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1.
Am J Nurs ; 121(6): 48-53, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34009162

RESUMO

ABSTRACT: The coronavirus disease 2019 pandemic has escalated clinical needs while interrupting regular processes and straining resources. Striving to deliver optimal care to infected patients with respiratory failure, Rush University Medical Center in Chicago created a multidisciplinary team to provide manual prone positioning safely and efficiently. Team members' experiences, which they shared through a survey, help to illustrate the advantages of a multidisciplinary approach and suggest opportunities to enhance the effectiveness of such a team.


Assuntos
COVID-19/terapia , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Decúbito Ventral , Centros Médicos Acadêmicos , COVID-19/fisiopatologia , Chicago , Humanos , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Respiração Artificial , SARS-CoV-2 , Inquéritos e Questionários
2.
BMC Pregnancy Childbirth ; 21(1): 326, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902483

RESUMO

BACKGROUND: Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS: Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS: A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS: Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.


Assuntos
COVID-19/epidemiologia , Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/fisiopatologia , COVID-19/terapia , Teste de Ácido Nucleico para COVID-19 , Cesárea/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Tosse/fisiopatologia , Diabetes Gestacional/epidemiologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Idade Gestacional , Humanos , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Fatores Imunológicos/uso terapêutico , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Unidades de Terapia Intensiva/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Masculino , Obesidade Materna/epidemiologia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Radiografia Torácica , Respiração Artificial , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Espanha/epidemiologia
7.
BMC Pulm Med ; 21(1): 126, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874930

RESUMO

BACKGROUND: Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea (platypnea) and arterial desaturation in the upright position resolved in the supine position (orthodeoxia). Intracardiac shunt, pulmonary ventilation-perfusion mismatch and others intrapulmonary abnormalities are involved. CASE PRESENTATION: We report a case of POS associated with two pathophysiological issues: one, cardiac POS caused by a patent foramen ovale (PFO) and second, pulmonary POS due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interstitial pneumonia. POS has resolved after recovery of coronavirus disease 2019 (COVID-19) pneumonia. CONCLUSIONS: Right-to-left interatrial shunt and intrapulmonary shunt caused by SARS-CoV-2 pneumonia contributed to refractory hypoxemia and POS. Therefore, in case of COVID-19 patient with unexplained POS, the existence of PFO must be investigated.


Assuntos
COVID-19 , Dispneia , Forame Oval Patente , Hipóxia , Pulmão/diagnóstico por imagem , Pneumonia Viral , COVID-19/diagnóstico , COVID-19/fisiopatologia , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/fisiopatologia , Ecocardiografia/métodos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Forame Oval Patente/fisiopatologia , Hemodinâmica , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/fisiopatologia , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/virologia , Masculino , Pessoa de Meia-Idade , Oxigênio/análise , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Postura/fisiologia , SARS-CoV-2/isolamento & purificação , Síndrome , Resultado do Tratamento
8.
Technol Health Care ; 29(S1): 153-164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33682755

RESUMO

BACKGROUND: The SARS-CoV-2 pneumonia infection is associated with high rates of hospitalization and mortality and this has placed healthcare systems under strain. Our study provides a novel method for the progress prediction, clinical treatment and prognosis of NCP, and has important clinical value for timely treatment of severe NCP patients. OBJECTIVE: To summarize the clinical features and severe illness risk factors of the patients with novel coronavirus pneumonia (NCP), in order to provide support for the progression prediction, clinical treatment and prognosis of NCP patients. MATERIALS AND METHODS: A total of 196 NCP patients treated in our hospital from January 25, 2020 to June 21, 2020 were divided into the severe group and the mild group. The clinical features of the two groups were analyzed and compared. The risk factors were explored by using multivariate logistic regression, and the receiver operating characteristic (ROC) curve was obtained. The correlations of the risk factors with the prognosis of NCP were investigated combined with the lung function test. RESULTS: The primary clinical symptoms of 196 cases of NCP included fever in 167 cases (85.2%) and cough in 121 cases (61.73%). The chest computed tomography (CT) scans of the 178 cases (90.81%) showed a typical ground-glass opacification. In 149 cases, the lymphocyte count was decreased, while the levels of creatine kinase (CK), lactate dehydrogenase (LDH), c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and D-dimer (D-D) increased. 44 cases (22.45%) were found to be severely ill. The multivariate logistic regression analysis demonstrated that age, underlying disease, length of hospital stay, body mass index (BMI), LDH, chest CT visual score, absolute lymphocyte count (ALC) and CRP were risk factors for severe.


