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Objectives: We aimed at examining whether patients with rheumatological conditions receiving chronic hydroxychloroquine therapy are at a lower risk of developing SARS-CoV-2 infection than those not receiving hydroxychloroquine. Method(s): This historical cohort study included information of all patients aged 18 years or older with rheumatoid arthritis, systemic lupus erythematosus, or associated rheumatological conditions (based on International Classification of Diseases, 10th edition, diagnostic codes). A propensity score was calculated for each patient, and each patientwho was receiving hydroxychloroquine was matched to two patients who were not receiving hydroxychloroquine (controls). The primary endpoint was the proportion of patients with PCR-confirmed SARS-CoV-2 infection among those receiving chronic hydroxychloroquine versus the propensity-matched patients not receiving chronic hydroxychloroquine in 2021. Result(s): 322 patients receiving hydroxychloroquine and 645 patients not receiving hydroxychloroquine were included in the primary analysis. The incidence of active SARS-CoV-2 infections during the study period did not differ between patients receiving hydroxychloroquine and patients not receiving hydroxychloroquine ( [0 3%] vs 78 [0 4%] of 21406;odds ratio 0 79, 95% CI 0 52-1 20, p = 0 27). There were no significant differences in secondary outcomes between the two groups of patients who developed active SARS-CoV-2 infection. For all patients in the study, overall mortality was lower in the hydroxychloroquine group than in the group of patients who did not receive hydroxychloroquine (odds ratio hydroxychloroquine was not associated with the development of active SARS-CoV-2 infection (odds ratio 0 79, 95% CI 0 51-1 42) Conclusion(s): Hydroxychloroquine was not associated with a protective effect against SARS-CoV-2 infection in a large group of patients with rheumatological conditions.
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In the context of a developing country like Cameroon characterized by the scarcity of financial resources and the appearance of Covid-19, this article shows that this pandemic was not more important than the pre-existing health problems to the point of giving it more importance in funding compared to strengthening the health system. The theoretical elasticity model of the poverty rate to growth is used to estimate the impact of Covid-19 and the incidence of impoverishing health expenditure is used for the impact of common diseases. It is estimated through direct health payments that common diseases push about 340,865 people into extreme poverty annually. The Covid-19, through the loss of growth generated between 4.8 and 6.6 points according to the optimistic or pessimistic scenarios, would impoverish between 224,193 and 398,565 people: impact on the number of poor ranging from 0.7 to 1.2 times that of all common diseases, i.e., equivalent on average, but sensitive to the speed of spread of the virus and the duration of the crisis while the impact of common diseases is structural and linked to the poorly performing health system. The solutions proposed are endogenous and linked to the impact mechanisms.
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Background: The population of Adults with Congenital Heart Disease (ACHD) is expanding. A significant number will require Cardiac Rhythm Management (CRM) devices. In current UK practice, these patients are routinely seen in non-specialist CRM clinics and little is published regarding best-practice CRM programming and management in the ACHD population. Objective(s): Our objective was to establish a new model of patient-centred/-specific care delivered by specialist CRM physiologists, supported by an EP consultant (with a special interest in ACHD) in a dedicated clinic. We hoped to set new standards of care and patient experience, and improve efficiency and outcomes. Method(s): Data was collected from the electronic record system and CRM device database. A control group of non-ACHD patients was selected at random at our institution over the same period (2018-2022). Result(s): The clinic population n = 468 had a sex ratio of 0.92 (M:F) and mean age of 44 years (range 16 - 86). Mean time since primary implant was 9 years. All device types were represented: loop recorder (52), pacemaker (262), cardioverter defibrillator (116) and cardiac resynchronisation therapy devices (38). The underlying ACHD condition was: simple 46%, moderate 28% and complex 26%. Outcomes of appointments (n = 1,234) are shown vs controls (n = 126) (figure 1). Appointment and patient numbers rose year-on-year (100 to 226 patients, 281 to 367 appointments). There was a lower incidence of 'no review / reprogramming ' in ACHD CRM clinic appointments compared to the non-ACHD population, as well as a higher incidence of programming changes, however the trend over time within the ACHD group showed an increase in 'no review / reprogramming' and a decrease in reviews / reprogramming events. In contrast, non-ACHD patients had an increase in medical reviews and reprogramming required between 2018/19 and 2021/22. This is likely due to the COVID pandemic and deferred time to appointments and review. Conclusion(s): Our data demonstrate that the ACHD CRM population require additional input from the medical and scientist teams when compared to non-ACHD patients, however over time there has been a reduction in major programming/review and a commensurate increase in minor programming/discussion and no review. A reverse trend was observed in the non-ACHD patients pre- and post- COVID. These data support the proposal that specialised clinics provide the optimal management ACHD CRM clinics and should be delivered by dedicated practitioners. [Formula presented]Copyright © 2023
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The new coronavirus infection (COVID-19) caused by the SARS-CoV-2 virus continues to spread rapidly worldwide, despite the increased prevention and treatment measures being taken. Vaccination is one of the most cost-effective and effective methods of preventing infectious diseases in the modern world, including one of the most effective methods of combating COVID-19. Over several centuries of history, vaccination has proven its effectiveness in saving people's lives, reducing the spread of infectious diseases among the population, as well as reducing mortality. The effectiveness of immunization against COVID-19 is an urgent problem at the moment, especially when it comes to vaccination. The aim of the work is to study the effect of vaccination on the incidence of a new coronavirus infection among residents of the Saratov Region. Material and methods. Methods of retrospective epidemiological analysis of trends in the epidemic process COVID-19 were used. The obtained materials were processed using methods of variational statistics (Excel program). The analysis was based on data from daily monitoring of laboratory diagnostic results (more than 1780 thousand PCR diagnostic studies were conducted during the epidemic), COVID-19 cases and deaths, taking into account the coverage of the population with preventive vaccinations. The statistical significance of the differences was assessed according to the Student's criterion. The differences were considered significant at t<=2. Results and discussion. As of June 30, 2021, more than 267 thousand people or 11% of the population of the Saratov region were fully vaccinated against COVID-19. There were no complications after the introduction of vaccines. In the structure of all medical immunobiological preparations that were immunized, the proportion of the vaccine "Gam-COVID-Vac" was 97.88%, "Epivaccorona" - 1.69% and "Covivac" - 0.43%. According to preliminary data, 361 of the vaccinated people were infected with SARS-CoV-2, of which: 255 (70.6%) had a mild course of the disease with manifestations of catarrhal syndrome, 84 (23.3%) had community-acquired pneumonia, 22 (6%) had no symptoms of the disease. No deaths have been registered among the vaccinated. The overall incidence of COVID-19 among vaccinated was 0.06%. The incidence rate of COVID-19 among the vaccinated population is 6.025+/-0.15 per 10 thousand people, which is significantly lower (t>2) than among the unvaccinated (103.8+/-0.63 per 10 thousand people), efficiency index - 17.23, epidemiological efficiency coefficient - 94.20% Conclusion. Insufficient coverage of the population of the Saratov Region with vaccination (as of June 30, 2021, 11% were fully vaccinated) does not allow to influence the reduction of the incidence of COVID-19. The high epidemiological effectiveness of COVID-19 vaccination of the adult population with domestic vaccines, including people over 65 years of age, has been revealed.Copyright © 2022 Geotar Media Publishing Group
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Background & Aims: In early January 2020, a new corona virus called corona was identified as an infectious agent by the World Health Organization and caused a viral pneumonia outbreak, the first of which was reported in Wuhan, China in December 2019. The virus has so far infected most countries in the world and has become a global problem. By this time in December 2021, about 265 million people in the world have been infected with this virus and 5 million 270 thousand people have died from this disease. According to the World Health Organization, the incidence of this disease is still increasing and will become the third leading cause of death in the world by 2030. This disease has a special complexity and has multiple dimensions and consequences that have caused many problems in the field of health, social and economic as well as psychological for people. The emergence of this disease is now a public health crisis. According to this research, exposure to news and restrictions caused by this disease can lead to many mental health problems. In fact, one of the situations that puts a lot of stress on people during the outbreak of covid 19 disease is the inability to predict and uncertainty about the control and end of the disease. Mental health is defined as a harmonious and harmonious behavior with society, recognizing and accepting social realities, the power to adapt to them and meeting one's balanced needs and is an important factor for the health of society. The prevalence of the disease can also increase feelings of loneliness, decrease social support, feelings of fear and anxiety to clinical stress and anxiety, obsessive-compulsive disorder associated with the disease, and decreased life expectancy. One of the hopeful factors is health and the disease can cause despair, fear and even despair of the patient. The outbreak of a disease has a much deeper and wider impact and affects not only the affected community and relatives, but the entire community. Because everyone finds themselves at risk, and therefore people's feel of safe and healthy changes, and this situation causes people to despair. Hope is the capacity to imagine the ability to create paths to desirable goals and to imagine the motivation to move in those paths. Hope predicts physical and mental health such as positive response to medical interventions, mental health, effective getting along, and health-promoting behaviors. Covid 19 disease can also lead to psychological problems due to its infectious nature and unpredictable nature. In this regard, various researchers consider the implementation of public health policies, including areas related to individual and collective mental health in accordance with the different stages of the epidemic of this disease is very necessary. Mindfulness can be an effective tool for achieving peace of mind and body that helps people become aware of their current feelings. Mindfulness-based interventions are considered as one of the third generation or third wave cognitive-behavioral therapies. Mindfulness is a form of meditation rooted in Eastern religious teachings and rituals, especially Buddhism. Segal has defined mindfulness as paying attention to specific and purposeful ways, in the present time, without judgment or prejudice. Linhan stressed for the first time the need to pay attention to mindfulness as one of the essential components of psychological therapy. Mindfulness requires the development of three components: judgment avoidance, purposeful awareness, and focus on the present moment. Focusing on the present and processing all aspects of the above experience makes one aware of the daily activities and automatic functioning of the mind in the past and future world and he controls emotions, thoughts, and physical states through moment-to-moment awareness of thoughts. As a result, it is released from the everyday and automatic mind focused on the past and the future. Although general vaccination has reduced the virus in some countries, including Iran, and reduced the number of infected people, a large num
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Background: COVID-19 infection is a disease caused by severe acute respiratory syndrome coronavirus 2. The manifestations, effects, and severity of the infection are varied in different waves, especially during pregnancy. Material(s) and Method(s): The study was conducted in two equal time periods during the first and second waves. During the first wave, the period of study was between June and August 2020 corresponding to the peak of the first wave, and in the second wave, the study period was between May and July 2021 corresponding to the peak of the second wave. Result(s): A total of 3,791 pregnant women was screened for COVID-19 infection during the first wave and second wave, the pregnant mothers with COVID-19 positive were 4.2 (n = 163) and 5.1% (n = 191), respectively. Around 60% were antenatal mothers and 37% were postnatal mothers who were COVID-19-positive. The predominant age group affected was between 20 and 25 years of age. Gestational diabetes mellitus (GDM), gestational hypertension, anemia, previous lower segment cesarean section (LSCS), postdated pregnancy, and past history of infertility were the high-risk factors observed during the study. Hypoxia was observed in 15% of patients in the second wave. About 49.7% (n = 95) of the COVID-19-positive mothers in the second wave required steroids, anticoagulants, and antiviral drugs. Conclusion(s): The incidence of COVID-19 infection was mild and asymptomatic during the first wave and symptomatic as well as with complications during the second wave. The disease severity, intensive care unit (ICU) admissions, duration of stay, LSCS delivery, and need for antivirals, anticoagulants, and steroids were more during the second wave of COVID-19.Copyright © The Author(s). 2023.
