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1.
Infect Dis Poverty ; 10(1): 3, 2021 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-33397470

RESUMEN

BACKGROUND: The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020. A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States. The risk factors associated with county-level mortality of COVID-19 with various levels of prevalence are not well understood. METHODS: Using the data obtained from the County Health Rankings and Roadmaps program, this study applied a negative binomial design to the county-level mortality counts of COVID-19 as of August 27, 2020 in the United States. In this design, the infected counties were categorized into three levels of infections using clustering analysis based on time-varying cumulative confirmed cases from March 1 to August 27, 2020. COVID-19 patients were not analyzed individually but were aggregated at the county-level, where the county-level deaths of COVID-19 confirmed by the local health agencies. Clustering analysis and Kruskal-Wallis tests were used in our statistical analysis. RESULTS: A total of 3125 infected counties were assigned into three classes corresponding to low, median, and high prevalence levels of infection. Several risk factors were significantly associated with the mortality counts of COVID-19, where higher level of air pollution (0.153, P < 0.001) increased the mortality in the low prevalence counties and elder individuals were more vulnerable in both the median (0.049, P < 0.001) and high (0.114, P < 0.001) prevalence counties. The segregation between non-Whites and Whites (low: 0.015, P < 0.001; median:0.025, P < 0.001; high: 0.019, P = 0.005) and higher Hispanic population (low and median: 0.020, P < 0.001; high: 0.014, P = 0.009) had higher likelihood of risk of the deaths in all infected counties. CONCLUSIONS: The mortality of COVID-19 depended on sex, race/ethnicity, and outdoor environment. The increasing awareness of the impact of these significant factors may help decision makers, the public health officials, and the general public better control the risk of pandemic, particularly in the reduction in the mortality of COVID-19.


Asunto(s)
/mortalidad , Anciano , /virología , Análisis por Conglomerados , Femenino , Humanos , Masculino , Mortalidad , Pandemias , Prevalencia , Salud Pública , Factores Raciales , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Estadísticas no Paramétricas , Estados Unidos/epidemiología
2.
J Med Virol ; 93(2): 1105-1110, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32915476

RESUMEN

Severe acute respiratory syndrome coronavirus 2 is responsible for the coronavirus disease 2019 (COVID-19) epidemic, which has severely affected global public health security. However, the diagnosis and treatment of the disease need further exploration. Therefore, this retrospective analysis was conducted on multiple indicators of peripheral blood in patients with COVID-19 to determine the role of leukocytes, lymphocytes, and eosinophils in the diagnosis and prognostic evaluation of COVID-19. Baseline information and clinical records of 40 patients were collected, including demographic data, disease status, medication, and laboratory routine. The correlation between the inspection indicators and disease classification, as well as prognostic factors, was analyzed. Decreased eosinophils were detected in 33 out of 40 patients with COVID-19 on admission, while lymphocytes and eosinophils were inversely related to the severity of the disease, according to the Spearman's correlation coefficient. Thus, it could be deduced that eosinophils have better sensitivity for the diagnosis of COVID-19 and play a major role similar to lymphocytes in assessing the prognosis of patients.


Asunto(s)
/diagnóstico , Eosinófilos/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Tiempo de Internación/estadística & datos numéricos , Linfocitos/inmunología , Persona de Mediana Edad , Neutrófilos/inmunología , Pronóstico , Estudios Retrospectivos , Estadísticas no Paramétricas , Adulto Joven
3.
PLoS One ; 15(12): e0242916, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33259509

