependientes del Observador , Pandemias , Sistemas de Información Radiológica , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Tomografía Computarizada por Rayos X/métodos
14.
Geriatr Gerontol Int ; 20(7): 715-719, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-682347

RESUMEN

AIM: To clarify the association of cluster number and size of coronavirus disease 2019 (COVID-19) in long-term care (LTC) hospitals/facilities, general medical/welfare facilities and non-medical/welfare facilities with morbidity and mortality in 47 prefectures during 16 January to 9 May 2020 in Japan. METHODS: Information on COVID-19 clusters (n ≥2), and morbidity and mortality of COVID-19 was collected. RESULTS: A total of 381 clusters with 3786 infected cases were collected, accounting for 23.9% of 15 852 cumulated cases on 9 May 2020. Although the cluster number (/107 subjects) in LTC hospitals/facilities was significantly smaller compared with those in the other two groups, the cluster size in LTC hospitals/facilities was significantly larger than that in non-medical/welfare facilities. Cluster numbers in general medical/welfare facilities and in non-medical/welfare facilities were significantly positively correlated with morbidity (/105 ), indicating relatively early identification of clusters in these facilities. Unlike in these facilities, cluster size in LTC hospitals/facilities was significantly positively correlated with morbidity, indicating that clusters in LTC hospitals/facilities were finally identified after already having grown to a large size in areas where infection was prevalent. Multivariate logistic regression analysis showed that both cluster number and cluster size only in LTC hospitals/facilities were independently associated with higher mortality (≥median 0.64/105 subjects) after adjustment. CONCLUSIONS: Preventive efforts against COVID-19 outbreaks even at the early phase of the epidemic are critically important in LTC hospitals/facilities, as both the larger number and size of clusters only in LTC hospitals/facilities were independently linked to higher mortality in prefectures in Japan. Geriatr Gerontol Int 2020; 20: 715-719.


Asunto(s)
Infecciones por Coronavirus , Hospitales de Enfermedades Crónicas/estadística & datos numéricos , Cuidados a Largo Plazo , Pandemias , Neumonía Viral , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Anciano , Betacoronavirus/aislamiento & purificación , Análisis por Conglomerados , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Control de Infecciones/organización & administración , Japón/epidemiología , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/organización & administración , Cuidados a Largo Plazo/tendencias , Masculino , Mortalidad , Pandemias/prevención & control , Neumonía Viral/mortalidad , Neumonía Viral/prevención & control
16.
Psychother Psychosom Med Psychol ; 70(7): 272-282, 2020 Jul.
Artículo en Alemán | MEDLINE | ID: covidwho-680660

RESUMEN

BACKGROUND: International studies point to increased mental health problems of medical staff during the Corona pandemic (COVID-19). This is the first study to investigate mental health, i. e. adjustment disorder, depression, stress symptoms, Corona related fears as well as coping mechanisms in this group in a German-speaking country. MATERIAL AND METHODS: In April 2020, N=100 subjects were recruited that currently are engaged in a hospital. A series of standardized assessments were included: adjustment disorder (ADNM-20), depression (PHQ-9), stress symptoms and coping strategies (SCI). Currently, cross-sectional data are analyzed, because the study is still going on and longitudinal data is not yet assessed. RESULTS: Frequencies of adjustment disorder and depression are 8 and 15%, respectively. Two hierarchical regression models were run to predict adjustment disorder and depression; predictive power was higher for the first (41 vs. 35%). Fear of infection was reported to be higher regarding one's family than oneself. Nursing staff, those with preloads, and women were found to report more mental health problems. Those with direct contact to people that fell ill with COVID-19 did not differ from those with no direct contact. DISCUSSION: Currently, medical staff has a high risk for being mentally stressed. China, being epidemically experienced, has published principles for psychiatric interventions in January 2020. This might be relevant for Switzerland, too. Specific psychotherapeutic interventions, targeting at cognitive restructuring and sensitizing regarding dealing with alcohol and cigarettes, may be needed in order to protect this vulnerable group of person during and after the Corona pandemic.


