Articles: coronavirus.
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Observational Study
Effects of Tocilizumab in COVID-19 patients: a cohort study.
Due to the lack of proven therapies, we evaluated the effects of early administration of tocilizumab for COVID-19. By inhibition of the IL-6 receptor, tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure from SARS-CoV-2. ⋯ Majority of patients demonstrated clinical improvement and were successfully discharged alive from the hospital after receiving tocilizumab. We observed a rebound effect with CRP, which may suggest the need for higher or subsequent doses to adequately manage cytokine storm. Based on our findings, we believe that tocilizumab may have a role in the early treatment of COVID-19, however larger randomized controlled studies are needed to confirm this.
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Cochrane Db Syst Rev · Dec 2020
ReviewCare bundles for improving outcomes in patients with COVID-19 or related conditions in intensive care - a rapid scoping review.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the strain of coronavirus that causes coronavirus disease 2019 (COVID-19) can cause serious illness in some people resulting in admission to intensive care units (ICU) and frequently, ventilatory support for acute respiratory failure. Evaluating ICU care, and what is effective in improving outcomes for these patients is critical. Care bundles, a small set of evidence-based interventions, delivered together consistently, may improve patient outcomes. To identify the extent of the available evidence on the use of care bundles in patients with COVID-19 in the ICU, the World Health Organization (WHO) commissioned a scoping review to inform WHO guideline discussions. This review does not assess the effectiveness of the findings, assess risk of bias, or assess the certainty of the evidence (GRADE). As this review was commissioned to inform guideline discussions, it was done rapidly over a three-week period from 26 October to 18 November 2020. ⋯ This scoping review has identified 21 studies on care bundle use in critically ill patients in ICU with COVID-19, ARDS, viral influenza or pneumonia and severe respiratory failure. The data for patients with COVID-19 specifically are limited, derived mainly from observational quality improvement or clinical experiential accounts. Research is required, urgently, to further assess care bundle use and optimal components of these bundles in this patient cohort. The care bundles described were also varied, with guidance on ventilator settings described in 10 care bundles, while chest X-ray was part mentioned in one care bundle in one study only. None of the studies identified in this scoping review measured users' experience of adapting care bundles. Optimising care bundle implementation requires that the components of the care bundle are collectively and consistently applied. Data on challenges, barriers and facilitators to implementation are needed. A formal synthesis of the outcome data presented in this review and a critical appraisal of the evidence is required by a subsequent effectiveness review. This subsequent review should further explore effect estimates across the included studies.
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J. Korean Med. Sci. · Dec 2020
ReviewQuarantine Facility for Patients with COVID-19 with Mild Symptoms in Korea: Experience from Eighteen Residential Treatment Centers.
With the rapid spread of coronavirus disease 2019 (COVID-19), a particularly sharp increase in the number of confirmed cases in Daegu and Gyeongbuk regions at the end of February, Korea faced an unprecedented shortage of medical resources, including hospital beds. To cope with this shortage, the government introduced a severity scoring system for patients with COVID-19 and designed a new type of quarantine facility for treating and isolating patients with mild symptoms out of the hospital, namely, the Residential Treatment Center (RTC). A patient with mild symptoms was immediately isolated in the RTC and continuously monitored to detect changes in symptoms. ⋯ Their duty was mainly to monitor the health conditions of quarantined patients, provide accommodations, and regularly collect specimens to determine if they can be released. For the past two months, RTCs secured approximately 4,000 isolation rooms and treated approximately 3,000 patients with mild symptoms and operated stably without additional spread of the disease in and out of the centers. Based on these experience, we would like to suggest the utilization of RTCs as strategic quarantine facilities in pandemic situations.
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Int J Environ Res Public Health · Dec 2020
Case ReportsUnderstanding South Korea's Response to the COVID-19 Outbreak: A Real-Time Analysis.
This case study focuses on the epidemiological situation of the COVID-19 outbreak, its impacts and the measures South Korea undertook during the first wave of the COVID-19 pandemic. Since the first case was confirmed on 20 January 2020, South Korea has been actively experiencing the COVID-19 outbreak. In the early stage of the pandemic, South Korea was one of the most-affected countries because of a large outbreak related to meetings of a religious movement, namely the Shincheonji Church of Jesus, in a city called Daegu and North Gyeongsang province. ⋯ Moreover, it was believed that the outbreak of COVID-19 and the governmental responses towards it has brought a huge impact on the general election in April. Despite of the large outbreak in late February, the Korean government has flattened the COVID-19 curve successfully and the downward trend in the number of new cases remained continuously as of 30 April. The most distinctive feature of South Korea's responses is that South Korea conducted proactive case finding, contacts tracing, and isolations of cases instead of taking traditional measures of the containment of the epidemic such as boarder closures and lockdowns.
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Iran J Allergy Asthma Immunol · Dec 2020
Meta AnalysisCOVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis.
The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. ⋯ Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.