5251
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Practical Considerations for the Diagnosis and Treatment of Fibrotic Interstitial Lung Disease During the Coronavirus Disease 2019 Pandemic. Chest 2020; 158:1069-1078. [PMID: 32333929 PMCID: PMC7194738 DOI: 10.1016/j.chest.2020.04.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has affected virtually all aspects of patient care. Health-care systems around the world are trying simultaneously to treat patients with COVID-19, prepare for its long-term impacts, and treat patients with other acute and chronic diseases. There are multiple ways that the COVID-19 pandemic will directly affect patients with fibrotic interstitial lung disease (ILD), particularly given their common risk factors for poor outcomes. Major issues for patients with ILD will include restricted access to key components of the diagnostic process, new uncertainties in the use of common ILD pharmacotherapies, limited ability to monitor both disease severity and the presence of medication adverse effects, and significantly curtailed research activities. The purpose of this review is to summarize how COVID-19 has impacted key components of the diagnosis and management of fibrotic ILD as well as to provide strategies to mitigate these challenges. We further review major obstacles for researchers and identify priority areas for future ILD research related to COVID-19. Our goals are to provide practical considerations to support the care of patients with ILD during the COVID-19 pandemic and to provide a road map for clinicians caring for these patients during future infectious disease outbreaks.
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5252
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Usul Afsar C. 2019-nCoV-SARS-CoV-2 (COVID-19) infection: Crucıalıty of Furın and relevance wıth cancer. Med Hypotheses 2020; 140:109770. [PMID: 32344311 PMCID: PMC7195133 DOI: 10.1016/j.mehy.2020.109770] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Cigdem Usul Afsar
- Balıkesir University Medical Faculty, Department of Internal Medicine and Medical Oncology, Balıkesir, Turkey
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5253
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[Handling of COVID-19 in the emergency department : Field report of the emergency ward of the University Hospital Münster]. Med Klin Intensivmed Notfmed 2020; 115:380-387. [PMID: 32322988 PMCID: PMC7175829 DOI: 10.1007/s00063-020-00693-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
Mit der COVID-19-Pandemie stehen die Notaufnahmen als Schnittstelle der ambulanten und stationären Krankenversorgung vor einer großen Herausforderung. Die Dynamik der Pandemie zwang die Notfallversorgung des Universitätsklinikums Münster zu umfassenden Anpassungsprozessen, die in kürzester Zeit erfolgen mussten. Dazu gehörte die Etablierung einer ambulanten Coronateststelle und einer studentischen Telefonhotline. Innerklinisch wurden neue Isolationskapazitäten in der Notaufnahme sowie eine eigene COVID-19-Station eingerichtet. Der Patientenfluss wurde durch Flussdiagramme sowohl für den ambulanten als auch für den stationären Bereich neu geregelt. Das allgemeine und spezielle Notfallmanagement wurde für die reibungslose Versorgung COVID-19-positiver Patienten optimiert und das Personal in der Benutzung von Schutzausrüstung trainiert. Dieser Erlebnisbericht soll anderen Notaufnahmen in der Vorbereitung auf die COVID-19-Pandemie unterstützen.
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5254
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Shiba T, Ghazizadeh S, Chhetri D, St John M, Long J. Tracheostomy Considerations during the COVID-19 Pandemic. OTO Open 2020; 4:2473974X20922528. [PMID: 32342026 PMCID: PMC7175063 DOI: 10.1177/2473974x20922528] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To compile current best practices regarding tracheostomy decision making, care, and technical performance during the global COVID-19 pandemic. Data Sources Articles listed in PubMed and Google sources for up-to-date information. Review Methods All sources presenting objective evidence related to the topic were reviewed and distilled. Conclusions Tracheostomy in patients with coronavirus disease should be a rare event yet one that requires significant decision making and procedural deliberation. Indications for surgery must be balanced by risk of disease transmission to health care workers. Considerations are given to personal protective equipment, viral testing, and alternatives. Implications for Practice Otolaryngologists worldwide must be aware of these considerations to provide safe patient care without undue risk to themselves or their hospital coworkers.
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Affiliation(s)
- Travis Shiba
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Shabnam Ghazizadeh
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Dinesh Chhetri
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Maie St John
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Jennifer Long
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA.,Greater Los Angeles Veterans Administration Healthcare System, Los Angeles, California, USA
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5255
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Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, Khare S, Srivastava A. Clinical Features of COVID-19 and Factors Associated with Severe Clinical Course: A Systematic Review and Meta-analysis. SSRN 2020:3566166. [PMID: 32714109 PMCID: PMC7366815 DOI: 10.2139/ssrn.3566166] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/21/2020] [Indexed: 01/08/2023]
Abstract
Background COVID-19 is a new disease which has become a global pandemic, and is caused by a novel coronavirus, SARS-CoV-2. The disease is still not very well characterized, and factors associated with severe clinical course are not well known. Methods The main objectives were to determine the demographic, clinical and laboratory manifestations of COVID-19 and to identify the factors associated with severe clinical course. We searched the PubMed for studies published between Jan 1, 2020 and Mar 17, 2020, and included them if they were in English language, published in full, were retrospective or prospective observational or case control study with data on clinical, laboratory and imaging features of adult patients with COVID-19 disease from single or multiple centers. Studies that included exclusively pediatric patients were excluded. The demographic, clinical and laboratory data was displayed as n (%) or mean (SD). The meta-analysis on factors associated with severe clinical course was performed using the random effects model, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated as the effect sizes. Findings We included 58 studies (6892 patients) for the systematic review on clinical manifestations and 21 studies (3496 patients) for meta-analysis on factors associated with severe clinical course. The mean age of patients with COVID-19 is 49.7±16.3 years with a male to female ratio of 1.2:1. Common symptoms and their frequency are: fever (83.4%), cough (60.5%), fatigue (33.8%), sputum (28.9%), dyspnea (22.1%), myalgia (20.6%), chest tightness / pain (16.3%), sore throat (13.5%), headache (11.2%), diarhhea (7.5%), nasal congestion / rhinorrhea (6.7%), nausea / vomiting (5.6%), pain abdomen (4.6%), and hemoptysis (1.7%). The comorbidities associated with COVID-19 are: hypertension (18.4%), diabetes mellitus (9.8%), cardiovascular diseases (8.8%), endocrine diseases (5.8%), gastrointestinal diseases (5%), CLD (3%), and COPD (2.8%). Among the laboratory parameters WBC was low in 27%, high in 9%, platelets were low in 22.9%, creatinine was high in 6.5%, AST was high in 25.3%, ALT was high in 22.7%, bilirubin was high in 8.8%, albumin was low 60.1%, CT chest was abnormal in 89%, CRP was high in 67.5%, LDH was high in 52%, D-dimer was high in 34.8%, CK was high in 14.4%, and procalcitonin was high in 15.4%. Factors significantly associated severe clinical course (with their ORs) are as follows: High CRP (5.78), high procalcitonin (5.45), age >60 (4.82), dyspnea (4.66), high LDH (4.59), COPD (4.37), low albumin (4.34), high D-dimer (4.03), cardiac disease (3.88), low lymphocyte count (3.22), any associated comorbidity (3.16), diabetes mellitus (3.11), high WBC count (2.67), high bilirubin level (2.55), high creatinine (2.34), high AST (2.31), hypertension (2.30), low platelets (1.78), High ALT (1.69), high CK (1.66), fever spikes ≥39°C (1.59), diarrhea (1.55), male gender (1.47), and sputum (1.35). Interpretation Identification of these factors associated with severe COVID-19 will help the physicians working at all levels of healthcare (primary, secondary, tertiary and ICU) in determining which patients need home care, hospital care, HDU care, and ICU admission; and thus, prioritize the scarce healthcare resource use more judiciously. Many of these identified factors can also help the public at large in the current COVID-19 epidemic setting, to judge when they should seek immediate medical care.
