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3.
Lancet Respir Med ; 8(10): 1032-1044, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32910897

RESUMO

Severe asthma in children is rare, accounting for only a small proportion of childhood asthma. After addressing modifiable factors such as adherence to treatment, comorbidities, and adverse exposures, children whose disease is not well controlled on high doses of medication form a heterogeneous group of severe asthma phenotypes. Over the past decade, considerable advances have been made in understanding the pathophysiology of severe therapy-resistant asthma in children. However, asthma attacks and hospital admissions are frequent and mortality is still unacceptably high. Strategies to modify the natural history of asthma, prevent severe exacerbations, and prevent lung function decline are needed. Mechanistic studies have led to the development of several biologics targeting type 2 inflammation. This growing pipeline has the potential to reduce the burden of severe asthma; however, detailed assessment and characterisation of each child with seemingly severe asthma is necessary so that the most effective and appropriate management strategy can be implemented. Risk stratification, remote monitoring, and the integration of multiple data sources could help to tailor management for the individual child with severe asthma.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Adolescente , Asma/complicações , Criança , Pré-Escolar , Progressão da Doença , Hospitalização , Humanos
4.
Semin Thromb Hemost ; 46(7): 850-852, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32886934
7.
Lancet Respir Med ; 8(11): 1106-1120, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32979987

RESUMO

BACKGROUND: Early descriptions of patients admitted to hospital during the COVID-19 pandemic showed a lower prevalence of asthma and chronic obstructive pulmonary disease (COPD) than would be expected for an acute respiratory disease like COVID-19, leading to speculation that inhaled corticosteroids (ICSs) might protect against infection with severe acute respiratory syndrome coronavirus 2 or the development of serious sequelae. We assessed the association between ICS and COVID-19-related death among people with COPD or asthma using linked electronic health records (EHRs) in England, UK. METHODS: In this observational study, we analysed patient-level data for people with COPD or asthma from primary care EHRs linked with death data from the Office of National Statistics using the OpenSAFELY platform. The index date (start of follow-up) for both cohorts was March 1, 2020; follow-up lasted until May 6, 2020. For the COPD cohort, individuals were eligible if they were aged 35 years or older, had COPD, were a current or former smoker, and were prescribed an ICS or long-acting ß agonist plus long-acting muscarinic antagonist (LABA-LAMA) as combination therapy within the 4 months before the index date. For the asthma cohort, individuals were eligible if they were aged 18 years or older, had been diagnosed with asthma within 3 years of the index date, and were prescribed an ICS or short-acting ß agonist (SABA) only within the 4 months before the index date. We compared the outcome of COVID-19-related death between people prescribed an ICS and those prescribed alternative respiratory medications: ICSs versus LABA-LAMA for the COPD cohort, and low-dose or medium-dose and high-dose ICSs versus SABAs only in the asthma cohort. We used Cox regression models to estimate hazard ratios (HRs) and 95% CIs for the association between exposure categories and the outcome in each population, adjusted for age, sex, and all other prespecified covariates. We calculated e-values to quantify the effect of unmeasured confounding on our results. FINDINGS: We identified 148 557 people with COPD and 818 490 people with asthma who were given relevant respiratory medications in the 4 months before the index date. People with COPD who were prescribed ICSs were at increased risk of COVID-19-related death compared with those prescribed LABA-LAMA combinations (adjusted HR 1·39 [95% CI 1·10-1·76]). Compared with those prescribed SABAs only, people with asthma who were prescribed high-dose ICS were at an increased risk of death (1·55 [1·10-2·18]), whereas those given a low or medium dose were not (1·14 [0·85-1·54]). Sensitivity analyses showed that the apparent harmful association we observed could be explained by relatively small health differences between people prescribed ICS and those not prescribed ICS that were not recorded in the database (e value lower 95% CI 1·43). INTERPRETATION: Our results do not support a major role for regular ICS use in protecting against COVID-19-related death among people with asthma or COPD. Observed increased risks of COVID-19-related death can be plausibly explained by unmeasured confounding due to disease severity. FUNDING: UK Medical Research Council.


