The FDA-approved drugs raloxifene and bazedoxifene could be among the best candidates to prevent mortality in severe COVID-19 patients. Raloxifene and bazedoxifene inhibit IL-6 signaling at therapeutic doses, suggesting they have the potential to prevent the cytokine storm, ARDS and mortality in severe COVID-19 patients, as is being shown with humanized antibodies blocking IL-6 signaling. In addition, raloxifene and bazedoxifene are selective estrogen receptor modulators with strong antiviral activity.

• MeSH
• Betacoronavirus účinky léků   patogenita   MeSH
• cytokiny antagonisté a inhibitory   genetika   MeSH
• indoly farmakologie   MeSH
• interleukin-6 antagonisté a inhibitory   genetika   MeSH
• koronavirové infekce farmakoterapie   genetika   mortalita   virologie   MeSH
• lidé MeSH
• pandemie MeSH
• raloxifen hydrochlorid farmakologie   MeSH
• receptory pro estrogeny antagonisté a inhibitory   MeSH
• selektivní modulátory estrogenních receptorů farmakologie   MeSH
• signální transdukce účinky léků   MeSH
• syndrom dechové tísně farmakoterapie   prevence a kontrola   virologie   MeSH
• virová pneumonie farmakoterapie   genetika   mortalita   virologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• Betacoronavirus izolace a purifikace   MeSH
• COVID-19 MeSH
• karanténa MeSH
• koronavirové infekce diagnóza   mortalita   prevence a kontrola   MeSH
• lidé MeSH
• masky MeSH
• ochrana veřejného zdraví metody   MeSH
• ochranné faktory MeSH
• pandemie prevence a kontrola   MeSH
• SARS-CoV-2 MeSH
• virová pneumonie diagnóza   mortalita   prevence a kontrola   MeSH
• zdravotní politika * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Evropa MeSH

In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.

• MeSH
• antihypertenziva terapeutické užití   MeSH
• Betacoronavirus patogenita   MeSH
• biologické markery krev   MeSH
• diabetes mellitus krev   diagnóza   farmakoterapie   mortalita   MeSH
• dyslipidemie farmakoterapie   mortalita   MeSH
• hodnocení rizik MeSH
• hypertenze farmakoterapie   mortalita   MeSH
• hypoglykemika škodlivé účinky   terapeutické užití   MeSH
• interakce hostitele a patogenu MeSH
• jednotky intenzivní péče * MeSH
• koronavirové infekce diagnóza   mortalita   terapie   virologie   MeSH
• krevní glukóza účinky léků   metabolismus   MeSH
• lidé MeSH
• pandemie MeSH
• rizikové faktory MeSH
• statiny terapeutické užití   MeSH
• virová pneumonie diagnóza   mortalita   terapie   virologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Novel coronavirus SARS-CoV-2 is known to be susceptible in vitro to exposure to hydroxychloroquine and its effect has been found to be potentiated by azithromycin. We hypothesise that early administration of hydroxychloroquine alone or in combination with azithromycin can prevent respiratory deterioration in patients admitted to intensive care due to rapidly progressive COVID-19 infection. METHODS: Design: Prospective, multi-centre, double-blind, randomised, controlled trial (RCT). PARTICIPANTS: Adult (> 18 years) within 24 h of admission to the intensive care unit with proven or suspected COVID-19 infection, whether or not mechanically ventilated. Exclusion criteria include duration symptoms of febrile disease for ≥ 1 week, treatment limitations in place or moribund patients, allergy or intolerance of any study treatment, and pregnancy. INTERVENTIONS: Patients will be randomised in 1:1:1 ratio to receive Hydroxychloroquine 800 mg orally in two doses followed by 400 mg daily in two doses and azithromycin 500 mg orally in one dose followed by 250 mg in one dose for a total of 5 days (HC-A group) or hydroxychloroquine + placebo (HC group) or placebo + placebo (C-group) in addition to the best standard of care, which may evolve during the trial period but will not differ between groups. Primary outcome is the composite percentage of patients alive and not on end-of-life pathway who are free of mechanical ventilation at day 14. SECONDARY OUTCOMES: The percentage of patients who were prevented from needing intubation until day 14, ICU length of stay, and mortality (in hospital) at day 28 and 90. DISCUSSION: Although both investigational drugs are often administered off label to patients with severe COVID-19, at present, there is no data from RCTs on their safety and efficacy. In vitro and observational trial suggests their potential to limit viral replication and the damage to lungs as the most common reason for ICU admission. Therefore, patients most likely to benefit from the treatment are those with severe but early disease. This trial is designed and powered to investigate whether the treatment in this cohort of patients leads to improved clinical patient-centred outcomes, such as mechanical ventilation-free survival. TRIAL REGISTRATION: Clinical trials.gov: NCT04339816 (Registered on 9 April 2020, amended on 22 June 2020); Eudra CT number: 2020-001456-18 (Registered on 29 March 2020).