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Affiliation(s)
- Ashish Kumar
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Praveen Sharma
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Shrihari Anil Anikhindi
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Naresh Bansal
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Vikas Singla
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Shivam Khare
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Abhishyant Srivastava
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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5256
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Zhu H, Rhee JW, Cheng P, Waliany S, Chang A, Witteles RM, Maecker H, Davis MM, Nguyen PK, Wu SM. Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response. Curr Cardiol Rep 2020; 22:32. [PMID: 32318865 PMCID: PMC7171437 DOI: 10.1007/s11886-020-01292-3] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Coronavirus disease of 2019 (COVID-19) is a cause of significant morbidity and mortality worldwide. While cardiac injury has been demonstrated in critically ill COVID-19 patients, the mechanism of injury remains unclear. Here, we review our current knowledge of the biology of SARS-CoV-2 and the potential mechanisms of myocardial injury due to viral toxicities and host immune responses. RECENT FINDINGS A number of studies have reported an epidemiological association between history of cardiac disease and worsened outcome during COVID infection. Development of new onset myocardial injury during COVID-19 also increases mortality. While limited data exist, potential mechanisms of cardiac injury include direct viral entry through the angiotensin-converting enzyme 2 (ACE2) receptor and toxicity in host cells, hypoxia-related myocyte injury, and immune-mediated cytokine release syndrome. Potential treatments for reducing viral infection and excessive immune responses are also discussed. COVID patients with cardiac disease history or acquire new cardiac injury are at an increased risk for in-hospital morbidity and mortality. More studies are needed to address the mechanism of cardiotoxicity and the treatments that can minimize permanent damage to the cardiovascular system.
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Affiliation(s)
- Han Zhu
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - June-Wha Rhee
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Paul Cheng
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Sarah Waliany
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
| | - Amy Chang
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Division of Infectious Disease, Stanford University, Stanford, CA USA
| | - Ronald M. Witteles
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Holden Maecker
- Department of Microbiology and Immunology, Stanford University, Stanford, CA USA
- Stanford Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA USA
| | - Mark M. Davis
- Department of Microbiology and Immunology, Stanford University, Stanford, CA USA
- Stanford Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA USA
- Howard Hughes Medical Institute, Stanford, CA USA
| | - Patricia K. Nguyen
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Sean M. Wu
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
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5257
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Zhai Z, Li C, Chen Y, Gerotziafas G, Zhang Z, Wan J, Liu P, Elalamy I, Wang C. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost 2020; 120:937-948. [PMID: 32316065 PMCID: PMC7295267 DOI: 10.1055/s-0040-1710019] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months, causing millions infected. Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has been frequently reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and coagulation disorders. Based on frontline practical experience and comprehensive literature review, here a panel of experts and physicians from China and Europe developed an evidence and opinion-based consensus on the prophylaxis and management of VTE associated with COVID-19. This statement aims for clinicians treating COVID-19 and provides practical recommendations in detailed situations, for example, how to choose thromboprophylactic measures for patients with diverse severity of disease and bleeding risk, or which kind of anticoagulant should be prescribed. With limited experience on COVID19-associated VTE, this expert consensus statement should be helpful for clinicians worldwide with specific suggestions.
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Affiliation(s)
- Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Chenghong Li
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Grigorios Gerotziafas
- Hematology and Thrombosis Center, Tenon University Hospital, INSERM UMRS 938, Sorbonne University, Paris, France
| | - Zhenlu Zhang
- Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan, China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Ismaïl Elalamy
- Hematology and Thrombosis Center, Tenon University Hospital, INSERM UMRS 938, Sorbonne University, Paris, France.,Department of Obstetrics and Gynaecology, the First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5258
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Solé G, Salort-Campana E, Pereon Y, Stojkovic T, Wahbi K, Cintas P, Adams D, Laforet P, Tiffreau V, Desguerre I, Pisella LI, Molon A, Attarian S. Guidance for the care of neuromuscular patients during the COVID-19 pandemic outbreak from the French Rare Health Care for Neuromuscular Diseases Network. Rev Neurol (Paris) 2020; 176:507-515. [PMID: 32354651 PMCID: PMC7167585 DOI: 10.1016/j.neurol.2020.04.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/16/2020] [Indexed: 12/12/2022]
Abstract
In France, the epidemic phase of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in February 2020 and resulted in the implementation of emergency measures and a degradation in the organization of neuromuscular reference centers. In this special context, the French Rare Health Care for Neuromuscular Diseases Network (FILNEMUS) has established guidance in an attempt to homogenize the management of neuromuscular (NM) patients within the French territory. Hospitalization should be reserved for emergencies, the conduct of treatments that cannot be postponed, check-ups for which the diagnostic delay may result in a loss of survival chance, and cardiorespiratory assessments for which the delay could be detrimental to the patient. A national strategy was adopted during a period of 1 to 2 months concerning treatments usually administered in hospitalization. NM patients treated with steroid/immunosuppressants for a dysimmune pathology should continue all of their treatments in the absence of any manifestations suggestive of COVID-19. A frequently asked questions (FAQ) sheet has been compiled and updated on the FILNEMUS website. Various support systems for self-rehabilitation and guided exercises have been also provided on the website. In the context of NM diseases, particular attention must be paid to two experimental COVID-19 treatments, hydroxycholoroquine and azithromycin: risk of exacerbation of myasthenia gravis and QT prolongation in patients with pre-existing cardiac involvement. The unfavorable emergency context related to COVID-19 may specially affect the potential for intensive care admission (ICU) for people with NMD. In order to preserve the fairest medical decision, a multidisciplinary working group has listed the neuromuscular diseases with a good prognosis, usually eligible for resuscitation admission in ICU and, for other NM conditions, the positive criteria suggesting a good prognosis. Adaptation of the use of noninvasive ventilation (NIV) make it possible to limit nebulization and continue using NIV in ventilator-dependent patients.
