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1.
Lancet ; 395(10238): 1705-1714, 2020 05 30.
Artículo en Inglés | MEDLINE | ID: covidwho-1217628

RESUMEN

BACKGROUND: Concerns have been raised about the possibility that inhibitors of the renin-angiotensin-aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19. METHODS: In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437. FINDINGS: We collected data for 1139 cases and 11 390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62-2·41) and risk factors (1·46, 1·23-1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77-1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64-1·00) or angiotensin-receptor blockers (1·10, 0·88-1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34-0·80). The adjusted ORs were similar across severity degrees of COVID-19. INTERPRETATION: RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19. FUNDING: Instituto de Salud Carlos III.


Asunto(s)
Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Infecciones por Coronavirus/epidemiología , Hospitalización/estadística & datos numéricos , Neumonía Viral/epidemiología , Sistema Renina-Angiotensina , Anciano , Anciano de 80 o más Años , Comorbilidad , Infecciones por Coronavirus/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Pandemias , Neumonía Viral/complicaciones , Renina/antagonistas & inhibidores , Factores de Riesgo , España/epidemiología
3.
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
4.
Neurology ; 95(11): e1479-e1487, 2020 09 15.
Artículo en Inglés | MEDLINE | ID: covidwho-1197357

RESUMEN

OBJECTIVE: To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19). METHODS: A retrospective multicenter cohort study was conducted between January 18 and March 20, 2020, including people with confirmed COVID-19 from 56 hospitals officially designated in 3 Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination, and investigations were noted, in which critical events included disorders of consciousness, stroke, CNS infection, seizures, and status epilepticus. RESULTS: We enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new-onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n = 25) or stroke (n = 10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurologic conditions. Noncritical events were seen in fewer than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic, and tremor. Brain CT in 28 people led to new findings in 9. Findings from lumbar puncture in 3 with suspected CNS infection, unexplained headache, or severe occipital neuralgia were unremarkable. CONCLUSIONS: People with COVID-19 aged over 60 and with neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of severe acute respiratory syndrome coronavirus 2 to the CNS is lacking.


Asunto(s)
Enfermedades del Sistema Nervioso Central/virología , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Enfermedades del Sistema Nervioso Central/epidemiología , Niño , Preescolar , China/epidemiología , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
5.
Rev Esp Geriatr Gerontol ; 55(5): 286-288, 2020.
Artículo en Español | MEDLINE | ID: covidwho-1196757

RESUMEN

INTRODUCTION: Cytokine storm syndrome (CTS) is a serious complication of patients with SARS-CoV-2 infection. Treatment and evolution in octogenarians are not well defined. Our objective is to describe its clinical characteristics, the treatments and its clinical evolution. PATIENTS AND METHOD: Retrospective observational study of consecutive patients admitted in the period between March 23 and April 12, 2020 with confirmed SARS-CoV-2 infection, with pneumonia by radiological study or chest tomography, whith STC criteria and who received treatment. We classified patients as those who received only glucocorticoid (GC) pulses, or GC and tocilizumab pulses. We determined serum levels of ferritin, CRP and D-dimers. The final variable was survival. RESULTS: 21 patients, (80-88 years). The mean ferritin was 1056 microg/L (317-3,553), CRP 115.8mg/dL (22-306) and D-dimers 2.9m/L (0.45-17.5). All patients received GC pulses and in 2 cases simultaneously tocilizumab. The mean follow-up time was 13.7 days (8-21). The overall mortality was 38.1% (8/21 patients). The 2 patients who received tocilizumab died. The deceased had significantly higher levels of ferritin (1,254 vs. 925microg/L; P=.045) and CRP (197.6 vs. 76mg / dL; P=.007). At the end of the follow-up, a decrease in the biochemical parameters was observed with ferritin of 727microg/L, CRP of 27mg/dl and D-dimers of 1.18mg/L. In 13/21 patients (61.9%), the CTS was controlled without the need to add other treatments. CONCLUSIONS: STC mortality from SARS-CoV-2 is high despite treatment. A greater inflammatory response was associated with a higher mortality. Although it seems that the early use of GC pulses could control it, and the use of other treatments such as tocilizumab shouldo be, with the study design and its limitations, this conclusion cannot be stablished.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Citocinas/inmunología , Glucocorticoides/uso terapéutico , Trastornos Inmunoproliferativos/tratamiento farmacológico , Trastornos Inmunoproliferativos/virología , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Pandemias , Estudios Retrospectivos , Síndrome
6.
Int J Gynaecol Obstet ; 150(1): 53-57, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-1196386

