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1.
Artículo en Inglés | MEDLINE | ID: mdl-34639522

RESUMEN

BACKGROUND: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. METHODS: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. RESULTS: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. CONCLUSIONS: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.


Asunto(s)
COVID-19 , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Morbilidad , Factores de Riesgo , SARS-CoV-2
2.
Front Public Health ; 9: 758347, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34631653

RESUMEN

Aim: The study aim was to assess the association of vitamin D supplementation before hospital admission and severe outcomes in subjects admitted for COVID-19. Methods: We performed a cross-sectional analysis of pseudonymised medical record data from subjects admitted to the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) for COVID-19 during March and April 2020. The composite primary study outcome was defined as death and/or invasive mechanical ventilation (IMV). Association between risk factors and study outcomes was evaluated by bivariate analysis, followed by logistic regression analysis. Results: In total, 1,267 persons were hospitalised during the observation period. Overall, 14.9% of the subjects were on active vitamin D supplementation treatment before admission. The subjects in the vitamin D group were significantly older than subjects without vitamin D supplementation. We observed higher rates of the primary outcome (death and/or IMV) among the persons with previous use of vitamin D (30.1 vs. 22.9% in those not receiving treatment). In the bivariate analysis, previous use of vitamin D was positively associated with death and/or IMV [odds ratio (OR): 1.45 95% CI: 1.03; 2.04]; however, after adjustment for other risk factors this association disappeared (OR: 1.09 95%CI: 0.65; 1.81). Conclusion: We did not find an association between vitamin D supplementation before hospital admission and death and/or IMV in subjects admitted for COVID-19. The age and the burden of age-associated comorbidities were independently associated with the in-hospital events.


Asunto(s)
COVID-19 , Vitamina D , Estudios Transversales , Suplementos Dietéticos , Humanos , Morbilidad , SARS-CoV-2
3.
BMC Health Serv Res ; 21(1): 1046, 2021 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-34600525

RESUMEN

BACKGROUND: Patients with chronic diseases have increased needs for assistance and care. The objective of this study was to describe the characteristics and use of primary care (PC) and hospital care (HC) health services by chronic patients according to risk level based on adjusted morbidity groups (AMG) and to analyze the associated factors. METHODS: Cross-sectional descriptive observational study. Patients from a basic health area classified as chronically ill by the AMG classification system of the Madrid PC electronic medical record were included. Sociodemographic, clinical-care characteristics (classified as predisposing factors or need factors) and service utilization variables were collected. Univariate, bivariate and simple linear regression analyses were performed. RESULTS: The sample consisted of 9866 chronic patients and 8332 (84.4%) used health services. Of these service users, 63% were women, mean age was 55.7 (SD = 20.8), 439 (5.3%) were high risk, 1746 (21.2%) were medium risk, and 6041(73.4%) were low risk. A total of 8226 (98.7%) were PC users, and 4284 (51.4%) were HC users. The average number of annual contacts with PC was 13.9 (SD = 15); the average number of contacts with HC was 4.8 (SD = 6.2). Predisposing factors associated with services utilization at both care levels were: age (B coefficient [BC] = 0.03 and 0.018, 95% CI = 0.017-0.052 and 0.008-0.028, respectively, for PC and HC) and Spanish origin (BC = 0.962 and 3.396, 95% CI = 0.198-1.726 and 2.722-4.070); need factors included: palliative care (BC = 10,492 and 5047; 95% CI = 6457-14,526 and 3098-6995), high risk (BC = 4631 and 2730, 95% CI = 3022-6241 and 1.949-3.512), number of chronic diseases (BC = 1.291 and 0.222, 95% CI = 1.068-1.51 and 0.103-0.341) and neoplasms (BC = 2.989 and 4.309, 95% CI = 1.659-4.319 and 3.629-4.989). CONCLUSIONS: The characteristics and PC and HC service utilization of chronic patients were different and varied according to their AMG risk level. There was greater use of PC services than HC services, although utilization of both levels of care was high. Service use was related to predisposing factors such as age and country of origin and, above all, to need factors such as immobility, high risk, and number and type of chronic diseases that require follow-up and palliative care.


