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1.
J Med Virol ; 94(1): 279-286, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468990

RESUMO

Vaccines have been seen as the most important solution for ending the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to evaluate the antibody levels after inactivated virus vaccination. We included 148 healthcare workers (74 with prior COVID-19 infection and 74 with not). They received two doses of inactivated virus vaccine (CoronaVac). Serum samples were prospectively collected three times (Days 0, 28, 56). We measured SARS-CoV-2 IgGsp antibodies quantitatively and neutralizing antibodies. After the first dose, antibody responses did not develop in 64.8% of the participants without prior COVID-19 infection. All participants had developed antibody responses after the second dose. We observed that IgGsp antibody titers elicited by a single vaccine dose in participants with prior COVID-19 infection were higher than after two doses of vaccine in participants without prior infection (geometric mean titer: 898 and 607 AU/ml). IgGsp antibodies, participants with prior COVID-19 infection had higher antibody levels as geometric mean titers at all time points (p < 0.001). We also found a positive correlation between IgGsp antibody titers and neutralizing capacity (rs = 0.697, p < 0.001). Although people without prior COVID-19 infection should complete their vaccination protocol, the adequacy of a single dose of vaccine is still in question for individuals with prior COVID-19. New methods are needed to measure the duration of protection of vaccines and their effectiveness against variants as the world is vaccinated. We believe quantitative IgGsp values may reflect the neutralization capacity of some vaccines.


Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Vacinas contra COVID-19/imunologia , Imunogenicidade da Vacina/imunologia , SARS-CoV-2/imunologia , Vacinas de Produtos Inativados/imunologia , Adulto , COVID-19/imunologia , COVID-19/prevenção & controle , Comorbidade , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Imunização Secundária , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vacinação , Adulto Jovem
2.
J Med Virol ; 94(1): 407-412, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34491572

RESUMO

The ChAdOx1 nCoV-19 vaccine (Oxford University-Astra Zeneca) has demonstrated nearly 70% efficacy against symptomatic COVID-19 in trials and some real-world studies. The vaccine was the first to be approved in India in early January 2021 and is manufactured by the Serum Institute of India. Favorable short-term safety data of the vaccine in India in a real-world setting has been recently demonstrated. Here, we report secondary objective (COVID-19 occurrence) measures of the same ongoing prospective observational study in prioritized recipients of the vaccine. The findings are based on participants who could complete at least 2 months of follow-up (n = 1500; female/male: 472/1028; mean age: 38.8 years). Laboratory confirmed SARS-CoV-2 infection was observed in 27/65 participants (41%) who received a single dose and 271/1435 (19%) who received both doses. Specifically, among doctors, 18/27 (66.7%) one dose recipients and 131/377 (34.7%) fully vaccinated developed SARS-CoV-2 infection. The majority of the cases were mild in all groups, and most were breakthrough infections. The occurrence of "severe" COVID-19 was 7.7 times lower (0.4%) in fully vaccinated participants compared to partially vaccinated (3.1%). Four deaths were observed in the study. One of the four deaths was due to sepsis, two due to unspecified cardiac events, and one due to unspecified post-COVID-19 complications. The results of this preliminary analysis necessitate vigorous research on the performance of vaccines against variants, optimal timing of vaccination, and also optimal timings of effectiveness studies to guide future vaccination policy.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Imunogenicidade da Vacina/imunologia , SARS-CoV-2/imunologia , Adulto , COVID-19/epidemiologia , COVID-19/mortalidade , Comorbidade , Feminino , Humanos , Imunização Secundária/estatística & dados numéricos , Índia/epidemiologia , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Vacinação
3.
J Med Virol ; 94(1): 291-297, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34491575

RESUMO

Due to current advances and growing experience in the management of coronavirus Disease 2019 (COVID-19), the outcome of COVID-19 patients with severe/critical illness would be expected to be better in the second wave compared with the first wave. As our hospitalization criteria changed in the second wave, we aimed to investigate whether a favorable outcome occurred in hospitalized COVID-19 patients with only severe/critical illness. Among 642 laboratory-confirmed hospitalized COVID-19 patients in the first wave and 1121 in the second wave, those who met World Health Organization (WHO) definitions for severe or critical illness on admission or during follow-up were surveyed. Data on demographics, comorbidities, C-reactive protein (CRP) levels on admission, and outcomes were obtained from an electronic hospital database. Univariate analysis was performed to compare the characteristics of patients in the first and second waves. There were 228 (35.5%) patients with severe/critical illness in the first wave and 681 (60.7%) in the second wave. Both groups were similar in terms of age, gender, and comorbidities, other than chronic kidney disease. Median serum CRP levels were significantly higher in patients in the second wave compared with those in the first wave [109 mg/L (interquartile range [IQR]: 65-157) vs. 87 mg/L (IQR: 39-140); p < 0.001]. However, intensive care unit admission and mortality rates were similar among the waves. Even though a lower mortality rate in the second wave has been reported in previous studies, including all hospitalized COVID-19 patients, we found similar demographics and outcomes among hospitalized COVID-19 patients with severe/critical illness in the first and second wave.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/mortalidade , Cuidados Críticos/estatística & dados numéricos , Índice de Gravidade de Doença , Idoso , Amidas/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Azitromicina/uso terapêutico , Proteína C-Reativa/análise , COVID-19/epidemiologia , COVID-19/patologia , Comorbidade , Combinação de Medicamentos , Enoxaparina/uso terapêutico , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Hidroxicloroquina/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pirazinas/uso terapêutico , Estudos Retrospectivos , Ritonavir/uso terapêutico , SARS-CoV-2 , Resultado do Tratamento , Turquia/epidemiologia
4.
Sci Total Environ ; 805: 150355, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-34818767

RESUMO

Post COVID-19, mucormycosis occurred after the SARS-CoV-2 has rampaged the human population and is a scorching problem among the pandemic globally, particularly among Asian countries. Invasive mucormycosis has been extensively reported from mild to severe COVID-19 survivors. The robust predisposing factor seems to be uncontrolled diabetes mellitus, comorbidity and immunosuppression acquired through steroid therapy. The prime susceptive reason for the increase of mucormycosis cases is elevated iron levels in the serum of the COVID survivors. A panoramic understanding of the infection has been elucidated based on clinical manifestation, genetic and non- genetic mechanisms of steroid drug administration, biochemical pathways and immune modulated receptor associations. This review lime-lights and addresses the "What", "Why", "How" and "When" about the COVID-19 associated mucormycosis (CAM) in a comprehensive manner with a pure intention to bring about awareness to the common public as the cases are inevitably and exponentially increasing in India and global countries as well. The article also unearthed the pathogenesis of mucormycosis and its association with the COVID-19 sequela, the plausible routes of entry, diagnosis and counter remedies to keep the infection at bay. Cohorts of case reports were analysed to spotlight the link between the pandemic COVID-19 and the nightmare-mucormycosis.


Assuntos
COVID-19 , Mucormicose , Comorbidade , Fungos , Humanos , Mucormicose/epidemiologia , Pandemias , SARS-CoV-2
5.
J Med Virol ; 94(1): 173-177, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34427924

RESUMO

In this study, it was aimed to determine the antibody responses after the two doses of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations in people who were above 65 years old and to evaluate the factors affecting this response. A total of 235 participants aged 65 years and older were included. Blood samples were taken and data about age, gender, comorbid diseases, and presence of side effects after vaccination were noted. Anti-SARS-CoV-2 QuantiVac ELISA (IgG) test kit (catalogue number: EI-2606-9601-10-G, Euroimmun) was used. The mean age was 70.38 ± 4.76. Approximately 120 of 235 participants had at least one comorbid disease. The mean levels of anti-SARS-CoV-2 IgG antibody after 4 weeks from the first and second doses of vaccine were 37.70 ± 57.08 IU/ml, and 194.61 ± 174.88 IU/ml, respectively. Additionally, 134 of 235 participants (57.02%) had under 25.6 IU/ml antibody level (negative) after 4 weeks from the first vaccine dose while this rate was 11.48% (n = 27) after 4 weeks from the second vaccine dose. The 19 (70.4%) participants who had under had 25.6 IU/ml antibody level after 4 weeks from the first dose of vaccine had at least one comorbid disease including diabetes mellitus, and 8 (29.6%) participants had no comorbid disease (F = 2.352, p = 0.006). Lower rates of antibody response were detected in participants aged 65 years and older and those with comorbidities both in our study and similar studies in the current literature. Further studies should evaluate whether the low antibody titers are really associated with age and comorbidities or not. Finally, prospective studies are needed to determine how long the immunity provided by SARS-CoV-2 vaccines will continue.


