Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 287
Filtrar
1.
Epidemiol Serv Saude ; 29(5): e2020644, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33175011

RESUMO

OBJECTIVE: To describe the profile of deaths and the lethality of Severe Acute Respiratory Syndrome (SARS) due to COVID-19 in hospitalized children and adolescents in Brazil. METHODS: This was a cross-sectional study conducted with data from the SARS notification forms of children and adolescents (0 to 19 years old) with laboratory-confirmed COVID-19. Notifications with complete progression of SARS due to COVID-19 were included, up to the 38th Epidemiological Week of 2020. RESULTS: 6,989 hospitalizations were investigated, 661 died, resulting in 9.5% hospital lethality. Higher lethality rates were observed among children under 1 year of age (14.2%), female children and adolescents (9.7%), the indigenous (23.0%), and those living in rural areas (18.1 %), as well as in the Northeast (15.4%) and North (9.7%) regions of Brazil. CONCLUSION: Differences in hospital mortality were found according to sociodemographic characteristics and marked regional inequalities.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Pneumonia Viral/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Adolescente , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Índios Sul-Americanos/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Características de Residência/estatística & dados numéricos , População Rural/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/etiologia , Distribuição por Sexo , Adulto Jovem
2.
BMJ Open ; 10(10): e043651, 2020 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-33040020

RESUMO

OBJECTIVES: COVID-19 causes lung parenchymal and endothelial damage that lead to hypoxic acute respiratory failure (hARF). The influence of hARF severity on patients' outcomes is still poorly understood. DESIGN: Observational, prospective, multicentre study. SETTING: Three academic hospitals in Milan (Italy) involving three respiratory high dependency units and three general wards. PARTICIPANTS: Consecutive adult hospitalised patients with a virologically confirmed diagnosis of COVID-19. Patients aged <18 years or unable to provide informed consent were excluded. INTERVENTIONS: Anthropometrical, clinical characteristics and blood biomarkers were assessed within the first 24 hours from admission. hARF was graded as follows: severe (partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) <100 mm Hg); moderate (PaO2/FiO2 101-200 mm Hg); mild (PaO2/FiO2 201-300 mm Hg) and normal (PaO2/FiO2 >300 mm Hg). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the assessment of clinical characteristics and in-hospital mortality based on the severity of respiratory failure. Secondary outcomes were intubation rate and application of continuous positive airway pressure during hospital stay. RESULTS: 412 patients were enrolled (280 males, 68%). Median (IQR) age was 66 (55-76) years with a PaO2/FiO2 at admission of 262 (140-343) mm Hg. 50.2% had a cardiovascular disease. Prevalence of mild, moderate and severe hARF was 24.4%, 21.9% and 15.5%, respectively. In-hospital mortality proportionally increased with increasing impairment of gas exchange (p<0.001). The only independent risk factors for mortality were age ≥65 years (HR 3.41; 95% CI 2.00 to 5.78, p<0.0001), PaO2/FiO2 ratio ≤200 mm Hg (HR 3.57; 95% CI 2.20 to 5.77, p<0.0001) and respiratory failure at admission (HR 3.58; 95% CI 1.05 to 12.18, p=0.04). CONCLUSIONS: A moderate-to-severe impairment in PaO2/FiO2 was independently associated with a threefold increase in risk of in-hospital mortality. Severity of respiratory failure is useful to identify patients at higher risk of mortality. TRIAL REGISTRATION NUMBER: NCT04307459.


Assuntos
Infecções por Coronavirus/patologia , Mortalidade Hospitalar , Hospitalização , Oxigênio/sangue , Pneumonia Viral/patologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome Respiratória Aguda Grave/etiologia , Índice de Gravidade de Doença , Idoso , Betacoronavirus , Gasometria , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Hospitais , Humanos , Hipóxia , Unidades de Terapia Intensiva , Itália/epidemiologia , Pulmão/metabolismo , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pressão Parcial , Pneumonia Viral/metabolismo , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/terapia , Síndrome do Desconforto Respiratório do Adulto/virologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , Fatores de Risco , Síndrome Respiratória Aguda Grave/mortalidade , Síndrome Respiratória Aguda Grave/terapia , Síndrome Respiratória Aguda Grave/virologia
3.
Clin Microbiol Rev ; 34(1)2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33055229

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in Wuhan, China, introduced the third highly pathogenic coronavirus into humans in the 21st century. Scientific advance after the severe acute respiratory syndrome coronavirus (SARS-CoV) epidemic and Middle East respiratory syndrome coronavirus (MERS-CoV) emergence enabled clinicians to understand the epidemiology and pathophysiology of SARS-CoV-2. In this review, we summarize and discuss the epidemiology, clinical features, and virology of and host immune responses to SARS-CoV, MERS-CoV, and SARS-CoV-2 and the pathogenesis of coronavirus-induced acute respiratory distress syndrome (ARDS). We especially highlight that highly pathogenic coronaviruses might cause infection-associated hemophagocytic lymphohistiocytosis, which is involved in the immunopathogenesis of human coronavirus-induced ARDS, and also discuss the potential implication of hemophagocytic lymphohistiocytosis therapeutics for combating severe coronavirus infection.


