Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 135
Filter
1.
PLoS One ; 17(3): e0264964, 2022.
Article in English | MEDLINE | ID: covidwho-1745314

ABSTRACT

INTRODUCTION: We performed a longitudinal SARS-CoV-2 seroepidemiological study in healthcare personnel of the two largest tertiary COVID-19 referral hospitals in Mexico City. METHODS: All healthcare personnel, including staff physicians, physicians in training, nurses, laboratory technicians, researchers, students, housekeeping, maintenance, security, and administrative staff were invited to voluntarily participate, after written informed consent. Participants answered a computer-assisted self-administered interview and donated blood samples for antibody testing every three weeks from October 2020 to June 2021. RESULTS: A total of 883 participants (out of 3639 registered employees) contributed with at least one blood sample. The median age was 36 years (interquartile range: 28-46) and 70% were women. The most common occupations were nurse (28%), physician (24%), and administrative staff (22%). Two hundred and ninety participants (32.8%) had a positive-test result in any of the visits, yielding an overall adjusted prevalence of 33.5% for the whole study-period. Two hundred and thirty-five positive tests were identified at the baseline visit (prevalent cases), the remaining 55 positive tests were incident cases. Prevalent cases showed associations with both occupational (institution 2 vs. 1: adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI]: 1.54-3.25; laboratory technician vs. physician: aOR = 4.38, 95% CI: 1.75-10.93) and community (municipality of residence Xochimilco vs. Tlalpan: aOR = 2.03, 95% CI: 1.09-3.79) risk-factors. The incidence rate was 3.0 cases per 100 person-months. Incident cases were associated with community-acquired risk, due to contact with suspect/confirmed COVID-19 cases (HR = 2.45, 95% CI: 1.21-5.00). CONCLUSIONS: We observed that between October 2020 and June 2021, healthcare workers of the two largest tertiary COVID-19 referral centers in Mexico City had similar level of exposure to SARS-CoV-2 than the general population. Most variables associated with exposure in this setting pointed toward community rather than occupational risk. Our observations are consistent with successful occupational medicine programs for SARS-CoV-2 infection control in the participating institutions but suggest the need to strengthen mitigation strategies in the community.


Subject(s)
COVID-19/epidemiology , Personnel, Hospital/statistics & numerical data , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Adult , COVID-19/diagnosis , COVID-19/etiology , COVID-19 Serological Testing/statistics & numerical data , Female , Humans , Male , Mexico/epidemiology , Middle Aged , Risk Factors , Seroepidemiologic Studies
4.
PLoS One ; 17(1): e0262774, 2022.
Article in English | MEDLINE | ID: covidwho-1643281

ABSTRACT

Recent studies on burnout (BO) have included both individual and situational factors, referred to as job-person fit (JPF). The present study aimed to evaluate the prevalence rate of BO in the hospital staff working at a tertiary referral hospital in southwest Iran and then to highlight the importance of the person in the context of his/her work life. This cross-sectional study was conducted in 2020 on all hospital staff using a three-part questionnaire comprised of personal and work-situational factors, the Perceived Stress Scale (PSS), and the Psychological Empowerment Scale (PES). The partial least squares (PLS) path modelling and the neural network (NN) model were used to identify the significant variables within the BO dimensions. A total of 358 staff completed the questionnaire and were recruited for the study. Emotional exhaustion (EE) was seen in 137 medical staff (38.3%) and depersonalization (DP) was observed in 75 individuals (20.1%). Thinking about job change was the most important factor positively correlated with EE. Positive stress and work experience were among the most significant factors negatively associated with PA and DP, respectively. The hospital staff experienced BO in a way comparable to the national results. Work-situational and personal variables interacted with the three dimensions of BO in the hospital staff. More experienced staff also felt more accomplished and successful, resulting in the identification of a decreased level of DP and elevated PA.


