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1.
Virol J ; 18(1): 67, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789703

RESUMEN

BACKGROUND: Risk scores are needed to predict the risk of death in severe coronavirus disease 2019 (COVID-19) patients in the context of rapid disease progression. METHODS: Using data from China (training dataset, n = 96), prediction models were developed by logistic regression and then risk scores were established. Leave-one-out cross validation was used for internal validation and data from Iran (test dataset, n = 43) was used for external validation. RESULTS: A NSL model (area under the curve (AUC) 0.932) and a NL model (AUC 0.903) were developed based on neutrophil percentage and lactate dehydrogenase with and without oxygen saturation (SaO2) using the training dataset. AUCs of the NSL and NL models in the test dataset were 0.910 and 0.871, respectively. The risk scoring systems corresponding to these two models were established. The AUCs of the NSL and NL scores in the training dataset were 0.928 and 0.901, respectively. At the optimal cut-off value of NSL score, the sensitivity and specificity were 94% and 82%, respectively. The sensitivity and specificity of NL score were 94% and 75%, respectively. CONCLUSIONS: These scores may be used to predict the risk of death in severe COVID-19 patients and the NL score could be used in regions where patients' SaO2 cannot be tested.


Asunto(s)
/mortalidad , Mortalidad Hospitalaria , L-Lactato Deshidrogenasa/sangre , Modelos Teóricos , Neutrófilos/citología , Oxígeno/sangre , Anciano , China , Progresión de la Enfermedad , Femenino , Humanos , Irán , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo
2.
Crit Care ; 25(1): 111, 2021 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-33741052

RESUMEN

BACKGROUND: In COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics. METHODS: This is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients. RESULTS: Forty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57-69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2 and PaCO2 values, but cerebral oxygenation decreased significantly (52 [51-54]% vs. 49 [47-50]%, p < 0.001). After PP, a significant increase was observed in PaO2 (from 62 [56-71] to 82 [76-87] mmHg, p = 0.005) and rSO2 (from 53 [52-54]% to 60 [59-64]%, p = 0.005). The use of iNO increased PaO2 (from 65 [67-73] to 72 [67-73] mmHg, p = 0.015) and rSO2 (from 53 [51-56]% to 57 [55-59]%, p = 0.007). The use of ECCO2R decreased PaO2 (from 75 [75-79] to 64 [60-70] mmHg, p = 0.009), with reduction of rSO2 values (59 [56-65]% vs. 56 [53-62]%, p = 0.002). In the whole population, a significant relationship was found between SpO2 and rSO2 (R = 0.62, p < 0.001) and between PaO2 and rSO2 (R0 0.54, p < 0.001). CONCLUSIONS: Rescue therapies exert specific pathophysiological mechanisms, resulting in different effects on systemic and cerebral oxygenation in critically ill COVID-19 patients with ARDS. Cerebral and systemic oxygenation are correlated. The choice of rescue strategy to be adopted should take into account both lung and brain needs. Registration The study protocol was approved by the ethics review board (Comitato Etico Regione Liguria, protocol n. CER Liguria: 23/2020).


Asunto(s)
/terapia , Circulación Cerebrovascular , Oxígeno/sangre , Respiración Artificial , /terapia , Anciano , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
3.
Respir Physiol Neurobiol ; 288: 103644, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33647535

RESUMEN

The purpose of this study was to examine the physiological mechanisms of persistent dyspnoea in COVID-19 survivors. Non-critical patients (n = 186) with varying degrees of COVID-19 severity reported persistent symptoms using a standardized questionnaire and underwent pulmonary function and 6-minute walk testing between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n = 70) and without (n = 116) persistent dyspnoea. Patients with persistent dyspnoea had significantly lower FVC (p = 0.03), FEV1 (p = 0.04), DLCO (p = 0.01), 6-minute walk distance (% predicted, p = 0.03), and end-exercise oxygen saturation (p < 0.001), and higher Borg 0-10 ratings of dyspnoea and fatigue (both p < 0.001) compared to patients without persistent dyspnoea. We have shown that dyspnoea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnoea had greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased exertional desaturation and symptoms. This suggests that there is a true physiological mechanism that may explain persistent dyspnoea after COVID-19.


