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1.
Rev. clín. esp. (Ed. impr.) ; 220(8): 480-494, nov. 2020. tab, mapas
Artículo en Español | IBECS | ID: ibc-192204

RESUMEN

ANTECEDENTES: España ha sido uno de los países más afectados por la pandemia de COVID-19. OBJETIVO: Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. MÉTODOS: Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. RESULTADOS: Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente. Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como la linfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%) y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años: 10,5%; 70-79 años: 26,9%; ≥80 años: 46%). CONCLUSIONES: El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad


BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Virus del SRAS/patogenicidad , Neumonía/epidemiología , España/epidemiología , Pacientes Internos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Estudios Retrospectivos , Registros de Enfermedades/estadística & datos numéricos
2.
Acta Med Port ; 33(11): 733-741, 2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33160423

RESUMEN

INTRODUCTION: Portugal took early action to control the COVID-19 epidemic, initiating lockdown measures on March 16th when it recorded only 62 cases of COVID-19 per million inhabitants and reported no deaths. The Portuguese public complied quickly, reducing their overall mobility by 80%. The aim of this study was to estimate the initial impact of the lockdown in Portugal in terms of the reduction of the burden on the healthcare system. MATERIAL AND METHODS: We forecasted epidemic curves for: Cases, hospital inpatients (overall and in intensive care), and deaths without lockdown, assuming that the impact of containment measures would start 14 days after initial lockdown was implemented. We used exponential smoothing models for deaths, intensive care and hospitalizations and an ARIMA model for number of cases. Models were selected considering fitness to the observed data up to the 31st March 2020. We then compared observed (with intervention) and forecasted curves (without intervention). RESULTS: Between April 1st and April 15th, there were 146 fewer deaths (-25%), 5568 fewer cases (-23%) and, as of April 15th, there were 519 fewer intensive care inpatients (-69%) than forecasted without the lockdown. On April 15th, the number of intensive care inpatients could have reached 748, three times higher than the observed value (229) if the intervention had been delayed. DISCUSSION: If the lockdown had not been implemented in mid-March, Portugal intensive care capacity (528 beds) would have likely been breached during the first half of April. The lockdown seems to have been effective in reducing transmission of SARS-CoV-2, serious COVID-19 disease, and associated mortality, thus decreasing demand on health services. CONCLUSION: An early lockdown allowed time for the National Health Service to mobilize resources and acquire personal protective equipment, increase testing, contact tracing and hospital and intensive care capacity and to promote broad prevention and control measures. When lifting more stringent measures, strong surveillance and communication strategies that mobilize individual prevention efforts are necessary.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Urgencias Médicas/epidemiología , Epidemias/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Política Pública/legislación & jurisprudencia , Cuarentena/métodos , Ocupación de Camas , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Cuidados Críticos/estadística & datos numéricos , Epidemias/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Portugal/epidemiología , Cuarentena/estadística & datos numéricos
3.
J Prim Care Community Health ; 11: 2150132720970717, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33135551

RESUMEN

The severity of COVID-19 ranges from asymptomatic subclinical infections to severe acute respiratory failure requiring mechanical ventilation. Patients admitted to the hospital have increased mortality rates and patients requiring intensive care have significantly increased mortality rates. Multiple factors influence these outcomes. This study used simple demographic information available on admission to evaluate possible associations between these variables and outcomes, including mortality and length of stay. Clinical outcomes in 63 patients admitted to a tertiary care hospital in West Texas were reviewed. Older patients, patients admitted from nursing homes, and patients admitted to medical intensive care units had increased mortality. Unadjusted analysis indicated that males had increased mortality. Adjusted analysis indicated that males spent nearly 5 days longer in the hospital than females. In summary, age, chronic illness requiring nursing home placement, and acute severe illness requiring intensive care unit admission identify patients with worse prognoses. In addition, males will likely have a longer length of hospital stay.


