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1.
Eye Vis (Lond) ; 9(1): 3, 2022 Jan 07.
Article in English | MEDLINE | ID: covidwho-1613256

ABSTRACT

The rise of artificial intelligence (AI) has brought breakthroughs in many areas of medicine. In ophthalmology, AI has delivered robust results in the screening and detection of diabetic retinopathy, age-related macular degeneration, glaucoma, and retinopathy of prematurity. Cataract management is another field that can benefit from greater AI application. Cataract  is the leading cause of reversible visual impairment with a rising global clinical burden. Improved diagnosis, monitoring, and surgical management are necessary to address this challenge. In addition, patients in large developing countries often suffer from limited access to tertiary care, a problem further exacerbated by the ongoing COVID-19 pandemic. AI on the other hand, can help transform cataract management by improving automation, efficacy and overcoming geographical barriers. First, AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs. This utilizes a deep-learning, convolutional neural network (CNN) to detect and classify referable cataracts appropriately. Second, some of the latest intraocular lens formulas have used AI to enhance prediction accuracy, achieving superior postoperative refractive results compared to traditional formulas. Third, AI can be used to augment cataract surgical skill training by identifying different phases of cataract surgery on video and to optimize operating theater workflows by accurately predicting the duration of surgical procedures. Fourth, some AI CNN models are able to effectively predict the progression of posterior capsule opacification and eventual need for YAG laser capsulotomy. These advances in AI could transform cataract management and enable delivery of efficient ophthalmic services. The key challenges include ethical management of data, ensuring data security and privacy, demonstrating clinically acceptable performance, improving the generalizability of AI models across heterogeneous populations, and improving the trust of end-users.

2.
Vaccines ; 10(1):24, 2022.
Article in English | MDPI | ID: covidwho-1580356

ABSTRACT

The COVID-19 pandemic caused by SARS-CoV-2 is unprecedented in recent memory owing to the non-stop escalation in number of infections and deaths in almost every country of the world. The lack of treatment options further worsens the scenario, thereby necessitating the exploration of already existing US FDA-approved drugs for their effectiveness against COVID-19. In the present study, we have performed virtual screening of nutraceuticals available from DrugBank against 14 SARS-CoV-2 proteins. Molecular docking identified several inhibitors, two of which, rutin and NADH, displayed strong binding affinities and inhibitory potential against SARS-CoV-2 proteins. Further normal model-based simulations were performed to gain insights into the conformational transitions in proteins induced by the drugs. The computational analysis in the present study paves the way for experimental validation and development of multi-target guided inhibitors to fight COVID-19.

3.
Clin Gastroenterol Hepatol ; 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1588134

ABSTRACT

BACKGROUND & AIMS: We aimed to assess the safety and immunogenicity of inactivated whole-virion severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with chronic liver diseases (CLD) in this study. METHODS: This was a prospective, multi-center, open-label study. Participants aged over 18 years with confirmed CLD and healthy volunteers were enrolled. All participants received 2 doses of inactivated whole-virion SARS-CoV-2 vaccines. Adverse reactions were recorded within 14 days after any dose of SARS-CoV-2 vaccine, laboratory testing results were collected after the second dose, and serum samples of enrolled subjects were collected and tested for SARS-CoV-2 neutralizing antibodies at least 14 days after the second dose. RESULTS: A total of 581 participants (437 patients with CLD and 144 healthy volunteers) were enrolled from 15 sites in China. Most adverse reactions were mild and transient, and injection site pain (n = 36; 8.2%) was the most frequently reported adverse event. Three participants had grade 3 aminopherase elevation (defined as alanine aminopherase >5 upper limits of normal) after the second dose of inactivated whole-virion SARS-CoV-2 vaccination, and only 1 of them was judged as severe adverse event potentially related to SARS-CoV-2 vaccination. The positive rates of SARS-CoV-2 neutralizing antibodies were 76.8% in the noncirrhotic CLD group, 78.9% in the compensated cirrhotic group, 76.7% in the decompensated cirrhotic group (P = .894 among CLD subgroups), and 90.3% in healthy controls (P = .008 vs CLD group). CONCLUSION: Inactivated whole-virion SARS-CoV-2 vaccines are safe in patients with CLD. Patients with CLD had lower immunologic response to SARS-CoV-2 vaccines than healthy population. The immunogenicity is similarly low in noncirrhotic CLD, compensated cirrhosis, and decompensated cirrhosis.

4.
Public Health Nurs ; 2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1571055

ABSTRACT

OBJECTIVE: To explore factors associated with depression and COVID-19 related fear among pregnant women and new mothers. DESIGN: A cross-sectional survey was conducted in China from July 2020 to July 2021. SAMPLE: A total of 3027 pregnant and new mothers were recruited. MEASUREMENT: Sociodemographic characteristics and the perceptions of the COVID-19 pandemic were collected. The Patient Health Questionnaire-9 (PHQ-9) and the Fear Scale was used to assess the depressive and fear level towards the COVID-19 pandemic, respectively. RESULTS: Approximately 17.2% of the participants had depression (PHQ-9 ≥10). In Hong Kong, participants who perceived that they have increased knowledge to prevent infection were less likely to have depression (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.74-0.94). There was no association between perceived severity if infected and severity of spread and the depression level in our sample. An inverse relationship was found between the COVID-19 related fear level and perceived knowledge to prevent infection (Beta-coefficient [ß] = -0.20; 95% CI = -0.38 to -0.02). CONCLUSION: Public health nurses need to promote accurate and up to date COVID-19 related information at clinical and community settings and implement effective screening for depression and fear symptoms to identify these high-risk groups to improve women's psychological well-being.

5.
Expert Rev Med Devices ; : 1-10, 2021 Dec 14.
Article in English | MEDLINE | ID: covidwho-1569460

ABSTRACT

BACKGROUND: The sudden outbreak of COVID-19 pneumonia has brought a heavy disaster to individuals globally. Facing this new virus, the clinicians have no automatic tools to assess the severity of pneumonia patients. METHODS: In the current work, a COVID-19 DET-PRE network with two pipelines was proposed. Firstly, the lungs in X-rays were detected and segmented through the improved YOLOv3 Dense network to remove redundant features. Then, the VGG16 classifier was pre-trained on the source domain, and the severity of the disease was predicted on the target domain by means of transfer learning. RESULTS: The experiment results demonstrated that the COVID-19 DET-PRE network can effectively detect the lungs from X-rays and accurately predict the severity of the disease. The mean average precisions (mAPs) of lung detection in patients with mild and severe illness were 0.976 and 0.983 respectively. Moreover, the accuracy of severity prediction of COVID-19 pneumonia can reach 86.1%. CONCLUSIONS: The proposed neural network has high accuracy, which is suitable for the clinical diagnosis of COVID-19 pneumonia.

6.
Front Public Health ; 9: 771638, 2021.
Article in English | MEDLINE | ID: covidwho-1551556

ABSTRACT

Background: Public health measures (such as wearing masks, physical distancing, and isolation) have significantly reduced the spread of the coronavirus disease-2019 (COVID-19), but the impact of public health measures on other respiratory infectious diseases is unclear. Objective: To assess the correlation between public health measures and the incidence of respiratory infectious diseases in China during the COVID-19 pandemic. Methods: We collected the data from the National Health and Construction Commission in China on the number of patients with six respiratory infectious diseases (measles, tuberculosis, pertussis, scarlet fever, influenza, and mumps) from 2017 to 2020 and assessed the correlation between public health measures and the incidence of respiratory infectious diseases. Finally, we used the data of the six respiratory infectious diseases in 2021 to verify our results. Results: We found public health measures significantly reduced the incidence of measles (p = 0.002), tuberculosis (p = 0.002), pertussis (p = 0.004), scarlet fever (p = 0.002), influenza (p = 0.034), and mumps (p = 0.002) in 2020, and prevented seasonal peaks. Moreover, the effects of public health measures were most marked during the peak seasons for these infections. Of the six respiratory infectious diseases considered, tuberculosis was least affected by public health measures. Conclusion: Public health measures were very effective in reducing the incidence of respiratory infectious diseases, especially when the respiratory infectious diseases would normally have been at their peak.

7.
Fluctuation and Noise Letters ; 20(6), 2021.
Article in English | ProQuest Central | ID: covidwho-1526532

ABSTRACT

In this study, we analyzed daily records of newly diagnosed cases in Wuhan, Hubei excluding Wuhan (HEW), and China excluding Hubei (CEH) to investigate the impact of the new coronavirus outbreak in Wuhan on cities around it and throughout China. We used multifractal detrended cross-correlation analysis (MF-DXA) method to investigate the correlations between the daily number of patients in Wuhan and HEW as well as in Wuhan and CEH. We concluded that the cross-correlations between the daily number of patients in Wuhan and HEW were higher than those between the daily number of patients in Wuhan and CEH because the multifractal features of Wuhan and HEW are greater than those of Wuhan and CEH. We also found that the “Wuhan closure” conducted on January 23 resulted in a decrease in cross-correlations between Wuhan and CEH.

8.
Complex Intell Systems ; : 1-8, 2021 Feb 10.
Article in English | MEDLINE | ID: covidwho-1516944

ABSTRACT

The distribution of relief materials is an important part of post-disaster emergency rescue. To meet the needs of the relief materials in the affected areas after a sudden disaster and ensure its smooth progress, an optimized dispatch model for multiple periods and multiple modes of transportation supported by the Internet of Things is established according to the characteristics of relief materials. Through the urgent production of relief materials, market procurement, and the use of inventory collection, the needs of the disaster area are met and the goal of minimizing system response time and total cost is achieved. The model is solved using CPLX software, and numerical simulation and results are analyzed using the example of the COVID-19 in Wuhan City, and the dispatching strategies are given under different disruption scenarios. The results show that the scheduling optimization method can meet the material demand of the disaster area with shorter time and lower cost compared with other methods, and can better cope with the supply interruptions that occur in post-disaster rescue.

9.
Asia Pac J Public Health ; : 10105395211053165, 2021 Oct 18.
Article in English | MEDLINE | ID: covidwho-1477162
10.
Chinese Journal of Zoonoses ; 37(7):658-663, 2021.
Article in Chinese | GIM | ID: covidwho-1456371

ABSTRACT

This study aimed to analyze the relationship between SARS-CoV-2 spreading and clinical classification to evaluate the transmission and pathogenicity characteristics of the local virus, and to understand the clinical characteristics of SARS-CoV-2 reactivation, on the basis of the clinical manifestations in Wuxi. We collected information on the SARS-CoV-2 positive cases admitted to The Fifth People's Hospital of Wuxi from January 23 to November 20, 2020. According to epidemiological and clinical characteristics, we analyzed the changes in the transmission and pathogenicity of the virus and the clinical manifestations of SARS-CoV-2 reactivation cases. The severe and critical COVID-19 cases appeared only before the second-generation, whereas the third-generation cases were all mild. The rate of severe illness in the second-generation (7.1%) was significantly lower than that in the first-generation (17.5%), and the overseas imported cases (n-generation cases) were asymptomatic and mild. The presence of antibodies (IgM and IgG) in partially asymptomatic and mild cases appeared to become negative. The clinical features of SARS-CoV-2 first-positive and reactivation cases showed that some cases (2/3) developed lung inflammation, but their blood clinical indicators were normal. The proportion of severe cases of SARS-CoV-2 infection in Wuxi has decreased gradually, and asymptomatic or mild cases may become a high-risk group of viral re-yang. Immunological indicators can help predict clinical re-positivity.

11.
Hum Vaccin Immunother ; : 1-2, 2021 Oct 06.
Article in English | MEDLINE | ID: covidwho-1455134

ABSTRACT

Evidence of BNT126b2 vaccine effectiveness and breakthrough has been primarily demonstrated in populations outside of Asia; studies in the Western Pacific region are limited. Our retrospective cohort study assessed SARS-CoV-2 cases after vaccine rollout starting from mid-March 2021 at a tertiary hospital in Tokyo. Of 8,749 staff members, no fully vaccinated staff demonstrated confirmed infection, versus 19 cases in unvaccinated or partially vaccinated staff, by the end of June. Three breakthrough cases were identified in July, correlating with spread of delta variant in Tokyo. While our findings confirm the effectiveness of BNT162b2 vaccine in Asian populations, the presence of breakthrough cases despite strict infection control regulations suggest that ongoing public hygiene measures are required even after vaccination.

12.
J Hepatol ; 75(2): 439-441, 2021 08.
Article in English | MEDLINE | ID: covidwho-1454288

ABSTRACT

BACKGROUND & AIMS: The development of COVID-19 vaccines has progressed with encouraging safety and efficacy data. Concerns have been raised about SARS-CoV-2 vaccine responses in the large population of patients with non-alcoholic fatty liver disease (NAFLD). The study aimed to explore the safety and immunogenicity of COVID-19 vaccination in NAFLD. METHODS: This multicenter study included patients with NAFLD without a history of SARS-CoV-2 infection. All patients were vaccinated with 2 doses of inactivated vaccine against SARS-CoV-2. The primary safety outcome was the incidence of adverse reactions within 7 days after each injection and overall incidence of adverse reactions within 28 days, and the primary immunogenicity outcome was neutralizing antibody response at least 14 days after the whole-course vaccination. RESULTS: A total of 381 patients with pre-existing NAFLD were included from 11 designated centers in China. The median age was 39.0 years (IQR 33.0-48.0 years) and 179 (47.0%) were male. The median BMI was 26.1 kg/m2 (IQR 23.8-28.1 kg/m2). The number of adverse reactions within 7 days after each injection and adverse reactions within 28 days totaled 95 (24.9%) and 112 (29.4%), respectively. The most common adverse reactions were injection site pain in 70 (18.4%), followed by muscle pain in 21 (5.5%), and headache in 20 (5.2%). All adverse reactions were mild and self-limiting, and no grade 3 adverse reactions were recorded. Notably, neutralizing antibodies against SARS-CoV-2 were detected in 364 (95.5%) patients with NAFLD. The median neutralizing antibody titer was 32 (IQR 8-64), and the neutralizing antibody titers were maintained. CONCLUSIONS: The inactivated COVID-19 vaccine appears to be safe with good immunogenicity in patients with NAFLD. LAY SUMMARY: The development of vaccines against coronavirus disease 2019 (COVID-19) has progressed rapidly, with encouraging safety and efficacy data. This study now shows that the inactivated COVID-19 vaccine appears to be safe with good immunogenicity in the large population of patients with non-alcoholic fatty liver disease.


Subject(s)
Antibodies, Neutralizing/blood , Antibodies, Viral/blood , COVID-19 , Immunogenicity, Vaccine/immunology , Non-alcoholic Fatty Liver Disease , Vaccination , Vaccines, Inactivated , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , China/epidemiology , Female , Humans , Male , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/epidemiology , Outcome Assessment, Health Care , SARS-CoV-2/immunology , Vaccination/adverse effects , Vaccination/methods , Vaccination/statistics & numerical data , Vaccines, Inactivated/administration & dosage , Vaccines, Inactivated/adverse effects
13.
J Infect Chemother ; 28(1): 116-119, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1440193

ABSTRACT

As the first authorized COVID-19 vaccine in Japan, the BNT162b2 mRNA COVID-19 vaccine is utilized for mass vaccination. Although efficacy has been proved, real-world evidence on reactogenicity in Japanese personnel is needed to prepare the public. Healthcare workers in a large academic hospital in Japan received two doses of the Pfizer-BioNTech vaccine from March 17 to May 19, 2021. Online questionnaires were distributed to registered recipients following each dose, from day 0 through day 8. Primary outcomes are the frequency of reactogenicity including local and systemic reactions. Length of absence from work was also analyzed. Most recipients self-reported reactogenicity after the first dose (97.3%; n = 3254; mean age [36.4]) and after the second dose (97.2%; n = 3165; mean age [36.5]). Systemic reactions following the second dose were substantially higher than the first dose, especially for fever (OR, 27.38; 95% CI, [22.00-34.06]; p < 0.001), chills (OR, 16.49; 95% CI, [13.53-20.11]; p < 0.001), joint pain (OR, 8.49; 95% CI, [7.21-9.99]; p < 0.001), fatigue (OR, 7.18; 95% CI, [6.43-8.02]; p < 0.001) and headache (OR, 5.43; 95% CI, [4.80-6.14]; p < 0.001). Reactogenicity was more commonly seen in young, female groups. 19.3% of participants took days off from work after the second dose (2.2% after the first dose), with 4.7% absent for more than two days. Although most participants reported reactogenicity, severe cases were limited. This study provides real-world evidence for the general population and organizations to prepare for BNT162b2 mRNA COVID-19 vaccination in Japan and other countries in the region.


Subject(s)
COVID-19 Vaccines , COVID-19 , Female , Health Personnel , Humans , Japan , RNA, Messenger/genetics , SARS-CoV-2
14.
Vaccines (Basel) ; 9(10)2021 Sep 24.
Article in English | MEDLINE | ID: covidwho-1438760

ABSTRACT

In response to the ongoing COVID-19 pandemic, the global effort to develop high efficacy countermeasures to control the infection are being conducted at full swing. While the efficacy of vaccines and coronavirus drugs are being tested, the microbiome approach represents an alternative pathophysiology-based approach to prevent the severity of the infection. In the current study, we evaluated the action of a novel probiotic Lactobacillus plantarum Probio-88 against SARS-COV-2 replication and immune regulation using an in vitro and in silico study. The results showed that extract from this strain (P88-CFS) significantly inhibited the replication of SARS-COV-2 and the production of reactive oxygen species (ROS) levels. Furthermore, compared with infected cells, P88-CFS treated cells showed a significant reduction in inflammatory markers such as IFN-α, IFN-ß, and IL-6. Using an in silico molecular docking approach, it was postulated that the antiviral activity of L. plantarum Probio-88 was derived from plantaricin E (PlnE) and F (PlnF). The high binding affinity and formation of hydrogen bonding indicated that the association of PlnE and PlnF on SARS-COV-2 helicase might serve as a blocker by preventing the binding of ss-RNA during the replication of the virus. In conclusion, our study substantiated that P88-CFS could be used as an integrative therapeutic approach along with vaccine to contain the spread of the highly infectious pathogen and possibly its variants.

16.
Front Mol Biosci ; 8: 699929, 2021.
Article in English | MEDLINE | ID: covidwho-1348520

ABSTRACT

SARS-CoV-2 infection has become an urgent public health concern worldwide, severely affecting our society and economy due to the long incubation time and high prevalence. People spare no effort on the rapid development of vaccine and treatment all over the world. Amongst the numerous ways of tackling this pandemic, some approaches using extracellular vesicles (EVs) are emerging. In this review, we summarize current prevalence and pathogenesis of COVID-19, involving the combination of SARS-CoV-2 and virus receptor ACE2, endothelial dysfunction and micro thrombosis, together with cytokine storm. We also discuss the ongoing EVs-based strategies for the treatment of COVID-19, including mesenchymal stem cell (MSC)-EVs, drug-EVs, vaccine-EVs, platelet-EVs, and others. This manuscript provides the foundation for the development of targeted drugs and vaccines for SARS-CoV-2 infections.

17.
Front Vet Sci ; 8: 687079, 2021.
Article in English | MEDLINE | ID: covidwho-1347366

ABSTRACT

Swine acute diarrhea syndrome (SADS) is a highly contagious infectious disease characterized by acute vomiting and watery diarrhea in neonatal piglets. The causative agent for SADS is the swine acute diarrhea syndrome coronavirus (SADS-CoV), an alphacoronavirus in the family Coronaviridae. Currently, SADS-CoV was identified only in Guangdong and Fujian provinces of China, not in any other regions or countries in the world. To explore the genetic diversity of SADS-CoV isolates, herein we comparatively analyzed 44 full-length genomes of viruses isolated in Guangdong and Fujian provinces during 2017-2019. The spike glycoprotein gene of SADS-CoV strain CH/FJWT/2018 isolated in Fujian province is distinct from that of other viral isolates in either spike glycoprotein gene-based phylogenetic analysis or whole genome-based gene similarity analysis. Moreover, at least 7 predicted linear B cell epitopes in the spike glycoprotein of CH/FJWT/2018 would be affected by amino acid variations when compared with a representative virus isolated in Guangdong province. The spike glycoprotein of coronaviruses determines viral host range and tissue tropism during virus infection via specific interactions with the cellular receptor and also plays critical roles in eliciting the production of neutralizing antibodies. Since SADS-CoVs have a broad cell tropism, the results in this report further emphasize that the spike glycoprotein gene is a pivotal target in the surveillance of SADS-CoV.

18.
Soc Sci Med ; 285: 114285, 2021 09.
Article in English | MEDLINE | ID: covidwho-1331238

ABSTRACT

The United States experienced three surges of COVID-19 community infection since the World Health Organization declared the pandemic on March 11, 2020. The prevalence of psychological distress among U.S. adults increased from 11 % in 2019 to 35.9 % in April 2020 when New York City become the epicenter of the COVID-19 outbreak. Analyzing 21 waves of the Household Pulse Survey data collected between April 2020 and December 2020, this study aimed to examine the distress level in the 15 most populated metropolitan areas in the U.S. Our study found that, as the pandemic swept from East to South and soared in the West, 39.9%-52.3 % U.S. adults living in these 15 metropolitan areas reported symptoms of psychological distress. The highest distress levels were found within the Western areas including Riverside-San Bernardino-Ontario (52.3 % in July 2020, 95 % CI: 44.9%-59.6 %) and Los Angeles-Long Beach-Anaheim (49.9 % in December 2020, 95 % CI: 44.5%-55.4 %). The lowest distress level was observed in Washington-Arlington-Alexandria ranging from 29.1 % in May 2020 to 39.9 % in November 2020. COVID-19 and its complex ecology of social and economic stressors have engaged high levels of sustained psychological distress. Our findings will support the efforts of local, state and national leadership to plan interventions by addressing not only the medical, but also the economic and social conditions associated with the pandemic.


Subject(s)
COVID-19 , Psychological Distress , Adult , Humans , Incidence , Pandemics , SARS-CoV-2 , Stress, Psychological/epidemiology , United States/epidemiology
19.
Hepatol Commun ; 2020 Jul 21.
Article in English | MEDLINE | ID: covidwho-1204738

ABSTRACT

Background & Aims: Although abnormal liver chemistries are linked to a higher risk of coronavirus disease 2019 (COVID-19)-related death, liver manifestations may be diverse and even confusing. Thus, we performed a meta-analysis of published liver manifestations and described the liver damage in patients with COVID-19 who died or discharged alive. Approach & Results: We searched PubMed, Google Scholar, medRxiv, bioRxiv, the Cochrane Library, Embase, and three Chinese electronic databases through April 22, 2020. We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19, using a fixed or random-effects model. In our meta-analysis of 19 studies, which included a total of 4,103 patients, the pooled mean alanine aminotransferase and aspartate aminotransferase levels were respectively 31.7 and 51.0 IU/L in the patients with COVID-19 who died and 27.7 and 32.9 IU/L in those discharged alive (both p < 0.0001). Compared with the patients discharged alive, those who died tended to have lower albumin levels but longer prothrombin time and higher international standardized ratio. Conclusions: In this meta-analysis, according to the main clinical outcome of COVID-19, we comprehensively described three patterns of liver impairment related to COVID-19, hepatocellular injury, cholestasis, and hepatocellular disfunction. The patients who died from COVID-19 tended to have different liver chemistries from those discharged alive. Special caution should be given to the patients with relatively higher index of liver chemistries.

20.
Ann Emerg Med ; 77(5): 532-544, 2021 05.
Article in English | MEDLINE | ID: covidwho-1038930

ABSTRACT

STUDY OBJECTIVE: Awareness with paralysis is a devastating complication for patients receiving mechanical ventilation and risks long-term psychological morbidity. Data from the emergency department (ED) demonstrate a high rate of longer-acting neuromuscular blocking agent use, delayed analgosedation, and a lack of sedation depth monitoring. These practices are discordant with recommendations for preventing awareness with paralysis. Despite this, awareness with paralysis has not been rigorously studied in the ED population. Our objective is to assess the prevalence of awareness with paralysis in ED patients receiving mechanical ventilation. METHODS: This was a single-center, prospective, observational cohort study on 383 mechanically ventilated ED patients. After extubation, we assessed patients for awareness with paralysis by using the modified Brice questionnaire. Three expert reviewers independently adjudicated awareness with paralysis. We report the prevalence of awareness with paralysis (primary outcome); the secondary outcome was perceived threat, a mediator for development of posttraumatic stress disorder. RESULTS: The prevalence of awareness with paralysis was 2.6% (10/383). Exposure to rocuronium at any point in the ED was significantly different between patients who experienced awareness with paralysis (70%) versus the rest of the cohort (31.4%) (unadjusted odds ratio 5.1; 95% confidence interval 1.30 to 20.1). Patients experiencing awareness with paralysis had higher mean values on the threat perception scale, denoting a higher degree of perceived threat, compared with patients who did not experience awareness with paralysis (13.4 [SD 7.7] versus 8.5 [SD 6.2]; mean difference 4.9; 95% confidence interval 0.94 to 8.8). CONCLUSION: Awareness with paralysis occurs in a significant minority of ED patients who receive mechanical ventilation. Potential associations of awareness with paralysis with ED care and increased perceived threat warrant further evaluation.


Subject(s)
Awareness , Paralysis/psychology , Respiration, Artificial/psychology , Adult , Aged , Anesthesia, General/adverse effects , Anesthesia, General/psychology , Case-Control Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Respiration, Artificial/adverse effects , Surveys and Questionnaires
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