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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.
Am J Ther ; 28(2): e189-e195, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33687027

RESUMEN

BACKGROUND: Acute respiratory distress syndrome (ARDS) was first described in 1967, but its definition has evolved considerably since then. ARDS is defined as the onset of hypoxemia, tachypnea, and loss of lung compliance due to some stimulus. In the United States, the incidence of ARDS has been growing because it is being increasingly recognized. The incidence of ARDS has also gone up recently due to the COVID-19 pandemic. AREAS OF UNCERTAINTY: To date, there is no known one treatment for ARDS. Multiple studies have looked into various causes of ARDS, pathophysiology, and ventilation and management strategies. However, there is still considerable variability in the treatment and management of these patients from institution to institution. DATA SOURCES: A literature search was conducted through PubMed and Google Scholar. Publications describing the epidemiology, diagnostic criteria, pathophysiology, and treatment were included in this review. RESULTS: The definition of ARDS has evolved over the years. The most recent and agreed upon diagnostic criteria are based on the Berlin criteria for ARDS. Management of patients with ARDS includes low tidal volume ventilation, prone ventilation, paralysis in certain patient populations, and perhaps extracorporeal membrane oxygenation (ECMO). This also applies to patients with ARDS due to COVID-19. CONCLUSIONS: Patients with ARDS have a high mortality due to the incredibly complex disease process. Because of the complexity of ARDS, the management and treatment is equally as difficult. This article reviews some of the strategies used to date, including the role of ECMO, and includes some society recommendations. Further research must be done into which methods best guide lung ventilation in severe ARDS and patients on ECMO.


Asunto(s)
/epidemiología , Manejo de la Enfermedad , Humanos , /fisiopatología , /terapia
3.
Infect Dis Poverty ; 10(1): 30, 2021 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-33731226

RESUMEN

The ongoing coronavirus disease 2019 (COVID-19) pandemic has put a strain on health systems globally. Although Africa is the least affected region to date, it has the weakest health systems and an exponential rise in cases as has been observed in other regions, is bound to overwhelm its health systems. Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic. The World Health Organization (WHO) recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility; however, where this is not possible due to the health system capacity, patients can be isolated in re-purposed facilities or at home. An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases, given the already limited health infrastructure and health workforce, and the risk of nosocomial transmission. Use of repurposed facilities requires additional resources, including health workers. Home isolation, on the other hand, would be a challenge given the poor housing, overcrowding, inadequate access to water and sanitation, and stigma related to infectious disease that is prevalent in many African societies. Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited. These unique cultural, social, economic and developmental differences on the continent, call for a tailored approach to COVID-19 case management strategies. This article proposes three broad case management strategies based on the transmission scenarios defined by WHO, and the criteria and package of care for each option, for consideration by policy makers and governments in African countries. Moving forward, African countries should generate local evidence to guide the development of realistic home-grown strategies, protocol and equipment for the management of COVID-19 cases on the continent .


Asunto(s)
/epidemiología , Manejo de Caso , África/epidemiología , Américas/epidemiología , Asia/epidemiología , /terapia , Prestación de Atención de Salud , Manejo de la Enfermedad , Europa (Continente)/epidemiología , Encuestas de Atención de la Salud , Humanos
4.
Arch Ital Urol Androl ; 93(1): 111-114, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33754622

RESUMEN

The SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) was first reported in December 2019, then its rapid spread around the world caused a global pandemic in March 2020 recording a high death rate. The epicenter of the victims moved from Asia to Europe and then to the United States. In this Pandemic, the different governance mechanisms adopted by local health regional authorities made the difference in terms of contagiousness and mortality together with a community strong solidarity. This document analyzes the andrological urgencies management in public hospitals and in private practice observed in Italy and in particular in the most affected Italian Regions: Emilia-Romagna and Marche.


Asunto(s)
Andrología/estadística & datos numéricos , Infertilidad Masculina/terapia , Pandemias , Manejo de la Enfermedad , Hospitales Públicos/estadística & datos numéricos , Humanos , Italia , Masculino , Práctica Privada/estadística & datos numéricos , Enfermedades Urológicas/terapia
5.
Am Fam Physician ; 103(7): 407-416, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33788514

RESUMEN

The HIV epidemic is an important public health priority. Transmissions continue to occur despite effective therapies that make HIV preventable and treatable. Approximately one-half of people with HIV are not receiving suppressive antiretroviral therapy (ART). Starting ART early, followed by continuous lifetime treatment, most effectively achieves durable virologic suppression and restoration of immune function that can improve clinical outcomes and prevent transmission to partners who are seronegative. National treatment guidelines include ART options that can be offered immediately after diagnosis, even before the results of baseline HIV drug-resistance testing are available. Initial ART selection should be guided by co-occurring conditions, including viral hepatitis, medications, and other factors such as pregnancy. Identifying and addressing psychosocial barriers to care is a key element of ensuring long-term adherence to treatment. The initial physical examination typically reveals no clinical manifestations of HIV in the absence of advanced disease. A comprehensive laboratory evaluation, including HIV viral load and CD4 lymphocyte monitoring, is necessary to guide decision-making for treatment, opportunistic infection prophylaxis, and vaccinations. The initial management of people with HIV presents a unique opportunity for family physicians to improve patients' long-term health care and reduce HIV transmissions.


Asunto(s)
Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/terapia , Guías de Práctica Clínica como Asunto , Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Neoplasias del Ano/diagnóstico , Recuento de Linfocito CD4 , Manejo de la Enfermedad , Detección Precoz del Cáncer , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Vacunas contra la Hepatitis A/uso terapéutico , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis Viral Humana/diagnóstico , Hepatitis Viral Humana/prevención & control , Herpes Zóster/prevención & control , Vacuna contra el Herpes Zóster/uso terapéutico , Humanos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Masculino , Tamizaje Masivo , Cumplimiento de la Medicación , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Infecciones por Pneumocystis/prevención & control , Enfermedades de Transmisión Sexual/diagnóstico , Tuberculosis/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Carga Viral
7.
Heart Fail Clin ; 17(2): 195-206, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673945

RESUMEN

Anemia is common in heart failure with preserved and reduced ejection fraction. It is independently associated with poor functional status, hospitalization, and reduced survival. Its etiology is complex and multifactorial. Hemodynamic and nonhemodynamic compensatory mechanisms have been discussed as a response to chronic anemia. Whether anemia is a risk marker of advanced disease or a risk factor for progressive heart failure is debated. Current guidelines recommend a diagnostic workup as a part of standard management. Studies investigating intravenous iron administration reported beneficial effects on clinical outcomes. This article reviews current information on anemia.


Asunto(s)
Anemia Ferropénica/epidemiología , Manejo de la Enfermedad , Insuficiencia Cardíaca/terapia , Comorbilidad , Salud Global , Insuficiencia Cardíaca/epidemiología , Humanos , Prevalencia , Factores de Riesgo
10.
Scand J Trauma Resusc Emerg Med ; 29(1): 51, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33752728

RESUMEN

BACKGROUND: Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. METHODS: This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers contributing to the TraumaBase® registry during the first wave of the SARS-CoV-2 pandemic in France. This COVID-19 trauma cohort was compared to historical cohorts (2017-2019). RESULTS: Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Trauma patient demographics changed substantially during the pandemic especially during the lockdown period, with an observed reduction in both the absolute numbers and proportion exposed to road traffic accidents and subsequently admitted to traumacenters (348 annually 2017-2019 [55.4% of trauma admissions] vs 143 [36.8%] in 2020 p < 0.005). The in-hospital observed mortality and predicted mortality during the pandemic period were not different compared to the non-pandemic years. CONCLUSIONS: During this first wave of COVID-19 in France, and more specifically during lockdown there was a significant reduction of patients admitted to designated trauma centers. Despite the reallocation and reorganization of medical resources this reduction prevented the saturation of the trauma rescue chain and has allowed maintaining a high quality of care for trauma patients.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Prestación de Atención de Salud/métodos , Manejo de la Enfermedad , Pandemias/prevención & control , Sistema de Registros , Centros Traumatológicos/estadística & datos numéricos , Adulto , Femenino , Francia/epidemiología , Hospitalización/tendencias , Humanos , Masculino , Estudios Retrospectivos
11.
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
12.
Sultan Qaboos Univ Med J ; 21(1): e116-e119, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33777432

RESUMEN

Objectives: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. Methods: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. Results: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. Conclusions: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.


Asunto(s)
/diagnóstico , Urgencias Médicas , Derivación y Consulta , Enfermedades Vasculares/terapia , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Amputación/métodos , Aneurisma Disecante/terapia , Angioplastia/métodos , Aneurisma de la Aorta/terapia , Derivación Arteriovenosa Quirúrgica , Estenosis Carotídea/terapia , Manejo de la Enfermedad , Embolectomía/métodos , Femenino , Oclusión de Injerto Vascular/complicaciones , Oclusión de Injerto Vascular/terapia , Humanos , Isquemia/terapia , Extremidad Inferior , Masculino , Persona de Mediana Edad , Omán , Centros de Atención Terciaria , Extremidad Superior
15.
J Public Health Manag Pract ; 27(3): 285-294, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33762544

RESUMEN

CONTEXT: Local agencies across the United States have identified public health isolation sites for individuals with coronavirus disease 2019 (COVID-19) who are not able to isolate in residence. PROGRAM: We describe logistics of establishing and operating isolation and noncongregate hotels for COVID-19 mitigation and use the isolation hotel as an opportunity to understand COVID-19 symptom evolution among people experiencing homelessness (PEH). IMPLEMENTATION: Multiple agencies in Atlanta, Georgia, established an isolation hotel for PEH with COVID-19 and noncongregate hotel for PEH without COVID-19 but at risk of severe illness. PEH were referred to the isolation hotel through proactive, community-based testing and hospital-based testing. Daily symptoms were recorded prospectively. Disposition location was recorded for all clients. EVALUATION: During April 10 to September 1, 2020, 181 isolation hotel clients (77 community referrals; 104 hospital referrals) were admitted a median 3 days after testing. Overall, 32% of community referrals and 7% of hospital referrals became symptomatic after testing positive; 83% of isolation hotel clients reported symptoms at some point; 93% completed isolation. Among 302 noncongregate hotel clients, median stay was 18 weeks; 61% were discharged to permanent housing or had a permanent housing discharge plan. DISCUSSION: Overall, a high proportion of PEH completed isolation at the hotel, suggesting a high level of acceptability. Many PEH with COVID-19 diagnosed in the community developed symptoms after testing, indicating that proactive, community-based testing can facilitate early isolation. Noncongregate hotels can be a useful COVID-19 community mitigation strategy by bridging PEH at risk of severe illness to permanent housing.


Asunto(s)
/prevención & control , Guías como Asunto , Personas sin Hogar/estadística & datos numéricos , Vivienda/normas , Salud Pública/normas , Cuarentena/normas , Aislamiento Social , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Manejo de la Enfermedad , Femenino , Georgia/epidemiología , Vivienda/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Salud Pública/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Adulto Joven
16.
A A Pract ; 15(3): e01419, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33684080

RESUMEN

The risk of aerosol transmission has been a key factor for the rapid dissemination of the coronavirus pandemic. Transportation of coronavirus disease 2019 (COVID-19)-infected patients with active air leaks could expose unprotected health care personnel and other patients to aerosolized viral particles. We devised a way to avoid aerosolization while the chest tube drain is on water seal. It involves placing an Ultipor100 viral filter on the suction port of the drain system as well as sealing off the safety valve. This mechanism allows positive pressure from an air leak to escape while on water seal while trapping viral particles.


Asunto(s)
/terapia , Portador Sano/prevención & control , Tubos Torácicos/efectos adversos , Manejo de la Enfermedad , Invenciones/tendencias , Cuidados Posoperatorios/tendencias , /epidemiología , Portador Sano/epidemiología , Humanos , Cuidados Posoperatorios/métodos
17.
Lancet ; 397(10280): 1214-1228, 2021 03 27.
Artículo en Inglés | MEDLINE | ID: mdl-33647239

RESUMEN

Guillain-Barré syndrome is the most common cause of acute flaccid paralysis worldwide. Most patients present with an antecedent illness, most commonly upper respiratory tract infection, before the onset of progressive motor weakness. Several microorganisms have been associated with Guillain-Barré syndrome, most notably Campylobacter jejuni, Zika virus, and in 2020, the severe acute respiratory syndrome coronavirus 2. In C jejuni-related Guillain-Barré syndrome, there is good evidence to support an autoantibody-mediated immune process that is triggered by molecular mimicry between structural components of peripheral nerves and the microorganism. Making a diagnosis of so-called classical Guillain-Barré syndrome is straightforward; however, the existing diagnostic criteria have limitations and can result in some variants of the syndrome being missed. Most patients with Guillain-Barré syndrome do well with immunotherapy, but a substantial proportion are left with disability, and death can occur. Results from the International Guillain-Barré Syndrome Outcome Study suggest that geographical variations exist in Guillain-Barré syndrome, including insufficient access to immunotherapy in low-income countries. There is a need to provide improved access to treatment for all patients with Guillain-Barré syndrome, and to develop effective disease-modifying therapies that can limit the extent of nerve injury. Clinical trials are currently underway to investigate some of the potential therapeutic candidates, including complement inhibitors, which, together with emerging data from large international collaborative studies on the syndrome, will contribute substantially to understanding the many facets of this disease.


Asunto(s)
Manejo de la Enfermedad , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/epidemiología , Síndrome de Guillain-Barré/patología , Síndrome de Guillain-Barré/terapia , Diagnóstico Diferencial , Humanos , Inmunoterapia , Pronóstico
18.
CMAJ Open ; 9(1): E181-E188, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33688026

RESUMEN

BACKGROUND: Clinical data on patients admitted to hospital with coronavirus disease 2019 (COVID-19) provide clinicians and public health officials with information to guide practice and policy. The aims of this study were to describe patients with COVID-19 admitted to hospital and intensive care, and to investigate predictors of outcome to characterize severe acute respiratory infection. METHODS: This observational cohort study used Canadian data from 32 selected hospitals included in a global multisite cohort between Jan. 24 and July 7, 2020. Adult and pediatric patients with a confirmed diagnosis of COVID-19 who received care in an intensive care unit (ICU) and a sampling of up to the first 60 patients receiving care on hospital wards were included. We performed descriptive analyses of characteristics, interventions and outcomes. The primary analyses examined in-hospital mortality, with secondary analyses of the length of hospital and ICU stay. RESULTS: Between January and July 2020, among 811 patients admitted to hospital with a diagnosis of COVID-19, the median age was 64 (interquartile range [IQR] 53-75) years, 495 (61.0%) were men, 46 (5.7%) were health care workers, 9 (1.1%) were pregnant, 26 (3.2%) were younger than 18 years and 9 (1.1%) were younger than 5 years. The median time from symptom onset to hospital admission was 7 (IQR 3-10) days. The most common symptoms on admission were fever, shortness of breath, cough and malaise. Diabetes, hypertension and cardiac, kidney and respiratory disease were the most common comorbidities. Among all patients, 328 received care in an ICU, admitted a median of 0 (IQR 0-1) days after hospital admission. Critically ill patients received treatment with invasive mechanical ventilation (88.8%), renal replacement therapy (14.9%) and extracorporeal membrane oxygenation (4.0%); 26.2% died. Among those receiving mechanical ventilation, 31.2% died. Age was an influential predictor of mortality (odds ratio per additional year of life 1.06, 95% confidence interval 1.03-1.09). INTERPRETATION: Patients admitted to hospital with COVID-19 commonly had fever, respiratory symptoms and comorbid conditions. Increasing age was associated with the development of critical illness and death; however, most critically ill patients in Canada, including those requiring mechanical ventilation, survived and were discharged from hospital.


Asunto(s)
/epidemiología , Cuidados Críticos , Hospitalización , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , /terapia , Canadá/epidemiología , Comorbilidad , Enfermedad Crítica , Manejo de la Enfermedad , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Mortalidad , Pandemias , Embarazo , Vigilancia en Salud Pública , Índice de Severidad de la Enfermedad , Adulto Joven
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