Asunto(s)
Infecciones por Coronavirus/terapia , Hospitalización/estadística & datos numéricos , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Pronóstico , Factores de Riesgo , Texas/epidemiología , Resultado del Tratamiento , Adulto Joven
4.
Ann Acad Med Singap ; 49(8): 538-542, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33164023

RESUMEN

INTRODUCTION: The coronavirus disease 2019 (COVID-19) outbreak is affecting hospital admissions of stroke patients. This, in turn, will reduce the use of proven stroke treatments, which will result in poorer stroke outcomes. We examined local stroke admissions before, during, and after the 2003 outbreak of the severe acute respiratory syndrome (SARS) (these periods being defined in both the Singapore and worldwide contexts), to extrapolate stroke admission patterns in Singapore during the current COVID-19 crisis. MATERIALS AND METHODS: National inpatient admission data from the Ministry of Health (MOH), Singapore, and death data from the Registry of Births and Deaths (RBD), Singapore, were analysed. Trends of local stroke admissions and stroke-related mortality pre-SARS, during SARS, and post-SARS periods, both in the Singapore and worldwide contexts, were analysed using time series plot in monthly time units. Differences between periods were presented as percentage change between: (1) SARS and pre-SARS periods, and (2) post-SARS and SARS periods and compared using two-sample t-tests. RESULTS: There was a 19% decline in stroke admissions into all local hospitals during the Singapore SARS period (P = 0.002) and a 13% reduction during the worldwide SARS period (P = 0.006). Stroke admissions increased by 18% after the Singapore SARS period was over (P = 0.003) and rose by a further 8% when the worldwide SARS period ended (P = 0.046). Stroke-related mortality remained stable throughout. CONCLUSIONS: During the SARS pandemic, there was a reduction in the number of stroke admissions, and this was apparent during both the local SARS and worldwide SARS outbreak periods. We should take appropriate steps through public education to minimise the expected reduced stroke admissions during the COVID-19 pandemic, inferred from the findings during the SARS pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Hospitalización/estadística & datos numéricos , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/virología , Accidente Cerebrovascular/epidemiología , Educación en Salud , Humanos , Pandemias , Estudios Retrospectivos , Síndrome Respiratorio Agudo Grave/terapia , Singapur/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Tasa de Supervivencia
5.
BMC Med ; 18(1): 355, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33167965

RESUMEN

BACKGROUND: Frailty has been associated with worse prognosis following COVID-19 infection. While several studies have reported the association between frailty and COVID-19 mortality or length of hospital stay, there have been no community-based studies on the association between frailty and risk of severe infection. Considering that different definitions have been identified to assess frailty, this study aimed to compare the association between frailty and severe COVID-19 infection in UK Biobank using two frailty classifications: the frailty phenotype and the frailty index. METHODS: A total of 383,845 UK Biobank participants recruited 2006-2010 in England (211,310 [55.1%] women, baseline age 37-73 years) were included. COVID-19 test data were provided by Public Health England (available up to 28 June 2020). An adapted version of the frailty phenotype derived by Fried et al. was used to define frailty phenotype (robust, pre-frail, or frail). A previously validated frailty index was derived from 49 self-reported questionnaire items related to health, disease and disability, and mental wellbeing (robust, mild frailty, and moderate/severe frailty). Both classifications were derived from baseline data (2006-2010). Poisson regression models with robust standard errors were used to analyse the associations between both frailty classifications and severe COVID-19 infection (resulting in hospital admission or death), adjusted for sociodemographic and lifestyle factors. RESULTS: Of UK Biobank participants included, 802 were admitted to hospital with and/or died from COVID19 (323 deaths and 479 hospitalisations). After analyses were adjusted for sociodemographic and lifestyle factors, a higher risk of COVID-19 was observed for pre-frail (risk ratio (RR) 1.47 [95% CI 1.26; 1.71]) and frail (RR 2.66 [95% CI 2.04; 3.47]) individuals compared to those classified as robust using the frailty phenotype. Similar results were observed when the frailty index was used (RR mildly frail 1.46 [95% CI 1.26; 1.71] and RR moderate/severe frailty 2.43 [95% CI 1.91; 3.10]). CONCLUSIONS: Frailty was associated with a higher risk of severe COVID-19 infection resulting in hospital admission or death, irrespective of how it was measured and independent of sociodemographic and lifestyle factors. Public health strategies need to consider the additional risk that COVID-19 poses in individuals with frailty, including which additional preventive measures might be required.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Fragilidad/diagnóstico , Fragilidad/epidemiología , Hospitalización/estadística & datos numéricos , Neumonía Viral/mortalidad , Adulto , Anciano , Betacoronavirus , Bancos de Muestras Biológicas , Infecciones por Coronavirus/epidemiología , Inglaterra/epidemiología , Femenino , Fragilidad/fisiopatología , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Neumonía Viral/epidemiología , Medición de Riesgo , Autoinforme , Reino Unido
6.
Epidemiol Serv Saude ; 29(5): e2020644, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33175011

