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2.
Medicine (Baltimore) ; 99(41): e22386, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031274

RESUMO

BACKGROUND: This study will assess the efficacy and safety of ventilator for the management of severe pneumonia (SP). METHODS: This study will search the following electronic databases in MEDLINE, EMBASE, Web of Science, PsycINFO, Cochrane Library, CNKI, and Scopus from the beginning to present without language restrictions. Two authors will screen all records according to the eligibility criteria; assess study quality; and extract all essential data from eligible studies. If sufficient studies are included, we will pool the extracted data and carry out meta-analysis. RESULTS: This study will summarize published studies to assess the efficacy and safety of ventilator for patients with SP. CONCLUSION: The results of this study may supply a genuine understanding of perspective from a scientific basis on ventilator for the management of patients with SP.


Assuntos
Pneumonia/terapia , Respiração Artificial , Ventiladores Mecânicos , Humanos , Gravidade do Paciente , Projetos de Pesquisa , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Revisões Sistemáticas como Assunto , Ventiladores Mecânicos/efeitos adversos
5.
JAMA ; 324(11): 1048-1057, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32821939

RESUMO

Importance: Remdesivir demonstrated clinical benefit in a placebo-controlled trial in patients with severe coronavirus disease 2019 (COVID-19), but its effect in patients with moderate disease is unknown. Objective: To determine the efficacy of 5 or 10 days of remdesivir treatment compared with standard care on clinical status on day 11 after initiation of treatment. Design, Setting, and Participants: Randomized, open-label trial of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and moderate COVID-19 pneumonia (pulmonary infiltrates and room-air oxygen saturation >94%) enrolled from March 15 through April 18, 2020, at 105 hospitals in the United States, Europe, and Asia. The date of final follow-up was May 20, 2020. Interventions: Patients were randomized in a 1:1:1 ratio to receive a 10-day course of remdesivir (n = 197), a 5-day course of remdesivir (n = 199), or standard care (n = 200). Remdesivir was dosed intravenously at 200 mg on day 1 followed by 100 mg/d. Main Outcomes and Measures: The primary end point was clinical status on day 11 on a 7-point ordinal scale ranging from death (category 1) to discharged (category 7). Differences between remdesivir treatment groups and standard care were calculated using proportional odds models and expressed as odds ratios. An odds ratio greater than 1 indicates difference in clinical status distribution toward category 7 for the remdesivir group vs the standard care group. Results: Among 596 patients who were randomized, 584 began the study and received remdesivir or continued standard care (median age, 57 [interquartile range, 46-66] years; 227 [39%] women; 56% had cardiovascular disease, 42% hypertension, and 40% diabetes), and 533 (91%) completed the trial. Median length of treatment was 5 days for patients in the 5-day remdesivir group and 6 days for patients in the 10-day remdesivir group. On day 11, patients in the 5-day remdesivir group had statistically significantly higher odds of a better clinical status distribution than those receiving standard care (odds ratio, 1.65; 95% CI, 1.09-2.48; P = .02). The clinical status distribution on day 11 between the 10-day remdesivir and standard care groups was not significantly different (P = .18 by Wilcoxon rank sum test). By day 28, 9 patients had died: 2 (1%) in the 5-day remdesivir group, 3 (2%) in the 10-day remdesivir group, and 4 (2%) in the standard care group. Nausea (10% vs 3%), hypokalemia (6% vs 2%), and headache (5% vs 3%) were more frequent among remdesivir-treated patients compared with standard care. Conclusions and Relevance: Among patients with moderate COVID-19, those randomized to a 10-day course of remdesivir did not have a statistically significant difference in clinical status compared with standard care at 11 days after initiation of treatment. Patients randomized to a 5-day course of remdesivir had a statistically significant difference in clinical status compared with standard care, but the difference was of uncertain clinical importance. Trial Registration: ClinicalTrials.gov Identifier: NCT04292730.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/uso terapêutico , Administração Intravenosa , Idoso , Alanina/administração & dosagem , Alanina/efeitos adversos , Alanina/uso terapêutico , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Infecções por Coronavirus/mortalidade , Esquema de Medicação , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Gravidade do Paciente , Pneumonia Viral/mortalidade , Resultado do Tratamento
6.
J Infect Dis ; 222(9): 1452-1461, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32766833

