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1.
BMC Infect Dis ; 21(1): 169, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568097

RESUMEN

BACKGROUND: Our main objectives were to estimate the incidence of illnesses presumably caused by SARS-CoV-2 infection during the lockdown period and to identify the associated risk factors. METHODS: Participants from 3 adult cohorts in the general population in France were invited to participate in a survey on COVID-19. The main outcome was COVID-19-Like Symptoms (CLS), defined as a sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days and occurred during the 17 days before the survey. We used delayed-entry Cox models to identify associated factors. RESULTS: Between April 2, 2020 and May 12, 2020, 279,478 participants were invited, 116,903 validated the questionnaire and 106,848 were included in the analysis. Three thousand thirty-five cases of CLS were reported during 62,099 person-months of follow-up. The cumulative incidences of CLS were 6.2% (95% Confidence Interval (95%CI): 5.7%; 6.6%) on day 15 and 8.8% (95%CI 8.3%; 9.2%) on day 45 of lockdown. The risk of CLS was lower in older age groups and higher in French regions with a high prevalence of SARS-CoV-2 infection, in participants living in cities > 100,000 inhabitants (vs rural areas), when at least one child or adolescent was living in the same household, in overweight or obese people, and in people with chronic respiratory diseases, anxiety or depression or chronic diseases other than diabetes, cancer, hypertension or cardiovascular diseases. CONCLUSION: The incidence of CLS in the general population remained high during the first 2 weeks of lockdown, and decreased significantly thereafter. Modifiable and non-modifiable risk factors were identified.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles , Adolescente , Adulto , Anciano , Niño , Estudios de Cohortes , Comorbilidad , Tos , Femenino , Fiebre , Francia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
2.
Chest ; 159(2): e107-e113, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33563452

RESUMEN

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


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Bacteriemia/complicaciones , /fisiopatología , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/diagnóstico por imagen , Tos/fisiopatología , Diarrea/fisiopatología , Progresión de la Enfermedad , Disnea/fisiopatología , Servicio de Urgencia en Hospital , Fiebre/fisiopatología , Cefalea/fisiopatología , Humanos , /diagnóstico por imagen , Linfopenia/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mialgia/fisiopatología , Oximetría , Neumonía Estafilocócica/complicaciones , Radiografía Torácica , Infecciones Estafilocócicas/complicaciones , Tomografía Computarizada por Rayos X
4.
Artif Intell Med ; 112: 102018, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33581830

RESUMEN

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


Asunto(s)
/fisiopatología , Biología Computacional/métodos , Algoritmos , /virología , Tos/fisiopatología , Disnea/fisiopatología , Fatiga/fisiopatología , Fiebre/fisiopatología , Humanos , Pandemias , Faringitis/fisiopatología , /aislamiento & purificación
5.
JAMA Netw Open ; 4(2): e210369, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33576820

RESUMEN

Importance: There is limited evidence regarding early treatment of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to mitigate symptom progression. Objective: To examine whether high-dose zinc and/or high-dose ascorbic acid reduce the severity or duration of symptoms compared with usual care among ambulatory patients with SARS-CoV-2 infection. Design, Setting, and Participants: This multicenter, single health system randomized clinical factorial open-label trial enrolled 214 adult patients with a diagnosis of SARS-CoV-2 infection confirmed with a polymerase chain reaction assay who received outpatient care in sites in Ohio and Florida. The trial was conducted from April 27, 2020, to October 14, 2020. Intervention: Patients were randomized in a 1:1:1:1 allocation ratio to receive either 10 days of zinc gluconate (50 mg), ascorbic acid (8000 mg), both agents, or standard of care. Outcomes: The primary end point was the number of days required to reach a 50% reduction in symptoms, including severity of fever, cough, shortness of breath, and fatigue (rated on a 4-point scale for each symptom). Secondary end points included days required to reach a total symptom severity score of 0, cumulative severity score at day 5, hospitalizations, deaths, adjunctive prescribed medications, and adverse effects of the study supplements. Results: A total of 214 patients were randomized, with a mean (SD) age of 45.2 (14.6) years and 132 (61.7%) women. The study was stopped for a low conditional power for benefit with no significant difference among the 4 groups for the primary end point. Patients who received usual care without supplementation achieved a 50% reduction in symptoms at a mean (SD) of 6.7 (4.4) days compared with 5.5 (3.7) days for the ascorbic acid group, 5.9 (4.9) days for the zinc gluconate group, and 5.5 (3.4) days for the group receiving both (overall P = .45). There was no significant difference in secondary outcomes among the treatment groups. Conclusions and Relevance: In this randomized clinical trial of ambulatory patients diagnosed with SARS-CoV-2 infection, treatment with high-dose zinc gluconate, ascorbic acid, or a combination of the 2 supplements did not significantly decrease the duration of symptoms compared with standard of care. Trial Registration: ClinicalTrials.gov Identifier: NCT04342728.