• MeSH
• azithromycin aplikace a dávkování   MeSH
• Betacoronavirus * MeSH
• dvojitá slepá metoda MeSH
• hydroxychlorochin aplikace a dávkování   MeSH
• jednotky intenzivní péče MeSH
• kombinovaná farmakoterapie MeSH
• koronavirové infekce farmakoterapie   mortalita   MeSH
• lidé MeSH
• pandemie MeSH
• prospektivní studie MeSH
• randomizované kontrolované studie jako téma * MeSH
• virová pneumonie farmakoterapie   mortalita   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• protokol klinické studie MeSH

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. We undertook this retrospective international multicenter study to characterize the course of COVID-19 in patients with CLL and identify potential predictors of outcome. Of 190 patients with CLL and confirmed COVID-19 diagnosed between 28/03/2020 and 22/05/2020, 151 (79%) presented with severe COVID-19 (need of oxygen and/or intensive care admission). Severe COVID-19 was associated with more advanced age (≥65 years) (odds ratio 3.72 [95% CI 1.79-7.71]). Only 60 patients (39.7%) with severe COVID-19 were receiving or had recent (≤12 months) treatment for CLL at the time of COVID-19 versus 30/39 (76.9%) patients with mild disease. Hospitalization rate for severe COVID-19 was lower (p < 0.05) for patients on ibrutinib versus those on other regimens or off treatment. Of 151 patients with severe disease, 55 (36.4%) succumbed versus only 1/38 (2.6%) with mild disease; age and comorbidities did not impact on mortality. In CLL, (1) COVID-19 severity increases with age; (2) antileukemic treatment (particularly BTK inhibitors) appears to exert a protective effect; (3) age and comorbidities did not impact on mortality, alluding to a relevant role of CLL and immunodeficiency.

• MeSH
• antitumorózní látky farmakologie   terapeutické užití   MeSH
• Betacoronavirus * MeSH
• chronická lymfatická leukemie komplikace   farmakoterapie   MeSH
• inhibitory proteinkinas farmakologie   terapeutické užití   MeSH
• komorbidita MeSH
• koronavirové infekce diagnóza   mortalita   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pandemie MeSH
• prognóza MeSH
• průzkumy a dotazníky MeSH
• pyrazoly farmakologie   terapeutické užití   MeSH
• pyrimidiny farmakologie   terapeutické užití   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• věkové faktory MeSH
• virová pneumonie diagnóza   mortalita   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

Covid-19 has reached almost all the nations in the world. More and more people are dying from it and in some countries, even the army has been called upon to help dispose of the dead as there is a shortage of coffins, and undertakers are overwhelmed. Therefore, it is essential to have measures in place to contain the spread of infection while handling dead bodies. In view of this, different guidelines and protocols have been proposed bearing in mind the limited information we have about the virus. This review article sets them out for better reference.

• MeSH
• Betacoronavirus * MeSH
• kontrola infekce MeSH
• kontrola infekčních nemocí MeSH
• koronavirové infekce mortalita   MeSH
• kremace MeSH
• lidé MeSH
• mrtvola * MeSH
• odstraňování zdravotnického odpadu MeSH
• osobní ochranné prostředky MeSH
• pandemie MeSH
• pitva MeSH
• pohřbívání MeSH
• pracovní expozice prevence a kontrola   MeSH
• přenos infekce z pacienta na zdravotnického pracovníka prevence a kontrola   MeSH
• soudní lékařství metody   MeSH
• Světová zdravotnická organizace MeSH
• virová pneumonie mortalita   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• Betacoronavirus MeSH
• časové faktory MeSH
• koronavirové infekce mortalita   MeSH
• lidé MeSH
• mortalita * trendy   MeSH
• pandemie MeSH
• počítačové systémy MeSH
• publikování MeSH
• sběr dat MeSH
• šíření informací * MeSH
• surveillance populace * MeSH
• veřejné zdravotnictví * MeSH
• virová pneumonie mortalita   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• práce podpořená grantem MeSH

