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3.
Neurol Neuroimmunol Neuroinflamm ; 8(6)2021 11.
Artigo em Inglês | MEDLINE | ID: covidwho-1456026

RESUMO

BACKGROUND AND OBJECTIVES: To describe the clinical features and disease outcomes of coronavirus disease 2019 (COVID-19) in patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS: The Neuroimmunology Brazilian Study Group has set up the report of severe acute respiratory syndrome (SARS-CoV2) cases in patients with NMOSD (pwNMOSD) using a designed web-based case report form. All neuroimmunology outpatient centers and individual neurologists were invited to register their patients across the country. Data collected between March 19 and July 25, 2020, were uploaded at the REDONE.br platform. Inclusion criteria were as follows: (1) NMOSD diagnosis according to the 2015 International Panel Criteria and (2) confirmed SARS-CoV2 infection (reverse transcription-polymerase chain reaction or serology) or clinical suspicion of COVID-19, diagnosed according to Center for Disease Control / Council of State and Territorial Epidemiologists (CDC/CSTE) case definition. Demographic and NMOSD-related clinical data, comorbidities, disease-modifying therapy (DMT), COVID-19 clinical features, and severity were described. RESULTS: Among the 2,061 pwNMOSD followed up by Brazilian neurologists involved on the registry of COVID-19 in pwNMOSD at the REDONE.br platform, 34 patients (29 women) aged 37 years (range 8-77), with disease onset at 31 years (range 4-69) and disease duration of 6 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibited mild disease, being treated at home (77%); 4 patients required admission at intensive care units (severe cases); and 1 patient died. Five of 34 (15%) presented neurologic manifestations (relapse or pseudoexacerbation) during or after SARS-CoV2 infection. DISCUSSION: Most NMOSD patients with COVID-19 presented mild disease forms. However, pwNMOSD had much higher odds of hospitalization and intensive care unit admission comparing with the general Brazilian population. The frequency of death was not clearly different. NMOSD disability, DMT type, and comorbidities were not associated with COVID-19 outcome. SARS-CoV2 infection was demonstrated as a risk factor for NMOSD relapses. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 severity and neurologic manifestations.


Assuntos
COVID-19/fisiopatologia , Hospitalização/estatística & dados numéricos , Neuromielite Óptica/fisiopatologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/terapia , Criança , Progressão da Doença , Feminino , Humanos , Imunossupressores/uso terapêutico , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neuromielite Óptica/tratamento farmacológico , Neuromielite Óptica/epidemiologia , Recidiva , SARS-CoV-2 , Índice de Gravidade de Doença , Adulto Jovem
4.
BMC Med ; 19(1): 208, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: covidwho-1455966

RESUMO

BACKGROUND: Coronavirus SARS-CoV-2, the causative agent of COVID-19, has caused a still evolving global pandemic. Given the worldwide vaccination campaign, the understanding of the vaccine-induced versus COVID-19-induced immunity will contribute to adjusting vaccine dosing strategies and speeding-up vaccination efforts. METHODS: Anti-spike-RBD IgGs and neutralizing antibodies (NAbs) titers were measured in BNT162b2 mRNA vaccinated participants (n = 250); we also investigated humoral and cellular immune responses in vaccinated individuals (n = 21) of this cohort 5 months post-vaccination and assayed NAbs levels in COVID-19 hospitalized patients (n = 60) with moderate or severe disease, as well as in COVID-19 recovered patients (n = 34). RESULTS: We found that one (boosting) dose of the BNT162b2 vaccine triggers robust immune (i.e., anti-spike-RBD IgGs and NAbs) responses in COVID-19 convalescent healthy recipients, while naïve recipients require both priming and boosting shots to acquire high antibody titers. Severe COVID-19 triggers an earlier and more intense (versus moderate disease) immune response in hospitalized patients; in all cases, however, antibody titers remain at high levels in COVID-19 recovered patients. Although virus infection promotes an earlier and more intense, versus priming vaccination, immune response, boosting vaccination induces antibody titers significantly higher and likely more durable versus COVID-19. In support, high anti-spike-RBD IgGs/NAbs titers along with spike (vaccine encoded antigen) specific T cell clones were found in the serum and peripheral blood mononuclear cells, respectively, of vaccinated individuals 5 months post-vaccination. CONCLUSIONS: These findings support vaccination efficacy, also suggesting that vaccination likely offers more protection than natural infection.


