Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 19 de 19
Filtrar
1.
Front Cardiovasc Med ; 8: 653655, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-2198735

RESUMO

Plasminogen activator inhibitor 1 (PAI-1) is a member of the serine protease inhibitor (serpin) superfamily. PAI-1 is the principal inhibitor of the plasminogen activators, tissue plasminogen activator (tPA), and urokinase-type plasminogen activator (uPA). Turbulence in the levels of PAI-1 tilts the balance of the hemostatic system resulting in bleeding or thrombotic complications. Not surprisingly, there is strong evidence that documents the role of PAI-1 in cardiovascular disease. The more recent uncovering of the coalition between the hemostatic and inflammatory pathways has exposed a distinct role for PAI-1. The storm of proinflammatory cytokines liberated during inflammation, including IL-6 and TNF-α, directly influence PAI-1 synthesis and increase circulating levels of this serpin. Consequently, elevated levels of PAI-1 are commonplace during infection and are frequently associated with a hypofibrinolytic state and thrombotic complications. Elevated PAI-1 levels are also a feature of metabolic syndrome, which is defined by a cluster of abnormalities including obesity, type 2 diabetes, hypertension, and elevated triglyceride. Metabolic syndrome is in itself defined as a proinflammatory state associated with elevated levels of cytokines. In addition, insulin has a direct impact on PAI-1 synthesis bridging these pathways. This review describes the key physiological functions of PAI-1 and how these become perturbed during disease processes. We focus on the direct relationship between PAI-1 and inflammation and the repercussion in terms of an ensuing hypofibrinolytic state and thromboembolic complications. Collectively, these observations strengthen the utility of PAI-1 as a viable drug target for the treatment of various diseases.

2.
Mult Scler Relat Disord ; 68: 104235, 2022 Oct 09.
Artigo em Inglês | MEDLINE | ID: covidwho-2061693

RESUMO

BACKGROUND AND OBJECTIVE: The COVID-19 pandemic negatively impacted the well-being of persons with neuroinflammatory diseases (pwNID). Identifying factors that influence the response to challenging conditions could guide supportive care. METHODS: 2185 pwNID and 1079 healthy controls (HCs) from five US centers completed an online survey regarding the effects of the COVID-19 pandemic on physical and psychological well-being. Survey instruments included resilience (Connor-Davidson Resilience Scale, CD-RISC), loneliness (UCLA Loneliness Scale), social support (modified social support survey, MSSS-5), personality traits (NEO-Five Factor Inventory, NEO-FFI), and disability (Patient-Determined Disability Steps (PDDS). Step-wise regression models and mediation analyses assessed whether the level of self-reported resilience, size of the social support, and specific personality traits (study predictors) were associated with self-reported disability and/or loneliness (study outcomes). RESULTS: The response rate varied significantly between the questionnaires. While, all pwNID completed the demographic questionnaire, 78.8% completed the loneliness questionnaire and 49.7% completed the NEO-FFI. Based on 787 responses, greater neuroticism (standardized ß = 0.312, p < 0.001), less social support (standardized ß = -0.242, p < 0.001), lower extraversion (standardized ß = -0.083, p=0.017), lower agreeableness (standardized ß = -0.119, p < 0.001), and lower resilience (standardized ß = -0.125, p = 0.002) were associated with the feeling of loneliness. Social support and resilience modestly but significantly mediated the association between personality traits and loneliness. Older age (standardized ß = 0.165, p < 0.001) and lower conscientiousness (standardized ß = -0.094, p = 0.007) were associated with worse disability (higher PDDS scores). There were no differences in outcomes between pwNID and HCs. CONCLUSION: Greater social support potentially attenuates the association between neuroticism and the feeling of loneliness in pwNID during the COVID-19 pandemic. Assessment of personality traits may identify pwNID that are in greater need of social support and guide targeted interventions.

