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1.
Infectio ; 25(4): 262-269, oct.-dic. 2021. tab, graf
Artículo en Inglés | LILACS, COLNAL | ID: biblio-1286720

RESUMEN

Abstract Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions. Materials and methods: Is a retrospective observational study of consecutive hospitalized patients with a diagnosis of COVID-19 confirmed from March 01 to May 30, 2020 in Colombia. Results: A total of 44 patients were included. The median age was 62 years. 43.2% had a history of smoking, while 69.8% were overweight or obese. 88.6% had at least one comorbidity and 52.3% had three or more comorbidities. Hypertension and dyslipidaemia were the most frequent comorbidities (40.9% and 34.1%, respectively). The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome occurred in the 36.4%. The biomarkers associated with mor tality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Conclusions: The clinical course of SARS-CoV-2 infection in hospitalized Colombian was characterised by a more advanced stage of the infection.


Resumen Objetivo: Analizar las características, clínicas, factores de riesgo, y la evolución de pacientes hospitalizados con infección confirmada por COVID-19 en 5 Institu ciones de Colombia. Material y método: Es un estudio observacional retrospectivo de pacientes consecutivos hospitalizados con diagnóstico de COVID-19 confirmado entre 01 de Febrero de 2020 y 30 de Mayo de 2020 en Colombia. Resultados: Un total de 44 pacientes fueron incluidos. La mediana de edad fue de 62 años y la mayoría del sexo masculino. El 43.2% tenían historia de tabaquismo, mientras que el 69.8% tenían sobrepeso u obesidad. El 88.6% tenían al menos una comorbilidad y el 52.3% tenían tres o más comorbilidades. La hipertensión arterial fue la comorbilidad más frecuente (40.9%), seguido de la dislipidemia (34.1%). La tasa de letalidad a 30 días fue de 47.7% y ocurrió con una mediana de 11 días. El 36.4% presentó el desenlace compuesto. Los biomarcadores asociados con el riesgo de muerte fue troponina > 14 ng/mL (RR:5.25, IC95% 1.37-20.1, p=0.004) y dímero D mayor a 1000 mg/dL (RR: 3.0, IC95% 1.4-6.3, p=0.008). Conclusiones: El curso clínico de la infección por SARS-CoV-2 en colombianos hospitalizados fue un estadio más avanzado de la infección.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Biomarcadores , COVID-19 , Pacientes , Tabaquismo , Comorbilidad , Riesgo , Factores de Riesgo , Mortalidad , Colombia , Sobrepeso , Cursos , Infecciones , Obesidad
3.
Sci Rep ; 11(1): 21888, 2021 11 08.
Artículo en Inglés | MEDLINE | ID: mdl-34750495

RESUMEN

Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of D-dimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PROSPERO, CRD42020186661.We included 113 studies in our systematic review, of which 100 records (n = 38,310) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15; adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of D-dimer for predicting adverse outcomes in COVID-19.


Asunto(s)
COVID-19/diagnóstico , COVID-19/inmunología , Productos de Degradación de Fibrina-Fibrinógeno/química , Adulto , Anciano , Área Bajo la Curva , Biomarcadores/sangre , COVID-19/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pronóstico , Modelos de Riesgos Proporcionales , Respiración Artificial , Riesgo , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Trombofilia/sangre
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(10): 1855-1862, 2021 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-34814624

RESUMEN

Objective: To systematically summarize and assess risk prediction models for occurrence of cervical cancer and to provide evidence for selecting the most reliable model for practice, and guide cervical cancer screening. Methods: Two groups of keywords related to cervical cancer and risk prediction model were searched on Chinese databases (CNKI, and Wanfang) and English databases (PubMed, Embase, and Cochrane Library). Original articles that developed or validated risk prediction models and published before November 21, 2019, were selected. Information form was created based on the CHARMS checklist. The PROBAST was used to assess the risk of bias. Results: 12 eligible articles were identified, describing 15 prediction models, of which five were established in China. The predicted outcomes included multiple stages from cervical precancerous lesions to cancer occurrence, i.e., abnormal Pap smear (1), occurrence or recurrence of CIN (9), and occurrence of cervical cancer (5), etc. The most frequently used predictors were HPV infection (12), age (7), smoking (5), and education (5). There were two models using machine learning to develop models. In terms of model performance, the discrimination ranged from 0.53 to 0.87, while only two models assessed the calibration correctly. Only two models were externally validated in Taiwan of China, using people in different periods. All of the models were at high risk of bias, especially in the analysis domain. The problems were concentrated in the improper handling of missing data (13), preliminary evaluation of model performance (13), improper use of internal validation (12), and insufficient sample size (11). In addition, the problems of inconsistency measurements of predictors and outcomes (8) and the flawed report of the use of blindness for outcome measures (8) were also severe. Compared with the other models, the Rothberg (2018) model had relatively high quality. Conclusions: There are a certain number of cervical cancer risk prediction models, but the quality is poor. It is urgent to improve the measurement of predictors and outcomes, the statistical analysis details such as handling missing data and evaluation of model performance and externally validate existing models to better guide screening.


Asunto(s)
Neoplasias del Cuello Uterino , Sesgo , Detección Precoz del Cáncer , Femenino , Humanos , Pronóstico , Riesgo , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología
5.
Front Immunol ; 12: 740260, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34745111

RESUMEN

Increased left ventricular fibrosis has been reported in patients hospitalized with coronavirus disease 2019 (COVID-19). It is unclear whether this fibrosis is a consequence of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection or a risk factor for severe disease progression. We observed increased fibrosis in the left ventricular myocardium of deceased COVID-19 patients, compared with matched controls. We also detected increased mRNA levels of soluble interleukin-1 receptor-like 1 (sIL1-RL1) and transforming growth factor ß1 (TGF-ß1) in the left ventricular myocardium of deceased COVID-19 patients. Biochemical analysis of blood sampled from patients admitted to the emergency department (ED) with COVID-19 revealed highly elevated levels of TGF-ß1 mRNA in these patients compared to controls. Left ventricular strain measured by echocardiography as a marker of pre-existing cardiac fibrosis correlated strongly with blood TGF-ß1 mRNA levels and predicted disease severity in COVID-19 patients. In the left ventricular myocardium and lungs of COVID-19 patients, we found increased neuropilin-1 (NRP-1) RNA levels, which correlated strongly with the prevalence of pulmonary SARS-CoV-2 nucleocapsid. Cardiac and pulmonary fibrosis may therefore predispose these patients to increased cellular viral entry in the lung, which may explain the worse clinical outcome observed in our cohort. Our study demonstrates that patients at risk of clinical deterioration can be identified early by echocardiographic strain analysis and quantification of blood TGF-ß1 mRNA performed at the time of first medical contact.


Asunto(s)
COVID-19/fisiopatología , Ventrículos Cardíacos/patología , Miocardio/patología , Fibrosis Pulmonar/fisiopatología , SARS-CoV-2/fisiología , Adulto , Anciano , COVID-19/inmunología , Femenino , Fibrosis , Ventrículos Cardíacos/metabolismo , Humanos , Proteína 1 Similar al Receptor de Interleucina-1/genética , Proteína 1 Similar al Receptor de Interleucina-1/metabolismo , Masculino , Persona de Mediana Edad , Miocardio/metabolismo , Neuropilina-1/genética , Neuropilina-1/metabolismo , Fibrosis Pulmonar/inmunología , Riesgo , Índice de Severidad de la Enfermedad , Factor de Crecimiento Transformador beta1/genética , Factor de Crecimiento Transformador beta1/metabolismo , Carga Viral
6.
JAMA Netw Open ; 4(11): e2133090, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34779847