Assuntos
Corticosteroides/administração & dosagem , Asma/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/complicações , Betacoronavirus , Estudos de Coortes , Registros Eletrônicos de Saúde , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Pandemias , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/complicações , Análise de Regressão , Adulto Jovem
8.
PLoS One ; 15(8): e0237296, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760127

RESUMO

BACKGROUND: To avoid a surge of demand on the healthcare system due to the COVID-19 pandemic, we must reduce transmission to individuals with chronic conditions who are at risk of severe illness with COVID-19. We aimed at understanding the perceptions, context and attitudes of individuals with chronic conditions during the COVID-19 pandemic to clarify their potential risk of infection. METHODS: A cross-sectional survey was nested in ComPaRe, an e-cohort of adults with chronic conditions, in France. It assessed participants' perception of their risk of severe illness with COVID-19; their context (i.e., work, household, contacts with external people); and their attitudes in situations involving frequent or occasional contacts with symptomatic or asymptomatic people. Data were collected from March 23 to April 2, 2020, during the lockdown in France. Analyses were weighted to represent the demographic characteristics of French patients with chronic conditions. The subgroup of participants at high risk according to the recommendations of the French High Council for Public Health was examined. RESULTS: Among the 7169 recruited participants, 63% patients felt at risk because of severe illness. About one quarter (23.7%) were at risk of infection because they worked outside home, had a household member working outside home or had regular visits from external contacts. Less than 20% participants refused contact with symptomatic people and <20% used masks when in contact with asymptomatic people. Among patients considered at high risk according to the recommendations of the French High Council for Public Health, 20% did not feel at risk, which led to incautious attitudes. CONCLUSION: Individuals with chronic conditions have distorted perceptions of their risk of severe illness with COVID-19. In addition, they are exposed to COVID-19 due to their context or attitudes.


Assuntos
Infecções por Coronavirus/patologia , Conhecimentos, Atitudes e Prática em Saúde , Pneumonia Viral/patologia , Adulto , Idoso , Asma/complicações , Asma/patologia , Asma/psicologia , Betacoronavirus/isolamento & purificação , Doença Crônica , Infecções por Coronavirus/virologia , Estudos Transversais , Complicações do Diabetes/patologia , Complicações do Diabetes/psicologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/patologia , Neoplasias/psicologia , Pandemias , Pneumonia Viral/virologia , Risco , Índice de Gravidade de Doença , Inquéritos e Questionários
9.
Front Immunol ; 11: 1337, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32733448

RESUMO

Autophagy is a cellular recycling system found in almost all types of eukaryotic organisms. The system is made up of a variety of proteins which function to deliver intracellular cargo to lysosomes for formation of autophagosomes in which the contents are degraded. The maintenance of cellular homeostasis is key in the survival and function of a variety of human cell populations. The interconnection between metabolism and autophagy is extensive, therefore it has a role in a variety of different cell functions. The disruption or dysfunction of autophagy in these cell types have been implicated in the development of a variety of inflammatory diseases including asthma. The role of autophagy in non-immune and immune cells both lead to the pathogenesis of lung inflammation. Autophagy in pulmonary non-immune cells leads to tissue remodeling which can develop into chronic asthma cases with long term effects. The role autophagy in the lymphoid and myeloid lineages in the pathology of asthma differ in their functions. Impaired autophagy in lymphoid populations have been shown, in general, to decrease inflammation in both asthma and inflammatory disease models. Many lymphoid cells rely on autophagy for effector function and maintained inflammation. In stark contrast, autophagy deficient antigen presenting cells have been shown to have an activated inflammasome. This is largely characterized by a TH17 response that is accompanied with a much worse prognosis including granulocyte mediated inflammation and steroid resistance. The cell specificity associated with changes in autophagic flux complicates its targeting for amelioration of asthmatic symptoms. Differing asthmatic phenotypes between TH2 and TH17 mediated disease may require different autophagic modulations. Therefore, treatments call for a more cell specific and personalized approach when looking at chronic asthma cases. Viral-induced lung inflammation, such as that caused by SARS-CoV-2, also may involve autophagic modulation leading to inflammation mediated by lung resident cells. In this review, we will be discussing the role of autophagy in non-immune cells, myeloid cells, and lymphoid cells for their implications into lung inflammation and asthma. Finally, we will discuss autophagy's role viral pathogenesis, immunometabolism, and asthma with insights into autophagic modulators for amelioration of lung inflammation.


Assuntos
Asma/complicações , Asma/patologia , Autofagia/imunologia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Animais , Asma/imunologia , Autofagossomos/metabolismo , Autofagia/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Células Dendríticas/metabolismo , Humanos , Linfócitos/metabolismo , Lisossomos/metabolismo , Células Mieloides/metabolismo , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Mucosa Respiratória/metabolismo , Transdução de Sinais/imunologia
10.
JAMA ; 324(8): 752-760, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32840597

RESUMO

Importance: Severe asthma exacerbations cause significant morbidity and costs. Whether vitamin D3 supplementation reduces severe childhood asthma exacerbations is unclear. Objective: To determine whether vitamin D3 supplementation improves the time to a severe exacerbation in children with asthma and low vitamin D levels. Design, Setting, and Participants: The Vitamin D to Prevent Severe Asthma Exacerbations (VDKA) Study was a randomized, double-blind, placebo-controlled clinical trial of vitamin D3 supplementation to improve the time to severe exacerbations in high-risk children with asthma aged 6 to 16 years taking low-dose inhaled corticosteroids and with serum 25-hydroxyvitamin D levels less than 30 ng/mL. Participants were recruited from 7 US centers. Enrollment started in February 2016, with a goal of 400 participants; the trial was terminated early (March 2019) due to futility, and follow-up ended in September 2019. Interventions: Participants were randomized to vitamin D3, 4000 IU/d (n = 96), or placebo (n = 96) for 48 weeks and maintained with fluticasone propionate, 176 µg/d (6-11 years old), or 220 µg/d (12-16 years old). Main Outcomes and Measures: The primary outcome was the time to a severe asthma exacerbation. Secondary outcomes included the time to a viral-induced severe exacerbation, the proportion of participants in whom the dose of inhaled corticosteroid was reduced halfway through the trial, and the cumulative fluticasone dose during the trial. Results: Among 192 randomized participants (mean age, 9.8 years; 77 girls [40%]), 180 (93.8%) completed the trial. A total of 36 participants (37.5%) in the vitamin D3 group and 33 (34.4%) in the placebo group had 1 or more severe exacerbations. Compared with placebo, vitamin D3 supplementation did not significantly improve the time to a severe exacerbation: the mean time to exacerbation was 240 days in the vitamin D3 group vs 253 days in the placebo group (mean group difference, -13.1 days [95% CI, -42.6 to 16.4]; adjusted hazard ratio, 1.13 [95% CI, 0.69 to 1.85]; P = .63). Vitamin D3 supplementation, compared with placebo, likewise did not significantly improve the time to a viral-induced severe exacerbation, the proportion of participants whose dose of inhaled corticosteroid was reduced, or the cumulative fluticasone dose during the trial. Serious adverse events were similar in both groups (vitamin D3 group, n = 11; placebo group, n = 9). Conclusions and Relevance: Among children with persistent asthma and low vitamin D levels, vitamin D3 supplementation, compared with placebo, did not significantly improve the time to a severe asthma exacerbation. The findings do not support the use of vitamin D3 supplementation to prevent severe asthma exacerbations in this group of patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02687815.


Assuntos
Asma/tratamento farmacológico , Colecalciferol/uso terapêutico , Suplementos Nutricionais , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Asma/sangue , Asma/complicações , Criança , Colecalciferol/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Masculino , Exacerbação dos Sintomas , Falha de Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Vitaminas/efeitos adversos
11.
J Allergy Clin Immunol ; 146(4): 790-798, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32810517

RESUMO

BACKGROUND: There is inconclusive and controversial evidence of the association between allergic diseases and the risk of adverse clinical outcomes of coronavirus disease 2019 (COVID-19). OBJECTIVE: We sought to determine the association of allergic disorders with the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and with clinical outcomes of COVID-19 (admission to intensive care unit, administration of invasive ventilation, and death). METHODS: A propensity-score-matched nationwide cohort study was performed in South Korea. Data obtained from the Health Insurance Review & Assessment Service of Korea from all adult patients (age, >20 years) who were tested for SARS-CoV-2 in South Korea between January 1, 2020, and May 15, 2020, were analyzed. The association of SARS-CoV-2 test positivity and allergic diseases in the entire cohort (n = 219,959) and the difference in clinical outcomes of COVID-19 were evaluated in patients with allergic diseases and SARS-CoV-2 positivity (n = 7,340). RESULTS: In the entire cohort, patients who underwent SARS-CoV-2 testing were evaluated to ascertain whether asthma and allergic rhinitis were associated with an increased likelihood of SARS-CoV-2 test positivity. After propensity score matching, we found that asthma and allergic rhinitis were associated with worse clinical outcomes of COVID-19 in patients with SARS-CoV-2 test positivity. Patients with nonallergic asthma had a greater risk of SARS-CoV-2 test positivity and worse clinical outcomes of COVID-19 than patients with allergic asthma. CONCLUSIONS: In a Korean nationwide cohort, allergic rhinitis and asthma, especially nonallergic asthma, confers a greater risk of susceptibility to SARS-CoV-2 infection and severe clinical outcomes of COVID-19.


