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1.
Epidemiol Infect ; 149: e92, 2021 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814027

RESUMEN

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.


Asunto(s)
Atención Ambulatoria , /diagnóstico , Dolor Abdominal/fisiopatología , Adolescente , Adulto , Estudios de Casos y Controles , Reglas de Decisión Clínica , Tos/fisiopatología , Diarrea/fisiopatología , Progresión de la Enfermedad , Disnea/fisiopatología , Femenino , Fiebre/fisiopatología , Cefalea/fisiopatología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Mialgia/fisiopatología , Oportunidad Relativa , Selección de Paciente , Faringitis/fisiopatología , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Adulto Joven
2.
BMC Pregnancy Childbirth ; 21(1): 326, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902483

RESUMEN

BACKGROUND: Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS: Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS: A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS: Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.


Asunto(s)
/epidemiología , Portador Sano/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , /fisiopatología , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Comorbilidad , Tos/fisiopatología , Diabetes Gestacional/epidemiología , Disnea/fisiopatología , Femenino , Fiebre/fisiopatología , Edad Gestacional , Humanos , Hipertensión/epidemiología , Hipotiroidismo/epidemiología , Factores Inmunológicos/uso terapéutico , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pulmón/diagnóstico por imagen , Masculino , Obesidad Materna/epidemiología , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Radiografía Torácica , Respiración Artificial , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiología
3.
BMC Pulm Med ; 21(1): 126, 2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-33874930

RESUMEN

BACKGROUND: Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea (platypnea) and arterial desaturation in the upright position resolved in the supine position (orthodeoxia). Intracardiac shunt, pulmonary ventilation-perfusion mismatch and others intrapulmonary abnormalities are involved. CASE PRESENTATION: We report a case of POS associated with two pathophysiological issues: one, cardiac POS caused by a patent foramen ovale (PFO) and second, pulmonary POS due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interstitial pneumonia. POS has resolved after recovery of coronavirus disease 2019 (COVID-19) pneumonia. CONCLUSIONS: Right-to-left interatrial shunt and intrapulmonary shunt caused by SARS-CoV-2 pneumonia contributed to refractory hypoxemia and POS. Therefore, in case of COVID-19 patient with unexplained POS, the existence of PFO must be investigated.


Asunto(s)
Disnea , Foramen Oval Permeable , Hipoxia , Pulmón/diagnóstico por imagen , Neumonía Viral , /diagnóstico , Disnea/diagnóstico , Disnea/etiología , Disnea/fisiopatología , Ecocardiografía/métodos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico , Foramen Oval Permeable/fisiopatología , Hemodinámica , Humanos , Hipoxia/diagnóstico , Hipoxia/etiología , Hipoxia/fisiopatología , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/fisiopatología , Enfermedades Pulmonares Intersticiales/virología , Masculino , Persona de Mediana Edad , Oxígeno/análisis , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Postura/fisiología , Síndrome , Resultado del Tratamiento
4.
Saudi Med J ; 42(4): 391-398, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33795494

RESUMEN

OBJECTIVES: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. METHODS: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. CONCLUSION: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.


Asunto(s)
/fisiopatología , Dolor Abdominal/fisiopatología , Adolescente , Asma/epidemiología , Atrofia , Encéfalo/patología , Bronquiolitis Obliterante/epidemiología , /epidemiología , Niño , Preescolar , Comorbilidad , Tos/fisiopatología , Diarrea/fisiopatología , Disnea/fisiopatología , Femenino , Fiebre/fisiopatología , Cardiopatías Congénitas/epidemiología , Mortalidad Hospitalaria , Hospitalización , Humanos , Hidrocefalia/epidemiología , Lactante , Unidades de Cuidado Intensivo Pediátrico , Masculino , Faringitis/fisiopatología , Respiración Artificial , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos , Arabia Saudita/epidemiología , Índice de Severidad de la Enfermedad , Vómitos/fisiopatología
5.
BMJ Open Respir Res ; 8(1)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33731329

