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1.
Rev Soc Bras Med Trop ; 55: e06152021, 2022.
Article in English | MEDLINE | ID: covidwho-1963139

ABSTRACT

BACKGROUND: Coronavirus disease-2019 (COVID-19) results in acute lung injury. This study examined the usefulness of serum transforming growth factor-beta 1 (TGF-ß1) and connective tissue growth factor (CTGF) levels in predicting disease severity in COVID-19 patients with pulmonary involvement. METHODS: Fifty patients with confirmed COVID-19 and pulmonary involvement between September 2020, and February 2021 (Group 1) and 45 healthy controls (Group 2) were classified into three subgroups based on clinical severity: moderate, severe, and critical pneumonia. Serum TGF-ß1 and CTGF concentrations were measured on days 1 and 7 of admission in Group 1 using an enzyme-linked immunosorbent assay. These concentrations were also measured in control cases. The mean serum TGF-ß1 and CTGF levels were then compared among COVID-19 patients, based on clinical severity. RESULTS: Significantly higher mean serum TGF-ß1 and CTGF levels were observed on both days in Group 1 than in the control group. The mean serum TGF-ß1 and CTGF levels on day 7 were also significantly higher than those on day 1 in Group 1. The critical patient group had the highest serum TGF-ß1 and CTGF levels on both days, and the difference between this group and the moderate and severe pneumonia groups was significant. Cutoff values of 5.36 ng/mL for TGF-ß1 and 626.2 pg/mL for CTGF emerged as predictors of COVID-19 with pulmonary involvement in receiver-operating characteristic curve analysis. CONCLUSIONS: TGF-ß1 and CTGF are potential markers that can distinguish COVID-19 patients with pulmonary involvement and indicate disease severity. These findings may be useful for initiating treatment for early-stage COVID-19.


Subject(s)
COVID-19 , Connective Tissue Growth Factor , Lung Diseases , Transforming Growth Factor beta1 , COVID-19/complications , Cohort Studies , Connective Tissue Growth Factor/blood , Humans , Lung Diseases/virology , Prospective Studies , Transforming Growth Factor beta1/blood
2.
J Behav Addict ; 11(2): 533-543, 2022 Jul 13.
Article in English | MEDLINE | ID: covidwho-1963103

ABSTRACT

Introduction: The COVID-19 pandemic had numerous consequences for general, mental and sexual health. As gender differences in sexual compulsivity (SC) have been reported in the past and SC has been connected to adverse events and psychological distress, the current study aims at investigating associations between these factors in the context of contact restrictions in the course of the COVID-19 pandemic in Germany. Methods: We collected data for five time points in four retrospective measurement points in an online convenience sample (n T0 = 399, n T4 = 77). We investigated the influence of gender, several pandemic-related psychosocial circumstances, sensation seeking (Brief Sensation Seeking Scale), and psychological distress (Patient-Health-Questionnaire-4) on the change of SC (measured with an adapted version of the Yale-Brown Obsessive Compulsive Scale) between T0 and T1 (n = 292) in a linear regression analysis. Additionally, the course of SC over the time of the pandemic was explored with a linear mixed model. Results: Male gender was associated with higher SC compared to female gender over all measurement points. An older age, being in a relationship, having a place to retreat was associated with a change to lower SC during the first time of the pandemic. Psychological distress was associated with SC in men, but not in women. Men, who reported an increase of psychological distress were also more likely to report an increase of SC. Discussion: The results demonstrate that psychological distress seems to correlate with SC differently for men and women. This could be due to different excitatory and inhibitory influences on men and women during the pandemic. Furthermore, the results demonstrate the impact of pandemic related psychosocial circumstances in the times of contact restrictions.


Subject(s)
COVID-19 , Psychological Distress , COVID-19/epidemiology , Female , Humans , Male , Pandemics , Retrospective Studies , Sex Factors
3.
EFORT Open Rev ; 7(7): 516-525, 2022 Jul 05.
Article in English | MEDLINE | ID: covidwho-1963086

ABSTRACT

Background: There are several studies on nonunion, but there are no systematic overviews of the current evidence of risk factors for nonunion. The aim of this study was to systematically review risk factors for nonunion following surgically managed, traumatic, diaphyseal fractures. Methods: Medline, Embase, Scopus, and Cochrane were searched using a search string developed with aid from a scientific librarian. The studies were screened independently by two authors using Covidence. We solely included studies with at least ten nonunions. Eligible study data were extracted, and the studies were critically appraised. We performed random-effects meta-analyses for those risk factors included in five or more studies. PROSPERO registration number: CRD42021235213. Results: Of 11,738 records screened, 30 were eligible, and these included 38,465 patients. Twenty-five studies were eligible for meta-analyses. Nonunion was associated with smoking (odds ratio (OR): 1.7, 95% CI: 1.2-2.4), open fractures (OR: 2.6, 95% CI: 1.8-3.9), diabetes (OR: 1.6, 95% CI: 1.3-2.0), infection (OR: 7.0, 95% CI: 3.2-15.0), obesity (OR: 1.5, 95% CI: 1.1-1.9), increasing Gustilo classification (OR: 2.2, 95% CI: 1.4-3.7), and AO classification (OR: 2.4, 95% CI: 1.5-3.7). The studies were generally assessed to be of poor quality, mainly because of the possible risk of bias due to confounding, unclear outcome measurements, and missing data. Conclusion: Establishing compelling evidence is challenging because the current studies are observational and at risk of bias. We conclude that several risk factors are associated with nonunion following surgically managed, traumatic, diaphyseal fractures and should be included as confounders in future studies.

