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1.
Geriatr Gerontol Int ; 20(7): 709-714, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32634855

RESUMEN

BACKGROUND: In December 2019, the outbreak of coronavirus disease 2019 (COVID-19) started in Wuhan, and is now causing a worldwide pandemic. However, the experience in very elderly patients is very limited, which has important implications for the investigation of hospital infection in medical and health institutions. METHODS: Seven patients with confirmed COVID-19 infection in the Department of Geriatrics at Zhongnan Hospital of Wuhan University were included. Clinical data were retrospectively collected and analyzed. Laboratory tests and chest computed tomography (CT) images from the patients before and after the COVID-19 infection were compared. RESULTS: The median age of patients was 91 years old (87-96). Six patients had pneumonia in the last 6 months. Dyspnea occurred in one patient 64 h after the onset of the disease. In the other six patients, minor fatigue with low fever were the only other manifestations of the disease. Lymphopenia and a significant reduction in plasma globulin level was observed compared with levels before the onset of the disease. None had typical chest CT phenotypes during the early stage, except the critically ill patient mentioned who had developed "white lung" and then died. One patient even showed absorption of inflammation compared with previous hypostatic pneumonia. CONCLUSIONS: The ratio of fatal cases in very elderly patients with COVID-19 is no higher than that reported in non-elderly patients was, and probably due to a low immune response. However, the elderly patients manifested minor clinical symptoms and atypical changes in chest CT images, which usually lead to misdiagnosis or delayed diagnosis. Geriatr Gerontol Int 2020; 20: 709-714.


Asunto(s)
Pulmón/diagnóstico por imagen , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Enfermedad Crítica/epidemiología , Errores Diagnósticos/prevención & control , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Mortalidad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Evaluación de Síntomas/métodos , Tomografía Computarizada por Rayos X/métodos
2.
Swiss Med Wkly ; 150: w20312, 2020 06 28.
Artículo en Inglés | MEDLINE | ID: mdl-32662060

RESUMEN

We present the case of an oncology patient admitted to our hospital during the current COVID-19 pandemic with clinical and radiological features strongly suggestive of interstitial pneumonia. Multiple laboratory tests were negative for SARS-CoV-2 (polymerase chain reaction testing of nasopharyngeal swabs, and of induced sputum and stool samples, investigation of serum immunoglobulins G and M). In the setting of an immunocompromised status due to recent chemotherapy cycles for lung adenocarcinoma and prolonged corticosteroid therapy (due to frequent exacerbations of chronic obstructive pulmonary disease in recent months), we actively searched for the pathological agent and found it to be Pneumocystis jirovecii. The patient started specific antibiotic treatment but finally had a negative outcome due to the progression of the lung adenocarcinoma. The importance of differential diagnostics in clinical practice should be a given, especially during times of pandemic. The novel coronavirus infection introduced new guidelines for and approaches to the investigation of immunocompromised patients, so it is especially important not to forget the basis of differential diagnosis, to and adopt a thorough approach when assessing these complex patients. We want to stress the importance of thorough investigation to avoid misdiagnosis of atypical pathogens in the current setting of SARS-CoV-2 pandemic.


Asunto(s)
Adenocarcinoma del Pulmón/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Pulmón/diagnóstico por imagen , Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis , Neumonía Viral/diagnóstico , Anciano , Betacoronavirus , Deterioro Clínico , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Pandemias , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/fisiopatología , Neumonía por Pneumocystis/terapia , Neumonía Viral/complicaciones , Evaluación de Síntomas/métodos , Tomografía Computarizada por Rayos X/métodos
3.
Swiss Med Wkly ; 150: w20314, 2020 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-32662869

RESUMEN

BACKGROUND: Since its first description in December 2019, coronavirus disease 19 (COVID-19) has spread worldwide. There is limited information about presenting characteristics and outcomes of Swiss patients requiring hospitalisation. Furthermore, outcomes 30 days after onset of symptoms and after hospital discharge have not been described. AIMS: To describe the clinical characteristics, outcomes 30 days after onset of symptoms and in-hospital mortality of a cohort of patients hospitalised for COVID-19 in a Swiss area. METHODS: In this retrospective cohort study, we included all inpatients hospitalised with microbiologically confirmed COVID-19 between 1 March and 12 April 2020 in the public hospital network of a Swiss area (Fribourg). Demographic data, comorbidities and outcomes were recorded. Rate of potential hospital-acquired infection, outcomes 30 days after onset of symptoms and in-hospital mortality are reported. RESULTS: One hundred ninety-six patients were included in the study. In our population, 119 (61%) were male and the median age was 70 years. Forty-nine patients (25%) were admitted to the intensive care unit (ICU). The rate of potential hospital-acquired infection was 7%. Overall, 30 days after onset of symptoms 117 patients (60%) had returned home, 23 patients (12%) were in a rehabilitation facility, 18 patients (9%) in a medical ward, 6 patients (3%) in ICU and 32 (16%) patients had died. Among patients who returned home within 30 days, 73 patients (63%) reported persistent symptoms. The overall in-hospital mortality was 17%. CONCLUSION: We report the first cohort of Swiss patients hospitalised with COVID-19. Thirty days after onset of the symptoms, 60% had returned home. Among them, 63% still presented symptoms. Studies with longer follow-up are needed to document long-term outcomes in patients hospitalised with COVID-19.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Hospitalización/estadística & datos numéricos , Pandemias , Neumonía Viral , Anciano , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Demografía , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Estudios Retrospectivos , Suiza/epidemiología , Evaluación de Síntomas/métodos
4.
Int J Med Sci ; 17(12): 1744-1750, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32714077

RESUMEN

Many studies have reported the risk factors for exacerbations in patients with 2019 novel coronavirus (2019-nCoV). This study aims to perform the meta-analysis of risk factors for the exacerbation of the novel coronavirus-infected pneumonia (NCIP). PubMed, Embase and Google scholar have been searched. We included the cohort studies involving risk factors for the exacerbation of NCIP. This meta-analysis compared the risk factors of patients between intensive care (ICU) group and non-ICU group. Two cohort studies were included in this study. After comparing the patients between intensive care (ICU) group and non-ICU group, several important factors were found to significantly increase the risk of exacerbations in patients with NCIP, and they included hypertension (RR=2.34; 95% CI=1.21 to 4.51; P=0.01), cardiovascular diseases (RR=2.28; 95% CI=1.13 to 4.58; P=0.02), COPD (RR=7.65; 95% CI=1.24 to 47.13; P=0.03), dyspnea (RR=2.89; 95% CI=2.05 to 4.08; P<0.00001), myalgia or fatigue (RR=1.24; 95% CI=1.01 to 1.52; P=0.04), but several factors such as gender, Huanan Seafood Wholesale Market exposure, diabetes, chronic liver disease, malignancy, fever, cough, expectoration, headache and diarrhoea appeared to have no obvious effect on the exacerbation of pneumonia. In addition, as the exacerbation of pneumonia, some complications had the high probability to occur according to the meta-analysis of acute respiratory distress syndrome (ARDS) (RR=13.95; 95% CI=6.20 to 31.41; P<0.00001), shock (RR=24.29; 95% CI=4.66 to 126.69; P=0.0002), acute cardiac injury (RR=10.32; 95% CI=3.05 to 34.96; P=0.0002) and acute kidney injury (RR=5.90; 95% CI=1.32 to 26.35; P=0.02) between two groups. Several risk factors were confirmed to significantly improve the risk of exacerbation in patients with NCIP, which was very important for the exacerbation prediction and treatment of these patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Adulto , Anciano , China/epidemiología , Estudios de Cohortes , Comorbilidad , Diabetes Mellitus/epidemiología , Progresión de la Enfermedad , Disnea/epidemiología , Disnea/etiología , Exposición a Riesgos Ambientales , Fatiga/epidemiología , Fatiga/etiología , Femenino , Cardiopatías/epidemiología , Cardiopatías/etiología , Humanos , Hipertensión/epidemiología , Hepatopatías/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Síndrome de Dificultad Respiratoria del Adulto/etiología , Factores de Riesgo , Choque/epidemiología , Choque/etiología , Evaluación de Síntomas
5.
MMWR Morb Mortal Wkly Rep ; 69(28): 904-908, 2020 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-32673296

RESUMEN

Coronavirus disease 2019 (COVID-19) was first detected in the United States in January 2020 (1), and by mid-July, approximately 3.4 million cases had been reported in the United States (2). Information about symptoms among U.S. COVID-19 patients is limited, especially among nonhospitalized patients. To better understand symptom profiles of patients with laboratory-confirmed COVID-19 in the United States, CDC used an optional questionnaire to collect detailed information on a convenience sample of COVID-19 patients from participating states. Symptom data were analyzed by age group, sex, hospitalization status, and symptom onset date relative to expansion of testing guidelines on March 8, 2020 (3). Among 164 symptomatic patients with known onset during January 14-April 4, 2020, a total of 158 (96%) reported fever, cough, or shortness of breath. Among 57 hospitalized adult patients (aged ≥18 years), 39 (68%) reported all three of these symptoms, compared with 25 (31%) of the 81 nonhospitalized adult patients. Gastrointestinal (GI) symptoms and other symptoms, such as chills, myalgia, headache, and fatigue, also were commonly reported, especially after expansion of testing guidelines. To aid prompt recognition of COVID-19, clinicians and public health professionals should be aware that COVID-19 can cause a wide variety of symptoms.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Evaluación de Síntomas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Tos/virología , Disnea/virología , Femenino , Fiebre/virología , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , Adulto Joven
6.
Emergencias ; 32(4): 233-241, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32692000

RESUMEN

OBJECTIVES: To describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) treated in hospital emergency departments (EDs) in Spain, and to assess associations between characteristics and outcomes. MATERIAL AND METHODS: Prospective, multicenter, nested-cohort study. Sixty-one EDs included a random sample of all patients diagnosed with COVID-19 between March 1 and April 30, 2020. Demographic and baseline health information, including concomitant conditions; clinical characteristics related to the ED visit and complementary test results; and treatments were recorded throughout the episode in the ED. We calculated crude and adjusted odds ratios for risk of in-hospital death and a composite outcome consisting of the following events: intensive care unit admission, orotracheal intubation or mechanical ventilation, or in-hospital death. The logistic regression models were constructed with 3 groups of independent variables: the demographic and baseline health characteristics, clinical characteristics and complementary test results related to the ED episode, and treatments. RESULTS: The mean (SD) age of patients was 62 (18) years. Most had high- or low-grade fever, dry cough, dyspnea, and diarrhea. The most common concomitant conditions were cardiovascular diseases, followed by respiratory diseases and cancer. Baseline patient characteristics that showed a direct and independent association with worse outcome (death and the composite outcome) were age and obesity. Clinical variables directly associated with worse outcomes were impaired consciousness and pulmonary crackles; headache was inversely associated with worse outcomes. Complementary test findings that were directly associated with outcomes were bilateral lung infiltrates, lymphopenia, a high platelet count, a D-dimer concentration over 500 mg/dL, and a lactate-dehydrogenase concentration over 250 IU/L in blood. CONCLUSION: This profile of the clinical characteristics and comorbidity of patients with COVID-19 treated in EDs helps us predict outcomes and identify cases at risk of exacerbation. The information can facilitate preventive measures and improve outcomes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Evaluación de Síntomas , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Niño , Preescolar , Comorbilidad , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Femenino , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Intubación Intratraqueal/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Obesidad/complicaciones , Oportunidad Relativa , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Pronóstico , Estudios Prospectivos , Trastornos Respiratorios/epidemiología , Respiración Artificial/estadística & datos numéricos , Distribución por Sexo , España/epidemiología , Adulto Joven
7.
Emergencias ; 32(4): 242-252, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32692001

RESUMEN

OBJECTIVES: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings. MATERIAL AND METHODS: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode. RESULTS: A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases. CONCLUSION: COVID-19 diagnostic groups differ according to clinical and laboratory characteristics, and the differences are associated with the 30-day prognosis.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Adulto , Causas de Muerte , Comorbilidad , Intervalos de Confianza , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Grupos Diagnósticos Relacionados , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Reacción en Cadena de la Polimerasa/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , España/epidemiología , Evaluación de Síntomas , Factores de Tiempo , Resultado del Tratamiento
9.
Artículo en Inglés | MEDLINE | ID: mdl-32609256

RESUMEN

Coronavirus disease 2019 (COVID-19) is an infectious disease initially reported in China and currently worldwide dispersed caused by a new coronavirus (SARS-CoV-2 or 2019-nCoV) affecting more than seven million people around the world causing more than 400 thousand deaths (on June 8th, 2020). The diagnosis of COVID-19 is based on the clinical and epidemiological history of the patient. However, the gold standard for COVID-19 diagnosis is the viral detection through the amplification of nucleic acids. Although the quantitative Reverse-Transcription Polymerase Chain Reaction (RT-PCR) has been described as the gold standard for diagnosing COVID-19, there are several difficulties involving its use. Here we comment on RT-PCR and describe alternative tests developed for the diagnosis of COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Betacoronavirus/genética , Ensayo de Inmunoadsorción Enzimática/métodos , Humanos , Inmunoensayo/métodos , Técnicas para Inmunoenzimas/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Técnicas de Amplificación de Ácido Nucleico/normas , Análisis por Matrices de Proteínas/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Evaluación de Síntomas/métodos
11.
Medicine (Baltimore) ; 99(28): e21240, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664179

RESUMEN

RATIONALE: Chest computed tomography (CT) scans play a key role in diagnosing and managing of COVID-19 pneumonia. The typical manifestations of COVID-19 pneumonia on a chest CT scan are ground glass opacities, consolidation, nodules, and linear opacities. It can be accompanied by a "crazy-paving" pattern, air bronchograms, pleural hypertrophy, and pleural effusion. However, no literature has reported a case with cavities in the lungs. PATIENT CONCERNS: A 34-year-old male patient complained of fever, cough, fatigue, myalgia, diarrhea, headache, and dizziness for 2 weeks. This patient is living in Xiaogan, a city around Wuhan, and he had contact with a patient with COVID-19 pneumonia from Wuhan <14 days before he had fever. DIAGNOSIS: A nucleic acid test by rRT-PCR returned positive on a pharyngeal swab, confirming the diagnosis of COVID-19 pneumonia. INTERVENTIONS: Isolation antiviral treatment. OUTCOMES: After 19 days of isolation and antiviral treatment, his temperature returned to normal and the symptoms were relieved. The laboratory results also were returning to normal levels. The chest CT scan showed that the acute inflammation had subsided significantly. With 2 consecutive novel coronavirus nucleic acid tests had returned negative, the patient was discharged from the hospital and sent to a government designated hotel for quarantine observation. The unique chest CT manifestation in this case was the small cavities in both lungs during the absorption phase of this disease. These small cavities developed into consolidated nodules with clear edges and gradually shrank or disappeared. LESSONS: Although 2 consecutive nucleic acid tests returned negative in this patient, the small cavity changes in the lungs were observed, so the patient was quarantined for 14 days. However, follow-up CT after the first 14 days' quarantine showed new small cavity changes on the lungs, a further 14 days of quarantine was recommended. Therefore, in some COVID-19 cases, even if the nucleic acid tests turns negative, the disappearance of lung lesions may take a long time. The repeated chest CT scan plays an important role in the diagnosis and evaluation of the recovery of COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/cirugía , Infecciones por Coronavirus/terapia , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/cirugía , Neumonía Viral/terapia , Cuarentena/métodos , Recuperación de la Función , Evaluación de Síntomas/métodos , Resultado del Tratamiento
12.
Epidemiol Serv Saude ; 29(3): e2020233, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32609142

