301
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Curci C, Pisano F, Bonacci E, Camozzi DM, Ceravolo C, Bergonzi R, De Franceschi S, Moro P, Guarnieri R, Ferrillo M, Negrini F, de Sire A. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol. Eur J Phys Rehabil Med 2020; 56:633-641. [PMID: 32667150 DOI: 10.23736/s1973-9087.20.06339-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial role in reducing disability in order to reintroduce patients in the community. AIM The aim of this study is to characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit. DESIGN Cross-sectional observational study. SETTING Inpatients Rehabilitation Unit. POPULATION Post-acute COVID-19 patients. METHODS Demographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FiO<inf>2</inf>), partial pressure of oxygen (PaO<inf>2</inf>), FiO<inf>2</inf>/PaO<inf>2</inf>, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2. RESULTS We included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FiO<inf>2</inf> (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters. CONCLUSIONS Taken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients. CLINICAL REHABILITATION IMPACT This study could provide an accurate description of COVID-19 sub-acute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.
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Affiliation(s)
- Claudio Curci
- Neurorehabilitation Unit, San Marco Polyclinic Hospital, San Donato Groups, Zingonia, Bergamo, Italy
| | - Fabrizio Pisano
- Neurorehabilitation Unit, San Marco Polyclinic Hospital, San Donato Groups, Zingonia, Bergamo, Italy
| | - Eleonora Bonacci
- Pulmonary Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy
| | - Danila M Camozzi
- Neurorehabilitation Unit, San Marco Polyclinic Hospital, San Donato Groups, Zingonia, Bergamo, Italy
| | - Claudia Ceravolo
- Orthopedic Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy
| | - Roberto Bergonzi
- Orthopedic Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy
| | - Silvia De Franceschi
- Orthopedic Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy
| | - Paolo Moro
- Orthopedic Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy
| | - Rodolfo Guarnieri
- Pulmonary Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy
| | - Martina Ferrillo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Vercelli, Italy
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302
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Gold MS, Sehayek D, Gabrielli S, Zhang X, McCusker C, Ben-Shoshan M. COVID-19 and comorbidities: a systematic review and meta-analysis. Postgrad Med 2020; 132:749-755. [PMID: 32573311 DOI: 10.1080/00325481.2020.1786964] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SARS-CoV-2 has caused a worldwide pandemic that began with an outbreak of pneumonia cases in the Hubei province of China. Knowledge of those most at risk is integral for treatment, guideline implementation, and resource allocation. We conducted a systematic review and meta-analysis to evaluate comorbidities associated with severe and fatal cases of COVID-19. A search was conducted on PubMed and EmBase on 20 April 2020. Pooled estimates were collected using a random-effects model. Thirty-three studies were included in the systematic review and twenty-two in the meta-analysis. Of the total cases 40.80% (95%CI: 35.49%, 46.11%) had comorbidities, while fatal cases had 74.37% (95%CI: 55.78%, 86.97%). Hypertension was more prevalent in severe [47.65% (95%CI: 35.04%, 60.26%)] and fatal [47.90% (95%CI: 40.33%, 55.48%)] cases compared to total cases [14.34% (95%CI: 6.60%, 28.42%)]. Diabetes was more prevalent among fatal cases [24.89% (95%CI: 18.80%, 32.16%)] compared to total cases [9.65% (95%CI: 6.83%, 13.48%)]. Respiratory diseases had a higher prevalence in fatal cases [10.89% (95%CI: 7.57%, 15.43%)] in comparison to total cases [3.65% (95%CI: 2.16%, 6.1%)]. Studies assessing the mechanisms accounting for the associations between severe cases and hypertension, diabetes, and respiratory diseases are crucial in understanding this new disease, managing patients at risk, and developing policies and guidelines that will reduce future risk of severe COVID-19 disease.
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Affiliation(s)
| | - Daniel Sehayek
- Faculté De Médecine, Université Laval , Quebec, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre , Montreal, Quebec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre , Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre , Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre , Montreal, Quebec, Canada
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303
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Vestergaard LS, Nielsen J, Richter L, Schmid D, Bustos N, Braeye T, Denissov G, Veideman T, Luomala O, Möttönen T, Fouillet A, Caserio-Schönemann C, An der Heiden M, Uphoff H, Lytras T, Gkolfinopoulou K, Paldy A, Domegan L, O'Donnell J, De' Donato F, Noccioli F, Hoffmann P, Velez T, England K, van Asten L, White RA, Tønnessen R, da Silva SP, Rodrigues AP, Larrauri A, Delgado-Sanz C, Farah A, Galanis I, Junker C, Perisa D, Sinnathamby M, Andrews N, O'Doherty M, Marquess DF, Kennedy S, Olsen SJ, Pebody R, Krause TG, Mølbak K. Excess all-cause mortality during the COVID-19 pandemic in Europe - preliminary pooled estimates from the EuroMOMO network, March to April 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32643601 PMCID: PMC7346364 DOI: 10.2807/1560-7917.es.2020.25.26.2001214] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March–April 2020. Excess mortality particularly affected ≥ 65 year olds (91% of all excess deaths), but also 45–64 (8%) and 15–44 year olds (1%). No excess mortality was observed in 0–14 year olds.
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Affiliation(s)
| | | | - Lukas Richter
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | | | | | - Gleb Denissov
- National Institute for Health Development, Tallinn, Estonia
| | | | - Oskari Luomala
- Finnish National Institute for Health and Welfare, Helsinki, Finland
| | - Teemu Möttönen
- Finnish National Institute for Health and Welfare, Helsinki, Finland
| | - Anne Fouillet
- French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | | | | | - Helmut Uphoff
- Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Dillenburg, Germany
| | | | | | - Anna Paldy
- National Public Health Institute, Budapest, Hungary
| | - Lisa Domegan
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donnell
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Patrick Hoffmann
- Health Directorate Luxembourg - Division de l'inspection sanitaire, Luxembourg
| | - Telma Velez
- Health Directorate Luxembourg - Division de l'inspection sanitaire, Luxembourg
| | - Kathleen England
- Directorate for Health Information and Research, Ministry for Health, Malta
| | - Liselotte van Asten
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | | | | | - Ana P Rodrigues
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Concepción Delgado-Sanz
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Ahmed Farah
- Public Health Agency of Sweden, Stockholm, Sweden
| | | | | | - Damir Perisa
- Federal Office of Public Health, Bern, Switzerland
| | | | - Nick Andrews
- Public Health England, Colindale, United Kingdom
| | | | | | | | - Sonja J Olsen
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Richard Pebody
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
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- The members of the ECDC Public Health Emergency Team for COVID-19 are listed below
| | | | - Kåre Mølbak
- Department of Veterinary and Animal Science, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Statens Serum Institut, Copenhagen, Denmark
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304
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Arunachalam MA, Halwai A. An analysis of the ethics of lockdown in India. Asian Bioeth Rev 2020; 12:481-489. [PMID: 32837557 PMCID: PMC7347396 DOI: 10.1007/s41649-020-00133-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
Over the past 6 months, coronavirus-induced disease (COVID-19) has spread across 212 countries, affecting millions of people. As it has no known cure, social distancing is highly recommended for prevention of spread of the disease. Here, we have described the impact of the social distancing measures implemented by the Government of India on various sections of the society, especially the vulnerable sections. Furthermore, we have presented an analysis of these measures, according to the World Health Organization´s Guidance for Managing Ethical Issues in Infectious Disease Outbreaks (2016); we have also applied principles, as applicable, from the Indian Council of Medical Research’s National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017). Finally, we have presented several measures that should have been adopted before and in addition to implementing the lockdown to improve its effectiveness.
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Affiliation(s)
- Meghna Ann Arunachalam
- YU-FIC Research Ethics Master's Program for India, Yenepoya Deemed to be University, Mangalore, India
| | - Aarti Halwai
- YU-FIC Research Ethics Master's Program for India, Yenepoya Deemed to be University, Mangalore, India
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305
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Khan JR, Awan N, Islam MM, Muurlink O. Healthcare Capacity, Health Expenditure, and Civil Society as Predictors of COVID-19 Case Fatalities: A Global Analysis. Front Public Health 2020; 8:347. [PMID: 32719765 PMCID: PMC7349997 DOI: 10.3389/fpubh.2020.00347] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background: The rapid growth in cases of COVID-19 has challenged national healthcare capacity, testing systems at an advanced ICU, and public health infrastructure level. This global study evaluates the association between multi-factorial healthcare capacity and case fatality of COVID-19 patients by adjusting for demographic, health expenditure, population density, and prior burden of non-communicable disease. It also explores the impact of government relationships with civil society as a predictor of infection and mortality rates. Methods: Data were extracted from the Johns Hopkins University database, World Bank records and the National Civic Space Ratings 2020 database. This study used data from 86 countries which had at least 1,000 confirmed cases on 30th April 2020. Negative binomial regression model was used to assess the association between case fatality (a ratio of total number of confirmed deaths to total number of confirmed cases) and healthcare capacity index adjusting for other covariates. Findings: Regression analysis shows that greater healthcare capacity was related to lesser case-fatality [incidence rate ratio (IRR) 0.5811; 95% confidence interval (CI) 0.4727-0.7184; p < 0.001] with every additional unit increase in the healthcare capacity index associated with a 42% decrease in the case fatality. Health expenditure and civil society variables did not reach statistical significance but were positively associated with case fatalities. Interpretation: Based on preliminary data, this research suggests that building effective multidimensional healthcare capacity is the most promising means to mitigate future case fatalities. The data also suggests that government's ability to implement public health measures to a degree determines mortality outcomes.
