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1.
Eur Respir Rev ; 29(157)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33020069

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.


Assuntos
Comitês Consultivos/organização & administração , Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Cooperação Internacional , Pneumonia Viral/epidemiologia , Pneumologia/normas , Sociedades Médicas , Europa (Continente) , Humanos , Pandemias , Estados Unidos
3.
Ann Saudi Med ; 40(5): 365-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32954790

RESUMO

Evidence of cardiovascular complications associated with the COVID-19 global pandemic continues to evolve. These include direct and indirect myocardial injury with subsequent acute myocardial ischemia, and cardiac arrhythmia. Some results from a limited number of trials of antiviral medications, along with chloroquine/hydroxychloroquine and azithromycin, have been beneficial. However, these pharmacotherapies may cause drug-induced QT prolongation leading to ventricular arrhythmias and sudden cardiac death. Mitigation of the potential risk in these susceptible patients may prove exceptionally challenging. The Saudi Heart Rhythm Society established a task force to perform a review of this subject based on has recently published reports, and studies and recommendations from major medical organizations. The objective of this review is to identify high-risk patients, and to set clear guidelines for management of patients receiving these pharmacotherapies.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Comitês Consultivos , Antivirais/efeitos adversos , Arritmias Cardíacas/diagnóstico , Azitromicina/efeitos adversos , Betacoronavirus , Cloroquina/efeitos adversos , Inibidores do Citocromo P-450 CYP2D6/efeitos adversos , Combinação de Medicamentos , Interações Medicamentosas , Monitoramento de Medicamentos , Eletrocardiografia , Humanos , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/diagnóstico , Lopinavir/efeitos adversos , Pandemias , Medição de Risco , Ritonavir/efeitos adversos , Arábia Saudita , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/diagnóstico
5.
Am Surg ; 86(7): 757-761, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32916074

RESUMO

From the onset of the COVID-19 global pandemic of 2020, the American College of Surgeons (ACS) has been a leader in disseminating credible information on the clinical and scientific aspects of the disease. As governmental regulations enforced the closure of hospitals and operating rooms to elective surgical cases as part of its "shelter-in-place" public lockdown policies, the ACS brought specialty societies together to create guidelines to protect patients and preserve surgical quality. Federal agencies made available financial aid programs to mitigate the economic impact of the outbreak. The division of advocacy and health policy of the ACS made certain that the interests of surgeons and their patients were served. Steven Wexner, member of the Board of Regents of the ACS interviewed the medical directors of the division, Frank Opelka in quality and health policy, and Patrick Bailey in advocacy, for their stories of how the College responded to the many health and public policy issues that came before Congress and governmental agencies during the pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Defesa do Paciente , Pneumonia Viral/prevenção & controle , Política Pública , Cirurgiões/organização & administração , Comitês Consultivos , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Sociedades Médicas/organização & administração , Estados Unidos
6.
Sante Publique ; 32(2): 273-278, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985844

RESUMO

The coverage of immunization against avoidable disease in the Republic of Benin as in other West African countries, is declining nowadays. To sustain the government effort, National Immunization Technical Advisory Groups (NITAG) were created technically and funded by the West African health organization (WAHO) and Preventive Medicine Agency in countries of the Economic Community of West African States (ECOWAS) including the Republic of Benin. The variation in experts’ methods of analyzing evidence sometimes results in risk error and lack of statistical power. This situation does not allow for the comparison of the scientific validity of certain recommendations made to policy makers, due to the lack of a rigorous framework. The aim of this paper is to design an improved framework to be used in the Republic of Benin in order to encourage a more harmonized approach based on evidence used by expert consultative committees. This framework shows four fundamental scientific steps including a Ministerial referral procedure, recommendation framework, evidence-based data collection, model analyses appropriate for expert advice on vaccines and child immunization, as well as three administrative steps including scientific discussion and work meetings without forgetting ethical aspects.


Assuntos
Comitês Consultivos , Política de Saúde , Imunização , Benin , Criança , Humanos
9.
Am J Gastroenterol ; 115(10): 1575-1583, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32868631

RESUMO

The American Neurogastroenterology and Motility Society Task Force recommends that gastrointestinal motility procedures should be performed in motility laboratories adhering to the strict recommendations and personal protective equipment (PPE) measures to protect patients, ancillary staff, and motility allied health professionals. When available and within constraints of institutional guidelines, it is preferable for patients scheduled for motility procedures to complete a coronavirus disease 2019 (COVID-19) test within 48 hours before their procedure, similar to the recommendations before endoscopy made by gastroenterology societies. COVID-19 test results must be documented before performing procedures. If procedures are to be performed without a COVID-19 test, full PPE use is recommended, along with all social distancing and infection control measures. Because patients with suspected motility disorders may require multiple procedures, sequential scheduling of procedures should be considered to minimize need for repeat COVID-19 testing. The strategies for and timing of procedure(s) should be adapted, taking into consideration local institutional standards, with the provision for screening without testing in low prevalence areas. If tested positive for COVID-19, subsequent negative testing may be required before scheduling a motility procedure (timing is variable). Specific recommendations for each motility procedure including triaging, indications, PPE use, and alternatives to motility procedures are detailed in the document. These recommendations may evolve as understanding of virus transmission and prevalence of COVID-19 infection in the community changes over the upcoming months.


