Risultati per: COVID-19: scoperto un nuovo meccanismo di resistenza immunitaria

Objectives
While older adults showed higher mortality during COVID-19 pandemic, protective behaviours (knowledge regarding coping with COVID-19 symptoms and preventive behaviours) were highlighted to be important to prevent the spread of infection. This study aimed to identify individual and community-level variables influencing deficient knowledge regarding coping with COVID-19 and not-practicing COVID-19 of older adults during the pandemic.

Design
This is a secondary analysis of a cross-sectional study using the 2020 Korea Community Health Survey (KCHS).

Setting
255 community public health centres nationwide, South Korea.

Methods and analysis
Using 2020 KCHS data, multilevel logistic regression analysis was conducted on 55 005 adults aged 65 years or older.

Results
Older adults who reside alone, as opposed to with their spouse and who lack the support of another individual exhibited insufficient COVID-19 coping-related knowledge (OR: 1.142, p

Objectives
To appraise the quality of clinical practice guidelines (CPGs) and expert consensus statements on rehabilitation for patients with COVID-19, summarise recommendations of rehabilitation assessments and interventions and evaluate the heterogeneity of the recommendations.

Design
Systematic review.

Data sources
PubMed and Embase databases and five online guideline repositories: The National Guideline Clearinghouse, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence and WHO were searched from their inception to August 2024. In addition, we reviewed reference lists of eligible citations and searched the grey literature on the relevant websites.

Eligibility criteria for selecting studies
We included CPGs and expert consensus statements which provided information about rehabilitation of patients with COVID-19. To be eligible, the CPGs and expert consensus statements were issued in English by a nationally or internationally recognised government authority, medical/academic society or organisation. If there were multiple versions of the guidelines, we included the latest one. The translations, interpretations and abstracts of guidelines were excluded.

Data extraction and synthesis
All recommendations on rehabilitation assessments and interventions for COVID-19 were extracted and summarised. Two reviewers independently evaluated the methodological quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and two other reviewers assessed the reporting quality using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement of included CPGs and expert consensus statements. We used the Measurement Scale of Rate of Agreement to evaluate the heterogeneity of the recommendations in different CPGs and expert consensus statements.

Results
A total of 31 CPGs and expert consensus statements were included. 14 guidelines provided recommendations for rehabilitation assessments. At the early, development, critical and recovery stages of COVID-19, the most frequently recommended were exercise therapy (25.8%, 35.5%, 25.8% and 58.1%, respectively). According to AGREE II, 17 included guidelines were assessed as low methodological quality (35%–56%), 10 guidelines were rated as moderate quality (46%– 62%) and four had high quality (69%–79%). Among 31 eligible guidelines, the reporting rate of 22 items in the RIGHT checklist ranged from 10% to 100%. The included guidelines were consistent with the reference guidelines (80%–100%). Only one guideline existed minor (60%–80%) disagreements in respiratory muscle training relative to the reference guideline.

Conclusions
Rehabilitation assessments and interventions should be implemented consistently throughout the entire process of COVID-19. The recommendations should be tailored to each stage of COVID-19. The methodological and reporting qualities of several guidelines remain suboptimal. Therefore, developers should adhere strictly to the AGREE II standard and RIGHT checklist to formulate and publish CPGs and expert consensus statements with high quality.

PROSPERO registration number
CRD42020190761.

Objectives
This study aims to describe the incidence, symptom clusters and determinants of post-acute COVID symptoms using data from the COVID RADAR app in the Netherlands.

Design
Prospective cohort.

Setting
General population in the Netherlands from April 2020 to February 2022.

Participants
A total of 1478 COVID RADAR app users, with data spanning 40 days before to 100 days after positive SARS-CoV-2 test.

Outcome measures
Incidence and duration of 10 new symptoms that developed during acute infection, defined as 10 days prior and 10 days after positive test. Clustering of these post-acute COVID symptoms and associations between factors known in the acute phase and 100-day symptom persistence.

Results
The most frequent post-acute symptoms were cough, loss of smell or taste and fatigue. At 100 days postinfection, 86 (8%) participants still experienced symptoms. Three post-acute COVID symptom clusters were identified: non-respiratory (headache and fatigue; 49% of participants with post-acute COVID symptoms); olfactory (15%) and respiratory (8%). Vaccination was associated with a lower risk of post-acute COVID symptoms 100 days after infection, although CIs were wide (OR: 0.5; 95% CI: 0.2 to 1.5), but not with non-respiratory symptoms (OR: 1.0; 95% CI: 0.3 to 4.4). Severe acute disease increased the risk of post-acute COVID symptoms (OR: 1.4; 95% CI: 1.2 to 1.5; per additional acute symptom).

Conclusions
In this cohort of infected community-dwelling app users, 5%–10% experienced post-acute COVID symptoms. The symptoms cluster in several distinct entities, which differ in incidence, patient characteristics and vaccination effects. This suggests multiple mechanisms underlying the development of post-acute COVID symptoms.

4,2 anni in più per le femmine, 1,4 per i maschi

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

While the incidence of persistent and recurring symptoms of SARS-CoV-2, also known as post–COVID-19 condition or long COVID, decreased over the course of the COVID-19 pandemic, the risk remained even among those who were vaccinated, according to a new study published in the New England Journal of Medicine.

Uno studio pubblicato su Nature Communication fa luce su Oser1

Scendono i decessi. La Lombardia è la regione con più contagi

Un pericolo per i pazienti fragili soprattutto negli ospedali

Objectives
To ensure sufficient resources to care for patients with COVID-19, healthcare systems delayed non-urgent surgeries to free capacity. This study explores the consequences of delaying non-urgent surgery on surgical care and healthcare resource use.

Design
This is a population-based retrospective cohort study.

Setting
This study took place in Alberta, Canada, from December 2018 to December 2021.

Participants
Adult patients scheduled for surgery in Alberta during the study period were included.

Primary and secondary outcomes measures
The proportion of surgeries completed and surgery wait time were the primary outcomes. The secondary outcomes were healthcare resource use (hospital length of stay, emergency room visits and physician visits). The association between the primary outcomes and patient and surgery-related variables was explored using regression.

Results
There were 202 470 unique patients with 259 677 scheduled surgeries included. Fewer surgeries were completed throughout the pandemic compared with before; in the fourth wave, there was a decrease from 79% pre-COVID-19 to 67%. There was a decrease in wait time for those who had surgery completed during COVID-19 (from 105 to 69 days). Having surgery completed and the wait for surgery were associated with the geographical zone, COVID-19 wave, and the surgery type and priority. There was a decrease in all measures of healthcare resource use and an increase in hospital and all-cause mortality during COVID-19 compared with before COVID-19.

Conclusions
The change in the proportion of scheduled surgeries completed and the wait time for completed surgery was modest and associated with COVID-19 wave and surgery-related variables, which was aligned with policies enacted during COVID-19 for surgery. The decrease in healthcare resource use suggests the effects of the COVID-19 pandemic may be delayed and may result in many patients presenting with advanced disease requiring surgical care.

Objective
To identify the associations of in-hospital cardiovascular events and mortality with pre-existing comorbidities and cardiovascular disease (CVD) risk factors among COVID-19 patients in Bangladesh without vaccine availability.

Design
A secondary analysis of a prospective multicountry study.

Setting
Three COVID-19-designated hospitals in Bangladesh.

Participants
Adult patients aged ≥18 years with PCR-positive COVID-19 admitted between 10 October 2020 and 31 July 2021 at participating hospitals.

Outcome measures
In-hospital cardiovascular events and mortality.

Main exposures
Pre-existing comorbidities and cardiovascular risk factors.

Results
In 897 COVID-19 patients, 18.7% developed cardiovascular events and 12.6% died. After adjusting for clinical information and treatment, patients with two comorbidities (excluding CVD risk factors) were significantly associated with cardiovascular events (adjusted (adj.) OR 2.47, 95% CI 1.24 to 4.90). Patients with a higher heart rate at admission (adj. OR 1.03, 95% CI 1.01 to 1.04) and those who were receiving intravenous fluids (adj. OR 2.13, 95% CI 1.23 to 3.70) or antibiotics (adj. OR 4.54, 95% CI 1.47 to 14.01) had significantly higher odds of cardiovascular events. The odds of cardiovascular events were lower in those receiving antiviral medications (adj. OR 0.31, 95% CI 0.18 to 0.53). There were no interactions between comorbidities and other covariates in the models. Comorbidities and cardiovascular risk factors were not significantly associated with 30-day mortality in the Cox regression models after adjusting with clinical information and treatment. The mortality within 30 days of admission was significantly higher in patients receiving corticosteroids (adj. HR 2.82, 95% CI 1.48 to 5.38) and lower in those receiving antiviral treatment (adj. HR 0.53, 95% CI 0.34 to 0.81). Those having cardiovascular events significantly increased mortality hazard.

Conclusions
Clinical factors and treatment affected in-hospital cardiovascular events, which subsequently increased the risk of mortality within 30 days for COVID-19 patients. COVID-19 patients regardless of CVD risk factors and comorbidities require close monitoring for cardiovascular events.

Impiegati a San Marino. Anelli, ‘sentenza dopo quella Consulta’

Crescono i decessi: sono stati 135, quasi la metà in Lombardia

Introduction
Post- or long-COVID-19 conditions manifest with a spectrum of symptoms reminiscent of pulmonary, musculoskeletal, psychological and neurological disorders. Individuals with post- or long-COVID-19 syndrome often present with myalgia, pulmonary problems and fatigue, which significantly impact their daily functioning. Physiotherapy interventions are an accepted medical remedy for these symptoms. This scoping review aims to outline the evidence of physiotherapy interventions documented in the scientific literature, specifically focusing on hands-on therapy.

Methods and analysis
This scoping review conforms to the methodological framework established by the Joanna Briggs Institute (JBI). The procedure for drafting a scoping review involves several steps, starting with defining the research question and the inclusion and exclusion criteria. Eligible studies are those analysing physiotherapy treatment parameters for direct patient interaction in post- and long-COVID-19 patients. Telemedicine and entirely home-based workouts will be excluded aligning with the context of outpatient physiotherapy in Germany. The literature search will be conducted in PubMed, EBSCO research, Scopus, Web of Science, Embase, PEDRO, Cochrane and WISO databases by two independent researchers. Screening, data extraction and a critical appraisal will be performed by these researchers using assessment tools provided by the JBI. Extracted data will encompass demographic characteristics, definitions of post- or long-COVID-19 conditions, descriptions of interventions, their treatment parameters and treatment outcome. Subsequently, findings will be disseminated through a scoping review article or conference presentation.

Ethics and dissemination
Given that this review does not involve human participants, ethical committee approval is deemed unnecessary. The results will be published in peer-reviewed journals and presented at academic and physiotherapeutic conferences.

A clinical trial evaluating the safety and effectiveness of a nasal vaccine candidate known as MPV/S-2P to protect against COVID-19 recently began enrolling participants, the US National Institutes of Health (NIH) announced.