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1.
J Med Virol ; 94(1): 253-262, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34463956

RESUMO

There is an established literature on the symptoms and complications of COVID-19 but the after-effects of COVID-19 are not well understood with few studies reporting persistent symptoms and quality of life. We aim to evaluate the pooled prevalence of poor quality of life in post-acute COVID-19 syndrome (PCS) and conducted meta-regression to evaluate the effects of persistent symptoms and intensive care unit (ICU) admission on the poor quality of life. We extracted data from observational studies describing persistent symptoms and quality of life in post-COVID-19 patients from March 10, 2020, to March 10, 2021, following PRISMA guidelines with a consensus of two independent reviewers. We calculated the pooled prevalence with 95% confidence interval (CI) and created forest plots using random-effects models. A total of 12 studies with 4828 PCS patients were included. We found that amongst PCS patients, the pooled prevalence of poor quality of life (EQ-VAS) was (59%; 95% CI: 42%-75%). Based on individual factors in the EQ-5D-5L questionnaire, the prevalence of mobility was (36, 10-67), personal care (8, 1-21), usual quality (28, 2-65), pain/discomfort (42, 28-55), and anxiety/depression (38, 19-58). The prevalence of persistent symptoms was fatigue (64, 54-73), dyspnea (39.5, 20-60), anosmia (20, 15-24), arthralgia (24.3, 14-36), headache (21, 3-47), sleep disturbances (47, 7-89), and mental health (14.5, 4-29). Meta-regression analysis showed the poor quality of life was significantly higher among post-COVID-19 patients with ICU admission (p = 0.004) and fatigue (p = 0.0015). Our study concludes that PCS is associated with poor quality of life, persistent symptoms including fatigue, dyspnea, anosmia, sleep disturbances, and worse mental health. This suggests that we need more research on PCS patients to understand the risk factors causing it and eventually leading to poor quality of life.


Assuntos
COVID-19/complicações , Qualidade de Vida , Adulto , Fatores Etários , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade
2.
Behav Brain Res ; 417: 113630, 2022 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-34656691

RESUMO

Social isolation gained discussion momentum due to the COVID-19 pandemic. Whereas many studies address the effects of long-term social isolation in post-weaning and adolescence and for periods ranging from 4 to 12 weeks, little is known about the repercussions of adult long-term social isolation in middle age. Thus, our aim was to investigate how long-term social isolation can influence metabolic, behavioural, and central nervous system-related areas in middle-aged mice. Adult male C57Bl/6 mice (4 months-old) were randomly divided into Social (2 cages, n = 5/cage) and Isolated (10 cages, n = 1/cage) housing groups, totalizing 30 weeks of social isolation, which ended concomitantly with the onset of middle age of mice. At the end of the trial, metabolic parameters, short-term memory, anxiety-like behaviour, and physical activity were assessed. Immunohistochemistry in the hippocampus (ΔFosB, BDNF, and 8OHDG) and hypothalamus (ΔFosB) was also performed. The Isolated group showed impaired memory along with a decrease in hippocampal ΔFosB at dentate gyrus and in BDNF at CA3. Food intake was also affected, but the direction depended on how it was measured in the Social group (individually or in the group) with no alteration in ΔFosB at the hypothalamus. Physical activity parameters increased with chronic isolation, but in the light cycle (inactive phase), with some evidence of anxiety-like behaviour. Future studies should better explore the timepoint at which the alterations found begin. In conclusion, long-term social isolation in adult mice contributes to alterations in feeding, physical activity pattern, and anxiety-like behaviour. Moreover, short-term memory deficit was associated with lower levels of hippocampal ΔFosB and BDNF in middle age.


