RESUMEN
Background: Pregnancy poses a risk factor for respiratory infections due to hormonal changes, reduced tolerance to hypoxia, immunodeficiency, and increased susceptibility towards viral infections. Pregnant women might develop a broad spectrum of clinical conditions associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, from asymptomatic to potentially life-threatening complications. Critical respiratory failure associated with the progression of viral pneumonia is the most severe complication of the coronavirus disease (COVID-19). In some cases, it may require intubation and invasive mechanical ventilation. Case series: In this case series, we evaluated the outcomes and clinical features of eight critically ill pregnant patients requiring invasive mechanical ventilation during treatment. The most commonly observed symptoms were fever at admission to the hospital, cough, difficulty breathing, and fatigue. Less frequently observed were sore throat and loss of smell and taste. All patients had anemia, and hypertension was the second most common comorbidity in pregnancy. Pregnant patients with lethal outcomes were older than those who recovered. They had higher body mass index values, more symptoms at admission, and higher C-reactive protein values and ferritin levels. Acute Respiratory Distress Syndrome (ARDS) was diagnosed in five cases, and none of these patients survived. Conclusion: Obesity, maternal age, and diagnosis of ARDS were most commonly observed in our group of patients with lethal outcomes. Preventive measurements, counseling, and enlightenment of potential risk factors, such as obesity, advanced maternal age, and pregnancy-related comorbidities, should be the cornerstones in crises such as COVID-19 when medical care and resources are limited or restricted. HIPPOKRATIA 2022, 26 (1):32-37.
RESUMEN
Background: With a prevalence of 1-3 cases per million, acquired haemophilia A (AHA) is a rare autoimmune bleeding disorder caused by the presence of neutralizing antibodies against factor VIII. Even though diagnosis of this bleeding disorder is rarely established among children and adolescents, AHA may lead to severe, life-threatening hemorrhage in this age group, and therefore it requires special caution. Case report: 19 year old primigravida with confirmed SARS-CoV-2 infection was admitted to hospital due to prolonged vaginal bleeding six weeks postpartum. All gynaecological causes of uterine bleeding were excluded, Foley catheter was placed, but the bleeding still persisted. Coagulation tests revealed isolated deranged aPTT values. Further haematology evaluation demonstrated factor VIII deficiency, presence of factor VIII inhibiting factors, and the diagnosis of AHA was proposed. The anti-inhibitor coagulant complex drug was introduced and patient has responded positively to the treatment. Conclusion(s): Due to disturbance of immune system, pregnancy and postpartum period represent predilection time for AHA development. Furthermore, viral infection in pregnancy, such as COVID-19, might be considered as an additional risk factor for AHA development and several reported cases of AHA after COVID-19 infection support this hypothesis. Even though AHA is a rare disease, due to its high mortality rate of more than 20%, it should be considered in all cases of unusual bleeding of unknown cause in all age groups. Publication of this case report is approved by Institutional Review Board.Copyright © 2023
RESUMEN
This study examines risk perceptions and evacuation planning for those residents affected by Hurricane Laura}the first major hurricane evacuation during the COVID-19 pandemic}and Hurricane Sally, prior to the wide-spread availability of vaccines. Research on hurricane evacuation behavior and risk perceptions during a pandemic is critical for quantifying the intersect of these compounding threats. Analyses captured how people perceive public shelters and whether evacuation choices changed in light of the pandemic. Many study participants considered themselves vulnerable to COVID-19 (39.4%), and two-thirds believed it would be “very serious” if they or their loved ones contracted COVID-19, but this had no impact on their actual evacuation decision-making. Approximately 75% of the sample stayed at home during Hurricanes Laura or Sally, and, of these, just over 80% indicated that COVID-19 was a somewhat important deciding factor. This reflects the partial role that COVID-19 played in balancing individual and household protective action decision-making during complex disasters, whereas 15.5% wanted to evacuate but waited until it was too late. For those who evacuated to a hotel, many found that staff and guests wore masks and socially distanced in common spaces. Of particular interest is that individuals have a continued negative perception of public shelters’ ability to safeguard against COVID-19 that was coupled with a significant decrease in the number of respondents that would potentially use shelters in 2020 as compared with before the COVID-19 pandemic. These results have informed and will inform future hazard mitigation planning during the current pandemic or future pandemics or infectious disease outbreaks. © 2022 American Meteorological Society.