RESUMEN

PURPOSE: The time-of-day variations in environmental heat stress have been known to affect thermoregulatory responses and the risk of exertional heat-related illness during outdoor exercise in the heat. However, such effect and risk are still needed to be examined during indoor sports/exercises. The current study investigated the diurnal relationships between thermoregulatory strain and environmental heat stress during regular judo training in a judo training facility without air conditioning on a clear day in the heat of summer. METHODS: Eight male high school judokas completed two 2.5-h indoor judo training sessions. The sessions were commenced at 09:00 h (AM) and 16:00 h (PM) on separate days. RESULTS: During the sessions, indoor and outdoor heat stress progressively increased in AM but decreased in PM, and indoor heat stress was less in AM than PM (mean ambient temperature: AM 32.7±0.4°C; PM 34.4±1.0°C, P<0.01). Mean skin temperature was higher in AM than PM (P<0.05), despite greater dry and evaporative heat losses in AM than PM (P<0.001). Infrared tympanic temperature, heart rate and thermal sensation demonstrated a trial by time interaction (P<0.001) with no differences at any time point between trials, showing relatively higher responses in these variables in PM compared to AM during the early stages of training and in AM compared to PM during the later stages of training. There were no differences between trials in body mass loss and rating of perceived exertion. CONCLUSIONS: This study indicates a greater thermoregulatory strain in the morning from 09:00 h than the late afternoon from 16:00 h during 2.5-h regular judo training in no air conditioning facility on a clear day in the heat of summer. This observation is associated with a progressive increase in indoor and outdoor heat stress in the morning, despite a less indoor heat stress in the morning than the afternoon.


Asunto(s)
Regulación de la Temperatura Corporal/fisiología , Ritmo Circadiano/fisiología , Artes Marciales/fisiología , Estaciones del Año , Adolescente , Líquidos Corporales/metabolismo , Ejercicio Físico/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Percepción , Temperatura Cutánea , Estadísticas no Paramétricas
4.
Medicine (Baltimore) ; 99(51): e23764, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371141

RESUMEN

ABSTRACT: Passive leg raising (PLR) is a convenient and reliable test to predict fluid responsiveness. The ability of thoracic electrical bioimpedance cardiography (TEB) to monitor changes of cardiac output (CO) during PLR is unknown.In the present study, we measured CO in 61 patients with shock or dyspnea by TEB and transthoracic echocardiography (TTE) during PLR procedure. Positive PLR responsiveness was defined as the velocity-time integral (VTI) ≥10% after PLR. TTE measured VTI in the left ventricular output tract. The predictive value of TEB parameters in PLR responders was tested. Furthermore, the agreement of absolute CO values between TEB and TTE measurements was assessed.Among the 61 patients, there were 28 PLR-responders and 33 non-responders. Twenty-seven patients were diagnosed with shock and 34 patients with dyspnea, with 55.6% (15/27) and 54.6% (18/34) non-responders, respectively. A change in TEB measured CO (ΔCO) ≥9.8% predicted PLR responders with 75.0% sensitivity and 78.8% specificity, the area under the receiver operating characteristic curve (AUROC) was 0.79. The Δd2Z/dt2 (a secondary derivative of the impedance wave) showed the best predictive value with AUROC of 0.90, the optimal cut point was -7.1% with 85.7% sensitivity and 87.9% specificity. Bias between TEB and TTE measured CO was 0.12 L/min, and the percentage error was 65.8%.TEB parameters had promising performance in predicting PLR responders, and the Δd2Z/dt2 had the best predictive value. The CO values measured by TEB were not interchangeable with TTE in critically ill settings.


Asunto(s)
Gasto Cardíaco/fisiología , Cardiografía de Impedancia/instrumentación , Hemodinámica/fisiología , Adulto , Anciano , Área Bajo la Curva , Cardiografía de Impedancia/métodos , China , Enfermedad Crítica , Ecocardiografía/métodos , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/tendencias , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Estadísticas no Paramétricas
5.
Medicine (Baltimore) ; 99(51): e23773, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371145

