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1.
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
2.
BMJ Case Rep ; 14(5)2021 May 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1223565

RESUMEN

Teprotumumab (Tepezza), an insulin-like growth factor type 1 receptor antagonist, was approved for treatment of thyroid eye disease in 2020. Teprotumumab is administered intravenously every 3 weeks for a total of eight doses. Common side effects include nausea, diarrhoea, muscle spasms, hearing impairment, dysgeusia, headaches, dry skin, infusion reactions and hyperglycaemia. We report here a 76-year-old man with Graves-related thyroid eye disease who developed a rapidly progressive cognitive decline after receiving four out of eight doses of teprotumumab (cumulative dose 4620 mg). He was admitted for workup and teprotumumab infusions were discontinued. Intravenous glucocorticoids and immunoglobulin were given which showed no improvement in clinical symptoms. He subsequently underwent plasmapheresis with resolution of his symptoms, suggesting a teprotumumab-induced encephalopathy. Further studies involving larger populations and longer durations are needed.


Asunto(s)
Disfunción Cognitiva , Oftalmopatía de Graves , Anciano , Anticuerpos Monoclonales Humanizados , Oftalmopatía de Graves/tratamiento farmacológico , Humanos , Masculino
3.
Adv Exp Med Biol ; 1318: 937-964, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222756

RESUMEN

Netting individuals separated from each other by vast distances; the present condition of COVID-19 needs art and its extraordinary capacity to connect human beings and integrate scientific disciplines. We can predict that the COVID-19 pandemic would leave the mind lonely and vulnerable to diseases, for, on the one hand, the COVID-19 pandemic and related problems, in particular social isolation, are itself stressor. On the other hand, studies confirm the potential of COVID-19 to involve the central nervous system by affecting the immune system, either directly or indirectly. The COVID-19 condition, thus, calls for a necessary compensation of loneliness to reduce the psychological impact of the pandemic. Not only art can fulfill this purpose by meeting social affiliation needs, but also its related creativity is a definite achievement of the performer while acting as a motivation facilitator of creation for the observer. Besides, artworks that illustrate effective hygiene behaviors and physical distancing in an easy-to-understand manner could help health information systems to control the spread of COVID-19. The integration of art with biomedical science applied for simulation of the infected population, lung imaging data, and the viral surface has been useful for prediction of the spread of disease and earlier diagnosis of COVID-19 by imaging techniques and might be a contributor to drug discovery for COVID-19. Also, arts admirably influence the immunoemotional regulatory system so that not only would it enable humanity to tolerate quarantine but also enhance antiviral immunity. More interestingly, the effects of dance have been observed in children, elderly, healthcare workers, and pregnant women, which have been of special attention during the COVID-19 pandemic. In summary, arts provide us powerful tools for tolerating the quarantine time and enhancing the immune system, educating behavioral tips for hygiene practices and physical distancing and in psychosocial care of vulnerable populations during the pandemic.


Asunto(s)
Pandemias , Anciano , Niño , Femenino , Humanos , Pandemias/prevención & control , Embarazo , Cuarentena , Aislamiento Social
4.
Adv Exp Med Biol ; 1318: 549-573, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222734

RESUMEN

The history of vaccine development spans centuries. At first, whole pathogens were used as vaccine agents, either inactivated or attenuated, to reduce virulence in humans. Safety and tolerability were increased by including only specific proteins as antigens and using cell culture methods, while novel vaccine strategies, like nucleic acid- or vector-based vaccines, hold high promise for the future. Vaccines have generally not been employed as the primary tools in outbreak response, but this might change since advances in medical technology in the last decades have made the concept of developing vaccines against novel pathogens a realistic strategy. Wandering the uncharted territory of a novel pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we can learn from other human Betacoronaviridae that emerged in the last decades, SARS-CoV-1 and MERS-CoV. We can identify the most likely target structures of immunity, establish animal models that emulate human disease and immunity as closely as possible, and learn about complex mechanisms of immune interaction such as cross-reactivity or antibody-dependent enhancement (ADE). However, significant knowledge gaps remain. What are the correlates of protection? How do we best induce immunity in vulnerable populations like the elderly? Will the immunity induced by vaccination (or by natural infection) wane over time? To date, at least 149 vaccine candidates against SARS-CoV-2 are under development. At the time of writing, at least 17 candidates have already progressed past preclinical studies (in vitro models and in vivo animal experiments) into clinical development. This chapter will provide an overview of this rapidly developing field.


Asunto(s)
Coronavirus del Síndrome Respiratorio de Oriente Medio , Vacunas , Vacunas Virales , Anciano , Animales , Humanos
5.
Adv Exp Med Biol ; 1318: 209-222, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222716

RESUMEN

Since December 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has begun to infect people. The virus first occurred in Wuhan, China, but the whole world is now struggling with the pandemic. Over 13 million confirmed cases and 571,000 deaths have been reported so far, and this number is growing. Older people, who constitute a notable proportion of the world population, are at an increased risk of infection because of altered immunity and chronic comorbidities. Thus, appropriate health care is necessary to control fatalities and spread of the disease in this specific population. The chapter provides an overview of diagnostic methods, laboratory and imaging findings, clinical features, and management of COVID-19 in aged people. Possible mechanisms behind the behavior of SARS-CoV-2 in the elderly include immunosenescence and related impaired antiviral immunity, mature immunity and related hyper-inflammatory responses, comorbidities and their effects on the functioning of critical organs/systems, and the altered expression of angiotensin-converting enzyme 2 (ACE2) that acts as an entry receptor for SARS-CoV-2. This evidence defines the herding behavior of COVID-19 in relation to ACE2 under the influence of immune dysregulation. Then, identifying the immunogenetic factors that affect the disease susceptibility and severity and as well as key inflammatory pathways that have the potential to serve as therapeutic targets needs to remain an active area of research.


Asunto(s)
Geriatría , Anciano , Anciano de 80 o más Años , China , Humanos , Peptidil-Dipeptidasa A/genética
6.
Adv Exp Med Biol ; 1318: 119-147, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222711

RESUMEN

The novel coronavirus disease (COVID-19) profoundly influences T-cell immunity. The counts of total T cells and T-cell subsets, especially CD4+ and CD8+ T cells, are decreased in patients with COVID-19. Also, the function of these cells becomes less effective as the expression of immune inhibitory receptors, such as Tim3 and PD-1, increases over time during the disease. Kinetic analyses show that the T-cell profile changes dynamically, so does the COVID-19 stages. As COVID-19 continues to deteriorate and progresses to severe/critical condition, the lymphocyte count steadily decreases. Therefore, the ability of COVID-19 to escape the immune system might lie in its power to profoundly diminish T-cell effective function, which is necessary for the establishment of a robust antiviral immunity. Also, COVID-19 is associated with increased numbers of monocytes and macrophages, and as the disease progresses from a mild form to a severe/critical condition, the macrophage population becomes denser. Monitoring the expression of cytokines associated with macrophage activation, mainly interleukin (IL)-6 and IL-10, indicates that the course of COVID-19 consists of two stages and the transition between disease stages occurs by the end of the first week after onset of symptoms. At the initial stage, the immune military recognizes the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as nonself and thus fires macrophages at the lungs against the virus. The first flame can control disease progression effectively. However, a trained immunocompetent system would maintain the fire of macrophages over an extended time. It lies in its immune memory in tissue-resident macrophages, especially alveolar macrophages, making a professionally trained immune system more likely to be feared by COVID-19 than an untrained immune system. In this manner, the trained immunocompetent system commits such a failure that causes the lungs to come down rapidly. The fact that younger age groups, including neonates and children, are less susceptible to COVID-19 than older age groups reflects that the natural affinities of the immune system that has not been trained thoroughly would be standard in combatting against COVID-19 whereas the higher affinities of the trained immune system for rapid activation of immune responses might raise faults - the lungs come down.


Asunto(s)
Anciano , Linfocitos T CD8-positivos , Niño , Citocinas , Humanos , Recién Nacido , Macrófagos
7.
JAMA ; 325(15): 1525-1534, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: covidwho-1222575

RESUMEN

Importance: Little is known about long-term sequelae of COVID-19. Objective: To describe the consequences at 4 months in patients hospitalized for COVID-19. Design, Setting, and Participants: In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit. Exposures: Survival of hospitalization for COVID-19. Main Outcomes and Measures: Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography. Results: Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%). Conclusions and Relevance: Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.


Asunto(s)
/complicaciones , Hospitalización , Enfermedades Pulmonares/etiología , Pulmón/patología , Anciano , Ansiedad/etiología , Trastornos del Conocimiento/etiología , Estudios de Cohortes , Depresión/etiología , Disnea/etiología , Fatiga/etiología , Femenino , Estudios de Seguimiento , Humanos , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
9.
Front Public Health ; 9: 648360, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1221994

RESUMEN

The clinical spectrum of COVID-19 pneumonia is varied. Thus, it is important to identify risk factors at an early stage for predicting deterioration that require transferring the patients to ICU. A retrospective multicenter study was conducted on COVID-19 patients admitted to designated hospitals in China from Jan 17, 2020, to Feb 17, 2020. Clinical presentation, laboratory data, and quantitative CT parameters were also collected. The result showed that increasing risks of ICU admission were associated with age > 60 years (odds ratio [OR], 12.72; 95% confidence interval [CI], 2.42-24.61; P = 0.032), coexisting conditions (OR, 5.55; 95% CI, 1.59-19.38; P = 0.007) and CT derived total opacity percentage (TOP) (OR, 8.0; 95% CI, 1.45-39.29; P = 0.016). In conclusion, older age, coexisting conditions, larger TOP at the time of hospital admission are associated with ICU admission in patients with COVID-19 pneumonia. Early monitoring the progression of the disease and implementing appropriate therapies are warranted.


Asunto(s)
Anciano , China/epidemiología , Humanos , Unidades de Cuidados Intensivos , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(4): 562-566, 2021 Apr 20.
Artículo en Chino | MEDLINE | ID: covidwho-1220174

RESUMEN

OBJECTIVE: To investigate the necessity, safety and feasibility of painless fiberoptic bronchoscopy in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE: We retrospectively analyzed the clinical characteristics of 33 patients diagnosed with COVID-19 who received painless fiberoptic bronchoscopy in Wuhan First Hospital. The general demographic and clinical data of the patients including age, gender, and ASA classification were collected. The patients received intravenous anesthesia with topical airway anesthesia with lidocaine. The changes in the vital signs of the patients were recorded before, during and after the procedure. The cough intensity of the patients during bronchoscopy were evaluated, and the adverse reactions within 24 h after the procedure were observed. The health status of the medical staff carrying out the procedure was also monitored. OBJECTIVE: The 33 patients with ASA class Ⅱ to Ⅳ included 19 male and 14 female patients with an average age of 63.58±11.85 years. The lowest SpO2 of the patients during bronchoscopy was (94.8±4.3)%, which was significantly lower than that before the procedure [(99.1±1.3)%, P < 0.05] but was restored to more than 95% after such treatment as holding the jaw to open the airway or face mask positive-pressure ventilation. Bronchoscopy was completed successfully in all the patients, and 28 patients (84.85%) had mild cough during the procedure. None of the patients had obvious complications related to anesthesia. While performing the procedure, all the medical staff used third-level protection and facial protection with powered air-purifying respirators (PAPR), and the patients' face were covered with single-use sterile medical plastic curtains that were originally intended for collecting flushing fluid during arthroscopic procedures. No medical personnel was diagnosed with COVID-19 at the end of the study. OBJECTIVE: For patients with COVID-19, painless techniques can be valuable during bronchoscopy, and this procedure can be safe and feasible under third-level protection.


Asunto(s)
Broncoscopía , Anciano , Bronquios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
11.
Stud Health Technol Inform ; 279: 1-9, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1219878

RESUMEN

The benefits of eHealth interventions for people with dementia and their informal caregivers have been demonstrated in several studies. In times of contact restrictions, digital solutions have become increasingly important, especially for people with dementia and their mostly elderly caregiving relatives, which are at increased risk of severe illness from COVID-19. As in many other health areas, there is a lack of digital interventions in the dementia landscape that are successfully implemented (i.e., put into practice), especially digital interventions that are scientifically evaluated. Evaluated and proven effective digital interventions exist, but these often do not find their way from research into practice and stay on low-level implementation readiness. Within the project digiDEM Bayern, a digital platform with digital services and interventions for people affected by dementia (people with dementia, caregivers, volunteers and interested citizens) is established. As one digital intervention for informal caregivers, the 'Angehörigenampel' (caregivers' traffic-light) was developed, which is able to assess the physical and psychological burden of caregivers. This can help to counteract the health effects of caregiving burden early on before it is too late. The development of the digital intervention as a WordPress-plugin was kept generic so that it can easily be adapted to other languages on further websites. The 'intervention as a plugin' approach demonstrates an easy and flexible way of deploying eHealth interventions to other service providers, especially from other countries. The implementation barriers for other service providers are low enough for them to be able to easily integrate the eHealth intervention on their website, enabling more caregivers to benefit from the disseminated eHealth intervention.


