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1.
Clin Infect Dis ; 73(11): 2055-2064, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1561261

ABSTRACT

BACKGROUND: Emerging evidence suggests many people have persistent symptoms after acute coronavirus disease 2019 (COVID-19) illness. Our objective was to estimate the prevalence and correlates of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC). METHODS: We used a population-based probability survey of adults with COVID-19 in Michigan. Living noninstitutionalized adults aged ≥18 in the Michigan Disease Surveillance System with COVID-19 onset through mid-April 2020 were eligible for selection (N = 28 000). Among 2000 selected, 629 completed the survey between June-December 2020. We estimated PASC prevalence, defined as persistent symptoms ≥30 (30-day COVID-19) or ≥60 (60-day COVID-19) days post-COVID-19 onset, overall and by sociodemographic and clinical factors. We used modified Poisson regression to produce adjusted prevalence ratios (aPRs) for potential risk factors. RESULTS: The analytic sample (n = 593) was predominantly female (56.1%), aged ≥45 years (68.2%), and non-Hispanic White (46.3%) or Black (34.8%). Thirty- and 60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among nonhospitalized respondents (43.7% and 26.9%) and respondents reporting mild symptoms (29.2% and 24.5%). Respondents reporting very severe (vs mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 (aPR, 2.25; 95% CI, 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19 (aPR, 1.71; 95% CI: 1.02-2.88). Hospitalized (vs nonhospitalized) respondents had ~40% higher prevalence of both 30-day (aPR, 1.37; 95% CI: 1.12-1.69) and 60-day (aPR, 1.40; 95% CI: 1.02-1.93) COVID-19. CONCLUSIONS: PASC is highly prevalent among cases reporting severe initial symptoms and, to a lesser extent, cases reporting mild and moderate symptoms.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Disease Progression , Female , Hospitalization , Humans , Prevalence
2.
Ann Intensive Care ; 10(1): 24, 2020 Feb 13.
Article in English | MEDLINE | ID: covidwho-1453061

ABSTRACT

BACKGROUND: Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate-severe ARDS patients. RESULTS: Forty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S', RV FAC). A RV global LSS value > - 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters. CONCLUSIONS: Global STE assessment of the RV was highly achievable and reproducible in moderate-severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness. Trial registration NCT02638844: NCT.

3.
JAMA Netw Open ; 4(5): e218049, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-1453498

ABSTRACT

Importance: In the US and the United Kingdom, cocaine use is the second leading cause of illicit drug overdose death. Psychosocial treatments for cocaine use disorder are limited, and no pharmacotherapy is approved for use in the US or Europe. Objective: To compare treatments for active cocaine use among adults. Data Sources: PubMed and the Cochrane Database of Systematic Reviews were searched for clinical trials published between December 31, 1995, and December 31, 2017. Study Selection: This meta-analysis was registered on Covidence.org (study 8731) on December 31, 2015. Clinical trials were included if they (1) had the term cocaine in the article title; (2) were published between December 31, 1995, and December 31, 2017; (3) were written in English; (4) enrolled outpatients 18 years or older with active cocaine use at baseline; and (5) reported treatment group size, treatment duration, retention rates, and urinalysis results for the presence of cocaine metabolites. A study was excluded if (1) more than 25% of participants were not active cocaine users or more than 80% of participants had negative test results for the presence of cocaine metabolites at baseline and (2) it reported only pooled urinalysis results indicating the presence of multiple substances and did not report the specific proportion of positive test results for cocaine metabolites. Multiple reviewers reached criteria consensus. Of 831 records screened, 157 studies (18.9%) met selection criteria and were included in the analysis. Data Extraction and Synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Search results were imported from PubMed XML into Covidence.org then Microsoft Excel. Data extraction was completed in 2 iterations to ensure fidelity. Analyses included a multilevel random-effects model, a multilevel mixed-effects meta-regression model, and sensitivity analyses. Treatments were clustered into 11 categories (psychotherapy, contingency management programs, placebo, opioids, psychostimulants, anticonvulsants, dopamine agonists, antidepressants, antipsychotics, miscellaneous medications, and other therapies). Missing data were imputed using multiple imputation by chained equations. The significance threshold for all analyses was P = .05. Data were analyzed using the metafor and mice packages in R software, version 3.3.2 (R Foundation for Statistical Computing). Data were analyzed from January 1, 2018, to February 28, 2021. Main Outcomes and Measures: The primary outcome was the intention-to-treat logarithm of the odds ratio (OR) of having a negative urinalysis result for the presence of cocaine metabolites at the end of each treatment period compared with baseline. The hypothesis, which was formulated after data collection, was that no treatment category would have a significant association with objective reductions in cocaine use. Results: A total of 157 studies comprising 402 treatment groups and 15 842 participants were included. Excluding other therapies, the largest treatment groups across all studies were psychotherapy (mean [SD] number of participants, 40.04 [36.88]) and contingency management programs (mean [SD] number of participants, 37.51 [25.51]). Only contingency management programs were significantly associated with an increased likelihood of having a negative test result for the presence of cocaine (OR, 2.13; 95% CI, 1.62-2.80), and this association remained significant in all sensitivity analyses. Conclusions and Relevance: In this meta-analysis, contingency management programs were associated with reductions in cocaine use among adults. Research efforts and policies that align with this treatment modality may benefit those who actively use cocaine and attenuate societal burdens.


Subject(s)
Cocaine-Related Disorders/therapy , Clinical Trials as Topic , Humans , Psychotherapy
4.
J Clin Immunol ; 41(6): 1146-1153, 2021 08.
Article in English | MEDLINE | ID: covidwho-1384523

ABSTRACT

Immunocompromised patients, including those with inborn errors of immunity (IEI), may be at increased risk for severe or prolonged infections with SARS-CoV-2 (Zhu et al. N Engl J Med. 382:727-33, 2020; Guan et al. 2020; Minotti et al. J Infect. 81:e61-6, 2020). While antibody and T cell responses to SARS-CoV-2 structural proteins are well described in healthy convalescent donors, adaptive humoral and cellular immunity has not yet been characterized in patients with antibody deficiency (Grifoni et al. Cell. 181:1489-1501 e1415, 2020; Burbelo et al. 2020; Long et al. Nat Med. 26:845-8, 2020; Braun et al. 2020). Herein, we describe the clinical course, antibody, and T cell responses to SARS-CoV-2 structural proteins in a cohort of adult and pediatric patients with antibody deficiencies (n = 5) and controls (related and unrelated) infected with SARS-CoV-2. Five patients within the same family (3 with antibody deficiency, 2 immunocompetent controls) showed antibody responses to nucleocapsid and spike proteins, as well as SARS-CoV-2 specific T cell immunity at days 65-84 from onset of symptoms. No significant difference was identified between immunocompromised patients and controls. Two additional unrelated, adult patients with common variable immune deficiency were assessed. One did not show antibody response, but both demonstrated SARS-CoV-2-specific T cell immunity when evaluated 33 and 76 days, respectively, following SARS-CoV-2 diagnosis. This report is the first to show robust T cell activity and humoral immunity against SARS-CoV-2 structural proteins in some patients with antibody deficiency. Given the reliance on spike protein in most candidate vaccines (Folegatti et al. Lancet. 396:467-78, 2020; Jackson et al. N Engl J Med. 383:1920-31, 2020), the responses are encouraging. Additional studies will be needed to further define the timing of onset of immunity, longevity of the immune response, and variability of response in immunocompromised patients.


Subject(s)
Antibodies, Viral/blood , COVID-19/immunology , Common Variable Immunodeficiency/immunology , SARS-CoV-2/physiology , T-Lymphocytes/immunology , Adolescent , Adult , Carrier State , Cells, Cultured , Child , Female , Humans , Immunity, Humoral , Lymphocyte Activation , Male , Middle Aged , Mutation/genetics , Pedigree , Transmembrane Activator and CAML Interactor Protein/genetics , Whole Exome Sequencing , Young Adult
5.
Lancet Respir Med ; 9(7): 712-720, 2021 07.
Article in English | MEDLINE | ID: covidwho-1337036

