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1.
Korean J Med Educ ; 33(2): 87-96, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34062640

RESUMO

PURPOSE: With the ongoing coronavirus disease 2019 (COVID-19) pandemic, health institutions and hospitals are increasingly relying on e-learning for continuing education. However, in many countries there is still limited data on the effectiveness of online learning particularly in the healthcare field. This study aims to evaluate whether webinar as a form of online educational intervention is satisfactory and effective for the continuing education of health professionals in Indonesia. METHODS: We collected participants' demographic information including health profession, place of work, work unit, and year of graduation. There were six independent webinars included in this study. Webinar outcomes included satisfaction and learning scores. Regarding satisfaction, participants were told to complete a satisfaction survey and asked whether they would recommend the webinar to their colleagues. Regarding learning, information on their mean pre-test and post-test scores was collected. RESULTS: A total of 3,607 health professionals were enrolled, with the highest participation in webinars about emergency cases and COVID-19 management. The response towards satisfaction was overwhelmingly positive. In all six webinars, post-test scores were statistically significantly higher than pre-test scores. Recently graduated physicians scored higher in learning than senior physicians, while place of work and work unit did not significantly affect the scores. CONCLUSION: The use of webinar for health professionals training in Indonesia was well-received amid the ongoing pandemic. In the future, health institutions and teaching hospitals should optimize the implementation of webinar training as it is associated with low cost, high flexibility, and less time commuting.


Assuntos
COVID-19 , Educação Continuada/métodos , Educação à Distância , Pessoal de Saúde , Pandemias , Análise Custo-Benefício , Gerenciamento Clínico , Avaliação Educacional , Hospitais de Ensino , Humanos , Indonésia , Aprendizagem , Satisfação Pessoal , Médicos , SARS-CoV-2 , Ensino
2.
BMC Public Health ; 21(1): 1013, 2021 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-34051768

RESUMO

BACKGROUND: The implementation of core capacities as stated in the International Health Regulations (IHR) is far from complete, and, as the COVID-19 pandemic shows, the spreading of infectious diseases through points of entry (POEs) is a serious problem. To guide training and exercises, we performed a training needs assessment on infectious disease management among professionals at European POE. METHODS: We disseminated a digital questionnaire to representatives of designated airports, ports, and ground-crossings in Europe. Topics were derived from the IHR core capacities for POEs. Based on the importance (4-point Likert scale) and training needs (4-point Likert scale), we identified the topics with the highest priority for training. These results were put in further perspective using prior experience (training < 3 year, exercise < 5 years, events < 5 years). Also, preferences for training methodologies were assessed. RESULTS: Fifty questionnaires were included in the analyses, representing 50 POEs from 19 European countries. Importance is high for 26/30 topics, although scores widely vary among respondents. Topics with a high training need (16/30) are amongst others the handling of ill travelers; using and composing the public health emergency contingency plan, and public health measures. Respondents from ports and airports attribute equal importance to most topics, but respondents from ports showed higher training needs on 75% of the topics. POEs are unevenly and generally little experienced. The most preferred training methods were presentations. Simulation is the preferred methodology for training the handling of ill or exposed travelers. CONCLUSIONS: The European workforce at designated ports, airports and ground-crossings has a different level of experience and perceives varying importance of the topics assessed in our study. We identified the topics on which training is required. We call for European collaboration between POEs to agree upon the importance of infectious disease management, and to jointly build a trained and prepared workforce that is ready to face the next crisis.


Assuntos
Aeroportos , Gerenciamento Clínico , Europa (Continente) , Humanos , Pandemias
3.
J Glob Health ; 11: 04030, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34055327

RESUMO

Background: The Strategy of the Integrated Management of Childhood Illness (IMCI) was introduced in Central Asia and Europe to address the absence of evidence-based guidelines, the misuse of antibiotics, polypharmacy and over-hospitalization of children. A study carried out in 16 countries analysed the status and strengths of as well as the barriers to IMCI implementation and investigated how different health systems affect the problems IMCI aims to address. Here we present findings in relation to IMCI's effects on the rational use of drugs, particularly the improved rational use of antibiotics in children, the mechanisms through which these were achieved as well as counteracting system factors. Methods: 220 key informants were interviewed ranging from 5 to 37 per country (median 12). Data was analysed for arising themes and peer-reviewed. Results: The implementation of IMCI led to improved prescribing patterns immediately after training of health workers according to key informants. IMCI provides standard treatment guidelines and an algorithmic diagnostic- and treatment-decision-tool for consistent decision-making. Doctors reported feeling empowered by the training to counsel parents and address their expectations and desire for invasive treatments and the use of multiple drugs. Improved prescribing patterns were not sustained over time but counteracted by factors such as: doctors prescribing antibiotics to create additional revenues or other benefits; aggressive marketing by pharmaceutical companies; parents pressuring doctors to prescribe antibiotics; and access to drugs without prescriptions. Conclusions: Future efforts to improve child health outcomes must include: (1) the continued support to improve health worker performance to enable them to adhere to evidence-based treatment guidelines, (2) patient and parent education, (3) improved reimbursement schemes and prescription regulations and their consistent enforcement and (4) the integration of point-of-care tests differentiating between viral and bacterial infection into standards of care. Pre-requisites will be sufficient remuneration of health workers, sound training, improved health literacy among parents, conducive laws and regulations and reimbursement systems with adequate checks and balances to ensure the best possible care.


Assuntos
Antibacterianos/uso terapêutico , Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Gerenciamento Clínico , Uso Indevido de Medicamentos/prevenção & controle , Criança , Humanos
4.
Clin Ter ; 172(3): 225-230, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33956042

RESUMO

Objective: Since December 2019, new pneumonia of unknown aetiology broke out in Wuhan, Hubei province, China. Subsequently, a virus, later named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the causative agent of the disease. Currently, the epidemic has spread all over the world. The most common manifestations of COVID-19 are fever, fatigue and dry cough. At the moment, the nuclide acid test is the gold standard method for the diagnosis of this infection. Methods: In the present paper, we report our experience with all patients who came to the Emergency Department from March 1 to April 1, 2020, with suggestive symptoms of COVID-19 infection. Patients: they all underwent a first oropharyngeal and nasopharyngeal swab in the emergency department and, if negative, a second one after at least 24 hours. Results: Our study shows how the results obtained at time zero are usually identical to the ones obtained after 24 hours. We thus suggest, in patients with high suspicion of COVID19 and a negative result at the first swab, to repeat the test after at least 48 hours, during which patients with symptoms of COVID-19 pneumonia disease should be kept in isolation to avoid the risk of contagion. Conclusions: these measures and in particular the early identifica-tion of cases with consequent isolation will allow the containment of the spread of the virus, representing one of the fundamental measures to guarantee and strengthen the control of the infection to reduce hospital admissions, the overload of national health service and health costs.


Assuntos
/terapia , Gerenciamento Clínico , Hospitalização/tendências , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Medicina Estatal , Adulto Jovem
6.
J Nutr Health Aging ; 25(5): 702-709, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33949641

RESUMO

BACKGROUND: Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. OBJECTIVE: We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. DESIGN: A systematic review and Meta-analysis of 16 cohort studies. PARTICIPANTS: Patients with COVID-19. METHODS: A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects. RESULTS: According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay. CONCLUSIONS: In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all- cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.


Assuntos
/patologia , Gerenciamento Clínico , Fragilidade/patologia , China , Estudos de Coortes , Fragilidade/diagnóstico , Hospitalização , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Risco , Resultado do Tratamento , Populações Vulneráveis/estatística & dados numéricos
7.
Am Soc Clin Oncol Educ Book ; 41: 1-11, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33956493

RESUMO

In the care of patients with operable breast cancer, there has been a shift toward increasing use of neoadjuvant therapy. There are benefits to neoadjuvant therapy, such as monitoring for response, as well as an increased rate of breast conservation and reduction of potential morbidity associated with breast surgery, including axillary management. Among patients with highly proliferative tumors, such as HER2-positive or triple-negative breast cancer, those with residual disease are at higher risk of recurrence, which informs the recommended systemic therapy in the adjuvant setting. For instance, in patients with residual disease after neoadjuvant chemotherapy and HER2-targeted therapy, there is a role for adjuvant trastuzumab emtansine for those with residual disease at the time of surgery. The same holds true regarding the role of adjuvant capecitabine in patients with residual disease after neoadjuvant chemotherapy. With the added complexities of treating patients in the era of the COVID-19 outbreak, additional considerations are critical, including initiation of surgery within an appropriate time from completion of neoadjuvant therapy. National consensus guidelines on time to surgery must be developed to improve measurement and comparison across systems. In addition, there is emerging radiation treatment management research addressing a number of factors, including hypofractionation, role of proton beam therapy, safe omission of radiotherapy, and preoperative radiotherapy with or without drug combination. In this article, the multidisciplinary approach of treating patients with operable breast cancer is highlighted, with updates and future considerations described.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Biomarcadores Tumorais , Neoplasias da Mama/etiologia , Tomada de Decisão Clínica , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Comorbidade , Gerenciamento Clínico , Suscetibilidade a Doenças , Feminino , Humanos , Avaliação de Resultados em Cuidados de Saúde , Assistência Perioperatória , Tempo para o Tratamento
8.
Sci Rep ; 11(1): 10124, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980931

RESUMO

Research objective was to detail COVID-19's natural trajectory in relation to the Czech population's viral load. Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19's impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a 14-day quarantine. Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. Another 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed as symptomatic on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median-19 days). The highest viral load occurred within 0-2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients. No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.


