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1.
Front Nutr ; 9: 853576, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35369105

RESUMEN

Objective: To assess the impact of SARS-CoV-2 viral infection on the metataxonomic profile and its evolution during the first month of lactation. Methods: Milk samples from 37 women with full-term pregnancies and mild SARS-CoV-2 infection and from 63 controls, collected in the first and fifth postpartum weeks, have been analyzed. SARS-CoV-2 RNA was assessed by reverse transcription polymerase chain reaction (RT-PCR) both in cases and controls. After DNA extraction, the V3-V4 hypervariable region of the gene 16S rRNA was amplified and sequenced using the MiSeq system of Illumina. Data were submitted for statistical and bioinformatics analyses after quality control. Results: All the 1st week and 5th week postpartum milk samples were negative for SARS-CoV-2 RNA. Alpha diversity showed no differences between milk samples from the study and control group, and this condition was maintained along the observation time. Analysis of the beta-diversity also indicated that the study and control groups did not show distinct bacterial profiles. Staphyloccus and Streptococcus were the most abundant genera and the only ones that were detected in all the milk samples provided. Disease state (symptomatic or asymptomatic infection) did not affect the metataxonomic profile in breast milk. Conclusion: These results support that in the non-severe SARS-CoV-2 pregnant woman infection the structure of the bacterial population is preserved and does not negatively impact on the human milk microbiota.

2.
Referência ; serVI(1,supl.1): e21049, dez. 2022. tab, graf
Artículo en Portugués | LILACS-Express | BDENF - Enfermería | ID: biblio-1387134

RESUMEN

Resumo Enquadramento: O cuidado obstétrico e a garantia da experiência de parto, assim como as interações profissionais foram atingidas pela pandemia de COVID-19, sendo necessárias reestruturações. Objetivo: Retratar o processo de comunicação entre a doula e o enfermeiro no cuidado obstétrico no contexto da pandemia de COVID-19. Principais tópicos em análise: Perturbações na interação da equipa de saúde têm vindo a repercutir-se em elementos como a comunicação em saúde e a colaboração, com déficits nas relações interpessoais entre enfermeiro e doula direcionadas à mulher. Associa-se à autonomia na execução e às interações profissionais, em que os conflitos e a perda de qualidade na assistência são observados. Reformas no trabalho em saúde incluindo respeito e qualidade no cuidado à mulher, família e comunidade são urgentes. Conclusão: O processo de comunicação tem sido prejudicado pela pandemia de COVID-19, o que exige o desenvolvimento de mecanismos de interação que facilitem as atividades de cuidado e as estratégias de melhoria das relações de poder que ocorrem entre enfermeiro obstetra e doula no cuidado da mulher.


Abstract Background: Obstetric care, a positive birth experience, and professional interactions were affected by the COVID-19 pandemic and had to be restructured. Objective: To describe the communication process between doulas and obstetric nurses during the COVID-19 pandemic. Main topics under analysis: Disturbances in the interaction of the health team have impacted aspects such as communication in health and collaboration, with deficits in the interpersonal relationships between nurses, doulas, and women. It is associated with autonomy of action and professional interactions, where conflicts and loss of quality of care were observed. Health sector reforms are urgent, including the delivery of respectful and quality care to women, families, and communities. Conclusion: The communication process has been negatively affected by the COVID-19 pandemic, requiring the development of interaction mechanisms to facilitate care activities and strategies to improve power relations between obstetric nurses and doulas in caring for women.


Resumen Marco contextual: La atención obstétrica y la garantía de la experiencia del parto, así como las interacciones profesionales se han visto afectadas por la pandemia de COVID-19, y es necesario reestructurarlas. Objetivo: Retratar el proceso de comunicación entre la doula y el enfermero en la atención obstétrica en el contexto de la pandemia de COVID-19. Principales temas en análisis: Las alteraciones en la interacción del equipo de salud han impactado en elementos como la comunicación sanitaria y la colaboración, y conllevan déficits en las relaciones interpersonales entre enfermeros y doulas dirigidas a la mujer. Se asocia a la autonomía en la ejecución y a las interacciones profesionales, en las que se observan conflictos y pérdida de calidad en la asistencia. Urge llevar a cabo reformas en el trabajo sanitario que incluyan el respeto y la calidad en la atención a la mujer, la familia y la comunidad. Conclusión: El proceso de comunicación se ha visto perjudicado por la pandemia de COVID-19, lo que exige desarrollar mecanismos de interacción que faciliten las actividades de atención y las estrategias de mejora de las relaciones de poder que tienen lugar entre enfermero obstetra y doula en la atención a la mujer.

