Risultati per: Anticoagulazione nei pazienti con COVID-19

Objectives
Globally, there is a lack of evidence regarding access to and utilisation of antigen rapid diagnostic tests (Ag-RDTs). This might hinder public health interventions to increase testing. We conducted a survey to understand access to and utilisation of COVID-19 Ag-RDT among residents in Phnom Penh, Cambodia.

Design
This is a representative household survey using linear regression models with random effects to account for clustering and a logistic model with random effects to assess factors associated with Ag-RDT access.

Setting
We conducted the study in 10 villages in Phnom Penh between August and mid-September 2022.

Participants
We enrolled one member per household (n=280), aged between 18 and 65 years.

Outcome measures
Both access and utilisation were defined at the individual level (self-reports). We defined access as having undergone COVID-19 rapid testing within 6 months and utilisation as having administered this test (to themselves or others) within 12 months, prior to the study interview.

Results
In a clustering-adjusted linear model, access to Ag-RDTs among the general population from the 10 villages was 34% (n=95) and utilisation was 28% (n=77). Price and advice from the pharmacist were commonly reported to be the main selection criteria for Ag-RDTs, with 41% (n=111) and 62% (n=175), respectively. In the logistic model, those with higher educational attainment were more likely to have access to the Ag-RDT compared with those with lower education levels (adjusted OR4.42, 95% CI 1.82 to 10.74).

Conclusions
Unfamiliarity with Ag-RDT tests and low education levels negatively affect access and utilisation of Ag-RDTs among the general population in Phnom Penh.

Objectives
To investigate the serum IL-6 levels and their rate of change in predicting the mortality of critically ill patients with COVID-19 in Vietnam.

Design
A single-centre, cross-sectional study.

Setting
An Intensive Care Centre for the Treatment of Critically Ill Patients with COVID-19 in Ho Chi Minh City, Vietnam.

Participants
We included patients aged 18 years or older who were critically ill with COVID-19 and presented to the study centre from 30 July 2021 to 15 October 2021. We excluded patients who did not have serum IL-6 measurements between admission and the end of the first day.

Primary outcome measures
The primary outcome was hospital all-cause mortality.

Results
Of 90 patients, 41.1% were men, the median age was 60.5 years (Q1–Q3: 52.0–71.0), and 76.7% of patients died in the hospital. Elevated IL-6 levels were observed on admission (41.79 pg/mL; Q1–Q3: 20.68–106.27) and on the third day after admission (72.00 pg/mL; Q1–Q3: 26.98–186.50), along with a significant rate of change in IL-6 during that period (839.5%; SD: 2753.2). While admission IL-6 level (areas under the receiver operator characteristic curve (AUROC): 0.610 (95% CI: 0.459 to 0.761); cut-off value ≥15.8 pg/mL) and rate of change in IL-6 on the third day of admission (AUROC: 0.586 (95% CI: 0.420 to 0.751); cut-off value ≥–58.7%) demonstrated poor discriminatory ability in predicting hospital mortality, the third day IL-6 rate of change from admission ≥–58.7% (adjusted OR: 12.812; 95% CI: 2.104 to 78.005) emerged as an independent predictor of hospital mortality.

Conclusions
This study focused on a highly selected cohort of critically ill COVID-19 patients with a high IL-6 level and mortality rate. Despite the poor discriminatory value of admission IL-6 levels, the rate of change in IL-6 proved valuable in predicting mortality. To identify critically ill COVID-19 patients with the highest risk for mortality, monitoring the serial serum IL-6 measurements and observing the rate of change in serum IL-6 levels over time are needed.

People who contracted COVID-19 during the early stages of the pandemic had an increased risk of myocardial infarction (heart attack), stroke, and death for the next 3 years, according to a study sponsored by the National Institutes of Health (NIH).

Introduction
The knowledge gaps on the experiences of early career health professionals during the COVID-19 pandemic informed this study, which examined their vaccination status, personal and workplace experiences in South Africa.

Methods
Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates (WiSDOM), a prospective longitudinal cohort study established in 2017, consists of eight health professional groups of clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. As a part of annual follow-up surveys, we examined the personal and workplace experiences and the vaccination status of cohort members during the COVID-19 pandemic years: 2020 until 2022. We measured workplace experiences using a Likert scale that ranged from 1 (strongly disagree) to 7 (strongly agree). We constructed a composite index of positive workplace COVID-19 support using a principal component analysis.
We compared differences among the professional groups using proportions for categorical variables and means for numerical variables. We used multiple linear regression to investigate factors associated with the workplace COVID-19 support score and Firth’s penalised logistic regression for COVID-19 infection and vaccination.

Results
In 2022, the mean age of the 363 cohort members was 28.9 (± 2.1), and the majority were female (74.2%). In 2020, 22.6% of the cohort reported COVID-19 infections but this increased to 45.3% by 2021. The composite index shows that doctors and nurses reported the lowest COVID-19 workplace support, while oral hygienists and dentists reported the most support. Although 89.5% of cohort members reported full COVID-19 vaccination status, 9.4% indicated non-intention to get vaccinated. The regression analysis showed that doctors (p

Objectives
Telehealth, the provision of healthcare through digital communication, has been proposed as a potential solution to meet the increasing demand for healthcare, particularly in the setting of the COVID-19 pandemic. Sweden has an established national telehealth service for triage and referral by phone (1177) since 2013 which has the potential to meet this increasing demand. However, little is known about the development and retention in demand during and after the pandemic in Sweden. The objective of this study was to investigate the utilisation of the national telehealth service in Sweden before, during and after the pandemic in relation to emergency department (ED) visits.

Methods
This was a retrospective observational study of telephone calls to the national telehealth service in Sweden. We collected the number of calls, number of answered calls and visits to ED in Sweden from 2017 through 2021, aggregated by month. The difference in number of calls and visits was analysed using Student’s t-test for related samples.

Results
Data were collected from all 21 healthcare regions in Sweden, serving 10.5 million citizens. The average number of monthly calls was 48 (SD 10) calls per 1000 citizens. The first month of the pandemic, March 2020, had the highest monthly calls per capita during the whole study period: 62 (diff 14, 95% CI 9 to 19, p

Objective
To examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established heart failure (HF) or established atherosclerotic cardiovascular disease (ASCVD).

Design
Observational study; longitudinal analysis of registry data.

Setting
Hospitals in the USA reporting to the American Heart Association (AHA) COVID-19 Registry from January 2020 to May 2021.

Participants
20 796 individuals with diabetes (11 244 men; mean age 64.2) and 30 798 without diabetes (15 980 men; mean age 59.0) hospitalised for COVID-19 in the USA.

Primary and secondary outcome measures
Primary outcome measures were all-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilation. Secondary outcome measures included the association with diabetes and these outcomes among those with and without pre-existing ASCVD and HF and the association with insulin use and these outcomes in patients hospitalised for COVID-19.

Results
After adjustment for relevant covariates diabetes increased the risk of mortality (HR 1.12, 95% CI: 1.03 to 1.21), MACE (HR 1.32, 95% CI: 1.17 to 1.48) and mechanical ventilation (HR 1.33, 95% CI: 1.26 to 1.42). Among patients with established ASCVD or HF, diabetes did not modify the risk of adverse outcomes. There was a significant difference in the risk of mortality between patients taking insulin compared with those who were not (HR 1.32, 95% CI: 1.01 to 1.26); however, there was no difference in the risk of MACE or mechanical ventilation.

Conclusions
Diabetes was associated with a higher risk of in-hospital all-cause mortality, MACE and need for mechanical ventilation in patients hospitalised for COVID-19. Diabetes was independently associated with adverse outcomes, particularly among those without pre-existing cardiovascular disease.

Objectives
This study investigates the relationship between flat rate pricing for unlimited alcohol consumption in restaurants and bar and problematic alcohol consumption patterns identified by the Alcohol Use Disorders Identification Test (AUDIT) during the COVID-19 pandemic.

Methods
A cross-sectional study was conducted using data from the Japan Society and New Tobacco Internet Survey in February 2022. A total of 19 585 current drinkers (55% of drinkers were men, and the mean age was 48.3 years) were categorised based on AUDIT scores; non-problem drinking (an AUDIT Score of 0–7), problem drinking (an AUDIT Score of 8 or over), hazardous alcohol use (an AUDIT Score of 8–14) and probable alcohol use disorders (an AUDIT Score of 15 or over). A score of 2 or higher in the third question of the AUDIT is identified as binge drinking. The explanatory variable was the presence of using flat rate pricing for unlimited alcohol consumption in the previous 12 months during the COVID-19 pandemic (February 2021 to February 2022). The associations of using the flat rate pricing with the problem or binge drinking, and with hazardous alcohol use or probable alcohol use disorders were analysed.

Results
People who used flat rate pricing during the COVID-19 pandemic were likely to be problem drinking and binge drinking compared with non-users of flat rate pricing; the respective adjusted ORs were 4.64 (95% CI: 4.24 to 5.07) and 3.65 (95% CI: 3.33 to 4.00) through multivariable binary logistic regression. The users of the flat rate pricing were associated with hazardous alcohol use and probable alcohol use disorder; the adjusted relative risk ratios were 3.40 (95% CI: 3.06 to 3.77) and 8.58 (95% CI: 7.51 to 9.80) through multinomial logistic regression.

Conclusions
Overall, using flat rate pricing for unlimited alcohol consumption was associated with both binge drinking and problem drinking, including hazardous alcohol use and probable alcohol use disorders.

In questi grandi raduni internazionali serve una sorveglianza epidemiologica per monitorare eventuali focolai di contagio di virus respiratori

A un anno da impianto microchip, leggono fino a 12 righe in più

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

The US Food and Drug Administration (FDA) recently granted authorization to market the first at-home influenza and COVID-19 combination test outside of emergency use.

Introduction
Understanding how RNA viral load changes (viral load kinetics) during acute infection in SARS-CoV-2 can help to identify when and which patients are most infectious. We seek to summarise existing data on the longitudinal RNA viral load kinetics of SARS-CoV-2 sampled from different parts of the respiratory tract (nose, nasopharynx, oropharynx, saliva and exhaled breath) and how this may vary with age, sex, ethnicity, immune status, disease severity, vaccination, treatment and virus variant.

Methods and analysis
We will conduct a systematic review and meta-analysis, using studies identified through MEDLINE and EMBASE (via Ovid). All research studies reporting primary data on longitudinal RNA viral load kinetics of infected patients with SARS-CoV-2 will be included. Methodological quality will be assessed using a validated checklist for longitudinal studies as well as predefined quality criteria for assessment of individual-level RNA viral load. Should the data allow, we will aim to perform individual patient-level meta-analysis. Our primary outcomes are duration to, and quantity of peak RNA viral load, and total duration of viral load shedding within different respiratory compartments. Secondary outcomes include duration of lateral flow antigen and virus culture positivity and variation of RNA viral load by age, immune status, disease severity, vaccination, treatment, lateral flow tests, viral culture positivity and SARS-CoV-2 variant. Study-level effects affecting observations, but not related to properties of the patient, such as the PCR platform and gene target will also be recorded. Random-effects models will estimate the population mean and individual-level variation in viral shedding conditional on the aforementioned variables. Finally, we will summarise the key mechanistic models used in the literature to reconstruct individual-level viral kinetics and estimate how different factors shape viral dynamics over time.

Ethics and dissemination
Ethical approval is not needed as data will be obtained from published articles or studies with data that have already received and ethical review for analysis. Manuscript(s) will be prepared for publication.

Systematic review protocol registration
PROSPERO ID: CRD42023385315

Incontro a Treviso, 2.500 nuovi casi e 61 morti in una settimana

The COVID-19 pandemic is officially endemic, with more than 775 million cases now reported by the World Health Organization. Thanks to the effectiveness of vaccination combined with natural immunity, SARS-CoV-2 infection is no longer the novel and life-threatening virus it was in the early days of the pandemic, although it still carries risk to some.

This cohort study investigates the long-term risk of autoimmune and autoinflammatory diseases among patients in South Korea who had a COVID-19 diagnosis using an extended observational period.