RESUMEN
Coronaviruses may activate dysregulated host immune responses. As exploratory studies have suggested that interleukin-6 (IL-6) levels are elevated in cases of complicated Covid-19, we undertook a systematic review and meta-analysis to assess the evidence in this field. We systematically searched MEDLINE and EMBASE for studies investigating the immunological response in Covid-19; additional grey literature searches were undertaken. Study selection and data abstraction was undertaken independently by two authors. Meta-analysis was undertaken using random effects models to compute ratios of means with 95% confidence intervals (95%CIs). Eight published studies and two preprints (n = 1798) were eligible for inclusion. Meta-analysis of mean IL-6 concentrations demonstrated 2.9-fold higher levels in patients with complicated Covid-19 compared with patients with noncomplicated disease (six studies; n = 1302; 95%CI, 1.17-7.19; I2 = 100%). Consistent results were found in sensitivity analyses exclusively restricted to studies comparing patients requiring ICU admission vs no ICU admission (two studies; n = 540; ratio of means = 3.24; 95%CI, 2.54-4.14; P < .001; I2 = 87%). Nine of ten studies were assessed to have at least moderate risk of bias. In patients with Covid-19, IL-6 levels are significantly elevated and associated with adverse clinical outcomes. Inhibition of IL-6 may be a novel target for therapeutics for the management of dysregulated host responses in patients with Covid-19 and high-quality studies of intervention in this field are urgently required.
Asunto(s)
COVID-19/metabolismo , COVID-19/virología , Interacciones Huésped-Patógeno , Interleucina-6/metabolismo , SARS-CoV-2/fisiología , Biomarcadores , COVID-19/complicaciones , COVID-19/terapia , Síndrome de Liberación de Citoquinas/etiología , Citocinas/metabolismo , Humanos , Pronóstico , Sesgo de PublicaciónRESUMEN
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.
Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/prevención & control , Oncología Médica/organización & administración , Neoplasias/terapia , Pandemias/prevención & control , Atención al Paciente/normas , Neumonía Viral/prevención & control , Betacoronavirus/aislamiento & purificación , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Higiene de las Manos/organización & administración , Higiene de las Manos/tendencias , Humanos , Control de Infecciones/organización & administración , Control de Infecciones/tendencias , Cooperación Internacional , Colaboración Intersectorial , Oncología Médica/economía , Oncología Médica/normas , Oncología Médica/tendencias , Atención al Paciente/economía , Atención al Paciente/tendencias , Educación del Paciente como Asunto , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Asignación de Recursos/economía , Asignación de Recursos/organización & administración , Asignación de Recursos/normas , Asignación de Recursos/tendencias , SARS-CoV-2 , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/normas , Telemedicina/tendencias , Organización Mundial de la SaludRESUMEN
OBJECTIVE: Systematically review the literature for cardiac catheterization and coronary angiography via distal transradial access (dTRA) and its outcomes. BACKGROUND: dTRA, via anatomical snuffbox, may have several advantages over conventional transradial access (cTRA) for percutaneous cardiac procedures, including easier left-sided access for aorto-coronary grafts, future proximal radial artery preservation, and patient and operator comfort. However, its procedural characteristics and safety profile remain unclear. METHODS: Ovid MEDLINE and EMBASE were searched from inception to September 2018. Two authors independently performed two-stage selection and data extraction. Reports assessing the dTRA approach for cardiac intervention in adults reporting any outcomes were eligible. Descriptive summary statistics were calculated from pooled data. RESULTS: A total of 19 publications comprising 4,212 participants undergoing dTRA were included. Mean age was 63.8 years, and 23.0% were female. dTRA was primarily undertaken for assessment of stable coronary artery disease (87.6%), with 41.7% for diagnostic procedures and 46.9% undergoing percutaneous coronary intervention. The overall success rate for undertaking the dTRA approach was 95.4% (69-100%). Complications occurred in 2.4% of cases, of which the leading complications were bleeding/hematoma (18.2%). Complication rates did not significantly differ between dTRA and cTRA. The occurrence of radial artery occlusion in patients undergoing dTRA was low (1.7%). CONCLUSIONS: Observational data demonstrate that dTRA is a safe and feasible method for percutaneous cardiac procedures, with high rates of procedural success and low rates of complication. As data comparing dTRA with cTRA remain limited, future high-quality randomized comparative studies are required.
