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1.
J Infect Chemother ; 27(1): 70-75, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32950393

RESUMEN

OBJECTIVES: The symptoms of Coronavirus disease 2019 (COVID-19) vary among patients. The aim of this study was to investigate the clinical manifestation and disease duration in young versus elderly patients. METHODS: We retrospectively analyzed 187 patients (87 elderly and 100 young patients) with confirmed COVID-19. The clinical characteristics and chest computed tomography (CT) extent as defined by a score were compared between the two groups. RESULTS: The numbers of asymptomatic cases and severe cases were significantly higher in the elderly group (elderly group vs. young group; asymptomatic cases, 31 [35.6%] vs. 10 [10%], p < 0.0001; severe cases, 25 [28.7%] vs. 8 [8.0%], p = 0.0002). The proportion of asymptomatic patients and severe patients increased across the 10-year age groups. There was no significant difference in the total CT score and number of abnormal cases. A significant positive correlation between the disease duration and patient age was observed in asymptomatic patients (ρ = 0.4570, 95% CI 0.1198-0.6491, p = 0.0034). CONCLUSIONS: Although the extent of lung involvement did not have a significant difference between the young and elderly patients, elderly patients were more likely to have severe clinical manifestations. Elderly patients were also more likely to be asymptomatic and a source of COVID-19 viral shedding.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Esparcimiento de Virus , Adulto , Factores de Edad , Anciano , Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/patología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
2.
J Infect Chemother ; 27(1): 76-82, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33051144

RESUMEN

INTRODUCTION: The severity of coronavirus disease (COVID-19) in Japanese patients is unreported. We retrospectively examined significant factors associated with disease severity in symptomatic COVID-19 patients (COVID-Pts) admitted to our institution between February 20 and April 30, 2020. METHODS: All patients were diagnosed based on the genetic detection of severe acute respiratory syndrome coronavirus 2. Information on the initial symptoms, laboratory data, and computed tomography (CT) images at hospitalization were collected from the patients' records. COVID-Pts were categorized as those with critical or severe illness (Pts-CSI) or those with moderate or mild illness (Pt-MMI). All statistical analyses were performed using R software. RESULTS: Data from 61 patients (16 Pt-CSI, 45 Pt-MMI), including 58 Japanese and three East Asians, were analyzed. Pt-CSI were significantly older and had hypertension or diabetes than Pt-MMI (P < 0.001, 0.014 and < 0.001, respectively). Serum albumin levels were significantly lower in Pt-CSI than in Pt-MMI (P < 0.001), whereas the neutrophil-to-lymphocyte ratio and C-reactive protein level were significantly higher in Pt-CSI than in Pt-MMI (P < 0.001 and P < 0.001, respectively). In the CT images of 60 patients, bilateral lung lesions were more frequently observed in Pt-CSI than in Pt-MMI (P = 0.013). Among the 16 Pt-CSI, 15 received antiviral therapy, 12 received tocilizumab, five underwent methylprednisolone treatment, six received mechanical ventilation, and one died. CONCLUSIONS: The illness severity of Japanese COVID-Pts was associated with older age, hypertension and/or diabetes, low serum albumin, high neutrophil-to-lymphocyte ratio, and C-reactive protein.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Índice de Severidad de la Enfermedad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Proteína C-Reactiva/análisis , Infecciones por Coronavirus/terapia , Femenino , Humanos , Japón/epidemiología , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Neutrófilos , Pandemias , Neumonía Viral/terapia , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica/análisis , Tomografía Computarizada por Rayos X , Adulto Joven
3.
Rev. enferm. UERJ ; 28: e39729, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1116093

RESUMEN

Objetivo: identificar as principais causas de óbito entre adolescentes de 10 a 19 anos em um município no interior do estado do Rio de Janeiro. Método: estudo descritivo, exploratório de abordagem quantitativa, a partir do levantamento de dados em registros de óbitos do município de Rio das Ostras. O desfecho foi causa básica do óbito. Os dados foram processados no Programa R. Resultados: foram observados 84 (100%) óbitos, com maior prevalência entre adolescentes de 17 a 19 anos, 49 (58,3%), do sexo masculino, 71 (84,5%) e de cor parda, 38 (45,2%). As principais causas de óbitos foram homicídio/perfuração por arma de fogo, 35 (41,7%), e acidentes, 32 (38,1%). Conclusão: o reconhecimento dessa vulnerabilidade configura importante caminho para o enfrentamento e resolução desse grave problema, sobretudo municípios localizados longe de centros urbanos, parece muitas vezes esquecido, no que tange o cumprimento de estatutos e políticas públicas a favor desse grupo etário.


