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1.
S Afr Med J ; 110(2): 135-139, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-32657685

RESUMEN

BACKGROUND: Clostridiodes difficile is a common cause of healthcare-associated diarrhoea. Laboratory testing for C. difficile infection (CDI) remains an area of confusion, as there is not a single accepted reference standard or a single best test. OBJECTIVES: To analyse the impact of different diagnostic methods on reported CDI rates. In addition, CDI incidence rates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa, were determined. METHODS: Results of stool samples submitted for C. difficile testing at CMJAH from 1 January 2014 to 31 August 2017 were reviewed. From January 2014 to July 2016, samples were tested by polymerase chain reaction (PCR) or toxin immunoassay, and from August 2016 to August 2017, algorithm-based testing (glutamate dehydrogenase and toxin immunoassay followed by PCR) was performed. RESULTS: A total of 4 829 samples were submitted. For the first period, toxin immunoassay and PCR showed a positivity rate of 11.4% and 21.1%, respectively, with an overall positivity rate of 18.7% (95% confidence interval (CI) 15.6 - 21.9). For the second period, the positivity rate was 15.9% (95% CI 11.3 - 17.7). This rate included samples that were GDH-positive and either showed toxin production or had a positive Xpert result. The CDI incidence for the two periods was different, with an incidence rate of 8.8 and 6.1 per 10 000 patient-days for the first and second periods, respectively. CONCLUSIONS: The choice of laboratory testing method has a major impact on the diagnosis of CDI, and therefore on reported rates of CDI. Standardisation of laboratory testing and incidence rate reporting is required in order to obtain robust and reliable data.


Asunto(s)
Infecciones por Clostridium/diagnóstico , Clostridium difficile/aislamiento & purificación , Diarrea/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Algoritmos , Infecciones por Clostridium/epidemiología , Diarrea/microbiología , Glutamato Deshidrogenasa/análisis , Humanos , Inmunoensayo/métodos , Incidencia , Estudios Retrospectivos , Sudáfrica
2.
Medicine (Baltimore) ; 99(28): e21293, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664185

RESUMEN

BACKGROUND: In the beginning of December 2019, the novel coronavirus pneumonia was first detected in Wuhan, China. Its widespread infectivity and strong pathogenicity has posed a great threat to public health, seriously affecting social production and life. Accumulating evidence suggests that gastrointestinal symptoms, such as diarrhea, are common among patients with COVID-19. Tuina (massage) therapy is 1 of the widely employed complementary and alternative medicine interventions in the world. It can act on the subcutaneous muscular layer, enhance the local blood circulation and tissue metabolism of the skin, thus exert its effects on digestive systems and alleviate aversive diarrhea symptoms. This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for diarrhea symptoms in COVID-19. METHODS: We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating exercise-induced fatigue: China National Knowledge Infrastructure, Wanfang and Pubmed Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. RESULTS: This proposed study will evaluate the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients. The outcomes will include the improvement of diarrhea symptoms and adverse effect. CONCLUSIONS: This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients.Dissemination and ethics: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.


Asunto(s)
Infecciones por Coronavirus , Diarrea , Fatiga , Masaje/métodos , Pandemias , Neumonía Viral , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Diarrea/etiología , Diarrea/fisiopatología , Diarrea/terapia , Fatiga/etiología , Fatiga/prevención & control , Humanos , Metaanálisis como Asunto , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
3.
Virulence ; 11(1): 707-718, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32490723

RESUMEN

With the outbreak of the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019, coronaviruses have become a global research hotspot in the field of virology. Coronaviruses mainly cause respiratory and digestive tract diseases, several coronaviruses are responsible for porcine diarrhea, such as porcine epidemic diarrhea virus (PEDV), porcine deltacoronavirus (PDCoV), and emerging swine acute diarrhea syndrome coronavirus (SADS-CoV). Those viruses have caused huge economic losses and are considered as potential public health threats. Porcine torovirus (PToV) and coronaviruses, sharing similar genomic structure and replication strategy, belong to the same order Nidovirales. Here, we developed a multiplex TaqMan-probe-based real-time PCR for the simultaneous detection of PEDV, PDCoV, PToV, and SADS-CoV for the first time. Specific primers and TaqMan fluorescent probes were designed targeting the ORF1a region of PDEV, PToV, and SADS-CoV and the ORF1b region of PDCoV. The method showed high sensitivity and specificity, with a detection limit of 1 × 102 copies/µL for each pathogen. A total of 101 clinical swine samples with signs of diarrhea were analyzed using this method, and the result showed good consistency with conventional reverse transcription PCR (RT-PCR). This method improves the efficiency for surveillance of these emerging and reemerging swine enteric viruses and can help reduce economic losses to the pig industry, which also benefits animal and public health.


Asunto(s)
Enfermedades Transmisibles Emergentes/veterinaria , Infecciones por Coronaviridae/veterinaria , Coronaviridae/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Enfermedades de los Porcinos/diagnóstico , Animales , Coinfección/diagnóstico , Coinfección/veterinaria , Enfermedades Transmisibles Emergentes/diagnóstico , Coronaviridae/genética , Infecciones por Coronaviridae/diagnóstico , Diarrea/diagnóstico , Diarrea/veterinaria , Sistemas de Lectura Abierta/genética , Reacción en Cadena de la Polimerasa/normas , ARN Viral/genética , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Porcinos
4.
Emerg Infect Dis ; 26(7): 1610-1612, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32568058

RESUMEN

We characterized novel coronaviruses detected in US bottlenose dolphins (BdCoVs) with diarrhea. These viruses are closely related to the other 2 known cetacean coronaviruses, Hong Kong BdCoV and beluga whale CoV. A deletion in the spike gene and insertions in the membrane gene and untranslated regions were found in US BdCoVs (unrelated to severe acute respiratory syndrome coronavirus 2).


Asunto(s)
Delfín Mular/virología , Infecciones por Coronavirus/veterinaria , Diarrea/veterinaria , Gammacoronavirus/clasificación , Gammacoronavirus/genética , Animales , Infecciones por Coronavirus/virología , Diarrea/virología , Gammacoronavirus/aislamiento & purificación , Gammacoronavirus/fisiología , Genes Virales , Genoma Viral , Mutación , Filogenia , Eliminación de Secuencia , Glicoproteína de la Espiga del Coronavirus/genética , Proteínas de la Matriz Viral/genética
5.
Cent Eur J Public Health ; 28(2): 135-142, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32592559

RESUMEN

OBJECTIVES: The aim of this study is to determine the risk factors of childhood diarrhoea in Turkey throughout Turkey Demographic and Health Survey (DHS) 1998 and 2008 data. METHODS: This study is a further analysis of the database of children under 5 years of age from the Turkey Demographic and Health Survey. Binomial logistic regression and Chi square analysis were used by weighted data of Turkey Demographic and Health Surveys. RESULTS: In 1998 DHS there were 3,459 and in 2008 DHS 3,463 children under 5 years of age. Diarrhoea prevalence was 30.1% and 18.3%, respectively. Multivariate analysis revealed that household wealth status index, region, mother's education, mother's age (15-19 age), age (under 2 years of age), and sex (male) of the child were the risk factors for 1998 DHS. In 2008 significant risk factors were geographic region, education of the mother and father, breastfeeding status of the child (still being breastfed), mother's age (20-29 age group), and age of child (under 2 years of age). CONCLUSIONS: As a result, patterns of the risk factors of diarrhoea has changed from 1998 to 2008 DHS in Turkey. However, impact of factors related with socioeconomic environment such as region and mother's education persisted.


Asunto(s)
Diarrea/epidemiología , Características de la Residencia , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Turquia/epidemiología
6.
JAMA Netw Open ; 3(6): e2013136, 2020 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32579195

RESUMEN

Importance: Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile. Objective: To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design, Setting, and Participants: In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece. Intervention: Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks. Main Outcomes and Measures: Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale, ranging from able to resume normal activities to death. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis. Results: A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group (P = .34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL (P = .73), respectively. The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = .02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P = .03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003). Conclusions and Relevance: In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration. There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels. These findings should be interpreted with caution. Trial Registration: ClinicalTrials.gov Identifier: NCT04326790.


Asunto(s)
Proteína C-Reactiva/metabolismo , Colchicina/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Neumonía Viral/tratamiento farmacológico , Troponina/metabolismo , Moduladores de Tubulina/uso terapéutico , Anciano , Anciano de 80 o más Años , Betacoronavirus , Causas de Muerte , Infecciones por Coronavirus/metabolismo , Diarrea/inducido químicamente , Progresión de la Enfermedad , Femenino , Grecia , Hospitalización , Humanos , Inflamación/metabolismo , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Mortalidad , Pandemias , Neumonía Viral/metabolismo , Respiración Artificial/estadística & datos numéricos , Factores de Tiempo , Resultado del Tratamiento
7.
Lancet ; 395(10239): 1779-1801, 2020 06 06.
Artículo en Inglés | MEDLINE | ID: mdl-32513411

RESUMEN

BACKGROUND: Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. METHODS: We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. FINDINGS: The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. INTERPRETATION: By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. FUNDING: Bill & Melinda Gates Foundation.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Diarrea/epidemiología , Diarrea/mortalidad , Carga Global de Enfermedades/estadística & datos numéricos , Salud Global/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Teorema de Bayes , Preescolar , Diarrea/prevención & control , Humanos , Incidencia , Prevalencia
8.
Infez Med ; 28(suppl 1): 37-41, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32532936

RESUMEN

In December 2019, a new Coronavirus (SARS-CoV-2) emerged in China, causing the pandemic disease COVID-19. The clinical presentation is variable, but the predominant symptoms are those of the upper respiratory tract. AIM: The aim of the current study is to describe the incidence and type of the gastrointestinal injury (GI) in COVID-19, as well as their prognostic value. MATERIALS AND METHODS: We conducted a coincidental search on this topic in PubMed, Web of Science and EMBASE. We also followed a group of 31 Bulgarian COVID-19 patients throughout the course of their disease and analyzed their symptoms (catarrhal and other) and outcome. RESULTS: The publications concerning our survey followed a total of 1509 COVID-19 patients. In the Bulgarian cohort, only 14 from the 31 patients were laboratory-confirmed COVID-19 cases. Approximately 1/3 of the infected individuals presented with GI. In some patients this was the first, or only, symptom of the disease. It was also indicative of a more severe disease course. CONCLUSION: GI may be an important symptom and prognostic factor in COVID-19. Therefore, patients with acute gastrointestinal symptoms must be actively tested for SARS-CoV-2.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Diarrea/etiología , Náusea/etiología , Neumonía Viral/complicaciones , Vómitos/etiología , Adolescente , Adulto , Anciano , Bulgaria/epidemiología , Niño , Preescolar , Técnicas de Laboratorio Clínico , Resfriado Común/etiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Diarrea/epidemiología , Femenino , Fiebre/etiología , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Hepatitis Viral Humana/epidemiología , Hepatitis Viral Humana/etiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Náusea/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Evaluación de Síntomas , Vómitos/epidemiología , Adulto Joven
9.
Int J Med Sci ; 17(9): 1142-1146, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32547309