Assuntos
Infecções por Coronavirus/epidemiologia , Síndrome da Liberação de Citocina/epidemiologia , Linfo-Histiocitose Hemofagocítica/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Betacoronavirus/genética , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Síndrome da Liberação de Citocina/imunologia , Síndrome da Liberação de Citocina/mortalidade , Síndrome da Liberação de Citocina/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Período de Incubação de Doenças Infecciosas , Pulmão/imunologia , Pulmão/fisiopatologia , Pulmão/virologia , Linfo-Histiocitose Hemofagocítica/imunologia , Linfo-Histiocitose Hemofagocítica/mortalidade , Linfo-Histiocitose Hemofagocítica/fisiopatologia , Coronavírus da Síndrome Respiratória do Oriente Médio/genética , Coronavírus da Síndrome Respiratória do Oriente Médio/imunologia , Coronavírus da Síndrome Respiratória do Oriente Médio/patogenicidade , Filogenia , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Vírus da SARS/genética , Vírus da SARS/imunologia , Vírus da SARS/patogenicidade , Síndrome Respiratória Aguda Grave/imunologia , Síndrome Respiratória Aguda Grave/mortalidade , Síndrome Respiratória Aguda Grave/fisiopatologia , Índice de Gravidade de Doença , Análise de Sobrevida
4.
Clin Microbiol Rev ; 34(1)2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33055231

RESUMO

Patients and physicians worldwide are facing tremendous health care hazards that are caused by the ongoing severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic. Remdesivir (GS-5734) is the first approved treatment for severe coronavirus disease 2019 (COVID-19). It is a novel nucleoside analog with a broad antiviral activity spectrum among RNA viruses, including ebolavirus (EBOV) and the respiratory pathogens Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV, and SARS-CoV-2. First described in 2016, the drug was derived from an antiviral library of small molecules intended to target emerging pathogenic RNA viruses. In vivo, remdesivir showed therapeutic and prophylactic effects in animal models of EBOV, MERS-CoV, SARS-CoV, and SARS-CoV-2 infection. However, the substance failed in a clinical trial on ebolavirus disease (EVD), where it was inferior to investigational monoclonal antibodies in an interim analysis. As there was no placebo control in this study, no conclusions on its efficacy in EVD can be made. In contrast, data from a placebo-controlled trial show beneficial effects for patients with COVID-19. Remdesivir reduces the time to recovery of hospitalized patients who require supplemental oxygen and may have a positive impact on mortality outcomes while having a favorable safety profile. Although this is an important milestone in the fight against COVID-19, approval of this drug will not be sufficient to solve the public health issues caused by the ongoing pandemic. Further scientific efforts are needed to evaluate the full potential of nucleoside analogs as treatment or prophylaxis of viral respiratory infections and to develop effective antivirals that are orally bioavailable.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/farmacologia , Infecções por Coronavirus/tratamento farmacológico , Doença pelo Vírus Ebola/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Monofosfato de Adenosina/farmacocinética , Monofosfato de Adenosina/farmacologia , Alanina/farmacocinética , Alanina/farmacologia , Antivirais/farmacocinética , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/crescimento & desenvolvimento , Betacoronavirus/patogenicidade , Ensaios Clínicos como Assunto , Ensaios de Uso Compassivo/métodos , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Esquema de Medicação , Ebolavirus/efeitos dos fármacos , Ebolavirus/crescimento & desenvolvimento , Ebolavirus/patogenicidade , Doença pelo Vírus Ebola/mortalidade , Doença pelo Vírus Ebola/patologia , Doença pelo Vírus Ebola/virologia , Humanos , Coronavírus da Síndrome Respiratória do Oriente Médio/efeitos dos fármacos , Coronavírus da Síndrome Respiratória do Oriente Médio/crescimento & desenvolvimento , Coronavírus da Síndrome Respiratória do Oriente Médio/patogenicidade , Pandemias , Segurança do Paciente , Pneumonia Viral/mortalidade , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Vírus da SARS/efeitos dos fármacos , Vírus da SARS/crescimento & desenvolvimento , Vírus da SARS/patogenicidade , Síndrome Respiratória Aguda Grave/mortalidade , Síndrome Respiratória Aguda Grave/patologia , Síndrome Respiratória Aguda Grave/virologia , Análise de Sobrevida , Resultado do Tratamento
5.
ESC Heart Fail ; 7(5): 3119-3123, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33121220

RESUMO

The present Perspective examined the latest evidence on the association between the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and the incidence/mortality of coronavirus disease 2019 (COVID-19). Our critical appraisal from existing literature does not support discontinuation of ACEIs/ARBs in clinical practice as there is absence of solid evidence. However, we do recommend future research perspective in formulation and implementation of practice-changing guidelines.


Assuntos
Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Infecções por Coronavirus/tratamento farmacológico , Pandemias/estatística & dados numéricos , Pneumonia Viral/tratamento farmacológico , Síndrome Respiratória Aguda Grave/mortalidade , Adulto , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Causas de Morte , Infecções por Coronavirus/mortalidade , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Prognóstico , Medição de Risco , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Análise de Sobrevida
6.
Rev. esp. anestesiol. reanim ; 67(8): 425-437, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192474

