Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.588
Filtrar
1.
BMC Fam Pract ; 22(1): 66, 2021 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-33832436

RESUMEN

BACKGROUND: To estimate the prevalence of symptoms and signs related to a COVID-19 case series confirmed by polymerase chain reaction (PCR) for SARS-CoV-2. Risk factors and the associated use of health services will also be analysed. METHODS: Observational, descriptive, retrospective case series study. The study was performed at two Primary Care Health Centres located in Madrid, Spain. The subjects studied were all PCR SARS-CoV-2 confirmed cases older than 18 years, diagnosed from the beginning of the community transmission (March 13) until April 15, 2020. We collected sociodemographic, clinical, health service utilization and clinical course variables during the following months. All data was gathered by their own attending physician, and electronic medical records were reviewed individually. STATISTICAL ANALYSIS: A descriptive analysis was carried out and a Poisson regression model was adjusted to study associated factors to Health Services use. RESULTS: Out of the 499 patients studied from two health centres, 55.1% were women and mean age was 58.2 (17.3). 25.1% were healthcare professionals. The most frequent symptoms recorded related to COVID-19 were cough (77.9%; CI 95% 46.5-93.4), fever (77.7%; CI95% 46.5-93.4) and dyspnoea (54.1%, CI95% 46.6-61.4). 60.7% were admitted to hospital. 64.5% first established contact with their primary care provider before going to the hospital, with a mean number of 11.4 Healthcare Providers Encounters with primary care during all the follow-up period. The number of visit-encounters with primary care was associated with being male [IRR 1.072 (1.013, 1.134)], disease severity {from mild respiratory infection [IRR 1.404 (1.095, 1.801)], up to bilateral pneumonia [IRR 1.852 (1.437,2.386)]}, and the need of a work leave [IRR 1.326 (1.244, 1.413]. CONCLUSION: Symptoms and risk factors in our case series are similar to those in other studies. There was a high number of patients with atypical unilateral or bilateral pneumonia. Care for COVID has required a high use of healthcare resources such as clinical encounters and work leaves.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Viral , Atención Primaria de Salud , Evaluación de Síntomas , /diagnóstico , /fisiopatología , Demografía , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , España/epidemiología , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
3.
JAMA Netw Open ; 4(4): e216468, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33885775

RESUMEN

Importance: Data on the efficacy of hydroxychloroquine or lopinavir-ritonavir for the treatment of high-risk outpatients with COVID-19 in developing countries are needed. Objective: To determine whether hydroxychloroquine or lopinavir-ritonavir reduces hospitalization among high-risk patients with early symptomatic COVID-19 in an outpatient setting. Design, Setting, and Participants: This randomized clinical trial was conducted in Brazil. Recently symptomatic adults diagnosed with respiratory symptoms from SARS-CoV-2 infection were enrolled between June 2 and September 30, 2020. The planned sample size was 1476 patients, with interim analyses planned after 500 patients were enrolled. The trial was stopped after the interim analysis for futility with a sample size of 685 patients. Statistical analysis was performed in December 2020. Interventions: Patients were randomly assigned to hydroxychloroquine (800 mg loading dose, then 400 mg daily for 9 days), lopinavir-ritonavir (loading dose of 800 mg and 200 mg, respectively, every 12 hours followed by 400 mg and 100 mg, respectively, every 12 hours for the next 9 days), or placebo. Main Outcomes and Measures: The primary outcomes were COVID-19-associated hospitalization and death assessed at 90 days after randomization. COVID-19-associated hospitalization was analyzed with a Cox proportional hazards model. The trial included the following secondary outcomes: all-cause hospitalization, viral clearance, symptom resolution, and adverse events. Results: Of 685 participants, 632 (92.3%) self-identified as mixed-race, 377 (55.0%) were women, and the median (range) age was 53 (18-94) years. A total of 214 participants were randomized to hydroxychloroquine; 244, lopinavir-ritonavir; and 227, placebo. At first interim analysis, the data safety monitoring board recommended stopping enrollment of both hydroxychloroquine and lopinavir-ritonavir groups because of futility. The proportion of patients hospitalized for COVID-19 was 3.7% (8 participants) in the hydroxychloroquine group, 5.7% (14 participants) in the lopinavir-ritonavir group, and 4.8% (11 participants) in the placebo group. We found no significant differences between interventions for COVID-19-associated hospitalization (hydroxychloroquine: hazard ratio [HR], 0.76 [95% CI, 0.30-1.88]; lopinavir-ritonavir: HR, 1.16 [95% CI, 0.53-2.56] as well as for the secondary outcome of viral clearance through day 14 (hydroxychloroquine: odds ratio [OR], 0.91 [95% CI, 0.82-1.02]; lopinavir-ritonavir: OR, 1.04 [95% CI, 0.94-1.16]). At the end of the trial, there were 3 fatalities recorded, 1 in the placebo group and 2 in the lopinavir-ritonavir intervention group. Conclusions and Relevance: In this randomized clinical trial, neither hydroxychloroquine nor lopinavir-ritonavir showed any significant benefit for decreasing COVID-19-associated hospitalization or other secondary clinical outcomes. This trial suggests that expedient clinical trials can be implemented in low-income settings even during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04403100.


Asunto(s)
Intervención Médica Temprana , Hidroxicloroquina/administración & dosificación , Lopinavir/administración & dosificación , Ritonavir/administración & dosificación , Antivirales/administración & dosificación , Brasil/epidemiología , /terapia , Monitoreo de Drogas/métodos , Monitoreo de Drogas/estadística & datos numéricos , Quimioterapia Combinada/métodos , Intervención Médica Temprana/métodos , Intervención Médica Temprana/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Inutilidad Médica , Persona de Mediana Edad , Ajuste de Riesgo/métodos , Evaluación de Síntomas/métodos , Resultado del Tratamiento
4.
Acta Med Indones ; 53(1): 13-17, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33818402

RESUMEN

BACKGROUND: real-time RT-PCR was recommended by WHO for COVID-19 diagnosis. The cycle threshold (Ct) values were expected to have an association with clinical manifestation. However, the diagnostic modalities such as quantitative molecular detection and virus isolation were not yet available for the routine test. This study has been conducted to analyze the relationship between the Ct values of qualitative rRT-PCR and the clinical manifestation and to describe the factors determining the result. METHODS: from March to April 2020, specimens were sent to our laboratory from different healthcare centers in Jakarta. The patient's characteristic and clinical manifestation were extracted from the specimen's epidemiology forms. The specimens extracted and tested using rRT-PCR, and the Ct value were collected. The data were analyzed using the appropriate statistic test. RESULTS: from 339 positive results, the mild to moderate case was 176 (52%) and the severe cases was 163 (48%). Female was dominant in the mild to moderate cases (58%), while the male was prevalent in the severe cases (60%). The median age for mild to moderate case was 35 years old and severe cases was 49 years old. Statistical analysis found relationship between both group with gender (p = 0.001) and age (p < 0.001), but not with the Ct value. CONCLUSION: many variables in specimen sampling and processing could affect the Ct value result. In addition, the disease's severity was depended with the host immune response, regardless the number of virus. There was suggested no significant difference between the Ct values of mild-moderate and severe COVID-19, and thus should not be loosely interpreted.


Asunto(s)
Reacción en Cadena en Tiempo Real de la Polimerasa , Evaluación de Síntomas , Adulto , Factores de Edad , /epidemiología , /métodos , /estadística & datos numéricos , Correlación de Datos , Femenino , Humanos , Indonesia/epidemiología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa/estadística & datos numéricos , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Factores Sexuales , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Carga Viral
5.
G Ital Nefrol ; 38(2)2021 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-33852220

RESUMEN

The new coronavirus disease (Covid-19) pandemic in Italy formally started on 21st February 2020, when a 38-years old man was established as the first Italian citizen with Covid-19 in Codogno, Lombardy region. In a few days, the deadly coronavirus swept beyond expectations across the city of Bergamo and its province, claiming thousands of lives and putting the hospital in Treviglio under considerable strain. Since designated Covid-dialysis hospitals to centrally manage infected hemodialysis patients were not set up in the epidemic areas, we arranged to treat all our patients. We describe the multiple strategies we had to implement fast to prevent/control Covid-19 infection and spread resources in our Dialysis Unit during the first surge of the pandemic in one of the worst-hit areas in Italy. The recommendations provided by existing guidelines and colleagues with significant experience in dealing with Covid-19 were combined with the practical judgement of our dialysis clinicians, nurses and nurse's aides.


Asunto(s)
/prevención & control , Fallo Renal Crónico/terapia , Pandemias , Diálisis Renal , Adulto , Anciano , Anciano de 80 o más Años , /epidemiología , Femenino , Administración Hospitalaria , Humanos , Italia/epidemiología , Fallo Renal Crónico/complicaciones , Masculino , Persona de Mediana Edad , Aislamiento de Pacientes/organización & administración , Administración de Personal en Hospitales/métodos , Guías de Práctica Clínica como Asunto , Evaluación de Síntomas/métodos , Triaje/organización & administración
6.
Medicine (Baltimore) ; 100(15): e25230, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847620

RESUMEN

ABSTRACT: Pediatric cases of coronavirus disease 2019 (COVID-19) have been reported. This meta-analysis was aimed at describing the clinical, laboratory, and imaging characteristics of children with COVID-19 based on published data of pediatric COVID-19 cases.Search of PubMed, Embase, Web of Sciences, Science Direct, and Google Scholar for articles published until December 14, 2020, that described the clinical, laboratory, and imaging features of children with COVID-19. Data were extracted independently by 2 authors. Random-effects meta-analysis models were used to report pooled results.Clinical data from 2874 children with COVID-19 from 37 articles were finally included for quantitative analyses. Fever (48.5%, 95% CI: 41.4%-55.6%) and cough (40.6%, 95% CI: 33.9%-47.5%) were the most common symptoms; asymptomatic infection and severe cases, respectively, accounted for 27.7% (95% CI: 19.7%-36.4%) patients and 1.1% of the 1933 patients included. Laboratory tests showed 5.5% (95% CI: 2.8%-8.9%) of the patients had lymphopenia. The pooled prevalence of leukopenia was 7.3% (95% CI: 3.4%-12.2%), and the C-reactive protein level was high in 14.0% (95% CI: 6.8%-22.8%). Chest computed tomography showed unilateral and bilateral lesions, and ground-glass opacity in 29.4% (95% CI: 24.8%-34.3%) and 24.7% (95% CI: 18.2%-31.6%), and 32.9% (95% CI: 25.3%-40.9%), respectively, and normal in approximately 36.0% (95% CI: 27.7%-44.7%).We found that children with COVID-19 had relatively mild disease, with quite a lot of asymptomatic infections and low rate of severe illness. Data from more regions are needed to determine the prevention and treatment strategies for children with COVID-19.


Asunto(s)
/métodos , Diagnóstico por Imagen/métodos , Evaluación de Síntomas/métodos , Infecciones Asintomáticas/epidemiología , /epidemiología , Niño , Salud Global/estadística & datos numéricos , Humanos , Pediatría , Índice de Severidad de la Enfermedad
7.
BMJ Open Respir Res ; 8(1)2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33827856

RESUMEN

BACKGROUND: The symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described. METHODS: Retrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness. RESULTS: 75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge. CONCLUSIONS: Patients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.


Asunto(s)
Cuidados Posteriores , Biomarcadores/análisis , Alta del Paciente/normas , Radiografía Torácica , Evaluación de Síntomas , Cuidados Posteriores/métodos , Cuidados Posteriores/organización & administración , /diagnóstico por imagen , /fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Radiografía Torácica/métodos , Radiografía Torácica/estadística & datos numéricos , Recuperación de la Función , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Factores de Tiempo , Reino Unido/epidemiología
8.
BMJ Health Care Inform ; 28(1)2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33685943

RESUMEN

OBJECTIVES: Identifying those individuals requiring medical care is a basic tenet of the pandemic response. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online 'symptom checkers' used within the triage pathway. METHODS: A simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical) and COVID-19 mimickers (eg, sepsis and bacterial pneumonia). The same simulations were applied to each of the four country's symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared. RESULTS: The symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77%, respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home. CONCLUSION: Our results suggest that whilst 'symptom checkers' may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well-performing symptom checkers are discussed.


Asunto(s)
/diagnóstico , Informática en Salud Pública/organización & administración , Evaluación de Síntomas/métodos , Triaje/organización & administración , Autoevaluación Diagnóstica , Alfabetización en Salud/estadística & datos numéricos , Humanos , Japón , Singapur
9.
Isr Med Assoc J ; 23(3): 153-159, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33734627

RESUMEN

BACKGROUND: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment. OBJECTIVES: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19). METHODS: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ≥ 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed. RESULTS: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ≥ 800/µL, CD3+ ≥ 400/µL, CD4+ ≥ 180/µL, CD8+ ≥ 150/µL, B cells CD19+ ≥ 80/µL, and NK ≥ 34/µL subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ≥ 10.150/µL or neutrophils ≥ 10,000/µL were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ≥ 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68). CONCLUSIONS: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.


Asunto(s)
Linfocitos T CD4-Positivos/patología , Linfocitos T CD8-positivos/patología , Linfopenia , Neutrófilos/patología , Biomarcadores/sangre , /diagnóstico , /terapia , Correlación de Datos , Estudios Transversales , Femenino , Humanos , Estimación de Kaplan-Meier , Células Asesinas Naturales/patología , Recuento de Leucocitos/métodos , Linfopenia/sangre , Linfopenia/diagnóstico , Linfopenia/etiología , Masculino , México/epidemiología , Persona de Mediana Edad , Mortalidad , Valor Predictivo de las Pruebas , Evaluación de Síntomas/métodos
11.
Bull Cancer ; 108(3): 242-249, 2021 Mar.
Artículo en Francés | MEDLINE | ID: mdl-33648719

RESUMEN

INTRODUCTION: To promote the early diagnosis of pediatric cancers in Ivory Coast, we have initiated a program to train local physicians in the warning signs and to raise public awareness. The aim of this work was to compare the times, stages and survival of patients before and three years after the initiation of the program. METHODS: This retrospective study involved children 0-17 years of age admitted from January to December 2014 and from May 2018 to April 2019. The Mann-Whitney non-parametric test and the Fisher's exact test were used to compare time limits, stages and survival. RESULTS: One hundred and fifty-nine doctors were trained and 1020 people were sensitized. The median age of the 216 children included was 7 years, sex ratio 1.4. For both periods, the median consultation times were 75 and 30 days (P=0.003) and the median diagnostic times were 120 and 105 days (P=0.033). High-risk lymphomas accounted for 60.5% and 58.5% (P=0.99) respectively and nephroblastoma 46.1% and 56.2% (P=0.51). The overall survival was 31% and 30.2% (P=0.92). DISCUSSION: The early diagnosis program had no impact. The diagnosis times and the proportion of cancer classified as high risk are comparable to the data reported in sub-Saharan Africa, which vary respectively from 7 to 15.8 weeks and from 60 to 71%. This program must be intensified, extended to all health workers and include improving access to care.


Asunto(s)
Detección Precoz del Cáncer , Educación Médica , Neoplasias/diagnóstico , Desarrollo de Programa , Evaluación de Síntomas/métodos , Adolescente , Niño , Preescolar , Costa de Marfil , Diagnóstico Tardío , Femenino , Humanos , Lactante , Recién Nacido , Neoplasias Renales/diagnóstico , Neoplasias Renales/mortalidad , Linfoma/diagnóstico , Linfoma/mortalidad , Masculino , Neoplasias/mortalidad , Neoplasias/patología , Médicos , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo , Tumor de Wilms/diagnóstico , Tumor de Wilms/mortalidad
12.
Infez Med ; 29(1): 20-36, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33664170

RESUMEN

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative pathogen for the COVID-19, first emerged in Wuhan, China, in December 2019 and by March 2020, it was declared a pandemic. COVID-19 pandemic has overburdened healthcare systems in most countries and has led to massive economic losses. SARS-CoV-2 transmission typically occurs by respiratory droplets. The average incubation period is 6.4 days and presenting symptoms typically include fever, cough, dyspnea, myalgia or fatigue. While the majority of patients tend to have a mild illness, a minority of patients develop severe hypoxia requiring hospitalization and mechanical ventilation. Management is mostly supportive. However, several direct anti-viral agents, and immunomodulatory therapy with steroids and various cytokine blockers seem promising in early results. However, an effective vaccine has been established, which will help curb the pandemic.


Asunto(s)
Salud Global/estadística & datos numéricos , Pandemias , /patogenicidad , Corticoesteroides/uso terapéutico , Microbiología del Aire , Antivirales/uso terapéutico , /diagnóstico , /terapia , /uso terapéutico , Transmisión de Enfermedad Infecciosa , Hospitalización , Humanos , Hipoxia/etiología , Hipoxia/terapia , Inmunización Pasiva , Factores Inmunológicos/uso terapéutico , Periodo de Incubación de Enfermedades Infecciosas , Prevención Primaria/métodos , Respiración Artificial , /genética , Esteroides/uso terapéutico , Evaluación de Síntomas/métodos
13.
Medicina (Kaunas) ; 57(2)2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33672384

RESUMEN

The global pandemic of the coronavirus disease 2019 is a known consequence of infection of severe respiratory syndrome coronavirus-2 (SARS-CoV-2). It has affected nations worldwide with soaring number of cases daily. Symptoms such as fever, cough, and shortness of breath, diarrhea, nausea and vomiting are commonly presented in COVID-19 patients. This focused review aims to discuss these uncommon and atypical COVID-19 symptoms that may be presented which might affect neurological, cardiovascular, cutaneous and ocular systems and their possible mode of actions. Nonetheless, there are some cases of reported uncommon or atypical symptoms which may warrant healthcare professionals to be aware of, especially when in contact with patients. The knowledge and information concerning these symptoms might be able to provide additional cues for healthcare professional by subjecting patients to COVID-19 screening. Meanwhile, it might be able to further enhance the alertness and additional precautions being taken by healthcare personnel, which eventually lead to reduced risk of infections.


Asunto(s)
/métodos , Tamizaje Masivo/métodos , Evaluación de Síntomas/métodos , Humanos
14.
Am J Nurs ; 121(4): 16, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33755610
15.
Medicine (Baltimore) ; 100(9): e24604, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655925

RESUMEN

ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.


Asunto(s)
Cuidados Críticos , Enfermedad Crítica , Evaluación de Síntomas , Tiempo de Tratamiento/estadística & datos numéricos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , /diagnóstico , /fisiopatología , China/epidemiología , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Enfermedades del Sistema Digestivo/diagnóstico , Enfermedades del Sistema Digestivo/etiología , Femenino , Neumonía Asociada a la Atención Médica/diagnóstico , Neumonía Asociada a la Atención Médica/mortalidad , Cardiopatías/diagnóstico , Humanos , Hiperamilasemia/diagnóstico , Hiperamilasemia/etiología , Hipernatremia/diagnóstico , Hipernatremia/etiología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Pronóstico , Análisis de Supervivencia , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
17.
BMJ Open ; 11(3): e044154, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33674374

RESUMEN

OBJECTIVE: Describe the disease course in a cohort of outpatients with COVID-19 and evaluate factors predicting duration of symptoms. DESIGN: Retrospective cohort study. SETTING: Telemedicine clinic at a large medical system in Atlanta, Georgia. PARTICIPANTS: 337 patients with acute COVID-19. Exclusion criteria included intake visit more than 10 days after symptom onset and hospitalisation prior to intake visit. MAIN OUTCOME MEASURES: Symptom duration in days. RESULTS: Common symptoms at intake visit are upper respiratory (73% cough, 55% loss of smell or taste, 57% sinus congestion, 32% sore throat) and systemic (66% headache, 64% body aches, 53% chills, 30% dizziness, 36% fever). Day of symptom onset was earliest for systemic and upper respiratory symptoms (median onset day 1 for both), followed by lower respiratory symptoms (day 3, 95% CI 2 to 4), with later onset of gastrointestinal symptoms (day 4, 95% CI 3 to 5), when present. Cough had the longest duration when present with median 17 days (95% CI 15 to 21), with 42% not resolved at final visit. Loss of smell or taste had the second longest duration with 14 days (95% CI 12 to 17), with 38% not resolved at final visit. Initial symptom severity is a significant predictor of symptom duration (p<0.01 for multiple symptoms). CONCLUSIONS: COVID-19 illness in outpatients follows a pattern of progression from systemic symptoms to lower respiratory symptoms and persistent symptoms are common across categories. Initial symptom severity is a significant predictor of disease duration for most considered symptoms.


Asunto(s)
/diagnóstico , Evaluación de Síntomas/métodos , Telemedicina , Adulto , Anciano , Femenino , Georgia , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos
18.
Aging (Albany NY) ; 13(3): 3176-3189, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33561834

RESUMEN

To establish an effective nomogram for predicting in-hospital mortality of COVID-19, a retrospective cohort study was conducted in two hospitals in Wuhan, China, with a total of 4,086 hospitalized COVID-19 cases. All patients have reached therapeutic endpoint (death or discharge). First, a total of 3,022 COVID-19 cases in Wuhan Huoshenshan hospital were divided chronologically into two sets, one (1,780 cases, including 47 died) for nomogram modeling and the other (1,242 cases, including 22 died) for internal validation. We then enrolled 1,064 COVID-19 cases (29 died) in Wuhan Taikang-Tongji hospital for external validation. Independent factors included age (HR for per year increment: 1.05), severity at admission (HR for per rank increment: 2.91), dyspnea (HR: 2.18), cardiovascular disease (HR: 3.25), and levels of lactate dehydrogenase (HR: 4.53), total bilirubin (HR: 2.56), blood glucose (HR: 2.56), and urea (HR: 2.14), which were finally selected into the nomogram. The C-index for the internal resampling (0.97, 95% CI: 0.95-0.98), the internal validation (0.96, 95% CI: 0.94-0.98), and the external validation (0.92, 95% CI: 0.86-0.98) demonstrated the fair discrimination ability. The calibration plots showed optimal agreement between nomogram prediction and actual observation. We established and validated a novel prognostic nomogram that could predict in-hospital mortality of COVID-19 patients.


Asunto(s)
Mortalidad Hospitalaria , Nomogramas , Factores de Edad , Anciano , Análisis Químico de la Sangre/métodos , Análisis Químico de la Sangre/estadística & datos numéricos , /diagnóstico , /fisiopatología , Enfermedades Cardiovasculares/epidemiología , China/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
20.
Emerg Infect Dis ; 27(4)2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33567247

RESUMEN

Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with higher transmission potential have been emerging globally, including SARS-CoV-2 variants from the United Kingdom and South Africa. We report 4 travelers from Brazil to Japan in January 2021 infected with a novel SARS-CoV-2 variant with an additional set of mutations.


Asunto(s)
/tratamiento farmacológico , Enfermedades Transmisibles Importadas , Adulto , Número Básico de Reproducción , Brasil/epidemiología , /terapia , /virología , Enfermedades Transmisibles Importadas/epidemiología , Enfermedades Transmisibles Importadas/fisiopatología , Enfermedades Transmisibles Importadas/terapia , Enfermedades Transmisibles Importadas/virología , Hospitalización , Humanos , Japón/epidemiología , Masculino , Mutación , Cuarentena/métodos , /aislamiento & purificación , Evaluación de Síntomas/métodos , Enfermedad Relacionada con los Viajes , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...