Assuntos
Anticorpos Antivirais/sangue , Vacinas contra COVID-19/imunologia , Imunogenicidade da Vacina , SARS-CoV-2/imunologia , Idoso , Idoso de 80 Anos ou mais , Vacinas contra COVID-19/administração & dosagem , Comorbidade , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Vacinas de Produtos Inativados/imunologia
6.
J Med Virol ; 94(1): 272-278, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468994

RESUMO

Data pertaining to risk factor analysis in coronavirus disease 2019 (COVID-19) is confounded by the lack of data from an ethnically diverse population. In addition, there is a lack of data for young adults. This study was conducted to assess risk factors predicting COVID-19 severity and mortality in hospitalized young adults. A retrospective observational study was conducted at two centers from China and India on COVID-19 patients aged 20-50 years. Regression analysis to predict adverse outcomes was performed using parameters including age, sex, country of origin, hospitalization duration, comorbidities, lymphocyte count, and National Early Warning Score 2 (NEWS2) score at admission. A total of 420 patients (172 East Asians and 248 South Asians) were included. The predictive model for intensive care unit (ICU) admission with variables NEWS2 Category II and higher, diabetes mellitus, liver dysfunction, and low lymphocyte counts had an area under the curve (AUC) value of 0.930 with a sensitivity of 0.931 and a specificity of 0.784. The predictive model for mortality with NEWS2 Category III, cancer, and decreasing lymphocyte count had an AUC value of 0.883 with a sensitivity of 0.903 and a specificity of 0.701. A combined predictive model with bronchial asthma and low lymphocyte count, in contrast, had an AUC value of 0.768 with a sensitivity of 0.828 and a specificity of 0.719 for NEWS2 score (5 or above) at presentation. NEWS2 supplemented with comorbidity profile and lymphocyte count could help identify hospitalized young adults at risk of adverse COVID-19 outcomes.


Assuntos
COVID-19/diagnóstico , COVID-19/etnologia , Adulto , Grupo com Ancestrais do Continente Asiático , COVID-19/mortalidade , COVID-19/fisiopatologia , China , Comorbidade , Progressão da Doença , Escore de Alerta Precoce , Feminino , Hospitalização , Humanos , Índia , Unidades de Terapia Intensiva , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-34753829

RESUMO

BACKGROUND AND OBJECTIVES: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. METHODS: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). RESULTS: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). DISCUSSION: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.


Assuntos
COVID-19/epidemiologia , COVID-19/fisiopatologia , Esclerose Múltipla/epidemiologia , Adulto , COVID-19/imunologia , COVID-19/terapia , Estudos de Coortes , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/imunologia , Esclerose Múltipla/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
8.
Esc. Anna Nery Rev. Enferm ; 26: e20210203, 2022. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1339876

RESUMO

RESUMO Objetivo analisar as características individuais, clínicas e os fatores associados à mortalidade de pacientes com COVID-19, em hospital público do estado do Paraná, Brasil. Métodos estudo seccional, retrospectivo, documental (n= 86), com pacientes adultos internados, de março a junho de 2020. Resultados a mortalidade foi de 12,8%, o grupo de maior risco foi de idosos com comorbidades, especialmente, cardiovasculares. A chance de óbito foi 58 vezes maior em idosos, comparada aos adultos, e oito vezes maior naqueles com comorbidades, comparadas aos hígidos. A maioria dos pacientes apresentou sintomatologia respiratória, febre e mialgia. Tratamento à base de antibióticos, anticoagulantes e antivirais, associado ao suporte ventilatório. As principais complicações foram hipóxia, insuficiência renal aguda e infecção secundária. Conclusão e implicações para a prática idosos com comorbidades cardiovasculares que necessitaram de cuidados intensivos apresentaram maior chance de óbito. Os resultados de um dos centros de referência na pandemia possibilitam discutir medidas epidemiológicas adotadas, com ênfase em conceitos restritivos nos primeiros meses.


RESUMEN Objetivo analizar las características individuales, clínicas y los factores asociados a la mortalidad en pacientes con COVID-19 en un hospital público del estado de Paraná. Métodos estudio transversal, retrospectivo, documental (n = 86), con pacientes adultos hospitalizados, de marzo a junio de 2020. Resultados la mortalidad fue del 12,8%, grupo de mayor riesgo para los ancianos con comorbilidades, especialmente enfermedades cardiovasculares. La probabilidad de muerte fue 58 veces mayor en los ancianos en comparación con los adultos y ocho veces mayor en aquellos con comorbilidades en comparación con los sanos. La mayoría de los pacientes presentaban síntomas respiratorios, fiebre y mialgia. Tratamiento a base de antibióticos, anticoagulantes y antivirales, asociado al soporte ventilatorio. Las principales complicaciones fueron hipoxia, insuficiencia renal aguda e infección secundaria. Conclusión e implicaciones para la práctica los ancianos con comorbilidades cardiovasculares que requirieron cuidados intensivos tenían una mayor probabilidad de muerte. Los resultados de uno de los centros de referencia pandémica permiten discutir las medidas epidemiológicas adoptadas, con énfasis en conceptos restrictivos en los primeros meses.


ABSTRACT Objective to analyze the individual and clinical characteristics and the factors associated with mortality in patients with COVID-19, in a public hospital in the state of Paraná, Brazil. Methods a cross-sectional, retrospective, documentary study (n= 86), with adult inpatients, from March to June 2020. Results mortality was 12.8%, the highest risk group was the elderly with comorbidities, especially cardiovascular ones. The chance of death was 58 times higher in the elderly compared to adults, and eight times higher in those with comorbidities compared to the healthy ones. Most patients presented with respiratory symptoms, fever, and myalgia. Treatment was based on antibiotics, anticoagulants and antivirals, associated with ventilatory support. The main complications were hypoxia, acute renal failure, and secondary infection. Conclusion and implications for practice elderly people with cardiovascular comorbidities who required intensive care had a higher chance of death. The results from one of the reference centers in the pandemic make it possible to discuss epidemiological measures adopted, with emphasis on restrictive concepts in the first months.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Perfil de Saúde , Morte , SARS-CoV-2 , COVID-19/mortalidade , Respiração Artificial , Doenças Cardiovasculares , Comorbidade , Registros Médicos , Estudos Retrospectivos , Fatores de Risco , Azitromicina/uso terapêutico , COVID-19/tratamento farmacológico , Unidades de Terapia Intensiva , Tempo de Internação
9.
Infectio ; 25(4): 262-269, oct.-dic. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1286720

RESUMO

Abstract Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions. Materials and methods: Is a retrospective observational study of consecutive hospitalized patients with a diagnosis of COVID-19 confirmed from March 01 to May 30, 2020 in Colombia. Results: A total of 44 patients were included. The median age was 62 years. 43.2% had a history of smoking, while 69.8% were overweight or obese. 88.6% had at least one comorbidity and 52.3% had three or more comorbidities. Hypertension and dyslipidaemia were the most frequent comorbidities (40.9% and 34.1%, respectively). The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome occurred in the 36.4%. The biomarkers associated with mor tality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Conclusions: The clinical course of SARS-CoV-2 infection in hospitalized Colombian was characterised by a more advanced stage of the infection.


Resumen Objetivo: Analizar las características, clínicas, factores de riesgo, y la evolución de pacientes hospitalizados con infección confirmada por COVID-19 en 5 Institu ciones de Colombia. Material y método: Es un estudio observacional retrospectivo de pacientes consecutivos hospitalizados con diagnóstico de COVID-19 confirmado entre 01 de Febrero de 2020 y 30 de Mayo de 2020 en Colombia. Resultados: Un total de 44 pacientes fueron incluidos. La mediana de edad fue de 62 años y la mayoría del sexo masculino. El 43.2% tenían historia de tabaquismo, mientras que el 69.8% tenían sobrepeso u obesidad. El 88.6% tenían al menos una comorbilidad y el 52.3% tenían tres o más comorbilidades. La hipertensión arterial fue la comorbilidad más frecuente (40.9%), seguido de la dislipidemia (34.1%). La tasa de letalidad a 30 días fue de 47.7% y ocurrió con una mediana de 11 días. El 36.4% presentó el desenlace compuesto. Los biomarcadores asociados con el riesgo de muerte fue troponina > 14 ng/mL (RR:5.25, IC95% 1.37-20.1, p=0.004) y dímero D mayor a 1000 mg/dL (RR: 3.0, IC95% 1.4-6.3, p=0.008). Conclusiones: El curso clínico de la infección por SARS-CoV-2 en colombianos hospitalizados fue un estadio más avanzado de la infección.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Biomarcadores , COVID-19 , Pacientes , Tabagismo , Comorbidade , Risco , Fatores de Risco , Mortalidade , Colômbia , Sobrepeso , Cursos , Infecções , Obesidade
11.
Surg Clin North Am ; 101(6): 981-993, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774276

RESUMO

Smoking and obesity are commonly encountered problems in the elective, perioperative setting. This article reviews the risks posed by smoking and diabetes and explores way to mitigate such risks. Other means of perioperative optimization are also discussed in an effort to describe perioperative strategies that can improve patient outcomes.


Assuntos
Complicações do Diabetes , Procedimentos Cirúrgicos Eletivos , Obesidade , Fumar , Comorbidade , Complicações do Diabetes/complicações , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Obesidade/complicações , Obesidade/terapia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Fatores de Risco , Fumar/efeitos adversos , Abandono do Hábito de Fumar
12.
Open Heart ; 8(2)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34782369

RESUMO

OBJECTIVE: To determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19. METHODS: A retrospective and prospective observational study of inpatients referred for transthoracic echocardiography for suspected cardiac pathology due to COVID-19 within a London NHS Trust. Echocardiograms were performed to assess left ventricular (LV), right ventricular (RV) and pulmonary variables along with collection of patient demographics, comorbid conditions, blood biomarkers and outcomes. RESULT: In the predominant non-white (72%) population, RV dysfunction was the primary cardiac abnormality noted in 50% of patients, with RV fractional area change <35% being the most common marker of this RV dysfunction. By comparison, LV systolic dysfunction occurred in 18% of patients. RV dysfunction was associated with LV systolic dysfunction and the presence of a D-shaped LV throughout the cardiac cycle (marker of significant pulmonary artery hypertension). LV systolic dysfunction (p=0.002, HR 3.82, 95% CI 1.624 to 8.982), pulmonary valve acceleration time (p=0.024, HR 0.98, 95% CI 0.964 to 0.997)-marker of increased pulmonary vascular resistance, age (p=0.047, HR 1.027, 95% CI 1.000 to 1.055) and an episode of tachycardia measured from admission to time of echo (p=0.004, HR 6.183, 95% CI 1.772 to 21.575) were independently associated with mortality. CONCLUSIONS: In this predominantly non-white population hospitalised with COVID-19, the most common cardiac pathology was RV dysfunction which is associated with both LV systolic dysfunction and elevated pulmonary artery pressure. The latter two, not RV dysfunction, were associated with mortality.


Assuntos
COVID-19/etnologia , Grupos Étnicos , Cardiopatias/etnologia , Ventrículos do Coração/diagnóstico por imagem , Vigilância da População , Comorbidade , Estudos Transversais , Ecocardiografia Doppler , Cardiopatias/diagnóstico , Hospitalização/tendências , Humanos , Pandemias , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências
13.
Heart Surg Forum ; 24(5): E906-E908, 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34730492

RESUMO

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease that threatens global health. During the pandemic period of COVID-19, the task for prevention in the general ward of cardiovascular surgery is fairly arduous. The present study intends to summarize our experience with infection control, including ward setting, admission procedures, personnel management, health education, and so on, to provide references for clinical management.


Assuntos
COVID-19/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/normas , Doenças Cardiovasculares/epidemiologia , Guias como Assunto , Pandemias/prevenção & controle , Quartos de Pacientes/normas , Centros de Atenção Terciária , COVID-19/epidemiologia , Doenças Cardiovasculares/cirurgia , China/epidemiologia , Comorbidade , Humanos , Estudos Retrospectivos , SARS-CoV-2
14.
BMC Pregnancy Childbirth ; 21(1): 745, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732157

RESUMO

BACKGROUND: Seasonal influenza can circulate in parallel with coronavirus disease (COVID-19) in winter. In the context of COVID-19 pandemic, the risk of co-infection and the burden it poses on healthcare system calls for timely influenza vaccination among pregnant women, who are the priority population recommended for vaccination. We aimed to evaluate the acceptance of influenza vaccination and associated factors among pregnant women during COVID-19 pandemic, provide evidence to improve influenza vaccination among pregnant women, help reduce the risk of infection and alleviate the burden of healthcare system for co-infected patients. METHODS: We conducted a multi-center cross-sectional study among pregnant women in China. Sociodemographic characteristics, health status, knowledge on influenza, attitude towards vaccination, and health beliefs were collected. Locally weighted scatterplot smoothing regression analysis was used to evaluate the trends in the acceptance of influenza vaccine. Logistic regression was applied to identify factors associated with vaccination acceptance. RESULTS: The total acceptance rate was 76.5% (95%CI: 74.8-78.1%) among 2568 pregnant women enrolled. Only 8.3% of the participants had a history of seasonal influenza vaccination. In the logistic regression model, factors associated with the acceptance of influenza vaccine were western region, history of influenza vaccination, high knowledge of influenza infection and vaccination, high level of perceived susceptibility, perceived benefit, cues to action and low level of perceived barriers. Among 23.5% of the participants who had vaccine hesitancy, 48.0% of them were worried about side effect, 35.6% of them lacked confidence of vaccine safety. CONCLUSIONS: Our findings highlighted that tailored strategies and publicity for influenza vaccination in the context of COVID-19 pandemic are warranted to reduce pregnant women's concerns, improve their knowledge, expand vaccine uptake and alleviate pressure for healthcare system.


Assuntos
COVID-19/epidemiologia , Vírus da Influenza A/imunologia , Vacinas contra Influenza/farmacologia , Influenza Humana/prevenção & controle , Pandemias , Complicações Infecciosas na Gravidez/prevenção & controle , Vacinação/métodos , Adulto , China/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Modelo de Crenças de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Influenza Humana/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , SARS-CoV-2 , Estações do Ano , Inquéritos e Questionários
15.
Rev Clin Esp (Barc) ; 221(9): 529-535, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34752264

RESUMO

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February 2020, who had been discharged or died up to 29th April 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) y cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335 UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345 IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345 IU/L and age≥65 years, are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Mortalidade Hospitalar , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Teste de Ácido Nucleico para COVID-19 , Cardiomiopatias/epidemiologia , Comorbidade , Feminino , Hospitais Gerais , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia
16.
Ann Ital Chir ; 92: 589-591, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795115

RESUMO

OBJECTIVE: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019(COVID-19) who developed bowel perforation. MATERIALS AND METHODS: This case series was conducted in Emergency Department of AORN Sant'Anna and S. Sebastiano located in Caserta. All patients resulted positive to SARS-Cov-2 in nasopharyngeal swabs whith a positive laboratory test for SARS-CoV-2 from real time reverse transcription polymerase chain reaction(RT-PCR) as well as bowel perforation which was identified by abdominal CT, from September 2020 to December 2020. RESULTS: A total of five patients were identified with Bowel perforation occurred despite all patients being on anticoagulation. All patients were Italian, predominantly male(four patients) with an average age of 60 years and the most common comorbidity was hypertension, diabetes and obesity. DISCUSSION: Bowel perforation in COVID-19 is clinically significant with high morbidity and mortality. In our series 40% of patients who were diagnosed of bowel perforation died. Average time to death after bowel perforation diagnosis was 6 days. CONCLUSION: We describe a case series of COVID-19 patients who developed bowel perforation. KEY WORDS: Covid-19, Bowel perforation.


Assuntos
COVID-19 , Perfuração Intestinal , Comorbidade , Humanos , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Fatores de Tempo
17.
Medicina (Kaunas) ; 57(11)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34833391

RESUMO

Obstructive sleep apnea is the most common type of sleep-disordered breathing with growing prevalence. Its presence has been associated with poor quality of life and serious comorbidities. There is increasing evidence for coexisting obstructive sleep apnea in patients suffering from head and neck cancer, a condition that ranks among the top ten most common types of cancer worldwide. Routinely, patients with head and neck cancer are treated with surgery, radiation therapy, chemotherapy, immunotherapy or a combination of these, all possibly interfering with the anatomy of the oral cavity, pharynx or larynx. Thus, cancer treatment might worsen already existing obstructive sleep apnea or trigger its occurrence. Hypoxia, the hallmark feature of obstructive sleep apnea, has an impact on cancer biology and its cure. Early diagnosis and sufficient treatment of coexisting obstructive sleep apnea in patients with head and neck cancer may improve quality of life and could also potentially improve oncological outcomes.


Assuntos
Neoplasias de Cabeça e Pescoço , Apneia Obstrutiva do Sono , Comorbidade , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Faringe , Qualidade de Vida , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia
18.
Medicina (Kaunas) ; 57(11)2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34833419

RESUMO

Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are usually associated with multi-morbidity. The aim of this study was to retrospectively investigate the prevalence of comorbidities in a cohort of patients with OSAS and COPD-OSAS overlap syndrome (OS) patients and to explore differences between these two groups. Materials and Methods: Included were consecutive OS patients and OSAS patients who had been referred to our sleep laboratory, and were matched in terms of sex, age, BMI, and smoking history. Presence of comorbidities was recorded based on their medical history and after clinical and laboratory examination. Results: The two groups, OS patients (n = 163, AHI > 5/h and FEV1/FVC < 0.7) and OSAS patients (n = 163, AHI > 5/h, and FEV1/FVC > 0.7), did not differ in terms of apnea hypopnea index (p = 0.346), and oxygen desaturation index (p = 0.668). Compared to OSAS patients, OS patients had lower average SpO2 (p = 0.008) and higher sleep time with oxygen saturation <90% (p = 0.002) during sleep, and lower PaO2 (p < 0.001) and higher PaCO2 (p = 0.04) in wakefulness. Arterial hypertension was the most prevalent comorbidity for both OS and OSAS, followed by dyslipidemia, cardiovascular disease (CVD) and diabetes. OS was characterized by a higher prevalence of total comorbidities (median (IQR):2 (1-3) vs. 2 (1-2), p = 0.033), which was due to the higher prevalence of CVD (p = 0.016) than OSAS. No differences were observed in other comorbidities. Conclusions: In OS patients, nocturnal hypoxia and impaired gas exchange in wakefulness are more overt, while a higher burden of CVD is observed among them in comparison to sex-, age- and BMI-matched OSAS patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Apneia Obstrutiva do Sono , Comorbidade , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Testes de Função Respiratória , Estudos Retrospectivos , Apneia Obstrutiva do Sono/epidemiologia
19.
Medicina (Kaunas) ; 57(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34833474

RESUMO

Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is not yet clear why people with bipolar disorder are at higher risk of addictive disorders, but recent data suggest common neurobiological and genetic underpinnings and epigenetic alterations. In the absence of specific diagnostic instruments, the clinical interview is conducive for the diagnosis. Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Most treatment trials focus on single drugs, such as cannabis alone or in combination with alcohol, cocaine, or amphetamines. Synopsis of data provides limited evidence that lithium and valproate are effective for the treatment of mood symptoms in cannabis users and may reduce substance use. Furthermore, the neuroprotective agent citicoline may reduce cocaine consumption in BD subjects. However, many of the available studies had an open-label design and were of modest to small sample size. The very few available psychotherapeutic trials indicate no significant differences in outcomes between BD with or without SUD. Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.


Assuntos
Alcoolismo , Transtorno Bipolar , Transtornos Relacionados ao Uso de Substâncias , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Comorbidade , Humanos , Psicotrópicos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
20.
Arch Ital Urol Androl ; 93(3): 251-254, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34839625

RESUMO

OBJECTIVES: Comorbidity along with tumor and patient characteristics is taken into account when deciding for the surgical treatment of renal cell carcinoma (RCC). Comorbidity has also been used as an independent predictive factor for postoperative complications of several major urological procedures including radical nephrectomy for RCC. The aim of the present study was to objectively evaluate the association between comorbidity and postoperative complications after radical nephrectomy for RCC, using standardized systems to grade both comorbidity and severity of postoperative complications. MATERIALS AND METHODS: Clinicopathological data of 171 patients undergoing open radical nephrectomy for lesions suspected of RCC were prospectively recorded for a period of 3 years. Comorbidity was scored using the Charlson Comorbidity Index (CCI) while postoperative complications were graded according to the Clavien-Dindo system. RESULTS: Patients were predominantly males (59.1%); their age ranged from 35 to 88 years (mean ± SD: 63.6 ± 11.9 yrs) with 50.8% of them being ≤ 65 yrs. CCI ranged from 0 to 8 with the majority (85.3%) scoring ≤ 2. The procedure was uncomplicated in 57.3% cases; 10 patients suffered major (grade III/IV) complications and 4 patients died within the 40 days postoperative period. CCI correlated with the manifestation of any postoperative complication, Clavien ≥ 1, OR (95% CI): 1.47 (1.09-1.96), p = 0.011 and the occurrence of severe complications, Clavien > 2. OR (95% CI): 1.29 (1.01-1.63), p = 0.038. CONCLUSIONS: The present prospective study showed that considerable complications occur in patients with major comorbidities. CCI is easily calculated and should be incorporated in preoperative consultation especially in cases of elder patients with severe comorbidity and favorable tumor characteristics where less invasive interventions or even active surveillance could be applied.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/cirurgia , Comorbidade , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos
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