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1.
J Environ Qual ; 49(2): 496-508, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33016424

RESUMEN

Phosphorus (P) loss from agricultural fields contributes to water quality degradation. A phosphorus index (PI) is a tool that scores fields based on P loss potential. Recently, a new transport × best or beneficial management practice (BMP) approach was proposed for the New York PI (NY-PI), which first scores fields using landscape-based transport factors (raw scores) and then offers various BMPs to reduce the score (i.e., risk of P transport). The final score is assigned a management implication (N needs based, P removal based, or zero P application), taking into account field-specific soil-test P (STP) and the farm's whole-farm P balance. With farmer and nutrient management planner input and data on field-specific transport factors and whole-farm P balances of 18 New York dairy farms, we set coefficients for transport factors, BMPs related to P application, and STP limits and determined the impact of implementation of the new NY-PI on manure management options. Based on raw scores, the proposed NY-PI initially limited manure application to 51% of the total cropland area of the participating farms (28% N-based, 23% P-based). Implementation of BMPs (i.e., changing the method and ground cover or timing of P application) allowed 43-98% of the land area to receive manure at N-based rates. For farms with whole-farm P balances within the feasible limits set for New York, an additional 0-50% of the land base was classified as N-based management, depending on BMP selection. These results show the ability of the new NY-PI to limit P applications on fields with high transport risk while incentivizing adoption of BMPs and improvements in whole-farm P management.


Asunto(s)
Estiércol , Fósforo/análisis , Agricultura , Granjas , New York , Medición de Riesgo
2.
Biomed Eng Online ; 19(1): 75, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008462

RESUMEN

BACKGROUND: The world is facing an unprecedented outbreak affecting all aspects of human lives which is caused by the COVID-19 pandemic. Due to the virus novelty, healthcare systems are challenged by a high rate of patients and the shortage of medical products. To address an increased need for essential medical products, national authorities, worldwide, made various legislative concessions. This has led to essential medical products being produced by automotive, textile and other companies from various industries and approved under the emergency use authorizations or legal concessions of national regulatory bodies. This paper presents a narrative commentary of the available documentation on emergency use authorizations and legal concessions for medical products during COVID-19 pandemic. METHODOLOGY: The basis for narrative commentary includes scientific articles published in Web of Science, Scopus, PubMed and Embase databases, official publications of international organizations: Food and Drug Agency (FDA), World Health Organisation (WHO), World Bank and United Nations (UN), and national regulatory agency reports in native languages (English, German, Bosnian, and Croatian) published from November 1, 2019 to May 1, 2020. This paper focuses on three types of essential medical products: mechanical ventilators, personal protective equipment (PPE) and diagnostic tests. Evidence-informed commentary of available data and potential identified risks of emergency use authorizations and legal concessions is presented. DISCUSSION: It is recognized that now more than ever, raising global awareness and knowledge about the importance of respecting the essential requirements is needed to guarantee the appropriate quality, performance and safety of medical products, especially during outbreak situation, such as the COVID-19 pandemic. Emergency use authorizations for production, import and approval of medical products should be strictly specified and clearly targeted from case to case and should not be general or universal for all medical products, because all of them are associated with different risk level. CONCLUSION: Presented considerations and experiences should be taken as a guide for all possible future outbreak situations to prevent improvised reactions of national regulatory bodies.


