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1.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 1304-1310, 2021 Aug.
Artigo em Russo | MEDLINE | ID: mdl-34792882

RESUMO

According to the literature, the main neurological complications of COVID-19 are hyposmia, hypogeia, headache, dizziness, myalgia, and severe neurological syndromes like encephalopathy, stroke, and coma. The mechanisms of neurological complications of the acute period are direct viral damage, hypoxic damage, and immune damage due to the activation of inflammation, including autoantibodies. After the end of the acute phase of the disease, neurological complications in the form of asthenic syndrome, vascular syndrome, exacerbation of chronic diseases (deterioration of cognitive and communication functions in patients with autism, schizophrenia, exacerbation of autoimmune neurological diseases, aggravation of the condition of patients with tics, increased frequency of epileptic seizures in adults and children, resumption of epileptic seizures in patients who were previously in stable remission, the debut of epileptic seizures). These disorders are based on the following mechanisms: neuroinflammation, activation of pro-inflammatory cytokines (IL-1, -2, -6, -8, -10, -17, -18, CXCL10, CCL2), formation of autoantibodies, increased permeability of the blood-brain barrier, mitochondrial dysfunction, adrenal and thyroid dysfunction, venous dyscirculation. In the treatment of neurological complications after a COVID-19 infection, it is advisable to use anti-inflammatory therapy, mitochondrial therapy (including the technique of intermittent hypoxic-hyperoxic therapy), detoxication, correction of hormonal status (primarily the state of the adrenal glands and thyroid gland), vasoactive therapy, and symptomatic therapy.


Assuntos
COVID-19 , Doenças do Sistema Nervoso , Adulto , Astenia , Criança , Humanos , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , SARS-CoV-2 , Síndrome
2.
Artigo em Russo | MEDLINE | ID: mdl-34693686

RESUMO

OBJECTIVE: To evaluate the clinical effects of ethylmethylhydroxypyridine malate (Ethoxidol) in patients with chronic cerebral ischemia in an outpatient practice. MATERIAL AND METHODS: 60 patients were examined, 58 patients with a diagnosis of cerebrovascular disease (chronic cerebral ischemia) completed the participation in the program. The average age of the patients is 61.2±8.2 years. Neurological complaints typical of patients with chronic cerebral ischemia were recorded. To assess the dynamics of neurological disorders during therapy were used: The Montreal Cognitive Assessment (MoCA), Multidimensional fatigue inventory (MFI-20), Berg Balance Scale (BBS), Tinnitus Handicap Inventory (THI), Clinical Global Impression of Improvement Scale (CGI). The doctors and the patients satisfaction with therapy was assessed using the Visual Analogue Scale (VAS); quality of life - by the VAS of the European Quality of Life Group (EQ-VAS). The course of therapy lasted 60 days. All patients received daily Ethoxidol chewable tablets 400 mg/day (2 tablets (200 mg) in the morning and 2 tablets (200 mg) in the evening). RESULTS: The results of the observational program showed high efficacy and good tolerability of Ethoxidol in patients with chronic cerebral ischemia. A statistically significant decrease in the severity of the clinical manifestations of chronic cerebral ischemia was noted as early as the 30th day of therapy, followed by maintaining a positive trend until the end of the course of treatment with the drug (60th day). On the therapy, the severity of asthenia, cognitive impairment, dizziness, balance disorders, and tinnitus decreased. There was a decrease in the severity of the condition and the presence of clinical improvement on the CGI scale; there was an increase in the quality of life of patients on the EQ-VAS scale. The majority of the patients and the doctors rated the therapy as effective and safe and were satisfied with it. No serious adverse events were reported. CONCLUSION: The data obtained allow us to consider Ethoxidol as an effective drug in the treatment of patients with chronic cerebral ischemia in an outpatient practice.


