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1.
Journal of Affective Disorders Reports ; : 100415, 2022.
Article in English | ScienceDirect | ID: covidwho-1996305

ABSTRACT

Background Mental health outcomes in Healthcare Workers (HCWs) has been few evaluated during COVID-19 pandemic in low-and middle-income countries. Our aim was carry-out a study to identify the prevalence of stress, anxiety, depression symptoms in HCWs and associated factors to severe illness in a northern region in Colombia. Method A cross-sectional, hospital-based survey was conducted to assess mental health outcomes in 1,149 HCWs in Colombia. The study used Perceived Stress Scale (PSS-10), 7-item Generalized Anxiety Disorder (GAD-7), and 9-item Patient Health Questionnaire (PHQ-9) to evaluate stress, anxiety, and depression symptoms, respectively. Results 682 HCWs completed the questionnaire. The 58,21% (397/682) were nurses, 31,23% were physicians (213/682), and 10,56% (72/682) were other health professionals. The proportion of HCWs with stress, anxiety, and depression symptoms were 59,97%, 44,87%, and 23,02%, respectively. HCWs in emergency room and Intensive Care Units (ICU) have 2-3-fold increase risk to have severe symptoms of stress. Staff in ICU have 64% more likely to have severe anxiety symptoms, and 97% more likely to have severe depression symptoms. Limitations Including HCWs only in the northern region in Colombia;a non-probabilistic sample, and a cross-sectional design to identify causality. Conclusion A higher proportion on mental health outcomes has been reported in HCWs in Colombia. There are work areas related with severe mental symptoms such as ICU and emergency room. Hospitals and patient-care institutions in Latin-America needs consider the mental and physical health of HCWs during outbreaks and identify health staff at-risk to implementing support strategies to mitigate adverse mental outcomes.

2.
European Journal of Trauma & Dissociation ; : 100293, 2022.
Article in English | ScienceDirect | ID: covidwho-1996136

ABSTRACT

Background : Mental health outcomes in healthcare workers (HCWs) in low- and middle-income countries (LMICs) have been poorly explored during COVID-19 pandemic. Our aim was to carry out a cross-sectional study of the prevalence of mental health symptoms in HCWs in Colombia. Methods : A cross-sectional web-survey study was performed during the COVID-19 pandemic mid-2021 including HCWs in two hospitals in Colombia. The PCL-5, GAD-7, and PHQ-9 scales were used to assess the prevalence of symptoms and severity of PTSD, anxiety, and depression in Colombia. Results : From 257 surveyed respondents, 44.36% were nurses, 36.58% physicians and 19.07% other health professionals. The prevalence of PTSD, anxiety, and depression symptoms were 18.68%, 43.19%, and 26.85%, amongst HCWs. The regression model evidence a strong risk of PTSD, anxiety, and depression symptoms in HCWs in Colombia during the second wave of COVID-19 in the middle of 2021. Conclusions : The prevalence for several mental health symptoms in HCWs in Colombia were higher compared with the general population. HCWs are at-risk population to develop chronic symptoms and mental disorders during and after outbreaks. These results will be helpful to tailor strategies to support the physical and mental health of the HCWs in LMICs.

3.
International Journal of Advanced Computer Science and Applications ; 12(10), 2021.
Article in English | ProQuest Central | ID: covidwho-1811494

ABSTRACT

The problem of the COVID-19 disease has deter-mined that about 219 million people have contracted it, of which 4.55 million died. This importance has led to the implementation of security protocols to prevent the spread of this disease. One of the main protocols is to use protective masks that properly cover the nose and mouth. The objective of this paper was to classify images of faces using protective masks of COVID-19, in the classes identified as correct mask, incorrect mask, and no mask, with a Hybrid model of Quantum Transfer Learning. To do this, the method used has made it possible to gather a data set of 660 people of both sexes (man and woman), with ages ranging from 18 to 86 years old. The classic transfer learning model chosen was ResNet-18;the variational layers of the proposed model were built with the Basic Entangler Layers template for four qubits, and the optimization of the training was carried out with the Stochastic Gradient Descent with Nesterov Momentum. The main finding was the 99.05% accuracy in classifying the correct Protective Masks using the Pennylane quantum simulator in the tests performed. The conclusion reached is that the proposed hybrid model is an excellent option to detect the correct position of the protective mask for COVID-19.

