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1.
J Int Med Res ; 49(5): 3000605211017686, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34044638

RESUMO

OBJECTIVE: Postoperative sore throat (POST) is an undesirable intubation-related complication after surgery. Several studies have investigated the efficacy of perioperative intravenous dexmedetomidine administration for the prevention of POST, but the results have been inconsistent. We aimed to summarize all existing evidence and draw a more precise conclusion to guide future clinical work. METHODS: PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure databases were comprehensively searched for all randomized controlled trials published before 1 February 2021 that investigated the efficacy of dexmedetomidine for the prevention of POST. RESULTS: Nine studies involving 400 patients were included in our meta-analysis. Compared with the control groups (i.e., saline and anesthetic drugs), perioperative intravenous use of dexmedetomidine significantly reduced the incidence of POST [risk ratio (RR): 0.56; 95% confidence interval (CI): 0.40-0.77; I2 = 0%) and coughing on the tube during extubation (RR: 0.58; 95% CI: 0.41-0.82; I2 = 0%). Additionally, patients in the dexmedetomidine group were more likely to develop bradycardia (RR: 2.46; 95% CI: 1.28-4.71; I2 = 0%) and hypotension (RR: 3.26; 95% CI: 1.14-9.33; I2 = 0%) during the administration of dexmedetomidine than those in the control group. CONCLUSION: Perioperative intravenous administration of dexmedetomidine has a positive effect on the prevention of POST.


Assuntos
Dexmedetomidina , Faringite , Administração Intravenosa , China , Dexmedetomidina/uso terapêutico , Humanos , Faringite/etiologia , Faringite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle
2.
BMC Infect Dis ; 21(1): 463, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34020607

RESUMO

BACKGROUND: Streptococcus pyogenes causes a profound global burden of morbidity and mortality across its diverse clinical spectrum. To support a new controlled human infection ('challenge') model seeking to accelerate S. pyogenes vaccine development, we aimed to develop an accurate and reliable molecular method for quantifying bacterial load from pharyngeal swabs collected during experimental human pharyngitis. METHODS: Combined sequential RNA + DNA extraction from throat swabs was compared to traditional separate RNA-only and DNA-only extractions. An emm-type specific qPCR was developed to detect the emm75 challenge strain. Results from the qPCR were compared to culture, using throat swab samples collected in a human challenge study. RESULTS: The qPCR was 100% specific for the emm75 challenge strain when tested against a panel of S. pyogenes emm-types and other respiratory pathogens. Combined RNA + DNA extraction had similar yield to traditional separate extractions. The combined extraction method and emm75 qPCR had 98.8% sensitivity compared to culture for throat swabs collected from challenge study participants. CONCLUSIONS: We have developed a reliable molecular method for measuring S. pyogenes bacterial load from throat swabs collected in a controlled human infection model of S. pyogenes pharyngitis. TRIAL REGISTRATION: NCT03361163 on 4th December 2017.


Assuntos
Antígenos de Bactérias/genética , Carga Bacteriana , Proteínas da Membrana Bacteriana Externa/genética , Faringite/microbiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/genética , Adulto , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Seguimentos , Voluntários Saudáveis , Humanos , RNA Bacteriano/genética , RNA Bacteriano/isolamento & purificação , Sensibilidade e Especificidade , Streptococcus pyogenes/classificação , Streptococcus pyogenes/isolamento & purificação
3.
MMW Fortschr Med ; 163(9): 28, 2021 05.
Artigo em Alemão | MEDLINE | ID: mdl-33961248
4.
BMJ Case Rep ; 14(5)2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34031087

RESUMO

This is a rare case of descending necrotising mediastinitis (DNM) that originated as an oropharyngeal infection, before spreading caudally to include all compartments of the mediastinum and the peritoneum beyond. The mediastinitis was treated early and aggressively with drainage, lavage and debridement in conjunction with broad-spectrum antimicrobial treatment. This case includes a right cervical incision, and a seldom needed surgical laparotomy approach to address the intra-abdominal involvement, and necessity of peritoneal washout. Following a prolonged Intesive Care Unit (ICU) stay and antibiotic course as well as other interventions detailed, the patient made a remarkable recovery and was discharged 101 days post presentation. This report goes on to discuss the rapidly evolving, life-threatening nature of DNM as well as providing an overview of possible management options, outlining how we think such cases should be approached and the clinical suspicion required in a deteriorating patient.


