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1.
Texto & contexto enferm ; 29: e20200154, Jan.-Dec. 2020. tab, graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1127490

RESUMEN

ABSTRACT Objective: to produce a predictive model for the incidence of COVID-19 cases, severity and deaths in Ponta Grossa, state of Paraná. Methods: this is an ecological study with data from confirmed cases of COVID-19 reported between March 21, 2020 and May 3, 2020 in Ponta Grossa and proportion of severity, hospitalization and lethality in the literature. A susceptible-infected-recovered (SIR) epidemic model was developed, and reproduction rate (R0), duration of epidemic, peak period, number of cases, hospitalized patients and deaths were estimated. Deaths were calculated by age group and in three scenarios: at day 24, at day 34, and at day 44 of the epidemic. Results: in the three scenarios assessed in this study, the variation in the number of cases was explained by an exponential curve (r2=0.74, 0.79 and 0.89, respectively, p<0.0001 in all scenarios). The SIR model estimated that, in the best scenario, the peak period will be around 120 days after the first case (between July 11, 2020 and July 25, 2020), estimated R0 will be 1.07 and will infect 0.23% of the population. In the worst scenario, peak period will involve 4,375 (95% CI; 4156-4594) cases and 825 (95% CI; 700-950) cases in the best scenario. Most cases and hospital admissions will involve patients aged 20 to 39 years, the number of deaths will be higher among the elderly and more pronounced among patients aged ≥80 years. Conclusion: this is the first study that provides COVID-19 projections for a municipality that is not a large capital. It shows a peak period at a later moment; therefore, the municipality will have more time to prepare and adopt protective measures to reduce the number of simultaneous cases.


RESUMEN Objetivo: obtener un modelo predictivo para la ocurrencia de casos, severidad y muertes por COVID-19 en Ponta Grossa-Paraná. Métodos: estudio ecológico con datos de casos confirmados de COVID-19 notificados del 21/03/2020 al 3/3/2020 en Ponta Grossa y proporción de severidad, hospitalización y letalidad en la literatura. Se construyó un modelo epidemiológico (SIR) infectado-recuperado susceptible y tasa de reproducción estimada (R0), duración de la epidemia, fecha pico, número de casos, hospitalizaciones y muertes. Este último por grupo de edad y en tres escenarios: a los 24 días, a los 34 días y a los 44 días de epidemia. Resultados: en los tres escenarios evaluados, la variación en el número de casos se explicó por una curva exponencial (r2 = 0.74, 0.79 y 0.89, respectivamente y p <0.0001 en total). El modelo SIR estimó que, en el mejor escenario, el pico ocurrirá alrededor de 120 días después del primer caso (entre el 7/11/2020 y el 25/7/2020), el R0 estimado será de 1.07 y alcanzará 0.23 % de habitantes infectados. En el peor de los casos, el pico estimado será de 4375 (IC del 95%: 4156-4594) y 825 (IC del 95%: 700-950) en el mejor de los casos. El mayor número estimado de casos y hospitalizaciones estará en el rango entre 20 y 39 años, el número de muertes será mayor entre los ancianos y más pronunciado entre ≥ 80 años. Conclusión: este es el primer estudio con proyecciones para COVID-19 en un municipio fuera de las grandes capitales y demostró que el pico llegará tarde, por lo tanto, el municipio tendrá más tiempo de preparación y que las medidas de protección pueden reducir el número simultáneo de casos.


