Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.727
Filtrar
1.
J Infect Dev Ctries ; 15(6): 766-772, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34242184

RESUMO

INTRODUCTION: COVID-19 is the infection caused by the new coronavirus. Specific treatment for COVID-19 has not been established, yet. It is important to determine the disease severity of the patients at the first admission. Therefore, the exploration of biomarkers is deemed necessary. We aimed to assess the diagnostic and early prognostic value of CRP and LDH levels in possible COVID-19 patients presenting with a severe clinical picture. METHODOLOGY: We evaluated the correlations of relevant routine laboratory test results with disease severity in COVID-19 patients admitted to our infectious diseases clinic. Patients were divided into severe and non-severe disease groups based on clinical findings, oxygen saturation levels in the arterial blood, biochemical test results, and radiological findings. Differences in the findings between the two disease severity groups were examined to determine potential biomarkers. RESULTS: Median age and the CRP and LDH levels in the severe disease group were statistically significantly higher compared to the nonsevere group (p < 0.0001). No other parameters statistically significant differences have been observed between the two groups (P > 0.05). CONCLUSIONS: CRP and LDH levels were positively correlated with lung lesions in early-stage COVID-19, potentially reflecting disease severity. Because LDH and CRP levels can potentially reflect the pulmonary function, they can be potential predictors of COVID-19- related respiratory failure. For avoiding poor prognosis; LDH and CRP should be considered as potential predictors for identifying the need for thoracic CT scans, close monitoring of pulmonary function, and aggressive supportive therapy early in the course of COVID-19.


Assuntos
Proteína C-Reativa/análise , COVID-19/sangue , COVID-19/diagnóstico , L-Lactato Desidrogenase/sangue , Índice de Gravidade de Doença , Adulto , Biomarcadores/sangue , COVID-19/classificação , Feminino , Hospitalização , Humanos , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Turquia
2.
Medicine (Baltimore) ; 100(23): e26319, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115045

RESUMO

RATIONALE: Dysgerminoma is a rare malignant tumor of the ovary, more frequently occurring in young women. The main signs of pseudo-Meigs syndrome (PMS) are ascites and hydrothorax accompanying benign or malignant ovarian tumors (no fibroma or fibroma-like tumor). PATIENT CONCERNS: A 19-year-old woman with fever and chest tightness for 2 days. DIAGNOSES: Pectoral-abdominal computed tomography (CT) scan and contrast-enhanced magnetic resonance imaging revealed a large amount of right pleural effusion, a small amount of ascites, and a huge abdominopelvic mass measuring about 29.2cm × 11.8cm × 8.4 cm in the left ovary. The result of hydrothorax examination was consistent with the diagnosis of exudative pleural effusion. In addition, Rivalta-test showed a positive result and lactate dehydrogenase was elevated. The histopathological diagnosis was a giant germ cell tumor, which was consistent with dysgerminoma in terms of both morphology and immunophenotype. Based on these findings, a diagnosis of malignant ovarian neoplasm with PMS was made. INTERVENTIONS: Surgical resection of the tumor was performed. OUTCOMES: The patient recovered well after operation, and the pleural effusion and abdominal ascites vanished. No recurrence was observed during the 1-year follow-up period. LESSONS: Ovarian dysgerminoma with PMS is a rare malignant tumor of the ovary, which often occurs in young women. It should be considered in differential diagnosis of patients with a pelvic mass, ascites and pleural effusion. Early diagnosis and surgical treatment are beneficial to prolonged survival.


Assuntos
Ascite , Disgerminoma , Síndrome de Meigs/diagnóstico , Neoplasias Ovarianas , Ovariectomia/métodos , Derrame Pleural , Ascite/diagnóstico por imagem , Ascite/etiologia , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Disgerminoma/sangue , Disgerminoma/patologia , Disgerminoma/fisiopatologia , Disgerminoma/cirurgia , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Imageamento por Ressonância Magnética/métodos , Estadiamento de Neoplasias , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/fisiopatologia , Neoplasias Ovarianas/cirurgia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
3.
Hemoglobin ; 45(2): 124-128, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34162301

RESUMO

This study aimed to examine the relationship between Hb A1c levels and the clinical course of coronavirus-19 (COVID-19) patients. Sixty-six COVID-19(+) patients with high Hb A1c and 46 with average Hb A1c and 30 COVID-19(-) patients with average Hb A1c were included. Hb A1c levels and parameters examined in COVID-19(+) patients were compared between groups, and correlation analysis was performed between these parameters and Hb A1c levels. The effect of Hb A1c levels on intensive care unit (ICU) admission and mortality rate in COVID-19 patients was analyzed with the χ2 test. It was observed that hemoglobin (Hb) and arterial oxygen saturation (SaO2) levels of the COVID-19 (+) groups was lower than the COVID-19 (-) group, while ferritin, D-dimer, procalcitonin (PCT), and C-reactive protein (CRP) levels were higher. The COVID-19 (+) group with high Hb A1c had higher lactate dehydrogenase (LDH), PCT and D-dimer levels than the other two groups, while Hb, partial arterial oxygen pressure (PaO2) levels were lower. The Hb A1c levels of the COVID-19 (+) groups were positively correlated with absolute neutrophil count (ANC), LDH, PCT and (K+) levels, while negatively correlated with Hb and PaO2 levels. Hb A1c was found to be associated with the inflammation process, coagulation disorders and low PaO2 in COVID-19 patients. The COVID-19 patients with high Hb A1c levels had a higher mortality rate than other COVID-19 patients. Using Hb A1c measurements with other prognostic markers would contribute to the patient's risk of death assessment.


Assuntos
COVID-19/sangue , Diabetes Mellitus/sangue , Hemoglobina A Glicada/análise , Hiperglicemia/sangue , SARS-CoV-2 , Adulto , Idoso , Sedimentação Sanguínea , Proteína C-Reativa/análise , COVID-19/complicações , COVID-19/mortalidade , Cuidados Críticos/estatística & dados numéricos , Complicações do Diabetes/sangue , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hiperglicemia/etiologia , L-Lactato Desidrogenase/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Oxigênio/sangue , Pressão Parcial , Pró-Calcitonina/sangue , Prognóstico , Risco , Índice de Gravidade de Doença , Trombofilia/sangue , Trombofilia/etiologia
4.
Molecules ; 26(9)2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-34066903

RESUMO

The effect of effective microorganisms (EM) on internal organ morphology, intestinal morphometry, and serum biochemical activity in Japanese quails under Clostridium perfringens challenge was determined. After 30 days of EM addition, one group of quails was orally inoculated with Clostridium perfringens. The second group did not receive EM and was inoculated with C. perfringens. In the gut, EM supplementation reduced the number of lesions, enhanced gut health, and protected the mucosa from pathogenic bacteria. EM showed an anti-inflammatory effect and fewer necrotic lesions in villi. In the internal organs, EM showed a protective effect against a typical lesion of C. perfringens infection. Necrosis and degeneration of the hepatocytes, necrosis of bile ducts, and bile duct proliferation were more severe in the infected group without EM. Morphometric evaluation showed significantly higher villi in the jejunum after EM addition. A greater crypt depth was observed in the C. perfringens group. Biochemical analysis of the blood indicated lower cholesterol on the 12th day of the experiment and between-group differences in total protein, lactate dehydrogenase (LDH), and albumin levels in the EM group. Further studies are needed to improve EM activity against pathologic bacteria as a potential alternative to antibiotics and to develop future natural production systems.


Assuntos
Anti-Inflamatórios/uso terapêutico , Doenças das Aves/sangue , Doenças das Aves/dietoterapia , Infecções por Clostridium/sangue , Infecções por Clostridium/dietoterapia , Clostridium perfringens , Enterite/sangue , Enterite/dietoterapia , Mucosa Intestinal/microbiologia , Probióticos/uso terapêutico , Substâncias Protetoras/uso terapêutico , Codorniz/sangue , Codorniz/microbiologia , Ração Animal/microbiologia , Animais , Ductos Biliares/patologia , Doenças das Aves/microbiologia , Colesterol/sangue , Infecções por Clostridium/microbiologia , Enterite/microbiologia , Feminino , Hepatócitos/patologia , Mucosa Intestinal/patologia , Jejuno/microbiologia , Jejuno/patologia , L-Lactato Desidrogenase/sangue , Necrose , Albumina Sérica/análise , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(24): e26260, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128855

RESUMO

ABSTRACT: This study aimed to evaluate times for measuring serum lactate dehydrogenase levels (SLLs) to predict neurological prognosis among out-of-hospital cardiac arrest (OHCA) survivors.This retrospective study examined patients who experienced OHCA treated with targeted temperature management (TTM). The SLLs were evaluated at the return of spontaneous circulation (ROSC) and at 24, 48, and 72 hours later. Neurological outcomes after 3 months were evaluated for relationships with the SLL measurement times.A total of 95 comatose patients with OHCA were treated using TTM. Seventy three patients were considered eligible, including 31 patients (42%) who experienced good neurological outcomes. There were significant differences between the good and poor outcome groups at most time points (P < .001), except for ROSC (P = .06). The ROSC measurement had a lower area under the receiver operating characteristic curve (AUC: 0.631, 95% confidence interval [CI]: 0.502-0.761) than at 48 hours (AUC: 0.830, 95% CI: 0.736-0.924), at 24 hours (AUC: 0.786, 95% CI: 0.681-0.892), and at 72 hours (AUC: 0.821, 95% CI: 0.724-0.919).A higher SLL seemingly predicted poor neurological outcomes, with good prognostic values at 48 hours and 72 hours. Prospective studies should be conducted to confirm these results.


Assuntos
Coma/sangue , Hipotermia Induzida , L-Lactato Desidrogenase/sangue , Parada Cardíaca Extra-Hospitalar/sangue , Fatores de Tempo , Biomarcadores/sangue , Coma/etiologia , Coma/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/psicologia , Parada Cardíaca Extra-Hospitalar/terapia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(19): e25917, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106657

RESUMO

ABSTRACT: The coronavirus disease (COVID-19) has become a global pandemic. Invasive mechanical ventilation is recommended for the management of patients with COVID-19 who have severe respiratory symptoms. However, various complications can develop after its use. The efficient and appropriate management of patients requires the identification of factors associated with an aggravation of COVID-19 respiratory symptoms to a degree where invasive mechanical ventilation becomes necessary, thereby enabling clinicians to prevent such ventilation. This retrospective study included 138 inpatients with COVID-19 at a tertiary hospital. We evaluated the differences in the demographic and clinical data between 27 patients who required invasive mechanical ventilation and 111 patients who did not. Multivariate logistic regression analysis indicated that the duration of fever, national early warning score (NEWS), and lactate dehydrogenase (LDH) levels on admission were significantly associated with invasive mechanical ventilation in this cohort. The optimal cut-off values were: fever duration ≥1 day (sensitivity 100.0%, specificity 54.95%), NEWS ≥7 (sensitivity 72.73%, specificity 92.52%), and LDH >810 mg/dL (sensitivity 56.0%, specificity 90.29%). These findings can assist in the early identification of patients who will require invasive mechanical ventilation. Further studies in larger patient populations are recommended to validate our findings.


Assuntos
COVID-19/fisiopatologia , Escore de Alerta Precoce , Respiração Artificial/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Feminino , Febre/fisiopatologia , Humanos , Hidroxicloroquina/uso terapêutico , L-Lactato Desidrogenase/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Reação em Cadeia da Polimerase em Tempo Real , República da Coreia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , SARS-CoV-2 , Fatores Sexuais , Fatores Socioeconômicos , Centros de Atenção Terciária , Adulto Jovem
7.
Respir Res ; 22(1): 157, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34020644

RESUMO

BACKGROUND: The long-term consequences of COVID-19 remain unclear. There is concern a proportion of patients will progress to develop pulmonary fibrosis. We aimed to assess the temporal change in CXR infiltrates in a cohort of patients following hospitalisation for COVID-19. METHODS: We conducted a single-centre prospective cohort study of patients admitted to University Hospital Southampton with confirmed SARS-CoV2 infection between 20th March and 3rd June 2020. Patients were approached for standard-of-care follow-up 12-weeks after hospitalisation. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates; 0-4 per lung (Nil = 0, < 25% = 1, 25-50% = 2, 51-75% = 3, > 75% = 4). RESULTS: 101 patients with paired CXRs were included. Demographics: 53% male with a median (IQR) age 53.0 (45-63) years and length of stay 9 (5-17.5) days. The median CXR follow-up interval was 82 (77-86) days with median baseline and follow-up CXR scores of 4.0 (3-5) and 0.0 (0-1) respectively. 32% of patients had persistent CXR abnormality at 12-weeks. In multivariate analysis length of stay (LOS), smoking-status and obesity were identified as independent risk factors for persistent CXR abnormality. Serum LDH was significantly higher at baseline and at follow-up in patients with CXR abnormalities compared to those with resolution. A 5-point composite risk score (1-point each; LOS ≥ 15 days, Level 2/3 admission, LDH > 750 U/L, obesity and smoking-status) strongly predicted risk of persistent radiograph abnormality (0.81). CONCLUSION: Persistent CXR abnormality 12-weeks post COVID-19 was common in this cohort. LOS, obesity, increased serum LDH, and smoking-status were risk factors for radiograph abnormality. These findings require further prospective validation.


Assuntos
COVID-19/complicações , COVID-19/diagnóstico por imagem , Tórax/diagnóstico por imagem , Idoso , Estudos de Coortes , Feminino , Seguimentos , Hospitalização , Humanos , L-Lactato Desidrogenase/sangue , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade , Reação em Cadeia da Polimerase , Estudos Prospectivos , Radiografia Torácica , Fatores de Risco , Fumar , Resultado do Tratamento
8.
Med Sci Monit ; 27: e930688, 2021 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-33934098

RESUMO

BACKGROUND Influenza-associated acute necrotizing encephalopathy (IANE) can be lethal and disabling and have a sudden onset and deteriorate rapidly but lacks early diagnostic indicators. We aimed to examine the early clinical diagnostic indicators in children with IANE. MATERIAL AND METHODS Acute influenza patients were grouped according to their clinical manifestations: flu alone (FA), flu with febrile seizure (FS), influenza-associated encephalopathy (IAE), and IANE. The clinical features, biomarkers, neuroelectrophysiological results, and neuroimaging examination results were compared. RESULTS A total of 31 patients were included (FA (n=4), FS (n=8), IAE (n=14), and IANE (n=5)). The IANE group, whose mean age was 3.7 years, was more likely to show rapid-onset seizure, acute disturbance of consciousness (ADOC), Babinski's sign, and death/sequela. More patients in the IANE group required tracheal intubation mechanical ventilation and received intravenous immunoglobulins (IVIG) and glucocorticoids. The alanine aminotransferase (ALT), aspartate transaminase (AST), and lactate dehydrogenase (LDH) levels in the IANE group were significantly higher than in the FS and IAE groups. The aquaporin-4 (AQP-4) antibody and malondialdehyde (MDA) levels in the serum and cerebrospinal fluid (CSF) were notably higher in IANE patients in the acute stage compared with FS and IAE patients. All patients in the IANE group had positive neuroimaging findings. CONCLUSIONS Early clinical warning factors for IANE include rapid-onset seizures in patients under 4 years of age, ADOC, and pathological signs. Increased AQP-4 antibodies and MDA levels in CSF might contribute to early diagnosis. Early magnetic resonance venography (MRV) and susceptibility-weighted imaging (SWI) sequences, or thrombelastography to identify deep vein thrombosis, might indicate clinical deterioration.


