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1.
Nurs Clin North Am ; 57(2): 245-258, 2022 06.
Article in English | MEDLINE | ID: covidwho-1819287

ABSTRACT

This article highlights the critical role of advanced practice registered nurses in the care of older adults living in nursing homes. This population is one of the frailest, marginalized, and often neglected in the United States. The COVID-19 pandemic impact on nursing homes resulted in a stunning number of infections and subsequent resident deaths. This is a shameful reminder of the many challenges and gaps in the nursing home industry including inadequate staffing, high staff turnover, improper isolation technique, and lack of fundamental knowledge of how to adequately implement infection prevention and control processes. Strong advanced practice registered nurse leadership may have mitigated some of these factors.


Subject(s)
COVID-19 , Nurses , Aged , Humans , Leadership , Nursing Homes , Pandemics , United States
2.
J Pak Med Assoc ; 72(8): 1572-1576, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2101071

ABSTRACT

OBJECTIVE: To assess the discrepancy in terms of history related to coronavirus disease-2019 and symptoms given in the pre-clinic triage and to the doctor attending the patient in a gastroenterology clinic. METHODS: The observational study was conducted from September 2020 to January 2021 at the Gastroenterology outpatient department of Dr Ziauddin Hospital's Clifton unit in Karachi, and comprised all patients visiting the facility regardless of age and gender. Data was collected using a questionnaire that was first filled up by the receptionist outside the clinic and was then administered again once the patient entered the clinic. Discrepancy on the answers was then checked and associations were determined with clinical assessment. Data was analysed using SPSS 20. RESULTS: Of the 300 patients, 184(61.3%) were males and 116(38.6%) were females. The overall mean age was 55 ± 16.98 (range: 18-92 years). Discrepancy between pre-clinic and in-clinic self-reported data was significant for fever, cough, fatigue, headache, body ache, diarrhoea, sore throat, loss of sense of smell/taste, shortness of breath, and contact with someone positive for coronavirus disease-2019 was significant (p<0.05). CONCLUSIONS: Patients were found to be afraid of getting barred from seeing a consultant, had fear of hospital-based isolation or were in denial regarding the pandemic.


Subject(s)
COVID-19 , Gastroenterology , Male , Female , Humans , Adult , Middle Aged , Aged , Triage , SARS-CoV-2 , Pandemics
3.
Acta Myol ; 41(2): 76-83, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2101026

ABSTRACT

The recent approval of disease-modifying therapies for spinal muscular atrophy (SMA) raised the need of alternative outcome measures to evaluate treatment efficacy. In this study, we investigated the potential of muscle quantitative MRI (qMRI) as a biomarker of disease progression in adult SMA3 patients during nusinersen treatment. Six adult SMA3 patients (age ranging from 19 to 65 years) underwent 2-point Dixon muscle qMRI at beginning of nusinersen treatment (T0) and after 14 months (T14) to evaluate the muscle fat fraction (FF) at thigh and leg levels; patients were clinically assessed at T0 and T14 with the Hammersmith Functional Rating Scale Expanded (HFMSE), the Revised Upper Limb Module (RULM) and the 6-minute walk test (6MWT). At T0, vastus lateralis muscle displayed the highest mean FF (67.5%), while tibialis anterior was the most preserved one (mean FF = 35.2%). At T0, a slightly significant correlation of FF with HFMSE (p = 0.042) and disease duration (p = 0.042) at thigh level and only with HFMSE (p = 0.042) at leg level was found. At T14, no significant change of mean FF values at thigh and leg muscles was found compared to T0. Conversely, a statistically significant (p = 0.042) improvement of HFMSE was reported at T14. We observed no significant change of FF in thigh and leg muscles after 14 months of nusinersen therapy despite a significant clinical improvement of HFMSE. Further studies with longer follow-up and larger cohorts are needed to better investigate the role of qMRI as marker of disease progression in SMA patients.