Assuntos
Ansiedade/etiologia , COVID-19 , Comportamento Alimentar , Hipocampo/metabolismo , Locomoção , Transtornos da Memória/etiologia , Isolamento Social , Fatores Etários , Animais , Comportamento Animal/fisiologia , Fator Neurotrófico Derivado do Encéfalo , COVID-19/prevenção & controle , Modelos Animais de Doenças , Comportamento Alimentar/fisiologia , Abrigo para Animais , Hipotálamo/metabolismo , Locomoção/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Proto-Oncogênicas c-fos/metabolismo
3.
J Med Virol ; 94(1): 366-371, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34546584

RESUMO

Co-epidemics happening simultaneously can generate a burden on healthcare systems. The co-occurrence of SARS-CoV-2 with vector-borne diseases (VBD), such as malaria and dengue in resource-limited settings represents an additional challenge to the healthcare systems. Herein, we assessed the coinfection rate between SARS-CoV-2 and VBD to highlight the need to carry out an accurate diagnosis and promote timely measures for these infections in Luanda, the capital city of Angola. This was a cross-sectional study conducted with 105 subjects tested for the SARS-CoV-2 and VBD with a rapid detection test in April 2021. The participants tested positive for SARS-CoV-2 (3.80%), malaria (13.3%), and dengue (27.6%). Low odds related to testing positivity to SARS-CoV-2 or VBD were observed in participants above or equal to 40 years (odds ratio [OR]: 0.60, p = 0.536), while higher odds were observed in male (OR: 1.44, p = 0.392) and urbanized areas (OR: 3.78, p = 0.223). The overall co-infection rate between SARS-CoV-2 and VBD was 11.4%. Our findings showed a coinfection between SARS-CoV-2 with malaria and dengue, which could indicate the need to integrate the screening for VBD in the SARS-CoV-2 testing algorithm and the adjustment of treatment protocols. Further studies are warranted to better elucidate the relationship between COVID-19 and VBD in Angola.


Assuntos
COVID-19/epidemiologia , Coinfecção/epidemiologia , Dengue/epidemiologia , Malária/epidemiologia , Doenças Transmitidas por Vetores/epidemiologia , Adolescente , Adulto , Fatores Etários , Angola/epidemiologia , Anticorpos Antiprotozoários/sangue , Anticorpos Antivirais/sangue , Teste para COVID-19 , Febre de Chikungunya/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , RNA Viral/sangue , SARS-CoV-2/isolamento & purificação , Fatores Sexuais , Adulto Jovem , Infecção por Zika virus/epidemiologia
4.
Ann R Coll Surg Engl ; 103(10): 734-737, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34719960

RESUMO

INTRODUCTION: Insertion of foreign objects into the rectum is a well-described phenomenon and not an uncommon referral to the general surgeon on call. Although usually not life-threatening, there can be consequences following migration of the object or perforation of the large bowel. This study looks at the incidence of removal of foreign objects from the rectum over the last decade and the financial burden it presents to the NHS. METHODS: Hospital Episode Statistics for 2010-2019 were used to calculate the number of rectal foreign bodies that required removal in hospital. Data for age groups and genders have been compared. RESULTS: A total of 3,500 rectal foreign bodies were removed over the course of 9 years. Males accounted for 85.1% of rectal foreign bodies whilst 14.9% were females. This equates to 348 bed-days per annum. Admission peaks were observed in the second and fifth decades of life. CONCLUSION: This study shows that the incidence of rectal foreign bodies is higher in men and has been increasing over the period studied. Most foreign bodies can be removed trans-anally with the use of anaesthesia, with only a small proportion of patients requiring hospital stay over 24 hours (mean length of stay = 24 hours). Nearly 400 rectal foreign body removals are performed each year with an annual cost of £338,819, illustrating the effect this has on NHS resources.


Assuntos
Corpos Estranhos/cirurgia , Custos de Cuidados de Saúde/estatística & dados numéricos , Reto , Medicina Estatal/economia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Corpos Estranhos/economia , Corpos Estranhos/epidemiologia , Migração de Corpo Estranho/economia , Migração de Corpo Estranho/epidemiologia , Migração de Corpo Estranho/cirurgia , Humanos , Lactente , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Reto/cirurgia , Fatores Sexuais , Medicina Estatal/estatística & dados numéricos , Reino Unido/epidemiologia , Adulto Jovem
5.
Pan Afr Med J ; 40: 11, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733379