Asunto(s)
Cateterismo Cardíaco , Cateterismo Periférico , Angiografía Coronaria , Intervención Coronaria Percutánea , Arteria Radial , Adulto , Anciano , Anciano de 80 o más Años , Cateterismo Cardíaco/efectos adversos , Cateterismo Periférico/efectos adversos , Angiografía Coronaria/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Intervención Coronaria Percutánea/efectos adversos , Punciones , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
Guidelines recommend annual dermatology screening after solid organ transplantation to facilitate early detection of keratinocyte carcinoma (nonmelanoma skin cancer), the most common posttransplant malignancy. There are limited data on adherence levels and barriers to screening. We conducted a cross-sectional survey of 477 physicians and nurses providing posttransplant care in Canada. The questionnaire asked about skin cancer screening and education practices, including the perceived importance and barriers. Whereas care providers viewed skin cancer screening as important for adult patients (median rating of 10/10, interquartile range 8-10), only 53% ensured annual screening for white adult transplant recipients. Having a screening policy in place (adjusted odds ratio 6.78, 95% confidence interval 3.12-14.74) and a dermatologist present at the transplant center (adjusted odds ratio 2.19, 95% confidence interval 1.03-4.67) were independently associated with higher adherence. Long wait times, lack of specialized transplant dermatologists, long travel distances, and insufficient priority were cited as the most common barriers for access to dermatologic care. Skin cancer education was provided to patients by over three quarters of care providers. Given the self-reported lack of adherence to annual skin cancer screening, there is need to develop, evaluate, and implement interventions that improve screening rates and skin cancer outcomes.
Asunto(s)
Dermatología/normas , Detección Precoz del Cáncer , Trasplante de Órganos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/prevención & control , Adulto , Canadá , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Enfermeras y Enfermeros , Cooperación del Paciente , Educación del Paciente como Asunto , Médicos , Periodo Posoperatorio , Factores de Riesgo , Neoplasias Cutáneas/complicaciones , Encuestas y Cuestionarios , Receptores de Trasplantes , Resultado del TratamientoRESUMEN
BK virus-associated hemorrhagic cystitis (BK-HC) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HCT), with incidences up to 70%. Cidofovir is an antiviral agent with growing evidence as a therapeutic intervention. To assess the safety profile and efficacy of intravenous and intravesical cidofovir in allo-HCT patients with BK-HC, a retrospective study was undertaken of the allo-HCT cohort who received cidofovir for symptomatic BK-HC (hematuria with BK viruria or viremia) from January 2010 until March 2017 in a single transplant center in Ontario, Canada. The primary outcome measure was a reduction in BK-HC severity (graded from 1 to 4); secondary outcomes included overall survival, BK virus titers, and the onset of acute kidney injury. Twelve allo-HCT patients received cidofovir for BK-HC, with pretreatment clinical severity of 3 (50%) or 4 (50%). Cidofovir was administered via intravenous (33%), intravesical (58%), or both modalities (8%). After a median cumulative dose of 10 mg/kg (range, 1 to 37), mean BK-HC grade decreased significantly by 1.8 (3.5 precidofovir, 1.7 postcidofovir, P < .01). Sixty-six percent of patients had at least partial response to cidofovir, with similar response rates between intravenous (66%) and intravesical (62%) administration. Sixty-seven percent of patients died, and 33% of patients experienced renal toxicity, including 2 patients receiving intravesical therapy. In this retrospective series, there was a significant reduction in BK-HC severity after cidofovir administration; most patients achieved at least partial response after cidofovir administration. Even with intravesical instillation, acute kidney injury remains a potential complication of cidofovir. Although cidofovir may be an efficacious therapy for BK-HC, albeit with potential demonstrated toxicities, further prospective trials are needed.
