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1.
Journal of Clinical Outcomes Management ; 29(5):39-48, 2022.
Article in English | EMBASE | ID: covidwho-2067257

ABSTRACT

Objective: The COVID-19 pandemic has been a challenge for hospital medical staffs worldwide due to high volumes of patients acutely ill with novel syndromes and prevailing uncertainty regarding optimum supportive and therapeutic interventions. Additionally, the response to this crisis was driven by a plethora of nontraditional information sources, such as email chains, websites, non-peer-reviewed preprints, and press releases. Care patterns became idiosyncratic and often incorporated unproven interventions driven by these nontraditional information sources. This report evaluates the efforts of a health system to create and empower a multidisciplinary committee to develop, implement, and monitor evidence-based, standardized protocols for patients with COVID-19. Method(s): This report describes the composition of the committee, its scope, and its important interactions with the health system pharmacy and therapeutics committee, research teams, and other work groups planning other aspects of COVID-19 management. It illustrates how the committee was used to demonstrate for trainees the process and value of critically examining evidence, even in a chaotic environment. Result(s): Data show successful interventions in reducing excessive ordering of certain laboratory tests, reduction of nonrecommended therapies, and rapid uptake of evidence-based or guidelines-supported interventions. Conclusion(s): A multidisciplinary committee dedicated solely to planning, implementing, and monitoring standard approaches that eventually became evidence-based decision-making led to an improved focus on treatment options and outcomes for COVID-19 patients. Data presented illustrate the attainable success of a committee that is both adaptable and suitable for similar emergencies in the future. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

2.
Drugs Context ; 112022.
Article in English | MEDLINE | ID: covidwho-2067166

ABSTRACT

The logistical management of an injectable therapy for the treatment of HIV can be expensive, time consuming, frustrating and riddled with barriers. In this Commentary, we describe our experiences to date with acquiring, storing, handling, administering and billing for long-acting cabotegravir and rilpivirine through four scenarios, each of which have presented their own unique obstacles and learning curves. At the time of writing, we have successfully transitioned four patients from the CUSTOMIZE trial to long-acting cabotegravir and rilpivirine. In doing so, we encountered a variety of barriers to acquiring, handling and administering the medication for both insured and uninsured patients; it is expensive, on a limited number of insurance formularies, and often requires a prior authorization from the provider. Cold-chain handling of the injectable therapy, along with individual patient characteristics, present barriers to management and administration of this therapy. Whilst a seemingly very attractive option for the treatment of HIV-1 infection in adults, long-acting cabotegravir and rilpivirine present a variety of challenges to pharmacists, providers and clinic staff on how to obtain it for and administer it to the patient. We plan to continue documenting our experiences, progress and successes, or lack thereof, in order to fine-tune our process and share with others.

4.
Enferm Infecc Microbiol Clin (Engl Ed) ; 2021 Mar 18.
Article in English, Spanish | MEDLINE | ID: covidwho-1977229

ABSTRACT

INTRODUCTION: The objective is to analyze the impact of the COVID-19 pandemic on the pediatric emergencies and hospital admissions. METHODS: Retrospective cohort study of patients treated in a tertiary hospital, from March 14 to April 26, 2020, compared to the same period of the previous 3 years. RESULTS: A notable overall reduction in emergency room visits and admissions is observed in all pediatric areas, maintaining care in neonatology and scheduled admissions in oncology. DISCUSSION: The reduction in global activity in pediatric emergencies is not only explained by the decrease in contagious diseases. The decrease in inadequate demand and inappropriate income may have contributed. The availability of pediatric beds would make the reduction of programmed surgical activity unnecessary and would allow the redistribution of resources to areas with greater healthcare pressure.

5.
J Formos Med Assoc ; 120 Suppl 1: S6-S18, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1972183

ABSTRACT

The spread of the emerging pathogen, named as SARS-CoV-2, has led to an unprecedented COVID-19 pandemic since 1918 influenza pandemic. This review first sheds light on the similarity on global transmission, surges of pandemics, and the disparity of prevention between two pandemics. Such a brief comparison also provides an insight into the potential sequelae of COVID-19 based on the inference drawn from the fact that a cascade of successive influenza pandemic occurred after 1918 and also the previous experience on the epidemic of SARS and MERS occurring in 2003 and 2015, respectively. We then propose a systematic framework for elucidating emerging infectious disease (EID) such as COVID-19 with a panorama viewpoint from natural infection and disease process, public health interventions (non-pharmaceutical interventions (NPIs) and vaccine), clinical treatments and therapies (antivirals), until global aspects of health and economic loss, and economic evaluation of interventions with emphasis on mass vaccination. This review not only concisely delves for evidence-based scientific literatures from the origin of outbreak, the spread of SARS-CoV-2 to three surges of pandemic, and NPIs and vaccine uptakes but also provides a new insight into how to apply big data analytics to identify unprecedented discoveries through COVID-19 pandemic scenario embracing from biomedical to economic viewpoints.


Subject(s)
COVID-19 , COVID-19/economics , COVID-19/epidemiology , COVID-19/prevention & control , Cost-Benefit Analysis , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics/prevention & control , SARS-CoV-2
6.
7th Brazilian Technology Symposium, BTSym 2021 ; 207 SIST:584-591, 2023.
Article in English | Scopus | ID: covidwho-1971374

ABSTRACT

With the arrival of the COVID-19 pandemic, health systems were forced to adapt their intra- and extra-hospital processes through mechanisms of articulation, integration, and coordination between the organic units of public and private institutions, configuring a single national health system. In this sense, the objective of this study was to determine whether there is a relationship between clinical management for the hospitalization of patients with COVID-19 and resolution capacity functionality in a Health Network. A hypothetical deductive method was used with a descriptive-correlational analysis with a cross-sectional design. The sample consisted of 150 health care workers (100%). The selection was conducted in 3 level I-4 facilities of the Contumazá-Cajamarca Health Network, Peru, 2021. The dependent variable was resolution capacity functionality, and the independent variable was clinical management for the hospitalization of patients with COVID-19. The results suggest an average level both in clinical management and in resolution capacity functionality and the transport dimension in 45.3%, extending a significant relationship (p < 0.05) with Rho = 0.755 and Rho = 0.251, respectively. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

7.
International Conference on Advances in Electrical and Computer Technologies, ICAECT 2021 ; 881:585-595, 2022.
Article in English | Scopus | ID: covidwho-1958933

ABSTRACT

Stroke is a critical condition with excessive mortality rate. The risk is largely from intracranial haemorrhage, and the primary causes are elevated blood pressure and trauma. Identification of haemorrhage is time critical, and it affects clinical management. Non-contrast computed tomography scans are pragmatic in disease confirmation and require the efforts of an expert radiologist. The impact of COVID-19 creates an extra burden on stroke care. We propose to develop an intelligent intracranial haemorrhage detection algorithm using K-nearest neighbourhood and support vector machine. The algorithm reported an accuracy of 85 and 87.5%. Further, we implemented a principal component analysis enhanced convolutional neural network (PCA-CNN) model that classified haemorrhage and normal subjects. The models achieved a sensitivity, specificity, and F1-score of 1.0, 0.91, and 0.95, respectively, for CNN and 1.0 each for PCA-CNN. We believe that our model can assist the radiologist in the clinical diagnosis of intracranial haemorrhage. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

8.
Front Public Health ; 10: 893770, 2022.
Article in English | MEDLINE | ID: covidwho-1952854

ABSTRACT

Background: The demand and consumption of immunoglobulins (IgGs) are growing, and there are many difficulties in obtaining supplies. The aim of the study was to analyze the evolution of IgG consumption and cost over a decade, describe the measures implemented for clinical management in the context of regional public health system, and evaluate the initial impact of these measures. Methods: We performed a retrospective longitudinal study including patients of all public health systems in Catalonia. First, we analyzed data on consumption and cost of IgGs during a period between 1 January, 2010 and 31 December 2021. Second, we analyzed the impact of a set of regional measures in terms of annual consumption and cost of IgGs. Regional measures were based on rational evidence-based measures and computer registries. We compared the data of year before applying intervention measures (1 January and 31 December 2020) with data of year after applying clinical management interventions (1 January and 31 December 2021). In addition, detailed information on clinical indications of IgG use between 1 January and 31 December 2021 was collected. Results: Overall, in terms of population, the consumption of IgGs (g/1,000 inhabitants) increased from 40.4 in 2010 to 94.6 in 2021. The mean cost per patient increased from €10,930 in 2010 to €15,595 in 2021. After implementing the measures, the mean annual estimated consumption per patient in 2021 was statistically lower than the mean annual estimated consumption per patient in 2020 (mean difference -47 g, 95% CI -62.28 g, -31.72 g, p = 0.03). The mean annual estimated cost per patient in 2021 was also lower than the mean annual estimated cost per patient in 2020 (the mean difference was -€1,492, 95% CI -€2,132.12, -€851.88; p = 0.027). In 2021, according to evidence-based classification, 75.66% treatments were prescribed for a demonstrated therapeutic evidence-based indication, 12.17% for a developed therapeutic evidence-based indication, 4.66% for non-evidence-based therapeutic role indication, and 8.1% could not be classified because of lack of information. Conclusion: The annual consumption and cost of IgGs have grown steadily over the last decade in our regional public health system. After implementing a set of regional measures, the annual consumption of IgGs per patient and annual cost per patient decreased. However, the decrease has occurred in the context of the coronavirus disease 2019 (COVID-19) pandemic, which may have influenced their clinical use. Managing the use of IgGs through a rational plan with strategies including evidence-based and data collection may be useful in a shortage situation with growing demand. Registries play a key role in collection of systematic data to analyze, synthesize, and obtain valuable information for decision support. The action developed needs close monitoring in order to verify its effectiveness.


Subject(s)
COVID-19 , Data Collection , Humans , Immunoglobulin G , Longitudinal Studies , Rationalization , Retrospective Studies
9.
Rev. méd. Urug ; 38(1): e38102, 2022.
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1918312

ABSTRACT

Resumen: Introducción: la pandemia por COVID-19 ha producido un fuerte impacto en la práctica quirúrgica mundial y luego de trascurridos 15 meses de diferir cirugías y seleccionar pacientes, aún no está bien establecida la magnitud del problema. Objetivo: conocer la evolución de la cirugía programada y su perfil de comportamiento en los servicios del Hospital Maciel (HM) durante el período de pandemia COVID-19. Método: se estudia la productividad quirúrgica del HM durante los períodos de prepandemia (2019) y pandemia (2020/2021), a partir del análisis de la oportunidad y especialidad de la cirugía realizada y la demanda de camas de Unidad de Cuidados Intensivos (UCI). Resultado: durante el período de pandemia (13/3/2020-30/6/2021) se operaron 5.302 pacientes; solo 132 (2,5%) se realizaron en pacientes COVID-19 positivos. La actividad quirúrgica global descendió 22,2% y en cirugías coordinadas 37,4%. Se mantuvo incambiado el volumen de cirugías de urgencias en relación al período prepandemia. Se constató un incremento exponencial de actividad en traumatología, (214%) y otorrinolaringología (57,4%); leve aumento en cirugías de tórax (12,7%), la cirugía vascular y la neurocirugía mantuvieron su actividad (0,3% y -7,8% respectivamente). Las clínicas de cirugía general descendieron su producción en forma importante: 63,5%. Conclusiones: se cumplió con la asistencia a pacientes oncológicos e impostergables, lo cual cambio el perfil de la cirugía, aumentando la actividad en las especialidades en detrimento marcado de la cirugía general y de las disciplinas que operan fundamentalmente patologías postergables y benignas de alta prevalencia.


Summary: Introduction: the COVID19 pandemic has caused a strong impact on surgical practices around the world, and after 15 months of differing surgeries and selecting patients, the actual magnitude of the problem has not been defined yet. Objective: to learn about the evolution of elective surgeries and behaviour profiles at the Maciel Hospital during the COVID19 pandemic. Method: the study analyses the delivery of elective surgeries at Maciel Hospital during the pre-pandemic (2019) and pandemic (2020/2021) periods by studying timing and area of specialization of the surgery performed and demand ICU beds. Results: during the pandemic period (13.3.2020-30.6.2021) 5302 patients were operated; and only 132 of them (2.5%) were COVID 19 positive. Global surgical services dropped 22.2% and 37.4% in elective surgeries. The number of emergency surgeries remained the same when compared to the pre-pandemic period. A huge growth was seen in traumatology (214%) and otorhinolaryngology (57.4%) services, a slight increase in thoracic consultations (12.7%) and no change was observed in vascular surgery consultations (0.3%). Consultations in other areas of specialization, such as urology, neurosurgery and general surgery significantly dropped, between 7.8% and 65.5%. Conclusions: health services were delivered to oncologic patients given their urgency, which, modfied the surgical profile, increasing activity in specializations and at the expense of general surgeries and the specialization areas the mainly operate bening conditions that may be delayed that are highly prevalent.


Resumo: Introdução: a pandemia COVID-19 teve um forte impacto na prática cirúrgica global e, após 15 meses de adiamento de cirurgias e seleção de pacientes, a magnitude do problema ainda não está bem estabelecida. Objetivo: conhecer a evolução da cirurgia programada e seu perfil de comportamento nos serviços do Hospital Maciel (HM) durante o período pandêmico de COVID-19. Método: estudou-se a produtividade cirúrgica programada do HM, nos períodos pré-pandêmico (2019) e pandêmico (2020/2021), a partir da análise da oportunidade e especialidade da cirurgia realizada e da demanda por leitos de UTI. Resultado: durante o período pandêmico (13/3/2020-30/6/2021), um total de 5.302 pacientes foram operados; Apenas 132 (2,5%) foram realizadas em pacientes COVID-19 positivos. A atividade cirúrgica global diminuiu 22,2% e 37,4% nas cirurgias coordenadas. Com relação ao período pré-pandêmico a quantidade de cirurgias de emergência permaneceu inalterada. Um aumento exponencial da atividade foi encontrado em trauma (214%) e otorrinolaringologia (57,4%); um pequeno aumento em tórax (12,7%); a cirurgia vascular manteve-se estável (0,3%), enquanto as demais disciplinas: urologia, neurocirurgia e ambas as clínicas de cirurgia geral diminuíram significativamente, entre 7,8% e 63,5%. Conclusões: foi cumprida a assistência aos doentes oncológicos e não postergáveis, o que alterou o perfil da cirurgia, aumentando a atividade nas especialidades, em acentuado detrimento da cirurgia geral e das disciplinas que operam sobretudo patologias postergáveis e benignas de alta prevalência.


Subject(s)
Surgery Department, Hospital/statistics & numerical data , Efficiency, Organizational , Pandemics , COVID-19
10.
J. oral res. (Impresa) ; S1: 1-7, abr. 30, 2022. tab
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1912342

ABSTRACT

Objective: To analyze clinical indicators of teledentistry management for the elderly population during the COVID-19 pandemic in Chile. Material and Methods:A pilot teledentistry project was developed for dental care of the elderly in 5 regions of Chile. The data obtained were recorded on the TEGO Platform to be subsequently selected and analyzed by the researchers in terms of clinical management indicators: degree of installed occupancy, degree of available occupation, degree of real occupation, interconsultation indicator per patient attended, urgencies according to reason for consultations, unpostponable prosthetic treatment according to reason for consultations, prevention in relation to granted benefits, prevention in relation to the patients cared for, and project absenteeism indicator. Results: The clinical management indicators obtained were as follows: The average degree of installed occupancy was 67%. The average degree of available occupancy was 78%, which accounts for the clinical time in which there are dental chairs and dentists willing to work. The average real occupancy degree was 86%. The average interconsultation indicator per patient observed was 25%. The indicator of urgencies according to the reason for the consultation was 95%, which indicates that the purpose of the study was fulfilled. The average unpostponable prosthetic treatment according to the reason for consultations was 5%. The prevention in relation to granted benefits reached 39%. Finally, the average indicator of absenteeism was 17%. Conclusion: The measurement of clinical management indicators contributes to meet the Chilean Ministry of Health Explicit Health Guarantees (GES), which are: Access, Timely Attention, Quality and Financial Protection.


Objetivo: Analizar indicadores clínicos del manejo de la teleodontología para la población de adultos mayores durante la pandemia de COVID-19 en Chile. Material y Métodos: Se desarrolló un proyecto piloto de teleodontología para la atención odontológica del adulto mayor en cinco regiones de Chile. Los datos obtenidos fueron registrados en la plataforma TEGO para ser posteriormente seleccionados y analizados por los investigadores en cuanto a indicadores de gestión clínica: grado de ocupación instalada, grado de ocupación disponible, grado de ocupación real, indicador de interconsulta por paciente atendido, urgencias según motivo por consultas, tratamiento protésico improrrogable según motivo de consultas, prevención en relación a las prestaciones otorgadas, prevención en relación a los pacientes atendidos e indicador de ausentismo del proyecto. Resultados: Los indicadores de gestión clínica obtenidos fueron los siguientes: El grado medio de ocupación instalada fue del 67%. El grado medio de ocupación disponible fue del 78%, lo que da cuenta del tiempo clínico en el que hay sillones dentales y odontólogos dispuestos a trabajar. El grado de ocupación real promedio fue del 86%. El indicador medio de interconsultas por paciente observado fue del 25%. El indicador de urgencias según el motivo de la consulta fue del 95%, lo que indica que se cumplió con el propósito del estudio. El promedio de tratamientos protésicos impostergables según el motivo de consulta fue del 5%. La prevención en relación a las prestaciones otorgadas alcanzó el 39%. Finalmente, el indicador promedio de ausentismo fue de 17%. Conclusión: La medición de indicadores de gestión clínica contribuye a cumplir con las Garantías Explícitas en Salud (GES) del Ministerio de Salud de Chile, que son: Acceso, Oportunidad, Calidad y Protección Financiera.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Dental Care/methods , Telemedicine/methods , Pandemics , Teledentistry , COVID-19 , Chile/epidemiology
11.
Enferm Infecc Microbiol Clin (Engl Ed) ; 40(9): 503-506, 2022 11.
Article in English | MEDLINE | ID: covidwho-1881953

ABSTRACT

INTRODUCTION: The objective is to analyze the impact of the COVID-19 pandemic on the pediatric emergencies and hospital admissions. METHODS: Retrospective cohort study of patients treated in a tertiary hospital, from March 14 to April 26, 2020, compared to the same period of the previous 3 years. RESULTS: A notable overall reduction in emergency room visits and admissions is observed in all pediatric areas, maintaining care in neonatology and scheduled admissions in oncology. DISCUSSION: The reduction in global activity in pediatric emergencies is not only explained by the decrease in contagious diseases. The decrease in inadequate demand and inappropriate income may have contributed. The availability of pediatric beds would make the reduction of programmed surgical activity unnecessary and would allow the redistribution of resources to areas with greater healthcare pressure.


Subject(s)
COVID-19 , Humans , Child , Pandemics , Tertiary Care Centers , SARS-CoV-2 , Emergencies , Retrospective Studies , Emergency Service, Hospital , Hospitalization
12.
Pediatr Surg Int ; 38(8): 1113-1123, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1877828

ABSTRACT

PURPOSE: To investigate the impact of COVID-19 on the treatment of children with congenital diaphragmatic hernia (CDH). METHODS: We retrospectively collected and compared the data of patients with CDH admitted between January 1, 2020 and December 31, 2021(study group) with the CDH patients admitted before the pandemic between January 1, 2018 and December 31, 2019 (control group). RESULTS: During the pandemic, 41 patients with CDH diagnosed prenatally were transferred to our hospital, and 40 underwent surgical repair. The number of patients treated in our hospital increased by 24.2% compared with the 33 patients before the pandemic. During the pandemic, the overall survival rate, postoperative survival rate and recurrence rate were 85.4%, 87.5% and 7.3%, respectively, and there were no significant differences compared with the control group (75.8%, 83.3% and 9.1%, respectively). The average length of hospital stay in patients admitted during the pandemic was longer than that in the control group (31 days vs. 16 days, P < 0.001), and the incidence of nosocomial infection was higher than that in the control group (19.5% vs. 3%, P = 0.037). CONCLUSIONS: CDH patients confirmed to be SARS-CoV-2 infection-free can receive routine treatment. Our data indicate that the implementation of protective measures during the COVID-19 pandemic, along with appropriate screening and case evaluation, do not have a negative impact on the prognosis of children.


Subject(s)
COVID-19 , Hernias, Diaphragmatic, Congenital , COVID-19/epidemiology , Child , Hernias, Diaphragmatic, Congenital/epidemiology , Hernias, Diaphragmatic, Congenital/surgery , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
13.
Iran J Pharm Res ; 21(1): e123947, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1847596

ABSTRACT

More than a year after the onset of the coronavirus disease pandemic in 2019, the disease remains a major global health issue. During this time, health organizations worldwide have tried to provide integrated treatment guidelines to control coronavirus disease 2019 (COVID-19) at different levels. However, due to the novel nature of the disease and the emergence of new variants, medical teams' updating medical information and drug prescribing guidelines should be given special attention. This version is an updated instruction of the National Research Institute of Tuberculosis and Lung Disease (NRITLD) in collaboration with a group of specialists from Masih Daneshvari Hospital in Tehran, Iran, which is provided to update the information of caring clinicians for the treatment and care of COVID-19 hospitalized patients.

14.
Int J Infect Dis ; 118: 1-9, 2022 May.
Article in English | MEDLINE | ID: covidwho-1838845

ABSTRACT

OBJECTIVE: To define the microbiologic characteristics of animal bites in tropical Australia and the appropriateness of current Australian antimicrobial guidelines for their management. METHODS: This retrospective audit examined hospitalizations in tropical Australia after an animal bite or animal-associated penetrating injury between 2013 and 2020. The primary outcome was a composite of death, intensive care unit admission, amputation, quaternary center transfer, or unplanned rehospitalization. RESULTS: A wide variety of animals were implicated, but snakes (734/1745, 42%), dogs (508/1745, 29%), and cats (153/1745, 9%) were the most common. Hospital presentation after 24 hours (odds ratio (OR) (95% confidence interval (CI)): 68.67 (42.10-112.01)) and a cat-related injury (OR (95% CI): 22.20 (11.18-44.08)) were independently associated with an increased risk of infection. A pathogen not covered by the relevant antimicrobial regimen recommended in Australian guidelines was identified in only 12/1745 (0.7%) cases. The primary outcome occurred in 107/1745 (6%) and was independently associated with tissue trauma (OR (95% CI): 9.29 (6.05-14.25), p<0.001), established deep infection at presentation (OR (95% CI): 2.95 (1.31-6.61), p=0.009) and hospital presentation after 24 hours (OR (95% CI): 1.77 (1.12-2.79), p=0.01). CONCLUSIONS: A wide variety of animals bite humans in tropical Australia, but empiric antimicrobial regimens recommended in current national guidelines cover almost all the microbiologic isolates from the resulting wounds.


Subject(s)
Bites and Stings , Wound Infection , Animals , Anti-Bacterial Agents , Australia/epidemiology , Bites and Stings/epidemiology , Bites and Stings/therapy , Dogs , Hospitalization , Humans , Retrospective Studies , Wound Infection/drug therapy , Wound Infection/epidemiology
15.
Nepal J Epidemiol ; 11(4): 1103-1125, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1822347

ABSTRACT

BACKGROUND: The novel Coronavirus Disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. METHODS: The current systematic review was performed utilising the following electronic databases PubMed, MEDLINE and EMBASE. We searched for the keywords "COVID-19 AND "pregnancy" between January 1, 2020 until December 31, 2020. RESULTS: Out of 4005 records which were identified, 36 original studies were included in this systematic review. Pooled prevalence of vertical transmission was 10%, 95% CI: 4-17%. Pooled prevalence of neonatal mortality was 7%, 95% CI: 0-21%. CONCLUSION: The contemporary evidence suggests that the incubation period of COVID-19 is 2-14 days, and this infection could be transmitted even from the infected asymptomatic individuals. It is found that the clinical presentation of pregnant women with COVID-19 infection is comparable with the infected non-pregnant females, and the frequent symptoms were fever, cough, myalgia, sore throat and malaise. Some cases have severe maternal morbidity and perinatal deaths secondary to COVID-19 infection. Under these circumstances, pregnant women should focus on maintaining personal hygiene, proper nutrition and extreme social distancing to reduce the risk of COVID-19. Therefore, systematic data reporting for evidence based clinical assessment, management and pregnancy outcomes is essential for preventing of COVID-19 infection among pregnant women.

17.
Rev. méd. Urug ; 38(1): e38102, 2022.
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1789908

ABSTRACT

Resumen: Introducción: la pandemia por COVID-19 ha producido un fuerte impacto en la práctica quirúrgica mundial y luego de trascurridos 15 meses de diferir cirugías y seleccionar pacientes, aún no está bien establecida la magnitud del problema. Objetivo: conocer la evolución de la cirugía programada y su perfil de comportamiento en los servicios del Hospital Maciel (HM) durante el período de pandemia COVID-19. Método: se estudia la productividad quirúrgica del HM durante los períodos de prepandemia (2019) y pandemia (2020/2021), a partir del análisis de la oportunidad y especialidad de la cirugía realizada y la demanda de camas de Unidad de Cuidados Intensivos (UCI). Resultado: durante el período de pandemia (13/3/2020-30/6/2021) se operaron 5.302 pacientes; solo 132 (2,5%) se realizaron en pacientes COVID-19 positivos. La actividad quirúrgica global descendió 22,2% y en cirugías coordinadas 37,4%. Se mantuvo incambiado el volumen de cirugías de urgencias en relación al período prepandemia. Se constató un incremento exponencial de actividad en traumatología, (214%) y otorrinolaringología (57,4%); leve aumento en cirugías de tórax (12,7%), la cirugía vascular y la neurocirugía mantuvieron su actividad (0,3% y -7,8% respectivamente). Las clínicas de cirugía general descendieron su producción en forma importante: 63,5%. Conclusiones: se cumplió con la asistencia a pacientes oncológicos e impostergables, lo cual cambio el perfil de la cirugía, aumentando la actividad en las especialidades en detrimento marcado de la cirugía general y de las disciplinas que operan fundamentalmente patologías postergables y benignas de alta prevalencia.


Summary: Introduction: the COVID19 pandemic has caused a strong impact on surgical practices around the world, and after 15 months of differing surgeries and selecting patients, the actual magnitude of the problem has not been defined yet. Objective: to learn about the evolution of elective surgeries and behaviour profiles at the Maciel Hospital during the COVID19 pandemic. Method: the study analyses the delivery of elective surgeries at Maciel Hospital during the pre-pandemic (2019) and pandemic (2020/2021) periods by studying timing and area of specialization of the surgery performed and demand ICU beds. Results: during the pandemic period (13.3.2020-30.6.2021) 5302 patients were operated; and only 132 of them (2.5%) were COVID 19 positive. Global surgical services dropped 22.2% and 37.4% in elective surgeries. The number of emergency surgeries remained the same when compared to the pre-pandemic period. A huge growth was seen in traumatology (214%) and otorhinolaryngology (57.4%) services, a slight increase in thoracic consultations (12.7%) and no change was observed in vascular surgery consultations (0.3%). Consultations in other areas of specialization, such as urology, neurosurgery and general surgery significantly dropped, between 7.8% and 65.5%. Conclusions: health services were delivered to oncologic patients given their urgency, which, modfied the surgical profile, increasing activity in specializations and at the expense of general surgeries and the specialization areas the mainly operate bening conditions that may be delayed that are highly prevalent.


Resumo: Introdução: a pandemia COVID-19 teve um forte impacto na prática cirúrgica global e, após 15 meses de adiamento de cirurgias e seleção de pacientes, a magnitude do problema ainda não está bem estabelecida. Objetivo: conhecer a evolução da cirurgia programada e seu perfil de comportamento nos serviços do Hospital Maciel (HM) durante o período pandêmico de COVID-19. Método: estudou-se a produtividade cirúrgica programada do HM, nos períodos pré-pandêmico (2019) e pandêmico (2020/2021), a partir da análise da oportunidade e especialidade da cirurgia realizada e da demanda por leitos de UTI. Resultado: durante o período pandêmico (13/3/2020-30/6/2021), um total de 5.302 pacientes foram operados; Apenas 132 (2,5%) foram realizadas em pacientes COVID-19 positivos. A atividade cirúrgica global diminuiu 22,2% e 37,4% nas cirurgias coordenadas. Com relação ao período pré-pandêmico a quantidade de cirurgias de emergência permaneceu inalterada. Um aumento exponencial da atividade foi encontrado em trauma (214%) e otorrinolaringologia (57,4%); um pequeno aumento em tórax (12,7%); a cirurgia vascular manteve-se estável (0,3%), enquanto as demais disciplinas: urologia, neurocirurgia e ambas as clínicas de cirurgia geral diminuíram significativamente, entre 7,8% e 63,5%. Conclusões: foi cumprida a assistência aos doentes oncológicos e não postergáveis, o que alterou o perfil da cirurgia, aumentando a atividade nas especialidades, em acentuado detrimento da cirurgia geral e das disciplinas que operam sobretudo patologias postergáveis e benignas de alta prevalência.


Subject(s)
Surgery Department, Hospital/statistics & numerical data , Efficiency, Organizational , Pandemics , COVID-19
18.
Sci Afr ; 15: e01083, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1778437

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa's outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.

19.
Front Immunol ; 13: 850846, 2022.
Article in English | MEDLINE | ID: covidwho-1775681

ABSTRACT

A relevant portion of patients with disease caused by the severe acute respiratory syndrome coronavirus 2 (COVID-19) experience negative outcome, and several laboratory tests have been proposed to predict disease severity. Among others, dramatic changes in peripheral blood cells have been described. We developed and validated a laboratory score solely based on blood cell parameters to predict survival in hospitalized COVID-19 patients. We retrospectively analyzed 1,619 blood cell count from 226 consecutively hospitalized COVID-19 patients to select parameters for inclusion in a laboratory score predicting severity of disease and survival. The score was derived from lymphocyte- and granulocyte-associated parameters and validated on a separate cohort of 140 consecutive COVID-19 patients. Using ROC curve analysis, a best cutoff for score of 30.6 was derived, which was associated to an overall 82.0% sensitivity (95% CI: 78-84) and 82.5% specificity (95% CI: 80-84) for detecting outcome. The scoring trend effectively separated survivor and non-survivor groups, starting 2 weeks before the end of the hospitalization period. Patients' score time points were also classified into mild, moderate, severe, and critical according to the symptomatic oxygen therapy administered. Fluctuations of the score should be recorded to highlight a favorable or unfortunate trend of the disease. The predictive score was found to reflect and anticipate the disease gravity, defined by the type of the oxygen support used, giving a proof of its clinical relevance. It offers a fast and reliable tool for supporting clinical decisions and, most important, triage in terms of not only prioritization but also allocation of limited medical resources, especially in the period when therapies are still symptomatic and many are under development. In fact, a prolonged and progressive increase of the score can suggest impaired chances of survival and/or an urgent need for intensive care unit admission.


Subject(s)
COVID-19 , Humans , Oxygen , ROC Curve , Retrospective Studies , SARS-CoV-2
20.
Emerg Med J ; 39(8): 589-594, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1745680

ABSTRACT

BACKGROUND: National Early Warning Scores (NEWS2) are used to detect all-cause deterioration. While studies have looked at NEWS2, the use of virtual consultation and remote monitoring of patients with COVID-19 mean there is a need to know which physiological observations are important. AIM: To investigate the relationship between outcome and NEWS2, change in NEWS2 and component physiology in COVID-19 inpatients. METHODS: A multi-centre retrospective study of electronically recorded, routinely collected physiological measurements between March and June 2020. First and maximum NEWS2, component scores and outcomes were recorded. Areas under the curve (AUCs) for 2-day, 7-day and 30-day mortality were calculated. RESULTS: Of 1263 patients, 26% died, 7% were admitted to intensive care units (ICUs) before discharge and 67% were discharged without ICU. Of 1071 patients with initial NEWS2, most values were low: 50% NEWS2=0-2, 27% NEWS2=3-4, 14% NEWS2=5-6 and 9% NEWS2=7+. Maximum scores were: 14% NEWS2=0-2, 22% NEWS2=3-4, 17% NEWS2=5-6 and 47% NEWS2=7+. Higher first and maximum scores were predictive of mortality, ICU admission and longer length of stay. AUCs based on 2-day, 7-day, 30-day and any hospital mortality were 0.77 (95% CI 0.70 to 0.84), 0.70 (0.65 to 0.74), 0.65 (0.61 to 0.68) and 0.65 (0.61 to 0.68), respectively. The AUCs for 2-day mortality were 0.71 (0.65 to 0.77) for supplemental oxygen, 0.65 (0.56 to 0.73) oxygen saturation and 0.64 (0.56 to 0.73) respiratory rate. CONCLUSION: While respiratory parameters were most predictive, no individual parameter was as good as a full NEWS2, which is an acceptable predictor of short-term mortality in patients with COVID-19. This supports recommendation to use NEWS2 alongside clinical judgement to assess patients with COVID-19.


Subject(s)
COVID-19 , Early Warning Score , COVID-19/diagnosis , Hospital Mortality , Humans , Prognosis , Retrospective Studies
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