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Arq. ciências saúde UNIPAR ; 26(3): 350-366, set-dez. 2022.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-2205388

ABSTRACT

Introdução: No final do ano de 2019 surgiu na China uma doença infectocontagiosa de característica respiratória e alto grau de disseminação até então desconhecida. No Brasil o primeiro caso de Covid-19 foi confirmado no final de fevereiro de 2020 e a primeira morte em meados de março. Segundo dados da plataforma Coronavírus Brasil, em 17 de março de 2021, houve registro de 11.603.535 casos confirmados e 282.127 óbitos. Objetivo: Descrever o perfil de pessoas que morreram tendo como causa básica do óbito a Covid-19, em um município do Sudoeste do Paraná, entre os anos de 2020 e 2021. Metodologia: Trata-se de um estudo transversal, descritivo, documental de caráter quantitativo que foi realizado na prefeitura municipal de Francisco Beltrão. Resultados: Houve prevalência de óbitos em pacientes do sexo masculino, idosos, com presença de alguma comorbidade associada, sendo hipertensão a mais citada (50,8%). Os sintomas mais prevalentes foram tosse (74,4%), dispneia (56,3%) e saturação < 95% (48,3%), necessitando ainda de hospitalização em algum período da doença (94,1%), sendo os leitos de Sistema Único de Saúde os mais procurados (74,4%). Quanto à taxa de ocupação 49,6% dos casos necessitou apenas de leitos de enfermaria e 42% unidades de terapia intensiva. Discussão: Diversas pesquisas apontam que o sexo masculino é o mais acometido por condições graves de saúde, devido à demora na busca de assistência médica. No que se refere à idade, neste estudo, a prevalência de óbitos se deu entre 71 e 75 anos (15,1%) o que justifica que o envelhecimento é um fator de risco elevado para complicações da doença. Durante a análise dos dados, notou- se que grande parte dos pacientes que tiveram como desfecho o óbito, possuíam algum fator associado, dentre os mais citados, verificou-se a Hipertensão Arterial Sistêmica (50,8%) Diabetes Mellitus (24,8%), doenças cardiovasculares (23,9%) e obesidade (14,7%). No que diz respeito à hospitalização, nesse estudo notou-se que 74,4% da amostra foram hospitalizadas em leitos de SUS, 18,5% em hospitais particulares e 7,1% não possuíam essa informação. Conclusão: É possível observar a importância do estudo epidemiológico para identificar o perfil da população em risco, podendo auxiliar no planejamento do atendimento, rastreamento e controle da doença, além de conhecer a evolução da patologia, a fim de buscar ações adequadas para seu enfrentamento.


Introduction: At the end of 2019, a previously unknown infectious disease with respiratory characteristics and a high degree of dissemination emerged in China. In Brazil the first case of Covid-19 was confirmed in late February 2020 and the first death in mid-March. According to data from the Coronavirus Brazil platform, as of March 17, 2021, 11,603,535 confirmed cases and 282,127 deaths were recorded. Objective: To describe the profile of people who died with Covid-19 as the underlying cause of death in a city in southwestern Paraná between the years 2020 and 2021. Methodology: This is a cross-sectional, descriptive, documental, quantitative study carried out at the Francisco Beltrão City Hall. Results: There was a prevalence of deaths in male patients, elderly, with the presence of some associated comorbidity, hypertension being the most cited (50.8%). The most prevalent symptoms were cough (74.4%), dyspnea (56.3%) and saturation < 95% (48.3%), requiring hospitalization in some period of the disease (94.1%), and the Unified Health System beds were the most sought (74.4%). As for the occupancy rate, 49.6% of the cases required only ward beds and 42% intensive care units. Discussion: Several studies show that men are the most affected by serious health conditions, due to the delay in seeking medical assistance. Regarding age, in this study, the prevalence of deaths was between 71 and 75 years (15.1%), which justifies that aging is a high risk factor for disease complications. During data analysis, it was noted that most patients who died had some associated factor, among the most cited were systemic arterial hypertension (50.8%), diabetes mellitus (24.8%), cardiovascular diseases (23.9%) and obesity (14.7%). Regarding hospitalization, in this study it was noted that 74.4% of the sample were hospitalized in SUS beds, 18.5% in private hospitals, and 7.1% did not have this information. Conclusion: It is possible to observe the importance of the epidemiological study to identify the profile of the population at risk, which can help in planning care, tracking and control of the disease, besides knowing the evolution of the pathology in order to seek appropriate actions for its confrontation


Introducción: A finales del año 2019 apareció en China una enfermedad infecto- contagiosa de característica respiratoria y alto grado de diseminación desconocida hasta entonces. En Brasil se confirmó el primer caso de Covid-19 a finales de febrero de 2020 y la primera muerte a mediados de marzo. Según los datos de la plataforma Coronavirus Brasil, hasta el 17 de marzo de 2021, había 11.603.535 casos confirmados y 282.127 muertes. Objetivo: Describir el perfil de las personas fallecidas con Covid-19 como causa subyacente de muerte en una ciudad del sudoeste de Paraná entre los años 2020 y 2021. Metodología: Se trata de un estudio transversal, descriptivo, documental de carácter cuantitativo que se realizó en la prefectura municipal de Francisco Beltrão. Resultados: Hubo una prevalencia de muertes en pacientes masculinos, de edad avanzada, con presencia de alguna comorbilidad asociada, siendo la hipertensión la más citada (50,8%). Los síntomas más prevalentes fueron la tos (74,4%), la disnea (56,3%) y la saturación < 95% (48,3%), requiriendo hospitalización en algún periodo de la enfermedad (94,1%), siendo las camas del Sistema Único de Salud las más solicitadas (74,4%). En cuanto a la tasa de ocupación, el 49,6% de los casos sólo necesitaban camas de sala y el 42% unidades de cuidados intensivos. Discusión: Varias investigaciones señalan que el género masculino es el más afectado por las condiciones de salud graves, debido al retraso en la búsqueda de asistencia médica. En cuanto a la edad, en este estudio, la prevalencia de muertes se produjo entre los 71 y los 75 años (15,1%), lo que justifica que el envejecimiento sea un factor de riesgo elevado para las complicaciones de la enfermedad. Durante el análisis de los datos, se observó que la mayoría de los pacientes que fallecieron tenían algún factor asociado, entre los más citados estaban la Hipertensión Arterial Sistémica (50,8%), la Diabetes Mellitus (24,8%), las enfermedades cardiovasculares (23,9%) y la obesidad (14,7%). En lo que respecta a la hospitalización, en este estudio se observó que el 74,4% de la muestra estaba hospitalizada en camas del SUS, el 18,5% en hospitales privados y el 7,1% no tenía esta información. Conclusión: Es posible observar la importancia del estudio epidemiológico para identificar el perfil de la población en riesgo, pudiendo ayudar en la planificación de la atención, el rastreo y el control de la enfermedad, además de conocer la evolución de la patología, con el fin de buscar las acciones adecuadas para su enfrentamiento.


Subject(s)
Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Health Profile , Epidemiologic Studies , Epidemiology/statistics & numerical data , Coronavirus Infections/mortality , Coronavirus Infections/rehabilitation , Coronavirus Infections/transmission , Coronavirus Infections/epidemiology , Death , Unified Health System , Aged , Aging/pathology , Cardiovascular Diseases , Global Health/statistics & numerical data , Prevalence , Cough , Diabetes Mellitus , Dyspnea , Oxygen Saturation , Hospitalization , Hypertension , Intensive Care Units/statistics & numerical data , Obesity
3.
Curr Pharm Des ; 28(22): 1833-1842, 2022.
Article in English | MEDLINE | ID: covidwho-2197773

ABSTRACT

BACKGROUND: Genetically modified micro-organisms like bacteria, viruses, algae and fungi are novel approaches used in the field of healthcare due to better efficacy and targeted delivery in comparison to conventional approaches. OBJECTIVES: This review article focuses on the applications of genetically modified micro-organisms in the treatment of cancer, obesity and HIV infection. The gut microbiome causes metabolic disorders, however, the use of genetically modified bacteria alters the gut microbiota and delivers therapeutically effective drugs in the treatment of obesity. METHODS: Enhancement of the therapeutic activity of different micro-organisms is required for multiple treatments in cancer, diabetes, etc., by incorporating their fragments into the microbial filaments with the help of genetic modification approaches. Various methods like amelioration of NAPE synthesis, silica immobilization, polyadenylation and electrochemical are used to integrate the strain into the bacteria and engineer a live virus with a peptide. RESULTS: The development of novel microbial strains using genetic modifications over core strains offers higher precision, greater molecular multiplicity, better prevention from the degradation of microbes in atmospheric temperature and significant reduction of side effects for therapeutic applications. Moreover, genetically modified micro-organisms are used in multidisciplinary sectors like generation of electricity, purification of water, bioremediation process, etc., indicating the versatility and scope of genetically engineered microbes. CONCLUSION: The bioengineered micro-organisms with genetic modifications proved to be advantageous in various conditions like cancer, diabetes, malaria, organ regeneration, inflammatory bowel disease, etc. This article provides insight into various applications of genetically modified microbes in different sectors with their implementation for regulatory approval.


Subject(s)
Diabetes Mellitus , Gastrointestinal Microbiome , HIV Infections , Bacteria , Biotechnology , Humans , Obesity
4.
N Engl J Med ; 387(15): 1433, 2022 10 13.
Article in English | MEDLINE | ID: covidwho-2186486
5.
Lancet ; 400(10350): 441-451, 2022 08 06.
Article in English | MEDLINE | ID: covidwho-2184590

ABSTRACT

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is an endolumenal, organ-sparing therapy for obesity, with wide global adoption. We aimed to explore the efficacy and safety of ESG with lifestyle modifications compared with lifestyle modifications alone. METHODS: We conducted a randomised clinical trial at nine US centres, enrolling individuals aged 21-65 years with class 1 or class 2 obesity and who agreed to comply with lifelong dietary restrictions. Participants were randomly assigned (1:1·5; with stratified permuted blocks) to ESG with lifestyle modifications (ESG group) or lifestyle modifications alone (control group), with potential retightening or crossover to ESG, respectively, at 52 weeks. Lifestyle modifications included a low-calorie diet and physical activity. Participants in the primary ESG group were followed up for 104 weeks. The primary endpoint at 52 weeks was the percentage of excess weight loss (EWL), with excess weight being that over the ideal weight for a BMI of 25 kg/m2. Secondary endpoints included change in metabolic comorbidities between the groups. We used multiple imputed intention-to-treat analyses with mixed-effects models. Our analyses were done on a per-protocol basis and a modified intention-to-treat basis. The safety population was defined as all participants who underwent ESG (both primary and crossover ESG) up to 52 weeks. FINDINGS: Between Dec 20, 2017, and June 14, 2019, 209 participants were randomly assigned to ESG (n=85) or to control (n=124). At 52 weeks, the primary endpoint of mean percentage of EWL was 49·2% (SD 32·0) for the ESG group and 3·2% (18·6) for the control group (p<0·0001). Mean percentage of total bodyweight loss was 13·6% (8·0) for the ESG group and 0·8% (5·0) for the control group (p<0·0001), and 59 (77%) of 77 participants in the ESG group reached 25% or more of EWL at 52 weeks compared with 13 (12%) of 110 in the control group (p<0·0001). At 52 weeks, 41 (80%) of 51 participants in the ESG group had an improvement in one or more metabolic comorbidities, whereas six (12%) worsened, compared with the control group in which 28 (45%) of 62 participants had similar improvement, whereas 31 (50%) worsened. At 104 weeks, 41 (68%) of 60 participants in the ESG group maintained 25% or more of EWL. ESG-related serious adverse events occurred in three (2%) of 131 participants, without mortality or need for intensive care or surgery. INTERPRETATION: ESG is a safe intervention that resulted in significant weight loss, maintained at 104 weeks, with important improvements in metabolic comorbidities. ESG should be considered as a synergistic weight loss intervention for patients with class 1 or class 2 obesity. This trial is registered with ClinicalTrials.gov, NCT03406975. FUNDING: Apollo Endosurgery, Mayo Clinic.


Subject(s)
Gastroplasty , Gastroplasty/adverse effects , Gastroplasty/methods , Humans , Obesity/etiology , Obesity/surgery , Prospective Studies , Treatment Outcome , Weight Loss
6.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.25.23284996

ABSTRACT

Objective: The severe acute respiratory syndrome coronavirus 2 has posed a significant challenge to health of individual. Increasing evidence shows that patients with metabolic unhealthy obesity (MUO) and COVID19 have severer complications and higher mortality rate. However, the molecular mechanisms underlying the association between MUO and COVID19 are poorly understood. We sought to implement transcriptomic analysis using bioinformatics and systems biology analysis approaches. Methods: Here, two datasets (GSE196822 and GSE152991) were employed to extract differentially expressed genes (DEGs) to identify common hub genes, shared pathways and candidate drugs and construct a gene disease network. Results: Based on the identified 65 common DEGs, the results revealed hub genes and essential modules. Moreover, common associations between MUO and COVID-19 were found. Transcription factors (TFs) and genes interaction, protein and drug interactions, and DEGs and miRNAs coregulatory network were identified. Furthermore, the gene-disease association were obtained and constructed. Conclusions: The shared pathogenic pathways are noted worth paying attention to. Several genes are highlighted as critical targets for developing treatments for and investigating the complications of COVID19 and MUO. Additionally, multiple genes are identified as promising biomarkers. We think this result of the study may help in selecting and inventing future treatments that can combat COVID-19 and MUO.


Subject(s)
Coronavirus Infections , COVID-19 , Obesity
7.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2508578.v1

ABSTRACT

Introduction: The Covid-19 (Covid) pandemic has significantly decreased the provision of UK bariatric surgery. We hypothesised that Internet searches for bariatric surgery might have increased during Covid. This study evaluated the impact of Covid on Internet searches for bariatric surgery in the UK population.  Materials and Methods: A Google Trends data search using search topics: ‘gastric bypass surgery’, ’sleeve gastrectomy’, ’adjustable gastric band’ and ‘gastric balloon’ was performed. Relative search volume (RSV) indices were reported from March 2017 to March 2022. Mean RSV pre-Covid (March 2017-March 2020) and during Covid (March 2020-March 2022) were compared. ANOVA was performed to determine the impact of Covid on RSV.  Results: Pre-Covid, gastric bypass surgery was most searched, whilst during Covid, sleeve gastrectomy became most commonly searched. ANOVA analysis revealed a significant increase in searches during Covid for sleeve gastrectomy (20.4% pre-Covid v 47.2% during Covid; p<00.1), gastric bypass surgery (25.4% v 30.7%; p<0.001) and gastric balloon (8.4% v 12.0%; p<0.001) but not adjustable gastric band (38.7% v 37.8%; p=0.350)  Conclusion: During the pandemic there was a significant increase in Internet searches for bariatric surgery, likely reflecting increased public awareness of the health impact of obesity and surgical treatment options.


Subject(s)
COVID-19 , Obesity , Stomach Neoplasms
8.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2507826.v1

ABSTRACT

Introduction COVID-19 is generally milder in children than in adults, however severe infection has been described in some patients. Few data are available on use of Remdesivir (RDV) in children, as most clinical trials focused on adult patients. We report a multicenter study to investigate the safety of RDV in children affected by COVID-19.Methods We collected the clinical data of children with COVID-19 treated with RDV between March 2020 and February 2022 in 10 Italian hospitals. Clinical data were compared according to the duration of RDV therapy. Linear and logistic regression models were used to determine the association of significant variables from the bivariate analysis to the duration of RDV therapy.Results A total of 50 patients were included, with a median age of 12.8 years. Many patients had at least one comorbidity (78%), mostly obesity. Symptoms were fever (88%), cough (74%) and dyspnea (68%). Most patients were diagnosed with pneumonia of either viral and/or bacterial etiology. Blood test showed leukopenia in 66% and increased C-reactive protein (CRP) levels in 63% of cases. Thirty-six patients received RDV for 5 days, nine patients up to 10 days. Most children who received RDV longer were admitted to the PICU (67%). Treatment with RDV was well tolerated with rare side effects (Table 1): bradycardia was recorded in 6% of cases, solved in less than 24 hours after discontinuation. A mild elevation of transaminases was observed in 26% of cases, however for the 8%, it was still detected before the RDV administration. Therefore, in these cases, we could not establish if it was caused by COVID-19, RDV o both. Patients who received RDV for more than 5 days waited longer for its administration after pneumonia diagnosis. The presence of comorbidities and the duration of O2 administration significantly correlated with the duration of RDV therapy at the linear regression analysis.Conclusion Our experience indicates that RDV against SARS-CoV-2 is safe and well-tolerated in pediatric populations at high risk of developing severe COVID-19. Our data suggest that delaying RDV therapy after diagnosis of pneumonia may be associated with a longer duration of antiviral therapy, especially in patients with comorbidities.