Asunto(s)
Hospitales , Cuidados Paliativos , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Morbilidad
4.
J Headache Pain ; 22(1): 118, 2021 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-34620087

RESUMEN

OBJECTIVE: Headache is the predominant disabler in idiopathic intracranial hypertension (IIH). The aim was to characterise headache and investigate the association with intracranial pressure. METHODS: IIH:WT was a randomised controlled parallel group multicentre trial in the United Kingdom investigating weight management methods in IIH. Participants with active IIH (evidenced by papilloedema) and a body mass index (BMI) ≥35 kg/m2 were recruited. At baseline, 12 months and 24 months headache characteristics and quality of life outcome measures were collected and lumbar puncture measurements were performed. RESULTS: Sixty-six women with active IIH were included with a mean age of 32.0 years (SD ± 7.8), and mean body mass index of 43.9 ± 7.0 kg/m2. The headache phenotype was migraine-like in 90%. Headache severity correlated with ICP at baseline (r = 0.285; p = 0.024); change in headache severity and monthly headache days correlated with change in ICP at 12 months (r = 0.454, p = 0.001 and r = 0.419, p = 0.002 respectively). Cutaneous allodynia was significantly correlated with ICP at 12 months. (r = 0.479, p < 0.001). Boot strap analysis noted a positive association between ICP at 12 and 24 months and enabled prediction of both change in headache severity and monthly headache days. ICP was associated with significant improvements in quality of life (SF-36). CONCLUSIONS: We demonstrate a positive relationship between ICP and headache and cutaneous allodynia, which has not been previously reported in IIH. Those with the greatest reduction in ICP over 12 months had the greatest reduction in headache frequency and severity; this was associated with improvement of quality of life measures. TRIAL REGISTRATION: This work provides Class IIa evidence of the association of raised intracranial pressure and headache. ClinicalTrials.gov number, NCT02124486 .


Asunto(s)
Seudotumor Cerebral , Adulto , Femenino , Cefalea/complicaciones , Cefalea/epidemiología , Humanos , Presión Intracraneal , Morbilidad , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/epidemiología , Calidad de Vida
5.
Artículo en Ruso | MEDLINE | ID: mdl-34486850

RESUMEN

The article presents results of comparative analysis of morbidity and mortality of diseases of circulatory system in the Republic of Buryatia in 2003-2018. The population mortality depends on identification of risk factors for cardiovascular diseases, diseases of circulatory system and subsequent coverage of population with medical care, including dispensary monitoring. The analysis was based on data from State statistical reporting forms and official data of the Territorial Board of the Federal State Statistics Service in the Republic of Buryatia, including the form № 12 "The information on number of diseases registered in patients residing in area of medical organization servicing activity"; the form № 025-12/s "The Out-Patient Registration Card"; the form № 25-2/y "The Statistical Coupon for Final (updated) Diagnosis Registration". The study was carried out using statistical, analytical and comparative analysis methods. Currently, in the Republic of Buryatia, diseases of circular system occupying second place in the structure of total morbidity (15.7%) and primary disability of adult population (28.6%) are among leading cause of total population mortality (41.6%).


Asunto(s)
Enfermedades Cardiovasculares , Sistema Cardiovascular , Adulto , Enfermedades Cardiovasculares/epidemiología , Humanos , Morbilidad , Pacientes Ambulatorios , Factores de Riesgo
6.
Artículo en Ruso | MEDLINE | ID: mdl-34486854

RESUMEN

All around the world, about 570 000 of new cases of cervical cancer are diagnosed annually and more than 300 000 of women die of this pathology. In the Russian Federation, in 2018, more than 17 500 of new cases of cervical cancer were diagnosed and more than 6 000 of women died of this pathology. The purpose of the study was to analyze incidence and mortality of cervical cancer in 2007-2018. The analysis of incidence rates of cervical cancer in the Russian Federation in 2007-2018 established steady trend of increasing of incidence rate from 12.8 (2007) to 15.8 (2018). The incidence rate increased up to 26.6%. The increasing is most pronounced in the age groups of 35-39, 40-44 and 45-49 years. The analysis of dynamics of mortality rates established relative stability indices in 2007-2018 (5.11 and 5.07 in standardized rates per 100 000). The decrease of 2018 as compared to 2007 made up to 0.78%. In most age groups mortality rates are decreasing. However, significant increase of mortality rate in age group of 40-44 years was established amounted up to 25%.


Asunto(s)
Neoplasias del Cuello Uterino , Adulto , Femenino , Humanos , Incidencia , Morbilidad , Mortalidad , Federación de Rusia/epidemiología , Neoplasias del Cuello Uterino/epidemiología
7.
Artículo en Ruso | MEDLINE | ID: mdl-34486860

RESUMEN

Currently, the characteristic of dynamics of morbidity of mental disorders of population of the Russian Federation is its increasing simultaneously with changing in structure of contingents in the direction of decreasing number of patients subjected to dispensary monitoring. The study of influence of medical organizational factors on morbidity of mental disorders demonstrated the role of provision with psychiatrists in dynamics of prevalence of mental disorders. The improvement of management of patients with mental disorders should be supported by appropriate resources and adaptation of mental service to actual conditions, in particular, solving the problem of manpower deficiency of psychiatrists.


Asunto(s)
Trastornos Mentales , Psiquiatría , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Morbilidad , Prevalencia , Recursos Humanos
8.
Artículo en Ruso | MEDLINE | ID: mdl-34486868

RESUMEN

The common coding of main diagnosis (so-called "manual coding") is accompanied by quite many errors associated with inobservance of classification algorithm and subjective causes that in statistical morbidity and mortality data corruption. The article presents the results of implementing automated system of diagnosis coding by the ICD-10 in the departments of the Medicosanitary Unit of MVD of Russia in City of Moscow. The functional and time losses and the error rate were studied under manual coding and automated coding system. In case of common coding of complete clinical diagnosis of one discharged patient per day, it takes from 5 to 15 minutes, for coding diagnoses of all discharged patients - about 1 hour. The number of errors in common coding made up to 14.1% (n=2472) and in case of automated coding it made up to 1.5% (n= 63, p>0.05). The application of automated coding system in medical organizations ensures exact correspondence of clinical and statistical diagnosis, unifies wording of clinical diagnosis, minimizes subjective deviations from algorithm of the ICD-10.


Asunto(s)
Clasificación Internacional de Enfermedades , Unidades Móviles de Salud , Algoritmos , Humanos , Morbilidad , Alta del Paciente
9.
J Coll Physicians Surg Pak ; 31(9): 1085-1088, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34500526

RESUMEN

OBJECTIVE: To identify the risk factors for postoperative complications of stoma closures. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Izmir University of Health Sciences, Tepecik Training and Research Hospital, Izmir Turkey from October 2008 to December 2018. METHODOLOGY: A total of 179 patients were divided into two groups according to presence or absence of postoperative complications. Differences between these two groups were analysed with tests of proportion; p <0.05 value was considered statistically significant. The results are reported as odds ratios (ORs) with 95% confidence interval (CI). RESULTS: The median age of the patients with postoperative complications was 57.00 (40.00-67.00) and 30/55 (54.5%) of them were males. American Society of Anesthesiology (ASA) score and coronary artery disease had significant association with postoperative complications of stoma closure (p=0.033, p=0.024). Although colostomy was not associated with presence of postoperative complications, but when the authors analysed correlations of colostomy with postoperative complications separately, it was found that colostomy was a risk factor for postoperative ileus (OR 0.257, 95% CI 0.081-0.821; p= 0.026). CONCLUSION: ASA score and coronary artery disease should be considered as risk factors for complications of stoma closure. Colostomy should be considered as a risk factor for postoperative ileus. Key Words: Colostomy, Ileostomy, Stoma closure, Risk factors.


Asunto(s)
Colostomía , Ileostomía , Humanos , Ileostomía/efectos adversos , Masculino , Morbilidad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo
10.
Artículo en Inglés | PAHO-IRIS | ID: phr-54914

RESUMEN

[ABSTRACT]. Objective. To describe the life expectancy, healthy life expectancy, disease burden, and leading causes of mortality and disability in adults aged 65 years and older in the Region of the Americas from 1990 to 2019. Methods. We used estimates from the Global Burden of Disease Study 2019 to examine the level and trends of life expectancy, healthy life expectancy, years of life lost, years lived with disability, and disability-adjusted life years (DALYs). Results. Across the Region, life expectancy at 65 years increased from 17.1 years (95% uncertainty intervals (UI): 17.0–17.1) in 1990 to 19.2 years (95% UI: 18.9–19.4) in 2019 while healthy life expectancy increased from 12.2 years (95% UI: 10.9–12.4) to 13.6 years (95% UI: 12.2–14.9). All-cause DALY rates decreased in each older persons’ age group; however, absolute proportional DALYs increased from 22% to 32%. Ischemic heart disease, stroke, and chronic obstructive pulmonary disease were the leading causes of premature mortality. Diabetes mellitus, age-related and other hearing loss, and lower back pain were the leading causes of disability. Conclusion. The increase in life expectancy and decrease of DALYs indicate the positive effect of improvements in social conditions and health policies. However, the smaller increase in healthy life expectancy suggests that, despite living longer, people spend a substantial amount of time in their old age with disability and illness. Preventable and controllable diseases account for most of the disease burden in older adults in the Americas. Society-wide and life-course approaches, and adequate health services are needed to respond to the health needs of older people in the Region.


[RESUMEN]. Objetivo. Describir la esperanza de vida, la esperanza de vida saludable, la carga de enfermedad y las principales causas de mortalidad y discapacidad en personas adultas de 65 años o más en la Región de las Américas desde 1990 hasta el 2019. Métodos. Se emplearon estimaciones del estudio sobre la carga mundial de enfermedad del 2019 para examinar las tendencias y el nivel de la esperanza de vida, la esperanza de vida saludable, los años de vida perdidos, los años vividos con discapacidad y los años de vida ajustados en función de la discapacidad (AVAD). Resultados. En toda la Región, la esperanza de vida a los 65 años aumentó de 17,1 años (intervalos de incertidumbre [IU] del 95 %: 17,0–17,1) en 1990 a 19,2 años (IU del 95 %: 18,9–19,4) en el 2019, mientras que la esperanza de vida saludable se incrementó de 12,2 años (IU del 95 %: 10,9-12,4) a 13,6 años (IU del 95 %: 12,2–14,9). Las tasas de AVAD debida a cualquier causa disminuyeron en cada grupo etario de mayor edad; sin embargo, los AVAD absolutos proporcionales aumentaron de 22 % a 32 %. La cardiopatía isquémica, los accidentes cerebrovasculares y la enfermedad pulmonar obstructiva crónica fueron las principales causas de muerte prematura. La diabetes mellitus, la pérdida de la audición relacionada con la edad y de otro tipo, y la lumbalgia fueron las principales causas de discapacidad. Conclusiones. El aumento de la esperanza de vida y la disminución de los AVAD indican el efecto positivo de las mejoras de las condiciones sociales y las políticas de salud. Sin embargo, el menor aumento de la esperanza de vida saludable indica que, a pesar de vivir más tiempo, las personas pasan una parte sustancial de su vejez con discapacidades y enfermedades. Las enfermedades controlables y prevenibles representan la mayor parte de la carga de enfermedad de las personas mayores en la Región. Se requieren enfoques a escala de toda la sociedad y el curso de vida, y servicios de salud adecuados para responder a las necesidades de salud de las personas mayores en la Región.


[RESUMO]. Objetivo. Descrever a expectativa de vida, a expectativa de vida saudável, a carga de doenças e as principais causas de mortalidade e incapacidade em adultos a partir dos 65 anos de idade na Região das Américas de 1990 a 2019.Métodos. Utilizamos estimativas do Estudo de Carga Global da Doença 2019 para examinar o nível e as tendências da expectativa de vida, expectativa de vida saudável, anos de vida perdidos, anos vividos com incapacidade e anos de vida ajustados por incapacidade (AVAI). Resultados. Em toda a Região, a expectativa de vida aos 65 anos aumentou de 17,1 anos (intervalos de incerteza (II) de 95%: 17,0-17,1) em 1990 para 19,2 anos (II de 95%: 18,9-19,4) em 2019, enquanto a expectativa de vida saudável aumentou de 12,2 anos (II de 95%: 10,9-12,4) para 13,6 anos (II de 95%: 12,2-14,9). As taxas de AVAI por todas as causas diminuiu em todos os grupos de pessoas idosas; porém, em termos absolutos, os AVAI proporcionais aumentaram de 22% para 32%. A cardiopatia isquêmica, o acidente vascular cerebral e a doença pulmonar obstrutiva crônica foram as principais causas de mortalidade precoce. A diabetes melitus, a perda da audição – em função da idade ou por outros motivos – e a dor lombar foram as principais causas de incapacidade. Conclusão. O aumento da expectativa de vida e a diminuição dos AVAI indicam o impacto positivo das melhorias nas condições sociais e nas políticas de saúde. Porém, o menor aumento na expectativa de vida saudável indica que, apesar de viverem mais, as pessoas passam uma quantidade considerável de tempo na velhice com incapacidade e doença. As doenças preveníveis e controláveis representam a maior parte da carga de doença nas pessoas idosas nas Américas. Abordagens que afetem a sociedade como um todo e o curso de vida, e serviços de saúde adequados, são necessários para atender às necessidades de saúde das pessoas idosas na Região.


Asunto(s)
Salud del Anciano , Mortalidad , Morbilidad , Anciano , Envejecimiento Saludable , Envejecimiento , Américas , Salud del Anciano , Anciano , Envejecimiento Saludable , Envejecimiento , Mortalidad , Morbilidad , Salud del Anciano , Anciano , Envejecimiento Saludable , Envejecimiento , Mortalidad , Morbilidad , Américas , Américas
11.
Public Health ; 198: 238-244, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34487867

RESUMEN

OBJECTIVES: During the COVID-19 pandemic, ethnic minorities have been more susceptible to infection and demonstrated poorer outcomes. This study describes COVID-19 morbidity and mortality by ethnic group, represented by Arab and Jewish localities in Israel, during the different waves of the outbreak and addresses sociocultural aspects of the pandemic. STUDY DESIGN: A retrospective national archive study was conducted in Israel. METHODS: Data were obtained from the Ministry of Health's database, including daily information on Arab, Jewish or mixed localities, from February 2020 to February 2021. RESULTS: During the first wave of the pandemic, the incidence of COVID-19 in Arab compared with Jewish localities was 67% lower and mortality was 85% lower, in addition to lower rates of severe disease requiring hospitalisation. During the second and third waves, these trends reversed, with the proportion of positive tests, incidence and mortality in Arab localities reaching and then surpassing rates in Jewish localities. By September 2020, COVID-19 mortality was twice as high in Arab compared with Jewish localities. CONCLUSIONS: After low morbidity during the first wave of the COVID-19 pandemic, a surge in infections occurred in the Arab population during subsequent waves, to match and surpass the high incidence seen in the Jewish population. This unique pattern highlights the changing experiences of a minority group as the pandemic progressed and demonstrates how COVID-19 exacerbates existing disparities.


Asunto(s)
COVID-19 , Pandemias , Árabes , Humanos , Israel/epidemiología , Judíos , Grupos Minoritarios , Morbilidad , Estudios Retrospectivos , SARS-CoV-2
13.
Blood Adv ; 5(18): 3690-3693, 2021 09 28.
Artículo en Inglés | MEDLINE | ID: mdl-34581772

RESUMEN

The COVID-19 pandemic has highlighted racial health disparities within the United States. Although social determinants of health are the most likely drivers of this disparity, it is possible that genetic traits enriched in the black population like sickle cell trait (SCT) could worsen the morbidity and mortality of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients admitted for SARS-CoV-2 infection who identified as black or African American were included in the study (n = 166). Blood remnants were tested for SCT, and clinical data were abstracted from the chart. There was no difference in mortality between those with SCT and those without. There was no difference in respiratory complications between groups, but those without SCT had a much higher burden of chronic lung disease (P = .004). Those with SCT had higher creatinine on admission (P = .004), but no difference in in-hospital renal complications (P = .532). Notably, 12% of the cohort had SCT, which is higher than the expected 7.31% (P = .025). Our study did not show any evidence of increased end organ damage, morbidity, or mortality from SARS-CoV-2 infection among patients with SCT but did show differences in admission creatinine and preexisting lung disease.


Asunto(s)
COVID-19 , Rasgo Drepanocítico , Humanos , Morbilidad , Pandemias , SARS-CoV-2 , Estados Unidos
14.
Artículo en Inglés | MEDLINE | ID: mdl-34574373

RESUMEN

The impact of COVID-19 morbidity and mortality among family and friends on vaccination preferences is not well explored. A valid and reliable questionnaire was deployed online via mTurk to recruit a national random sample of adult Americans to understand COVID-19 vaccination preferences and its relationship with COVID-19 infection in social networks. A total of 1602 individuals participated in the study where the majority had taken at least one dose of the COVID-19 vaccine (79%) and almost a tenth were planning to do so (10%) or did not want to take the vaccine (11%). Compared to those who knew family members or friends affected by COVID-19, those who did not know anyone infected with (AOR = 3.20), hospitalized for (AOR = 3.60), or died of COVID-19 (AOR = 2.97) had statistically significantly higher odds of refusing the vaccines. Most strategies for reducing COVID-19 vaccination hesitancy focus on highlighting the benefits of COVID-19 vaccines. We suggest that the dangers of not getting the vaccine should also be emphasized as many people who do not know someone who was affected with COVID-19 are also hesitant towards vaccination. These individuals may not fully appreciate the morbidity and mortality impact of COVID-19 infections and the messaging can be tailored to highlight the risk of not having vaccines.


Asunto(s)
COVID-19 , Vacunas , Adulto , Vacunas contra la COVID-19 , Humanos , Morbilidad , SARS-CoV-2 , Red Social , Vacunación
15.
Eur J Med Res ; 26(1): 107, 2021 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-34530915

RESUMEN

BACKGROUND: COVID-19, the pandemic disease caused by infection with SARS-CoV-2, may take highly variable clinical courses, ranging from symptom-free and pauci-symptomatic to fatal disease. The goal of the current study was to assess the association of COVID-19 clinical courses controlled by patients' adaptive immune responses without progression to severe disease with patients' Human Leukocyte Antigen (HLA) genetics, AB0 blood group antigens, and the presence or absence of near-loss-of-function delta 32 deletion mutant of the C-C chemokine receptor type 5 (CCR5). PATIENT AND METHODS: An exploratory observational study including 157 adult COVID-19 convalescent patients was performed with a median follow-up of 250 days. The impact of different HLA genotypes, AB0 blood group antigens, and the CCR5 mutant CD195 were investigated for their role in the clinical course of COVID-19. In addition, this study addressed levels of severity and morbidity of COVID-19. The association of the immunogenetic background parameters were further related to patients' humoral antiviral immune response patterns by longitudinal observation. RESULTS: Univariate HLA analyses identified putatively protective HLA alleles (HLA class II DRB1*01:01 and HLA class I B*35:01, with a trend for DRB1*03:01). They were associated with reduced durations of disease instead decreased (rather than increased) total anti-S IgG levels. They had a higher virus neutralizing capacity compared to non-carriers. Conversely, analyses also identified HLA alleles (HLA class II DQB1*03:02 und HLA class I B*15:01) not associated with such benefit in the patient cohort of this study. Hierarchical testing by Cox regression analyses confirmed the significance of the protective effect of the HLA alleles identified (when assessed in composite) in terms of disease duration, whereas AB0 blood group antigen heterozygosity was found to be significantly associated with disease severity (rather than duration) in our cohort. A suggestive association of a heterozygous CCR5 delta 32 mutation status with prolonged disease duration was implied by univariate analyses but could not be confirmed by hierarchical multivariate testing. CONCLUSION: The current study shows that the presence of HLA class II DRB1*01:01 and HLA class I B*35:01 is of even stronger association with reduced disease duration in mild and moderate COVID-19 than age or any other potential risk factor assessed. Prospective studies in larger patient populations also including novel SARS-CoV-2 variants will be required to assess the impact of HLA genetics on the capacity of mounting protective vaccination responses in the future.


Asunto(s)
Sistema del Grupo Sanguíneo ABO/genética , COVID-19/etiología , Antígenos HLA/genética , Receptores CCR5/genética , Adulto , Anciano , COVID-19/epidemiología , COVID-19/genética , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Cadenas HLA-DRB1/genética , Antígenos de Histocompatibilidad Clase I/genética , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Morbilidad , Mutación , Índice de Severidad de la Enfermedad
16.
Neurol India ; 69(4): 1085-1086, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34507460
17.
Virology ; 563: 98-106, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34509029

