ABSTRACT
BACKGROUND AND OBJECTIVE: SARS-CoV-2 is more easily spread by close contact, which is inherent to sexual intercourse. People with, or at risk for, sexually transmitted infections (STIs) may therefore have higher rates of COVID-19. The aim of this study was to estimate SARS-CoV-2 antibody seroprevalence in people seen at a dedicated STI clinic, compare our findings to the estimated seroprevalence in the local general population, and study factors associated with SARS-CoV-2 infection in this setting. MATERIAL AND METHODS: Cross-sectional observational study including consecutive patients older than 18 years of age who had not yet been vaccinated against COVID-19 and who underwent examination or screening at a dedicated municipal STI clinic in March and April 2021. We ordered rapid SARS-CoV-2 serology and collected information on demographic, social, and sexual variables, STI diagnoses, and history of symptoms compatible with SARS-CoV-2 infection. RESULTS: We studied 512 patients (37% women). Fourteen (24.2%) had a positive SARS-CoV-2 test. Variables associated with positivity were use of FFP2 masks (odds ratio 0.50) and a higher-than-average number of sexual partners (odds ratio 1.80). Use of FFP2 masks was not randomly distributed in this sample. CONCLUSIONS: Sexually active members of the population in this study had a higher incidence of SARS-CoV-2 infection than the general population. The main route of infection in this group appears to be respiratory, linked to close contact during sexual encounters; sexual transmission of the virus is probably limited.
Subject(s)
COVID-19 , Sexual Health , Sexually Transmitted Diseases , Humans , Female , Male , COVID-19/epidemiology , SARS-CoV-2 , Incidence , Cross-Sectional Studies , Seroepidemiologic Studies , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & controlABSTRACT
BACKGROUND AND OBJECTIVE: SARS-CoV-2 is more easily spread by close contact, which is inherent to sexual intercourse. People with, or at risk for, sexually transmitted infections (STIs) may therefore have higher rates of COVID-19. The aim of this study was to estimate SARS-CoV-2 antibody seroprevalence in people seen at a dedicated STI clinic, compare our findings to the estimated seroprevalence in the local general population, and study factors associated with SARS-CoV-2 infection in this setting. MATERIAL AND METHODS: Cross-sectional observational study including consecutive patients older than 18 years of age who had not yet been vaccinated against COVID-19 and who underwent examination or screening at a dedicated municipal STI clinic in March and April 2021. We ordered rapid SARS-CoV-2 serology and collected information on demographic, social, and sexual variables, STI diagnoses, and history of symptoms compatible with SARS-CoV-2 infection. RESULTS: We studied 512 patients (37% women). Fourteen (24.2%) had a positive SARS-CoV-2 test. Variables associated with positivity were use of FFP2 masks (odds ratio 0.50) and a higher-than-average number of sexual partners (odds ratio 1.80). Use of FFP2 masks was not randomly distributed in this sample. CONCLUSIONS: Sexually active members of the population in this study had a higher incidence of SARS-CoV-2 infection than the general population. The main route of infection in this group appears to be respiratory, linked to close contact during sexual encounters; sexual transmission of the virus is probably limited.