Assuntos
Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , Vacinas contra COVID-19/uso terapêutico , COVID-19 , Glicoproteína da Espícula de Coronavírus/imunologia , COVID-19/prevenção & controle , COVID-19/terapia , Humanos , Cinética , Leucócitos Mononucleares , RNA Mensageiro , SARS-CoV-2
6.
Front Health Serv Manage ; 38(1): 32-38, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1455390

RESUMO

SUMMARY: Fighting the global COVID-19 pandemic has shifted from immediate response efforts to recognition of the long-term effects on the mental health and well-being of the general population and healthcare workforce. Leaders need to understand the vital role of behavioral health services in a population-based, integrated healthcare framework and address the needs of the behavioral health workforce to successfully deploy services in their organizations and communities.During the ongoing national response to COVID-19, three major trends have emerged: (1) a shift to telehealth and digital care, (2) greater awareness of the impact on the workforce of the shift to digital care, and (3) an open dialogue to counteract the stigma and discrimination related to mental illness and to emphasize mental well-being instead. When they address stigma and discrimination, healthcare leaders embrace a more holistic approach that welcomes behavioral health professionals as equal, vital members of the care team. They help their organizations advance the mental well-being of all.


Assuntos
COVID-19/psicologia , COVID-19/terapia , Pessoal de Saúde/psicologia , Promoção da Saúde/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Estigma Social , Telemedicina/organização & administração , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Objetivos Organizacionais , Pandemias , SARS-CoV-2 , Estados Unidos
7.
Front Health Serv Manage ; 38(1): 39-44, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1455388

RESUMO

SUMMARY: Well-being, engagement, and burnout among clinicians are interconnected, and the common denominator is energy. Decades of research show that employees' energy is a decisive factor in achieving organizational outcomes. Knowing this, healthcare leaders can create well-being programs with measurable outcomes that make a positive impact on the bottom line. Just as important, leaders can avoid wasting money on fruitless efforts. How can clinician well-being be incorporated in organizational culture and strategic and operational plans? What are the special challenges to achieving clinician well-being? What key leadership actions promote and protect the well-being of clinicians? Which approaches are most effective during a crisis such as the COVID-19 pandemic? This article addresses those questions by presenting the rationale and methodology behind well-being programs that also address engagement and burnout so that clinicians can succeed in times of crisis and beyond.


Assuntos
Atitude do Pessoal de Saúde , Esgotamento Profissional/psicologia , COVID-19/terapia , Atenção à Saúde/organização & administração , Pessoal de Saúde/psicologia , Promoção da Saúde/organização & administração , Engajamento no Trabalho , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Objetivos Organizacionais , Pandemias , SARS-CoV-2
8.
Front Health Serv Manage ; 38(1): 27-31, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1455387

RESUMO

SUMMARY: Critical access hospitals (CAHs) serve their rural communities as the main access points and communication centers for healthcare, typically with very limited financial, staffing, and support resources. Local residents rely on their CAHs as the only providers for many miles around. When the COVID-19 pandemic hit in early 2020, CAH leaders had to rethink operations and priorities, both internally with staffs and externally with community leaders and organizations. Few critical care beds were available when the need was greatest. Testing was problematic, and cultural barriers complicated care. Now, as virus variants strike where vaccination numbers are low, CAH leaders remain wary of financial hits to elective procedure income, limited resources, and added stress for their staffs. Working with community service organizations and larger regional healthcare centers is a crucial strategy for CAHs as they address care delivery issues and ensure that their caregivers can do their jobs now and in the future.


Assuntos
COVID-19/terapia , Cuidados Críticos/organização & administração , Atenção à Saúde/organização & administração , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Administradores Hospitalares/psicologia , Serviços de Saúde Rural/organização & administração , Adulto , Animais , Atitude do Pessoal de Saúde , Feminino , Administração Hospitalar , Humanos , Illinois , Liderança , Masculino , Pessoa de Meia-Idade , Objetivos Organizacionais , Pandemias , SARS-CoV-2
9.
Front Health Serv Manage ; 38(1): 20-26, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1455386

RESUMO

SUMMARY: At Texas Health Resources, the well-being of our patients, our workforce, and our communities has long been at the core of who we are and the driving force behind business decisions, employee interactions, programs, practices, and the patient care we deliver. It is in our DNA, from our vision "to partner with you for a lifetime of health and well-being" to Our Texas Health Promise: Individuals Caring for Individuals, Together. That solid foundation-always the basis of our business preparations-made it possible for us to weather the challenges brought by the COVID-19 pandemic and to prepare ourselves for what comes next, emerging stronger and with sustained energy to transform the enterprise on the other end.


Assuntos
COVID-19/psicologia , COVID-19/terapia , Cuidadores/psicologia , Atenção à Saúde/organização & administração , Pessoal de Saúde/psicologia , Objetivos Organizacionais , Apoio Social , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Texas
10.
Front Health Serv Manage ; 38(1): 14-19, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1455385

RESUMO

SUMMARY: Enhancing employee well-being and creating a distinct employee experience are crucial to the success of Atrium Health. Our strategies for listening, well-being, and experience have always been deep-rooted in our culture, and the COVID-19 pandemic brought extraordinary opportunities to refresh those strategies as we carried out our mission during a time of uncertainty, crisis, and disruption to our everyday lives. From the start of the pandemic, we have deliberately anticipated the needs of our employees to provide support when they need it most. As the pandemic eases, we continue to make relevant and timely resources available to increase resilience and overall well-being. Our efforts have evolved to support our heroes-including our nonclinical workers-and to better position Atrium Health for future challenges that come our way. Although we are constantly changing, our primary focus remains the same. Employee well-being and experience are a significant part of who we are and an essential element of the care we all provide at Atrium Health.


Assuntos
Atitude do Pessoal de Saúde , COVID-19/psicologia , COVID-19/terapia , Atenção à Saúde/organização & administração , Instalações de Saúde , Pessoal de Saúde/psicologia , Cultura Organizacional , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Pandemias , SARS-CoV-2
11.
Anaesthesist ; 70(7): 573-581, 2021 07.
Artigo em Alemão | MEDLINE | ID: covidwho-1453676

RESUMO

BACKGROUND: In a pandemic situation the overall mortality rate is of considerable interest; however, these data must always be seen in relation to the given healthcare system and the availability of local level of care. A recently published German data evaluation of more than 10,000 COVID-19 patients treated in 920 hospitals showed a high mortality rate of 22% in hospitalized patients and of more than 50% in patients requiring invasive ventilation. Because of the high infection rates in Bavaria, a large number of COVID-19 patients with considerable severity of disease were treated at the intensive care units of the LMU hospital. The LMU hospital is a university hospital and a specialized referral center for the treatment of patients with acute respiratory distress syndrome (ARDS). OBJECTIVE: Data of LMU intensive care unit (ICU) patients were systematically evaluated and compared with the recently published German data. METHODS: Data of all COVID-19 patients with invasive and noninvasive ventilation and with completed admission at the ICU of the LMU hospital until 31 July 2020 were collected. Data were processed using descriptive statistics. RESULTS: In total 70 critically ill patients were included in the data evaluation. The median SAPS II on admission to the ICU was 62 points. The median age was 66 years and 81% of the patients were male. More than 90% were diagnosed with ARDS and received invasive ventilation. Treatment with extracorporeal membrane oxygenation (ECMO) was necessary in 10% of the patients. The median duration of ventilation was 16 days, whereby 34.3% of patients required a tracheostomy. Of the patients 27.1% were transferred to the LMU hospital from external hospitals with reference to our ARDS/ECMO program. Patients from external hospitals had ARDS of higher severity than the total study population. In total, nine different substances were used for virus-specific treatment of COVID-19. The most frequently used substances were hydroxychloroquine and azithromycin. Immunomodulatory treatment, such as Cytosorb® (18.6%) and methylprednisolone (25.7%) were also frequently used. The overall in-hospital mortality rate of ICU patients requiring ventilation was 28.6%. The mortality rates of patients from external hospitals, patients with renal replacement therapy and patients with ECMO therapy were 47.4%, 56.7% and 85.7%, respectively. CONCLUSION: The mortality rate in the ventilated COVID-19 intensive care patients was considerably different from the general rate in Germany. The data showed that treatment in an ARDS referral center could result in a lower mortality rate. Low-dose administration of steroids may be another factor to improve patient outcome in a preselected patient population. In the authors' opinion, critically ill COVID-19 patients should be treated in an ARDS center provided that sufficient resources are available.


Assuntos
COVID-19/terapia , Respiração Artificial/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , COVID-19/complicações , COVID-19/mortalidade , Estado Terminal/terapia , Oxigenação por Membrana Extracorpórea , Feminino , Alemanha , Mortalidade Hospitalar , Hospitais Universitários , Humanos , Fatores Imunológicos/uso terapêutico , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes , Terapia de Substituição Renal/estatística & dados numéricos , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Resultado do Tratamento
12.
Front Immunol ; 12: 739037, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1448729

RESUMO

Background: Transfusion of COVID-19 convalescent plasma (CCP) containing high titers of anti-SARS-CoV-2 antibodies serves as therapy for COVID-19 patients. Transfusions early during disease course was found to be beneficial. Lessons from the SARS-CoV-2 pandemic could inform early responses to future pandemics and may continue to be relevant in lower resource settings. We sought to identify factors correlating to high antibody titers in convalescent plasma donors and understand the magnitude and pharmacokinetic time course of both transfused antibody titers and the endogenous antibody titers in transfused recipients. Methods: Plasma samples were collected up to 174 days after convalescence from 93 CCP donors with mild disease, and from 16 COVID-19 patients before and after transfusion. Using ELISA, anti-SARS-CoV-2 Spike RBD, S1, and N-protein antibodies, as well as capacity of antibodies to block ACE2 from binding to RBD was measured in an in vitro assay. As an estimate for viral load, viral RNA and N-protein plasma levels were assessed in COVID-19 patients. Results: Anti-SARS-CoV-2 antibody levels and RBD-ACE2 blocking capacity were highest within the first 60 days after symptom resolution and markedly decreased after 120 days. Highest antibody titers were found in CCP donors that experienced fever. Effect of transfused CCP was detectable in COVID-19 patients who received high-titer CCP and had not seroconverted at the time of transfusion. Decrease in viral RNA was seen in two of these patients. Conclusion: Our results suggest that high titer CCP should be collected within 60 days after recovery from donors with past fever. The much lower titers conferred by transfused antibodies compared to endogenous production in the patient underscore the importance of providing CCP prior to endogenous seroconversion.


Assuntos
COVID-19/terapia , Convalescença , SARS-CoV-2/imunologia , Soroconversão , Adulto , Anticorpos Neutralizantes/sangue , Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Antígenos Virais/sangue , Doadores de Sangue , COVID-19/sangue , COVID-19/imunologia , Feminino , Humanos , Imunização Passiva , Cinética , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , RNA Viral/sangue
13.
CMAJ ; 193(38): E1483-E1493, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: covidwho-1448587

RESUMO

BACKGROUND: Risk factors for severe outcomes of SARS-CoV-2 infection are not well established in children. We sought to describe pediatric hospital admissions associated with SARS-CoV-2 infection in Canada and identify risk factors for more severe disease. METHODS: We conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP). Cases involving children who were admitted to hospital with microbiologically confirmed SARS-CoV-2 infection were reported from Apr. 8 to Dec. 31 2020, through weekly online questionnaires distributed to the CPSP network of more than 2800 pediatricians. We categorized hospital admissions as related to COVID-19, incidental, or for social or infection control reasons and determined risk factors for disease severity in hospital. RESULTS: Among 264 hospital admissions involving children with SARS-CoV-2 infection during the 9-month study period, 150 (56.8%) admissions were related to COVID-19 and 100 (37.9%) were incidental infections (admissions for other reasons and found to be positive for SARS-CoV-2 on screening). Infants (37.3%) and adolescents (29.6%) represented most cases. Among hospital admissions related to COVID-19, 52 (34.7%) had critical disease, 42 (28.0%) of whom required any form of respiratory or hemodynamic support, and 59 (39.3%) had at least 1 underlying comorbidity. Children with obesity, chronic neurologic conditions or chronic lung disease other than asthma were more likely to have severe or critical COVID-19. INTERPRETATION: Among children who were admitted to hospital with SARS-CoV-2 infection in Canada during the early COVID-19 pandemic period, incidental SARS-CoV-2 infection was common. In children admitted with acute COVID-19, obesity and neurologic and respiratory comorbidities were associated with more severe disease.


Assuntos
COVID-19/epidemiologia , Hospitalização , Índice de Gravidade de Doença , Doença Aguda , Adolescente , COVID-19/diagnóstico , COVID-19/etiologia , COVID-19/terapia , Teste para COVID-19 , Canadá/epidemiologia , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Achados Incidentais , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Vigilância em Saúde Pública , Fatores de Risco
14.
PLoS Negl Trop Dis ; 15(10): e0009766, 2021 10.
Artigo em Inglês | MEDLINE | ID: covidwho-1448571

RESUMO

BACKGROUND: The world population is currently at a very high risk of Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). People who live in malaria-endemic areas and get infected by SARS-CoV-2 may be at increased risk of severe COVID-19 or unfavorable disease outcomes if they ignore their malaria status. Therefore, the present study aimed to synthesize, qualitatively and quantitatively, information on the prevalence and characteristics of malaria infection among COVID-19-infected individuals. The findings will help us better understand this particular comorbidity during the COVID-19 pandemic. METHODS: The systematic review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number: CRD42021247521. We searched for studies reporting on the coinfection of COVID-19 and malaria in PubMed, Web of Science, and Scopus from inception to March 27, 2021 using Medical Subject Headings (MeSH) terms. The study's methodological quality in the search output was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional study. The pooled prevalence of Plasmodium spp. infection among patients infected with COVID-19 was estimated using the random effect model and then graphically presented as forest plots. The heterogeneity among the included studies was assessed using Cochrane Q and I2 statistics. The characteristics of patients co-infected with COVID-19 and malaria were derived from case reports and series and were formally analyzed using simple statistics. RESULTS: Twelve of 1,207 studies reporting the coinfection of COVID-19 and malaria were selected for further analysis. Results of quantitative synthesis show that the pooled prevalence of Plasmodium spp. infection (364 cases) among COVID-19 individuals (1,126 cases) is 11%, with a high degree of heterogeneity (95% CI: 4%-18%, I2: 97.07%, 5 studies). Most of the coinfections were reported in Nigeria (336 cases), India (27 cases), and the Democratic Republic of Congo (1 case). Results of qualitative synthesis indicate that patients with coinfection are typically symptomatic at presentation with mild or moderate parasitemia. An analysis of case reports and series indicates that co-infected individuals often display thrombocytopenia, lymphopenia, and elevated bilirubin levels. Among four patients (30%) who required treatment with intravenous artesunate, one experienced worsened clinical status after administering the drug. One serious outcome of coinfection involved a pregnant woman who experienced fetal abortion due to the initial misdiagnosis of malaria. CONCLUSIONS: All individuals in malaria-endemic regions who are febrile or display symptoms of COVID-19 should be evaluated for malaria to avoid serious complications. Further prospective studies are required to investigate the burden and outcomes of COVID-19 in malaria-endemic regions. Prompt management is required to prevent serious outcomes in individuals co-infected with COVID-19 and malaria.


Assuntos
COVID-19/epidemiologia , Coinfecção/epidemiologia , Malária/epidemiologia , SARS-CoV-2 , COVID-19/terapia , Humanos , Parasitemia/epidemiologia , Prevalência
15.
J Ambul Care Manage ; 44(4): 293-303, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1447660

RESUMO

COVID-19 necessitated significant care redesign, including new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. Opportunities also exist to harvest lessons from workflow innovations to benefit routine care. We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , COVID-19/terapia , Continuidade da Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Unidades de Cuidados Respiratórios/organização & administração , Adulto , Idoso , Boston/epidemiologia , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Encaminhamento e Consulta/estatística & dados numéricos , SARS-CoV-2 , Análise de Sistemas , Fluxo de Trabalho
16.
Pol Arch Intern Med ; 131(9): 854-861, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: covidwho-1444602

RESUMO

Infection with SARS­CoV­2, responsible for COVID­19, has spread all over the world since the beginning of 2020. Healthcare providers and researchers have been overwhelmed not only by the rapid diffusion of the disease resulting in a pandemic with more than 4 million cases of death, but also by the lack of therapeutic options. After more than 1 year, the knowledge on COVID­19 has increased thanks to the enormous effort of the scientific community. To date, some algorithms of management have been adopted. While asymptomatic or mildly symptomatic patients should receive only a symptom­based treatment and clinical monitoring when necessary, inpatients could be candidates for antiviral treatment due to fully symptomatic disease. Corticosteroid treatment should be limited to patients with severe disease, particularly those with respiratory failure or acute respiratory distress syndrome. Since the main clinical features of COVID­19 are hypoxemia and dyspnea, oxygen therapy remains the cornerstone of managing more severe cases. In this context, the first­line approach should be represented by low­flow oxygen delivery via a nasal cannula or, more frequently, via a face mask with a known fraction of inspired oxygen. When low­flow oxygen fails to significantly improve oxygen saturation, oxygen therapy using a high­flow nasal cannula is recommended. The current challenges in the treatment of COVID­19 include the need to define the role of convalescent plasma and monoclonal antibodies as well as to identify the optimal target and time for anticoagulation. In this review, we highlight the main aspects of these challenges in light of recent updates.


Assuntos
COVID-19 , Infecções por Coronavirus , COVID-19/terapia , Humanos , Imunização Passiva , Pandemias , SARS-CoV-2
17.
Laeknabladid ; 107(10): 460-468, 2021 Oct.
Artigo em Islandês | MEDLINE | ID: covidwho-1444585

RESUMO

Introduction Infections due to COVID-19 can lead to life threatening pneumonia. Accompanying severe disease are more prominent pulmonary changes on Computed Tomography (CT) scan of the chest. The goal of this study was to describe pulmonary CT changes during acute COVID-19 and at follow up and whether the extent of changes correlate with severity of illness, demographics or other risk factors. Materials and methods Included in this study are all individuals that had confirmed COVID-19 and came for a follow up CT of the chest at Landspitali from May to September 2020. Information regarding medical history was obtained retrospectively from medical charts. All CT scans were reviewed using an international staging system to evaluate the extent of lung changes. Results Eighty-five patients with a mean age of 59 years were included in the study. Sixty patients (71%) were hospitalized during the acute phase and 18 (21%) were admitted to the ICU. During the acute phase more pronounced lung involvement was seen in males and patients admitted to the ICU. At follow-up females had less lung involvement but there was a significant relationship between a higher CT score and age, ICU admissions and days in the ICU. Full recovery was seen at follow-up CT in 31% of patients (median 68,5 days between acute and follow-up imaging). Conclusion Patients with severe COVID-19 have more pronounced lung involvement on CT than patients with milder disease during the acute phase and follow-up. Older patients and males are at greater risk of acute and persistent COVID-19 related lung changes.


Assuntos
COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , SARS-CoV-2/patogenicidade , Tomografia Computadorizada por Raios X , Adulto , Fatores Etários , Idoso , COVID-19/terapia , COVID-19/virologia , Bases de Dados Factuais , Feminino , Hospitalização , Interações Hospedeiro-Patógeno , Humanos , Islândia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
19.
JMIR Public Health Surveill ; 7(9): e29544, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: covidwho-1443972

RESUMO

BACKGROUND: COVID-19 is a major public health concern. Given the extent of the pandemic, it is urgent to identify risk factors associated with disease severity. More accurate prediction of those at risk of developing severe infections is of high clinical importance. OBJECTIVE: Based on the UK Biobank (UKBB), we aimed to build machine learning models to predict the risk of developing severe or fatal infections, and uncover major risk factors involved. METHODS: We first restricted the analysis to infected individuals (n=7846), then performed analysis at a population level, considering those with no known infection as controls (ncontrols=465,728). Hospitalization was used as a proxy for severity. A total of 97 clinical variables (collected prior to the COVID-19 outbreak) covering demographic variables, comorbidities, blood measurements (eg, hematological/liver/renal function/metabolic parameters), anthropometric measures, and other risk factors (eg, smoking/drinking) were included as predictors. We also constructed a simplified (lite) prediction model using 27 covariates that can be more easily obtained (demographic and comorbidity data). XGboost (gradient-boosted trees) was used for prediction and predictive performance was assessed by cross-validation. Variable importance was quantified by Shapley values (ShapVal), permutation importance (PermImp), and accuracy gain. Shapley dependency and interaction plots were used to evaluate the pattern of relationships between risk factors and outcomes. RESULTS: A total of 2386 severe and 477 fatal cases were identified. For analyses within infected individuals (n=7846), our prediction model achieved area under the receiving-operating characteristic curve (AUC-ROC) of 0.723 (95% CI 0.711-0.736) and 0.814 (95% CI 0.791-0.838) for severe and fatal infections, respectively. The top 5 contributing factors (sorted by ShapVal) for severity were age, number of drugs taken (cnt_tx), cystatin C (reflecting renal function), waist-to-hip ratio (WHR), and Townsend deprivation index (TDI). For mortality, the top features were age, testosterone, cnt_tx, waist circumference (WC), and red cell distribution width. For analyses involving the whole UKBB population, AUCs for severity and fatality were 0.696 (95% CI 0.684-0.708) and 0.825 (95% CI 0.802-0.848), respectively. The same top 5 risk factors were identified for both outcomes, namely, age, cnt_tx, WC, WHR, and TDI. Apart from the above, age, cystatin C, TDI, and cnt_tx were among the top 10 across all 4 analyses. Other diseases top ranked by ShapVal or PermImp were type 2 diabetes mellitus (T2DM), coronary artery disease, atrial fibrillation, and dementia, among others. For the "lite" models, predictive performances were broadly similar, with estimated AUCs of 0.716, 0.818, 0.696, and 0.830, respectively. The top ranked variables were similar to above, including age, cnt_tx, WC, sex (male), and T2DM. CONCLUSIONS: We identified numerous baseline clinical risk factors for severe/fatal infection by XGboost. For example, age, central obesity, impaired renal function, multiple comorbidities, and cardiometabolic abnormalities may predispose to poorer outcomes. The prediction models may be useful at a population level to identify those susceptible to developing severe/fatal infections, facilitating targeted prevention strategies. A risk-prediction tool is also available online. Further replications in independent cohorts are required to verify our findings.


Assuntos
COVID-19/epidemiologia , Modelos Estatísticos , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Bancos de Espécimes Biológicos , COVID-19/mortalidade , COVID-19/terapia , Estudos de Coortes , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Reino Unido/epidemiologia
20.
ASAIO J ; 67(10): 1097-1099, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1443141

RESUMO

COVID-19 can be associated with acute respiratory distress syndrome, which increases the likelihood of morbidity and mortality. Ventilator-induced lung injury is a known complication of mechanical ventilation (MV) and can further compound lung injury and recovery. Escalation to extracorporeal membrane oxygenation can be required in patients who deteriorate on MV. We report our experience with complete avoidance of MV using an ECMO First strategy deployed in an awake nonintubated COVID-19 patient with severe pneumonia.


Assuntos
COVID-19/terapia , Oxigenação por Membrana Extracorpórea/métodos , Lesão Pulmonar/terapia , Síndrome do Desconforto Respiratório/terapia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , SARS-CoV-2 , Lesão Pulmonar Induzida por Ventilação Mecânica/etiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle
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