3.
rev.cuid. (Bucaramanga.2010) ; 13(1): 1-20, 20221213.
Artículo en Español | LILACS, BDENF - Enfermería, COLNAL | ID: biblio-1369171

RESUMEN

Introducción: El SARS-CoV-2 es un Betacoronavirus, así como el SARS-CoV y el MERS-CoV, ambos asociados a abortos espontáneos, parto prematuro, morbi-mortalidad materna y alto número de ingresos a UCI en las gestantes. Además, al ser un virus nuevo, se conoce poco sobre los efectos en la gestación. Esta revisión tiene como objetivo analizar la evidencia disponible sobre el SARS-CoV-2 en la gestación. Materiales y métodos: Se realizó una búsqueda de la literatura en PubMed, ProQuest, Scopus, BVS y SciElo. Se realizó la crítica de la evidencia y la extracción de la información con dos instrumentos propuestos por el Instituto Joanna Briggs. Lo anterior bajo las directrices de PRISMA-ScR. Resultados: Se incluyeron 85 artículos que evidenciaron que la mayoría de gestantes con SARS-CoV-2 desarrollaron enfermedad leve a moderada, pero presentaron mayor riesgo de muerte y complicaciones comparado con las pacientes no embarazadas. Se documentó bajo riesgo de transmisión vertical y los resultados perinatales se asociaron a la severidad del cuadro clínico materno. La efectividad del tratamiento no fue concluyente.Discusión: Se discute la presentación clínica de la infección en las gestantes, la transmisión vertical, el tratamiento, la gravedad de la enfermedad y los desenlaces neonatales.Conclusiones: La COVID-19 en la gestación es una complicación que genera mayor morbimortalidad, por lo que es de vital importancia el desarrollo de más investigaciones que amplíen la comprensión de su comportamiento, las implicaciones fisiológicas, emocionales y el posible tratamiento. Esta revisión hace un análisis riguroso de la calidad de los estudios y aporta información valiosa de la evidencia.


Introduction: SARS-CoV-2 is a betacoronavirus as well as SARS-CoV and MERS-CoV, both associated with spontaneous miscarriage, preterm birth, maternal morbidity and mortality and a higher number of ICU admissions for pregnant women. Being a new virus, its effects on pregnancy are little known. This review aims to analyze the available evidence on SARS-CoV-2 in pregnancy. Materials and Methods: A literature review was conducted in PubMed, ProQuest, Scopus, BVS and SciElo. Evidence criticism and information extraction were conducted using two instruments from the Joanna Briggs Institute, following the PRISMA-ScR guidelines. Results: 85 articles were included evidencing that most pregnant women with SARS-COV-2 suffered mild to moderate disease and were at a higher risk of death and complications compared to non-pregnant patients. Low risk of vertical transmission was documented and adverse perinatal outcomes were associated with severe maternal clinical manifestations. The effectiveness of treatment was inconclusive. Discussion: Clinical presentation of infection in pregnant women, vertical transmission, treatment, disease severity and neonatal outcomes were discussed. Conclusions: COVID-19 during pregnancy is a complication that generates greater morbidity and mortality, for which it is vital to develop further research on the understanding of the behavior, physiological and emotional implications and possible treatment. This review makes a rigorous analysis of the quality of studies and provides valuable information from evidence.


