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1.
Medicine (Baltimore) ; 99(41): e22386, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031274

RESUMO

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


Assuntos
Pneumonia/terapia , Respiração Artificial , Ventiladores Mecânicos , Humanos , Gravidade do Paciente , Projetos de Pesquisa , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Revisões Sistemáticas como Assunto , Ventiladores Mecânicos/efeitos adversos
2.
PLoS One ; 15(9): e0239655, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976491

RESUMO

INTRODUCTION: Globally, pneumonia is a major cause of morbidity and mortality among children which leads to over 156 million episodes and 14.9 million hospitalizations each year. Besides this fact, the recovery time and predictors of children's hospitalization related to severe community-acquired pneumonia is not well known. Therefore, the aim of this study was to estimate the median time to recovery and its predictors among severe community-acquired pneumonia patients admitted to the pediatric ward, Debre Markos referral hospital, North West Ethiopia. METHODS: An institution-based retrospective follow-up study was employed among 352 records of children who were admitted starting from January 2016 to December 2018. Patients' charts were retrieved using a structured data extraction tool. Cox proportional hazard model assumption and model fitness was checked. Stratified Cox regression was fitted as a final model. Hazard ratio with its 95% confidence interval was used and P-value < 0.05 was considered as a statistically significant association. RESULT: The overall median recovery time was 4 days IQR (3-7). Recovery rate from severe community acquired pneumonia was 16.25 (95% CI: 14.54-18.15) per 100 person day observation. Age (AHR; 0.94 95% CI (0.90-0.98)), being stunted (AHR; 0.62 95% CI (0.43-0.91)), presence of danger sign at admission (AHR; 0.61 95% CI (0.40-0.94)), late presentation to seek care(AHR; 0.64 95% CI (0.47-0.88)) and co-morbidity (AHR; 0.45 95% CI (0.35-0.58)) were significant predictors of recovery time. CONCLUSION: The median recovery time from severe community-acquired pneumonia was long so that measures to reduce recovery time should be strengthened.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia/epidemiologia , Adolescente , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/terapia , Etiópia , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Pneumonia/terapia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(38): e22245, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957371

RESUMO

BACKGROUND: CMS recently decided to produce private "healthcare disparities reports" that include dual eligibility (DE) as the sole stratifying variable used to assess pneumonia readmission disparities. RESEARCH DESIGN: We measure the relationship between DE status and readmissions, both with and without conceptually relevant social risk factors, including air pollution, severe housing problems, and food insecurity, using data from county- and hospital-level readmission rates, DE status, and social risk factors. RESULTS: At the county level, the relationship between DE status and readmissions is partially confounded by at least three social risk factors. DE populations vary widely across hospitals, creating unequal between-hospital comparisons. CONCLUSIONS: Because of differences in the DE population, between-hospital comparisons could be misleading using a methodology that stratifies by DE only. We suggest viable alternatives to sole-factor stratification to properly account for social risk factors and better isolate quality differences that might yield readmission rate inequities. IMPLICATIONS: CMS's healthcare disparities reports provided to hospitals are limited by relying exclusively on DE proportion as the measure of social risk, undercutting the power of quality measurement and its related incentives to close or minimize healthcare inequities.


Assuntos
Definição da Elegibilidade , Disparidades em Assistência à Saúde , Medicaid/organização & administração , Medicare/organização & administração , Determinantes Sociais da Saúde , Poluição do Ar/efeitos adversos , Abastecimento de Alimentos , Habitação , Humanos , Readmissão do Paciente , Pneumonia/terapia , Fatores de Risco , Estados Unidos
4.
Medicine (Baltimore) ; 99(39): e22012, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991404

RESUMO

BACKGROUND: Traditional Chinese medicine injections (TCMJ) used in the treatment of severe pneumonia have been widely implemented in clinical practice, but their overall efficacy and safety remain unclear. This paper aims to evaluate the efficacy and safety of TCMJ in the treatment of severe pneumonia. METHODS: PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, and the Chongqing VIP Chinese Science and Technology Periodical Database were all searched for randomized controlled trials focusing on the administration of TCMJ for severe pneumonia. Two researchers independently screened titles, abstracts, full texts, and extracted relevant data. The RevMan 5.3 software (The Cochrane Collaboration, Software Update, Oxford, UK) and Stata 14 software (STATA Corporation, College Station, TX) were used for statistical analysis. RESULTS: This study summarizes the related randomized controlled trials to assess the effect and safety of TCMJ in the treatment of severe pneumonia. CONCLUSION: This article provides theoretical support for the clinical application of TCMJ in the treatment of severe pneumonia. PROSPERO REGISTRATION NUMBER: CRD42020185072.