Asunto(s)
Ácido Ascórbico/uso terapéutico , Suplementos Dietéticos , Zinc/uso terapéutico , Adulto , Atención Ambulatoria , Antioxidantes/uso terapéutico , Tos/tratamiento farmacológico , Tos/etiología , Disnea/tratamiento farmacológico , Disnea/etiología , Fatiga/tratamiento farmacológico , Fatiga/etiología , Femenino , Fiebre/tratamiento farmacológico , Fiebre/etiología , Gluconatos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Nivel de Atención , Oligoelementos/uso terapéutico , Resultado del Tratamiento
6.
Medicina (Kaunas) ; 57(2)2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33572732

RESUMEN

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12-24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.


Asunto(s)
/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , /métodos , Tos/fisiopatología , Diagnóstico Diferencial , Femenino , Fiebre/fisiopatología , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Faringitis/fisiopatología , Estudios Retrospectivos , Rumanía/epidemiología , Síndrome , Tomografía Computarizada por Rayos X , Adulto Joven
7.
Am J Case Rep ; 22: e929447, 2021 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-33612712

RESUMEN

BACKGROUND Since the emergence of coronavirus disease 2019 (COVID-19), patients with the illness have presented with considerable variation in severity. Some infected individuals present mild or no symptoms, while others present severe illness with some fatal outcomes. Multiple lines of management have been suggested for critically ill patients, such as intravenous immunoglobulin (IVIG) and steroids. IVIG is the main treatment for patients with X-linked agammaglobulinemia. Multiple studies have reported that these patients have excellent outcomes when they contract COVID-19. This report describes the clinical course of COVID-19 pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a 19-year-old man on IVIG replacement therapy for X-linked agammaglobulinemia (XLA). CASE REPORT A patient with XLA receiving a monthly dose of IVIG and having bronchiectasis managed by prophylactic azithromycin presented with fever, shortness of breath, productive cough, and diarrhea. He was admitted to our hospital with SARS-CoV-2 infection. His treatment course for COVID-19 was uncomplicated and had excellent results. He completed a 10-day course of piperacillin/tazobactam and his symptoms resolved 3 days after admission, without complications, oxygen supplementation, or intensive care unit admission. CONCLUSIONS Patients with XLA have weakened immunity and therefore may present with an infection as a first symptom. This report describes the mild course of COVID-19 pneumonia in an immunologically vulnerable patient with XLA who presented with SARS-CoV-2 infection while undergoing IVIG replacement therapy. Currently, IVIG is one of many supportive immune therapies undergoing clinical evaluation in patients with severe COVID-19.