RESUMEN

Importance: Antidepressant use may be associated with reduced levels of several proinflammatory cytokines suggested to be involved with the development of severe COVID-19. An association between the use of selective serotonin reuptake inhibitors (SSRIs)-specifically fluoxetine hydrochloride and fluvoxamine maleate-with decreased mortality among patients with COVID-19 has been reported in recent studies; however, these studies had limited power due to their small size. Objective: To investigate the association of SSRIs with outcomes in patients with COVID-19 by analyzing electronic health records (EHRs). Design, Setting, and Participants: This retrospective cohort study used propensity score matching by demographic characteristics, comorbidities, and medication indication to compare SSRI-treated patients with matched control patients not treated with SSRIs within a large EHR database representing a diverse population of 83 584 patients diagnosed with COVID-19 from January to September 2020 and with a duration of follow-up of as long as 8 months in 87 health care centers across the US. Exposures: Selective serotonin reuptake inhibitors and specifically (1) fluoxetine, (2) fluoxetine or fluvoxamine, and (3) other SSRIs (ie, not fluoxetine or fluvoxamine). Main Outcomes and Measures: Death. Results: A total of 3401 adult patients with COVID-19 prescribed SSRIs (2033 women [59.8%]; mean [SD] age, 63.8 [18.1] years) were identified, with 470 receiving fluoxetine only (280 women [59.6%]; mean [SD] age, 58.5 [18.1] years), 481 receiving fluoxetine or fluvoxamine (285 women [59.3%]; mean [SD] age, 58.7 [18.0] years), and 2898 receiving other SSRIs (1733 women [59.8%]; mean [SD] age, 64.7 [18.0] years) within a defined time frame. When compared with matched untreated control patients, relative risk (RR) of mortality was reduced among patients prescribed any SSRI (497 of 3401 [14.6%] vs 1130 of 6802 [16.6%]; RR, 0.92 [95% CI, 0.85-0.99]; adjusted P = .03); fluoxetine (46 of 470 [9.8%] vs 937 of 7050 [13.3%]; RR, 0.72 [95% CI, 0.54-0.97]; adjusted P = .03); and fluoxetine or fluvoxamine (48 of 481 [10.0%] vs 956 of 7215 [13.3%]; RR, 0.74 [95% CI, 0.55-0.99]; adjusted P = .04). The association between receiving any SSRI that is not fluoxetine or fluvoxamine and risk of death was not statistically significant (447 of 2898 [15.4%] vs 1474 of 8694 [17.0%]; RR, 0.92 [95% CI, 0.84-1.00]; adjusted P = .06). Conclusions and Relevance: These results support evidence that SSRIs may be associated with reduced severity of COVID-19 reflected in the reduced RR of mortality. Further research and randomized clinical trials are needed to elucidate the effect of SSRIs generally, or more specifically of fluoxetine and fluvoxamine, on the severity of COVID-19 outcomes.


Asunto(s)
Antidepresivos , COVID-19/mortalidad , Fluoxetina , Fluvoxamina , Inhibidores de la Captación de Serotonina , Índice de Severidad de la Enfermedad , Adulto , Anciano , Antidepresivos/farmacología , COVID-19/metabolismo , Citalopram/farmacología , Citocinas/metabolismo , Femenino , Fluoxetina/farmacología , Fluvoxamina/farmacología , Humanos , Masculino , Persona de Mediana Edad , Medicamentos bajo Prescripción , Estudios Retrospectivos , Riesgo , SARS-CoV-2 , Inhibidores de la Captación de Serotonina/farmacología , Sertralina , Estados Unidos
7.
Indian J Med Res ; 154(1): 62-77, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34782531

RESUMEN

Background &objectives: Women with gestational diabetes are at an increased risk of being diagnosed as type 2 diabetes, but the postpartum screening rate is low. To provide evidence-based data for health providers and promote postpartum screening, this systematic review and meta-analysis was conducted to access the risks of type 2 diabetes mellitus (T2DM) diagnosis after gestational diabetes mellitus (GDM) in different demographic and maternal subgroups. Methods: MEDLINE, Embase and Cochrane Library were searched systematically. Unadjusted relative risks (RRs) and 95 per cent confidence intervals (CIs) were calculated and pooled using a random-effects model. Heterogeneity was assessed with Cochrane's Q text and by calculating I2 values. Subgroup analyses were conducted to address the disparities of type 2 diabetes conversion after gestational diabetes in different demographic and maternal subgroups. Results: 1809 publications were screened and 39 cohort studies including 2,847,596 women were selected. In these studies, 78,893 women were diagnosed as T2DM at six weeks or later after delivery. The unadjusted RRs of women diagnosed T2DM at six weeks or later after delivery ranged from 1.32 (95% CI, 0.46-3.37) to 47.25 (95% CI, 2.95-758.01) with a pooled unadjusted RR of 8.92 (95% CI, 7.84-10.14). Older women, women with a family history of diabetes, Black and non-Hispanic White women and women living in Europe and South-East Asia had a higher risk of developing T2DM after GDM. Interpretation & conclusions: It is suggested that healthcare providers may focus on older women with GDM and women with GDM and a family history of diabetes. Black and non-Hispanic White women with GDM may receive more attention, and healthcare providers, especially those in Europe and South-East Asia, may pay more attention to preventive measures for postpartum T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Anciano , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etiología , Diabetes Gestacional/epidemiología , Femenino , Humanos , Tamizaje Masivo , Periodo Posparto , Embarazo , Riesgo
8.
PLoS One ; 16(11): e0259514, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34735523

RESUMEN

INTRODUCTION: Famotidine is a competitive histamine H2-receptor antagonist most commonly used for gastric acid suppression but thought to have potential efficacy in treating patients with Coronavirus disease 2019 (COVID-19). The aims of this systematic review and meta-analysis are to summarize the current literature and report clinical outcomes on the use of famotidine for treatment of hospitalized patients with COVID-19. METHODS: Five databases were searched through February 12, 2021 to identify observational studies that reported on associations of famotidine use with outcomes in COVID-19. Meta-analysis was conducted for composite primary clinical outcome (e.g. rate of death, intubation, or intensive care unit admissions) and death separately, where either aggregate odds ratio (OR) or hazard ratio (HR) was calculated. RESULTS: Four studies, reporting on 46,435 total patients and 3,110 patients treated with famotidine, were included in this meta-analysis. There was no significant association between famotidine use and composite outcomes in patients with COVID-19: HR 0.63 (95% CI: 0.35, 1.16). Across the three studies that reported mortality separated from other endpoints, there was no association between famotidine use during hospitalization and risk of death-HR 0.67 (95% CI: 0.26, 1.73) and OR 0.79 (95% CI: 0.19, 3.34). Heterogeneity ranged from 83.69% to 88.07%. CONCLUSION: Based on the existing observational studies, famotidine use is not associated with a reduced risk of mortality or combined outcome of mortality, intubation, and/or intensive care services in hospitalized individuals with COVID-19, though heterogeneity was high, and point estimates suggested a possible protective effect for the composite outcome that may not have been observed due to lack of power. Further randomized controlled trials (RCTs) may help determine the efficacy and safety of famotidine as a treatment for COVID-19 patients in various care settings of the disease.


Asunto(s)
COVID-19/tratamiento farmacológico , Famotidina/uso terapéutico , Hospitalización , Adulto , Anciano , Manejo de Datos , Femenino , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como Asunto , Riesgo , SARS-CoV-2
9.
PLoS One ; 16(11): e0258700, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34739484

RESUMEN

Protecting healthcare professionals is crucial in maintaining a functioning healthcare system. The risk of infection and optimal preventive strategies for healthcare workers during the COVID-19 pandemic remain poorly understood. Here we report the results of a cohort study that included pre- and asymptomatic healthcare workers. A weekly testing regime has been performed in this cohort since the beginning of the COVID-19 pandemic to identify infected healthcare workers. Based on these observations we have developed a mathematical model of SARS-CoV-2 transmission that integrates the sources of infection from inside and outside the hospital. The data were used to study how regular testing and a desynchronisation protocol are effective in preventing transmission of COVID-19 infection at work, and compared both strategies in terms of workforce availability and cost-effectiveness. We showed that case incidence among healthcare workers is higher than would be explained solely by community infection. Furthermore, while testing and desynchronisation protocols are both effective in preventing nosocomial transmission, regular testing maintains work productivity with implementation costs.


Asunto(s)
Infecciones Asintomáticas , Prueba de COVID-19/métodos , COVID-19/diagnóstico , COVID-19/economía , Personal de Salud , SARS-CoV-2 , Algoritmos , Análisis Costo-Beneficio , Infección Hospitalaria , Recolección de Datos , Atención a la Salud , Hospitales , Humanos , Tamizaje Masivo/métodos , Modelos Teóricos , Exposición Profesional , Pandemias , Riesgo , Procesos Estocásticos , Suiza/epidemiología
10.
PLoS One ; 16(11): e0259362, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34739509

RESUMEN

We analyze whether and to what extent strategies employed by governments to fight the COVID-19 pandemic made a difference for GDP growth developments in 2020. Based on the strength and speed with which governments imposed non-pharmaceutical interventions (NPIs) when confronted with waves of infections we distinguish between countries pursuing an elimination strategy and countries following a suppression / mitigation strategy. For a sample of 44 countries fixed effect panel regression results show that NPI changes conducted by elimination strategy countries had a less severe effect on GDP growth than NPI changes in suppression / mitigation strategy countries: strategy matters. However, this result is sensitive to the countries identified as "elimination countries" and to the sample composition. Moreover, we find that exogenous country characteristics drive the choice of strategy. At the same time our results show that countries successfully applying the elimination strategy achieved better health outcomes than their peers without having to accept lower growth.


