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1.
Int J Environ Res Public Health ; 19(14)2022 07 12.
Article in English | MEDLINE | ID: covidwho-2043680

ABSTRACT

BACKGROUND: Pregnancy is a crucial stage in a woman's life and can be affected by epigenetic and environmental factors. Diet also plays a key role in gestation. This study aimed to evaluate how a greater or lesser adherence to the Mediterranean Diet (MD) influences specific parameters of mother and newborn. METHODS: After delivery, the women participating in the study answered a questionnaire: demographic information; anthropometric data (pre-pregnancy weight, height, and gestational weight gain); dietary habits information (adherence to MD before and during pregnancy, using the validated Mediterranean Diet Adherence Screener (MEDAS), quality of protein intake); pregnancy information (onset of complications, cesarean/vaginal delivery, gestational age at birth, birth weight, birth length); and clinical practitioner for personalized dietary patterns during pregnancy. RESULTS: A total of 501 respondents have been included in the study, and 135 were excluded for complications. Women who followed the advice of clinical nutritionists showed better adherence to MD (p = 0.02), and the baby's birth weight was higher (p = 0.02). Significant differences in gestational weight gain (p < 0.01) between groups with dissimilar diet adherence were demonstrated. CONCLUSION: Our data demonstrate a significant relationship between adherence to MD and birthweight.


Subject(s)
Diet, Mediterranean , Gestational Weight Gain , Birth Weight , Cesarean Section , Diet , Female , Humans , Infant, Newborn , Pregnancy
2.
Dig Liver Dis ; 2022 Aug 29.
Article in English | MEDLINE | ID: covidwho-2004022

ABSTRACT

BACKGROUND: Patients on immunosuppressive drugs have been excluded from COVID-19 vaccines trials, creating concerns regarding their efficacy. AIMS: To explore the humoral response to COVID-19 vaccines in patients with inflammatory bowel disease (IBD) METHODS: Effectiveness and Safety of COVID-19 Vaccine in Patients with Inflammatory Bowel Disease (IBD) Treated with Immunomodulatory or Biological Drugs (ESCAPE-IBD) is a prospective, multicentre study promoted by the Italian Group for the study of Inflammatory Bowel Disease. We present data on serological response eight weeks after the second dose of COVID-19 vaccination in IBD patients and healthy controls (HCs). RESULTS: 1076 patients with IBD and 1126 HCs were analyzed. Seropositivity for anti-SARS-CoV-2 IgG was reported for most IBD patients, even if with a lesser rate compared with HCs (92.1% vs. 97.9%; p<0.001). HCs had higher antibody concentrations (median OD 8.72 [IQR 5.2-14-2]) compared to the whole cohort of IBD patients (median OD 1.54 [IQR 0.8-3.6]; p<0.001) and the subgroup of IBD patients (n=280) without any treatment or on aminosalicylates only (median OD 1.72 [IQR 1.0-4.1]; p<0.001). CONCLUSIONS: Although most IBD patients showed seropositivity after COVID-19 vaccines, the magnitude of the humoral response was significantly lower than in HCs. Differently from other studies, these findings seem to be mostly unrelated to the use of immune-modifying treatments (ClinicalTrials.govID:NCT04769258).

