STROKE IN COVID-19 PATIENTS: A SCOPING REVIEW

ABSTRACT Objective: to map the scientific production on patients infected by COVID-19 and the occurrence of stroke. Method: a scoping review, according to the framework proposed by the Joanna Briggs Institute, using the LILACS, MEDLINE, WoS, EMBASE, CINAHL and SCOPUS databases, from April to September 2020. The following keywords were used: coronavirus infections, stroke, nervous system diseases and inpatients, based on the Medical Subject Headings. Results: 24 studies that evidenced specific clinical symptoms of stroke such as dysarthria, facial paralysis, sensory deficit, headache, hemiparesis and ataxia in patients with COVID-19 were included. The association between stroke and COVID-19 was found by the following exams: C-reactive protein, D-dimer, computed tomography and, magnetic resonance, among others, as well as by care procedures focused on the findings in the exams, associated with three clinical outcomes, based on the brain ischemia zone affected and the time of viral manifestation of each patient. Conclusion: the specific clinical manifestations of patients who suffered a stroke after COVID-19 were mapped, as well as diagnostic procedures and therapies used, in addition to identifying neurological damage based on the clinical outcome of these patients.

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Pseudo paralysis of the shoulder and increased C-reactive protein are predictive factors for septic shoulder in children superior to other clinical symptoms: a retrospective case series of 25 patients

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190126 ◽

2020 ◽

Vol 14 (1) ◽

pp. 85-90 ◽

Cited By ~ 1

Author(s):

Cezara Danilov ◽

Christoph Ihle ◽

Francisco F. Fernandez ◽

Gunnar Blumenstock ◽

Thomas Wirth ◽

...

Keyword(s):

Septic Arthritis ◽

Clinical Symptoms ◽

Case Series ◽

Diagnostic Procedures ◽

White Blood Count ◽

C Reactive Protein ◽

Retrospective Case ◽

Level Of Evidence ◽

Reactive Protein ◽

Shoulder Arthritis

Purpose The aim of the study was to evaluate predictable parameters with the highest sensitivity used in the diagnosis of children septic shoulder arthritis. Methods All children treated in our paediatric orthopaedic hospital between 2000 and 2017 with intraoperative verified septic arthritis of the shoulder were included in this retrospective study. Diagnostic procedures e.g. ultrasound, MRI, radiograph or blood samples as well as typical clinical symptoms were evaluated as predictable parameters for septic shoulder arthritis in paediatric patients. Descriptive statistics as well as sensitivity analysis were performed. Results In all, 25 children, 20 boys and five girls, aged from eight days to 15 years, were included for further statistical analysis. All parameters included were tested for sensitivity with binomial confidence intervals (Cis) of 95%. Predictive parameters with highest sensitivity were pseudo paralysis (100%, CI 0.86 to 1.00) and C-reactive protein (CRP) (96%, CI 0.79 to 0.99) superior to temperature (52%, CI 0.3 to 0.73), white blood count (11%, CI 0.01 to 0.34), radiograph (21%, CI 0.04 to 0.50), ultrasound (71%, CI 0.47 to 0.88) or MRI (100%, CI 0.78 to 1.00). Conclusion The diagnosis of a septic arthritis of the shoulder in children can be challenging for the clinician and especially for the resident doctor. Clinical symptoms such as pseudo paralysis and increased CRP level must be considered as predictive markers not to delay further diagnostics and treatment. Level of Evidence IV

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Treatment of Covid-19 Patients With High Dose of Ulinastatin

10.21203/rs.3.rs-32627/v1 ◽

2020 ◽

Author(s):

Hai Huang ◽

Ping-Fang Hu ◽

Liang-Liang Sun ◽

Yi-Bin Guo ◽

Qiong Wang ◽

...

Keyword(s):

Standard Care ◽

Oxygen Therapy ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Therapeutic Agents ◽

High Dose ◽

C Reactive Protein ◽

Peripheral Oxygen Saturation ◽

Reactive Protein ◽

Laboratory Examinations

Abstract Background No specific therapeutic agents or vaccines are available for the treatment of Coronavirus disease 2019 (Covid-19) yet. In this study, we aimed to assess the efficacy of high dose ulinastatin for patients with Covid-19.Methods Twelve patients hospitalized with confirmed SARS-CoV-2 infection were treated with high dose of ulinastatin beyond standard care. The changes of clinical manifestations, laboratory examinations and chest images were retrospectively analyzed. Results A total of 10 patients with severe Covid-19 and 2 patients with moderate Covid-19 received ulinastatin treatment. The average age of the patients was 68.0 ± 11.9 years, ranging from 48 to 87 years. Nine of 12 patients (75.0%) had one or more comorbidities. The most common symptoms on admission were fever (8/12, 66.7%), cough (5/12, 41.7%) and dyspnea (5/12, 41.7%). The percentage of lymphocytes was decreased in 41.7% of patients (5/12), and 58.3% of patients (7/12) had elevated hypersensitive C-reactive protein (CRP) levels (mean, 49.70 ± 77.70 mg/L). The white blood cell levels and the percentage of lymphocytes returned to normal in all of the patients, and CRP decreased significantly and returned to normal in 83.3% of patients (10/12; mean, 6.87 ± 6.63 mg/L) on the seventh day after ulinastatin treatment. Clinical symptoms were relieved synchronously. The peripheral oxygen saturation improved and 66.7% of the patients (8/12) did not need further oxygen therapy seven days after ulinastatin treatment. No patients required intensive care unit admission or mechanical ventilation. All patients revealed different degrees of absorption of pulmonary lesions after treatment. No obvious adverse events were observed.Conclusions Our preliminary data revealed that high dose of ulinastatin treatment was safe and showed a potential beneficial effect for patients with Covid-19.

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An emerging marker predicting the severity of COVID-19: Neutrophil-Lymphocyte Count Ratio

10.21203/rs.3.rs-28850/v1 ◽

2020 ◽

Author(s):

Minping Zhang ◽

Enhua Xiao ◽

Jiayi Liu ◽

Yeyu Cai ◽

Qizhi Yu

Keyword(s):

Neutrophil Count ◽

Lymphocyte Count ◽

Clinical Symptoms ◽

Characteristic Curve ◽

C Reactive Protein ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Count Ratio ◽

Severe Group ◽

D Dimer

Abstract Background: To analyze clinical features and laboratory indicators and identify the markers of exacerbation in COVID-19. Methods: We reviewed clinical histories of 177 patients with confirmed COVID-19. The patients were categorized into mild group (153 patients) and severe group (24 patients). The baseline demographic and laboratory indicators of all patients were collected, including the neutrophil-lymphocyte count ratio (NLCR) and C-reactive protein to albumin ratio (CAR). Receiver operating characteristic curve (ROC) analysis was performed to search for indicators predicting exacerbation in COVID-19 patients, and acquiring the area under the curves (AUCs), sensitivity, specificity and cut-off value. Results: The age of the severe group were significantly older than those of the mild group (P <0.01). Fever was the typical symptom in all COVID-19 patients. Cough and fatigue were manifested in mild group, yet severe patients were more prominent in dyspnea. The laboratory indicators showing that the mild group mainly had an elevated C-reactive protein; the severe group had a decreased lymphocyte count and lymphocyte ratio. WBC, neutrophil count, neutrophil ratio, D-dimer, AST, ALT, LDH, BUN, CRP levels increased. Furthermore, compared to mild group, WBC, neutrophil count, neutrophil ratio (Neut%), D-dimer, total bilirubin, albumin, AST, ALT, LDH, BUN, creatine kinase, CRP, CAR, NLCR were significantly higher, the lymphocyte count, lymphocyte ratio, and APTT were significantly lower in severe group (P<0.05). The ROC indicating that NLCR, Neut%, CAR, CRP, and LDH were better at distinguishing mild and severe patients. The AUCs of NLCR was larger than others (NLCR>Neut%>CAR>CRP>LDH: 0.939>0.925>0.908>0.895>0.873), which suggested that NLCR was the optimal maker; a cut-off value for NLCR of 6.15 had 87.5% sensitivity and 97.6% specificity for predicting exacerbation in COVID-19 patients. Conclusions: The different types of COVID-19 had significant differences in age, clinical symptoms and laboratory indicators, and severe patients might be easier to suffer from the multiple organ damage. An elevated NLCR may indicate that the disease was progressing towards exacerbation. It was essential to dynamically monitor the serum NLCR levels which contributed to evaluate the patient's condition and efficacy. NLCR could be used as a novel, highly specific and sensitive marker for predicting severity of COVID-19 patients.

