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1.
Rev Paul Pediatr ; 39: e2020217, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32876096

RESUMEN

OBJECTIVE: To analyze the current scientific literature to document, in an integrative review, the main findings that correlate Kawasaki disease (KD) to COVID-19. DATA SOURCES: The search was carried out in June 2020 in the following databases: Biblioteca Virtual em Saúde (BVS), periódico da CAPES and U.S National Library of Medicine (PubMed). The combination of descriptors used was [(COVID-19 OR SARS-CoV-2) AND (Kawasaki disease)], and the inclusion criteria stipulated were studies published from January 2019 to June 2020, without restriction of language or location, and available online in full. News, editorials, comments, and letters, as well as duplicates and articles that did not answer the guiding question were excluded. DATA SYNTHESIS: A total of 97 articles were identified, of which seven comprised this review. The association of KD to the new coronavirus appears to trigger a severe clinical condition of vasculitis. Different from the usual, in this inflammatory syndrome, patients are older, and prevalence is higher in children from African or Caribbean ancestry; clinical and laboratory manifestations are also atypical, with a predominance of abdominal complaints and exaggerated elevation of inflammatory markers. In addition, there was a greater report of rare complications and greater resistance to the recommended treatment for KD. CONCLUSIONS: Pediatric COVID-19 and its potential association to severe KD, still unfamiliar to health professionals, reinforces the importance of testing patients with vasculitis for the new coronavirus and the need to wage high surveillance and preparation of the health system during the current pandemic.


Asunto(s)
Infecciones por Coronavirus , Síndrome Mucocutáneo Linfonodular , Pandemias , Neumonía Viral , Síndrome de Respuesta Inflamatoria Sistémica/virología , Betacoronavirus/aislamiento & purificación , Niño , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/fisiopatología , Manejo de la Enfermedad , Humanos , Síndrome Mucocutáneo Linfonodular/epidemiología , Síndrome Mucocutáneo Linfonodular/terapia , Síndrome Mucocutáneo Linfonodular/virología , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/fisiopatología
2.
Gene ; 766: 145145, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-32941953

RESUMEN

COVID-19, a novel coronavirus-related illness, has spread worldwide. Patients with apparently mild/moderate symptoms can suddenly develop severe pneumonia. Therefore, almost all COVID-19 patients require hospitalization, which can reduce limited medical resources in addition to overwhelming medical facilities. To identify predictive markers for the development of severe pneumonia, a comprehensive analysis of serum chemokines and cytokines was conducted using serial serum samples from COVID-19 patients. The expression profiles were analyzed along the time axis. Serum samples of common diseases were enrolled from a BioBank to confirm the usefulness of predictive markers. Five factors, IFN-λ3, IL-6, IP-10, CXCL9, and CCL17, were identified as predicting the onset of severe/critical symptoms. The factors were classified into two categories. Category A included IFN-λ3, IL-6, IP-10, and CXCL9, and their values surged and decreased rapidly before the onset of severe pneumonia. Category B included CCL17, which provided complete separation between the mild/moderate and the severe/critical groups at an early phase of SARS-CoV-2 infection. The five markers provided a high predictive value (area under the receiver operating characteristic curve (AUROC): 0.9-1.0, p < 0.001). Low expression of CCL17 was specifically observed in pre-severe COVID-19 patients compared with other common diseases, and the predictive ability of CCL17 was confirmed in validation samples of COVID-19. The factors identified could be promising prognostic markers to distinguish between mild/moderate and severe/critical patients, enabling triage at an early phase of infection, thus avoiding overwhelming medical facilities.