Asunto(s)
Trastornos de Adaptación/psicología , Ansiedad/psicología , Infecciones por Coronavirus/psicología , Depresión/psicología , Pandemias , Personal de Hospital/psicología , Neumonía Viral/psicología , Estrés Psicológico/psicología , Adaptación Psicológica , Trastornos de Adaptación/epidemiología , Trastornos de Adaptación/etiología , Adulto , Anciano , Ansiedad/epidemiología , Ansiedad/etiología , Infecciones por Coronavirus/transmisión , Estudios Transversales , Depresión/epidemiología , Depresión/etiología , Familia , Miedo , Femenino , Humanos , Masculino , Cuerpo Médico , Persona de Mediana Edad , Pruebas Neuropsicológicas , Neumonía Viral/transmisión , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Suiza/epidemiología
17.
J Am Med Dir Assoc ; 21(7): 951-953, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-680411

RESUMEN

Residents of congregate care settings have been severely impacted by the current Coronavirus disease 2019 (COVID-19) pandemic. In this report, we describe the methods our home-based primary care practice has developed to mitigate the spread of COVID-19 in assisted living facilities (ALFs) and we present an initial evaluation of this innovation. Shortly after the first COVID-19 case was reported in the United States, our organization assembled an outbreak committee, designed to support the 1794 ALF residents and the 101 communities in which they reside. The committee led the development and deployment of a comprehensive COVID-19 prevention and suppression strategy. The average age of the cohort was 83 ± 11 years, and 74% were female. Seven individuals (0.4% of census) tested positive for SARS-CoV-2. The positive individuals were located in 3 ALFs, representing 3% of our total number of ALFs. There has been 1 death. Home-based primary care-led outbreak mitigation may be an enabler to suppress COVID-19 in ALFs.


Asunto(s)
Instituciones de Vida Asistida/organización & administración , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Atención Primaria de Salud/métodos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Masculino , Casas de Salud/organización & administración , Evaluación de Resultado en la Atención de Salud , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/prevención & control , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Medición de Riesgo , Estados Unidos
19.
Am J Pathol ; 190(8): 1680-1690, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-677458

RESUMEN

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has spread globally, and no proven treatments are available. Convalescent plasma therapy has been used with varying degrees of success to treat severe microbial infections for >100 years. Patients (n = 25) with severe and/or life-threatening COVID-19 disease were enrolled at the Houston Methodist hospitals from March 28, 2020, to April 14, 2020. Patients were transfused with convalescent plasma, obtained from donors with confirmed severe acute respiratory syndrome coronavirus 2 infection who had recovered. The primary study outcome was safety, and the secondary outcome was clinical status at day 14 after transfusion. Clinical improvement was assessed on the basis of a modified World Health Organization six-point ordinal scale and laboratory parameters. Viral genome sequencing was performed on donor and recipient strains. At day 7 after transfusion with convalescent plasma, nine patients had at least a one-point improvement in clinical scale, and seven of those were discharged. By day 14 after transfusion, 19 (76%) patients had at least a one-point improvement in clinical status, and 11 were discharged. No adverse events as a result of plasma transfusion were observed. Whole genome sequencing data did not identify a strain genotype-disease severity correlation. The data indicate that administration of convalescent plasma is a safe treatment option for those with severe COVID-19 disease.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Adulto , Anciano , Betacoronavirus/genética , Femenino , Humanos , Inmunización Pasiva , Aplicación de Nuevas Drogas en Investigación , Masculino , Persona de Mediana Edad , Pandemias , Texas , Secuenciación Completa del Genoma , Adulto Joven
20.
AJNR Am J Neuroradiol ; 41(7): 1179-1183, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-677455

RESUMEN

Coronavirus disease 2019 (COVID-19) is a serious public health crisis and can have neurologic manifestations. This is a retrospective observational case series performed March 1-31, 2020, at New York University Langone Medical Center campuses. Clinical and imaging data were extracted, reviewed, and analyzed. Two hundred forty-two patients with COVID-19 underwent CT or MRI of the brain within 2 weeks after the positive result of viral testing (mean age, 68.7 ± 16.5 years; 150 men/92 women [62.0%/38.0%]). The 3 most common indications for imaging were altered mental status (42.1%), syncope/fall (32.6%), and focal neurologic deficit (12.4%). The most common imaging findings were nonspecific white matter microangiopathy (134/55.4%), chronic infarct (47/19.4%), acute or subacute ischemic infarct (13/5.4%), and acute hemorrhage (11/4.5%). No patients imaged for altered mental status demonstrated acute ischemic infarct or acute hemorrhage. White matter microangiopathy was associated with higher 2-week mortality (P < .001). Our data suggest that in the absence of a focal neurologic deficit, brain imaging in patients with early COVID-19 with altered mental status may not be revealing.


Asunto(s)
Betacoronavirus , Encefalopatías/diagnóstico por imagen , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Encefalopatías/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen , Pandemias , Estudios Retrospectivos , Estados Unidos
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