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[This corrects the article DOI: 10.1371/journal.pone.0245772.].
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Dexamethasone implementation for COVID-19 management represented a milestone but data regarding its impact and safety have not been consistently reproduced. We aimed to evaluate in-hospital mortality before and after the implementation of corticosteroid treatment (CS-T) for severe and critical COVID-19. We conducted a cohort study that included patients admitted with severe and critical COVID-19. The primary outcome was death during hospitalization. Secondary outcomes included the length of stay (LOS), need for invasive mechanical ventilation (IMV), time to IMV initiation, IMV duration, and development of hospital-acquired infections (HAIs). Bivariate, multivariate, and propensity-score matching analysis were performed. Among 1540 patients, 688 (45%) received CS-T. Death was less frequent in the CS-T group (18 vs 31%, p < .01). Among patients on IMV, death was also less frequent in the CS-T group (25 vs 55%, p < .01). The median time to IMV was longer in the CS-T group (5 vs 3 days, p < .01). HAIs occurred more frequently in the CS-T group (20 vs 10%, p < .01). LOS, IMV, and IMV duration were similar between groups. Multivariate analysis revealed an independent association between CS-T and lower mortality (aOR 0.26, 95% CI 0.19-0.36, p < .001). Propensity-score matching analysis revealed that CS-T was independently associated with lower mortality (aOR 0.33, 95% CI 0.22-0.50, p < .01). Treatment with corticosteroids was associated with reduced in-hospital mortality among patients with severe and critical COVID-19, including those on IMV.
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Tratamiento Farmacológico de COVID-19 , COVID-19/virología , Dexametasona/uso terapéutico , SARS-CoV-2/efectos de los fármacos , Anciano , COVID-19/diagnóstico , COVID-19/epidemiología , Toma de Decisiones Clínicas , Comorbilidad , Enfermedad Crítica , Dexametasona/administración & dosificación , Manejo de la Enfermedad , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
El brote mundial del SARS-CoV-2, descrito a partir del 2019, provocó la pandemia de COVID-19, originando un riesgo para la salud de las personas, una amenaza a la vida y una emergencia de salud pública internacional, que hasta Julio del 2021 no se ha logrado controlar. La coinfección en estos pacientes, por virus, bacterias y hongos, aumenta la dificultad de diagnóstico, tratamiento y pronóstico de la enfermedad. Es importante profundizar los conocimientos sobre el virus SARS-CoV-2 y las coinfecciones que podrían presentarse, en particular, en pacientes con COVID-19 que presentan micosis. El objetivo de esta revisión bibliográfica es, determinar la importancia de las micosis, como enfermedad oportunista, en pacientes con COVID-19. Se realizó una revisión bibliográfica sistemática, en la base de datos "PubMed-NCBI". Se utilizaron las palabras claves: "COVID-19", "SARS-CoV-2", "Coronavirus", "COVID-19 and coinfection", "Mycosis", "Aspergillus spp.", "Candida spp.", "COVID-19 and Aspergillus spp.", "COVID-19 and Candida spp.". Del análisis de la bibliografía, se concluye la importancia de las micosis respiratorias, originadas por diversos hongos en pacientes con COVID-19. Hay poca información del manejo de estas, siendo necesario fortalecer la investigación de la coinfección, para así, mejorar los flujogramas de sospecha clínica, contribuyendo a diagnósticos, tratamientos precisos y fomentar la prevención frente a esta pandemia.