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Background and Aims: The treatment of chronic hepatitis C (CHC) has evolved from genotype-specific to pan-genotypic direct acting antivirals (DAAs) with high efficacy and safety. However, drug-drug interactions (DDIs) must be avoided when used in combination with other medications, especially with the possible concomitant use of COVID-19 infection antivirals during the COVID-19 pandemic. This study aimed to access the potential DDIs of concomitant drugs with pan-genotypic DAAs and COVID-19 infection antivirals, and actual incidence of DDIs in real-world experience. Method(s): From January 2022 to October 2022, consecutive 116 HCV patients receiving pan-genotypic DAAs were retrospectively enrolled in Taipei Veterans General Hospital. The number of comedications and their potential DDIs with three pan-genotypic DAA regimens and three COVID-19 infection antivirals were analyzed. The actual incidence of DDIs during DAAs treatment were also investigated. Result(s): The mean age was 60.9 years old, with male predominant (55.2%). Of them, 12 (10.3%) patients had cirrhosis, and 24 (20.7%) patients had diabetes mellitus. Most patients were within Child-Pugh class A (109/116, 94.0%). The distribution of HCV genotypes was 8.6% in GT 1a, 36.2% in GT 1b, 39.7% in GT 2, 6.9% in GT 6, and 8.6% in indeterminate genotype, respectively. Of them, 43 (37.1%) patients received GLE/PIB, 69 (59.5%) received SOF/VEL 7plusmn;RBV, and 4 (3.4%) received SOF/VEL/VOX as DAAs regimen. Noteworthy, four patients had COVID-19 infection during DAAs treatment course. The rates of ETVR and SVR12 were 97.6% and 95.3%. The mean number of concomitant medications was 2.01. The distribution of concomitant drugs was 64.7% with no concomitant drug, 11.2% with 1-3 drugs, 11.2% with 4-6 drugs, 9.5% with 7-9 drugs, and 3.4% had more than 9 drugs, respectively. In potential contraindicated (red) DDI class, GLE/PIB was the most prevalent (7.3%), followed by SOF/VEL/VOX (6.4%), and SOF/VEL (1.8%) for non-cirrhosis and compensated cirrhosis patients;and no red DDI occurred in decompensated cirrhosis patients. In addition, the percentage of patients without potential DDIs was higher with SOF/VEL (79.8%) than with the other regimens. The potential red DDIs were predominantly with lipid-lowering agents for DAAs. For potential red DDI class with COVID-19 infection antivirals, Nirmatrelvir/Ritonavir was the most prevalent (6%), followed by Remdesivir (0.9%), and no potential DDIs with Molnupiravir. For COVID-19 antivirals, the potential red DDIs was mainly with central nervous system drugs. Finally, the actual incidence of DDIs during DAAs treatment showed no red DDI occurred for all patients, and GLE/PIB was the most prevalent (93%) of no potential DDIs. Conclusion(s): The potential DDIs between these comedications differed, with the most potential DDIs occurring with GLE/PIB and Nirmatrelvir/Ritonavir. After careful assessment of comedications and their potential DDIs, the actual incidence of DDIs could be reduced, and optimize safety in real-world practice.
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[Background] Front-line medical staff are an important group in fighting against Coronavirus Disease 2019 (COVID-19), and their mental health should not be ignored. [Objective] This study investigates the current situation and influencing factors of post-traumatic stress disorder (PTSD) among front-line anti-epidemic medical staff during COVID-19 epidemic. [Methods] Medical staff who had participated in fighting against the COVID-19 epidemic wereselected from three grade III Class A hospitals and four grade II Class A hospitals in a city of Hubei Province by convenient sampling method in May 2020. The survey was conducted online using the Post-traumatic Stress Checklist-Civilian Version (PCL-C) as the main survey tool to investigate current situation and characteristics of PTSD among these participants. A total of 1120 questionnaires were collected, of which 1071 were valid, and the effective rate was 95.6%. [Results] Of the 1071 participants, the average age was (32.59+/-5.21) years;the ratio of male to female was 1: 5.02;the ratio of doctor to nurse was 1:5.8;nearly 70% participants came from grade III Class A hospitals;married participants accounted for 75.4%;most of them held a bachelor degree or above (86.5%);members of the Communist Party of China (CPC) accounted for 22.9%;50.9% had junior titles;the working years were mainly 5-10 years (42.8%);more than 80.0% participants volunteered to join the front-line fight;95.1% participants received family support;43.0% participated in rescue missions;78.1% participants fought the epidemic in their own hospitals;more than 60% participants considered the workload was greater than before;34.4% participants fought in the front-line for 2-4 weeks, and 23.5% participants did for more than 6 weeks. There were 111 cases of positive PTSD syndromes (PCL-C total score >=38) with an overall positive rate of 10.4%, and the scores of reexperience [1.40 (1.00, 1.80)] and hypervigilance [1.40 (1.00, 2.00)] were higher than the score of avoidance [1.14 (1.00, 2.57)]. The results of univariate analysis revealed that PTSD occurred differently among participants grouped by age, political affiliation, working years, anti-epidemic activities location, accumulated working hours in fighting against COVID-19, having child parenting duty, voluntariness, family support, whether family members participated in front-line activities, and rescue mission assignment (P<0.05). The results of logistic regression analysis showed that the incidence rates of reporting PTSD syndromes in medical personnel aged 31-40 years (OR=0.346, 95%CI: 0.164-0.730) and aged 41 years and above (OR=0.513, 95%CI: 0.319-0.823) were lower than that in those aged 20-30 years;the incidence rates of reporting PTSD syndromes in medical staff who were CPC members (OR=0.499, 95%CI: 0.274-0.909), volunteered to participate (OR=0.584, 95%CI: 0.360-0.945), and received family support (OR=0.453, 95%CI: 0.222-0.921) were lower than those did not (P<0.05);the incidence rates of reporting PTSD syndromes among medical workers who had child parenting duty (OR=2.372, 95%CI: 1.392-4.042), whose family members participated in front-line activities (OR=1.709, 95%CI: 1.135-2.575), and who participated in rescue missions (OR=1.705, 95%CI: 1.133-2.565) were higher than those who did not (P<0.05). [Conclusion] The positive PTSD syndrome rate is 10.4% in the front-line anti-epidemic medical staff. Age, political affiliation, voluntariness, family support, having child parenting duty, with a family members participating in the fight, and rescue mission assignment are the influencing factors of PTSD.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.
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Introduction: Patients with inflammatory bowel disease (IBD) harbor a higher risk of deep venous thrombosis and venous thromboembolism (VTE) compared to healthy individuals. Previous studies, including a large meta-analysis, estimate the risk of VTE incidence to be almost 2-3 times baseline. Guidelines, therefore, recommend VTE prophylaxis in most inpatients with IBD. While previous studies have demonstrated less than ideal adherence with these guidelines, we sought to determine the rate of VTE prophylaxis at an academic medical center. Method(s): A retrospective chart review of inpatients with Crohn's disease or ulcerative colitis admitted to a tertiary medical center in Bronx, NY from 1/2015 to 2/2020 was performed. All patients who were admitted with a primary gynecological or psychiatric disorder, COVID infection, or known hypercoagulable disorder were excluded. Orders for pharmacologic and mechanical VTE prophylaxis at any point during the patient's admission were ed. Using ICD10 codes, IBD patients with acute VTE variations were identified. Clinical and demographic variables were analyzed for their association with VTE prophylaxis. Two-sample t-tests and Fisher's exact tests were used as appropriate. A p-value < 0.05 was considered statistically significant. Result(s): A total of 1670 patients with IBD were identified among whom 1280 (76.7%) were prescribed either pharmacological or mechanical VTE prophylaxis during their hospital admission. 70 patients were excluded from the analysis of development of VTE because their diagnosis of VTE was prior to their admission date. Older age (p<.0001), higher BMI (p<.0001), female sex (p=.001), havingMedicare insurance (p<.0001) were associated with VTE prophylaxis ordering (see Table). There was a VTE incidence of 6.2% (n=98/1600) of the IBD patients in our cohort, with 3/388 patients (0.8%) not being prescribed prophylaxis and 95/1212 (7.8%) being prescribed prophylaxis (p< 0.001). Conclusion(s): Contrary to other studies, we show that VTE prophylaxis rates may not be associated with a reduction in VTE incidence during hospitalization. While bias by indication may be contributing to this finding with those at greatest risk more likely to receive prophylaxis, other factors may be involved. Further studies are warranted. (Table Presented).
