Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 51.875
Filtrar
1.
Sci Rep ; 11(1): 7477, 2021 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-33820944

RESUMEN

We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24-6.47) and neutrophil count (aOR 2.39, 95% CI 1.34-4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828-0.979). Median APACHE II score was 19 (IQR 17-22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89-129). Median peak FiO2 was 0.75 (IQR 0.6-1.0), positive end-expiratory pressure 12 (IQR 10-14) and plateau pressure 22 (IQR 18-26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5-13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.


Asunto(s)
/patología , Adulto , Área Bajo la Curva , Proteína C-Reactiva/metabolismo , Disnea/etiología , Femenino , Humanos , Unidades de Cuidados Intensivos , L-Lactato Deshidrogenasa/metabolismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Estudios Prospectivos , Curva ROC , Respiración Artificial , Frecuencia Respiratoria , Índice de Severidad de la Enfermedad , Singapur
2.
Crit Care ; 25(1): 128, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33823862

RESUMEN

BACKGROUND: Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. METHODS: Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. RESULTS: Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). CONCLUSIONS: During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. TRIAL REGISTRATION: clinicaltrials.gov number: NCT04388670.


Asunto(s)
/terapia , Cuidados Críticos/normas , Intubación/normas , Posicionamiento del Paciente/normas , Posición Prona , Respiración Artificial/normas , Posición Supina , Anciano , Estudios de Cohortes , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos
3.
PLoS One ; 16(4): e0249349, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33831046

RESUMEN

BACKGROUND: Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease. METHODS: In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test. RESULTS: We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168). CONCLUSIONS: There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Infecciones Bacterianas , Brotes de Enfermedades , Hospitales de Enseñanza , Anticuerpos Monoclonales Humanizados/efectos adversos , Infecciones Bacterianas/etiología , Infecciones Bacterianas/mortalidad , /mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Respiración Artificial , Estudios Retrospectivos , Tasa de Supervivencia
4.
BMC Infect Dis ; 21(1): 353, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33858331

RESUMEN

BACKGROUND: The primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors. MATERIALS AND METHODS: Patients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed. RESULTS: Sixty-four patients were enrolled, median age of 64 years (IQR 58-69). The majority cells in the BALF were neutrophils (70%, IQR 37.5-90.5) and macrophages (27%, IQR 7-49) while a minority were lymphocytes, 1%, TCD3+ 92% (IQR 82-95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p = 0.033) and peripheral lymphocytes (p = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014-1.759, p = 0.039). CONCLUSIONS: In critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.


Asunto(s)
Líquido del Lavado Bronquioalveolar/citología , Líquido del Lavado Bronquioalveolar/inmunología , /inmunología , Recuento de Leucocitos , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Respiración Artificial , Adulto , Anciano , Líquido del Lavado Bronquioalveolar/virología , /virología , Enfermedad Crítica/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Linfocitos/citología , Macrófagos/citología , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Neumonía Viral/mortalidad , Neumonía Viral/virología , /patogenicidad , Sobrevivientes/estadística & datos numéricos , Resultado del Tratamiento
6.
Saudi Med J ; 42(4): 391-398, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33795494

RESUMEN

OBJECTIVES: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. METHODS: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. CONCLUSION: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.


Asunto(s)
/fisiopatología , Dolor Abdominal/fisiopatología , Adolescente , Asma/epidemiología , Atrofia , Encéfalo/patología , Bronquiolitis Obliterante/epidemiología , /epidemiología , Niño , Preescolar , Comorbilidad , Tos/fisiopatología , Diarrea/fisiopatología , Disnea/fisiopatología , Femenino , Fiebre/fisiopatología , Cardiopatías Congénitas/epidemiología , Mortalidad Hospitalaria , Hospitalización , Humanos , Hidrocefalia/epidemiología , Lactante , Unidades de Cuidado Intensivo Pediátrico , Masculino , Faringitis/fisiopatología , Respiración Artificial , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos , Arabia Saudita/epidemiología , Índice de Severidad de la Enfermedad , Vómitos/fisiopatología
7.
BMC Pregnancy Childbirth ; 21(1): 305, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33863292

RESUMEN

BACKGROUND: Pregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity. METHODS: We used retrospective data from January through June 2020 on female patients aged 18-44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions. RESULTS: Out of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%, P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day, P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days, P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%, P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups. CONCLUSIONS: Among women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.


Asunto(s)
/epidemiología , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas , Respiración Artificial/estadística & datos numéricos , Adolescente , Adulto , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Mortalidad Materna , Embarazo , Análisis de Regresión , Estudios Retrospectivos , Estados Unidos/epidemiología
8.
Pneumologie ; 75(4): 261-267, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33873221

RESUMEN

AIM: With the emergence of a new virus and the associated pandemic, the ICU started to see a brand new kind of patient with severe ARD. As with any disease, sometimes the discontinuation of mechanical ventilation for any reason can be difficult. As a center specializing in weaning patients after prolonged mechanical ventilation, we wanted to compare our results with weaning patients who had prolonged mechanical ventilation for other reasons than those of patients who had prolonged mechanical ventilation due to SARS-CoV-2 infection. METHODS: We obtained our data from WeanNet register, the weaning register of the German Institute for Lung Research (ILF). In our analysis, we included only patient data from January until July 2020, which was recorded in our in-house study files. RESULTS: Our analysis included data on 28 patients; 11 were treated with prolonged mechanical ventilation due to SARS-CoV-2 pneumonia, 17 had no SARS-CoV-2 infection. 81.2 % of SARS-CoV-2 patients were successfully weaned from invasive ventilator therapy compared to 76.4 % of patients without SARS-CoV-2. Mortality in the SARS-CoV-2 group was 18.2 % compared to 11.8 % in the other group. Patients with SARS-CoV-2 infections were predominantly males with preexisting cardiovascular disease or a history of nicotine abuse. ARDS was the most common cause of respiratory failure which led to primary intubation. CONCLUSION: Even though we were only able to analyze a small number of patient histories due to the novelty of the disease, we were able to show that patients with prolonged mechanical ventilation after SARS-CoV-2 infection can be equally successfully weaned compared to patients with prolonged mechanical ventilation due to other diseases. Risk factors for prolonged mechanical ventilation after a severe case of SARS-CoV-2 infection seemed to be male gender, nicotine abuse and cardiovascular disease.


Asunto(s)
Respiración Artificial , Insuficiencia Respiratoria , Femenino , Humanos , Masculino , Pandemias , Insuficiencia Respiratoria/terapia , Desconexión del Ventilador
9.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 38(1): 185-190, 2021 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-33899444

RESUMEN

The high frequency oscillatory ventilation (HFOV) is characterized with low tidal volume and low mean airway pressure, and can well support the breathing of the patients with respiratory diseases. Since the HFOV was proposed, it has been widely concerned by medical and scientific researchers. About the HFOV, this paper discussed its current research status and prospected its future development in technologies. The research status of ventilation model, mechanisms and ventilation mode were introduced in detail. In the next years, the technologies in developing HFOV will be focused on: to develop the branched high-order nonlinear or volume-depended resistance-inertance-compliance (RIC) ventilation model, to fully understand the mechanisms of HFOV and to achieve the noninvasive HFOV. The development in technologies of HFOV will be beneficial to the patients with respiratory diseases who failed with conventional mechanical ventilation as one of considerable ventilation methods.


Asunto(s)
Ventilación de Alta Frecuencia , Humanos , Pulmón , Respiración Artificial , Volumen de Ventilación Pulmonar
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(3): 418-423, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-33849834