RESUMEN

The COVID-19 pandemic has paralyzed the global economy and resulted in millions of deaths globally. People with co-morbidities like obesity, diabetes and hypertension are at an increased risk for severe COVID-19 illness. This is of overwhelming concern because 42% of Americans are obese, 30% are pre-diabetic and 9.4% have clinical diabetes. Here, we investigated the effect of obesity on disease severity following SARS-CoV-2 infection using a well-established mouse model of diet-induced obesity. Diet-induced obese and lean control C57BL/6 N mice, transduced for ACE2 expression using replication-defective adenovirus, were infected with SARS-CoV-2, and monitored for lung pathology, viral titers, and cytokine expression. No significant differences in tissue pathology or viral replication was observed between AdV transduced lean and obese groups, infected with SARS-CoV-2, but certain cytokines were expressed more significantly in infected obese mice compared to the lean ones. Notably, significant weight loss was observed in obese mice treated with the adenovirus vector, independent of SARS-CoV-2 infection, suggesting an obesity-dependent morbidity induced by the vector. These data indicate that the adenovirus-transduced mouse model of SARS-CoV-2 infection, as described here and elsewhere, may be inappropriate for nutrition studies.


Asunto(s)
COVID-19/epidemiología , Modelos Animales de Enfermedad , Obesidad/epidemiología , Animales , Chlorocebus aethiops , Comorbilidad , Femenino , Células HEK293 , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Morbilidad , Células Vero
18.
J Pak Med Assoc ; 71(9): 2255-2257, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34580525

RESUMEN

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients' charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 (11.1%) patients while none was noted in the early THR group. The difference was statistically significant with a P-value of 0.008. With regards to post-operative complications, significantly higher percentage of patients were noted to have developed electrolyte imbalances (P = 0.003), postoperative psychosis (P = 0.02), and acute kidney injury (AKI) (P = 0.02) in the delayed THR group compared to the early THR group. Delay in surgery for neck of femur fracture is associated with increased 30-day mortality and postoperative complications.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Fracturas del Cuello Femoral , Fracturas de Cadera , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/cirugía , Fracturas de Cadera/cirugía , Humanos , Morbilidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos
19.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34472787

RESUMEN

BACKGROUND: The present study intended to estimate the comorbidities and risk factors among patients with hypertension in India. Further, the current practice of hypertension management was evaluated and the choice of therapy was assessed based on hypertension grade, risk factors, and comorbidities. METHODS: Electronic medical record data (June 2017-June 2019) of Indian adult hypertensive patients (≥140/90 mmHg) who had two blood pressure (BP) readings were retrospectively analyzed. Demographic characteristics, BP readings, comorbidities, medications and co-medications, and laboratory data were collected at baseline. Grids based on hypertension grade (I, II, and III), demographic factors, risk factors, and comorbidities were created and prescribed antihypertensive drugs (AHDs) in each grid were evaluated. RESULTS: Among 100,075 patients, the proportion of patients in 18-40 year, 40-65 year, and >65 year age groups were 11.4%, 65.1%, and 23.4%, respectively. Proportion of men and women was similar (52.0% vs 47.9%). Proportion of patients with BMI <25 Kg/m2 was 8.1%, 25-29.9 Kg/m2 was 11.9%, and >30 Kg/m2 was 8.8%. Mean BP of patients with hypertension was: grade I (145.05/90.73 mmHg), grade II (160.07/95.64 mmHg), and grade III (180.82/102.76 mmHg). Mean low density lipoprotein (113.26 mg/dL), serum creatinine (2.28 mg/dL), mean HbA1c (8.7%) levels were highest among patients with grade III hypertension. Commonly observed comorbidities were type 2 diabetes mellitus (T2DM: 51.5%), dyslipidemia (36.4%), and chronic kidney disease (CKD: 4.4%). Top concomitant medications included anti-diabetic therapies (34.6%), drugs for dyslipidemia (30.0%), and anti-platelet therapies (6.9%). CONCLUSION: Most prescribed AHD monotherapies were angiotensin receptor II blockers (ARBs) and calcium channel blockers (CCBs) and most prescribed combination therapies were ARBs + diuretics and ARBs + CCBs. Telmisartan and amlodipine+telmisartan for patients with comorbid T2DM or dyslipidemia and metoprolol for those with coronary artery disease were the commonly prescribed AHDs.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipertensión , Adolescente , Adulto , Anciano , Antagonistas de Receptores de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina , Antihipertensivos/uso terapéutico , Presión Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , India/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
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