RESUMO

ANTECEDENTES: No se ha reportado plenamente la evolución clínica de los pacientes críticos de COVID-19 durante su ingreso en la unidad de cuidados intensivos (UCI), incluyendo las complicaciones médicas e infecciosas y terapias de soporte, así como su asociación con la mortalidad en ICU. OBJETIVO: El objetivo de este estudio es describir las características clínicas y la evolución de los pacientes ingresados en UCI por COVID-19, y determinar los factores de riesgo de la mortalidad en UCI de dichos pacientes. MÉTODOS: Estudio prospectivo, multi-céntrico y de cohorte, que incluyó a los pacientes críticos de COVID-19 ingresados en 30 UCIs de España y Andorra. Se incluyó a los pacientes consecutivos de 12 de Marzo a 26 de Mayo de 2020 si habían fallecido o habían recibido el alta de la UCI durante el periodo de estudio. Se reportaron los datos demográficos, síntomas, signos vitales, marcadores de laboratorio, terapias de soporte, terapias farmacológicas, y complicaciones médicas e infecciosas, realizándose una comparación entre los pacientes fallecidos y los pacientes dados de alta. RESULTADOS: Se incluyó a un total de 663 pacientes. La mortalidad general en UCI fue del 31% (203 pacientes). Al ingreso en UCI los no supervivientes eran más hipoxémicos [SpO2 sin mascarilla de no reinhalación, de 90 (RIC 83-93) vs 91 (RIC 87-94); p < 0,001] y con mayor puntuación en la escala SOFA - Evaluación de daño orgánico secuencial - [SOFA, 7 (RIC 5-9) vs 4 (RIC 3-7); p < 0,001]. Las complicaciones fueron más frecuentes en los no supervivientes: síndrome de distrés respiratorio agudo (SDRA) (95% vs 89%; p = 0,009), insuficiencia renal aguda (IRA) (58% vs 24%; p < 10−16), shock (42% vs 14%; p < 10−13), y arritmias (24% vs 11%; p < 10−4). Las súper-infecciones respiratorias, infecciones del torrente sanguíneo y los shock sépticos fueron más frecuentes en los no supervivientes (33% vs 25%; p = 0,03, 33% vs 23%; p = 0,01 y 15% vs 3%, p = 10−7), respectivamente. El modelo de regresión multivariable reflejó que la edad estaba asociada a la mortalidad, y que cada año incrementaba el riesgo de muerte en un 1% (95%IC: 1-10, p = 0,014). Cada incremento de 5 puntos en la escala APACHE II predijo de manera independiente la mortalidad [OR: 1,508 (1,081, 2,104), p = 0,015]. Los pacientes con IRA [OR: 2,468 (1,628, 3,741), p < 10−4)], paro cardiaco [OR: 11,099 (3,389, 36,353), p = 0,0001], y shock séptico [OR: 3,224 (1,486, 6,994), p = 0,002] tuvieron un riesgo de muerte incrementado. CONCLUSIONES: Los pacientes mayores de COVID-19 con puntuaciones APACHE II más altas al ingreso, que desarrollaron IRA en grados II o III y/o shock séptico durante la estancia en UCI tuvieron un riesgo de muerte incrementado. La mortalidad en UCI fue del 31%


BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83-93) vs 91 (IQR 87-94); p < 0.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5-9) vs 4 (IQR 3-7); p < 0.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs 89%; p = 0.009), acute kidney injury (AKI) (58% vs 24%; p < 10−16), shock (42% vs 14%; p < 10−13), and arrhythmias (24% vs 11%; p < 10−4). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs 25%; p = 0.03, 33% vs 23%; p = 0.01 and 15% vs 3%, p = 10−7), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1-10, p = 0.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), p = 0.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), p < 10−4)], cardiac arrest [OR: 11.099 (3.389, 36.353), p = 0.0001], and septic shock [OR: 3.224 (1.486, 6.994), p = 0.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades II or III and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%


Assuntos
Humanos , Infecções por Coronavirus/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Vírus da SARS/patogenicidade , Estudos Prospectivos , Unidades de Terapia Intensiva/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Índice de Gravidade de Doença
7.
OMICS ; 24(11): 634-644, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32940573

RESUMO

In the first quarter of the 21st century, we are already facing the third emergence of a coronavirus outbreak, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for the coronavirus disease 2019 (COVID-19) pandemic. Comparative genomics can inform a deeper understanding of the pathogenesis of COVID-19. Previous strains of coronavirus, SARS-CoV, and Middle-East respiratory syndrome-coronavirus (MERS-CoV), have been known to cause acute lung injuries in humans. SARS-CoV-2 shares genetic similarity with SARS-CoV with some modification in the S protein leading to their enhanced binding affinity toward the angiotensin-converting enzyme 2 (ACE2) receptors of human lung cells. This expert review examines the features of all three coronaviruses through a conceptual lens of comparative genomics. In particular, the life cycle of SARS-CoV-2 that enables its survival within the host is highlighted. Susceptibility of humans to coronavirus outbreaks in the 21st century calls for comparisons of the transmission history, hosts, reservoirs, and fatality rates of these viruses so that evidence-based and effective planetary health interventions can be devised to prevent future zoonotic outbreaks. Comparative genomics offers new insights on putative and novel viral targets with an eye to both therapeutic innovation and prevention. We conclude the expert review by (1) articulating the lessons learned so far, whereas the research is still being actively sought after in the field, and (2) the challenges and prospects in deciphering the linkages among multiomics biological variability and COVID-19 pathogenesis.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Genômica/métodos , Pandemias , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Animais , Betacoronavirus/genética , Quirópteros/virologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Eutérios/virologia , Saúde Global/tendências , Humanos , Coronavírus da Síndrome Respiratória do Oriente Médio/genética , Coronavírus da Síndrome Respiratória do Oriente Médio/patogenicidade , Peptidil Dipeptidase A/genética , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Ligação Proteica , Receptores Virais/genética , Receptores Virais/metabolismo , Vírus da SARS/genética , Vírus da SARS/patogenicidade , Síndrome Respiratória Aguda Grave/mortalidade , Síndrome Respiratória Aguda Grave/virologia , Índice de Gravidade de Doença , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/metabolismo , Análise de Sobrevida
8.
Rev. esp. med. legal ; 46(3): 101-108, jul.-sept. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-192311

