ABSTRACT
Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.
Subject(s)
COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adult , COVID-19/physiopathology , Cesarean Section , Cough/physiopathology , Female , Fetal Growth Retardation/epidemiology , Fetal Membranes, Premature Rupture/epidemiology , Headache/physiopathology , Hospitalization , Hospitals, Maternity , Humans , Labor, Induced , Obstetric Labor, Premature/epidemiology , Portugal/epidemiology , Postpartum Hemorrhage/epidemiology , Pregnancy , Pregnancy Outcome , Premature Birth/epidemiology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Stillbirth/epidemiology , Vacuum Extraction, ObstetricalABSTRACT
Introducción. La infección causada por el SARS-CoV-2 puede producir un cuadro inflamatorio severo, sepsis, falla respiratoria, disfunción orgánica, y muerte. Es plausible fisiopatológicamente, que los corticoides sean una opción terapéutica razonable para Covid-19. Sin embargo, la evidencia del efecto benéfico de los corticoides sobre la mortalidad no es categórica. Objetivo: determinar si existe evidencia que avale el uso de corticoides parenterales en Covid-19 grave y Síndrome de Distrés Respiratorio Agudo (SDRA). Material y método: Este estudio se desarrolló en concordancia con la guía PRIMA. Según la estrategia PICO, nuestra Población fueron los pacientes con Covid-19 grave y/o SRDA; la Intervención, el uso de corticoides parenterales; el Comparador, los pacientes con Covid-19 severo con tratamiento estándar (sin corticoides); y el Outcome, la mortalidad y otros resultados clínicos. La búsqueda se realizó en las bases de datos PubMed, Medline, Cochrane, Embase, y LILACS usando los términos relacionados con nuestra pregunta PICO, entre el de 01 enero al 31 de agosto del 2020. Se logró recopilar un total de 287 artículos, de los que finalmente se seleccionaron 9 que cumplieron con los criterios PICO y de selección. Resultados: Según nuestro estudio, los corticoides parenterales reducen la mortalidad en pacientes con Covid-19 severo y SRDA[OR 0.83 (IC 95% 0.63-1.08)]. Conclusión: la revisión sistemática muestra que los corticoides parenterales podrían disminuir la mortalidad de pacientes con Covid-19 severo y ARDS.
Introduction. Infections caused by SARS-CoV-2 may produce a severe inflammatory response,sepsis, respiratory failure, organ dysfunction, and death. From a pathophysiological point of view, it is plausible that glucocorticoids could be a reasonable therapeutic option for Covid-19. However, the evidence supporting the benefit of corticosteroids on mortality and other clinical outcomes is no tconclusive. Objective: determinate if there exist evidence supporting corticosteroids therapy in patients with severe Covid-19 and Acute Respiratory Distress Syndrome (ARDS). Material and method: This study was performed in concordance with PRISMA guidelines. According to the PICO strategy, Population were patients with severe Covid-19 and/or ARDS; Intervention, parenteral corticosteroid administration; Comparator, patients with severe Covid-19 and/or ARDS with standard treatment (without corticosteroids); and Outcome, mortality and other clinical outcomes. Search strategy was performed in the data bases PubMed, Medline, Cochrane, Embase, and LILACS, using terms related with the PICO question; from January 1 to august 31 (2020). A total of 287 articles were initially retrieved. Of these, we finally selected only 9 article which fulfilled with PICO and selection criteria. Results: According to our study, parenteral corticosteroids reduce mortality in patients with Severe Covid-19 and/or ARDS [OR 0.83 (IC 95% 0.63-1.08)]. Conclusion: the systematic review shows that parenteral corticosteroids could reduce the mortality of patients with severe Covid-19 and ARDS.
ABSTRACT
Background: Puerto Rico has experienced the full impact of the COVID-19 pandemic. Since SARS-CoV-2, the virus that causes COVID-19, was first detected on the island in March of 2020, it spread rapidly though the island's population and became a critical threat to public health. Methods: We conducted a genomic surveillance study through a partnership with health agencies and academic institutions to understand the emergence and molecular epidemiology of the virus on the island. We sampled COVID-19 cases monthly over 19 months and sequenced a total of 753 SARS-CoV-2 genomes between March 2020 and September 2021 to reconstruct the local epidemic in a regional context using phylogenetic inference. Results: Our analyses reveal that multiple importation events propelled the emergence and spread of the virus throughout the study period, including the introduction and spread of most SARS-CoV-2 variants detected world-wide. Lineage turnover cycles through various phases of the local epidemic were observed, where the predominant lineage was replaced by the next competing lineage or variant after ~4 months of circulation locally. We also identified the emergence of lineage B.1.588, an autochthonous lineage that predominated in Puerto Rico from September to December 2020 and subsequently spread to the United States. Conclusions: The results of this collaborative approach highlight the importance of timely collection and analysis of SARS-CoV-2 genomic surveillance data to inform public health responses.
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The term Gain-of-Function (GoF) describes the gain of new functions by organisms through genetic changes, which can naturally occur or by experimental genetic modifications. Gain-of-Function research on viruses is enhancing transmissibility, virus replication, virulence, host range, immune evasion or drug and vaccine resistance to get insights into the viral mechanisms, to create and analyze animal models, to accelerate drug and vaccine development and to improve pandemic preparedness. A subset is the GoF research of concern (GOFROC) on enhanced potentially pandemic pathogens (ePPPs) that could be harmful for humans. A related issue is the military use of research as dual-use research of concern (DURC). Influenza and coronaviruses are main research targets, because they cause pandemics by airborne infections. Two studies on avian influenza viruses initiated a global debate and a temporary GoF pause in the United States which ended with a new regulatory framework in 2017. In the European Union and China, GoF and DURC are mainly covered by the legislation for laboratory safety and genetically modified organisms. After the coronavirus outbreaks, the GoF research made significant advances, including analyses of modified MERS-like and SARS-like viruses and the creation of synthetic SARS-CoV-2 viruses as a platform to generate mutations. The GoF research on viruses will still play an important role in future, but the need to clarify the differences and overlaps between GoF research, GOFROC and DURC and the need for specialized oversight authorities are still debated.
Subject(s)
COVID-19 , Influenza, Human , Animals , Gain of Function Mutation , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics/prevention & control , SARS-CoV-2/genetics , United StatesABSTRACT
Background: Neurological complications during and after SARS-CoV-2 infection have been frequently described. The detection of either SARS-CoV-2 RNA or specific antibodies against SARS-CoV-2 in cerebrospinal fluid in the context of concomitant neurological manifestations indicates neuroinfection. Methods and Results: This is a retrospective descriptive analysis of cerebrospinal fluids and serum samples from 2 hospitalized patients and autopsy findings from 2 patients who died at home. Samples were analysed by 3 independent enzyme-linked immunosorbent assays. Specific antibodies against SARS-CoV-2 were detected in cerebrospinal fluids and paired serum in all 4 cases. Levels of antibodies in cerebrospinal fluids were highest in samples from a deceased man with critical progression of COVID-19 and detectable SARS-CoV-2 viral RNA in cerebrospinal fluid, serum, 4 brain biopsies and 15 additional tissue samples, though immunohistochemical staining for SARS-CoV-2 in brain tissue did not detect the virus. Conclusion: Detection of SARS-CoV-2 antibodies in paired serum and cerebrospinal fluid may support the presence of SARS-CoV-2 neuroinflammatory disease in patients with COVID-19 and neurological manifestations.
ABSTRACT
Long COVID, in which disease-related symptoms persist for months after recovery, has led to a revival of the discussion of whether neuropsychiatric long-term symptoms after viral infections indeed result from virulent activity or are purely psychological phenomena. In this review, we demonstrate that, despite showing differences in structure and targeting, many viruses have highly similar neuropsychiatric effects on the host. Herein, we compare severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus 1 (HIV-1), Ebola virus disease (EVD), and herpes simplex virus 1 (HSV-1). We provide evidence that the mutual symptoms of acute and long-term anxiety, depression and post-traumatic stress among these viral infections are likely to result from primary viral activity, thus suggesting that these viruses share neuroinvasive strategies in common. Moreover, it appears that secondary induced environmental stress can lead to the emergence of psychopathologies and increased susceptibility to viral (re)infection in infected individuals. We hypothesize that a positive feedback loop of virus-environment-reinforced systemic responses exists. It is surmised that this cycle of primary virulent activity and secondary stress-induced reactivation, may be detrimental to infected individuals by maintaining and reinforcing the host's immunocompromised state of chronic inflammation, immunological strain, and maladaptive central-nervous-system activity. We propose that this state can lead to perturbed cognitive processing and promote aversive learning, which may manifest as acute, long-term neuropsychiatric illness.
ABSTRACT
(1) Background: Coronavirus disease, also called COVID-19, is a worldwide pandemic with a major impact on all aspects of the individual (health status, psychological, and economic aspects, among others). The perception of health professionals in this situation has been influenced by their economic and psychosocial situations. On the economic level, self-employed workers have no state subsidies, with the added disadvantage of not having sufficient means to cope with contagion. This could potentially have an impact on their health and indirectly on their family members, creating additional stress. The aim of this study was to determine whether there are differences in the level of anxiety of health professionals working in private practice compared to healthcare workers working in public institutions during the first three waves of COVID-19. (2) Methods: A cohort study on 517 subjects comparing anxiety between a group of health workers and a group of health professionals working in the public sector at three key moments during the pandemic was performed. (3) Results: Statistically significant differences were found between self-employed private health professionals compared to those working as public health workers. The perception of impact was worse in the self-employed; however, a higher level of anxiety was evident in public employees in all assessed domains (cognitive, physiological, and motor, p = 0.001). (4) Conclusions: There were significant changes when comparing the first phase between both groups; employed public healthcare workers manifested a sense of lower risk of COVID-19 contagion than privately employed professionals, who had a higher level of anxiety. In the second and third waves, negative feelings improved for both groups, and the fear of showing anxiety to the patient decreased over the course of the waves.
ABSTRACT
Emerging infectious diseases (EIDs) can be responsible for epidemics or even pandemics that disrupt societies and cause national and international crises. In our globalized world, anarchic urbanization, ecosystem disruptions (deforestation, creation of dams ), changes in crop and livestock farming conditions, the increasing availability of air transport, population displacement and climate change are all factors that favor the occurrence and spread of emerging or re-emerging pathogens such as SARS-Cov, MERS-CoV, Ebola, Zika, influenza, or more recently SARS-CoV-2 and Monkeypox. States, regional and international organizations, health and research agencies, non-governmental organizations and the pharmaceutical industry are today challenged by the repetition of these crises and their consequences on health, social, economic and political balances. For the past fifteen years, we have clearly been in a new regime of infectious emergence and re-emergence. This new regime calls for new responses, to meet in the urgency the challenges of emergency epidemic crises and to better respond to the issues of crisis management in a context of "One Health". Research is an essential pillar in the response to these epidemics with a double challenge: (i) to improve knowledge on the disease, its prevention, treatment, diagnosis, impact on society. and (ii) to prepare for and understand future emergencies, "anticipate". As epidemics have occurred over the last fifteen years, French research has been organized and has evolved to respond to these crises, from the genesis of REACTing in 2011, to the creation of the ANRS Emerging Infectious Diseases in 2021.