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4.
Rev. neurol. (Ed. impr.) ; 70(9): 329-340, 1 mayo, 2020.
Artigo em Espanhol | IBECS | ID: ibc-188037

RESUMO

INTRODUCCIÓN: La pandemia actual por el SARS-CoV-2 está obligando a los neurólogos a una serie de adaptaciones en el manejo de la esclerosis múltiple. Los neurólogos deben sopesar la necesidad de iniciar o continuar los tratamientos modificadores de la enfermedad en función del riesgo de infección, del riesgo de complicaciones de la infección y del riesgo de actividad de la esclerosis múltiple. Dado que ésta es una situación sin precedentes, la mayoría de las decisiones se están tomando sobre la base de un abordaje teórico y del criterio de cada neurólogo. OBJETIVOS: Se pretende, a través de una búsqueda bibliográfica, recopilar la evidencia disponible sobre la relación entre tratamientos modificadores de la enfermedad en la esclerosis múltiple y la infección por el SARS-CoV-2. Esta evidencia, junto con la experiencia de los autores en el manejo de pacientes con esclerosis múltiple durante la pandemia, permitirá brindar algunas propuestas de tratamiento y seguimiento de los pacientes en este contexto epidemiológico. DESARROLLO: Después de la búsqueda bibliográfica y de nuestra experiencia en el manejo de pacientes, se establecen unas propuestas de tratamiento sobre cada fármaco que necesariamente han de individualizarse para cada paciente, ya que, en esta circunstancia excepcional, sus peculiaridades pueden marcar el pronóstico. CONCLUSIONES: El neurólogo debe tener conocimiento de la evidencia actual para valorar el riesgo-beneficio de iniciar, mantener y suspender los tratamientos modificadores de la enfermedad en la esclerosis múltiple durante la pandemia


INTRODUCTION: The current SARS-CoV-2 pandemic is forcing neurologists to carry out a series of adaptations in the management of multiple sclerosis. Neurologists must weigh up the need to start or continue disease-modifying treatments against the risk of infection, the risk of complications from the infection, and the risk of multiple sclerosis activity. Since this is an unprecedented situation, most decisions are being made on the basis of a theoretical approach and the criteria of each neurologist. AIMS: The aim of this study is conduct a literature search to collect available evidence on the relationship between diseasemodifying therapies in multiple sclerosis and SARS-CoV-2 infection. This evidence, together with the experience of the authors in the management of patients with multiple sclerosis during the pandemic, will make it possible to offer some proposals for the treatment and follow-up of patients in this epidemiological context. DEVELOPMENT: After the literature search and our experience in the management of patients, a number of proposals for treatment are established for each drug, which must necessarily be individualised for each patient, since, in these exceptional circumstances, their peculiarities can affect the prognosis. CONCLUSIONS: The neurologist should be aware of current evidence to assess the risk-benefit of starting, maintaining and stopping disease-modifying therapies in multiple sclerosis during the pandemic


Assuntos
Humanos , Infecções por Coronavirus/complicações , Esclerose Múltipla/tratamento farmacológico , Pneumonia Viral/complicações , Betacoronavirus , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Neurologistas , Pandemias , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Gerenciamento Clínico , Tomada de Decisões , Fatores de Risco
5.
Rev. esp. enferm. dig ; 112(5): 383-388, mayo 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-188376

RESUMO

Although SARS-CoV-2 may primarily enter the cells of the lungs, the small bowel may also be an important entry or interaction site, as the enterocytes are rich in angiotensin converting enzyme (ACE)-2 receptors. The initial gastrointestinal symptoms that appear early during the course of COVID-19 support this hypothesis. Furthermore, SARSCoV virions are preferentially released apically and not at the basement of the airway cells. Thus, in the setting of a productive infection of conducting airway epithelia, the apically released SARS-CoV may be removed by mucociliary clearance and gain access to the GI tract via a luminal exposure. In addition, post-mortem studies of mice infected by SARS-CoV have demonstrated diffuse damage to the GI tract, with the small bowel showing signs of enterocyte desquamation, edema, small vessel dilation and lymphocyte infiltration, as well as mesenteric nodes with severe hemorrhage and necrosis. Finally, the small bowel is rich in furin, a serine protease which can separate the S-spike of the coronavirus into two “pinchers” (S1 and 2). The separation of the S-spike into S1 and S2 is essential for the attachment of the virion to both the ACE receptor and the cell membrane. In this special review, we describe the interaction of SARS-CoV-2 with the cell and enterocyte and its potential clinical implications