ABSTRACT

BACKGROUND: Whether young adults who are infected with SARS-CoV-2 are at risk of subsequent infection is uncertain. We investigated the risk of subsequent SARS-CoV-2 infection among young adults seropositive for a previous infection. METHODS: This analysis was performed as part of the prospective COVID-19 Health Action Response for Marines study (CHARM). CHARM included predominantly male US Marine recruits, aged 18-20 years, following a 2-week unsupervised quarantine at home. After the home quarantine period, upon arrival at a Marine-supervised 2-week quarantine facility (college campus or hotel), participants were enrolled and were assessed for baseline SARS-CoV-2 IgG seropositivity, defined as a dilution of 1:150 or more on receptor-binding domain and full-length spike protein ELISA. Participants also completed a questionnaire consisting of demographic information, risk factors, reporting of 14 specific COVID-19-related symptoms or any other unspecified symptom, and brief medical history. SARS-CoV-2 infection was assessed by PCR at weeks 0, 1, and 2 of quarantine and participants completed a follow-up questionnaire, which included questions about the same COVID-19-related symptoms since the last study visit. Participants were excluded at this stage if they had a positive PCR test during quarantine. Participants who had three negative swab PCR results during quarantine and a baseline serum serology test at the beginning of the supervised quarantine that identified them as seronegative or seropositive for SARS-CoV-2 then went on to basic training at Marine Corps Recruit Depot-Parris Island. Three PCR tests were done at weeks 2, 4, and 6 in both seropositive and seronegative groups, along with the follow-up symptom questionnaire and baseline neutralising antibody titres on all subsequently infected seropositive and selected seropositive uninfected participants (prospective study period). FINDINGS: Between May 11, 2020, and Nov 2, 2020, we enrolled 3249 participants, of whom 3168 (98%) continued into the 2-week quarantine period. 3076 (95%) participants, 2825 (92%) of whom were men, were then followed up during the prospective study period after quarantine for 6 weeks. Among 189 seropositive participants, 19 (10%) had at least one positive PCR test for SARS-CoV-2 during the 6-week follow-up (1·1 cases per person-year). In contrast, 1079 (48%) of 2247 seronegative participants tested positive (6·2 cases per person-year). The incidence rate ratio was 0·18 (95% CI 0·11-0·28; p<0·001). Among seropositive recruits, infection was more likely with lower baseline full-length spike protein IgG titres than in those with higher baseline full-length spike protein IgG titres (hazard ratio 0·45 [95% CI 0·32-0·65]; p<0·001). Infected seropositive participants had viral loads that were about 10-times lower than those of infected seronegative participants (ORF1ab gene cycle threshold difference 3·95 [95% CI 1·23-6·67]; p=0·004). Among seropositive participants, baseline neutralising titres were detected in 45 (83%) of 54 uninfected and in six (32%) of 19 infected participants during the 6 weeks of observation (ID50 difference p<0·0001). INTERPRETATION: Seropositive young adults had about one-fifth the risk of subsequent infection compared with seronegative individuals. Although antibodies induced by initial infection are largely protective, they do not guarantee effective SARS-CoV-2 neutralisation activity or immunity against subsequent infection. These findings might be relevant for optimisation of mass vaccination strategies. FUNDING: Defense Health Agency and Defense Advanced Research Projects Agency.


Subject(s)
Antibodies, Viral/blood , COVID-19/blood , COVID-19/epidemiology , SARS-CoV-2/immunology , Adolescent , COVID-19/diagnosis , COVID-19 Serological Testing , Cohort Studies , Female , Humans , Male , Prospective Studies , Quarantine , Risk Assessment , Young Adult
6.
Crit Care Explor ; 3(6): e0451, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1274517

ABSTRACT

Accurate identification of acute respiratory distress syndrome is essential for understanding its epidemiology, patterns of care, and outcomes. We aimed to design a computable phenotyping strategy to detect acute respiratory distress syndrome in electronic health records of critically ill patients. DESIGN: This is a retrospective cohort study. Using a near real-time copy of the electronic health record, we developed a computable phenotyping strategy to detect acute respiratory distress syndrome based on the Berlin definition. SETTING: Twenty multidisciplinary ICUs in Mayo Clinic Health System. SUBJECTS: The phenotyping strategy was applied to 196,487 consecutive admissions from year 2009 to 2019. INTERVENTIONS: The acute respiratory distress syndrome cohort generated by this novel strategy was compared with the acute respiratory distress syndrome cohort documented by clinicians during the same period. The sensitivity and specificity of the phenotyping strategy were calculated in randomly selected patient cohort (50 patients) using the results from manual medical record review as gold standard. MEASUREMENTS AND MAIN RESULTS: Among the patients who did not have acute respiratory distress syndrome documented, the computable phenotyping strategy identified 3,169 adult patients who met the Berlin definition, 676 patients (21.3%) were classified to have severe acute respiratory distress syndrome (Pao2/Fio2 ratio ≤ 100), 1,535 patients (48.4%) had moderate acute respiratory distress syndrome (100 < Pao2/Fio2 ratio ≤ 200), and 958 patients (30.2%) had mild acute respiratory distress syndrome (200 < Pao2/Fio2 ratio ≤ 300). The phenotyping strategy achieved a sensitivity of 94.4%, specificity of 96.9%, positive predictive value of 94.4%, and negative predictive value of 96.9% in a randomly selected patient cohort. The clinicians documented acute respiratory distress syndrome in 1,257 adult patients during the study period. The clinician documentation rate of acute respiratory distress syndrome was 28.4%. Compared with the clinicians' documentation, the phenotyping strategy identified a cohort that had higher acuity and complexity of illness suggested by higher Sequential Organ Failure Assessment score (9 vs 7; p < 0.0001), higher Acute Physiology and Chronic Health Evaluation score (76 vs 63; p < 0.0001), higher rate of requiring invasive mechanical ventilation (99.1% vs 71.8%; p < 0.0001), higher ICU mortality (20.6% vs 16.8%; p < 0.0001), and longer ICU length of stay (5.1 vs 4.2 d; p < 0.0001). CONCLUSIONS: Our rule-based computable phenotyping strategy can accurately detect acute respiratory distress syndrome in critically ill patients in the setting of high clinical complexity. This strategy can be applied to enhance early recognition of acute respiratory distress syndrome and to facilitate best-care delivery and clinical research in acute respiratory distress syndrome.