Asunto(s)
Biomarcadores/sangre , Quimiocina CCL17/sangre , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Neumonía Viral/sangre , Neumonía Viral/fisiopatología , Betacoronavirus/fisiología , Citocinas/sangre , Hospitalización , Humanos , Pandemias , Índice de Severidad de la Enfermedad
3.
World J Gastroenterol ; 26(39): 6087-6097, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33132657

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. Most critically ill patients have organ injury, including acute respiratory distress syndrome, acute kidney injury, cardiac injury, or liver dysfunction. However, few studies on acute gastrointestinal injury (AGI) have been reported in critically ill patients with COVID-19. AIM: To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19. METHODS: In this retrospective study, demographic data, laboratory parameters, AGI grades, clinical severity and outcomes were collected. The primary endpoints were AGI incidence and 28-d mortality. RESULTS: From February 10 to March 10 2020, 83 critically ill patients out of 1314 patients with COVID-19 were enrolled. Seventy-two (86.7%) patients had AGI during hospital stay, of these patients, 30 had AGI grade I, 35 had AGI grade II, 5 had AGI grade III, and 2 had AGI grade IV. The incidence of AGI grade II and above was 50.6%. Forty (48.2%) patients died within 28 days of admission. Multiple organ dysfunction syndrome developed in 58 (69.9%) patients, and septic shock in 16 (19.3%) patients. Patients with worse AGI grades had worse clinical variables, a higher incidence of septic shock and 28-d mortality. Sequential organ failure assessment (SOFA) scores (95%CI: 1.374-2.860; P < 0.001), white blood cell (WBC) counts (95%CI: 1.037-1.379; P = 0.014), and duration of mechanical ventilation (MV) (95%CI: 1.020-1.340; P = 0.025) were risk factors for the development of AGI grade II and above. CONCLUSION: The incidence of AGI was 86.7%, and hospital mortality was 48.2% in critically ill patients with COVID-19. SOFA scores, WBC counts, and duration of MV were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Enfermedades Gastrointestinales/fisiopatología , Mortalidad Hospitalaria , Neumonía Viral/fisiopatología , Lesión Renal Aguda/epidemiología , Anciano , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Incidencia , Recuento de Leucocitos , Hepatopatías/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Insuficiencia Multiorgánica/epidemiología , Puntuaciones en la Disfunción de Órganos , Pandemias , Neumonía Viral/epidemiología , Prevalencia , Respiración Artificial/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Choque Séptico/epidemiología
4.
Br J Hosp Med (Lond) ; 81(10): 1-8, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33135911

RESUMEN

Despite initial reports, renal involvement, including acute kidney injury, has emerged as a serious complication of COVID-19 disease, particularly in critically ill patients. The reported prevalence varies considerably, which may reflect reporting practices, although differences in pre-existing comorbidities and socioeconomic factors, and differences between ethnic groups, almost certainly contribute. Renal involvement may present as an active urinary sediment or as changes in serum creatinine levels and urine output leading to acute kidney injury. In common with acute kidney injury complicating critical illness, the cause is often multifactorial and often presents as part of a multiorgan dysfunction syndrome. Treatment is, in the main, supportive, with kidney replacement therapy required in nearly 25% of reported cases. Few data currently exist as to the long-term burden of COVID-19-associated acute kidney injury but evidence suggests that only approximately one-third of patients are discharged with recovered renal function.


Asunto(s)
Lesión Renal Aguda , Infecciones por Coronavirus/complicaciones , Manejo de Atención al Paciente/métodos , Neumonía Viral/complicaciones , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Betacoronavirus , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Enfermedad Crítica/terapia , Humanos , Pruebas de Función Renal , Pandemias , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Terapia de Reemplazo Renal/métodos , Factores de Riesgo
5.
Artículo en Inglés | MEDLINE | ID: mdl-33139595