RESUMEN

OBJECTIVE: To explore the role of prostacyclin (PGI2) and thromboxane A2 (TXA2) in lung hyper-permeability induced by mechanical ventilation (MV) in rabbits. OBJECTIVE: Forty-eight healthy Japanese white rabbits were randomly allocated to vehicle treatment group (group V), tranylcypromine (a PGI2 synthase inhibitor) treatment group (group T), dazoxiben (a TXA2 synthase inhibitor) treatment group (group D), vehicle-treated MV group (group VM), tranylcyprominetreated MV group (group TM) and dazoxiben-treated MV group (group DM). The contents of PGI2 and TXA2 in the lung tissues and TNF-α level in BALF and lung tissues were measured by ELISA. The lung wet/dry weight (W/D) ratio, lung permeability index and pulmonary expressions of myosin light chain kinase (MLCK) protein and mRNA were detected to evaluate the pulmonary permeability. The severities of lung injury were assessed by lung histological scores. OBJECTIVE: The measured parameters did not differ significantly among the rabbits receiving different treatments without MV. In rabbits in group VM, the contents of PGI2 and TXA2 in the lungs, TNF-α in BALF and lung tissues, PGI2/TXA2 ratio, lung W/D ratio, lung permeability index, pulmonary expressions of MLCK protein and mRNA and histological scores of the lungs all increased significantly (P < 0.05) as compared with those in group V, group T and group D. In rabbits undergoing MV, inhibition of PGI2 production by tranylcypromine significantly decreased the PGI2/TXA2 ratio (P < 0.05), further enhanced the production of TNF-α in the BALF and lung tissue (P < 0.05), and worsened lung hyper-permeability and lung injury (P < 0.05), while treatment with dazoxiben significantly reduced TXA2 production in the lung tissue (P < 0.05), increased the PGI2/TXA2 ratio (P < 0.05) and decreased TNF-α production in the BALF and lung tissue (P < 0.05), thus resulting in alleviated lung hyperpermeability and lung injury (P < 0.05). OBJECTIVE: PGI2 plays a protective role against MV-induced lung hyper-permeability and lung injury by downregulating TNF-α/MLCK signaling pathway, while TXA2 can exacerbate MV-induced lung hyperpermeability in rabbits by up-regulating TNF-α/ MLCK signaling pathway.


Asunto(s)
Epoprostenol , Tromboxano A2 , Animales , Pulmón , Permeabilidad , Conejos , Respiración Artificial/efectos adversos
11.
BMC Infect Dis ; 21(1): 371, 2021 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-33879073

RESUMEN

BACKGROUND: The current coronavirus disease 2019 (COVID-19) is a public health emergency. In this study, we aimed to evaluate the risk factors for mortality in severe and critical COVID-19 patients. METHODS: We performed a retrospective study of patients diagnosed with severe and critical COVID-19 from four hospitals in Wuhan, China, by evaluating the clinical characteristics and laboratory results, and using Cox proportional hazards model to assess the risk factors involved in disease progression. RESULTS: In total, 446 patients with COVID-19 were enrolled. The study indicated a high mortality rate (20.2%) in severe and critical COVID-19 patients. At the time of admission, all patients required oxygen therapy, and 52 (12%) required invasive mechanical ventilation, of which 50 (96%) died. The univariate Cox proportional hazards model showed a white blood cell count of more than 10 × 109/L (HR 3.993,95%CI 2.469 to 6.459) that correlated with an increased mortality rate. The multivariable Cox proportional hazards model demonstrated that older age (HR 1.066, 95% CI 1.043 to 1.089) and higher white blood cell count (HR 1.135, 95% CI 1.080 to 1.192) were independent risk factors for determining COVID-19 associated mortality. CONCLUSIONS: COVID-19 is associated with a significant risk of morbidity and mortality in the population. Older age and higher white blood cell count were found to be independent risk factors for mortality.


Asunto(s)
Factores de Edad , Recuento de Leucocitos , Adulto , Anciano , China/epidemiología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo
12.
Monaldi Arch Chest Dis ; 91(2)2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33926176

RESUMEN

COVID-19 has involved numerous countries across the globe and the disease burden, susceptible age group; mortality rate has been variable depending on the demographical profile, economic status, and health care infrastructure. In the current clinical environment, COVID-19 is one of the most important clinical differential diagnoses in patients presenting with respiratory symptoms. The optimal mechanical ventilation strategy for these patients has been a constant topic of discussion and very importantly so, since a great majority of these patients require invasive mechanical ventilation and often for an extended period of time. In this report we highlight our experience with a COVID-19 patient who most likely suffered barotrauma either as a result of traumatic endotracheal intubation or primarily due to COVID-19 itself. We also aim to highlight the current literature available to suggest the management strategy for these patients for a favorable outcome. The cases described are diverse in terms of age variance and other comorbidities. According to the literature, certain patients, with COVID-19 disease and spontaneous pneumothorax were noted to be managed conservatively and oxygen supplementation with nasal cannula sufficed. Decision regarding need and escalation to invasive mechanical ventilation should be taken early in the disease to avoid complications such as patient self-inflicted lung injury (P-SILI) and barotrauma sequelae such as pneumothorax and pneumomediastinum Recent systematic review further supports the fact that the use of non-invasive ventilation (NIV) in certain patients with COVID-19 pneumonia may give a false sense of security and clinical stabilization but has no overall benefit to avoid intubation. While invasive mechanical ventilation may be associated with higher rates of barotrauma, this should not mean that intubation and invasive mechanical ventilation should be delayed. This becomes an important consideration when non-intensivists or personnel with less experience provide care for this vulnerable patient population who may rely too heavily on NIV to avoid intubation and mechanical ventilation.