RESUMEN

ABSTRACT: Chagas disease affects approximately 7 million people, causing disability and mortality in the most productive life stages of infected individuals. Considering the lifestyle of the world population, metabolic syndrome is a synergistic factor for an increased cardiovascular risk of patients with Chagas disease.This study transversally evaluated the metabolic and immunological profiles of patients with indeterminate (IF) and cardiac (CF) forms of Chagas disease and their correlations with left ventricular dysfunction (LVD).Clinical and electrical bioimpedance analysis, levels of cytokines (interferon [IFN]-γ, tumor necrosis factor [TNF]-α, interleukin [IL]-17, IL-10, and IL-33) and adipocytokines (adiponectin, leptin, and resistin), metabolic syndrome components, and brain natriuretic peptide (BNP) levels were assessed in 57 patients (13 IF and 44 CF) with a mean age of 61.63 ±â€Š12.1 years. Chest x-ray, electrocardiogram, and echocardiogram were performed to classify the clinical forms.The CF group had a higher number of individuals with metabolic syndrome components blood pressure altered, while more participants in the CF group with LVD had low high-density lipoprotein (HDL) levels. The IF group had more participants with a higher waist-to-hip ratio (WHR). No significant difference was observed between metabolic syndrome, cytokine and adipocytokine level, and clinical forms of the disease or in relation to LVD.Individuals with the IF showed metabolic and immunological profiles compatible with increased disease control, whereas those with CF showed marked inflammatory immune response.


Asunto(s)
Enfermedad de Chagas/inmunología , Enfermedad de Chagas/metabolismo , Adiponectina/análisis , Adiponectina/sangre , Anciano , Análisis de Varianza , Biomarcadores/análisis , Biomarcadores/sangre , Femenino , Cardiopatías/inmunología , Cardiopatías/metabolismo , Humanos , Interleucina-10/análisis , Interleucina-10/sangre , Interleucina-17/análisis , Interleucina-17/biosíntesis , Interleucina-33/análisis , Interleucina-33/sangre , Leptina/análisis , Leptina/sangre , Masculino , Persona de Mediana Edad , Resistina/análisis , Resistina/sangre , Estadísticas no Paramétricas
6.
Medicine (Baltimore) ; 99(51): e23803, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371155

RESUMEN

INTRODUCTION: Post-stroke cognitive impairment (PSCI), which has a high morbidity, is closely associated with the recurrence and rehabilitation of ischemic stroke. There are 2 different stages of PSCI, including post-stroke cognitive impairment with no dementia (PSCIND) and post-stroke dementia (PSD). The latter has a significantly higher mortality rate than the previous one. Therefore, preventing the onset of PSD is of vital importance. However, there is no unequivocally effective prevention or treatment for PSCI, except intensive secondary prevention of stroke. The primary aim of this protocol is to explore whether acupuncture can improve cognitive function of patients with PSCIND and reduce the chances of developing PSD. On this bias, we also want to explore its possible mechanisms. METHODS AND ANALYSIS: A prospective, multicenter, large sample, randomized controlled trial will be conducted. A total of 360 eligible patients will be recruited from 5 different hospitals and randomly allocated into the acupuncture group (AG), sham acupuncture group (NAG), and waiting-list group (WLG) in a 1:1:1 ratio. The intervention period of NAG and AG will last 3 months (30 minutes per day, 3 times per week). Primary and secondary outcomes will be measured at baseline, 12 weeks (at the end of the intervention), 24 weeks (after the 12-week follow-up period), and 36 weeks (after the 24-week follow-up period). Resting-state and task-state functional MRI will be conducted at baseline and 12 weeks. ETHICS AND DISSEMINATION: The ethic committee of First Teaching Hospital of University of Traditional Chinese Medicine approved the study. Study results will be first informed to each participant and later disseminated to researchers, and the general public through courses, presentations and the internet, regardless of the magnitude or direction of effect. The results will also be documented in a published peer-reviewed academic journal. REGISTRATION: We have registered at ClinicalTrials.gov(ChiCTR2000033801).


Asunto(s)
Terapia por Acupuntura/normas , Disfunción Cognitiva/terapia , Accidente Cerebrovascular/complicaciones , Terapia por Acupuntura/métodos , Terapia por Acupuntura/estadística & datos numéricos , China , Disfunción Cognitiva/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placebos , Estudios Prospectivos , Estadísticas no Paramétricas , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular/métodos , Factores de Tiempo , Resultado del Tratamiento
7.
Crit Care ; 24(1): 688, 2020 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-33302991