Asunto(s)
Agammaglobulinemia/terapia , Enfermedades Genéticas Ligadas al Cromosoma X/terapia , Inmunoglobulinas Intravenosas/uso terapéutico , Combinación Piperacilina y Tazobactam/uso terapéutico , Neumonía Viral/terapia , Antibacterianos/uso terapéutico , Fiebre , Humanos , Huésped Inmunocomprometido , Masculino , Neumonía Viral/virología , Adulto Joven
8.
Pediatr Infect Dis J ; 40(3): e113-e115, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33565816

RESUMEN

Multisystem inflammatory syndrome in children (MIS-C) is an emerging entity during the coronavirus disease 2019 pandemic. Medium- and large-vessel changes are present in MIS-C; however, microcirculatory impairment has not been documented. We report a case of MIS-C in a toddler that presented with persistent fever, gastrointestinal symptoms and rash. Nailfold videocapillaroscopy was abnormal, suggesting microcirculatory disease in the setting of MIS-C.


Asunto(s)
/diagnóstico , Enfermedades Gastrointestinales/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , /fisiopatología , Exantema , Fiebre , Enfermedades Gastrointestinales/fisiopatología , Enfermedades Gastrointestinales/virología , Humanos , Lactante , Masculino , México , Microcirculación , Angioscopía Microscópica , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatología , Síndrome de Respuesta Inflamatoria Sistémica/virología
9.
Medicine (Baltimore) ; 100(7): e24847, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607856

RESUMEN

ABSTRACT: The objective of this study was to evaluate the risk factors, pathogenic bacteria and drug sensitivity of maternal sepsis, and provide evidence for clinical prevention and treatment.A retrospective investigation of pregnant women with full-term maternal sepsis was performed to analyze the risk factors, pathogenic bacteria, and drug sensitivity of maternal sepsis.Univariate analysis showed that temperature, serum procalcitonin (PCT) and C-reactive protein (CRP) at admission, white blood cell count (WBC), PCT, CRP and neutrophilic granulocyte percentage (N%) during fever, premature rupture of membranes (PROM), antibiotic use within 1 week, mode of production, onset and duration of fever, between groups were statistically significant (P < .05). Logistic regression analysis showed that cesarean section was an independent risk factor for sepsis (OR = 11.839, 95%CI: 3.121-44.906). Apparent increase was found in body temperature (OR = 3.664, 95%CI: 1.722-7.795), duration of fever (OR = 1.953, 95%CI: 1.242-3.071), and PCT (OR = 1.080, 95%CI: 1.002-1.163). Also, increasing neutrophil ratio (OR = 1.180, 95%CI: 1.073-1.297) indicated a high possibility of maternal sepsis. The organism Escherichia coli (E. coli) was the most common pathogenic bacteria in the positive blood culture group (90%), and the sensitivity to carbapenems (meropenem and imipenem/cilastatin) was 100%, that to piperacillin-tazobactam and amoxicillin sulbactam was over 90%, and that to ceftazidime was 95%.Cesarean section was an independent risk factor for maternal sepsis in term pregnant women with positive blood culture. Besides, the E. coli was the most common pathogenic bacteria in the positive blood culture group. Antibiotics should be used in time and reasonably when the temperature was significantly increased with elevated PCT and N% after a cesarean section.


Asunto(s)
Antibacterianos/uso terapéutico , Bacterias/patogenicidad , Hospitalización/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/microbiología , Adulto , Antibacterianos/normas , Bacterias/efectos de los fármacos , Cultivo de Sangre/métodos , Cultivo de Sangre/estadística & datos numéricos , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Cesárea/estadística & datos numéricos , China/epidemiología , Escherichia coli/patogenicidad , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Fiebre , Humanos , Recuento de Leucocitos/métodos , Recuento de Leucocitos/estadística & datos numéricos , Pruebas de Sensibilidad Microbiana/métodos , Neutrófilos/citología , Neutrófilos/patología , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Mujeres Embarazadas , Polipéptido alfa Relacionado con Calcitonina/sangre , Estudios Retrospectivos , Factores de Riesgo
10.
PLoS One ; 16(2): e0245257, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33534845

RESUMEN

Despite the increasing personalization of medicine, surprisingly ~37.0°C (98.6°F) continues as the estimate of normal temperature. We investigated between-subject and within-subject thermal variability, whether a significant percentage of individuals have a low mean oral temperature, and whether these differ by sex, age, time of day, ethnicity, body mass index (BMI), or menstrual phase. Oral temperature was measured by Life Brand® Fast-Read Digital Oral Thermometers and sampled 14 times over two weeks, seven morning and seven evening readings. The volunteer sample consisted of 96 adults (42 men, 54 women; 27 couples, 42 singletons), ages 18-67 years. We found sizeable individual differences in body temperature and that the normal temperature of many individuals is considerably lower than 37.0°C (98.6°F). Mean temperatures ranged from 35.2°C (95.4°F) to 37.4°C (99.3°F). The mean temperature across all participants was 36.1°C (97.0°F)-lower than most studies have reported, consistent with recent evidence of temperature declining over decades. 77% had mean temperatures at least 0.55°C (1°F) lower than 37.0°C (98.6°F). Mean temperature did not differ by age, but women had higher temperatures than men, even within a couple with room temperature and warmth of clothing equated. Although oral temperature varied widely across individuals, it showed marked stability within individuals over days. Variability of temperature over days did not differ by sex, but was larger among younger adults. Using 37.0°C (98.6°F) as the assumed normal temperature for everyone can result in healthcare professionals failing to detect a serious fever in individuals with a low normal temperature or obtaining false negatives for those individuals when using temperature to screen for COVID-19, mistaking their elevated temperature as normal. Some have called for lowering the estimate of normal temperature slightly (e.g., 0.2°C [0.36°F]). That still seems an overly high estimate. More important, using any standardized "normal" temperature will lead to errors for many people. Individual differences are simply too great. Personalizing body temperature is needed. Temperature could be measured at yearly doctor visits, as blood pressure is now. That would be simple to implement. Since our results show marked thermal stability within an individual, sampling temperature only once yearly could provide an accurate indication of a person's normal temperature at that time of day. Such records over time would also provide a more accurate understanding of how temperature changes over the lifespan.


Asunto(s)
Temperatura Corporal , Adolescente , Adulto , Factores de Edad , Anciano , /virología , Femenino , Fiebre/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Adulto Joven
11.
BMC Infect Dis ; 21(1): 141, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33535989

RESUMEN

BACKGROUND: The impact of COVID-19 has been devastating on a global scale. The negative conversion time (NCT) of SARS-CoV-2 RNA is closely related to clinical manifestation and disease progression in COVID-19 patients. Our study aimed to predict factors associated with prolonged NCT of SARS-CoV-2 RNA in mild/moderate COVID-19 patients. METHODS: The clinical features, laboratory data and treatment outcomes of COVID-19 patients were retrospectively analyzed. Then univariate and multivariate analysis were used to screen out risk factors of influencing prolonged NCT of SARS-CoV-2 RNA. RESULTS: Thirty-two hospitalized mild/moderate COVID-19 patients were enrolled. The general clinical symptoms were cough (78.1%), fever (75%), diarrhea (68.8%), expectoration (56.3%), and nausea (37.5%). More than 40% of the patients had decreased erythrocyte, hemoglobin and leucocyte and 93.8% patients were detected in abnormalities of chest CT. The median NCT of SARS-CoV-2 RNA was 19.5 days (IQR: 14.25-25). Univariate analysis found fever, nausea, diarrhea and abnormalities in chest CTs were positively associated with prolonged NCT of viral RNA (P< 0.05). The multivariate Cox proportional hazard model revealed that fever [Exp (B), 0.284; 95% CI, 0.114-0.707; P<0.05] and nausea [Exp (B), 0.257; 95%CI, 0.096-0.689; P<0.05] were two significant independent factors. CONCLUSIONS: Fever and nausea were two significant independent factors in prolonged NCT of viral RNA in mild/moderate COVID-19 patients, which provided a useful references for disease progression and treatment of COVID-19.


Asunto(s)
/diagnóstico , ARN Viral/metabolismo , /genética , Adulto , /patología , Tos/etiología , Diarrea/etiología , Femenino , Fiebre/etiología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tórax/diagnóstico por imagen , Factores de Tiempo
12.
Ann Palliat Med ; 10(1): 672-680, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33545796

RESUMEN

BACKGROUND: The novel 2019 coronavirus (COVID-19) has largely abated in China; however, sporadic or imported cases are still a concern, while in other countries, the COVID-19 pandemic persists as a major health crisis. METHODS: All patients enrolled in this study were diagnosed with COVID-19 from February 21, 2020 to April 14, 2020 in Wuhan. We retrospectively analyzed the patients admitted to the ICU (137 patients) and general wards (114 patients) of Wuhan Leishenshan Hospital in China. The population characteristics, symptoms, and laboratory examination results between the patients in the ICU and those in the general wards were compared. Furthermore, the differences between the deceased patients in the ICU and those discharged from the ICU were compared. RESULTS: There were significant differences between the two groups in terms of symptoms, including fever, shortness of breath, no presence of complications, presence of 1 complication, and presence of 3 or more complications (P<0.05). There were also significant differences between the patients in terms of the laboratory examination results including elevated urea nitrogen, creatinine, direct bilirubin, aspartate aminotransferase, total protein, albumin, creatine kinase, lactate dehydrogenase, procalcitonin, erythrocyte sedimentation rate, white blood cells, C-reactive protein, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, interleukin 6, interleukin 8, interleukin 10, interleukin 2 receptor, tumor necrosis factor-α, troponin I, phosphokinase isoenzyme-MB, and B-type natriuretic peptide; and decreased platelets, lymphocyte absolute value, and eosinophil absolute value (<0.05). There were 45 patients who died in ICU and 57 improved and discharged patients. There were significant differences between the two groups in the number of patients that had 1 complication and 3 or more complications (P<0.05). There were also significant differences in the laboratory examination results between the patients including elevated urea nitrogen, total bilirubin, direct bilirubin, aspartate aminotransferase, procalcitonin, white blood cells, interleukin 8, interleukin 10, phosphokinase isoenzyme-MB, and B-type natriuretic peptide; and decreased platelets and eosinophil absolute value (P<0.05). CONCLUSIONS: Our findings highlight that the identified determinants may help to improve treatment of COVID-19 patients, to predict the risk of developing severe illness and to optimizing arrangement of health resources.


Asunto(s)
/sangre , Hospitalización , Unidades de Cuidados Intensivos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Recuento de Células Sanguíneas , Pruebas de Coagulación Sanguínea , Proteínas Sanguíneas/análisis , Sedimentación Sanguínea , Nitrógeno de la Urea Sanguínea , Creatina Quinasa/sangre , Creatinina/análisis , Citocinas/sangre , Femenino , Fiebre/virología , Humanos , L-Lactato Deshidrogenasa/sangre , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Estudios Retrospectivos , Adulto Joven
13.
BMC Infect Dis ; 21(1): 155, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557777

RESUMEN

BACKGROUND: The outbreak of COVID-19 has resulted in serious concerns in China and abroad. To investigate clinical features of confirmed and suspected patients with COVID-19 in west China, and to examine differences between severe versus non-severe patients. METHODS: Patients admitted for COVID-19 between January 21 and February 11 from fifteen hospitals in Sichuan Province, China were included. Experienced clinicians trained with methods abstracted data from medical records using pre-defined, pilot-tested forms. Clinical characteristics between severe and non-severe patients were compared. RESULTS: Of the 169 patients included, 147 were laboratory-confirmed, 22 were suspected. For confirmed cases, the most common symptoms from onset to admission were cough (70·7%), fever (70·5%) and sputum (33·3%), and the most common chest CT patterns were patchy or stripes shadowing (78·0%); throughout the course of disease, 19·0% had no fever, and 12·4% had no radiologic abnormality; twelve (8·2%) received mechanical ventilation, four (2·7%) were transferred to ICU, and no death occurred. Compared to non-severe cases, severe ones were more likely to have underlying comorbidities (62·5% vs 26·2%, P = 0·001), to present with cough (92·0% vs 66·4%, P = 0·02), sputum (60·0% vs 27·9%, P = 0·004) and shortness of breath (40·0% vs 8·2%, P <  0·0001), and to have more frequent lymphopenia (79·2% vs 43·7%, P = 0·003) and eosinopenia (84·2% vs 57·0%, P = 0·046). CONCLUSIONS: The symptoms of patients in west China were relatively mild, and an appreciable proportion of infected cases had no fever, warranting special attention.


Asunto(s)
/fisiopatología , Adulto , Anciano , Preescolar , China , Comorbilidad , Tos , Brotes de Enfermedades , Femenino , Fiebre , Hospitalización , Humanos , Lactante , Pulmón/diagnóstico por imagen , Linfopenia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
14.
Ugeskr Laeger ; 183(5)2021 02 01.
Artículo en Danés | MEDLINE | ID: mdl-33570034

RESUMEN

SARS-CoV-2 infection causes COVID-19. Most infected children have asymptomatic or mild clinical manifestations. A few develop serious illness, and the case fatality rate is lower than in adults. The most frequent symptoms are fever and cough. Studies indicate that children might be less susceptible to infection than adults as summarised in this review. Despite mild manifestation, some children experience a hyper-inflammatory response to SARS-CoV-2 infection called multisystem inflammatory syndrome, similarly to Kawasaki disease. The syndrome is still very rare, and the pathogenesis remains unknown.


Asunto(s)
/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Niño , Tos/virología , Fiebre/virología , Humanos
15.
PLoS One ; 16(2): e0246793, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571300

RESUMEN

BACKGROUND: There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina. RESEARCH QUESTION: What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality? STUDY DESIGN AND METHODS: Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. RESULTS: RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects. INTERPRETATION: Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.


Asunto(s)
/epidemiología , /fisiopatología , Adulto , Argentina/epidemiología , Asma/epidemiología , Asma/fisiopatología , Comorbilidad , Tos/epidemiología , Tos/fisiopatología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Femenino , Fiebre/epidemiología , Fiebre/fisiopatología , Cefalea/epidemiología , Cefalea/fisiopatología , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
16.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547120

RESUMEN

There is increasing literature to suggest numerous subgroups of Brugada syndrome (BrS), including those with ST elevation in the lateral or inferior leads. We present a case of a patient presenting with recurrent collapse and inferior ST elevation degenerating to ventricular fibrillation and ultimately leading to a diagnosis of BrS.


Asunto(s)
Síndrome de Brugada/diagnóstico , Síndrome de Brugada/terapia , Desfibriladores Implantables , Infarto del Miocardio con Elevación del ST/complicaciones , Fibrilación Ventricular/diagnóstico , Fibrilación Ventricular/terapia , Anciano , Angiografía Coronaria , Diagnóstico Diferencial , Progresión de la Enfermedad , Electrocardiografía , Fiebre , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia
17.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547128

RESUMEN

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.


Asunto(s)
Analgésicos Opioides/efectos adversos , Osteomielitis/microbiología , Síndrome de la Serotonina/diagnóstico , Infecciones Estafilocócicas/microbiología , Infección de la Herida Quirúrgica/microbiología , Tapentadol/efectos adversos , Bacteriemia/microbiología , Desbridamiento , Diagnóstico Diferencial , Fiebre , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/cirugía , Osteotomía , Infecciones Estafilocócicas/cirugía , Infección de la Herida Quirúrgica/cirugía , Tibia/cirugía
18.
Nat Commun ; 12(1): 814, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547300

RESUMEN

On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesize that the anti-vascular endothelial growth factor (VEGF) drug bevacizumab might be beneficial for treating Covid-19 patients. From Feb 15 to April 5, 2020, we conducted a single-arm trial (NCT04275414) and recruited 26 patients from 2-centers (China and Italy) with severe Covid-19, with respiratory rate ≥30 times/min, oxygen saturation ≤93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100 mmHg and ≤300 mmHg, and diffuse pneumonia confirmed by chest imaging. Followed up for 28 days. Among these, bevacizumab plus standard care markedly improves the PaO2/FiO2 ratios at days 1 and 7. By day 28, 24 (92%) patients show improvement in oxygen-support status, 17 (65%) patients are discharged, and none show worsen oxygen-support status nor die. Significant reduction of lesion areas/ratios are shown in chest computed tomography (CT) or X-ray within 7 days. Of 14 patients with fever, body temperature normalizes within 72 h in 13 (93%) patients. Relative to comparable controls, bevacizumab shows clinical efficacy by improving oxygenation and shortening oxygen-support duration. Our findings suggest bevacizumab plus standard care is highly beneficial for patients with severe Covid-19. Randomized controlled trial is warranted.


Asunto(s)
Bevacizumab/uso terapéutico , /efectos de los fármacos , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Temperatura Corporal/efectos de los fármacos , China , Femenino , Fiebre/prevención & control , Humanos , Italia , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
19.
J Med Case Rep ; 15(1): 65, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557906

RESUMEN

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused irreparable damage to society, and the damage continues. Pediatricians are confronted with COVID-19 in a variety of presentations, which may lead to delayed diagnosis and treatment. Early diagnosis of the disease plays an important role in preventing transmission of the virus in the community. CASE PRESENTATION: Here we report a 27-month-old previously healthy Iranian female child who presented with fever and bloody diarrhea, diagnosed with COVID-19 based on contact history, exclusion of enteric bacterial pathogens and parasites, and positive stool and nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction (RT-PCR) tests. The patient had viral shedding for more than a month. CONCLUSIONS: The pediatric population usually does not present with typical clinical features of COVID-19, which are respiratory involvement. Dysentery may be the only presentation of this disease, and long-term isolation should be considered, as the viral shedding may last for more than a month.


Asunto(s)
/diagnóstico , Disentería/virología , /complicaciones , Preescolar , Heces/virología , Femenino , Fiebre/virología , Humanos , Nasofaringe/virología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Esparcimiento de Virus
20.
Medicine (Baltimore) ; 100(6): e24630, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578579

RESUMEN

RATIONALE: Mucormycosis is a rare fungal infection that typically occurs in immunosuppressed patients following chemotherapy or hematopoietic stem cell transplantation. PATIENT CONCERNS: An 11-year-old child with newly developed acute lymphoblastic leukemia suffered from the paroxysmal left chest pain, fever, and hemoptysis. DIAGNOSES: We made a histopathologic diagnosis aided by bronchoscopy techniques, which indicated invasive fungal hyphae that are characteristic of mucormycosis. INTERVENTIONS: The patient was treated with oral posaconazole and repeated bronchoscopy interventions for 4 months. OUTCOMES: The patient's clinical signs and symptoms and signs were no longer present. The prior lung lesions were also no longer observable using radiologic methods, and a 3-month follow-up with the patient showed no signs of mucormycosis recurrence. Finally, the patient was cured, when the cancer chemotherapy was stopped. Close follow-up for another 2 years showed no evidence of recurrence. LESSONS: Mucormycosis diagnosis is difficult as clinical and imaging findings vary. This case demonstrates that posaconazole monotherapy combined with bronchoscopy interventions may be a safe and effective treatment option for pediatric pulmonary mucormycosis.


Asunto(s)
Huésped Inmunocomprometido , Enfermedades Pulmonares Fúngicas/diagnóstico , Mucormicosis/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras , Administración Oral , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Niño , Diagnóstico Diferencial , Fiebre/etiología , Humanos , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/patología , Masculino , Mucormicosis/complicaciones , Mucormicosis/tratamiento farmacológico , Mucormicosis/patología , Triazoles/administración & dosificación , Triazoles/uso terapéutico
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