RESUMEN

OBJECTIVE: To study vaginal delivery outcomes and neonatal prognosis and summarize the management of vaginal delivery during the COVID-19 pandemic. METHODS: A retrospective analysis of medical records and comparison of vaginal delivery outcomes between 10 pregnant women with clinical diagnosis of COVID-19 and 53 pregnant women without COVID-19 admitted to Zhongnan Hospital of Wuhan University between January 20 and March 2, 2020. Results of laboratory tests, imaging tests, and SARS-CoV-2 nucleic acid tests were also analyzed in neonates delivered by pregnant women with clinical diagnosis of COVID-19. RESULTS: There were no significant differences in gestational age, postpartum hemorrhage, and perineal resection rates between the two groups. There were no significant differences in birth weight of neonates and neonatal asphyxia rates between the two groups. Neonates delivered by pregnant women with clinical diagnosis of COVID-19 tested negative for SARS-CoV-2 infection. CONCLUSIONS: Under the premise of full evaluation of vaginal delivery conditions and strict protection measures, pregnant women with ordinary type COVID-19 can try vaginal delivery without exacerbation of COVID-19 and without increasing the risk of SARS-CoV-2 infection in neonates.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Parto Obstétrico/métodos , Neumonía Viral/complicaciones , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo/epidemiología , Adulto , Peso al Nacer , China/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Femenino , Hospitalización , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Pandemias , Neumonía Viral/transmisión , Neumonía Viral/virología , Hemorragia Posparto/epidemiología , Hemorragia Posparto/virología , Embarazo , Estudios Retrospectivos , Vagina/virología
7.
Medicine (Baltimore) ; 100(16): e25619, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1195757

RESUMEN

ABSTRACT: The coronavirus disease (COVID-19) outbreak was first reported in December 2019 in Wuhan, China. Specific information about critically ill COVID-19 patients receiving invasive mechanical ventilation (IMV) is rare.To describe the clinical course and complications of critically ill patients with COVID-19 who received IMV and were successfully weaned from it.This retrospective study included patients admitted to 3 intensive care units (ICUs) and 1 sub-ICU of Renmin Hospital of Wuhan University and Wuhan Jin Yin-tan Hospital between December 24, 2019, and March 12, 2020. Eleven patients who had been diagnosed with critically ill COVID-19 according to the World Health Organization interim guidance, received invasive ventilation, and were finally successfully weaned from it, were enrolled in our study. Their presenting symptoms, comorbidity conditions, laboratory values, ICU course, ventilator parameters, treatments, and relative complications were recorded.Of 108 critically ill COVID-19 patients who received invasive ventilation, 11 patients who underwent tracheal extubation or terminal weaning were included. The mean age of the 11 patients was 52.8 years (range, 38-70 years), 8 (72.7%) were male, and 2 were health care workers. The median time from onset of symptoms to dyspnea was 6.6 days (range, 3-13 days), and the median duration of IMV was 15.7 days (range, 6-29 days). All 11 patients presented with acute severe hypoxemic respiratory failure and received IMV, and 1 patient switched to extracorporeal membrane oxygenation assistance. A lung-protective strategy with lower tidal volume ventilation and proper driving pressure is the main strategy of IMV. All patients had extrapulmonary manifestations, including acute kidney injury, hepatic dysfunction, myocardial damage, and/or lymphopenia. Hospital-acquired infections occurred in 7 (63.6%) patients.Critical COVID-19 illness is characterized by acute hypoxemic respiratory failure and subsequent dysfunction of other organs with a high mortality rate. Correct ventilation strategies and other clinical strategies to improve oxygenation based on the skilled trained group and the availability of equipment are the key methods to rescue lives.


Asunto(s)
Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Respiración Artificial , Desconexión del Ventilador , Adulto , Anciano , China , Infecciones por Coronavirus/complicaciones , Oxigenación por Membrana Extracorpórea , Femenino , Humanos , Hipoxia/terapia , Hipoxia/virología , Masculino , Persona de Mediana Edad , Respiración Artificial/efectos adversos , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/virología , Estudios Retrospectivos
8.
Int J Gynaecol Obstet ; 150(1): 47-52, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-1187996