RESUMO Objetivo: obter um modelo preditivo da ocorrência de casos, gravidade e óbitos por COVID-19 em Ponta Grossa-Paraná. Métodos: estudo ecológico com dados de casos confirmados de COVID-19 notificados de 21/03/2020 a 03/05/2020 em Ponta Grossa e proporção de gravidade, hospitalização e letalidade da literatura. Um modelo epidemiológico suscetível-infectado-recuperado (SIR) foi construído e estimadas taxa de reprodução (R0), duração da epidemia, data do pico, número de casos, hospitalizações e óbitos. Estas últimas por faixa etária e em três cenários: aos 24 dias, aos 34 dias e aos 44 dias de epidemia. Resultados: nos três cenários avaliados, a variação no número de casos foi explicada por uma curva exponencial (r2=0,74, 0,79 e 0,89, respectivamente e p<0,0001 em todos). O modelo SIR estimou que, no melhor cenário, o pico ocorrerá em torno de 120 dias após o primeiro caso (entre 11/07/2020 e 25/07/2020), o R0 estimado será 1,07 e chegará a 0,23% dos habitantes infectados. No pior cenário, o pico estimado será de 4375 (IC 95% 4156-4594) casos e 825 (IC 95% 700-950) no melhor cenário. O maior número estimado de casos e hospitalizações será na faixa entre 20 e 39 anos, o número de óbitos será maior entre idosos e mais acentuado entre ≥ 80 anos. Conclusão: este é o primeiro estudo com projeções para a COVID-19 em um município fora das grandes capitais e mostrou que o pico será tardio, portanto, o município terá mais tempo de preparo e que medidas protetivas podem reduzir o número simultâneo de casos.


Asunto(s)
Humanos , Adulto , Anciano , Mortalidad , Coronavirus , Número Básico de Reproducción , Epidemias , Betacoronavirus , Hospitalización , Predicción
2.
Rev Soc Bras Med Trop ; 53: e20200558, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33174964

RESUMEN

INTRODUCTION: In March 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic. In Brazil, 110 thousand cases and 5,901 deaths were confirmed by the end of April 2020. The scarcity of laboratory resources, the overload on the service network, and the broad clinical spectrum of the disease make it difficult to document all the deaths due to COVID-19. The aim of this study was to assess the mortality rate in Brazilian capitals with a high incidence of COVID-19. METHODS: We assessed the weekly mortality between epidemiological week 1 and 16 in 2020 and the corresponding period in 2019. We estimated the expected mortality at 95% confidence interval by projecting the mortality in 2019 to the population in 2020, using data from the National Association of Civil Registrars (ARPEN-Brasil). RESULTS: In the five capitals with the highest incidence of COVID-19, we identified excess deaths during the pandemic. The age group above 60 years was severely affected, while 31% of the excess deaths occurred in the age group of 20-59 years. There was a strong correlation (r = 0.94) between excess deaths and the number of deaths confirmed by epidemiological monitoring. The epidemiological surveillance captured only 52% of all mortality associated with the COVID-19 pandemic in the cities examined. CONCLUSIONS: Considering the simplicity of the method and its low cost, we believe that the assessment of excess mortality associated with the COVID-19 pandemic should be used as a complementary tool for regular epidemiological surveillance.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Mortalidad , Neumonía Viral/mortalidad , Adulto , Betacoronavirus , Brasil/epidemiología , Humanos , Persona de Mediana Edad , Pandemias , Adulto Joven
4.
Pan Afr Med J ; 35(Suppl 2): 143, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33193958

RESUMEN

Zimbabwe reported its first case of COVID-19 on 20 March 2020, and since then the number has increased to over 4000. To contain the spread of the causative SARS-CoV-2 and prepare the healthcare system, public health interventions, including lockdowns, were imposed on 30 March 2020. These resulted in disruptions in healthcare provision, and movement of people and supply chains. There have been resultant delays in seeking and accessing healthcare by the patients. Additionally, disruption of essential health services in the areas of maternal and child health, sexual and reproductive health services, care for chronic conditions and access to oncological and other specialist services has occurred. Thus, there may be avoidable excess morbidity and mortality from non-COVID-19 causes that is not justifiable by the current local COVID-19 burden. Measures to restore normalcy to essential health services provision as guided by the World Health Organisation and other bodies needs to be considered and implemented urgently, to avoid preventable loss of life and excess morbidity. Adequate infection prevention and control measures must be put in place to ensure continuity of essential services whilst protecting healthcare workers and patients from contracting COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud , Pandemias , Neumonía Viral/epidemiología , Enfermedad Crónica/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Continuidad de la Atención al Paciente , Infecciones por Coronavirus/prevención & control , Guías como Asunto , Recursos en Salud/provisión & distribución , Accesibilidad a los Servicios de Salud , Humanos , Pacientes no Asegurados , Medicina , Modelos Teóricos , Mortalidad , Neoplasias/terapia , Pandemias/prevención & control , Aceptación de la Atención de Salud , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/prevención & control , Servicios de Salud Reproductiva/provisión & distribución , Organización Mundial de la Salud , Zimbabwe/epidemiología
5.
Int J Med Sci ; 17(18): 2974-2986, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33173418