Assuntos
Infecções por Coronavirus/prevenção & controle , Gastroenterologia/normas , Gastroenteropatias/diagnóstico , Controle de Infecções/normas , Laboratórios/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Comitês Consultivos/normas , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Gastroenterologia/métodos , Gastroenteropatias/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Humanos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Seleção de Pacientes , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Prevalência , Sociedades Médicas/normas , Triagem/normas , Estados Unidos/epidemiologia
10.
Epidemiol Serv Saude ; 29(4): e2020499, 2020 09 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32901699

RESUMO

This article presents an experience report about integration between public and private health services, health service managers and the academy, for surveillance and control of the COVID-19 epidemic, in the municipality of Tubarão, Santa Catarina, Brazil. The city is home to a university and has a large flow of people from different parts of the country, as well as being one of the first municipalities in the state of Santa Catarina to report cases of community transmission of SARS-CoV-2. The measures adopted included the implementation of the COVID-19 Monitoring Committee, the Municipal Health Emergency Operations Center, and the COVID-19 Contingency Plan. After 100 days of pandemic, 5,979 cases had been reported, 431 (7.2%) had been confirmed, of which five (1.2%) died. Early decisions, such as the immediate suspension of business activities and crowded events, may have reduced the spread of the virus. The partnerships put into place have provided innovation and supported public service management in decision-making based upon scientific evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Relações Interinstitucionais , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Parcerias Público-Privadas/organização & administração , Comitês Consultivos , Brasil/epidemiologia , Comunicação , Infecções por Coronavirus/transmissão , Implementação de Plano de Saúde , Humanos , Pneumonia Viral/transmissão , Vigilância da População/métodos
13.
J Bras Nefrol ; 42(2 suppl 1): 41-43, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877498

RESUMO

Vascular accesses for hemodialysis are considered the patient's lifeline and their maintenance is essential for treatment continuity. Following the example of institutions in other countries affected by the Covid-19 pandemic, the Brazilian Society of Nephrology developed these guidelines for healthcare services, elaborating on the importance of carrying out procedures for the preparation and preservation of vascular accesses. Creating definitive accesses for hemodialysis, grafts and arteriovenous fistulas are non-elective procedures, as well as the transition from the use of non-tunneled catheters to tunneled catheters, which cause less morbidity. In the case of patients with suspected or confirmed coronavirus infection, one may postpone the procedures for the quarantine period, to avoid spreading the disease.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Diálise Renal/métodos , Dispositivos de Acesso Vascular , Comitês Consultivos , Derivação Arteriovenosa Cirúrgica/normas , Brasil , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Humanos , Nefrologia/normas , Pandemias , Sociedades Médicas
14.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32788267

RESUMO

CONTEXT: The International Liaison Committee on Resuscitation Neonatal Life Support Task Force reviewed evidence for the duration of cardiopulmonary resuscitation (CPR) for newborns immediately after birth. OBJECTIVE: To summarize evidence for ongoing CPR on the outcomes of survival, neurodevelopment, and the composite of survival without moderate or severe neurodevelopmental impairment (NDI). DATA SOURCES: Medline, Embase, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scientific Electronic Library Online were searched between inception and February 29, 2020. STUDY SELECTION: Two independent reviewers selected studies of newborns with at least 10 minutes of asystole, bradycardia, or pulseless electrical activity for which CPR is indicated. DATA EXTRACTION: Two independent reviewers extracted data and appraised the risk of bias. RESULTS: In 16 eligible studies, researchers reported outcomes of 579 newborns born between 1982 and 2017. Within individual studies, 2% to 100% of infants survived to last follow-up (hospital discharge through 12 years). Summarized across studies, 237 of 579 (40.9%) newborns survived to last follow-up. In 13 studies, researchers reported neurodevelopmental outcomes of 277 newborns. Of these, 30 of 277 (10.8%) survived without moderate or severe impairment, and 240 of 277 (87%) met the composite outcome of death or NDI (191 died and 49 survived with moderate or severe impairment). LIMITATIONS: There was very low certainty of evidence because of risk of bias and inconsistency. CONCLUSIONS: Infants with ongoing CPR at 10 minutes after birth are at high risk for mortality and neurodisability, but survival without moderate or severe NDI is possible. One specified duration of CPR is unlikely to uniformly predict survival or survival without neuroimpairment.