Subject(s)
COVID-19 , Sexual Health , Sexually Transmitted Diseases , Humans , Female , Male , COVID-19/epidemiology , SARS-CoV-2 , Incidence , Cross-Sectional Studies , Seroepidemiologic Studies , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & controlABSTRACT
OBJECTIVE: To compare the effects of intensive vs standard blood pressure (BP) targets on the mortality of hypertensive patients with chronic renal disease. DESIGN AND METHOD: A bibliographic search of all relevant databases was carried out without restriction by language, year of publication or publication status.We considered randomized controlled clinical trials on patients older than 18 years, diagnosed with hypertension and chronic renal disease who were allocated to either "intensive'' BP target (less than or equal to 130/80 mmHg) or "standard'' BP target (less than or equal to 140-160/90-100 mmHg). Additionally, trials should include more than 50 participants per group followed during at least one year. Trials were not limited by any concomitant disease or baseline cardiovascular risk.We contacted trials' authors to obtain Individual Patient Data and, if necessary, extracted information from chronic renal patients.COVIDENCE software was used for screening, the Cochrane Review Manager (RevMan web) for data synthesis and analysis, and the Cochrane Risk of Bias Tool (ROB2) to assess the risk of bias for each trial. RESULTS: A total of 2298 records were identified by the bibliographic search. We obtained the full text of 29 publications from the pre-selected studies. Of these, six studies met the inclusion criteria and we obtained Individual Patient Data for all of them (AASK, SPRINT, HOT, ACCORD BP, MDRD, SPS3).There was no statistically significant difference in total mortality between the intensive and standard blood pressure target groups (RR 0.92, 95%CI 0.75-1.13, p = 0.42, 6 studies, 7,348 participants). In absolute terms, there were 5 additional deaths per 1000 participants in the standard target group (95% CI: 6 fewer to 16 more deaths per 1000 participants). Overall deaths were 227/3352 (6.8%) in the intensive target group vs 285/3996 (7.9%) in the standard target group (Figure).The quality of evidence was moderate according to the GRADE assessment. CONCLUSIONS: Intensive blood pressure lowering targets in patients with arterial hypertension and chronic renal disease do not result in lower mortality compared to standard blood pressure lowering. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
ABSTRACT
OBJECTIVE: Primary Care (PC) must attend and follow COVID-19 patients with mild and moderate symptoms, and identify severe cases. The aim of this study was to describe the characteristics of patients attended in PC with suspicious COVID-19 and health care provision by PC. METHODS: Retrospective longitudinal observational study of electronic health records (EHR) and agendas. Probabilistic sampling of suspicious COVID-19 patients' pathway in 5 health centers in Madrid between March 16 and 20, 2020. The variables used were sociodemographic, symptoms, examination, radiography, characteristics of schedules and professional sick leaves. Descriptive analysis and time to event (pneumonia). RESULTS: 240 EHR were reviewed. Average age 48 years, 60% women. Most frequent symptoms: cough (80%) and elevation of temperature (63%). Pneumonia appeared in 23%. 73% were bilateral. Age and male gender were related to pneumonia. 20% required admission. 7 patients died (2.9%). 19,027 COVID-19 appointments were scheduled in PC. 60% of patients were attended in PC without performing chest X-ray or assistance by other care level. 22.4% of GPs working days were absent because of sick leaves. Differences were found amongst facilities in chest X-ray requesting (max. 62%, min. 2%). The PC center with the fewest X-rays requested was the one with the major number of sick leaves. CONCLUSIONS: Age and male gender were related to pneumonia onset in PC. Health care activity was intense, and variability was found amongst facilities. Professional sick leaves could affect the quality of care.
ABSTRACT
BACKGROUND: Possible cases of SARS-CoV-2 infection were diagnosed in primary care in Madrid, some of these cases had pneumonia. Most of the SARS-CoV-2 pneumonia published data came from hospitalised patients. This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia diagnosed in primary care across age groups and type of pneumonia. METHODS: Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April. EXPOSURE: Diagnosis of SARS-CoV-2 pneumonia by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia, physical examination and diagnostic tests as a blood test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results. RESULTS: The overall SARS-CoV-2 pneumonias collected were 172 (female 87 [50.6%], mean age 60.5 years standard deviation [SD] 17.0). Comorbidities were body mass index >= 25 kg/m<sup>2</sup> (90 [52.3%]), hypertension (83 [48.3%]), dyslipidaemia (68 [39.5%]) and diabetes (33 [19.2%]). The sample was stratified by age groups (< 50 years, 50-75 years and >= 75 years). Clinical manifestations at onset were fever (144 [83.7%]), cough (140 [81.4%]), dyspnoea (103 [59.9%]) and gastrointestinal disturbances (72 [41.9%]). Day 7.8 (SD:4.1) from clinical onset was the mean day of pneumonia diagnosis. Bilateral pneumonia was more prevalent than unilateral (126 [73.3%] and 46 [26.7%]). Patients with unilateral pneumonia were prone to higher pulse oximetry (96% vs 94%, p < 0.001). We found differences between unilateral and bilateral cases in C-reactive protein (29.6 vs 81.5 mg/L, p < 0.001), and lymphocytes (1400.0 vs 1000.0E3/ml, p < 0.001). Complications were registered: 42 (100%) of patients >= 75 years were admitted into hospital;pulmonary embolism was only present at bilateral pneumonia (7 patients [5.6%]) and death occurred in 1 patient with unilateral pneumonia (2.2%) vs 10 patients (7.9%) with bilateral pneumonia ( p 0.170). CONCLUSION: Clinical manifestations of SARS-CoV-2 pneumonia were fever, cough and dyspnoea;this was especially clear in the elderly. We described different characteristics between unilateral and bilateral pneumonia.