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Affiliation(s)
- G Solé
- Reference Center for Neuromuscular Disorders AOC, Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - E Salort-Campana
- Reference Center of Neuromuscular disorders and ALS, Timone University Hospital, AP-HM, 13385 Marseille, France; Medical Genetics, Aix-Marseille Université, Inserm UMR_1251, 13005 Marseille, France
| | - Y Pereon
- CHU Nantes, Reference Center for Neuromuscular Disorders AOC, Hôtel-Dieu, Nantes, France
| | - T Stojkovic
- Reference Center of Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Inserm UMR_S 974, Paris, France
| | - K Wahbi
- AP-HP, Cochin Hospital, Cardiology Department, FILNEMUS, Centre de Référence de Pathologie Neuromusculaire Nord/Est/Île-de-France, Paris-Descartes, Sorbonne Paris Cité University, 75006 Paris, France; INSERM Unit 970, Paris Cardiovascular Research Centre (PARCC), Paris, France
| | - P Cintas
- Reference Center of Neuromuscular Disorders AOC, Toulouse, University Hospitals, 31000 Toulouse, France
| | - D Adams
- Department of Neurology, CHU Bicetre, Hôpitaux Universitaires Paris Sud, Paris, France
| | - P Laforet
- Nord/Est/Île-de-France Neuromuscular Reference Center, Neurology Department, Raymond-Poincaré Teaching Hospital, AP-HP, Garches, France; INSERM U1179, END-ICAP, Versailles-Saint-Quentin-en-Yvelines University, Université Paris Saclay, Montigny-le-Bretonneux, France
| | - V Tiffreau
- Reference Center of Neuromuscular Disorders Nord/Est/Île-de-France, Hôpital Pierre-Swynghedauw, CHU de Lille, EA 7369 URePSSS, 59000 Lille, France
| | - I Desguerre
- Reference Center of Neuromuscular Disorders Nord/Est/Île-de-France, Pediatric Neurology Department, Necker-Enfants-Malades Hospital, AP-HP, Paris, France
| | | | - A Molon
- Filnemus, AP-HM, Marseille, France
| | - S Attarian
- Reference Center of Neuromuscular disorders and ALS, Timone University Hospital, AP-HM, 13385 Marseille, France; Medical Genetics, Aix-Marseille Université, Inserm UMR_1251, 13005 Marseille, France.
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5259
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Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, Aaron JG, Claassen J, Rabbani LE, Hastie J, Hochman BR, Salazar-Schicchi J, Yip NH, Brodie D, O'Donnell MR. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.04.15.20067157. [PMID: 32511638 PMCID: PMC7276994 DOI: 10.1101/2020.04.15.20067157] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Nearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed. METHODS We prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation. RESULTS Of 1,150 adults hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension (63%; 162/257) and diabetes mellitus (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age, hypertension, chronic lung disease, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality. CONCLUSIONS Critical illness among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality.
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5260
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Rodriguez JA, Rubio-Gomez H, Roa AA, Miller N, Eckardt PA. Co-Infection with SARS-COV-2 and Parainfluenza in a young adult patient with pneumonia: Case Report. IDCases 2020; 20:e00762. [PMID: 32368493 PMCID: PMC7186517 DOI: 10.1016/j.idcr.2020.e00762] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 01/23/2023] Open
Abstract
Coronavirus 2 (SARS-CoV-2) is now considered a pandemic causing Coronavirus disease (COVID-19), multiple fatalities and morbidities which have been associated with it worldwide. We report a severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-COV-2 and Parainfluenza 4 virus in a Hispanic 21 year old male in Florida, USA. The case represents the importance of prompt diagnosis and awareness of the potential co-infection with other respiratory viruses and this novel deadly virus.
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Affiliation(s)
- Jose A Rodriguez
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Heysu Rubio-Gomez
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
| | - Alejandra A Roa
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - N Miller
- Microbiology and Molecular Infectious Disease Pathology Consultants of South Broward, LLC, Memorial Healthcare System, Hollywood, FL, USA
| | - Paula A Eckardt
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
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5261
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Song JC, Wang G, Zhang W, Zhang Y, Li WQ, Zhou Z. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res 2020; 7:19. [PMID: 32307014 PMCID: PMC7167301 DOI: 10.1186/s40779-020-00247-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022] Open
Abstract
Since December 2019, a novel type of coronavirus disease (COVID-19) in Wuhan led to an outbreak throughout China and the rest of the world. To date, there have been more than 1,260,000 COVID-19 patients, with a mortality rate of approximately 5.44%. Studies have shown that coagulation dysfunction is a major cause of death in patients with severe COVID-19. Therefore, the People's Liberation Army Professional Committee of Critical Care Medicine and Chinese Society on Thrombosis and Hemostasis grouped experts from the frontline of the Wuhan epidemic to come together and develop an expert consensus on diagnosis and treatment of coagulation dysfunction associated with a severe COVID-19 infection. This consensus includes an overview of COVID-19-related coagulation dysfunction, tests for coagulation, anticoagulation therapy, replacement therapy, supportive therapy and prevention. The consensus produced 18 recommendations which are being used to guide clinical work.
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Affiliation(s)
- Jing-Chun Song
- Department of Critical Care Medicine, the 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, 330002, China.
| | - Gang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710001, China
| | - Wei Zhang
- Department of Emergency Medicine, the 900th Hospital of Joint Logistics Support Forces of Chinese PLA, Fuzhou, 350000, China
| | - Yang Zhang
- Department of Laboratory Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Wei-Qin Li
- Department of Critical Care Medicine, General Hospital of Eastern Theater Command of Chinese PLA, Nanjing, 210002, China.
| | - Zhou Zhou
- Department of Laboratory Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China.
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5262
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Wang X, Fang X, Cai Z, Wu X, Gao X, Min J, Wang F. Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis. RESEARCH (WASHINGTON, D.C.) 2020; 2020:2402961. [PMID: 32377638 PMCID: PMC7187729 DOI: 10.34133/2020/2402961] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Abstract
The recent outbreak of COVID-19 has been rapidly spreading on a global scale. To date, there is no specific vaccine against the causative virus, SARS-CoV-2, nor is there an effective medicine for treating COVID-19, thus raising concerns with respect to the effect of risk factors such as clinical course and pathophysiological parameters on disease severity and outcome in patients with COVID-19. By extracting and analyzing all available published clinical data, we identified several major clinical characteristics associated with increased disease severity and mortality among patients with COVID-19. Specifically, preexisting chronic conditions such as hypertension, cardiovascular disease, chronic kidney disease, and diabetes are strongly associated with an increased risk of developing severe COVID-19; surprisingly, however, we found no correlation between chronic liver disease and increased disease severity. In addition, we found that both acute cardiac injury and acute kidney injury are highly correlated with an increased risk of COVID-19-related mortality. Given the high risk of comorbidity and the high mortality rate associated with tissue damage, organ function should be monitored closely in patients diagnosed with COVID-19, and this approach should be included when establishing new guidelines for managing these high-risk patients. Moreover, additional clinical data are needed in order to determine whether a supportive therapy can help mitigate the development of severe, potentially fatal complications, and further studies are needed to identify the pathophysiology and the mechanism underlying this novel coronavirus-associated infectious disease. Taken together, these findings provide new insights regarding clinical strategies for improving the management and outcome of patients with COVID-19.