Assuntos
Medicina Tradicional Chinesa/métodos , Pneumonia/terapia , Proteína C-Reativa/análise , Humanos , Injeções , Interleucina-6/sangue , Tempo de Internação , Contagem de Leucócitos , Medicina Tradicional Chinesa/efeitos adversos , Pneumonia/mortalidade , Pró-Calcitonina/biossíntese , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Respiração Artificial , Fator de Necrose Tumoral alfa/sangue
5.
J Hosp Infect ; 106(3): 570-576, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32828864

RESUMO

BACKGROUND: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. AIM: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. METHODS: Environmental swab samples and air samples were collected from the isolation rooms of three COVID-19 patients with severe pneumonia. Patients 1 and 2 received mechanical ventilation with a closed suction system, while patient 3 received high-flow oxygen therapy and non-invasive ventilation. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR. FINDINGS: Of the 48 swab samples collected in the rooms of patients 1 and 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of patient 1 and seven sites in patient 3's room. CONCLUSION: Environmental contamination of SARS-CoV-2 may be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.


Assuntos
Infecções por Coronavirus/terapia , Descontaminação/normas , Poluição Ambiental/análise , Oxigenação Hiperbárica/normas , Quartos de Pacientes/normas , Pneumonia Viral/terapia , Pneumonia/terapia , Guias de Prática Clínica como Assunto , Respiração Artificial/normas , Microbiologia do Ar , Humanos , Pandemias
6.
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
7.
Med Sci Monit ; 26: e925364, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32759887

RESUMO

Traced back to December 2019, an unexpected outbreak of a highly contagious new coronavirus pneumonia (COVID-19) has rapidly swept around China and the globe. There have now been an estimated 2 580 000 infections and more than 170 000 fatal cases around the world. The World Health Organization (WHO) estimated that approximately 14% of infections developed into severe disease, 5% were critically ill, and the mortality rate of critically ill patients is reported to be over 50%. The shortage of specific anti-viral treatment and vaccines remains a huge challenge. In COVID-19, refractory hypoxemia is common among the critically ill with acute respiratory distress syndrome (ARDS) despite invasive mechanical ventilation, and is further complicated by respiratory and circulatory failure. This difficult situation calls for the use of extracorporeal membrane oxygenation (ECMO) for assisting respiration and circulation if necessary. This article reviews the pertinent clinical literature, technical guidance, and expert recommendations on use of ECMO in critically ill cases of COVID-19. Here, we present basic knowledge and opinions about COVID-19 and ECMO, review the evidence on ECMO use in Middle East Respiratory Syndrome (MERS) and H1N1 influenza, share the technical guidance and recommendations on use of ECMO in COVID-19, summarize the current use of ECMO against COVID-19 in China, and discuss the issues in use of ECMO in COVID-19.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/terapia , Estado Terminal , Oxigenação por Membrana Extracorpórea , Pneumonia Viral/terapia , Pneumonia/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Humanos , Pandemias , Guias de Prática Clínica como Assunto
8.
J Control Release ; 325: 135-140, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32622963

RESUMO

The COVID-19 epidemic represents an unprecedented global health emergency, further aggravated by the lack of effective therapies. For this reason, several clinical trials are testing different off-label drugs, already approved for other pathologies. Mesenchymal stem/stromal cells (MSCs) have been tested during the last two decades for the treatment of various pathologic conditions, including acute and chronic lung diseases, both in animal models and in patients. In particular, promising results have been obtained in the experimental therapy of acute respiratory distress syndrome, which represents the most threatening complication of COVID-19 infection. Furthermore, more recently, great interest has been devoted to the possible clinical applications of extracellular vesicles secreted by MSCs, nanoparticles that convey much of the biological effects and of the therapeutic efficacy of their cells of origin. This review summarizes the experimental evidence underlying the possible use of MSCs and of MSC-EVs in severe COVID-19 infection and underlines the need to evaluate the possible efficacy of these therapeutic approaches through controlled studies under the supervision of the Regulatory Authorities.


Assuntos
Infecções por Coronavirus/terapia , Vesículas Extracelulares , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/metabolismo , Pneumonia Viral/terapia , Pneumonia/terapia , Animais , Infecções por Coronavirus/complicações , Humanos , Pandemias , Pneumonia/etiologia , Pneumonia Viral/complicações
9.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(8): 639-647, 2020 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-32727174

RESUMO

Patients with diabetes mellitus are prone to various infections owing to host immune impairment, especially pneumonia. In China, morbidity of pneumonia in patients with diabetes mellitus is high. And in case of pneumonia, patients with diabetes mellitus were of increased probability of opportunistic infections, low detection rate of pathogens, more severe pneumonia and high mortality, resulting in heavy medical and economic burdens. Therefore, it is urgent for multi-disciplinary experts to explore and formulate standards for diagnosis and treatment of pneumonia in patients with diabetes mellitus to improve the prognosis. Based on domestic and international literatures and clinical experiences of experts in respiratory and critical care medicine, endocrinology, microbiology and clinical pharmacy, a consensus was developed on the diagnosis and treatment of pneumonia in patients with diabetes mellitus.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Pneumonia/diagnóstico , Pneumonia/terapia , China , Consenso , Humanos , Infecções Oportunistas/microbiologia , Pneumonia/microbiologia , Prognóstico
10.
J Investig Med High Impact Case Rep ; 8: 2324709620933438, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-535847

RESUMO

In this article, we present a case of a young female patient with previously diagnosed lupus pneumonitis, now with a flare and new superimposed COVID-19 infection that was treated with intravenous steroids. On computed tomography scans, she had extensive interstitial lung fibrosis in addition to a positive COVID-19 polymerase chain reaction test requiring 6 L of oxygen via nasal cannula on admission. After administration of methylprednisolone, the patient improved and was weaned off her oxygen requirements and was discharged home.


Assuntos
Infecções por Coronavirus/complicações , Lúpus Eritematoso Sistêmico/complicações , Pneumonia Viral/complicações , Pneumonia/complicações , Anticorpos Antinucleares/imunologia , Antirreumáticos/uso terapêutico , Betacoronavirus , Tamponamento Cardíaco , Complemento C3/imunologia , Complemento C4/imunologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , DNA , Progressão da Doença , Inibidores Enzimáticos/uso terapêutico , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Pulmão/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Nefrite Lúpica , Linfopenia/etiologia , Metilprednisolona/uso terapêutico , Ácido Micofenólico/uso terapêutico , Oxigenoterapia , Pandemias , Pneumonia/diagnóstico por imagem , Pneumonia/imunologia , Pneumonia/terapia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(4): 430-434, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: covidwho-594902

RESUMO

OBJECTIVE: To provide a reference for extracorporeal membrane oxygenation (ECMO) inter-hospital transport during coronavirus disease 2019 (COVID-19), based on the transport experience of 6 patients with severe H1N1 influenza virus pneumonia using ECMO. METHODS: Clinical data of patients with severe H1N1 influenza virus pneumonia implemented by ECMO in the First Affiliated Hospital of Wannan Medical College from October 2018 to December 2019 were retrospective analyzed, including general information, ECMO transport distance, time, clinical parameters before and after ECMO, including the patients' oxygenation index (PaO2/FiO2), respiratory rate (RR), pulse blood oxygen saturation (SpO2), arterial blood carbon dioxide partial pressure (PaCO2), and pH value, various complications during transport, mechanical ventilation time, patients' prognosis and other indicators. Experience from the aspects of personal protection, transport process and equipment, team cooperation, mid-transit monitoring, quality control, etc., was summarized to provide suggestions for patients with severe COVID-19 using ECMO during inter-hospital transport and protection. RESULTS: A total of 6 patients with severe H1N1 influenza virus pneumonia were transported on ECMO. All patients were transported to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College by the ECMO transport team after the establishment of ECMO in the local hospital. The transfer distance was 11 to 197 km, with an average of (93.8±58.6) km; the transfer time was 30 to 150 minutes, with an average of (79.2±40.6) minutes. Two patients experienced a drop in ECMO flow and SpO2 during the process, and the main reason was insufficient volume, which was improved after fluid resuscitation and posture adjustment. All patients maintained SpO2 above 0.93. Six patients survived and were discharged. ECMO assisted time was 4-9 days, with an average of (6.5±1.5) days; mechanical ventilation time was 7-24 days, and median time was 10.0 (8.0, 14.5) days. No H1N1 transmission occurred in medical personnel. To achieve good therapeutic effect, the main experience was to choose the proper timing and mode of ECMO; intact transportation vehicles and equipment to reduce or avoid mechanical complications; the effective management of respiration and circulation during the transportation to avoid ventilation-associated lung injury (VALI) and serious hypoxemia; the appropriate space for the transfer team to quickly handle various critical situations; and personal protection to avoid infection. CONCLUSIONS: With an experienced ECMO transport team, good transport equipment, comprehensive protection measures, reasonable transport procedures, and a perfect emergency plan, it is safe to use ECMO transport for COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Oxigenação por Membrana Extracorpórea , Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Pneumonia Viral/epidemiologia , Pneumonia/terapia , Síndrome do Desconforto Respiratório do Adulto , Humanos , Pandemias , Estudos Retrospectivos , Resultado do Tratamento
12.
Clin Nucl Med ; 45(7): 531-533, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-543334

RESUMO

Some patients undergoing routine SPECT/CT and PET/CT examinations during the COVID-19 pandemic may incidentally reveal findings of COVID-19-associated pneumonia (C-19AP) on localizing CT. It is critical for nuclear medicine physicians to develop diagnostic skills for timely recognition of typical findings of C-19AP on a localizing CT. Furthermore, it is our responsibility to know the optimal practices for safely isolating and managing such patients while protecting the staff, other patients at the facility, family and/or friend accompanying the patients, and the public in general from risky exposure to COVID-19 sources. We offer several steps following an encounter suspicious of C-19AP.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Gerenciamento Clínico , Humanos , Achados Incidentais , Pandemias , Pneumonia/etiologia , Pneumonia/terapia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/normas , Coluna Vertebral/diagnóstico por imagem
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(4): 430-434, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-32527347

RESUMO

OBJECTIVE: To provide a reference for extracorporeal membrane oxygenation (ECMO) inter-hospital transport during coronavirus disease 2019 (COVID-19), based on the transport experience of 6 patients with severe H1N1 influenza virus pneumonia using ECMO. METHODS: Clinical data of patients with severe H1N1 influenza virus pneumonia implemented by ECMO in the First Affiliated Hospital of Wannan Medical College from October 2018 to December 2019 were retrospective analyzed, including general information, ECMO transport distance, time, clinical parameters before and after ECMO, including the patients' oxygenation index (PaO2/FiO2), respiratory rate (RR), pulse blood oxygen saturation (SpO2), arterial blood carbon dioxide partial pressure (PaCO2), and pH value, various complications during transport, mechanical ventilation time, patients' prognosis and other indicators. Experience from the aspects of personal protection, transport process and equipment, team cooperation, mid-transit monitoring, quality control, etc., was summarized to provide suggestions for patients with severe COVID-19 using ECMO during inter-hospital transport and protection. RESULTS: A total of 6 patients with severe H1N1 influenza virus pneumonia were transported on ECMO. All patients were transported to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College by the ECMO transport team after the establishment of ECMO in the local hospital. The transfer distance was 11 to 197 km, with an average of (93.8±58.6) km; the transfer time was 30 to 150 minutes, with an average of (79.2±40.6) minutes. Two patients experienced a drop in ECMO flow and SpO2 during the process, and the main reason was insufficient volume, which was improved after fluid resuscitation and posture adjustment. All patients maintained SpO2 above 0.93. Six patients survived and were discharged. ECMO assisted time was 4-9 days, with an average of (6.5±1.5) days; mechanical ventilation time was 7-24 days, and median time was 10.0 (8.0, 14.5) days. No H1N1 transmission occurred in medical personnel. To achieve good therapeutic effect, the main experience was to choose the proper timing and mode of ECMO; intact transportation vehicles and equipment to reduce or avoid mechanical complications; the effective management of respiration and circulation during the transportation to avoid ventilation-associated lung injury (VALI) and serious hypoxemia; the appropriate space for the transfer team to quickly handle various critical situations; and personal protection to avoid infection. CONCLUSIONS: With an experienced ECMO transport team, good transport equipment, comprehensive protection measures, reasonable transport procedures, and a perfect emergency plan, it is safe to use ECMO transport for COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Oxigenação por Membrana Extracorpórea , Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Pneumonia Viral/epidemiologia , Pneumonia/terapia , Síndrome do Desconforto Respiratório do Adulto , Humanos , Pandemias , Estudos Retrospectivos , Resultado do Tratamento
14.
Clin Nucl Med ; 45(7): 531-533, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32502091

RESUMO

Some patients undergoing routine SPECT/CT and PET/CT examinations during the COVID-19 pandemic may incidentally reveal findings of COVID-19-associated pneumonia (C-19AP) on localizing CT. It is critical for nuclear medicine physicians to develop diagnostic skills for timely recognition of typical findings of C-19AP on a localizing CT. Furthermore, it is our responsibility to know the optimal practices for safely isolating and managing such patients while protecting the staff, other patients at the facility, family and/or friend accompanying the patients, and the public in general from risky exposure to COVID-19 sources. We offer several steps following an encounter suspicious of C-19AP.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Gerenciamento Clínico , Humanos , Achados Incidentais , Pandemias , Pneumonia/etiologia , Pneumonia/terapia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/normas , Coluna Vertebral/diagnóstico por imagem
15.
J Investig Med High Impact Case Rep ; 8: 2324709620933438, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32500773

RESUMO

In this article, we present a case of a young female patient with previously diagnosed lupus pneumonitis, now with a flare and new superimposed COVID-19 infection that was treated with intravenous steroids. On computed tomography scans, she had extensive interstitial lung fibrosis in addition to a positive COVID-19 polymerase chain reaction test requiring 6 L of oxygen via nasal cannula on admission. After administration of methylprednisolone, the patient improved and was weaned off her oxygen requirements and was discharged home.


Assuntos
Infecções por Coronavirus/complicações , Lúpus Eritematoso Sistêmico/complicações , Pneumonia Viral/complicações , Pneumonia/complicações , Anticorpos Antinucleares/imunologia , Antirreumáticos/uso terapêutico , Betacoronavirus , Tamponamento Cardíaco , Complemento C3/imunologia , Complemento C4/imunologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , DNA , Progressão da Doença , Inibidores Enzimáticos/uso terapêutico , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Pulmão/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Nefrite Lúpica , Linfopenia/etiologia , Metilprednisolona/uso terapêutico , Ácido Micofenólico/uso terapêutico , Oxigenoterapia , Pandemias , Pneumonia/diagnóstico por imagem , Pneumonia/imunologia , Pneumonia/terapia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Undersea Hyperb Med ; 47(2): 181-187, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574433

RESUMO

Objectives: To determine whether hyperbaric oxygen (HBO2) therapy be effective to improve hypoxemia for severe COVID-19 pneumonia patients. Methods: Two male patients ages 57 and 64 years old were treated. Each met at least one of the following criteria: shortness of breath; respiratory rate (RR) ≥30 breaths/minute; finger pulse oxygen saturation (SpO2) ≤93% at rest; and oxygen index (P/F ratio: PaO2/FiO2 ≤300 mmHg). Each case excluded any combination with pneumothorax, pulmonary bullae or other absolute contraindications to HBO2. Patients were treated with 1.5 atmospheres absolute HBO2 with an oxygen concentration of more than 95% for 60 minutes per treatment, once a day for one week. Patients' self-reported symptoms, daily mean SpO2 (SO2), arterial blood gas analysis, D-dimer, lymphocyte, cholinesterase (che) and chest CT were conducted and measured. Results: For both patients, dyspnea and shortness of breath were immediately alleviated after the first HBO2 treatment and remarkably relieved after seven days of HBO2 therapy. The RR also decreased daily. Neither patient became critically ill. The decreasing trend of SO2 and P/F ratio was immediately reversed and increased day by day. The lymphocyte count and ratio corresponding to immune function gradually recovered. D-dimer corresponding to peripheral circulation disorders and serum cholinesterase, reflecting liver function had improved. Follow-up chest CT showed that the pulmonary inflammation had clearly subsided. Conclusion: Our preliminary uncontrolled case reports suggest that HBO2 therapy may promptly improve the progressive hypoxemia of patients with COVID-2019 pneumonia. However, the limited sample size and study design preclude a definitive statement about the potential effectiveness of HBO2 therapy to COVID-2019 pneumonia. It requires evaluation in randomized clinical trials in future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Oxigenação Hiperbárica/métodos , Hipóxia/terapia , Pneumonia Viral/terapia , Pneumonia/terapia , China , Terapia Combinada , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Oxigenação Hiperbárica/instrumentação , Hipóxia/etiologia , Hipóxia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/diagnóstico por imagem , Pneumonia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Troca Gasosa Pulmonar , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Undersea Hyperb Med ; 47(2): 297-298, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574446