3.
Journal of Rural Mental Health ; : No Pagination Specified, 2022.
Artigo em Inglês | APA PsycInfo | ID: covidwho-2016598

RESUMO

Telehealth implementation has potential to reduce disparities in access to mental health care. We examined the number of mental health visits accessed and the visit format used (office, phone, or virtual) by patient demographics before and after a large health system's shift to telehealth during the COVID-19 pandemic. Patients ages 6-17 accessed relatively fewer and female patients accessed relatively more mental health visits after the telehealth transition. Demographic variables were associated with visit format used, with rural residents, older adults, females, and White and Black/African American patients using a higher proportion of phone visits. Implications are discussed for the future implementation of telehealth. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement This study found changes in the gender and age of patients accessing mental health services before and after a large health system began providing services remotely in response to the COVID-19 pandemic. It also found that phone calls were relatively preferred by certain demographic groups. These groups may be adversely affected by limitations on reimbursement for mental health services provided by phone. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

4.
medrxiv; 2022.
Preprint em Inglês | medRxiv | ID: ppzbmed-10.1101.2022.08.17.22278896

RESUMO

BackgroundThe COVID-19 pandemic has negatively impacted the social fabric of people with multiple sclerosis (pwMS). ObjectiveTo evaluate the associations between personal social network environment and neurological function in pwMS and controls during the COVID-19 pandemic and compare with the pre-pandemic baseline. MethodsWe first analyzed data collected from 8 cohorts of pwMS and control participants during the COVID-19 pandemic (March-December 2020). We then leveraged data collected between 2017-2019 in 3 of the 8 cohorts for longitudinal comparison. Participants completed a questionnaire that quantified the structure and composition of their personal social network, including the health behaviors of network members. We assessed neurological disability using three interrelated patient-reported outcomes: Patient Determined Disease Steps (PDDS), Multiple Sclerosis Rating Scale - Revised (MSRS-R), and Patient Reported Outcomes Measurement Information System (PROMIS)-Physical Function. We identified the network features associated with neurologic disability using paired t-tests and covariate-adjusted regressions. ResultsIn the cross-sectional analysis of the pandemic data from 1130 pwMS and 1250 control participants, higher percent of network members with a perceived negative health influence was associated with greater neurological symptom burden in pwMS (MSRS-R: Beta[95% CI]=2.181[1.082, 3.279], p<.001) and worse physical function in controls (PROMIS-Physical Function: Beta[95% CI]=-5.707[-7.405, -4.010], p<.001). In the longitudinal analysis of 230 pwMS and 136 control participants, the percent of people contacted "weekly or less" (p<.001) decreased during the COVID-19 pandemic for both pwMS (30.34% to 18.78%) and controls (23.48% to 14.89%) when compared to the pre-pandemic period. PwMS further experienced a greater reduction in network size (p<.001), increase in constraint (a measure of close ties of the network, p<.001) and decrease in maximum degree (highest number of ties of a network member, p<.001) than controls during the COVID-19 pandemic. These changes in network features were not associated with worsening neurological disability during the pandemic. ConclusionsOur findings suggest that negative health influences in personal social networks are associated with worse disability in all participants, and the COVID-19 pandemic led to contraction of personal social networks to a greater extent for pwMS than controls.

5.
J Thromb Haemost ; 20(10): 2394-2406, 2022 10.
Artigo em Inglês | MEDLINE | ID: covidwho-1916259

RESUMO

BACKGROUND: Severe COVID-19 disease is associated with thrombotic complications and extensive fibrin deposition. This study investigates whether the hemostatic complications in COVID-19 disease arise due to dysregulation of the fibrinolytic system. METHODS: This prospective study analyzed fibrinolytic profiles of 113 patients hospitalized with COVID-19 disease with 24 patients with non-COVID-19 respiratory infection and healthy controls. Antigens were quantified by Ella system or ELISA, clot lysis by turbidimetric assay, and plasminogen activator inhibitor-1 (PAI-1)/plasmin activity using chromogenic substrates. Clot structure was visualized by confocal microscopy. RESULTS: PAI-1 and its cofactor, vitronectin, are significantly elevated in patients with COVID-19 disease compared with those with non-COVID-19 respiratory infection and healthy control groups. Thrombin activatable fibrinolysis inhibitor and tissue plasminogen activator were elevated in patients with COVID-19 disease relative to healthy controls. PAI-1 and tissue plasminogen activator (tPA) were associated with more severe COVID-19 disease severity. Clots formed from COVID-19 plasma demonstrate an altered fibrin network, with attenuated fiber length and increased branching. Functional studies reveal that plasmin generation and clot lysis were markedly attenuated in COVID-19 disease, while PAI-1 activity was elevated. Clot lysis time significantly correlated with PAI-1 levels. Stratification of COVID-19 samples according to PAI-1 levels reveals significantly faster lysis when using the PAI-1 resistant (tPA) variant, tenecteplase, over alteplase lysis. CONCLUSION: This study shows that the suboptimal fibrinolytic response in COVID-19 disease is directly attributable to elevated levels of PAI-1, which attenuate plasmin generation. These data highlight the important prognostic potential of PAI-1 and the possibility of using pre-existing drugs, such as tenecteplase, to treat COVID-19 disease and potentially other respiratory diseases.