RESUMEN

Coronavirus (SARS-CoV-2) emerged in China in December 2019 and rapidly caused a global health pandemic. Current evidence seems to suggest a possible link with ecosystem disequilibrium and even air pollution. The primary manifestations affect respiratory and circulatory systems, but neurological features are also being reported through case reports and case series. We summarize neurological symptoms and complications associated with COVID-19. We have searched for original articles published in PubMed/Medline, PubMed Central and Google Scholar using the following keywords: "COVID-19", "Coronavirus", "pandemic", "SARS-COV-2", "neurology", "neurological", "complications" and "manifestations". We found around 1000 publications addressing the issue of neurological conditions associated with COVID-19 infection. Amongst those, headache and dizziness are the most common reported symptoms followed by encephalopathy and delirium, while the most frequent complications are cerebrovascular accidents, Guillain-Barré syndrome, acute transverse myelitis, and acute encephalitis. Specific symptoms affecting the peripheral nervous system such as hyposmia and dysgeusia are the most common manifestations recorded in the selected studies. Interestingly, it was noted that these kinds of neurological symptoms might precede the typical features, such as fever and cough, in COVID patients. Neurological symptoms and complications associated with COVID-19 should be considered as a part of the clinical features of this novel global pandemic.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/psicología , Mareo/etiología , Disgeusia/etiología , Cefalea/etiología , Enfermedades del Sistema Nervioso/fisiopatología , Pandemias , Neumonía Viral/fisiopatología , Neumonía Viral/psicología , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Humanos , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/psicología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología
6.
In Vivo ; 34(6): 3735-3746, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33144492

RESUMEN

BACKGROUND/AIM: This study investigated the correlation of chest computed tomography (CT), findings, graded using two different scoring methods, with clinical and laboratory features and disease outcome, including a novel clinical predictive score, in patients with novel coronavirus-infected pneumonia (NCIP). PATIENTS AND METHODS: In this retrospective, observational study, CT scan of 92 NCIP patients admitted to Policlinico Tor Vergata, were analyzed using a quantitative, computed-based and a semiquantitative, radiologist-assessed scoring system. Correlations of the two radiological scores with clinical and laboratory features, the CALL score, and their association with a composite adverse outcome were assessed. RESULTS: The two scores correlated significantly with each other (ρ=0.637, p<0.0001) and were independently associated with age, LDH, estimated glomerular filtration rate, diabetes, and with the composite outcome, which occurred in 24 patients. CONCLUSION: In NCIP patients, two different radiological scores correlated with each other and with several clinical, laboratory features, and the CALL score. The quantitative score was a better independent predictor of the composite adverse outcome than the semiquantitative score.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Neumonía/diagnóstico por imagen , Tórax/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía/mortalidad , Neumonía/fisiopatología , Neumonía/virología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Neumonía Viral/virología , Tórax/fisiopatología , Tórax/virología , Tomografía Computarizada por Rayos X
7.
F1000Res ; 9: 1107, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33163160

RESUMEN

Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched and extracted as of April 5, 2020. Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/fisiopatología , Humanos , Pandemias , Neumonía Viral/fisiopatología , Factores de Riesgo , Índice de Severidad de la Enfermedad
8.
BMJ Case Rep ; 13(11)2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33139373

RESUMEN

A 27-year-old patient presented with acral chilblain-like lesions atypical of dermatological presentations appearing in current reports of COVID-19. Prominent bullae had formed on the dorsa of her toes and became haemorrhagic 2 days after the initial presentation. The patient had no underlying medical conditions, including any history of collagen vascular disease, Raynaud's phenomenon, chilblains or cold exposure, and was not taking any medications. The patient reported 10 days of ageusia and anosmia 6 weeks prior to the manifestation of her toe lesions, with no other symptoms. A nasopharyngeal swab test for SARS-CoV-2 RNA was positive. It is important that physicians recognise the myriad of cutaneous lesions associated with COVID-19 in this ongoing pandemic.


Asunto(s)
Ageusia , Eritema Pernio/diagnóstico , Infecciones por Coronavirus , Trastornos del Olfato , Pandemias , Neumonía Viral , Dedos del Pie , Adulto , Ageusia/diagnóstico , Ageusia/virología , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Femenino , Humanos , Trastornos del Olfato/diagnóstico , Trastornos del Olfato/virología , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología
9.
BMJ Case Rep ; 13(11)2020 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-33148560

RESUMEN

A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


Asunto(s)
Aspirina/administración & dosificación , Fibrilación Atrial , Ceguera , Infartos del Tronco Encefálico , Infecciones por Coronavirus , Diplopía , Endocarditis Bacteriana , Oftalmoplejía , Pandemias , Neumonía Viral , Pirazoles/administración & dosificación , Piridonas/administración & dosificación , Oclusión de la Arteria Retiniana , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Betacoronavirus/aislamiento & purificación , Ceguera/diagnóstico , Ceguera/etiología , Infartos del Tronco Encefálico/diagnóstico por imagen , Infartos del Tronco Encefálico/tratamiento farmacológico , Infartos del Tronco Encefálico/fisiopatología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diplopía/diagnóstico , Diplopía/etiología , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/fisiopatología , Inhibidores del Factor Xa/administración & dosificación , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Oftalmoplejía/diagnóstico , Oftalmoplejía/etiología , Inhibidores de Agregación Plaquetaria/administración & dosificación , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Oclusión de la Arteria Retiniana/diagnóstico por imagen , Oclusión de la Arteria Retiniana/tratamiento farmacológico , Oclusión de la Arteria Retiniana/etiología , Oclusión de la Arteria Retiniana/fisiopatología , Tomografía de Coherencia Óptica/métodos , Resultado del Tratamiento
10.
BMC Infect Dis ; 20(1): 811, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33158425

RESUMEN

BACKGROUND: Covid-19 is causing a pandemic and forces physicians to restructure their work. We want to share our experience in the outpatient management of potentially-infected patients with special consideration of altered national test strategies during the crisis. METHODS: We analysed patients with respiratory symptoms reporting to our three rural general practitioner (GP) offices in North Rhine-Westphalia, Germany, from 27.01-20.04.2020 (n = 489 from a total of 6090 patients). A history of symptoms was taken at the doorstep following a specific questionnaire. Patients with respiratory symptoms were examined in a separated isolation area, while the others were allowed to enter the office. We applied the first recommended algorithm of the German Robert Koch Institute (RKI) to test suspected patients and compared our results with an adapted, more liberal version of the RKI, which is currently applied in Germany. RESULTS: Eighty patients (16.36%, mean age: 47.03 years+ - 18.08) were sent to a nasopharyngeal smear. Five patients (6.25%) proved to be positive, four of whom had established risk factors for COVID-19. Overall, the most common symptoms were cough (83.75%), sore throat (71.25%), as well as myalgia and fatigue (66.25%). The most common diagnoses were rhinopharyngitis (37.22%) and acute bronchitis (30.27%). A sore throat was more common in positively-tested patients (80% vs. 12%). Applying the first RKI test strategy yielded 6.25% of positive tests (n = 80), while the more liberal later RKI recommendation would have achieved 1.36% positive tests from 369 patients. No positive test was missed by applying the conservative strategy. None of our employees called in sick during this period, which emphasises the efficacy and safety of our screening methods. CONCLUSION: A clinical distinction between ordinary respiratory infections and COVID-19 is not possible in a low-prevalence population. Our model to prevent unprotected physical contact, screen patients in front of the office with protective equipment, and examine respiratory infections in separated areas works in the GP setting without overt health risks for employees. Thus, this approach should be used as a GP standard to uphold patient care without major health risks for the personnel. Large multi-centre studies are necessary to work out the most suitable test strategy.


Asunto(s)
Atención Ambulatoria/métodos , Betacoronavirus , Infecciones por Coronavirus/terapia , Médicos Generales , Neumonía Viral/terapia , Servicios de Salud Rural , Adulto , Anciano , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios
11.
BMC Infect Dis ; 20(1): 824, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176693

RESUMEN

BACKGROUND: In December 2019, the novel coronavirus disease 2019 (COVID-19) emerged in Wuhan, Hubei Province, China. It rapidly spread and many cases were identified in multiple countries, posing a global health problem. Here, we report the first patient cured of COVID-19 infection in Changsha, China, and the symptoms, diagnosis, treatment, and management of this patient are all described in this report. CASE PRESENTATION: A 57-year-old woman developed cough and fever after returning to Changsha from Wuhan on January 9, 2020. She tested positive for COVID-19 infection, a diagnosis which was supported by chest CT. The patient was treated with lopinavir and ritonavir tablets and interferon alfa-2b injection. A low dose of glucocorticoids was used for a short period to control bilateral lung immune response, and this patient avoided being crushed by cytokine storms that might have occurred. The clinical condition of this patient improved, and a COVID-19 assay conducted on January 25, 2020 generated negative results. This patient recovered and was discharged on January 30, 2020. CONCLUSIONS: Currently, there are numerous reports on COVID-19 infections focusing on the disease's epidemiological and clinical characteristics. This case describes the symptoms, diagnosis, treatment, and management of a patient cured of COVID-19 infection, which may serve as reference for future cases, while further studies are needed.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Inhibidores de la Proteasa del VIH/uso terapéutico , Interferón alfa-2/uso terapéutico , Lopinavir/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Ritonavir/uso terapéutico , China , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Tos , Femenino , Fiebre , Humanos , Pulmón/diagnóstico por imagen , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
12.
Molecules ; 25(21)2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33147850

RESUMEN

Zebrafish has been a reliable model system for studying human viral pathologies. SARS-CoV-2 viral infection has become a global chaos, affecting millions of people. There is an urgent need to contain the pandemic and develop reliable therapies. We report the use of a humanized zebrafish model, xeno-transplanted with human lung epithelial cells, A549, for studying the protective effects of a tri-herbal medicine Coronil. At human relevant doses of 12 and 58 µg/kg, Coronil inhibited SARS-CoV-2 spike protein, induced humanized zebrafish mortality, and rescued from behavioral fever. Morphological and cellular abnormalities along with granulocyte and macrophage accumulation in the swim bladder were restored to normal. Skin hemorrhage, renal cell degeneration, and necrosis were also significantly attenuated by Coronil treatment. Ultra-high-performance liquid chromatography (UHPLC) analysis identified ursolic acid, betulinic acid, withanone, withaferine A, withanoside IV-V, cordifolioside A, magnoflorine, rosmarinic acid, and palmatine as phyto-metabolites present in Coronil. In A549 cells, Coronil attenuated the IL-1ß induced IL-6 and TNF-α cytokine secretions, and decreased TNF-α induced NF-κB/AP-1 transcriptional activity. Taken together, we show the disease modifying immunomodulatory properties of Coronil, at human equivalent doses, in rescuing the pathological features induced by the SARS-CoV-2 spike protein, suggesting its potential use in SARS-CoV-2 infectivity.


Asunto(s)
Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Extractos Vegetales/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Glicoproteína de la Espiga del Coronavirus/antagonistas & inhibidores , Sacos Aéreos/efectos de los fármacos , Sacos Aéreos/virología , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Cromatografía Líquida de Alta Presión/métodos , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/fisiopatología , Modelos Animales de Enfermedad , Fiebre/tratamiento farmacológico , Fiebre/etiología , Hemorragia/prevención & control , Humanos , Interleucina-6/metabolismo , Riñón/efectos de los fármacos , Necrosis/patología , Necrosis/prevención & control , Pandemias , Fitoterapia , Neumonía Viral/patología , Neumonía Viral/fisiopatología , Mucosa Respiratoria/trasplante , Activación Transcripcional/efectos de los fármacos , Factor de Necrosis Tumoral alfa/metabolismo , Pez Cebra
13.
BMJ Open Respir Res ; 7(1)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33148777

RESUMEN

OBJECTIVE: To evaluate the role of continuous positive air pressure (CPAP) in the management of respiratory failure associated with COVID-19 infection. Early clinical management with limited use of CPAP (3% of patients) was compared with a later clinical management strategy which had a higher proportion of CPAP use (15%). DESIGN: Retrospective case-controlled service evaluation for a single UK National Health Service (NHS) Trust during March-June 2020 designed and conducted solely to estimate the effects of current care. SETTING: The acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized English NHS Trust. PARTICIPANTS: 206 patients with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 and 3 April 2020 for the early group (controls), and between 10 April 2020 and 11 May 2020 for the late group (cases). Follow-up for all cases was until 11 June by which time all patients had a final outcome of death or discharge. Both groups were composed of 103 patients. Cases and controls were matched by age and sex. OUTCOME MEASURE: The outcome measure was the proportion of patients surviving at time t (time from the positive result of COVID-19 test to discharge/death date). The predictors were CPAP intervention, intubation, residence in care homes and comorbidities (renal, pulmonary, cardiac, hypertension and diabetes). A stratified Cox proportional hazard for clustered data (via generalised estimating equations) and model selection algorithms were employed to identify the effect of CPAP on patients' survival and the effect on gas exchange as measured by alveolar arterial (A-a) gradient and timing of CPAP treatment on CPAP patients' survival. RESULTS: CPAP was found to be significantly (HR 0.38, 95% CI 0.36 to 0.40) associated with lower risk of death in patients with hospital stay equal to, or below 7 days. However, for longer hospitalisation CPAP was found to be associated with increased risk of death (HR 1.72, 95% CI 1.40 to 2.12). When CPAP was initiated within 4 days of hospital admission, the survival probability was above 73% (95% CI 53% to 99%). In addition, lower A-a gradient was associated with lower risk of death in CPAP patients (HR 1.011, 95% CI 1.010 to 1.013). The selected model (best fit) was stratified by sex and clustered by case/control groups. The predictors were age, intubation, hypertension and the residency from care homes, which were found to be statistically significantly associated with patient's death/discharge. CONCLUSIONS: CPAP is a simple and cost-effective intervention. It has been established for care of other respiratory disorders but not for COVID-19 respiratory failure. This evaluation establishes that CPAP as a potentially viable treatment option for this group of patients during the first days of hospital admission. As yet there is limited availability of quantitative research on CPAP use for COVID-19. Whist this work is hampered by both the relatively small sample size and retrospective design (which reduced the ability to control potential confounders), it represents evidence of the significant benefit of early CPAP intervention. This evaluation should stimulate further research questions and larger study designs on the potential benefit of CPAP for COVID-19 infections. Globally, this potentially beneficial low cost and low intensity therapy could have added significance economically for healthcare provision in less developed countries.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Insuficiencia Respiratoria/terapia , Factores de Edad , Anciano , Betacoronavirus , Estudios de Casos y Controles , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Femenino , Humanos , Hipertensión/complicaciones , Pacientes Internos/estadística & datos numéricos , Intubación Intratraqueal , Tiempo de Internación , Masculino , Casas de Salud , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Modelos de Riesgos Proporcionales , Intercambio Gaseoso Pulmonar , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/virología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo
14.
BMC Infect Dis ; 20(1): 749, 2020 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-33050892

RESUMEN

BACKGROUND: Two months after the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, tens of thousands of hospitalized patients had recovered, and little is known about the follow-up of the recovered patients. METHODS: The clinical characteristics, reverse transcriptase-polymerase chain reaction (RT-PCR) results from throat swab specimens and the results of serological COVID-19 rapid diagnostic test (RDT) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were retrospectively reviewed for a total of 758 recovered patients who were previously hospitalized in 17 hospitals and quarantined at 32 rehabilitation stations in Wuhan, China. RESULTS: In total, 59 patients (7.78%) had recurrent positive findings for COVID-19 on RT-PCR from throat swabs. With regard to antibody detection, 50/59 (84.75%) and 4/59 (6.78%) patients had positive IgG or dual positive IgG/IgM RDT results, respectively. CONCLUSIONS: Some patients who had been quarantined and had subsequently recovered from COVID-19 had recurrent positive RT-PCR results for SARS-CoV-2, and the possibility of transmission of the virus by recovered patients needs further investigation. TRIAL REGISTRATION: Current Controlled Trials ChiCTR2000033580 , Jun 6th 2020. Retrospectively registered.


Asunto(s)
Betacoronavirus/genética , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Síndrome Respiratorio Agudo Grave/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Niño , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/fisiopatología , Neumonía Viral/transmisión , Neumonía Viral/virología , Estudios Retrospectivos , Factores de Riesgo , Síndrome Respiratorio Agudo Grave/fisiopatología , Síndrome Respiratorio Agudo Grave/virología , Adulto Joven
16.
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
18.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artículo en Italiano | MEDLINE | ID: mdl-33026202

RESUMEN

We report the case of a 68-year-old patient who arrived at the hospital with a fever and a cough for 7 days, a history of high blood pressure and chronic kidney failure stage 2 according to CKD-EPI (GFR: 62 ml/minute with creatinine: 1.2 mg/dl). Home therapy included lercanidipine and clonidine. A chest radiograph performed in the emergency department immediately showed images suggestive of pneumonia from COVID-19, confirmed in the following days by a positive swab for coronavirus. Kidney function parameters progressively deteriorated towards a severe acute kidney failure on the 15th day, with creatinine values of 6.6 mg/dl and urea of 210 mg/dl. The situation was managed first in the intensive care unit with CRRT cycles (continuous renal replacement therapy) and then in a "yellow area" devoted to COVID patients, where the patient was dialyzed by us nephrologists through short cycles of CRRT. In our short experience we have used continuous techniques (CRRT) in positive patients hemodynamically unstable and intermittent dialysis (IRRT) in our stable chronic patients with asymptomatic COVID -19. We found CRRT to be superior in hemodynamically unstable patients hospitalized in resuscitation and in the "yellow area". Dialysis continued with high cut-off filters until the normalization of kidney function; the supportive medical therapy has also improved the course of the pathology and contributed to the favorable outcome for our patient. During the COVID-19 pandemic, our Nephrology Group at Savona's San Paul Hospital has reorganized the department to better manage both chronic dialyzed patients and acute patients affected by the new coronavirus.


Asunto(s)
Lesión Renal Aguda/terapia , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pandemias , Neumonía Viral/complicaciones , Lesión Renal Aguda/diagnóstico por imagen , Lesión Renal Aguda/etiología , Lesión Renal Aguda/fisiopatología , Anciano , Antihipertensivos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus/fisiología , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Creatinina/sangre , Cuidados Críticos/métodos , Manejo de la Enfermedad , Hemodinámica , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Comunicación Interdisciplinaria , Fallo Renal Crónico/complicaciones , Masculino , Grupo de Atención al Paciente , Aislamiento de Pacientes , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Diálisis Renal/métodos , Respiración Artificial , Urea/sangre
19.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028572

RESUMEN

A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks' duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing's sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Neumonía Viral/diagnóstico , Sarcoma de Ewing , Tomografía Computarizada por Rayos X/métodos , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica , Examen de la Médula Ósea/métodos , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/fisiopatología , Neoplasias Pulmonares/secundario , Masculino , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/fisiopatología , Tomografía Computarizada de Emisión de Fotón Único/métodos
20.
Geriatr Psychol Neuropsychiatr Vieil ; 18(2): 135-139, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33048052

RESUMEN

The COVID-19 pandemic affects older adults particularly severely. Our objective was to identify from the international literature the symptoms most commonly experienced by older adults infected with SARS-CoV-2. This systematic literature review was conducted using MEDLINE between 1 December 2019 and 13 April 2020. The methodological quality analysis used a method dedicated to case series and case reports. Of the 260 articles initially identified, only two studies were ultimately included in the qualitative analysis. The mean age was relatively low, between 71 and 74 years on average. COVID-19 symptoms were as follows: fever, dry cough, dyspnoea, asthenia, anorexia, chest tightness, diarrhoea and, to a lesser extent, myalgia, pharyngitis, nausea, dizziness, headache, abdominal pain, and vomiting. Lymphopenia was noted from complete blood counts. In conclusion, this systematic review of the international literature reveals a lack of data about the semiology of COVID-19 in older adults, especially in very elderly frail people, who are normally considered to constitute the geriatric population. The national survey conducted by the Société Française de Gériatrie et Gérontologie will help bridge this semiological gap.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Anciano Frágil , Humanos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología
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