Introdução: O SARS-CoV-2 é um betacoronavírus, assim como o SARS-CoV e o MERS-CoV, ambos associados ao aborto espontâneo, parto prematuro, morbidade e mortalidade materna e alto número de internações na UTI em mulheres grávidas. Além disso, sendo um novo vírus, pouco se sabe sobre seus efeitos na gravidez. Esta revisão tem como objetivo analisar as evidências disponíveis sobre o SARS-CoV-2 na gravidez. Materiais e métodos: Foi realizada uma pesquisa bibliográfica na PubMed, ProQuest, Scopus, BVS e SciElo. A analise crítica das provas e a extração de dados foram realizadas utilizando dois instrumentos propostos pelo Instituto Joanna Briggs sob as diretrizes do PRISMA-ScR. Resultados: 85 artigos foram incluídos, mostrando que a maioria das mulheres grávidas com SRA-CoV-2 desenvolveu doença leve a moderada, mas tinha um risco maior de morte e complicações em comparação com pacientes não grávidas. Baixo risco de transmissão vertical foi documentado e os resultados perinatais foram associados à gravidade do quadro clínico materno. A eficácia do tratamento foi inconclusiva. Discussão: Apresentação clínica da infecção em mulheres grávidas, transmissão vertical, tratamento, gravidade da doença e resultados neonatais são discutidos. Conclusões: A COVID-19 na gravidez é uma complicação que gera maior morbidade e mortalidade, portanto, mais pesquisas para expandir a compreensão de seu comportamento, implicações fisiológicas e emocionais, e o tratamento potencial são de vital importância. Esta revisão fornece uma análise rigorosa da qualidade dos estudos e informações valiosas a partir das evidências.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Embarazo , Coronavirus , SARS-CoV-2 , COVID-19
4.
Rev. enferm. UERJ ; 30: e65662, jan. -dez. 2022.
Artículo en Inglés, Portugués | LILACS-Express | LILACS | ID: biblio-1372342

RESUMEN

Objetivo: identificar fatores associados à procura por pronto atendimento entre gestantes e puérperas com infecção pela COVID-19. Métodos: estudo transversal, com coleta de dados realizada entre agosto de 2021 e janeiro de 2022, baseado nas respostas de 258 mulheres que estiveram gestantes ou pariram durante a pandemia, após aprovação do Comitê de Ética em Pesquisa da instituição. Resultados: entre as entrevistadas, 27,1% tiveram COVID-19, sendo mais comumente relatados os sintomas perda de olfato e fadiga. A prevalência de procura por pronto atendimento foi de 30,4%, explicada por casos de maior gravidade, em que houve necessidade de internação (p < 0,001); portadoras de asma (p <0,001) e de hipertensão crônica (p <0,001). Conclusão: o Pronto atendimento foi o local de maior procura na presença dos sintomas, principalmente nos casos de maior gravidade e comorbidades, embora os resultados sejam divergentes das orientações constantes nos protocolos nacionais e internacionais voltados para assistência à população obstétrica.


Objective: to identify factors associated with demand for emergency health services from pregnant/puerperal women with COVID-19. Method: in this cross-sectional study, data were collected between August 2021 and January 2022 from the responses of 258 women who were pregnant or gave birth during the pandemic, after research ethics committee approval. Results: 27.1% of respondents had COVID-19, with loss of smell and fatigue being the most commonly reported symptoms. The highest prevalence of seeking emergency hospital care (30.4%) was accounted for by the more serious cases, who sought emergency care needing hospitalization (p < 0.001), patients with asthma (p < 0.001) and chronic hypertension (p < 0.001). Conclusion: the emergency facility was the service most accessed in the presence of symptoms, especially in cases of greater severity and comorbidities, although the results are at variance with the guidelines contained in national and international protocols on care for the obstetric population.


Objetivo: identificar los factores asociados a la búsqueda de servicios médicos de urgencia por embarazadas y puérperas con infección por COVID-19. Método: estudio transversal, cuya recolección de datos tuvo lugar entre agosto de 2021 y enero de 2022, a partir de las respuestas de 258 mujeres que estuvieron embarazadas o dieron a luz durante la pandemia, previa aprobación del Comité de Ética en Investigación de la Institución. Resultados: entre las encuestadas, el 27,1% tuvo COVID-19, siendo más comunes los síntomas como pérdida del olfato y cansancio. La prevalencia de búsqueda de atención en urgencias fue del 30,4%, explicada por casos de mayor gravedad, en los que hubo necesidad de hospitalización (p < 0,001); asma (p <0,001) e hipertensión crónica (p <0,001). Conclusión: el Servicio de Urgencias fue el lugar más buscado ante la presencia de síntomas, especialmente en los casos de mayor gravedad y comorbilidades, aunque los resultados sean divergentes de las directrices contenidas em los protocolos nacionales e internacionales dirigidos a la atención de la población obstétrica.

5.
Women Birth ; 2022 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-36184532

RESUMEN

BACKGROUND: The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman's experience - with likely adverse effects on mental health and wellbeing. AIM: To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. METHODS: Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. FINDINGS: Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (-1.17, 95% CI: -1.81, -0.53) and the EPDS (-0.83, 95% CI: -1.5, -0.15). DISCUSSION: The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. CONCLUSION: This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.

6.
IJID Reg ; 2022 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-36185781

RESUMEN

Introduction: : Evidences about the interplay between HIV and COVID-19 are not entirely consistent. Methods: : We conducted a retrospective cohort study on medical records of patients who had a positive RT-PCR for COVID-19 and were admitted to Eka Kotebe General Hospital from March 2020 to October 2021. Results: : Four hundred twenty-seven, 108 exposed (people living with HIV/AIDS) and 319 non-exposed (people without HIV/AIDS) were included in the study. The median age for PLWH and people without HIV was 49.5 (40-59) and 48 (32-65) respectively. Of those, 258 (60.4%) were male. There were significant differences between PLWH and people without HIV in terms of age, TB, pregnancy, chronic liver disease, complications, shock, WBC count, and end outcome (alive or dead). There was no association between HIV status and the need for oxygen, ICU admission, and disease severity. After adjusting for other variables, mortality was significantly higher among PLWH (AOR = 2.25, 95% CI 1.11-5.56, p=0.023). Conclusion: : PLWH with COVID-19 have a higher rate of in-hospital mortality than people without HIV, although there was no association between HIV status and the requirement for ICU admission, mechanical ventilation, oxygen support, or the severity of the disease at the time of admission.

7.
Addiction ; 2022 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-36189777

RESUMEN

BACKGROUND AND AIMS: Cannabis use is increasingly common among pregnant individuals and might be a risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to test whether prenatal cannabis use is associated with increased risk of SARS-CoV-2 infection during pregnancy. DESIGN: Retrospective cohort study. SETTING: California USA. PARTICIPANTS: 58,114 pregnancies (with outcomes from 3/5/2020 to 9/30/2021) among 57,287 unique pregnant women aged 14-54 years who were screened for prenatal substance use, enrolled in Kaiser Permanente Northern California (KPNC) (a healthcare system), and had not tested positive for COVID-19 prior to pregnancy onset. MEASUREMENTS: We utilized data from the KPNC electronic health record. Cannabis use status (current, recently quit, non-user) was based on universal screenings during prenatal care (including ≥1 urine toxicology test and self-reported use on a self-administered questionnaire). SARS-CoV-2 infection (based on polymerase chain reaction (PCR) tests) was estimated in time-to-event analyses using Cox proportional hazard regression models adjusting for covariates. Secondary analyses examined differences in a) SARS-CoV-2 positivity testing rates and b) SARS-CoV-2 infection rates among those tested. FINDINGS: We observed 348,810 person-months of follow-up time in our cohort with 41,064 SARS-CoV-2 PCR tests, and 6% (n=2,414) of tests being positive. At the start of follow-up, 7% of pregnant individuals had current use, 12% had recently quit, and 81% did not use cannabis. Adjusting for covariates, current use was associated with lower rates of SARS-CoV-2 infection (adjusted hazard ratio [aHR]=0.60,95% confidence interval [CI]:0.49-0.74) than non-use. Those who had recently quit did not differ from non-cannabis users in infection rates (aHR=0.96,95%CI:0.86-1.08). Sensitivity analyses among patients who received a SARS-CoV-2 test also found lower odds of infection associated with current versus no cannabis use (aOR=0.76,CI:0.61-0.93). CONCLUSIONS: Current cannabis use appears to be associated with a reduced risk of severe acute respiratory syndrome coronavirus 2 infection among pregnant individuals.

8.
Can J Diabetes ; 2022 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-36182614

RESUMEN

OBJECTIVES: For women with pre-existing and gestational diabetes, pregnancy involves specialized and intensive medical care to optimize maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. COVID-19-induced barriers to face-to-face care have identified the need for high-quality, patient-centred virtual health-care modalities, such as mobile health (mHealth) technologies. Our aim in this review was to identify the patient-reported benefits and limitations of mHealth technologies among women with diabetes in pregnancy. We also aimed to determine how the women's experiences aligned with the best practice standards for patient-centred communication. METHODS: The framework presented by Arksey and O'Malley for conducting scoping reviews, with refinements by Levac et al, was used to guide this review. Relevant studies were identified through comprehensive database searches of MEDLINE, Embase, Emcare and PsycINFO. Thomas and Harden's methods for the thematic synthesis of qualitative research in systematic reviews guided the synthesis of patient-reported benefits and limitations of mHealth technology. RESULTS: Overall, 19 studies describing the use of 16 unique mobile health technologies among 742 women were included in the final review. Patient-reported benefits of mobile health included convenience, support of psychosocial well-being and facilitation of diabetes self-management. Patient-reported limitations included lack of important technological features, perceived burdensome aspects of mHealth and lack of trust in virtual health care. CONCLUSIONS: Women with diabetes report some benefits from mHealth use during pregnancy. Codesigning future technologies with end-users may help address the perceived limitations and effectiveness of mHealth technologies.

9.
Med J Aust ; 2022 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-36183307

RESUMEN

INTRODUCTION: Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS: As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES: The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.

10.
Medicine (Baltimore) ; 101(39): e30816, 2022 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-36181037

RESUMEN

There are currently no data regarding characteristics of critically ill patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variant of concern (VOC) 20H/501Y.V2. We therefore aimed to describe changes of characteristics in critically ill patients with Covid-19 between the first and the second wave when viral genome sequencing indicated that VOC was largely dominant in Mayotte Island (Indian Ocean). Consecutive patients with Covid-19 and over 18 years admitted in the unique intensive care unit (ICU) of Mayotte during wave 2 were compared with an historical cohort of patients admitted during wave 1. We performed a LR comparing wave 1 and wave 2 as outcomes. To complete analysis, we built a Random Forest model (RF), that is, a machine learning classification tool- using the same variable set as that of the LR. We included 156 patients, 41 (26.3%) and 115 (73.7%) belonging to the first and second waves respectively. Univariate analysis did not find difference in demographic data or in mortality. Our multivariate LR found that patients in wave 2 had less fever (absence of fever aOR 5.23, 95% confidence interval (CI) 1.89-14.48, p = .001) and a lower simplified acute physiology score (SAPS II) (aOR 0.95, 95% CI 0.91-0.99, p = .007) at admission; at 24 hours, the need of invasive mechanical ventilation was higher (aOR 3.49, 95% CI 0.98-12.51, p = .055) and pO2/FiO2 ratio was lower (aOR 0.99, 95 % CI 0.98-0.99, p = .03). Patients in wave 2 had also an increased risk of ventilator-associated pneumonia (VAP) (aOR 4.64, 95% CI 1.54-13.93, p = .006). Occurrence of VAP was also a key variable to classify patients between wave 1 and wave 2 in the variable importance plot of the RF model. Our data suggested that VOC 20H/501Y.V2 could be associated with a higher severity of respiratory failure at admission and a higher risk for developing VAP. We hypothesized that the expected gain in survival brought by recent improvements in critical care management could have been mitigated by increased transmissibility of the new lineage leading to admission of more severe patients. The immunological role of VOC 20H/501Y.V2 in the propensity for VAP requires further investigations.


Asunto(s)
COVID-19 , Neumonía Asociada al Ventilador , Estudios de Cohortes , Enfermedad Crítica , Humanos , Unidades de Cuidados Intensivos , Oxígeno , SARS-CoV-2
11.
Eur J Med Res ; 27(1): 193, 2022 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-36183122

RESUMEN

BACKGROUND: The ventilatory management of COVID-ARDS is controversial, especially with regard to the different subtypes and associated PEEP titration. A higher PEEP may be beneficial only in patients with potential for lung recruitment. The assessment of lung recruitment may be guided by lung imaging, such as electric impedance tomography or recruitment computed tomography, but is complex and not established in routine clinical practice. Therefore, bedside identification of recruitable ARDS phenotypes can aid in PEEP titration in clinical settings. METHODS: In this retrospective consecutive cohort study in 40 patients with moderate-to-severe COVID-ARDS, we assessed lung recruitment using the recruitment-to-inflation ratio (R/I) in moderate-to-severe COVID-ARDS. Evidence of recruitment (R/I ≥ 0.5) was compared between clinical and computed tomography data. RESULTS: Of the included patients, 28 (70%) were classified as recruiters by the R/I. Lung recruitment was associated with higher compliance and was not associated with a consolidated lung pattern assessed using CT. Even in the tertile of patients with the highest compliance (37-70 ml/mbar), eight (73%) patients were classified as recruitable. Patients classified as recruitable presented a lower reticular lung pattern (2% vs. 6%, p = 0.032). CONCLUSIONS: Prediction of lung recruitment is difficult based on routine clinical data but may be improved by assessment of radiographic lung patterns. A bedside assessment of recruitment is necessary to guide clinical care. Even a high compliance may not rule out the potential for lung recruitment.


Asunto(s)
COVID-19 , Síndrome de Dificultad Respiratoria , Estudios de Cohortes , Humanos , Pulmón/diagnóstico por imagen , Respiración con Presión Positiva/métodos , Mecánica Respiratoria , Estudios Retrospectivos
12.
Int J Med Educ ; 13: 261-266, 2022 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-36183190

RESUMEN

Objectives: To investigate the association between online activities and the number of new obstetrics and gynecology senior residents. Methods: A nationwide web-based, self-administered anonymous survey was conducted to investigate recruitment and clerkship activities during the coronavirus disease 2019 pandemic. An online questionnaire was sent to 576 obstetrics and gynecology training institutions in Japan between December 21, 2020, and January 31, 2021. Overall, 334 institutions that gave valid responses were included (response rate: 58.0%). Multivariate logistic regression analysis examined the association between online activities, including recruitment and clerkship activities, and the number of new obstetrics and gynecology senior residents in 2021. The stratified analysis by implementing face-to-face activities was conducted to clarify the association. Results: The number of new senior residents increased in 187 facilities (56.0%) and decreased in 147 facilities (44.0%). The facilities that implemented face-to-face and online activities were 185 (55.4%) and 120 (35.9%), respectively. In multivariate logistic regression analysis, an increased number of new obstetrics and gynecology senior residents was significantly associated with face-to-face activities (adjusted odds ratio (AOR)=2.58, 95% confidence interval (CI): 1.11-5.97, p<.001) but not with online activities. In the stratified analysis, online activities were significantly associated with an increased number of new obstetrics and gynecology senior residents among the facilities without face-to-face activities (AOR=3.81, 95% CI: 1.40-10.32, p=.009) but not among those with face-to-face activities (AOR=0.87, 95% CI: 0.42-1.78). Conclusions: Online activities were associated with an increased number of new obstetrics and gynecology senior residents among the facilities that did not conduct face-to-face activities.


Asunto(s)
COVID-19 , Ginecología , Internado y Residencia , Obstetricia , COVID-19/epidemiología , Femenino , Ginecología/educación , Humanos , Obstetricia/educación , Embarazo , Encuestas y Cuestionarios
13.
Klin Mikrobiol Infekc Lek ; 28(1): 18-21, 2022 Mar.
Artículo en Eslovaco | MEDLINE | ID: mdl-36183413

RESUMEN

The article describes the use of the last-resort carbapenem antibiotic imipenem in combination with relebactam, a novel b-lactamase inhibitor, in the treatment of ventilator-associated pneumonia developing after SARS-CoV-2 infection in a young pregnant patient. The introduction briefly describes the mechanism and spectrum of activity of the antibiotic, including its dosage.


Asunto(s)
COVID-19 , Neumonía Asociada al Ventilador , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Compuestos de Azabiciclo , Combinación Cilastatina e Imipenem , Humanos , Imipenem/farmacología , Imipenem/uso terapéutico , Pruebas de Sensibilidad Microbiana , Neumonía Asociada al Ventilador/tratamiento farmacológico , SARS-CoV-2
14.
Clin Nutr ESPEN ; 51: 120-127, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36184196

RESUMEN

BACKGROUND: Serum vitamin D levels are reported to be associated with the risk of incidence and severity of COVID-19 in the general population. During pregnancy, immune system alterations in line with changes in vitamin D metabolism may affect the course of COVID-19. Thus, we aimed to systematically review the association between vitamin D, pregnancy, and COVID-19. METHODS: A systematic literature search was conducted in PubMed, Scopus, Web of Science, Embase, and Google Scholar until the end of May 2022. Mean differences (MD) with 95% CI were used as desired effect sizes to assess the association of serum vitamin D levels with the risk of incidence and severity of COVID-19 in pregnant women. RESULTS: Among 259 records, 7 and 6 studies were included in the systematic review and meta-analysis, respectively. All included studies had acceptable quality. Our results demonstrated an insignificant difference between infected women and non-infected controls (MD = -2.55 ng/ml, 95% CI: -6.85 - 1.74). But serum vitamin D levels in severe/moderate cases compared to mild ones (MD = -2.71 ng/ml, 95% CI: -4.18 to -1.24) are significantly lower. CONCLUSION: Based on the current evidence, serum vitamin D level does not associate with the risk of SARS-CoV-2 infection among pregnant women, but we find a significant association with the severity of the disease. These findings may be helpful in similar conditions and future studies to better understand the complex immune alterations during pregnancy.


Asunto(s)
COVID-19 , Femenino , Humanos , Embarazo , SARS-CoV-2 , Vitamina D , Vitaminas
15.
Nat Commun ; 13(1): 5780, 2022 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-36184633

RESUMEN

Vaccination constitutes the best long-term solution against Coronavirus Disease-2019; however, vaccine-derived immunity may not protect all groups equally, and the durability of protective antibodies may be short. We evaluate Spike-antibody responses following BNT162b2 or ChAdOx1-S vaccination amongst SARS-CoV2-naive adults across England and Wales enrolled in a prospective cohort study (Virus Watch). Here we show BNT162b2 recipients achieved higher peak antibody levels after two doses; however, both groups experience substantial antibody waning over time. In 8356 individuals submitting a sample ≥28 days after Dose 2, we observe significantly reduced Spike-antibody levels following two doses amongst individuals reporting conditions and therapies that cause immunosuppression. After adjusting for these, several common chronic conditions also appear to attenuate the antibody response. These findings suggest the need to continue prioritising vulnerable groups, who have been vaccinated earliest and have the most attenuated antibody responses, for future boosters.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Adulto , Anticuerpos Antivirales , Formación de Anticuerpos , Vacuna BNT162 , COVID-19/prevención & control , Estudios de Cohortes , Demografía , Humanos , Estudios Prospectivos , ARN Viral , SARS-CoV-2 , Vacunación
16.
BMJ Open ; 12(10): e065588, 2022 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-36192094

RESUMEN

INTRODUCTION: The COVID-19 pandemic has led to concerns about potential adverse pregnancy outcomes associated with infection, resulting in intensive research. Numerous studies have attempted to examine whether COVID-19 is associated with an increased risk of pregnancy loss. However, studies and reviews to date have drawn differing conclusions. The aim of this systematic review is to provide a summary of all quantitative research on the relationship between pregnancy loss and COVID-19 infection and, if appropriate, to synthesise the evidence into an overall effect estimate. METHODS AND ANALYSIS: Three publication databases (Embase, PubMed and Cochrane) and four preprint databases (medRxiv, Lancet Preprint, Gates Open Research and Wellcome Open Research) will be searched. Boolean logic will be used to combine terms associated with pregnancy loss and COVID-19. The population of interest are pregnant women. Retrieved results will be assessed in two phases: (1) abstract screening and (2) full text evaluation. All studies which compare pregnancy loss outcomes in women who had COVID-19 versus those who did not quantitatively will be included. Narrative and non-English studies will be excluded. Two reviewers will screen independently, with results compared and discrepancies resolved by the study team. Study quality and risk of bias will be assessed using a quality appraisal tool. Results will be summarised descriptively and where possible synthesised in a meta-analysis. ETHICS AND DISSEMINATION: This systematic review requires no ethical approval. This review will be published in a peer-reviewed journal and provide an important update in a rapidly evolving field of research. PROSPERO REGISTRATION NUMBER: CRD42022327437.


Asunto(s)
Aborto Espontáneo , COVID-19 , Aborto Espontáneo/epidemiología , COVID-19/epidemiología , Femenino , Humanos , Metaanálisis como Asunto , Pandemias , Embarazo , Resultado del Embarazo/epidemiología , Proyectos de Investigación , Mortinato/epidemiología , Revisiones Sistemáticas como Asunto
17.
J Immunol ; 209(8): 1465-1473, 2022 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-36192115

RESUMEN

Widespread SARS-CoV-2 infection among pregnant individuals has led to a generation of fetuses exposed in utero, but the long-term impact of such exposure remains unknown. Although fetal infection is rare, children born to mothers with SARS-CoV-2 infection may be at increased risk for adverse neurodevelopmental and cardiometabolic outcomes. Fetal programming effects are likely to be mediated at least in part by maternal immune activation. In this review, we discuss recent evidence regarding the effects of prenatal SARS-CoV-2 infection on the maternal, placental, and fetal immune response, as well as the implications for the long-term health of offspring. Extrapolating from what is known about the impact of maternal immune activation in other contexts (e.g., obesity, HIV, influenza), we review the potential for neurodevelopmental and cardiometabolic morbidity in offspring. Based on available data suggesting potential increased neurodevelopmental risk, we highlight the importance of establishing large cohorts to monitor offspring born to SARS-CoV-2-positive mothers for neurodevelopmental and cardiometabolic sequelae.