Asunto(s)
/complicaciones , Disnea/fisiopatología , Tolerancia al Ejercicio , Fatiga/fisiopatología , Intercambio Gaseoso Pulmonar , Espirometría , Adulto , Anciano , Enfermedad Crónica , Disnea/sangre , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Sobrevivientes , Capacidad Vital , Prueba de Paso
4.
Syst Rev ; 10(1): 77, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726854

RESUMEN

BACKGROUND: Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute Covid-19. MAIN RESEARCH QUESTIONS: 1. What exercise tests have been used to assess exertional hypoxia at home or in an ambulatory setting in the context of Covid-19 and to what extent have they been validated? 2. What exercise tests have been used to assess exertional hypoxia in other lung conditions, to what extent have they been validated and what is the applicability of these studies to acute Covid-19? METHOD: AMED, CINAHL, EMBASE MEDLINE, Cochrane and PubMed using LitCovid, Scholar and Google databases were searched to September 2020. Studies where participants had Covid-19 or another lung disease and underwent any form of exercise test which was compared to a reference standard were eligible. Risk of bias was assessed using QUADAS 2. A protocol for the review was published on the Medrxiv database. RESULTS: Of 47 relevant papers, 15 were empirical studies, of which 11 described an attempt to validate one or more exercise desaturation tests in lung diseases other than Covid-19. In all but one of these, methodological quality was poor or impossible to fully assess. None had been designed as a formal validation study (most used simple tests of correlation). Only one validation study (comparing a 1-min sit-to-stand test [1MSTST] with reference to the 6-min walk test [6MWT] in 107 patients with interstitial lung disease) contained sufficient raw data for us to calculate the sensitivity (88%), specificity (81%) and positive and negative predictive value (79% and 89% respectively) of the 1MSTST. The other 4 empirical studies included two predictive studies on patients with Covid-19, and two on HIV-positive patients with suspected pneumocystis pneumonia. We found no studies on the 40-step walk test (a less demanding test that is widely used in clinical practice to assess Covid-19 patients). Heterogeneity of study design precluded meta-analysis. DISCUSSION: Exertional desaturation tests have not yet been validated in patients with (or suspected of having) Covid-19. A stronger evidence base exists for the diagnostic accuracy of the 1MSTST in chronic long-term pulmonary disease; the relative intensity of this test may raise safety concerns in remote consultations or unstable patients. The less strenuous 40-step walk test should be urgently evaluated.


Asunto(s)
/sangre , Prueba de Esfuerzo , Ejercicio Físico , Enfermedades Pulmonares/diagnóstico , Oxígeno/sangre , Esfuerzo Físico , /patología , Disnea , Prueba de Esfuerzo/efectos adversos , Humanos , Hipoxia , Enfermedades Pulmonares/sangre , Enfermedades Pulmonares/patología , Enfermedades Pulmonares/virología , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
5.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33727298

RESUMEN

A 64-year-old man was intubated and ventilated for COVID-19-associated acute respiratory distress syndrome. He had a background history of chronic obstructive pulmonary disease and ischaemic heart disease. His oxygen saturations dropped rapidly to 80% on day 9 of ICU admission. Chest auscultation revealed absent breath sounds over the left upper chest which raised suspicions for pneumothorax, of which a small stable left apical pneumothorax was documented on a recent CT scan of the thorax. Point-of-care ultrasonography was performed prior to attempting chest drain insertion which demonstrated sliding pleura on the left side (GE Healthcare model: Vscan Extend-display: 5 inches, 720×1280 pixels resolution, sector probe-broad bandwidth: 1.7-3.8 MHz, 24 cm penetration and linear probe-broad bandwidth: 3.3-8 MHz, 8 cm penetration). A portable chest X-ray was obtained which demonstrated left upper lobe collapse secondary to mucus plugging. The mucus plug was successfully suctioned from the patient's airway using bedside bronchoscopy subsequently improving the patient's oxygen saturation. A follow-up chest X-ray and CT scan of the thorax demonstrated interval resolution of the left upper lobe collapse. While expansion of his existing pneumothorax was first on the list of differential diagnoses, the use of ultrasonography early in the patient's assessment ensured it was ruled out prior to attempting chest drain insertion, thus prompting the acquisition of the chest X-ray which subsequently demonstrated the left upper lobe collapse as the correct diagnosis.


