scholarly journals Characterization of epidemiological distribution and outcome of COVID-19 in patients with hereditary hemorrhagic telangiectasia: a nationwide retrospective multi-centre study during first wave in Italy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Patrizia Suppressa ◽  
Fabio Pagella ◽  
Gennaro Mariano Lenato ◽  
Eleonora Gaetani ◽  
Ilaria Serio ◽  
...  
Keyword(s):  
Intensive Care ◽  
General Population ◽  
Hospital Admission ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Fatal Outcome ◽  
Structured Interview ◽  
Infection Risk ◽  
Multi Centre Study ◽  
The Impact ◽  
Pandemic Wave

Abstract Background Coronavirus Disease 2019 (COVID-19) continues to have a devastating impact across the world. A number of pre-existing common clinical conditions were reported to represent risk factors for more severe COVID-19 outcomes. Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular heritable disorders, characterized by complications secondary to visceral Arterio-Venous Malformations. The impact of HHT, as well as for many Rare Diseases (RDs) on infection susceptibility profile and clinical adverse outcome risk is an unresolved issue. Objectives The main objectives were: to assess the clinical features and outcomes of HHT patients infected with COVID-19; to compare the relative infection risk in these patients with the Italian general population throughout the first pandemic wave; to investigate the factors potentially associated with severe COVID-19 outcome in HHT patients, and the possible impact of COVID-19 infection on HHT-related symptoms/complications. Finally, we aimed to estimate how the lockdown-associated wearing of personal protective equipment/individual protection devices could affect HHT-related telangiectasia bleeding frequency. Methods The study is a nation-wide questionnaire-based survey, with a multi-Center retrospective cross-sectional design, addressed to the whole Italian HHT population. COVID-19 cases, occurring throughout the first pandemic wave, were collected by a questionnaire-based semi-structured interview. Only the cases ascertained by laboratory confirmation (molecular/serological) were included for epidemiological estimates. Information concerning eventual SarS-Cov-2 infection, as well as regarding HHT-related manifestations and HHT-unrelated co-morbidities were collected by the questionnaire. Prevalence data were compared to Italian general population in the same period. Results The survey disclosed 9/296 (3.04%) COVID-19 cases, 8/9 of them being resident in Lombardy, the main epidemic epicenter. Pneumonia was reported by 4/9 patients, which prompted hospital admission and intensive care management in 2 cases. No fatal outcome was recorded. After careful refinement of epidemiological analysis, the survey evidenced overlapping infection risk in HHT compared to general population. Conclusions COVID-19 infection profile parallels geographical distribution of epidemic foci. COVID-19 in HHT patients can lead to highly variable clinical profile, likely overlapping with that of general population. The HHT disease does not seem to involve a different approach in terms of hospital admission and access to intensive care with respect to general population.

scholarly journals Medication Changes and Diagnosis of New Chronic Illnesses in COVID-19 Intensive Care Unit Survivors

2022 ◽  
pp. 106002802110633
Author(s):  
Rima A. Mohammad ◽  
Cynthia T. Nguyen ◽  
Patrick G. Costello ◽  
Janelle O. Poyant ◽  
Siu Yan Amy Yeung ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Medical Condition ◽  
Hospital Length Of Stay ◽  
Medical Conditions ◽  
Medication Change ◽  
The Impact ◽  
Medication Changes

