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1.
Front Public Health ; 9: 801609, 2021.
Article in English | MEDLINE | ID: covidwho-1604379

ABSTRACT

As of November 17, 2021, SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2), the causative agent of COVID-19 (COronaVIrus Disease 19), has infected ~250 million people worldwide, causing around five million deaths. Titers of anti-SARS-CoV-2 neutralizing antibodies were relatively stable for at least 9 months in a population-based study conducted in Wuhan, China, both in symptomatic and in asymptomatic individuals. In the mass screening campaign conducted in the town of Ariano Irpino (Avellino, Italy) in May, 2020, 5.7% (95% CI: 5.3-6-1) of the 13,444 asymptomatic citizens screened were positive for anti-nucleocapsid antibodies against SARS-CoV-2. Among these, 422 citizens were re-tested for anti SARS-CoV-2 antibodies in January, 2021 and/or in April, 2021 and enrolled in this longitudinal observational study. Median (interquartile range) age of the study cohort was 46 years (29-59), with 47 (11.1%) participants of minor age, while 217 (51.4%) participants were females. There was no evidence of re-infection in any of the subjects included. Presence of anti-nuclear antibodies antibodies (Elecysis, Roche) was reported in 95.7 and 93.7% of evaluable participants in January and April, 2021. Multiple logistic regression analysis used to explore associations between age, sex and seroprevalence showed that adults vs. minors had significantly lower odds of having anti-S1 antibodies (Biorad) both in January, 2021 and in April, 2021. Our findings showed that antibodies remained detectable at least 11.5 months after infection in >90% of never symptomatic cases. Further investigation is required to establish duration of immunity against SARS-CoV-2.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Female , Follow-Up Studies , Humans , Immunity, Humoral , Middle Aged , Seroepidemiologic Studies
2.
G Ital Cardiol (Rome) ; 23(1): 4-9, 2022 Jan.
Article in Italian | MEDLINE | ID: covidwho-1609117

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 has greatly modified outpatient follow-ups. The aim of this retrospective study was to evaluate the organizational modalities and clinical effects of rearrangements of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) outpatient visits performed in our centers at Ravenna and Lugo Hospitals, Italy, during the pandemic outbreak in 2020. METHODS: All scheduled in-person device follow-up visits in March-December 2020 have been considered. On the basis of documented past functioning of each device and of remote monitoring (RM) capabilities, in-person visits were either performed or postponed at variable times. The characteristics of the follow-ups and the device-related clinically relevant events were analyzed, the latter being further divided into serious malfunction and problems to be corrected by device reprogramming. RESULTS: Overall, 27% of in-person visits were postponed (n = 576) (36% of ICDs and 25% of PMs), peaking 62% in March-May 2020. RM compensated nearly all hold-ups in ICDs and just 63% of postponements in PMs. The postponement-caused delay between in-person visits was 5.6 ± 1.1 months for ICDs and 4.7 ± 1.2 months for PMs; in 24% of ICDs the time interval between in-person visits was ≥18 months. Clinically relevant events were 56 (18 [4.4%] in ICDs, 38 [2.1%] in PMs), with no deaths and 21 serious malfunctions (4 [1%] in ICDs, 15 [0.8%] in PMs). RM identified all ICD malfunctions, while it was not available in the affected PMs. In comparison with the year 2019, serious malfunctions increased, though the difference was not significant. Monthly RM transmissions increased by 2.3 fold. CONCLUSIONS: In our single-center experience during the COVID-19 pandemic, numerous in-person PM/ICD follow-up visits were postponed, and delays were well beyond the previously recommended time limits. However, device-related malfunctions did not increase, notably, when RM capabilities were used.


Subject(s)
COVID-19 , Defibrillators, Implantable , Pacemaker, Artificial , Electronics , Follow-Up Studies , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
3.
Neuromodulation ; 24(3): 441-447, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1593901

ABSTRACT

OBJECTIVES: Due to the impact of COVID-19 epidemic, face-to-face follow-up treatments for patients with chronic pain and implanted spinal cord stimulation (SCS) devices are forced to be delayed or stopped. This has led to more follow ups being done remotely. Meanwhile, with the development of 4G/5G networks, smartphones, and novel devices, remote programming has become possible. Here, we investigated the demand and utility of remote follow-ups including remote programming for SCS for patients with chronic pain. MATERIALS AND METHODS: A questionnaire including questions on demographic characteristics, pain history, postimplantation life quality, standard follow-up experience, remote follow-up, and remote programming experience was sent to patients diagnosed as chronic intractable pain and treated with SCS during January 2019 to January 2020. RESULTS: A total of 64 participants completed the questionnaire. About 70% of participants expressed demands for remote follow-ups due to the inconvenience, high costs, and time consumption of traditional follow-up visits. Nearly 97% of participants have attempted remote follow-ups, and about 81% of participants have further tried remote programming. Approximately, 96% of them recognized the benefits. CONCLUSIONS: The remote programming was in high demand among participants. Most of the participants have tried remote follow-ups or even remote programming. The remote programming appeared to be more efficient, economic and were widely recognized among participants.