Asunto(s)
Betacoronavirus , Comercio/legislación & jurisprudencia , Infecciones por Coronavirus , Concesión de Licencias/legislación & jurisprudencia , Industria Manufacturera/legislación & jurisprudencia , Pandemias , Equipo de Protección Personal/provisión & distribución , Neumonía Viral , Juego de Reactivos para Diagnóstico/provisión & distribución , Ventiladores Mecánicos/provisión & distribución , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/diagnóstico , Falla de Equipo , Unión Europea , Salud Global , Humanos , Equipo de Protección Personal/normas , Juego de Reactivos para Diagnóstico/normas , Medición de Riesgo , Estados Unidos , United States Food and Drug Administration , Ventiladores Mecánicos/normas
3.
Rev Bras Epidemiol ; 23: e200095, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33027434

RESUMEN

OBJECTIVE: To assess, through space-time analyses, whether the income inequality of the Federative Units (FUs) in Brazil can be associated with the risk of infection and death by COVID-19. METHODS: This was an ecological study, based on secondary data on incidence and mortality rates for COVID-19. Data were analyzed at the state level, having the Gini coefficient as the main independent variable. Records of twelve days were used, spaced one week each, between April 21th and June 7th, 2020. The weekly variation in the rates was calculated through Prais-Winsten regression, aiming at measuring the evolution of the pandemic in each FU. Spearman's correlation test was used to assess correlation between the rates and their weekly evolution and the independent variables. Lastly, a spatial dependence diagnosis was conducted, and a Spatial Regression lag model was used when applicable. RESULTS: Incidence and mortality rates of COVID-19 increased in all Brazilian FUs, being more pronounced among those with greater economic inequality. Association between Gini coefficient and COVID-19 incidence and mortality rates remained even when demographic and spatial aspects were taken into account. CONCLUSION: Income inequality can play an important role in the impact of COVID-19 on the Brazilian territory, through absolute and contextual effects. Structural policies to reduce inequality are essential to face this and future health crises in Brazil.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Disparidades en el Estado de Salud , Pandemias , Neumonía Viral/epidemiología , Brasil/epidemiología , Infecciones por Coronavirus/mortalidad , Humanos , Neumonía Viral/mortalidad , Medición de Riesgo , Factores Socioeconómicos
4.
J Indian Soc Pedod Prev Dent ; 38(3): 266-273, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33004725

RESUMEN

Aim: This longitudinal, observational study was conducted in the schools of Yamunanagar, Haryana, to evaluate and compare the predictive value of formal type of caries risk assessment using reduced Cariogram software, including only seven factors and informal type among 8-9 years' school-going children. Methods: A.total of 111 school-going children were included in the study. Risk profile for each child was created using cariogram as well as informal factors. The same children were scheduled for re-examination at an interval of 9 and 18 months. The caries status was recorded again using the Collapsed International Caries Detection and Assessment System (ICDAS) concept. Statistical Analysis: The precoded data were transferred to the computer and analyzed using the SPSS software (version 17.0). Data were analyzed for the identification of children with lesion progression and numbers of lesions progressing using the Transition Scoring System. Results: Cariogram being a multifactorial model gives significant individual weightage to each etiological factor causing dental caries as compared to informal caries risk assessment which though easy to implement yet unstructured unlike cariogram and thus does not guarantee consistent implementation. Conclusion: Cariogram is a perfect option for patient motivation and supports the clinician in decision making for planning preventive strategies for the patients. Along with this, a combination of the factors for informal caries risk assessment can help in making a simple yet multifactorial model which can be applied in daily practice.


Asunto(s)
Caries Dental/diagnóstico , Niño , Humanos , Medición de Riesgo , Instituciones Académicas , Programas Informáticos
6.
Am J Case Rep ; 21: e926886, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-32999267

