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1.
EClinicalMedicine ; 46:101359, 2022.
Article in English | MEDLINE | ID: covidwho-1828410

ABSTRACT

Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings: Among 372 KT which included 38(10.21%) ABO-incompatible, 12(3.22%) sensitized, 64(17.20%) coexisting donors with COVID-19 history and 20 (5.37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9.1%) with 1(0.26%) death censored graft loss, and 4(1.07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0.14(0.03-0.59);p-value = 0.0071], and use of thymoglobulin use compared to other induction strategies [HR = 0.17(0.03-0.95);p-value = 0.044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1.74-65.83);p-value = 0.011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale <= 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding: Sanofi.

2.
Indian Journal of Transplantation ; 16(1):8-16, 2022.
Article in English | EMBASE | ID: covidwho-1798829

ABSTRACT

COVID has drastically impacted organ donation across the world, leading to untold misery for thousands of patients who have been waiting for organs. Early rules on the use of organs from COVID positive or affected donors were stringent due to the fear of spread of disease or thrombotic complications in patients who received these organs. However much has changed in the past two years. Most of our adult population has either been infected with COVID, or has received two doses of vaccine, or both. The current variant, despite being more infective, is associated with mild disease, especially in those who have been vaccinated Our armamentarium against severe COVID has improved dramatically in the past year- we have effective vaccines, monoclonal antibodies for treatment of mild COVID in high risk patients and post exposure and antiviral prophylaxis and treatment which can substantially reduce the risk of severe COVID requiring ICU admission. The risk of transmission of COVID infection has to be balanced against the risk of patients dying with end organ disease. We will have to learn to live with COVID- this also means investigating whether organs from donors who are, or have been COVID positive can be used with acceptable risk -benefit in selected patients with end stage organ failure. This document is a summary of evidence and information regarding donor screening for SARS-CoV-2 and considerations for organ acceptance from donors with a history of COVID-19.

3.
Kidney international reports ; 7(2):S329-S330, 2022.
Article in English | EuropePMC | ID: covidwho-1696131
4.
Kidney International Reports ; 7(2):S329-S330, 2022.
Article in English | PMC | ID: covidwho-1693642
5.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326677

ABSTRACT

Monoclonal antibodies are emerging as a viable treatment for COVID-19. However, new SARS-CoV-2 variants can reduce the efficacy of currently available antibodies and can diminish vaccine-induced immunity. Here, we demonstrate that the molecular dynamics of neutralizing monoclonal antibodies can be profoundly modified by the amino-acid mutations present in the spike proteins of the SARS-COV-2 variants currently circulating in the world population. The dynamical perturbations within the antibody structure, which can alter the thermodynamics of antigen-antibody binding, are found to be diverse and to depend both on the nature of the antibody and on the spatial location of the spike mutation. The correlation between the motion of the antibody and that of the spike receptor binding domain (RBD) can also be changed, and this, in turn, can additionally modify the binding affinity. Using protein graph connectivity networks, we delineated the mutant-induced modifications in the information-flow along the allosteric pathway throughout the antibody. Changes in the collective dynamics were spatially distributed both locally and across long-range distances within the antibody. On the receptor side, we identified an anchor-like structural element that prevents the detachment of the antibodies;individual mutations there can significantly affect the antibody binding propensity. Our study provides insight into how virus neutralization by monoclonal antibodies can be impacted by local mutations in the epitope via a dynamical standpoint. This realization adds a new layer of sophistication to be included in the efforts to rationally design monoclonal antibodies effective against new variants of SARS-CoV2 that take allostery in the antibody in consideration.

6.
JCO Oncol Pract ; 17(7): e427-e438, 2021 07.
Article in English | MEDLINE | ID: covidwho-1278136

ABSTRACT

INTRODUCTION: The COVID-19 pandemic is an unprecedented global crisis profoundly affecting oncology care delivery. PURPOSE: This study will describe the occupational and personal consequences of the COVID-19 pandemic on oncologist well-being and patient care. MATERIALS AND METHODS: Four virtual focus groups were conducted with US ASCO member oncologists (September-November 2020). Inquiry and subsequent discussions centered on self-reported accounts of professional and personal COVID-19 experiences affecting well-being, and oncologist recommendations for well-being interventions that the cancer organization and professional societies (ASCO) might implement were explored. Qualitative interviews were analyzed using Framework Analysis. RESULTS: Twenty-five oncologists were interviewed: median age 44 years (range: 35-69 years), 52% female, 52% racial or ethnic minority, 76% medical oncologists, 64% married, and an average of 51.5 patients seen per week (range: 20-120). Five thematic consequences emerged: (1) impact of pre-COVID-19 burnout, (2) occupational or professional limitations and adaptations, (3) personal implications, (4) concern for the future of cancer care and the workforce, and (5) recommendations for physician well-being interventions. Underlying oncologist burnout exacerbated stressors associated with disruptions in care, education, research, financial practice health, and telemedicine. Many feared delays in cancer screening, diagnosis, and treatment. Oncologists noted personal and familial stressors related to COVID-19 exposure fears and loss of social support. Many participants strongly considered working part-time or taking early retirement. Yet, opportunities arose to facilitate personal growth and rise above pandemic adversity, fostering greater resilience. Recommendations for organizational well-being interventions included psychologic or peer support resources, flexible time-off, and ASCO and state oncology societies involvement to develop care guidelines, well-being resources, and mental health advocacy. CONCLUSION: Our study suggests that the COVID-19 pandemic has adversely affected oncologist burnout, fulfillment, practice health, cancer care, and workforce. It illuminates where professional organizations could play a significant role in oncologist well-being.


Subject(s)
COVID-19 , Oncologists , Adult , Burnout, Psychological , Female , Humans , Male , Minority Groups , Pandemics , SARS-CoV-2
7.
Am Soc Clin Oncol Educ Book ; 41: e339-e353, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1249568

ABSTRACT

Optimizing the well-being of the oncology clinician has never been more important. Well-being is a critical priority for the cancer organization because burnout adversely impacts the quality of care, patient satisfaction, the workforce, and overall practice success. To date, 45% of U.S. ASCO member medical oncologists report experiencing burnout symptoms of emotional exhaustion and depersonalization. As the COVID-19 pandemic remains widespread with periods of outbreaks, recovery, and response with substantial personal and professional consequences for the clinician, it is imperative that the oncologist, team, and organization gain direct access to resources addressing burnout. In response, the Clinician Well-Being Task Force was created to improve the quality, safety, and value of cancer care by enhancing oncology clinician well-being and practice sustainability. Well-being is an integrative concept that characterizes quality of life and encompasses an individual's work- and personal health-related environmental, organizational, and psychosocial factors. These resources can be useful for the cancer organization to develop a well-being blueprint: a detailed start plan with recognized strategies and interventions targeting all oncology stakeholders to support a culture of community in oncology.


Subject(s)
Burnout, Professional/psychology , Medical Oncology/methods , Neoplasms/therapy , Oncologists/psychology , Stress, Psychological/prevention & control , Burnout, Psychological/prevention & control , Burnout, Psychological/psychology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , Humans , Internet , Job Satisfaction , Medical Oncology/organization & administration , Neoplasms/diagnosis , Pandemics , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology , Social Support , United States
8.
Kidney International Reports ; 6(4):S339-S339, 2021.
Article in English | PMC | ID: covidwho-1192350
9.
Kidney International Reports ; 6(4):S271-S272, 2021.
Article in English | PMC | ID: covidwho-1192349
11.
Anaesthesia ; 76(2): 225-237, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-960777

ABSTRACT

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.


Subject(s)
Case Management/standards , Hip Fractures/therapy , Anesthesia/standards , COVID-19 , Guidelines as Topic , Hip Fractures/surgery , Humans , Pandemics , Quality Improvement
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