Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 584
Filter
1.
BJPsych Open ; 7(5), 2021.
Article in English | EMBASE | ID: covidwho-1883558

ABSTRACT

Background Cognitive-behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments. Results Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual. Conclusions A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.

2.
Fertility and Sterility ; 116(3 SUPPL):e297-e298, 2021.
Article in English | EMBASE | ID: covidwho-1880406

ABSTRACT

OBJECTIVE: To assess the effect of telemedicine during the COVID-19 pandemic year on the treatment decision of new patient for IVF (in-vitro fertilization) protocols, medication doses and clinical outcomes compared to new patients seen in-person during the previous year, in an academic fertility practice. MATERIALS AND METHODS: This is a retrospective cohort study, in a university-based fertility clinic. All new patients seen via telemedicine between March 11, 2020, and March 10, 2021, were compared with all new patients seen in person between March 11, 2019, and March 10, 2020. Statistical analysis included t-test, Fisher exact test and Pearson chi square. The primary outcome was clinical pregnancy rate. Secondary outcomes included protocol type, dosage of Gonadotropins, duration of stimulation, type of trigger medication (HCG vs. GnRH- agonist), number of oocytes retrieved, fresh embryo transfer rate, “freeze all” rate due to OHSS reduction and implantation rate. RESULTS: The study included 715 new patient in the fertility clinic;365 patients seen in person (March 11, 2019 - March 10, 2020), and 350 patients seen via telemedicine (March 11, 2020 - March 10, 2021). The following were similar between the Covid year and the previous year: Female age (35.9±5.06 vs. 36.4±4.9, P=0.21), number of oocytes retrieved at the first IVF cycle (12.8±9.0 vs. 12.77±8.5, P=0.92), and stage of embryo transferred (cleavage stage 66 (41.3%) Vs. 86 (47.3%) and Blastocyts 94 (58.7%) vs. 96 (52.7%) P=0.27). There were more cases of male factor infertility and less cases of unexplained infertility in Covid year compared to the previous year (29% vs. 19%, P=0.001 and 9% vs. 16%, P=0.003 respectively), however, there was no difference in other diagnoses made at new-patient visit. There were no differences between the groups in the following outcomes: type of protocol (P=0.41), FSH dosage (P=0.25), number of days of stimulation (P=0.10), maximal estradiol value (P=0.97) type of trigger medication (Hcg 227 (72.8%) vs. 266 (74.9%), P=0.38 Agonist 86 (27.2%) vs. 89 (25.1%), P=0.3), and fresh embryo transfer rate (47.7% vs. 51.2%, P=0.36). There were less cases of “freeze all” to reduce OHSS risk in the Covid year (3.1% vs. 13.4%, P<0.0001). There was no difference between the groups in the clinical pregnancy rates (35.3% vs. 36.3%, P=0.91) and implantation rates (29.2% vs. 32.7%, P=0.42). CONCLUSIONS: New patients seen in person and those evaluated via telemedicine are likely to receive similar treatment protocols, medication doses and are likely to have similar duration of stimulation. IVF outcomes are not affected by telemedicine consultation, either. IMPACT STATEMENT: Telemedicine consultation for new-patient visits is feasible in an academic fertility practice for IVF treatment and may be particularly useful during the pandemic.

3.
Topics in Antiviral Medicine ; 30(1 SUPPL):75, 2022.
Article in English | EMBASE | ID: covidwho-1880058

ABSTRACT

Background: Understanding the role of crucial biomolecules and mechanistic pathways supporting coronavirus disease 2019 (COVID-19) pathophysiology is essential to handle the immune dysregulation and complications driven by uncontrolled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Thus, we evaluated the proteomics, metabolomics and lipidomics plasma profile in a well-characterized cohort of COVID-19 patients ranging from asymptomatic to critical illness. Methods: This multicenter case-control study enrolled 273 adults with SARS-CoV-2 infection, confirmed by Polymerase chain reaction (PCR), who were recruited within the first 21 days of the infection during the first wave (March-May 2020) of COVID-19 pandemic. Participants were categorized into three groups of severity according to the inclusion criteria described in "Diagnosis and Treatment Protocol for COVID-19 Patients" and distributed as mild (n=77), severe (n=134) and critical (n=62). Serum profile of COVID-19 patients was characterized in the acute phase of the infection using a nontargeted multiomics approach. Univariate and multivariate analyses were performed to identify key molecules involved in critical COVID-19 and to evaluate their predictive power as biomarkers of COVID-19 severity. Results: COVID-19 critically ill patients presented a well-differentiated blood pattern for severe disease. The multiomic analysis identified specific alterations in pathways linked to complement and coagulation cascades, platelet activation, cell adhesion, acute inflammation, energy production (Krebs cycle and Warburg effect), amino acid catabolism and lipid transport as hallmarks of critical COVID-19. A new biomarker panel including the combination of selected proteins, metabolites and lipids predicted with high accuracy the most adverse COVID-19 outcomes (AUC: 0.994, 85.9% specificity and 100% sensitivity). Conclusion: The identification of predictive molecules related to critical COVID-19 outcomes provides a valuable tool for the rapid and efficient identification of clinical worsening in the early stage of SARS-CoV-2 infection. The association of a distinctive proteomic, metabolomic and lipidomic fingerprint with COVID-19 severity provides a better understanding of the immunopathogenesis and the host response to SARS-CoV-2 infection which could help in the identification of potential therapeutic targets.

4.
Aust N Z J Public Health ; 46(3): 401-406, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1878979

ABSTRACT

OBJECTIVE: In this paper, we describe the design and baseline data of a study aimed at improving injury surveillance data quality of hospitals contributing to the Victorian Emergency Minimum Dataset (VEMD). METHODS: The sequential study phases include a baseline analysis of data quality, direct engagement and communication with each of the emergency department (ED) hospital sites, collection of survey and interview data and ongoing monitoring. RESULTS: In 2019/20, there were 371,683 injury-related ED presentations recorded in the VEMD. Percentage unspecified, the indicator of (poor) data quality, was lowest for 'body region' (2.7%) and 'injury type' (7.4%), and highest for 'activity when injured' (29.4%). In the latter, contributing hospitals ranged from 3.0-99.9% unspecified. The 'description of event' variable had a mean word count of 10; 16/38 hospitals had a narrative word count of <5. CONCLUSIONS: Baseline hospital injury surveillance data vary vastly in data quality, leaving much room for improvement and justifying intervention as described. IMPLICATIONS FOR PUBLIC HEALTH: Hospital engagement and feedback described in this study is expected to have a marked effect on data quality from 2021 onwards. This will ensure that Victorian injury surveillance data can fulfil their purpose to accurately inform injury prevention policy and practice.


Subject(s)
Emergency Service, Hospital , Hospitals , Data Accuracy , Data Collection , Humans
5.
Journal of Health Literacy ; 7(1):75-85, 2022.
Article in English | Scopus | ID: covidwho-1876378

ABSTRACT

Background and Objective: Adequate health literacy and compliance with COVID-9 health and safety protocols are among the main ways to break the SARS-CoV-2 transmission chain. This study aimed to investigate the level and relationship between awareness, attitude and behavior of students, staff and faculty in Mashhad University of medical sciences, regarding compliance with COVID-9 health and safety protocols in 2021. Materials and Methods: This analytical cross-sectional descriptive study was conducted at Mashhad University of medical sciences, Mashhad, Iran in October 2021. The study sample included 411 students, staff and faculty selected through available sampling. The data were collected using a previous standard questionnaire and analyzed through the partial least squares (PLS) approach for structural equation modeling (SEM) using Smart PLS software (version 3.0). We employed descriptive and inferential statistics for our data analysis. Results: Respondents ‘awareness, attitude and behavior towards COVID-19 health protocols yielded significant positive correlations (P<0.001). Furthermore, the mean score percentage of awareness, attitude and behavior were 85%, 65% and 84% of the total score, respectively.  Additionally, respondents’ mean scores for behavior and attitude differ significantly across age, gender, job and marital status. Conclusion: The level of awareness of the participants in Mashhad University of Medical Sciences about the COVID-19 health safety protocols was good. A significant relationship was observed between awareness, attitude and behaviors related to compliance with COVID-19 protocols. It seems that these people can be good representatives in the community to increase people’s awareness, considering the participants’ observance of the protocols. © 2022, Mashhad University of Medical Sciences. All rights reserved.

6.
JMIR Res Protoc ; 11(5): e37126, 2022 May 04.
Article in English | MEDLINE | ID: covidwho-1875299

ABSTRACT

BACKGROUND: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. OBJECTIVE: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. METHODS: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. RESULTS: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. CONCLUSIONS: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37126.

7.
25th IEEE International Conference on Computer Supported Cooperative Work in Design, CSCWD 2022 ; : 1498-1503, 2022.
Article in English | Scopus | ID: covidwho-1874157

ABSTRACT

In this paper, we report on the design and development of a collaborative application for mobile devices, built by elementary and undergraduate students, whose goal was to help comply with Covid-19 protocols on the occasion of the resumption of face-to-face classes in schools in the city of Macaé, in Rio de Janeiro. Collective intelligence guided both the problem-solving activity (application construction) and collective inspection by students (application use) of the actions needed to prevent the spread of the Covid-19 virus. © 2022 IEEE.

8.
Contemp Clin Trials ; 117: 106760, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1872954

ABSTRACT

On 1/20/2020 when the first case of a novel coronavirus (COVID-19) was confirmed in Washington state, its major impact was unknown. Memorial Sloan Kettering Cancer Center's (MSK) Hospital Incident Command System (HICS) was activated on 2/5, with our first COVID-19 case identified in early March. By 3/17, our Protocol Activation and Human Research Protection Program was fully remote and on 3/23, MSK leadership requested the creation of the COVID-19 Research Committee. Given the race to identify safe and effective treatments for COVID-19, modifications to workflows and review processes were needed. The goal was to provide quick access to COVID-19 treatments to our patients by creating a COVID-19 Committee as a "one-stop" committee, providing comprehensive review of clinical research related to COVID-19 including scientific review mandated by the Cancer Center Support Grant (CCSG) guidelines, prior to IRB review and protocol activation. Protocols that were reviewed by the COVID-19 Committee opened to accrual in an unprecedented 44 days from submission to the committee to open to accrual. Patients were accrued on most of the therapeutic protocols within 1 day of opening. These statistics have prompted our institution to explore how more protocols can benefit from this "one-stop" committee structure.


Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Treatment Outcome , Washington
9.
Int J Environ Res Public Health ; 19(11)2022 May 28.
Article in English | MEDLINE | ID: covidwho-1869603

ABSTRACT

The COVID-19 pandemic, and the social distancing practices that followed, have been associated with increased prevalence of emotional disorders. However, not all individuals affected by COVID-19-related social distancing experienced elevations in emotional disorder symptoms. Understanding this phenomenon is of crucial public health significance given the burden of emotional disorders on individuals and systems. In this narrative review, we consider the differential impact of COVID-19-related social distancing on mental health outcomes from a transdiagnostic perspective. We argue that individuals high in negative affect and aversive reactivity to emotion, that is, neuroticism, and who respond to such emotional experiences with emotion-motivated avoidant coping, are most likely to experience emotional disorders in the context of COVID-19 social distancing. We acknowledge the pro-social and adaptive function of some types of avoidance during the pandemic, which may have initially buffered against negative mental health outcomes. Implications of this conceptualization for treatment of emotional disorders in the present sociocultural context are discussed.


Subject(s)
COVID-19 , COVID-19/epidemiology , Emotions , Humans , Mental Health , Pandemics , Physical Distancing
10.
J Adv Nurs ; 2022 May 27.
Article in English | MEDLINE | ID: covidwho-1868665

ABSTRACT

AIM: To explore how General Practice Nurses experience implementing change at pace and scale in delivering care during consecutive waves of the COVID-19 pandemic. To evaluate the impact of changes to general practice nurses' working practices on professional wellbeing. BACKGROUND: In response to the COVID-19 pandemic, general practice rapidly and extensively changed care delivery. There has been little exploration of the experiences of General Practice Nurses and care delivery, job satisfaction, workload, stress and professional support. DESIGN: A qualitative case study design of three to five general practice case sites will explore General Practice Nurses' experiences during the Covid-19 pandemic. The study was funded and approved by the General Nursing Council Trust in June 2021. University ethics approval was gained in July 2021. Health Research Authority approval has been obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. METHODS: Data will consist of focus groups and/or semi-structured interviews with General Practice Nurses, primary healthcare team members and other key informants. Business/strategy and nurse team meetings relating to workforce planning/review will be observed. Documents will be analysed and routinely collected general practice data will provide descriptive contextualisation at each site. The study will be theoretically underpinned by the Non-adoption, Abandonment, Scale-up, Spread and Sustainability Framework and data analysed using framework analysis. DISCUSSION: General Practice Nurses have a unique sphere of knowledge and undertake specific work in primary care. This workforce is challenged by recruitment, retention and retirement issues, leading to the loss of highly experienced and knowledgeable professionals. It is important to explore how working practices brought about by Covid-19 affect General Practice Nurses. IMPACT: This study will explore working practices brought about by the Covid-19 pandemic to inform care delivery, patient care and support General Practice Nursing workforce wellbeing and will highlight and mitigate negative aspects of novel and changing care delivery. Key factors in implementing and supporting future practice and change implementation will be developed. TRIAL REGISTRATION: CPMS: 51834.

11.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):37-38, 2022.
Article in English | EMBASE | ID: covidwho-1868959

ABSTRACT

Objective: The COVID 19 rapid guideline NG161: delivery of systemic anticancer treatment (SACT) was issued to reduce the risk to patients and manage capacity during the pandemic. With national screening programmes and cancer surgery postponed, SACT treatment was often the only treatment option for many cancer patients. However, workforce and capacity reduction in day units due to social distancing rules and COVID related sickness many day units were unable to cope with demand. Through MDT approach, MVCC was able to maximise and maintain safe delivery of SACT treatment throughout the pandemic. Methods: To maximise safe delivery of SACT treatment, the critical factors identified were environment, workforce, asymptomatic COVID testing, workflow management and SACT treatment protocol review and implementation. In addition to implementation of Covid safety measures and asymptomatic testing of patients and staff, workflow redesign in outpatient, day units and wards was undertaken. This was further bolstered with use of remote consultations and expansion of Non-Medical Prescribing Pharmacist clinics. Implementation of electronic referral system to monitor and prioritise SACT referrals in line with the NG161 guidelines and rapid implementation of the national interim treatment options allowed significant efficiencies in treatment times. To measure the effect of these initiatives, a retrospective analysis of data from local and national cancer waiting times(CWT) along with the Cancerstat COVID dashboard was conducted. Results: The Pre-COVID period is defined as April 2019-February 2020 and March 2020-January 2021 is defined as during COVID. For the CWT31 days wait from a decision-to-treat to first treatment for cancer, there was a significant statistical difference between pre-and during COVID with CI = 198 to 224;p < 0.0497. There were fewer referrals but performance improved during COVID. There was no statistically significant difference in the total number of of patients seen for both one month wait from a decision-to-treat to a subsequent treatment and 2 month wait for GP urgent referral to a first treatment, but a statistically significant improvement in performance with p < 0.002 and p < 0.0005 during COVID better than pre-COVID. From the Cancerstat COVID dashboards, with CI = 1480.6 to 1592.6, p value = 0.114 there is no statistically difference in the number of patients treated pre and during COVID. The measures that the MDT team put in place allowed the cancer centre to deliver the same amount of SACT treatments to cancer patients during COVID. There is a statistically significant difference in the type of SACT treatment delivered pre and during COVID with a significantly higher number of oral and immunotherapy containing SACT regimens delivered. Conclusion: With the measures that the MDT team put in place the cancer centre was able to maintain business as usual and deliver the same volume of SACT treatments during COVID compared to pre-COVID levels. The oncology pharmacy workforce played a critical role within the MDT team and was at the forefront of many of the initiative implemented to counter the workforce and capacity restrictions resulting from the COVID pandemic, can be demonstrated as a crucial role in the multidisciplinary team to make a positive impact to cancer patient care.

12.
European Review for Medical and Pharmacological Sciences ; 26(7):2572-2578, 2022.
Article in English | Web of Science | ID: covidwho-1865967

ABSTRACT

OBJECTIVE: Compliance with the 5M health protocols of washing hands, wearing masks, keeping a distance of at least one meter, avoiding crowds, and reducing mobility is the best effort to prevent COVID-19. Adolescents are non-compliant in implementing health protocols during the pandemic. Therefore, this study aimed to investigate the level of compliance with the 5M health protocols. It also examines the relationship between self-efficacy, motivation, and compliance with health protocols. MATERIALS AND METHODS: Data analysis was conducted on a cross-sectional survey of 978 adolescents in Surabaya, Indonesia. Multiple logistic regression was performed to analyze the relationship between the three. Furthermore, adolescent self-efficacy was measured using the General Self Efficacy Scale (GSES), while motivation scale and sociodemographic questionnaire were measured to assess the motivation and characteristics of the respondents. RESULTS: Adolescent self-efficacy in compliance with health protocols is around (92.0%) with an average GSES score of 25.52 + 4.64. The analysis showed that adolescents with high self-efficacy and motivation had a high level of adherence (OR 2.804, 95% CI 2.008, 3.915) and high motivation (OR 2.926, 95% CI 2.087, 4.102), compared to those with low self-efficacy and motivation. CONCLUSIONS: The results suggested that initial identification of self-efficacy and motivation should be addressed to ensure compliance with health protocols to prevent the pandemic.

13.
Journal of the Egyptian National Cancer Institute ; 34, 2022.
Article in English | EMBASE | ID: covidwho-1865819

ABSTRACT

The proceedings contain 12 papers. The topics discussed include: prognostic implication of MYC/BCL2 expressions in patients with diffuse large B-cell NHL;clinical outcomes of pediatric-inspired chemotherapy protocol in adolescent and young adults (AYAs) acute lymphoblastic leukemia patients;effect of nutritional status on survival of Egyptian patients with gastrointestinal malignancies;characterization of COVID-19 disease in cancer patients, single institute experience, low income setting;malignant obstructive jaundice;review of 232 patients;determining resectability in pancreatic tumors;review of 70 cases;Inhibition of dynamins restricts the survival of vasopressin stimulated and PI3K/Akt/mTOR inhibited breast cancer cells;and complete mesocolic excision and central vascular ligation in colon cancer surgery, feasibility and outcome.

14.
BMJ Open ; 12(5): e057233, 2022 05 24.
Article in English | MEDLINE | ID: covidwho-1865173

ABSTRACT

INTRODUCTION: The COVID-19 global pandemic has posed enormous threats to public health around the world. Vaccines are considered the best therapeutic strategy against the COVID-19 pandemic. However, the adverse reactions of vaccines significantly affect the rates of vaccination and may be more serious in patients with non-communicable diseases (NCDs). This protocol aims to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) which analysed the safety of vaccines in patients with NCDs. METHODS AND ANALYSIS: This study will be according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive search will be carried out to identify registered RCTs in PubMed, Embase, Web of Science, ClinicalTrials.gov and Cochrane Library between 1 January 2020 and 31 May 2022. Selection of trials, data extraction, risk of bias assessment and quality of evidence assessment will be done by two researchers, and disagreements will be resolved by the corresponding author. The primary outcomes are local and systemic adverse events of vaccines in patients with NCDs. Additional outcomes are related events caused by vaccine adverse events, including but not limited to cases of adverse events leading to discontinuation from a dose or withdrawal from participation in the trial. Heterogeneity will be assessed with I2 statistics and data analysis will be conducted with RevMan V.5.4.1. ETHICS AND DISSEMINATION: This is a protocol and ethical approval is not necessary. The results of this protocol will be disseminated to peer-reviewed publications or conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021254914.


Subject(s)
COVID-19 , Noncommunicable Diseases , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Meta-Analysis as Topic , Randomized Controlled Trials as Topic , Research Design , SARS-CoV-2 , Systematic Reviews as Topic
15.
Infektsionnye Bolezni ; 20(1):32-41, 2022.
Article in Russian | EMBASE | ID: covidwho-1863502

ABSTRACT

Objective. To analyze the accumulated clinical experience in the management of patients with severe and extremely severe forms of COVID-19 coronavirus infection using biological therapy with an assessment of its efficacy and safety. Patients and methods. Forty-seven patients with severe and extremely severe COVID-19 infection were under observation, who were prescribed biological therapy with tocilizumab according to indications. All patients underwent a complete comprehensive clinical, laboratory and instrumental examination based on the current clinical protocol for the treatment of children with COVID-19 coronavirus infection. Results. Before and after biological therapy, no significant differences in the parameters of complete blood count and urinalysis were obtained. The study of biochemical blood parameters and coagulogram in dynamics showed a significant decrease in the levels of LDH and CPK, as well as inflammatory markers CRP and PCT, fibrinogen. Most patients had extremely high levels of proinflammatory cytokine IL-6 in the acute period of the disease, which decreased by 3.5 times after biological therapy, on average, 3–5 days after the start of treatment with tocilizumab, which coincided with a clinical improvement in the condition of patients. Prolonged SARS-CoV-2 isolation was noted according to nasopharyngeal smear PCR in 37 (88%) children up to 3–5 days after tocilizumab administration and in 10 (21%) patients over 10–14 days. On days 3–5 after the application of biological therapy, there was a decrease in the volume of lung damage to 50.7 ± 26.9% on average [0;90], however, by 10–14 days, most patients still had signs of viral pneumonia up to 50.2 ± 27.2% of lung damage [0;80] without clinical manifestations. Conclusion. After tocilizumab administration, most children with severe COVID-19 showed clinical and laboratory improvement in the form of normalized body temperature and reduced severity of intoxication syndrome, a 3.5-fold decrease in the level of IL-6, a decrease in the values of markers of systemic inflammation (CRP, PCT, fibrinogen) with a significant increase in antibody titer to SARS-CoV-2 IgM/IgG, in connection with which further observation was carried out by specialists at the outpatient stage.

16.
Journal of Clinical and Diagnostic Research ; 16(5):OC17-OC23, 2022.
Article in English | EMBASE | ID: covidwho-1863299

ABSTRACT

Introduction: Solid Organ Transplants (SOT) is at increased risk of Coronavirus Disease 2019 (COVID-19) infection, which may result in acute graft dysfunction and even death. While the disease has been well studied in the general population, it is not the case in renal transplant recipients. The poor immunological response of the vaccine in postrenal transplant patients, the emergence of newer strains, and the possibility of a third wave in India, makes it even more important to know more about the course and outcome of the disease in post renal transplant patients. Aim: To evaluate the demographics, clinical presentation, biochemical profile, course of hospitalisation in post kidney transplant patients with COVID-19. Materials and Methods: This retrospective observational study study with 18 patients was conducted in Madurai Medical College, Tamil Nadu, India for duration of four months, from May 2021 to August 2021 and data collection from May 2021 to July 2021 and data analysis in August 2021. All post kidney transplant patients having evidence of COVID-19 were included. Detailed clinical history, biochemical profile, radiological findings, treatment, and final outcomes were collected and compared. Non parametric statistical tests were used, in addition to Chi-square test and odds ratio. Kaplan-Meier plot was used for survival analysis. Results: The most common presentation was fever 15 (83.3%), followed by cough 10 (55.6%). C-reactive Protein (CRP) {65 mg/L (11.48-94.48)}, D-dimer {0.72 mcg/mL (0.59-1.1)}, serum creatinine {3.5 mg/dL (2.12-5.93)}, and platelet count {200,000 cells/cu.mm (1.75-2.22)} and showed statistically significant (p<0.05) association with the outcome. About 15 (83.3%) patients developed Acute Kidney Injury (AKI). Seven patients (38.9%) had stage three AKI necessitating haemodialysis, of which six did not survive. The median survival time was 22 days, with 95% confidence interval (19.792-24.208), with case fatality rate of 33.3% Conclusion: Postkidney transplant patients are at high risk of contracting COVID-19. CRP, D-dimer, serum creatinine, platelet counts, and arterial oxygen saturation may serve as prognostic markers. Dialysis may be required in view of high incidence of AKI and acute graft dysfunction, though the outcome seems dismal in such patients. Hence, the need for early hospitalisation and more effective treatment protocol is essential to improve outcome.

17.
Trials ; 23(1): 414, 2022 May 18.
Article in English | MEDLINE | ID: covidwho-1862143

ABSTRACT

BACKGROUND: The INNODIA consortium has established a pan-European infrastructure using validated centres to prospectively evaluate clinical data from individuals with newly diagnosed type 1 diabetes combined with centralised collection of clinical samples to determine rates of decline in beta-cell function and identify novel biomarkers, which could be used for future stratification of phase 2 clinical trials. METHODS: In this context, we have developed a Master Protocol, based on the "backbone" of the INNODIA natural history study, which we believe could improve the delivery of phase 2 studies exploring the use of single or combinations of Investigational Medicinal Products (IMPs), designed to prevent or reverse declines in beta-cell function in individuals with newly diagnosed type 1 diabetes. Although many IMPs have demonstrated potential efficacy in phase 2 studies, few subsequent phase 3 studies have confirmed these benefits. Currently, phase 2 drug development for this indication is limited by poor evaluation of drug dosage and lack of mechanistic data to understand variable responses to the IMPs. Identification of biomarkers which might permit more robust stratification of participants at baseline has been slow. DISCUSSION: The Master Protocol provides (1) standardised assessment of efficacy and safety, (2) comparable collection of mechanistic data, (3) the opportunity to include adaptive designs and the use of shared control groups in the evaluation of combination therapies, and (4) benefits of greater understanding of endpoint variation to ensure more robust sample size calculations and future baseline stratification using existing and novel biomarkers.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adolescent , Adult , Biomarkers , Child , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/drug therapy , Humans , SARS-CoV-2 , Treatment Outcome
18.
Am J Health Syst Pharm ; 2022 May 23.
Article in English | MEDLINE | ID: covidwho-1860805

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To evaluate the efficacy and safety of a pharmacist-managed protocol for transitioning critically ill patients from intravenous (IV) to subcutaneous insulin. METHODS: This single-center, retrospective, observational study included patients admitted to the medical or surgical/trauma intensive care unit who received a continuous infusion of IV insulin from January 2019 to April 2021. Patients were excluded if they were less than 18 years old, pregnant, or incarcerated or received IV insulin for the diagnosis of diabetic ketoacidosis, hyperglycemic hyperosmolar state, calcium channel blocker or ß-blocker overdose, or hypertriglyceridemia. The primary outcome was to evaluate the percentage of blood glucose (BG) concentrations within the target range of 70 to 150 mg/dL within 48 hours of the transition to subcutaneous insulin. Secondary outcomes included the percentage of BG concentrations within the goal range following transition at 0 to 12 hours and 12 to 24 hours, the incidence of hypo- and hyperglycemia, and the percentage of patients requiring dose adjustments after the initial transition. RESULTS: Pharmacists were able to achieve BG concentrations in the target range for 53% of transitions at 12 hours, 40% of transitions at 24 hours, and 47% of transitions at 48 hours. With respect to safety endpoints, the pharmacist-managed group had a low rate of hypoglycemia (1.0%) and no severe hypoglycemia. Hyperglycemia was reported for 28% of BG concentrations while severe hyperglycemia was reported for 27%. Pharmacists transitioned patients to an average of 63% of the 24-hour total daily dose of insulin as basal insulin. CONCLUSION: Pharmacists can effectively and safely transition critically ill patients from IV to subcutaneous insulin utilizing a standardized protocol.

19.
Lung India ; 39(SUPPL 1):S131, 2022.
Article in English | EMBASE | ID: covidwho-1857384

ABSTRACT

Background: The COVID 19 pandemic caused by the betacoronavirus SARS-CoV-2 with its virulence and contagiousness is a public health emergency. The prefferred method of diagnosis is the FDA aprroved RT-PCR testing of nasopharyngeal swabs with 65% sensitivity, with false negative rates of <5% to 40%. Clinical diagnosis should supplant when there is high suspicion with labs and imaging consistent with COVID'19 and negative RT-PCR does not rule out the disease. Here we report one such case. Case Report: 45-year-old female with nil comorbidities presented with fever and breathlessnesss since 7 days with tachypnoea (46 breaths/min), hypoxia (spo2 75% room air) and bilateral coarse crepitations on auscultation. ABG & CXR suggested severe ARDS. CT Thorax revealed CTSI 21/25.CORADS 5.Two nasopharyngeal swabs 24 hours apart tested negative for COVID'19. Lab investigations suggested deranged inflammatory markers (ferritin 910ng/mL;CRP 121.2ng/L ;D-dimer 660ng/mL). Presumed diagnosis of COVID 19 was established based on early CT findings and lab parameters consistent with COVID'19 Pneumonitis,the patient was immediately isolated and received treatment as per COVID'19 treatment protocols (steroids,LMWH,Remdesivir). After 6th week patient showed clinical and radiological improvement.Subsequently she also developed postcovid fibrosis and discharged on pirfenidone and home based low-flow o2. Discussion and Conclusion: Fever, sore throat and breathlessness are common symptoms of Covid'19, most of which are virtually present in any viral LRTI, however in the setting of current pandemic maintain high index of suspicion for Covid'19 especially in the presence of radiological evidence even with negative RT-PCR.

20.
J Health Monit ; 6(Suppl 1): 2-16, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1856609

ABSTRACT

The SARS-CoV-2 coronavirus has spread rapidly across Germany. Infections are likely to be under-recorded in the notification data from local health authorities on laboratory-confirmed cases since SARS-CoV-2 infections can proceed with few symptoms and then often remain undetected. Seroepidemiological studies allow the estimation of the proportion in the population that has been infected with SARS-CoV-2 (seroprevalence) as well as the extent of undetected infections. The 'CORONA-MONITORING bundesweit' study (RKI-SOEP study) collects biospecimens and interview data in a nationwide population sample drawn from the German Socio-Economic Panel (SOEP). Participants are sent materials to self-collect a dry blood sample of capillary blood from their finger and a swab sample from their mouth and nose, as well as a questionnaire. The samples returned are tested for SARS-CoV-2 IgG antibodies and SARS-CoV-2 RNA to identify past or present infections. The methods applied enable the identification of SARS-CoV-2 infections, including those that previously went undetected. In addition, by linking the data collected with available SOEP data, the study has the potential to investigate social and health-related differences in infection status. Thus, the study contributes to an improved understanding of the extent of the epidemic in Germany, as well as identification of target groups for infection protection.

SELECTION OF CITATIONS
SEARCH DETAIL