Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.040
Filtrar
1.
BMC Infect Dis ; 20(1): 769, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076855

RESUMO

BACKGROUND: Norwegian children are more frequently hospitalized with influenza than adults. Little is known about the characteristics of these children. Our aim was to investigate the presence of pre-existing risk conditions and to determine the duration of influenza hospitalizations in children during two influenza seasons. METHODS: The Norwegian Patient Registry holds data on all hospitalized patients in Norway. We included all patients younger than 18 years hospitalized with a diagnosis of influenza during the influenza seasons 2017-18 and 2018-19. Pre-existing risk conditions for influenza were identified by ICD-10 diagnoses in the Norwegian Patient Registry. In addition, information on asthma diagnoses were also retrieved from the Norwegian Registry for Primary Health Care. To estimate the prevalence of risk conditions in the child population, we obtained diagnoses on all Norwegian children in a two-year period prior to each influenza season. We calculated age-specific rates for hospitalization and risk for being hospitalized with influenza in children with risk conditions. RESULTS: In total, 1013 children were hospitalized with influenza during the two influenza seasons. Children younger than 6 months had the highest rate of hospitalization, accounting for 13.5% of all admissions (137 children). Hospitalization rates decreased with increasing age. Among children hospitalized with influenza, 25% had one or more pre-existing risk conditions for severe influenza, compared to 5% in the general population under 18 years. Having one or more risk conditions significantly increased the risk of hospitalization, (Odds Ratio (OR) 6.1, 95% confidence interval (CI) 5.0-7.4 in the 2017-18 season, and OR 6.8, 95% CI 5.4-8.4 in the 2018-19 season). Immunocompromised children and children with epilepsy had the highest risk of hospitalization with influenza, followed by children with heart disease and lung disease. The average length of stay in hospital were 4.6 days, and this did not differ with age. CONCLUSION: Children with pre-existing risk conditions for influenza had a higher risk of hospitalization for influenza. However, most children (75%) admitted to hospital with influenza in Norway during 2017-2019 did not have pre-existing risk conditions. Influenza vaccination should be promoted in particular for children with risk conditions and pregnant women to protect new-borns.


Assuntos
Hospitalização , Influenza Humana/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Cardiopatias/complicações , Hospitalização/estatística & dados numéricos , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Pneumopatias/complicações , Masculino , Noruega/epidemiologia , Razão de Chances , Cobertura de Condição Pré-Existente , Medição de Risco , Estações do Ano
3.
Epidemiol Infect ; 148: e266, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-33092664

RESUMO

OBJECTIVES: Cardiac injury is associated with poor prognosis of 2019 novel coronavirus disease 2019 (COVID-19), but the risk factors for cardiac injury have not been fully studied. In this study, we carried out a systematic analysis of clinical characteristics in COVID-19 patients to determine potential risk factors for cardiac injury complicated COVID-19 virus infection. METHODS: We systematically searched relevant literature published in Pubmed, Embase, Europe PMC, CNKI and other databases. All statistical analyses were performed using STATA 16.0. RESULTS: We analysed 5726 confirmed cases from 17 studies. The results indicated that compared with non-cardiac-injured patients, patients with cardiac injury are older, with a greater proportion of male patients, with higher possibilities of existing comorbidities, with higher risks of clinical complications, need for mechanical ventilation, ICU transfer and mortality. Moreover, C-reactive protein, procalcitonin, D-dimer, NT-proBNP and blood creatinine in patients with cardiac injury are also higher while lymphocyte counts and platelet counts decreased. However, we fortuitously found that patients with cardiac injury did not present higher clinical specificity for chest distress (P = 0.304), chest pain (P = 0.334), palpitations (P = 0.793) and smoking (P = 0.234). Similarly, the risk of concomitant arrhythmia (P = 0.103) did not increase observably either. CONCLUSION: Age, male gender and comorbidities are risk factors for cardiac injury complicated COVID-19 infection. Such patients are susceptible to complications and usually have abnormal results of laboratory tests, leading to poor outcomes. Contrary to common cardiac diseases, cardiac injury complicated COVID-19 infection did not significantly induce chest distress, chest pain, palpitations or arrhythmias. Our study indicates that early prevention should be applied to COVID-19 patients with cardiac injury to reduce adverse outcomes.


