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Κορονοϊός ( COVID-19 )

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Argirios Argiriou:
June 3, 2021, Journal Watch.

Epidemiology of Long-Term COVID-19 Symptoms
Thomas L. Schwenk, MD, reviewing Nasserie T et al. JAMA Netw Open 2021 May 26

Nearly three quarters of patients had at least one persistent symptom following SARS-CoV-2 infection.

Studies of patients who have recovered from SARS-CoV-2 infection but have persistent symptoms, so called “long-haulers,” have ranged widely in size, quality, and methodology, leading to confusion about the prevalence and types of persistent symptoms. In this meta-analysis, researchers identified nearly 2000 studies that addressed persistent post–COVID-19 symptoms; 45 studies, with a total of ≈10,000 patients and 84 discrete symptoms, were deemed suitable for analysis. The studies were highly heterogeneous, including wide variation in the severity and nature of the original infections.

Nearly three quarters of patients reported at least one persistent symptom for a mean or median of 2 to 4 months; and some symptoms were reported to persist for as long as 6 to 8 months. The most common symptoms were fatigue (40% of patients), shortness of breath (36%), anosmia (24%), anxiety (22%), persistent cough (17%), ageusia (16%), and depression (15%).

COMMENT
This systematic analysis really constitutes more of a large case series than a robust meta-analysis because of the highly heterogeneous nature of the original studies. The results will help clinicians advise patients about what to expect post-COVID, albeit without much guidance on specific treatments.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Thomas L. Schwenk, MD, at time of publication
Editorial boards   UpToDate
CITATION(S):
Nasserie T et al. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: A systematic review. JAMA Netw Open 2021 May 26; 4:e2111417. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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Argirios Argiriou:
June 2, 2021 Journal Watch.

In a Large Randomized Trial, Convalescent Plasma Strikes Out
Rajesh T. Gandhi, MD, reviewing RECOVERY Collaborative Group. Lancet 2021 May 29

Among patients hospitalized with COVID-19, convalescent plasma did not improve survival over usual care.

From COVID-19's earliest days, patients have been treated with plasma from individuals who have recovered from their infections (convalescent plasma; CP). Still, it remains unclear whether this therapy improves outcomes. Investigators in the U.K. randomized 11,558 hospitalized participants in the RECOVERY trial to receive open-label, high-titer CP plus usual care or usual care alone. Median time from symptom onset to randomization was 9 days. Regarding disease severity at enrollment, 87% of participants required oxygen only, 5% were receiving invasive mechanical ventilation (IMV), and 8% did not need any supplemental oxygen. Use of other therapies, such as corticosteroids and remdesivir, was balanced between the two groups.

Mortality at 28 days was 24% in both the CP and usual care groups. Time to discharge, probability of being discharged alive, and number of patients progressing to IMV or death were similar in both groups. Among participants negative for anti–SARS-CoV-2 antibodies at baseline, mortality was comparable in the CP and usual care groups (32% and 34%, respectively).

COMMENT
As this large, randomized trial does not demonstrate a survival benefit of CP in hospitalized patients with COVID-19, the findings should steer us away from such treatment in this setting. However, the study does not answer whether convalescent plasma would improve outcomes among high-risk patients earlier in the course of their disease (as suggested in a different study; NEJM JW Infect Dis Mar 2021 and N Engl J Med 2021 Jan 6; [e-pub]) or in highly immunosuppressed patients with persistent SARS-CoV-2 replication. Those important patient populations require evaluation in future studies.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Rajesh T. Gandhi, MD, at time of publication
Grant/Research Support   NIH
Editorial Boards   UpToDate; Partners ID Images
Leadership Positions in Professional Societies   Department of Health and Human Services, Antiretroviral Guidelines for Adults and Adolescents (Scientific Member); HIV Medicine Association (Chair); International Antiviral Society-USA (Guidelines Committee); NIH COVID-19 Treatment Guidelines (Scientific Member); Infectious Diseases Society of America COVID-19 Treatment Guidelines

CITATION(S):
RECOVERY Collaborative Group. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): A randomised controlled, open-label, platform trial. Lancet 2021 May 29; 397:2049. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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Γιώργος Κανελλόπουλος:
Τι γίνεται επίσημα με τον εμβολιασμό όσων έχουν φαρμακευτικές αλλεργίες; νομίζω στα εμβολιαστικά κέντρα αυθαίρετα διώχνουν τον κόσμο. Με προβλημάτισε πολύ μια ασθενής μου που με πήρε πολύ αγχωμένη γιατί την τρόμαξαν χωρίς λόγο. Μπορώ να δώσω γνωμάτευση εγώ ή χρειάζεται υποχρεωτικά αλλεργιολόγος, όπως της είπαν; υπάρχει κάποια οδηγία;

schumifer:
Εδώ πάνω τους εμβολιάζουμε αβέρτα, εκτός από περιπτώσεις αναφυλακτικών, όπου δεν ξέρουμε και σε τι έχει κάνει αλλεργία. Αυτοί πάνε στο αλλεργιολογικό

Argirios Argiriou:
27 June 2021

Covid-19 Killed 26 Indonesian Doctors in June—at Least 10 Had Taken China’s Sinovac Vaccine

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