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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 45(1): 6-9, 2022 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-35000302

RESUMO

Typical reflux symptoms associated with gastroesophageal reflux-related cough have diagnostic implications. Questionnaires including these symptoms can be used as valuable screening tools for potential candidates. When reflux monitoring provides the objective evidence of abnormal reflux, the favorable response to anti-reflux therapy is essential for the diagnostic confirmation, in which anti-acid drugs are still the first-line choice. The benefits of neuromodulators in the treatment of refractory gastroesophageal reflux-related cough need to be further clarified. However, anti-reflux surgery may be a promising curative therapy for some patients with definitive surgical indications.


Assuntos
Tosse , Refluxo Gastroesofágico , Doença Crônica , Consenso , Tosse/diagnóstico , Tosse/tratamento farmacológico , Tosse/etiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Inquéritos e Questionários
2.
Zhonghua Jie He He Hu Xi Za Zhi ; 45(1): 10-12, 2022 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-35000303

RESUMO

Chronic cough is a common complaint, which may cause various complications involving many organ systems, including respiratory system, circulatory system, digestive system, urinary system, reproductive system, skeletal movement system, nervous system, etc. Cough and its complications are associated with an adverse impact on the work and quality of life in the huge population with chronic cough, and lead to an increased healthcare resource utilization. In this paper, we review the common complications of chronic cough by organ system classification.


Assuntos
Tosse , Qualidade de Vida , Doença Crônica , Tosse/epidemiologia , Tosse/etiologia , Humanos
3.
In Vivo ; 36(1): 446-449, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34972747

RESUMO

BACKGROUND/AIM: Measuring the fraction of exhaled nitric oxide (FeNO) is useful in the diagnosis of asthma and cough variant asthma. The aim of this study was to clarify the significance of measuring the FeNO in the differential diagnosis of acute cough. PATIENTS AND METHODS: We analyzed 80 patients who visited the clinic with the chief complaint of acute cough having experienced an asthma-like episode from January 2014 to July 2015. RESULTS: Infectious cough alone was present in 21% of patients, while 30% had asthmatic cough alone and 49% had a combination of infectious and asthmatic cough. The values of FeNO in those with asthmatic cough (30.4±24.7 ppb) and asthmatic/infectious cough (33.2±17.4 ppb) were significantly higher than those with just infectious cough (13.7±3.2 ppb) (p=0.0089 and p<0.0001, respectively). CONCLUSION: FeNO measurement is useful for distinguishing asthmatic diseases, even in the differential diagnosis of acute cough.


Assuntos
Asma , Óxido Nítrico , Asma/diagnóstico , Tosse/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Expiração , Humanos
4.
Anaesthesia ; 77(1): 22-27, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34700360

RESUMO

Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol-generating procedure. This designation is based on one epidemiological study suggesting an association between facemask ventilation and transmission during the SARS-CoV-1 outbreak in 2003. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation and facemask ventilation with an intentionally generated leak in anaesthetised patients. Recordings were made in ultraclean operating theatres and compared against the aerosol generated by tidal breathing and cough manoeuvres. Respiratory aerosol from tidal breathing in 11 patients was reliably detected above the very low background particle concentrations with median [IQR (range)] particle counts of 191 (77-486 [4-1313]) and 2 (1-5 [0-13]) particles.l-1 , respectively, p = 0.002. The median (IQR [range]) aerosol concentration detected during facemask ventilation without a leak (3 (0-9 [0-43]) particles.l-1 ) and with an intentional leak (11 (7-26 [1-62]) particles.l-1 ) was 64-fold (p = 0.001) and 17-fold (p = 0.002) lower than that of tidal breathing, respectively. Median (IQR [range]) peak particle concentration during facemask ventilation both without a leak (60 (0-60 [0-120]) particles.l-1 ) and with a leak (120 (60-180 [60-480]) particles.l-1 ) were 20-fold (p = 0.002) and 10-fold (0.001) lower than a cough (1260 (800-3242 [100-3682]) particles.l-1 ), respectively. This study demonstrates that facemask ventilation, even when performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, we argue facemask ventilation should not be considered an aerosol-generating procedure.


Assuntos
Máscaras , /química , Adulto , Idoso , Tosse/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vírus da SARS/isolamento & purificação , Síndrome Respiratória Aguda Grave/patologia , Síndrome Respiratória Aguda Grave/virologia
5.
Heart Surg Forum ; 24(6): E1054-E1056, 2021 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-34962481

RESUMO

Ascending thoracic aortic aneurysms are rare in childhood and typically are seen in the setting of connective tissue defect syndromes. These aneurysms may lead to rupture, dissection, or valvular insufficiency, so root replacement is recommended. Here, we present a 17-month-old girl who presented with fever, cough, and pericardial effusion. Initially, we suspected this could be a COVID-19 case, so a nasopharyngeal swap was performed. An ascending aorta aneurysm involving the aortic arch was confirmed by echo, and urgent ascending aorta and arch replacement were done by utilizing the descending aorta as a new arch. The final diagnosis came with cutis laxa syndrome. In similar cases, good outcomes can be achieved with accurate diagnosis and appropriate surgical management.


Assuntos
Aorta Torácica/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Cútis Laxa/complicações , Aneurisma Aórtico/diagnóstico por imagem , COVID-19/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Ecocardiografia , Feminino , Febre/etiologia , Humanos , Lactente , Derrame Pericárdico/etiologia , Radiografia Torácica , SARS-CoV-2 , Síndrome
6.
PLoS Comput Biol ; 17(12): e1009629, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34914688

RESUMO

Identifying order of symptom onset of infectious diseases might aid in differentiating symptomatic infections earlier in a population thereby enabling non-pharmaceutical interventions and reducing disease spread. Previously, we developed a mathematical model predicting the order of symptoms based on data from the initial outbreak of SARS-CoV-2 in China using symptom occurrence at diagnosis and found that the order of COVID-19 symptoms differed from that of other infectious diseases including influenza. Whether this order of COVID-19 symptoms holds in the USA under changing conditions is unclear. Here, we use modeling to predict the order of symptoms using data from both the initial outbreaks in China and in the USA. Whereas patients in China were more likely to have fever before cough and then nausea/vomiting before diarrhea, patients in the USA were more likely to have cough before fever and then diarrhea before nausea/vomiting. Given that the D614G SARS-CoV-2 variant that rapidly spread from Europe to predominate in the USA during the first wave of the outbreak was not present in the initial China outbreak, we hypothesized that this mutation might affect symptom order. Supporting this notion, we found that as SARS-CoV-2 in Japan shifted from the original Wuhan reference strain to the D614G variant, symptom order shifted to the USA pattern. Google Trends analyses supported these findings, while weather, age, and comorbidities did not affect our model's predictions of symptom order. These findings indicate that symptom order can change with mutation in viral disease and raise the possibility that D614G variant is more transmissible because infected people are more likely to cough in public before being incapacitated with fever.


Assuntos
COVID-19/diagnóstico , COVID-19/virologia , Modelos Biológicos , SARS-CoV-2 , COVID-19/epidemiologia , China/epidemiologia , Biologia Computacional , Tosse/etiologia , Diarreia/etiologia , Febre/etiologia , Humanos , Japão/epidemiologia , Mutação , Náusea/etiologia , Pandemias , SARS-CoV-2/genética , SARS-CoV-2/patogenicidade , Fatores de Tempo , Estados Unidos/epidemiologia , Vômito/etiologia
7.
Vopr Kurortol Fizioter Lech Fiz Kult ; 98(6. Vyp. 2): 17-24, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34965710

RESUMO

Postoperative respiratory complications in cardiac surgery patients occur in 22-30% of cases, mostly associated with ineffective cough and evacuation of bronchial secretion. OBJECTIVE: To evaluate the effectiveness and safety of cough stimulation using the mechanical in- and exsufflator in the early postoperative period in cardiac surgery patients. MATERIAL AND METHODS: The study included 37 patients; mean age was 57±12.3 years. Inclusion criteria: age over 18 years; post-extubation spontaneous breathing; fully conscious and cooperative; adequate gas exchange with oxygen therapy; adequate pain control (2 points or less on 10-point visual analogue scale). Exclusion criteria: need for re-intubation and mechanical ventilation; noninvasive mask ventilation; high-flow oxygen therapy; acute cerebrovascular event; uncontrolled bleeding; heart failure (inotropic score over 10); shock; need of extracorporeal blood purification; neuromuscular disease; pneumothorax, hydro- or hemothorax. Cough stimulation was performed using the mechanical in- and exsufflator Comfort Cough Plus («Seoil Pacific Corporation¼, Republic of Korea). The device provides cough stimulation after high-frequency vibrations transmitted through a special vest and lung tissue recruiting by changing the airways pressure of the gas mixture, delivered through the anesthesia face mask. RESULTS: Cough stimulation device use was associated with an increase in the cough effectiveness; the number of patients with productive cough increased 8-fold, from 4 (10.8%) to 32 (86.4%), p=0.0000. The increase of blood oxygen saturation (SpO2) on room air from 92% to 96% (p=0.000001) and inspiratory capacity (IC) from 750 mL to 1200 mL (p=0.000002) was observed. The number of patients with IC of 1200-1500 mL increased 3-fold, and those with an IC over 1500 mL increased 2.6-fold. The proportion of patients with low oxygenation (SpO2 less than 92%) decreased 5-fold after the procedure (p=0.0011). Good tolerability and no side effects of the procedure were noted in all patients. CONCLUSION: Impaired sputum expectoration early after cardiac surgery is observed in most patients and may cause low oxygenation. The main effects of the cough stimulation device were improvement of sputum expectoration and an increase in oxygenation. An increase in blood oxygen saturation and inspiratory capacity after a single procedure with this device was demonstrated. It resulted in a significantly decreased proportion of patients with respiratory insufficiency. No adverse effects of the procedure were observed.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Transtornos Respiratórios , Insuficiência Respiratória , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tosse/etiologia , Humanos , Pessoa de Meia-Idade
8.
Ann Palliat Med ; 10(10): 11209-11215, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763478

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a rare chronic necrotizing eosinophilic granulomatous inflammatory disease characterized by eosinophil-rich granulomatous inflammation and small- to medium-size vessel vasculitis associated with bronchial asthma and eosinophilia, which is positive for anti-neutrophil cytoplasmic antibody (ANCA) in approximately 50-70% of cases. We report a case of a 23-year-old woman was admitted to our hospital because of a of small vesicles on both lower limbs and a 4-month history of small scattered skin rash with pruritus V6 on both lower limbs four-month history of scattered skin rash with pruritus. Laboratory data from peripheral blood revealed leukocytosis, eosinophilia, thrombocytosis, hyperfibrinolysis, and mild renal injury. Her ANCA was negative, and the skin pathological examination showed granuloma lesions with eosinophils, while elevated eosinophils were also found in the bone marrow. EGPA was diagnosed. On the other hand, the patient had 2-year-long rhinosinusitis, 9-month-long nephrotic syndrome, and 1-month-long dry cough, which might be a type of asthma. With steroid therapy followed by systemic immunomodulatory therapy, the patient's symptoms were relieved. Our case report and literature review highlight the importance of recognizing cough variant asthma as an initial presenting symptom of EGPA, providing an opportunity for early diagnosis and treatment to reduce the risk of further disease progression and morbidity.


Assuntos
Asma , Síndrome de Churg-Strauss , Granulomatose com Poliangiite , Anticorpos Anticitoplasma de Neutrófilos , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/diagnóstico , Tosse/etiologia , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Humanos , Adulto Jovem
9.
J Korean Med Sci ; 36(42): e295, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725979

RESUMO

BACKGROUND: To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied. METHODS: All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week. RESULTS: During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44-2.10] vs. 0.59 [CI, 0.52-0.65], respectively) (P < 0.001). CONCLUSION: Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/prevenção & controle , Tosse/etiologia , Febre/etiologia , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , COVID-19/epidemiologia , Criança , Feminino , Humanos , Incidência , Controle de Infecções , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
10.
Indian J Tuberc ; 68(4): 527-528, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34752324

RESUMO

A 26 year old female presented with complaints of high grade fever and cough for 10 days. Nasopharyngeal swab tested for COVID-19 RT-PCR at admission was negative. Clinical examination suggested a patch of bronchial breathing in left infrascapular region and bilateral diffuse rhonchi. Chest X-ray was suggestive of left lower zone consolidation. HRCT showed a large patch of consolidation with GGO along with a cavitary lesion involving left lower lobe. Sputum for RT-PCR COVID 19 was positive. Patient was managed as per covid-19 protocol, subsequently showing clinical and radiological improvement.


Assuntos
COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Escarro/virologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Broncoscopia , Teste de Ácido Nucleico para COVID-19 , Teste para COVID-19 , Tosse/etiologia , Feminino , Febre/etiologia , Humanos , Radiografia , SARS-CoV-2
11.
Drug Discov Ther ; 15(5): 254-260, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34719599

RESUMO

Post COVID-19 sequelae are a constellation of symptoms often reported after recovering from COVID-19. There is a need to better understand the clinical spectrum and long-term course of this clinical entity. The aim of this study is to describe the clinical features and risk factors of post COVID-19 sequelae in the North Indian population. This prospective observational study was conducted at a tertiary healthcare centre in Northern India between October 2020 and February 2021. Patients aged >18 years with laboratory-confirmed COVID-19 were recruited after at least two weeks of diagnosis, and details were captured. A total of 1234 patients were recruited and followed up for a median duration of 91 days (IQR: 45-181 days). Among them, 495 (40.1%) had persistent symptoms post-discharge or recovery. In 223 (18.1%) patients, the symptoms resolved within four weeks; 150 (12.1%) patients had symptoms till 12 weeks, and 122 (9.9%) patients had symptoms beyond 12 weeks of diagnosis/symptom-onset of COVID-19. Most common symptoms included myalgia (10.9%), fatigue (5.5%), shortness of breath (6.1%), cough (2.1%), insomnia (1.4%), mood disturbances (0.48%) and anxiety (0.6%). Patients who were hospitalized were more likely to report fatigue as a feature of long COVID. Hypothyroidism (OR: 4.13, 95% CI: 2.2-7.6, p-value < 0.001) and hypoxia (SpO2 ≤ 93%) (OR: 1.7, 95% CI: 1.1-2.4, p-value 0.012) were identified as risk factors for long COVID sequelae. In conclusion, long COVID symptoms were common (22%), and 9.9% had the post COVID-19 syndrome. Myalgias, fatigue and dyspnoea were common symptoms. Patients with hypothyroidism and hypoxia during acute illness were at higher risk of long COVID.


Assuntos
COVID-19/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/etiologia , COVID-19/patologia , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/epidemiologia , Mialgia/etiologia , Estudos Prospectivos , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Adulto Jovem
12.
Pan Afr Med J ; 39: 219, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34630831

RESUMO

Aberrant course of the internal carotid artery is a rare congenital malformation. Aberrant course of cervical internal carotid artery accounts for 5% of cases. Several cases of fatal hemorrhage due to an injury to the aberrant internal carotid artery have been observed in patients undergoing pharyngeal surgery procedures. This was associated with a lack of detection during surgery. Ear nose and throat (ENT) practitioner need to know it. We here report a case of aberrant internal carotid manifesting as chronic cough due to the contact of the epiglottis with the pharyngeal mass caused by the aberrant artery. The patient was treated for chronic lung disease without success. This particular anatomical condition should be suspected in patients with pharyngeal mass before any invasive procedure.


Assuntos
Doenças das Artérias Carótidas/diagnóstico , Artéria Carótida Interna/anormalidades , Tosse/etiologia , Doenças Faríngeas/diagnóstico , Idoso , Doenças das Artérias Carótidas/complicações , Doença Crônica , Feminino , Humanos
14.
Am J Case Rep ; 22: e932945, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34645779

RESUMO

BACKGROUND Chronic cough is a common medical concern. Giant cell arteritis (GCA) is an uncommon cause of chronic cough and is not usually suspected since symptoms can be non-specific. We present a case of chronic cough due to GCA in which symptoms were subtle but imaging was remarkable and clearly disclosed the diagnosis. CASE REPORT A 71-year-old woman presented to the pulmonary clinic with a concern of worsening cough for 4 months. She had been treated with proton pump inhibitor, intranasal steroids, and antibiotics, without improvement. Other symptoms were an occasional headache for the prior 5 months, but this had resolved. She had a history of early-stage breast and thyroid cancers, both of which were treated surgically several years earlier and were in remission. Results of a physical examination including flexible video laryngoscopy of the upper airway were completely normal. Laboratory investigations showed normal blood chemistries and blood cell counts. Her C-reactive protein level was 1 mg/L (upper limit of normal <10) but her erythrocyte sedimentation level was 121 mm/hr (upper limit of normal <30). A positron emission tomography (PET) scan was performed as surveillance for her prior cancers. This showed diffuse tracer uptake in the aorta as well as bilateral common carotid, subclavian, and common iliac arteries, revealing GCA as the underlying diagnosis. CONCLUSIONS Giant cell arteritis is a rare cause of chronic cough. Other symptoms can be subtle or non-specific as in our case, and a high index of suspicion is needed to obtain a temporal artery biopsy. In these cases, imaging adjuncts can provide a non-invasive diagnosis.


Assuntos
Arterite de Células Gigantes , Idoso , Aorta , Tosse/etiologia , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Humanos , Artéria Ilíaca , Tomografia por Emissão de Pósitrons
15.
BMJ Case Rep ; 14(10)2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34716149

RESUMO

Acute COVID-19 usually lasts 4 weeks from the onset of symptoms. We report two cases of COVID-19-associated organising pneumonia (OP) occurring beyond 4 weeks from the acute onset of symptoms. Both tested positive for SARS reverse transcription-PCR 2 months before presentation with a resolution of respiratory symptoms. The first case presented with residual fatigue and worsening exertional dyspnoea. Chest CT revealed an OP pattern. The second case presented with worsening cough and new-onset pleuritic chest pain with persistent radiological consolidation. A transbronchial lung biopsy confirmed OP. Both patients responded well to 12 weeks of steroid therapy. This case illustrates the rare presentation of OP as a late sequela of COVID-19 and the good response to steroid therapy.


Assuntos
COVID-19 , Pneumonia em Organização Criptogênica , Pneumonia , Tosse/etiologia , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Pneumonia em Organização Criptogênica/tratamento farmacológico , Humanos , Pulmão/diagnóstico por imagem , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , SARS-CoV-2
16.
Aging (Albany NY) ; 13(20): 23459-23470, 2021 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-34710058

RESUMO

BACKGROUND: Since April 2021, the SARS-CoV-2 (B.1.167) Delta variant has been rampant worldwide. Recently, this variant has spread in Guangzhou, China. Our objective was to characterize the clinical features and risk factors of severe cases of the Delta variant in Guangzhou. METHODS: A total of 144 patients with the Delta variant were enrolled, and the data between the severe and non-severe groups were compared. Logistic regression methods and Cox multivariate regression analysis were used to investigate the risk factors of severe cases. RESULTS: The severity of the Delta variant was 11.1%. Each 1-year increase in age (OR, 1.089; 95% CI, 1.035-1.147; P = 0.001) and each 1-µmol/L increase in total bilirubin (OR, 1.198; 95% CI, 1.021-1.406; P = 0.039) were risk factors for severe cases. Moreover, the risk of progression to severe cases increased 13.444-fold and 3.922-fold when the age was greater than 58.5 years (HR, 13.444; 95% CI, 2.989-60.480; P = 0.001) or the total bilirubin level was greater than 7.23 µmol/L (HR, 3.922; 95% CI, 1.260-12.207; P = 0.018), respectively. CONCLUSION: Older age and elevated total bilirubin were independent risk factors for severe cases of the Delta variant in Guangzhou, especially if the age was greater than 58.5 years or the total bilirubin level was greater than 7.23 µmol/L.


Assuntos
COVID-19/terapia , SARS-CoV-2/isolamento & purificação , Adulto , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Tosse/etiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Febre/etiologia , Mortalidade Hospitalar , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/genética , Índice de Gravidade de Doença
18.
PLoS Med ; 18(9): e1003777, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34582457

RESUMO

BACKGROUND: Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type. METHODS AND FINDINGS: We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%-27%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value < 34 (N = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2-7 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. The resulting model (rounds 2-7) predicted PCR positivity in round 8 with area under the curve (AUC) of 0.77. The same 7 symptoms were selected as jointly predictive of B.1.1.7 infection in round 8, although when comparing B.1.1.7 with wild type, new persistent cough and sore throat were more predictive of B.1.1.7 infection while loss or change of sense of smell was more predictive of the wild type. The main limitations of our study are (i) potential participation bias despite random sampling of named individuals from the National Health Service register and weighting designed to achieve a representative sample of the population of England and (ii) the necessary reliance on self-reported symptoms, which may be prone to recall bias and may therefore lead to biased estimates of symptom prevalence in England. CONCLUSIONS: Where testing capacity is limited, it is important to use tests in the most efficient way possible. We identified a set of 7 symptoms that, when considered together, maximize detection of COVID-19 in the community, including infection with the B.1.1.7 lineage.


Assuntos
COVID-19/complicações , COVID-19/diagnóstico , Modelos Biológicos , Ageusia/diagnóstico , Ageusia/etiologia , Ageusia/virologia , Anosmia/diagnóstico , Anosmia/etiologia , Anosmia/virologia , Apetite , Área Sob a Curva , COVID-19/virologia , Calafrios/diagnóstico , Calafrios/etiologia , Calafrios/virologia , Controle de Doenças Transmissíveis , Tosse/diagnóstico , Tosse/etiologia , Tosse/virologia , Inglaterra , Reações Falso-Positivas , Feminino , Febre/diagnóstico , Febre/etiologia , Febre/virologia , Humanos , Masculino , Programas de Rastreamento , Mialgia/diagnóstico , Mialgia/etiologia , Mialgia/virologia , Faringite/diagnóstico , Faringite/etiologia , Faringite/virologia , Reação em Cadeia da Polimerase , SARS-CoV-2/genética , Medicina Estatal
19.
Rev Gaucha Enferm ; 42(spe): e20200282, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34524357

RESUMO

OBJECTIVE: To know the therapeutic itinerary of people diagnosed with Covid-19 from suspicion to the diagnosis. METHOD: Qualitative research. 65 people diagnosed with Covid-19 residing in Rio de Janeiro participated. Data collected using a semi-structured form sent via social media and processed in the software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires by Descending Hierarchical Classification and Correspondence Factor Analysis. RESULTS: Three classes of text segments were obtained that revealed the therapeutic itinerary, with emphasis on the search for care; shortage of tests; need to return to the units for diagnosis and follow-up; and the path to confirmatory test. CONCLUSION: The therapeutic itinerary of patients with Covid-19 showed weaknesses in the face of difficulties related to access to diagnostic tests and the organization of the system to meet the population's demand in the face of the pandemic.


Assuntos
COVID-19/diagnóstico , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Idoso , Brasil/epidemiologia , COVID-19/epidemiologia , Tosse/etiologia , Dispneia/etiologia , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Pandemias , Pesquisa Qualitativa , SARS-CoV-2 , Adulto Jovem
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