Subject(s)
Muscular Atrophy, Spinal , Spinal Muscular Atrophies of Childhood , Adult , Aged , Disease Progression , Humans , Longitudinal Studies , Magnetic Resonance Imaging , Middle Aged , Muscle, Skeletal/diagnostic imaging , Oligonucleotides , Spinal Muscular Atrophies of Childhood/drug therapy , Young Adult
4.
In Vivo ; 36(6): 2823-2827, 2022.
Article in English | MEDLINE | ID: covidwho-2100683

ABSTRACT

BACKGROUND/AIM: COVID-19 is a concerning issue among in-center hemodialysis (HD) patients. To prevent COVID-19 diffusion in our HD facility, weekly rapid nasal antigen test screening was performed for all asymptomatic patients on chronic HD. This study aimed to assess the performance of weekly rapid antigen test in detecting SARS-CoV-2 infection among asymptomatic patients receiving HD. PATIENTS AND METHODS: A retrospective analysis was conducted in HD patients who underwent rapid antigen test screening from December 2021 to March 2022. The diagnosis of COVID-19 with rapid antigen test was always confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: During the observational period, 1,748 rapid antigen tests were performed in 220 HD patients. Mean age was 68.4±14.6 years. Fifteen (8.5%) patients resulted positive for SARS-CoV-2 infection using rapid antigen tests. The diagnosis was subsequently confirmed in 14 (93.3%) patients by RT-PCR. During the same period, 12 (5.4%) symptomatic patients, regularly screened with weekly rapid antigen test, resulted positive for SARS-CoV-2 infection using RT-PCR. Overall, weekly rapid antigen test screening identified 14 out of 26 (53.8%) COVID-19 cases and showed a positive predictive value of 93%. CONCLUSION: Weekly antigen test screening of asymptomatic patients on chronic HD detected around half of the COVID-19 cases in our population.


Subject(s)
COVID-19 , Humans , Middle Aged , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , SARS-CoV-2 , Retrospective Studies , COVID-19 Testing , Renal Dialysis , Sensitivity and Specificity
5.
Ulus Travma Acil Cerrahi Derg ; 28(11): 1655-1658, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2100494

ABSTRACT

The pulmonary symptoms secondary to severe acute respiratory syndrome in coronavirus (COVID-19) infections are the most common presentation for the disease; however, it is now known that in a small portion of patients, severe hemorrhagic complications can also be seen. In this report, three cases of elderly women with known COVID-19 infection, developing spontaneous rectus sheath hematoma on anticoagulation therapy, are presented. Three cases presented above emphasize the need to perform a computed tomography examination after a sudden hemodynamic deterioration and a decrease in hemoglobin count in COVID-19 patients in intensive care units (ICUs). Since this clinical deterioration can be caused by spontaneous rectus sheath hematomas (RSH), it must be taken into consideration while examination. If these RSHs rupture into the abdominal cavity, the outcome may be fatal in few hours as represented in two of our cases. Major spontaneous hemorrhage in COVID-19 patients is quite uncommon; therefore, it may cause serious complications as it is rarely taken into consideration. Failure to acknowledge such a risk could significantly worsen the prognosis of the patients especially in ERs and ICUs.


Subject(s)
COVID-19 , Muscular Diseases , Humans , Female , Aged , Rectus Abdominis/diagnostic imaging , COVID-19/complications , Hematoma/etiology , Hematoma/complications , Muscular Diseases/complications , Muscular Diseases/therapy , Tomography, X-Ray Computed , Anticoagulants/adverse effects
6.
Am J Case Rep ; 23: e937760, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2100412

ABSTRACT

BACKGROUND On rare occasions, viral infections are known to also depress immune cell lines, further worsening clinical outcomes. We describe a patient who presented 3 weeks after recovery from mild COVID-19 disease with clinical features of an atypical pneumonia and was found to have a low CD4+ T-cell count. CASE REPORT An 82-year-old man with a past medical history of coronary artery disease, rheumatoid arthritis, gout, hypertension, and atrial fibrillation presented with a 1-week history of progressively worsening shortness of breath and cough. He was noted to have recovered from mild SARS-CoV-2 infection 3 weeks prior to his current presentation and had been at his baseline level of health following infection. A T cell subset panel was obtained, which revealed an absolute CD3 count of 92 (reference range 840-3060), absolute CD4 count of 52 (reference range 500-1400), absolute CD8 count of 37 (reference range 180-1170), and a normal CD4: CD8 ratio. He was subsequently started on atovaquone for pneumocystis jiroveci pneumonia prophylaxis. CONCLUSIONS This case highlights the need for a high index of suspicion for lymphocyte depletion in older patients with multiple comorbidities who present during or after SARS-CoV-2 infection with atypical symptoms that are suggestive of immunosuppression. In such instances, there should be a low threshold to start prophylactic therapy for possible opportunistic infections.


