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3.
Int J Qual Health Care ; 33(1)2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: covidwho-1093551

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has forced health-care providers to find creative ways to allow continuity of care in times of lockdown. Telemedicine enables provision of care when in-person visits are not possible. Sheba Medical Center made a rapid transition of outpatient clinics to video consultations (VC) during the first wave of COVID-19 in Israel. OBJECTIVE: Results of a survey of patient and clinician user experience with VC are reported. METHODS: Satisfaction surveys were sent by text messages to patients, clinicians who practice VC (users) and clinicians who do not practice VC (non-users). Questions referred to general satisfaction, ease of use, technical issues and medical and communication quality. Questions and scales were based on surveys used regularly in outpatient clinics of Sheba Medical Center. RESULTS: More than 1200 clinicians (physicians, psychologists, nurses, social workers, dietitians, speech therapists, genetic consultants and others) provided VC during the study period. Five hundred and forty patients, 162 clinicians who were users and 50 clinicians who were non-users completed the survey. High level of satisfaction was reported by 89.8% of patients and 37.7% of clinician users. Technical problems were experienced by 21% of patients and 80% of clinician users. Almost 70% of patients but only 23.5% of clinicians found the platform very simple to use. Over 90% of patients were very satisfied with clinician's courtesy, expressed a high sense of trust, thought that clinician's explanations and recommendations were clear and estimated that the clinician understood their problems and 86.5% of them would recommend VC to family and friends. Eighty-seven percent of clinician users recognize the benefit of VC for patients during the COVID-19 pandemic but only 68% supported continuation of the service after the pandemic. CONCLUSION: Our study reports high levels of patient satisfaction from outpatient clinics VC during the COVID-19 pandemic. Lower levels of clinician satisfaction can mostly be attributed to technical and administrative challenges related to the newly implemented telemedicine platform. Our findings support the continued future use of VC as a means of providing patient-centered care. Future steps need to be taken to continuously improve the clinical and administrative application of telemedicine services.


Asunto(s)
Actitud del Personal de Salud , Satisfacción del Paciente , Neumonía Viral/epidemiología , Consulta Remota , Control de Enfermedades Transmisibles , Femenino , Humanos , Israel/epidemiología , Masculino , Pandemias , Neumonía Viral/virología , Encuestas y Cuestionarios
4.
Medicine (Baltimore) ; 100(7): e24668, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: covidwho-1091183

RESUMEN

ABSTRACT: We aimed to retrospectively analyze the clinical and computed tomography (CT) characteristics of young adults with Coronavirus Disease 2019 (COVID-19) pneumonia who were critically ill and to identify the features associated with non-survival.Thirty-eight COVID-19 patients (20-45 years old, 28 men) who had been admitted in the intensive care unit were included, including 18 non-survivors (group 1) and 20 survivors (group 2). Their clinical characteristics and initial and follow-up CT were compared between groups.In group 1, the days from illness onset to death were 21.1 ±â€Š10.3 days; 7 patients had underlying comorbidities. At admission, group 1 exhibited higher serum ferritin and interleukin-6 (IL-6) levels (1142.6 ±â€Š242.4 mg/L and 33.8 ±â€Š18.6 mmol/L) compared with group 2 (728.3 ±â€Š150.9 mg/L and 15.2 ±â€Š6.9 mmol/L, P < .01). Group 1 exhibited more rapidly progressive opacities and consolidation in follow-up CT (16.7 ±â€Š3.1 scores, 15.7 ±â€Š3.1 segments) than group 2 (11.4 ±â€Š4.0 scores, 10.3 ±â€Š4.6 segments, P < .01). The oxygenation index was lower (87.6 ±â€Š19.2 vs 99.1 ±â€Š20.4 mm Hg) and the mechanical ventilation duration was longer (14.7 ±â€Š6.9 vs 9.7 ±â€Š3.7 days) in group 1 compare with group 2 (P < .01).Compared with the survivors, the non-survivors showed higher serum ferritin and IL-6 levels, more rapidly progressive opacities in CT, lower oxygenation index, and longer mechanical ventilation durations. Special attention to ferritin/IL-6 levels and oxygenation index as well as early CT application and timely reexaminations are important to identify the individuals who may be at risk of becoming critically ill.