Assuntos
COVID-19/diagnóstico por imagem , COVID-19/fisiopatologia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Adulto , Idoso , Índice de Massa Corporal , COVID-19/mortalidade , China , Comorbidade , Progressão da Doença , Feminino , Testes Hematológicos , Humanos , Tempo de Internação , Modelos Logísticos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 100(9): e25072, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655986

RESUMO

RATIONALE: Northern Italy has been particularly hit by the current Covid-19 pandemic. Italian deceased patients have a mean age of 78.5 years and only 1.2% have no comorbidities. These data started a public debate whether patients die "with" or "from" Covid-19. If on one hand the public opinion has been persuaded to believe that Covid-19 infection has poor outcomes just in elderly and/or fragile subjects, on the other hand, hospitals are admitting an increasing number of healthy young patients needing semi-intensive or intensive care units. PATIENT CONCERNS: At the end of March 2020, a 79-year-old patient (M.G.) was admitted to the emergency department of our hospital with a 5 days history of fever, dyspnea, and cough. He was known for hypertension and coronary artery disease with a previous coronary artery stenting. Both the comorbidities were carried out without complications and the patient was previously asymptomatic and in good health. At admission, he was febrile and showed signs of respiratory failure with hypoxia and hypocapnia at blood gas analysis. DIAGNOSIS: The day after, he was tested for SARS-CoV-2 with a real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swab, which turned positive and a chest CT-Scan was consistent with the diagnosis of interstitial pneumonia. INTERVENTIONS: He was treated with i.v. diuretics, paracetamol, prolonged noninvasive ventilation (CPAP), and empiric antibiotic therapy on top of his chronic treatment. OUTCOMES: A treatment with heparin and corticosteroids was started; however, he developed irreversible respiratory failure. Invasive ventilation was not considered appropriate due to his comorbidities, low chances of recovery, and intensive care unit overcrowding. The patient died 9 days after admission. LESSONS: Health conditions that are most reported as risk factors are common cardiovascular diseases that can be managed in modern clinical practice. Through a brief illustrative clinical case, we would like to underline how Covid-19 can be per se the cause of death in patients that would otherwise have had an acceptable life expectancy.


Assuntos
COVID-19 , Doença da Artéria Coronariana , Hipertensão , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral , Idoso , Gasometria/métodos , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/fisiopatologia , Teste de Ácido Nucleico para COVID-19/métodos , Deterioração Clínica , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Evolução Fatal , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertensão/terapia , Masculino , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Medição de Risco , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos
10.
Med. intensiva (Madr., Ed. impr.) ; 45(2): 96-103, mar. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-193526

RESUMO

OBJECTIVE: Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients. DESIGN: Observational and prospective study. SETTING: Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain). PATIENTS: COVID-19 patients admitted in ICU and healthy subjects. INTERVENTIONS: Determination of HLA genetic polymorphisms. MAIN VARIABLE OF INTEREST: Mortality at 30 days. RESULTS: A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p = 0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p = 0.02) and HLA-C*16 (p = 0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR = 7.693; 95% CI = 1.063-55.650; p = 0.04) or APACHE-II (OR = 11.858; 95% CI = 1.524-92.273; p = 0.02), the allele HLA-C*01 after controlling for SOFA (OR = 11.182; 95% CI = 1.053-118.700; p = 0.04) or APACHE-II (OR = 17.604; 95% CI = 1.629-190.211; p = 0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR = 9.963; 95% CI = 1.235-80.358; p = 0.03). CONCLUSIONS: The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn


OBJETIVO: Diferentes polimorfismos genéticos de los antígenos leucocitarios humanos (HLA) están asociados con el riesgo y el pronóstico de enfermedades autoinmunes e infecciosas. Los objetivos de estudio fueron determinar si existe una asociación entre polimorfismos genéticos de HLA y la susceptibilidad y mortalidad de pacientes con la enfermedad del coronavirus 2019 (COVID-19). DISEÑO: Estudio observacional y prospectivo. ÁMBITO: Ocho unidades de cuidados intensivos (UCI) de 6 hospitales de las Islas Canarias (España). PACIENTES: Pacientes COVID-19 ingresados en la UCI y sujetos sanos. INTERVENCIONES: Se determinaron los polimorfismos genéticos de los HLA. VARIABLE DE INTERÉS PRINCIPAL: Mortalidad a los 30 días. RESULTADOS: Se incluyeron 3.886 sujetos sanos y 72 pacientes COVID-19 (10 fallecidos y 62 supervivientes a 30 días). Encontramos una tendencia a una mayor frecuencia de los alelos HLA-A*32 (p = 0,004) en sujetos sanos que en pacientes COVID-19, y de los alelos HLA-B*39 (p = 0,02) y HLA-C*16 (p = 0,02) en pacientes COVID-19 que en sujetos sanos; sin embargo, no fueron significativos al corregir por comparaciones múltiples. En la regresión logística encontramos que la presencia de ciertos alelos estuvo asociada con mayor mortalidad, como el alelo HLA-A*11 controlando por SOFA (OR = 7.693; IC del 95% = 1.063-55.650; p = 0,04) o APACHE-II (OR = 11.858; IC del 95% = 1.524-92.273; p = 0,02), el alelo HLA-C*01 controlando por SOFA (OR = 11.182; IC del 95% = 1.053-118.700; p = 0,04) o APACHE-II (OR = 17.604; IC del 95% = 1.629-190.211; p = 0,02) y el alelo HLA-DQB1*04 controlando por SOFA (OR = 9.963; IC del 95% = 1.235-80.358; p = 0,03). CONCLUSIONES: Los nuevos hallazgos de nuestro preliminar estudio de pequeño tamaño muestral fueron que determinados polimorfismos genéticos de los HLA podrían estar asociados con la mortalidad de pacientes COVID-19; sin embargo, son necesarios estudios de mayor tamaño muestral para concluirlo definitivamente


