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1.
Isr Med Assoc J ; 23(1): 7-10, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443334

RESUMO

BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic outbreak our blood bank developed protocols to guarantee accurate blood components to COVID-19 patients. OBJECTIVES: To provide convalescent whole blood donor screening strategies for patients recovering from COVID-19. METHODS: We recruited COVID-19 recovering patients who met our defined inclusion criteria for whole blood donation. All blood units were screened for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA by real time reverse transcription polymerase chain reaction (RT-PCR) and SARS-COV-2 immunoglobulin G (IgG) antibodies against the S1 domain. RESULTS: We screened 180 blood units from patients recovering from COVID-19. All results were negative for SARS-CoV-2 RNA and 87.2% were positive for SARS-COV-2 IgG antibodies in the plasma. CONCLUSIONS: Blood component units from recovering COVID-19 patients are safe. Plasma units with positive IgG antibodies could serve as an efficient passive immunization for COVID-19 patients. Moreover, in the face of increased transfusion demand for treatment of anemia and coagulation dysfunction in critical ill COVID-19 patients, red blood cells units and random platelets units from convalescent donors can be safely transfused.


Assuntos
Doadores de Sangue , Seleção do Doador , /imunologia , Adulto , Anticorpos Antivirais/imunologia , Feminino , Humanos , Imunização Passiva/métodos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sobreviventes , Adulto Jovem
2.
Cell Host Microbe ; 29(1): 7-9, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33444556

RESUMO

High-dose ionizing radiation used during cancer radiotherapy is associated with the induction of hematopoietic, gastrointestinal, and cerebrovascular injuries. In a recent Science issue, Guo et al. demonstrated that the gut microbiota-and its associated metabolites-play a central role in protecting against high-dose radiation.


Assuntos
Microbioma Gastrointestinal , Radiação , Trato Gastrointestinal , Humanos , Sobreviventes
4.
J Med Virol ; 93(2): 1013-1022, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32729939

RESUMO

BACKGROUND: There is currently very limited information on the nature and prevalence of post-COVID-19 symptoms after hospital discharge. METHODS: A purposive sample of 100 survivors discharged from a large University hospital were assessed 4 to 8 weeks after discharge by a multidisciplinary team of rehabilitation professionals using a specialist telephone screening tool designed to capture symptoms and impact on daily life. EQ-5D-5L telephone version was also completed. RESULTS: Participants were between 29 and 71 days (mean 48 days) postdischarge from hospital. Thirty-two participants required treatment in intensive care unit (ICU group) and 68 were managed in hospital wards without needing ICU care (ward group). New illness-related fatigue was the most common reported symptom by 72% participants in ICU group and 60.3% in ward group. The next most common symptoms were breathlessness (65.6% in ICU group and 42.6% in ward group) and psychological distress (46.9% in ICU group and 23.5% in ward group). There was a clinically significant drop in EQ5D in 68.8% in ICU group and in 45.6% in ward group. CONCLUSIONS: This is the first study from the United Kingdom reporting on postdischarge symptoms. We recommend planning rehabilitation services to manage these symptoms appropriately and maximize the functional return of COVID-19 survivors.


Assuntos
/complicações , Alta do Paciente/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos , Estudos Transversais , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reino Unido/epidemiologia , Adulto Jovem
5.
J Psychiatr Res ; 132: 23-31, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33038562

RESUMO

Trauma survivors who suffer from posttraumatic stress disorder (PTSD) symptoms may be particularly vulnerable when facing the COVID-19 pandemic. Yet trauma exposure may also lead to salutogenic outcomes, known as posttraumatic growth (PTG). Nevertheless, the implications of PTG attributed to prior trauma, for trauma survivors' adjustment when facing additional stressors, are unclear. Addressing this gap, 528 Israeli trauma survivors were assessed for PTG and PTSD symptoms attributed to prior trauma, as well as peritraumatic stress symptoms related to the pandemic, as part of an online survey. Analyses revealed that being younger, female, quarantined, negatively self-rating one's health status, and suffering from PTSD symptoms were associated with elevated peritraumatic stress symptoms. Furthermore, PTG attributed to prior trauma made a significant contribution in explaining elevated intrusion, avoidance, and hyperarousal symptoms. The present results point to the need for clinicians to take into account reports of PTG attributed to prior trauma when treating trauma survivors during the current pandemic.


Assuntos
Nível de Saúde , Crescimento Psicológico Pós-Traumático , Trauma Psicológico/psicologia , Quarentena/psicologia , Transtornos de Estresse Traumático/psicologia , Sobreviventes/psicologia , Adolescente , Adulto , Idoso , Autoavaliação Diagnóstica , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
Clin Microbiol Infect ; 27(1): 89-95, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32979574

RESUMO

OBJECTIVES: To describe the prevalence, nature and risk factors for the main clinical sequelae in coronavirus disease 2019 (COVID-19) survivors who have been discharged from the hospital for more than 3 months. METHODS: This longitudinal study was based on a telephone follow-up survey of COVID-19 patients hospitalized and discharged from Renmin Hospital of Wuhan University, Wuhan, China before 1 March 2020. Demographic and clinical characteristics and self-reported clinical sequelae of the survivors were described and analysed. A cohort of volunteers who were free of COVID-19 and lived in the urban area of Wuhan during the outbreak were also selected as the comparison group. RESULTS: Among 538 survivors (293, 54.5% female), the median (interquartile range) age was 52.0 (41.0-62.0) years, and the time from discharge from hospital to first follow-up was 97.0 (95.0-102.0) days. Clinical sequelae were common, including general symptoms (n = 267, 49.6%), respiratory symptoms (n = 210, 39%), cardiovascular-related symptoms (n = 70, 13%), psychosocial symptoms (n = 122, 22.7%) and alopecia (n = 154, 28.6%). We found that physical decline/fatigue (p < 0.01), postactivity polypnoea (p= 0.04) and alopecia (p < 0.01) were more common in female than in male subjects. Dyspnoea during hospitalization was associated with subsequent physical decline/fatigue, postactivity polypnoea and resting heart rate increases but not specifically with alopecia. A history of asthma during hospitalization was associated with subsequent postactivity polypnoea sequela. A history of pulse ≥90 bpm during hospitalization was associated with resting heart rate increase in convalescence. The duration of virus shedding after COVID-19 onset and hospital length of stay were longer in survivors with physical decline/fatigue or postactivity polypnoea than in those without. CONCLUSIONS: Clinical sequelae during early COVID-19 convalescence were common; some of these sequelae might be related to gender, age and clinical characteristics during hospitalization.


Assuntos
Alopecia/epidemiologia , Dispneia/epidemiologia , Fadiga/epidemiologia , Sobreviventes , Taquicardia/epidemiologia , Adulto , Alopecia/complicações , Alopecia/fisiopatologia , Alopecia/terapia , /fisiopatologia , China/epidemiologia , Convalescença , Dispneia/complicações , Dispneia/fisiopatologia , Dispneia/terapia , Fadiga/complicações , Fadiga/fisiopatologia , Fadiga/terapia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Fatores de Risco , Índice de Gravidade de Doença , Taquicardia/complicações , Taquicardia/fisiopatologia , Taquicardia/terapia
7.
Support Care Cancer ; 29(1): 289-300, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32358776

RESUMO

PURPOSE: To investigate lifestyle in a population-based sample of long-term (≥ 5 years since diagnosis) young adult cancer survivors (YACSs), and explore factors associated with not meeting the lifestyle guidelines for physical activity (PA), body mass index (BMI), and smoking. METHODS: YACSs (n = 3558) diagnosed with breast cancer (BC), colorectal cancer (CRC), non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), or localized malignant melanoma (MM) between the ages of 19 and 39 years and treated between 1985 and 2009 were invited to complete a mailed questionnaire. Survivors of localized MM treated with limited skin surgery served as a reference group for treatment burden. RESULTS: In total, 1488 YACSs responded (42%), and 1056 YACSs were evaluable and included in the present study (74% females, average age at survey 49 years, average 15 years since diagnosis). Forty-four percent did not meet PA guidelines, 50% reported BMI ≥ 25 and 20% smoked, with no statistically significant differences across diagnostic groups. Male gender, education ≤ 13 years, comorbidity, lymphedema, pain, chronic fatigue, and depressive symptoms were associated with not meeting single and/or an increasing number of lifestyle guidelines. CONCLUSION: A large proportion of long-term YACSs do not meet the lifestyle guidelines for PA, BMI, and/or smoking. Non-adherence to guidelines is associated with several late effects and/or comorbidities that should be considered when designing lifestyle interventions for YACSs.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Exercício Físico/psicologia , Estilo de Vida Saudável , Cooperação do Paciente/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Neoplasias da Mama/terapia , Sobreviventes de Câncer/psicologia , Neoplasias Colorretais/terapia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Melanoma/terapia , Pessoa de Meia-Idade , Dor/complicações , Neoplasias Cutâneas/terapia , Fumar/epidemiologia , Inquéritos e Questionários , Sobreviventes/psicologia , Adulto Jovem
8.
PLoS One ; 15(12): e0244129, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370366

RESUMO

BACKGROUND: Detailed temporal analyses of complete (full) blood count (CBC) parameters, their evolution and relationship to patient age, gender, co-morbidities and management outcomes in survivors and non-survivors with COVID-19 disease, could identify prognostic clinical biomarkers. METHODS: From 29 January 2020 until 28 March 2020, we performed a longitudinal cohort study of COVID-19 inpatients at the Italian National Institute for Infectious Diseases, Rome, Italy. 9 CBC parameters were studied as continuous variables [neutrophils, lymphocytes, monocytes, platelets, mean platelet volume, red blood cell count, haemoglobin concentration, mean red blood cell volume and red blood cell distribution width (RDW %)]. Model-based punctual estimates, as average of all patients' values, and differences between survivors and non-survivors, overall, and by co-morbidities, at specific times after symptoms, with relative 95% CI and P-values, were obtained by marginal prediction and ANOVA- style joint tests. All analyses were carried out by STATA 15 statistical package. MAIN FINDINGS: 379 COVID-19 patients [273 (72% were male; mean age was 61.67 (SD 15.60)] were enrolled and 1,805 measures per parameter were analysed. Neutrophils' counts were on average significantly higher in non-survivors than in survivors (P<0.001) and lymphocytes were on average higher in survivors (P<0.001). These differences were time dependent. Average platelets' counts (P<0.001) and median platelets' volume (P<0.001) were significantly different in survivors and non-survivors. The differences were time dependent and consistent with acute inflammation followed either by recovery or by death. Anaemia with anisocytosis was observed in the later phase of COVID-19 disease in non-survivors only. Mortality was significantly higher in patients with diabetes (OR = 3.28; 95%CI 1.51-7.13; p = 0.005), obesity (OR = 3.89; 95%CI 1.51-10.04; p = 0.010), chronic renal failure (OR = 9.23; 95%CI 3.49-24.36; p = 0.001), COPD (OR = 2.47; 95% IC 1.13-5.43; p = 0.033), cardiovascular diseases (OR = 4.46; 95%CI 2.25-8.86; p = 0.001), and those >60 years (OR = 4.21; 95%CI 1.82-9.77; p = 0.001). Age (OR = 2.59; 95%CI 1.04-6.45; p = 0.042), obesity (OR = 5.13; 95%CI 1.81-14.50; p = 0.002), renal chronic failure (OR = 5.20; 95%CI 1.80-14.97; p = 0.002) and cardiovascular diseases (OR 2.79; 95%CI 1.29-6.03; p = 0.009) were independently associated with poor clinical outcome at 30 days after symptoms' onset. INTERPRETATION: Increased neutrophil counts, reduced lymphocyte counts, increased median platelet volume and anaemia with anisocytosis, are poor prognostic indicators for COVID19, after adjusting for the confounding effect of obesity, chronic renal failure, COPD, cardiovascular diseases and age >60 years.


Assuntos
/sangue , Biomarcadores/sangue , Contagem de Células Sanguíneas , Estudos de Coortes , Demografia/métodos , Índices de Eritrócitos/imunologia , Feminino , Humanos , Inflamação/sangue , Inflamação/imunologia , Contagem de Leucócitos/métodos , Estudos Longitudinais , Linfócitos/imunologia , Masculino , Volume Plaquetário Médio/métodos , Pessoa de Meia-Idade , Neutrófilos/imunologia , Prognóstico , Roma , Sobreviventes
9.
PLoS One ; 15(12): e0244131, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370368

RESUMO

INTRODUCTION: A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. METHODS: We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. RESULTS: Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). CONCLUSIONS AND RELEVANCE: Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/patologia , Rim/patologia , Lesão Renal Aguda/virologia , Idoso , Estado Terminal/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva , Rim/virologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Modelos de Riscos Proporcionais , Terapia de Substituição Renal/métodos , Estudos Retrospectivos , Sobreviventes
11.
Medicine (Baltimore) ; 99(51): e23872, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371174

RESUMO

ABSTRACT: At present, the association between albumin, N-terminal pro-brain natriuretic peptide (NT-proBNP) and long-term prognosis in patients with chronic heart failure (CHF) is unclear. Therefore, the purpose of this study is to explore the relationship between albumin, NT-proBNP and all-cause mortality in CHF patients.Three hundred fifty two CHF patients were recruited in our study, and patients were divided into 2 groups according to the mean (37.16 g/L) of albumin concentration [low group (albumin < 37.16 g/L) and high group (albumin≥37.16 g/L)]. Differences between groups was compared by odds ratio (OR) and 95% confidence interval (CI).NT-proBNP in the high group was significantly lower than that in the low group at baseline [1811.50 (698.75-4037.00) vs 3479.50 (1538.50-7824.25), P < .001]. Spearman correlation analysis showed that there was a negative correlation between albumin and NT-pro BNP log10 transform (ρ= -0.217, P < .001). Furthermore, curve fitting further confirmed that albumin was negatively correlated with NT-proBNP. After a median follow-up of 1726 days, 90 patients in the high group occur all-cause mortality, and 98 patients in the low group occur all-cause mortality (46.88% vs 61.25%, OR = 0.29, 95% CI: 0.08-0.50). After adjusting for the selected confounding covariates by multivariate regression analysis, decreased albumin was still associated with increased all-cause mortality (high group vs low group: OR = 0.62, 95% CI: 0.39-0.97).Decreased albumin is associated with elevated NT-ProBNP and poor long-term prognosis in CHF patients. Clinicians need to pay enough attention to the nutritional status of CHF patients.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Peptídeo Natriurético Encefálico/análise , Fragmentos de Peptídeos/análise , Prognóstico , Albumina Sérica Humana/análise , Sobreviventes , Idoso , Estudos de Coortes , Feminino , Insuficiência Cardíaca/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Retrospectivos
12.
Ned Tijdschr Geneeskd ; 1642020 10 29.
Artigo em Holandês | MEDLINE | ID: mdl-33331730

RESUMO

In the early phase of the COVID-19 pandemic, knowledge about the natural course of recovery of COVID-19 is limited. We therefore describe - based on generic knowledge of post IC syndrome (PICS) and (pulmonary) rehabilitation - the possibilities to organize personalized rehabilitation programs in several care settings. To illustrate variety in need for rehabilitation, we described three cases of critical COVID-19 disease survivors after treatment in the intensive care unit. Some patients require immediate rehabilitation following hospitalization, but rehabilitation may also be initiated in the home environment. For the latter population monitoring of progress and recovery should be organized to assess whether a more intensified multidisciplinary rehabilitation program is needed. This may be initiated in one of the medical rehabilitation centers or in pulmonary rehabilitation centers. Post-COVID-19 rehabilitation, regardless of the specific form, should be patient-centered and multidisciplinary organized.


Assuntos
Estado Terminal/reabilitação , Serviços de Assistência Domiciliar/organização & administração , Centros de Reabilitação/organização & administração , Reabilitação , /reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Assistência Centrada no Paciente , Recuperação de Função Fisiológica , Reabilitação/métodos , Reabilitação/organização & administração , Reabilitação/tendências , Sobreviventes
13.
Med Sci Monit ; 26: e930340, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33323916

RESUMO

Alterations in complex behavioral patterns during the extended period of the COVID-19 pandemic are predicted to promote a variety of psychiatric disease symptoms due to enforced social isolation and self-quarantine. Accordingly, multifaceted mental health problems will continue to increase, thereby creating a challenge for society and the health care system in general. Recent studies show that COVID-19 can directly or indirectly influence the central nervous system, potentially causing neurological pathologies such as Alzheimer disease and Parkinson disease. Thus, chronic COVID-19-related disease processes have the potential to cause serious mental illnesses, including depression, anxiety, and sleep disorders. Importantly, mental health problems can foster systemic changes in functionally-linked neuroendocrine conditions that heighten a person's susceptibility to COVID-19 infection. These altered defense mechanisms may include compromised "self-control" and "self-care", as well as a "lack of insight" into the danger posed by the virus. These consequences may have serious social impacts on the future of COVID-19 survivors. Compounding the functionally related issues of altered mental health parameters and viral susceptibility are the potential effects of compromised immunity on the establishment of functional herd immunity. Within this context, mental health takes on added importance, particularly in terms of the need to increase support for mental health research and community-based initiatives. Thus, COVID-19 infections continue to reveal mental health targets, a process we must now be prepared to deal with.


Assuntos
/complicações , Saúde Mental , Sobreviventes/psicologia , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/prevenção & controle , Doença de Alzheimer/virologia , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , Ansiedade/psicologia , /psicologia , Depressão/epidemiologia , Depressão/prevenção & controle , Depressão/psicologia , Suscetibilidade a Doenças/psicologia , Humanos , Pandemias , Doença de Parkinson/epidemiologia , Doença de Parkinson/prevenção & controle , Doença de Parkinson/virologia , Autocuidado/psicologia , Autocontrole/psicologia , Isolamento Social/psicologia
14.
PLoS One ; 15(12): e0243883, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332386

RESUMO

OBJECTIVE: To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures. DESIGN: Multi-center retrospective cohort study. SETTING: Twenty-eight hospitals located in eight provinces of China. METHODS: A total of 432 survivors with laboratory-confirmed SARS CoV-2 infection participated in this study. At discharge, we assessed instrumental activities of daily living (IADL) with Lawton's IADL scale, dependence in activities of daily living (ADL) with the Barthel Index, and anxiety with Zung's self-reported anxiety scale. Exposures included comorbidity, smoking, setting (Hubei vs. others), disease severity, symptoms, and length of hospital stay. Other risk factors considered were age, gender, and ethnicity (Han vs. Tibetan). RESULTS: Prevalence of at least one IADL problem was 36.81% (95% CI: 32.39-41.46). ADL dependence was present in 16.44% (95% CI: 13.23-20.23) and 28.70% (95% CI: 24.63-33.15) were screened positive for clinical anxiety. Adjusted risk ratio (RR) of IADL limitations (RR 2.48, 95% CI: 1.80-3.40), ADL dependence (RR 2.07, 95% CI 1.15-3.76), and probable clinical anxiety (RR 2.53, 95% CI 1.69-3.79) were consistently elevated in survivors with severe Covid-19. Age was an additional independent risk factor for IADL limitations and ADL dependence; and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a protective factor for anxiety but a risk factor for IADL limitations. CONCLUSION: A significant proportion of Covid-19 survivors had disability and anxiety at discharge from hospital. Health systems need to be prepared for an additional burden resulting from rehabilitation needs of Covid-19 survivors.


Assuntos
Transtornos de Ansiedade , Pessoas com Deficiência , Sobreviventes , Atividades Cotidianas , Adulto , Fatores Etários , Idoso , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , /psicologia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco
16.
Clin Dermatol ; 38(6): 737-743, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33341207

RESUMO

Amid the coronavirus disease 2019 (COVID-19) pandemic, there has been an alarming rise in domestic violence worldwide. Factors believed to be fueling this escalation in domestic violence include increasing social confinement at home during lockdowns and mounting stress levels from unemployment that have resulted from the economic uncertainties of these times. This contribution explores some of the challenges faced by physicians in clinically assessing victims of domestic violence during the COVID-19 era. One such challenge is the increased reliance on telemedicine during the pandemic, a medium of communication that offers a narrower clinical view of patients than is what is usually provided by an in-person examination. In this contribution, we offer suggestions on how best to screen for domestic violence, whether through telemedicine or during an in-person encounter. The history and physical findings that suggest domestic violence are reviewed along with recommendations on how to make the clinical examination more sensitive and compassionate to the needs of the victims. One of the authors of this contribution (L.C.H.) is herself a survivor of domestic violence and has courageously shared, in these pages, details of her harrowing near murder by an abusing husband. From this case history, it is hoped that readers will gain wider insights into what domestic violence means from the perspective of a victim and how we can better help save victims from this widespread and devastating social problem.


Assuntos
/epidemiologia , Dermatologia , Papel do Médico , Maus-Tratos Conjugais/prevenção & controle , Sobreviventes/psicologia , Feminino , Humanos , Maus-Tratos Conjugais/legislação & jurisprudência , Maus-Tratos Conjugais/psicologia , Telemedicina , Ferimentos e Lesões/diagnóstico
17.
Br J Community Nurs ; 25(12): 594-597, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33275514

RESUMO

The COVID-19 pandemic will have long-term ramifications for many patients, including those who work in the NHS and have been victims of the disease. This short case study describes the journey of an emergency department (ED) charge nurse who contracted COVID-19 and was hospitalised in the intensive care unit (ICU). Post-discharge, he experienced a multitude of physical and mental health complications, which ultimately impacted on each other. Therefore, a bio-psycho-pharmaco-social approach to care is recommended from admission through ICU, discharge and beyond. From this and other narratives, it appears that COVID-19 patients are not adequately followed up after ICU discharge, something that must be considered going forward.


