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1.
Medicina (Kaunas) ; 57(3)2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33803690

RESUMEN

The COVID-19 pandemic dramatically changed medical care. Healthcare professionals are faced with new issues. Patients who survived COVID-19 have plenty of different continuing symptoms, of which the most common are fatigue and breathlessness. It is not well known how to care for patients with persistent or worsening respiratory symptoms and changes on chest X-ray following COVID-19 pneumonia. In this article, we talk about a subgroup of patients with organizing pneumonia following COVID-19 pneumonia that could be effectively treated with systemic glucocorticoids. It is important that patients with COVID-19 pneumonia be followed-up at least three weeks after diagnosis, in order to recognize early lung damage. We are providing a management algorithm for early diagnosis of lung diseases after COVID-19 pneumonia.


Asunto(s)
/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Algoritmos , Biopsia , /tratamiento farmacológico , Angiografía por Tomografía Computarizada , Manejo de la Enfermedad , Diagnóstico Precoz , Glucocorticoides/uso terapéutico , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/fisiopatología , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/fisiopatología , Capacidad de Difusión Pulmonar , Espirometría , Tomografía Computarizada por Rayos X , Prueba de Paso
2.
RMD Open ; 7(1)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33790049

RESUMEN

BACKGROUND: The CHIC study (COVID-19 High-intensity Immunosuppression in Cytokine storm syndrome) is a quasi-experimental treatment study exploring immunosuppressive treatment versus supportive treatment only in patients with COVID-19 with life-threatening hyperinflammation. Causal inference provides a means of investigating causality in non-randomised experiments. Here we report 14-day improvement as well as 30-day and 90-day mortality. PATIENTS AND METHODS: The first 86 patients (period 1) received optimal supportive care only; the second 86 patients (period 2) received methylprednisolone and (if necessary) tocilizumab, in addition to optimal supportive care. The main outcomes were 14-day clinical improvement and 30-day and 90-day survival. An 80% decline in C reactive protein (CRP) was recorded on or before day 13 (CRP >100 mg/L was an inclusion criterion). Non-linear mediation analysis was performed to decompose CRP-mediated effects of immunosuppression (defined as natural indirect effects) and non-CRP-mediated effects attributable to natural prognostic differences between periods (defined as natural direct effects). RESULTS: The natural direct (non-CRP-mediated) effects for period 2 versus period 1 showed an OR of 1.38 (38% better) for 14-day improvement and an OR of 1.16 (16% better) for 30-day and 90-day survival. The natural indirect (CRP-mediated) effects for period 2 showed an OR of 2.27 (127% better) for 14-day improvement, an OR of 1.60 (60% better) for 30-day survival and an OR of 1.49 (49% better) for 90-day survival. The number needed to treat was 5 for 14-day improvement, 9 for survival on day 30, and 10 for survival on day 90. CONCLUSION: Causal inference with non-linear mediation analysis further substantiates the claim that a brief but intensive treatment with immunosuppressants in patients with COVID-19 and systemic hyperinflammation adds to rapid recovery and saves lives. Causal inference is an alternative to conventional trial analysis, when randomised controlled trials are considered unethical, unfeasible or impracticable.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Proteína C-Reactiva/inmunología , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Metilprednisolona/uso terapéutico , /inmunología , Causalidad , Síndrome de Liberación de Citoquinas/inmunología , Estudio Históricamente Controlado , Humanos , Inflamación/inmunología , Mortalidad , Tasa de Supervivencia , Resultado del Tratamiento
3.
Br J Hosp Med (Lond) ; 82(3): 1-9, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33792391

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread and have grave health and socioeconomic consequences worldwide. Researchers have raced to understand the pathophysiological mechanisms underpinning the disease caused by SARS-CoV-2 so that effective therapeutic targets can be discovered. This review summarises the key pharmacotherapies that are being investigated for treatment of COVID-19, including antiviral, immunomodulator and anticoagulation strategies.


