RESUMO
ЦелÑ: ÐзÑÑение оÑобенноÑÑей клиниÑеÑкого ÑеÑÐµÐ½Ð¸Ñ Ð½Ð¾Ð²Ð¾Ð¹ коÑонавиÑÑÑной инÑекÑии и влиÑÐ½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ на иÑÑ Ð¾Ð´ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ñ Ñ Ð³Ð¾ÑпиÑализиÑованнÑÑ Ð±Ð¾Ð»ÑнÑÑ Ñ Ð¸Ð½ÑекÑией SARS-CoV-2 в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸.ÐеÑÐ¾Ð´Ñ Ð¸ ÑезÑлÑÑаÑÑ. ÐÐ»Ñ Ð¾Ñенки оÑобенноÑÑей ÑеÑÐµÐ½Ð¸Ñ COVID-19 в ÐвÑазийÑком Ñегионе бÑли ÑÐ¾Ð·Ð´Ð°Ð½Ñ Ð¼ÐµÐ¶Ð´ÑнаÑоднÑе ÑегиÑÑÑÑ ÐÐТÐÐ 1 и во вÑÐµÐ¼Ñ Ð²ÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÐÐТÐÐ 2. ÐÐ°Ð±Ð¾Ñ Ð±Ð¾Ð»ÑнÑÑ Ð² ÑегиÑÑÑ ÐÐТÐÐ 1 пÑоводили Ñ 29.06.20 по 29.10.20, набÑано 5 397 паÑиенÑов. ÐÑием паÑиенÑов на ÑÑÐµÑ Ð² ÐÐТÐÐ 2 пÑоводили Ñ 01.11.20 до 30.03.21, набÑано 2 665 болÑнÑÑ .РезÑлÑÑаÑÑ. ÐоÑпиÑалÑÐ½Ð°Ñ Ð»ÐµÑалÑноÑÑÑ ÑнизилаÑÑ Ð² пеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ и ÑоÑÑавила 4,8 % пÑоÑив 7,6 % в пеÑиод пеÑвой волнÑ. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°ÑиенÑÑ Ð±Ñли ÑÑаÑÑе, имели болÑÑе ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ и поÑÑÑпали в ÑÑаÑÐ¸Ð¾Ð½Ð°Ñ Ð² более ÑÑжелом ÑоÑÑоÑнии, паÑиенÑÑ Ð¸Ð¼ÐµÐ»Ð¸ более вÑÑокий ÑÑÐ¾Ð²ÐµÐ½Ñ Ð¿Ð¾Ð»Ð¸Ð¼Ð¾ÑбидноÑÑи. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÑвелиÑилаÑÑ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°ÐµÐ¼Ð¾ÑÑÑ Ð±Ð°ÐºÑеÑиалÑной пневмонией и ÑепÑиÑом, но Ñеже вÑÑÑеÑалиÑÑ ÑÑÐ¾Ð¼Ð±Ð¾Ð·Ñ Ð³Ð»ÑÐ±Ð¾ÐºÐ¸Ñ Ð²ÐµÐ½ и «ÑиÑокиновÑй ÑÑоÑм¼. Ðаиболее неблагопÑиÑÑнÑми Ð´Ð»Ñ Ð¿Ñогноза ÑмеÑÑноÑÑи, как в пеÑвÑÑ, Ñак и во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ñпидемии бÑли