RESUMO

Introduction: despite the wide availability of free male condoms in South Africa, high rates of new HIV transmissions are reported to occur among married couples. The aim of this study was to determine the level of condom use among the married people and to assess the factors associated with condom use in the Tshwane district of the Gauteng province. Methods: a cross-sectional study was conducted among 325 clients accessing health care services at the Steve Biko Academic Hospital. A self- administered questionnaire was used to collect data, which were entered onto an Excel spreadsheet and imported into Epi info version 7 for analysis. A logistic regression model was used to investigate the association between condom use and the explanatory variables. The odds ratio was used to measure the strength of the associations. The 95% CI and a cut-off point of 0.05 for the p-value were used to indicate statistical significance. Results: the mean age of the participants was 41.6 years (SD=7.7). Two hundred and seventy-six (276; 85%) of the 325 participants reported not using condoms. Trust, doing regular HIV testing, and refusal by the husband were among the reasons given for not using condoms. In this study it was found that, the level of education, age and employment status were the determinants of condom use. Conclusion: the level of condom use was low and sero-discordance was found to be the primary motivator for condom use. This study recommends the strengthening of and the widespread implementation of the CVCT service.


Assuntos
Preservativos/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Cônjuges/estatística & dados numéricos , Adulto , Fatores Etários , Estudos Transversais , Escolaridade , Emprego/estatística & dados numéricos , Feminino , Infecções por HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul , Cônjuges/psicologia , Inquéritos e Questionários , Confiança
6.
Pan Afr Med J ; 40: 17, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733385

RESUMO

Introduction: in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania. Methods: a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value < 0.05 were considered statistically significant. Results: twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young (<25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45, 95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38, 95% CI=1.15-9.93). Conclusion: about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age.


Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Resultado da Gravidez , Cuidado Pré-Natal , Adulto , Fatores Etários , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Gravidez , Tanzânia , Fatores de Tempo , Adulto Jovem
7.
Pan Afr Med J ; 40: 30, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34733398

RESUMO

Introduction: hepatitis C is a public health problem worldwide, in particular in sub-Saharan Africa. The purpose of this study is to determine the seroprevalence of hepatitis C virus antibodies and associated factors during a voluntary general population screening program in Benin. Method: we conducted a descriptive and analytical cross-sectional study in 4 big cities of 4 different departments in Benin in July 2016. All volunteers of all ages, residing in these targeted cities, who gave their informed consent were included in the study. ImuMed HCV Rapid Diagnostic Test (Healgen Scientific LLC, USA) was used. Logistic regression analysis was also used to identify factors associated with hepatitis C virus infection. Results: a total of 2809 volunteers with an average age of 25.9 ± 16.5 years (ranging from 0 to 86 years) were included in the study; 53.9% (1514/2809) of them were men and 46.1% (1295/2809) were women. More than half of the study population consisted of single (59.1%; 1612/2726); 41.3% (1074/2809) were pupils or students. VHC Seroprevalence was 1.5% (42/2809). In multivariate analysis, the variables significantly associated with anti-HCV carriage were: be 60 years old and older (aOR: 46.9, 95% CI 10.2-216.0; p<0.0001) and a history of alcoholism (aOR: 6.3; 95% CI 95% 3.3-12.1; p < 0.0001). Conclusion: in the general population, the seroprevalence of anti-HCV antibodies was 1.5%. HCV infection mainly occurred in people aged 60 years and older and in those with a history of alcoholism.


Assuntos
Anticorpos Anti-Hepatite C/sangue , Hepatite C/epidemiologia , Programas de Rastreamento/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/epidemiologia , Benin/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hepatite C/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estudos Soroepidemiológicos , Adulto Jovem
8.
An Acad Bras Cienc ; 93(suppl 3): e20201677, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34730742

RESUMO

The current study was undertaken to test the hypothesis that the high physical capacity of rowing athletes may not reverse the influence of age on cardiac autonomic control decline estimated by heart rate variability (HRV). Forty-four male subjects divided in four groups: 11 young athletes (YA; 18 ±1 year), 11 young non-athletes (YNA; 20 ±1 year), 11 middle age athletes (MAA; 43 ±6 years) and 11 middle age non-athletes (MNA; 44 ±8 years) participated in the study. Heart rate (HR) was recorded beat-by-beat for 10 minutes in supine (SUP) and 10 min in orthostatic (ORT) positions. HRV was analyzed in the frequency domain to obtain the spectral power in the high (HF) and low frequency (LF) bands, and the changes to ORT (%∆HRV) were calculated (ORT - SUP / SUP). During SUP, HF was lower in MNA and MA compared to YA and YNA, while LF was lower in MNA than YA. For %ΔHRV, %ΔHF was higher in YA than YNA, MA and MNA. The %ΔLF was not different among groups. In conclusion, aging seems to overcome the influence of physical fitness on neural regulation of the heart, as highlighted by the HRV response to active standing.


