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1.
Arch Ital Urol Androl ; 93(1): 71-76, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33754613

RESUMO

This collection of cases describes some unusual urological tumors and complications related to urological tumors and their treatment. Case 1: A case of uretero-arterial fistula in a patient with long-term ureteral stenting for ureteral oncological stricture and a second case associated to retroperitoneal fibrosis were described. Abdominal CT, pyelography, cystoscopy were useful to show the origin of the bleeding. Angiography is useful for confirming the diagnosis and for subsequent positioning of an endovascular prosthesis which represents a safe approach with reduced post-procedural complications. Case 2: A case of patient who suffered from interstitial pneumonitis during a cycle of intravesical BCG instillations for urothelial cancer. The patient was hospitalized for more than two weeks in a COVID ward for a suspected of COVID-19 pneumonia, but he did not show any evidence of SARS-CoV-2 infection during his hospital stay. Case 3: A case of a young man with a functional urinary bladder paraganglioma who was successfully managed with complete removal of the tumor, leaving the urinary bladder intact. Case 4: A case of a 61 year old male suffering from muscle invasive bladder cancer who was admitted for a radical cystectomy and on the eighth postoperative day developed microangiopathic hemolytic anemia and thrombocytopenia, which clinically defines thrombotic microangiopathy.


Assuntos
Neoplasias Urológicas/terapia , Administração Intravesical , Adulto , Vacina BCG/uso terapêutico , /terapia , Carcinoma de Células de Transição/patologia , Angiografia por Tomografia Computadorizada , Cistectomia , Fístula/complicações , Fístula/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/cirurgia , Paraganglioma/terapia , Pneumonia/complicações , Pneumonia/terapia , Complicações Pós-Operatórias/terapia , Púrpura Trombocitopênica Trombótica/etiologia , Púrpura Trombocitopênica Trombótica/terapia , Doenças Ureterais/complicações , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/terapia , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/terapia , Neoplasias Urológicas/complicações , Neoplasias Urológicas/diagnóstico por imagem
2.
Med Sci Monit ; 27: e928837, 2021 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-33580949

RESUMO

BACKGROUND Coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organization (WHO) in March 2020. To further reveal the pathologic associations between coronavirus and hypoxemia, we report the findings of 4 complete systematic autopsies of severe acute respiratory syndrome coronavirus 2-positive individuals who died of multiple organ failure caused by severe hypoxemia. MATERIAL AND METHODS We examined the donated corpses of 4 deceased patients who had been diagnosed with severe acute respiratory syndrome coronavirus 2. A complete post-mortem examination was carried out on each corpse, and multiple organs were macroscopically examined. RESULTS The 4 corpses were 2 males and 2 females, with an average age of 69 years. Bilateral lungs showed various degrees of atrophy and consolidation, with diffusely tough and solid texture in the sections. A thromboembolism was found in the main pulmonary artery extending into the atrium in 1 corpse, and significant atherosclerotic plaques tagged in the inner wall of the aortic arch were found in 2 corpses. Two corpses were found to have slightly atrophied bilateral renal parenchyma. Atrophic changes in the spleen were found in 2 corpses. Notably, there were significantly expanded alveolar septa and prominent fibroblastic proliferation. CONCLUSIONS The laboratory data of these corpses showed a progressive decrease in blood oxygen saturation, followed by refractory and irreversible hypoxemia. Clinical and laboratory information and autopsy and histologic presentations of multiple organs showed insufficient air exchange due to abnormalities in the respiratory system, and reduced erythropoiesis in bone marrow may play a role.


Assuntos
Autopsia , /virologia , Hipóxia/complicações , Hipóxia/patologia , Pneumonia/patologia , Pneumonia/virologia , /fisiologia , Idoso , Idoso de 80 Anos ou mais , Células Epiteliais Alveolares/metabolismo , Células Epiteliais Alveolares/patologia , Agregação Celular , Feminino , Humanos , Pulmão/patologia , Macrófagos/patologia , Masculino , Pessoa de Meia-Idade , Muco/metabolismo , Miocárdio/patologia , Necrose , Pneumonia/complicações , Cavidade Torácica/patologia
3.
Am J Emerg Med ; 42: 49-54, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33450707

