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1.
Porto Alegre; CEVS/RS; out. 2021. 1-15 p. ilus., graf., tab., mapas.
No convencional en Portugués | Coleciona SUS, CONASS, SES-RS | ID: biblio-1292931

RESUMEN

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Perfil de Salud , Mortalidad Hospitalaria/etnología , Grupos de Población/estadística & datos numéricos , COVID-19/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , COVID-19/complicaciones , COVID-19/mortalidad
2.
Glob Health Res Policy ; 6(1): 36, 2021 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-34593053

RESUMEN

BACKGROUND: The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) places physicians in South Asia at high risk of contracting the infection. Accordingly, we conducted this study to provide an updated account of physician deaths in South Asia during the COVID-19 pandemic and to analyze and compare the different characteristics associated with physician mortality amongst the countries of the region. METHODS: We performed a cross-sectional study by using published news reports on the websites of news agencies from 9 selected countries in South Asia. Our study included only those physicians and doctors who died after contracting COVID-19 from their respective workplaces. All available data about the country of origin, type of, sex, age, medical or surgical specialty, and date of death were included. RESULTS: The total number of physician deaths reported due to COVID-19 in our study was 170, with half (87/170, 51%) of the deaths reported from Iran. Male physician deaths were reported to be 145 (145/170 = 85%). Internal Medicine (58.43%) was the most severely affected sub-specialty. The highest physician mortality rate in the general population recorded in Afghanistan (27/1000 deaths). General physicians from India [OR = 11.00(95% CI = 1.06-114.08), p = 0.045] and public sector medical practitioners from Pakistan [aOR = 4.52 (95% CI = 1.18-17.33), p = 0.028] were showing significant mortality when compared with other regions in multivariate logistic regression. CONCLUSION: An increased number of physician deaths, owing to COVID-19, has been shown in South Asia. This could be due to decreased personal protective equipment and the poor health care management systems of the countries in the region to combat the pandemic. Future studies should provide detailed information of characteristics associated with physician mortalities along with the main complications arising due to the virus.


Asunto(s)
COVID-19/mortalidad , Mortalidad , Enfermedades Profesionales/mortalidad , Exposición Profesional/estadística & datos numéricos , Salud Laboral/estadística & datos numéricos , Médicos/estadística & datos numéricos , Adulto , Afganistán/epidemiología , Anciano , Bangladesh/epidemiología , Bután/epidemiología , COVID-19/virología , Estudios Transversales , Femenino , Salud Global/estadística & datos numéricos , Humanos , India/epidemiología , Islas del Oceano Índico/epidemiología , Irán/epidemiología , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Enfermedades Profesionales/virología , Pakistán/epidemiología , Sri Lanka/epidemiología
4.
Int J Public Health ; 66: 1604004, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34630005

RESUMEN

Objectives: To quantify the Black/Hispanic disparity in COVID-19 mortality in the United States (US). Methods: COVID-19 deaths in all US counties nationwide were analyzed to estimate COVID-19 mortality rate ratios by county-level proportions of Black/Hispanic residents, using mixed-effects Poisson regression. Excess COVID-19 mortality counts, relative to predicted under a counterfactual scenario of no racial/ethnic disparity gradient, were estimated. Results: County-level COVID-19 mortality rates increased monotonically with county-level proportions of Black and Hispanic residents, up to 5.4-fold (≥43% Black) and 11.6-fold (≥55% Hispanic) higher compared to counties with <5% Black and <15% Hispanic residents, respectively, controlling for county-level poverty, age, and urbanization level. Had this disparity gradient not existed, the US COVID-19 death count would have been 92.1% lower (177,672 fewer deaths), making the rate comparable to other high-income countries with substantially lower COVID-19 death counts. Conclusion: During the first 8 months of the SARS-CoV-2 pandemic, the US experienced the highest number of COVID-19 deaths. This COVID-19 mortality burden is strongly associated with county-level racial/ethnic diversity, explaining most US COVID-19 deaths.