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Introduction: Hepatocellular carcinoma (HCC) comprises the majority of primary liver cancer and has a poor prognosis. Clivus metastasis is rare with only a few reported cases in the medical literature. We report a case of a patient who presented with clival mass found to have metastatic HCC. Case Description/Methods: A 63-year-old woman presented for neurosurgical evaluation after she was found to have a skull base mass on computerized tomography (CT) of the head at an outside hospital. She endorsed dysphagia for three months, however denied headaches or visual disturbances. A magnetic resonance imaging (MRI) revealed a 5.4 cm by 2.9 cm by 3.6 cm mass in the clivus, which was deemed as the cause of dysphagia (Figure 1a). The patient subsequently underwent an endoscopic transsphenoidal resection of the clival mass. Histopathology from the tissue revealed a hepatoid carcinoma, concerning for metastatic HCC (Figure 1b and 2c). Immunohistochemical strains were positive for hepatocytic marker arginase-1 (Figure 1d). Laboratory studies revealed alpha fetoprotein (AFP) of 56,344 ng/mL, CA-125 of 376 ng/mL, normal B-HCG and carcinoembryonic antigen (CEA). Thereafter, a triple phase CT of the liver revealed two LI-RADS 5 lesions suggestive of HCC as the primary malignancy. Patient's case was discussed at multidisciplinary tumor board with recommendations for systemic immunotherapy with atezolimumab plus bevacizumab and radiation therapy to the clivus. Discussion(s): The incidence of HCC has almost tripled since the 1980s making it the fastest rising cause of cancer related deaths. Metastasis to the brain comprises 0.26% to 2.2% of cases and the skull base is the most rarely affected anatomical site. Although CNS presentation is rare, we may see more neurological manifestations of metastatic HCC with the persistence of chronic hepatitis infections, the rise of metabolic diseases such as NASH, and an increase in alcohol-related liver disease during the COVID-19 pandemic. Although exceedingly rare, metastasis to the clivus should be considered in the differential diagnosis of skull base masses. Despite detection and treatment, prognosis remains poor and emphasis should be placed on consistent HCC surveillance. This case emphasizes that skull masses must be evaluated diligently as they can be the first sign of underlying liver malignancy. Given the morbidity and mortality associated with HCC, recognition of atypical manifestations of HCC can lead to a prompt diagnosis and initiation of life-saving treatment. (Figure Presented).
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Background: The COVID-19 pandemic disproportionally affected Black communities who were at greater risk of SARS-CoV-2 acquisition, morbidity, and mortality than those of White ethnicity. We describe the clinical epidemiology of COVID-19 in the GEN-AFRICA cohort of Black people with HIV in two South London clinics. Method(s): First reported episodes of COVID-19 up to 12/2021 were ascertained by direct questioning and/or medical records review. The cumulative incidence of COVID-19 and vaccination was determined by Nelson- Aalen methods. Pre-pandemic immunovirological and comorbidity status obtained prior to 01/2020 was used to identify risk factors for COVID-19 using Cox regression. We compared characteristics of participants with mild/ moderate (not requiring hospitalization) and severe (requiring hospitalization or resulting in death) COVID-19. Result(s): COVID-19 status was available for 1184 (95%) of 1289 GEN-AFRICA participants (mean age 49.1 years;55% female;median CD4 565;93% HIV RNA <200), and SARS-CoV-2 vaccination status for 1160;998 (86%) had received at least one vaccine dose (administered to 50% by 16/02/2021). A total of 310 participants (26.2%) reported a first episode of COVID-19 (any severity), with a cumulative incidence of 6%, 14%, 15% and 22% following the initial, alpha, delta, and omicron waves. Women, people of East African ancestry, and those with detectable HIV RNA were more likely to report COVID-19 (Table). CD4 (current/nadir), class of antiretroviral therapy (ART), and comorbidity status were not associated with COVID-19. Findings were similar when restricted to episodes in 2020 (prior to vaccine availability) or testconfirmed COVID-19. Severe COVID-19 cases (N=34) were more often male (p=0.002), of West-African ancestry (p=0.01), with lower CD4 cell counts (p=0.002), and they more often had a history of AIDS, diabetes mellitus, cardiovascular disease, and chronic kidney disease (all p=0.001) compared to mild/moderate cases;they were also more likely to be on protease inhibitor (PI)- containing ART (p=0.01). Conclusion(s): By the end of the second year of the pandemic, 22% of black people with HIV in South London had experienced COVID-19. Immune and comorbidity status were not associated with COVID-19 when all cases were considered but strongly associated with severe COVID-19 disease, as were West-African ancestry and being on a PI. (Table Presented).
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Background: The incidence of maternal morbidity and mortality gets reduced if antenatal care (ANC) is provided since it focuses on providing birth preparedness, good health maintenance measures, and awareness regarding pregnancy complications as well as danger signs.Methodology: The present study was conducted in the selected 10 villages in the Bahadarbad block of Haridwar (Uttarakhand). 479 out of 580 pregnant women (who had visited Antenatal Health Camps), responded to the questionnaire thus, leading to a response rate of 82.8%. Most respondents, i.e. 96% (n=461), were 21-30 years old. Result: Out of 461 pregnant women, only 45% visited Antenatal Health Camps and 58% were found anemic. The study also indicated that of the pregnant women who visited Antenatal Health Camps during this period, more than 72% of women gave their previous birth in less than two years. Only 15% of women obtained complete ANC (4 Visits) during the study period, just half of the previous year's coverage (31%) for the same duration. The study found that home deliveries increased significantly during the lockdown period. From April to June 2020, the percentage of home deliveries was 41% while from July to December 2020 it was 24%.Conclusion: The study suggested reduced utilization of ANC services during the pandemic and significant factors were women's age, residence, educational status, repurposing of maternity healthcare services, fear of COVID-19 transmission, and transportation disruptions. Thus, efforts should be taken to enhance maternal health services.
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Background: Studies have suggested that myocardial damage due to severe acute respiratory syndrome-2 (SARS-CoV-2), commonly referred to as COVID-19, may increase the risk of arrhythmias. Objective(s): To compare the one-year incidence of atrial fibrillation (AF) among patients with COVID-19 as compared to patients with non-COVID-19 acute upper respiratory infection (AURI). Method(s): The Optum Clinformatics database, an administrative claims databaseof commercially insured beneficiaries in the United States (US), was used for study purposes. Three cohorts of patients were identified: patients with COVID-19 diagnosis in any setting (April 2020-June 2021);patients with AURI in the pandemic period (April 2020-June 2021);and patients with AURI in the pre-pandemic period (January 2018-December 2018). Patients with prior AF diagnosis were excluded from each cohort. Three sets of analysis comparing AF incidence were performed: COVID-19 cohort vs AURI pandemic cohort;COVID-19 cohort vs AURI pre-pandemic cohort;and AURI pandemic cohort vs AURI pre-pandemic cohort. For each of the three comparisons, a matching weight method was used to help ensure balance among groups on baseline socio-demographic and clinical comorbidities. Logistic regression was used to assess the odds of 1-year incident AF among matched patients. Result(s): When comparing the matched COVID-19 (n=102,227) and AURI pandemic (n=102,101) cohorts, one-year incidence of AF was significantly higher in the COVID-19 cohort (2.2% vs 1.2%;p<0.001), who were 83% more likely to develop AF (odds ratio [OR] 1.83;95% confidence interval [CI] 1.72-1.95) as compared to the AURI group. COVID-19 patients were also observed to have significantly higher risk of incident AF as compared to AURI pre-pandemic cohort (2.7% vs 1.6%;p<0.001;OR 1.70, 95% CI 1.63-1.78). No significant difference was observed in AF incidence among the AURI pandemic versus AURI pre-pandemic cohort (1.1% vs 1.2%;p=0.133;OR 0.95, 95% CI 0.90-1.01). Figure 1 depicts differences in AF incidence across the comparator cohorts. Conclusion(s): Patients with COVID-19 were observed to have a higher incidence of AF as compared to those with upper respiratory infections. Awareness amongst clinicians of an increased AF incidence in COVID-19 affected patients appears warranted. [Formula presented] French language not detected for EMBFRA articles source xmlCopyright © 2023
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Background/Aims The COVID-19 pandemic abruptly changed healthcare delivery. This study describes the impact the pandemic had on time to referral and diagnosis of inflammatory arthropathies (IA), including rheumatoid arthritis (RA) and juvenile inflammatory arthritis (JIA), in patients presenting in primary care with musculoskeletal problems. Methods Data from the Clinical Practice Research Datalink (CPRD) Aurum were analysed from 01/04/17 to 01/10/2021 to describe episodes of care for patients with musculoskeletal conditions for pre-COVID-19 (01/04/ 2017-31/03/2020), peri-COVID-19 (01/04/2020-31/07/2021), and post- COVID-19 lockdown (01/08/2020-31/10/2021) periods. Prevalent and incident musculoskeletal consultations were determined. Referrals were matched to these consultations. Trends in referrals to musculoskeletal services and further incident diagnoses of IA were described using Joinpoint Regression and comparisons made between timeperiods. Negative binomial regression was used to compare incident rates between time-periods of: RA/JIA/IA diagnosis and referral from first musculoskeletal consultation;and RA/JIA/IA diagnosis from first referral. The number of consultations between first musculoskeletal consultation and referral/diagnosis were described. Results were adjusted for age and sex and further stratified by geographical region and deprivation. Results The incidence rate of RA and JIA reduced by average -13.32% (from 31.98 per 1,000,000 to 17.15 per 1,000,000) and -17.43% (from 1.77 per 1,000,000 to 0.97 per 1,000,000) per month respectively between January 2020 and April 2020, then increased by 1.9% (from 17.15 per 1,000,000 to 25.22 per 1,000,000) and 3.7% (from 0.97 per 1,000,000 to 1.28 per 1,000,000) per month respectively between April 2020 and October 2021. Referral incidence decreased between February 2020 and May 2020 by -16.8% per month in patients presenting with a musculoskeletal condition. After May 2020, referrals increased significantly (16.8% per month) July 2020. Time from first musculoskeletal consultation to RA diagnosis, and referral to RA diagnosis increased in the peri-COVID-19 period (IRR 1.11, 95%CI 1.07-1.15;IRR 1.23, 95%CI 1.17-1.30) and remained consistent in the post- COVID-19 (IRR 1.13, 95%CI 1.11-1.16;IRR 1.27, 95%CI 1.23-1.32) periods respectively, compared to the pre-COVID-19 period. Similarly, number of consultations between first musculoskeletal consultation and referral/RA diagnosis reduced significantly in the peri-COVID-19 (IRR 0.92, 95%CI 0.88-0.96) and post-COVID-19 (IRR 0.92, 95%CI 0.90-0.95) periods. No change was observed between first musculoskeletal consultation and first referral. Similar results were observed for IA but not for JIA. Conclusion Patients with RA/JIA onset during the pandemic may be yet to present or are currently transitioning through referral and diagnosis. Primary care clinicians should remain alert to possible IA diagnosis and consider fast-track referral pathways where indicated. Patients developing incident episodes of IA may display a prodrome of other musculoskeletal symptoms and conditions, which alone may not warrant referral but in combination require further investigation. Commissioners should be alert to these findings to allow for the appropriate planning and commissioning of services.
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Objective To investigate the mental health status of military healthcare workers in shelter hospitals in Shanghai during the epidemic caused by severe acute respiratory syndrome coronavirus 2 omicron variant and its influencing factors. Methods A total of 540 military healthcare workers in shelter hospitals in Shanghai were investigated with patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Athens insomnia scale (AIS) to explore their mental health status, and logistic regression was used to analyze the influencing factors. Results A total of 536 valid questionnaires were collected, with an effective rate of 99.3% (536/540). The incidence of depression, anxiety and insomnia among military healthcare workers in shelter hospitals in Shanghai was 45.5% (244/536), 26.1% (140/536) and 59.5% (319/536), respectively. Logistic regression analysis showed that whether people resided in Shanghai, the proportion of negative information in daily browsing information and diet status in shelter hospitals were the influencing factors of depression, anxiety and insomnia (all P<0.05);age and confidence in the future of Shanghai were the influencing factors of depression and insomnia (all P<0.05);and the time spent daily on epidemic-related information was an influencing factor of insomnia (P=0.021). Conclusion The incidence of depressive, anxiety and insomnia among military healthcare workers in shelter hospitals in Shanghai is high during the epidemic caused by severe acute respiratory syndrome coronavirus 2 omicron variant. Psychological consequences of the epidemic should be monitored regularly and continuously to promote the mental health of military healthcare workers.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Background: Pregnant individuals are at increased risk of coronavirus disease 2019 (COVID-19) hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population. Method(s): Among a cohort of pregnant individuals who received prenatal care at 3 healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for severe acute respiratory syndrome coronavirus 2 circulation;model covariates included site, age, race, ethnicity, insurance status, prepregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction. Result(s): Among 19 456 pregnant individuals with an estimated due date during 1 March 2020-28 February 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (adjusted hazard ratio [aHR], 2.7 [95% confidence interval {CI}, 1.3-5.5]), Native Hawaiian or Pacific Islander race (aHR, 12 [95% CI, 3.2-45.5]), age <25 years (aHR, 3.1 [95% CI, 1.3-7.6]), prepregnancy obesity (aHR, 2.1 [95% CI, 1.1-3.9]), diagnosis of a metabolic disorder (aHR, 2.2 [95% CI, 1.2-3.8]), lung disease excluding asthma (aHR, 49 [95% CI, 28-84]), and cardiovascular disease (aHR, 2.6 [95% CI, 1.5-4.7]). Conclusion(s): Although hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination. Copyright © 2022 Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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Intro: The COVID-19 pandemic has triggered global collaborative efforts on response and research to detect SARS-CoV-2 particles not just in the human population but also in wastewater. While the examination of clinical samples from COVID-19 patients links SARS-CoV-2 to specific individuals, the analysis of an amalgam of human feces through environmental surveillance (ES) links SARSCoV-2 to populations and communities served by the wastewater system. Studies on SARS-CoV-2 in the environment were already done in high-resource countries. However, its epidemiology in wastewater bodies in the Philippines is limited. In this study, we used the National ES for Polio and Other Pathogens Network to investigate the molecular epidemiology and transmission dynamics of SARS-CoV-2 at the outset of the pandemic. Method(s): This is a retrospective study of 250 wastewater samples collected from May 2020 to July 2021. Samples were processed using the two-phase concentration technique. Pepper mild mottle virus RNAs were quantified as the internal control. Real-time PCR was used to detect the N-gene of the SARS-CoV-2. Whole genomes were sequenced using the COVID-19 ARTIC v4.0. Phylogenetic and mutation analysis were done and lineage assignments were established using the PANGOLIN software. Finding(s): Forty-two percent (107/250) of the environmental samples detected SARS-CoV-2 particles. Fifty-nine samples with Ct values <=38 were sequenced and the whole genome analysis revealed B.1.1 and B.6. lineages of SARS-CoV-2. When viral load were plotted with the weekly cases in the respective site, we observed that SARS-CoV2 can be detected in wastewater weeks before the spike of cases in the community. Conclusion(s): This is the first report on the detection of B.1.1 and B.6 SARS-CoV-2 particles in waste/surface waters in the Philippines. With the declining incidence of COVID-19 cases, this study provided data regarding the feasibility of establishing environmental surveillance for SARS-CoV-2 as a supplemental tool for human or case monitoring especially in resource-limited settings.Copyright © 2023
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Ziel/Aim We aimed at evaluating the incidence of SARS-CoV2 vaccine-related axillary and supraclavicular hypermetabolic lymphadenopathy (HLA) and evaluate which timepoint produces the least number of false-positive findings in HLA. Methodik/Methods For this retrospective, multi-center imaging study patients with any form of SARS-CoV2 vaccination prior to 18F-FDG-PET/CT between January 2021 and December 2021 were included. Patients were divided into six groups according to the timepoint of vaccination prior to 18F-FDG-PET/CT imaging: Group 1 (0-6 Days), Group 2 (7-13 Days), Group 3 (14-20 Days), Group 4 (21-27 Days), Group 5 (28-34 Days) and Group 6 (35-80 Days). As reference SUVmax of mediastinal blood pool (MBP) and SUVmax contralateral reference lymph node (RL) were determined. For each group, the following parameters were assessed. A) absolute SUVmax of HLA B) incidence of HLA [defined as the ratio of SUVmaxHLA/ SUVmax Mediastinal Blood Pool (rHLA/MBP)] greater than 1,5 C) rHLA/MBP D) ratio SUVmax HLA vs. SUVmax contralateral reference lymph node (rHLA/RL). Ergebnisse/Results HLA showed the highest incidence in Group 1(day 0-6) 16/23 (70 %). Similarly, SUVmax HLA and rHLA/MBP were highest in this group, SUVmax 4.97 +/- 4.1 and 2.58 +/- 2.1 respectively. The incidence of HLA, SUVmax HLA, and rHLA/MBP were higher in Group 3 (14-20 days) than in Group 2 (7- 13days);57 % vs 44 %;5.05 +/- 4.33vs 3.9 +/- 2.81 (p = 0.723 and 2.32 +/- 1.8 vs 1.83 +/- 1.38(p = 0.788). All parameters for HLA dropped markedly after at least 21 days of vaccination. There were no significant differences in SUVmax HLA, rHLA/MBP and rHLA/RL in group 4 (21-27 days), group 5 (28-34 days) and group 6 (35-80 Days). [1] Schlussfolgerungen/Conclusions It is crucial for diagnostic physicians to assess the recent history of COVID-19 vaccination prior to FDG-PET/CT scan to reduce the risk of false-positive calls. If feasible, FDG PET should be postponed by at least 3 weeks after SARS-CoV2 vaccination especially if an accurate evaluation of axillary status is required.
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Before reopening society in December 2022, China had not achieved sufficiently high vaccination coverage among people aged 80 years and older, who are vulnerable to severe infection and death owing to COVID-19. Suddenly ending the zero-COVID policy was anticipated to lead to substantial mortality. To investigate the mortality impact of COVID-19, we devised an age-dependent transmission model to derive a final size equation, permitting calculation of the expected cumulative incidence. Using an age-specific contact matrix and published estimates of vaccine effectiveness, final size was computed as a function of the basic reproduction number, R0. We also examined hypothetical scenarios in which third-dose vaccination coverage was increased in advance of the epidemic, and also in which mRNA vaccine was used instead of inactivated vaccines. Without additional vaccination, the final size model indicated that a total of 1.4 million deaths (half of which were among people aged 80 years and older) were anticipated with an assumed R0 of 3.4. A 10% increase in third-dose coverage would prevent 30,948, 24,106, and 16,367 deaths, with an assumed second-dose effectiveness of 0%, 10%, and 20%, respectively. With mRNA vaccine, the mortality impact would have been reduced to 1.1 million deaths. The experience of reopening in China indicates the critical importance of balancing pharmaceutical and non-pharmaceutical interventions. Ensuring sufficiently high vaccination coverage is vital in advance of policy changes. ©2023 the Author(s)
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Background: COVID-19 tends to have a harsher course in the elderly population, which can include the development of arrhythmias, including supraventricular tachycardia (SVT). Due to lack of sufficient data, we studied baseline patient characteristics, comorbidities, and outcomes of SVT in octogenarians admitted with COVID-19, using the 2020 National Inpatient Sample (NIS). Objective(s): We aimed to study the patient characteristics and outcomes of SVT in octogenarians admitted with COVID-19, using the 2020 National Inpatient Sample (NIS). Method(s): Octogenarians (ages 80-89 years, inclusive) with COVID-19 were recruited from the 2020 NIS (April 1st 2020 - December 31st 2020). A diagnosis of SVT was identified via the ICD-10 code "I47. 1". Patient characteristics that can influence the presence of SVT were identified via logistic regression models. The adjusted odds ratios (aOR) having cardiogenic shock or mortality among COVID-19 positive octogenarians with SVT were also explored. Result(s): Our study consisted of 240570 octogenarians who tested positive for COVID-19. 2.2% of them (5250 cases) also had a diagnosis of SVT during their hospitalization. Among them, Females (aOR 0.919, 95%CI 0.868-0.973, p<0.01) were more likely to develop SVT. Racial disparities were also observed as Blacks (aOR 1.234, 95%CI 1.137-1.338, p<0.01) had higher odds of having SVT, whereas Hispanics (aOR 0.898, 95%CI 0.819-0.984, p=0.021) had lower odds compared to Whites. Comorbidities such as chronic pulmonary disease (aOR 1.106, 95%CI 1.037-1.179, p<0.01), and heart failure (aOR 1.122, 95%CI 1.053-1.195, p<0.01) also led to higher odds of SVT. Lower odds were seen among those with diabetes (aOR 0.852, 95%CI 0.802-0.905, p<0.01), obesity (aOR 0.839, 95%CI 0.764-0.921, p<0.01), or smoking history (aOR 0.892, 95%CI 0.835-0.954, p<0.01). The use of mechanical ventilation (aOR 2.829, 95%CI 2.638-3.034, p<0.01) or non-invasive ventilation (aOR 1.755, 95%CI 1.615-1.907, p<0.01) showed higher odds of developing SVT. Finally, patients with SVT had increased risk of cardiogenic shock (aOR 1.510, 95%CI 1.206-1.891, p<0.01) and mortality (aOR 1.166, 95%CI 1.085-1.253, p<0.01). Conclusion(s): Multiple factors influenced the presence of SVT among octogenarians who had COVID-19. SVT in these patients was associated with higher incidences of cardiogenic shock and mortality. Additional focus targeting patient care and further research to better understand the mechanisms behind these variations may help improve outcomes. [Formula presented]Copyright © 2023