Asunto(s)
COVID-19 , Enfermedades Cardiovasculares , Complicaciones Infecciosas del Embarazo , Niño , Femenino , Humanos , Inmunidad , Transmisión Vertical de Enfermedad Infecciosa , Placenta , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , SARS-CoV-2
18.
J Immunol ; 209(8): 1450-1464, 2022 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-36192116

RESUMEN

Pregnancy success requires constant dialogue between the mother and developing conceptus. Such crosstalk is facilitated through complex interactions between maternal and fetal cells at distinct tissue sites, collectively termed the "maternal-fetal interface." The emergence of single-cell technologies has enabled a deeper understanding of the unique processes taking place at the maternal-fetal interface as well as the discovery of novel pathways and immune and nonimmune cell types. Single-cell approaches have also been applied to decipher the cellular dynamics throughout pregnancy, in parturition, and in obstetrical syndromes such as recurrent spontaneous abortion, preeclampsia, and preterm labor. Furthermore, single-cell technologies have been used during the recent COVID-19 pandemic to evaluate placental viral cell entry and the impact of SARS-CoV-2 infection on maternal and fetal immunity. In this brief review, we summarize the current knowledge of cellular immunobiology in pregnancy and its complications that has been generated through single-cell investigations of the maternal-fetal interface.


Asunto(s)
COVID-19 , Placenta , Femenino , Humanos , Recién Nacido , Pandemias , Parto , Embarazo , SARS-CoV-2
19.
Sci Rep ; 12(1): 16534, 2022 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-36192471

RESUMEN

Social care is a frequent topic in UK policy debates, with widespread concern that the country will be unable to face the challenges posed by the increase in demand for social care. While this is a societal problem whose dynamics depends on long-term trends, such as the increase of human lifespans and the drop of birth-rates, a short-term crisis, such as a pandemic, can affect the need and supply of social care to a considerable, although temporary, extent. Building on previous modelling effort of social care provision, we present an agent-based computational model to investigate social care provision in the context of a pandemic (using as an example, the early stages of the Covid-19 pandemic), and related mitigation policies, on social care demand and supply, using a proof-of-concept agent-based model (ABM). We show how policy solutions aimed at controlling the pandemic may have substantial effects on the level of unmet social care need and propose that such models may help policymakers to compare alternative containment policies, taking into account their side effects on the social care provision process.


Asunto(s)
COVID-19 , COVID-19/epidemiología , Humanos , Pandemias , Apoyo Social
20.
BMC Anesthesiol ; 22(1): 310, 2022 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-36192702

RESUMEN

BACKGROUND: During the COVID-19 first wave in France, the capacity of intensive care unit (ICU) beds almost doubled, mainly because of the opening of temporary ICUs with staff and equipment from anaesthesia. OBJECTIVES: We aim to investigate if the initial management in temporary ICU is associated with a change in ICU mortality and short-term prognosis. DESIGN: Retrospective single-centre cohort study. SETTING: Surgical ICU of the Bichat Claude Bernard University Hospital during the COVID-19 "first wave" (from 18 March to 10 April 2020). PATIENTS: All consecutive patients older than 18 years of age with laboratory-confirmed SARS-CoV-2 infection and/or typical radiological patterns were included during their first stay in the ICU for COVID-19. INTERVENTION: Patients were admitted to a temporary ICU if no room was available in the classical ICU and if they needed invasive mechanical ventilation but no renal replacement therapy or Extracorporeal Membrane Oxygenation (ECMO) in the short term. The temporary ICUs were managed by mixed teams (from the ICU and anaesthesiology departments) following a common protocol and staff meetings. MAIN OUTCOME MEASURE: ICU mortality RESULTS: Among the 59 patients admitted, 37 (62.7%) patients had initial management in the temporary ICU. They had the same characteristics on admission and the same medical management as patients admitted to the classical ICU. ICU mortality was similar in the 2 groups (32.4% in temporary ICUs versus 40.9% in classical ICUs; p=0.58). SAPS-II and ECMO use were associated with mortality in multivariate analysis but not admission to the temporary ICU. CONCLUSION: In an overload context of the ICU of a geographical area, our temporary ICU model allowed access to intensive care for all patients requiring it without endangering them.


Asunto(s)
COVID-19 , Estudios de Cohortes , Humanos , Unidades de Cuidados Intensivos , Pandemias , Estudios Retrospectivos , SARS-CoV-2
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