Assuntos
Mediastinite , Peritonite , Faringite , Drenagem , Humanos , Mediastinite/diagnóstico , Mediastinite/terapia , Mediastino , Necrose , Faringite/complicações
5.
J Paediatr Child Health ; 57(6): 797-802, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33876472

RESUMO

Rheumatic heart disease (RHD) is a large, preventable, global public health burden. In New Zealand (NZ), acute rheumatic fever (ARF) and RHD rates are highest for Maori and Pacific children. This structured review explores the evidence for primary prevention interventions to diagnose and effectively treat group A Streptococcus (GAS) pharyngitis and skin infections to reduce rates of ARF and RHD. Medline, EMBASE and Scopus databases were searched as well as other electronic publications. Included were 50 publications from 1980 onwards. This review has identified that there is little available evidence for effective primary prevention strategies to reduce ARF rates in NZ. However, two primary intervention strategies that should be considered by communities at high-risk of ARF are: the use of school-based clinics to identify and treat GAS pharyngitis and GAS skin infections; and intramuscular benzathine penicillin G with lignocaine analgesia in children who present with a GAS positive throat.


Assuntos
Faringite , Febre Reumática , Cardiopatia Reumática , Infecções Estreptocócicas , Criança , Humanos , Nova Zelândia , Faringite/tratamento farmacológico , Febre Reumática/tratamento farmacológico , Febre Reumática/prevenção & controle , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/prevenção & controle , Streptococcus pyogenes
6.
BMC Infect Dis ; 21(1): 322, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827439

RESUMO

BACKGROUND: Despite a notable decrease in acute rheumatic fever (ARF) incidence in the past few decades, there are still cases in our setting. Sydenham chorea (SC) may be the initial manifestation for this condition in childhood in a significant proportion of children. We report two cases of choreoathetosis in children as the first manifestation of ARF. CASE PRESENTATION: A previously healthy 8-year-old boy presented with right hemichorea with a predominance in the brachial region, orofacial dyskinesias and speech difficulties for the past 2 weeks. The only medical history of interest was a common catarrhal illness 3 weeks before and nonspecific bilateral tenosynovitis in both feet since a year prior. A brain computerized tomography was normal and the echocardiogram showed mild mitral and aortic regurgitation, meeting ARF criteria. He demonstrated clinical improvement with treatment based on prednisone and carbamazepine. The second patient was a 10-year-old girl with choreic movements of the right half of the body and repetitive right eye closure of 1 week duration. She had symptoms of fever and rash the previous week and pharyngitis that resolved without antibiotic 2 months before. Blood tests revealed elevated C reactive protein (12 mg/dl) and erythrocyte sedimentation rate (96 mm/h). Brain magnetic resonance was normal and echocardiogram showed left ventricle dilation and mild mitral regurgitation, leading to the diagnosis of ARF. Due to neurological involvement, she received corticosteroids and intravenous immunoglobulin treatment, with worsening of neurological symptoms that required valproic acid with remission of the hemichorea. In addition skin lessions compatible with erythema marginatum appeared on the upper limbs. CONCLUSIONS: SC should be the main diagnostic consideration in cases of hemichorea with normal neuroimaging in children. The cases reported highlight the need to maintain a high index of suspicion even in settings where incidende of ARF is low and the need to perform cardiological investigations in all patients with suspected SC, due to the possibility of subclinical valve lesions. Good adherence to secondary prophylaxis is crucial to avoid chorea relapses and worsening valve disease.


Assuntos
Coreia/diagnóstico , Febre Reumática/diagnóstico , Sedimentação Sanguínea , Criança , Coreia/etiologia , Ecocardiografia , Eritema , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Faringite/complicações , Prevalência , Febre Reumática/complicações , Febre Reumática/epidemiologia , Prevenção Secundária , Dermatopatias Genéticas
7.
Saudi Med J ; 42(4): 391-398, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33795494

RESUMO

OBJECTIVES: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. METHODS: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. CONCLUSION: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.


