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1.
Porto Alegre; CEVS/RS; out. 2021. 1-15 p. ilus., graf., tab., mapas.
No convencional en Portugués | Coleciona SUS, CONASS, SES-RS | ID: biblio-1292931

RESUMEN

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Perfil de Salud , Mortalidad Hospitalaria/etnología , Grupos de Población/estadística & datos numéricos , COVID-19/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , COVID-19/complicaciones , COVID-19/mortalidad
2.
Br J Community Nurs ; 26(10): 474-480, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34632792

RESUMEN

Despite its many devastating effects, the COVID-19 pandemic has had a positive impact in the ways in which society, scientific institutions, governing bodies, businesses, educational organisations, and communication have functioned unchallenged over the years. Rapid advancement in science enabled identification and characterisation of the virus and in developing vaccines to combat the disease. The mysterious ways in which the virus attacks the vital organs that lead on to multiorgan failure and thrombosis of the arterial and venous system have also been revealed. The ability to study the microcirculatory changes at the bedside and predict prognosis is a way forward. All the evidence suggests that the outcome of COVID-19 infection is related to the severity of the disease seen in the intensive care unit setting. This article discusses microcirculatory changes and immune coagulopathy caused by COVID-19.


Asunto(s)
COVID-19 , Microcirculación , Trombosis , COVID-19/complicaciones , COVID-19/enfermería , Humanos , Trombosis/virología
3.
Front Endocrinol (Lausanne) ; 12: 708494, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34603199

RESUMEN

Aims: We conducted a systematic review and meta-analysis to assess various antidiabetic agents' association with mortality in patients with type 2 diabetes (T2DM) who have coronavirus disease 2019 (COVID-19). Methods: We performed comprehensive literature retrieval from the date of inception until February 2, 2021, in medical databases (PubMed, Web of Science, Embase, and Cochrane Library), regarding mortality outcomes in patients with T2DM who have COVID-19. Pooled OR and 95% CI data were used to assess relationships between antidiabetic agents and mortality. Results: Eighteen studies with 17,338 patients were included in the meta-analysis. Metformin (pooled OR, 0.69; P=0.001) and sulfonylurea (pooled OR, 0.80; P=0.016) were associated with lower mortality risk in patients with T2DM who had COVID-19. However, patients with T2DM who had COVID-19 and received insulin exhibited greater mortality (pooled OR, 2.20; P=0.002). Mortality did not significantly differ (pooled OR, 0.72; P=0.057) between DPP-4 inhibitor users and non-users. Conclusions: Metformin and sulfonylurea could be associated with reduced mortality risk in patients with T2DM who have COVID-19. Furthermore, insulin use could be associated with greater mortality, while DPP-4 inhibitor use could not be. The effects of antidiabetic agents in patients with T2DM who have COVID-19 require further exploration. Systematic Review Registration: PROSPERO (identifier, CRD42021242898).


Asunto(s)
COVID-19/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Hipoglucemiantes/uso terapéutico , Medición de Riesgo
4.
Pan Afr Med J ; 39: 199, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34603580

RESUMEN

Coronavirus disease 2019 (COVID-19) was first reported in December 2019. The disease is caused by severe acute respiratory syndrome virus corona virus 2 (SARS-CoV-2). Mild respiratory symptoms are the most common manifestations of SARS-CoV-2, but new signs are constantly being discovered as it spreads. Disorders of sodium balance are increasingly described in patients with SARS-CoV-2. We report, here, the cases of two patients presented with COVID-19 and in whom we discovered sodium disorders. The first patient is a 74-year-old man who presented with fatal hypernatremia. The second patient is a 66-years-old man presented with COVID-19 and euvolemic hyponatremia attributed to syndrome of inappropriate anti-diuretic hormone secretion (SIADH). This hyponatremia persisted long after the respiratory signs disappeared. Sodium balance disorders are increasingly described in the literature; special attention should be paid to the electrolyte status of COVID-19 patients. Pathophysiological mechanisms associating SARS-CoV-2 with these disorders are being studied.


Asunto(s)
COVID-19/complicaciones , Hipernatremia/virología , Síndrome de Secreción Inadecuada de ADH/virología , Anciano , Resultado Fatal , Humanos , Hipernatremia/diagnóstico , Hiponatremia/diagnóstico , Hiponatremia/virología , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Masculino , Sodio/sangre
5.
Acta Med Indones ; 53(3): 349-351, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34611076

RESUMEN

COVID-19 is a disease reported to suppress cellular immunity. This may lead to the development of opportunistic infections, among others black fungus, or mucormycosis. On the other hand, pre-existing defect in immunity may render patients susceptible to both mucormycosis and COVID-19. Mucormycosis is a relatively rare fungal infection with rapid progression unless diagnosed promptly and treated adequately, and urgent surgical and medical intervention is lifesaving. The manifestation of mucormycosis largely depends on the presence of exposure to the pathogen and the existing risk factor of the host. As black fungus is locally invasive, the majority of cases will involve tissue damage with local destruction and contiguous spread to nearby structure. We here with present a case of black fungus complicated with COVID-19 in a man with underlying non-Hodgkin's lymphoma.


Asunto(s)
COVID-19 , Linfoma no Hodgkin , Mucorales/aislamiento & purificación , Mucormicosis , Tabique Nasal/patología , SARS-CoV-2/aislamiento & purificación , Adulto , Biopsia/métodos , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/fisiopatología , COVID-19/terapia , Desbridamiento/métodos , Progresión de la Enfermedad , Humanos , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/patología , Linfoma no Hodgkin/fisiopatología , Masculino , Mucormicosis/complicaciones , Mucormicosis/microbiología , Mucormicosis/patología , Mucormicosis/fisiopatología , Enfermedades Nasales/microbiología , Enfermedades Nasales/patología , Aislamiento de Pacientes/métodos , Tiempo de Tratamiento , Tomografía Computarizada por Rayos X/métodos
6.
Front Endocrinol (Lausanne) ; 12: 705214, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34594302

RESUMEN

The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global health crisis affecting millions of people worldwide. SARS-CoV-2 enters the host cells by binding to angiotensin-converting enzyme 2 (ACE2) after being cleaved by the transmembrane protease serine 2 (TMPRSS2). In addition to the lung, gastrointestinal tract and kidney, ACE2 is also extensively expressed in endocrine tissues, including the pituitary and adrenal glands. Although glucocorticoids could play a central role as immunosuppressants during the cytokine storm, they can have both stimulating and inhibitory effects on immune response, depending on the timing of their administration and their circulating levels. Patients with adrenal insufficiency (AI) or Cushing's syndrome (CS) are therefore vulnerable groups in relation to COVID-19. Additionally, patients with adrenocortical carcinoma (ACC) could also be more vulnerable to COVID-19 due to the immunosuppressive state caused by the cancer itself, by secreted glucocorticoids, and by anticancer treatments. This review comprehensively summarizes the current literature on susceptibility to and outcome of COVID-19 in AI, CS and ACC patients and emphasizes potential pathophysiological mechanisms of susceptibility to COVID-19 as well as the management of these patients in case of SARS-CoV-2. Finally, by performing an in silico analysis, we describe the mRNA expression of ACE2, TMPRSS2 and the genes encoding their co-receptors CTSB, CTSL and FURIN in normal adrenal and adrenocortical tumors (both adenomas and carcinomas).


Asunto(s)
COVID-19/complicaciones , COVID-19/virología , Glucocorticoides/administración & dosificación , Insuficiencia Suprarrenal/complicaciones , Insuficiencia Suprarrenal/inmunología , Enzima Convertidora de Angiotensina 2/genética , Enzima Convertidora de Angiotensina 2/inmunología , Animales , COVID-19/genética , COVID-19/inmunología , Síndrome de Cushing/complicaciones , Síndrome de Cushing/inmunología , Humanos , Neoplasias/complicaciones , Neoplasias/inmunología , SARS-CoV-2/genética , SARS-CoV-2/fisiología
7.
Int Marit Health ; 72(3): 223-227, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34604993

RESUMEN

Since the global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of a coronavirus disease 2019 (COVID-19) infection started, millions of people globally have become infected. It must not be forgotten that thousands of those affected are commercial or recreational divers. A severe COVID-19 seriously affects the respiratory system and the pulmonary parenchyma but it may also involve the cardiovascular and the blood coagulation system. For this reason, many divers and hyperbaric medicine specialists are becoming increasingly concerned about a diver's ability to safely return to diving after a SARS-CoV-2 infection. The article presents current guidelines for diving fitness health assessment after a COVID-19 both for active and prospective divers, with particular emphasis on the types of diagnostic procedures and tests to be performed in cases of asymptomatic infection with SARS-CoV-2 as well as in patients who have recovered from a symptomatic COVID-19.


Asunto(s)
COVID-19/complicaciones , Buceo/normas , Reinserción al Trabajo , Guías como Asunto , Humanos , SARS-CoV-2
8.
Sci Rep ; 11(1): 19645, 2021 10 04.
Artículo en Inglés | MEDLINE | ID: mdl-34608197

RESUMEN

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.


Asunto(s)
Apendicitis/patología , COVID-19/patología , Colecistitis/patología , Diverticulitis/patología , Adulto , Anciano , Apendicitis/complicaciones , Apendicitis/epidemiología , Apendicitis/cirugía , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/virología , Colecistitis/complicaciones , Colecistitis/epidemiología , Colecistitis/cirugía , Diverticulitis/complicaciones , Diverticulitis/epidemiología , Diverticulitis/cirugía , Femenino , Humanos , Laparoscopía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , España/epidemiología
9.
PLoS One ; 16(10): e0258271, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34610041

RESUMEN

OBJECTIVE: Data on the course of severe COVID-19 in inflammatory bowel disease (IBD) patients remains limited. We aimed to determine the incidence rate and clinical course of severe COVID-19 in the heavily affected South-Limburg region in the Netherlands. METHODS: All COVID-19 patients admitted to the only two hospitals covering the whole South-Limburg region between February 27, 2020 and January 4, 2021 were included. Incidence rates for hospitalization due to COVID-19 were determined for the IBD (n = 4980) and general population (n = 597,184) in South-Limburg. RESULTS: During a follow-up of 4254 and 510,120 person-years, 20 IBD patients (0.40%; 11 ulcerative colitis (UC), 9 Crohn's disease (CD)) and 1425 (0.24%) patients from the general population were hospitalized due to proven COVID-19 corresponding to an incidence rate of 4.7 (95% Confidence interval (CI) 3.0-7.1) and 2.8 (95% CI 2.6-2.9) per 1000 patient years, respectively (Incidence rate ratio: 1.68, 95% CI 1.08-2.62, p = 0.019). Median age (IBD: 63.0 (IQR 58.0-75.8) years vs. general population: 72.0 (IQR 62.0-80.0) years, p = 0.10) and mean BMI (IBD: 24.4 (SD 3.3) kg/m2 vs. general population 24.1 (SD 4.9) kg/m2, p = 0.79) at admission were comparable in both populations. As for course of severe COVID-19, similar rates of ICU admission (IBD: 12.5% vs. general population: 15.7%, p = 1.00), mechanical ventilation (6.3% vs. 11.2%, p = 1.00) and death were observed (6.3% vs. 21.8%, p = 0.22). CONCLUSION: We found a statistically significant higher rate of hospitalization due to COVID-19 in IBD patients in a population-based setting in a heavily impacted Dutch region. This finding reflects previous research that showed IBD patients using systemic medication were at an increased risk of serious infection. However, although at an increased risk of hospitalization, clinical course of severe COVID-19 was comparable to hospitalized patients without IBD.


Asunto(s)
COVID-19/patología , Enfermedades Inflamatorias del Intestino/complicaciones , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/virología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Respiración Artificial , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Adulto Joven
10.
PLoS One ; 16(10): e0258229, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34610052

RESUMEN

BACKGROUND/AIMS: We measured the association between underlying chronic hepatitis B (CHB) and antiviral use with infection rates among patients who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. METHODS: In total, 204,418 patients who were tested for SARS-CoV-2 between January and June 2020 were included. For each case patient (n = 7,723) with a positive SARS-CoV-2 test, random controls (n = 46,231) were selected from the target population who had been exposed to someone with coronavirus disease 2019 (COVID-19) but had a negative SARS-CoV-2 test result. We merged claim-based data from the Korean National Health Insurance Service database collected. Primary endpoints were SARS-CoV-2 infection and severe clinical outcomes of COVID-19. RESULTS: The proportion of underlying CHB was lower in COVID-19 positive patients (n = 267, 3.5%) than in COVID-19 negative controls (n = 2482, 5.4%). Underlying CHB was associated with a lower SARS-CoV-2 positivity rate, after adjusting for comorbidities (adjusted odds ratio [aOR] 0.65; 95% confidence interval [CI], 0.57-0.74). Among patients with confirmed COVID-19, underlying CHB tended to confer a 66% greater risk of severe clinical outcomes of COVID-19, although this value was statistically insignificant. Antiviral treatment including tenofovir and entecavir was associated with a reduced SARS-CoV-2 positivity rate (aOR 0.49; 95% CI, 0.37-0.66), while treatment was not associated with severe clinical outcomes of COVID-19. CONCLUSIONS: Underlying CHB and antiviral agents including tenofovir decreased susceptibility to SARS-CoV-2 infection. HBV coinfection did not increase the risk of disease severity or lead to a worse prognosis in COVID-19.


Asunto(s)
COVID-19/patología , Hepatitis B Crónica/patología , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/virología , Estudios de Casos y Controles , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Guanina/análogos & derivados , Guanina/uso terapéutico , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , República de Corea/epidemiología , Riesgo , Índice de Severidad de la Enfermedad , Tenofovir/uso terapéutico , Adulto Joven
11.
Sci Rep ; 11(1): 19713, 2021 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-34611200

RESUMEN

The novel coronavirus disease 2019 (COVID-19) presents with non-specific clinical features. This may result in misdiagnosis or delayed diagnosis, and lead to further transmission in the community. We aimed to derive early predictors to differentiate COVID-19 from influenza and dengue. The study comprised 126 patients with COVID-19, 171 with influenza and 180 with dengue, who presented within 5 days of symptom onset. All cases were confirmed by reverse transcriptase polymerase chain reaction tests. We used logistic regression models to identify demographics, clinical characteristics and laboratory markers in classifying COVID-19 versus influenza, and COVID-19 versus dengue. The performance of each model was evaluated using receiver operating characteristic (ROC) curves. Shortness of breath was the strongest predictor in the models for differentiating between COVID-19 and influenza, followed by diarrhoea. Higher lymphocyte count was predictive of COVID-19 versus influenza and versus dengue. In the model for differentiating between COVID-19 and dengue, patients with cough and higher platelet count were at increased odds of COVID-19, while headache, joint pain, skin rash and vomiting/nausea were indicative of dengue. The cross-validated area under the ROC curve for all four models was above 0.85. Clinical features and simple laboratory markers for differentiating COVID-19 from influenza and dengue are identified in this study which can be used by primary care physicians in resource limited settings to determine if further investigations or referrals would be required.


Asunto(s)
COVID-19/patología , Dengue/patología , Gripe Humana/patología , Adulto , Área Bajo la Curva , COVID-19/complicaciones , COVID-19/virología , Estudios de Cohortes , Dengue/complicaciones , Dengue/virología , Diagnóstico Diferencial , Diarrea/etiología , Femenino , Fiebre/etiología , Humanos , Gripe Humana/complicaciones , Gripe Humana/virología , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , ARN Viral/análisis , ARN Viral/metabolismo , Curva ROC , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Vómitos/etiología , Adulto Joven
12.
Sci Rep ; 11(1): 19752, 2021 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-34611227

RESUMEN

Although metabolic syndrome (MetS) is linked to an elevated risk of cardiovascular disease (CVD), the cardiac-specific risk mechanism is unknown. Obesity, hypertension, and diabetes (all MetS components) are the most common form of CVD and represent risk factors for worse COVID-19 outcomes compared to their non MetS peers. Here, we use obese Yorkshire pigs as a highly relevant animal model of human MetS, where pigs develop the hallmarks of human MetS and reproducibly mimics the myocardial pathophysiology in patients. Myocardium-specific mass spectroscopy-derived metabolomics, proteomics, and transcriptomics enabled the identity and quality of proteins and metabolites to be investigated in the myocardium to greater depth. Myocardium-specific deregulation of pro-inflammatory markers, propensity for arterial thrombosis, and platelet aggregation was revealed by computational analysis of differentially enriched pathways between MetS and control animals. While key components of the complement pathway and the immune response to viruses are under expressed, key N6-methyladenosin RNA methylation enzymes are largely overexpressed in MetS. Blood tests do not capture the entirety of metabolic changes that the myocardium undergoes, making this analysis of greater value than blood component analysis alone. Our findings create data associations to further characterize the MetS myocardium and disease vulnerability, emphasize the need for a multimodal therapeutic approach, and suggests a mechanism for observed worse outcomes in MetS patients with COVID-19 comorbidity.


Asunto(s)
COVID-19/patología , Susceptibilidad a Enfermedades , Síndrome Metabólico/patología , Animales , Factores de Coagulación Sanguínea/genética , Factores de Coagulación Sanguínea/metabolismo , COVID-19/complicaciones , COVID-19/virología , Ciclooxigenasa 2/genética , Ciclooxigenasa 2/metabolismo , Dieta Alta en Grasa/veterinaria , Modelos Animales de Enfermedad , Humanos , Inmunidad Innata/genética , Síndrome Metabólico/complicaciones , Síndrome Metabólico/metabolismo , Metiltransferasas/genética , Metiltransferasas/metabolismo , Miocardio/metabolismo , Estrés Oxidativo/genética , Agregación Plaquetaria , Receptores Purinérgicos P2Y1/genética , Receptores Purinérgicos P2Y1/metabolismo , Sistema Renina-Angiotensina , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Porcinos , Activador de Plasminógeno de Tipo Uroquinasa/genética , Activador de Plasminógeno de Tipo Uroquinasa/metabolismo
14.
Eur J Med Res ; 26(1): 117, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34600589

RESUMEN

BACKGROUND: Interleukin-6 receptor antagonists (IL-6RAs) and steroids are emerging immunomodulatory therapies for severe and critical coronavirus disease (COVID-19). In this preliminary report, we aim to describe the epidemiology, clinical characteristics, and outcomes of adult critically ill COVID-19 patients, requiring invasive mechanical ventilation (iMV), and receiving IL-6RA and steroids therapy over the last 11 months. MATERIALS AND METHODS: International, multicenter, cohort study derived from Viral Infection and Respiratory Illness University Study registry and conducted through Discovery Network, Society of Critical Care Medicine. Data were collected between March 01, 2020, and January 10, 2021. RESULTS: Of 860 patients who met eligibility criteria, 589 received steroids, 170 IL-6RAs, and 101 combinations. Patients who received IL-6RAs were younger (median age of 57.5 years vs. 61.1 and 61.8 years in the steroids and combination groups, respectively). The median C-reactive protein level was > 75 mg/L, indicating a hyperinflammatory phenotype. The median daily steroid dose was 7.5 mg dexamethasone or equivalent (interquartile range: 6-14 mg); 80.8% and 19.2% received low-dose and high-dose steroids, respectively. Of the patients who received IL-6RAs, the majority received one dose of tocilizumab and sarilumab (dose range of 600-800 mg for tocilizumab and 200-400 mg for sarilumab). Regarding the timing of administration, we observed that steroid and IL-6RA administration on day 0 of ICU admission was only 55.6% and 39.5%, respectively. By day 28, when compared with steroid use alone, IL-6RA use was associated with an adjusted incidence rate ratio (aIRR) of 1.12 (95% confidence interval [CI] 0.88, 1.4) for ventilator-free days, while combination therapy was associated with an aIRR of 0.83 (95% CI 0.6, 1.14). IL-6RA use was associated with an adjusted odds ratio (aOR) of 0.68 (95% CI 0.44, 1.07) for the 28-day mortality rate, while combination therapy was associated with an aOR of 1.07 (95% CI 0.67, 1.70). Liver dysfunction was higher in IL-6RA group (p = 0.04), while the bacteremia rate did not differ among groups. CONCLUSIONS: Discordance was observed between the registry utilization patterns (i.e., timing of steroids and IL-6RA administration) and new evidence from the recent randomized controlled trials and guideline recommendations. These data will help us to identify areas of improvement in prescribing patterns and enhance our understanding of IL-6RA safety with different steroid regimens. Further studies are needed to evaluate the drivers of hospital-level variation and their impact on clinical outcomes. Trial registration ClinicalTrials.gov: NCT04486521. Registered on July 2020.


Asunto(s)
Corticoesteroides/uso terapéutico , COVID-19/complicaciones , Receptores de Interleucina-6/antagonistas & inhibidores , Sistema de Registros/estadística & datos numéricos , Respiración Artificial/métodos , Insuficiencia Respiratoria/mortalidad , SARS-CoV-2/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crítica , Femenino , Estudios de Seguimiento , Humanos , Agencias Internacionales , Masculino , Persona de Mediana Edad , Pronóstico , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/virología , Tasa de Supervivencia , Adulto Joven
15.
Pan Afr Med J ; 39: 230, 2021.
Artículo en Francés | MEDLINE | ID: mdl-34630842

RESUMEN

Introduction: the main purpose of this study is to describe chest computed tomography (CT) findings in 26 patients hospitalized with COVID-19 pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (UCK). Methods: we conducted a descriptive study of chest CT findings in 26 patients hospitalized with coronavirus pneumonia at the UCK over a 9-month period, from March 17 to November 17, 2020. Hitachi - CT-scanner 16 slice was used in all our patients. After analyzing lesions, these were divided into lesions suggestive and non-suggestive of SARS-CoV-2 infection. Results: the average age of patients was 53.02 years. Male sex was the most affected (76.9%). Respiratory distress was the most common clinical symptom (61.5%). Arterial hypertension and renal failure were the most common comorbidities (3O% and 6%). Bilateral ground-glass opacities, with a predominantly peripheral distribution, accounted for 69.2% of cases, followed by condensations (57.7%) and crazy paving (19.2%). Severe COVID-19 was most frequently found (34.61%). Distal and proximal pulmonary embolism was the most common complication (11.5%). Among the associated diseases, pleurisy and pulmonary PAH were most frequently found (30.8%). The majority of our patients had parenchymal lung lesions, corresponding to early-stage disease on CT (50%). Conclusion: at the UCK, during the first wave of SARS-CoV-2 pandemic, lesions on CT suggestive of COVID-19 were dominated by plaque-like ground-glass opacities, followed by nonsystematized parenchymatous condensations and crazy paving. The less observed atypical lesions consisted of unilateral, peribronchovascular pseudo-nodular condensations and infection in the remodeled lung. Severe COVID-19 was the most common CT finding. Proximal and distal pulmonary embolism was the most common complication. This study highlights that these findings are consistent with those reported in the literature.


Asunto(s)
COVID-19/complicaciones , Hospitalización , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , COVID-19/diagnóstico por imagen , Niño , Preescolar , República Democrática del Congo , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neumonía Viral/virología , Índice de Severidad de la Enfermedad , Distribución por Sexo , Adulto Joven
16.
J Zhejiang Univ Sci B ; 22(10): 876-884, 2021 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-34636190

RESUMEN

Since the outbreak of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) discovered in December 2019, the disease has emerged as a global pandemic (Shi et al., 2020; World Health Organization, 2020). Several studies have shown a higher incidence of COVID-19, as well as related poor outcomes in patients with malignancies as compared with those without them (Liang et al., 2020; Tian et al., 2020). The impact of cancer on COVID-19 may be attri­buted to the use of antitumor treatments that may disturb the host response to SARS-CoV-2 infection (Wang et al., 2020), while the current studies on this topic have drawn controversial conclusions. Some implied that anticancer treatments might elevate the risk of death (García-Suárez et al., 2020; Liu et al., 2020). On the contrary, others pointed out that this association is not significant (Brar et al., 2020; Lee et al., 2020a). Although previous systematic reviews have investigated this important issue (Wang and Huang, 2020), the heterogeneity of findings is obvious and the general conclusion has remained unclear. Considering this ambiguity, it is difficult for clinicians to make therapeutic decisions when facing patients with both cancer and COVID-19; therefore, a high-quality and accurate evaluation of the impact of anticancer treatments on COVID-19 patients is necessary. Accordingly, we conducted a pooled analysis with the original data of each patient for the first time to provide a comprehensive perspective into the association between anticancer regimens and the outcomes of cancer patients with COVID-19.


Asunto(s)
COVID-19/complicaciones , Neoplasias/terapia , SARS-CoV-2 , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
17.
Int J Mol Sci ; 22(19)2021 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-34638691

RESUMEN

A high incidence of thromboembolic events associated with high mortality has been reported in severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections with respiratory failure. The present study characterized post-transcriptional gene regulation by global microRNA (miRNA) expression in relation to activated coagulation and inflammation in 21 critically ill SARS-CoV-2 patients. The cohort consisted of patients with moderate respiratory failure (n = 11) and severe respiratory failure (n = 10) at an acute stage (day 0-3) and in the later course of the disease (>7 days). All patients needed supplemental oxygen and severe patients were defined by the requirement of positive pressure ventilation (intubation). Levels of D-dimers, activated partial thromboplastin time (aPTT), C-reactive protein (CRP), and interleukin (IL)-6 were significantly higher in patients with severe compared with moderate respiratory failure. Concurrently, next generation sequencing (NGS) analysis demonstrated increased dysregulation of miRNA expression with progression of disease severity connected to extreme downregulation of miR-320a, miR-320b and miR-320c. Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis revealed involvement in the Hippo signaling pathway, the transforming growth factor (TGF)-ß signaling pathway and in the regulation of adherens junctions. The expression of all miR-320 family members was significantly correlated with CRP, IL-6, and D-dimer levels. In conclusion, our analysis underlines the importance of thromboembolic processes in patients with respiratory failure and emphasizes miRNA-320s as potential biomarkers for severe progressive SARS-CoV-2 infection.


Asunto(s)
COVID-19/complicaciones , COVID-19/genética , MicroARNs/genética , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/genética , Anciano , Anciano de 80 o más Años , Coagulación Sanguínea , COVID-19/sangre , Progresión de la Enfermedad , Regulación hacia Abajo , Femenino , Humanos , Inflamación/sangre , Inflamación/etiología , Inflamación/genética , Masculino , MicroARNs/sangre , Persona de Mediana Edad , Insuficiencia Respiratoria/sangre , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad
18.
Int J Mol Sci ; 22(19)2021 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-34638785

RESUMEN

For a yet unknown reason, a substantial share of patients suffering from COVID-19 develop long-lasting neuropsychiatric symptoms ranging from cognitive deficits to mood disorders and/or an extreme fatigue. We previously reported that in non-neural cells, angiotensin-1 converting enzyme 2 (ACE2), the gene coding for the SARS-CoV2 host receptor, harbors tight co-expression links with dopa-decarboxylase (DDC), an enzyme involved in the metabolism of dopamine. Here, we mined and integrated data from distinct human expression atlases and found that, among a wide range of tissues and cells, enterocytes of the small intestine express the highest expression levels of ACE2, DDC and several key genes supporting the metabolism of neurotransmitters. Based on these results, we performed co-expression analyses on a recently published set of RNA-seq data obtained from SARS-CoV2-infected human intestinal organoids. We observed that in SARS-CoV2-infected enterocytes, ACE2 co-regulates not only with DDC but also with a specific group of genes involved in (i) the dopamine/trace amines metabolic pathway, (ii) the absorption of microbiota-derived L-DOPA and (iii) the absorption of neutral amino acids serving as precursors to neurotransmitters. We conclude that in patients with long COVID, a chronic infection and inflammation of small intestine enterocytes might be indirectly responsible for prolonged brain alterations.


Asunto(s)
Encéfalo/patología , COVID-19/complicaciones , Regulación de la Expresión Génica , Intestino Delgado/patología , Enzima Convertidora de Angiotensina 2/genética , Descarboxilasas de Aminoácido-L-Aromático/genética , Encéfalo/metabolismo , COVID-19/genética , COVID-19/patología , Células Cultivadas , Enterocitos/metabolismo , Enterocitos/patología , Humanos , Intestino Delgado/metabolismo , SARS-CoV-2/aislamiento & purificación
19.
Front Immunol ; 12: 752612, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34616409

RESUMEN

Background: Lymphopenia and the neutrophil/lymphocyte ratio may have prognostic value in COVID-19 severity. Objective: We investigated neutrophil subsets and functions in blood and bronchoalveolar lavage (BAL) of COVID-19 patients on the basis of patients' clinical characteristics. Methods: We used a multiparametric cytometry profiling based to mature and immature neutrophil markers in 146 critical or severe COVID-19 patients. Results: The Discovery study (38 patients, first pandemic wave) showed that 80% of Intensive Care Unit (ICU) patients develop strong myelemia with CD10-CD64+ immature neutrophils (ImNs). Cellular profiling revealed three distinct neutrophil subsets expressing either the lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), the interleukin-3 receptor alpha (CD123), or programmed death-ligand 1 (PD-L1) overrepresented in ICU patients compared to non-ICU patients. The proportion of LOX-1- or CD123-expressing ImNs is positively correlated with clinical severity, cytokine storm (IL-1ß, IL-6, IL-8, TNFα), acute respiratory distress syndrome (ARDS), and thrombosis. BALs of patients with ARDS were highly enriched in LOX-1-expressing ImN subsets and in antimicrobial neutrophil factors. A validation study (118 patients, second pandemic wave) confirmed and strengthened the association of the proportion of ImN subsets with disease severity, invasive ventilation, and death. Only high proportions of LOX-1-expressing ImNs remained strongly associated with a high risk of severe thrombosis independently of the plasma antimicrobial neutrophil factors, suggesting an independent association of ImN markers with their functions. Conclusion: LOX-1-expressing ImNs may help identifying COVID-19 patients at high risk of severity and thrombosis complications.


Asunto(s)
COVID-19/complicaciones , Neutrófilos/inmunología , Receptores Depuradores de Clase E/genética , Trombosis/etiología , Adulto , Anciano , Antígeno B7-H1/genética , Antígeno B7-H1/inmunología , Líquido del Lavado Bronquioalveolar/inmunología , COVID-19/genética , COVID-19/inmunología , COVID-19/virología , Enfermedad Crítica , Femenino , Humanos , Subunidad alfa del Receptor de Interleucina-3/genética , Subunidad alfa del Receptor de Interleucina-3/inmunología , Interleucina-8/genética , Interleucina-8/inmunología , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/genética , Síndrome de Dificultad Respiratoria/inmunología , SARS-CoV-2/fisiología , Receptores Depuradores de Clase E/inmunología , Trombosis/genética , Trombosis/inmunología
20.
Reumatol Clin (Engl Ed) ; 17(8): 431-436, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34625144

RESUMEN

The novel SARS-CoV-2 human coronavirus in Wuhan, China, has triggered a worldwide respiratory disease outbreak (COVID-19). Acute respiratory distress syndrome (ARDS), multiorgan dysfunction and thrombotic events are among the leading causes of death in critically ill patients with COVID-19. The elevated inflammatory cytokines suggest that a "cytokine storm", also known as cytokine release syndrome (CRS), may play a major role in the pathology of COVID-19. In addition to anti-viral therapy and supportive treatment in critically ill patients, unique medications for this condition are also under investigation. Here we reviewed therapeutic options, including the antibody therapy that might be an immediate strategy for SARS-CoV-2 therapy.


Asunto(s)
COVID-19/terapia , Síndrome de Liberación de Citoquinas/terapia , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/uso terapéutico , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/inmunología , Cloroquina/uso terapéutico , Terapia Combinada , Síndrome de Liberación de Citoquinas/diagnóstico , Síndrome de Liberación de Citoquinas/inmunología , Síndrome de Liberación de Citoquinas/virología , Fibrinolíticos/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Inmunización Pasiva , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Intercambio Plasmático , Inhibidores de Proteínas Quinasas/uso terapéutico , Terapia Respiratoria , Reumatología , Índice de Severidad de la Enfermedad , Trombosis/tratamiento farmacológico , Trombosis/virología
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