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1.
Lancet ; 398(10303): 843-855, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-2106189

ABSTRACT

BACKGROUND: A previous efficacy trial found benefit from inhaled budesonide for COVID-19 in patients not admitted to hospital, but effectiveness in high-risk individuals is unknown. We aimed to establish whether inhaled budesonide reduces time to recovery and COVID-19-related hospital admissions or deaths among people at high risk of complications in the community. METHODS: PRINCIPLE is a multicentre, open-label, multi-arm, randomised, controlled, adaptive platform trial done remotely from a central trial site and at primary care centres in the UK. Eligible participants were aged 65 years or older or 50 years or older with comorbidities, and unwell for up to 14 days with suspected COVID-19 but not admitted to hospital. Participants were randomly assigned to usual care, usual care plus inhaled budesonide (800 µg twice daily for 14 days), or usual care plus other interventions, and followed up for 28 days. Participants were aware of group assignment. The coprimary endpoints are time to first self-reported recovery and hospital admission or death related to COVID-19, within 28 days, analysed using Bayesian models. The primary analysis population included all eligible SARS-CoV-2-positive participants randomly assigned to budesonide, usual care, and other interventions, from the start of the platform trial until the budesonide group was closed. This trial is registered at the ISRCTN registry (ISRCTN86534580) and is ongoing. FINDINGS: The trial began enrolment on April 2, 2020, with randomisation to budesonide from Nov 27, 2020, until March 31, 2021, when the prespecified time to recovery superiority criterion was met. 4700 participants were randomly assigned to budesonide (n=1073), usual care alone (n=1988), or other treatments (n=1639). The primary analysis model includes 2530 SARS-CoV-2-positive participants, with 787 in the budesonide group, 1069 in the usual care group, and 974 receiving other treatments. There was a benefit in time to first self-reported recovery of an estimated 2·94 days (95% Bayesian credible interval [BCI] 1·19 to 5·12) in the budesonide group versus the usual care group (11·8 days [95% BCI 10·0 to 14·1] vs 14·7 days [12·3 to 18·0]; hazard ratio 1·21 [95% BCI 1·08 to 1·36]), with a probability of superiority greater than 0·999, meeting the prespecified superiority threshold of 0·99. For the hospital admission or death outcome, the estimated rate was 6·8% (95% BCI 4·1 to 10·2) in the budesonide group versus 8·8% (5·5 to 12·7) in the usual care group (estimated absolute difference 2·0% [95% BCI -0·2 to 4·5]; odds ratio 0·75 [95% BCI 0·55 to 1·03]), with a probability of superiority 0·963, below the prespecified superiority threshold of 0·975. Two participants in the budesonide group and four in the usual care group had serious adverse events (hospital admissions unrelated to COVID-19). INTERPRETATION: Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths (although our results did not meet the superiority threshold), in people with COVID-19 in the community who are at higher risk of complications. FUNDING: National Institute of Health Research and United Kingdom Research Innovation.


Subject(s)
Budesonide/administration & dosage , COVID-19/drug therapy , Glucocorticoids/administration & dosage , Administration, Inhalation , Aged , Bayes Theorem , COVID-19/mortality , Female , Hospitalization , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome
2.
Lancet ; 396(10250): 535-544, 2020 08 22.
Article in English | MEDLINE | ID: covidwho-2106188

ABSTRACT

BACKGROUND: Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. METHODS: 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FINDINGS: Seroprevalence was 5·0% (95% CI 4·7-5·4) by the point-of-care test and 4·6% (4·3-5·0) by immunoassay, with a specificity-sensitivity range of 3·7% (3·3-4·0; both tests positive) to 6·2% (5·8-6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1-92·1; both tests positive) to 91·8% (86·3-95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8-16·8) to 19·3% (17·7-21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1-24·9) to 35·8% (33·1-38·5). Only 19·5% (16·3-23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. INTERPRETATION: The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. FUNDING: Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Antibodies, Viral/blood , Betacoronavirus/immunology , COVID-19 , Child , Child, Preschool , Female , Humans , Immunoassay , Immunoglobulin G/blood , Immunoglobulin M/blood , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Point-of-Care Testing , Prevalence , Risk Factors , SARS-CoV-2 , Seroepidemiologic Studies , Spain/epidemiology , Young Adult
4.
Am J Speech Lang Pathol ; 31(6): 2825-2834, 2022 Nov 16.
Article in English | MEDLINE | ID: covidwho-2106540

ABSTRACT

PURPOSE: During the COVID-19 pandemic, clinicians and researchers have increasingly used remote online assessments to pursue their activities, but mostly with tests not validated for videoconference administration. This study aims to validate the remote online administration of picture description in Canadian French neurotypical speakers and to explore the thematic unit (TU) checklist recently developed. METHOD: Spoken discourse elicited through the picture description task of the Western Aphasia Battery-Revised (WAB-R) was collected from Canadian French neurotypical speakers from Québec aged between 50 and 79 years old. Forty-seven participants completed the task in person, and 49 participants completed the task by videoconference. Videos of each discourse sample were transcribed using CHAT conventions. Microstructural variables were extracted using the CLAN (Computerized Language ANalysis) program, whereas thematic informativeness was scored for each sample using TUs. Chi-square tests were conducted to compare both groups on each TU; t tests were also performed on the total score of TUs and microstructural variables. RESULTS: Groups were matched on sex, age, and education variables. The t tests revealed no intergroup difference for the total TU score and for the microstructural variables (e.g., mean length of utterances and number of words per minute). Chi-square tests showed no significant intergroup difference for all 16 TUs. CONCLUSIONS: These findings support remote online assessment of the picnic scene of the WAB-R picture description in Canadian French neurotypical speakers. These results also validate the 16 TUs most consistently produced. The use of videoconference could promote and improve the recruitment of participants who are usually less accessible, such as people using assistive mobility technologies. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21476961.


Subject(s)
Aphasia , COVID-19 , Humans , Middle Aged , Aged , Language , Pandemics , Canada , Videoconferencing
5.
Vaccine ; 40(45): 6512-6519, 2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2106121

ABSTRACT

BACKGROUND: Studies have reported evidence about the effectiveness of a third dose with BNT162b2 for preventing hospitalization and death by COVID-19. However, there is little evidence regarding other primary vaccine schedules such as BBIBP-CorV and ChAdOx1-S. We estimated the relative vaccine effectiveness (RVE) of the booster dose versus the primary regimens of COVID-19 vaccines based on BBIBP-CorV, ChAdOx1-S, or BNT162b2 for preventing death during the Omicron wave in Peruvian adult people. METHODS: We carried out a nested case-control study with a risk set sampling of controls using data from Peru between December 20, 2021, and February 20, 2022 (during the Omicron wave). Data on vaccination, COVID-19 tests and deaths were collected from national surveillance databases. We performed conditional logistic regression models to estimate the RVE on the adult population. In addition, we executed sub-group analysis per age group (18 to 59 years, and 60 years or more) and per primary regime (based on BNT162b2, BBIBP-CorV, or ChAdOx1-S). RESULTS: Of the 11,188,332 people eligible to enter the study 1,974 met the case definition (death from COVID-19) and were matched to 9,183 controls. The overall RVE of a third dose to prevent death was 87.2% (84.2%-89.7%), which varied according to the primary regime (87.3% for BNT162b2, 82.0% for BBIPB-CorV-2, and 79.5% for ChAdOx-S). In older adults, the RVE was 87.1%, without significant variations according to the primary regime (86.1% for BNT162b2, 86.1 for BBIBP-CorV, and 82% for ChAdOx-S). CONCLUSIONS: The booster) dose of vaccine against COVID-19 had a high RVE for preventing death by COVID-19 in the Peruvian population in all primary regimes of vaccines during the Omicron wave. This effect was consistent in people over 60 years of age, the group most vulnerable to die from this infection.


Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Humans , Middle Aged , Aged , Adolescent , Young Adult , Adult , COVID-19 Vaccines , BNT162 Vaccine , Peru/epidemiology , Case-Control Studies , COVID-19/prevention & control , Vaccine Efficacy , Influenza, Human/prevention & control
6.
Vaccine ; 40(46): 6640-6648, 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2106120

ABSTRACT

BACKGROUND: Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years. METHODS: National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. FINDINGS: By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. INTERPRETATION: Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. FUNDING: SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , Male , Aged , Adolescent , Young Adult , Adult , Middle Aged , Sweden/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Vaccination , Vaccination Coverage
7.
Psychiatr Danub ; 32(3-4): 499-504, 2020.
Article in English | MEDLINE | ID: covidwho-2100771

ABSTRACT

BACKGROUND: Pandemics are direct antecedent of distinctive physical, psychological, social and financial impacts. A large number of researches are being conducted regarding previous epidemics and pandemics and lot more is currently in progress vis-?-vis COVID-19. The current research is an attempt to explore psychological impacts of COVID-19 specifically to find out the existence, intensity and dynamics of COVID-19 fear in non-clinical educated population. SUBJECTS AND METHODS: A cross sectional online study was conducted with non-clinical educated Pakistani citizens. Self-structured questionnaire comprising close and open ended questions was used for data collection from different cities of Pakistan. N=317 participants (men=121, women=196) were the sample for this study. Demographic information was also sought. The age range of sample was 18 to 50+ years. Most of the participants fall in the category of age group 23-28 of sample. All the participants were educated from Intermediate till PhD but majority of participants had 16 years of education. SPSS 22 was used for quantitative data analysis. Qualitative data were analyzed using thematic analysis and content analysis. RESULTS: Results yield significant age wise and profession wise difference in existence of COVID fear. Nine major themes were extracted regarding nature of fear i.e. Corona Fear, Loss, fear of isolation or quarantine, religion related fear, death, consequences of COVID-19, Under developed country, Psychological component of fear and empathy. Those who denied fear were asked the reasons and six major themes were extracted here i.e Religion, Inevitability of death, Precautions, Belief in self, Myths or misinterpretation of disease and Avoidant approach. CONCLUSIONS: Age and profession significantly influenced fear of COVID-19. Gender-wise exploration of themes yields interesting insights. Participants reflected positivity and empathy in crisis situation.


Subject(s)
COVID-19 , Adolescent , Adult , Cross-Sectional Studies , Fear , Humans , Middle Aged , Prevalence , SARS-CoV-2 , Young Adult
8.
Psychiatr Danub ; 32(2): 287-293, 2020.
Article in English | MEDLINE | ID: covidwho-2100760

ABSTRACT

BACKGROUND: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, health workers have shown an incredible commitment to their patients, sometimes in apocalyptic conditions. We explored ways to deal with the coronavirus stressor and psychological outcomes among physicians and nurses. SUBJECTS AND METHODS: 124 healthcare workers in General Hospital Nasice (Croatia) were invited to participate in a study by performing within the period of March 26 to April 6 2020 questionnaire collected information on socio-demographic characteristics and living conditions that may be risk factors for covid-19 concern, Short form health survey-36, Depression Anxiety Stress Scales (DASS-21) and Ways of Coping Questionnaire (WOC; consisting of 8 subscales: Confrontive Coping, Distancing, Self-Controlling, Seeking Social Support, Accepting Responsibility, Escape-Avoidance, Planful Problem Solving, Positive Reappraisal). RESULTS: 11% healthworkers reports moderate to very-severe depression, 17% moderate to extremely-severe anxiety and 10% for moderate to extremely-severe stress. 67% of medical staff are worried. No statistically significant differences in the scales of depression, anxiety, and stress were found between nurses and physicians, but differences were found on Escape-Avoidance and Positive Reappraisal subscales. Nurses use significantly more avoiding coping style and positive reappraisal than doctors. Seeking social support is more pronounced in those over 40 years old, while those under 40 use more avoidable stress management techniques. CONCLUSIONS: Monitoring and ensuring the mental health of coronavirus care staff is crucial for global health. The education of medical staff in the field of stress management is a conditio sine qua non of the issue of an adequate relationship with the COVID-19 pandemic.


Subject(s)
Adaptation, Psychological , Coronavirus Infections/psychology , Health Surveys , Mental Health/statistics & numerical data , Nurses/psychology , Physicians/psychology , Pneumonia, Viral/psychology , Stress, Psychological , Adult , COVID-19 , Child , Coronavirus Infections/epidemiology , Croatia/epidemiology , Humans , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology
9.
Psychiatr Danub ; 32(2): 273-279, 2020.
Article in English | MEDLINE | ID: covidwho-2100758

ABSTRACT

BACKGROUND: Turkey is one of the countries affected during the period of COVID-19 outbreak. The purpose of the current study is to investigate psychological resilience and depression in individuals during the period of COVID-19 outbreak in Turkey in relation to different variables. The study also aims to explore the relationship between psychological resilience and depression. SUBJECTS AND METHODS: The current study was conducted on a total of 518 people over the social media through the Google e-forms. In the study, the "Short Psychological Resilience Scale" and the "Beck Depression Scale" were used to collect data. In the analysis of the collected data, t-test, One Way Anova, Mann-Whitney U Test, Kruskal Wallis-H Test, Pearson Correlation Coefficient were used. RESULTS: In the current study, psychological resilience and depression were investigated in relation to different variables. Psychological resilience was found to be higher male participants, educators,university graduates and groups with not mental health problems. Depression was found to be higher females, university students, high school and lower graduates,with mental health problems. When the relationship between psychological resilience and depression was investigated, it was found that there is a medium and negative correlation between them. Moreover, the cut-off point for the depression score was set to be 17 and the rate of the people having 17 points or higher scores was found to be 16.6%. CONCLUSION: In light of the findings of the current study, it can be suggested to offer more mental health care services to those having higher levels of depression. Studies can be conducted to improve online psychological support services. A medium and negative correlation was found between psychological resilience and depression in the current study, which shows that more importance should be attached to activities to improve psychological resilience.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Depression/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Resilience, Psychological , Adolescent , Adult , COVID-19 , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Pandemics , Turkey/epidemiology , Young Adult
10.
Cir Cir ; 90(5): 670-677, 2022.
Article in English | MEDLINE | ID: covidwho-2100846

ABSTRACT

OBJECTIVE: To determine the clinical-demographic characteristics of patients recovered from COVID-19 in a third level rehabilitation service. METHOD: A cross-sectional and descriptive study of recovered COVID-19 patients in a rehabilitation service was carried out. Demographic, personal pathological history, his work activity and COVID-19 were taken, as well as alterations after the disease. Descriptive statistics were performed. RESULTS: 186 files were collected. The mean age was 48.04 ± 11.32 years. Male predominance was found (65.6%). 50% of the patients were health workers. The most common previous pathological conditions were sedentary lifestyle (73.7%) and diabetes mellitus (29%). 43.5% presented grade 3 dyspnea according to the modified Medical Research Council scale. There was a high prevalence of neuromuscular involvement, predominantly peripheral neuropathy (48.4%) and dysautonomia (46.2%). CONCLUSIONS: It was possible to determine the clinical-demographic characteristics of patients recovered from COVID-19 in a third-level rehabilitation service, such as age, sex, type of work, previous pathological conditions (diabetes mellitus and arterial hypertension), body mass index, dyspnea, hospitalization, and post-illness disorders. Further investigation of COVID-19 is needed in the development of conditions to different systems.


OBJETIVO: Determinar las características clínico-demográficas de pacientes recuperados de COVID-19 en un servicio de rehabilitación de tercer nivel. MÉTODO: Se realizó un estudio transversal y descriptivo de pacientes recuperados de COVID-19 en un servicio de rehabilitación. Se tomaron antecedentes demográficos, personales patológicos, de su actividad laboral y de COVID-19, así como alteraciones posteriores a la enfermedad. Se realizó estadística descriptiva. RESULTADOS: Se recolectaron 186 expedientes. La edad media fue de 48.04 ± 11.32 años. Se encontró predominio del sexo masculino (65.6%). El 50% de los pacientes eran trabajadores de la salud. Las condiciones patológicas previas más comunes fueron sedentarismo (73.7%) y diabetes mellitus (29%). El 43.5% presentaron disnea de grado 3 acorde a la escala Medical Research Council modificada. Existió alta prevalencia de compromiso neuromuscular, predominando la neuropatía periférica (48.4%) y la disautonomía (46.2%). CONCLUSIONES: Se logró determinar las características clínico-demográficas de pacientes recuperados de COVID-19 en un servicio de rehabilitación de tercer nivel, como la edad, el sexo, el tipo de trabajo, las condiciones patológicas previas (diabetes mellitus e hipertensión arterial), el índice de masa corporal, la disnea, la hospitalización y las alteraciones posteriores a la enfermedad. Es necesaria mayor investigación de la COVID-19 en el desarrollo de afecciones en diferentes sistemas.


Subject(s)
COVID-19 , Humans , Male , Adult , Middle Aged , Female , Cross-Sectional Studies , COVID-19/epidemiology , Dyspnea/etiology , Retrospective Studies
11.
In Vivo ; 36(6): 2823-2827, 2022.
Article in English | MEDLINE | ID: covidwho-2100683

ABSTRACT

BACKGROUND/AIM: COVID-19 is a concerning issue among in-center hemodialysis (HD) patients. To prevent COVID-19 diffusion in our HD facility, weekly rapid nasal antigen test screening was performed for all asymptomatic patients on chronic HD. This study aimed to assess the performance of weekly rapid antigen test in detecting SARS-CoV-2 infection among asymptomatic patients receiving HD. PATIENTS AND METHODS: A retrospective analysis was conducted in HD patients who underwent rapid antigen test screening from December 2021 to March 2022. The diagnosis of COVID-19 with rapid antigen test was always confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: During the observational period, 1,748 rapid antigen tests were performed in 220 HD patients. Mean age was 68.4±14.6 years. Fifteen (8.5%) patients resulted positive for SARS-CoV-2 infection using rapid antigen tests. The diagnosis was subsequently confirmed in 14 (93.3%) patients by RT-PCR. During the same period, 12 (5.4%) symptomatic patients, regularly screened with weekly rapid antigen test, resulted positive for SARS-CoV-2 infection using RT-PCR. Overall, weekly rapid antigen test screening identified 14 out of 26 (53.8%) COVID-19 cases and showed a positive predictive value of 93%. CONCLUSION: Weekly antigen test screening of asymptomatic patients on chronic HD detected around half of the COVID-19 cases in our population.


Subject(s)
COVID-19 , Humans , Middle Aged , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , SARS-CoV-2 , Retrospective Studies , COVID-19 Testing , Renal Dialysis , Sensitivity and Specificity
12.
Int J Yoga Therap ; 32(2022)2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-2100570

ABSTRACT

To avoid severe courses of COVID-19 infections and reduce death rates, vaccination against the SARS-CoV-1 virus was considered an essential strategy in fighting the pandemic. However, some yoga practitioners reject such vaccinations and assume that their yoga practices protect them. We therefore aimed to analyze how many yoga practitioners were vaccinated, their reasons for being vaccinated, and the influence of the ethical principles of yoga (yamas/niyamas) on these decisions. In a cross-sectional survey in summer 2021, we enrolled 1,545 yoga practitioners (86% women; mean age 51.1 ± 10.9 y). The majority of participants were already vaccinated (66%), and their percentage corresponded to that of the general population. Those who were not willing to get vaccinated scored significantly higher on the yama/niyama factors Contentment/Self-Reflection/Devotion and Surrender and Non-Possessiveness. Depending on the centrality of the yamas/niyamas in their lives, yoga participants differed on their vaccination decisions, but they did not relevantly differ on their pro-social reasons (protection of groups at risk, protection of family) when they were already vaccinated. This assumed protection against severe courses of the COVID-19 infection was higher in the nonvaccinated compared to the vaccinated individuals (Cohen's d = 0.99). This conviction was related to the niyama factor Contentment/Self-Reflection/Devotion and Surrender. Thus, in the yoga schools and other places of yoga practice the relevance of vaccination to also protect others should be discussed, and the consequences of following the yamas and niyamas for the sake of others should be clarified.


Subject(s)
COVID-19 , Yoga , Humans , Female , Adult , Middle Aged , Male , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Vaccination , Germany
13.
Acta Med Acad ; 51(2): 99-107, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2100260

ABSTRACT

OBJECTIVE: Airway management has undergone a dramatic transformation since the arrival of video laryngoscope (VL). VL has higher intubation success rate on first try and lower complications in comparison to direct laryngoscope (DL). The use of VL is recommended in intubating COVID-19 patients to speed up intubation time and reduce failure rate. A team from Airlangga University developed Wycope Video Laryngoscope (Wycope VL), a VL with Wi-Fi connection to smartphones for an easier VL with low cost. This study aimed to compare the effectiveness of Wycope VL, C-MAC Video Laryngoscope (C-MAC VL), and DL. MATERIALS AND METHODS: This study was an analytic observational study with a cross sectional design, involving 63 patients who were divided into 3 groups based on the type of laryngoscope, namely Wycope VL, C-MAC VL, and DL. Intubation is carried out by 4th year anaesthesiology resident. Research subjects were patients who will undergo elective surgery at Dr. Soetomo General Hospital under general anaesthesia using orotracheal tube. Inclusion age of 19-64 years, PS ASA 1-2, no anatomical abnormalities of the airway, did not have difficult airway, and was willing to participate in the study. RESULTS: All patients were successfully intubated without complications. C-MAC VL (5.33±1.42 seconds) and Wycope VL (5.95±0.74 seconds) was significantly faster in seeing vocal folds and glottis compared to DL (7.14±0.72 seconds) with P=0.000. DL was significantly faster in average time of intubation (15.52±5.90 seconds) compared to C-MAC VL (16.95±1.11 seconds) and Wycope VL (20.29±2.81 seconds) with P=0.000. CONCLUSION: DL was faster compared to VL in speed of intubation while C-MAC VL and Wycope VL was faster in viewing the vocal folds and glottis compared to DL.


Subject(s)
COVID-19 , Laryngoscopes , Humans , Young Adult , Adult , Middle Aged , Cross-Sectional Studies , Intubation, Intratracheal , Laryngoscopy
14.
Turk J Ophthalmol ; 52(5): 324-330, 2022 10 28.
Article in English | MEDLINE | ID: covidwho-2100078

ABSTRACT

Objectives: Retinal vascular complications have been described in patients with coronavirus disease 2019 (COVID-19). This study aimed to analyze retinal microvascular changes and their correlations with clinical findings. Materials and Methods: This case-controlled study was conducted in a university hospital. The right eyes of 52 otherwise healthy patients recovered from COVID-19 and 42 healthy controls were examined with optical coherence tomography angiography. Mann-Whitney U test was used to compare vessel density (VD) and foveal avascular zone (FAZ) parameters. Associations with treatment choices, pneumonia, and laboratory findings were analyzed. Results: Twenty-nine patients (56%) and 18 healthy controls (43%) were men. Mean age of the COVID-19 group was 39.00±13.04 years. Twenty-two patients had pneumonia, 18 (35%) received hydroxychloroquine (HCQ), 17 (33%) received HCQ plus low-molecular-weight heparin (LMWH), and 10 (19%) received favipiravir. The patient group had lower parafoveal VD in the superficial capillary plexus (SCP) and lower parafoveal VD and perifoveal VD in the deep capillary plexus (DCP) than controls (p=0.003, p=0.004, p=0.001). FAZ area did not differ significantly (p=0.953). Perifoveal VD in the DCP was also significantly lower in the HCQ+LMWH group than the HCQ group (p=0.020) and in the presence of pneumonia (p=0.040). C-reactive protein (CRP) and ferritin levels were negatively correlated with perifoveal VD in the DCP (r=-0.445, p=0.023; r=-0.451, p=0.040). Ferritin was also negatively correlated with parafoveal VD in the SCP (r=-0.532, p=0.013). Conclusion: Parafoveal and perifoveal VD was found to be lower in the COVID-19 group. Presence of pneumonia, need for LMWH prophylaxis, and levels of CRP and ferritin were found to be negatively associated with retinal VD. Large-scale studies are needed to evaluate the clinical importance.


Subject(s)
COVID-19 , Tomography, Optical Coherence , Male , Humans , Adult , Middle Aged , Female , Tomography, Optical Coherence/methods , Fluorescein Angiography/methods , Fovea Centralis , COVID-19/complications , Heparin, Low-Molecular-Weight , Hydroxychloroquine/therapeutic use , Ferritins
15.
J Pak Med Assoc ; 72(8): 1572-1576, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2101071

ABSTRACT

OBJECTIVE: To assess the discrepancy in terms of history related to coronavirus disease-2019 and symptoms given in the pre-clinic triage and to the doctor attending the patient in a gastroenterology clinic. METHODS: The observational study was conducted from September 2020 to January 2021 at the Gastroenterology outpatient department of Dr Ziauddin Hospital's Clifton unit in Karachi, and comprised all patients visiting the facility regardless of age and gender. Data was collected using a questionnaire that was first filled up by the receptionist outside the clinic and was then administered again once the patient entered the clinic. Discrepancy on the answers was then checked and associations were determined with clinical assessment. Data was analysed using SPSS 20. RESULTS: Of the 300 patients, 184(61.3%) were males and 116(38.6%) were females. The overall mean age was 55 ± 16.98 (range: 18-92 years). Discrepancy between pre-clinic and in-clinic self-reported data was significant for fever, cough, fatigue, headache, body ache, diarrhoea, sore throat, loss of sense of smell/taste, shortness of breath, and contact with someone positive for coronavirus disease-2019 was significant (p<0.05). CONCLUSIONS: Patients were found to be afraid of getting barred from seeing a consultant, had fear of hospital-based isolation or were in denial regarding the pandemic.


Subject(s)
COVID-19 , Gastroenterology , Male , Female , Humans , Adult , Middle Aged , Aged , Triage , SARS-CoV-2 , Pandemics
16.
Acta Myol ; 41(2): 76-83, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2101026

ABSTRACT

The recent approval of disease-modifying therapies for spinal muscular atrophy (SMA) raised the need of alternative outcome measures to evaluate treatment efficacy. In this study, we investigated the potential of muscle quantitative MRI (qMRI) as a biomarker of disease progression in adult SMA3 patients during nusinersen treatment. Six adult SMA3 patients (age ranging from 19 to 65 years) underwent 2-point Dixon muscle qMRI at beginning of nusinersen treatment (T0) and after 14 months (T14) to evaluate the muscle fat fraction (FF) at thigh and leg levels; patients were clinically assessed at T0 and T14 with the Hammersmith Functional Rating Scale Expanded (HFMSE), the Revised Upper Limb Module (RULM) and the 6-minute walk test (6MWT). At T0, vastus lateralis muscle displayed the highest mean FF (67.5%), while tibialis anterior was the most preserved one (mean FF = 35.2%). At T0, a slightly significant correlation of FF with HFMSE (p = 0.042) and disease duration (p = 0.042) at thigh level and only with HFMSE (p = 0.042) at leg level was found. At T14, no significant change of mean FF values at thigh and leg muscles was found compared to T0. Conversely, a statistically significant (p = 0.042) improvement of HFMSE was reported at T14. We observed no significant change of FF in thigh and leg muscles after 14 months of nusinersen therapy despite a significant clinical improvement of HFMSE. Further studies with longer follow-up and larger cohorts are needed to better investigate the role of qMRI as marker of disease progression in SMA patients.


Subject(s)
Muscular Atrophy, Spinal , Spinal Muscular Atrophies of Childhood , Adult , Aged , Disease Progression , Humans , Longitudinal Studies , Magnetic Resonance Imaging , Middle Aged , Muscle, Skeletal/diagnostic imaging , Oligonucleotides , Spinal Muscular Atrophies of Childhood/drug therapy , Young Adult
17.
Scand J Trauma Resusc Emerg Med ; 28(1): 107, 2020 Oct 28.
Article in English | MEDLINE | ID: covidwho-2098376

ABSTRACT

OBJECTIVES: COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. METHODS: Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. RESULTS: As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373-399) minutes to 307 (297-317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55-0.99). CONCLUSIONS: It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Crowding , Emergency Service, Hospital , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , Bed Occupancy , COVID-19 , Female , Hospitalization , Hospitals, University , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sweden
18.
Scand J Trauma Resusc Emerg Med ; 28(1): 106, 2020 Oct 27.
Article in English | MEDLINE | ID: covidwho-2098375

ABSTRACT

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) is a global public health emergency. Here, we developed and validated a practical model based on the data from a multi-center cohort in China for early identification and prediction of which patients will be admitted to the intensive care unit (ICU). METHODS: Data of 1087 patients with laboratory-confirmed COVID-19 were collected from 49 sites between January 2 and February 28, 2020, in Sichuan and Wuhan. Patients were randomly categorized into the training and validation cohorts (7:3). The least absolute shrinkage and selection operator and logistic regression analyzes were used to develop the nomogram. The performance of the nomogram was evaluated for the C-index, calibration, discrimination, and clinical usefulness. Further, the nomogram was externally validated in a different cohort. RESULTS: The individualized prediction nomogram included 6 predictors: age, respiratory rate, systolic blood pressure, smoking status, fever, and chronic kidney disease. The model demonstrated a high discriminative ability in the training cohort (C-index = 0.829), which was confirmed in the external validation cohort (C-index = 0.776). In addition, the calibration plots confirmed good concordance for predicting the risk of ICU admission. Decision curve analysis revealed that the prediction nomogram was clinically useful. CONCLUSION: We established an early prediction model incorporating clinical characteristics that could be quickly obtained on hospital admission, even in community health centers. This model can be conveniently used to predict the individual risk for ICU admission of patients with COVID-19 and optimize the use of limited resources.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Hospitalization , Intensive Care Units , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Adult , Aged , COVID-19 , China , Coronavirus Infections/diagnosis , Female , Humans , Logistic Models , Male , Middle Aged , Nomograms , Pandemics , Pneumonia, Viral/diagnosis , Retrospective Studies , Risk Assessment , SARS-CoV-2
19.
Scand J Trauma Resusc Emerg Med ; 28(1): 94, 2020 Sep 22.
Article in English | MEDLINE | ID: covidwho-2098374

ABSTRACT

BACKGROUND: COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services-particularly helicopter services-caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients. METHODS: Nine different HEMS providers in seven different countries across Europe were invited to share their experiences and to report their data regarding the care, transport, and safety measures in suspected or confirmed COVID-19 missions. Six air ambulance providers in six countries agreed and reported their data regarding development of special procedures and safety instructions in preparation for the COVID-19 pandemic. Four providers agreed to provide mission related data. Three hundred eighty-five COVID-19-related missions were analysed, including 119 primary transport missions and 266 interfacility transport missions. RESULTS: All providers had developed special procedures and safety instructions in preparation for COVID-19. Ground transport was the preferred mode of transport in primary missions, whereas air transport was preferred for interfacility transport. In some countries the transport of COVID-19 patients by regular air ambulance services was avoided. Patients in interfacility transport missions had a significantly higher median (range) NACA Score 4 (2-5) compared with 3 (1-7), needed significantly more medical interventions, were significantly younger (59.6 ± 16 vs 65 ± 21 years), and were significantly more often male (73% vs 60.5%). CONCLUSIONS: All participating air ambulance providers were prepared for COVID-19. Safe care and transport of suspected or confirmed COVID-19 patients is achievable. Most patients on primary missions were transported by ground. These patients were less sick than interfacility transport patients, for whom air transport was the preferred method.


Subject(s)
Air Ambulances/organization & administration , Betacoronavirus , Coronavirus Infections/therapy , Emergency Service, Hospital/organization & administration , Pandemics , Pneumonia, Viral/therapy , Transportation of Patients/methods , COVID-19 , Coronavirus Infections/epidemiology , Europe/epidemiology , Female , Humans , Male , Middle Aged , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2
20.
Scand J Trauma Resusc Emerg Med ; 28(1): 66, 2020 Jul 13.
Article in English | MEDLINE | ID: covidwho-2098371

ABSTRACT

BACKGROUND: There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. METHODS: This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥ 6, quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥ 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong's test. RESULTS: In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥ 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% CI 0.690-0.953). NEWS2 was superior to qSOFA score ≥ 2 (AUC 0.624, 95% CI 0.446-0.810, p < 0.05) and other clinical risk scores for this purpose. CONCLUSION: NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Early Warning Score , Hospital Mortality , Patient Admission , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Female , Humans , Male , Middle Aged , Norway/epidemiology , Pandemics , Risk Assessment , SARS-CoV-2 , Sensitivity and Specificity , Severity of Illness Index
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