RESUMEN

In the ongoing COVID-19 pandemic, all COVID-19 patients are naïve patients as it is the first-time humans have been exposed to the SARS-CoV-2 virus. As with exposure to many viruses, individuals with pre-existing, compromised immune systems may be at increased risk of developing severe symptoms and/or dying because of (SARS-CoV-2) infection. To learn more about such individuals, we conducted a search and review of published reports on the clinical characteristics and outcomes of COVID-19 patients with pre-existing, compromised immune systems. Here we present our review of patients who possess pre-existing primary antibody deficiency (PAD) and those who are organ transplant recipients on maintenance immunosuppressants. Our review indicates different clinical outcomes for the patients with pre-existing PAD, depending on the underlying causes. For organ transplant recipients, drug-induced immune suppression alone does not appear to enhance COVID-19 mortality risk - rather, advanced age, comorbidities, and the development of secondary complications appears required.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Enfermedades del Sistema Inmune/complicaciones , Enfermedades del Sistema Inmune/diagnóstico , Huésped Inmunocomprometido , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Betacoronavirus/inmunología , Betacoronavirus/fisiología , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Humanos , Huésped Inmunocomprometido/inmunología , Inmunosupresores/uso terapéutico , Mortalidad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Enfermedades de Inmunodeficiencia Primaria/complicaciones , Enfermedades de Inmunodeficiencia Primaria/diagnóstico , Enfermedades de Inmunodeficiencia Primaria/inmunología , Enfermedades de Inmunodeficiencia Primaria/mortalidad , Pronóstico , Receptores de Trasplantes/estadística & datos numéricos
6.
Trials ; 21(1): 919, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176850

RESUMEN

OBJECTIVES: Assessing the effect of surfactant on clinical outcome in patients with COVID-19 under mechanical ventilation TRIAL DESIGN: Single centre, two arm, parallel group (1:1 allocation ratio), randomised superiority trial with blinded care and outcome assessment. PARTICIPANTS: Inclusion criteria: Adult COVID-19 patients admitted to the ICU in Modarres hospital, Tehran, Iran (age range of 18 to 99 years) with moderate to severe ARDS (based on definition of P/F ratio) requiring auxiliary respiratory devices (either intubation or face mask). EXCLUSION CRITERIA: ● Existence of a major underlying pulmonary disease in addition to COVID-19 ● Underlying congenital heart disease ● Patients needing extracorporeal membrane oxygenation (ECMO) ● ARDS primarily due to any other reason rather than COVID-19 ● The primary source of pulmonary involvement was bacterial pneumonia or any other etiology except for COVID-10 induced lung involvement ● Those who refused to continue the study (either the patient or their family) ● any patient had any sign of healing before entering the study leading to discharge from ICU in less than 12 hours INTERVENTION AND COMPARATOR: In the intervention group, the dose of the drug is a vial containing 4 ml, equivalent to 100 mg, which is prescribed for an adult weighing about 70 kg each time, and if the patient's weight is much lower or higher, it will be adjusted accordingly. Surfactant is prescribed inside the trachea in two doses, starting on the day of intubation with a second dose 6 hours later. The control group will receive the same volume of normal saline, based on weight, administered into the trachea with the same time schedule. MAIN OUTCOMES: 30 days mortality; patient mortality during stay in ICU up to 30 days; ICU length of stay up to 30 days; Time under mechanical ventilation up to 30 days. RANDOMISATION: After the participant enters the study, i.e. after the qualification of the patients in the trial is confirmed and their informed written consent is taken, we will use a simple randomisation method using a table of random numbers. In order to hide the random allocation process, a central randomisation approach will be used and the random sequence will be at the disposal of one of the researchers, excluding the principal investigator. BLINDING (MASKING): Participants, healthcare providers and the principal investigator assessing the outcomes will all be blinded to the group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 60 participants will be randomised in a 1:1 allocation ratio (30 patients allocated to the intervention group and 30 patients allocated to the control group). TRIAL STATUS: The protocol is Version 1.0, May 31, 2020. Recruitment began July 30, 2020, and is anticipated to be completed by October 30, 2020. TRIAL REGISTRATION: IRCT registration number: IRCT20091201002804N12 Registration date: 1st June 2020, 1399/03/12 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Surfactantes Pulmonares , Respiración Artificial/métodos , Adulto , Betacoronavirus , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Cálculo de Dosificación de Drogas , Monitoreo de Drogas/métodos , Femenino , Humanos , Masculino , Mortalidad , Pandemias , Surfactantes Pulmonares/administración & dosificación , Surfactantes Pulmonares/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Tensoactivos/administración & dosificación , Tensoactivos/efectos adversos , Resultado del Tratamiento
8.
Artículo en Ruso | MEDLINE | ID: mdl-33161659

RESUMEN

The article analyzes the demographic situation in the Republic of Dagestan and presents analysis of indices of population mortality and life expectancy. It is established that number of deaths per 1000 people of the Republic of Dagestan is one of the lowest not only in the Northern Caucasus, but in the country at large. At the same time, high mortality indices are determined in elder age groups both in Dagestan and on average in Russia. The main causes of death in the Republic of Dagestan are diseases of circulatory system and respiratory system, neoplasms, accidents, poisoning and traumas, which account almost three quarters of all cases of deaths. However, mortality indices in Dagestan from diseases of circulatory system, neoplasms, digestive system diseases, infectious and parasitic diseases are significantly lower as compared to the national average level. In Dagestan, one of the highest indices of life expectancy is observed as compared with other subjects of the Russian Federation (2nd place in the Russian Federation) - on 6 years exceeding the national average level (in males, difference in values ​​of indicator amounted to 7.5 years). In Dagestan, during analyzed period, life expectancy at birth increased more than on 5 years.


Asunto(s)
Enfermedades Transmisibles , Neoplasias , Adulto , Anciano , Daguestán , Humanos , Esperanza de Vida , Masculino , Mortalidad , Federación de Rusia/epidemiología
9.
Ig Sanita Pubbl ; 76(3): 187-197, 2020.
Artículo en Italiano | MEDLINE | ID: mdl-33142310

RESUMEN

INTRODUCTION: in Italy and Tuscany the resident population aged> 99 reached its all-time high in 2015. Respiratory diseases in men and ischemic heart diseases in women were the leading causes of death for Italian centenarians in 2015. The aim of this study is to describe the mortality of Tuscan centenarians by cause. MATERIALS AND METHODS: population-based observational study using current health data, extracted from the Tuscan Regional Mortality Register. Main outcome measures are: proportional mortality and annual mortality trend at age >99, age-specific mortality rates (85-89; 90-94; 95-99, >99). RESULTS: at age >99 ischemic heart diseases, cerebrovascular diseases and respiratory diseases are among the top 5 causes of death as in the less elderly age, the relative frequency of tumors decreases and that of the ill-defined causes increases. If ill-defined and ischemic heart diseases are separated, the first cause of death is cerebrovascular diseases in males and senility in females. In the period 2002-2015 at age >99 all-cause mortality fell on average every year by -0.15% for males and -0.14% for females, mortality due to arteriosclerosis decreases -10% (males) and -12% (females) every year, due to cardiac arrest and other non-specific cardiopathies -5% (males) and -7% (females) and due to cerebrovascular diseases -3% (females). Mortality due to senility increases +6% per year in women. CONCLUSIONS: in Tuscany the first cause of death is different by gender (cerebrovascular diseases in males and senility in females) and differs from what has been observed nationally. In the 2000s, mortality from cardiovascular diseases without diagnostic significance decreased in Tuscan centenarians and that from senility increased.