7.
Trials ; 22(1): 323, 2021 May 04.
Article in English | MEDLINE | ID: covidwho-1273249

ABSTRACT

BACKGROUND: Convalescent plasma has been used for numerous viral diseases including influenza, severe acute respiratory syndrome, Middle East respiratory syndrome and Ebola virus; however, evidence to support its use is weak. SARS-CoV-2 is a novel coronavirus responsible for the 2019 global pandemic of COVID-19 community acquired pneumonia. We have undertaken a randomized controlled trial to assess the efficacy and safety of COVID-19 convalescent plasma (CCP) in patients with SARS-CoV-2 infection. METHODS: CONCOR-1 is an open-label, multicentre, randomized trial. Inclusion criteria include the following: patients > 16 years, admitted to hospital with COVID-19 infection, receiving supplemental oxygen for respiratory complications of COVID-19, and availability of blood group compatible CCP. Exclusion criteria are : onset of respiratory symptoms more than 12 days prior to randomization, intubated or imminent plan for intubation, and previous severe reactions to plasma. Consenting patients are randomized 2:1 to receive either approximately 500 mL of CCP or standard of care. CCP is collected from donors who have recovered from COVID-19 and who have detectable anti-SARS-CoV-2 antibodies quantified serologically. The primary outcome is intubation or death at day 30. Secondary outcomes include ventilator-free days, length of stay in intensive care or hospital, transfusion reactions, serious adverse events, and reduction in SARS-CoV-2 viral load. Exploratory analyses include patients who received CCP containing high titre antibodies. A sample size of 1200 patients gives 80% power to detect a 25% relative risk reduction assuming a 30% baseline risk of intubation or death at 30 days (two-sided test; α = 0.05). An interim analysis and sample size re-estimation will be done by an unblinded independent biostatistician after primary outcome data are available for 50% of the target recruitment (n = 600). DISCUSSION: This trial will determine whether CCP will reduce intubation or death non-intubated adults with COVID-19. The trial will also provide information on the role of and thresholds for SARS-CoV-2 antibody titres and neutralization assays for donor qualification. TRIAL REGISTRATION: Clinicaltrials.gov NCT04348656 . Registered on 16 April 2020.


Subject(s)
COVID-19 , Coronavirus Infections , Adult , Bisoprolol , COVID-19/therapy , Humans , Immunization, Passive , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , SARS-CoV-2 , Treatment Outcome
8.
BMJ Case Rep ; 14(6)2021 Jun 15.
Article in English | MEDLINE | ID: covidwho-1270883

ABSTRACT

Isolated cortical vein thrombosis (ICVT) is a rare entity and accounts for only 6.3% of cerebral venous and sinus thrombosis. ICVT is an uncommon cause of seizures in young adults. We present a 27-year-old man with no medical history who presented with dizziness, loss of consciousness and a seizure-like episode. The patient was found to have an elevated D-dimer and brain imaging revealed ICVT. The patient was started on anticoagulation and antiseizure medications. A high index of suspicion for uncommon aetiologies for new-onset seizure, especially in the young, is key to accurate diagnosis of ICVT. Evaluation and work-up should include detailed physical examination, along with appropriate brain imaging and testing for other conditions that predispose venous thrombosis. In the setting of the SARS-CoV-2 pandemic, testing for COVID-19 may also be warranted. Rapid diagnosis and full anticoagulation can help avoid debilitating complications and long-term sequelae.


