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1.
MMWR Morb Mortal Wkly Rep ; 70(38): 1344-1348, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: covidwho-1468851

RESUMO

The Pfizer-BioNTech COVID-19 vaccine (BNT162b2) is a lipid nanoparticle-formulated, nucleoside mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. Vaccination with the Pfizer-BioNTech COVID-19 vaccine consists of 2 intramuscular doses (30 µg, 0.3 mL each) administered 3 weeks apart. In December 2020, the vaccine was granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) as well as an interim recommendation for use among persons aged ≥16 years by the Advisory Committee on Immunization Practices (ACIP) (1). In May 2021, the EUA and interim ACIP recommendations for Pfizer-BioNTech COVID-19 vaccine were extended to adolescents aged 12-15 years (2). During December 14, 2020-September 1, 2021, approximately 211 million doses of Pfizer-BioNTech COVID-19 vaccine were administered in the United States.* On August 23, 2021, FDA approved a Biologics License Application for use of the Pfizer-BioNTech COVID-19 vaccine, Comirnaty (Pfizer, Inc.), in persons aged ≥16 years (3). The ACIP COVID-19 Vaccines Work Group's conclusions regarding the evidence for the Pfizer-BioNTech COVID-19 vaccine were presented to ACIP at a public meeting on August 30, 2021. To guide its deliberations regarding the Pfizer-BioNTech COVID-19 vaccine, ACIP used the Evidence to Recommendation (EtR) Framework,† and incorporated a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.§ In addition to initial clinical trial data, ACIP considered new information gathered in the 8 months since issuance of the interim recommendation for Pfizer-BioNTech COVID-19 vaccine, including additional follow-up time in the clinical trial, real-world vaccine effectiveness studies, and postauthorization vaccine safety monitoring. The additional information increased certainty that benefits from prevention of asymptomatic infection, COVID-19, and associated hospitalization and death outweighs vaccine-associated risks. On August 30, 2021, ACIP issued a recommendation¶ for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Imunização/normas , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Comitês Consultivos , COVID-19/epidemiologia , Vacinas contra COVID-19/efeitos adversos , Centers for Disease Control and Prevention, U.S. , Aprovação de Drogas , Feminino , Humanos , Masculino , Estados Unidos/epidemiologia , Vacinas Sintéticas/administração & dosagem , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 70(38): 1332-1336, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: covidwho-1468850

RESUMO

Foodborne illnesses are a substantial and largely preventable public health problem; before 2020 the incidence of most infections transmitted commonly through food had not declined for many years. To evaluate progress toward prevention of foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food reported by 10 U.S. sites.* FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration. This report summarizes preliminary 2020 data and describes changes in incidence with those during 2017-2019. During 2020, observed incidences of infections caused by enteric pathogens decreased 26% compared with 2017-2019; infections associated with international travel decreased markedly. The extent to which these reductions reflect actual decreases in illness or decreases in case detection is unknown. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. After the declaration, state and local officials implemented stay-at-home orders, restaurant closures, school and child care center closures, and other public health interventions to slow the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Federal travel restrictions were declared (1). These widespread interventions as well as other changes to daily life and hygiene behaviors, including increased handwashing, have likely changed exposures to foodborne pathogens. Other factors, such as changes in health care delivery, health care-seeking behaviors, and laboratory testing practices, might have decreased the detection of enteric infections. As the pandemic continues, surveillance of illness combined with data from other sources might help to elucidate the factors that led to the large changes in 2020; this understanding could lead to improved strategies to prevent illness. To reduce the incidence of these infections concerted efforts are needed, from farm to processing plant to restaurants and homes. Consumers can reduce their risk of foodborne illness by following safe food-handling and preparation recommendations.