RESUMO

La certificación de la defunción es un acto médico en el que el profesional debe poner el mismo esfuerzo y dedicación que en el resto de los informes elaborados en vida del paciente. Para su correcta cumplimentación el facultativo debe seguir las instrucciones básicas, poniendo especial cuidado en rellenar adecuadamente la secuencia de causas de muerte. En casos de pandemia, la cumplimentación del certificado de defunción corresponde a la medicina asistencial y para poder hacerlo, los organismos oficiales deben publicar instrucciones basadas en recomendaciones internacionales. Debe establecerse, cuanto antes, la posibilidad de comunicación telemática de las defunciones. Mientras eso no sea posible tienen que establecerse procedimientos que permitan en situación de pandemia, comunicar de forma inmediata la mortalidad a las autoridades sanitarias


Death certification requires the same effort and dedication as all reports by doctors during their patients' lifetimes. The physician must follow the basic instructions to complete a death certificate correctly, taking special care to fill in the sequence of causes of death. In the case of a pandemic, completion of the death certificate falls to the primary care physician and therefore the official bodies must publish instructions based on international recommendations. It should be established as soon as possible whether it is possible to report deaths telematically. While this is not possible, in a pandemic procedures should be put in place to enable the immediate reporting of deaths to the health authorities


Assuntos
Humanos , Infecções por Coronavirus/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Pneumonia Viral/mortalidade , Atestado de Óbito/legislação & jurisprudência , Causas de Morte , Pandemias/legislação & jurisprudência , Precauções Universais/legislação & jurisprudência
9.
Rev. esp. med. legal ; 46(3): 127-138, jul.-sept. 2020. ilus, tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-192314

RESUMO

En este artículo se revisan los aspectos microbiológicos de la infección COVID-19 y se presentan las recomendaciones sobre los análisis que deben realizarse en casos forenses. En primer lugar se analizan las características taxonómicas del virus, su relación con la familia Coronaviridae y su estructura genética. Se presentan brevemente las características clínicas y patológicas de la infección COVID-19, así como las coinfecciones que pueden asociarse a este virus. En el diagnóstico de laboratorio se describen la PCR -técnica de elección en la fase aguda de la infección-, los estudios antigénicos y los estudios serológicos. Finalmente se detallan los principales objetivos para los estudios microbiológicos en fallecidos en relación con la pandemia COVID-19 y se describen los principales análisis microbiológicos post mortem a realizar en fallecidos en el ámbito forense. Los estudios microbiológicos deben estar dirigidos tanto a la detección del SARS-CoV-2 como a la de las coinfecciones, que también podrían contribuir a la causa de muerte


We review the microbiological aspects of COVID-19 infection and present the microbiological studies that should be performed in forensic cases. We describe the taxonomic characteristics of the virus, its relationship with the Coronaviridae family and its genetic structure. We briefly present the clinical and pathological characteristics of COVID-19 infection, as well as the co-infections that could be associated with this virus. In the laboratory, PCR is a first-choice technique in the acute phase of the infection, together with antigen and serological studies. Finally, we describe the main objectives of microbiological studies in the deceased in relation to the COVID-19 pandemic, as well as the main post-mortem microbiological analysis to be carried out in the medico-legal context. The microbiological analysis should aim to detect both SARS-CoV-2 and coinfections, which may also contribute to the cause of death


Assuntos
Humanos , Infecções por Coronavirus/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Pneumonia Viral/mortalidade , Atestado de Óbito/legislação & jurisprudência , Causas de Morte , Vírus da SARS/isolamento & purificação , Genoma Viral , Infecções por Coronavirus/diagnóstico , Ciências Forenses/métodos , Técnicas Microbiológicas/métodos , Pandemias/legislação & jurisprudência
10.
Rev. esp. patol ; 53(3): 188-192, jul.-sept. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-192406

RESUMO

The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed changes typical of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy


El nuevo coronavirus SARS-CoV-2, identificado inicialmente en China en diciembre de 2019 puede cursar con un Síndrome Respiratorio Agudo Severo (SARS) con daño alveolar masivo y fracaso respiratorio progresivo. Presentamos los hallazgos más relevantes encontrados en la autopsia clínica efectuada en nuestro hospital (Hospital Arnau de Vilanova-Lliria de Valencia) a fecha de 14 de febrero de 2020, al primer paciente fallecido conocido en España por neumonía COVID-19. A nivel pulmonar, la autopsia revela cambios típicos de daño alveolar difuso (DAD) en fase exudativa y fase proliferativa. Se observan células multinucleadas gigantes, células tipo smudge intraalveolares y trombosis vasculares. El diagnóstico microbiológico confirmativo mediante PCR se realizó 15 días después de la autopsia sobre la muestra faríngea del enfermo tomada durante su ingreso