Assuntos
Pessoa de Meia-Idade , Idoso , Humanos , Polimorfismo Genético , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Betacoronavirus , Prognóstico , Antígenos HLA/análise , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Pandemias , Estudos Prospectivos , Unidades de Terapia Intensiva , Modelos Logísticos , APACHE , Escores de Disfunção Orgânica
11.
Crit Care ; 25(1): 53, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557908

RESUMO

The current pandemic of COVID-19 caused thousands of deaths and healthcare professionals struggle to properly manage infected patients. This review summarizes information about SARS-CoV-2 receptor binding dynamics and intricacies, lung autopsy findings, immune response patterns, evidence-based explanations for the immune response, and COVID-19-associated hypercoagulability.


Assuntos
COVID-19/fisiopatologia , Proteínas de Transporte/fisiologia , Pneumopatias/fisiopatologia , Pneumonia Viral/fisiopatologia , SARS-CoV-2/patogenicidade , COVID-19/imunologia , Proteínas de Transporte/imunologia , Humanos , Pneumopatias/imunologia , Pandemias , Pneumonia Viral/imunologia , SARS-CoV-2/imunologia
12.
Int J Biol Sci ; 17(2): 539-548, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33613111

RESUMO

Rationale: Coronavirus disease 2019 (COVID-19) has caused a global pandemic. A classifier combining chest X-ray (CXR) with clinical features may serve as a rapid screening approach. Methods: The study included 512 patients with COVID-19 and 106 with influenza A/B pneumonia. A deep neural network (DNN) was applied, and deep features derived from CXR and clinical findings formed fused features for diagnosis prediction. Results: The clinical features of COVID-19 and influenza showed different patterns. Patients with COVID-19 experienced less fever, more diarrhea, and more salient hypercoagulability. Classifiers constructed using the clinical features or CXR had an area under the receiver operating curve (AUC) of 0.909 and 0.919, respectively. The diagnostic efficacy of the classifier combining the clinical features and CXR was dramatically improved and the AUC was 0.952 with 91.5% sensitivity and 81.2% specificity. Moreover, combined classifier was functional in both severe and non-serve COVID-19, with an AUC of 0.971 with 96.9% sensitivity in non-severe cases, which was on par with the computed tomography (CT)-based classifier, but had relatively inferior efficacy in severe cases compared to CT. In extension, we performed a reader study involving three experienced pulmonary physicians, artificial intelligence (AI) system demonstrated superiority in turn-around time and diagnostic accuracy compared with experienced pulmonary physicians. Conclusions: The classifier constructed using clinical and CXR features is efficient, economical, and radiation safe for distinguishing COVID-19 from influenza A/B pneumonia, serving as an ideal rapid screening tool during the COVID-19 pandemic.


Assuntos
Teste para COVID-19/métodos , COVID-19/diagnóstico por imagem , Influenza Humana/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Radiografia Torácica , Idoso , COVID-19/epidemiologia , COVID-19/fisiopatologia , COVID-19/virologia , Aprendizado Profundo , Diagnóstico Diferencial , Humanos , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/fisiopatologia , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Curva ROC , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Sensibilidade e Especificidade
18.
Arch. bronconeumol. (Ed. impr.) ; 57(supl.1): 21-34, ene. 2021. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-192603

RESUMO

OBJETIVO: El objetivo del estudio ha sido responder a las siguientes preguntas: ¿se asocia el consumo de tabaco en pacientes con COVID-19 con una progresión negativa y desenlace adverso de la enfermedad? y, ¿se asocia el consumo de tabaco, actual y pasado a una mayor posibilidad de desarrollar COVID-19? MATERIAL Y MÉTODOS: Se realizó una revisión sistemática (RS) y metaanálisis (MA) de trabajos publicados previamente. La estrategia de búsqueda incluyó todos los descriptores conocidos sobre COVID-19 y tabaco, y se realizó en diferentes bases de datos. Se utilizaron modelos estadísticos adecuados para abordar el tamaño del efecto en un MA: modelo de efectos aleatorios y de efectos fijos. RESULTADOS: Fueron identificados 34 artículos en la RS de los cuales fueron incluidos 19 en el MA. Ser fumador o exfumador se mostró como un factor de riesgo para una peor progresión de la infección por COVID-19 (OR 1,96, IC del 95%, 1,36-2,83) y una mayor probabilidad de presentar una condición más crítica de la infección (OR 1,79, IC del 95%, 1,19-2,70). Como limitaciones del MA encontramos que la mayoría de los estudios analizados eran observacionales con un sesgo de publicación limitado y con 2 estudios discrepantes con el resto, aunque tras retirarlos del MA se mantenía el tabaco como un factor de riesgo de peor evolución. CONCLUSIÓN: El tabaquismo actual y pasado produce una forma clínica más grave de la COVID-19 y lleva con mayor frecuencia a estos pacientes a ingresar en Cuidados Intensivos, sean intubados y mueran


OBJECTIVE: The aim of this study was to determine if tobacco use in patients with Covid-19 is associated with a negative disease course and adverse outcome, and if smoking, current and past, is associated with a greater possibility of developing COVID-19. MATERIAL AND METHODS: A systematic review (SR) and meta-analysis (MA) of previously published works were performed. The search strategy included all known descriptors for Covid-19 and tobacco and was conducted in different databases. Appropriate statistical models were used to address the effect size in meta-analysis, namely random effects and fixed effects model. RESULTS: Thirty-four articles were identified in the SR of which 19 were included in the MA. Being a smoker or former smoker was shown to be a risk factor for worse progression of Covid-19 infection (OR 1.96, 95% CI, 1.36 - 2.83) and a greater probability of presenting a more critical condition (OR 1.79 95% CI, 1.19 - 2.70). As limitations of the MA, we found that most of the studies analyzed were observational with limited publication bias. Two studies that disagreed with the rest were included, although after withdrawing them from the MA, smoking was maintained as a risk factor for worse progress. CONCLUSION: Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death


Assuntos
Humanos , Fumar Tabaco/efeitos adversos , Fumar Tabaco/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Pandemias , Índice de Gravidade de Doença , Medicina Baseada em Evidências
19.
Mayo Clin Proc ; 96(1): 32-39, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33413833

RESUMO

OBJECTIVE: To investigate the relationship between maximal exercise capacity measured before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalization due to coronavirus disease 2019 (COVID-19). METHODS: We identified patients (≥18 years) who completed a clinically indicated exercise stress test between January 1, 2016, and February 29, 2020, and had a test for SARS-CoV-2 (ie, real-time reverse transcriptase polymerase chain reaction test) between February 29, 2020, and May 30, 2020. Maximal exercise capacity was quantified in metabolic equivalents of task (METs). Logistic regression was used to evaluate the likelihood that hospitalization secondary to COVID-19 is related to peak METs, with adjustment for 13 covariates previously identified as associated with higher risk for severe illness from COVID-19. RESULTS: We identified 246 patients (age, 59±12 years; 42% male; 75% black race) who had an exercise test and tested positive for SARS-CoV-2. Among these, 89 (36%) were hospitalized. Peak METs were significantly lower (P<.001) among patients who were hospitalized (6.7±2.8) compared with those not hospitalized (8.0±2.4). Peak METs were inversely associated with the likelihood of hospitalization in unadjusted (odds ratio, 0.83; 95% CI, 0.74-0.92) and adjusted models (odds ratio, 0.87; 95% CI, 0.76-0.99). CONCLUSION: Maximal exercise capacity is independently and inversely associated with the likelihood of hospitalization due to COVID-19. These data further support the important relationship between cardiorespiratory fitness and health outcomes. Future studies are needed to determine whether improving maximal exercise capacity is associated with lower risk of complications due to viral infections, such as COVID-19.


Assuntos
COVID-19/fisiopatologia , Tolerância ao Exercício , Hospitalização/estatística & dados numéricos , Pneumonia Viral/fisiopatologia , Teste para COVID-19 , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos , SARS-CoV-2
20.
Rev Paul Pediatr ; 39: e2020217, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876096

RESUMO

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


Assuntos
Infecções por Coronavirus , Síndrome de Linfonodos Mucocutâneos , Pandemias , Pneumonia Viral , Síndrome de Resposta Inflamatória Sistêmica/virologia , Betacoronavirus/isolamento & purificação , COVID-19 , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Gerenciamento Clínico , Humanos , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia , Síndrome de Linfonodos Mucocutâneos/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , SARS-CoV-2
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