RESUMEN

OBJECTIVE: To describe the profile of deaths and the lethality of Severe Acute Respiratory Syndrome (SARS) due to COVID-19 in hospitalized children and adolescents in Brazil. METHODS: This was a cross-sectional study conducted with data from the SARS notification forms of children and adolescents (0 to 19 years old) with laboratory-confirmed COVID-19. Notifications with complete progression of SARS due to COVID-19 were included, up to the 38th Epidemiological Week of 2020. RESULTS: 6,989 hospitalizations were investigated, 661 died, resulting in 9.5% hospital lethality. Higher lethality rates were observed among children under 1 year of age (14.2%), female children and adolescents (9.7%), the indigenous (23.0%), and those living in rural areas (18.1 %), as well as in the Northeast (15.4%) and North (9.7%) regions of Brazil. CONCLUSION: Differences in hospital mortality were found according to sociodemographic characteristics and marked regional inequalities.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria , Neumonía Viral/mortalidad , Síndrome Respiratorio Agudo Grave/mortalidad , Adolescente , Distribución por Edad , Brasil/epidemiología , Niño , Preescolar , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Indios Sudamericanos/estadística & datos numéricos , Lactante , Recién Nacido , Masculino , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Características de la Residencia/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Síndrome Respiratorio Agudo Grave/etiología , Distribución por Sexo , Adulto Joven
7.
MMWR Morb Mortal Wkly Rep ; 69(46): 1725-1729, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33211680

RESUMEN

New York City (NYC) was an epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States during spring 2020 (1). During March-May 2020, approximately 203,000 laboratory-confirmed COVID-19 cases were reported to the NYC Department of Health and Mental Hygiene (DOHMH). To obtain more complete data, DOHMH used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalization status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalizations, and deaths were concentrated in communities of color, high-poverty areas, and among persons aged ≥75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalized patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalization and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalization and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Adulto Joven
8.
Saudi Med J ; 41(11): 1204-1210, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33130840

RESUMEN

OBJECTIVES: To evaluate acute cardiac injury in COVID-19 patients and its association with adverse outcomes including mortality in the United Arab Emirates (UAE) population. METHODS: A retrospective study conducted between February and June 2020 in Dubai, UAE, for all laboratory-confirmed Coronavirus disease-19 patients. Demographic, clinical, laboratory, radiological, and clinical outcomes were compared between patients with and without acute cardiac injury. RESULTS: During the study period, 203 patients were included, of which, 44 (21.7%) had evidence of acute cardiac injury. Compared with patients without acute cardiac injury, patients with acute cardiac injury were: older, had more shortness of breath, diabetes, hypertension, and more bilateral airspace shadowing on admission chest radiography. These patients also had a higher neutrophil count, C-reactive protein, procalcitonin, ferritin, D-dimers and lactate dehydrogenase but lower lymphocyte count. Regarding outcomes, these patients had higher intensive care admissions; a higher rate of complications including acute kidney and liver injury, acidosis, septic shock, acute respiratory distress syndrome, needed more mechanical ventilation, and had a significantly higher risk of death. CONCLUSION: Acute cardiac injury is common among Coronavirus disease-19 patients. These patients present with higher comorbidities, have high inflammatory markers and have greater risk for in-hospital multi-organ damage, need for mechanical ventilation, and death. Prompt full assessment and intervention are recommended.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Lesiones Cardíacas/epidemiología , Mortalidad Hospitalaria/tendencias , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Enfermedad Aguda , Adulto , Anciano , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Lesiones Cardíacas/diagnóstico , Hospitalización/estadística & datos numéricos , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Estudios Retrospectivos , Arabia Saudita/epidemiología , Índice de Severidad de la Enfermedad , Tasa de Supervivencia
9.
Saudi Med J ; 41(11): 1217-1226, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33130842