Subject(s)
Burnout, Professional/epidemiology , Job Satisfaction , Personnel, Hospital/statistics & numerical data , Tertiary Care Centers/statistics & numerical data , Adult , Burnout, Professional/etiology , Cross-Sectional Studies , Educational Status , Female , Humans , Iran/epidemiology , Least-Squares Analysis , Male , Marital Status , Models, Statistical , Occupational Stress/epidemiology , Occupational Stress/etiology , Personnel Turnover/statistics & numerical data , Personnel, Hospital/psychology , Surveys and Questionnaires
5.
PLoS One ; 17(1): e0262202, 2022.
Article in English | MEDLINE | ID: covidwho-1622355

ABSTRACT

BACKGROUND: The unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures in a tertiary Children's Hospital in southwest China, which might be used to predict long-term effects related to health-seeking behavior of parents/caregivers. METHODS: This study included newborns enrolled over a span of 86 weeks between January 4, 2019, and August 27, 2020. We designated two time periods for analysis purposes: a stable pre-COVID period(55 weeks between January 4, 2019, and January 23, 2020) and a COVID-impacted period (31 weeks between January 24, 2020, and August 27, 2020). An interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectra before and after the period of nonpharmaceutical interventions (NPIs). Furthermore, this study was conducted to evaluate whether the health-seeking behavior of parents/caregivers was influenced by pandemic factors. RESULTS: Overall, 16,640 infants were admitted to the neonatology department during the pre-COVID period (n = 12,082) and the COVID-impacted period (n = 4,558). The per week neonatal admissions consistently decreased following the first days of NPIs (January 24, 2020). The average weekly admission rates of 220/week pre-COVID period and 147/week COVID-impacted period. There was an evident decrease in the volume of admissions for all disease spectra after the intervention, whereas the decrease of patients complaining about pathological jaundice-related conditions was statistically significant (p<0.05). In the COVID-impacted period, the percentage of patients who suffered from respiratory system diseases, neonatal encephalopathy, and infectious diseases decreased, while the percentage of pathological jaundice-related conditions and gastrointestinal system diseases increased. The neonatal mortality rates (NMRs) increased by 8.7% during the COVID-impacted period compared with the pre-COVID period. CONCLUSIONS: In summary, there was a significant decline in neonatal admissions in a tertiary care hospital during the COVID-19 Pandemic and the associated NPIs. Additionally, this situation had a remarkable impact on disease spectra and health-seeking behavior of parents/caregivers. We, therefore, advise continuing follow-ups and monitoring the main health indicators in vulnerable populations affected by this Pandemic over time.


Subject(s)
COVID-19/epidemiology , Hospitalization/statistics & numerical data , Pandemics/statistics & numerical data , Tertiary Care Centers/statistics & numerical data , China , Female , Humans , Infant, Newborn , Interrupted Time Series Analysis/statistics & numerical data , Male
6.
Microbiol Spectr ; 10(1): e0201521, 2022 02 23.
Article in English | MEDLINE | ID: covidwho-1622005

ABSTRACT

Emergency department areas were repurposed as intensive care units (ICUs) for patients with acute respiratory distress syndrome during the initial months of the coronavirus disease 2019 (COVID-19) pandemic. We describe an outbreak of New Delhi metallo-ß-lactamase 1 (NDM-1)-producing Escherichia coli infections in critically ill COVID-19 patients admitted to one of the repurposed units. Seven patients developed infections (6 ventilator-associated pneumonia [VAP] and 1 urinary tract infection [UTI]) due to carbapenem-resistant E. coli, and only two survived. Five of the affected patients and four additional patients had rectal carriage of carbapenem-resistant E. coli. The E. coli strain from the affected patients corresponded to a single sequence type. Rectal screening identified isolates of two other sequence types bearing blaNDM-1. Isolates of all three sequence types harbored an IncFII plasmid. The plasmid was confirmed to carry blaNDM-1 through conjugation. An outbreak of clonal NDM-1-producing E. coli isolates and subsequent dissemination of NDM-1 through mobile elements to other E. coli strains occurred after hospital conversion during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This emphasizes the need for infection control practices in surge scenarios. IMPORTANCE The SARS-CoV-2 pandemic has resulted in a surge of critically ill patients. Hospitals have had to adapt to the demand by repurposing areas as intensive care units. This has resulted in high workload and disruption of usual hospital workflows. Surge capacity guidelines and pandemic response plans do not contemplate how to limit collateral damage from issues like hospital-acquired infections. It is vital to ensure quality of care in surge scenarios.


Subject(s)
Cross Infection/microbiology , Escherichia coli Infections/microbiology , Escherichia coli/enzymology , Escherichia coli/isolation & purification , beta-Lactamases/metabolism , Adult , Aged , COVID-19/epidemiology , COVID-19/virology , Conjugation, Genetic , Cross Infection/epidemiology , Disease Outbreaks , Escherichia coli/classification , Escherichia coli/genetics , Escherichia coli Infections/epidemiology , Escherichia coli Infections/mortality , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Mexico/epidemiology , Middle Aged , Plasmids/genetics , SARS-CoV-2/physiology , Tertiary Care Centers/statistics & numerical data , beta-Lactamases/genetics
7.
J Cancer Res Ther ; 17(6): 1540-1546, 2021.
Article in English | MEDLINE | ID: covidwho-1597096

ABSTRACT

Purpose: Coronavirus disease (COVID-19) pandemic has affected the entire health-care system and has led to a sense of fear and anxiety in the minds of patients. Patient's perceptions in this scenario of the pandemic are unknown. Providing continued care for cancer patients during the lockdown has been challenging. Measures are needed to improve patient safety and satisfaction during these challenging times and hence the importance of measuring the degree of satisfaction for the quality of care provided. The aim of the study was to evaluate the factors related to patients' satisfaction and also understand their apprehensions, fears, and anxieties they face as they receive radiotherapy treatment amid COVID-19 pandemic. The study's objective was to explore other aspects such as logistic issues, patient-staff communication, and also perceptions of the patients toward the outbreak. Materials and Methods: This study was conducted from April to September 2020. A questionnaire was created for which the patients were asked to provide answers. Parameters assessed included general information such as mode of transport used, frame of mind during treatment, awareness about pandemic, satisfaction toward care provided by health-care staff, and also documenting the suggestions to improve the quality of care. Results: During this period, we interviewed 108 patients: 56 males (51.9%) and 52 females (48.1%). 90.7% of the participants were satisfied with the condition and safety measures employed in waiting area and billing section. Majority (88.9%) were found to be aware about COVID-19. 74.1% of the participants were very satisfied with the services provided to them in the department of radiation oncology. Conclusion: The survey was useful in measuring the patient satisfaction, in understanding their fears and anxieties, and also in determining their awareness about the pandemic. The survey was also useful to get the patients' opinion and ideas for improvement in the health-care services.


Subject(s)
Neoplasms/radiotherapy , Patient Satisfaction/statistics & numerical data , Professional-Patient Relations , Tertiary Care Centers/statistics & numerical data , Adult , Aged , Anxiety/psychology , COVID-19/epidemiology , Communication , Fear/psychology , Female , Humans , India/epidemiology , Male , Middle Aged , Patient Safety , Quality of Health Care , SARS-CoV-2 , Surveys and Questionnaires
8.
Hematology ; 26(1): 1007-1012, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1555722

ABSTRACT

BACKGROUND: Haematological markers such as absolute lymphopenia have been associated with severe COVID-19 infection. However, in the literature to date, the cohorts described have typically included patients who were moderate to severely unwell with pneumonia and who required intensive care stay. It is uncertain if these markers apply to a population with less severe illness. We sought to describe the haematological profile of patients with mild disease with COVID-19 admitted to a single centre in Singapore. METHODS: We examined 554 consecutive PCR positive SARS-COV-2 patients admitted to a single tertiary healthcare institution from Feb 2020 to April 2020. In all patients a full blood count was obtained within 24 h of presentation. RESULTS: Patients with pneumonia had higher neutrophil percentages (66.5 ± 11.6 vs 55.2 ± 12.6%, p < 0.001), lower absolute lymphocyte count (1.5 ± 1.1 vs 1.9 ± 2.1 x109/L, p < 0.011) and absolute eosinophil count (0.2 ± 0.9 vs 0.7 ± 1.8 × 109/L, p = 0.002). Platelet counts (210 ± 56 vs 230 ± 61, p = 0.020) were slightly lower in the group with pneumonia. We did not demonstrate significant differences in the neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio in patients with or without pneumonia. Sixty-eight patients (12.3%) had peripheral eosinophilia. This was more common in migrant workers living in dormitories. CONCLUSION: Neutrophilia and lymphopenia were found to be markers associated with severe COVID-19 illness. We did not find that combined haematological parameters: neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio, had any association with disease severity in our cohort of patients with mild-moderate disease. Migrant workers living in dormitories had eosinophilia which may reflect concurrent chronic parasitic infection.


Subject(s)
Blood Cell Count , COVID-19/blood , Pandemics , SARS-CoV-2 , Adult , Anthelmintics/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/epidemiology , Comorbidity , Diabetes Mellitus, Type 2/epidemiology , Dyslipidemias/epidemiology , Eosinophilia/epidemiology , Eosinophilia/etiology , Female , Fever/epidemiology , Fever/etiology , Housing , Humans , Hypertension/epidemiology , Hypoxia/epidemiology , Hypoxia/etiology , Male , Middle Aged , Neutrophils , Parasitic Diseases/drug therapy , Parasitic Diseases/epidemiology , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Singapore/epidemiology , Tertiary Care Centers/statistics & numerical data , Transients and Migrants/statistics & numerical data , Travel-Related Illness , Young Adult
9.
Rev Neurol ; 73(11): 390-393, 2021 12 01.
Article in Spanish | MEDLINE | ID: covidwho-1539089

ABSTRACT

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.


TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.


Subject(s)
COVID-19/epidemiology , Epilepsy/drug therapy , Pandemics , Remote Consultation/statistics & numerical data , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Adolescent , Adult , Aged , Anticonvulsants/therapeutic use , Child , Child, Preschool , Disease Management , Drug Resistant Epilepsy/drug therapy , Drug Resistant Epilepsy/epidemiology , Epilepsies, Partial/drug therapy , Epilepsies, Partial/epidemiology , Epilepsy/epidemiology , Female , Guatemala/epidemiology , Health Facility Closure , Humans , Infant , Male , Middle Aged , Mobile Applications , Office Visits/statistics & numerical data , Procedures and Techniques Utilization/statistics & numerical data , Remote Consultation/trends , Retrospective Studies , Seizures/epidemiology , Seizures/prevention & control , Telephone , Tertiary Care Centers/organization & administration , Treatment Outcome , Videoconferencing , Young Adult
10.
Clin Pediatr (Phila) ; 61(2): 177-183, 2022 02.
Article in English | MEDLINE | ID: covidwho-1523150

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic became an important public health problem affecting all age groups. The aim of this study was to evaluate clinical and laboratory findings of newborns born to mothers with COVID-19. Thirty pregnant women with COVID-19 were admitted to Turgut Ozal University Hospital for delivery. Fourteen pregnant women had at least one symptom associated with COVID-19. Positive polymerase chain reaction (PCR) results were seen in only 3 (9.7%) of 31 newborns. A statistically significant difference was observed between PCR-positive and PCR-negative newborns in terms of any adverse pregnancy outcomes. Neonatal lymphocyte count and partial arterial oxygen pressure were significantly lower in the PCR-positive group. Results were also compared according to the interval from the maternal diagnosis time to delivery. Hemoglobin and hematocrit levels in newborns born to mothers diagnosed more than 7 days before delivery were significantly lower. Neonates born to mothers with COVID-19 had mild clinical symptoms and favorable outcomes.


