The Stanford Hall consensus statement for post-COVID-19 rehabilitation

British Journal of Sports Medicine, Год журнала: 2020, Номер 54(16), С. 949 - 959

Опубликована: Май 31, 2020

The highly infectious and pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2, has emerged causing a global pandemic. Although COVID-19 predominantly affects the system, evidence indicates multisystem disease which is frequently often results in death. Long-term sequelae of are unknown, but from previous CoV outbreaks demonstrates impaired pulmonary physical function, reduced quality life emotional distress. Many survivors who require critical care may develop psychological, cognitive impairments. There clear need for guidance on rehabilitation survivors. This consensus statement was developed by an expert panel fields rehabilitation, sport exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology specialist pain, working at Defence Medical Rehabilitation Centre, Stanford Hall, UK. Seven teams appraised following domains relating to requirements: pulmonary, cardiac, SEM, musculoskeletal, neurorehabilitation medical. A chair combined recommendations generated within teams. writing committee prepared accordance with appraisal guidelines research evaluation criteria, grading all levels evidence. Authors scored their level agreement each recommendation scale 0–10. Substantial (range 7.5–10) reached 36 chaired meeting that attended authors. provides overarching framework assimilating likely requirements multidisciplinary post illness, target population active individuals, including military personnel athletes.

Язык: Английский

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The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy

European Journal of Endocrinology, Год журнала: 2021, Номер 185(4), С. G43 - G67

Опубликована: Июль 23, 2021

Graves' orbitopathy (GO) is the main extrathyroidal manifestation of disease (GD). Choice treatment should be based on assessment clinical activity and severity GO. Early referral to specialized centers fundamental for most patients with Risk factors include smoking, thyroid dysfunction, high serum level thyrotropin receptor antibodies, radioactive iodine (RAI) treatment, hypercholesterolemia. In mild active GO, control risk factors, local treatments, selenium (selenium-deficient areas) are usually sufficient; if RAI selected manage GD, low-dose oral prednisone prophylaxis needed, especially coexist. For both moderate-to-severe sight-threatening antithyroid drugs preferred when managing hyperthyroidism. GO i.v. glucocorticoids more effective better tolerated than glucocorticoids. Based current evidence efficacy/safety profile, costs reimbursement, drug availability, long-term effectiveness, patient choice after extensive counseling, a combination methylprednisolone mycophenolate sodium recommended as first-line treatment. A cumulative dose 4.5 g in 12 weekly infusions optimal regimen. Alternatively, higher doses not exceeding 8 can used monotherapy severe cases constant/inconstant diplopia. Second-line treatments (a) second course (7.5 g) subsequent careful ophthalmic biochemical evaluation, (b) prednisone/prednisolone combined either cyclosporine or azathioprine; (c) orbital radiotherapy glucocorticoids, (d) teprotumumab; (e) rituximab (f) tocilizumab. Sight-threatening treated several single per week and, unresponsive, urgent decompression. Rehabilitative surgery (orbital decompression, squint, eyelid surgery) indicated inactive residual manifestations.

Язык: Английский

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Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico

The Journal of Clinical Endocrinology & Metabolism, Год журнала: 2020, Номер 105(8), С. 2752 - 2761

Опубликована: Май 31, 2020

Abstract Background The SARS-CoV-2 outbreak poses a challenge to health care systems due its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose clinical score predict COVID-19 lethality, including specific for diabetes obesity, role improving prediction. Methods We obtained data of confirmed negative cases their demographic characteristics from the General Directorate Epidemiology Mexican Ministry Health. investigated associated positivity mortality explored impact obesity on modifying COVID-19-related lethality. Finally, built Results Among 177 133 subjects at time writing this report (May 18, 2020), observed 51 633 5,332 deaths. Risk lethality include early-onset diabetes, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, kidney disease (CKD); that mediates 49.5% effect Early-onset conferred an increased hospitalization intensive unit admission intubation. Our predictive included age ≥ 65 years, < 40 CKD, immunosuppression significantly discriminates lethal non-lethal (C-statistic = 0.823). Conclusions mechanistic approach evaluate complications attributable COVID-19, considering Mexico. offers tool quick determination high-risk susceptibility first-contact scenario.

Язык: Английский

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Coronavirus Disease (COVID-19): Comprehensive Review of Clinical Presentation

Frontiers in Public Health, Год журнала: 2021, Номер 8

Опубликована: Янв. 15, 2021

COVID-19 is a rapidly growing pandemic with its first case identified during December 2019 in Wuhan, Hubei Province, China. Due to the rampant rise number of cases China and globally, WHO declared as on 11th March 2020. The disease transmitted via respiratory droplets infected patients coughing or sneezing affects primarily lung parenchyma. spectrum clinical manifestations can be seen ranging from asymptomatic infections severe resulting mortality. Although involvement most common patients, virus affect other organ systems well. systemic inflammation induced by along multisystem expression Angiotensin Converting Enzyme 2 (ACE2), receptor which allows viral entry into cells, explains manifestation extra-pulmonary symptoms affecting gastrointestinal, cardiovascular, hematological, renal, musculoskeletal, endocrine system. Here, we have reviewed extensive literature available about various presentations based system involved well presentation specific population including children, pregnant women, immunocompromised patients. We also briefly discussed Multisystemic Inflammatory Syndrome occurring children adults COVID-19. Understanding help clinicians diagnose an early stage ensure appropriate measures undertaken order prevent further spread disease.

Язык: Английский

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Endocrine and metabolic aspects of the COVID-19 pandemic

Reviews in Endocrine and Metabolic Disorders, Год журнала: 2020, Номер 21(4), С. 495 - 507

Опубликована: Июль 9, 2020

COVID-19 infection has tremendously impacted our daily clinical practice as well social living organization. Virtually all organs and biological systems suffer from this new coronavirus infection, either because the virus targets directly specific tissues or of indirect effects. Endocrine diseases are not an exception some endocrine at risk direct lesion by COVID-19. Although there is still no evidence higher predisposition to contract in patients with diabetes and/or obesity, coexistence these conditions contributes a worse prognosis both confer impaired immunologic system. Cytokines storm can be amplified two latter thereby leading multisystemic failure death. Glycaemic control been demonstrated crucial avoiding long hospital stays, ICU requirement also prevention excessive mortality. treatment modifications consequence required proactive manner, order avoid decompensation eventual admission. This case adrenal insufficiency which prompt increase insulin dosage substitutive steroids through adoption sick day's rules should warranted, easy contact health care provider telematic different modalities. New possible endocrinological have recently described warrant full study next future.

Язык: Английский

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COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study

Clinical Nutrition, Год журнала: 2020, Номер 40(4), С. 2420 - 2426

Опубликована: Окт. 30, 2020

Background & aimsCoronavirus disease 2019 (COVID-19) may associate with clinical manifestations, ranging from alterations in smell and taste to severe respiratory distress requiring intensive care, that might weight loss malnutrition. We aimed assess the incidence of unintentional malnutrition COVID-19 survivors.MethodsIn this post-hoc analysis a prospective observational cohort study, we enrolled all adult (age ≥18 years) patients confirmed diagnosis who had been discharged home either medical ward or Emergency Department San Raffaele University Hospital, were re-evaluated after remission at Outpatient Follow-Up Clinic same Institution April 7, 2020, May 11, 2020. Demographic, anthropometric, biochemical parameters upon admission prospectively collected. At follow-up, anthropometrics, mini nutritional assessment screening visual analogue scale for appetite assessed.ResultsA total 213 included (33% females, median age 59.0 [49.5–67.9] years, 70% overweight/obese initial assessment, 73% hospitalised). Sixty-one (29% total, 31% hospitalised vs. 21% managed home, p = 0.14) lost >5% body (median 6.5 [5.0–9.0] kg, 8.1 [6.1–10.9]%). Patients greater systemic inflammation (C-reactive protein 62.9 [29.0–129.5] vs.48.7 [16.1–96.3] mg/dL; 0.02), impaired renal function (23.7% 8.7% patients; 0.003) longer duration (32 [27–41] 24 [21–30] days; 0.047) as compared those did not lose weight. multivariate logistic regression analysis, only independently predicted (OR 1.05 [1.01–1.10] 0.022).ConclusionsCOVID-19 negatively impact status. In patients, evaluation, counselling treatment should be implemented throughout course disease, remission.Clinicaltrials.gov registrationNCT04318366.

Язык: Английский

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Obesity and COVID‐19: An Italian Snapshot

Obesity, Год журнала: 2020, Номер 28(9), С. 1600 - 1605

Опубликована: Май 28, 2020

The clinical manifestations of coronavirus disease (COVID-19) run from asymptomatic to severe acute respiratory syndrome. Older age and comorbidities are associated more disease. A role obesity is suspected.Patients hospitalized in the medical COVID-19 ward with syndrome 2-related pneumonia were enrolled. primary outcome study was assess relationship between severity classes according BMI.A total 92 patients (61.9% males; 70.5 [13.3] years) Patients overweight younger than normal weight (68.0 [12.6] 67.0 years vs. 76.1 [13.0] years, P < 0.01). higher need for assisted ventilation beyond pure oxygen support (invasive mechanical or noninvasive ventilation) a admission intensive semi-intensive care units observed (P 0.01 0.05, respectively) even after adjusting sex, age, 0.05 0.001, when dementia advanced cancer removed analysis 0.05).Patients admitted pneumonia, despite their required frequently access patients.

Язык: Английский

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Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19

Endocrine, Год журнала: 2020, Номер 68(3), С. 475 - 478

Опубликована: Июнь 1, 2020

Язык: Английский

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Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England

The Lancet Diabetes & Endocrinology, Год журнала: 2021, Номер 9(5), С. 293 - 303

Опубликована: Март 31, 2021

Язык: Английский

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Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis

International Journal of Obesity, Год журнала: 2021, Номер 45(5), С. 998 - 1016

Опубликована: Фев. 26, 2021

Recent studies have shown that obesity is associated with the severity of coronavirus disease (COVID-19). We reviewed clinical to clarify relationship COVID-19 severity, comorbidities, and discussing possible mechanisms. The electronic databases, including Web Science, PubMed, Scopus, Google Scholar, were searched all conducted on reviewed. All independently screened by reviewers based their titles abstracts. Forty relevant articles selected, full texts Obesity affects respiratory immune systems through various Cytokine adipokine secretion from adipose tissue leads a pro-inflammatory state in obese patients, predisposing them thrombosis, incoordination innate adaptive responses, inadequate antibody response, cytokine storm. Obese patients had longer virus shedding. other comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, vitamin D deficiency. Hospitalization, intensive care unit admission, mechanical ventilation, even mortality higher than normal-weight patients. could alter direction severe symptoms younger individuals. Reduced physical activity, unhealthy eating habits and, more stress fear experienced during pandemic may result weight gain obesity. should be considered an independent risk factor for COVID-19. Paying attention preventing infection early levels crucial this pandemic.

Язык: Английский

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