4.
Eur J Endocrinol ; 187(3): K19-K25, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-1963085

ABSTRACT

Objective: Since the outbreak of the COVID-19 pandemic, several cases of pituitary apoplexy (PA) following a SARS-CoV-2 infection have been described in several countries. Here, we describe a case series of PA occurring in the aftermath of a SARS-CoV-2 infection to alert physicians about possible neuro-endocrinological damage caused by the virus that can lead to visual sequelae and hypopituitarism. Design and methods: We retrospectively identified all the adult patients treated at Amiens University Hospital between March 2020 and May 2021 for PA confirmed by cerebral imaging and following an RT-PCR-confirmed SARS-CoV-2 infection. Results: Eight cases (six women, two men) occurred between March 2020 and May 2021 and were reviewed in this study. The mean age at diagnosis was 67.5 ± 9.8 years. Only one patient had a 'known' non-functional pituitary macroadenoma. The most common symptom of PA was a sudden headache. Brain imaging was typical in all cases. Only two patients required decompression surgery, whereas the others were managed conservatively. The clinical outcome was favorable for all patients but without recovery of their pituitary deficiencies. There was no diabetes insipidus. Conclusion: This case series, the largest in the literature, reinforces the strength, consistency, and coherence of the association between SARS-CoV-2 infection and PA. Our study provides support for the hypothesis that SARS-CoV-2 may be a new precipitating factor for PA. It is essential that practitioners be alerted about possible pituitary disease due to the virus so that such patients are recognized and appropriately managed, hence improving their prognosis.


Subject(s)
COVID-19 , Hypopituitarism , Pituitary Apoplexy , Pituitary Neoplasms , Adult , COVID-19/complications , Female , Hospitals, University , Humans , Hypopituitarism/complications , Male , Pandemics , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/surgery , Retrospective Studies , SARS-CoV-2
5.
Clin Exp Rheumatol ; 2022 Jul 21.
Article in English | MEDLINE | ID: covidwho-1965228

ABSTRACT

OBJECTIVES: Pandemic caused by coronavirus disease (COVID-19) determines the life of clinicians and patients since 2 years. We have a lot of information about disease course, treatment and protection against virus, but less on the prognosis of infection in patients with idiopathic inflammatory myopathies (IIM). Also few data are available on triggered humoral response and side effects after vaccination. METHODS: Our goal was to assess by a retrospective cross-sectional study the above data in our cohort (176 IIM patients) by identifying COVID-19 positive patients and follow disease course. Incidence and complications of vaccination were determined by questionnaires. 101 patients volunteered for complex blood test. RESULTS: By June 1st, 2021 significantly higher incidence of COVID 19 infections (34.7%) were identified comparing to the national prevalence (8.2%). A third of these infections occurred asymptomatically or mild. Patients requiring hospitalisation had a significantly longer disease duration and a higher incidence of anti-Jo-1 antibody. All patients infected by COVID-19 became seropositive regardless the immunosuppressive therapy or symptoms severity. 54.3% of the patients received anti-COVID-19 vaccine. 72.3% of patients became seropositive after vaccination. Higher antibody titer against spike protein was detected after Pfizer-BioNTech vaccination compared to others. Patients receiving steroid therapy had decreased post-vaccination antibody response compared to those without steroid treatment. No major post-vaccination infection was observed. CONCLUSIONS: Based on our results, myositis may be associated with an increased risk of COVID-19 infection. Independent risk factor for hospitalisation are longer disease duration and anti-Jo1 positivity. Anti-SARS-CoV2 vaccines seem safe and tolerable and strongly recommended for that population.

6.
Clin Exp Rheumatol ; 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1965227

ABSTRACT

OBJECTIVES: To investigate the humoral immune response and risk of disease flare in systemic lupus erythematosus (SLE) patients following three-doses of SARS-CoV-2 vaccines. METHODS: In adult patients with SLE, we measured SARS-CoV-2 spike IgG in blood samples drawn three weeks after the 1st dose (baseline), four and eight weeks after the 2nd dose and after the 3rd dose. A sufficient antibody response was ≥54BAU/mL. SLEDAI-2K, SLAQ and SDI were assessed at baseline and eight weeks after the 2nd dose along with adverse events. Demographic and treatment data were collected from hospital records. RESULTS: Of 123 patients, 115 (93.5%) received the BNT162b2 vaccine, the remaining received the 1st dose of ChAdOx-1 followed by a 2nd and 3rd dose of mRNA-1273. After the 2nd dose 102 (83%) patients had a sufficient antibody response (median 559.2, IQR 288.8-1180.5 BAU/mL), increasing to 115 (93.5%) (median 2416.9, IQR 1289-4603.8 BAU/mL) patients after the 3rd dose. Eight weeks after the 2nd dose patients treated with high dose prednisolone (p=0.034) and DMARDs (p<0.001) had significantly lower antibodies; however, this difference was not significant following the 3rd dose. Disease activity and damage were stable during the study period. Adverse events were more frequent in patients with a sufficient response. Breakthrough infections were reported in 39 (31.7%) patients; all with mild symptoms. CONCLUSIONS: A 3rd dose improved the humoral response to SARS-CoV-2 vaccines in patients with SLE to the level of healthy individuals. Vaccination did not affect SLE disease activity. Subsequent breakthrough infections were mild and did not require hospitalisation.