Assuntos
Bradicardia/terapia , Reanimação Cardiopulmonar/estatística & dados numéricos , Desenvolvimento Infantil , Parada Cardíaca/terapia , Transtornos do Neurodesenvolvimento/epidemiologia , Comitês Consultivos , Viés , Frequência Cardíaca , Humanos , Recém-Nascido , Transtornos do Neurodesenvolvimento/mortalidade , Sobreviventes/estatística & dados numéricos , Fatores de Tempo
16.
Pediatrics ; 146(Suppl 1): S3-S8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737225

RESUMO

One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Pediatria/ética , Suspensão de Tratamento/ética , Comitês Consultivos/ética , Temas Bioéticos/história , Temas Bioéticos/legislação & jurisprudência , Crianças com Deficiência/legislação & jurisprudência , Síndrome de Down/história , Atresia Esofágica/história , Atresia Esofágica/terapia , Fundações , História do Século XX , Humanos , Recém-Nascido , Consentimento dos Pais/ética , Consentimento dos Pais/legislação & jurisprudência , Pais , Pediatria/legislação & jurisprudência , Assistência Terminal/ética , Suspensão de Tratamento/legislação & jurisprudência
17.
MMWR Recomm Rep ; 69(8): 1-24, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32820746

RESUMO

This report updates the 2019-20 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2019;68[No. RR-3]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. Most influenza vaccines available for the 2020-21 season will be quadrivalent, with the exception of MF59-adjuvanted IIV, which is expected to be available in both quadrivalent and trivalent formulations.Updates to the recommendations described in this report reflect discussions during public meetings of ACIP held on October 23, 2019; February 26, 2020; and June 24, 2020. Primary updates to this report include the following two items. First, the composition of 2020-21 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. Second, recent licensures of two new influenza vaccines, Fluzone High-Dose Quadrivalent and Fluad Quadrivalent, are discussed. Both new vaccines are licensed for persons aged ≥65 years. Additional changes include updated discussion of contraindications and precautions to influenza vaccination and the accompanying Table, updated discussion concerning use of LAIV4 in the setting of influenza antiviral medication use, and updated recommendations concerning vaccination of persons with egg allergy who receive either cell culture-based IIV4 (ccIIV4) or RIV4.The 2020-21 influenza season will coincide with the continued or recurrent circulation of SARS-CoV-2 (the novel coronavirus associated with coronavirus disease 2019 [COVID-19]). Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient illnesses, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html.This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2020-21 season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used within Food and Drug Administration (FDA)-licensed indications. Updates and other information are available from CDC's influenza website (https://www.cdc.gov/flu). Vaccination and health care providers should check this site periodically for additional information.


Assuntos
Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Adolescente , Adulto , Comitês Consultivos , Idoso , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Feminino , Humanos , Esquemas de Imunização , Lactente , Vírus da Influenza A Subtipo H1N1 , Vírus da Influenza A Subtipo H3N2 , Vírus da Influenza B , Vacinas contra Influenza/efeitos adversos , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Estações do Ano , Estados Unidos/epidemiologia , Vacinas Atenuadas/uso terapêutico , Adulto Jovem
18.
Plast Reconstr Surg ; 146(2): 248e-250e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740631
20.
S Afr Med J ; 110(5): 360-363, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657717

RESUMO

Despite a substantial decline in childhood mortality rates in South Africa (SA), progress in neonatal mortality reduction has been much slower. Severe bacterial infections remain a leading cause of neonatal morbidity and a direct cause of 13.1% of neonatal deaths among babies >1 kg. The incidence of hospital-acquired infections, antimicrobial resistance and outbreaks of infections in SA neonatal units is substantial, and is possibly higher than the currently available estimates. The SA Neonatal Sepsis Task Force was launched in Port Elizabeth, SA, on 13 September 2019 to provide technical advice and guidance on surveillance for neonatal sepsis, infection prevention, case management, antimicrobial stewardship and containment of neonatal unit outbreaks.


Assuntos
Comitês Consultivos , Gestão de Antimicrobianos , Unidades de Terapia Intensiva Neonatal , Sepse Neonatal/epidemiologia , Sepse Neonatal/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Resistência Microbiana a Medicamentos , Humanos , Recém-Nascido , Controle de Infecções , Vigilância da População , África do Sul/epidemiologia
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