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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.
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: 293-313, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1222720

RESUMEN

Novel coronavirus disease 2019 (COVID-19) has posed a crucial hazard to global health. The new species share similarities with the two previously emerged entities: severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) that have caused outbreaks in 2002 and 2012, respectively. Interestingly, all of these coronaviruses can cause potentially fatal respiratory syndromes, though behave differently in patients with cancer compared to patients without cancer. Accordingly, the present chapter aims to, through a systematic investigation, estimate the prevalence of cancer among COVID-19, SARS, and MERS confirmed cases. Our analysis based on data from 78 studies with SARS, MERS, and COVID-19 confirmed cases showed that the prevalence of cancer (4.94%) stands at fourth place after hypertension (20.8%), diabetes (11.39%), and cardiovascular diseases (7.46%). According to the findings of the present study, comorbidities are significantly more common in patients with MERS compared to patients with COVID-19 and SARS, and this was the cancer case as well. Further studies need to address whether or not patients with coronaviruses and cancer are different from patients with coronaviruses without cancer in terms of clinical manifestations, laboratory findings, outcomes, and men to women ratio.


Asunto(s)
Coronavirus del Síndrome Respiratorio de Oriente Medio , Neoplasias , Síndrome Respiratorio Agudo Grave , Femenino , Humanos , Masculino , Neoplasias/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología
6.
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
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
10.
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
11.
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
12.
Gut Microbes ; 13(1): 1-7, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1219896

RESUMEN

Mortality and morbidity from SARS-CoV2 (COVID-19) infections in children remains low, including an exceedingly low rate of horizontal and vertical transmission. However, unforeseen complications to childhood health have emerged secondary to the pandemic. Few studies to date have examined unintended complications of the pandemic in newborns and infants. In this Commentary, we discuss the impact that COVID-19 may have on inheritance of the newborn microbiome and its assembly throughout the first years of life. In the early stages of the pandemic when vertical transmission of COVID-19 was poorly understood, several studies reported increased rates of C-sections in COVID-19 positive women. Initial recommendations discouraged COVID-19 positive mothers from breastfeeding and participating in skin-to-skin care, advising them to isolate during their window of infectivity. These shifts in perinatal care can adversely impact microbial colonization during the first 1000 days of life. While obstetrical and neonatal management have evolved to reflect our current knowledge of perinatal transmission, we are observing other changes in early life exposures of infants, including increased attention to hygiene, fewer social interactions, and decreased global travel, all of which are major drivers of early-life gut colonization. Composition of the gut microbiota in adults directly impacts severity of infection, suggesting a role of microbial communities in modulating immune responses to COVID-19. Conversely, the role of the intestinal microbiome in susceptibility and severity of COVID-19 in newborns and children remains unknown. The onset of adulthood diseases is related to the establishment of a healthy gut microbiome during childhood. As we continue to define COVID-19 biology, further research is necessary to understand how acquisition of the neonatal microbiome is affected by the pandemic. Furthermore, infection control measures must be balanced with strategies that promote microbial diversity to impart optimal health outcomes and potentially modulate susceptibility of children to COVID-19.


Asunto(s)
/complicaciones , Microbioma Gastrointestinal/fisiología , Transmisión Vertical de Enfermedad Infecciosa , Microbiota/fisiología , Complicaciones Infecciosas del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo
13.
Ann Am Thorac Soc ; 18(5): 799-806, 2021 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1219727

RESUMEN

Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment.Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone.Methods: A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms.Results: At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, P < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, P = 0.014), with significant symptomatic and radiological improvement.Conclusions: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.


Asunto(s)
Cuidados Posteriores/métodos , Glucocorticoides/uso terapéutico , Enfermedades Pulmonares Intersticiales , Pulmón , Pruebas de Función Respiratoria/métodos , /mortalidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Pulmón/virología , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/fisiopatología , Enfermedades Pulmonares Intersticiales/terapia , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Sobrevivientes/estadística & datos numéricos , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Reino Unido/epidemiología
14.
Euro Surveill ; 26(18)2021 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1219630

RESUMEN

Despite social distancing measures implemented in Madrid to prevent the propagation of SARS-CoV-2, a significant increase (57.1%; 28.5 to 38.5 cases/month) in cases of lymphogranuloma venereum was detected during the COVID-19 pandemic. This unusual scenario might have accelerated a shift in Chlamydia trachomatis (CT) epidemiology towards a higher proportion of L genotypes compared with non-L genotypes in CT-positive samples. Our data underscore the importance of surveillance of sexually transmitted infections during the pandemic, in particular among vulnerable populations.


Asunto(s)
Linfogranuloma Venéreo , Chlamydia trachomatis/genética , Homosexualidad Masculina , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiología , Masculino , Pandemias , España/epidemiología
15.
J Med Internet Res ; 23(4): e26459, 2021 04 22.
Artículo en Inglés | MEDLINE | ID: covidwho-1219487

RESUMEN

BACKGROUND: The year 2020 was the year of the global COVID-19 pandemic. The severity of the situation has become so substantial that many or even most of the patients with mild to moderate symptoms had to self-isolate without specific medical treatments or even without being tested for COVID-19. Many patients joined internet membership groups to exchange information and support each other. OBJECTIVE: Our goal is to determine the benefits and limits of using social media to understand the symptoms of patients with suspected COVID-19 with mild to moderate symptoms and, in particular, their symptoms of anosmia (loss of the sense of smell) and ageusia (loss of the sense of taste). The voluntary reports on an internet website of a membership group will be the platform of the analyses. METHODS: Posts and comments of members of an internet group known as COVID-19 Smell and Taste Loss, founded on March 24, 2020, to support patients with suspected COVID-19 were collected and analyzed daily. Demographic data were collected using the software mechanism called Group Insights on the membership group website. RESULTS: Membership groups on social media have become rare sources of support for patients with suspected COVID-19 with mild to moderate symptoms. These groups provided mental support to their members and became resources for information on COVID-19 tests and medicines or supplements. However, the membership was voluntary, and often the members leave without notification. It is hard to be precise from the free voluntary reports. The number of women in the group (6995/9227, 75.38% as of October 12, 2020) was about three times more than men (2272/9227, 24.62% as of October 12, 2020), and the peak age of members was between 20-40 years in both men and women. Patients who were asymptomatic other than the senses comprised 14.93% (53/355) of the total patients. Recovery of the senses was higher in the patients who were asymptomatic besides having anosmia and ageusia. Most (112/123, 91.06%) patients experienced other symptoms first and then lost their senses, on average, 4.2 days later. Patients without other symptoms tended to recover earlier (P=.02). Patients with anosmia and ageusia occasionally reported distorted smell and taste (parosmia and dysgeusia) as well as experiencing or perceiving the smell and taste without the sources of the smell or taste (phantosmia and phantogeusia). CONCLUSIONS: Our analysis of the social media database of suspected COVID-19 patients' voices demonstrated that, although accurate diagnosis of patients is not always obtained with social media-based analyses, it may be a useful tool to collect a large amount of data on symptoms and the clinical course of worldwide rapidly growing infectious diseases.


Asunto(s)
Ageusia/virología , /fisiopatología , Femenino , Humanos , Masculino , Pandemias , Medios de Comunicación Sociales
16.
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
17.
BMJ Open Gastroenterol ; 8(1)2021 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1219408

RESUMEN

OBJECTIVES: Following the disruption of normal paediatric inflammatory bowel disease (IBD) services during the peak of the COVID-19 pandemic, we prospectively audited the first-time use of home faecal calprotectin testing. We aimed to provide an alternative to laboratory tests and to assess the value of home testing as part of our regular services going forward. METHODS: Home test kits as well as accompanying user instructions were made available to our patients with paediatric IBD that required faecal calprotectin test between 17 April and 12 August 2020. Once the user completed the test, results were automatically uploaded to the result portal and clinical staff were alerted. A user feedback questionnaire was sent to users that had completed the home test. RESULTS: Of the 54 patients, 41 (76%) aged between 4.7 and 18.1 years used the home test. A total of 45 home tests were done, one of which produced an invalid result. The decision to modify management was made in 12 (29%) of the patients, while 14 (34%) had no changes made and 15 (37%) required further assessment. Twenty (48.8%) responded to the questionnaire and 85% stated that they preferred the home test to the laboratory testing method. CONCLUSIONS: Home calprotectin tests were useful in guiding clinical management during a time when laboratory testing was less available. They may offer benefits as part of routine paediatric IBD monitoring to help target appointments and reduce unnecessary hospital attendances in the future.


Asunto(s)
/epidemiología , Heces/química , Enfermedades Inflamatorias del Intestino/terapia , Complejo de Antígeno L1 de Leucocito/análisis , Pandemias , Pruebas en el Punto de Atención , Adolescente , Biomarcadores/análisis , Niño , Preescolar , Pruebas de Química Clínica/estadística & datos numéricos , Retroalimentación , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Masculino , Portales del Paciente , Prioridad del Paciente/estadística & datos numéricos , Estudios Prospectivos , Juego de Reactivos para Diagnóstico/estadística & datos numéricos , Valores de Referencia , Encuestas y Cuestionarios
18.
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
19.
J Med Internet Res ; 23(4): e27832, 2021 04 22.
Artículo en Inglés | MEDLINE | ID: covidwho-1219328

RESUMEN

BACKGROUND: Communicating scientific uncertainty about public health threats such as COVID-19 is an ethically desirable task endorsed by expert guidelines on crisis communication. However, the communication of scientific uncertainty is challenging because of its potential to promote ambiguity aversion-a well-described syndrome of negative psychological responses consisting of heightened risk perceptions, emotional distress, and decision avoidance. Communication strategies that can inform the public about scientific uncertainty while mitigating ambiguity aversion are a critical unmet need. OBJECTIVE: This study aimed to evaluate whether an "uncertainty-normalizing" communication strategy-aimed at reinforcing the expected nature of scientific uncertainty about the COVID-19 pandemic-can reduce ambiguity aversion, and to compare its effectiveness to conventional public communication strategies aimed at promoting hope and prosocial values. METHODS: In an online factorial experiment conducted from May to June 2020, a national sample of 1497 US adults read one of five versions of an informational message describing the nature, transmission, prevention, and treatment of COVID-19; the versions varied in level of expressed scientific uncertainty and supplemental focus (ie, uncertainty-normalizing, hope-promoting, and prosocial). Participants then completed measures of cognitive, emotional, and behavioral manifestations of ambiguity aversion (ie, perceived likelihood of getting COVID-19, COVID-19 worry, and intentions for COVID-19 risk-reducing behaviors and vaccination). Analyses assessed (1) the extent to which communicating uncertainty produced ambiguity-averse psychological responses; (2) the comparative effectiveness of uncertainty-normalizing, hope-promoting, and prosocial communication strategies in reducing ambiguity-averse responses; and (3) potential moderators of the effects of alternative uncertainty communication strategies. RESULTS: The communication of scientific uncertainty about the COVID-19 pandemic increased perceived likelihood of getting COVID-19 and worry about COVID-19, consistent with ambiguity aversion. However, it did not affect intentions for risk-reducing behaviors or vaccination. The uncertainty-normalizing strategy reduced these aversive effects of communicating scientific uncertainty, resulting in levels of both perceived likelihood of getting COVID-19 and worry about COVID-19 that did not differ from the control message that did not communicate uncertainty. In contrast, the hope-promoting and prosocial strategies did not decrease ambiguity-averse responses to scientific uncertainty. Age and political affiliation, respectively, moderated the effects of uncertainty communication strategies on intentions for COVID-19 risk-reducing behaviors and worry about COVID-19. CONCLUSIONS: Communicating scientific uncertainty about the COVID-19 pandemic produces ambiguity-averse cognitive and emotional, but not behavioral, responses among the general public, and an uncertainty-normalizing communication strategy reduces these responses. Normalizing uncertainty may be an effective strategy for mitigating ambiguity aversion in crisis communication efforts. More research is needed to test uncertainty-normalizing communication strategies and to elucidate the factors that moderate their effectiveness.


Asunto(s)
/diagnóstico , Comunicación , Incertidumbre , Femenino , Humanos , Masculino , Pandemias , /aislamiento & purificación
20.
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
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