Assuntos
/terapia , Adulto , Instituições de Assistência Ambulatorial , /epidemiologia , República Tcheca/epidemiologia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Prospectivos , Quarentena , Telemedicina , Carga Viral
9.
Cir Esp ; 99(5): 361-367, 2021 May.
Artigo em Espanhol | MEDLINE | ID: mdl-34024915

RESUMO

Introduction: During the state of alarm established in Spain due to the COVID-19 pandemic, most of the face-to-face outpatient consultations were cancelled and a telephone consultation was established to follow up coloproctological patients. The objective of this study was to analyse the efficacy of telemedicine (by telephone) in monitoring patients in a coloproctology unit, in the context of the COVID-19 pandemic. Method: Prospective descriptive study of consecutive patients in a single centre. The result of the teleconsultation was classified as discharge, resolved visit or reprogramming and was analysed by different diagnostic groups. Results: From March 19th to April 17th, 2020, the teleconsultation of 190 patients was carried out. The response rate was 94.2% (179). The diagnostic categories of the patients attended were: 51 (26.9%) colorectal neoplasia, 48 (25.3%) proctological pathology, 72 (37.9%) pelvic floor dysfunctions and 19 (10%) other benign pathologies. 105 (55.26%) could be recited as if they had come in person. Eleven (5.8%) patients were discharged. No significant differences were found between the different diagnostic categories and the resolution of the teleconsultation. The reasons for reprogramming are analyzed in the study. Conclusion: In the context of a pandemic, teleconsultation has allowed 61% of follow-up visits to be definitively solved, avoiding the reprogramming of 116 patients. The new social and health paradigm after the pandemic will require a rethinking of our healthcare model, and in many aspects, telemedicine can offer tools for this.


Assuntos
Neoplasias Colorretais/terapia , Cirurgia Colorretal/métodos , Distúrbios do Assoalho Pélvico/terapia , Doenças Retais/terapia , Telemedicina/métodos , Telefone , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Constipação Intestinal/terapia , Atenção à Saúde , Gerenciamento Clínico , Diverticulite/terapia , Incontinência Fecal/terapia , Feminino , Fissura Anal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Dor Pélvica/terapia , Estudos Prospectivos , Fístula Retal/terapia , Espanha , Adulto Jovem
10.
Int J Mol Sci ; 22(9)2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33946233

RESUMO

Neoplasms derived from follicular tissue are extremely rare. Clinically, they are reported as non-symptomatic, slow-growing nodules. These lesions are mainly benign, but the malignant type can occur. Mainly middle-aged people (50-60 years of age) are affected. These carcinomas are mainly localized on the head and neck or torso. They can be locally aggressive and infiltrate surrounding tissue and metastasize to regional lymph nodes. In the minority of cases, distant metastases are diagnosed. Quick and relevant diagnosis is the basis of a treatment for all types of tumors. The patient's life expectancy depends on multiple prognostic factors, including the primary tumor size and its mitotic count. Patients should be referred to a specialized skin cancer center to receive optimal multidisciplinary treatment. This article tries to summarize all the information that is currently available about pathogenesis, diagnosis, and treatment methods of follicular tumors.


Assuntos
Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Cutâneas/diagnóstico , Animais , Carcinogênese/patologia , Gerenciamento Clínico , Humanos , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Epiteliais e Glandulares/terapia , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia
11.
Hematology ; 26(1): 398-407, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34057050

RESUMO

Invasive pulmonary aspergillosis is a life-threatening complication in the cases of patients with hematologic malignancies. In December 2019, the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and the Mycoses Study Group Education and Research Consortium published a revision and an update of the consensus definitions of invasive fungal disease. The aim of this study was to evaluate the signs and radiologic patterns of early-stage invasive pulmonary aspergillosis in computed tomography in patients with hematologic entities according to the latest criteria.This retrospective analysis of a baseline high-resolution computed tomography included neutropenic patients with hematological malignancies and probable invasive pulmonary aspergillosis. The data were collected between the years 2017 and 2019. Computed tomography was performed within 72 h from the beginning of clinical symptoms: fever, dyspnea or nonproductive cough. CT scans were analyzed by two independent radiologists according to the standardized protocol based on predefined criteria.All 35 evaluated patients had typical lesions for early-stage invasive aspergillosis. Wedge-shaped infiltrates were noted in 48.6% of patients. In this group, 40% of patients had coexisting atypical radiological findings. In 11.4% of patients, wedge-shape consolidations were noted as the only type of lesions.Employment of the latest EORTC/MSG criteria increased diagnostic value of the baseline high resolution computed tomography in our study group by 11.4%.