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Affiliation(s)
- Jahidur Rahman Khan
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Biomedical Research Foundation, Dhaka, Bangladesh
| | - Nabil Awan
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Md. Mazharul Islam
- Bangladesh Institute of Governance and Management (BIGM), Dhaka, Bangladesh
| | - Olav Muurlink
- School of Business and Law, Central Queensland University, Brisbane, QLD, Australia
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306
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No SARS-CoV-2 detection in the German CAPNETZ cohort of community acquired pneumonia before COVID-19 peak in March 2020. Infection 2020; 48:971-974. [PMID: 32621281 PMCID: PMC7332473 DOI: 10.1007/s15010-020-01471-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/23/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The first SARS-CoV-2 cases in Europe were reported in January 2020. Recently, concern arose on unrecognized infections before this date. For a better understanding of the pandemic, we retrospectively analyzed patient samples for SARS-CoV-2 from the prospective CAPNETZ study cohort. METHODS We used nasopharyngeal swab samples from a cohort of well characterized patients with community acquired pneumonia of the CAPNETZ study group, recruited from different geographic regions across Germany, Austria, the Netherlands, and Switzerland between 02nd December 2019 and 28th April 2020. Multiplex real-time RT-PCR for a broad range of respiratory pathogens and SARS-CoV-2 real-time RT-PCR were performed on all samples. RESULTS In our cohort, respiratory pathogens other than SARS-CoV-2 were detected in 21.5% (42/195) of patients with rhinovirus as the most frequently detected pathogen. The detection rate increased to 29.7% (58/195) when SARS-CoV-2 was included. No SARS-CoV-2 positive sample was detected before end of March 2020. CONCLUSIONS Respiratory viral pathogens accounted for a considerable number of positive results but no SARS-CoV-2 case was identified before the end of March 2020.
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307
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Mishra S, Wang L, Ma H, Yiu KCY, Paterson JM, Kim E, Schull MJ, Pequegnat V, Lee A, Ishiguro L, Coomes E, Chan A, Downing M, Landsman D, Straus S, Muller M. Estimated surge in hospital and intensive care admission because of the coronavirus disease 2019 pandemic in the Greater Toronto Area, Canada: a mathematical modelling study. CMAJ Open 2020; 8:E593-E604. [PMID: 32963024 PMCID: PMC7641231 DOI: 10.9778/cmajo.20200093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired. METHODS To estimate hospital-level surge in March and April 2020, we simulated a range of scenarios of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in the Greater Toronto Area (GTA), Canada, using the best available data at the time. We applied outputs to hospital-specific data to estimate surge over 6 weeks at 2 hospitals (St. Michael's Hospital and St. Joseph's Health Centre). We examined multiple scenarios, wherein the default (R0 = 2.4) resembled the early trajectory (to Mar. 25, 2020), and compared the default model projections with observed COVID-19 admissions in each hospital from Mar. 25 to May 6, 2020. RESULTS For the hospitals to remain below non-ICU bed capacity, the default pessimistic scenario required a reduction in non-COVID-19 inpatient care by 38% and 28%, respectively, with St. Michael's Hospital requiring 40 new ICU beds and St. Joseph's Health Centre reducing its ICU beds for non-COVID-19 care by 6%. The absolute difference between default-projected and observed census of inpatients with COVID-19 at each hospital was less than 20 from Mar. 25 to Apr. 11; projected and observed cases diverged widely thereafter. Uncertainty in local epidemiological features was more influential than uncertainty in clinical severity. INTERPRETATION Scenario-based analyses were reliable in estimating short-term cases, but would require frequent re-analyses. Distribution of the city's surge was expected to vary across hospitals, and community-level strategies were key to mitigating each hospital's surge.
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Affiliation(s)
- Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.
| | - Linwei Wang
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Huiting Ma
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Kristy C Y Yiu
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - J Michael Paterson
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Eliane Kim
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Michael J Schull
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Victoria Pequegnat
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Anthea Lee
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Lisa Ishiguro
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Eric Coomes
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Adrienne Chan
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Mark Downing
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - David Landsman
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Sharon Straus
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Matthew Muller
- Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
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308
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Grelat M, Pommier B, Portet S, Amelot A, Barrey C, Leroy HA, Madkouri R. Patients with Coronavirus 2019 (COVID-19) and Surgery: Guidelines and Checklist Proposal. World Neurosurg 2020; 139:e769-e773. [PMID: 32344143 PMCID: PMC7194971 DOI: 10.1016/j.wneu.2020.04.155] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
Abstract
The management of patients with novel coronavirus 2019 (COVID-19) represents a new challenge for medical and surgical teams. Each operating room in the world should be prepared thoughtfully, and the development of a protocol and patient route seems mandatory. An adequate degree of protection must be used. We propose recommendations to help different professionals in the establishment of protocols for the management of patients with COVID-19. We also offer a checklist that could be used in the operating room.
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Affiliation(s)
- Michael Grelat
- Department of Neurosurgery, Dijon University Hospital, Dijon, France.
| | - Benjamin Pommier
- Department of Neurosurgery, Saint-Etienne University Hospital, Saint Etienne, France
| | - Sylvain Portet
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Aymeric Amelot
- Department of Neurosurgery, Tours University Hospital, Tours, France
| | - Cédric Barrey
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | | | - Rachid Madkouri
- Department of Neurosurgery, Dijon University Hospital, Dijon, France
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309
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Sultan S, Altayar O, Siddique SM, Davitkov P, Feuerstein JD, Lim JK, Falck-Ytter Y, El-Serag HB. AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19. Gastroenterology 2020; 159:320-334.e27. [PMID: 32407808 PMCID: PMC7212965 DOI: 10.1053/j.gastro.2020.05.001] [Citation(s) in RCA: 276] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Multiple gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting, and abdominal pain, as well as liver enzyme abnormalities, have been variably reported in patients with coronavirus disease 2019 (COVID-19). This document provides best practice statements and recommendations for consultative management based on a systematic review and meta-analysis of international data on GI and liver manifestations of COVID-19. METHODS We performed a systematic literature search to identify published and unpublished studies using OVID Medline and preprint servers (medRxiv, LitCovid, and SSRN) up until April 5, 2020; major journal sites were monitored for US publications until April 19, 2020. We pooled the prevalence of diarrhea, nausea, vomiting, and abdominal pain, as well as liver function tests abnormalities, using a fixed-effect model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. RESULTS We identified 118 studies and used a hierarchal study selection process to identify unique cohorts. We performed a meta-analysis of 47 studies including 10,890 unique patients. Pooled prevalence estimates of GI symptoms were as follows: diarrhea 7.7% (95% confidence interval [CI], 7.2%-8.2%), nausea/vomiting 7.8% (95% CI, 7.1%-8.5%), and abdominal pain 2.7% (95% CI, 2.0%-3.4%). Most studies reported on hospitalized patients. The pooled prevalence estimates of elevated liver abnormalities were as follows: aspartate transaminase 15.0% (95% CI, 13.6%-16.5%) and alanine transaminase 15.0% (95% CI, 13.6%-16.4%). When we compared studies from China to studies from other countries in subgroup analyses, diarrhea, nausea/vomiting, and liver abnormalities were more prevalent outside of China, with diarrhea reported in 18.3% (95% CI, 16.6%-20.1%). Isolated GI symptoms were reported rarely. We also summarized the Gl and liver adverse effects of the most commonly utilized medications for COVID-19. CONCLUSIONS GI symptoms are associated with COVID-19 in <10% of patients. In studies outside of China, estimates are higher. Further studies are needed with standardized GI symptoms questionnaires and liver function test checks on admission to better quantify and qualify the association of these symptoms with COVID-19. Based on findings from our meta-analysis, we provide several Best Practice Statements for the consultative management of COVID-19.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Shazia M Siddique
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Perica Davitkov
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joseph D Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
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310
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D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L. Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. Clin Gastroenterol Hepatol 2020; 18:1663-1672. [PMID: 32278065 PMCID: PMC7141637 DOI: 10.1016/j.cgh.2020.04.001] [Citation(s) in RCA: 357] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) pandemic is a worldwide emergency. An increasing number of diarrhea cases is reported. Here we investigate the epidemiology, clinical presentation, molecular mechanisms, management, and prevention of SARS-CoV-2 associated diarrhea. We searched on PubMed, EMBASE, and Web of Science up to March 2020 to identify studies documenting diarrhea and mechanism of intestinal inflammation in patients with confirmed diagnosis of SARS-CoV-2 infection. Clinical studies show an incidence rate of diarrhea ranging from 2% to 50% of cases. It may precede or trail respiratory symptoms. A pooled analysis revealed an overall percentage of diarrhea onset of 10.4%. SARS-CoV uses the angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 for S protein priming. ACE2 and TMPRSS2 are not only expressed in lung, but also in the small intestinal epithelia. ACE2 is expressed furthermore in the upper esophagus, liver, and colon. SARS-CoV-2 binding affinity to ACE2 is significantly higher (10-20 times) compared with SARS-CoV. Several reports indicate viral RNA shedding in stool detectable longer time period than in nasopharyngeal swabs. Current treatment is supportive, but several options appear promising and are the subject of investigation. Diarrhea is a frequent presenting symptom in patients infected with SARS-CoV-2. Increasing evidence indicates possible fecal oral transmission, indicating the need for a rapid and effective modification of the screening and diagnostic algorithms. The optimal methods to prevent, manage, and treat diarrhea in COVID-19 infected patients are subjects of intensive research.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.
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311
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Schmulson M, Dávalos MF, Berumen J. Beware: Gastrointestinal symptoms can be a manifestation of COVID-19. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 85:282-287. [PMID: 32376072 PMCID: PMC7158807 DOI: 10.1016/j.rgmx.2020.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is an increasing number of reports on the presentation of gastrointestinal symptoms in cases of COVID-19. AIM To review the studies reporting gastrointestinal symptoms in COVID-19. RESULTS Fifteen articles (2,800 patients) were identified. Gastrointestinal symptom frequency varied from 3.0% to 39.6% and included diarrhea (7.5%), náusea (4.5%), anorexia (4.4%), vomiting (1.3%), abdominal pain (0.5%), and belching/reflux (0.3%). Those symptoms can be the first manifestation of COVID-19, but whether they reflect a better or worse prognosis, is controversial. The potential relation of the angiotensin converting enzyme 2 receptor in the digestive tract as an entry route for the virus is discussed. CONCLUSION Gastrointestinal symptoms may be common in COVID-19, in some cases appearing as the first manifestation, even before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists must be aware of those atypical cases during the current pandemic, as well as of the fecal-oral route and corresponding preventive measures.