Assuntos
Isquemia Encefálica , Disfunção Cognitiva , Idoso , Astenia , Isquemia Encefálica/complicações , Isquemia Encefálica/tratamento farmacológico , Humanos , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Qualidade de Vida
3.
Arch Pediatr ; 28(7): 537-543, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509348

RESUMO

BACKGROUND: The neurological effects of Lyme borreliosis in children are varied and their clinical progression is not widely reported in the French literature. We carried out a retrospective study to describe the clinical characteristics of Lyme neuroborreliosis in children in southwest France and their clinical progression at 6 months. METHODS: This study was carried out at Toulouse University Hospital during the period 2006-2017 using patient records. Case definition was based on the combined French clinical and laboratory diagnostic criteria. RESULTS: In total, 26 children were included. The median age was 8 years (4-14 years). The different neurological symptoms reported were: meningoradiculitis (62%), which was usually associated with facial palsy (54%); isolated facial palsy (15%); isolated meningitis (8%); polyradiculoneuritis (4%); benign intracranial hypertension (4%) and myelomeningoradiculitis (4%). The most common functional symptoms were headaches (54%), the perception of asthenia (42%), neck pain (27%), and a loss of appetite (19%). Patients with laboratory meningitis (84%) often had no signs of meningism or headaches (38%). CONCLUSION: The majority of the cases involved meningoradiculitis but other, less common, neurological conditions have been described. The clinical signs suggestive of meningitis are not very marked and might delay the diagnosis.


Assuntos
Neuroborreliose de Lyme/complicações , Adolescente , Astenia/etiologia , Criança , Pré-Escolar , Feminino , Febre/etiologia , França/epidemiologia , Cefaleia/etiologia , Humanos , Neuroborreliose de Lyme/epidemiologia , Masculino , Pediatria/métodos , Pediatria/estatística & dados numéricos , Estudos Retrospectivos
4.
Artigo em Russo | MEDLINE | ID: mdl-34481448

RESUMO

The article explains the changes in terminology and diagnostic criteria for asthenic disorders as manifestations of chronic fatigue syndrome CFS (myalgic encephalomyelitis). Chronic fatigue syndrome is defined as neuroimmune endocrine dysfunction with a purely clinical diagnosis. Probably, viral infections can play a leading role in the pathogenesis. Published diagnostic criteria reveal possible correlations between chronic fatigue syndrome and COVID-19 disease. A promising strategy for the therapy and rehabilitation of patients is the use of smart peptides, a representative of which is the drug cortexin.


Assuntos
Astenia , Síndrome de Fadiga Crônica , Astenia/diagnóstico , Astenia/etiologia , COVID-19 , Síndrome de Fadiga Crônica/complicações , Síndrome de Fadiga Crônica/diagnóstico , Humanos
5.
Artigo em Russo | MEDLINE | ID: mdl-34460158

RESUMO

OBJECTIVE: To study asthenic symptoms in patients with adjustment disorders and to assess the efficacy of cytoflavin in their treatment. MATERIAL AND METHODS: The study included 100 patients, aged 20 to 43 years, with a diagnosis of adjustment disorder. Clinical, neurophysiological and parametric methods were used. An asthenic state scale, the Multidimensional Fatigue Inventory (MFI-20), a digital rating scale (a 10-point variant) and the Headache Impact Test (HIT-6), the Psychological Stress Measure (PSM-25), the Cognitive Emotion Regulation Questionnaire, the Test of Variables of Attention (TOVA) were administered. Cytoflavin was used in a dose of 2 tab. 2 times a day for 25 days for the treatment of patients from the study group. RESULTS: In the study group, 48.0% of patients had a pronounced degree of asthenia, and 52% had a moderate one. The clinical improvement was achieved in 73.0%. In the subgroup with moderate asthenia, the improvement was recorded in 88.5% of cases, in the subgroup of patients with severe asthenia in 56.3% of patients. There was a significant decrease in the severity of indicators on the scales of general asthenia, decreased activity and mental asthenia; a significant decrease in the integral indicator of mental tension, a significant improvement in the indicator of attention, a decrease in the frequency and intensity of headache. The improvement in the functional state of the brain in the form of a decrease in the power of the alpha rhythm in the anterior cerebral cortex was shown. CONCLUSION: The results of the study allow us to conclude that the use of cytoflavin is effective in the treatment of adjustment disorders.


