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1.
Indian J Ophthalmol ; 69(4): 985-986, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33727473

RESUMEN

A 32-year-old man with a clear and compact graft following a penetrating keratoplasty 6 years back, developed an episode of acute graft rejection, coinciding with the COVID-19 disease. Subsequent to the infection with the novel coronavirus, he developed symptoms of acute graft rejection concurrent with the development of respiratory distress and peak systemic symptoms. This was the phase of cytokine storm as evidenced by the raised inflammatory markers in his blood tests. Such a case of acute corneal graft rejection coinciding with SARS-CoV-2 infection has been reported only once in the literature and this unique association needs to be researched further.


Asunto(s)
/diagnóstico , Enfermedades de la Córnea/diagnóstico , Infecciones Virales del Ojo/diagnóstico , Rechazo de Injerto/diagnóstico , Queratoplastia Penetrante , Enfermedad Aguda , Adulto , /virología , Extracción de Catarata , Enfermedades de la Córnea/tratamiento farmacológico , Enfermedades de la Córnea/virología , Citocinas/sangre , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/virología , Glucocorticoides/uso terapéutico , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/virología , Humanos , Incidencia , Mediadores de Inflamación/sangre , Implantación de Lentes Intraoculares , Masculino , Neumonía Viral/sangre , Prednisolona/uso terapéutico , Agudeza Visual
2.
Medicine (Baltimore) ; 100(9): e25072, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655986

RESUMEN

RATIONALE: Northern Italy has been particularly hit by the current Covid-19 pandemic. Italian deceased patients have a mean age of 78.5 years and only 1.2% have no comorbidities. These data started a public debate whether patients die "with" or "from" Covid-19. If on one hand the public opinion has been persuaded to believe that Covid-19 infection has poor outcomes just in elderly and/or fragile subjects, on the other hand, hospitals are admitting an increasing number of healthy young patients needing semi-intensive or intensive care units. PATIENT CONCERNS: At the end of March 2020, a 79-year-old patient (M.G.) was admitted to the emergency department of our hospital with a 5 days history of fever, dyspnea, and cough. He was known for hypertension and coronary artery disease with a previous coronary artery stenting. Both the comorbidities were carried out without complications and the patient was previously asymptomatic and in good health. At admission, he was febrile and showed signs of respiratory failure with hypoxia and hypocapnia at blood gas analysis. DIAGNOSIS: The day after, he was tested for SARS-CoV-2 with a real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swab, which turned positive and a chest CT-Scan was consistent with the diagnosis of interstitial pneumonia. INTERVENTIONS: He was treated with i.v. diuretics, paracetamol, prolonged noninvasive ventilation (CPAP), and empiric antibiotic therapy on top of his chronic treatment. OUTCOMES: A treatment with heparin and corticosteroids was started; however, he developed irreversible respiratory failure. Invasive ventilation was not considered appropriate due to his comorbidities, low chances of recovery, and intensive care unit overcrowding. The patient died 9 days after admission. LESSONS: Health conditions that are most reported as risk factors are common cardiovascular diseases that can be managed in modern clinical practice. Through a brief illustrative clinical case, we would like to underline how Covid-19 can be per se the cause of death in patients that would otherwise have had an acceptable life expectancy.


Asunto(s)
Enfermedad de la Arteria Coronaria , Hipertensión , Manejo de Atención al Paciente/métodos , Neumonía Viral , Anciano , Análisis de los Gases de la Sangre/métodos , /mortalidad , /métodos , Deterioro Clínico , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Resultado Fatal , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Hipertensión/terapia , Masculino , Neumonía Viral/sangre , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodos
3.
BMC Infect Dis ; 21(1): 241, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33673818

RESUMEN

BACKGROUND: Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD: This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS: Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION: Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Síndrome de Liberación de Citoquinas , Hipoxia , Interleucina-6/antagonistas & inhibidores , Neumonía Viral , /epidemiología , /fisiopatología , Ensayos de Uso Compasivo/estadística & datos numéricos , Síndrome de Liberación de Citoquinas/etiología , Síndrome de Liberación de Citoquinas/inmunología , Síndrome de Liberación de Citoquinas/terapia , Femenino , Humanos , Hipoxia/etiología , Hipoxia/terapia , India/epidemiología , Interleucina-6/inmunología , Masculino , Persona de Mediana Edad , Neumonía Viral/sangre , Neumonía Viral/etiología , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Respiración Artificial/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del Tratamiento
5.
BMC Infect Dis ; 21(1): 213, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33632148

RESUMEN

BACKGROUND: Previous studies have demonstrated an association between adenovirus viremia and disease severity in immunocompromised children. However, few studies have focused on this association in immunocompetent children. This study explored the association between adenovirus viremia and adenovirus pneumonia severity in immunocompetent children. METHODS: We performed a retrospective, observational study of immunocompetent children with adenovirus pneumonia admitted to Shenzhen Children's Hospital in Shenzhen, China. Pneumonia was classified as severe or mild based on the Chinese guideline for the classification of pneumonia severity. Serum samples from all the children included in the study were tested for adenovirus DNA with a quantitative polymerase chain reaction. Clinical manifestations, laboratory examinations, and disease severity were compared between children with severe and mild pneumonia. RESULTS: A total of 111 immunocompetent children with adenovirus pneumonia (60 severe, 51 mild) were included. The median age was 40 months, and 64 patients were male. Five patients were admitted to the intensive care unit, and two underwent endotracheal intubation. All patients were discharged after recovery or improvement. Univariate analysis and binary logistic regression analysis showed that leukocytosis (OR = 1.1; 95% CI: 1.0 to 1.2; P = 0.033), co-infection with Mycoplasma pneumoniae (OR = 5.0; 95% CI: 2.1 to 12.3; P <  0.001), and high blood viral load (OR = 1.5; 95% CI: 1.2 to 2.0; P = 0.001) may be risk factors for severe adenovirus pneumonia. CONCLUSIONS: Leukocytosis, co-infection with Mycoplasma pneumoniae, and high blood viral load may be risk factors for severe adenovirus pneumonia in immunocompetent children. Blood viral load may predict pneumonia severity.


Asunto(s)
Adenoviridae/fisiología , Infecciones por Adenovirus Humanos/virología , Neumonía Viral/virología , Viremia/virología , Infecciones por Adenovirus Humanos/sangre , Infecciones por Adenovirus Humanos/epidemiología , Niño , Preescolar , China/epidemiología , Femenino , Hospitales Pediátricos , Humanos , Lactante , Masculino , Neumonía Viral/sangre , Neumonía Viral/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Carga Viral , Viremia/epidemiología
6.
Prehosp Disaster Med ; 36(2): 131-134, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33397545

