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2.
Pediatr Infect Dis J ; 40(1): e39-e41, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33093429

RESUMO

A significant drop was found in the number of hospitalizations due to bacterial infections among children during the first peak period of COVID-19 in Israel. There was a 77% decrease in serious bacterial infections, and ≥50% decrease in most types of bacterial infections, especially osteoarticular and skin infections, followed by pneumonia and ENT infections.


Assuntos
Infecções Bacterianas/epidemiologia , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Infecções Bacterianas/patologia , Criança , Hospitalização/tendências , Hospitais Pediátricos , Humanos , Incidência , Israel/epidemiologia , Estudos Retrospectivos
3.
Scand J Gastroenterol ; 56(1): 68-71, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33119428

RESUMO

OBJECTIVE: Several studies have reported on liver injury during COVID-19. However, the definition and timing of liver injury is different among the published articles. The aim of the present study is to evaluate whether COVID-19 related liver injury at the time of first presentation is associated with the course of the disease. METHODS: We conducted a single center retrospective study at Amphia Hospital in Breda, The Netherlands, from February 1 through April 30, 2020. Patients with reverse transcription polymerase chain reaction confirmed COVID-19 were included. We excluded patients with known chronic liver disease, harmful alcohol consumption or patients on certain antibiotics prior to admission. The clinical characteristics and outcomes of patients with and without COVID-19 related liver injury were compared. Liver injury was defined as elevated alanine aminotransferase and/or alkaline phosphatase at the time when the first positive COVID-19 sample was obtained. RESULTS: We included 382 patients with COVID-19 infection. The incidence of liver injury was 41.6% (n = 159). Being female was associated with liver injury (p < .05). Liver injury was not associated with a more severe course of the disease in terms of hospitalization, length of hospital stay, intensive care unit admission and mortality. CONCLUSION: COVID-19 related liver injury at the time of diagnosis of COVID-19 does not seem to be associated with a more severe course of the disease in our hospital.


Assuntos
/epidemiologia , Hospitalização/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Hepatopatias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Hepatopatias/diagnóstico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pandemias , Estudos Retrospectivos
4.
Brain Behav Immun ; 91: 383-392, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33148439

RESUMO

INTRODUCTION: Our understanding of risk factors for COVID­19, including pre-existing medical conditions and genetic variations, is limited. To what extent the pre-existing clinical condition and genetic background have implications for COVID-19 still needs to be explored. METHODS: Our study included 389,620 participants of European descent from the UK Biobank, of whom 3,884 received the COVID-19 test and 1,091 were tested positive for COVID-19. We examined the association of COVID-19 status with an extensive list of 974 medical conditions and 30 blood biomarkers. Additionally, we tested the association of genetic variants in two key genes related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2), with COVID-19 or any other phenotypes. RESULTS: The most significant risk factors for COVID-19 include Alzheimer's disease (OR = 2.29, 95% CI: 1.25-4.16), dementia (OR = 2.16, 95% CI: 1.36-3.42), and the overall category of delirium, dementia, amnestic and other cognitive disorders (OR = 1.90, 95% CI: 1.24-2.90). Evidence suggesting associations of genetic variants in SARS-CoV-2 infection-related genes with COVID-19 (rs7282236, OR = 1.33, 95% CI: 1.14-1.54, p = 2.31 × 10-4) and other phenotypes, such as an immune deficiency (p = 5.65 × 10-5) and prostate cancer (p = 1.1 × 10-5), was obtained. CONCLUSIONS: Our unbiased and extensive search identified pre-existing Alzheimer's disease and dementia as top risk factors for hospital admission due to COVID-19, highlighting the importance of providing special protective care for patients with cognitive disorders during this pandemic. We also obtained evidence suggesting a direct association of genetic variants with COVID-19.


Assuntos
/psicologia , Disfunção Cognitiva/fisiopatologia , Hospitalização/tendências , Adulto , Idoso , /metabolismo , Biomarcadores/sangue , Cognição , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , /metabolismo , Serina Endopeptidases/genética , Serina Endopeptidases/metabolismo
5.
Res Social Adm Pharm ; 17(1): 1978-1983, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32317153

RESUMO

The coronavirus disease-19 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus that was first detected at the end of December 2019. The epidemic has affected various regions of China in different degrees. As the situations evolve, the COVID-19 had been confirmed in many countries, and made a assessment that it can be characterized as a pandemic by the World Health Organization on March 11, 2020. Drugs are the main treatment of COVID-19 patients. Pharmaceutical service offers drug safety ensurance for COVID-19 patients. According to COVID-19 prevention and control policy and requirements, combined with series of diagnosis and treatment plans, pharmacists in the first provincial-level COVID-19 diagnosis and treatment unit in Jilin Province in Northeast China have established the management practices of drug supply and pharmaceutical care from four aspects: personnel, drugs supply management, off-label drug use management and pharmaceutical care. During the outbreak, the pharmaceutical department of THJU completed its assigned workload to ensure drug supply. So far, no nosocomial infections and medication errors have occurred, which has stabilized the mood of the staff and boosted the pharmacists' confidence in fighting the epidemic. For the treatment of COVID-19, pharmacists conducted adverse reaction monitoring and participated in the multidisciplinary consultation of COVID-19. Up to now, the COVID-19 patients admitted to THJU have not shown any new serious adverse reactions and been cured finally. The hospital pharmacy department timely adjusted the work mode, and the formed management practices is a powerful guarantee for the prevention and control of the COVID-19 epidemic. This paper summarized the details and practices of drug supply and pharmaceutical services management to provide experience for the people who involving in COVID-19 prevention and contain in other abroad epidemic areas.


Assuntos
/terapia , Hospitais/provisão & distribução , Uso Off-Label , Preparações Farmacêuticas/provisão & distribução , Assistência Farmacêutica/provisão & distribução , Serviço de Farmácia Hospitalar/provisão & distribução , /epidemiologia , China/epidemiologia , Epidemias , Hospitalização/tendências , Hospitais/tendências , Humanos , Assistência Farmacêutica/tendências , Serviço de Farmácia Hospitalar/tendências
7.
Res Social Adm Pharm ; 17(1): 2009-2011, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32425713

RESUMO

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic having caused a major health care crises across the globe. Pharmacy professionals are considered vital in preparation for optimal response to the COVID-19 pandemic. Therefore, in response to the estimated potential impact of COVID-19 on Johns Hopkins Aramco Healthcare (joint venture between Saudi Aramco and Johns Hopkins Medicine International), several initiatives were taken by the hospital's inpatient pharmacy department with focus on infection control, staffing, meeting clinical operational challenges, ethics, increased utilization of automation, and maintenance of employee wellness to prepare for this challenge. The plan implemented by the inpatient pharmacy department was prepared while incorporating information and recommendations from leading pharmacy organizations, ministry of health, institute's experience in battling another similar coronavirus (the Middle East respiratory syndrome-coronavirus) previously, and updated scientific research. The key focus areas include development of an institutionalized COVID-19 protocol, measures to improve infection control when handling and dispensing medications, modified staffing plan, system changes in peri-operative areas, keeping pharmacy professionals updated about new and scientific researches, increased utilization of automation, clinical interventions by pharmacist ensuring appropriate utilization of medications while monitoring for drug-drug interactions, adverse drug event prevention, and preparing for handling drug shortages. By implementing a robust plan, pharmacy professionals continue to show that they are an integral member of inter-professional health care teams.


Assuntos
/epidemiologia , Farmacêuticos , Serviço de Farmácia Hospitalar/métodos , Hospitalização/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/tendências , Pandemias , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , Arábia Saudita/epidemiologia
10.
Neurosurg Focus ; 49(6): E7, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33260131

RESUMO

OBJECTIVE: COVID-19 has affected surgical practice globally. Treating neurosurgical patients with the restrictions imposed by the pandemic is challenging in institutions with shared patient areas. The present study was performed to assess the changing patterns of neurosurgical cases, the efficacy of repeated testing before surgery, and the prevalence of COVID-19 in asymptomatic neurosurgical inpatients. METHODS: Cases of non-trauma-related neurosurgical patients treated at the Postgraduate Institute of Medical Education and Research (PGIMER) before and during the COVID-19 pandemic were reviewed. During the pandemic, all patients underwent a nasopharyngeal swab reverse transcription-polymerase chain reaction test to detect COVID-19 at admission. Patients who needed immediate intervention were surgically treated following a single COVID-19 test, while stable patients who initially tested negative for COVID-19 were subjected to repeated testing at least 5 days after the first test and within 48 hours prior to the planned surgery. The COVID-19 positivity rate was compared with the local period prevalence. The number of patients who tested positive at the second test, following a negative first test, was used to determine the probable number of people who could have become infected during the surgical procedure without second testing. RESULTS: Of the total 1769 non-trauma-related neurosurgical patients included in this study, a mean of 337.2 patients underwent surgery per month before COVID-19, while a mean of 184.2 patients (54.6% of pre-COVID-19 capacity) underwent surgery per month during the pandemic period, when COVID-19 cases were on the rise in India. There was a significant increase in the proportion of patients undergoing surgery for a ruptured aneurysm, stroke, hydrocephalus, and cerebellar tumors, while the number of patients seeking surgery for chronic benign diseases declined. At the first COVID-19 test, 4 patients (0.48%) tested were found to have the disease, a proportion 3.7 times greater than that found in the local community. An additional 5 patients tested positive at the time of the second COVID-19 test, resulting in an overall inpatient period prevalence of 1%, in contrast to a 0.2% national cumulative caseload. It is possible that COVID-19 was prevented in approximately 67.4 people every month by using double testing. CONCLUSIONS: COVID-19 has changed the pattern of neurosurgical procedures, with acute cases dominating the practice. Despite the fact that the pandemic has not yet reached its peak in India, COVID-19 has been detected 3.7 times more often in asymptomatic neurosurgical inpatients than in the local community, even with single testing. Double testing displays an incremental value by disclosing COVID-19 overall in 1 in 100 inpatients and thus averting its spread through neurosurgical services.


Assuntos
/tendências , /epidemiologia , Hospitalização/tendências , Procedimentos Neurocirúrgicos/tendências , Adolescente , Adulto , Idoso , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Prevalência , Resultado do Tratamento
11.
Nephrol Dial Transplant ; 35(12): 2083-2095, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33275763

RESUMO

BACKGROUND: Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3-5), HD and RT patients with a control group of patients is still lacking. METHODS: We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3-5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared. RESULTS: A total of 1210 patients were included [median age, 61 (quartile 1-quartile 3 48-71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9-45.2; and 82/289 (28.4%); 95% CI 23.9-34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3-29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0-20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2-30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7-19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8-10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5-6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52-5.44); P = 0.001; 2.44 (1.35-4.40); P = 0.003; HD: 2.32 (1.21-4.46); P = 0.011; 2.25 (1.23-4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76-4.72); P = 0.169; 1.87 (0.81-4.28); P = 0.138, respectively]. CONCLUSIONS: Hospitalized COVID-19 patients with CKDs, including Stages 3-5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3-5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.


Assuntos
/epidemiologia , Transplante de Rim , Diálise Renal/métodos , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Comorbidade , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Turquia/epidemiologia
12.
Eur Rev Med Pharmacol Sci ; 24(22): 11919-11925, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33275264

RESUMO

OBJECTIVE: The pandemic from SARS-CoV-2 is having a profound impact on daily life of a large part of world population. Italy was the first Western country to impose a general lockdown to its citizens. Implications of these measures on several aspects of public health remain unknown. The aim of this study was to investigate the effects of the lockdown on surgical emergencies volumes and care in a large, tertiary referral center. MATERIALS AND METHODS: Electronic medical records of all patients visited in our Emergency Department (ED) and admitted in a surgical ward from February 21st 2020 to May 3rd 2020 were collected, analyzed and compared with the same periods of 2019 and 2018 and a cross-sectional study was performed. RESULTS: Number of surgical admissions dropped significantly in 2020 with respect to the same periods of 2019 and 2018, by almost 50%. The percentage distribution of admissions in different surgical wards did not change over the three years. Time from triage to operating room significantly reduced in 2020 respect to 2019 and 2018 (p<0.001). CONCLUSIONS: The lockdown in Italy due to SARS-CoV-2 pandemic arguably represents the largest social experiment in modern times. Data provided by our study provide useful information to health authorities and policymakers about the effects of activity restriction on surgical accesses and changing epidemiology due to an exceptional external event.


Assuntos
Colecistite Aguda/epidemiologia , Gastroenteropatias/epidemiologia , Hospitalização/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Adulto , Apendicite/epidemiologia , Apendicite/cirurgia , Colecistite Aguda/cirurgia , Diverticulite/epidemiologia , Diverticulite/cirurgia , Emergências , Serviço Hospitalar de Emergência , Feminino , Gastroenteropatias/cirurgia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/cirurgia , Hérnia/epidemiologia , Herniorrafia/tendências , Humanos , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/cirurgia , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/cirurgia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Retais/epidemiologia , Doenças Retais/cirurgia , Centro Cirúrgico Hospitalar , Centros de Atenção Terciária , Tempo para o Tratamento/tendências
13.
BMC Pediatr ; 20(1): 562, 2020 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-33353540

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore. METHODS: We performed a retrospective review of ED attendances and hospital admissions among children < 18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs). RESULTS: We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline (p < 0.001), attributed largely to a drop in respiratory (% change - 87.9, 95% CI - 89.3 to - 86.3, p < 0.001) and gastrointestinal infections (% change - 72.4, 95%CI - 75.9 to - 68.4, p < 0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change - 40.0, 95%CI - 44.3 to - 35.3, p < 0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p < 0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change - 73.9, 95%CI - 75.9 to - 71.7, p < 0.001). CONCLUSIONS: We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.


Assuntos
/epidemiologia , Emergências/epidemiologia , Hospitalização/tendências , Pandemias , Pré-Escolar , Serviço Hospitalar de Emergência/tendências , Feminino , Humanos , Masculino , Estudos Retrospectivos , Singapura/epidemiologia
14.
Arch Iran Med ; 23(12): 856-863, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33356344

RESUMO

BACKGROUND: Due to the physiological changes in the body during pregnancy, the increased susceptibility to viral infections during this period and also the high prevalence of coronavirus disease 2019 (COVID-19) in the Guilan province, Iran, this study aimed to evaluate risk factors, clinical symptoms, laboratory findings and imaging of pregnant mothers with COVID-19. METHODS: In this descriptive study, 70 pregnant women aged 17-41 years with COVID-19 who were hospitalized from early March to late April 2020 were enrolled. Sampling was performed by census and from all hospitals in Guilan. The research instruments included a researcher-made questionnaire, including demographic characteristics, clinical symptoms, medical examinations, and paraclinical results. Data were analyzed with SPSS version 16. Frequency and percent were used to describe qualitative variables; for quantitative variables, if they were normally distributed, mean and standard deviation were used, and if they were non-normal, median and interquartile range (IQR) were used. RESULTS: The most severe symptoms recorded in mothers at the time of hospitalization were fever (47%), shortness of breath (16%) and cough (15%), respectively. One of 68 (1%) was in the severe stage of the disease and two mothers (2%) were in critical condition and admitted to the intensive care unit and finally died. Fifty-five of 66 women (83%) had lymphopenia, 22 of 42 (52%) tested positive on PCR, and 30 of 33 (90%) had an increase in lactate dehydrogenase (LDH) levels.Results showed that 15 of 32 patients who gave birth had preterm delivery (46%). CONCLUSION: The most common manifestations of the disease in pregnant women were fever, cough and shortness of breath, and in some cases muscle pain. The most common laboratory finding in infected mothers was lymphopenia. Complications of pregnancy and childbirth in women included an increase in cesarean delivery.


Assuntos
/epidemiologia , Hospitalização/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Indian Heart J ; 72(6): 593-598, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33357651

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has led to a widespread morbidity and mortality. Limited data exists regarding the involvement of cardiovascular system in COVID-19 patients. We sought to evaluate the cardiovascular (CV) complications and its impact on outcomes in symptomatic COVID-19 patients. METHODS: This was a single center observational study among symptomatic COVID-19 patients. Data regarding clinical profile, laboratory investigations, CV complications, treatment and outcomes were collected. Cardiac biomarkers and 12 lead electrocardiograms were done in all while echocardiography was done in those with clinical indications for the same. Corrected QT-interval (QTc) at baseline and maximum value during hospitalization were computed. RESULTS: Of the 108 patients, majority of them were males with a mean age of 51.2 ± 17.7 years. Hypertension (38%) and diabetes (32.4%) were most prevalent co-morbidities. ECG findings included sinus tachycardia in 18 (16.9%), first degree AV block in 5 (4.6%), VT/VF in 2 (1.8%) and sinus bradycardia in one (0.9%). QTc prolongation was observed in 17.6% subjects. CV complications included acute cardiac injury in 25.9%, heart failure, cardiogenic shock and acute coronary syndrome in 3.7% each, "probable" myocarditis in 2.8% patients. Patients with acute cardiac injury had higher mortality than those without (16/28 [57.1%] vs 14/78 [17.5%]; P < 0.0001). Multivariate logistic regression analysis showed that acute cardiac injury (OR: 11.3), lymphopenia (OR: 4.91), use of inotropic agents (OR: 2.46) and neutrophil-lymphocyte ratio (OR:1.1) were independent predictors of mortality. CONCLUSIONS: CV complications such as acute cardiac injury is common in COVID-19 patients and is associated with worse prognosis.


Assuntos
/complicações , Doenças Cardiovasculares/etiologia , Hospitalização/tendências , /epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Comorbidade , Eletrocardiografia , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Estudos Retrospectivos
16.
Indian Heart J ; 72(6): 599-602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33357652

RESUMO

Few studies from various countries have reported decline in Acute Coronary Syndrome (ACS) admissions to hospital during COVID-19 pandemic. We studied the impact of COVID-19 strict lockdown on ACS admission in a tertiary referral hospital in India. This showed 43% decline in admissions (n = 104 vs mean n = 183) and even in those who got admitted, there was a delay in presentation compared to previous year, which was reflected in the outcome of patients. Government and health organizations should educate the public early-on during the pandemic about the consequences of ignoring other acute medical problems such as ACS.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Hospitalização/tendências , Pandemias , Centros de Atenção Terciária/estatística & dados numéricos , Síndrome Coronariana Aguda/terapia , Comorbidade , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
N Z Med J ; 133(1526): 31-44, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332338

RESUMO

AIMS: For older patients with hip fracture, we explored patient characteristics, outcomes and osteoporosis treatments for those admitted to rehabilitation compared to those discharged directly from hospital, using data set analysis. METHODS: Retrospective cohort study including all consecutive patients (65 years and over) admitted to Christchurch Hospital over one year. Outcomes were compared for patients in four groups: 1) aged residential care (ARC) residents and 2) not ARC residents discharge from acute orthopaedics, and those discharged from 3) orthogeriatric or 4) general geriatric rehabilitation. Clinical data was extracted from hospital data warehouse using signals from noise. RESULTS: Over 12 months, 415 patients were admitted with hip fracture. Over half (n=282) were transferred for inpatient rehabilitation. Thirty-day mortality was 10%. Mortality at 180 days was 7% in orthogeriatric rehabilitation group and 8% in general rehabilitation group. Length of stay was shorter in orthogeriatric compared with general rehabilitation (median 12.9 vs 20.4 days). Osteoporosis treatment was addressed in 88% of patients in the orthogeriatric group compared with 62% in general rehabilitation group. More patients in orthogeriatric group discharged home compared with general rehabilitation group (70% vs 43%), but functional improvements were similar. For ARC residents discharged following acute admission, length of stay was short (median 6.5 day), but overall 180-day mortality was 7%. The not-ARC resident group discharged directly from hospital was less comorbid than the other groups with lower 180-day mortality (4%). Osteoporosis treatment rates were lower in patients discharged from acute admission (15-42%). CONCLUSION: Mortality was highest in ARC residents discharged from acute orthopaedics. Patients admitted for orthogeriatric rehabilitation had shorter length of stay, lower 30-day mortality, were more likely to return home and most likely to be offered osteoporosis treatment (88%), noting less underlying comorbidity and better baseline functional status in this group. This paper supports further study (eg, randomised trials) to examine the effects of targeted post-surgical rehabilitation for patients with hip fracture and explore measures to increase uptake of osteoporosis treatment.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Avaliação Geriátrica/métodos , Fraturas do Quadril/reabilitação , Hospitalização/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Morbidade/tendências , Nova Zelândia/epidemiologia , Prognóstico , Estudos Retrospectivos
18.
N Z Med J ; 133(1526): 55-66, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332340

RESUMO

AIM: This retrospective review examined the influence of age and severity of comorbidities on goals-of-care in advance care plans (ACPlans) and concordance between these wishes and care received during hospital admission. METHODS: The medical records of 149 people with an ACPlan admitted to a public hospital were reviewed to evaluate concordance with treatment. The associations between age and comorbidities and goals-of-care were determined using contingency tables and logistic regression analyses. RESULTS: The majority of the review cohort were Caucasian and elderly, with people from minority ethnic groups under-represented compared to census data. Increasing age had a measurable influence on the choice of goal-of-care, whereas comorbidity severity had less influence on this decision. In 60 of the 411 hospital admissions the patient was classified as incompetent, with the goal-of-care adhered to in 59 of these cases and treatment preferences adhered to in six of seven cases. Fifty-five people had died since writing their ACPlan, with 63% dying at their preferred place or with no preference stated. CONCLUSIONS: Age and to a lesser extent the severity of comorbidities influence the choice of goal-of-care in an ACPlan. Our review also showed that end-of-life care appeared to adhere to the instructions in the plan.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Hospitalização/tendências , Hospitais Públicos/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Preferência do Paciente , Assistência Terminal/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Nova Zelândia , Estudos Retrospectivos
19.
J Gastrointestin Liver Dis ; 29(4): 549-553, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33331349

RESUMO

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBD) patients management has been challenging during the ongoing coronavirus disease 2019 (COVID-19) pandemic, due to lockdowns, limitation of access to medical facilities and new recommendations regarding patient management. The implications of the COVID-19 pandemic on IBD patients' management were assessed in our Tertiary Gastroenterology Center in Bucharest, Romania. METHODS: Medical records of IBD patients admitted between 15th of March and 15th of August 2020 were retrospectively reviewed and compared to a control cohort of consecutive IBD patients admitted to our unit during the corresponding period of 2019. RESULTS: There was a highly significant shift towards one-day hospitalization during the referral period in 2020 for IBD cases (91% in 2020 vs 82.2% in 2019, p=0.0001). There was no statistically significant difference between the distribution of patient's gender, IBD phenotype or newly diagnosed IBD cases. A significantly lower proportion of admitted patients received 5-aminosalicylic acid (29% vs 41.2%, p=0.0001), whereas a substantially higher number of patients were prescribed biological therapy in 2020 in comparison to the corresponding 2019-time frame (79.5% vs 57.9%, p<0.0001). The distribution of the biological agent used was significantly different in 2019 in comparison to the 2020 period mainly due to the increase in vedolizumab prescription in 2020 (p<0.0001). During the study period in 2020, seven IBD patients (1.7%) were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection, all of them with mild symptoms without impact on the IBD course. CONCLUSIONS: The COVID-19 pandemic led to reorganizing medical care, limiting the hospital admissions in favor of severe IBD cases, favoring telemedicine for mild disease and optimization of treatment for moderate to severe IBD with an increased use of biologicals aimed to maximize the risk/benefit ratio. Incidence of SARS-Cov2 infection during the first wave of COVID-19 infection in our study group was 1.7% and did not adversely impact the IBD disease course.


Assuntos
Anti-Inflamatórios/uso terapêutico , Produtos Biológicos/uso terapêutico , Prestação Integrada de Cuidados de Saúde/tendências , Hospitalização/tendências , Doenças Inflamatórias Intestinais/tratamento farmacológico , Telemedicina/tendências , Anti-Inflamatórios/efeitos adversos , Produtos Biológicos/efeitos adversos , Humanos , Incidência , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Segurança do Paciente , Estudos Retrospectivos , Romênia/epidemiologia , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
20.
Med Gas Res ; 10(4): 174-178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380584

RESUMO

World Health Organization has declared coronavirus disease-19 (COVID-19) as a pandemic. Although there are studies about this novel virus, our knowledge is still limited. There is limited information about its diagnosis, treatment and prognosis. We aimed to investigate the effect of methemoglobin and carboxyhemoglobin levels on the prognosis of COVID-19. In this observational study, patients who were diagnosed with COVID-19 during March 1-April 31, 2020 in a secondary-level state hospital in Turkey were included in the study. COVID-19 diagnosis was confirmed with reverse transcription polymerase chain reaction method, with nasal, oral or sputum specimens. During the period this study was performed, 3075 patients were tested for COVID-19 and 573 of them were hospitalized. Among the hospitalised patients, 23.2% (133) of them had a positive polymerase chain reaction result for COVID-19. A total of 125 patients, 66 (52.8%) males and 59 (47.2%) females, with an average age of 50.2 ± 19.8 years, were included in the study. The most common findings in chest radiogram were ground-glass areas and consolidations, while one-third of the patients had a normal chest radiogram. Computed thorax tomography was performed for 77.6% (97/125) of the patients. The 24.7% of computed tomographies (24/97) did not reveal any pathological findings, and the most common findings were ground-glass appearance and consolidation. Those who needed intensive care had statistically significantly lower platelet count (P = 0.011) and higher lactate dehydrogenase levels (P < 0.001). No statistically significant difference was found in carboxyhemoglobin (P = 0.395) and methemoglobin (P = 1.000) levels. We found that carboxyhemoglobin and methemoglobin levels had no effect on COVID-19 prognosis, but low platelet level played a role in predicting COVID-19 prognosis. This study was approved by the Ethical Committee of Harran University Faculty of Medicine on May 11, 2020 with approval No. 09.


Assuntos
/sangue , Carboxihemoglobina/metabolismo , Metemoglobina/metabolismo , Adulto , Idoso , Biomarcadores/sangue , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/métodos , Valor Preditivo dos Testes , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Turquia/epidemiologia
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