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1.
J Biol Dyn ; 16(1): 14-28, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-34994299

RESUMO

COVID-19 is a disease caused by infection with the virus 2019-nCoV, a single-stranded RNA virus. During the infection and transmission processes, the virus evolves and mutates rapidly, though the disease has been quickly controlled in Wuhan by 'Fangcang' hospitals. To model the virulence evolution, in this paper, we formulate a new age structured epidemic model. Under the tradeoff hypothesis, two special scenarios are used to study the virulence evolution by theoretical analysis and numerical simulations. Results show that, before 'Fangcang' hospitals, two scenarios are both consistent with the data. After 'Fangcang' hospitals, Scenario I rather than Scenario II is consistent with the data. It is concluded that the transmission pattern of COVID-19 in Wuhan obey Scenario I rather than Scenario II. Theoretical analysis show that, in Scenario I, shortening the value of L (diagnosis period) can result in an enormous selective pressure on the evolution of 2019-nCoV.


Assuntos
COVID-19 , China/epidemiologia , Humanos , Modelos Biológicos , SARS-CoV-2 , Virulência
2.
BMC Genomics ; 23(1): 20, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996351

RESUMO

BACKGROUND: Carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP) causes serious infections with significant morbidity and mortality. However, the epidemiology and transmission mechanisms of CR-hvKP and the corresponding carbapenem-resistant plasmids require further investigation. Herein, we have characterized an ST11 K. pneumoniae strain EBSI041 from the blood sample encoding both hypervirulence and carbapenem resistance phenotypes from a patient in Egypt. RESULTS: K. pneumoniae strain EBSI041 showed multidrug-resistance phenotypes, where it was highly resistant to almost all tested antibiotics including carbapenems. And hypervirulence phenotypes of EBSI041 was confirmed by the model of Galleria mellonella infection. Whole-genome sequencing analysis showed that the hybrid plasmid pEBSI041-1 carried a set of virulence factors rmpA, rmpA2, iucABCD and iutA, and six resistance genes aph(3')-VI, armA, msr(E), mph(E), qnrS, and sul2. Besides, blaOXA-48 and blaSHV-12 were harboured in a novel conjugative IncL-type plasmid pEBSI041-2. The blaKPC-2-carrying plasmid pEBSI041-3, a non-conjugative plasmid lacking the conjugative transfer genes, could be transferred with the help of pEBSI041-2, and the two plasmids could fuse into a new plasmid during co-transfer. Moreover, the emergence of the p16HN-263_KPC-like plasmids is likely due to the integration of pEBSI041-3 and pEBSI041-4 via IS26-mediated rearrangement. CONCLUSION: To the best of our knowledge, this is the first report on the complete genome sequence of KPC-2- and OXA-48-coproducing hypervirulent K. pneumoniae from Egypt. These results give new insights into the adaptation and evolution of K. pneumoniae during nosocomial infections.


Assuntos
Infecções por Klebsiella , Klebsiella pneumoniae , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Carbapenêmicos/farmacologia , Egito , Humanos , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Plasmídeos/genética , beta-Lactamases/genética
3.
BMC Neurol ; 22(1): 15, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996388

RESUMO

BACKGROUND: An increased susceptibility to COVID-19 has been suggested for individuals with neurodegenerative diseases, but data are scarce from longitudinal studies. METHODS: In this community-based cohort study, we included 96,275 participants of the UK Biobank who had available SARS-CoV-2 test results in Public Health England. Of these, 2617 had a clinical diagnosis of neurodegenerative diseases in the UK Biobank inpatient hospital data before the outbreak of COVID-19 (defined as January 31st, 2020), while the remaining participants constituted the reference group. We then followed both groups from January 31st, 2020 to June 14th, 2021 for ascertainment of COVID-19 outcomes, including any COVID-19, inpatient care for COVID-19, and COVID-19 related death. Logistic regression was applied to estimate the association between neurogenerative disease and risks of COVID-19 outcomes, adjusted for multiple confounders and somatic comorbidities. RESULTS: We observed an elevated risk of COVID-19 outcomes among individuals with a neurodegenerative disease compared with the reference group, corresponding to a fully adjusted odds ratio of 2.47 (95%CI 2.25-2.71) for any COVID-19, 2.18 (95%CI 1.94-2.45) for inpatient COVID-19, and 3.67 (95%CI 3.11-4.34) for COVID-19 related death. Among individuals with a positive test result for SARS-CoV-2, individuals with neurodegenerative diseases had also a higher risk of COVID-19 related death than others (fully adjusted odds ratio 2.08; 95%CI 1.71-2.53). CONCLUSION: Among UK Biobank participants who received at least one test for SARS-CoV-2, a pre-existing diagnosis of neurodegenerative disease was associated with a subsequently increased risk of COVID-19, especially COVID-19 related death.


