Risultati per: Identificate le origini evolutive di SARS-CoV-2

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 175, Issue 12, Page 1707-1715, December 2022.

The SARS-CoV-2 outbreak overwhelmed the healthcare systems worldwide. Saturation of hospitals and the risk of contagion led to a reduction in the care of other diseases.
Objective
To determine the impact of SARS-CoV-2 pandemic on urological surgery in France during the year 2020.

Design, setting and participants
An observational descriptive study was conducted on anonymised data collected from the national healthcare database established each year as part of the Program for the Medicalization of Information Systems in Medicine, Surgery, Obstetrics and Odontology.

Intervention
None.

Primary and secondary outcome measures
We gathered the number of urology surgical procedures carried out between 2010 and 2019, and we observed the difference between the forecast and actual number of urological surgeries performed in 2020.

Results
Urological surgeries decreased by 11.4%, non-oncological surgeries being more affected (–13.1%) than oncological ones (–4.1%). Among the most relevant surgeries, female urinary incontinence (–44.7%) and benign prostatic hyperplasia (–20.8%) were the most impacted ones, followed by kidney cancer (–9%), urolithiasis (–8.7%), radical cystectomy for bladder cancer (–6.1%), prostate cancer (–3.6%) and transurethral resection of bladder tumour (–2%). Public hospitals had a more reduced activity (–17.7%) than private ones (–9.1%). Finally, the distribution of the reduction in urological activities by region did not correspond to the regional burden of SARS-CoV-2.

Conclusions
Urological care was severely affected during SARS-CoV-2 pandemic. Even if oncological surgeries were prioritised, the longer it takes to receive appropriate care, the greater the risk on survival impact.

Trial registration
The data collection and analysis was authorised by the French Data Protection Authority (CNIL) under the number1 861 282v2.

Introduction
SARS-CoV-2 infection rarely causes hospitalisation in children and young people (CYP), but mild or asymptomatic infections are common. Persistent symptoms following infection have been reported in CYP but subsequent healthcare use is unclear. We aim to describe healthcare use in CYP following community-acquired SARS-CoV-2 infection and identify those at risk of ongoing healthcare needs.

Methods and analysis
We will use anonymised individual-level, population-scale national data linking demographics, comorbidities, primary and secondary care use and mortality between 1 January 2019 and 1 May 2022. SARS-CoV-2 test data will be linked from 1 January 2020 to 1 May 2022. Analyses will use Trusted Research Environments: OpenSAFELY in England, Secure Anonymised Information Linkage (SAIL) Databank in Wales and Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 in Scotland (EAVE-II). CYP aged ≥4 and

Objectives
SARS-CoV-2 vaccination is a crucial intervention for infection control; however, the immune response to vaccination in dialysis patients has been reported to be moderate compared with healthy adults. There are few studies available on humoral response in immunised dialysis patients compared with well-matched control group, we conducted a prospective cohort study measuring SARS-CoV-2 antibody titres in Fukushima Prefecture, Japan since September 2021.

Participants
We compared the titres of both anti-SARS-CoV-2 S1 IgG and neutralising antibodies of 65 haemodialysis patients (dialysis group) with 500 residents in Soma, Fukushima (control group).

Methods
Coarsened exact matching was used to balance sex, age and days from the second dose between dialysis and control groups.

Results
Significant differences in the titres of anti-SARS-CoV-2 S1 IgG and neutralising antibodies were observed between the dialysis and control groups; anti-SARS-CoV-2 S1 IgG: 168.35 (4.48–1074.29) AU/mL and 269.81 (4.72–945.96) AU/mL in dialysis and control groups, p=0.02, neutralising antibodies: 35.77 (2.94–826.06) AU/mL and 62.22 (0.00–535.57) AU/mL, p=0.007, respectively).

Conclusions
We observed significantly reduced anti-SARS-CoV-2 S1 antibody and neutralising antibodies in haemodialysis patients compared with cohorts matched for duration after vaccination. Patients receiving haemodialysis should be carefully monitored for immunological responses to the vaccination and COVID-19 infection.

Mohraz M, Salehi M, Tabarsi P, et al. Safety and immunogenicity of an inactivated virus particle vaccine for SARS-CoV-2, BIV1-CovIran: findings from double-blind, randomised, placebo-controlled, phase I and II clinical trials among healthy adults. BMJ Open 2022;12:e056872. doi: 10.1136/bmjopen-2021-056872 In the corrected version of the article, the competing interest statements for authors Hamed Hosseini, Minoo Mohraz, and Payam Tabaris have been changed. The original article indicated they had no competing interests. It now states the following: HH: as manager of the Clinical Trial Center (CTC), an academic CRO affiliated with Tehran University of Medical Sciences, Tehran, Iran, I was responsible for the conduct and monitoring of clinical trials. I was a non-voting member of the Data Safety Monitoring Board, as mandated by the national regulatory authority. MM: a research contract between Shifapharmed (sponsor) and Iranian Research Centre for HIV/AIDS (IRCHA) for supervising all clinical trial activities of phases one…

Objective
Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection than the general population. This group is pivotal to healthcare system resilience during the COVID-19, and future, pandemics. We investigated demographic, social, behavioural and occupational risk factors for SARS-CoV-2 infection among HCWs.

Design/setting/participants
HCWs enrolled in a large-scale sero-epidemiological study at a UK university teaching hospital were sent questionnaires spanning a 5-month period from March to July 2020. In a retrospective observational cohort study, univariate logistic regression was used to assess factors associated with SARS-CoV-2 infection. A Least Absolute Shrinkage Selection Operator regression model was used to identify variables to include in a multivariate logistic regression model.

Results
Among 2258 HCWs, highest ORs associated with SARS-CoV-2 antibody seropositivity on multivariate analysis were having a household member previously testing positive for SARS-CoV-2 antibodies (OR 6.94 (95% CI 4.15 to 11.6); p

We recently published the COVIDPAN study1 and follow-up data2 in Gut, which explored the association between concomitant SARS-CoV-2 infection and acute pancreatitis (AP).1 2 We would like to further report the impact of SARS-CoV-2 pandemic on aetiology and management of patients presenting with AP, particularly those with gallstone pancreatitis (GSP) in a cohort of patients who did not have SARS-CoV-2 infection. Between 1 March 2020 and 23 July 2020, 1628 patients presenting with AP were included in the analysis with median age of 54 years (IQR 40–69). Gallstones were the predominant aetiology of AP (43.6%), followed by alcohol-related AP (25.8%) and idiopathic AP (21.5%). The idiopathic group was further followed for 12 months, and after completion of appropriate investigations, 14.4% of the cohort remain to have an idiopathic aetiology. Most patients had mild AP (1244, 77.8%), 256 (16%) had moderate to…

We read with great interest the recent publication from Siegel and colleagues, reporting recommendations from an international consensus meeting for SARS-CoV-2 vaccination in patients with inflammatory bowel diseases (IBDs).1 Based on experiences with other vaccines, it is reported that several immunosuppressive agents are associated with suboptimal vaccine response in patients with IBD. We assessed the effect of immunosuppressive blood levels on the SARS-CoV-2-specific immunogenicity of SARS-CoV-2 vaccination in liver transplant (LT) recipients vaccinated with two doses of the mRNA vaccines: BNT162b2 or mRNA-1273 or the vector vaccine ChAdOx1 nCoV-19. Excluded were patients with a history of a SARS-CoV-2 infection. A total of 476 LT recipients (476/795=59.9% of all alive recipients) were eligible for analysis between March and July 2021 at the Erasmus University Medical Centre (Rotterdam, the Netherlands). In total, 36 LT recipients had a history of a SARS-CoV-2 infection confirmed by PCR before vaccination, 128 LT…

Protection against mild COVID-19 wanes within a few months, but prevention of severe outcomes lasts longer (except in immunocompromised persons).

Objectives
This body of work aimed to elicit ambulance service staff’s perceptions on the barriers and facilitators to adoption, and clinical utility of incorporating rapid SARS-CoV-2 testing during ambulance assessments.

Design
A mixed-methods survey-based project using a framework analysis method to organise qualitative data.

Setting
Emergency and non-emergency care ambulatory services in the UK were approached to take part.

Participants
Current, practising members of the UK ambulance service (paramedics, technicians, assistants and other staff) were included in this body of work.

Results
Survey 1: 226 responses were collected between 3 December 2020 and 11 January 2021, 179 (79.2%) of which were completed in full. While the majority of respondents indicated that an ambulance-based testing strategy was feasible in concept (143/190, 75.3%), major barriers to adoption were noted. Many open-ended responses cited concerns regarding misuse of the service by the general public and other healthcare services, timing and conveyance issues, and increased workloads, alongside training and safety concerns. Survey 2: 26 responses were received between 8 February 2021 and 22 February 2021 to this follow-up survey. Survey 2 revealed conveyance decision-making, and risk stratification to be the most frequently prioritised use cases among ambulance service staff. Optimal test characteristics for clinical adoption according to respondents were; accuracy (above 90% sensitivity and specificity), rapidity (

Circulation, Volume 146, Issue Suppl_1, Page A12956-A12956, November 8, 2022. Case Presentation: 49 year old male with past medical history of hypertension who presented with dyspnea and nasal congestion of three days duration. Testing for SARS-CoV-2 was positive. ECG revealed sinus tachycardia with an incomplete right bundle branch block. D-dimer was elevated 3,388 ng/mL and CT pulmonary angiogram revealed thrombosis of a right lower lobe pulmonary vein extending to the posterior aspect of the left atrium along with consolidation in the right lower lobe concerning for pulmonary infarct versus congestion in the setting of pulmonary venous thrombosis. The patient was admitted and started on intravenous unfractionated heparin. Echocardiogram performed later in the day revealed left ventricular segmental wall motion to be globally hypokinetic with mildly reduced ejection fraction of 45%. Left atrium was severely enlarged. No thrombus could be seen in the left atrium or ventricle. Bubble study revealed no evidence of atrial septal defect or patent foramen ovale. The next day after admission, his symptoms had resolved and he was back to his baseline, so he was discharged. No supplemental oxygen was required. Heparin was transitioned to apixaban, and metoprolol succinate and lisinopril were initiated. Cardiac monitoring during the hospitalization did not demonstrate any arrhythmias. Etiology of his pulmonary vein thrombosis was ultimately felt to be due to coagulopathy secondary to COVID-19 given that the patient’s medical history was otherwise unremarkable.Discussion: This case describes a rare complication due to infection with SARS-CoV-2. Pulmonary artery thrombi are common with SARS-CoV-2 infection, but pulmonary vein thrombi are rare. With thrombus extending to the left atrium, cardiac monitoring was performed and did not reveal evidence of atrial fibrillation or atrial flutter. With no other identifiable cause of the thrombus, the etiology was likely due to SARS-CoV-2 infection.

Circulation, Volume 146, Issue Suppl_1, Page A12023-A12023, November 8, 2022. BACKGROUND:It is well known that the entry of the SARS- CoV-2 into cells is mediated by the binding between the virus Spike-glycoprotein (S) and the membrane ACE2-receptor (ACE2R). When SARS-CoV-2 binds to ACE2R, a down-regulation of ACE2R occurs, playing a crucial role in the inflammatory response. Also ACE2 deficiency is thought to play an important role in the pathogenesis of SARS-CoV-2 infection, and could be particularly harmful in subjects with pre-existing ACE2 deficiency, for example due to advanced age, the presence of DM, arterial hypertension or pre-existing heart disease, including HF.AIM OF THE STUDY:we aimed to identify predicting factors of a higher risk in terms of severity of the clinical course and worse prognosis in the population of the Brescia area, affected by a large number of cases in the first period of COVID-19 outbreak. In particular, we aimed to verify whether there is correlation between levels of serum ACE2 (sACE2) and the risk of SARS-CoV-2 infection, as well as between sACE2 and the different severity of the clinical manifestations of COVID-19 in pts with and without CV diseases.Methods:we enrolled subjects with previous documented SARS-CoV-2 infection and divided they into three groups: pts with asymptomatic course; pts with symptomatic course but without the need for hospitalization for COVID-19; pts with severe symptomatic course requiring hospitalization in ICU. Blood samples were taken for sACE2 dosage. We compared the concentrations of sACE2 in these groups in relation to the age, clinical course, comorbidities, and ongoing therapies.Results:at March 2022, we enrolled 178 pts, 51 (28%) were hospitalized for COVID-19, whereas 78 (44%) had symptomatic course without hospitalization and 49 (28%) were completely pauci-asymptomatic. Only 6 pts (4%) had myocarditis or pericarditis SARS-CoV-2-related. Between hospitalized pts, male sex (67%), older age and higher BMI were most frequent. Moreover, chronic heart failure (20%), a diagnosis of cardiopathy (29%) and AF or atrial flutter (22%) were most frequent.PERSPECTIVES:ACCEPT study will help to clarify the relationship between ACE2 molecule, the risk of SARS-CoV2 infection and the severity of clinical presentation of COVID-19 in pts with or without CV diseases.