Assuntos
Infecções por Coronavirus/complicações , Cardiopatias/complicações , Pneumonia Viral/complicações , Fatores Etários , Betacoronavirus , Comorbidade , Infecções por Coronavirus/patologia , Cardiopatias/patologia , Humanos , Pandemias , Pneumonia Viral/patologia , Fatores de Risco , Fatores Sexuais
5.
Nutr Hosp ; 37(5): 1039-1042, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32960622

RESUMO

Introduction: Background: coronavirus disease 2019 (COVID-19) can induce an exaggerated inflammatory response. Vitamin D is a key modulator of the immune system. We hypothesized that vitamin D deficiency (VDD) could increase the risk of developing severe COVID-19 infection. Methods: patients with confirmed COVID-19 seen at the emergency department of our hospital with recent measurements of 25(OH)D were recruited. We explored the association of vitamin D deficiency (VDD), defined as 25-hydroxyvitamin D < 20 ng/mL, with a composite of adverse clinical outcomes. Results: we included 80 patients, of which 31 (39 %) presented the endpoint. VDD tended to predict an increased risk of developing severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease [OR 3.2 (95 % CI: 0.9-11.4), p = 0.07]. Age had a negative interaction with the effect of VDD on the composite outcome (p = 0.03), indicating that the effect was more noticeable at younger ages. Furthermore, male gender was associated with VDD and with severe COVID-19 at younger ages. Conclusions: in this retrospective study, vitamin D deficiency showed a signal of association with severe COVID-19 infection. A significant interaction with age was noted, suggesting VDD may have a greater impact in younger patients. These findings should be confirmed in larger, prospective, adequately powered studies.


Assuntos
Fatores Etários , Betacoronavirus , Infecções por Coronavirus/etiologia , Pneumonia Viral/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Adulto , Idoso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Feminino , Cardiopatias/complicações , Humanos , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Espanha/epidemiologia , Vitamina D/sangue
7.
BMC Infect Dis ; 20(1): 646, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873235

RESUMO

BACKGROUND: COVID-19 is known as a new viral infection. Viral-bacterial co-infections are one of the biggest medical concerns, resulting in increased mortality rates. To date, few studies have investigated bacterial superinfections in COVID-19 patients. Hence, we designed the current study on COVID-19 patients admitted to ICUs. METHODS: Nineteen patients admitted to our ICUs were enrolled in this study. To detect COVID-19, reverse transcription real-time polymerase chain reaction was performed. Endotracheal aspirate samples were also collected and cultured on different media to support the growth of the bacteria. After incubation, formed colonies on the media were identified using Gram staining and other biochemical tests. Antimicrobial susceptibility testing was carried out based on the CLSI recommendations. RESULTS: Of nineteen COVID-19 patients, 11 (58%) patients were male and 8 (42%) were female, with a mean age of ~ 67 years old. The average ICU length of stay was ~ 15 days and at the end of the study, 18 cases (95%) expired and only was 1 case (5%) discharged. In total, all patients were found positive for bacterial infections, including seventeen Acinetobacter baumannii (90%) and two Staphylococcus aureus (10%) strains. There was no difference in the bacteria species detected in any of the sampling points. Seventeen of 17 strains of Acinetobacter baumannii were resistant to the evaluated antibiotics. No metallo-beta-lactamases -producing Acinetobacter baumannii strain was found. One of the Staphylococcus aureus isolates was detected as methicillin-resistant Staphylococcus aureus and isolated from the patient who died, while another Staphylococcus aureus strain was susceptible to tested drugs and identified as methicillin-sensitive Staphylococcus aureus. CONCLUSIONS: Our findings emphasize the concern of superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus. Consequently, it is important to pay attention to bacterial co-infections in critical patients positive for COVID-19.


