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BackgroundThe global inequity in coronavirus disease 2019 (COVID-19) vaccine distribution, primarily affecting low- and middle-income countries (LMICs), highlights the urgent need for innovative and cost-effective vaccine technologies to address availability disparities. This is crucial for achieving and sustaining widespread immunity and protecting vulnerable populations during future booster campaigns. MethodsTo address this need, we conducted a phase II clinical trial evaluating the safety and immunogenicity of the AVX/COVID-12 "Patria" vaccine as a booster dose. The vaccine was administered through both intramuscular (IM) and intranasal (IN) routes to participants who had previously received severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines based on adenoviral technology, inactivated virus, or mRNA technology. The inclusion criterion involved individuals with initial anti-spike IgG titers below 1,200 U/mL, allowing observation of the booster effect induced by vaccination. ResultsImmunization with AVX/COVID-12 resulted in a significant (>2.5 times) increase in neutralizing antibodies against the original Wuhan strain and variants of concern (VOCs) such as Alpha, Beta, Delta, and Omicron (BA.2 and BA.5). This immune response was accompanied by cellular interferon-gamma (IFN-{gamma}) production, indicating a robust and multifaceted reaction. ConclusionsThe administration of AVX/COVID-12 as a booster dose, whether through IM or IN routes, was safe and well-tolerated. The vaccine extended immune responses not only against the original Wuhan-1 strain but also against various VOCs. Its ability to enhance preexisting immune responses suggests a potential contribution to expanding and sustaining herd immunity within the population.
Subject(s)
Coronavirus Infections , COVID-19 , Newcastle DiseaseABSTRACT
Introducción: La artritis reactiva (ReA) es una monoartritis u oligoartritis que compromete principalmente las extremidades, y se puede relacionar con infecciones bacterianas o virales. En la actualidad, la covid-19 se ha relacionado con el desarrollo de artropatías debido a su componente inflamatorio. Objetivos: Llevar a cabo una revisión exploratoria de la literatura que describa las características clínicas de la ReA en pacientes sobrevivientes a la infección por SARS-CoV-2. Materiales y métodos: Revisión sistemática exploratoria basada en las guías para comunicar revisiones sistemáticas adaptadas para las revisiones exploratorias Prisma-P y pasos propuestos Arksey y ajustados por Levan. Se incluyeron estudios de tipo experimental y observacional publicados en PubMed y Scopus, en inglés y español, que respondieran las preguntas de investigación planteadas. Resultados: Se incluyeron 25 documentos que describen las principales manifestaciones clínicas de la ReA en 27 pacientes con antecedente de infección por SARS-Cov-2. El tiempo desde el inicio de los síntomas o diagnóstico microbiológico de la covid-19 hasta el desarrollo de manifestaciones articulares o extraarticulares compatibles con ReA osciló entre 7 y 120 días. Las manifestaciones articulares clínicas descritas fueron las artralgias y el edema de predominio en articulaciones de las rodillas, tobillos, codos, interfalángicas, metatarsofalángica y metacarpofalángica. Conclusiones: Las artralgias en las extremidades son el principal síntoma de la ReA en pacientes con antecedente de covid-19. Sus síntomas se pueden presentar en un periodo de días a semanas, desde el inicio de los síntomas clínicos o el diagnóstico microbiológico de la infección por SARS-CoV-2.
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The coronavirus infectious disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been spreading rapidly worldwide, creating a pandemic. This article describes the evaluation of the antiviral activity of nordihydroguaiaretic acid (NDGA), a molecule found in Creosote bush (Larrea tridentata) leaves, against SARS-CoV-2 in vitro. A 35 µM concentration of NDGA was not toxic to Vero cells and exhibited a remarkable inhibitory effect on the SARS-CoV-2 cytopathic effect, viral plaque formation, RNA replication, and expression of the SARS-CoV-2 spike glycoprotein. The 50% effective concentration for NDGA was as low as 16.97 µM. Our results show that NDGA could be a promising therapeutic candidate against SARS-CoV-2.
Subject(s)
COVID-19 , SARS-CoV-2 , Animals , Chlorocebus aethiops , Masoprocol/pharmacology , Masoprocol/therapeutic use , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , Vero CellsABSTRACT
Resumen Introducción: La artritis reactiva (ReA) es una monoartritis u oligoartritis que compromete principalmente las extremidades, y se puede relacionar con infecciones bacterianas o virales. En la actualidad, la covid-19 se ha relacionado con el desarrollo de artropatías debido a su componente inflamatorio. Objetivos: Llevar a cabo una revisión exploratoria de la literatura que describa las características clínicas de la ReA en pacientes sobrevivientes a la infección por SARS-CoV-2. Materiales y métodos: Revisión sistemática exploratoria basada en las guías para comunicar revisiones sistemáticas adaptadas para las revisiones exploratorias Prisma-P y pasos propuestos Arksey y ajustados por Levan. Se incluyeron estudios de tipo experimental y observacional publicados en PubMed y Scopus, en inglés y español, que respondieran las preguntas de investigación planteadas. Resultados: Se incluyeron 25 documentos que describen las principales manifestaciones clínicas de la ReA en 27 pacientes con antecedente de infección por SARS-Cov-2. El tiempo desde el inicio de los síntomas o diagnóstico microbiológico de la covid-19 hasta el desarrollo de manifestaciones articulares o extraarticulares compatibles con ReA osciló entre 7 y 120 días. Las manifestaciones articulares clínicas descritas fueron las artralgias y el edema de predominio en articulaciones de las rodillas, tobillos, codos, interfalángicas, metatarsofalángica y metacarpofalángica. Conclusiones: Las artralgias en las extremidades son el principal síntoma de la ReA en pacientes con antecedente de covid-19. Sus síntomas se pueden presentar en un periodo de días a semanas, desde el inicio de los síntomas clínicos o el diagnóstico microbiológico de la infección por SARS-CoV-2. Introduction: Reactive arthritis (ReA) is a monoarthritis or oligoarthritis that mainly affects the extremities, it can be related to bacterial or viral infections. Currently, COVID-19 has been linked to the development of arthropathies due to its inflammatory component. Objectives: A scoping review of the literature that describes the clinical characteristics of ReA in survivors of SARS-CoV-2 infection. Materials and methods: A systematic review based on the guidelines for reporting systematic reviews adapted for Prisma-P exploratory reviews and steps proposed by Arksey and adjusted by Levan. Experimental and observational studies published in PubMed and Scopus, English and Spanish, which answered the research questions posed, were included. Results: 25 documents were included describing the main clinical manifestations of ReA in 27 patients with a history of SARS-Cov-2 infection. The time from the onset of symptoms or microbiological diagnosis of COVID-19 to the development of articular and/or extra-articular manifestations compatible with ReA ranged from 7 days to 120 days. The clinical joint manifestations described were arthralgia and oedema, predominantly in knee, ankle, elbow, interphalangeal, metatarsophalangeal, and metacarpophalangeal joints. Conclusions: Arthralgias in the extremities are the main symptom of ReA in patients with a history of COVID-19, whose symptoms can present in a period of days to weeks from the onset of clinical symptoms or microbiological diagnosis of SARS-CoV-2 infection.
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The authors of the image chapters of the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC), as well as personnel from the Department of Medicine and Nutrition of the University of Guanajuato, together with prominent experts in cardiovascular imaging from Mexico, have collaborated in the review, analysis and expansion of the various health strategies published in the first year of the coronavirus disease 2019 (COVID-19) pandemic, to safely perform cardiac imaging studies. This update aims to reduce the risk of COVID-19 transmission among patients and health-care personnel in the CT, MRI, and nuclear cardiology services. This work was expanded with supplementary information available free of charge on the website www.ancam-imagen.com.
Los capítulos de imagen de la Asociación Nacional de Cardiólogos de México (ANCAM) y de la Sociedad Mexicana de Cardiología (SMC), así como personal del Departamento de Medicina y Nutrición de la Universidad de Guanajuato, en conjunto con destacados expertos de la imagen cardiovascular en México, han colaborado en la revisión, análisis y ampliación de las diversas estrategias sanitarias publicadas en los primeros 15 meses de la pandemia de enfermedad por coronavirus 2019 (COVID-19) para realizar con seguridad los estudios de imagen cardiaca; esta actualización tiene como objetivo principal disminuir el riesgo de transmisión de la COVID-19 entre los pacientes y el personal de salud en los servicios de tomografía, resonancia y cardiología nuclear. Este trabajo se amplió con información suplementaria disponible sin costo en el sitio www.ancam-imagen.com.
Subject(s)
COVID-19 , Cardiology , Infection Control , Societies, Medical , COVID-19/prevention & control , Cardiovascular System/diagnostic imaging , Humans , MexicoABSTRACT
OBJECTIVE: To determine the incidence of adverse reactions (AR) after the first dose of Pfizer-BioNTech vaccine, and to identify some factors associated with AR. METHOD: A retrospective cohort study was conducted. Data were obtained through an epidemiological survey answered online. Multivariate analyses were performed to identify factors associated with early (< 2 h) and late (≥ 2 h) AR. RESULTS: A total of 2295 health care workers were included; in them, the cumulative incidence of AR was 18.2% (95% confidence interval: 16.6-19.8), where the majority were late (78.2%). The associated factors that increased the risk of early AR were being female (odds ratio [OR]: 2.23, p = 0.002) and belonging to the medical staff (OR: 1.56; p = 0.041). In late AR were being female (OR: 1.94; p < 0.0001); on the other hand, diabetes (OR: 0.46; p = 0.021), asthma (OR: 0.53; p = 0.040) and smoking (OR: 0.44, p = 0.002) were inversely associated factors. Interestingly, history of COVID-19 was not associated with either early or late AR. CONCLUSIONS: The risk of presenting some type of AR due to the Pfizer-BioNTech vaccine in health care workers is < 20%.
OBJETIVO: Determinar la incidencia de reacciones adversas (RA) tras la primera dosis de la vacuna Pfizer-BioNTech e identificar algunos factores asociados con ellas. MÉTODO: Se realizó un estudio de cohorte retrospectiva. Los datos fueron obtenidos mediante una encuesta epidemiológica contestada en línea. Se realizaron análisis multivariados para identificar factores asociados con las RA tempranas (< 2 h) y tardías (≥ 2 h). RESULTADOS: Se incluyeron 2295 trabajadores de la salud; en ellos, la incidencia acumulada de RA fue del 18.2% (intervalo de confianza del 95%: 16.6-19.8%) y la mayoría fueron tardías (78.2%). Las RA tempranas más frecuentes fueron dolor local, cefalea y mareo; en las tardías fueron dolor local, cefalea y fatiga. No se documentaron casos de anafilaxia; sin embargo, en el grupo de RA tempranas y tardías hubo un caso y tres casos, respectivamente, con síntomas sistémicos que afectaron a dos órganos diferentes. Los factores asociados que incrementaron el riesgo de RA tempranas fueron ser mujer (odds ratio [OR]: 2.23; p = 0.002) y pertenecer al personal médico (OR: 1.56; p = 0.041). En las RA tardías fue ser mujer (OR: 1.94; p < 0.0001); por su parte, la diabetes (OR: 0.46; p = 0.021), el asma (OR: 0.53; p = 0.040) y el tabaquismo (OR: 0.44; p = 0.002) fueron factores asociados inversamente. Es interesante que la historia de COVID-19 no se asoció con RA tempranas ni tardías. CONCLUSIONES: El riesgo de presentar algún tipo de RA debido a la vacuna Pfizer-BioNTech en trabajadores de la salud es < 20%.
Subject(s)
COVID-19 , Diabetes Mellitus , Humans , Female , Male , Retrospective Studies , COVID-19/epidemiology , COVID-19/prevention & control , Smoking/adverse effects , Smoking/epidemiology , IncidenceABSTRACT
Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703-0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217-0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623-0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822-0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829-0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity.
Subject(s)
Hypotension , Female , Humans , Aged , Hypotension/etiology , Hypotension/diagnosis , Diagnosis, DifferentialABSTRACT
Background Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS;however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. Methods This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. Results Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. Conclusion The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.
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Introduction Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic. Methods In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID-19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. Results The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU;1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores. Discussion and conclusions The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.
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COVID-19 has serious effects on cardiorespiratory capacity. In this sense, physical activity has been identified as beneficial in the treatment of cardiorespiratory diseases due to its anti-inflammatory and immunosuppressive benefits. To date, no study has been found on cardiorespiratory capacity and rehabilitation in patients cured after COVID-19. Thus, this brief report aims to relate the benefits of physical activity to cardiorespiratory function after COVID-19. It is important to know how different levels of physical activity can be related to the different symptoms of COVID-19. In view of this, the objectives of this brief report were to: (1) explore the theoretical associations between COVID-19 symptoms and physical activity;(2) compare the cardiorespiratory function of non-COVID-19 participants and post-COVID-19 patients;and (3) propose a physical activity program to improve the cardiorespiratory fitness of post-COVID-19 patients. Thus, we note that moderate-intensity physical activity (i.e., walking) has a greater beneficial effect on immune function, whereas vigorous activity (i.e., marathon running) tends to temporarily reduce immune function through an imbalance of cytokine types I and II in the hours and days after exercise. However, there is no consensus in the literature in this regard, since other investigations suggest that high-intensity training can also be beneficial, not causing clinically relevant immunosuppression. Physical activity has been shown to be beneficial in improving the clinical conditions most frequently associated with severe COVID-19. Thus, it is possible to infer that physically active individuals seem to be less exposed to the dangers of severe COVID-19 compared to non-active individuals through the benefits of physical activity in strengthening the immune system and fighting infections. The current study demonstrates that physical activity appears to be beneficial in improving the clinical conditions most often associated with severe COVID-19.
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BACKGROUND: Whether pembrolizumab given both before surgery (neoadjuvant therapy) and after surgery (adjuvant therapy), as compared with pembrolizumab given as adjuvant therapy alone, would increase event-free survival among patients with resectable stage III or IV melanoma is unknown. METHODS: In a phase 2 trial, we randomly assigned patients with clinically detectable, measurable stage IIIB to IVC melanoma that was amenable to surgical resection to three doses of neoadjuvant pembrolizumab, surgery, and 15 doses of adjuvant pembrolizumab (neoadjuvant-adjuvant group) or to surgery followed by pembrolizumab (200 mg intravenously every 3 weeks for a total of 18 doses) for approximately 1 year or until disease recurred or unacceptable toxic effects developed (adjuvant-only group). The primary end point was event-free survival in the intention-to-treat population. Events were defined as disease progression or toxic effects that precluded surgery; the inability to resect all gross disease; disease progression, surgical complications, or toxic effects of treatment that precluded the initiation of adjuvant therapy within 84 days after surgery; recurrence of melanoma after surgery; or death from any cause. Safety was also evaluated. RESULTS: At a median follow-up of 14.7 months, the neoadjuvant-adjuvant group (154 patients) had significantly longer event-free survival than the adjuvant-only group (159 patients) (P = 0.004 by the log-rank test). In a landmark analysis, event-free survival at 2 years was 72% (95% confidence interval [CI], 64 to 80) in the neoadjuvant-adjuvant group and 49% (95% CI, 41 to 59) in the adjuvant-only group. The percentage of patients with treatment-related adverse events of grades 3 or higher during therapy was 12% in the neoadjuvant-adjuvant group and 14% in the adjuvant-only group. CONCLUSIONS: Among patients with resectable stage III or IV melanoma, event-free survival was significantly longer among those who received pembrolizumab both before and after surgery than among those who received adjuvant pembrolizumab alone. No new toxic effects were identified. (Funded by the National Cancer Institute and Merck Sharp and Dohme; S1801 ClinicalTrials.gov number, NCT03698019.).
Subject(s)
Antineoplastic Agents, Immunological , Melanoma , Neoadjuvant Therapy , Skin Neoplasms , Humans , Adjuvants, Immunologic , Disease Progression , Melanoma/drug therapy , Melanoma/pathology , Melanoma/surgery , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Antineoplastic Agents, Immunological/administration & dosage , Antineoplastic Agents, Immunological/adverse effects , Antineoplastic Agents, Immunological/therapeutic use , Chemotherapy, AdjuvantABSTRACT
BACKGROUND: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. METHODS: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. RESULTS: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. CONCLUSION: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.
Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Male , Aged , Female , Prone Position/physiology , Cohort Studies , Respiratory Distress Syndrome/therapy , Respiration, Artificial/adverse effects , Respiration, Artificial/methods , AgingABSTRACT
COVID-19 has serious effects on cardiorespiratory capacity. In this sense, physical activity has been identified as beneficial in the treatment of cardiorespiratory diseases due to its anti-inflammatory and immunosuppressive benefits. To date, no study has been found on cardiorespiratory capacity and rehabilitation in patients cured after COVID-19. Thus, this brief report aims to relate the benefits of physical activity to cardiorespiratory function after COVID-19. It is important to know how different levels of physical activity can be related to the different symptoms of COVID-19. In view of this, the objectives of this brief report were to: (1) explore the theoretical associations between COVID-19 symptoms and physical activity; (2) compare the cardiorespiratory function of non-COVID-19 participants and post-COVID-19 patients; and (3) propose a physical activity program to improve the cardiorespiratory fitness of post-COVID-19 patients. Thus, we note that moderate-intensity physical activity (i.e., walking) has a greater beneficial effect on immune function, whereas vigorous activity (i.e., marathon running) tends to temporarily reduce immune function through an imbalance of cytokine types I and II in the hours and days after exercise. However, there is no consensus in the literature in this regard, since other investigations suggest that high-intensity training can also be beneficial, not causing clinically relevant immunosuppression. Physical activity has been shown to be beneficial in improving the clinical conditions most frequently associated with severe COVID-19. Thus, it is possible to infer that physically active individuals seem to be less exposed to the dangers of severe COVID-19 compared to non-active individuals through the benefits of physical activity in strengthening the immune system and fighting infections. The current study demonstrates that physical activity appears to be beneficial in improving the clinical conditions most often associated with severe COVID-19.
Subject(s)
COVID-19 , Cardiorespiratory Fitness , Humans , Physical Fitness/physiology , Exercise/physiology , ImmunityABSTRACT
INTRODUCTION: Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic. METHODS: In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID-19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. RESULTS: The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores. DISCUSSION AND CONCLUSIONS: The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.
Subject(s)
COVID-19 , Humans , Retrospective Studies , Hospital Mortality , Hospitalization , Critical Care , Intensive Care UnitsABSTRACT
The maturation of genomic surveillance in the past decade has enabled tracking of the emergence and spread of epidemics at an unprecedented level. During the COVID-19 pandemic, for example, genomic data revealed that local epidemics varied considerably in the frequency of SARS-CoV-2 lineage importation and persistence, likely due to a combination of COVID-19 restrictions and changing connectivity. Here, we show that local COVID-19 epidemics are driven by regional transmission, including across international boundaries, but can become increasingly connected to distant locations following the relaxation of public health interventions. By integrating genomic, mobility, and epidemiological data, we find abundant transmission occurring between both adjacent and distant locations, supported by dynamic mobility patterns. We find that changing connectivity significantly influences local COVID-19 incidence. Our findings demonstrate a complex meaning of 'local' when investigating connected epidemics and emphasize the importance of collaborative interventions for pandemic prevention and mitigation.
Subject(s)
COVID-19ABSTRACT
INTRODUCTION: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. OBJECTIVES: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. METHODS: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. RESULTS: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). CONCLUSIONS: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.
INTRODUCCIÓN: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. OBJETIVOS: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. MÉTODOS: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. RESULTADOS: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). CONCLUSIONES: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.
Subject(s)
COVID-19 , Malaria , Humans , COVID-19/epidemiology , SARS-CoV-2 , Incidence , Mexico/epidemiology , Retrospective StudiesABSTRACT
Wastewater surveillance has proven to be a useful tool for evidence-based epidemiology in the fight against the SARS-CoV-2 virus. It is particularly useful at the population level where acquisition of individual test samples may be time or cost-prohibitive. Wastewater surveillance for SARS-CoV-2 has typically been performed at wastewater treatment plants; however, this study was designed to sample on a local level to monitor the spread of the virus among three communities with distinct social vulnerability indices in Shreveport, Louisiana, located in a socially vulnerable region of the United States. Twice-monthly grab samples were collected from September 30, 2020, to March 23, 2021, during the Beta wave of the pandemic. The goals of the study were to examine whether: 1) concentrations of SARS-CoV-2 RNA in wastewater varied with social vulnerability indices and, 2) the time lag of spikes differed during wastewater monitoring in the distinct communities. The size of the population contributing to each sample was assessed via the quantification of the pepper mild mottle virus (PMMoV), which was significantly higher in the less socially vulnerable community. We found that the communities with higher social vulnerability exhibited greater viral loads as assessed by wastewater when normalized with PMMoV (Kruskal-Wallis, p < 0.05). The timing of the spread of the virus through the three communities appeared to be similar. These results suggest that interconnected communities within a municipality experienced the spread of the SARS-CoV-2 virus at similar times, but areas of high social vulnerability experienced more intense wastewater viral loads.
Subject(s)
COVID-19 , Humans , RNA, Viral , SARS-CoV-2 , Viral Load , Wastewater , Wastewater-Based Epidemiological MonitoringABSTRACT
Resumen Introducción: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. Objetivos: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. Métodos: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. Resultados: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). Conclusiones: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.
Abstract Introduction: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. Objectives: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. Methods: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. Results: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). Conclusions: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.