The global outbreak of SARS-CoV-2, described as of 2019 whose expansion caused the COVID-19 pandemic, has created a risk to people's health, presenting itself as a threat to life and an international public health emergency, which to the date cannot be controlled. Coinfection in these patients, by viruses, bacteria and fungi, increases the difficulty of diagnosis, treatment and prognosis of the disease. It's important to deepen the knowledge about the SARS-CoV-2 virus and the co-infections that could occur, in particular, in patients with COVID-19 who present with mycosis. The objective of this bibliographic review is to determine the importance of mycosis, as an opportunistic disease, in patients affected by SARS-CoV-2. A systematic bibliographic review was carried out in the "PubMed-NCBI" database, using the keywords and / or headings: "COVID-19", "SARS-CoV-2", "Coronavirus", "COVID-19 and coinfection" ,"Mycosis", "Aspergillus spp.", "Candida spp." COVID-19 and Aspergillus spp.", "COVID-19 and Candida spp.". From the analysis of the literature, one can conclude the importance of respiratory mycoses, caused by various fungal pathogens in patients with COVID-19. The disease was described in 2019 and there is few a information on cases and their management, making it necessary to strengthen the investigation of coinfection in these patients, in order to improve the flow charts of clinical suspicion, contributing to diagnoses, accurate treatments and promoting prevention against to this pandemic.
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Aspergillus , Candida , Coinfección , SARS-CoV-2 , Tolerancia InmunológicaRESUMEN
BACKGROUND: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has remained in Latin America, Mexico has become the third country with the highest death rate worldwide. Data regarding in-hospital mortality and its risk factors, as well as the impact of hospital overcrowding in Latin America has not been thoroughly explored. METHODS AND FINDINGS: In this prospective cohort study, we enrolled consecutive adult patients hospitalized with severe confirmed COVID-19 pneumonia at a SARS-CoV-2 referral center in Mexico City from February 26th, 2020, to June 5th, 2020. A total of 800 patients were admitted with confirmed diagnosis, mean age was 51.9 ± 13.9 years, 61% were males, 85% were either obese or overweight, 30% had hypertension and 26% type 2 diabetes. From those 800, 559 recovered (69.9%) and 241 died (30.1%). Among survivors, 101 (18%) received invasive mechanical ventilation (IMV) and 458 (82%) were managed outside the intensive care unit (ICU); mortality in the ICU was 49%. From the non-survivors, 45.6% (n = 110) did not receive full support due to lack of ICU bed availability. Within this subgroup the main cause of death was acute respiratory distress syndrome (ARDS) in 95% of the cases, whereas among the non-survivors who received full (n = 105) support the main cause of death was septic shock (45%) followed by ARDS (29%). The main risk factors associated with in-hospital death were male sex (RR 2.05, 95% CI 1.34-3.12), obesity (RR 1.62, 95% CI 1.14-2.32)-in particular morbid obesity (RR 3.38, 95%CI 1.63-7.00)-and oxygen saturation < 80% on admission (RR 4.8, 95%CI 3.26-7.31). CONCLUSIONS: In this study we found similar in-hospital and ICU mortality, as well as risk factors for mortality, compared to previous reports. However, 45% of the patients who did not survive justified admission to ICU but did not receive IMV / ICU care due to the unavailability of ICU beds. Furthermore, mortality rate over time was mainly due to the availability of ICU beds, indirectly suggesting that overcrowding was one of the main factors that contributed to hospital mortality.
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Ocupación de Camas/estadística & datos numéricos , COVID-19/patología , Mortalidad Hospitalaria , Anciano , COVID-19/complicaciones , COVID-19/mortalidad , COVID-19/virología , Causas de Muerte , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , México , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/patología , Estudios Prospectivos , Respiración Artificial , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/mortalidad , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Choque Séptico/diagnóstico , Choque Séptico/etiología , Choque Séptico/mortalidad , Centros de Atención TerciariaRESUMEN
OBJECTIVE: Sarcopenia has been related to negative outcomes in different clinical scenarios from critical illness to chronic conditions. The aim of this study was to verify whether there was an association between low skeletal muscle index and in-hospital mortality, intensive care unit admission, and invasive mechanical ventilation need in hospitalized patients with COVID-19. DESIGN: This was a retrospective cohort study of a referral center for COVID-19. We included all consecutive patients admitted to the hospital between February 26 and May 15, 2020, with a confirmed diagnosis of COVID-19. Skeletal muscle index was assessed from a transverse computed tomography image at the level of twelfth thoracic vertebra with National Institutes of Health ImageJ software, and statistical analysis was performed to find an association between skeletal muscle index and in-hospital mortality, need of invasive mechanical ventilation, and intensive care unit admission. RESULTS: We included 519 patients, the median age was 51 (42-61) yrs, and 115 patients (22%) had low skeletal muscle index. On multivariable analysis, skeletal muscle index was not associated with mortality, intensive care unit admission, or invasive mechanical ventilation need nor in a subanalysis of patients 65 yrs or older. CONCLUSIONS: Skeletal muscle index determined by computed tomography at the level of twelfth thoracic vertebra was not associated with negative outcomes in hospitalized patients with COVID-19.
