ABSTRACT
BACKGROUND AND AIM: COVID-19 affects children less seriously than adults;however, severe cases and deaths are documented. This study objective is to determine sociodemographic, clinical and laboratory indicators associated with severe pediatric COVID-19 and mortality at hospital entrance. METHOD(S): A multicenter, retrospective, cross-sectional study was performed in 13 tertiary hospitals in Bolivia. Clinical records were collected retrospectively from patients less than 18 years of age and positive for SARS-CoV-2 infection. All variables were measured at hospital entrance;outcomes of interest were ICU admission and death. A score for disease severity was developed using a logistic regression model. RESULT(S): 209 patients were included in the analysis. By the end of the study, 43 (20.6%) of children were admitted to the Intensive care unit (ICU), and 17 (8.1%) died. Five indicators were independently predictive of COVID-19 severity: age below 10 years OR: 3.3 (CI95%: 1.1 - 10.4), days with symptoms to medical care OR: 2.8 (CI95%: 1.2 - 6.5), breathing difficulty OR: 3.4 (CI95%: 1.4 - 8.2), vomiting OR: 3.3 (CI95%: 1.4 - 7.4), cutaneous lesions OR: 5.6 (CI95%: 1.9 - 16.6). Presence of three or more of these risk factors at hospital entrance predicted severe disease in COVID-19 positive children. Age, presence of underlying illness, male sex, breathing difficulty, and dehydration were predictive of death in COVID-19 children. CONCLUSION(S): Our study identifies several predictors of severe pediatric COVID-19 and death. Incorporating these predictors, we developed a tool that clinicians can use to identify children at high risk of severe COVID-19 in limited resource settings.
ABSTRACT
Background: The COVID-19 pandemic remains a large contributor to the global burden of disease. SARS-CoV-2 RNAemia detection has been connected to higher mortality, but consistent data of solid organ transplant (SOT) recipients have not been analyzed. Aim: To determine and quantify RNAemia at hospital admission and its impact on robust unfavorable clinical outcomes. Methods: From January 6, 2020 to August 13, 2021, we followed a multicenter cohort of 408 immunocompetent and 47 SOT patients hospitalized with COVID-19. Outcome variables were 30-day allcause mortality and invasive mechanical ventilation. Multivariate Cox regression analyses were performed and a propensity score (PS) was calculated. Results: SARS-CoV-2 RNAemia was demonstrated in 104 (22.9%) patients. Those with RNAemia were more frequently transplanted and presented a higher proportion of severe symptoms and signs. Mortality was 29.8% (31/104) and 3.4% (12/351) in RNAemic and non-RNAemic patients (p <0.001). The multivariate analysis adjusted by PS selected CURB-65≥2 (HR, 3.61;95% CI, 1.18-11.01;p = 0.02) and RNAemia (HR, 7.46;95% CI, 2.41-25.38;p = 0.001) as independent predictors of death. In the PS matching, SOT patients showed higher prevalence of RNAemia (57.6% vs. 13.6%) and mortality (HR, 4.56;95% CI, 1.47-7.13;p = 0.01). Conclusions: Positive RNAemia is an independent predictor of unfavorable outcome in immunocompetent and SOT. High viral load was linked to worse prognosis in a univariate analysis. Our findings help elucidate the pathogenesis of SARS-CoV-2 and provide insights for the better management of patients.
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Introduction: The COVID-19 pandemic substantially modified the normal functioning of health systems in the world, promoting, among other problems, delays in the care of patients with acute diseases such as stroke. We analyze the particularities of our population with acute stroke before and during the pandemic. Materials and methods: Prospective cohort of adult patients admitted to the British Hospital of Buenos Aires for ischemic stroke between March 20, 2020 and March 20, 2021 and compared with patients admitted in the same time interval during the previous year. Results: One hundred and twenty-one patients were included;the 51.2% (n = 62) were male and the average age was 70.4 years (SD 19.9). COVID nasopharyngeal swab was performed in 104 (85.6%) patients, resulting positive in 11 of them (9.1%);in 4 patients, stroke was the first manifestation of the COVID infection. Stroke of undetermined cause was more frequent during the pandemic (P <.05), there was a 21% decrease in the total number of consultations for ischemic stroke and a 4-h delay (IQR 0-2.5) in the window period during pandemic. Conclusion: The pandemic has a negative impact on the evaluation of stroke patients. Future changes in outpatient and inpatient care and patient information must continue to avoid delays in care, even as all eyes are focused on patients infected with COVID 19.
ABSTRACT
The aim of this present research was to test whether the discourse of groups opposed to the acceptance of COVID-19 preventive measures could be framed within conspiracy theories and to analyse their arguments. This study was conducted using quantitative methodology by applying the technique of content analysis to the messages sent within the denialist collective Docentes por la Verdad Telegram mesanging application group. The data collection timeframe was from December 2020 (when vaccination against COVID-19 started) to May 2021 (when the vaccination schedule for the majority of teachers ended). Systematic sampling with the function K = N/n was used to select sufficient days within this aforementioned date range to comply with a 95% confidence level and error of 5%, resulting in a sample of 124 from a total of 182 days. The pre-coding of the analysis was based on Brotherton's (2013) characterisation of conspiracy theories and the denialist arguments detected by the Comision Central de Deontologia de la Organizacion Medica Colegial (Central Commission of Deontology of the Spanish Medical Association;2020). The results showed that these collectives can be considered conspiracy groups and reaffirmed the arguments of other research groups while also adding some new lines of enquiry.