RESUMEN

OBJECTIVES: To provide a detailed study of demographic, baseline comorbidities, clinical features, and outcome for Coronavirus disease 2019 (COVID-19) patients. METHODS: A record-based case-series study conducted from March 23 to June 15, 2020 in King Saud Medical City, Riyadh, Saudi Arabia. Demographic data, clinical presentation, laboratory investigations, complications, and in-hospital outcome of COVID-19 patients collected with analysis of the clinical characteristics for survivors and deceased. RESULTS: A total of 768 patients were included. The mean age was 46.36±13.7 years and 76.7% were men. Approximately 96.3% reported more than one comorbidity; diabetes mellitus was the most frequent (46.4%). Fever (84.5%), cough (82.3%), and shortness of breath (79.8%) were the main presenting symptoms. During the follow-up, pneumonia reported in 68.6%, acute respiratory distress syndrome in 32.7%, septic shock in 20.7%, respiratory failure in 20.3%, and acute kidney injury in 19.3%. Approximately 45.8% of enrolled patients required intensive care unit admission. Lung disease (odd ratio [OR]=3.862 with 95% confident interval [CI] (2.455-6.074), obesity (OR=3.732, CI=2.511-5.546), smoking (OR=2.991, CI=2.072-4.317), chronic kidney disease (OR=2.296. CI=1.497-3.521), and diabetes mellitus (OR=2.291, CI=1.714-3.063) are predictors of ICU admission. Fatality ratio was 4.27%; therefore, men were more prevalent in dead group. CONCLUSION: Coronavirus disease 2019 places a huge burden on healthcare facilities, particularly in patients with comorbidity. Coronavirus disease 2019 patients who are obese and smokers with history of diabetes mellitus have a high risk of death.


Asunto(s)
Comorbilidad , Infecciones por Coronavirus/epidemiología , Mortalidad Hospitalaria/tendencias , Control de Infecciones/métodos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Adulto , Factores de Edad , Causas de Muerte , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Bases de Datos Factuales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Arabia Saudita/epidemiología , Factores Sexuales , Adulto Joven
10.
MMWR Morb Mortal Wkly Rep ; 69(45): 1695-1699, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33180754

RESUMEN

Coronavirus disease 2019 (COVID-19) is a complex clinical illness with potential complications that might require ongoing clinical care (1-3). Few studies have investigated discharge patterns and hospital readmissions among large groups of patients after an initial COVID-19 hospitalization (4-7). Using electronic health record and administrative data from the Premier Healthcare Database,* CDC assessed patterns of hospital discharge, readmission, and demographic and clinical characteristics associated with hospital readmission after a patient's initial COVID-19 hospitalization (index hospitalization). Among 126,137 unique patients with an index COVID-19 admission during March-July 2020, 15% died during the index hospitalization. Among the 106,543 (85%) surviving patients, 9% (9,504) were readmitted to the same hospital within 2 months of discharge through August 2020. More than a single readmission occurred among 1.6% of patients discharged after the index hospitalization. Readmissions occurred more often among patients discharged to a skilled nursing facility (SNF) (15%) or those needing home health care (12%) than among patients discharged to home or self-care (7%). The odds of hospital readmission increased with age among persons aged ≥65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the index hospitalization, and if discharge from the index hospitalization was to a SNF or to home with health care assistance. These results support recent analyses that found chronic conditions to be significantly associated with hospital readmission (6,7) and could be explained by the complications of underlying conditions in the presence of COVID-19 (8), COVID-19 sequelae (3), or indirect effects of the COVID-19 pandemic (9). Understanding the frequency of, and risk factors for, readmission can inform clinical practice, discharge disposition decisions, and public health priorities such as health care planning to ensure availability of resources needed for acute and follow-up care of COVID-19 patients. With the recent increases in cases nationwide, hospital planning can account for these increasing numbers along with the potential for at least 9% of patients to be readmitted, requiring additional beds and resources.