RESUMO

BACKGROUND: The COVID-19 pandemic necessitates better understanding of the kinetics of antibody production induced by infection with SARS-CoV-2. We aimed to develop a high-throughput multiplex assay to detect antibodies to SARS-CoV-2 to assess immunity to the virus in the general population. METHODS: Spike protein subunits S1 and receptor binding domain, and nucleoprotein were coupled to microspheres. Sera collected before emergence of SARS-CoV-2 (n = 224) and of non-SARS-CoV-2 influenza-like illness (n = 184), and laboratory-confirmed cases of SARS-CoV-2 infection (n = 115) with various severities of COVID-19 were tested for SARS-CoV-2-specific IgG concentrations. RESULTS: Our assay discriminated SARS-CoV-2-induced antibodies and those induced by other viruses. The assay specificity was 95.1%-99.0% with sensitivity 83.6%-95.7%. By merging the test results for all 3 antigens a specificity of 100% was achieved with a sensitivity of at least 90%. Hospitalized COVID-19 patients developed higher IgG concentrations and the rate of IgG production increased faster compared to nonhospitalized cases. CONCLUSIONS: The bead-based serological assay for quantitation of SARS-CoV-2-specific antibodies proved to be robust and can be conducted in many laboratories. We demonstrated that testing of antibodies against multiple antigens increases sensitivity and specificity compared to single-antigen-specific IgG determination.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Imunoglobulina G/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Imunidade Adaptativa , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Casos e Controles , Feminino , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Proteínas Nucleares/imunologia , Gravidade do Paciente , Curva ROC , Soroconversão , Estudos Soroepidemiológicos , Glicoproteína da Espícula de Coronavírus/imunologia
8.
J Infect Public Health ; 13(9): 1224-1228, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32622796

RESUMO

BACKGROUND: The aim of this study was to investigate the performance and predictive value of hypocalcemia in severe COVID-19 patients. METHODS: We retrospectively investigated the clinical and laboratory characteristics of severe COVID-19 patients. 107 patients were divided into hypocalcemia group and normal serum calcium group. The clinical and laboratory data were compared between two groups. The discriminative power of hypocalcemia regarding poor outcome were evaluated by receiver operating curves (ROC) analyses. RESULTS: Sixty seven patients (62.6%) had hypocalcemia. In hypocalcemia group, leukocytes, c-reactive protein (CRP), procalcitonin (PCT), Interleukin 6 (IL-6), and D-dimer levels was higher, while lymphocytes and albumin (ALB) levels was lower. No significant difference was identified in gender, age, signs and symptoms, comorbidities and other laboratory indicators. Serum calcium levels were negatively correlated with leukocytes, CRP, PCT, IL-6 and D-dimer, while positively correlated with lymphocytes and ALB. Patients with hypocalcemia more commonly presented poor outcome (47.8% (32/67) vs 25% (10/40), p=0.02). Median serum calcium levels were significantly lower in the patients with poor outcome (2.01(1.97-2.05) vs 2.10(2.03-2.20), p<0.001), and it could predict the prognosis with an area under the ROC curve (AUC) of 0.73(95% confidence interval (CI) 0.63-0.83, p<0.001). CONCLUSIONS: Hypocalcemia commonly occurred in severe COVID-19 patients and it was associated with poor outcome.


Assuntos
Cálcio/sangue , Infecções por Coronavirus/sangue , Hipocalcemia/sangue , Gravidade do Paciente , Pneumonia Viral/sangue , Idoso , Betacoronavirus , Proteína C-Reativa/metabolismo , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Interleucina-6/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Pandemias , Valor Preditivo dos Testes , Pró-Calcitonina/sangue , Prognóstico , Curva ROC , Estudos Retrospectivos , Albumina Sérica/metabolismo
9.
Iran J Kidney Dis ; 14(4): 267-277, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32655021

