ABSTRACT
Background: To investigate the etiology and clinical characteristics of community-acquired pneumonia (CAP) among children requiring bronchoalveolar lavage (BAL) and analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on the pathogen spectrum and clinical manifestations. Methods: Children <14 years old hospitalized with CAP requiring BLA were enrolled between February 2019 to January 2020 and August 2021 to July 2022. Multiplex reverse transcription polymerase chain reaction (mRT-PCR) was used for pathogen detection. The demographic and clinical characteristics were compared between different pathogen-type infection groups, and before and during the COVID-19 pandemic. Results: Pathogen was detected in 91.66% (1363/1487) children. Mycoplasma pneumoniae, adenovirus and human rhinovirus were the most frequently detected pathogens. The frequency of detection of virus infections and co-infections was decreased during the pandemic, but the detection of atypical bacterial infections was increased. The clinical manifestations and the results of CT scans and fiberoptic bronchoscopy showed a significant difference between different types of pathogen infection, and lung inflammation was reduced during the COVID-19 pandemic compared with before the pandemic. Conclusions: M. pneumoniae infection might be the greatest pediatric disease burden leading to CAP in northern China. Wearing masks and social distancing in public places during the COVID-19 pandemic effectively reduced the transmission of respiratory viruses, but it did not reduce the infection rate of M. pneumoniae. In addition, these interventions significantly reduced lung inflammation in children compared with before the pandemic.
Subject(s)
Coinfection , Pneumonia, Mycoplasma , Pneumonia , Tumor Virus Infections , Bacterial Infections , COVID-19ABSTRACT
Background: Previous study have shown that seizures may occur as a result of vaccination. This study aimed to evaluate the risk and correlative factors of seizures in patients with epilepsy (PWE) after being vaccinated with COVID-19 and to provide reference opinions for PWE to receive COVID-19 vaccine. Methods: : We retrospectively enrolled PWE patients who were vaccinated against COVID-19 in the epilepsy centers of nine hospitals in China. The binary logistic regression analysis included variables with a P-value less than 0.1 in the univariate analysis. Results: : The study included 290 patients, of which 40 (13.8%) developed seizures within 14 days after vaccination, whereas 250 (86.2%) remained seizure-free. The binary logistic regression analysis revealed statistical significance in seizures within three months before vaccination (P<0.001, OR=10.121, 95% CI: 4.301-23.816) and withdrawal or reduction of anti-seizures medications (ASM) during the peri-vaccination period (P=0.027, OR=4.452, 95% CI: 1.182-16.768). In addition, 32 of 33 patients (97.0%) who were seizure-free within three months before vaccination and had normal EEG results before vaccination did not have any seizures within 14 days following vaccination. Conclusions: SARS-CoV-2 may induce epilepsy through an inflammatory cascade. It is recommended to provide the COVID-19 vaccine to seizure-free patients for at least three months before vaccination, and the vaccination is safer if EEG result is normal. During peri-vaccination period, all PWE should be prohibited from reducing ASM dosage. PWE with well-controlled seizures who have discontinued ASM might consider resuming ASM during the peri-vaccination period if their EEG results are aberrant.
Subject(s)
COVID-19ABSTRACT
BACKGROUND: The popularity of video consultations in healthcare has accelerated during the Coronavirus-19 pandemic. More and more physicians began offering video consultations at their clinics, and the market of commercial telemedicine platforms proliferated. Despite increased availability and obvious benefits, such as convenience, many patients remain hesitant about using video consultations.OBJECTIVE: This thesis aims to evaluate the relative importance of the consultation mode in a patient’s appointment choice and provide insights to practitioners and policymakers to promote video consultation uptake. This study further investigates individual characteristics that may affect preferences for video over in-clinic consultations.METHODS: An online self-administered discrete choice experiment (DCE) was conducted with adults living in Germany through a crowdsourcing provider in November 2020. Based on interviews with patients and healthcare experts, consultation mode, the waiting time until the next available appointment, the waiting time on appointment day, opening hours, and continuity of care were included as attributes. Mixed logit models were used to analyze the choice data. Predictive analyses based on individual choice probabilities were performed to determine the impact of univariate and multivariate attribute level changes on the choice probability of a video compared to a typical in-clinic consultation and opt-out.RESULTS: A total of 459 participants started the survey, of which 350 (76.3%) complete and valid responses were included. The sample was representative of the German adult population in gender and age. Among the included participants, 79 (22.6%) had experience with telemedicine. Participants largely preferred in-clinic over video consultations (β=-1.429, PCONCLUSION: This study provides insights on the effect of consultation mode on appointment choice in a time when telemedicine gains momentum. The results of this DCE suggest that policymakers and providers of video consultations should focus on increasing the level of continuity of care and decreasing the waiting time until the next available appointment to prompt the adoption of video consultations. Although participants preferred in-clinic over video as a consultation mode per se, the demand for video consultations can be increased significantly by improving the attributes of video consultations.