Subject(s)
COVID-19/prevention & control , Chronic Pain/therapy , Disease Outbreaks/prevention & control , Implantable Neurostimulators , Remote Sensing Technology/methods , Spinal Cord Stimulation/methods , Adult , COVID-19/epidemiology , China/epidemiology , Chronic Pain/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement/methods
4.
Med Sci Monit ; 27: e935379, 2021 Dec 30.
Article in English | MEDLINE | ID: covidwho-1593238

ABSTRACT

BACKGROUND This retrospective study aimed to investigate outcomes and hospitalization rates in patients with a confirmed diagnosis of early COVID-19 treated at home with prescribed and non-prescribed treatments. MATERIAL AND METHODS The medical records of a cohort of 158 Italian patients with early COVID-19 treated at home were analyzed. Treatments consisted of indomethacin, low-dose aspirin, omeprazole, and a flavonoid-based food supplement, plus azithromycin, low-molecular-weight heparin, and betamethasone as needed. The association of treatment timeliness and of clinical variables with the duration of symptoms and with the risk of hospitalization was evaluated by logistic regression. RESULTS Patients were divided into 2 groups: group 1 (n=85) was treated at the earliest possible time (<72 h from onset of symptoms), and group 2 (n=73) was treated >72 h after the onset of symptoms. Clinical severity at the beginning of treatment was similar in the 2 groups. In group 1, symptom duration was shorter than in group 2 (median 6.0 days vs 13.0 days, P<0.001) and no hospitalizations occurred, compared with 19.18% hospitalizations in group 2. One patient in group 1 developed chest X-ray alterations and 2 patients experienced an increase in D-dimer levels, compared with 30 and 22 patients, respectively, in group 2. The main factor determining the duration of symptoms and the risk of hospitalization was the delay in starting therapy (P<0.001). CONCLUSIONS This real-world study of patients in the community showed that early diagnosis and early supportive patient management reduced the severity of COVID-19 and reduced the rate of hospitalization.


Subject(s)
COVID-19/diagnosis , COVID-19/drug therapy , Hospitalization/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , Aged, 80 and over , Aspirin/therapeutic use , Betamethasone/therapeutic use , Cohort Studies , Dietary Supplements , Early Diagnosis , Female , Flavonoids/therapeutic use , Follow-Up Studies , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Indomethacin/therapeutic use , Italy , Male , Middle Aged , Omeprazole/therapeutic use , Patient Acuity , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Time , Treatment Outcome
5.
Med Sci Monit ; 27: e935075, 2021 Dec 31.
Article in English | MEDLINE | ID: covidwho-1592562

ABSTRACT

BACKGROUND Thyroiditis is an important extrahepatic association in chronic hepatitis C virus (HCV) infection. There have been reports of an association between SARS-CoV-2 infection and the onset or re-activation of autoimmune hypothyroidism. Therefore, we performed this prospective observational study of 42 patients with COVID-19 infection and a history of hepatitis C virus infection and thyroid disease with follow-up thyroid function and autoantibody testing. MATERIAL AND METHODS From April 2020 to October 2020, we performed a prospective observational study of patients with cured hepatitis C virus (HCV) infection and documented thyroid disease who became infected with SARS-CoV-2 (confirmed by SARS-CoV-2 RNA detection via reverse-transcription polymerase chain reaction [RT-PCT] from the upper respiratory tract, both nasal and pharyngeal swabs). Evaluation at 1 and 3 months after SARS-CoV-2 infection included serum determination of antithyroid antibodies (anti-thyroglobulin [anti-Tg] and antithyroid peroxidase [ATPO]), thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and evaluation of thyroid medication, with dose adjustment if required. RESULTS One-month follow-up showed that both patients with autoimmune thyroiditis as well as patients without antibodies had increased ATPO levels. Also, levels of TSH, fT3, and fT4 were significantly decreased. At 3-month follow-up, levels of ATPO were decreased in all patient groups and the levels of thyroid hormones increased to normal values. CONCLUSIONS This study supports previous reports of an association between SARS-CoV-2 infection and thyroid dysfunction associated with thyroid autoantibodies. Thyroid function tests may be considered as part of the laboratory work-up in patients with COVID-19.