Assuntos
Encefalopatias/diagnóstico , Influenza Humana/diagnóstico , Doença Aguda , Alanina Transaminase/sangue , Alanina Transaminase/metabolismo , Aquaporinas/sangue , Aquaporinas/metabolismo , Aspartato Aminotransferases/sangue , Aspartato Aminotransferases/metabolismo , Biomarcadores/sangue , Biomarcadores/metabolismo , Encefalopatias/sangue , Encefalopatias/metabolismo , Líquido Cefalorraquidiano/metabolismo , Pré-Escolar , Feminino , Glucocorticoides/sangue , Glucocorticoides/metabolismo , Humanos , Imunoglobulinas Intravenosas/sangue , Imunoglobulinas Intravenosas/metabolismo , Influenza Humana/sangue , Influenza Humana/metabolismo , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/metabolismo , Masculino , Malondialdeído/sangue , Malondialdeído/metabolismo , Neuroimagem/métodos , Convulsões/sangue , Convulsões/diagnóstico , Convulsões/metabolismo
9.
J Clin Lab Anal ; 35(5): e23767, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33951237

RESUMO

BACKGROUND: Different disease severities of COVID-19 patients could be reflected on clinical laboratory findings. METHODS: In this single-centered retrospective study, demographic, clinical, and laboratory indicators on and during admission were compared among 74 participants with mild, moderate, critical severe, or severe classification. Risk factors associated with disease severity were analyzed by multivariate analyses. The AUC and 95% CI of the ROC curve were calculated. RESULTS: The most common manifestations of these patients were fever and cough. Critical severe or severe group owned the longest length of stay (23 (19,31), p < 0.001). After multivariate logistic regression, independent influence factors on admission for severity of disease were CK-MB (OR 0.674; 95% CI 0.489-0.928; p = 0.016), LDH (OR 1.111 or 1.107; 95% CI 1.026-1.204 or 1.022-1.199; p = 0.009 or 0.013), normal T-BIL (OR 4.58 × 10-8 ; 95% CI 3.05 × 10-9 -6.88 × 10-7 ; p < 0.001), LYM% (OR 0.008; 95% CI 0-0.602; p = 0.029), and normal ESR (OR 0.016; 95% CI 0-0.498; p = 0.019). Factors during hospitalization were normal T-BIL (OR 8.56 × 10-9 ; 95% CI 8.30 × 10-10 -8.83 × 10-8 ; p < 0.001), LYM (OR 0.068; 95% CI 0.005-0.934; p = 0.044), albumin (OR 0.565; 95% CI 0.327-0.977; p = 0.041), and normal NEU% (OR 0.013; 95% CI 0.000-0.967; p = 0.048). Combined indicators of AUC were 0.860 (LYM, LDH, and normal ESR on admission, p < 0.001) and 0.750 (CK-MB, LDH, and normal T-BIL during hospitalization, p = 0.020) when predicting for severe or critical severe patients. CONCLUSION: To pay close attention to the progression of COVID-19 and take measures promptly, we should be cautious of the laboratory indicators when patients on admission especially CK-MB, LDH, LYM%, T-BIL as well as ESR; and T-BIL, LYM, albumin, NEU% with the process of disease.


Assuntos
COVID-19/diagnóstico , SARS-CoV-2 , Adulto , Idoso , Bilirrubina/sangue , Sedimentação Sanguínea , COVID-19/sangue , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Laboratórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
Phys Ther Sport ; 50: 65-73, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33932873

RESUMO

OBJECTIVE: To compare the effects of moderate intensity running and cycling on markers of exercise-induced muscle damage in men. STUDY DESIGN: Randomized controlled trial. SETTING: Laboratory. PARTICIPANTS: Thirty volunteers were randomized in three groups [running (RG; n = 10), cycling (CG; n = 10) and control (CON; n = 10)] and were evaluated at baseline, post 24, 48 and 72 h of knee extensors' muscle damage protocol. CON performed passive recovery, while RG and CG performed active recovery immediately after the protocol, as well as 24 h and 48 h afterwards. MAIN OUTCOMES: (i) maximal voluntary isometric contraction (MVIC); (ii) delayed-onset muscle soreness (DOMS); (iii) plasma creatine kinase (CK) and lactate dehydrogenase (LDH) levels. RESULTS: No group-by-time interaction was found in any outcome evaluated (p > 0.05). All groups presented decreases in MVIC and increases in DOMS (p < 0.001), without differences in CK and LDH. Compared with CON, exercise groups presented likely beneficial effects for LDH, while only CG had a likely beneficial effect for DOMS. Lastly, CG presented likely/very likely beneficial effects for MVIC and DOMS compared to RG. CONCLUSION: Although the null hypothesis analysis did not find differences, the magnitude-based inference analysis suggested that moderate intensity cycling have likely beneficial effects on knee extensor muscle recovery after eccentric exercise protocol.


Assuntos
Ciclismo , Músculo Esquelético/lesões , Mialgia/reabilitação , Corrida , Adolescente , Adulto , Creatina Quinase/sangue , Exercício Físico , Humanos , Contração Isométrica , Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , L-Lactato Desidrogenase/sangue , Masculino , Recuperação de Função Fisiológica , Adulto Jovem
11.
Emergencias ; 33(3): 174-180, 2021 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33978330

RESUMO

OBJECTIVES: We aimed to analyze the clinical course of patients discharged from our emergency departament (ED) with pneumonia symptoms compatible with a diagnosis of COVID-19. MATERIAL AND METHODS: We followed 102 patients discharged home with a diagnosis of pneumonia compatible with COVID19 between March 12 and 21, 2020, in our hospital in the southern part of the autonomous community of Madrid. Descriptive statistics (medians and interquartile ranges or frequencies, as appropriate) were compiled for the main variables. Treatments and prognoses were compared with 􀁆2, Kruskal-Wallis, or Mann-Whitney tests. The data then underwent logistic regression analysis. RESULTS: Most patients (accounting for 74.5% of the discharges) were treated with hydroxychloroquine alone. The readmission rate was 15.7%; the ED revisiting rate was 25.7%. Admission was associated with an elevated lactate dehydrogenase (LDH) level (P=.011), elevated creatine kinase (CK) (P=.004), and lymphopenia (P=.034). Hypertension and chronic obstructive pulmonary disease were also related to admission. Ischemic heart disease was associated with longer duration of symptoms. CONCLUSION: Lymphopenia, and elevated LDH and CK levels predicted the need for hospital admission better than other traditional biological markers in patients with mild to moderate symptoms. Telephone follow-up proved useful for dealing with the overloading of health care services.


Assuntos
COVID-19/sangue , Creatina Quinase/sangue , L-Lactato Desidrogenase/sangue , Contagem de Linfócitos , Adulto , Idoso , Antivirais/uso terapêutico , Biomarcadores , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , Comorbidade , Feminino , Seguimentos , Hospitais Universitários/estatística & dados numéricos , Humanos , Hidroxicloroquina/uso terapêutico , Hipertensão/epidemiologia , Linfopenia/sangue , Linfopenia/etiologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , SARS-CoV-2 , Espanha/epidemiologia , Telefone
12.
BMC Infect Dis ; 21(1): 356, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863287

RESUMO

BACKGROUND: COVID-19 pandemic has forced physicians to quickly determine the patient's condition and choose treatment strategies. This study aimed to build and validate a simple tool that can quickly predict the deterioration and survival of COVID-19 patients. METHODS: A total of 351 COVID-19 patients admitted to the Third People's Hospital of Yichang between 9 January to 25 March 2020 were retrospectively analyzed. Patients were randomly grouped into training (n = 246) or a validation (n = 105) dataset. Risk factors associated with deterioration were identified using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. The factors were then incorporated into the nomogram. Kaplan-Meier analysis was used to compare the survival of patients between the low- and high-risk groups divided by the cut-off point. RESULTS: The least absolute shrinkage and selection operator (LASSO) regression was used to construct the nomogram via four parameters (white blood cells, C-reactive protein, lymphocyte≥0.8 × 109/L, and lactate dehydrogenase ≥400 U/L). The nomogram showed good discriminative performance with the area under the receiver operating characteristic (AUROC) of 0.945 (95% confidence interval: 0.91-0.98), and good calibration (P = 0.539). Besides, the nomogram showed good discrimination performance and good calibration in the validation and total cohorts (AUROC = 0.979 and AUROC = 0.954, respectively). Decision curve analysis demonstrated that the model had clinical application value. Kaplan-Meier analysis illustrated that low-risk patients had a significantly higher 8-week survival rate than those in the high-risk group (100% vs 71.41% and P < 0.0001). CONCLUSION: A simple-to-use nomogram with excellent performance in predicting deterioration risk and survival of COVID-19 patients was developed and validated. However, it is necessary to verify this nomogram using a large-scale multicenter study.


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Nomogramas , Adulto , Idoso , Proteína C-Reativa/análise , China , Feminino , Hospitalização , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
13.
Virol J ; 18(1): 67, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789703

RESUMO

BACKGROUND: Risk scores are needed to predict the risk of death in severe coronavirus disease 2019 (COVID-19) patients in the context of rapid disease progression. METHODS: Using data from China (training dataset, n = 96), prediction models were developed by logistic regression and then risk scores were established. Leave-one-out cross validation was used for internal validation and data from Iran (test dataset, n = 43) was used for external validation. RESULTS: A NSL model (area under the curve (AUC) 0.932) and a NL model (AUC 0.903) were developed based on neutrophil percentage and lactate dehydrogenase with and without oxygen saturation (SaO2) using the training dataset. AUCs of the NSL and NL models in the test dataset were 0.910 and 0.871, respectively. The risk scoring systems corresponding to these two models were established. The AUCs of the NSL and NL scores in the training dataset were 0.928 and 0.901, respectively. At the optimal cut-off value of NSL score, the sensitivity and specificity were 94% and 82%, respectively. The sensitivity and specificity of NL score were 94% and 75%, respectively. CONCLUSIONS: These scores may be used to predict the risk of death in severe COVID-19 patients and the NL score could be used in regions where patients' SaO2 cannot be tested.


Assuntos
COVID-19/mortalidade , Mortalidade Hospitalar , L-Lactato Desidrogenase/sangue , Modelos Teóricos , Neutrófilos/citologia , Oxigênio/sangue , Idoso , COVID-19/terapia , China , Progressão da Doença , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco
14.
J Med Internet Res ; 23(5): e25988, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-33872186

RESUMO

BACKGROUND: Early detection and intervention are the key factors for improving outcomes in patients with COVID-19. OBJECTIVE: The objective of this observational longitudinal study was to identify nonoverlapping severity subgroups (ie, clusters) among patients with COVID-19, based exclusively on clinical data and standard laboratory tests obtained during patient assessment in the emergency department. METHODS: We applied unsupervised machine learning to a data set of 853 patients with COVID-19 from the HM group of hospitals (HM Hospitales) in Madrid, Spain. Age and sex were not considered while building the clusters, as these variables could introduce biases in machine learning algorithms and raise ethical implications or enable discrimination in triage protocols. RESULTS: From 850 clinical and laboratory variables, four tests-the serum levels of aspartate transaminase (AST), lactate dehydrogenase (LDH), C-reactive protein (CRP), and the number of neutrophils-were enough to segregate the entire patient pool into three separate clusters. Further, the percentage of monocytes and lymphocytes and the levels of alanine transaminase (ALT) distinguished cluster 3 patients from the other two clusters. The highest proportion of deceased patients; the highest levels of AST, ALT, LDH, and CRP; the highest number of neutrophils; and the lowest percentages of monocytes and lymphocytes characterized cluster 1. Cluster 2 included a lower proportion of deceased patients and intermediate levels of the previous laboratory tests. The lowest proportion of deceased patients; the lowest levels of AST, ALT, LDH, and CRP; the lowest number of neutrophils; and the highest percentages of monocytes and lymphocytes characterized cluster 3. CONCLUSIONS: A few standard laboratory tests, deemed available in all emergency departments, have shown good discriminative power for the characterization of severity subgroups among patients with COVID-19.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Aprendizado de Máquina não Supervisionado , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Proteína C-Reativa/análise , COVID-19/mortalidade , Contagem de Células , Análise por Conglomerados , Conjuntos de Dados como Assunto , Serviço Hospitalar de Emergência , Humanos , L-Lactato Desidrogenase/sangue , Estudos Longitudinais , Linfócitos , Monócitos , Neutrófilos , Prognóstico , Espanha/epidemiologia , Triagem
15.
Endocrinol Diabetes Metab ; 4(2): e00215, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33851033

RESUMO

Background: COVID-19 has a broad clinical spectrum. We investigated the role of serum markers measured on admission on severity as assessed at discharge and investigated those which relate to the effect of BMI on severity. Methods: Clinical and laboratory data from 610 COVID-19 cases hospitalized in the province of Zheijang, China were investigated as risk factors for severe COVID-19 (assessed by respiratory distress) compared to mild or common forms using logistic regression methods. Biochemical markers were correlated with severity using spearman correlations, and a ROC analysis was used to determine the individual contribution of each of the biochemical markers on severity. We carried out formal mediation analyses to investigate the extent of the effect of body mass index (BMI) on COVID-19 severity mediated by hypertension, glycemia, Lactose Dehydrogenase (LDH) at the time of hospitalization and C-Reactive Protein levels (CRP), in units of standard deviations. Results: The individual markers measured on admission contributing most strongly to prediction of COVID-19 severity as assessed at discharge were LDH, CRP and glucose. The proportion of the effect of BMI on severity of COVID-19 mediated by CRP, glycemia or hypertension, we find that glucose mediated 79% (p < .0001), LDH mediated 78% (p < .0001), hypertension mediated 66% (p < .0001); however, only 44% (p < .005) was mediated by systemic inflammation (CRP). Conclusion: Our data indicate that a larger proportion of the effect of BMI on severity of COVID-19 is mediated by glycemia and LDH levels whereas less than half of it is mediated by systemic inflammation.


Assuntos
Glicemia/metabolismo , COVID-19/sangue , COVID-19/patologia , Hipertensão/complicações , L-Lactato Desidrogenase/sangue , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , COVID-19/complicações , COVID-19/fisiopatologia , China , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
16.
Nutrients ; 13(3)2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33807745

RESUMO

We assessed whether a protein supplementation protocol could attenuate running-induced muscle soreness and other muscle damage markers compared to iso-caloric placebo supplementation. A double-blind randomized controlled trial was performed among 323 recreational runners (age 44 ± 11 years, 56% men) participating in a 15-km road race. Participants received milk protein or carbohydrate supplementation, for three consecutive days post-race. Habitual protein intake was assessed using 24 h recalls. Race characteristics were determined and muscle soreness was assessed with the Brief Pain Inventory at baseline and 1-3 days post-race. In a subgroup (n = 149) muscle soreness was measured with a strain gauge algometer and creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations were measured. At baseline, no group-differences were observed for habitual protein intake (protein group: 79.9 ± 26.5 g/d versus placebo group: 82.0 ± 26.8 g/d, p = 0.49) and muscle soreness (protein: 0.45 ± 1.08 versus placebo: 0.44 ± 1.14, p = 0.96). Subjects completed the race with a running speed of 12 ± 2 km/h. With the Intention-to-Treat analysis no between-group differences were observed in reported muscle soreness. With the per-protocol analysis, however, the protein group reported higher muscle soreness 24 h post-race compared to the placebo group (2.96 ± 2.27 versus 2.46 ± 2.38, p = 0.039) and a lower pressure muscle pain threshold in the protein group compared to the placebo group (71.8 ± 30.0 N versus 83.9 ± 27.9 N, p = 0.019). No differences were found in concentrations of CK and LDH post-race between groups. Post-exercise protein supplementation is not more preferable than carbohydrate supplementation to reduce muscle soreness or other damage markers in recreational athletes with mostly a sufficient baseline protein intake running a 15-km road race.


Assuntos
Carboidratos da Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Mialgia/prevenção & controle , Corrida/fisiologia , Adulto , Biomarcadores/sangue , Creatina Quinase/sangue , Método Duplo-Cego , Feminino , Humanos , Análise de Intenção de Tratamento , L-Lactato Desidrogenase/sangue , Masculino , Mialgia/sangue , Mialgia/etiologia , Limiar da Dor
17.
Nutrients ; 13(4)2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33805883

RESUMO

The aim of the study was to determine the effect of simultaneous supplementation of ß-hydroxy-ß-methylbutyrate and L-Arginine α-ketoglutarate on lower limb power and muscle damage in medium distance runners aged 15.3 (±0.9) years old. METHODS: The study group consisted of 40 volunteers aged 14-17 years practicing medium distance running for at least two years. The study lasted 12 days and followed a randomized, double-blind, placebo-controlled, parallel design. All subjects attended a familiarization session on day 0 before the test. The subjects were randomly divided into two groups: supplements and placebo group. The same training cycle protocol was used in both groups during the 12-day training period. Morning warm-up involved 10 min jogging at 60-75% of maximal heart rate and countermovement jump height measurement. Main training units were carried out for both groups with the same volume. Training load assessment (the daily session Rating of Perceived Exertion (s-RPE) method) method takes into consideration the intensity and the duration of the training session to calculate the "training load" (TL). RESULTS: At the end of the training cycle, a significant (p = 0.002) decrease in the countermovement jump (CMJ) height was found in the placebo group when compared to the baseline. In the supplement group, there was no decrease in the countermovement jump height. Creatine kinase and lactate dehydrogenase concentration increased during the training days similarly in both groups and decreased on rest days. There were no differences between groups in enzymes concentration. The research results indicate that the supplement combination used in the supplements group prevented a reduction in the CMJ values. In contrast to the supplements group, in the placebo group, the CMJ changes were statistically significant: a noticeable (p = 0.002) decrease in CMJ was noted between the baseline measurement and the 6th measurement. The well-being of the subjects from both groups changed significantly during the training period, and the intergroup differences in the mood level were similar and not statistically significant. CONCLUSIONS: The results of this study indicate that the daily co-supplementation with calcium salt of ß-hydroxy-ß-methylbutyrate (7.5 g) and L-Arginine α-ketoglutarate (10 g) during training might help to prevent decline in jump performance. No influence on muscle damage markers or mood was shown.


Assuntos
Arginina/análogos & derivados , Atletas/estatística & dados numéricos , Desempenho Atlético/estatística & dados numéricos , Ácidos Cetoglutáricos/farmacologia , Músculo Esquelético/efeitos dos fármacos , Atletismo , Valeratos/farmacologia , Adolescente , Arginina/sangue , Arginina/farmacologia , Creatina Quinase/sangue , Creatina Quinase/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Ácidos Cetoglutáricos/sangue , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/efeitos dos fármacos , Perna (Membro)/fisiologia , Masculino , Força Muscular/efeitos dos fármacos , Valeratos/sangue
18.
Medicine (Baltimore) ; 100(14): e25318, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832106

RESUMO

BACKGROUND: Several studies indicate the level of pretreatment lactate dehydrogenase (LDH) may be associated with the prognosis of patients receiving immune checkpoint inhibitors targeting programmed death receptor-1 (PD-1)/programmed death ligand 1 (PD-L1) which had been reported to dramatically improve the survival of patients with advanced or metastatic melanoma; however, no consensus has been reached because the presence of controversial conclusions. This study was to perform a meta-analysis to comprehensively explore the prognostic values of LDH for melanoma patients receiving anti-PD1/PD-L1 monotherapy. METHODS: A systematic electronic search in the databases of PubMed, EMBASE and the Cochrane library was performed to identify all related articles up to April, 2020. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained to assess the prognostic values of pretreatment LDH in blood for overall survival (OS) and progression-free survival (PFS). RESULTS: A total of 22 eligible studies involving 2745 patients were included. Of them, 19 studies with 20 results assessed the OS and the pooled analysis showed that an elevated pretreatment LDH level was significantly associated with a worse OS (HR = 2.44; 95% CI: 1.95-3.04, P < .001). Thirteen studies reported PFS and meta-analysis also revealed that a higher pretreatment LDH level predicted a significantly shorter PFS (HR, 1.61; 95% CI, 1.34-1.92; P < .001). Although heterogeneity existed among these studies, the same results were acquired in subgroup analyses based on sample size, country, study design, cut-off of LDH, type of PD-1/PD-L1 inhibitors and statistics for HRs (all HRs > 1 and P < .05). CONCLUSION: This meta-analysis suggests LDH may serve as a potential biomarker to identify patients who can benefit from anti-PD-1/PD-L1 and then schedule treatments.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Antígeno B7-H1/antagonistas & inibidores , L-Lactato Desidrogenase/sangue , Melanoma/tratamento farmacológico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Biomarcadores Tumorais , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Melanoma/mortalidade , Melanoma/patologia , Prognóstico , Análise de Sobrevida
19.
PLoS One ; 16(4): e0249346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861750

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a serious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in severe cases associated with acute respiratory distress syndrome (ARDS). OBJECTIVE: To describe the clinical characteristics of patients with ARDS-COVID-19. MATERIALS AND METHODS: This study involved 197 male Egyptian participants, among them111 COVID-19 patients presented with ARDS, 60 COVID-19 patients presented with non-ARDS, and 26 Non-COVID-19 patients. We reported the analysis results of clinical and laboratory information, including blood routine tests, blood biochemistry parameters [aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine and C-reactive protein (CRP)], thrombotic activity (D-dimer) and serum ferritin and lactate dehydrogenase (LDH). RESULTS: The levels of hemoglobin, AST, creatinine, monocyte count, monocyte %, RBC count, TLC, and platelet count were not significantly different among the groups. The lymphopenia and increased CRP, ALT, D-dimer, ferritin, and LDH were observed in patients with ARDS-COVID-19. CONCLUSION: COVID-19 patients with ARDS presented with lymphopenia, increased thrombotic activity, increased CRP, LDH, and ferritin levels. The results revealed that CRP, D-dimer, LDH levels, and lymphopenia have a significant association with the COVID-19 severity and can be used as biomarkers to predict the disease severity.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Síndrome do Desconforto Respiratório/virologia , Adulto , Idoso , Alanina Transaminase/sangue , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/sangue , Aspartato Aminotransferases/metabolismo , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/virologia , Creatinina/sangue , Creatinina/metabolismo , Egito/epidemiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hospitalização , Humanos , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/metabolismo , Contagem de Leucócitos , Contagem de Linfócitos , Linfopenia/sangue , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Síndrome do Desconforto Respiratório/sangue , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/epidemiologia , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença
20.
J Med Virol ; 93(7): 4559-4563, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33811680

RESUMO

Coronavirus disease 2019 (COVID-19) is globally rampant, and to curb the growing burden of this disease, in-depth knowledge about its pathophysiology is needed. This was an observational study conducted at a single center to investigate serum cytokine and chemokine levels of COVID-19 patients, based on disease severity. We included 72 consecutive COVID-19 patients admitted to our hospital from March 21 to August 31, 2020. Patients were divided into Mild-Moderate I (mild) and Moderate II-Severe (severe) groups based on the COVID-19 severity classification developed by the Ministry of Health, Labor and Welfare (MHLW) of Japan. We compared the patient characteristics as well as the serum cytokine and chemokine levels on the day of admission between the two groups. Our findings indicated that the severe group had significantly higher levels of serum fibrinogen, d-dimer, lactate dehydrogenase, C-reactive protein, ferritin, Krebs von den Lungen-6, surfactant protein (SP)-D, and SP-A than the mild group. Strikingly, the levels of interleukin (IL)-28A/interferon (IFN)-λ2 were significantly lower in the severe group than in the mild group. We believe that reduced levels of type III interferons (IFN-λs) and alterations in the levels of other cytokines and chemokines may impact the severity of the disease.


Assuntos
COVID-19/sangue , Quimiocinas/sangue , Interferons/sangue , SARS-CoV-2/imunologia , Adulto , Idoso , Proteína C-Reativa/análise , COVID-19/patologia , Regulação para Baixo , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Humanos , Interferons/biossíntese , Interleucinas/sangue , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Mucina-1/sangue , Proteína A Associada a Surfactante Pulmonar/sangue , Proteína D Associada a Surfactante Pulmonar/sangue , Índice de Gravidade de Doença
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...