las características clínicas y el tratamiento recibido por los pacientes hospitalizados por COVID-19 han ido modificándose con el tiempo. El objetivo fue analizar la evolución clínico-terapéutica de ...los pacientes en las ondas epidémicas y estimar un modelo predictivo de la mortalidad.
estudio observacional de cohortes retrospectivo considerando los pacientes ingresados con infección confirmada por SARS-CoV-2 hasta marzo de 2022. Se recogieron variables sociodemográficas, comorbilidades y tratamientos, y se creó un modelo predictivo de fallecimiento mediante regresión logística multivariante.
se incluyeron 1.784 pacientes. Se encontraron diferencias entre las ondas epidémicas con respecto a la edad, sexo, hipertensión arterial, diabetes mellitus, obesidad y enfermedad renal crónica. Ceftriaxona, azitromicina, hidroxicloroquina, metilprednisolona y lopinavir-ritonavir fueron los fármacos más frecuentemente utilizados en la primera onda. Amoxicilina, dexametasona y tocilizumab se prescribieron en mayor frecuencia en ondas sucesivas. El porcentaje de fallecimientos varió desde un 5,6% en la cuarta onda a un 14,1% en la tercera (p<0,001). Los factores resultantes asociados con la mortalidad (OR; IC 95%) fueron el ingreso en UCI (56,5; 27,4-121), la edad (1,09; 1,08-1,11), los días de ingreso (0,98; 0,96-0,99), la enfermedad renal crónica (1,67; 1,16-2,40) y haber recibido tratamiento con tocilizumab (2,49; 1,43-4,30), dexametasona (1,58; 1,10-2,26) y metilprednisolona (2,46; 1,63-3,68). El área bajo la curva alcanzado por el modelo fue de 0,863.
parecen existir diferencias clínico-terapéuticas en los pacientes durante las 6 primeras ondas epidémicas. El conocimiento de los factores de riesgo de mortalidad permitirá la detección de los pacientes hospitalizados con mayor riesgo y optimizar precozmente su manejo terapéutico.
The clinical characteristics and treatment received by patients hospitalized with COVID-19 have changed over time. The objective was to analyze the clinicaltherapeutic evolution of patients in the epidemic waves and estimate a predictive model for mortality.
Retrospective cross-sectional study considering patients admitted with confirmed SARS-CoV-2 infection until March 2022. Sociodemographic variables, comorbidities and treatments were collected and a predictive model for mortality was created using multivariate logistic regression.
1,784 patients were included. Significant differences were found between the epidemic waves with respect to age, sex, arterial hypertension, diabetes mellitus, obesity and chronic kidney disease. Ceftriaxone, azithromycin, hydroxychloroquine, methylprednisolone and lopinavir-ritonavir were the most frequently used drugs in the first wave. Amoxicillin, dexamethasone and tocilizumab were prescribed more frequently in successive waves. The percentage of deaths varied from 5.6% in the fourth wave to 14.1% in the third (p<0.001). The resulting factors associated with mortality (OR; 95% CI) were ICU admission (56.5; 27.4-121), age (1.09; 1.08-1.11), days of admission (0.98; 0.96-0.99), chronic kidney disease (1.67; 1.16-2.40) and having received treatment with tocilizumab (2.49; 1.43-4.30), dexamethasone (1.58; 1.10-2.26) and methylprednisolone (2.46; 1.63-3.68). The area under the curve achieved by the model was 0.863.
There are significant clinical-therapeutic differences in patients along the first six epidemic waves. Knowledge of mortality risk factors will allow the detection of hospitalized patients at higher risk and early optimization of their therapeutic management.
Porcine Epidemic Diarrhea Virus (PEDV) is a coronavirus that infects the intestinal tract and causes diarrhea and vomiting in older pigs or extreme dehydration and death that could reach 100% ...mortality in neonatal piglets. In the US, the first PEDV outbreaks occurred in 2013 and since then US PEDV strains have quickly spread throughout the US and worldwide, causing significant economic and public health concerns. Currently two conditionally approved vaccines exist in the US, but there is no live attenuated vaccine, which is considered the best option in controlling PEDV by inducing transferrable mucosal immunity to susceptible neonatal piglets. In this study, we passaged an US PEDV isolate under various conditions to generate three strains and characterized their growth and antigenicity in cell culture using various assays including Western blot analysis, serum neutralization assay, sequencing analysis and confocal microscopy. Finally, these strains were evaluated for pathogenicity in nursing piglets (1-4 days old).
One of the PEDV strains generated in this study (designated as PEDV 8aa) is able to replicate in cells without any protease and grows to a high titer of >8 log
TCID
/ml in cell culture. Interestingly, replication of PEDV 8aa was severely reduced by trypsin and this correlated with the inhibition of virus attachment and entry into the cells. In neonatal nursing piglets, PEDV 8aa (passage number 70 or 105) was found to be fully attenuated with limited virus shedding.
These results suggest that applying selective pressure during viral passages can facilitate attainment of viral attenuation and that PEDV 8aa warrants further investigation as an attenuated vaccine.
Yellow fever (YF) is a re-emerging viral zoonosis caused by the
(YFV), affecting humans and non-human primates (NHP). YF is endemic in South America and Africa, being considered a burden for public ...health worldwide despite the availability of an effective vaccine. Acute infectious disease can progress to severe hemorrhagic conditions and has high rates of morbidity and mortality in endemic countries. In 2016, Brazil started experiencing one of the most significant YF epidemics in its history, with lots of deaths being reported in regions that were previously considered free of the disease. Here, we reviewed the historical aspects of YF in Brazil, the epidemiology of the disease, the challenges that remain in Brazil's public health context, the main lessons learned from the recent outbreaks, and our perspective for facing future YF epidemics.
Two months after it was firstly reported, the novel coronavirus disease COVID-19 spread worldwide. However, the vast majority of reported infections until February occurred in China. To assess the ...effect of early travel restrictions adopted by the health authorities in China, we have implemented an epidemic metapopulation model that is fed with mobility data corresponding to 2019 and 2020. This allows to compare two radically different scenarios, one with no travel restrictions and another in which mobility is reduced by a travel ban. Our findings indicate that i) travel restrictions might be an effective measure in the short term, however, ii) they are ineffective when it comes to completely eliminate the disease. The latter is due to the impossibility of removing the risk of seeding the disease to other regions. Furthermore, our study highlights the importance of developing more realistic models of behavioral changes when a disease outbreak is unfolding.
We previously identified a third porcine epidemic diarrhoea virus (PEDV) S variant with a large deletion of 582 nucleotides in the 5' terminal region of the S gene, in addition to the North American ...type and the S INDELs type. To investigate the pathogenicity of this variant, TTR-2/JPN/2014, we performed experimental infection using colostrum-deprived piglets and compared the results with those from the North American type PEDV, OKN-1/JPN/2013. Fifteen newborn piglets were divided into two groups of 7-8 piglets each and inoculated orally with one of PEDV isolates maintained at the eighth passage in Vero cell culture. Although all PEDV-inoculated piglets showed acute watery diarrhoea, lethality clearly differed between both PEDV-inoculated groups. Moreover, there were differences in virus distribution and lesions on the intestines between the two PEDV-inoculated groups. Therefore, our data suggest that the OKN-1/JPN/2013 PEDV isolate is virulent, whereas the TTR-2/JPN/2014 PEDV isolate is avirulent.
Severe acute respiratory syndrome coronavirus (SARS-CoV), emerged from China and rapidly spread worldwide. Over 8098 people fell ill and 774 died before the epidemic ended in July 2003. Bats are ...likely an important reservoir for SARS-CoV. SARS-like CoVs have been detected in horseshoe bats and civet cats. The main mode of transmission of SARS-CoV is through inhalation of respiratory droplets. Faeco-oral transmission has been recorded. Strict infection control procedures with respiratory and contact precautions are essential. Fever and respiratory symptoms predominate, and diarrhea is common. Treatment involves supportive care. There are no specific antiviral treatments or vaccines available.
•The experiences of pregnant women from past epidemics and pandemics were consolidated.•Midwives’ and nurses’ perceptions of epidemics and pandemics were explored.•Individualized and contextualized ...educational support is needed.•Culturally congruent care and emotional and financial support need to be prioritized.•Healthcare professionals can consider technology-based and community-led supportive programs.
To consolidate qualitative research studies that examined the experiences and needs of pregnant women, midwives, and nurses of maternity units to provide a way forward for future research and practices during the current pandemic and future epidemics and pandemics.
Qualitative systematic review and meta-synthesis.
Four electronic databases—PubMed, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health (CINAHL).
Qualitative studies with samples of pregnant women, midwives, and/or nurses of maternity units who experienced epidemics and/or pandemics were searched from 1 January 2000 to 4 April 2020. The included studies were critically appraised using the ten-item Critical Appraisal Skills Programme (CASP) tool.
Eight studies were included in this review. Four themes emerged from the synthesis: (1) psychological responses, (2) challenges faced, (3) coping strategies, and (4) sources of support and support needs.
Pregnant women, midwives, and nurses experienced negative psychological responses during epidemics and pandemics. Challenges, such as limited available information and public stigma, were faced. Various coping strategies, such as actively looking for more information and seeking solace in religions, were practiced by pregnant women, midwives, and nurses. Families were both sources of support and stress and they expressed needs for more informational, emotional, and financial support during pandemics.
More culturally diverse research in the future that includes the development of technology-based programs, trained community volunteer-led programs, psychosocial interventions, and anti-stigma and awareness initiatives are needed to combat the current pandemic and future public health crises.
Online education has become a vital weapon to fight against the COVID-19 epidemic in the world. In the home-based online education environment, female pre-school teachers are expected to balance the ...dual roles of teacher and mother at the same time, which may trigger the work-family conflict. Although previous studies analyzed individual stressors, work-family conflict and its outcomes, there is little research on pre-school teachers' work and parenting experience during major public health emergencies. The current study examined the associations among work overload, parenting stress, work-family conflict, and job satisfaction during the COVID-19. Seven hundred eighteen female pre-school teachers with children who worked online at home participated in the study. Female pre-school teachers reported that the COVID-19 has increased work overload and parenting stress. Moreover, work overload was negatively associated with job satisfaction via its positive association with work-to-family conflict. Parenting stress was negatively associated with job satisfaction via both family-to-work conflict and work-to-family conflict. The study contributes to a better understanding of the association among female pre-school teachers' work overload, parenting stress, work-family conflict, and job satisfaction. Our findings highlighted potential avenues for interventions aimed at balancing female pre-school teachers' work and family and improving their job satisfaction during the COVID-19.
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