RESUMEN

BACKGROUND: Although first responders (FRs) represent a high-risk group for exposure, little information is available regarding their risk of coronavirus disease 2019 (COVID-19) infection. The purpose of the current study was to determine the serological prevalence of past COVID-19 infection in a cohort of municipal law enforcement (LE) and firefighters (FFs). METHODS: Descriptive analysis of a de-identified data reporting Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) immunoglobulin G (IgG), or COR2G, serology results for municipal FRs. As part of the serology process, FRs were surveyed for COVID-19-like symptoms since February 2020 and asked to report any prior COVID-19 nasal swab testing. Descriptive statistics and two-sided Chi Square tests with Yates correction were used to compare groups. RESULTS: Of 318 FRs, 225 (80.2%) underwent serology testing (LE: 163/207 [78.7%]; FF: 92/111 [82.9%]). The prevalence of positive serology for all FRs tested was 3/255 (1.2%). Two LE (1.2%) and one FF (1.1%) had positive serology (P = 1.0). Two hundred and twenty-four FRs responded to a survey regarding prior symptoms and testing. Fifty-eight (25.9%) FRs (44 LE; 14 FFs) reported the presence of COVID-19-like symptoms. Of these, only nine (15.5%) received reverse transcriptase - polymerase chain reaction (RT-PCR) testing; none were positive. Two of the three FRs with positive serology reported no COVID-19-like symptoms and none of these responders had received prior nasal RT-PCR swabs. The overall community positive RT-PCR rate was 0.36%, representing a three-fold higher rate of positive seroprevalence amongst FRs compared with the general population (P = .07). CONCLUSIONS: Amongst a cohort of municipal FRs with low community COVID-19 prevalence, the seroprevalence of SARS-CoV-19 IgG Ab was three-fold greater than the general community. Two-thirds of positive FRs reported a lack of symptoms. Only 15.5% of FRs with COVID-19-like symptoms received RT-PCR testing. In addition to workplace control measures, increased testing availability to FRs is critical in limiting infection spread and ensuring response capability.


Asunto(s)
Anticuerpos Antivirales/sangre , /epidemiología , Socorristas , Inmunoglobulina G/sangre , Neumonía Viral/sangre , Neumonía Viral/epidemiología , Adulto , Femenino , Humanos , Masculino , Minnesota/epidemiología , Neumonía Viral/virología , Estudios Seroepidemiológicos
9.
Aust Crit Care ; 34(2): 160-166, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33509706

RESUMEN

BACKGROUND: A high number of thrombotic complications have been reported in critically ill patients with coronavirus disease 2019 (COVID-19) and appear to be related to a hypercoagulable state. Evidence regarding detection, management, and monitoring of COVID-19-associated coagulopathy is still missing. We propose to describe the thrombus viscoelastic properties to investigate the mechanisms of hypercoagulability in patients with COVID-19. METHODS: Thromboelastography (TEG) was performed in 24 consecutive patients admitted to a single intensive care unit for COVID-19 pneumonia, and 10 had a second TEG before being discharged alive from the intensive care unit. RESULTS: Compared with a group of 20 healthy participants, patients with COVID-19 had significantly decreased values of reaction time, coagulation time, and lysis index and increased values of α angle, maximum amplitude, clot strength, and coagulation index. Velocity curves were consistent with increased generation of thrombin. These values persisted in surviving patients despite their good clinical course. DISCUSSION: In patients with COVID-19, TEG demonstrates a complex and prolonged hypercoagulable state including fast initiation of coagulation and clot reinforcement, low fibrinolysis, high potential of thrombin generation, and high fibrinogen and platelet contribution. The antithrombotic strategy in patients with COVID-19 during intensive care hospitalisation and after discharge should be investigated in further studies.


Asunto(s)
/sangre , Neumonía Viral/sangre , Tromboelastografía , Trombofilia/diagnóstico , Trombofilia/virología , Anciano , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Neumonía Viral/virología
10.
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
11.
Biosens Bioelectron ; 171: 112679, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33069957

RESUMEN

The 2019 SARS CoV-2 (COVID-19) pandemic has illustrated the need for rapid and accurate diagnostic tests. In this work, a multiplexed grating-coupled fluorescent plasmonics (GC-FP) biosensor platform was used to rapidly and accurately measure antibodies against COVID-19 in human blood serum and dried blood spot samples. The GC-FP platform measures antibody-antigen binding interactions for multiple targets in a single sample, and has 100% selectivity and sensitivity (n = 23) when measuring serum IgG levels against three COVID-19 antigens (spike S1, spike S1S2, and the nucleocapsid protein). The GC-FP platform yielded a quantitative, linear response for serum samples diluted to as low as 1:1600 dilution. Test results were highly correlated with two commercial COVID-19 antibody tests, including an enzyme linked immunosorbent assay (ELISA) and a Luminex-based microsphere immunoassay. To demonstrate test efficacy with other sample matrices, dried blood spot samples (n = 63) were obtained and evaluated with GC-FP, yielding 100% selectivity and 86.7% sensitivity for diagnosing prior COVID-19 infection. The test was also evaluated for detection of multiple immunoglobulin isotypes, with successful detection of IgM, IgG and IgA antibody-antigen interactions. Last, a machine learning approach was developed to accurately score patient samples for prior COVID-19 infection, using antibody binding data for all three COVID-19 antigens used in the test.


Asunto(s)
Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Técnicas Biosensibles/instrumentación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/sangre , Neumonía Viral/sangre , Anticuerpos Antivirales/inmunología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/inmunología , Pruebas con Sangre Seca , Diseño de Equipo , Fluorescencia , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Dispositivos Laboratorio en un Chip , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Sensibilidad y Especificidad
12.
Biosens Bioelectron ; 171: 112709, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33075724

RESUMEN

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was classified as a pandemic by the World Health Organization and has caused over 550,000 deaths worldwide as of July 2020. Accurate and scalable point-of-care devices would increase screening, diagnosis, and monitoring of COVID-19 patients. Here, we demonstrate rapid label-free electrochemical detection of SARS-CoV-2 antibodies using a commercially available impedance sensing platform. A 16-well plate containing sensing electrodes was pre-coated with receptor binding domain (RBD) of SARS-CoV-2 spike protein, and subsequently tested with samples of anti-SARS-CoV-2 monoclonal antibody CR3022 (0.1 µg/ml, 1.0 µg/ml, 10 µg/ml). Subsequent blinded testing was performed on six serum specimens taken from COVID-19 and non-COVID-19 patients (1:100 dilution factor). The platform was able to differentiate spikes in impedance measurements from a negative control (1% milk solution) for all CR3022 samples. Further, successful differentiation and detection of all positive clinical samples from negative control was achieved. Measured impedance values were consistent when compared to standard ELISA test results showing a strong correlation between them (R2=0.9). Detection occurs in less than five minutes and the well-based platform provides a simplified and familiar testing interface that can be readily adaptable for use in clinical settings.


Asunto(s)
Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Técnicas Biosensibles/instrumentación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/sangre , Espectroscopía Dieléctrica/instrumentación , Neumonía Viral/sangre , Anticuerpos Antivirales/inmunología , Técnicas Biosensibles/economía , Técnicas de Laboratorio Clínico/economía , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/inmunología , Espectroscopía Dieléctrica/economía , Impedancia Eléctrica , Diseño de Equipo , Humanos , Proteínas Inmovilizadas/inmunología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Sensibilidad y Especificidad , Glicoproteína de la Espiga del Coronavirus/inmunología , Factores de Tiempo
13.
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
15.
Rev. patol. respir ; 23(supl.3): S263-S267, dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-197102

RESUMEN

El diagnóstico microbiológico de la infección por SARS-CoV-2 es de gran importancia por su repercusión clínica a nivel individual y para la elaboración de estrategias de salud pública para intentar frenar su propagación. Actualmente la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) es la técnica de elección para el diagnóstico microbiológico del paciente sintomático por COVID-19, detectando material genético del virus en el organismo. Requiere un adecuado manejo de las muestras y un laboratorio bien equipado. Otros métodos diagnósticos utilizados son la detección de anticuerpos generados por el individuo en contacto con el virus, son útiles para el estudio de infección pasada, estudios de vacunas o estrategias epidemiológicas; y la detección de antígenos del SARS-CoV-2 en muestras biológicas, de mayor rentabilidad, menor coste y gran especificidad, pero con altas tasas de falsos negativos en pacientes con baja carga viral. Es fundamental una correcta indicación e interpretación de las pruebas diagnósticas para su mayor rentabilidad