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Affiliation(s)
- Xinhui Wang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xuexian Fang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Zhaoxian Cai
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xiaotian Wu
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xiaotong Gao
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Junxia Min
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Fudi Wang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China
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5263
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Hadadi A, Mortezazadeh M, Kolahdouzan K, Alavian G. Does recombinant human erythropoietin administration in critically ill COVID-19 patients have miraculous therapeutic effects? J Med Virol 2020; 92:915-918. [PMID: 32270515 PMCID: PMC7262240 DOI: 10.1002/jmv.25839] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 12/29/2022]
Abstract
An 80‐year‐old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O2 saturation and definitive chest computerized tomography scan findings in favor of COVID‐19 and positive PCR results in 48 hours. He received antiviral treatment plus recombinant human erythropoietin (rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the severe acute respiratory syndrome coronavirus 2 virus through multiple mechanisms including cytokine modulation, antiapoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus. Recombinant human erythropoietin can rapidly correct anemia and symptoms associated with COVID‐19 Through cytokine modulation, rhEPO exerts its cytoprotective and anti‐apoptotic effects in COVID pneumonia. rhEPO takes iron away from intracellular virus into the bone marrow, undermining the viral enzymatic requirements.
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Affiliation(s)
- Azar Hadadi
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mortezazadeh
- Internal Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Kolahdouzan
- Radiation Oncology Department, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Golbarg Alavian
- Pharmacotherapy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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5264
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Larina VN, Golovko MG, Larin VG. Possible effects of coronavurus infection (COVID-19) on the cardiovascular system. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute viral respiratory infections can increase the risk of progression of a pre-existing condition, including a cardiovascular pathology. Life-threatening complications of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) necessitate research into the cardiovascular effects of COVID-19 crucial for developing adequate treatment strategy for infected patients, especially those of advanced age. This article reviews the literature on the clinical and functional characteristics of patients with COVID-19, including those with poor outcomes. The article looks at the pathophysiological processes occurring in the cardiovascular system in the setting of SARS-CoV-2 infection, risk factors and death predictors. It also discusses continuation of therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with COVID-19.
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Affiliation(s)
- VN Larina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - MG Golovko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - VG Larin
- Pirogov Russian National Research Medical University, Moscow, Russia
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5265
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Abstract
AbstractA novel coronavirus, SARS-CoV-2, emerged in December 2019, leading within a few months to a global pandemic. COVID-19, the disease caused by this highly contagious virus, can have serious health consequences, though risks of complications are highly age-dependent. Rates of hospitalization and death are less than 0.1% in children, but increase to 10% or more in older people. Moreover, at all ages, men are more likely than women to suffer serious consequences from COVID-19. These patterns are familiar to the geroscience community. The effects of age and sex on mortality rates from COVID-19 mirror the effects of aging on almost all major causes of mortality. These similarities are explored here, and underscore the need to consider the role of basic biological mechanisms of aging on potential treatment and outcomes of COVID-19.
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Affiliation(s)
- Daniel E L Promislow
- Department of Pathology, University of Washington School of Medicine, Seattle
- Department of Biology, University of Washington, Seattle
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5266
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Abstract
There is no doubt about the importance of diagnostic testing in an emergency; specifically, which range of tests is available, where and when they are dispensed, and who might be tested using laboratory-developed tests, or other diagnostic tests including experimental tests. This includes testing for the SARS-CoV-2 virus that causes the COVID-19 disease. Testing is essential to “flatten the curve” of the number of confirmed positive cases of the disease, in addition to handwashing, isolation, and social distancing, among other essential measures. Is one diagnostic test enough to obtain the correct decision about a confirmed positive outcome?
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5267
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Plaçais L, Richier Q. [COVID-19: Clinical, biological and radiological characteristics in adults, infants and pregnant women. An up-to-date review at the heart of the pandemic]. Rev Med Interne 2020; 41:308-318. [PMID: 32334862 PMCID: PMC7164907 DOI: 10.1016/j.revmed.2020.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023]
Abstract
La propagation du nouveau coronavirus SARS-CoV-2, découvert en Chine en janvier 2020, a mené à une pandémie dès mars 2020, obligeant chaque système de soins des pays touchés à une adaptation rapide. Pour mieux faire face à cette crise sanitaire majeure, qui a donné lieu à de nombreuses publications scientifiques, nous avons synthétisé les principales études cliniques originales afin de faciliter la prise en charge au quotidien des patients atteints de COVID-19. Nous détaillons les premiers signes et l’évolution de la maladie ainsi que les différentes formes cliniques, y compris extra-pulmonaires, telles qu’elles sont connues au début de cette pandémie. Nous insistons sur les marqueurs cliniques, biologiques et scannographiques prédictifs de sévérité ou de mortalité. Enfin, nous discutons de l’impact de l’infection par le SARS-CoV-2 dans les populations suspectes d’être à haut risque de formes sévères.
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Affiliation(s)
- L Plaçais
- Médecine interne, Sorbonne Université, 15-21, rue de l'École-de-médecine, 75006 Paris, France
| | - Q Richier
- Médecine interne, Université de Paris, 12, rue de l'École-de-médecine, 75006 Paris, France.
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5268
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Iacucci M, Cannatelli R, Labarile N, Mao R, Panaccione R, Danese S, Kochhar GS, Ghosh S, Shen B. Endoscopy in inflammatory bowel diseases during the COVID-19 pandemic and post-pandemic period. Lancet Gastroenterol Hepatol 2020; 5:598-606. [PMID: 32305075 PMCID: PMC7162648 DOI: 10.1016/s2468-1253(20)30119-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is changing the management of many chronic diseases, including that of patients with inflammatory bowel diseases (IBD). In particular, the performance of routine endoscopy is temporarily suspended, and only emergency endoscopy is allowed in many countries where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread. We highlight different scenarios in which endoscopy should still be performed urgently in patients with IBD, as well as recommendations regarding the use of personal protective equipment. We suggest a pathway for performing safe endoscopy and discuss the potential risks of postponing endoscopy in IBD. Finally, we propose a post-pandemic plan for access to endoscopy.
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Affiliation(s)
- Marietta Iacucci
- Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Rosanna Cannatelli
- Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology, Spedali Civili of Brescia, Italy
| | - Nunzia Labarile
- Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Remo Panaccione
- Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gursimran S Kochhar
- Department of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Subrata Ghosh
- Institute of Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK; Department of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada.
| | - Bo Shen
- Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
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5269
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Ou X, Zhou L, Huang H, Lin Y, Pan X, Chen D. A severe case with co-infection of SARS-CoV-2 and common respiratory pathogens. Travel Med Infect Dis 2020; 35:101672. [PMID: 32305630 PMCID: PMC7161507 DOI: 10.1016/j.tmaid.2020.101672] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Xueting Ou
- Department of Infectious Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liyang Zhou
- Department of Infectious Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huanliang Huang
- Emergency Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuebao Lin
- Department of General Practice, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingfei Pan
- Department of Infectious Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Dexiong Chen
- Emergency Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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5270
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Moreno Torres A, Rojas Gutiérrez A, Vásconez Escobar JN, Silva Rueda R, Morales Rubio L, Herrera Chaparro JA, Rodríguez Sabogal C, Jiménez Díaz LH. Recomendaciones para realización de traqueostomías y atención de los pacientes traqueostomizados en Colombia durante la pandemia COVID-19. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Establecer una serie de recomendaciones para la realización de las traqueostomías, que se centren en la seguridad de los pacientes y de los equipos de atención médica durante la pandemia de COVID-19, minimizando el riesgo, la exposición viral y agotamiento del equipo de protección personal (EPP). Este documento está destinado a proporcionar los antecedentes, consideraciones y recomendaciones basadas en la literatura e información de primera línea de esta etapa de la pandemia. Estas recomendaciones pueden requerir individualización en función de la región del país, la institución, la capacidad instalada, los recursos y los factores específicos del paciente. Se encuentran en constante actualización según la evolución de la enfermedad y aparición de nuevos datos.