RESUMEN

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China, in late 2019 and has led to an ongoing pandemic. COVID-19 typically affects the respiratory tract and mucous membranes, leading to pathological involvement of various organ systems. Although patients usually present with fever, cough, and fatigue, less common manifestations have been reported including symptoms arising from thrombosis and thromboembolism. A spectrum of dermatologic changes is becoming recognized in patients with COVID-19 who initially present with respiratory symptoms. The mechanism behind these manifestations remains unclear. This report presents the case of a 47-year-old Hispanic man who developed cutaneous vasculitic lesions and gangrene of the toes following admission to hospital with COVID-19 pneumonia. CASE REPORT COVID-19 has been associated with cardiovascular disease entities including stroke, acute coronary syndrome, venous thromboembolism, and peripheral vascular disease. We present a case in which a 47-year-old Hispanic man arrived at the Emergency Department with COVID-19 and was admitted for respiratory failure. Despite anticoagulation initiated on admission in the presence of an elevated D-dimer, the patient developed gangrene of all his toes, which required bilateral transmetatarsal amputation. CONCLUSIONS This case shows that dermatologic manifestations may develop in patients who initially present with COVID-19 pneumonia. These symptoms may be due to venous thrombosis following SARS-CoV-2 vasculitis, leading to challenging decisions regarding anticoagulation therapy. Randomized controlled trials are needed to evaluate the efficacy of anticoagulation, to choose appropriate anticoagulants and dosing, and to assess bleeding risk.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Gangrena/etiología , Gangrena/cirugía , Neumonía Viral/complicaciones , Síndrome Respiratorio Agudo Grave/complicaciones , Dedos del Pie/cirugía , Vasculitis/etiología , Amputación/métodos , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Gangrena/fisiopatología , Hispanoamericanos , Humanos , Masculino , Huesos Metatarsianos/cirugía , Persona de Mediana Edad , Multimorbilidad , Pandemias , Admisión del Paciente , Neumonía Viral/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Dedos del Pie/irrigación sanguínea , Dedos del Pie/fisiopatología , Resultado del Tratamiento , Vasculitis/fisiopatología
7.
Arch Pathol Lab Med ; 144(10): 1204-1208, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33002153

RESUMEN

CONTEXT.­: Glycemic control requires accurate blood glucose testing. The extent of hematocrit interference is difficult to assess to assure quality patient care. OBJECTIVE.­: To predict the effect of patient hematocrit on the performance of a glucose meter and its corresponding impact on insulin-dosing error. DESIGN.­: Multilevel mixed regression was conducted to assess the extent that patient hematocrit influences Roche Accu-Chek Inform II glucose meters, using the Radiometer ABL 837 as a reference method collected during validation of 35 new meters. Regression coefficients of fixed effects for reference glucose, hematocrit, an interaction term, and random error were applied to 4 months of patient reference method results extracted from the laboratory information system. A hospital inpatient insulin dose algorithm was used to determine the frequency of insulin dose error between reference glucose and meter glucose results. RESULTS.­: Fixed effects regression for method and hematocrit predicted biases to glucose meter results that met the "95% within ±12%" for the US Food and Drug Administration goal, but combinations of fixed and random effects exceeded that target in emergency and hospital inpatient units. Insulin dose errors were predicted from the meter results. Twenty-eight percent of intensive care unit, 20.8% of hospital inpatient, and 17.7% of emergency department results were predicted to trigger a ±1 insulin dose error by fixed and random effects. CONCLUSIONS.­: The current extent of hematocrit interference on glucose meter performance is anticipated to cause insulin error by 1-dose category, which is likely associated with low patient risk.


Asunto(s)
Glucemia/análisis , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Errores Médicos , Algoritmos , Hematócrito , Humanos , Medición de Riesgo , Estados Unidos
8.
Arch Pathol Lab Med ; 144(10): 1193-1198, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33002154

RESUMEN

CONTEXT.­: Convenience, avoidance of doctor's appointments, curiosity, and the desire to take control of one's health are driving interest toward direct-to-consumer (DTC) testing. DTC is laboratory testing that is initiated by the consumer without a physician order. The results are reported back directly to the consumer. DTC testing is an exciting addition to the traditional healthcare model for consumers who want knowledge of their health status and disease risk, ancestry, and their body's expected response to certain medications based on their genotype. OBJECTIVES.­: To discuss the perceived and potential benefits and risks involved in DTC testing. DATA SOURCES.­: Recent published literature on DTC testing. CONCLUSIONS.­: The benefits of DTC testing are enticing and are driving the DTC testing market. Consumers must weigh the perceived benefits with the potential risks, including privacy concerns, the possibility of receiving confusing health information, and/or information that could generate unexpected emotions, misdiagnosis, and over-testing.