RESUMEN

BACKGROUND: Clinical presentation and outcomes of COVID-19 infection during pregnancy remain limited and fragmented. OBJECTIVES: To summarize the existing literature on COVID-19 infection during pregnancy and childbirth, particularly concerning clinical presentation and outcomes. SEARCH STRATEGY: A systematic search of LitCovid, EBSCO MEDLINE, CENTRAL, CINAHL, Web of Science, and Scopus electronic databases. The references of relevant studies were also searched. SELECTION CRITERIA: Identified titles and abstracts were screened to select original reports and cross-checked for overlap of cases. DATA COLLECTION AND ANALYSIS: A descriptive summary organized by aspects of clinical presentations (symptoms, imaging, and laboratory) and outcomes (maternal and perinatal). MAIN RESULTS: We identified 33 studies reporting 385 pregnant women with COVID-19 infection: 368 (95.6%) mild; 14 (3.6%) severe; and 3 (0.8%) critical. Seventeen women were admitted to intensive care, including six who were mechanically ventilated and one maternal mortality. A total of 252 women gave birth, comprising 175 (69.4%) cesarean and 77 (30.6%) vaginal births. Outcomes for 256 newborns included four RT-PCR positive neonates, two stillbirths, and one neonatal death. CONCLUSION: COVID-19 infection during pregnancy probably has a clinical presentation and severity resembling that in non-pregnant adults. It is probably not associated with poor maternal or perinatal outcomes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Parto Obstétrico/estadística & datos numéricos , Transmisión Vertical de Enfermedad Infecciosa , Parto , Neumonía Viral/complicaciones , Complicaciones Infecciosas del Embarazo/virología , Adulto , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Pandemias , Neumonía Viral/transmisión , Embarazo
9.
Int J Gynaecol Obstet ; 150(1): 58-63, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-1187994

RESUMEN

OBJECTIVE: To study chest CT images and clinical characteristics of COVID-19 pneumonia in pregnant patients to examine any correlation. METHODS: Between December 31, 2019 and March 7, 2020, 23 hospitalized pregnant patients with confirmed COVID-19 were enrolled in the study. Clinical presentations were collected retrospectively from records, including laboratory testing, chest CT imaging, and symptoms. Descriptive analysis and correlation of patients' clinical and CT characteristics were performed. Laboratory results from time of first admission and CT absorption (defined as reduction in lesion area, decrease in density, and absorption of some solid components) were compared between symptomatic and asymptomatic patients. RESULTS: Fifteen (65.2%) patients were asymptomatic with patchy ground-glass opacity in a single lung lobe. Eight (34.8%) patients were symptomatic with multiple patchy ground-glass shadows, consolidation, and fibrous stripes. Differences in lymphocyte percentage and neutrophil granulocyte rate between first admission and CT absorption were significant (P<0.001). Median absorption time was shorter in the asymptomatic group compared with the symptomatic group (5 vs 10 days; P<0.001). Median hospitalization time between asymptomatic and symptomatic patients was 14 vs 25.5 days; P>0.001. Median absorption time and length of hospitalization for all patients was 6 days (IQR 5-8) and 17 days (IQR 13-25), respectively. CONCLUSION: Radiological findings and clinical characteristics in pregnant women with COVID-19 were similar to those of non-pregnant women with COVID-19. Median absorption time and length of hospitalization in asymptomatic patients were significantly shorter than in symptomatic patients. Lymphocyte percentage and neutrophil granulocyte rate may be used as laboratory indicators of CT absorption.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Femenino , Hospitalización , Humanos , Recuento de Leucocitos , Pulmón/diagnóstico por imagen , Pulmón/virología , Linfocitos , Neutrófilos , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Complicaciones Infecciosas del Embarazo/virología , Estudios Retrospectivos
10.
BMJ Case Rep ; 13(9)2020 Sep 14.
Artículo en Inglés | MEDLINE | ID: covidwho-1186219

RESUMEN

A construction worker in his 30s presented three times in 4 days with progressive upper and then lower limb weakness. On the first two occasions he had no systemic symptoms, but on the third presentation he had fever and cough, starting from day 4 of weakness. Examination identified weakness in all four limbs and areflexia, suggesting a peripheral neuromuscular disorder. Investigations were consistent with Guillain-Barré syndrome and additional COVID-19 (SARS-CoV-2) infection. The patient improved after immunoglobulin treatment. At least four cases of Guillain-Barré syndrome have been reported in the literature with concurrent COVID-19 illness in whom respiratory signs appeared a few days after the onset of neurological signs. With the incubation period for COVID-19 respiratory symptoms believed to be up to 14 days, it is possible that neurological symptoms could develop before respiratory and other symptoms. During the current pandemic, presence of concurrent COVID-19 infection needs to be considered in patients presenting with Guillain-Barré syndrome.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Síndrome de Guillain-Barré/etiología , Neumonía Viral/complicaciones , Adulto , Humanos , Masculino , Pandemias
11.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 48-54, 2020. tab
Artículo en Inglés | LILACS (Américas) | ID: covidwho-1175945

RESUMEN

SUMMARY INTRODUCTION In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature. METHODS We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane. RESULTS 16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy. CONCLUSION Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.


