scholarly journals COVID-19 IN PATIENTS RECOVERING FROM CARDIAC SURGERY: A SURPRISING MILD DISEASE COURSE

2020 ◽  
Author(s):  
Alfredo Cerillo ◽  
Niccolò Marchionni ◽  
Beatrice Bacchi ◽  
Pier Luigi Stefano
Keyword(s):  
Care Pathway ◽  
Mortality Rates ◽  
Surgical Patients ◽  
Disease Course ◽  
Comorbid Conditions ◽  
Mild Disease ◽  
Rehabilitation Facility ◽  
Nasal Swabs ◽  
Rehabilitation Clinic ◽  
Benign Course

Cardiac surgical patients are often discharged to a rehabilitation facility to complete the convalescence in a protected setting. This care pathway is usually reserved for elderly and fragile patients, with severe and invalidating comorbid conditions. Between March and April 2020, nineteen patients were discharged from our unit to a rehabilitation clinic where a hotbed of SARS-CoV-2 infection was documented on April 17. After the outbreak, all patients underwent screening with real-time PCR on nasal swabs, and 18/19 patients were found positive. Diversely from other observations on perioperative COVID-19 reporting mortality rates of 30-40%, the COVID-19 had a benign course in our cohort: six patients were completely asymptomatic, and only seven patients required hospitalization (no deaths). We describe the baseline, operative and postoperative features of these patients, and present some potential explanations for the surprisingly benign course of the COVID-19 in this cohort.

scholarly journals Pneumomediastinum in COVID-19 disease: Outcomes and relation to the Macklin effect

2021 ◽  
pp. 021849232110100
Author(s):  
João Brito ◽  
Paulo Gregório ◽  
Alessandro Mariani ◽  
Paula D’ambrosio ◽  
Mauro Filho ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Retrospective Studies ◽  
Underlying Mechanism ◽  
Hemodynamic Instability ◽  
Disease Course ◽  
Lung Involvement ◽  
Radiological Findings ◽  
Disease Outcomes ◽  
Macklin Effect ◽  
Benign Course

Aim Pneumomediastinum (PM) is associated with several etiologies and mechanisms. Although it has been described more than 100 years ago, the literature is limited to small retrospective studies. This study aimed to follow patients with coronavirus disease (COVID-19) that developed PM during hospitalization and describe their clinical and radiological evolution. Methods A prospective cohort was developed with patients with PM, excluding those with aerodigestive trauma, inside a hospital COVID-19 dedicated hospital. Clinical variables including onset of symptoms, hemodynamic instability, associated complications, the need of interventions, and disease course were all recorded. Also, radiological findings such as the presence of the Macklin effect, extension of lung involvement by COVID-19, and characteristics of the PM were analyzed. Results Twenty-one patients with non-traumatic PM were followed, resulting in an overall incidence of 0.5% during the study period. Seven (33%) patients had associated pneumothorax and malignant/tension PM was observed in three (14%) cases. The Macklin effect could be found in 11 patients (52%) and the majority of them had more than 50% of lung involvement due to COVID-19. The mortality rate was 49%; however, no deaths were directly related to the PM. Conclusions PM incidence is probably increased in the severe acute respiratory syndrome caused by COVID-19, especially in those with greater involvement of the lungs, and the Macklin effect may be an important underlying mechanism of this complication. Usually, PM has a benign course, but complications like tension/malignant PM may occur requiring prompt detection and intervention.

Mortality rates increase dramatically below a systolic blood pressure of 105-mm Hg in septic surgical patients

2016 ◽  
Vol 212 (5) ◽  
pp. 941-945 ◽  
Author(s):  
Damian L. Clarke ◽  
Jennifer A. Chipps ◽  
Benn Sartorius ◽  
John Bruce ◽  
Grant L. Laing ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Mortality Rates ◽  
Surgical Patients

scholarly journals Mild asthma: from paradoxes to therapy optimization

2018 ◽  
pp. 38-42
Author(s):  
R. S. Fassakhov
Keyword(s):  
Bronchial Asthma ◽  
Early Onset ◽  
Mild Asthma ◽  
Disease Course ◽  
Adherence To Treatment ◽  
Combination Drug ◽  
Promising Direction ◽  
Mild Disease ◽  
Combination Drugs ◽  
Beta 2