Asunto(s)
/complicaciones , Cuidados Críticos/métodos , Sistemas de Atención de Punto , /etiología , Ultrasonografía/métodos , /sangre , Diagnóstico Diferencial , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Oxígeno/sangre , /sangre
6.
Front Immunol ; 12: 613422, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33679753

RESUMEN

Hyper-inflammatory responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are a major cause of disease severity and death. Predictive prognosis biomarkers to guide therapeutics are critically lacking. Several studies have indicated a "cytokine storm" with the release of interleukin-1 (IL-1), IL-6, and IL-8, along with tumor necrosis factor alpha (TNFα) and other inflammatory mediators. Here, we proposed to assess the relationship between IL-6 and outcomes of patients with coronavirus disease 2019 (COVID-19). Our cohort consisted of 46 adult patients with PCR-proven SARS-CoV-2 infection admitted in a COVID-19 ward of the Hospital de Braga (HB) from April 7 to May 7, 2020, whose IL-6 levels were followed over time. We found that IL-6 levels were significantly different between the disease stages. Also, we found a significant negative correlation between IL-6 levels during stages IIb and III, peripheral oxygen saturation (SpO2), and partial pressure of oxygen in arterial blood (PaO2), showing that IL-6 correlates with respiratory failure. Compared to the inflammatory markers available in the clinic routine, we found a positive correlation between IL-6 and C-reactive protein (CRP). However, when we assessed the predictive value of these two markers, IL-6 behaves as a better predictor of disease progression. In a binary logistic regression, IL-6 level was the most significant predictor of the non-survivors group, when compared to age and CRP. Herein, we present IL-6 as a relevant tool for prognostic evaluation, mainly as a predictor of outcome.


Asunto(s)
Síndrome de Liberación de Citoquinas , Interleucina-6/sangre , /metabolismo , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , /mortalidad , Síndrome de Liberación de Citoquinas/sangre , Síndrome de Liberación de Citoquinas/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre
7.
Recenti Prog Med ; 112(3): 216-218, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33687360

RESUMEN

We analysed RRI and other hemodynamic, re-spiratory and inflammation parameters in critically ill pa-tients affected by severe covid-19 with acute distress respi-ratory syndrome (ARDS) aiming at verifying their modifica-tions during supine and prone positioning and any mutual correlation or interplay with RRI.


Asunto(s)
Velocidad del Flujo Sanguíneo , Inflamación/fisiopatología , Riñón/fisiopatología , Pulmón/fisiopatología , Arteria Renal/fisiopatología , Circulación Renal , /fisiopatología , Biomarcadores , Proteína C-Reactiva/análisis , /complicaciones , Creatinina/sangre , Diástole , Diagnóstico Precoz , Femenino , Humanos , Inflamación/sangre , Inflamación/diagnóstico , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Posición Prona , /etiología , Posición Supina , Sístole
8.
Artículo en Inglés | MEDLINE | ID: mdl-33670983