RESUMEN

Objective: To analyze the blood test indicators of patients after infection of COVID-19 in Chongqing and analyze the clinical indicators of 8 patients with diarrhea. Materials and Methods: From January 26, 2019 to February 13, 2020, 70 patients diagnosed with 2019-nCoV according to the World Health Organization interim guidance for NCP and divided into diarrhea and non-diarrhea groups. The laboratory tests liver and kidney function, blood routine, coagulation function, and immune status. Results: The study population included 70 hospitalized patients with confirmed CONV-2019. NCP patients (43males and 27 females) with a mean age of 48.57±17.80 (9~82) years and only 4.3% of patients have lung-related diseases. The positive rate of ESR, CRP, PT, IL6, lymphocyte count, GGT, Prealbumin and CD4 was more than 50%. We further analyzed the differences between 8 diarrhea patients and 62 non-diarrhea patients. Among these indicators, only Lymphocyte, CRP, Prealbumin and Cystatin C positive rate is more than 50%. Although there is no statistical difference in GGT, 100% of the 7 patients tested decreased. Conclusion: Our data recommended that the ESR, CRP, PT, IL6, lymphocyte count, GGT, prealbumin and CD4 have important value in the diagnosis of COVID-19, and the decrease of GGT may be an important indicator for judging the intestinal dysfunction of patients.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Diarrea/diagnóstico , Neumonía Viral/complicaciones , gamma-Glutamiltransferasa/sangre , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Niño , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Diarrea/sangre , Diarrea/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Adulto Joven
11.
J Pak Med Assoc ; 70(Suppl 3)(5): S98-S100, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32515381

RESUMEN

The current pandemic coronavirus disease (COVID-19) is an ongoing healthcare crisis. While COVID- 19 typically presents as fever and respiratory illness, almost 50% of the patients also have associated digestive symptoms which vary from abdominal pain to diarrhoea and indigestion. Literature review of association of COVID- 19 with digestive symptoms was done using Google search and the results are presented herein.


Asunto(s)
Dolor Abdominal , Betacoronavirus , Infecciones por Coronavirus , Diarrea , Pandemias , Neumonía Viral , Dolor Abdominal/epidemiología , Dolor Abdominal/virología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Diarrea/epidemiología , Diarrea/virología , Humanos , Pandemias/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión
12.
BMJ Case Rep ; 13(6)2020 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-32546557

RESUMEN

A 33-year-old man presented repeatedly with severe abdominal pain and diarrhoea. Renal colic was suspected, and he was admitted for pain management. Questioning elicited an additional history of sore throat and mild, dry cough. Inflammatory markers were mildly raised (C reactive protein (CRP) 40 mg/L). Initial nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by PCR. CT of the kidneys, ureters and bladder (CT KUB) was normal; however, CT of the thorax showed multifocal bilateral peripheral areas of consolidation consistent with COVID-19 infection. He developed respiratory compromise and was transferred to the intensive care unit (ICU). Sputum was positive for SARS-CoV-2 by PCR, and culture grew Yersinia enterocolitica He recovered following supportive management and treatment with piperacillin-tazobactam.


Asunto(s)
Dolor Abdominal , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Combinación Piperacilina y Tazobactam/administración & dosificación , Neumonía Viral , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Adulto , Antibacterianos/administración & dosificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etiología , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Esputo/microbiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Yersinia enterocolitica/aislamiento & purificación
13.
PLoS Med ; 17(6): e1003130, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32544155

RESUMEN

BACKGROUND: As of April 18, 2020, over 2,000,000 patients had been diagnosed with coronavirus disease-2019 (COVID-19) globally, and more than 140,000 deaths had been reported. The clinical and epidemiological characteristics of adult patients have been documented recently. However, information on pediatric patients is limited. We describe the clinical and epidemiological characteristics of pediatric patients to provide valuable insight into the early diagnosis and assessment of COVID-19 in children. METHODS AND FINDINGS: This retrospective, observational study involves a case series performed at 4 hospitals in West China. Thirty-four pediatric patients with COVID-19 were included from January 27 to February 23, 2020. The final follow-up visit was completed by March 16, 2020. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, radiological findings, and treatment information. Data analysis was performed for 34 pediatrics patients with COVID-19 aged from 1 to 144 months (median 33.00, interquartile range 10.00-94.25), among whom 14 males (41%) were included. All the patients in the current study presented mild (18%) or moderate (82%) forms of COVID-19. A total of 48% of patients were noted to be without a history of exposure to an identified source. Mixed infections of other respiratory pathogens were reported in 16 patients (47%). Comorbidities were reported in 6 patients (18%). The most common initial symptoms were fever (76%) and cough (62%). Expectoration (21%), vomiting (12%), and diarrhea (12%) were also reported in a considerable portion of cases. A substantial increase was detected in serum amyloid A for 17 patients (among 20 patients with available data; 85%) and in high-sensitivity C-reactive protein for 17 patients (among 29 patients with available data; 59%), whereas a decrease in prealbumin was noticed in 25 patients (among 32 patients with available data; 78%). In addition, significant increases in the levels of lactate dehydrogenase and α-hydroxybutyrate dehydrogenase were detected in 28 patients (among 34 patients with available data; 82%) and 25 patients (among 34 patients with available data; 74%), respectively. Patchy lesions in lobules were detected by chest computed tomographic scans in 28 patients (82%). Ground-glass opacities, which were a typical feature in adults, were rare in pediatric patients (3%). Rapid radiologic progression and a late-onset pattern of lesions in the lobules were also noticed. Lesions in lobules still existed in 24 (among 32 patients with lesions; 75%) patients that were discharged, although the main symptoms disappeared a few days after treatment. All patients were discharged, and the median duration of hospitalization was 10.00 (8.00-14.25) days. The current study was limited by the small sample size and a lack of dynamic detection of inflammatory markers. CONCLUSIONS: Our data systemically presented the clinical and epidemiological features, as well as the outcomes, of pediatric patients with COVID-19. Stratified analysis was performed between mild and moderate cases. The findings offer new insight into early identification and intervention in pediatric patients with COVID-19.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Pulmón/diagnóstico por imagen , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Betacoronavirus , Proteína C-Reactiva/metabolismo , Niño , Preescolar , China/epidemiología , Coinfección/epidemiología , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/metabolismo , Tos/epidemiología , Tos/fisiopatología , Diarrea/epidemiología , Diarrea/fisiopatología , Femenino , Fiebre/epidemiología , Fiebre/fisiopatología , Humanos , Hidroxibutirato Deshidrogenasa/metabolismo , Lactante , L-Lactato Deshidrogenasa/metabolismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Pandemias , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/metabolismo , Prealbúmina/metabolismo , Estudios Retrospectivos , Proteína Amiloide A Sérica/metabolismo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Vómitos/epidemiología , Vómitos/fisiopatología
14.
Medicine (Baltimore) ; 99(23): e20631, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32502043

RESUMEN

This retrospective study aimed to explore the benefits and safety of probiotics (live combined Bacillus subtilis and Enterococcus faecium granules with multivitamines) for the treatment of children with antibiotic-associated diarrhea (AAD).A total of 72 children with AAD were analyzed in this study. Of these, 36 children received routine treatment plus probiotics, and were assigned to a treatment group. The other 36 children underwent routine treatment alone, and were assigned to a control group. Patients in both groups were treated for a total of 7 days. The efficacy and safety were evaluated by duration of diarrhea (days), number of dressings needed daily, abdominal pain intensity, stool consistency (as assessed by Bristol Stool Scale (BSS)), and any adverse events.After treatment, probiotics showed encouraging benefits in decreasing duration of diarrhea (days) (P < .01), number of dressings needed every day (P < .01), abdominal pain intensity (P < .01), and stool consistency (BSS (3-5), P < .01; BSS (6-7), P < .01). In addition, no adverse events were documented in this study.The findings of this study demonstrated that probiotics may provide promising benefit for children with AAD. Further studies are still needed to warrant theses findings.


Asunto(s)
Diarrea/inducido químicamente , Probióticos/efectos adversos , Bacillus subtilis/metabolismo , Estudios de Casos y Controles , Niño , Preescolar , Enterococcus faecium/metabolismo , Femenino , Humanos , Masculino , Probióticos/farmacología , Estudios Retrospectivos
15.
Postgrad Med J ; 96(1137): 392-398, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32522844

RESUMEN

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Tardío/prevención & control , Errores Diagnósticos/prevención & control , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , Enfermedades Cardiovasculares/virología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/fisiopatología , Síndrome de Liberación de Citoquinas/virología , Diagnóstico Tardío/estadística & datos numéricos , Diagnóstico Diferencial , Errores Diagnósticos/estadística & datos numéricos , Diarrea/virología , Disgeusia/virología , Humanos , Enfermedades del Sistema Nervioso/virología , Trastornos del Olfato/virología , Neumonía Viral/inmunología , Neumonía Viral/virología , Replicación Viral
16.
Acad Radiol ; 27(7): 910-921, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32505599

RESUMEN

RATIONALE AND OBJECTIVES: We aimed to assess the prevalence of significant computed tomographic(CT) manifestations and describe some notable features based on chest CT images, as well as the main clinical features of patients with coronavirus disease 2019(COVID-19). MATERIALS AND METHODS: A systematic literature search of PubMed, EMBASE, the Cochrane Library, and Web of Science was performed to identify studies assessing CT features, clinical, and laboratory results of COVID-19 patients. A single-arm meta-analysis was conducted to obtain the pooled prevalence and 95% confidence interval (95% CI). RESULTS: A total of 14 articles (including 1115 patients) based on chest CT images were retrieved. In the lesion patterns on chest CTs, we found that pure ground-glass opacities (GGO) (69%, 95% CI 58-80%), consolidation (47%, 35-60%) and "air bronchogram sign" (46%, 25-66%) were more common than the atypical lesion of "crazy-paving pattern" (15%, 8-22%). With regard to disease extent and involvement, 70% (95% CI 46-95%) of cases showed a location preference for the right lower lobe, 65% (58-73%) of patients presented with ≥3 lobes involvement, and meanwhile, 42% (32-53%) of patients had involvement of all five lobes, while 67% (55-78%) of patients showed a predominant peripheral distribution. An understanding of some important CT features might be helpful for medical surveillance and management. In terms of clinical features, muscle soreness (21%, 95% CI 15-26%) and diarrhea (7%, 4-10%) were minor symptoms compared to fever (80%, 74-87%) and cough (53%, 33-72%). CONCLUSION: Chest CT manifestations in patients with COVID-19, as well as its main clinical characteristics, might be helpful in disease evolution and management.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Biomarcadores/metabolismo , Broncografía/métodos , Proteína C-Reactiva/metabolismo , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/patología , Tos/virología , Diarrea/virología , Femenino , Fiebre/virología , Humanos , Leucopenia/virología , Pulmón/patología , Pulmón/virología , Linfopenia/virología , Masculino , Persona de Mediana Edad , Mialgia/virología , Pandemias , Neumonía Viral/patología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tórax
17.
Medicine (Baltimore) ; 99(22): e20197, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32481385

RESUMEN

RATIONALE: Neuroendocrine tumors (NETs) are neoplasms that can arise from the neuroendocrine cells distributed widely throughout the body. Majority of NETs overexpress somatostatin receptors (SSTR) on their cell surface. This biologic characteristic is exploited by SSTR-based imaging such as In octreotide scintigraphy and Ga DOTATATE positron emission tomography (PET)/computed tomography (CT), which are considered standard for initial evaluation of NETs. Although highly sensitive and specific, recent reports demonstrate a concerning incidence of "false-positive" physiologic uptake of these tracers in the pancreatic head - a common site of neuroendocrine tumor (NET) involvement. We present false positive uptake on Ga DOTATATE PET/CT along with false positive CT findings. Role of other imaging modalities is discussed. PATIENT CONCERNS: A 78-year-old woman presented with a year-long history of diarrhea. DIAGNOSIS: Serum vasoactive intestinal peptide (VIP) levels were slightly elevated at 134.2 pg/mL (normal <75 pg/mL). CT showed a mildly enhancing 2.5 cm × 1.8 cm × 2.8 cm area in the pancreatic uncinate process which corresponded to focal uptake with Ga DOTATATE PET/CT. A presumptive diagnosis of pancreatic NET (vipoma) was made, and the patient was scheduled to undergo Whipple's surgery. INTERVENTIONS: She sought a second opinion and a subsequent magnetic resonance imaging (MRI) showed no lesion and the patient's surgery was deferred. Thereafter, her VIP levels spontaneously normalized. Endoscopic ultrasound (EUS) with fine needle aspiration cytology of the uncinate process showed normal pancreatic acini with no evidence of NET. OUTCOMES: Patient is currently pursuing workup for alternative etiologies for chronic diarrhea. LESSONS: Conspicuous physiological uptake has been reported in the pancreatic head on 16% to 70% of Ga DOTATATE or Ga DOTANOC PET/CT scans, and 26% of the In octreotide scintigraphy scans. Image-based quantitative attempts to distinguish physiologic from pathologic uptake using SUVmax have rendered mixed results. When evaluating SSTR-based imaging uptake in the pancreatic head, patients can benefit from a higher index of suspicion of false positive uptake. Such cases require additional confirmation by MRI or EUS. Interestingly, the patient described also had mild contrast enhancement on CT, but without an MRI correlate. Because of potential morbidity and mortality related to false positive uptake, a systematic review with evidence-based recommendations for imaging may benefit patient care.


Asunto(s)
Errores Diagnósticos , Páncreas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Vipoma/diagnóstico por imagen , Anciano , Enfermedad Crónica , Diarrea/etiología , Reacciones Falso Positivas , Femenino , Radioisótopos de Galio , Humanos , Imagen por Resonancia Magnética , Compuestos Organometálicos
18.
Acad Emerg Med ; 27(6): 469-474, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32396670

RESUMEN

BACKGROUND: Symptom criteria for COVID-19 testing of heath care workers (HCWs) limitations on testing availability have been challenging during the COVID-19 pandemic. An evidence-based symptom criteria for identifying HCWs for testing, based on the probability of positive COVID-19 test results, would allow for a more appropriate use of testing resources. METHODS: This was an observational study of outpatient COVID-19 testing of HCWs. Prior to testing, HCWs were asked about the presence of 10 symptoms. Their responses were then compared to their subsequent pharyngeal swab COVID-19 polymerase chain reaction test results. These data were used to derive and evaluate a symptom-based testing criteria. RESULTS: A total of 961 HCWs were included in the analysis, of whom 225 (23%) had positive test results. Loss of taste or smell was the symptom with the largest positive likelihood ratio (3.33). Dry cough, regardless of the presence or absence of other symptoms, was the most sensitive (74%) and the least specific (32%) symptom. The existing testing criteria consisting of any combination of one or more of three symptoms (fever, shortness of breath, dry cough) was 93% sensitive and 9% specific (area unce the curve [AUC] = 0.63, 95% confidence interval [CI] = 0.59 to 0.67). The derived testing criteria consisting of any combination of one or more of two symptoms (fever, loss of taste or smell) was 89% sensitive and 48% specific (AUC = 0.75, 95% CI = 0.71 to 0.78). The hybrid testing criteria consisting of any combination of one or more of four symptoms (fever, shortness of breath, dry cough, loss of taste or smell) was 98% sensitive and 8% specific (AUC = 0.77, 95% CI = 0.73 to 0.80). CONCLUSION: An evidence-based approach to COVID-19 testing that at least includes fever and loss of taste or smell should be utilized when determining which HCWs should be tested.


Asunto(s)
Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Personal de Salud , Neumonía Viral/diagnóstico , Ageusia/etiología , Anorexia/etiología , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Tos/etiología , Diarrea/etiología , Disnea/etiología , Fatiga/etiología , Fiebre/etiología , Humanos , Mialgia/etiología , Trastornos del Olfato/etiología , Pandemias , Faringitis/etiología , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Reacción en Cadena de la Polimerasa
19.
Clin Res Hepatol Gastroenterol ; 44(3): 282-283, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32371006

RESUMEN

In a retrospective study in the Nord Franche-Comté hospital conducted between March 1st and March 17th 2020, and compared to the review of Li et al., diarrhea was a main symptom in patients with COVID-19. Out of the 114 patients, 55 (48%) had diarrhea; it was the fifth most common symptom. In the group of patients with diarrhea, the median age was 56 years (±18) and 32 (58%) were female. Only 2 patients (3.6%) had a past history of inflammatory bowel disease. Fifty-six percent of patients (n=30/54) were hospitalised. Diarrhea appeared 4.5 days (±1.8) after the onset of the first other symptoms in COVID-19. Of the 55 patients with diarrhea, 29 (52.7%) had at least one simultaneous gastrointestinal (GI) symptom other than diarrhea. Twenty-five patients (45.5%) had nausea, 19 patients (34.5%) had abdominal pain and 9 (16.3%) had vomiting. Myalgia, sore throat, sneezing and the other GI symptoms were statistically more frequent in the group with diarrhea than in the group without diarrhea (P<0.05).


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Diarrea/etiología , Neumonía Viral/complicaciones , Dolor Abdominal/epidemiología , Infecciones por Coronavirus/diagnóstico , Diarrea/epidemiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Mialgia/epidemiología , Náusea/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Estudios Retrospectivos , Distribución por Sexo , Evaluación de Síntomas , Vómitos/epidemiología
20.
Dig Dis Sci ; 65(7): 1932-1939, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32447742

RESUMEN

The month of December 2019 became a critical part of the time of humanity when the first case of coronavirus disease 2019 (COVID-19) was reported in the Wuhan, Hubei Province in China. As of April 13th, 2020, there have been approximately 1.9 million cases and 199,000 deaths across the world, which were associated with COVID-19. The COVID-19 is the seventh coronavirus to be identified to infect humans. In the past, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome were the two coronaviruses that infected humans with a high fatality, particularly among the elderly. Fatalities due to COVID-19 are higher in patients older than 50 years of age or those with multimorbid conditions. The COVID-19 is mainly transmitted through respiratory droplets, with the most common symptoms being high fever, cough, myalgia, atypical symptoms included sputum production, headache, hemoptysis and diarrhea. However, the incubation period can range from 2 to 14 days without any symptoms. It is particularly true with gastrointestinal (GI) symptoms in which patients can still shed the virus even after pulmonary symptoms have resolved. Given the high percentage of COVID-19 patients that present with GI symptoms (e.g., nausea and diarrhea), screening patients for GI symptoms remain essential. Recently, cases of fecal-oral transmission of COVID-19 have been confirmed in the USA and China, indicating that the virus can replicate in both the respiratory and digestive tract. Moreover, the epidemiology, clinical characteristics, diagnostic procedures, treatments and prevention of the gastrointestinal manifestations of COVID-19 remain to be elucidated.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Diarrea/fisiopatología , Náusea/fisiopatología , Neumonía Viral/fisiopatología , Vómitos/fisiopatología , Betacoronavirus/fisiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Síndrome de Liberación de Citoquinas/inmunología , Citocinas/inmunología , Diarrea/inmunología , Endoscopía del Sistema Digestivo , Heces/virología , Humanos , Náusea/inmunología , Pandemias/prevención & control , Neumonía Viral/inmunología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Tropismo Viral , Esparcimiento de Virus , Vómitos/inmunología
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