Assuntos
COVID-19 , Carboxipeptidase B2 , Hemostáticos , Trombose , COVID-19/tratamento farmacológico , Compostos Cromogênicos , Fibrina , Fibrinolisina/farmacologia , Fibrinólise , Hemostáticos/farmacologia , Humanos , Inibidor 1 de Ativador de Plasminogênio , Estudos Prospectivos , Tenecteplase , Trombose/tratamento farmacológico , Ativador de Plasminogênio Tecidual/farmacologia , Vitronectina
6.
Journal of the American College of Cardiology ; 79(9):2046-2046, 2022.
Artigo em Inglês | Web of Science | ID: covidwho-1848861
7.
Fam Court Rev ; 60(2): 303-321, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: covidwho-1741379

RESUMO

Family courts are increasingly interested in online parenting programs for divorcing and separating parents, particularly during the COVID-19 pandemic. To our knowledge, no previous study has evaluated the barriers to and facilitators of parent participation in these programs for family law cases. We interviewed 61 parents in the midst of family law cases regarding their perspectives. While many parents viewed online parent programs positively (e.g., convenient), they also reported barriers to participation (e.g., technology problems). We offer recommendations (e.g., communication about program benefits) to support courts as they decide whether to continue ordering online parent programs following the pandemic.

8.
Mult Scler Relat Disord ; 57: 103433, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: covidwho-1549996

RESUMO

BACKGROUND: Patients with autoimmune disease and on immunotherapy were largely excluded from seminal anti-SARS-CoV-2 vaccine trials. This has led to significant vaccine hesitancy in patients with neuroinflammatory diseases (NID); including, but not limited to: multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), neurosarcoidosis and myelin oligodendrocyte antibody-mediated disease (MOG-AD). Data is urgently needed to help guide clinical care in the NID population. METHODS: This was a cross-sectional observational study evaluating adults with a neurologist-confirmed diagnosis of a neuroinflammatory disease (NID) and a neurologically asymptomatic control population. Participants were recruited from multiple academic centers participating in the MS Resilience to COVID-19 Collaborative study. We analyzed participant responses from a vaccine-specific questionnaire collected between February and May 2021. RESULTS: 1164 participants with NID and 595 controls completed the vaccine survey. Hesitancy rates were similar between NID and control groups (n = 134, 32.7% NID vs. n = 56, 30.6% control; p = 0.82). The most common reasons for hesitancy in NID participants were lack of testing in the autoimmune population and fear of demyelinating/neurologic events. Unvaccinated patients who had discussed vaccination with their doctor were less likely to be hesitant (n=184, 73.6% vs. n=83, 59.7%; p = 0.007). 634 NID patients and 332 controls had received at least one dose of a vaccine against SARS-CoV-2 at the time of survey completion. After adjusting for age, BMI, and comorbidities, there was no difference in self-reported side effects (SE) between groups with the first dose (n = 256, 42.2% NID vs. 141, 45.3% control; p = 0.20) or second dose (n = 246, 67.0% NID vs. n = 114, 64.8% control, p = 0.85) of the mRNA vaccines nor with the viral-vector vaccines (n = 6, 46% NID vs. n = 8, 66% control; p = 0.39). All reported SEs fell into the expected SE profile. There was no difference in report of new/recurrent neurologic symptoms (n = 110, 16.2% vaccinated vs. 71, 18.2% unvaccinated; p = 0.44) nor radiologic disease activity (n = 40, 5.9% vaccinated vs. n = 30, 7.6% unvaccinated) between vaccinated and unvaccinated NID participants. CONCLUSIONS: We found no difference in patient-reported vaccine side effects and no evidence of NID worsening after vaccination. Large-scale real-world evidence is needed for further validation.


Assuntos
COVID-19 , SARS-CoV-2 , Vacinas contra COVID-19 , Estudos Transversais , Humanos , Doenças Neuroinflamatórias , Vacinação
9.
Neurology ; 97(16): 767-775, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: covidwho-1394514

RESUMO

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global effort to rapidly develop and deploy effective and safe coronavirus disease 2019 (COVID-19) vaccinations. Vaccination has been one of the most effective medical interventions in human history, although potential safety risks of novel vaccines must be monitored, identified, and quantified. Adverse events must be carefully assessed to define whether they are causally associated with vaccination or coincidence. Neurologic adverse events following immunizations are overall rare but with significant morbidity and mortality when they occur. Here, we review neurologic conditions seen in the context of prior vaccinations and the current data to date on select COVID-19 vaccines including mRNA vaccines and the adenovirus-vector COVID-19 vaccines, ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2.S Johnson & Johnson (Janssen/J&J).


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Doenças do Sistema Nervoso/epidemiologia , Vacinação/tendências , Vacinas contra COVID-19/efeitos adversos , Humanos , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Vacina contra Sarampo-Caxumba-Rubéola/efeitos adversos , Doenças do Sistema Nervoso/induzido quimicamente , Doenças do Sistema Nervoso/diagnóstico , Vacinas contra Poliovirus/administração & dosagem , Vacinas contra Poliovirus/efeitos adversos , Vacinação/efeitos adversos
10.
13th International Conference on Virtual, Augmented and Mixed Reality, VAMR 2021, Held as Part of the 23rd HCI International Conference, HCII 2021 ; 12770 LNCS:452-471, 2021.
Artigo em Inglês | Scopus | ID: covidwho-1359836

RESUMO

Addressing consumer needs is key to success in new product development. Due to COVID-19, however, gathering feedback on food products has become challenging. Our preliminary research on the food industry revealed that the socially distanced lifestyle has deprived food practitioners of in-person testing platforms, inspiring our research questions. Although a myriad of virtual methods for food testing have been reported in the past two decades, the literature does not provide systematic assessment of their applicability. Therefore, in this review of 108 papers, we delineate the landscape of virtual technologies for food testing and present their practical implications. From our analysis, VR emerged as a promising tool, yet it was not being used by practitioners. Other technologies (e.g. flavor simulators) were too preliminary to be adopted in industry. Furthermore, the types of technologies were fragmented, leaving much room for cross-tech integration. Future research goals to address the gaps are discussed. © 2021, Springer Nature Switzerland AG.

11.
Psychology, Public Policy, and Law ; : No Pagination Specified, 2021.
Artigo em Inglês | APA PsycInfo | ID: covidwho-1331371

RESUMO

We report 1-year follow-up outcomes from a randomized controlled trial involving parents resolving separation or divorce-related disputes and reporting high levels of intimate partner violence (IPV). We compared traditional litigation to two mediation approaches designed to protect parent safety (i.e., shuttle and videoconferencing) at a court-annexed mediation division. The sample was not nationally representative, limiting generalizability. We found no significant differences across conditions in parent reports of satisfaction with the process, level of continuing IPV or interparental conflict, parenting quality, parent functioning, or child functioning. Parents in traditional litigation, relative to parents in mediation, reported significantly more social support. Also, parents in videoconferencing, versus those in shuttle, mediation reported more PTSD symptoms from IPV. Based on coding of legal records, no significant condition differences emerged in relitigation rates in the family court case or charges of study case IPV-related incidents. Given few differences across study conditions, including in satisfaction levels, in contrast to the immediate outcomes, the 1-year follow-up findings do not clearly favor mediation or litigation. We conclude that when both parents in cases with reported high IPV are willing to mediate, mediation designed with safety protocols and carried out in a protected environment by well-trained staff may be an appropriate alternative to traditional litigation. We consider implications of our findings;for example, we discuss implications of the form of videoconferencing mediation examined for conducting online mediation, including during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