Assuntos
COVID-19 , Doenças Neurodegenerativas , Bancos de Espécimes Biológicos , Estudos de Coortes , Inglaterra , Humanos , Doenças Neurodegenerativas/epidemiologia , Fatores de Risco , SARS-CoV-2
4.
BMC Surg ; 22(1): 8, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996399

RESUMO

BACKGROUND: Spinal tumor surgery usually involved long operation time, large area of soft tissue resection and long wound, and was prone to hypothermia during the operation. Therefore, actively promoting insulation and optimizing the intraoperative insulation program have great potential in reducing the incidence of hypothermia and reducing the incidence of postoperative complications. In this study, we compared patients who did not implement multi-mode nursing insulation program (MNIP) with those who implemented MNIP, observing and comparing clinical outcomes, and complications in both groups, with the aim of developing an optimal management plan for the preoperative, intraoperative, and postoperative periods, respectively. METHODS: We selected 2 periods of 1 year, before (n = 120 patients) and after MINP implementation (n = 120 patients). Data were collected on patient demographics, operative, perioperative details, temperature changes, anesthesia recovery effect, incidence of postoperative wound infection, length of hospital stay and complications. PS analyses were used for dealing with confounding bias in this retrospective observational study. RESULTS: After PS matching, the outcomes of 120 well-balanced pairs of patients were compared (No-MNIP vs MNIP). There was no significant difference concerning the satisfaction survey. The results indicated that the MNIP had better insulation effect at 90 min, 120 min, 150 min after anesthesia induction and after surgery. There were 16 cases of complications in the No-MNIP group and 5 cases in the MNIP group postoperative, which have significant statistical difference. CONCLUSION: In this study, the incidence of intraoperative hypothermia was effectively reduced by adopting the multi-mode insulation scheme, thus reducing the incidence of incision infection and shortening the length of hospital stay of patients.


Assuntos
Hipotermia , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Pontuação de Propensão , Estudos Retrospectivos , Coluna Vertebral
5.
BMC Surg ; 22(1): 5, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996411

RESUMO

BACKGROUND: The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). Therefore, this study aimed to evaluate the incidence of gallstones after LG. METHODS: We retrospectively reviewed the records of 184 patients who underwent LG between January 2011 and May 2016 at Saiseikai Utsunomiya Hospital. After gastrectomy, abdominal ultrasonography was generally performed every 6 months for 5 years. Patients who underwent cholecystectomy before LG, underwent simultaneous cholecystectomy, and did not undergo abdominal ultrasonography, with an observation period of < 24 months, were excluded from the study. Finally, 90 patients were analyzed. Laparoscopic cholecystectomy was performed whenever biliary complications occurred. Patient characteristics were compared using the two-tailed Fisher's exact test or Chi-square test. In addition, the risk factors for postoperative gallstones were analyzed using logistic regression analysis. RESULTS: Among the 90 patients included in this study, 60 were men (78%), and the mean age was 65.5 years. Laparoscopic total gastrectomy was performed for 15 patients and laparoscopic distal gastrectomy for 75 patients. D2 lymph node dissection was performed for 8 patients (9%), whereas 68 patients underwent LG with Roux-en-Y reconstruction (76%). Gallstones were detected after LG in 27 of the 90 (30%) patients. Multivariate analysis identified Roux-en-Y reconstruction and male sex as significant risk factors of gallstones after gastrectomy. The incidence of gallstones was significantly higher (53%) in male patients who underwent Roux-en-Y reconstruction. Symptomatic gallstones after laparoscopic cholecystectomy were found in 6 cases (6/27, 22%), and all patients underwent laparoscopic cholecystectomy. CONCLUSION: Roux-en-Y reconstruction and male sex were identified as significant risk factors for gallstones after LG.