Objective: to identify the main causes of death among adolescents aged 10 to 19 years in a municipality in the state of Rio de Janeiro. Method: in this exploratory, descriptive, quantitative study, based on data collected from death records in the municipality of Rio das Ostras, the basic cause of death was the outcome. The data were processed in the statistics software, R. Results: of the 84 (100%) deaths observed, prevalence was higher among adolescents aged 17 to 19 years (49; 58.3%), males (71; 84.5%), and pardos (38; 45.2%). The main causes of deaths were firearm Injury / homicide (35; 41.7%) and accidents (32; 38.1%). Conclusion: one important step towards confronting and solving this serious problem is to acknowledge this vulnerability, especially in municipalities distant from urban centers, which often seem neglected as regards compliance with statutes and public policies in favor of this age group.


Objetivo: identificar las principales causas de muerte entre adolescentes de 10 a 19 años en un municipio del estado de Río de Janeiro. Método: en este estudio exploratorio, descriptivo, cuantitativo, basado en los datos recopilados de los registros de defunciones en el municipio de Rio das Ostras, la causa básica de la muerte fue el resultado. Los datos se procesaron en el programa estadístico R. Resultados: de las 84 (100%) muertes observadas, la prevalencia fue mayor entre los adolescentes de 17 a 19 años (49; 58.3%), varones (71; 84.5%) y pardos (38; 45,2%). Las principales causas de muerte fueron lesiones por arma de fuego / homicidio (35; 41.7%) y accidentes (32; 38.1%). Conclusión: un paso importante para enfrentar y resolver este grave problema es reconocer esta vulnerabilidad, especialmente en municipios alejados de los centros urbanos, que a menudo parecen descuidados en cuanto al cumplimiento de los estatutos y las políticas públicas a favor de este grupo de edad.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Accidentes/estadística & datos numéricos , Causas de Muerte , Poblaciones Vulnerables/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Brasil , Epidemiología Descriptiva , Factores de Edad , Vulnerabilidad Social , Mortalidad Prematura
4.
BMJ Open Respir Res ; 7(1)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33148777

RESUMEN

OBJECTIVE: To evaluate the role of continuous positive air pressure (CPAP) in the management of respiratory failure associated with COVID-19 infection. Early clinical management with limited use of CPAP (3% of patients) was compared with a later clinical management strategy which had a higher proportion of CPAP use (15%). DESIGN: Retrospective case-controlled service evaluation for a single UK National Health Service (NHS) Trust during March-June 2020 designed and conducted solely to estimate the effects of current care. SETTING: The acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized English NHS Trust. PARTICIPANTS: 206 patients with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 and 3 April 2020 for the early group (controls), and between 10 April 2020 and 11 May 2020 for the late group (cases). Follow-up for all cases was until 11 June by which time all patients had a final outcome of death or discharge. Both groups were composed of 103 patients. Cases and controls were matched by age and sex. OUTCOME MEASURE: The outcome measure was the proportion of patients surviving at time t (time from the positive result of COVID-19 test to discharge/death date). The predictors were CPAP intervention, intubation, residence in care homes and comorbidities (renal, pulmonary, cardiac, hypertension and diabetes). A stratified Cox proportional hazard for clustered data (via generalised estimating equations) and model selection algorithms were employed to identify the effect of CPAP on patients' survival and the effect on gas exchange as measured by alveolar arterial (A-a) gradient and timing of CPAP treatment on CPAP patients' survival. RESULTS: CPAP was found to be significantly (HR 0.38, 95% CI 0.36 to 0.40) associated with lower risk of death in patients with hospital stay equal to, or below 7 days. However, for longer hospitalisation CPAP was found to be associated with increased risk of death (HR 1.72, 95% CI 1.40 to 2.12). When CPAP was initiated within 4 days of hospital admission, the survival probability was above 73% (95% CI 53% to 99%). In addition, lower A-a gradient was associated with lower risk of death in CPAP patients (HR 1.011, 95% CI 1.010 to 1.013). The selected model (best fit) was stratified by sex and clustered by case/control groups. The predictors were age, intubation, hypertension and the residency from care homes, which were found to be statistically significantly associated with patient's death/discharge. CONCLUSIONS: CPAP is a simple and cost-effective intervention. It has been established for care of other respiratory disorders but not for COVID-19 respiratory failure. This evaluation establishes that CPAP as a potentially viable treatment option for this group of patients during the first days of hospital admission. As yet there is limited availability of quantitative research on CPAP use for COVID-19. Whist this work is hampered by both the relatively small sample size and retrospective design (which reduced the ability to control potential confounders), it represents evidence of the significant benefit of early CPAP intervention. This evaluation should stimulate further research questions and larger study designs on the potential benefit of CPAP for COVID-19 infections. Globally, this potentially beneficial low cost and low intensity therapy could have added significance economically for healthcare provision in less developed countries.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Insuficiencia Respiratoria/terapia , Factores de Edad , Anciano , Betacoronavirus , Estudios de Casos y Controles , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Femenino , Humanos , Hipertensión/complicaciones , Pacientes Internos/estadística & datos numéricos , Intubación Intratraqueal , Tiempo de Internación , Masculino , Casas de Salud , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Modelos de Riesgos Proporcionales , Intercambio Gaseoso Pulmonar , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/virología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo
5.
Eur Respir Rev ; 29(158)2020 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-33153991