Subject(s)
COVID-19 , Cerebral Veins , Intracranial Thrombosis , Venous Thrombosis , Adult , COVID-19 Testing , Cerebral Veins/diagnostic imaging , Humans , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/drug therapy , Male , SARS-CoV-2 , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Young Adult
9.
J Speech Lang Hear Res ; 64(6): 2038-2046, 2021 06 04.
Article in English | MEDLINE | ID: covidwho-1263515

ABSTRACT

Purpose The use of technology (e.g., telehealth) in clinical settings has rapidly increased, and its use in research settings continues to grow. The aim of this report is to present one potential solution to a clinical issue that of virtual and remote assessment for the purposes of spoken language research in persons with aphasia (PWA). To do so, we report detailed methods for conducting a multitimepoint (test-retest) virtual paradigm, assessing lifestyle, physiological, cognitive, and linguistic factors in persons with and without aphasia. Method Procedures for virtual assessment are detailed in a sample of adults with no brain damage (N = 24) and PWA (N = 25) on a test-retest paradigm (data collection approximately 10 ± 3 days apart). This report provides practical information about pre-assessment (e.g., recruitment, scheduling), assessment (e.g., aphasia-friendly consent presentation, investigator fidelity), and postassessment (e.g., data storage, quality check) procedures for human behavior research using a virtual platform. Results Preliminary study data are provided, indicating high retention rates, high rates of data acquisition, and feasibility. Common technological troubles and solutions are discussed, and solutions are offered. The results suggest that our pre-assessment, assessment, and postassessment procedures contributed to the success of our study. Conclusions We provide a practical methodology for conducting a multitimepoint study, with considerations for PWA, adding to the body of research on telehealth in clinical populations. Future studies should continue to evaluate telemethodology, which may be core for diversifying studies, improving study retention, and enrolling larger sample sizes. Supplemental Material https://doi.org/10.23641/asha.14608101.


Subject(s)
Aphasia , Brain Injuries , Adult , Humans , Linguistics
10.
Am J Health Promot ; 36(1): 21-28, 2022 01.
Article in English | MEDLINE | ID: covidwho-1261247

ABSTRACT

PURPOSE: To determine whether perceived changes (i.e. perception of engagement during the pandemic relative to pre-pandemic) in specific health behaviors differ by weight status (i.e. healthy weight, overweight, obese). DESIGN: Cross-sectional. Recruitment took place between June-August 2020, via social media posts and Qualtrics online panels. SETTING: Participants completed the survey online through the Qualtrics platform. SAMPLE: Analyses included N = 502 participants (≥18 years); 45.2% healthy weight (n = 227), 28.5% overweight (n = 143), and 26.3% obese (n = 132). MEASURES: Study-specific survey items included questions about demographics and perceived changes in health behaviors. ANALYSIS: Logistic regression models, adjusted for age, race, ethnicity, gender, education, and COVID-19 diagnosis, assessed the odds of perceiving changes in health behaviors considered a risk for weight gain. RESULTS: Participants with obesity, but not overweight, were significantly more likely to report deleterious changes to health behaviors compared to healthy weight peers, including: (1) decreased fruit/vegetable consumption [adjusted odds ratio (AOR) = 1.92; 95% confidence interval (CI): (1.13, 3.26)]; (2) increased processed food consumption [AOR = 1.85; 95%CI: (1.15, 3.00)]; (3) increased caloric intake [AOR = 1.66; 95% CI: (1.06, 2.61)]; (4) decreased physical activity [AOR = 2.07; 95%CI: (1.31, 3.28)]; and (5) deterioration in sleep quality [AOR = 2.07; 95%CI: (1.32, 3.25)]. CONCLUSION: Our findings suggest that adults with obesity may be at greater risk for unhealthy behaviors during a period of prolonged social distancing, potentially exacerbating the obesity epidemic.


Subject(s)
COVID-19 , COVID-19 Testing , Cross-Sectional Studies , Health Behavior , Humans , Pandemics , SARS-CoV-2 , Weight Gain
11.
Nutr Cancer ; 74(2): 450-462, 2022.
Article in English | MEDLINE | ID: covidwho-1254176

ABSTRACT

Cancer is making patients vulnerable to diseases by impairing immunity directly or by anticancer therapy. In COVID-19 era, it is mandatory to face cancer with more organized & prompter response. Nutrition plays an important role in prevention & management of cancer patients. The objective of this study is to understand the role of nutrition in cancer patients during Corvid 19 era. We conducted literature searches till May 2020, electronic databases, evidence-based collections, relevant websites and trial registries about SARS-CoV2/COVID-19 and nutrition in cancer patients. Search generated 836 sources; 83/836 sources were relevant. This review summarized role of nutrition in predisposition, prevention and management of COVID-19 in cancer patient and role of vitamins, mineral supplements and microbiota in era of COVID-19. In this review, implementing appropriate nutritional care with vitamins or mineral supplementation & their effect on outcome remain largely unknown. COVID co-infection with cancer whether under chemotherapy or not have worse outcome especially in male adults. Findings may help in creating recommendations on nutritional protocol of management & prevention of complications during ongoing COVID-19 pandemic for all cancer patients.


