m_falafel
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Guys, on reste sur le sujet svp.
Étude de 138 infectés du coronavirus: https://jamanetwork.com/journals/jama/fullarticle/2761044
Résumé:
This report, to our knowledge, is the largest case series to date of hospitalized patients with NCIP. As of February 3, 2020, of the 138 patients included in this study, 26% required ICU care, 34.1% were discharged, 6 died (4.3%), and 61.6% remain hospitalized. For those who were discharged (n = 47), the hospital stay was 10 days (IQR, 7.0-14.0). The time from onset to dyspnea was 5.0 days, 7.0 days to hospital admission, and 8.0 days to ARDS. Common symptoms at onset of illness were fever, dry cough, myalgia, fatigue, dyspnea, and anorexia. However, a significant proportion of patients presented initially with atypical symptoms, such as diarrhea and nausea. Major complications during hospitalization included ARDS, arrhythmia, and shock. Bilateral distribution of patchy shadows and ground glass opacity was a typical hallmark of CT scan for NCIP.
Donc plus du quart des patients ont besoin de soins intensifs sinon ils meurent. Je reviens à mon point de départ: À voir la vitesse de propagation du virus, les hopitaux vont être pleins très rapidement. Une fois les hopitaux pleins, tous ces gens qui auraient normalement des bonnes chances de survies avec soins intensifs vont se voir refuser les soins par manque de capacité et ils vont retourner chez eux s'étouffer dans leurs sécrétions...
Si vous cliquez sur le lien et que vous prenez la peine de lire l'étude, après un mois, 61% des patients étaient toujours hospitalisés. Donc en plus que les hopitaux vont se remplir vite, les lits vont prendre en majorité plus d'un mois avant de se libérer pour d'autres personnes qui en ont de besoin.
Rendu là, me semble que c'est clair qu'on va avoir un problème. Loin de moi la volonté de faire du fear mongering, je fais juste relater des stats et en déduire des conclusions logiques. À date tous le monde me traite de parano mais personne apporte des arguments valides pour discréditer les miens.
Results
Presenting Characteristics
The study population included 138 hospitalized patients with confirmed NCIP. The median age was 56 years (IQR, 42-68; range, 22-92 years), and 75 (54.3%) were men. Of these patients, 102 (73.9%) were admitted to isolation wards, and 36 (26.1%) were admitted and transferred to the ICU because of the development of organ dysfunction (Table 1). The median durations from first symptoms to dyspnea, hospital admission, and ARDS were 5 days (IQR, 1-10), 7 days (IQR, 4-8), and 8 days (IQR, 6-12), respectively (Table 1). Of the 138 patients, 64 (46.4%) had 1 or more coexisting medical conditions. Hypertension (43 [31.2%]), diabetes (14 [10.1%]), cardiovascular disease (20 [14.5%]), and malignancy (10 [7.2%]) were the most common coexisting conditions.
The most common symptoms at onset of illness were fever (136 [98.6%]), fatigue (96 [69.6%]), dry cough (82 [59.4%]), myalgia (48 [34.8%]), and dyspnea (43 [31.2%]). Less common symptoms were headache, dizziness, abdominal pain, diarrhea, nausea, and vomiting (Table 1). A total of 14 patients (10.1%) initially presented with diarrhea and nausea 1 to 2 days prior to development of fever and dyspnea.
Compared with patients who did not receive ICU care (n = 102), patients who required ICU care (n = 36) were significantly older (median age, 66 years [IQR, 57-78] vs 51 years [IQR, 37-62]; P < .001) and were more likely to have underlying comorbidities, including hypertension (21 [58.3%] vs 22 [21.6%], diabetes (8 [22.2%] vs 6 [5.9%]), cardiovascular disease (9 [25.0%] vs 11 [10.8%]), and cerebrovascular disease (6 [16.7%] vs 1 [1.0%]). Compared with the non-ICU patients, patients admitted to the ICU were more likely to report pharyngeal pain, dyspnea, dizziness, abdominal pain, and anorexia.
