RESUMO
Background: Since the beginning of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, pneumomediastinum has been reported in patients with COVID-19 pneumonia and acute respiratory distress syndrome. It has been suggested that pneumomediastinum may portend a worse outcome in such patients although no investigation has established this association definitively. Research Question: We hypothesized that the finding of pneumomediastinum in the setting of COVID-19 disease may be associated with a worse clinical outcome. The purpose of this study was to determine if the presence of pneumomediastinum was predictive of increased mortality in patients with COVID-19. Study Design and Methods: A retrospective case-control study utilizing clinical data and imaging for COVID-19 patients seen at our institution from 3/7/2020 to 5/20/2020 was performed. 87 COVID-19 positive patients with pneumomediastinum were compared to 87 COVID-19 positive patients without pneumomediastinum and to a historical group of patients with pneumomediastinum during the same time frame in 2019. Results: The incidence of pneumomediastinum was increased more than 6-fold during the COVID-19 pandemic compared to 2019 (P = <.001). 1.5% of all COVID-19 patients and 11% of mechanically ventilated COVID-19 patients at our institution developed pneumomediastinum. Patients who developed pneumomediastinum had a significantly higher PEEP and lower P/F ratio than those who did not (P = .002 and .033, respectively). Pneumomediastinum was not found to be associated with increased mortality (P = .16, confidence interval [CI]: 0.89-2.09, 1.37). The presence of concurrent pneumothorax at the time of pneumomediastinum diagnosis was associated with increased mortality (P = .013 CI: 1.15-3.17, 1.91). Conclusion: Pneumomediastinum is not independently associated with a worse clinical prognosis in COVID-19 positive patients. The presence of concurrent pneumothorax was associated with increased mortality.
Assuntos
COVID-19 , Enfisema Mediastínico , Estudos de Casos e Controles , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/epidemiologia , Enfisema Mediastínico/etiologia , Pandemias , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2RESUMO
Background The coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges worldwide, particularly in developing countries with limited healthcare resources. Among the various demographics, adolescents represent a crucial group in understanding and curbing the spread of the virus. Aim This research aims to assess the level of knowledge and practice of COVID-19 prevention measures among adolescents in a developing country. Methodology This study's descriptive cross-sectional study design was appropriate for capturing a snapshot of adolescents' understanding of COVID-19 in Umuahia, Abia State, Nigeria, a developing country. The study's participants were secondary school students in Umuahia's urban and rural secondary schools, aged 10-19. Fisher's formula was used to calculate the sample size. A multistage systematic sampling method was used to select 424 participants. Data were gathered using a self-administered questionnaire. The Statistical Package for the Social Sciences (SPSS) software version 25 (IBM SPSS Statistics, Armonk, NY) was used to handle and evaluate the data that had been obtained. Results All the respondents were aware of COVID-19, primarily informed through social media and television (TV). It is concerning that less than half correctly identify the disease as caused by a virus (46.9%), with some falsely attributing it to bacteria (31.1%) or fungi (15.6%). While the majority of respondents knew about the existence of COVID-19 vaccines, only 63.4% were aware that there was no definitive cure for the disease. The most worrying finding was the limited awareness and practice of recommended precautions to prevent the spread of COVID-19. Handwashing with soap and water, social distancing, and using hand sanitizers were the most frequently recognized precautions. However, even these were poorly practiced, with less than 30% of the respondents following them regularly. It was also noted that misconceptions about precautions exist, including unusual practices such as regularly drinking hot water or eating bitter kola/pepperfruit. Also, the most prominent reason for refusal among the respondents for COVID-19 vaccines was parental refusal, accounting for 57.5% of negative responses. Conclusion The study's findings underscore the urgent need for tailored, accessible, and effective health education strategies to improve adolescents' understanding and adoption of COVID-19 preventive measures in the region.
Assuntos
Asma/epidemiologia , Toxocara/imunologia , Toxocaríase/epidemiologia , Adolescente , Adulto , Idoso , Animais , Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos/imunologia , Asma/imunologia , Testes Respiratórios , Criança , Expiração , Feminino , Humanos , Imunoglobulina G/sangue , Lectinas Tipo C/imunologia , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Pobreza , Prevalência , Sistema Respiratório/imunologia , Toxocaríase/imunologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Endotracheal intubation poses high risk of transmission of severe acute respiratory syndrome coronavirus 2 and other respiratory pathogens. We designed and here describe a protective drape that we believe will greatly reduce this risk. Unlike the intubation box that has been described prior, it is portable, disposable, and does not restrict operator dexterity. We have used it extensively and successfully during the height of the corona virus disease of 2019 outbreak.
Assuntos
COVID-19/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Intubação Intratraqueal/instrumentação , Exposição Ocupacional/prevenção & controle , Campos Cirúrgicos , COVID-19/prevenção & controle , Humanos , Intubação Intratraqueal/efeitos adversos , SARS-CoV-2RESUMO
PURPOSE: Sex, race/ethnicity, and geographic disparities in sarcoidosis-associated mortality were assessed for the most recent period. METHODS: US data for multiple causes of death for 1999-2016 were used to determine numbers of deaths and age-adjusted rates for sarcoidosis as an underlying or a contributing cause of death using International Classification of Diseases, 10th Revision code D86 for Hispanics, non-Hispanic blacks, and non-Hispanic whites. RESULTS: For persons of all ages in the United States in 1999-2016, there were a total of 28,923 sarcoidosis-associated deaths. In 2008-2016, 9112 deaths had sarcoidosis as the underlying cause (56%) compared with 16,129 with sarcoidosis listed as any cause. Age-adjusted annual death rates per 100,000 were 5.7 (95% confidence interval [CI], 5.6-5.8) for females and 4.1 (95% CI, 4.0-4.2) for males. Age-adjusted annual death rates were 1.5 (95% CI, 1.4-1.6) for Hispanics and 5.4 (95% CI, 5.3-5.4) for non-Hispanics. Rates in non-Hispanic blacks were 8 times those in non-Hispanic whites. Among females, the highest rate was in non-Hispanic blacks in the East-Central division. Between 1999-2007 and 2008-2016, rates increased most in non-Hispanic white males (52.5%) and least in non-Hispanic black females (5.8%). CONCLUSIONS: Sarcoidosis-related multiple cause of death mortality rates were highest in females and in non-Hispanic blacks, and they varied geographically.
Assuntos
Sarcoidose/mortalidade , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , National Center for Health Statistics, U.S. , Grupos Raciais/estatística & dados numéricos , Distribuição por Sexo , Estados Unidos/epidemiologia , UrbanizaçãoRESUMO
PURPOSE: To assess gender, race/ethnicity, and geographic disparities in sepsis-associated mortality. MATERIALS AND METHODS: The US data for multiple causes of death (MCOD) for years 2013-2016 were used to determine numbers of deaths and age-adjusted rates for sepsis as underlying or contributing cause of death using the International Classification of Diseases-10 (ICD-10) codes for non-Hispanic blacks (NHB) and whites (NHW) aged 15 years and older. RESULTS: There were a total of 746,725 sepsis-associated deaths. Among females, age-adjusted death rate for NHB was 88.6 (95% CI 87.8-89.3) and for NHW, 55.4 (95% CI 55.1-55.6). Among males, age-adjusted death rate for NHB was 115.2 (95% CI 114.1-116.3) and for NHW, 69.5 (95% CI 69.2-69.8). Rates were generally higher in divisions of the south region (West South Central in NHB). Within the South, NHW and NHB who resided in non-metropolitan areas had the highest rates, while the lowest were in suburban metropolitan areas. CONCLUSIONS: Sepsis-related MCOD mortality rates were highest in males, in NHB, in the South region, and, within the South, non-metropolitan areas.
Assuntos
Disparidades nos Níveis de Saúde , Grupos Raciais/estatística & dados numéricos , Sepse/mortalidade , Urbanização , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Multidrug-resistant tuberculosis (MDR-TB) occurs when strains of Mycobacterium are resistant to the first-line anti-tuberculosis regimen. We present the case of a 22-year-old immigrant female of African descent who presented to her primary care physician complaining of a two-month history of an enlarging neck mass. Aspiration of the mass, analysis, and culture revealed colonization with a strain of Mycobacterium that was resistant to first-line anti-tuberculosis medications. She was subsequently placed on second line anti-tuberculosis medications.
RESUMO
OBJECTIVE: To test the hypothesis that cognitive impairment increases mortality independent of airflow obstruction. MATERIALS AND METHODS: In 1988-1994 the Third National Health and Nutrition Examination Survey (NHANES III) measured forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) and selected items on cognitive function with mortality follow-up. For this survival analysis 4365 persons aged 60 and over with complete data formed the analytic sample. RESULTS: The FEV1/FVC less than the lower limit of predicted ratio (LLP) defined airflow obstruction and Composite Cognitive Function Score (CCF) ≤4, cognitive impairment. The percentage who died during follow up was 67% among those with neither FEV1/FVC < LLP nor CCF ≤4, 82% with FEV1/FVC < LLP only, 85% with CCF score ≤4 only and 93% with both FEV1/FVC LLP and CCF score ≤4 (P < .001). Weighted Cox proportional hazards regression revealed an increased hazard ratio (HR) in persons with FEV1/FVC Assuntos
Obstrução das Vias Respiratórias/mortalidade
, Cognição/fisiologia
, Previsões
, Pulmão/fisiopatologia
, Inquéritos Nutricionais
, Idoso
, Obstrução das Vias Respiratórias/diagnóstico
, Obstrução das Vias Respiratórias/fisiopatologia
, Feminino
, Seguimentos
, Volume Expiratório Forçado/fisiologia
, Humanos
, Pulmão/diagnóstico por imagem
, Masculino
, Pessoa de Meia-Idade
, Estudos Retrospectivos
, Espirometria
, Taxa de Sobrevida/tendências
, Estados Unidos/epidemiologia
, Capacidade Vital
RESUMO
Paracentesis is a safe procedure with severe bleeding occurring in less than 1% of cases. Paracentesis is often times performed as an outpatient procedure. Hemorrhagic complications can be rapidly fatal if not diagnosed and treated in a timely fashion. We present the case of a 55-year-old female with decompensated cirrhosis who developed hemodynamically significant bleeding post paracentesis. This case brings up the question whether certain patients who undergo paracentesis should be admitted for close observation for at least 24 hours after the procedure. It also identifies the need for more research into pre-operative risk factors in cirrhotics that predisposes them to severe bleeding.