4.
Am J Obstet Gynecol MFM ; 4(5): 100654, 2022 09.
Article in English | MEDLINE | ID: covidwho-1814040

ABSTRACT

OBJECTIVE: To systematically identify and critically assess the quality of clinical practice guidelines for the management of SARS-CoV-2 infection in pregnancy. DATA SOURCES: Medline, Scopus, and ISI Web of Science databases were searched until February 15, 2022. STUDY ELIGIBILITY CRITERIA: Inclusion criteria were clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. The risk of bias and quality assessments of the included clinical practice guidelines were performed using the Appraisal of Guidelines for REsearch and Evaluation II tool, which is considered the gold standard for quality assessment of clinical practice guidelines. To define a clinical practice guideline as of good quality, we adopted the cutoff score proposed by Amer et al: if the overall clinical practice guideline score was >60%, it was recommended. METHODS: The following clinical points related to the management of pregnant women with SARS-CoV-2 infection were addressed: criteria for maternal hospitalization, recommendations for follow-up fetal growth scan, specific recommendations against invasive procedures, management of labor, timing of delivery, postpartum care, and vaccination strategy. RESULTS: A total of 28 clinical practice guidelines were included. All recommended hospitalization only for severe disease; 46.1% (6/13) suggested a fetal growth scan after SARS-CoV-2 infection, whereas 23.1% (3/13) did not support this practice. Thromboprophylaxis with low-molecular-weight heparin was recommended in symptomatic women by 77.1% (7/9) of the clinical practice guidelines. None of the guidelines recommended administering corticosteroids only for the presence of SARS-CoV-2 infection in preterm gestation, unless specific obstetrical indication exists. Elective induction of labor from 39 weeks of gestation was suggested by 18.1% (2/11) of the clinical practice guidelines included in the present review, whereas 45.4% (5/11) did not recommend elective induction unless other obstetrical indications coexisted. There were 27% (3/11) of clinical practice guidelines that suggested shortening of the second stage of labor, and active pushing was supported by 18.1% (2/11). There was general agreement among the clinical practice guidelines in not recommending cesarean delivery only for the presence of maternal infection and in recommending vaccine boosters at least 6 months after the primary series of vaccination. The Appraisal of Guidelines for REsearch and Evaluation II standardized domain scores for the first overall assessment of clinical practice guidelines had a mean of 50% (standard deviation±21.82%), and 9 clinical practice guidelines scored >60%. CONCLUSION: A significant heterogeneity was found in some of the main aspects of the management of SARS-CoV-2 infection in pregnancy, as reported by the published clinical practice guidelines.


Subject(s)
COVID-19 , Venous Thromboembolism , Anticoagulants , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , SARS-CoV-2
5.
J Perinat Med ; 50(4): 398-403, 2022 May 25.
Article in English | MEDLINE | ID: covidwho-1649095

ABSTRACT

OBJECTIVES: To explore whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect umbilical vein blood flow (UVBF) and fetal cardiac function. METHODS: Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. Measurements of UVBF normalized for fetal abdominal circumference (UVBF/AC), atrial area (AA) and ventricular sphericity indices (SI) were compared between the two study groups. Chi-square and Mann-Whitney U tests were sued to analyze the data. RESULTS: Fifty-four consecutive pregnancies complicated and 108 not complicated by SARS-CoV-2 infection were included. The median gestational age at infection was 30.2 (interquartile range [IQR] 26.2 34.1). General baseline and pregnancy characteristics were similar between pregnant women with compared to those without SARS-CoV-2 infection. There was no difference in UVBF/AC (study groups z value -0.11 vs. 0.14 control p 0.751) values between pregnancies complicated compared to those not complicated by SARS-CoV-2 infection. Likewise, there was no difference in the left and right AA (left 1.30 vs. 1.28 p=0.221 and right 1.33 vs. 1.31 p=0.324) and SI (left 1.75 vs. 1.77 p=0.208 and right 1.51 vs. 1.54 p=0.121) between the two groups. CONCLUSIONS: SARS-CoV-2 infection does not affect UVBF and fetal cardiac function in uncomplicated pregnancies.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Case-Control Studies , Female , Humans , Pregnancy , Prospective Studies , SARS-CoV-2 , Umbilical Veins
6.
Eur J Obstet Gynecol Reprod Biol ; 268: 144-164, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1561999