Assuntos
/fisiopatologia , Dor Abdominal/fisiopatologia , Adolescente , Asma/epidemiologia , Atrofia , Encéfalo/patologia , Bronquiolite Obliterante/epidemiologia , /epidemiologia , Criança , Pré-Escolar , Comorbidade , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Cardiopatias Congênitas/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Hidrocefalia/epidemiologia , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Faringite/fisiopatologia , Respiração Artificial , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Índice de Gravidade de Doença , Vômito/fisiopatologia
8.
Epidemiol Infect ; 149: e92, 2021 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-33814027

RESUMO

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.


Assuntos
Assistência Ambulatorial , /diagnóstico , Dor Abdominal/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Regras de Decisão Clínica , Tosse/fisiopatologia , Diarreia/fisiopatologia , Progressão da Doença , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Mialgia/fisiopatologia , Razão de Chances , Seleção de Pacientes , Faringite/fisiopatologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto Jovem
10.
Vestn Otorinolaringol ; 86(2): 85-89, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33929158

RESUMO

A description of a clinical case of oligosymptomatic pharyngitis associated with Neisseria gonorrhoeae is presented. On the example of oligosymptomatic localized gonococcal pharyngitis in a sexually active young man, included in the risk group for extragenital forms of sexually transmitted infections, an advantage has been shown molecular biological diagnostic method. Study of the spectrum of microflora of the oropharynx and urethra with assessment sensitivity to antibacterial drugs of representatives of the genus Neisseria isolated during mixed infection oropharynx, demonstrated that non-pathogenic Neisseria species are resistant to cephalosporins III-IV generations. Unrecognized forms of oropharyngeal gonococcal infection, as a consequence of the complications of clinical and diagnostic identification when patients refer to an otolaryngologist or dermatovenerologist, can serve a reservoir of resistant N. gonorrhoeae and a source of intractable gonococcal infection.


Assuntos
Gonorreia , Faringite , Antibacterianos/uso terapêutico , Cefalosporinas , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Masculino , Neisseria gonorrhoeae , Faringite/diagnóstico , Faringite/tratamento farmacológico
11.
Anaesth Intensive Care ; 49(2): 133-139, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33832336

RESUMO

Published reports of uvular necrosis are uncommon and it is possibly an under-reported complication of oropharyngeal manipulation. Uvular necrosis is thought to develop due to ischaemia secondary to mechanical compression of the uvula from oropharyngeal devices. Patients typically present with symptoms of a sore throat within 48 hours postoperatively. It is unclear whether there are any preventable factors, or any specific management strategies that might reduce this complication. Treatment is most commonly conservative management, including observation and simple analgesia. We present 13 cases of uvular injury that were reported to a web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand. While the postoperative findings varied, sore throat was the most frequent symptom. Most of the cases resolved spontaneously; the remainder with supportive treatment only. The findings suggest that patients who sustain a uvular injury can be reassured, but they should be advised to seek review early if sore throat persists or any difficulty with breathing develops.


Assuntos
Anestesia , Máscaras Laríngeas , Faringite , Austrália , Humanos , Doença Iatrogênica , Internet , Necrose/etiologia , Nova Zelândia , Faringite/etiologia , Complicações Pós-Operatórias , Gestão de Riscos , Úvula
12.
Cochrane Database Syst Rev ; 3: CD004406, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33728634

RESUMO

BACKGROUND: Antibiotics provide only modest benefit in treating sore throat, although their effectiveness increases in people with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. This is an update of a review first published in 2010, and updated in 2013, 2016, and 2020. OBJECTIVES: To assess the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing clinical relapse (i.e. recurrence of symptoms after initial resolution); and (d) preventing complications (suppurative complications, acute rheumatic fever, post-streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk-benefit of antibiotic treatment for streptococcal pharyngitis. SEARCH METHODS: We searched the following databases up to 3 September 2020: CENTRAL (2020, Issue 8), MEDLINE Ovid (from 1946), Embase Elsevier (from 1974), and Web of Science Thomson Reuters (from 2010). We also searched clinical trial registers on 3 September 2020. SELECTION CRITERIA: Randomised, double-blind trials comparing different antibiotics, and reporting at least one of the following: clinical cure, clinical relapse, or complications and/or adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently screened trials for inclusion and extracted data using standard methodological procedures as recommended by Cochrane. We assessed the risk of bias of included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions, and used the GRADE approach to assess the overall certainty of the evidence for the outcomes. We have reported the intention-to-treat analysis, and also performed an analysis of evaluable participants to explore the robustness of the intention-to-treat results. MAIN RESULTS: We included 19 trials reported in 18 publications (5839 randomised participants): six trials compared penicillin with cephalosporins; six compared penicillin with macrolides; three compared penicillin with carbacephem; one compared penicillin with sulphonamides; one compared clindamycin with ampicillin; and one compared azithromycin with amoxicillin in children. All participants had confirmed acute GABHS tonsillopharyngitis, and ages ranged from one month to 80 years. Nine trials included only, or predominantly, children. Most trials were conducted in an outpatient setting. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. We downgraded the certainty of the evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both; heterogeneity; and wide confidence intervals. Cephalosporins versus penicillin We are uncertain if there is a difference in symptom resolution (at 2 to 15 days) for cephalosporins versus penicillin (odds ratio (OR) for absence of symptom resolution 0.79, 95% confidence interval (CI) 0.55 to 1.12; 5 trials; 2018 participants; low-certainty evidence). Results of the sensitivity analysis of evaluable participants differed (OR 0.51, 95% CI 0.27 to 0.97; 5 trials; 1660 participants; very low-certainty evidence). We are uncertain if clinical relapse may be lower for cephalosporins compared with penicillin (OR 0.55, 95% CI 0.30 to 0.99; number needed to treat for an additional beneficial outcome (NNTB) 50; 4 trials; 1386 participants; low-certainty evidence). Very low-certainty evidence showed no difference in reported adverse events. Macrolides versus penicillin We are uncertain if there is a difference between macrolides and penicillin for resolution of symptoms (OR 1.11, 95% CI 0.92 to 1.35; 6 trials; 1728 participants; low-certainty evidence). Sensitivity analysis of evaluable participants resulted in an OR of 0.79, 95% CI 0.57 to 1.09; 6 trials; 1159 participants). We are uncertain if clinical relapse may be different (OR 1.21, 95% CI 0.48 to 3.03; 6 trials; 802 participants; low-certainty evidence).  Azithromycin versus amoxicillin Based on one unpublished trial in children, we are uncertain if resolution of symptoms is better with azithromycin in a single dose versus amoxicillin for 10 days (OR 0.76, 95% CI 0.55 to 1.05; 1 trial; 673 participants; very low-certainty evidence). Sensitivity analysis for per-protocol analysis resulted in an OR of 0.29, 95% CI 0.11 to 0.73; 1 trial; 482 participants; very low-certainty evidence). We are also uncertain if there was a difference in relapse between groups (OR 0.88, 95% CI 0.43 to 1.82; 1 trial; 422 participants; very low-certainty evidence). Adverse events were more common with azithromycin compared to amoxicillin (OR 2.67, 95% CI 1.78 to 3.99; 1 trial; 673 participants; very low-certainty evidence). Carbacephem versus penicillin There is low-certainty evidence that compared with penicillin, carbacephem may provide better symptom resolution post-treatment in adults and children (OR 0.70, 95% CI 0.49 to 0.99; NNTB 14.3; 3 trials; 795 participants). Studies did not report on long-term complications, so it was unclear if any class of antibiotics was better in preventing serious but rare complications.  AUTHORS' CONCLUSIONS: We are uncertain if there are clinically relevant differences in symptom resolution when comparing cephalosporins and macrolides with penicillin in the treatment of GABHS tonsillopharyngitis. Low-certainty evidence in children suggests that carbacephem may be more effective than penicillin for symptom resolution. There is insufficient evidence to draw conclusions regarding the other comparisons in this review. Data on complications were too scarce to draw conclusions. These results do not demonstrate that other antibiotics are more effective than penicillin in the treatment of GABHS pharyngitis. All studies were conducted in high-income countries with a low risk of streptococcal complications, so there is a need for trials in low-income countries and Aboriginal communities, where the risk of complications remains high.


