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      Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19 : The CoDEX Randomized Clinical Trial

      1 , 2 , 3 , 4 , 3 , 4 , 5 , 4 , 6 , 4 , 7 , 8 , 9 , 10 , 1 , 1 , 1 , 1 , 11 , 1 , 1 , 1 , 12 , 3 , 3 , 4 , 13 , 3 , 3 , 4 , 5 , 14 , 15 , 16 , 17 , 2 , 18 , 11 , 1 , 19 , 4 , 20 , 21 , 22 , 23 , 24 , 24 , 4 , 20 , 1 , 4 , 25 , for the COALITION COVID-19 Brazil III Investigators
      American Medical Association (AMA)

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          Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) is associated with substantial mortality and use of health care resources. Dexamethasone use might attenuate lung injury in these patients.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

              There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).

                Author and article information

                American Medical Association (AMA)
                September 02 2020
                [1 ]Hospital Sírio-Libanês, São Paulo, Brazil
                [2 ]Departamento de Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
                [3 ]HCor Research Institute, São Paulo, Brazil
                [4 ]Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
                [5 ]Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil
                [6 ]Hospital Moinhos de Vento, Porto Alegre, Brazil
                [7 ]BP–A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
                [8 ]International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
                [9 ]Brazilian Clinical Research Institute, São Paulo, Brazil
                [10 ]Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
                [11 ]UTI Respiratória, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
                [12 ]Departamento de Cardiopneumologia, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
                [13 ]Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil
                [14 ]Hospital Vila Santa Catarina, São Paulo, Brazil
                [15 ]Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
                [16 ]Laboratorio de Medicina Intensiva, Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
                [17 ]Barretos Cancer Hospital, Barretos, Brazil
                [18 ]Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
                [19 ]UTI 09DN, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
                [20 ]Anesthesiology, Pain, and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
                [21 ]Hospital Mario Covas, FMABC, Santo Andre, Brazil
                [22 ]Hospital Samaritano Paulista, São Paulo, Brazil
                [23 ]Hospital Evangélico de Vila Velha, Vila Velha, Brazil
                [24 ]Aché Laboratórios Farmacêuticos, São Paulo, Brazil
                [25 ]Disciplina de Emergências Clínicas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
                © 2020


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