ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant of concern evades antibody-mediated immunity that comes from vaccination or infection with earlier variants due to accumulation of numerous spike mutations. To understand the Omicron antigenic shift, we determined cryo-electron microscopy and x-ray crystal structures of the spike protein and the receptor-binding domain bound to the broadly neutralizing sarbecovirus monoclonal antibody (mAb) S309 (the parent mAb of sotrovimab) and to the human ACE2 receptor. We provide a blueprint for understanding the marked reduction of binding of other therapeutic mAbs that leads to dampened neutralizing activity. Remodeling of interactions between the Omicron receptor-binding domain and human ACE2 likely explains the enhanced affinity for the host receptor relative to the ancestral virus.
ABSTRACT
Background: Obesity is considered a risk factor for severe COVID-19 illness. Thus, individuals with obesity may be especially motivated to lose weight because of COVID-19. To our knowledge, this is the first study to assess COVID-related motivators to lose weight and whether they predict weight loss. Methods: In this prospective study, 530 new users of a digital commercial weight loss program completed a baseline survey in January 2021 assessing overall motivation to lose weight due to COVID (one item: 'how much of your interest in losing weight is because of COVID-19 or its impact, however minor, on your life?'), and three specific COVID motivators. These specific motivators were measured by the validated Fear of COVID-19 scale (F-C), one item assessing motivation to improve eating habits which got worse during COVID-19 (EH-C), and one item assessing motivation to prevent diseases that could increase COVID-19 risk (D-C). The main outcome was weight loss at 2 months, extracted from self-reported weight on the program. Results: Participants were 84% female, had a median age of 46, mean baseline BMI of 32.12 (SD = 6.96), and lost 3.13kg (3.49%) at 2 months (SD = 2.72kg). Overall COVID motivation was high;66% reported that their interest in losing weight was due to COVID. There was high F-C (M = 25.2 out of 35) and EH-C (M = 7.7 out of 10), and moderate D-C (M = 5.4 out of 10). Despite high COVID-related motivation, overall motivation, F-C, and EH-C did not predict weight loss at 2 months. D-C marginally significantly predicted weight loss at 2 months (B = -. 09, p = .06). Conclusions: Results suggest that even though individuals showed initial high motivation due to COVID, it did not manifest in actual weight loss, except in the most at-risk individuals who sought to prevent diseases that put them at greater risk. Individuals may need support to translate initial COVID-related motivation to actual weight loss. Next, we will examine relationships between COVID motivators, vaccination status, and weight loss at 4 months.
ABSTRACT
With increasing rates of obesity, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of abnormal liver function tests (LFTs) in the UK.1 Lifestyle change is the mainstay of clinical management for NAFLD.2Patients achieving ≥ 5-10% weight reduction show regression in fibrosis score and improvements in histological aspects of NAFLD.3 However, there is limited evidence of what works to support weight loss/improve self management in clinical settings. Evidence highlights just providing patients with NAFLD with information and advice to change behaviour is an insufficient intervention. Readiness to change weight-related behaviours is often low and not associated with severity of liver disease. The Lead Clinician and Hepatology Nurse Specialist led on development of a new NAFLD pathway. They established a multidisciplinary clinic with input General Practitioners, dietitians and psychologists. Eligible patients (Fib 4>1.45) were offered input from a Liver Nurse, Health Psychologist, dietitian and Consultant. Over 6 months patients received a low intensity psychology intervention. Each participant was seen for an assessment (and 8 weekly follow-ups via email, telephone or video call). Psychologist reviewed patients at three and six months. 101 patients, (53% Males and 47% Females) agreed to participate in the health psychology intervention. Average BMI of patients assessed was 40.1 (113.5kg). Baseline daily step count was 1635. Majority of patients presented with two or more Long Term Conditions alongside NAFLD. Most common being Type 2 Diabetes (44%) and anxiety/depression (27%). Average Fib 4 score was 1.4, KPa 14.4. HbA1c 58.8, Cholesterol 5.0, ALT 81.4, AST 58.4. 91% of patients were followed up (9% drop out). Average weight loss 5.5kg (range 0.5kg- 23kg). 82% increased daily step count (1635 to 5958). Anxiety scores (HADs) decreased from (7.4 to 6) and Depression scores reduced 6.3 to 3.3 Due to Covid 19 restrictions we don't have repeat measures on medical markers. However self reported outcomes at 6 months are encouraging. A learning point when we are able to fully resume normal service delivery is to try and increase the number of patients benefitting from this service. We see scope to access patients earlier in primary care thus reducing waiting times and freeing up secondary care medical staff for more complex cases. Overall, it is considered that this new pathway and multidisciplinary clinic has been very worthwhile. There were noticeable improvements identified through the use of appropriate assessment tools and from positive qualitative patient/ clinician feedback.