Asunto(s)
/diagnóstico , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Neumonía Viral/mortalidad , Tomografía Computarizada por Rayos X/métodos , Adulto , Enfermedad Crítica , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Neumonía Viral/virología , Estudios Retrospectivos , Análisis de Supervivencia
5.
Front Immunol ; 11: 609198, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1080669

RESUMEN

During COVID-19 pandemic the care of onco-hematologic and autoimmune patients has raised the question whether they are at higher risk of infection and/or worse outcome. Here, we describe the clinical course of COVID-19 pneumonia in patients with autoimmune cytopenias (AIC) regularly followed at a reference center in Northern Italy. The study period started from COVID-19 outbreak (February 22, 2020) until the time of writing. Moreover, we provide a review of the literature, showing that most cases reported so far are AIC developed during or secondary to COVID-19 infection. At variance, data about AIC pre-existing to COVID infection are scanty. The 4 patients here described (2 autoimmune hemolytic anemias, AIHA, 1 Evans syndrome, and 1 immune thrombocytopenia) with COVID-19 pneumonia belong to a large cohort of 500 AIC patients, making this study nearly population-based. The observed frequency (4/501; 0.7%) is only slightly superior to that of the general population admitted to hospital/intensive care unit (0.28/0.03%, respectively) in Lombardy in the same period of observation. All cases occurred between March 21 and 25, whilst no more AIC were recorded later on. Although different in intensity of care needed, all patients recovered from COVID-19 pneumonia, with apparently no detrimental effect of previous/current immunomodulatory treatments. AIHA relapse occurred in two patients, but promptly responded to therapy. With limitations due to sample size, these results suggest a favorable outcome and a lower-than-expected incidence of COVID-19 pneumonia in patients with previously diagnosed AIC, and allow speculating that immunomodulatory drugs used for AIC may play a beneficial rather than a harmful effect on COVID-19 infection.


Asunto(s)
Anemia Hemolítica Autoinmune/complicaciones , Neumonía Viral/epidemiología , Púrpura Trombocitopénica Idiopática/complicaciones , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Viral/virología , Adulto Joven
6.
BMC Med Res Methodol ; 21(1): 28, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1079209

RESUMEN

BACKGROUND: COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools. MAIN TEXT: Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures. To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended. CONCLUSION: Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.


Asunto(s)
/prevención & control , Salud Global , Prioridades en Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , /epidemiología , Investigación sobre Servicios de Salud , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/virología , Proyectos de Investigación , Asignación de Recursos , Organización Mundial de la Salud
8.
Rev. chil. pediatr ; 91(4): 623-630, ago. 2020.
Artículo en Español | LILACS (Américas) | ID: covidwho-1070235

RESUMEN

Resumen: SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARS- CoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se en cuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gas trointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las caracte rísticas de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmón- intestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede per manecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enferme dad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.


Abstract: SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.


Asunto(s)
Humanos , Niño , Neumonía Viral/complicaciones , Infecciones por Coronavirus/complicaciones , Enfermedades Gastrointestinales/virología , Hepatopatías/virología , Neumonía Viral/diagnóstico , Índice de Severidad de la Enfermedad , Citocinas/metabolismo , Infecciones por Coronavirus/diagnóstico , Peptidil-Dipeptidasa A/metabolismo , Técnicas de Laboratorio Clínico , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/fisiopatología , Hepatopatías/diagnóstico , Hepatopatías/fisiopatología
9.
Rev. chil. pediatr ; 91(4): 623-630, ago. 2020.
Artículo en Español | LILACS (Américas) | ID: covidwho-1070104

RESUMEN

Resumen: SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARS- CoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se en cuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gas trointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las caracte rísticas de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmón- intestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede per manecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enferme dad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.


Abstract: SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.


Asunto(s)
Humanos , Niño , Neumonía Viral/complicaciones , Infecciones por Coronavirus/complicaciones , Enfermedades Gastrointestinales/virología , Hepatopatías/virología , Neumonía Viral/diagnóstico , Índice de Severidad de la Enfermedad , Citocinas/metabolismo , Infecciones por Coronavirus/diagnóstico , Peptidil-Dipeptidasa A/metabolismo , Técnicas de Laboratorio Clínico , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/fisiopatología , Hepatopatías/diagnóstico , Hepatopatías/fisiopatología
10.
Crit Care ; 25(1): 53, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1069578

RESUMEN

The current pandemic of COVID-19 caused thousands of deaths and healthcare professionals struggle to properly manage infected patients. This review summarizes information about SARS-CoV-2 receptor binding dynamics and intricacies, lung autopsy findings, immune response patterns, evidence-based explanations for the immune response, and COVID-19-associated hypercoagulability.


Asunto(s)
/fisiopatología , Proteínas Portadoras/fisiología , Enfermedades Pulmonares/fisiopatología , Neumonía Viral/fisiopatología , /patogenicidad , /inmunología , Proteínas Portadoras/inmunología , Humanos , Enfermedades Pulmonares/inmunología , Pandemias , Neumonía Viral/inmunología , /inmunología
11.
J Coll Physicians Surg Pak ; 31(1): 14-20, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1068267

RESUMEN

OBJECTIVE:   To identify utility of chest computed tomography severity score (CT-SS) as an additional tool to COVID-19 pneumonia imaging classification in assessing severity of COVID-19. STUDY DESIGN: Descriptive analytical study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, from April 2020 to June 2020. METHODOLOGY: Five hundred suspected COVID-19 cases referred for high resolution computed tomography - chest were included in the study. Cases were categorised by radiological findings using COVID-19 pneumonia imaging classification, proposed in the radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. CT-SS was calculated for all scans. Patients were clinically classified according to disease severity as per 'Diagnosis And Treatment Program of Pneumonia of New Coronavirus Infection' recommended by China's National Health Commission. The relationships between radiological findings, CT-SS, and clinical severity were explored. RESULTS: Based on the radiological findings, 298 cases were graded as typical, 34 as indeterminate, 15 as atypical, and 153 as negative for pneumonia. The apical and posterior basal segments of lower lobes were most commonly involved. The CT-SS showed higher values in patients of severe group as compared to those in moderate group (p < 0.05). CT-SS threshold for recognising severe COVID-19 was 18.5 (area under curve, 0.960), with 84.3% sensitivity and 92.5% specificity. CONCLUSION: In coherence with COVID-19 pneumonia imaging classification, CT-SS may provide a comprehensive and objective assessment of COVID-19 severity. Key Words: COVID-19, COVID-19 pneumonia, CT-SS, High resolution computed tomography.


Asunto(s)
Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pakistán , Radiografía Torácica/métodos , Atención Terciaria de Salud , Adulto Joven
12.
Epidemiol Prev ; 44(5-6 Suppl 2): 216-225, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1068142