Asunto(s)
Demencia , Telemedicina , Anciano , Cuidadores , Demencia/terapia , Humanos
12.
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
13.
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
14.
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
15.
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
16.
MMWR Morb Mortal Wkly Rep ; 70(18): 674-679, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1218744

RESUMEN

Adults aged ≥65 years are at increased risk for severe outcomes from COVID-19 and were identified as a priority group to receive the first COVID-19 vaccines approved for use under an Emergency Use Authorization (EUA) in the United States (1-3). In an evaluation at 24 hospitals in 14 states,* the effectiveness of partial or full vaccination† with Pfizer-BioNTech or Moderna vaccines against COVID-19-associated hospitalization was assessed among adults aged ≥65 years. Among 417 hospitalized adults aged ≥65 years (including 187 case-patients and 230 controls), the median age was 73 years, 48% were female, 73% were non-Hispanic White, 17% were non-Hispanic Black, 6% were Hispanic, and 4% lived in a long-term care facility. Adjusted vaccine effectiveness (VE) against COVID-19-associated hospitalization among adults aged ≥65 years was estimated to be 94% (95% confidence interval [CI] = 49%-99%) for full vaccination and 64% (95% CI = 28%-82%) for partial vaccination. These findings are consistent with efficacy determined from clinical trials in the subgroup of adults aged ≥65 years (4,5). This multisite U.S. evaluation under real-world conditions suggests that vaccination provided protection against COVID-19-associated hospitalization among adults aged ≥65 years. Vaccination is a critical tool for reducing severe COVID-19 in groups at high risk.


Asunto(s)
/administración & dosificación , Hospitalización/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Medición de Riesgo , Resultado del Tratamiento , Estados Unidos/epidemiología , Cobertura de Vacunación/estadística & datos numéricos , Vacunas Sintéticas
17.
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
18.
Dtsch Med Wochenschr ; 146(10): 671-676, 2021 05.
Artículo en Alemán | MEDLINE | ID: covidwho-1217717

RESUMEN

The COVID-19 pandemic poses new challenges for the healthcare systems world-wide which will go beyond prevention, acute and intensive care treatment of patients with severe illness. A large proportion of "COVID-survivors" - and not only elderly patients - suffers from "post-COVID-syndrome". Risk factors are preexisting somatic multimorbidity, cognitive and cerebral changes together with pneumonia and hypoxemia, intensive care treatment and confusional states during the acute phase of illness. Post-COVID cognitive deficits usually manifest as a frontal dysexecutive syndrome combined with fatigue and dysphoria and/or with attentional and memory deficits. Several pathogenetic mechanisms of COVID encephalopathy are understood, but no specific treatment strategies have been established so far. We assume that general practitioners, psychiatrists, neurologists and social workers will need to take care of the activation, reintegration and expert appraisals of patients with post-COVID fatigue and cognitive deficits during the years to come.


Asunto(s)
Disfunción Cognitiva , Anciano , /epidemiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Multimorbilidad , Pandemias , Factores de Riesgo
19.
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
20.
Unfallchirurg ; 124(5): 358-361, 2021 May.
Artículo en Alemán | MEDLINE | ID: covidwho-1217422

RESUMEN

The coronavirus disease 2019 (COVID-19) has spread rapidly worldwide and leads to high morbidity and mortality. Clinical experience regarding the surgical management in COVID-19 patients is limited. We report the interdisciplinary approach in a COVID-19 patient with severe thoracic trauma and pulmonary symptoms, who was admitted to the emergency unit after blunt chest trauma with dislocated serial rib fractures and concomitant hemothorax.


Asunto(s)
Fracturas de las Costillas , Traumatismos Torácicos , Heridas no Penetrantes , Anciano , Humanos , Fracturas de las Costillas/complicaciones , Fracturas de las Costillas/diagnóstico por imagen , Fracturas de las Costillas/cirugía , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/cirugía
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