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2.
Rev. clín. esp. (Ed. impr.) ; 220(8): 463-471, nov. 2020. tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-192195

RESUMO

ANTECEDENTES: El primer caso de COVID-19 se detectó en México el 27 de febrero de 2020. El 30 de abril, 64 días después de este primer diagnóstico, el número de pacientes aumentó exponencialmente, alcanzando un total de 19.224 casos confirmados y 1.859 (9,67%) fallecidos. En respuesta a este brote global, resumimos el estado actual del conocimiento sobre COVID-19 en México. MÉTODOS: Los datos se obtuvieron del sitio web oficial del Ministerio de Salud en México. El período analizado fue entre el 27 de febrero y el 30 de abril de 2020. Los casos se confirmaron mediante RT-PCR en tiempo real y se analizaron los datos epidemiológicos, demográficos y clínicos. RESULTADOS: La mayoría de los casos de COVID-19 se ubicaron en la Ciudad de México. La edad promedio de los pacientes fue de 46 años. De los 12.656 casos confirmados, el mayor número de infectados ocurre en el rango de edad entre 30 y 59 años (65,85%), y hubo una mayor incidencia en hombres (58,18%) que en mujeres (41,82%). Los pacientes fallecidos tenían una o múltiples comorbilidades, principalmente hipertensión (45,53%), diabetes (39,39%) y obesidad (30,4%). En los primeros 64 días de epidemia, China había reportado 80.304 casos con una tasa de mortalidad del 3,66%. CONCLUSIONES: Nuestros resultados indican la transmisión temprana de COVID-19 en México. La epidemiología descriptiva muestra las similitudes entre los casos de COVID-19 de México y China. En el mismo período de la curva epidémica, observamos en México una reducción en el número de casos confirmados de COVID-19 y una mayor tasa de mortalidad en comparación con China


BACKGROUND: The first case of COVID-19 detected in Mexico was on the 27th of February 2020. On the 30th of April, 64 days after this first diagnosis, the number of patients had increased exponentially, reaching 19 224 confirmed cases and 1859 (9.67%) deaths. In response to this global outbreak, we summarize the current state of our understanding regarding COVID-19 in Mexico. METHODS: We obtained the data from the official website of the Ministry of Health in Mexico. The study period was between the 27th of February and the 30th of April 2020. The cases were confirmed using real-time reverse transcription-polymerase chain reaction, and we analysed epidemiological, demographic and clinical data. RESULTS: In Mexico, most cases of COVID-19 were located in Mexico City. The mean age of the patients was 46 years. Of the 12 656 confirmed cases, most infected individuals were between the ages of 30 and 59 years (65.85%), and there was a higher incidence rate in men (58.18%) than in women (41.82%). The patients who died had one or more comorbidities, mainly hypertension (45.53%), diabetes (39.39%) and obesity (30.4%). In the first 64 days of the epidemic, China had reported 80 304 cases with a mortality rate of 3.66%. CONCLUSIONS: Our results indicate an early transmission of COVID-19 in Mexico. The descriptive epidemiology shows similarities between the cases of COVID-19 in Mexico and those in China. In the same period of the epidemic curve, we observed a reduction in the number of confirmed cases of COVID-19 in Mexico and a higher mortality rate compared with that of China


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Controle de Doenças Transmissíveis/tendências , Síndrome Respiratória Aguda Grave/epidemiologia , México/epidemiologia , Infecções por Coronavirus/transmissão , Quarentena/tendências , Pandemias/estatística & dados numéricos , Vírus da SARS/patogenicidade
5.
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
6.
Ann Acad Med Singap ; 49(8): 538-542, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33164023

