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1.
Rev. enferm. UERJ ; 28: e47321, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1116094

RESUMO

Objetivo: analisar a produção científica nacional e internacional, buscando as interfaces existentes entre os princípios bioéticos e os cuidados em saúde prestados ao fim da vida às pessoas idosas. Método: revisão integrativa, cuja busca ocorreu entre outubro e novembro de 2019 nas bases de dados Medline via Pubmed, Lilacs e Scopus com os descritores: "Palliative Care", "Aged" e "Bioethics" de 2014-2019. Resultados: a partir dos artigos selecionados, emergiram as seguintes categorias: condutas terapêuticas frente aos cuidados ao fim da vida; tomada de decisão nos cuidados ao fim da vida; e desafios nos cuidados ao fim da vida. Conclusão: destaca-se a relevância dos profissionais manterem o compromisso com a pessoa idosa e sua família de forma a considerar suas subjetividades e preferências e os instrumentalizar para que os cuidados sejam pautados em princípios bioéticos, para assim proporcionar um processo de morte e de morrer com dignidade.


Objective: to examine the Brazilian and international scientific production for connections between bioethical principles and the health care provided to older adults at the end of their lives. Method: between October and November 2019 this integrative review searched the Medline (Pubmed), Lilacs, and Scopus databases using the descriptors: "Palliative Care", "Aged", and "Bioethics" for the period 2014-2019. Results: the following categories emerged from the selected articles: therapeutic conducted with regard to end-of-life care; decision making on end-of-life care; and challenges in end-of-life care. Conclusion: of particular importance is for health professionals to uphold their commitment to older adults and their families, consider their subjectivities and preferences, and empower and equip them so that care is guided by bioethical principles in order to assure a dignified process of dying and death.


Objetivo: examinar la producción científica brasileña e internacional en busca de conexiones entre los principios bioéticos y la atención médica brindada a los adultos mayores al final de sus vidas. Método: entre octubre y noviembre de 2019, esta revisión integradora buscó en las bases de datos Medline (Pubmed), Lilacs y Scopus utilizando los descriptores: "Cuidados paliativos", "Envejecido" y "Bioética" para el período 2014-2019. Resultados: las siguientes categorías surgieron de los artículos seleccionados: terapéutico realizado con respecto a la atención al final de la vida; toma de decisiones sobre la atención al final de la vida; y desafíos en la atención al final de la vida. Conclusión: es de particular importancia que los profesionales de la salud mantengan su compromiso con los adultos mayores y sus familias, consideren sus subjetividades y preferencias, y los empoderen y equipen para que la atención se guíe por principios bioéticos para asegurar un proceso digno de muerte y muerte.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Cuidados Paliativos na Terminalidade da Vida/ética , Temas Bioéticos , Pessoalidade , Morte , Relações Profissional-Família/ética , Relações Profissional-Paciente/ética , Atitude Frente a Morte , Valor da Vida
2.
Rev. enferm. UERJ ; 28: e35054, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1117622

RESUMO

Objetivo: avaliar a mobilidade do cliente com dermatose imunobolhosa antes e após aplicação do curativo com gaze vaselinada. Método: estudo quase experimental, interinstitucional, com clientes com dermatoses imunobolhosas hospitalizados em um hospital estadual e um hospital federal do Estado do Rio de Janeiro e uma instituição do Mato Grosso do Sul. Utilizou-se a lógica fuzzy para classificar a mobilidade dos sujeitos antes, 24 horas após e uma semana após aplicação do curativo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Resultados: Incluídos 14 participantes, sendo nove com pênfigo vulgar, dois com pênfigo foliáceo e três com penfigóide bolhoso, entre 27 e 82 anos, predominando 11 mulheres. Após 24 horas, nenhum participante se considerou com baixa mobilidade, sete passaram a mobilidade média, e sete, alta, o que foi mantido uma semana após aplicação do curativo. Conclusão: constatou-se significativo aumento da mobilidade logo nas primeiras 24 horas após aplicação do curativo.


Objective: to assess the mobility of clients with immunobullous dermatoses, before and after applying vaseline gauze dressings. Method: in this quasi-experimental, interinstitutional study of inpatients with immunobullous dermatoses at a state hospital and a federal hospital in Rio de Janeiro State and an institution in Mato Grosso do Sul (Brazil), patient mobility before, 24 hours after, and one week after applying the dressing was classified using fuzzy logic. The study was approved by the research ethics committee. Results: 14 participants, nine with pemphigus vulgaris, two with pemphigus foliaceus, and three with bullous pemphigoid, aged between 27 and 82 years old, and predominantly (11) women. After 24 hours, none of the participants considered their mobility to be poor, seven began to be moderately mobile, and seven were highly mobile, and continued so one week after applying the dressing. Conclusion: mobility increased significant in the first 24 hours after applying the dressing.


Objetivo: evaluar la movilidad de clientes con dermatosis inmunobullosa, antes y después de la aplicación de apósitos de gasa con vaselina. Método: en este estudio cuasi-experimental, interinstitucional de pacientes hospitalizados con dermatosis inmunobullosa en un hospital estatal y un hospital federal en el estado de Río de Janeiro y una institución en Mato Grosso do Sul (Brazil), la movilidad del paciente antes, 24 horas después y una semana después la aplicación del apósito se clasificó mediante lógica difusa. El estudio fue aprobado por el comité de ética en investigación. Resultados: se incluyeron 14 participantes, nueve con pénfigo vulgar, dos con pénfigo foliáceo y tres con penfigoide ampolloso, con edades comprendidas entre 27 y 82 años, y predominantemente mujeres (n=11). Después de 24 horas, ninguno de los participantes consideró que su movilidad fuera pobre, siete comenzaron a ser moderadamente móviles y siete eran altamente móviles, y así continuaron una semana después de la aplicación del apósito. Conclusión: la movilidad aumentó significativamente en las primeras 24 horas después de la aplicación del apósitoconsideraba con baja movilidad, siete comenzaron a tener movilidad media y siete, alta, que se mantuvo una semana después de aplicar el apósito. Conclusión: hubo un aumento significativo en la movilidad en las primeras 24 horas después de aplicar el apósito.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vaselina/uso terapêutico , Bandagens , Dermatopatias Vesiculobolhosas/terapia , Penfigoide Bolhoso/terapia , Pênfigo/terapia , Limitação da Mobilidade , Brasil , Lógica Fuzzy , Lesão por Pressão/prevenção & controle , Prevenção Secundária , Ensaios Clínicos Controlados não Aleatórios como Assunto , Hospitais Públicos , Pacientes Internados , Cuidados de Enfermagem
3.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(5): 286-288, sept.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192478

RESUMO

INTRODUCCIÓN: El síndrome de tormenta de citoquinas (STC) es una complicación muy grave de los pacientes con infección por SARS-CoV-2. El tratamiento y la evolución no están bien definidos. Nuestro objetivo es describir sus características clínicas, los tratamientos empleados y su evolución clínica. PACIENTES Y MÉTODO: Estudio retrospectivo observacional de pacientes consecutivos ingresados en el período comprendido entre el 23 de marzo y el 12 de abril de 2020 con infección por SARS-CoV-2 confirmada, con neumonía por estudio radiológico o tomografía de tórax, que cumplían criterios de STC y que recibieron tratamiento. Clasificamos a los pacientes en los que recibieron solo pulsos de glucocorticoides (GC), o pulsos de GC y tocilizumab. Determinamos niveles séricos de ferritina, PCR y dímeros-D. La variable final fue la supervivencia. RESULTADOS: Veintiún pacientes con una edad de 83 años (80-88 años). La ferritina media fue de 1.056 microg/L (317-3.553), la PCR de 115,8mg/dL (22-306) y los dímeros-D de 2,9mg/L (0,45-17,5). Todos los pacientes recibieron pulsos de GC y en 2 casos simultáneamente tocilizumab. El tiempo medio de seguimiento fue de 13,7 días (8-21). La mortalidad global fue del 38,1% (8/21pacientes). Los 2 pacientes que recibieron tocilizumab fallecieron. Los fallecidos presentaron niveles significativamente más elevados de ferritina (1.254 vs. 925microg/L; p = 0,045) y PCR (197,6 vs. 76mg/dL; p = 0,007). Al final del seguimiento se observó una disminución en los parámetros bioquímicos con ferritina de 727microg/L, PCR de 27mg/dl y dímeros-D de 1,18mg/L. En 13/21 pacientes (61,9%) el STC se controló sin necesidad de añadir otros tratamientos. CONCLUSIONES: La mortalidad del STC por SARS-CoV-2 es alta a pesar del tratamiento. Una mayor respuesta inflamatoria se asoció con una mayor mortalidad. Aunque parece que el uso precoz de pulsos de GC puede controlarlo, pudiendo disminuir la necesidad de uso de otros tratamientos, con el diseño del estudio y sus limitaciones, no se puede establecer esta conclusión


INTRODUCTION: Cytokine storm syndrome (CTS) is a serious complication of patients with SARS-CoV-2 infection. Treatment and evolution in octogenarians are not well defiREVned. Our objective is to describe its clinical characteristics, the treatments and its clinical evolution. PATIENTS AND METHOD: Retrospective observational study of consecutive patients admitted in the period between March 23 and April 12, 2020 with confirmed SARS-CoV-2 infection, with pneumonia by radiological study or chest tomography, whith STC criteria and who received treatment. We classified patients as those who received only glucocorticoid (GC) pulses, or GC and tocilizumab pulses. We determined serum levels of ferritin, CRP and D-dimers. The final variable was survival. RESULTS: 21 patients, (80-88 years). The mean ferritin was 1056 microg/L (317-3,553), CRP 115.8mg/dL (22-306) and D-dimers 2.9m/L (0.45-17.5). All patients received GC pulses and in 2 cases simultaneously tocilizumab. The mean follow-up time was 13.7 days (8-21). The overall mortality was 38.1% (8/21 patients). The 2 patients who received tocilizumab died. The deceased had significantly higher levels of ferritin (1,254 vs. 925microg/L; P=.045) and CRP (197.6 vs. 76mg / dL; P=.007). At the end of the follow-up, a decrease in the biochemical parameters was observed with ferritin of 727microg/L, CRP of 27mg/dl and D-dimers of 1.18mg/L. In 13/21 patients (61.9%), the CTS was controlled without the need to add other treatments. CONCLUSIONS: STC mortality from SARS-CoV-2 is high despite treatment. A greater inflammatory response was associated with a higher mortality. Although it seems that the early use of GC pulses could control it, and the use of other treatments such as tocilizumab shouldo be, with the study design and its limitations, this conclusion cannot be stablished


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Síndrome Respiratória Aguda Grave/imunologia , Vírus da SARS/patogenicidade , Citocinas/efeitos adversos , Inflamação/fisiopatologia , Glucocorticoides/administração & dosagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Estudos Retrospectivos , Infecções por Coronavirus/epidemiologia , Epidemias , Mediadores da Inflamação/imunologia , Inflamação/imunologia , Ferritinas/efeitos dos fármacos , Linfo-Histiocitose Hemofagocítica/imunologia
4.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(8): 629-638, oct. 2020.
Artigo em Espanhol | IBECS | ID: ibc-188364

RESUMO

BACKGROUND AND OBJECTIVES: Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma. MATERIAL AND METHODS: Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points. RESULTS: Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter > 4 cm or thickness > 6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (> 6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five-and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months. CONCLUSIONS: In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect tosee to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays


ANTECEDENTES Y OBJETIVOS: La pandemia del coronavirus COVID-19 ha provocado un confinamiento indefinido. Una posible consecuencia de esta situación es un retraso en los procedimientos asistenciales de las patologías comunes. El objetivo de este estudio es estimar el hipotético impacto en la supervivencia que tendría el aumento del tamaño tanto para los carcinomas de células escamosas (CCE) como de los melanomas. MATERIAL Y MÉTODO: Estudio observacional retrospectivo de cohortes multicéntrico. Se desarrolló un modelo de crecimiento exponencial para cada tumor basado en el tiempo de evolución que refiere el paciente. RESULTADOS: Se incluyeron un total de 200 pacientes con CCEs localizados en la cabeza y el cuello y 1000 pacientes con melanoma cutáneo. Se calculó una curva de crecimiento exponencial para cada tumor y se estimó el tamaño del tumor tras 1, 2 y 3 mes tras el diagnóstico. En la muestra, los CCE mayores de 4 cm o > 6 mm de grosor (definidos como T3) pasaron de 83 (41.5%) en el grupo de estudio real a una estimación de 58,5%, 70,5% y 72% tras 1, 2 y 3 meses de retraso quirúrgico estimado. Se estimó una disminución de la supervivencia específica de enfermedad (SEE) de un 6,2%, 8,2% y 5,2% a los 2, 5 y 10 años, respectivamente, tras tres meses de retraso. Para los melanomas, los melanomas ultragruesos (> 6 mm) pasaron del 6,9% en el grupo de estudio al 21,9%, 30,2% y 30,2% tras 1,2 y 3 meses de demora. La SEE a los 5 y 10 años del grupo de estudio descendió un 14,4% en ambos tiempos. CONCLUSIONES: En ausencia de un adecuado diagnóstico y tratamiento de los pacientes con CCE y melanoma en la actual situación de confinamiento en España, podemos llegar a asistir a un considerable aumento de los casos de CCE y melanomas gruesos y de gran tamaño. Se deben fomentar los esfuerzos para promocionar la autoexploración y facilitar el acceso a los dermatólogos para no aumentar la demora de estos pacientes. Palabras clave: melanoma, pronóstico, diagnóstico precoz, carcinoma de células escamosas cutáneo, COVID-19, confinamiento


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Neoplasias de Células Escamosas/mortalidade , Melanoma/mortalidade , Neoplasias Cutâneas/mortalidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Betacoronavirus , Pandemias , Quarentena , Análise de Sobrevida , Estudos Retrospectivos , Estudos de Coortes
5.
Rev. esp. quimioter ; 33(5): 369-378, oct. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193705

RESUMO

BACKGROUND: There are few descriptions of the clinical presentation and evolution of consecutive SARS-CoV-2 infections with a long-enough follow up. METHODS: Description of the first consecutive 100 patients with microbiologically-proven COVID-19 in a large hospital in Madrid, Spain including a minimum of two-month follow up. RESULTS: The median age of the patients (52% males) was 61.5 years (IQR=39.5-82.0) and the median BMI was 28.8 kg/m2 (IQR=24.7-33.7). Overall 72% of the patients had one or more co-morbid conditions with a median age-adjusted Charlson index of 2 (IQR=0-5.7). Five patients (5%) were immunosuppressed. The most common symptoms at the time of diagnosis were fever (80.0%), cough (53.0%) and dyspnea (23.0%). The median O2 saturation at the time of first examination was 94% (IQR=90-97). Chest X-ray on admission was compatible with pneumonia in 63% of the cases (bilateral in 42% and unilateral in 21%). Overall, 30% were managed at home and 70% were admitted to the hospital. Thirteen patients were admitted to the ICU with a median of 11 days of stay in the Unit (IQR=6.0-28.0). CALL score of our population ranged from 4 to 13. Overall, 60.0% of patients received antibiotic treatment and 66.0%, empirical antiviral treatment, mainly with lopinavir/ritonavir (65%) or hydroxychloroquine (42%). Mortality, with a minimum of 60 days of follow up, was 23%. The median age of the deceased patients was 85 years (IQR=79-93). CONCLUSIONS: We found a high mortality in the first 100 patients diagnosed with COVID-19 at our institution, associated with advanced age and the presence of serious underlying diseases


ANTECEDENTES: Existen pocas descripciones de la presentación clínica y evolución de infecciones consecutivas por SARS-CoV-2 con un seguimiento lo suficientemente largo. MÉTODOS: Descripción de los primeros 100 pacientes consecutivos con COVID-19 probada microbiológicamente en un gran hospital de Madrid, incluyendo un seguimiento mínimo de dos meses. RESULTADOS: La mediana de edad de los pacientes (52% hombres) fue de 61,5 años (RIC=39,5-82,0) y la mediana de IMC fue de 28,8 kg/m2 (RIC=24,7-33,7). El 72% de los pacientes tuvieron una o más comorbilidades con un índice de Charlson ajustado a la edad de 2 (RIC=0-5,7). Cinco pacientes (5%) estaban inmunodeprimidos. Los síntomas más comunes al momento del diagnóstico fueron fiebre (80,0%), tos (53,0%) y disnea (23,0%). La mediana de saturación de O2 en el momento del primer examen fue del 94% (RIC=90-97). La radiografía de tórax al ingreso fue compatible con neumonía en el 63% de los casos (bilateral en el 42% y unilateral en el 21%). El 30% fueron manejados en su domicilio y el 70% ingresados en el hospital. Trece pacientes ingresaron en la UCI con una mediana de 11 días de estancia en la Unidad (RIC=6,0-28,0). El score CALL de nuestra población varió de 4 a 13. En general, el 60,0% de los pacientes recibió tratamiento antibiótico y el 66,0%, tratamiento antiviral empírico, principalmente con lopinavir/ritonavir (65%) o hidroxicloroquina (42%). La mortalidad, con un mínimo de 60 días de seguimiento, fue del 23%. La mediana de edad de los pacientes fallecidos fue de 85 años (RIC=79-93). CONCLUSIONES: Encontramos una alta mortalidad en los primeros 100 pacientes diagnosticados con COVID-19 en nuestra institución, asociada con edad avanzada y presencia de enfermedades subyacentes graves


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Pneumonia Viral/epidemiologia , Mortalidade Hospitalar/tendências , Espanha/epidemiologia , Estatísticas Hospitalares , Antivirais/uso terapêutico , Reação em Cadeia da Polimerase/estatística & dados numéricos , Infecções por Coronavirus/complicações , Índice de Gravidade de Doença
9.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(5): 272-278, sept.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193032

RESUMO

OBJETIVOS: Analizar si existen diferencias en función de la edad en ansiedad, tristeza, soledad y comorbilidad ansioso-depresiva en personas jóvenes, de mediana edad y mayores confinadas debido a la pandemia de la COVID-19, y explorar la relación entre la autopercepción negativa del envejecimiento y nivel de sintomatología psicológica en función del grupo de edad. MÉTODO: Participan 1.501 personas (rango de edad: 18 a 88 años). Se evaluaron el grado de ansiedad, tristeza y soledad, y la autopercepción del envejecimiento. Se dividió a la muestra en función del grupo de edad y por cuartiles (bajo, intermedios y alto) en ansiedad, tristeza, soledad y autopercepción del envejecimiento. RESULTADOS: Las personas mayores informan de menor ansiedad y tristeza que los de mediana edad y jóvenes, y los de mediana edad de menores niveles que los jóvenes. Los de mediana edad informan de menor soledad, seguidos de los mayores y los jóvenes. Para cada grupo de edad, aquellos con una alta autopercepción negativa del envejecimiento informan de mayor ansiedad, tristeza y soledad. Hay más comorbilidad ansioso-depresiva en jóvenes y menos en mayores; más personas deprimidas en mediana edad, menos mayores con ansiedad, y más mayores y menos jóvenes sin sintomatología ansiosa y depresiva. Para todos los grupos de edad, las personas con comorbilidad ansioso-depresiva son las que tienen puntuaciones altas en autopercepción negativa del envejecimiento. CONCLUSIONES: Las personas mayores informan de menos malestar psicológico que otros grupos de edad. Tener una alta autopercepción negativa del envejecimiento perjudica a la salud psicológica, independientemente de la edad


OBJECTIVES: To analyze differences by age group in anxiety, depression, loneliness and comorbid anxiety and depression in young people, middle aged adults and older adults during the lock-down period at home due to the COVID-19 pandemic, and to explore the association between negative self-perceptions of aging and psychological symptoms controlling by age group. METHOD: Participants are 1501 people (age range 18 to 88 years). Anxiety, sadness, loneliness and self-perceptions of aging were assessed. The sample was divided according to the age group and quartiles (lower, intermediate levels, and higher) of anxiety, sadness, loneliness and self-perceptions of aging. RESULTS: Older adults reported lower levels of anxiety and sadness than middle aged adults, and middle aged adults reported lower levels than younger participants. Middle aged adults reported the lowest loneliness, followed by older adults and younger participants. For each age group, those with more negative self-perceptions of aging reported higher anxiety, sadness and loneliness. More comorbid anxiety and sadness was found in younger adults and less in older adults; more depressed participants in the middle aged group, and more older adults and less younger participants were found in the group with the lowest levels of anxiety and sadness. For all the age groups, participants with high levels of comorbid anxiety and sadness are those who report the highest scores in negative self-perceptions of aging. CONCLUSIONS: Older adults reported lower psychological anxiety, sadness and loneliness than the other age groups. Having negative self-perceptions of aging damage psychological health irrespective of the chronological age


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Quarentena/psicologia , Envelhecimento/psicologia , Autoimagem , Solidão/psicologia , Depressão/psicologia , Ansiedade/epidemiologia , Adaptação Psicológica , Inquéritos de Morbidade , Pandemias , Fatores Etários , Questionário de Saúde do Paciente/estatística & dados numéricos , Transtornos de Adaptação/epidemiologia
11.
J Orthop Surg Res ; 15(1): 452, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008440

RESUMO

BACKGROUND: A large number of cases of pneumonia caused by novel ß-coronavirus emerged in Hubei Province, China, at the end of 2019 and demonstrated great potential for transmission. At present, known independent risk factors include age, diabetes, and other chronic diseases, which may be similar to the patients with chronic wound; thus, we try to explore the clinical characteristics, prognostic factors, and management recommendation of patients with chronic infective wounds during the COVID-19 epidemic period. METHODS: In this single-center, retrospective observational study, we included all cases with chronic infective wounds that came to our hospital between the full outbreak of the COVID-19 in China (January 23, 2020) and the latest date prior to posting (20 April 2020). Demographic data, comorbidities, laboratory and imaging findings, consultation history, and clinical outcomes (lesion cured, uncontrolled, amputated, etc. as of May 10, 2020) were collected for all individuals. Patients were subdivided into gangrene, traumatic infection, and other types of soft tissue infection wound (including bedsores, gout ruptures, stab wounds, and so on) according to the causes of wound, and their disease-related information were compared group by group. RESULTS: Among the total 81 patients with chronic infective wounds, 60% were male, with a mean age of 60.8 years (SD 18.6), including 38 (47%) patients with traumatic infection, 29 (36%) gangrene cases, and 14 (17%) other soft tissue infection wounds. Common comorbidities are hypertension (32%), diabetes (32%), cardiovascular disease (24%), and kidney injury (12%), and the patients with gangrenes have the most comorbidities. As of May 10, 2020, there were 78 patients discharged, and their average stay time is 15.8 days (SD 14.2), while people still at the hospital is 39.7 days (SD 8.7) much longer than the discharged and also has more comorbidities. But there is no significant difference in the hospitalization time of three types of wounds. And fortunately, none of all the patients were infected by coronavirus. CONCLUSION: The majority of patients with chronic wounds are severely ill with high risk of infection and poor prognosis; therefore, management of patients with chronic wounds should be improved.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Infecção dos Ferimentos/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , China/epidemiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
12.
Pan Afr Med J ; 36: 257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014253

RESUMO

Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Dor Abdominal/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Lesões Encefálicas/complicações , Dor no Peito/complicações , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Achados Incidentais , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Tunísia/epidemiologia , Adulto Jovem
13.
BMC Public Health ; 20(1): 1525, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032575

RESUMO

BACKGROUND: This study was intended to investigate the epidemiological characteristics of COVID-19 clusters and the severity distribution of clinical symptoms of involved cases in Sichuan Province, so as to provide information support for the development and adjustment of strategies for the prevention and control of local clusters. METHODS: The epidemiological characteristics of 67 local clusters of COVID-19 cases in Sichuan Province reported as of March 17, 2020 were described and analyzed. Information about all COVID-19 clusters and involved cases was acquired from the China Information System for Disease Control and Prevention and analyzed with the epidemiological investigation results taken into account. RESULTS: The clusters were temporally and regionally concentrated. Clusters caused by imported cases from other provinces accounted for 73.13%; familial clusters accounted for 68.66%; the average attack rate was 8.54%, and the average secondary attack rate was 6.11%; the median incubation period was 8.5 d; a total of 28 cases met the criteria for incubation period determination, and in the 28 cases, the incubation period was > 14 d in 21.43% (6/28). a total of 226 confirmed cases were reported in the 67 clusters. Ten cases were exposed before the confirmed cases they contacted with developed clinical symptoms, and the possibility of exposure to other infection sources was ruled out; two clusters were caused by asymptomatic carriers; confirmed cases mainly presented with fever, respiratory and systemic symptoms; a gradual decline in the severity of clinical symptoms was noted with the increase of the case generation. CONCLUSIONS: Population movement and gathering restrictions and strict close contact management measures will significantly contribute to the identification and control of cases. Transmission during the incubation period and asymptomatic infections have been noted. Studies on the pathogenicity and transmissibility in these populations and on COVID-19 antibody levels and protective effects in healthy people and cases are required.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Análise por Conglomerados , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
14.
PLoS One ; 15(10): e0240081, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007008

RESUMO

Given the global spread of coronavirus disease (COVID-19), strict discharge standard is of great significance for the prevention and control of the epidemic, thus, the purpose of this study is to formulate more strict and scientific discharge standards. A total of 845 patients with mild and general COVID-19 who were considered to be discharged from hospital were included in this study. The median time from the onset of COVID-19 to the occurrence of two consecutive negative nucleic acid tests of these patients was 21 days. 223 of the 845 patients were tested again after two consecutive negative nucleic acid tests and 17.49% of the patients were positive. Moreover, 82.51% (184 of 223) of these patients experienced negative results from three consecutive nucleic acid tests, the median time from the onset of COVID-19 to the occurrence of three consecutive negative nucleic acid tests was 23 days (range: 3-56 days), and 38 of which were further tested after three consecutive negative nucleic acid tests, while about 5.26% (2 of 38) patients showed positive nucleic acid test results. Thus, we suggested that the patient should be negative for at least 3 consecutive nucleic acid tests before discharge, and the test time should be no earlier than the 23rd day since the onset of the disease.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Alta do Paciente , Pneumonia Viral/diagnóstico , RNA Viral/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , China/epidemiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Adulto Jovem
15.
BMC Med Imaging ; 20(1): 111, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008329

RESUMO

BACKGROUND: To develop and validate a nomogram for early identification of severe coronavirus disease 2019 (COVID-19) based on initial clinical and CT characteristics. METHODS: The initial clinical and CT imaging data of 217 patients with COVID-19 were analyzed retrospectively from January to March 2020. Two hundred seventeen patients with 146 mild cases and 71 severe cases were randomly divided into training and validation cohorts. Independent risk factors were selected to construct the nomogram for predicting severe COVID-19. Nomogram performance in terms of discrimination and calibration ability was evaluated using the area under the curve (AUC), calibration curve, decision curve, clinical impact curve and risk chart. RESULTS: In the training cohort, the severity score of lung in the severe group (7, interquartile range [IQR]:5-9) was significantly higher than that of the mild group (4, IQR,2-5) (P < 0.001). Age, density, mosaic perfusion sign and severity score of lung were independent risk factors for severe COVID-19. The nomogram had a AUC of 0.929 (95% CI, 0.889-0.969), sensitivity of 84.0% and specificity of 86.3%, in the training cohort, and a AUC of 0.936 (95% CI, 0.867-1.000), sensitivity of 90.5% and specificity of 88.6% in the validation cohort. The calibration curve, decision curve, clinical impact curve and risk chart showed that nomogram had high accuracy and superior net benefit in predicting severe COVID-19. CONCLUSION: The nomogram incorporating initial clinical and CT characteristics may help to identify the severe patients with COVID-19 in the early stage.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Nomogramas , Pneumonia Viral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Criança , Diagnóstico Precoce , Humanos , Pessoa de Meia-Idade , Pandemias , Distribuição Aleatória , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Goiânia; s.n; out. 02, 2020. 1-24 p. ilus, tab, mapas, graf.(Boletim Epidemiológico Covid-19, 26).
Monografia em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1121439

RESUMO

O Boletim Epidemiológico COVID-19 objetiva documentar e divulgar informações oficiais atualizadas da situação epidemiológica no Estado de Goiás-GO, Brasil. Resume que desde os primeiros registros na China em dezembro de 2019 até o dia 26 de setembro foram confirmados 32.730.945 casos de COVID-19 no mundo. Deste total, 991.224 evoluíram a óbito. Quando comparados o número de casos e óbitos confirmados desta semana epidemiológica (SE 39) com a semana anterior, houve aumento de 6,7% nos casos e 3,8% nos óbitos. Sintetiza que, no Brasil, neste mesmo intervalo de tempo, o aumento foi 4,2% e 3,5% no número de casos e óbitos, respectivamente. No país o primeiro caso foi confirmado no dia 26 de fevereiro e até 26 de setembro foram registrados 4.717.991 casos confirmados com 141.406 óbitos. Informa que o registro dos primeiros casos suspeitos em Goiás foi a partir de 04 de fevereiro e até 26 de setembro foram notificados à Vigilância Epidemiológica 595.334 casos de COVID-19. Infere que, nesta última semana epidemiológica (SE 39) houve a confirmação de 17.551 casos novos, representando um aumento nos casos de COVID-19 de 9,5%, superior ao aumento observado no Brasil 4,2%. No Estado, 202.528 (34,0%) foram confirmados sendo 196.210 (96,9%) por critério laboratorial, 4.408 (2,2%) pelo critério clínico-epidemiológico, 589 (0,3%) por critério clínico imagem e 802 (0,4%) pelo critério clínico, 148.086 (24,9%) foram descartados e 221.461 (37,2%) continuam como suspeitos


The COVID-19 Epidemiological Bulletin aims to document and disseminate updated official information on the epidemiological situation in the State of Goiás-GO, Brazil. It summarizes that since the first registrations in China in December 2019 until the 26th of September, 32,730,945 cases of COVID-19 have been confirmed worldwide. Of this total, 991,224 died. When comparing the number of confirmed cases and deaths of this epidemiological week (SE 39) with the previous week, there was an increase of 6.7% in cases and 3.8% in deaths. It synthesizes that, in Brazil, in this same time interval, the increase was 4.2% and 3.5% in the number of cases and deaths, respectively. In the country, the first case was confirmed on February 26 and until September 26, 4,717,991 confirmed cases were recorded, with 141,406 deaths. Informs that the record of the first suspected cases in Goiás was from February 4 and until September 26, 595,334 cases of COVID-19 were notified to the Epidemiological Surveillance. It infers that, in this last epidemiological week (SE 39), 17,551 new cases were confirmed, representing an increase in the cases of COVID-19 of 9.5%, higher than the increase observed in Brazil 4.2%. In the State, 202,528 (34.0%) were confirmed, 196,210 (96.9%) by laboratory criteria, 4,408 (2.2%) by clinical-epidemiological criteria, 589 (0.3%) by clinical image criteria and 802 (0.4%) by the clinical criterion, 148,086 (24.9%) were discarded and 221,461 (37.2%) remain as suspects


Assuntos
Humanos , Animais , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico
18.
Goiânia; s.n; Out. 14, 2020. ilus, tab, mapas, graf.(Boletim Epidemiológico Covid-19, 28).
Monografia em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1123103

RESUMO

Esta edição do Boletim Epidemiológico COVID19 apresenta um panorama geral desde os primeiros registros na China em dezembro de 2019 até o dia 10 de outubro foram confirmados 37.109.851 casos de COVID-19 no mundo. Deste total, 1.070.355 evoluíram a óbito. Quando comparados o número de casos e óbitos confirmados desta semana epidemiológica (SE 41) com a semana anterior, houve aumento de 6,6% nos casos e 3,8% nos óbitos. No Brasil, neste mesmo intervalo de tempo, o aumento foi 3,6% e 2,7% no número de casos e óbitos, respectivamente. No país o primeiro caso foi confirmado no dia 26 de fevereiro e até 10 de outubro foram registrados 5.103.408 casos confirmados com 150.689 óbitos. Apresenta os dados referentes a situação epidemiológica COVID-19 no período de 02 de fevereiro a 10 de outubro de 2020 no Estado de Goiás, Brasil, informando que o registro dos primeiros casos suspeitos em Goiás foi a partir de 04 de fevereiro e até 10 de outubro foram notificados à Vigilância Epidemiológica 656.938 casos de COVID-19. Nesta última semana epidemiológica (SE 40) houve a confirmação de 12.721 casos novos, representando um aumento de 5,9%, superior ao aumento observado no Brasil 3,6%. No Estado, 228.717 (34,8%) foram confirmados sendo 220.473 (96,4%) por critério laboratorial, 5.565 (2,4%) pelo critério clínico-epidemiológico, 780 (0,3%) por critério clínico-imagem e 1.393 (0,6%) pelo critério clínico, 168.061 (25,6%) foram descartados e 228.443 (34,8%) continuam como suspeitos


This edition of the EPIDEMIOLOGICAL BULLETIN COVID19 presents an overview from the first records in China in December 2019 to October 10, 37,109,851 cases of COVID-19 worldwide were confirmed. Of this total, 1,070,355 died. When comparing the number of confirmed cases and deaths of this epidemiological week (SE 41) with the previous week, there was an increase of 6.6% in cases and 3.8% in deaths. In Brazil, in this same time interval, the increase was 3.6% and 2.7% in the number of cases and deaths, respectively. In the country the first case was confirmed on February 26 and until October 10, 5,103,408 confirmed cases with 150,689 deaths were recorded. It presents data regarding the epidemiological situation COVID-19 from February 2 to October 10, 2020 in the State of Goiás, Brazil, stating that the registration of the first suspected cases in Goiás was from February 4 and until October 10, 656,938 cases of COVID-19 were reported to epidemiological surveillance. In this last epidemiological week (SE 40) there was the confirmation of 12,721 new cases, representing an increase of 5.9%, higher than the increase observed in Brazil 3.6%. In the State, 228,717 (34.8%) were confirmed to be 220,473 (96.4%) by laboratory criterion, 5,565 (2.4%) by clinical and epidemiological criteria, 780 (0.3%) by clinical-imaging criterion and 1,393 (0.6%) by clinical criterion, 168,061 (25.6%) were discarded and 228,443 (34.8%) continue as suspects


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Brasil/epidemiologia , Incidência , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico
19.
Goiânia; s.n; out. 09, 2020. ilus, tab, mapas, graf.(Boletim Epidemiológico Covid-19, 27).
Monografia em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1122129

RESUMO

Através do Boletim Epidemiológico Covid 19 n° 27, a Secretaria Estadual de Saúde do Estado de Goiás, Brasil, tem o objetivo de informar a situação epidemiológica no período de 02 de fevereiro à 03 de outubro do ano de 2020, considerando que desde os primeiros registros na China em dezembro de 2019 até o dia 03 de outubro foram confirmados 34.804.348 casos de COVID-19 no mundo. Deste total, 1.030.738 evoluíram a óbito. Quando comparados o número de casos e óbitos confirmados desta semana epidemiológica (SE 40) com a semana anterior, houve aumento de 6,3% nos casos e 4,0%nos óbitos. No Brasil, neste mesmo intervalo de tempo, o aumento foi 4,4% e 3,7% no número de casos e óbitos, respectivamente. No país o primeiro caso foi confirmado no dia 26 de fevereiro e até 03 de setembro foram registrados 4.927.235 casos confirmados com 146.675 óbitos. O registro dos primeiros casos suspeitos em Goiás foi a partir de 04 de fevereiro e até 03 de outubro foram notificados à Vigilância Epidemiológica 630.054 casos de COVID-19. Nesta última semana epidemiológica (SE 40) houve a confirmação de 13.468 casos novos, representando um aumento nos casos de COVID-19 de 6,6%, superior ao aumento observado no Brasil 4,4%. No Estado, 215.996(34,3%) foram confirmados sendo 208.780(96,7%) por critério laboratorial, 4.920(2,3%) pelo critério clínico-epidemiológico, 660(0,3%) por critério clínico-imagem e 1.144(0,5%) pelo critério clínico, 160.855(25,5%) foram descartados e 225.955(35,9%) continuam como suspeitos


Through the Epidemiological Bulletin Covid 19 n° 27, the State Department of Health of the State of Goiás, Brazil, aims to inform the epidemiological situation in the period from February 2 to October 3 of the year 2020, considering that from the first records in China in December 2019 to October 3, 34,804,348 cases of COVID-19 worldwide were confirmed. Of this total, 1,030,738 died. When comparing the number of confirmed cases and deaths of this epidemiological week (SE 40) with the previous week, there was an increase of 6.3% in cases and 4.0% in deaths. In Brazil, in this same time interval, the increase was 4.4% and 3.7% in the number of cases and deaths, respectively. In the country the first case was confirmed on February 26 and until September 3, 4,927,235 confirmed cases were recorded with 146,675 deaths. The record of the first suspected cases in Goiás was from February 4 and until October 3 were notified to the Epidemiological Surveillance 630,054 cases of COVID-19. In this last epidemiological week (SE 40) there was the confirmation of 13,468 new cases, representing an increase in cases of COVID-19 of 6.6%, higher than the increase observed in Brazil 4.4%. In the State, 215,996 (34.3%) were confirmed being 208,780 (96.7%) by laboratory criterion, 4,920 (2.3%) by clinical and epidemiological criteria, 660 (0.3%) by clinical-imaging criterion and 1,144 (0.5%) by clinical criterion, 160,855 (25.5%) were discarded and 225,955 (35.9%) continue as suspects


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Brasil/epidemiologia , Incidência , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico
20.
Nat Commun ; 11(1): 5009, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33024121

RESUMO

Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Hospitalização , Influenza Humana/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Feminino , Humanos , Influenza Humana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/tratamento farmacológico , Prevalência , República da Coreia/epidemiologia , Fatores Sexuais , Espanha/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
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