RESUMEN

BACKGROUND: Safety in medical work requires eye protection, such as glasses, and protective facial masks (PFM) during clinical practice to prevent viral respiratory infections. The use of facial masks and other full personal protective equipment increases air flow resistance, facial skin temperature and physical discomfort. The aim of the present study was to measure surgeons' oxygenation status and discomfort before and after their daily routine activities of oral interventions. METHODS: 10 male voluntary dentists, specializing in oral surgery, and 10 male voluntary doctors in dentistry, participating in master's courses in oral surgery in the Department of Oral Surgery of the University of Chieti, with mean age 29 ± 6 (27-35), were enrolled. This study was undertaken to investigate the effects of wearing a PFM on oxygenation status while the oral surgeons were actively working. Disposable sterile one-way surgical paper masks (Surgical Face Mask, Euronda, Italy) and FFP2 (Surgical Face Mask, Euronda, Italy) were used and the mask position covering the nose did not vary during the procedures. The FFP2 was covered by a surgical mask during surgical treatment. A pulse oximeter was used to measure the blood oximetry saturation during the study. RESULTS: In all 20 surgeons wearing FFP2 covered by surgical masks, a reduction in arterial O2 saturation from around 97.5% before surgery to 94% after surgery was recorded with increase of heart rates. A shortness of breath and light-headedness/headaches were also noted. CONCLUSIONS: In conclusion, wearing an FFP2 covered by a surgical mask induces a reduction in circulating O2 concentrations without clinical relevance, while an increase of heart frequency and a sensation of shortness of breath, light-headedness/headaches were recorded.


Asunto(s)
Frecuencia Cardíaca , Máscaras , Cirujanos Oromaxilofaciales , Oxígeno/sangre , Adulto , Humanos , Italia , Masculino , Adulto Joven
9.
JAMA Netw Open ; 4(3): e210414, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33651109

RESUMEN

Importance: Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older. Objective: To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress. Design, Setting, and Participants: This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020. Interventions: All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes. Main Outcomes and Measures: Changes in respiratory parameters during the use of surgical masks were evaluated. Results: Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis = .59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis = .69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis = .97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P < .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P < .05). Conclusions and Relevance: This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger.


Asunto(s)
/prevención & control , Máscaras/efectos adversos , Pandemias , Respiración , Insuficiencia Respiratoria/etiología , Dióxido de Carbono/fisiología , Preescolar , Femenino , Humanos , Lactante , Italia , Masculino , Oxígeno/sangre , Oxígeno/fisiología , Presión Parcial , Pruebas de Función Respiratoria , Frecuencia Respiratoria
10.
Reumatismo ; 72(4): 189-196, 2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33677945

RESUMEN

The role of 25-OH-vitamin D in the assessment of coronavirus disease 19 (COVID-19) has not been investigated. We sought to investigate the prevalence of 25-OH-vitamin D deficiency among COVID-19 patients, and to determine the associations between 25-OH-vitamin D status and the severity of the disease. We have conducted a retrospective observational study of COVID-19 patients admitted to the University of Verona Hospital Trust. Demographic, clinical and biochemical parameters were collected at hospital admission, and serum 25-OH-vitamin D levels were measured. The following outcomes were assessed: arterial partial oxygen pressure (PaO2); C-reactive protein (CRP); length of hospitalization; requirement of oxygen therapy; non-invasive ventilation (NIV); mechanical ventilation; and death. Among 61 patients enrolled, 72.1% was 25-OH-vitamin D deficient (<20 ng/mL) and 57.4% had 25-OHvitamin D <15 ng/mL. Patients with arterial PaO2 <60 mmHg had significantly lower mean 25-OH-vitamin D levels compared to patients with PaO2 ≥60 mmHg (13.3 ng/mL vs 20.4 ng/mL respectively, p=0.03). Vitamin D deficiency was associated with 3-fold higher risk of having arterial pO2 <60 mmHg. 25-OH-vitamin D deficiency was associated with increased CRP and dyspnea. 25-OH-vitamin D deficiency was associated with more severe systemic inflammatory response and respiratory failure in COVID-19 patients.