RESUMEN

The 2019 coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Clinical outcomes, including mortality, are worse in males, older individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibility to virus-induced exacerbations, compromised pulmonary function and high prevalence of associated comorbidities. Using evidence from basic science and cohort studies, this review addresses key questions concerning COVID-19 and COPD. First, are there mechanisms by which COPD patients are more susceptible to SARS-CoV-2 infection? Secondly, do inhaled corticosteroids offer protection against COVID-19? And, thirdly, what is the evidence regarding clinical outcomes from COVID-19 in COPD patients? This up-to-date review tackles some of the key issues which have significant impact on the long-term outlook for COPD patients in the context of COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto , Factores de Edad , Anciano , Comorbilidad , Infecciones por Coronavirus/terapia , Medicina Basada en la Evidencia , Humanos , Incidencia , Persona de Mediana Edad , Pandemias/estadística & datos numéricos , Neumonía Viral/terapia , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Pruebas de Función Respiratoria , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/epidemiología , Índice de Severidad de la Enfermedad , Factores Sexuales
6.
Medicine (Baltimore) ; 99(45): e22980, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157941

RESUMEN

Coronavirus disease 2019 (COVID-19) has spread worldwide, causing significant stress on the medical system. We explored the risk factors for condition changes in COVID-19 pneumonia patients after admission.The patients diagnosed with COVID-19 pneumonia at 2 medical centers in Hunan Province were studied, and those whose conditions changed after admission were compared. Their clinical characteristics and experimental indicators were compared using SPSS software and R language to build a disease risk prediction model.Patients with condition changes after admission were older and had more blood cell abnormalities and impaired organ function (decreased albumin, elevated D-dimer) than normal patients. We found that age, neutrophil ratio, D-dimer, chest Computed tomograpgy (CT) changes, and glucocorticoid use were risk factors for COVID-19 pneumonia after admission.Elderly patients are more susceptible to disease changes after COVID-19 pneumonia; COVID-19 pneumonia patients who develop disease changes after admission have higher neutrophil ratios, increased D-dimer levels, chest imaging changes, and glucocorticoid usage. Additional research is needed.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Hospitalización , Neumonía Viral/diagnóstico , Adulto , Factores de Edad , Anciano , Betacoronavirus , China , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Pandemias , Radiografía Torácica , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X
7.
BMC Cardiovasc Disord ; 20(1): 479, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33167876