OBJECTIVE: To identify markers associated with in-hospital death in patients with coronavirus disease 2019 (COVID-19)-associated pneumonia. PATIENTS AND METHODS: A retrospective cohort study was conducted of 140 patients with moderate to critical COVID-19-associated pneumonia requiring oxygen supplementation admitted to the hospital from January 28, 2020, through February 28, 2020, and followed up through March 13, 2020, in Union Hospital, Wuhan, China. Oxygen saturation (SpO2) and other measures were tested as predictors of in-hospital mortality in survival analysis. RESULTS: Of 140 patients with COVID-19-associated pneumonia, 72 (51.4%) were men, with a median age of 60 years. Patients with SpO2 values of 90% or less were older and were more likely to be men, to have hypertension, and to present with dyspnea than those with SpO2 values greater than 90%. Overall, 36 patients (25.7%) died during hospitalization after median 14-day follow-up. Higher SpO2 levels after oxygen supplementation were associated with reduced mortality independently of age and sex (hazard ratio per 1-U SpO2, 0.93; 95% CI, 0.91 to 0.95; P<.001). The SpO2 cutoff value of 90.5% yielded 84.6% sensitivity and 97.2% specificity for prediction of survival. Dyspnea was also independently associated with death in multivariable analysis (hazard ratio, 2.60; 95% CI, 1.24 to 5.43; P=.01). CONCLUSION: In this cohort of patients with COVID-19, hypoxemia was independently associated with in-hospital mortality. These results may help guide the clinical management of patients with severe COVID-19, particularly in settings requiring strategic allocation of limited critical care resources. TRIAL REGISTRATION: Chictr.org.cn Identifier: ChiCTR2000030852.

• MeSH
• Betacoronavirus izolace a purifikace   MeSH
• hodnocení rizik metody   MeSH
• hypoxie * diagnóza   etiologie   terapie   MeSH
• koronavirové infekce * komplikace   diagnóza   mortalita   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• oxygenoterapie * metody   statistika a číselné údaje   MeSH
• pandemie * MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• spotřeba kyslíku MeSH
• stupeň závažnosti nemoci MeSH
• virová pneumonie * krev   komplikace   diagnóza   etiologie   mortalita   patofyziologie   terapie   MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Čína MeSH

• Klíčová slova
• Covid 19,
• MeSH
• COVID-19 * diagnostické zobrazování   mortalita   patologie   terapie   MeSH
• klinický obraz nemoci MeSH
• lidé MeSH
• virová pneumonie diagnostické zobrazování   komplikace   mortalita   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Chřipkové viry způsobují každoroční epidemii, která se vyskytuje v různých obdobích jak na severní, tak i na jižní polokouli. V případech sezonní chřipky se jedná většinou o lehké formy onemocnění, které jen málokdy vedou k úmrtí nemocného. Ohroženy jsou zejména rizikové skupiny obyvatel (vysoký nebo nízký věk, přidružená onemocnění) zpravidla v řádech desetitisíců obětí na celém světě. Občas se však objeví rozsáhlá epidemie způsobená novou nebezpečnou variantou viru, která se vyznačuje obvykle velkou kontagiozitou a patogenitou (virulencí). Následkem pak často bývá komplikovaný průběh s vysokou mortalitou. V roce 2009 se objevilo pandemické onemocnění virem označeným pH1N1 2009 Influenza A. I přesto, že původní očekávání byla daleko horší, průběh chřipky způsobené tímto virem byl relativně často komplikován akutním respiračním selháním ve formě syndromu akutní respirační tísně (ARDS) probíhajícím v rámci syndromu multiorgánového selhání (MODS). Tento typ viru častěji napadá mladší věkové skupiny a vyznačuje se výraznější kontagiozitou ve srovnání se sezonní chřipkou. K dokreslení průběhu komplikované formy virózy pH1N1 2009 Influenza A popisujeme průběh tří kazuistik komplikovaných plicní manifestací probíhající pod obrazem primární formy ARDS.

Influenza viruses cause annual epidemics that occur at different times in both the northern and southern hemisphere. In cases of seasonal influenza these are usually mild forms of the disease, which rarely lead to death of the patient. Vulnerable groups include the elderly, the young or those with comorbidities, where the virus affects tens of thousands of victims around the world. Occasionally, however, large epidemics appear caused by a dangerous variant of a new virus, which is usually characterized by high contagiousness and pathogenicity (virulence). Consequently, it is often accompanied by a complicated disease course and associated with high mortality. In 2009, a viral pandemic disease marked pH1N1 2009 Influenza A appeared. Even though the initial predictions were far worse, the course of influenza caused by this virus was often complicated by acute respiratory failure in the form of acute respiratory distress syndrome (ARDS). This formed part of the wider multiple organ failure syndrome (MODS). This type of virus often infects younger age groups and is more contagious compared to the seasonal flu. In order to illustrate the complicated forms of viral infections pH1N1 2009 Influenza A we present three case studies which demonstrate complicated pulmonary manifestation, which take the primary form of ARDS.

• MeSH
• anamnéza MeSH
• chřipka lidská * diagnóza   patologie   terapie   MeSH
• dospělí MeSH
• hospitalizace MeSH
• lidé středního věku MeSH
• lidé MeSH
• obezita komplikace   MeSH
• pandemie MeSH
• pitva MeSH
• plíce patologie   MeSH
• příčina smrti MeSH
• prognóza MeSH
• rizikové faktory MeSH
• syndrom akutního respiračního selhání etiologie   mortalita   MeSH
• terapie neúspěšná MeSH
• virová pneumonie * etiologie   komplikace   mortalita   MeSH
• virus chřipky A, podtyp H1N1 * účinky léků   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH