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1.
PLoS One ; 16(3): e0248675, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735325

RESUMO

BACKGROUND: In December 2019, a new disease named coronavirus disease 2019 (COVID-19) was occurred. Patients who are critically ill with COVID-19 are more likely to die, especially elderly patients. We aimed to describe the effect of age on the clinical and immune characteristics of critically ill patients with COVID-19. METHODS: We retrospectively included 32 patients with COVID-19 who were confirmed to have COVID-19 by the local health authority and who were admitted to the first affiliated hospital of Zhengzhou University in Zhengzhou, China between January 3 and March 20, 2020. Clinical information and experimental test data were retrospectively collected for the patients. The 32 patients in this study were all in a critical condition and were classified as severe, according to the guidelines of 2019-nCoV infection from the National Health Commission of the People's Republic of China. Data were compared between those <60 years old and ≥60 years old. RESULTS: Of 32 patients, 13 were under 60 years old, and 19 patients were ≥60 years old. The most common symptom among all patients upon admission was fever (93.8%, 30/32). Compared to younger patients, older patients exhibited increased comorbidities. Among patients who were 60 years and older, platelet count, direct bilirubin (DBIL), indirect bilirubin(IBIL), lactate dehydrogenase (LDH), B-type natriuretic peptide (BNP), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-10 (IL-10) were significantly higher than in younger patients who were less than 60 years old. CD4+ T lymphocytes, CD8+ T lymphocytes, and NKT lymphocytes were decreased, CD4+/CD8+ T lymphocytes were significantly increased in all 32 patients, while there were no evident differences between younger and older patients. The CURB-65 (confusion, urea, respiratory, rate, blood pressure plus age ≥65 years), Acute Physiology and Chronic Health Evaluation (APACHE) II and pH value were significantly higher in older patients than in patients who were under 60 years old. However, the PaO2 and PaO2:FiO2 were lower in older patients than the younger. Compared to patients under 60 years old, patients who were 60 years and older tended to develop ARDS (15 [78.9%] vs 5 [38.5%]), septic shock (7 [36.8%] vs 0 [0.0%]) and were more likely to receive mechanical ventilation (13 [68.4%] vs 3[23.1%]). Dynamic trajectories of seven laboratory parameters were tracked on days 1, 3, 5 and 7, and significant differences in lymphocyte count (P = 0.026), D-dimer (P = 0.010), lactate dehydrogenase (P = 0.000) and C-reactive protein (P = 0.000) were observed between the two age groups. CONCLUSIONS: A high proportion of critically ill patients were 60 or older. Furthermore, rapid disease progression was noted in elderly patients. Therefore, close monitoring and timely treatment should be performed in elderly COVID-19 patients.


Assuntos
/epidemiologia , Fatores Etários , Idoso , Relação CD4-CD8 , /diagnóstico , Estado Terminal , Feminino , Humanos , Imunidade , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Dados Preliminares , Estudos Retrospectivos , Índice de Gravidade de Doença
3.
Appetite ; 156: 104985, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33038477

RESUMO

BACKGROUND: The COVID-19 New Mum Study is recording maternal experiences and infant feeding during the UK lockdown. This report from week 1 of the survey describes and compares the delivery and post-natal experiences of women who delivered before (BL) versus during (DL) the lockdown. METHODS: Women living in the UK aged ≥18 years with an infant ≤12 months of age completed an anonymous online survey (https://is.gd/covid19newmumstudy). Information/links are shared via websites, social media and existing contacts. RESULTS: From 27.5.20-3.6.20, 1365 women provided data (94% white, 95% married/with partner, 66% degree/higher qualification, 86% living in house; 1049 (77%) delivered BL and 316 (23%) DL. Delivery mode, skin-to-skin contact and breastfeeding initiation did not differ between groups. DL women had shorter hospital stays (p < 0.001). 39% reported changes to their birth plan. Reflecting younger infant age, 59% of DL infants were exclusively breast-fed/mixed fed versus 39% of BL (p < 0.05). 13% reported a change in feeding; often related to lack of breastfeeding support, especially with practical problems. Important sources of feeding support were the partner (60%), health professional (50%) and online groups (47%). 45% of DL women reported insufficient feeding support. Among BL women, 57% and 69% reported decreased feeding support and childcare, respectively. 40% BL/45% DL women reported insufficient support with their own health, 8%/9% contacted a mental health professional; 11% reported their mental health was affected. 9% highlighted lack of contact/support from family and distress that they had missed seeing the baby. CONCLUSION: Lockdown has impacted maternal experiences, resulting in distress for many women. Our findings suggest the need for better infant feeding support, especially 'face-to-face' support for practical issues; and recognising and supporting mothers who are struggling with mental health challenges or other aspects of their health. The effectiveness of online versus face-to-face contact is currently uncertain, and requires further evaluation.


Assuntos
Comportamento Alimentar , Acesso aos Serviços de Saúde , Mães , Pandemias , Estresse Psicológico , Adulto , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Saúde Mental , Mães/psicologia , Dados Preliminares , Isolamento Social , Inquéritos e Questionários , Reino Unido
4.
Muscle Nerve ; 63(3): 371-383, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33340120

RESUMO

BACKGROUND: To collect preliminary data on the effects of mexiletine on cortical and axonal hyperexcitability in sporadic amyotrophic lateral sclerosis (ALS) in a phase 2 double-blind randomized controlled trial. METHODS: Twenty ALS subjects were randomized to placebo and mexiletine 300 or 600 mg daily for 4 wk and assessed by transcranial magnetic stimulation and axonal excitability studies. The primary endpoint was change in resting motor threshold (RMT). RESULTS: RMT was unchanged with 4 wk of mexiletine (combined active therapies) as compared to placebo, which showed a significant increase (P = .039). Reductions of motor evoked potential (MEP) amplitude (P = .013) and accommodation half-time (P = .002), secondary outcome measures of cortical and axonal excitability, respectively, were also evident at 4 wk on mexiletine. CONCLUSIONS: The relative stabilization of RMT in the treated subjects was unexpected and could be attributed to unaccounted sources of error or chance. However, a possible alternative cause is neuromodulation preventing an increase. The change in MEP amplitude and accommodation half-time supports the reduction of cortical and axonal hyperexcitability with mexiletine.


Assuntos
Esclerose Amiotrófica Lateral/tratamento farmacológico , Axônios , Excitabilidade Cortical , Mexiletina/uso terapêutico , Bloqueadores do Canal de Sódio Disparado por Voltagem/uso terapêutico , Adulto , Idoso , Esclerose Amiotrófica Lateral/fisiopatologia , Método Duplo-Cego , Eletrodiagnóstico , Eletromiografia , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Dados Preliminares , Estimulação Magnética Transcraniana
5.
Medicine (Baltimore) ; 99(52): e23857, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350778

RESUMO

ABSTRACT: To compare the relationship between background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM), mammographic breast density (MBD), age, in the group with benign vs malignant breast lesions.Four hundred thirty three non-high-risk patients from January 2018 to May 2019 were retrospectively analyzed. Patients were assigned into 4 groups: premenopausal benign lesions, premenopausal malignant lesions, postmenopausal benign lesions, and postmenopausal malignant lesions. The differences in CESM BPE and MBD between premenopausal benign lesions and premenopausal malignant lesions, between postmenopausal benign lesions and postmenopausal malignant lesions, between premenopausal and postmenopausal benign lesions, and between premenopausal and postmenopausal malignant lesions were evaluated. Pearson Chi-Squared test was used to analyze the differences between the above groups. Spearman rank correlation analysis was used to evaluate the correlations between BPE, MBD, and age. Multiple logistic regression was used to analyze the influencing factors of breast cancer. P < .05 was considered statistically significant.There was no significant difference in CESM BPE or MBD of benign and malignant lesions regardless of premenopausal or postmenopausal status, but there was a significant difference in CESM BPE and MBD of premenopausal and postmenopausal patients regardless of the presence of benign or malignant lesions. The intensity of CESM BPE was positively correlated with MBD, and the intensity of CESM BPE and MBD were negatively correlated with age. Multiple logistic regression analysis showed that age was an influencing factor for breast cancer in both premenopausal and postmenopausal patients.For non-high-risk women, CESM BPE and MBD were not correlated with benign or malignant breast lesions, and age was an influencing factor for breast cancer.


Assuntos
Fatores Etários , Densidade da Mama , Neoplasias da Mama/diagnóstico , Mama , Mamografia/métodos , Neoplasias/diagnóstico , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Meios de Contraste/farmacologia , Correlação de Dados , Feminino , Humanos , Aumento da Imagem/métodos , Pessoa de Meia-Idade , Pós-Menopausa , Dados Preliminares , Pré-Menopausa
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3557-3560, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018771

RESUMO

Anodal transcranial direct current stimulation (AtDCS) can improve memory and cognitive dysfunction in patients with Alzheimer's disease (AD), which has been proven in basic and clinical studies. Intervention of AD in preclinical stage is important to prevent progression of AD in the aging society. At the same time, there is increasing evidence that a close link exists between cerebrovascular dysfunction and AD disease. Here we investigated the changes of local cerebral blood microcirculation in preclinical AD mouse model after AtDCS based on the previous studies. Twenty-four 6-month-old male APP/PS1 double transgenic mice were randomly divided into three groups: a model group (AD), a model sham stimulation (ADST) group and a model stimulation group (ATD). Eight 6-month-old male C57 wild-type mice served as a control group (CTL). Mice in the ATD group received 10 AtDCS sessions. Two months after the end of AtDCS in the ATD group, the microcirculation parameters of the frontal cortex of the mice in each group, including cerebral blood flow (CBF), blood flow velocity (Velo), oxygen saturation (SO2) and relative hemoglobin content (rHb), were obtained by the non-invasive laser-Doppler spectrophotometry system "Oxygen-to-See (O2C)". The results showed that AtDCS increased CBF, Velo and SO2, and reduce rHb in APP/PS1 double transgenic mice at the preclinical stage of AD.Clinical Relevance-This shows the positive effect of AtDCS on preclinical AD in cerebrovascular function, and provides effective basic research facts for AtDCS to intervene and delay the clinical application of AD disease.


Assuntos
Doença de Alzheimer , Estimulação Transcraniana por Corrente Contínua , Doença de Alzheimer/genética , Precursor de Proteína beta-Amiloide/genética , Animais , Criança , Modelos Animais de Doenças , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Microcirculação , Dados Preliminares , Presenilina-1/genética
9.
BMC Infect Dis ; 20(1): 783, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081710

RESUMO

BACKGROUND: A cost effective and efficient diagnostic tool for COVID-19 as near to the point of care (PoC) as possible would be a game changer in the current pandemic. We tested reverse transcription loop mediated isothermal amplification (RT-LAMP), a method which can produce results in under 30 min, alongside standard methods in a real-life clinical setting. METHODS: This prospective service improvement project piloted an RT-LAMP method on nasal and pharyngeal swabs on 21 residents of a high dependency care home, with two index COVID-19 cases, and compared it to multiplex tandem reverse transcription polymerase chain reaction (RT-PCR). We recorded vital signs of patients to correlate clinical and laboratory information and calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a single swab using RT-LAMP compared with the current standard, RT-PCR, as per Standards for Reporting Diagnostic Accuracy Studies (STARD) guidelines. RESULTS: The novel method accurately detected 8/10 RT-PCR positive cases and identified a further 3 positive cases. Eight further cases were negative using both methods. Using repeated RT-PCR as a "gold standard", the sensitivity and specificity of a single novel test were 80 and 73% respectively. PPV was 73% and NPV was 83%. Incorporating retesting of low signal RT-LAMP positives improved the specificity to 100%. We also speculate that hypothermia may be a significant early clinical sign of COVID-19. CONCLUSIONS: RT-LAMP testing for SARS-CoV-2 was found to be promising, fast and to work equivalently to RT-PCR methods. RT-LAMP has the potential to transform COVID-19 detection, bringing rapid and accurate testing to the PoC. RT-LAMP could be deployed in mobile community testing units, care homes and hospitals to detect disease early and prevent spread.


Assuntos
Betacoronavirus/genética , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Pneumonia Viral/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Reação em Cadeia da Polimerase/métodos , Dados Preliminares , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/virologia , Confiabilidade dos Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/economia , Técnicas de Amplificação de Ácido Nucleico/economia , Pandemias , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase/economia , Estudos Prospectivos , Sensibilidade e Especificidade
11.
J Psychiatr Pract ; 26(5): 400-404, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32936586

RESUMO

The COVID-19 pandemic and its need for social distancing as a response have the potential to increase the experience of loneliness in the population, with an associated increase in symptoms of mental disorders. As the world has largely adapted to remote platforms for employment, socializing, and health service delivery, the degree to which virtual opportunities for social engagement may offset the impact of limited in-person interactions on mental health functioning is unknown. This column offers preliminary data from an ongoing experience sampling study of the prevalence, course, and impact of loneliness on mental health in a community adult sample living under social distancing requirements during the COVID-19 pandemic. Initial findings aggregated across all experience sampling reports showed negative associations between virtual social contact (via text, phone, or videoconferencing) and feelings of loneliness, while in-person interactions appeared to have no impact on loneliness. In addition, respondents reported frequent instances of negative effects on physical and mental health, including disruptions in sleep and recurring suicidal ideation. While further analyses are needed, these findings are consistent with similar emerging reports showing increased rates of mental health concerns during periods of social distancing. Possible avenues for addressing these concerns using remote interventions are explored.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Distúrbios do Início e da Manutenção do Sono , Isolamento Social/psicologia , Ideação Suicida , Realidade Virtual , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Relações Interpessoais , Solidão/psicologia , Saúde Mental/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Dados Preliminares , Prevalência
12.
Front Med ; 14(5): 664-673, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32761491

RESUMO

The Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was identified in December 2019. The symptoms include fever, cough, dyspnea, early symptom of sputum, and acute respiratory distress syndrome (ARDS). Mesenchymal stem cell (MSC) therapy is the immediate treatment used for patients with severe cases of COVID-19. Herein, we describe two confirmed cases of COVID-19 in Wuhan to explore the role of MSC in the treatment of COVID-19. MSC transplantation increases the immune indicators (including CD4 and lymphocytes) and decreases the inflammation indicators (interleukin-6 and C-reactive protein). High-flow nasal cannula can be used as an initial support strategy for patients with ARDS. With MSC transplantation, the fraction of inspired O2 (FiO2) of the two patients gradually decreased while the oxygen saturation (SaO2) and partial pressure of oxygen (PO2) improved. Additionally, the patients' chest computed tomography showed that bilateral lung exudate lesions were adsorbed after MSC infusion. Results indicated that MSC transplantation provides clinical data on the treatment of COVID-19 and may serve as an alternative method for treating COVID-19, particularly in patients with ARDS.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Cuidados Críticos/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Pandemias , Pneumonia Viral , Adulto , Idoso , Células Sanguíneas/fisiologia , Testes de Coagulação Sanguínea/métodos , China , Técnicas de Laboratório Clínico/métodos , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Monitorização Imunológica/métodos , Oximetria/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Dados Preliminares , Índice de Gravidade de Doença , Avaliação de Sintomas/métodos , Resultado do Tratamento
13.
Int J Antimicrob Agents ; 56(5): 106136, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32777263

RESUMO

During the Covid-19 pandemic, many intensive care unit (ICU) patients received hydroxychloroquine. The primary objective of this study was to assess the effects of hydroxychloroquine according to its plasma concentration in ICU patients. A single-center retrospective study was performed from March to April 2020 in an ICU of a university hospital. All patients admitted to the ICU with confirmed Covid-19 pneumonia and treated with hydroxychloroquine were included. The study compared 17 patients in whom the hydroxychloroquine plasma concentration was in the therapeutic target (on-target) and 12 patients in whom the plasma concentration was below the target (off-target). The follow-up of patients was 15 days. No association was found between hydroxychloroquine plasma concentration and viral load evolution (P = 0.77). There was no significant difference between the two groups for duration of mechanical ventilation, length of ICU stay, in-hospital mortality, and 15-days mortality. These findings indicate that hydroxychloroquine administration for Covid-19 patients hospitalized in ICU is not associated with improved outcomes. Larger multicenter studies are needed to confirm these results.


Assuntos
Anti-Inflamatórios/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/sangue , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/sangue , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Dados Preliminares , Estudos Retrospectivos , Carga Viral/efeitos dos fármacos
17.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1571-1575, July-Aug. 2020. tab, ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1131505

RESUMO

O objetivo deste estudo foi realizar a caracterização genética de Staphylococcus spp. resistentes a meticilina isolados de suínos. Foram coletadas 30 amostras de swab nasal de suínos, abatidos em um frigorífico com Serviço de Inspeção Federal. Os isolados foram submetidos a análises macro e microscópicas que, em seguida, para detectar a resistência bacteriana, foram submetidos a ensaios fenotípicos da sensibilidade aos antimicrobianos. Posteriormente, as amostras resistentes a oxacilina, foram submetidas à reação em cadeia pela polimerase (PCR) para verificar a presença do gene mecA. Das 30 amostras analisadas, foram isolados 12 (40%) Staphylococcus spp. coagulase positiva, e 18 (60%) coagulase negativa, e, dentre os isolados, 26 (86,66%) foram resistentes a oxacilina sendo possível detectar o gene mecA em seis (23%) amostras. Este estudo evidencia a presença de genes de resistência em microrganismos comuns a microbiota de animais de produção que podem ser transmitidos ao homem. Além de chamar a atenção para a frequência e quantidade de antimicrobianos aos quais estes animais são expostos durante toda sua vida, podendo ser considerado um problema para a saúde única.(AU)


Assuntos
Animais , Suínos/microbiologia , Staphylococcus aureus Resistente à Meticilina/genética , Cavidade Nasal/microbiologia , Refrigeração/veterinária , Reação em Cadeia da Polimerase/veterinária , Dados Preliminares
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