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1.
BMC Pulm Med ; 21(1): 73, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648488

RESUMO

BACKGROUND: Scarring central airway stenosis (SCAS) is a potentially life-threatening condition with debilitating symptoms. Interventional bronchoscopy is increasingly used to relieve symptoms in patients with SCAS, but recurrent stenosis is frequently observed. Little data exist on the long-term prognosis of interventional bronchoscopy for SCAS. We aimed to assess the prognostic factors of bronchoscopic interventions in patients with SCAS to optimize treatment. METHODS: This was a retrospective study that enrolled 119 consecutive patients with SCAS from January 2010 to April 2019 at our institution. Long-term clinical success was defined as airway stenosis < 50%, no limitation of physical activity, and a stable condition for > 12 months after the last interventional procedure. We compared patients' demographics, airway stenosis characteristics, and interventional procedures between the successful and unsuccessful groups, and identified significant predictors of long-term outcome with univariate and multivariate logistic regression. RESULTS: A total of 119 patients with 577 therapeutic bronchoscopies were included. Seventy-five (63%) patients were considered to have long-term clinical success. Older age, male gender, smoking, elevated C-reactive protein level, subglottic stenosis, stent or T-tube implantation, previous interventional treatment, and multiple procedures per year were potentially associated with unsuccessful long-term outcomes in the univariate analysis. Current smoker status (odds ratio [OR] 5.70, 95% confidence interval [CI] 1.35-24.17, P = 0.018), subglottic stenosis (OR 4.35, 95% CI 1.31-14.46, P = 0.017), and stent implantation (OR 4.96, 95% CI 1.33-18.48, P = 0.017) were associated with decreased odds of long-term success in the multivariate logistic regression analysis. Of note, there was no significant difference in odds of success between former smokers and nonsmokers. CONCLUSIONS: Current smoker status, subglottic stenosis, and stent implantation are independent factors associated with reduced long-term efficacy of interventional bronchoscopy for SCAS. Smoking cessation should be encouraged to improve the outcome of therapeutic bronchoscopy.


Assuntos
Broncopatias/cirurgia , Broncoscopia/métodos , Cicatriz/cirurgia , Laringoestenose/cirurgia , Stents , Estenose Traqueal/cirurgia , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapêutico , Broncopatias/patologia , Broncopatias/fisiopatologia , Cicatriz/fisiopatologia , Constrição Patológica , Tosse/fisiopatologia , Criocirurgia/métodos , Dilatação/métodos , Combinação de Medicamentos , Dispneia/fisiopatologia , Feminino , Volume Expiratório Forçado , Glucocorticoides/uso terapêutico , Humanos , Injeções Intralesionais , Laringoestenose/fisiopatologia , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fumar , Estenose Traqueal/fisiopatologia , Capacidade Vital , Adulto Jovem
2.
JAMA Netw Open ; 4(3): e211085, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33688964

RESUMO

Importance: Solid estimates of the risk of developing symptoms and of progressing to critical disease in individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are key to interpreting coronavirus disease 2019 (COVID-19) dynamics, identifying the settings and the segments of the population where transmission is more likely to remain undetected, and defining effective control strategies. Objective: To estimate the association of age with the likelihood of developing symptoms and the association of age with the likelihood of progressing to critical illness after SARS-CoV-2 infection. Design, Setting, and Participants: This cohort study analyzed quarantined case contacts, identified between February 20 and April 16, 2020, in the Lombardy region of Italy. Contacts were monitored daily for symptoms and tested for SARS-CoV-2 infection, by either real-time reverse transcriptase-polymerase chain reaction using nasopharyngeal swabs or retrospectively via IgG serological assays. Close contacts of individuals with laboratory-confirmed COVID-19 were selected as those belonging to clusters (ie, groups of contacts associated with an index case) where all individuals were followed up for symptoms and tested for SARS-CoV-2 infection. Data were analyzed from February to June 2020. Exposure: Close contact with individuals with confirmed COVID-19 cases as identified by contact tracing operations. Main Outcomes and Measures: Age-specific estimates of the risk of developing respiratory symptoms or fever greater than or equal to 37.5 °C and of experiencing critical disease (defined as requiring intensive care or resulting in death) in SARS-CoV-2-infected case contacts. Results: In total, 5484 case contacts (median [interquartile range] age, 50 [30-61] years; 3086 female contacts [56.3%]) were analyzed, 2824 of whom (51.5%) tested positive for SARS-CoV-2 (median [interquartile range] age, 53 [34-64] years; 1604 female contacts [56.8%]). The proportion of infected persons who developed symptoms ranged from 18.1% (95% CI, 13.9%-22.9%) among participants younger than 20 years to 64.6% (95% CI, 56.6%-72.0%) for those aged 80 years or older. Most infected contacts (1948 of 2824 individuals [69.0%]) did not develop respiratory symptoms or fever greater than or equal to 37.5 °C. Only 26.1% (95% CI, 24.1%-28.2%) of infected individuals younger than 60 years developed respiratory symptoms or fever greater than or equal to 37.5 °C; among infected participants older than 60 years, 6.6% (95% CI, 5.1%-8.3%) developed critical disease. Female patients were 52.7% (95% CI, 24.4%-70.7%) less likely than male patients to develop critical disease after SARS-CoV-2 infection. Conclusions and Relevance: In this Italian cohort study of close contacts of patients with confirmed SARS-CoV-2 infection, more than one-half of individuals tested positive for the virus. However, most infected individuals did not develop respiratory symptoms or fever. The low proportion of children and young adults who developed symptoms highlights the possible challenges in readily identifying SARS-CoV-2 infections.


Assuntos
/fisiopatologia , Portador Sadio/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Febre/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , /epidemiologia , Dor no Peito/epidemiologia , Dor no Peito/fisiopatologia , Criança , Pré-Escolar , Busca de Comunicante , Tosse/fisiopatologia , Estado Terminal , Progressão da Doença , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Faringite/epidemiologia , Faringite/fisiopatologia , Quarentena , Fatores de Risco , Índice de Gravidade de Doença , Taquipneia/epidemiologia , Taquipneia/fisiopatologia , Adulto Jovem
3.
Chron Respir Dis ; 18: 14799731211002240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729021

RESUMO

Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38-0.66, p < 0.01, I 2 = 97%), 0.37 (CI 0.28-0.48, p < 0.01, I 2 = 93%), 0.16 (CI 0.10-0.23, p < 0.01, I 2 = 90%) and 0.14 (CI 0.06-0.24, p < 0.01, I 2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.


Assuntos
/complicações , Dor no Peito/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Fadiga/epidemiologia , /epidemiologia , Dor no Peito/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Humanos , Prevalência , Sobreviventes
4.
Pediatr Rheumatol Online J ; 19(1): 29, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33726806

RESUMO

BACKGROUND: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.


Assuntos
/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Hipotensão/fisiopatologia , Linfopenia/fisiopatologia , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Miocardite/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Distribuição por Idade , Antirreumáticos/uso terapêutico , Aspirina/uso terapêutico , Proteína C-Reativa/metabolismo , /metabolismo , Criança , Pré-Escolar , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Feminino , Glucocorticoides/uso terapêutico , Insuficiência Cardíaca/fisiopatologia , Humanos , /fisiopatologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Lactente , Unidades de Terapia Intensiva Pediátrica , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Itália/epidemiologia , Masculino , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/metabolismo , Síndrome de Linfonodos Mucocutâneos/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Choque/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/terapia , Taquipneia/fisiopatologia , Troponina T/metabolismo , Vômito/fisiopatologia
5.
J Med Case Rep ; 15(1): 143, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33741059

RESUMO

BACKGROUND: There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. CASE PRESENTATION: In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. CONCLUSIONS: The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.


Assuntos
/diagnóstico , Cardiomiopatias/diagnóstico , Insuficiência Cardíaca/diagnóstico , Transtornos Puerperais/diagnóstico , Edema Pulmonar/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , /terapia , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/fisiopatologia , Cesárea , Tosse/fisiopatologia , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Dispneia/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Interferon beta/uso terapêutico , Pulmão/diagnóstico por imagem , Pré-Eclâmpsia , Gravidez , Transtornos Puerperais/tratamento farmacológico , Transtornos Puerperais/fisiopatologia , Edema Pulmonar/tratamento farmacológico , Edema Pulmonar/fisiopatologia , Volume Sistólico , Tomografia Computadorizada por Raios X
6.
J Med Case Rep ; 15(1): 171, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771221

RESUMO

BACKGROUND: The pandemic of this century has overwhelmed the healthcare systems of affected countries, and all resources have been diverted to coronavirus disease 2019. At the onset, coronavirus disease 2019 can present as any other acute febrile undifferentiated illness. In tropical regions, clinicians are increasingly challenged to differentiate these febrile illnesses without the use of diagnostics. With this pandemic, many of these tropical diseases are neglected and go underreported. Dengue is holoendemic in the Maldives, and dengue viruses circulate throughout the year. Reports about coinfections with dengue virus and severe acute respiratory syndrome coronavirus 2 are scarce, and the outcome and the dynamics of the disease may be altered in the presence of coinfection. We have described the clinical manifestation and serial laboratory profile, and highlighted the atypical findings uncommon in dengue infection. CASE PRESENTATION: Case 1 was a 39-year old Asian male, presented on day 6 of dengue infection with warning signs. Reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 that was done as per hospital protocol was found to be positive. Case 2 was a 38-year old Asian male, was admitted on day 5 of illness with symptoms of acute respiratory infection with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2. Evaluation of progressive leukopenia and thrombocytopenia showed positive dengue serology. CONCLUSION: Clinicians must be conscientious when working on the differential diagnosis of possible tropical diseases in cases of coronavirus disease 2019, specifically, when patients develop hemoconcentration, thrombocytopenia, and transaminitis with elevated expression of aspartate higher than alanine transaminase, which is frequently observed in dengue infection. Caution must be taken during the administration of intravenous fluids when treating patients with coronavirus disease 2019 and dengue coinfection, as coronavirus disease 2019 patients are more prone to develop pulmonary edema. Timely diagnosis and appropriate management are essential to avoid the devastating complications of severe forms of dengue infection. It is important to repeat and reconfirm the dengue serology in coronavirus disease 2019 patients to avoid false positivity. Diligence and care must be taken not to neglect other endemic tropical diseases in the region during the present pandemic.


Assuntos
/complicações , Dengue/complicações , Leucopenia/sangue , Trombocitopenia/sangue , Dor Abdominal/fisiopatologia , Adulto , /sangue , Coinfecção , Tosse/fisiopatologia , Dengue/sangue , Dengue/fisiopatologia , Dengue/terapia , Diarreia/fisiopatologia , Disgeusia/fisiopatologia , Febre/fisiopatologia , Hidratação , Cefaleia/fisiopatologia , Humanos , Masculino , Mialgia/fisiopatologia , Faringite/fisiopatologia , Vômito/fisiopatologia
7.
BMJ Open Respir Res ; 8(1)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33731329

RESUMO

BACKGROUND: Descriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequelae of patients admitted to two large District General Hospitals across a large East London National Health Service Trust during the first wave of the pandemic. METHODS: A retrospective analysis was carried out on a cohort of 1946 patients with a clinical or laboratory diagnosis of COVID-19, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three respiratory units in the trust. RESULTS: Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow-up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 70% of survivors, with 39% of patients unable to return to work due to ongoing symptoms. CONCLUSIONS: Understanding the acute clinical features, course of illness and outcomes of COVID-19 will be crucial in understanding the effect of differences in risk, as well as the effectiveness of new interventions and vaccination between the successive waves of the pandemic.


Assuntos
/complicações , /epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alopecia/fisiopatologia , /fisiopatologia , Estudos de Coortes , Tosse/fisiopatologia , Dispneia/fisiopatologia , Grupos Étnicos , Fadiga/fisiopatologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Londres/epidemiologia , Masculino , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Análise Multivariada , Ventilação não Invasiva/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Retorno ao Trabalho , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
8.
Medicina (Kaunas) ; 57(2)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33572732

RESUMO

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12-24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.


Assuntos
/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , /métodos , Tosse/fisiopatologia , Diagnóstico Diferencial , Feminino , Febre/fisiopatologia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Faringite/fisiopatologia , Estudos Retrospectivos , Romênia/epidemiologia , Síndrome , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
JAMA Netw Open ; 4(2): e210202, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33630090

RESUMO

Importance: Owing to concerns of coronavirus disease 2019 (COVID-19) outbreaks, many congregant settings are forced to close when cases are detected because there are few data on the risk of different markers of transmission within groups. Objective: To determine whether symptoms and laboratory results on the first day of COVID-19 diagnosis are associated with development of a case cluster in a congregant setting. Design, Setting, and Participants: This cohort study of trainees with COVID-19 from May 11 through August 24, 2020, was conducted at Joint Base San Antonio-Lackland, the primary site of entry for enlistment in the US Air Force. Symptoms and duration, known contacts, and cycle threshold for trainees diagnosed by reverse transcription-polymerase chain reaction were collected. A cycle threshold value represents the number of nucleic acid amplification cycles that occur before a specimen containing the target material generates a signal greater than the predetermined threshold that defines positivity. Cohorts with 5 or more individuals with COVID-19 infection were defined as clusters. Participants included 10 613 trainees divided into 263 parallel cohorts of 30 to 50 people arriving weekly for 7 weeks of training. Exposures: All trainees were quarantined for 14 days on arrival. Testing was performed on arrival, on day 14, and anytime during training when indicated. Protective measures included universal masking, physical distancing, and rapid isolation of trainees with COVID-19. Main Outcomes and Measures: Association between days of symptoms, specific symptoms, number of symptoms, or cycle threshold values of individuals diagnosed with COVID-19 via reverse transcription-polymerase chain reaction and subsequent transmission within cohorts. Results: In this cohort study of 10 613 US Air Force basic trainees in 263 cohorts, 403 trainees (3%) received a diagnosis of COVID-19 in 129 cohorts (49%). Among trainees with COVID-19 infection, 318 (79%) were men, and the median (interquartile range [IQR]) age was 20 (19-23) years; 204 (51%) were symptomatic, and 199 (49%) were asymptomatic. Median (IQR) cycle threshold values were lower in symptomatic trainees compared with asymptomatic trainees (21.2 [18.4-27.60] vs 34.8 [29.3-37.4]; P < .001). Cohorts with clusters of individuals with COVID-19 infection were predominantly men (204 cohorts [89%] vs 114 cohorts [64%]; P < .001), had more symptomatic trainees (146 cohorts [64%] vs 53 cohorts [30%]; P < .001), and had more median (IQR) symptoms per patient (3 [2-5] vs 1 [1-2]; P < .001) compared with cohorts without clusters. Within cohorts, subsequent development of clusters of 5 or more individuals with COVID-19 infection compared with those that did not develop clusters was associated with cohorts that had more symptomatic trainees (31 of 58 trainees [53%] vs 43 of 151 trainees [28%]; P = .001) and lower median (IQR) cycle threshold values (22.3 [18.4-27.3] vs 35.3 [26.5-37.8]; P < .001). Conclusions and Relevance: In this cohort study of US Air Force trainees living in a congregant setting during the COVID-19 pandemic, higher numbers of symptoms and lower cycle threshold values were associated with subsequent development of clusters of individuals with COVID-19 infection. These values may be useful if validated in future studies.


Assuntos
/métodos , Militares/estatística & dados numéricos , /diagnóstico , /fisiopatologia , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Portador Sadio/transmissão , Estudos de Coortes , Tosse/fisiopatologia , Feminino , Cefaleia/fisiopatologia , Humanos , Masculino , Mialgia/fisiopatologia , Faringite/fisiopatologia , Características de Residência , Fatores de Risco , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto Jovem
10.
Can Respir J ; 2021: 6692409, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628349

RESUMO

We aimed to investigate changes in pulmonary function and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the recovery period. COVID-19 patients underwent symptom assessment, pulmonary function tests, and high-resolution chest CT 6 months after discharge from the hospital. Of the 54 patients enrolled, 31 and 23 were in the moderate and severe group, respectively. The main symptoms 6 months after discharge were fatigue and exertional dyspnea, experienced by 24.1% and 18.5% of patients, respectively, followed by smell and taste dysfunction (9.3%) and cough (5.6%). One patient dropped out of the pulmonary function tests. Of the remaining 54 patients, 41.5% had pulmonary dysfunction. Specifically, 7.5% presented with restrictive ventilatory dysfunction (forced vital capacity <80% of the predicted value), 18.9% presented with small airway dysfunction, and 32.1% presented with pulmonary diffusion impairment (diffusing capacity for carbon monoxide <80% of the predicted value). Of the 54 patients enrolled, six patients dropped out of the chest CT tests. Eleven of the remaining 48 patients presented with abnormal lung CT findings 6 months after discharge. Patients with residual lung lesions were more common in the severe group (52.6%) than in the moderate group (3.4%); a higher proportion of patients had involvement of both lungs (42.1% vs. 3.4%) in the severe group. The residual lung lesions were mainly ground-glass opacities (20.8%) and linear opacities (14.6%). Semiquantitative visual scoring of the CT findings revealed significantly higher scores in the left, right, and both lungs in the severe group than in the moderate group. COVID-19 patients 6 months after discharge mostly presented with fatigue and exertional dyspnea, and their pulmonary dysfunction was mostly characterized by pulmonary diffusion impairment. As revealed by chest CT, the severe group had a higher prevalence of residual lesions than the moderate group, and the residual lesions mostly manifested as ground-glass opacities and linear opacities.


Assuntos
/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Pulmão/fisiopatologia , Adulto , Idoso , Tosse/fisiopatologia , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/fisiopatologia , Pico do Fluxo Expiratório , Capacidade de Difusão Pulmonar , Recuperação de Função Fisiológica , Testes de Função Respiratória , Índice de Gravidade de Doença , Distúrbios do Paladar/fisiopatologia , Tomografia Computadorizada por Raios X , Capacidade Vital
11.
Artif Intell Med ; 112: 102018, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33581830

RESUMO

BACKGROUND AND OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). As of April 3, 2020, there were 1,009,625 reported confirmed cases, and 51,737 reported deaths. Doctors have been faced with a myriad of patients who present with many different symptoms. This raises two important questions. What are the common symptoms, and what are their relative importance? METHODS: A non-structured and incomplete COVID-19 dataset of 14,251 confirmed cases was preprocessed. This produced a complete and organized COVID-19 dataset of 738 confirmed cases. Six different feature selection algorithms were then applied to this new dataset. Five of these algorithms have been proposed earlier in the literature. The sixth is a novel algorithm being proposed by the authors, called Variance Based Feature Weighting (VBFW), which not only ranks the symptoms (based on their importance) but also assigns a quantitative importance measure to each symptom. RESULTS: For our COVID-19 dataset, the five different feature selection algorithms provided different rankings for the most important top-five symptoms. They even selected different symptoms for inclusion within the top five. This is because each of the five algorithms ranks the symptoms based on different data characteristics. Each of these algorithms has advantages and disadvantages. However, when all these five rankings were aggregated (using two different aggregating methods) they produced two identical rankings of the five most important COVID-19 symptoms. Starting from the most important to least important, they were: Fever/Cough, Fatigue, Sore Throat, and Shortness of Breath. (Fever and cough were ranked equally in both aggregations.) Meanwhile, the sixth novel Variance Based Feature Weighting algorithm, chose the same top five symptoms, but ranked fever much higher than cough, based on its quantitative importance measures for each of those symptoms (Fever - 75 %, Cough - 39.8 %, Fatigue - 16.5 %, Sore Throat - 10.8 %, and Shortness of Breath - 6.6 %). Moreover, the proposed VBFW method achieved an accuracy of 92.1 % when used to build a one-class SVM model, and an NDCG@5 of 100 %. CONCLUSIONS: Based on the dataset, and the feature selection algorithms employed here, symptoms of Fever, Cough, Fatigue, Sore Throat and Shortness of Breath are important symptoms of COVID-19. The VBFW algorithm also indicates that Fever and Cough symptoms were especially indicative of COVID-19, for the confirmed cases that are documented in our database.


Assuntos
/fisiopatologia , Biologia Computacional/métodos , Algoritmos , /virologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Humanos , Pandemias , Faringite/fisiopatologia , /isolamento & purificação
12.
Chest ; 159(2): e107-e113, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33563452

RESUMO

CASE PRESENTATION: A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.


Assuntos
/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Bacteriemia/complicações , /fisiopatologia , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Tosse/fisiopatologia , Diarreia/fisiopatologia , Progressão da Doença , Dispneia/fisiopatologia , Serviço Hospitalar de Emergência , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , /diagnóstico por imagem , Linfopenia/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Oximetria , Pneumonia Estafilocócica/complicações , Radiografia Torácica , Infecções Estafilocócicas/complicações , Tomografia Computadorizada por Raios X
14.
PLoS One ; 16(2): e0246793, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571300

RESUMO

BACKGROUND: There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina. RESEARCH QUESTION: What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality? STUDY DESIGN AND METHODS: Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. RESULTS: RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects. INTERPRETATION: Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.


Assuntos
/epidemiologia , /fisiopatologia , Adulto , Argentina/epidemiologia , Asma/epidemiologia , Asma/fisiopatologia , Comorbidade , Tosse/epidemiologia , Tosse/fisiopatologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Feminino , Febre/epidemiologia , Febre/fisiopatologia , Cefaleia/epidemiologia , Cefaleia/fisiopatologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
15.
J Acoust Soc Am ; 149(2): 1120, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33639822

RESUMO

The COVID-19 outbreak was announced as a global pandemic by the World Health Organization in March 2020 and has affected a growing number of people in the past few months. In this context, advanced artificial intelligence techniques are brought to the forefront as a response to the ongoing fight toward reducing the impact of this global health crisis. In this study, potential use-cases of intelligent speech analysis for COVID-19 identification are being developed. By analyzing speech recordings from COVID-19 positive and negative patients, we constructed audio- and symptomatic-based models to automatically categorize the health state of patients, whether they are COVID-19 positive or not. For this purpose, many acoustic features were established, and various machine learning algorithms are being utilized. Experiments show that an average accuracy of 80% was obtained estimating COVID-19 positive or negative, derived from multiple cough and vowel /a/ recordings, and an average accuracy of 83% was obtained estimating COVID-19 positive or negative patients by evaluating six symptomatic questions. We hope that this study can foster an extremely fast, low-cost, and convenient way to automatically detect the COVID-19 disease.


Assuntos
Inteligência Artificial , Tosse/diagnóstico , Sinais (Psicologia) , Inquéritos e Questionários , Voz/fisiologia , Inteligência Artificial/tendências , /psicologia , Tosse/fisiopatologia , Tosse/psicologia , Humanos
16.
BMJ Open ; 11(1): e042745, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436471

RESUMO

BACKGROUND: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. METHODS: The Corona São Caetano programme is a primary care initiative providing care to all residents with COVID-19 in São Caetano do Sul, Brazil. It was designed to capture standardised clinical data on community COVID-19 cases. After triage of potentially severe cases, consecutive patients presenting to a multimedia screening platform between 13 April and 13 May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days with phone calls every 2 days. RT-PCR-negative patients were offered additional SARS-CoV-2 serology testing to establish their infection status. We describe the clinical, virological and natural history features of this prospective population-based cohort. FINDINGS: Of 2073 suspected COVID-19 cases, 1583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95% CI 25.9 to 30.3) were positive; 604/1136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of confirmed COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever (OR 3.0, 95% CI 2.4 to 3.9), anosmia (OR 3.3, 95% CI 2.6 to 4.4) and ageusia (OR 2.9, 95% CI 2.3 to 3.8) were most strongly associated with a positive COVID-19 diagnosis by RT-PCR or serology. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia and closer to symptom onset. The rates of hospitalisation and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalised group. CONCLUSION: COVID-19 presents in a similar way to other mild community-acquired respiratory diseases, but the presence of fever, anosmia and ageusia can assist the specific diagnosis. Most patients recovered without requiring hospitalisation with a low fatality rate compared with other hospital-based studies.


Assuntos
/diagnóstico , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Fatores Etários , Brasil , Criança , Estudos de Coortes , Tosse/etiologia , Tosse/fisiopatologia , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Febre/etiologia , Febre/fisiopatologia , Cefaleia/etiologia , Cefaleia/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Fatores Sexuais , Adulto Jovem
17.
Medicine (Baltimore) ; 100(1): e24158, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429797

RESUMO

BACKGROUND: The pelvic floor muscle (PFM) is associated with respiratory function. We investigated the effects of PFM training by pelvic floor electrical stimulation (PFES) on PFM strength, diaphragm excursion, and upper rib cage movement during tidal and forceful breathing and coughing in women with stress urinary incontinence (SUI). METHODS: In total, 33 participants with SUI were divided into PFES and control groups. The two groups were measured pre- and post-8 weeks of training. Diaphragm excursion and upper rib cage movement during tidal and forceful breathing and coughing and PFM strength were measured using sonography, electromagnetic sensors, and perineometry. RESULTS: There were significant difference of main effect between pre- and post-training and between groups in PFM strength (between groups: P = .001, between time: P < .001) and diaphragm excursion during forceful breathing (between groups: P = .015, between time: P = .026) and coughing (between groups: P = .035, between time: P = .006). There were significant differences in diaphragm excursion during tidal (P = .002) and forceful breathing (P = .005) and coughing (P < .001) between pre- and post-training in the PFES group. Elevation of the upper rib cage during tidal (P < .001) and forceful breathing (P = .001) was significantly decreased after 8 weeks of training in the PFES group. Widening in the horizontal plane in the upper rib cage during forceful breathing (P < .001) was significantly increased after 8 weeks of training in the PFES group. PFM strength (P < .001) was significantly increased after 8 weeks of training in the PFES group. CONCLUSIONS: Pelvic floor muscles training by electrical stimulation can improve diaphragm excursion and breathing patterns in women with SUI.


Assuntos
Tosse/complicações , Diafragma/inervação , Estimulação Elétrica/métodos , Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Tosse/fisiopatologia , Diafragma/fisiopatologia , Estimulação Elétrica/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , República da Coreia , Caixa Torácica/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Resultado do Tratamento , Ultrassonografia/métodos
18.
Trials ; 22(1): 60, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461602

RESUMO

OBJECTIVES: Basic and clinical studies have shown that magnesium sulphate ameliorates lung injury and controls asthma attacks by anti-inflammatory and bronchodilatory effects. Both intravenous and inhaled magnesium sulphate have a clinical impact on acute severe asthma by inhibition of airway smooth muscle contraction. Besides, magnesium sulphate can dilate constricted pulmonary arteries and reduce pulmonary artery resistance. However, it may affect systemic arteries when administered intravenously. A large number of patients with covid-19 admitted to the hospital suffer from pulmonary involvement. COVID-19 can cause hypoxia due to the involvement of the respiratory airways and parenchyma along with circulatory impairment, which induce ventilation-perfusion mismatch. This condition may result in hypoxemia and low arterial blood oxygen pressure and saturation presented with some degree of dyspnoea and shortness of breath. Inhaled magnesium sulphate as a smooth muscle relaxant (natural calcium antagonist) can cause both bronchodilator and consequently vasodilator effects (via a direct effect on alveolar arterioles in well-ventilated areas) in the respiratory tract. We aim to investigate if inhaled magnesium sulphate as adjuvant therapy to standard treatment can reduce ventilation-perfusion mismatch in the respiratory tract and subsequently improve arterial oxygen saturation in hospitalized patients with COVID-19. TRIAL DESIGN: A multi-centre, open-label, randomised controlled trial (RCT) with two parallel arms design (1:1 ratio) PARTICIPANTS: Patients aged 18-80 years hospitalized at Masih Daneshvari Hospital and Shahid Dr. Labbafinejad hospital in Tehran and Shahid Sadoughi Hospital in Yazd will be included if they meet the inclusion criteria of the study. Inclusion criteria are defined as 1. Confirmed diagnosis of SARS-CoV-2 infection based on polymerase chain reaction (PCR) of nasopharyngeal secretions or clinical manifestations along with chest computed tomography (chest CT) scan 2. Presenting with moderate or severe COVID-19 lung involvement confirmed with chest CT scan and arterial oxygen saturation below 93% 3. Length of hospital stay ≤48 hours. Patients with underlying cardiovascular diseases including congestive heart failure, bradyarrhythmia, heart block, the myocardial injury will be excluded from the study. INTERVENTION AND COMPARATOR: Participants will be randomly divided into two arms. Patients in the intervention arm will be given both standard treatment for COVID-19 (according to the national guideline) and magnesium sulphate (5 cc of a 20% injectable vial or 2 cc of a 50% injectable vial will be diluted by 50 cc distilled water and nebulized via a mask) every eight hours for five days. Patients in the control (comparator) arm will only receive standard treatment for COVID-19. MAIN OUTCOMES: Improvement of respiratory function and symptoms including arterial blood oxygen saturation, dyspnoea (according to NYHA functional classification), and cough within the first five days of randomization. RANDOMISATION: Block randomisation will be used to allocate eligible patients to the study arms (in a 1:1 ratio). Computer software will be applied to randomly select the blocks. BLINDING (MASKING): The study is an open-label RCT without blinding. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The trial will be performed on 100 patients who will be randomly divided into two arms of control (50) and intervention (50). TRIAL STATUS: The protocol is Version 5.0, January 05, 2021. Recruitment of the participants started on July 30, 2020, and it is anticipated to be completed by February 28, 2021. TRIAL REGISTRATION: The trial was registered in the Iranian Registry of Clinical Trials (IRCT) on July 28, 2020. It is available on https://en.irct.ir/trial/49879 . The registration number is IRCT20191211045691N1. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Assuntos
/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Administração por Inalação , Gasometria , Broncodilatadores , Tosse/fisiopatologia , Dispneia/fisiopatologia , Humanos , Hipóxia/fisiopatologia , Irã (Geográfico) , Nebulizadores e Vaporizadores , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento , Vasodilatadores , Relação Ventilação-Perfusão
19.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462033

RESUMO

A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days.This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.


Assuntos
/complicações , Convalescença , Pneumotórax/etiologia , Adulto , Dor no Peito/fisiopatologia , Tubos Torácicos , Tosse/fisiopatologia , Dispneia/fisiopatologia , Febre/fisiopatologia , Humanos , Masculino , Mialgia/fisiopatologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/fisiopatologia , Pneumotórax/terapia , Radiografia Torácica , Índice de Gravidade de Doença , Toracostomia , Tomografia Computadorizada por Raios X
20.
J Prim Care Community Health ; 12: 2150132720987432, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33448254

RESUMO

A "superspreader" refers to an unusually contagious organism infected with a disease. With respect to a human borne illnesses, a superspreader is someone who is more likely to infect other humans when compared to a typically infected person. The existence of human superspreaders is deeply entrenched in history; the most famous case being that of Typhoid Mary. Through contact tracing, epidemiologists have identified human superspreaders in measles, tuberculosis, rubella, monkeypox, smallpox, Ebola hemorrhagic fever, and SARS. The recent outbreak of Coronavirus disease (COVID-19) has shifted the focus back on the superspreaders. We herein present a case report of a COVID-19 superspreader with a hitherto unusually high number of infected contacts. The index case was a 33 year old male who resided in a low income settlement comprising of rehabilitated slum dwellers and worked as a healthcare worker (HCW) in a tertiary care hospital and had tested positive for COVID-19.On contact tracing, he had a total of 125 contacts, of which 49 COVID-19 infections had direct or indirect contact with the index case, qualifying him as a "superspreader." This propagated infection led to an outbreak in the community. Contact tracing, testing and isolation of such superspreaders from the other members of the community is essential to stop the spread of this disease and contain the COVID-19 pandemic.


Assuntos
Número Básico de Reprodução , Busca de Comunicante , Pessoal de Saúde , Adulto , Tosse/fisiopatologia , Surtos de Doenças , Febre/fisiopatologia , Humanos , Índia , Masculino , Faringite/fisiopatologia , Áreas de Pobreza , Centros de Atenção Terciária , Local de Trabalho
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