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5271
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Abstract
Given the rapidly progressing coronavirus disease 2019 (COVID-19) pandemic, this report on a US cohort of 54 COVID-19 patients from Stanford Hospital and data regarding risk factors for severe disease obtained at initial clinical presentation is highly important and immediately clinically relevant. We identified low presenting oxygen saturation as predictive of severe disease outcomes, such as diagnosis of pneumonia, acute respiratory distress syndrome, and admission to the intensive care unit, and also replicated data from China suggesting an association between hypertension and disease severity. Clinicians will benefit by tools to rapidly risk stratify patients at presentation by likelihood of progression to severe disease.
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5272
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Hajifathalian K, Mahadev S, Schwartz RE, Shah S, Sampath K, Schnoll-Sussman F, Brown Jr RS, Carr-Locke D, Cohen DE, Sharaiha RZ. SARS-COV-2 infection (coronavirus disease 2019) for the gastrointestinal consultant. World J Gastroenterol 2020; 26:1546-1553. [PMID: 32327904 PMCID: PMC7167410 DOI: 10.3748/wjg.v26.i14.1546] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/08/2020] [Accepted: 04/11/2020] [Indexed: 02/06/2023] Open
Abstract
The current pandemic due to the severe acute respiratory syndrome coronavirus 2 has caused an extreme burden for health care systems globally, and the number of cases is expected to continue to increase, at least in the immediate future. The virus is estimated to have infected more than 1.5 million individuals. The available reports suggest that gastrointestinal (GI) involvement in coronavirus disease 2019 (COVID-19) is common and in some cases the GI symptoms may precede the respiratory symptoms. In addition to direct effects of severe acute respiratory syndrome coronavirus 2, the infected patients remain at risk for the complications commonly managed by gastroenterology and hepatology consultants. The most commonly reported GI manifestation of COVID-19 is diarrhea, which is reported in a third to up to more than half of the patients. Mild to moderate elevation of the liver enzymes are also common, although no case of acute liver failure has been reported so far. Many of the medications used for treatment of COVID-19 can also be associated with GI symptoms or liver injury and can be included in the differential diagnosis in these patients. Although the diagnosis of the infection is currently based on RNA analysis in respiratory samples, the available literature on fecal shedding of this virus suggests that fecal RNA testing might prove to be a useful diagnostic test. It is reasonable to delay all non-urgent endoscopic procedures during the peak of the pandemic and use additional protective equipment such as N95 respirators during endoscopy while most patients can be considered high risk for having been exposed to the virus.
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Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - Robert E Schwartz
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - Shawn Shah
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - Felice Schnoll-Sussman
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - Robert S Brown Jr
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - David Carr-Locke
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - David E Cohen
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, United States
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5273
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Di Gennaro F, Pizzol D, Marotta C, Antunes M, Racalbuto V, Veronese N, Smith L. Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2690. [PMID: 32295188 PMCID: PMC7215977 DOI: 10.3390/ijerph17082690] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 01/08/2023]
Abstract
At the end of 2019 a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing severe acute respiratory syndrome expanded globally from Wuhan, China. In March 2020 the World Health Organization declared the SARS-Cov-2 virus a global pandemic. We performed a narrative review to describe existing literature with regard to Corona Virus Disease 2019 (COVID-19) epidemiology, pathophysiology, diagnosis, management and future perspective. MEDLINE, EMBASE and Scopus databases were searched for relevant articles. Although only when the pandemic ends it will be possible to assess the full health, social and economic impact of this global disaster, this review represents a picture of the current state of the art. In particular, we focus on public health impact, pathophysiology and clinical manifestations, diagnosis, case management, emergency response and preparedness.
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Affiliation(s)
- Francesco Di Gennaro
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, 86077 Pozzilli, Italy; (F.D.G.); (C.M.)
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum 79371, Sudan;
| | - Claudia Marotta
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, 86077 Pozzilli, Italy; (F.D.G.); (C.M.)
| | - Mario Antunes
- Department of Surgery, Central Hospital of Beira, Beira 2102, Mozambique;
| | | | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90100 Palermo, Italy;
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK;
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5274
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Muscogiuri G, Barrea L, Savastano S, Colao A. Nutritional recommendations for CoVID-19 quarantine. Eur J Clin Nutr 2020; 74:850-851. [PMID: 32286533 PMCID: PMC7155155 DOI: 10.1038/s41430-020-0635-2] [Citation(s) in RCA: 235] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Giovanna Muscogiuri
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy. .,Centro italiano per la cura e il benessere del paziente (C.I.B.O) Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy.
| | - Luigi Barrea
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy.,Centro italiano per la cura e il benessere del paziente (C.I.B.O) Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Silvia Savastano
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy.,Centro italiano per la cura e il benessere del paziente (C.I.B.O) Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy.,Centro italiano per la cura e il benessere del paziente (C.I.B.O) Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
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5275
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Lai CC, Wang JH, Ko WC, Yen MY, Lu MC, Lee CM, Hsueh PR. COVID-19 in long-term care facilities: An upcoming threat that cannot be ignored. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:444-446. [PMID: 32303483 PMCID: PMC7153522 DOI: 10.1016/j.jmii.2020.04.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Jui-Hsiang Wang
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Muh-Yong Yen
- Division of Infectious Diseases, Taipei City Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Min-Chi Lu
- Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ming Lee
- Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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5276
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Whittle JS, Pavlov I, Sacchetti AD, Atwood C, Rosenberg MS. Respiratory support for adult patients with COVID-19. J Am Coll Emerg Physicians Open 2020; 1:95-101. [PMID: 32427171 PMCID: PMC7228246 DOI: 10.1002/emp2.12071] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID‐19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of non‐invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVID‐19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosol‐generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use non‐rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Non‐invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi‐organ failure, or acute respiratory distress syndrome (ARDS).
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Affiliation(s)
- Jessica S Whittle
- Department of Emergency Medicine University of Tennessee/ Erlanger Health Chattanooga Tennessee USA
| | - Ivan Pavlov
- Department of Emergency Medicine Verdun Hospital Montreal Quebec Canada
| | - Alfred D Sacchetti
- Our Lady of Lourdes Medical Center Camden New Jersey USA.,Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Charles Atwood
- University of Pittsburgh and UPM Pittsburgh Pennsylvania USA.,Department of Sleep Medicine Pittsburgh Healthcare System Pittsburgh Pennsylvania USA
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5277
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Ahn JY, Sohn Y, Lee SH, Cho Y, Hyun JH, Baek YJ, Jeong SJ, Kim JH, Ku NS, Yeom JS, Roh J, Ahn MY, Chin BS, Kim YS, Lee H, Yong D, Kim HO, Kim S, Choi JY. Use of Convalescent Plasma Therapy in Two COVID-19 Patients with Acute Respiratory Distress Syndrome in Korea. J Korean Med Sci 2020; 35:e149. [PMID: 32281317 PMCID: PMC7152526 DOI: 10.3346/jkms.2020.35.e149] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 not yet has established its treatment, but convalescent plasma has been expected to increase survival rates as in the case with other emerging viral infections. We describe two cases of COVID-19 treated with convalescent plasma infusion. Both patients presented severe pneumonia with acute respiratory distress syndrome and showed a favorable outcome after the use of convalescent plasma in addition to systemic corticosteroid. To our knowledge, this is the first report of the use of convalescent plasma therapy for COVID-19 in Korea.
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Affiliation(s)
- Jin Young Ahn
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yujin Sohn
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Hwan Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yunsuk Cho
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hoon Hyun
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yae Jee Baek
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Su Ku
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Sup Yeom
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Juhye Roh
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Young Ahn
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Bum Sik Chin
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyukmin Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dongeun Yong
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ok Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sinyoung Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jun Yong Choi
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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5278
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Du X, Yu X, Li Q, Li X, Qin T, Luo Q, Wang M, Jiang M, Bai L, Wang X, Pan Y. Duration for carrying SARS-CoV-2 in COVID-19 patients. J Infect 2020; 81:e78-e79. [PMID: 32283161 PMCID: PMC7195094 DOI: 10.1016/j.jinf.2020.03.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Xinwei Du
- Department of Infection, The People's Hospital of Suzhou New District, 95th Huashan road, Suzhou New District, Suzhou, Jiangsu 215129, China; Department of Respiratory Medicine, Shangqiu Municipal Hospital, Intersection of guide south road and yingbin road, Suiyang, Henan province, 476000, China
| | - Xue Yu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Rd, Zhengzhou, 450000 China
| | - Qingqing Li
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Rd, Zhengzhou, 450000 China
| | - Xianyang Li
- Department of Infectious Diseases, Shenqiu People's Hospital, China
| | - Tao Qin
- Department of Hepatobiliary Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qiankun Luo
- Department of Hepatobiliary Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Miaomiao Wang
- Department of Disease prevention and control, the First Affiliated Hospital of Zhengzhou University, China
| | - Minlin Jiang
- Tongji University School of Medicine, No 1239 Siping Road, Shanghai 200092, China
| | - Li Bai
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Rd, Zhengzhou, 450000 China
| | - Xiaoping Wang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Rd, Zhengzhou, 450000 China
| | - Yanfeng Pan
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Rd, Zhengzhou, 450000 China.
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5279
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Passaro A, Peters S, Mok TSK, Attili I, Mitsudomi T, de Marinis F. Testing for COVID-19 in lung cancer patients. Ann Oncol 2020; 31:832-834. [PMID: 32278879 PMCID: PMC7144604 DOI: 10.1016/j.annonc.2020.04.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - T S K Mok
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Hong Kong, China
| | - I Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - T Mitsudomi
- Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - F de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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5280
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Sawalha AH, Manzi S. Coronavirus Disease-2019: Implication for the care and management of patients with systemic lupus erythematosus. Eur J Rheumatol 2020; 7:S117-S120. [PMID: 32352359 DOI: 10.5152/eurjrheum.2020.20055] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/24/2022] Open
Abstract
Systemic lupus erythematosus is a chronic remitting-relapsing autoimmune disease that affects multiple organ systems. In this article we discuss aspects in the management of lupus patients that are particularly relevant during the current SARS-CoV-2 pandemic. We speculate that lupus patients might be more susceptible for a more severe COVID-19 disease course and emphasize the importance of maintaining remission in lupus patients. We discuss the critical role hydroxychloroquine plays in the management of lupus patients and suggest considering the psychosocial implications of the current pandemic on lupus care.
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Affiliation(s)
- Amr H Sawalha
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Lupus Center of Excellence, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Susan Manzi
- Autoimmunity Institute and Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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5281
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Poggiali E, Bastoni D, Ioannilli E, Vercelli A, Magnacavallo A. Deep Vein Thrombosis and Pulmonary Embolism: Two Complications of COVID-19 Pneumonia? Eur J Case Rep Intern Med 2020; 7:001646. [PMID: 32399449 PMCID: PMC7213837 DOI: 10.12890/2020_001646] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
Coronavirus disease 19 (COVID-19) is a worldwide infection which was recently declared a global health emergency by the WHO Emergency Committee. The most common symptoms are fever and cough, which can progress to pneumonia, acute respiratory distress syndrome (ARDS) and/or end-organ failure. Risk factors associated with ARDS and death are older age, comorbidities (e.g., hypertension, diabetes, hyperlipidaemia), neutrophilia, and organ and coagulation dysfunction. Disseminated intravascular coagulation and coagulopathy can contribute to death. Anticoagulant treatment is associated with decreased mortality in severe COVID-19 pneumonia. In this report we describe two patients with COVID-19 pneumonia who developed venous thromboembolism.
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Affiliation(s)
- Erika Poggiali
- Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Davide Bastoni
- Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Eva Ioannilli
- Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Andrea Vercelli
- Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
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5282
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Affiliation(s)
- Laura B Lewandowski
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-1102, USA
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy, and Immunology, Yale School of Medicine, New Haven, CT, USA.,Section of Rheumatology, Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA
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5283
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Nutrition support in the time of SARS-CoV-2 (COVID-19). Nutrition 2020; 74:110834. [PMID: 32276799 PMCID: PMC7132492 DOI: 10.1016/j.nut.2020.110834] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022]
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5284
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Case Study: A Patient with Asthma, Covid-19 Pneumonia and Cytokine Release Syndrome Treated with Corticosteroids and Tocilizumab. WITS JOURNAL OF CLINICAL MEDICINE 2020; 2. [PMCID: PMC7187784 DOI: 10.18772/26180197.2020.v2nsia9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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5285
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Henry BM, Lippi G. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): Pooled analysis of early reports. J Crit Care 2020; 58:27-28. [PMID: 32279018 PMCID: PMC7118619 DOI: 10.1016/j.jcrc.2020.03.011] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 03/31/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, OH, USA.
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
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5286
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Çinkooğlu A, Bayraktaroğlu S, Savaş R. Lung Changes on Chest CT During 2019 Novel Coronavirus (COVID-19) Pneumonia. Eur J Breast Health 2020; 16:89-90. [PMID: 32285028 PMCID: PMC7138361 DOI: 10.5152/ejbh.2020.010420] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Akın Çinkooğlu
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | | | - Recep Savaş
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
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5287
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Gentile S, Strollo F, Ceriello A. COVID-19 infection in Italian people with diabetes: Lessons learned for our future (an experience to be used). Diabetes Res Clin Pract 2020; 162:108137. [PMID: 32259611 PMCID: PMC7270733 DOI: 10.1016/j.diabres.2020.108137] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Felice Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy.
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5288
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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5289
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McCreary EK, Pogue JM. Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options. Open Forum Infect Dis 2020; 7:ofaa105. [PMID: 32284951 PMCID: PMC7144823 DOI: 10.1093/ofid/ofaa105] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has spread across the globe resulting in a pandemic. At the time of this review, COVID-19 has been diagnosed in more than 200 000 patients and associated with over 8000 deaths (Centers for Disease Control and Prevention, World Health Organization). On behalf of the Society of Infectious Diseases Pharmacists, we herein summarize the current evidence as of March 18, 2020 to provide guidance on potential COVID-19 treatment options. It is important to caution readers that new data emerges daily regarding clinical characteristics, treatment options, and outcomes for COVID-19. Optimized supportive care remains the mainstay of therapy, and the clinical efficacy for the subsequent agents is still under investigation. Antimicrobial stewardship programs, including infectious diseases pharmacists and physicians, are at the forefront of COVID-19 emergency preparedness. We encourage all readers to continue to assess clinical data as it emerges and share their experience within our community in a well-controlled, adequately powered fashion.
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Affiliation(s)
- Erin K McCreary
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jason M Pogue
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
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5290
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Celli B, Fabbri LM. Urgent need of a management plan for survivors of COVID-19. Eur Respir J 2020; 55:2000764. [PMID: 32217657 PMCID: PMC7098479 DOI: 10.1183/13993003.00764-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
Acute exacerbations of COPD (AECOPD) or “COPD crises” [1], are crucial events in the natural course of COPD. Although they can occur at any severity stage, their impact increases as patients develop more severe airflow limitation.
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Affiliation(s)
- Bartolome Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Wellesley, Massachusetts, USA
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5291
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Baradaran A, Ebrahimzadeh MH, Baradaran A, Kachooei AR. Prevalence of Comorbidities in COVID-19 Patients: A Systematic Review and Meta-Analysis. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:247-255. [PMID: 32733980 PMCID: PMC7296605 DOI: 10.22038/abjs.2020.47754.2346] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In this study, we aimed to assess the prevalence of comorbidities in the confirmed COVID-19 patients. This might help showing which comorbidity might pose the patients at risk of more severe symptoms. METHODS We searched all relevant databases on April 7th, 2020 using the keywords ("novel coronavirus" OR COVID-19 OR SARS-CoV-2 OR Coronavirus) AND (comorbidities OR clinical characteristics OR epidemiologic*). We reviewed 33 papers' full text out of 1053 papers. There were 32 papers from China and 1 from Taiwan. There was no language or study level limit. Prevalence of comorbidities including hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, chronic kidney disease, malignancies, cerebrovascular diseases, chronic liver disease and smoking were extracted to measure the pooled estimates. We used OpenMeta and used random-effect model to do a single arm meta-analysis. RESULTS The mean age of the diagnosed patients was 51 years. The male to female ratio was 55 to 45. The most prevalent finding in the confirmed COVID-19 patients was hypertension, which was found in 1/5 of the patients (21%). Other most prevalent finding was diabetes mellitus (DM) in 11%, cerebrovascular disease in 2.4%, cardiovascular disease in 5.8%, chronic kidney disease in 3.6%, chronic liver disease in 2.9%, chronic pulmonary disease in 2.0%, malignancy in 2.7%, and smoking in 8.7% of the patients. CONCLUSION COVID-19 infection seems to be affecting every race, sex, age, irrespective of health status. The risk of symptomatic and severe disease might be higher due to the higher age which is usually accompanied with comorbidities. However, comorbidities do not seem to be the prerequisite for symptomatic and severe COVID-19 infection, except hypertension.
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Affiliation(s)
- Ashkan Baradaran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Amir R. Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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5292
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Stawicki SP, Jeanmonod R, Miller AC, Paladino L, Gaieski DF, Yaffee AQ, De Wulf A, Grover J, Papadimos TJ, Bloem C, Galwankar SC, Chauhan V, Firstenberg MS, Di Somma S, Jeanmonod D, Garg SM, Tucci V, Anderson HL, Fatimah L, Worlton TJ, Dubhashi SP, Glaze KS, Sinha S, Opara IN, Yellapu V, Kelkar D, El-Menyar A, Krishnan V, Venkataramanaiah S, Leyfman Y, Saoud Al Thani HA, WB Nanayakkara P, Nanda S, Cioè-Peña E, Sardesai I, Chandra S, Munasinghe A, Dutta V, Dal Ponte ST, Izurieta R, Asensio JA, Garg M. The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper. J Glob Infect Dis 2020; 12:47-93. [PMID: 32773996 PMCID: PMC7384689 DOI: 10.4103/jgid.jgid_86_20] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a "new normal" are discussed in this article.
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Affiliation(s)
- Stanislaw P Stawicki
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Rebecca Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Andrew C Miller
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Lorenzo Paladino
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - David F Gaieski
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Anna Q Yaffee
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Annelies De Wulf
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Joydeep Grover
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Thomas J. Papadimos
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Christina Bloem
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar C Galwankar
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vivek Chauhan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Michael S. Firstenberg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Salvatore Di Somma
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Donald Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Sona M Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Veronica Tucci
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Harry L Anderson
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Lateef Fatimah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Tamara J Worlton
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | - Krystal S Glaze
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar Sinha
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ijeoma Nnodim Opara
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Vikas Yellapu
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Dhanashree Kelkar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ayman El-Menyar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vimal Krishnan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - S Venkataramanaiah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Yan Leyfman
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | | | - Sudip Nanda
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Eric Cioè-Peña
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Indrani Sardesai
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Shruti Chandra
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Aruna Munasinghe
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vibha Dutta
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Silvana Teixeira Dal Ponte
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Ricardo Izurieta
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Juan A Asensio
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Manish Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
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5293
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Tal-Singer R, Crapo JD. COPD at the Time of COVID-19: A COPD Foundation Perspective. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2020; 7:73-75. [PMID: 32324976 PMCID: PMC7454024 DOI: 10.15326/jcopdf.7.2.2020.0149] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - James D. Crapo
- Editor in Chief, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, COPD Foundation, Washington, DC
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
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5294
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Villar J, Confalonieri M, Pastores SM, Meduri GU. Rationale for Prolonged Corticosteroid Treatment in the Acute Respiratory Distress Syndrome Caused by Coronavirus Disease 2019. Crit Care Explor 2020; 2:e0111. [PMID: 32426753 PMCID: PMC7188431 DOI: 10.1097/cce.0000000000000111] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | | | - Stephen M. Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - G. Umberto Meduri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
- Memphis Veterans Affairs Medical Center, Memphis, TN
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5295
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Bein B, Bachmann M, Huggett S, Wegermann P. [SARS CoV-2/COVID-19: Evidence-Based Recommendation on Diagnosis and Therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:257-265. [PMID: 32274773 PMCID: PMC7295266 DOI: 10.1055/a-1146-8674] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic with serious challenges to health systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 - 6 days; 5% of patients need intensive care therapy. Morbidity is about 1 - 2%. Protecting health care workers is of paramount importance in order to prevent hospital acquired infections. Therefore, during all procedures associated with aerosol production, a personal safety equipment consisting of a FFP2/FFP3 (N95) respiratory mask, gloves, safety glasses and a waterproof overall should be used. Therapy is based on established recommendations issued for patients with acute lung injury (ARDS). Lung protective ventilation, prone position, restrictive fluid management and an adequate management of organ failures are the mainstays of therapy. In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies evolve with ever increasing frequency; currently, however, there is no evidence based recommendation possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.