Asunto(s)
Antivirales/uso terapéutico , Virus BK/patogenicidad , Cidofovir/uso terapéutico , Cistitis/inducido químicamente , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trastornos Hemorrágicos/inducido químicamente , Acondicionamiento Pretrasplante/efectos adversos , Adulto , Anciano , Antivirales/farmacología , Cidofovir/farmacología , Cistitis/tratamiento farmacológico , Femenino , Trasplante de Células Madre Hematopoyéticas/métodos , Trastornos Hemorrágicos/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Acondicionamiento Pretrasplante/métodosAsunto(s)
Infecciones por Coronavirus , Neutropenia Febril , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2Asunto(s)
COVID-19 , Neoplasias , Humanos , Neoplasias/epidemiología , Neoplasias/terapia , Pandemias , SARS-CoV-2Asunto(s)
Amidas/uso terapéutico , Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Pirazinas/uso terapéutico , Betacoronavirus/efectos de los fármacos , COVID-19 , Ensayos Clínicos como Asunto , Humanos , Pandemias , SARS-CoV-2 , Tratamiento Farmacológico de COVID-19Asunto(s)
Cuarentena , Betacoronavirus , COVID-19 , Canadá , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Historia del Siglo XV , Historia del Siglo XXI , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Cuarentena/historia , Cuarentena/legislación & jurisprudencia , Cuarentena/psicología , SARS-CoV-2 , Síndrome Respiratorio Agudo Grave/prevención & control , Síndrome Respiratorio Agudo Grave/transmisiónAsunto(s)
Síndrome Coronario Agudo/terapia , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/administración & dosificación , Clorhidrato de Prasugrel/administración & dosificación , Antagonistas del Receptor Purinérgico P2/administración & dosificación , Ticagrelor/administración & dosificación , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/diagnóstico , Administración Oral , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/farmacocinética , Clorhidrato de Prasugrel/efectos adversos , Clorhidrato de Prasugrel/farmacocinética , Antagonistas del Receptor Purinérgico P2/efectos adversos , Antagonistas del Receptor Purinérgico P2/farmacocinética , Ensayos Clínicos Controlados Aleatorios como Asunto , Comprimidos , Ticagrelor/efectos adversos , Ticagrelor/farmacocinética , Resultado del TratamientoAsunto(s)
Atrios Cardíacos/diagnóstico por imagen , Osteofitosis Vertebral/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Anciano , Constricción Patológica/diagnóstico por imagen , Femenino , Soplos Cardíacos/etiología , Humanos , Osteofitosis Vertebral/complicaciones , Tomografía Computarizada por Rayos XAsunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico , Leucoencefalopatía Multifocal Progresiva/diagnóstico por imagen , Progresión de la Enfermedad , Glucocorticoides/uso terapéutico , Humanos , Leucoencefalopatía Multifocal Progresiva/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Prednisona/uso terapéutico , Activación ViralAsunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Cetoacidosis Diabética/complicaciones , Enfermedades del Esófago/etiología , Esófago/patología , Hemorragia Gastrointestinal/etiología , Necrosis/patología , Inhibidores de la Bomba de Protones/uso terapéutico , Enfermedad Aguda , Anorexia/etiología , Diabetes Mellitus Tipo 1/patología , Cetoacidosis Diabética/patología , Enfermedades del Esófago/tratamiento farmacológico , Enfermedades del Esófago/patología , Femenino , Hemorragia Gastrointestinal/patología , Humanos , Cumplimiento de la Medicación , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Adenocarcinoma/complicaciones , Dermatitis Exfoliativa/etiología , Dermatomiositis/etiología , Síndromes Paraneoplásicos/etiología , Neoplasias Gástricas/complicaciones , Adenocarcinoma/diagnóstico , Anciano , Dermatosis Facial/etiología , Femenino , Dermatosis de la Mano/etiología , Humanos , Neoplasias Gástricas/diagnósticoRESUMEN
OBJECTIVE: To evaluate the utility of autologous bone-flap swab cultures performed at the time of cranioplasty in predicting postcranioplasty surgical site infection (SSI). DESIGN: Retrospective cohort study. PARTICIPANTS: Patients undergoing craniectomy (with bone-flap storage in tissue bank), followed by delayed autologous bone-flap replacement cranioplasty between January 1, 2010, and November 30, 2020. SETTING: Tertiary-care academic hospital. METHODS: We framed the bone-flap swab culture taken at the time of cranioplasty as a diagnostic test for predicting postcranioplasty SSI. We calculated, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. RESULTS: Among 282 unique eligible cases, 16 (5.6%) developed SSI after cranioplasty. A high percentage of bone-flap swab cultures were positive at the time of craniectomy (66.7%) and cranioplasty (59.5%). Most organisms from bone-flap swab cultures were Cutibacterium acnes or coagulase-negative staphylococci (76%-85%), and most SSI pathogens were methicillin-susceptible Staphylococcus aureus (38%). Bone-flap swab culture had poor sensitivity (0.07; 95% CI, 0.01-0.31), specificity (0.4; 95% CI, 0.34-0.45), and positive likelihood ratio (0.12) for predicting postcranioplasty SSI. CONCLUSION: Overall, autologous bone-flap swab cultures performed at the time of cranioplasty have poor utility in predicting postcranioplasty SSI. Eliminating this low-value practice would result in significant workload reductions and associated healthcare costs.