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1.
Front Biosci (Elite Ed) ; 13: 117-139, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33048778

RESUMEN

Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the human coronavirus (HCoV) family that targets the lower part of the respiratory tract and causes severe acute respiratory syndrome (SARS). In a short span of time, this infection has led to a global pandemic and has become a significant threat to the existence of present human society. Currently, there are no treatments for this infection and the measures established across various countries such as social distancing, usage of mask to prevent entry of the virus into the respiratory tract, quarantine, and containment together have reduced the prevalence of this disease and mortality in highly susceptible individuals. Here, we examine the structure, replication cycle, phylogeny and genomic organization of this virus and discuss the role of spike (S) protein of the virus, an important structure that interacts with the host ACE2 receptor facilitating viral entry. Further, we explore the epidemiology, symptoms of the disease, describe the reverse transcriptase-polymerase chain reaction (RT-PCR) that establishes the diagnosis of the disease and also review its unique diagnostic features in the chest CT-Scan. Finally, we review the current approaches to develop therapies and vaccines as a measure for disease prevention and control.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Humanos , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Neumonía Viral/virología
2.
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
3.
J Infect Chemother ; 27(1): 76-82, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33051144

RESUMEN

INTRODUCTION: The severity of coronavirus disease (COVID-19) in Japanese patients is unreported. We retrospectively examined significant factors associated with disease severity in symptomatic COVID-19 patients (COVID-Pts) admitted to our institution between February 20 and April 30, 2020. METHODS: All patients were diagnosed based on the genetic detection of severe acute respiratory syndrome coronavirus 2. Information on the initial symptoms, laboratory data, and computed tomography (CT) images at hospitalization were collected from the patients' records. COVID-Pts were categorized as those with critical or severe illness (Pts-CSI) or those with moderate or mild illness (Pt-MMI). All statistical analyses were performed using R software. RESULTS: Data from 61 patients (16 Pt-CSI, 45 Pt-MMI), including 58 Japanese and three East Asians, were analyzed. Pt-CSI were significantly older and had hypertension or diabetes than Pt-MMI (P < 0.001, 0.014 and < 0.001, respectively). Serum albumin levels were significantly lower in Pt-CSI than in Pt-MMI (P < 0.001), whereas the neutrophil-to-lymphocyte ratio and C-reactive protein level were significantly higher in Pt-CSI than in Pt-MMI (P < 0.001 and P < 0.001, respectively). In the CT images of 60 patients, bilateral lung lesions were more frequently observed in Pt-CSI than in Pt-MMI (P = 0.013). Among the 16 Pt-CSI, 15 received antiviral therapy, 12 received tocilizumab, five underwent methylprednisolone treatment, six received mechanical ventilation, and one died. CONCLUSIONS: The illness severity of Japanese COVID-Pts was associated with older age, hypertension and/or diabetes, low serum albumin, high neutrophil-to-lymphocyte ratio, and C-reactive protein.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Índice de Severidad de la Enfermedad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Proteína C-Reactiva/análisis , Infecciones por Coronavirus/terapia , Femenino , Humanos , Japón/epidemiología , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Neutrófilos , Pandemias , Neumonía Viral/terapia , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica/análisis , Tomografía Computarizada por Rayos X , Adulto Joven
4.
An. pediatr. (2003. Ed. impr.) ; 92(4): 241.e1-241.e11, abr. 2020. mapas, graf, tab
Artículo en Español | IBECS | ID: ibc-186847

RESUMEN

El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo 7 casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente «nuevo coronavirus», 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declara el brote una Emergencia Internacional. El día 11 de febrero la OMS le asigna el nombre de SARS-CoV2 e infección COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectología Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización


On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them


Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Coronavirus/clasificación , Coronavirus/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Índice de Severidad de la Enfermedad , Sociedades Médicas , España
5.
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
6.
In Vivo ; 34(6): 3747-3751, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33144493