Circulation, Volume 146, Issue Suppl_1, Page A12017-A12017, November 8, 2022. BACKGROUND:the entry of the SARS-CoV-2 into cells is mediated by the binding between the virus Spike-glycoprotein and the membrane ACE2-receptor (ACE2-R). When SARS-CoV-2 binds to ACE2-R, a down-regulation of these receptors occurs, playing a crucial role in the inflammatory response. A dysregulation of the RAAS linked to a different expression of ACE2-R and TMPRSS2 gene polymorphisms and different levels of serum ACE2 (sACE2), could be associated with abnormal inflammatory and immune response to SARS-CoV-2 infection.AIM OF THE STUDY:we aimed to verify whether there is an association between the clinical course of COVID-19 pts and the presence of more frequent ACE2 and TMPRSS2 single-nucleotide polymorphisms (SNPs) and if sACE2 levels are related to specific ACE2 and TMPRSS2 polymorphic variants.Methods:we consecutively enrolled subjects with previous documented SARS-CoV-2 infection and divided our sample into three groups: pts with asymptomatic course; pts with symptomatic course without an hospitalization for COVID-19; pts with severe symptomatic course requiring hospitalization in ICU. Data about age, clinical course, comorbidities, and therapies were collected. Blood samples were taken for the genetic analysis of the most frequent SNPs of the ACE2-R and TMPRSS2 detected in Italian population, in particular genotypic variants TT and CC of ACE2 SNPs 1 and 5 (5% and 14% respectively) and genotypic variants TT and CC of TMPRSS2 SNPs 2 and 3 (rate of 50% and 30% respective).Results:among 178 pts enrolled up to March 2022, we have so far analyzed the genetic polymorphisms of 74 pts; 21 (28%) were hospitalized for COVID-19, 38 (51%) had symptomatic course without hospitalization and 15 (21%) were completely asymptomatics. We found that sACE2 levels were higher in genotypic variant CC of SNP 1 of TMPRSS2 gene. Considering that a high concentration of sACE2 outlines a proinflammatory condition, it could be hypothesized that the CC genotype may be a predisposing condition to the cytokine storm of COVID-19.PERSPECTIVES:Genetic analysis of ACE2 and TMPRSS2 SNPs will help to clarify the relationship between these polymorphic variant, sACE2 levels, risk of SARS-CoV2 infection and severity of clinical presentation of COVID-19 in pts with or without CV diseases.

Circulation, Volume 146, Issue Suppl_1, Page A10071-A10071, November 8, 2022. Introduction:COVID-19 infection and vaccines are associated with acute myocarditis. However, the relative risk of myocarditis is not fully characterized. The aim of this study is to compare the risk ratio (RR) of myocarditis in COVID-19 vaccines and SARS-CoV-2 infection groups and to delineate the effect modifiers.Hypothesis:Risk ratio of myocarditis is higher in the infection group than in the vaccinated group, and this risk is modified by age and sex.Methods:Multiple electronic databases and trial registries were searched to April 2022, for randomized controlled trials and observational cohort studies reporting the risk of myocarditis associated with the COVID-19 vaccines and the risk associated with SARS-CoV-2 infection. We estimated the effect of COVID-19 infection and vaccines on rates of myocarditis by random-effects meta-analyses using the generic inverse variance method. Meta-regression analyses were conducted to assess the effect of sex and age on the incidence of myocarditis.Results:22 eligible studies consisting of 55.5 million in the vaccinated cohort and 2.5 million in the infection cohort were included. Median age was 49 years (interquartile range (IQR): 38-56), and 49% (IQR: 43% to 52%) were male. Of patients diagnosed with myocarditis, 3.48% were hospitalized and 0.05% died. The RR for myocarditis in the infection group was15 (95% CI: 11.09 – 19.81) and 2.0 (95% CI: 1.44-2.65) in the vaccine group. Of patients who developed myocarditis after receiving the vaccine or having the infection, 61% (IQR: 39% -87%) were male. Meta-regression analysis indicated that male sex and young age were associated with myocarditis. Risk of bias assessment was moderate.Conclusions:In this systematic review and meta-analysis, we found that the risk of incident myocarditis is about 7 times higher in persons who were infected with SARS-CoV-2 virus than in those who received the vaccine.

Circulation, Volume 146, Issue Suppl_1, Page A11491-A11491, November 8, 2022. Introduction:Post-acute sequelae of SARS-CoV-2 cardiovascular syndrome (PASC-CVS) is a heterogeneous disorder of post-COVID syndrome that involves a wide range of cardiovascular symptoms including palpitations, chest pain, dyspnea and dizziness. The clinical time-course of PASC-CVS is not well characterized. We sought to understand predictors of time to symptom improvement for patients with PASC-CVS.Methods:Patients with PASC-CVS undergoing evaluation in a dedicated post-COVID cardiology clinic were recruited after informed consent. Information was obtained from chart review and included demographics, comorbidities, symptoms, time of infection to time of presentation to the clinic and time to improvement in symptoms. A multivariate linear regression model was used to determine predictors of time to improvement.Results:A total of 144 consecutive patients were included that had complete records available for review. Average age was 46 years, 74% were female and 94% were Caucasian. Comorbities included obesity (49%), mental health disorder (25%), hypertension (24%), hyperlipidemia (24%), pulmonary disease (18%), type II diabetes (9%), atrial arrhythmia (5%) and coronary artery disease (3%). Time from infection to presentation (p