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic. Studies showed COVID-19 affected not only the lung but also other organs. In this study, we aimed to explore the cardiac damage in patients with COVID-19. METHODS: We collected data of 100 patients diagnosed as severe type of COVID-19 from February 8 to April 10, 2020, including demographics, illness history, physical examination, laboratory test, and treatment. In-hospital mortality were observed. Cardiac damage was defined as plasma hypersensitive troponin I (hsTnI) over 34.2 pg/ml and/or N-terminal-pro brain natriuretic peptide (NTproBNP) above 450 pg/ml at the age < 50, above 900 pg/ml at the age < 75, or above 1800 pg/ml at the age ≥ 75. RESULTS: The median age of the patients was 62.0 years old. 69 (69.0%) had comorbidities, mainly presenting hypertension, diabetes, and cardiovascular disease. Fever (69 [69.0%]), cough (63 [63.0%]), chest distress (13 [13.0%]), and fatigue (12 [12.0%]) were the common initial symptoms. Cardiac damage occurred in 25 patients. In the subgroups, hsTnI was significantly higher in elder patients (≥ 60 years) than in the young (median [IQR], 5.2 [2.2-12.8] vs. 1.9 [1.9-6.2], p = 0.018) and was higher in men than in women (4.2 [1.9-12.8] vs. 2.9 [1.9-7.4], p = 0.018). The prevalence of increased NTproBNP was significantly higher in men than in women (32.1% vs. 9.1%, p = 0.006), but was similar between the elder and young patients (20.0% vs. 25.0%, p = 0.554). After multivariable analysis, male and hypertension were the risk factors of cardiac damage. The mortality was 4.0%. CONCLUSIONS: Cardiac damage exists in patients with the severe type of COVID-19, especially in male patients with hypertension. Clinicians should pay more attention to cardiac damage.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Cardiopatías/etiología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Neumonía Viral/complicaciones , Factores de Edad , Anciano , Biomarcadores/sangre , China , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Femenino , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Troponina I/sangre
8.
Open Biol ; 10(11): 200213, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33171068

RESUMEN

COVID-19 pandemic has caused a global lockdown in many countries throughout the world. Faced with a new reality, and until a vaccine or efficient treatment is found, humanity must figure out ways to keep the economy going, on one hand, while keeping the population safe, on the other hand, especially those that are susceptible to this virus. Here, we use a Watts-Strogatz network simulation, with parameters that were drawn from what is already known about the virus, to explore five different scenarios of partial lockdown release in two geographical locations with different age distributions. We find that separating age groups by reducing interactions between them protects the general population and reduces mortality rates. Furthermore, the addition of new connections within the same age group to compensate for the lost connections outside the age group still has a strong beneficial influence and reduces the total death toll by about 62%. While complete isolation from society may be the most protective scenario for the elderly population, it would have an emotional and possibly cognitive impact that might outweigh its benefit. Therefore, we propose creating age-related social recommendations or even restrictions, thereby allowing social connections while still offering strong protection for the older population.


Asunto(s)
Simulación por Computador , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adolescente , Adulto , Factores de Edad , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Humanos , Lactante , Recién Nacido , Israel/epidemiología , Italia/epidemiología , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/patología , Neumonía Viral/virología , Adulto Joven
9.
J Thromb Haemost ; 18(11): 3099-3105, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33174388

RESUMEN

BACKGROUND: Observational studies indicate that children hospitalized with COVID-19-related illness, like adults, are at increased risk for venous thromboembolism (VTE). A multicenter phase 2 clinical trial of anticoagulant thromboprophylaxis in children hospitalized with COVID-19-related illness has recently been initiated in the United States. To date, there remains a paucity of high-quality evidence to inform clinical practice world-wide. Therefore, the objective of this scientific statement is to provide consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses, and to identify priorities for future research. METHODS: We surveyed 20 pediatric hematologists and pediatric critical care physicians from several continents who were identified by Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee leadership as having experience and expertise in the use of anticoagulant thromboprophylaxis and/or the management of COVID-19-related illness in children. A comprehensive review of the literature on COVID-19 in children was also performed. RESULTS: Response rate was 90%. Based on consensus of expert opinions, we suggest the administration of low-dose low molecular weight heparin subcutaneously twice-daily as anticoagulant thromboprophylaxis (in the absence of contraindications, and in combination with mechanical thromboprophylaxis with sequential compression devices, where feasible) in children hospitalized for COVID-19-related illness (including the multisystem inflammatory syndrome in children [MIS-C]) who have markedly elevated D-dimer levels or superimposed clinical risk factors for hospitalassociated VTE. For children who are clinically unstable or have severe renal impairment, we suggest the use of unfractionated heparin by continuous intravenous infusion as anticoagulant thromboprophylaxis. In addition, continued efforts to characterize VTE risk and risk factors in children with COVID-19, as well as to evaluate the safety and efficacy of anticoagulant thromboprophylaxis strategies in children hospitalized with COVID-19-related illness (including MIS-C) via cooperative multicenter trials, were identified among several key priorities for future research. CONCLUSION: These consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses and priorities for future research will be updated as high-quality evidence emerges.