Asunto(s)
Infecciones por Coronavirus/terapia , Hospitalización/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
11.
MMWR Morb Mortal Wkly Rep ; 69(45): 1691-1694, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33180757

RESUMEN

Mitigation measures, including stay-at-home orders and public mask wearing, together with routine public health interventions such as case investigation with contact tracing and immediate self-quarantine after exposure, are recommended to prevent and control the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1-3). On March 11, the first COVID-19 case in Delaware was reported to the Delaware Division of Public Health (DPH). The state responded to ongoing community transmission with investigation of all identified cases (commencing March 11), issuance of statewide stay-at-home orders (March 24-June 1), a statewide public mask mandate (from April 28), and contact tracing (starting May 12). The relationship among implementation of mitigation strategies, case investigations, and contact tracing and COVID-19 incidence and associated hospitalization and mortality was examined during March-June 2020. Incidence declined by 82%, hospitalization by 88%, and mortality by 100% from late April to June 2020, as the mask mandate and contact tracing were added to case investigations and the stay-at-home order. Among 9,762 laboratory-confirmed COVID-19 cases reported during March 11-June 25, 2020, two thirds (6,527; 67%) of patients were interviewed, and 5,823 (60%) reported completing isolation. Among 2,834 contacts reported, 882 (31%) were interviewed and among these contacts, 721 (82%) reported completing quarantine. Implementation of mitigation measures, including mandated mask use coupled with public health interventions, was followed by reductions in COVID-19 incidence and associated hospitalizations and mortality. The combination of state-mandated community mitigation efforts and routine public health interventions can reduce the occurrence of new COVID-19 cases, hospitalizations, and deaths.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Salud Pública/legislación & jurisprudencia , Adolescente , Adulto , Anciano , Trazado de Contacto , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Delaware/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Máscaras/estadística & datos numéricos , Persona de Mediana Edad , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Neumonía Viral/transmisión , Cuarentena/legislación & jurisprudencia , Adulto Joven
12.
Artículo en Inglés | MEDLINE | ID: mdl-33182696

RESUMEN

ED-visits and through-ED admissions to medical/surgical wards (MSW) and intensive care unit (ICU) during influenza, COVID-19 and lockdown periods were evaluated in a four-hospital prospective observational study from November 2018 to March 2020. ED visit characteristics and main diagnostic categories were assessed. Analysis of 368,262 ED-visits highlighted a significantly increasing trend in ED-visits during influenza followed by a significantly decreasing trend after lockdown. For MSW-admissions, a pattern of growth during influenza was followed by a fall that began during COVID-19 pandemic and intensified during the lockdown. For ICU-admissions, a significant rise during the COVID-19 pandemic was followed by diminution during the lockdown period. During lockdown, significantly diminishing trends were shown for all diagnostic categories (between -40.8% and -73.6%), except influenza-like illness/COVID cases (+31.6%), Pulmonary embolism/deep vein thrombosis (+33.5%) and frequent users (+188.0%). The present study confirms an increase in demand during the influenza epidemic and during the initial phase of the COVID-19 epidemic, but a drop in activity during the lockdown, mainly related to non-COVID conditions. Syndromic surveillance of ILI cases in ED is a tool for monitoring influenza and COVID-19, and it can predict ED activity and the need for MSW and ICU beds.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Gripe Humana/epidemiología , Neumonía Viral/epidemiología , Betacoronavirus , Francia , Humanos , Pandemias , Estudios Prospectivos
13.
PLoS One ; 15(11): e0241827, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33141872

RESUMEN

BACKGROUND: Epidemiological differences between men and women have been reported with regards to sepsis, influenza and severe coronavirus infections including SARS-CoV and MERS-CoV. AIM: To systematically review the literature relating to men versus women on SARS-CoV-2 in order to seek differences in disease characteristics (e.g. infectivity, severity) and outcomes (e.g. mortality). METHODS: We searched 3 electronic databases up or observational studies reporting differences between men and women in the SARS-CoV-2 disease characteristics stated. We identified and included 47 studies, reporting data for 21,454 patients mainly from China. RESULTS: The unadjusted mortality rates of men were higher than those of women, with a mortality OR 0.51 [0.42, 0.61] (p<0.001) for women. The proportion of men presenting with severe disease and admitted to the intensive care unit (ICU) was also higher than that of women (OR 0.75 [0.60-0.93] p<0.001 and OR 0.45 [0.40-0.52] p<0.001 respectively). Adjusted analyses could not be conducted due to lack of data. CONCLUSION: COVID-19 may be associated with worse outcomes in males than in females. However, until more detailed data are provided in further studies enabling adjusted analysis, this remains an unproven assumption.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Susceptibilidad a Enfermedades , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Oportunidad Relativa , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/patología , Neumonía Viral/virología , Índice de Severidad de la Enfermedad , Factores Sexuales
14.
Artículo en Inglés | MEDLINE | ID: mdl-33050574