Assuntos
Fatores Etários , Sistema Nervoso Autônomo , Frequência Cardíaca , Aptidão Física , Esportes Aquáticos , Adolescente , Adulto , Atletas , Sistema Nervoso Autônomo/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Posição Ortostática , Decúbito Dorsal , Adulto Jovem
9.
Front Immunol ; 12: 750229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34745122

RESUMO

Improving COVID-19 intervention strategies partly relies on animal models to study SARS-CoV-2 disease and immunity. In our pursuit to establish a model for severe COVID-19, we inoculated young and adult male ferrets intranasally or intratracheally with SARS-CoV-2. Intranasal inoculation established an infection in all ferrets, with viral dissemination into the brain and gut. Upon intratracheal inoculation only adult ferrets became infected. However, neither inoculation route induced observable COVID-19 symptoms. Despite this, a persistent inflammation in the nasal turbinates was prominent in especially young ferrets and follicular hyperplasia in the bronchi developed 21 days post infection. These effects -if sustained- might resemble long-COVID. Respiratory and systemic cellular responses and antibody responses were induced only in animals with an established infection. We conclude that intranasally-infected ferrets resemble asymptomatic COVID-19 and possibly aspects of long-COVID. Combined with the increasing portfolio to measure adaptive immunity, ferrets are a relevant model for SARS-CoV-2 vaccine research.


Assuntos
Brônquios/patologia , COVID-19/complicações , COVID-19/imunologia , Furões/imunologia , SARS-CoV-2/fisiologia , Administração Intranasal , Fatores Etários , Animais , Doenças Assintomáticas , Modelos Animais de Doenças , Furões/virologia , Humanos , Hiperplasia , Imunidade Celular , Imunidade Humoral , Injeção Intratimpânica , Masculino , Internalização do Vírus
10.
Pulm Med ; 2021: 4496488, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34721903

RESUMO

When managing coronavirus disease 2019 (COVID-19) patients, radiological imaging complements clinical evaluation and laboratory parameters. We aimed to assess the sensitivity of chest radiography findings in detecting COVID-19, describe those findings, and assess the association of positive chest radiography findings with clinical and laboratory findings. A multicentre, cross-sectional study was conducted involving all primary health care corporation-registered patients (2485 patients) enrolled over a 1-month period during the peak of the 2020 pandemic wave in Qatar. These patients had reverse transcription-polymerase chain reaction-confirmed COVID-19 and underwent chest radiography within 72 hours of the swab test. A positive result on reverse transcription-polymerase chain reaction was the gold standard for diagnosing COVID-19. The sensitivity of chest radiography was calculated. The airspace opacities were mostly distributed in the peripheral and lower lung zones, and most of the patients had bilateral involvement. Pleural effusion was detected in some cases. The risk of having positive chest X-ray findings increased with age, Southeast Asian nationality, fever, or a history of fever and diarrhoea. Patients with cardiac disease, obesity, hypertension, diabetes, and chronic kidney disease were at a higher risk of having positive chest X-ray findings. There was a statistically significant increase in the mean serum albumin, white blood cell count, neutrophil count, and serum C-reactive protein, hepatic enzymes, and total bilirubin with an increase in the radiographic severity score.