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Clinical Traits of SARS-CoV-2 Infection

Russian Journal of Gastroenterology Hepatology Coloproctology ◽

10.22416/1382-4376-2020-30-6-28-39 ◽

2020 ◽

Vol 30 (6) ◽

pp. 28-39

Author(s):

O. Yu. Zolnikova ◽

N. L. Dzhakhaya ◽

N. D. Potskherashvili ◽

K. B. Puzakov ◽

O. Yu. Кiseleva ◽

...

Keyword(s):

Demographic Data ◽

Clinical Manifestations ◽

Male Gender ◽

C Reactive Protein ◽

Diagnostic Pcr ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein ◽

Duration Of Disease ◽

Coronavirus Infection ◽

D Dimer

Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.Materials and methods. The study included 92 patients with conﬁrmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and ﬁbrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p < 0.01), diabetes mellitus (p < 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial ﬁbrillation (p <0.05).Conclusion. The risk of severe and adverse coronavirus infection is signiﬁcantly higher in elder comorbid patients.

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Therapeutic potential of anticoagulant therapy in association with cytokine storm inhibition in severe cases of COVID-19: A case report

Open Life Sciences ◽

10.1515/biol-2021-0088 ◽

2021 ◽

Vol 16 (1) ◽

pp. 809-814

Author(s):

Qiancheng Xu ◽

Tao Wang ◽

Weihua Lu

Keyword(s):

Anticoagulant Therapy ◽

Therapeutic Potential ◽

Clinical Manifestations ◽

Treatment Strategies ◽

Oxygenation Index ◽

C Reactive Protein ◽

Reactive Protein ◽

Timely Treatment ◽

D Dimer

Abstract Inflammation and coagulation are considered to the development of Coronavirus disease 2019 (COVID-19)-related hypoxemia. However, this is still controversial, which brings challenges to clinical treatment. Here, we reviewed the levels of interleukin-6 (IL-6), coagulation indexes, and clinical manifestations of a patient with severe COVID-19 after Tocilizumab administration. In this case, the patient’s body temperature quickly dropped to normal after using Tocilizumab, while C reactive protein progressively decreased and stabilized at a lower level. However, IL-6 and D-dimers increased and were accompanied by a continuous decrease of the oxygenation index. After anticoagulant therapy with heparin, D-dimer decreased slowly, gradually improving the oxygenation index and disease remission. This case suggests that the formation of microthrombus might be the main reason for COVID-19-derived hypoxemia. However, the mechanism of hypoxemia and the role of Tocilizumab in COVID-19 need further research. Nevertheless, these findings might still assist medical workers in formulating timely treatment strategies for similar severe patients.

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Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Viruses ◽

10.3390/v13061067 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1067

Author(s):

Oleksandr Oliynyk ◽

Wojciech Barg ◽

Anna Slifirczyk ◽

Yanina Oliynyk ◽

Vitaliy Gurianov ◽

...

Keyword(s):

Macrophage Activation Syndrome ◽

Macrophage Activation ◽

Cytokine Storm ◽

Cytokine Release ◽

Cytokine Release Syndrome ◽

C Reactive Protein ◽

Treatment Results ◽

Reactive Protein ◽

Median Serum ◽

D Dimer

Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0–4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25–0.99). Сonclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.

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Comparison of Effects of Statin Use on Mortality in Patients With Peripheral Arterial Disease With Versus Without Elevated C-Reactive Protein and D-Dimer Levels

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.12.054 ◽

2010 ◽

Vol 105 (9) ◽

pp. 1348-1352 ◽

Cited By ~ 12

Author(s):

Himabindu Vidula ◽

Lu Tian ◽

Kiang Liu ◽

Michael H. Criqui ◽

Luigi Ferrucci ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Peripheral Arterial ◽

D Dimer ◽

Statin Use

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Chondrosternal Arthritis in Infant: An Unusual Entity

Case Reports in Orthopedics ◽

10.1155/2014/652539 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Athina Nikolarakou ◽

Dana Dumitriu ◽

Pierre-Louis Docquier

Keyword(s):

Clinical Symptoms ◽

Therapeutic Option ◽

White Blood Cells ◽

Laboratory Data ◽

C Reactive Protein ◽

Reactive Protein ◽

History Of ◽

Local Tenderness ◽

Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

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