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1.
Rev Paul Pediatr ; 39: e2020217, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876096

RESUMO

OBJECTIVE: To analyze the current scientific literature to document, in an integrative review, the main findings that correlate Kawasaki disease (KD) to COVID-19. DATA SOURCES: The search was carried out in June 2020 in the following databases: Biblioteca Virtual em Saúde (BVS), periódico da CAPES and U.S National Library of Medicine (PubMed). The combination of descriptors used was [(COVID-19 OR SARS-CoV-2) AND (Kawasaki disease)], and the inclusion criteria stipulated were studies published from January 2019 to June 2020, without restriction of language or location, and available online in full. News, editorials, comments, and letters, as well as duplicates and articles that did not answer the guiding question were excluded. DATA SYNTHESIS: A total of 97 articles were identified, of which seven comprised this review. The association of KD to the new coronavirus appears to trigger a severe clinical condition of vasculitis. Different from the usual, in this inflammatory syndrome, patients are older, and prevalence is higher in children from African or Caribbean ancestry; clinical and laboratory manifestations are also atypical, with a predominance of abdominal complaints and exaggerated elevation of inflammatory markers. In addition, there was a greater report of rare complications and greater resistance to the recommended treatment for KD. CONCLUSIONS: Pediatric COVID-19 and its potential association to severe KD, still unfamiliar to health professionals, reinforces the importance of testing patients with vasculitis for the new coronavirus and the need to wage high surveillance and preparation of the health system during the current pandemic.


Assuntos
Infecções por Coronavirus , Síndrome de Linfonodos Mucocutâneos , Pandemias , Pneumonia Viral , Síndrome de Resposta Inflamatória Sistêmica/virologia , Betacoronavirus/isolamento & purificação , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Gerenciamento Clínico , Humanos , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia , Síndrome de Linfonodos Mucocutâneos/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia
2.
Acta Biomed ; 91(11-S): e2020004, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-33004774

RESUMO

Italy is one of the most exposed countries worldwide to COVID-19, and Lombardy is the most affected region in Italy. In this context, Fondazione IRCCS Policlinico San Matteo in Pavia, one of the largest University hospitals in the region, has been involved in the management of the outbreak since its inception. Immediately after the communication of the first Italian COVID-19+ patient, the Pediatric Unit has been completely reorganized to face the approaching outbreak. The optimization of the Pediatric Unit resources for COVID-19 emergency is reported as an example to safely preserve health activity during the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Serviço Hospitalar de Emergência/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , Pneumonia Viral/epidemiologia , Criança , Infecções por Coronavirus/terapia , Humanos , Itália/epidemiologia , Pandemias , Pneumonia Viral/terapia
3.
Acta Med Indones ; 52(3): 306-313, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33020343

RESUMO

Cytokine storm in COVID-19 infection is an excessive immune response to external stimuli where the pathogenesis is complex. The disease progresses rapidly and the mortality is high. Certain evidence shows that the severe deterioration of some patients has been closely related to the strong upregulation of cytokine production in SARS-Co-V2 induced pneumonia with an associated cytokine storm syndrome. Identification of existing approaved therapy with proven safety profile to treat hyperinflammation is critical unmet need in order to reduce COVID-19 associated mortality. To date, no specific therapeutic drugs are available to treat COVID-19 infection. Preliminary studies have shown that immune-modulatory or immune suppressive treatments might be considered as treatment choices for COVID-19, particularly in severe disease. This article review the pathogenesis and treatment strategies of COVID-19 virus-induced inflammatory storm in attempt to provide valuable medication guidance for clinical treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/imunologia , Citocinas/sangue , Gerenciamento Clínico , Imunidade Inata , Pandemias , Pneumonia Viral/imunologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Citocinas/imunologia , Humanos , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia
4.
Clin Appl Thromb Hemost ; 26: 1076029620955240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32873056

RESUMO

The management of sickle cell disease (SCD) and its complications in the COVID-19 era is very challenging. The recurrent sickling process in SCD causes tissue hypoxemia and micro-infarcts, resulting in end organ damage. Since the outbreak of SARS-CoV-2 pandemic, little data has been published about SCD concerning clinical presentation with COVID-19 and management. Hydroxyurea has been the cornerstone of management in children and adults with SCD, with evidence of its effect on controlling end organ damage. There are several anti-sickling drugs that have been approved recently that might have an additive value toward the management of SCD and its complications. The role of simple and exchange transfusions is well established and should always be considered in the management of various complications. The value of convalescent plasma has been demonstrated in small case series, but large randomized controlled studies are still awaited. Immunomodulatory agents may play a role in reducing the damaging effects of cytokines storm that contributes to the morbidity and mortality in advanced cases. Prophylactic anticoagulation should be considered in every management protocol because SCD and COVID-19 are thrombogenic conditions. Management proposals of different presentations of patients with SCD and COVID-19 are outlined.