Assuntos
COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Bilirrubina/sangue , Proteína C-Reativa/análise , COVID-19/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Febre , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Doenças não Transmissíveis , Pandemias , Derrame Pleural/diagnóstico por imagem , Atenção Primária à Saúde , Catar/epidemiologia , Fatores Raciais , Estudos Retrospectivos , Sensibilidade e Especificidade , Albumina Sérica , Raios X , Adulto Jovem
11.
Sci Rep ; 11(1): 21464, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34728696

RESUMO

The Sputnik V is a COVID- 19 vaccine developed by the Gamalia institute of epidemiology and microbiology and released on August 11, 2020. We provided independent evidence on side effects and immunogenicity following the administration of the Sputnik V COVID-19 in Iran. In this observational study, the healthcare workers who were vaccinated with the Sputnik V COVID-19 vaccine within February and April 2021 were evaluated. Among a total of 13,435 vaccinated healthcare workers, we received 3236 self-declaration reports of Sputnik V associated adverse events with the mean age 39.32 ± 10.19 years old which 38.8% were men and 61.2% were women. Totally 68.8% of females versus 66.2% of males reported side effects after receiving the first dose and 31.2% of females versus 33.8% of males reported side effects after the second dose of vaccine. The most common side effect was a pain in the injection site (56.9%), fatigue (50.9%), body pain (43.9%), headache (35.7%), fever (32.9%), joint pain (30.3%), chilling (29.8%) and drowsiness (20.3%). Side effects of the vaccine were significantly more frequent in females and younger individuals. Among a total of 238 participants, more than 90% after the first and second dose of vaccine had a detectable level of SARS-CoV-2 RBD antibody and SARS-CoV-2 neutralizing antibody. Although the overall rate of adverse effects was higher than the interim results from randomized controlled trials, our findings support the manufacturer's reports about the high humoral immunogenicity of vaccine against COVID-19.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Imunidade Humoral , Adulto , Fatores Etários , Idoso , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , COVID-19/imunologia , COVID-19/virologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Fadiga/etiologia , Feminino , Pessoal de Saúde , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Dor/etiologia , SARS-CoV-2/isolamento & purificação , Fatores Sexuais , Adulto Jovem
12.
Ital J Pediatr ; 47(1): 217, 2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736495

RESUMO

BACKGROUND: We investigated the volume and the characteristics of pediatric eye emergency department (PEED) consultations performed at our tertiary eye center during the early months of the COVID-19 pandemic and we compared them to those carried out in the same time interval of the previous three years. METHODS: Ophthalmic emergency examinations of patients aged ≤18 years old and done during the national COVID-19 lockdown (March 9th, 2020 - May 3rd, 2020) and in the corresponding date range of the previous three years (2017, 2018, and 2019) have been considered and reviewed. The following features were retrieved and analyzed: age, gender, duration and type of accused symptoms, traumatic etiology, and the discharge diagnosis. RESULTS: 136, 133, and 154 PEED visits have been performed respectively in 2017, 2018, and 2019, while 29 patients presented in 2020. Therefore, the volume of PEED activity decreased by 79.4% (p < 0.0001). Demographical and clinical characteristics were comparable to those of the pre-COVID period. Despite the absolute reduction in the number of traumas, urgent conditions increased significantly from 30.7 to 50.7% (p = 0.024). CONCLUSIONS: PEED activity decreased consistently after the onset of the pandemic and it was mainly attended by those children whose conditions required prompt assistance, reducing the number of patients diagnosed with milder pathologies. At the end of the emergency, better use of PEED could avoid overcrowding and minimize waste, allowing resource optimization for the management of urgent cases.


Assuntos
COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Oftalmopatias/epidemiologia , Fatores Etários , COVID-19/prevenção & controle , COVID-19/transmissão , Criança , Pré-Escolar , Controle de Doenças Transmissíveis , Emergências , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Utilização de Instalações e Serviços , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
13.
Ital J Pediatr ; 47(1): 218, 2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736514