Asunto(s)
/sangre , Vitamina D/sangre , Adulto , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/análisis , Comorbilidad , Susceptibilidad a Enfermedades , Disnea/etiología , Femenino , Fibrinógeno/análisis , Humanos , Italia/epidemiología , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Presión Parcial , Prevalencia , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología
11.
Physiol Rep ; 9(3): e14726, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33523608

RESUMEN

Corona virus disease 2019 (COVID-19) causes symptoms from multiple organs after infection by severe acute respiratory syndrome corona virus 2 (SARS CoV-2). They range from early, low blood oxygen levels (hypoxemia) without breathlessness ("silent hypoxia"), delirium, rashes, and loss of smell (anosmia), to persisting chest pain, muscle weakness and -pain, fatigue, confusion, memory problems and difficulty to concentrate ("brain fog"), mood changes, and unexpected onset of hypertension or diabetes. SARS CoV-2 affects the microcirculation, causing endothelial cell swelling and damage (endotheliitis), microscopic blood clots (microthrombosis), capillary congestion, and damage to pericytes that are integral to capillary integrity and barrier function, tissue repair (angiogenesis), and scar formation. Similar to other instances of critical illness, COVID-19 is also associated with elevated cytokine levels in the systemic circulation. This review examines how capillary damage and inflammation may contribute to these acute and persisting COVID-19 symptoms by interfering with blood and tissue oxygenation and with brain function. Undetectable by current diagnostic methods, capillary flow disturbances limit oxygen diffusion exchange in lungs and tissue and may therefore cause hypoxemia and tissue hypoxia. The review analyzes the combined effects of COVID-19-related capillary damage, pre-existing microvascular changes, and upstream vascular tone on tissue oxygenation in key organs. It identifies a vicious cycle, as infection- and hypoxia-related inflammation cause capillary function to deteriorate, which in turn accelerates hypoxia-related inflammation and tissue damage. Finally, the review addresses the effects of low oxygen and high cytokine levels in brain tissue on neurotransmitter synthesis and mood. Methods to assess capillary functions in human organs and therapeutic means to protect capillary functions and stimulate capillary bed repair may prove important for the individualized management of COVID-19 patients and targeted rehabilitation strategies.


Asunto(s)
/complicaciones , Microvasos/patología , Consumo de Oxígeno , Oxígeno/metabolismo , Animales , /patología , Humanos , Inflamación , Microvasos/metabolismo , Microvasos/virología , Oxígeno/sangre , /patogenicidad
12.
Eur J Med Res ; 26(1): 20, 2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33573699

RESUMEN

BACKGROUND: Vitamin C is an essential water-soluble nutrient that functions as a key antioxidant and has been proven to be effective for boosting immunity. In this study, we aimed to assess the efficacy of adding high-dose intravenous vitamin C (HDIVC) to the regimens for patients with severe COVID-19 disease. METHODS: An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received HDIVC (6 g daily) added to the same regimen. RESULTS: There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. The mean body temperature was significantly lower in the case group on the 3rd day of hospitalization (p = 0.001). Peripheral capillary oxygen saturations (SpO2) measured at the 3rd day of hospitalization was also higher in the case group receiving HDIVC (p = 0.014). The median length of hospitalization in the case group was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in SpO2 levels at discharge time, the length of intensive care unit (ICU) stay, and mortality between the two groups. CONCLUSIONS: We did not find significantly better outcomes in the group who were treated with HDIVC in addition to the main treatment regimen at discharge. Trial registration irct.ir (IRCT20200411047025N1), April 14, 2020.


Asunto(s)
Antivirales/uso terapéutico , Ácido Ascórbico/administración & dosificación , /tratamiento farmacológico , Antivirales/administración & dosificación , Ácido Ascórbico/uso terapéutico , Temperatura Corporal , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Unidades de Cuidados Intensivos , Tiempo de Internación , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Oxígeno/sangre , /virología , Ritonavir/uso terapéutico , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 100(5): e24483, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592900

RESUMEN

ABSTRACT: Intermediate care units (ImCUs) have been shown as appropriate units for the management of selected septic patients. Developing specific protocols for residents in training may be useful for their medical performance. The objective of this study was to analyze whether a simulation-based learning bundle is useful for residents while acquiring competencies in the management of sepsis during their internship in an ImCU.A prospective study, set in a tertiary-care academic medical center was performed enrolling residents who performed their internship in an ImCU from 2014 to 2017. The pillars of the simulation-based learning bundle were sepsis scenario in the simulation center, instructional material, and sepsis lecture, and management of septic patients admitted in the ImCU. Each resident was evaluated in the beginning and at the end of their internship displaying a sepsis-case scenario in the simulation center. The authors developed a sepsis-checklist that residents must fulfill during their performance which included 5 areas: hemodynamics (0-10), oxygenation (0-5), antibiotic therapy (0-9), organic injury (0-5), and miscellaneous (0-4).Thirty-four residents from different years of residency and specialties were evaluated. The total median score (interquartile range) increased significantly after training: 12 (25) vs 23 (16), P = .001. First-year residents scored significantly lower than older residents at baseline: 10 (14) vs 14.5 (19), P = .024. However, the performance at the end of the training period was similar in both groups: 21.5 (11) vs 23 (16), P = 1.000. Internal Medicine residents scored significantly higher than residents from other specialties: 18 (17) vs 10.5 (21), P = .007. Nonetheless, the performance at the end of the training period was similar in both groups: 24.5 (9) vs 22 (13), P = 1.000.Combining medical simulation with didactic lectures and a rotation in an ImCU staffed by hospitalists seems to be useful in acquiring competencies to manage critically ill patients with sepsis. We designed a checklist to assure an objective evaluation of the performance of the residents and to identify those aspects that could be potentially improved.


Asunto(s)
Internado y Residencia/organización & administración , Sepsis/terapia , Entrenamiento Simulado/organización & administración , Centros Médicos Académicos , Antibacterianos/administración & dosificación , Competencia Clínica , Evaluación Educacional , Hemodinámica , Humanos , Insuficiencia Multiorgánica/patología , Oxígeno/sangre , Estudios Prospectivos
15.
BMC Infect Dis ; 21(1): 157, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557778

RESUMEN

BACKGROUND: Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. METHODS: This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. RESULTS: Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. CONCLUSIONS: Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.


Asunto(s)
/diagnóstico , Pulmón/diagnóstico por imagen , Adulto , Proteína C-Reactiva/metabolismo , Estudios Transversales , Femenino , Humanos , Italia , Pulmón/patología , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
16.
Aerosp Med Hum Perform ; 92(2): 75-82, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33468287

RESUMEN

BACKGROUND: Ischemic hypoxia induced by suprathreshold G-force loading can adversely affect vision, cognition, and lead to loss of consciousness (LOC). The purpose of this study was to determine whether reductions in cerebral oxygenation, caused by subthreshold G-forces (up to 4 Gz and of limited durations that do not lead to LOC), would affect visual perception and working memory performance.METHODS: Sixteen subjects performed visual perception and working memory tasks both before and during Gz exposures (1, 2.2, 3, 4 with leg pressurization, 4 with leg and abdomen pressurization) within a human-use centrifuge.RESULTS: As measured using near-infrared spectroscopy, blood oxygenation over medial prefrontal cortex was similar in the 1 and 2.2 Gz conditions, but was reduced to a similar extent in the 3 and 4 Gz conditions. In parallel, visual perception accuracy was reduced in the 3 and 4 Gz conditions, with no difference between the 3 and 4 Gz conditions. No change in reaction time was seen. Conversely, neither accuracy nor reaction time changes were observed for the visual working memory task.DISCUSSION: These results indicate that although visual working memory is not affected, the ability to visually discriminate between stimuli is reduced at G-forces as low as 3 and 4 Gz. This may have important ramifications for pilots who are routinely subjected to such forces.Croft RJ, Klegrd R, Tribukait A, Taylor NAS, Eiken O. Effects of acceleration-induced reductions in retinal and cerebral oxygenation on human performance. Aerosp Med Hum Perform. 2021; 92(2):7582.