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) outbreak is affecting hospital admissions of stroke patients. This, in turn, will reduce the use of proven stroke treatments, which will result in poorer stroke outcomes. We examined local stroke admissions before, during, and after the 2003 outbreak of the severe acute respiratory syndrome (SARS) (these periods being defined in both the Singapore and worldwide contexts), to extrapolate stroke admission patterns in Singapore during the current COVID-19 crisis. MATERIALS AND METHODS: National inpatient admission data from the Ministry of Health (MOH), Singapore, and death data from the Registry of Births and Deaths (RBD), Singapore, were analysed. Trends of local stroke admissions and stroke-related mortality pre-SARS, during SARS, and post-SARS periods, both in the Singapore and worldwide contexts, were analysed using time series plot in monthly time units. Differences between periods were presented as percentage change between: (1) SARS and pre-SARS periods, and (2) post-SARS and SARS periods and compared using two-sample t-tests. RESULTS: There was a 19% decline in stroke admissions into all local hospitals during the Singapore SARS period (P = 0.002) and a 13% reduction during the worldwide SARS period (P = 0.006). Stroke admissions increased by 18% after the Singapore SARS period was over (P = 0.003) and rose by a further 8% when the worldwide SARS period ended (P = 0.046). Stroke-related mortality remained stable throughout. CONCLUSIONS: During the SARS pandemic, there was a reduction in the number of stroke admissions, and this was apparent during both the local SARS and worldwide SARS outbreak periods. We should take appropriate steps through public education to minimise the expected reduced stroke admissions during the COVID-19 pandemic, inferred from the findings during the SARS pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/virologia , Acidente Vascular Cerebral/epidemiologia , Educação em Saúde , Humanos , Pandemias , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/terapia , Singapura/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Taxa de Sobrevida
7.
Biomedica ; 40(Supl. 2): 173-179, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152201

RESUMO

Coronaviruses cause respiratory and gastrointestinal disorders in animals and humans. The current SARS-CoV-2, the COVID-19 infectious agent, belongs to a subgroup called betacoronavirus including the SARS-CoV and MERS-CoV responsible for epidemics in 2002 and 2012, respectively. These viruses can also infect the nervous system due to their affinity for the human angiotensin-converting enzyme 2 (ACE2) expressed in neurons and glial cells. Infections with SARS-CoV, MERS-CoV, and now SARS-CoV-2 also produce neurological signs such as acute cerebrovascular disease, impaired consciousness, and muscle injury, as well as dizziness, hypogeusia, hyposmia, hypoxia, neuralgia, and hypoxic encephalopathy. For this reason, close attention should be paid to the neurological manifestations of COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Coronavírus da Síndrome Respiratória do Oriente Médio/patogenicidade , Doenças do Sistema Nervoso/etiologia , Pneumonia Viral/complicações , Vírus da SARS/patogenicidade , Síndrome Respiratória Aguda Grave/complicações , Líquido Cefalorraquidiano/virologia , Transtornos Cerebrovasculares/etiologia , Transtornos da Consciência/etiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Previsões , Humanos , Doenças Musculoesqueléticas/etiologia , Pandemias , Pneumonia Viral/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Transtornos das Sensações/etiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Latência Viral
9.
Saudi Med J ; 41(11): 1165-1174, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33130835

RESUMO

OBJECTIVES: To determine the association between comorbidities and the severity of the disease among COVID-19 patients. METHODS: We searched the Cochrane, Medline, Trip, and EMBASE databases from 2019. The review included all available studies of COVID-19 patients published in the English language and studied the clinical characteristics, comorbidities, and disease outcomes from the beginning of the pandemic.  Two authors extracted studies characteristics and the risk of bias. Odds ratio (OR) was used to analyze the data with 95% confidence interval (CI). RESULTS: The review included 1,885 COVID-19 patients from 7 observational studies with some degree of bias risk and substantial heterogeneity. A significant association was recorded between COVID-19 severity and the following variables: male (OR= 1.60, 95%CI= 1.05 - 2.43); current smoker (OR=2.06, 95%CI= 1.08 - 3.94); and the presence of comorbidities including hypertension (OR=2.05, 95%CI= 1.56 - 2.70), diabetes (OR=2.46, 95%CI= 1.53 - 3.96), coronary heart disease (OR=4.10, 95%CI= 2.36 - 7.12), chronic kidney disease (OR=4.06, 95%CI= 1.45 - 11.35), and cancer (OR=2.28, 95%CI= 1.08 - 4.81). CONCLUSIONS: Comorbidities among COVID-19 patients may contribute to increasing their susceptibility to severe illness. The identification of these potential risk factors could help reduce mortality by identifying patients with poor prognosis at an early stage.


