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Pregnant women with coronavirus at higher risk of severe illness, death, CDC finds

Pregnant women who contract the coronavirus are more at risk for severe illness and death than non-pregnant women, a Centers for Disease Control and Prevention (CDC) analysis found. The agency has previously warned that pregnant people might be at an increased risk for severe illness from COVID-19, but research is ongoing.

The new report, issued Monday, analyzed data collected from over 400,000 women ages 15-44 with symptomatic COVID-19.

Of the 409,462 women with symptomatic coronavirus, 23,434 were pregnant.

CORONAVIRUS FACE MASKS AT POLLS ENCOURAGED, BUT NOT REQUIRED IN SOME STATES

“After adjusting for age, race/ethnicity, and underlying medical conditions, pregnant women were significantly more likely than were non-pregnant women to be admitted to an intensive care unit, receive ventilation, receive extracorporeal membrane oxygenation and die,” the report said.

The CDC said the findings may be due to the physiologic changes associated with pregnancy.

The CDC said the findings may be due to the physiologic changes associated with pregnancy.
(iStock)

The CDC said the findings may be due to the physiologic changes associated with pregnancy, including increased heart rate and oxygen consumption, decreased lung capacity, immunity changes and increased risk for thromboembolic disease.

POSTPARTUM DEPRESSION MAY LAST 3 YEARS AFTER CHILDBIRTH, STUDY FINDS

Separately, the analysis also found racial and ethnic disparities in both risks for infection and disease severity among pregnant women, “indicating a need to address potential drivers of risk in these populations,” the report said.

The health agency said pregnant women should be counseled about the importance of seeking prompt medical care if they develop symptoms of coronavirus, and that there should be a strong emphasis on coronavirus prevention for pregnant women at each medical appointment.

OVER HALF OF CORONAVIRUS-INFECTED PREGNANT WOMEN SHOWED NO SYMPTOMS, CDC FINDS

“To minimize the risk for acquiring SARS-CoV-2 infection, pregnant women should limit unnecessary interactions with persons who might have been exposed to or are infected with SARS-CoV-2, including those within their household, as much as possible,” the CDC said. “When going out or interacting with others, pregnant women should wear a mask, social distance, avoid persons who are not wearing a mask, and frequently wash their hands.”

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The CDC also advised pregnant women stay up to date with flu shots and prenatal care.

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Pregnant women with Covid-19 face higher risk of severe illness and death, study says

Pregnant women infected with the coronavirus are more likely to become severely ill and die from Covid-19, and they’re at increased risk for premature delivery, according to a pair of reports released Monday by the US Centers for Disease Control and Prevention.





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Although the overall risk of severe illness or death remains low, CDC researchers found that pregnant women with coronavirus are more likely to need intensive care, ventilation and heart and lung support than non-pregnant women with the virus.

A separate report found that the rate of preterm birth, when a baby is born before 37 weeks of pregnancy, is 12.9% among women with coronavirus, compared to 10.2% among the general population.

The new research adds to a growing body of evidence that pregnant women are at increased risk when it comes to coronavirus, said Dr. Denise Jamieson, chair of the gynecology and obstetrics department at Emory University School of Medicine.

“It also demonstrates that their infants are at risk, even if their infants are not infected, they may be affected,” Jamieson noted on a call with reporters Monday.

Increased risk for severe illness and death

For one of the reports, researchers reviewed data on 461,825 women between the ages of 15 and 44 who tested positive for Covid-19 between January 22 and October 3. They focused only on those who experienced coronavirus symptoms.

The team adjusted for outside factors and found that pregnant women were more likely to need intensive care, with 10.5 per 1,000 pregnant women admitted to the ICU, compared to 3.9 per 1,000 women who aren’t pregnant.

Pregnant women were 3 times more likely to need help breathing with invasive ventilation than women who aren’t pregnant. Similarly, they were at greater risk of requiring lung and heart support with oxygenation.

They were also more likely to die, with 1.5 deaths per 1,000 pregnant women, compared to 1.2 per 1,000 women who aren’t pregnant.

In keeping with trends seen across the general population, researchers found some racial and ethnic minorities had an even greater potential for infection or severe disease. Among pregnant women, Hispanic women were 2.4 times more likely to die and Asian and Native Hawaiian/ Pacific Islander women had a more pronounced risk for ICU admission, they found.

The team noted that regardless of whether they were pregnant, women over 35 were more likely to experience severe illness.

The researchers said that the greater probability for severe illness among pregnant women might be due to physiological changes in pregnancy, including increased heart rate and decreased lung capacity.

“To reduce the risk for severe illness and death from COVID-19, pregnant women should be counseled about the importance of seeking prompt medical care if they have symptoms and measures to prevent SARS-CoV-2 infection should be strongly emphasized for pregnant women and their families during all medical encounters, including prenatal care visits,” the team wrote.

Risk of preterm delivery and infant infection

Pregnant women with coronavirus infection were also more likely to deliver babies

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Low dose of the medicine intravenous immunoglobulin decreases the effect of dangerous toxins during severe infections

immunity
Credit: Pixabay/CC0 Public Domain

During necrotizing soft tissue infections ordinary bacteria infect our body, spread rapidly and cause tissue death. Treatment with antibiotics is not sufficient and infected tissue needs to be removed through surgery. 22% of people who suffer from this disease need to amputate a limb and 18% do not survive.

A common cause of these infections is group A streptococcus. These bacteria form toxins that lead to overactivation of the body’s otherwise helpful immune cells, causing a so called “cytokine storm” which contributes to a severe course of the disease and the need of intensive care.

Recently, a study called INSTINCT was performed. In this study patients with necrotizing soft tissue infections were randomized to treatment with either intravenous immunoglobulin (IVIG) or placebo, in addition to other treatment. This study showed a trend towards better health after treatment with IVIG in the subgroup often caused by group A streptococcus, but no clear correlation during infections caused by other bacteria. However, the study used a lower dose than in previous studies: 25 g per day.

Bergsten et. al. tested blood samples from infected patients before and after treatment with IVIG, and found that treatment with IVIG leads to decreased effect of the toxins produced by the bacteria—even at the low dose of 25 g per day that was used in the INSTINCT study. Based on these results, the researchers suggest a new dosage regime of IVIG during these infections. It is still not proven that IVIG leads to better health during these devastating infections and the researchers suggest that the new dosage is tested in a controlled clinical trial of patients with necrotizing soft tissue infections caused by group A streptococcus.


IV immunoglobulin use up in interstitial lung disease


More information:
Helena Bergsten et al. Correlation Between Immunoglobulin Dose Administered and Plasma Neutralization of Streptococcal Superantigens in Patients With Necrotizing Soft Tissue Infections, Clinical Infectious Diseases (2020). DOI: 10.1093/cid/ciaa022
Provided by
Karolinska Institutet

Citation:
Low dose of the medicine intravenous immunoglobulin decreases the effect of dangerous toxins during severe infections (2020, October 28)
retrieved 28 October 2020
from https://medicalxpress.com/news/2020-10-dose-medicine-intravenous-immunoglobulin-decreases.html

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Kansas nursing home faces severe federal penalties after deadly coronavirus outbreak

The first hint that the novel coronavirus was tearing through the nursing home in rural Kansas arrived in a Facebook post this month. The Andbe Home was in the grips of “a full COVID outbreak,” administrator Megan Mapes wrote, “despite the precautions we have been taking since March.”



a house that has a sign on the side of a road: The Andbe Home in Kansas is facing penalties from the Centers for Medicare and Medicaid Services after all 63 residents became infected with the coronavirus and at least 10 died. (Dana M. Paxton/Norton Telegram/AP)


The Andbe Home in Kansas is facing penalties from the Centers for Medicare and Medicaid Services after all 63 residents became infected with the coronavirus and at least 10 died. (Dana M. Paxton/Norton Telegram/AP)

But behind the walls of the facility, nursing home officials had failed to take the most basic measures to prevent the spread of the highly contagious virus after learning two residents were infected, according to a blistering report released Tuesday by the Centers for Medicare and Medicaid Services, which resulted in severe penalties.

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By the time the viral firestorm had finished sweeping through the nursing home, all 63 residents were infected and at least 10 had died. Medicare moved Monday to terminate the Andbe Home from its program, cutting it off from federal dollars and imposing thousands of dollars in fines.

Government inspectors found that infected residents were separated from their healthy roommates by little more than a privacy sheet. Communal dining continued for two days. Multiple staff members failed to wear masks — even after the outbreak took hold.

In an email Tuesday to The Washington Post, the nursing home administrator disputed some of the findings outlined in the report and stood by the response to the outbreak, saying the facility had immediately quarantined infected residents and that staff wore full personal protective equipment, including goggles, masks and gloves.

“This is a terrible virus, but I am proud of how our staff has battled COVID-19 over the course of the pandemic, coming to work every day under extenuating circumstances, and caring for all of our residents,” Mapes wrote. “I am also proud of and thankful for the mutual support between Andbe Home and our community during trying times for everyone.”

The Medicare report, however, said the facility’s failures had “placed all residents in immediate jeopardy by the spread of Covid-19 to all residents.”