Subject(s)
COVID-19 , Neoplasms , Adult , Humans , Male , Neoplasms/complications , Pandemics , RNA, Viral , SARS-CoV-2
12.
Rev Esp Quimioter ; 34(4): 342-352, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1235030

ABSTRACT

OBJECTIVE: Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. METHODS: This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. RESULTS: One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. CONCLUSIONS: Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Aged , Aged, 80 and over , COVID-19/drug therapy , Cohort Studies , Comorbidity , Critical Care , Female , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Respiration, Artificial/statistics & numerical data , Spain , Survival Analysis , Treatment Outcome
13.
Birth ; 48(4): 470-479, 2021 12.
Article in English | MEDLINE | ID: covidwho-1234217

ABSTRACT

BACKGROUND: Few studies have evaluated whether pandemic-related stressors, worries, and social distancing have affected the mental health of pregnant women during the COVID-19 pandemic. METHODS: Data came from an online survey of United States pregnant women (n = 715), conducted in May 2020. The Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder Scale were used to assess depressive symptoms, thoughts of self-harm, and moderate or severe anxiety. Multiple logistic regressions were used to examine the associations of COVID-19 experiences with mental health outcomes. RESULTS: Participants were racially diverse. The prevalence of adverse mental health outcomes was 36% for probable depression, 20% for thoughts of self-harm, and 22% for anxiety. Women who reported family members dying from COVID-19 had four times higher odds of having thoughts of self-harm than women who did not experience family death. Depression was more prevalent among women who canceled or reduced medical appointments. Women were more likely to have worse mental health outcomes if they expressed worry about getting financial or emotional/social support, about their pregnancy, or about family or friends. Strict social distancing was positively associated with depression. A higher proportion of adults working from home was inversely associated with depression and thoughts of self-harm. CONCLUSION: High percentages of pregnant women had symptoms of depression or anxiety, suggesting an urgent need to screen and treat mental health conditions among pregnant women during the pandemic. Pandemic-related risks and protective factors are relevant to developing tailored interventions to address the mental health of pregnant women during pandemic circumstances.


Subject(s)
COVID-19 , Mental Health , Adult , Anxiety/epidemiology , Depression/epidemiology , Female , Humans , Pandemics , Pregnancy , Pregnant Women , SARS-CoV-2 , United States/epidemiology
14.
Clin Infect Dis ; 73(11): 2055-2064, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1233845

ABSTRACT

BACKGROUND: Emerging evidence suggests many people have persistent symptoms after acute coronavirus disease 2019 (COVID-19) illness. Our objective was to estimate the prevalence and correlates of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC). METHODS: We used a population-based probability survey of adults with COVID-19 in Michigan. Living noninstitutionalized adults aged ≥18 in the Michigan Disease Surveillance System with COVID-19 onset through mid-April 2020 were eligible for selection (N = 28 000). Among 2000 selected, 629 completed the survey between June-December 2020. We estimated PASC prevalence, defined as persistent symptoms ≥30 (30-day COVID-19) or ≥60 (60-day COVID-19) days post-COVID-19 onset, overall and by sociodemographic and clinical factors. We used modified Poisson regression to produce adjusted prevalence ratios (aPRs) for potential risk factors. RESULTS: The analytic sample (n = 593) was predominantly female (56.1%), aged ≥45 years (68.2%), and non-Hispanic White (46.3%) or Black (34.8%). Thirty- and 60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among nonhospitalized respondents (43.7% and 26.9%) and respondents reporting mild symptoms (29.2% and 24.5%). Respondents reporting very severe (vs mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 (aPR, 2.25; 95% CI, 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19 (aPR, 1.71; 95% CI: 1.02-2.88). Hospitalized (vs nonhospitalized) respondents had ~40% higher prevalence of both 30-day (aPR, 1.37; 95% CI: 1.12-1.69) and 60-day (aPR, 1.40; 95% CI: 1.02-1.93) COVID-19. CONCLUSIONS: PASC is highly prevalent among cases reporting severe initial symptoms and, to a lesser extent, cases reporting mild and moderate symptoms.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Disease Progression , Female , Hospitalization , Humans , Prevalence
15.
Rheumatology (Oxford) ; 60(12): 5527-5537, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1231045

