The World Health Organization has recently advised against corticosteroids use in COVID-19 patients, unless indicated for another reason, as in adrenal insufficiency (AI). Indeed, both patients with primary or secondary AI are at higher risk of developing infections, precipitating an adrenal crisis. No specific protocol has been studied for AI patients in the context of […]
Delayed umbilical cord clamping does not seem to increase pathogens transmission. Leaving vernix caseosa in place 24h after birth can be considered due to the presence of antimicrobial peptides. The majority of neonatal infections are caused by the environment and droplet transmission from the mother and other relatives. Physical separation at birth can be considered […]
Recommendations for AIBD patients undergoing immunosuppressive therapy during the pandemic : Immunomodulatory therapy should be maintained when necessary since unjustified withdrawal could lead to uncontrolled AIBD activity. Adhere to standard precautions including social distancing and hand washing. What if AIBD patients are SARS-CoV-2 infected ? Evaluate the risk for each patient. May be stopped during […]
Confirmed cases should be treated in a negative pressure isolation room when available. Critically ill patients should be placed in left lateral decubitus. Treatment options include oxygen therapy, hydration, and empirical antibiotic therapy. The use of antiretroviral therapy and chloroquine is under investigation. Target saturation is ≥ 95%. Is hydroxychloroquine safe in pregnancy? Some […]
About coagulation and inflammation biochemical parameters: Markedly decreased fibrinogen, high FDP (fibrin degradation product), high D-dimers and increased PT/PTT are observed in COVID-19 non survivors.1,2,3,4,5,6 Rapidly rising FDP may be correlated with disease progression and may be a better surrogate marker than D-dimers.1,4,5 Plasminogen levels tend to be higher in severe disease and may play […]
Few papers suggested that viral replication in vitro was diminished by chloroquine, but those were only laboratory studies. It has not been supported by animal studies; Antimalarial drugs such as chloroquine and its derivatives are associated with significant adverse effects; Particularly in times of restricted supplies, unjustified and/or overuse can cause drug shortages for those […]
Diabetes is an important risk factor for poorer outcomes in COVID-19. Mechanistic hypotheses include the effect of acute and chronic hyperglycemia on angiotensin-converting-enzyme-2 receptor, impaired immune response and confounding population characteristics such as age and cardiovascular comorbidities. Prevention: Patients at risk of metabolic disease who have contracted the infection should be monitored to prevent new […]
Clinical manifestations : Clinical manifestations in pregnant women were comparable to those seen in infected non-pregnant adults. Initial normal body temperature was seen more commonly in pregnant women, thus rendering early detection of the virus more difficult in this population. It has not been shown that pregnancy is a risk factor for more severe infection. […]
There is currently no data about the benefits or the risks of stopping immunomodulators/immunosuppressants during the COVID-19 outbreak. Pre-coronavirus pivotal trials for psoriasis show that patients under biologic therapies had respiratory infection rates similar to placebo. Price et al recommend: Consider stopping classic immunosuppressants and rituximab when viral symptoms present, especially with known or potential […]
Before COVID-19: Favipiravir is approved in Japan and China for treating severe influenza virus, as well as a promising prophylaxis and treatment of Ebola virus and treatment of Fever with Thrombocytopenia Syndrome.1 It was shown to be safe in several human clinical trials for influenza.1 It is renowned for its broad anti-RNA virus action1, and […]
DIC (Disseminated Intravascular Coagulation) is highly associated with death, as the majority of patients (71%) who died from NCP (novel coronavirus pneumoniae) met the criteria for DIC (with median time of four days after admission) compared to few survivor (0.6% developing DIC). Coagulation parameters (mainly D-dimers) should be done at baseline and followed throughout the […]
Lymphopenia is frequent1,2 and severe lymphopenia may be useful to identify patients that will need ICU care1,2,3. Patients requiring ICU tend to have higher LDH (lactate dehydrogenase) and higher ANC (absolute neutrophil count)1,2,3. Thrombocytopenia is frequent2,3, but does not seem to correlate the need of ICU care.1,2,3. Hemoglobin, monocyte, prothrombin time, activated partial thromboplastin time […]
AKI (acute kidney injury) is independently strongly associated with increased mortality and morbidity and is dependent on its severity (Stage 1 HR = 3.51, Stage 2 HR = 6.24, Stage 3 HR = 9.81)1 CKD (chronic kidney disease) is associated with enhanced risk of severe COVID-19 infection (OR 3.03)2 and a greater in-hospital mortality (HR […]
The LYM% (blood lymphocyte percentage) can be used as a reliable indicator to classify the infection as moderate, severe and critical independently of any other auxiliary indicators. TML (Time-LYM%-model) is a tool of classification and prognosis prediction. TML-1 is defined as the LYM% at day 10-12 after symptom onset and TML-2 is the LYM% at […]
Patients with cancer have a higher risk of severe events and death compared with patients without cancer.1,2 Patients who underwent chemotherapy or surgery in the past month had higher risk.1 In Italy, it was found that 20% of patient who died from COVID-19 had an active cancer. 2 Wenhua L and al. conducted a […]
Prior anti-tumor treatment within 14 days before COVID-19 diagnosis is a major risk factor for developing severe events.1 Patchy consolidation on the first CT on admission is a major risk factor for developing severe events.1 Patients with blood cancer and metastatic cancer seem to have a higher risk of severe events compared to patients without […]