Asunto(s)
Anticoagulantes/administración & dosificación , Infecciones por Coronavirus/tratamiento farmacológico , Medicina Basada en la Evidencia/normas , Hospitalización , Neumonía Viral/tratamiento farmacológico , Investigación/normas , Tromboembolia Venosa/prevención & control , Adolescente , Factores de Edad , Anticoagulantes/efectos adversos , Niño , Preescolar , Toma de Decisiones Clínicas , Consenso , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Encuestas de Atención de la Salud , Humanos , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Tromboembolia Venosa/sangre , Tromboembolia Venosa/etiología , Adulto Joven
10.
PLoS One ; 15(11): e0241825, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33175863

RESUMEN

BACKGROUND: Available COVID-19 mortality indices are limited to acute inpatient data. Using nationwide medical administrative data available prior to SARS-CoV-2 infection from the US Veterans Health Administration (VA), we developed the VA COVID-19 (VACO) 30-day mortality index and validated the index in two independent, prospective samples. METHODS AND FINDINGS: We reviewed SARS-CoV-2 testing results within the VA between February 8 and August 18, 2020. The sample was split into a development cohort (test positive between March 2 and April 15, 2020), an early validation cohort (test positive between April 16 and May 18, 2020), and a late validation cohort (test positive between May 19 and July 19, 2020). Our logistic regression model in the development cohort considered demographics (age, sex, race/ethnicity), and pre-existing medical conditions and the Charlson Comorbidity Index (CCI) derived from ICD-10 diagnosis codes. Weights were fixed to create the VACO Index that was then validated by comparing area under receiver operating characteristic curves (AUC) in the early and late validation cohorts and among important validation cohort subgroups defined by sex, race/ethnicity, and geographic region. We also evaluated calibration curves and the range of predictions generated within age categories. 13,323 individuals tested positive for SARS-CoV-2 (median age: 63 years; 91% male; 42% non-Hispanic Black). We observed 480/3,681 (13%) deaths in development, 253/2,151 (12%) deaths in the early validation cohort, and 403/7,491 (5%) deaths in the late validation cohort. Age, multimorbidity described with CCI, and a history of myocardial infarction or peripheral vascular disease were independently associated with mortality-no other individual comorbid diagnosis provided additional information. The VACO Index discriminated mortality in development (AUC = 0.79, 95% CI: 0.77-0.81), and in early (AUC = 0.81 95% CI: 0.78-0.83) and late (AUC = 0.84, 95% CI: 0.78-0.86) validation. The VACO Index allows personalized estimates of 30-day mortality after COVID-19 infection. For example, among those aged 60-64 years, overall mortality was estimated at 9% (95% CI: 6-11%). The Index further discriminated risk in this age stratum from 4% (95% CI: 3-7%) to 21% (95% CI: 12-31%), depending on sex and comorbid disease. CONCLUSION: Prior to infection, demographics and comorbid conditions can discriminate COVID-19 mortality risk overall and within age strata. The VACO Index reproducibly identified individuals at substantial risk of COVID-19 mortality who might consider continuing social distancing, despite relaxed state and local guidelines.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Betacoronavirus/aislamiento & purificación , Comorbilidad , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Bases de Datos Factuales , Grupos Étnicos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/patología , Neumonía Viral/virología , Curva ROC , Factores de Riesgo , Salud de los Veteranos , Adulto Joven
12.
Ann Acad Med Singap ; 49(8): 530-537, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33164022

RESUMEN

INTRODUCTION: In this study, a comparison of clinical, epidemiological and laboratory parameters between symptomatic and asymptomatic children with SARS-CoV-2 infection was performed. MATERIALS AND METHODS: Data from all children with laboratory confirmed SARS-CoV-2 infection admitted to KK Women's and Children's Hospital (KKH), Singapore, from January to May 2020 were analysed. RESULTS: Of the 39 COVID-19 children included, 38.5% were asymptomatic. Household transmission accounted for 95% of cases. The presenting symptoms of symptomatic children were low-grade fever (54.2%), rhinorrhoea (45.8%), sore throat (25%), diarrhoea (12.5%) and acute olfactory dysfunction (5.4%). Children of Chinese ethnicity (37.5% vs 6.7%), complete blood count (45.8% vs 6.7%) and liver enzyme abnormalities (25% vs 7.7%) were more common in symptomatic versus asymptomatic children. All children had a mild disease course and none required oxygen supplementation or intensive care. CONCLUSIONS: The high proportion of asymptomatic infected children coupled with household transmission as the main source of paediatric COVID-19 infection underscores the importance of early screening and isolation of children upon detection of an index case of COVID-19 in a household. Symptomatic children were more likely to have abnormal laboratory parameters but they did not have a poorer outcome compared to asymptomatic cases.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Adolescente , Factores de Edad , Betacoronavirus , Niño , Preescolar , Estudios de Cohortes , Infecciones por Coronavirus/complicaciones , Hospitalización , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Pandemias , Neumonía Viral/complicaciones , Singapur , Evaluación de Síntomas
13.
PLoS One ; 15(11): e0241950, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33170903

RESUMEN

The COVID-19 pandemic has had tremendous impact on Americans' lives including their personal and social behaviors. While people of all ages are affected in some way by the pandemic, older persons have been far more likely to suffer the most severe health consequences. For this reason, how people have responded to mitigating behaviors to COVID-19 may differ by age. Using a nationally representative sample from the longitudinal data of the Understanding America Study (UAS), we examined differentials in behavioral responses to COVID-19 by age and how they changed over the first three months of the pandemic. Behavioral responses and changes in behavior over time differed by age, type of behaviors and time reference. At the beginning of the pandemic (March, 2020), older and younger people were similar in their likelihood of engaging in preventive personal behaviors when controlling for other influences. As the pandemic progressed, however, older people adopted mitigating personal behavioral changes more than younger people, such that about 1-2 months after the pandemic started, older people were more likely to comply with suggested behaviors and regulations including practicing better hygiene, quarantining, and social distancing. One month into the pandemic, older people were less likely than younger people to engage in two of four risky behaviors. The change in risky behavior over time did not differ by age; but both younger and older people were more likely to engage in risky behaviors after two months. Being female, a member of a racial/ethnic minority group, higher socioeconomic status, having more COVID-19 cases in one's state of residence, a higher perceived risk for infection and dying, and a more left-leaning political orientation were related to adopting more pandemic mitigating behaviors.


Asunto(s)
Infecciones por Coronavirus/patología , Conductas Relacionadas con la Salud , Neumonía Viral/patología , Conducta Social , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Grupos Étnicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/virología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
14.
BMJ Open ; 10(11): e042573, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33172950

RESUMEN

OBJECTIVE: To analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19. DESIGN: Meta-analysis. DATA SOURCES: PubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020. STUDY SELECTION: Studies examining the following demographics and outcomes were included: patients' age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection. RESULTS: A total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92-4.25) and an OR of 6.07, 95% CI (2.53-14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83-15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13-13.36). CONCLUSION: AKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.


Asunto(s)
Lesión Renal Aguda/epidemiología , Infecciones por Coronavirus/fisiopatología , Mortalidad Hospitalaria , Neumonía Viral/fisiopatología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Factores de Edad , Betacoronavirus , China/epidemiología , Terapia de Reemplazo Renal Continuo , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Europa (Continente)/epidemiología , Humanos , América del Norte/epidemiología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Pronóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales
15.
BMJ Open ; 10(11): e042398, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33172949

RESUMEN

OBJECTIVES: To describe demographic, clinical, radiological and laboratory characteristics, as well as outcomes, of patients admitted for COVID-19 in a secondary hospital. DESIGN AND SETTING: Retrospective case series of sequentially hospitalised patients with confirmed SARS-CoV-2, at Infanta Leonor University Hospital (ILUH) in Madrid, Spain. PARTICIPANTS: All patients attended at ILUH testing positive to reverse transcriptase-PCR on nasopharyngeal swabs and diagnosed with COVID-19 between 1 March 2020 and 28 May 2020. RESULTS: A total of 1549 COVID-19 cases were included (median age 69 years (IQR 55.0-81.0), 57.5% men). 78.2% had at least one underlying comorbidity, the most frequent was hypertension (55.8%). Most frequent symptoms at presentation were fever (75.3%), cough (65.7%) and dyspnoea (58.1%). 81 (5.8%) patients were admitted to the intensive care unit (ICU) (median age 62 years (IQR 51-71); 74.1% men; median length of stay 9 days (IQR 5-19)) 82.7% of them needed invasive ventilation support. 1393 patients had an outcome at the end of the study period (case fatality ratio: 21.2% (296/1393)). The independent factors associated with fatality (OR; 95% CI): age (1.07; 1.06 to 1.09), male sex (2.86; 1.85 to 4.50), neurological disease (1.93; 1.19 to 3.13), chronic kidney disease (2.83; 1.40 to 5.71) and neoplasia (4.29; 2.40 to 7.67). The percentage of hospital beds occupied with COVID-19 almost doubled (702/361), with the number of patients in ICU quadrupling its capacity (32/8). Median length of stay was 9 days (IQR 6-14). CONCLUSIONS: This study provides clinical characteristics, complications and outcomes of patients with COVID-19 admitted to a European secondary hospital. Fatal outcomes were similar to those reported by hospitals with a higher level of complexity.


Asunto(s)
Lesión Renal Aguda/fisiopatología , Infecciones por Coronavirus/fisiopatología , Neumonía Viral/fisiopatología , Síndrome de Dificultad Respiratoria del Adulto/fisiopatología , Lesión Renal Aguda/terapia , Corticoesteroides/uso terapéutico , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Tos/fisiopatología , Disnea/fisiopatología , Femenino , Fiebre/fisiopatología , Hospitalización , Humanos , Hipertensión/epidemiología , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neoplasias , Enfermedades del Sistema Nervioso/epidemiología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Renal Crónica/epidemiología , Respiración Artificial , Síndrome de Dificultad Respiratoria del Adulto/terapia , Estudios Retrospectivos , Factores Sexuales , España/epidemiología
16.
Epidemiol Serv Saude ; 29(5): e2020432, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33175010

RESUMEN

OBJECTIVE: To analyze the adherence of the population to physical contact restriction measures and the spread of COVID-19 in Brazil. METHODS: This was a web-based health survey carried out from April 24 to May 24 2020 using a chain sampling procedure. Intensity of adherence to physical contact restriction measures was analyzed according to sociodemographic characteristics, using logistic regression models to investigate associations with 'No/little adherence'. RESULTS: Of the 45,161 participants, 74.2% (73.8;74.6%) reported intense adherence to the measures. The group that did not adhere to the measures was characterized by men (31.7%), those aged 30 to 49 (36.4%), those with low education levels (33.0%), those who worked during the pandemic (81.3%), those resident in the North (28.1%) and Midwest (28.5%) regions of the country. In Brazil as a whole, there was a decrease in COVID-19 daily growth rates, from 45.4% to 5.0%. CONCLUSION: A large part of the Brazilian population adhered to physical contact restriction measures, which possibly contributed to decreasing the spread of COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Programas Obligatorios/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuarentena/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Brasil/epidemiología , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia/estadística & datos numéricos , Factores Sexuales , Adulto Joven
18.
Euro Surveill ; 25(45)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33183404

RESUMEN

We analysed factors associated with neutralising antibody levels in 330 convalescent plasma donors. Women and younger donors were more likely not to have measurable neutralising antibodies, while higher antibody levels were observed in men, in older donors and in those who had been hospitalised. These data will be of value in the timely recruitment of convalescent plasma donors most likely to have high levels of neutralising antibodies for ongoing studies investigating its effectiveness.


Asunto(s)
Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Donantes de Sangre , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/terapia , Hospitalización , Neumonía Viral/sangre , Neumonía Viral/terapia , Factores de Edad , Anciano , Anticuerpos Neutralizantes/uso terapéutico , Donantes de Sangre/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/inmunología , Inglaterra , Ensayo de Inmunoadsorción Enzimática , Humanos , Inmunización Pasiva , Masculino , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Factores Sexuales
19.
BMJ Open ; 10(11): e041989, 2020 11 12.
Artículo en Inglés | MEDLINE | ID: mdl-33184086

RESUMEN

OBJECTIVE: The reliable risk factors for mortality of COVID-19 has not evaluated in well-characterised cohort. This study aimed to identify risk factors for in-hospital mortality within 56 days in patients with severe infection of COVID-19. DESIGN: Retrospective multicentre cohort study. SETTING: Five tertiary hospitals of Daegu, South Korea. PARTICIPANTS: 1005 participants over 19 years old confirmed COVID-19 using real-time PCR from nasopharyngeal and oropharyngeal swabs. METHODS: The clinical and laboratory features of patients with COVID-19 receiving respiratory support were analysed to ascertain the risk factors for mortality using the Cox proportional hazards regression model. The relationship between overall survival and risk factors was analysed using the Kaplan-Meier method. OUTCOME: In-hospital mortality for any reason within 56 days. RESULTS: Of the 1005 patients, 289 (28.8%) received respiratory support, and of these, 70 patients (24.2%) died. In multivariate analysis, high fibrosis-4 index (FIB-4; HR 2.784), low lymphocyte count (HR 0.480), diabetes (HR 1.917) and systemic inflammatory response syndrome (HR 1.714) were found to be independent risk factors for mortality in patients with COVID-19 receiving respiratory support (all p<0.05). Regardless of respiratory support, survival in the high FIB-4 group was significantly lower than in the low FIB-4 group (28.8 days vs 44.0 days, respectively, p<0.001). A number of risk factors were also significantly related to survival in patients with COVID-19 regardless of respiratory support (0-4 risk factors, 50.2 days; 49.7 days; 44.4 days; 32.0 days; 25.0 days, respectively, p<0.001). CONCLUSION: FIB-4 index is a useful predictive marker for mortality in patients with COVID-19 regardless of its severity.


Asunto(s)
Factores de Edad , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Infecciones por Coronavirus/sangre , Mortalidad Hospitalaria , Linfopenia/sangre , Recuento de Plaquetas , Neumonía Viral/sangre , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Betacoronavirus , Estudios de Cohortes , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Diabetes Mellitus/epidemiología , Femenino , Humanos , Factores Inmunológicos/uso terapéutico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/inmunología , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Modelos de Riesgos Proporcionales , República de Corea , Respiración Artificial , Estudios Retrospectivos , Medición de Riesgo , Síndrome de Respuesta Inflamatoria Sistémica/inmunología
20.
BMJ Open ; 10(11): e044202, 2020 11 14.
Artículo en Inglés | MEDLINE | ID: mdl-33191269

RESUMEN

OBJECTIVE: In Ethiopia, community-level knowledge about the current COVID-19 pandemic has not been well studied. This study is aimed to assess knowledge level and factors influencing the prevention of the COVID-19 pandemic among residents of Dessie and Kombolcha city administrations, Ethiopia. DESIGN: Community-based cross-sectional study. SETTINGS: Dessie and Kombolcha city administrations. PARTICIPANTS: Participants were household heads or members (n=828, >18 years) who have lived in the study area for at least 2 months preceding the survey. METHODS: Binary logistic regression was used for a single outcome and multiple response variables. In the multivariable regression model, a value of p<0.05 and adjusted OR (AOR) with 95% CI were used to identify factors associated with knowledge level of the community. Epi Info V.7.2 and SPSS V.20 software were used for data entry and analysis, respectively. OUTCOME: Knowledge level. RESULTS: A total of 828 participants was involved with a response rate of 98%. Women were 61.7%. Participants' mean (±SD) age was 39 (±14) years. Of the total participants 54.11% (95% CI 50.6% to 57.6%) had inadequate knowledge about COVID-19 prevention. Significant associations were reported among women (AOR=1.41; 95% CI 1.03 to 1.92); age ≥65 years (AOR=2.72; 95% CI 1.45 to 5.11); rural residence (AOR=2.69; 95% CI 1.78 to 4.07); unable to read and write (AOR=1.60; 95% CI 1.02 to 2.51); information not heard from healthcare workers, mass media and social media (AOR=1.95; 95% CI 1.35 to 2.82), (AOR=2.5; 95% CI 1.58 to 4.19) and (AOR=2.13; 95% CI 1.33 to 3.42), respectively, with inadequate knowledge. CONCLUSION: These findings revealed that more than 50% of participants had inadequate knowledge about COVID-19. It highlights the need for widespread awareness campaigns about COVID-19 through mass media, healthcare professionals and social media as sources of information. House-to-house awareness creation is recommended to address older adults who are more vulnerable to the pandemic.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adolescente , Adulto , Factores de Edad , Anciano , Betacoronavirus , Infecciones por Coronavirus/transmisión , Estudios Transversales , Etiopía , Femenino , Humanos , Alfabetización , Masculino , Persona de Mediana Edad , Neumonía Viral/transmisión , Población Rural , Factores Sexuales , Población Urbana , Adulto Joven
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