RESUMEN

BACKGROUND: Descriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequelae of patients admitted to two large District General Hospitals across a large East London National Health Service Trust during the first wave of the pandemic. METHODS: A retrospective analysis was carried out on a cohort of 1946 patients with a clinical or laboratory diagnosis of COVID-19, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three respiratory units in the trust. RESULTS: Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow-up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 70% of survivors, with 39% of patients unable to return to work due to ongoing symptoms. CONCLUSIONS: Understanding the acute clinical features, course of illness and outcomes of COVID-19 will be crucial in understanding the effect of differences in risk, as well as the effectiveness of new interventions and vaccination between the successive waves of the pandemic.


Asunto(s)
/complicaciones , /epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Alopecia/fisiopatología , /fisiopatología , Estudios de Cohortes , Tos/fisiopatología , Disnea/fisiopatología , Grupos Étnicos , Fatiga/fisiopatología , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Londres/epidemiología , Masculino , Trastornos de la Memoria/fisiopatología , Persona de Mediana Edad , Análisis Multivariante , Ventilación no Invasiva/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Reinserción al Trabajo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales
6.
Respir Physiol Neurobiol ; 288: 103644, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33647535

RESUMEN

The purpose of this study was to examine the physiological mechanisms of persistent dyspnoea in COVID-19 survivors. Non-critical patients (n = 186) with varying degrees of COVID-19 severity reported persistent symptoms using a standardized questionnaire and underwent pulmonary function and 6-minute walk testing between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n = 70) and without (n = 116) persistent dyspnoea. Patients with persistent dyspnoea had significantly lower FVC (p = 0.03), FEV1 (p = 0.04), DLCO (p = 0.01), 6-minute walk distance (% predicted, p = 0.03), and end-exercise oxygen saturation (p < 0.001), and higher Borg 0-10 ratings of dyspnoea and fatigue (both p < 0.001) compared to patients without persistent dyspnoea. We have shown that dyspnoea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnoea had greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased exertional desaturation and symptoms. This suggests that there is a true physiological mechanism that may explain persistent dyspnoea after COVID-19.


Asunto(s)
/complicaciones , Disnea/fisiopatología , Tolerancia al Ejercicio , Fatiga/fisiopatología , Intercambio Gaseoso Pulmonar , Espirometría , Adulto , Anciano , Enfermedad Crónica , Disnea/sangre , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Sobrevivientes , Capacidad Vital , Prueba de Paso
7.
Diabetes Metab Syndr ; 15(2): 535-541, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33711574

RESUMEN

BACKGROUND AND AIMS: Corona virus disease 2019 (COVID-19) has been an extremely difficult pandemic to contain and it has affected more than 148 countries worldwide. The main aim of this systematic review is to provide a comprehensive summary of clinical and laboratory parameters that are associated with and indicative of increased severity among COVID-19 patients. MATERIAL AND METHODS: All the available data from high-quality research articles relevant to the epidemiology, demographics, trends in hospitalization and outcomes, clinical signs and symptoms, diagnostic methods and treatment methods of COVID-19 were retrieved and evaluated for inclusion. RESULTS: As per our review, the mean age of patients in the severe group was 59.3 years compared to 46.5 years in non severe group. COVID-19 was more severe among men than women. Clinical presentation was variable among different studies. and dyspnea was the factor indicating severe disease. Laboratory parameters associated with increased severity were lymphopenia <0.8 × 109/L, thrombocytopenia 100 × 109/L, leucocytosis TC > 11 × 109/L, procalcitonin >0.5 ng/mL, d dimer >2 mcg/mL, aspartate transaminase elevation >150U/L, LDH >250U/L. CONCLUSION: This systematic review suggests that COVID-19 is a disease with varied clinical presentation and laboratory parameters. The commonest clinical symptoms were fever, cough and dyspnea. The laboratory parameters associated with severe disease were lymphopenia, elevated LDH, D dimer and Procalcitonin.


Asunto(s)
Aspartato Aminotransferasas/sangre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , L-Lactato Deshidrogenasa/sangre , Leucocitosis/sangre , Linfopenia/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Trombocitopenia/sangre , /epidemiología , Comorbilidad , Tos/fisiopatología , Disnea/fisiopatología , Fiebre/fisiopatología , Humanos , Respiración Artificial , Factores de Riesgo , Índice de Severidad de la Enfermedad
8.
Medicine (Baltimore) ; 100(9): e24930, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655957

RESUMEN

BACKGROUND: Rehabilitation training is beneficial for patients with chronic obstructive pulmonary disease (COPD). This study was aimed at evaluating the efficacy of muscle training on dyspnea. METHODS: We used 5 common databases for conducting a meta-analysis included PubMed, the Cochrane Library, Science Direct, Web of Science and Clinical Trials.gov, and eligible randomized controlled trials (RCTs) were included. The main results of include studies were dyspnea of patients who had a clinical diagnosis of COPD measured using Borg score and Medical Research Council (MRC) or modified Medical Research Council (mMRC) scale as the criteria before and after intervention. The intervention measures included respiratory or expiratory muscles or upper limb (UL) or lower limb (LL) training. The mean differences (MD) with the 95% confidence interval (CI) were considered for summary statistics. We also assessed risk of bias using the Cochrane collaboration's tool, and the value of I2 was applied to evaluate the heterogeneity of the trials. RESULTS: Fourteen RCTs with 18 interventions (n = 860 participants) were included. Muscle training significantly improved dyspnea during exercise and in the daily life of patients with COPD (MD, 95% CI: -0.58, -0.84 to -0.32, P  < .0001 and -0.44, -0.65 to -0.24, P  < .0001, respectively). In the subgroup analyses, the trials that used respiratory muscle and UL trainings significantly improved dyspnea during exercise (MD, 95% CI: -0.72, -1.13 to -0.31, P = .0005 and -0.53, -0.91 to -0.15, P = .007, respectively). The studies also showed that the participants in the rehabilitation group, who received respiratory muscle and UL trainings, had a significant improvement of dyspnea in daily life (MD, 95% CI: -0.38, -0.67 to -0.09, P = .01 and -0.51, -0.80 to -0.22, P = .0007, respectively). CONCLUSION: There were some limitations that most of the subjects in this study were patients with moderate to severe COPD and were male, and the training period and duration were different. The analyses revealed that respiratory muscle and UL trainings can improve dyspnea in patients with COPD during exercise and in daily life.


Asunto(s)
Disnea/rehabilitación , Tolerancia al Ejercicio/fisiología , Espiración/fisiología , Modalidades de Fisioterapia , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Ensayos Clínicos Controlados Aleatorios como Asunto , Músculos Respiratorios/fisiopatología , Disnea/etiología , Disnea/fisiopatología , Humanos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida
9.
BMC Pulm Med ; 21(1): 73, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33648488

RESUMEN

BACKGROUND: Scarring central airway stenosis (SCAS) is a potentially life-threatening condition with debilitating symptoms. Interventional bronchoscopy is increasingly used to relieve symptoms in patients with SCAS, but recurrent stenosis is frequently observed. Little data exist on the long-term prognosis of interventional bronchoscopy for SCAS. We aimed to assess the prognostic factors of bronchoscopic interventions in patients with SCAS to optimize treatment. METHODS: This was a retrospective study that enrolled 119 consecutive patients with SCAS from January 2010 to April 2019 at our institution. Long-term clinical success was defined as airway stenosis < 50%, no limitation of physical activity, and a stable condition for > 12 months after the last interventional procedure. We compared patients' demographics, airway stenosis characteristics, and interventional procedures between the successful and unsuccessful groups, and identified significant predictors of long-term outcome with univariate and multivariate logistic regression. RESULTS: A total of 119 patients with 577 therapeutic bronchoscopies were included. Seventy-five (63%) patients were considered to have long-term clinical success. Older age, male gender, smoking, elevated C-reactive protein level, subglottic stenosis, stent or T-tube implantation, previous interventional treatment, and multiple procedures per year were potentially associated with unsuccessful long-term outcomes in the univariate analysis. Current smoker status (odds ratio [OR] 5.70, 95% confidence interval [CI] 1.35-24.17, P = 0.018), subglottic stenosis (OR 4.35, 95% CI 1.31-14.46, P = 0.017), and stent implantation (OR 4.96, 95% CI 1.33-18.48, P = 0.017) were associated with decreased odds of long-term success in the multivariate logistic regression analysis. Of note, there was no significant difference in odds of success between former smokers and nonsmokers. CONCLUSIONS: Current smoker status, subglottic stenosis, and stent implantation are independent factors associated with reduced long-term efficacy of interventional bronchoscopy for SCAS. Smoking cessation should be encouraged to improve the outcome of therapeutic bronchoscopy.


Asunto(s)
Enfermedades Bronquiales/cirugía , Broncoscopía/métodos , Cicatriz/cirugía , Laringoestenosis/cirugía , Stents , Estenosis Traqueal/cirugía , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapéutico , Enfermedades Bronquiales/patología , Enfermedades Bronquiales/fisiopatología , Cicatriz/fisiopatología , Constricción Patológica , Tos/fisiopatología , Criocirugia/métodos , Dilatación/métodos , Combinación de Medicamentos , Disnea/fisiopatología , Femenino , Volumen Espiratorio Forzado , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intralesiones , Laringoestenosis/fisiopatología , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Ápice del Flujo Espiratorio , Complicaciones Posoperatorias/epidemiología , Pronóstico , Recurrencia , Estudios Retrospectivos , Fumar , Estenosis Traqueal/fisiopatología , Capacidad Vital , Adulto Joven
10.
Chron Respir Dis ; 18: 14799731211002240, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729021

RESUMEN

Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38-0.66, p < 0.01, I 2 = 97%), 0.37 (CI 0.28-0.48, p < 0.01, I 2 = 93%), 0.16 (CI 0.10-0.23, p < 0.01, I 2 = 90%) and 0.14 (CI 0.06-0.24, p < 0.01, I 2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.


Asunto(s)
/complicaciones , Dolor en el Pecho/epidemiología , Tos/epidemiología , Disnea/epidemiología , Fatiga/epidemiología , /epidemiología , Dolor en el Pecho/fisiopatología , Tos/fisiopatología , Disnea/fisiopatología , Fatiga/fisiopatología , Humanos , Prevalencia , Sobrevivientes
11.
JAMA Netw Open ; 4(3): e211085, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33688964

RESUMEN

Importance: Solid estimates of the risk of developing symptoms and of progressing to critical disease in individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are key to interpreting coronavirus disease 2019 (COVID-19) dynamics, identifying the settings and the segments of the population where transmission is more likely to remain undetected, and defining effective control strategies. Objective: To estimate the association of age with the likelihood of developing symptoms and the association of age with the likelihood of progressing to critical illness after SARS-CoV-2 infection. Design, Setting, and Participants: This cohort study analyzed quarantined case contacts, identified between February 20 and April 16, 2020, in the Lombardy region of Italy. Contacts were monitored daily for symptoms and tested for SARS-CoV-2 infection, by either real-time reverse transcriptase-polymerase chain reaction using nasopharyngeal swabs or retrospectively via IgG serological assays. Close contacts of individuals with laboratory-confirmed COVID-19 were selected as those belonging to clusters (ie, groups of contacts associated with an index case) where all individuals were followed up for symptoms and tested for SARS-CoV-2 infection. Data were analyzed from February to June 2020. Exposure: Close contact with individuals with confirmed COVID-19 cases as identified by contact tracing operations. Main Outcomes and Measures: Age-specific estimates of the risk of developing respiratory symptoms or fever greater than or equal to 37.5 °C and of experiencing critical disease (defined as requiring intensive care or resulting in death) in SARS-CoV-2-infected case contacts. Results: In total, 5484 case contacts (median [interquartile range] age, 50 [30-61] years; 3086 female contacts [56.3%]) were analyzed, 2824 of whom (51.5%) tested positive for SARS-CoV-2 (median [interquartile range] age, 53 [34-64] years; 1604 female contacts [56.8%]). The proportion of infected persons who developed symptoms ranged from 18.1% (95% CI, 13.9%-22.9%) among participants younger than 20 years to 64.6% (95% CI, 56.6%-72.0%) for those aged 80 years or older. Most infected contacts (1948 of 2824 individuals [69.0%]) did not develop respiratory symptoms or fever greater than or equal to 37.5 °C. Only 26.1% (95% CI, 24.1%-28.2%) of infected individuals younger than 60 years developed respiratory symptoms or fever greater than or equal to 37.5 °C; among infected participants older than 60 years, 6.6% (95% CI, 5.1%-8.3%) developed critical disease. Female patients were 52.7% (95% CI, 24.4%-70.7%) less likely than male patients to develop critical disease after SARS-CoV-2 infection. Conclusions and Relevance: In this Italian cohort study of close contacts of patients with confirmed SARS-CoV-2 infection, more than one-half of individuals tested positive for the virus. However, most infected individuals did not develop respiratory symptoms or fever. The low proportion of children and young adults who developed symptoms highlights the possible challenges in readily identifying SARS-CoV-2 infections.


Asunto(s)
/fisiopatología , Portador Sano/epidemiología , Tos/epidemiología , Disnea/epidemiología , Fiebre/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , /epidemiología , Dolor en el Pecho/epidemiología , Dolor en el Pecho/fisiopatología , Niño , Preescolar , Trazado de Contacto , Tos/fisiopatología , Enfermedad Crítica , Progresión de la Enfermedad , Disnea/fisiopatología , Femenino , Fiebre/fisiopatología , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Persona de Mediana Edad , Faringitis/epidemiología , Faringitis/fisiopatología , Cuarentena , Factores de Riesgo , Índice de Severidad de la Enfermedad , Taquipnea/epidemiología , Taquipnea/fisiopatología , Adulto Joven
12.
Pediatr Rheumatol Online J ; 19(1): 29, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726806

RESUMEN

BACKGROUND: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.


Asunto(s)
/fisiopatología , Enfermedad de la Arteria Coronaria/fisiopatología , Hipotensión/fisiopatología , Linfopenia/fisiopatología , Síndrome Mucocutáneo Linfonodular/fisiopatología , Miocarditis/fisiopatología , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatología , Distribución por Edad , Antirreumáticos/uso terapéutico , Aspirina/uso terapéutico , Proteína C-Reactiva/metabolismo , /metabolismo , Niño , Preescolar , Tos/fisiopatología , Diarrea/fisiopatología , Disnea/fisiopatología , Femenino , Glucocorticoides/uso terapéutico , Insuficiencia Cardíaca/fisiopatología , Humanos , /fisiopatología , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Lactante , Unidades de Cuidado Intensivo Pediátrico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Italia/epidemiología , Masculino , Síndrome Mucocutáneo Linfonodular/epidemiología , Síndrome Mucocutáneo Linfonodular/metabolismo , Síndrome Mucocutáneo Linfonodular/terapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Choque/fisiopatología , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/metabolismo , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Taquipnea/fisiopatología , Troponina T/metabolismo , Vómitos/fisiopatología
13.
J Med Case Rep ; 15(1): 143, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33741059

RESUMEN

BACKGROUND: There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. CASE PRESENTATION: In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. CONCLUSIONS: The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.


Asunto(s)
/diagnóstico , Cardiomiopatías/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Trastornos Puerperales/diagnóstico , Edema Pulmonar/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Azitromicina/uso terapéutico , /terapia , Cardiomiopatías/tratamiento farmacológico , Cardiomiopatías/fisiopatología , Cesárea , Tos/fisiopatología , Diagnóstico Diferencial , Diuréticos/uso terapéutico , Disnea/fisiopatología , Ecocardiografía , Electrocardiografía , Femenino , Furosemida/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Interferón beta/uso terapéutico , Pulmón/diagnóstico por imagen , Preeclampsia , Embarazo , Trastornos Puerperales/tratamiento farmacológico , Trastornos Puerperales/fisiopatología , Edema Pulmonar/tratamiento farmacológico , Edema Pulmonar/fisiopatología , Volumen Sistólico , Tomografía Computarizada por Rayos X
14.
JAMA Netw Open ; 4(2): e2037632, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33630086

RESUMEN

Importance: Improved survival in patients with advanced cancer has increased the need for better understanding of how to manage common symptoms that they may experience, such as breathlessness. Objective: To assess the benefits and harms associated with pharmacologic interventions for breathlessness in adults with advanced cancer. Data Sources: PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published from database inception through May 31, 2020, using predefined eligibility criteria within a PICOTS (population, intervention, comparator, outcome, timing, setting) format. Study Selection: Randomized clinical trials (RCTs), non-RCTs, and observational studies with a comparison group that evaluated benefits and/or harms and cohort studies that reported harms were selected. Data Extraction and Synthesis: Two reviewers independently screened studies for eligibility, serially abstracted data, independently assessed risk of bias, and graded strength of evidence (SOE). Main Outcomes and Measures: Benefits and harms of pharmacologic interventions were compared, focusing on breathlessness, anxiety, exercise capacity, and health-related quality of life. When possible, meta-analyses were conducted and standardized mean differences (SMDs) calculated. Results: In this systematic review and meta-analysis, a total of 7729 unique citations were identified, of which 19 studies (17 RCTs and 2 retrospective studies) that included a total of 1424 patients assessed the benefits of medications for management of breathlessness in advanced cancer or reported harms. The most commonly reported type of cancer was lung cancer. Opioids were not associated with more effectiveness than placebo for improving breathlessness (SMD, -0.14; 95% CI, -0.47 to 0.18) or exercise capacity ( SMD, 0.06; 95% CI, -0.43 to 0.55) (SOE, moderate); most studies examined exertional breathlessness. Specific dose and/or route of administration of opioids did not differ in effectiveness for breathlessness (SMD, 0.15; 95% CI, -0.22 to 0.52) (SOE, low). Anxiolytics were not associated with more effectiveness than placebo for breathlessness or anxiety (reported mean between-group difference, -0.52; 95% CI, -1.045 to 0.005) (SOE, low). Evidence for other pharmacologic interventions was limited. Pharmacologic interventions demonstrated some harms compared with usual care, but dropout attributable to adverse events was minimal in these short-term studies (range 3.2%-16%). Conclusions and Relevance: Evidence did not support the association of opioids or other pharmacologic interventions with improved breathlessness. Given that studies had many limitations, pharmacologic interventions should be considered in selected patients but need to be considered in the context of potential harms and evidence of an association of nonpharmacologic interventions with improved breathlessness.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Ansiolíticos/uso terapéutico , Ansiedad/psicología , Disnea/tratamiento farmacológico , Tolerancia al Ejercicio , Neoplasias/fisiopatología , Calidad de Vida , Broncodilatadores/uso terapéutico , Disnea/etiología , Disnea/fisiopatología , Disnea/psicología , Glucocorticoides/uso terapéutico , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/fisiopatología , Neoplasias/complicaciones , Neoplasias/patología , Resultado del Tratamiento
15.
Can Respir J ; 2021: 6692409, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33628349

RESUMEN

We aimed to investigate changes in pulmonary function and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the recovery period. COVID-19 patients underwent symptom assessment, pulmonary function tests, and high-resolution chest CT 6 months after discharge from the hospital. Of the 54 patients enrolled, 31 and 23 were in the moderate and severe group, respectively. The main symptoms 6 months after discharge were fatigue and exertional dyspnea, experienced by 24.1% and 18.5% of patients, respectively, followed by smell and taste dysfunction (9.3%) and cough (5.6%). One patient dropped out of the pulmonary function tests. Of the remaining 54 patients, 41.5% had pulmonary dysfunction. Specifically, 7.5% presented with restrictive ventilatory dysfunction (forced vital capacity <80% of the predicted value), 18.9% presented with small airway dysfunction, and 32.1% presented with pulmonary diffusion impairment (diffusing capacity for carbon monoxide <80% of the predicted value). Of the 54 patients enrolled, six patients dropped out of the chest CT tests. Eleven of the remaining 48 patients presented with abnormal lung CT findings 6 months after discharge. Patients with residual lung lesions were more common in the severe group (52.6%) than in the moderate group (3.4%); a higher proportion of patients had involvement of both lungs (42.1% vs. 3.4%) in the severe group. The residual lung lesions were mainly ground-glass opacities (20.8%) and linear opacities (14.6%). Semiquantitative visual scoring of the CT findings revealed significantly higher scores in the left, right, and both lungs in the severe group than in the moderate group. COVID-19 patients 6 months after discharge mostly presented with fatigue and exertional dyspnea, and their pulmonary dysfunction was mostly characterized by pulmonary diffusion impairment. As revealed by chest CT, the severe group had a higher prevalence of residual lesions than the moderate group, and the residual lesions mostly manifested as ground-glass opacities and linear opacities.


Asunto(s)
/fisiopatología , Disnea/fisiopatología , Fatiga/fisiopatología , Pulmón/fisiopatología , Adulto , Anciano , Tos/fisiopatología , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Trastornos del Olfato/fisiopatología , Ápice del Flujo Espiratorio , Capacidad de Difusión Pulmonar , Recuperación de la Función , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Trastornos del Gusto/fisiopatología , Tomografía Computarizada por Rayos X , Capacidad Vital
16.
Chest ; 159(2): e107-e113, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33563452

RESUMEN

CASE PRESENTATION: A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Bacteriemia/complicaciones , /fisiopatología , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/diagnóstico por imagen , Tos/fisiopatología , Diarrea/fisiopatología , Progresión de la Enfermedad , Disnea/fisiopatología , Servicio de Urgencia en Hospital , Fiebre/fisiopatología , Cefalea/fisiopatología , Humanos , /diagnóstico por imagen , Linfopenia/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mialgia/fisiopatología , Oximetría , Neumonía Estafilocócica/complicaciones , Radiografía Torácica , Infecciones Estafilocócicas/complicaciones , Tomografía Computarizada por Rayos X
17.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33542004

RESUMEN

Platypnoea-orthodeoxia syndrome (POS) is defined by oxygen desaturation and dyspnoea in upright position that improves by lying down. It results from a right to left shunt at the intracardiac or intrapulmonary level. A 53-year-old ovarian cancer patient presented with POS that was refractory to oxygen therapy. The symptoms began after an extensive abdominal and pelvic surgery as treatment of her cancer with a complex hospital course. A patent foramen ovale was found with the use of transoesophageal echocardiography. A percutaneous closure was done with positive outcome and dyspnoea disappearance. In this case with its challenging clinical setting, we present a unique clinical scenario of an immediate postoperative POS syndrome. We address the different therapeutic modalities and the need for a multidisciplinary medical approach.


Asunto(s)
Foramen Oval Permeable/diagnóstico , Neoplasias Ováricas , Accidente Cerebrovascular/diagnóstico , Disnea/fisiopatología , Ecocardiografía Transesofágica , Femenino , Foramen Oval Permeable/fisiopatología , Foramen Oval Permeable/cirugía , Humanos , Hipoxia/fisiopatología , Persona de Mediana Edad , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/cirugía , Accidente Cerebrovascular/fisiopatología , Síndrome
18.
Artif Intell Med ; 112: 102018, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33581830

RESUMEN

BACKGROUND AND OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). As of April 3, 2020, there were 1,009,625 reported confirmed cases, and 51,737 reported deaths. Doctors have been faced with a myriad of patients who present with many different symptoms. This raises two important questions. What are the common symptoms, and what are their relative importance? METHODS: A non-structured and incomplete COVID-19 dataset of 14,251 confirmed cases was preprocessed. This produced a complete and organized COVID-19 dataset of 738 confirmed cases. Six different feature selection algorithms were then applied to this new dataset. Five of these algorithms have been proposed earlier in the literature. The sixth is a novel algorithm being proposed by the authors, called Variance Based Feature Weighting (VBFW), which not only ranks the symptoms (based on their importance) but also assigns a quantitative importance measure to each symptom. RESULTS: For our COVID-19 dataset, the five different feature selection algorithms provided different rankings for the most important top-five symptoms. They even selected different symptoms for inclusion within the top five. This is because each of the five algorithms ranks the symptoms based on different data characteristics. Each of these algorithms has advantages and disadvantages. However, when all these five rankings were aggregated (using two different aggregating methods) they produced two identical rankings of the five most important COVID-19 symptoms. Starting from the most important to least important, they were: Fever/Cough, Fatigue, Sore Throat, and Shortness of Breath. (Fever and cough were ranked equally in both aggregations.) Meanwhile, the sixth novel Variance Based Feature Weighting algorithm, chose the same top five symptoms, but ranked fever much higher than cough, based on its quantitative importance measures for each of those symptoms (Fever - 75 %, Cough - 39.8 %, Fatigue - 16.5 %, Sore Throat - 10.8 %, and Shortness of Breath - 6.6 %). Moreover, the proposed VBFW method achieved an accuracy of 92.1 % when used to build a one-class SVM model, and an NDCG@5 of 100 %. CONCLUSIONS: Based on the dataset, and the feature selection algorithms employed here, symptoms of Fever, Cough, Fatigue, Sore Throat and Shortness of Breath are important symptoms of COVID-19. The VBFW algorithm also indicates that Fever and Cough symptoms were especially indicative of COVID-19, for the confirmed cases that are documented in our database.


Asunto(s)
/fisiopatología , Biología Computacional/métodos , Algoritmos , /virología , Tos/fisiopatología , Disnea/fisiopatología , Fatiga/fisiopatología , Fiebre/fisiopatología , Humanos , Pandemias , Faringitis/fisiopatología , /aislamiento & purificación
19.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33526525

RESUMEN

We present a case of multifocal laryngotracheal amyloidosis (LTA) in a 43-year-old man with persistent and progressive dysphonia and dyspnoea, and a first inconclusive histology. Although laryngeal amyloidosis accounts for fewer than 1% of all benign laryngeal tumours, it is in fact the most common site of amyloid deposition in the head, neck and respiratory tract. The clinical scenario is non-specific and diagnosis depends on a high degree of suspicion and on histology. Imaging is useful in mapping lesions, which are often more extensive than they appear during laryngoscopy. Despite being a benign entity, the prognosis is variable with a high-rate and long-latency recurrences, requiring long-term follow-up.


Asunto(s)
Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/diagnóstico , Enfermedades de la Laringe/diagnóstico por imagen , Enfermedades de la Tráquea/diagnóstico por imagen , Adulto , Broncoscopía , Disfonía/fisiopatología , Disnea/fisiopatología , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/patología , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/fisiopatología , Enfermedades de la Laringe/patología , Enfermedades de la Laringe/fisiopatología , Laringoscopía , Masculino , Tomografía Computarizada por Rayos X , Enfermedades de la Tráquea/patología , Enfermedades de la Tráquea/fisiopatología
20.
J Card Fail ; 27(3): 373-378, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33385524

RESUMEN

The severe acute respiratory syndrome novel coronavirus-2 pandemic has established a new set of challenges to health care delivery. Remotely monitored physiologic sensors on implantable cardiac devices can provide insight into the differential diagnosis of dyspnea in the heart failure population. We report on a unique pattern of sensor deviations that seem to occur specifically with severe acute respiratory syndrome novel coronavirus-2 infection.


Asunto(s)
/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Monitoreo Fisiológico/instrumentación , Transductores , Anciano , Disnea/fisiopatología , Fiebre/fisiopatología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Frecuencia Respiratoria/fisiología
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