Subject(s)
Pneumonia , Cough , Bradycardia , COVID-19 , Dyspnea , Fever , Obesity , Leukopenia
9.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.17.23284684

ABSTRACT

Background: COVID-19 would kill fewer people if health programs can predict who is at higher risk of mortality because resources can be targeted to protect those people from infection. We predict mortality in a very large population in Mexico with machine learning using demographic variables and pre-existing conditions. Methods: We conducted a population-based cohort study with over 1.4 million laboratory-confirmed COVID-19 patients using the Mexican social security database. Analysis is performed on data from March 2020 to November 2021 and over three phases: (1) from March to October in 2020, (2) from November 2020 to March 2021, and (3) from April to November 2021. We predict mortality using an ensemble machine learning method, super learner, and independently estimate the adjusted mortality relative risk of each pre-existing condition using targeted maximum likelihood estimation. Results: Super learner fit has a high predictive performance (C-statistic: 0.907), where age is the most predictive factor for mortality. After adjusting for demographic factors, renal disease, hypertension, diabetes, and obesity are the most impactful pre-existing conditions. Phase analysis shows that the adjusted mortality risk decreased over time while relative risk increased for each pre-existing condition. Conclusions: While age is the most important predictor of mortality, younger individuals with hypertension, diabetes and obesity are at comparable mortality risk as individuals who are 20 years older without any of the three conditions. Our model can be continuously updated to identify individuals who should most be protected against infection as the pandemic evolves.


Subject(s)
COVID-19 , Hypertension , Kidney Diseases , Obesity , Diabetes Mellitus
10.
preprints.org; 2023.
Preprint in English | PREPRINT-PREPRINTS.ORG | ID: ppzbmed-10.20944.preprints202301.0245.v1

ABSTRACT

The covid-19 pandemic has generated substantial changes in the lives of the population, such as increased physical inactivity, which can lead to overweight and, consequently, repercussions on glucose homeostasis. A population-based household epidemiological survey was conducted by stratified, multistage probability cluster sampling (October and December 2020) in Brazil. Participants were classified as physically active or inactive during leisure time according to the recommendations of the World Health Organization. HbA1c levels were categorized as normal (≤6.4%) or with glycemic changes (≥ 6.5%). The mediating variable was excess weight (overweight and obese). Multivariate logistic regression analyzes were performed to examine the association between physical inactivity and glycemic changes. Mediation was analyzed using the Karlson–Holm–Breen method to verify the influence of excess weight on the association. We interviewed 1,685 individuals, mostly women (52.4%), 35–59 years old (45.8%), race/ethnicity brown (48.1%), and excess weight (56.5%). The mean HbA1c was 5.68% (95% CI: 5.58-5.77). Individuals physically inactive were 2.62 times more likely to have glycemic alterations (OR:2.62.95% CI:1.29-5.33), and 26.87% of this association was mediated by excess weight (OR:1.30:95% CI:1.06-1.57). Physical inactivity in leisure time increases the chances of glycemic alterations, and part of this association can be explained by excess weight.


Subject(s)
COVID-19 , Obesity
11.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.13.23284305

ABSTRACT

BackgroundThe global estimated prevalence of long COVID-19 is 43%, and the most common symptoms found globally are fatigue, confusion, or lack of confusion, and dyspnea, with prevalence rates of 23%, 14%, and 13%, respectively. However, long COVID still lacks an overall review in African populations. The aim of this review was to determine the prevalence of long COVID, its most common symptoms, comorbidities, and pathophysiological mechanisms. MethodsA systematic review of long COVID in African populations was conducted. The random effects model was used to calculate the pooled prevalence rates (95% CI). If the results could not be pooled, a narrative synthesis was performed. ResultsWe included 14 studies from 7 African countries, totaling 6,030 previously SARS-CoV-2 infected participants and 2,954 long COVID patients. Long COVID had a pooled prevalence of 41% [26%-56%]. Fatigue, dyspnea, and confusion or lack of concentration were the most common symptoms, with prevalence rates (95% CI) of 41% [26%-56%], 25% [12%-38%], and 40% [12%-68%], respectively. Long COVID was associated with advanced age, being female, more than three long COVID symptoms in the acute phase, initial fatigue and dyspnea, post-recovery stress, sadness, and sleep disturbances, and loss of appetite at symptoms onset, mild, moderate, and severe, pre-existing obesity, hypertension, diabetes mellitus, and the presence of any chronic illness (P [≤]0.05). According to our review, high micro clot and platelet poor plasma (PPP) viscosity explain the pathophysiology of long COVID. ConclusionLong COVID prevalence in Africa was comparable to the global prevalence. However, the prevalence of the most common symptoms was higher in Africa. Comorbidities associated with long COVID may lead to additional complications in African populations due to hypercoagulation and thrombosis.


Subject(s)
Confusion , Sleep Wake Disorders , Thrombophilia , COVID-19 , Hypertension , Dyspnea , Severe Acute Respiratory Syndrome , Obesity , Fatigue , Diabetes Mellitus
12.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.12.23284434

ABSTRACT

Background: Infections by SARS-CoV-2 variants of concern (VOCs) might affect children and adolescents differently than earlier viral lineages. We aimed to address five questions about SARS-CoV-2 VOC infections in children and adolescents: i) symptoms and severity, ii) risk factors for severe disease, iii) the risk of becoming infected, iv) the risk of transmission and v) long-term consequences following a VOC infection. Methods: We carried out a systematic review. We searched the COVID-19 Open Access Project database up to 1 March 2022 and PubMed up to 9 May 2022 for observational epidemiological studies about alpha, beta, gamma, delta and omicron VOCs among 0 to 18 year olds. We synthesised data for each question descriptively and assessed the risks of bias at the outcome level. Results: We included 53 articles, of which 47% were from high-income countries and none were from low-income countries, according to World Bank categories. Most children with any VOC infection presented with mild disease, with more severe disease being described with the delta or the gamma VOC. Diabetes and obesity were reported as risk factors for severe disease during the whole pandemic period. The risk of becoming infected with a SARS-CoV-2 VOC seemed to increase with age, while in daycare settings the risk of onward transmission of VOCs was higher for younger than older children or at least partially vaccinated adults. Long-term symptoms or signs following an infection with a VOC were described in <5% of children and adolescents. Conclusion: Overall patterns of SARS-CoV-2 VOC infections in children and adolescents are similar to those of earlier lineages. Comparisons between different pandemic periods, countries and age groups should be improved with complete reporting of relevant contextual factors, including VOCs, vaccination status of study participants and the risk of exposure of the population to SARS-CoV-2.


Subject(s)
Infections , COVID-19 , Severe Acute Respiratory Syndrome , Obesity , Diabetes Mellitus
13.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2469492.v1

ABSTRACT

The pandemic has been characterized by several waves defined by viral strains responsible for the predominance of infections. We aimed to analyze the mean length of hospital stay for patients with COVID-19 during the first three waves of the pandemic and its distribution according to sociodemographic and clinical variables. This retrospective study used the notifications of patients hospitalized for COVID-19 in a Brazilian state during the period of the three waves of the disease as the data source. There were 13,910 hospitalizations for confirmed COVID-19 cases. The first wave was the longest, with 4,101 (29.5%) hospitalizations, while the third, although shorter, had a higher number of hospitalized patients (N=6,960). The average length of stay in the hospital was associated with age groups up to 59 years old and from 60 to 79 y.o., high school and higher education, pregnant women (P=0,036) white and non-white race, female and male sex, and residents of the urban area (P < 0.05). Regarding the presence of comorbidities, there was a statistically significant difference in the mean number of days of hospitalization among patients with chronic cardiovascular disease, diabetes mellitus, and obesity (P< 0.05). In conclusion, the COVID-19 pandemic has been distinctly revealed among the waves.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus , Obesity
14.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.11.23284437

ABSTRACT

Background: The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed method study we explored perceived pandemic-related practice changes to cervical cancer screenings and colposcopies. Methods: In 2021, a national sample of 1,251 clinicians completed surveys, including 675 clinicians who performed colposcopy; a subset (n=55) of clinicians completed qualitative interviews. Results: Nearly half of all clinicians reported they were currently performing fewer cervical cancer screenings (47%) and colposcopies (44% of those who perform the procedure) than before the pandemic. About one-fifth (18.6%) of colposcopists reported performing fewer LEEPs than prior to the pandemic. Binomial regression analyses indicated that older, non-White, internal medicine and family medicine clinicians (compared to OB-GYNs), and those practicing in community health centers (compared to private practice) had higher odds of reporting reduced screening. Among colposcopists, males, internal medicine physicians, those practicing in community health centers, and in the South had higher odds of reporting reduced colposcopies. Qualitative interviews highlighted pandemic-related care disruptions and lack of tracking systems to identify overdue screenings. Conclusions: Reductions in cervical cancer screening and colposcopy among nearly half of clinicians more than one year into the pandemic raise concerns that inadequate screening and follow-up will lead to future increases in preventable cancers. Funding: This study was funded by the American Cancer Society, who had no role in the studys design, conduct, or reporting.


Subject(s)
Obesity , Uterine Cervical Neoplasms , COVID-19 , Neoplasms
15.
biorxiv; 2023.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2023.01.05.522853

ABSTRACT

Background: As the pandemic evolves, post-acute sequelae of CoV-2 (PACS) including cardiovascular manifestations have emerged as a new health threat. This study aims to study whether the Spike protein plus obesity can exacerbate PACS-related cardiomyopathy. Methods: A Spike protein-pseudotyped (Spp) virus with the proper surface tropism of SARS-CoV-2 was developed for viral entry assay in vitro and administration into high fat diet (HFD)-fed mice. The systemic viral loads and cardiac transcriptomes were analyzed at 2 and 24 hrs, 3, 6, and 24 weeks post introducing (wpi) Spp using RNA-seq or real time RT-PCR. Echocardiography was used to monitor cardiac functions. Results: Low-density lipoprotein cholesterol enhanced viral uptake in endothelial cells, macrophages, and cardiomyocyte-like H9C2 cells. Selective cardiac and adipose viral depositions were observed in HFD mice but not in normal-chow-fed mice. The cardiac transcriptional signatures in HFD mice at 3, 6, and 24 wpi showed systemic suppression of mitochondria respiratory chain genes including ATP synthases and nicotinamide adenine dinucleotide:ubiquinone oxidoreductase gene members, upregulation of stress pathway-related crucial factors such as nuclear factor-erythroid 2-related factor 1 and signal transducer and activator of transcription 5A, and increases in expression of glucose metabolism-associated genes. As compared with the age-matched HFD control mice, cardiac ejection fraction and fractional shortening were significantly decreased, while left ventricular end-systolic diameter and volume were significantly elevated, and cardiac fibrosis was increased in HFD mice at 24 wpi. Conclusion: Our data demonstrated that the Spike protein could induce long-term transcriptional suppression of mitochondria metabolic genes and cause cardiac fibrosis and myocardial contractile impairment, providing mechanistic insights to PACS-related cardiomyopathy.


Subject(s)
Fibrosis , Cardiomyopathies , Severe Acute Respiratory Syndrome , Obesity
16.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2447975.v1

ABSTRACT

A web application designed to predict high-risk patients affected by COVID-19 runs a machine learning model at the backend to generate results. The random forest classification technique is used to predict the high-risk status of patients who are COVID-19 positive and are at the initial stage of infection. We used hybridized algorithms to predict high-risk patients, and the model used the patients’ current underlying health conditions, such as age, sex, diabetes, asthma, hypertension, smoking, and other factors. After data preprocessing and training, the model could predict the severity of the patient with an accuracy of 65-70%. According to some studies, random forest ML models outperform other ML models for solving the challenge of predicting unusual events, such as in this case. Pneumonia, hypertension, diabetes, obesity, and chronic renal disease were the most contributory variables for model implementation. This project will help patients and hospital staff make necessary decisions and actions in advance. This will help healthcare workers arrange resources and hospital areas for high-risk COVID-19 patients. Thus, this study provides an effective and optimized treatment. Using this application and suitable patient data, hospitals can predict whether a patient will require urgent care.


Subject(s)
Renal Insufficiency, Chronic , COVID-19 , Hypertension , Asthma , Obesity , Diabetes Mellitus
17.
Patient Educ Couns ; 105(7): 2371-2381, 2022 07.
Article in English | MEDLINE | ID: covidwho-2150394

ABSTRACT

OBJECTIVE: To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS: 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS: 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION: Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS: Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.


Subject(s)
Obesity , Weight Loss , Counseling/methods , Humans , Obesity/psychology , Obesity/therapy , Primary Health Care/methods , Rural Population , Weight Loss/physiology
18.
Lancet Diabetes Endocrinol ; 10(7): 488, 2022 07.
Article in English | MEDLINE | ID: covidwho-2150876
19.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2413065.v1

ABSTRACT

COVID-19 aggravates pre-existing diabetes mellitus and contributes to newly discovered hypertension by increasing blood pressure by inhibiting the activity of angiotensin-converting enzymes 2 in the rennin-angiotensin system. Diabetes patients may be more vulnerable to COVID-19 due to chronic comorbidities such as obesity and cardiovascular disease such as hypertension. On March 23, 2022, a retired black African woman in her sixties was taken into the emergency room with the chief complaints of frequent midnight urine, hazy vision, headache, fever, and tingling in her hands and feet. A throat swab polymerase chain reaction test that revealed positive results after 28 hours was used to confirm COVID-19. Her electrocardiogram showed sinus tachycardia with a heart rate of 105 beats per minute. Fluid resuscitation (0.9% normal saline) of 1000 mL and drip insulin administration were commenced as soon as she was brought to an intensive care unit. In this case report, the patient had been previously diagnosed with type 2 diabetes mellitus. COVID-19 affects the beta cells, forcing them to release insulin and increasing the insulin insufficiency, which leads to her blood glucose raising. Type 2 diabetes mellitus is therefore the most frequent comorbidity of COVID-19 in this case report. Poor blood glucose management in the case of COVID-19 may increase the pathogen's susceptibility, the likelihood that patients will be admitted to the hospital, and the likelihood that mortality will be enhanced.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Tachycardia, Sinus , COVID-19 , Hypertension , Headache , Fever , Obesity , Diabetes Mellitus , Addison Disease
20.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.21.22283753

ABSTRACT

Background: Long Covid is an emerging chronic illness potentially affecting millions, sometimes preventing the ability to work or participate in normal daily activities. COVID-OUT was an investigator-initiated, multi-site, phase 3, randomized, quadruple-blinded placebo-controlled clinical trial ( NCT04510194 ). The design simultaneously assessed three oral medications (metformin, ivermectin, fluvoxamine) using two by three parallel treatment factorial assignment to efficiently share placebo controls and assessed Long Covid outcomes for 10 months to understand whether early outpatient treatment of SARS-CoV-2 with metformin, ivermectin, or fluvoxamine prevents Long Covid. Methods: This was a decentralized, remotely delivered trial in the US of 1,125 adults age 30 to 85 with overweight or obesity, fewer than 7 days of symptoms, and enrolled within three days of a documented SARS-CoV-2 infection. Immediate release metformin titrated over 6 days to 1,500mg per day 14 days total; ivermectin 430mcg/kg/day for 3 days; fluvoxamine, 50mg on day one then 50mg twice daily through 14 days. Medical-provider diagnosis of Long Covid, reported by participant by day 300 after randomization was a pre-specified secondary outcome; the primary outcome of the trial was severe Covid by day 14. Result: The median age was 45 years (IQR 37 to 54), 56% female of whom 7% were pregnant. Two percent identified as Native American; 3.7% as Asian; 7.4% as Black/African American; 82.8% as white; and 12.7% as Hispanic/Latino. The median BMI was 29.8 kg/m2 (IQR 27 to 34); 51% had a BMI >30kg/m2. Overall, 8.4% reported having received a diagnosis of Long Covid from a medical provider: 6.3% in the metformin group and 10.6% in the metformin control; 8.0% in the ivermectin group and 8.1% in the ivermectin control; and 10.1% in the fluvoxamine group and 7.5% in the fluvoxamine control. The Hazard Ratio (HR) for Long Covid in the metformin group versus control was 0.58 (95% CI 0.38 to 0.88); 0.99 (95% CI 0.592 to 1.643) in the ivermectin group; and 1.36 in the fluvoxamine group (95% CI 0.785 to 2.385). Conclusions: There was a 42% relative decrease in the incidence of Long Covid in the metformin group compared to its blinded control in a secondary outcome of this randomized phase 3 trial. Trial registration: NCT04510194 ; IND 152439


Subject(s)
COVID-19 , Obesity
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