Humoral immunoresponse elicited against an adenoviral-based SARS-CoV-2 coronavirus vaccine in elderly patients.

The early sequencing of the SARS-CoV-2 viral genome allowed for a speedy development of effective vaccines against the virus. Nevertheless, age-related immunosenescence, the inability to mount strong immune responses, still represents a major obstacle. Here, in a group of 149 elderly volunteers (70-96 years old), evolution of the humoral immune response over time to Gam-COVID-Vac (Sputnik V), a vaccine based on heterologous recombinant adenovirus-26 (Ad26) and adenovirus-5 (Ad5) carrying the Spike genome, was analyzed by an anti-RBD ELISA. At 28 days post vaccination (dpv), a seroconversion rate of 91% was achieved, showing the importance of administering at least two doses of Gam-COVID-Vac to elicit a robust immune response, especially in elderly individuals without previous SARS-CoV-2 infection. Interestingly, IgG specific antibodies that reached their highest titers around 28 dpv (median = 740), persisted without significant decrease after 60 dpv (median = 650). After 90 dpv, IgG titers began to drop, and at 180 dpv only 44.7% of the elderly individuals remained with detectable anti-RBD IgG antibodies. No significant differences were observed in specific humoral immune responses between genders at early times point. However, at 60 dpv anti-RBD titers were more persistent in elderly females, and only dropped at 90 dpv (p < 0.0001). As expected, the highest antibodies titers were elicited in the youngest subgroup (70-74 years). Our results show that Gam-COVID-Vac was able to deal with the ageing of the immune system, eliciting a robust immune response in an elderly cohort, which lasted approximately 90 dpv at high levels, and protected against COVID-19.

Long-term analysis of antibodies elicited by SPUTNIK V: A prospective cohort study in Tucumán, Argentina.

BACKGROUND: Gam-COVID-Vac (SPUTNIK V) has been granted emergency use authorization in 70 nations and has been administered to millions worldwide. However, there are very few peer-reviewed studies describing its effects. Independent reports regarding safety and effectiveness could accelerate the final approval by the WHO. We aimed to study the long-term humoral immune response in naïve and previously infected volunteers who received SPUTNIK V. METHODS: Humoral immune responses, assayed by anti-SARS-CoV-2-spike-RBD IgG ELISA and neutralization assays, were measured in 602 healthcare workers at 0, 14, 28, 60 and 180 days after receiving SPUTNIK V between December 2020 and July 2021 in Tucumán, Argentina. FINDINGS: Seroconversion was detected in 97% of individuals after 28 days post-vaccination (dpv) (N = 405). Anti-RBD titers began to decrease after 60 dpv (N = 328), but remained detectable in 94% at 90 dpv (N = 224). At 180 dpv, anti-RDB titers persisted in 31% (N = 146). Previous infection triggered an increased immune response to the first dose and increased neutralization activity against variants of concern (VOC). Second doses in previously infected individuals further increased titers, even 90 dpv (N = 75). Basal antibody titers had more influence on post-vaccination anti-RBD responses than the time elapsed between diagnosis and vaccination (N = 274). INTERPRETATION: Data presented herein provides essential knowledge regarding the kinetics of antibodies induced by SPUTNIK V up to six months after immunization, and suggests that when considering one-dose vaccination policies for individuals with previous SARS-CoV-2 infection, serological studies to determine basal titers may be important, independent of when diagnosis occurred. FUNDING: Tucumán Public Health System (SIPROSA), Argentinean National Research Council (CONICET), National University of Tucumán (UNT).

Past SARS-CoV-2 infection elicits a strong immune response after a single vaccine dose

We hypothesized that in individuals with previous SARS-CoV-2 infection, the first vaccine dose would work as a booster, eliciting a faster and more intense immune response. We herein describe antibody responses to the first and second doses of Gam-COVID-Vac (SPUTNIK V) vaccine in health personnel of Tucuman, Argentina, with previous COVID-19 and compared it with uninfected personnel. Individuals with anti-SARS-CoV-2 titers at baseline showed significantly higher responses to the first dose than people with no prior history of disease (p <0.0001), with titers higher to those registered after the second dose in the control group, representing a clear secondary antibody response. This suggests that a single dose of SPUTNIK V for people with previous SARS-CoV-2 infection could contribute to a better use of available doses. One-Sentence SummaryFirst vaccine dose in subjects with prior COVID19 elicits a higher antibody response than two doses in uninfected individuals

An In-House ELISA for SARS-CoV-2 RBD uncovers elevatedimmune response at higher altitudes

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) first reported in Wuhan has caused a global pandemic with dramatic health and socioeconomic consequences. The Coronavirus Disease 2019 (COVID-19) associated represents a challenge for health systems that had to quickly respond developing new diagnostic and therapeutic strategies. In the present work, we developed an "In House" ELISA with high sensitivity (92.2 %), specificity (100%) and precision (93.9%), with an area under the ROC curve (AUC) of 0.991, rendering the assay as an excellent serological test to correctly discriminate between SARS-COv-2 infected and non-infected individuals and study population seroprevalence. Among 758 patients evaluated for SARS-CoV-2 diagnosis in the province of Tucuman, Argentina, we found a Pearson correlation coefficient of 0.5048 between antibodies elicited against the RBD and the nucleocapsid (N) antigen. Additionally, 33.6% of individuals diagnosed with COVID-19 displayed mild levels of RBD-IgG antibodies, while 19% of the patients showed high antibody titers. Interestingly, patients with SARS-COV-2 infection over 60 years old elicited significantly higher levels of IgG antibodies against RBD compared to younger ones, while no difference was found between women and men. Surprisingly, individuals from a high altitude village displayed statistically significant higher and longer lasting anti-RBD antibodies compared to those from a city at a lower altitude, suggesting that a hypobaric hypoxia-adapted mechanism may act as a protective factor for COVID-19. To our knowledge, this is the first report correlating altitude with increased humoral immune response against SARS-Cov-2 infection.

A Multi-User Game-Theoretical Multipath Routing Protocol to Send Video-Warning Messages over Mobile Ad Hoc Networks.

The prevention of accidents is one of the most important goals of ad hoc networks in smart cities. When an accident happens, dynamic sensors (e.g., citizens with smart phones or tablets, smart vehicles and buses, etc.) could shoot a video clip of the accident and send it through the ad hoc network. With a video message, the level of seriousness of the accident could be much better evaluated by the authorities (e.g., health care units, police and ambulance drivers) rather than with just a simple text message. Besides, other citizens would be rapidly aware of the incident. In this way, smart dynamic sensors could participate in reporting a situation in the city using the ad hoc network so it would be possible to have a quick reaction warning citizens and emergency units. The deployment of an efficient routing protocol to manage video-warning messages in mobile Ad hoc Networks (MANETs) has important benefits by allowing a fast warning of the incident, which potentially can save lives. To contribute with this goal, we propose a multipath routing protocol to provide video-warning messages in MANETs using a novel game-theoretical approach. As a base for our work, we start from our previous work, where a 2-players game-theoretical routing protocol was proposed to provide video-streaming services over MANETs. In this article, we further generalize the analysis made for a general number of N players in the MANET. Simulations have been carried out to show the benefits of our proposal, taking into account the mobility of the nodes and the presence of interfering traffic. Finally, we also have tested our approach in a vehicular ad hoc network as an incipient start point to develop a novel proposal specifically designed for VANETs.

Rastreamento de resultados adversos nas internações do Sistema Único de Saúde / Adverse outcome screening in hospitalizations of the Brazilian Unified Health System

OBJETIVO: Descrever a frequência de rastreadores de potenciais resultados adversos em internações no Sistema Único de Saúde. MÉTODOS: Estudo retrospectivo, incluindo as internações de adultos na clínica médica (n = 3.565.811) e clínica cirúrgica (n = 2.614.048) no Brasil em 2007. O Sistema de Informações Hospitalares foi utilizado como fonte de informação. A mensuração dos resultados adversos baseou-se no rastreamento de 11 condições clínicas, definidas em estudos internacionais anteriores, registradas no campo diagnóstico secundário. Foram realizadas análises bivariada e multivariada, no intuito de associar resultado adverso, óbito (variável dependente) e outras variáveis como idade, utilização de unidade de terapia intensiva e realização de cirurgia. RESULTADOS: A frequência obtida foi 3,6 potenciais resultados adversos por 1.000 internações para ambas as clínicas, superior na clínica médica (5,3 por 1.000) em relação à clínica cirúrgica (1,3 por 1.000). Houve diferenças no perfil das internações: na clínica médica predominaram idosos, maior tempo médio de permanência, maior taxa de mortalidade e menor custo total de internação. O rastreador de resultado adverso mais frequente foi pneumonia hospitalar. Choque/parada cardíaca apresentou maior risco de óbito (OR = 5,76) em relação aos demais resultados adversos. Os maiores gastos com internações estiveram relacionados à sepse hospitalar. Os rastreadores de potencial resultado adverso apresentaram altas chances de óbito, mesmo com a introdução de variáveis como uso de terapia intensiva e realização de cirurgia. CONCLUSÕES: A alta frequência de resultados adversos em internações indica a necessidade de desenvolver estratégias de monitoramento e melhorias dirigidas para a segurança do paciente.

OBJECTIVE: To assess the frequency of screening for potential adverse outcomes in hospitalizations of the Brazilian Unified Health System. METHODS: A retrospective study, including all hospital admissions of adults in medical clinics (n = 3,565,811) and surgical clinics (n = 2,614,048) in Brazil in 2007. The Hospital Information System was used as a source of information. The measurement of adverse events was based on screening for eleven clinical conditions, as defined by previous international studies, recorded in the secondary diagnosis field. We performed bivariate and multivariate analysis to investigate associations between adverse events, death (dependent variable) and other variables such as age, use of the intensive care unit and performance of surgery. RESULTS: The frequency obtained for both clinic types was 3.6 potential adverse events per 1,000 admissions, with a greater frequency in medical clinics (5.3 per 1,000) than in surgery clinics (1.3 per 1,000). There were differences in the profile of hospital admissions between the two clinics: medical clinics were characterized by a predominance of older adults, longer average length of stay, higher mortality rate and lower total cost of hospitalization. The most common potential adverse outcome was hospital-acquired pneumonia. Cardiac arrest had a higher risk of death (OR= 5.76) compared to other potential adverse outcomes. Increased cost for hospitalizations was associated with sepsis. The conditions used as the screening criteria were associated with greater odds of death even after the introduction of variables such as use of intensive care and surgery. CONCLUSIONS: The high frequency of adverse outcomes in hospital admissions indicates a need to develop monitoring strategies and to improve quality of care for improved patient safety.

[Adverse outcome screening in hospitalizations of the Brazilian Unified Health System]. / Rastreamento de resultados adversos nas internações do Sistema Único de Saúde.

OBJECTIVE: To assess the frequency of screening for potential adverse outcomes in hospitalizations of the Brazilian Unified Health System. METHODS: A retrospective study, including all hospital admissions of adults in medical clinics (n = 3,565,811) and surgical clinics (n = 2,614,048) in Brazil in 2007. The Hospital Information System was used as a source of information. The measurement of adverse events was based on screening for eleven clinical conditions, as defined by previous international studies, recorded in the secondary diagnosis field. We performed bivariate and multivariate analysis to investigate associations between adverse events, death (dependent variable) and other variables such as age, use of the intensive care unit and performance of surgery. RESULTS: The frequency obtained for both clinic types was 3.6 potential adverse events per 1,000 admissions, with a greater frequency in medical clinics (5.3 per 1,000) than in surgery clinics (1.3 per 1,000). There were differences in the profile of hospital admissions between the two clinics: medical clinics were characterized by a predominance of older adults, longer average length of stay, higher mortality rate and lower total cost of hospitalization. The most common potential adverse outcome was hospital-acquired pneumonia. Cardiac arrest had a higher risk of death (OR= 5.76) compared to other potential adverse outcomes. Increased cost for hospitalizations was associated with sepsis. The conditions used as the screening criteria were associated with greater odds of death even after the introduction of variables such as use of intensive care and surgery. CONCLUSIONS: The high frequency of adverse outcomes in hospital admissions indicates a need to develop monitoring strategies and to improve quality of care for improved patient safety.

Segurança do paciente: rastreamento de resultados adversos nas internações do Sistema Único de Saúde / Patient safety: adverse outcomes tracking the hospitalization of Health System

A presente dissertação, apresentada no formato de artigo científico, aborda o rastreamento de resultados adversos no cuidado hospitalar, através de base de dados administrativos. O objetivo geral é avaliar a prevalência de resultados adversos nas internações brasileiras financiadas pelo Sistema Único de Saúde. Metodologia: Estudo exploratório de corte retrospectivo, cuja fonte de informação foi o Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH-SUS). O universo de estudo é composto pelas internações de adultos nas especialidades de clínica médica (n = 3.565.811) e clínica cirúrgica (n = 2.614.048) ocorridas no Brasil no ano de 2007. O rastreamento de resultados adversos utilizou onze condições clínicas, sendo adaptadas para a Classificação Internacional de Doenças décima revisão (CID-10), a partir de códigos da CID-09-CM, com a participação de profissional especialista em codificação de doenças. A análise dos dados deteve-se na descrição da prevalência de resultado adverso por especialidade médica selecionada e de sua variabilidade quanto a mortalidade hospitalar, o tempo médio de permanência e o valor de reembolso da internação. Resultado: O perfil das internações foi distinto ao comparar as duas clínicas; na clínica médica a faixa etária foi predominante de idosos (70-79), com maior tempo médio de permanência (1,3 dias a mais), maior taxa bruta de mortalidade(7,4% versus 3,1% de óbitos na cirúrgica), e menor valor de reembolso da internação. A prevalência de resultados adversos foi 4 por 1000 internações para a população de estudo...

This thesis, presented in the format of a scientific paper, addresses the tracking of adverse outcomes in hospital care through administrative database. The overall objective is to assess the prevalence of adverse outcomes in admissions financed by the Brazilian Health System. Methodology: Exploratory study of the retrospective cohort, whose source of information was the Hospital Information System of the Unified Health System (SIH-SUS). The study universe consists of admissions for adults in the specialties of internal medicine (n = 3,565,811) and general surgery (n = 2,614,048) occurred in Brazil in 2007. Screening for adverse outcomes used eleven medical conditions, were adapted to the International Classification of Diseases tenth revision (ICD-10) from the adaptation of ICD-09-CM, which included the participation of professional expert coding of diseases. The measurement of adverse outcomes in the SIH-SUS employed the analysis of data held bythe description of the prevalence of adverse outcomes by medical specialty selected and its variability in hospital mortality, the average time residence and the redemption value ofhospitalization. Result: The profile of hospitalization was distinguished by comparing the two clinics, in medical practice was predominant age group of elderly (70-79), with higher average length of stay (1.3 days longer) and higher crude mortality rate (7.4% versus 3.1% of deaths in surgical). The prevalence of adverse outcomes was 4 per 1000 admissions for the study population...

Estratégias gerenciais na implantação do Programa de Saúde da Família / Managerial strategies in the implantation of Family Health Program

Estudo que trata do processo de implantação de equipes do Programa Saúde da Família (PSF) em uma comunidade no bairro de Santa Cruz, zona oeste do município do Rio de Janeiro, caracterizada por alto risco social e sanitário e marcada pela violência. Tem por objetivos: (1) identificar as estratégias utilizadas pela gerência local na implantação de oito equipes de PSF em uma comunidade no bairro de Santa Cruz; (2) descrever os mecanismos de participação comunitária no processo de implantação do PSF e, (3) analisar a inserção do Enfermeiro na coordenação deste processo. Dentre os achados ressalta-se a importância do controle social no processo de legitimação da estratégia PSF junto à comunidade; a função gerencial do Enfermeiro na construção da autonomia local das equipes de Saúde da Família e as abordagens utilizadas pela gerência local ao introduzir o PSF em comunidades marginalizadas.

[Managerial strategies in the implantation of family health program]. / Estratégias gerencias na implantação do programa de saüde da família.

Study that focuses on the implementation process of Family Health Program (FHP) in a community of Santa Cruz, district of Rio de Janeiro city. This community is characterized by a high social and sanitary risk marked by violence. The objectives were: (1) to identify strategies used by local managers in the implantation of eight teams of FHP in this community; (2) to describe the mechanism of community participation in the implantation process and, (3) to analyse the nurse's insertion in as this process coordinator. Among these findings, the importance of social control is emphasized at legitimation process that FHP strategy causes to users, the nurse's management function to construct the local autonomy and approaches used by the management to introduce FHP in poverty communities.