scholarly journals Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Zouina Sarfraz ◽  
Azza Sarfraz ◽  
Alanna Barrios ◽  
Radhika Garimella ◽  
Asimina Dominari ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Infection ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Case Reports ◽  
Case Series ◽  
Infectious Complications ◽  
Care Physician ◽  
Cross Sectional ◽  
Infection Period

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

2020 ◽  
pp. 009121742097799
Author(s):  
Krista Schultz ◽  
Sharan Sandhu ◽  
David Kealy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Primary Care Physician ◽  
Population Based ◽  
Borderline Personality ◽  
Care Physician ◽  
Cross Sectional

Objective The purpose of the current study is to examine the relationship between the quality of the Patient-Doctor Relationship and suicidality among patients seeking mental health care; specifically, whether patients who perceive having a more positive relationship with primary care physician will have lower levels of suicidality. Method Cross-sectional population-based study in Greater Vancouver, Canada. One-hundred ninety-seven participants were recruited from three Mental Health Clinics who reported having a primary care physician. Participants completed a survey containing questions regarding items assessing quality of Patient-Doctor Relationship, general psychiatric distress (K10), borderline personality disorder, and suicidality (Suicidal Behaviours Questionnaire-Revised-SBQ-R). Zero-order correlations were computed to evaluate relationships between study variables. Hierarchical regression analysis was used to control for confounding variables. Results The quality of the patient doctor relationship was significantly negatively associated with suicidality. The association between the quality of the patient-doctor relationship and suicidality remained significant even after controlling for the effects of psychiatric symptom distress and borderline personality disorder features. Conclusions The degree to which patients’ perceive their primary care physician as understanding, reliable, and dedicated, is associated with a reduction in suicidal behaviors. Further research is needed to better explicate the mechanisms of this relationship over time.

scholarly journals The study on knowledge-attitude-practice of primary care physician toward anticoagulants therapy in Non-valvular atrial fibrillation patients in Shanghai of China

2020 ◽  
Author(s):  
Shasha Ye ◽  
Tianhao Wang ◽  
Arthur Liu ◽  
Ying Yu ◽  
Zhigang Pan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Work Experience ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Bachelor's Degree ◽  
Cluster Sampling ◽  
Primary Role ◽  
Cross Sectional ◽  
Positive Attitudes

Abstract Background As the large number of CHS centers in China face the majority of NVAF patients, primary care physicians (PCPs) play the primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in NVAF patients must be brought into focus among PCPs in China. This study will help primary care physicians (PCPs) increase their awareness of oral anticoagulant (OAC) therapy for non-valvular atrial fibrillation (NVAF) to prevent embolization.Method This was a cross-sectional observational study of 462 PCPs in community health service (CHS) centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.Result Among 462 participants, 69.3% (320/462) of females with a medical bachelor’s degree and more than 10 years of work experience predominated in the 30 to 49 years of age group. The mean score for “knowledge,” “attitude” and “practices” of OAC therapy in NVAF patients among PCPs was 3.68±2.752, 53.62±7.148, and 37.63±10.336, respectively. The level of knowledge of OAC therapy in NVAF patients among PCPs was insufficient in over half (75.8%) of participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of NVAF patients.Conclusion The knowledge and behaviors of PCPs were insufficient in OAC therapy to prevent embolization in NVAF patients. The study also revealed the positive attitudes of participants, and their desire to learn the latest knowledge of OAC therapy.

scholarly journals Probable Neuropsychological & Cognitive Complications due to Cytokine Storm in Patients With COVID-19

2021 ◽  
Vol 0 (0) ◽  
pp. 1-37
Author(s):  
Zahra Keshtgar ◽  
◽  
GH. Reza Chalabianloo ◽  
Niloofar Esmaeili ◽  
◽  
...  
Keyword(s):  
Nervous System ◽  
Case Reports ◽  
Case Series ◽  
Executive Dysfunction ◽  
Inflammatory Factors ◽  
Cytokine Storm ◽  
Case Control Studies ◽  
Necrosis Factor Alpha ◽  
Cross Sectional ◽  
Tnf Α

Introduction: COVID-19 (coronavirus disease 2019) was identified in China in December 2019 for the first time and is rapidly spreading throughout the world as a pandemic. As COVID-19 causes mild to severe acute respiratory syndrome, most studies in this context have focused on pathogenesis primarily in the respiratory system. However, evidence shows that the central nervous system (CNS) may also be affected by COVID-19. Since COVID-19 is spreading, it is imperative to study its possible cognitive effects in patients suffering and recovering from COVID-19. Methods: The articles used in this study were searched by keywords such as Cytokine storm and covid-19, covid-19 and executive dysfunction, cognitive disorder and covid-19, CNS and covid 19, Coronavirus, Neuroinvasion in science direct, Scopus, PubMed, Embase, and Web of Science databases based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. The study will assess all observational studies published between December 2019 and April 2021 in peer-reviewed journals, including cross-sectional, cohort, case-control studies, case reports and case series. The search result was 106 articles, of which 73 articles related to Covid-19, the stages of infection by this virus, its effect on the nervous system and neurological symptoms, the cytokine storm caused by this infection, and the possible cognitive consequences caused by this virus in patients, has been reviewed. Other articles were not checked due to their limited relevance to the topic under discussion. Results: Studies show that neurons may be directly affected by SARS-CoV-1 and SARS-CoV-2. Furthermore, various studies indicate that systemic inflammation (so-called "cytokine storm") is also responsible for brain damage induced by infection with SARS-CoV-1 and SARS-CoV-2. Such a way that this patients showed elevated levels of interleukin (IL-), 6, 8, and 10 and of tumor necrosis factor-alpha (TNF- α) in their blood. Conclusion: Various cognitive defects following an increase level of cytokines such as TNF-α and IL-6,8 have been observed. Therefore, due to the increase level of these pro-inflammatory factors in the brains of these patients, cognitive deficits can be expected, which need further investigation.

scholarly journals Manual Interventions for Musculoskeletal Factors in Infants With Suboptimal Breastfeeding: A Scoping Review

2018 ◽  
Vol 23 ◽  
pp. 2515690X1881697
Author(s):  
Cheryl Hawk ◽  
Amy Minkalis ◽  
Carol Webb ◽  
Olivia Hogan ◽  
Sharon Vallone
Keyword(s):  
Manual Therapy ◽  
Case Reports ◽  
Research Question ◽  
Case Series ◽  
First Year ◽  
Serious Adverse Events ◽  
Cross Sectional ◽  
Maternal Report ◽  
Suboptimal Breastfeeding ◽  
First Year Of Life

Exclusive breastfeeding for the first 6 months, and continuing for at least the first year of life, is strongly recommended. Suboptimal breastfeeding, which is breastfeeding that does not meet these recommendations, is a multifactorial issue. Some authorities, particularly in the nursing and lactation counseling professions, have identified musculoskeletal issues that may interfere with successful breastfeeding. The purpose of this project was to survey the literature on manual treatments to correct musculoskeletal dysfunctions in infants with suboptimal breastfeeding. Our research question was, “Have manual interventions been used to correct infants’ musculoskeletal dysfunctions thought to be linked to suboptimal breastfeeding?” We searched PubMed and Index to Chiropractic Literature, from inception through July 2018, as well as relevant gray literature. We assessed quality of randomized controlled trials (RCTs) and cohort studies using modified SIGN checklists, and the overall strength of evidence using GRADE. The search yielded 461 articles, with a final inclusion of 27 articles: 7 expert commentaries, 1 high-quality RCT, 1 low-quality cohort, 1 pilot study, 2 cross-sectional surveys, 5 narrative reviews, and 10 case series or case reports. Combining the 10 case series and reports in our search with 18 discussed in narrative reviews included in our review yielded 201 infants who received manual therapy for nursing dysfunction. No serious adverse events were reported and improvement in nursing ability was observed using various outcome measures, usually maternal report. Based on the GRADE criteria, there is moderate positive evidence for the effect of manual therapy on suboptimal breastfeeding.

scholarly journals Prevalence of Autism Spectrum Disorder among Rural, Urban, and Tribal Children (1–10 Years of Age)

2017 ◽  
Vol 08 (03) ◽  
pp. 368-374 ◽  
Author(s):  
Sunil Kumar Raina ◽  
Vishav Chander ◽  
Ashok K. Bhardwaj ◽  
Dinesh Kumar ◽  
Seema Sharma ◽  
...  
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Autism Spectrum ◽  
Second Phase ◽  
Age Group ◽  
Socioeconomic Group ◽  
Cross Sectional ◽  
Geographical Regions ◽  
Evaluation Phase ◽  
Tribal Populations

ABSTRACT Introduction: Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. Materials and Methods: A cross-sectional two-phase study was conducted cring children in the age group of 1–10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). Results: Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1–10 years were diagnosed as cases of ASD yielding a prevalence of 0.15% (95% confidence interval [CI] =0.15–0.25). Logistic regression analysis showed a two times significantly higher risk of diagnosing ASD in rural area as compared to tribal (odds ratio [OR]; 95% CI = 2.17 [1.04–4.52], P = 0.04). Male sex and upper socioeconomic group of head of family/father had a higher risk of getting diagnosed as autism as compared to lower socioeconomic group (OR; 95% CI - 3.23; 0.24–44.28, P = 0.38). Conclusions: Estimation of true prevalence of ASD in India is going to improve policies on developmental disabilities.

scholarly journals Efficacy of nicotine administration on obsessions and compulsions in OCD: a systematic review

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Daria Piacentino ◽  
Annalisa Maraone ◽  
Valentina Roselli ◽  
Isabella Berardelli ◽  
Massimo Biondi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ethical Issues ◽  
Case Reports ◽  
Treatment Strategies ◽  
Case Series ◽  
Symptom Improvement ◽  
Open Label ◽  
Cross Sectional ◽  
Positive Effects ◽  
Nicotine Administration

Abstract Background Preliminary studies have tested nicotine as a novel treatment for OCD patients who respond partially/incompletely or not at all to first and second-line treatment strategies, with the former represented by SSRIs or clomipramine, and the latter by switching to another SSRI, or augmentation with atypical antipsychotics, and/or combination with/switching to cognitive–behavioural therapy. Some studies found nicotine-induced reduction of obsessive thoughts and/or compulsive behaviour in OCD patients. We aimed to evaluate the efficacy of nicotine administration in OCD patients. Methods We searched the PubMed, ScienceDirect Scopus, CINHAL, Cochrane, PsycINFO/PsycARTICLES, and EMBASE databases from inception to the present for relevant papers. The ‘Preferred Reporting Items for Systematic Review and Meta-Analyses’ (PRISMA) standards were used. We included all studies focusing on the effects of nicotine administration on OCD patients’ obsessions or compulsions. Studies could be open-label, cross-sectional, randomized controlled trials, case series or case reports. Results A total of five studies could be included. Nicotine administration may ameliorate behavioural features and recurrent thoughts of severe, treatment-resistant OCD patients; however, in one study it was not associated with OC symptom improvement or cognitive enhancement across various executive function subdomains. Conclusions Although encouraging, the initial positive response from the use of nicotine in OCD needs testing in large controlled studies. This, however, raises ethical issues related to nicotine administration, due to its addiction potential, which were not addressed in the limited literature we examined. As an alternative, novel treatments with drugs able to mimic only the positive effects of nicotine could be implemented.

scholarly journals Is Non-Chlamydial Non-Gonococcal Urethritis Associated with Significant Clinical Complications in Men? A Systematic Review

2020 ◽  
Vol 14 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Cassandra E.L. Fairhead ◽  
Alexander Hampson ◽  
Louis Dwyer-Hemmings ◽  
Nikhil Vasdev
Keyword(s):  
Systematic Review ◽  
Reactive Arthritis ◽  
Case Reports ◽  
Case Series ◽  
Current Evidence ◽  
Future Research ◽  
Qualitative Synthesis ◽  
Cross Sectional ◽  
Gonococcal Urethritis ◽  
Clinical Complications

Background: It is estimated that between 50 and 89% of non-gonococcal urethritis is not caused by Chlamydia trachomatis. Associations between non-chlamydial non-gonococcal urethritis (NCNGU) with balanoposthitis, epididymo-orchitis and reactive arthritis have been suggested, but evidence to support these often-theoretical relationships is sparse and further investigation is called for. Concerns over increasing antimicrobial resistance has rendered the need for clarity over this question ever more pressing in recent years. A review of the current evidence on the complications of NCNGU in men is therefore urgently warranted. Objective: This systematic review summarizes and evaluates the available evidence that NCNGU, whether symptomatic or asymptomatic, causes the significant complications that are already well-recognized to be associated with non-gonococcal urethritis. These significant complications are epididymo-orchitis, balanoposthitis, and sexually-acquired reactive arthritis (Reiter's syndrome) including arthritis or conjunctivitis. Summary: We conducted a systematic review and qualitative synthesis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Five databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and British Nursing Index) were searched. We included studies that measured clinical outcome after diagnosis of NCNGU in men. Bias was assessed using variations of the Newcastle-Ottawa scale. Data were extracted and entered into a pre-written data abstraction proforma. Seven peer-review studies were included. This included 2 retrospective cohort studies, 1 case series, 2 case reports and 2 cross-sectional studies. The studies described and analyzed 3 types of complication: balanitis, posthitis and/or meatitis; reactive arthritis and/or conjunctivitis; and epididymitis. All studies reported one or more complications. Key Messages: This review identifies an important avenue for future research: while the available evidence suggests that NCNGU has the potential to cause significant complications in men, with the strongest evidence existing for balanitis, posthitis and/or meatitis, the nature and significance of these relationships is far from clear. The findings of this review suggest that prospective, adequately powered research into whether there is a causal link between NCNGU and significant clinical complications in men would be highly worthwhile. The findings of this review raise important questions about the utility of the term NCNGU in research and clinical practice.

scholarly journals General practitioner attitudes and confidence to deprescribing for elderly patients

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Pier Riccardo Rossi ◽  
Sarah E. Hegarty ◽  
Vittorio Maio ◽  
Marco Lombardi ◽  
Andrea Pizzini ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Real Life ◽  
Care Physician ◽  
Local Health Authority ◽  
Local Health ◽  
Cross Sectional Survey ◽  
Patient Centered ◽  
Cross Sectional ◽  
Factors Affecting

Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.

Is SARS-CoV-2 transmitted by asymptomatic and pre-symptomatic infected individuals?

2021 ◽  
Vol 54 ◽  
Author(s):  
Abigail F. Melicor ◽  
Katrina Loren R. Rey ◽  
Leonila F. Dans
Keyword(s):  
Case Reports ◽  
Case Series ◽  
The Philippines ◽  
World Health ◽  
Current Evidence ◽  
Wide Confidence Interval ◽  
Cross Sectional ◽  
Viral Shedding ◽  
Asymptomatic Patients ◽  
Health Organization

KEY FINDINGSAsymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur.• Manifestations of COVID-19 are highly varied and may include asymptomatic cases, who do not manifest with anysigns and symptoms despite testing positive for COVID-19 by viral nucleic acid tests. Pre-symptomatic cases areinfected individuals who are still in their incubation period, hence do not exhibit any symptoms yet but eventuallydevelop symptoms.• As of June 2020, only 586 (2.8%) of the 20,990 active cases in the Philippines were classified as asymptomatic,but it is unclear whether cases are pre-symptomatic or carriers (true asymptomatic).• Based on 36 observational studies (case reports, case series, cross-sectional and cohort studies) and 9 statisticalmodeling analysis, asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. However, 3studies reported no transmission from pre-symptomatic and asymptomatic cases.• Studies on viral load comparing symptomatic cases with pre-symptomatic and asymptomatic cases reportedcontradicting results. The duration of viral shedding was significantly longer for symptomatic patients comparedto asymptomatic patients but similar for asymptomatic and pre-symptomatic patients.• Therewas no difference in the transmission rates of symptomatic and asymptomatic cases. However,the estimatedinfectivity and probability of transmission was higherfor symptomatic cases compared to asymptomatic cases, butresults were imprecise due to a wide confidence interval.• The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recognize thepossibility of pre-symptomatic and asymptomatic transmission. According to WHO, current evidence suggestsasymptomatic cases are less likely to transmit the virus than symptomatic cases.

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