RESUMEN

OBJECTIVES: to explore clinical and epidemiological characteristics associated with an imaging feature of COVID-19 pneumonia at disease onset, in order to identify factors that may be evaluable by general practitioners at patient's home, and which may lead to identify a more severe disease, needing hospitalization. DESIGN: this is a retrospective/prospective observational hospital cohort. SETTING AND PARTICIPANTS: the study population includes all patients consecutively admitted to the emergency department of Città della salute e della scienza University Hospital from 01.03 to 31.05.2020 with a confirmed diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES: patients were classified in two groups according to the findings of X-ray imaging, lung ultrasound and chest computer tomography, as pneumonia or not pneumonia patients. RESULTS: in multivariable analysis, factors most strongly associated with emergency department admission with pneumonia were age, oxygen saturation <90% (adj OR 4.16 ;95%CI 1.44-12.07), respiratory rate >24 breaths/min (adj OR 6.50; 95%CI 2.36-17.87), fever ≥38° (adj OR 3.05; 95%CI 1.53-6.08) and the presence of gastroenteric symptoms (vomiting and diarrhea). A delay (> 7 days) between the appearance of the initial lung symptoms (cough and dyspnea) and the admission to the emergency department was also related to a higher probability of receiving a positive imaging report (OR 4.99; 95%CI 2,02-12,34). CONCLUSIONS: in order to reorganize the management of COVID-19 patients in Italy, in view of the risk of a second wave of epidemic or of local outbreaks, it would be desirable to relocate the triage, and possibly the patient's care, from hospital to home. In this scenario it is important to identify all symptoms and signs associated with COVID-19 pneumonia that would facilitate the decision-making process of GPs leading to patients hospitalization.


Asunto(s)
/epidemiología , Pandemias , Neumonía Viral/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Diarrea/epidemiología , Diarrea/etiología , Disnea/epidemiología , Disnea/etiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Italia/epidemiología , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Oxígeno/sangre , Neumonía Viral/sangre , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/virología , Estudios Prospectivos , Frecuencia Respiratoria , Estudios Retrospectivos , Evaluación de Síntomas , Factores de Tiempo , Vómitos/epidemiología , Vómitos/etiología
13.
Mayo Clin Proc ; 96(1): 78-85, 2021 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1065438

RESUMEN

OBJECTIVE: To examine differences in community mobility reduction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes across counties with differing levels of socioeconomic disadvantage. METHODS: The sample included counties in the United States with at least one SARS-CoV-2 case between April 1 and May 15, 2020. Outcomes were growth in SARS-CoV-2 cases, SARS-CoV-2-related deaths, and mobility reduction across three settings: retail/recreation, grocery/pharmacy, and workplace. The main explanatory variable was the social deprivation index (SDI), a composite socioeconomic disadvantage measure. RESULTS: Adjusted differences in outcomes between low-, medium-, and high-SDI counties (defined by tertile) were calculated using linear regression with state-fixed effects. Workplace mobility reduction was 1.75 (95% CI, -2.36 to -1.14; P<.001) and 3.48 percentage points (95% CI, -4.21 to -2.75; P<.001) lower for medium- and high-SDI counties relative to low-SDI counties, respectively. Mobility reductions in the other settings were also significantly lower for higher-SDI counties. In analyses adjusted for SARS-CoV-2 prevalence on April 1, medium- and high-SDI counties had 1.39 (95% CI, 0.85 to 1.93; P<.001) and 2.56 (95% CI, 1.77 to 3.34; P<.001) more SARS-CoV-2 cases/1000 population on May 15 compared with low-SDI counties, respectively. Deaths per capita were also significantly higher for higher-SDI counties. CONCLUSION: Counties with higher social deprivation scores experienced greater growth in SARS-CoV-2 cases and deaths, but reduced mobility at lower rates. These findings are consistent with evidence demonstrating that economically disadvantaged communities have been disproportionately impacted by the coronavirus disease 2019 pandemic. Efforts to socially distance may be more burdensome for these communities, potentially exacerbating disparities in SARS-CoV-2-related outcomes.