Asunto(s)
Enfermedad de Alzheimer/mortalidad , Enfermedades Cardiovasculares/mortalidad , Mortalidad/tendencias , Neoplasias/mortalidad , Anciano de 80 o más Años , Causas de Muerte , Femenino , Humanos , Italia/epidemiología , Masculino
10.
BMJ Open ; 10(11): e043560, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33148769

RESUMEN

OBJECTIVE: To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally. DESIGN: Publicly available register-based ecological study. SETTING: Two hundred and nine countries/territories in the world. PARTICIPANTS: Aggregated data including 10 445 656 confirmed COVID-19 cases. PRIMARY AND SECONDARY OUTCOME MEASURES: COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website. RESULTS: The average of country/territory-specific COVID-19 CFR is about 2%-3% worldwide and higher than previously reported at 0.7%-1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The strictness of anti-COVID-19 measures was not statistically significantly associated with CFR overall, but the higher Stringency Index was associated with higher CFR in higher-income countries with active testing policies (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR. CONCLUSION: The association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the income level of a country. When testing is warranted and healthcare resources are sufficient, strict quarantine and/or lockdown measures might result in excess deaths in underprivileged populations. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Control de Enfermedades Transmisibles/estadística & datos numéricos , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Producto Interno Bruto/estadística & datos numéricos , Neumonía Viral/mortalidad , Densidad de Población , Regresión Espacial , Distribución por Edad , Betacoronavirus , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Política de Salud , Indicadores de Salud , Humanos , Esperanza de Vida , Mortalidad , Pandemias , Prevalencia , Fumar/epidemiología , Análisis Espacial
11.
ESMO Open ; 5(Suppl 3)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33158968

RESUMEN

BACKGROUND: In the midst of the COVID-19 pandemic, patients with cancer are regarded as a highly vulnerable population. Overall, those requiring hospital admission for treatment administration are potentially exposed to a higher risk of infection and worse outcome given the multiple in-hospital exposures and the treatment immunosuppressive effects. METHODS: COVINT is an observational study assessing COVID-19 incidence among patients receiving anticancer treatment in the outpatient clinic of the Istituto Nazionale dei Tumori di Milano. All consecutive patients with non-haematological malignancies treated with intravenous or subcutaneous/intramuscular anticancer therapy in the outpatient clinic were enrolled. The primary endpoint is the rate of occurrence of COVID-19. Secondary endpoints included the rate of COVID-19-related deaths and treatment interruptions. The association between clinical and biological characteristics and COVID-19 occurrence is also evaluated. COVID-19 diagnosis is defined as (1) certain if confirmed by reverse transcriptase PCR assay of nasopharyngeal swabs (NPS); (2) suspected in case of new symptoms or CT scan evidence of interstitial pneumonia with negative/not performed NPS; (3) negative in case of neither symptoms nor radiological evidence. RESULTS: In the first 2 months (16 February-10 April 2020) of observation, 1081 patients were included. Of these, 11 (1%) were confirmed and 73 (6.7%) suspected for COVID-19. No significant differences in terms of cancer and treatment type emerged between the three subgroups. Prophylactic use of myeloid growth factors was adopted in 5.3%, 2.7% and 0% of COVID-19-free, COVID-19-suspected and COVID-19-confirmed patients (p=0.003). Overall, 96 (8.9%) patients delayed treatment as a precaution for the pandemic. Among the 11 confirmed cases, 6 (55%) died of COVID-19 complications, and anticancer treatment was restarted in only one. CONCLUSIONS: During the pandemic peak, accurate protective measures successfully resulted in low rates of COVID-19 diagnosis, although with high lethality. Prospective patients' surveillance will continue with NPS and serology testing to provide a more comprehensive epidemiological picture, a biological insight on the impact of cytotoxic treatments on the immune response, and to protect patients and healthcare workers.


Asunto(s)
Antineoplásicos/uso terapéutico , Infecciones por Coronavirus/epidemiología , Neoplasias/tratamiento farmacológico , Neumonía Viral/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Betacoronavirus , Instituciones Oncológicas , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Estadificación de Neoplasias , Neoplasias/epidemiología , Neoplasias/patología , Pandemias , Neumonía Viral/mortalidad , Tiempo de Tratamiento , Adulto Joven
12.
Sci Rep ; 10(1): 18909, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33144595

RESUMEN

While the epidemic of SARS-CoV-2 has spread worldwide, there is much concern over the mortality rate that the infection induces. Available data suggest that COVID-19 case fatality rate had varied temporally (as the epidemic has progressed) and spatially (among countries). Here, we attempted to identify key factors possibly explaining the variability in case fatality rate across countries. We used data on the temporal trajectory of case fatality rate provided by the European Center for Disease Prevention and Control, and country-specific data on different metrics describing the incidence of known comorbidity factors associated with an increased risk of COVID-19 mortality at the individual level. We also compiled data on demography, economy and political regimes for each country. We found that temporal trajectories of case fatality rate greatly vary among countries. We found several factors associated with temporal changes in case fatality rate both among variables describing comorbidity risk and demographic, economic and political variables. In particular, countries with the highest values of DALYs lost to cardiovascular, cancer and chronic respiratory diseases had the highest values of COVID-19 CFR. CFR was also positively associated with the death rate due to smoking in people over 70 years. Interestingly, CFR was negatively associated with share of death due to lower respiratory infections. Among the demographic, economic and political variables, CFR was positively associated with share of the population over 70, GDP per capita, and level of democracy, while it was negatively associated with number of hospital beds ×1000. Overall, these results emphasize the role of comorbidity and socio-economic factors as possible drivers of COVID-19 case fatality rate at the population level.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Canadá , Infecciones por Coronavirus/epidemiología , Interpretación Estadística de Datos , Demografía/estadística & datos numéricos , Europa (Continente) , Humanos , Mortalidad/tendencias , Pandemias , Neumonía Viral/epidemiología , Sistemas Políticos/estadística & datos numéricos , Factores Socioeconómicos , Estados Unidos
14.
Washington, D.C.; PAHO; 2020-11-17.
en Inglés | PAHO-IRIS | ID: phr-53026

RESUMEN

Tuberculosis is one of the ten leading causes of death worldwide, and still represents a major public health problem in the Region of the Americas. The Region has made great strides in TB prevention and control; nevertheless, at the current rate of decline in the number of TB deaths and incidence of TB, the proposed targets and milestones needed to end TB will not be achieved. Countries must thus ramp up their efforts to meet these targets. Tuberculosis in the Americas: Regional Report presents the situation of tuberculosis in the Region, as well as the progress made by countries in the prevention, diagnosis, treatment, and elimination of TB under the framework of the End TB Strategy, the Sustainable Development Goals, and the commitments made at the high-level TB meeting of the United Nations General Assembly in 2018. Epidemiological analyses and programmatic data provide an overview of the TB situation in the Region, with emphasis on case detection, preventive treatment, treatment outcomes, drug-resistant TB, TB/HIV co-infection, and vulnerable groups, among other aspects. An analysis of TB funding in the Region is also included. The authors hope that this report will facilitate understanding of the situation of TB in the Region and serve as an example for similar country-level analyses, with a view to promoting better decision-making and ending TB.


Asunto(s)
Tuberculosis , Desarrollo Sostenible , Mortalidad , Salud Pública , Américas
15.
Artículo en Inglés | PAHO-IRIS | ID: phr-53009

RESUMEN

[ABSTRACT]. Objective. To examine the impact of four ambient air pollutants on the COVID-19 mortality rate in the United States of America. Methods. Using publicly accessible data collected by the United States Census Bureau, Environmental Protection Agency, and other agencies, county-level mortality rates were regressed on concentration values of ground-level ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide. Four confounder variables were included in the regression analysis: median household income, rate of hospital beds, population density, and days since first confirmed case. Results. Regression analysis showed that ground-level ozone is positively correlated with county-level mortality rates regardless of whether confounders are controlled for. Nitrogen dioxide is also shown to have a direct relationship with county-level mortality rates, except when all confounders are included in the analysis. Conclusions. High ground-level ozone and nitrogen dioxide concentrations contribute to a greater COVID-19 mortality rate. To limit further losses, it is important to reflect research findings in public policies. In the case of air pollution, environmental restrictions should be reinforced, and extra precautions should be taken as facilities start reopening.


[ABSTRACT]. Objective. To examine the impact of four ambient air pollutants on the COVID-19 mortality rate in the United States of America. Methods. Using publicly accessible data collected by the United States Census Bureau, Environmental Protection Agency, and other agencies, county-level mortality rates were regressed on concentration values of ground-level ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide. Four confounder variables were included in the regression analysis: median household income, rate of hospital beds, population density, and days since first confirmed case. Results. Regression analysis showed that ground-level ozone is positively correlated with county-level mortality rates regardless of whether confounders are controlled for. Nitrogen dioxide is also shown to have a direct relationship with county-level mortality rates, except when all confounders are included in the analysis. Conclusions. High ground-level ozone and nitrogen dioxide concentrations contribute to a greater COVID-19 mortality rate. To limit further losses, it is important to reflect research findings in public policies. In the case of air pollution, environmental restrictions should be reinforced, and extra precautions should be taken as facilities start reopening.


Asunto(s)
Infecciones por Coronavirus , Contaminación del Aire , Mortalidad , Ozono , Dióxido de Nitrógeno , Estados Unidos , Infecciones por Coronavirus , Contaminación del Aire , Mortalidad , Ozono , Dióxido de Nitrógeno , Estados Unidos , Infecciones por Coronavirus
17.
World J Gastroenterol ; 26(39): 6087-6097, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33132657

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. Most critically ill patients have organ injury, including acute respiratory distress syndrome, acute kidney injury, cardiac injury, or liver dysfunction. However, few studies on acute gastrointestinal injury (AGI) have been reported in critically ill patients with COVID-19. AIM: To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19. METHODS: In this retrospective study, demographic data, laboratory parameters, AGI grades, clinical severity and outcomes were collected. The primary endpoints were AGI incidence and 28-d mortality. RESULTS: From February 10 to March 10 2020, 83 critically ill patients out of 1314 patients with COVID-19 were enrolled. Seventy-two (86.7%) patients had AGI during hospital stay, of these patients, 30 had AGI grade I, 35 had AGI grade II, 5 had AGI grade III, and 2 had AGI grade IV. The incidence of AGI grade II and above was 50.6%. Forty (48.2%) patients died within 28 days of admission. Multiple organ dysfunction syndrome developed in 58 (69.9%) patients, and septic shock in 16 (19.3%) patients. Patients with worse AGI grades had worse clinical variables, a higher incidence of septic shock and 28-d mortality. Sequential organ failure assessment (SOFA) scores (95%CI: 1.374-2.860; P < 0.001), white blood cell (WBC) counts (95%CI: 1.037-1.379; P = 0.014), and duration of mechanical ventilation (MV) (95%CI: 1.020-1.340; P = 0.025) were risk factors for the development of AGI grade II and above. CONCLUSION: The incidence of AGI was 86.7%, and hospital mortality was 48.2% in critically ill patients with COVID-19. SOFA scores, WBC counts, and duration of MV were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Enfermedades Gastrointestinales/fisiopatología , Mortalidad Hospitalaria , Neumonía Viral/fisiopatología , Lesión Renal Aguda/epidemiología , Anciano , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Incidencia , Recuento de Leucocitos , Hepatopatías/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Insuficiencia Multiorgánica/epidemiología , Puntuaciones en la Disfunción de Órganos , Pandemias , Neumonía Viral/epidemiología , Prevalencia , Respiración Artificial/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Choque Séptico/epidemiología
19.
Trials ; 21(1): 880, 2020 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-33106183

RESUMEN

OBJECTIVES: We will investigate the effectiveness of high dose Interferon Beta 1a, compared to low dose Interferon Beta 1a (the base therapeutic regimen) in COVID-19 Confirmed Cases (Either RT-PCR or CT Scan Confirmed) with moderate to severe disease TRIAL DESIGN: This is a single center, open label, randomized, controlled, 2-arm parallel group (1:1 ratio), clinical trial. PARTICIPANTS: The eligibility criteria in this study is: age ≥ 18 years, oxygen saturation (SPO2) ≤ 93% or respiratory rate ≥ 24, at least one of the following manifestation: radiation contactless body temperature ≥37.8, Cough, shortness of breath, nasal congestion/ discharge, myalgia/arthralgia, diarrhea/vomiting, headache or fatigue on admission. The onset of the symptoms should be acute (≤ 14 days). The exclusion criteria include refusal to participate, using drugs with potential interaction with lopinavir/ritonavir or interferon-ß 1a, blood ALT/AST levels > 5 times the upper limit of normal on laboratory results, pregnant or lactating women, history of alcohol or drug addiction in the past 5 years, the patients who be intubated less than one hours after admission to hospital. This study will be undertaken at the Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences. INTERVENTION AND COMPARATOR: COVID- 19 confirmed patients (using the RT-PCR test or CT scan) will be randomly assigned to one of two groups. The intervention group (Arms1) will be treated with lopinavir / ritonavir (Kaletra) + high dose Interferon-ß 1a (Recigen) and the control group will be treated with lopinavir / ritonavir (Kaletra) + low dose Interferon-ß 1a (Recigen) (the base therapeutic regimen). Both groups will receive standard care consisting of the necessary oxygen support, non-invasive, or invasive mechanical ventilation. MAIN OUTCOMES: Primary outcome: Time to clinical improvement is our primary outcome measure. This is an improvement of two points on a seven-category ordinal scale (recommended by the World Health Organization: Coronavirus disease (COVID-2019) R&D. Geneva: World Health Organization) or discharge from the hospital, whichever comes first. SECONDARY OUTCOMES: mortality from the date of randomization until the last day of the study which will be the day all of the patients have had at least one of the following outcomes: 1) Improvement of two points on a seven-category ordinal scale. 2) Discharge from the hospital 3) Death. Improvement of SPO2 during the hospitalization, duration of hospitalization from date of randomization until the date of hospital discharge or death, whichever comes first. The incidence of new mechanical ventilation uses from the date of randomization until the last day of the study and the duration of it will be extracted. Please note that we are trying to add further secondary outcomes and this section of the protocol is still evolving. RANDOMIZATION: Eligible patients with confirmed SARS-Cov-2 infections will be randomly assigned in a 1:1 ratio to two therapeutic arms using permuted, block-randomization to balance the number of patients allocated to each group. The permuted block (three or six patients per block) randomization sequence will be generated, using Package 'randomizeR' in R software version 3.6.1. and placed in individual sealed and opaque envelopes by the statistician. The investigator will enroll the patients and only then open envelopes to assign patients to the different treatment groups. This method of allocation concealment will result in minimum selection and confounding biases. BLINDING (MASKING): The present research is open-label (no masking) of patients and health care professionals who are undertaking outcome assessment of the primary outcome - time to clinical improvement. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Of the 100 patients randomised, 50 patients will be assigned to receive high dose Interferon beta-1a plus lopinavir/ritonavir (Kaletra), 50 patients will be assigned to receive low dose Interferon beta 1a plus lopinavir/ritonavir (Kaletra). TRIAL STATUS: Protocol version 1.2.1. Recruitment is finished, the start date of recruitment was on August 20th 2020, and the end date was on September 4th 2020. Last point of data collection will be the last day on which all of the 100 participants have had an outcome of clinical improvement or death, up to 14th days after hospitalization. TRIAL REGISTRATION: This study was registered with National Institutes of Health Clinical trials ( www.clinicaltrials.gov ; identification number NCT04521400, https://clinicaltrials.gov/ct2/show/NCT04521400 , registered August 18, 2020 and first available online August 20, 2020). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Interferón beta-1a/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Adulto , Antivirales/administración & dosificación , Estudios de Casos y Controles , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Humanos , Interferón beta-1a/administración & dosificación , Lopinavir/administración & dosificación , Lopinavir/uso terapéutico , Mortalidad/tendencias , Evaluación de Resultado en la Atención de Salud , Pandemias , Alta del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/virología , Respiración Artificial/estadística & datos numéricos , Ritonavir/administración & dosificación , Ritonavir/uso terapéutico
20.
Soc Sci Med ; 263: 113386, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33036797

RESUMEN

This study investigates associations between central aspects of social capital (social trust, group affiliations, civic engagement, confidence in state institutions), income inequality (Gini index for income), and COVID-19 mortality in 84 countries included in different time waves of the World Values Survey (WVS) (Elgar et al., 2020). Comments: First, infectious diseases are either patterned according to socioeconomic status (SES), determined by e.g. habitus, nutrition and crowded housing or clustering, or not according to SES. Second, the focus on economic inequality measured as income inequality (Gini index) should be complemented with measures of wealth inequality (Gini index for wealth), following the globalization process with tax exempted multinational companies. Third, the aspects of social capital were measured in different time waves of the World Values Survey (WVS) for different countries, which is a weakness because trust and other aspects of social capital vary over time and depend on specific events and social and economic trends.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Capital Social , Betacoronavirus , Humanos , Mortalidad , Factores Socioeconómicos
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