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1.
Crit Care ; 26(1): 236, 2022 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-35922860

RESUMO

BACKGROUND: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).


Assuntos
COVID-19 , Coinfecção , Pneumonia Bacteriana , Pneumonia Viral , Corticosteroides/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , COVID-19/complicações , COVID-19/epidemiologia , Teste para COVID-19 , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia
2.
Cad Saude Publica ; 38(7): e00001022, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35894360

RESUMO

Off-label use of azithromycin, hydroxychloroquine, and ivermectin (the "COVID kit") has been suggested for COVID-19 treatment in Brazil without clinical or scientific evidence of efficacy. These drugs have known adverse drug reactions (ADR). This study aimed to analyze if the sales of drugs in the "COVID kit" are correlated to the reported number of ADR after the COVID-19 pandemic began. Data was obtained from the Brazilian Health Regulatory Agency (Anvisa) website on reported sales and ADRs for azithromycin, hydroxychloroquine, and ivermectin for all Brazilian states. The period from March 2019 to February 2020 (before the pandemic) was compared to that from March 2020 to February 2021 (during the pandemic). Trend adjustment was performed for time series data and cross-correlation analysis to investigate correlation between sales and ADR within the same month (lag 0) and in the following months (lag 1 and lag 2). Spearman's correlation coefficient was used to assess the magnitude of the correlations. After the pandemic onset, sales of all investigated drugs increased significantly (69.75% for azithromycin, 10,856,481.39% for hydroxychloroquine, and 12,291,129.32% for ivermectin). ADR levels of all medications but azithromycin were zero before the pandemic, but increased after its onset. Cross-correlation analysis was significant in lag 1 for all drugs nationwide. Spearman's correlation was moderate for azithromycin and hydroxychloroquine but absent for ivermectin. Data must be interpreted cautiously since no active search for ADR was performed. Our results show that the increased and indiscriminate use of "COVID kit" during the pandemic correlates to an increased occurrence of ADRs.


Assuntos
COVID-19 , Infecções por Coronavirus , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Pneumonia Viral , Azitromicina/efeitos adversos , Brasil/epidemiologia , COVID-19/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Hidroxicloroquina/efeitos adversos , Ivermectina/efeitos adversos , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia
3.
Cardiol Clin ; 40(3): 277-285, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35851451

RESUMO

The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure (HF), and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular manifestations of COVID-19, and cardiovascular complications associated with COVID-19 vaccination.


Assuntos
COVID-19 , Doenças Cardiovasculares , Pneumonia Viral , COVID-19/complicações , Vacinas contra COVID-19 , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/etiologia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2
4.
BMC Pediatr ; 22(1): 452, 2022 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-35897053

RESUMO

BACKGROUND: Pneumonia is a serious problem that threatens the health of newborns. This study aimed to investigate the clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia. METHODS: This was a retrospective analysis of cases of community-acquired viral pneumonia in the Neonatal Department. Nasopharyngeal aspirate (NPA) samples were collected for pathogen detection, and clinical data were collected. We analysed pathogenic species and clinical characteristics among these infants. RESULTS: RSV is the main virus in term infants, and parainfluenza virus (PIV) 3 is the main virus in preterm infants. Patients infected with PIV3 were more susceptible to coinfection with bacteria than those with respiratory syncytial virus (RSV) infection (p < 0.05). Preterm infants infected with PIV3 were more likely to be coinfected with bacteria than term infants (p < 0.05), mainly gram-negative bacteria (especially Klebsiella pneumonia). Term infants with bacterial infection were more prone to fever, cyanosis, moist rales, three concave signs, elevated C-reactive protein (CRP) levels, respiratory failure and the need for higher level of oxygen support and mechanical ventilation than those with simple viral infection (p < 0.05). The incidence of hyponatremia in neonatal community-acquired pneumonia (CAP) was high. CONCLUSIONS: RSV and PIV3 were the leading causes of neonatal viral CAP. PIV3 infection is the main cause of viral CAP in preterm infants, and these individuals are more likely to be coinfected with bacteria than term infants, mainly gram-negative bacteria. Term infants with CAP coinfected with bacteria were more likely to have greater disease severity than those with single viral infections.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Viral , Infecções por Vírus Respiratório Sincicial , Viroses , Infecções Comunitárias Adquiridas/epidemiologia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/epidemiologia , Estudos Retrospectivos
5.
J Infect Public Health ; 15(8): 856-869, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35785594

RESUMO

BACKGROUND: Several studies have reported prolonged symptoms especially neurological symptoms following acute infection in patients with COVID-19, known as long COVID-19. There are only few studies investigating this population and relatively less known, including nervous system involvement. A systematic review and meta-analysis of these studies are required to understanding the prevalence of persistent neurological manifestations after COVID-19. OBJECTIVE: To conduct a systematic review and meta-analysis on the persistent neurological manifestations in COVID-19 survivors. METHODS: Authors conducted a literature search through PubMed and MedRxiv from January 1st, 2020 to October 2021 according to PRISMA guideline. Furthermore, the authors added additional sources by reviewing related references. Studies presenting the neurologic features of long COVID-19 patients in their data were included. Case reports and case series also included in this review. The quality of the studies was assessed based on the Oxford Centre for Evidence-Based Medicine guidelines. Selected studies were included in the meta-analysis of proportion and heterogeneity test. FINDINGS: From 128 identified studies, 36 were eligible, with 9944 participants included. Most of the included studies had mean duration of follow-up after COVID-19 onset of less than 6 months. Fatigue was the most common (52.8%, 95%CI 19.9 - 84.4) symptoms of long COVID, followed by cognitive disorder (35.4%, 95%CI 2.1 - 81.7); paresthesia (33.3%, 95%CI 2.7 - 76.6); sleep disorder (32.9%, 95%CI 6.5 - 67.4); musculoskeletal pain (27.8%, 95%CI 12.7 - 46); and dizziness (26.4%, 95%CI 4.6 - 57.9). CONCLUSION: Neurological manifestations are prevalent and persisting in patients with long COVID. The duration of the symptoms are vary among literatures. However, the frequency are mostly observed during the first six months after the illness onset.


Assuntos
COVID-19 , Infecções por Coronavirus , Pneumonia Viral , COVID-19/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
6.
Ann Afr Med ; 21(2): 113-117, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35848641

RESUMO

Background: Coronavirus disease-2019 (COVID-19) pandemic has engulfed the whole world with millions getting infected and losing their lives. Health care professionals (HCPs) who are in the front line of fighting with COVID-19 are particularly vulnerable and it is crucial to protect them from COVID-19. In this regard, the Indian Council of Medical Research (ICMR) has recommended hydroxychloroquine (HCQS) chemoprophylaxis in HCPs. However, considering the lack of sufficient evidence the HCP are in a dilemma about this aspect. Moreover, there is a paucity of data on use of HCQS as a chemoprophylaxis among Indian HCP. Hence, this study was carried out to study the extent of use and also the perception of Indian HCP toward use of HCQS as a chemoprophylaxis for COVID-19. Materials and Methods: This was a cross-sectional study done on 205 HCPs working across India. The responses were collected electronically using a prevalidated semi-structured questionnaire. Results: 62.9% (129/205) respondents reported having taken HCQS chemo-prophylaxis for COVID-19 while 34.7% (76/205) did not take it. Among HCP, who did not take the prophylaxis, the main reasons cited were concern about adverse effects (61.5%) and lack of robust evidence (24%). Only 14% of respondents felt that there was sufficient evidence to justify use of HCQS for prophylaxis while an overwhelming majority (86%) felt otherwise or were uncertain. Conclusion: The majority of participants felt that despite a lack of proven efficacy, ICMR guidelines on HCQS prophylaxis in COVID-19 are justified considering the pandemic situation. Our study also found that HCQS is well tolerated by participants and there was no reported serious adverse effect and cardiac-related side effects among them.