Subject(s)
COVID-19/complications , Hepatitis C/complications , Hypothyroidism/etiology , Adult , Aged , COVID-19/virology , Female , Follow-Up Studies , Hepacivirus/pathogenicity , Hepatitis C/virology , Humans , Hypothyroidism/physiopathology , Hypothyroidism/virology , Male , Middle Aged , Prospective Studies , RNA, Viral , Romania/epidemiology , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Thyroid Diseases/physiopathology , Thyroid Function Tests , Thyroid Gland/physiology , Thyroiditis, Autoimmune/blood , Thyroiditis, Autoimmune/immunology , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood
6.
Biomed Res Int ; 2021: 9928276, 2021.
Article in English | MEDLINE | ID: covidwho-1582875

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is a global public health crisis. However, whether it can cause respiratory dysfunction or physical and psychological disorders in patients remains unknown. Thus, this study was conducted to investigate the respiratory function, activities of daily living, quality of life, and mental status of patients with COVID-19. Participants and outcomes. Data was collected from the follow-up of eligible patients who attended the fever clinic of three hospitals in Jiangxi Province, from March to May 2020. The outcomes included respiratory muscle function, degree of dyspnea, aerobic capacity, activities of daily living, quality of life, and mental status. Results: A total of 139 patients (72 men and 67 women) were included in this study. The proportions of mild, moderate, severe, and critical cases of COVID-19 were 7.1% (10 cases), 68.3% (95 cases), 20.1% (28 cases), and 4.2% (6 cases), respectively. The rates of abnormal maximal inspiratory pressure were 10.0%, 25.2%, 25.0%, and 16.7%, respectively. There were 50%, 65.3%, 50%, and 66.7% of the patients with abnormal dyspnea in the four clinical classifications, respectively. Patients generally show a decline in quality of life, anxiety, and depression symptoms. Conclusions: Respiratory dysfunction, decreased quality of life, and psychological disorders were present in each clinical classification of COVID-19. Therefore, it is necessary to carry out respiratory rehabilitation and psychological intervention for COVID-19 patients.


Subject(s)
Activities of Daily Living , COVID-19 , Quality of Life , Respiratory Mechanics , SARS-CoV-2 , Adult , Aged , Anxiety/physiopathology , Anxiety/psychology , Anxiety/rehabilitation , COVID-19/physiopathology , COVID-19/psychology , COVID-19/rehabilitation , Depression/physiopathology , Depression/psychology , Depression/rehabilitation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies
7.
Inquiry ; 58: 469580211060165, 2021.
Article in English | MEDLINE | ID: covidwho-1582740

ABSTRACT

OBJECTIVES: Post-COVID-19 symptoms and its features in many recovered patients are almost similar to post-severe acute respiratory syndrome. The study aims to assess the outcome and manifestations during post-COVID follow-up period in recovered patients. METHODS: Ambidirectional longitudinal study was conducted among recovered COVID-19 patients from a tertiary care hospital near Chennai through telephonic interview after discharge. Total admitted patients from June to November 2020 were 3496 and among those 183 died and 12 transferred to other hospitals. Totally 1354 consented for study and the rest were wrong numbers or not willing to participate. Chi-square test and multinominal logistic regression analysis were done. RESULTS: Majority of, that is, 27.6% and 18.7% were in 21-30 years and >60 years, respectively. Majority were admitted with fever (38.3%), cough (15.3), and body pain (10%). Post-COVID symptoms reported were fatigue (39.7%), stress and anxiety (27.6%), and mood changes (5.8%). Some patients were newly diagnosed with diabetes mellitus (10), hypertension (5), and TB (1) after discharge. Having diabetes mellitus is an independent risk to have neurological and cardio-respiratory symptoms and patients who were discharged with minimal support were to have an independent risk factor of renal symptoms on follow-up than other subjects. CONCLUSION: The follow-up symptoms were associated with the patients' comorbidities, age, severity of illness, and environmental factors.


Subject(s)
COVID-19 , Telemedicine , Follow-Up Studies , Humans , India , Longitudinal Studies , SARS-CoV-2 , Tertiary Care Centers
8.
BMC Infect Dis ; 21(1): 1271, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1582103

ABSTRACT

BACKGROUND: The long-term functional outcome of discharged patients with coronavirus disease 2019 (COVID-19) remains unresolved. We aimed to describe a 6-month follow-up of functional status of COVID-19 survivors. METHODS: We reviewed the data of COVID-19 patients who had been consecutively admitted to the Tumor Center of Union Hospital (Wuhan, China) between 15 February and 14 March 2020. We quantified a 6-month functional outcome reflecting symptoms and disability in COVID-19 survivors using a post-COVID-19 functional status scale ranging from 0 to 4 (PCFS). We examined the risk factors for the incomplete functional status defined as a PCFS > 0 at a 6-month follow-up after discharge. RESULTS: We included a total of 95 COVID-19 survivors with a median age of 62 (IQR 53-69) who had a complete functional status (PCFS grade 0) at baseline in this retrospective observational study. At 6-month follow-up, 67 (70.5%) patients had a complete functional outcome (grade 0), 9 (9.5%) had a negligible limited function (grade 1), 12 (12.6%) had a mild limited function (grade 2), 7 (7.4%) had moderate limited function (grade 3). Univariable logistic regression analysis showed a significant association between the onset symptoms of muscle or joint pain and an increased risk of incomplete function (unadjusted OR 4.06, 95% CI 1.33-12.37). This association remained after adjustment for age and admission delay (adjusted OR 3.39, 95% CI 1.06-10.81, p = 0.039). CONCLUSIONS: A small proportion of discharged COVID-19 patients may have an incomplete functional outcome at a 6-month follow-up; intervention strategies are required.


Subject(s)
COVID-19 , Patient Discharge , Follow-Up Studies , Functional Status , Humans , SARS-CoV-2
9.
PLoS One ; 16(12): e0261024, 2021.
Article in English | MEDLINE | ID: covidwho-1581763

ABSTRACT

BACKGROUND: Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. METHODS: We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. RESULTS: Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. CONCLUSIONS: Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.


Subject(s)
COVID-19/surgery , Tracheostomy/methods , Aged , COVID-19/mortality , COVID-19/therapy , Critical Care/methods , Female , Follow-Up Studies , Hospitals, University , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Paris , Personnel, Hospital , Respiration, Artificial , Retrospective Studies , Tracheostomy/adverse effects , Treatment Outcome
10.
PLoS One ; 16(12): e0261707, 2021.
Article in English | MEDLINE | ID: covidwho-1581734

ABSTRACT

The objective of this retrospective cohort study was to describe pre-treatment characteristics, treatment patterns, health resource use, and clinical outcomes among adults hospitalized with COVID-19 in the United States (US) who initiated common treatments for COVID-19. The Optum® COVID-19 electronic health records database was used to identify patients >18 years, diagnosed with COVID-19, who were admitted to an inpatient setting and received treatments of interest for COVID-19 between September 2020 and January 2021. Patients were stratified into cohorts based on index treatment use. Patient demographics, medical history, care setting, medical procedures, subsequent treatment use, patient disposition, clinical improvement, and outcomes were summarized descriptively. Among a total of 26,192 patients identified, the most prevalent treatments initiated were dexamethasone (35.4%) and dexamethasone + remdesivir (14.9%), and dexamethasone was the most common subsequent treatment. At day 14 post-index, <10% of patients received any treatments of interest. Mean (standard deviation [SD]) patient age was 65.6 (15.6) years, and the most prevalent comorbidities included hypertension (44.8%), obesity (35.4%), and diabetes (25.7%). At the end of follow-up, patients had a mean (SD) 8.1 (6.6) inpatient days and 1.4 (4.1) days with ICU care. Oxygen supplementation, non-invasive, or invasive ventilation was required by 4.5%, 3.0%, and 3.1% of patients, respectively. At the end of follow-up, 84.2% of patients had evidence of clinical improvement, 3.1% remained hospitalized, 83.8% were discharged, 4% died in hospital, and 9.1% died after discharge. Although the majority of patients were discharged alive, no treatments appeared to alleviate the inpatient morbidity and mortality associated with COVID-19. This highlights an unmet need for effective treatment options for patients hospitalized with COVID-19.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Dexamethasone/therapeutic use , Hypertension/epidemiology , Obesity/epidemiology , Patient Discharge , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Adenosine Monophosphate/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Alanine/therapeutic use , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Drug Therapy, Combination/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , RNA, Viral/genetics , Retrospective Studies , Treatment Outcome , United States/epidemiology , Young Adult
11.
Int J Environ Res Public Health ; 19(1)2021 12 27.
Article in English | MEDLINE | ID: covidwho-1580808

ABSTRACT

BACKGROUND: Prevalence, incidence, and factors associated with posttraumatic stress disorder (PTSD) symptoms at follow-up among healthcare workers after the first wave of the COVID-19 pandemic are unknown. METHODS: A web survey invitation was sent to healthcare worker listservs at a NYC medical center (April, 2020). The Primary Care (PC)-PTSD questionnaire was used to screen for PTSD symptoms at baseline and then every 2 weeks for 10 weeks. Incidence and prevalence of PTSD symptoms were determined at each time point. Multivariable generalized estimating equation models were performed to investigate the factors associated with a positive PC-PTSD screen at follow-up. RESULTS: Median age (interquartile range) of N = 230 participants was 36 (31-48) years; 79.6% were women; 82.6% worked in COVID-19-focused settings. The prevalence of PTSD symptoms decreased from 55.2% at baseline to 25.0% at 10 weeks (p < 0.001). Among participants who had a baseline negative screen for PTSD symptoms, the incidence of PTSD at 10 weeks was 12.2% (p-trend 0.034). In multivariable-adjusted analyses, being a nurse (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.06-2.71), female (OR: 3.00, 95% CI: 1.59, 5.72), and working in a COVID-19-focused location (OR: 1.51, 95% CI: 1.02, 2.21) were associated with increased odds of PTSD symptoms at 10-weeks. CONCLUSIONS: PTSD symptoms improved over 3 months following the first wave of the COVID-19 pandemic. However, one out of four NYC healthcare workers still had an increased risk for PTSD at 10-weeks. Screening healthcare workers for PTSD symptoms should be considered during the COVID-19 pandemic.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Cross-Sectional Studies , Female , Follow-Up Studies , Health Personnel , Humans , Incidence , New York City/epidemiology , Pandemics , Prevalence , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology
12.
Int J Environ Res Public Health ; 18(24)2021 12 16.
Article in English | MEDLINE | ID: covidwho-1580742

ABSTRACT

Background: This proposal aims to explain some of the gaps in scientific knowledge on the natural history of coronavirus disease (COVID-19), with a specific focus on immune, inflammatory, and metabolic markers, in parallel with temporal assessment of clinical and mental health in patients with COVID-19. The study will explore the temporal modulatory effects of physical activity and body composition on individual trajectories. This approach will provide a better understanding of the survival mechanisms provided by the immunomodulatory role of physical fitness. Methods: We will conduct a prospective observational cohort study including adult patients previously infected with the SARS-CoV-2 virus who have expressed a mild to moderate COVID-19 infection. Procedures will be conducted for all participants at baseline, six weeks after vaccination, and again at 12 months. At each visit, a venous blood sample will be collected for immune phenotypic characterization and biochemistry assays (inflammatory and metabolic parameters). Also, body composition, physical activity level, cardiovascular and pulmonary function, peripheral and respiratory muscle strength, functional exercise capacity, and mental health will be evaluated. Using the baseline information, participants will be grouped based on physical activity levels (sedentary versus active), body composition (normal weight versus overweight or obese), and SARS-CoV-2 status (positive versus negative). A sub-study will provide mechanistic evidence using an in-vitro assay based on well-trained individuals and age-matched sedentary controls who are negative for SARS-CoV-2 infection. Whole blood will be stimulated using recombinant human coronavirus to determine the cytokine profile. Peripheral blood mononuclear cells (PBMCs) from healthy well-trained participants will be collected and treated with homologous serum (from the main study; samples collected before and after the vaccine) and recombinant coronavirus (inactive virus). The metabolism of PBMCs will be analyzed using Respirometry (Seahorse). Data will be analyzed using multilevel repeated-measures ANOVA. Conclusions: The data generated will help us answer three main questions: (1) Does the innate immune system of physically active individuals respond better to viral infections compared with that of sedentary people? (2) which functional and metabolic mechanisms explain the differences in responses in participants with different physical fitness levels? and (3) do these mechanisms have long-term positive modulatory effects on mental and cardiovascular health? Trial registration number: Brazilian Registry of Clinical Trials: RBR-5dqvkv3. Registered on 21 September 2021.


Subject(s)
COVID-19 , Adult , Exercise , Follow-Up Studies , Humans , Immunity , Leukocytes, Mononuclear , Observational Studies as Topic , Prospective Studies , SARS-CoV-2
13.
Tuberk Toraks ; 69(4): 492-498, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1580009

ABSTRACT

Introduction: To date, there is limited data on the long-term changes in the lungs of patients recovering from coronavirus (COVID-19) pneumonia. In order to evaluate pulmonary sequelae, it was planned to investigate fibrotic changes observed as sequelae in lung tissue in 3-6-month control thorax computerized tomography (CT) scans of moderate-to-severe COVID-19 pneumonia survivors. Materials and Methods: A total of 84 patients (mean age: 67.3 years ±15) with moderate-to-severe pneumonia on chest tomography at the time of diagnosis were included in the study, of which 51 (61%) were males and 33 (39%) were females. Initial and follow-up CT scans averaged 8.3 days ± 2.2 and 112.1 days ± 14.6 after symptom onset, respectively. Participants were recorded in two groups as those with and without fibrotic-like changes such as traction bronchiectasis, fibrotic - parenchymal bands, honeycomb appearance according to 3-6 months follow-up CT scans. Differences between the groups were evaluated with a two-sampled t-test. Logistic regression analyzes were performed to determine independent predictive factors of fibrotic-like sequelae changes. Result: On follow-up CTs, fibrotic-like changes were observed in 29 (35%) of the 84 participants (Group 1), while the remaining 55 (65%) showed complete radiological recovery (Group 2). With logistic regression analysis, hospital stay of 22 days or longer (OR: 4.9; 95% CI: 20, 32; p< 0.05) and a CT score of 15 or more at diagnosis (OR: 2.2; 95% CI: 13.5, 18; p< 0.05) were found to be an independent predictor for sequelae fibrotic changes in lung tissue. Conclusions: More than one-third of patients who survived COVID-19 pneumonia had fibrotic-like sequelae changes in the lung parenchyma. These changes were found to be associated with the presence of severe pneumonia at the time of diagnosis and longer hospital stay.


Subject(s)
COVID-19 , Pneumonia , Aged , Female , Follow-Up Studies , Humans , Lung/diagnostic imaging , Male , Pneumonia/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Thorax , Tomography, X-Ray Computed
14.
Ann Med ; 53(1): 337-344, 2021 12.
Article in English | MEDLINE | ID: covidwho-1575678

ABSTRACT

BACKGROUND: To minimise the risk of COVID-19 transmission, an ambulant screening protocol for COVID-19 in patients before admission to the hospital was implemented, combining the SARS CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) on a nasopharyngeal swab, a chest computed tomography (CT) and assessment of clinical symptoms. The aim of this study was to evaluatethe diagnostic yield and the proportionality of this pre-procedural screeningprotocol. METHODS: In this mono-centre, prospective, cross-sectional study, all patients admitted to the hospital between 22nd April 2020 until 14th May 2020 for semi-urgent surgery, haematological or oncological treatment, or electrophysiological investigationunderwent a COVID-19 screening 2 days before their procedure. At a 2-week follow-up, the presence of clinical symptoms was evaluated by telephone as a post-hoc evaluation of the screening approach.Combined positive RT-PCR assay and/or positive chest CT was used as gold standard. Post-procedural outcomes of all patients diagnosed positive for COVID-19 were assessed. RESULTS: In total,528 patients were included of which 20 (3.8%) were diagnosed as COVID-19 positive and 508 (96.2%) as COVID-19 negative. 11 (55.0%) of COVID-19 positive patients had only a positive RT-PCR assay, 3 (15.0%) had only a positive chest CT and 6 (30%) had both a positive RT-PCR assay and chest CT. 10 out of 20 (50.0%) COVID-19 positive patients reported no single clinical symptom at the screening. At 2 week follow-up, 50% of these patients were still asymptomatic. 37.5% of all COVID-19 negative patients were symptomatic at screening. In the COVID-19 negative group without symptoms at screening, 78 (29.3%) patients developed clinical symptoms at a 2-week follow-up. CONCLUSION: This study suggests that routine chest CT and assessment of self-reported symptoms have limited value in the preprocedural COVID-19 screening due to low sensitivity and/or specificity.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Mass Screening/methods , Patient Admission , Adult , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Sensitivity and Specificity , Tomography, X-Ray Computed
15.
Swiss Med Wkly ; 151: w30093, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1575741

ABSTRACT

AIM OF THE STUDY: Patients surviving COVID-19 have been described as being at risk of developing sequelae. We aimed to investigate and elicit persistent symptoms, emotional status and quality-of-life in patients discharged after an acute COVID-19 episode. METHODS: Patient-reported outcome measures were collected during a telephone interview 30 days and 1 year after discharge. Patients' general health status was evaluated using questions based on their symptoms, emotional status was assessed using the items 9 to 12 of the HeartQoL questionnaire and quality of life was assessed at 1 year through the EQ-5D-5L. In patients with a history of cardiovascular disease, all 14 items of the HeartQoL questionnaire were completed to derive the HeartQoL global score. RESULTS: Among 687 patients who survived after being hospitalised for COVID-19 at the University Hospitals of Geneva between 26 February and 26 April 2020, 184 (27%) and 165 (24%), respectively, participated in the follow-up at 30 days and 1 year. Of these 184 participants, 62% were male, median age was 58 years and 21% had a past medical history of cardiovascular disease. At one month after discharge, 61% (113/184) of patients presented fatigue and 28% (52/184) dyspnoea. One year after discharge, the main complaints were persistent fatigue in 27% (45/165) of patients, neurological problems in 17% (28/165) and dyspnoea in 14% (23/165). Eight percent (14/184) of patients declared being significantly worried 1 month after discharge and 5% (9/184) feeling depressed. The number of patients reporting being significantly worried or depressed at 1 year was lower. Regarding the quality of life at 1 year, the median EQ-5D-5L visual analogue scale score was 80 (interquartile range 70-90). CONCLUSIONS: Approximately half of patients reported some symptoms 1 year after discharge following an acute episode of COVID-19. The predominant symptom was persistent fatigue both at 1-month and at 1-year follow-up. Emotional status and quality of life appeared satisfactory.


Subject(s)
COVID-19 , Quality of Life , Follow-Up Studies , Humans , Male , Middle Aged , Patient Discharge , SARS-CoV-2
16.
Medwave ; 21(11): e8500, 2021 Dec 15.
Article in Spanish, English | MEDLINE | ID: covidwho-1574130

ABSTRACT

Introduction: COVID-19 disease affects newborns, but its middle and long-term effects are still unclear. Objective: To describe the clinical and epidemiological characteristics and follow-up of newborns infected with SARS-CoV-2. Methods: An observational and descriptive study. We included newborns with SARS-CoV-2 positive RT-PCR born from SARS-CoV-2 seropositive mothers. Delivery and newborn care were provided at the 'Instituto Nacional Materno Perinatal' from Peru between June 1 and September 30, 2020. Perinatal information was collected from medical records. Remote follow-up and face-to-face evaluations gathered epidemiological and clinical information, in addition to serological and RT-PCR tests for SARS-CoV-2. Descriptive statistics were used for analysis. Results: During the study period, 4733 neonates were born at the institution. We found that 1488 (31.4%) were born from seropositive for SARS-CoV-2 mothers. Finally, we included the 34 (2.3%) newborns with positive RT-PCR for SARS-CoV-2. Regarding the included newborns, 29.4% were delivered by cesarean section, 26.5% had low birth weight, 11.8% were preterm, 26.5% were hospitalized, and one died. Twenty-eight had a remote follow-up, and 18 also had a face-to-face follow-up. A total of 64.3% were exclusively breastfed, 28.6% were mixed breastfed, and 7.1% used a substitute formula. The face-to-face evaluation was performed between one and four months of chronological age. We found that 100% had negative control RT-PCR test for COVID-19, 38.9% had a negative serological test (IgM, IgG), and 61.1% positive IgG. Conclusions: Neonatal SARS-CoV-2 infection is rare, and most infected infants are asymptomatic. Vaginal delivery, breastfeeding, and joint isolation did not related with complications during hospital care. Infants under remote and in-person follow-up showed favorable clinical evolution during the study period.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Cesarean Section , Female , Follow-Up Studies , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/epidemiology , SARS-CoV-2
17.
Int J Cardiol ; 340: 113-118, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1561875

ABSTRACT

BACKGROUND: Long-term effects of Coronavirus Disease of 2019 (COVID-19) are of utmost relevance. We aimed to determine: 1) the functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) the characteristics associated with cardiopulmonary exercise testing (CPET) performance; 3) the safety and tolerability of CPET. METHODS: We prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 from Azienda Sanitaria Locale 3, Genoa. Three months after hospital discharge a complete clinical evaluation, trans-thoracic echocardiography, CPET, pulmonary function tests, and dominant leg extension (DLE) maximal strength measurement were performed. RESULTS: From the 225 patients discharged alive from March to November 2020, we excluded 12 incomplete/missing cases and 13 unable to perform CPET, leading to a final cohort of 200. Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3-103.1). Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value. Among the 99 patients with reduced %pVO2, 61 (61%) had a normal anaerobic threshold: of these, 9(14.8%) had respiratory, 21(34.4%) cardiac, and 31(50.8%) non-cardiopulmonary reasons for exercise limitation. Inerestingly, 80% of patients experienced at least one disabling symtpom, not related to %pVO2 or functional capacity. Multivariate linear regression showed percent-predicted forced expiratory volume in one-second(ß = 5.29,p = 0.023), percent-predicted diffusing capacity of lungs for carbon monoxide(ß = 6.31,p = 0.001), and DLE maximal strength(ß = 14.09,p = 0.008) to be independently associated with pVO2. No adverse event was reported during or after CPET, and no involved health professional developed COVID-19. CONCLUSIONS: At three months after discharge, about 1/3rd of COVID-19 survivors show functional limitations, mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.


Subject(s)
COVID-19 , Exercise Test , Echocardiography , Exercise Tolerance , Follow-Up Studies , Humans , Oxygen Consumption , SARS-CoV-2
18.
Lancet Infect Dis ; 21(11): 1590-1597, 2021 11.
Article in English | MEDLINE | ID: covidwho-1561435

ABSTRACT

BACKGROUND: Trials of BCG vaccination to prevent or reduce severity of COVID-19 are taking place in adults, some of whom have been previously vaccinated, but evidence of the beneficial, non-specific effects of BCG come largely from data on mortality in infants and young children, and from in-vitro and animal studies, after a first BCG vaccination. We assess all-cause mortality following a large BCG revaccination trial in Malawi. METHODS: The Karonga Prevention trial was a population-based, double-blind, randomised controlled in Karonga District, northern Malawi, that enrolled participants between January, 1986, and November, 1989. The trial compared BCG (Glaxo-strain) revaccination versus placebo to prevent tuberculosis and leprosy. 46 889 individuals aged 3 months to 75 years were randomly assigned to receive BCG revaccination (n=23 528) or placebo (n=23 361). Here we report mortality since vaccination as recorded during active follow-up in northern areas of the district in 1991-94, and in a demographic surveillance follow-up in the southern area in 2002-18. 7389 individuals who received BCG (n=3746) or placebo (n=3643) lived in the northern follow-up areas, and 5616 individuals who received BCG (n=2798) or placebo (n=2818) lived in the southern area. Year of death or leaving the area were recorded for those not found. We used survival analysis to estimate all-cause mortality. FINDINGS: Follow-up information was available for 3709 (99·0%) BCG recipients and 3612 (99·1%) placebo recipients in the northern areas, and 2449 (87·5%) BCG recipients and 2413 (85·6%) placebo recipients in the southern area. There was no difference in mortality between the BCG and placebo groups in either area, overall or by age group or sex. In the northern area, there were 129 deaths per 19 694 person-years at risk in the BCG group (6·6 deaths per 1000 person-years at risk [95% CI 5·5-7·8]) versus 133 deaths per 19 111 person-years at risk in the placebo group (7·0 deaths per 1000 person-years at risk [95% CI 5·9-8·2]; HR 0·94 [95% CI 0·74-1·20]; p=0·62). In the southern area, there were 241 deaths per 38 399 person-years at risk in the BCG group (6·3 deaths per 1000 person-years at risk [95% CI 5·5-7·1]) versus 230 deaths per 38 676 person-years at risk in the placebo group (5·9 deaths per 1000 person-years at risk [95% CI 5·2-6·8]; HR 1·06 [95% CI 0·88-1·27]; p=0·54). INTERPRETATION: We found little evidence of any beneficial effect of BCG revaccination on all-cause mortality. The high proportion of deaths attributable to non-infectious causes beyond infancy, and the long time interval since BCG for most deaths, might obscure any benefits. FUNDING: British Leprosy Relief Association (LEPRA); Wellcome Trust.


Subject(s)
BCG Vaccine/administration & dosage , Immunization, Secondary/statistics & numerical data , Mortality , Vaccination/methods , Adolescent , Adult , Aged , BCG Vaccine/immunology , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , Child , Child, Preschool , Double-Blind Method , Female , Follow-Up Studies , Humans , Immunogenicity, Vaccine , Leprosy/immunology , Leprosy/mortality , Leprosy/prevention & control , Malawi/epidemiology , Male , Middle Aged , Mycobacterium leprae/immunology , SARS-CoV-2/immunology , Treatment Outcome , Tuberculosis/immunology , Tuberculosis/mortality , Tuberculosis/prevention & control , Vaccination/statistics & numerical data , Young Adult
19.
Medicina (Kaunas) ; 57(12)2021 Dec 05.
Article in English | MEDLINE | ID: covidwho-1554942

ABSTRACT

Background and Objectives: Comprehension regarding immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited, and the durability of immune responses after vaccination is currently unknown. Several studies have reported on the antibody response in fully vaccinated individuals with a limited follow-up of the participants, i.e., below 7 months. Materials and Methods: The antibody response to complete vaccination with the BNT162b2 mRNA COVID-19 vaccine was assessed monthly, for 7 months, in 92 healthcare workers, between February 26 and September 26, 2021. The SARS-CoV-2 anti-spike protein IgG (IgGS) antibody was detected using the SARS-CoV-2 IgG II Quant assay (Abbott, Diagnostics Division, Sligo, Ireland), a chemiluminescent microparticle immunoassay (CMIA) with a sensitivity of 98.1% and specificity of 99.6%. Participants were divided into two groups, one for individuals previously infected with SARS-CoV-2 and the other for individuals without previous infection. Results: The median IgGS titers decreased monthly both in previously infected individuals and in the uninfected group. Previously infected individuals had significantly higher median titers of IgGS compared with previously uninfected subjects at all seven time points after complete vaccination (p < 0.001). Conclusions: Seven months after vaccination, the median IgGS titer had decreased by more than 92% both in individuals previously infected with SARS-CoV-2 and in uninfected individuals. However, IgGS antibodies were still detected in all study participants and persisted throughout the 7 months after the second dose of the vaccine. Further studies should be conducted to monitor the antibody response to the BNT162b2 mRNA vaccine beyond 7 months, to assess the need for a new booster dose in order to extend the duration and amplitude of the specific immune response.


Subject(s)
COVID-19 , Antibodies, Viral , Antibody Formation , COVID-19 Vaccines , Follow-Up Studies , Humans , RNA, Messenger/genetics , SARS-CoV-2 , Vaccines, Synthetic
20.
Viruses ; 13(12)2021 12 04.
Article in English | MEDLINE | ID: covidwho-1554851

ABSTRACT

The persistent circulation of SARS-CoV-2 represents an ongoing global threat due to the emergence of new viral variants that can sometimes evade the immune system of previously exposed or vaccinated individuals. We conducted a follow-up study of adult individuals that had received an inactivated SARS-CoV-2 vaccine, evaluating antibody production and neutralizing activity over a period of 6 months. In addition, we performed mice immunization with inactivated SARS-CoV-2, and evaluated the immune response and pathological outcomes against Gamma and Zeta variant infection. Vaccinated individuals produced high levels of antibodies with robust neutralizing activity, which was significantly reduced against Gamma and Zeta variants. Production of IgG anti-S antibodies and neutralizing activity robustly reduced after 6 months of vaccination. Immunized mice demonstrated cellular response against Gamma and Zeta variants, and after viral infection, reduced viral loads, IL-6 expression, and histopathological outcome in the lungs. TNF levels were unchanged in immunized or not immunized mice after infection with the Gamma variant. Furthermore, serum neutralization activity rapidly increases after infection with the Gamma and Zeta variants. Our data suggest that immunization with inactivated WT SARS-CoV-2 induces a promptly responsive cross-reactive immunity response against the Gamma and Zeta variants, reducing COVID-19 pathological outcomes.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/prevention & control , SARS-CoV-2/immunology , Vaccines, Inactivated/immunology , Animals , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/immunology , COVID-19/pathology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Cross Protection , Cytokines/metabolism , Follow-Up Studies , Humans , Immunization , Lung/metabolism , Lung/pathology , Mice , Vaccines, Inactivated/administration & dosage , Viral Load
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