Asunto(s)
/epidemiología , Neumonía Viral/epidemiología , Condiciones Sociales , Control Social Formal , /mortalidad , Femenino , Humanos , Masculino , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/virología , Factores Socioeconómicos , Estados Unidos/epidemiología
14.
Mayo Clin Proc ; 96(1): 32-39, 2021 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1065435

RESUMEN

OBJECTIVE: To investigate the relationship between maximal exercise capacity measured before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalization due to coronavirus disease 2019 (COVID-19). METHODS: We identified patients (≥18 years) who completed a clinically indicated exercise stress test between January 1, 2016, and February 29, 2020, and had a test for SARS-CoV-2 (ie, real-time reverse transcriptase polymerase chain reaction test) between February 29, 2020, and May 30, 2020. Maximal exercise capacity was quantified in metabolic equivalents of task (METs). Logistic regression was used to evaluate the likelihood that hospitalization secondary to COVID-19 is related to peak METs, with adjustment for 13 covariates previously identified as associated with higher risk for severe illness from COVID-19. RESULTS: We identified 246 patients (age, 59±12 years; 42% male; 75% black race) who had an exercise test and tested positive for SARS-CoV-2. Among these, 89 (36%) were hospitalized. Peak METs were significantly lower (P<.001) among patients who were hospitalized (6.7±2.8) compared with those not hospitalized (8.0±2.4). Peak METs were inversely associated with the likelihood of hospitalization in unadjusted (odds ratio, 0.83; 95% CI, 0.74-0.92) and adjusted models (odds ratio, 0.87; 95% CI, 0.76-0.99). CONCLUSION: Maximal exercise capacity is independently and inversely associated with the likelihood of hospitalization due to COVID-19. These data further support the important relationship between cardiorespiratory fitness and health outcomes. Future studies are needed to determine whether improving maximal exercise capacity is associated with lower risk of complications due to viral infections, such as COVID-19.


Asunto(s)
/fisiopatología , Tolerancia al Ejercicio , Hospitalización/estadística & datos numéricos , Neumonía Viral/fisiopatología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/virología , Estudios Retrospectivos
16.
Iran J Allergy Asthma Immunol ; 19(5): 471-477, 2020 Oct 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1068113

RESUMEN

The emergence of a highly pathogenic virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) accounts for severe pneumonia throughout the world. More than 7 million world population have been infected with SARS-CoV-2, and the number of deaths is increasing every day. This study aimed to evaluate the frequency of SARS-CoV-2 in hospitalized patients with an acute respiratory infection (ARI). During an outbreak of the SARS-CoV-2, the nasopharyngeal and oropharyngeal swabs were collected from 909 hospitalized patients with severe pneumonia, including 517 (56.9%) males and 392 (43.1%) females. All the collected samples were from different cities of Khuzestan province from 19 February to- 27 March 2020. The RNA was extracted from samples and subjected to real-time polymerase chain reaction (PCR) tests for the detection of the SARS-CoV-2. Simultaneously, the computerized tomography (CT) scan was tested for the presence of ground-glass opacity in the lung among the patients. Of the total number of 909 specimens, 328 (36.08%) cases, including 185 (20.35%) females and 143 (15.73%) males, were positive for the SARS-CoV-2 while, 581 (63.9%) cases, including 374 (41.14%) males and 207 (22.77%) were negative for the SARS-CoV-2 by real-time PCR (p=0.001).Four hundred sixteen (45.76%) cases were positive for ground-glass opacity in the lung by CT scan, while 328/909 (36.08%) trials proved positive for SARS-CoV-2 by the real-time PCR (p=0.003).  In this study, 36.08% of patients were positive for SARS-CoV-2. Although the results of positive cases by CT scan showed higher than real-time PCR, screening the SARS-COV-2 with a real-time PCR method is the first line of choice.


Asunto(s)
/epidemiología , Hospitalización , Pulmón/diagnóstico por imagen , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/metabolismo , Niño , Preescolar , Femenino , Humanos , Lactante , Irán/epidemiología , Linfopenia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Prevalencia , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Adulto Joven
17.
PLoS One ; 16(1): e0245547, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1067419

