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Differential Diagnosis in the Management of Acute Respiratory Infections through Point-of-Care Rapid Testing in a Post-Pandemic Scenario in Latin America: Special Focus on COVID-19, Influenza, and Respiratory Syncytial Virus 在拉丁美洲大流行后通过护理点快速检测对急性呼吸道感染进行鉴别诊断:特别关注 COVID-19、流感和呼吸道合胞病毒
Pub Date : 2024-02-10 DOI: 10.3390/covid4020017
C. Álvarez-Moreno, Evaldo Stanislau Affonso de Araújo, Elsa Baumeister, Katya A. Nogales Crespo, A. Kalergis, José Esteban Muñoz Medina, P. Tsukayama, C. Ugarte-Gil
This review provides a comprehensive summary of evidence to explore the role and value of differential diagnosis in the management of Acute Respiratory Infections (ARIs) through point-of-care (POC) rapid testing in a post-pandemic scenario, paying particular attention to coronavirus disease 2019 (COVID-19), influenza, and respiratory syncytial virus (RSV). The document builds on a review of literature and policies and a process of validation and feedback by a group of seven experts from Latin America (LATAM). Evidence was collected to understand scientific and policy perspectives on the differential diagnosis of ARIs and POC rapid testing, with a focus on seven countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. The evidence indicates that POC rapid testing can serve to improve ARI case management, epidemiological surveillance, research and innovation, and evidence-based decision-making. With multiple types of rapid tests available for POC, decisions regarding which tests to use require the consideration of the testing purpose, available resources, and test characteristics regarding accuracy, accessibility, affordability, and results turnaround time. Based on the understanding of the current situation, this document provides a set of recommendations for the implementation of POC rapid testing in LATAM, supporting decision-making and guiding efforts by a broad range of stakeholders.
本综述提供了一份全面的证据摘要,以探讨在大流行后的情况下通过护理点 (POC) 快速检测进行鉴别诊断在急性呼吸道感染 (ARI) 管理中的作用和价值,尤其关注 2019 年冠状病毒病 (COVID-19)、流感和呼吸道合胞病毒 (RSV)。本文件以文献和政策审查为基础,并经过拉丁美洲 (LATAM) 七位专家的验证和反馈。收集证据的目的是了解关于急性呼吸道感染鉴别诊断和 POC 快速检测的科学和政策观点,重点关注七个国家:阿根廷、巴西、智利、哥伦比亚、哥斯达黎加、墨西哥和秘鲁。证据表明,POC 快速检测可用于改善急性呼吸道感染病例管理、流行病监测、研究与创新以及循证决策。由于有多种 POC 快速检测方法可供选择,在决定使用哪种检测方法时,需要考虑检测目的、可用资源以及检测的准确性、可及性、可负担性和结果周转时间等特点。基于对当前情况的了解,本文件为在拉丁美洲和加勒比海地区实施 POC 快速检测提供了一套建议,为决策提供支持,并为广大利益相关者的工作提供指导。
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引用次数: 0
Development of Mouse Hepatitis Virus Chimeric Reporter Viruses Expressing the 3CLpro Proteases of Human Coronaviruses HKU1 and OC43 Reveals Susceptibility to Inactivation by Natural Inhibitors Baicalin and Baicalein 表达人类冠状病毒 HKU1 和 OC43 的 3CLpro 蛋白酶的小鼠肝炎病毒嵌合报告病毒的开发揭示了天然抑制剂黄芩苷和黄芩素对灭活的敏感性
Pub Date : 2024-02-09 DOI: 10.3390/covid4020016
Elise R Huffman, Jared X. Franges, Jayden M. Doster, Alexis R. Armstrong, Yara S Batista, Cameron M. Harrison, Jon D. Brooks, Morgan N. Thomas, Butler Student Virology Group, Sakshi Tomar, Christopher C. Stobart, Dia C. Beachboard
The recent emergence of SARS-CoV-2 in 2019 has highlighted the necessity of antiviral therapeutics for current and future emerging coronaviruses. Recently, the traditional herbal medicines baicalein, baicalin, and andrographolide have shown inhibition against the main protease of SARS-CoV-2. This provides a promising new direction for COVID-19 therapeutics, but it remains unknown whether these three substances inhibit other human coronaviruses. In this study, we describe the development of novel chimeric mouse hepatitis virus (MHV) reporters that express firefly luciferase (FFL) and the 3CLpro proteases of human coronaviruses HKU1 and OC43. These chimeric viruses were used to determine if the phytochemicals baicalein, baicalin, and andrographolide are inhibitory against human coronavirus strains HKU1 and OC43. Our data show that both baicalein and baicalin exhibit inhibition towards the chimeric MHV strains. However, andrographolide induces cytotoxicity and failed to demonstrate selective toxicity towards the viruses. This study reports the development and use of a safe replicating reporter platform to investigate potential coronavirus 3CLpro inhibitors against common-cold human coronavirus strains HKU1 and OC43.
最近在 2019 年出现的 SARS-CoV-2 强调了针对当前和未来新出现的冠状病毒进行抗病毒治疗的必要性。最近,传统中药黄芩苷、黄芩素和穿心莲内酯显示出对 SARS-CoV-2 主要蛋白酶的抑制作用。这为 COVID-19 疗法提供了一个很有前景的新方向,但这三种物质是否能抑制其他人类冠状病毒仍是未知数。在本研究中,我们描述了新型嵌合小鼠肝炎病毒(MHV)报告基因的开发过程,这些报告基因表达萤火虫荧光素酶(FFL)以及人类冠状病毒 HKU1 和 OC43 的 3CLpro 蛋白酶。我们利用这些嵌合病毒来确定植物化学物质黄芩苷、黄芩素和穿心莲内酯是否对人类冠状病毒 HKU1 和 OC43 株具有抑制作用。我们的数据显示,黄芩素和黄芩苷对嵌合型 MHV 毒株都有抑制作用。然而,穿心莲内酯会诱导细胞毒性,且未能对病毒表现出选择性毒性。本研究报告了开发和使用安全复制报告平台来研究潜在的冠状病毒 3CLpro 抑制剂对普通冷人冠状病毒 HKU1 和 OC43 株的抑制作用。
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引用次数: 0
Development of Mouse Hepatitis Virus Chimeric Reporter Viruses Expressing the 3CLpro Proteases of Human Coronaviruses HKU1 and OC43 Reveals Susceptibility to Inactivation by Natural Inhibitors Baicalin and Baicalein 表达人类冠状病毒 HKU1 和 OC43 的 3CLpro 蛋白酶的小鼠肝炎病毒嵌合报告病毒的开发揭示了天然抑制剂黄芩苷和黄芩素对灭活的敏感性
Pub Date : 2024-02-09 DOI: 10.3390/covid4020016
Elise R Huffman, Jared X. Franges, Jayden M. Doster, Alexis R. Armstrong, Yara S Batista, Cameron M. Harrison, Jon D. Brooks, Morgan N. Thomas, Butler Student Virology Group, Sakshi Tomar, Christopher C. Stobart, Dia C. Beachboard
The recent emergence of SARS-CoV-2 in 2019 has highlighted the necessity of antiviral therapeutics for current and future emerging coronaviruses. Recently, the traditional herbal medicines baicalein, baicalin, and andrographolide have shown inhibition against the main protease of SARS-CoV-2. This provides a promising new direction for COVID-19 therapeutics, but it remains unknown whether these three substances inhibit other human coronaviruses. In this study, we describe the development of novel chimeric mouse hepatitis virus (MHV) reporters that express firefly luciferase (FFL) and the 3CLpro proteases of human coronaviruses HKU1 and OC43. These chimeric viruses were used to determine if the phytochemicals baicalein, baicalin, and andrographolide are inhibitory against human coronavirus strains HKU1 and OC43. Our data show that both baicalein and baicalin exhibit inhibition towards the chimeric MHV strains. However, andrographolide induces cytotoxicity and failed to demonstrate selective toxicity towards the viruses. This study reports the development and use of a safe replicating reporter platform to investigate potential coronavirus 3CLpro inhibitors against common-cold human coronavirus strains HKU1 and OC43.
最近在 2019 年出现的 SARS-CoV-2 强调了针对当前和未来新出现的冠状病毒进行抗病毒治疗的必要性。最近,传统中药黄芩苷、黄芩素和穿心莲内酯显示出对 SARS-CoV-2 主要蛋白酶的抑制作用。这为 COVID-19 疗法提供了一个很有前景的新方向,但这三种物质是否能抑制其他人类冠状病毒仍是未知数。在本研究中,我们描述了新型嵌合小鼠肝炎病毒(MHV)报告基因的开发过程,这些报告基因表达萤火虫荧光素酶(FFL)以及人类冠状病毒 HKU1 和 OC43 的 3CLpro 蛋白酶。我们利用这些嵌合病毒来确定植物化学物质黄芩苷、黄芩素和穿心莲内酯是否对人类冠状病毒 HKU1 和 OC43 株具有抑制作用。我们的数据显示,黄芩素和黄芩苷对嵌合型 MHV 毒株都有抑制作用。然而,穿心莲内酯会诱导细胞毒性,且未能对病毒表现出选择性毒性。本研究报告了开发和使用安全复制报告平台来研究潜在的冠状病毒 3CLpro 抑制剂对普通冷人冠状病毒 HKU1 和 OC43 株的抑制作用。
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引用次数: 0
Patient-Perceived Impact of the COVID-19 Pandemic on Medication Adherence and Access to Care for Long-Term Diseases: A Cross-Sectional Online Survey 患者认为 COVID-19 大流行对坚持用药和获得长期疾病护理的影响:横断面在线调查
Pub Date : 2024-02-08 DOI: 10.3390/covid4020015
Beatriz Santos, Younes Boulaguiem, H. Baysson, N. Pullen, I. Guessous, Stéphane Guerrier, S. Stringhini, Marie P. Schneider
The COVID-19 pandemic has been associated with lifestyle changes, reduced access to care and potential impacts on medication self-management. Our main objectives are to evaluate the impact of the pandemic on patient adherence and access to care and long-term medications and determine its association with sociodemographic and clinical factors. This study is part of the Specchio-COVID-19 longitudinal cohort study in Geneva, Switzerland, conducted through an online questionnaire. Among the 982 participants (median age: 56; 61% female), 827 took long-term medications. There were 76 reported changes in medication dosages, of which 24 (31%) were without a physician’s recommendation, and 51 delays in initiation or premature medication interruptions, of which 24 (47%) were without a physician’s recommendation. Only 1% (9/827) of participants faced medication access issues. Participants taking a respiratory medication had a four-times greater odds of reporting more regular medication (OR = 4.27; CI 95%: 2.11–8.63) intake, whereas each year increase in age was significantly associated with 6% fewer relative risks of discontinuation (OR = 0.94; CI 95%: 0.91–0.97) and 3% fewer relative risks of changes in medication dosage (OR = 0.97; CI 95%: 0.95–1.00). Despite the limited impact of the pandemic on adherence and access to medications, our results emphasize the need for understanding patient challenges when self-managing their long-term medication, notably during public health crises.
COVID-19 大流行与生活方式的改变、医疗服务的减少以及对药物自我管理的潜在影响有关。我们的主要目标是评估大流行对患者坚持治疗、获得护理和长期用药的影响,并确定其与社会人口和临床因素的关联。本研究是瑞士日内瓦 Specchio-COVID-19 纵向队列研究的一部分,通过在线问卷进行。在 982 名参与者(中位年龄:56 岁;61% 为女性)中,有 827 人长期服用药物。据报告,有 76 人改变了用药剂量,其中 24 人(31%)未经医生建议,有 51 人延迟用药或过早中断用药,其中 24 人(47%)未经医生建议。只有 1%(9/827)的参与者面临用药问题。服用呼吸系统药物的参与者报告更经常服药的几率是其他参与者的四倍(OR = 4.27;CI 95%:2.11-8.63),而年龄每增加一岁,停药的相对风险就会降低 6%(OR = 0.94;CI 95%:0.91-0.97),改变药量的相对风险降低 3%(OR = 0.97;CI 95%:0.95-1.00)。尽管大流行对患者的用药依从性和用药途径影响有限,但我们的研究结果强调了了解患者在自我管理长期用药时所面临的挑战的必要性,尤其是在公共卫生危机期间。
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引用次数: 0
Patient-Perceived Impact of the COVID-19 Pandemic on Medication Adherence and Access to Care for Long-Term Diseases: A Cross-Sectional Online Survey 患者认为 COVID-19 大流行对坚持用药和获得长期疾病护理的影响:横断面在线调查
Pub Date : 2024-02-08 DOI: 10.3390/covid4020015
Beatriz Santos, Younes Boulaguiem, H. Baysson, N. Pullen, I. Guessous, Stéphane Guerrier, S. Stringhini, Marie P. Schneider
The COVID-19 pandemic has been associated with lifestyle changes, reduced access to care and potential impacts on medication self-management. Our main objectives are to evaluate the impact of the pandemic on patient adherence and access to care and long-term medications and determine its association with sociodemographic and clinical factors. This study is part of the Specchio-COVID-19 longitudinal cohort study in Geneva, Switzerland, conducted through an online questionnaire. Among the 982 participants (median age: 56; 61% female), 827 took long-term medications. There were 76 reported changes in medication dosages, of which 24 (31%) were without a physician’s recommendation, and 51 delays in initiation or premature medication interruptions, of which 24 (47%) were without a physician’s recommendation. Only 1% (9/827) of participants faced medication access issues. Participants taking a respiratory medication had a four-times greater odds of reporting more regular medication (OR = 4.27; CI 95%: 2.11–8.63) intake, whereas each year increase in age was significantly associated with 6% fewer relative risks of discontinuation (OR = 0.94; CI 95%: 0.91–0.97) and 3% fewer relative risks of changes in medication dosage (OR = 0.97; CI 95%: 0.95–1.00). Despite the limited impact of the pandemic on adherence and access to medications, our results emphasize the need for understanding patient challenges when self-managing their long-term medication, notably during public health crises.
COVID-19 大流行与生活方式的改变、医疗服务的减少以及对药物自我管理的潜在影响有关。我们的主要目标是评估大流行对患者坚持治疗、获得护理和长期用药的影响,并确定其与社会人口和临床因素的关联。本研究是瑞士日内瓦 Specchio-COVID-19 纵向队列研究的一部分,通过在线问卷进行。在 982 名参与者(中位年龄:56 岁;61% 为女性)中,有 827 人长期服用药物。据报告,有 76 人改变了用药剂量,其中 24 人(31%)未经医生建议,有 51 人延迟用药或过早中断用药,其中 24 人(47%)未经医生建议。只有 1%(9/827)的参与者面临用药问题。服用呼吸系统药物的参与者报告更经常服药的几率是其他参与者的四倍(OR = 4.27;CI 95%:2.11-8.63),而年龄每增加一岁,停药的相对风险就会降低 6%(OR = 0.94;CI 95%:0.91-0.97),改变药量的相对风险降低 3%(OR = 0.97;CI 95%:0.95-1.00)。尽管大流行对患者的用药依从性和用药途径影响有限,但我们的研究结果强调了了解患者在自我管理长期用药时所面临的挑战的必要性,尤其是在公共卫生危机期间。
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引用次数: 0
The Effects of a Collegiate Recovery Community Psychotherapy Program Incorporating Equine Interaction during the COVID-19 Pandemic on Young Adults with Substance Abuse Disorder COVID-19 大流行期间融入马匹互动的高校康复社区心理治疗计划对药物滥用失调症青少年的影响
Pub Date : 2024-01-25 DOI: 10.3390/covid4020013
K. Holtcamp, M. C. Nicodemus, Tommy Phillips, David Christiansen, B. Rude, Peter L. Ryan, K. Galarneau
While psychotherapy incorporating equine interaction (PIE) has proven to be a viable therapeutic intervention, it is not a common mental health service found on college campuses. Nevertheless, with the rise of mental health challenges on campuses after the COVID-19 pandemic, a need for effective therapeutic solutions is warranted. Therefore, the objective of this study was to determine the effect of a collegiate recovery community (CRC) PIE program for substance abuse disorder (SUD) compared to that of traditional cognitive behavioral therapy (CBT) and to determine whether physiological synchronization occurs between the human and horse during the therapy process. College-aged adults were recruited during the COVID-19 pandemic for two types of short-term SUD therapeutic interventions, CRC-PIE and CBT. Both groups completed a self-reporting survey assessing emotional safety. Vital signs measurements for human and horse participants within the CRC-PIE were collected prior to and after the first and last therapeutic sessions. Results concluded that although emotional safety did not improve significantly for PIE participants by the last therapy session (p = 0.85), emotional safety scores were significantly different between therapy types, with lower post-therapy scores for PIE (p = 0.04). As for physiological measures for PIE participants, respiratory rates (Human: p = 0.01; Horse: p = 0.01) and pain rating scores (Human: p = 0.03; Horse: p = 0.01) significantly decreased post-therapy and a strong positive correlation (R = 0.73, R2 = 0.53) associated with vital signs was observed between humans and horses. This human–horse physiological synchronization during the therapeutic intervention suggests that the horse may be a viable tool within campus CRC programs for the development of therapeutic alliances within the therapy process.
虽然结合马匹互动的心理疗法(PIE)已被证明是一种可行的治疗干预措施,但它在大学校园中并不是一种常见的心理健康服务。然而,随着 COVID-19 大流行后校园心理健康挑战的增加,我们需要有效的治疗方案。因此,本研究旨在确定大学生康复社区(CRC)PIE 计划与传统认知行为疗法(CBT)相比,对药物滥用障碍(SUD)的治疗效果,并确定在治疗过程中人与马之间是否会发生生理同步。在 COVID-19 大流行期间,我们招募了大学年龄段的成年人接受两种类型的短期药物滥用障碍治疗干预,即 CRC-PIE 和 CBT。两组受试者均完成了一项评估情绪安全的自我报告调查。在第一次和最后一次治疗前后,对参加 CRC-PIE 的人和马进行了生命体征测量。结果表明,虽然在最后一次治疗过程中,PIE 参与者的情绪安全感没有得到明显改善(p = 0.85),但不同治疗类型的情绪安全感得分存在显著差异,PIE 的治疗后得分较低(p = 0.04)。至于 PIE 参与者的生理指标,呼吸频率(人:p = 0.01;马:p = 0.01)和疼痛评分(人:p = 0.03;马:p = 0.01)在治疗后显著下降,并且观察到人和马的生命体征之间存在很强的正相关性(R = 0.73,R2 = 0.53)。在治疗干预过程中,人与马的生理同步表明,在校园 CRC 项目中,马可能是在治疗过程中发展治疗联盟的可行工具。
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引用次数: 0
Addressing Inequality in the COVID-19 Pandemic in Africa: A Snapshot from Clinical Symptoms to Vaccine Distribution 解决非洲 COVID-19 大流行中的不平等问题:从临床症状到疫苗分发的缩影
Pub Date : 2024-01-25 DOI: 10.3390/covid4020014
A. Pêgo, I. Lima, R. Gozzelino
On 30 January 2020, WHO declared COVID-19 a public health emergency of global concern. COVID-19 became pandemic on 11 March 2020, and spread unprecedently. No country was prepared to face its impact. Major fears started to be expressed for Africa, where dramatic consequences were expected, due to the weakness of health systems. In this review, we related major concerns, at that time but still present, regarding the limited resources in terms of qualified physicians and researchers, as well as the scarce funds to purchase essential medical equipment and improve hospital infrastructures. The difficulties to provide proper care became an undeniable mark of inequality, highlighting the need to empower local capacity and raise preparedness against infection outbreaks. The transmissibility of genetic variants affecting African nations, the immunopathology underlying comorbidities, sequelae, and pre-existing conditions, often related to changes in iron metabolism and enhancing COVID-19 severity, were described. The obstacles in adopting standardized prevention measures were highlighted, along with testing capacity biases and inequity of healthcare access and vaccine distribution. By providing a better understanding of the COVID-19 pandemic in Africa, we draw attention to the need for collaborative efforts to leverage the quality of healthcare and research in this continent.
2020 年 1 月 30 日,世卫组织宣布 COVID-19 为全球关注的突发公共卫生事件。COVID-19 于 2020 年 3 月 11 日成为大流行病,传播速度之快令人措手不及。没有一个国家做好了应对其影响的准备。人们开始对非洲表示严重担忧,由于卫生系统薄弱,预计会对非洲造成严重后果。在这次回顾中,我们提到了当时仍然存在的主要担忧,即合格医生和研究人员的资源有限,以及用于购买基本医疗设备和改善医院基础设施的资金匮乏。难以提供适当的医疗服务已成为不平等的一个不可否认的标志,凸显了增强地方能力和提高防范感染爆发能力的必要性。会议介绍了影响非洲国家的遗传变异的传播性、合并症、后遗症和原有疾病背后的免疫病理学,这些往往与铁代谢的变化和 COVID-19 的严重性有关。此外,还强调了采用标准化预防措施的障碍,以及检测能力的偏差和医疗保健服务与疫苗分配的不公平。通过更好地了解 COVID-19 在非洲的流行情况,我们提请人们注意需要共同努力提高非洲大陆的医疗保健和研究质量。
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引用次数: 0
A Comparative Analysis of COVID-19 Response Measures and Their Impact on Mortality Rate COVID-19 反应措施及其对死亡率影响的比较分析
Pub Date : 2024-01-24 DOI: 10.3390/covid4020012
T. Konishi
(1) Background: The coronavirus disease 2019 (COVID-19) pandemic significantly affected the population worldwide, with varying responses implemented to control its spread. This study aimed to compare the epidemic data compiled by the World Health Organization (WHO) to understand the impact of the measures adopted by each country on the mortality rate. (2) Methods: The increase or decrease in the number of confirmed cases was understood in logarithmic terms, for which logarithmic growth rates “K” were used. The mortality rate was calculated as the percentage of deaths from the confirmed cases, which was also used for logarithmic comparison. (3) Results: Countries that effectively detected and isolated patients had a mortality rate 10 times lower than those who did not. Although strict lockdowns were once effective, they could not be implemented on an ongoing basis. After their cancellation, large outbreaks occurred because of medical breakdowns. The virus variants mutated with increased infectivity, which impeded the measures that were once effective, including vaccinations. Although the designs of mRNA vaccines were renewed, they could not keep up with the virus mutation rate. The only effective defence lies in steadily identifying and isolating patients. (4) Conclusions: these findings have crucial implications for the complete containment of the pandemic and future pandemic preparedness.
(1) 背景:冠状病毒病 2019(COVID-19)大流行对全球人口造成了重大影响,各国为控制其传播采取了不同的应对措施。本研究旨在比较世界卫生组织(WHO)编制的疫情数据,以了解各国采取的措施对死亡率的影响。(2) 方法:确诊病例数的增减用对数表示,使用对数增长率 "K"。死亡率按确诊病例中死亡人数的百分比计算,也用于对数比较。(3) 结果:有效发现和隔离病人的国家的死亡率比没有发现和隔离病人的国家低 10 倍。虽然严格的封锁措施曾经有效,但无法持续实施。取消封锁后,由于医疗失误,大规模疫情爆发。病毒变种发生变异,传染性增强,这阻碍了曾经有效的措施,包括疫苗接种。虽然 mRNA 疫苗的设计得到了更新,但仍无法跟上病毒变异的速度。唯一有效的防御措施是稳步识别和隔离患者。(4) 结论:这些发现对彻底遏制大流行和未来的大流行准备工作具有重要意义。
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引用次数: 0
Haematological Profile and ACE2 Levels of COVID-19 Patients in a Metropolis in Ghana 加纳某大都市 COVID-19 患者的血液学特征和 ACE2 水平
Pub Date : 2024-01-23 DOI: 10.3390/covid4020011
E. B. Ackah, M. Owusu, B. Sackey, Justice K. Boamah, J. S. Kamasah, Albert A. Aduboffour, Debora Akortia, Gifty Nkrumah, Andrews Amaniampong, Nicholas Klevor, Lawrence D. Agyemang, N. K. Ayisi-Boateng, A. Sylverken, Richard O. Phillips, E. Owusu-Dabo
Background: Several studies have linked coronavirus disease 2019 (COVID-19) risk to age and ABO blood groups. Variations in plasma angiotensin-converting enzyme 2 (ACE2) levels and blood counts have been reported, suggesting an association between disease severity and low lymphocyte levels. Aim: this study aimed to understand how these factors relate to COVID-19 in Ghanaian patients, considering geographical and demographic differences. Methods: Participants were recruited from six hospitals in Kumasi, Ghana, between June 2020 and July 2021. Nasopharyngeal swabs were taken to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and blood samples were collected for complete blood count testing, ABO/Rhesus typing, and assessment of plasma ACE2 levels. Demographic and COVID-19 severity data were gathered, and IBM SPSS version 25.0 was used for analysis. Results: Overall, 515 patients were enrolled, out of which 55.9% (n = 288/515) were males and 50.3% (n = 259/515) tested positive for SARS-CoV-2. The median age was 37 years (IQR = 26–53). Age was significantly associated with SARS-CoV-2 infection (p = 0.002). The severe COVID-19 group was the oldest (70 years, IQR = 35–80) and presented with anaemia (haemoglobin, g/dL: 9.55, IQR = 7.85–11.93), leukocytosis (WBC × 103/μL: 15.87, IQR = 6.68–19.80), neutrophilia (NEUT × 106/μL: 14.69, IQR = 5.70–18.96) and lymphocytopenia (LYMPH × 106/μL: 0.47, IQR = 0.22–0.66). No association was found between SARS-CoV-2 positivity and ABO (p = 0.711) or Rh (p = 0.805) blood groups; no association was also found between plasma ACE2 levels and SARS-CoV-2 status (p = 0.079). However, among COVID-19 participants, plasma ACE2 levels were significantly reduced in the moderate illness group (40.68 ng/mL, IQR = 34.09–48.10) compared with the asymptomatic group (50.61 ng/mL, IQR = 43.90–58.61, p = 0.015). Conclusions: While there may be no real association between the ABO blood group, as well as plasma ACE2 levels, and SARS-CoV-2 infection in Ghanaian patients, older individuals are at a higher risk of severe disease. Anaemia, and leukocytosis with lymphocytopenia may be indicators of poor disease progression.
背景:多项研究表明,2019年冠状病毒病(COVID-19)的风险与年龄和ABO血型有关。血浆血管紧张素转换酶 2 (ACE2) 水平和血细胞计数的变化也有报道,这表明疾病的严重程度与低淋巴细胞水平有关。目的:本研究旨在了解这些因素与加纳患者 COVID-19 的关系,同时考虑到地域和人口统计学差异。研究方法2020 年 6 月至 2021 年 7 月期间,从加纳库马西的六家医院招募参与者。采集鼻咽拭子以检测严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2),采集血样以检测全血细胞计数、ABO/瑞氏分型和评估血浆 ACE2 水平。收集了人口统计学和 COVID-19 严重程度数据,并使用 IBM SPSS 25.0 版进行分析。结果共有 515 名患者入组,其中 55.9%(n = 288/515)为男性,50.3%(n = 259/515)SARS-CoV-2 检测呈阳性。年龄中位数为 37 岁(IQR = 26-53)。年龄与 SARS-CoV-2 感染明显相关(p = 0.002)。严重的 COVID-19 组年龄最大(70 岁,IQR = 35-80),表现为贫血(血红蛋白,g/dL:9.55,IQR = 7.85-11.93)、白细胞增多(WBC × 103/μL:15.87,IQR = 6.68-19.80)、中性粒细胞增多(NEUT × 106/μL:14.69,IQR = 5.70-18.96)和淋巴细胞减少(LYMPH × 106/μL:0.47,IQR = 0.22-0.66)。SARS-CoV-2 阳性与 ABO 血型(p = 0.711)或 Rh 血型(p = 0.805)之间没有关联;血浆 ACE2 水平与 SARS-CoV-2 状态之间也没有关联(p = 0.079)。然而,在 COVID-19 参与者中,与无症状组(50.61 纳克/毫升,IQR = 43.90-58.61,p = 0.015)相比,中度疾病组(40.68 纳克/毫升,IQR = 34.09-48.10)的血浆 ACE2 水平显著降低。结论虽然加纳病人的 ABO 血型和血浆 ACE2 水平与 SARS-CoV-2 感染之间可能没有真正的联系,但年龄较大的人罹患严重疾病的风险较高。贫血和白细胞增多伴淋巴细胞减少可能是病情恶化的指标。
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引用次数: 0
Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic COVID-19 在大流行之前和期间对英格兰一家 NHS 基金会信托机构的 "明智起步,突出重点 "抗菌药物管理工作的影响
Pub Date : 2024-01-21 DOI: 10.3390/covid4010010
R. Abdelsalam Elshenawy, N. Umaru, Z. Aslanpour
Background: Antimicrobial resistance (AMR), a major global public health threat that has caused 1.2 million deaths, calls for immediate action. Antimicrobial stewardship (AMS) promotes judicious antibiotic use, but the COVID-19 pandemic increased AMR by 15%. Although there are paramount data on the impact of COVID-19 on AMS, empirical data on AMS implementation during the pandemic are lacking. This study aimed to investigate antibiotic prescribing and AMS implementation prior to the pandemic (PP) in 2019 and during the pandemic (DP) in 2020 at one NHS Foundation Trust in England. Method: This cross-sectional study involved adult patients admitted to one NHS Foundation Trust in England, focusing on those prescribed antibiotics for respiratory tract infections (RTIs). This included cases of pneumonia in both years under study and COVID-19 cases in 2020. Data were retrospectively extracted from medical records using a validated data extraction tool, which was developed based on the ‘Start Smart, Then Focus’ (SSTF) approach of the AMS Toolkit. Results: This study included 640 patients. The largest age group in the study was 66–85 years, comprising 156 individuals (48.8%) PP in 2019 and 148 (46.3%) DP in 2020. CAP was the predominant diagnosis, affecting approximately 126 (39.4%) PP and 136 (42.5%) DP patients. Regarding the timing of antibiotic review post-admission, reviews were typically conducted within 48–72 h, with no significant difference between 2019 and 2020, with an odds ratio of 1.02 (95% CI 0.97 to 1.08, p-Value = 0.461). During the pandemic, there was a significant difference in both AMS interventions, ‘Continue Antibiotics’ and ‘De-escalation’, with odds ratios of 3.36 (95% CI 1.30–9.25, p = 0.015) and 2.77 (95% CI 1.37–5.70, p = 0.005), respectively. Conclusion: This study emphasises the need for robust AMS to ensure adherence to guidelines. It acknowledges the impact of comorbidities and advocates for sustained stewardship efforts to combat resistance both during and after the pandemic era.
背景:抗菌素耐药性(AMR)是全球公共卫生的一大威胁,已造成 120 万人死亡,因此需要立即采取行动。抗菌药物管理(AMS)提倡合理使用抗生素,但 COVID-19 大流行使 AMR 增加了 15%。尽管有关于 COVID-19 对 AMS 影响的大量数据,但缺乏在大流行期间实施 AMS 的经验数据。本研究旨在调查 2019 年大流行(PP)前和 2020 年大流行(DP)期间英国一家 NHS 基金会信托基金会的抗生素处方和 AMS 实施情况。研究方法这项横断面研究涉及英格兰一家 NHS 基金会信托机构收治的成年患者,重点关注因呼吸道感染 (RTI) 而被处方抗生素的患者。其中包括研究中两个年份的肺炎病例和 2020 年的 COVID-19 病例。研究人员使用经过验证的数据提取工具从病历中回顾性地提取数据,该工具是根据 AMS 工具包中的 "明智开始,然后聚焦"(SSTF)方法开发的。研究结果这项研究包括 640 名患者。研究中最大的年龄组为 66-85 岁,其中 2019 年 PP 患者 156 人(48.8%),2020 年 DP 患者 148 人(46.3%)。CAP是最主要的诊断,影响了约126名(39.4%)PP患者和136名(42.5%)DP患者。关于入院后抗生素复查的时间,复查通常在 48-72 小时内进行,2019 年和 2020 年之间没有显著差异,几率比为 1.02(95% CI 0.97 至 1.08,p-Value = 0.461)。在大流行期间,"继续使用抗生素 "和 "降级 "这两种急性呼吸系统疾病干预措施存在显著差异,几率比分别为 3.36(95% CI 1.30-9.25,p = 0.015)和 2.77(95% CI 1.37-5.70,p = 0.005)。结论本研究强调,有必要建立健全的 AMS,以确保遵守指南。它承认了合并症的影响,并倡导在大流行期间和之后持续开展管理工作以消除耐药性。
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引用次数: 0
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