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1.
BMJ Open Respir Res ; 7(1)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33148777

RESUMO

OBJECTIVE: To evaluate the role of continuous positive air pressure (CPAP) in the management of respiratory failure associated with COVID-19 infection. Early clinical management with limited use of CPAP (3% of patients) was compared with a later clinical management strategy which had a higher proportion of CPAP use (15%). DESIGN: Retrospective case-controlled service evaluation for a single UK National Health Service (NHS) Trust during March-June 2020 designed and conducted solely to estimate the effects of current care. SETTING: The acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized English NHS Trust. PARTICIPANTS: 206 patients with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 and 3 April 2020 for the early group (controls), and between 10 April 2020 and 11 May 2020 for the late group (cases). Follow-up for all cases was until 11 June by which time all patients had a final outcome of death or discharge. Both groups were composed of 103 patients. Cases and controls were matched by age and sex. OUTCOME MEASURE: The outcome measure was the proportion of patients surviving at time t (time from the positive result of COVID-19 test to discharge/death date). The predictors were CPAP intervention, intubation, residence in care homes and comorbidities (renal, pulmonary, cardiac, hypertension and diabetes). A stratified Cox proportional hazard for clustered data (via generalised estimating equations) and model selection algorithms were employed to identify the effect of CPAP on patients' survival and the effect on gas exchange as measured by alveolar arterial (A-a) gradient and timing of CPAP treatment on CPAP patients' survival. RESULTS: CPAP was found to be significantly (HR 0.38, 95% CI 0.36 to 0.40) associated with lower risk of death in patients with hospital stay equal to, or below 7 days. However, for longer hospitalisation CPAP was found to be associated with increased risk of death (HR 1.72, 95% CI 1.40 to 2.12). When CPAP was initiated within 4 days of hospital admission, the survival probability was above 73% (95% CI 53% to 99%). In addition, lower A-a gradient was associated with lower risk of death in CPAP patients (HR 1.011, 95% CI 1.010 to 1.013). The selected model (best fit) was stratified by sex and clustered by case/control groups. The predictors were age, intubation, hypertension and the residency from care homes, which were found to be statistically significantly associated with patient's death/discharge. CONCLUSIONS: CPAP is a simple and cost-effective intervention. It has been established for care of other respiratory disorders but not for COVID-19 respiratory failure. This evaluation establishes that CPAP as a potentially viable treatment option for this group of patients during the first days of hospital admission. As yet there is limited availability of quantitative research on CPAP use for COVID-19. Whist this work is hampered by both the relatively small sample size and retrospective design (which reduced the ability to control potential confounders), it represents evidence of the significant benefit of early CPAP intervention. This evaluation should stimulate further research questions and larger study designs on the potential benefit of CPAP for COVID-19 infections. Globally, this potentially beneficial low cost and low intensity therapy could have added significance economically for healthcare provision in less developed countries.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Fatores Etários , Idoso , Betacoronavirus , Estudos de Casos e Controles , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Pacientes Internados/estatística & dados numéricos , Intubação Intratraqueal , Tempo de Internação , Masculino , Casas de Saúde , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Modelos de Riscos Proporcionais , Troca Gasosa Pulmonar , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/virologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
2.
J Nurs Adm ; 50(12): 649-654, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33181525

RESUMO

OBJECTIVE: The aim of this study was to examine the effect of nurses' mobility plan use on patients' length of stay, discharge destination, falls, physical therapy consults, and nurses' knowledge, attitudes, and beliefs regarding patient mobility. BACKGROUND: Functional decline due to decreased mobility during hospitalization results in diminished quality of life. Sixty-five percent of older inpatients lose the ability to ambulate during hospitalization and 30% do not regain that capability. METHODS: Using a quasi-experimental design, nurses' use of a mobility assessment on 4 patient outcome variables was examined before (n = 2,259) and after (n = 3,649) use. Nurses' attitudes, knowledge, and beliefs regarding mobility were also examined. RESULTS: Positive changes in patient variables occurred. Limited change occurred relative to nurses' knowledge, attitudes, and beliefs. CONCLUSIONS: Implementing a nurse-led mobility plan enhances therapy resource utilization through identification of appropriate consults and improves patients' discharge home. In addition, nurses' knowledge, attitudes, and beliefs toward patient mobility planning can be positively influenced.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Assistência Domiciliar , Pacientes Internados/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Caminhada/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Alta do Paciente/estatística & dados numéricos , Qualidade de Vida/psicologia , Inquéritos e Questionários , Estados Unidos
3.
Biomedica ; 40(Supl. 2): 116-130, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152195

RESUMO

Introduction: Infection with the new SARS-Cov-2 coronavirus is a worldwide public health emergency; its diagnosis is based on molecular tests, while its prognosis depends on the patient's history and on some paraclinical tests. In Colombia, forecasts are not yet counted. Objective: To assess the factors associated with the development of severe disease in hospitalized patients diagnosed with SARS-CoV-2 infection, as well as the prognostic factors for the outcome of mortality. Materials and methods: We conducted an ambispective cohort study in hospitalized patients at the Fundación Cadioinfantil from March to June, 2020. Results: Of the 104 patients analyzed, 31.7% (n=33) had a severe presentation and 9.6% (n=10) had a mortality outcome. For mortality, the most important prognostic factor was the development of severe disease followed by age over 60 years and malnutrition. For the development of the severe disease, prognostic factors were a history of hemodialysis (HR=135), diabetes (HR=4.4), and an increased level of lactate dehydrogenase (LDH) (HR=1,004), while the lymphocyte count over 1,064 was a protective factor (HR=0.9). In the classification of patients, the National Early Warning Score (NEWS2) score in the high and low-risk categories corresponded to the best performance. There was no difference between the treatments administered. Conclusions: The most important prognostic factors for mortality were being over 60 years of age, hypertension, diabetes, and cirrhosis, while for the development of severe disease they were chronic kidney disease with hemodialysis, NEWS2 with high risk at admission, increased levels of LDH and C reactive protein (CRP), and leukocytosis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pandemias , Pneumonia Viral/mortalidade , Adulto , Idoso , Antígenos de Grupos Sanguíneos , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Colômbia/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/terapia , Diabetes Mellitus/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Pacientes Internados/estatística & dados numéricos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia
4.
Rev. clín. esp. (Ed. impr.) ; 220(8): 480-494, nov. 2020. tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-192204

RESUMO

ANTECEDENTES: España ha sido uno de los países más afectados por la pandemia de COVID-19. OBJETIVO: Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. MÉTODOS: Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. RESULTADOS: Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente. Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como la linfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%) y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años: 10,5%; 70-79 años: 26,9%; ≥80 años: 46%). CONCLUSIONES: El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad


BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , 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/epidemiologia , Espanha/epidemiologia , Pacientes Internados/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos , Registros de Doenças/estatística & dados numéricos
5.
Medicine (Baltimore) ; 99(44): e22463, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126300

RESUMO

This study was conducted to estimate the 25-hydroxyvitamin D (25 (OH)D) levels and explore factors related to vitamin D deficiency/insufficiency. This was a multicenter, hospital-based, cross-sectional observational study. Children admitted to hospitals for health examination were included for vitamin D measurement and the 25(OH)D concentration results were categorized into 3 groups: deficiency (<30 nmol/L), insufficiency (30-50 nmol/L), and sufficiency (>50 nmol/L). Four lakh sixty thousand five hundred thirty-seven children in 825 hospitals from 18 provinces participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 6.69%, 15.92%, and 77.39%, respectively. Vitamin D deficiency was the most severe in the central region, followed by the north, and southwest regions; however, data for the western region were lacking.Logistic regression showed that vitamin D status was worse in girls, newborns, and those visiting the hospital in the winter. In conclusion, the prevalence of vitamin D deficiency is high among Chinese children and adolescents. Studies on population estimates, cost-effective screening strategies, and interventions for high-risk cases are needed.


