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1.
Med Sci Monit ; 26: e927212, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32883943

RESUMO

BACKGROUND The rapid worldwide spread of the coronavirus disease 2019 (COVID-19) epidemic has placed patients with pre-existing conditions at risk of severe morbidity and mortality. The present study investigated the clinical characteristics and outcomes of patients with severe COVID-19 and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS This study enrolled 336 consecutive patients with confirmed severe COVID-19, including 28 diagnosed with COPD, from January 20, 2020, to April 1, 2020. Demographic data, symptoms, laboratory values, comorbidities, and clinical results were measured and compared in survivors and non-survivors. RESULTS Patients with severe COVID-19 and COPD were older than those without COPD. The proportions of men, of patients admitted to the intensive care unit (ICU) and of those requiring invasive ventilation were significantly higher in patients with than without COPD. Leukocyte and neutrophil counts, as well as the concentrations of NT-proBNP, hemoglobin, D-dimer, hsCRP, ferritin, IL-2R, TNF-alpha and procalcitonin were higher, whereas lymphocyte and monocyte counts were lower, in patients with than without COPD. Of the 28 patients with COPD, 22 (78.6%) died, a rate significantly higher than in patients without COPD (36.0%). A comparison of surviving and non-surviving patients with severe COVID-19 and COPD showed that those who died had a longer history of COPD, more fatigue, and a higher ICU occupancy rate, but a shorter average hospital stay, than those who survived. CONCLUSIONS COPD increases the risks of death and negative outcomes in patients with severe COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Distribuição por Idade , Idoso , Biomarcadores , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Cuidados Críticos , Diabetes Mellitus/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Respiração Artificial , Distribuição por Sexo , Sobreviventes , Resultado do Tratamento
3.
Med Sci Monit ; 26: e927212, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: covidwho-745340

RESUMO

BACKGROUND The rapid worldwide spread of the coronavirus disease 2019 (COVID-19) epidemic has placed patients with pre-existing conditions at risk of severe morbidity and mortality. The present study investigated the clinical characteristics and outcomes of patients with severe COVID-19 and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS This study enrolled 336 consecutive patients with confirmed severe COVID-19, including 28 diagnosed with COPD, from January 20, 2020, to April 1, 2020. Demographic data, symptoms, laboratory values, comorbidities, and clinical results were measured and compared in survivors and non-survivors. RESULTS Patients with severe COVID-19 and COPD were older than those without COPD. The proportions of men, of patients admitted to the intensive care unit (ICU) and of those requiring invasive ventilation were significantly higher in patients with than without COPD. Leukocyte and neutrophil counts, as well as the concentrations of NT-proBNP, hemoglobin, D-dimer, hsCRP, ferritin, IL-2R, TNF-alpha and procalcitonin were higher, whereas lymphocyte and monocyte counts were lower, in patients with than without COPD. Of the 28 patients with COPD, 22 (78.6%) died, a rate significantly higher than in patients without COPD (36.0%). A comparison of surviving and non-surviving patients with severe COVID-19 and COPD showed that those who died had a longer history of COPD, more fatigue, and a higher ICU occupancy rate, but a shorter average hospital stay, than those who survived. CONCLUSIONS COPD increases the risks of death and negative outcomes in patients with severe COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Distribuição por Idade , Idoso , Biomarcadores , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Cuidados Críticos , Diabetes Mellitus/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Respiração Artificial , Distribuição por Sexo , Sobreviventes , Resultado do Tratamento
6.
J Investig Med High Impact Case Rep ; 8: 2324709620949307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32779481

RESUMO

The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Transplante de Rim/efeitos adversos , Pneumonia Viral/fisiopatologia , Infecções por Coronavirus/complicações , Diarreia/etiologia , Fadiga/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Transplante de Órgãos , Pandemias , Pneumonia Viral/complicações , Transplantados
7.
Curr Med Sci ; 40(4): 625-635, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32767264