RESUMEN

SARS-CoV-2 is a new coronavirus that has caused a worldwide pandemic. It produces severe acute respiratory disease (COVID-19), which is fatal in many cases, characterised by the cytokine release syndrome (CRS). According to the World Health Organization, those who smoke are likely to be more vulnerable to infection. Here, in order to clarify the epidemiologic relationship between smoking and COVID-19, we present a systematic literature review until 28th April 2020 and a meta-analysis. We included 18 recent COVID-19 clinical and epidemiological studies based on smoking patient status from 720 initial studies in China, the USA, and Italy. The percentage of hospitalised current smokers was 7.7% (95% CI: 6.9-8.4) in China, 2.3% (95% CI: 1.7-2.9) in the USA and 7.6% (95% CI: 4.2-11.0) in Italy. These percentages were compared to the smoking prevalence of each country and statistically significant differences were found in them all (p < 0.0001). By means of the meta-analysis, we offer epidemiological evidence showing that smokers were statistically less likely to be hospitalised (OR = 0.18, 95% CI: 0.14-0.23, p < 0.01). In conclusion, the analysis of data from 18 studies shows a much lower percentage of hospitalised current smokers than expected. As more studies become available, this trend should be checked to obtain conclusive results and to explore, where appropriate, the underlying mechanism of the severe progression and adverse outcomes of COVID-19.


Asunto(s)
Infecciones por Coronavirus/terapia , Hospitalización/estadística & datos numéricos , Neumonía Viral/terapia , Fumadores/estadística & datos numéricos , China/epidemiología , Infecciones por Coronavirus/epidemiología , Humanos , Italia/epidemiología , Pandemias , Neumonía Viral/epidemiología , Estados Unidos/epidemiología
15.
Isr Med Assoc J ; 22(10): 552-556, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33070485

RESUMEN

BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) experience frequent exacerbations and need to be hospitalized, resulting in an economic and social burden. Although data exist regarding reasons of frequent hospitalizations, there is no data available about the impact on the length of stay (LOS). OBJECTIVES: To characterize the causes of prolonged hospitalizations in COPD patients. METHODS: A retrospective study was conducted of patients who were diagnosed and treated in the pulmonary department for severe COPD exacerbations. All patient demographic data and medical history were collected. Data regarding the disease severity were also collected (including Global Initiative for Obstructive Lung Disease [GOLD] criteria, pulmonologist follow-up, prior hospitalizations, and LOS). RESULTS: The study comprised 200 patients, average age 69.5 ± 10.8 years, 61% males. Of these patients, 89 (45%) were hospitalized for up to 4 days, 111 (55%) for 5 days or more, and 34 (17%) for more than 7 days. Single patients had longer LOS compared with married patients (48% vs. 34%, P = 0.044). Multivariate analysis showed that the number of prior hospital admissions in the last year was a predictor of LOS (P = 0.038, odds ratio [OR] = 0.807, 95% confidence interval [95%CI] = 0.659-0.988), as well as the use of non-invasive respiratory support by bilevel positive airway pressure (BiPAP) during the hospitalization (P = 0.024, OR = 4.662, 95%CI = 1.229-17.681). CONCLUSIONS: Fewer previous hospitalizations due to COPD exacerbations and the need for non-invasive respiratory support by BiPAP were found as predictors of longer LOS.