RESUMO

BACKGROUND: COVID-19 pandemic has stretched healthcare system capacities worldwide and deterred people from seeking medical support at Emergency Departments (ED). Nevertheless, population-based studies examining the consequences on children are lacking. METHODS: All ED visits from 2019 to 2020 in Veneto, Italy (4.9 million residents) were collected. Anonymized records of pediatric (≤14 years) ED visits included patient characteristics, arrival mode, triage code, clinical presentation, and discharge mode. Year-on-year variation of the main ED visit characteristics, and descriptive trends throughout the study period have been examined. RESULTS: Overall, 425,875 ED presentations were collected, 279,481 in 2019, and 146,394 in 2020 (- 48%), with a peak (- 79%) in March-April (first pandemic wave), and a second peak (below - 60%) in November-December (second pandemic wave). Burn or trauma, and fever were the two most common clinical presentations. Visits for nonurgent conditions underwent the strongest reduction during both pandemic waves, while urgent conditions reduced less sharply. ED arrival by ambulance was more common in 2020 (4.5%) than 2019 (3.5%), with a higher proportion of red triage codes (0.5%, and 0.4% respectively), and hospitalizations following ED discharge (9.1%, and 5.9% respectively). CONCLUSION: Since the beginning of the COVID-19 pandemic, pediatric ED presentations underwent a steeper reduction than that observed for adults. Lockdown and fear of contagion in hospital-based services likely deterred parents from seeking medical support for their children. Given COVID-19 could become endemic, it is imperative that public health experts guarantee unhindered access to medical support for urgent, and less urgent health conditions, while minimizing infectious disease risks, to prevent children from suffering direct and indirect consequences of the pandemic.


Assuntos
COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Fatores Etários , COVID-19/prevenção & controle , COVID-19/transmissão , Criança , Pré-Escolar , Controle de Doenças Transmissíveis , Emergências , Utilização de Instalações e Serviços , Feminino , Humanos , Lactente , Recém-Nascido , Itália , Masculino , Estudos Retrospectivos
14.
Surg Clin North Am ; 101(6): 1023-1031, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774265

RESUMO

Nonoperative management (NOM) of acute appendicitis is becoming more popular, especially in resource-strapped locations, to minimize hospital system costs. In uncomplicated cases of appendicitis, NOM can effectively treat the patient. It does carry a 39.1% risk of recurrence in 5 years, and operative management (OM) does not increase morbidity or risk of complication, so the authors recommend laparoscopic OM for uncomplicated appendicitis. For complicated cases of appendicitis, the authors recommend initial NOM with interval appendectomy in all patients. All appendicitis patients should undergo surveillance endoscopy if older than 40 years to rule out a contributing neoplasm.


Assuntos
Neoplasias do Apêndice/diagnóstico , Apendicite/terapia , Fatores Etários , Algoritmos , Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/complicações , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Tomada de Decisão Clínica , Colonoscopia , Impacção Fecal/cirurgia , Humanos , Laparoscopia , Fatores de Tempo
16.
Medicine (Baltimore) ; 100(41): e27521, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731142

RESUMO

ABSTRACT: To investigate the effect of a combined immune score including the lymphocyte-to-monocyte ratio (LMR) and uninvolved immunoglobulin (u-Ig) levels on the prognosis of newly diagnosed multiple myeloma (NDMM) patients treated with bortezomib.Clinical data of 201 NDMM patients were retrospectively analyzed. Patients with LMR ≥ 3.6 and LMR < 3.6 were scored 0 and 1, respectively. Patients with preserved u-Ig levels, suppression of 1 u-Ig, and suppression of at least 2 u-Igs were scored 0, 1, and 2, respectively. The immune score, established from these individual scores, was used to separate patients into good (0-1 points), intermediate (2 points), and poor (3 points) risk groups. The baseline data, objective remission rate (ORR), whether receive maintenance treatment regularly and overall survival of patients before treatment were analyzed.The ORR of the good-risk group was significantly higher than that of the intermediate-risk group (75.6% vs 57.7%, P = .044) and the poor-risk group (75.6% vs 48.2%, P = .007). The multivariate analysis results showed that age ≥ 65 years, International Staging System stage III, platelet count ≤ 100 × 109/L, lactate dehydrogenase (LDH) > 250 U/L, serum calcium > 2.75 mmol/L, no receipt of regular maintenance treatment, LMR < 3.6, suppressed u-Igs = 1, suppressed u-Igs ≥ 2, intermediate-risk group and poor-risk group were independent predictors of poor overall survival.In the bortezomib era, the LMR, u-Ig levels, and the immune score play an important role in the prognosis of NDMM patients. Among them, the immune score showed the strongest prognostic value, and it could be a beneficial supplement for the early identification of high-risk patients.