Assuntos
Humanos , Masculino , Idoso , Autopsia/métodos , Infecções por Coronavirus/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Vírus da SARS/isolamento & purificação , Técnicas Histológicas/métodos , Alvéolos Pulmonares/patologia , Espanha/epidemiologia , Causas de Morte , Pandemias
11.
Clin Radiol ; 75(11): 804-810, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32829885

RESUMO

Coronavirus disease 2019 (COVID-19) is a newly emerging human infectious disease that has quickly become a worldwide threat to health, mainly causing severe acute respiratory syndrome. In addition to the widely described respiratory syndrome, COVID-19 may cause life-treating complications directly or indirectly related to this infection. Among these, thrombotic complications have emerged as an important issue in patients with COVID-19 infection, particularly in patients in intensive care units. Thrombotic complications due to COVID-19 are likely to occur due to a pro-coagulant pattern encountered in some of these patients or to a progressive endothelial thrombo-inflammatory syndrome causing microvascular disease. In the present authors' experience, from five different hospitals in Italy and the UK, imaging has proved its utility in identifying these COVID-19-related thrombotic complications, with translational clinical relevance. The aim of this review is to illustrate thromboembolic complications directly or indirectly related to COVID-19 disease. Specifically, this review will show complications related to thromboembolism due to a pro-coagulant pattern from those likely related to an endothelial thrombo-inflammatory syndrome.


Assuntos
Anticoagulantes/administração & dosagem , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/etiologia , Síndrome Respiratória Aguda Grave/complicações , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia , Adulto , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Isquemia Encefálica/mortalidade , Causas de Morte , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/mortalidade , Radiografia Torácica/métodos , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/mortalidade , Análise de Sobrevida , Tromboembolia/diagnóstico por imagem , Tromboembolia/mortalidade , Tromboplastina/metabolismo , Tomografia Computadorizada por Raios X/métodos
12.
Am J Cardiol ; 135: 150-153, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-32861733

RESUMO

This study aimed to determine if cardiac troponin I (cTnI) is an independent predictor of clinical outcomes and whether higher values are associated with worse clinical outcomes in Covid-19 patients. This case-series study was conducted at Phoebe Putney Health System. Participants were confirmed Covid-19 patients admitted to our health system between March 2, 2020 and June 7, 2020. Data were collected from electronic medical records. Patients were divided into 2 groups: with and without elevated cTnI. The cTnI were further divided in 4 tertiles. Multivariable logistic regression analysis was performed to adjust for demographics, baseline comorbidities, and laboratory parameters including D-dimer, ferritin, lactate dehydrogenase, procalcitonin and C-reactive protein. Out of 309 patients, 116 (37.5%) had elevated cTnI. Those with elevated cTnI were older (59.9 vs. 68.2 years, p <0.001), and more likely to be males (53.5% vs. 36.3%, p = 0.003). Elevated cTnI group had higher baseline comorbidities. After multivariable adjustment, overall mortality was significantly higher in elevated cTnI group (37.9% vs. 11.4%, odds ratio:4.45; confidence interval:1.78 to 11.14, p <0.001). Need for intubation, dialysis, and intensive care unit (ICU) transfer was higher in elevated cTnI group. Among those with elevated cTnI, mortality was 23.2% for 50th percentile, 48.4% for 75th percentile, and 55.2% for 100th percentile. Similarly, further increase in cTnI was associated with a higher need for intubation, dialysis, and ICU transfer. In conclusion, myocardial injury occurs in significant proportion of hospitalized Covid-19 patients and is an independent predictor of clinical outcomes, with higher values associated with worse outcomes.


Assuntos
Doenças Cardiovasculares/mortalidade , Causas de Morte , Infecções por Coronavirus/mortalidade , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Troponina I/sangue , Adulto , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Bases de Dados Factuais , Feminino , Georgia/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Prognóstico , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Análise de Sobrevida
13.
Am J Cardiol ; 135: 143-149, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-32861734

RESUMO

Since the modified CHA2DS2VASC (M-CHA2DS2VASc) risk score includes the prognostic risk factors for COVID-19; we assumed that it might predict in-hospital mortality and identify high-risk patients at an earlier stage compared with troponin increase and neutrophil-lymphocyte ratio (NLR). We aimed to investigate whether M-CHA2DS2VASC RS is an independent predictor of mortality in patients hospitalized with COVID-19 and to compare its discriminative ability with troponin increase and NLR in terms of predicting mortality. A total of 694 patients were retrospectively analyzed and divided into 3 groups according to M-CHA2DS2VASC RS which was simply created by changing gender criteria of the CHA2DS2VASC RS from female to male (Group 1, score 0-1 (n = 289); group 2, score 2-3 (n = 231) and group 3, score ≥4 (n = 174)). Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and/or intubation. As the M-CHA2DS2VASC RS increased, adverse clinical outcomes were also significantly increased (Group 1, 3.8%; group 2, 12.6%; group 3, 20.8%; p <0.001 for in-hospital mortality). The multivariate logistic regression analysis showed that M-CHA2DS2VASC RS, troponin increase and neutrophil-lymphocyte ratio were independent predictors of in-hospital mortality (p = 0.005, odds ratio 1.29 per scale for M-CHA2DS2VASC RS). In receiver operating characteristic analysis, comparative discriminative ability of M-CHA2DS2VASC RS was superior to CHA2DS2VASC RS score. Area under the curve (AUC) values for in-hospital mortality was 0.70 and 0.64, respectively. (AUCM-CHA2DS2-VASc vs. AUCCHA2DS2-VASc z test = 3.56, p 0.0004) In conclusion, admission M-CHA2DS2VASc RS may be a useful tool to predict in-hospital mortality in patients with COVID-19.