RESUMEN

OBJECTIVE: to describe the most frequent signs and symptoms of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: this is a narrative literature review carried out in April 2020; the search was performed on electronic databases and complemented with a manual review of the references of the selected papers and Brazilian Ministry of Health publications. RESULTS: the spectrum of clinical disease was wide; fever, coughing and dyspnea were the most frequent signs/symptoms, however, they may not be present, thus hindering case definition; gastrointestinal symptoms and loss of taste or smell have been reported among mild cases; dyspnea was frequent among severe and fatal cases. CONCLUSION: considering the scarcity of diagnostic tests and the diversity of symptoms, health services should use a sensitive case definition, in order to adopt appropriate surveillance, prevention and treatment actions.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Humanos , Pandemias , Índice de Severidad de la Enfermedad , Evaluación de Síntomas
13.
Indian J Med Res ; 151(5): 401-410, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32611911

RESUMEN

The novel coronavirus disease 2019 (COVID-19) with its early origin from Wuhan city in China has evolved into a global pandemic. Maximal precautionary measures and resources have been put forward by most nations in war footing to mitigate transmission and decrease fatality rates. This article was aimed to review the evidence on clinical management and to deal with the identification of high-risk groups, warning signs, appropriate investigations, proper sample collection for confirmation, general and specific treatment measures, strategies as well as infection control in the healthcare settings. Advanced age, cardiovascular disease, diabetes, hypertension and cancer have been found to be the risk factors for severe disease. Fever lasting for >five days with tachypnoea, tachycardia or hypotension are indications for urgent attention and hospitalization in a patient with suspected COVID-19. At present, reverse transcription-polymerase chain reaction (RT-PCR) from the upper respiratory tract samples is the diagnostic test of choice. While many drugs have shown in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there are insufficient clinical data to promote or dissuade their usage. Among the currently available drugs, hydroxychloroquine and lopinavir/ritonavir may be considered for patients with severe COVID-19 infection, awaiting further clinical trials. Stringent droplet and contact precautions will protect healthcare workers against most clinical exposures to COVID-19.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Corticoesteroides/uso terapéutico , Manejo de la Vía Aérea , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antimaláricos/uso terapéutico , Enfermedad Crítica , Humanos , Hidroxicloroquina/uso terapéutico , Inmunización Pasiva , Pandemias , Gravedad del Paciente , Choque/terapia , Manejo de Especímenes , Evaluación de Síntomas , Poblaciones Vulnerables
15.
Aust J Gen Pract ; 49(7): 444-446, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32600002

RESUMEN

BACKGROUND: Joint replacement surgery is a highly effective treatment option for patients with severe osteoarthritis (OA) of the hip and knee when other treatments have failed. Unfortunately, as a result of the COVID-19 pandemic, a temporary suspension of non-urgent elective surgery was implemented. Thousands of patients currently awaiting hip and knee replacements have been affected. Many of these patients will present to their general practitioners for symptom management during this interim period. OBJECTIVE: The purpose of this article is to summarise current recommendations for the non-operative management of patients with symptomatic OA. DISCUSSION: Non-operative treatment modalities for OA include education, lifestyle modification and exercise, mass reduction, physiotherapy, orthoses, psychology, pharmaceuticals and injections. Multimodal therapy is required for patients with severe symptoms. A number of useful online resources are presented, as access to public allied health services may be limited because of the COVID-19 pandemic.


Asunto(s)
Tratamiento Conservador/métodos , Infecciones por Coronavirus , Procedimientos Quirúrgicos Electivos/métodos , Osteoartritis de la Cadera , Osteoartritis de la Rodilla , Pandemias , Neumonía Viral , Evaluación de Síntomas/métodos , Australia/epidemiología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Humanos , Control de Infecciones/métodos , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/diagnóstico , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Espera Vigilante/métodos
16.
Cochrane Database Syst Rev ; 7: CD013665, 2020 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-32633856

RESUMEN

BACKGROUND: Some people with SARS-CoV-2 infection remain asymptomatic, whilst in others the infection can cause mild to moderate COVID-19 disease and COVID-19 pneumonia, leading some patients to require intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever or cough, and signs such as oxygen saturation or lung auscultation findings, are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19 disease, or select patients for further diagnostic testing. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19 disease or COVID-19 pneumonia. SEARCH METHODS: On 27 April 2020, we undertook electronic searches in the Cochrane COVID-19 Study Register and the University of Bern living search database, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with suspected COVID-19 disease, or if they recruited known cases with COVID-19 disease and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards including reverse transcription polymerase chain reaction (RT-PCR), clinical expertise, imaging, serology tests and World Health Organization (WHO) or other definitions of COVID-19. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the QUADAS-2 checklist. Analyses were descriptive, presenting sensitivity and specificity in paired forest plots, in ROC (receiver operating characteristic) space and in dumbbell plots. We did not attempt meta-analysis due to the small number of studies, heterogeneity across studies and the high risk of bias. MAIN RESULTS: We identified 16 studies including 7706 participants in total. Prevalence of COVID-19 disease varied from 5% to 38% with a median of 17%. There were no studies from primary care settings, although we did find seven studies in outpatient clinics (2172 participants), and four studies in the emergency department (1401 participants). We found data on 27 signs and symptoms, which fall into four different categories: systemic, respiratory, gastrointestinal and cardiovascular. No studies assessed combinations of different signs and symptoms and results were highly variable across studies. Most had very low sensitivity and high specificity; only six symptoms had a sensitivity of at least 50% in at least one study: cough, sore throat, fever, myalgia or arthralgia, fatigue, and headache. Of these, fever, myalgia or arthralgia, fatigue, and headache could be considered red flags (defined as having a positive likelihood ratio of at least 5) for COVID-19 as their specificity was above 90%, meaning that they substantially increase the likelihood of COVID-19 disease when present. Seven studies carried a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional four studies, we were unable to assess the risk for selection bias. These factors make it very difficult to determine the diagnostic properties of these signs and symptoms from the included studies. We also had concerns about the applicability of these results, since most studies included participants who were already admitted to hospital or presenting to hospital settings. This makes these findings less applicable to people presenting to primary care, who may have less severe illness and a lower prevalence of COVID-19 disease. None of the studies included any data on children, and only one focused specifically on older adults. We hope that future updates of this review will be able to provide more information about the diagnostic properties of signs and symptoms in different settings and age groups. AUTHORS' CONCLUSIONS: The individual signs and symptoms included in this review appear to have very poor diagnostic properties, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19 disease, are urgently needed. Results from such studies could inform subsequent management decisions such as self-isolation or selecting patients for further diagnostic testing. We also need data on potentially more specific symptoms such as loss of sense of smell. Studies in older adults are especially important.


Asunto(s)
Atención Ambulatoria , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Atención Primaria de Salud , Evaluación de Síntomas , Artralgia/diagnóstico , Artralgia/etiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Fatiga/diagnóstico , Fatiga/etiología , Fiebre/diagnóstico , Fiebre/etiología , Cefalea/diagnóstico , Humanos , Mialgia/diagnóstico , Mialgia/etiología , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Pandemias , Examen Físico , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Sesgo de Selección , Evaluación de Síntomas/clasificación , Evaluación de Síntomas/estadística & datos numéricos
17.
Rev. esp. cardiol. (Ed. impr.) ; 73(7): 569-576, jul. 2020. tab
Artículo en Español | IBECS | ID: ibc-187328

