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1.
Rev. enferm. UERJ ; 28: e48849, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1119635

RESUMEN

Objetivo: descrever o atual processo de convocação de pacientes para procedimento cirúrgico, bem como a comunicação entre a equipe multiprofissional e o paciente no período pré-operatório e identificar a linha de cuidados prestados pela equipe multiprofissional no período pré-operatório. Método: pesquisa exploratória, descritiva e qualitativa. Amostra contemplou 28 participantes, membros da equipe multidisciplinar da clínica cirurgia geral de um hospital universitário do Rio de Janeiro. Os dados foram coletados por dois roteiros de entrevista semiestruturada, de fevereiro a abril de 2019, após autorização do Comitê de Ética em Pesquisa. Resultados: a falta de planejamento, protocolos e fluxo intenso de pacientes levou a dúvidas, estresse, cancelamento de cirurgias no decorrer da internação. Conclusão: a ausência de protocolos articulados com ações e treinamentos prejudicou o processo de internação, bem como a comunicação entre a equipe multiprofissional e paciente. Fizeram parte da linha de cuidados: anamnese, sinais vitais, conciliação medicamentosa e orientações gerais.


Objective: to describe the current process of calling patients in for surgical-clinic unit, as well as communication between multidisciplinary team and patient in the preoperative period. Method: in this exploratory, qualitative, descriptive study, the 28 participants were members of the multidisciplinary team of surgical-clinic unit of a university hospital in Rio de Janeiro. Data were collected from February to April 2019 using two semi-structured interview scripts. The study was authorized by the research ethics committee. Results: the lack of planning and protocols and the intense flow of patients led to doubts, stress, and cancellation of surgeries during hospitalization. Conclusion: the absence of protocols coupled with actions and training impaired the hospitalization process, as well as communication between multidisciplinary team and patient. The line of care comprised: anamnesis, vital signs, medication reconciliation and general guidelines.


Objetivo: describir el proceso actual de convocatoria de pacientes para unidad clínica quirúrgica, así como la comunicación entre equipo multidisciplinario y paciente en el período preoperatorio. Método: en este estudio exploratorio, cualitativo, descriptivo, los 28 participantes eran miembros del equipo multidisciplinario de la unidad clínica quirúrgica de un hospital universitario de Río de Janeiro. Los datos se recopilaron de febrero a abril de 2019 mediante dos guiones de entrevistas semiestructurados. El estudio fue autorizado por el comité de ética en investigación. Resultados: la falta de planificación y protocolos y el intenso flujo de pacientes generó dudas, estrés y cancelación de cirugías durante la hospitalización. Conclusión: la ausencia de protocolos sumados a acciones y formación perjudicó el proceso de internación, así como la comunicación entre equipo multidisciplinar y paciente. La línea de atención comprendió: anamnesis, constantes vitales, conciliación de medicamentos y pautas generales.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Admisión del Paciente , Cuidados Preoperatorios/métodos , Hospitales Universitarios , Grupo de Atención al Paciente , Relaciones Profesional-Paciente , Brasil , Epidemiología Descriptiva , Investigación Cualitativa , Hospitalización , Relaciones Interprofesionales
2.
J Cardiovasc Pharmacol ; 76(5): 540-548, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33170591

RESUMEN

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. This study sought to share our experiences with in-hospital management and outcomes of acute myocardial infarction (AMI) during the COVID-19 pandemic. We retrospectively analyzed consecutive AMI patients, including those with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), from February 1, 2020, to April 15, 2020 (during the COVID-19 pandemic), and from January 1, 2019, to December 31, 2019 (before the COVID-19 pandemic), respectively. Fifty-three AMI patients (31 STEMI, 22 NSTEMI) during the COVID-19 pandemic were matched to 53 AMI patients before the pandemic. Baseline characteristics were comparable between the matched patients. STEMI patients during the COVID-19 pandemic had a longer delay time, less primary or remedial PCI and more emergency thrombolysis than those before the pandemic. Less coronary angiography and stenting were performed in AMI patients during the COVID-19 pandemic than before the pandemic. There were no statistically significant differences in the clinical outcomes between the matched patients. However, STEMI patients during the COVID-19 pandemic had a 4-fold (12.9% vs. 3.2%) increase in all-cause mortality rate compared with those before the pandemic. AMI combined with COVID-19 infection was associated with higher rates of mortality than AMI alone. This study demonstrates that the COVID-19 pandemic results in significant reperfusion delays in STEMI patients and has a marked impact on the treatment options selection in AMI patients. The mortality rate of STEMI patients exhibits an increasing trend during the pandemic of COVID-19.


Asunto(s)
Servicio de Cardiología en Hospital/tendencias , Infecciones por Coronavirus , Infarto del Miocardio sin Elevación del ST/terapia , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Pandemias , Intervención Coronaria Percutánea/tendencias , Neumonía Viral , Infarto del Miocardio con Elevación del ST/terapia , Terapia Trombolítica/tendencias , Tiempo de Tratamiento/tendencias , Anciano , China , Angiografía Coronaria/tendencias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/mortalidad , Admisión del Paciente , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Estudios Retrospectivos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Factores de Tiempo , Resultado del Tratamiento
3.
Br J Community Nurs ; 25(11): 526-530, 2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33161746

RESUMEN

The pandemic caused by Covid-19 has long term ramifications for many, especially those patients who have experienced an intensive care unit (ICU) admission including ventilation and sedation. This paper will explore aspects of care delivery in the ICU regarding the current pandemic and the impact of such on the mental health of some of these patients. Post discharge, patients will be returning to a very different community incorporating social distancing, and in some cases, social isolation and/or shielding. Many may experience a multitude of physical and mental health complications which can ultimately impact upon each other, therefore a bio-psycho-pharmaco-social approach to discharge, case management, risk assessment and positive behavioural support planning is recommended.


Asunto(s)
Cuidados Posteriores/psicología , Infecciones por Coronavirus/enfermería , Infecciones por Coronavirus/psicología , Cuidados Críticos/psicología , Sedación Profunda/psicología , Salud Mental/estadística & datos numéricos , Neumonía Viral/enfermería , Neumonía Viral/psicología , Respiración Artificial/psicología , Aislamiento Social/psicología , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Admisión del Paciente/estadística & datos numéricos
4.
Rev Assoc Med Bras (1992) ; 66(10): 1361-1365, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33174927

RESUMEN

OBJECTIVE: The aim of our study was to investigate whether there has been a reduction in patient admission to a high-complexity cancer care center in Brasil during the COVID-19 pandemic, similar to what was reported in Europe. METHODS: We reviewed the cancer tracking database of the largest cancer center in southern Brasil and performed statistical tests to compare first-time appointments from the onset of the outbreak until the end of June to those of the equivalent period in 2019. RESULTS: We observed a dramatic reduction (-42%) in first-time appointments during the pandemic compared to the same period in the previous year (P <0.001). This reduction was observed among all medical specialties (P <0.001). CONCLUSION: The onset of COVID-19 was correlated with a reduction in admission to a high-complexity cancer care center in Brasil. Since a delay in diagnosis and treatment may influence prognosis, it is important that cancer centers and public health strategies reinforce care for non-COVID-19 patients to prevent potentially unnecessary deaths.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neoplasias , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , Brasil/epidemiología , Humanos , Neoplasias/epidemiología , Neoplasias/terapia , Pandemias
5.
WMJ ; 119(3): 198-201, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33091289

RESUMEN

BACKGROUND: Several studies describing Coronavirus disease 2019 (COVID-19) have been reported; however, to our knowledge, no case series has been published from the Midwest. OBJECTIVE: To describe demographic characteristics and outcomes of patients admitted with COVID-19 to a Wisconsin academic medical center. METHODS: We performed a retrospective analysis of data obtained for COVID-19 patients admitted from March 14, 2020, through April 19, 2020. RESULTS: One hundred sixty-eight patients were admitted. Outcomes measured include time in the intensive care unit (53%), mechanical ventilation (18%), and death (19%). ICU patients had higher rates of diabetes, obesity, and higher inflammatory markers. The majority of patients admitted were African American (68%). CONCLUSION: This case series highlights demographic similarities and differences, as well as outcomes, among COVID-19 patients in a Wisconsin Academic Medical Center compared to those reported in other geographic regions.


Asunto(s)
Centros Médicos Académicos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Anciano , Betacoronavirus , Infecciones por Coronavirus/mortalidad , Demografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Wisconsin/epidemiología
8.
Am J Case Rep ; 21: e926886, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-32999267

RESUMEN

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China, in late 2019 and has led to an ongoing pandemic. COVID-19 typically affects the respiratory tract and mucous membranes, leading to pathological involvement of various organ systems. Although patients usually present with fever, cough, and fatigue, less common manifestations have been reported including symptoms arising from thrombosis and thromboembolism. A spectrum of dermatologic changes is becoming recognized in patients with COVID-19 who initially present with respiratory symptoms. The mechanism behind these manifestations remains unclear. This report presents the case of a 47-year-old Hispanic man who developed cutaneous vasculitic lesions and gangrene of the toes following admission to hospital with COVID-19 pneumonia. CASE REPORT COVID-19 has been associated with cardiovascular disease entities including stroke, acute coronary syndrome, venous thromboembolism, and peripheral vascular disease. We present a case in which a 47-year-old Hispanic man arrived at the Emergency Department with COVID-19 and was admitted for respiratory failure. Despite anticoagulation initiated on admission in the presence of an elevated D-dimer, the patient developed gangrene of all his toes, which required bilateral transmetatarsal amputation. CONCLUSIONS This case shows that dermatologic manifestations may develop in patients who initially present with COVID-19 pneumonia. These symptoms may be due to venous thrombosis following SARS-CoV-2 vasculitis, leading to challenging decisions regarding anticoagulation therapy. Randomized controlled trials are needed to evaluate the efficacy of anticoagulation, to choose appropriate anticoagulants and dosing, and to assess bleeding risk.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Gangrena/etiología , Gangrena/cirugía , Neumonía Viral/complicaciones , Síndrome Respiratorio Agudo Grave/complicaciones , Dedos del Pie/cirugía , Vasculitis/etiología , Amputación/métodos , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Gangrena/fisiopatología , Hispanoamericanos , Humanos , Masculino , Huesos Metatarsianos/cirugía , Persona de Mediana Edad , Multimorbilidad , Pandemias , Admisión del Paciente , Neumonía Viral/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Dedos del Pie/irrigación sanguínea , Dedos del Pie/fisiopatología , Resultado del Tratamiento , Vasculitis/fisiopatología
9.
Front Immunol ; 11: 560381, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33072099

RESUMEN

Background: Emerging evidence indicates a potential role for monocytes in COVID-19 immunopathology. We investigated two soluble markers of monocyte activation, sCD14 and sCD163, in COVID-19 patients, with the aim of characterizing their potential role in monocyte-macrophage disease immunopathology. To the best of our knowledge, this is the first study of its kind. Methods: Fifty-nine SARS-Cov-2 positive hospitalized patients, classified according to ICU or non-ICU admission requirement, were prospectively recruited and analyzed by ELISA for levels of sCD14 and sCD163, along with other laboratory parameters, and compared to a healthy control group. Results: sCD14 and sCD163 levels were significantly higher among COVID-19 patients, independently of ICU admission requirement, compared to the control group. We found a significant correlation between sCD14 levels and other inflammatory markers, particularly Interleukin-6, in the non-ICU patients group. sCD163 showed a moderate positive correlation with the time lapsed from admission to sampling, independently of severity group. Treatment with corticoids showed an interference with sCD14 levels, whereas hydroxychloroquine and tocilizumab did not. Conclusions: Monocyte-macrophage activation markers are increased and correlate with other inflammatory markers in SARS-Cov-2 infection, in association to hospital admission. These data suggest a preponderant role for monocyte-macrophage activation in the development of immunopathology of COVID-19 patients.


Asunto(s)
Antígenos CD , Antígenos de Diferenciación Mielomonocítica , Betacoronavirus , Infecciones por Coronavirus , Receptores de Lipopolisacáridos , Pandemias , Neumonía Viral , Receptores de Superficie Celular , Corticoesteroides/administración & dosificación , Adulto , Anciano , Anticuerpos Monoclonales Humanizados/administración & dosificación , Antígenos CD/sangre , Antígenos CD/inmunología , Antígenos de Diferenciación Mielomonocítica/sangre , Antígenos de Diferenciación Mielomonocítica/inmunología , Betacoronavirus/inmunología , Betacoronavirus/metabolismo , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/patología , Femenino , Humanos , Hidroxicloroquina/administración & dosificación , Unidades de Cuidados Intensivos , Interleucina-6/sangre , Interleucina-6/inmunología , Receptores de Lipopolisacáridos/sangre , Receptores de Lipopolisacáridos/inmunología , Activación de Macrófagos , Macrófagos/inmunología , Macrófagos/metabolismo , Macrófagos/patología , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Monocitos/patología , Admisión del Paciente , Neumonía Viral/sangre , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/inmunología , Neumonía Viral/patología , Receptores de Superficie Celular/sangre , Receptores de Superficie Celular/inmunología , Factores de Tiempo
10.
Assist Inferm Ric ; 39(3): 118-121, 2020.
Artículo en Italiano | MEDLINE | ID: mdl-33077980

RESUMEN

. Care path for non-deferred elective hospitalizations in cardiology in the Covid-19 period. INTRODUCTION: The novel coronavirus-19 (Covid-19) has rapidly resulted in a global pandemic. Our hospital had to postpone all elective admissions to increase capacity for COVID-19 patients. Therefore, a rearrangement of the elective admissions was necessary to guarantee a restart of ordinary procedures. AIM: To describe the organizational model adopted for elective procedures during the Covid-19 pandemic, to guarantee maximum safety for patients and healthcare workers. METHODS: Patients on waiting list for cardiac procedures were rearranged based on risks prioritization. Procedure of coronary angiography and cardiac devices (PM and ICD) implants or replacement took priority upon other cardiac procedures. Each patient underwent a telephone nurse triage to assess for any covid-19 symptoms. The hospital admissions were organized in accordance with health and safety measures declared by the National Institute of Health, with different paths according to the swab results. RESULTS: A total of 66 patients were contacted and 40 accepted the hospital admission (26 refused it, for fear of infection or covid-19 related family problems). No patient resulted positive to the nasal swab. CONCLUSIONS: In view of the impact on the health care system of this new pandemic, the choice of an appropriate pathway which can preserve patients' safety is essential, while guaranteeing the treatment of problems, such as cardiovascular diseases, with a high mortality rate.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Hospitalización/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Planificación de Atención al Paciente , Neumonía Viral/epidemiología , Cardiología/estadística & datos numéricos , Hospitales , Humanos , Modelos Organizacionales , Pandemias , Listas de Espera
11.
Sci Rep ; 10(1): 16496, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33020546

RESUMEN

This study aimed to analyze aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio in COVID-19 patients. After exclusion, 567 inpatients were included in this study and separated into two groups according to their AST/ALT ratio on admission. Death was regarded as poor prognosis in this study. Of 567 patients, 200 (35.3%) had AST/ALT ≥ 1.38. Of the 200 patients, older age (median age 60 years), myalgia (64 [32%] cases), fatigue (91 [45.5%] cases), some comorbidities and outcomes were significantly different from patients with AST/ALT < 1.38. They also had worse chest computed tomography (CT) findings, laboratory results and severity scores. Levels of platelet count (OR 0.995, 95% CI [0.992-0.998]) and hemoglobin (OR 0.984, 95% CI [0.972-0.995]) were independently associated with AST/ALT ≥ 1.38 on admission. Furthermore, a high AST/ALT ratio on admission was an independent risk factor for poor prognosis (OR 99.9, 95% CI [2.1-4280.5]). In subsequent monitoring, both survivors and non-survivors showed decreased AST/ALT ratio during hospitalization. In conclusion, high AST/ALT ratio might be the indication of worse status and outcomes in COVID-19 patients.


Asunto(s)
Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Infecciones por Coronavirus/sangre , Neumonía Viral/sangre , Adulto , Factores de Edad , Anciano , Biomarcadores/sangre , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/patología , Fatiga/epidemiología , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Mialgia/epidemiología , Pandemias , Admisión del Paciente/estadística & datos numéricos , Recuento de Plaquetas , Neumonía Viral/epidemiología , Neumonía Viral/patología , Análisis de Supervivencia
12.
PLoS One ; 15(10): e0240645, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052968

RESUMEN

INTRODUCTION: Because of the COVID-19 pandemic, intensive care units (ICU) can be overwhelmed by the number of hypoxemic patients. MATERIAL AND METHODS: This single centre retrospective observational cohort study took place in a French hospital where the number of patients exceeded the ICU capacity despite an increase from 18 to 32 beds. Because of this, 59 (37%) of the 159 patients requiring ICU care were referred to other hospitals. From 27th March to 23rd April, consecutive patients who had respiratory failure or were unable to maintain an SpO2 > 90%, despite receiving 10-15 l/min of oxygen with a non-rebreather mask, were treated by continuous positive airway pressure (CPAP) unless the ICU physician judged that immediate intubation was indicated. We describe the characteristics, clinical course, and outcomes of these patients. The main outcome under study was CPAP discontinuation. RESULTS: CPAP was initiated in 49 patients and performed out of ICU in 41 (84%). Median age was 65 years (IQR = 54-71) and 36 (73%) were men. Median respiratory rate before CPAP was 36 (30-40) and median SpO2 was 92% (90-95) under 10 to 15 L/min oxygen flow. Median duration of CPAP was 3 days (IQR = 1-5). Reasons for discontinuation of CPAP were: intubation in 25 (51%), improvement in 16 (33%), poor tolerance in 6 (12%) and death in 2 (4%) patients. A decision not to intubate had been taken for 8 patients, including the 2 who died while on CPAP. Two patients underwent less than one hour CPAP for poor tolerance. In the end, 15 (38%) out of 39 evaluable patients recovered with only CPAP whereas 24 (62%) were intubated. CONCLUSIONS: CPAP is feasible in a non-ICU environment in the context of massive influx of patients. In our cohort up to 1/3 of the patients presenting with acute respiratory failure recovered without intubation.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Anciano , Presión de las Vías Aéreas Positiva Contínua/economía , Presión de las Vías Aéreas Positiva Contínua/instrumentación , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Costos y Análisis de Costo , Femenino , Francia , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias/economía , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/economía , Neumonía Viral/epidemiología
13.
PLoS One ; 15(10): e0237297, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33022004

RESUMEN

BACKGROUND: The global rate of intensive care unit (ICU) admission during the COVID-19 pandemic varies within countries and is among the main challenges for health care systems worldwide. Conflicting results have been reported about the response to coronavirus infection and COVID-19 outcomes in men and women. Understanding predictors of intensive care unit admission might be of help for future planning and management of the disease. METHODS AND FINDINGS: We designed a cross-sectional observational multicenter nationwide survey in Italy to understand gender-related clinical predictors of ICU admission in patients with COVID-19. We analyzed information from 2378 charts of Italian patients certified for COVID-19 admitted in 26 hospitals. Three hundred ninety-five patients (16.6%) required ICU admission due to COVID19 infection, more frequently men (74%), with a higher prevalence of comorbidities (1,78±0,06 vs 1,54±0,03 p<0.05). In multivariable regression model main predictors of admission to ICU are male gender (OR 1,74 95% CI 1,36-2,22 p<0.0001) and presence of obesity (OR 2,88 95% CI 2,03-4,07 p<0.0001), chronic kidney disease (OR: 1,588; 95%, 1,036-2,434 p<0,05) and hypertension (OR: 1,314; 95% 1,039-1,662; p<0,05). In gender specific analysis, obesity, chronic kidney disease and hypertension are associated with higher rate of admission to ICU among men, whereas in women, obesity (OR: 2,564; 95% CI 1,336-4.920 p<0.0001) and heart failure (OR: 1,775 95% CI: 1,030-3,057) are associated with higher rate of ICU admission. CONCLUSIONS: Our study demonstrates that gender is the primary determinant of the disease's severity among COVID-19. Obesity is the condition more often observed among those admitted to ICU within both genders. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04331574.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/epidemiología , Unidades de Cuidados Intensivos , Admisión del Paciente , Neumonía Viral/epidemiología , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/virología , Estudios Transversales , Femenino , Insuficiencia Cardíaca , Humanos , Hipertensión , Italia/epidemiología , Masculino , Persona de Mediana Edad , Obesidad , Pandemias , Neumonía Viral/virología , Insuficiencia Renal Crónica , Factores de Riesgo , Factores Sexuales , Adulto Joven
14.
Cell Mol Biol (Noisy-le-grand) ; 66(6): 148-156, 2020 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-33040802

RESUMEN

Investigating the infectivity of body fluid can be useful for preventative measures in the community and ensuring safety in the operating rooms and on the laboratory practices. We performed a literature search of clinical trials, cohorts, and case series using PubMed/MEDLINE, Google Scholar, and Cochrane library, and downloadable database of CDC. We excluded case reports and searched all-language articles for review and repeated until the final drafting. The search protocol was registered in the PROSPERO database. Thirty studies with urinary sampling for viral shedding were included. A total number of 1,271 patients were enrolled initially, among which 569 patients had undergone urinary testing. Nine studies observed urinary viral shedding in urine from 41 patients. The total incidence of urinary SARS-CoV-2 shedding was 8%, compared to 21.3% and 39.5 % for blood and stool, respectively. The summarized risk ratio (RR) estimates for urine positive rates compared to the pharyngeal rate was 0.08. The pertaining RR urine compared to blood and stool positive rates were 0.20 and 0.33, respectively. Our review concludes that not only the SARS-CoV-2 can be excreted in the urine in eight percent of patients but also its incidence may have associations with the severity of the systemic disease, ICU admission, and fatality rates. Moreover, the findings in our review suggest that a larger population size may reveal more positive urinary cases possibly by minimizing biases.


Asunto(s)
Betacoronavirus/genética , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Heces/virología , Neumonía Viral/epidemiología , Orina/virología , Viremia/diagnóstico , Esparcimiento de Virus , Adolescente , Adulto , Anciano , Niño , Preescolar , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Femenino , Humanos , Incidencia , Lactante , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Admisión del Paciente , Neumonía Viral/mortalidad , Neumonía Viral/virología , ARN Viral/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Índice de Severidad de la Enfermedad , Adulto Joven
15.
Medicina (B Aires) ; 80(5): 425-432, 2020.
Artículo en Español | MEDLINE | ID: mdl-33048784

RESUMEN

The COVID-19 pandemic has led to measures of social isolation, labor restrictions, a strong information campaign and the suspension of scheduled medical activities. The aim of this study was to describe the impact of these measures on the number of hospitalizations in Cardiovascular Intensive Care Units, with the hypothesis that the social behavior generated by this emergency promotes a decreased demand for medical care, even when severe cardiovascular disease is involved. We compared the number of admissions in March-April 2010-2019 versus March-April 2020, based on a prospective study including six institutions (three public and three private) that use Epi-Cardio® as a multicenter registry of cardiovascular care unit discharge. Altogether, we included 6839 patients discharged during the 11-year study period (2010-2020). The average number of patient admissions on March-April 2010-19 was 595 (CI 95%: 507-683) and decreased to 348 in 2020 (fall of 46.8%, p < 0.001). The reasons for hospitalization were classified into 11 groups and a statistically significant reduction was seen in 10 of these groups: cardiovascular surgery 72.3%, electrophysiological interventions 67.8%, non-ST acute coronary syndromes 52.6%, angioplasties 47.6%, arrhythmias 48.7%, heart failure 46%, atrial fibrillation 35.7%, ST elevation myocardial infarction 34.7%, non cardiac chest pain 31.8%, others 51.6%. Although with low prevalence, hypertensive crisis increased in 89%. The abrupt decrease observed in the number of admissions due to critical pathologies may be considered an "adverse effect" related to the measures adopted, with potentially severe consequences. This trend could be reversed by improving public communication and policy adjustment.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pandemias , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral , Argentina/epidemiología , Betacoronavirus , Enfermedades Cardiovasculares/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Estudios Prospectivos
16.
Open Heart ; 7(2)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33106441

RESUMEN

OBJECTIVES: To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19. METHODS: We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes RESULTS: There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62-118) min in 2020 vs 75 (57-95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34-65) min in 2020 vs 48 (35-70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3-9) days vs 3 (2-4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19. CONCLUSION: These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.


Asunto(s)
Infecciones por Coronavirus , Vías Clínicas/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Pandemias , Intervención Coronaria Percutánea , Neumonía Viral , Infarto del Miocardio con Elevación del ST/terapia , Anciano , Ambulancias/organización & administración , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Londres/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Seguridad del Paciente , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Neumonía Viral/transmisión , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Trombosis/mortalidad , Trombosis/terapia , Factores de Tiempo , Tiempo de Tratamiento/organización & administración , Resultado del Tratamiento
17.
Medicina (Kaunas) ; 56(10)2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33019514

RESUMEN

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February -31 March) in the last three years (2018-2019-2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Servicio de Urgencia en Hospital/tendencias , Oftalmopatías/epidemiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades Otorrinolaringológicas/epidemiología , Admisión del Paciente/tendencias , Estudios Retrospectivos , Enfermedades Torácicas/epidemiología , Enfermedades Urológicas/epidemiología , Heridas y Traumatismos/epidemiología , Adulto Joven
18.
Anesth Analg ; 131(5): 1337-1341, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33079852

RESUMEN

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


Asunto(s)
Citas y Horarios , Infecciones por Coronavirus/terapia , Cuidados Críticos , Prestación Integrada de Atención de Salud , Procedimientos Quirúrgicos Electivos , Unidades de Cuidados Intensivos/provisión & distribución , Admisión del Paciente , Neumonía Viral/terapia , Capacidad de Reacción , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Bases de Datos Factuales , Necesidades y Demandas de Servicios de Salud , Humanos , Evaluación de Necesidades , New York/epidemiología , Sistemas de Información en Quirófanos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Respiración Artificial , Factores de Tiempo , Ventiladores Mecánicos/provisión & distribución
19.
Trials ; 21(1): 799, 2020 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-32943115

RESUMEN

OBJECTIVES: The Bacille Calmette-Guérin (BCG) vaccine against tuberculosis is associated with non- specific protective effects against other infections, and significant reductions in all-cause morbidity and mortality have been reported. We aim to test whether BCG vaccination may reduce susceptibility to and/or the severity of COVID-19 and other infectious diseases in health care workers (HCW) and thus prevent work absenteeism.The primary objective is to reduce absenteeism due to illness among HCW during the COVID-19 pandemic. The secondary objectives are to reduce the number of HCW that are infected with SARS-CoV-2, and to reduce the number of hospital admissions among HCW during the COVID-19 pandemic. HYPOTHESIS: BCG vaccination of HCW will reduce absenteeism by 20% over a period of 6 months. TRIAL DESIGN: Placebo-controlled, single-blinded, randomised controlled trial, recruiting study participants at several geographic locations. The BCG vaccine is used in this study on a different indication than the one it has been approved for by the Danish Medicines Agency, therefore this is classified as a phase III study. PARTICIPANTS: The trial will recruit 1,500 HCW at Danish hospitals.To be eligible for participation, a subject must meet the following criteria: Adult (≥18 years); Hospital personnel working at a participating hospital for more than 22 hours per week.A potential subject who meets any of the following criteria will be excluded from participation in this study: Known allergy to components of the BCG vaccine or serious adverse events to prior BCG administration Known prior active or latent infection with Mycobacterium tuberculosis (M. tuberculosis) or other mycobacterial species Previous confirmed COVID-19 Fever (>38 C) within the past 24 hours Suspicion of active viral or bacterial infection Pregnancy Breastfeeding Vaccination with other live attenuated vaccine within the last 4 weeks Severely immunocompromised subjects. This exclusion category comprises: a) subjects with known infection by the human immunodeficiency virus (HIV-1) b) subjects with solid organ transplantation c) subjects with bone marrow transplantation d) subjects under chemotherapy e) subjects with primary immunodeficiency f) subjects under treatment with any anti-cytokine therapy within the last year g) subjects under treatment with oral or intravenous steroids defined as daily doses of 10 mg prednisone or equivalent for longer than 3 months h) Active solid or non-solid malignancy or lymphoma within the prior two years Direct involvement in the design or the execution of the BCG-DENMARK-COVID trial Intervention and comparator: Participants will be randomised to BCG vaccine (BCG-Denmark, AJ Vaccines, Copenhagen, Denmark) or placebo (saline). An adult dose of 0.1 ml of resuspended BCG vaccine (intervention) or 0.1 ml of sterile 0.9% NaCl solution (control) is administered intradermally in the upper deltoid area of the right arm. All participants will receive one injection at inclusion, and no further treatment of study participants will take place. MAIN OUTCOMES: Main study endpoint: Days of unplanned absenteeism due to illness within 180 days of randomisation.Secondary study endpoints: The cumulative incidence of documented COVID-19 and the cumulative incidence of hospital admission for any reason within 180 days of randomisation.Randomisation: Randomisation will be done centrally using the REDCap tool with stratification by hospital, sex and age groups (+/- 45 years of age) in random blocks of 4 and 6. The allocation ratio is 1:1.Blinding (masking): Participants will be blinded to treatment. The participant will be asked to leave the room while the allocated treatment is prepared. Once ready for injection, vaccine and placebo will look similar, and the participant will not be able to tell the difference.The physicians administering the treatment are not blinded.Numbers to be randomised (sample size): Sample size: N=1,500. The 1,500 participants will be randomised 1:1 to BCG or placebo with 750 participants in each group.Trial Status: Current protocol version 5.1, from July 6, 2020.Recruitment of study participants started on May 18, 2020 and we anticipate having finished recruiting by the end of December 2020. TRIAL REGISTRATION: The trial was registered with EudraCT on April 16, 2020, EudraCT number: 2020-001888-90, and with ClinicalTrials.gov on May 1, 2020, registration number NCT04373291.Full protocol: The full protocol is attached as an additional file, accessible from the Trialswebsite (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Vacuna BCG/administración & dosificación , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/prevención & control , Personal de Salud , Salud Laboral , Pandemias/prevención & control , Neumonía Viral/prevención & control , Vacunación , Absentismo , Vacuna BCG/efectos adversos , Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Dinamarca , Femenino , Humanos , Masculino , Estudios Multicéntricos como Asunto , Admisión del Paciente , Neumonía Viral/inmunología , Neumonía Viral/transmisión , Neumonía Viral/virología , Ensayos Clínicos Controlados Aleatorios como Asunto , Ausencia por Enfermedad , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento
20.
ESMO Open ; 5(5)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32958531

RESUMEN

BACKGROUND: Immunosuppression induced by anticancer therapy in a COVID-19-positive asymptomatic patient with cancer may have a devastating effect and, eventually, be lethal. To identify asymptomatic cases among patients receiving active cancer treatment, the Federico II University Hospital in Naples performs rapid serological tests in addition to hospital standard clinical triage for COVID-19 infection. METHODS: From 6 to 17 April 2020, all candidates for chemotherapy, radiotherapy or target/immunotherapy, if negative at the standard clinical triage on the day scheduled for anticancer treatment, received a rapid serological test on peripheral blood for COVID-19 IgM and IgG detection. In case of COVID-19 IgM and/or IgG positivity, patients underwent a real-time PCR (RT-PCR) SARS-CoV-2 test to confirm infection, and active cancer treatment was delayed. RESULTS: Overall 466 patients, negative for COVID-19 symptoms, underwent serological testing in addition to standard clinical triage. The average age was 61 years (range 25-88 years). Most patients (190, 40.8%) had breast cancer, and chemotherapy with or without immunotherapy was administered in 323 (69.3%) patients. Overall 433 (92.9%) patients were IgG-negative and IgM-negative, and 33 (7.1%) were IgM-positive and/or IgG-positive. Among the latter patients, 18 (3.9%), 11 (2.4%) and 4 (0.9%) were IgM-negative/IgG-positive, IgM-positive/IgG-negative and IgM-positive/IgG-positive, respectively. All 33 patients with a positive serological test, tested negative for RT-PCR SARS-CoV-2 test. No patient in our cohort developed symptoms suggestive of active COVID-19 infection. CONCLUSION: Rapid serological testing at hospital admission failed to detect active asymptomatic COVID-19 infection. Moreover, it entailed additional economic and human resources, delayed therapy administrationand increased hospital accesses.


Asunto(s)
Infecciones Asintomáticas , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Inmunosupresión/efectos adversos , Neoplasias/terapia , Neumonía Viral/diagnóstico , Triaje/normas , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Antineoplásicos Inmunológicos/efectos adversos , Betacoronavirus/genética , Betacoronavirus/inmunología , Betacoronavirus/aislamiento & purificación , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Técnicas de Laboratorio Clínico/economía , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Inmunosupresión/métodos , Masculino , Persona de Mediana Edad , Neoplasias/inmunología , Pandemias , Admisión del Paciente/economía , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/sangre , Neumonía Viral/inmunología , Neumonía Viral/virología , Guías de Práctica Clínica como Asunto , ARN Viral/aislamiento & purificación , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/economía , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/estadística & datos numéricos , Sensibilidad y Especificidad
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