Asunto(s)
Aceleración , Memoria a Corto Plazo , Oxígeno/sangre , Corteza Prefrontal/irrigación sanguínea , Vasos Retinianos , Percepción Visual , Adulto , Medicina Aeroespacial , Femenino , Voluntarios Sanos , Humanos , Masculino , Espectroscopía Infrarroja Corta , Suecia , Análisis y Desempeño de Tareas
17.
Am J Physiol Heart Circ Physiol ; 320(3): H1055-H1065, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33449849

RESUMEN

Pannexin 1 (Panx1) channels export ATP and may contribute to increased concentration of the vasodilator ATP in plasma during hypoxia in vivo. We hypothesized that Panx1 channels and associated ATP export contribute to hypoxic vasodilation, a mechanism that facilitates the matching of oxygen delivery to metabolic demand of tissue. Male and female mice devoid of Panx1 (Panx1-/-) and wild-type controls (WT) were anesthetized, mechanically ventilated, and instrumented with a carotid artery catheter or femoral artery flow transducer for hemodynamic and plasma ATP monitoring during inhalation of 21% (normoxia) or 10% oxygen (hypoxia). ATP export from WT vs. Panx1-/-erythrocytes (RBC) was determined ex vivo via tonometer experimentation across progressive deoxygenation. Mean arterial pressure (MAP) was similar in Panx1-/- (n = 6) and WT (n = 6) mice in normoxia, but the decrease in MAP in hypoxia seen in WT was attenuated in Panx1-/- mice (-16 ± 9% vs. -2 ± 8%; P < 0.05). Hindlimb blood flow (HBF) was significantly lower in Panx1-/- (n = 6) vs. WT (n = 6) basally, and increased in WT but not Panx1-/- mice during hypoxia (8 ± 6% vs. -10 ± 13%; P < 0.05). Estimation of hindlimb vascular conductance using data from the MAP and HBF experiments showed an average response of 28% for WT vs. -9% for Panx1-/- mice. Mean venous plasma ATP during hypoxia was 57% lower in Panx1-/- (n = 6) vs. WT mice (n = 6; P < 0.05). Mean hypoxia-induced ATP export from RBCs from Panx1-/- mice (n = 8) was 82% lower than that from WT (n = 8; P < 0.05). Panx1 channels participate in hemodynamic responses consistent with hypoxic vasodilation by regulating hypoxia-sensitive extracellular ATP levels in blood.NEW & NOTEWORTHY Export of vasodilator ATP from red blood cells requires pannexin 1. Blood plasma ATP elevations in response to hypoxia in mice require pannexin 1. Hemodynamic responses to hypoxia are accompanied by increased plasma ATP in mice in vivo and require pannexin 1.


Asunto(s)
Adenosina Trifosfato/sangre , Conexinas/sangre , Eritrocitos/metabolismo , Hemodinámica , Miembro Posterior/irrigación sanguínea , Hipoxia/sangre , Proteínas del Tejido Nervioso/sangre , Oxígeno/sangre , Animales , Presión Arterial , Conexinas/deficiencia , Conexinas/genética , Modelos Animales de Enfermedad , Femenino , Frecuencia Cardíaca , Hiperemia/sangre , Hiperemia/genética , Hiperemia/fisiopatología , Hipotensión/sangre , Hipotensión/genética , Hipotensión/fisiopatología , Hipoxia/genética , Hipoxia/fisiopatología , Masculino , Ratones Endogámicos C57BL , Ratones Noqueados , Proteínas del Tejido Nervioso/deficiencia , Proteínas del Tejido Nervioso/genética , Flujo Sanguíneo Regional , Vasodilatación
18.
Methods Mol Biol ; 2216: 171-185, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33476000

