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1.
Ann Med ; 53(1): 78-86, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-32997542

RESUMEN

BACKGROUND: Identification of patients with novel coronavirus disease 2019 (COVID-19) requiring hospital admission or at high-risk of in-hospital mortality is essential to guide patient triage and to provide timely treatment for higher risk hospitalized patients. METHODS: A retrospective multi-centre (8 hospital) cohort at Beaumont Health, Michigan, USA, reporting on COVID-19 patients diagnosed between 1 March and 1 April 2020 was used for score validation. The COVID-19 Risk of Complications Score was automatically computed by the EHR. Multivariate logistic regression models were built to predict hospital admission and in-hospital mortality using individual variables constituting the score. Validation was performed using both discrimination and calibration. RESULTS: Compared to Green scores, Yellow Scores (OR: 5.72) and Red Scores (OR: 19.1) had significantly higher odds of admission (both p < .0001). Similarly, Yellow Scores (OR: 4.73) and Red Scores (OR: 13.3) had significantly higher odds of in-hospital mortality than Green Scores (both p < .0001). The cross-validated C-Statistics for the external validation cohort showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77-0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71-0.78)). CONCLUSIONS: The COVID-19 Risk of Complications Score predicts the need for hospital admission and in-hospital mortality patients with COVID-19. Key points: Can an electronic health record generated risk score predict the risk of hospital admission and in-hospital mortality in patients diagnosed with coronavirus disease 2019 (COVID-19)? In both validation cohorts of 2,025 and 1,290 COVID-19, the cross-validated C-Statistics showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77-0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71-0.78)), respectively. The COVID-19 Risk of Complications Score may help predict the need for hospital admission if a patient contracts SARS-CoV-2 infection and in-hospital mortality for a hospitalized patient with COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Enfermedad Crítica/mortalidad , Mortalidad Hospitalaria , Neumonía Viral/mortalidad , Adulto , Anciano , Estudios de Cohortes , Infecciones por Coronavirus/terapia , Enfermedad Crítica/terapia , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/terapia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
2.
Ann Med ; 53(1): 103-116, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33063540

RESUMEN

BACKGROUND: Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. METHODS: This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. RESULTS: Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. CONCLUSIONS: Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. KEY MESSAGE Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Hiperglucemia/complicaciones , Neumonía Viral/mortalidad , Sistema de Registros , Anciano , Anciano de 80 o más Años , Glucemia , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Cuidados Críticos/estadística & datos numéricos , Femenino , Humanos , Hiperglucemia/mortalidad , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Respiración Artificial/estadística & datos numéricos , España/epidemiología
3.
Ann Med ; 53(1): 151-159, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33138653

RESUMEN

OBJECTIVE: To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the USA. MATERIALS AND METHODS: Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests and mortality from March 14th through April 30th. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses. RESULTS: A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p < .01), transportation volume (beta coefficient 0.1, p < .01), tourism index (beta coefficient -0.1, p = .02) and older age (beta coefficient 0.2, p = .01) are associated with case frequency and percent mortality. CONCLUSIONS: There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality. Key messages There were wide variations in testing and case frequencies of COVID-19 among different states in the USA. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.


Asunto(s)
Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Pandemias , Neumonía Viral/diagnóstico , Estados Unidos/epidemiología
4.
Rev. bioét. derecho ; (50): 81-98, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191347

RESUMEN

Las medidas de seguridad de salud pública tomadas en todo el mundo para detener el ascenso de contagios por SARS-CoV-2 ha despertado el interés por determinados aspectos de la ética asistencial. Se ha hablado ampliamente de las recomendaciones médicas para priorizar la atención sanitaria de pacientes críticos o la distribución equitativa de recursos bajo la amenaza de saturación de los servicios. No obstante, se ha prestado mínima atención a la soledad inevitable de los enfermos con COVID-19 al final de sus vidas. Los procedimientos y normativas de seguridad sanitaria actuales exigen el aislamiento de las personas diagnosticados con COVID-19 o de aquellas bajo sospecha de contagio por falta de pruebas confirmatorias. Estas pautas de actuación conllevan una serie de condiciones que atentan los derechos del paciente, con especial relevancia al final de vida, como el derecho a una muerte digna y al acompañamiento, y que contribuyen a un elevado número de muertes en soledad. Si bien el aislamiento es una de las medidas de prevención de la infección más eficaces, es necesario adaptar un protocolo para situaciones de final de vida que contemple flexibilizar el aislamiento de estos pacientes siempre que haya una voluntad expresa por su parte. El presente manuscrito analiza la vulneración de los derechos del paciente al final de vida en situación de emergencia sanitaria y plantea una serie de recomendaciones para promover el respeto a su libertad y autonomía sin que ello suponga la asunción de riesgo colectivo excesivo


Public health security measures launched worldwide in order to prevent the rapid transmission of SARS-CoV-2 have renewed the interest in certain aspects of health care ethics. General medical recommendations such as critically ill patient prioritization or equitable distribution of scarce resources have been widely discussed. Nevertheless, little consideration has so far been given to the loneliness of patients with COVID- 19 at the end of their lives. Present health safety policies and regulations inevitably entail the isolation of people diagnosed with COVID-19 or those suspected of being infected -due to shortage of diagnostic tests. This procedure necessarily spells patient's rights violation particularly affecting the right to a dignified death and end-of-life care, thus contributing to a high number of lonely deaths. Although the isolation is one of the best strategies to prevent the infection, it is needed to ease such policy towards a relaxation of these measures whenever patients expressly requests it. To this aim, the current manuscript analyzes patient end-of-life right infringements within the context of the health crisis caused by COVID-19 and provides recommendations to promote respect for their freedom and autonomy with negligible social risk-taking


Les mesures de seguretat de salut pública preses a tot el món per aturar l'ascens de contagis per SARS-CoV-2 han despertat l'interès per determinats aspectes de l'ètica assistencial. S'ha parlat àmpliament de les recomanacions ètiques per prioritzar l'atenció de pacients crítics o la distribució equitativa de recursos sota l'amenaça de saturació dels serveis. Malauradament, s'ha prestat una atenció mínima a la solitud inevitable dels malalts amb COVID-19 a la fi de les seves vides. Els procediments I normatives de seguretat sanitària actuals exigeixen l'aïllament de les persones diagnosticats amb COVID-19 o d'aquelles sota sospita de contagi per falta de proves confirmatòries. Aquestes pautes d'actuació comporten una sèrie de condicions que atempten els drets del pacient, amb especial rellevància al final de vida, com el dret a una mort digna I a l'acompanyament, I que contribueixen a un elevat nombre de morts en soledat. Si bé l'aïllament és una de les mesures de prevenció de la infecció més eficaces, és necessari adaptar un protocol per a situacions de final de vida que contempli flexibilitzar l'aïllament d'aquests pacients sempre que hi hagi una voluntat expressa per part seva. El present manuscrit analitza la vulneració dels drets del pacient a la fi de vida en situació d'emergència sanitària I planteja una sèrie de recomanacions per promoure el respecte a la seva llibertat I autonomia sense que això suposi l'assumpció d'una amenaça col·lectiva excesiva


Asunto(s)
Humanos , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Pandemias , Soledad , Aislamiento de Pacientes , Cuidados Paliativos al Final de la Vida
5.
Rev. bioét. derecho ; (50): 149-166, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191351

RESUMEN

Se presenta una reflexión de la valía e importancia de los talleres de filosofía, inscritos en el Proyecto Boecio, que se han llevado a cabo en el Reclusorio Femenil de Santa Martha Acatitla y Reclusorio Varonil Oriente, ambos en Ciudad de México. Se mencionarán los contenidos y aprendizajes de dichos talleres, los cuales han sido significativos para las personas privadas de su libertad, para sobrellevar su proceso judicial, y el sobrevivir su "encierro", así como también, la manera en que sus familiares y amistades han sido beneficiados con dichos aprendizajes de sus seres queridos en reclusión, al brindarles herramientas para sobrellevar el estar "encerrados en casa" por la cuarentena de la COVID-19


This is a reflection about the value and importance of the philosophy workshops, registered in the Boethius Project, which have been carried out at the Santa Martha Acatitla's Womens Prison and East Men's Prison both of them in Mexico City. The contents and learning from these workshops will be mentioned, which have been signicant for the people in prison, to survive their judicial process and "confinement", as well as the way in which their family and friends have been benefitied with these learnings from their loved ones in jail, by providing then with tools to support "Stay in home" by the COVID-19 quarantine


Es presenta una reflexió de la importància dels tallers de filosofia, inscrits en el Projecte Boeci, que s'han dut a terme en el Reclusorio Femenil de Santa Martha Acatitla y Reclusorio Varonil Oriente, tots dos a Ciutat de Mèxic. Es parlarà dels continguts I aprenentatges d'aquests tallers, els quals han estat significatius per a les persones privades de la seva llibertat, per suportar el seu procés judicial, I sobreviure el seu "tancament", així com també, la manera en què els seus familiars I amistats s'han beneficiat d'aquests aprenentatges dels seus éssers estimats en reclusió, en poder brindar-los eines per a suportar l'estar "tancats a casa" per la quarantena de la COVID-19


Asunto(s)
Humanos , Masculino , Femenino , Prisiones/ética , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Bioética , México
6.
s.l; Organización Panamericana de la Salud; nov. 12, 2020. 5 p.
No convencional en Español | LILACS | ID: biblio-1128907

RESUMEN

La letalidad acumulada es de 2.16, llegando en la semana 43 a 1.278 muertes por COVID-19. Comparando los meses de agosto (245 muertes), septiembre (531), y octubre (482) -datos preliminares-; se visualiza un aumento en la tasa de letalidad de 2,2% en agosto, 2,3% en septiembre y 2,4% en octubre del 2020. Los fallecidos se concentran en el departamento Central y la capital, Asunción. Las muertes confirmadas por COVID-19 de las últimas dos semanas fueron 223. Es importante notar que esta semana se reporta una disminución en el promedio de muertes diarias por COVID-19 de 19 por día a 15,9 fallecidos por día; siempre con predominio en el grupo etario de 60 años y más (73%), entre 50 y 59 años (15%) y en grupo etario entre 40 y 49 años (9%). El resto de los grupos etarios representa solo 6%. Continúa el predominio del sexo masculino en un 67%.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Neumonía Viral/mortalidad , Infecciones por Coronavirus/mortalidad , Pandemias/estadística & datos numéricos , Betacoronavirus , Paraguay/epidemiología
7.
Goiânia; s.n; 06 nov. 2020. 1-23 p. ilus, tab, mapas, graf.(Boletim Epidemiológico Covid-19, 31).
Monografía en Portugués | Coleciona SUS, CONASS, SES-GO | ID: biblio-1128737

RESUMEN

O Boletim epidemiológico COVID-19, da Secretaria de Estado da Saúde do Estado de Goiás (SES-GO) objetiva apresentar as informações oficiais da situação epidemiológica referente ao período compreendido entre 04 de fevereiro à 31 de outubro de 2020. No Estado de Goiás, 255.744 (35,3%) foram confirmados sendo 244.877 (95,8%) por critério laboratorial, 7.152 (2,8%) pelo critério clínico epidemiológico, 1.054 (0,4%) por critério clínico-imagem e 2.106 (0,8%) pelo critério clínico, 226.894 (31,3%) foram descartados e 242.166 (33,4%) continuam como suspeitos. Na SE 44 foram realizados 601 testes (26,9% a menos do que na SE anterior), sendo 120 (19,9%) positivos e 480 (79,9%) negativos e 1 (0,2) inconclusivo


The epidemiological bulletin COVID-19, of the State Department of Health of the State of Goiás (SES-GO) aims to present the official information of the epidemiological situation referring to the period from February 4 to October 31, 2020. In the State of Goiás, 255,744 (35.3%) were confirmed, with 244,877 (95.8%) by laboratory criterion, 7,152 (2.8%) epidemiological clinical criterion, 1,054 (0.4%) by clinical-imaging criterion and 2,106 (0.8%) by clinical criterion, 226,894 (31.3%) were discarded and 242,166 (33.4%) remain as suspects. In the SE 44, 601 tests were performed (26.9% less than in the previous SE), 120 (19.9%) positive and 480 (79.9%) negative and 1 (0.2) inconclusive


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Neumonía Viral/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Betacoronavirus , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Brasil/epidemiología , Incidencia , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Monitoreo Epidemiológico
8.
Goiânia; s.n; Nov. 13, 2020. 1-22 p. ilus, mapas, graf, tab.(Boletim Epidemiológico Covid-19, 32).
Monografía en Portugués | Coleciona SUS, CONASS, SES-GO | ID: biblio-1128966

RESUMEN

O Boletim epidemiológico COVID-19, da Secretaria de Estado da Saúde do Estado de Goiás (SES-GO) objetiva apresentar as informações oficiais da situação epidemiológica do Estado de Goiás referente ao período compreendido entre 04 de fevereiro a 07 de novembro de 2020. Nesta última semana epidemiológica (SE 45) houve a confirmação de 5.895 casos novos, representando uma redução de 29%, inferior a redução observada no Brasil, 75%. No Estado, 261.639 (35,3%) foram confirmados sendo 250.066 (95,6%) por critério laboratorial, 7.544 (2,9%) pelo critério clínico epidemiológico, 1.157 (0,4%) por critério clínico-imagem e 2.262 (0,9%) pelo critério clínico, 235.601 (31,8%) foram descartados e 243.031 (32,8%) continuam como suspeitos. Na SE 45 foram realizados 460 testes (23,4% a menos do que na SE anterior), sendo 80 (17,3%) positivos, 379 (82,3%) negativos e 2 (0,4) inconclusivos


The epidemiological bulletin COVID-19, of the State Department of Health of the State of Goiás (SES-GO) aims to present the official information of the epidemiological situation of the State of Goiás for the period from February 4 to November 7, 2020. In this last epidemiological week (SE 45) there was confirmation of 5,895 new cases, representing a reduction of 29%, lower than the reduction observed in Brazil, 75%. In the State, 261,639 (35.3%) were confirmed being 250,066 (95.6%) by laboratory criterion, 7,544 (2.9%) by epidemiological clinical criterion, 1,157 (0.4%) by clinical-imaging criterion and 2,262 (0.9%) by clinical criterion, 235,601 (31.8%) were discarded and 243,031 (32.8%) remain as suspects. In the SE 45, 460 tests were performed (23.4% less than in the previous SE), 80 (17.3%) positive, 379 (82.3%) negative and 2 (0.4) inconclusive


Asunto(s)
Humanos , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Neumonía Viral/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Betacoronavirus , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Brasil/epidemiología , Incidencia , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Monitoreo Epidemiológico
9.
Open Heart ; 7(2)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33154144

RESUMEN

OBJECTIVE: The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear. We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension. METHODS: PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and medrxiv.org were searched from 1 January 2020 to 1 September 2020. Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified. RESULTS: Fourteen studies were included in the systematic review (n=73,073 patients with COVID-19; mean age 61 years; 53% male). Overall, the between-study heterogeneity was high (I2=80%, p<0.01). Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0.65, 95% CI 0.45 to 0.94). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as 'moderate' quality. CONCLUSIONS: In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension. Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension. PROSPERO REGISTRATION NUMBER: The present study has been registered with PROSPERO (registration ID: CRD 42020187963).


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Infecciones por Coronavirus/mortalidad , Hospitalización , Hipertensión/tratamiento farmacológico , Neumonía Viral/mortalidad , Sistema Renina-Angiotensina/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
10.
Acta Med Port ; 33(11): 733-741, 2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33160423

RESUMEN

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


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Urgencias Médicas/epidemiología , Epidemias/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Política Pública/legislación & jurisprudencia , Cuarentena/métodos , Ocupación de Camas , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Cuidados Críticos/estadística & datos numéricos , Epidemias/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Portugal/epidemiología , Cuarentena/estadística & datos numéricos
11.
PLoS One ; 15(11): e0241947, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33166346

RESUMEN

BACKGROUND: A recent cluster of pneumonia cases in Wuhan, China, has been caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We propose the protocol described below to perform an individual-patient data (IPD) network meta-analysis (NMA) in order to evaluate the efficacies of different antiviral drugs to treat patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: We will search the Medline, EMBASE, Cochrane Library, SinoMed, CNKI and VIP databases from their inceptions through July 2020. There will be no restrictions on language, publication year, or publication type. Randomized clinical trials (RCTs) and prospective cohort studies with antiviral treatments for COVID-19 will be considered. Two reviewers will independently select studies and collect data. Risk-of-bias assessments will be completed using the Cochrane risk-of-bias scale. Primary outcome will be the COVID-19 recovery rate. We will combine aggregated data from IPD with the NMA in a single model, compare the effects of different antiviral drugs on patient-relevant efficacy, and rank the results to decide which is the most effective. TRIAL REGISTRATION: PROSPERO registration number: CRD42020167038.


Asunto(s)
Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Bases de Datos Factuales , Humanos , Metaanálisis en Red , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/patología , Neumonía Viral/virología , Ensayos Clínicos Controlados Aleatorios como Asunto , Riesgo , Resultado del Tratamiento
12.
PLoS One ; 15(11): e0242045, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33166991

RESUMEN

Coronavirus Disease 2019 (COVID-19) has recently become a public emergency and a worldwide pandemic. However, the information on the risk factors associated with the mortality of COVID-19 and of their prognostic potential is limited. In this retrospective study, the clinical characteristics, treatment and outcome data were collected and analyzed from 676 COVID-19 patients stratified into 140 non-survivors and 536 survivors. We found that the levels of Dimerized plasmin fragment D (D-dimer), C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT) were significantly higher in non-survivals on admission (non-survivors vs. survivors: D-Dimer ≥ 0.5 mg/L, 83.2% vs. 44.9%, P<0.01; CRP ≥10 mg/L, 50.4% vs. 6.0%, P<0.01; LDH ≥ 250 U/L, 73.8% vs. 20.1%, P<0.01; PCT ≥ 0.5 ng/ml, 27.7% vs. 1.8%, P<0.01). Moreover, dynamic tracking showed D-dimer kept increasing in non-survivors, while CRP, LDH and PCT remained relatively stable after admission. D-dimer has the highest C-index to predict in-hospital mortality, and patients with D-dimer levels ≥0.5 mg/L had a higher incidence of mortality (Hazard Ratio: 4.39, P<0.01). Our study suggested D-dimer could be a potent marker to predict the mortality of COVID-19, which may be helpful for the management of patients.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Neumonía Viral/mortalidad , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Proteína C-Reactiva/análisis , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Femenino , Humanos , Estimación de Kaplan-Meier , L-Lactato Deshidrogenasa/análisis , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/patología , Neumonía Viral/virología , Polipéptido alfa Relacionado con Calcitonina/análisis , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo
13.
BMC Cardiovasc Disord ; 20(1): 479, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33167876

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic. Studies showed COVID-19 affected not only the lung but also other organs. In this study, we aimed to explore the cardiac damage in patients with COVID-19. METHODS: We collected data of 100 patients diagnosed as severe type of COVID-19 from February 8 to April 10, 2020, including demographics, illness history, physical examination, laboratory test, and treatment. In-hospital mortality were observed. Cardiac damage was defined as plasma hypersensitive troponin I (hsTnI) over 34.2 pg/ml and/or N-terminal-pro brain natriuretic peptide (NTproBNP) above 450 pg/ml at the age < 50, above 900 pg/ml at the age < 75, or above 1800 pg/ml at the age ≥ 75. RESULTS: The median age of the patients was 62.0 years old. 69 (69.0%) had comorbidities, mainly presenting hypertension, diabetes, and cardiovascular disease. Fever (69 [69.0%]), cough (63 [63.0%]), chest distress (13 [13.0%]), and fatigue (12 [12.0%]) were the common initial symptoms. Cardiac damage occurred in 25 patients. In the subgroups, hsTnI was significantly higher in elder patients (≥ 60 years) than in the young (median [IQR], 5.2 [2.2-12.8] vs. 1.9 [1.9-6.2], p = 0.018) and was higher in men than in women (4.2 [1.9-12.8] vs. 2.9 [1.9-7.4], p = 0.018). The prevalence of increased NTproBNP was significantly higher in men than in women (32.1% vs. 9.1%, p = 0.006), but was similar between the elder and young patients (20.0% vs. 25.0%, p = 0.554). After multivariable analysis, male and hypertension were the risk factors of cardiac damage. The mortality was 4.0%. CONCLUSIONS: Cardiac damage exists in patients with the severe type of COVID-19, especially in male patients with hypertension. Clinicians should pay more attention to cardiac damage.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Cardiopatías/etiología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Neumonía Viral/complicaciones , Factores de Edad , Anciano , Biomarcadores/sangre , China , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Femenino , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Troponina I/sangre
14.
Open Heart ; 7(2)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33168640

RESUMEN

The COVID-19, due to SARS-CoV-2, has uncovered many real-world issues when it comes to healthcare management and has led to a widespread mortality. Observations thus far from the reports of COVID-19 have indicated that certain risk groups for example, those with pre-existing cardiovascular (CV) disease, hypertension, diabetes, chronic kidney disease and tobacco use are prone to disease development and specifically development of severe disease and possible fatality. It is increasingly evident that many CV conditions occur frequently. These include myopericarditis, acute coronary syndromes, thrombosis, arrhythmias, hypertension and heart failure. Many professional organisations and societies related to cardiology have produced guidelines or recommendations on most of the above-mentioned aspects. Given these rapid developments, the aims of this review manuscript were to summarise and integrate recent publications with newly developed guidelines and with the first-hand experience of frontline physicians and to yield a pragmatic insight and approach to CV complications of COVID-19. We emphasise on a strategic tier-based approach for initial assessment and management of COVID-19, and then delve into focused areas within CV domains, and additionally highlighting the role of point-of-care ultrasound especially lung ultrasound, echocardiography and electrocardiography, in the management of these patients. We hope this paper will serve as a useful tool in the CV management of COVID-19 for clinicians practicing in both developing and developed countries.


Asunto(s)
Enfermedades Cardiovasculares/terapia , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Medicina Basada en la Evidencia , Humanos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Pronóstico , Medición de Riesgo , Factores de Riesgo
15.
J Cardiovasc Pharmacol ; 76(5): 540-548, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33170591

RESUMEN

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. This study sought to share our experiences with in-hospital management and outcomes of acute myocardial infarction (AMI) during the COVID-19 pandemic. We retrospectively analyzed consecutive AMI patients, including those with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), from February 1, 2020, to April 15, 2020 (during the COVID-19 pandemic), and from January 1, 2019, to December 31, 2019 (before the COVID-19 pandemic), respectively. Fifty-three AMI patients (31 STEMI, 22 NSTEMI) during the COVID-19 pandemic were matched to 53 AMI patients before the pandemic. Baseline characteristics were comparable between the matched patients. STEMI patients during the COVID-19 pandemic had a longer delay time, less primary or remedial PCI and more emergency thrombolysis than those before the pandemic. Less coronary angiography and stenting were performed in AMI patients during the COVID-19 pandemic than before the pandemic. There were no statistically significant differences in the clinical outcomes between the matched patients. However, STEMI patients during the COVID-19 pandemic had a 4-fold (12.9% vs. 3.2%) increase in all-cause mortality rate compared with those before the pandemic. AMI combined with COVID-19 infection was associated with higher rates of mortality than AMI alone. This study demonstrates that the COVID-19 pandemic results in significant reperfusion delays in STEMI patients and has a marked impact on the treatment options selection in AMI patients. The mortality rate of STEMI patients exhibits an increasing trend during the pandemic of COVID-19.


Asunto(s)
Servicio de Cardiología en Hospital/tendencias , Infecciones por Coronavirus , Infarto del Miocardio sin Elevación del ST/terapia , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Pandemias , Intervención Coronaria Percutánea/tendencias , Neumonía Viral , Infarto del Miocardio con Elevación del ST/terapia , Terapia Trombolítica/tendencias , Tiempo de Tratamiento/tendencias , Anciano , China , Angiografía Coronaria/tendencias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/mortalidad , Admisión del Paciente , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Estudios Retrospectivos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Factores de Tiempo , Resultado del Tratamiento
16.
Open Biol ; 10(11): 200213, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33171068

RESUMEN

COVID-19 pandemic has caused a global lockdown in many countries throughout the world. Faced with a new reality, and until a vaccine or efficient treatment is found, humanity must figure out ways to keep the economy going, on one hand, while keeping the population safe, on the other hand, especially those that are susceptible to this virus. Here, we use a Watts-Strogatz network simulation, with parameters that were drawn from what is already known about the virus, to explore five different scenarios of partial lockdown release in two geographical locations with different age distributions. We find that separating age groups by reducing interactions between them protects the general population and reduces mortality rates. Furthermore, the addition of new connections within the same age group to compensate for the lost connections outside the age group still has a strong beneficial influence and reduces the total death toll by about 62%. While complete isolation from society may be the most protective scenario for the elderly population, it would have an emotional and possibly cognitive impact that might outweigh its benefit. Therefore, we propose creating age-related social recommendations or even restrictions, thereby allowing social connections while still offering strong protection for the older population.


Asunto(s)
Simulación por Computador , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adolescente , Adulto , Factores de Edad , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Humanos , Lactante , Recién Nacido , Israel/epidemiología , Italia/epidemiología , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/patología , Neumonía Viral/virología , Adulto Joven
17.
Ther Adv Respir Dis ; 14: 1753466620963035, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33138694

RESUMEN

AIM: To investigate clinical characteristics and identify risk factors for severity of coronavirus disease 2019 (COVID-19) pneumonia outside of Wuhan, China. MATERIALS AND METHODS: We included 213 patients with confirmed COVID-19 who had been discharged or died by 15 March 2020. We retrospectively collected epidemiological, clinical, laboratory, computed tomography imaging and outcome data. Clinical characteristics were described and relative risk factors were compared. RESULTS: Most clinical characteristics of this study were similar to those from studies in Wuhan, but there were lower mortality rate and milder severity. The median time from onset of symptoms to confirmation and hospitalization was 4 and 5 days, respectively. The median virus clearance and shedding times were 10 and 15 days, respectively. When the severe/critical group was compared with the mild/moderate group, significant risk factors included: older age; dyspnea; hypertension; poor appetite; fatigue; higher white cell count, neutrophil count, prothrombin time, creatine kinase, creatine kinase-MB, D-dimer, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and C-reactive protein; and lower lymphocyte count and albumin (p < 0.05). In the intensive care unit (ICU) group compared with the non-ICU group, risk factors included: older age; chronic obstructive pulmonary disease (COPD); dyspnea; poor appetite; higher white cell count, D-dimer, ALT, AST and LDH; and lower lymphocyte count and albumin (p < 0.05). Independent risk factors associated with the severe/critical group were dyspnea [odds ratio (OR) = 19.48], ALT (OR = 6.02) and albumin (OR = 3.36). Independent risk factors associated with the ICU group were dyspnea (OR = 8.88), COPD (OR = 31.80), D-dimer (OR = 8.37), ALT (OR = 28.76) and LDH (OR = 9.95) (p < 0.05). CONCLUSION: The severity of COVID-19 outside Wuhan, China was milder than that within Wuhan. The clinical infective period was long, and the longest virus shedding time was 35 days. The most important risk factors were dyspnea, COPD, D-dimer, ALT, LDH and albumin.The reviews of this paper are available via the supplemental material section.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Adulto , China , Infecciones por Coronavirus/mortalidad , Cuidados Críticos , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Evaluación de Síntomas , Factores de Tiempo , Tomografía Computarizada por Rayos X , Esparcimiento de Virus
18.
BMJ Open ; 10(11): e043560, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33148769

RESUMEN

OBJECTIVE: To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally. DESIGN: Publicly available register-based ecological study. SETTING: Two hundred and nine countries/territories in the world. PARTICIPANTS: Aggregated data including 10 445 656 confirmed COVID-19 cases. PRIMARY AND SECONDARY OUTCOME MEASURES: COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website. RESULTS: The average of country/territory-specific COVID-19 CFR is about 2%-3% worldwide and higher than previously reported at 0.7%-1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The strictness of anti-COVID-19 measures was not statistically significantly associated with CFR overall, but the higher Stringency Index was associated with higher CFR in higher-income countries with active testing policies (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR. CONCLUSION: The association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the income level of a country. When testing is warranted and healthcare resources are sufficient, strict quarantine and/or lockdown measures might result in excess deaths in underprivileged populations. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Control de Enfermedades Transmisibles/estadística & datos numéricos , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Producto Interno Bruto/estadística & datos numéricos , Neumonía Viral/mortalidad , Densidad de Población , Regresión Espacial , Distribución por Edad , Betacoronavirus , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Política de Salud , Indicadores de Salud , Humanos , Esperanza de Vida , Mortalidad , Pandemias , Prevalencia , Fumar/epidemiología , Análisis Espacial
19.
ESMO Open ; 5(Suppl 3)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33158968

RESUMEN

BACKGROUND: In the midst of the COVID-19 pandemic, patients with cancer are regarded as a highly vulnerable population. Overall, those requiring hospital admission for treatment administration are potentially exposed to a higher risk of infection and worse outcome given the multiple in-hospital exposures and the treatment immunosuppressive effects. METHODS: COVINT is an observational study assessing COVID-19 incidence among patients receiving anticancer treatment in the outpatient clinic of the Istituto Nazionale dei Tumori di Milano. All consecutive patients with non-haematological malignancies treated with intravenous or subcutaneous/intramuscular anticancer therapy in the outpatient clinic were enrolled. The primary endpoint is the rate of occurrence of COVID-19. Secondary endpoints included the rate of COVID-19-related deaths and treatment interruptions. The association between clinical and biological characteristics and COVID-19 occurrence is also evaluated. COVID-19 diagnosis is defined as (1) certain if confirmed by reverse transcriptase PCR assay of nasopharyngeal swabs (NPS); (2) suspected in case of new symptoms or CT scan evidence of interstitial pneumonia with negative/not performed NPS; (3) negative in case of neither symptoms nor radiological evidence. RESULTS: In the first 2 months (16 February-10 April 2020) of observation, 1081 patients were included. Of these, 11 (1%) were confirmed and 73 (6.7%) suspected for COVID-19. No significant differences in terms of cancer and treatment type emerged between the three subgroups. Prophylactic use of myeloid growth factors was adopted in 5.3%, 2.7% and 0% of COVID-19-free, COVID-19-suspected and COVID-19-confirmed patients (p=0.003). Overall, 96 (8.9%) patients delayed treatment as a precaution for the pandemic. Among the 11 confirmed cases, 6 (55%) died of COVID-19 complications, and anticancer treatment was restarted in only one. CONCLUSIONS: During the pandemic peak, accurate protective measures successfully resulted in low rates of COVID-19 diagnosis, although with high lethality. Prospective patients' surveillance will continue with NPS and serology testing to provide a more comprehensive epidemiological picture, a biological insight on the impact of cytotoxic treatments on the immune response, and to protect patients and healthcare workers.


Asunto(s)
Antineoplásicos/uso terapéutico , Infecciones por Coronavirus/epidemiología , Neoplasias/tratamiento farmacológico , Neumonía Viral/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Betacoronavirus , Instituciones Oncológicas , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Estadificación de Neoplasias , Neoplasias/epidemiología , Neoplasias/patología , Pandemias , Neumonía Viral/mortalidad , Tiempo de Tratamiento , Adulto Joven
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