Search Results for: Il significato della carica virale e l’effetto del vaccino anti-COVID-19

This Medical News story discusses experimental mucosal COVID-19 vaccines.

This cohort study compares the mortality and hospitalization risks among patients with vs without solid cancer and diagnosed with COVID-19 during the period when the Omicron variant was dominant.

This nonrandomized controlled trial assesses the safety and clinical activity of anti–PD-1 therapy to treat high-risk proliferative verrucous leukoplakia.

To the Editor A study by Wallace et al, “Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic,” makes important contributions at the intersection of the fields of political science, public health, and medicine. With the increase in the power of conservative ideologues within Republican party politics, understanding the public health implications of political science variables is a worthy goal. However, conceptual conflation inherent in the authors’ measurement of political party affiliation may confound their state-level results.

In Reply A letter from O’Mahen provides valuable context and commentary on our article, “Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic.”

This cohort study examines changes in cancer diagnoses and treatment in the US during the first year of the COVID-19 pandemic.

To the Editor In a recent issue of JAMA Oncology, Harrington et al reported on the outcome of the CheckMate 714 randomized clinical trial, which compared combination immunotherapy using the anti–programmed death 1 (PD-1) antibody nivolumab and the anti–cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibody ipilimumab vs nivolumab monotherapy in patients with advanced head and neck cancer. The trial failed to show superiority of the combination, and as the authors briefly acknowledge, the chosen ipilimumab dosing may have contributed to the negative outcome of the study.

The identification of genomic alterations within driver oncogenes has revolutionized the management of non–small cell lung cancer (NSCLC). Indeed, we now approach the twentieth anniversary of the discovery of epidermal growth factor receptor (EGFR) mutations in NSCLC, a finding that catalyzed a new paradigm of precision medicine that has culminated in regulatory approvals of more than 20 targeted agents across various oncogenes. Importantly, insights into EGFR-mutant biology have continued to provide a roadmap for management of oncogene-driven NSCLC. Historically, EGFR-mutant NSCLC has been classified into 3 distinct subgroups. Classic EGFR mutations, which are characterized by exon 19 deletions or the exon 21 L858R substitution, account for approximately 80% of EGFR mutations and confer marked sensitivity to EGFR tyrosine kinase inhibitors. By contrast, EGFR exon 20 insertion mutations, which compose approximately 10% of EGFR mutations, are generally insensitive to treatment with early-generation EGFR inhibitors. Finally, uncommon or atypical EGFR mutations comprise a heterogeneous group of point mutations, deletions, or insertions within exons 18 to 25 and make up the remaining 10% to 15% of EGFR mutations. Currently, the optimal management of patients with these atypical mutations remains an open question. Okuma and colleagues present findings from the UNICORN study, a prospective, multicenter, phase 2 trial aimed at evaluating the clinical activity of the third-generation EGFR inhibitor osimertinib in patients with NSCLC harboring uncommon EGFR mutations. Among 42 treatment-naive patients enrolled over a 2-year period, the objective response rate (ORR) was 55% with a median progression-free survival (PFS) of 9.4 months. The median duration of response was 22.7 months. Consistent with earlier studies using osimertinib, common adverse events included diarrhea (47.5%), acneiform eruption/rash (42.5%), thrombocytopenia (65%), and mucositis (32.5%), but only 3 patients (7.5%) required dose reductions.

This cross-sectional study systematically examines the contributions of COVID-19 and other underlying causes of death to the widened gender life expectancy gap from 2010 to 2021.

The COVID-19 pandemic devastated the population of the US, causing over 1 million deaths and an even greater number of hospitalizations or cases of post–COVID-19 condition (also referred to colloquially as long COVID), but perhaps the most sorrowful remembrance will be the unnecessary losses in lives. Even after messenger RNA vaccines became widely available by the spring of 2021, the COVID-19 deaths continued to climb because of widescale vaccine refusal. One estimate found that between the end of May 2021 and beginning of September 2022, more than 200 000 deaths could have been prevented had those adults been immunized with a primary series. At least 3 other analyses arrived at similar estimates for the deaths among unvaccinated people in the US during the Delta and Omicron BA.1 waves in 2021 and 2022.

Introduction
The abrupt transition of the mode of learning due to the COVID-19 pandemic resulted in an increase in complaints of musculoskeletal (MSK) discomfort among students in Higher Education Institutions (HEI). Inadequate physical space and equipment are one major cause of these complaints. Among HEIs, physical therapy (PT) students have sufficient background in managing MSK discomforts. However, this does not prevent them from experiencing pain and discomfort during online classes. This analytical cross-sectional study aims to determine the correlation between ergonomic knowledge and MSK discomfort among first-year to fourth-year PT students.

Methods and analysis
The study will use two questionnaires, the Ergonomic Knowledge Questionnaire, and the Cornell Musculoskeletal Discomfort Questionnaire, that determine the level of ergonomic knowledge and MSK discomfort, respectively. This will be disseminated to 144 students through google forms. Results will then be analysed using Pearson Correlation Test. The study anticipates a correlation between the level of ergonomic knowledge and MSK discomfort among the participants.

Ethics and dissemination
The study has been approved by the University of Santo Tomas-College of Rehabilitation Sciences Ethics Review Committee. The participants will receive the results prior to publication in a peer-reviewed scientific journal.

Trial registration number
Philippine Health Research Registry with registry ID PHRR230216-005443.

Objective
Non-compliance with COVID-19 infection prevention and control (IPC) is one of the global public health problems particularly among those frontline healthcare workers. However, there are no detailed investigations on COVID-19 IPC compliance among healthcare workers in conflict-affected settings. The objective of this research was to assess compliance with COVID-19 IPC measures and determine the factors associated with it among healthcare providers in Ethiopian governmental hospitals affected by conflict.

Design
A cross-sectional study was carried out within institutional settings.

Study setting and period
The study was conducted in three public hospitals located in northeastern Ethiopia during the period of March to April 2022.

Participants
Simple random sampling technique was used to select 325 healthcare workers after proportional allocation was made to each public hospital.

Primary outcome measures
The primary outcome was non-compliance with COVID-19 IPC. A multivariable logistic regression analysis was employed to identify factors associated with the lack of adherence to the COVID-19 IPC protocol.

Results
Nearly half (150, 46.2%) of the healthcare workers had non-compliance with COVID-19 IPC protocol. Absence of hand washing soap (adjusted OR (AOR)=2.99; 95% CI 2.46 to 5.76), workload (AOR=2.25; 95% CI 1.33 to 3.84), disruption in the supply of piped water (AOR=1.82; 95% CI 1.11 to 2.99), did not undergo training in COVID-19 IPC (AOR=2.85; 95% CI 1.85 to 4.84), absence of COVID-19 IPC guidelines (AOR=2.14; 95% CI 1.11 to 4.13) and chewing khat (AOR=2.3; 95% CI 1.32 to 3.72) were determinant factors for non-compliance.

Conclusions
The magnitude of non-compliance with COVID-19 IPC was high. Hospital managers and federal ministry of health should provide regular training on COVID-19 IPC, continuous piped water and personal protective facilities for healthcare workers. Ultimately, improving the security situation in the area would help improve COVID-19 IPC compliance among healthcare workers in these and other similar conflict-affected settings.

Introduction
Armed conflict worldwide and across history has harmed the health of populations directly and indirectly, including generations beyond those immediately exposed to violence. The 2020 war between Armenia and Azerbaijan over Nagorno-Karabakh, inhabited by an ethnically Armenian population, provides an example of how conflict harmed health during COVID-19. We hypothesised that crises exposure would correspond to decreased healthcare utilisation rates and worse health outcomes for the maternal and infant population in Armenia, compounded during the pandemic.

Methods
Following a mixed-methods approach, we used ecological data from 1980 to 2020 to evaluate health trends in conflict, measured as battle-related deaths (BRDs), COVID-19 cases, and maternal and infant health indicators during periods of conflict and peace in Armenia. We also interviewed 10 key informants about unmet needs, maternal health-seeking behaviours and priorities during the war, collecting recommendations to mitigate the effects of future crisis on maternal and infant health. We followed a deductive coding approach to analyse transcripts and harvest themes.

Results
BRDs totalled more in the 2020 war compared with the previous Nagorno-Karabakh conflicts. Periods of active conflict between 1988–2020 were associated with increased rates of sick newborn mortality, neonatal mortality and pre-eclampsia or eclampsia. Weekly average COVID-19 cases increased sevenfold during the 2020 Nagorno-Karabakh war. Key informants expressed concerns about the effects of stress and grief on maternal health and pregnancy outcomes and recommended investing in healthcare system reform. Participants also stressed the synergistic effects of the war and COVID-19, noting healthcare capacity concerns and the importance of a strong primary care system.

Conclusions
Maternal and infant health measures showed adverse trends during the 2020 Nagorno-Karabakh war, potentially amplified by the concurrent COVID-19 pandemic. To mitigate effects of future crises on population health in Armenia, informants recommended investments in healthcare system reform focused on primary care and health promotion.

Covid circola a livelli sostenuti. Iss: ‘Prudenza e vaccinarsi’

Monitoraggio Iss-ministero, terapie intensive stabili, Jn1 resta la variante dominante

Objective
Investigate risk for falls, fractures and syncope in older adult patients treated with nortriptyline compared with paroxetine and alternative medications.

Design
Retrospective cohort study.

Setting
The electronic medical record and prescription drug database of a large integrated healthcare system in Southern California.

Participants
Ambulatory patients, age ≥65 years diagnosed with depression, anxiety disorder or peripheral neuropathy, dispensed one or more of ten study medications between 1 January 2008 and 31 December 2018.

Main outcome measures
HR for falls, fractures and syncope with exposure to study medications adjusted for patient demographic variables and comorbidities.

Results
Among 195 207 subjects, 19 305 falls, 15 088 fractures and 11 313 episodes of syncope were observed during the study period. Compared with the reference medication, nortriptyline, the adjusted HRs (aHRs) for falls were statistically significantly greater for: paroxetine (aHR 1.48, 95% CI 1.39 to 1.57), amitriptyline (1.20, 95% CI 1.08 to 1.33), venlafaxine (1.44, 95% CI 1.34 to 1.56), duloxetine (1.25, 95% CI 1.12 to 1.40), fluoxetine (1.51, 95% CI 1.44 to 1.59), sertraline (1.53, 95% CI 1.44 to 1.62), citalopram (1.61, 95% CI 1.52 to 1.71) and escitalopram (1.37, 95% CI 1.21 to 1.54), but not gabapentin (0.95, 95% CI 0.89 to 1.02). For fractures, compared with nortriptyline, aHRs were significantly greater for: paroxetine, venlafaxine, duloxetine, fluoxetine, sertraline, citalopram, escitalopram and gabapentin, with aHRs ranging from 1.30 for gabapentin to 1.82 for escitalopram; risk was statistically similar for amitriptyline. For syncope, the aHRs were significantly greater for: paroxetine, venlafaxine, fluoxetine, sertraline and citalopram, with aHRs ranging from 1.19 for fluoxetine and paroxetine up to 1.30 for citalopram and sertraline; risk was similar for amitriptyline, duloxetine, escitalopram and gabapentin.

Conclusions
Compared with therapeutic alternatives, nortriptyline was found to represent a lower risk for falls, fractures and syncope, versus comparator medications, except for a few instances that had equivalent risk. The risk for these adverse events from paroxetine was comparable to the alternative medications.