Assuntos
Pacientes Internados/estatística & dados numéricos , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Prevalência , Fatores de Risco , Estações do Ano , Vitamina D/sangue , Deficiência de Vitamina D/etiologia
6.
PLoS One ; 15(10): e0241261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33104715

RESUMO

OBJECTIVE: This study aimed to describe the demographic and clinical characteristics of cancer inpatients with COVID-19 exploring clinical outcomes. METHODS: A retrospective search in the electronic medical records of cancer inpatients admitted to the Brazilian National Cancer Institute from April 30, 2020 to May 26, 2020 granted identification of 181 patients with COVID-19 confirmed by RT-PCR. RESULTS: The mean age was 55.3 years (SD ± 21.1). Comorbidities were present in 110 (60.8%) cases. The most prevalent solid tumors were breast (40 [22.1%]), gastrointestinal (24 [13.3%]), and gynecological (22 [12.2%]). Among hematological malignancies, lymphoma (20 [11%]) and leukemia (10 [5.5%]) predominated. Metastatic disease accounted for 90 (49.7%) cases. In total, 63 (34.8%) had recently received cytotoxic chemotherapy. The most common complications were respiratory failure (70 [38.7%]), septic shock (40 [22.1%]) and acute kidney injury (33 [18.2%]). A total of 60 (33.1%) patients died due to COVID-19 complications. For solid tumors, the COVID-19-specific mortality rate was 37.7% (52 out of 138 patients) and for hematological malignancies, 23.5% (8 out of 34). According to the univariate analysis COVID-19-specific mortality was significantly associated with age over 75 years (P = .002), metastatic cancer (p <0.001), two or more sites of metastases (P < .001), the presence of lung (P < .001) or bone metastases (P = .001), non-curative treatment or best supportive care intent (P < .001), higher C-reactive protein levels (P = .002), admission due to COVID-19 (P = .009), and antibiotics use (P = .02). After multivariate analysis, cases with admission due to symptoms of COVID-19 (P = .027) and with two or more metastatic sites (P < .001) showed a higher risk of COVID-19-specific death. CONCLUSION: This is the first Brazilian cohort of cancer patients with COVID-19. The rates of complications and COVID-19-specific death were significantly high.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pacientes Internados/estatística & dados numéricos , Neoplasias/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Academias e Institutos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Brasil/epidemiologia , Institutos de Câncer/estatística & dados numéricos , Causas de Morte , Criança , Pré-Escolar , Comorbidade , Diabetes Mellitus/epidemiologia , Suscetibilidade a Doenças , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão/epidemiologia , Hospedeiro Imunocomprometido , Lactente , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Estudos Retrospectivos , Adulto Jovem
7.
Hematology ; 25(1): 383-388, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33124971

RESUMO

Background: The first cases of proved COVID-19 in Iran were reported in February 2020 and has since rapidly spread worldwide. We aimed to clarify the clinical significance of hematologic parameters alteration in COVID-19. Methods: Different hematologic parameters were measured in 225 hospitalized COVID-19 patients in a tertiary care university hospital, during the peak of COVID-19 outbreak and their association with duration of hospitalization, ICU admission and especially mortality was analyzed. Results: Among a total of 225 patients, 24.4% did not survive after admission. Lymphopenia and neutrophilia were observed in 52.7% and 21.4% of the patients, respectively. The mean count of neutrophils was significantly higher in non-survived patients (P = .032). Elevated neutrophil-to-lymphocyte ratio (NLR) was significantly associated with mortality (P < .001). Low hemoglobin (Hb) concentration significantly correlated with mortality (P = .004) and ICU admission (P = .04). Platelet (Plt) count was significantly lower in the non-survived patients (P = .023). Non-survivors had significantly lower nadir Hb and Plt counts than survivors (P < .001 in both parameters). Platelet-to-lymphocyte ratio (PLR) also correlated with mortality and was significantly higher in non-survivors (P = .034). Conclusions: Hematologic laboratory parameters have always been a crucial component of diagnostic and therapeutic strategies in infectious disease. Hematologic predictors of a fatal outcome in COVID19 hospitalized patients in our series include elevated NLR and PLR, lower than normal Hb and Plt, elevated d-dimer and prolonged prothrombin time (PT), together with elevated inflammatory indicators in the blood.


Assuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Mortalidade Hospitalar , Pandemias , Pneumonia Viral/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Contagem de Células Sanguíneas , Sedimentação Sanguínea , Proteína C-Reativa/análise , Infecções por Coronavirus/mortalidade , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemoglobinas/análise , Hospitais Universitários , Humanos , Inflamação , Pacientes Internados/estatística & dados numéricos , Irã (Geográfico)/epidemiologia , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pró-Calcitonina/sangue , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
8.
PLoS One ; 15(10): e0238693, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007005

RESUMO

INTRODUCTION: Most research depicts older adults as needing personal care, with limited research on older adults' contributions in the lives of others in developing countries like Ghana. The purpose of the study was to examine the personal care provision and socio-demographic correlates of personal care provision by older adult inpatients in Ghana. MATERIALS AND METHODS: A hospital-based survey was conducted among 400 consecutively surveyed older adult inpatients at Komfo Anokye Teaching Hospital in southern Ghana. Stata 15 was used to analyse the data. The relationship between personal care and older adult inpatients' socio-demographic characteristics were analysed using the chi-square test. Multivariate logistic regression analysis was employed. RESULTS: Overall, 28% of older adult inpatients provided personal care. Participants were mostly females, married or cohabiting, completed at most junior high school, Christians, urban residents, not working and living with their immediate family. Primarily, most participants provided personal care to one person, once a week, and one-hour duration. Nearly three-quarters of participants provided personal care to someone who lives with them. After adjustment, male older adults were 50% less likely to and urban residents were 83% more likely to provide personal care. Being single, separated or divorced was statistically significantly associated with personal care provision, however, were not statistically significant after adjusting for sex and residence. A post hoc analysis testing for interaction revealed no relationship existing between sex and marital status concerning personal care provision (p = 0.106). CONCLUSION: Female and urban resident older adult inpatients in Ghana are not just passive receivers of care but also provide personal care to others with functional difficulties, independent on age. It further draws attention to the need for policies and programs that can support older adults, particularly females and urban residents, to be productive in the later life.


Assuntos
Cuidadores , Pacientes Internados , Autocuidado , Idoso , Idoso de 80 Anos ou mais , Cuidadores/estatística & dados numéricos , Características da Família , Feminino , Gana , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , População Rural , Autocuidado/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana
9.
BMJ Open Respir Res ; 7(1)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33020114

RESUMO

INTRODUCTION: Smoking causes inflammation of the lung epithelium by releasing cytokines and impairing mucociliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association. METHODS: This was a retrospective analysis of all adults hospitalised with COVID-19 from 9 March to 18 May 2020. RESULTS: 1173 patients met the study criteria. 837 patients never smoked whereas 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying chronic obstructive pulmonary disease (19% vs 6%, p<0.001), HIV infection (11% vs 5%,p<0.001), cancer (11% vs 6%, p=0.005), congestive heart failure (15% vs 8%, p<0.001), coronary artery disease (15% vs 9%, p=0.3), chronic kidney disease (11% vs 8%, p=0.037) and end-stage renal disease (10% vs 6%, p=0.009) compared with non-smokers. Outcome analysis showed that smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that among smokers only current smokers had higher risk of death compared with never smokers (HR 1.61, 95% CI 1.22 to 2.12, p<0.001). In the multivariate approach, Cox model for the survival, female sex, young age, low serum lactate dehydrogenase and systemic steroid use were associated with overall improved survival. CONCLUSION: In our large single-centre retrospective database of patients hospitalised with COVID-19, smoking was associated with development of critical illness and higher likelihood of death.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pacientes Internados/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Pneumonia Viral/epidemiologia , Respiração Artificial/estatística & dados numéricos , Fumar/epidemiologia , Idoso , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
10.
Transl Psychiatry ; 10(1): 355, 2020 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-33077738

RESUMO

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients' mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pacientes Internados/psicologia , Pneumonia Viral/psicologia , Quarentena/psicologia , Doença Aguda , Adulto , China , Estudos de Avaliação como Assunto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pandemias , Quarentena/métodos , Quarentena/estatística & dados numéricos
11.
PLoS One ; 15(10): e0239571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057443

RESUMO

IMPORTANCE: The rapid pandemic expansion of the disease caused by the new SARS-CoV-2 virus has compromised health systems worldwide. Knowledge of prognostic factors in affected patients can help optimize care. OBJECTIVE: The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. DESIGN, PARTICIPANTS AND LOCATIONS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia (Spain). As primary outcomes, severe disease (need for oxygen therapy via nonrebreather mask or mechanical ventilation) and death were studied. Multivariate binary logistic regression models were performed to study the association between the different factors and the results. RESULTS: Advanced age, male sex and obesity were independent markers of poor prognosis. The most frequent presenting symptom was fever, while dyspnea was associated with severe disease and the presence of cough with greater survival. Low oxygen saturation in the emergency room, elevated CRP in the emergency room and initial radiological involvement were all related to worse prognosis. The presence of eosinophilia (% of eosinophils) was an independent marker of less severe disease. CONCLUSIONS: This study identified the most robust markers of poor prognosis for COVID-19. These results can help to correctly stratify patients at the beginning of hospitalization based on the risk of developing severe disease.


Assuntos
Infecções por Coronavirus/epidemiologia , Pacientes Internados/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Eosinofilia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Prognóstico , Fatores Sexuais , Espanha
12.
Acta Med Indones ; 52(3): 199-205, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33020331

RESUMO

Latar BelakangSebanyak 38.6% kasus kematian pasien COVID-19 di Indonesia terjadi di populasi lansia. Data mengenai profil klinis pasien rawat inap lansia dengan COVID-19 masih tidak ada. Padahal kelompok pasien ini adalah pasien risiko tinggi selama pandemi ini yang memerlukan perhatian lebih.MetodeStudi deskriptif ini menggunakan data lengkap pasien lansia dengan COVID-19 yang dirawat inap di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN Cipto Mangunkusumo) dari April hingga akhir Agustus 2020. Data termasuk karakteristik klinis, gejala, komorbiditas, multimorbiditas dan luaran mortalitas pasien.HasilDi populasi pasien lansia (n=44), mayoritas berusia di antara 60-69 tahun (68%), berjenis kelamin laki-laki (66%), dan tidak memiliki riwayat kontak erat dengan pasien COVID-19 sebelumnya (86%). Gejala tersering ialah demam, batuk, dan sesak yang merupakan gejala khas COVID-19, sedangkan penyakit kronis tersering adalah diabetes melitus, hipertensi, dan keganasan. Multimorbiditas ditemukan hanya di 14% pasien lansia, dan para pasien tersebut bertahan hidup pasca infeksi virus SARS-CoV-2. Angka kematian pasien lansia rawat inap dengan COVID-19 di studi ini adalah 23%, dan 90% dari kasus kematian berjenis kelamin laki-laki.KesimpulanPasien laki-laki mendominasi kasus terkonfirmasi dan kasus kematian lansia dengan COVID-19. Gejala khas COVID-19 hanya ditemukan di sekitar setengah pasien penelitian. Pasien yang meninggal dunia memiliki persentase gejala khas lebih tinggi. Gejala tidak khas pun mungkin ditemukan di pasien lansia. Immunosenescence dan fungsi imunoregulasi jenis kelamin tertentu dihipotesiskan memiliki peran penting dalam menyebabkan kematian lansia di studi ini.Kata Kunci: Profil Klinis, Lansia, Pasien Geriatri, COVID-19, Indonesia  ABSTRACTBackgroundOlder people contributed to 38.6% of death cases related to COVID-19 in Indonesia. Data regarding clinical profile of hospitalised elderly with COVID-19 in Indonesia were still lacking. Older people are at-risk population in the pandemic, whom we should pay attention to.MethodsThis single centre descriptive study utilised complete data of elderly inpatients with COVID-19 in Indonesia's national general hospital from April to late August 2020. The data consisted of clinical characteristics, symptoms, comorbidities, multimorbidity, and mortality outcome.ResultsAmong elderly patients (n=44), a majority of patients were aged 60-69 years (68%), were male (66%), and had no history of close contact with COVID-19 patient (86%). The most common symptoms were fever, cough and shortness of breath (classic symptoms of COVID-19), whereas the most common chronic diseases were diabetes mellitus, hypertension, and malignancy. Multimorbidity was only found in 14% of patients, all of whom remained alive following SARS-CoV-2 infection. The death rate among elderly inpatients with COVID-19 in this study was 23%, and male older adults contributed to 90% of death cases.ConclusionMale patients dominated both confirmed cases and death cases among elderly with COVID-19. Classic symptoms of COVID-19 were only found in about half of the study patients. Non-survivors had higher percentage of the classic symptoms of COVID-19 than survivors. Atypical COVID-19 presentations are possible in older adults. We postulated that immunosenescence and sex-specific immunoregulatory function play an important role in causing death in this study cohort. Keywords: Clinical Profile, Elderly, Geriatric Patient, COVID-19, Indonesia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitais Gerais , Pacientes Internados/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Idoso , Comorbidade , Infecções por Coronavirus/terapia , Feminino , Humanos , Indonésia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Distribuição por Sexo , Fatores Sexuais , Taxa de Sobrevida/tendências
13.
Transl Psychiatry ; 10(1): 339, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33024072

RESUMO

There were several studies about the psychiatric and mental health issues related to the severe adult respiratory syndrome (SARS) outbreak in 2003, however, the association between SARS and the overall risk of psychiatric disorders and suicides has, as yet, to be studied in Taiwan. The aim of this study is to examine as to whether SARS is associated with the risk of psychiatric disorders and suicide. A total of 285 patients with SARS and 2850 controls without SARS (1:10) matched for sex, age, insurance premium, comorbidities, residential regions, level of medical care, and index date were selected between February 25 and June 15, 2003 from the Inpatient Database Taiwan's National Health Insurance Research Database. During the 12-year follow-up, in which 79 in the SARS cohort and 340 in the control group developed psychiatric disorders or suicide (4047.41 vs. 1535.32 per 100,000 person-years). Fine and Gray's survival analysis revealed that the SARS cohort was associated with an increased risk of psychiatric disorders and suicide, and the adjusted subdistribution HR (sHR) was 2.805 (95% CI: 2.182-3.605, p < 0.001) for psychiatric disorders and suicide. The SARS cohort was associated with anxiety, depression, sleep disorders, posttraumatic stress disorder/acute stress disorder (PTSD/ASD), and suicide. The sensitivity analysis revealed that the SARS group was associated with anxiety, depression, sleep disorders, PTSD/ASD, and suicide after the individuals with a diagnosis of psychiatric disorders and suicide were excluded within the first year, and with anxiety, depression, and sleep disorders, while those in the first five years were excluded. In conclusion, SARS was associated with the increased risk of psychiatric disorders and suicide.


Assuntos
Infecções por Coronavirus , Transtornos Mentais , Saúde Mental/estatística & dados numéricos , Pandemias , Pneumonia Viral , Síndrome Respiratória Aguda Grave , Suicídio/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Bases de Dados Factuais , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/virologia , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medição de Risco , Fatores de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/psicologia , Síndrome Respiratória Aguda Grave/terapia , Taiwan/epidemiologia
14.
J Rehabil Med ; 52(9): jrm00105, 2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-32924065

RESUMO

OBJECTIVE: To identify predictors of admission to post-acute inpatient rehabilitation settings follow-ing acute care for stroke survivors in Taiwan. DESIGN: Prospective observation study. PARTICIPANTS: Stroke survivors (n = 558) admitted to acute care wards for inpatient rehabilitation (62% male; mean age 60.0 ± 12.2 years). METHODS: The primary outcome was whether survivors were admitted to post-acute inpatient rehabilitation settings after discharge from acute care wards. Logistic regression model was adopted to examine the predictors of admission to post-acute inpatient rehabilitation. A receiver operating characteristic curve was drawn to compute the ability of the predictors to discriminate the outcome. RESULTS: Multivariate analysis results indicated Activity Measure Post-Acute Care "6-Clicks" Basic Mobility score to be the only significant predictor of admission to post-acute inpatient rehabilitation (odds ratio = 0.44, 95% confidence interval: 0.34-0.56). Receiver operating characteristic curve analysis results indicated that the cut-off point for Basic Mobility was 13 (standardized score: 33.99). This yielded a sensitivity value of 0.98 and a specificity value of 0.96 for determining the admission to post-acute inpatient rehabilitation. CONCLUSION: Activity Measure Post-Acute Care "6-Clicks" Basic Mobility subscale scores at admission for acute care can predict admission to post-acute inpatient rehabilitation for stroke survivors in Taiwan. This tool can aid clinicians in formulating adequate discharge plans at an early stage, and thus improve the quality of care.


Assuntos
Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Acidente Vascular Cerebral/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reabilitação do Acidente Vascular Cerebral/métodos
17.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 71-76, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965360

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is an emerging health threat caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Previous studies have noted hypertension is associated with increased mortality due to COVID-19; however, it is not clear whether the increased risk is due to hypertension itself or antihypertensive agents. We aimed to evaluate the impact of antihypertensive agents on the clinical outcomes of hypertensive patients with COVID-19. METHODS: Our study included 169 consecutive hypertensive patients hospitalized due to COVID-19 between March 20 and April 10, 2020. The demographic characteristics, clinical data, and type of antihypertensive agents being used were reviewed. RESULTS: The mean age of patients was 65.8±11.7 years.30 patients(17.7%) died during hospitalization. A total of 142 patients(84%) were using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), 91 (53.8%) were using diuretics, 69 (40.8%) were using calcium channel blockers (CCBs), 66 (39.1%) were using beta-blockers, 12 (7.1%) were using alpha-blockers, and 5 (2.9%) were using mineralocorticoid receptor antagonists (MRAs). There was no significant difference between survivors and non-survivors based on the type of antihypertensive agents being used. Binary logistic regression analysis showed that the type of the antihypertensive agent being used had no effect on mortality [OR=0.527 (0.130-2.138), p=0.370 for ACEIs/ARBs; OR=0.731 (0.296-1.808), p=0.498 for CCBs; OR=0.673 (0.254-1.782), p=0.425 for diuretics; OR=1.846 (0.688-4.950), p=0.223 for beta-blockers; OR=0.389 (0.089-1.695), p=0.208 for alpha-blockers; and OR=1.372 (0.107-17.639), p=0.808 for MRAs]. CONCLUSION: The type of antihypertensive agent being used had no effect on the clinical course and mortality in hypertensive patients with COVID-19. The use of these agents should be maintained for the treatment of hypertension during hospitalization.


Assuntos
Anti-Hipertensivos/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Coronavirus , Mortalidade Hospitalar , Hipertensão/tratamento farmacológico , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Hipertensão/mortalidade , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade
18.
J Med Internet Res ; 22(9): e23565, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32930099

RESUMO

BACKGROUND: Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic. OBJECTIVE: We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non-intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls. METHODS: A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, at 15 Northwell Health hospitals. The findings for these patients were abstracted into a database and statistically analyzed. RESULTS: Of 2634 patients who died of COVID-19, 1478 (56.1%) had oxygen saturation levels ≥90% on presentation and required no respiratory support. At least one RRT/CA was called on 1112/2634 patients (42.2%) at a non-ICU level of care. Before the RRT/CA call, the most recent oxygen saturation levels for 852/1112 (76.6%) of these non-ICU patients were at least 90%. At the time the RRT/CA was called, 479/1112 patients (43.1%) had an oxygen saturation of <80%. CONCLUSIONS: This study represents one of the largest reviewed cohorts of mortality that also captures data in nonstructured fields. Approximately 50% of deaths occurred at a non-ICU level of care despite admission to the appropriate care setting with normal staffing. The data imply a sudden, unexpected deterioration in respiratory status requiring RRT/CA in a large number of non-ICU patients. Patients admitted at a non-ICU level of care suffered rapid clinical deterioration, often with a sudden decrease in oxygen saturation. These patients could benefit from additional monitoring (eg, continuous central oxygenation saturation), although this approach warrants further study.


Assuntos
Infecções por Coronavirus/mortalidade , Demografia , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Unidades de Terapia Intensiva , Masculino , Registros Médicos , Pessoa de Meia-Idade , New York/epidemiologia , Oxigênio/metabolismo , Pandemias , Adulto Jovem
19.
Virus Res ; 289: 198171, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32979474

RESUMO

BACKGROUND: Innate and adaptive immune responses have been evaluated in infected patients with COVID-19. The severity of the disease has been supposed to be associated with some profile not reported with other bacterial and viral pneumonia. We proposed a study in patients with moderate to severe COVID-19 infection to evaluate the interleukin patterns and its role as prognosis factors. METHODS: A prospective cohort with moderate and severe cases of COVID-19 infection from June to July 2020. Blood samples from patients were collected regularly to evaluate IFN-γ, TNF-α, IL-4, IL-6, and IL-10. Clinical, laboratory, radiological data, and outcomes were recorded. The outcome variable was in-hospital death, survival, mechanical ventilation, and admission at the intensive care unit. Data are presented in median and interquartile range [IQR]. RESULTS: We evaluated the Th1 and Th2 responses according to evolution, distinguishing possible predictive markers. The IFN-γ median of 323 pg/mL [IQR 166-570] was found in patients who died and 208 pg/mL [IQR 155-392] in the survival group (p = 0.017). IFN-γ was also higher in the early stages of the disease (394 pg/mL [IQR 229-575] against 162 pg/mL [IQR 117-259], p < 0.001). IL-4 that was increased in late-stage (182 pg/mL [IQR 162-199] against 131 pg/mL [IQR 124-152], p < 0.001) but not associated with mortality. Also, death was also related to male gender (relative risk = 1.5 [95 % confidence interval = 1.1-2.0]). CONCLUSION: Our results suggest that the activation of the host immune response between Th1 or Th2 in COVID-19 infection may be related to the final result between discharge or death. This implies an attempt to control cytokines, such as IFN-γ, with combined therapies for clinical treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Interferon gama/fisiologia , Pandemias , Pneumonia Viral/mortalidade , Idoso , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/etiologia , Citocinas/sangue , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Imunidade Inata , Pacientes Internados/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Interferon gama/sangue , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Prognóstico , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Células Th1/imunologia , Células Th2/imunologia
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