12.
J Intensive Care Soc ; 23(3): 281-284, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: covidwho-1223695

RESUMO

Introduction: Post-extubation dysphagia (PED) can have serious consequences for critically unwell patients. COVID-19 has resulted in an increasing need for a PED screen in order to effectively identify patients and mitigate risk, whilst balancing under-resourced services. Online training provides the advantage of reducing time pressures on staff and supporting social distancing. This project aimed to adapt the Leeds Post-Extubation Dysphagia Screen (L-PEDS) and the associated training package to be more suitable and effective for use during COVID-19 pandemic. Methods: The screen was modified to a digital format with additional guidance for users. The training package was shortened and converted to an online package while keeping the interactive mode of training. Results: Preliminary results of 14 staff members indicate that the median confidence levels for screening patients for PED improved from 5 to 8 (on a scale of 0 to 10) after completing the L-PEDS-COVID training package. Likewise, knowledge of PED improved from a median of 4 to 8 (on a scale of 0 to 10). Training quality was rated at a median of 8 on a scale of 0 to 10 (0 being very poor; 10 being very good). Conclusions: Preliminary evidence demonstrated increased knowledge of PED and confidence in screening. The development of an adapted version of the L-PEDS and online training package may allow easier implementation of post-extubation dysphagia screening. This could help to compensate for insufficient speech and language therapy critical care staffing, assist in identifying patients at risk and improve outcomes by enabling earlier and safe resumption of oral intake.

13.
BMJ Open ; 11(3): e047782, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: covidwho-1153682

RESUMO

OBJECTIVE: The COVID-19 pandemic has transformed healthcare delivery in the USA, but there has been little empirical work describing the impact of these changes on clinicians. We conducted a study to address the following question: how has the pandemic impacted US clinicians' professional roles and relationships? DESIGN: Inductive thematic analysis of semi-structured interviews. SETTING: Clinical settings across the USA in April and May of 2020. PARTICIPANTS: Clinicians with leadership and/or clinical roles during the COVID-19 pandemic. MEASURES: Emergent themes related to professional roles and relationships. RESULTS: Sixty-one clinicians participated in semi-structured interviews. Study participants were practising in 15 states across the USA, and the majority were White physicians from large academic centres. Three overlapping and inter-related themes emerged from qualitative analysis of interview transcripts: (1) disruption: boundaries between work and home life became blurred and professional identity and usual clinical roles were upended; (2) constructive adaptation: some clinicians were able to find new meaning in their work and described a spirit of collaboration, shared goals, open communication and mutual respect among colleagues; and (3) discord and estrangement: other clinicians felt alienated from their clinical roles and experienced demoralising work environments marked by division, value conflicts and mistrust. CONCLUSIONS: Clinicians encountered marked disruption of their professional roles, identities and relationships during the pandemic to which they and their colleagues responded in a range of different ways. Some described a spirit of collaboration and camaraderie, while others felt alienated by their new roles and experienced work environments marked by division, value conflicts and mistrust. Our findings highlight the importance of effective teamwork and efforts to support clinician well-being during the COVID-19 pandemic.


Assuntos
COVID-19/psicologia , Atenção à Saúde , Pessoal de Saúde/psicologia , Relações Interprofissionais , Pandemias , Papel Profissional , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , SARS-CoV-2
14.
Ann Clin Transl Neurol ; 8(4): 918-928, 2021 04.
Artigo em Inglês | MEDLINE | ID: covidwho-1092494

RESUMO

OBJECTIVE: To report initial results of a planned multicenter year-long prospective study examining the risk and impact of COVID-19 among persons with neuroinflammatory disorders (NID), particularly multiple sclerosis (MS). METHODS: In April 2020, we deployed online questionnaires to individuals in their home environment to assess the prevalence and potential risk factors of suspected COVID-19 in persons with NID (PwNID) and change in their neurological care. RESULTS: Our cohort included 1115 participants (630 NID, 98% MS; 485 reference) as of 30 April 2020. 202 (18%) participants, residing in areas with high COVID-19 case prevalence, met the April 2020 CDC symptom criteria for suspected COVID-19, but only 4% of all participants received testing given testing shortages. Among all participants, those with suspected COVID-19 were younger, more racially diverse, and reported more depression and liver disease. PwNID had the same rate of suspected COVID-19 as the reference group. Early changes in disease management included telemedicine visits in 21% and treatment changes in 9% of PwNID. After adjusting for potential confounders, increasing neurological disability was associated with a greater likelihood of suspected COVID-19 (ORadj  = 1.45, 1.17-1.84). INTERPRETATIONS: Our study of real-time, patient-reported experience during the COVID-19 pandemic complements physician-reported MS case registries which capture an excess of severe cases. Overall, PwNID seem to have a risk of suspected COVID-19 similar to the reference population.


Assuntos
Doenças Autoimunes do Sistema Nervoso/epidemiologia , Doenças Autoimunes do Sistema Nervoso/psicologia , COVID-19/epidemiologia , COVID-19/psicologia , Autorrelato , Adulto , Doenças Autoimunes do Sistema Nervoso/diagnóstico , COVID-19/diagnóstico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/psicologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/psicologia , Pandemias , Estudos Prospectivos
15.
medrxiv; 2021.
Preprint em Inglês | medRxiv | ID: ppzbmed-10.1101.2021.02.15.21251150

RESUMO

We propose a prognostic dynamic risk stratification for 48-hour in-hospital mortality in patients with COVID-19, using demographics and routinely-collected observations and laboratory tests: age, Clinical Frailty Scale score, heart rate, respiratory rate, SpO2/FiO2 ratio, white cell count, acidosis (pH < 7.35) and Interleukin-6. We train and validate the model using data from a UK teaching hospital, adopting a landmarking approach that accounts for competing risks and informative missingness. Internal validation of the model on the first wave of patients presenting between March 1 and September 12, 2020 achieves an AUROC of 0.90 (95% CI 0.87-0.93). Temporal validation on patients presenting between September 13, 2020 and January 1, 2021 gives an AUROC of 0.91 (95% CI 0.88-0.95). The resulting mortality stratification tool has the potential to provide physicians with an assessment of a patient's evolving prognosis throughout the course of active hospital treatment.

16.
Am J Obstet Gynecol MFM ; 2(4): 100229, 2020 11.
Artigo em Inglês | MEDLINE | ID: covidwho-1064757

RESUMO

Both acute and chronic stress can cause allostatic overload, or long-term imbalance in mediators of homeostasis, that results in disruptions in the maternal-placental-fetal endocrine and immune system responses. During pregnancy, disruptions in homeostasis may increase the likelihood of preterm birth and preeclampsia. Expectant mothers traditionally have high rates of anxiety and depressive disorders, and many are susceptible to a variety of stressors during pregnancy. These common life stressors include financial concerns and relationship challenges and may be exacerbated by the biological, social, and psychological changes occurring during pregnancy. In addition, external stressors such as major weather events (eg, hurricanes, tornados, floods) and other global phenomena (eg, the coronavirus disease 2019 pandemic) may contribute to stress during pregnancy. This review investigates recent literature published about the use of nonpharmacologic modalities for stress relief in pregnancy and examines the interplay between psychiatric diagnoses and stressors, with the purpose of evaluating the feasibility of implementing nonpharmacologic interventions as sole therapies or in conjunction with psychotherapy or psychiatric medication therapy. Further, the effectiveness of each nonpharmacologic therapy in reducing symptoms of maternal stress is reviewed. Mindfulness meditation and biofeedback have shown effectiveness in improving one's mental health, such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied postpartum and in response to pregnancy challenges. Although some of these nonpharmacologic interventions can be convenient and low cost, there is a trend toward inconsistent implementation of these modalities. Future investigations should focus on methods to increase ease of uptake, ensure each option is available at home, and provide a standardized way to evaluate whether combinations of different interventions may provide added benefit.


Assuntos
COVID-19 , Terapias Complementares/métodos , Complicações na Gravidez , Resultado da Gravidez/epidemiologia , Psicoterapia/métodos , Estresse Psicológico , COVID-19/epidemiologia , COVID-19/psicologia , Feminino , Humanos , Recém-Nascido , Saúde Mental , Gravidez , Complicações na Gravidez/psicologia , Complicações na Gravidez/terapia , SARS-CoV-2 , Estresse Psicológico/etiologia , Estresse Psicológico/terapia
17.
Cell Rep Med ; 1(5): 100062, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: covidwho-1026726

RESUMO

There is an urgent need for rapid SARS-CoV-2 testing in hospitals to limit nosocomial spread. We report an evaluation of point of care (POC) nucleic acid amplification testing (NAAT) in 149 participants with parallel combined nasal and throat swabbing for POC versus standard lab RT-PCR testing. Median time to result is 2.6 (IQR 2.3-4.8) versus 26.4 h (IQR 21.4-31.4, p < 0.001), with 32 (21.5%) positive and 117 (78.5%) negative. Cohen's κ correlation between tests is 0.96 (95% CI 0.91-1.00). When comparing nearly 1,000 tests pre- and post-implementation, the median time to definitive bed placement from admission is 23.4 (8.6-41.9) versus 17.1 h (9.0-28.8), p = 0.02. Mean length of stay on COVID-19 "holding" wards is 58.5 versus 29.9 h (p < 0.001). POC testing increases isolation room availability, avoids bed closures, allows discharge to care homes, and expedites access to hospital procedures. POC testing could mitigate the impact of COVID-19 on hospital systems.


Assuntos
Teste de Ácido Nucleico para COVID-19 , COVID-19/diagnóstico , Controle de Infecções/métodos , Testes Imediatos , SARS-CoV-2/isolamento & purificação , Adulto , Idoso , Teste de Ácido Nucleico para COVID-19/normas , Infecção Hospitalar/prevenção & controle , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Testes Imediatos/normas , SARS-CoV-2/genética
18.
Mult Scler J Exp Transl Clin ; 6(3): 2055217320942931, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-721277

RESUMO

We report a fatal case of COVID-19 in a 51-year-old African American woman with multiple sclerosis on natalizumab. She had multiple risk factors for severe COVID-19 disease including race, obesity, hypertension, and elevated inflammatory markers, but the contribution of natalizumab to her poor outcome remains unknown. We consider whether altered dynamics of peripheral immune cells in the context of natalizumab treatment could worsen the cytokine storm syndrome associated with severe COVID-19. We discuss extended interval dosing as a risk-reduction strategy for multiple sclerosis patients on natalizumab, and the use of interleukin-6 inhibitors in such patients who contract COVID-19.

19.
J Thromb Haemost ; 18(7): 1548-1555, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-116254

RESUMO

The global pandemic of coronavirus disease 2019 (COVID-19) is associated with the development of acute respiratory distress syndrome (ARDS), which requires ventilation in critically ill patients. The pathophysiology of ARDS results from acute inflammation within the alveolar space and prevention of normal gas exchange. The increase in proinflammatory cytokines within the lung leads to recruitment of leukocytes, further propagating the local inflammatory response. A consistent finding in ARDS is the deposition of fibrin in the air spaces and lung parenchyma. COVID-19 patients show elevated D-dimers and fibrinogen. Fibrin deposits are found in the lungs of patients due to the dysregulation of the coagulation and fibrinolytic systems. Tissue factor (TF) is exposed on damaged alveolar endothelial cells and on the surface of leukocytes promoting fibrin deposition, while significantly elevated levels of plasminogen activator inhibitor 1 (PAI-1) from lung epithelium and endothelial cells create a hypofibrinolytic state. Prophylaxis treatment of COVID-19 patients with low molecular weight heparin (LMWH) is important to limit coagulopathy. However, to degrade pre-existing fibrin in the lung it is essential to promote local fibrinolysis. In this review, we discuss the repurposing of fibrinolytic drugs, namely tissue-type plasminogen activator (tPA), to treat COVID-19 associated ARDS. tPA is an approved intravenous thrombolytic treatment, and the nebulizer form has been shown to be effective in plastic bronchitis and is currently in Phase II clinical trial. Nebulizer plasminogen activators may provide a targeted approach in COVID-19 patients to degrade fibrin and improving oxygenation in critically ill patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Fibrinólise/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , COVID-19 , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Reposicionamento de Medicamentos , Fibrinolíticos/efeitos adversos , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , SARS-CoV-2 , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA