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1.
Cutis ; 106(6): 318-320, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: covidwho-1225960

RESUMEN

Varicella-zoster virus infection causes 2 distinct forms of disease: varicella (commonly known as chickenpox) and herpes zoster (HZ)(commonly known as shingles). Primary varicella-zoster virus infection results in the diffuse vesicular rash that is characteristic of chickenpox. Following primary infection, varicella-zoster virus remains dormant in the dorsal root ganglia. This latent phase usually lasts for several decades before reactivation occurs. Varicella-zoster virus reactivation normally presents as HZ in middle-aged adults. A number of cutaneous skin manifestations have appeared in relation to the newly diagnosed coronavirus disease 2019 (COVID-19) pandemic and continue to emerge every day. We report a case of HZ complication in a COVID-19-positive woman who was 27 weeks pregnant.


Asunto(s)
/complicaciones , Herpes Zóster/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , Activación Viral , Adulto , Femenino , Herpes Zóster/virología , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Embarazo
2.
Public Health Rep ; 136(3): 327-337, 2021 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1223668

RESUMEN

INTRODUCTION: Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia. METHODS: A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution. RESULTS: Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non-English-speaking groups. PRACTICAL IMPLICATIONS: This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.


Asunto(s)
/epidemiología , Recolección de Datos/métodos , Intervención basada en la Internet , Vigilancia en Salud Pública/métodos , Autoinforme , Evaluación de Síntomas , Adolescente , Adulto , Anciano , Región de los Apalaches/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Participación del Paciente , Adulto Joven
3.
BMJ Case Rep ; 14(5)2021 May 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1223562

RESUMEN

We describe the case of a 31-year-old man who presented with a 3-day history of right iliac fossa pain with associated nausea and vomiting. He denied any previous incidents of abdominal pain and had no relevant medical history or family history to note. Given the typical history, examination findings of localised peritonism and infection risk, he was taken to theatre for laparoscopic appendicectomy without diagnostic imaging. Intraoperatively, we noted gut malrotation and an inflammatory jejunal mass which was resected after converting to a mini-laparotomy. The inflammatory mass was reported to be an ectopic pancreatic tissue from histology. Given that this patient had tested positive for SARS-CoV-2 on admission, we propose a possible case of SARS-CoV-2 infection triggering inflammation of the ectopic pancreatic tissue.


Asunto(s)
Vólvulo Intestinal , Adulto , Humanos , Ilion , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/diagnóstico por imagen , Masculino , Páncreas/diagnóstico por imagen , Páncreas/cirugía
4.
Adv Exp Med Biol ; 1318: 469-483, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222730

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the novel coronavirus disease 2019 (COVID-19) pandemic, which spread throughout the world. Acute hypoxemic respiratory failure is the most dangerous complication of COVID-19 pneumonia. To date, no specific therapeutic drugs or vaccines have been proven efficacious. Ventilatory support is still a significant challenge for physicians facing COVID-19. The mechanisms underlying hypoxemia in those patients are not fully understood, but a new physiopathology model has been proposed. Oxygen therapy should be delivered to patients with mild to moderate hypoxemia. More severe patients could benefit from other treatments (high-flow nasal cannula, noninvasive ventilation or intubation, and invasive ventilation). Given the rapid evolution of COVID-19, there has been a paucity of the high-quality data that typically inform clinical practice guidelines from professional societies, and a worldwide consensus is still lacking. This chapter aims to illustrate the potentials of ventilatory support as therapeutic options for adult and pediatric patients affected by COVID-19 pneumonia.