Asunto(s)
Pruebas Dirigidas al Consumidor , Confidencialidad , Pruebas Genéticas , Humanos , Medición de Riesgo
9.
Can Respir J ; 2020: 2045341, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33005276

RESUMEN

Objective: Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods: This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results: The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p < 0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p < 0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p < 0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p < 0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions: Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.


Asunto(s)
Enfermedades Asintomáticas , Infecciones por Coronavirus , Transmisión de Enfermedad Infecciosa/prevención & control , Pandemias , Neumonía Viral , Medición de Riesgo/métodos , Adulto , Factores de Edad , Enfermedades Asintomáticas/epidemiología , Enfermedades Asintomáticas/terapia , Betacoronavirus/aislamiento & purificación , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Errores Diagnósticos/prevención & control , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Pronóstico , Factores Sexuales
10.
Urol Clin North Am ; 47(4): 433-442, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008494

RESUMEN

Natural killer (NK) cells are potently cytolytic innate lymphocytes involved in the immune surveillance of tumors and virally infected cells. Although much progress has been made in manipulating the ability of T cells to recognize and eliminate tumors, a comprehensive understanding of NK-cell infiltration into solid tumors, and their amenability to immunomodulation, remains incomplete. This article discusses recent studies showing that urologic tumors are infiltrated by NK cells and that these NK cells are often dysfunctional, but that strategies interfering with inhibitory axes have significant potential to alleviate this dysfunction.


Asunto(s)
Inmunoterapia/métodos , Células Asesinas Naturales/efectos de los fármacos , Células Asesinas Naturales/inmunología , Terapia Molecular Dirigida/métodos , Neoplasias Urogenitales/terapia , Terapia Biológica/métodos , Femenino , Humanos , Inmunidad Innata/efectos de los fármacos , Inmunidad Innata/inmunología , Neoplasias Renales/inmunología , Neoplasias Renales/terapia , Masculino , Neoplasias de la Próstata/inmunología , Neoplasias de la Próstata/terapia , Medición de Riesgo , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/inmunología , Neoplasias de la Vejiga Urinaria/terapia , Neoplasias Urogenitales/inmunología
11.
Urol Clin North Am ; 47(4): 443-456, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008495

RESUMEN

Cancer vaccines, cytokines, and checkpoint inhibitors are immunotherapeutic agents that act within the cancer immunity cycle. Prostate cancer has provided unique opportunities for, and challenges to, immunotherapy drug development, including low tumor mutational burdens, limited expression of PD-L1, and minimal T-cell intratumoral infiltrates. Nevertheless, efforts are ongoing to help prime prostate tumors by turning a "cold" prostate cancer "hot" and thus rendering them more susceptible to immunotherapy. Combination treatments, use of molecular biomarkers, and use of new immunotherapeutic agents provide opportunities to enhance the immune response to prostate tumors.


Asunto(s)
Vacunas contra el Cáncer/uso terapéutico , Factores Inmunológicos/uso terapéutico , Inmunoterapia/métodos , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Anciano , Biomarcadores de Tumor/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Pronóstico , Neoplasias de la Próstata/mortalidad , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento
12.
Urol Clin North Am ; 47(4): 457-467, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008496

RESUMEN

Biochemically recurrent prostate cancer represents a stage of prostate cancer where conventional (continued on next page) computed tomography and technetium Tc 99m bone scan imaging are unable to detect disease after curative intervention despite rising prostate-specific antigen. There is no clear standard of care and no systemic therapy has been shown to improve survival. Immunotherapy-based treatments potentially are attractive options relative to androgen deprivation therapy due to the generally more favorable side-effect profile. Biochemically recurrent prostate cancer patients have a low tumor burden and likely lymph node-based disease, which may make them more likely to respond to immunotherapy.


Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Inmunoterapia/métodos , Recurrencia Local de Neoplasia/terapia , Neoplasias de la Próstata/patología , Anciano , Terapia Combinada , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Selección de Paciente , Pronóstico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/terapia , Medición de Riesgo , Rol , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
13.
Urol Clin North Am ; 47(4): 475-485, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008498

RESUMEN

Cancer is a highly complex and heterogeneous disease and immunotherapy has shown promise as a therapeutic approach. The increased resolution afforded by single-cell analysis offers the hope of finding and characterizing previously underappreciated populations of cells that could prove useful in understanding cancer progression and treatment. Urologic and prostate cancers are inherently heterogeneous diseases, and the potential for single-cell analysis to help understand and develop immunotherapeutic approaches to treat these diseases is very exciting. In this review, we view cancer immunotherapy through a single-cell lens and discuss the state-of-the-art technologies that enable advances in this field.


Asunto(s)
Inmunoterapia/métodos , Terapia Molecular Dirigida/métodos , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/terapia , Microambiente Tumoral/efectos de los fármacos , Femenino , Predicción , Humanos , Masculino , Terapia Molecular Dirigida/tendencias , Pronóstico , Neoplasias de la Próstata/patología , Medición de Riesgo , Análisis de Secuencia de ADN , Análisis de Secuencia de ARN , Análisis de la Célula Individual , Resultado del Tratamiento , Microambiente Tumoral/genética , Neoplasias Urológicas/genética , Neoplasias Urológicas/patología , Neoplasias Urológicas/terapia
14.
Urol Clin North Am ; 47(4): 523-536, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008501

RESUMEN

Personalized medicine uses a patient's genotype, environment, and lifestyle choices to create a tailored diagnosis and therapy plan, with the goal of minimizing side effects, avoiding lost time with ineffective treatments, and guiding preventative strategies. Although most precision medicine strategies are still within the laboratory phase of development, this article reviews the promising technologies with the greatest potential to improve the diagnosis and treatment options for male infertility, including sperm cell transplantation, genomic editing, and new biomarker assays, based on the latest proteomic and epigenomic studies.


Asunto(s)
Genómica , Infertilidad Masculina/genética , Infertilidad Masculina/terapia , Medicina de Precisión/métodos , Biomarcadores/sangre , Terapia Combinada , Predicción , Humanos , Infertilidad Masculina/diagnóstico , Masculino , Proteómica , Medición de Riesgo , Resultado del Tratamiento
15.
Nat Commun ; 11(1): 4968, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33009413

RESUMEN

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread to become a worldwide emergency. Early identification of patients at risk of progression may facilitate more individually aligned treatment plans and optimized utilization of medical resource. Here we conducted a multicenter retrospective study involving patients with moderate COVID-19 pneumonia to investigate the utility of chest computed tomography (CT) and clinical characteristics to risk-stratify the patients. Our results show that CT severity score is associated with inflammatory levels and that older age, higher neutrophil-to-lymphocyte ratio (NLR), and CT severity score on admission are independent risk factors for short-term progression. The nomogram based on these risk factors shows good calibration and discrimination in the derivation and validation cohorts. These findings have implications for predicting the progression risk of COVID-19 pneumonia patients at the time of admission. CT examination may help risk-stratification and guide the timing of admission.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Progresión de la Enfermedad , Neumonía Viral/diagnóstico , Neumonía , Tomografía Computarizada por Rayos X/métodos , Adulto , Betacoronavirus , China , Técnicas de Laboratorio Clínico , Coinfección , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/fisiopatología , Femenino , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Linfocitos , Masculino , Persona de Mediana Edad , Neutrófilos , Pandemias , Neumonía Viral/patología , Neumonía Viral/fisiopatología , Análisis de Regresión , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
16.
Ann Emerg Med ; 76(4): 442-453, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33012378