Assuntos
COVID-19/epidemiologia , Microbiologia de Alimentos/estatística & dados numéricos , Parasitologia de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Pandemias , Conduta Expectante , Adolescente , Criança , Pré-Escolar , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , Lactente , Estados Unidos/epidemiologia
3.
Hong Kong Med J ; 26(6): 551-552, 2020 12.
Artigo em Inglês | MEDLINE | ID: covidwho-1468805
4.
Am J Case Rep ; 22: e932765, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: covidwho-1468751

RESUMO

BACKGROUND Constant stimulation of lymphocytes and histiocytes can result in hemophagocytic lymphohistiocytosis (HLH), which can be primary or secondary (sHLH). The main causes of sHLH are infections and hematological malignancies, especially non-Hodgkin lymphoma. Despite new insights into the pathogenesis of HLH, the diagnosis and treatment of this immune disorder remain a great challenge. CASE REPORT We present a case of a young adult without comorbidities whose clinical course was nonspecific for several months and resulted in late diagnosis of HLH secondary to peripheral T cell lymphoma (PTCL). The etiological factor of recurring fever, hepatosplenomegaly, and deteriorating condition was unidentified for a long time before fatal sHLH was finally diagnosed. The patient was treated according to the HLH-2004 protocol; however, he did not achieve any response. Unfortunately, due to nonspecific symptoms, lack of lymphadenopathy for a long time, and negative positron emission tomography results, the diagnosis of PTCL was established only after the patient's death. CONCLUSIONS It should be emphasized that early diagnosis is crucial for better prognosis of patients with sHLH. Bone marrow biopsy is worth considering in patients with prolonged fever of unknown origin, hyperferritinemia, splenomegaly, and unexplained cytopenia of 2 or more lineages. Despite the existence of diagnostic and therapeutic protocols available in the literature, the prompt diagnosis and treatment of HLH remains a great challenge. More precise and specific diagnostic tools for HLH are needed.


Assuntos
Linfo-Histiocitose Hemofagocítica , Linfoma de Células T Periférico , Medula Óssea , Febre , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma de Células T Periférico/complicações , Linfoma de Células T Periférico/diagnóstico , Masculino , Recidiva Local de Neoplasia , Adulto Jovem
5.
Pan Afr Med J ; 39: 173, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1468745

RESUMO

The coronavirus disease-19 (COVID-19), first appearing in Wuhan, China, and later declared as a pandemic, has caused serious morbidity and mortality worldwide. Severe cases usually present with acute respiratory distress syndrome (ARDS), pneumonia, acute kidney injury (AKI), liver damage, or septic shock. However, with recent advances in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) research, the virus´s effect on cardiac tissues has become evident. Reportedly, an increased number of COVID-19 patients manifested serious cardiac complications such as heart failure, increased troponin, and N-terminal pro-B-type natriuretic peptide levels (NT-proBNP), cardiomyopathies, and myocarditis. These cardiac complications initially present as chest tightness, chest pain, and heart palpitations. Diagnostic investigations such as telemetry, electrocardiogram (ECG), cardiac biomarkers (troponin, NT-proBNP), and inflammatory markers (D-dimer, fibrinogen, PT, PTT), must be performed according to the patient´s condition. The best available options for treatment are the provision of supportive care, anti-viral therapy, hemodynamic monitoring, IL-6 blockers, statins, thrombolytic, and anti-hypertensive drugs. Cardiovascular disease (CVD) healthcare workers should be well-informed about the evolving research regarding COVID-19 and approach as a multi-disciplinary team to devise effective strategies for challenging situations to reduce cardiac complications.


Assuntos
COVID-19/complicações , Cardiopatias/virologia , SARS-CoV-2/isolamento & purificação , Biomarcadores/metabolismo , COVID-19/diagnóstico , Teste para COVID-19 , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Humanos , Equipe de Assistência ao Paciente/organização & administração
8.
Sante Publique ; 33(2): 255-263, 2021.
Artigo em Francês | MEDLINE | ID: covidwho-1468549

RESUMO

INTRODUCTION: This study observes the results of outbreak and mortality in three comparable countries that have been widely affected: Belgium, the Netherlands, Sweden. These countries carried out “non-pharmaceutical interventions” at three different levels, from lockdown (Belgium) to social distancing (Sweden). OBJECTIVE: This study examines the effectiveness of general and undifferentiated interventions (lockdown) and their side effects. It implements models as a decision-making and crisis management tool. It examines relevant statistical predictive use (hospitalization and mortality projections) in the case of a versatile coronavirus outbreak. RESULTS: General non-pharmaceutical interventions (lockdown, shut down, social distancing) did not “delay” the peak or “flatten” the curves. CONCLUSION: Non-targeted “Non-Pharmaceutical Interventions” (NPIs) do not have any direct effect on the R indicator (basic reproductive number). On the other hand, overly intense NPIs keep R above the imagined level.