RESUMO

Nurses' work-related fatigue has been recognized as a threat to nurse health and patient safety. The aim of this study was to assess the prevalence of fatigue among first-line nurses combating with COVID-19 in Wuhan, China, and to analyze its influencing factors on fatigue. A multi-center, descriptive, cross-sectional design with a convenience sample was used. The statistical population consisted of the first-line nurses in 7 tertiary general hospitals from March 3, 2020 to March 10, 2020 in Wuhan of China. A total of 2667 samples from 2768 contacted participants completed the investgation, with a response rate of 96.35%. Social-demographic questionnaire, work-related questionnaire, Fatigue Scale-14, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Chinese Perceived Stress Scale were used to conduct online survey. The descriptive statistic of nurses' social-demographic characteristics was conducted, and the related variables of work, anxiety, depression, perceived stress and fatigue were analyzed by t-tests, nonparametric test and Pearson's correlation analysis. The significant factors which resulted in nurses' fatigue were further analyzed by multiple linear regression analysis. The median score for the first-line nurses' fatigue in Wuhan was 4 (2, 8). The median score of physical and mental fatigue of them was 3 (1, 6) and 1 (0, 3) respectively. According to the scoring criteria, 35.06% nurses (n=935) of all participants were in the fatigue status, their median score of fatigue was 10 (8, 11), and the median score of physical and mental fatigue of them was 7 (5, 8) and 3 (2, 4) respectively. Multiple linear regression analysis revealed the participants in the risk groups of anxiety, depression and perceived stress had higher scores on physical and mental fatigue and the statistically significant positive correlation was observed between the variables and nurses' fatigue, the frequency of exercise and nurses' fatigue had a statistically significant negative correlation, and average daily working hours had a significantly positive correlation with nurses' fatigue, and the frequency of weekly night shift had a low positive correlation with nurses' fatigue (P<0.01). There was a moderate level of fatigue among the first-line nurses fighting against COVID-19 pandemic in Wuhan, China. Government and health authorities need to formulate and take effective intervention strategies according to the relevant risk factors, and undertake preventive measures aimed at reducing health hazards due to increased work-related fatigue among first-line nurses, and to enhance their health status and provide a safe occupational environment worldwide. Promoting both medical and nursing safety while combating with the pandemic currently is warranted.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Fadiga/etiologia , Enfermeiras e Enfermeiros , Doenças Profissionais/etiologia , Estresse Ocupacional/etiologia , Pandemias , Pneumonia Viral/enfermagem , Adulto , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Modelos Lineares , Masculino , Fadiga Mental/epidemiologia , Fadiga Mental/etiologia , Fadiga Mental/psicologia , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/psicologia , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/psicologia , Pneumonia Viral/epidemiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Centros de Atenção Terciária , Carga de Trabalho/psicologia , Adulto Jovem
8.
J Alzheimers Dis ; 77(1): 67-73, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804094

RESUMO

BACKGROUND: Facing the novel coronavirus disease 2019 (COVID-19), most vulnerable individuals are seniors, especially those with comorbidities. More attention needs to been paid to the COVID-19 patients with Alzheimer's disease (AD), which is the top age-related neurodegenerative disease. OBJECTIVE: Since it is unclear whether AD patients are prone to COVID-19 infection and progression to severe stages, we report for the first time a retrospective analysis of the clinical characteristics of AD patients with COVID-19 pneumonia. METHODS: We conducted a retrospective cohort study of the clinical data of 19 AD patients with COVID-19 pneumonia, compared with 23 non-AD COVID-19 patients admitted at the same time to our hospital. Demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. RESULTS: Between AD patients and non-AD patients with COVID-19 pneumonia, the pneumonia severity was not significantly different. AD patients had a higher clustering onset than non-AD patients. The median duration from symptom onset to hospitalization were shorter in AD patients than non-AD patients, indicating the former were sent to the hospital by their family or from nursing home earlier than the later. The median duration from hospitalization to discharge seemed shorter in AD patients than non-AD patients. Dementia patients seemed less likely to report fatigue. It is noticed that more AD patients might have pericardial effusion than the non-AD patients. CONCLUSION: AD patients with COVID-19 were in milder conditions with a better prognosis than non-AD patients. AD patients who had adequate access to healthcare showed resilience to COVID-19 with shorter hospital stays.