Assuntos
Cálculos Biliares , Laparoscopia , Neoplasias Gástricas , Idoso , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia
6.
BMC Surg ; 22(1): 7, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996421

RESUMO

BACKGROUND: A relationship between obesity and adverse outcomes in patients with post-sternotomy wounds undergoing pedicle flap reconstruction is not well-documented. In this study, we present a single-centre retrospective case series analysis of early postoperative outcomes of patients with infected post-sternotomy wounds undergoing pedicle flap reconstruction. We also propose a management algorithm for such patients, based on BMI and wound width. METHODS: We retrospectively analyzed all patients, who underwent pedicle flap reconstruction for major sternal wound infections after sternotomy for cardiac surgery in a tertiary hospital in Germany during a 5-year period. Exclusion criteria included patients younger than 18 years of age and patients with BMI < 18.5 kg/m2. Patients were divided into 2 groups according to BMI: normal-weight (NW; BMI < 25 kg/m2) and overweight/obese (OB/OW; BMI > 25 kg/m2). Both groups were compared in terms of preoperative parameters and early postoperative outcomes. Preoperative parameters included demographics, wound bacteria and comorbidities. Postoperative outcomes included duration of surgery time (from incision to skin closure), transfusion requirement (during surgery and entire hospital stay), onset of flap and donor-site complications, length of stay and 30-day mortality. We employed the two-tailed t-test to compare continuous variables and the two-sided Fischer's exact test to compare categorical variables. Statistical significance was set at p < 0.05. RESULTS: The total sample consisted of 48 patients. Overall mean BMI was 28.4 (6.1) kg/m2. Mean age was 67 (12) years. The study group consisted of 28 patients with BMI > 25 kg/m2, who were compared with 20 normal-weight patients. There was a significant difference amongst both groups regarding duration of surgery (120 vs. 174 min, p < 0.05). Donor-site complications requiring intervention were observed in 30% of patients in both groups. Flap-related complications were recorded in 16 (57%) cases in the study group and 7 cases in the control group (35%, p = 0.15). CONCLUSIONS: We conclude that wound width and BMI can aid the decision-making process for patients with infected sternal wounds after cardiac surgery requiring pedicle flap reconstruction. However, in our case series analysis, OB/OW patients were not found to be at statistically significantly increased risk for worse postoperative outcomes, but were associated with a longer duration of surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Esternotomia , Idoso , Algoritmos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Obesidade/complicações , Sobrepeso , Estudos Retrospectivos , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia
7.
BMC Health Serv Res ; 22(1): 41, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996426

RESUMO

BACKGROUND: The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. METHODS: The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. RESULTS: The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. CONCLUSIONS: Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.


Assuntos
Cirurgia Bariátrica , Brasil/epidemiologia , Custos de Cuidados de Saúde , Humanos , Análise de Séries Temporais Interrompida , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos
8.
J Emerg Nurs ; 48(1): 102.e1-102.e12, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34996571

RESUMO

INTRODUCTION: Prolonged length of stay in emergency departments is associated with increased hospitalization, hospital-acquired pressure ulcers, medication errors, and mortality. In acute admissions in Denmark in 2018, 67% of patients experienced waiting time from arrival to examination. This study aimed to estimate the prevalence of prolonged length of stay (≥6 hours) and identify risk factors related to input, throughput, and output components. METHODS: A retrospective health records repository review included 4743 patients admitted to a single urban emergency department in Denmark in January 2019. Data collected from the electronic health record system repository included demographic and organizational characteristics and were analyzed using descriptive statistics and logistic regression. RESULTS: Among patients admitted in the study period, 31% had a prolonged length of stay of ≥6 hours. Prolonged length of emergency department stay was associated with being female (male odds ratio [OR], 0.86; 95% confidence interval [CI], 0.75-0.98), treatment by medical service (OR, 4.25, 95% CI, 3.63-4.98) vs surgical or injury, triage acuity of 2-Orange (OR, 1.45; 95% CI, 1.18-1.78) or 3-Yellow (OR, 1.47; 95% CI, 1.23-1.75) on a 5-level scale, evening (OR, 1.44; 95% CI, 1.24-1.66) or night (OR, 2.36; 95% CI, 1.91-2.91) arrival, ages 56 to 80 (OR, 1.79; 95% CI, 1.52-2.11) and >81 (OR, 2.40; 95% CI, 1.99-2.88) years, and hospital admission (OR, 1.19; 95% CI, 1.04-1.38) vs discharge from the emergency department to home. DISCUSSION: Female, elderly, and medical patients were each identified as at-risk characteristics for ≥6-hour length of stay in the emergency department. Acute care patient pathways in the emergency department, particularly for evening and night, with guideline-based care and system level improvements in patient flow are warranted. Further research with larger populations is needed to identify and support interventions to decrease prolonged length of stay.


