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1.
J Cardiothorac Surg ; 15(1): 297, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008444

RESUMO

BACKGROUND: While the aneurysms of the membranous septum (AVS) are rare, the possibility that they lead to obstruction is even rarer. To the best of our knowledge, 11 similar cases have been reported since 1982. CASE PRESENTATION: Initially, the five-year-old boy was evaluated for dyspnoea that had been present since birth. He did not receive any medical treatment until the previous year. At the age of four, the transthoracic echocardiography showed a large aneurysm extending to the right ventricular outflow tract (RVOT) and causing RVOT stenosis. Complete surgical resection of the aneurysmal tissue was performed, and the boy was discharged home in satisfactory condition. CONCLUSIONS: As the occurrence of RVOT obstruction by a membranous ventricular septal aneurysm is very rare, we are reporting the second case in which an aneurysm of the membranous septum dynamically obstructed the RVOT in a child. We are also reviewing all the previously reported similar cases in the literature. Further studies are needed to obtain a more comprehensive understanding of aneurysms of the membranous septum (AVS).


Assuntos
Aneurisma Cardíaco/cirurgia , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , Septo Interventricular/cirurgia , Pré-Escolar , Dispneia/etiologia , Ecocardiografia , Aneurisma Cardíaco/complicações , Cardiopatias Congênitas/complicações , Comunicação Interventricular/complicações , Ventrículos do Coração , Humanos , Masculino
2.
Acta Biomed ; 91(3): ahead of print, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32921749

RESUMO

Platypnea-orthodeoxia syndrome (POS) is a clinical entity characterized by positional dyspnoea (platypnea) and arterial desaturation (orthodeoxia) that occurs when sitting or standing up and usually resolves by lying down. POS may result from some cardiopulmonary disorders or from other miscellaneous aetiologies. We report a case of POS in a patient after fibrotic evolution of SARS-CoV-2 interstitial pneumonia associated with pulmonary embolism. The patient did not have any evidence of an intracardiac/intrapulmonary shunt.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Dispneia/etiologia , Doenças Pulmonares Intersticiais/complicações , Pulmão/diagnóstico por imagem , Pneumonia Viral/complicações , Idoso , Infecções por Coronavirus/diagnóstico , Dispneia/diagnóstico , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X
3.
Pan Afr Med J ; 36: 167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32952811

RESUMO

Coronavirus disease 2019 (COVID-19) has been reported as the possible cause of acute myocarditis. Myocarditis is an inflammatory heart disease mostly caused by viral infections. Cytomegalovirus (CMV) primary infection is often not suspected as a cause of myocarditis in immune-competent adults. We report the case of a 37-year-old male admitted with fever, cough and dyspnea. Chest CT showed typical ground-glass changes indicative of viral pneumonia. He was tested negative for COVID-19 but had biological markers that made us still suspect it. He had elevated troponin I level (up to 111.5 ng/mL) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF). He was diagnosed with CMV myocarditis with cardiac insufficiency and totally recovered without antiviral therapy. During the COVID-19 pandemic patients may develop myocarditis, still every myocarditis is not a COVID infection. Myocarditis linked to CMV infection may be rare, but life-threatening.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Miocardite/diagnóstico , Pneumonia Viral/diagnóstico , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Tosse/etiologia , Infecções por Citomegalovirus/virologia , Diagnóstico Diferencial , Dispneia/etiologia , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Miocardite/virologia , Pandemias , Pneumonia Viral/epidemiologia , Tomografia Computadorizada por Raios X
4.
Rev Peru Med Exp Salud Publica ; 37(2): 253-258, 2020.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32876213

RESUMO

In order to describe manifestations from patients with coronavirus disease 2019 (COVID-19), sociodemographic variables such as, previous medical history, clinical and radiological manifestations, treatments and evolution of patients were evaluated. This took place from March 6th to 25th, 2020, in the "Edgardo Rebagliati Martins" National Hospital in Lima. Seventeen patients were registered: 76% were male, with an average age of 53.5 years (range 25-94); 23.5% had returned from abroad; 41.2% were referred from other health facilities; 41.2% were admitted to mechanical ventilation; 29.4% (5 patients) died. The risk factors detected were: advanced age, arterial hypertension and obesity. The main symptoms detected were: cough, fever and dyspnea. Frequent laboratory findings were: elevated C-reactive protein and lymphopenia. The predominant radiological presentation was bilateral interstitial lung infiltrate. A first experience in the management of patients diagnosed with severe COVID-19 in Peru is reported.


Assuntos
Infecções por Coronavirus/fisiopatologia , Hospitalização , Pneumonia Viral/fisiopatologia , Respiração Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Peru , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
5.
JAMA Netw Open ; 3(9): e2022310, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32965502

RESUMO

Importance: Identifying independent risk factors for adverse outcomes in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can support prognostication, resource utilization, and treatment. Objective: To identify excess risk and risk factors associated with hospitalization, mechanical ventilation, and mortality in patients with SARS-CoV-2 infection. Design, Setting, and Participants: This longitudinal cohort study included 88 747 patients tested for SARS-CoV-2 nucleic acid by polymerase chain reaction between Feburary 28 and May 14, 2020, and followed up through June 22, 2020, in the Department of Veterans Affairs (VA) national health care system, including 10 131 patients (11.4%) who tested positive. Exposures: Sociodemographic characteristics, comorbid conditions, symptoms, and laboratory test results. Main Outcomes and Measures: Risk of hospitalization, mechanical ventilation, and death were estimated in time-to-event analyses using Cox proportional hazards models. Results: The 10 131 veterans with SARS-CoV-2 were predominantly male (9221 [91.0%]), with diverse race/ethnicity (5022 [49.6%] White, 4215 [41.6%] Black, and 944 [9.3%] Hispanic) and a mean (SD) age of 63.6 (16.2) years. Compared with patients who tested negative for SARS-CoV-2, those who tested positive had higher rates of 30-day hospitalization (30.4% vs 29.3%; adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08-1.13), mechanical ventilation (6.7% vs 1.7%; aHR, 4.15; 95% CI, 3.74-4.61), and death (10.8% vs 2.4%; aHR, 4.44; 95% CI, 4.07-4.83). Among patients who tested positive for SARS-CoV-2, characteristics significantly associated with mortality included older age (eg, ≥80 years vs <50 years: aHR, 60.80; 95% CI, 29.67-124.61), high regional COVID-19 disease burden (eg, ≥700 vs <130 deaths per 1 million residents: aHR, 1.21; 95% CI, 1.02-1.45), higher Charlson comorbidity index score (eg, ≥5 vs 0: aHR, 1.93; 95% CI, 1.54-2.42), fever (aHR, 1.51; 95% CI, 1.32-1.72), dyspnea (aHR, 1.78; 95% CI, 1.53-2.07), and abnormalities in the certain blood tests, which exhibited dose-response associations with mortality, including aspartate aminotransferase (>89 U/L vs ≤25 U/L: aHR, 1.86; 95% CI, 1.35-2.57), creatinine (>3.80 mg/dL vs 0.98 mg/dL: aHR, 3.79; 95% CI, 2.62-5.48), and neutrophil to lymphocyte ratio (>12.70 vs ≤2.71: aHR, 2.88; 95% CI, 2.12-3.91). With the exception of geographic region, the same covariates were independently associated with mechanical ventilation along with Black race (aHR, 1.52; 95% CI, 1.25-1.85), male sex (aHR, 2.07; 95% CI, 1.30-3.32), diabetes (aHR, 1.40; 95% CI, 1.18-1.67), and hypertension (aHR, 1.30; 95% CI, 1.03-1.64). Notable characteristics that were not significantly associated with mortality in adjusted analyses included obesity (body mass index ≥35 vs 18.5-24.9: aHR, 0.97; 95% CI, 0.77-1.21), Black race (aHR, 1.04; 95% CI, 0.88-1.21), Hispanic ethnicity (aHR, 1.03; 95% CI, 0.79-1.35), chronic obstructive pulmonary disease (aHR, 1.02; 95% CI, 0.88-1.19), hypertension (aHR, 0.95; 95% CI, 0.81-1.12), and smoking (eg, current vs never: aHR, 0.87; 95% CI, 0.67-1.13). Most deaths in this cohort occurred in patients with age of 50 years or older (63.4%), male sex (12.3%), and Charlson Comorbidity Index score of at least 1 (11.1%). Conclusions and Relevance: In this national cohort of VA patients, most SARS-CoV-2 deaths were associated with older age, male sex, and comorbidity burden. Many factors previously reported to be associated with mortality in smaller studies were not confirmed, such as obesity, Black race, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking.