Asunto(s)
COVID-19/epidemiología , COVID-19/prevención & control , Gobierno Federal , Gobierno , Humanos , Internacionalidad , Modelos Económicos , Pandemias , Distanciamiento Físico , Política Pública , Cuarentena , Análisis de Regresión , Riesgo , SARS-CoV-2
11.
PLoS One ; 16(10): e0258121, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34597332

RESUMEN

The COVID-19 global incidence rate among young adults (age 19-40) drastically increased since summer 2020, and young adults were often portrayed by popular media as the "main spreader" of the pandemic. However, young adults faced unique challenges during the pandemic due to working in high-risk, low-paying essential service occupations, as well as having higher levels of financial insecurity and mental burden. This qualitative study aims to examine the attitudes and perceptions of health orders of young adults to better inform public health messaging to reach this demographic and increase compliance to public health orders. A total of 50 young adults residing in British Columbia, Canada, were recruited to participate in focus group in groups of four to six. Focus group discussions were conducted via teleconferencing. Thematic analysis revealed four major themes: 1) risks of contracting the disease, 2) the perceived impact of COVID-19, 3) responsibility of institutions, 4) and effective public health messaging. Contrary to existing literature, our findings suggest young adults feel highly responsible for protecting themselves and others. They face a higher risk of depression and anxiety compared to other age groups, especially when they take on multiple social roles such as caregivers and parents. Our findings suggest young adults face confusion due to inconsistent messaging and are not reached due to the ineffectiveness of existing strategies. We recommend using evidence-based strategies proven to promote behaviour change to address the barriers identified by young adults through tailoring public health messages, specifically by using positive messaging, messaging that considers the context of the intended audiences, and utilizing digital platforms to facilitate two-way communication.


Asunto(s)
COVID-19/patología , Salud Pública , Adolescente , Adulto , COVID-19/epidemiología , COVID-19/virología , Comunicación , Femenino , Grupos Focales , Humanos , Masculino , Pandemias , Percepción , Riesgo , SARS-CoV-2/aislamiento & purificación , Medios de Comunicación Sociales , Encuestas y Cuestionarios , Adulto Joven
12.
PLoS One ; 16(10): e0258132, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34597334

RESUMEN

This confirmatory research investigates the influence of risk framing of COVID-19 on support for restrictive government policy based on two web survey experiments in Russia. Using 2x2 factorial design, we estimated two main effects-factors of risk severity (low vs. high) and object at risk (individual losses vs. losses to others). First, focusing on higher risks had a positive effect on support for the government's restrictive policy. Second, focusing on the losses for others did not produce stronger support for the restrictive policy compared to focusing on personal losses. However, we found a positive moderation effect of such prosocial values as universalism and benevolence. We found that those with prosocial values had a stronger positive effect in the "losses for others" condition and were more willing to support government restrictive policy when others were included. The effects found in our experimental study reveal both positive and negative aspects in risk communication during the pandemic, which may have a great and long-term impact on trust, attitudes, and behavior.


Asunto(s)
COVID-19/patología , Política de Salud , Apoyo Social , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/virología , Brotes de Enfermedades , Femenino , Gobierno , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Federación de Rusia/epidemiología , SARS-CoV-2/aislamiento & purificación , Encuestas y Cuestionarios , Adulto Joven
13.
Clin Appl Thromb Hemost ; 27: 10760296211039288, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34595937

RESUMEN

Coronavirus disease 2019 (COVID-19) is a systemic disease that can be life-threatening involving immune and inflammatory responses, and that can result in potentially lethal complications, including venous thrombo-embolism (VTE). Forming an integrative approach to thrombo-prophylaxis and coagulation treatment for COVID-19 patients ensues. We aim at reviewing the literature for anticoagulation in the setting of COVID-19 infection to provide a summary on anticoagulation for this patient population. COVID-19 infection is associated with a state of continuous inflammation, which results in macrophage activation syndrome and an increased rate of thrombosis. Risk assessment models to predict the risk of thrombosis in critically ill patients have not yet been validated. Currently published guidelines suggest the use of prophylactic intensity over intermediate intensity or therapeutic intensity anticoagulant for patients with critical illness or acute illness related to COVID-19 infection. Critically ill COVID-19 patients who are diagnosed with acute VTE are considered to have a provoking factor, and, therefore, treatment duration should be at least 3 months. Patients with proximal deep venous thrombosis or pulmonary embolism should receive parenteral over oral anticoagulants with low-molecular-weight heparin or fondaparinux preferred over unfractionated heparin. In patients with impending hemodynamic compromise due to PE, and who are not at increased risk for bleeding, reperfusion may be necessary. Internists should remain updated on new emerging evidence regarding anticoagulation for COVID-19 patients. Awaiting these findings, we invite internists to perform individualized decisions that are unique for every patient and to base them on clinical judgment for risk assessment.


Asunto(s)
Anticoagulantes/uso terapéutico , COVID-19/complicaciones , SARS-CoV-2 , Trombofilia/tratamiento farmacológico , Antiinflamatorios/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Consenso , Enfermedad Crítica , Manejo de la Enfermedad , Inhibidores del Factor Xa/administración & dosificación , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/uso terapéutico , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fondaparinux/efectos adversos , Fondaparinux/uso terapéutico , Hemorragia/inducido químicamente , Heparina/efectos adversos , Heparina/uso terapéutico , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Pacientes Internos , Masculino , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Hematológicas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/sangre , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Riesgo , Trombofilia/etiología , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & control
14.
PLoS One ; 16(10): e0258229, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34610052

RESUMEN

BACKGROUND/AIMS: We measured the association between underlying chronic hepatitis B (CHB) and antiviral use with infection rates among patients who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. METHODS: In total, 204,418 patients who were tested for SARS-CoV-2 between January and June 2020 were included. For each case patient (n = 7,723) with a positive SARS-CoV-2 test, random controls (n = 46,231) were selected from the target population who had been exposed to someone with coronavirus disease 2019 (COVID-19) but had a negative SARS-CoV-2 test result. We merged claim-based data from the Korean National Health Insurance Service database collected. Primary endpoints were SARS-CoV-2 infection and severe clinical outcomes of COVID-19. RESULTS: The proportion of underlying CHB was lower in COVID-19 positive patients (n = 267, 3.5%) than in COVID-19 negative controls (n = 2482, 5.4%). Underlying CHB was associated with a lower SARS-CoV-2 positivity rate, after adjusting for comorbidities (adjusted odds ratio [aOR] 0.65; 95% confidence interval [CI], 0.57-0.74). Among patients with confirmed COVID-19, underlying CHB tended to confer a 66% greater risk of severe clinical outcomes of COVID-19, although this value was statistically insignificant. Antiviral treatment including tenofovir and entecavir was associated with a reduced SARS-CoV-2 positivity rate (aOR 0.49; 95% CI, 0.37-0.66), while treatment was not associated with severe clinical outcomes of COVID-19. CONCLUSIONS: Underlying CHB and antiviral agents including tenofovir decreased susceptibility to SARS-CoV-2 infection. HBV coinfection did not increase the risk of disease severity or lead to a worse prognosis in COVID-19.


Asunto(s)
COVID-19/patología , Hepatitis B Crónica/patología , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/virología , Estudios de Casos y Controles , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Guanina/análogos & derivados , Guanina/uso terapéutico , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , República de Corea/epidemiología , Riesgo , Índice de Severidad de la Enfermedad , Tenofovir/uso terapéutico , Adulto Joven
15.
J Prim Health Care ; 13(2): 102-105, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34620289

RESUMEN

Vulnerability during the coronavirus disease 2019 (COVID-19) pandemic is an emotional state that affects all of us globally. The Italian experience shows that our general practitioners (GPs) seem to have a higher rate of death due to COVID-19 infection than other physicians.


Asunto(s)
COVID-19/psicología , Médicos Generales/psicología , Pandemias , COVID-19/epidemiología , Humanos , Italia/epidemiología , Exposición Profesional , Riesgo
16.
Artículo en Inglés | MEDLINE | ID: mdl-34639661

RESUMEN

Policy decisions about the accessibility of home birth hinge on questions of safety and affordability. Families consider safety and cost along with the comfort and familiarity of birthing venues. A substantial literature addresses safety concerns, generally reporting that for low-risk mothers in the care of credentialed midwives, the safety of planned home births is comparable to that in birth centers and hospitals. The lack of notable safety tradeoffs for low-risk mothers elevates the relevance of the economic efficiency of home births. The available cost figures for home births are largely out of date or anecdotal. The purpose of this research is to offer scholars, policymakers, and families improved estimates of both the cost of home births and the potential savings from greater access to home births. On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth. Further, we find that each shift of one percent of births from hospitals to homes would represent an annual cost savings to society of at least USD 321 million.


Asunto(s)
Centros de Asistencia al Embarazo y al Parto , Parto Domiciliario , Partería , Femenino , Humanos , Recién Nacido , Embarazo , Riesgo , Estados Unidos
17.
Gac Med Mex ; 157(3): 231-236, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34667311

RESUMEN

INTRODUCTION: The scarcity of person-centered applications aimed at developing awareness on the risk posed by the COVID-19 pandemic, stimulates the exploration and creation of preventive tools that are accessible to the population. OBJECTIVE: To develop a predictive model that allows evaluating the risk of mortality in the event of SARS-CoV-2 virus infection. METHODS: Exploration of public data from 16,000 COVID-19-positive patients to generate an efficient discriminant model, evaluated with a score function and expressed by a self-rated preventive interest questionnaire. RESULTS: A useful linear function was obtained with a discriminant capacity of 0.845; internal validation with bootstrap and external validation, with 25 % of tested patients showing marginal differences. CONCLUSION: The predictive model with statistical support, based on 15 accessible questions, can become a structured prevention tool.


Asunto(s)
COVID-19/prevención & control , Modelos Estadísticos , Adolescente , Adulto , Anciano , COVID-19/mortalidad , Niño , Preescolar , Análisis Discriminante , Femenino , Humanos , Lactante , Modelos Lineales , Masculino , Persona de Mediana Edad , Riesgo , Adulto Joven
18.
J Coll Physicians Surg Pak ; 31(10): 1244-1246, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34601853

RESUMEN

Longitudinal studies for determining the risk of anxiety and depression among COVID-19 survivor healthcare workers are lacking. This study aimed to determine the risk of anxiety and depression among healthcare workers that survived COVID-19 infection through a six-month post-recovery follow-up. This was a cohort study conducted at the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, from 1st March to 30th August 2020. A total of 64 subjects participated. Hospital Anxiety and Depression Scale (HADS) was used for assessing the anxiety and depression symptoms. HADS has three score cutoff as normal, borderline abnormal and, abnormal anxiety/depression. For the purpose of the study, borderline and above scores were taken as positive for anxiety/depression. Data was analysed using STATA Corp 15.1. There was no increased risk of anxiety or depression six months post-COVID-19 infection in the infected HCW, compared to uninfected HCW. It is recommended to conduct longitudinal studies with large sample and longer follow-up. Key Words: Relative risk, Anxiety, Depression, HADS, COVID-19, Healthcare workers.


Asunto(s)
COVID-19 , Depresión , Ansiedad/epidemiología , Estudios de Cohortes , Depresión/epidemiología , Femenino , Personal de Salud , Humanos , Pakistán/epidemiología , Proyectos Piloto , Embarazo , Riesgo , SARS-CoV-2 , Encuestas y Cuestionarios , Sobrevivientes , Centros de Atención Terciaria
19.
Front Immunol ; 12: 733418, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34603311

RESUMEN

Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and abnormal fatigability due to the antibodies against postsynaptic receptors. Despite the individual discrepancy, patients with MG share common muscle weakness, autoimmune dysfunction, and immunosuppressive treatment, which predispose them to infections that can trigger or exacerbate MG. Vaccination, as a mainstay of prophylaxis, is a major management strategy. However, the past years have seen growth in vaccine hesitancy, owing to safety and efficacy concerns. Ironically, vaccines, serving as an essential and effective means of defense, may induce similar immune cross-reactivity to what they are meant to prevent. Herein, we outline the progress in vaccination, review the current status, and postulate the clinical association among MG, vaccination, and immunosuppression. We also address safety and efficacy concerns of vaccination in MG, in relation to COVID-19. Since only a handful of studies have reported vaccination in individuals with MG, we further review the current clinical studies and guidelines in rheumatic diseases. Overall, our reviews offer a reference to guide future vaccine clinical decision-making and improve the management of MG patients.


Asunto(s)
Vacunas contra la COVID-19/efectos adversos , Vacunas contra la COVID-19/inmunología , COVID-19/prevención & control , Miastenia Gravis/inmunología , Miastenia Gravis/patología , SARS-CoV-2/inmunología , Autoinmunidad/inmunología , Humanos , Tolerancia Inmunológica/inmunología , Vacunas contra la Influenza/inmunología , Riesgo , Vacunación/efectos adversos
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