Assuntos
/diagnóstico , Serviços Médicos de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Sobreviventes/psicologia , Adulto , /fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Reino Unido/epidemiologia
18.
BMC Psychiatry ; 20(1): 594, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334331

RESUMO

BACKGROUND: In addition to physical problems, patients with COVID-19 suffer from considerable stress throughout the disease crisis. It is important to address mental health needs and not to ignore the psychological dimension in this group of patients. In this regard, the first practical step is to have a clear understanding of patients' psychological issues. Therefore, this study aimed to explore the psychological disturbances of COVID-19 survivors throughout the disease crisis. METHOD: This qualitative study was conducted using a phenomenological approach through 14 individual semi-structured in-depth interviews with patients recovered from COVID-19. Data were analyzed using Colaizzi's seven-step method. RESULTS: Three themes of "living in limbo", "psychological distress behind the wall" and "psychological burden of being a carrier" were extracted as the psychological disturbances of COVID-19 survivors throughout the disease crisis. CONCLUSION: This study portrayed a better understanding of psychological disturbances of COVID-19 survivors throughout the disease crisis based on their lived experiences. Given the ambiguity in the time of the disease eradication and its continuing course, a deep understanding of these experiences in the current critical situation can help healthcare officials to make appropriate decisions and take measures to assess and identify psychological traumas and perform interventions to improve the mental state of these patients.


Assuntos
Adaptação Psicológica , Humanos , Pesquisa Qualitativa , Estresse Psicológico , Sobreviventes
19.
BMC Infect Dis ; 20(1): 901, 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33256638

RESUMO

BACKGROUND: Staphylococcus aureus bacteremia (SAB) presents heterogeneously, owing to the differences in underlying host conditions and immune responses. Although Toll-like receptor 2 (TLR2) is important in recognizing S. aureus, its function during S. aureus infection remains controversial. We aimed to examine the association of TLR2 expression and associated cytokine responses with clinical SAB outcomes. METHODS: Patients from a prospective SAB cohort at two tertiary-care medical centers were enrolled. Blood was sampled at several timepoints (≤5 d, 6-9 d, 10-13 d, 14-19 d, and ≥ 20 d) after SAB onset. TLR2 mRNA levels were determined via real-time PCR and serum tumor necrosis factor [TNF]-α, interleukin [IL]-6, and IL-10 levels were analyzed with multiplex-high-sensitivity electrochemiluminescent ELISA. RESULTS: TLR2 levels varied among 59 SAB patients. On days 2-5, TLR2 levels were significantly higher in SAB survivors than in healthy controls (p = 0.040) and slightly but not significantly higher than non-survivors (p = 0.120), and SAB patients dying within 7 d had lower TLR2 levels than survivors (P = 0.077) although statistically insignificant. IL-6 and IL-10 levels were significantly higher in non-survivors than in survivors on days 2-5 post-bacteremia (P = 0.010 and P = 0.021, respectively), and those dying within 7 d of SAB (n = 3) displayed significantly higher IL-10/TNF-α ratios than the survivors did (P = 0.007). CONCLUSION: TLR2 downregulation and IL-6 and IL-10 concentrations suggestive of immune dysregulation during early bacteremia may be associated with mortality from SAB. TLR2 expression levels and associated cytokine reactions during early-phase SAB may be potential prognostic factors in SAB, although larger studies are warranted.


Assuntos
Bacteriemia/metabolismo , Bacteriemia/mortalidade , Citocinas/metabolismo , Regulação para Baixo/genética , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus/isolamento & purificação , Receptor 2 Toll-Like/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Citocinas/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , RNA Mensageiro/genética , Reação em Cadeia da Polimerase em Tempo Real , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/metabolismo , Sobreviventes , Centros de Atenção Terciária
20.
J Korean Med Sci ; 35(47): e409, 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33289371

RESUMO

As the coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, there are growing concerns about patients' mental health. We investigated psychological problems in COVID-19 patients assessed with self-reported questionnaires including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, and Impact of Event Scale-Revised Korean version. Ten patients who recovered from COVID-19 pneumonia without complications underwent self-reported questionnaires about 1 month after discharge. Of them, 10% reported depression and posttraumatic stress disorder (PTSD) while 50% had depression during the treatment. Perceived stigma and history of psychiatric treatment affected PTSD symptom severity, consistent with previous emerging infectious diseases. Survivors also reported that they were concerned about infecting others and being discriminated and that they chose to avoid others after discharge. Further support and strategy to minimize their psychosocial difficulties after discharge should be considered.


Assuntos
/psicologia , Sobreviventes/psicologia , Idoso , /virologia , Depressão/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Autorrelato , Apoio Social , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários , Fatores de Tempo
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