scholarly journals Severe covid-19 pneumonia: pathogenesis and clinical management

BMJ ◽  
2021 ◽  
pp. n436
Author(s):  
Amy H Attaway ◽  
Rachel G Scheraga ◽  
Adarsh Bhimraj ◽  
Michelle Biehl ◽  
Umur Hatipoğlu
Keyword(s):  
Disease Transmission ◽  
Diffuse Alveolar Damage ◽  
Severe Disease ◽  
Invasive Mechanical Ventilation ◽  
Interdisciplinary Approach ◽  
Pulmonary Capillaries ◽  
Volume Ventilation ◽  
Increase Risk ◽  
Male Sex

Abstract Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission. During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.

scholarly journals Comorbidities as Risk Factors for Severe Disease in Hospitalized Elderly COVID-19 Patients by Different Age-Groups in Japan

Gerontology ◽  
2022 ◽  
pp. 1-11
Author(s):  
Yusuke Asai ◽  
Hidetoshi Nomoto ◽  
Kayoko Hayakawa ◽  
Nobuaki Matsunaga ◽  
Shinya Tsuzuki ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Hematological Malignancies ◽  
Severe Disease ◽  
Invasive Mechanical Ventilation ◽  
Age Groups ◽  
Renal Disorder ◽  
Gerontological Society ◽  
Hospitalized Elderly ◽  
Male Sex ◽  
Epidemiological Characteristics

<b><i>Introduction:</i></b> Old age is an independent risk factor (RF) for severe COVID-19; evidence for clinico-epidemiological characteristics among elderly COVID-19 patients is scarce. We aimed to analyze clinical and epidemiological characteristics and comorbidities associated with COVID-19 inpatients in age-stratified populations of an elderly COVID-19 cohort. <b><i>Methods:</i></b> We conducted a retrospective cohort study, using nationwide registry data of COVID-19 patients hospitalized before October 31, 2020 (major information entered in the registry as of December 28, 2020). Participants were divided by age according to the Japan Geriatrics Society and the Japan Gerontological Society: pre-old (65–74 years), old (75–89 years), and super-old (≥90 years). Multivariable logistic regression (MLR) analyses were conducted to identify stratified risk and relationships with comorbidities associated with worse outcomes in different age-groups of elderly patients. Demographics and supportive care were evaluated by category. <b><i>Results:</i></b> Data of 4,701 patients from 444 hospitals were included. Most patients (79.3%) had at least one comorbidity; the proportion of patients with hypertension was high in all categories. The proportion of patients with dementia, cardiovascular disease, and cerebrovascular disease increased with age. The percentage of patients who underwent invasive mechanical ventilation/extracorporeal membrane oxygenation was lower in the super-old group. In total, 11.5% of patients died (5.3%, pre-old; 15.2%, old; and 22.4%, super-old). MLR showed that the risk of critical illness differed among age-groups. Male sex was a significant RF in all ages. Collagen disease, moderate to severe renal disorder, and dialysis were significant RFs in older patients, while hematological malignancies and metastatic tumors were more important RFs for severe disease in relatively younger patients. Most of the RFs for critical illnesses were associated with death. <b><i>Conclusion:</i></b> Differences in the epidemiological and clinical characteristics among the different age-groups were found.

Periodic monitoring of vampire bats and rabies: a new framework for animal restoration projects in the Neotropics

2020 ◽  
Author(s):  
Fernando Gonçalves ◽  
Daniel G. Streicker ◽  
Mauro Galetti
Keyword(s):  
Disease Transmission ◽  
Lessons Learned ◽  
Multidisciplinary Teams ◽  
Risk Area ◽  
Food Web Structure ◽  
Land Bridge ◽  
High Risk Area ◽  
Restoration Project ◽  
Vampire Bats

Nowadays, restoration project might lead to increased public engagement and enthusiasm for biodiversity and is receiving increased media attention in major newspapers, TED talks and the scientific literature. However, empirical research on restoration project is rare, fragmented, and geographically biased and long-term studies that monitor indirect and unexpected effects are needed to support future management decisions especially in the Neotropical area. Changes in animal population dynamics and community composition following species (re)introduction may have unanticipated consequences for a variety of downstream ecosystem processes, including food web structure, predator-prey systems and infectious disease transmission. Recently, an unprecedented study in Brazil showed changes in vampire bat feeding following a rewilding project and further transformed the land-bridge island into a high-risk area for rabies transmission. Due the lessons learned from ongoing project, we present a novel approach on how to anticipate, monitor, and mitigate the vampire bats and rabies in rewilding projects. We pinpoint a series of precautions and the need for long-term monitoring of vampire bats and rabies responses to rewilding projects and highlighted the importance of multidisciplinary teams of scientist and managers focusing on prevention educational program of rabies risk transmitted by bats. In addition, monitoring the relative abundance of vampire bats, considering reproductive control by sterilization and oral vaccines that autonomously transfer among bats would reduce the probability, size and duration of rabies outbreaks. The rewilding assessment framework presented here responds to calls to better integrate the science and practice of rewilding and also could be used for long-term studying of bat-transmitted pathogen in the Neotropical area as the region is considered a geographic hotspots of “missing bat zoonoses”.

National coastal management challenges and needs

Shore & Beach ◽  
2020 ◽  
pp. 34-43
Author(s):  
Nicole Elko ◽  
Tiffany Roberts Briggs
Keyword(s):  
Coastal Management ◽  
Harmful Algal Blooms ◽  
Algal Blooms ◽  
Local Community ◽  
Extreme Event ◽  
Technical Information ◽  
Interdisciplinary Approach ◽  
Beach Erosion ◽  
The U.S

In partnership with the U.S. Geological Survey Coastal and Marine Hazards and Resources Program (USGS CMHRP) and the U.S. Coastal Research Program (USCRP), the American Shore and Beach Preservation Association (ASBPA) has identified coastal stakeholders’ top coastal management challenges. Informed by two annual surveys, a multiple-choice online poll was conducted in 2019 to evaluate stakeholders’ most pressing problems and needs, including those they felt most ill-equipped to deal with in their day-to-day duties and which tools they most need to address these challenges. The survey also explored where users find technical information and what is missing. From these results, USGS CMHRP, USCRP, ASBPA, and other partners aim to identify research needs that will inform appropriate investments in useful science, tools, and resources to address today’s most pressing coastal challenges. The 15-question survey yielded 134 complete responses with an 80% completion rate from coastal stakeholders such as local community representatives and their industry consultants, state and federal agency representatives, and academics. Respondents from the East, Gulf, West, and Great Lakes coasts, as well as Alaska and Hawaii, were represented. Overall, the prioritized coastal management challenges identified by the survey were: Deteriorating ecosystems leading to reduced (environmental, recreational, economic, storm buffer) functionality, Increasing storminess due to climate change (i.e. more frequent and intense impacts), Coastal flooding, both Sea level rise and associated flooding (e.g. nuisance flooding, king tides), and Combined effects of rainfall and surge on urban flooding (i.e. episodic, short-term), Chronic beach erosion (i.e. high/increasing long-term erosion rates), and Coastal water quality, including harmful algal blooms (e.g. red tide, sargassum). A careful, systematic, and interdisciplinary approach should direct efforts to identify specific research needed to tackle these challenges. A notable shift in priorities from erosion to water-related challenges was recorded from respondents with organizations initially formed for beachfront management. In addition, affiliation-specific and regional responses varied, such as Floridians concern more with harmful algal blooms than any other human and ecosystem health related challenge. The most common need for additional coastal management tools and strategies related to adaptive coastal management to maintain community resilience and continuous storm barriers (dunes, structures), as the top long-term and extreme event needs, respectively. In response to questions about missing information that agencies can provide, respondents frequently mentioned up-to-date data on coastal systems and solutions to challenges as more important than additional tools.

Corticosteroids in Inflammatory Bowel Disease patients: a practical guide for physicians.

2020 ◽  
Vol 15 ◽  
Author(s):  
Maria Carla Di Paolo ◽  
Cristiano Pagnini ◽  
Maria Giovanna Graziani
Keyword(s):  
Severe Disease ◽  
Unknown Etiology ◽  
History Of Disease ◽  
Bowel Diseases ◽  
Literature Evidence ◽  
History Of ◽  
Inflammatory Bowel ◽  
Favorable Safety ◽  
Pass Metabolism

: Inflammatory bowel diseases (IBDs) are chronic conditions characterized by unknown etiology and pathogenesis with deregulation of mucosal immunity. Among possible treatments, corticosteroids, already available from the 50’, are still the mainstay of treatment for moderate-severe disease. Nonetheless, the use of steroids is still largely empirical and solid evidence about therapeutic schemes are lacking. Moreover, due to the important side-effects and for the unsatisfactory impact on long-term natural history of disease, the steroid sparing has become an important therapeutic goal in IBD management. Besides conventional steroids, the so called “low bioavailability” steroids, which are steroids with high affinity for peripheral receptors and elevated hepatic first-pass metabolism, have demonstrated efficacy and more favorable safety profile. In the present review of the literature evidence of efficacy and safety of conventional and low bioavailability steroids in IBD patients are evaluated, and practical suggestions for a correct use in clinical practice are presented according to the current clinical guidelines.

scholarly journals COVID-19 in an Asymptomatic Renal Transplant Recipient Employed in the Health Care Setting: A Case Report

2021 ◽  
Author(s):  
Harsha Adnani ◽  
Akshay Khatri ◽  
Nirav Agrawal ◽  
Ernesto Molmenti ◽  
Madhu Bhaskaran
Keyword(s):  
Health Care ◽  
Renal Transplant ◽  
Transplant Recipient ◽  
Renal Transplant Recipient ◽  
Clinical Symptoms ◽  
Severe Disease ◽  
Care Facility ◽  
Health Care Facility ◽  
Asymptomatic Patients

AbstractDuring the ongoing pandemic, there have been varying presentations of coronavirus disease 2019 (COVID-19) infection, with the concern that patients who are immunosuppressed (due to underlying medical conditions and/or therapies) are at higher risk of severe disease. We report the case of an elderly renal transplant recipient working in a long-term health care facility who was being monitored by weekly surveillance testing and tested positive for COVID-19 by polymerase chain reaction (PCR) testing, despite having no clinical symptoms. He recovered with supportive care, despite being on multiple long-term immunosuppressant drugs and having multiple comorbidities. Additionally, it was found that he did not mount an antibody response, when he tested negative by serologic testing. Through this case, we wish to highlight the unique clinical scenario of asymptomatic patients who may have an underwhelming immune response to COVID-19, but may nevertheless be an important source of dissemination. We further discuss the probable mechanism of such asymptomatic presentations in immunosuppressed patients, while reinforcing the importance of self-isolation of COVID-19 patients (particularly in asymptomatic health care workers).

scholarly journals Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 48
Author(s):  
Roger E. Thomas
Keyword(s):  
Nursing Homes ◽  
Infection Control ◽  
Strong Evidence ◽  
Disease Transmission ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities ◽  
Meta Analyses ◽  
Tract Infections

The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.

scholarly journals Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051237
Author(s):  
Emilio Ortega ◽  
Rosa Corcoy ◽  
Mònica Gratacòs ◽  
Francesc Xavier Cos Claramunt ◽  
Manel Mata-Cases ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Male Sex ◽  
Poor Outcomes ◽  
The Relationship

AimThis study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).DesignThis was a cross-sectional study.SettingsWe used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measuresMultiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.ResultsOverall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.ConclusionThe results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.

Long-term mortality rates and associated risk factors following primary and revision knee arthroplasty

2022 ◽  
Vol 104-B (1) ◽  
pp. 45-52
Author(s):  
Liam Zen Yapp ◽  
Nick D. Clement ◽  
Matthew Moran ◽  
Jon V. Clarke ◽  
A. Hamish R. W. Simpson ◽  
...  
Keyword(s):  
General Population ◽  
Knee Arthroplasty ◽  
Mortality Rates ◽  
Factors Associated ◽  
Revision Knee Arthroplasty ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Male Sex ◽  
Long Term Mortality

Aims The aim of this study was to determine the long-term mortality rate, and to identify factors associated with this, following primary and revision knee arthroplasty (KA). Methods Data from the Scottish Arthroplasty Project (1998 to 2019) were retrospectively analyzed. Patient mortality data were linked from the National Records of Scotland. Analyses were performed separately for the primary and revised KA cohorts. The standardized mortality ratio (SMR) with 95% confidence intervals (CIs) was calculated for the population at risk. Multivariable Cox proportional hazards were used to identify predictors and estimate relative mortality risks. Results At a median 7.4 years (interquartile range (IQR) 4.0 to 11.6) follow-up, 27.8% of primary (n = 27,474/98,778) and 31.3% of revision (n = 2,611/8,343) KA patients had died. Both primary and revision cohorts had lower mortality rates than the general population (SMR 0.74 (95% CI 0.73 to 0.74); p < 0.001; SMR 0.83 (95% CI 0.80 to 0.86); p < 0.001, respectively), which persisted for 12 and eighteight years after surgery, respectively. Factors associated with increased risk of mortality after primary KA included male sex (hazard ratio (HR) 1.40 (95% CI 1.36 to 1.45)), increasing socioeconomic deprivation (HR 1.43 (95% CI 1.36 to 1.50)), inflammatory polyarthropathy (HR 1.79 (95% CI 1.68 to 1.90)), greater number of comorbidities (HR 1.59 (95% CI 1.51 to 1.68)), and periprosthetic joint infection (PJI) requiring revision (HR 1.92 (95% CI 1.57 to 2.36)) when adjusting for age. Similarly, male sex (HR 1.36 (95% CI 1.24 to 1.49)), increasing socioeconomic deprivation (HR 1.31 (95% CI 1.12 to 1.52)), inflammatory polyarthropathy (HR 1.24 (95% CI 1.12 to 1.37)), greater number of comorbidities (HR 1.64 (95% CI 1.33 to 2.01)), and revision for PJI (HR 1.35 (95% 1.18 to 1.55)) were independently associated with an increased risk of mortality following revision KA when adjusting for age. Conclusion The SMR of patients undergoing primary and revision KA was lower than that of the general population and remained so for several years post-surgery. However, approximately one in four patients undergoing primary and one in three patients undergoing revision KA died within tenten years of surgery. Several patient and surgical factors, including PJI, were associated with the risk of mortality within ten years of primary and revision surgery. Cite this article: Bone Joint J 2022;104-B(1):45–52.

Sign in / Sign up

Export Citation Format

Share Document