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Patients with antibody deficiency disorders, such as primary immunodeficiency (PID) or secondary immunodeficiency (SID) to B-cell lymphoproliferative disorder (B-CLPD), are two groups vulnerable to developing the severe or chronic form of coronavirus disease caused by SARS-CoV-2 (COVID-19). The data on adaptive immune responses against SARS-CoV-2 are well described in healthy donors, but still limited in patients with antibody deficiency of a different cause. Herein, we analyzed spike-specific IFN-γ and anti-spike IgG antibody responses at 3 to 6 months after exposure to SARS-CoV-2 derived from vaccination and/or infection in two cohorts of immunodeficient patients (PID vs. SID) compared to healthy controls (HCs). Pre-vaccine anti-SARS-CoV-2 cellular responses before vaccine administration were measured in 10 PID patients. Baseline cellular responses were detectable in 4 out of 10 PID patients who had COVID-19 prior to vaccination, perceiving an increase in cellular responses after two-dose vaccination (p < 0.001). Adequate specific cellular responses were observed in 18 out of 20 (90%) PID patients, in 14 out of 20 (70%) SID patients and in 74 out of 81 (96%) HCs after vaccination (and natural infection in some cases). Specific IFN-γ response was significantly higher in HC with respect to PID (1908.5 mUI/mL vs. 1694.1 mUI/mL; p = 0.005). Whereas all SID and HC patients mounted a specific humoral immune response, only 80% of PID patients showed positive anti-SARS-CoV-2 IgG. The titer of anti-SARS-CoV-2 IgG was significantly lower in SID compared with HC patients (p = 0.040), without significant differences between PID and HC patients (p = 0.123) and between PID and SID patients (p =0.683). High proportions of PID and SID patients showed adequate specific cellular responses to receptor binding domain (RBD) neoantigen, with a divergence between the two arms of the adaptive immune response in PID and SID patients. We also focused on the correlation of protection of positive SARS-CoV-2 cellular response to omicron exposure: 27 out of 81 (33.3%) HCs referred COVID-19 detected by PCR or antigen test, 24 with a mild course, 1 with moderate symptoms and the remaining 2 with bilateral pneumonia that were treated in an outpatient basis. Our results might support the relevance of these immunological studies to determine the correlation of protection with severe disease and for deciding the need for additional boosters on a personalized basis. Follow-up studies are required to evaluate the duration and variability in the immune response to COVID-19 vaccination or infection.
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Background: Despite an increasing proportion of pregnant women accessing antenatal care (ANC) in low-income countries, preventable maternal morbidity and mortality remains high. Limited women’s knowledge on common diseases during pregnancy and on the indications of routine health interventions delivered at the ANC clinic may reduce the compliance and effectiveness of these interventions. We assessed pregnant women’s knowledge on common diseases in pregnancy and on routine interventions delivered at the ANC clinic as well as their compliance with these interventions. Methods: From December-2019 to October-2020, we undertook a qualitative study using individual semi-structured and in-depthinterviews in 79 pregnant women attending the ANC clinic of a rural hospital in Mozambique. Participant’s ability to identify the drugs administrated was assessed by showing them the drugs without the label (antiretroviral, ferrous sulfate, cotrimoxazole, isoniazid, mebendazol and antimalarial). Interviews were recorded, transcribed, coded and a combined Content and Thematic analysis technique used. NVivo 12 software was used to store and retrieve the data. Results: Most of the participants recognized that infectious diseases such as HIV, malaria, sexually transmitted infections, tuberculosis and COVID-19, could be harmful in pregnancy. Overall, knowledge on the indication of the prescribed drugs was limited, being higher for antiretroviral drugs and ferrous sulfate, and lower for mebendazol and isoniazid. The general perception was that all drugs prescribed at the ANC clinic prevent or treat malaria infection. Knowledge on the indication of the prescribed drugs was generally higher in HIV-infected pregnant women compared to HIV uninfected women. Forgetting daily medication intake, non-compliance with the drug intake schedule and perceived importance given to some drugs instead of others, were practices found regarding compliance to the pharmacological interventions. Conclusion: Knowledge of Mozambican pregnant women on health interventions delivered at the ANC clinic was generally limited. The latter may reduce compliance and adherence with these interventions and thus their effectiveness and safety. Reinforcing Information and education on ANC health interventions targeting women of childbearing age would improve maternal and infant health.
