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1.
Washington, D.C.; PAHO; 2020-07-13. (PAHO/IMS/EIH/COVID-19/20-0011).
em Inglês | PAHO-IRIS | ID: phr-52481

RESUMO

This document includes the results of a rapid systematic review of currently available literature. The information included in this review reflects the evidence as of the date posted in the document. Yet, recognizing that there are numerous ongoing clinical studies, PAHO will periodically update these reviews and corresponding recommendations as new evidence becomes available.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Condutas Terapêuticas , Medicina de Emergência Baseada em Evidências , Infectologia
2.
Washington, D.C.; PAHO; 2020-06-16. (PAHO/IMS/EIH/COVID-19/20-0008).
em Inglês | PAHO-IRIS | ID: phr-52294

RESUMO

Take home message thus far: • We examined 24 therapeutic options thus far; currently, there is no evidence of any important benefit from any therapeutic option (though remdesivir is revealing promise as one option based on 2 randomized controlled trials, and while not peer-reviewed and published, preliminary findings from the RECOVERY Trial (Oxford University Group) using the corticosteroid dexamethasone, indicates a reduction in mortality in COVID-19 patients hospitalized and requiring respiratory support) and that conclusively allows for safe and effective use to mitigate or eliminate the causative agent of COVID-19; the same can be said about prophylaxis. Nearly 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. • Preliminary findings from the RECOVERY Trial showed that low doses of dexamethasone (6 mg of oral or intravenous preparation once daily for 10 days) significantly reduced mortality by one-third in ventilated patients and by one fifth in patients receiving oxygen only. • Patients with COVID19, frequently older adults and with established comorbidities such as diabetes, hypertension, obesity, cardiovascular disease, kidney disease, and liver disease as well as malignancy, are receiving multiple concomitant medications, without considering possible adverse events and interactions. This is an area of research that is being overlooked and the potential toxicity due to concomitant treatments must be urgently addressed. • The use of medications such as ivermectin, antivirals, and immunomodulators, among others, should be done in the context of patient consented, randomized clinical trials that evaluate their safety and efficacy. • Countries should follow WHO guidance on the ethical use of drugs in emergencies, including use on unauthorized indications and compassionate use...


Assuntos
Infecções por Coronavirus , Coronavirus , Medicina de Emergência Baseada em Evidências , Condutas Terapêuticas , Infectologia , Pandemias
3.
Artigo em Inglês | MEDLINE | ID: mdl-32521811

RESUMO

COVID-19 painfully demonstrates how little resilience our societies have to novel viruses. Societies, decision makers, and scientists lack (1) a comprehensive understanding of the complexity of viral outbreaks and their impact on society; (2) intervention portfolios; and (3) a global crisis and resilience policy, all of which are required to develop appropriate measures and to improve societal resilience. We highlight COVID-19 immunity as one key benchmark in preparation for the next wave of the pandemic. Specifically, using network scenarios, we demonstrate the substantial advantage of reintegrating health care workers with acquired COVID-19 immunity in epidemic hotspots, which would not only enable their safe contribution to the health care system but also drastically contain further spread.


Assuntos
Betacoronavirus/imunologia , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Benchmarking , Infecções por Coronavirus/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Humanos , Infectologia , Pneumonia Viral/prevenção & controle
4.
Farm Hosp ; 44(7): 40-42, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533669

RESUMO

Since the implementation of the Antimicrobial Therapy Optimization Programme, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain.  Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in  hospitals. The COVID-19 pandemic forced hospital pharmacists to abruptly  suspend all their structured activities and concentrate on the health crisis.  Realtime information sharing between different medicine specialties is an  effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear. Hospital pharmacies had to reorganize their activities to  respond to the pandemic. On the one side were patients with COVID-19, and on  the other were routine hospital pharmacy tasks, with the added difficulty of  adapting to individual protection measures. New communication and  collaboration strategies were adopted. Protocols were established for the  management of COVID-19 patients, with continuous changes; special  medications had to be prepared and distributed; circuits were designed for the  home- or institution-based care of patients; internal circuits were created to  minimize the movements of hospital staff and professionals caring for COVID-19  patients. The most effective antiviral drug and anti inflammatory therapy  remains elusive. In this scenario, hospital pharmacists emerge as a key player,  as they have a deep understanding of the mechanisms of action of drugs and  potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary  teams has become essential for the optimization of clinical outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Unidades Hospitalares , Comunicação Interdisciplinar , Pandemias , Equipe de Assistência ao Paciente , Farmacêuticos , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos , Tomada de Decisões , Gerenciamento Clínico , Necessidades e Demandas de Serviços de Saúde , Hospitais Universitários , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Infectologia/organização & administração , Pacientes Internados , Unidades de Terapia Intensiva/organização & administração , Preparações Farmacêuticas/provisão & distribução , Comitê de Farmácia e Terapêutica/organização & administração , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Espanha/epidemiologia
6.
J Immunother Cancer ; 8(1)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32554619

RESUMO

Immune-related (IR)-pneumonitis is a rare and potentially fatal toxicity of anti-PD(L)1 immunotherapy. Expert guidelines for the diagnosis and management of IR-pneumonitis include multidisciplinary input from medical oncology, pulmonary medicine, infectious disease, and radiology specialists. Severe acute respiratory syndrome coronavirus 2 is a recently recognized respiratory virus that is responsible for causing the COVID-19 global pandemic. Symptoms and imaging findings from IR-pneumonitis and COVID-19 pneumonia can be similar, and early COVID-19 viral testing may yield false negative results, complicating the diagnosis and management of both entities. Herein, we present a set of multidisciplinary consensus recommendations for the diagnosis and management of IR-pneumonitis in the setting of COVID-19 including: (1) isolation procedures, (2) recommended imaging and interpretation, (3) adaptations to invasive testing, (4) adaptations to the management of IR-pneumonitis, (5) immunosuppression for steroid-refractory IR-pneumonitis, and (6) management of suspected concurrent IR-pneumonitis and COVID-19 infection. There is an emerging need for the adaptation of expert guidelines for IR-pneumonitis in the setting of the global COVID-19 pandemic. We propose a multidisciplinary consensus on this topic, in this position paper.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia/terapia , Guias de Prática Clínica como Assunto , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/imunologia , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Infectologia/normas , Comunicação Interdisciplinar , Pulmão/diagnóstico por imagem , Pulmão/efeitos dos fármacos , Pulmão/imunologia , Oncologia/normas , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico , Pneumonia/imunologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Pneumologia/normas , Radiologia/normas , Estados Unidos/epidemiologia
8.
Infez Med ; 28(suppl 1): 84-88, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532943

RESUMO

Clinical presentation of COVID-19 is common to other respiratory infections. We compared the characteristics at hospital admission of confirmed and not-confirmed COVID-19 patients, in the early phase of the epidemic. Thirty-seven suspected patients were enrolled, and COVID-19 was confirmed in 17. Confirmed patients are older, have more frequently contact with confirmed cases. Distinctive clinical characteristics among COVID-19 were the grand-glass opacities at CT scan, and a pO2/FiO2 ratio less than 250. In not-confirmed group, Influenza represented the most frequent alternative diagnosis. This study contributes to highlight the characteristics to consider at hospital admission in order to promptly suspect COVID-19.


Assuntos
Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Estudos de Coortes , Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Reações Falso-Positivas , Feminino , Hospitais Especializados/estatística & dados numéricos , Humanos , Infectologia , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Pneumonia Viral/diagnóstico , Fatores de Risco , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Superinfecção , Avaliação de Sintomas
9.
Postgrad Med J ; 96(1137): 384-386, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404498

RESUMO

The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year's end.


Assuntos
Competência Clínica/normas , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Educação Médica Continuada/tendências , Medicina , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Medicina de Emergência/educação , Pesquisa sobre Serviços de Saúde , Humanos , Infectologia/educação , Inovação Organizacional , Pneumonia Viral/epidemiologia , Medicina Preventiva/educação , Psiquiatria/educação , Pneumologia/educação
10.
Washington, D.C.; PAHO; 2020-05-23. (PAHO/IMS/PHE/Covid-19/20-0023).
em Inglês | PAHO-IRIS | ID: phr-52193

RESUMO

This document includes the results of a rapid systematic review of currently available literature. The information included in this review reflects the evidence as of the date posted in the document. Yet, recognizing that there are numerous ongoing clinical studies, PAHO will periodically update these reviews and corresponding recommendations as new evidence becomes available. The drugs currently under review are: meplazumab, ivermectin, siltuximab, danoprevir, tocilizumab (IL-6), favipiravir, darunavir, nelfinavir, remdesivir, interferon-alpha, chloroquine or hydroxychloroquine, convalescent plasma, heparin, corticosteroids, IVIG, sarilumab, umifenovir (arbidol), lopinavir/ritonavir, and α-Lipoic acid. The focus was any type of comparative effectiveness research (ideally RCTs studies) for all of the included therapeutic pharmacological interventions (adults and children) and this review was open to any study that could be informative, including case-series and observational designs. Adults and children exposed to or with confirmed or suspected COVID-19 were and will be included. Trials that compare interventions head-to-head or against no intervention or placebo are the focus. We have focused on comparative effectiveness studies that provide evidence on patient-important outcomes, but were open to all reported outcomes at this time. No electronic database search restrictions were imposed. If meta-analytical pooling was and is possible from retrieved evidence, this review would seek to do this to derive more precise estimates of effect and derive additional statistical power.


Assuntos
Infecções por Coronavirus , Coronavirus , Medicina de Emergência Baseada em Evidências , Infectologia , Condutas Terapêuticas , Pandemias
11.
Clin Hemorheol Microcirc ; 74(4): 363-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32390611

RESUMO

BACKGROUND: In the early phase of the COVID-19 pandemic Germany missed to set up efficient containment measures. Consequently, the number of cases increased exponentially until a lockdown was implemented to suppress the spread of SARS-CoV-2. Fortunately, Germany has a high capability for coronavirus lab testing and more than 30,000 ICU beds. These capabilities and the lockdown turned out to be an advantage to combat the pandemic and to prevent a health-system overload. AIM: The aim was to predict the plateau day of SARS-CoV-2 infections or deaths. RESULTS: The effect on the viral spread of the German measures taken and the impact on the peak of new infection cases is shown. By normalizing daily case numbers, the plateau day of the current outbreak in Germany could be calculated to be reached at April 12, 2020 (day 103 of 2020). CONCLUSION: Normalized case number curves are helpful to predict the time point at which no further new infections will occur if the epidemic situation remains stable. Upon reaching the plateau day during a lockdown phase, a residual time-period of about 2-3 weeks can be utilized to prepare a safe unlocking period. As can be learned from Asian countries such as South Korea and Taiwan there must be strict rules to keep the risk of infection low. Those include social distancing, face mask wearing in combination with digital contact tracing and serosurveillance studies. Following those rules, a safe dance around the infection curve allows to keep the population at a reduced infection rate.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Alemanha/epidemiologia , Humanos , Infectologia/tendências , Unidades de Terapia Intensiva , Modelos Lineares , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena , Organização Mundial da Saúde
13.
Am J Transplant ; 20(7): 1773-1779, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32202064

RESUMO

The COVID-19 pandemic has rapidly evolved and changed our way of life in an unprecedented manner. The emergence of COVID-19 has impacted transplantation worldwide. The impact has not been just restricted to issues pertaining to donors or recipients, but also health-care resource utilization as the intensity of cases in certain jurisdictions exceeds available capacity. Here we provide a personal viewpoint representing different jurisdictions from around the world in order to outline the impact of the current COVID-19 pandemic on organ transplantation. Based on our collective experience, we discuss mitigation strategies such as donor screening, resource planning, and a staged approach to transplant volume considerations as local resource issues demand. We also discuss issues related to transplant-related research during the pandemic, the role of transplant infectious diseases, and the influence of transplant societies for education and disseminating current information.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Transplante de Órgãos/tendências , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Betacoronavirus , Tomada de Decisões , Seleção do Doador , Saúde Global , Humanos , Infectologia/organização & administração , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Transplantes , Populações Vulneráveis
14.
Artigo em Português | LILACS | ID: biblio-1100237

RESUMO

Objetivo: analisar a atual situação epidemiológica brasileira e gaúcha da leishmaniose visceral (LVH), em idosos e verificar o coeficiente de letalidade. Métodos: trata-se um estudo transversal realizado com fonte de dados secundária, em consulta à base de dados do Sistema de Informação de Agravos de Notificação (SINAN), de janeiro de 2013 a dezembro de 2017, de casos confirmados de leishmaniose visceral no Brasil e no Rio Grande do Sul, que foram tabulados em Excel e analisados com Epiinfo 7.0. Resultados: casos de LVH em idosos têm aumentado nos últimos 5 anos, dentro do cenário brasileiro e gaúcho. Embora pouco divulgado, é frequente o comprometimento e o aumento da proporção de idosos que vão a óbito pelo LHV, que foi de 20,3% dos casos no período de 2013 a 2017, demonstrando a gravidade da infecção nesse público. Em nosso estudo também encontramos forte relação da idade com o aumento do coeficiente de letalidade, chegando a 46,87% em 2016. Discussão: uma das estratégias recentes no combate à LVH é o abate de cães que contêm o parasita responsável pela transmissão da doença, porém esse método de controle não tem sido muito efetivo. Com isso, constata-se que a medida imunoprofilática, através da vacina Leish-Tec®, tem um efeito favorável no combate à doença somente em animais que não estão em áreas de alta transmissão.


Aims: to analyze the current Brazilian and of the state of Rio Grande do Sul epidemiological situation of visceral leishmaniasis (LVH) in the elderly and verify the mortality coefficient. Methods: This is a cross-sectional study with a secondary data source, taken from SINAN data from January 2013 to December 2017, with confirmed visceral leishmaniasis in Brazil and Rio Grande do Sul, which are tabulated in Excel and analyzed with Epiinfo 7. Results: cases of LVH in the elderly have increased in the last 5 years, within the Brazilian and the state of Rio Grande do Sul settings. Although not widely reported, it is frequent to compromise and increase the proportion of elderly people who die from LVH, which was 20,3% of the cases in the period from 2013 to 2017, demonstrating the seriousness of the infection in this public. In our study we also found a strong relation between age and the increase in the lethality coefficient, reaching 46.87% in 2016. Discussion: One of the recent strategies in the fight against HVL is the slaughter of dogs that contains the parasite responsible for the transmission of the disease, but this method of control has not been very effective. Thus, the immunoprophylactic measurement by Leish-Tec® vaccine has a favorable effect in the fight against the disease only in animals that are not in high transmission areas.


Assuntos
Leishmaniose Visceral , Idoso , Infectologia , Geriatria , Medicina
16.
Pneumologie ; 73(10): 586-591, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31622997

RESUMO

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.


Assuntos
Escolha da Profissão , Infectologia/educação , Infectologia/organização & administração , Médicos , Estudos Transversais , Alemanha , Humanos , Médicos/organização & administração , Médicos/estatística & dados numéricos , Sociedades Médicas , Inquéritos e Questionários
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