Assuntos
Antineoplásicos/uso terapêutico , Bortezomib/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , Fatores Etários , Idoso , Antineoplásicos/administração & dosagem , Bortezomib/administração & dosagem , Cálcio/sangue , Estudos de Casos e Controles , Feminino , Humanos , Sistema Imunitário/efeitos dos fármacos , Sistema Imunitário/imunologia , Imunoglobulinas/efeitos dos fármacos , Imunoglobulinas/imunologia , L-Lactato Desidrogenase/análise , Linfócitos/citologia , Masculino , Pessoa de Meia-Idade , Monócitos/citologia , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/imunologia , Estadiamento de Neoplasias/métodos , Contagem de Plaquetas/estatística & dados numéricos , Contagem de Plaquetas/tendências , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco
17.
Rev Saude Publica ; 55: 72, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34755823

RESUMO

OBJECTIVE: Estimate the effect of age, period, and birth cohort on mortality from oral and oropharyngeal cancer in Brazil and its macro-regions. METHODS: Deaths from oral and oropharyngeal cancer from 1983 to 2017 were analyzed. The Poisson regression model was applied, using estimable functions proposed by Holford. RESULTS: From 1983 to 2017, 142,634 deaths from oral and oropharyngeal cancer were registered in Brazil, 81% among men, and the South and Southeast regions had the highest rates. The most significant period effects were observed in male mortality in the Southeast and Central-West regions for the 2003-2007 reference period. In the North, Northeast, and Central-West regions, an increased risk of mortality was observed in the most recent male cohorts. In the North region, the most significant risk identified was for men born during 1973-1977 (RR = 1.47; 95%CI 1.05-2.08); in the Northeast, for men born during 1988-1992 (RR = 2.77; 95%CI 1.66-4.63); and in the Central-West, for women born during 1973-1977 (RR = 2.01; 95%CI 1.19-3.39). In the Southeast and South regions, the most recent cohorts had lower mortality rates. The lowest risk in the Southeast region was observed in the male cohort born during 1978-1982 (RR = 0.53; 95%CI 0.45-0.62) and 1983-1987 in the South region (RR = 0.25; 95%CI 0.12-0.54). CONCLUSIONS: Age had a significant effect on mortality from oral and oropharyngeal cancer in all regions. In the North, Northeast, and Central-West regions, an increase in risk was observed in the most recent cohorts, while in the South and Southeast regions, these cohorts presented a lower risk when compared to the older cohorts.


Assuntos
Neoplasias Orofaríngeas , Fatores Etários , Brasil/epidemiologia , Efeito de Coortes , Estudos de Coortes , Feminino , Humanos , Masculino , Mortalidade
18.
Ital J Pediatr ; 47(1): 221, 2021 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-34742330

RESUMO

BACKGROUND: With the gradual resumption of sports activities after the lock-down period for coronavirus pandemic, a new problem is emerging: Allow all athletes to be able to return to compete after SARS-CoV-2 infection in total safety. Several protocols have been proposed for healed athletes but all of them have been formulated for the adult population. The aim of the present study is to evaluate the adequacy of Italian practical recommendations for return-to-paly, in order to exclude cardiorespiratory complications due to COVID-19 in children and adolescents. METHODS: Between April 2020 and January 2021 the Italian Sports Medical Federation formulated cardiorespiratory protocols to be applied to athletes recovered from SARS-CoV-2 infection. The protocols take into account the severity of the infection. Protocols include lung function tests, cardiopulmonary exercise test, echocardiographic evaluation, blood chemistry tests. RESULTS: From September 2020 to February 2021, 45 children and adolescents (aged from 9 to 18 years; male = 26) with previous SARS-CoV-2 infection were evaluated according to the protocols in force for adult. 55.5% of the subjects (N = 25) reported an asymptomatic infection; 44.5% reported a mild symptomatic infection. Results of lung function test have exceeded the limit of 80% of the theoretical value in all patients. The cardiorespiratory capacity of all patients was within normal limits (average value of maximal oxigen uptake 41 ml/kg/min). No arrhythmic events or reduction in the ejection fraction were highlighted. CONCLUSION: The data obtained showed that, in the pediatric population, mild coronavirus infection does not cause cardiorespiratory complications in the short and medium term. Return to play after Coronavirus infection seems to be safe but it will be necessary to continue with the data analysis in order to modulate and optimize the protocols especially in the pediatric field.


Assuntos
COVID-19/complicações , Volta ao Esporte , Adolescente , Fatores Etários , COVID-19/fisiopatologia , COVID-19/terapia , Aptidão Cardiorrespiratória , Criança , Protocolos Clínicos , Feminino , Humanos , Itália , Masculino , Recuperação de Função Fisiológica , Testes de Função Respiratória , Fatores de Tempo
19.
BMC Endocr Disord ; 21(1): 228, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34781943

RESUMO

BACKGROUND: The outbreak of severe acute respiratory syndrome novel coronavirus 2 (SARS-CoV-2) has spread rapidly worldwide. SARS-CoV-2 has been found to cause multiple organ damage; however, little attention has been paid to the damage to the endocrine system caused by this virus, and the subsequent impact on prognosis. This may be the first research on the hypothalamic-pituitary-thyroid (HPT) axis and prognosis in coronavirus disease 2019 (COVID-19). METHODS: In this retrospective observational study, 235 patients were admitted to the hospital with laboratory-confirmed SARS-CoV-2 infection from 22 January to 17 March 2020. Clinical characteristics, laboratory findings, and treatments were obtained from electronic medical records with standard data collection forms and compared among patients with different thyroid function status. RESULTS: Among 235 patients, 17 (7.23%) had subclinical hypothyroidism, 11 (4.68%) severe non-thyroidal illness syndrome (NTIS), and 23 (9.79%) mild to moderate NTIS. Composite endpoint events of each group, including mortality, admission to the ICU, and using IMV were observed. Compared with normal thyroid function, the hazard ratios (HRs) of composite endpoint events for mild to moderate NTIS, severe NTIS, subclinical hypothyroidism were 27.3 (95% confidence interval [CI] 7.07-105.7), 23.1 (95% CI 5.75-92.8), and 4.04 (95% CI 0.69-23.8) respectively. The multivariate-adjusted HRs for acute cardiac injury among patients with NTF, subclinical hypothyroidism, severe NTIS, and mild to moderate NTIS were 1.00, 1.68 (95% CI 0.56-5.05), 4.68 (95% CI 1.76-12.4), and 2.63 (95% CI 1.09-6.36) respectively. CONCLUSIONS: Our study shows that the suppression of the HPT axis could be a common complication in COVID-19 patients and an indicator of the severity of prognosis. Among the three different types of thyroid dysfunction with COVID-19, mild to moderate NTIS and severe NTIS have a higher risk of severe outcomes compared with subclinical hypothyroidism.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Síndromes do Eutireóideo Doente/etiologia , Hipertensão/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores Sexuais
20.
Anticancer Res ; 41(11): 5585-5591, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732429

RESUMO

BACKGROUND/AIM: Predictors for complications such as insufficiency of intestinal anastomosis in urinary diversion and other risk factors are not well defined. We aimed to elucidate predictive factors for complications in urinary diversions based on preoperative comorbidities and major complications. A special focus was set on anastomosis insufficiency as a major complication. PATIENTS AND METHODS: Preoperative comorbidities, postoperative complications, duration of hospital stay, and follow-up were analyzed in 317 patients with urinary diversion. The impact of preoperative comorbidities on diversion types was described and quantified as defined by the age-adjusted Charlson Comorbidity Index. RESULTS: Overall, 14.8% of patients showed anastomosis-related complications, most within the ileal conduit group (15.9% in the cohort). Severe complications (Clavien-Dindo Classification Score >IIIa) were found in smokers (p=0.046), and in patients with vascular diseases (p=0.007), a high American Society of Anaesthesiologists (ASA)-score (p=0.047), a R1- (p=0.009), as well as a pN1 (p=0.007) status. CONCLUSION: Several independent predictors for several postoperative complications in urinary diversions were identified, which were independent of the diversion method.


Assuntos
Cistectomia , Complicações Pós-Operatórias/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Fatores Etários , Idoso , Comorbidade , Cistectomia/efeitos adversos , Bases de Dados Factuais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
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