Asunto(s)
Afroamericanos , COVID-19 , Disparidades en el Estado de Salud , Hispanoamericanos , Pandemias , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , COVID-19/etnología , COVID-19/mortalidad , Niño , Preescolar , Hispanoamericanos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Factores Socioeconómicos , Estados Unidos/epidemiología , Adulto Joven
5.
Lancet ; 398(10307): 1230-1238, 2021 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-34599878

RESUMEN

BACKGROUND: Over the course of the COVID-19 pandemic, the care of patients with COVID-19 has changed and the use of extracorporeal membrane oxygenation (ECMO) has increased. We aimed to examine patient selection, treatments, outcomes, and ECMO centre characteristics over the course of the pandemic to date. METHODS: We retrospectively analysed the Extracorporeal Life Support Organization Registry and COVID-19 Addendum to compare three groups of ECMO-supported patients with COVID-19 (aged ≥16 years). At early-adopting centres-ie, those using ECMO support for COVID-19 throughout 2020-we compared patients who started ECMO on or before May 1, 2020 (group A1), and between May 2 and Dec 31, 2020 (group A2). Late-adopting centres were those that provided ECMO for COVID-19 only after May 1, 2020 (group B). The primary outcome was in-hospital mortality in a time-to-event analysis assessed 90 days after ECMO initiation. A Cox proportional hazards model was fit to compare the patient and centre-level adjusted relative risk of mortality among the groups. FINDINGS: In 2020, 4812 patients with COVID-19 received ECMO across 349 centres within 41 countries. For early-adopting centres, the cumulative incidence of in-hospital mortality 90 days after ECMO initiation was 36·9% (95% CI 34·1-39·7) in patients who started ECMO on or before May 1 (group A1) versus 51·9% (50·0-53·8) after May 1 (group A2); at late-adopting centres (group B), it was 58·9% (55·4-62·3). Relative to patients in group A2, group A1 patients had a lower adjusted relative risk of in-hospital mortality 90 days after ECMO (hazard ratio 0·82 [0·70-0·96]), whereas group B patients had a higher adjusted relative risk (1·42 [1·17-1·73]). INTERPRETATION: Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers. FUNDING: None.


Asunto(s)
COVID-19/terapia , Oxigenación por Membrana Extracorpórea/métodos , Mortalidad Hospitalaria/tendencias , Síndrome de Dificultad Respiratoria/terapia , Adulto , COVID-19/mortalidad , Duración de la Terapia , Oxigenación por Membrana Extracorpórea/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Guías de Práctica Clínica como Asunto , Sistema de Registros , Síndrome de Dificultad Respiratoria/mortalidad , SARS-CoV-2
6.
Sovrem Tekhnologii Med ; 13(4): 16-24, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34603760

RESUMEN

The aim of the study is to assess the gender-related specifics of the COVID-19 course in patients under 55 years of age. Materials and Methods: This pilot single-center continuous retrospective non-randomized study was carried out in the repurposed infectious diseases hospital of the Privolzhsky Research Medical University (Nizhny Novgorod, Russia). The study inclusion criterion was the age of patients (up to 55 years) and confirmed coronavirus infection. In the groups based on gender differences (25 men, average age 44.0±7.8 years and 32 women, average age 41.9±9.1 years), we monitored complications of COVID-19 such as the transfer of patients to the ICU and the volume of lung damage (determined with CT scans). Results: The course of COVID-19 in male patients younger than 55 was aggravated by concomitant diseases (γ=0.36; p=0.043), among which IHD (γ=1.00; p=0.003) and liver disease (γ=0.58; p=0.007) dominated. Frequency analysis confirmed the high prevalence of coronary artery disease in men (p=0.044). Significant differences between the gender-related groups were noted in the volume of lung lesions: at admission (p=0.050), during hospital treatment (p=0.019), and at discharge (p=0.044). Using the logistic regression method, a relationship was found between the transfer of male patients to ICU and the Krebs index [y= -2.033 + 1.154 male gender + 1.539 Krebs index (χ2=5.68; p=0.059)] and comorbidity [y= -2.836 + 1.081 male gender + 2.052 comorbidity (χ2=7.03; p=0.030)]. The influence of the Krebs index and the male gender on the excess volume of lung lesions was shown [y= -1.962 + 0.575 male gender + 1.915 Krebs index (χ2=7.78; p=0.021)]. Conclusion: In individuals under the age of 55 diagnosed with COVID-19, gender is of significant importance: in men, there is a more pronounced lesion of the lung parenchyma and a more significant change in laboratory parameters. Risk factors for a severe course of COVID-19 in men are coronary artery disease and hepatobiliary disorder. Calculating the Krebs index can be used to assess the risk of disease progression.


Asunto(s)
COVID-19 , SARS-CoV-2 , Caracteres Sexuales , Adulto , COVID-19/mortalidad , COVID-19/terapia , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prevalencia , Estudios Retrospectivos , Federación de Rusia/epidemiología
7.
Porto Alegre; CEVS/RS; set. 2021. 1-31 p. ilus., graf., tab., mapas.
Monografía en Portugués | Coleciona SUS, CONASS, SES-RS | ID: biblio-1292070

RESUMEN

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Perfil de Salud , Mortalidad Hospitalaria/etnología , Personal de Salud/estadística & datos numéricos , Vigilancia de Guardia , Grupos de Población/estadística & datos numéricos , Salud de Poblaciones Indígenas/estadística & datos numéricos , COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Salud del Niño/estadística & datos numéricos , Salud del Anciano , Brotes de Enfermedades , Salud del Adolescente/estadística & datos numéricos , Prueba de Ácido Nucleico para COVID-19 , SARS-CoV-2 , COVID-19/complicaciones , COVID-19/mortalidad
8.
Porto Alegre; CEV/RS; set. 2021. 1-15 p. ilus., graf., tab., mapas.
Monografía en Portugués | Coleciona SUS, CONASS, SES-RS | ID: biblio-1292074

RESUMEN

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Perfil de Salud , Mortalidad Hospitalaria/etnología , Grupos de Población/estadística & datos numéricos , COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Salud del Anciano , Brotes de Enfermedades , SARS-CoV-2 , COVID-19/mortalidad
9.
Porto Alegre; CEVS/RS; set. 2021. 1-15 p. ilus., graf., tab., mapas.
No convencional en Portugués | Coleciona SUS, CONASS, SES-RS | ID: biblio-1292928

RESUMEN

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Perfil de Salud , Mortalidad Hospitalaria/etnología , Grupos de Población/estadística & datos numéricos , COVID-19/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , COVID-19/complicaciones , COVID-19/mortalidad
10.
Sci Rep ; 11(1): 17648, 2021 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-34480041

RESUMEN

Ascorbic acid represents an appealing option for clinicians to utilize in the context of the global COVID-19 pandemic due to its proposed clinical efficacy, relative safety, and low cost. The aim of this study was to evaluate the efficacy and safety of using ascorbic acid in supplemental doses as adjunctive therapy for patients critically ill with COVID-19. This was a two-center, non-interventional, retrospective cohort study. All critically ill adult patients admitted to ICU with a confirmed COVID-19 diagnosis between March 1st and December 31st, 2020, were included in the final analysis. The study was conducted at two large governmental tertiary hospitals in Saudi Arabia. The purpose was to investigate the clinical outcomes of low-dose ascorbic acid as adjunctive therapy in COVID-19 after propensity score matching using baseline severity scores, systematic use of corticosteroids, and study centers. A number of 739 patients were included in this study, among whom 296 patients were included after propensity score matching. There was no association between the administration of ascorbic acid and in-hospital mortality or the 30-day mortality [OR (95% CI) 0.77 (0.47, 1.23), p value = 0.27 and OR (95% CI) 0.73 (0.43, 1.20), p value = 0.21, respectively]. Using ascorbic acid was associated with a lower incidence of thrombosis compared with the non-ascorbic-acid group [6.1% vs. 13% respectively; OR (95% CI) 0.42 (0.184, 0.937), p value = 0.03]. Low dose of ascorbic acid as an adjunctive therapy in COVID-19 critically ill patients was not associated with mortality benefits, but it was associated with a lower incidence of thrombosis. Further studies are required to confirm these findings.


Asunto(s)
Ácido Ascórbico/administración & dosificación , COVID-19 , Mortalidad Hospitalaria , Hospitalización , SARS-CoV-2 , Anciano , COVID-19/tratamiento farmacológico , COVID-19/mortalidad , Enfermedad Crítica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos , Arabia Saudita/epidemiología
11.
PLoS One ; 16(9): e0257613, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34543345

RESUMEN

This paper analyses COVID-19 patients' dynamics during the first wave in the region of Castilla y León (Spain) with around 2.4 million inhabitants using multi-state competing risk survival models. From the date registered as the start of the clinical process, it is assumed that a patient can progress through three intermediate states until reaching an absorbing state of recovery or death. Demographic characteristics, epidemiological factors such as the time of infection and previous vaccinations, clinical history, complications during the course of the disease and drug therapy for hospitalised patients are considered as candidate predictors. Regarding risk factors associated with mortality and severity, consistent results with many other studies have been found, such as older age, being male, and chronic diseases. Specifically, the hospitalisation (death) rate for those over 69 is 27.2% (19.8%) versus 5.3% (0.7%) for those under 70, and for males is 14.5%(7%) versus 8.3%(4.6%)for females. Among patients with chronic diseases the highest rates of hospitalisation are 26.1% for diabetes and 26.3% for kidney disease, while the highest death rate is 21.9% for cerebrovascular disease. Moreover, specific predictors for different transitions are given, and estimates of the probability of recovery and death for each patient are provided by the model. Some interesting results obtained are that for patients infected at the end of the period the hazard of transition from hospitalisation to ICU is significatively lower (p < 0.001) and the hazard of transition from hospitalisation to recovery is higher (p < 0.001). For patients previously vaccinated against pneumococcus the hazard of transition to recovery is higher (p < 0.001). Finally, internal validation and calibration of the model are also performed.


Asunto(s)
COVID-19/diagnóstico , COVID-19/mortalidad , Progresión de la Enfermedad , Registros de Hospitales , Hospitales , Atención Primaria de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/complicaciones , COVID-19/tratamiento farmacológico , Calibración , Niño , Preescolar , Comorbilidad , Intervalos de Confianza , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Probabilidad , Modelos de Riesgos Proporcionales , Reproducibilidad de los Resultados , España/epidemiología , Adulto Joven
12.
Front Immunol ; 12: 700921, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34539631

RESUMEN

Cytokines, chemokines and growth factors present different expression profiles related to the prognosis of COVID-19. We analyzed clinical parameters and assessed the expression of these biomarkers in patients with different disease severity in a hospitalized Peruvian cohort to determine those associated with worse prognosis. We measured anti-spike IgG antibodies by ELISA and 30 cytokines by quantitative suspension array technology in 123 sera samples. We analyzed differences between patients with moderate, severe and fatal COVID-19 by logistic regression at baseline and in longitudinal samples. Significant differences were found among the clinical parameters: hemoglobin, neutrophils, lymphocytes and C-reactive protein (CRP), creatinine and D-dimer levels. Higher anti-spike IgG antibody concentrations were associated to fatal patient outcomes. At hospitalization, IL-10, IL-6, MIP-1α, GM-CSF, MCP-1, IL-15, IL-5, IL1RA, TNFα and IL-8 levels were already increased in fatal patients´ group. Meanwhile, multivariable analysis revealed that increased GM-CSF, MCP-1, IL-15, and IL-8 values were associated with fatal outcomes. Moreover, longitudinal analysis identified IL-6 and MCP-1 as the main risk factors related to mortality in hospitalized COVID-19 patients. In this Peruvian cohort we identified and validated biomarkers related to COVID-19 outcomes. Further studies are needed to identify novel criteria for stratification of SARS-CoV-2 infected patients at hospital entry. Background: In the most severe forms of SARS-CoV-2 infection, large numbers of innate and adaptive immune cells become activated and begin to produce pro-inflammatory cytokines, establishing an exacerbated feedback loop of inflammation. Methods: A total of 55 patients with laboratory-confirmed COVID-19 admitted to the Hospital Nacional Guillermo Almenara Irigoyen in Lima, Peru were enrolled during August-October 2020. Of these, 21 had moderate disease, 24 severe diseases and 10 died. We measured 30 cytokines and chemokines by quantitative suspension array technology and anti-spike IgG antibodies using a commercial ELISA. We evaluated these parameters in peripheral blood every 2-5 days until patient discharge or death. Patient information and clinical parameters related were obtained from the respective clinical histories. Results: The frequency of obesity differed among the 3 groups, being most frequent in patients who died. There were also significant differences in clinical parameters: hemoglobin, segmented neutrophils, lymphocytes,C-reactive protein, creatinine and D-dimer levels. Greater anti-spike IgG antibody concentrations were associated to fatal outcomes. In univariate analyses, higher baseline concentrations of IL-6, MIP-1α, GM-CSF, MCP-1, IL-15, IL-5, IL1RA, TNFα, IL-8 and IL-12p70 correlated with severity, while multivariable analysis showed that increased concentrations in 4 biomarkers (GM-CSF, MCP-1, IL-15, IL-8) were associated with fatal outcomes. Longitudinal analysis showed IL-6 (hazard ratio [HR] 6.81, 95% confidence interval [CI] 1.6-28.7) and MCP-1 (HR 4.61, 95%CI 1.1-19.1) to be related to mortality in hospitalized COVID-19 patients. Conclusions: Cytokine, chemokine and growth factor profiles were identified and validated related to severity and outcomes of COVID-19. Our findings may be useful to identify novel criteria for COVID-19 patient stratification at hospital entry.


Asunto(s)
Anticuerpos Antivirales/sangre , COVID-19/sangre , COVID-19/mortalidad , Citocinas/sangre , Anticuerpos Antivirales/inmunología , Biomarcadores/sangre , COVID-19/inmunología , Comorbilidad , Ensayo de Inmunoadsorción Enzimática , Femenino , Hospitalización , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Perú/epidemiología , Pronóstico , SARS-CoV-2/inmunología , Índice de Severidad de la Enfermedad , Glicoproteína de la Espiga del Coronavirus/inmunología
13.
Proc Natl Acad Sci U S A ; 118(39)2021 09 28.
Artículo en Inglés | MEDLINE | ID: mdl-34544858

RESUMEN

The 2020 US mortality totaled 2.8 million after early March, which is 17.3% higher than age-population-weighted mortality over the same time interval in 2017 to 2019, for a total excess death count of 413,592. We use data on weekly death counts by cause, as well as life tables, to quantify excess mortality and life years lost from both COVID-19 and non-COVID-19 causes by race/ethnicity, age, and gender/sex. Excess mortality from non-COVID-19 causes is substantial and much more heavily concentrated among males and minorities, especially Black, non-Hispanic males, than COVID-19 deaths. Thirty-four percent of the excess life years lost for males is from non-COVID-19 causes. While minorities represent 36% of COVID-19 deaths, they represent 70% of non-COVID-19 related excess deaths and 58% of non-COVID-19 excess life years lost. Black, non-Hispanic males represent only 6.9% of the population, but they are responsible for 8.9% of COVID-19 deaths and 28% of 2020 excess deaths from non-COVID-19 causes. For this group, nearly half of the excess life years lost in 2020 are due to non-COVID-19 causes.


Asunto(s)
COVID-19/mortalidad , Causas de Muerte , Disparidades en el Estado de Salud , Grupos Minoritarios , Adolescente , Adulto , Afroamericanos/genética , Factores de Edad , Anciano , Anciano de 80 o más Años , COVID-19/genética , COVID-19/virología , Niño , Preescolar , Grupos de Población Continentales/genética , Grupos Étnicos/genética , Grupo de Ascendencia Continental Europea/genética , Femenino , Hispanoamericanos/genética , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , SARS-CoV-2/patogenicidad , Caracteres Sexuales , Estados Unidos/epidemiología , Adulto Joven
14.
PLoS One ; 16(9): e0256203, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34555027

RESUMEN

OBJECTIVES: We conducted the present multicenter, retrospective study to assess the epidemiological, clinical, laboratory, and radiological characteristics associated with critical illness among patients with COVID-19 from Egypt. METHODS: The present study was a multicenter, retrospective study that retrieved the data of all Egyptian cases with confirmed COVID-19 admitted to hospitals affiliated to the General Organization for Teaching Hospitals and Institutes (GOTHI) through the period from March to July 2020. The diagnosis of COVID-19 was based on a positive reverse transcription-polymerase chain reaction (RT-PCR) laboratory test. RESULTS: This retrospective study included 2724 COVID-19 patients, of whom 423 (15.52%) were critically ill. Approximately 45.86% of the critical group aged above 60 years, compared to 39.59% in the non-critical group (p = 0.016). Multivariate analysis showed that many factors were predictors of critically illness, including age >60 years (OR = 1.30, 95% CI [1.05, 1.61], p = 0.014), low oxygen saturation (OR = 0.93, 95% CI [0.91, 0.95], p<0.001), low Glasgow coma scale (OR = 0.75, 95% CI [0.67, 0.84], p<0.001), diabetes (OR = 1.62, 95% CI [1.26, 2.08], p<0.001), cancer (OR = 2.47, 95% CI [1.41, 4.35], p = 0.002), and serum ferritin (OR = 1.004, 95% CI [1.0003, 1.008], p = 0.031). CONCLUSION: In the present report, we demonstrated that many factors are associated with COVID-19 critical illness, including older age groups, fatigue, elevated temperature, increased pulse, lower oxygen saturation, the preexistence of diabetes, malignancies, cardiovascular disease, renal diseases, and pulmonary disease. Moreover, elevated serum levels of ALT, AST, and ferritin are associated with worse outcomes. Further studies are required to identify independent predictors of mortality for patients with COVID-19.


Asunto(s)
COVID-19/complicaciones , COVID-19/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedad Crítica/mortalidad , Egipto , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Lactante , Recién Nacido , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Factores de Riesgo , SARS-CoV-2/patogenicidad , Adulto Joven
15.
PLoS One ; 16(9): e0257775, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34555104

RESUMEN

BACKGROUND: In this study, we aimed to investigate whether FIB-4 index is useful in predicting mortality in patients with concurrent hematological malignancies and COVID-19. We also aimed to determine the optimal cut-off point for the prediction. METHODS: This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia. Consecutive sampling of adults with hematological malignancies and COVID-19 was performed between May 2020 and January 2021. COVID-19 screening test using the reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal samples were performed prior to hospitalization for chemotherapy. FIB-4 index is derived from [age (years) × AST (IU/L)]/[platelet count (109/L) × âˆšALT (U/L)]. The primary outcome of this study is mortality, defined as clinically validated death/non-survivor during a 3-months (90 days) follow-up. RESULTS: There were a total of 70 patients with hematological malignancies and COVID-19 in this study. Median FIB-4 Index was higher in non-survivors (13.1 vs 1.02, p<0.001). FIB-4 index above 3.85 has a sensitivity of 79%, specificity of 84%, PLR of 5.27, and NLR of 0.32. The AUC was 0.849 95% CI 0.735-0.962, p<0.001. This cut-off point was associated with OR of 16.70 95% CI 4.07-66.67, p<0.001. In this study, a FIB-4 >3.85 confers to 80% posterior probability of mortality and FIB-4 <3.85 to 19% probability. FIB-4 >3.85 was associated with shorter time-to-mortality (HR 9.10 95% CI 2.99-27.65, p<0.001). Multivariate analysis indicated that FIB-4 >3.85 (HR 4.09 95% CI 1.32-12.70, p = 0.015) and CRP> 71.57 mg/L (HR 3.36 95% CI 1.08-10.50, p = 0.037) were independently associated with shorter time-to-mortality. CONCLUSION: This study indicates that a FIB-4 index >3.85 was independent predictor of mortality in patients with hematological malignancies and COVID-19 infection.


Asunto(s)
COVID-19/mortalidad , Neoplasias Hematológicas/mortalidad , Adulto , Femenino , Humanos , Indonesia , Masculino , Recuento de Plaquetas/métodos , Curva ROC , Estudios Retrospectivos , SARS-CoV-2/patogenicidad
16.
Ann Clin Microbiol Antimicrob ; 20(1): 69, 2021 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-34563202

RESUMEN

BACKGROUND: Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial coinfection superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. METHODS: Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05. RESULTS: Average patient age was 68.7 years and LOS 19.9 days. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall did not suggest acute bacterial or fungal infection in 73 (45%) of 165 individuals sampled within 24 h of intubation. Cultures ≥ 1 week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus. CONCLUSIONS: In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum prior to/around the time of intubation correlated with no culture growth or recovery of normal oral flora ± yeast. Discontinuation of empiric antibacterials should be considered in these patients aided by other clinical findings, history of prior antimicrobials, laboratory testing, and overall clinical course. Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance. TRIAL REGISTRATION: Not applicable as this was a retrospective chart review study without interventional arm.


Asunto(s)
Bacterias/efectos de los fármacos , Infecciones Bacterianas/complicaciones , COVID-19/terapia , Infección Hospitalaria/complicaciones , Hongos/efectos de los fármacos , Micosis/complicaciones , Neumonía/terapia , Esputo/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos , Antiinfecciosos/farmacología , Bacterias/genética , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , COVID-19/complicaciones , COVID-19/mortalidad , COVID-19/virología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana , Farmacorresistencia Fúngica Múltiple , Femenino , Hongos/genética , Hongos/aislamiento & purificación , Hospitalización , Humanos , Intubación , Tiempo de Internación , Masculino , Persona de Mediana Edad , Micosis/microbiología , Neumonía/complicaciones , Neumonía/mortalidad , Neumonía/virología , Estudios Retrospectivos , SARS-CoV-2/fisiología
17.
Nutrients ; 13(9)2021 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-34578888

RESUMEN

We aimed to study the possible association of stress hyperglycemia in COVID-19 critically ill patients with prognosis, artificial nutrition, circulating osteocalcin, and other serum markers of inflammation and compare them with non-COVID-19 patients. Fifty-two critical patients at the intensive care unit (ICU), 26 with COVID-19 and 26 non-COVID-19, were included. Glycemic control, delivery of artificial nutrition, serum osteocalcin, total and ICU stays, and mortality were recorded. Patients with COVID-19 had higher ICU stays, were on artificial nutrition for longer (p = 0.004), and needed more frequently insulin infusion therapy (p = 0.022) to control stress hyperglycemia. The need for insulin infusion therapy was associated with higher energy (p = 0.001) and glucose delivered through artificial nutrition (p = 0.040). Those patients with stress hyperglycemia showed higher ICU stays (23 ± 17 vs. 11 ± 13 days, p = 0.007). Serum osteocalcin was a good marker for hyperglycemia, as it inversely correlated with glycemia at admission in the ICU (r = -0.476, p = 0.001) and at days 2 (r = -0.409, p = 0.007) and 3 (r = -0.351, p = 0.049). In conclusion, hyperglycemia in critically ill COVID-19 patients was associated with longer ICU stays. Low circulating osteocalcin was a good marker for stress hyperglycemia.


Asunto(s)
COVID-19/sangre , Hiperglucemia/sangre , Osteocalcina/sangre , Nutrición Parenteral/mortalidad , SARS-CoV-2 , Anciano , Biomarcadores/sangre , COVID-19/complicaciones , COVID-19/mortalidad , Resultados de Cuidados Críticos , Enfermedad Crítica/mortalidad , Femenino , Humanos , Hiperglucemia/mortalidad , Hiperglucemia/virología , Unidades de Cuidados Intensivos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pronóstico
18.
Nutrients ; 13(9)2021 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-34578898

RESUMEN

We evaluated associations between serum 25-hydroxyvitamin D [25(OH)D] level and severity of new coronavirus infection (COVID-19) in hospitalized patients. We assessed serum 25(OH)D level in 133 patients aged 21-93 years. Twenty-five (19%) patients had severe disease, 108 patients (81%) had moderate disease, and 18 (14%) patients died. 25(OH)D level ranged from 3.0 to 97.0 ng/mL (median, 13.5 [25%; 75%, 9.6; 23.3] ng/mL). Vitamin D deficiency was diagnosed in 90 patients, including 37 with severe deficiency. In patients with severe course of disease, 25(OH)D level was lower (median, 9.7 [25%; 75%, 6.0; 14.9] ng/mL), and vitamin D deficiency was more common than in patients with moderate course (median, 14.6 [25%; 75%, 10.6; 24.4] ng/mL, p = 0.003). In patients who died, 25(OH)D was 9.6 [25%; 75%, 6.0; 11.5] ng/mL, compared with 14.8 [25%; 75%, 10.1; 24.3] ng/mL in discharged patients (p = 0.001). Severe vitamin D deficiency was associated with increased risk of COVID-19 severity and fatal outcome. The threshold for 25(OH)D level associated with increased risk of severe course was 11.7 ng/mL. Approximately the same 25(OH)D level, 10.9 ng/mL, was associated with increased risk of mortality. Thus, most COVID-19 patients have vitamin D deficiency; severe vitamin D deficiency is associated with increased risk of COVID-19 severity and fatal outcome.


Asunto(s)
COVID-19/sangre , COVID-19/mortalidad , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/mortalidad , Vitamina D/análogos & derivados , Anciano , COVID-19/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Pronóstico , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Vitamina D/sangre , Deficiencia de Vitamina D/virología
19.
J BUON ; 26(4): 1379-1385, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34564995

RESUMEN

PURPOSE: The purpose of this study was to examine the effect of COVID-19 infection on the morbidity and mortality rates of breast cancer patients performed in the East Mediterranean region of Turkey during the COVID-19 pandemic and to share the results of those investigations. METHODS: This retrospective study included all breast cancer patients that underwent surgery during the COVID-19 pandemic in the General Surgery Clinic of Adana City Training and Research Hospital, a regional pandemic hospital, between March 11, 2020 and December 25, 2020. The patients were evaluated preoperatively and postoperatively (the first 30 days) in terms of COVID-19 infection. Moreover, these patients were also evaluated in terms of admission to the hospital, length of hospital stay, and mortality due to COVID-19 infection during the follow-up period of the study. RESULTS: Included in the study were 139 patients that underwent surgery for breast cancer during the pandemic period, with no observed mortality or morbidity associated with COVID-19 in any patient postoperatively within the first 30 days. In addition, within 121.22±70.05 days, the mean and standard deviation of the study's follow-up period, 19 patients (15.7%) were admitted to the hospital with a suspected COVID-19 infection (after the first 30 days postoperatively) and 6 of them (4.3%) returned a positive PCR test. All of the COVID-19 positive patients (6 patients, 4.3%) were hospitalised and 3 of them (2.2%) died due to the COVID-19 infection. CONCLUSION: Breast cancer surgery can be performed safely during the COVID-19 pandemic period after taking the necessary precautions.


Asunto(s)
Neoplasias de la Mama/cirugía , COVID-19/prevención & control , Mastectomía , Adulto , Anciano , Neoplasias de la Mama/mortalidad , COVID-19/mortalidad , COVID-19/transmisión , Femenino , Mortalidad Hospitalaria , Humanos , Mastectomía/efectos adversos , Mastectomía/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Turquia
20.
J Aging Soc Policy ; 33(4-5): 305-319, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34542025

RESUMEN

The COVID-19 pandemic has disrupted life globally through virus-related mortality and morbidity and the social and economic impacts of actions taken to stop the virus' spread. It became evident early in the pandemic that COVID-19 and the strategies adopted to mitigate its effects would have a disproportionate impact on older adults. This special issue of the Journal of Aging & Social Policy reports original empirical research and perspectives on the ramifications of the COVID-19 pandemic for this population. This introductory essay highlights key issues pertaining to the impact of COVID-19 on older adults and their families, caregivers, and communities. The prevalence and susceptibility of COVID-19 infection in the older adult population is discussed, including the devastating consequences of the pandemic for residents and staff of long-term care facilities. This is followed by a brief examination of ageism and social isolation brought to the fore during the pandemic, as well as the adverse effects of the pandemic for the economy and racial and ethnic minority populations. It concludes with an overview of issue content.


Asunto(s)
Ageísmo , COVID-19/etnología , COVID-19/epidemiología , Casas de Salud , Aislamiento Social/psicología , Anciano , COVID-19/mortalidad , Personal de Salud/psicología , Disparidades en Atención de Salud , Humanos , Estados Unidos/epidemiología
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