Assuntos
Antibacterianos/uso terapêutico , Faringite/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/efeitos adversos , Amoxicilina/uso terapêutico , Ampicilina/efeitos adversos , Ampicilina/uso terapêutico , Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Azitromicina/uso terapêutico , Cefalosporinas/efeitos adversos , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Clindamicina/efeitos adversos , Clindamicina/uso terapêutico , Humanos , Lactente , Macrolídeos/efeitos adversos , Macrolídeos/uso terapêutico , Pessoa de Meia-Idade , Penicilinas/efeitos adversos , Penicilinas/uso terapêutico , Faringite/microbiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Estreptocócicas/microbiologia , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Adulto Jovem
13.
BMJ Case Rep ; 14(3)2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33753397

RESUMO

Spontaneous pharyngeal haematoma is a rare but life-threatening cause of acute upper airway obstruction, and the clinical manifestation may mimic haemoptysis. A 65-year-old man presented to our emergency department with symptoms of sore throat and haemoptysis. He had no medical history. At arrival, O2 saturation was 95% on 5 L/min of oxygen with a mask. Results of a blood examination including a coagulation test were normal. Laryngoscopy showed enlargement of the left pharynx and a narrowed airway. Contrast-enhanced CT showed extravascular leakage of contrast medium inside the left pharyngeal haematoma. Fortunately, the haematoma did not lead to airway obstruction, and it decreased spontaneously. We finally diagnosed this case as spontaneous pharyngeal haematoma. When we examine a patient with a symptom of haemoptysis accompanied by sore throat, it is necessary to consider pharyngeal haematoma and to prepare emergency airway protection for acute upper airway obstruction.


Assuntos
Obstrução das Vias Respiratórias , Faringite , Idoso , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Serviço Hospitalar de Emergência , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Faringite/complicações , Faringe
14.
JAMA Netw Open ; 4(3): e211085, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33688964

RESUMO

Importance: Solid estimates of the risk of developing symptoms and of progressing to critical disease in individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are key to interpreting coronavirus disease 2019 (COVID-19) dynamics, identifying the settings and the segments of the population where transmission is more likely to remain undetected, and defining effective control strategies. Objective: To estimate the association of age with the likelihood of developing symptoms and the association of age with the likelihood of progressing to critical illness after SARS-CoV-2 infection. Design, Setting, and Participants: This cohort study analyzed quarantined case contacts, identified between February 20 and April 16, 2020, in the Lombardy region of Italy. Contacts were monitored daily for symptoms and tested for SARS-CoV-2 infection, by either real-time reverse transcriptase-polymerase chain reaction using nasopharyngeal swabs or retrospectively via IgG serological assays. Close contacts of individuals with laboratory-confirmed COVID-19 were selected as those belonging to clusters (ie, groups of contacts associated with an index case) where all individuals were followed up for symptoms and tested for SARS-CoV-2 infection. Data were analyzed from February to June 2020. Exposure: Close contact with individuals with confirmed COVID-19 cases as identified by contact tracing operations. Main Outcomes and Measures: Age-specific estimates of the risk of developing respiratory symptoms or fever greater than or equal to 37.5 °C and of experiencing critical disease (defined as requiring intensive care or resulting in death) in SARS-CoV-2-infected case contacts. Results: In total, 5484 case contacts (median [interquartile range] age, 50 [30-61] years; 3086 female contacts [56.3%]) were analyzed, 2824 of whom (51.5%) tested positive for SARS-CoV-2 (median [interquartile range] age, 53 [34-64] years; 1604 female contacts [56.8%]). The proportion of infected persons who developed symptoms ranged from 18.1% (95% CI, 13.9%-22.9%) among participants younger than 20 years to 64.6% (95% CI, 56.6%-72.0%) for those aged 80 years or older. Most infected contacts (1948 of 2824 individuals [69.0%]) did not develop respiratory symptoms or fever greater than or equal to 37.5 °C. Only 26.1% (95% CI, 24.1%-28.2%) of infected individuals younger than 60 years developed respiratory symptoms or fever greater than or equal to 37.5 °C; among infected participants older than 60 years, 6.6% (95% CI, 5.1%-8.3%) developed critical disease. Female patients were 52.7% (95% CI, 24.4%-70.7%) less likely than male patients to develop critical disease after SARS-CoV-2 infection. Conclusions and Relevance: In this Italian cohort study of close contacts of patients with confirmed SARS-CoV-2 infection, more than one-half of individuals tested positive for the virus. However, most infected individuals did not develop respiratory symptoms or fever. The low proportion of children and young adults who developed symptoms highlights the possible challenges in readily identifying SARS-CoV-2 infections.


Assuntos
/fisiopatologia , Portador Sadio/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Febre/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , /epidemiologia , Dor no Peito/epidemiologia , Dor no Peito/fisiopatologia , Criança , Pré-Escolar , Busca de Comunicante , Tosse/fisiopatologia , Estado Terminal , Progressão da Doença , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Faringite/epidemiologia , Faringite/fisiopatologia , Quarentena , Fatores de Risco , Índice de Gravidade de Doença , Taquipneia/epidemiologia , Taquipneia/fisiopatologia , Adulto Jovem
16.
J Med Case Rep ; 15(1): 171, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771221

RESUMO

BACKGROUND: The pandemic of this century has overwhelmed the healthcare systems of affected countries, and all resources have been diverted to coronavirus disease 2019. At the onset, coronavirus disease 2019 can present as any other acute febrile undifferentiated illness. In tropical regions, clinicians are increasingly challenged to differentiate these febrile illnesses without the use of diagnostics. With this pandemic, many of these tropical diseases are neglected and go underreported. Dengue is holoendemic in the Maldives, and dengue viruses circulate throughout the year. Reports about coinfections with dengue virus and severe acute respiratory syndrome coronavirus 2 are scarce, and the outcome and the dynamics of the disease may be altered in the presence of coinfection. We have described the clinical manifestation and serial laboratory profile, and highlighted the atypical findings uncommon in dengue infection. CASE PRESENTATION: Case 1 was a 39-year old Asian male, presented on day 6 of dengue infection with warning signs. Reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 that was done as per hospital protocol was found to be positive. Case 2 was a 38-year old Asian male, was admitted on day 5 of illness with symptoms of acute respiratory infection with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2. Evaluation of progressive leukopenia and thrombocytopenia showed positive dengue serology. CONCLUSION: Clinicians must be conscientious when working on the differential diagnosis of possible tropical diseases in cases of coronavirus disease 2019, specifically, when patients develop hemoconcentration, thrombocytopenia, and transaminitis with elevated expression of aspartate higher than alanine transaminase, which is frequently observed in dengue infection. Caution must be taken during the administration of intravenous fluids when treating patients with coronavirus disease 2019 and dengue coinfection, as coronavirus disease 2019 patients are more prone to develop pulmonary edema. Timely diagnosis and appropriate management are essential to avoid the devastating complications of severe forms of dengue infection. It is important to repeat and reconfirm the dengue serology in coronavirus disease 2019 patients to avoid false positivity. Diligence and care must be taken not to neglect other endemic tropical diseases in the region during the present pandemic.


Assuntos
/complicações , Dengue/complicações , Leucopenia/sangue , Trombocitopenia/sangue , Dor Abdominal/fisiopatologia , Adulto , /sangue , Coinfecção , Tosse/fisiopatologia , Dengue/sangue , Dengue/fisiopatologia , Dengue/terapia , Diarreia/fisiopatologia , Disgeusia/fisiopatologia , Febre/fisiopatologia , Hidratação , Cefaleia/fisiopatologia , Humanos , Masculino , Mialgia/fisiopatologia , Faringite/fisiopatologia , Vômito/fisiopatologia
17.
PLoS One ; 16(3): e0247773, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33705435