Assuntos
Serviço Hospitalar de Emergência , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
9.
Rev Alerg Mex ; 69 Suppl 1: s15-s23, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998306

RESUMO

The COVID-19 pandemic has collapsed the health systems of many countries in the world and comorbidities in adults have exponentially increased their mortality; in matters of asthma, it has not been possible to establish a defining relationship in mortality. The clinical manifestations of asthmatic patients with SARS COV 2 are presented in a wide range; from asymptomatic to those who experience acute respiratory failure. The most sensitive method for the diagnosis of SARS-CoV-2 infection is RT-PCR. Antigen and serologic tests are quicker than RT-PCR, but they are less sensitive. Radiologic studies and the computed tomography of the chest assist in the diagnosis and follow-up of SARS-CoV-2 infection. The use of spirometry for diagnosis and follow-up is restricted due to the elevated risk of contagion. It has been shown that eosinophilia and TH2 inflammation, due to their antiviral immune effect, are protective factors against severe SARS-CoV-2/COVID-19. Patients with mild asthma express less angiotensin converting enzyme receptors (ACE2), and those with neutrophilic asthma express it in greater proportion, which suggests more severe presentations of COVID-19. The conventional asthma treatment modulates the SARS-CoV-2/COVID-19 immune response, which is why patients with controlled asthma have non-severe manifestations of COVID 19, however, the mechanisms are not clear.


Assuntos
Asma , COVID-19 , Asma/diagnóstico , Asma/epidemiologia , Humanos , Pandemias , RNA Viral , SARS-CoV-2
10.
Rev Alerg Mex ; 69 Suppl 1: s24-s30, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998307

RESUMO

Air pollution, climate change, and the decrease of biological diversity are major threats to human health. In the past decades, an increase in allergic diseases, including asthma and rhinoconjunctivitis, has been observed. Up to 40 % of the world population may have an allergic disease, which represents a significant impact on the quality of life of those who suffer from it, and environmental pollution is one of the causes of its presentation. Air pollution causes significant morbidity and mortality in patients with inflammatory airway diseases such as allergic rhinitis, chronic rhinosinusitis, asthma, and chronic obstructive pulmonary disease. Oxidative stress in patients with respiratory diseases can induce eosinophilic inflammation in the airways, increase atopic allergic sensitization, and rise susceptibility to infections. Climate change has influenced exposure to extramural allergens and it is associated with exacerbations of respiratory diseases in the upper and lower airway. The interaction of indoor and outdoor environmental exposure and host factors can affect the development and progression of lifelong allergic diseases. The decrease of exposure to air pollutants has been associated with a favorable response in respiratory health, which is why it is necessary to implement measures that contribute to an improvement in air quality.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Rinite Alérgica , Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Alérgenos , Asma/epidemiologia , Asma/etiologia , Humanos , Qualidade de Vida , Rinite Alérgica/epidemiologia , Rinite Alérgica/etiologia
11.
Rev Alerg Mex ; 69 Suppl 1: s31-s37, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998308

RESUMO

This allergy is a hypersensitivity reaction that is triggered by contact with latex. Symptoms vary depending on factors such as route, frequency, and exposure dose, as well as individual susceptibility. The clinical manifestations can be localized at the site of contact with latex or generalized. Exposure can occur directly as a result of contact with the skin and mucous membranes, that is by touching or being touched by objects with latex, or by inhaling (breathing) particles from objects with latex. Contact can also be indirect; for example, by ingesting food that has been handled by a worker wearing latex gloves or by having contact with a person who has been blowing up balloons. The diagnosis of latex allergy is made based on the patient's medical history and on what has been reported in the interrogation, and it is complemented with in vivo studies (such as skin tests and provocation tests) or in vitro studies (determination of specific IgE). The fundamental pillar in the treatment of latex allergy is the education of the patient to achieve the avoidance of products made with this material or the contact and intake of food that has had contact with latex. In view of the foregoing, latex allergy has a great medical and social relevance due to all the safety measures that the patient must take.