RESUMO

INTRODUCTION: Low muscle mass is associated with an increased mortality risk due to medical comorbidities such as chronic obstructive pulmonary disease, cardiovascular disease, and cerebrovascular disease. Computed tomography (CT) has been identified as the gold standard for measuring body composition. We evaluated the relationship between the L1 SMI measured from CT and in-hospital mortality in patients with community-acquired pneumonia (CAP). METHODS: From January 2015 to June 2015, 311 patients who were diagnosed with CAP and underwent CT in the ED were retrospectively analyzed. Multivariate binary logistic regression analysis was used to assess independent predictors of in-hospital mortality. All variables with a significance level < 0.1 by univariate analysis were included in a multivariate logistic regression model. The primary outcome was all-cause in-hospital mortality. RESULTS: Among the 311 patients, 33 (10.6%) died. We divided the patients into two groups based on the optimal sex-specific cut-off value of the L1 SMI (45 cm2/m2 in males and 40 cm2/m2 in females). A low L1 SMI was present in 90 (28.9%) of the 311 patients. In multivariate analysis, low L1 SMI, diabetes mellitus, albumin and APACHE II score were significantly associated with in-hospital mortality (aOR 3.39, 3.73, 0.09 and 1.10, respectively). CONCLUSION: SMI assessment at L1 is achievable in patients with CAP receiving routine chest CT, and the L1 SMI is associated with high in-hospital mortality, more hospitalizations and ventilator application in patients with CAP in the ED. This could help establish an early strategy for critical care of patients with L1 SMI obtained by chest CT for diagnosis in CAP patients in the ED.


Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Mortalidade Hospitalar , Músculo Esquelético/patologia , Pneumonia/mortalidade , Sarcopenia/complicações , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/patologia , Infecções Comunitárias Adquiridas/terapia , Cuidados Críticos , Feminino , Hospitalização , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Pneumonia/complicações , Pneumonia/patologia , Pneumonia/terapia , Respiração Artificial , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Tomografia Computadorizada por Raios X
4.
PLoS One ; 16(1): e0245924, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481950

RESUMO

SARS-CoV-2 is a single stranded RNA (ssRNA) virus and contains GU-rich sequences distributed abundantly in the genome. In COVID-19, the infection and immune hyperactivation causes accumulation of inflammatory immune cells, blood clots, and protein aggregates in lung fluid, increased lung alveolar wall thickness, and upregulation of serum cytokine levels. A serum protein called serum amyloid P (SAP) has a calming effect on the innate immune system and shows efficacy as a therapeutic for fibrosis in animal models and clinical trials. Here we show that aspiration of the GU-rich ssRNA oligonucleotide ORN06 into mouse lungs induces all of the above COVID-19-like symptoms. Men tend to have more severe COVID-19 symptoms than women, and in the aspirated ORN06 model, male mice tended to have more severe symptoms than female mice. Intraperitoneal injections of SAP starting from day 1 post ORN06 aspiration attenuated the ORN06-induced increase in the number of inflammatory cells and formation of clot-like aggregates in the mouse lung fluid, reduced ORN06-increased alveolar wall thickness and accumulation of exudates in the alveolar airspace, and attenuated an ORN06-induced upregulation of the inflammatory cytokines IL-1ß, IL-6, IL-12p70, IL-23, and IL-27 in serum. SAP also reduced D-dimer levels in the lung fluid. In human peripheral blood mononuclear cells, SAP attenuated ORN06-induced extracellular accumulation of IL-6. Together, these results suggest that aspiration of ORN06 is a simple model for both COVID-19 as well as cytokine storm in general, and that SAP is a potential therapeutic for diseases with COVID-19-like symptoms and/or a cytokine storm.


Assuntos
/tratamento farmacológico , Síndrome da Liberação de Citocina/tratamento farmacológico , Pneumonia/tratamento farmacológico , Componente Amiloide P Sérico/uso terapêutico , Animais , /patologia , Síndrome da Liberação de Citocina/complicações , Síndrome da Liberação de Citocina/patologia , Modelos Animais de Doenças , Feminino , Humanos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Pneumonia/complicações , Pneumonia/patologia , Componente Amiloide P Sérico/administração & dosagem
5.
Cytokine ; 140: 155438, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33493861

RESUMO

BACKGROUND: Patients infected by SARS-CoV-2 can develop interstitial pneumonia, requiring hospitalisation or mechanical ventilation. Increased levels of inflammatory biomarkers are associated with development of acute respiratory distress syndrome (ARDS). The aim of the present study was to determine which cytokines are associated with respiratory insufficiency in patients hospitalised for COVID-19. PATIENTS AND METHODS: Data on 67 consecutive patients were collected between March 8 and March 30, 2020. PaO2/FiO2 ratio (P/F) was calculated at hospital admission. The following cytokines were analysed: interleukin (IL)-6, IL-1α, IL-18, tumour necrosis factor (TNF)-ß, macrophage colony-stimulating factor (M-CSF), macrophage migration inhibitory factor (MIF), soluble IL-2 receptor alpha (sIL-2Rα; CD25), IL-12ß, IL-3, interferon (IFN) α2a, monokine induced by gamma interferon (MIG), monocyte-chemotactic protein 3 (MCP3) and hepatocyte growth factor (HGF). RESULTS: P/F lower than 300 was recorded in 22 out of 67 patients (32.8%). P/F strongly correlated with IL-6 (r = -0.62, P < 0.0001), M-CSF (r = -0.63, P < 0.0001), sIL-2Rα (r = -0.54, P < 0.0001), and HGF (r = -0.53, P < 0.0001). ROC curve analyses for IL-6 (AUC 0.83, 95% CI 0.73-0.93, P < 0.0001), M-CSF (AUC 0.87, 95% CI 0.79-0.96, P < 0.0001), HGF (AUC 0.81, 95% CI 0.70-0.93, P < 0.0001), and sIL-2Rα (AUC 0.80, 95% CI, 0.69-0.90, P < 0.0001) showed that these four soluble factors were highly significant. All four soluble factors correlated with LDH, white blood cell count, neutrophil count, lymphocyte count, and CRP. CONCLUSION: IL-6, M-CSF, sIL-2Rα, and HGF are possibly involved in the main biological processes of severe COVID-19, mirroring the level of systemic hyperinflammatory state, the level of lung inflammation, and the severity of organ damage.


Assuntos
/sangue , Citocinas/sangue , Imunidade Inata/imunologia , Inflamação/sangue , Subunidade alfa de Receptor de Interleucina-2/sangue , Insuficiência de Múltiplos Órgãos/sangue , Pneumonia/sangue , Idoso , /virologia , Feminino , Fator de Crescimento de Hepatócito/sangue , Interações Hospedeiro-Patógeno , Humanos , Inflamação/complicações , Interleucina-6/sangue , Fator Estimulador de Colônias de Macrófagos/sangue , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Pneumonia/complicações , Pneumonia/virologia , Estudos Retrospectivos , /fisiologia
6.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495195

RESUMO

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Insuficiência Adrenal/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Testes de Função do Córtex Suprarrenal , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/complicações , Insuficiência Adrenal/tratamento farmacológico , Idoso , Asma/tratamento farmacológico , Proteína C-Reativa/metabolismo , Diagnóstico Diferencial , Ecocardiografia , Eczema/tratamento farmacológico , Eletrocardiografia , Glucocorticoides/efeitos adversos , Terapia de Reposição Hormonal , Humanos , Hidrocortisona/uso terapêutico , Hiperpotassemia/etiologia , Hiponatremia/etiologia , Masculino , Pneumonia/complicações , Pneumonia/diagnóstico , Cardiomiopatia de Takotsubo/complicações
7.
ESC Heart Fail ; 8(1): 37-46, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33350605

RESUMO

AIMS: COVID-19, a respiratory viral disease causing severe pneumonia, also affects the heart and other organs. Whether its cardiac involvement is a specific feature consisting of myocarditis, or simply due to microvascular injury and systemic inflammation, is yet unclear and presently debated. Because myocardial injury is also common in other kinds of pneumonias, we investigated and compared such occurrence in severe pneumonias due to COVID-19 and other causes. METHODS AND RESULTS: We analysed data from 156 critically ill patients requiring mechanical ventilation in four European tertiary hospitals, including all n = 76 COVID-19 patients with severe disease course requiring at least ventilatory support, matched to n = 76 from a retrospective consecutive patient cohort of severe pneumonias of other origin (matched for age, gender, and type of ventilator therapy). When compared to the non-COVID-19, mortality (COVID-19 = 38.2% vs. non-COVID-19 = 51.3%, P = 0.142) and impairment of systolic function were not significantly different. Surprisingly, myocardial injury was even more frequent in non-COVID-19 (96.4% vs. 78.1% P = 0.004). Although inflammatory activity [C-reactive protein (CRP) and interleukin-6] was indifferent, d-dimer and thromboembolic incidence (COVID-19 = 23.7% vs. non-COVID-19 = 5.3%, P = 0.002) driven by pulmonary embolism rates (COVID-19 = 17.1% vs. non-COVID-19 = 2.6%, P = 0.005) were higher. CONCLUSIONS: Myocardial injury was frequent in severe COVID-19 requiring mechanical ventilation, but still less frequent than in similarly severe pneumonias of other origin, indicating that cardiac involvement may not be a specific feature of COVID-19. While mortality was also similar, COVID-19 is characterized with increased thrombogenicity and high pulmonary embolism rates.


Assuntos
/complicações , Cardiomiopatias/etiologia , Doença Aguda , Idoso , /terapia , Cardiomiopatias/mortalidade , Estudos de Casos e Controles , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Miocardite/etiologia , Miocardite/mortalidade , Pneumonia/complicações , Respiração Artificial , Estudos Retrospectivos , Centros de Atenção Terciária
8.
Rev. medica electron ; 42(6): 2560-2574, nov.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1150037

RESUMO

RESUMEN Introducción: la neumonía adquirida en la comunidad es la enfermedad infecciosa que conlleva una mayor mortalidad en los países desarrollados. El diagnóstico pasa por varios momentos, el cuadro clínico, la analítica y las imágenes. Objetivos: realizar la validación externa de un modelo matemático predictivo de mortalidad en pacientes ingresados por neumonía grave adquirida en la comunidad. Material y métodos: estudio longitudinal prospectivo (cohorte) con un grupo, con todos los pacientes que ingresaron en la Unidad de Cuidados intensivos emergentes con el diagnóstico de neumonía adquirida en la comunidad en el Hospital Militar Dr. Carlos J. Finlay, de febrero de 2018 hasta marzo del 2019. El universo estuvo constituido por 160 pacientes y no se tomó muestra alguna. Resultados: índice de Kappa K=1. Test Hosmer Lemenshow 0,650 con elevado ajuste. Resultados del modelo con sensibilidad= 79%. Especificidad: 91% con (VPP): 80 y (VPN)= 91. RR: 9,1. Área bajo la Curva = 0997. Porcentaje de aciertos en la regresión logística de 88,4 %. Conclusiones: el modelo propuesto constituyo una herramienta útil en la detección temprana de pacientes con riesgo de muerte a corto plazo. Permitió unificar en una sola variable el resultado de otras que aparentemente no tienen relación entre ellas; con lo que se hace más fácil la interpretación de los resultados, toda vez que este refleja, el conjunto y no la individualidad (AU).


SUMMARY Introduction: community-acquired pneumonia is the infectious disease leading to higher mortality in developed countries. The diagnosis goes through several moments, clinical symptoms, analytics, and images. Objective: to perform the external validation of a predictive mathematical model of mortality in patients admitted by serious community-acquired pneumonia. Methods: longitudinal prospective (cohort) study with a group formed with all patients who were admitted to the Emergent Intensive Care Unit in the Military Hospital ¨Dr. Carlos Juan Finlay¨ with the diagnosis of community-acquired pneumonia, from February 2018 to March 2019. The universe was formed by 160 patients and no sample was chosen. Results: Kappa index K= 1. Hosmer Lemenshow test= 0.650 with a high adjustment. Result of the model with sensibility= 79 %. Specificity= 91 % with (APV) = 80 and (NPV) = 91. RR= 9.1. Area under the curve= 0997. Percentage of correctness in logistic regression of 88.4 %. Conclusions: The proposed model was a useful tool in the early detection of patients at near-term death risk. It allowed to unite in an only variant the result of others that apparently are not related one to another, making it easier the interpretation of the results, since it reflects the whole and not the individuality (AU).


Assuntos
Humanos , Masculino , Feminino , Idoso , Pneumonia/mortalidade , Idoso/fisiologia , Pneumonia/complicações , Pneumonia/diagnóstico , Cuidados Críticos/métodos , Previsões/métodos , Assistência ao Paciente/métodos
9.
PLoS One ; 15(12): e0244349, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347477

RESUMO

BACKGROUND: Angiotensin-converting enzyme 2 is the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for entry into lung cells. Because ACE-2 may be modulated by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk of coronavirus disease 2019 (COVID-19) pneumonia. AIM: This study sought to analyze the association of COVID-19 pneumonia with previous treatment with ACEIs and ARBs. MATERIALS AND METHODS: We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by polymerase chain reaction assay. Patients were split into two groups, according to whether (group 1, n = 484) or not (group 2, n = 250) COVID-19 was confirmed. Multivariable adjusted comparisons included a propensity score analysis. RESULTS: The mean age was 63.6 ± 18.7 years, and 302 patients (44%) were female. Hypertension was present in 42.6% and 38.4% of patients in groups 1 and 2, respectively (P = 0.28). Treatment with ARBs was more frequent in group 1 than group 2 (20.7% vs. 12.0%, respectively; odds ratio [OR] 1.92, 95% confidence interval [CI] 1.23-2.98; P = 0.004). No difference was found for treatment with ACEIs (12.7% vs. 15.7%, respectively; OR 0.81, 95% CI 0.52-1.26; P = 0.35). Propensity score-matched multivariable logistic regression confirmed a significant association between COVID-19 and previous treatment with ARBs (adjusted OR 2.36, 95% CI 1.38-4.04; P = 0.002). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged > 60 years, women, and hypertensive patients. CONCLUSIONS: This study suggests that ACEIs and ARBs are not similarly associated with COVID-19. In this retrospective series, patients with COVID-19 pneumonia more frequently had previous treatment with ARBs compared with patients without COVID-19.


Assuntos
Bloqueadores do Receptor Tipo 2 de Angiotensina II/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Pneumonia/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueadores do Receptor Tipo 2 de Angiotensina II/uso terapêutico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Estudos Retrospectivos , Fatores de Risco
10.
Environ Health Perspect ; 128(12): 127004, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33325772

RESUMO

BACKGROUND: Environmental cadmium exposure is widespread. In humans, cadmium is poorly excreted, triggers pulmonary inflammation, reduces pulmonary function, and enhances lung injury by respiratory syncytial virus. OBJECTIVES: We examined the association of cadmium burden with mortality related to influenza or pneumonia. METHODS: This prospective analysis of the National Health and Nutrition Examination Survey (NHANES) included 7,173 and 8,678 participants ≥45 years of age enrolled in NHANES-III and NHANES 1999-2006, respectively. Associations were evaluated between cadmium and mortality from influenza or pneumonia during a median follow-up of 17.3 y (NHANES-III, based on creatinine-corrected urine cadmium) and 11.4 y (NHANES 1999-2006, based on blood cadmium). Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HRs) comparing the mortality of individuals at the 80th vs. the 20th percentile of cadmium concentrations. RESULTS: In NHANES-III, after adjustment for sex, race/ethnicity, education, body mass index, serum cholesterol, hypertension, and NHANES phase (or cycle), the HR comparing influenza or pneumonia mortality among participants with creatinine-corrected urinary cadmium in the 80th vs. 20th percentile was 1.15 (95% CI: 1.05, 1.26; p=0.002) in the population as a whole and 1.27 (95% CI: 1.12, 1.43; p=0.002) among never smokers. In NHANES 1999-2006, adjusted HRs for the 80th vs. 20th percentile of blood cadmium were 1.14 (95% CI: 0.96, 1.36; p=0.15) for the overall population and 1.71 (95% CI: 0.95, 3.09; p=0.07) in never smokers. DISCUSSION: Among middle-aged and older adults in the United States, higher cadmium burdens are associated with higher mortality from influenza or pneumonia. This raises the possibility that cadmium may worsen outcomes from COVID-19 infections. https://doi.org/10.1289/EHP7598.


Assuntos
/mortalidade , Cádmio/sangue , Poluentes Ambientais/sangue , Influenza Humana/mortalidade , Pneumonia/mortalidade , Idoso , Idoso de 80 Anos ou mais , /complicações , Exposição Ambiental , Feminino , Humanos , Influenza Humana/sangue , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Pneumonia/sangue , Pneumonia/complicações , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estados Unidos/epidemiologia
11.
Sci Rep ; 10(1): 19196, 2020 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-33154542

RESUMO

Computed tomography (CT) is the preferred imaging method for diagnosing 2019 novel coronavirus (COVID19) pneumonia. We aimed to construct a system based on deep learning for detecting COVID-19 pneumonia on high resolution CT. For model development and validation, 46,096 anonymous images from 106 admitted patients, including 51 patients of laboratory confirmed COVID-19 pneumonia and 55 control patients of other diseases in Renmin Hospital of Wuhan University were retrospectively collected. Twenty-seven prospective consecutive patients in Renmin Hospital of Wuhan University were collected to evaluate the efficiency of radiologists against 2019-CoV pneumonia with that of the model. An external test was conducted in Qianjiang Central Hospital to estimate the system's robustness. The model achieved a per-patient accuracy of 95.24% and a per-image accuracy of 98.85% in internal retrospective dataset. For 27 internal prospective patients, the system achieved a comparable performance to that of expert radiologist. In external dataset, it achieved an accuracy of 96%. With the assistance of the model, the reading time of radiologists was greatly decreased by 65%. The deep learning model showed a comparable performance with expert radiologist, and greatly improved the efficiency of radiologists in clinical practice.


Assuntos
Infecções por Coronavirus/complicações , Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Pneumonia Viral/complicações , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Razão Sinal-Ruído , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
12.
Sci Rep ; 10(1): 19649, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33184424

RESUMO

We examined characteristics of chest CT across different time periods for patients with COVID-19 pneumonia in Huizhou, China. This study included 56 COVID-19 patients with abnormal CT acquired between January 22 and March 3, 2020. The 141 scans of 56 patients were classified into four groups (Groups 1-4) based on dates on which scans were obtained at the 1st, 2nd, 3rd week or longer than three weeks after illness onset. Forty-five patients with follow-up scans were categorized into four groups (Groups A-D) according to extent that lesions reduced (≥ 75%, 50-75%, 25-50% and < 25%). Ground-glass opacities (GGO) was prevalent in Groups 1-4 (58.1-82.6%), while percentages of consolidation ranged between 9.7% in Group 4 and 26.2% in Group 2. The highest frequency of fibrous stripes occurred in Group 3 (46.7%). Total CT scores were on average higher in Groups 2-3. Among 45 follow-up patients, 11 (24.4%) of them recovered with lesions reducing ≥ 75%, with the lowest median age and total CT scores on admission. There are temporal patterns of lung abnormalities in COVID-19 patients, with higher extent of lesion involvement occurring in the 2nd and 3rd week. Persisting lung changes indicate some patients may need isolation after discharge from hospital.


Assuntos
Infecções por Coronavirus/complicações , Pulmão/diagnóstico por imagem , Pneumonia Viral/complicações , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia
13.
Wiad Lek ; 73(8): 1707-1711, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055338

RESUMO

OBJECTIVE: The aim: To assess the metabolic by-products of nitric oxide in peripheral blood before and after the medicamentous management in patients suffering from community-acquired pneumonia associated with coronary heart disease. PATIENTS AND METHODS: Materials and methods: We have examined 102 patients with community-acquired pneumonia aged from 50 to 65 years, of which 58 patients were diagnosed with coronary heart disease (CHD). The complex treatment of patients with coronary heart disease was supplemented by the additional use of tivortin aspartate, which was taken orally with food at the dose of 5 ml (1g) 3 times a day for 15 days. The NO content in blood plasma was assessed by the concentration of the amount of final NO metabolites (NO3 + NO2), identified by means of the photocalorimetric method. RESULTS: Results: The content of (NO3 + NO2) in peripheral blood of patients with CAP was slightly higher (6.83 ± 0.29) µmol/l as compared to the group of apparently healthy individuals (5.19 ± 0.14) µmol/l, while in patients with CAP associated with CHD it has markedly increased to (12.74 ± 1.09) µmol/l. Against the background of administered treatment, the index of (NO3 + NO2) in patients with coronary heart disease has decreased to (5.76 ± 0.33) µmol/l, while in the group of patients who were not given tivortin aspartate additionally, this index has even slightly increased (7.01 ± 0.40) µmol/l. CONCLUSION: Conclusions: Marked increase of (NO3 + NO2) levels in blood pointed to destabilization of the course of coronary heart disease with CAP, which was eliminated by the involvement of tivortin aspartate (15 days) to the main course of treatment.


Assuntos
Infecções Comunitárias Adquiridas , Doença das Coronárias , Pneumonia , Idoso , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/tratamento farmacológico , Doença das Coronárias/complicações , Doença das Coronárias/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Óxido Nítrico , Nitritos , Pneumonia/complicações , Pneumonia/tratamento farmacológico
14.
Acta pediátr. hondu ; 11(1): 1096-1102, abr.- sept. 2020. tab, map, graf
Artigo em Espanhol | LILACS | ID: biblio-1140359

RESUMO

Antecedentes: El 31 de diciembre de 2019, Chi-na comunicó un reporte de casos de neumonía de etiología desconocida. El 11 de febrero de 2020, la Organización Mundial de la Salud (OMS) de-nominó a la enfermedad por coronavirus 2019: COVID-19.(1) En América Latina el primer caso se confirmó el 25 de febrero de 2020 en Brasil.(2) En Honduras se confirmaron los dos primeros casos de COVID-19 el 10 de marzo,(3) y el primer caso en edad pediátrica en San Pedro Sula (S.P.S.) se confirmó el 25 de marzo de 2020.(4)Objetivo: Caracterizar clínica y epidemiológicamente la enfermedad por coronavirus 2019 en la edad pediátrica en S.P.S., Honduras. Pacientes y mé-todos: Estudio cuantitativo, descriptivo, y trans-versal. Se utilizó un muestreo no probabilístico de 415 pacientes en edad pediátrica (IC 95%) a quienes se les realizó una prueba de reacción en cadena de la polimerasa en tiempo real (PCR-tr). Las variables estudiadas fueron: sociodemográ-ficas, curso de la enfermedad, manifestaciones clínicas, factores de riesgo, manejo del pacien-te, condición actual del paciente y distribución según el establecimiento de salud notificante. La información recolectada fue ingresada en una base de datos y analizada en Microsoft Ex-cel. Resultados: 170 (40.96%) pacientes en edad pediátrica resultaron positivos. El grupo etáreo más afectado fueron los adolescentes (54.71%). El curso de la enfermedad fue sintomático en 124 pacientes. El síntoma que más frecuentemente se reportó fue fiebre (37.10%). A la fecha de finalización del estudio, 152 con-tinuaban activos con COVID-19. Conclusiones: Este estudio resume las principales característi-cas clínicas y epidemiológicas de la COVID-19 en niños y adolescentes de S.P.S...(AU)


Assuntos
Humanos , Criança , Reação em Cadeia da Polimerase/métodos , Infecções por Coronavirus/transmissão , Pneumonia/complicações , Insuficiência Respiratória
15.
Acta pediátr. hondu ; 11(1): 1142-1147, abr.- sept. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1145398

RESUMO

Las infecciones respiratorias agudas son causa de alta morbi-mortalidad a nivel mundial. El Coronavirus descubierto en Wuhan, China en el 2019 es de interés mundial por las diferentes manifestaciones clínicas que pueden aparecer en niños. Nuestro objetivo principal es revisar las manifestaciones del COVID-19 en el aparato respiratorio y los hallazgos a nivel radiológicos en pediatría. Se estiman que solo el 5,7% de los niños han sido hospitalizados, siendo los niños con comorbilidades y menores de 1 año los que suponen un riesgo mayor para enfermedad grave. A nivel global la mediana de edad de presentación de los casos es alrededor de 7 años, detectándose más casos a mayor edad, pero siendo la gravedad inversamente proporcional a la edad. La forma asintomática o leve son las presentaciones más comunes reportadas en niños, siendo de hasta en el 90% de los niños infectados. Los estudios de laboratorio pueden ser normales o presentar leucocitos alterados en un 69,2% y a nivel radiológico se ha observado en niños que en un 69% presentan opacidades bilaterales en vidrio despulido. En este momento, cualquier infección respiratoria aguda hay que descartar COVID-19, para poder evitar complicaciones en el paciente...(AU)


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Vírus da SARS , Pneumopatias/complicações , Pneumonia/complicações , Infecções por Coronavirus
16.
J Cancer Res Clin Oncol ; 146(12): 3385-3388, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32857179

RESUMO

PURPOSE: Coronavirus disease 2019 (COVID-19) tends to affect multiple organs and induce abnormal laboratory parameters. We designed this study to investigate the association between carcinoembryonic antigen (CEA) elevation and SARS-CoV-2 infection. METHODS: We retrospectively analyzed 177 patients with confirmed SARS-CoV-2 infection who received plasma CEA assays during hospitalization. Patients with other causes of CEA elevation were excluded. Data regarding epidemiological and demographical characteristics, clinical symptoms, laboratory tests, and outcomes were analyzed. Linear regression analysis was used to evaluate the correlation between CEA levels and inflammation severity. RESULTS: 171 patients were included in the final study and 32 patients (18.7%) had raised serum of CEA (> 5 ng/ml), with a median (range) age of 66 (53-86). The median [interquartile range (IQR)] CEA level was 11.4 ng/ml (8.1-21.6), which was significantly higher than the upper limit of reference range. CEA level between 5-10 ng/ml was in 11 patients, 10-15 ng/ml in 10 patients, and > 15 ng/ml in 11 patients. No correlation was found between CEA levels and lymphocyte (R2 = 0.055; P = 0.10) nor CRP (R2 = 0.026; P = 0.38). The median levels of CEA were 20.0 ng/ml (IQR, 14.7-23.0) in non-survivors and 10.9 ng/ml (IQR 7.5-16.1) in survivors, and the difference between two groups was statistically significant (P = 0.048). CONCLUSION: SARS-CoV-2 infection might be another cause of CEA elevation, with nearly 20% of patients experienced transient and marked CEA increment during COVID-19 pneumonia. The false-positive results of CEA elevation might have clinical significance for patients with colorectal cancer.


Assuntos
Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/sangue , Infecções por Coronavirus/sangue , Pneumonia Viral/sangue , Pneumonia/sangue , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/complicações , Pneumonia/patologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia
17.
J Alzheimers Dis ; 77(1): 67-73, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804094

RESUMO

BACKGROUND: Facing the novel coronavirus disease 2019 (COVID-19), most vulnerable individuals are seniors, especially those with comorbidities. More attention needs to been paid to the COVID-19 patients with Alzheimer's disease (AD), which is the top age-related neurodegenerative disease. OBJECTIVE: Since it is unclear whether AD patients are prone to COVID-19 infection and progression to severe stages, we report for the first time a retrospective analysis of the clinical characteristics of AD patients with COVID-19 pneumonia. METHODS: We conducted a retrospective cohort study of the clinical data of 19 AD patients with COVID-19 pneumonia, compared with 23 non-AD COVID-19 patients admitted at the same time to our hospital. Demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. RESULTS: Between AD patients and non-AD patients with COVID-19 pneumonia, the pneumonia severity was not significantly different. AD patients had a higher clustering onset than non-AD patients. The median duration from symptom onset to hospitalization were shorter in AD patients than non-AD patients, indicating the former were sent to the hospital by their family or from nursing home earlier than the later. The median duration from hospitalization to discharge seemed shorter in AD patients than non-AD patients. Dementia patients seemed less likely to report fatigue. It is noticed that more AD patients might have pericardial effusion than the non-AD patients. CONCLUSION: AD patients with COVID-19 were in milder conditions with a better prognosis than non-AD patients. AD patients who had adequate access to healthcare showed resilience to COVID-19 with shorter hospital stays.


Assuntos
Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Resiliência Psicológica , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Estudos de Coortes , Progressão da Doença , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Alta do Paciente/estatística & dados numéricos , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Pneumonia/complicações , Pneumonia/terapia , Prognóstico
18.
Biomed Eng Online ; 19(1): 66, 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32814568

RESUMO

BACKGROUND: Chest CT screening as supplementary means is crucial in diagnosing novel coronavirus pneumonia (COVID-19) with high sensitivity and popularity. Machine learning was adept in discovering intricate structures from CT images and achieved expert-level performance in medical image analysis. METHODS: An integrated machine learning framework on chest CT images for differentiating COVID-19 from general pneumonia (GP) was developed and validated. Seventy-three confirmed COVID-19 cases were consecutively enrolled together with 27 confirmed general pneumonia patients from Ruian People's Hospital, from January 2020 to March 2020. To accurately classify COVID-19, region of interest (ROI) delineation was implemented based on ground-glass opacities (GGOs) before feature extraction. Then, 34 statistical texture features of COVID-19 and GP ROI images were extracted, including 13 gray-level co-occurrence matrix (GLCM) features, 15 gray-level-gradient co-occurrence matrix (GLGCM) features and 6 histogram features. High-dimensional features impact the classification performance. Thus, ReliefF algorithm was leveraged to select features. The relevance of each feature was the average weights calculated by ReliefF in n times. Features with relevance larger than the empirically set threshold T were selected. After feature selection, the optimal feature set along with 4 other selected feature combinations for comparison were applied to the ensemble of bagged tree (EBT) and four other machine learning classifiers including support vector machine (SVM), logistic regression (LR), decision tree (DT), and K-nearest neighbor with Minkowski distance equal weight (KNN) using tenfold cross-validation. RESULTS AND CONCLUSIONS: The classification accuracy (ACC), sensitivity (SEN), specificity (SPE) of our proposed method yield 94.16%, 88.62% and 100.00%, respectively. The area under the receiver operating characteristic curve (AUC) was 0.99. The experimental results indicate that the EBT algorithm with statistical textural features based on GGOs for differentiating COVID-19 from general pneumonia achieved high transferability, efficiency, specificity, sensitivity, and impressive accuracy, which is beneficial for inexperienced doctors to more accurately diagnose COVID-19 and essential for controlling the spread of the disease.


Assuntos
Infecções por Coronavirus/complicações , Processamento de Imagem Assistida por Computador , Aprendizado de Máquina , Pneumonia Viral/complicações , Pneumonia/complicações , Pneumonia/diagnóstico , Feminino , Humanos , Masculino , Pandemias , Tomografia Computadorizada por Raios X
19.
PLoS One ; 15(7): e0235207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32629459

RESUMO

BACKGROUND AND AIMS: The effects of physician specialty on the outcome of heart disease remains incompletely understood because of inconsistent findings from some previous studies. Our purpose is to compare the admission outcomes of heart disease in patients receiving care by cardiologists and noncardiologist (NC) physicians. METHODS: Using reimbursement claims data of Taiwan's National Health Insurance from 2008-2013, we conducted a matched study of 6264 patients aged ≥20 years who received a cardiologist's care during admission for heart disease. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, and type of heart disease, 6264 controls who received an NC physician's care were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for complications and mortality during admission for heart disease associated with a cardiologist's care. RESULTS: Patients who received a cardiologist's care had a lower risk of pneumonia (OR = 0.61; 95% CI, 0.53-0.70), septicemia (OR = 0.49; 95% CI, 0.39-0.61), urinary tract infection (OR = 0.76; 95% CI, 0.66-0.88), and in-hospital mortality (OR = 0.37; 95% CI, 0.29-0.47) than did patients who received an NC physician's care. The association between a cardiologist's care and reduced adverse events following admission was significant in both sexes and in patients aged ≥40 years. CONCLUSION: We raised the possibility that cardiologist care was associated with reduced infectious complications and mortality among patients who were admitted due to heart disease.


Assuntos
Cardiologistas , Clínicos Gerais , Cardiopatias/diagnóstico , Mortalidade Hospitalar/tendências , Pneumonia/diagnóstico , Sepse/diagnóstico , Infecções Urinárias/diagnóstico , Adulto , Idoso , Feminino , Cardiopatias/complicações , Cardiopatias/mortalidade , Cardiopatias/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Admissão do Paciente/estatística & dados numéricos , Pneumonia/complicações , Pneumonia/mortalidade , Pneumonia/fisiopatologia , Pontuação de Propensão , Fatores de Risco , Sepse/complicações , Sepse/mortalidade , Sepse/fisiopatologia , Taiwan/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/mortalidade , Infecções Urinárias/fisiopatologia
20.
PLoS One ; 15(6): e0235468, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603334

RESUMO

BACKGROUND AND OBJECTIVES: Hospital readmissions are a frequent complication of pneumonia. Most data regarding readmissions are obtained from the United States, whereas few data are available from the European healthcare utilization (HCU) systems. In a large cohort of Italian patients with a previous hospitalization for pneumonia, our aim was to evaluate the incidence and predictors of early readmissions due to pneumonia. METHODS: This is a observational retrospective, population based, cohort study. Data were retrieved from the HCU databases of the Italian Lombardy region. 203,768 patients were hospitalized for pneumonia between 2003 and 2012. The outcome was the first rehospitalization for pneumonia. The patients were followed up after the index hospital admission to estimate the hazard ratio, and relative 95% confidence interval, of the outcome associated with the risk factors that we had identified. RESULTS: 7,275 patients (3.6%) had an early pneumonia readmission. Male gender, age ≥70 years, length of stay of the first admission and a higher burden of comorbidities were significantly associated with the outcome. Chronic use of antidepressants, antiarrhythmics, glucocorticoids and drugs for obstructive airway diseases were also more frequently prescribed in patients requiring rehospitalization. Previous use of inhaled broncodilators, including both beta2-agonists and anticholinergics, but not inhaled steroids, were associated with an increased risk of hospital readmission. CONCLUSIONS: Frail elderly patients with multiple comorbidities and complex drug regimens were at higher risk of early rehospitalization and, thus, may require closer follow-up and prevention strategies.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Pneumonia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Itália , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
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