Assuntos
Anemia Falciforme/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Hidroxiureia/administração & dosagem , Controle de Infecções/métodos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Anemia Falciforme/diagnóstico , Anemia Falciforme/epidemiologia , Infecções por Coronavirus/prevenção & controle , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Resultado do Tratamento
6.
Br J Surg ; 107(10): 1245-1249, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32880908

RESUMO

The battle of COVID-19 is currently at different levels of intensity in each country and even each city. The authors have prepared succinct recommendations regarding the care of patients with breast cancer, divided into phases that can easily be adapted to each units' needs and resources, and stepped up or stepped down according to escalating and de-escalating circumstances. The structure can also be transposed easily to different cancer types, enabling continued provision of best standards of care despite unprecedented stressors. Surgery must go on.


Assuntos
Betacoronavirus , Neoplasias da Mama/complicações , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Assistência de Longa Duração/métodos , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Neoplasias da Mama/terapia , Infecções por Coronavirus/complicações , Feminino , Humanos , Pandemias , Pneumonia Viral/complicações
9.
Pediatr Clin North Am ; 67(5): 811-819, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888683

RESUMO

Treatment of Kawasaki disease (KD) with intravenous immunoglobulin (IVIG) administered within the initial 10 days of fever onset decreases the risk of coronary artery aneurysms (CAAs) from ∼ 25% to less than 5%. However, patients with IVIG resistance, young infants, men, highly inflamed patients, and/or those with coronary changes at diagnosis remain at high risk for CAA. High-risk patients may benefit from acute, adjunctive antiinflammatory treatment in addition to IVIG. Optimal therapy remains unknown. This article reviews the acute pharmacologic management of patients with KD, focusing on adjunctive primary therapy options and treatment of patients with IVIG resistance.


Assuntos
Anti-Inflamatórios/uso terapêutico , Gerenciamento Clínico , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/terapia , Criança , Humanos , Resultado do Tratamento
10.
Pediatr Clin North Am ; 67(5): 843-853, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888685

RESUMO

Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment.


Assuntos
Gerenciamento Clínico , Programas de Rastreamento/métodos , Cardiopatia Reumática , Criança , Progressão da Doença , Ecocardiografia , Saúde Global , Humanos , Morbidade , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia
11.
Pediatr Clin North Am ; 67(5): 855-874, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888686

RESUMO

Myocarditis in the pediatric population can be a challenging diagnosis to make and often requires utilization of multiple diagnostic modalities. The cause is often due to a viral infection with activation of the innate and acquired immune response with either recovery or disease progression. Laboratory testing often includes inflammatory markers, cardiac troponin levels, and natriuretic peptides. Noninvasive testing should include electrocardiogram, echocardiogram, and possibly an MRI. Treatment of myocarditis remains controversial with most providers using immune modulators with intravenous immunoglobulin and corticosteroids.


Assuntos
Gerenciamento Clínico , Miocardite/diagnóstico , Criança , Diagnóstico Diferencial , Progressão da Doença , Saúde Global , Humanos , Incidência , Miocardite/epidemiologia , Miocardite/terapia
12.
Pediatr Clin North Am ; 67(5): 875-888, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888687

RESUMO

This article presents updates and an overview of pediatric infective endocarditis. It includes a discussion of presentation of illness, diagnosis of this disorder, differential diagnosis, treatment recommendation, and associated morbidity and mortality.