7.
Rev Esp Quimioter ; 2022 Jul 22.
Article in Spanish | MEDLINE | ID: covidwho-1965160

ABSTRACT

OBJECTIVE: The disease caused by SARS-CoV-2 (COVID-19) has been a challenge for healthcare professionals since its appearance. Staphylococcus aureus has been described as one of the main pathogens causing bacterial infections in viral pandemics. However, co- infection with S. aureus causing bacteremia in patients with COVID-19 has yet to be well studied. METHODS: We performed a e study of S. aureus bacteremia (SAB) at Hospital Miguel Servet (Zaragoza) from March 2020 to February 2021. The clinical characteristics, mortality and risk factors of adults hospitalized patients with BSA associated COVID-19 compared to patients without COVID-19. RESULTS: A total of 95 patients with SAB were identified. 27.3% were positive for SARS-CoV-2. SAB represented 9.9% of bacteremia, being the second agent in frequency after E. coli. Nosocomial bacteremia was more frequent in the group of COVID-19 patients. The most frequent source of BSA in these patients was the respiratory source (26.9% vs 0%; P<0.001) followed by the skin (15.5% vs 15.9%; P=1). The development of sepsis was more frequent in COVID-19 patients (61,5% vs 7,8%; P=0,336) and among them, who received dexamethasone at doses > 6 mg/day (62.5% vs. 37.5%, P<0.05). CONCLUSIONS: Our data suggest that BSA has a negative impact on the evolution of patients with COVID-19. However, further and preferably prospective studies are required to obtain solid data on the impact of BSA on coronavirus patients.

8.
Rev Neurol ; 75(4): 97-100, 2022 Aug 16.
Article in Spanish | MEDLINE | ID: covidwho-1965112

ABSTRACT

INTRODUCTION: Infection by coronavirus type 2, which is the cause of severe acute respiratory syndrome (SARS-CoV-2), gives rise to thromboembolic complications, including acute cerebrovascular disease. Due to the hypercoagulable state that accompanies pregnancy, the thrombotic risk in these patients may be particularly significant. CASE REPORT: We report the case of a 41-year-old woman, 34+1 weeks pregnant, diagnosed with bilateral interstitial pneumonia, caused by coronavirus disease 2019 (COVID-19). The patient presented with severe respiratory failure, and so the decision was made to perform an emergency caesarean section and she was transferred to the intensive care unit. During her stay in hospital, the patient suffered a sudden episode of decreased level of consciousness, and magnetic resonance angiography revealed thrombosis in the left vertebral artery and in the basilar artery, with the presence of acute ischaemic infarction in both cerebellar hemispheres and bilateral involvement of the brainstem. CONCLUSION: Severe SARS-CoV-2 disease results in a prothrombotic state that correlates with the prognosis of the disease. The last trimester of pregnancy and the puerperium are known prothrombotic risk factors. Recommendations for anticoagulation management in pregnant patients with COVID-19 are based on limited evidence. This is the first case to be published in Spain involving cerebral arterial thrombosis in a pregnant patient with SARS-CoV-2 infection.


TITLE: Ictus isquémico por oclusión de la arteria basilar en una paciente puérpera con infección por SARS-CoV-2.Introducción. La infección por coronavirus de tipo 2 (SARS-CoV-2), causante del síndrome respiratorio agudo grave (COVID-19), produce complicaciones tromboembólicas, incluyendo casos de enfermedad cerebrovascular aguda. Debido al estado de hipercoagulabilidad que acompaña al embarazo, el riesgo trombótico en estas pacientes puede ser especialmente relevante. Caso clínico. Presentamos el caso de una mujer de 41 años, gestante de 34 + 1 semanas, diagnosticada de neumonía intersticial bilateral, SARS-CoV-2. La paciente presentó insuficiencia respiratoria grave, por lo que se decidió la realización de una cesárea urgente y se trasladó a la unidad de cuidados intensivos. Durante su estancia en ésta, la paciente presentó un episodio brusco de disminución del nivel de consciencia, y se evidenció por angiorresonancia magnética una trombosis en la arteria vertebral izquierda y en la arteria basilar, con presencia de infarto isquémico agudo en ambos hemisferios cerebelosos y afectación bilateral del tronco del encéfalo. Conclusión. La enfermedad grave por el SARS-CoV-2 produce un estado protrombótico que se correlaciona con el pronóstico de la enfermedad. El último trimestre del embarazo y el puerperio son factores de riesgo protrombóticos conocidos. Las recomendaciones del manejo de anticoagulación en pacientes embarazadas con COVID-19 se basan en una evidencia limitada. Éste es el primer caso publicado en España de trombosis arterial cerebral en una paciente embarazada con infección por el SARS-CoV-2.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Thrombosis , Adult , Basilar Artery/diagnostic imaging , COVID-19/complications , Cesarean Section , Female , Humans , Postpartum Period , Pregnancy , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/etiology
9.
Front Biosci (Landmark Ed) ; 27(7): 204, 2022 Jun 27.
Article in English | MEDLINE | ID: covidwho-1965057

ABSTRACT

BACKGROUND: COVID-19 displays an increased mortality rate and higher risk of severe symptoms with increasing age, which is thought to be a result of the compromised immunity of elderly patients. However, the underlying mechanisms of aging-associated immunodeficiency against Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. Epigenetic modifications show considerable changes with age, causing altered gene regulations and cell functions during the aging process. The DNA methylation patterns among patients with coronavirus 2019 disease (COVID-19) who had different ages were compared to explore the effect of aging-associated methylation modifications in SARS-CoV-2 infection. METHODS: Patients with COVID-19 were divided into three groups according to age. Boruta was used on the DNA methylation profiles of the patients to remove irrelevant features and retain essential signature sites to identify substantial aging-associated DNA methylation changes in COVID-19. Next, these features were ranked using the minimum redundancy maximum relevance (mRMR) method, and the feature list generated by mRMR was processed into the incremental feature selection method with decision tree (DT), random forest, k-nearest neighbor, and support vector machine to obtain the key methylation sites, optimal classifier, and decision rules. RESULTS: Several key methylation sites that showed distinct patterns among the patients with COVID-19 who had different ages were identified, and these methylation modifications may play crucial roles in regulating immune cell functions. An optimal classifier was built based on selected methylation signatures, which can be useful to predict the aging-associated disease risk of COVID-19. CONCLUSIONS: Existing works and our predictions suggest that the methylation modifications of genes, such as NHLH2, ZEB2, NWD1, ELOVL2, FGGY, and FHL2, are closely associated with age in patients with COVID-19, and the 39 decision rules extracted with the optimal DT classifier provides quantitative context to the methylation modifications in elderly patients with COVID-19. Our findings contribute to the understanding of the epigenetic regulations of aging-associated COVID-19 symptoms and provide the potential methylation targets for intervention strategies in elderly patients.


Subject(s)
COVID-19 , SARS-CoV-2 , Aged , COVID-19/genetics , DNA Methylation , Humans , Protein Processing, Post-Translational , SARS-CoV-2/genetics , Support Vector Machine
10.
Psychiatry Investig ; 19(7): 551-561, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1965048

ABSTRACT

OBJECTIVE: This study was performed to identify factors associated with depression and anxiety among Korean adolescents during the coronavirus disease (COVID-19) pandemic. METHODS: We conducted a cross-sectional study of 1,898 Korean adolescents (55.2% male, 44.8% female) ranging in age from 12 to 17 years (mean±standard deviaion age, 15.4±2.6 years). Depression and anxiety were defined as a Patient Health Questionnaire-9 score ≥10 and Generalized Anxiety Disorder-7 score ≥10, respectively. Other questionnaires included sociodemographic data, psychosocial stresses, and experiences in association with COVID-19. Psychiatric scales included Gratitude Questionnaire-6, Perceived Stress Scale-10, and UCLA Loneliness Scale-3. RESULTS: The prevalence rates of depressive and anxiety symptoms among participants were 13.8% and 21.0%, respectively. Multivariable logistic regression analysis revealed that female sex, fear of COVID-19 infection, low gratitude were risk factors for depression. Fear of COVID-19 infection, increased TV watching time, and academic-related stress were risk factors for anxiety. CONCLUSION: Depression and anxiety were prevalent during the pandemic in Korean adolescents, and were associated with fear of COVID-19 infection. Providing appropriate information on COVID-19, helping adolescents manage academic-related stress and maintain daily life patterns, and implementing interventions to foster gratitude are important for preventing depression and anxiety in Korean adolescents.

11.
Turk J Pediatr ; 64(3): 500-509, 2022.
Article in English | MEDLINE | ID: covidwho-1964985

ABSTRACT

BACKGROUND: Human coronaviruses (HCoVs) cause a comprehensive clinic ranging from asymptomatic course to pneumonia. We aimed to describe the HCoV infections in children to determine the clinical status and coinfection effects in a five-year retrospective surveillance study. The primary outcome was admission to the intensive care unit (ICU) and the secondary outcome was the need of high oxygen support. METHODS: Between September 2015 and November 2020, all patients whose reverse transcription polymerase chain reaction (RT-PCR) tests were positive were determined and patients with HCoVs were included in the study. Demographical characteristics, underlying chronic diseases, clinical diagnosis, laboratory data, subtypes of HCoVs, radiological findings, treatments, hospitalization, and ICU admission were analyzed. RESULTS: Of the 2606 children, the overall respiratory tract virus detection rate was 82.4%. Among these, 98 cases were HCoVs positive and of these 80 (81.6%) were under five years of age and most of the patients were admitted to the hospital in spring and 70% were a mixed infection with other respiratory viruses. Since lower respiratory tract infections are more common in HCoV coinfections, a significant difference was found in clinical diagnosis (p < 0.001). The presence of hypoxia (p=0.003) and underlying disease (p=0.004) were found to be significantly more common in patients admitted to the ICU. The presence of hypoxia, infiltration on chest X-ray, and elevated C-reactive protein levels were more frequently determined in patients who received high oxygen support (p=0.001, p=0.036, p=0.004, respectively). CONCLUSIONS: Clinical findings may be more severe if HCoVs, which generally cause mild respiratory disease, are coinfected with another viral agent.