Asunto(s)
/complicaciones , Enfisema Mediastínico/diagnóstico , Neumotórax/diagnóstico , Anciano , Humanos , Intubación Intratraqueal/efectos adversos , Enfisema Mediastínico/etiología , Enfisema Mediastínico/terapia , Neumotórax/etiología , Neumotórax/terapia , Respiración Artificial/efectos adversos
13.
BMC Infect Dis ; 21(1): 397, 2021 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-33926392

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Despite abundant data on that many COVID-19 patients also displayed kidney disease, there is limited information available about the recovery of kidney disease after discharge. METHODS: Retrospective and prospective cohort study to patients with new-onset kidney disease during the COVID-19 hospitalization, admitted between January 28 to February 26, 2020. The median follow-up was 4 months after discharge. The follow-up patients were divided into the recovery group and non-recovery group. Descriptive statistics and between-groups comparison were used. RESULTS: In total, 143 discharged patients with new-onset kidney disease during the COVID-19 hospitalization were included. Patients had a median age was 64 (IQR, 51-70) years, and 59.4% of patients were men. During 4-months median follow-up, 91% (130 of 143) patients recovered from kidney disease, and 9% (13 of 143) patients haven't recovered. The median age of patients in the non-recovery group was 72 years, which was significantly higher than the median age of 62 years in the recovery group. Discharge serum creatinine was significantly higher in the non-recovery group than in the recovery group. CONCLUSIONS: Most of the new-onset kidney diseases during hospitalization of COVID-19 patients recovered 4 months after discharge. We recommend that COVID-19 patients with new-onset kidney disease be followed after discharge to assess kidney recovery, especially elderly patients or patients with high discharge creatinine.


Asunto(s)
/etiología , Creatinina/sangre , Enfermedades Renales/etiología , Anciano , Antivirales/uso terapéutico , /epidemiología , China/epidemiología , Comorbilidad , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Enfermedades Renales/epidemiología , Enfermedades Renales/terapia , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Prospectivos , Proteinuria/epidemiología , Proteinuria/virología , Respiración Artificial , Estudios Retrospectivos
14.
Medicine (Baltimore) ; 100(14): e25408, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832136

RESUMEN

BACKGROUND: Acute respiratory distress syndrome (ARDS) is caused by an inflammatory injury to the lung. Dysregulated inflammation is the cardinal feature of ARDS. Methylprednisolone is an option for treating ARDS. However, the benefits and adverse effects of methylprednisolone have not been well assessed in patients with ARDS. This study aimed to evaluate the efficacy and safety of methylprednisolone against ARDS. MATERIAL AND METHODS: The electronic database of Embase, PubMed, the Cochrane Library, CNKI, and Wanfang were searched, and randomized controlled trials (RCTs) reporting the efficacy and safety of methylprednisolone for ARDS were included. Revman 5.3 and Stata 15.0 were used to conduct the analysis. The fixed-effects model was used to calculate summary odds ratios (ORs) and 95% confidence interval (CIs). RESULTS: Ten RCTs studies involving 692 patients with ARDS. The summary results demonstrated that, compared with placebo, methylprednisolone had a statistically significant effect on mortality (OR = 0.64; 95% CI: 0.43-0.95, I2 = 42%); the time of mechanical ventilation (MD) = -2.70, 95% CI: -3.31 to -2.10; I2 = 0%) in patients with ARDS, but it was not associated with increased rates of adverse events (OR = 0.80; 95% CI: 0.34-1.86; I2 = 58%). CONCLUSIONS: This systematic review and meta-analysis demonstrated that Methylprednisolone is safe against ARDS. It may reduce mortality and shorten the time of mechanical ventilation. However, well-designed and large-sample studies were required to fully characterize the efficacy and safety of methylprednisolone against ARDS.


Asunto(s)
Antiinflamatorios/uso terapéutico , Metilprednisolona/uso terapéutico , Respiración Artificial/estadística & datos numéricos , /tratamiento farmacológico , Adulto , Anciano , Antiinflamatorios/efectos adversos , Estudios de Casos y Controles , Manejo de Datos , Humanos , Inflamación/fisiopatología , Metilprednisolona/efectos adversos , Persona de Mediana Edad , Mortalidad/tendencias , Placebos/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto , /patología , Seguridad , Resultado del Tratamiento
15.
PLoS One ; 16(4): e0249285, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33793600

RESUMEN

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has affected millions of people across the globe. It is associated with a high mortality rate and has created a global crisis by straining medical resources worldwide. OBJECTIVES: To develop and validate machine-learning models for prediction of mechanical ventilation (MV) for patients presenting to emergency room and for prediction of in-hospital mortality once a patient is admitted. METHODS: Two cohorts were used for the two different aims. 1980 COVID-19 patients were enrolled for the aim of prediction ofMV. 1036 patients' data, including demographics, past smoking and drinking history, past medical history and vital signs at emergency room (ER), laboratory values, and treatments were collected for training and 674 patients were enrolled for validation using XGBoost algorithm. For the second aim to predict in-hospital mortality, 3491 hospitalized patients via ER were enrolled. CatBoost, a new gradient-boosting algorithm was applied for training and validation of the cohort. RESULTS: Older age, higher temperature, increased respiratory rate (RR) and a lower oxygen saturation (SpO2) from the first set of vital signs were associated with an increased risk of MV amongst the 1980 patients in the ER. The model had a high accuracy of 86.2% and a negative predictive value (NPV) of 87.8%. While, patients who required MV, had a higher RR, Body mass index (BMI) and longer length of stay in the hospital were the major features associated with in-hospital mortality. The second model had a high accuracy of 80% with NPV of 81.6%. CONCLUSION: Machine learning models using XGBoost and catBoost algorithms can predict need for mechanical ventilation and mortality with a very high accuracy in COVID-19 patients.


Asunto(s)
/mortalidad , Aprendizaje Automático , Pandemias/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Ventiladores Mecánicos/estadística & datos numéricos , Anciano , Servicio de Urgencia en Hospital/tendencias , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
17.
Acta Med Indones ; 53(1): 82-85, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33818410

RESUMEN

Although typically patients with coronavirus disease-19 (COVID-19) have pulmonary symptoms atypical cases can occasionally present with extra-pulmonary symptoms. We report an interesting case of COVID-19 female patient presenting with combination of central nervous system disorder and acute myocardial infarct as initial manifestation. Multiorgan involvement in COVID-19 might lead to multiple atypical presentation which could be overlooked by the physician.


Asunto(s)
Síndrome Coronario Agudo , Encefalitis , /aislamiento & purificación , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/terapia , Adulto , /diagnóstico , /fisiopatología , /métodos , Deterioro Clínico , Coma/diagnóstico , Coma/etiología , Electrocardiografía/métodos , Encefalitis/sangre , Encefalitis/etiología , Encefalitis/fisiopatología , Encefalitis/terapia , Resultado Fatal , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Respiración Artificial/métodos
18.
BMJ Open ; 11(4): e042042, 2021 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-33827831

RESUMEN

OBJECTIVE: To report the clinical characteristics of patients hospitalised with COVID-19 in Southeast Michigan. DESIGN: Retrospective cohort study. SETTING: Eight hospitals in Southeast Michigan. PARTICIPANTS: 3219 hospitalised patients with a positive SARS-CoV-2 infection by nasopharyngeal PCR test from 13 March 2020 until 29 April 2020. MAIN OUTCOMES MEASURES: Outcomes were discharge from the hospital or in-hospital death. Examined predictors included patient demographics, chronic diseases, home medications, mechanical ventilation, in-hospital medications and timeframe of hospital admission. Multivariable logistic regression was conducted to identify risk factors for in-hospital mortality. RESULTS: During the study period, 3219 (90.4%) patients were discharged or died in the hospital. The median age was 65.2 (IQR 52.6-77.2) years, the median length of stay in the hospital was 6.0 (IQR 3.2-10.1) days, and 51% were female. Hypertension was the most common chronic disease, occurring in 2386 (74.1%) patients. Overall mortality rate was 16.0%. Blacks represented 52.3% of patients and had a mortality rate of 13.5%. Mortality was highest at 18.5% in the prepeak hospital COVID-19 volume, decreasing to 15.3% during the peak period and to 10.8% in the postpeak period. Multivariable regression showed increasing odds of in-hospital death associated with older age (OR 1.04, 95% CI 1.03 to 1.05, p<0.001) for every increase in 1 year of age and being male (OR 1.47, 95% CI 1.21 to 1.81, p<0.001). Certain chronic diseases increased the odds of in-hospital mortality, especially chronic kidney disease. Administration of vitamin C, corticosteroids and therapeutic heparin in the hospital was associated with higher odds of death. CONCLUSION: In-hospital mortality was highest in early admissions and improved as our experience in treating patients with COVID-19 increased. Blacks were more likely to get admitted to the hospital and to receive mechanical ventilation, but less likely to die in the hospital than whites.


Asunto(s)
/epidemiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Michigan/epidemiología , Persona de Mediana Edad , Respiración Artificial , Estudios Retrospectivos
19.
Medwave ; 21(2): e8142, 2021 Mar 30.
Artículo en Español | MEDLINE | ID: mdl-33905406

RESUMEN

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 is a potentially severe and rare condition that still needs a better understanding to guide its management. Reports worldwide, and especially in Latin America, are still scarce. This report presents ten cases of pediatric inflammatory multisystem syndrome temporally associated with COVID-19 in children between 2 and 12 years old treated in a Peruvian hospital, diagnosed using the Centers for Disease Control and Prevention criteria. Severe acute respiratory syndrome coronavirus 2 was detected through serological tests (immunoglobulin M or G). Most had gastrointestinal symptoms. Therapeutics consisted mainly of intravenous immunoglobulin, corticosteroids, ivermectin, hydroxychloroquine, digoxin, and antibiotic therapy. Three patients underwent mechanical ventilation; no mortality occurred in this case series. In conclusion, the manifestations presented here are similar to those reported in the literature. A timely diagnosis is necessary for proper management.


Asunto(s)
/terapia , Hospitalización , Síndrome de Respuesta Inflamatoria Sistémica/terapia , /diagnóstico , Niño , Preescolar , Femenino , Humanos , Masculino , Perú , Respiración Artificial , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatología
20.
Pan Afr Med J ; 38: 107, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912277

RESUMEN

The COVID-19 pandemic had caused significant morbidity and mortality, with over a million deaths recorded to date. Mortality recorded among severe-critically ill patients admitted to intensive care units (ICU) has been significantly high, especially in most COVID-19 epicenters. Reports on the unique clinical characteristics and outcomes from the ICU admissions are on-going with isolated studies in Africa. This study was a retrospective single-centre study involving all polymerase chain reaction (PCR) confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients admitted to the medical intensive care unit (MICU) of the department of medicine and therapeutics, Korle-Bu Teaching Hospital, over the period of 13th April - 28th June 2020. Twenty-two (22) patients in total fulfilled the inclusion criteria and are included in this report. Patients' socio-demographic characteristics, clinical and laboratory parameters outcomes as well as treatment modalities employed were extracted from their respective medical records and analyzed using STATA version 14. Dyspnoea, fever and cough were most common associated symptoms. The mean duration of admission at the ICU was 4.1 ± 3.0 days with five deaths (22.7%). About 91% (20/22) had at least one comorbidity with hypertension as the most prevalent. The median oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) level was significantly higher in persons with only COVID-19 pneumonia compared to those with complicated respiratory failure (p<0.001). Six (27.3%) out of the 22 patients had non-invasive ventilation, with only 1/22 (4.5%) receiving mechanical ventilation. Although non-significant, the mean duration of ICU stay was relatively shorter in patients who received therapeutic doses of anticoagulation (p=0.32). Duration of treatment with methylprednisolone was significantly associated with patient outcomes (p=0.04) and serum ferritin levels had a tendency to negatively affect outcome (p=0.06). Clearly there are still no specific targeted medications for COVID-19 treatment, except for empirically symptoms-guided treatments and management of mild to critically ill patients. Early use of systemic corticosteroids for severe to critically ill patients in the ICU using S/F ratio and CRP levels may improve outcomes.


Asunto(s)
/terapia , Enfermedad Crítica/terapia , Unidades de Cuidados Intensivos , Insuficiencia Respiratoria/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , /fisiopatología , Cuidados Críticos/métodos , Enfermedad Crítica/mortalidad , Femenino , Ghana , Humanos , Masculino , Persona de Mediana Edad , Respiración Artificial/estadística & datos numéricos , Insuficiencia Respiratoria/virología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...