Asunto(s)
Ventilación no Invasiva , Insuficiencia Respiratoria , Adulto , Niño , Humanos , Pandemias , Insuficiencia Respiratoria/terapia
5.
Adv Exp Med Biol ; 1318: 223-241, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222717

RESUMEN

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the etiological agent of coronavirus disease 2019 (COVID-19), is similar to two other coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), in causing life-threatening respiratory infections and systemic complications in both children and adults. As the COVID-19 pandemic has continued to spread globally, increasing numbers of pregnant women have become infected, raising concern not only for their health but also for the health of their infants. This chapter discusses the effects of coronavirus infections, e.g., MERS, SARS, and COVID 19, on pregnancy and describes the evolving knowledge of COVID 19 among pregnant women. The physiological changes that occur in pregnancy, especially changes in the immune system, are reviewed in terms of their effect on susceptibility to infectious diseases. The effects of COVID-19 on the placenta, fetus, and neonate are also reviewed, including potential clinical outcomes and issues relating to testing and diagnosis. The potential mechanisms of vertical transmission of the virus between pregnant women and their infants are analyzed, including intrauterine, intrapartum, and postpartum infections. Several recent studies have reported the detection of SARS-CoV-2 in tissues from the fetal side of the placenta, permitting the diagnosis of transplacental infection of the fetus by SARS-CoV-2. Placentas from infected mothers in which intrauterine transplacental transmission of SARS-CoV-2 has occurred demonstrate an unusual combination of pathology findings which may represent risk factors for placental as well as fetal infection.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Adulto , Niño , Femenino , Feto , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Pandemias , Placenta , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas
6.
Adv Exp Med Biol ; 1318: 197-208, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222715

RESUMEN

Viral respiratory tract infections are prevalent in children. They have substantial effects on childhood morbidity throughout the world, especially in developing countries. In this chapter, we describe the preliminary characteristics of pediatric COVID-19 and discover that severe and critical disease in children is rare. Many children remain asymptomatic. The reason why severity increases with progressing age and largely spares children is not yet known. In the search for possible explanations, we explore key differences between the pediatric and adult immune responses to new pathogens, and in host factors, such as ACE2 abundance.


Asunto(s)
Pediatría , Adulto , Niño , Humanos , Peptidil-Dipeptidasa A
8.
JAMA ; 325(15): 1535-1544, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: covidwho-1222577

RESUMEN

Importance: Control of the global COVID-19 pandemic will require the development and deployment of safe and effective vaccines. Objective: To evaluate the immunogenicity of the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) in humans, including the kinetics, magnitude, and phenotype of SARS-CoV-2 spike-specific humoral and cellular immune responses. Design, Setting, and Participants: Twenty-five participants were enrolled from July 29, 2020, to August 7, 2020, and the follow-up for this day 71 interim analysis was completed on October 3, 2020; follow-up to assess durability will continue for 2 years. This study was conducted at a single clinical site in Boston, Massachusetts, as part of a randomized, double-blind, placebo-controlled phase 1 clinical trial of Ad26.COV2.S. Interventions: Participants were randomized to receive 1 or 2 intramuscular injections with 5 × 1010 viral particles or 1 × 1011 viral particles of Ad26.COV2.S vaccine or placebo administered on day 1 and day 57 (5 participants in each group). Main Outcomes and Measures: Humoral immune responses included binding and neutralizing antibody responses at multiple time points following immunization. Cellular immune responses included immunospot-based and intracellular cytokine staining assays to measure T-cell responses. Results: Twenty-five participants were randomized (median age, 42; age range, 22-52; 52% women, 44% male, 4% undifferentiated), and all completed the trial through the day 71 interim end point. Binding and neutralizing antibodies emerged rapidly by day 8 after initial immunization in 90% and 25% of vaccine recipients, respectively. By day 57, binding and neutralizing antibodies were detected in 100% of vaccine recipients after a single immunization. On day 71, the geometric mean titers of spike-specific binding antibodies were 2432 to 5729 and the geometric mean titers of neutralizing antibodies were 242 to 449 in the vaccinated groups. A variety of antibody subclasses, Fc receptor binding properties, and antiviral functions were induced. CD4+ and CD8+ T-cell responses were induced. Conclusion and Relevance: In this phase 1 study, a single immunization with Ad26.COV2.S induced rapid binding and neutralization antibody responses as well as cellular immune responses. Two phase 3 clinical trials are currently underway to determine the efficacy of the Ad26.COV2.S vaccine. Trial Registration: ClinicalTrials.gov Identifier: NCT04436276.


Asunto(s)
Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , /prevención & control , Inmunidad Celular , Inmunogenicidad Vacunal , Adulto , /administración & dosificación , Método Doble Ciego , Femenino , Humanos , Inmunidad Humoral , Masculino , Persona de Mediana Edad , Potencia de la Vacuna , Adulto Joven
9.
Front Public Health ; 9: 578366, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1221986

RESUMEN

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.


Asunto(s)
Adulto , Depresión , Femenino , Humanos , Masculino , Pakistán/epidemiología , Pandemias
10.
J Med Internet Res ; 23(4): e27503, 2021 04 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1219469

RESUMEN

BACKGROUND: A decrease in the level of pulse oxygen saturation as measured by pulse oximetry (SpO2) is an indicator of hypoxemia that may occur in various respiratory diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and COVID-19. Currently, no mass-market wrist-worn SpO2 monitor meets the medical standards for pulse oximeters. OBJECTIVE: The main objective of this monocentric and prospective clinical study with single-blind analysis was to test and validate the accuracy of the reflective pulse oximeter function of the Withings ScanWatch to measure SpO2 levels at different stages of hypoxia. The secondary objective was to confirm the safety of this device when used as intended. METHODS: To achieve these objectives, we included 14 healthy participants aged 23-39 years in the study, and we induced several stable plateaus of arterial oxygen saturation (SaO2) ranging from 100%-70% to mimic nonhypoxic conditions and then mild, moderate, and severe hypoxic conditions. We measured the SpO2 level with a Withings ScanWatch on each participant's wrist and the SaO2 from blood samples with a co-oximeter, the ABL90 hemoximeter (Radiometer Medical ApS). RESULTS: After removal of the inconclusive measurements, we obtained 275 and 244 conclusive measurements with the two ScanWatches on the participants' right and left wrists, respectively, evenly distributed among the 3 predetermined SpO2 groups: SpO2≤80%, 80%

Asunto(s)
/sangre , Hipoxia/sangre , Hipoxia/complicaciones , Oximetría/normas , Muñeca , Adulto , Femenino , Voluntarios Sanos , Humanos , Enfermedades Pulmonares/sangre , Enfermedades Pulmonares/complicaciones , Masculino , Monitoreo Fisiológico , Oximetría/efectos adversos , Oxígeno/sangre , Estudios Prospectivos , Método Simple Ciego , Adulto Joven
11.
BMC Endocr Disord ; 21(1): 97, 2021 May 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1219368

RESUMEN

AIMS: Hyperuricemia has attracted increasing attention. However, limited concern has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in patients with COVID-19. Therefore, we aim to explore whether patients with COVID-19 had SUA lower than normal and the relationship of SUA and the severity of COVID-19. METHODS: This was a case-control study based on 91 cases with COVID-19 and 273 age- and sex-matched healthy control subjects. We first compared SUA levels and uric acid/creatinine (UA/Cr) ratio between patients with COVID-19 and the healthy controls. Then, we examined the association of SUA levels and UA/Cr ratios with COVID-19 severity in COVID-19 cases only, defined according to the fifth edition of China's Diagnosis and Treatment Guidelines of COVID-19. RESULTS: SUA levels in patients with COVID-19 were 2.59% lower, UA/Cr ratios 6.06% lower at admission compared with healthy controls. In sex stratified analysis, levels of SUA and UA/Cr were lower in male patients with COVID-19 while only level of SUA was lower in female patients with COVID-19. Moreover, SUA and UA/Cr values were 4.27 and 8.23% lower in the severe group than that in the moderate group among male COVID-19 patients. Bivariate and partial correlations analysis showed negative correlations between SUA or UA/Cr ratio and COVID-19 after adjusting for age, sex, BMI and eGFR. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent risk factors associated with lower SUA levels. Male patients with COVID-19 accompanied by low SUA levels had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11, 14.72) at admission. Comparing SUA and UA/Cr ratio at three time points (admission, discharge, and follow-up), we found that male patients experienced severe symptoms had lower SUA and UA/Cr ratio levels comparing to moderate patients, but no significant difference between three time points. On the contrary, female patients had lower SUA and UA/Cr ratio at discharge than those at admission, but no significant difference of SUA and UA/Cr ratio between moderate and severe group. CONCLUSION: Patients with COVID-19 had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher crude risk of developing severe symptoms than those with high SUA levels. During disease aggravation, the level of SUA gradually decreased until discharge. At the follow-up exam, the level of SUA was similar to the levels at admission.