Assuntos
Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Resiliência Psicológica , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Estudos de Coortes , Progressão da Doença , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Alta do Paciente/estatística & dados numéricos , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Pneumonia/complicações , Pneumonia/terapia , Prognóstico
9.
PLoS One ; 15(8): e0237005, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813740

RESUMO

INTRODUCTION: Interferon (IFN)-free regimens for the treatment of chronic hepatitis C have shown high rates of sustained virological response (SVR) and improved patient-reported outcomes (PROs). The aim of this study was to evaluate the health-related quality of life (HRQoL) and fatigue of patients with chronic hepatitis C (HCV) treated with IFN-free direct-acting antiviral (DAA) agents that achieved SVR following treatment and identify the predictive factors related to HRQoL. METHODS: Prospective cohort study that included patients with HCV treated with DAA who obtained an SVR. The patients answered three self-reported questionnaires (PROs): Short Form 36 (SF-36), the Chronic Liver Diseases Questionnaire (CLDQ), and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire at baseline, weeks 6 and 12 of treatment, and at 12 weeks after therapy. Patients were treated with DAA with or without ribavirin (RBV). The PRO scores were compared using analysis of variance (ANOVA). A comparison of PROs and serum hemoglobin levels was performed between the group that used ribavirin and the one that did not use ribavirin using the t student test. Predictive factors were calculated using a multiple linear regression model. RESULTS: Among the 113 patients selected, 105 presented an SVR and were included in the study, in which, 54% men, 80% genotype 1, 44% cirrhosis and 46% with RBV. At 12 weeks after the end of treatment, there was a significant improvement in the scores of the patient self-reports (PROs) when compared with baseline for the CLDQ (+10.52%, p<0.001), SF-36-Physical Summary (+19%, p<0.001), and FACIT (+17.34%, p<0.001). Patients who used RBV had worse PROs and serum hemoglobin levels compared to the group that did not use RBV (p<0,05). As predictors of worsening of the PROs we had the presence of diabetes mellitus, liver cirrhosis and HIV co-infected. CONCLUSION: Patients treated with IFN free regimens presents significant improvement in PROs. The presence of diabetes mellitus, cirrhosis, and HIV co-infected has a negative effect on HRQoL before, during and after treatment of hepatitis C. The addition of ribavirin to the antiviral regimens used compromises the HRQoL indexes during antiviral therapy.


Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Idoso , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Brasil , Estudos de Coortes , Fadiga/etiologia , Fadiga/prevenção & controle , Feminino , Hepatite C Crônica/fisiopatologia , Hepatite C Crônica/virologia , Humanos , Interferons/administração & dosagem , Interferons/efeitos adversos , Interferons/uso terapêutico , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Qualidade de Vida , Ribavirina/administração & dosagem , Ribavirina/efeitos adversos , Ribavirina/uso terapêutico , Resposta Viral Sustentada
10.
J Alzheimers Dis ; 77(1): 67-73, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-721452