Subject(s)
COVID-19ABSTRACT
The COVID-19 pandemic brought to the forefront longstanding and pervasive health disparities (HD) in the United States that are driven by underlying structural inequities rooted in racism and intersecting systems of power. It is imperative that medical physics training programs increase their commitment and investment in teaching trainees about HD, especially as the profession becomes more patient-facing. To address this current training gap, we designed an introductory HD curriculum for medical physics graduate students and residents. A HD scholar and medical physicist collaborated to design this course. The curriculum consisted of four weekly 1.5-hour synchronous online sessions. Sessions were developed based on transformative learning theory and involved didactic lectures, case studies, large and small group discussions, and reflection exercises. Session topics included social determinants of equity, structural racism, implicit bias, public outreach, and critical reflection. Participants were asked to fill out pre-post surveys containing open- and close-ended questions for each session and the overall course to evaluate the curriculum's impact on participants. Due to the relevance and timeliness of this topic, trainees were encouraged to attend any part of the course as getting exposure to at least some HD training was prioritized over having a consistent course cohort for optimal data collection. Fifteen trainees attended at least part of the course with 8-11 attendees/session. Most participants reported that weekly sessions increased their feelings of competence to explain the relevance of HD to their role in medical physics (4/7), address mistrust, bias, and stereotyping during patient-provider encounters (6/10), engage in critical reflection (7/8), and design public engagement strategies to reduce HD (5/5). Among participants that completed a pre-post survey for the overall course (N=4), 75% reported they will likely/very likely explore issues related to HD in their future education, research, and/or practice. All would recommend this course to colleagues noting satisfaction with topics, atmosphere to discuss sensitive issues, virtual format, activities, and facilitators. The course was well-attended despite being outside of program requirements, which showed there was interest in the subject. Topics presented resonated with participants and were viewed as timely and relevant to their practice. The implementation of this course shows that it is possible to successfully incorporate HD instruction into the medical physics curriculum in an introductory manner. More robust and consistent data collection is necessary to fully assess the impact of the course on participants. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Evidence is scant regarding the long-term humoral and cellular responses triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines in cancer patients after repeated booster doses. The possibility of T-cell exhaustion following these booster doses in this population has not yet been fully studied and remains uncertain. In this observational study, we explored the specific humoral and cellular response to S1 antigen in 36 patients with solid malignancies at baseline, and after the second and third doses of the mRNA-1273 vaccine. A dual behavior was observed: 24 (66.7%) patients showed partial specific IFN-γ response after the second dose that was further enhanced after the third dose; and 11 (30.5%) already showed an optimal response after the second dose and experienced a marked fall-off of specific IFN-γ production after the third (4 patients negativization), which might suggest T cell exhaustion due to repetitive priming to the same antigen. One (2.8%) patient had persistently negative responses after all three doses. Seroconversion occurred in all patients after the second dose. We then studied circulating exhausted CD8 + T-cells in 4 patients from each of the two response patterns, those with increase and those with decrease in cellular response after the third booster. The patients with decreased cellular response after the booster had a higher expression of CD57hiPD1hiCD8+ and CD57intPD1hiCD8+ exhausted T cells compared with those with an increased cellular response both in vivo and in vitro. Our preliminary data show that the two-dose SARS-CoV-2 vaccine regimen was beneficial in all cancer patients. An additional booster seems to be beneficial in non-optimal cancer responders to SARS-CoV-2 vaccines, in contrast to maximal responders that might develop exhaustion. Our data should be interpreted with caution given the small sample size and highlight the urgent need to validate our results in other independent and larger cohorts. Altogether, our data support the relevance of immunological functional studies to personalize preventive and treatment decisions in cancer patients.
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Population-level immunity to SARS-CoV-2 is growing through vaccination as well as ongoing circulation. Given waning immunity and emergence of new variants, it is important to dynamically determine the risk of re-infection in the population. For estimating immune protection, neutralization titers are most informative, but these assays are difficult to conduct at a population level. Measurement of antibody levels can be implemented at high throughput, but has not been robustly validated as a correlate of protection. Here, we have developed a method that predicts neutralization and protection based on variant-specific antibody measurements to SARS-CoV-2 antigens. This approach allowed us to estimate population-immunity in a longitudinal cohort from France followed for up to 2 years. Participants with a single vaccination or immunity caused by infection only are especially vulnerable to COVID-19 or hospitalization due to SARS-CoV-2. While the median reduced risk to COVID-19 in participants with 3 vaccinations was 96%, the median reduced risk among participants with infection-acquired immunity only was 42%. The results presented here are consistent with data from vaccine-effectiveness studies indicating robustness of our approach. Our multiplex serological assay can be readily optimized and employed to study any new variant and provides a framework for development of an assay that would include protection estimates.
Subject(s)
COVID-19ABSTRACT
The appearance of the SARS-CoV-2 pandemic on the world stage has implemented changes in all social activities and, therefore, in teaching at all educational levels. On the one hand, it is argued that the closure of centers and virtual teaching minimizes the risk of contagion and, on the other, this closure implies a reduction in social interactions in the population at ages in which social skills are lower developing. In addition, it is necessary to guarantee that all children and adolescents have access to the necessary means for distance education. This article analyzes the impact of the COVID-19 pandemic during the second, third and fourth waves in Galicia (northwestern region of Spain), where the centers were kept open with strict security protocols, with the aim of evaluating whether the measure of the center closure is a proportionate measure or not. The results obtained show that, at all educational levels, the incidence of infections has been low, as has the appearance of outbreaks of infections related to educational centers, so the damage caused by this measure can be considered uncompensated, with greater health security.
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Patients with antibody deficiency disorders, such as common variable immunodeficiency (CVID), or secondary immunodeficiency (SIDs) to B-cell lymphoproliferative disorder (B-CLPD), are two vulnerable groups of developing severe or chronic form of coronavirus disease caused by SARS-CoV-2 (COVID-19). Data on adaptive immune responses against SARS-CoV-2 is well described in healthy donors, but still limited in patients with antibody deficiency of different cause. Herein, we analyzed Spike-specific IFN-γ and anti-Spike IgG antibody responses at 3 and 6 months after exposure to SARS-CoV-2 derived from vaccination and infection in two cohorts of immunodeficient patients (CVID vs. SID) compared to healthy controls (HC). Baseline cellular responses before vaccine administration were measured in 10 CVID patients. Adequate specific cellular responses was observed in 18 out of 20 (90%) CVID patients, in 14 out of 20 (70%) out of 20 SID patients and in 74 out of 81 (96%) HC. Specific IFN-γ response was significantly higher in HC respect to CVID (1,908.5 mUI/ml versus 1,694.1 mUI/ml; p = 0.005). Pre-vaccine anti-SARS-CoV-2 cellular responses were detectable in 4 out of 10 CVID patients, who had COVID-19 prior to vaccination, noticing an increase in cellular responses after vaccination (p < 0.001). Whereas all SID and HC mounted a specific humoral immune response, only 80% of CVID patients showed positive anti-SARS-CoV-2 IgG. The titer of anti-SARS-CoV-2 IgG was significantly lower in SID compared with HC (p = 0.040), without significant differences between CVID and HC (p = 0.123) and between CVID and SID (p = 0.683). High proportions of CVID and SID patients showed adequate specific cellular responses to S1 neoantigen, with divergence between cellular and humoral immune responses in CVID and SID patients. Our data might support the relevance of these immunological studies to determine the correlate of protection to severe disease and for deciding the need of additional boosters. Follow-up studies are required to evaluate the duration and variability of the immune response to COVID-19 vaccination or infection.
Subject(s)
COVID-19ABSTRACT
This paper analyses the determinants of the tourism demand, following an approach which innovates in a) using spatial models applying a well-founded specification selection process b) exploring the effects of two types of institutions, corruption and Rule of Law, and c) assessing the spillover effects of the COVID-19 shock on the international tourism demand in Portugal and Spain. The study is conducted using a sample of 109 countries for the period 1995-2018. It shows that tourism shocks in neighbouring countries, and particularly the coronavirus pandemic, significantly affect tourism demand in the host country with the same sign as the shock itself, and that the Rule of Law of the destination country influences positively on tourists' inflow. Corruption does not seem to have significant effects on the tourist demand of the host country. From these results, we derive that national governments should provide fair and transparent legal frameworks that generate security for potential tourists. Moreover, national authorities of neighbouring countries are advised to cooperate in both promoting tourism and adopting coordinated actions against negative external shocks that hit them symmetrically, such as COVID-19.
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Background: Excessive inflammation is pathogenic in pneumonitis associated to severe COVID-19. Neutrophils are among the most abundantly present leukocytes in the inflammatory infiltrates and may form neutrophil extracellular traps (NETs) under the local influence of cytokines. NETs constitute a defence mechanism against bacteria but have also been shown to mediate tissue damage in a number of diseases. Methods: In this retrospective cohort study, sixteen immediate post-mortem lung biopsies were methodologically analysed as exploratory and validation cohorts. NETs were quantitatively analysed by multiplexed immunofluorescence and correlated with local levels of IL-8 mRNA expression and the density of CD8+ T-cell infiltration. SARS-CoV-2 presence in tissue was quantified by RT-PCR and immunohistochemistry.Findings: NETs were found in the lung interstitium and surrounding the bronchiolar epithelium with interindividual and spatial heterogeneity. NET density did not correlate with SARS-CoV-2 tissue viral load. NETs were associated with local IL-8 mRNA levels. NETs were also detected in pulmonary thrombi and in only one out of eight liver tissues in spatial fashion. NET focal presence negatively correlated with CD8+ T-cell infiltration in the lungs. Interpretation: Abundant neutrophils undergoing NETosis are found in the lungs of patients with fatal COVID-19, showing no correlation with viral loads. The strong association between NETs and IL-8 focal expression points to this chemokine as the potential causative factor. The function of cytotoxic T-lymphocytes in the immune responses against SARS-CoV-2 may be interfered by the presence of NETs.Funding Information: This study was supported by Banco Bilbao Vizcaya (BBVA) Foundation, “Ayudas a Equipos de Investigación Científica SARS-CoV-2 y COVID-19”. Declaration of Interests: I.M. reports receiving commercial research grants from BMS, Bioncotech, Alligator, Pfizer, Leadartis and Roche; has received speakers bureau honoraria from MSD; and is a consultant or advisory board member for BMS, Roche, Genmab, F-Star, Bioncotech, Bayer, Numab, Pieris, Alligator, and Merck Serono. C.E.A reports research grants from AstraZeneca. All other authors declare no competing interests.Ethics Approval Statement: This study was approved by the ethics committee of the University of Navarra, Spain (Approval 2020.192). Tissue collections were obtained with consent from a first-degree relative, following a protocol approved by the ethics committee of the University of Navarra (Protocol 2020.192p).
Subject(s)
Pneumonia , COVID-19 , Leukemia, T-Cell , Multiple Sulfatase Deficiency DiseaseABSTRACT
This work is the result of an international research effort to determine the main impacts of the COVID-19 pandemic on marine recreational fishing. Changes were assessed on 1) access to fishing, derived from lockdowns and other mobility restrictions;2) ecosystems, because alterations in fishing intensity and human presence;3) the blue economy, derived from alterations in the investments and expenses of the fishers;and 4) society, derived from variations in fishers’ health and well-being. For this, a consultation with experts of 16 countries was carried out, as well as an international online survey aimed at recreational fishers, that included specific questions designed to capture fishers’ heterogeneity in relation to behavior, skills and know-how, and vital involvement. Fishers’ participation in the online survey (5998 recreational fishers in 15 countries) was promoted through a marketing campaign. The sensitivity of the fishers’ clustering procedure, based on the captured heterogeneity, was evaluated by SIMPER analysis and by GLMs. Results from expert consultation highlighted a worldwide reduction in recreational fishing activity. Lower human-driven pressures are expected to generate some benefits for marine ecosystems. However, experts also identified high negative impacts on the blue economy, as well as on fisher health and well-being because of the loss of recreational fishing opportunities. Most (98%) of the fishers who participated in the online survey were identified as advanced, showing a much higher degree of commitment to recreational fishing than basic fishers (2%). Advanced fishers were, in general, more pessimistic about the impacts of COVID-19, reporting higher reductions in physical activity and fish consumption, as well as poorer quality of night rest, foul mood, and raised more concerns about their health status. Controlled and safe access to marine recreational fisheries during pandemics would provide benefits to the health and well-being of the population and reduce negative socioeconomic impacts, especially for vulnerable social groups.
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1) To identify challenges for conducting ongoing and future rehabilitation research during and after the COVID-19 pandemic, and 2) to develop strategies that can support ongoing and future rehabilitation research. A two-hour facilitated online workshop with guided discussion. Online workshop synchronously recorded via Zoom. Trainees (14 doctoral;2 MSc students;1 post-doctoral fellow) and research faculty (5 physiotherapy;3 occupational therapy), School of Rehabilitation Science, McMaster University, Canada. Not applicable. Workshop transcript and field notes were cross-compared by 4 workshop facilitators from which 3 main categories emerged: 1) pandemic protocol adjustment, 2) participant accessibility, and 3) knowledge dissemination. 1) Pandemic protocol adjustment: Workshop participants identified concerns with transitioning pre- to post-pandemic research, such as variations in intervention protocols and psychometric properties of virtually guided outcome assessments. Strategies identified: Delivering toolkits containing equipment needed for virtually guided assessments, and their comprehensive psychometric evaluation prior to use. 2) Participant accessibility: Virtually guided rehabilitation research may present barriers to participation for some populations due to a lack of internet access and proficiency. Strategies identified: Including community stakeholders in the decision-making process to help guide the development of safe and feasible study protocols, and simplifying protocols to maintain participants' adherence. 3) Knowledge dissemination: Virtually delivered conferences have required additional preparation time due to requirements of pre-recorded presentations, and hinder important conversations between conference attendees. Strategies identified: Researchers should account for delays in knowledge translation plans for funding applications, and conference organizers should consider hosting networking events for attendees. This workshop served as a catalyst for creative solutions to complex methodological challenges that can be integrated within existing and future rehabilitation-focused studies during the COVID-19 pandemic and beyond. None.
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During a global pandemic, the great impact of populist discourse on the construction of social reality is undeniable. This study analyzes the fantasmatic dimension of political discourse from Donald Trump’s and Jair Bolsonaro’s Twitter accounts between 1 March and 31 May. To do so, it applies a Clause-Based Semantic Text Analysis (CBSTA) methodology that categorizes speech in Subject-Verb-Object (SVO) triplets. The study findings show that in spite of the Coronavirus pandemic, the main beatific and horrific subjects remain the core populist signifiers: the people and the elite. While Bolsonaro’s narrative was predominantly beatific, centered on the government, Trump’s was mostly horrific, centered on the elite. Trump signified the pandemic as a subject and an enemy to be defeated, whereas Bolsonaro portrayed it as a circumstance. Finally, both leaders defined the people as working people, therefore their concerns about the pandemic were focused on the people’s ability to work.
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Background: and Objective: The knowledge about the impact of the nonpharmacological measures to control the COVID-19 pandemic can give insight to ways in which they can also be applied for other respiratory diseases. To assess the impact of containment measures of the COVID-19 pandemic on pneumonia hospitalizations in children from 0 to 14 years of age in Brazil. Methods: Data from hospital admissions for pneumonia were obtained from the Department of Informatics of Brazilian Public Health System database in the period of 2015–2020 and analyzed by macro-regions and age groups. To evaluate the effect of containment measures, used in the pandemic, on the incidence of pneumonia, the absolute reduction and relative reduction were calculated by analyzing the subsets 2015-2019 vs 2020. Results: Comparing the subsets of April-August 2015-2019 vs April-August 2020, there was an expressive reduction in the average incidence of hospitalizations, with numbers ranging from -87% [IRR 0.12 (0.10 to 0.14)] for < 4 years, -79% [IRR 0.21 (0.07 to 0.57)] for 5-9 years, -73% [IRR 0.26 (0.05 to 1.21)] for 10-14 and -86% [IRR 0.14 (0.06 to 0.29)] for <14 years. Conclusion: We found a significant decrease in cases of pneumonia during the COVID-19 pandemic. Nonpharmacological public health interventions can contribute to the decline of other respiratory infectious diseases.
Subject(s)
COVID-19 , Pneumonia , Communicable DiseasesABSTRACT
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a complex antibody response that varies by orders of magnitude between individuals and over time. Waning antibody levels lead to reduced sensitivity of serological diagnostic tests over time. This undermines the utility of serological surveillance as the SARS-CoV-2 pandemic progresses into its second year. Here we develop a multiplex serological test for measuring antibodies of three isotypes (IgG, IgM, IgA) to five SARS-CoV-2 antigens (Spike (S), receptor binding domain (RBD), Nucleocapsid (N), Spike subunit 2, Membrane-Envelope fusion) and the Spike proteins of four seasonal coronaviruses. We measure antibody responses in several cohorts of French and Irish hospitalized patients and healthcare workers followed for up to eleven months after symptom onset. The data are analysed with a mathematical model of antibody kinetics to quantify the duration of antibody responses accounting for inter-individual variation. One year after symptoms, we estimate that 36% (95% range: 11%, 94%) of anti-S IgG remains, 31% (9%, 89%) anti-RBD IgG remains, and 7% (1%, 31%) anti-N IgG remains. Antibodies of the IgM isotype waned more rapidly, with 9% (2%, 32%) anti-RBD IgM remaining after one year. Antibodies of the IgA isotype also waned rapidly, with 10% (3%, 38%) anti-RBD IgA remaining after one year. Quantitative measurements of antibody responses were used to train machine learning algorithms for classification of previous infection and estimation of time since infection. The resulting diagnostic test classified previous infections with 99% specificity and 98% (95% confidence interval: 94%, 99%) sensitivity, with no evidence for declining sensitivity over the time scale considered. The diagnostic test also provided accurate classification of time since infection into intervals of 0 - 3 months, 3 - 6 months, and 6 - 12 months. Finally, we present a computational method for serological reconstruction of past SARS-CoV-2 transmission using the data from this test when applied to samples from a single cross-sectional sero-prevalence survey.
Subject(s)
Coronavirus Infections , Severe Acute Respiratory Syndrome , COVID-19ABSTRACT
Background: COVID-19 entails large overloads of hospitals’ capacity. Alternatives to conventional hospitalization are key to optimize health systems resilience during outbreaks of the pandemic.Methods: From March 25th to May 25th 2020 the Hospital at Home Unit (HaH) of Hospital Clinic Barcelona adapted a 500-bed hotel for treating patients with non-critical COVID-19.Findings: 516 patients were admitted to the hotel during the study period. Median age was 57 . 5 years (IQR 45-70), 304 (59%) were referred from hospital wards and 196 (38%) from the emergency room. Median length of stay was 9 days in the hotel (IQR 6-13). Bilateral infiltrates were present in the chest x-ray of 348 (68%) patients. Treatment for COVID-19 was administered to 494 (96%) patients, 137 (27%) of whom had it interrupted due to adverse events. Complications after 14 days from symptoms onset were detected in 85 (16 . 5%) patients: 24 (5%) pulmonary embolism, 23 (4 . 5%) pulmonary fibrosis, 50 (9.7%) organising pneumonia, 133 (26%) neutropoenia. History of smoking, oxygen requirement, bacterial infection and prior ICU admission were predictors of subacture complications. Twenty-eight (5 . 5%) patients required transfer back to hospital. Chronic kidney disease, oxygen requirement and previous shock were predictors of readmission. Two patients (0 . 4%) died after hospital readmission.Interpretation: The adaptation of hotels for the management of COVID-19 patients seems to be safe and efficacious, therefore providing a suitable alternative to alleviate hospital overload during the pandemic. Accurate selection of patients for transfer based on the clinic and potential severity is key.Funding: None.Declaration of Interests: None of the authors declare competing interests with regards to the current work or at all.Ethics Approval Statement: The Ethical Board of the Hospital Clínic evaluated and approved the study protocol (HCB.2020.0443). A waiver for informed consent was granted due to the state of infectious disease emergency
Subject(s)
Communicable Diseases, Emerging , Pneumonia , Bacterial Infections , Kidney Diseases , COVID-19ABSTRACT
Covid-19 is particularly mild with children, and its severity escalates with age. Several theories have been proposed to explain these facts. In particular, it was proposed that the lower expression of the viral receptor ACE2 in children protects them from severe Covid. However, other works suggested an inverse relationship between ACE2 expression and disease severity. Here we try to reconcile seemingly contradicting observations noting that ACE2 is not monotonically related with age but it reaches a maximum at a young age that depends on the cell type and then decreases. This pattern is consistent with most existing data from humans and rodents and it is expected to be more marked for ACE2 cell protein than for mRNA because of the increase with age of the protease TACE/ADAM17 that sheds ACE2 from the cell membrane to the serum. The negative relation between ACE2 level and Covid-19 severity at old age is not paradoxical but it is consistent with a mathematical model of virus propagation that predicts that higher viral receptor does not necessarily favour virus propagation and it can even slow it down. More importantly, ACE2 is known to protect organs from chronic and acute inflammation, which are worsened by low ACE2 levels. Here we propose that ACE2 contributes essentially to reverse the inflammatory process by downregulating the pro-inflammatory peptides of the angiotensin and bradykinin system, and that failure to revert the inflammation triggered by SARS-COV-2 may underlie both severe CoViD-19 infection and its many post-infection manifestations, including the multi-inflammatory syndrome of children (MIS-C). Within this view, lower severity in children despite lower ACE2 expression may be consistent with their higher expression of the alternative angiotensin II receptor ATR2 and in general of the anti-inflammatory arm of the Renin-Angiotensin System (RAS) at young age.