Assuntos
Hipersensibilidade ao Látex , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Hipersensibilidade ao Látex/etiologia , Testes Cutâneos
12.
Rev Alerg Mex ; 69 Suppl 1: s46-s54, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998310

RESUMO

An increasing number of studies are analyzing the relationship between serum vitamin D levels and the development of sensitization and allergic diseases in genetically predisposed individuals, as well as the impact of vitamin D supplementation. This article reviews the literature on this subject. Clinical trials, meta-analyses and systematic reviews consulted in PubMed, EMBASE, Scopus, Ovid, Wiley Online Library, Springer, Cochrane and manual resources were included, with the keywords: vitamin D, 25 hydroxyvitamin D, cholecalciferol, asthma, rhinitis, allergy, 25-OH-D, 1,25 hydroxyvitamin D, supplementation. The results show a positive linear trend, however, differ. We should keep in mind that in the studies there is heterogeneity of population groups and associated factors, which may modify such studies. It is necessary to increase research to clarify this relationship and to have successful interventions from the patient's approach to the strengthening of pharmacological and immunological treatment of allergic patients with these diseases.


Assuntos
Asma , Hipersensibilidade , Deficiência de Vitamina D , Asma/tratamento farmacológico , Colecalciferol , Humanos , Hipersensibilidade/epidemiologia , Vitamina D , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/epidemiologia , Vitaminas/uso terapêutico
13.
Rev Alerg Mex ; 69 Suppl 1: s55-s68, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998311

RESUMO

Latex allergy is a major problem worldwide due to both the severity of the symptomatology it produces and the risk groups that are exposed to it. Complete avoidance is difficult, if not impossible, due to its ubiquity. Natural rubber latex (NRL) is a natural polymer that is released by the Hevea brasiliensis (Hev b) tree, which functions as a protective sealant. It is currently used for the manufacture of health-care products such as tube caps, pistons, masks, and cannulas. The purpose of this review is to highlight the epidemiological, clinical, and diagnostic aspects of NRL allergy, and to conduct a review of the literature on its management through a bibliographic search of articles in databases such as PubMed, Cochrane, UpToDate, and Google Scholar, up to September 2021. About 121 articles were reviewed, of which 76 were used as a reference. We concluded that latex allergy is an entity for which its treatment, even nowadays, is avoidance, despite having a worldwide prevalence of 4.3 % and representing a surgical complication in about 20 % of surgeries with an anaphylactic reaction and a mortality rate that can reach 9 %. The only treatment that could modify the evolution of this disease is immunotherapy, but there are no standardized extracts yet and it has not been possible to determine the safest and most effective way to apply it.


Assuntos
Hevea , Hipersensibilidade ao Látex , Alérgenos , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Hipersensibilidade ao Látex/terapia , Prevalência , Borracha
14.
Rev Alerg Mex ; 69 Suppl 1: s69-s80, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998312

RESUMO

Chronic spontaneous urticaria is a condition that persists for more than six weeks, it occurs in the absence of an identifiable triggering factor and from the pathogenic activation of mast cells and basophils. The possibility of autoimmune etiology in up to 40 % of patients is presented, followed by subclinical infections and psychological factors. Two main mechanisms of the pathogenesis of chronic urticaria have been proposed: the former is the dysregulation of intracellular signaling pathways within mast cells and basophils, which leads to defects in the traffic or function of these cells. The latter is the development of autoantibodies against FcεRIα or IgE, in both mast cells and basophils. Numerous autoimmune diseases such as systemic lupus erythematosus, polymyositis, dermatomyositis, and rheumatoid arthritis have been associated with chronic urticaria; however, autoimmune thyroid disease deserves a special mention. A higher prevalence of antithyroid antibodies has been found, regardless of thyroid function (euthyroidism, hypo and hyperthyroidism) in patients with chronic spontaneous urticaria. Several infections have been linked to chronic urticaria. The best evidence is for Helicobacter pylori infection. Finally, stress is associated with the onset of the disease through the activation of the sympathetic and adrenomedullary system and the hypothalamic-pituitary- adrenal axis. Diagnosis may vary in different regions of the world, but the common feature is the completion of a thorough medical history.


Assuntos
Doenças Autoimunes , Urticária Crônica , Infecções por Helicobacter , Helicobacter pylori , Urticária , Autoanticorpos , Doenças Autoimunes/epidemiologia , Autoimunidade , Doença Crônica , Humanos , Imunoglobulina E , Receptores de IgE , Urticária/epidemiologia , Urticária/etiologia
15.
Rev Alerg Mex ; 69 Suppl 1: s81-s93, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998313

RESUMO

Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams. Penicillin allergy ranks first in relation to drug allergy. 10 to 20 % of the population is labeled as allergic to it, often wrongly. Cross reaction is reported in 2 to 5 % between penicillins and cephalosporin. There is no cross reaction between penicillins and aztreonam, but there is with ceftazidime. All the mechanisms of the Gell and Coombs classification are included in the pathophysiology of hypersensitivity reactions to penicillin. Stratification according to risk allows us to take the most objective behavior to label the patient as allergic to. In the natural history of penicillin allergy, 80-90 % of patients lose this sensitivity by 10 years. If necessary, the patient can undergo a desensitization protocol. The immuno-allergist is a key piece in the selection of the patient, the elaboration of the challenge and desensitization protocols, in a controlled environment.


Assuntos
Hipersensibilidade a Drogas , Penicilinas , Antibacterianos/efeitos adversos , Carbapenêmicos , Cefalosporinas/efeitos adversos , Reações Cruzadas , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Humanos , Penicilinas/efeitos adversos , Testes Cutâneos
16.
Rev Alerg Mex ; 69 Suppl 1: s94-s111, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998314

RESUMO

Difficult-to-treat asthma refers to asthma that is not controlled despite high or medium doses of inhaled steroids or in which high doses of treatment are required to maintain an adequate control of the symptoms and to reduce the risk of exacerbations. An inadequate technique to use the inhaler, poor adherence to treatment, smoking, comorbidities, or an incorrect diagnosis should be considered. In severe asthma, despite adherence to treatment with optimized maximum doses and the management of factors that could contribute, multiple medications in maximum doses are required to have an adequate therapeutic control or this is not achieved. The approach to these patients involves a meticulous process due to the multiple factors that can influence poor asthma control and that can lead to a misclassification of the disease when, in reality, the patient can be presenting different comorbidities whose treatment could decrease the severity of asthma symptoms and modify the prognosis. The objective of this document is to make the approach to patients with difficult-to-treat asthma and severe asthma known, as well as the most frequent comorbidities. A search was made in PubMed with the purpose of identifying the main pathologies that may be present in patients and, based on what is described in the literature, to propose a diagnostic approach. 100 studies were comprised in this review, including clinical guidelines such as GINA, GEMA, and ERS/ATS.


Assuntos
Antiasmáticos , Asma , Administração por Inalação , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/tratamento farmacológico , Asma/epidemiologia , Comorbidade , Humanos
17.
Biomed Res Int ; 2022: 3401566, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35005026

RESUMO

Early in the COVID-19 pandemic, asymptomatic transmission represented an important challenge for controlling the spread of SARS-CoV-2 through the traditional public health strategies. Further understanding of the contribution of asymptomatic infections to SARS-CoV-2 transmission has been of crucial importance for pandemic control. We conducted a retrospective epidemiological study to characterize asymptomatic COVID-19 cases occurred in the Apulia region, Italy, during the first epidemic wave of COVID-19 outbreak (February 29-July 7, 2020). We analyzed data collected in a regional platform developed to manage surveillance activities, namely, investigation and follow-up of cases and contacts, contact tracing, and laboratory and clinical data collection. We included all asymptomatic cases that were laboratory-confirmed during the appropriate follow-up, defined as persons infected with SARS-CoV-2 who did not develop symptoms/clinical signs of the disease. Between February 29 and July 7, 2020, a total of 4,536 cases were diagnosed with COVID-19 among 193,757 tests performed. The group of persons with asymptomatic SARS-CoV-2 infection consisted of 903 cases; the asymptomatic proportion was 19.9% (95% CI: 18.8-21.1%); this decreased with increasing age (OR: 0.89, 95% CI: 0.83-0.96; p = 0.001), in individuals with underlying comorbidities (OR: 0.55, 95% CI: 0.41-0.73; p < 0.001), and in males (OR: 0.69, 95% CI: 0.54-0.87; p = 0.002). The median asymptomatic SARS-CoV-2 RNA positive period was 19 days (IQR: 14-31) and the cumulative proportion of persons with resolution of infection 14 days after the first positive PCR test was 74%. As the public health community is debating the question of whether asymptomatic and late spreaders could sustain virus transmission in the communities, such cases present unique opportunities to gain insight into SARS-CoV-2 adaptation to human host. This has important implications for future COVID-19 surveillance and prevention.


Assuntos
Infecções Assintomáticas/epidemiologia , COVID-19/epidemiologia , Portador Sadio/epidemiologia , Adaptação Fisiológica , Adulto , Idoso , COVID-19/transmissão , Busca de Comunicante , Surtos de Doenças , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , RNA Viral , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/patogenicidade
18.
Bull Math Biol ; 84(2): 30, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35006388

RESUMO

The COVID-19 pandemic has adversely affected the entire world. The effective implementation of vaccination strategy is critical to prevent the resurgence of the pandemic, especially during large-scale population migration. We establish a multiple patch coupled model based on the transportation network among the 31 provinces in China, under the combined strategies of vaccination and quarantine during large-scale population migration. Based on the model, we derive a critical quarantine rate to control the pandemic transmission and a vaccination rate to achieve herd immunity. Furthermore, we evaluate the influence of passenger flow on the effective reproduction number during the Chinese-Spring-Festival travel rush. Meanwhile, the spread of the COVID-19 pandemic is investigated for different control strategies, viz. global control and local control. The impact of vaccine-related parameters, such as the number, the effectiveness and the immunity period of vaccine, are explored. It is believed that the articulated models as well as the presented simulation results could be beneficial to design of feasible strategies for preventing COVID-19 transmission during the Chinese-Spring-Festival travel rush or the other future events involving large-scale population migration.


Assuntos
COVID-19 , Quarentena , China/epidemiologia , Férias e Feriados , Humanos , Conceitos Matemáticos , Modelos Biológicos , Pandemias/prevenção & controle , SARS-CoV-2 , Viagem , Vacinação
19.
BMC Psychiatry ; 22(1): 25, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012486

RESUMO

BACKGROUND: The COVID-19 pandemic and its associated national lockdowns have been linked to deteriorations in mental health worldwide. A number of studies analysed changes in mental health indicators during the pandemic; however, these studies generally had a small number of timepoints, and focused on the initial months of the pandemic. Furthermore, most studies followed-up the same individuals, resulting in significant loss to follow-up and biased estimates of mental health and its change. Here we report on time trends in key mental health indicators amongst Danish adults over the course of the pandemic (March 2020 - July 2021) focusing on subgroups defined by gender, age, and self-reported previously diagnosed chronic and/or mental illness. METHODS: We used time-series data collected by Epinion (N=8,261) with 43 timepoints between 20 March 2020 and 22 July 2021. Using a repeated cross-sectional study design, independent sets of individuals were asked to respond to the Copenhagen Corona-Related Mental Health questionnaire at each timepoint, and data was weighted to population proportions. The six mental health indicators examined were loneliness, anxiety, social isolation, quality of life, COVID-19-related worries, and the mental health scale. Gender, age, and the presence of previously diagnosed mental and/or chronic illness were used to stratify the population into subgroups for comparisons. RESULTS: Poorer mental health were observed during the strictest phases of the lockdowns, whereas better outcomes occurred during reopening phases. Women, young individuals (<34 yrs), and those with a mental- and/or chronic illness demonstrated poorer mean time-series than others. Those with a pre-existing mental illness further had a less reactive mental health time-series. The greatest differences between women/men and younger/older age groups were observed during the second lockdown. CONCLUSIONS: People with mental illness have reported disadvantageous but stable levels of mental health indicators during the pandemic thus far, and they seem to be less affected by the factors that result in fluctuating time-series in other subgroups.


Assuntos
COVID-19 , Adulto , Idoso , Controle de Doenças Transmissíveis , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental , Pandemias , Qualidade de Vida , SARS-CoV-2
20.
BMC Psychiatry ; 22(1): 32, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012512

RESUMO

BACKGROUND: Long-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I. METHODS: Ten experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search. RESULTS: Individuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic. CONCLUSIONS: The COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.


Assuntos
Antipsicóticos , Transtorno Bipolar , COVID-19 , Esquizofrenia , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Teste para COVID-19 , Preparações de Ação Retardada/uso terapêutico , Humanos , Adesão à Medicação , Pandemias , SARS-CoV-2 , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia
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