RESUMEN

BACKGROUND: A subset of critically ill COVID-19 patients develop a hyperinflammatory state. Anakinra, a recombinant interleukin-1 receptor antagonist, is known to be effective in several hyperinflammatory diseases. We investigated the effects of anakinra on inflammatory parameters and clinical outcomes in critically ill, mechanically ventilated COVID-19 patients with clinical features of hyperinflammation. METHODS: In this prospective cohort study, 21 critically ill COVID-19 patients treated with anakinra were compared to a group of standard care. Serial data of clinical inflammatory parameters and concentrations of multiple circulating cytokines were determined and aligned on start day of anakinra in the treatment group, and median start day of anakinra in the control group. Analysis was performed for day - 10 to + 10 relative to alignment day. Clinical outcomes were analyzed during 28 days. Additionally, three sensitivity analyses were performed: (1) using propensity score-matched groups, (2) selecting patients who did not receive corticosteroids, and (3) using a subset of the control group aimed to match the criteria (fever, elevated ferritin) for starting anakinra treatment. RESULTS: Baseline patient characteristics and clinical parameters on ICU admission were similar between groups. As a consequence of bias by indication, plasma levels of aspartate aminotransferase (ASAT) (p = 0.0002), ferritin (p = 0.009), and temperature (p = 0.001) were significantly higher in the anakinra group on alignment day. Following treatment, no relevant differences in kinetics of circulating cytokines were observed between both groups. Decreases of clinical parameters, including temperature (p = 0.03), white blood cell counts (p = 0.02), and plasma levels of ferritin (p = 0.003), procalcitonin (p = 0.001), creatinine (p = 0.01), and bilirubin (p = 0.007), were more pronounced in the anakinra group. No differences in duration of mechanical ventilation or ICU length of stay were observed between groups. Sensitivity analyses confirmed these results. CONCLUSIONS: Anakinra is effective in reducing clinical signs of hyperinflammation in critically ill COVID-19 patients. A randomized controlled trial is warranted to draw conclusion about the effects of anakinra on clinical outcomes.


Asunto(s)
/tratamiento farmacológico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Receptores de Interleucina-1/antagonistas & inhibidores , Anciano , Estudios de Cohortes , Enfermedad Crítica/terapia , Femenino , Humanos , Proteína Antagonista del Receptor de Interleucina 1/efectos adversos , Proteína Antagonista del Receptor de Interleucina 1/farmacología , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Estudios Prospectivos , Receptores de Interleucina-1/uso terapéutico , Estadísticas no Paramétricas
8.
Crit Care ; 24(1): 691, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33317616

RESUMEN

BACKGROUND: COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS: A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS: The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS: SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.


Asunto(s)
/complicaciones , ARN Viral/análisis , Carga Viral/inmunología , Adulto , Anciano , Biomarcadores/análisis , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Enfermedad Crítica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Reacción en Cadena de la Polimerasa/métodos , ARN Viral/sangre , Estadísticas no Paramétricas
9.
PLoS One ; 15(11): e0241425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33156848

RESUMEN

In response to stagnant Federal grant funding levels and to catalyze early stage or high-risk research not currently supported by the NIH, many academic medical centers (AMCs) provide supplemental intramural funding to faculty investigators. However, it can be challenging to decide how to deploy these funds for maximum impact. We conducted a retrospective, descriptive analysis to explore trends in applications and awards associated with an institution-wide intramural funding center at a major U.S. AMC. From 2010 to 2017, the Brigham Research Institute at Brigham and Women's Hospital awarded a total of 354 grants totaling over $9 million to affiliated researchers through six distinct and complementary grant programs. The number of applicants remained essentially stable, despite expansion of the funding program portfolio. Distribution of applicants and awardees by academic rank and gender generally reflected that of medical school faculty at large. This descriptive analysis demonstrates interest in a diverse range of intramural funding programs among AMC faculty, and a lack of overt rank or gender bias in the programs' awardees. However, it highlights the institution's need to better understand the amount of residual unmet demand for intramural funding; the degree to which underrepresented constituencies can and should be actively supported; and the "return on investment" of these grants.


Asunto(s)
Centros Médicos Académicos/economía , Investigación Biomédica/economía , Apoyo a la Investigación como Asunto/economía , Docentes Médicos , Femenino , Organización de la Financiación/economía , Humanos , Masculino , Facultades de Medicina , Estadísticas no Paramétricas , Factores de Tiempo
11.
Am J Emerg Med ; 38(10): 2002-2006, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33137540

RESUMEN

PURPOSE: We evaluated whether combining the serum albumin level and the Prediction Rule for Admission policy in Complicated urinary Tract InfeCtion LEiden (PRACTICE) class could be a prognostic predictor in elderly patients with urinary tract infection (UTI). METHODS: We retrospectively included adult patients (age ≥ 65 years) with UTI who were hospitalized in the emergency department (ED) between January 1, 2014 and December 31, 2018. We graded the serum albumin level and classified the PRACTICE score; the modified PRACTICE was defined as the sum of the albumin level grade and the PRACTICE class. We comparatively assessed the predictive value for in-hospital mortality and admission to the intensive care unit (ICU) in survivor and non-survivor groups. RESULTS: In total, the study analysis included 1159 patients, and in-hospital mortality was 3.4% (n = 39). The modified PRACTICE score (4.0 [1.4] vs 6.1 [1.2], p < 0.001) was significantly increased in the non-survivor group. The area under the curve value of factors associated with in-hospital mortality were the Modified Early Warning Score (MEWS) 0.57 (95% CI 0.54-0.60), albumin 0.83 (95% CI 0.81-0.85), PRACTICE 0.71 (95% CI 0.69-0.74), and the modified PRACTICE 0.86 (95% CI 0.84-0.88). Factors associated with ICU admission were MEWS 0.65 (95% CI 0.62-0.68), albumin 0.66 (95% CI 0.64-0.69), PRACTICE 0.66 (95% CI 0.63-0.68), and the modified PRACTICE 0.72 (95% CI 0.69-0.74). CONCLUSION: The modified PRACTICE score can be a useful prognostic predictor in elderly patients with UTI.


Asunto(s)
Geriatría/instrumentación , Pronóstico , Albúmina Sérica/análisis , Infecciones Urinarias/complicaciones , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/análisis , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Geriatría/métodos , Geriatría/normas , Humanos , Masculino , Curva ROC , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Análisis de Supervivencia , Infecciones Urinarias/sangre , Infecciones Urinarias/diagnóstico
12.
Am J Emerg Med ; 38(10): 2028-2033, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33142169

RESUMEN

INTRODUCTION: Emergency department (ED) crowding is associated with increased mortality and delays in care. We developed a rapid admission pathway targeting critically-ill trauma patients in the ED. This study investigates the sustainability of the pathway, as well as its effectiveness in times of increased ED crowding. MATERIALS & METHODS: This was a retrospective cohort study assessing the admission of critically-ill trauma patients with and without the use of a rapid admission pathway from 2013 to 2018. We accessed demographic and clinical data from trauma registry data and ED capacity logs. Statistical analyses included univariate and multivariate testing. RESULTS: A total of 1700 patients were included. Of this cohort, 434 patients were admitted using the rapid admission pathway, whereas 1266 were admitted using the traditional pathway. In bivariate analysis, mean ED LOS was 1.54 h (95% Confidence Interval [CI]: 1.41, 1.66) with the rapid pathway, compared with 5.88 h (95% CI: 5.64, 6.12) with the traditional pathway (p < 0.01). We found no statistically significant relationship between rapid admission pathway use and survival to hospital discharge. During times of increased crowding, rapid pathway use continued to be associated with reduction in ED LOS (p < 0.01). The reduction in ED LOS was sustained when comparing initial results (2013-2014) to recent data (2015-2018). CONCLUSION: This study found that a streamlined process to admit critically-ill trauma patients is sustainable and associated with reduction in ED LOS. As ED crowding remains pervasive, these findings support restructured care processes to limit prolonged ED boarding times for critically-ill patients.


Asunto(s)
Aglomeración , Admisión del Paciente/normas , Factores de Tiempo , Heridas y Traumatismos/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Enfermedad Crítica/terapia , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Admisión del Paciente/tendencias , Estudios Retrospectivos , Estadísticas no Paramétricas
13.
Am J Emerg Med ; 38(10): 2049-2054, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33142173

RESUMEN

OBJECTIVE: It remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury. METHODS: We conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs). RESULTS: We analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3). CONCLUSIONS: We identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately.


Asunto(s)
Diagnóstico por Imagen/estadística & datos numéricos , Anamnesis/métodos , Océanos y Mares , Examen Físico/métodos , Heridas y Traumatismos/complicaciones , Adulto , Anciano , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/etiología , Diagnóstico por Imagen/métodos , Femenino , Humanos , Masculino , Maryland/epidemiología , Anamnesis/estadística & datos numéricos , Persona de Mediana Edad , Examen Físico/estadística & datos numéricos , Estudios Prospectivos , Estudios Retrospectivos , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/etiología , Estadísticas no Paramétricas , Heridas y Traumatismos/epidemiología
16.
Medicine (Baltimore) ; 99(46): e22427, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181640

RESUMEN

There is paucity of data on the impact of surgical incision and analgesia on relevant outcomes.A retrospective STROBE-compliant cohort study was performed between July 2007 and August 2017 of patients undergoing lung transplantation. Gender, age, indication for lung transplantation, and the 3 types of surgical access (Thoracotomy (T), Sternotomy (S), and Clamshell (C)) were used, as well as 2 analgesic techniques: epidural and intravenous opioids. Outcome variables were: pain scores; postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation, and length of stay at intensive care unit (ICU).Three hundred forty-one patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01; 2.74, P: .045) and no differences were found between Clamshell and Sternotomy incision. The median blood loss was 800 mL [interquartile range (IQR): 500; 1238], thoracotomy patients had 500 mL [325; 818] (P < .001). Median durations of mechanical ventilation in Thoracotomy, Sternotomy, and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours, and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU (P < .001).Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation, and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.


Asunto(s)
Analgesia/normas , Trasplante de Pulmón/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Esternotomía/efectos adversos , Toracotomía/efectos adversos , Administración Intravenosa/normas , Administración Intravenosa/estadística & datos numéricos , Adulto , Anciano , Analgesia/estadística & datos numéricos , Analgesia Epidural/normas , Analgesia Epidural/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Trasplante de Pulmón/normas , Trasplante de Pulmón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Estadísticas no Paramétricas , Esternotomía/métodos , Esternotomía/estadística & datos numéricos , Toracotomía/métodos , Toracotomía/estadística & datos numéricos , Resultado del Tratamiento
17.
Medicine (Baltimore) ; 99(46): e23180, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181695

RESUMEN

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.


Asunto(s)
Huesos/cirugía , Senos Paranasales/cirugía , Prótesis e Implantes/tendencias , Elevación del Piso del Seno Maxilar/estadística & datos numéricos , Pesos y Medidas , Huesos/anomalías , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quírurgicos Nasales/instrumentación , Procedimientos Quírurgicos Nasales/métodos , Osteotomía/métodos , Radiografía/métodos , Radiografía/estadística & datos numéricos , Elevación del Piso del Seno Maxilar/instrumentación , Elevación del Piso del Seno Maxilar/métodos , Estadísticas no Paramétricas , Resultado del Tratamiento
18.
PLoS One ; 15(11): e0242147, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33166366

RESUMEN

The aim of time-varying heart rate variability spectral analysis is to detect and quantify changes in the heart rate variability spectrum components during nonstationary events. Of the methods available, the nonparametric short-time Fourier Transform and parametric time-varying autoregressive modeling are the most commonly employed. The current study (1) compares short-time Fourier Transform and autoregressive modeling methods influence on heart rate variability spectral characteristics over time and during an experimental ozone exposure in mature adult spontaneously hypertensive rats, (2) evaluates the agreement between short-time Fourier Transform and autoregressive modeling method results, and (3) describes the advantages and disadvantages of each method. Although similar trends were detected during ozone exposure, statistical comparisons identified significant differences between short-time Fourier Transform and autoregressive modeling analysis results. Significant differences were observed between methods for LF power (p ≤ 0.014); HF power (p ≤ 0.011); total power (p ≤ 0.027); and normalized HF power (p = 0.05). Furthermore, inconsistencies between exposure-related observations accentuated the lack of agreement between short-time Fourier Transform and autoregressive modeling overall. Thus, the short-time Fourier Transform and autoregressive modeling methods for time-varying heart rate variability analysis could not be considered interchangeable for evaluations with or without interventions that are known to affect cardio-autonomic activity.