RESUMEN

Endemic human coronaviruses (HCoVs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are members of the family Coronaviridae. Comparing the findings of the infections caused by these viruses would help reveal the novel characteristics of SARS-CoV-2 and provide insight into the unique pathogenesis of SARS-CoV-2 infection. This study aimed to compare the clinical and radiological characteristics of SARS-CoV-2 and endemic HCoVs infection in adult hospitalized patients with community-acquired pneumonia (CAP). This study was performed at a university-affiliated tertiary hospital in the Republic of Korea, between January 1, 2015, and July 31, 2020. A total of 109 consecutive patients who were over 18 years of age with confirmed SARS-CoV-2 and endemic HCoVs were enrolled. Finally, 19 patients with SARS-CoV-2 CAP were compared to 40 patients with endemic HCoV CAP. Flu-like symptoms such as cough, sore throat, headache, myalgia, and prolonged fever were more common in SARS-CoV-2 CAP, whereas clinical findings suggestive of bacterial pneumonia such as dyspnea, leukocytosis with left shift, and increased C-reactive protein were more common in endemic HCoV CAP. Bilateral peripherally distributed ground-glass opacities (GGOs) were typical radiologic findings in SARS-CoV-2 CAP, whereas mixed patterns of GGOs, consolidations, micronodules, and pleural effusion were observed in endemic HCoV CAP. Coinfection was not observed in patients with SARS-CoV-2 CAP, but was observed in more than half of the patients with endemic HCoV CAP. There were distinctive differences in the clinical and radiologic findings between SARS-CoV-2 and endemic HCoV CAP. Further investigations are required to elucidate the mechanism underlying this difference. Follow-up observations are needed to determine if the presentation of SARS-CoV-2 CAP changes with repeated infection.


Asunto(s)
/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Anciano , /patología , Estudios de Cohortes , Coinfección/diagnóstico por imagen , Coinfección/epidemiología , Coinfección/patología , Coinfección/virología , Infecciones Comunitarias Adquiridas , Coronavirus/aislamiento & purificación , Enfermedades Endémicas , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Coronavirus del Síndrome Respiratorio de Oriente Medio/aislamiento & purificación , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/patología , Neumonía Viral/virología , Radiografía Torácica/métodos , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tórax/diagnóstico por imagen
18.
Open Heart ; 7(2)2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1066930

RESUMEN

SARS-CoV-2 is the virus responsible for the ongoing COVID-19 outbreak. The virus uses ACE2 receptor for viral entry. ACE2 is part of the counter-regulatory renin-angiotensin-aldosterone system and is also expressed in the lower respiratory tract along the alveolar epithelium. There is, however, significant controversy regarding the role of ACE2 expression in COVID-19 pathogenesis. Some have argued that decreasing ACE2 expression would result in decreased susceptibility to the virus by decreasing available binding sites for SARS-CoV-2 and restricting viral entry into the cells. Others have argued that, like the pathogenesis of other viral pneumonias, including those stemming from previous severe acute respiratory syndrome (SARS) viruses, once SARS-CoV-2 binds to ACE2, it downregulates ACE2 expression. Lack of the favourable effects of ACE2 might exaggerate lung injury by a variety of mechanisms. In order to help address this controversy, we conducted a literature search and review of relevant preclinical and clinical publications pertaining to SARS-CoV-2, COVID-19, ACE2, viral pneumonia, SARS, acute respiratory distress syndrome and lung injury. Our review suggests, although controversial, that patients at increased susceptibility to COVID-19 complications may have reduced baseline ACE2, and by modulating ACE2 expression one can possibly improve COVID-19 outcomes. Herein, we elucidate why and how this potential mechanism might work.


Asunto(s)
/metabolismo , /metabolismo , Sistema Renina-Angiotensina/efectos de los fármacos , /genética , Adulto , Antagonistas de Receptores de Angiotensina/farmacología , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Animales , /virología , Regulación hacia Abajo , Femenino , Humanos , Inmunidad/inmunología , Lesión Pulmonar/tratamiento farmacológico , Lesión Pulmonar/fisiopatología , Masculino , Ratones , Persona de Mediana Edad , Modelos Animales , Neumonía Viral/tratamiento farmacológico , Factores de Riesgo , Internalización del Virus/efectos de los fármacos
19.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1066845

RESUMEN

COVID-19 is a biphasic illness with an initial viraemia phase and later effective adaptive immune phase, except in a minority of people who develop severe disease. Immune regulation is the key target to treat COVID illness. In anticipation, an elderly man self-medicated himself with dexamethasone on the day of symptom onset of a flu-like illness, took other symptomatic measures and was tested positive for SARS-CoV-2. His condition deteriorated with each passing day resulting in hospitalisation. He demanded oxygen and declared as severe COVID. With supportive treatment, he recovered after the 20th day of illness. Immunosuppression and anti-inflammation are likely to benefit when the immune response is dysregulated and turning into a cytokine storm. A medication that has saved many could be the one predisposing to severity if taken as a preventive measure, too early in the disease course, especially the viraemia phase.


Asunto(s)
Antiinflamatorios/efectos adversos , Dexametasona/efectos adversos , Viremia/tratamiento farmacológico , Anciano , Antiinfecciosos/uso terapéutico , Antiinflamatorios/uso terapéutico , Dexametasona/uso terapéutico , Hospitalización , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Automedicación/métodos , Esteroides/efectos adversos , Esteroides/uso terapéutico , Resultado del Tratamiento , Viremia/complicaciones
20.
mBio ; 12(1)2021 01 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1066816

RESUMEN

In December 2019 a new coronavirus (CoV) emerged as a human pathogen, SARS-CoV-2. There are few data on human coronavirus infections among individuals living with HIV. In this study we probed the role of pneumococcal coinfections with seasonal CoVs among children living with and without HIV hospitalized for pneumonia. We also described the prevalence and clinical manifestations of these infections. A total of 39,836 children who participated in a randomized, double-blind, placebo-controlled clinical trial on the efficacy of a 9-valent pneumococcal conjugate vaccine (PCV9) were followed for lower respiratory tract infection hospitalizations until 2 years of age. Nasopharyngeal aspirates were collected at the time of hospitalization and were screened by PCR for four seasonal CoVs. The frequency of CoV-associated pneumonia was higher in children living with HIV (19.9%) than in those without HIV (7.6%, P < 0.001). Serial CoV infections were detected in children living with HIV. The case fatality risk among children with CoV-associated pneumonia was higher in those living with HIV (30.4%) than without HIV (2.9%, P = 0.001). C-reactive protein and procalcitonin levels were elevated in 36.8% (≥40 mg/liter) and 64.7% (≥0.5 ng/ml), respectively, of the fatal cases living with HIV. Among children without HIV, there was a 64.0% (95% CI: 22.9% to 83.2%) lower incidence of CoV-associated pneumonia hospitalizations among PCV9 recipients compared to placebo recipients. These data suggest that Streptococcus pneumoniae infections might have a role in the development of pneumonia associated with endemic CoVs, that PCV may prevent pediatric CoV-associated hospitalization, and that children living with HIV with CoV infections develop more severe outcomes.IMPORTANCE SARS-CoV-2 may cause severe hospitalization, but little is known about the role of secondary bacterial infection in these severe cases, beyond the observation of high levels of reported inflammatory markers, associated with bacterial infection, such as procalcitonin. We did a secondary analysis of a double-blind randomized trial of PCV to examine its impact on human CoV infections before the pandemic. We found that both children living with and without HIV randomized to receive PCV had evidence of less hospitalization due to seasonal CoV, suggesting that pneumococcal coinfection may play a role in severe hospitalized CoV infections.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Infecciones por Coronavirus/prevención & control , Vacunas Neumococicas/administración & dosificación , Neumonía Viral/prevención & control , Streptococcus pneumoniae/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/prevención & control , Coinfección/virología , Coronavirus/clasificación , Coronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/patología , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lactante , Neumonía Neumocócica/epidemiología , Neumonía Neumocócica/prevención & control , Neumonía Viral/epidemiología , Prevalencia , Ensayos Clínicos Controlados Aleatorios como Asunto
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