Assuntos
Causas de Morte , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Índice de Gravidade de Doença , Adulto , Idoso , Estudos de Coortes , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Curva ROC , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Análise de Sobrevida , Turquia/epidemiologia
14.
Medicine (Baltimore) ; 99(32): e21615, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769921

RESUMO

BACKGROUND: From the end of 2019 to the present, coronavirus disease 2019 (COVID-19) has put considerable pressure on the worlds medical system and caused significant mortality and economic losses around the world. In China, the Shufeng Jiedu capsule has been widely used in the treatment of COVID-19, but there is still a lack of evidence-based medical evaluation. METHODS: According to the retrieval strategies, randomized controlled trials (RCTs) on the Shufeng Jiedu capsule for COVID-19 were obtained from CNKI, WanFang, VIP, PubMed, Embase and Cochrane Library, regardless of publication date, or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool was used to evaluate the quality of the studies. The meta-analysis was performed using RevMan 5.3 and STATA 14.2 software. Ultimately, the evidentiary grade for the results will be evaluated. RESULTS: This study will evaluate the efficacy and safety of the Shufeng Jiedu capsule in the treatment of COVID-19 and provide a more reasonable choice of medication in clinical practice. CONCLUSION: Our findings will provide references for future clinical decision and guidance development. REGISTRATION: INPLASY registration number: INPLASY202070024.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Medicamentos de Ervas Chinesas/administração & dosagem , Segurança do Paciente , Pneumonia Viral/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , China , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/mortalidade , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(32): e21616, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769922

RESUMO

BACKGROUND: COVID-19 is a global public health emergency. At present, there is no highly effective medicine for the prevention and treatment of 2019-nCoV. Western medicine for COVID-19 is mainly based on symptomatic support therapy. Chinese herbal medicine has been used to prevent infectious diseases for thousands of years in China. Western medicine routine treatment combined with Chinese herbal medicine is an alternative clinical option but lacks evidence-based medical evidence. The systematic review protocol aims to formulate a research plan that can evaluate the efficacy and safety of western medicine routine treatment combined with Chinese herbal medicine for COVID-19. METHODS: We will search the following eight databases: Cochrane Library, PubMed, Embase, Medline, CNKI, Wanfang, VIP, and CBM. The search time is up to the end of July 2020. Two authors will independently complete literature screening, data extraction, and risk of bias assessment. In case of disagreement, the third author will assist in the judgment. The primary outcome will be the clinical cure rate. The secondary outcome will be accounting symptoms, fever time, time of virus nucleic acid turning negative, check the condition by drawing blood, pneumonia absorption rate, patient hospitalization time, severe conversion rate and case fatality rate, adverse reactions, and adverse events. Revman 5.3 will be used for systematic reviews and meta-analysis. The report of the protocol will follow the PRISMA-P statement, and the report of the systematic review and meta-analysis will follow the PRISMA statement. RESULTS: We will provide evidence-based medical evidence of the efficacy and safety of western medicine routine treatment combined with Chinese herbal medicine for COVID-19. The findings will be published in peer-reviewed journals. REGISTRATION DETAILS: CRD42020190106.


Assuntos
Anti-Infecciosos/administração & dosagem , Antivirais/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Medicamentos de Ervas Chinesas/administração & dosagem , Medicina Tradicional Chinesa/métodos , Pneumonia Viral/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Resultado do Tratamento , China , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Masculino , Pandemias , Segurança do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/mortalidade , Análise de Sobrevida , Estados Unidos
16.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(supl.1): 12-19, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192612

RESUMO

INTRODUCCIÓN: La pandemia por el virus SARS-CoV-2 ha supuesto un auténtico reto para los sistemas sanitarios. En España, la distribución heterogénea del virus y las diferentes estrategias sanitarias han condicionado la morbilidad y la letalidad. El objetivo de este estudio fue analizar la letalidad de la infección por sexo y rangos de edad en las comunidades autónomas (CC.AA.) de España. MATERIAL Y MÉTODOS: Para realizar el análisis, los datos se extrajeron del Ministerio de Sanidad, Consejerías y Departamentos de Salud Pública de las diferentes CC.AA. Se estimó la población infectada a partir de los resultados del ENE-COVID19 y de la población censada a 1 de enero de 2020 (INE) para una validez del test de anticuerpos IgG con 80% de sensibilidad y 100% de especificidad. La tasa de letalidad (TL) (fallecidos/1.000 infectados estimados) por sexo y edad (< 20 años, 20-64 y ≥ 65 años) se calculó para cada CC.AA. Se calculó la razón estandarizada de letalidad (REL) por el método exacto (EPIDAT). RESULTADOS: La prevalencia estimada de infección por SARS-CoV-2 en España fue del 6% (rango, 1,4% [Ceuta] - 14,1% [Comunidad de Madrid]). La TL para el conjunto de España fue del 9,6/1.000, oscilando entre el 1/1.000 en Melilla y el 26,6/1.000 en La Rioja, sin que se encontrara correlación entre letalidad y prevalencia de la infección. La TL fue mayor en hombres (10,2/1.000, razón 1,17 respecto de mujeres), excepto en Cataluña (razón 0,92), y especialmente elevada en los mayores de 64 años en La Rioja (143,5/1.000), Asturias (69,2/1.000) y País Vasco (46,6/1.000). Se encontró un exceso de letalidad (REL) global superior al 30% en La Rioja (2,91; IC 95%: 2,36-3,57), Asturias (1,51; IC 95%: 1,27-1,80), País Vasco (1,42; IC 95%: 1,31-1,54) y Extremadura (1,37; IC 95%: 1,20-1,57) y en los mayores de 64 años en Madrid y Canarias. CONCLUSIONES: La infección por el virus SARS-CoV-2 se ha distribuido de forma muy irregular en las diferentes CCAA, existiendo una gran diferencia en la tasa de letalidad entre comunidades, siendo especialmente elevada en La Rioja, Asturias y País Vasco. Es relevante el exceso de letalidad respecto a la media nacional en la población mayor de 64 años en las CC.AA. de Madrid y Canarias