Assuntos
Antibacterianos/uso terapêutico , Gerenciamento Clínico , Ecocardiografia/métodos , Endocardite/diagnóstico , Criança , Endocardite/tratamento farmacológico , Humanos , Prognóstico
13.
Pediatr Clin North Am ; 67(5): 923-944, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888690

RESUMO

Although progress had been made in reducing cardiovascular disease (CVD) mortality, the positive trend has reversed in recent years, and CVD remains the most common cause of mortality in US women and men. Youth represent the future of CVD prevention; emerging evidence suggests exposure to risk factors in children contributes to atherosclerosis and results in vascular changes and increased CVD events. The contributors to CVD include those commonly seen in adults. This article reviews hypercholesterolemia, hypertension, obesity, diabetes, and smoking. It discusses the prevalence of each disease, diagnosis, treatment, and cardiovascular complications.


Assuntos
Cardiologia/métodos , Doenças Cardiovasculares/prevenção & controle , Gerenciamento Clínico , Medicina Preventiva/métodos , Criança , Humanos
14.
J Am Med Dir Assoc ; 21(10): 1365-1370.e7, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32981662

RESUMO

During the first few months of the coronavirus disease 2019 (COVID-19) pandemic, Canadian nursing homes implemented strict no-visitor policies to reduce the risk of introducing COVID-19 in these settings. There are now growing concerns that the risks associated with restricted access to family caregivers and visitors have started to outweigh the potential benefits associated with preventing COVID-19 infections. Many residents have sustained severe and potentially irreversible physical, functional, cognitive, and mental health declines. As Canada emerges from its first wave of the pandemic, nursing homes across the country have cautiously started to reopen these settings, yet there is broad criticism that emerging visitor policies are overly restrictive, inequitable, and potentially harmful. We reviewed the nursing home visitor policies for Canada's 10 provinces and 3 territories as well as international policies and reports on the topic to develop 10 provi-informed, data-driven, and expert-reviewed guidance for the re-opening of Canadian nursing homes to family caregivers and visitors.


Assuntos
Infecções por Coronavirus/prevenção & controle , Solidão/psicologia , Casas de Saúde/organização & administração , Pandemias/prevenção & controle , Segurança do Paciente/normas , Pneumonia Viral/prevenção & controle , Isolamento Social/psicologia , Envelhecimento/psicologia , Betacoronavirus , Canadá , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Política de Saúde , Humanos , Pneumonia Viral/epidemiologia
18.
World J Gastroenterol ; 26(32): 4753-4762, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32921955

RESUMO

The outbreak of novel coronavirus disease 2019 (COVID-19) has resulted in global emergence. With the expansion of related research, in addition to respiratory symptoms, digestive system involvement such as nausea, vomiting, and diarrhea have also been reported with COVID-19. Besides, abnormal liver function is also frequent in biochemical tests of COVID-19 patients, which is correlated with the severity and mortality of the disease course. The etiology of liver injury in patients with COVID-19 might include viral immunologic injury, drug-induced liver injury, the systemic inflammatory response, hypoxic hepatitis, and the exacerbation of preexisting liver disease. Although liver injuries in COVID-19 are often transient and reversible, health workers need to pay attention to preexisting liver disease, monitor liver function, strengthen supportive treatment, and reduce the chance of drug-induced liver injury. This article reviews the epidemiological characteristics, etiology, management, and preventive strategies for liver injury in patients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Hepatopatias/virologia , Pneumonia Viral/complicações , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Feminino , Humanos , Fígado/virologia , Hepatopatias/epidemiologia , Testes de Função Hepática , Masculino , Pandemias , Pneumonia Viral/virologia
19.
Acta Biomed ; 91(3): e2020028, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921723

RESUMO

This article reviews the current knowledges of congenital bleeding disorders (CBD) amid the COVID-19 pandemic. It appears that CBD is not associated with higher risk of getting COVID-19 and so the prevalence of COVID-19 among them seems not higher compared to the general population. In absence of specific therapeutic recommendations, it is essential to make a correct assessment of the risk of haemorrhage/thrombosis. Based on expert opinion, strategies for outpatient management include adherence to prescribed regimens, telemedicine, and communication about COVID-19 in patients with CBD. More data should be also collected to better characterize the impact of COVID-19 on patients with CBD. The current findings encourage further studies to determine the prevalence of SARS-CoV2 infection in CBD patients to understand more fully the burden of this novel pathogen and to develop adequate preventive measures against this infection.


Assuntos
Betacoronavirus , Transtornos Herdados da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Guias como Assunto , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Transtornos Herdados da Coagulação Sanguínea/terapia , Humanos , Pacientes Ambulatoriais
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