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IMPACT OF COMORBIDITIES IN MEXICAN SARS-COV-2-POSITIVE PATIENTS: A RETROSPECTIVE ANALYSIS IN A NATIONAL COHORT.
Kammar-García, A, Vidal-Mayo, JJ, Vera-Zertuche, JM, Lazcano-Hernández, M, Vera-López, O, Segura-Badilla, O, Aguilar-Alonso, P, Navarro-Cruz, AR
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion. 2020;(3):151-158
Abstract
BACKGROUND The coronavirus disease 2019 outbreak is a significant challenge for health-care systems around the world. OBJECTIVE The objective of the study was to assess the impact of comorbidities on the case fatality rate (CFR) and the development of adverse events in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Mexican population. MATERIALS AND METHODS We analyzed the data from 13,842 laboratory-confirmed SARS-CoV-2 patients in Mexico between January 1, 2020, and April 25, 2020. We investigated the risk of death and the development of adverse events (hospitalization, pneumonia, orotracheal intubation, and intensive care unit [ICU] admission), comparing the number of comorbidities of each patient. RESULTS The patient mean age was 46.6 ± 15.6 years, 42.3% (n = 5853) of the cases were women, 38.8% of patients were hospitalized, 4.4% were intubated, 29.6% developed pneumonia, and 4.4% had critical illness. The CFR was 9.4%. The risk of hospitalization (odds ratio [OR] = 3.1, 95% confidence interval [CI]: 2.7-3.7), pneumonia (OR = 3.02, 95% CI: 2.6-3.5), ICU admission (OR = 2, 95% CI: 1.5-2.7), and CFR (hazard ratio = 3.5, 95% CI: 2.9-4.2) was higher in patients with three or more comorbidities than in patients with 1, 2, or with no comorbidities. CONCLUSIONS The number of comorbidities may be a determining factor in the clinical course and its outcomes in SARS-CoV-2-positive patients.
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Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia.
Zieleskiewicz, L, Markarian, T, Lopez, A, Taguet, C, Mohammedi, N, Boucekine, M, Baumstarck, K, Besch, G, Mathon, G, Duclos, G, et al
Intensive care medicine. 2020;(9):1707-1713
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Abstract
PURPOSE The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO2)/fractional inspired oxygen (FiO2) ratio. METHODS A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. RESULTS One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357. CONCLUSION In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.
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Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19.
Cavalcanti, AB, Zampieri, FG, Rosa, RG, Azevedo, LCP, Veiga, VC, Avezum, A, Damiani, LP, Marcadenti, A, Kawano-Dourado, L, Lisboa, T, et al
The New England journal of medicine. 2020;(21):2041-2052
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BACKGROUND Hydroxychloroquine and azithromycin have been used to treat patients with coronavirus disease 2019 (Covid-19). However, evidence on the safety and efficacy of these therapies is limited. METHODS We conducted a multicenter, randomized, open-label, three-group, controlled trial involving hospitalized patients with suspected or confirmed Covid-19 who were receiving either no supplemental oxygen or a maximum of 4 liters per minute of supplemental oxygen. Patients were randomly assigned in a 1:1:1 ratio to receive standard care, standard care plus hydroxychloroquine at a dose of 400 mg twice daily, or standard care plus hydroxychloroquine at a dose of 400 mg twice daily plus azithromycin at a dose of 500 mg once daily for 7 days. The primary outcome was clinical status at 15 days as assessed with the use of a seven-level ordinal scale (with levels ranging from one to seven and higher scores indicating a worse condition) in the modified intention-to-treat population (patients with a confirmed diagnosis of Covid-19). Safety was also assessed. RESULTS A total of 667 patients underwent randomization; 504 patients had confirmed Covid-19 and were included in the modified intention-to-treat analysis. As compared with standard care, the proportional odds of having a higher score on the seven-point ordinal scale at 15 days was not affected by either hydroxychloroquine alone (odds ratio, 1.21; 95% confidence interval [CI], 0.69 to 2.11; P = 1.00) or hydroxychloroquine plus azithromycin (odds ratio, 0.99; 95% CI, 0.57 to 1.73; P = 1.00). Prolongation of the corrected QT interval and elevation of liver-enzyme levels were more frequent in patients receiving hydroxychloroquine, alone or with azithromycin, than in those who were not receiving either agent. CONCLUSIONS Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care. (Funded by the Coalition Covid-19 Brazil and EMS Pharma; ClinicalTrials.gov number, NCT04322123.).
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Covid-19 and the role of smoking: the protocol of the multicentric prospective study COSMO-IT (COvid19 and SMOking in ITaly).
Cattaruzza, MS, Gorini, G, Bosetti, C, Boffi, R, Lugo, A, Veronese, C, Carreras, G, Santucci, C, Stival, C, Pacifici, R, et al
Acta bio-medica : Atenei Parmensis. 2020;(3):e2020062
Abstract
The emergency caused by Covid-19 pandemic raised interest in studying lifestyles and comorbidities as important determinants of poor Covid-19 prognosis. Data on tobacco smoking, alcohol consumption and obesity are still limited, while no data are available on the role of e-cigarettes and heated tobacco products (HTP). To clarify the role of tobacco smoking and other lifestyle habits on COVID-19 severity and progression, we designed a longitudinal observational study titled COvid19 and SMOking in ITaly (COSMO-IT). About 30 Italian hospitals in North, Centre and South of Italy joined the study. Its main aims are: 1) to quantify the role of tobacco smoking and smoking cessation on the severity and progression of COVID-19 in hospitalized patients; 2) to compare smoking prevalence and severity of the disease in relation to smoking in hospitalized COVID-19 patients versus patients treated at home; 3) to quantify the association between other lifestyle factors, such as e-cigarette and HTP use, alcohol and obesity and the risk of unfavourable COVID-19 outcomes. Socio-demographic, lifestyle and medical history information will be gathered for around 3000 hospitalized and 700-1000 home-isolated, laboratory-confirmed, COVID-19 patients. Given the current absence of a vaccine against SARS-COV-2 and the lack of a specific treatment for -COVID-19, prevention strategies are of extreme importance. This project, designed to highly contribute to the international scientific debate on the role of avoidable lifestyle habits on COVID-19 severity, will provide valuable epidemiological data in order to support important recommendations to prevent COVID-19 incidence, progression and mortality.