INTRODUCTION: The SARS-CoV-2 pandemic has posed a real challenge to health systems. In Spain, the heterogeneous distribution of the virus infection and the different health strategies have conditioned the morbidity and fatality rate. The aim of this study was to analyse the lethality of the infection by sex and age range in the Autonomous Communities (AC) of Spain. MATERIAL AND METHODS: To perform the analysis, data were extracted from the Ministry of Health, Regional and Public Health Departments of the different AC. The infected population was estimated from the results of the ENE-COVID19 and the population registered on 1 January 2020 (INE) for the validity of the IgG antibody test with 80% sensitivity and 100% specificity. The case fatality rate (TL) (deaths/1000 estimated infected) by sex and age (< 20 years, 20-64 and ≥ 65 years) was calculated for each AC. The standardized case fatality ratio (REL) was calculated by the exact method (EPIDAT). RESULTS: The estimated prevalence of SARS-CoV-2 infection in Spain was 6% (range, 1.4% [Ceuta] - 14.1% [Community of Madrid]). The TL in Spain was 9,6/1000, ranged per AC from 1/1000 in Melilla to 26.6/1000 in La Rioja, with no correlation between case fatality and prevalence of infection. The TL was higher in men (10.2/1000, ratio 1.17 with respect to women), except in Cataluña (ratio 0.92), and especially high in those over 64 years of age in La Rioja (143.5/1000), Asturias (69.2/1000) and Basque Country (46.6/1000). Overall excess REL was found to be over 30% in La Rioja (2.91; 95% CI: 2.36-3.57), Asturias (1.51; 95% CI: 1.27-1.80), Basque Country (1.42; 95% CI: 1.31-1.54) and Extremadura (1.37; 95% CI: 1.20-1.57) and in those over 64 years in Madrid and the Canary Islands. CONCLUSIONS: SARs-CoV-2 virus infection has been very unevenly distributed in the different ACs, with notably differences in TL between ACs, particularly high in La Rioja, Asturias and the Basque Country. Is important to study the excess in TL the population over 64 years of age in the ACs of Madrid and the Canary Islands


Assuntos
Humanos , Infecções por Coronavirus/mortalidade , Mortalidade/tendências , Síndrome Respiratória Aguda Grave/mortalidade , Vírus da SARS/patogenicidade , Distribuição por Idade e Sexo , Causas de Morte/tendências , Sensibilidade e Especificidade , Imunoglobulina G/análise , Espanha/epidemiologia , Epidemiologia Descritiva
17.
Cancer Invest ; 38(8-9): 436-444, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32787597

RESUMO

BACKGROUND: Coronavirus 2019 (COVID-19) has spread rapidly around the world to become a global pandemic. There is limited data on the impact of COVID-19 among patients with cancer. METHODS: A systematic review was performed to determine outcomes of adult patients with cancer affected by coronavirus infections, specifically SARS, MERS, and COVID-19. Studies were independently screened by two reviewers and assessed for quality and bias. Outcomes measured included study characteristics, cancer type, phase of care at the time of diagnosis, and clinical presentation. Morbidity and mortality outcomes were analyzed to assess the severity of infection as compared to the general population. RESULTS: A total of 19 studies with 110 patients were included. Of these, 66.4% had COVID-19 infections, 32.7% MERS and only one patient with SARS. The majority of COVID-19 studies were based on studies in China. There was a 56.6% rate of a severe event, including ICU admission or requiring mechanical ventilation, with an overall 44.5% fatality rate. CONCLUSIONS: Patients with cancer with coronavirus infections may be more susceptible to higher morbidity and mortality.


Assuntos
Infecções por Coronavirus/mortalidade , Neoplasias/mortalidade , Neoplasias/virologia , Adulto , China/epidemiologia , Humanos , Pandemias , Pneumonia Viral/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade
18.
Arterioscler Thromb Vasc Biol ; 40(10): 2539-2547, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32840379

RESUMO

OBJECTIVE: To determine the prevalence of D-dimer elevation in coronavirus disease 2019 (COVID-19) hospitalization, trajectory of D-dimer levels during hospitalization, and its association with clinical outcomes. Approach and Results: Consecutive adults admitted to a large New York City hospital system with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 1, 2020 and April 8, 2020 were identified. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>230 ng/mL). Outcomes included critical illness (intensive care, mechanical ventilation, discharge to hospice, or death), thrombotic events, acute kidney injury, and death during admission. Among 2377 adults hospitalized with COVID-19 and ≥1 D-dimer measurement, 1823 (76%) had elevated D-dimer at presentation. Patients with elevated presenting baseline D-dimer were more likely than those with normal D-dimer to have critical illness (43.9% versus 18.5%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), any thrombotic event (19.4% versus 10.2%; adjusted odds ratio, 1.9 [95% CI, 1.4-2.6]; P<0.001), acute kidney injury (42.4% versus 19.0%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), and death (29.9% versus 10.8%; adjusted odds ratio, 2.1 [95% CI, 1.6-2.9]; P<0.001). Rates of adverse events increased with the magnitude of D-dimer elevation; individuals with presenting D-dimer >2000 ng/mL had the highest risk of critical illness (66%), thrombotic event (37.8%), acute kidney injury (58.3%), and death (47%). CONCLUSIONS: Abnormal D-dimer was frequently observed at admission with COVID-19 and was associated with higher incidence of critical illness, thrombotic events, acute kidney injury, and death. The optimal management of patients with elevated D-dimer in COVID-19 requires further study.


Assuntos
Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Estado Terminal/epidemiologia , Progressão da Doença , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Mortalidade Hospitalar/tendências , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Adulto , Idoso , Biomarcadores/sangue , Causas de Morte , Estudos de Coortes , Infecções por Coronavirus/fisiopatologia , Bases de Dados Factuais , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/fisiopatologia , Prevalência , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/sangue , Síndrome Respiratória Aguda Grave/mortalidade , Síndrome Respiratória Aguda Grave/fisiopatologia , Índice de Gravidade de Doença
19.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(7): 726-730, 2020 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-32842293

RESUMO

Objective: To compare epidemic characteristics between severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19). Methods: The general information, including epidemiological and clinical data of the confirmed cases during the epidemic period of the two infectious diseases was collected. The data of SARS in Guangzhou was derived from the technical files of Guangzhou Center for Disease Control and Prevention (GZCDC), including the statistical report and brief report of the epidemic situation (from January 2 to May 11, 2003);The data of COVID-19 in Wuhan was derived from the epidemic data published by Wuhan health and Health Committee's official website and other publicly reported documents (from December 9, 2019 to March 11, 2020). Descriptive analysis was used for a comparativeanalysis of the time and age characteristics, the number of cases, basic reproduction number (R0), proportion of medical staff in confirmed cases (%), crude mortality, etc. Results: A total of 1 072 cases of SARS in Guangzhou were included in the study. The incidence ratio of male to female was 1∶1.26. 43 cases of death were reported with a mortality rate of 4.01%. The median age was 36 years old. The proportion of medical staff in the early stage of the epidemic was 29.04% (88 cases). As to COVID-19 in Wuhan, a total of 49 978 cases were included, The incidence ratio of male to female was 1.04∶1. The 2 423 cases of death were reported with a mortality rate of 4.85%. The median age was 56 years old. The proportion of medical staff in the early stage of the epidemic was 30.43% (42 cases). Conclusion: The COVID-19 in Wuhan has the characteristics of high incidence and wide population. However, the epidemic situation is falling rapidly, and the prevention and control strategy needs to be adjusted timely. The prevention and control of nosocomial infection should be addressed in future.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Adulto , Distribuição por Idade , China/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Distribuição por Sexo
20.
Eur J Cardiothorac Surg ; 58(3): 598-604, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32856063

RESUMO

OBJECTIVES: There is currently a lack of clinical data on the novel beta-coronavirus infection [caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and concomitant primary lung cancer. Our goal was to report our experiences with 5 patients treated for lung cancer while infected with SARS-CoV-2. METHODS: We retrospectively evaluated 5 adult patients infected with SARS-CoV-2 who were admitted to our thoracic surgery unit between 29 January 2020 and 4 March 2020 for surgical treatment of a primary lung cancer. Clinical data and outcomes are reported. RESULTS: All patients were men with a mean age of 74.0 years (range 67-80). Four of the 5 patients (80%) reported chronic comorbidities. Surgery comprised minimally invasive lobectomy (2 patients) and segmentectomy (1 patient), lobectomy with en bloc chest wall resection (1 patient) and pneumonectomy (1 patient). Mean chest drain duration was 12.4 days (range 8-22); mean hospital stay was 33.8 days (range 21-60). SARS-CoV-2-related symptoms were fever (3 patients), persistent cough (3 patients), diarrhoea (2 patients) and syncope (2 patients); 1 patient reported no symptoms. Morbidity related to surgery was 60%; 30-day mortality was 40%. Two patients (1 with a right pneumonectomy, 74 years old; 1 with a lobectomy with chest wall resection and reconstruction, 70 years old), developed SARS-CoV-2-related lung failure leading to death 60 and 32 days after surgery, respectively. CONCLUSIONS: Lung cancer surgery may represent a high-risk factor for developing a severe case of coronavirus disease 2019, particularly in patients with advanced stages of lung cancer. Additional strategies are needed to reduce the risk of morbidity and mortality from SARS-CoV-2 infection during treatment for lung cancer.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/prevenção & controle , Neoplasias Pulmonares/cirurgia , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Itália , Tempo de Internação , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pandemias , Pneumonectomia/métodos , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Amostragem , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/mortalidade , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA