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

Objectives
To assess the prevalence of SARS-CoV-2 antibodies in the residents of Kibera informal settlement in Nairobi, Kenya, before vaccination became widespread, and explore demographic and health-related risk factors for infection.

Design
A cross-sectional study.

Setting
Kibera informal settlement, Nairobi, Kenya.

Participants
Residents of Kibera informal settlement between October 2019 and August 2021, age 1 year and above who reported no current symptoms of COVID-19.

Main outcome measures
Associations were determined between SARS-CoV-2 positive tests measured with one rapid test and two ELISAs and demographic and health-related factors, using Pearson’s 2 test. Crude OR and adjusted OR were calculated to quantify the strength of associations between variables and seropositive status.

Results
A total of 438 participants were recruited. Most (79.2%) were age 18–50 years; females (64.2%) exceeded males. More than one-third (39.1%) were unemployed; only 7.4% were in formal, full-time employment. Less than one-quarter (22.1%) self-reported any underlying health conditions. Nearly two-thirds (64.2%) reported symptoms compatible with COVID-19 in the previous 16 months; only one (0.23%) had been hospitalised with a reported negative COVID-19 test. 370 (84.5%) participants tested positive in any of the three tests. There was no significant difference in SARS-CoV-2 seropositivity across age, sex, presence of underlying health conditions, on medication or those ever tested for SARS-CoV-2. Multiple logistic regression analysis showed that COVID-19 symptoms in the previous 16 months were the only significant independent predictor of seropositivity (p=0.0085).

Conclusion
High SARS-CoV-2 exposure with limited morbidity was found in the residents of Kibera informal settlement. The study confirms other reports of high SARS-CoV-2 exposure with limited morbidity in slum communities. Reasons cited include the high infectious disease burden on the African continent, demographic age structure and underreporting due to limited testing and lack of access to healthcare services; genetic factors may also play a role. These factors require further investigation.

Introduction
During the pandemic, overweight and obese adolescents were at a higher risk of COVID-19 infection. Indonesia’s government has implemented prevention programmes and immunisation; however, the rise in SARS-CoV-2 infections among adolescents is exacerbated by low-quality diet and lifestyle habits. Also, the vaccine programme is not prioritised in this population. To address this, a solution involves providing probiotics and counselling on healthy lifestyle habits to improve diet and immunity. Therefore, we designed a protocol for a randomised controlled trial with a 20-week intervention to investigate the effect of probiotics supplementation and counselling on healthy lifestyle habits, including healthy eating and physical activity, and psychosocial stimulation, on nutritional status and antibody response against SARS-CoV-2 in this group.

Methods and analysis
This clinical trial aims to investigate the effects of probiotic supplementation on healthy overweight and obese adolescents. The study will involve 440 adolescents aged 12–17 living in Jakarta, Surabaya or Yogyakarta for at least 6 months and have completed at least two doses of the COVID-19 vaccine. The intervention group will receive daily probiotic supplementation of three strains, including Bifidobacterium animalis subsp. Lactis (BB-12), Lactobacillus acidophilus (LA-5) and Lactobacillus rhamnosus (LGG), at the level of 109–1010 colony-forming units for 20 weeks, while the control group will receive a placebo. Both groups will receive weekly counselling on healthy eating habits, physical activity and psychosocial stimulation. The primary outcomes will be changes in the body mass index for age z-score and IgG specific to SARS-CoV-2 titre concentrations between groups. The secondary outcomes will include changes in secretory IgA specific to SARS-CoV-2 titre concentrations, monoclonal antibodies against SARS-CoV-2 spike protein, gut microbiota diversity and the score of Healthy Eating Index 2015.

Ethics and dissemination
The study protocol was approved by the Ethics Committee of the Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital (KET 763/UN2.F1/ETIK/PPM.00.02/2022: 1 August 2022). The study results will be disseminated in open-access international journals, scientific meetings and conferences with stakeholders.

Trial registration number
The study has been registered at https://clinicaltrials.gov with identifier number NCT05623007.

Il 70% paga le cure, il 30% teme la perdita del lavoro. Pesa la tossicità finanziaria

‘Basta difformità, lavorare ad una strategia comune’

Nel 2019 il marito tentò di ucciderla dandole fuoco

Introduction
The elderly are particularly vulnerable to morbidity and mortality from COVID-19, the disease caused by the SARS-CoV-2. Approximately 20% of the elderly showed no antibodies 3–5 months post-second dose of the COVID-19 vaccine. As probiotics have been shown to increase influenza-specific antibody levels post-influenza vaccination, we aim to reduce the percentage of participants without antibodies against the SARS-CoV-2 spike protein receptor-binding domain (anti-S1-RBD) at 6 months post-vaccination.

Methods and analysis
Our study design is a double-blind randomised controlled trial, using intention-to-treat analysis. Eligible participants are a purposive sample of 688 adults aged 65–89 years, in Quebec, Canada, not diagnosed with COVID-19 in the 3 months prior to recruitment and who wish to receive a government-recommended mRNA booster (Pfizer-BioNTech, Moderna) vaccine. The intervention consists of one capsule/day of a probiotic dietary supplement of Lacticaseibacillus rhamnosus and Lacticaseibacillus casei 6×109 CFU/capsule or a placebo, for 15 days pre-booster and post-booster vaccine. All participants provide dried blood spot samples at three timepoints (inclusion, 3 and 6 months post-vaccination) and a stool sample for microbiome analysis. A subgroup of 100 participants living near Sherbrooke, Quebec, is expected to volunteer for two onsite blood-test visits (at inclusion and 6 months post-vaccination). The primary outcome is the percentage of participants without anti-S1-RBD antibodies at 6 months post-vaccination. Secondary outcomes include longitudinal analysis of anti-S1-RBD and anti-N antibodies at three timepoints. In the subgroup, serum levels of neutralising antibodies will be determined at inclusion and 6 months post-vaccination. Probiotic and vaccine side effects are monitored. At the end of the study, we expect to identify the adjuvant effect of probiotic on vaccine-induced immune response.

Ethics and dissemination
The study was approved by Research Ethics Board of the Centre Intégré Universitaire de Santé et des Services Sociaux de l’Estrie- Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l’Estrie-CHUS) and the CHU de Québec-Université Laval # MP-31-2022-4598 as well as Health Canada. All participants will provide informed consent. Results will be disseminated to the scientific community and to all networks related in this research.

Trial registration number
NCT05195151.

‘La ventilazione è necessaria per ossigenare il sangue’

Objectives
To analyse the relationships between SARS-CoV-2 laboratory testing capacity (TC) and socioeconomic factors (wealth, governance and social inequality) across 109 countries in 2020–2021, to identify potential determinants of global disparities in TC during the COVID-19 pandemic.

Design
An ecological study using regression analyses to explore the associations between TC and socioeconomic determinants within and across global regions.

Setting/participants
Data from 109 countries from Our World in Data, the WHO, the United Nations and others grouped into six geographic and sociodemographic regions (global burden of disease regions), were analysed separately for the years 2020–2021 based on differential vaccine availability and country-level responses throughout the pandemic.

Outcome measures
Relationships between SARS-CoV-2 TC and factors such as vaccination rates, wealth, vulnerable employment (VE), gender and income inequality within and across world regions in 2020–2021.

Results
TC increased a minimum of 2.1-fold for ‘Sub-Sahara’ (median TC 1800–3700 tests) to a maximum of 4.9-fold for ‘Asia and Oceania’ (4500–22 000) between 2020 and 2021. Factors associated with TC among the socioeconomic variables included VE that was associated with reduced TC both in 2020 (relative change (RC) –43%; 95% CI –57% to –25%) and 2021 (RC –46%; 95% CI –62% to –24%) and employment-to-population ratio that had a positive effect on TC in 2021 (RC 27%; 95% CI 44% to 55%). Socioeconomic variables showed similar patterns for both the established measles–mumps–rubella and the new COVID-19 vaccines. Region-level analyses revealed stark heterogeneity in the associations between socioeconomic variables and TC between the analysed years (2020 vs 2021) and across regions. Region-specific trends showed that in Latin America and Asia/Oceania, TC was linked to health expenditure in both analysed years (RC2020: 199%; 95% CI 74% to 405%; RC2021: 142%; 95% CI 67% to 24%). VE was associated with decreased TC in the ‘high-income’, ‘Central Europe’ and ‘Sub-Saharan’ regions.

Conclusions
Socioeconomic and gender inequalities play a significant role in determining SARS-CoV-2 TC. These inequalities underscore the necessity of ensuring equitable access to health services and targeted public health interventions, particularly in resource-limited settings, to improve health outcomes and pandemic preparedness. Socioeconomic and gender disparities can exacerbate health inequalities and hinder the effectiveness of public health policies in a globally interconnected world.

We thank Dr Bompart and colleagues for highlighting the importance of the ethical issues surrounding controlled human infection and, in particular, the clinical study on which this analysis was based. While the ethics of the clinical study were out of the scope of this paper, ethical principles and participant safety were the major priority when designing the research and a number of linked publications have discussed these in detail.

The Declaration of Helsinki states that the purposes of medical research cannot take precedence over the rights and interests of individual participants, and that its ethical principles must be upheld during public health emergencies.1

This cohort study assesses the severity and long-term mortality of COVID-19, influenza, and respiratory syncytial virus in a large cohort of nonhospitalized veterans.

Da Mazzara del Vallo, ora in cura a Milano

‘Stato gold’ nell’ambito del programma ‘Eso-Angels Awards