Assuntos
Causas de Morte , Infecções por Coronavirus , Hospitalização , Pandemias , Pneumonia Viral , Respiração Artificial , Veteranos , Idoso , Betacoronavirus , Estudos de Coortes , Comorbidade , Coronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Dispneia/etiologia , Dispneia/terapia , Feminino , Febre/etiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Modelos de Riscos Proporcionais , Fatores de Risco , Síndrome Respiratória Aguda Grave , Índice de Gravidade de Doença , Estados Unidos , United States Department of Veterans Affairs
6.
JAMA Netw Open ; 3(9): e2021892, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32975575

RESUMO

Importance: Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19). Objective: To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities. Design, Setting, and Participants: This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds). Exposures: Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown). Main Outcomes and Measures: Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death. Conclusions and Relevance: In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.


Assuntos
Afro-Americanos , Infecções por Coronavirus/etnologia , Disparidades nos Níveis de Saúde , Hospitalização , Unidades de Terapia Intensiva , Pneumonia Viral/etnologia , Adulto , Idoso , Betacoronavirus , Índice de Massa Corporal , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estudos Transversais , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Razão de Chances , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Pobreza , Respiração Artificial , Wisconsin/epidemiologia
7.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(10): 839-843, 2020 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-32992437

RESUMO

Objective: To analyze the clinic features of isolated myeloid sarcoma (IMS) involving the pleural cavity. Methods: A case of pleural isolated myeloid sarcoma (PIMS) with pleural effusion as the first manifestation was described. The related cases in literatures were reviewed with"myeloid sarcoma"and"pleural effusions"as the keywords to search China HowNet, Wanfang database and PubMed database. Results: A 59-year-old man complained of right chest pain for 2 months and worsening pain with distress and shortness of breath for 2 weeks. The chest CT scan showed pleural effusion on the right side. Flow cytometric analysis of pleural fluid showed that a population of blasts with CD34 expressing was 37.6% of the total nucleated cells. The pleural biopsy through medical thoracoscopy indicated lymphoproliferative lesions by pathological examination. Immunohistochemistry was performed on pleural histological sections and cell blocks of pleural effusions, which showed CD34 and CD117 positive expression. The diagnosis of PIMS was finally made. Two literature papers with 2 complete cases were found and reviewed. The 3 cases were analyzed. There were 2 males and 1 female. The age was 59, 51, 56 years respectively. One case was a patient with 3 weeks of right upper quadrant and epigastric pain, nausea, and weight loss. Cytological examination of the pleural fluid showed numerous poorly differentiated malignant cells. Histology from an open laparotomy in duodenal biopsies, gallbladder, and mesenteric lymph nodes supported the diagnosis of IMS. The other case was a patient with 6 weeks of dyspnea and a large swelling in the upper vestibular region. Thoracentesis showed 82% myeloid blasts in the pleural fluid. A gingival biopsy showed a diffuse infiltration by cells with a blastic appearance and supported IMS. Conclusion: PIMS was a very rare cause of pleural effusions. The cytological and histopathological evidences were useful to diagnose IMS involving the pleural cavity.


Assuntos
Dor no Peito/etiologia , Dispneia/etiologia , Derrame Pleural/patologia , Sarcoma Mieloide/diagnóstico , Dor no Peito/diagnóstico por imagem , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura , Sarcoma Mieloide/patologia , Toracoscopia
8.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(10): 844-849, 2020 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-32992438

RESUMO

Objective: To evaluate the clinical value of next-generation sequencing in the diagnosis of Pneumocystis pneumonia in non-HIV infected patients. Methods: A retrospective study was conducted on the diagnosis and treatment of Pneumocystis pneumonia in 5 non-HIV patients in the Fourth Medical Center of the General Hospital of the PLA from September 1, 2017 to September 1, 2018. Next-generation sequencing of BALF were compared with the traditional laboratory microbiological test, and the advantages of the next-generation sequencing in the diagnosis of Pneumocystis pneumonia in non-HIV infected patients were analyzed. Results: There were 3 males and 2 females, with a mean age (48±6) years. Three patients had membranous nephropathy, a patient had tuberculous meningitis, and a patient had esophageal cancer after radiotherapy and chemotherapy. All patients had glucocorticoid medication history before. The clinical manifestations were fever, cough and dyspnea. The chest CT mainly showed bilateral lung ground glass shadows. All the results of 1, 3-ß-D-glucan test were more than 1 000 ng/L. Bronchoalveolar lavage was performed in the 5 cases, and Pneumocystis cysts were found in 1 BALF by Gomori's methenamine silver nitrate staining, and the DNAs of Pneumocystis and human herpesvirus were detected in 5 BALFs by next-generation sequencing. All patients were treated with sulfamethoxazole/trimethoprim (orally, 1.44 g, q8 h) for 23 to 72 days (median 33 days), and with ganciclovir(Ⅳ, 250 mg q12 h) for 6 to 22 days (median 15 days). The chest CT manifestations and symptoms were improved after treatment, without death. Conclusions: The next-generation sequencing of BALF is more specific and sensitive in the diagnosis of Pneumocystis pneumoniae in non-HIV patients. It is faster, more comprehensive and more accurate than the traditional laboratory test, and could be widely used as a PCP diagnosis technique.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala/métodos , Pulmão/diagnóstico por imagem , Pneumonia por Pneumocystis/diagnóstico , Adulto , Anti-Infecciosos/uso terapêutico , Líquido da Lavagem Broncoalveolar , Tosse/etiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Ganciclovir/uso terapêutico , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/tratamento farmacológico , Estudos Retrospectivos , Sulfametoxazol/uso terapêutico , Resultado do Tratamento , Trimetoprima/uso terapêutico
10.
Am J Case Rep ; 21: e926781, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32952147

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease.


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico , Intensificação de Imagem Radiográfica , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Corticosteroides/administração & dosagem , Idoso , Antibacterianos/administração & dosagem , Técnicas de Laboratório Clínico , Meios de Contraste , Infecções por Coronavirus/complicações , Tosse/diagnóstico , Tosse/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Seguimentos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/terapia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Medição de Risco , Síndrome Respiratória Aguda Grave/virologia , Resultado do Tratamento
11.
Am J Case Rep ; 21: e927304, 2020 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-32978364

RESUMO

BACKGROUND This case series describes 5 patients with SARS-CoV-2 infection and COVID-19 in Ecuador who had been treated with hydroxychloroquine for systemic lupus erythematosus (SLE) prior to their COVID-19 illness. CASE REPORT Case #1 reports a 29-year-old woman who had been treated with 200 mg of hydroxychloroquine per day for 1 year and presented with flu-like symptoms, chest pain, fever, odynophagia, asthenia, dry cough, and chills. Case #2 was a 34-year-old woman whose treatment for SLE included 200 mg of hydroxychloroquine per day since 2017. She arrived at the clinic with a dry cough, asthenia, and myalgias. Case #3 was a 24-year-old woman who had been using 200 mg of hydroxychloroquine per day since 2010. She presented with asthenia, myalgias, headaches, hypogeusia, and anosmia. Case #4 was a 39-year-old woman taking 200 mg of hydroxychloroquine every day for SLE who presented with dyspnea, chest pain, odynophagia, hypogeusia, anosmia, diarrhea, and fever. Case #5 was a 46-year-old woman who had been taking 200 mg of hydroxychloroquine since 2019. She came to our hospital complaining of chest pain, fever, and dyspnea. In all 5 patients, SARS-CoV-2 infection was confirmed with a nasopharyngeal SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test using the Cepheid/GeneXpert system. CONCLUSIONS All 5 of our patients with SLE who were taking hydroxychloroquine presented with SARS-CoV-2 infection and symptoms of COVID-19. This case series provides support for a lack of prevention of COVID-19 by hydroxychloroquine.


