Posts filed under ‘REVIEWS’

REVISION – Nuevas cefalosporinas

Revista Chilena de Infectología Julio 2018 V.35 N.5

La resistencia bacteriana se ha incrementado en América Latina y el mundo, por lo que se requiere investigación y creación de nuevos antimicrobianos capaces de erradicar a los microorganismos resistentes. Se realizó una revisión acerca de nuevas cefalosporinas y sus combinaciones con un inhibidor de β-lactamasas, recopilando información de espectro, farmacocinética, farmacodinamia y estudios clínicos de las indicaciones actuales para:

ceftarolina,

ceftazidima/avibactam y

ceftolozano/tazobactam.

La primera, con actividad frente a Staphylococcus aureus y Staphylococcus coagulasa negativa sensibles y resistentes a meticilina, y contra Streptococcus pneumoniae resistente a penicilina; por lo tanto, aprobada para uso en neumonía bacteriana adquirida en comunidad e infecciones bacterianas de piel y tejidos blandos. Entre las nuevas combinaciones, ceftazidima, una cefalosporina de tercera generación con actividad anti-pseudomonas, asociada a avibactam, un inhibidor de β-lactamasas, ha demostrado efectividad en el tratamiento de infecciones abdominales e infecciones urinarias complicadas.

Por último, la combinación ceftolozano y el conocido tazobactam presenta acción comparable a la combinación de ceftazidima y avibactam por su actividad contra bacilos gramnegativos y, en combinación con metronidazol no presenta inferioridad a meropenem en infecciones intra-abdominales. Se presentan los estudios clínicos y las potenciales indicaciones y escenarios de uso de estas cefalosporinas.

PDF

https://scielo.conicyt.cl/pdf/rci/v35n5/0716-1018-rci-35-05-0465.pdf

August 5, 2020 at 6:20 pm

Neurological Manifestations of COVID-19: A systematic review and current update

Acta Neurol Scand. July 2020 V.142 N.1 P.14-22. 

Varios informes detallan sus síntomas y resultados, centrándose principalmente en las complicaciones respiratorias.

Sin embargo, están surgiendo informes de los efectos del virus sistémicamente, incluido el del sistema nervioso.

Se realizó una revisión de toda la literatura publicada actual, y reportamos que el dolor de cabeza y la anosmia eran manifestaciones neurológicas comunes del SARS-CoV-2.

Los síntomas menos comunes incluyen convulsiones, derrames cerebrales y casos aislados del síndrome de Guillain-Barré.

Ahora se justifica la investigación adicional para determinar con precisión la relación entre aquellos pacientes que desarrollan secuelas neurológicas, su estado clínico y cualquier morbilidad y mortalidad posteriores.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273036/pdf/ANE-9999-na.pdf

August 5, 2020 at 5:32 pm

REVIEW – Nervous system involvement after infection with COVID-19 and other coronaviruses

Brain Behav Immun. July 2020 V.87 P. 18-22. 

Las infecciones virales tienen efectos perjudiciales en las funciones neurológicas, e incluso pueden causar daños neurológicos graves.

Muy recientemente, los coronavirus (CoV), especialmente el SARS-CoV-2, exhiben propiedades neurotrópicas y también pueden causar enfermedades neurológicas.

Se informa que el CoV se puede encontrar en el cerebro o en el LCR.

La pato-biología de estos virus neuroinvasivos aún se conoce de manera incompleta y, por lo tanto, es importante explorar el impacto de las infecciones por CoV en el sistema nervioso.

Revisan la investigación sobre las complicaciones neurológicas en las infecciones por CoV y los posibles mecanismos de daño al sistema nervioso.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146689/pdf/main.pdf

August 5, 2020 at 5:31 pm

REVIEW – Neurological manifestations and complications of COVID-19

J Clin Neurosci. July 2020 V.77 P.8-12. 

La manifestación primaria es respiratoria y cardíaca, pero las características neurológicas también se informan en la literatura como informes de casos y series de casos.

Los síntomas informados más comunes incluyen dolor de cabeza y mareos, seguidos de encefalopatía y delirio.

Entre las complicaciones observadas se encuentran el accidente cerebrovascular, el síndrome de Guillian-Barre, la mielitis transversa aguda y la encefalitis aguda.

La manifestación periférica más frecuente fue la hiposmia.

Se observa además que a veces las manifestaciones neurológicas pueden preceder a las características típicas como fiebre y tos y más tarde se desarrollan manifestaciones típicas en estos pacientes.

Por lo tanto, se requiere un alto índice de sospecha para el diagnóstico oportuno y el aislamiento de casos para prevenir la propagación en las salas de neurología.

Presentan una revisión narrativa de las manifestaciones neurológicas y complicaciones de COVID-19.

El objetivo es actualizar a los neurólogos y médicos que trabajan con casos sospechosos de COVID-19 sobre las posibles presentaciones neurológicas y las posibles complicaciones neurológicas resultantes de esta nueva infección por el virus.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200361/pdf/main.pdf

August 5, 2020 at 5:29 pm

COVID-19 and newborn health: systematic review

Rev Panam Salud Publica. APRIL 2020 V.44 P.54. 

Objective

To describe perinatal and neonatal outcomes in newborns exposed to SARS-CoV-2.

Methods

A systematic review was conducted by searching PubMed Central, LILACS, and Google Scholar using the keywords ‘covid ‘ AND ‘newborn’ OR ‘child’ OR ‘infant,’ on 18 March 2020, and again on 17 April 2020. One researcher conducted the search and extracted data on demographics, maternal outcomes, diagnostic tests, imaging, and neonatal outcomes.

Results

Of 256 publications identified, 20 met inclusion criteria and comprised neonatal outcome data for 222 newborns whose mothers were suspected or confirmed to be SARS-CoV-2 positive perinatally (17 studies) or of newborns referred to hospital with infection/pneumonia (3 studies). Most (12 studies) were case-series reports; all were from China, except three (Australia, Iran, and Spain). Of the 222 newborns, 13 were reported as positive for SARS-CoV-2; most of the studies reported no or mild symptoms and no adverse perinatal outcomes. Two papers among those from newborns who tested positive reported moderate or severe clinical characteristics. Five studies using data on umbilical cord blood, placenta, and/or amniotic fluid reported no positive results. Nine studies reported radiographic imaging, including 5 with images of pneumonia, increased lung marking, thickened texture, or high-density nodular shadow. Minor, non-specific changes in biochemical variables were reported. Studies that tested breast milk reported negative SARS-CoV-2 results.

Conclusions

Given the paucity of studies at this time, vertical transmission cannot be confirmed or denied. Current literature does not support abstaining from breastfeeding nor separating mothers and newborns. Further evidence and data collection networks, particularly in the Americas, are needed for establishing definitive guidelines and recommendations.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241573/pdf/rpsp-44-e54.pdf

 

August 1, 2020 at 10:27 am

Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation

Obstet Gynecol. May 2020 V.135 N.5 P.999-1002. 

As the world confronts coronavirus disease 2019 (COVID-19), an illness caused by yet another emerging pathogen (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), obstetric care providers are asking what this means for pregnant women. The global spread has been swift, and many key questions remain. The case-fatality rate for persons cared for in the United States and whether asymptomatic persons transmit the virus are examples of questions that need to be answered to inform public health control measures. There are also unanswered questions specific to pregnant women, such as whether pregnant women are more severely affected and whether intrauterine transmission occurs. Although guidelines for pregnant women from the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention have been rapidly developed based on the best available evidence, additional information is critically needed to inform key decisions, such as whether pregnant health care workers should receive special consideration, whether to temporarily separate infected mothers and their newborns, and whether it is safe for infected women to breastfeed. Some current recommendations are well supported, based largely on what we know from seasonal influenza: patients should avoid contact with ill persons, avoid touching their face, cover coughs and sneezes, wash hands frequently, disinfect contaminated surfaces, and stay home when sick. Prenatal clinics should ensure all pregnant women and their visitors are screened for fever and respiratory symptoms, and symptomatic women should be isolated from well women and required to wear a mask. As the situation with COVID-19 rapidly unfolds, it is critical that obstetricians keep up to date.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141586/pdf/ong-135-999.pdf

August 1, 2020 at 10:25 am

REVIEW – Guidance on breastfeeding during the Covid-19 pandemic

Rev Assoc Med Bras April 2020 V.66 N.4 P.541-546. 

Objective

These recommendations aim to provide guidance on breastfeeding for mothers with suspected or confirmed Covid-19.

Methods

We performed a review of the recent medical literature on breastfeeding mothers with suspected or confirmed Covid-19, focusing on the neonatal period.

Results

We analyzed 20 recent publications on breastfeeding, Covid-19, and its transmission through breastmilk. We presented possible options for breastfeeding and their consequences for the mother and the child.

Conclusion

All maternal decisions in relation to breastfeeding are justifiable since the infection by Covid-19 is still poorly known. However, puerperal women and their families must be very well informed to make a conscious choice based on the information available in the literature so far.

PDF

https://www.scielo.br/pdf/ramb/v66n4/1806-9282-ramb-66-4-0541.pdf

August 1, 2020 at 10:24 am

REVIEW – Novel Coronavirus disease (COVID-19) in newborns and infants: what we know so far

Ital J Pediatr. April 29, 2020 V.46 N.1 P.56. 

Recently, an outbreak of viral pneumonitis in Wuhan, Hubei, China successively spread as a global pandemia, led to the identification of a novel betacoronavirus species, the 2019 novel coronavirus, successively designated 2019-nCoV then SARS-CoV-2). The SARS-CoV-2 causes a clinical syndrome designated coronavirus disease 2019 (COVID19) with a spectrum of manifestations ranging from mild upper respiratory tract infection to severe pneumonitis, acute respiratory distress syndrome (ARDS) and death. Few cases have been observed in children and adolescents who seem to have a more favorable clinical course than other age groups, and even fewer in newborn babies. This review provides an overview of the knowledge on SARS-CoV-2 epidemiology, transmission, the associated clinical presentation and outcomes in newborns and infants up to 6 months of life.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190200/pdf/13052_2020_Article_820.pdf

August 1, 2020 at 10:22 am

REVIEW – Coronavirus disease 2019 (COVID-19) pandemic and pregnancy

Am J Obstet Gynecol. June 2020 V.222 N.6 P.521-531. 

The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2-2.5, indicating that 2-3 persons will be infected from an index patient. A serious public health emergency, it is particularly deadly in vulnerable populations and communities in which healthcare providers are insufficiently prepared to manage the infection. As of March 16, 2020, there are more than 180,000 confirmed cases of COVID-19 worldwide, with more than 7000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious 2 weeks after cessation of symptoms. The substantial morbidity and socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns and border closures. Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks. To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure in the gravida. Furthermore, the pregnancy bias toward T-helper 2 (Th2) system dominance, which protects the fetus, leaves the mother vulnerable to viral infections, which are more effectively contained by the Th1 system. These unique challenges mandate an integrated approach to pregnancies affected by SARS-CoV-2. Here we present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcription polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission, and maternal-fetal complications. We discuss the latest options in antiviral therapy and vaccine development, including the novel use of chloroquine in the management of COVID-19. Fetal surveillance, in view of the predisposition to growth restriction and special considerations during labor and delivery, is addressed. In addition, we focus on keeping frontline obstetric care providers safe while continuing to provide essential services. Our clinical service model is built around the principles of workplace segregation, responsible social distancing, containment of cross-infection to healthcare providers, judicious use of personal protective equipment, and telemedicine. Our aim is to share a framework that can be adopted by tertiary maternity units managing pregnant women in the flux of a pandemic while maintaining the safety of the patient and healthcare provider at its core.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270569/pdf/main.pdf

August 1, 2020 at 10:21 am

REVIEW – COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review

J Am Coll Cardiol. June 16, 2020 V.75 N.23 P.2950-2973. 

La COVID-19, una enfermedad viral respiratoria causada por el SARS-CoV-2, puede predisponer a los pacientes a la enfermedad trombótica, tanto en las circulaciones venosas como arteriales, debido a inflamación excesiva, activación plaquetaria, disfunción endotelial y estasis.

Además, muchos pacientes que reciben terapia antitrombótica para la enfermedad trombótica pueden desarrollar COVID-19, lo que puede tener implicaciones para la elección, la dosificación y el monitoreo de laboratorio de la terapia antitrombótica.

Además, durante un tiempo con mucho enfoque en COVID-19, es crítico considerar cómo optimizar la tecnología disponible para atender a pacientes sin COVID-19 que tienen enfermedad trombótica.

En esta revisión los autores analizan la comprensión actual de la patogénesis, epidemiología, manejo y resultados de pacientes con COVID-19 que desarrollan trombosis venosa o arterial, de aquellos con enfermedad trombótica preexistente que desarrollan COVID-19, o aquellos que necesitan prevención. o cuidar su enfermedad trombótica durante la pandemia de COVID-19.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164881/pdf/main.pdf

July 30, 2020 at 5:27 pm

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