RESUMO INTRODUÇÃO Na literatura atual, houve um aumento dos casos apresentados com doença coronavírus de 2019 (COVID-19) induzida por miocardite aguda. Nesta revisão baseada em casos, buscamos descrever as características clínicas, achados de imagem e curso hospitalar de miocardite aguda. Além disso, as limitações em relação ao diagnóstico de miocardite foram discutidas, uma vez que apenas casos de miocardite fulminante foram mencionados na literatura atual. MÉTODOS Fizemos uma revisão da literatura de todos os pacientes diagnosticados com miocardite aguda induzida por COVID-19 com a utilização das bases de dados PubMed, Embase e Cochrane. RESULTADO Dezesseis casos relatados estão relacionados com a miocardite aguda induzida pela COVID-19. Observamos que os achados de ECG na maioria dos pacientes com COVID-19 não eram específicos, incluindo elevação difusa do segmento ST, atraso não específico da condução intraventricular, taquicardia sinusal e ondas T invertidas em pistas anteriores. Os resultados ecocardiográficos de doentes com miocardite aguda COVID-19 variaram entre a fração de ejeção ventricular esquerda preservada (LVEF) sem anomalias segmentais e a LVEF reduzida com hipocinésia global. Curiosamente, alguns pacientes com COVID-19 induzidos à miocardite aguda fulminante eram sensíveis aos esteroides e tinham uma melhoria com glucocorticoides e terapia com imunoglobulina. CONCLUSÃO Apesar da pandemia de COVID-19 em todo o mundo, um número limitado de casos tem sido compartilhado na literatura atual. Há muitas dificuldades para o diagnóstico diferencial de miocardite aguda no contexto da COVID-19.


Asunto(s)
Humanos , Neumonía Viral/diagnóstico , Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Pandemias , Miocarditis/diagnóstico , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Volumen Sistólico , Enfermedad Aguda , Función Ventricular Izquierda/fisiología , Infecciones por Coronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Técnicas de Laboratorio Clínico , Electrocardiografía , Betacoronavirus , Miocarditis/complicaciones
12.
Glob Heart ; 16(1): 18, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: covidwho-1175699

RESUMEN

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.


Asunto(s)
/fisiopatología , Enfermedades Cardiovasculares/fisiopatología , Síndrome Coronario Agudo/economía , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/fisiopatología , África , Antimaláricos/efectos adversos , Arritmias Cardíacas/economía , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , /economía , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/etiología , Cloroquina/efectos adversos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Prestación de Atención de Salud/economía , Recesión Económica , Producto Interno Bruto , Recursos en Salud/economía , Recursos en Salud/provisión & distribución , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Hidroxicloroquina/efectos adversos , Inflamación , Isquemia Miocárdica/economía , Isquemia Miocárdica/etiología , Isquemia Miocárdica/fisiopatología , Miocarditis/economía , Miocarditis/etiología , Miocarditis/fisiopatología , Síndrome Respiratorio Agudo Grave/complicaciones , Síndrome Respiratorio Agudo Grave/fisiopatología , Factores Socioeconómicos , Cardiomiopatía de Takotsubo/economía , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/fisiopatología
14.
J Acquir Immune Defic Syndr ; 85(2): 239-243, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1165586

RESUMEN

BACKGROUND: The effectiveness of lopinavir/ritonavir (LPV/r) and chloroquine treatment for COVID-19 has not been verified. METHODS: We conducted a retrospective study to summarize the clinical practices of nonsevere patients with COVID-19 receiving the standard care, LPV/r or chloroquine in Beijing Ditan Hospital from January 20 to March 26, 2020. The main outcome measurements include the changes of cycle threshold values of open reading frame 1 ab (ORF1ab) and nucleocapsid (N) genes by reverse transcriptase-polymerase chain reaction assay from day 1 to 7 after admission for patients receiving standard care or after treatment being initiated for patients receiving either LPV/r or chloroquine. The proportion of developing severe illness, fever duration and the time from symptom onset to chest computer tomography improvement, and negative conversion of nucleic acid were compared. RESULTS: Of the 129 patients included in the study, 59 received the standard care, 51 received LPV/r, and 19 received chloroquine. The demographics and baseline characteristics were comparable among the 3 groups. The median duration of fever, median time from symptom onset to chest computer tomography improvement, and negative conversion of the nucleic acid were similar among the 3 groups. The median increase in cycle threshold values of N and ORF1ab gene for patients receiving LPV/r or chloroquine or the standard care during the treatment course was 7.0 and 8.5, 8.0, and 7.6, 5.0, and 4.0, respectively. These figures were not found significantly different among the 3 groups. CONCLUSIONS: Antiviral therapy using LPV/r or chloroquine seemed not to improve the prognosis or shorten the clinical course of COVID-19.


Asunto(s)
Cloroquina/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Lopinavir/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Ritonavir/uso terapéutico , Adulto , Antimaláricos/uso terapéutico , Enfermedad Crónica , Infecciones por Coronavirus/complicaciones , Combinación de Medicamentos , Femenino , Fiebre , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
15.
J Acquir Immune Defic Syndr ; 85(1): 1-5, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1165585

RESUMEN

BACKGROUND: Given the magnitude of the global COVID-19 pandemic, persons living with HIV (PLWH) may become coinfected with SARS-CoV-2. SETTING: We conducted a survey in Wuhan, China, to characterize the status of coinfected PLWH, their time to clinical improvement, and clinical prognoses. METHODS: Using a Wuhan shipping service for antiretroviral medications, the Wuhan LGBT Center screened 2900 PLWH shipping addresses and cross-referenced 36 of them to quarantine sites or hospitals, suggesting possible COVID-19 cases. Through telephone calls and WeChat (social media) messaging, we conducted a survey after obtaining online informed consent. RESULTS: We had 12 HIV-infected respondents (10 men and 2 women) who also reported COVID-19. The median age was 36 years (interquartile range: 33.0-56.3), mean age 42.4 years, and range 25-66 years of age. Nine of 10 persons on antiretroviral therapy (ART) presented with only mild COVID-19 symptoms. The 10th person on ART was a 56-year-old man who died at home early in the outbreak when health care services were overwhelmed. Two additional cases who had been in intensive care with acute COVID-19 were both men, aged 25 and 37 years; both were ART-naive until this hospitalization. Excluding the deceased man, 6 of 11 coinfected persons reported feeling depressed even after clinical improvements. CONCLUSION: Twelve coinfected persons were identified in Wuhan; 9 of 10 were on long-term ART and had favorable outcomes. Two men identified as having started ART only recently were found to have severe symptoms. Our case series suggests the value of ART for potential mitigation of COVID-19 coinfection.


Asunto(s)
Betacoronavirus , Coinfección/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Adulto , Anciano , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias
16.
J Acquir Immune Defic Syndr ; 85(1): 6-10, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1165584

RESUMEN

BACKGROUND: SARS-CoV-2 infection continues to cause significant morbidity and mortality worldwide. Preliminary data on SARS-CoV-2 infection suggest that some immunocompromised hosts experience worse outcomes. We performed a retrospective matched cohort study to characterize outcomes in HIV-positive patients with SARS-CoV-2 infection. METHODS: Leveraging data collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March 2, 2020, and April 23, 2020, we matched 21 HIV-positive patients with 42 non-HIV patients using a greedy nearest-neighbor algorithm. Admission characteristics, laboratory test results, and hospital outcomes were recorded and compared between the 2 groups. RESULTS: Although there was a trend toward increased rates of intensive care unit admission, mechanical ventilation, and mortality in HIV-positive patients, these differences were not statistically significant. Rates for these outcomes in our cohort are similar to those previously published for all patients hospitalized with COVID-19. HIV-positive patients had significantly higher admission and peak C-reactive protein values. Other inflammatory markers did not differ significantly between groups, although HIV-positive patients tended to have higher peak values during their clinical course. Three HIV-positive patients had superimposed bacterial pneumonia with positive sputum cultures, and all 3 patients died during hospitalization. There was no difference in frequency of thrombotic events or myocardial infarction between these groups. CONCLUSIONS: This study provides evidence that HIV coinfection does not significantly impact presentation, hospital course, or outcomes of patients infected with SARS-CoV-2, when compared with matched non-HIV patients. A larger study is required to determine whether the trends we observed apply to all HIV-positive patients.


Asunto(s)
Betacoronavirus , Coinfección/virología , Infecciones por Coronavirus/complicaciones , Infecciones por VIH/complicaciones , Neumonía Viral/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios de Cohortes , Coinfección/mortalidad , Infecciones por Coronavirus/mortalidad , Cuidados Críticos , Femenino , Infecciones por VIH/mortalidad , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Respiración Artificial , Estudios Retrospectivos , Resultado del Tratamiento
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