ABSTRACT

OBJECTIVES: Acute respiratory distress syndrome and cytokine release syndrome are the major complications of coronavirus disease 2019 (COVID-19) associated with increased mortality risk. We performed a meta-analysis to assess the efficacy and safety of anakinra in adult hospitalized non-intubated patients with COVID-19. METHODS: Relevant trials were identified by searching literature until 24 April 2021 using the following terms: anakinra, IL-1, coronavirus, COVID-19, SARS-CoV-2. Trials evaluating the effect of anakinra on the need for invasive mechanical ventilation and mortality in hospitalized non-intubated patients with COVID-19 were included. RESULTS: Nine studies (n = 1119) were eligible for inclusion in the present meta-analysis. Their bias risk with reference to the assessed parameters was high. In pooled analyses, anakinra reduced the need for invasive mechanical ventilation (odds ratio (OR): 0.38, 95% CI: 0.17-0.85, P = 0.02, I2 = 67%; six studies, n = 587) and mortality risk (OR: 0.32, 95% CI: 0.23-0.45, P < 0.00001, I2 = 0%; nine studies, n = 1119) compared with standard of care therapy. There were no differences regarding the risk of adverse events, including liver dysfunction (OR: 0.75, 95% CI: 0.48-1.16, P > 0.05, I2 = 28%; five studies, n = 591) and bacteraemia (OR: 1.07, 95% CI: 0.42-2.73, P > 0.05, I2 = 71%; six studies, n = 727). CONCLUSIONS: Available evidence shows that treatment with anakinra reduces both the need for invasive mechanical ventilation and mortality risk of hospitalized non-intubated patients with COVID-19 without increasing the risk of adverse events. Confirmation of efficacy and safety requires randomized placebo-controlled trials.


Subject(s)
COVID-19/drug therapy , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Receptors, Interleukin-1/antagonists & inhibitors , Humans , Treatment Outcome
16.
Pers Individ Dif ; 180: 110994, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1230703

ABSTRACT

The current research sought to shed light on the behavioral science that underlies the spread of SARS-CoV-2. We tested the extraversion hypothesis, which suggests that the sociability facet of extraversion may predispose people to becoming infected with the coronavirus via greater human-to-human contact. Since extraverts seek out social opportunities and seem less likely to follow containment measures related to social distancing, we hypothesized that people who have previously become infected would exhibit greater extraversion than would those who have not contracted the virus. We measured overall extraversion and three of its facets-sociability, assertiveness, and energy levels-as well as political orientation. We collected data from 217 adults, aged 40 and older, from the US and the UK, of whom 53 had had the virus at some point prior to the study, and 164 had not. Participants who had had COVID-19 were more dispositionally sociable and were also more conservative-leaning compared to participants who had never had COVID-19. Implications regarding the behavioral science underlying the current pandemic are discussed.

17.
J Clin Immunol ; 41(6): 1146-1153, 2021 08.
Article in English | MEDLINE | ID: covidwho-1226229

ABSTRACT

Immunocompromised patients, including those with inborn errors of immunity (IEI), may be at increased risk for severe or prolonged infections with SARS-CoV-2 (Zhu et al. N Engl J Med. 382:727-33, 2020; Guan et al. 2020; Minotti et al. J Infect. 81:e61-6, 2020). While antibody and T cell responses to SARS-CoV-2 structural proteins are well described in healthy convalescent donors, adaptive humoral and cellular immunity has not yet been characterized in patients with antibody deficiency (Grifoni et al. Cell. 181:1489-1501 e1415, 2020; Burbelo et al. 2020; Long et al. Nat Med. 26:845-8, 2020; Braun et al. 2020). Herein, we describe the clinical course, antibody, and T cell responses to SARS-CoV-2 structural proteins in a cohort of adult and pediatric patients with antibody deficiencies (n = 5) and controls (related and unrelated) infected with SARS-CoV-2. Five patients within the same family (3 with antibody deficiency, 2 immunocompetent controls) showed antibody responses to nucleocapsid and spike proteins, as well as SARS-CoV-2 specific T cell immunity at days 65-84 from onset of symptoms. No significant difference was identified between immunocompromised patients and controls. Two additional unrelated, adult patients with common variable immune deficiency were assessed. One did not show antibody response, but both demonstrated SARS-CoV-2-specific T cell immunity when evaluated 33 and 76 days, respectively, following SARS-CoV-2 diagnosis. This report is the first to show robust T cell activity and humoral immunity against SARS-CoV-2 structural proteins in some patients with antibody deficiency. Given the reliance on spike protein in most candidate vaccines (Folegatti et al. Lancet. 396:467-78, 2020; Jackson et al. N Engl J Med. 383:1920-31, 2020), the responses are encouraging. Additional studies will be needed to further define the timing of onset of immunity, longevity of the immune response, and variability of response in immunocompromised patients.


Subject(s)
Antibodies, Viral/blood , COVID-19/immunology , Common Variable Immunodeficiency/immunology , SARS-CoV-2/physiology , T-Lymphocytes/immunology , Adolescent , Adult , Carrier State , Cells, Cultured , Child , Female , Humans , Immunity, Humoral , Lymphocyte Activation , Male , Middle Aged , Mutation/genetics , Pedigree , Transmembrane Activator and CAML Interactor Protein/genetics , Whole Exome Sequencing , Young Adult
18.
J Pediatr Gastroenterol Nutr ; 72(6): 807-814, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1225639

ABSTRACT

OBJECTIVE: Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry. METHODS: In this multicenter observational cohort study, we collected data from 91 patients <21 years (LD 44, LT 47) with laboratory-confirmed SARS-CoV2 infection between April 21 and September 17, 2020. RESULTS: Patients with LD were more likely to require admission (70% vs 43% LT, P = 0.007) and pediatric intensive care unit (PICU) management (32% vs 4% LT, P = 0.001). Seven LD patients required mechanical ventilation (MV) and 2 patients died; no patients in the LT cohort died or required MV. Four LD patients presented in pediatric acute liver failure (PALF), 2 with concurrent multisystem inflammatory syndrome in children (MIS-C); all recovered without LT. Two LD patients had MIS-C alone and 1 patient died. Bivariable logistic-regression analysis found that patients with nonalcoholic fatty LD (NAFLD) (odds ratio [OR] 5.6, P = 0.02) and LD (OR 6.1, P = 0.01, vs LT) had higher odds of severe disease (PICU, vasopressor support, MV, renal replacement therapy or death). CONCLUSIONS: Although not directly comparable, LT recipients had lower odds of severe SARS-CoV2 infection (vs LD), despite immunosuppression burden. NAFLD patients reported to the registry had higher odds of severe SARS-CoV2 disease. Future controlled studies are needed to evaluate effective treatments and further stratify LD and LT patients with SARS-CoV2 infection.


Subject(s)
COVID-19 , Liver Diseases , Liver Transplantation , Adult , Child , Humans , RNA, Viral , Registries , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
19.
Front Public Health ; 9: 578366, 2021.
Article in English | MEDLINE | ID: covidwho-1221986

ABSTRACT

Background: In the wake of the worldwide spread of the novel coronavirus and the resultant restrictive measures, mental health has become a crucial issue. Physical health is not the only aspect of humans that is at risk. Globally, the rates and severity of mental illness are being significantly impacted by this pandemic. Two scales have been validated to measure the impact of coronavirus disease 2019 (COVID-19) on the levels of anxiety and obsessional thinking in clinical and non-clinical populations. The present study was designed to investigate the levels of anxiety and obsessions related to COVID-19 in the general public of Lahore, Pakistan. Materials and Methods: Data were collected via snowball sampling from May 9 to May 19. An online survey consisting of a demographic profile and two scales, Coronavirus Anxiety Scale (CAS) and Obsession with COVID-19 Scale (OCS), was sent through email, WhatsApp, and Facebook groups to adults (18 years and above) of Lahore, Pakistan. Results: A total of 240 individuals (20% men and 80% women) recorded their responses. The majority belonged to a nuclear family system (60%), and their education level ranged from high school to Ph.D. The cut-off score for probable dysfunctional coronavirus anxiety and obsession levels was not met within this sample (CAS, M = 3.24, SD = 4.21; OCS, M = 4.14, SD = 3.15), suggesting that the general population of Lahore, Pakistan is not suffering from dysfunctional anxiety or obsessions related to COVID-19. Forty-seven participants' score on OCS and 35 participants' scores on CAS were above the cut-off, i.e., ≥7 and ≥9, respectively. The results of the correlation analysis showed a significant positive relationship (** p < 0.619) between anxiety and obsessions related to COVID-19. Conclusion: One important, yet surprising, conclusion of this study is that the average adult in Lahore does not show much anxiety or obsessions related to COVID-19. Other studies around the world using these measurement tools have indicated significantly high levels of both anxiety and obsessions related to COVID-19. These findings may demonstrate the resilience of Pakistanis or perhaps the lack of understanding of the seriousness of the situation.


Subject(s)
COVID-19 , Adult , Depression , Female , Humans , Male , Pakistan/epidemiology , Pandemics , SARS-CoV-2
20.
J Nurse Pract ; 17(8): 946-949, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1220983

ABSTRACT

As the numbers of acute severe acute respiratory syndrome coronavirus 2 infections continue to rise, we are learning that symptoms do not resolve quickly in all patients. Although why some patients experience persistent symptoms is not clear, these individuals suffer. Long-hauler is the term that is associated with these persistent symptoms, and this review of the literature provides information to nurse practitioners working in primary care about symptoms, risk factors, and resources for disease management.

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