Assuntos
Causas de Morte , Comorbidade , Infecções por Coronavirus/epidemiologia , Suscetibilidade a Doenças/epidemiologia , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Infecções por Coronavirus/diagnóstico , Gerenciamento de Dados , Feminino , Humanos , Incidência , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Arábia Saudita/epidemiologia , Síndrome Respiratória Aguda Grave/diagnóstico , Índice de Gravidade de Doença , Análise de Sobrevida
10.
BMJ Case Rep ; 13(10)2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130585

RESUMO

Infection with SARS-CoV-2 represents a great source of concern and a new threat for immunocompromised patients. Limited studies are available on COVID-19 in immunocompromised children. This case series aimed to evaluate the clinical and laboratory characteristics, management and outcomes of COVID-19 in five children immunocompromised due to different underlying conditions. All had mild symptoms or were asymptomatic at presentation. All had a benign course of illness. No changes or delays in their treatment regimens occurred, and none experienced a relapse of the original disease, developed severe COVID-19 or died. However, these cases showed a prolonged duration of virus shedding. This report suggests that immunocompromised paediatric patients may not be at a higher risk of developing severe COVID-19. However, further studies are required to elaborate on the pathogenesis of COVID-19 in this vulnerable group.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/diagnóstico , Fatores Etários , Criança , Pré-Escolar , Terapia Combinada , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/terapia , Prognóstico , Medição de Risco , Amostragem , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/terapia , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento
11.
Cochrane Database Syst Rev ; 11: CD013779, 2020 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-33150970

RESUMO

BACKGROUND: Evidence from disease epidemics shows that healthcare workers are at risk of developing short- and long-term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID-19 crisis on the mental well-being of health and social care professionals. Symptoms of mental health problems commonly include depression, anxiety, stress, and additional cognitive and social problems; these can impact on function in the workplace. The mental health and resilience (ability to cope with the negative effects of stress) of frontline health and social care professionals ('frontline workers' in this review) could be supported during disease epidemics by workplace interventions, interventions to support basic daily needs, psychological support interventions, pharmacological interventions, or a combination of any or all of these. OBJECTIVES: Objective 1: to assess the effects of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. Objective 2: to identify barriers and facilitators that may impact on the implementation of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. SEARCH METHODS: On 28 May 2020 we searched the Cochrane Database of Systematic Reviews, CENTRAL, MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Global Index Medicus databases and WHO Institutional Repository for Information Sharing. We also searched ongoing trials registers and Google Scholar. We ran all searches from the year 2002 onwards, with no language restrictions. SELECTION CRITERIA: We included studies in which participants were health and social care professionals working at the front line during infectious disease outbreaks, categorised as epidemics or pandemics by WHO, from 2002 onwards. For objective 1 we included quantitative evidence from randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies, which investigated the effect of any intervention to support mental health or resilience, compared to no intervention, standard care, placebo or attention control intervention, or other active interventions. For objective 2 we included qualitative evidence from studies that described barriers and facilitators to the implementation of interventions. Outcomes critical to this review were general mental health and resilience. Additional outcomes included psychological symptoms of anxiety, depression or stress; burnout; other mental health disorders; workplace staffing; and adverse events arising from interventions. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently applied selection criteria to abstracts and full papers, with disagreements resolved through discussion. One review author systematically extracted data, cross-checked by a second review author. For objective 1, we assessed risk of bias of studies of effectiveness using the Cochrane 'Risk of bias' tool. For objective 2, we assessed methodological limitations using either the CASP (Critical Appraisal Skills Programme) qualitative study tool, for qualitative studies, or WEIRD (Ways of Evaluating Important and Relevant Data) tool, for descriptive studies. We planned meta-analyses of pairwise comparisons for outcomes if direct evidence were available. Two review authors extracted evidence relating to barriers and facilitators to implementation, organised these around the domains of the Consolidated Framework of Implementation Research, and used the GRADE-CERQual approach to assess confidence in each finding. We planned to produce an overarching synthesis, bringing quantitative and qualitative findings together. MAIN RESULTS: We included 16 studies that reported implementation of an intervention aimed at supporting the resilience or mental health of frontline workers during disease outbreaks (severe acute respiratory syndrome (SARS): 2; Ebola: 9; Middle East respiratory syndrome (MERS): 1; COVID-19: 4). Interventions studied included workplace interventions, such as training, structure and communication (6 studies); psychological support interventions, such as counselling and psychology services (8 studies); and multifaceted interventions (2 studies). Objective 1: a mixed-methods study that incorporated a cluster-randomised trial, investigating the effect of a work-based intervention, provided very low-certainty evidence about the effect of training frontline healthcare workers to deliver psychological first aid on a measure of burnout. Objective 2: we included all 16 studies in our qualitative evidence synthesis; we classified seven as qualitative and nine as descriptive studies. We identified 17 key findings from multiple barriers and facilitators reported in studies. We did not have high confidence in any of the findings; we had moderate confidence in six findings and low to very low confidence in 11 findings. We are moderately confident that the following two factors were barriers to intervention implementation: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well-being; and a lack of equipment, staff time or skills needed for an intervention. We are moderately confident that the following three factors were facilitators of intervention implementation: interventions that could be adapted for local needs; having effective communication, both formally and socially; and having positive, safe and supportive learning environments for frontline workers. We are moderately confident that the knowledge or beliefs, or both, that people have about an intervention can act as either barriers or facilitators to implementation of the intervention. AUTHORS' CONCLUSIONS: There is a lack of both quantitative and qualitative evidence from studies carried out during or after disease epidemics and pandemics that can inform the selection of interventions that are beneficial to the resilience and mental health of frontline workers. Alternative sources of evidence (e.g. from other healthcare crises, and general evidence about interventions that support mental well-being) could therefore be used to inform decision making. When selecting interventions aimed at supporting frontline workers' mental health, organisational, social, personal, and psychological factors may all be important. Research to determine the effectiveness of interventions is a high priority. The COVID-19 pandemic provides unique opportunities for robust evaluation of interventions. Future studies must be developed with appropriately rigorous planning, including development, peer review and transparent reporting of research protocols, following guidance and standards for best practice, and with appropriate length of follow-up. Factors that may act as barriers and facilitators to implementation of interventions should be considered during the planning of future research and when selecting interventions to deliver within local settings.


Assuntos
Surtos de Doenças , Pessoal de Saúde/psicologia , Saúde Mental , Saúde do Trabalhador , Resiliência Psicológica , Assistentes Sociais/psicologia , Betacoronavirus , Viés , Esgotamento Profissional/psicologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Epidemias , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Sistemas de Apoio Psicossocial , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/terapia , Local de Trabalho
12.
Eur Respir Rev ; 29(158)2020 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-33153991

RESUMO

The 2019 coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Clinical outcomes, including mortality, are worse in males, older individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibility to virus-induced exacerbations, compromised pulmonary function and high prevalence of associated comorbidities. Using evidence from basic science and cohort studies, this review addresses key questions concerning COVID-19 and COPD. First, are there mechanisms by which COPD patients are more susceptible to SARS-CoV-2 infection? Secondly, do inhaled corticosteroids offer protection against COVID-19? And, thirdly, what is the evidence regarding clinical outcomes from COVID-19 in COPD patients? This up-to-date review tackles some of the key issues which have significant impact on the long-term outlook for COPD patients in the context of COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Suscetibilidade a Doenças , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Fatores Etários , Idoso , Comorbidade , Infecções por Coronavirus/terapia , Medicina Baseada em Evidências , Humanos , Incidência , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Pneumonia Viral/terapia , Prognóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Testes de Função Respiratória , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/epidemiologia , Índice de Gravidade de Doença , Fatores Sexuais
14.
Tidsskr Nor Laegeforen ; 140(14)2020 10 13.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-33070603

RESUMO

BACKGROUND: The course of COVID-19 may be particularly long-lasting in elderly patients. Caring for patients with dementia suffering from COVID-19 is challenging due to unclear symptom presentation, delirium, and maintaining isolation procedures. CASE PRESENTATION: A man in his sixties with dementia, hospitalised in a psychogeriatric ward, presented with mild upper respiratory tract symptoms and recovered within 24 hours. Ten days later he developed more severe symptoms. PCR test for SARS-CoV-2 was positive. Over the following two months his clinical state fluctuated, from almost symptom-free days to being bedridden and assessed as potentially terminal. After the initial positive test, he had three consecutive negative tests, before he again tested positive for SARS-CoV-2. Uncertainty as to whether the patient remained contagious resulted in isolation of the patient for over two months. INTERPRETATION: PCR testing of SARS-CoV-2 does not differentiate between intact virus and remnants thereof, and patients may test positive for a long time. This along with a fluctuating clinical course makes it difficult for clinicians to decide when to end isolation of COVID-19 patients.


Assuntos
Infecções por Coronavirus , Demência , Pandemias , Pneumonia Viral , Síndrome Respiratória Aguda Grave , Idoso , Betacoronavirus , Infecções por Coronavirus/complicações , Demência/complicações , Humanos , Masculino , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/epidemiologia , Fatores de Tempo
15.
BMC Infect Dis ; 20(1): 805, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126857

RESUMO

BACKGROUND: Both coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) are caused by coronaviruses and have infected people in China and worldwide. We aimed to investigate whether COVID-19 and SARS exhibited similar spatial and temporal features at provincial level in mainland China. METHODS: The number of people infected by COVID-19 and SARS were extracted from daily briefings on newly confirmed cases during the epidemics, as of Mar. 4, 2020 and Aug. 3, 2003, respectively. We depicted spatiotemporal patterns of the COVID-19 and SARS epidemics using spatial statistics such as Moran's I and the local indicators of spatial association (LISA). RESULTS: Compared to SARS, COVID-19 had a higher overall incidence. We identified 3 clusters (predominantly located in south-central China; the highest RR = 135.08, 95% CI: 128.36-142.08) for COVID-19 and 4 clusters (mainly in Northern China; the highest RR = 423.51, 95% CI: 240.96-722.32) for SARS. Fewer secondary clusters were identified after the "Wuhan lockdown". The LISA cluster map detected a significantly high-low (Hubei) and low-high spatial clustering (Anhui, Hunan, and Jiangxi, in Central China) for COVID-19. Two significant high-high (Beijing and Tianjin) and low-high (Hebei) clusters were detected for SARS. CONCLUSIONS: COVID-19 and SARS outbreaks exhibited distinct spatiotemporal clustering patterns at the provincial levels in mainland China, which may be attributable to changes in social and demographic factors, local government containment strategies or differences in transmission mechanisms.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Betacoronavirus/fisiologia , China/epidemiologia , Análise por Conglomerados , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Incidência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Vírus da SARS/fisiologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Síndrome Respiratória Aguda Grave/transmissão , Análise Espaço-Temporal
16.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192934

RESUMO

INTRODUCCIÓN: ¿cómo seguir trabajando la orientación y participación comunitaria en Atención Primaria durante la pandemia por COVID-19?. OBJETIVOS Y MÉTODOS: observar, describir, reflexionar y documentar aspectos relativos a la atención comunitaria en el momento actual de pandemia por COVID-19 en los equipos de Atención Primaria (EAP) de Aragón. Estudio exploratorio-descriptivo observacional transversal con enfoque cualitativo, con dos fases. 1ª: recopilación de experiencias comunitarias y localización de informantes clave. 2ª: descripción de acciones comunitarias. Análisis descriptivo y tipo DAFO. RESULTADOS: se detectaron 47 iniciativas. Participaron 11 expertas y 54 informantes clave. El 66,6% consideró el rol de los EAP como consultores/colaboradores. El 64,9% de las iniciativas contempló la diversidad. El 49,1% no sabía si valoraron diferencias por género. Destacaron la importancia de lo comunitario para superar la crisis y la cooperación y coordinación con la comunidad e instituciones locales. DISCUSIÓN: protocolos con orientación biomédica, miedo e incertidumbre por la COVID-19 dificultaron el desarrollo de iniciativas comunitarias; frente a esto, fue clave la trayectoria comunitaria previa de los EAP, el trabajo en equipo, con especial relevancia el de las trabajadoras sociales, y su motivación. La participación del EAP como colaborador refuerza la importancia del liderazgo compartido. Son necesarios espacios colaborativos, apoyo institucional y coordinación intersectorial. CONCLUSIÓN: durante la pandemia, las comunidades deben ser parte de la respuesta; la orientación comunitaria de los EAP es clave. Es preciso visibilizar, acompañar y reforzar el trabajo comunitario y estimular la coordinación con Salud Pública


INTRODUCTION: How to continue working on community guidance and participation in Primary Care during the COVID-19 pandemic?. OJECTIVES AND METHODS: To observe, report, reflect and document autonomous community experiences of Aragonese Primary Care Teams (PCT) during the COVID-19 pandemic. A two-phase exploratory-descriptive observational, cross-sectional study with a qualitative approach. Phase 1: compilation of experiences in community health and location of key informants. Phase 2: description of community actions. Descriptive and SWOT analysis. RESULTS: A total of 47 initiatives were detected; 11 experts and 54 key informants took part. A total of 66.6% considered the role of the PCT as consultants or collaborators; 64.9% of initiatives considered diversity. A total of 49.1% did not know whether they evaluated differences by sex. They highlighted the importance of the community to overcome the crisis, and cooperation and coordination with community and local institutions. DISCUSSION: Protocols with biomedical guidance, fear and uncertainty due to COVID-19 hindered development of community initiatives. In light of this, the previous community trajectory of PCTs, teamwork with special relevance of social workers and their motivation were fundamental. PCT involvement as a partner strengthens the importance of shared leadership. Collaborative spaces, institutional support and intersectoral coordination are all necessary. CONCLUSION: During the pandemic, communities must be part of the response; PCT community guidance is essential. Visibility, working alongside and strengthening community work and stimulating public health coordination are all necessary requirements


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Serviço Social/organização & administração , Assistência ao Paciente/tendências , Serviços de Saúde Comunitária/organização & administração , Participação da Comunidade/tendências , Pandemias/estatística & dados numéricos , Estudos Transversais , Pesquisa sobre Serviços de Saúde/tendências
17.
Rev. esp. anestesiol. reanim ; 67(8): 438-445, oct. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-193564

RESUMO

La infección por COVID-19 afecta también a las pacientes obstétricas. La atención obstétrica habitual ha continuado a pesar de la pandemia. Existen series de casos de pacientes obstétricas. Parece que las técnicas neuroaxiales son seguras y es importante asegurarse que los bloqueos funcionen correctamente antes de una cesárea. Es por esto que se recomienda que los bloqueos sean realizados por anestesiólogos expertos. La protección y seguridad de los profesionales es un punto fundamental y, en caso de anestesia general, también se recomienda acudir al anestesiólogo más experto. Las pacientes gravemente enfermas deben reconocerse rápida y precozmente, para poder suministrarles el tratamiento adecuado lo antes posible. La susceptibilidad a las trombosis hace que la anticoagulación profiláctica sea prioritaria


COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Anestesia Obstétrica/métodos , Cesárea/métodos , Gestantes , Pandemias , Complicações Infecciosas na Gravidez/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Precauções Universais/métodos
18.
Rev. esp. quimioter ; 33(5): 313-326, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193704

RESUMO

ANTECEDENTES: La aparición de nuevas enfermedades infecciosas, como el COVID-19, supone un reto en el seguimiento de la gestación y la prevención de complicaciones obstétricas y neonatales. La revisión exploratoria tiene el objetivo de revisar la información disponible en mujeres embarazadas infectadas por los coronavirus MERS-CoV, SARS-CoV, SARS-CoV-2 para evaluar las similitudes y diferencias en las características clínicas de las madres y los resultados neonatales. MÉTODOS: Realizamos una búsqueda bibliográfica (revisión exploratoria) acorde a las pautas de PRISMA entre marzo y abril del 2020 en las bases de datos de MEDLINE, SciELO, y CUIDEN y el Centro de Información sobre el COVID-19 de Elsevier. RESULTADOS: Analizamos 20 artículos con un total de 102 casos: 9 de MERS-CoV, 14 de SARS-CoV y 79 de SARS-CoV-2. La fiebre (75,5%) y la neumonía (73,5%) resultaron ser los síntomas más frecuentes en las gestantes infectadas. Las complicaciones obstétricas más frecuentes fueron la amenaza de parto prematuro (23,5%) y la cesárea (74,5%). No se documentó ninguna transmisión vertical en los neonatos. CONCLUSIONES: Los tres coronavirus producen una neumonía con sintomatología muy similar, resultando más leve en el caso de SARS-CoV-2. A pesar de las complicaciones obstétricas documentadas, los resultados neonatales son favorables en su mayoría. Es preciso aumentar el conocimiento para mejorar y prevenir las complicaciones obstétricas y neonatales de estas infecciones en mujeres embarazadas


BACKGROUND: The appearance of new infectious diseases, such as COVID-19, poses a challenge in monitoring pregnancy and preventing obstetric and neonatal complications. A scoping review has the objective to review the information available in pregnant women infected with the MERS-CoV, SARSCoV, SARS-CoV-2 coronaviruses to assess the similarities in terms of and differences in the clinical characteristics of the mothers and neonatal outcomes. METHODS: We carried out a bibliographic search (scoping review) according to the PRISMA guidelines between March and April 2020 in the MEDLINE, SciELO, and CUIDEN databases and the Elsevier COVID-19 Information Center. RESULTS: We analyzed 20 articles with a total of 102 cases. 9 of MERS-CoV, 14 of SARS-CoV and 79 of SARS-CoV-2. Fever (75.5%) and pneumonia (73.5%) were the most frequent symptoms in infected pregnant women. The most frequent obstetric complications were the threat of premature delivery (23.5%) and caesarean section (74.5%). No vertical transmission was documented in any of the infants. CONCLUSIONS: All three coronaviruses produce pneumonia with very similar symptoms, being milder in the case of SARSCoV2. Despite documented obstetric complications, neonatal outcomes are mostly favorable. Increased knowledge is needed to improve and prevent obstetric and neonatal complications from these infections in pregnant women


Assuntos
Humanos , Complicações Infecciosas na Gravidez/epidemiologia , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Coronavírus da Síndrome Respiratória do Oriente Médio/patogenicidade
19.
Rev. esp. quimioter ; 33(5): 369-378, oct. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193705

RESUMO

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


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


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Pneumonia Viral/epidemiologia , Mortalidade Hospitalar/tendências , Espanha/epidemiologia , Estatísticas Hospitalares , Antivirais/uso terapêutico , Reação em Cadeia da Polimerase/estatística & dados numéricos , Infecções por Coronavirus/complicações , Índice de Gravidade de Doença
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