Assuntos
Aspergillus/isolamento & purificação , Neoplasias Hematológicas/complicações , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Europa (Continente) , Feminino , Humanos , Aspergilose Pulmonar Invasiva/terapia , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
12.
Heart Fail Clin ; 17(3): 327-335, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051965

RESUMO

Heart failure with preserved ejection fraction (HFpEF) is a major public health problem that affects half of all patients with HF. It is rising in prevalence, is associated with high morbidity and mortality, and has very few effective treatments. HFpEF is currently understood as a heterogeneous syndrome originating from the interplay of cardiac and extracardiac abnormalities. The most important pathophysiology in patients with HFpEF is diastolic dysfunction, which presents with impairments in relaxation or increases in chamber stiffness that lead to an increase in left ventricular filling pressures at rest or during exercise that causes dyspnea.


Assuntos
Gerenciamento Clínico , Exercício Físico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico/fisiologia , Insuficiência Cardíaca/terapia , Humanos , Resultado do Tratamento
13.
Heart Fail Clin ; 17(3): 337-343, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051966

RESUMO

The prevalence of heart failure with preserved ejection fraction (HFpEF) is increasing rapidly, and its prognosis is as poor as that of HF with reduced EF. Hypertension is an important risk factor involved in the pathophysiology of HFpEF. Although treatment of hypertension lowers the incidence of HF and is beneficial in patients with HFpEF, there is conflicting evidence on this topic. This article discusses the pathophysiological mechanisms linking hypertension with HFpEF and also the current evidence on the treatment of hypertension in patients with HFpEF.


Assuntos
Pressão Sanguínea/fisiologia , Gerenciamento Clínico , Insuficiência Cardíaca/fisiopatologia , Hipertensão/complicações , Volume Sistólico/fisiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/fisiopatologia , Hipertensão/terapia , Incidência , Prognóstico , Fatores de Risco
14.
Heart Fail Clin ; 17(3): 463-482, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051977

RESUMO

Heart failure with preserved ejection fraction (HFpEF) is a significantly symptomatic disease and has a poor prognosis similar to that of heart failure with reduced ejection fraction (HFrEF). Contrary to HFrEF, HFpEF is difficult to diagnose, and the recommended diagnostic algorithm of HFpEF is complicated. Several therapies for HFpEF have failed to reduce mortality or morbidity. HFpEF is thought to be a complex and heterogeneous systemic disorder that has various phenotypes and multiple comorbidities. Therefore, therapeutic strategies of HFpEF need to change depending on the phenotype of the patient. This review highlights the pharmacologic and nonpharmacologic treatment of HFpEF.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Gerenciamento Clínico , Insuficiência Cardíaca/terapia , Volume Sistólico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Humanos
15.
Heart Fail Clin ; 17(3): 483-498, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051978

RESUMO

Heart failure with preserved ejection fraction (HFpEF) accounts for more than one-half of patients with heart failure. Effective treatment of HFpEF has not been established, largely because of the complexities and heterogeneity in the phenotypes of HFpEF. Categorizing patients based on clinical and pathophysiologic phenotype may provide more targeted and efficacious therapies. Despite this clinical need, there is no consensus on how to categorize patients with HFpEF into phenogroups. Possible metrics include the presence or absence of specific comorbidities that influence pathophysiology, imaging, hemodynamics, or other biomarkers. This article describes currently recognized phenotypes of HFpEF and potential treatment strategies.


Assuntos
Gerenciamento Clínico , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico/fisiologia , Insuficiência Cardíaca/terapia , Humanos , Fenótipo
16.
Heart Fail Clin ; 17(3): 499-518, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051979

RESUMO

Heart failure with preserved ejection fraction (HFpEF) is characterized by a high rate of hospitalization and mortality (up to 84% at 5 years), which are similar to those observed for heart failure with reduced ejection fraction (HFrEF). These epidemiologic data claim for the development of specific and innovative therapies to reduce the burden of morbidity and mortality associated with this disease. Compared with HFrEF, which is due to a primary myocardial damage (eg ischemia, cardiomyopathies, toxicity), a heterogeneous etiologic background characterizes HFpEF. The authors discuss these phenotypes and specificities for defining therapeutic strategies that could be proposed according to phenotypes.


Assuntos
Gerenciamento Clínico , Insuficiência Cardíaca/diagnóstico , Aprendizado de Máquina , Volume Sistólico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Fenótipo , Prognóstico
17.
Adv Respir Med ; 89(2): 231-233, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33966265

RESUMO

Coronavirus Disease-2019 (COVID-19), caused by the novel coronavirus, remains a largely unsolved mystery for researchers around the world as its global onslaught upon mankind continues unabated. To make matters worse, an upcoming and alarming trend that is increasingly being noticed as a post-COVID sequel is that of pulmonary fibrosis. Given the scale of the pandemic, the magnitude of this problem is likely to be high. Extrapolated conclusions from previous studies discussing the beneficial role of antifibrotics in progressive fibrosing interstitial lung diseases provide some hope that these medicines might have a potentially useful role in COVID-19 related lung fibrosis as well. Increased serum levels of inflammatory and pro-fibrotic mediators in COVID-19 patients, similar cytokine profiles in idiopathic pulmonary fibrosis and COVID-19, and broad anti-fibrotic activity of approved antifibrotics irrespective of the underlying etiology, are some of the proposed mechanisms favoring the argument. However, no studies currently support or refute the use of antifibrotics in patients developing post-COVID-19 pulmonary fibrosis. In view of such uncertainties, it is critically important for lung fibrosis networks to conduct well-designed prospective clinical trials addressing this issue to find conclusive answers.


Assuntos
Antifibrinolíticos/uso terapêutico , /terapia , /estatística & dados numéricos , Gerenciamento Clínico , Humanos
18.
Endokrynol Pol ; 72(2): 170-178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33970482

RESUMO

On March 11, 2020, the World Health Organisation (WHO) observed the scale of epidemic risk and declared the state of the COVID-19 pandemic. Most countries, including Poland, implemented national and local emergency management plans to deal with the imminent threat of SARS-CoV-2 infection, one of the most serious in this century, according to many experts. In the era of pandemic, during which an epidemiological regime and social distancing are constantly recommended, and routine medical care and planned surgical procedures have been postponed or significantly reduced, patients and their physicians have to struggle on a daily basis with difficult access to diagnostic and therapeutic procedures. This is a great challenge for both groups. The aim of this study is to assess the current state of knowledge about thyreological diseases during the COVID-19 pandemic and to provide indications for the introduced therapeutic changes on the basis of recent scientific literature published up to December 2020 and searches of the PubMed, Google Scholar, EMBASE, and Web of Science databases, which searched for keywords related to SARS-CoV-2 and its influence on thyreology problems. The main focus was on diagnostic and therapeutic differences in the era of the COVID-19 pandemic, bearing in mind the most common endocrinopathies, i.e. hypothyroidism and hyperthyroidism, as well as advantages and disadvantages and possibilities of using telemedicine in the common practice of a specialist physician.


Assuntos
/terapia , Hipertireoidismo/terapia , Hipotireoidismo/terapia , /epidemiologia , Gerenciamento Clínico , Humanos , Polônia , Fatores de Risco , Telemedicina/organização & administração
20.
PLoS One ; 16(5): e0249655, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33983981

RESUMO

Moderate cases account for the majority in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can also progress to severe/critical condition. Here, we investigated the clinical course and management of hospitalized moderate SARS-CoV-2 patients. The medical records and follow-up data were analyzed from the SARS-CoV-2 patients outside Wuhan. A total of 73 moderate patients (38 men, 35 women) were included, with median age of 47.0 (38.5-57.5) years. Among them, only one patient (1.4%) died using active treatment to improve symptoms. The median duration of the four main symptoms cough, fever, chest tightness, and fatigue were 11.0, 8.0, 11.0, and 7.0 days, respectively; the median duration of the positive nucleic acid test (NAT) results for SARS-CoV-2 was 16.5 days; the median hospitalization time was 25.0 days in 72 moderate survivors. The duration of cough and fever was positively correlated with the duration of the positive NAT results. On admission, 50% had lymphopenia; less than 30% had abnormal blood biochemistry findings involving hyperglycemia, liver function and myocardial enzymes. At discharge, the laboratory indexes were substantially improved. Two weeks after discharge, 5.6% survivors experienced a recurrence of the positive NAT results. Moderate SARS-CoV-2 patients have a good prognosis by the active treatment. A small proportion of the recovered moderate patients still may be virus carriers and require an additional round of viral detection.


Assuntos
/diagnóstico , /isolamento & purificação , Adulto , Antivirais/uso terapêutico , /epidemiologia , China/epidemiologia , Gerenciamento Clínico , Feminino , Seguimentos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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