Asunto(s)
Progresión de la Enfermedad , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Respiración con Presión Positiva/métodos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Distribución por Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Distribución de Chi-Cuadrado , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Israel , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Análisis de Supervivencia
16.
Trials ; 21(1): 881, 2020 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-33106170

RESUMEN

OBJECTIVES: The BCG vaccine, widely used in Brazil in new-borns, induces adjuvant protection for several diseases, including childhood virus infections. BCG activates monocytes and innate memory NK cells which are crucial for the antiviral immune response. Therefore, strategies to prevent COVID-19 in health workers (HW) should be carried out to prevent them becoming unwell so that they can continue to work during the pandemic. The hypothesis is that BCG will improve the innate immune response and prevent symptomatic infection or COVID-19 severity. The primary objective is to verify the effectiveness and safety of the BCG vaccine to prevent or reduce incidence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the city of Goiânia (Brazil) among HW previously vaccinated with BCG and also its severity and mortality during the pandemic of the disease. Secondary objectives are to estimate the incidence of COVID-19 among these professionals and the innate immune response elicited to BCG. TRIAL DESIGN: This a phase II trial for repositioning BCG as a preventive strategy against COVID-19. The trial is an open-label, parallel-group randomised clinical trial, comparing HW vaccinated with BCG and HW not vaccinated. PARTICIPANTS: The trial will recruit 800 HW of Goiânia - Goiás, Brazil to reach a total of 400 HW included after comorbidities questioning and laboratorial evaluation. Eligibility criteria: Any HW presenting BCG vaccination scar with direct contact with suspected COVID-19 patients for at least 8 hours per week, whether in hospital beds, ICU, or in transportation or admission (nurses, doctors, physiotherapists, nutritionists, receptionists, etc.) who have negative IgM and IgG COVID-19 test. Participants with any of the following characteristics will be excluded: - Have had in the last fifteen days any signs or symptoms of virus infection, including COVID-19; - Have had fever in the last fifteen days; - Have been vaccinated fifteen days before the inclusion; - Have a history or confirmation of any immunosuppressive disease such as HIV, presented solid tumour in the last two years or autoimmune diseases; - Are under preventive medication with antibiotics, steroid anti-inflammatories, or chemotherapy; - Have less than 500 neutrophils per mL of blood; - Have previously been diagnosed with tuberculosis; - Are breastfeeding or pregnant; - Are younger than 18 years old; - Are participating as an investigator in this clinical trial. INTERVENTION AND COMPARATOR: HW will be randomized into the BCG vaccinated group or the BCG unvaccinated control group. The BCG vaccinated group will receive in the right arm, intradermally, a one off dose of 0.1 mL corresponding to approximately 2 x105 to 8 x105 CFU of live, freeze-dried, attenuated BCG Moscow 361-I, Bacillus Calmette Guerin vaccine (Serum Institute of India PVT. LTD.). The unvaccinated control group will not be vaccinated. The HW allocated in both groups will be followed up at specific times points until 180 days post inclusion. The vaccinated and control groups will be compared according to COVID-19 related outcomes. MAIN OUTCOMES: The primary outcomes are the incidence coefficient of infection by SARS-CoV-2 determined by RT-PCR of naso-oropharyngeal swab specimen or rapid lateral flow IgG and IgM test, and presence of general COVID-19 symptoms, disease severity and admission to hospital during the 180 days of follow up. The secondary outcome is the innate immune response elicited 15-20 days after vaccination. RANDOMISATION: The vaccine vial contains approximately 10 doses. In order to optimize the vaccine use, the randomisation was performed in blocks of 20 participants using the platform randomization.com [ http://www.jerrydallal.com/random/permute.htm ]. The randomization was prepared before any HW inclusion. The results were printed and inserted in sealed envelopes that were numbered with BCG-001 to BCG-400. The printed results as well the envelopes had the same numbers. At the time of the randomisation, each participant that meets the inclusion criteria will receive a consecutive participant number [BCG-001-BCG-400]. The sealed envelope with the assigned number, blinded to the researchers, will be opened in front of the participant and the arm allocation will be known. BLINDING (MASKING): There is no masking for the participants or for the healthcare providers. The study will be blinded to the laboratory researchers and to those who will be evaluating the outcomes and performing the statistical analyses. In this case, only the participant identification number will be available. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Four hundred heath workers will be randomised in two groups. Two hundred participants will be vaccinated, and 200 participants will not be vaccinated. TRIAL STATUS: The protocol approved by the Brazilian Ethical Committee is the seventh version, number CAAE: 31783720.0.0000.5078. The trial has been recruiting since September 20th, 2020. The clinical trial protocol was registered on August 5th, 2020. It is estimated that recruitment will finish by March 2021. TRIAL REGISTRATION: The protocol number was registered on August 5th, 2020 at REBEC (Registro Brasileiro de Ensaios Clínicos). Register number: RBR-4kjqtg and WHO trial registration number UTN: U1111-1256-3892. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Vacuna BCG/administración & dosificación , Infecciones por Coronavirus/prevención & control , Inmunidad Innata/inmunología , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus/inmunología , Brasil/epidemiología , Estudios de Casos y Controles , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Protección Cruzada/inmunología , Estudios de Seguimiento , Personal de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Inmunización Secundaria/métodos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Incidencia , Inyecciones Intradérmicas , Células Asesinas Naturales/inmunología , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Seguridad , Resultado del Tratamiento
17.
Inflamm Bowel Dis ; 26(11): e134-e136, 2020 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-33029612
18.
J Med Internet Res ; 22(10): e21801, 2020 10 28.
Artículo en Inglés | MEDLINE | ID: mdl-33090964