ABSTRACT

BACKGROUND: SARS-CoV-2 vaccine has been recommended to pregnant women, but survey studies showed contrasting findings worldwide in relation to the willingness to accept vaccination during pregnancy. OBJECTIVE: To evaluate the evidence from the literature regarding the acceptance rate of the SARS-CoV-2 vaccine in pregnant and breastfeeding women. STUDY DESIGN: We performed a systematic review on the main databases (MEDLINE (PubMed), Scopus, ISI Web of Science) searching for all the peer-reviewed survey studies analyzing the eventual acceptance rate of the SARS-CoV-2 vaccine among pregnant and breastfeeding women. To combine data meta-analyses of proportions and pooled proportions with their 95% confidence intervals (CI) were calculated. RESULTS: 15 studies including 25,839 women were included in the analysis. The proportion of women actually willing to be vaccinated during pregnancy is 49.1% (95% CI, 42.3-56.0), and the proportion of breastfeeding women is 61.6% (95% CI, 50.0-75.0). CONCLUSION: The cumulative SARS-CoV-2 vaccine acceptance rate among pregnant women appears still low. Vaccinal campaign are urgently needed to drive more confidence into the vaccine to help reducing the spread of the infection and the possible consequences during pregnancy.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19 Vaccines , Female , Humans , Pregnancy , Pregnant Women , SARS-CoV-2
7.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-295097

ABSTRACT

The trend of deploying digital systems in numerous industries has induced a hike in recording digital information. The health sector has observed an extensive adoption of digital devices and systems that generate large volumes of personal medical records. Electronic health records contain valuable information for retrospective and prospective analysis that is often not entirely exploited because of the dense information storage. The crude purpose of condensing health records is to select the information that holds most characteristics of the original documents based on reported disease. These summaries may boost diagnosis and extend a doctor's time with the patient during a high workload situation like the COVID-19 pandemic. In this paper, we propose applying a multi-head attention-based mechanism to perform extractive summarization of meaningful phrases in clinical notes. This method finds major sentences for a summary by correlating tokens, segments, and positional embeddings. The model outputs attention scores that are statistically transformed to extract key phrases and can be used to projection on the heat-mapping tool for visual and human use.

8.
Am J Obstet Gynecol MFM ; 3(6): 100468, 2021 11.
Article in English | MEDLINE | ID: covidwho-1525659

ABSTRACT

OBJECTIVE: This study aimed to report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection. DATA SOURCES: MEDLINE, Embase, Google Scholar, and the Web of Science databases were searched up to August 11, 2021. STUDY ELIGIBILITY CRITERIA: Histopathologic anomalies included maternal vascular malperfusion, fetal vascular malperfusion, acute inflammatory pathology, chronic inflammatory pathology, increased perivillous fibrin, and intervillous thrombosis. Moreover, subanalyses of symptomatic women only and high-risk pregnancies were performed. METHODS: Histopathologic analysis of the placenta included gross examination, histopathology on hematoxylin and eosin, immunohistochemistry, fluorescence in situ hybridization, quantitative reverse transcription-polymerase chain reaction on placental tissue, and transmission electron microscope. Random-effect meta-analyses were used to analyze the data. RESULTS: A total of 56 studies (1008 pregnancies) were included. Maternal vascular malperfusion was reported in 30.7% of placentas (95% confidence interval, 20.3-42.1), whereas fetal vascular malperfusion was observed in 27.08 % of cases (95% confidence interval, 19.2-35.6). Acute and chronic inflammatory pathologies were reported in 22.68% (95% confidence interval, 16.9-29.0) and 25.65% (95% confidence interval, 18.4-33.6) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% confidence interval, 24.1-42.0) of placentas undergoing histopathologic analysis, whereas intervillous thrombosis was observed in 14.6% of cases (95% confidence interval, 9.7-20.2). Other placental findings, including a basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated red blood cells, or membranes with hemorrhage, were reported in 37.5% of cases (95% confidence interval, 28.0-47.5), whereas only 17.5% of cases (95% confidence interval, 10.9-25.2) did not present any abnormal histologic findings. The subanalyses according to maternal symptoms owing to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed a similar distribution of the different histopathologic anomalies to that reported in the main analysis. Moreover, the risk of placental histopathologic anomalies was higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls. CONCLUSION: In pregnant women with SARS-CoV-2 infection, a significant proportion of placentas showed histopathologic findings, suggesting placental hypoperfusion and inflammation. Future multicenter prospective blinded studies are needed to correlate these placental lesions with pregnancy outcomes.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Female , Humans , In Situ Hybridization, Fluorescence , Multicenter Studies as Topic , Placenta , Pregnancy , Pregnancy Outcome , Prospective Studies , SARS-CoV-2
10.
J Matern Fetal Neonatal Med ; : 1-4, 2021 Apr 11.
Article in English | MEDLINE | ID: covidwho-1177215