Subject(s)
COVID-19 , Pneumonia, Pneumocystis , Male , Humans , Aged , Aged, 80 and over , SARS-CoV-2 , T-Lymphocyte Subsets , Cough
7.
Ann Glob Health ; 88(1): 94, 2022.
Article in English | MEDLINE | ID: covidwho-2100231

ABSTRACT

Background: Since 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in >554M cases and >6.3M deaths worldwide. The disease caused by SARS-CoV-2, COVID-19, has resulted in a broad range of clinical symptoms differing in severity. Initially, the elderly were identified as particularly susceptible to severe COVID-19, with children experiencing less severe disease. However, as new variants arise, the epidemiology of SARS-CoV-2 infection is changing, and the disease severity in children is increasing. While environmental impacts on COVID-19 have been described, the underlying mechanisms are poorly described. Objective: The Pacific Basin Consortium for Environment and Health (PBC) held meeting on September 16, 2021, to explore environmental impacts on infectious diseases, including COVID-19. Methods: The PBC is an international group of environmental scientists and those interested in health outcomes. The PBC met to present preliminary data and discuss the role of exposures to airborne pollutants in enhancing susceptibility to and severity of respiratory tract viral infections, including COVID-19. Findings: Analysis of the literature and data presented identified age as an important factor in vulnerability to air pollution and enhanced COVID-19 susceptibility and severity. Mechanisms involved in increasing severity of COVID-19 were discussed, and gaps in knowledge were identified. Conclusions: Exposure to particulate matter (PM) pollution enhanced morbidity and mortality to COVID-19 in a pediatric population associated with induction of oxidative stress. In addition, free radicals present on PM can induce rapid changes in the viral genome that can lead to vaccine escape, altered host susceptibility, and viral pathogenicity. Nutritional antioxidant supplements have been shown to reduce the severity of viral infections, inhibit the inflammatory cytokine storm, and boost host immunity and may be of benefit in combating COVID-19.


Subject(s)
Air Pollution , COVID-19 , Virus Diseases , Child , Humans , Aged , COVID-19/epidemiology , SARS-CoV-2 , Air Pollution/adverse effects , Particulate Matter/adverse effects , Particulate Matter/analysis , Environment
8.
Indian J Pathol Microbiol ; 65(4): 928-930, 2022.
Article in English | MEDLINE | ID: covidwho-2100026

ABSTRACT

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It commonly affects the respiratory system, producing pneumonia-like symptoms. Among extrapulmonary manifestations, involvement of the gastrointestinal tract is common with symptoms of nausea, vomiting, diarrhea, and abdominal pain. Coronavirus acts by targeting the ACE-2 receptors in the alveoli of the lungs, but because these receptors are also present in other organs, such as the pancreas, it can affect the pancreas as well, thus causing acute pancreatitis. We here discuss a case of a 72-year-old hypertensive male with COVID-19 who presented with atypical presentation of acute abdominal pain and a few episodes of vomiting. Laboratory investigations were inconclusive. Imaging findings were suggestive of small bowel obstruction and perforation; thus, an exploratory laparotomy was done in which a mesenteric growth was found, reported as acute pancreatitis on histopathology. Therefore, attention should be paid to the pancreatic involvement and atypical presentations in COVID-19 patients.


Subject(s)
COVID-19 , Pancreatitis , Humans , Male , Aged , SARS-CoV-2 , Acute Disease , Pancreatitis/diagnosis , Abdominal Pain , Vomiting
9.
Cleve Clin J Med ; 89(11): 617-624, 2022 11 01.
Article in English | MEDLINE | ID: covidwho-2099970

ABSTRACT

Articles published in 2020 and 2021 contain important research related to preventing Alzheimer dementia; the relationships between frailty, social isolation, and mortality; COVID-19 risks in patients with dementia; hospital-at-home programs; deprescribing antihypertensive drugs; bisphosphonate-related atypical femoral fractures; and cannabis use in older adults.


Subject(s)
Alzheimer Disease , COVID-19 , Frailty , Humans , Aged , Diphosphonates/adverse effects
10.
Risk Anal ; 42(7): 1571-1584, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2097864

ABSTRACT

Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality, deprivation levels, care home bed capacity, age distribution, rurality, access to employment centers, and population density. We considered these covariates as risk factors for excess cases and excess deaths in the 28 days after confirmation of positive Covid status relative to the overall case load and death recorded for the study area as a whole. We used the conditional autoregressive Besag-York-Mollie model to investigate the spatial dependency of cases and deaths allowing for a Poisson error structure. Structural equation models were applied to clarify relationships between predictors and outcomes. Excess case counts or excess deaths were both predicted by the percentage of population age 65 years, care home bed capacity and less rurality: older population and more urban areas saw excess cases. Greater deprivation did not correlate with excess case counts but was significantly linked to higher mortality rates after infection. Neither excess cases nor excess deaths were predicted by population density, travel time to local employment centers, or air quality indicators. Only 66% of mortality was explained by locally high case counts. Higher deprivation clearly linked to higher COVID-19 mortality separate from wider community prevalence and other spatial risk factors.


Subject(s)
Air Pollution , COVID-19 , Aged , Air Pollution/adverse effects , England/epidemiology , Humans , Mortality , Risk Factors , SARS-CoV-2
11.
Scand J Trauma Resusc Emerg Med ; 28(1): 107, 2020 Oct 28.
Article in English | MEDLINE | ID: covidwho-2098376

ABSTRACT

OBJECTIVES: COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. METHODS: Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. RESULTS: As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373-399) minutes to 307 (297-317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55-0.99). CONCLUSIONS: It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Crowding , Emergency Service, Hospital , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , Bed Occupancy , COVID-19 , Female , Hospitalization , Hospitals, University , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sweden
12.
Scand J Trauma Resusc Emerg Med ; 28(1): 106, 2020 Oct 27.
Article in English | MEDLINE | ID: covidwho-2098375

ABSTRACT

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) is a global public health emergency. Here, we developed and validated a practical model based on the data from a multi-center cohort in China for early identification and prediction of which patients will be admitted to the intensive care unit (ICU). METHODS: Data of 1087 patients with laboratory-confirmed COVID-19 were collected from 49 sites between January 2 and February 28, 2020, in Sichuan and Wuhan. Patients were randomly categorized into the training and validation cohorts (7:3). The least absolute shrinkage and selection operator and logistic regression analyzes were used to develop the nomogram. The performance of the nomogram was evaluated for the C-index, calibration, discrimination, and clinical usefulness. Further, the nomogram was externally validated in a different cohort. RESULTS: The individualized prediction nomogram included 6 predictors: age, respiratory rate, systolic blood pressure, smoking status, fever, and chronic kidney disease. The model demonstrated a high discriminative ability in the training cohort (C-index = 0.829), which was confirmed in the external validation cohort (C-index = 0.776). In addition, the calibration plots confirmed good concordance for predicting the risk of ICU admission. Decision curve analysis revealed that the prediction nomogram was clinically useful. CONCLUSION: We established an early prediction model incorporating clinical characteristics that could be quickly obtained on hospital admission, even in community health centers. This model can be conveniently used to predict the individual risk for ICU admission of patients with COVID-19 and optimize the use of limited resources.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Hospitalization , Intensive Care Units , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Adult , Aged , COVID-19 , China , Coronavirus Infections/diagnosis , Female , Humans , Logistic Models , Male , Middle Aged , Nomograms , Pandemics , Pneumonia, Viral/diagnosis , Retrospective Studies , Risk Assessment , SARS-CoV-2
13.
Scand J Trauma Resusc Emerg Med ; 28(1): 66, 2020 Jul 13.
Article in English | MEDLINE | ID: covidwho-2098371

ABSTRACT

BACKGROUND: There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. METHODS: This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥ 6, quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥ 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong's test. RESULTS: In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥ 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% CI 0.690-0.953). NEWS2 was superior to qSOFA score ≥ 2 (AUC 0.624, 95% CI 0.446-0.810, p < 0.05) and other clinical risk scores for this purpose. CONCLUSION: NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Early Warning Score , Hospital Mortality , Patient Admission , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Female , Humans , Male , Middle Aged , Norway/epidemiology , Pandemics , Risk Assessment , SARS-CoV-2 , Sensitivity and Specificity , Severity of Illness Index
15.
Rev Esc Enferm USP ; 56: e20210421, 2022.
Article in English, Portuguese | MEDLINE | ID: covidwho-2098904

ABSTRACT

OBJECTIVE: To characterize and identify depressive symptoms, anxiety, and stress associated with the COVID-19 Infodemic in the elderly from São Paulo. METHOD: Exploratory and cross-sectional study with the elderly in the capital of São Paulo who had internet access. The sociodemographic profile, the COVID-19 infodemic, depressive symptoms, stress, and anxiety were analyzed. RESULTS: A total of 411 older people participated in the study. There was a predominance of women (76.4%), with higher education (57.9%), using private health services, and with little income variation. Older people were more exposed to news or information about COVID-19 on the internet (45.3%), followed by television (34.5%), and radio (11.4%). The average stress was 19.96 points; 33.1% had anxiety, and 39.7% had depressive symptoms. The greater the number of people living with the elderly, the greater the stress (p = 0.001) and anxiety (p = 0.02). The hours of exposure to information on the internet led to stress (p = 0.001), depressive symptoms (p = 0.02), and anxiety (p = 0.02) in the elderly. CONCLUSION: During the pandemic, exposure to information on the internet triggered anxiety, stress, and depressive symptoms in the elderly. The findings highlight the need for multi and interdisciplinary interventions to mitigate such repercussions on the elderly's health.


Subject(s)
COVID-19 , Aged , Anxiety/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Female , Humans , Infodemic , Male , Mental Health
16.
Endocr J ; 69(10): 1173-1181, 2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2098816

ABSTRACT

Symptoms of long COVID are complex and long-lasting, and endocrine dysfunction might be involved in the underlying mechanisms. In this study, to clarify the hormonal characteristics of long COVID patients, laboratory data for patients who visited the outpatient clinic for long COVID were evaluated. A retrospective analysis was performed for patients who visited Okayama University Hospital during the period from Feb 2021 to Dec 2021 with focus on the interrelationships between major symptoms and endocrine data. Information and laboratory data were obtained from medical records for 186 patients. The patients had various symptoms, and the most frequent symptoms were general malaise, dysosmia/dysgeusia, hair loss, headache, dyspnea, and sleeplessness. Patients who were suffering from fatigue and dysosmia/dysgeusia were younger, while hair loss was more frequent in older and female patients. As for the characteristics of patients suffering from general fatigue, the scores of depression and fatigue were positively correlated with serum levels of cortisol and free thyroxin (FT4), respectively. Also, patients suffering from general fatigue had lower levels of serum growth hormone and higher levels of serum FT4, while patients with dysosmia/dysgeusia had a significantly lower level of serum cortisol. Serum thyrotropin (TSH) levels were higher and the ratios of FT4/TSH were lower in the initially severe cases, suggesting occult hypothyroidism. In addition, the ratios of plasma adrenocorticotropin to serum cortisol were decreased in patients with relatively high titers of serum SARS-CoV-2 antibody. Thus, hormonal changes seem to be, at least in part, involved in the persistent symptoms of long COVID.


Subject(s)
COVID-19 , Olfaction Disorders , Humans , Female , Aged , Thyrotropin , Hydrocortisone , Retrospective Studies , Dysgeusia , SARS-CoV-2 , Alopecia , Fatigue/epidemiology , Fatigue/etiology , Thyroxine
17.
Respir Res ; 23(1): 296, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2098345

ABSTRACT

BACKGROUND: Anticoagulant treatment is recommended for at least three months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related acute pulmonary embolism (PE), but the persistent pulmonary clot burden after that time is unknown. METHODS: Lung perfusion was assessed by ventilation-perfusion (V/Q) SPECT/CT in 20 consecutive patients with SARS-CoV-2-associated acute PE after a minimum of three months anticoagulation therapy in a retrospective observational study. RESULTS: Remaining perfusion defects after a median treatment period of six months were observed in only two patients. All patients (13 men, seven women, mean age 55.6 ± 14.5 years) were on non-vitamin K direct oral anticoagulants (DOACs). No recurrent venous thromboembolism or anticoagulant-related bleeding complications were observed. Among patients with partial clinical recovery, high-risk PE and persistent pulmonary infiltrates were significantly more frequent (p < 0.001, respectively). INTERPRETATION: Temporary DOAC treatment seems to be safe and efficacious for resolving pulmonary clot burden in SARS-CoV-2-associated acute PE. Partial clinical recovery is more likely caused by prolonged SARS-CoV-2-related parenchymal lung damage rather than by persistent pulmonary perfusion defects.


Subject(s)
COVID-19 , Pulmonary Embolism , Male , Humans , Female , Adult , Middle Aged , Aged , SARS-CoV-2 , COVID-19/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Lung/diagnostic imaging , Single Photon Emission Computed Tomography Computed Tomography , Anticoagulants/therapeutic use , Acute Disease , Perfusion
18.
BMC Med Res Methodol ; 22(1): 281, 2022 11 01.
Article in English | MEDLINE | ID: covidwho-2098313

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the most effective combination of autoregressive integrated moving average (ARIMA), a time series model, and association rule mining (ARM) techniques to identify meaningful prognostic factors and predict the number of cases for efficient COVID-19 crisis management. METHODS: The 3685 COVID-19 patients admitted at Thailand's first university field hospital following the four waves of infections from March 2020 to August 2021 were analyzed using the autoregressive integrated moving average (ARIMA), its derivative to exogenous variables (ARIMAX), and association rule mining (ARM). RESULTS: The ARIMA (2, 2, 2) model with an optimized parameter set predicted the number of the COVID-19 cases admitted at the hospital with acceptable error scores (R2 = 0.5695, RMSE = 29.7605, MAE = 27.5102). Key features from ARM (symptoms, age, and underlying diseases) were selected to build an ARIMAX (1, 1, 1) model, which yielded better performance in predicting the number of admitted cases (R2 = 0.5695, RMSE = 27.7508, MAE = 23.4642). The association analysis revealed that hospital stays of more than 14 days were related to the healthcare worker patients and the patients presented with underlying diseases. The worsening cases that required referral to the hospital ward were associated with the patients admitted with symptoms, pregnancy, metabolic syndrome, and age greater than 65 years old. CONCLUSIONS: This study demonstrated that the ARIMAX model has the potential to predict the number of COVID-19 cases by incorporating the most associated prognostic factors identified by ARM technique to the ARIMA model, which could be used for preparation and optimal management of hospital resources during pandemics.


Subject(s)
COVID-19 , Humans , Aged , COVID-19/epidemiology , Time Factors , Models, Statistical , Pandemics , Forecasting , Data Mining
19.
Pediatr Int ; 64(1): e15329, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-2097855

ABSTRACT

BACKGROUND: Although widely reported to affect older adults more, coronavirus disease 2019 (COVID-19) also affects adolescents, especially those with co-morbidities, including heart diseases. The safety and efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines has been established in healthy adolescents, yet there are few data for humoral and cellular immunogenicity in adolescents with cardiac diseases. METHODS: We evaluated anti-spike antibodies, neutralizing activities, and interferon-gamma production prior to and after SARS-CoV-2 vaccination in adolescents with cardiac diseases and healthy controls. RESULTS: Five healthy adolescents and 26 patients with cardiac diseases, including congenital heart disease (CHD, n = 10), dilated cardiomyopathy (DCM, n = 4), idiopathic pulmonary arterial hypertension (IPAH, n = 4), and those post-heart transplantation (post-HTx, n = 8) were enrolled. No severe adverse events, including myocarditis and pericarditis, were noted, even in patients with severe heart failure. Febrile events were noted after 21 of 62 injections (34%). All the healthy adolescents and 21 of the 26 patients (81%) showed sufficient elevation of neutralizing antibodies after the second dose of vaccination. Neutralizing antibodies and cellular immunity were absent in four of the eight post-HTx patients and one with single ventricle CHD. There was no correlation between the anti-spike and neutralizing antibody titers and interferon-gamma levels. When comparing the clinical characteristics of the patients post-HTx who did or did not acquire antibodies, there was no significant difference in the immunosuppressant types and trough levels. CONCLUSIONS: SARS-CoV-2 mRNA vaccine has efficient immunogenicity for adolescents with CHD, IPAH, and DCM. Half of post-HTx patients could not acquire sufficient humoral immunity.


Subject(s)
COVID-19 , Heart Diseases , Viral Vaccines , Adolescent , Humans , Aged , COVID-19 Vaccines , SARS-CoV-2 , COVID-19/prevention & control , Interferon-gamma , Antibodies, Viral , Viral Vaccines/adverse effects , Antibodies, Neutralizing , Vaccination , Heart Diseases/chemically induced
20.
Infect Control Hosp Epidemiol ; 42(2): 228-229, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-2096442

ABSTRACT

Coronavirus disease 2019 (COVID-19) has migrated to regions that were initially spared, and it is likely that different populations are currently at risk for illness. Herein, we present our observations of the change in characteristics and resource use of COVID-19 patients over time in a national system of community hospitals to help inform those managing surge planning, operational management, and future policy decisions.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Hospitalization/statistics & numerical data , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/ethnology , COVID-19/mortality , Female , Hospitals, Community , Humans , Male , Middle Aged , SARS-CoV-2/isolation & purification , Virginia/epidemiology , Young Adult
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