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Affiliation(s)
- M Schmulson
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
| | - M F Dávalos
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - J Berumen
- Laboratorio de Genómica, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
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312
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Yogeswaran A, Gall H, Tello K, Grünig E, Xanthouli P, Ewert R, Kamp JC, Olsson KM, Wißmüller M, Rosenkranz S, Klose H, Harbaum L, Lange TJ, Opitz CF, Waelde A, Milger K, Sommer N, Seeger W, Ghofrani HA, Richter MJ. Impact of SARS-CoV-2 pandemic on pulmonary hypertension out-patient clinics in Germany: a multi-centre study. Pulm Circ 2020; 10:2045894020941682. [PMID: 32754309 PMCID: PMC7378724 DOI: 10.1177/2045894020941682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension is frequently underdiagnosed, and referral is delayed with subsequent impact on outcomes. During the SARS-CoV-2 pandemic, restrictions on daily life and changes in hospitals' daily routine care were introduced in Germany. This multi-centre study provides evidence for a negative influence of these restrictions on patient care in pulmonary hypertension expert referral centres.
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Affiliation(s)
- Athiththan Yogeswaran
- Department of Internal Medicine,
Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center
(UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine,
Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center
(UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Khodr Tello
- Department of Internal Medicine,
Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center
(UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension at
Thoraxklinik gGmbH at Heidelberg University Hospital, Member of the German Center
for Lung Research (DZL), Heidelberg, Germany
| | - Panagiota Xanthouli
- Centre for Pulmonary Hypertension at
Thoraxklinik gGmbH at Heidelberg University Hospital, Member of the German Center
for Lung Research (DZL), Heidelberg, Germany
| | - Ralf Ewert
- Universitätsmedizin Greifswald, Zentrum
für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, Greifswald,
Germany
| | - Jan C. Kamp
- Department of Respiratory Medicine,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and
Obstructive Lung Disease (BREATH) Hannover, German Center for Lung Research (DZL),
Hannover, Germany
| | - Karen M. Olsson
- Department of Respiratory Medicine,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and
Obstructive Lung Disease (BREATH) Hannover, German Center for Lung Research (DZL),
Hannover, Germany
| | - Max Wißmüller
- Klinik III für Innere Medizin and
Cologne Cardiovascular Research Center (CCRC), Herzzentrum der Universität zu Köln,
Köln, Germany
| | - Stephan Rosenkranz
- Klinik III für Innere Medizin and
Cologne Cardiovascular Research Center (CCRC), Herzzentrum der Universität zu Köln,
Köln, Germany
| | - Hans Klose
- Department of Respiratory Medicine,
University of Hamburg, Hamburg, Germany
| | - Lars Harbaum
- Department of Respiratory Medicine,
University of Hamburg, Hamburg, Germany
| | - Tobias J. Lange
- Department of Internal Medicine II,
Division of Pneumology, University Medical Center Regensburg, Regensburg,
Germany
| | | | - Andrea Waelde
- Department of Internal Medicine 5,
Ludwig-Maximilians University of Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center
(CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine 5,
Ludwig-Maximilians University of Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center
(CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Natascha Sommer
- Department of Internal Medicine,
Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center
(UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine,
Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center
(UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
- Institute for Lung Health (ILH),
Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine,
Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center
(UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
- Department of Medicine, Imperial
College London, London, United Kingdom
| | - Manuel J. Richter
- Department of Internal Medicine,
Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center
(UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
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313
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COVID-19 Network: the response of an Italian Reference Institute to research challenges about a new pandemia. Clin Microbiol Infect 2020; 26:1576-1578. [PMID: 32619733 PMCID: PMC7326383 DOI: 10.1016/j.cmi.2020.06.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022]
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314
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Khalili M, Karamouzian M, Nasiri N, Javadi S, Mirzazadeh A, Sharifi H. Epidemiological characteristics of COVID-19: a systematic review and meta-analysis. Epidemiol Infect 2020; 148:e130. [PMID: 32594937 PMCID: PMC7343974 DOI: 10.1017/s0950268820001430] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022] Open
Abstract
Our understanding of the Coronavirus disease 2019 (COVID-19) continues to evolve and there are many unknowns about its epidemiology. This study aims to synthesise case fatality rate (CFR) among confirmed COVID-19 patients, incubation period and time from onset of COVID-19 symptoms to first medical visit, intensive care unit (ICU) admission, recovery, and death. We searched MEDLINE, Embase, Google Scholar, and bibliographies of relevant articles from 01 December 2019 to 11 March 2020 without any language restrictions. Quantitative studies that recruited people with confirmed COVID-19 diagnosis were included. Two independent reviewers extracted the data. Out of 1675 non-duplicate studies, 43 were included in the meta-analysis. The pooled mean incubation period was 5.68 (99% confidence interval [CI]: 4.78, 6.59) days. The pooled mean number of days from the onset of COVID-19 symptoms to first clinical visit was 4.92 (95% CI: 3.95, 5.90), ICU admission was 9.84 (95% CI: 8.78, 10.90), recovery was 18.55 (95% CI: 13.69, 23.41), and death was 15.93 (95% CI: 13.07, 18.79). Pooled CFR among confirmed COVID-19 patients was 0.02 (95% CI: 0.02, 0.03). We found that the incubation period and lag between the onset of symptoms and first clinical visit for COVID-19 are longer than other respiratory viral infections including Middle East respiratory syndrome and severe acute respiratory syndrome; however, the current policy of 14 days of mandatory quarantine for everyone potentially exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be too conservative. Longer quarantine periods might be more justified for extreme cases.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naser Nasiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Javadi
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
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315
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Luo Y, Xue Y, Mao L, Yuan X, Lin Q, Tang G, Song H, Wang F, Sun Z. Prealbumin as a Predictor of Prognosis in Patients With Coronavirus Disease 2019. Front Med (Lausanne) 2020; 7:374. [PMID: 32671085 PMCID: PMC7333015 DOI: 10.3389/fmed.2020.00374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background: The predictive value of prealbumin for the prognosis of coronavirus disease 2019 (COVID-19) has not been extensively investigated. Methods: A total of 1,115 patients with laboratory-confirmed COVID-19 were enrolled at Tongji hospital from February to April 2020 and classified into fatal (n = 129) and recovered (n = 986) groups according to the patient's outcome. Prealbumin and other routine laboratory indicators were measured simultaneously. Results: The level of prealbumin on admission was significantly lower in fatal patients than in recovered patients. For predicting the prognosis of COVID-19, the performance of prealbumin was better than most routine laboratory indicators, such as albumin, lymphocyte count, neutrophil count, hypersensitive C-reactive protein, d-dimer, lactate dehydrogenase, creatinine, and hypersensitive cardiac troponin I. When a threshold of 126 mg/L was used to discriminate between fatal and recovered patients, the sensitivity and specificity of prealbumin were, respectively, 78.29 and 90.06%. Furthermore, a model based on the combination of nine indexes showed an improved performance in predicting the death of patients with COVID-19. Using a cut-off value of 0.19, the prediction model was able to distinguish between fatal and recovered individuals with a sensitivity of 86.82% and a specificity of 90.37%. Conclusions: A lower level of prealbumin on admission may indicate a worse outcome of COVID-19. Immune and nutritional status may be vital factors for predicting disease progression in the early stage of COVID-19.
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Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Xue
- Department of Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Yuan
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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316
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Abed Alah M, Abdeen S, Kehyayan V. The first few cases and fatalities of Corona Virus Disease 2019 (COVID-19) in the Eastern Mediterranean Region of the World Health Organization: A rapid review. J Infect Public Health 2020; 13:1367-1372. [PMID: 32586684 PMCID: PMC7303600 DOI: 10.1016/j.jiph.2020.06.009] [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: 04/08/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
In December 2019, a cluster of atypical Pneumonia cases in Wuhan, China were reported to the World Health Organization (WHO). Later, those cases were attributed to a novel respiratory virus currently known as COVID-19. The infection is affecting every continent. It was characterized by WHO as a global pandemic on 11 March 2020. Countries worldwide are implementing various preventive measures to contain the spread of the infection such as travel and trade restrictions, closure of educational institutions and shops, and some took more strict measures such as imposing curfew. WHO is emphasizing the importance of early detection of cases, contact tracing, risk communications, implementing multisectoral approach in order to combat COVID-19 infection. Countries should provide the public with accurate, transparent information about the local and global situation of this escalating infection. Much uncertainty still surrounds this viral infection, its modes of transmission and dynamics. Epidemiological investigations particularly for the first few cases of COVID-19 infection are critical to expand our knowledge about this evolving pandemic. In this review we summarized the data available about the first few cases and fatalities of COVID-19 infection up to 18 March 2020 across Eastern Mediterranean Region of the World Health Organization. such data were only available in websites of ministries of health of the targeted countries, WHO situational reports, online newspapers, and other media channels and this gave us an idea about the amount and type of data available for the public regarding this evolving infection.
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Affiliation(s)
- Muna Abed Alah
- Community Medicine Residency program, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Sami Abdeen
- Community Medicine Residency program, Hamad Medical Corporation (HMC), Doha, Qatar.
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317
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Abstract
The COVID-19 pandemic is exerting major pressures on society, health and social care services and science. Understanding the progression and current impact of the pandemic is fundamental to planning, management and mitigation of future impact on the population. Surveillance is the core function of any public health system, and a multi-component surveillance system for COVID-19 is essential to understand the burden across the different strata of any health system and the population. Many countries and public health bodies utilise ‘syndromic surveillance’ (using real-time, often non-specific symptom/preliminary diagnosis information collected during routine healthcare provision) to supplement public health surveillance programmes. The current COVID-19 pandemic has revealed a series of unprecedented challenges to syndromic surveillance including: the impact of media reporting during early stages of the pandemic; changes in healthcare-seeking behaviour resulting from government guidance on social distancing and accessing healthcare services; and changes in clinical coding and patient management systems. These have impacted on the presentation of syndromic outputs, with changes in denominators creating challenges for the interpretation of surveillance data. Monitoring changes in healthcare utilisation is key to interpreting COVID-19 surveillance data, which can then be used to better understand the impact of the pandemic on the population. Syndromic surveillance systems have had to adapt to encompass these changes, whilst also innovating by taking opportunities to work with data providers to establish new data feeds and develop new COVID-19 indicators. These developments are supporting the current public health response to COVID-19, and will also be instrumental in the continued and future fight against the disease.
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Pericàs JM, Hernandez-Meneses M, Sheahan TP, Quintana E, Ambrosioni J, Sandoval E, Falces C, Marcos MA, Tuset M, Vilella A, Moreno A, Miro JM. COVID-19: from epidemiology to treatment. Eur Heart J 2020; 41:2092-2112. [PMID: 32511724 PMCID: PMC7279517 DOI: 10.1093/eurheartj/ehaa462] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has greatly impacted the daily clinical practice of cardiologists and cardiovascular surgeons. Preparedness of health workers and health services is crucial to tackle the enormous challenge posed by SARS-CoV-2 in wards, operating theatres, intensive care units, and interventionist laboratories. This Clinical Review provides an overview of COVID-19 and focuses on relevant aspects on prevention and management for specialists within the cardiovascular field.
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Affiliation(s)
- J M Pericàs
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Hernandez-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - T P Sheahan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Quintana
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - J Ambrosioni
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Sandoval
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - C Falces
- Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M A Marcos
- Microbiology Service, Hospital Clinic-ISGlobal, University of Barcelona, Barcelona, Spain
| | - M Tuset
- Farmacy Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Vilella
- Preventive Medicine Service, Hospital Clinic-ISGlobal, University of Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Miro
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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319
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A Cohort of Patients with COVID-19 in a Major Teaching Hospital in Europe. J Clin Med 2020; 9:jcm9061733. [PMID: 32512688 PMCID: PMC7356883 DOI: 10.3390/jcm9061733] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the region of Madrid. This article describes the first 2226 adult patients with COVID-19, consecutively admitted to La Paz University Hospital in Madrid. Methods: Our cohort included all patients consecutively hospitalized who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from 25 February (first case admitted) to 19 April 2020. The data were manually entered into an electronic case report form, which was monitored prior to the analysis. Results: We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients’ median age was 61 years, and 51.8% were women. The most common comorbidity was arterial hypertension (41.3%), and the most common symptom on admission was fever (71.2%). The median time from disease onset to hospital admission was 6 days. The overall mortality was 20.7% and was higher in men (26.6% vs. 15.1%). Seventy-five patients with a final outcome were transferred to the intensive care unit (ICU) (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. Conclusions: We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male sex, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.
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320
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Morena V, Milazzo L, Oreni L, Bestetti G, Fossali T, Bassoli C, Torre A, Cossu MV, Minari C, Ballone E, Perotti A, Mileto D, Niero F, Merli S, Foschi A, Vimercati S, Rizzardini G, Sollima S, Bradanini L, Galimberti L, Colombo R, Micheli V, Negri C, Ridolfo AL, Meroni L, Galli M, Antinori S, Corbellino M. Off-label use of tocilizumab for the treatment of SARS-CoV-2 pneumonia in Milan, Italy. Eur J Intern Med 2020; 76:36-42. [PMID: 32448770 PMCID: PMC7241995 DOI: 10.1016/j.ejim.2020.05.011] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tocilizumab, a humanized monoclonal antibody, targets IL-6 receptors blocking downstream pro-inflammatory effects of IL-6. In preliminary reports it was suggested to be beneficial in patients with severe COVID-19. METHODS In this open-label prospective study we describe clinical characteristics and outcome of 51 patients hospitalized with confirmed and severe COVID-19 pneumonia treated with tocilizumab intravenously. All patients had elevated IL-6 plasma level (>40 pg/mL) and oxygen saturation <93% in ambient air. Clinical outcomes, oxygen support, laboratory data and adverse events were collected over a follow-up of 30 days. RESULTS Forty-five patients (88%) were on high-flow oxygen supplementation, six of whom with invasive ventilation. From baseline to day 7 after tocilizumab we observed a dramatic drop of body temperature and CRP value with a significant increase in lymphocyte count (p<0.001). Over a median follow-up time of 34 days from tocilizumab, 34 patients (67%) showed an improvement in their clinical severity class; 31 were discharged; 17 (33%) showed a worsening of their clinical status, of these 14 died (27%). The mortality rate was significantly associated with mechanical ventilation at baseline (83.3% vs 20% of patients on non-invasive oxygen support; p=0.0001). The most frequent side effects were an increase of hepatic enzymes (29%), thrombocytopenia (14%), and serious bacterial and fungal infections (27%). CONCLUSION Tocilizumab exerts a rapidly beneficial effect on fever and inflammatory markers, although no significant impact on the clinical outcome can be inferred by our results. Critically ill patients seem to have a high risk of serious infections with this drug.
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MESH Headings
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antiviral Agents/adverse effects
- Betacoronavirus/drug effects
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/blood
- Coronavirus Infections/epidemiology
- Coronavirus Infections/physiopathology
- Coronavirus Infections/therapy
- Female
- Fever/diagnosis
- Fever/drug therapy
- Humans
- Italy/epidemiology
- Lymphocyte Count/methods
- Male
- Middle Aged
- Outcome and Process Assessment, Health Care
- Pandemics
- Pneumonia, Viral/blood
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/etiology
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Receptors, Interleukin-6/antagonists & inhibitors
- Respiration, Artificial/methods
- Respiratory Insufficiency/etiology
- Respiratory Insufficiency/therapy
- Retrospective Studies
- SARS-CoV-2
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Affiliation(s)
- Valentina Morena
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Laura Milazzo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Letizia Oreni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanna Bestetti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Cinzia Bassoli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Alessandro Torre
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Caterina Minari
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Elisabetta Ballone
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Perotti
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Davide Mileto
- Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Fosca Niero
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefania Merli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefania Vimercati
- Clinical Pathology Laboratory, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Salvatore Sollima
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Lucia Bradanini
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Laura Galimberti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Valeria Micheli
- Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Cristina Negri
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luca Meroni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Galli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy; Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy; Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Mario Corbellino
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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321
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Chirumbolo S, Bjørklund G. Wheat and chaffs in the interpretation of the current COVID19 outbreak in Italy. Virusdisease 2020; 31:85-93. [PMID: 32656304 PMCID: PMC7274266 DOI: 10.1007/s13337-020-00602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022] Open
Abstract
The COVID19 outbreak in Italy is still a big concern. The Italian Government has recommended citizens to respect faithfully any compulsory legal disposition in order to stay home and so contributing in escaping viral contacts and slowing down epidemic. Emergency has raised a widely animated debate about how to read and comprehend the daily case numbers, the medical and caregivers availability, the needs to swab asymptomatic subjects. In this review the authors discuss about the many wheat and chaffs of how this virus disease is addressed .
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Affiliation(s)
- Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
- CONEM Scientific Secretary, strada Le Grazie 9, 37134 Verona, Italy
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
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322
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Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, Khare S, Srivastava A. Gastrointestinal and hepatic manifestations of Corona Virus Disease-19 and their relationship to severe clinical course: A systematic review and meta-analysis. Indian J Gastroenterol 2020; 39:268-284. [PMID: 32749643 PMCID: PMC7399358 DOI: 10.1007/s12664-020-01058-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many case series on Corona Virus Disease (COVID-19) have reported gastrointestinal (GI) and hepatic manifestations in a proportion of cases; however, the data is conflicting. The relationship of GI and hepatic involvement with severe clinical course of COVID-19 has also not been explored. OBJECTIVES The main objectives were to determine the frequency of GI and hepatic manifestations of COVID-19 and to explore their relationship with severe clinical course. METHODS We searched PubMed for studies published between January 1, 2020, and March 25, 2020, with data on GI and hepatic manifestations in adult patients with COVID-19. These data were compared between patients with severe and good clinical course using the random-effects model and odds ratio (OR) as the effect size. If the heterogeneity among studies was high, sensitivity analysis was performed for each outcome. RESULTS We included 62 studies (8301 patients) in the systematic review and 26 studies (4676 patients) in the meta-analysis. Diarrhea was the most common GI symptom (9%), followed by nausea/vomiting (5%) and abdominal pain (4%). Transaminases were abnormal in approximately 25%, bilirubin in 9%, prothrombin time (PT) in 7%, and low albumin in 60%. Up to 20% patients developed severe clinical course, and GI and hepatic factors associated with severe clinical course were as follows: diarrhea (OR 2), high aspartate aminotransferase (OR 1.4), high alanine aminotransferase (OR 1.6), high bilirubin (OR 2.4), low albumin (OR 3.4), and high PT (OR 3). CONCLUSIONS GI and hepatic involvement should be sought in patients with COVID-19 since it portends severe clinical course. The pathogenesis of GI and hepatic involvement needs to be explored in future studies.
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Affiliation(s)
- Ashish Kumar
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
| | - Anil Arora
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Praveen Sharma
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Shrihari Anil Anikhindi
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Naresh Bansal
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Vikas Singla
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Shivam Khare
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Abhishyant Srivastava
- Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, New Delhi, 110 085, India
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323
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A Review of Potential Antiviral Drugs and Vaccines to Treat COVID-19. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.spl1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 19 (COVID-19) is a challenge to the whole humanity. COVID-19 was first reported in China and rigorous researches are going on for developing vaccine for the pandemic. This review was prepared by following PRISMA guidelines and used the resources from the Web of Science and PubMed. This research focuses on the niches of symptoms and vaccines for COVID-19. The research for vaccine involves research for new vaccine and drug repurposing. Out of various drug repurposing options, Remdesivir, and Favipiravir, Chloroquine and Lopinavir/Ritonavir were found to be the popular ones for treating COVID-19 patients across the world. Even though there are concerns regarding asymptotic patients, the most dominant symptoms of COVID-19 are fever and cough, followed by Dyspnoea and muscle ache. This review concludes that the COVID-19 related research should focus on developing immunity vaccines, and repurposing of drugs. Research on the problems of quarantine life, patient monitoring, and usage of information technology in facing COVID-19 will improve the quality of patient handling during the pandemic. The research on the effectiveness of various models of lockdown and regulation of social life during lockdown periods, improving the safety of health care workers in the workplace will definitely help the governments in their fight against COVID-19.
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324
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Lehrich BM, Goshtasbi K, Raad RA, Ganti A, Papagiannopoulos P, Tajudeen BA, Kuan EC. Aggregate Prevalence of Chemosensory and Sinonasal Dysfunction in SARS-CoV-2 and Related Coronaviruses. Otolaryngol Head Neck Surg 2020; 163:156-161. [PMID: 32423285 DOI: 10.1177/0194599820929278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Much of the published literature regarding the novel coronavirus disease 2019 (COVID-19) constitutes lower respiratory system symptomatology, while there exists a paucity of data describing the complicated sequelae of the upper respiratory system, including chemosensory and/or sinonasal dysfunction. This study utilized the National Library of Medicine's PubMed/MEDLINE database to query for articles describing COVID-19, SARS-CoV-2, SARS-CoV-1, MERS-CoV, and other coronaviruses, with any mention of smell, taste, or other chemosensory or sinonasal dysfunction. Aggregate analysis demonstrated an incidence of 49.6% (n = 497 of 1002; 95% CI, 46.5%-52.7%), 47.9% (n = 480 of 1002; 95% CI, 44.8%-51.0%), and 17.9% (n = 880 of 4909; 95% CI, 16.9%-19.0%) for smell loss, taste loss, and smell or taste loss, respectively, in patients infected with SARS-CoV-2. Additionally, there were significantly higher incidences of runny nose/rhinorrhea/rhinitis and nasal congestion/obstruction/blockage in other coronaviruses as compared with SARS-CoV-2 (P < .001). Understanding these less well-characterized symptoms may help develop measures for estimating early markers of disease prevalence and/or resolution. Level of evidence: 4.
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Affiliation(s)
- Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Richard A Raad
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ashwin Ganti
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
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325
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Preparedness of European diagnostic microbiology labs for detection of SARS-CoV-2, March 2020. J Clin Virol 2020; 128:104432. [PMID: 32422569 PMCID: PMC7227504 DOI: 10.1016/j.jcv.2020.104432] [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: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND To track the European spread of SARS-CoV-2, decentralized testing became necessary and test capacity needed to be expanded outside reference laboratories rapidly. METHODS We assessed via an online questionnaire the preparedness of European hospital laboratories for detection of SARS-CoV-2 and listed the main drawbacks for implementation. RESULTS Forty-five percent of the surveyed labs had a test in place by March 26th which is well into the first wave of the pandemic in most countries. CONCLUSIONS The main implementation barriers for introduction of a SARSCoV-2 molecular assay in European diagnostic laboratories were availability of positive controls and a specificity panel.
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326
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SARS-CoV-2 infection diagnosed only by cell culture isolation before the local outbreak in an Italian seven-week-old suckling baby. Int J Infect Dis 2020; 96:387-389. [PMID: 32417248 PMCID: PMC7224665 DOI: 10.1016/j.ijid.2020.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 01/12/2023] Open
Abstract
The study described the case of a 7-week-old suckling baby infected withSARS-CoV-2 virus. Only culture isolation allowed the identification of the cytopathogenic agent. Cell culture still remains the only reference method for emerging viruses.
SARS-CoV-2 emerged in China in December 2019 and has now been declared a pandemic by the World Health Organization. This paper described the case of a 7-week-old suckling baby from Italy who was SARS-CoV-2-positive only by the cell culture method, with no clinical suspicion of and/or risk factors for SARS-CoV-2 infection. The baby was referred to hospital, with signs and symptoms of upper respiratory tract infection, before the virus had spread to the province. Nasal and pharyngeal swabs and a nasopharyngeal aspirate were used for conventional and molecular diagnostic assays not including the SARS-CoV-2 virus. Bacteria referred to the resident population were revealed in nasal and pharyngeal swabs. No viruses were detected using both immunofluorescence assay and nucleic acid amplification assays in the nasopharyngeal aspirate. The baby was discharged in good condition after 3 days of hospitalisation. Later, a cytopathic effect on the cell monolayers currently used for respiratory viruses was observed and the viral particles were identified as Coronaviridae by transmission electron microscopy. SARS-CoV-2 was identified by RT-PCR performed both on cell culture and on the stored aliquot of the original sample. The virus isolate was named SARS-Cov-2/human/Parma/1/2020. Cell culture still remains the only reference diagnostic method also for emerging viruses, allowing it to reveal cytopathogenic viruses and demonstrate their infectivity.
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327
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Sechi GM, Migliori M, Dassi G, Pagliosa A, Bonora R, Oradini-Alacreu A, Odone A, Signorelli C, Zoli A, Response Team AC. Business Intelligence applied to Emergency Medical Services in the Lombardy region during SARS-CoV-2 epidemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:39-44. [PMID: 32420923 PMCID: PMC7569617 DOI: 10.23750/abm.v91i2.9557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/05/2022]
Abstract
Background and aim of the work: On the 21st of February, the first patient was tested positive for SARS-CoV-2 at Codogno hospital in the Lombardy region. From that date, the Regional Emergency Medical Services (EMS) Trust (AREU) of the Lombardy region decided to apply Business Intelligence (BI) to the management of EMS during the epidemic. The aim of the study is to assess in this context the impact of BI on EMS management outcomes. Methods: Since the beginning of the COVID-19 outbreak, AREU is using BI daily to track the number of first aid requests received from 112. BI analyses the number of requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview. Moreover, BI allows identifying the numerical trend of episodes in each municipality (increasing, stable, decreasing). Results: AREU decides to reallocate in the territory the resources based on real-time data recorded and elaborated by BI. Indeed, based on that data, the numbers of vehicles and personnel have been implemented in the municipalities that registered more episodes and where the clusters are supposed to be. BI has been of paramount importance in taking timely decisions on the management of EMS during COVID-19 outbreak. Conclusions: Even if there is little evidence-based literature focused on BI impact on health care, this study suggests that BI can be usefully applied to promptly identify clusters and patterns of the SARS-CoV-2 epidemic and, consequently, make informed decisions that can improve EMS management response to the outbreak. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Gabriele Dassi
- Azienda Regionale Emergenza Urgenza, Lombardy, Milan - Italy .
| | - Andrea Pagliosa
- Azienda Regionale Emergenza Urgenza, Lombardy, Milan - Italy .
| | - Rodolfo Bonora
- Azienda Regionale Emergenza Urgenza, Lombardy, Milan - Italy .
| | - Aurea Oradini-Alacreu
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan - Italy.
| | - Anna Odone
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan - Italy.
| | - Carlo Signorelli
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan - Italy.
| | - Alberto Zoli
- Azienda Regionale Emergenza Urgenza, Lombardy, Milan - Italy .
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328
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Chintalapudi N, Battineni G, Sagaro GG, Amenta F. COVID-19 outbreak reproduction number estimations and forecasting in Marche, Italy. Int J Infect Dis 2020; 96:327-333. [PMID: 32437930 PMCID: PMC7211603 DOI: 10.1016/j.ijid.2020.05.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background COVID-19 disease is becoming a global pandemic and more than 200 countries were affected because of this disease. Italy is one of the countries is largely suffered with this virus outbreak, and about 180,000 cases (as of 20 April 2020) were registered which explains the large transmissibility and reproduction case numbers. Objective In this study, we considered the Marche region of Italy to compute different daily transmission rates (Rt) including five provinces in it. We also present forecasting of daily and cumulative incidences associated after the next thirty days. The Marche region is the 8th in terms of number of people infected in Italy and the first in terms of diffusion of the infection among the 4 regions of the center of Italy. Methods Epidemic statistics were extracted from the national Italian Health Ministry website. We considered outbreak information where the first case registered in Marche with onset symptoms (26 February 2020) to the present date (20 April 2020). Adoption of incidence and projections with R statistics was done. Results The median values of Rt for the five provinces of Pesaro and Urbano, Ancona, Fermo, Ascoli Piceno, and Macerata, was 2.492 (1.1–4.5), 2.162 (1.0–4.0), 1.512 (0.75–2.75), 1.141 (1.0–1.6), and 1.792 (1.0–3.5) with 95% of CI achieved. The projections at end of 30th day of the cumulative incidences 323 (95% CI), and daily incidences 45 (95% CI) could be possible. Conclusions This study highlights the knowledge of essential insights into the Marche region in particular to virus transmission dynamics, geographical characteristics of positive incidences, and the necessity of implementing mitigation procedures to fight against the COVID-19 outbreak.
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Affiliation(s)
- Nalini Chintalapudi
- E-health and Telemedicine Center, University of Camerino, Camerino, 62032, Italy.
| | - Gopi Battineni
- E-health and Telemedicine Center, University of Camerino, Camerino, 62032, Italy
| | - Getu Gamo Sagaro
- E-health and Telemedicine Center, University of Camerino, Camerino, 62032, Italy
| | - Francesco Amenta
- E-health and Telemedicine Center, University of Camerino, Camerino, 62032, Italy; Research Department, International Radio Medical Centre (C.I.R.M.), Rome, 00144, Italy
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329
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Potdar V, Cherian SS, Deshpande GR, Ullas PT, Yadav PD, Choudhary ML, Gughe R, Vipat V, Jadhav S, Patil S, Nyayanit D, Majumdar T, Walimbe A, Gaikwad S, Dighe H, Shete-Aich A, Mohandas S, Chowdhury D, Sapkal G, Basu A, Gupta N, Gangakhedkar RR, Giri S, Dar L, Jain A, Malhotra B, Abraham P. Genomic analysis of SARS-CoV-2 strains among Indians returning from Italy, Iran & China, & Italian tourists in India. Indian J Med Res 2020; 151:255-260. [PMID: 32362650 PMCID: PMC7366550 DOI: 10.4103/ijmr.ijmr_1058_20] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Varsha Potdar
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Sarah S. Cherian
- Bioinformatics & Data Management Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Gururaj Rao Deshpande
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | | | - Pragya D. Yadav
- Maximum Containment Laboratory, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Manohar Lal Choudhary
- Maximum Containment Laboratory, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Rohan Gughe
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Veena Vipat
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Sheetal Jadhav
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Savita Patil
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Dimpal Nyayanit
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Triparna Majumdar
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Atul Walimbe
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Shivshankar Gaikwad
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Hitesh Dighe
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Anita Shete-Aich
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Sreelekshmy Mohandas
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Deepika Chowdhury
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Gajanan Sapkal
- Influenza Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Atanu Basu
- Electron Microscopy & Histopathology Group, ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - Nivedita Gupta
- 6Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Raman R. Gangakhedkar
- 6Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Sidhartha Giri
- 6Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow 226 003, Uttar Pradesh, India
| | - Bharati Malhotra
- Department of Microbiology, SMS Medical College, Jaipur 302 004, Rajasthan, India
| | - Priya Abraham
- ICMR-National Institute of Virology, Pune 411 001, Maharashtra, India
| | - NIC Team
- National Influenza Centre (NIC) Team: S.D. Bharadwaj, Y. Gurav, S. Tomar, H. Kaushal, M. Lavania, B. Mathapati, K.P. Patil, A. Deoshatwar, V.K. Meena, N. Srivastava, V. Malik, V. Saha, S. Hundekar, H.K. Kengale, A.S. Awhale, A.S. Jagtap, A. Gondhalekar, S. Digraskar, P. Malsane, K.D. Patel, S. Ranshing, N.Y.B. Karthick, M.B. Kakade, S. Ranawade, S. Vaidya, V.N. Autade, S. Bhorekar, S.S. Salve, P.A. Shinde & B. Nimhas
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330
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Bowale A, Abayomi A, Idris J, Omilabu S, Abdus-Salam I, Adebayo B, Opawoye F, Finnih-Awokoya O, Zamba E, Abdur-Razzaq H, Erinoso O, Onasanya T, Ramadan P, Nyenyi S, Aniaku E, Balogun M, Okunromade O, Adejumo O, Adesola S, Ogunniyan T, Balogun M, Osibogun A. Clinical presentation, case management and outcomes for the first 32 COVID-19 patients in Nigeria. Pan Afr Med J 2020; 35:24. [PMID: 33623549 PMCID: PMC7875732 DOI: 10.11604/pamj.supp.2020.35.2.23262] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/02/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Success in curtailing the pandemic coronavirus disease (COVID-19) depends largely on a sound understanding of the epidemiologic and clinical profile of cases in a population as well as the case management approach. This study documents the presenting characteristics, treatment modalities and outcomes of the first 32 COVID-19 patients in Nigeria. METHODS This retrospective study used medical records of the first 32 patients admitted and discharged from the Mainland Hospital, Lagos State, southwest Nigeria between February 27 and April 6, 2020. The outcomes of interest were death, promptness of admission process and duration of hospitalization. RESULTS The mean age of the patients was 38.1 years (SD: 15.5) and 66% were male. Three-quarters (75%) of the patients presented in moderately severe condition while 16% were asymptomatic. The most common presenting symptoms were fever (59%) and dry cough (44%). The mean time between a positive test result and admission was 1.63 days (SD: 1.31). Almost all (97%) the patients were treated with lopinavir-ritonavir with no recorded death. The median duration of hospital stay was 12 days (IQR: 9-13.5). CONCLUSION In this preliminary analysis of the first COVID-19 cases in Nigeria, clinical presentation was mild to moderate with no mortality. Processes to improve promptness of admission and reduce hospital stay are required to enhance the response to COVID-19 in Nigeria.
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Affiliation(s)
| | | | - Jide Idris
- Lagos State Ministry of Health, Lagos, Nigeria
| | | | | | - Busayo Adebayo
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | | | | | | | | | | | | | - Sam Nyenyi
- World Health Organization, Nigerian Office, Lagos, Nigeria
| | | | | | | | | | | | | | - Mobolanle Balogun
- College of Medicine University of Lagos, Lagos, Nigeria
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - Akin Osibogun
- College of Medicine University of Lagos, Lagos, Nigeria
- Lagos State Primary Health Care Board, Lagos, Nigeria
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331
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Monteleone PA, Nakano M, Lazar V, Gomes AP, de H, Bonetti TC. A review of initial data on pregnancy during the COVID-19 outbreak: implications for assisted reproductive treatments. JBRA Assist Reprod 2020; 24:219-225. [PMID: 32301600 PMCID: PMC7169922 DOI: 10.5935/1518-0557.20200030] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The current outbreak of the novel 2019 coronavirus disease (COVID-19) started in China in December 2019 and has since spread to several other countries. On March 25, 2020, a total of 375,498 cases had been confirmed globally with 2,201 cases in Brazil, showing the urgency of reacting to this international public health emergency. While in most cases, mild symptoms are observed, in some cases the infection leads to serious pulmonary disease. As a result, the possible consequences of the COVID-19 outbreak for pregnant women and its potential effects on the management of assisted reproductive treatments, demand attention. In this review, we summarize the latest research progress related to COVID-19 epidemiology and the reported data of pregnant women, and discuss the current evidence of COVID-19 infections during pregnancy and its potential consequences for assisted reproductive treatments. Reported data suggest that symptoms in pregnant women are similar to those in other people, and that there is no evidence for higher maternal or fetal risks. However, considering the initial data and lack of comprehensive knowledge on the pathogenesis of SARS-CoV-2 during pregnancy, human reproduction societies have recommended postponing the embryo transfers and do not initiate new treatment cycles. New evidence must be considered carefully in order to adjust these recommendations accordingly at any time and to guide assisted reproductive treatments.
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Affiliation(s)
- Pedro Aa Monteleone
- Centro de Reprodução Humana Monteleone.,Disciplina de Ginecologia - Departamento de Obstetrícia e Ginecologia. Faculdade de Medicina da Universidade de São Paulo (FMUSP)
| | - Mayra Nakano
- Centro de Reprodução Humana Monteleone.,Disciplina de Ginecologia - Departamento de Obstetrícia e Ginecologia. Faculdade de Medicina da Universidade de São Paulo (FMUSP)
| | | | | | - Hamilton de
- Centro de Reprodução Humana Monteleone.,Disciplina de Ginecologia - Departamento de Obstetrícia e Ginecologia. Faculdade de Medicina da Universidade de São Paulo (FMUSP)
| | - Tatiana Cs Bonetti
- Centro de Reprodução Humana Monteleone.,Departamento de Ginecologia. Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM)
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332
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Park JH, Jang W, Kim SW, Lee J, Lim YS, Cho CG, Park SW, Kim BH. The Clinical Manifestations and Chest Computed Tomography Findings of Coronavirus Disease 2019 (COVID-19) Patients in China: A Proportion Meta-Analysis. Clin Exp Otorhinolaryngol 2020; 13:95-105. [PMID: 32434310 PMCID: PMC7248616 DOI: 10.21053/ceo.2020.00570] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objectives of this study were to identify the clinical features and chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) patients and to compare the characteristics of patients diagnosed in Wuhan and in other areas of China by integrating the findings reported in previous studies. METHODS We conducted a proportion meta-analysis to integrate the results of previous studies identified in online databases, and subsequently compared the overlapping of 95% confidence intervals (CIs) between locations of diagnosis. The heterogeneity of the results of the included studies was also demonstrated. RESULTS Nine studies with level IV evidence were considered to be eligible for the meta-analysis, and a comparative analysis was only possible between patients diagnosed in Wuhan and outside of Wuhan in China. Fever (84.8%; 95% CI, 78.5% to 90.1%) was identified as the most common clinical manifestation in all COVID-19 patients, and signs of respiratory infection were also frequently present in these patients. When comparing the clinical features according to the location of diagnosis, fever and dyspnea were less frequent in patients diagnosed outside of Wuhan (fever: 78.1%; 95% CI, 73.2% to 82.7%; dyspnea: 3.80%; 95% CI, 0.13% to 12.22%) than in patients diagnosed in Wuhan (fever: 91.7%; 95% CI, 88.0% to 94.8%; dyspnea: 21.1%; 95% CI, 13.2% to 30.3%). The chest CT findings exhibited no significant differences between the groups. CONCLUSION Fever was found to be the most common symptom in COVID-19, and respiratory infection signs were also commonly present. Fever and dyspnea were less frequently observed in the patients diagnosed outside of Wuhan, which should be considered in COVID-19 screening programs. These results may be attributable to the earlier diagnosis of the disease and the younger age of patients outside of Wuhan although further analysis is needed. The role of chest CT in COVID-19 diagnosis is inconclusive based on this study.
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Affiliation(s)
- Joo-Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.,Sensory Organ Research Institute, Dongguk University College of Medicine, Gyeongju, Korea
| | - Wook Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Sang-Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jeongjun Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yun-Sung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.,Sensory Organ Research Institute, Dongguk University College of Medicine, Gyeongju, Korea
| | - Chang-Gun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.,Sensory Organ Research Institute, Dongguk University College of Medicine, Gyeongju, Korea
| | - Seok-Won Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.,Sensory Organ Research Institute, Dongguk University College of Medicine, Gyeongju, Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.,Sensory Organ Research Institute, Dongguk University College of Medicine, Gyeongju, Korea
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333
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Abstract
Much has happened here since the local news media trumpeted the first Australian COVID-19 fatality, and stirred up a medieval fear of contagion. We now need to take a step back to examine the logic underlying the use of our limited COVID-19 countermeasures. Emerging infectious diseases by their nature, pose new challenges to the diagnostic-treatment-control nexus, and push our concepts of causality beyond the limits of the conventional Koch-Henle approach to aetiology. We need to use contemporary methods of assessing causality to ensure that clinical, laboratory and public health measures draw on a rational, evidence-based approach to argumentation. The purpose of any aetiological hypothesis is to derive actionable insights into this latest emerging infectious disease. This review is an introduction to a conversation with medical microbiologists, which will be supported by a moderated blog.
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Affiliation(s)
- Timothy J. J. Inglis
- Division of Pathology and Laboratory Medicine, School of Medicine, University of Western Australia, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA 6009, Australia
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334
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Jääskeläinen AJ, Kekäläinen E, Kallio-Kokko H, Mannonen L, Kortela E, Vapalahti O, Kurkela S, Lappalainen M. Evaluation of commercial and automated SARS-CoV-2 IgG and IgA ELISAs using coronavirus disease (COVID-19) patient samples. Euro Surveill 2020; 25:2000603. [PMID: 32400364 PMCID: PMC7219034 DOI: 10.2807/1560-7917.es.2020.25.18.2000603] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022] Open
Abstract
Antibody-screening methods to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) need to be validated. We evaluated SARS-CoV-2 IgG and IgA ELISAs in conjunction with the EUROLabworkstation (Euroimmun, Lübeck, Germany). Overall specificities were 91.9% and 73.0% for IgG and IgA ELISAs, respectively. Of 39 coronavirus disease patients, 13 were IgG and IgA positive and 11 IgA alone at sampling. IgGs and IgAs were respectively detected at a median of 12 and 11 days after symptom onset.
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Affiliation(s)
- Anne J Jääskeläinen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eliisa Kekäläinen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannimari Kallio-Kokko
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Mannonen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elisa Kortela
- Infectious diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Vapalahti
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Kurkela
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- These authors contributed equally to the work
| | - Maija Lappalainen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- These authors contributed equally to the work
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335
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Giorgi PD, Gallazzi E, Capitani P, D’Aliberti GA, Bove F, Chiara O, Peretti G, Schirò GR. How we managed elective, urgent, and emergency orthopedic surgery during the COVID-19 pandemic: The Milan metropolitan area experience. Bone Jt Open 2020; 1:93-97. [PMID: 33225281 PMCID: PMC7677718 DOI: 10.1302/2633-1462.15.bjo-2020-0016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The COVID-19 virus is a tremendous burden for the Italian health system. The regionally-based Italian National Health System has been reorganized. Hospitals' biggest challenge was to create new intensive care unit (ICU) beds, as the existing system was insufficient to meet new demand, especially in the most affected areas. Our institution in the Milan metropolitan area of Lombardy, the epicentre of the infection, was selected as one of the three regional hub for major trauma, serving a population of more than three million people. The aims were the increase the ICU beds and the rationalization of human and structural resources available for treating COVID-19 patients. In our hub hospital, the reorganization aimed to reduce the risk of infection and to obtained resources, in terms of beds and healthcare personnel to be use in the COVID-19 emergency. Non-urgent outpatient orthopaedic activity and elective surgery was also suspended. A training programme for healthcare personnel started immediately. Orthopaedic and radiological pathways dedicated to COVID-19 patients, or with possible infection, have been established. In our orthopaedic department, we passed from 70 to 26 beds. Our goal is to treat trauma surgery's patient in the "golden 72 hours" in order to reduce the overall hospital length of stay. We applied an objective priority system to manage the flow of surgical procedures in the emergency room based on clinical outcomes and guidelines. Organizing the present to face the emergency is a challenge, but in the global plan of changes in hospital management one must also think about the near future. We reported the Milan metropolitan area orthopaedic surgery management during the COVID-19 pandemic. Our decisions are not based on scientific evidence; therefore, the decision on how reorganize hospitals will likely remain in the hands of individual countries.
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Affiliation(s)
- Pietro Domenico Giorgi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Gallazzi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Capitani
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Antiono D’Aliberti
- Neurosurgery Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Bove
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe Rosario Schirò
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
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336
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Abstract
We report the first 7,755 patients with confirmed COVID-19 in Korea as of March 12th, 2020. A total of 66 deaths have been recorded, giving a case fatality proportion of 0.9%. Older people, and those with comorbidities were at a higher risk of a fatal outcome. The highest number of cases of COVID-19 were in Daegu, followed by Gyeongbuk. This summary may help to understand the disease dynamics in the early phase of the COVID-19 outbreaks, and may therefore, guide future public health measures.
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337
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Oksanen A, Kaakinen M, Latikka R, Savolainen I, Savela N, Koivula A. Regulation and Trust: 3-Month Follow-up Study on COVID-19 Mortality in 25 European Countries. JMIR Public Health Surveill 2020; 6:e19218. [PMID: 32301734 PMCID: PMC7184967 DOI: 10.2196/19218] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The outbreak of the coronavirus disease (COVID-19) has dramatically changed societies in 2020. Since the end of February, Europe has been hit particularly hard by COVID-19, but there are major country differences in both the spread of the virus and measures taken to stop the virus. Social psychological factors such as institutional trust could be important in understanding the development of the epidemic. OBJECTIVE The aim of this study was to examine country variations of COVID-19 mortality in Europe by analyzing social risk factors explaining the spread of the disease, restrictions and control measures, and institutional trust. METHODS The present study was based on a background analysis of European Social Survey data on 25 European countries (N=47,802). Multilevel mixed effects linear regression models focused on 84 days of the COVID-19 epidemic (January 22 to April 14, 2020) and modelled the daily COVID-19 mortality. Analysis focused on the impact of social relations, restrictions, and institutional trust within each country. RESULTS The spread of the COVID-19 epidemic has been fast everywhere, but the findings revealed significant differences between countries in COVID-19 mortality. Perceived sociability predicted higher COVID-19 mortality. Major differences between the 25 countries were found in reaction times to the crisis. Late reaction to the crisis predicted later mortality figures. Institutional trust was associated with lower COVID-19 mortality. CONCLUSIONS The analyses demonstrated the importance of societal and social psychological factors in the spread of the COVID-19 epidemic. By considering multiple perspectives, this study showed that country differences in Europe are major, and this will have an impact on how countries will cope with the ongoing crisis in the following months. The results indicated the importance of timely restrictions and cooperation with people.
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338
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Millán-Oñate J, Millan W, Mendoza LA, Sánchez CG, Fernandez-Suarez H, Bonilla-Aldana DK, Rodríguez-Morales AJ. Successful recovery of COVID-19 pneumonia in a patient from Colombia after receiving chloroquine and clarithromycin. Ann Clin Microbiol Antimicrob 2020; 19:16. [PMID: 32331519 PMCID: PMC7180682 DOI: 10.1186/s12941-020-00358-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND COVID-19 pandemics is a challenge for public health and infectious diseases clinicians, especially for the therapeutical approach that is not yet adequately defined. Amid this situation, investigational agents are being used, including chloroquine. We report here the clinical features and therapeutic course of the first reported patient with confirmed COVID-19 pneumonia that recovered in Colombia, after the use of chloroquine and clarithromycin. CASE PRESENTATION A 34-year-old male, returning from Spain, presented with complaints of fever, and cough, and class-II obesity, being hospitalized. The respiratory viruses and bacteria tested by FilmArray® PCR were negative. Two days later, clarithromycin was started because the patient was suspected as community-acquired pneumonia. At the third day, the rRT-PCR confirmed the SARS-CoV-2 infection. A day later, chloroquine was started because of that. His chest computed tomography was performed and showed bilateral multifocal ground-glass opacities with consolidation, which suggested viral pneumonia as a differential diagnosis. Progressively his clinical condition improved and at day 9, patient rRT-PCR for SARS-CoV-2 became negative. The patient was discharged and isolated at home per 14 days. CONCLUSIONS Our patient improved significantly. This and other COVID-19 cases are urgently demanding results from clinical trials that support evidence-based therapeutical approaches to this pandemic and the clinical management of patients, especially those at critical care.
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Affiliation(s)
- José Millán-Oñate
- Infectious Diseases Division, Centro Médico Imbanaco, Cali, Valle del Cauca, Colombia.,Asociación Colombiana de Infectología, Bogotá DC, Colombia
| | - William Millan
- Fundación Hospital San Jose de Buga, Buga, Valle del Cauca, Colombia
| | | | | | | | - D Katterine Bonilla-Aldana
- Asociación Colombiana de Infectología, Bogotá DC, Colombia.,Incubator in Zoonosis (SIZOO), Biodiversity and Ecosystem Conservation Research Group (BIOECOS), Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira, Risaralda, Colombia.,Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - Alfonso J Rodríguez-Morales
- Asociación Colombiana de Infectología, Bogotá DC, Colombia. .,Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia. .,Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia.
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339
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Giorgi PD, Villa F, Gallazzi E, Debernardi A, Schirò GR, Crisà FM, Talamonti G, D'Aliberti G. The management of emergency spinal surgery during the COVID-19 pandemic in Italy. Bone Joint J 2020; 102-B:671-676. [PMID: 32323563 DOI: 10.1302/0301-620x.102b6.bjj-2020-0537] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. METHODS An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. RESULTS A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). CONCLUSION The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671-676.
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Affiliation(s)
- P D Giorgi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - F Villa
- Neurosurgery Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Gallazzi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Debernardi
- Neurosurgery Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G R Schirò
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - F M Crisà
- Neurosurgery Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Università Degli Studi di Milano, Milan, Italy
| | - G Talamonti
- Neurosurgery Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G D'Aliberti
- Neurosurgery Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Aquino EML, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JAD, Rocha ADS, Ferreira A, Victor A, Teixeira C, Machado DB, Paixão E, Alves FJO, Pilecco F, Menezes G, Gabrielli L, Leite L, Almeida MDCCD, Ortelan N, Fernandes QHRF, Ortiz RJF, Palmeira RN, Junior EPP, Aragão E, Souza LEPFD, Netto MB, Teixeira MG, Barreto ML, Ichihara MY, Lima RTDRS. Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. CIENCIA & SAUDE COLETIVA 2020; 25:2423-2446. [PMID: 32520287 DOI: 10.1590/1413-81232020256.1.10502020] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.
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Affiliation(s)
- Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). R. Basílio da Gama s/no, Canela. 40110-040 Salvador BA Brasil.
| | - Ismael Henrique Silveira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). R. Basílio da Gama s/no, Canela. 40110-040 Salvador BA Brasil.
| | | | - Rosana Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). R. Basílio da Gama s/no, Canela. 40110-040 Salvador BA Brasil.
| | | | | | | | | | | | | | - Enny Paixão
- Grupo de síntese da Rede CoVida. Salvador BA Brasil
| | | | | | | | | | | | | | - Naiá Ortelan
- Grupo de síntese da Rede CoVida. Salvador BA Brasil
| | | | | | | | | | - Erika Aragão
- Grupo de síntese da Rede CoVida. Salvador BA Brasil
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341
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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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342
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COVID-19 in otolaryngologist practice: a review of current knowledge. Eur Arch Otorhinolaryngol 2020; 277:1885-1897. [PMID: 32306118 PMCID: PMC7166003 DOI: 10.1007/s00405-020-05968-y] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
Purpose Otorhinolaryngological manifestations are common symptoms of COVID-19. This study provides a brief and precise review of the current knowledge regarding COVID-19, including disease transmission, clinical characteristics, diagnosis, and potential treatment. The article focused on COVID-19-related information useful in otolaryngologist practice. Methods The Medline and Web of Science databases were searched without a time limit using terms “COVID-19”, “SARS-CoV-2” in conjunction with “otorhinolaryngological manifestation”, “ENT”, and “olfaction”. Results The most common otolaryngological dysfunctions of COVID-19 were cough, sore throat, and dyspnea. Rhinorrhea, nasal congestion and dizziness were also present. COVID-19 could manifest as an isolated sudden hyposmia/anosmia. Upper respiratory tract (URT) symptoms were commonly observed in younger patients and usually appeared initially. They could be present even before the molecular confirmation of SARS-CoV-2. Otolaryngologists are of great risk of becoming infected with SARS-CoV-2 as they cope with URT. ENT surgeons could be easily infected by SARS-CoV-2 during performing surgery in COVID-19 patients. Conclusion Ear, nose and throat (ENT) symptoms may precede the development of severe COVID-19. During COVID-19 pandemic, patients with cough, sore throat, dyspnea, hyposmia/anosmia and a history of travel to the region with confirmed COVID-19 patients, should be considered as potential COVID-19 cases. An otolaryngologist should wear FFP3/N95 mask, glasses, disposable and fluid resistant gloves and gown while examining such individuals. Not urgent ENT surgeries should be postponed. Additional studies analyzing why some patients develop ENT symptoms during COVID-19 and others do not are needed. Further research is needed to determine the mechanism leading to anosmia.
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343
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Zehender G, Lai A, Bergna A, Meroni L, Riva A, Balotta C, Tarkowski M, Gabrieli A, Bernacchia D, Rusconi S, Rizzardini G, Antinori S, Galli M. Genomic characterization and phylogenetic analysis of SARS-COV-2 in Italy. J Med Virol 2020; 92:1637-1640. [PMID: 32222993 PMCID: PMC7228393 DOI: 10.1002/jmv.25794] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/02/2022]
Abstract
This report describes the isolation, molecular characterization, and phylogenetic analysis of the first three complete genomes of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) isolated from three patients involved in the first outbreak of COVID‐19 in Lombardy, Italy. Early molecular epidemiological tracing suggests that SARS‐CoV‐2 was present in Italy weeks before the first reported cases of infection.
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Affiliation(s)
- Gianguglielmo Zehender
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,EpiSoMi CRC-Coordinated Research Center, University of Milan, Milan, Italy.,Romeo ed Enrica Invernizzi Pediatric Research Center, University of Milan, Milan, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,EpiSoMi CRC-Coordinated Research Center, University of Milan, Milan, Italy
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Luca Meroni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Agostino Riva
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Claudia Balotta
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Maciej Tarkowski
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Arianna Gabrieli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Dario Bernacchia
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Stefano Rusconi
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | | | - Spinello Antinori
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,EpiSoMi CRC-Coordinated Research Center, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
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344
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Bal A, Destras G, Gaymard A, Bouscambert-Duchamp M, Valette M, Escuret V, Frobert E, Billaud G, Trouillet-Assant S, Cheynet V, Brengel-Pesce K, Morfin F, Lina B, Josset L. Molecular characterization of SARS-CoV-2 in the first COVID-19 cluster in France reveals an amino acid deletion in nsp2 (Asp268del). Clin Microbiol Infect 2020; 26:960-962. [PMID: 32234449 PMCID: PMC7142683 DOI: 10.1016/j.cmi.2020.03.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Bal
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France; Laboratoire Commun de Recherche Hospices Civils de Lyon-bioMérieux, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - G Destras
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - A Gaymard
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - M Bouscambert-Duchamp
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - M Valette
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - V Escuret
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - E Frobert
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - G Billaud
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - S Trouillet-Assant
- Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France; Laboratoire Commun de Recherche Hospices Civils de Lyon-bioMérieux, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - V Cheynet
- Laboratoire Commun de Recherche Hospices Civils de Lyon-bioMérieux, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - K Brengel-Pesce
- Laboratoire Commun de Recherche Hospices Civils de Lyon-bioMérieux, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - F Morfin
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - B Lina
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - L Josset
- Centre National de Référence des Virus Respiratoires, Hospices Civils de Lyon, Lyon, France; Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France.
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345
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Kinross P, Suetens C, Gomes Dias J, Alexakis L, Wijermans A, Colzani E, Monnet DL. Rapidly increasing cumulative incidence of coronavirus disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020. Euro Surveill 2020; 25:2000285. [PMID: 32186277 PMCID: PMC7096777 DOI: 10.2807/1560-7917.es.2020.25.11.2000285] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The cumulative incidence of coronavirus disease (COVID-19) cases is showing similar trends in European Union/European Economic Area countries and the United Kingdom confirming that, while at a different stage depending on the country, the COVID-19 pandemic is progressing rapidly in all countries. Based on the experience from Italy, countries, hospitals and intensive care units should increase their preparedness for a surge of patients with COVID-19 who will require healthcare, and in particular intensive care.
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Affiliation(s)
- Pete Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Carl Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Joana Gomes Dias
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Ariana Wijermans
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Edoardo Colzani
- European Centre for Disease Prevention and Control, Solna, Sweden
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346
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Wen T, Huang C, Shi FJ, Zeng XY, Lu T, Ding SN, Jiao YJ. Development of a lateral flow immunoassay strip for rapid detection of IgG antibody against SARS-CoV-2 virus. Analyst 2020; 145:5345-5352. [DOI: 10.1039/d0an00629g] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Rapid and simple LFIA strips based on Au NPs provide a preliminary test result for physicians to make the correct diagnosis of SARS-CoV-2 infections along with alternative testing methods.
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Affiliation(s)
- Tian Wen
- Jiangsu Provincial Center for Disease Control and Prevention
- NHC Key laboratory of Enteric Pathogenic Microbiology
- Nanjing
- P. R. China
| | - Chao Huang
- Jiangsu Provincial Center for Disease Control and Prevention
- NHC Key laboratory of Enteric Pathogenic Microbiology
- Nanjing
- P. R. China
| | - Feng-Juan Shi
- Jiangsu Provincial Center for Disease Control and Prevention
- NHC Key laboratory of Enteric Pathogenic Microbiology
- Nanjing
- P. R. China
| | - Xiao-Yan Zeng
- Jiangsu Provincial Center for Disease Control and Prevention
- NHC Key laboratory of Enteric Pathogenic Microbiology
- Nanjing
- P. R. China
| | - Tian Lu
- Jiangsu Province Hi-Tech Key Laboratory for Bio-medical Research
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 211189
- China
| | - Shou-Nian Ding
- Jiangsu Province Hi-Tech Key Laboratory for Bio-medical Research
- School of Chemistry and Chemical Engineering
- Southeast University
- Nanjing 211189
- China
| | - Yong-Jun Jiao
- Jiangsu Provincial Center for Disease Control and Prevention
- NHC Key laboratory of Enteric Pathogenic Microbiology
- Nanjing
- P. R. China
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347
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Imam A, Karatas C, Imam R, Armutlu A, Mecit N, Karakaya A, Kalayoglu M, Kanmaz T. Three Consequent Pediatric Liver Transplant Deaths in the COVID-19 Era. Int J Organ Transplant Med 2020; 11:202-206. [PMID: 33335701 PMCID: PMC7726841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
The effect of COVID-19 on the transplant recipients is not well-established. Many reports underestimate the effect of COVID-19 on the immunosuppressed population. Herein, we report on 3 pediatric liver transplant recipients who were transplanted at our center between February 11 and March 10, 2020-during the COVID-19 pandemic era. The 3 patients aged between 5 and 10 months, had a rapid and aggressive respiratory deterioration that necessitated mechanical ventilation and extracorporeal life support; and eventually died. The clinical and pathological pictures likely represent COVID-19 pneumonia. Chest x-rays showed progressive infiltrates. Lung autopsies showed diffuse alveolar damage in two cases. We concluded that COVID-19 is very likely to have catastrophic effects on transplant recipients.
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Affiliation(s)
- A Imam
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - C Karatas
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - R Imam
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - A Armutlu
- Pathology Department, Koc University Hospital, Istanbul, Turkey
| | - N Mecit
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - A Karakaya
- Radiology Department, Koc University Hospital, Istanbul, Turkey
| | - M Kalayoglu
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
| | - T Kanmaz
- Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
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348
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Borlongan MC, Borlongan MC, Sanberg PR. The Disillusioned Comfort with COVID-19 and the Potential of Convalescent Plasma and Cell Therapy. Cell Transplant 2020; 29:963689720940719. [PMID: 32841042 PMCID: PMC7563883 DOI: 10.1177/0963689720940719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 or COVID-19 is highly infectious, which can lead to acute and chronic debilitating symptoms, as well as mortality. The advent of safe and effective vaccines or antiviral drugs remains distant in the future. Practical public health measures, such as social distancing, hand washing, and wearing a face mask, are the current recommended guidelines by the Centers for Disease Control and Prevention for limiting the spread of the virus. Weakened immune system and aberrant inflammation represent a major pathological symptom of COVID-19 patients. Based on the unique immunomodulatory properties of both convalescent plasma and stem cells, we discuss here their potential use for treating COVID-19.
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Ferreira LL, Sampaio DL, Chagas ACP, Guimarães HP, Hajjar LA, Lobo SMA, Abdo CHN, Bonamigo Filho JL, Bacha HA, Moura RFD, Bernardo WM. AMB Guidelines: COVID –19. Rev Assoc Med Bras (1992) 2020; 66Suppl 2:17-21. [DOI: 10.1590/1806-9282.66.s2.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Hélio Penna Guimarães
- Associação Brasileira de Medicina de Emergência, Brasil; Hospital Israelita Albert Einstein, Brasil; Hospital do Coração, Brasil; Universidade Federal de São Paulo, Brasil
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