Asunto(s)
/sangre , Ácido Úrico/sangre , Adulto , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales
12.
J Nurs Adm ; 51(3): 156-161, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1219129

RESUMEN

OBJECTIVE: The purpose of this study was to test the effectiveness of a daylong resilience retreat on healthcare professionals' anxiety levels, intention to engage in mindfulness practices, and self-efficacy around mindfulness. BACKGROUND: Caregiver burnout is a concern that needs to be addressed at the organizational level so that professionals can reduce their risk of psychological injury while providing high-quality care. The COVID-19 (novel coronavirus) pandemic has exacerbated symptoms of burnout among nurses nationally. METHODS: Ten sessions of daylong resilience retreats were delivered to independent groups of nurses, nurse practitioners, and other healthcare professionals. Preretreat and postretreat assessments were completed using a 19-item survey developed by the research team to assess state anxiety, intention to engage in mindfulness practices, and self-efficacy around mindfulness. RESULTS: One hundred six healthcare professionals completed the resilience retreats. There was a statistically significant decrease in state anxiety scores following the retreat. The majority of the participants reported high intentions to engage in mindfulness practices and felt confident about incorporating mindfulness in their lives. CONCLUSIONS: Brief resilience retreats endorsed by nurse leadership can reduce perceived anxiety and facilitate engagement in contemplative practices, which are associated with a decrease in the risk of burnout.


Asunto(s)
Ansiedad/prevención & control , Agotamiento Profesional/psicología , /psicología , Atención Plena , Atención de Enfermería/psicología , Personal de Enfermería en Hospital/psicología , Adulto , Agotamiento Profesional/prevención & control , Femenino , Humanos , Liderazgo , Masculino , Persona de Mediana Edad , Enfermeras Administradoras/psicología , Pandemias , Resiliencia Psicológica , Estados Unidos
13.
Medicine (Baltimore) ; 100(4): e24524, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: covidwho-1218898

RESUMEN

ABSTRACT: This study aimed to evaluate the incidence of co-infection with different types of pathogens in patients with hypoxemic pneumonia due to coronavirus disease 2019 (COVID-19) in Reunion Island.This observational study using a prospectively collected database of hypoxemic pneumonia due to COVID-19 cases was conducted at Félix Guyon University Hospital in Reunion Island, France.Between 18 March 2020 and 15 April 2020, 156 patients were admitted to our hospital for COVID-19. A total of 36 patients had hypoxemic pneumonia (23.1%) due to COVID-19. Thirty of these cases (83.3%) were imported by travelers returning mainly from metropolitan France and Spain. Patients were screened for co-infection with other pathogens at admission: 31 (86.1%) by multiplex polymerase chain reaction (PCR) and 16 (44.4%) by cytobacteriological examination of sputum culture. Five patients (13.9%) were found to have co-infection: 1 with influenza virus A H1N1 (pdm09) associated with Branhamella catarrhalis, 1 with Streptococcus pneumoniae associated with Haemophilus influenzae, 1 with Human Coronavirus 229E, 1 with Rhinovirus, and 1 with methicillin-susceptible Staphylococcus aureus. Patients with co-infection had higher D-dimer levels than those without co-infection (1.36 [1.34-2.36] µg/mL vs 0.63 [0.51-1.12] µg/mL, P = .05).The incidence of co-infection in our cohort was higher than expected (13.9%). Three co-infections (with influenza virus A(H1N1) pdm09, Streptococcus pneumoniae, and Staphylococcus aureus) required specific treatment. Patients with hypoxemic pneumonia due to COVID-19 should be screened for co-infection using respiratory cultures or multiplex PCR. Whilst our study has a number of limitations, the results from our study suggest that in the absence of screening, patients should be commenced on treatment for co-infection in the presence of an elevated D-dimer.