Vital Signs and Laboratory Parameters in ICU and Non-ICU Patients
Heart rate, respiratory rate, and mean arterial pressure did not differ between patients who received ICU care and patients who did not receive ICU care. These measures were recorded on day of hospital admission for all patients, then divided into those who were later admitted to the ICU or not. There were numerous differences in laboratory findings between patients admitted to the ICU and those not admitted to the ICU (Table 2), including higher white blood cell and neutrophil counts, as well as higher levels of D-dimer, creatine kinase, and creatine. All of the 138 enrolled patients showed bilateral involvement of chest CT scan (Figure 1). The median time from onset of symptoms to ICU admission was 10 days (IQR, 6-12) (Table 3). On the day of ICU admission, the median Glasgow Coma Scale; Acute Physiology and Chronic Health Evaluation II; and Sequential Organ Failure Assessment scores were 15 (IQR, 9-15), 17 (IQR, 10-22), and 5 (IQR, 3-6), respectively (Table 3). The median partial pressure of oxygen level was 68 mm Hg (IQR, 56-89) and the median of partial pressure of oxygen to fraction of inspired oxygen ratio was 136 mm Hg (IQR, 103-234).
Organ Dysfunctions and Main Interventions
The organ dysfunction and treatment of the 138 patients are shown in Table 4. As of February 3, 2020, 85 patients (61.6%) were still hospitalized. A total of 47 patients (34.1%) had been discharged, and 6 patients (4.3%) had died. Of the 36 patients admitted to the ICU, 11 were still in the ICU, 9 had been discharged to home, 10 had been transferred to the general wards, and 6 had died. Of the 11 patients who remained in the ICU, 6 received invasive ventilation (1 switched to extracorporeal membrane oxygenation) and 5 to noninvasive ventilations). Common complications among the 138 patients included shock (12 [8.7%]), ARDS (27 [19.6%]), arrhythmia (23 [16.7%]), and acute cardiac injury (10 [7.2%]). Patients who received care in the ICU were more likely to have one of these complications than non-ICU patients.
Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). In the ICU, 4 patients (11.1%) received high-flow oxygen and 15 (44.4%) received noninvasive ventilation. Invasive mechanical ventilation was required in 17 patients (47.2%), 4 of whom received extracorporeal membrane oxygenation as rescue therapy. A total of 13 patients received vasopressors, and 2 patients received kidney replacement therapy.
Dynamic Profile of Laboratory Findings in Patients With NCIP
To determine the major clinical features that appeared during NCIP progression, the dynamic changes in 6 clinical laboratory parameters, including hematological and biochemical parameters, were tracked from day 1 to day 19 after the onset of the disease at 2-day intervals. At the end of January 28, 2020, data from 33 patients with complete clinical course were analyzed (Figure 2). During hospitalization, most patients had marked lymphopenia, and nonsurvivors developed more severe lymphopenia over time. White blood cell counts and neutrophil counts were higher in nonsurvivors than those in survivors. The level of D-dimer was higher in nonsurvivors than in survivors. Similarly, as the disease progressed and clinical status deteriorated, the levels of blood urea and creatinine progressively increased before death.
Presumed Hospital-Related Transmission and Infection
Of the 138 patients, 57 (41.3%) were presumed to have been infected in hospital, including 17 patients (12.3%) who were already hospitalized for other reasons and 40 health care workers (29%). Of the hospitalized patients, 7 patients were from the surgical department, 5 were from internal medicine, and 5 were from the oncology department. Of the infected health care workers, 31 (77.5%) worked on general wards, 7 (17.5%) in the emergency department, and 2 (5%) in the ICU. One patient in the current study presented with abdominal symptoms and was admitted to the surgical department. More than 10 health care workers in this department were presumed to have been infected by this patient. Patient-to-patient transmission also was presumed to have occurred, and at least 4 hospitalized patients in the same ward were infected, and all presented with atypical abdominal symptoms. One of the 4 patients had fever and was diagnosed as having nCoV infection during hospitalization. Then, the patient was isolated. Subsequently, the other 3 patients in the same ward had fever, presented with abdominal symptoms, and were diagnosed as having nCoV infection.
Étude de 138 infectés du coronavirus: https://jamanetwork.com/journals/jama/fullarticle/2761044
Résumé:
This report, to our knowledge, is the largest case series to date of hospitalized patients with NCIP. As of February 3, 2020, of the 138 patients included in this study, 26% required ICU care, 34.1% were discharged, 6 died (4.3%), and 61.6% remain hospitalized. For those who were discharged (n = 47), the hospital stay was 10 days (IQR, 7.0-14.0). The time from onset to dyspnea was 5.0 days, 7.0 days to hospital admission, and 8.0 days to ARDS. Common symptoms at onset of illness were fever, dry cough, myalgia, fatigue, dyspnea, and anorexia. However, a significant proportion of patients presented initially with atypical symptoms, such as diarrhea and nausea. Major complications during hospitalization included ARDS, arrhythmia, and shock. Bilateral distribution of patchy shadows and ground glass opacity was a typical hallmark of CT scan for NCIP.
Donc plus du quart des patients ont besoin de soins intensifs sinon ils meurent. Je reviens à mon point de départ: À voir la vitesse de propagation du virus, les hopitaux vont être pleins très rapidement. Une fois les hopitaux pleins, tous ces gens qui auraient normalement des bonnes chances de survies avec soins intensifs vont se voir refuser les soins par manque de capacité et ils vont retourner chez eux s'étouffer dans leurs sécrétions...
Si vous cliquez sur le lien et que vous prenez la peine de lire l'étude, après un mois, 61% des patients étaient toujours hospitalisés. Donc en plus que les hopitaux vont se remplir vite, les lits vont prendre en majorité plus d'un mois avant de se libérer pour d'autres personnes qui en ont de besoin.
Rendu là, me semble que c'est clair qu'on va avoir un problème. Loin de moi la volonté de faire du fear mongering, je fais juste relater des stats et en déduire des conclusions logiques. À date tous le monde me traite de parano mais personne apporte des arguments valides pour discréditer les miens.
Results
Presenting Characteristics
The study population included 138 hospitalized patients with confirmed NCIP. The median age was 56 years (IQR, 42-68; range, 22-92 years), and 75 (54.3%) were men. Of these patients, 102 (73.9%) were admitted to isolation wards, and 36 (26.1%) were admitted and transferred to the ICU because of the development of organ dysfunction (Table 1). The median durations from first symptoms to dyspnea, hospital admission, and ARDS were 5 days (IQR, 1-10), 7 days (IQR, 4-8), and 8 days (IQR, 6-12), respectively (Table 1). Of the 138 patients, 64 (46.4%) had 1 or more coexisting medical conditions. Hypertension (43 [31.2%]), diabetes (14 [10.1%]), cardiovascular disease (20 [14.5%]), and malignancy (10 [7.2%]) were the most common coexisting conditions.
The most common symptoms at onset of illness were fever (136 [98.6%]), fatigue (96 [69.6%]), dry cough (82 [59.4%]), myalgia (48 [34.8%]), and dyspnea (43 [31.2%]). Less common symptoms were headache, dizziness, abdominal pain, diarrhea, nausea, and vomiting (Table 1). A total of 14 patients (10.1%) initially presented with diarrhea and nausea 1 to 2 days prior to development of fever and dyspnea.
Compared with patients who did not receive ICU care (n = 102), patients who required ICU care (n = 36) were significantly older (median age, 66 years [IQR, 57-78] vs 51 years [IQR, 37-62]; P < .001) and were more likely to have underlying comorbidities, including hypertension (21 [58.3%] vs 22 [21.6%], diabetes (8 [22.2%] vs 6 [5.9%]), cardiovascular disease (9 [25.0%] vs 11 [10.8%]), and cerebrovascular disease (6 [16.7%] vs 1 [1.0%]). Compared with the non-ICU patients, patients admitted to the ICU were more likely to report pharyngeal pain, dyspnea, dizziness, abdominal pain, and anorexia.
Vital Signs and Laboratory Parameters in ICU and Non-ICU Patients
Heart rate, respiratory rate, and mean arterial pressure did not differ between patients who received ICU care and patients who did not receive ICU care. These measures were recorded on day of hospital admission for all patients, then divided into those who were later admitted to the ICU or not. There were numerous differences in laboratory findings between patients admitted to the ICU and those not admitted to the ICU (Table 2), including higher white blood cell and neutrophil counts, as well as higher levels of D-dimer, creatine kinase, and creatine. All of the 138 enrolled patients showed bilateral involvement of chest CT scan (Figure 1). The median time from onset of symptoms to ICU admission was 10 days (IQR, 6-12) (Table 3). On the day of ICU admission, the median Glasgow Coma Scale; Acute Physiology and Chronic Health Evaluation II; and Sequential Organ Failure Assessment scores were 15 (IQR, 9-15), 17 (IQR, 10-22), and 5 (IQR, 3-6), respectively (Table 3). The median partial pressure of oxygen level was 68 mm Hg (IQR, 56-89) and the median of partial pressure of oxygen to fraction of inspired oxygen ratio was 136 mm Hg (IQR, 103-234).
Organ Dysfunctions and Main Interventions
The organ dysfunction and treatment of the 138 patients are shown in Table 4. As of February 3, 2020, 85 patients (61.6%) were still hospitalized. A total of 47 patients (34.1%) had been discharged, and 6 patients (4.3%) had died. Of the 36 patients admitted to the ICU, 11 were still in the ICU, 9 had been discharged to home, 10 had been transferred to the general wards, and 6 had died. Of the 11 patients who remained in the ICU, 6 received invasive ventilation (1 switched to extracorporeal membrane oxygenation) and 5 to noninvasive ventilations). Common complications among the 138 patients included shock (12 [8.7%]), ARDS (27 [19.6%]), arrhythmia (23 [16.7%]), and acute cardiac injury (10 [7.2%]). Patients who received care in the ICU were more likely to have one of these complications than non-ICU patients.
Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). In the ICU, 4 patients (11.1%) received high-flow oxygen and 15 (44.4%) received noninvasive ventilation. Invasive mechanical ventilation was required in 17 patients (47.2%), 4 of whom received extracorporeal membrane oxygenation as rescue therapy. A total of 13 patients received vasopressors, and 2 patients received kidney replacement therapy.
Dynamic Profile of Laboratory Findings in Patients With NCIP
To determine the major clinical features that appeared during NCIP progression, the dynamic changes in 6 clinical laboratory parameters, including hematological and biochemical parameters, were tracked from day 1 to day 19 after the onset of the disease at 2-day intervals. At the end of January 28, 2020, data from 33 patients with complete clinical course were analyzed (Figure 2). During hospitalization, most patients had marked lymphopenia, and nonsurvivors developed more severe lymphopenia over time. White blood cell counts and neutrophil counts were higher in nonsurvivors than those in survivors. The level of D-dimer was higher in nonsurvivors than in survivors. Similarly, as the disease progressed and clinical status deteriorated, the levels of blood urea and creatinine progressively increased before death.
Presumed Hospital-Related Transmission and Infection
Of the 138 patients, 57 (41.3%) were presumed to have been infected in hospital, including 17 patients (12.3%) who were already hospitalized for other reasons and 40 health care workers (29%). Of the hospitalized patients, 7 patients were from the surgical department, 5 were from internal medicine, and 5 were from the oncology department. Of the infected health care workers, 31 (77.5%) worked on general wards, 7 (17.5%) in the emergency department, and 2 (5%) in the ICU. One patient in the current study presented with abdominal symptoms and was admitted to the surgical department. More than 10 health care workers in this department were presumed to have been infected by this patient. Patient-to-patient transmission also was presumed to have occurred, and at least 4 hospitalized patients in the same ward were infected, and all presented with atypical abdominal symptoms. One of the 4 patients had fever and was diagnosed as having nCoV infection during hospitalization. Then, the patient was isolated. Subsequently, the other 3 patients in the same ward had fever, presented with abdominal symptoms, and were diagnosed as having nCoV infection.
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