Assuntos
Transtornos de Adaptação , Astenia , Astenia/diagnóstico , Astenia/tratamento farmacológico , Cefaleia , Humanos
6.
Artigo em Russo | MEDLINE | ID: mdl-34380299

RESUMO

OBJECTIVE: Effectiveness comparison of local and general magneto-therapy for determining differentiated indications in order to prescribe the techniques for early rehabilitation of patients after surgical treatment of breast cancer (BC). MATERIAL AND METHODS: It was examined 114 women after radical mastectomy for breast cancer. The patients were divided into 3 groups by the method of simple randomization: the control group (37 women) received therapeutic exercises without additional prescription of physiotherapeutic procedures; 1st main group (38 women) - in addition to exercises a course of local magneto-therapy; 2nd main group (39 women) - general magneto-therapy. The results were assessed using a visual analogue pain scale, goniometry results, remote infrared thermography, hospital anxiety and depression scale (HADS). RESULTS: The inclusion of magneto-therapy in the rehabilitation complex reduced local hyperemia and edema in the area of the postoperative suture on the 7th-8th day in 73.7 and 76.9% of patients of the 1st and 2nd groups, respectively, while in the control group a similar result was observed by 10-14 days. Both methods of magneto-therapy eliminated temperature asymmetry and restored the normal thermographic pattern of the skin surface in the area of the surgical field, reduced the severity of pain, and increased the range of motion in the shoulder joint on the side of the operation. When studying the possibility of eliminating the manifestations of asthenic syndrome a comparison of the two studied methods showed the undoubted advantage of the general exposure to a magnetic field. In addition, it has also caused a statistically significant decrease in indicators of anxiety and depression on the HADS scale, while local exposure to a magnetic field did not have a similar effect. CONCLUSION: The choice of exposure to a magnetic field at the stage of early rehabilitation of women after surgery for breast cancer is determined by the intensity of the pain syndrome, the degree of activity of aseptic inflammation in the area of the postoperative suture, the level of anxiety and depression, and the severity of asthenic syndrome.


Assuntos
Neoplasias da Mama , Terapia de Campo Magnético , Astenia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Síndrome
7.
Sci Rep ; 11(1): 14321, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253805

RESUMO

Trifluridine/tipiracil increases overall survival (OS) in patients with refractory, metastatic colorectal cancer (mCRC). A post hoc exploratory analysis of the RECOURSE randomized clinical trial (RCT) established two categories, a good prognosis corresponding to subjects having a low tumor burden and indolent disease. Other models in refractory mCRC are the FAS-CORRECT and Colon Life nomogram. The main objective was to externally validate the prognostic factors of the RECOURSE and FAS-CORRECT trials, and the Colon Life nomogram in a multicenter, real-world series of mCRC treated in 3rd and successive lines with trifluridine/tipiracil. The secondary aim was to develop an OS predictive model, TAS-RECOSMO. Between 2016 and 2019, 244 patients were recruited. Median OS was 8.15 vs 8.12 months for the poor (85% of the subjects) and good (15%) prognosis groups from the RESOURCE trial, respectively, log-rank p = 0.9. The most common grade 3-4 toxicities were neutropenia (17%), asthenia (6%), and anemia (5%). The AFT lognormal model TAS-RECOSMO included six variables: ECOG-PS, KRAS/NRAS/BRAF mutation status, time between diagnosis of metastasis and beginning of trifluridine/tipiracil, NLR, CEA, and alkaline phosphatase. The model's bootstrapped bias-corrected c-index was 0.682 (95% CI, 0.636-0.722). The factors from the Colon Life model, FAS-CORRECT, and RECOURSE displayed a c-index of 0.690, 0.630, and 0.507, respectively. TAS-RECOSMO, FAS-CORRECT, and the Colon Life nomogram appear to predict OS in patients with refractory mCCR who begin trifluridine/tipiracil treatment in the real world. The prognostic groups of the RECOURCE RCT were unable to capture the situation of real-world subjects treated with trifluridine/tipiracil in this series.


Assuntos
Neoplasias Colorretais/tratamento farmacológico , Pirrolidinas/uso terapêutico , Timina/uso terapêutico , Trifluridina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Astenia/tratamento farmacológico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Neutropenia/tratamento farmacológico , Adulto Jovem
8.
Wiad Lek ; 74(5): 1104-1108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090272

RESUMO

OBJECTIVE: The aim: Is research into development of asthenic syndrome and its effect on the productivity in post-COVID-19 patients. PATIENTS AND METHODS: Materials and methods: All patients underwent neuropsychological testing immediately after the COVID-19 treatment and one month after a comprehensive rehabilitation program. RESULTS: Results: The research proved that of all post-COVID-19 patients, who showed signs of asthenic syndrome from predominantly moderate to extreme severity, the patients who followed the complete comprehensive rehabilitation intervention significantly reduced verifiable severity of asthenic syndrome as well as the disability duration. CONCLUSION: Conclusions: Early administration of combined rehabilitation methods enables preventing the development of long-term side effects, reduces recovery time and enchases the productivity in post-COVID-19 patients.


Assuntos
COVID-19 , Astenia , COVID-19/tratamento farmacológico , Humanos , SARS-CoV-2 , Síndrome
9.
Crit Care Med ; 49(8): 1227-1240, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34115639

RESUMO

The advent of modern critical care medicine has revolutionized care of the critically ill patient in the last 50 years. The Society of Critical Care Medicine (was formed in recognition of the challenges and need for specialized treatment for these fragile patients. As the specialty has grown, it has achieved impressive scientific advances that have reduced mortality and saved lives. With those advances, however, came growing recognition that the burden of critical illness did not end at the doorstep of the hospital. Delirium, once thought to be a mere by-product of critical illness, was found to be an independent predictor of mortality, prolonged mechanical ventilation, and long-lasting cognitive impairment. Similarly, deep sedation and immobility, so often used to keep patients "comfortable" and to facilitate mechanical ventilation and recovery, worsen mortality and lead to the development of ICU-acquired weakness. The realization that these outcomes are inextricably linked to one another and how we manage our patients has helped us recognize the need for culture change. We, as a specialty, now understand that although celebrating the successes of survival, we now also have a duty to focus on those who survive their diseases. Led by initiatives such as the ICU Liberation Campaign of the Society of Critical Care Medicine, the natural progression of the field is now focused on getting patients back to their homes and lives unencumbered by disability and impairment. Much work remains to be done, but the futures of our most critically ill patients will continue to benefit if we leverage and build on the history of our first 50 years.


Assuntos
Estado Terminal/terapia , Delírio/etiologia , Demência/etiologia , Fragilidade/etiologia , Sobrevivência , Astenia/etiologia , Cuidados Críticos/métodos , Humanos , Doença Iatrogênica/prevenção & controle , Unidades de Terapia Intensiva , Doenças Neuromusculares/etiologia , Fatores de Risco
10.
Artigo em Russo | MEDLINE | ID: mdl-34037351

RESUMO

OBJECTIVE: To study the features of asthenic syndrome and the possibilities of its therapy in patients in the post-covid period. MATERIAL AND METHODS: The study included 129 patients with an average age of 49.8±8.9 years who had undergone COVID-19 using a continuous sample method. Patients for the study were selected at the clinical bases of outpatient clinics in Samara (Russia) in July-August 2020. All patients signed an informed consent form prior to enrollment. Patients were randomized into two groups: in the main group (n=64), ethylmethylhydroxypyridine succinate (Neurox) was prescribed 1 tablet (125 mg) 3 times a day for 4 weeks; in the comparison group (n=65), medical drugs (MD) did not contain substances from the pharmacological group related to antihypoxants/antioxidants/nootropics. Three visits (V) were conducted: the first (V1) - the period of inclusion, the second (V2) - after 14 days, the third (V3) - on the 28th day from the start of therapy. The dynamics of the general state (weakness, fatigue, concentration, dizziness, headache, sleep disorders) were evaluated on a visual-analog scale (VAS), the assessment of the subjective feeling of severity of asthenia (fatigue, physical and mental fatigue, decreased motivation and activity) - on Multidimensional Fatigue Inventory (MFI-20), cognitive functions - on Mini-Mental State Examination (MMSE), vegetative tone - according to the Kerdo index. RESULTS: At the end of the study (V3), statistically significant changes in indicators (VAS, MFI-20) were obtained only in the main group patients; no statistically significant differences were obtained for the Kerdo index. Analysis of the MMSE data revealed a decrease in cognitive functions in both groups, which may be associated with pseudocognitive deficits due to asthenia. CONCLUSIONS: We have obtained evidence of a high incidence of asthenic syndrome after COVID-19. Against the background of taking Neurox, there was a decrease in the severity and expression of asthenia symptoms.


Assuntos
Astenia , COVID-19 , Adulto , Humanos , Pessoa de Meia-Idade , Niacinamida , Federação Russa , SARS-CoV-2 , Síndrome
11.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(3. Vyp. 2): 60-66, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33908234

RESUMO

OBJECTIVE: To study the possibility of improving the efficacy of treatment with mexidol in COVID-19 patients with chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Three hundred and four patients with CCI and COVID-19 were observed, group 1 (n=152) consisted of patients receiving basic therapy and mexidol, group 2 (n=152) received only basic therapy. Mexidol was administered intravenously for 14 days, 500 mg (10 ml) per 400 ml of saline solution, then Mexidol FORTE 250 was administered in a dose of 250 mg 3 times a day for 2 months. The state of cognitive functions (MoCA scale), sleep (Spiegel questionnaire), asthenia (MFI-20 scale), and quality of life (SIP questionnaire) were evaluated. Examinations were performed before treatment, 30 and 75 days after start of treatment. RESULTS: In group 1, there was a more complete and earlier recovery of the state of cognitive functions (an increase in indicators on the MoCA scale, p<0.01), a regression of asthenia (p<0.05), and normalization of sleep (p<0.01). By the end of the study, there were significantly more patients in group 1 with complete or significant recovery of all quality of life indicators. CONCLUSION: Long-term sequential therapy with mexidol provides a more complete recovery of impaired functions in patients with CCI and COVID-19.


Assuntos
Isquemia Encefálica , COVID-19 , Astenia , Isquemia Encefálica/tratamento farmacológico , Humanos , Picolinas/uso terapêutico , Qualidade de Vida , SARS-CoV-2
12.
J Surg Res ; 264: 394-401, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33848838

RESUMO

BACKGROUND: After thyroidectomy some patients experience a chronic fatigue syndrome called asthenia. The purpose of this study was to determine the post-operative health related quality of life (HRQOL) and risk of asthenia in patients undergoing thyroidectomy. METHODS: A single institution prospective observational cohort study of adults undergoing thyroidectomy from September 2016 to July 2019 with four HRQOL surveys: preoperative baseline, 2 wk-, 6 mo- and 12 mo-postoperatively. Patients were surveyed using the Short Form 36 version 2 and Brief Fatigue Inventory. Asthenia was defined as Brief Fatigue Inventory > 60 at 12 mo. HRQOL was compared between patients undergoing thyroid lobectomy (TL) or total thyroidectomy (TT) with benign (-B) or malignant (-Ca) final pathology. RESULTS: A total of 182 patients were included: 67 (37%) with TL-B, 32 (17%) with TL-Ca, 40 (22%) with TT-B, and 43 (24%) with TT-Ca. The incidence of asthenia was 42% for TT and 4% for TL. In the TL-B group, 2 patients (3%) developed asthenia, compared with 2 patients (6.25%) in the TL-Ca group, 14 patients (35%) in the TT-B group, and 21 (48.8%) in the TT-Ca group (P = 0.0001). The odds ratio of asthenia for TT compared to TL was 10.4 (95% CI 3.86-28.16) and for patients with malignancy compared to benign disease was 2.05 (95% CI 1.17-3.61). CONCLUSIONS: Patients undergoing TT have a higher risk of developing asthenia than those undergoing TL, particularly if the final pathology shows malignancy.


Assuntos
Astenia/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Tireoidectomia/efeitos adversos , Adulto , Idoso , Astenia/etiologia , Astenia/psicologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos
13.
Artigo em Russo | MEDLINE | ID: mdl-33728844

RESUMO

OBJECTIVE: To determine the structure and mechanisms of interaction of asthenic disorders with negative and positive psychopathological symptoms in hypochondriac schizophrenia. MATERIAL AND METHODS: The study included male and female patients, aged 17-69 years, with a diagnosis of hypochondriac schizophrenia (F20.80 according to ICD-10) and asthenia symptoms. The main research method was clinical, which was supplemented by pathopsychological examination and the use of psychometric scales (PANSS, SANS, MFI-20,VAS asthenia). RESULTS AND CONCLUSION: Asthenia in case of hypochondriac schizophrenia (schizoasthenia) integrates two unrelated phenomena: «weakness¼ and «exhaustion¼ (intolerance to stress), and also acts within the framework of three psychopathological syndromes: neurotic, senestopathic/hypochondriac and overvalued hypochondria. Asthenia with hypochondriac schizophrenia is a predictor of an unfavorable social and clinical prognosis. Integrating into the structure of the clinical manifestations of hypochondriac schizophrenia, asthenia forms close relationships with positive and negative disorders of the type of «general syndromes¼, but remains outside the categories of both positive and negative symptoms of the disease, thus forming a separate «dimension¼ in the psychopathological space of schizophrenia.


Assuntos
Esquizofrenia , Adolescente , Adulto , Idoso , Astenia/diagnóstico , Astenia/etiologia , Feminino , Humanos , Hipocondríase/diagnóstico , Masculino , Pessoa de Meia-Idade , Psicometria , Psicopatologia , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Adulto Jovem
14.
Rev. iberoam. micol ; 38(1): 23-26, ene.-mar. 2021. ilus
Artigo em Espanhol | IBECS | ID: ibc-202391

RESUMO

Paciente de 31 años y sexo femenino que nació y vivió en la Ciudad Autónoma de Buenos Aires, Argentina, en vivienda con sanitarios completos y necesidades básicas satisfechas. Refirió haber realizado viajes a la costa atlántica (provincia de Buenos Aires). Fue fumadora de 10 cigarrillos al día desde los 18 hasta los 30 años. No consumía alcohol. Como antecedentes acerca de su estado de salud solo dijo haber padecido varicela en la infancia. Acudió a la consulta por disnea clase funcional II/III de 3 semanas de evolución y fiebre durante los últimos 3 días


A 31-year-old woman, with signs of HIV infection (oral thrush, weight loss, asthenia) presented to our hospital with dyspnea and fever. A rapid HIV test yielded a positive result, and cryptococcal capsular antigen was detected in serum. In the mycological study of the clinical respiratory samples, yeasts compatible with Cryptococcus were observed under light microscope in a wet mount; structures compatible with Pneumocystis jirovecii were also observed in Giemsa stain. Treatment for both pathologies was prescribed but, unfortunately, the patient died 7 days after. The finding of two etiologic agents in the same clinical picture is rare but not exceptional, and it always must be considered in immunocompromised hosts


Assuntos
Humanos , Feminino , Adulto , Registros Médicos Orientados a Problemas , Infecções por HIV/complicações , Infecções Oportunistas/diagnóstico , Astenia/complicações , Radiografia Torácica , Infecções por HIV/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/patologia , Reação em Cadeia da Polimerase
15.
J Intern Med ; 290(2): 421-429, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33527495

RESUMO

OBJECTIVE: To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes. METHODS: Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed. RESULTS: Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode. CONCLUSION: The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.


Assuntos
COVID-19/epidemiologia , Reinfecção/epidemiologia , Adulto , Astenia/epidemiologia , Comorbidade , Dispneia/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Febre/epidemiologia , Cefaleia/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Imunoglobulina G/sangue , Masculino , Mialgia/epidemiologia , Transtornos do Olfato/epidemiologia , Índice de Gravidade de Doença , Distúrbios do Paladar/epidemiologia
17.
Chest ; 159(2): 657-662, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32910974
18.
Clin Microbiol Infect ; 27(2): 258-263, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33031948

RESUMO

OBJECTIVES: To describe the clinical evolution and predictors of symptom persistence during 2 months' follow-up in adults with noncritical coronavirus disease 2019 (COVID-19). METHODS: We performed descriptive clinical follow-up (day (D) 7, D30 and D60) of 150 patients with noncritical COVID-19 confirmed by real-time reverse transcriptase PCR at Tours University Hospital from 17 March to 3 June 2020, including demographic, clinical and laboratory data collected from the electronic medical records and by phone call. Persisting symptoms were defined by the presence at D30 or D60 of at least one of the following: weight loss ≥5%, severe dyspnoea or asthenia, chest pain, palpitations, anosmia/ageusia, headache, cutaneous signs, arthralgia, myalgia, digestive disorders, fever or sick leave. RESULTS: At D30, 68% (103/150) of patients had at least one symptom; and at D60, 66% (86/130) had symptoms, mainly anosmia/ageusia: 59% (89/150) at symptom onset, 28% (40/150) at D30 and 23% (29/130) at D60. Dyspnoea concerned 36.7% (55/150) patients at D30 and 30% (39/130) at D60. Half of the patients (74/150) at D30 and 40% (52/130) at D60 reported asthenia. Persistent symptoms at D60 were significantly associated with age 40 to 60 years old, hospital admission and abnormal auscultation at symptom onset. At D30, severe COVID-19 and/or dyspnoea at symptom onset were additional factors associated with persistent symptoms. CONCLUSIONS: Up to 2 months after symptom onset, two thirds of adults with noncritical COVID-19 had complaints, mainly anosmia/ageusia, dyspnoea or asthenia. A prolonged medical follow-up of patients with COVID-19 seems essential, whatever the initial clinical presentation.


Assuntos
COVID-19/complicações , COVID-19/epidemiologia , Adulto , Idoso , Ageusia/epidemiologia , Ageusia/etiologia , Anosmia/epidemiologia , Anosmia/etiologia , Astenia/epidemiologia , Astenia/etiologia , COVID-19/patologia , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2 , Avaliação de Sintomas
19.
Arthritis Rheumatol ; 73(2): 286-294, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32951354

RESUMO

OBJECTIVE: Temporal arteritis (TA) is a typical manifestation of giant cell arteritis (GCA). Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are rarely revealed by TA manifestations, leading to a risk of misdiagnosis of GCA and inappropriate treatments. This study was undertaken to describe the clinical, biologic, and histologic presentations and outcomes in cases of TA revealing AAV (TA-AAV) compared to controls with classic GCA. METHODS: In this retrospective case-control study, the characteristics of patients with TA-AAV were compared to those of control subjects with classic GCA. Log-rank test, with hazard ratios (HRs) and 95% confidence intervals (95% CIs), was used to assess the risk of treatment failure. RESULTS: Fifty patients with TA-AAV (median age 70 years) were included. Thirty-three patients (66%) presented with atypical symptoms of GCA (ear, nose, and throat involvement in 32% of patients, and renal, pulmonary, and neurologic involvement in 26%, 20%, and 16% of patients, respectively). Blood samples were screened for ANCAs at the time of disease onset in 33 patients, and results were positive in 88%, leading to a diagnosis of early TA-AAV in 20 patients. The diagnosis of AAV was delayed a median interval of 15 months in 30 patients. Compared to controls with GCA, patients with TA-AAV were younger (median age 70 years versus 74 years), were more frequently men (48% versus 30%), and had high frequencies of atypical manifestations and higher C-reactive protein levels (median 10.8 mg/dl versus 7.0 mg/dl). In patients with TA-AAV, temporal artery biopsy (TAB) showed fibrinoid necrosis and small branch vasculitis in 23% of patients each, whereas neither of these characteristics was evident in controls with GCA. Treatment failure-free survival was comparable between early TA-AAV cases and GCA controls, whereas those with delayed TA-AAV had a significantly higher risk of treatment failure compared to controls (HR 3.85, 95% CI 1.97-7.51; P < 0.0001). CONCLUSION: TA-AAV should be considered diagnostically in cases of atypical manifestations of GCA, refractoriness to glucocorticoid treatment, or early relapse. Analysis of TAB specimens for the detection of small branch vasculitis and/or fibrinoid necrosis could be useful. Detection of ANCAs should be performed in cases of suspected GCA with atypical clinical features and/or evidence of temporal artery abnormalities on TAB.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Arterite de Células Gigantes/fisiopatologia , Artérias Temporais/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/patologia , Arterite/diagnóstico , Arterite/tratamento farmacológico , Arterite/patologia , Arterite/fisiopatologia , Astenia/fisiopatologia , Estudos de Casos e Controles , Tosse/fisiopatologia , Diagnóstico Tardio , Diagnóstico Diferencial , Diplopia/fisiopatologia , Feminino , Febre/fisiopatologia , França , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/patologia , Glucocorticoides/uso terapêutico , Cefaleia/fisiopatologia , Humanos , Arcada Osseodentária , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Polimialgia Reumática/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Couro Cabeludo , Sudorese , Artérias Temporais/patologia , Falha de Tratamento , Transtornos da Visão/fisiopatologia , Perda de Peso
20.
Eur Rev Med Pharmacol Sci ; 24(22): 11960-11963, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33275270

RESUMO

Though the exact etiology of autoimmune diseases still remains not completely known, there are various factors which are known to contribute to be trigger of autoimmune diseases. Viral infection is known to be among the other. It is known as the infection from severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) can be an autoimmune trigger, so, we suppose that SARS-Coronavirus (SARS-CoV-2) could be as well. Several authors have highlighted the temporal consequence between SARS-CoV-2 and autoimmune diseases. In this case report we described a patient admitted for COVID-19 pneumonia with completely negative autoimmunity at admission who developed major pulmonary interstitial disease. During the hospitalization the weaning difficulties from oxygen led us to the repetition of autoimmunity pattern which became positive (both during hospitalization then after two months from dismission) with marked positivity for specific antibodies for myositis even after the patient's infectious healing. In the follow-up, the patient continued to have asthenia and muscle weakness despite steroid therapy. She is still in follow-up and will be further evaluated over time. Can we therefore think that in this case the development of autoimmunity can persist beyond the infectious phase and determine over time the development of a real autoimmune myositis?


Assuntos
Autoanticorpos/imunologia , Doenças Autoimunes/imunologia , COVID-19/imunologia , Doenças Pulmonares Intersticiais/imunologia , Debilidade Muscular/imunologia , Miosite/imunologia , Idoso , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Anticorpos Antinucleares/imunologia , Antígenos Nucleares/imunologia , Astenia/imunologia , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/etiologia , Doenças Autoimunes/fisiopatologia , COVID-19/complicações , COVID-19/fisiopatologia , COVID-19/terapia , Feminino , Humanos , Autoantígeno Ku/imunologia , Complexo Mi-2 de Remodelação de Nucleossomo e Desacetilase/imunologia , Miosite/tratamento farmacológico , Miosite/etiologia , Miosite/fisiopatologia
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