Asunto(s)
/epidemiología , Coinfección/epidemiología , Neumonía/epidemiología , Neumonía/microbiología , Adulto , Femenino , Francia/epidemiología , Humanos , Hipoxia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
14.
JMIR Public Health Surveill ; 7(5): e27412, 2021 05 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1218859

RESUMEN

This article briefly describes Egypt's acute respiratory infection (ARI) epidemic preparedness and containment plan and illustrates the impact of implementation of the plan on combating the early stage of the COVID-19 epidemic in Egypt. Pillars of the plan include crisis management, enhancing surveillance systems and contact tracing, case and hospital management, raising community awareness, and quarantine and entry points. To identify the impact of the implementation of the plan on epidemic mitigation, a literature review was performed of studies published from Egypt in the early stage of the pandemic. In addition, data for patients with COVID-19 from February to July 2020 were obtained from the National Egyptian Surveillance system and studied to describe the situation in the early stage of the epidemic in Egypt. The lessons learned indicated that the single most important key to success in early-stage epidemic containment is the commitment of all partners to a predeveloped and agreed-upon preparedness plan. This information could be useful for other countries in the region and worldwide in mitigating future anticipated ARI epidemics and pandemics. Postepidemic evaluation is needed to better assess Egypt's national response to the COVID-19 epidemic.


Asunto(s)
/epidemiología , Pandemias/prevención & control , Infecciones del Sistema Respiratorio/prevención & control , Enfermedad Aguda , Adolescente , Adulto , Anciano , Niño , Preescolar , Trazado de Contacto , Egipto/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Vigilancia en Salud Pública , Cuarentena , Adulto Joven
15.
MMWR Morb Mortal Wkly Rep ; 70(18): 685-688, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1218746

RESUMEN

On April 7, 2021, after 5 weeks' use of the Janssen COVID-19 vaccine under the Food and Drug Administration (FDA) Emergency Use Authorization (EUA), CDC received reports of clusters of anxiety-related events after administration of Janssen COVID-19 vaccine from five mass vaccination sites, all in different states. To further investigate these cases, CDC interviewed vaccination site staff members to gather additional information about the reported events and vaccination site practices. Four of the five sites temporarily closed while an investigation took place. Overall, 64 anxiety-related events, including 17 reports of syncope (fainting), an anxiety-related event, among 8,624 Janssen COVID-19 vaccine recipients, were reported from these sites for vaccines administered during April 7-9. As a follow-up to these interviews, CDC analyzed reports of syncope shortly after receipt of Janssen COVID-19 vaccine to the Vaccine Adverse Event Reporting System (VAERS), the vaccine safety monitoring program managed by CDC and FDA. To compare the occurrence of these events with those reported after receipt of other vaccines, reports of syncopal events after influenza vaccine administered in the 2019-20 influenza season were also reviewed. Syncope after Janssen COVID-19 vaccination was reported to VAERS (8.2 episodes per 100,000 doses). By comparison, after influenza vaccination, the reporting rate of syncope was 0.05 episodes per 100,000 doses. Anxiety-related events can occur after any vaccination. It is important that vaccination providers are aware that anxiety-related adverse events might be reported more frequently after receipt of the Janssen COVID-19 vaccine than after influenza vaccination and observe all COVID-19 vaccine recipients for any adverse reactions for at least 15 minutes after vaccine administration.


Asunto(s)
Ansiedad/complicaciones , Vacunación Masiva/psicología , Síncope/epidemiología , Adolescente , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
16.
MMWR Morb Mortal Wkly Rep ; 70(18): 680-684, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1218745