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COVID-19/mortalidad , COVID-19/terapia , Sarcopenia/complicaciones , Adulto , Anciano , COVID-19/complicaciones , Cuidados Críticos , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético , Evaluación de Resultado en la Atención de Salud , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , Sarcopenia/diagnóstico , Sarcopenia/mortalidad , Tomografía Computarizada por Rayos XRESUMEN
Most children with autism spectrum disorder (ASD), in resource-limited settings (RLS), are diagnosed after the age of four. Our work confirmed and extended results of Pierce that eye tracking could discriminate between typically developing (TD) children and those with ASD. We demonstrated the initial 15 s was at least as discriminating as the entire video. We evaluated the GP-MCHAT-R, which combines the first 15 s of manually-coded gaze preference (GP) video with M-CHAT-R results on 73 TD children and 28 children with ASD, 36-99 months of age. The GP-MCHAT-R (AUC = 0.89 (95%CI: 0.82-0.95)), performed significantly better than the MCHAT-R (AUC = 0.78 (95%CI: 0.71-0.85)) and gaze preference (AUC = 0.76 (95%CI: 0.64-0.88)) alone. This tool may enable early screening for ASD in RLS.
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Trastorno del Espectro Autista/diagnóstico , Lista de Verificación/métodos , Tecnología de Seguimiento Ocular , Fijación Ocular/fisiología , Recursos en Salud , Tamizaje Masivo/métodos , Trastorno del Espectro Autista/epidemiología , Trastorno del Espectro Autista/fisiopatología , Lista de Verificación/normas , Niño , Preescolar , Tecnología de Seguimiento Ocular/normas , Femenino , Recursos en Salud/normas , Humanos , Masculino , Tamizaje Masivo/normas , Perú/epidemiologíaRESUMEN
Oncocytic lesions may be metaplastic, hyperplastic, or neoplastic and occur in a variety of tissues, including those of the ocular adnexa. Oncocytes are enlarged epithelial cells with abundant eosinophilic granules in the cytoplasm, which represent large mitochondria with distorted cristae. The causes of oncocytic lesions remain uncertain, although in some sites such as the lacrimal sac, chronic inflammation may be a factor. Oncocytic neoplasms in all adnexal sites are generally benign (oncocytoma/oncocytic adenoma) and oncocytic adenocarcinomas are uncommon. Research into oncocytic neoplasms, particularly of the kidney and thyroid, has shed some light on the complicated genomic and metabolic changes that are associated with mitochondrial dysfunction in such neoplasms. The major driver event is mutation of mitochondrial DNA-encoding subunits of complex I in the respiratory chain. The subsequent metabolic events may promote tumorigenesis and inhibit malignant transformation. This review discusses the histopathology and histogenesis of two examples of oncocytoma in the ocular adnexa and presents a simplified synopsis of the genomic and metabolic changes that are significant in the pathogenesis of these neoplasms.
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RESUMEN La crisis sanitaria mundial que enfrenta el mundo debido al COVID-19 tiene como característica principal que afecta la población más vulnerable. La principal vía de contagio de esta enfermedad es la transmisión aérea debido al contacto social. Los países adoptaron una serie de intervenciones focalizadas para mitigar las consecuencias derivadas de esta pandemia e impactar significativamente en el bienestar de las personas. No obstante, se deben fortalecer acciones que favorezcan la capacidad resolutiva en el primer nivel de atención, especialmente, en poblaciones de alta vulnerabilidad, entre ellas, las personas en situación de discapacidad, cuyas circunstancias tienden a complicarse. La rehabilitación basada en comunidad ha sido una estrategia de gran impacto social que integra una serie de factores tanto individuales como colectivos. La eficacia y efectividad de la participación intersectorial, comunitaria y de los Gobiernos locales, así como la gestión de los diferentes agentes comunitarios para darle continuidad a los procesos de atención en salud son pertinentes para amortiguar situaciones de alta complejidad que alteran, en mayor medida, el bienestar de todas las personas. Además, contribuyen a potencializar acciones para gestionar el sistema de salud.
ABSTRACT As main feature, the global health crisis due to COVID-19 affects the most vulnerable groups of people. The main way of contagion of this disease is the airway transmission by social contact. Countries take steps to reduce the consequences of the pandemic and significantly improve the well-being of the people. However, they must boost measurements to support the capacity to resolve situations at the first level of assistance, mainly for the people that are so vulnerable: persons with disabilities, that get everyday worse. The Community Based Rehabilitation has been a strategy that group together collective and individual factors. The effectiveness and efficacy of the involvement of different groups, community, and local government, as well as management of the different community agents to give continuity to the health care processes, they are relevant to mitigate problems that affect, to a greater extent, the well-being of people. Besides, they strengthen actions to manage the health system.
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As main feature, the global health crisis due to COVID-19 affects the most vulnerable groups of people. The main way of contagion of this disease is the airway transmission by social contact. Countries take steps to reduce the consequences of the pandemic and significantly improve the well-being of the people. However, they must boost measurements to support the capacity to resolve situations at the first level of assistance, mainly for the people that are so vulnerable: persons with disabilities, that get everyday worse. The Community Based Rehabilitation has been a strategy that group together collective and individual factors. The effectiveness and efficacy of the involvement of different groups, community, and local government, as well as management of the different community agents to give continuity to the health care processes, they are relevant to mitigate problems that affect, to a greater extent, the well-being of people. Besides, they strengthen actions to manage the health system.
La crisis sanitaria mundial que enfrenta el mundo debido al COVID-19 tiene como característica principal que afecta la población más vulnerable. La principal vía de contagio de esta enfermedad es la transmisión aérea debido al contacto social. Los países adoptaron una serie de intervenciones focalizadas para mitigar las consecuencias derivadas de esta pandemia e impactar significativamente en el bienestar de las personas. No obstante, se deben fortalecer acciones que favorezcan la capacidad resolutiva en el primer nivel de atención, especialmente, en poblaciones de alta vulnerabilidad, entre ellas, las personas en situación de discapacidad, cuyas circunstancias tienden a complicarse. La rehabilitación basada en comunidad ha sido una estrategia de gran impacto social que integra una serie de factores tanto individuales como colectivos. La eficacia y efectividad de la participación intersectorial, comunitaria y de los Gobiernos locales, así como la gestión de los diferentes agentes comunitarios para darle continuidad a los procesos de atención en salud son pertinentes para amortiguar situaciones de alta complejidad que alteran, en mayor medida, el bienestar de todas las personas. Además, contribuyen a potencializar acciones para gestionar el sistema de salud.
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COVID-19 , Personas con Discapacidad , Humanos , Personas con Discapacidad/rehabilitación , Salud GlobalAsunto(s)
Neoplasias del Ojo/diagnóstico , Transportador de Glucosa de Tipo 1/sangre , Hemangioma Capilar/diagnóstico , Administración Oral , Antagonistas Adrenérgicos beta/administración & dosificación , Biomarcadores de Tumor/sangre , Neoplasias del Ojo/sangre , Neoplasias del Ojo/tratamiento farmacológico , Femenino , Hemangioma Capilar/sangre , Hemangioma Capilar/tratamiento farmacológico , Humanos , Inmunohistoquímica , Recién Nacido , Imagen por Resonancia Magnética , Órbita/diagnóstico por imagen , Propranolol/administración & dosificación , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Orbital exenteration is a disfiguring procedure reserved for life-threatening malignancies. This study examines the clinical course and outcomes of a large series of patients who underwent orbital exenteration for malignant periocular neoplasms. METHODS: This is a retrospective review of patients who underwent orbital exenteration from 1 July 2005 to 30 June 2015 at four tertiary referral centres in the USA, Australia and Canada. Demographics, indication for surgery, pathology, surgical technique, reconstruction type and outcomes were reviewed. RESULTS: Orbital exenteration was performed on 102 patients. The mean age at surgery was 67.5 years. The most common malignant tumours encountered were squamous cell carcinoma, melanoma and basal cell carcinoma. Seventy-six patients (75%) underwent reconstruction with a local myocutaneous flap, twelve with partial-thickness skin grafts (PTSG), or split skin graft, two had a free flap, and one had a dermis fat graft. Sixteen patients had combined procedures of two of the above. Complete removal of the tumour was achieved with clear margins in 81 cases. Of all patients, 72% were alive at 48 months or more. CONCLUSION: The majority of orbital exenterations performed in this series were secondary to periocular malignancies with unsuccessful/insufficient previous treatments. Regional myocutaneous flaps, PTSG, full-thickness skin grafts and dermis fat grafts were all highly effective and durable reconstructive options, and were able to withstand radiation therapy without complications.
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Evisceración Orbitaria/métodos , Neoplasias Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Humanos , Melanoma/cirugía , Estudios Retrospectivos , Colgajos QuirúrgicosAsunto(s)
Cuerpos Extraños en el Ojo/cirugía , Lesiones Oculares Penetrantes/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Órbita/lesiones , Juego e Implementos de Juego/lesiones , Heridas por Arma de Fuego/cirugía , Adolescente , Cuerpos Extraños en el Ojo/diagnóstico , Lesiones Oculares Penetrantes/diagnóstico , Humanos , Masculino , Órbita/diagnóstico por imagen , Órbita/cirugía , Tomografía Computarizada por Rayos X , Ultrasonografía , Heridas por Arma de Fuego/diagnósticoRESUMEN
This article evaluates malignant transformation of lesions presenting in the periocular skin under the eye spectacle nose pad. A non-comparative retrospective chart review of clinical features and pathological findings of patients presenting with periocular malignancies in the exact vicinity where the nose pads of their eye spectacles rested was completed. The study took place in one tertiary oculoplastic referral center between 2007-2013. Ten patients were included, six of whom were male. All subjects wore eye spectacles while awake for at least 15 years, and had an evident suspicious lesion in the exact area that coincided with the resting place of the nose pad. The mean age was 73.5 years (range 65-85 years) and all patients had the lesion present for at least one year. Most cases were squamous skin malignancies (five squamous cell carcinomas [SCC], 2 intra-epidermal carcinomas [IEC], while 3 basal cell carcinomas [BCC]). Treatment involved surgical excision of the lesion with frozen section for margin control and reconstruction with a myocutaneous flap. Periocular malignancies of the inferior medial canthal area, where the nose pad of eye spectacle places pressure, can be easily missed or misdiagnosed. Marjolin ulcers (MU) classically present as an aggressive SCC in area of chronic inflammation, which has been previously correlated to constant pressure, repetitive trauma, or non-healing wounds in other areas of the body. We propose that the traumatic chronic pressure in the infero-medial canthal region from long-term eye spectacle nose pad use, may induce poor lymphatic regeneration leading to an immune system deficiency that predisposes this skin to a malignant transformation. The presence of chronic eye spectacle nose pads also prevents proper and timely detection of such malignancies. Complete excision of these lesions with margin control, adequate follow-up for possible recurrence, and surveillance for new lesions on the patient's contralateral side, is crucial for adequate management.
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Carcinoma in Situ/etiología , Carcinoma Basocelular/etiología , Carcinoma de Células Escamosas/etiología , Anteojos/efectos adversos , Neoplasias Cutáneas/etiología , Anciano , Anciano de 80 o más Años , Carcinoma in Situ/patología , Carcinoma in Situ/cirugía , Carcinoma Basocelular/patología , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Masculino , Nariz , Estudios Retrospectivos , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaAsunto(s)
Adenoma Pleomórfico/cirugía , Médula Ósea/patología , Neoplasias del Ojo/cirugía , Hiperostosis Frontal Interna/etiología , Enfermedades del Aparato Lagrimal/cirugía , Complicaciones Posoperatorias , Adenoma Pleomórfico/patología , Neoplasias del Ojo/patología , Humanos , Hiperostosis Frontal Interna/diagnóstico , Hipertrofia/etiología , Enfermedades del Aparato Lagrimal/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Procedimientos Quirúrgicos OftalmológicosRESUMEN
Apocrine hidrocystomas are benign cystic lesions derived from the sweat glands of Moll and seldom found in the orbit. The authors present a case of a 41-year-old healthy man, with no prior medical history, referred for a painless enlarging mass, medial to his right upper eyelid for the past 3 months. Computed tomography showed a well-defined cystic lesion localized in the supero-medial anterior orbit. Following complete excision of the lesion, histopathology revealed an apocrine hidrocystoma. Although rare, apocrine hidrocystomas should be considered in the differential diagnosis for cystic mass of the orbit at any age group.
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Glándulas Apocrinas/patología , Hidrocistoma/diagnóstico , Hidrocistoma/cirugía , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/cirugía , Neoplasias de las Glándulas Sudoríparas/diagnóstico , Neoplasias de las Glándulas Sudoríparas/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Fibrosarcoma is a rare and malignant spindle cell tumor of mesenchymal origin that infrequently presents in the orbit. Evolving diagnostic criteria confound the identification of these tumors, as well as the interpretation of previous studies on this unusual entity. We report a case of a 66-year-old man with a mass on his left inferior orbit, with associated paresthesia. A computed tomography (CT) scan showed a lesion on the left anteroinferomedial orbit, with bone erosion. An en bloc surgical excision followed by a thorough immunohistologic evaluation allowed diagnosis of an orbital fibrosarcoma. The patient has had no recurrence after 14 months of follow up. Once a commonly identified soft tissue malignancy, fibrosarcoma has become a diagnosis of exclusion as a result of improved diagnostic and classification techniques, such as immunohistochemistry and fluorescence in situ hybridization (FISH). This type of soft tissue tumor is now an uncommon entity, and we report the first case of a primary orbital fibrosarcoma in an adult, using modern diagnostic and classification methods.
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Isolated sphenoid sinus disease is a rare entity with severe and potentially life threatening sequela. Because of the proximity of the sinus to the orbit, anatomical defects within the surrounding bony structures can facilitate communication with orbital content, predisposing the patient to substantial visual consequences. We report a case of a 51-year-old immunocompromised male who presented with headache and gradual unilateral decreases in vision. Computed tomography revealed opacification of the left sphenoid sinus accompanied by unusual bony dehiscence of the proximal optic canal. Early recognition and treatment of sphenoid sinusitis requires urgent surgical intervention with delay of treatment potentially leading to irreversible blindness or other devastating consequences. Bony dehiscence of the sphenoid sinus overlying the optic nerve has only been found in 4% of cadavers. It is associated with increased risk of orbital complications and predicts a poor prognosis. Immediate intervention is particularly important in immunocompromised individuals who are at greater risk of these severe complications.