4.
J Stroke Cerebrovasc Dis ; 31(6): 106450, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1799803

ABSTRACT

BACKGROUND: The relationship between cardiac function and mortality after thrombectomy for acute ischemic stroke is not well elucidated. METHODS: We analyzed the relationship between cardiac function and mortality prior to discharge in a cohort of patients who underwent thrombectomy for acute ischemic stroke at two large medical centers in New York City between December 2018 and November 2020. All analyses were performed using Welch's two sample t-test and logistic regression accounting for age, initial NIHSS and post-procedure ASPECTS score, where OR is for each unit increase in the respective variables. RESULTS: Of 248 patients, 41 (16.5%) died prior to discharge. Mortality was significantly associated with higher initial heart rate (HR; 89 ± 19 bpm vs 80 ± 18 bpm, p = 0.004) and higher maximum HR over entire admission (137 ± 26 bpm vs 114 ± 25 bpm, p < 0.001). Mortality was also associated with presence of NSTEMI/STEMI (63% vs 29%, p < 0.001). When age, initial NIHSS score, and post-procedure ASPECTS score were included in multivariate analysis, there was still a significant relationship between mortality and initial HR (OR 1.03, 95% CI 1.01- 1.05, p = 0.02), highest HR over the entire admission (OR 1.03, 95% CI 1.02-1.05, p < 0.001), and presence of NSTEMI/STEMI (OR 3.76, 95% CI 1.66-8.87, p = 0.002). CONCLUSIONS: Tachycardia is associated with mortality in patients who undergo thrombectomy. Further investigation is needed to determine whether this risk is modifiable.


Subject(s)
Ischemic Stroke , Non-ST Elevated Myocardial Infarction , ST Elevation Myocardial Infarction , Stroke , Humans , Retrospective Studies , ST Elevation Myocardial Infarction/complications , Stroke/complications , Stroke/diagnosis , Stroke/therapy , Tachycardia/complications , Thrombectomy , Treatment Outcome
5.
Revista Ibérica de Sistemas e Tecnologias de Informação ; - (E46):647-659, 2021.
Article in Spanish | ProQuest Central | ID: covidwho-1776971

ABSTRACT

: The objective of this scientific article was to determine the profile of the entrepreneur by opportunity in Latin America in the context of the Covid pandemic19, for this purpose a referential framework of the entrepreneur proposed by Veciana (1999) was considered and secondary sources were analyzed accordingly. After applying the methodology and obtaining results, the most outstanding characteristics for an entrepreneur by opportunity in times of pandemic are proposed and described, which are: emotional leadership, creativity and innovation and the ambition for growth and help to others. El Enfoque Económico, manifiesta que el emprendedor es el cuarto factor de la producción, puesto que es aquella persona que combina tierra, capital y trabajo;y que por ello es merecedor de un beneficio económico (Say, 1840), (Mill, 1848) a esto Schumpeter (1934) manifiesta que la innovación en las combinaciones productivas es propia de los empresarios y emprendedores. Sin embargo, se destacan las medidas para fortalecer estas economías, como ser: el involucramiento de expertos, instituciones (puntaje) y el gobierno, lo cual hace pensar que el ecosistema (enfoque sociocultural) es influyente para la generación de nuevos emprendimientos en concordancia a lo propuesto por North (1990).

6.
Crit Care Explor ; 4(4): e0668, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1774426

ABSTRACT

Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. OBJECTIVES: To investigate mortality and management of mechanically ventilated patients in temporary ICUs. DESIGN SETTING AND PARTICIPANTS: Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021. MAIN OUTCOMES AND MEASURES: To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed. RESULTS: We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar. CONCLUSIONS AND RELEVANCE: We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality.

8.
J Infect Dev Ctries ; 16(1): 73-80, 2022 01 31.
Article in English | MEDLINE | ID: covidwho-1703776

ABSTRACT

INTRODUCTION: Coronavirus disease 19 (COVID-19) has been a global public health emergency, with 209.89 million cases of infection with SARS-CoV-2 recorded, resulting in 4,401,675 deaths. After recuperation, it is probable that COVID-19 patients have sequelae of the disease. This study aimed to evaluate the respiratory anatomical-functional sequelae in Mexican patients who recovered from COVID-19. METHODOLOGY: This study included twenty-four patients who recovered from COVID-19 and eight non-infected patients (controls). Participants were screened for SARS-CoV-2 and the presence of IgM/IgG antibodies. Pulmonary function and lung anatomical abnormalities were evaluated by spirometry and computerized tomography. RESULTS: A total of 45.8% of the patients had pulmonary function with obstructive patterns: 70.8% of recovered cases had COVID-19 Reporting and Data System (CO-RADS) 1, 20.8% CO-RADS 3 and 16.7% CO-RADS 4. A total of 35.3% of patients with CO-RADS 1 also showed bilateral nodal growth; 70.8% of patients tested positive for IgG and 8.4% for IgG/IgM, and 20.8% tested negative for both antibodies. CONCLUSIONS: There were respiratory anatomical and functional sequelae in Mexican patients who recovered from COVID-19, with a high occurrence of pulmonary obstructive patterns in the study population. These observations indicate the importance of the routine evaluation of sequelae in Mexican patients who recovered from COVID-19 and the need for strict follow-up to improve the quality of life of these patients.


Subject(s)
COVID-19 , Antibodies, Viral , Humans , Immunoglobulin M , Lung , Quality of Life , SARS-CoV-2
9.
SSRN;
Preprint in English | SSRN | ID: ppcovidwho-326356

ABSTRACT

Despite some improvement since 2011, Latin America and the Caribbean continue to lag behind other regions in terms of financial inclusion. There is no clear evidence that fintech developments have supported greater financial inclusion in LAC, contrary to what has been observed elsewhere in the world. Case studies by national policy experts suggest that barriers to entry in the financial sector, along with a constraining regulatory environment, may have hindered a faster adoption of fintech. However, fintech development seems to have accelerated in the wake of the COVID-19 pandemic and with the support of recent policy initiatives. Keywords: fintech development, policy initiative, financial product, cash transfer program, ACH Colombia, electronic cash, per capita income, credit card payment, Financial inclusion, Fintech, Financial sector, Caribbean, Middle East and Central Asia, Central America, South America, Asia and Pacific

10.
Arch. med ; 21(1): 266-278, 2021/01/03.
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1677826

ABSTRACT

La pandemia COVID-19 ha causado grandes estragos en los sistemas de salud a nivel mundial. Desde la fisioterapia respiratoria, se propende por realizar intervenciones costo-efectivas basadas en la mejor evidencia disponible, para minimizar los efectos funcionales en dichos pacientes con COVID-19. Por ello, se revisó la literatura para cimentar una revisión teórica desde la funcionalidad en lo relacionado a la fisioterapia respiratoria frente a la pandemia. Los resultados incluyeron publicaciones y guías de manejo en español, inglés y portugués acerca de las acciones de los diferentes países frente a los compromisos funcionales que repercuten en la calidad de vida de estos pacientes. Se concluyó que la fisioterapia respiratoria aplica protocolos de intervención efectos en el COVID-19 para la mitigación de complicaciones físico y funcionales que mejoran la calidad de vida de los pacientes..Au


The COVID-19 pandemic has wreaked great havoc on health systems globally. From respiratory physiotherapy, it tends to carry out cost-effective interventions based on the best available evidence, to minimize the functional effects in said patients with COVID-19. For this reason, the literature was reviewed to establish a theoretical review from the functionality in relation to respiratory physiotherapy in the face of the pandemic. The results included publications and management guides in Spanish, English and Portuguese about the actions of the different countries in the face of functional compromises that affect the quality of life of these patients. It was concluded that respiratory physiotherapy applies intervention protocols effects in COVID-19 for the mitigation of physical and functional complications that improve the quality of life of patients..Au


Subject(s)
Humans , Respiratory Tract Diseases , Coronavirus Infections , Physical Therapy Specialty
11.
PLoS One ; 17(1): e0261711, 2022.
Article in English | MEDLINE | ID: covidwho-1643247

ABSTRACT

OBJECTIVE: To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses. METHODS: Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses. RESULTS: Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59-79] vs 73 years [IQR 61-83]; p < .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91-2.24 p < .001) and megadose use with increased survival (OR 0.84 95% CI 0.75-0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32-1.80; p < .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71-0.95; p < .001 and OR 0.80 95% CI 0.65-0.97; p < .001) respectively. CONCLUSION: There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/drug therapy , COVID-19/epidemiology , Prednisone/therapeutic use , Registries , SARS-CoV-2/pathogenicity , Sepsis/drug therapy , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/virology , Drug Administration Schedule , Female , Hospital Mortality/trends , Humans , Male , Middle Aged , SARS-CoV-2/growth & development , Sepsis/epidemiology , Sepsis/mortality , Sepsis/virology , Spain/epidemiology , Survival Analysis , Treatment Outcome
12.
Sustainability ; 13(23):13260, 2021.
Article in English | ProQuest Central | ID: covidwho-1561762

ABSTRACT

This study proposes a synthetic visual indicator with which to perform debt sustainability analysis using dynamic general equilibrium models. In a single diagram, we summarized the general equilibrium relationships among economic activity, government budget, and the maximum amount of sustainable public debt. Then, we measured sustainability using the distance of actual debt from the model-consistent maximum debt. This indicator can be implemented with any DSGE model;as a backing theory, we used a neoclassical model augmented with endogenous tax revenues, disaggregated public spending, different production technologies for public and private goods, non-atomistic wage setters in public labor (unions), and a fully specified maturity curve for public bonds. We provided an example of its usage using the case of Greece during the last public debt crisis. To perform the numerical analysis, we developed original software, whose advantage is allowing an audience without expertise in DSGE models to perform general equilibrium debt sustainability analyses without requiring an understanding of the technicalities of DSGE models.

13.
Front Psychol ; 12: 755965, 2021.
Article in English | MEDLINE | ID: covidwho-1528859

ABSTRACT

Background: The COVID-19 pandemic has caused mental health problems worldwide. The psychopathological implications of COVID-19 in cancer patients have rarely been addressed. Considering the increased vulnerability of oncology patients, this issue needs to be addressed to improve the long-term mental health status of these patients. Methods: We conducted a prospective study in outpatients under active cancer treatment during the first wave of the COVID-19 pandemic. A semi-structured 24-question survey was designed to measure baseline sociodemographic, psychosocial and COVID-19 exposure characteristics. The Hospital Anxiety and Depression Scale was used to measure psychological symptoms. A descriptive and analytical univariate analysis of the variables studied was performed. We used the Z-score to compare different populations (experimental and historical control cohort). Results: 104 patients were included, the majority of which were women (64.4%), were above 65 years of age (57.7%), had either lung and breast cancer (56.7%), had advanced disease (64%) and were undergoing chemotherapy (63.5%). 51% of them expressed greater fear of cancer than of COVID-19 infection or both. In relation to HADS, 52.8% of emotional distress, 42.3% of anxiety and 58.6% of depression rates were detected. The main factors related with higher rates of psychological symptomatology were history of previous psychotropic drug consumption and the adoption of additional infection prevention measures because they considered themselves at risk of severe COVID-19 infection (p = 0.008; p = 0.003 for emotional distress, p = 0.026; p = 0.004 for anxiety, and p = 0.013; p = 0.008 for depression). Tumor type, stage, oncologic treatment or rescheduling of cancer treatments were not related to higher levels of psychological symptomatology. Comparison of our results with another population of similar characteristics was not significant (Z score = -1.88; p = 0.060). Conclusions: We detected high rates of emotional distress during the first wave of the COVID-19 pandemic among cancer patients in active treatment (52.8%). This was higher and clinically relevant than observed in a comparable population (42.5%), although not significant. Cancer itself is the main factor of concern for cancer patients, above and beyond the emotional distress generated by COVID-19 pandemic.

14.
J Cell Sci ; 134(19)2021 10 01.
Article in English | MEDLINE | ID: covidwho-1463292

ABSTRACT

The Autophagy, Inflammation and Metabolism (AIM) Center organized a globally accessible, virtual eSymposium during the COVID-19 pandemic in 2020. The conference included presentations from scientific leaders, as well as a career discussion panel, and provided a much-needed platform for early-career investigators (ECIs) to showcase their research in autophagy. This Perspective summarizes the science presented by the ECIs during the event and discusses the lessons learned from a virtual meeting of this kind during the pandemic. The meeting was a learning experience for all involved, and the ECI participants herein offer their thoughts on the pros and cons of virtual meetings as a modality, either as standalone or hybrid events, with a view towards the post-pandemic world.


Subject(s)
COVID-19 , Pandemics , Autophagy , Humans , Inflammation , SARS-CoV-2
15.
PLoS One ; 16(6): e0252507, 2021.
Article in English | MEDLINE | ID: covidwho-1388918

ABSTRACT

We recently developed 'cellular' reagents-lyophilized bacteria overexpressing proteins of interest-that can replace commercial pure enzymes in typical diagnostic and molecular biology reactions. To make cellular reagent technology widely accessible and amenable to local production with minimal instrumentation, we now report a significantly simplified method for preparing cellular reagents that requires only a common bacterial incubator to grow and subsequently dry enzyme-expressing bacteria at 37°C with the aid of inexpensive chemical desiccants. We demonstrate application of such dried cellular reagents in common molecular and synthetic biology processes, such as PCR, qPCR, reverse transcription, isothermal amplification, and Golden Gate DNA assembly, in building easy-to-use testing kits, and in rapid reagent production for meeting extraordinary diagnostic demands such as those being faced in the ongoing SARS-CoV-2 pandemic. Furthermore, we demonstrate feasibility of local production by successfully implementing this minimized procedure and preparing cellular reagents in several countries, including the United Kingdom, Cameroon, and Ghana. Our results demonstrate possibilities for readily scalable local and distributed reagent production, and further instantiate the opportunities available via synthetic biology in general.


Subject(s)
COVID-19 Testing/standards , COVID-19/diagnosis , COVID-19/epidemiology , Diagnostic Tests, Routine/standards , Indicators and Reagents/standards , Real-Time Polymerase Chain Reaction/standards , SARS-CoV-2/genetics , COVID-19/virology , COVID-19 Testing/methods , Cameroon/epidemiology , Escherichia coli/genetics , Escherichia coli/metabolism , Gene Expression , Geobacillus stearothermophilus/genetics , Geobacillus stearothermophilus/metabolism , Ghana/epidemiology , Humans , Indicators and Reagents/chemistry , Indicators and Reagents/metabolism , Indicators and Reagents/supply & distribution , Molecular Diagnostic Techniques , Plasmids/chemistry , Plasmids/metabolism , Real-Time Polymerase Chain Reaction/methods , Recombinant Proteins/biosynthesis , Recombinant Proteins/genetics , Synthetic Biology/methods , Transformation, Bacterial , United Kingdom/epidemiology
16.
Stroke ; 52(11): e706-e709, 2021 11.
Article in English | MEDLINE | ID: covidwho-1371922
17.
Mach Learn Appl ; 6: 100138, 2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1364367

ABSTRACT

COVID-19 global pandemic affects health care and lifestyle worldwide, and its early detection is critical to control cases' spreading and mortality. The actual leader diagnosis test is the Reverse transcription Polymerase chain reaction (RT-PCR), result times and cost of these tests are high, so other fast and accessible diagnostic tools are needed. Inspired by recent research that correlates the presence of COVID-19 to findings in Chest X-ray images, this papers' approach uses existing deep learning models (VGG19 and U-Net) to process these images and classify them as positive or negative for COVID-19. The proposed system involves a preprocessing stage with lung segmentation, removing the surroundings which does not offer relevant information for the task and may produce biased results; after this initial stage comes the classification model trained under the transfer learning scheme; and finally, results analysis and interpretation via heat maps visualization. The best models achieved a detection accuracy of COVID-19 around 97%.

18.
Results Phys ; 27: 104483, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1284507

ABSTRACT

Nowadays, society faces a catastrophic problem related to respiratory syndrome due to the coronavirus SARS-CoV-2: the Covid-19 disease. This virus has changed our coexistence rules and, in consequence, has reshaped the daily activities in modern societies. Thus, there are many efforts to understand the virus behaviour in order to reduce its negative impact, and these efforts produce an incredible amount of information and data sources every week. Data scientists, which use techniques such as Machine learning, are focusing their abilities to develop mathematical models for analysing this critical situation. This paper uses Machine Learning techniques as tools to help understand some specific new patterns in Covid patients that arise from unknown complex interactions in the transmission-dynamic models of the SARS-CoV-2 virus, and their relation with the corresponding social contact patterns which are often known or can be inferred from populations variables. One of the main motivations of this research is to find the diseases that cause an increase in the risk of death in infected people with the Covid-19 virus. Mexico is the case of study in this research. The general conditions of health that cause death are well known generally in the world. However, these conditions in each country can differ depending on different factors such as the general health status of people. The results show that the principal causes of death in Mexico are related to age, bad eating habits, chronic diseases, and contact with infected people having not proper care. Results from the analysis show a remarkable accuracy of 87%, which is considered satisfactory.

20.
Neurology ; 96(4): e575-e586, 2021 01 26.
Article in English | MEDLINE | ID: covidwho-1048797

ABSTRACT

OBJECTIVE: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes. METHODS: We conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders. RESULTS: Of 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001). CONCLUSIONS: Neurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Adult , Age Factors , Aged , Brain Diseases/epidemiology , Brain Diseases/etiology , COVID-19/mortality , Female , Hospital Mortality , Humans , Intubation, Intratracheal/statistics & numerical data , Male , Middle Aged , Nervous System Diseases/mortality , Neurotoxicity Syndromes , New York City/epidemiology , Organ Dysfunction Scores , Patient Discharge/statistics & numerical data , Prospective Studies , Sex Factors , Spinal Cord Diseases/epidemiology , Spinal Cord Diseases/etiology , Young Adult
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