RESUMEN

BACKGROUND: Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19. OBJECTIVE: Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease. METHODS: We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases. RESULTS: A total of 10,504 patients with a clinical or polymerase chain reaction-confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature <39 degrees Celsius (or >39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care. CONCLUSIONS: Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admission.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Registros Electrónicos de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Aprendizaje Automático , Procesamiento de Lenguaje Natural , Neumonía Viral/diagnóstico , Adulto , Anciano , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Pronóstico , Estudios Retrospectivos , España/epidemiología , Resultado del Tratamiento
19.
BMJ ; 371: m3582, 2020 10 28.
Artículo en Inglés | MEDLINE | ID: mdl-33115726

RESUMEN

OBJECTIVE: To assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members. DESIGN: Nationwide linkage cohort study. SETTING: Scotland, UK, 1 March to 6 June 2020. PARTICIPANTS: Healthcare workers aged 18-65 years, their households, and other members of the general population. MAIN OUTCOME MEASURE: Admission to hospital with covid-19. RESULTS: The cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in "front door," intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity. CONCLUSIONS: Healthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Familia , Personal de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Betacoronavirus , Estudios de Cohortes , Comorbilidad , Femenino , Personal de Salud/clasificación , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Factores de Riesgo , Escocia/epidemiología , Adulto Joven
20.
Transplant Proc ; 52(9): 2637-2641, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33012543

RESUMEN

Here we report a single-center cohort of 6 patients (4 kidney only, and 2 simultaneous liver/kidney transplants) diagnosed with COVID-19 at a median of 1.9 years (range = 0.2-9.3 years) post transplant. Five (of 6) patients required inpatient admission, 2 patients (mortality = 33%) died. Among those with mortality, an increased concentration of inflammatory biomarkers (interleukin-6 and C-reactive protein) was noted with a lack of response to interleukin-6 blockade, remdesivir, and/or convalescent plasma. None of the kidney-only transplants (4/6; 67%) had elevation in plasma donor-derived cell-free DNA above the previously published cut-off of 1%, suggesting absence of significant allo-immune injury. Four (of 5) admitted patients had detectable SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) in blood on samples obtained at/during hospitalization. Of the 4 discharged patients, 2 patients with undetectable virus on repeat nasopharyngeal swabs had seroconversion with positive SARS-CoV-2 IgG formation at 30 to 48 days post infection. One patient had prolonged shedding of virus on nasopharyngeal swab at 28 days post discharge despite lack of symptoms. In this preliminary report, we find that immunocompromised transplant patients had higher rates of RNAemia (67%) than reported in the general population (15%), seeming absence of allo-immune injury despite systemic inflammation, and formation of IgG overtime after recovery from infection.


Asunto(s)
Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Huésped Inmunocomprometido/inmunología , Trasplante de Riñón/efectos adversos , Neumonía Viral/inmunología , Complicaciones Posoperatorias/inmunología , Adulto , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Inmunización Pasiva , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/virología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/virología , Viremia/inmunología , Viremia/mortalidad , Viremia/virología
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