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Affiliation(s)
- Berthold Bein
- Korrespondenzadresse Prof. Dr. med. Berthold Bein Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und SchmerztherapieAsklepios Klinik St. GeorgLohmühlenstraße 520099 Hamburg
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5296
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Lam PW, Sehgal P, Andany N, Mubareka S, Simor AE, Ozaldin O, Leis JA, Daneman N, Chan AK. A virtual care program for outpatients diagnosed with COVID-19: a feasibility study. CMAJ Open 2020; 8:E407-E413. [PMID: 32447283 PMCID: PMC7252690 DOI: 10.9778/cmajo.20200069] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In patients who are discharged home to self-isolate while coronavirus disease 2019 (COVID-19) test results are pending, there is no formal method for physician assessments or counselling to occur if the result returns positive. Our aim was to develop and test the feasibility of a virtual care program for self-isolating outpatients diagnosed with COVID-19. METHODS In preparation for this gap in health care, the COVID-19 Expansion to Outpatients (COVIDEO) program was developed at the Sunnybrook Health Sciences Centre, Toronto, Ontario, to provide ongoing care for outpatients diagnosed with COVID-19. As part of a feasibility study, we describe our experiences with the first 50 patients managed using this program from its inception (Mar. 1, 2020) until Mar. 27, 2020. RESULTS All 50 people who tested positive for COVID-19 at the Sunnybrook Health Sciences Centre and were discharged home to self-isolation during the study period were assessed through the COVIDEO program. Thirty-two patients (64%) were assessed via the Ontario Telemedicine Network virtual care platform, and the remainder by telephone. The median time from viral swab collection to first COVIDEO program assessment was 2 (interquartile range [IQR] 1-2) days. Among the 26 patients for whom further follow-up care through the COVIDEO program was discontinued by the end of March 2020, the median duration of virtual care was 12.5 (IQR 8.75-16) days. During the study period, 6 patients required transfer to hospital for assessment, of whom 4 required admission. INTERPRETATION We have shown that a virtual care program can be used in the management of outpatients diagnosed with COVID-19. Further studies evaluating its sustainability and impact on health outcomes are underway.
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Affiliation(s)
- Philip W Lam
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Prateek Sehgal
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Nisha Andany
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Samira Mubareka
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Andrew E Simor
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Omar Ozaldin
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Jerome A Leis
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Nick Daneman
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
| | - Adrienne K Chan
- Department of Medicine (Lam, Sehgal, Andany, Mubareka, Simor, Leis, Daneman, Chan), University of Toronto; Division of Infectious Diseases (Lam, Andany, Mubareka, Simor, Leis, Daneman, Chan), Sunnybrook Health Sciences Centre; Toronto Public Health (Ozaldin), Toronto, Ont
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5297
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Li Y, He F, Zhou N, Wei J, Ding Z, Wang L, Chen P, Guo S, Zhang B, Wan X, Zhu W. Organ function support in patients with coronavirus disease 2019: Tongji experience. Front Med 2020; 14:232-248. [PMID: 32405974 PMCID: PMC7220847 DOI: 10.1007/s11684-020-0774-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 01/12/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease and a serious threat to human health. COVID-19 can cause multiple organ dysfunction, such as respiratory and circulatory failure, liver and kidney injury, disseminated intravascular coagulation, and thromboembolism, and even death. The World Health Organization reports that the mortality rate of severe-type COVID-19 is over 50%. Currently, the number of severe cases worldwide has increased rapidly, but the experience in the treatment of infected patients is still limited. Given the lack of specific antiviral drugs, multi-organ function support treatment is important for patients with COVID-19. To improve the cure rate and reduce the mortality of patients with severe- and critical-type COVID-19, this paper summarizes the experience of organ function support in patients with severe- and critical-type COVID-19 in Optical Valley Branch of Tongji Hospital, Wuhan, China. This paper systematically summarizes the procedures of functional support therapies for multiple organs and systems, including respiratory, circulatory, renal, hepatic, and hematological systems, among patients with severe- and critical-type COVID-19. This paper provides a clinical reference and a new strategy for the optimal treatment of COVID-19 worldwide.
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Affiliation(s)
- Yong Li
- Department of Respiratory and Critical Care Medicine, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fan He
- Department of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ning Zhou
- Department of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jia Wei
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zeyang Ding
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Luyun Wang
- Department of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Peng Chen
- Department of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shuiming Guo
- Department of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Binhao Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoning Wan
- Department of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Zhu
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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5298
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Abstract
This article has online supplemental material.
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Affiliation(s)
- Furkan Ufuk
- From the Department of Radiology, University of Pamukkale, Kinikli, 20100 Denizli, Turkey
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5299
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The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China. CLINICAL IMMUNOLOGY (ORLANDO, FLA.) 2020. [PMID: 32222466 DOI: 10.1016/j.clim.2020.108393.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The pandemic outbreak of coronavirus disease 2019 (COVID-19) is rapidly spreading all over the world. Reports from China showed that about 20% of patients developed severe disease, resulting in a fatality of 4%. In the past two months, we clinical immunologists participated in multi-rounds of MDT (multidiscipline team) discussion on the anti-inflammation management of critical COVID-19 patients, with our colleagues dispatched from Chinese leading PUMC Hospital to Wuhan to admit and treat the most severe patients. Here, from the perspective of clinical immunologists, we will discuss the clinical and immunological characteristics of severe patients, and summarize the current evidence and share our experience in anti-inflammation treatment, including glucocorticoids, IL-6 antagonist, JAK inhibitors and choloroquine/hydrocholoroquine, of patients with severe COVID-19 that may have an impaired immune system.
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5300
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Ahmed T, Shah RJ, Rahim SEG, Flores M, O'Linn A. Coronavirus Disease 2019 (COVID-19) Complicated by Acute Respiratory Distress Syndrome: An Internist's Perspective. Cureus 2020; 12:e7482. [PMID: 32351860 PMCID: PMC7188448 DOI: 10.7759/cureus.7482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 01/20/2023] Open
Abstract
A pandemic outbreak of a novel coronavirus disease (COVID-19) that began in Wuhan, China, in December 2019 has spread rapidly to multiple countries. In the United States, the first confirmed case was reported on January 20, 2020, and since then, the number of cases is rising exponentially on a daily basis. We report a case of COVID-19 infection that presented with symptoms suggestive of pneumonia. Due to the major backlog with an immense number of pending tests, it took 48 hours for the result to come back positive, while the patient went into acute respiratory distress syndrome. We provide an internist's perspective of the difficulties encountered in terms of the available management options, as the patient progressively deteriorated on the regular medical floor prompting transfer to the intensive care unit.
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Affiliation(s)
- Taha Ahmed
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Ronak J Shah
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Shab E Gul Rahim
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Monica Flores
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Amy O'Linn
- Hospital Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
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