Assuntos
Infecções por Acinetobacter/complicações , Acinetobacter baumannii/isolamento & purificação , Betacoronavirus/fisiologia , Coinfecção/epidemiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Complicações do Diabetes/epidemiologia , Feminino , Cardiopatias/complicações , Humanos , Hipertensão/complicações , Unidades de Terapia Intensiva , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sistema Respiratório/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos
8.
Asian Cardiovasc Thorac Ann ; 28(9): 610-612, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32903022

RESUMO

Hydatid disease remains a problem in endemic areas. The combination of both intracardiac and pulmonary hydatid disease in association with chronic pulmonary thromboembolism is a rare presentation. We report a case of a 14-year-old girl with hydatid disease of the lungs, right ventricle, and pulmonary arteries, presenting as chronic pulmonary thromboembolism. She underwent surgery for wedge resection of the pulmonary hydatid in the right lower lobe, removal of the right ventricular hydatid (under cardiopulmonary bypass), and pulmonary endarterectomy (under total circulatory arrest). Her postoperative recovery was uneventful.


Assuntos
Equinococose Pulmonar/complicações , Equinococose/complicações , Cardiopatias/complicações , Embolia Pulmonar/etiologia , Adolescente , Procedimentos Cirúrgicos Cardíacos , Doença Crônica , Equinococose/diagnóstico por imagem , Equinococose/parasitologia , Equinococose Pulmonar/diagnóstico por imagem , Equinococose Pulmonar/parasitologia , Endarterectomia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/parasitologia , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Resultado do Tratamento
11.
JACC Cardiovasc Interv ; 13(16): 1945-1948, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819483

RESUMO

Teleproctoring can be used successfully in performing challenging and innovative structural heart interventions using sophisticated technology that allows real-time bidirectional audiovisual communication with digital transmission of live videos and direct observation of the operative field by a remote proctor. The authors share an illustrative case that was performed amid the coronavirus disease-2019 global pandemic that led to travel restrictions to limit spread of the virus. Teleproctoring has future implications beyond the current global health crisis to facilitate rapid dissemination and exchange of knowledge for ultimately helping patients around the globe.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Cardiopatias/cirurgia , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral/complicações , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Cardiopatias/complicações , Cardiopatias/diagnóstico , Humanos , Pneumonia Viral/epidemiologia
13.
Pediatr Cardiol ; 41(7): 1532-1537, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32813029

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our aim is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) cardiac resynchronization in children with symptomatic ventricular dysfunction and dyssynchrony which seems to result in higher transplant-free survival, (2) outcomes of aortic leaflet reconstruction including Ozaki procedure to repair aortic valve disease in adolescents, (3) meta-analysis for risk factors of ventricular tachycardia and death after repaired tetralogy of Fallot which reiterates the known risk factors and showed that the severity of pulmonary regurgitation is not in itself associated with outcomes although the ventricular response to regurgitation (dilation and dysfunction) is, (4) preschool promotion of healthy life style did not associate with sustained effect when evaluated later in childhood although repeated intervention seems to have a dose-related effect to promote healthy life style, (5) the lack of beneficial effects of angiotensin-converting enzyme inhibitors in the interstage period, and (6) a new phenomenon of acute heart failure and multisystem inflammatory syndrome in children temporarily related to the COVID-19 pandemic.