ABSTRACT

OBJECTIVE: The use of Coronavirus 2 (SARS-CoV-2) vaccine in pregnant women is controversial and still not performed in Italy. Our objective was to evaluate the propensity of a population of Italian women to receive the vaccine and its psychological impact. METHODS: A prospective, observational study was performed on pregnant women attending Ospedale Cristo Re Università Roma TorVergata. A multi-section questionnaire was sent to each included woman on the first day of available SARS-CoV-2 vaccination. Part-A was finalized to acquire maternal characteristics and to test the women's perception of vaccinations in pregnancy and their fear-induced by vaccines. Part-B included the State-Trait-Anxiety-Inventory (STAI) a validated test for scoring trait anxiety (basal anxiety, STAI-T) and state anxiety (STAI-S). An abnormal value of STAI was considered when ≥40. Comparisons of maternal variables were performed according to their vaccine attitude. RESULTS: The questionnaire was completed by 161 women (80.5% of the population considered). A positive attitude toward the vaccine was present in 136 (84.5%) women (positive) while the remaining 25.5% considered the vaccine not useful (negative). Among the former group 52.9% were favorable to obtain the vaccine during pregnancy despite the current national limitations, a percentage significantly higher (p = .02) than in the negative groups. Women with a negative attitude to the vaccine had a lower educational (p = .002) and employment level (p = .016) when compared to the positive group. In all the women a significant increase of STAI-S from STAI-T values was evidenced (p < .0001). The incidence of abnormal STAI T values (basal anxiety) was similar between the 2 groups (p = .81), while there was a significant increase of STAI-S values in the negative group (negative 88.0%; vs positive 63.4%; p = .018). CONCLUSIONS: The majority of pregnant women considered have a positive attitude to SARS-CoV-2 vaccine. Vaccine campaign seems to increase the maternal level of anxiety and this increase is more marked with a negative attitude toward the vaccine.

11.
Acta Obstet Gynecol Scand ; 100(6): 1034-1039, 2021 06.
Article in English | MEDLINE | ID: covidwho-1087948

ABSTRACT

INTRODUCTION: Our objective was to compare the fetal growth velocity and fetal hemodynamics in pregnancies complicated and in those not complicated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MATERIAL AND METHODS: Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. The z scores of head circumference, abdominal circumference, femur length, and estimated fetal weight were compared between the two groups. Fetal growth was assessed by analyzing the growth velocity of head circumference, abdominal circumference, femur length, and estimated fetal weight between the second- and third-trimester scans. Similarly, changes in the pulsatility index of uterine, umbilical, and middle cerebral arteries, and their ratios were compared between the two study groups. RESULTS: Forty-nine consecutive pregnancies complicated, and 98 not complicated, by SARS-CoV-2 infection were included. General baseline and pregnancy characteristics were similar between pregnant women with and those without SARS-CoV-2 infection. There was no difference in head circumference, abdominal circumference, femur length, and estimated fetal weight z scores between pregnancies complicated and those not complicated by SARS-CoV-2 infection at both the second- and third-trimester scans. Likewise, there was no difference in the growth velocity of all these body parameters between the two study groups. Finally, there was no difference in the pulsatility index of both maternal and fetal Doppler scans throughout gestation between the two groups. CONCLUSIONS: Pregnancies complicated by SARS-CoV-2 infection are not at higher risk of developing fetal growth restriction through impaired placental function. The findings from this study do not support a policy of increased fetal surveillance in these women.


Subject(s)
COVID-19/complications , Fetal Development , Hemodynamics , Pregnancy Complications, Infectious/virology , Pulsatile Flow , Adult , Biometry , Case-Control Studies , Female , Gestational Age , Humans , Pregnancy , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Prospective Studies , SARS-CoV-2 , Ultrasonography, Doppler
12.
Am J Obstet Gynecol MFM ; 2(2): 100107, 2020 05.
Article in English | MEDLINE | ID: covidwho-1064726

ABSTRACT

Objective: The aim of this systematic review was to report pregnancy and perinatal outcomes of coronavirus spectrum infections, and particularly coronavirus 2019 (COVID-19) disease because of severe acute respiratory syndrome-coronavirus-2 infection during pregnancy. Data Sources: Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for coronavirus or severe acute respiratory syndrome or SARS or Middle East respiratory syndrome or MERS or COVID-19 and pregnancy. The search and selection criteria were restricted to English language. Study Eligibility Criteria: Inclusion criteria were hospitalized pregnant women with a confirmed coronavirus related-illness, defined as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), or COVID-19. Study Appraisal and Synthesis Methods: We used meta-analyses of proportions to combine data and reported pooled proportions, so that a pooled proportion may not coincide with the actual raw proportion in the results. The pregnancy outcomes observed included miscarriage, preterm birth, preeclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score <7 at 5 minutes, neonatal asphyxia, admission to a neonatal intensive care unit, perinatal death, and evidence of vertical transmission. Results: Nineteen studies including 79 hospitalized women were eligible for this systematic review: 41 pregnancies (51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An overt diagnosis of pneumonia was made in 91.8%, and the most common symptoms were fever (82.6%), cough (57.1%), and dyspnea (27.0%). For all coronavirus infections, the pooled proportion of miscarriage was 64.7% (8/12; 95% confidence interval, 37.9-87.3), although reported only for women affected by SARS in two studies with no control group; the pooled proportion of preterm birth <37 weeks was 24.3% (14/56; 95% confidence interval, 12.5-38.6); premature prelabor rupture of membranes occurred in 20.7% (6/34; 95% confidence interval, 9.5-34.9), preeclampsia in 16.2% (2/19; 95% confidence interval, 4.2-34.1), and fetal growth restriction in 11.7% (2/29; 95% confidence interval, 3.2-24.4), although reported only for women affected by SARS; 84% (50/58) were delivered by cesarean; the pooled proportion of perinatal death was 11.1% (5/60; 95% confidence interval, 84.8-19.6), and 57.2% of newborns (3/12; 95% confidence interval, 3.6-99.8) were admitted to the neonatal intensive care unit. When focusing on COVID-19, the most common adverse pregnancy outcome was preterm birth <37 weeks, occurring in 41.1% of cases (14/32; 95% confidence interval, 25.6-57.6), while the pooled proportion of perinatal death was 7.0% (2/41; 95% confidence interval, 1.4-16.3). None of the 41 newborns assessed showed clinical signs of vertical transmission. Conclusion: In hospitalized mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, preterm birth is the most common adverse pregnancy outcome. COVID-19 infection was associated with higher rate (and pooled proportions) of preterm birth, preeclampsia, cesarean, and perinatal death. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy, although they should be interpreted with caution in view of the very small number of included cases.


Subject(s)
Abortion, Spontaneous/epidemiology , COVID-19/epidemiology , Fetal Growth Retardation/epidemiology , Fetal Membranes, Premature Rupture/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy Complications, Infectious/epidemiology , Premature Birth/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Cesarean Section/statistics & numerical data , Coronavirus Infections/epidemiology , Female , Hospitalization , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Intensive Care Units, Neonatal/statistics & numerical data , Middle East Respiratory Syndrome Coronavirus , Perinatal Death , Pregnancy , Pregnancy Outcome/epidemiology , SARS Virus , SARS-CoV-2
13.
Annals of the Russian Academy of Medical Sciences ; 75(4):306-317, 2020.
Article in English | Web of Science | ID: covidwho-940398

ABSTRACT

The spread of a new coronavirus infection worldwide since the end of 2019 has becomes a pandemic. Thrombotic complications are the leading cause of death in this disease. After entering the human body, the virus starts a cascade of reactions leading to the development of a cytokine storm, activation of all parts of the hemostasis and complement systems and other changes that result in disturbances in the circulation system with the development of multiple organ failures. Numerous studies have shown that a predictor of a severe course of COVID-19 is a sharp increase of D-dimer concentration in the blood and rise of some other markers of hemostasis activation. Based on the pathogenesis, the developed schemes for the prevention and treatment of COVID-19 severe complications include low molecular weight heparins (LMWH) which are also recommended for an outpatient COVID-19 patient. The prescription of low molecular weight heparin, the duration of their use and doses should be decided on the basis of a risk assessment of factors for each individual patient in combination with laboratory monitoring. Распространение новой коронавирусной инфекции по всему миру с конца 2019 г. превратилось в пандемию. Тромботические осложнения являются ведущей причиной смерти при этом заболевании. После попадания в организм человека вирус запускает каскад реакций, приводящих к развитию цитокинового «шторма», активации всех звеньев системы гемостаза и комплемента, другим изменениям, приводящим к нарушениям в системе кровообращения с развитием полиорганных нарушений. Многочисленные исследования показали, что предиктором тяжелого течения заболевания является резкое повышение концентрации D-димера в крови и некоторых других маркеров активации гемостаза. Исходя из патогенеза, разработанные схемы профилактики и лечения тяжелых осложнений COVID-19 включают низкомолекулярные гепарины, которые также рекомендуют для применения в амбулаторных условиях. Назначение низкомолекулярных гепаринов, длительность их применения и дозы должны определяться на основе оценки факторов риска для каждого отдельного пациента в сочетании с лабораторным мониторингом.

14.
Annals of the Russian Academy of Medical Sciences ; 75(3):214-225, 2020.
Article in Russian | RSCI | ID: covidwho-890768

ABSTRACT

The article discusses the issues of hemostatic system disorders in patients with COVID-19. Strengthening the coagulopathy characteristic of DIC-syndrome, is a key sign of deterioration and an unfavorable prognosis in COVID-19 patients. Data obtained by Chinese colleagues demonstrates that a significantly increased level of D-dimer is one of the predictors of death. The article also highlights the preliminary recommendations of the International society of Thrombosis and Hemostasis (ISTH, 2020) to identify markers such as D-dimer, prothrombin time and platelet count as significant predictive markers in severe COVID-19 patients. The necessity of anticoagulant therapy in hospitalized patients is justified. The article discusses the features of sepsis in pregnant women. Data from a meta-analysis of 19 studies evaluating pregnancy complications and outcomes in patients with various coronavirus infections are presented. Despite the complicated course of pregnancy, there were no cases of vertical transmission of viral infection. In the pathogenesis of severe COVID-19 complications with the formation of severe acute respiratory distress syndrome, multi-organ dysfunction, super inflammation and cytokine storm play a leading role. In connection with viral sepsis, the article discusses the role of hemophagocytic lymphohistiocytosis as a hyperinflammatory syndrome characterized by fulminant and fatal hypercytokinemia with multiple organ failure, the role of hyperferritinemia in predicting the outcomes of severe sepsis. Groups of patients at high risk of death are discussed, as well as the need for anticoagulant and anti-cytokine therapy in patients with COVID-19. В статье рассматриваются вопросы нарушения системы гемостаза у пациентов с COVID-19. Нарастание коагулопатии, характерной для диссеминированного внутрисосудистого свертывания крови (ДВС-синдрома), - ключевой признак ухудшения состояния и неблагоприятного прогноза у пациентов с COVID-19. Приводятся данные, полученные китайскими коллегами, согласно которым значительно повышенный уровень D-димера является одним из предикторов смерти. Также освещены предварительные рекомендации Международного общества тромбоза и гемостаза (International Society on Thrombosis and Haemostasis, ISTH, 2020) по определению таких маркеров, как D-димер, протромбиновое время и количество тромбоцитов, в качестве значимых прогностических маркеров у тяжелых больных COVID-19. Обосновывается необходимость антикоагулянтной терапии у госпитализированных больных. В статье обсуждаются особенности сепсиса у беременных. Приводятся данные метаанализа 19 исследований, посвященных оценке осложнений и исходов беременности у пациенток с различными коронавирусными инфекциями. Несмотря на осложненное течение беременности, не отмечено ни одного случая вертикальной передачи вирусной инфекции. В патогенезе тяжелых осложнений COVID-19 с формированием тяжелого острого респираторного дистресс-синдрома, полиорганной дисфункции ведущую роль играют супервоспаление и цитокиновый шторм. В статье в связи с вирусным сепсисом обсуждается роль гемофагоцитарного лимфогистиоцитоза как гипервоспалительного синдрома, характеризуемого фульминантной и фатальной гиперцитокинемией с полиорганной недостаточностью, роль гиперферритинемии в прогнозировании исходов тяжелого сепсиса. Обсуждаются группы пациентов высокого риска развития летальных исходов, а также необходимость антикоагулянтной и антицитокиновой терапии у больных COVID-19.

15.
J Perinat Med ; 48(9): 950-958, 2020 11 26.
Article in English | MEDLINE | ID: covidwho-797424

ABSTRACT

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.


Subject(s)
Abortion, Spontaneous/epidemiology , Betacoronavirus , Coronavirus Infections/complications , Fetal Death , Perinatal Death , Pneumonia, Viral/complications , Pregnancy Complications, Infectious/virology , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Clinical Laboratory Techniques , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Infectious Disease Transmission, Vertical/statistics & numerical data , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Reverse Transcriptase Polymerase Chain Reaction , Risk Factors , SARS-CoV-2
16.
Annals of the Russian Academy of Medical Sciences ; 75(2):118-128, 2020.
Article | Web of Science | ID: covidwho-789980

ABSTRACT

The pandemic of a new coronavirus infection (Coronavirus Disease 2019, COVID-19) caused by SARS-CoV-2 became a real challenge to humanity and the medical community in 2020 and raised a number of medical, social and even philosophical questions. An almost avalanche-like increase in the number of infected people in a short time, due to the high contagiousness of viral infection, allowed us to identify groups of patients with mild, moderate and severe forms of the disease. Doctors around the world are faced with an acute problem of treating a large number of patients in critical conditions caused by COVID-19. From the currently available information on clinical cases of COVID-19, it follows that COVID-19 patients in critical condition have a clinical picture of disseminated intravascular coagulation (DIC), septic shock with the development of multiple organ failure. The first part of the article discusses the pathogenesis of non-specific universal biological responses of the body in critical condition - from the Sanarelli-Schwartzman phenomenon to the DIC, septic shock, systemic inflammatory response syndrome and the so-called neutrophil extracellular traps (NETs). The questions of cytokine storm in severe forms of systemic inflammatory response syndrome (SIRS), the role of inflammation in the activation of coagulation, and the relationship between inflammation and thrombosis are discussed. Modern ideas about the mechanisms of so-called NETosis, their role in the occurrence of immunothrombosis and inflammation-induced thrombosis in autoimmune diseases - vasculitis, antiphospholipid syndrome, and systemic lupus erythematosus is highlighted. The article discusses the possibility of participation of ADAMTS-13 metalloproteinase in the pathogenesis of multiple organ failure in severe endotheliopathy in patients with viral septic shock. Пандемия новой коронавирусной инфекции (COronaVIrus Disease 2019, СOVID-19), вызванная тяжелым острым респираторным синдромом, связанным с коронавирусом 2 (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV-2) стала настоящим вызовом человечеству и медицинскому сообществу в 2020 году и поставила целый ряд медицинских, социальных и даже философских вопросов. Практически лавинообразно нарастающее число зараженных за короткое время, связанное с высокой контагиозностью вирусной инфекции, позволило выделить группы пациентов с легкой, средней тяжести и тяжелой формами заболевания. Перед врачами всего мира встала острая проблема лечения большого количества больных в критических состояниях, вызванных COVID-19. Из имеющейся в настоящее время информации о клинических случаях COVID-19 следует, что у больных в критическом состоянии наблюдается клиническая картина диссеминированного внутрисосудистого свертывания крови, септического шока с развитием полиорганной недостаточности. В первой части статьи изложены вопросы патогенеза неспецифических универсальных биологических ответов организма в критических состояниях - от феномена Санарелли-Шварцмана до учения о диссеминированном внутрисосудистом свертывании крови, септическом шоке, синдроме системного воспалительного ответа и так называемых внеклеточных ловушках нейтрофилов (neutrophil extracellular traps, NETs). Обсуждаются вопросы цитокинового шторма при тяжелых формах синдрома системного воспалительного ответа, роль воспаления в активации коагуляции и взаимосвязь между воспалением и тромбозом (inflathrombosis). Освещаются современные представления о механизмах так называемых NETозов (NETosis) и их роли в возникновении иммунообусловленных и «воспалительных» тромбозов при аутоиммунных состояниях - васкулитах, антифосфолипидном синдроме, системной красной волчанке. Обсуждаются вопросы возможности участия металлопротеиназы ADAMTS-13 в патогенезе полиорганной недостаточности в условиях тяжелой эндотелиопатии у пациентов с вирусобусловленным септическим шоком.

17.
J Perinat Med ; 48(6): 545-550, 2020 Jul 28.
Article in English | MEDLINE | ID: covidwho-620121

ABSTRACT

Objectives Coronavirus (COVID-19) is a new respiratory disease that is spreading widely throughout the world. The aim of this study was to evaluate the psychological impact of COVID-19 pandemic on pregnant women in Italy. Methods We considered 200 pregnancies attending our antenatal clinic. A questionnaire was sent to each woman in the days of maximum spread of COVID-19. Sectional was finalized to acquire in 18 items maternal characteristics and to test the women's perception of infection. Section included the State-trait anxiety inventory (STAI) 40 items validated test for scoring trait anxiety (basal anxiety, STAI-T) and state anxiety (related to the ongoing pandemic, STAI-S). An abnormal value of STAI was considered when ≥40. Results The questionnaire was completed by 178 women (89%). Fear that COVID-19 could induce fetal structural anomalies was present in 47%, fetal growth restriction in 65% and preterm birth in 51% of the women. The median value of STAI-T was 37 and in 38.2% of the study group STAI-T score ≥40 was evidenced. STAI-S values were significantly higher with an increase of median values of 12 points (p≤0.0001). There was a positive linear correlation between STAI-T and STAI-S (Pearson=0.59; p≤0.0001). A higher educational status was associated with increased prevalence of STAI-S ≥ 40(p=0.004). Subgrouping women by the other variables considered did not show any further difference. Conclusions COVID-19 pandemic induces a doubling of the number of women who reached abnormal level of anxiety. These findings validate the role of the remote use of questionnaire for identifying women at higher risk of anxiety disorders allowing the activation of support procedures.


Subject(s)
Anxiety/epidemiology , Betacoronavirus , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pregnancy Complications/psychology , Adult , COVID-19 , Educational Status , Female , Humans , Italy/epidemiology , Pregnancy , Pregnancy Complications/epidemiology , Pregnant Women/psychology , Prospective Studies , SARS-CoV-2 , Stress, Psychological/epidemiology , Surveys and Questionnaires
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