Asunto(s)
Enfermedades Cardiovasculares/fisiopatología , Frecuencia Cardíaca , Algoritmos , Análisis de Varianza , Animales , Sistema Nervioso Autónomo/fisiología , Modelos Animales de Enfermedad , Electrocardiografía , Análisis de Fourier , Masculino , Ozono , Ratas , Ratas Endogámicas SHR , Análisis de Regresión , Estadísticas no Paramétricas , Telemetría
19.
PLoS One ; 15(11): e0241407, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33141845

RESUMEN

OBJECTIVES: The purpose is to assess the ability of low-dose CT (LDCT) to determine lung involvement in SARS-CoV-2 pneumonia and to describe a COVID19-LDCT severity score. MATERIALS AND METHODS: Patients with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively analysed. Clinical data, the National Early Warning Score (NEWS) and imaging features were recorded. Lung features included ground-glass opacities (GGO), areas of consolidation and crazy paving patterns. The COVID19-LDCT score was calculated by summing the score of each segment from 0 (no involvement) to 10 (severe impairment). Univariate analysis was performed to explore predictive factor of high COVID19-LDCT score. The nonparametric Mann-Whitney test was used to compare groups and a Spearman correlation used with p<0.05 for significance. RESULTS: Eighty patients with positive RT-PCR were analysed. The mean age was 55 years ± 16, with 42 males (53%). The most frequent symptoms were fever (60/80, 75%) and cough (59/80, 74%), the mean NEWS was 1.7±2.3. All LDCT could be analysed and 23/80 (28%) were normal. The major imaging finding was GGOs in 56 cases (67%). The COVID19-LDCT score (mean value = 19±29) was correlated with NEWS (r = 0.48, p<0.0001). No symptoms were risk factor to have pulmonary involvement. Univariate analysis shown that dyspnea, high respiratory rate, hypertension and diabetes are associated to a COVID19-LDCT score superior to 50. CONCLUSIONS: COVID19-LDCT score did correlate with NEWS. It was significantly different in the clinical low-risk and high-risk groups. Further work is needed to validate the COVID19-LDCT score against patient prognosis.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Tos/etiología , Femenino , Fiebre/etiología , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/virología , Frecuencia Respiratoria , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X , Adulto Joven
20.
Rev Bras Enferm ; 73(Suppl 2): e20200673, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33206820

RESUMEN

OBJECTIVE: To analyze the influence of socioeconomic, demographic, epidemiological factors, and the health system structure in the evolution of the COVID-19 pandemic in Brazil. METHODS: Ecological study with variables extracted from databases, having the incidence and mortality by COVID-19 until August 23, 2020, in Brazilian states, as response variables. The magnitude of the associations was estimated using Spearman's correlation coefficient and multiple regression analysis. RESULTS: In the Brazilian states, 59.8% of variation in the incidence of COVID-19 was justified by income inequality, significant home densification, and higher mortality. In the case of mortality, those same variables explained 57.9% of the country's variations in federal units. CONCLUSION: Our results indicate that socioeconomic factors influenced the evolution and impact of COVID-19 in Brazil. Thus, we suggest comprehensive actions to ensure economic conditions and strengthening of health networks for populations with socioeconomic vulnerability.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Determinantes Sociales de la Salud , Brasil/epidemiología , Infecciones por Coronavirus/mortalidad , Estudios Epidemiológicos , Humanos , Incidencia , Renta , Pandemias , Neumonía Viral/mortalidad , Análisis de Regresión , Factores Socioeconómicos , Estadísticas no Paramétricas
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