The virus’s rampage through the nursing home came amid a surge of infections in Kansas’s Norton County, which led the nation in per capita case increases between Oct. 12 and Oct. 19 and ranked second this week, according to a Post analysis. Before Oct. 13, the county near the Nebraska border had been spared virus-related deaths.

Now, there are clusters of cases at the nursing home, where 55 of 70 staff members tested positive for the virus, as well as at a correctional facility and a bank. City offices are closed to the public, municipal court is postponed and multiple businesses have temporarily shut their doors. The funeral home has posted a wave of obituaries for people who lived at the Andbe Home: a stained glass artist with pieces displayed around town, a onetime staffer turned resident, a skilled home cook known

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Psoriasis Meds Don’t Raise Risk of Severe COVID-19: Study | Health News

By Cara Roberts Murez, HealthDay Reporter

(HealthDay)

TUESDAY, Oct. 27, 2020 (HealthDay News) — Researchers in the United Kingdom have reassuring news for people with psoriasis based on the first analysis of a global registry of COVID-19 patients who also have the skin disease.

Moderate-to-severe cases of psoriasis are treated with drugs that suppress the immune system. This analysis of the international PsoProtect registry found that more than 90% of psoriasis patients survive infection with the new coronavirus.

“We can reassure our patients that the survival for people with psoriasis is high, and the risk factors for psoriasis patients are similar to those of the general population,” said Dr. Satveer Mahil, a consultant dermatologist at St. John’s Institute of Dermatology in London, who co-leads the registry.

The registry was established to understand how psoriasis and the medications used to treat it affect severity of COVID-19, according to a news release from the U.K.’s National Institute for Health Research.

Psoriasis is a skin disease believed to be related to an immune system problem. It causes red patches and flaky plaques of skin that are covered with silvery scales.

The findings were recently published online in the Journal of Allergy and Clinical Immunology.

For the study, the researchers analyzed 374 cases from 25 countries in which psoriasis patients had COVID-19 between March and July 2020. About 71% were taking biologic medications and 18% were taking traditional immunosuppressants. About 93% fully recovered from COVID-19, 21% were hospitalized and 2% died.

Helen McAteer is chief executive of the Psoriasis Association. She said, “From the beginning of the pandemic, we understood the importance of being proactive in order to address the many concerns expressed by people who are living with psoriasis. The PsoProtect registry is vital in helping us understand more about the interactions between psoriasis, its treatments and COVID-19 infection so patients can make the most informed choices about their care and treatment at this challenging time.”

Copyright © 2020 HealthDay. All rights reserved.

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India’s capital chokes on ‘severe’ smog as farm fires soar

New Delhi was blanketed in noxious haze Friday as air pollution levels in parts of the city soared to “severe” levels, hours after US President Donald Trump described the air in the vast nation as “filthy”.

Smoke from agricultural burning, vehicle fumes and industrial emissions — combined with cooler temperatures and slow-moving winds that trap pollutants over the city — turns air in the Indian capital into a toxic soup every winter.

The air quality index at Delhi’s 36 pollution monitoring sites — which monitors tiny PM2.5 and PM10 particles that get into the bloodstream and vital organs — was between 282 and 446, pushing levels into the “severe” category, the Central Pollution Control Board said.

The “good” category is between 0-50, the government’s environmental watchdog added.

A “significant increase in stubble fire count” to 1,213 in Haryana and Punjab states was the highest of this season and made up 17 percent of Delhi’s PM2.5 levels, the state-run System of Air Quality Weather Forecasting and Research added Friday.

“Further deterioration of (air quality) is expected for the two days,” SAFAR said.

This season’s burning started earlier because of advanced sowing and harvesting by farmers amid fears of labour shortages during the coronavirus pandemic, officials said.

The worsening conditions came as Trump complained that action on climate change was unfair to the US.

“Look at China, how filthy it is. Look at Russia, look at India — it’s filthy. The air is filthy,” Trump said at his presidential debate with Democratic rival Joe Biden.

Scientists warned this year’s pollution season would make Delhi’s 20 million residents more vulnerable to the coronavirus.

“Air pollution increases the risk of noncommunicable diseases — the same underlying conditions that make people more likely to experience severe illness or death from Covid-19,” epidemiologist Sumi Mehta from global non-profit Vital Strategies told AFP.

Healthcare systems, stretched by the pandemic, could be further stressed by more hospitalisations from pollution-related illnesses, researchers added.

“There are serious worries that during winter when higher air pollution levels in any case worsens respiratory illness and increases hospitalisation, the vulnerability to Covid-19 may be further enhanced,” Anumita Roy Chowdhury of the Delhi-based Centre for Science and Environment told AFP.

The chief medical officer of Gurugram city near New Delhi, Virender Yadav, told The Times of India Thursday some recovering Covid-19 patients were experiencing a reoccurence of respiratory conditions triggered by the heightened air pollution.

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Convalescent plasma did not reduce Covid-19 deaths or keep patients from severe illness in new study

The study, conducted in India and published in the medical journal the BMJ on Thursday, suggests that “as a potential treatment for patients with moderate Covid-19, convalescent plasma showed limited effectiveness.”

Convalescent plasma is the antibody-rich serum taken from the blood of people who recovered from Covid-19. The idea is that the plasma can help the immune response of patients still fighting the disease.

In August, the US Food and Drug Administration authorized the emergency use of convalescent plasma as a treatment option for hospitalized Covid-19 patients. However, data were still being collected in randomized controlled trials — the gold standard — to study the safety and effectiveness of the treatment. Last month, a National Institutes of Health panel said there’s no evidence backing the use of convalescent plasma to treat coronavirus patients and that doctors should not treat it as a standard of care until more study has been done.

Randomized controlled trials of convalescent plasma to treat Covid-19 patients are still underway in the United States.

The new study, called the PLACID trial, included data on 464 adults with moderate Covid-19 in 39 hospitals across India. Among them, 235 patients were randomly selected to receive convalescent plasma along with standard care for treatment and 229 patients received only standard care.

The new study showed that a higher proportion of patients who received convalescent plasma saw improvements in their symptoms of fatigue and shortness of breath compared with those given standard care, but there was no difference between patients when it came to resolving fever and cough.

The proportion of patients who needed invasive ventilation did not differ among the two groups, and overall, the researchers found that 34 patients who received convalescent plasma, or 15%, had died — compared with 31 who were given standard care, or 14%.

Dozens of hospitals poised to defy FDA's directive on Covid plasma

The study had some limitations, including that it was an “open label design” so the physicians treating the patients knew who was given convalescent plasma and who wasn’t. Additionally, more research is needed to determine whether similar findings would emerge among a larger group of patients in other parts of the world.

Simon Clarke, an associate professor in cellular microbiology at the University of Reading in the United Kingdom, called the new study “a blow” to the use of convalescent plasma as a Covid-19 treatment.

“While this is a blow to the use of plasma therapy for Covid-19, it should not be abandoned, there may be ways to refine it as a treatment and deliver solid, demonstrable benefits,” Clarke said in a written statement distributed by the UK-based Science Media Centre.
Researchers hope this old-fashioned treatment will work for coronavirus

“Use of someone’s blood plasma that contains antibodies against a virus or bacteria to treat an infection in someone else, is not a new technology and although usually safe, is not entirely without risk,” said Clarke, who was not involved in the new study.

“The PLACID trial was able to show a small effect on the rate at which patients were able rid themselves of the virus, but this

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Severe Morning Sickness Linked to Depression Before and After Birth | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

FRIDAY, Oct. 16, 2020 (HealthDay News) — Women who suffer severe morning sickness may have higher risk of depression during and after pregnancy, according to a new British study.

It enrolled 214 women in London during the first trimester of pregnancy. Half had severe morning sickness; half did not. None had been treated for mental health conditions during the previous year.

The women’s mental health was assessed in their first trimester and six weeks after giving birth.

Nearly half of the women with severe morning sickness had depression in the first trimester and nearly 30% had depression after delivery. Among the women without morning sickness, the rates were 6% and 7%, respectively.

Half of the women with severe morning sickness had to take four or more weeks off work during or after pregnancy, according to findings published Oct. 14 in the journal BMJ Open.

Severe morning sickness, also known as hyperemesis gravidarum, is one of the most common reasons for hospitalization during pregnancy. Women with the condition are often severely nauseated with persistent vomiting. They can be bedridden for weeks, suffer dehydration and weight loss, and often can’t work or care for their other children.

But lead author Dr. Nicola Mitchell-Jones, a specialist registrar in obstetrics and gynecology at Imperial College London, said many health care providers don’t take the mental health impact of severe morning sickness seriously enough.

Women with severe morning sickness are about eight times more likely to suffer depression before giving birth and four times more likely to be depressed afterward, she said.

“Some women in the study even had thoughts of self-harm whilst suffering HG [hyperemesis gravidarum],” Mitchell-Jones said in a college news release. “These figures are shocking and should be reflected in the treatment women receive. We need to do much more than simply treat the physical symptoms of HG; assessment for mental health support should also be routine for any woman with the condition.”

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