RESUMEN

La infección por SARS-CoV-2, denominada COVID-19 (Coronavirus Infectious Disease-19), es una enfermedad desconocida hasta diciembre de 2019 a la que nos enfrentamos en España desde el 31 de enero de 2020 -fecha del primer caso diagnosticado en nuestro país- y que ya ha causado la muerte de 7.340 personas (a 30 de marzo de 2020), sobre todo mayores. Es importante tener en cuenta que, dado que la información evoluciona con extremada rapidez en este campo, lo expuesto en el presente documento puede estar sujeto a modificaciones. La población de mayor edad es especialmente susceptible a la infección por COVID-19, así como a desarrollar criterios de gravedad. Este aumento de morbimortalidad en el paciente mayor se ha asociado tanto con las comorbilidades, especialmente la enfermedad cardiovascular, como con la situación de fragilidad, que conlleva una respuesta inmunológica más pobre. La situación actual, tanto por los países afectados como por el número de casos, constituye una pandemia y supone una emergencia sanitaria de primer nivel. Como España es uno de los países más envejecidos del mundo, la COVID-19 se ha convertido en una emergencia geriátrica. El presente documento se ha elaborado conjuntamente entre la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología y la Sociedad Española de Geriatría y Gerontología


SARS-CoV2 infection, also known as COVID-19 (coronavirus infectious disease-19), was first identified in December 2019. In Spain, the first case of this infection was diagnosed on 31 January, 2020 and, by 30 March 2020, has caused 7340 deaths, especially in the elderly. Due to the rapidly evolving situation regarding this disease, the data reported in this article may be subject to modifications. The older population are particularly susceptible to COVID-19 infection and to developing severe disease. The higher morbidity and mortality rates in older people have been associated with comorbidity, especially cardiovascular disease, and frailty, which weakens the immune response. Due to both the number of affected countries and the number of cases, the current situation constitutes an ongoing pandemic and a major health emergency. Because Spain has one of the largest older populations in the world, COVID-19 has emerged as a geriatric emergency. This document has been prepared jointly between the Geriatric Cardiology Section of the Spanish Society of Cardiology and the Spanish Society of Geriatrics and Gerontology


Asunto(s)
Humanos , Neumonía Viral/diagnóstico , Síndrome Torácico Agudo/diagnóstico , Infecciones por Coronavirus/epidemiología , Evaluación Geriátrica/métodos , Evaluación de Síntomas/métodos , Indicadores de Morbimortalidad , Infecciones por Coronavirus/complicaciones , Pandemias , Tratamiento de Urgencia/métodos , Estrategias Mundiales , Cuidados Críticos/métodos
18.
West Afr J Med ; 37(3): 275-280, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32476122

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a complex multisystemic disorder of public health interest. It has both pulmonary and extrapulmonary manifestation that affect the Health-related Quality of Life (HRQOL) of the patients. The COPD Assessment Test (CAT) is an example of HRQOL, a self-administered questionnaire. The study objectives were to determine the HRQOL of COPD patients using the CAT and to determine the predictors of (HRQOL). STUDY DESIGN: This was a cross-sectional analysis of stable COPD patients. METHODS: Patients recruited had clinical and spirometry diagnosis of COPD. Spirometry assessed the pulmonary function, the Modified Medical Research Council (MMRC) dyspnea scale assessed the dyspnoea ratings. The Six-minute Walk Distance Test (6MWDT) measured the exercise capacity, and the CAT questionnaire assessed the HRQOL. RESULTS: Sixty patients recruited for the study had a mean age of 68.8 years ±10.3. Thirty-six (60%) of the patients were males, while 24 (40%) were females. Seven (11.6%) of the participants were in the low impact level with CAT scores less than 10, majority 50 (83.4%) were in the medium to very high impact level with poor HRQOL. The MMRC scale and 6MWDT were the main predictors of the HRQOL. CONCLUSION: COPD results in significant impairment of HRQOL; the MMRC and 6MWDT were the main predictors of the poor HRQOL. Initiating measures that will improve physical activity and level of dyspnea will positively impact on the patient's HRQOL.


Asunto(s)
Disnea/diagnóstico , Pulmón/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Calidad de Vida/psicología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Disnea/fisiopatología , Femenino , Estado de Salud , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Índice de Severidad de la Enfermedad , Espirometría , Encuestas y Cuestionarios , Evaluación de Síntomas
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