RESUMO

BACKGROUND: The coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant morbidities, severe acute respiratory failures and subsequently emergency departments' (EDs) overcrowding in a context of insufficient laboratory testing capacities. The development of decision support tools for real-time clinical diagnosis of COVID-19 is of prime importance to assist patients' triage and allocate resources for patients at risk. METHODS AND PRINCIPAL FINDINGS: From March 2 to June 15, 2020, clinical patterns of COVID-19 suspected patients at admission to the EDs of Liège University Hospital, consisting in the recording of eleven symptoms (i.e. dyspnoea, chest pain, rhinorrhoea, sore throat, dry cough, wet cough, diarrhoea, headache, myalgia, fever and anosmia) plus age and gender, were investigated during the first COVID-19 pandemic wave. Indeed, 573 SARS-CoV-2 cases confirmed by qRT-PCR before mid-June 2020, and 1579 suspected cases that were subsequently determined to be qRT-PCR negative for the detection of SARS-CoV-2 were enrolled in this study. Using multivariate binary logistic regression, two most relevant symptoms of COVID-19 were identified in addition of the age of the patient, i.e. fever (odds ratio [OR] = 3.66; 95% CI: 2.97-4.50), dry cough (OR = 1.71; 95% CI: 1.39-2.12), and patients older than 56.5 y (OR = 2.07; 95% CI: 1.67-2.58). Two additional symptoms (chest pain and sore throat) appeared significantly less associated to the confirmed COVID-19 cases with the same OR = 0.73 (95% CI: 0.56-0.94). An overall pondered (by OR) score (OPS) was calculated using all significant predictors. A receiver operating characteristic (ROC) curve was generated and the area under the ROC curve was 0.71 (95% CI: 0.68-0.73) rendering the use of the OPS to discriminate COVID-19 confirmed and unconfirmed patients. The main predictors were confirmed using both sensitivity analysis and classification tree analysis. Interestingly, a significant negative correlation was observed between the OPS and the cycle threshold (Ct values) of the qRT-PCR. CONCLUSION AND MAIN SIGNIFICANCE: The proposed approach allows for the use of an interactive and adaptive clinical decision support tool. Using the clinical algorithm developed, a web-based user-interface was created to help nurses and clinicians from EDs with the triage of patients during the second COVID-19 wave.


Assuntos
/diagnóstico , Sistemas de Apoio a Decisões Clínicas , Adulto , Idoso , Tosse/diagnóstico , Dispneia/diagnóstico , Feminino , Febre/diagnóstico , Cefaleia/diagnóstico , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Faringite/diagnóstico , /isolamento & purificação
18.
Acute Med ; 20(1): 78-82, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33749697

RESUMO

We present the case of a previously healthy, immunocompetent male with Lemierre's Syndrome. He presented with headache, sore throat and pyrexia. Initial blood tests revealed raised inflammatory markers and electrolyte abnormalities. Blood cultured Fusobacterium necrophorum. He developed respiratory distress and imaging confirmed lung abscess and empyema due to septic emboli. He required surgical drainage and a prolonged course of antibiotics. This case highlights the rare, but life-threatening condition of Lemierre's Syndrome. We discuss the importance of prompt recognition and early antibiotic therapy.


Assuntos
Síndrome de Lemierre , Faringite , Sepse , Antibacterianos/uso terapêutico , Fusobacterium necrophorum , Humanos , Síndrome de Lemierre/complicações , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/tratamento farmacológico , Masculino , Faringite/tratamento farmacológico , Faringite/etiologia , Sepse/tratamento farmacológico
20.
Zhen Ci Yan Jiu ; 46(2): 164-7, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33788439

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) intervention on postoperative sore throat (POST) and postoperative nausea and vomiting (PONV) after endotracheal intubation and general anesthesia. METHODS: According to the random number table, 60 patients of gastrointestinal surgery under general anesthesia with tracheal intubation were randomly divided into EA group (30 cases) and control group (30 cases). Patients in the EA group were given acupuncture at Shaoshang (LU11) 30 minutes before general anesthesia, and EA at Chize (LU5) and Hegu (LI4) continued until the operation was completed. The incidence and severity of POST and visual analogue scale (VAS) score at 12, 24, and 48 h after surgery, and the incidence and severity of PONV at 12, 24 h after surgery were analyzed, respectively. RESULTS: The incidence and severity of POST and PONV, and VAS score in the EA group were significantly lower than those in the control group 12 h and 24 h after surgery (P<0.05). Both groups had significant reductions in VAS score at 24 h and 48 h after surgery compared with that at 12 h (P<0.05). CONCLUSION: EA can significantly improve the prognosis of patients on sore throat and reduce the incidence of PONV.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Eletroacupuntura , Faringite , Humanos , Náusea , Faringite/etiologia , Faringite/terapia , Vômito
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