Subject(s)
Coronavirus Infections , Coronavirus , Respiratory Tract Infections , Child , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Hypoxia/etiology , Infant , Oxygen , Respiratory Tract Infections/epidemiology , Retrospective Studies , Seasons
12.
Bol Med Hosp Infant Mex ; 79(3): 170-179, 2022.
Article in English | MEDLINE | ID: covidwho-1964981

ABSTRACT

BACKGROUND: There are only a few reports of acute respiratory distress syndrome (ARDS) in patients with SARS-CoV-2 in pediatrics. This study aimed to describe the characteristics of critically ill pediatric patients with COVID-19, the frequency of ARDS, ventilatory mechanics and results of prone position. METHODS: We conducted a retrospective, observational study of patients admitted to the pediatric intensive care unit (PICU) between April 1 to September 30, 2020. RESULTS: Thirty-four patients were admitted to pediatric intensive care unit, 31.7% were SARS-CoV-2 positive. 13 presented ARDS, 11 required invasive mechanical ventilation, and seven were pronated as an oxygenation strategy. All patients classified as severe ARDS were pronated. Obesity was the most important comorbidity. The complications associated with ARDS were multisystemic inflammatory syndrome (8 vs. 4; p < 0.05) and acute kidney injury (8 vs. 3; p < 0.05). Procalcitonin was higher in patients with ARDS, as were the days of stay in PICU (p < 0.05). The success of the pronation maneuver was achieved 8 hours later , with the following results: arterial oxygen partial pressure to fractional inspired oxygen ratio 128 vs. 204, oxygenation index 8.9 vs. 5.9, static lung compliance 0.54 vs. 0.70 ml/cmH2O/kg, plateau pressure 24 vs. 19 cmH2O (p < 0.05). The use of narcotics was higher in the group with ARDS plus pronation 124 vs. 27 hours in the non-pronated (p < 0.01). Mortality associated with SARS-CoV-2 was 5.8%. CONCLUSIONS: ARDS was presented in 38.2% of the children admitted to PICU and was more frequent in obese patients. Pronation, performed in severe cases, improved oxygenation and lung mechanics indexes. No patient died of ARDS.


INTRODUCCIÓN: Existen pocos reportes de síndrome de dificultad respiratoria aguda (SDRA) con COVID-19 en pacientes pediátricos. El objetivo de este estudio fue describir las características de los pacientes pediátricos críticamente enfermos con COVID-19, la frecuencia del SDRA, la mecánica ventilatoria y los resultados de la posición prona. MÉTODOS: Se llevó a cabo un estudio retrospectivo y observacional de los pacientes ingresados del 1 de abril al 30 de septiembre de 2020. RESULTADOS: Ingresaron 34 pacientes a la unidad de terapia intensiva pediátrica (UTIP) con prueba positiva para SARS-CoV-2. De ellos, 13 presentaron SDRA, 11 requirieron ventilación mecánica invasiva y siete fueron pronados como estrategia de oxigenación. Todos los pacientes clasificados como SDRA graves fueron pronados. La obesidad fue la comorbilidad más importante. Las complicaciones asociadas con SDRA fueron el síndrome inflamatorio multisistémico (p < 0.05) y la lesión renal aguda (p < 0.05). La procalcitonina fue mayor en los pacientes con SDRA, al igual que los días de estancia en la UTIP (p < 0.05). El éxito de la maniobra de pronación se alcanzó 8 horas después.Los resultados observados fueron los siguientes relación presión arterial de oxígeno/fracción inspirada de oxígeno 128 vs. 204, índice de oxigenación 8.9 vs. 5.9, distensibilidad pulmonar estática 0.54 vs. 0.70 ml/cmH2O/kg, y presión meseta 24 vs. 19 cmH2O (p < 0.05). El uso de narcóticos fue mayor en el grupo de SDRA más pronación que en los no pronados (124 vs. 27 h; p < 0.01). La mortalidad asociada con SARS-CoV-2 fue del 5.8%. CONCLUSIONES: El SDRA se presentó en el 38.2% de los niños admitidos a UTIP, y con mayor frecuencia en los pacientes con obesidad. La maniobra de pronación aplicada en los casos severos, mejoró la oxigenación de la mécanica pulmonar. Ninguno de los pacientes falleció por SDRA.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , COVID-19/complications , COVID-19/therapy , Child , Humans , Oxygen , Prospective Studies , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Retrospective Studies , SARS-CoV-2
13.
Int Angiol ; 41(4): 356-363, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1964957

ABSTRACT

BACKGROUND: Coronavirus disease-2019 (COVID-19) infection and thrombosis are of great clinical importance as this association has shown to increase mortality. We intend to estimate the incidence of thrombotic events (TE) and their impact on clinical outcomes in hospitalized COVID-19 patients. METHODS: This was an analytical cross-sectional study. The study population comprised of hospitalized COVID-19 patients between 1st March 2021 and 31st May 2021. The clinico-demographic data, thrombotic events, and clinical outcomes were collected from electronic health records. RESULTS: A total of 1274 patients were analyzed. The median age of the study population was 56 years (IQR: 44-66 years). The estimated incidence of TE was 5.8% (N.=74); 60.8% of these TE occurred in patients having severe/critical COVID-19 illness and 70.3% of TE occurred in patients in the intensive care unit. Venous events (3.9%) were common compared to arterial events(1.9%). On multivariate logistic regression analysis, total leukocyte count, C-reactive protein, and D-dimer level were found to be the independent predictors of having TE. Receiver operator curve revealed a cut-off point of 872.5 DDU µg/L for D-dimer level (sensitivity: 67.6% and specificity: 72.1%; P<0.001, area under curve 0.78) for predicting TE. Patients with TE had significantly higher mortality compared to those without TE (58.1% vs. 22.2%; P<0.001); and the presence of TE (OR=2.94; 95% CI:1.7-5.1, P<0.001) was found to be the independent predictor of mortality. CONCLUSIONS: The incidence of TE is high for hospitalized COVID-19 patients and it is even higher in severe/critical COVID illness. Its presence has shown to double the mortality compared to those without it.


Subject(s)
COVID-19 , Thrombosis , Adult , Aged , COVID-19/epidemiology , Critical Illness , Cross-Sectional Studies , Humans , Incidence , Middle Aged , Retrospective Studies , SARS-CoV-2 , Thrombosis/epidemiology
15.
Cent Eur J Public Health ; 30(2): 99-106, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1964909

ABSTRACT

OBJECTIVES: Vaccine hesitancy presents one of the critical constraints in combating COVID-19 pandemic. The aim of this study was to develop and validate an instrument for measuring factors that contribute to COVID-19 vaccine hesitancy. METHODS: The key constructs in the study instrument were factors that constitute the "3C" model of vaccine hesitancy: Confidence, Complacency and Convenience. Using a cross-sectional, online survey design, the 8-item COVID-19 Vaccine Hesitancy Questionnaire was administered to a sample of 667 adult citizens of Serbia in December 2020. We used confirmatory factor analysis to investigate the model that assumes three latent variables. To ensure that the instrument measures the same constructs in different groups, the measurement invariance examination was conducted. To examine criterion validity, Spearman's correlation was applied to determine the association between the instrument total score and the single-item measuring the likelihood of getting vaccinated against SARS-CoV-2. RESULTS: Confirmatory factor analysis established the three-factor structure, with subscales fitting within the "3C" model of vaccine hesitancy comprising confidence, convenience and complacency. The full scalar invariance was found across gender, and the partial scalar invariance was achieved for the age, region and education level. A higher level of the COVID-19 vaccine hesitancy was associated with the lower likelihood to get vaccinated against the SARS-CoV-2 virus. CONCLUSION: Our scale is brief and consistent, maintaining a good fit across key socio-demographic subgroups. This result implies that the scale could be useful for quick assessment of COVID-19 vaccine hesitancy in various target populations.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Humans , Pandemics , Patient Acceptance of Health Care , SARS-CoV-2 , Surveys and Questionnaires , Vaccination , Vaccination Hesitancy
16.
Acta Med Port ; 2022 Jul 27.
Article in Portuguese | MEDLINE | ID: covidwho-1964897

ABSTRACT

INTRODUCTION: The COVID-19 pandemic forced the reorganization of primary health care services. The aim of this study was to describe how the health services responded to organizational requests; how the health services involved and supported their employees; how professionals perceived their involvement in the procedures and what support was provided to them. Additions aims included assessing the levels of anxiety and depression of professionals and their association with the perceived support, availability of personal protective equipment and involvement in pandemic-related tasks. MATERIAL AND METHODS: Cross-sectional, analytical study directed at professionals from three health center groups using an online questionnaire. We collected information from sociodemographic data, access to personal protective equipment, perceived support, workload and levels of anxiety and depression. Between each variable and the levels of anxiety and depression, multivariate logistic regression was applied. RESULTS: There were responses from 237 professionals (83.8% women; mean age 43.7 years; 43.2% physicians). Almost 60% worked with COVID-19 patients. The availability of personal protective equipment in March versus June 2020 increased (17.7% vs 55.3%). There was a risk management plan in 86% of the workplaces. A high workload (90%) and time pressure (74.6%) were identified. Physicians and nurses had a higher prevalence of depression associated with workload and fatigue (p < 0.001). Protective anxiety factors were having space to talk about problems, support in face of these problems and having a place to relax in the health unit. A lower risk of depression was found in the administrative staff group, in those who felt supported, and in those who actively participated in the contingency plans. CONCLUSION: The COVID-19 pandemic led to considerable changes in the dynamics of primary health care. The time pressure to carry out tasks and the level of concentration required were associated with a higher risk of mental disease. The support felt by healthcare professionals regarding their problems and concerns and the existence of places to relax in the health units were identified as protective factors. Health promotion, the maintenance of the social contacts of healthcare professionals and their involvement in the processes should be taken into account in the organizational dynamics of the institutions.


Introdução: A pandemia de COVID-19 forçou a reorganização dos serviços dos cuidados de saúde primários. Com este estudo pretendemos descrever como responderam os serviços de saúde às solicitações organizacionais, como envolveram e apoiaram os seus colaboradores; como os profissionais percecionaram o seu envolvimento nos procedimentos e que apoio lhes foi fornecido. Pretendemos também avaliar os níveis de ansiedade e depressão dos profissionais e a sua associação não só com o apoio sentido pelos profissionais, mas também com a disponibilidade de equipamentos de proteção individual e com o seu envolvimento nas tarefas relacionadas com a pandemia.Material e Métodos: Estudo transversal analítico dirigido aos profissionais de três agrupamentos de centros de saúde usando um questionário online. Colhemos dados sociodemográficos, informação sobre o acesso a equipamento de proteção individual, apoio percecionado, carga de trabalho e níveis de ansiedade e depressão. Entre cada variável e os níveis de ansiedade e depressão aplicou-se regressão logística multivariada.Resultados: Responderam 237 profissionais (83,8% mulheres; idade média 43,7 anos; 43,2% de médicos). Quase 60% trabalhou com doentes COVID-19. A disponibilidade de equipamento de proteção individual em março versus junho de 2020 aumentou (17,7% vs 55,3%). Existia plano de gestão do risco em 86% dos locais. Identificou-se uma alta carga de trabalho (90%) e pressão do tempo (74,6%). Médicos e enfermeiros apresentavam maior prevalência de depressão associada à carga de trabalho e fadiga (p < 0,001). Ter espaço para falar dos problemas, apoio sentido perante esses problemas e dispor na unidade de saúde de um espaço para relaxar foram alguns fatores protetores de ansiedade. Foi encontrado menor riso de depressão no grupo do secretariado clínico, nos profissionais que se sentiram apoiados, e nos que tiveram participação ativa nos planos de contingência.Conclusão: A pandemia de COVID-19 levou a grandes alterações na dinâmica dos CSP. A pressão do tempo para realização de tarefas e a concentração exigida associaram-se a maior risco de desenvolvimento de patologia mental. O apoio sentido pelos profissionais perante os seus problemas e preocupações, e a existência de espaços para relaxar nas USF foram identificados como fatores protetores. A promoção da saúde, a manutenção dos contactos sociais dos profissionais e o seu envolvimento nos processos deverão ser tidos em conta na dinâmica organizacional das instituições.

17.
Tob Induc Dis ; 20: 65, 2022.
Article in English | MEDLINE | ID: covidwho-1964866

ABSTRACT

INTRODUCTION: Although some research papers have suggested that smoking may increase mortality in patients with sepsis, no evidence has been produced in this regard. This systematic research evaluated the risk of death in patients with sepsis who were smokers to facilitate better clinical decision making. METHODS: This is a systematic review registered in PROPERO (CRD42022296654). Searches were conducted to identify suitable studies from the databases of PubMed, Embase, Web of Science and the Cochrane Controlled Register of Trials from January 1980 to June 2021. Two independent reviewers screened the articles using keywords and extracted the data. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of evidence. The primary endpoints included the mortality of patients with sepsis. RESULTS: Five studies involving 2694 participants were included in our study. Among the five included articles, three studies had an NOS score of 6, while the other two had an NOS score of 7. The results showed that a significantly higher risk of death was observed in smokers with sepsis compared with non-smokers with sepsis (hazard ratio, HR=1.62; 95% CI: 1.11-2.37, p=0.01). Among the patients followed for more than 2 months, the mortality rate of smokers was significantly higher (2.33 times) than that of non-smokers (HR=2.33; 95% CI: 1.83-2.96, p<0.01). The difference in mortality did not reach statistical significance when the follow-up period was shorter than 2 months (HR=1.22; 95% CI: 0.96-1.56, p=0.10). CONCLUSIONS: Smoking increased mortality in patients with sepsis when the follow-up period was longer than 2 months.