Assuntos
Cardiopatias/complicações , Cardiopatias/terapia , Adolescente , Betacoronavirus , Terapia de Ressincronização Cardíaca/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Cardiopatias Congênitas/terapia , Cardiopatias/cirurgia , Insuficiência Cardíaca/complicações , Ventrículos do Coração/fisiopatologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/complicações , Taquicardia Ventricular/complicações , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
14.
Stroke ; 51(9): 2724-2732, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32757753

RESUMO

BACKGROUND AND PURPOSE: In patients with acute ischemic stroke and atrial fibrillation, treatment with low molecular weight heparin increases early hemorrhagic risk without reducing early recurrence, and there is limited data comparing warfarin to direct oral anticoagulant (DOAC) therapy. We aim to compare the effects of the treatments above on the risk of 90-day recurrent ischemic events and delayed symptomatic intracranial hemorrhage. METHODS: We included consecutive patients with acute ischemic stroke and atrial fibrillation from the IAC (Initiation of Anticoagulation after Cardioembolic) stroke study pooling data from stroke registries of 8 comprehensive stroke centers across the United States. We compared recurrent ischemic events and delayed symptomatic intracranial hemorrhage between each of the following groups in separate Cox-regression analyses: (1) DOAC versus warfarin and (2) bridging with heparin/low molecular weight heparin versus no bridging, adjusting for pertinent confounders to test these associations. RESULTS: We identified 1289 patients who met the bridging versus no bridging analysis inclusion criteria and 1251 patients who met the DOAC versus warfarin analysis inclusion criteria. In adjusted Cox-regression models, bridging (versus no bridging) treatment was associated with a high risk of delayed symptomatic intracranial hemorrhage (hazard ratio, 2.74 [95% CI, 1.01-7.42]) but a similar rate of recurrent ischemic events (hazard ratio, 1.23 [95% CI, 0.63-2.40]). Furthermore, DOAC (versus warfarin) treatment was associated with a lower risk of recurrent ischemic events (hazard ratio, 0.51 [95% CI, 0.29-0.87]) but not delayed symptomatic intracranial hemorrhage (hazard ratio, 0.57 [95% CI, 0.22-1.48]). CONCLUSIONS: Our study suggests that patients with ischemic stroke and atrial fibrillation would benefit from the initiation of a DOAC without bridging therapy. Due to our study limitations, these findings should be interpreted with caution pending confirmation from large prospective studies.


Assuntos
Anticoagulantes/uso terapêutico , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Embolia/complicações , Embolia/tratamento farmacológico , Cardiopatias/complicações , Cardiopatias/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Isquemia Encefálica/epidemiologia , Embolia/epidemiologia , Feminino , Cardiopatias/epidemiologia , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Incidência , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Neuroimagem , Recidiva , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Varfarina/uso terapêutico
15.
Stroke ; 51(9): e242-e245, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811375

RESUMO

BACKGROUND AND PURPOSE: Cardiac pathologies are the second most frequent risk factor (RF) in children with arterial ischemic stroke (AIS). This study aimed to analyze RFs for AIS in children with cardiac disease and cardiac intervention. METHODS: Data were drawn from the Swiss Neuropediatric Stroke Registry. Patients with cardiac disease and postprocedural AIS registered from 2000 until 2015 were analyzed for the cause of cardiac disease and for potential RFs. RESULTS: Forty-seven out of 78 children with cardiac disease had a cardiac intervention. Of these, 36 presented a postprocedural AIS. Median time from cardiac intervention to symptom onset was 4 days (interquartile range, 2-8.5); time to diagnosis of AIS was 2 days (interquartile range, 0-5.8). Main RFs for postprocedural AIS were hypotension, prosthetic cardiac material, right-to-left shunt, arrhythmias, low cardiac output, and infections. CONCLUSIONS: In children with postprocedural AIS, time to diagnosis was delayed. Most patients presented multiple potentially modifiable RFs as hemodynamic alterations and infections.


Assuntos
Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Cardiopatias/complicações , Cardiopatias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adolescente , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Diagnóstico Tardio , Feminino , Hemodinâmica , Humanos , Infecções/complicações , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Suíça/epidemiologia , Adulto Jovem
16.
Stroke ; 51(9): 2810-2816, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811390

RESUMO

BACKGROUND AND PURPOSE: Identification of acute ischemic stroke (AIS) cause is crucial for guidance of secondary prevention. Previous studies have yielded inconsistent results regarding possible correlations between AIS cause and thrombus composition, as assessed by semiquantitative histological analysis. Here, we performed a correlation analysis between AIS cause and AIS thrombus cellular composition and content, as assessed using quantitative biochemical assays. METHODS: Homogenates of 250 patients with AIS thrombi were prepared by mechanical grinding. Platelet, red blood cell, and leukocyte content of AIS thrombi were estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. AIS cause was defined as cardioembolic, noncardioembolic, or embolic stroke of undetermined source, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment). RESULTS: Cardioembolic thrombi were richer in DNA (35.8 versus 13.8 ng/mg, P<0.001) and poorer in GPVI (0.104 versus 0.117 ng/mg, P=0.045) than noncardioembolic ones. The area under the receiver operating characteristic curve of DNA content to discriminate cardioembolic thrombi from noncardioembolic was 0.72 (95% CI, 0.63-0.81). With a threshold of 44.7 ng DNA/mg thrombus, 47% of thrombi from undetermined cause would be classified as cardioembolic with a specificity of 90%. CONCLUSIONS: Thrombus DNA content may provide an accurate biomarker for identification of cardioembolic thrombi in patients with AIS with embolic stroke of undetermined source. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03268668.


Assuntos
Isquemia Encefálica/genética , DNA/genética , Embolia/genética , Cardiopatias/genética , Trombose Intracraniana/genética , Acidente Vascular Cerebral/genética , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Plaquetas/patologia , Isquemia Encefálica/sangue , Diagnóstico Diferencial , Embolia/complicações , Feminino , Cardiopatias/complicações , Humanos , Trombose Intracraniana/sangue , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Sensibilidade e Especificidade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia
19.
J Stroke Cerebrovasc Dis ; 29(9): 105086, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807482

RESUMO

BACKGROUND: P wave indices represent electrocardiographic marker of left atrial pathology. We hypothesized that P wave would be more abnormal in patients presenting with ischemic stroke than a comparable group without ischemic stroke. METHODS: We compared P wave terminal force in V1 (PTFV1) between patients admitted with ischemic stroke (case) and patients followed in cardiology clinic (control) at a single medical center. Using logistic regression models, we tested for an association between abnormal PTFV1 (> 4000 µV ms) and ischemic stroke. We also defined several optimal cut-off values of PTFV1 using a LOESS plot and estimated odds ratio of ischemic stroke when moving from one cut-point level to the next higher-level. RESULTS: A total of 297 patients (case 147, control 150) were included. PTFV1 was higher in patients with vs. those without ischemic stroke (median 4620 vs 3994 µV ms; p=0.006). PTFV1 was similar between cardioembolic/cryptogenic and other stroke subtypes. In multivariable analyses adjusting for sex, obesity, age, and hypertension, the association between abnormal PTFV1 and ischemic stroke ceased to be significant (OR 1.53 [0.95, 2.50], p=0.083). Increase to the next cutoff level of PTFV1 (900, 2000, 3000, 4000, 5000, and 6000 µV ms) was associated with 18% increase in odds of having ischemic stroke (vs. no ischemic stroke) (OR 1.18 [1.02, 1.36], p=0.026). CONCLUSION: Patients presenting with acute ischemic stroke are more likely to have abnormal PTFV1. These findings from a real-world clinical setting support the results of cohort studies that left atrial pathology manifested as abnormal PTFV1 is associated with ischemic stroke.


Assuntos
Função do Átrio Esquerdo , Remodelamento Atrial , Isquemia Encefálica/etiologia , Eletrocardiografia , Átrios do Coração/fisiopatologia , Cardiopatias/diagnóstico , Frequência Cardíaca , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Feminino , Cardiopatias/complicações , Cardiopatias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA