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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
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.
BMC Infect Dis ; 20(1): 549, 2020 Jul 29.
Artículo en Inglés | MEDLINE | ID: covidwho-684717

RESUMEN

BACKGROUND: We aimed to report the epidemiological and clinical characteristics of hospitalized patients with coronavirus disease-19 (COVID-19) in Zengdu District, Hubei Province, China. METHODS: Clinical data on COVID-19 inpatients in Zengdu Hospital from January 27 to March 11, 2020 were collected; this is a community hospital in an area surrounding Wuhan and supported by volunteer doctors. All hospitalized patients with COVID-19 were included in this study. The epidemiological findings, clinical features, laboratory findings, radiologic manifestations, and clinical outcomes of these patients were analyzed. The patients were followed up for clinical outcomes until March 22, 2020. Severe COVID-19 cases include severe and critical cases diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. Severe and critical COVID-19 cases were diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. RESULTS: All hospitalized COVID-19 patients, 276 (median age: 51.0 years), were enrolled, including 262 non-severe and 14 severe patients. The proportion of patients aged over 60 years was higher in the severe group (78.6%) than in the non-severe group (18.7%, p < 0.01). Approximately a quarter of the patients (24.6%) had at least one comorbidity, such as hypertension, diabetes, or cancer, and the proportion of patients with comorbidities was higher in the severe group (85.7%) than in the non-severe group (21.4%, p < 0.01). Common symptoms included fever (82.2% [227/276]) and cough (78.0% [218/276]). 38.4% (106/276) of the patients had a fever at the time of admission. Most patients (94.9% [204/276]) were cured and discharged; 3.6% (10/276) deteriorated to a critical condition and were transferred to another hospital. The median COVID-19 treatment duration and hospital stay were 14.0 and 18.0 days, respectively. CONCLUSIONS: Most of the COVID-19 patients in Zengdu had mild disease. Older patients with underlying diseases were at a higher risk of progression to severe disease. The length of hospital-stay and antiviral treatment duration for COVID-19 were slightly longer than those in Wuhan. This work will contribute toward an understanding of COVID-19 characteristics in the areas around the core COVID-19 outbreak region and serve as a reference for decision-making for epidemic prevention and control in similar areas.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Tiempo de Internación/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Adolescente , Adulto , Niño , Preescolar , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Tos/epidemiología , Femenino , Fiebre/epidemiología , Humanos , Hipertensión/epidemiología , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
12.
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
13.
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
14.
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
15.
Drug Alcohol Rev ; 39(5): 441-446, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-681748

RESUMEN

INTRODUCTION AND AIMS: The Australian Treatment Outcomes Profile (ATOP) is a brief clinical tool measuring recent substance use, health and wellbeing among clients attending alcohol and other drug (AOD) treatment services. It has previously been assessed for concurrent validity and inter-rater reliability. In this study we examine whether it is suitable for administration over the telephone. DESIGN AND METHODS: We recruited a sample of 107 AOD clients across public sector specialist AOD treatment services in New South Wales, Australia between 2016 and 2018. Participants had a mean age of 47 years and 46% were female. Participants completed a face-to-face ATOP and a phone ATOP with a researcher within 5 days. Comparisons between the two administration modes were undertaken using Spearman's rank correlation coefficient for continuous or ordinal variables, and Cohen's Kappa for nominal variables. RESULTS: Among 107 participants, 59% were attending for alcohol treatment and 41% for opioid treatment. Most ATOP items (76%) reached above 0.7 (good) or 0.9 (excellent) agreement between face-to-face and telephone use. DISCUSSION AND CONCLUSIONS: Our findings suggest that the ATOP is a suitable instrument for telephone monitoring of recent substance use, health and social functioning among AOD clients. Its validation for remote use over the telephone will support staff to monitor clients' risks and outcomes-of particular relevance in response to the COVID-19 pandemic in which services are increasingly relying on telework approaches to client monitoring.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Centros de Tratamiento de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/rehabilitación , Teléfono , Adulto , Alcoholismo/rehabilitación , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur , Pandemias , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Resultado del Tratamiento
16.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 53-55, jun. 2020. ilus
Artículo en Español | LILACS (Américas) | ID: covidwho-679083

RESUMEN

Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)


Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria del Adulto/microbiología , Infecciones por Coronavirus/terapia , Fenotipo , Síndrome de Dificultad Respiratoria del Adulto/genética , Mecánica Respiratoria , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Tos/etiología , Disnea/etiología , Fiebre/etiología , Hipertensión/complicaciones , Unidades de Cuidados Intensivos , Hipoxia/fisiopatología , Obesidad/complicaciones
18.
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
19.
Pneumologie ; 74(7): 417-422, 2020 Jul.
Artículo en Alemán | MEDLINE | ID: covidwho-680640

RESUMEN

We present the case of a 48-year old man, a triathlet, with severe COVID-19 and extensive bilateral pneumonia. On day 7 since onset of symptoms, the patient had fever, cough, rheumatic pain, dyspnea as well as severe hypoxemic respiratory failure (PaO2 49,9 mmHg, PaCO2 35,7 mmHg, Horovitz-Index 130). CT of the lung showed extensive bilateral ground glass opacities.The patient was treated according to a predefined standard, including oxygen supplementation and, after intermittent worsening, with CPAP-ventilation. The patient improved and could be discharged with normal blood gases at ambient air after 12 days of hospitalization. Six weeks after discharge the patient was fully recovered and lung function as well as CT of the lungs were normal.Our case demonstrates that invasive ventilation can successfully be avoided in patients with severe hypoxemia caused by COVID-19 with bilateral pneumonia.


Asunto(s)
Betacoronavirus , Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus , Oxígeno/uso terapéutico , Pandemias , Neumonía Viral/complicaciones , Neumonía/complicaciones , Insuficiencia Respiratoria/terapia , Humanos , Intubación Intratraqueal , Masculino , Máscaras , Persona de Mediana Edad , Oxígeno/sangre , Insuficiencia Respiratoria/etiología , Resultado del Tratamiento
20.
Pneumologie ; 74(7): 423-428, 2020 Jul.
Artículo en Alemán | MEDLINE | ID: covidwho-680639

RESUMEN

We report the case of a 60-year old female patient with advanced severe lung injury as a consequence of COVID-19-pneumonia. The patient was initially treated with highflow oxygen via nasal cannula (HFNC) and CPAP for two days but had to be intubated and mechanically ventilated. After failure of mechanical ventilation because of persistant severe hypoxemia treatment was switched to ECMO which was applicated for 24 days. Prognostic parameters indicated a favourable trend after day 14. After discontinuation of ECMO and 11 days of intermittent assisted ventilation via tracheostoma and low dose oxygen (1 l/min), the patient could be transferred to rehabilitation. The last chest radiograph prior to transferral revealed a nearly complete resolution of bilateral pulmonary infiltrates. Our case demonstrates that severe COVID-19-associated lung injury can be reversible even after prolonged ECMO.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Coronavirus , Oxigenación por Membrana Extracorpórea/métodos , Neumonía Viral/complicaciones , Síndrome de Dificultad Respiratoria del Adulto/terapia , Insuficiencia Respiratoria/terapia , Betacoronavirus , Infecciones por Coronavirus/virología , Femenino , Humanos , Pulmón/fisiopatología , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Síndrome de Dificultad Respiratoria del Adulto/etiología , Resultado del Tratamiento
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