Assuntos
Infecções por Coronavirus/prevenção & controle , Hidroxicloroquina/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Dispneia/diagnóstico , Dispneia/etiologia , Equador , Serviço Hospitalar de Emergência , Feminino , Febre/diagnóstico , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , RNA Viral/análise , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Amostragem , Falha de Tratamento , Adulto Jovem
12.
Am J Case Rep ; 21: e925931, 2020 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-32980852

RESUMO

BACKGROUND The worldwide spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) has created unprecedented situations for healthcare professionals and healthcare systems. Although infection with this virus is considered the main health problem currently, other diseases are still prevalent. CASE REPORT This report describes a 59-year-old man who presented with symptoms of dyspnea and fever that were attributed to Covid-19 infection. His clinical condition deteriorated and further examinations revealed a subjacent severe aortic regurgitation due to acute infective endocarditis. Surgical treatment was successful. CONCLUSIONS The results of diagnostic tests for Covid-19 should be re-evaluated whenever there are clinical mismatches or doubts, as false-positive Covid-19 test results can occur. Clinical interpretation should not be determined exclusively by the Covid-19 pandemic. This case report highlights the importance of using validated and approved serological and molecular testing to detect infection with SARS-CoV-2, and to repeat tests when there is doubt about presenting symptoms.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Diagnóstico Tardio , Endocardite/complicações , Endocardite/diagnóstico , Pneumonia Viral/diagnóstico , Anticorpos Antivirais/análise , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Estado Terminal , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Endocardite/virologia , Reações Falso-Positivas , Febre/diagnóstico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Resultado do Tratamento
13.
J Assoc Physicians India ; 68(9): 62-66, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32798347

RESUMO

The pandemic due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) has rapidly engulfed the entire world, and continues to evolve at an aggressive pace. Although the characteristic concern in patients with COVID-19 is acute respiratory distress, there is meteoric accrual of data on neurological involvement. Neurological manifestations in COVID-19 have staggering diversity, ranging from mild olfactory and gustatory perception abnormalities to necrotising encephalopathy and stroke. Understanding of pathophysiological mechanisms underlying neurological invasion and disease is still nascent, and dictated largely by evidence from previous coronavirus infections which are known to have neuroinvasive potential. It has also been postulated that SARS CoV2 may affect the medullary respiratory centres in the brain stem thereby playing a possible role in causing neurogenic acute respiratory failure. Preliminary data suggest a role of immune hyperinflammation and hyperthrombosis mediating neurological features. Apart from acute neurological manifestations, immune dysregulation may contribute to para and post-infectious complications and potentially, neurodegenerative conditions. These concepts are paramount in developing therapeutic paradigms to mitigate the impact of the pandemic. In this review, we summarise putative pathophysiological underpinnings of neurological manifestations of COVID-19 and guidance for their management.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Tosse/etiologia , Dispneia/etiologia , Neurologia , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Humanos , Pneumonia Viral/complicações
14.
Ned Tijdschr Geneeskd ; 1642020 07 02.
Artigo em Holandês | MEDLINE | ID: mdl-32779934

RESUMO

Venous thromboembolism (VTE) seems to be an underdiagnosed complication in COVID-19 patients. We present three male patients, aged 67, 29 and 71 years, who were admitted to the hospital with COVID-19. They all showed deterioration in the course of their disease caused by VTE. In our hospital, VTE was diagnosed in 10% of COVID-19 patients admitted to the general ward (non-ICU patients) despite regular thromboprophylaxis. Deterioration in the course of COVID-19 has differential diagnoses such as progression of the infection itself, secondary bacterial pneumonia, left heart failure and in our experience not infrequently VTE. We therefore recommend to consider VTE in COVID-19 patients with a sudden clinical deterioration such as hypotension, tachycardia, unexplained hypoxaemia or insufficient clinical improvement and to perform CT-angiography if indicated. A high dose of thromboprophylaxis in COVID-19 patients may be considered because of increased coagulation activation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Dispneia/fisiopatologia , Pneumonia Viral/fisiopatologia , Tromboembolia Venosa/fisiopatologia , Adulto , Idoso , Anticoagulantes/uso terapêutico , Infecções por Coronavirus/complicações , Progressão da Doença , Dispneia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Tromboembolia Venosa/etiologia
15.
JAMA Netw Open ; 3(8): e2017703, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32797176

RESUMO

Importance: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes are used to characterize coronavirus disease 2019 (COVID-19)-related symptoms. Their accuracy is unknown, which could affect downstream analyses. Objective: To compare the performance of fever-, cough-, and dyspnea-specific ICD-10 codes with medical record review among patients tested for COVID-19. Design, Setting, and Participants: This cohort study included patients who underwent quantitative reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 at University of Utah Health from March 10 to April 6, 2020. Data analysis was performed in April 2020. Main Outcomes and Measures: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-10 codes for fever (R50*), cough (R05*), and dyspnea (R06.0*) were compared with manual medical record review. Performance was calculated overall and stratified by COVID-19 test result, sex, age group (<50, 50-64, and >64 years), and inpatient status. Bootstrapping was used to generate 95% CIs, and Pearson χ2 tests were used to compare different subgroups. Results: Among 2201 patients tested for COVD-19, the mean (SD) age was 42 (17) years; 1201 (55%) were female, 1569 (71%) were White, and 282 (13%) were Hispanic or Latino. The prevalence of fever was 66% (1444 patients), that of cough was 88% (1930 patients), and that of dyspnea was 64% (1399 patients). For fever, the sensitivity of ICD-10 codes was 0.26 (95% CI, 0.24-0.29), specificity was 0.98 (95% CI, 0.96-0.99), PPV was 0.96 (95% CI, 0.93-0.97), and NPV was 0.41 (95% CI, 0.39-0.43). For cough, the sensitivity of ICD-10 codes was 0.44 (95% CI, 0.42-0.46), specificity was 0.88 (95% CI, 0.84-0.92), PPV was 0.96 (95% CI, 0.95-0.97), and NPV was 0.18 (95% CI, 0.16-0.20). For dyspnea, the sensitivity of ICD-10 codes was 0.24 (95% CI, 0.22-0.26), specificity was 0.97 (95% CI, 0.96-0.98), PPV was 0.93 (95% CI, 0.90-0.96), and NPV was 0.42 (95% CI, 0.40-0.44). ICD-10 code performance was better for inpatients than for outpatients for fever (χ2 = 41.30; P < .001) and dyspnea (χ2 = 14.25; P = .003) but not for cough (χ2 = 5.13; P = .16). Conclusions and Relevance: These findings suggest that ICD-10 codes lack sensitivity and have poor NPV for symptoms associated with COVID-19. This inaccuracy has implications for any downstream data model, scientific discovery, or surveillance that relies on these codes.


Assuntos
Codificação Clínica/normas , Infecções por Coronavirus/diagnóstico , Tosse/diagnóstico , Dispneia/diagnóstico , Registros Eletrônicos de Saúde , Febre/diagnóstico , Classificação Internacional de Doenças , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Codificação Clínica/métodos , Estudos de Coortes , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Tosse/etiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Utah/epidemiologia
16.
BMJ Case Rep ; 13(8)2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747596
17.
Eur Rev Med Pharmacol Sci ; 24(14): 7826-7833, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32744710

RESUMO

OBJECTIVE: The outbreak of the 2019 Novel Coronavirus Disease (COVID-19) is seriously threatening the health of people all over China and the world. This study aims to investigate the clinical characteristics and outcomes of COVID-19 patients admitted at different time periods. PATIENTS AND METHODS: A total of 132 discharged cases and 10 deaths of laboratory or clinically confirmed cases were retrospectively collected from The First People's Hospital of Jingzhou, Hubei. All cases were divided into two groups according to different admission times (group 1 from 2020-1-23 to 2020-2-3 and group 2 from 2020-2-4 to 2020-2-15). Individual data, clinical data, laboratory indices and prognosis were collected for the two groups, and statistical analysis was performed using the t-test or chi-square test to assess differences between the groups. RESULTS: Among the 142 cases, there were 67 in the first group and 75 in the second group. According to the individual data and clinical manifestations of the two groups, the hospital stay in the first group was significantly longer than that of the second group (26 [9-39] compared with 20 [6-30], p=0.000). There were more clinical symptoms upon admission in group 1 than in group 2; although 66.2% of all patients had fever, the proportion of patients with fever on admission in the first group was significantly higher than that in the second group (79.1% compared with 54.7%, p=0.002). The proportion of patients with chills in the first group was higher than that in the second group (16.4% compared with 5.3%, p=0.032), and the proportion of patients with dyspnea was also higher than that in the second group (17.9% compared with 4%, p=0.007). Four of the 67 patients in the first group had symptoms of ocular discomfort, but none in the second group had this symptom (6.0% compared with 0, p=0.032). Based on laboratory examination, the inflammatory index of patients in the first group was higher than that in the second group, and the proportion of patients with a C-reactive protein (CRP) increase was also significantly higher (60% compared with 38.7%, p=0.020). The main difference in routine blood tests involved white blood cell and lymphocyte counts and the lymphocyte percentage. The proportion of patients with reduced white blood cell counts in the first group was higher than that in the second group (23.9% compared with 10.7% p=0.036). Moreover, more patients in the first group had a reduced lymphocyte count and percentage (71.6% compared with 30.7% p=0.000; 49.3% compared with 29.7% p=0.015, respectively), and the former was significantly lower than that in the second group (0.94 [0.24-2.42] compared with 1.365 [0.22-3.62], p=0.000). Regarding prognosis, the proportion of severe cases and mortality in the first group were slightly higher than in the second group (p>0.05). CONCLUSIONS: The clinical manifestations, blood changes and outcomes differed in patients admitted at different time periods. In the second group of patients, clinical symptoms were less common than in the first group, routine blood changes and inflammatory indices were milder, and the clinical prognosis was better.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Proteína C-Reativa/análise , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Humanos , Tempo de Internação , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Fatores de Tempo , Adulto Jovem
18.
Medicine (Baltimore) ; 99(31): e21528, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756199

RESUMO

RATIONALE: Massive retropharyngeal hematoma secondary to a minor blunt trauma is rare and easy to be missed in emergency settings due to the absence of visible tissue injury, especially in young patients. However, missing this pathology is dangerous and can result in airway obstruction and even death. Therefore, an effective diagnostic strategy must be developed and thoroughly performed to minimize missed retropharyngeal hematoma. PATIENT CONCERNS: A 49-year-old man with a brief cervical hyperextension secondary to a minor collision presented with mild respiratory discomfort. No externally visible injuries were found; however, dyspnea was persistent and aggravating. DIAGNOSIS: Lateral neck X-ray, neck computed tomography, and spine magnetic resonance imaging revealed a huge retropharyngeal hematoma obstructing the upper airway, without any severe fracture or ligament injury. INTERVENTIONS: An emergent orotracheal intubation followed by imaging studies was performed to resolve the aggravating dyspnea. Neck exploration surgery was immediately performed for rapid absorption of the hematoma, bleeding control, and identification of the reason of the pathology. OUTCOMES: The surgery was successful, and the patient was discharged without any postoperative sequelae on the 30 postoperative day. CONCLUSION: Retropharyngeal hematoma that develops in young patients without visible injuries or severe symptoms after a minor trauma can easily go undetected. Although most hematomas under observation resolve spontaneously, the retropharyngeal hematomas missed at initial assessment may result in critical complications. High level of suspicion, repeated neck CT, and thorough tertiary survey in emergency rooms are helpful in avoiding missed life-threatening retropharyngeal hematoma.


Assuntos
Vértebras Cervicais/lesões , Dispneia/etiologia , Hematoma/etiologia , Doenças Faríngeas/etiologia , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Humanos , Masculino , Pessoa de Meia-Idade
20.
Am J Case Rep ; 21: e925787, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32798215

RESUMO

BACKGROUND At the end of 2019, coronavirus (SARS-CoV-2) was recognized as the cause of a cluster of pneumonia cases in Wuhan, a city in China. There are numerous complications associated with COVID-19 infection, such as acute respiratory distress syndrome, renal failure, circulatory shock, and multi-organ failure. Spontaneous pneumothorax following COVID-19 pneumonia is an extremely rare complication. CASE REPORT We report the case of a 49-year-old man with a past medical history of type 2 diabetes mellitus with an initial presentation of cough, shortness of breath, and fever. He was diagnosed with COVID-19 pneumonia and rapidly deteriorated on the day of admission, requiring initiation of mechanical ventilation. The patient recovered clinically and was discharged home. He returned 21 days after discharge with a spontaneous pneumothorax. CONCLUSIONS Spontaneous pneumothorax is a rare complication after apparent recovery from COVID-19 pneumonia. It is imperative that treating physicians are aware of this complication in order to recognize it early and treat it promptly.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/virologia , Tubos Torácicos , Diabetes Mellitus Tipo 2 , Dispneia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumotórax/diagnóstico por imagem , Pneumotórax/terapia , Tomografia Computadorizada por Raios X
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