18.
Kans J Med ; 15: 241-246, 2022.
Article in English | MEDLINE | ID: covidwho-1964824

ABSTRACT

Introduction: Metabolic-associated fatty liver disease (MAFLD) is a hepatic manifestation of metabolic syndrome (MS). MAFLD patients have a higher prevalence of COVID-19. MAFLD also is associated with worse clinical outcomes of COVID-19, such as disease severity, intensive care unit (ICU) admission rate, and higher mortality rates. However, this evidence has not been well characterized in the literature. This meta-analysis aimed to determine the clinical outcomes of COVID-19 among MAFLD patients compared to the non-MAFLD group. Methods: A comprehensive search was conducted in the Cumulative Index of Nursing and Allied Health (CINAHL), PubMed/Medline, and Embase for studies reporting MAFLD prevalence among COVID-19 patients and comparing clinical outcomes such as severity, ICU admission, and mortality among patients with and without MAFLD. The pooled prevalence of MAFLD among COVID-19 patients and the pooled odds ratios (OR) with 95% confidence intervals (CI) for clinical outcomes of COVID-19 were calculated. Results: Sixteen observational studies met inclusion criteria involving a total of 11,484 overall study participants, including 1,746 MAFLD patients. The prevalence of COVID-19 among MAFLD patients was 0.29 (95% CI: 0.19-0.40). MAFLD was associated with the COVID-19 disease severity OR 3.07 (95% CI: 2.30-4.09). Similarly, MAFLD was associated with an increased risk of ICU admission compared to the non-MAFLD group OR 1.46 (95% CI: 1.12-1.91). Lastly, the association between MAFLD and COVID-19 mortality was not statistically significant OR 1.45 (95% CI: 0.74-2.84). Conclusions: In this study, a high percentage of COVID-19 patients had MAFLD. Moreover, MAFLD patients had an increased risk of COVID-19 disease severity and ICU admission rate.

19.
Agri ; 34(2): 84-90, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1964749

ABSTRACT

OBJECTIVES: In the coronavirus disease 2019 (COVID-19) pandemic, physical inactivity and health anxiety which are common risk factors for musculoskeletal pain have become widespread due to strict precautions and isolation. Thus, we aimed to com-pare physical activity, health anxiety, and spinal pain history in people experiencing and not experiencing spinal pain during the COVID-19 lockdown. METHODS: This study was designed as a case-control study. Assessments including the Nordic Musculoskeletal Questionnaire (NMQ), the International Physical Activity Questionnaire-Short Form, and the Short Health Anxiety Inventory were performed through an online questionnaire using Google forms during the COVID-19 lockdown. We reached 494 volunteers, and 348 were eliminated by the exclusion criteria. One hundred and fifty-six participants were classified as the spinal pain group (n=70) and the asymptomatic group (n=86) based on the NMQ. RESULTS: The total amount of physical activity was less in the spinal pain group than the asymptomatic group (p<0.05). The spi-nal pain group had higher levels of health anxiety than the asymptomatic group (p<0.05). Further, the percentage of people who experienced spinal pain in the past year was higher in the spinal pain group (p<0.05). CONCLUSION: People experiencing spinal pain during the COVID-19 lockdown were physically less active and more concerned about their health. These results may be useful to improve the management of spinal pain during the lockdown or possible pandemic wave scenarios.


Subject(s)
COVID-19 , Musculoskeletal Pain , Anxiety/epidemiology , COVID-19/epidemiology , Case-Control Studies , Communicable Disease Control , Exercise , Humans
20.
CMAJ Open ; 10(3): E692-E701, 2022.
Article in English | MEDLINE | ID: covidwho-1964597

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected older adults disproportionately, and delirium is a concerning consequence; however, the relationship between delirium and corticosteroid use is uncertain. The objective of the present study was to describe patient characteristics, treatments and outcomes among older adults hospitalized with COVID-19, with a focus on dexamethasone use and delirium incidence. METHODS: We completed this retrospective cohort study at 7 sites (including acute care, rehabilitation and long-term care settings) in Toronto, Ontario, Canada. We included adults aged 65 years or older, consecutively hospitalized with confirmed SARS-CoV-2 infection, between Mar. 11, 2020, and Apr. 30, 2021. We abstracted patient characteristics and outcomes from charts and analyzed them descriptively. We used a logistic regression model to determine the association between dexamethasone use and delirium incidence. RESULTS: During the study period, 927 patients were admitted to the acute care hospitals with COVID-19. Patients' median age was 79.0 years (interquartile range [IQR] 72.0-87.0), and 417 (45.0%) were female. Most patients were frail (61.9%), based on a Clinical Frailty Scale score of 5 or greater. The prevalence of delirium was 53.6%, and the incidence was 33.1%. Use of restraints was documented in 20.4% of patients. In rehabilitation and long-term care settings (n = 115), patients' median age was 86.0 years (IQR 78.5-91.0), 72 (62.6%) were female and delirium occurred in 17 patients (14.8%). In patients admitted to acute care during wave 2 of the pandemic (Aug. 1, 2020, to Feb. 20, 2021), dexamethasone use had a nonsignificant association with delirium incidence (adjusted odds ratio 1.38, 95% confidence interval 0.77-2.50). Overall, in-hospital death occurred in 262 (28.4%) patients in acute care settings and 28 (24.3%) patients in rehabilitation or long-term care settings. INTERPRETATION: In-hospital death, delirium and use of restraints were common in older adults admitted to hospital with COVID-19. Further research should be directed to improving the quality of care for this population with known vulnerabilities during continued waves of the COVID-19 pandemic.


Subject(s)
COVID-19 , Delirium , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/therapy , Delirium/epidemiology , Delirium/etiology , Dexamethasone/therapeutic use , Female , Hospital Mortality , Humans , Incidence , Male , Ontario/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
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