RESUMEN

BACKGROUND/AIM: Tracheostomy performed on patients with Coronavirus disease 2019 (COVID-19) may lead to the infection of operators and medical staff. To date, there are no established methods of infection control. The aim of this study was to provide helpful and useful information regarding tracheostomy during the COVID-19 pandemic. PATIENTS AND METHODS: We performed a retrospective analysis on 12 patients with severe COVID-19 who were intubated and underwent tracheostomy in our hospital. RESULTS: Percutaneous tracheostomy was performed in eight cases, and open tracheostomy was performed in four cases. Open tracheostomy in the operating room was performed under a negative pressure closed-space system using a surgical drape to prevent aerosolization. CONCLUSION: Our experience suggests that bedside percutaneous tracheostomy may be a useful option in patients with COVID-19. In cases where percutaneous tracheostomy is anticipated to be difficult, open tracheostomy using a negative pressure closure may be useful in preventing aerosolization and reducing the risk of infection of healthcare workers.


Asunto(s)
Infecciones por Coronavirus/terapia , Intubación/métodos , Pandemias , Neumonía Viral/terapia , Traqueostomía/métodos , Adulto , Anciano , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/patología , Neumonía Viral/virología
7.
In Vivo ; 34(6): 3753-3756, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33144494

RESUMEN

BACKGROUND/AIM: Novel coronavirus infection in a cancer patient treated with immunotherapy, requires high attention. CASE REPORT: Clinical and radiological data were obtained from the electronic medical record. Pharynx swab was tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA by reverse transcription-polymerase chain reaction (RT-PCR). The nasopharyngeal carcinoma patient developed fever on the third day after chemotherapy and immunotherapy. Laboratory examination showed lymphocytopenia. On the sixth day, chest computed tomography (CT) images showed bilateral scattered ground-glass opacities and reticulation. Pharynx swab was positive for SARS-CoV-2 nucleic acid and the patient was confirmed as having Coronavirus Disease 2019 (COVID-19). Unfortunately, despite aggressive treatment after the diagnosis of COVID-19, the patient died quickly. CONCLUSION: The patient with nasopharyngeal carcinoma in this case developed severe COVID-19 after receiving immunotherapy. For patients treated with immune checkpoint inhibitors (ICIs) in epidemic areas, the safety of ICIs in cancer patients infected with SARS-CoV-2 should be considered.


Asunto(s)
Infecciones por Coronavirus/terapia , Inmunoterapia/métodos , Carcinoma Nasofaríngeo/terapia , Neumonía Viral/terapia , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Humanos , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/complicaciones , Carcinoma Nasofaríngeo/inmunología , Carcinoma Nasofaríngeo/virología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Neumonía Viral/virología
8.
J Biol Regul Homeost Agents ; 34(4 Suppl. 1): 1-13, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33176412

RESUMEN

Despite various opinions and healthy controversy on Ozone Therapy (OT), the practices of this therapy have increased worldwide. Main areas of study with consistent scientific outcomes are the topical treatment of both disk herniation and periodontal disease. On the other hand, there is a net dissociation of the scientific resonance concerning systemic oxygen/ozone treatments. It is our intention to discuss in logical terms the numerous papers that commendably reported adverse reactions attributable to OT, focusing our attention mainly to the techniques of administration and not to the simple contact of ozone with biological material. The case reports on OT treatments safety concerns discussed on international journals, make it possible to state that most safety issues are secondary to infections or traumatic reactions due to malpractice. Commonly, the molecule of ozone itself is not responsible of severe reactions at the therapeutic modalities. The millions of patients treated so far from the thousands of physicians correctly practicing OT world widely in the last 40 years demonstrate the safety of this simple and cost-effective regenerative medicine tool. The promising therapeutic implications also for the current COVID-19 emergency are a further stimulus to the standardization of this therapeutic resource with multiple application specificities.


Asunto(s)
Ozono/uso terapéutico , Medicina Regenerativa/tendencias , Betacoronavirus , Infecciones por Coronavirus/terapia , Humanos , Pandemias , Neumonía Viral/terapia
10.
Sheng Wu Gong Cheng Xue Bao ; 36(10): 1970-1978, 2020 Oct 25.
Artículo en Chino | MEDLINE | ID: mdl-33169563

RESUMEN

At present, SARS-CoV-2 is raging, and novel coronavirus pneumonia (COVID-19) has caused more than 35 million confirmed patients and more than 500 000 cases death, which seriously endanger human health, socioeconomic development, as well as global medical and public health systems. COVID-19 is highly contagious, has a long incubation period, and causes many death cases due to lack of effective specific treatment. Mesenchymal stem cells have powerful anti-inflammatory and immunoregulatory functions, and can effectively reduce the cytokine storm caused by coronavirus in patients, and improve the pulmonary fibrosis of patients, promote the repair of damaged lung tissue, and reduce the mortality. Currently, a number of related clinical trials of mesenchymal stem cell treatment of COVID-19 have been conducted, and have confirmed the safety and efficacy, suggesting a good clinical application prospect. While progress has been made in mesenchymal stem cell therapy for COVID-19, we should also catch sight of the problems and challenges faced by mesenchymal stem cell clinical trials under severe epidemic situation, including clinical trials design, stem cell quality management, and ethics in treatment. Only by paying attention to these can we guarantee the safe and effective development of mesenchymal stem cell clinical trials in the treatment of COVID-19.


Asunto(s)
Infecciones por Coronavirus/terapia , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/citología , Neumonía Viral/terapia , Betacoronavirus , Ensayos Clínicos como Asunto , Humanos , Pandemias
11.
Sheng Wu Gong Cheng Xue Bao ; 36(10): 1979-1991, 2020 Oct 25.
Artículo en Chino | MEDLINE | ID: mdl-33169564

RESUMEN

Coronavirus disease 2019 (COVID-19) has spread widely on a large scale in the whole world at present, seriously endangering human health. There are still no effective and specific drugs, so it is urgent to find safe and effective therapeutic methods. Mesenchymal stem cells (MSCs) have many biological functions of powerful immunomodulation and tissue repair and regeneration. As a stem cell therapy, it has the potential to reduce the tissue injury and mortality in severe patients infected with novel coronavirus. At present, many research institutions in China and abroad have started a number of clinical research projects about MSCs in the treatment of COVID-19. In addition, those projects have initially confirmed the safety and effectiveness of this therapy. Therefore, this research field has been proved to have a very good clinical therapy prospect.


Asunto(s)
Infecciones por Coronavirus/terapia , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/citología , Neumonía Viral/terapia , Betacoronavirus , China , Humanos , Pandemias
12.
BMJ Case Rep ; 13(10)2020 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-33130585

RESUMEN

Infection with SARS-CoV-2 represents a great source of concern and a new threat for immunocompromised patients. Limited studies are available on COVID-19 in immunocompromised children. This case series aimed to evaluate the clinical and laboratory characteristics, management and outcomes of COVID-19 in five children immunocompromised due to different underlying conditions. All had mild symptoms or were asymptomatic at presentation. All had a benign course of illness. No changes or delays in their treatment regimens occurred, and none experienced a relapse of the original disease, developed severe COVID-19 or died. However, these cases showed a prolonged duration of virus shedding. This report suggests that immunocompromised paediatric patients may not be at a higher risk of developing severe COVID-19. However, further studies are required to elaborate on the pathogenesis of COVID-19 in this vulnerable group.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Huésped Inmunocomprometido/inmunología , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/diagnóstico , Factores de Edad , Niño , Preescolar , Terapia Combinada , Infecciones por Coronavirus/terapia , Femenino , Humanos , Masculino , Pandemias/estadística & datos numéricos , Neumonía Viral/terapia , Pronóstico , Medición de Riesgo , Muestreo , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/terapia , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del Tratamiento
13.
JAMA Netw Open ; 3(11): e2023547, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33136133

RESUMEN

Importance: Hospitals ceased most elective procedures during the height of coronavirus disease 2019 (COVID-19) infections. As hospitals begin to recommence elective procedures, it is necessary to have a means to assess how resource intensive a given case may be. Objective: To evaluate the development and performance of a clinical decision support tool to inform resource utilization for elective procedures. Design, Setting, and Participants: In this prognostic study, predictive modeling was used on retrospective electronic health records data from a large academic health system comprising 1 tertiary care hospital and 2 community hospitals of patients undergoing scheduled elective procedures from January 1, 2017, to March 1, 2020. Electronic health records data on case type, patient demographic characteristics, service utilization history, comorbidities, and medications were and abstracted and analyzed. Data were analyzed from April to June 2020. Main Outcomes and Measures: Predicitons of hospital length of stay, intensive care unit length of stay, need for mechanical ventilation, and need to be discharged to a skilled nursing facility. These predictions were generated using the random forests algorithm. Predicted probabilities were turned into risk classifications designed to give assessments of resource utilization risk. Results: Data from the electronic health records of 42 199 patients from 3 hospitals were abstracted for analysis. The median length of stay was 2.3 days (range, 1.3-4.2 days), 6416 patients (15.2%) were admitted to the intensive care unit, 1624 (3.8%) received mechanical ventilation, and 2843 (6.7%) were discharged to a skilled nursing facility. Predictive performance was strong with an area under the receiver operator characteristic ranging from 0.76 to 0.93. Sensitivity of the high-risk and medium-risk groupings was set at 95%. The negative predictive value of the low-risk grouping was 99%. We integrated the models into a daily refreshing Tableau dashboard to guide decision-making. Conclusions and Relevance: The clinical decision support tool is currently being used by surgical leadership to inform case scheduling. This work shows the importance of a learning health care environment in surgical care, using quantitative modeling to guide decision-making.


Asunto(s)
Infecciones por Coronavirus , Toma de Decisiones , Sistemas de Apoyo a Decisiones Clínicas , Procedimientos Quirúrgicos Electivos , Asignación de Recursos para la Atención de Salud , Hospitalización , Hospitales , Pandemias , Neumonía Viral , Anciano , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Registros Electrónicos de Salud , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología , Respiración Artificial , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Instituciones de Cuidados Especializados de Enfermería
14.
Nutrients ; 12(11)2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33147894

RESUMEN

BACKGROUND: The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. METHODS: Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. RESULTS: The three groups (n = 77; mean ± SD, 88 ± 5years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p= 0.03). CONCLUSIONS: Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Suplementos Dietéticos , Fragilidad/mortalidad , Neumonía Viral/mortalidad , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Anciano de 80 o más Años , Betacoronavirus , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/terapia , Femenino , Anciano Frágil/estadística & datos numéricos , Fragilidad/sangre , Fragilidad/virología , Hospitalización , Humanos , Masculino , Ensayos Clínicos Controlados no Aleatorios como Asunto , Pandemias , Neumonía Viral/sangre , Neumonía Viral/terapia , Tasa de Supervivencia
15.
Cochrane Database Syst Rev ; 11: CD013779, 2020 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-33150970

RESUMEN

BACKGROUND: Evidence from disease epidemics shows that healthcare workers are at risk of developing short- and long-term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID-19 crisis on the mental well-being of health and social care professionals. Symptoms of mental health problems commonly include depression, anxiety, stress, and additional cognitive and social problems; these can impact on function in the workplace. The mental health and resilience (ability to cope with the negative effects of stress) of frontline health and social care professionals ('frontline workers' in this review) could be supported during disease epidemics by workplace interventions, interventions to support basic daily needs, psychological support interventions, pharmacological interventions, or a combination of any or all of these. OBJECTIVES: Objective 1: to assess the effects of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. Objective 2: to identify barriers and facilitators that may impact on the implementation of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. SEARCH METHODS: On 28 May 2020 we searched the Cochrane Database of Systematic Reviews, CENTRAL, MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Global Index Medicus databases and WHO Institutional Repository for Information Sharing. We also searched ongoing trials registers and Google Scholar. We ran all searches from the year 2002 onwards, with no language restrictions. SELECTION CRITERIA: We included studies in which participants were health and social care professionals working at the front line during infectious disease outbreaks, categorised as epidemics or pandemics by WHO, from 2002 onwards. For objective 1 we included quantitative evidence from randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies, which investigated the effect of any intervention to support mental health or resilience, compared to no intervention, standard care, placebo or attention control intervention, or other active interventions. For objective 2 we included qualitative evidence from studies that described barriers and facilitators to the implementation of interventions. Outcomes critical to this review were general mental health and resilience. Additional outcomes included psychological symptoms of anxiety, depression or stress; burnout; other mental health disorders; workplace staffing; and adverse events arising from interventions. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently applied selection criteria to abstracts and full papers, with disagreements resolved through discussion. One review author systematically extracted data, cross-checked by a second review author. For objective 1, we assessed risk of bias of studies of effectiveness using the Cochrane 'Risk of bias' tool. For objective 2, we assessed methodological limitations using either the CASP (Critical Appraisal Skills Programme) qualitative study tool, for qualitative studies, or WEIRD (Ways of Evaluating Important and Relevant Data) tool, for descriptive studies. We planned meta-analyses of pairwise comparisons for outcomes if direct evidence were available. Two review authors extracted evidence relating to barriers and facilitators to implementation, organised these around the domains of the Consolidated Framework of Implementation Research, and used the GRADE-CERQual approach to assess confidence in each finding. We planned to produce an overarching synthesis, bringing quantitative and qualitative findings together. MAIN RESULTS: We included 16 studies that reported implementation of an intervention aimed at supporting the resilience or mental health of frontline workers during disease outbreaks (severe acute respiratory syndrome (SARS): 2; Ebola: 9; Middle East respiratory syndrome (MERS): 1; COVID-19: 4). Interventions studied included workplace interventions, such as training, structure and communication (6 studies); psychological support interventions, such as counselling and psychology services (8 studies); and multifaceted interventions (2 studies). Objective 1: a mixed-methods study that incorporated a cluster-randomised trial, investigating the effect of a work-based intervention, provided very low-certainty evidence about the effect of training frontline healthcare workers to deliver psychological first aid on a measure of burnout. Objective 2: we included all 16 studies in our qualitative evidence synthesis; we classified seven as qualitative and nine as descriptive studies. We identified 17 key findings from multiple barriers and facilitators reported in studies. We did not have high confidence in any of the findings; we had moderate confidence in six findings and low to very low confidence in 11 findings. We are moderately confident that the following two factors were barriers to intervention implementation: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well-being; and a lack of equipment, staff time or skills needed for an intervention. We are moderately confident that the following three factors were facilitators of intervention implementation: interventions that could be adapted for local needs; having effective communication, both formally and socially; and having positive, safe and supportive learning environments for frontline workers. We are moderately confident that the knowledge or beliefs, or both, that people have about an intervention can act as either barriers or facilitators to implementation of the intervention. AUTHORS' CONCLUSIONS: There is a lack of both quantitative and qualitative evidence from studies carried out during or after disease epidemics and pandemics that can inform the selection of interventions that are beneficial to the resilience and mental health of frontline workers. Alternative sources of evidence (e.g. from other healthcare crises, and general evidence about interventions that support mental well-being) could therefore be used to inform decision making. When selecting interventions aimed at supporting frontline workers' mental health, organisational, social, personal, and psychological factors may all be important. Research to determine the effectiveness of interventions is a high priority. The COVID-19 pandemic provides unique opportunities for robust evaluation of interventions. Future studies must be developed with appropriately rigorous planning, including development, peer review and transparent reporting of research protocols, following guidance and standards for best practice, and with appropriate length of follow-up. Factors that may act as barriers and facilitators to implementation of interventions should be considered during the planning of future research and when selecting interventions to deliver within local settings.


Asunto(s)
Brotes de Enfermedades , Personal de Salud/psicología , Salud Mental , Salud Laboral , Resiliencia Psicológica , Trabajadores Sociales/psicología , Betacoronavirus , Sesgo , Agotamiento Profesional/psicología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Epidemias , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/terapia , Humanos , Evaluación de Necesidades , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Sistemas de Apoyo Psicosocial , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/terapia , Lugar de Trabajo
17.
Niger Postgrad Med J ; 27(4): 261-267, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33154276

RESUMEN

COVID-19, a highly infectious disease, caused by a novel virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought about an unprecedented threat to global health. First reported in Wuhan, China, in December 2019, it has now spread to all continents of the world becoming a pandemic. There is no known treatment or vaccine for it although many candidate drugs and vaccines are in various clinical trial phases. For now, non-pharmacological interventions (NPIs) have become the mainstay of response for COVID-19 and are being used across the world to flatten the epidemiologic curve with some success. This review focussed on identifying which NPIs have been effective. NPIs that are effective include isolation and quarantine, physical distancing, use of face masks and hand hygiene. These measures are best used in combination and simultaneously. The evidence is that they should be instituted early in the pandemic and for sustained periods. They should also be implemented in the context of the cultural and socioeconomic conditions of the populace. Ineffective NPIs include ultraviolet irradiation and spraying of outdoor spaces and individuals. We recommend that decision makers weigh the evidence carefully, as it applies to the local setting to inform public health decisions.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Betacoronavirus , Higiene de las Manos , Humanos , Máscaras , Nigeria , Pandemias , Cuarentena , Aislamiento Social
18.
Orv Hetil ; 161(45): 1899-1907, 2020 11 08.
Artículo en Húngaro | MEDLINE | ID: mdl-33161388

RESUMEN

Összefoglaló. A 2020. év elején kirobbant COVID-19-világjárvány többek között ráirányította a figyelmet az életmento-életfenntartó kezelések igazságos elosztásának érzékeny kérdésére is. Európán belül elsoként Olaszországot sújtotta a katasztrófa, a válsághelyzetben pedig az érzéstelenítés, fájdalomcsillapítás, újraélesztés és intenzív ellátás területén tevékenykedo szakemberek olasz társasága, a SIAARTI 2020. március 6-án közzétett egy 15 pontos ajánlást. E szerint utilitarista megközelítéssel a rendelkezésre álló szukös eroforrásokat azon betegek kezelésére kellene fordítani, akik túlélési esélye nagyobb, valamint több életévre számíthatnak a jövoben, mert ez biztosíthatja a leheto legtöbb ember számára a leheto legnagyobb hasznot. A javaslat komoly szakmai vitát robbantott ki, amely egyértelmuvé tette, hogy az orvosi eszközök igazságos elosztására vonatkozó diskurzust feltétlenül folytatni kell, nemcsak Olaszországon belül, hanem a pandémiától sújtott többi államban is. Orv Hetil. 2020; 161(45): 1899-1907. Summary. Among other queries, the explosion of the COVID-19 pandemic at the beginning of 2020 has firmly put in focus the sensitive issue of how to allocate scarcely available life-saving treatments in a fair and just manner. The first European country to face an emergency caused by the pandemic was Italy. In a rapidly escalating crisis, on 6th March 2020, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) issued a series of 15 recommendations, suggesting that a utilitarian approach should be adopted in Italian health care and the extremely scarce resources should be reserved for patients with a greater probability of survival and life expectancy, in order to maximize the benefits for the largest possible number of people. The recommendations generated a heated debate among health care professionals, thereby evidencing that similar discussions must be initiated and pursued in all countries affected by the pandemic. Orv Hetil. 2020; 161(45): 1899-1907.


Asunto(s)
Infecciones por Coronavirus/terapia , Asignación de Recursos para la Atención de Salud/ética , Neumonía Viral/terapia , Justicia Social , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Humanos , Italia , Pandemias , Neumonía Viral/epidemiología
20.
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
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