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2.
Revista Chilena de Infectologia ; 38(4):506-511, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1471049

ABSTRACT

BACKGROUND: The knowledge of the clinical and evolutionary characteristics of children with SARS-CoV-2 is continuously updated. The true impact of the disease in the pediatric population is still unknown. AIM: To describe the clinical characteristics, the use of resources and the evolution of children with COVID-19 in the Garrahan Pediatric Hospital, Buenos Aires, Argentina, in the first 20 weeks from the identification of the first case. METHODS: Descriptive, analytical, retrospective study. The epidemiological, clinical, evolutionary characteristics and the use of hospital resources of patients < 18 years with confirmed COVID-19 are described. In addition, these characteristics were compared according to whether they occurred in the first 10 epidemiological weeks from the first case of COVID-19 in the hospital or in the following ten weeks. RESULTS: n: 280. The median age was 83 months (IQR 33-144). 209 patients (74.6%) were hospitalized. The median days of hospitalization was 8 days (IQR 3-13). According to the WHO severity classification, there were 184 mild cases (65.7%), 3 moderate (1.1%), 16 severe (5.7%) and 20 critical patients (7.1%). The main reasons for admission to the ICU were not related to SARS-CoV-2 infection. When comparing the characteristics of the patients in the two periods, in the first period there was a higher frequency of underlying comorbidities, immunosuppressive treatment, the consultation was later and the patients had more requirements for ICU admission. Two children (0.7%) died in relation to the infection, both with severe comorbidities and severe bacterial coinfections. CONCLUSION: In this study, patients with underlying disease predominated. The mild form of the disease was the most frequent presentation. At the beginning of the pandemic, there were more patients under immunosuppressive treatment, the consultation was later and the hospitalization was more frequent, prolonged and with more serious clinical pictures.

3.
J Hosp Infect ; 115: 51-58, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1379144

ABSTRACT

BACKGROUND: Occurrence of hepatitis C virus (HCV) infection is reduced by effective risk management procedures, but patient-to-patient transmission continues to be reported in healthcare settings. AIM: To report the use of phylogenetic analysis in the clinical risk management of an HCV outbreak among 128 thalassaemia outpatients followed at a thalassaemia centre of an Italian hospital. METHODS: Epidemiological investigation and root-cause analysis were performed. All patients with acute hepatitis and known chronic infection were tested for HCV RNA, HCV genotyping, and NS3, NS5A, and NS5B HCV genomic region sequencing. To identify transmission clusters, phylogenetic trees were built for each gene employing Bayesian methods. FINDINGS: All patients with acute hepatitis were infected with HCV genotype 1b. Root-cause analysis, including a lookback procedure, excluded blood donors as the source of HCV transmission. The phylogenetic analysis, conducted on seven patients with acute infection and eight patients with chronic infection, highlighted four transmission clusters including at least one patient with chronic and one patient with acute HCV infection. All patients in the same cluster received a blood transfusion during the same day. Two patients with acute hepatitis spontaneously cleared HCV within four weeks and nine patients received ledipasvir plus sofosbuvir for six weeks, all achieving a sustained virological response. CONCLUSION: Combined use of root-cause analysis and molecular epidemiology was effective in ascertaining the origin of the HCV outbreak. Antiviral therapy avoided the chronic progression of the infection and further spread in care units and in the family environment.


Subject(s)
Hepatitis C , Thalassemia , Antiviral Agents/therapeutic use , Bayes Theorem , Disease Outbreaks , Genotype , Hepacivirus/genetics , Hepatitis C/epidemiology , Humans , Italy/epidemiology , Phylogeny , Risk Management , Thalassemia/complications , Thalassemia/epidemiology , Thalassemia/therapy
4.
Critical Care Medicine ; 49(1):35-35, 2021.
Article in English | Web of Science | ID: covidwho-1326449
5.
Critical Care Medicine ; 49(1 SUPPL 1):35, 2021.
Article in English | EMBASE | ID: covidwho-1193789

ABSTRACT

INTRODUCTION: Global cases of COVID-19 continue to increase despite mitigation and containment efforts. As a large proportion of COVID-19 patients require hospitalization and treatment in an intensive care unit (ICU), understanding the impact on ICU clinicians remains an essential component of meeting current and projected needs during pandemic care. In order to capture the ongoing impact on COVID-19 patient care on ICU resources and clinicians, the Society of Critical Care Medicine (SCCM), an international organization of healthcare professionals including physicians, nurses, pharmacists, respiratory therapists, and others deployed a series of rapid cycle surveys. METHODS: A descriptive cross-sectional survey methodology was used. Three national web-based anonymous surveys launched beginning March 18, 2020. The brief (12 question) rapid cycle (open for 2 weeks) descriptive surveys assessed ICU clinician's perceptions of the impact of the ongoing COVID-19 pandemic on ICU care and demographic information related to respondent profession, geographic location, and if they had cared for a suspected or confirmed COVID-19 patient. SurveyMonkey® was used to distribute the surveys via email and newsletter blasts. RESULTS: Collectively, over 14,000 multi-professional ICU clinicians practicing in all 50 United States (U.S.) responded, including ICU physicians (n=876, 7.1%), nurses (n=10,201, 83%), advanced practice providers [nurse practitioners and physician assistants] (n=668, 5.5%), respiratory therapists (n=267, 2.2%), and pharmacists (n=109, 0.9%). Majority (n=8762;62.6%) reported having cared for a patient with presumed or confirmed COVID-19. ICU clinicians report that the most challenging aspects of COVID-19 are related to caring for critically ill patients, minimizing staff exposure to SARS-CoV-2 during the course of direct care, and communication with patient's family members while visitation is restricted, among others. CONCLUSIONS: As the ICU workforce represents the foundation for caring for critically ill COVID-19 patients, monitoring the impact of sustained stress on the critical care workforce warrants surveillance and the elaboration of mitigation strategies in order to ensure critical care clinician health, and the ability to continue to serve at the frontlines of COVID-19 patient care.

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