RESUMEN

STUDY OBJECTIVE: The goal of this study is to create a predictive, interpretable model of early hospital respiratory failure among emergency department (ED) patients admitted with coronavirus disease 2019 (COVID-19). METHODS: This was an observational, retrospective, cohort study from a 9-ED health system of admitted adult patients with severe acute respiratory syndrome coronavirus 2 (COVID-19) and an oxygen requirement less than or equal to 6 L/min. We sought to predict respiratory failure within 24 hours of admission as defined by oxygen requirement of greater than 10 L/min by low-flow device, high-flow device, noninvasive or invasive ventilation, or death. Predictive models were compared with the Elixhauser Comorbidity Index, quick Sequential [Sepsis-related] Organ Failure Assessment, and the CURB-65 pneumonia severity score. RESULTS: During the study period, from March 1 to April 27, 2020, 1,792 patients were admitted with COVID-19, 620 (35%) of whom had respiratory failure in the ED. Of the remaining 1,172 admitted patients, 144 (12.3%) met the composite endpoint within the first 24 hours of hospitalization. On the independent test cohort, both a novel bedside scoring system, the quick COVID-19 Severity Index (area under receiver operating characteristic curve mean 0.81 [95% confidence interval {CI} 0.73 to 0.89]), and a machine-learning model, the COVID-19 Severity Index (mean 0.76 [95% CI 0.65 to 0.86]), outperformed the Elixhauser mortality index (mean 0.61 [95% CI 0.51 to 0.70]), CURB-65 (0.50 [95% CI 0.40 to 0.60]), and quick Sequential [Sepsis-related] Organ Failure Assessment (0.59 [95% CI 0.50 to 0.68]). A low quick COVID-19 Severity Index score was associated with a less than 5% risk of respiratory decompensation in the validation cohort. CONCLUSION: A significant proportion of admitted COVID-19 patients progress to respiratory failure within 24 hours of admission. These events are accurately predicted with bedside respiratory examination findings within a simple scoring system.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Insuficiencia Respiratoria/virología , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Pandemias , Neumonía Viral/terapia , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos , Medición de Riesgo/métodos , Adulto Joven
17.
BMJ Open ; 10(10): e039887, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33020106

RESUMEN

OBJECTIVES: To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China. DESIGN AND SETTING: Retrospective, multicentre cohort study performed at 24 hospitals in Jiangsu, China. PARTICIPANTS: 625 patients with COVID-19 enrolled between 10 January and 15 March 2020. RESULTS: Of the 625 patients (median age, 46 years; 329 (52.6%) men), 37 (5.9%) were children (18 years or younger), 261 (41.8%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years) and 79 (12.6%) elderly adults (65 years or older). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease and diabetes comorbidities increased with age (trend test, p<0.0001, p=0.0003, p<0.0001 and p<0.0001, respectively). Fever, cough and shortness of breath occurred more commonly among older patients, especially the elderly, compared with children (χ2 test, p=0.0008, 0.0146 and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both p<0.0001). Older patients had many significantly different laboratory parameters from younger patients. Elderly patients had the highest proportion of severe or critically-ill cases (33.0%, χ2 test p<0.0001), intensive care unit use (35.4%, χ2 test p<0.0001), respiratory failure (31.6%, χ2 test p<0.0001) and the longest hospital stay (median 21 days, Kruskal-Wallis test p<0.0001). CONCLUSIONS: Elderly (≥65 years) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure and the longest hospital stay, which may be due partly to their having a higher incidence of comorbidities and poor immune responses to COVID-19.


Asunto(s)
Factores de Edad , Infecciones por Coronavirus , Cuidados Críticos , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral , Evaluación de Síntomas , Adolescente , Anciano , Betacoronavirus/aislamiento & purificación , China/epidemiología , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Enfermedad Crítica/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
18.
Crit Care ; 24(1): 597, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023669

RESUMEN

BACKGROUND: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. METHODS: Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. RESULTS: A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53-1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0-2.5) vs 2 IQR 1.0-3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40-2.72), p = 0.92]. CONCLUSION: In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.


