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Purpose of Study The detrimental long-term effects of obesity are well-described in literature;however, there has been recently emerging evidence describing a possible mortality benefit in obese patients with acute injury. The scope of this review is to provide an overview of the ongoing debate surrounding this observation. We focused our discussion on evaluating the evidences suggesting an impact of obesity and overweight on multiple acute medical conditions. Methods Used We searched the PubMed database with the keywords 'obesity', 'paradox', 'trauma', 'mortality', 'BMI', 'cancer', 'sepsis', 'lung injury', 'stroke', 'COVID', and 'myocardial infarct' from inception to 2020 and selected 40 relevant papers discussing the relationship between mortality and BMI in the setting of these stressors, and the mechanisms behind them. Summary of Results Amongst the fields of blunt trauma, cardiovascular disease, cancer, and critical care admissions for sepsis and lung injury, there are a growing amount of evidences supporting the existence of a paradoxical mortality benefit with overweight and mild obesity compared to normal and lean BMI. These findings must be attenuated with study design and BMI limitations, as well as biases prevalent throughout these studies. Although several hypotheses have been proposed, the exact mechanisms behind this relationship are largely unknown. Conclusions This survey of the obesity paradox shows promise in regard to overweight and mild obesity helping with survival post-acute illness, possibly due to metabolic reserves, antiinflammatory, and anti-oncogenic conditions seen in obesity. We recommend addressing current major limitations by having future studies prospectively designed to evaluate alternative body weight metrics such as waist-to-hip ratio or waist circumference, with special attention to the timing of body weight measurements and its progression in the patient's life. In the future, elucidating the biological mechanisms of this relationship may allow us to adapt our recommendations to the patients and help direct optimal therapeutic approach in the management of certain acute pathologies.
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Purpose of Study: Previous Osteopathic manipulative treatment (OMT) research has shown evidence of increased lymphatic movement resulting in increased leukocyte and cytokine flow. One study even showed increased antibody titer response in patients when used in conjunction with the Hepatitis B vaccine. Given previous studies, our group conducted a year-long longitudinal randomized controlled clinical trial to evaluate the ability of OMT to improve the COVID-19 vaccine immune response. Methods Used: Subjects were randomized into either the control arm or OMT intervention arm. OMT consisted of myofascial release of the thoracic inlet, pectoral traction, diaphragm release with MFR, splenic pump, and thoracic pump applied the day of and the day following each vaccination session. All subjects in each group received the Pfizer mRNA COVID-19 vaccine. All subjects had blood drawn on day 0 (1st vaccine), day 7, day 21 (2nd vaccine), days 28, 90, 210, and 365. Anti-spike IgG immunoglobulin titers (AS IgG) were measured at all time points for all subjects. Side effects, adverse events, and medication usage in response to the vaccines or OMT was documented. Breakthrough cases with symptomology and medication usage was documented for both groups. The study was approved by the WesternU IRB committee, protocol #FB21/IRB026. Summary of Results: Data for 91 subjects were analyzed with 41 male (45.1%) and 50 female (54.9%). Age distribution was comparable between the two groups. Side effects and medication usage reported by the subjects was similar between groups (p>0.1). AS IgG measured at baseline distinguished between previously infected individuals and those naive to COVID-19, regardless of OMT treatment. For all time points measured, the average AS IgG in subjects trended higher in OMT group than control group. Two-way ANOVA analysis showed statistical significance at 1 week after 2nd injection (p<0.001) in the COVID-19 naive population. 13 symptomatic breakthrough infections were reported in the control group and 12 in the OMT group. Length of symptoms were reported as 8.36 +/- 4.60 days (control) and 4.62 +/- 2.60 days (OMT) (p<0.05). Length of medication usage was 3.64 +/- 3.58 days (control) and 1.23 +/- 1.24 days (OMT) (p<0.1). Conclusion(s): Both groups had comparable side effects after COVID-19 vaccination with no adverse events linked to OMT, indicating that OMT is a safe adjunct that can be used with COVID-19 vaccination. The data showed an enhanced immune response by OMT, as evidenced by increased levels of AS IgG in previously naive subjects. Although both control and OMT groups had similar rates of symptomatic breakthrough infection, the OMT data shows reduced length of symptoms and medication duration in this population when compared to control breakthrough infections. This study is underpowered for statistical significance at each time point and future vaccination studies should recruit more patients to confirm the trends seen here.
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Background. The COVID-19 pandemic has demonstrated the importance of pathogen genomic surveillance. At RKI, the German National Institute of Public Health, we established the Integrated Molecular Surveillance for SARS-CoV-2 (IMS-SC2) network to perform SARS-CoV-2 genomic surveillance. Methods. SARS-CoV-2 positive samples from laboratories distributed across Germany regularly undergo whole-genome sequencing at RKI. This surveillance instrument enables (i) almost-real-time monitoring of SARS-CoV-2 genomic diversity and evolution, (ii) in vitro assessment of vaccine coverage against emerging variants and (iii) genome-based estimates of SARS-CoV-2-incidences. Results. We report the results of our analyses of 3623 SARS-CoV-2 genomes collected between 12/1/2020 and 12/31/2021. All variants of concern were identified, at ratios equivalent to those in the 100-fold larger German GISAID sequence dataset from the same time period. Lineage distributions fluctuated over time, covering the rise of the Alpha and Delta, as well as the emergence of Omicron. Phylogenetic analysis confirmed variant assignments. Multiple mutations of concern emerged during the observation period. To model vaccine effectiveness in vitro, we employed authentic-virus neutralization assays, confirming that both the Beta and Zeta variants are capable of immune evasion. The IMS-SC2 sequence dataset facilitated an estimate of the SARS-CoV-2 incidence based on genetic evolution rates. Together with modelled vaccine efficacies, Delta-specific incidence estimation indicated that the German vaccination campaign contributed substantially to a deceleration of the nascent German Delta wave. Conclusion. This example illustrates that pathogen genomics enables a proactive approach to controlling a pandemic as the virus evolves. Molecular and genomic SARS-CoV-2 surveillance will be crucial during the post-pandemic future, informing public health policies including vaccination strategies. Of note, the IMS-SC2 infrastructure can be adapted to many other pathogens, serving as a blueprint for future efforts to increase genomic pathogen surveillance.
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Hybrid conferences are in-person events that have an online component. This type of meeting format was rare before the COVID-19 pandemic, but started to become more common recently given the asynchronous global progression of the pandemic, the uneven access to vaccines and different travel regulations among countries that led to a large proportion of participants being unable to attend conferences in person. Here we report the organization of a middle-sized (581 participants: 159 onsite, 422 online) international hybrid conference that took place in France in September 2021. We highlight particular organizational challenges inherent to this relatively new type of meeting format. Furthermore, we surveyed both in-person and online participants to better understand their conference experience and to propose improvements based on the feedback received. Finally, we compare the advantages and disadvantages of three types of conferences (onsite-only, online-only and hybrid) and suggest that hybrid events should be favored in the future because they offer the most flexibility to participants. We conclude by proposing suggestions and ways forward to maximize accessibility and inclusivity of hybrid conferences. Our study brings novel insights on the challenges and opportunities created by hybrid conferences, by reporting not only the organizing committee experience but also by considering the participants’ perspective. Copyright © 2022 Puccinelli, Zeppilli, Stefanoudis, Wittische-Helou, Kermorgant, Fuchs, Menot, Easton and Weber.