Background Currently, there is limited literature on the impact of the COVID-19 infection on medications and medical conditions in COVID-19 intensive care unit (ICU) survivors. Our study is, to our knowledge, the first multicenter study to describe the prevalence of new medical conditions and medication changes at hospital discharge in COVID-19 ICU survivors. Objective To determine the number of medical conditions and medications at hospital admission compared to at hospital discharge in COVID-19 ICU survivors. Methods Retrospective multicenter observational study (7 ICUs) evaluated new medical conditions and medication changes at hospital discharge in patients with COVID-19 infection admitted to an ICU between March 1, 2020, to March 1, 2021. Patient and hospital characteristics, baseline and hospital discharge medication and medical conditions, ICU and hospital length of stay, and Charlson comorbidity index were collected. Descriptive statistics were used to describe patient characteristics and number and type of medical conditions and medications. Paired t-test was used to compare number of medical conditions and medications from hospital discharge to admission. Results Of the 973 COVID-19 ICU survivors, 67.4% had at least one new medical condition and 88.2% had at least one medication change. Median number of medical conditions (increased from 3 to 4, P < .0001) and medications (increased from 5 to 8, P < .0001) increased from admission to discharge. Most common new medical conditions at discharge were pulmonary disorders, venous thromboembolism, psychiatric disorders, infection, and diabetes. Most common therapeutic categories associated with medication change were cardiology, gastroenterology, pain, hematology, and endocrinology. Conclusion and Relevance Our study found that the number of medical conditions and medications increased from hospital admission to discharge. Our results provide additional data to help guide providers on using targeted approaches to manage medications and diseases in COVID-19 ICU survivors after hospital discharge.

scholarly journals The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 60-72 ◽  
Author(s):  
José María Pego-Reigosa ◽  
Lindsay Nicholson ◽  
Nick Pooley ◽  
Sue Langham ◽  
Nina Embleton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herpes Zoster ◽  
General Population ◽  
Meta Analysis ◽  
Severe Infection ◽  
Infection Risk ◽  
Sensitivity Analyses ◽  
Healthy Controls ◽  
Increased Risk ◽  
The Impact

Abstract Objectives We conducted a systematic review and meta-analysis to determine the magnitude of infection risk in patients with SLE and evaluate the effect of general and SLE-related factors on infection risk. Methods We searched MEDLINE and Embase from inception to July 2018, screening for observational studies that evaluated infection risk in patients with SLE compared with the general population/healthy controls. Outcomes of interest included overall severe infection, herpes zoster infection/reactivation, opportunistic infections, pneumonia and tuberculosis. Random-effects models were used to calculate pooled risk ratios (RRs) for each type of infection. Sensitivity analysis assessed the impact of removing studies with high risk of bias. Results Eleven retrospective or prospective cohort studies were included in the meta-analysis: overall severe infection (n = 4), pneumonia (n = 6), tuberculosis (n = 3) and herpes zoster (n = 2). Pooled RRs for overall severe infection significantly increased for patients with SLE compared with the general population/healthy controls [RR 2.96 (95% CI 1.28, 6.83)]. Pooled RRs for pneumonia, herpes zoster and tuberculosis showed significantly increased risk compared with the general population/healthy controls [RR 2.58 (1.80, 3.70), 2.50 (2.36, 2.65) and 6.11 (3.61, 10.33), respectively]. Heterogeneity and evidence of publication bias were present for all analyses, except herpes zoster. Sensitivity analyses confirmed robustness of the results. Conclusion Patients with SLE have significantly higher risk of infection compared with the general population/healthy controls. Efforts to strengthen strategies aimed at preventing infections in SLE are needed. Protocol registration PROSPERO number: CRD42018109425.

scholarly journals Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

BMJ ◽  
2020 ◽  
pp. m3582 ◽  
Author(s):  
Anoop S V Shah ◽  
Rachael Wood ◽  
Ciara Gribben ◽  
David Caldwell ◽  
Jennifer Bishop ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
General Population ◽  
Hospital Admission ◽  
Healthcare Workers ◽  
Hospital Admissions ◽  
Absolute Risk ◽  
Hazard Ratio ◽  
Front Door ◽  
Household Members

AbstractObjectiveTo assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.DesignNationwide linkage cohort study.SettingScotland, UK, 1 March to 6 June 2020.ParticipantsHealthcare workers aged 18-65 years, their households, and other members of the general population.Main outcome measureAdmission to hospital with covid-19.ResultsThe cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in “front door,” intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity.ConclusionsHealthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.

scholarly journals Impact of Air Transport on SpO2/FiO2 among Critical COVID-19 Patients during the First Pandemic Wave in France

2021 ◽  
Vol 10 (22) ◽  
pp. 5223
Author(s):  
Jean-Baptiste Bouillon-Minois ◽  
Vincent Roux ◽  
Matthieu Jabaudon ◽  
Mara Flannery ◽  
Jonathan Duchenne ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Air Transport ◽  
Arterial Oxygenation ◽  
Full Data ◽  
Critical Patients ◽  
The Impact ◽  
Pandemic Wave

During the first wave of the COVID-19 pandemic, some French regions were more affected than others. To relieve those areas most affected, the French government organized transfers of critical patients, notably by plane or helicopter. Our objective was to investigate the impact of such transfers on the pulse oximetric saturation (SpO2)-to-inspired fraction of oxygen (FiO2) ratio among transferred critical patients with COVID-19. We conducted a retrospective study on medical and paramedical records. The primary endpoint was the change in SpO2/FiO2 during transfers. Thirty-eight patients were transferred between 28 March and 5 April 2020, with a mean age of 62.4 years and a mean body mass index of 29.8 kg/m2. The population was 69.7% male, and the leading medical history was hypertension (42.1%), diabetes (34.2%), and dyslipidemia (18.4%). Of 28 patients with full data, we found a decrease of 28.9 points in SpO2/FiO2 (95% confidence interval, 5.8 to 52.1, p = 0.01) between the starting and the arrival intensive care units (SpO2/FiO2, 187.3 ± 61.3 and 158.4 ± 62.8 mmHg, respectively). Air medical transfers organized to relieve intensive care unit teams under surging conditions during the first COVID wave were associated with significant decreases in arterial oxygenation.

scholarly journals The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19 – the COVIP Study

2021 ◽  
Author(s):  
Christian Jung ◽  
Hans Flaatten ◽  
Jesper Fjølner ◽  
Raphael Romano Bruno ◽  
Bernhard Wernly ◽  
...  
Keyword(s):  
Intensive Care ◽  
Management Strategies ◽  
Prognostic Indicators ◽  
Prognostic Information ◽  
Clinical Frailty Scale ◽  
Multi Centre Study ◽  
Intensive Care Patients ◽  
Frail Patients ◽  
Large Numbers ◽  
The Impact

Abstract BackgroundThe COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.MethodsA prospective multi-centre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the Clinical Frailty Scale (CFS). Additionally, comorbidities, management strategies and treatment limitations were recorded.ResultsThe study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years and 21% of the patients were frail. The overall survival at 30 days was 59% (95%CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p<0.001). In frail patients, there was no difference in 30 day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.ConclusionFrailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.

scholarly journals The impact of the hospitalization process on the caregiver of a chronic critical patient hospitalized in a Semi-Intensive Care Unit

2018 ◽  
Vol 22 (2) ◽  
Author(s):  
Letícia Neves ◽  
Andressa Alencar Gondim ◽  
Sara Costa Martins Rodrigues Soares ◽  
Denis Pontes Coelho ◽  
Joana Angélica Marques Pinheiro
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Structured Interview ◽  
Care Hospital ◽  
Exploratory Research ◽  
Hospitalization Period ◽  
The Family ◽  
Critical Patients ◽  
The Impact ◽  
Intense Process

Abstract Objective: To understand the impact of the hospitalization process on the family companion of critical patients admitted to a Semi-Intensive Care Unit (SICU). Method: Exploratory research with a qualitative approach, conducted in the months of April to July of 2016 through a semi-structured interview applied to relatives who were accompanying patients hospitalized in an SICU of a high complexity care hospital in Fortaleza. The interviews were submitted to content analysis. Results: Three themes emerged through the perception of the family members, which reveal the companion's functioning during the hospitalization period: emotional, familiar and behavioural. Conclusion: The companion experiences an intense process of suffering and emotional fragility, causing changes in the family organization. The companion, being a caregiver, is subjected to high levels of stress, having to use coping skills, with; spirituality and social media among the most evident. The companion is an integral care unit for the hospitalized patient and a key piece in the humanization process of health.

scholarly journals Sentimentos maternos frente à hospitalização do filho prematuro: análise de conteúdo

2018 ◽  
Vol 16 (4) ◽  
pp. 439
Author(s):  
Keli Regiane Tomeleri da Fonseca Pinto ◽  
Evelin Daiane Gabriel Pinhatti ◽  
Adriana Valongo Zani ◽  
Cristina Maria Garcia de Lima Pàrada
Keyword(s):  
Intensive Care ◽  
Interpersonal Relationships ◽  
Neonatal Intensive Care ◽  
Structured Interview ◽  
Analysis Framework ◽  
Care Environment ◽  
Descriptive Research ◽  
Premature Child ◽  
Qualitative Nature ◽  
The Impact

Aim: understand the feelings experienced by the mother when having her premature child hospitalized in the Neonatal Intensive Care Unit (NICU). Method: Descriptive research of a qualitative nature, performed with 11 mothers, through a semi-structured interview. The Content Analysis framework was adopted. Results: three thematic categories were identified: Suffering from the hospitalization of the premature child; Premature child care: trust in the team; Experiencing the impact of the neonatal intensive care environment. Discussion: mothers were faced with feelings such as fear, guilt over suffering and possible loss of the child, and reported feeling powerless and unable to care for the child at this time, which increased their anguish. Conclusion: mothers, when faced with the premature child in the NICU, experienced different feelings, feeling incapable and, often, moving away from the newborn. However, they reported confidence and security in the care of professionals with their children, valuing both technical aspects and interpersonal relationships.

Voices of Distress: The Emotional Peril of Not Attaining a Dietetic Internship in Ontario

2013 ◽  
Vol 1 (3) ◽  
pp. 9
Author(s):  
Jennifer Lee Brady ◽  
Annie Hoang ◽  
Olivia Siswanto ◽  
Jordana Riesel ◽  
Jacqui Gingras
Keyword(s):  
Empirical Research ◽  
Current Model ◽  
Well Being ◽  
Structured Interview ◽  
Application Process ◽  
Dietetic Education ◽  
Dietetic Internship ◽  
The Impact ◽  
And Training ◽  
Future Growth

Obtaining dietetic licensure in Ontario requires completion of a Dietitians of Canada (DC) accredited four-year undergraduate degree in nutrition and an accredited post-graduate internship or combined Master’s degree program. Given the scarcity of internship positions in Ontario, each year approximately two-thirds of the eligible applicants who apply do not receive a position XX, XX, XX, XX, XX, XX, in press). Anecdotally, not securing an internship position is known to be a particularly disconcerting experience that has significant consequences for individuals’ personal, financial, and professional well-being. However, no known empirical research has yet explored students’ experiences of being unsuccessful in applying for internship positions. Fifteen individuals who applied between 2005 and 2009 to an Ontario-based dietetic internship program, but were unsuccessful at least once, participated in a one-on-one semi-structured interview. Findings reveal that participants’ experiences unfold successively in four phases that are characterized by increasingly heightened emotional peril: naïveté, competition, devastation, and frustration. The authors conclude that the current model of dietetic education and training in Ontario causes lasting distress to students and hinders the future growth and vitality of the dietetic profession. Further research is required to understand the impact of the current model on dietetic educators, internship coordinators, and preceptors as coincident participants in the internship application process.

HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA

2020 ◽  
Vol 6 (5) ◽  
pp. 1183-1189
Author(s):  
Dr. Tridibesh Tripathy ◽  
Dr. Umakant Prusty ◽  
Dr. Chintamani Nayak ◽  
Dr. Rakesh Dwivedi ◽  
Dr. Mohini Gautam
Keyword(s):  
Large Scale ◽  
National Level ◽  
Uttar Pradesh ◽  
Life Time ◽  
Structured Interview ◽  
The Other ◽  
Registration System ◽  
Action Group ◽  
Current Article ◽  
The Impact

The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP. The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period.     The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents.   A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions.  The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.   Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs.   Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.

Sign in / Sign up

Export Citation Format

Share Document