Assuntos
COVID-19 , Epidemias , Controle de Doenças Transmissíveis , Humanos , Distanciamento Físico , SARS-CoV-2
9.
Br J Gen Pract ; 71(705): 157, 2021 04.
Artigo em Inglês | MEDLINE | ID: covidwho-1468508
10.
Sensors (Basel) ; 21(18)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1468446

RESUMO

Edge intelligence (EI) has received a lot of interest because it can reduce latency, increase efficiency, and preserve privacy. More significantly, as the Internet of Things (IoT) has proliferated, billions of portable and embedded devices have been interconnected, producing zillions of gigabytes on edge networks. Thus, there is an immediate need to push AI (artificial intelligence) breakthroughs within edge networks to achieve the full promise of edge data analytics. EI solutions have supported digital technology workloads and applications from the infrastructure level to edge networks; however, there are still many challenges with the heterogeneity of computational capabilities and the spread of information sources. We propose a novel event-driven deep-learning framework, called EDL-EI (event-driven deep learning for edge intelligence), via the design of a novel event model by defining events using correlation analysis with multiple sensors in real-world settings and incorporating multi-sensor fusion techniques, a transformation method for sensor streams into images, and lightweight 2-dimensional convolutional neural network (CNN) models. To demonstrate the feasibility of the EDL-EI framework, we presented an IoT-based prototype system that we developed with multiple sensors and edge devices. To verify the proposed framework, we have a case study of air-quality scenarios based on the benchmark data provided by the USA Environmental Protection Agency for the most polluted cities in South Korea and China. We have obtained outstanding predictive accuracy (97.65% and 97.19%) from two deep-learning models on the cities' air-quality patterns. Furthermore, the air-quality changes from 2019 to 2020 have been analyzed to check the effects of the COVID-19 pandemic lockdown.


Assuntos
COVID-19 , Aprendizado Profundo , Inteligência Artificial , Controle de Doenças Transmissíveis , Humanos , Inteligência , Pandemias , SARS-CoV-2 , Estados Unidos
11.
Sensors (Basel) ; 21(18)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: covidwho-1468445

RESUMO

Older adults are susceptible to poor night-time sleep, characterized by short sleep duration and high sleep disruptions (i.e., more frequent and longer awakenings). This study aimed to longitudinally and objectively assess the changes in sleep patterns of older Australians during the 2020 pandemic lockdown. A non-invasive mattress-based device, known as the EMFIT QS, was used to continuously monitor sleep in 31 older adults with an average age of 84 years old before (November 2019-February 2020) and during (March-May 2020) the COVID-19, a disease caused by a form of coronavirus, lockdown. Total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, time to bed, and time out of bed were measured across these two periods. Overall, there was no significant change in total sleep time; however, women had a significant increase in total sleep time (36 min), with a more than 30-min earlier bedtime. There was also no increase in wake after sleep onset and sleep onset latency. Sleep efficiency remained stable across the pandemic time course between 84-85%. While this sample size is small, these data provide reassurance that objective sleep measurement did not deteriorate through the pandemic in older community-dwelling Australians.


Assuntos
COVID-19 , Pandemias , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Controle de Doenças Transmissíveis , Feminino , Humanos , SARS-CoV-2 , Sono
12.
J Med Internet Res ; 23(10): e29025, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1468289

RESUMO

BACKGROUND: Measuring public response during COVID-19 is an important way of ensuring the suitability and effectiveness of epidemic response efforts. An analysis of social media provides an approximation of public sentiment during an emergency like the current pandemic. The measures introduced across the globe to help curtail the spread of the coronavirus have led to the development of a situation labeled as a "perfect storm," triggering a wave of domestic violence. As people use social media to communicate their experiences, analyzing public discourse and sentiment on social platforms offers a way to understand concerns and issues related to domestic violence during the COVID-19 pandemic. OBJECTIVE: This study was based on an analysis of public discourse and sentiment related to domestic violence during the stay-at-home periods of the COVID-19 pandemic in Australia in 2020. It aimed to understand the more personal self-reported experiences, emotions, and reactions toward domestic violence that were not always classified or collected by official public bodies during the pandemic. METHODS: We searched social media and news posts in Australia using key terms related to domestic violence and COVID-19 during 2020 via digital analytics tools to determine sentiments related to domestic violence during this period. RESULTS: The study showed that the use of sentiment and discourse analysis to assess social media data is useful in measuring the public expression of feelings and sharing of resources in relation to the otherwise personal experience of domestic violence. There were a total of 63,800 posts across social media and news media. Within these posts, our analysis found that domestic violence was mentioned an average of 179 times a day. There were 30,100 tweets, 31,700 news reports, 1500 blog posts, 548 forum posts, and 7 comments (posted on news and blog websites). Negative or neutral sentiment centered on the sharp rise in domestic violence during different lockdown periods of the 2020 pandemic, and neutral and positive sentiments centered on praise for efforts that raised awareness of domestic violence as well as the positive actions of domestic violence charities and support groups in their campaigns. There were calls for a positive and proactive handling (rather than a mishandling) of the pandemic, and results indicated a high level of public discontent related to the rising rates of domestic violence and the lack of services during the pandemic. CONCLUSIONS: This study provided a timely understanding of public sentiment related to domestic violence during the COVID-19 lockdown periods in Australia using social media analysis. Social media represents an important avenue for the dissemination of information; posts can be widely dispersed and easily accessed by a range of different communities who are often difficult to reach. An improved understanding of these issues is important for future policy direction. Heightened awareness of this could help agencies tailor and target messaging to maximize impact.


Assuntos
COVID-19 , Violência Doméstica , Mídias Sociais , Controle de Doenças Transmissíveis , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
13.
BMC Med Educ ; 21(1): 414, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: covidwho-1468058

RESUMO

BACKGROUND: The aim of the study was to analyze the perception of dental faculties students regarding the complete transition to distance-based education (DE) and the adaptation of this educational strategy, due to Covid-19 pandemic. A questionnaire to be completed anonymously was submitted online to students attending the faculties of Dentistry and Oral Hygiene at Sapienza, University of Rome, after the end of distance lessons. The collected data were processed statistically, providing descriptive data and analysis of correlation of the most significant parameters, using Chi-squared test, Cramér V and Pearson φ2, Goodman and Kruskal's γ and λ and Kendall's τb. The level of statistical significance was p < 0.05. RESULTS: A total of 314 students participated in the survey. The overall level of satisfaction on a ten- point scale was 5.39 ± 2.59 for Oral Hygiene students and 6.15 ± 2.98 for Dentistry students. The most common complaints were the lack of a structured online curriculum, less interaction with professors and a lower level of attention. On the basis of the responses, scored using Likert-type Scale, oral Hygiene students reported statistically higher level of physical fatigue(p = 0.0189), a lower level of attention (p = 0.0136) and of the quality and quantity of acquired knowledge during distance education (p = 0.0392), compared to Dentistry students. Level of perceived stress and quality and quantity of acquired knowledge (γ = 0.81 and τb =0.56) and quality and quantity of acquired knowledge and fear of a decrease in knowledge (γ = 0.76 and τb =0.54) are associated variables. CONCLUSION: Students' feedback is essential to solve the key issues emerged from the questionnaire. New educational models should be define in order to ensure that distance education could be effective, meeting the learning needs of the students, and could not be a merely "online shift" of traditional methods, used as an alternative of live education.


Assuntos
COVID-19 , Educação à Distância , Humanos , Itália , Pandemias , Percepção , SARS-CoV-2 , Estudantes , Universidades
14.
JCI Insight ; 6(18)2021 09 22.
Artigo em Inglês | MEDLINE | ID: covidwho-1467778

RESUMO

The importance of the adaptive T cell response in the control and resolution of viral infection has been well established. However, the nature of T cell-mediated viral control mechanisms in life-threatening stages of COVID-19 has yet to be determined. The aim of the present study was to determine the function and phenotype of T cell populations associated with survival or death of patients with COVID-19 in intensive care as a result of phenotypic and functional profiling by mass cytometry. Increased frequencies of circulating, polyfunctional CD4+CXCR5+HLA-DR+ stem cell memory T cells (Tscms) and decreased proportions of granzyme B-expressing and perforin-expressing effector memory T cells were detected in recovered and deceased patients, respectively. The higher abundance of polyfunctional PD-L1+CXCR3+CD8+ effector T cells (Teffs), CXCR5+HLA-DR+ Tscms, and anti-nucleocapsid (anti-NC) cytokine-producing T cells permitted us to differentiate between recovered and deceased patients. The results from a principal component analysis show an imbalance in the T cell compartment that allowed for the separation of recovered and deceased patients. The paucity of circulating PD-L1+CXCR3+CD8+ Teffs and NC-specific CD8+ T cells accurately forecasts fatal disease outcome. This study provides insight into the nature of the T cell populations involved in the control of COVID-19 and therefore might impact T cell-based vaccine designs for this infectious disease.


Assuntos
Antígeno B7-H1/imunologia , Linfócitos T CD4-Positivos/imunologia , Antígenos CD8/imunologia , Linfócitos T CD8-Positivos/imunologia , COVID-19/imunologia , Imunidade Celular , Receptores CXCR3/imunologia , Adulto , COVID-19/mortalidade , COVID-19/patologia , Epitopos de Linfócito T/imunologia , Feminino , França/epidemiologia , Humanos , Memória Imunológica , Ativação Linfocitária , Masculino , SARS-CoV-2 , Taxa de Sobrevida/tendências
15.
BMJ Glob Health ; 6(9)2021 09.
Artigo em Inglês | MEDLINE | ID: covidwho-1467699

RESUMO

Although programmes and policies targeting violence against women and girls (VAWG) have increased in the past decade, there is a paucity of evidence on the effectiveness of these interventions. To expand this evidence base, researchers increasingly employ remote data collection (RDC)-including online surveys, mobile applications and telephone interviews-in their evaluations. Although RDC allows for evaluations without in-person interactions-which are restricted during crises such as the COVID-19 pandemic- information about these methods is necessary to understand their potential usefulness and limitations. This scoping review examines remote evaluations of VAWG interventions to describe the landscape of RDC methods, reflect on safety and ethical considerations, and offer best practices for RDC in VAWG research. Fourteen studies met eligibility criteria, with seven, five, and two studies employing telephone interviews, online surveys, and mobile applications, respectively. Studies commonly stated that participants were asked to use a safe email or device, but the method for verifying such safety was rarely specified. Best practices around safety included creating a 'quick escape' button for online data collection to use when another individual was present, explaining to participants how to erase browsing history and application purchases, and asking participants to specify a safe time for researchers to call. Only eight studies established referral pathways for respondents as per best practice. None of the eligible studies took place in low/middle-income countries (LMICs) or humanitarian settings, likely reflecting the additional challenges to using RDC methods in lower resource settings. Findings were used to create a best practice checklist for programme evaluators and Institutional Review Boards using RDC for VAWG interventions. The authors found that opportunities exist for researchers to safely and effectively use RDC methodologies to gather VAWG data, but that further study is needed to gauge the feasibility of these methods in LMICs and humanitarian settings.


Assuntos
COVID-19 , Pandemias , Feminino , Humanos , Pobreza , SARS-CoV-2 , Violência/prevenção & controle
16.
BMJ Glob Health ; 6(9)2021 09.
Artigo em Inglês | MEDLINE | ID: covidwho-1467698

RESUMO

In early 2019, following the 2015-2016 severe drought, the provinces of Sofala and Cabo Delgado, Mozambique, were hit by Cyclones Idai and Kenneth, respectively. These were the deadliest and most destructive cyclones in the country's history. Currently, these two provinces host tens of thousands of vulnerable households due to the climatic catastrophes and the massive influx of displaced people associated with violent terrorist attacks plaguing Cabo Delgado. The emergence of the COVID-19 pandemic added a new challenge to this already critical scenario, serving as a real test for Mozambique's public health preparedness. On the planetary level, Mozambique can be viewed as a 'canary in the coal mine', harbingering to the world the synergistic effects of co-occurring anthropogenic and natural disasters. Herein, we discuss how the COVID-19 pandemic has accentuated the need for an effective and comprehensive public health response in a country already deeply impacted by health problems associated with natural disasters and population displacement.


Assuntos
COVID-19 , Tempestades Ciclônicas , Emergências , Humanos , Moçambique/epidemiologia , Pandemias , Saúde Pública , SARS-CoV-2
17.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: covidwho-1467682

RESUMO

An 82-year-old man with a history of herpes simplex keratitis 40 years previously presented with recurrence, 1 day following vaccination for novel COVID-19. His condition worsened despite topical treatment with ganciclovir gel. A diagnosis of herpetic stromal keratitis was made, requiring systemic aciclovir, topical prednisolone, moxifloxacin and atropine, and oral doxycycline. He improved clinically on treatment, with some residual corneal scarring. Visual acuity improved from 6/36 corrected at presentation, to 6/24 following treatment. Clearly, public and personal health benefits from vaccination are hugely important and we would not suggest avoiding vaccination in such patients. It is, however, important for ophthalmic providers to be aware of the rare potential for reactivation of herpetic eye disease following vaccination to enable prompt diagnosis and treatment.


Assuntos
COVID-19 , Ceratite Herpética , Aciclovir/uso terapêutico , Idoso de 80 Anos ou mais , Antivirais/efeitos adversos , Humanos , Ceratite Herpética/induzido quimicamente , Ceratite Herpética/diagnóstico , Ceratite Herpética/tratamento farmacológico , Masculino , Prednisolona/uso terapêutico , SARS-CoV-2 , Vacinação/efeitos adversos
18.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: covidwho-1467680

RESUMO

Remdesivir is an antiviral used for the treatment of COVID-19 requiring hospitalisation. Information on its cardiovascular safety profile is scarce. We report the case of a 37-year-old man with COVID-19 who developed bradycardia after receiving remdesivir. We recommend a baseline ECG for all patients prior to receiving remdesivir and continuous cardiac monitoring during treatment, especially among those with underlying cardiovascular disease, elderly and using ß-blockers.


Assuntos
Bradicardia , COVID-19 , Monofosfato de Adenosina/análogos & derivados , Adulto , Idoso , Alanina/análogos & derivados , Antivirais/uso terapêutico , Bradicardia/induzido quimicamente , Bradicardia/tratamento farmacológico , COVID-19/tratamento farmacológico , Humanos , Masculino , SARS-CoV-2
19.
BMJ Case Rep ; 14(9)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1467678

RESUMO

We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.


Assuntos
COVID-19 , Nascimento Prematuro , Adulto , Cesárea , Feminino , Feto , Humanos , Recém-Nascido , Gravidez , Gestantes , Respiração Artificial , SARS-CoV-2
20.
Ann Rheum Dis ; 80(10): 1255-1265, 2021 10.
Artigo em Inglês | MEDLINE | ID: covidwho-1467676

RESUMO

Patients with rheumatic diseases are at increased risk of infectious complications; vaccinations are a critical component of their care. Disease-modifying antirheumatic drugs may reduce the immunogenicity of common vaccines. We will review here available data regarding the effect of these medications on influenza, pneumococcal, herpes zoster, SARS-CoV-2, hepatitis B, human papilloma virus and yellow fever vaccines. Rituximab has the most substantial impact on vaccine immunogenicity, which is most profound when vaccinations are given at shorter intervals after rituximab dosing. Methotrexate has less substantial effect but appears to adversely impact most vaccine immunogenicity. Abatacept likely decrease vaccine immunogenicity, although these studies are limited by the lack of adequate control groups. Janus kinase and tumour necrosis factor inhibitors decrease absolute antibody titres for many vaccines, but do not seem to significantly impact the proportions of patients achieving seroprotection. Other biologics (interleukin-6R (IL-6R), IL-12/IL-23 and IL-17 inhibitors) have little observed impact on vaccine immunogenicity. Data regarding the effect of these medications on the SARS-CoV-2 vaccine immunogenicity are just now emerging, and early glimpses appear similar to our experience with other vaccines. In this review, we summarise the most recent data regarding vaccine response and efficacy in this setting, particularly in light of current vaccination recommendations for immunocompromised patients.


Assuntos
Antirreumáticos/uso terapêutico , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Hospedeiro Imunocomprometido , Imunogenicidade da Vacina/imunologia , Doenças Reumáticas/tratamento farmacológico , COVID-19/complicações , Vacinas contra COVID-19/uso terapêutico , Humanos , Doenças Reumáticas/complicações , SARS-CoV-2
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