Subject(s)
COVID-19/complications , Pregnancy Outcome/epidemiology , Pregnant Women , Adult , COVID-19/epidemiology , Disease Transmission, Infectious/statistics & numerical data , Female , Humans , Pregnancy , Tertiary Care Centers/organization & administration , Tertiary Care Centers/statistics & numerical data
11.
Am J Emerg Med ; 51: 69-75, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1458668

ABSTRACT

OBJECTIVE: To compare clinical and laboratory features of children with Multisystem Inflammatory Syndrome in Children (MIS-C) to those evaluated for MIS-C in the Emergency Department (ED). METHODS: We conducted a retrospective review of the medical record of encounters with testing for inflammatory markers in an urban, tertiary care Pediatric ED from March 1, 2020 to July 31, 2020. We abstracted demographic information, laboratory values, selected medications and diagnoses. We reviewed the record for clinical presentation for the subset of patients admitted to the hospital for suspected MIS-C. We then used receiver operating curves and logistic regression to evaluate the utility of candidate laboratory values to predict MIS-C status. RESULTS: We identified 32 patients with confirmed MIS-C and 15 admitted and evaluated for MIS-C but without confirmation of SARS CoV-2 infection. We compared these patients to 267 encounters with screening laboratories for MIS-C. Confirmed MIS-C patients had an older median age, higher median fever on presentation and were predominantly of Hispanic and non-Hispanic Black race/ethnicity. All children with MIS-C had a C-reactive protein (CRP) >4.5 mg/dL, were more likely to have Brain Natriuretic Peptide >400 pg/mL (OR 10.50, 95%CI 4.40-25.04), D-Dimer >3 µg/mL (7.51, [3.18-17.73]), and absolute lymphocyte count (ALC) <1.5 K/mcL (21.42, [7.19-63.76]). We found CRP >4.5 mg/dL and ALC <1.5 K/mcL to be 86% sensitive and 91% specific to identify MIS-C among patients screened in our population. CONCLUSIONS: We identified that elevated CRP and lymphopenia was 86% sensitive and 91% specific for identification of children with MIS-C.


Subject(s)
C-Reactive Protein , COVID-19/complications , Lymphopenia , Systemic Inflammatory Response Syndrome/diagnosis , COVID-19/diagnosis , Child , Child, Preschool , District of Columbia , Emergency Service, Hospital/statistics & numerical data , Female , Fibrin Fibrinogen Degradation Products , Hospitalization , Humans , Infant , Logistic Models , Lymphocyte Count , Male , Natriuretic Peptide, Brain , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Tertiary Care Centers/statistics & numerical data
12.
Arch Dis Child ; 107(2): 189-191, 2022 02.
Article in English | MEDLINE | ID: covidwho-1435023

ABSTRACT

OBJECTIVE: Rapid implementation of home sleep studies during the first UK COVID-19 'lockdown'-completion rates, family feedback and factors that predict success. DESIGN: We included all patients who had a sleep study conducted at home instead of as inpatient from 30 March 2020 to 30 June 2020. Studies with less than 4 hours of data for analysis were defined 'unsuccessful'. RESULTS: 137 patients were included. 96 underwent home respiratory polygraphy (HRP), median age 5.5 years. 41 had oxycapnography (O2/CO2), median age 5 years. 56% HRP and 83% O2/CO2 were successful. A diagnosis of autism predicted a lower success rate (29%) as did age under 5 years. CONCLUSION: Switching studies rapidly from an inpatient to a home environment is possible, but there are several challenges that include a higher failure rate in younger children and those with neurodevelopmental disorders.


Subject(s)
COVID-19/prevention & control , Parents/psychology , Polysomnography/methods , Self-Testing , Sleep Apnea, Obstructive/diagnosis , Adolescent , Age Factors , COVID-19/epidemiology , COVID-19/transmission , Child , Child, Preschool , Feasibility Studies , Female , Humans , Infant , Male , Perception , Polysomnography/psychology , Polysomnography/standards , Quarantine/standards , Retrospective Studies , Sleep Apnea, Obstructive/etiology , Surveys and Questionnaires/statistics & numerical data , Tertiary Care Centers/standards , Tertiary Care Centers/statistics & numerical data , United Kingdom/epidemiology
13.
Ultrasound Q ; 37(3): 254-260, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1393538

ABSTRACT

ABSTRACT: This retrospective study shares our departmental experience of screening of ultrasound (US) requests, triaging of studies, and abbreviated US protocols implemented during the COVID-19 pandemic. For US studies requested in April and May 2020, the following data were collected: type of study, indication, COVID-19 status (positive or patient under investigation [PUI]), decision to perform study, US findings, and location of patient. A total of 196 US studies in 150 patients were included. The median age of patients was 60 years (female: 46.7% [70/150]). At the time of study request, 83 patients (55.3%) were COVID-19-positive and 67 (44.7%) were PUI, of which 8 (11.9%) tested positive after waiting for test result. The most frequently requested study was venous extremity Doppler (51%), followed by right upper quadrant (20.4%), renal (11.7%), and liver duplex (6.6%). After radiologist screening and triage of US requests, 156 studies were performed (79.6%), 15 were postponed until COVID test result (7.6%), and 40 were not performed after discussion with ordering provider (20.4%). Notably, 40.1% of studies performed on COVID-19-positive patients yielded pathological findings, most frequently deep venous thrombosis (18.1%), medical renal disease (7.6%), and gall bladder sludge (5.7%). Abbreviated US protocols were used in 29.4% of studies. In conclusion, US study screening and triage played an important role to optimize care of COVID-19 patients and PUIs.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Ultrasonography, Doppler, Duplex/methods , Venous Thrombosis/diagnosis , Adult , COVID-19/complications , Female , Humans , Male , Middle Aged , Retrospective Studies , Venous Thrombosis/etiology
14.
Medicine (Baltimore) ; 100(35): e26752, 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1393504

ABSTRACT

ABSTRACT: To describe the outcomes of elective cancer surgeries and adverse consequences on the patients and medical staff due to the surgical interventions in children during the Coronavirus Disease 2019 (COVID-19) pandemic.The study included children younger than 15 years who underwent elective cancer surgeries from March 4, 2020 and December 3, 2020.A total of 121 patients (62% male; median age, 3 years) underwent surgery. The surgical procedures included nephrectomies (n = 18), neuroblastoma (n = 26) and soft tissue tumor resections (n = 24) and complex surgical procedures like extended liver resections (n = 2), intra-atrial thrombectomy under cardiopulmonary bypass (n = 2), pancreatoduodenectomy (n = 1), and free microvascular flaps (n = 7). Clavien-Dindo Grade III complications were 5% (n = 6), and there were no postoperative deaths. Preoperative COVID-19 testing was performed in 82% of children, and only 2% showed severe acute respiratory syndrome coronavirus 2 positivity. Postoperatively, 26 children were tested because of specific symptoms and, 6 tested positive for severe acute respiratory syndrome coronavirus 2. Except for a median delay of 23 days in treatment, none of the patients with COVID-19 required critical hospital management. None of the surgical residents or faculty acquired COVID-19, while 4 each medical and support staff were tested positive in the study period.COVID-19 was not a deterrent for continued cancer care, and surgeries could be safely performed adopting universal preventive measures without any added morbidity from COVID-19. Caregivers and centers dealing with childhood cancers can be encouraged to sustain or seek early healthcare.


Subject(s)
Elective Surgical Procedures/statistics & numerical data , Neoplasms/surgery , Adolescent , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child, Preschool , Female , Humans , India/epidemiology , Infant , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data
15.
Br J Haematol ; 196(2): 351-355, 2022 01.
Article in English | MEDLINE | ID: covidwho-1373796

ABSTRACT

The COVID-19 pandemic has created many challenges in the management of immune thrombocytopenic purpura (ITP). The recommendation for avoidance of steroids by WHO led to the off-licence use, supported by NHS England, of thrombopoietin mimetics (TPO-RA) for newly diagnosed or relapsed ITP. This is a real-world prospective study which investigated the treatment patterns and outcomes in this setting. Twenty-four hospitals across the UK submitted 343 cases. Corticosteroids remain the mainstay of ITP treatment, but TPO-RAs were more effective. Incidental COVID-19 infection was identified in a significant number of patients (9·5%), while 14 cases were thought to be secondary to COVID-19 vaccination.


Subject(s)
COVID-19/epidemiology , Pandemics , Purpura, Thrombocytopenic, Idiopathic/therapy , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Autoimmune Diseases/complications , COVID-19/blood , COVID-19 Vaccines/adverse effects , Combined Modality Therapy , Comorbidity , Connective Tissue Diseases/complications , Contraindications, Drug , Disease Management , Female , Hemorrhage/epidemiology , Hemorrhage/etiology , Hospitals, District/statistics & numerical data , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Neoplasms/complications , Off-Label Use , Platelet Transfusion , Prospective Studies , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/epidemiology , Purpura, Thrombocytopenic, Idiopathic/etiology , Tertiary Care Centers/statistics & numerical data , Thromboembolism/epidemiology , Thromboembolism/etiology , Thrombopoietin/agonists , Tranexamic Acid/therapeutic use , Treatment Outcome , United Kingdom/epidemiology , Young Adult
16.
J Laryngol Otol ; 135(10): 897-903, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1368885

ABSTRACT

OBJECTIVE: This study aimed to compare treatment outcomes in patients with laryngeal and tracheal stenosis treated during and prior to the coronavirus disease 2019 pandemic period. METHOD: Patients treated for laryngotracheal lesions with impending airway compromise during the active pandemic period were matched with those treated for similar lesions in the preceding years in a monocentric tertiary hospital setting. RESULTS: During the pandemic period of 55 days, 31 patients underwent 47 procedures. Seven patients (2 children, 5 adults) had open airway surgery, and one had an operation-specific complication. Twenty-four patients (10 children, 14 adults) underwent 40 endoscopic interventions without any complications. Operation specific results during and prior to the pandemic were comparable. CONCLUSION: The management strategy in patients with laryngotracheal lesions and impending airway compromise should not be altered during periods of risk from coronavirus disease 2019. Avoiding a tracheostomy by performing primary corrective surgery or proceeding with a definitive decannulation would be beneficial in these patients to reduce the risk of contagion.


Subject(s)
COVID-19/transmission , Endoscopy/statistics & numerical data , Laryngostenosis/surgery , Tracheal Stenosis/surgery , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Catheterization/adverse effects , Child, Preschool , Clinical Decision-Making/ethics , Endoscopy/adverse effects , Female , Humans , Male , Postoperative Complications/epidemiology , Retrospective Studies , SARS-CoV-2/genetics , Tertiary Care Centers/statistics & numerical data , Tracheostomy/adverse effects , Treatment Outcome
17.
Pediatr Infect Dis J ; 40(12): e509-e511, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1348077

ABSTRACT

Systematic data are lacking on pediatric long COVID. This study prospectively assessed 90 children with persistent symptoms who presented to a designated multidisciplinary clinic for long COVID. In nearly 60%, symptoms were associated with functional impairment at 1-7 months after the onset of infection. A comprehensive structured evaluation revealed mild abnormal findings in approximately half the patients, mainly in the respiratory aspect.


Subject(s)
COVID-19/complications , SARS-CoV-2/pathogenicity , Adolescent , COVID-19/virology , Child , Female , Humans , Male , Prospective Studies , Tertiary Care Centers/statistics & numerical data
19.
Med Intensiva (Engl Ed) ; 45(6): 325-331, 2021.
Article in English | MEDLINE | ID: covidwho-1343315

ABSTRACT

OBJECTIVE: To describe outcomes of critically ill patients with COVID-19, particularly the association of renal replacement therapy to mortality. DESIGN: A single-center prospective observational study was carried out. SETTING: ICU of a tertiary care center. PATIENTS: Consecutive adults with COVID-19 admitted to the ICU. INTERVENTION: Renal replacement therapy. MAIN VARIABLES OF INTEREST: Demographic data, medical history, illness severity, type of oxygen therapy, laboratory data and use of renal replacement therapy to generate a logistic regression model describing independent risk factors for mortality. RESULTS: Of the total of 166 patients, 51% were mechanically ventilated and 26% required renal replacement therapy. The overall hospital mortality rate was 36%, versus 56% for those requiring renal replacement therapy, and 68% for those with both mechanical ventilation and renal replacement therapy. The logistic regression model identified four independent risk factors for mortality: age (adjusted OR 2.8 [95% CI 1.8-4.4] for every 10-year increase), mechanical ventilation (4.2 [1.7-10.6]), need for continuous venovenous hemofiltration (2.3 [1.3-4.0]) and C-reactive protein (1.1 [1.0-1.2] for every 10mg/L increase). CONCLUSIONS: In our cohort, acute kidney injury requiring renal replacement therapy was associated to a high mortality rate similar to that associated to the need for mechanical ventilation, while multiorgan failure necessitating both techniques implied an extremely high mortality risk.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/complications , Critical Illness/therapy , Renal Replacement Therapy , SARS-CoV-2 , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Adrenal Cortex Hormones/therapeutic use , Adult , Age Factors , Aged , C-Reactive Protein/analysis , COVID-19/blood , Comorbidity , Continuous Renal Replacement Therapy , Critical Illness/mortality , District of Columbia/epidemiology , Female , Hospital Mortality , Hospitals, University/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/mortality , Oxygen Inhalation Therapy/statistics & numerical data , Procedures and Techniques Utilization/statistics & numerical data , Prospective Studies , Renal Replacement Therapy/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/mortality , Respiratory Distress Syndrome/therapy , Risk Factors , Tertiary Care Centers/statistics & numerical data , Treatment Outcome
20.
Cornea ; 40(11): 1474-1481, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1322677

ABSTRACT

PURPOSE: The purpose of this study was to report the adverse effects of the COVID-19 pandemic on the clinical outcomes of infectious keratitis in South India. METHODS: Two hundred fifty-eight patients presented with infectious keratitis at 6 tertiary care centers when strict travel restrictions were in place from March 24 to May 31, 2020. Case records were collected retrospectively and analyzed for demographics, type of initial treatment, length of delay in presentation, microbiological diagnosis, clinical course, and final treatment outcome. RESULTS: The mean age of the patients was 49.2 years, with most of them (61.2%) being male. Forty-one patients (15.9%) did not receive any treatment for at least a week after the onset of symptoms. One hundred eight patients (41.9%) presented with severe ulcer (32 had a frank perforation). Resolution of the infection was achieved only in 103 patients (45.6%). A total of 90 patients (39.8%) with ulcers had a perforation, yet only 29 patients (32.2%) could receive keratoplasty because of the unavailability of donor tissues. At the end of 6-month follow-up, 47 patients had anatomical failure (loss of globe) and 12 additional patients had functional failure (total permanent vision loss). CONCLUSIONS: Delay in presentation and acute shortage of donor corneal tissues for emergency keratoplasty because of the COVID-19 pandemic had a grave impact, resulting in irreversible blindness in a significant number of patients.


Subject(s)
COVID-19/epidemiology , Corneal Ulcer/therapy , Delivery of Health Care/statistics & numerical data , Eye Infections, Bacterial/therapy , Eye Infections, Fungal/therapy , SARS-CoV-2 , Adult , Anti-Bacterial Agents/therapeutic use , Corneal Ulcer/diagnosis , Corneal Ulcer/microbiology , Eye Banks/statistics & numerical data , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/microbiology , Female , Humans , India/epidemiology , Keratoplasty, Penetrating/statistics & numerical data , Male , Middle Aged , Quarantine , Retrospective Studies , Tertiary Care Centers/statistics & numerical data , Tissue Donors/statistics & numerical data , Treatment Outcome , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL