Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.260
Filtrar
Adicionar filtros

Tipo de documento
Ano de publicação
Intervalo de ano
1.
Am J Phys Med Rehabil ; 100(11): 1031-1032, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1537604

RESUMO

ABSTRACT: This brief report summarizes the comparative experience of an inpatient rehabilitation facility dealing with two episodes of COVID-19 infection, one before and one after the availability of vaccination, which was deployed to staff. The experience exemplifies the high rate of infection and potential for asymptomatic presentation of COVID-19 as well as the protective advantage of the vaccine for healthcare workers in this report. With a significant reduction in the rate of infection, from nearly 30% before vaccination to only 2.5% after vaccination. The data presented should serve as an encouragement for vaccination across all populations.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Pessoal de Saúde , Controle de Infecções/normas , Pneumonia Viral/prevenção & controle , Centros de Reabilitação , Adulto , COVID-19/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Fidelidade a Diretrizes , Humanos , Pacientes Internados , Masculino , Programas de Rastreamento , Pennsylvania/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2
7.
Ren Fail ; 43(1): 1329-1337, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: covidwho-1493366

RESUMO

BACKGROUND: This study sought to investigate incidence and risk factors for acute kidney injury (AKI) in hospitalized COVID-19. METHODS: In this retrospective study, we enrolled 823 COVID-19 patients with at least two evaluations of renal function during hospitalization from four hospitals in Wuhan, China between February 2020 and April 2020. Clinical and laboratory parameters at the time of admission and follow-up data were recorded. Systemic renal tubular dysfunction was evaluated via 24-h urine collections in a subgroup of 55 patients. RESULTS: In total, 823 patients were enrolled (50.5% male) with a mean age of 60.9 ± 14.9 years. AKI occurred in 38 (40.9%) ICU cases but only 6 (0.8%) non-ICU cases. Using forward stepwise Cox regression analysis, we found eight independent risk factors for AKI including decreased platelet level, lower albumin level, lower phosphorus level, higher level of lactate dehydrogenase (LDH), procalcitonin, C-reactive protein (CRP), urea, and prothrombin time (PT) on admission. For every 0.1 mmol/L decreases in serum phosphorus level, patients had a 1.34-fold (95% CI 1.14-1.58) increased risk of AKI. Patients with hypophosphatemia were likely to be older and with lower lymphocyte count, lower serum albumin level, lower uric acid, higher LDH, and higher CRP. Furthermore, serum phosphorus level was positively correlated with phosphate tubular maximum per volume of filtrate (TmP/GFR) (Pearson r = 0.66, p < .001) in subgroup analysis, indicating renal phosphate loss via proximal renal tubular dysfunction. CONCLUSION: The AKI incidence was very low in non-ICU patients as compared to ICU patients. Hypophosphatemia is an independent risk factor for AKI in patients hospitalized for COVID-19 infection.


Assuntos
Injúria Renal Aguda/etiologia , COVID-19/complicações , Hipofosfatemia/complicações , Pneumonia Viral/complicações , Injúria Renal Aguda/epidemiologia , COVID-19/epidemiologia , China/epidemiologia , Feminino , Hospitalização , Humanos , Hipofosfatemia/epidemiologia , Incidência , Unidades de Terapia Intensiva , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
8.
Sci Rep ; 11(1): 21259, 2021 10 28.
Artigo em Inglês | MEDLINE | ID: covidwho-1493217

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently a serious public health concern worldwide. Notably, co-infection with other pathogens may worsen the severity of COVID-19 symptoms and increase fatality. Here, we show that co-infection with influenza A virus (IAV) causes more severe body weight loss and more severe and prolonged pneumonia in SARS-CoV-2-infected hamsters. Each virus can efficiently spread in the lungs without interference by the other. However, in immunohistochemical analyses, SARS-CoV-2 and IAV were not detected at the same sites in the respiratory organs of co-infected hamsters, suggesting that either the two viruses may have different cell tropisms in vivo or each virus may inhibit the infection and/or growth of the other within a cell or adjacent areas in the organs. Furthermore, a significant increase in IL-6 was detected in the sera of hamsters co-infected with SARS-CoV-2 and IAV at 7 and 10 days post-infection, suggesting that IL-6 may be involved in the increased severity of pneumonia. Our results strongly suggest that IAV co-infection with SARS-CoV-2 can have serious health risks and increased caution should be applied in such cases.


Assuntos
COVID-19/complicações , Infecções por Orthomyxoviridae/complicações , Pneumonia Viral/complicações , SARS-CoV-2 , Animais , COVID-19/patologia , COVID-19/virologia , Coinfecção/patologia , Modelos Animais de Doenças , Feminino , Humanos , Interleucina-6/sangue , Pulmão/diagnóstico por imagem , Pulmão/patologia , Mesocricetus , Orthomyxoviridae/patogenicidade , Infecções por Orthomyxoviridae/patologia , Infecções por Orthomyxoviridae/virologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , SARS-CoV-2/patogenicidade , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Replicação Viral
9.
Sci Rep ; 10(1): 16598, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1493167

RESUMO

We address the diffusion of information about the COVID-19 with a massive data analysis on Twitter, Instagram, YouTube, Reddit and Gab. We analyze engagement and interest in the COVID-19 topic and provide a differential assessment on the evolution of the discourse on a global scale for each platform and their users. We fit information spreading with epidemic models characterizing the basic reproduction number [Formula: see text] for each social media platform. Moreover, we identify information spreading from questionable sources, finding different volumes of misinformation in each platform. However, information from both reliable and questionable sources do not present different spreading patterns. Finally, we provide platform-dependent numerical estimates of rumors' amplification.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Mídias Sociais , Número Básico de Reprodução , COVID-19 , Infecções por Coronavirus/virologia , Análise de Dados , Humanos , Disseminação de Informação , Modelos Lineares , Redes Neurais de Computação , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2 , Comportamento Social
11.
AJR Am J Roentgenol ; 217(5): 1093-1102, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: covidwho-1484970

RESUMO

BACKGROUND. Previous studies compared CT findings of COVID-19 pneumonia with those of other infections; however, to our knowledge, no studies to date have included noninfectious organizing pneumonia (OP) for comparison. OBJECTIVE. The objectives of this study were to compare chest CT features of COVID-19, influenza, and OP using a multireader design and to assess the performance of radiologists in distinguishing between these conditions. METHODS. This retrospective study included 150 chest CT examinations in 150 patients (mean [± SD] age, 58 ± 16 years) with a diagnosis of COVID-19, influenza, or non-infectious OP (50 randomly selected abnormal CT examinations per diagnosis). Six thoracic radiologists independently assessed CT examinations for 14 individual CT findings and for Radiological Society of North America (RSNA) COVID-19 category and recorded a favored diagnosis. The CT characteristics of the three diagnoses were compared using random-effects models; the diagnostic performance of the readers was assessed. RESULTS. COVID-19 pneumonia was significantly different (p < .05) from influenza pneumonia for seven of 14 chest CT findings, although it was different (p < .05) from OP for four of 14 findings (central or diffuse distribution was seen in 10% and 7% of COVID-19 cases, respectively, vs 20% and 21% of OP cases, respectively; unilateral distribution was seen in 1% of COVID-19 cases vs 7% of OP cases; non-tree-in-bud nodules was seen in 32% of COVID-19 cases vs 53% of OP cases; tree-in-bud nodules were seen in 6% of COVID-19 cases vs 14% of OP cases). A total of 70% of cases of COVID-19, 33% of influenza cases, and 47% of OP cases had typical findings according to RSNA COVID-19 category assessment (p < .001). The mean percentage of correct favored diagnoses compared with actual diagnoses was 44% for COVID-19, 29% for influenza, and 39% for OP. The mean diagnostic accuracy of favored diagnoses was 70% for COVID-19 pneumonia and 68% for both influenza and OP. CONCLUSION. CT findings of COVID-19 substantially overlap with those of influenza and, to a greater extent, those of OP. The diagnostic accuracy of the radiologists was low in a study sample that contained equal proportions of these three types of pneumonia. CLINICAL IMPACT. Recognized challenges in diagnosing COVID-19 by CT are furthered by the strong overlap observed between the appearances of COVID-19 and OP on CT. This challenge may be particularly evident in clinical settings in which there are substantial proportions of patients with potential causes of OP such as ongoing cancer therapy or autoimmune conditions.


Assuntos
COVID-19/diagnóstico por imagem , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Influenza Humana/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Feminino , Humanos , Influenza Humana/virologia , Masculino , Massachusetts , Pessoa de Meia-Idade , Variações Dependentes do Observador , Pneumonia Viral/virologia , Radiografia Torácica , Estudos Retrospectivos , SARS-CoV-2
14.
J Med Ethics ; 46(8): 505-507, 2020 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1467731

RESUMO

COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients' outcome within the constraints of pandemic management and its long-term outlook.


Assuntos
Infecções por Coronavirus/complicações , Tomada de Decisões/ética , Ética Médica , Cirurgia Geral/ética , Equidade em Saúde/ética , Pandemias/ética , Seleção de Pacientes/ética , Pneumonia Viral/complicações , Betacoronavirus , COVID-19 , Infecções por Coronavirus/virologia , Análise Custo-Benefício , Inglaterra , Análise Ética , Teoria Ética , Humanos , Consentimento Livre e Esclarecido/ética , Obrigações Morais , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Ética Baseada em Princípios , Medição de Risco , SARS-CoV-2 , Medicina Estatal , Cirurgiões , Procedimentos Cirúrgicos Operatórios
15.
J Med Ethics ; 46(8): 510-513, 2020 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1467730

RESUMO

During the COVID-19 pandemic, the media have repeatedly praised healthcare workers for their 'heroic' work. Although this gratitude is undoubtedly appreciated by many, we must be cautious about overuse of the term 'hero' in such discussions. The challenges currently faced by healthcare workers are substantially greater than those encountered in their normal work, and it is understandable that the language of heroism has been evoked to praise them for their actions. Yet such language can have potentially negative consequences. Here, I examine what heroism is and why it is being applied to the healthcare workers currently, before outlining some of the problems associated with the heroism narrative currently being employed by the media. Healthcare workers have a clear and limited duty to treat during the COVID-19 pandemic, which can be grounded in a broad social contract and is strongly associated with certain reciprocal duties that society has towards healthcare workers. I argue that the heroism narrative can be damaging, as it stifles meaningful discussion about what the limits of this duty to treat are. It fails to acknowledge the importance of reciprocity, and through its implication that all healthcare workers have to be heroic, it can have negative psychological effects on workers themselves. I conclude that rather than invoking the language of heroism to praise healthcare workers, we should examine, as a society, what duties healthcare workers have to work in this pandemic, and how we can support them in fulfilling these.


Assuntos
Infecções por Coronavirus , Coragem , Atenção à Saúde , Pessoal de Saúde , Meios de Comunicação de Massa , Pandemias , Pneumonia Viral , Opinião Pública , Atitude Frente a Saúde , Betacoronavirus , COVID-19 , Comunicação , Infecções por Coronavirus/virologia , Humanos , Obrigações Morais , Pneumonia Viral/virologia , SARS-CoV-2 , Responsabilidade Social
16.
J Med Ethics ; 46(8): 495-498, 2020 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1467727

RESUMO

Key ethical challenges for healthcare workers arising from the COVID-19 pandemic are identified: isolation and social distancing, duty of care and fair access to treatment. The paper argues for a relational approach to ethics which includes solidarity, relational autonomy, duty, equity, trust and reciprocity as core values. The needs of the poor and socially disadvantaged are highlighted. Relational autonomy and solidarity are explored in relation to isolation and social distancing. Reciprocity is discussed with reference to healthcare workers' duty of care and its limits. Priority setting and access to treatment raise ethical issues of utility and equity. Difficult ethical dilemmas around triage, do not resuscitate decisions, and withholding and withdrawing treatment are discussed in the light of recently published guidelines. The paper concludes with the hope for a wider discussion of relational ethics and a glimpse of a future after the pandemic has subsided.


Assuntos
Tomada de Decisões/ética , Ética Clínica , Alocação de Recursos para a Atenção à Saúde/ética , Equidade em Saúde/ética , Pessoal de Saúde/ética , Pandemias/ética , Betacoronavirus , COVID-19 , Infecções por Coronavirus/virologia , Planejamento em Desastres , Humanos , Obrigações Morais , Pneumonia Viral/virologia , Pobreza , Guias de Prática Clínica como Assunto , Relações Profissional-Paciente , Ordens quanto à Conduta (Ética Médica) , SARS-CoV-2 , Valores Sociais , Triagem/ética , Populações Vulneráveis , Suspensão de Tratamento/ética
17.
J Med Ethics ; 46(8): 514-525, 2020 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1467726

RESUMO

BACKGROUND: Humanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care-a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, the WHO released a guide on 'Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises'-the first guidance on the topic by an international body. AIMS: This paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances. IMPLICATIONS: In parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance.


Assuntos
Temas Bioéticos , Atenção à Saúde/ética , Planejamento em Desastres , Cuidados Paliativos/ética , Pandemias/ética , Assistência Terminal/ética , Altruísmo , Betacoronavirus , Bioética , COVID-19 , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Cuidados Críticos , Tomada de Decisões/ética , Emergências , Ética Clínica , Saúde Global , Alocação de Recursos para a Atenção à Saúde , Equidade em Saúde , Recursos em Saúde , Humanos , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Fatores Socioeconômicos , Estresse Psicológico
18.
Pan Afr Med J ; 39: 230, 2021.
Artigo em Francês | MEDLINE | ID: covidwho-1464030

RESUMO

Introduction: the main purpose of this study is to describe chest computed tomography (CT) findings in 26 patients hospitalized with COVID-19 pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (UCK). Methods: we conducted a descriptive study of chest CT findings in 26 patients hospitalized with coronavirus pneumonia at the UCK over a 9-month period, from March 17 to November 17, 2020. Hitachi - CT-scanner 16 slice was used in all our patients. After analyzing lesions, these were divided into lesions suggestive and non-suggestive of SARS-CoV-2 infection. Results: the average age of patients was 53.02 years. Male sex was the most affected (76.9%). Respiratory distress was the most common clinical symptom (61.5%). Arterial hypertension and renal failure were the most common comorbidities (3O% and 6%). Bilateral ground-glass opacities, with a predominantly peripheral distribution, accounted for 69.2% of cases, followed by condensations (57.7%) and crazy paving (19.2%). Severe COVID-19 was most frequently found (34.61%). Distal and proximal pulmonary embolism was the most common complication (11.5%). Among the associated diseases, pleurisy and pulmonary PAH were most frequently found (30.8%). The majority of our patients had parenchymal lung lesions, corresponding to early-stage disease on CT (50%). Conclusion: at the UCK, during the first wave of SARS-CoV-2 pandemic, lesions on CT suggestive of COVID-19 were dominated by plaque-like ground-glass opacities, followed by nonsystematized parenchymatous condensations and crazy paving. The less observed atypical lesions consisted of unilateral, peribronchovascular pseudo-nodular condensations and infection in the remodeled lung. Severe COVID-19 was the most common CT finding. Proximal and distal pulmonary embolism was the most common complication. This study highlights that these findings are consistent with those reported in the literature.


Assuntos
COVID-19/complicações , Hospitalização , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , COVID-19/diagnóstico por imagem , Criança , Pré-Escolar , República Democrática do Congo , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Índice de Gravidade de Doença , Distribuição por Sexo , Adulto Jovem
19.
Ann Intern Med ; 174(6): 811-821, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1456489

RESUMO

BACKGROUND: The clinical significance of the antibody response after SARS-CoV-2 infection remains unclear. PURPOSE: To synthesize evidence on the prevalence, levels, and durability of detectable antibodies after SARS-CoV-2 infection and whether antibodies to SARS-CoV-2 confer natural immunity. DATA SOURCES: MEDLINE (Ovid), Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, World Health Organization global literature database, and Covid19reviews.org from 1 January through 15 December 2020, limited to peer-reviewed publications available in English. STUDY SELECTION: Primary studies characterizing the prevalence, levels, and duration of antibodies in adults with SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR); reinfection incidence; and unintended consequences of antibody testing. DATA EXTRACTION: Two investigators sequentially extracted study data and rated quality. DATA SYNTHESIS: Moderate-strength evidence suggests that most adults develop detectable levels of IgM and IgG antibodies after infection with SARS-CoV-2 and that IgG levels peak approximately 25 days after symptom onset and may remain detectable for at least 120 days. Moderate-strength evidence suggests that IgM levels peak at approximately 20 days and then decline. Low-strength evidence suggests that most adults generate neutralizing antibodies, which may persist for several months like IgG. Low-strength evidence also suggests that older age, greater disease severity, and presence of symptoms may be associated with higher antibody levels. Some adults do not develop antibodies after SARS-CoV-2 infection for reasons that are unclear. LIMITATIONS: Most studies were small and had methodological limitations; studies used immunoassays of variable accuracy. CONCLUSION: Most adults with SARS-CoV-2 infection confirmed by RT-PCR develop antibodies. Levels of IgM peak early in the disease course and then decline, whereas IgG peaks later and may remain detectable for at least 120 days. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. (PROSPERO: CRD42020207098).


Assuntos
Anticorpos Antivirais/sangue , Formação de Anticorpos , COVID-19/imunologia , Pneumonia Viral/imunologia , SARS-CoV-2/imunologia , Especificidade de Anticorpos/imunologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...