ABSTRACT
Understanding how older people respond to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical if we are to confront the coronavirus disease 2019 (COVID-19) pandemic and establish effective vaccination strategies. Immunosenescence reduces the ability to respond to neoantigens and may compromise the life of infected individuals. Here, we analyzed the immunological memory to SARS-CoV-2 in 102 recovered patients aged over 60 years several months after the infection had been resolved. Specific memory T lymphocytes against the virus were measured by interferon-γ (IFN-γ) and granzyme B release by ELISpot; memory B-lymphocyte responses were quantified by detection of anti-S IgG1 producer cells by ELISpot and anti-S and anti-N antibodies were determined by enzyme-linked immunosorbent assay (ELISA). Memory T lymphocytes were found in peripheral blood of most of the studied donors, more than 7 months after the infection in some of them. Fewer patients maintained memory B lymphocytes, but antibodies, mainly anti-S, were highly durable and positively correlated with T responses. More robust humoral responses were found in patients who had more severe symptoms and had been admitted to hospital. We concluded that specific immunity against SARS-CoV-2 is effectively preserved regardless of age, despite the great heterogeneity of their immune responses, and that memory T lymphocytes and anti-S IgG might be more durable than memory B cells and anti-N IgG.
Subject(s)
Antibodies, Viral/immunology , COVID-19 , Immunity, Cellular/physiology , Immunity, Humoral , Immunologic Memory , SARS-CoV-2 , Aged , Aged, 80 and over , Enzyme-Linked Immunospot Assay , Female , Humans , Immunoglobulin G , Male , Memory B Cells , Memory T Cells , Middle AgedABSTRACT
Se analiza el uso de los desfibriladores externos automáticos (DEA) de uso público en caso de parada cardiaca en el Principado de Asturias desde enero del 2012 hasta diciembre del 2014, así como el manejo hospitalario y el estado neurológico al alta de los pacientes. Para ello se realizó un estudio observacional retrospectivo poblacional sobre la utilización de DEA de uso público en el Principado de Asturias en tres fases: 1) cuestionario telefónico a todas las entidades con DEA; 2) análisis de las historias clínicas del SAMU-Asturias; y 3) análisis de las historias clínicas hospitalarias. Se han identificado 13 usos de un DEA público. En cuanto al ritmo inicial, 11 (84,5%) eran desfibrilables, 3 pacientes (23%) fallecieron a nivel prehospitalario, 1 (7,6%) en el hospital y 9 (69,2%) sobrevivieron, todos con un ritmo inicial desfibrilable y todos con una puntuación en la escala Cerebral Performance Categories (CPC) al alta de 1. Ocho de los 10 pacientes que llegaron con vida al hospital fueron sometidos a angioplastia primaria y 3 a hipotermia. La estancia hospitalaria media de los supervivientes fue de 9,4 días (DE = 4,88). Se concluye que el uso de DEA público mejora notablemente la supervivencia de la parada cardiorrespiratoria extrahospitalaria, probablemente relacionado con la reducción del tiempo de espera hasta la desfibrilación
On-site bystander use of automated external defibrillators (AEDs) was analized in Asturias, Spain, between January 2012 and December 2014. Hospital management and neurologic state on discharge were also studied. Our retrospective observational population-based design had 3 phases comrpising: 1) a telephone survey of facilities with onsite public-access AEDsc, 2) analysis of relevant case records held by the Asturian emergency medical service, and 3) analysis of relevant hospital case records. Thirteen cases of AED use by bystanders were found. Eleven patients (84.5%) had initial shockable rhythms. Three patients (23%) died before reaching the hospital, 1 (7.6%) died in hospital, and 9 (69.2%) survived. All of the survivors had a shockable rhythm and all had a score of 1 on the Cerebral Performance Category scale on discharge. Eight of the 10 patients who were alive on arrival at the hospital were treated with primary angioplasty; therapeutic hypothermia was applied in 3 cases. The mean (SD) hospital stay of survivors was 9.4 (4.88) days. We conclude that bystander use of an AED notably improves survival in out-of-hospital sudden cardiac arrest, probably related to shortening the delay in starting defibrillation
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Defibrillators , Cardiopulmonary Resuscitation/instrumentation , Emergency Service, Hospital , Heart Arrest/mortality , Defibrillators/statistics & numerical data , Spain , Cardiopulmonary Resuscitation , Retrospective Studies , Observational StudyABSTRACT
EN: On-site bystander use of automated external defibrillators (AEDs) was analized in Asturias, Spain, between January 2012 and December 2014. Hospital management and neurologic state on discharge were also studied. Our retrospective observational population-based design had 3 phases comrpising: 1) a telephone survey of facilities with onsite public-access AEDsc, 2) analysis of relevant case records held by the Asturian emergency medical service, and 3) analysis of relevant hospital case records. Thirteen cases of AED use by bystanders were found. Eleven patients (84.5%) had initial shockable rhythms. Three patients (23%) died before reaching the hospital, 1 (7.6%) died in hospital, and 9 (69.2%) survived. All of the survivors had a shockable rhythm and all had a score of 1 on the Cerebral Performance Category scale on discharge. Eight of the 10 patients who were alive on arrival at the hospital were treated with primary angioplasty; therapeutic hypothermia was applied in 3 cases. The mean (SD) hospital stay of survivors was 9.4 (4.88) days. We conclude that bystander use of an AED notably improves survival in out-of-hospital sudden cardiac arrest, probably related to shortening the delay in starting defibrillation.
ES: Se analiza el uso de los desfibriladores externos automáticos (DEA) de uso público en caso de parada cardiaca en el Principado de Asturias desde enero del 2012 hasta diciembre del 2014, así como el manejo hospitalario y el estado neurológico al alta de los pacientes. Para ello se realizó un estudio observacional retrospectivo poblacional sobre la utilización de DEA de uso público en el Principado de Asturias en tres fases: 1) cuestionario telefónico a todas las entidades con DEA; 2) análisis de las historias clínicas del SAMU-Asturias; y 3) análisis de las historias clínicas hospitalarias. Se han identificado 13 usos de un DEA público. En cuanto al ritmo inicial, 11 (84,5%) eran desfibrilables, 3 pacientes (23%) fallecieron a nivel prehospitalario, 1 (7,6%) en el hospital y 9 (69,2%) sobrevivieron, todos con un ritmo inicial desfibrilable y todos con una puntuación en la escala Cerebral Performance Categories (CPC) al alta de 1. Ocho de los 10 pacientes que llegaron con vida al hospital fueron sometidos a angioplastia primaria y 3 a hipotermia. La estancia hospitalaria media de los supervivientes fue de 9,4 días (DE = 4,88). Se concluye que el uso de DEA público mejora notablemente la supervivencia de la parada cardiorrespiratoria extrahospitalaria, probablemente relacionado con la reducción del tiempo de espera hasta la desfibrilación.