Assuntos
Humanos , Diarreia/virologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Betacoronavirus/fisiologia , Intestino Delgado/virologia , Serina Proteases/metabolismo , Enterócitos/virologia , Pandemias , Receptor Tipo 2 de Angiotensina/metabolismo , Colite/virologia
9.
J Investig Med High Impact Case Rep ; 8: 2324709620925571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32370558

RESUMO

The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that has significant potential cardiovascular implications for patients. These include myocarditis, acute coronary syndromes, cardiac arrhythmias, cardiomyopathies with heart failure and cardiogenic shock, and venous thromboembolic events. We describe a Caribbean-Black gentleman with COVID-19 infection presenting with atrial arrhythmias, namely, atrial flutter and atrial fibrillation, which resolved with rate and rhythm control strategies, and supportive care.


Assuntos
Fibrilação Atrial/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Tórax/diagnóstico por imagem
12.
Can J Surg ; 63(3): E231-E232, 2020 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386473

RESUMO

Summary: Postoperative fever is common following orthopedic trauma surgery. As the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases in the community, migration into the acute care hospital setting intensifies, creating confusion when fever develops postoperatively. The transmission dynamics of SARS-CoV-2 make it difficult to adequately gauge and pinpoint risk groups with questionnaires at the time of hospital admission. This is particularly problematic when asymptomatic or presymptomatic patients infected with SARS-CoV-2 require urgent surgery and cannot be screened effectively. One approach is to treat every patient as though they were SARS-CoV-2-positive in preparation for surgery, but doing so could exacerbate shortages of personal protective equipment and staffing limitations. Uncertainty regarding the etiology of postoperative fever could be significantly reduced by universal SARS-CoV-2 testing of all surgical patients at the time of hospital admission in addition to routine screening, but testing capacity and a rapid turnaround time would be required.


Assuntos
Infecções por Coronavirus/diagnóstico , Transmissão de Doença Infecciosa/prevenção & controle , Febre/etiologia , Programas de Rastreamento/métodos , Procedimentos Ortopédicos , Pneumonia Viral/diagnóstico , Ferimentos e Lesões/cirurgia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Febre/virologia , Humanos , Programas de Rastreamento/normas , Procedimentos Ortopédicos/efeitos adversos , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Precauções Universais/métodos , Ferimentos e Lesões/complicações
13.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 203-208, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32391665

RESUMO

OBJECTIVE: To explore the risk factors of anxiety and depression in patients with suspected coronavirus disease 2019 (COVID-19) so as to achieve early intervention and better clinical prognosis. METHODS: Seventy-six patients with suspected COVID-19 in fever isolation wards of Second Hospital of Lanzhou University were enrolled From January 31, 2020 to February 22, 2020. Their clinical baseline data were collected. The anxiety of patients was assessed by Hamilton Anxiety Scale, and the depression of patients was assessed by Hamilton Depression Scale. Multivariate Logistic regression analysis was performed to explore the risk factors of anxiety and depression in these patients. RESULTS: Female patients are more likely to have anxiety (OR=3.206, 95%CI: 1.073-9.583, P<0.05) and depression (OR=9.111, 95%CI: 2.143-38.729, P<0.01) than male patients; patients with known contact history of epidemic area and personnel in epidemic area are more likely to have depression (OR=3.267, 95%CI: 1.082-9.597, P<0.05). CONCLUSIONS: During the isolation treatment of suspected COVID-19 patients, early psychological intervention should be carried out for the female patients with known contact history of epidemic area and personnel in epidemic area, and drug treatment should be given in advance if necessary.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Depressão , Pandemias , Pneumonia Viral , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/terapia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Depressão/diagnóstico , Depressão/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Fatores de Risco
14.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 240-244, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32391671

RESUMO

OBJECTIVE: To analyze the clinical characteristics and pregnancy outcomes of pregnant women complicated with coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 3 pregnant women with COVID-19 admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 19 to February 10, 2020 were retrospectively analyzed. RESULTS: There was one case in the first-trimester pregnancy (case 1), one in the second-trimester pregnancy (case 2) and one in third-trimester pregnancy (case 3). Cough, fever, fatigue, lung imaging changes were the main manifestations. The white cell count, lymphocyte percentage had no significantly changes in case 1 and case 3, while the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 elevated. The lymphocyte count and lymphocyte percentage decreased and the inflammatory indicators significantly increased in case 2. All patients were treated with antiviral, antitussive, oxygen inhalation; case 3 received glucocorticoids, case 2 with severe illness received glucocorticoids and additionally gamma globulin. All three cases were cured and discharged. Case 1 with early pregnancy chose to terminate pregnancy after discharge; case 2 chose to continue pregnancy without obstetric complications; and case 3 had cesarean section delivery due to abnormal fetal heart monitoring. CONCLUSIONS: The report shows that COVID-19 in pregnancy women could be cured with active treatment, and the maternal and fetal outcomes can be satisfactory.


Assuntos
Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez , Antivirais/uso terapêutico , Betacoronavirus/isolamento & purificação , Cesárea , Infecções por Coronavirus/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Oxigênio/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/patologia , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento , gama-Globulinas/uso terapêutico
15.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 249-252, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32391673

RESUMO

Since the coronavirus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management and protection of medical staff in the cesarean section is significantly different from that in ordinary surgical operation. This paper reports a case of cesarean section for a woman with COVID-19, which was successfully performed in the First Affiliated Hospital of Zhejiang University School of Medicine on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the pregnant woman during the operation were discussed. Importance has been attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For moderate patients, intraspinal anesthesia is preferred in cesarean section, and try to reduce its influence in respiration and circulation in both maternal and infant; general anesthesia with endotracheal intubation should be adopted for severe or critically ill patients. Ensure the safety of medical environment, and anesthetists should carry out level-Ⅲ standard protection. Special attention and support should be paid to maternal psychology: fully explanation before operation to reduce anxiety; relieve the discomfort during operation, so as to reduce tension; avoid the bad mood due to pain after operation.


Assuntos
Anestesia , Cesárea , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Cesárea/métodos , Infecções por Coronavirus/complicações , Feminino , Humanos , Lactente , Injeções Espinhais , Pneumonia Viral/complicações , Gravidez
16.
Ugeskr Laeger ; 182(18)2020 04 27.
Artigo em Dinamarquês | MEDLINE | ID: mdl-32400371

RESUMO

This case report describes a physician in the early 30ies with subjective anosmia and ageusia as the major presenting symptoms of COVID-19. Apart from a week of slightly runny nose when coming from cold to warm air, the only symptom was a sudden onset of persistent anosmia and ageusia. Two weeks after normalisation of the mild sino-nasal symptoms, the patient was tested positive for SARS-CoV-2, and anosmia was verified with Sniffin' Sticks tests. Hypogeusia was verified with taste screening and two validated taste tests. Olfactory and gustatory loss may be underestimated symptoms of COVID-19.


Assuntos
Ageusia , Infecções por Coronavirus/complicações , Transtornos do Olfato , Pneumonia Viral/complicações , Adulto , Ageusia/virologia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Humanos , Transtornos do Olfato/virologia , Pandemias , Pneumonia Viral/diagnóstico
17.
Rev Bras Ter Intensiva ; 32(1): 2-10, 2020 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401989

RESUMO

Current COVID-19 epidemics was declared on December 31, 2019 at the Wuhan city seafood market, rapidly spreading throughout China, and later reaching several countries (mainly South Korea, Japan, Italy and Iran) and, since March 1, reaching Portugal. Most of the infected patients present with mild symptoms, not requiring hospitalization. Among those admitted to the hospital, 6% to 10% require admission to the intensive care unit. These recommendations are aimed to support the organization of intensive care services to respond COVID-19, providing optimized care to the patient and protection for healthcare professionals.


Assuntos
Infecções por Coronavirus , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral , Guias de Prática Clínica como Assunto , Sepse , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Cuidados Críticos/normas , Hospitalização , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Portugal , Sepse/etiologia , Sepse/terapia
18.
BMJ Case Rep ; 13(5)2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404376

RESUMO

COVID-19 is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first arose in Wuhan, China, in December 2019 and has since been declared a pandemic. The clinical sequelae vary from mild, self-limiting upper respiratory infection symptoms to severe respiratory distress, acute cardiopulmonary arrest and death. Otolaryngologists around the globe have reported a significant number of mild or otherwise asymptomatic patients with COVID-19 presenting with olfactory dysfunction. We present a case of COVID-19 resulting in intensive care unit (ICU) admission, presenting with the initial symptom of disrupted taste and flavour perception prior to respiratory involvement. After 4 days in the ICU and 6 days on the general medicine floor, our patient regained a majority of her sense of smell and was discharged with only lingering dysgeusia. In this paper, we review existing literature and the clinical course of SARS-CoV-2 in relation to the reported symptoms of hyposmia, hypogeusia and dysgeusia.


Assuntos
Ageusia/etiologia , Infecções por Coronavirus/complicações , Disgeusia/etiologia , Pulmão , Pneumonia Viral/complicações , Infecções por Coronavirus/diagnóstico , Hospitalização , Humanos , Unidades de Terapia Intensiva , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X
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