Asunto(s)
Infecciones por Coronavirus/terapia , Intubación Intratraqueal/efectos adversos , Terapia por Inhalación de Oxígeno/métodos , Neumonía Viral/terapia , Posición Prona , Vigilia , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Medición de Riesgo
19.
Transl Psychiatry ; 10(1): 339, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33024072

RESUMEN

There were several studies about the psychiatric and mental health issues related to the severe adult respiratory syndrome (SARS) outbreak in 2003, however, the association between SARS and the overall risk of psychiatric disorders and suicides has, as yet, to be studied in Taiwan. The aim of this study is to examine as to whether SARS is associated with the risk of psychiatric disorders and suicide. A total of 285 patients with SARS and 2850 controls without SARS (1:10) matched for sex, age, insurance premium, comorbidities, residential regions, level of medical care, and index date were selected between February 25 and June 15, 2003 from the Inpatient Database Taiwan's National Health Insurance Research Database. During the 12-year follow-up, in which 79 in the SARS cohort and 340 in the control group developed psychiatric disorders or suicide (4047.41 vs. 1535.32 per 100,000 person-years). Fine and Gray's survival analysis revealed that the SARS cohort was associated with an increased risk of psychiatric disorders and suicide, and the adjusted subdistribution HR (sHR) was 2.805 (95% CI: 2.182-3.605, p < 0.001) for psychiatric disorders and suicide. The SARS cohort was associated with anxiety, depression, sleep disorders, posttraumatic stress disorder/acute stress disorder (PTSD/ASD), and suicide. The sensitivity analysis revealed that the SARS group was associated with anxiety, depression, sleep disorders, PTSD/ASD, and suicide after the individuals with a diagnosis of psychiatric disorders and suicide were excluded within the first year, and with anxiety, depression, and sleep disorders, while those in the first five years were excluded. In conclusion, SARS was associated with the increased risk of psychiatric disorders and suicide.


Asunto(s)
Infecciones por Coronavirus , Trastornos Mentales , Salud Mental/estadística & datos numéricos , Pandemias , Neumonía Viral , Síndrome Respiratorio Agudo Grave , Suicidio/estadística & datos numéricos , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Bases de Datos Factuales , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/virología , Persona de Mediana Edad , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Medición de Riesgo , Factores de Riesgo , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/psicología , Síndrome Respiratorio Agudo Grave/terapia , Taiwán/epidemiología
20.
Nat Commun ; 11(1): 5033, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33024092

RESUMEN

Soaring cases of coronavirus disease (COVID-19) are pummeling the global health system. Overwhelmed health facilities have endeavored to mitigate the pandemic, but mortality of COVID-19 continues to increase. Here, we present a mortality risk prediction model for COVID-19 (MRPMC) that uses patients' clinical data on admission to stratify patients by mortality risk, which enables prediction of physiological deterioration and death up to 20 days in advance. This ensemble model is built using four machine learning methods including Logistic Regression, Support Vector Machine, Gradient Boosted Decision Tree, and Neural Network. We validate MRPMC in an internal validation cohort and two external validation cohorts, where it achieves an AUC of 0.9621 (95% CI: 0.9464-0.9778), 0.9760 (0.9613-0.9906), and 0.9246 (0.8763-0.9729), respectively. This model enables expeditious and accurate mortality risk stratification of patients with COVID-19, and potentially facilitates more responsive health systems that are conducive to high risk COVID-19 patients.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Aprendizaje Automático , Pandemias , Neumonía Viral/mortalidad , Anciano , Betacoronavirus , China/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Redes Neurales de la Computación , Medición de Riesgo , Máquina de Vectores de Soporte
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