RESUMO

There have been numerous recent inquiries regarding use of hyperbaric oxygen (HBO2) for patients with COVID-19. Questions have been raised pertinent to two possible mechanisms for HBO2 in this clinical context. The UHMS Hyperbaric Oxygen Therapy Committee, UHMS Executive Committee, with collaborative input from multiple senior UHMS members and researchers have drafted this position statement.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Oxigenação Hiperbárica , Pneumonia Viral/terapia , Ensaios Clínicos como Assunto , Infecções por Coronavirus/complicações , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/métodos , Hipóxia/etiologia , Hipóxia/terapia , Pandemias , Pneumonia/etiologia , Pneumonia/terapia , Pneumonia Viral/complicações , Sociedades Médicas
19.
BMJ ; 369: m1780, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32554705

RESUMO

OBJECTIVE: To evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use. DESIGN: Quasi-experimental difference-in-differences analysis. SETTING: US hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals. PARTICIPANTS: 238 hospitals participating in the Bundled Payments for Care Improvement initiative (BPCI) and 1415 non-BPCI hospitals. 226 BPCI hospitals were matched to 700 non-BPCI hospitals. MAIN OUTCOME MEASURES: Primary outcomes were total spending on episodes and death 90 days after discharge. Secondary outcomes included spending and use by type of post-acute care. BPCI and non-BPCI hospitals were compared by patient, hospital, and hospital market characteristics. Market characteristics included population size, competitiveness, and post-acute bed supply. RESULTS: In the 226 BPCI hospitals, episodes of care totaled 261 163 in the baseline period and 93 562 in the treatment period compared with 211 208 and 78 643 in the 700 matched non-BPCI hospitals, respectively, with small differences in hospital and market characteristics after matching. Differing trends were seen for some patient characteristics (eg, mean age change -0.3 years at BPCI hospitals v non- BPCI hospitals, P<0.001). In the adjusted analysis, participation in BPCI was associated with a decrease in total episode spending (-1.2%, 95% confidence interval -2.3% to -0.2%). Spending on care at skilled nursing facilities decreased (-6.3%, -10.0% to -2.5%) owing to a reduced number of facility days (-6.2%, -9.8% to -2.6%), and home health spending increased (4.4%, 1.4% to 7.5%). Mortality at 90 days did not change (-0.1 percentage points, 95% confidence interval -0.5 to 0.2 percentage points). CONCLUSIONS: In this longer term evaluation of a large national programme on medical bundled payments in the US, participation in bundles for four common medical conditions was associated with savings at three years. The savings were generated by practice changes that decreased use of high intensity care after hospital discharge without affecting quality, which also suggests that bundles for medical conditions could require multiple years before changes in savings and practice emerge.


Assuntos
Insuficiência Cardíaca/economia , Medicare , Infarto do Miocárdio/economia , Pacotes de Assistência ao Paciente , Pneumonia/economia , Doença Pulmonar Obstrutiva Crônica/economia , Idoso , Cuidado Periódico , Feminino , Gastos em Saúde , Insuficiência Cardíaca/terapia , Humanos , Masculino , Infarto do Miocárdio/terapia , Alta do Paciente/economia , Pneumonia/terapia , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/terapia , Estados Unidos
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