RESUMEN

On February 27, 2021, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Janssen (Ad.26.COV2.S) COVID-19 vaccine (Janssen Biotech, Inc., a Janssen Pharmaceutical company, Johnson & Johnson) (1). The Janssen COVID-19 vaccine, the third COVID-19 vaccine authorized for use in the United States, uses a replication-incompetent human adenoviral type 26 vector platform* (2) and is administered as a single intramuscular dose, whereas the first two authorized vaccines use an mRNA platform and require 2 doses. On February 28, 2021, the Advisory Committee on Immunization Practices (ACIP) issued interim recommendations for use of Janssen COVID-19 vaccine among persons aged ≥18 years (3). During April 13-23, CDC and FDA recommended a pause in use of Janssen vaccine after reports of six cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia (platelet count <150,000/µL of blood) among Janssen vaccine recipients (4). Similar thrombotic events, primarily among women aged <60 years, have been described in Europe after receipt of the AstraZeneca COVID-19 vaccine, which uses a replication-incompetent chimpanzee adenoviral vector (5-7). The U.S. CVST cases that prompted the pause in Janssen vaccination, as well as subsequently detected CVST cases, are described elsewhere (8). This report summarizes adverse events among Janssen vaccine recipients, including non-CVST cases of thrombosis with thrombocytopenia syndrome (TTS), reported to the Vaccine Adverse Events Reporting System (VAERS), a passive surveillance system, and through v-safe, an active monitoring system. As of April 21, 2021, 7.98 million doses of the Janssen COVID-19 vaccine had been administered. Among 13,725 VAERS reports reviewed, 97% were classified as nonserious and 3% as serious,† including three reports among women of cases of thrombosis in large arteries or veins accompanied by thrombocytopenia during the second week after vaccination. These three cases and the previously detected CVST cases are consistent with 17 cases of TTS,§ a newly defined condition. Approximately 338,700 Janssen COVID-19 vaccine recipients completed at least one v-safe survey during the week after vaccination; 76% reported a systemic reaction, 61% reported a local reaction, and 34% reported a health impact.¶ Fatigue and pain were commonly reported symptoms in both VAERS and v-safe. The overall safety profile is consistent with preauthorization clinical trials data. Prompt review of U.S. vaccine safety data detected three additional cases of non-CVST TTS, in addition to the previously recognized CVST cases that initiated the pause in use of the Janssen COVID-19 vaccine. Ongoing monitoring of adverse events after COVID-19 vaccination, including vaccination with the Janssen single-dose vaccine, is essential for evaluating the risks and benefits of each vaccine.


Asunto(s)
/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Vigilancia de Productos Comercializados , Adolescente , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Anciano de 80 o más Años , Centers for Disease Control and Prevention, U.S. , Niño , Preescolar , Aprobación de Drogas , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Medición de Riesgo , Retirada de Medicamento por Seguridad , Trombosis de los Senos Intracraneales/epidemiología , Estados Unidos/epidemiología , United States Food and Drug Administration , Adulto Joven
17.
JMIR Mhealth Uhealth ; 9(5): e25895, 2021 05 06.
Artículo en Inglés | MEDLINE | ID: covidwho-1218467

RESUMEN

BACKGROUND: Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. OBJECTIVE: This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. METHODS: Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. RESULTS: Patients' median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. CONCLUSIONS: In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796.


Asunto(s)
Quemadura Solar , Adolescente , Adulto , Conductas Relacionadas con la Salud , Humanos , Pandemias , Estudios Prospectivos , Quemadura Solar/tratamiento farmacológico , Quemadura Solar/epidemiología , Quemadura Solar/prevención & control , Protectores Solares/uso terapéutico , Rayos Ultravioleta/efectos adversos , Estados Unidos , Adulto Joven
18.
Medicine (Baltimore) ; 100(15): e25290, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1217990

RESUMEN

ABSTRACT: Health care employees are the front liners whom are directly involved in the management of COVID-19 at high risk of developing psychological distress and other mental health illness. We aim to assess the burden of depression during this pandemic on health care employees treating COVID-19 in Saudi Arabia. We also will shed the light on the best solutions of how to encounter depression.A cross-sectional, hospital-based survey conducted via a region-stratified, 2-stage cluster sample was conducted for 554 participants in >15 hospitals from April 29, 2020, to June 30, 2020. Depression is measured using the established PHQ9 score system. We grade PHQ9 depression scores as: normal, 0 to 4, mild, 5 to 9, significant (moderate or severe), 10 to 27. χ2/Fisher exact test was used; significant association between level of depression and survey characteristics were made. P value <0.05 was considered statistically significant.A total of 554 participants completed the survey. A total of 18.9% (n = 105) were aged <29 years, 51.2% (n = 284) were between 30 to 39 years and female represent 70% of all participants. Of all participants, 53.7% (n = 298) were nurses, and 38.6% (n = 214) were physicians; 68.5% (n = 380) worked in central area hospitals in Saudi Arabia. No significant (P = .432, 95% confidence interval [CI]) association was observed between sex and depression classifications. However, female had high proportion of significant depression 75.0% (n = 76) was observed as compared to male 24.8% (n = 25). Depression was significant in Saudis 61.4% (n = 62) (P < .001, 95% CI) and medical staff who encountered corona patients 51.5% (n = 52) (P < .002, 95% CI). Hospital preparedness associated with more freedom of depression symptoms 69.1% (n = 199/288) (P < .001, 95% CI).Frontline young health care workers especially physician in Saudi Arabia reported a high rate of depression symptoms. Countermeasures for health care workers represent a key component for the mental and physical well-being as part of public health measures during this pandemic. Attention to hospital preparedness and adequacy of personal protective equipment contributed to milder depression symptoms. Further studies need to be conducted on crisis management and depression.


Asunto(s)
Ansiedad , Depresión , Personal de Salud , Control de Infecciones , Estrés Laboral , Adulto , Ansiedad/diagnóstico , Ansiedad/etiología , Ansiedad/prevención & control , /psicología , Estudios Transversales , Depresión/diagnóstico , Depresión/etiología , Depresión/prevención & control , Femenino , Personal de Salud/clasificación , Personal de Salud/psicología , Médicos Hospitalarios/psicología , Médicos Hospitalarios/estadística & datos numéricos , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Control de Infecciones/normas , Masculino , Salud Mental/estadística & datos numéricos , Salud Laboral/normas , Estrés Laboral/prevención & control , Estrés Laboral/psicología , Equipo de Protección Personal/provisión & distribución , Arabia Saudita/epidemiología
19.
J Healthc Qual ; 43(3): 137-144, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1217965

RESUMEN

ABSTRACT: The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March-May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March-July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.


Asunto(s)
/epidemiología , Enfermedad Iatrogénica/epidemiología , Úlcera por Presión/epidemiología , Centros Médicos Académicos , Adulto , Anciano , Femenino , Hospitales Urbanos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sudeste de Estados Unidos/epidemiología
20.
Virol Sin ; 35(6): 820-829, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: covidwho-1217486

RESUMEN

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly around the world, posing a major threat to human health and the economy. Currently, long-term data on viral shedding and the serum antibody responses in COVID-19 patients are still limited. Herein, we report the clinical features, viral RNA loads, and serum antibody levels in a cohort of 112 COVID-19 patients admitted to the Honghu People's Hospital, Hubei Province, China. Overall, 5.36% (6/112) of patients showed persistent viral RNA shedding (> 45 days). The peak viral load was higher in the severe disease group than in the mild group (median cycle threshold value, 36.4 versus 31.5; P = 0.002). For most patients the disappearance of IgM antibodies occurred approximately 4-6 weeks after symptoms onset, while IgG persisted for over 194 days after the onset of symptoms, although patients showed a 46% reduction in antibodies titres against SARS-CoV-2 nucleocapsid protein compared with the acute phase. We also studied 18 asymptomatic individuals with RT-qPCR confirmed SARS-CoV-2 infection together with 17 symptomatic patients, and the asymptomatic individuals were the close contacts of these symptomatic cases. Delayed IgG seroconversion and lower IgM seropositive rates were observed in asymptomatic individuals. These data indicate that higher viral loads and stronger antibody responses are related to more severe disease status in patients with SARS-CoV-2 infection, and the antibodies persisted in the recovered patient for more than 6 months so that the vaccine may provide protection against SARS-CoV-2 infection.


Asunto(s)
Anticuerpos Antivirales/inmunología , /inmunología , Adulto , Anciano , Anticuerpos Antivirales/sangre , Formación de Anticuerpos , /virología , China/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Cinética , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Carga Viral , Esparcimiento de Virus
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