Asunto(s)
Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Glucocorticoides/uso terapéutico , Factores Inmunológicos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Azetidinas/uso terapéutico , Colchicina/uso terapéutico , Dexametasona/uso terapéutico , Humanos , Inmunización Pasiva , Ivermectina/uso terapéutico , Inhibidores de las Cinasas Janus/uso terapéutico , Purinas/uso terapéutico , Pirazoles/uso terapéutico , Sulfonamidas/uso terapéutico
4.
Medicina (Kaunas) ; 57(3)2021 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-33799535

RESUMEN

Background and Objectives: On 24 March 2020, the United States Food and Drug Administration (FDA) announced the approval of convalescent plasma therapy for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergency investigational new drug. This pilot study from Romania aimed to determine if convalescent plasma transfusion can be beneficial in the treatment of selected critically ill patients diagnosed with a SARS-CoV-2 infection. Materials and Methods: Donor and receiver eligibility for critically ill coronavirus disease 2019 (COVID-19) patients was based on Romanian guidelines issued at the time of the study. Here, we describe the evolution of a total of five eligible patients diagnosed with COVID-19 who received convalescent plasma (CP) in Romania. Results: In spite of our efforts and convalescent plasma administration, three of the five patients did not survive, while the other two recovered completely. Over the course of our five-day laboratory record, the surviving patients had significantly lower values for C-reactive protein, interleukin-6, and white blood cells. Conclusions: This pilot study provides insufficient evidence to determine the efficacy of convalescent plasma use as a therapeutic option for critically ill COVID-19 patients.


Asunto(s)
/terapia , Adulto , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Proteína C-Reactiva/metabolismo , /fisiopatología , Enfermedad Crítica , Glucocorticoides/uso terapéutico , Humanos , Inmunización Pasiva/métodos , Interleucina-6/sangre , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Rumanía , Resultado del Tratamiento
5.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 28-33, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33666909

RESUMEN

Coronavirus 2019 (COVID-19) has spread across the globe with a concerningly high infectivity resulting in the World Health Organization deeming it a pandemic. It has resulted in thousands of deaths and placed enormous strain on communities, healthcare systems and healthcare workers as they battle shortages of ventilators, supplies, and difficulties in protecting patients and hospital staff alike. Challenges in managing the disease have led to new treatment and management strategies as healthcare teams struggle to adapt. We present the first case of COVID-19 managed in the austere deployed environment of Operation Inherent Resolve in which the patient was treated with dexamethasone, remdesivir, COVID-19 convalescent plasma, positive pressure ventilation, and proning. We discuss some of the inherent and unique challenges of caring for a patient in this resource constrained environment with a brief review of the literature on the treatment and management.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , /terapia , Dexametasona/uso terapéutico , Personal Militar , Insuficiencia Respiratoria/terapia , Adenosina Monofosfato/uso terapéutico , Alanina/uso terapéutico , Antivirales/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Inmunización Pasiva , Masculino , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/virología , Adulto Joven
7.
Pediatr Rheumatol Online J ; 19(1): 29, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726806

RESUMEN

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


Asunto(s)
/fisiopatología , Enfermedad de la Arteria Coronaria/fisiopatología , Hipotensión/fisiopatología , Linfopenia/fisiopatología , Síndrome Mucocutáneo Linfonodular/fisiopatología , Miocarditis/fisiopatología , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatología , Distribución por Edad , Antirreumáticos/uso terapéutico , Aspirina/uso terapéutico , Proteína C-Reactiva/metabolismo , /metabolismo , Niño , Preescolar , Tos/fisiopatología , Diarrea/fisiopatología , Disnea/fisiopatología , Femenino , Glucocorticoides/uso terapéutico , Insuficiencia Cardíaca/fisiopatología , Humanos , /fisiopatología , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Lactante , Unidades de Cuidado Intensivo Pediátrico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Italia/epidemiología , Masculino , Síndrome Mucocutáneo Linfonodular/epidemiología , Síndrome Mucocutáneo Linfonodular/metabolismo , Síndrome Mucocutáneo Linfonodular/terapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Choque/fisiopatología , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/metabolismo , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Taquipnea/fisiopatología , Troponina T/metabolismo , Vómitos/fisiopatología
8.
Nat Rev Immunol ; 21(4): 245-256, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33723416

RESUMEN

Since the initial reports of a cluster of pneumonia cases of unidentified origin in Wuhan, China, in December 2019, the novel coronavirus that causes this disease - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - has spread throughout the world, igniting the twenty-first century's deadliest pandemic. Over the past 12 months, a dizzying array of information has emerged from numerous laboratories, covering everything from the putative origin of SARS-CoV-2 to the development of numerous candidate vaccines. Many immunologists quickly pivoted from their existing research to focus on coronavirus disease 2019 (COVID-19) and, owing to this unprecedented convergence of efforts on one viral infection, a remarkable body of work has been produced and disseminated, through both preprint servers and peer-reviewed journals. Here, we take readers through the timeline of key discoveries during the first year of the pandemic, which showcases the extraordinary leaps in our understanding of the immune response to SARS-CoV-2 and highlights gaps in our knowledge as well as areas for future investigations.


Asunto(s)
/inmunología , /inmunología , /metabolismo , Anticuerpos Antivirales/inmunología , Autoanticuerpos/inmunología , /prevención & control , /uso terapéutico , Dexametasona/uso terapéutico , Desarrollo de Medicamentos , Glucocorticoides/uso terapéutico , Humanos , Inmunización Pasiva , Factores Inmunológicos/uso terapéutico , Interferón Tipo I/inmunología , /genética , /patogenicidad , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/prevención & control , Síndrome de Respuesta Inflamatoria Sistémica/terapia
11.
Medicine (Baltimore) ; 100(13): e25359, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787639

RESUMEN

RATIONALE: Eosinophilic fasciitis (EF) is an uncommon connective tissue disorder characterized by limb and trunk erythema, with symmetrical thickening of the skin. Its pathogenesis is poorly understood. Treatment consists mainly of glucocorticoids. Yet, no randomized trials have evaluated therapies for this rare disease and the optimal treatment modality remains unclear. Although most patients show partial or complete response to glucocorticoids, many relapse upon drug tapering, while others either do not respond at all or fail to sustain prolonged remission. Second-line therapy for this rare disorder includes mainly methotrexate (MTX), azathioprine, cyclosporine and hydroxychloroquine. Recently, several attempts using rituximab and intravenous immunoglobulins (IVIG) have shown good clinical results. PATIENT CONCERNS: The three patients had good clinical response to glucocorticoid treatment, followed by disease flare when the drug dose was tapered. Adding methotrexate in all patients and azathioprine to patient 3 did not lead to remission. DIAGNOSES: EF was diagnosed in all patients based on clinical presentation accompanied by fascia biopsy that demonstrated eosinophilic fasciitis. INTERVENTIONS: The patients were successfully treated with rituximab or IVIG, achieving sustained remission. OUTCOMES: The three cases had good clinical response to glucocorticoid treatment, followed by disease flare when the drug dose was tapered. The patients were then successfully treated with rituximab or IVIG, achieving sustained remission. LESSONS: This review of three cases of EF supports the results of previous reports, suggesting addition of rituximab and IVIG is an effective treatment for patients with refractory disease.


Asunto(s)
Productos Biológicos/uso terapéutico , Eosinofilia/tratamiento farmacológico , Fascitis/tratamiento farmacológico , Glucocorticoides/farmacología , Azatioprina/farmacología , Azatioprina/uso terapéutico , Productos Biológicos/farmacología , Biopsia , Relación Dosis-Respuesta a Droga , Resistencia a Medicamentos , Quimioterapia Combinada/métodos , Eosinofilia/inmunología , Eosinofilia/patología , Fascia/inmunología , Fascia/patología , Fascitis/inmunología , Fascitis/patología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/farmacología , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Metotrexato/farmacología , Metotrexato/uso terapéutico , Persona de Mediana Edad , Prednisona/farmacología , Prednisona/uso terapéutico , Rituximab/farmacología , Rituximab/uso terapéutico , Brote de los Síntomas , Resultado del Tratamiento
12.
Diabetes Metab Syndr ; 15(2): 569-571, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33706188

RESUMEN

BACKGROUND AND AIMS: We aimed to study newly diagnosed diabetes in patients with mild to moderate COVID-19. METHODS: This was a retrospective cohort study of COVID-19 patients who were admitted to a tertiary care hospital in India from May to October 2020. RESULTS: Of 102 patients, 21 (20.6%) had newly diagnosed diabetes on admission. Of which, four (19.0%) had marked hyperglycemia with no ketosis or ketoacidosis. CONCLUSION: In this study of patients with mild to moderate COVID-19, newly diagnosed diabetes and marked hyperglycemia in those with newly diagnosed diabetes were common.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Hemoglobina A Glucada/metabolismo , Adulto , Anticoagulantes/uso terapéutico , /terapia , Estudios de Cohortes , Dexametasona/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Glucocorticoides/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , India , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
13.
Paediatr Drugs ; 23(2): 171-182, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33651370