RESUMO

INTRODUCTION: In this study, we aimed to evaluate the presentation and outcome of COVID-19 in patients with chronic kidney disease (CKD). METHODS: We included 43 patients with a past history of CKD and confirmed diagnosis of COVID-19. Patients were evaluated for demographic characteristics, clinical and laboratory data and findings of initial chest computed tomography (CT) and were followed until either death or discharge occurred. Then, study variables were compared based on final outcome and stage of CKD. RESULTS: Mean age ± SD of patients was 60.65 ± 14.36 years; 65.1% were male. Five of 43 patients (11.6%) died on follow-up and the rest were discharged. Disease outcome did not differ across CKD stages (P > .05). More than half of the patients (58.1%) presented with severe disease on admission. Clinical symptoms were similar to those of non-CKD individuals. Mean duration of hospitalization was higher in those who died, although not significant (16.6 ± 8.38 vs. 11 ± 6.26, P > .05). The only hematologic parameter that significantly differed between survivors and non-survivors was lactase dehydrogenase level (P < .05). Ground-glass opacification and reticular pattern were the most frequent patterns on CT and pleural effusion existed in about one-fifth of all patients. A greater lower zone score was noted in deceased patients (P < .05). CONCLUSION: Patients with CKD are vulnerable to a more severe form of COVID-19 and experience a higher mortality rate than the general population; however, higher CKD stage is not related to worse prognosis or different imaging manifestation compared with lower stage.


Assuntos
Infecções por Coronavirus , Pandemias , Derrame Pleural , Pneumonia Viral , Radiografia Torácica/métodos , Insuficiência Renal Crônica , Tomografia Computadorizada por Raios X/métodos , Idoso , Betacoronavirus/isolamento & purificação , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Irã (Geográfico)/epidemiologia , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Índice de Gravidade de Doença , Análise de Sobrevida
10.
Emerg Infect Dis ; 26(10): 2504-2506, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32610036

RESUMO

Coronavirus disease is reported to affect the cardiovascular system. We showed that relative bradycardia was a common characteristic for 54 patients with PCR-confirmed mild-to-moderate coronavirus disease in Japan. This clinical sign could help clinicians to diagnose this disease.


Assuntos
Temperatura Corporal , Bradicardia/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Frequência Cardíaca , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pandemias , Gravidade do Paciente , Pneumonia Viral/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
11.
Emerg Infect Dis ; 26(10): 2473-2476, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32639228

RESUMO

Sickle cell disease (SCD) disproportionately affects Black or African American persons in the United States and can cause multisystem organ damage and reduced lifespan. Among 178 persons with SCD in the United States who were reported to an SCD-coronavirus disease case registry, 122 (69%) were hospitalized and 13 (7%) died.


Assuntos
Anemia Falciforme/epidemiologia , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Infecções Assintomáticas/epidemiologia , Betacoronavirus , Criança , Pré-Escolar , Comorbidade , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias , Gravidade do Paciente , Pneumonia Viral/mortalidade , Sistema de Registros , Estados Unidos/epidemiologia , Adulto Jovem
12.
Washington; Organización Panamericana de la Salud; 2020; 20200729. 115 p.
Monografia em Inglês, Espanhol | BIGG | ID: biblio-1116760

RESUMO

Esta guía de práctica clínica provee recomendaciones informadas por la evidencia para la identificación de marcadores y factores de riesgo de mortalidad de los pacientes críticos, control de la infección, recolección de muestras, cuidado de soporte (ventilatorio y hemodinámico), tratamiento farmacológico, rehabilitación temprana, uso de imágenes diagnósticas, prevención de complicaciones y criterios de egreso. Las recomendaciones están dirigidas a todo el personal de salud que atiende a los pacientes en el servicio de urgencias y de emergencias y la unidad de cuidados intensivos (médicos especialistas en medicina de urgencias, neumología, medicina intensiva, medicina interna, anestesiología, infectología, terapistas respiratorios, terapistas físicos, enfermeras y químicos farmacéuticos). La guía está elaborada para su uso por tomadores de decisiones y miembros de entidades gubernamentales relacionados con el manejo de pacientes con COVID-19 en las UCI de la Región de las Américas.


These clinical practice guidelines (short version) were developed in order to provide recommendations for the management of critically ill adult patients with COVID-19 treated in intensive care units (ICUs). These clinical practice guidelines provide evidence-informed recommendations for identifying markers and mortality risk factors in critically ill patients, as well as infection control, sample collection, supportive care (respiratory and hemodynamic), pharmacological treatment, early rehabilitation, diagnostic imaging use, prevention of complications, and discharge requirements. The recommendations are for all healthcare staff who deal with patients in emergency departments and ICUs. These guidelines are also intended for use by decision-makers and government entities involved in the management of patients with COVID-19 in ICUs in the Region of the Americas. This document is the result of a rapid guideline adaptation process. The information presented reflects published evidence as of the date of inclusion in the document. The recommendations are based on the evidence available and the quality thereof (GRADE methodology) at the time the guidelines were published. However, PAHO recognizes that there are numerous research projects under way and will periodically update these reviews and the applicable recommendations.


Assuntos
Humanos , Adulto , Antivirais/uso terapêutico , Plasma/imunologia , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Administração dos Cuidados ao Paciente/organização & administração , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Assistência Centrada no Paciente/organização & administração , Prática Clínica Baseada em Evidências/organização & administração , Gravidade do Paciente , Betacoronavirus , Fatores Imunológicos/uso terapêutico , Unidades de Terapia Intensiva/organização & administração , Antibacterianos/uso terapêutico , América/epidemiologia
13.
Indian J Med Res ; 151(5): 401-410, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32611911

RESUMO

The novel coronavirus disease 2019 (COVID-19) with its early origin from Wuhan city in China has evolved into a global pandemic. Maximal precautionary measures and resources have been put forward by most nations in war footing to mitigate transmission and decrease fatality rates. This article was aimed to review the evidence on clinical management and to deal with the identification of high-risk groups, warning signs, appropriate investigations, proper sample collection for confirmation, general and specific treatment measures, strategies as well as infection control in the healthcare settings. Advanced age, cardiovascular disease, diabetes, hypertension and cancer have been found to be the risk factors for severe disease. Fever lasting for >five days with tachypnoea, tachycardia or hypotension are indications for urgent attention and hospitalization in a patient with suspected COVID-19. At present, reverse transcription-polymerase chain reaction (RT-PCR) from the upper respiratory tract samples is the diagnostic test of choice. While many drugs have shown in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there are insufficient clinical data to promote or dissuade their usage. Among the currently available drugs, hydroxychloroquine and lopinavir/ritonavir may be considered for patients with severe COVID-19 infection, awaiting further clinical trials. Stringent droplet and contact precautions will protect healthcare workers against most clinical exposures to COVID-19.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Corticosteroides/uso terapêutico , Manuseio das Vias Aéreas , Alanina/análogos & derivados , Alanina/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antimaláricos/uso terapêutico , Estado Terminal , Humanos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Pandemias , Gravidade do Paciente , Choque/terapia , Manejo de Espécimes , Avaliação de Sintomas , Populações Vulneráveis
14.
N Engl J Med ; 383(3): 218-228, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32668112

RESUMO

BACKGROUND: Rheumatoid arthritis, like many inflammatory diseases, is characterized by episodes of quiescence and exacerbation (flares). The molecular events leading to flares are unknown. METHODS: We established a clinical and technical protocol for repeated home collection of blood in patients with rheumatoid arthritis to allow for longitudinal RNA sequencing (RNA-seq). Specimens were obtained from 364 time points during eight flares over a period of 4 years in our index patient, as well as from 235 time points during flares in three additional patients. We identified transcripts that were differentially expressed before flares and compared these with data from synovial single-cell RNA-seq. Flow cytometry and sorted-blood-cell RNA-seq in additional patients were used to validate the findings. RESULTS: Consistent changes were observed in blood transcriptional profiles 1 to 2 weeks before a rheumatoid arthritis flare. B-cell activation was followed by expansion of circulating CD45-CD31-PDPN+ preinflammatory mesenchymal, or PRIME, cells in the blood from patients with rheumatoid arthritis; these cells shared features of inflammatory synovial fibroblasts. Levels of circulating PRIME cells decreased during flares in all 4 patients, and flow cytometry and sorted-cell RNA-seq confirmed the presence of PRIME cells in 19 additional patients with rheumatoid arthritis. CONCLUSIONS: Longitudinal genomic analysis of rheumatoid arthritis flares revealed PRIME cells in the blood during the period before a flare and suggested a model in which these cells become activated by B cells in the weeks before a flare and subsequently migrate out of the blood into the synovium. (Funded by the National Institutes of Health and others.).