Exacerbations of bronchial asthma are specific not only for severe, but also for mild disease course. Analysis of the causes revealed paradoxes in the treatment that contribute to the uncontrolled course of mild asthma. A promising direction is the use of combination drugs containing a early-onset beta-2-agonist and inhaled glucocorticosteroid, which can significantly improve adherence to treatment and significantly improve control and reduce the number of exacerbations. The review discusses in detail the merits of the combination drug SabaComb, its place in the recommendations for the treatment of mild asthma.

scholarly journals Comorbidity in multiple sclerosis: Past, present and future

2019 ◽  
Vol 42 (1) ◽  
pp. E5-E12 ◽  
Author(s):  
Ruth Ann Marrie
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Chronic Disease ◽  
Disease Course ◽  
Comorbid Conditions ◽  
Therapeutic Approaches ◽  
Neurologic Diseases ◽  
New Therapeutic Approaches ◽  
Source Studies ◽  
The Central Nervous System

Purpose: Multiple sclerosis (MS) is an inflammatory and degenerative condition affecting the central nervous system. Like many neurologic diseases, it is chronic and incurable, and confers a substantial burden on affected individuals, their families and society. Although many individuals suffering from a serious chronic disease also suffer from comorbid conditions, the important consequences of their interaction often receive little attention. This was particularly true for MS two decades ago. Broadening our perspective by better understanding the effects of comorbidity on an individual with a particular chronic disease offers us an opportunity to improve understanding of prognosis, personalize disease management, develop new therapeutic approaches and illuminate the pathophysiology of disease. Source: Studies examining the incidence, prevalence and outcomes related to comorbidity in MS will be discussed, along with areas requiring further investigation. Conclusion: Comorbidity is highly prevalent in MS throughout the disease course. Comorbid conditions, including depression, anxiety, hypertension, hyperlipidemia, diabetes and chronic lung disease, adversely affect a broad range of outcomes. Less is known about the effects of MS on outcomes related to these comorbid conditions. These findings highlight an urgent need to determine how to best prevent and treat comorbidity in MS.

scholarly journals K18-hACE2 mice develop respiratory disease resembling severe COVID-19

2021 ◽  
Vol 17 (1) ◽  
pp. e1009195 ◽  
Author(s):  
Claude Kwe Yinda ◽  
Julia R. Port ◽  
Trenton Bushmaker ◽  
Irene Offei Owusu ◽  
Jyothi N. Purushotham ◽  
...  
Keyword(s):  
Animal Models ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Small Animal ◽  
Future Application ◽  
Rapid Weight Loss ◽  
Disease Course ◽  
Mild Disease ◽  
Disease Spectrum ◽  
Moderate Disease

SARS-CoV-2 emerged in late 2019 and resulted in the ongoing COVID-19 pandemic. Several animal models have been rapidly developed that recapitulate the asymptomatic to moderate disease spectrum. Now, there is a direct need for additional small animal models to study the pathogenesis of severe COVID-19 and for fast-tracked medical countermeasure development. Here, we show that transgenic mice expressing the human SARS-CoV-2 receptor (angiotensin-converting enzyme 2 [hACE2]) under a cytokeratin 18 promoter (K18) are susceptible to SARS-CoV-2 and that infection resulted in a dose-dependent lethal disease course. After inoculation with either 104 TCID50 or 105 TCID50, the SARS-CoV-2 infection resulted in rapid weight loss in both groups and uniform lethality in the 105 TCID50 group. High levels of viral RNA shedding were observed from the upper and lower respiratory tract and intermittent shedding was observed from the intestinal tract. Inoculation with SARS-CoV-2 resulted in upper and lower respiratory tract infection with high infectious virus titers in nasal turbinates, trachea and lungs. The observed interstitial pneumonia and pulmonary pathology, with SARS-CoV-2 replication evident in pneumocytes, were similar to that reported in severe cases of COVID-19. SARS-CoV-2 infection resulted in macrophage and lymphocyte infiltration in the lungs and upregulation of Th1 and proinflammatory cytokines/chemokines. Extrapulmonary replication of SARS-CoV-2 was observed in the cerebral cortex and hippocampus of several animals at 7 DPI but not at 3 DPI. The rapid inflammatory response and observed pathology bears resemblance to COVID-19. Additionally, we demonstrate that a mild disease course can be simulated by low dose infection with 102 TCID50 SARS-CoV-2, resulting in minimal clinical manifestation and near uniform survival. Taken together, these data support future application of this model to studies of pathogenesis and medical countermeasure development.

Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma

1990 ◽  
Vol 77 (6) ◽  
pp. 677-680 ◽  
Author(s):  
T. Matsumata ◽  
T. Kanematsu ◽  
K. Shirabe ◽  
T. Sonoda ◽  
T. Furuta ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Surgical Patients

scholarly journals Ethnic Disparities in Cervical Cancer Survival Among Medicare Eligible Women in a Multiethnic Population

2009 ◽  
Vol 19 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Ann L. Coker ◽  
Katherine S. Eggleston ◽  
Xianglin L. Du ◽  
Lois Ramondetta
Keyword(s):  
Cervical Cancer ◽  
Cancer Survival ◽  
Hispanic Women ◽  
Mortality Rates ◽  
Comorbid Conditions ◽  
Cancer Specific Survival ◽  
Medicare Data ◽  
Specific Mortality ◽  
Multiethnic Population ◽  
Cancer Specific Mortality

Objectives:To determine predictors of cervical cancer survival by socioeconomic status (SES), urbanization, race/ethnicity, comorbid conditions, and treatment among elderly Medicare-eligible women whose conditions were diagnosed with cervical cancer in a multiethnic population.Methods:A total of 538 women with cervical cancer aged 65 years or older were identified from 1999 to 2001 from the Texas Cancer Registry and were linked with the state Medicare data and Texas Vital Records to determine survival times. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of SES was created using census tract-level data as was urbanization. Treatment and comorbid conditions were available from the Medicare data. Cox proportional hazards modeling was used for all-cause and cervical cancer-specific survival analysis.Results:Increased age (P < 0.0001) and advanced tumor stage (P < 0.0001) were associated with poorer all-cause and cervical cancer-specific survival. Having a comorbid condition was associated with all-cause survival (P < 0.01) but not cervical cancer-specific mortality. After adjusting for confounders, women receiving some form of treatment were almost half as likely to die with cervical cancer (adjusted hazard ratio = 0.68; 95% confidence interval, 0.52-0.89). After adjustment for all confounders, Hispanic women consistently had lower all-cause and cervical cancer-specific mortality rates relative to non-Hispanic white and non-Hispanic black women.Conclusions:Among women with similar health care coverage, Hispanic women had consistently lower all-cause and cervical cancer-specific mortality rates than other older women whose conditions were diagnosed with this disease in Texas. The presence of comorbid conditions and treatment were important predictors of survival, yet these factors do not explain the survival advantage for Hispanic women.

scholarly journals Impact of chronic respiratory diseases on re-intubation rate in critically ill patients: a cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yanfei Shen ◽  
Weizhe Ru ◽  
Xinmei Huang ◽  
Shangzhong Chen ◽  
Jing Yan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Partial Pressure ◽  
Propensity Score Matching ◽  
Disease Severity ◽  
Respiratory Diseases ◽  
Mortality Rates ◽  
Carbon Dioxide Partial Pressure ◽  
Intubation Rate ◽  
Chronic Respiratory Diseases ◽  
Mild Disease

AbstractChronic respiratory diseases’ (CRDs) impact on re-intubation rate remains unclear. We investigated the association between these factors in mechanically ventilated patients. Data were extracted from the freely available online Medical Information Mart for Intensive Care III database. CRDs were defined according to ICD-9 codes. Generalised linear regression and propensity score matching were performed. Of 13,132 patients, 7.9% required re-intubation. Patients with chronic obstructive pulmonary disease (COPD) had higher re-intubation (OR 2.48, 95% CI 1.83–3.33) and mortality rates (OR 1.64, 95% CI 1.15–2.34) than those without. Patients with asthma had a lower mortality rate (OR 0.63, 95% CI 0.43–0.92) but a similar re-intubation rate to those of patients without. These findings remained stable after propensity score matching and bootstrapping analysis. The association of COPD with re-intubation was significantly stronger in patients with high oxygen-partial pressure (PaO2) or mild disease severity but was independent of carbon dioxide partial pressure. Corticosteroid use was associated with increased re-intubation rates in subgroups without CRDs (OR 1.77–1.99, p < 0.001) but not in subgroups with CRDs. COPD patients with high post-extubation PaO2 or mild disease severity should be carefully monitored as they have higher re-intubation and mortality rates.