RESUMEN

OBJECTIVE: The aim of this study was to examine patterns of initial prescriptions, investigate time to initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs), and evaluate the impact of clinical and other baseline factors associated with the time to first bDMARD in treating children with newly diagnosed non-systemic juvenile idiopathic arthritis (JIA). METHODS: Using longitudinal patient-level data extracted from electronic medical records (EMR) in a large Midwestern pediatric hospital from 2009 to 2018, the initial prescriptions and prescribing patterns of bDMARDs, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids within 3 months of JIA diagnosis were examined. Kaplan-Meier analyses were performed to assess time to initiation of bDMARDs. Cox proportional hazard models were used to identify factors associated with time to first bDMARD. RESULTS: Of 821 children, the proportion of patients with initial csDMARDs increased from 45.3% in 2009 to 60.3% in 2018. Around 57.5% of polyarthritis rheumatoid factor-positive (Poly RF+) patients and 43.2% of polyarthritis rheumatoid factor-negative (Poly RF-) patients received a bDMARD therapy within 3 months of diagnosis, 14.4% as monotherapy and 28.3% in combination with a csDMARD. Among patients who received combination therapy, combination of methotrexate with adalimumab increased from 16.7% in 2009 to 40% in 2018. The proportion of patients treated with adalimumab gradually increased and passed etanercept in 2016. The predictors of earlier initiation of biologic therapy were JIA category enthesitis-related arthritis (ERA) [hazard ratio (HR) vs persistent oligoarthritis 4.82; p < 0.0001], psoriatic arthritis (PsA) (HR 2.46; p = 0.0002), or Poly RF- (HR 2.43; p = 0.0002); the number of joints with limited range of motion (HR 1.02; p = 0.0222), and erythrocyte sedimentation rate (ESR, HR 1.01; p = 0.0033). CONCLUSIONS: There was a substantial increase in the proportion of patients receiving the combination of methotrexate and adalimumab among patients receiving combination therapy. Adalimumab overtook etanercept as the most frequently prescribed bDMARD. Multiple factors affect the time to biologic initiation, including the number of joints with limited range of motion, ESR, and JIA category.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Juvenil/tratamiento farmacológico , Terapia Biológica/métodos , Adalimumab/uso terapéutico , Adolescente , Artritis/tratamiento farmacológico , Niño , Preescolar , Etanercept/administración & dosificación , Femenino , Glucocorticoides/uso terapéutico , Humanos , Estudios Longitudinales , Masculino , Metotrexato/uso terapéutico , Estudios Retrospectivos
14.
World J Gastroenterol ; 27(11): 1022-1042, 2021 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-33776370

RESUMEN

Managing inflammatory bowel disease (IBD) during the coronavirus disease 2019 (COVID-19) pandemic has been a challenge faced by clinicians and their patients, especially concerning whether to proceed with biologics and immunosuppressive agents in the background of a global outbreak of a highly contagious new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2). The knowledge about the impact of this virus on patients with IBD, although it is still scarce, is rapidly evolving. In particular, concerns surrounding medications' impact for IBD on the risk of acquiring SARS-CoV-2 infection or developing COVID-19, and potentially exacerbate viral replication and the COVID-19 course, are a current thinking of both practicing clinicians and providers caring for patients with IBD. Managing patients with IBD infected with SARS-CoV-2 depends on both the clinical activity of the IBD and the occasional development and severity of COVID-19. In this review, we summarize the current data regarding gastrointestinal involvement by SARS-CoV-2 and pharmacologic and surgical management for IBD concerning this infection, and the COVID-19 impact on both the patient's psychological functioning and endoscopy services, and we concisely summarize the telemedicine roles during the COVID-19 pandemic.


Asunto(s)
Productos Biológicos/uso terapéutico , Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Telemedicina , Atención Ambulatoria , Portador Sano , Deprescripciones , Manejo de la Enfermedad , Endoscopía Gastrointestinal , Hospitalización , Humanos , Factores Inmunológicos/uso terapéutico , Enfermedades Inflamatorias del Intestino/complicaciones , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Índice de Severidad de la Enfermedad
15.
Indian J Ophthalmol ; 69(4): 985-986, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33727473

RESUMEN

A 32-year-old man with a clear and compact graft following a penetrating keratoplasty 6 years back, developed an episode of acute graft rejection, coinciding with the COVID-19 disease. Subsequent to the infection with the novel coronavirus, he developed symptoms of acute graft rejection concurrent with the development of respiratory distress and peak systemic symptoms. This was the phase of cytokine storm as evidenced by the raised inflammatory markers in his blood tests. Such a case of acute corneal graft rejection coinciding with SARS-CoV-2 infection has been reported only once in the literature and this unique association needs to be researched further.


