Risultati per: Trattamento domiciliare di un paziente positivo al virus SARS-Cov-2

In a meta-analysis, testing reduced antibiotic use in some test-positive patients, but not in patients overall.

Basato su Omvs ricombinanti, colma lacune prodotti precedenti

Studio apre prospettive sul Long Covid

Nefrite lupica è frequente e severa, da curare tempestivamente

Although safe and effective vaccines against HBV (hepatitis B virus) are available, there are worldwide more than 2 billion people who had an HBV infection and about 250 million people suffering from chronic HBV infection. Chronic HBV infection is a major cause for liver diseases such as fibrosis, cirrhosis and hepatocellular carcinoma (HCC). It is estimated that about 800 000–1 000 000 people die each year due to the consequences of chronic HBV infection.1 Moreover, in almost all HBV-associated HCCs integrated HBV-DNA is found. Therapy options at present are limited and based on nucleoside/nucleotide analogues and interferon alpha. Since persistence of HBV infection frequently can be attributed to an insufficient cellular immune response approaches to rescue host immune response may help to eliminate infected cells and to suppress virus replication. A recent development are HBV-specific CARs (chimeric antigen receptors) human T-cells that are intended to recognise and eliminate HBV positive…

We read Kennedy et al1’s findings with interest, and report in-depth analyses of antibody and T cell responses in patients with inflammatory bowel disease (IBD) to COVID-19 vaccination. We prospectively recruited 100 SARS-CoV-2-uninfected patients with IBD on varying treatments at the Royal Melbourne Hospital (HREC/74403/MH-2021). Healthcare workers who did not have IBD and were not on immunosuppressive medication were enrolled as controls with approvals from Melbourne Health (HREC/68355/MH-2020) and University of Melbourne (HREC 22268, 21626). Participant characteristics are outlined in table 1. IBD medication regimens needed to be stable for at least 8 weeks prior to enrolment. Only one participant was on concomitant low-dose systemic corticosteroids with anti-TNF combination therapy. Eighty-nine patients received BNT162b2 (Pfizer–BioNTech), and 11 received ChAdOx1 nCoV-19 (Oxford–AstraZeneca). No participants had a clinical history of SARS-CoV-2 infection at enrolment. Anti-S1/2 and anti-RBD SARS-CoV-2-specific antibodies were measured at baseline and at five time…

Luxenburger H, Thimme R. SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease. Gut 2023;72:1783-94
The correct legend for figure 4 should be:
Effect of booster vaccination on the adaptive immune response in LTR and AIH patients (A) Booster vaccination significantly improves the SARS-CoV- 2-specific antibody response in AIH, while the frequency of T cells remains stable. (B) Booster vaccination significantly improves the SARS-CoV-2- specific antibody response in LTR, while the frequency of T cells remains stable. (C) After two RNA vaccine doses, the CD4+T cell subset distribution is altered in LTR with lower frequencies of TFH cells, however, the frequencies increase after booster infection. AIH, autoimmune hepatitis; LTR, liver transplant recipients; TFH cells: T follicular helper cells.

Disponibile profilassi con anticorpi monoclonali

This Medical News story discusses a recent study that found people who are immunocompromised clear SARS-CoV-2 at varying rates.

Objectives
To determine the most epidemiologically effective and cost-effective school-based SARS-CoV-2 antigen-detection rapid diagnostic test (Ag-RDT) self-testing strategies among teachers and students.

Design
Mathematical modelling and economic evaluation.

Setting and participants
Simulated school and community populations were parameterised to Brazil, Georgia and Zambia, with SARS-CoV-2 self-testing strategies targeted to teachers and students in primary and secondary schools under varying epidemic conditions.

Interventions
SARS-CoV-2 Ag-RDT self-testing strategies for only teachers or teachers and students—only symptomatically or symptomatically and asymptomatically at 5%, 10%, 40% or 100% of schools at varying frequencies.

Outcome measures
Outcomes were assessed in terms of total infections and symptomatic days among teachers and students, as well as total infections and deaths within the community under the intervention compared with baseline. The incremental cost-effectiveness ratios (ICERs) were calculated for infections prevented among teachers and students.

Results
With respect to both the reduction in infections and total cost, symptomatic testing of all teachers and students appears to be the most cost-effective strategy. Symptomatic testing can prevent up to 69·3%, 64·5% and 75·5% of school infections in Brazil, Georgia and Zambia, respectively, depending on the epidemic conditions, with additional reductions in community infections. ICERs for symptomatic testing range from US$2 to US$19 per additional school infection averted as compared with symptomatic testing of teachers alone.

Conclusions
Symptomatic testing of teachers and students has the potential to cost-effectively reduce a substantial number of school and community infections.

Objective
Patients receiving immunosuppressives have been excluded from trials for SARS-CoV-2 vaccine efficacy. Investigation of immunosuppressants’ impact on effectiveness of vaccines, particularly in patients with immune-mediated inflammatory diseases (IMID), is therefore required.

Design
We performed a nationwide cohort study to assess the risk of COVID-19 infection in vaccinated patients with IMID exposed to immunosuppressives compared with IMID unexposed to immunosuppressives. Exposure to immunosuppressives in the 120 days before receiving the second SARS-CoV-2 mRNA vaccination was assessed. Patients were followed from date of second vaccination and weighted Cox models were used to estimate the risk of infection associated with immunosuppressives. Secondary outcomes included hospitalisation and death associated with a positive SARS-CoV-2 test. Risk of infection by immunosuppressant drug class was also analysed.

Setting
This study used population-representative data from Danish national health registries in the period from 1 January to 30 November 2021.

Results
Overall, 152 440 patients were followed over 19 341 person years. Immunosuppressants were associated with a significantly increased risk of infection across IMID (HR: 1.4, 95% CI 1.2 to 1.5), in inflammatory bowel disease (IBD) (HR: 1.6, 95% CI 1.4 to 1.9) and arthropathy (HR: 1.3, 95% CI 1.1 to 1.4) but not psoriasis (HR: 1.1, 95% CI 0.9 to 1.4). Immunosuppressants were also associated with an increased risk of hospitalisation across IMID (HR: 1.4, 95% CI 1.1 to 2.0), particularly in IBD (HR: 2.1, 95% CI 1.0 to 4.1). No significantly increased risk of death in immunosuppressant exposed patients was identified. Analyses by immunosuppressant drug class showed increased COVID-19 infection and hospitalisation with anti-tumour necrosis factor (TNF), systemic corticosteroid, and rituximab and other immunosuppressants in vaccinated patients with IMID.

Conclusion
Immunosuppressive therapies reduced effectiveness of mRNA SARS-CoV-2 vaccination against infection and hospitalisation in patients with IMID. Anti-TNF, systemic corticosteroids, and rituximab and other immunosuppressants were particularly associated with these risks.

Objective
To identify and summarise the evidence on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection and persistence in body fluids associated with sexual activity (saliva, semen, vaginal secretion, urine and faeces/rectal secretion).

Eligibility
All studies that reported detection of SARS-CoV-2 in saliva, semen, vaginal secretion, urine and faeces/rectal swabs.

Information sources
The WHO COVID-19 database from inception to 20 April 2022.

Risk of bias assessment
The National Institutes of Health tools.

Synthesis of results
The proportion of patients with positive results for SARS-CoV-2 and the proportion of patients with a viral duration/persistence of at least 14 days in each fluid was calculated using fixed or random effects models.

Included studies
A total of 182 studies with 10 023 participants.

Results
The combined proportion of individuals with detection of SARS-CoV-2 was 82.6% (95% CI: 68.8% to 91.0%) in saliva, 1.6% (95% CI: 0.9% to 2.6%) in semen, 2.7% (95% CI: 1.8% to 4.0%) in vaginal secretion, 3.8% (95% CI: 1.9% to 7.6%) in urine and 31.8% (95% CI: 26.4% to 37.7%) in faeces/rectal swabs. The maximum viral persistence for faeces/rectal secretions was 210 days, followed by semen 121 days, saliva 112 days, urine 77 days and vaginal secretions 13 days. Culturable SARS-CoV-2 was positive for saliva and faeces.

Limitations
Scarcity of longitudinal studies with follow-up until negative results.

Interpretation
SARS-CoV-2 RNA was detected in all fluids associated with sexual activity but was rare in semen and vaginal secretions. Ongoing droplet precautions and awareness of the potential risk of contact with faecal matter/rectal mucosa are needed.

PROSPERO registration number
CRD42020204741.

New England Journal of Medicine, Volume 390, Issue 8, Page 771-772, February 2024.

Annals of Internal Medicine, Ahead of Print.