Microbiological diagnosis of SARS-CoV-2 infection is crucial due to its clinical repercussion at the individual level and for the development of public health strategies to try to stop its spread. Currently, reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard for microbiological diagnosis of symptomatic COVID-19 patients, detecting genetic material of the virus in the body. It requires proper sample handling and a well-equipped laboratory. Other diagnostic methods used are the detection of antibodies generated by the individual in contact with the virus, useful for the study of past infection, vaccine studies or epidemiological strategies; and the detection of SARS-CoV-2 antigens in biological samples, with greater profitability, lower cost and high specificity, but with high rates of false negatives in patients with low viral load. Correct indication and interpretation of diagnostic tests is essential for greater profitability


Asunto(s)
Humanos , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Pandemias , Infecciones por Coronavirus/sangre , Neumonía Viral/sangre , Reacción en Cadena de la Polimerasa , Sensibilidad y Especificidad , Pruebas Serológicas , Anticuerpos/sangre
16.
Int J Mol Sci ; 21(22)2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33233715

RESUMEN

The pulmonary endothelium is a metabolically active continuous monolayer of squamous endothelial cells that internally lines blood vessels and mediates key processes involved in lung homoeostasis. Many of these processes are disrupted in acute respiratory distress syndrome (ARDS), which is marked among others by diffuse endothelial injury, intense activation of the coagulation system and increased capillary permeability. Most commonly occurring in the setting of sepsis, ARDS is a devastating illness, associated with increased morbidity and mortality and no effective pharmacological treatment. Endothelial cell damage has an important role in the pathogenesis of ARDS and several biomarkers of endothelial damage have been tested in determining prognosis. By further understanding the endothelial pathobiology, development of endothelial-specific therapeutics might arise. In this review, we will discuss the underlying pathology of endothelial dysfunction leading to ARDS and emerging therapies. Furthermore, we will present a brief overview demonstrating that endotheliopathy is an important feature of hospitalised patients with coronavirus disease-19 (COVID-19).


Asunto(s)
Infecciones por Coronavirus/patología , Células Endoteliales/patología , Neumonía Viral/patología , /patología , Animales , Betacoronavirus/aislamiento & purificación , Coagulación Sanguínea , Permeabilidad Capilar , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Humanos , Inflamación/sangre , Inflamación/etiología , Inflamación/patología , Pulmón/patología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , /etiología
17.
Eur Rev Med Pharmacol Sci ; 24(21): 11386-11394, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33215460

RESUMEN

OBJECTIVE: To explore the expression and significance of SAA, CRP and FERR in patients diagnosed with COVID-19. PATIENTS AND METHODS: A total of 225 patients diagnosed with COVID-19 who were admitted to the North Hospital of First Hospital in Changsha, China, from 9th February 2020 to 7th March 2020 were enrolled. Their general data, laboratory test results and levels of SAA, CRP and FERR were extracted from electronic medical records. RESULTS: Age was an important risk factor for the severity of COVID-19 in the patients. Compared with the non-severe group, the severe group showed statistical significance in the levels of total protein, albumin, ALT and AST in liver function, UA in renal function, myocardial enzyme CK-MB and LDH, and immunoglobulin IgG and IgM. The levels of SAA, CRP, and FERR were significantly increased in patients with severe COVID-19. ROC curve analysis results showed that the AUC, from small to large, was as follows: SAA+CRP+FERR, CRP + FERR, SAA + CRP, SAA + FERR, SAA, FERR, and CRP, which indicated the benefit of the combination of the three indicators. The sensitivity and specificity of the combined detection of the three indicators were higher than those of the detection of any single indicator or two combined indicators. A Spearman correlation analysis of the data showed that the initial CRP/SAA, SAA/FERR, and CRP/FERR were positively correlated. The continuous results of SAA, CRP and FERR throughout the study period showed that the values of the severe group on a given day were higher than those of the non-severe group; the values of the two groups peaked on the 5th or 7th day and then decreased, and the decreasing trend of the severe group was more evident. CONCLUSIONS: SAA, CRP and FERR are sensitive serological indicators used to evaluate the severity of COVID-19. The combined detection of serum SAA, FERR, and CRP, which are positively related to COVID-19 infection, offers guiding significance for the occurrence of COVID-19 infection and the severity of the disease. Such detection provides effective detection indicators for the progress and prognosis of COVID-19; these indicators will enable effective intervention measures to be implemented in time and the rates of severe illness and mortality to be reduced.


Asunto(s)
Proteína C-Reactiva/análisis , Infecciones por Coronavirus/diagnóstico , Ferritinas/sangre , Neumonía Viral/diagnóstico , Proteína Amiloide A Sérica/análisis , Adulto , Factores de Edad , Anciano , Betacoronavirus/aislamiento & purificación , Betacoronavirus/patogenicidad , Biomarcadores/sangre , China/epidemiología , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Neumonía Viral/virología , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad
18.
PLoS One ; 15(11): e0242306, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33216772

RESUMEN

BACKGROUND: Since 1920, a decrease in serum cholesterol has been identified as a marker of severe pneumonia. We have assessed the performance of serum apolipoprotein-A1, the main transporter of HDL-cholesterol, to identify the early spread of coronavirus disease 2019 (Covid-19) in the general population and its diagnostic performance for the Covid-19. METHODS: We compared the daily mean serum apolipoprotein-A1 during the first 34 weeks of 2020 in a population that is routinely followed for a risk of liver fibrosis risk in the USA (212,297 serum) and in France (20,652 serum) in relation to a local increase in confirmed cases, and in comparison to the same period in 2019 (266,976 and 28,452 serum, respectively). We prospectively assessed the sensitivity of this marker in an observational study of 136 consecutive hospitalized cases and retrospectively evaluated its specificity in 7,481 controls representing the general population. RESULTS: The mean serum apolipoprotein-A1 levels in the survey populations began decreasing in January 2020, compared to the same period in 2019. This decrease was highly correlated with the daily increase in confirmed Covid-19 cases in the following 34 weeks, both in France and USA, including the June and mid-July recovery periods in France. Apolipoprotein-A1 at the 1.25 g/L cutoff had a sensitivity of 90.6% (95%CI84.2-95.1) and a specificity of 96.1% (95.7-96.6%) for the diagnosis of Covid-19. The area under the characteristics curve was 0.978 (0.957-0.988), and outperformed haptoglobin and liver function tests. The adjusted risk ratio of apolipoprotein-A1 for survival without transfer to intensive care unit was 5.61 (95%CI 1.02-31.0; P = 0.04). CONCLUSION: Apolipoprotein-A1 could be a sentinel of the pandemic in existing routine surveillance of the general population. NCT01927133, CER-2020-14.


Asunto(s)
Apolipoproteína A-I/sangre , Infecciones por Coronavirus/sangre , Neumonía Viral/sangre , Adulto , Anciano , Betacoronavirus , Biomarcadores/sangre , Infecciones por Coronavirus/epidemiología , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Estudios Retrospectivos , Estados Unidos
19.
Medicine (Baltimore) ; 99(47): e23315, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33217868

RESUMEN

Our study aimed to assess the existing evidence on whether severe coronavirus disease 2019 (COVID-19) is associated with elevated inflammatory markers.The PubMed, Embase, Web of Science, Scopus, Chinese National Knowledge Infrastructure, WanFang, and China Science and Technology Journal databases were searched to identify studies published between January 1 and April 21, 2020 that assayed inflammatory markers in COVID-19 patients. Three reviewers independently examined the literature, extracted relevant data, and assessed the risk of publication bias before including the meta-analysis studies.Fifty-six studies involving 8719 COVID-19 patients were identified. Meta-analysis showed that patients with severe disease showed elevated levels of white blood cell count (WMD: 1.15, 95% CI: 0.78-1.52), C-reactive protein (WMD: 38.85, 95% CI: 31.19-46.52), procalcitonin (WMD: 0.08, 95% CI: 0.06-0.11), erythrocyte sedimentation rate (WMD: 10.15, 95% CI: 5.03-15.46), interleukin-6 (WMD: 23.87, 95% CI: 15.95-31.78), and interleukin-10 (WMD: 2.12, 95% CI: 1.97-2.28). Similarly, COVID-19 patients who died during follow-up showed significantly higher levels of white blood cell count (WMD: 4.11, 95% CI: 3.25-4.97), C-reactive protein (WMD: 74.18, 95% CI: 56.63-91.73), procalcitonin (WMD: 0.26, 95% CI: 0.11-0.42), erythrocyte sedimentation rate (WMD: 10.94, 95% CI: 4.79-17.09), and interleukin-6 (WMD: 59.88, 95% CI: 19.46-100.30) than survivors.Severe COVID-19 is associated with higher levels of inflammatory markers than a mild disease, so tracking these markers may allow early identification or even prediction of disease progression.


Asunto(s)
Betacoronavirus , Biomarcadores/sangre , Infecciones por Coronavirus/sangre , Mediadores de Inflamación/sangre , Neumonía Viral/sangre , Índice de Severidad de la Enfermedad , Adulto , Anciano , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Infecciones por Coronavirus/mortalidad , Progresión de la Enfermedad , Femenino , Humanos , Inflamación , Interleucina-10/sangre , Interleucina-6/sangre , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Polipéptido alfa Relacionado con Calcitonina/sangre
20.
Medicine (Baltimore) ; 99(47): e23365, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33217881

RESUMEN

Hypercoagulability and thrombosis remain a challenge in severe coronavirus disease 2019 (COVID-19) infections. Our aim is to investigate the hemostatic profile of critically ill COVID-19 patients on therapeutic anticoagulant treatment.Forty one patients were enrolled into the study. We recruited 11 consecutive, COVID-19, patients who received therapeutic anticoagulant treatment on intensive care unit (ICU) admission. Disease severity indexes, biochemical, hematological and haemostatic parameters, endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1) activity and extrinsically activated rotational thromboelastometry assay (EXTEM) were recorded on days 1, 3, 7. We also enrolled 9 ICU non-COVID-19, 21 non-ICU COVID-19 patients and 20 healthy blood donors as control populations.Critically ill COVID-19 patients demonstrated a more hypercoagulable and hypofibrinolytic profile related to those with COVID-19 mild illness, based on EXTEM amplitude at 10 min (A10), maximum clot firmness (MCF) and lysis index at 60 min (LI60) variables (p = 0.020, 0.046 and 0.001, respectively). Similarly, a more hypercoagulable state was detected in COVID-19 ICU patients related to non-COVID-19 ICU patients based on A10 and MCF parameters (p = 0.03 and 0.04, respectively). On the contrary, ETP and EXTEM (clotting time) CT values were similar between patients with severe and mild form of the COVID-19 infection, probably due to anticoagulant treatment given.Critically ill COVID-19 patients showed a hypercoagulable profile despite the therapeutic anticoagulant doses given. Due to the small sample size and the study design, the prognostic role of the hypercoagulability in this clinical setting remains unknown and further research is required in order to be assessed.


Asunto(s)
Anticoagulantes/farmacología , Infecciones por Coronavirus/sangre , Hemostasis/efectos de los fármacos , Neumonía Viral/sangre , Trombofilia/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Betacoronavirus , Pruebas de Coagulación Sanguínea , Estudios de Casos y Controles , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Enfermedad Crítica , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Pronóstico , Índice de Severidad de la Enfermedad , Tromboelastografía , Trombofilia/sangre , Trombofilia/virología , Trombosis/sangre , Trombosis/virología , Resultado del Tratamiento
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