scholarly journals Could obesity be a risk factor for adverse clinical outcomes of COVID-19? Review article

2021 ◽  
Vol 100 (5) ◽  
pp. 472-478
Author(s):  
Betina Linardi Espinosa ◽  
Emily Brenda de Lima Sousa ◽  
Flavia Morandi El Faro ◽  
Tatiana Carvalho Marques ◽  
Celine de Carvalho Furtado ◽  
...  
Keyword(s):  
Risk Factor ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Review Article ◽  
Important Risk Factor ◽  
Pathophysiological Mechanism ◽  
Direct Relation ◽  
Eligibility Criteria ◽  
Infectious State

Aims: This narrative review’s purpose was to verify a possible association between obesity and COVID-19-related outcomes. Methods: A PubMed research was done in May 2020, and after the eligibility criteria, 10 articles were included, which were analyzed, and its results compared. Results: It was observed that, because of the changes caused by obesity in the organism, this comorbidity is an important risk factor for Sars-CoV-2’s infection severity and hospital stay. Moreover, obesity has been considered a risk factor for adverse clinical outcomes. Also, it was possible to notice that most individuals with obesity were male, therefore a direct relation was traced between men with obesity and COVID-19’s severity, and this population required more intubation and those older than 20 years old presented higher mortality rate. Besides that, the association between obesity and other comorbidities seems to worsen even more the infectious state. Conclusions: However, it was not possible to find a pathophysiological mechanism that can fully explain those associations. Therefore, more studies are vital to understand this subject.

scholarly journals Situation of the Covid-19 epidemic in patients on peritoneal dialysis on 2020/05/15 in France : RDPLF data-base

2020 ◽  
Vol 3 (2) ◽  
pp. 73-81 ◽  
Author(s):  
Mathilde Nouvier ◽  
Christian Verger ◽  
Denis Fouque
Keyword(s):  
Renal Failure ◽  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Chronic Renal Failure ◽  
Mortality Rate ◽  
Nursing Homes ◽  
Hospital Stay ◽  
Data Base ◽  
French Language ◽  
Patient Profiles

Numerous studies have shown that chronic renal failure, whatever the treatment, is an important risk factor during the SARS-Cov2 pandemic. We present the incidence of COVID-19 infection, and its lethality, in France according to data from the French Language Peritoneal Dialysis Registry (RDPLF), during the period of the epidemic peak between March 1 and May 15, 2020. Of the 3,104 patients treated with PD during this period, from 156 centers, 59 contracted COVID-19, ie 1.8%, a percentage significantly lower than that observed in center hemodialysis. Diabetes was found in 64% of infected patients while it was only present in 36% of uncontaminated patients. The mode of contamination was attributed to a hospital stay in 19% of the cases, a family infection in 17% of the cases, treatment in nursing homes in 15% of the cases, unknown in 44% of the cases. Sixty-two percent of the infected patients were on assisted PD, without identifying the source of contamination. The mortality rate was high at 40%, comparable to other countries in PD. A comparison with hemodialysis could only be made after adjustment for comorbidities and patient profiles: data on hemodialysis are not available in the RDPLF. Home peritoneal dialysis decreases the risk of Covid-19 contamination, but associated comorbidities and age are the source of high mortality. Non-autonomous patients have a higher risk of contamination.

scholarly journals Thrombosis in Systemic Lupus Erythematosus: A Review Article

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ibrahim A. Al-Homood
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Risk Factor ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Review Article ◽  
Important Risk Factor ◽  
Clinical Entity ◽  
Systemic Lupus ◽  
Thrombosis Risk

Thrombosis is a well-known clinical entity in systemic lupus erythematosus (SLE), and it is multifactorial. The most important risk factor is the presence of antiphospholipid antibodies (APLAs). However, approximately 40% of adults with SLE who are negative for APL A are diagnosed with thrombosis, indicating the importance of other risk factors. Thus, the thrombosis risk factors should be evaluated extensively and regularly and treated aggressively in every patient with systemic lupus erythematosus.

scholarly journals Desfechos e características clinicas de pessoas com obesidade e covid-19: revisão integrativa

2021 ◽  
Vol 20 (3) ◽  
pp. 544-580
Author(s):  
Francisco João de Carvalho Neto ◽  
Brenda Moreira Loiola ◽  
Vitória Eduarda Silva Rodrigues ◽  
Laelson Rochelle Milanês Sousa ◽  
Ana Luiza Negreiros
Keyword(s):  
Risk Factor ◽  
Mortality Rate ◽  
Clinical Outcomes ◽  
High Mortality ◽  
Clinical Characteristics ◽  
Oxygen Therapy ◽  
Medical Literature ◽  
Mortality Rates ◽  
Obese People ◽  
On Line

Objetivo: Identificar los resultados y las características clínicas de las personas con obesidad y covid-19 en la literatura científica nacional e internacional.Método: Revisión Integrativa, en la que tuvo como objetivo dar respuesta a la pregunta orientadora: “¿Cuáles son las características clínicas que presentan las personas con obesidad con diagnóstico confirmado de COVID-19, y su impacto en la salud?” indexados en la base de datos Medical Literature and Retrivial System on Line, y Virtual Health Library en noviembre de 2020.Resultados: De los 13 artículos analizados en su totalidad, todos fueron publicados en revistas internacionales, en el año 2020, en relación a los resultados clínicos, se evidenció una alta tasa de mortalidad en pacientes ingresados con covid-19 que presentaban obesidad en comparación con aquellos sin obesidad, estancia hospitalaria más prolongada, necesidad de oxigenoterapia, aumento de la gravedad de la enfermedad Covid-19, factor de riesgo para las tasas de morbilidad en personas más jóvenes, pudiendo predisponer al riesgo de enfermedades más graves e influir en la progresión y pronóstico de la enfermedad . En cuanto a las características clínicas, mostraron que la ferritina tendía a permanecer más alta en el grupo de personas obesas, siendo más propensas a tener fiebre, tos y dificultad para respirar.Conclusión: La obesidad en personas con covid-19 potencia características clínicas como tos, fatiga, fiebre y cansancio. Además, los resultados clínicos incluyen el riesgo potencial de complicaciones, altas tasas de mortalidad, mayor propensión a intubar, mayor tiempo de terapia de oxígeno. Por tanto, los equipos sanitarios deberían prestar más atención a estos pacientes. Objective: To identify people's outcomes and clinical characteristics of those with obesity and covid-19 in the national and international scientific literature.Method: Integrative Review, in which it aimed to answer the guiding question: What are the clinical characteristics presented by people with obesity with a confirmed diagnosis of COVID-19, and its impact on health?" indexed in the database Medical LiteratureandRetrivial System on Line, and Virtual Health Library in November 2020.Results: Out of the 13 articles analyzed in total, all were published in international journals; in the year 2020, concerning clinical outcomes, a high mortality rate was evidenced in patients admitted with covid-19 who had obesity in comparison with those without obesity, more extended hospital stay, need for oxygen therapy, increased severity of Covid-19 disease, a risk factor for morbidity rates in younger people, being able to predispose to risk of more severe conditions and influence the progression and prognosis of the disease. Regarding the clinical characteristics, they showed that ferritin tended to remain higher in the group of obese people, being more likely to have fever, cough, and shortness of breath.Conclusion: Obesity in people with covid-19 potentiates clinical characteristics such as cough, fatigue, fever, and tiredness. Clinical outcomes include the potential risk of complications, high mortality rates, greater propensity to be intubated, longer oxygen therapy time. Thus, more attention should be paid to these patients by the health teams. Objetivo: Identificar os desfechos e características clínicas de pessoas com obesidade e covid-19 na literatura científica nacional e internacional. Método: Revisão Integrativa, na qual visou responder à questão norteadora: “Quais as características clínicas apresentadas por pessoas com obesidade com diagnóstico confirmado de COVID-19, e sua repercussão para a saúde?” indexadas na base de dados Medical Literature and Retrivial System on Line e Biblioteca Virtual de Saúde no mês de novembro de 2020. Resultados: Dos 13 artigos analisados na íntegra, todos foram publicados em periódicos internacionais, no ano de 2020, em relação aos desfechos clínicos evidenciou-se alta taxa de mortalidade nos pacientes admitidos com covid-19 que tinham obesidade em comparação com aqueles sem obesidade, maior tempo de permanência hospitalar, necessidade de oxigenoterapia, aumento da gravidade da doença do Covid-19, fator de risco para as taxas de morbidade em pessoas mais jovens, podendo predispor a risco de doenças mais graves e influenciar na progressão e o prognóstico da doença. A respeito das características clínicas, demostraram que a ferritina tendeu a permanecer mais elevada no grupo de pessoas obesas, sendo mais propensos a apresentar febre, tosse e falta de ar. Conclusão: A obesidade em pessoas com covid-19 potencializa as características clinicas como tosse, fadiga, febre e cansaço. Ademais, tem como desfechos clínicos o potencial risco de complicações, altas taxas de mortalidade, maior propensão a serem intubados, maior tempo de oxigenoterapia. Assim, mais atenção deve ser dispensada a esses pacientes por parte das equipes de saúde.

scholarly journals 1596. Ceftolozane/tazobactam (Zerbaxa) for the Treatment of Pseudomonas aeruginosa (PSA) Bacteremia: A Systematic Literature Review (SLR)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S794-S794
Author(s):  
Ryan J Dillon ◽  
Zarmina S Khankhel ◽  
Carisa De Anda ◽  
Christopher Bruno ◽  
Laura A Puzniak
Keyword(s):  
Clinical Outcomes ◽  
Clinical Success ◽  
Complicated Urinary Tract Infection ◽  
Clinical Trial Data ◽  
Empiric Therapy ◽  
Multidrug Resistant ◽  
Eligibility Criteria ◽  
Published Evidence ◽  
Gram Negative Bacteremia ◽  
Intra Abdominal Infection

Abstract Background Bacteremia is a significant cause of morbidity and mortality. Several studies have shown this burden to increase among patients with multidrug resistant (MDR) PSA, and in those treated with inappropriate empiric therapy. Ceftolozane/tazobactam (C/T) is a combination of a novel antipseudomonal cephalosporin and an established β-lactamase inhibitor approved for the treatment of complicated urinary tract infection, complicated intra-abdominal infection and hospital-acquired and ventilator-associated bacterial pneumonia. In the absence of specific bacteremia clinical trial data; the aim of this study is to describe all published evidence relating to C/T for the treatment of Gram negative bacteremia. Methods This SLR includes all published evidence from December 2015 to March 2020 searched via the OVID platform: EMBASE, MEDLINE, and MEDLINE In-Process. In addition, data published (2018-2019) from the European Society of Clinical Microbiology and Infectious Diseases and Infectious Disease Week Congresses were included. Eligible publications were on adult patients treated with C/T reporting any clinical outcome where data were reported specifically for the bacteremia population. Results The SLR identified 1,455 citations, of which 24 publications representing 23 unique studies met eligibility criteria. This included primary and secondary bacteremia. Ten studies included patients with primary bacteremia, only 7 of which reported results specific to primary bacteremia patients. Despite heterogeneity in study design, patient and treatment characteristics, and a lack of detailed reporting; the majority of studies focused on MDR/ extensively drug resistant (XDR) infections (range: 68.3%-100%). Clinical success/ cure ranged from 33%-100%, with 6/7 studies at >85%; 30-day mortality from 0%-67%, with 3/7 studies at 0% (Table 1). Table 1. Clinical Outcomes reported among Primary Bacteremia population(s) Conclusion Although the number of C/T treated patients was small, favorable clinical outcomes were observed, even among highly resistant PSA infections. Heterogeneity was ubiquitous, with diverse and complex patient profiles identified. Further studies where outcomes are stratified by bacteremia status and by timing of C/T treatment are needed. Disclosures Ryan J. Dillon, MSc, Merck & Co., Inc., (Employee) Carisa De Anda, PharMD, Merck & Co Inc, (Employee) Christopher Bruno, MD, Merck & Co., Inc. (Employee) Laura A. Puzniak, PhD, Merck (Employee)

scholarly journals 270. Clinical Outcomes of Ceftriaxone versus Penicillin G for Complicated Viridans Group Streptococci Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Stephanie Wo ◽  
Yanina Dubrovskaya ◽  
Justin Siegfried ◽  
John Papadopoulos ◽  
Shin-Pung Jen
Keyword(s):  
Clinical Outcomes ◽  
Hospital Readmission ◽  
Protective Factor ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Penicillin G ◽  
Eligibility Criteria ◽  
Extended Spectrum Beta Lactamase ◽  
Increased Risk ◽  
Viridans Group Streptococci

Abstract Background Viridans group streptococci (VGS) is an infrequent yet significant cause of bloodstream infections, and complicated cases may require prolonged antibiotic therapy. Ceftriaxone (CTX) and penicillin G (PCN G) are both considered first line options for VGS infections, but comparisons between these agents are limited. We evaluated the clinical outcomes amongst patients treated with CTX and PCN G for complicated VGS bacteremia. Methods This was a single-center, retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in PCN G arm) between January 2013 and June 2019. The primary outcome was a composite of safety endpoints, including hospital readmission due to VGS or an adverse event (AE) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to an antibiotic-related AE, and development of extended-spectrum beta lactamase resistance. Secondary outcomes included the individual safety endpoints, VGS bacteremia recurrence, hospital readmission, and all-cause mortality. Results Of 328 patients screened for inclusion, 94 patients met eligibility criteria (CTX n= 64, PCN G n=34). Median age was 68 years (IQR 56–81) and 68% were male. Study patients did not present with critical illness, as reflected by a median Pitt bacteremia score of 0 in the CTX and 1 in the PCN G arms, P=0.764. Streptococcus mitis was the most common VGS isolate and infective endocarditis (IE) was the predominant source of infection. CTX was not significantly associated with increased risk of the primary outcome (14% vs. 27%; P= 0.139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. Results were similar in the subgroup of patients with IE (12.5% vs. 23.5%). No secondary endpoints differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary outcome (OR 0.1; 95% CI 0.020–0.6771; P= 0.017). Conclusion Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate a higher rate of treatment failure, adverse events, or resistance. These findings warrant further exploration. Disclosures All Authors: No reported disclosures

scholarly journals Probiotics use is associated with improved clinical outcomes among hospitalized patients with COVID-19

2021 ◽  
Vol 14 ◽  
pp. 175628482110356
Author(s):  
Lina Zhang ◽  
Huanqin Han ◽  
Xuan Li ◽  
Caozhen Chen ◽  
Xiaobing Xie ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Standard Care ◽  
Cox Model ◽  
Improvement Rate ◽  
Viral Shedding ◽  
Microbial Dysbiosis ◽  
Relationship Of

Background and aims: Currently, there are no definitive therapies for coronavirus disease 2019 (COVID-19). Gut microbial dysbiosis has been proved to be associated with COVID-19 severity and probiotics is an adjunctive therapy for COIVD-19. However, the potential benefit of probiotics in COVID-19 has not been studied. We aimed to assess the relationship of probiotics use with clinical outcomes in patients with COVID-19. Methods: We conducted a propensity-score matched retrospective cohort study of adult patients with COVID-19. Eligible patients received either probiotics plus standard care (probiotics group) or standard care alone (non-probiotics group). The primary outcome was the clinical improvement rate, which was compared among propensity-score matched groups and in the unmatched cohort. Secondary outcomes included the duration of viral shedding, fever, and hospital stay. Results: Among the propensity-score matched groups, probiotics use was related to clinical improvement rates (log-rank p = 0.028). This relationship was driven primarily by a shorter (days) time to clinical improvement [difference, −3 (−4 to −1), p = 0.022], reduction in duration of fever [−1.0 (−2.0 to 0.0), p = 0.025], viral shedding [−3 (−6 to −1), p < 0.001], and hospital stay [−3 (−5 to −1), p = 0.009]. Using the Cox model with time-varying exposure, use of probiotics remained independently related to better clinical improvement rate in the unmatched cohort. Conclusion: Our study suggested that probiotics use was related to improved clinical outcomes in patients with COVID-19. Further studies are required to validate the effect of probiotics in combating the COVID-19 pandemic.

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