scholarly journals Cell type-specific immune dysregulation in severely ill COVID-19 patients

2020 ◽  
Author(s):  
Changfu Yao ◽  
Stephanie A Bora ◽  
Tanyalak Parimon ◽  
Tanzira Zaman ◽  
Oren A Friedman ◽  
...  
Keyword(s):  
Immune Response ◽  
Cell Activation ◽  
Mononuclear Cells ◽  
Severe Disease ◽  
Ventilatory Support ◽  
Adaptive Immune Response ◽  
Disease Course ◽  
B Cell Activation ◽  
Peripheral Blood Mononuclear ◽  
Mild Disease

Coronavirus disease 2019 (COVID-19) has quickly become the most serious pandemic since the 1918 flu pandemic. In extreme situations, patients develop a dysregulated inflammatory lung injury called acute respiratory distress syndrome (ARDS) that causes progressive respiratory failure requiring mechanical ventilatory support. Recent studies have demonstrated immunologic dysfunction in severely ill COVID-19 patients. To further delineate the dysregulated immune response driving more severe clinical course from SARS-CoV-2 infection, we used single-cell RNA sequencing (scRNAseq) to analyze the transcriptome of peripheral blood mononuclear cells (PBMC) from hospitalized COVID-19 patients having mild disease (n = 5), developing ARDS (n = 6), and recovering from ARDS (n = 6). Our data demonstrated an overwhelming inflammatory response with select immunodeficiencies within various immune populations in ARDS patients. Specifically, their monocytes had defects in antigen presentation and deficiencies in interferon responsiveness that contrasted the higher interferon signals in lymphocytes. Furthermore, cytotoxic activity was suppressed in both NK and CD8 lymphocytes whereas B cell activation was deficient, which is consistent with the delayed viral clearance in severely ill COVID-19 patients. Finally, we identified altered signaling pathways in the severe group that suggests immunosenescence and immunometabolic changes could be contributing to the dysfunctional immune response. Our study demonstrates that COVID-19 patients with ARDS have an immunologically distinct response when compared to those with a more innocuous disease course and show a state of immune imbalance in which deficiencies in both the innate and adaptive immune response may be contributing to a more severe disease course in COVID-19.

scholarly journals CD8+ T cells specific for conserved coronavirus epitopes correlate with milder disease in COVID-19 patients

2021 ◽  
Vol 6 (61) ◽  
pp. eabg5669
Author(s):  
Vamsee Mallajosyula ◽  
Conner Ganjavi ◽  
Saborni Chakraborty ◽  
Alana M. McSween ◽  
Ana Jimena Pavlovitch-Bedzyk ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Cd8 T Cells ◽  
Protective Role ◽  
Severe Illness ◽  
Central Feature ◽  
Disease Course ◽  
Mild Disease ◽  
Cell Staining ◽  
Mhc Tetramers

A central feature of the SARS-CoV-2 pandemic is that some individuals become severely ill or die, whereas others have only a mild disease course or are asymptomatic. Here we report development of an improved multimeric αβ T cell staining reagent platform, with each maxi-ferritin “spheromer” displaying 12 peptide-MHC complexes. Spheromers stain specific T cells more efficiently than peptide-MHC tetramers and capture a broader portion of the sequence repertoire for a given peptide-MHC. Analyzing the response in unexposed individuals, we find that T cells recognizing peptides conserved amongst coronaviruses are more abundant and tend to have a “memory” phenotype, compared to those unique to SARS-CoV-2. Significantly, CD8+ T cells with these conserved specificities are much more abundant in COVID-19 patients with mild disease versus those with a more severe illness, suggesting a protective role.

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