Assuntos
Asma/complicações , Betacoronavirus/patogenicidade , Doenças Cardiovasculares/complicações , Infecções por Coronavirus/complicações , Dermatite Atópica/complicações , Complicações do Diabetes/diagnóstico , Pneumonia Viral/complicações , Rinite Alérgica/complicações , Adulto , Idoso , Asma/diagnóstico , Asma/imunologia , Asma/mortalidade , Betacoronavirus/imunologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/mortalidade , Técnicas de Laboratório Clínico , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/mortalidade , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Dermatite Atópica/mortalidade , Complicações do Diabetes/imunologia , Complicações do Diabetes/mortalidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/imunologia , Diabetes Mellitus/mortalidade , Suscetibilidade a Doenças , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Rinite Alérgica/diagnóstico , Rinite Alérgica/imunologia , Rinite Alérgica/mortalidade , Índice de Gravidade de Doença , Análise de Sobrevida
13.
J Adolesc Health ; 67(4): 612-614, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32798098

RESUMO

PURPOSE: We report on a coronavirus disease 2019 (COVID-19) outbreak among adolescents at an inpatient behavioral health facility that was identified within 5 weeks of known viral transmission in the surrounding community. METHODS: Clinical records were reviewed for all inpatients aged <18 years with laboratory-confirmed COVID-19 between March 23 and April 21, 2020. RESULTS: A total of 19 COVID-19-positive patients aged 11-17 years were identified. Patients most commonly presented with sore throat (37%) and nausea/vomiting (32%). Only 26% of patients presented with cough, shortness of breath, or fever. The most common medical comorbidity was asthma (32%), and the most common psychiatric comorbidity was posttraumatic stress disorder (63%). Infected patients were colocated and managed together on a separate COVID-19 unit to maintain a therapeutic group milieu. Mental health treatment was modified to limit staff exposure. Patients received daily medical assessment by an in-house pediatrician. One patient required intravenous fluids. No patients required transfer to a medical facility. CONCLUSIONS: Adolescents in psychiatric inpatient settings may be especially vulnerable to COVID-19 infection. Close collaboration between medical and psychiatric care providers is needed to optimize care for this population and to address admission and disposition options for infected patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Hospitais Psiquiátricos , Pneumonia Viral/epidemiologia , Adolescente , Asma/complicações , Betacoronavirus , Criança , Infecções por Coronavirus/complicações , Feminino , Humanos , Pacientes Internados , Masculino , Pandemias , Philadelphia , Pneumonia Viral/complicações , Transtornos de Estresse Pós-Traumáticos/complicações
14.
PLoS One ; 15(7): e0236034, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702046

RESUMO

BACKGROUND: Evidence suggests that the single-disease paradigm does not accurately reflect the individual experience, with increasing prevalence of chronic disease multimorbidity, and subtle yet important differences in types of co-occurring diseases. Knowledge of multimorbidity patterns can aid clarification of individual-level burden and needs, to inform prevention and treatment strategies. This study aimed to estimate the prevalence of multimorbidity in Jamaica, identify population subgroups with similar and distinct disease profiles, and examine consistency in patterns identified across statistical techniques. METHODS: Latent class analysis (LCA) was used to examine multimorbidity patterns in a sample of 2,551 respondents aged 15-74 years, based on data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 and self-reported presence/absence of 11 chronic conditions. Secondary analyses compared results with patterns identified using exploratory factor analysis (EFA). RESULTS: Nearly one-quarter of the sample (24.1%) were multimorbid (i.e. had ≥2 diseases), with significantly higher burden in females compared to males (31.6% vs. 16.1%; p<0.001). LCA revealed four distinct classes, including a predominant Relatively Healthy class, comprising 52.7% of the sample, with little to no morbidity. The remaining three classes were characterized by varying degrees and patterns of multimorbidity and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Four diseases determined using physical assessments (obesity, hypertension, diabetes, hypercholesterolemia) were primary contributors to multimorbidity patterns overall. EFA identified three patterns described as "Vascular" (hypertension, obesity, hypercholesterolemia, diabetes, stroke); "Respiratory" (asthma, COPD); and "Cardio-Mental-Articular" (cardiovascular disease, arthritis, mental disorders). CONCLUSION: This first study of multimorbidity in the Caribbean has revealed a high burden of co-existing conditions in the Jamaican population, that is predominantly borne by females. Consistency across methods supports the validity of patterns identified. Future research into the causes and consequences of multimorbidity patterns can guide development of clinical and public health strategies that allow for targeted prevention and intervention.


Assuntos
Análise de Classes Latentes , Multimorbidade , Adolescente , Adulto , Idoso , Asma/complicações , Asma/epidemiologia , Asma/patologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/patologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão/patologia , Jamaica/epidemiologia , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Transtornos Mentais/patologia , Pessoa de Meia-Idade , Prevalência , Autorrelato , Fatores Sexuais , Adulto Jovem
17.
Allergy Asthma Proc ; 41(4): 296-300, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32605700

RESUMO

Underlying lung disease, especially asthma, has recently been found to be associated with a higher risk of hospitalization with coronavirus disease 2019 (COVID-19) infection. Inhaled corticosteroids (ICS) are the most commonly used controller medications in patients with asthma. It is unclear whether ICS use increases the risk for severe COVID-19 infection. At the current time, asthma organizations are still recommending the continued use of ICS and other asthma medications to minimize the risk of uncontrolled asthma. However, for patients with asthma and who have recovered from COVID-19 infection, the timing of resumption of asthma therapy is equally uncertain. Pulmonary function testing and exhaled oral nitric oxide testing are aerosol-generating procedures and are currently being severely restricted at most health-care facilities. We presented a case of a patient with cough-variant asthma who developed severe COVID-19 associated acute respiratory distress syndrome with the need for intubation and prolonged mechanical ventilation. We highlighted the potential utility of using COVID-19 RNA detection as well as immunoglobulin G antibody testing to help guide the timing of resumption of asthma therapy.


Assuntos
Corticosteroides/uso terapêutico , Asma/complicações , Asma/tratamento farmacológico , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Algoritmos , Asma/diagnóstico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/genética , Biomarcadores , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Testes de Função Respiratória , Resultado do Tratamento
18.
Ann Allergy Asthma Immunol ; 125(4): 481-483, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32717301
19.
A A Pract ; 14(7): e01235, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-593778

RESUMO

Patients with coronavirus disease 2019 (COVID-19) with variable clinical presentations are encountered in the perioperative setting. While some have already been diagnosed and are symptomatic, others have undiagnosed, asymptomatic COVID-19. The latter group poses the greatest risk of transmission. Given limited capacities in most health care systems, diagnostic testing is mainly performed in symptomatic patients or those with relevant exposure. We report an intraoperative diagnosis of COVID-19 in an asymptomatic patient, prompted by clinical signs. To control a pandemic such as COVID-19, a high index of suspicion is pivotal when caring for asymptomatic patients in the perioperative setting.


Assuntos
Infecções Assintomáticas , Infecções por Coronavirus/diagnóstico , Pessoas em Situação de Rua , Cuidados Intraoperatórios , Mastectomia , Pneumonia Viral/diagnóstico , Extubação/métodos , Asma/complicações , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Feminino , Humanos , Hipertensão/complicações , Hipóxia , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Pandemias , Pneumonia Viral/complicações , Reação em Cadeia da Polimerase , Respiração com Pressão Positiva , Respiração Artificial/métodos
20.
A A Pract ; 14(7): e01235, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32539267

RESUMO

Patients with coronavirus disease 2019 (COVID-19) with variable clinical presentations are encountered in the perioperative setting. While some have already been diagnosed and are symptomatic, others have undiagnosed, asymptomatic COVID-19. The latter group poses the greatest risk of transmission. Given limited capacities in most health care systems, diagnostic testing is mainly performed in symptomatic patients or those with relevant exposure. We report an intraoperative diagnosis of COVID-19 in an asymptomatic patient, prompted by clinical signs. To control a pandemic such as COVID-19, a high index of suspicion is pivotal when caring for asymptomatic patients in the perioperative setting.


Assuntos
Infecções Assintomáticas , Infecções por Coronavirus/diagnóstico , Pessoas em Situação de Rua , Cuidados Intraoperatórios , Mastectomia , Pneumonia Viral/diagnóstico , Extubação/métodos , Asma/complicações , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Feminino , Humanos , Hipertensão/complicações , Hipóxia , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Pandemias , Pneumonia Viral/complicações , Reação em Cadeia da Polimerase , Respiração com Pressão Positiva , Respiração Artificial/métodos
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