Actus Santé

Functional genomics for curation of variants in telomere biology disorder associated genes, a systematic review.

Background Patients with an underlying telomere biology disorder (TBD) have variable clinical presentations and can be challenging to diagnose clinically. A genomic diagnosis for patients presenting with TBD is vital for optimal treatments. Unfortunately, many variants identified during diagnostic testing are variants of uncertain significance (VOUS). This complicates management decisions, delays treatment and risks non-uptake of a potentially curative therapies. Improved application of functional genomic evidence may reduce VOUS classifications. Methods We systematically searched the literature for published functional assays interrogating TBD gene variants. Where possible, established likely benign/benign and likely pathogenic/pathogenic variants were used to estimate the assay sensitivity, specificity, positive predictive value, negative predictive value and odds of pathogenicity. Results 3131 articles were screened and 152 met inclusion criteria. Sufficient data to enable a PS3/BS3 recommendation was available for TERT variants only. We recommend PS3 and BS3 can be applied at a moderate and supportive level respectively. PS3/BS3 application was limited by a lack of assay standardisation and limited inclusion of benign variants. Conclusions Further assay standardisation and assessment of benign variants is required for optimal use of the PS3/BS3 criterion for TBD gene variant classification.
Catégories: Actus Santé

Efficacy and longevity of immune response to 3rd COVID-19 vaccine and effectiveness of a 4th dose in severely immunocompromised patients with cancer

Cancer patients show increased morbidity with COVID-19 and need effective immunization strategies. We demonstrate that a 3rd dose of COVID-19 vaccine leads to seroconversion in 57% of patients that were seronegative after primary vaccination. The immune response is durable as assessed by anti-S antibody titers, T-cell activity and neutralization activity against wild-type SARS-CoV2 and BA1.1.529 at 6 months of follow up. A subset of severely immunocompromised hematologic malignancy patients were unable to mount adequate immune response after the 3rd dose and were treated with a 4th dose in a prospective clinical trial which led to adequate immune-boost in 67% of patients. Low baseline IgM levels and CD19 counts were associated with inadequate seroconversion. Booster doses induced limited neutralization activity against the Omicron variant. These results indicate that vaccine booster-induced immunity is durable in cancer patients and additional doses can further stimulate immunity in a subset of hematologic malignancy patients
Catégories: Actus Santé

Reductions in stillbirths and preterm birth in COVID-19 vaccinated women: a multi-center cohort study of vaccination uptake and perinatal outcomes

Background: COVID-19 infection in pregnancy is associated with a higher risk of progression to severe disease, but vaccine uptake by pregnant women is hindered by persistent safety concerns. COVID-19 vaccination in pregnancy has been shown to reduce stillbirth, but its relationship with preterm birth is uncertain. Objective: The aim of this study was to investigate the sociodemographic characteristics associated with vaccine uptake in Melbourne, Australia, and to compare perinatal outcomes by vaccination status. Study design: Retrospective multicenter cohort study in Melbourne following the national recommendations for mRNA COVID-19 vaccination during pregnancy in June 2021. Routinely collected data from all 12 public maternity hospitals in Melbourne were extracted on births > 20 weeks gestation from 1st July 2021 to 31 March 2022. Maternal sociodemographic characteristics were analyzed from the total birth cohort. Perinatal outcomes were compared between vaccinated and unvaccinated women for whom weeks 20-43 of gestation fell entirely within the 9-month data collection period. The primary outcome was the rate of congenital anomaly in singleton infants >= 20 weeks gestation among women vaccinated during pregnancy. Secondary perinatal outcomes including stillbirth, preterm birth (spontaneous and iatrogenic), birthweight <= 3rd centile, and newborn intensive care unit admissions were examined for singleton infants >= 24 weeks gestation without congenital anomalies. We calculated the adjusted odds ratio of congenital anomalies and perinatal outcomes among vaccinated versus unvaccinated women using inverse propensity score weighting regression adjustment with multiple covariates; p< 0.05 was considered statistically significant. Results: Births from 32,536 women were analyzed: 17,365 (53.4%) were vaccinated and 15,171 (47.6%) were unvaccinated. Vaccinated women were significantly more likely to be older, nulliparous, non-smoking, not requiring an interpreter, of higher socioeconomic status, and vaccinated against pertussis and influenza. Vaccination status also varied by region of birth: compared with women born in Australia, women born in South and Eastern Europe, the Middle East, Africa and Oceania had lower adjusted odds of vaccination. There was no significant increase in the rate of congenital anomalies or birth weight <= 3rd centile in vaccinated women. Vaccinated women were significantly less like to have an infant with a major congenital anomaly compared with the unvaccinated group (2.4% vs 3.0%, aOR 0.72, 95%CI 0.56-0.94, p=0.02). This finding remained significant even when the analysis was restricted to women vaccinated before 20 weeks gestation. Vaccinated women had a significantly lower rate of stillbirth (0.2% vs 0.8%, aOR 0.18, 95%CI 0.09-0.37, P < 0.001. Vaccination was associated with a significant reduction in total preterm births < 37 weeks (5.1% vs 9.2%, aOR 0.60, 95% CI 0.51-0.71, p< 0.001), spontaneous preterm birth (2.4% vs 4.0%, aOR 0.73 95% CI 0.56-0.96, p=0.02) and iatrogenic preterm birth (2.7% vs 5.2%, aOR 0.52, 95%CI 0.41-0.65, p< 0.001). Conclusions COVID-19 Vaccine coverage was significantly influenced by known social determinants of health, which is likely to influence the strong association between COVID-19 vaccination and lower risks of stillbirth and preterm birth. We did not observe any adverse impacts of vaccination on fetal growth or development.
Catégories: Actus Santé

Transcriptomic and connectomic correlates of differential spatial patterning among glioblastomas and low-grade gliomas

Background: Unravelling the complex events driving grade-specific spatial distribution of brain tumour occurrence requires rich datasets from both healthy individuals and patients. Here, we combined open-access data from The Cancer Genome Atlas, the UKBiobank and the Allen Brain Human Atlas to disentangle how the different spatial occurrences of Glioblastoma Multiforme (GBM) and Low-Grade Gliomas (LGG) are linked to brain network features and the normative transcriptional profiles of brain regions. Methods: From MRI of brain tumour patients we first constructed a grade-related frequency map of the regional occurrence of LGG and the more aggressive GBM. Using associated mRNA transcription data, we derived a set of differential gene expressions from GBM and LGG tissues of the same patients. By combining the resulting values with normative gene expressions from postmortem brain tissue, we constructed a grade-related expression map indicating which brain regions express genes dysregulated in aggressive gliomas. Additionally, we derived an expression map of genes previously associated with tumour subtypes in a GWAS study (tumour-related genes). Results: There were significant associations between grade-related frequency, grade-related expression, and tumour-related expression maps, as well as functional brain network features (specifically, nodal strength and participation coefficient) that are implicated in neurological and psychiatric disorders. Conclusions: These findings identify brain network dynamics and transcriptomic signatures as key factors in regional vulnerability for GBM and LGG occurrence, placing primary brain tumours within a well-established framework of neurological and psychiatric cortical alterations.
Catégories: Actus Santé

Vascular Encasement Image Defined Risk Factors Predict Surgical Complications in Neuroblastoma

Background Specific Image Defined Risk Factors (IDRF) may be of more relevance to the pediatric surgical oncologist than simply the presence of any IDRF. The aim of this study was to correlate IDRF with surgical complications with reference to vascular encasement IDRF and the grade of complication. Methods We searched the New Zealand Children's Cancer Registry for all cases of neuroblastoma treated at a single pediatric oncology center between January 2007 - February 2021 and reviewed the pre-treatment axial imaging for IDRF status. Surgical complications were scored by Clavien-Dindo grade and correlated with the number of IDRF and with the subset of vascular encasement IDRF. Results Of 101 patients, 77 were IDRF positive. In total, 74 underwent surgical resection and 32 (43.2%) had a surgical complication. Complications were related to the number of IDRF (OR 1.33, 95% CI 1.05 - 1.73, p = 0.02) and the subgroup of vascular encasement IDRF (OR 1.78, 95% CI 1.12 - 3.04, p = 0.01) but were not significantly correlated with the subgroup of non-vascular encasement IDRF. We report three cases of chyle leak associated with tumor encasing the origin of the celiac axis and/or the superior mesenteric artery. Conclusions The vascular encasement IDRF subgroup is potentially a more useful prognostic indicator of surgical complications than non-vascular IDRF. More studies are needed to correlate specific IDRF with specific surgical complications to aid operative decision making.
Catégories: Actus Santé

Effects of Physical Exercises on Emotion Regulation: A Meta-Analysis

Background: At present, there are inconsistent results in the research on the effect of physical exercise on emotion regulation ability, and there is no relevant research on how to exercise scientificlc. Therefore, on the basis of previous research, this study conducted a meta-analysis on the theme of physical exercise affecting emotion regulation ability according to the statement of PRISMA, and added relevant moderator variables to clarify the effect of physical exercise on emotion regulation ability. Objective: We identified physical exercise studies and randomized controlled trials (RCTs) of emotion regulation ability that reported overall effect, heterogeneity, and publication bias of physical exercises on emotion regulation ability. Methods: We searched for RCT s of exercise interventions on emotion regulation ability from databases including PubMed, Web of Science, Ebsco, The Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, from January 1 2000 to January 1 2022. We performed methodological quality evaluations on the included literature and graded evidence with a meta-analysis using Review Manager 5.3 software. Results: In total, 10 RCT s were included; the overall results of the meta-analysis (936participants) indicated that physical exercises improved emotion regulation ability (standardized mean difference (SMD) = 0.47; 95% confidence interval (CI) 0.21 to 0.72; p < 0.05), sensory arousal ability (SMD = 0.70; 95% CI 0.14 to 1.27; p < 0.05), and emotion regulation strategies (SMD = 0.46; 95% CI 0.04 to 0.87; p < 0.05); Subgroup analysis showed that a single exercise of more than 30 minutes can improve emotional regulation ability, which is not affected by exercise intensity, period and the health status of the participants. Conclusion: Physical exercises can effectively improve the emotion regulation ability. The effects are considered as moderate effect sizes. While single exercise time should be at least 30 minutes.Limited by the quantity and quality of the included studies, the above conclusions need to be verified with more high-quality studies. PROSPERO registration number: CRD42021217978
Catégories: Actus Santé

Drivers of Mortality in COVID ARDS Depend on Patient Sub-Type

Background: The most common cause of death in people with COVID-19 is acute respiratory distress syndrome (ARDS). ARDS is a heterogeneous syndrome, however subgroups that have been identified among non-COVID-19 ARDS patients do not clearly apply to COVID-19 ARDS patients. Additionally, studies of COVID-19 ARDS have been limited by sample size. Methods: We applied an iterative clustering and machine learning framework to electronic health record data from thousands of hospitalized COVID-19 ARDS patients with the goal of defining and characterizing clinically-relevant COVID-19 ARDS subgroups (phenoclusters). We then applied a supervised model to identify risk factors for hospital mortality for each phenocluster and compared these between phenoclusters and the entire cohort. Findings: Risk factors that predict mortality in the overall cohort of COVID-19 ARDS patients do not necessarily predict mortality in phenoclusters. In fact, some risk factors increase the risk of hospital mortality in some phenoclusters, but decrease in others. Interpretation: These phenocluster-specific risk factors would not have been observed with a single predictive model; therefore, it is critical to: (1) cluster patients based on attributes, and (2) model within a cluster to discover the drivers of mortality.
Catégories: Actus Santé

AI-based image quality assessment in CT

Medical imaging, especially computed tomography (CT), is becoming increasingly important in research studies and clinical trials and adequate image quality is essential for reliable results. The aim of this study was to develop an artificial intelligence (AI)-based method for quality assessment of CT studies, both regarding the parts of the body included (i.e. head, chest, abdomen, pelvis), and other image features (i.e. presence of hip prosthesis, intravenous contrast and oral contrast). Approach: 1,000 CT studies from eight different publicly available CT databases were retrospectively in- cluded. The full dataset was randomly divided into a training (n = 500), a validation/tuning (n = 250), and a testing set (n = 250). All studies were manually classified by an imaging specialist. A deep neural network network was then trained to directly classify the 7 different properties of the image. Results: The classification results on the 250 test CT studies showed accuracy for the anatomical regions and presence of hip prosthesis in the interval 98.4% to 100.0%. The accuracy for intravenous contrast was 89.6% and for oral contrast 82.4%. Conclusions: We have shown that it is feasible to develop an AI-based method to automatically perform a quality assessment regarding if correct body parts are included in CT scans, with a very high accuracy.
Catégories: Actus Santé

Knowledge, attitudes, and practices regarding COVID-19 among university students and employees in Massachusetts, USA: a qualitative study

Background At the time of this study, Massachusetts had recorded a total of 352,558 COVID-19 cases and 12,076 deaths. Few qualitative studies have been conducted that investigate the experiences of university students and employees during the COVID-19 pandemic. The objective of this study was to explore the knowledge, attitudes, and practices regarding COVID-19 in university affiliates to inform future COVID-19 policies. Methods Semi-structured focus groups and interviews were conducted via Zoom between December 14, 2020 and January 15, 2021. Twenty-two focus group participants included undergraduate students, graduate students and university employees who had not experienced isolation or quarantine during the Fall 2020 semester. Fourteen participants who had experienced quarantine or isolation were interviewed individually to protect confidentiality. Data were analyzed using Dedoose software via inductive thematic analysis, with reporting as per Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines. Results Five major themes emerged from these data: COVID-19 knowledge, stress and coping, trust, decision-making, and institutional feedback. Misinformation regarding COVID-19 was common, compounding high levels of stress reported by many participants. Reported direct sources of stress included physical illness, fear of infection, and lack of access to resources while in quarantine or isolation settings. Reported indirect sources of stress included social isolation and financial constraints. Levels of trust were generally high regarding mainstream news media, scientific journals, and university-related information sources. For decision-making processes, participants described altered behaviors to socialize safely during the pandemic, which included increased testing, gathering outdoors, and limiting group sizes. Conversely, some undergraduate students reported increases in socialization behaviors after testing negative for COVID-19, while most university employees did not report altered behaviors after negative test results. While some participants described negative feedback regarding university decisions, most feedback for the institution was positive, with participants reporting appreciation for the university's asymptomatic testing program and other on-campus health response activities. Conclusion The university's investment in COVID-related resources, including the asymptomatic testing program and the on-campus quarantine and isolation spaces, were reported to greatly reduce stress and increase perceived safety. Key findings from this research could guide institutional communication, public health protocols, and support for university community members.
Catégories: Actus Santé

Autoimmunity in Satoyoshi Disease: a Systematic Review

Background: Satoyoshi syndrome (SS) is a rare multisystem disease. Although its cause is unknown, an autoimmune etiology has been postulated. In this paper we carried out a systematic review of all published cases of SS to evaluate the available evidence to support that autoimmune hypothesis. Methods: We carried out a systematic review of the published cases of SS following the recommendations of the PRISMA statement for systematic reviews. We searched for SS cases in PubMed, the Web of Knowledge (WOS) and Scopus up to January 2022, using keywords "Satoyoshi syndrome" or "Komuragaeri disease". Data on symptoms, associated autoimmune diseases, presence of autoantibodies and response to treatment were collected. Results: 77 patients from 57 articles published between 1967 and 2021 were included. 59 patients were women. The mean age at diagnosis was 21.2 years. All cases had painful muscular spasms and alopecia. Other frequent manifestations included: diarrhea, malabsorption, growth retardation, amenorrhea and bone deformity. SS was associated with other autoimmune diseases: myasthenia gravis (2 patients), autoimmune thyroiditis (one patient), idiopathic thrombocytopenic purpura (one patient), atopic dermatitis (one patient), bronchial asthma (one patient) and lupus erythematosus (one patient). Autoantibody determinations were performed in 39 patients, of which 27 had positive results. The most frequently detected autoantibodies were antinuclear antibodies (21 patients). Other less frequently found auto-antibodies were: anti-acetylcholine receptor antibodies (7 patients), anti-DNA antibodies (5 patients), antithyroid antibodies (3 patients), anti-GAD (2 patients) and anti-gliadin antibodies (2 patients). Pharmacological treatment was reported in 50 patients. Most of them improved with corticosteroids (33 patients), immunosuppressants (9 patients) and immunoglobulins (10 patients), or a combination of these medications. Conclusions: SS is associated with other autoimmune diseases and a variety of autoantibodies. Improvement after corticosteroid or other immunosupressant treatment was observed in 90% of cases. These data support an autoimmune etiology for SS. More studies are necessary, including the systematic determination of autoantibodies in all patients with SS to help us advance in our understanding of this disease.
Catégories: Actus Santé

CHILDHOOD DEATHS, DEPRIVATION, AND MODIFIABLE FACTORS: FINDINGS FROM THE NATIONAL CHILD MORTALITY DATABASE

Objectives: The aim of this analysis is to identify and report the patterns of social deprivation in relation to childhood mortality; and identify potential points where public health, social and education interventions or health policy may be best targeted. Design: Decile of deprivation and underlying population distribution was derived using Office for National Statistics (ONS) data. The risk of death was then derived using a Poisson regression model, calculating the increasing risk of death for each increasing deprivation decile. Setting: England Participants: 2688 childhood deaths in England reviewed between the April 2019 and March 2020. Main Outcome Measures: The relationship between deprivation and risk of death; for deaths with, and without modifiable factors. Results: There was evidence of increasing mortality risk with increase in deprivation decile (RR 1.08 (1.07 to 1.10)), with the gradient of risk stronger in children who died with modifiable factors than those without (RR 1.12 (1.09 to 1.15)) vs (RR 1.07 (1.05 to 1.08)). Deprivation sub-domains of Employment, Adult Education, Barriers to Housing and Services, and Indoor Living Environments appeared to be the most important predictors of child mortality Conclusions: There is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over a fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment and education, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities.
Catégories: Actus Santé

Modelling the epidemiological implications for SARS-CoV-2 of Christmas household bubbles in England

The emergence of SARS-CoV-2 saw severe detriments to public health being inflicted by COVID-19 disease throughout 2020. In the lead up to Christmas 2020, the UK Government sought an easement of social restrictions that would permit spending time with others over the Christmas period, whilst limiting the risk of spreading SARS-CoV-2. In November 2020, plans were published to allow individuals to socialise within "Christmas bubbles" with friends and family. This policy involved a planned easing of restrictions in England between 23-27 December 2020, with Christmas bubbles allowing people from up to three households to meet throughout the holiday period. We estimated the epidemiological impact of both this and alternative bubble strategies that allowed extending contacts beyond the immediate household. We used a stochastic individual-based model for a synthetic population of 100,000 households, with demographic and SARS-CoV-2 epidemiological characteristics comparable to England as of November 2020. We evaluated five Christmas bubble scenarios for the period 23-27 December 2020, assuming our populations of households did not have symptomatic infection present and were not in isolation as the eased social restrictions began. Assessment comprised incidence and cumulative infection metrics. We tested the sensitivity of the results to a situation where it was possible for households to be in isolation at the beginning of the Christmas bubble period and also when there was lower adherence to testing, contact tracing and isolation interventions. We found that visiting family and friends over the holiday period for a shorter duration and in smaller groups was less risky than spending the entire five days together. The increases in infection from greater amounts of social mixing disproportionately impacted the eldest. We provide this account as an illustration of a real-time contribution of modelling insights to a scientific advisory group, the Scientific Pandemic Influenza Group on Modelling, Operational sub-group (SPI-M-O) for the Scientific Advisory Group for Emergencies (SAGE) in the UK, during the COVID-19 pandemic.
Catégories: Actus Santé

Waning of SARS-CoV-2 vaccine-induced immunity: A systematic review and secondary data analysis

The emergence of Omicron (B.1.1.529) variant of SARS-CoV-2 in late 2021 was followed by a marked increase of breakthrough infections. Estimates of vaccine effectiveness (VE) in the long term are key to assess potential resurgence of COVID-19 cases in the future. We conducted a systematic review of manuscripts published until June 21, 2022 to identify studies reporting the level of protection provided by COVID-19 vaccines against SARS-CoV-2 infection and symptomatic disease at different time points since vaccine administration. An exponential model was used to perform a secondary data analysis of the retrieved data to estimate the progressive waning of VE associated with different vaccine products, numbers of received doses, and SARS-CoV-2 variants. Our results show that VE of BNT162b2, mRNA-1273, ChAdOx1 nCoV-19 vaccines against any laboratory confirmed infection with Delta might have been lower than 70% at 9 months from second dose administration. We found a marked immune escape associated with Omicron infection and symptomatic disease, both after the administration of two and three doses. The half-life of protection against symptomatic infection provided by two doses was estimated in the range of 178-456 days for Delta, and between 66 and 73 days for Omicron. Booster doses were found to restore the VE to levels comparable to those acquired soon after administration of the second dose; however, a fast decline of booster VE against Omicron was observed, with less than 20% VE against infection and less than 25% VE against symptomatic disease at 9 months from the booster administration. This study provides a cohesive picture of the waning of vaccine protection; obtained estimates can inform the identification of appropriate targets and timing for future COVID-19 vaccination programs.
Catégories: Actus Santé

Preconception Care for Women with Medicaid: Self-report vs. Claims-based Utilization Measures

Background: Preconception care may improve perinatal outcomes and reduce disparities, but there is no standard population measure of preconception care utilization (PCU). Objective: We compared claims-based PCU from Medicaid Analytic Extract (MAX) data to self-report in the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey. Methods: Among Medicaid-enrolled women ages 15-45 with births during 2012, we identified preconception services in MAX using 55 ICD9 codes published by Health and Human Services. We estimated the proportion reporting preconception care from 26 PRAMS states and compared this to the states' proportion who received services in MAX. We fit mixed-effects logistic regression models of the probability of PCU on demographic factors (age, race/ethnicity) and diagnoses (depression, diabetes, or hypertension), separately for each dataset. Finally, we computed the population proportions receiving care by state (MAX) and the empirical Bayes means of the state-level effects (MAX and PRAMS). Results: Among 652,929 deliveries in MAX from the included states, 28.1% received at least one preconception service. In PRAMS, 23.6% (95% CI [22.1, 25.3]) of Medicaid-covered respondents reported preconception care. In both datasets, PCU rates were higher for Black non-Hispanic vs. White non-Hispanic women (PRAMS OR 2.05 [1.60, 1.62]; MAX OR 1.51 [1.49, 1.54]) and for those with diabetes (PRAMS OR 1.82 [1.16, 2.85]; MAX OR 1.34 [1.29, 1.40]) or hypertension (OR 1.85 [1.41, 2.44]; MAX OR 1.22 [1.18, 1.27]). In PRAMS, Asian (OR 3.37 [2.28, 4.98]) and Hispanic women (OR 2.07 [1.5, 2.80]) were more likely to report PCU than White non-Hispanic women, but in MAX they were less likely to receive services. The correlation between the PRAMS state-specific effects and those from MAX was 0.31 (p = 0.124). Conclusions: Claims-based estimates of PCU are moderately concordant with self-reported rates at the state level; however, rates measured through Medicaid claims vs. self-report diverge in some groups.
Catégories: Actus Santé

A Bayesian nonparametric method for detecting rapid changes in disease transmission

Whether an outbreak of infectious disease is likely to grow or dissipate is determined through the time-varying reproduction number, Rt. Real-time or retrospective identification of changes in Rt following the imposition or relaxation of interventions can thus contribute important evidence about disease transmission dynamics which can inform policymaking. Here, we present a method for estimating shifts in Rt within a renewal model framework. Our method, which we call EpiCluster, is a Bayesian nonparametric model based on the Pitman-Yor process. We assume that Rt is piecewise-constant, and the incidence data and priors determine when or whether Rt should change and how many times it should do so throughout the series. We also introduce a prior which induces sparsity over the number of changepoints. Being Bayesian, our approach yields a measure of uncertainty in Rt and its changepoints. EpiCluster is fast, straightforward to use, and we demonstrate that it provides automated detection of rapid changes in transmission, either in real-time or retrospectively, for synthetic data series where the Rt profile is known. We illustrate the practical utility of our method by fitting it to case data of outbreaks of COVID-19 in Australia and Hong Kong, where it finds changepoints coinciding with the imposition of non-pharmaceutical interventions. Bayesian nonparametric methods, such as ours, allow the volume and complexity of the data to dictate the number of parameters required to approximate the process and should find wide application in epidemiology.
Catégories: Actus Santé

The association between diabetes and mortality among patients hospitalized with COVID-19: Cohort Study of Hospitalized Adults in Ontario, Canada and Copenhagen, Denmark

Importance: Diabetes has been reported to be associated with an increased risk of death among patients with COVID-19. However, available studies lack detail on COVID illness severity and measurement of relevant comorbidities. Design, Setting, and Participants: We conducted a multicenter, retrospective cohort study of patients over the age of 18 years who were hospitalized with COVID-19 between January 1, 2020 and November 30, 2020 in Ontario, Canada and Copenhagen, Denmark. Chart abstraction emphasizing co-morbidities and disease severity was performed by trained research personnel. The association between diabetes and death was measured using Poissson regression. Main Outcomes and Measures: within hospital 30-day risk of death. Results: Our study included 1018 hospitalized patients with COVID-19 in Ontario and 305 in Denmark, of whom 405 and 75 patients respectively had pre-existing diabetes. In both Ontario and Denmark, patients with diabetes were more likely to be older, have chronic kidney disease, cardiovascular disease, higher troponin levels, and to receive antibiotics compared with adults who did not have diabetes. In Ontario, the crude mortality rate ratio among patients with diabetes was 1.60 [1.24 -- 2.07 95% CI] and in the adjusted regression model was 1.20 [0.86 -- 1.66 95% CI]. In Denmark, the crude mortality rate ratio among patients with diabetes was 1.27 (0.68 -- 2.36 95% CI) and in the adjusted model was 0.90 (0.49 -- 1.54 95% CI)]. Meta-analyzing the two rate ratios from each region resulted in a crude mortality rate ratio of 1.55 (95% CI 1.22,1.96) and an adjusted mortality rate ratio of 1.11 (95% CI 0.84, 1.47). Conclusions: Presence of diabetes was not strongly associated with in-hospital COVID mortality independent of illness severity and other comorbidities.
Catégories: Actus Santé

SARS-CoV-2 seroprevalence among public school staff in Metro Vancouver after the first Omicron wave in British Columbia, Canada

Objective: To determine the SARS-CoV-2 seroprevalence among school workers in the setting of full in-person schooling and the highly transmissible Omicron variants of concern. Design: Cross-sectional study among school staff, comparing to period-, age-, sex- and postal code-weighted data from Canadian blood donors from the same community. Setting: Three large school districts in the greater Vancouver metropolitan area, British Columbia, Canada, with serology sampling done between January 26, 2022 and April 8, 2022. Participants: School staff actively working in the Vancouver, Richmond and Delta School Districts. Main outcome measure: SARS-CoV-2 seroprevalence based on nucleocapsid (N)-protein testing, adjusted for the sensitivity and specificity of the assay. Results: A majority (65.8%) of the 1845 school staff enrolled reported close contact with a COVID-19 case outside the household. Of those, about half reported close contact with a COVID-19 case at school either in a student (51.5%) or co-worker (54.9%). In a representative sample of 1620 (87.8%) school staff, the adjusted seroprevalence was 26.5% [95%CrI: 23.9-29.3%]. This compared to an age, sex and residency area-weighted seroprevalence of 32.4% [95%CrI: 30.6-34.5%] among 7164 blood donors. Conclusion: Despite frequent COVID-19 exposures, the prevalence of SARS-CoV-2 infections among the staff of three main school districts in the Vancouver metropolitan area was no greater than a reference group of blood donors, even after the emergence of the more transmissible Omicron variant.
Catégories: Actus Santé

Strong neutralizing antibody responses to SARS-CoV-2 variants following a single vaccine dose in subjects with previous SARS-CoV-2 infection

Background Previous SARS-CoV-2 infection primes the immune system and thus individuals who recovered from infection have enhanced immune responses to subsequent vaccination (hybrid immunity). However, it remains unclear how well hybrid immunity induced by severe or mild infection can cross-neutralize emerging variants. We aimed to compare the strength and breadth of antibody responses in vaccinated recovered and uninfected subjects. Methods We measured spike-specific IgG and neutralizing antibodies (NAbs) from vaccinated subjects including 320 with hybrid immunity and 20 without previous infection. From 29 subjects with a previous severe or mild infection, we also measured NAb responses against Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2) and Omicron (B.1.1.529/BA.1) variants following vaccination. Results A single vaccine dose induced 2-fold higher anti-spike IgG concentrations and 3-fold higher neutralizing potency of antibodies in previously infected compared to uninfected fully vaccinated subjects. We found similar IgG concentrations in previously infected subjects after one or two vaccine doses. NAb titers were higher in subjects with severe compared to those with mild infection. This difference remained after vaccination with sequentially decreasing titers against Alpha, Beta, Delta, and Omicron variants. Conclusions Hybrid immunity induced strong IgG responses, particularly after severe infection. However, the NAb titers were low against heterologous variants, especially against Omicron.
Catégories: Actus Santé

New rules to improve road safety and enable fully driverless vehicles in the EU

EU Newsroom - Research and innovation - mer, 06/07/2022 - 00:00

European Commission Press release Brussels, 06 Jul 2022 The new Vehicle General Safety Regulation starts applying today.

Catégories: Actus Santé

New rules to improve road safety and enable fully driverless vehicles in the EU

European Commission Press release Brussels, 06 Jul 2022 The new Vehicle General Safety Regulation starts applying today.

Catégories: Actus Santé

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