Assuntos
Artrite Reumatoide/sangue , Linfócitos B/fisiologia , Expressão Gênica , Células-Tronco Mesenquimais , Análise de Sequência de RNA/métodos , Adulto , Artrite Reumatoide/genética , Artrite Reumatoide/imunologia , Feminino , Fibroblastos/metabolismo , Citometria de Fluxo , Humanos , Masculino , Células-Tronco Mesenquimais/metabolismo , Pessoa de Meia-Idade , Gravidade do Paciente , Inquéritos e Questionários , Exacerbação dos Sintomas , Líquido Sinovial/citologia
15.
J Infect Public Health ; 13(9): 1202-1209, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32718894

RESUMO

BACKGROUND: The COVID-19 outbreak in late December 2019 has quickly emerged into pandemic in 2020. We aimed to describe the epidemiology and clinical characteristics of hospitalized COVID-19 patients, and to investigate the potential risk factors for COVID-19 severity. METHOD: 1663 hospitalized patients with laboratory-confirmed diagnosed COVID-19 from Tongji Hospital between January 14, 2020, and February 28, 2020 were included in the present study. Demographic information, exposure history, medical history, comorbidities, signs and symptoms, chest computed tomography (CT) scanning, severity of COVID-19 and laboratory findings on admission were collected from electronic medical records. Multivariable logistic regression was used to explore the association between potential risk factors with COVID-19 severity. RESULTS: In the present study, the majority (79%) of 1663 COVID-19 patients were aged over 50 years old. A total of 2.8% were medical staff, and an exposure history of Huanan seafood market was document in 0.7%, and 7.4% were family infection. Fever (85.8%), cough (36.0%), fatigue (23.6%) and chest tightness (11.9%) were the most common symptoms in COVID-19 patients. As of February 28, 2020, of the 1663 patients included in this study, 26.0% were discharged, 10.2% were died, and 63.8% remained hospitalized. More than 1/3 of the patients had at least one comorbidity. Most (99.8%) patients had abnormal results Chest CT, and the most common manifestations of chest CT were local patchy shadowing (70.7%) and ground-glass opacity (44.8%). On admission, lymphocytopenia was present in 51.1% of the patients, mononucleosis in 26.6%, and erythrocytopenia in 61.3%. Most of the patients had increased levels of C-reactive protein (80.4%) and D-dimer (64.4%). Compared with non-severe patients, severe patients had more obvious abnormal laboratory results related to inflammation, coagulation disorders, liver and kidney damage (all P < 0.05). Older age (OR = 2.37, 95% CI: 1.47-3.83), leukocytosis (OR = 2.37, 95% CI: 1.47-3.83), and increased creatine kinase (OR = 2.37, 95% CI: 1.47-3.83) on admission were significantly associated with COVID-19 severity. CONCLUSION: Timely medical treatment and clear diagnosis after the onset might be beneficial to control the condition of COVID-19. Severe patients were more likely to be to be elder, and tended to have higher proportion of comorbidities and more prominent laboratory abnormalities. Older age, leukocytosis, and increased creatine kinase might help clinicians to identify severe patients with COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pandemias , Gravidade do Paciente , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Idoso , Angina Pectoris/virologia , Transtornos da Coagulação Sanguínea/virologia , Proteína C-Reativa/metabolismo , China/epidemiologia , Comorbidade , Infecções por Coronavirus/mortalidade , Tosse/virologia , Creatina Quinase/sangue , Fadiga/virologia , Feminino , Febre/virologia , Hospitalização , Humanos , Leucocitose/virologia , Linfopenia/virologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Radiografia Torácica , Fatores de Risco , Tomografia Computadorizada por Raios X
16.
J Infect Public Health ; 13(10): 1373-1380, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32605780

RESUMO

The outbreak of COVID-19 has created a global public health crisis. Little is known about the protective factors of this infection. Therefore, preventive health measures that can reduce the risk of infection, progression and severity are desperately needed. This review discussed the possible roles of vitamin D in reducing the risk of COVID-19 and other acute respiratory tract infections and severity. Moreover, this study determined the correlation of vitamin D levels with COVID-19 cases and deaths in 20 European countries as of 20 May 2020. A significant negative correlation (p=0.033) has been observed between mean vitamin D levels and COVID-19 cases per one million population in European countries. However, the correlation of vitamin D with COVID-19 deaths of these countries was not significant. Some retrospective studies demonstrated a correlation between vitamin D status and COVID-19 severity and mortality, while other studies did not find the correlation when confounding variables are adjusted. Several studies demonstrated the role of vitamin D in reducing the risk of acute viral respiratory tract infections and pneumonia. These include direct inhibition with viral replication or with anti-inflammatory or immunomodulatory ways. In the meta-analysis, vitamin D supplementation has been shown as safe and effective against acute respiratory tract infections. Thus, people who are at higher risk of vitamin D deficiency during this global pandemic should consider taking vitamin D supplements to maintain the circulating 25(OH)D in the optimal levels (75-125nmol/L). In conclusion, there is not enough evidence on the association between vitamin D levels and COVID-19 severity and mortality. Therefore, randomized control trials and cohort studies are necessary to test this hypothesis.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Suplementos Nutricionais , Progressão da Doença , Europa (Continente)/epidemiologia , Humanos , Gravidade do Paciente , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitamina D/farmacologia , Vitaminas/farmacologia
17.
J Infect Public Health ; 13(10): 1397-1404, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32712106

RESUMO

Secondary bacterial infections are commonly associated with prior or concomitant respiratory viral infections. Viral infections damage respiratory airways and simultaneously defects both innate and acquired immune response that provides a favorable environment for bacterial growth, adherence, and facilitates invasion into healthy sites of the respiratory tract. Understanding the molecular mechanism of viral-induced secondary bacterial infections will provide us a chance to develop novel and effective therapeutic approaches for disease prevention. The present study describes details about the secondary bacterial infection during viral infections and their immunological changes.The outcome of discussion avails an opportunity to understand possible secondary bacterial infections associated with novel SARS-CoV-2, presently causing pandemic outbreak COVID-19.


Assuntos
Infecções Bacterianas/imunologia , Infecções Bacterianas/virologia , Infecções por Coronavirus/imunologia , Influenza Humana/imunologia , Pneumonia Viral/imunologia , Imunidade Adaptativa , Bactérias/crescimento & desenvolvimento , Aderência Bacteriana , Betacoronavirus , Infecções por Coronavirus/complicações , Humanos , Tolerância Imunológica , Imunidade Inata , Inflamação/complicações , Influenza Humana/complicações , Interações Microbianas , Pandemias , Gravidade do Paciente , Pneumonia Viral/complicações
18.
Enferm. actual Costa Rica (Online) ; (38): 89-102, Jan.-Jun. 2020. graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1090089

RESUMO

Resumo O objetivo desta pesquisa foi analisar o grau de dependência de pacientes em uma Unidade de Recuperação Pós-Anestésica, comparando as necessidades de cuidados de enfermagem. Trata-se de um estudo quantitativo, transversal e descritivo. Dois instrumentos validados foram utilizados para classificar os pacientes de acordo com o grau de dependência e o índice Kappa para avaliar a concordância entre os instrumentos. Verificou-se uma prevalência na população masculina de 45 (64,3%), a especialidade médica mais atendida foi a neurocirurgia com 48 (68,6%). 65 pacientes (92,9%) foram geralmente classificados como graves e 59 (84%) a 60 (86%) que necessitaram de cuidados intensivos de enfermagem de acordo com os instrumentos que avaliam o grau de dependência. Conclui-se que o aumento da necessidade de cuidados depende inteiramente da gravidade do paciente e pode-se verificar que a faixa etária e os procedimentos invasivos realizados são variáveis que envolvem diretamente os cuidados prestados, uma vez que esses fatores contribuem diretamente para o aumento da o grau de dependência e duração da permanência no serviço de saúde.


Abstract The objective of this research was to analyze the degree of dependence of patients in a Post Anesthesia Recovery Unit comparing nursing care needs. It is a quantitative, cross-sectional and descriptive study. Two validated instruments were used to classify patients according to the degree of dependence, and the Kappa index was used to assess the agreement between the instruments. It was found that there is a prevalence of the male population of 45 (64.3%), the most attended medical specialty was neurosurgery with 48 (68.6%). 65 patients (92.9%) were generally classified as serious and 59 (84%) to 60 (86%) who required intensive nursing care according to the instruments that assess the degree of dependence. It is concluded that the increase in the need for care depends entirely on the severity of the patient, and it can be verified that the age group and the invasive procedures performed are variables that directly involve the care provided since these factors contribute directly to the increase in the degree of dependence and duration of stay in the health service.


Resumen El objetivo de esta investigación fue analizar el grado de dependencia de los pacientes en una Unidad de Recuperación Post anestesia comparando las necesidades de atención de enfermería. Es un estudio cuantitativo, transversal y descriptivo. Se utilizaron dos instrumentos validados para clasificar a los pacientes según el grado de dependencia, y se utilizó el índice Kappa para evaluar el acuerdo entre los instrumentos. Se encontró que hay una prevalencia de la población masculina de 45 (64.3%), la especialidad médica más atendida fue la neurocirugía con 48 (68.6%). 65 pacientes (92,9%) estaban en general clasificados como graves y 59 (84%) a 60 (86%) que requerían atención de enfermería intensiva según los instrumentos que evalúan el grado de dependencia. Se concluye que el aumento en la necesidad de atención depende totalmente de la gravedad del paciente, y se puede verificar que el grupo de edad y los procedimientos invasivos realizados son variables que implican directamente la atención brindada, ya que estos factores contribuyen directamente al aumento en el grado de dependencia y duración de la estancia en el servicio de salud.


Assuntos
Humanos , Período de Recuperação da Anestesia , Enfermagem em Pós-Anestésico , Gravidade do Paciente , Cuidados de Enfermagem
19.
Khirurgiia (Mosk) ; (5): 27-33, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500686

RESUMO

OBJECTIVE: To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. MATERIAL AND METHODS: A prospective study enrolled 43 patients with diffuse secondary peritonitis. RESULTS: Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.


Assuntos
Peritonite/terapia , Sepse/terapia , Comorbidade , Hospitalização , Humanos , Escores de Disfunção Orgânica , Gravidade do Paciente , Peritonite/etiologia , Peritonite/cirurgia , Cuidados Pré-Operatórios , Prognóstico , Estudos Prospectivos , Sepse/etiologia , Sepse/cirurgia
20.
Respiration ; 99(6): 521-542, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32564028

RESUMO

Against the background of the pandemic caused by infection with the SARS-CoV-2 virus, the German Respiratory Society has appointed experts to develop therapy strategies for COVID-19 patients with acute respiratory failure (ARF). Here we present key position statements including observations about the pathophysiology of (ARF). In terms of the pathophysiology of pulmonary infection with SARS-CoV-2, COVID-19 can be divided into 3 phases. Pulmonary damage in advanced COVID-19 often differs from the known changes in acute respiratory distress syndrome (ARDS). Two types (type L and type H) are differentiated, corresponding to early- and late-stage lung damage. This differentiation should be taken into consideration in the respiratory support of ARF. The assessment of the extent of ARF should be based on arterial or capillary blood gas analysis under room air conditions, and it needs to include the calculation of oxygen supply (measured from the variables of oxygen saturation, hemoglobin level, the corrected values of Hüfner's factor, and cardiac output). Aerosols can cause transmission of infectious, virus-laden particles. Open systems or vented systems can increase the release of respirable particles. Procedures in which the invasive ventilation system must be opened and endotracheal intubation carried out are associated with an increased risk of infection. Personal protective equipment (PPE) should have top priority because fear of contagion should not be a primary reason for intubation. Based on the current knowledge, inhalation therapy, nasal high-flow therapy (NHF), continuous positive airway pressure (CPAP), or noninvasive ventilation (NIV) can be performed without an increased risk of infection to staff if PPE is provided. A significant proportion of patients with ARF present with relevant hypoxemia, which often cannot be fully corrected, even with a high inspired oxygen fraction (FiO2) under NHF. In this situation, the oxygen therapy can be escalated to CPAP or NIV when the criteria for endotracheal intubation are not met. In ARF, NIV should be carried out in an intensive care unit or a comparable setting by experienced staff. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring and readiness for intubation are to be ensured at all times. If the ARF progresses under CPAP/NIV, intubation should be implemented without delay in patients who do not have a "do not intubate" order.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos Respiratórios/terapia , Respiração Artificial , Doença Aguda , Progressão da Doença , Alemanha , Humanos , Hipóxia/etiologia , Pandemias , Gravidade do Paciente , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Transtornos Respiratórios/etiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia
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