Subject(s)
Inflammation , Dementia, Multi-Infarct , COVID-19ABSTRACT
Background Coronavirus disease 2019 (COVID-19) pandemic has an impact on the university student’s lifestyles. The present study aims to investigate the perceived changes in lifestyles among Spanish university students during the confinement.Method: An observational, descriptive, cross-sectional study with a 2-time cut was conducted during the month of April in 2020. Sociodemographic and anthropometric data was then obtained. The FANTASTIC questionnaire was used to assess lifestyles of the 488 participants who took part in the study. The STROBE cross-sectional reporting guidelines were followed on this study.Results 76.3% of the participants were female. Overall, the lifestyles of university students had significantly deteriorated during the period of confinement caused by the COVID-19 pandemic in Spain. University female students have been especially affected compared to their male fellows (p = .010). For women, social and family relationships (p < .001), personality (p < .001), interior (p < .001) and career (p < .001) were the aspects that worsened during confinement. For men, lack of physical exercise practice (p < .001), social and family relationships (p < .001) and career (p = .002) were affected to a greater extent. In both cases confinement was a protective factor against the consumption of tobacco, toxins (p < .001) and alcohol (p < .001). Gender (p = .008) and obesity (p = .044) are the two factors that most affected the change in the score of the FANTASTIC questionnaire.Conclusions The Spanish university students’ lifestyles have worsened during the lockdown caused by the COVID-19 pandemic, especially women who were the most affected. Some aspects such as those related to social and emotional behaviors have been deeply affected, while confinement could be a protective factor against previous toxic habits.
Subject(s)
COVID-19 , ObesityABSTRACT
The purpose of this paper was to analyze the food intake quality in one year-old children seen by a primary healthcare (PHC) service. This is a cross-sectional studied nested within a child oral health cohort study which collected data regarding children born in 2013 and monitored in Porto Alegre for two years. We applied a questionnaire on maternal variables and frequency of pediatric appointments, weight and height measurements, and children's food intake. To that end, a score was generated based on the points assigned according to SISVAN (meaning 'food and nutrition monitoring system,' run by the Brazilian Ministry of Health). A multivariate model was calculated using Poisson regression with robust variance. The sample comprised 249 children. We found 30.5% (76) of poor/regular dietary quality, which in the multivariate model was associated to the guardian's educational background, considering up to incomplete high school (PR = 2.14, CI95% = 1.03-4.44) and complete high school (PR = 1.70, CI95% = 0.81-3.54), as well as their failure to see a dentist (PR = 2.54, CI95% = 1.33-4.84) or having seen one before the age of four months (PR = 1.94, CI95% = 1.01-3.72). It is our conclusion that failing to see a dentist within the first year of life and lower maternal schooling negatively impact on children's dietary quality.
O objetivo foi analisar a qualidade do consumo alimentar de crianças com um ano de idade acompanhadas por um serviço de Atenção Primária à Saúde (APS). Trata-se de estudo transversal aninhado a uma coorte de saúde bucal infantil em que foram coletados dados de crianças nascidas em 2013 e acompanhadas por 2 anos, em Porto Alegre. Foi aplicado um questionário sobre variáveis maternas e frequência de consultas de puericultura, medidas antropométricas e consumo alimentar da criança. Para tal, foi gerado um escore a partir da pontuação criada conforme o SISVAN (Sistema de Vigilância Alimentar e Nutricional). Foi calculado um modelo multivariado, por meio da Regressão de Poisson com variância robusta. A amostra consistiu de 249 crianças. Encontrou-se 30,5% (76) de qualidade ruim/regular da alimentação, que no modelo multivariado esteve associada com nível educacional do responsável, sendo até ensino médio incompleto (RP = 2,14, IC95% = 1,03-4,44) e ensino médio completo (RP = 1,70, IC95% = 0,81-3,54), assim como não ter consultado com dentista (RP = 2,54, IC95% = 1,33-4,84) ou ter consultado até o quarto mês de idade (RP = 1,94, IC95% = 1,01-3,72). Conclui-se que não consultar com dentista no primeiro ano de vida e menor escolaridade materna repercutem negativamente na qualidade alimentar infantil.