RESUMO

BACKGROUND: Facing the novel coronavirus disease 2019 (COVID-19), most vulnerable individuals are seniors, especially those with comorbidities. More attention needs to been paid to the COVID-19 patients with Alzheimer's disease (AD), which is the top age-related neurodegenerative disease. OBJECTIVE: Since it is unclear whether AD patients are prone to COVID-19 infection and progression to severe stages, we report for the first time a retrospective analysis of the clinical characteristics of AD patients with COVID-19 pneumonia. METHODS: We conducted a retrospective cohort study of the clinical data of 19 AD patients with COVID-19 pneumonia, compared with 23 non-AD COVID-19 patients admitted at the same time to our hospital. Demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. RESULTS: Between AD patients and non-AD patients with COVID-19 pneumonia, the pneumonia severity was not significantly different. AD patients had a higher clustering onset than non-AD patients. The median duration from symptom onset to hospitalization were shorter in AD patients than non-AD patients, indicating the former were sent to the hospital by their family or from nursing home earlier than the later. The median duration from hospitalization to discharge seemed shorter in AD patients than non-AD patients. Dementia patients seemed less likely to report fatigue. It is noticed that more AD patients might have pericardial effusion than the non-AD patients. CONCLUSION: AD patients with COVID-19 were in milder conditions with a better prognosis than non-AD patients. AD patients who had adequate access to healthcare showed resilience to COVID-19 with shorter hospital stays.


Assuntos
Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Resiliência Psicológica , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Estudos de Coortes , Progressão da Doença , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Alta do Paciente/estatística & dados numéricos , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Pneumonia/complicações , Pneumonia/terapia , Prognóstico
11.
Curr Med Sci ; 40(4): 625-635, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: covidwho-697010

RESUMO

Nurses' work-related fatigue has been recognized as a threat to nurse health and patient safety. The aim of this study was to assess the prevalence of fatigue among first-line nurses combating with COVID-19 in Wuhan, China, and to analyze its influencing factors on fatigue. A multi-center, descriptive, cross-sectional design with a convenience sample was used. The statistical population consisted of the first-line nurses in 7 tertiary general hospitals from March 3, 2020 to March 10, 2020 in Wuhan of China. A total of 2667 samples from 2768 contacted participants completed the investgation, with a response rate of 96.35%. Social-demographic questionnaire, work-related questionnaire, Fatigue Scale-14, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Chinese Perceived Stress Scale were used to conduct online survey. The descriptive statistic of nurses' social-demographic characteristics was conducted, and the related variables of work, anxiety, depression, perceived stress and fatigue were analyzed by t-tests, nonparametric test and Pearson's correlation analysis. The significant factors which resulted in nurses' fatigue were further analyzed by multiple linear regression analysis. The median score for the first-line nurses' fatigue in Wuhan was 4 (2, 8). The median score of physical and mental fatigue of them was 3 (1, 6) and 1 (0, 3) respectively. According to the scoring criteria, 35.06% nurses (n=935) of all participants were in the fatigue status, their median score of fatigue was 10 (8, 11), and the median score of physical and mental fatigue of them was 7 (5, 8) and 3 (2, 4) respectively. Multiple linear regression analysis revealed the participants in the risk groups of anxiety, depression and perceived stress had higher scores on physical and mental fatigue and the statistically significant positive correlation was observed between the variables and nurses' fatigue, the frequency of exercise and nurses' fatigue had a statistically significant negative correlation, and average daily working hours had a significantly positive correlation with nurses' fatigue, and the frequency of weekly night shift had a low positive correlation with nurses' fatigue (P<0.01). There was a moderate level of fatigue among the first-line nurses fighting against COVID-19 pandemic in Wuhan, China. Government and health authorities need to formulate and take effective intervention strategies according to the relevant risk factors, and undertake preventive measures aimed at reducing health hazards due to increased work-related fatigue among first-line nurses, and to enhance their health status and provide a safe occupational environment worldwide. Promoting both medical and nursing safety while combating with the pandemic currently is warranted.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Fadiga/etiologia , Enfermeiras e Enfermeiros , Doenças Profissionais/etiologia , Estresse Ocupacional/etiologia , Pandemias , Pneumonia Viral/enfermagem , Adulto , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Modelos Lineares , Masculino , Fadiga Mental/epidemiologia , Fadiga Mental/etiologia , Fadiga Mental/psicologia , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/psicologia , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/psicologia , Pneumonia Viral/epidemiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Centros de Atenção Terciária , Carga de Trabalho/psicologia , Adulto Jovem
12.
J Investig Med High Impact Case Rep ; 8: 2324709620949307, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-708945

RESUMO

The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Transplante de Rim/efeitos adversos , Pneumonia Viral/fisiopatologia , Infecções por Coronavirus/complicações , Diarreia/etiologia , Fadiga/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Transplante de Órgãos , Pandemias , Pneumonia Viral/complicações , Transplantados
13.
Arch Gynecol Obstet ; 302(3): 545-551, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32696241

RESUMO

OBJECTIVE: To investigate the maternal and infant outcomes of full-term pregnant patients in Wuhan, China, who were infected with 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is responsible for coronavirus disease 2019 (COVID-2019). DESIGN: Retrospective case series. SETTING: The Central Hospitals of Wuhan, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China. PARTICIPANTS: Twenty one full-term pregnant patients who were admitted to the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, confirmed SARS-CoV-2 infection and COVID-2019 with laboratorial and clinical methods, were reviewed by our medical team, and the data were collected from January 20, 2020 to February 29, 2020. MAIN CLINICAL DATA COLLECTION: Clinical data had been collecting using a standard case report form, such as epidemiological history, clinical manifestations, auxiliary examination of major laboratory and clinic, etc. All the information was collected and confirmed by our medical team. RESULTS: Twenty one full-term pregnant patients were reviewed (median age 29 years), and no patients were admitted to intensive care unit (ICU), and died during the treating progress. According to our review, all the cases were infected by human to human transmission, and the most common symptoms at onset of illness were cough in 17 (80.95%), fatigue in 10 (47.62%), fever in 7 (33.33%), expectoration in 1 (4.76%), and only one patient (4.76%) developed shortness of breath on admission. The median time from exposure to onset of illness was 10 days (interquartile range 7 -2 days), and from onset of symptoms to first hospital admission was 1 day (interquartile range 1-2 days). CONCLUSIONS: As of February 29, 2020, all the patients who were full-term pregnancy combined with COVID-2019 were cured and delivered successfully, and all the newborns were not infected with SARS-CoV-2, and there were no evidence of mother-to-child transmission.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Hospitalização/estatística & dados numéricos , Pandemias , Pneumonia Viral/diagnóstico , Complicações na Gravidez/virologia , Adulto , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tosse/etiologia , Dispneia/etiologia , Fadiga/etiologia , Feminino , Febre/etiologia , Humanos , Recém-Nascido , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Gravidez , Complicações na Gravidez/terapia , Resultado da Gravidez , Estudos Retrospectivos
14.
Neurol India ; 68(3): 560-572, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32643664

RESUMO

COVID-19, in most patients, presents with mild flu-like illness. Elderly patients with comorbidities, like hypertension, diabetes, or lung and cardiac disease, are more likely to have severe disease and deaths. Neurological complications are frequently reported in severely or critically ill patients with comorbidities. In COVID-19, both central and peripheral nervous systems can be affected. The SARS-CoV-2 virus causes the disease COVID-19 and has the potential to invade the brain. The SARS-CoV-2 virus enters the brain either via a hematogenous route or olfactory system. Angiotensin-converting enzyme two receptors, present on endothelial cells of cerebral vessels, are a possible viral entry point. The most severe neurological manifestations, altered sensorium (agitation, delirium, and coma), are because of hypoxic and metabolic abnormalities. Characteristic cytokine storm incites severe metabolic changes and multiple organ failure. Profound coagulopathies may manifest with ischemic or hemorrhagic stroke. Rarely, SARS-CoV-2 virus encephalitis or pictures like acute disseminated encephalomyelitis or acute necrotizing encephalopathy have been reported. Nonspecific headache is a commonly experienced neurological symptom. A new type of headache "personal protection equipment-related headache" has been described. Complete or partial anosmia and ageusia are common peripheral nervous system manifestations. Recently, many cases of Guillain-Barré syndrome in COVID-19 patients have been observed, and a postinfectious immune-mediated inflammatory process was held responsible for this. Guillain-Barré syndrome does respond to intravenous immunoglobulin. Myalgia/fatigue is also common, and elevated creatine kinase levels indicate muscle injury. Most of the reports about neurological complications are currently from China. COVID-19 pandemic is spreading to other parts of the world; the spectrum of neurological complications is likely to widen further.


Assuntos
Ageusia/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Síndrome da Liberação de Citocina/imunologia , Encefalite/fisiopatologia , Síndrome de Guillain-Barré/fisiopatologia , Cefaleia/fisiopatologia , Transtornos do Olfato/fisiopatologia , Pneumonia Viral/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Ageusia/etiologia , Betacoronavirus , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Barreira Hematoencefálica , Isquemia Encefálica/sangue , Isquemia Encefálica/etiologia , Isquemia Encefálica/imunologia , Isquemia Encefálica/fisiopatologia , Coma/etiologia , Coma/fisiopatologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Delírio/etiologia , Delírio/fisiopatologia , Encefalite/etiologia , Encefalite/imunologia , Encefalomielite Aguda Disseminada/etiologia , Encefalomielite Aguda Disseminada/imunologia , Encefalomielite Aguda Disseminada/fisiopatologia , Fadiga/etiologia , Fadiga/fisiopatologia , Síndrome de Guillain-Barré/etiologia , Cefaleia/etiologia , Humanos , Hemorragias Intracranianas/sangue , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Leucoencefalite Hemorrágica Aguda/etiologia , Leucoencefalite Hemorrágica Aguda/imunologia , Leucoencefalite Hemorrágica Aguda/fisiopatologia , Mialgia/etiologia , Mialgia/fisiopatologia , Transtornos do Olfato/etiologia , Pandemias , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/imunologia
15.
Int J Med Sci ; 17(12): 1744-1750, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32714077

RESUMO

Many studies have reported the risk factors for exacerbations in patients with 2019 novel coronavirus (2019-nCoV). This study aims to perform the meta-analysis of risk factors for the exacerbation of the novel coronavirus-infected pneumonia (NCIP). PubMed, Embase and Google scholar have been searched. We included the cohort studies involving risk factors for the exacerbation of NCIP. This meta-analysis compared the risk factors of patients between intensive care (ICU) group and non-ICU group. Two cohort studies were included in this study. After comparing the patients between intensive care (ICU) group and non-ICU group, several important factors were found to significantly increase the risk of exacerbations in patients with NCIP, and they included hypertension (RR=2.34; 95% CI=1.21 to 4.51; P=0.01), cardiovascular diseases (RR=2.28; 95% CI=1.13 to 4.58; P=0.02), COPD (RR=7.65; 95% CI=1.24 to 47.13; P=0.03), dyspnea (RR=2.89; 95% CI=2.05 to 4.08; P<0.00001), myalgia or fatigue (RR=1.24; 95% CI=1.01 to 1.52; P=0.04), but several factors such as gender, Huanan Seafood Wholesale Market exposure, diabetes, chronic liver disease, malignancy, fever, cough, expectoration, headache and diarrhoea appeared to have no obvious effect on the exacerbation of pneumonia. In addition, as the exacerbation of pneumonia, some complications had the high probability to occur according to the meta-analysis of acute respiratory distress syndrome (ARDS) (RR=13.95; 95% CI=6.20 to 31.41; P<0.00001), shock (RR=24.29; 95% CI=4.66 to 126.69; P=0.0002), acute cardiac injury (RR=10.32; 95% CI=3.05 to 34.96; P=0.0002) and acute kidney injury (RR=5.90; 95% CI=1.32 to 26.35; P=0.02) between two groups. Several risk factors were confirmed to significantly improve the risk of exacerbation in patients with NCIP, which was very important for the exacerbation prediction and treatment of these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Adulto , Idoso , China/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Progressão da Doença , Dispneia/epidemiologia , Dispneia/etiologia , Exposição Ambiental , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Hipertensão/epidemiologia , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Fatores de Risco , Choque/epidemiologia , Choque/etiologia , Avaliação de Sintomas
16.
Mol Med Rep ; 22(3): 2583-2587, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32705222

RESUMO

Since December 2019, an increasing number of cases associated with the 2019 novel coronavirus (2019­nCoV) have emerged in Wuhan, China, which has resulted in a rapid outbreak in China and worldwide. The present study aimed to describe the clinical, laboratory and radiological characteristics of 2019­nCoV pneumonia (NCP) in Zhejiang province, outside of Wuhan. A total of 74 patients with 2019­nCoV were continuously enrolled between January 22 and March 2, 2020 at Zhejiang Hospital. Diagnosis was confirmed at Zhejiang Hospital by reverse transcription­PCR (RT­PCR), which was approved by the Chinese government. Subsequently, the clinical features between positive­ and negative­NCP patients in Zhejiang were compared. Among the 74 hospitalized patients with suspected 2019­NCP, six patients (one male and five female patients) were confirmed to be infected with 2019­nCoV by RT­PCR. The average age of the confirmed patients was 40±13 years. There were three family clusters among the confirmed cases, one patient from each of these families had travel history or contact with patients from Wuhan within 2 weeks. Compared with non­NCP patients, the most common symptoms at onset for patients with NCP were fever (5/6; 83.3%) and cough (5/6; 83.3%), followed by dyspnea/pharyngalgia (2/6; 33.3%), whereas myalgia (1/6; 16.7%) and fatigue (1/6; 16.7%) were less common. All 74 patients with suspected NCP exhibited abnormal computerized tomography (CT) images. In total, 2/6 (33.3%) patients with confirmed NCP presented with bilateral pneumonia, and 21/68 (30.9%) non­NCP patients exhibited bilateral pneumonia, with bilateral distribution of patchy shadows or ground glass opacity. The present study revealed that epidemiological history was critical to the diagnosis of 2019­nCoV in low epidemic regions outside Hubei province. It was also identified that chest CT could not replace nucleic acid testing due to similar radiological manifestations.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Tosse/etiologia , Fadiga/etiologia , Febre/etiologia , Pneumonia Viral/complicações , Adulto , China/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Tosse/patologia , Fadiga/patologia , Feminino , Febre/patologia , Humanos , Incidência , Masculino , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
17.
Medicine (Baltimore) ; 99(28): e21293, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664185

RESUMO

BACKGROUND: In the beginning of December 2019, the novel coronavirus pneumonia was first detected in Wuhan, China. Its widespread infectivity and strong pathogenicity has posed a great threat to public health, seriously affecting social production and life. Accumulating evidence suggests that gastrointestinal symptoms, such as diarrhea, are common among patients with COVID-19. Tuina (massage) therapy is 1 of the widely employed complementary and alternative medicine interventions in the world. It can act on the subcutaneous muscular layer, enhance the local blood circulation and tissue metabolism of the skin, thus exert its effects on digestive systems and alleviate aversive diarrhea symptoms. This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for diarrhea symptoms in COVID-19. METHODS: We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating exercise-induced fatigue: China National Knowledge Infrastructure, Wanfang and Pubmed Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. RESULTS: This proposed study will evaluate the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients. The outcomes will include the improvement of diarrhea symptoms and adverse effect. CONCLUSIONS: This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients.Dissemination and ethics: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.


Assuntos
Infecções por Coronavirus , Diarreia , Fadiga , Massagem/métodos , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Diarreia/etiologia , Diarreia/fisiopatologia , Diarreia/terapia , Fadiga/etiologia , Fadiga/prevenção & controle , Humanos , Metanálise como Assunto , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(29): e21123, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702863

RESUMO

INTRODUCTION: Gitelman syndrome (GS) is an autosomal-recessive disease caused by SLC12A3 gene mutations. It is characterized by hypokalemic metabolic alkalosis in combination with hypomagnesemia and hypocalciuria. Recently, patients with GS are found at an increased risk for developing type 2 diabetes mellitus (T2DM). However, diagnosis of hyperglycemia in GS patients has not been thoroughly investigated, and family studies on SLC12A3 mutations and glucose metabolism are rare. Whether treatment including potassium and magnesium supplements, and spironolactone can ameliorate impaired glucose tolerance in GS patients, also needs to be investigated. PATIENT CONCERNS: We examined a 55-year-old Chinese male with intermittent fatigue and persistent hypokalemia for 17 years. DIAGNOSES: Based on the results of the clinical data, including electrolytes, oral glucose tolerance test (OGTT), and genetic analysis of the SLC12A3 gene, GS and T2DM were newly diagnosed in the patient. Two mutations of the SLC12A3 gene were found in the patient, one was a missense mutation p.N359K in exon 8, and the other was a novel insert mutation p.I262delinsIIGVVSV in exon 6. SLC12A3 genetic analysis and OGTT of 9 other family members within 3 generations were also performed. Older brother, youngest sister, and son of the patient carried the p.N359K mutation in exon 8. The older brother and the youngest sister were diagnosed with T2DM and impaired glucose tolerance by OGTT, respectively. INTERVENTIONS: The patient was prescribed potassium and magnesium (potassium magnesium aspartate, potassium chloride) oral supplements and spironolactone. The patient was also suggested to maintain a high potassium diet. Acarbose was used to maintain the blood glucose levels. OUTCOMES: The electrolyte imbalance including hypokalemia and hypomagnesemia, and hyperglycemia were improved with a remission of the clinical manifestations. CONCLUSION: GS is one of the causes for manifestation of hypokalemia. SLC12A3 genetic analysis plays an important role in diagnosis of GS. Chinese male GS patients characterized with heterozygous SLC12A3 mutation should be careful toward occurrence of T2DM. Moreover, the patients with only 1 SLC12A3 mutant allele should pay regular attention to blood potassium and glucose levels. GS treatment with potassium and magnesium supplements, and spironolactone can improve impaired glucose metabolism.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Síndrome de Gitelman/complicações , Hipopotassemia/etiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Fadiga/etiologia , Síndrome de Gitelman/fisiopatologia , Humanos , Hipopotassemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mutação/genética , Membro 3 da Família 12 de Carreador de Soluto/genética
19.
J Cancer Res Clin Oncol ; 146(10): 2479-2487, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32617701

RESUMO

PURPOSE: Fatigue is a distressing symptom in head & neck cancer patients before during and at the end of curative therapy. Pharmacologic and not pharmacologic treatments have been proposed with scarce or no evidence of efficacy. The aim of the study is to evaluate the efficacy of American ginseng in respect to placebo in reducing fatigue in patients treated for head and neck cancer with curative intent. METHODS: Thirty-two patients who had completed oncological treatment for a primary Head & neck tumor for at least 1 year and had a global fatigue score > 4 by means of Brief Fatigue Inventory (BFI) were randomized to receive 1000 mg of American ginseng or placebo per day for 8 weeks with the aim to assess their efficacy. Changes in fatigue scores in the 2 subgroups of patients before and after the treatment with American ginseng or placebo, were assessed by the BFI at baseline and at the end of week 8. RESULTS: The mean of the mean values of the BFI measured at 8 weeks (end of treatment) was 4.6 in the Ginseng arm and 3.4 in the Placebo arm (p = ns). Mean comparison showed a tendency to statistical significance only for the single item on interference with general activity (p = 0.06), with better performance for placebo. The mean of the differences between baseline values and 8 weeks values was not significantly different between treatment arms considering the entire questionnaire. CONCLUSION: The present data shows that American ginseng has insufficient evidence to be recommended for Cancer Related Fatigue (CRF) in post treatment HNC survivors.


Assuntos
Fadiga/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/terapia , Panax , Adulto , Idoso , Fadiga/diagnóstico , Fadiga/etiologia , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fitoterapia/métodos
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