RESUMEN

The role of hypoxia in renal disease and injury has long been suggested but much work still remains, especially as it relates to human translation. Invasive pO2 probes are feasible in animal models but not for human use. In addition, they only provide localized measurements. Histological methods can identify hypoxic tissue and provide a spatial distribution, but are invasive and allow only one-time point. Blood oxygenation level dependent (BOLD) MRI is a noninvasive method that can monitor relative oxygen availability across the kidney. It is based on the inherent differences in magnetic properties of oxygenated vs. deoxygenated hemoglobin. Presence of deoxyhemoglobin enhances the spin-spin relaxation rate measured using a gradient echo sequence, known as R2* (= 1/T2*). While the key interest of BOLD MRI is in the application to humans, use in preclinical models is necessary primarily to validate the measurement against invasive methods, to better understand physiology and pathophysiology, and to evaluate novel interventions. Application of MRI acquisitions in preclinical settings involves several challenges both in terms of logistics and data acquisition. This section will introduce the concept of BOLD MRI and provide some illustrative applications. The following sections will discuss the technical issues associated with data acquisition and analysis.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by two separate chapters describing the experimental procedure and data analysis.


Asunto(s)
Biomarcadores/análisis , Procesamiento de Imagen Asistido por Computador/métodos , Riñón/fisiología , Imagen por Resonancia Magnética/métodos , Monitoreo Fisiológico/métodos , Consumo de Oxígeno , Oxígeno/sangre , Animales , Análisis de los Gases de la Sangre , Humanos , Programas Informáticos
19.
Methods Mol Biol ; 2216: 403-417, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33476013

RESUMEN

Renal hypoxia is generally accepted as a key pathophysiologic event in acute kidney injury of various origins, and has also been suggested to play a role in the development of chronic kidney disease. Here we describe a step-by-step experimental protocol for indirect monitoring of renal blood oxygenation in rodents via the deoxyhemoglobin sensitive MR parameters T2* and T2-a contrast mechanism known as the blood oxygenation level dependent (BOLD) effect. Since an absolute quantification of renal oxygenation from T2*/T2 remains challenging, the effects of controlled and standardized variations in the fraction of inspired oxygen are used for bench marking. This MRI method may be useful for investigating renal blood oxygenation of small rodents in vivo under various experimental (patho)physiological conditions.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This experimental protocol chapter is complemented by two separate chapters describing the basic concept and data analysis.


Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Riñón/fisiología , Imagen por Resonancia Magnética/métodos , Monitoreo Fisiológico/métodos , Oxígeno/sangre , Animales , Consumo de Oxígeno , Ratas , Ratas Endogámicas Lew , Ratas Sprague-Dawley , Ratas Wistar , Programas Informáticos
20.
Methods Mol Biol ; 2216: 591-610, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33476026

RESUMEN

Renal hypoxia is generally accepted as a key pathophysiologic event in acute kidney injury of various origins and has also been suggested to play a role in the development of chronic kidney disease. Here we describe step-by-step data analysis protocols for MRI monitoring of renal oxygenation in rodents via the deoxyhemoglobin concentration sensitive MR parameters T2* and T2-a contrast mechanism known as the blood oxygenation level dependent (BOLD) effect.This chapter describes how to use the analysis tools provided by vendors of animal and clinical MR systems, as well as how to develop an analysis software. Aspects covered are: data quality checks, data exclusion, model fitting, fitting algorithm, starting values, effects of multiecho imaging, and result validation.This chapter is based upon work from the PARENCHIMA COST Action, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This experimental protocol chapter is complemented by two separate chapters describing the basic concept and data analysis.


Asunto(s)
Biomarcadores/análisis , Medios de Contraste/química , Procesamiento de Imagen Asistido por Computador/métodos , Riñón/fisiología , Imagen por Resonancia Magnética/métodos , Monitoreo Fisiológico/métodos , Oxígeno/sangre , Algoritmos , Animales , Consumo de Oxígeno , Programas Informáticos
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