Résumé Contexte: La pandémie de maladie à coronavirus-2019 (COVID-19) a englouti le monde entier avec des millions de personnes infectées et perdant leur des vies. Les professionnels de la santé (HCP) qui sont en première ligne dans la lutte contre le COVID-19 sont particulièrement vulnérables et il est essentiel de les protéger du COVID-19. À cet égard, le Conseil indien de la recherche médicale (ICMR) a recommandé l'hydroxychloroquine (HCQS) chimioprophylaxie chez les professionnels de la santé. Cependant, compte tenu du manque de preuves suffisantes, le professionnel de la santé est confronté à un dilemme à propos de cet aspect. En outre, il y a peu de données sur l'utilisation du HCQS comme chimioprophylaxie parmi les professionnels de la santé indiens. Par conséquent, cette étude a été menée pour étudier l'étendue de l'utilisation et aussi la perception des professionnels de la santé indiens à l'égard de l'utilisation du HCQS comme chimioprophylaxie pour le COVID-19. Matériel et Méthodes: c'était un étude transversale réalisée sur 205 professionnels de la santé travaillant en Inde. Les réponses ont été recueillies par voie électronique à l'aide d'un système semi-structuré prévalidé questionnaire. Résultats: 62,9% (129/205) des répondants ont déclaré avoir suivi une chimioprophylaxie HCQS pour le COVID-19, tandis que 34,7% (76/205) ne l'a pas pris. Parmi les professionnels de la santé qui n'ont pas pris de prophylaxie, les principales raisons invoquées étaient la préoccupation concernant les effets indésirables (61,5%) et le manque de preuves solides (24%). Seulement 14% des répondants estimaient qu'il y avait des preuves suffisantes pour justifier l'utilisation du HCQS à des fins prophylactiques alors qu'un une écrasante majorité (86%) pensait le contraire ou était incertaine. Conclusion: La majorité des participants ont estimé que malgré un manque de efficacité, les lignes directrices de l'ICMR sur la prophylaxie du HCQS dans le COVID-19 sont justifiées compte tenu de la situation pandémique. Notre étude a également révélé que Le HCQS est bien toléré par les participants et aucun effet indésirable grave ni effet secondaire cardiaque n'a été signalé parmi eux. Mots-clés: Chimioprophylaxie, COVID-19, hydroxychloroquine, Conseil indien de la recherche médicale.


Assuntos
COVID-19 , Infecções por Coronavirus , Pneumonia Viral , COVID-19/tratamento farmacológico , COVID-19/prevenção & controle , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Pessoal de Saúde , Humanos , Hidroxicloroquina/efeitos adversos , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Inquéritos e Questionários
8.
Acta Gastroenterol Belg ; 85(2): 400-402, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35709786

RESUMO

We report a case of abdominal pain followed by acute systolic heart failure due to multisystem inflammatory syndrome in children (MIS-C). This multisystem disease typically appears several weeks after infection with COVID-19 in children and young adults. There is a wide spectrum of presentation with MIS-C: some present with features of shock, others with a condition that has overlapping characteristics with Kawasaki disease (KD), and others with more non-specific features. Very often the symptoms include gastrointestinal symptoms. Our 17-year-old patient presented with fever, abdominal pain and inflammatory laboratory results. Rapidly after admission he developed acute heart failure with biopsy-confirmed myocarditis. The diagnostic criteria of MIS-C were met. This case emphasizes the changing diagnostic landscape. However rare, we want to raise awareness for MIS-C in children and young adults presenting with abdominal pain. Because of the risk of rapid clinical deterioration, early recognition and a multidisciplinary approach can be life-saving.


Assuntos
COVID-19 , Pneumonia Viral , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adolescente , COVID-19/complicações , Criança , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica , Adulto Jovem
9.
Zhonghua Jie He He Hu Xi Za Zhi ; 45(7): 706-711, 2022 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-35768378

RESUMO

Coronavirus Disease-2019 (COVID-19) has been a major public health issue all over the world, placing a significant burden on available healthcare resources. The most common types of COVID-19 are the mild and common forms. Although the proportion of the severe-critical types is smaller, the rate of death is significantly higher and the medical resources required tend to be greater. Thus, a variety of scores based on other disease and COVID-19 were used to assess the risk of poor prognosis on the COVID-19, including the common scores for community-acquired pneumonia, sepsis and viral pneumonia. Unfortunately, the above scores often lacked an adequate description of the applicable population or were at high risk of bias with unknown applicability. Therefore, the article summarized the existing scores, aiming to provide a reference for clinical prognostic risk assessment.


Assuntos
COVID-19 , Pneumonia Viral , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prognóstico , Medição de Risco , SARS-CoV-2
10.
J Infect Dev Ctries ; 16(4): 592-599, 2022 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-35544618

RESUMO

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS CoV2-CoV-2) viral outbreak in Wuhan (China) caused thousands of confirmed cases and deaths around the world. Severe viral pneumonia with respiratory failure and death are the ultimate consequence of infection. AIM: This study aimed to evaluate the regularly performed standard laboratory parameters that can assist in COVID-19 case identification and establish an effective approach to help care and management of (COVID-19) patients. METHODOLOGY: COVID-19 (n = 129) patients were hospitalized in the Suez Canal University Hospital and were retrospectively examined. Laboratory parameters were gathered from patients upon admission (n = 129) during the period from the 20th of June to 15th of August 2020. SARS-CoV-2 cases were diagnosed clinically and radiologically by chest Computed Tomography (CT) and confirmed by RT-PCR. RESULTS: The results showed that COVID-19 survivors exhibited lower hemoglobin (Hb) and hematocrit (HCT), while showed higher Red Cell Distribution Width (RDW), neutrophil lymphocyte ratio (NLR), and lymphocytes. Logistic regression analysis showed that age greater than 60 years old, neutrophilia and high NLR were associated with more deaths. CONCLUSION: Monitoring of lymphopenia, neutrophilia and NLR may help categorizing patients who may need Intensive care.


Assuntos
COVID-19 , Pneumonia Viral , COVID-19/diagnóstico , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , SARS-CoV-2
11.
Lancet Child Adolesc Health ; 6(8): 555-570, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35636455

RESUMO

BACKGROUND: Respiratory viruses are increasingly detected in children with community-acquired pneumonia but prevalence estimates vary substantially. We aimed to systematically review and pool estimates for 22 viruses commonly associated with community-acquired pneumonia. METHODS: We conducted a systematic review and meta-analysis to determine the prevalence of each of the common respiratory viruses detected by any diagnostic method in children aged up to 18 years with community-acquired pneumonia. We searched MEDLINE, PubMed, Embase, Web of Science, and Scopus databases with no language restrictions for relevant published articles and reports published between Jan 1, 1995, and Dec 31, 2019, restricting the review to pre-COVID-19 pandemic years. Three independent reviewers screened articles and extracted data using a predefined protocol. We calculated the pooled prevalence for each virus in childhood pneumonia using DerSimonian-Laird random-effects models. We assessed bias using the Newcastle-Ottawa Scale. The review protocol was registered in PROSPERO (CRD42016034047). FINDINGS: We identified 186 eligible articles that represented 152 209 children up to age 18 years with community-acquired pneumonia. One or more respiratory viruses were detected in 55·0% (95% CI 50·4-59·7) of paediatric patients with a diagnosis of community-acquired pneumonia; heterogeneity was high (I2=99·4%). Respiratory syncytial virus (22·7%, 20·9-24·5) and rhinovirus (22·1%, 19·5-24·7) were the most commonly detected causes of paediatric pneumonia globally, with other viruses detected in 1-9% of cases. There was non-significant variation in prevalence by the country's national income, under-5 mortality rate, or WHO region. INTERPRETATION: Respiratory viruses are frequently detected in community-acquired pneumonia among children of all ages and geographical regions, with non-significant variation by country's national income or region. Further strategies to limit antibiotic use in children with viral pneumonia and develop treatment and prevention approaches targeting common respiratory viruses are expected to have a substantial effect on the residual burden of childhood pneumonia. FUNDING: None.


Assuntos
COVID-19 , Infecções Comunitárias Adquiridas , Pneumonia Viral , Vírus , Criança , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/etiologia , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Prevalência
12.
Med. intensiva (Madr., Ed. impr.) ; 46(5): 248-258, mayo. 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-204312

RESUMO

Objetivo: La pandemia de la COVID-19 ha supuesto una amenaza de colapso de los servicios hospitalarios y de unidades de cuidado intensivo (UCI), así como una reducción de la dinámica asistencial de pacientes afectados por otras patologías. El objetivo fue desarrollar un modelo matemático diseñado para optimizar las predicciones relacionadas con las necesidades de hospitalización e ingresos en UCI por la COVID-19. Diseño: Estudio prospectivo. Ámbito: Provincia de Granada (España). Pacientes: Pacientes de COVID-19 hospitalizados, ingresados en UCI, recuperados y fallecidos desde el 15 de marzo hasta el 22 de septiembre del 2020. Intervenciones: Desarrollo de un modelo matemático tipo susceptible, expuesto, infectado y recuperado (SEIR) capaz de predecir la evolución de la pandemia, considerando las medidas de salud pública establecidas. Variables de interés: Número de pacientes infectados por SARS-CoV-2, hospitalizados e ingresados en UCI por la COVID-19.Resultados: A partir de los datos registrados, hemos podido desarrollar un modelo matemático que refleja el flujo de la población entre los diferentes grupos de interés en relación con la COVID-19. Esta herramienta permite analizar diferentes escenarios basados en medidas de restricción socio-sanitarias y pronosticar el número de infectados, hospitalizados e ingresados en UCI. Conclusiones: El modelo matemático es capaz de proporcionar predicciones sobre la evolución de la COVID-19 con suficiente antelación como para poder conjugar los picos de prevalencia y de necesidades de asistencia hospitalaria y de UCI, con la aparición de ventanas temporales que posibiliten la atención de enfermos no-COVID (AU)


Objective: The COVID-19 pandemic has threatened to collapse hospital and ICU services, and it has affected the care programs for non-COVID patients. The objective was to develop a mathematical model designed to optimize predictions related to the need for hospitalization and ICU admission by COVID-19 patients. Design: Prospective study. Setting: Province of Granada (Spain). Population: COVID-19 patients hospitalized, admitted to ICU, recovered and died from March 15 to September 22, 2020. Study variables: The number of patients infected with SARS-CoV-2 and hospitalized or admitted to ICU for COVID-19. Results: The data reported by hospitals was used to develop a mathematical model that reflects the flow of the population among the different interest groups in relation to COVID-19. This tool allows to analyse different scenarios based on socio-health restriction measures, and to forecast the number of people infected, hospitalized and admitted to the ICU. Conclusions:The mathematical model is capable of providing predictions on the evolution of the COVID-19 sufficiently in advance as to anticipate the peaks of prevalence and hospital and ICU care demands, and also the appearance of periods in which the care for non-COVID patients could be intensified (AU)


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Modelos Teóricos , Unidades de Terapia Intensiva , Estudos Prospectivos
13.
Rev. clín. esp. (Ed. impr.) ; 222(4): 205-2011, abr. 2022. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-204725

RESUMO

Antecedentes: La infección por coronavirus SARS-CoV-2 se transmite rápidamente en residencias de mayores y centros sociosanitarios, provocando una elevada letalidad. Los datos generados por el programa de vigilancia epidemiológica permiten información válida sobre la epidemiología del problema y las posibilidades de prevención.Objetivo: Analizar la epidemiología de la infección por COVID-19 entre los profesionales sociosanitarios del Distrito Sanitario Sevilla y su papel en la evolución de los brotes en las residencias de mayores.Metodología: Estudio sobre 88 centros sociosanitarios de la ciudad de Sevilla en el período del 1 marzo al 23 mayo de 2020, partiendo de las encuestas epidemiológicas en casos del personal donde hubo brotes (n=732 en 14 residencias). Se calcularon incidencias acumuladas, curvas epidémicas, características sociodemográficas y clínicas, y demoras en el aislamiento y notificación de los casos. Para el análisis estadístico se emplearon medidas de tendencia central y de dispersión, así como intervalos de confianza y pruebas de contraste de hipótesis.Resultados: Se produjeron 124 casos en trabajadores (tasa de ataque 16,9%), 79,0% en mujeres. La gran mayoría presentaron síntomas leves (87,1%). Los comunes fueron fiebre (31,5%) y tos (49,2%). La mediana de días desde el inicio de los síntomas hasta el aislamiento fue 3 días.Conclusiones: Se objetiva una elevada incidencia en el personal sociosanitario con demoras en el aislamiento que pudieron condicionar la dinámica de transmisión en los brotes. Es necesario revisar las prácticas de identificación de la enfermedad y el aislamiento entre el personal, énfasis en la implementación rápida de medidas de prevención (AU)


Background: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 infection, spreads swiftly in nursing homes and assisted living facilities, leading to a high degree of lethality. The data generated by an epidemiological surveillance program allow for obtaining valid information on the diseases’ epidemiology and possible prevention methods.Objective: This work aims to analyze COVID-19 epidemiology among healthcare staff based in the Seville healthcare district (Spain) and evaluate its role in outbreaks in nursing homes.Methods: This is an observational, descriptive study of 88 assisted living facilities located in the city of Seville from March 1 to May 23, 2020. Data were obtained via epidemiological surveys on staff at centers where there were outbreaks (n=732 in 14 nursing homes). The cumulative incidence, epidemic curves, sociodemographic and clinical characteristics, and delays in isolation and notification of cases were calculated. For the statistical analysis, measures of central tendency and dispersion were used as well as confidence intervals and statistical hypothesis tests.Results: There were 124 cases in staff members (cumulative incidence 16.9%), 79.0% of which were in women. The majority presented with mild symptoms (87.1%). The most common symptoms were fever (31.5%) and cough (49.2%). The median number of days from onset of symptoms to isolation was three.Conclusions: A high incidence in nursing home staff along with delays in isolation were observed, which could affect the dynamics of transmission in outbreaks. It is necessary to review disease identification and isolation practices among staff as well as emphasize rapid implementation of prevention measures (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Pandemias , Espanha/epidemiologia
14.
J Pak Med Assoc ; 72(2): 329-336, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35320187

RESUMO

Coronavirus disease-2019, or Covid-19, was first reported in Wuhan, China, at the end of December 2019 as viral pneumonia. The causative agent, the Novel Coronavirus also known as severe acute respiratory syndrome Corona virus (SARS CoV-2), spread rapidly across the world to cause a considerable death toll. On March 11, 2020, the World Health Organisation declared Covid-19 a pandemic. For a little over a year, the coronavirus has been around. Pregnancy is an immunodeficient state predisposing women to an increased risk of respiratory viral infections. The risk is even higher in pregnant women who already have underlying health problems due to growing age, such as diabetes, hypertension, cardiac or respiratory diseases. The exact treatment of Covid-19 is still unknown. This narrative review was planned to summarises the current information on pathophysiology, diagnosis and effects of Covid-19 in pregnancy for better treatment plans.


Assuntos
COVID-19 , Pneumonia Viral , China , Feminino , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Gravidez , Organização Mundial da Saúde
15.
J Nucl Med ; 63(7): 971-980, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35177424

RESUMO

Molecular imaging techniques such as PET and SPECT have been used to shed light on how coronavirus disease 2019 (COVID-19) affects the human brain. We provide a systematic review that summarizes the current literature according to 5 predominant topics. First, a few case reports have suggested reversible cortical and subcortical metabolic alterations in rare cases with concomitant para- or postinfectious encephalitis. Second, imaging findings in single patients with the first manifestations of parkinsonism in the context of COVID-19 resemble those in neurodegenerative parkinsonism (loss of nigrostriatal integrity), but scarceness of data and a lack of follow-up preclude further etiologic conclusions (e.g., unmasking/hastening of neurodegeneration vs. infectious or parainfectious parkinsonism). Third, several case reports and a few systematic studies have addressed focal symptoms and lesions, most notably hyposmia. The results have been variable, although some studies found regional hypometabolism of regions related to olfaction (e.g., orbitofrontal and mesiotemporal). Fourth, a case series and systematic studies in inpatients with COVID-19-related encephalopathy (acute to subacute stage) consistently found a frontoparietal-dominant neocortical dysfunction (on imaging and clinically) that proved to be grossly reversible in most cases until 6 mo. Fifth, studies on post-COVID-19 syndrome have provided controversial results. In patients with a high level of self-reported complaints (e.g., fatigue, memory impairment, hyposmia, and dyspnea), some authors found extensive areas of limbic and subcortical hypometabolism, whereas others found no metabolic alterations on PET and only minor cognitive impairments (if any) on neuropsychologic assessment. Furthermore, we provide a critical appraisal of studies with regard to frequent methodologic issues and current pathophysiologic concepts. Finally, we devised possible applications of PET and SPECT in the clinical work-up of diagnostic questions related to COVID-19.


Assuntos
COVID-19 , Infecções por Coronavirus , Transtornos Parkinsonianos , Pneumonia Viral , Anosmia , Encéfalo/diagnóstico por imagem , COVID-19/complicações , COVID-19/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Humanos , Imagem Molecular , Pandemias , Pneumonia Viral/epidemiologia
16.
Clin Respir J ; 16(4): 301-308, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35202498

RESUMO

PURPOSE: Severe viral pneumonia is associated with significant morbidity and mortality. Recent COVID-19 pandemic continues to impose significant health burden worldwide, and individual pandemic waves often lead to a large surge in the intensive care unit (ICU) admissions for respiratory support. Comparisons of severe SARS-CoV-2 pneumonia with other seasonal and nonseasonal severe viral infections are rarely studied in an intensive care setting. METHODS: A retrospective cohort study comparing patients admitted to ICU with COVID-19 between March and June 2020 and those with viral pneumonias between January and December 2019. We compared patient specific demographic variables, duration of illness, ICU organ supportive measures and outcomes between both groups. RESULTS: Analysis of 93 COVID-19 (Group 1) and 52 other viral pneumonia patients (Group 2) showed an increased proportion of obesity (42% vs. 23%, p = 0.02), non-White ethnicities (41% vs. 6%, p < 0.001) and diabetes mellitus (30% vs. 13%, p = 0.03) in Group 1, with lower prevalence of chronic obstructive pulmonary disease (COPD)/asthma (16% vs. 34%, p = 0.02). In Group 1, the neutrophil to lymphocyte ratio was much lower (6.7 vs. 10, p = 0.006), and invasive mechanical ventilation (58% vs. 26%, p < 0.001) was more common. Length of ICU (8 vs. 4, p < 0.001) and hospital stay (22 vs. 11, p < 0.001) was prolonged in Group 1, with no significant difference in mortality. Influenza A and rhinovirus were the most common pathogens in Group 2 (26% each). CONCLUSIONS: Key differences were identified within demographics (obesity, ethnicity, age, ICU scores, comorbidities) and organ support. Despite these variations, there were no significant differences in mortality between both groups. Further studies with larger sample sizes would allow for further assessment of clinical parameters in these patients.


Assuntos
COVID-19 , Pneumonia Viral , COVID-19/epidemiologia , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Obesidade/complicações , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Respiração Artificial , Estudos Retrospectivos , SARS-CoV-2
17.
Stud Health Technol Inform ; 289: 473-476, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35062193

RESUMO

In December 2019, Wuhan, China, reported an outbreak of nSARS-CoV2 that caused viral pneumonia, COVID-19. Li Wenliang, a Chinese ophthalmologist, first communicated on Chinese social media about the existence and spread of the unknown viral pneumonia in Wuhan, China. By the end of March 2020, the virus had spread worldwide. However, non-scientific information related to the viral outbreak, disease, and mortality spread even faster on social media. This study performed literature searches among different databases, i.e., PubMed, PubMed Central, and Web of Science, to understand the pitfall of social media during the COVID-19 pandemic and the impact of non-scientific information on public health. Social media not only shared information regarding the outbreak of nSARS-CoV2 and COVID-19 disease but also misinformation regarding epidemiology, government policies, prevention, cure, and vaccination. Thus, strict regulation is required to control the spread of misleading information.


Assuntos
COVID-19 , Pneumonia Viral , Mídias Sociais , China/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2
19.
BMC Pulm Med ; 22(1): 47, 2022 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-35093039

RESUMO

BACKGROUND: The need for invasive mechanical ventilation (IMV) is linked to significant morbidity and mortality in patients with influenza-related pneumonia (Flu-p). We aimed to develop an assessment tool to predict IMV among Flu-p patients within 14 days of admission. METHODS: In total, 1107 Flu-p patients from five teaching hospitals were retrospectively enrolled from January 2012 to December 2019, including 895 patients in the derivation cohort and 212 patients in the validation cohort. The predictive model was established based on independent risk factors for IMV in the Flu-p patients from the derivation cohort. RESULTS: Overall, 10.6% (117/1107) of patients underwent IMV within 14 days of admission. Multivariate regression analyses revealed that the following factors were associated with IMV: early neuraminidase inhibitor use (- 3 points), lymphocytes < 0.8 × 109/L (1 point), multi-lobar infiltrates (1 point), systemic corticosteroid use (1 point), age ≥ 65 years old (1 points), PaO2/FiO2 < 300 mmHg (2 points), respiratory rate ≥ 30 breaths/min (3 points), and arterial PH < 7.35 (4 points). A total score of five points was used to identify patients at risk of IMV. This model had a sensitivity of 85.5%, a specificity of 88.8%, and exhibited better predictive performance than the ROX index (AUROC = 0.909 vs. 0.594, p = 0.004), modified ROX index (AUROC = 0.909 vs. 0.633, p = 0.012), and HACOR scale (AUROC = 0.909 vs. 0.622, p < 0.001) using the validation cohort. CONCLUSIONS: Flu-IV score is a valuable prediction rule for 14-day IMV rates in Flu-p patients. However, it should be validated in a prospective study before implementation.


Assuntos
Influenza Humana/epidemiologia , Influenza Humana/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Respiração Artificial/estatística & dados numéricos , Medição de Risco/métodos , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
20.
Semin Respir Crit Care Med ; 43(2): 310-318, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35100650

RESUMO

Among the viruses possibly responsible for hospital-acquired and ventilator-associated pneumonia, herpes simplex virus (HSV) is probably the most often involved: HSV reactivation is frequent in intensive care unit patients, and lung parenchymal infection (HSV bronchopneumonitis) has been well described, either using cytological signs of parenchymal involvement in cells obtained during bronchoalveolar lavage or using HSV virus load in the lower respiratory tract. Although treating patients with HSV bronchopneumonitis may be recommended, based on expert opinion, prophylactic or preemptive treatment of HSV reactivation should be avoided. Ventilator-associated pneumonia due to cytomegalovirus (CMV) is less frequent than HSV bronchopneumonitis, and more difficult to diagnose. No data exists on the impact of antiviral treatment on CMV pneumonia. The involvement of respiratory viruses has been described in patients with healthcare-associated pneumonia and hospital-acquired pneumonia, but their role in ventilator-associated pneumonia is not clear.


Assuntos
Infecções por Citomegalovirus , Herpes Simples , Infecções por Herpesviridae , Pneumonia Associada à Ventilação Mecânica , Pneumonia Viral , Herpes Simples/diagnóstico , Hospitais , Humanos , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Simplexvirus
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