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1.
Medicine (Baltimore) ; 100(14): e25467, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832159

RESUMO

RATIONALE: Coronavirus disease 2019 (COVID-19) is a disease caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which commonly presents with symptoms including fever, cough, and dyspnea. More recently, however, some patients have tested positive for COVID-19 after developing gastrointestinal (GI) symptoms either solely or in conjunction with respiratory symptoms. This may be due to SARS-CoV-2 infection of the GI tract. In patients with chronic GI illnesses, COVID-19 may initially present as a flare of their underlying GI conditions as viruses have historically been implicated in exacerbations of GI disorders, including gastroparesis. PATIENT CONCERNS: We report a case of a 37-year-old female with a history of diabetic gastroparesis who presented to the Emergency Department (ED) with nausea and vomiting similar to her gastroparesis flares. DIAGNOSES: Her symptoms in the ED failed to improve with fluids and anti-emetic medications. After developing a fever, she was tested and found to be positive for COVID-19. INTERVENTIONS: She was started on antibiotic, steroid, and antiviral medications. OUTCOMES: Her symptoms improved, her fever defervesced on day 4 of hospitalization, and she was discharged on day 5 of hospitalization. The patient reported symptom improvement at a follow-up outpatient gastroenterology visit 2 months after hospitalization. LESSONS: To the best of our knowledge, at the present time, this is the first report of a patient with COVID-19 presenting with signs and symptoms of a gastroparesis flare. This case illustrates that COVID-19 may present in an exacerbation of symptoms of an underlying disorder, such as a severe gastroparesis flare, in a patient with underlying gastroparesis. Initial presentation of these patients manifesting as a flare of their chronic GI disease, more severe than usual, should prompt an index of suspicion for COVID-19.


Assuntos
/complicações , Complicações do Diabetes/complicações , Complicações do Diabetes/fisiopatologia , Gastroparesia/fisiopatologia , Adulto , Feminino , Humanos
3.
Eur J Endocrinol ; 184(5): 627-636, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33630752

RESUMO

Objective: Patients with diabetes have an increased risk of osteoporosis and shorter life expectancy. Hip fracture (HF) is the most serious consequence of osteoporosis and is associated with increased mortality risk. We aimed to assess the association of antidiabetic medications with HF and the post-hip fracture mortality risk among diabetic patients ≥50 years. Design: In this nationwide case-control study 53 992 HF cases and 112 144 age-, sex- and region-matched non-hip fracture controls were analyzed. A cohort of hip-fractured diabetic patients were followed-up for an all-cause mortality. Methods: We defined three groups of diabetic patients based on a prescription of antidiabetic medications: group 1 treated with insulin monotherapy (G1DM), group 2 (G2DM) treated with blood glucose-lowering drugs (BGLD) only, group 3 on a combined BGLD and insulin therapy (G3DM). We applied logistic regression and Cox regression. Results: We identified 2757 G1DM patients, 15 310 G2DM patients, 3775 G3DM patients and 144 294 patients without any antidiabetic treatment. All three groups of diabetic patients had increased odds of HF compared to controls. G1DM patients aged 50-64 years (aOR: 4.80, 95% CI: 3.22-7.17) and G3DM patients (aOR: 1.39, 95% CI: 1.02-1.88) showed the highest HF odds, whereas G2DM patients had 18% decrease in HF odds than their non-diabetic controls (aOR: 0.82, 95% CI: 0.69-0.99). All diabetic patients had increased post-hip fracture mortality risk compared to non-diabetic controls. The highest mortality hazard was observed in G1DM patients, being greater for women than men (HR: 1.71, 95% CI: 1.55-1.89 and HR: 1.44, 95% CI: 1.27-1.64, respectively). Conclusions: Antidiabetic medications increase the probability of HF. Diabetic patients, who sustained HF have a higher mortality risk than non-diabetic patients.


Assuntos
Doenças Ósseas , Diabetes Mellitus , Fraturas do Quadril/complicações , Fraturas do Quadril/mortalidade , Áustria/epidemiologia , Doenças Ósseas/complicações , Doenças Ósseas/tratamento farmacológico , Doenças Ósseas/mortalidade , Doenças Ósseas/patologia , Estudos de Casos e Controles , Causas de Morte , Estudos de Coortes , Efeitos Psicossociais da Doença , Complicações do Diabetes/complicações , Complicações do Diabetes/mortalidade , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/mortalidade , Diabetes Mellitus/patologia , Feminino , Seguimentos , Fraturas do Quadril/patologia , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco
4.
Diabetes Res Clin Pract ; 171: 108607, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33310122

RESUMO

AIMS: To investigate the risk of retinal vein occlusion (RVO) in new-onset diabetes mellitus (DM) patients. METHODS: This nationwide, retrospective, matched cohort study included 240,761 DM patients registered between January 2003 and December 2005 in the Longitudinal Cohort of Diabetes Patients database. An age- and sex-matched control group comprising 240,761 non-DM patients (case: control = 1:1) was selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient from the index date until December 2013 was collected. The incidence and risk of RVO were compared between the two groups. Cox proportional hazard regression analysis was performed to calculate the adjusted hazard ratio (HR) for RVO after adjustment for potential confounders. The RVO cumulative incidence rate was obtained using Kaplan-Meier analysis. RESULTS: During the follow-up period, 1,456 DM patients developed RVO (491, central retinal vein occlusion; 965, branch retinal vein occlusion). There was a significantly elevated risk of RVO in DM patients compared with the controls (incidence rate ratio = 1.91, 95% confidence interval [CI] = 1.75-2.08). Patients with DM showed significant risk of RVO after adjustment for potential confounders (hypertension, hyperlipidemia, congestive heart failure, coronary artery disease, and chronic renal disease) in the full cohort (adjusted HR = 1.76, 95% CI = 1.61-1.93). Additionally, patients with hypertension had a significantly higher risk of RVO than patients without hypertension after adjustment for other confounders in the cohort (adjusted HR = 1.50, 95% CI = 1.36-1.65). CONCLUSIONS: We found that patients with DM have increased risks of RVO. In addition to blood pressure control, we recommend educating patients with DM about RVO, to prevent its subsequent occurrence.


Assuntos
Complicações do Diabetes/complicações , Oclusão da Veia Retiniana/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
Diabetes Res Clin Pract ; 171: 108591, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33310124

RESUMO

AIMS: We assessed whether and to what extent established cardiovascular disease (CVD) risk factors moderate (enhance/reduce) the effect of hyperglycemia on CVD outcomes in the long-term follow-up of the Diabetes Control and Complications Trial type 1 diabetes (T1D) cohort (N = 1441). METHODS: Moderation of the effect of glycemia on subsequent risk of major adverse cardiovascular events (MACE: fatal or non-fatal myocardial infarction or stroke) and any-CVD (MACE plus confirmed angina, silent MI, revascularization, or congestive heart failure) was assessed separately using interaction terms between HbA1c and other risk factors in Cox proportional hazards models. RESULTS: Over a median follow-up of 29 years, there were 120 MACE cases and 239 any-CVD cases. Higher pulse, higher triglycerides, use of calcium channel blockers, and presence of neuropathy individually enhanced (p < 0.01) the effect of glycemia on any-CVD. Higher pulse and triglyceride levels, albumin excretion rate, hypertension, and no family history of type 2 diabetes enhanced (p < 0.01) the effect of glycemia on MACE. CONCLUSIONS: Such moderation analyses identify subgroups with increased CVD risk who might especially benefit from earlier and/or more intensive glycemic control. Interventions treating modifiable moderating factors may independently reduce the risk of CVD and also reduce the risk associated with a higher HbA1c.


Assuntos
Doenças Cardiovasculares/etiologia , Complicações do Diabetes/complicações , Diabetes Mellitus Tipo 1/complicações , Hiperglicemia/complicações , Adulto , Doenças Cardiovasculares/patologia , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Masculino , Fatores de Risco
6.
PLoS One ; 15(12): e0243343, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315929

RESUMO

This study reviewed 395 young adults, 18-35 year-old, admitted for COVID-19 to one of the eleven hospitals in New York City public health system. Demographics, comorbidities, clinical course, outcomes and characteristics linked to hospitalization were analyzed including temporal survival analysis. Fifty-seven percent of patients had a least one major comorbidity. Mortality without comorbidity was in 3.8% patients. Further investigation of admission features and medical history was conducted. Comorbidities associated with mortality were diabetes (n = 54 deceased/73 diagnosed,74% tested POS;98.2% with diabetic history deceased; Wilcoxon p (Wp) = .044), hypertension (14/44,32% POS, 25.5%; Wp = 0.030), renal (6/16, 37.5% POS,11%; Wp = 0.000), and cardiac (6/21, 28.6% POS,11%; Wp = 0.015). Kaplan survival plots were statistically significant for these four indicators. Data suggested glucose >215 or hemoglobin A1c >9.5 for young adults on admission was associated with increased mortality. Clinically documented respiratory distress on admission was statistically significant outcome related to mortality (X2 = 236.6842, df = 1, p < .0001). Overall, 28.9% required supportive oxygen beyond nasal cannula. Nasal cannula oxygen alone was required for 71.1%, who all lived. Non-invasive ventilation was required for 7.8%, and invasive mechanical ventilation 21.0% (in which 7.3% lived, 13.7% died). Temporal survival analysis demonstrated statistically significant response for Time to Death <10 days (X2 = 18.508, df = 1, p = .000); risk lessened considerably for 21 day cut off (X2 = 3.464, df = 1, p = .063), followed by 31 or more days of hospitalization (X2 = 2.212, df = 1, p = .137).


Assuntos
/mortalidade , Complicações do Diabetes/mortalidade , Hipertensão/mortalidade , /patogenicidade , Adolescente , Adulto , /terapia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/virologia , Complicações do Diabetes/complicações , Complicações do Diabetes/patologia , Complicações do Diabetes/virologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/terapia , Hipertensão/virologia , Nefropatias/complicações , Nefropatias/mortalidade , Nefropatias/terapia , Nefropatias/virologia , Masculino , Cidade de Nova Iorque/epidemiologia , Oxigênio/uso terapêutico , Pandemias , /mortalidade , /virologia , Adulto Jovem
8.
J Card Surg ; 35(10): 2759-2767, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32939829

RESUMO

OBJECTIVES: Hyperglycemia is associated with an increased risk of adverse cardiovascular outcomes, such as heart failure, coronary heart disease, stroke, and in-hospital mortality. For those receiving cardiac surgery, up to half develop hyperglycemia while 30% have a diagnosis of diabetes, which is defined by chronic hyperglycemia. Due to a prothrombic state and endovascular damage, patients with diabetes have a twofold increased risk of cardiovascular events. METHODS: Electronic literature search was done to identify articles that have discussed antidiabetic medications and how it is impacting the glycemia status as well as cardiovascular outcomes. No limits were placed on timing of the publication or type of the article. Key words and MeSH terms were used to conduct the search and the results are summarized in a narrative manner within each relevant section. RESULTS: Antidiabetic medications play a key role in lowering blood glucose levels to reduce adverse cardiovascular outcomes. However, it is a challenge to assess their cardiovascular safety due to confounding factors, such as age, obesity, smoking, hyperlipidemia, and high blood pressure. Further research in this field is required to understand this correlation closely. CONCLUSION: Optimizing blood glucose level during the perioperative period with correct medication and dose have a significant role in reducing morbidities. Measures should be taken to provide a safe blood glucose level for optimum outcomes.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/cirurgia , Complicações do Diabetes/complicações , Diabetes Mellitus/tratamento farmacológico , Hiperglicemia/complicações , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Assistência Perioperatória , Complicações Pós-Operatórias/prevenção & controle , Humanos , Risco , Resultado do Tratamento
9.
Arch. esp. urol. (Ed. impr.) ; 73(7): 634-642, sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-195961

RESUMO

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017 and April 2019, 546 patients who underwent ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p = 0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1c level were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully


OBJETIVO: La litotricia ureteroscópica (URS) es la opción estándar actual de tratamiento para cálculos renales tanto ureterales como adecuados. Aunque se sabe que es un procedimiento seguro, la infección urinaria febril posoperatoria (ITU) no es rara. Especialmente en pacientes diabéticos, la tasa de infección del tracto urinario es mayor. Por lo tanto, nuestro objetivo fue describir los factores de riesgo de IU después de la URS en diabéticos. MATERIALES Y MÉTODOS: Entre enero de 2017 y abril de 2019, se incluyeron 546 pacientes que se sometieron a litotricia ureteroscópica por cálculos ureterales y/o renales. Se realizó un análisis de pares emparejados para comparar las tasas de ITU postoperatorias entre diabéticos y no diabéticos. Revisamos retrospectivamente los registros médicos. Se realizó un análisis de regresión logística para determinar los factores de riesgo de infección urinaria postoperatoria en diabéticos. RESULTADOS: En pacientes diabéticos, la tasa de ITU postoperatoria fue del 29% (13/45). Después del análisis de pares emparejados dentro del grupo de no diabéticos, la incidencia fue del 11% (5/44) (p = 0,04). En el análisis univariado, el historial de ITU y el nivel de HbA1c fueron los factores de riesgo de ITU después de la URS en diabéticos. El historial de ITU y el nivel de HbA1c fueron los factores de riesgo independientes para desarrollar ITU postoperatoria en pacientes diabéticos. El umbral de HbA1c del 6,9% proporcionó una sensibilidad del 75% y una especificidad del 67% para predecir la infección urinaria postoperatoria en diabéticos. CONCLUSIONES: Los pacientes diabéticos tienen un mayor riesgo de desarrollar ITU postoperatoria después de la URS. Los pacientes con antecedentes de ITU y un nivel de HbA1c superior al 6,9% deben ser seguidos cuidadosamente


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Infecções Urinárias/etiologia , Febre/etiologia , Litotripsia/efeitos adversos , Complicações do Diabetes/complicações , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Diabetes Mellitus/prevenção & controle , Análise por Pareamento , Estatísticas não Paramétricas , Curva ROC , Análise Multivariada
10.
Biomed J ; 43(4): 325-327, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32713780

RESUMO

Most patients with severe complications from COVID-19 have underlying conditions such as obesity, diabetes, and hypertension. In parallel, there is growing evidence for a link between periodontitis and non-oral systemic diseases. The oral cavity is also a reservoir for respiratory pathogens, and patients with periodontal disease are more likely to develop hospital-acquired pneumonia than healthy individuals. We therefore hypothesize that improving oral health could decrease the severity of COVID-19 symptoms and reduce the associated morbidity.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/etiologia , Obesidade/complicações , Saúde Bucal , Pneumonia Viral/etiologia , Complicações do Diabetes/complicações , Complicações do Diabetes/virologia , Diabetes Mellitus/virologia , Humanos , Hipertensão/complicações , Obesidade/virologia , Pandemias
12.
Stroke ; 51(9): e223-e226, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32684144

RESUMO

BACKGROUND AND PURPOSE: Ischemic infarction of the corpus callosum is rare and infarction isolated to the corpus callosum alone rarer still, accounting for much <1% of ischemic stroke in most stroke registries. About half of callosal infarctions affect the splenium. METHODS: During a 2-week period, at the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, 4 patients at Montefiore Medical Center in the Bronx were found to have ischemic lesions of the splenium of the corpus callosum, 2 with infarction isolated to the corpus callosum. RESULTS: All patients tested positive for COVID-19 and 3 had prolonged periods of intubation. All had cardiovascular risk factors. Clinically, all presented with encephalopathy and had evidence of coagulopathy and raised inflammatory markers. CONCLUSIONS: Infarction of the splenium of the corpus callosum is exceedingly rare and a cluster of such cases suggests COVID-19 as an inciting agent, with the mechanisms to be elucidated.


Assuntos
Infarto Cerebral/complicações , Infarto Cerebral/patologia , Infecções por Coronavirus/complicações , Corpo Caloso/patologia , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/patologia , Complicações do Diabetes/complicações , Evolução Fatal , Feminino , Humanos , Hipertensão/complicações , Hipotireoidismo/complicações , Inflamação/sangue , Intubação Intratraqueal , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Reabilitação do Acidente Vascular Cerebral
13.
Diabetes Res Clin Pract ; 166: 108315, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32679058

RESUMO

AIMS: To evaluate the effects of gestational diabetes mellitus (GDM) on the structural characteristics of the rectus abdominis muscle (RAM) and its indirect effects on pregnancy-specific urinary incontinence (PSUI). METHODS: A total of 92 pregnant women were divided into four groups, according to their clinical conditions: non-GDM continent, non-GDM associated PSUI, GDM continent and GDM associated PSUI. The muscle morphometry (histochemistry and immunohistochemistry) for the fiber types and collagen fiber distribution, the ultrastructural analysis (transmission electron microscopy), the protein expression of fiber types and calcium signaling (Western blotting), and the content of types I and III collagen fiber (ELISA) in RAM collected at delivery were assessed. RESULTS: The GDM groups presented a significantly increased number of slow fibers and slow-twitch oxidative fiber expression; decreased fiber area, number of fast fibers, and area of collagen; an increase in central nuclei; ultrastructural alterations with focal lesion areas such as myeloid structures, sarcomere disorganization, and mitochondrial alteration. The PSUI groups presented a considerable decrease in types I and III collagen contents and the localization of collagen fiber. CONCLUSIONS: Our data reveal that GDM causes morphological, biochemical and physiological changes in the RAM, and this might predispose women to PSUI.


Assuntos
Complicações do Diabetes/complicações , Diabetes Gestacional/fisiopatologia , Reto do Abdome/anormalidades , Incontinência Urinária/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez
14.
Cell Metab ; 32(3): 437-446.e5, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32697943

RESUMO

COVID-19 can result in severe lung injury. It remained to be determined why diabetic individuals with uncontrolled glucose levels are more prone to develop the severe form of COVID-19. The molecular mechanism underlying SARS-CoV-2 infection and what determines the onset of the cytokine storm found in severe COVID-19 patients are unknown. Monocytes and macrophages are the most enriched immune cell types in the lungs of COVID-19 patients and appear to have a central role in the pathogenicity of the disease. These cells adapt their metabolism upon infection and become highly glycolytic, which facilitates SARS-CoV-2 replication. The infection triggers mitochondrial ROS production, which induces stabilization of hypoxia-inducible factor-1α (HIF-1α) and consequently promotes glycolysis. HIF-1α-induced changes in monocyte metabolism by SARS-CoV-2 infection directly inhibit T cell response and reduce epithelial cell survival. Targeting HIF-1ɑ may have great therapeutic potential for the development of novel drugs to treat COVID-19.


Assuntos
Betacoronavirus/fisiologia , Glicemia/metabolismo , Infecções por Coronavirus/complicações , Complicações do Diabetes/complicações , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Monócitos/metabolismo , Pneumonia Viral/complicações , Adulto , Linhagem Celular , Infecções por Coronavirus/metabolismo , Complicações do Diabetes/metabolismo , Diabetes Mellitus/metabolismo , Feminino , Glicólise , Humanos , Inflamação/complicações , Inflamação/metabolismo , Masculino , Pessoa de Meia-Idade , Monócitos/virologia , Pandemias , Pneumonia Viral/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais
15.
Epidemiol Infect ; 148: e123, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32580809

RESUMO

This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan-Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3-5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9-7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4-4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4-14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/complicações , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/complicações , Complicações do Diabetes/complicações , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Nefropatias/complicações , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Pandemias , Pneumonia Viral/complicações , Distribuição de Poisson , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
16.
Cardiol Young ; 30(8): 1196-1198, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32522306

RESUMO

Little is know about COVID-19 outcome in specific populations such as Adult congenital heart disease (ACHD) patients. We report three cases of adult patients with similar underlying disease with completely different clinical severity at the time of COVID-19 infection. The patient with the most severe clinical course was obese and diabetic, suggesting that COVID-19 mortality and morbidity in Adult congenital heart disease patients might be independent of anatomic complexity.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Cardiopatias Congênitas/complicações , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Adulto , Infecções por Coronavirus/terapia , Complicações do Diabetes/complicações , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pandemias , Pneumonia Viral/terapia , Insuficiência Renal/complicações , Fatores de Risco
17.
Mycoses ; 63(8): 766-770, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32585069

RESUMO

BACKGROUND: Invasive aspergillosis is a well-known complication of severe influenza pneumonia with acute respiratory distress syndrome (ARDS). However, recent studies are reporting emergence of aspergillosis in severe COVID-19 pneumonia, named as COVID-19-associated pulmonary aspergillosis (CAPA). METHODS: A retrospective observational study was conducted in patients with severe COVID-19 pneumonia from February 2020 to April 2020. Patients ≥18 years of age with clinical features and abnormal chest imaging with confirmed COVID-19 by RT-PCR for SARS-CoV-2 were included. CAPA was diagnosed based on clinical parameters, radiological findings and mycological data. Data were recorded on a structured proforma, and descriptive analysis was performed using Stata ver 12.1. RESULTS: A total of 147 patients with confirmed COVID-19 and 23 (15.6%) patients requiring ICU admission were identified. Aspergillus species were isolated from tracheal aspirates of nine (39.1%) patients, and of these, five patients (21.7%) were diagnosed with CAPA and four (17.4%) had Aspergillus colonisation. The mean age of patients with CAPA was 69 years (Median age: 71, IQR: 24, Range: 51-85), and 3/5 patients were male. The most frequent co-morbid was diabetes mellitus (4/5). The overall fatality rate of COVID-19 patients with aspergillosis was 44% (4/9). The cause of death was ARDS in all three patients with CAPA, and the median length of stay was 16 days (IQR: 10; Range 6-35 days). CONCLUSION: This study highlights the need for comparative studies to establish whether there is an association of aspergillosis and COVID-19 and the need for screening for fungal infections in severe COVID-19 patients with certain risk factors.


Assuntos
Infecções por Coronavirus/complicações , Aspergilose Pulmonar Invasiva/complicações , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Azitromicina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Complicações do Diabetes/complicações , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Paquistão , Pandemias , Pneumonia Viral/tratamento farmacológico , /mortalidade , Estudos Retrospectivos , Fatores de Risco
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