Asunto(s)
/diagnóstico , Enfermedades de la Córnea/diagnóstico , Infecciones Virales del Ojo/diagnóstico , Rechazo de Injerto/diagnóstico , Queratoplastia Penetrante , Enfermedad Aguda , Adulto , /virología , Extracción de Catarata , Enfermedades de la Córnea/tratamiento farmacológico , Enfermedades de la Córnea/virología , Citocinas/sangre , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/virología , Glucocorticoides/uso terapéutico , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/virología , Humanos , Incidencia , Mediadores de Inflamación/sangre , Implantación de Lentes Intraoculares , Masculino , Neumonía Viral/sangre , Prednisolona/uso terapéutico , Agudeza Visual
16.
Indian J Ophthalmol ; 69(4): 989-991, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33727475

RESUMEN

Ocular manifestations of COVID-19 are still being studied. Posterior segment involvement in viral entities is either direct viral involvement or a delayed immune response to the antigen. A 22-year-old woman presented with history of perceiving absolute inferior scotoma in the right eye for 4 days and history of fever and sore throat 10 days ago. Fundus examination revealed disc edema and vessel tortuosity. Humphreys Field Analyzer confirmed inferior field defect and Optical Coherence Tomography showed superior, nasal and inferior retinal nerve fiber layer thickening in the right eye. Patient was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) testing. Patient received three doses of injection methylprednisolone over 3 days. There was subjective resolution of scotoma reported 3 weeks posttreatment. We bring forward the first reported case of parainfectious optic neuritis associated with COVID-19.


Asunto(s)
/diagnóstico , Infecciones Virales del Ojo/diagnóstico , Papiledema/diagnóstico , Escotoma/diagnóstico , Campos Visuales/fisiología , /tratamiento farmacológico , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/virología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Metilprednisolona/uso terapéutico , Papiledema/tratamiento farmacológico , Papiledema/virología , Escotoma/tratamiento farmacológico , Escotoma/virología , Tomografía de Coherencia Óptica , Agudeza Visual , Pruebas del Campo Visual , Adulto Joven
17.
Indian J Ophthalmol ; 69(4): 992-994, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33727476

RESUMEN

COVID-19 is a respiratory virus, which has affected various organ systems as well. Here we report a neuro-ophthalmic presentation of pituitary apoplexy under the setting of COVID-19 infection in a middle-aged man who presented to ophthalmic emergency with sudden bilateral loss of vision along with a history of fever past 10 days. There was sluggishly reacting pupils and RT-PCR for COVID was positive. Imaging pointed the diagnosis as pituitary macroadenoma with apopexy. In view of pandemic situation, patient was given symptomatic treatment as per the protocols and stabilized. Vision also showed improvement to some extent and the patient is awaiting neurosurgery.


Asunto(s)
Adenoma/diagnóstico , Infecciones Virales del Ojo/diagnóstico , Apoplejia Hipofisaria/diagnóstico , Neoplasias Hipofisarias/diagnóstico , Adenoma/tratamiento farmacológico , Adenoma/virología , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/virología , Glucocorticoides/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Apoplejia Hipofisaria/tratamiento farmacológico , Apoplejia Hipofisaria/virología , Neoplasias Hipofisarias/tratamiento farmacológico , Neoplasias Hipofisarias/virología
18.
PLoS One ; 16(3): e0248750, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33750952

RESUMEN

BACKGROUND: Severe acute respiratory infection (SARI) results in a tremendous disease burden worldwide. Available research on active surveillance among hospitalized adult patients suffering from SARI in China is limited. This pilot study aimed to identify associated etiologies and describe the demographic, epidemiological and clinical profiles of hospitalized SARI patients aged over 16 years in Jinshan, Shanghai. METHODS: Active surveillance was conducted at 1 sentinel hospital in Jinshan district, Shanghai, from April 2017 to March 2018. Hospitalized SARI patients aged over 16 years old were enrolled, and nasopharyngeal swabs were collected within 24 hours of admission and tested for multiple respiratory viruses (including 18 common viruses) and Mycoplasma pneumoniae with real-time polymerase chain reaction. Demographic, epidemiological and clinical information was obtained from case report forms. RESULTS: In total, 397 SARI patients were enrolled; the median age was 68 years, and 194 (48.9%) patients were male. A total of 278 (70.0%) patients had at least one underlying chronic medical condition. The most frequent symptoms were cough (99.2%) and sputum production (88.4%). The median duration of hospitalization was 10 days. A total of 250 infection patients (63.0%) were positive for at least one pathogen, of whom 198 (49.9%) were positive for a single pathogen and 52 (13.1%) were positive for multiple pathogens. The pathogens identified most frequently were M. pneumoniae (23.9%, 95/397), followed by adenovirus (AdV) (11.6%, 46/397), influenza virus A/H3N2 (Flu A/H3N2) (11.1%, 44/397), human rhinovirus (HRhV) (8.1%, 32/397), influenza virus B/Yamagata (Flu B/Yamagata) (6.3%, 25/397), pandemic influenza virus A/H1N1 (Flu A/pH1N1) (4.0%, 16/397), parainfluenza virus (PIV) type 1 (2.0%, 8/397), human coronavirus (HCoV) type NL63 (2.0%, 8/397), HCoV 229E (1.5%, 6/397), HCoV HKU1 (1.5%, 6/397), PIV 3 (1.5%, 6/397), human metapneumovirus (HMPV) (1.5%, 6/397), PIV 4 (1.3%, 5/397), HCoV OC43 (1.0%, 4/397), influenza virus B/Victoria (Flu B/Victoria) (0.5%, 2/397), respiratory syncytial virus (RSV) type B (0.5%, 2/397), and human bocavirus (HBoV) (0.3%, 1/397). The seasonality of pathogen-confirmed SARI patients had a bimodal distribution, with the first peak in the summer and the second peak in the winter. Statistically significant differences were observed with respect to the rates of dyspnea, radiographically diagnosed pneumonia and the presence of at least one comorbidity in patients who were infected with only M. pneumoniae, AdV, HRhV, Flu A/H3N2, Flu A /pH1N1 or Flu B/Yamagata. The differences in the positivity rates of the above 6 pathogens among the different age groups were nonsignificant. CONCLUSIONS: M. pneumoniae, AdV and Flu A/H3N2 were the main pathogens detected in hospitalized SARI patients aged over 16 years old in Jinshan district, Shanghai. Our findings highlight the importance of sustained multipathogen surveillance among SARI patients in sentinel hospitals, which can provide useful information on SARI etiologies, epidemiology, and clinical characteristics.


Asunto(s)
Virus ADN/aislamiento & purificación , Mycoplasma pneumoniae/aislamiento & purificación , Virus ARN/aislamiento & purificación , Infecciones del Sistema Respiratorio/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , China , Tos/etiología , Femenino , Glucocorticoides/uso terapéutico , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/microbiología , Nasofaringe/virología , Proyectos Piloto , Pronóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Adulto Joven
19.
Medicine (Baltimore) ; 100(12): e23597, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761626

RESUMEN

BACKGROUND: The efficacy and safety of integrated Chinese and western medicine in the treatment of Systemic Lupus Erythematosus (SLE) have not been systematically evaluated. METHODS: This systematic review and meta-analysis will be performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will search PubMed, Embase, Cochrane Library, Chinese Biomedical Database WangFang, VIP, and China National Knowledge Infrastructure (CNKI) for potentially eligible studies from their inception to Dec. 2020, and we will select all the eligible randomized controlled trials (RCTs) of the integrated Chinese and western medicine for Systemic Lupus Erythematosus. All the studies will be screened according to the inclusion and exclusion criteria and meta-analysis will be conducted using Review Manager V.5.3. and Stata V.12.0. The primary endpoint was the clinical efficacy rate, the secondary outcomes were SLEDAI score, adverse reaction rate, and laboratory test parameters (white blood cells, complement C3). RESULTS: The results of this study will systematically evaluate the effectiveness and safety of the integrated Chinese and western medicine in the treatment of primary dysmenorrhea. CONCLUSION: The efficacy and safety of integrated Chinese and western medicine will be systematically evaluated in this paper, thus providing evidence for the clinical application of this therapy. ETHICS AND DISSEMINATION: This study is a systematic review, which is based on the published studies, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. OPEN SCIENCE FRAMEWORK OSFREGISTRATION NUMBER: https://osf.io/mabxh.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Glucocorticoides/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Quimioterapia Combinada/métodos , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
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