ÑоÑеÑÐ°Ð½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹: аÑÑеÑиалÑÐ½Ð°Ñ Ð³Ð¸Ð¿ÐµÑÑÐµÐ½Ð·Ð¸Ñ (ÐÐ) + Ñ ÑониÑеÑÐºÐ°Ñ ÑеÑдеÑÐ½Ð°Ñ Ð½ÐµÐ´Ð¾ÑÑаÑоÑноÑÑÑ (ХСÐ) + ÑÐ°Ñ Ð°ÑнÑй Ð´Ð¸Ð°Ð±ÐµÑ (СÐ) + ожиÑение, ÐÐ + иÑемиÑеÑÐºÐ°Ñ Ð±Ð¾Ð»ÐµÐ·Ð½Ñ ÑеÑдÑа (ÐÐС) + ХСР+ СÐ, ÐÐ + ÐÐС + ХСР+ ожиÑение.ÐаклÑÑение. У паÑиенÑов во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ наблÑдалоÑÑ Ð±Ð¾Ð»ÐµÐµ обÑиÑное поÑажение Ñкани Ð»ÐµÐ³ÐºÐ¸Ñ , ÑаÑе возникала ÑебÑилÑÐ½Ð°Ñ Ð»Ð¸Ñ Ð¾Ñадка, бÑли вÑÑе ÑÑовни С-ÑеакÑивного белка и ÑÑопонина, ниже ÑÑовни гемоглобина и лимÑоÑиÑов. ÐÑо, веÑоÑÑно, ÑвÑзано Ñ ÑазлиÑной ÑакÑикой гоÑпиÑализаÑии паÑиенÑов в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ в ÑÑÑÐ°Ð½Ð°Ñ , пÑинÑвÑÐ¸Ñ ÑÑаÑÑие в ÑоÑмиÑовании ÑегиÑÑÑов ÐÐТÐÐ 1 и ÐÐТÐÐ 2.
Assuntos
COVID-19 , Síndrome do Intestino Irritável , Humanos , SARS-CoV-2RESUMO
ЦелÑ: ÐзÑÑение оÑобенноÑÑей клиниÑеÑкого ÑеÑÐµÐ½Ð¸Ñ Ð½Ð¾Ð²Ð¾Ð¹ коÑонавиÑÑÑной инÑекÑии и влиÑÐ½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ на иÑÑ Ð¾Ð´ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ñ Ñ Ð³Ð¾ÑпиÑализиÑованнÑÑ Ð±Ð¾Ð»ÑнÑÑ Ñ Ð¸Ð½ÑекÑией SARS-CoV-2 в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸.ÐеÑÐ¾Ð´Ñ Ð¸ ÑезÑлÑÑаÑÑ. ÐÐ»Ñ Ð¾Ñенки оÑобенноÑÑей ÑеÑÐµÐ½Ð¸Ñ COVID-19 в ÐвÑазийÑком Ñегионе бÑли ÑÐ¾Ð·Ð´Ð°Ð½Ñ Ð¼ÐµÐ¶Ð´ÑнаÑоднÑе ÑегиÑÑÑÑ ÐÐТÐÐ 1 и во вÑÐµÐ¼Ñ Ð²ÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÐÐТÐÐ 2. ÐÐ°Ð±Ð¾Ñ Ð±Ð¾Ð»ÑнÑÑ Ð² ÑегиÑÑÑ ÐÐТÐÐ 1 пÑоводили Ñ 29.06.20 по 29.10.20, набÑано 5 397 паÑиенÑов. ÐÑием паÑиенÑов на ÑÑÐµÑ Ð² ÐÐТÐÐ 2 пÑоводили Ñ 01.11.20 до 30.03.21, набÑано 2 665 болÑнÑÑ .РезÑлÑÑаÑÑ. ÐоÑпиÑалÑÐ½Ð°Ñ Ð»ÐµÑалÑноÑÑÑ ÑнизилаÑÑ Ð² пеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ и ÑоÑÑавила 4,8 % пÑоÑив 7,6 % в пеÑиод пеÑвой волнÑ. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°ÑиенÑÑ Ð±Ñли ÑÑаÑÑе, имели болÑÑе ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ и поÑÑÑпали в ÑÑаÑÐ¸Ð¾Ð½Ð°Ñ Ð² более ÑÑжелом ÑоÑÑоÑнии, паÑиенÑÑ Ð¸Ð¼ÐµÐ»Ð¸ более вÑÑокий ÑÑÐ¾Ð²ÐµÐ½Ñ Ð¿Ð¾Ð»Ð¸Ð¼Ð¾ÑбидноÑÑи. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÑвелиÑилаÑÑ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°ÐµÐ¼Ð¾ÑÑÑ Ð±Ð°ÐºÑеÑиалÑной пневмонией и ÑепÑиÑом, но Ñеже вÑÑÑеÑалиÑÑ ÑÑÐ¾Ð¼Ð±Ð¾Ð·Ñ Ð³Ð»ÑÐ±Ð¾ÐºÐ¸Ñ Ð²ÐµÐ½ и «ÑиÑокиновÑй ÑÑоÑм¼. Ðаиболее неблагопÑиÑÑнÑми Ð´Ð»Ñ Ð¿Ñогноза ÑмеÑÑноÑÑи, как в пеÑвÑÑ, Ñак и во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ñпидемии бÑли ÑоÑеÑÐ°Ð½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹: аÑÑеÑиалÑÐ½Ð°Ñ Ð³Ð¸Ð¿ÐµÑÑÐµÐ½Ð·Ð¸Ñ (ÐÐ) + Ñ ÑониÑеÑÐºÐ°Ñ ÑеÑдеÑÐ½Ð°Ñ Ð½ÐµÐ´Ð¾ÑÑаÑоÑноÑÑÑ (ХСÐ) + ÑÐ°Ñ Ð°ÑнÑй Ð´Ð¸Ð°Ð±ÐµÑ (СÐ) + ожиÑение, ÐÐ + иÑемиÑеÑÐºÐ°Ñ Ð±Ð¾Ð»ÐµÐ·Ð½Ñ ÑеÑдÑа (ÐÐС) + ХСР+ СÐ, ÐÐ + ÐÐС + ХСР+ ожиÑение.ÐаклÑÑение. У паÑиенÑов во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ наблÑдалоÑÑ Ð±Ð¾Ð»ÐµÐµ обÑиÑное поÑажение Ñкани Ð»ÐµÐ³ÐºÐ¸Ñ , ÑаÑе возникала ÑебÑилÑÐ½Ð°Ñ Ð»Ð¸Ñ Ð¾Ñадка, бÑли вÑÑе ÑÑовни С-ÑеакÑивного белка и ÑÑопонина, ниже ÑÑовни гемоглобина и лимÑоÑиÑов. ÐÑо, веÑоÑÑно, ÑвÑзано Ñ ÑазлиÑной ÑакÑикой гоÑпиÑализаÑии паÑиенÑов в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ в ÑÑÑÐ°Ð½Ð°Ñ , пÑинÑвÑÐ¸Ñ ÑÑаÑÑие в ÑоÑмиÑовании ÑегиÑÑÑов ÐÐТÐÐ 1 и ÐÐТÐÐ 2.
Assuntos
COVID-19 , Síndrome do Intestino Irritável , Humanos , Pandemias , SARS-CoV-2RESUMO
AIM: To determine the detection rates, clinical features, and risk factors for lack of registration of alcohol use in medical patients admitted in European hospitals. METHODS: A point-prevalence, cross-sectional, multicenter survey involving 2100 medical inpatients from 43 hospitals from 8 European countries. Patients were screened for current alcohol use, using standardized questionnaires. Alcohol use recording in medical records was assessed. RESULTS: Of the 2100, more than a half reported alcohol use. Significant differences were shown in the prevalence of drinking and the recording rates of alcohol use among the hospitals and countries involved. Overall, 346 patients (16%) fulfilled criteria for alcohol use disorder. Alcohol use was registered in 909 (43%) of medical records, with quantification in 143 (7%). Multivariate analysis showed that women (OR 1.49), older age patients (OR 1.23), patients from the Northern European countries (OR 4.79) and from hospitals with high local alcohol prevalence (OR 1.59) were more likely to have lack of alcohol use registration in their medical files. CONCLUSIONS: A considerable proportion of medical patients admitted in European hospitals fulfill criteria for alcohol use disorders. These patients are frequently overlooked during hospitalization and not appropriately registered in medical records. Women, older patients, and inpatients from European areas with high local alcohol use prevalence are at higher risk associated with a non-recording of alcohol use.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Hospitais/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Prontuários Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Adulto JovemRESUMO
The aim of this study is to investigate the course of the acute period of COVID-19 and devise a prognostic scale for patients hospitalized. Materials and methods: The ACTIV registry encompassed both male and female patients aged 18 years and above, who were diagnosed with COVID-19 and subsequently hospitalized. Between June 2020 and March 2021, a total of 9364 patients were enrolled across 26 medical centers in seven countries. Data collected during the patients' hospital stay were subjected to multivariate analysis within the R computational environment. A predictive mathematical model, utilizing the "Random Forest" machine learning algorithm, was established to assess the risk of reaching the endpoint (defined as in-hospital death from any cause). This model was constructed using a training subsample (70% of patients), and subsequently tested using a control subsample (30% of patients). Results: Out of the 9364 hospitalized COVID-19 patients, 545 (5.8%) died. Multivariate analysis resulted in the selection of eleven variables for the final model: minimum oxygen saturation, glomerular filtration rate, age, hemoglobin level, lymphocyte percentage, white blood cell count, platelet count, aspartate aminotransferase, glucose, heart rate, and respiratory rate. Receiver operating characteristic analysis yielded an area under the curve of 89.2%, a sensitivity of 86.2%, and a specificity of 76.0%. Utilizing the final model, a predictive equation and nomogram (termed the ACTIV scale) were devised for estimating in-hospital mortality amongst COVID-19 patients. Conclusion: The ACTIV scale provides a valuable tool for practicing clinicians to predict the risk of in-hospital death in patients hospitalized with COVID-19.
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AIMS: To study all-cause mortality in patients hospitalized with COVID-19 with or without chronic heart failure (CHF) during hospitalization and at 3 and 6 months of follow-up. METHODS AND RESULTS: The international registry Analysis of Comorbid Disease Dynamics in Patients with SARS-CoV-2 Infection (ACTIV) was conducted at 26 centres in seven countries: Armenia, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russian Federation, and Uzbekistan. The primary endpoints were in-hospital all-cause mortality and all-cause mortality at 3 and 6 months of follow-up. Of the 5616 patients hospitalized with COVID-19, 917 (16.3%) had CHF. Total in-hospital mortality was 7.6%. In-hospital mortality was higher in patients with CHF than in patients without a history of CHF [17.7% vs. 4.0%, P < 0.001; odds ratio (OR) 4.614, 95% confidence interval (CI) 3.633-5.859; P < 0.001]. The risk of in-hospital all-cause mortality correlated significantly with the severity of CHF; specifically, the risk of in-hospital all-cause mortality was greater for patients in New York Heart Association functional classes III and IV (OR 6.124, 95% CI 4.538-8.266; P < 0.001 vs. patients without CHF) than for patients in functional classes I and II (OR 2.446, 95% CI 1.831-3.267, P < 0.001 vs. patients without CHF). The risk of mortality in patients with ischemic CHF was 58% higher than in patients with non-ischaemic CHF [OR 1.58 (95% CI 1.05-2.45), P = 0.030]. In the first 3 months of follow-up, the all-cause mortality rate in patients with CHF was 10.32%, compared with 1.83% in patients without CHF (P < 0.001). At 6 months of follow-up, NYHA classes II-IV was a strong risk factor for all-cause mortality [OR 5.343 (95% CI 2.717-10.508); P < 0.001]. CONCLUSIONS: Hospitalized COVID-19 patients with CHF have an increased risk of in-hospital all-cause mortality, which remains high 6 months after discharge.
Assuntos
COVID-19 , Insuficiência Cardíaca , Humanos , COVID-19/complicações , SARS-CoV-2 , Insuficiência Cardíaca/complicações , Hospitalização , Sistema de RegistrosRESUMO
BACKGROUND: Maintaining sustained adherence to medication for optimal management of chronic noninfectious diseases, such as atherosclerotic vascular disease, is a well-documented therapeutic challenge. OBJECTIVE: The DIAPAsOn study was a 6-month, multicenter prospective observational study in the Russian Federation that examined adherence to a preparation of highly purified omega-3 polyunsaturated fatty acids (Omacor) in 2167 adult patients with a history of recent myocardial infarction or endogenous hypertriglyceridemia. METHODS: A feature of DIAPAsOn was the use of a bespoke electronic patient engagement and data collection system to monitor adherence. Adherence was also monitored by enquiry at clinic visits. A full description of the study's aims and methods has appeared in JMIR Research Protocols. RESULTS: The net average reduction from baseline in both total and low-density lipoprotein cholesterol was approximately 1 mmol/L and the net average increase in high-density lipoprotein cholesterol was 0.2 (SD 0.53) mmol/L (P<.001 for all outcomes vs baseline). The mean triglyceride level was 3.0 (SD 1.3) mmol/L at visit 1, 2.0 (SD 0.9) mmol/L at visit 2, and 1.7 (SD 0.7) mmol/L at visit 3 (P<.001 for later visits vs visit 1). The percentage of patients with a triglyceride level <1.7 mmol/L rose from 13.1% (282/2151) at baseline to 54% (1028/1905) at the end of the study. Digital reporting of adherence was registered by 8.3% (180/2167) of patients; average scores indicted poor adherence. However, a clinic-based enquiry suggested high levels of adherence. Data on health-related quality of life accrued from digitally engaged patients identified improvements among patients reporting high adherence to study treatment, but patient numbers were small. CONCLUSIONS: The lipid and lipoprotein findings indicate that Omacor had nominally favorable effects on the blood lipid profile. Less than 10% of patients enrolled in DIAPAsOn used the bespoke digital platform piloted in the study, and the level of self-reported adherence to medication by these patients was also low. Reasons for this low uptake and adherence are unclear. Better adherence was recorded in clinical reports. TRIAL REGISTRATION: ClinicalTrials.gov NCT03415152; https://clinicaltrials.gov/ct2/show/NCT03415152.
RESUMO
BACKGROUND: Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic, noncommunicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that many patients with these conditions have poor long-term adherence to their treatments. The population of Russia is affected by poor adherence in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease. OBJECTIVE: The purpose of this study was to examine patient adherence to a prescription-only preparation of highly purified omega-3 polyunsaturated fatty acids (1.2 to 1 eicosapentaenoic acid to docosahexaenoic ratio, 90% purity) in a large sample of patients at risk for cardiovascular diseases using digital technology to monitor patient behavior and as an outreach facility for patient education and engagement. METHODS: We conducted a 6-month prospective observational study (DIAPAsOn) at >100 centers in the Russian Federation. A bespoke electronic data capture and patient engagement system were developed with a well-established Russian technology supplier that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other aspects of the program included raising patients' awareness about their condition via educational materials available in personal patient accounts in the electronic system. RESULTS: From an initial cohort of 3000 patients, a safety population of 2572 patients (age: mean 60 years) with an equal proportion of men and women has been characterized. There was widespread concomitant cardiovascular pathology and commensurate use of multiple classes of cardiovascular medication, notably lipid-modifying and antihypertensive drugs. The program was completed by 1975 patients, of whom 780 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for secondary prevention after myocardial infarction and 1195 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for hypertriglyceridemia. Data collection and analysis have been completed. CONCLUSIONS: DIAPAsOn will provide insights into patient adherence with prescription-grade omega-3 polyunsaturated fatty acid therapy and perspectives on the role of mobile technology in monitoring and encouraging adherence to therapy.