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Thread: COVID 19 and Wegener's - musings

  1. #21
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    Default Re: COVID 19 and Wegener's - musings

    Gives a new meaning to "Mans Best Friend"
    Sorry to all the cat lovers!!

    Regards Woz.....

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  3. #22
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    Default Re: COVID 19 and Wegener's - musings Easier form of testing for Covid-19

    September 29, 2020



    Self-collected saliva test could detect silent SARS-CoV-2 carriers





    Self-collected saliva is a valuable specimen to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in mass screening of asymptomatic persons, according to a study published in Clinical Infectious Diseases.
    “Rapid detection of asymptomatic infected patients is critical for the prevention of outbreaks of coronavirus disease 2019 (COVID-19) in communities and hospitals,” wrote Isao Yokota, Hokkaido University Graduate School of Medicine, Sapporo, Japan, and colleagues.
    The researchers conducted a mass-screening study to determine and compare the sensitivity and specificity of nucleic acid amplification using paired samples (nasopharyngeal swabs and self-collected saliva) for the detection of SARS-CoV-2 in 1,924 asymptomatic individuals from two cohorts (contact tracing and airport quarantine cohorts) in Japan, using reverse transcriptase-polymerase chain reaction (RT-PCR) and reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) test.
    The study showed that the sensitivity of nucleic acid amplification testing with nasopharyngeal and saliva specimens was 86% (90%CI: 77-93%) and 92% (90%CI: 83-97%), respectively, with specificities of 99.93% (90% CI: 99.77-99.99%) and 99.96% (90%CI: 99.85-100.00%), respectively. Further, the researchers found the viral loads were equivalent and highly correlated between nasopharyngeal and saliva samples of individuals testing positive and they said both specimens “may be useful in detecting viral RNA.”
    In addition, the true concordance probability was estimated at 0.998 (90% CI: 0.996-0.999) in the airport quarantine cohort. The researchers noted that “true concordance probability with varying estimation constraints of sensitivity is shown to be very high, and therefore the RT-PCR results from saliva and nasopharyngeal [samples] appeared to be sufficiently consistent.”
    “We report for the first time the accuracy of viral detection using natural clinical specimens of asymptomatic persons, that the sensitivity is higher than the 52% to 71% reported in symptomatic patients,” the authors wrote.
    “The current study further extends that saliva may be a beneficial alternative to nasopharyngeal fluid in detecting SARS-CoV-2 in asymptomatic carriers. The comparison between paired samples have shown equivalent utility with similar sensitivity and specificity,” the authors said.
    They added that “self-collected saliva has significant advantages over nasopharyngeal sampling especially in the setting of mass screening. For example, saliva collection is non-invasive and does not require specialized personnel nor the use of PPE.”
    “It is unlikely that the sensitivity of RT-LAMP is significantly less than that of RT-PCR, and that tests by RT-LAMP had little impact on our conclusions. Our study suggests that RT-LAMP may be a useful alternative to RT-PCR for the diagnosis of SARSCoV-2, especially where diagnosis is required at the point of sample, ” the authors noted.
    “Mass screening of the virus using self-collected saliva can be performed easily, noninvasively, and with minimal risk of viral transmission to health care workers,” the authors concluded.




    Reference: https://academic.oup.com/cid/advance...aa1388/5911780



    SOURCE: Clinical Infectious Diseases
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  4. #23
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    Default Re: COVID 19 and Wegener's - musings Vacine progress

    This might be helpful for us? The big question is how a vaccine works and if it will be safe and effective for us people with a suppressed immune system.

    September 30, 2020



    Interim data show mRNA-1273 vaccine for COVID-19 triggered antibodies, had acceptable safety profile in older adults



    Interim data from a Phase I study published in The New England Journal of Medicine showed that adverse events associated with the coronavirus disease 2019 (COVID-19) vaccine candidate mRNA-1273 were mainly mild or moderate among adults who were 56 years of age or older. In addition, the 100-μg dose of the vaccine, which encodes the prefusion-stabilized spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was found to induce higher binding- and neutralizing-antibody titers than the 25-μg dose.
    The Phase I trial, initially conducted among participants between the ages of 18 and 55 years, was expanded to include 40 older healthy participants who were stratified into two subgroups: 20 adults between the ages of 56 and 70 years, and 20 who were 71 years of age or older. All participants were assigned sequentially to receive two doses of either 25 μg or 100 μg of vaccine administered 28 days apart. The trial was conducted at Kaiser Permanente Washington Health Research Institute in Seattle, the Emory University School of Medicine in Atlanta, and the National Institute of Allergy and Infectious Diseases (NIAID) Vaccine Research Center in Bethesda, Maryland.
    The researchers reported that solicited adverse events were predominantly mild or moderate in severity and most frequently included fatigue, chills, headache, myalgia, and pain at the injection site. All 10 solicited local adverse events that were classified as moderate, and all but 2 moderate systemic events, occurred after the administration of the second dose. Symptoms typically occurred on the day of vaccination or 1 day afterward and "resolved quickly," researchers noted.
    The study showed that binding-antibody responses increased rapidly after the first immunization. By day 57, among participants who received the 25-μg dose, the anti–S-2P geometric mean titer (GMT) was 323,945 (95% confidence interval [CI], 182,202 to 575,958) for those ages of 56 and 70 years, and 1,128,391 (95% CI, 636,087 to 2,001,717) among those 71 years or more. Meanwhile, for participants who received the 100-μg dose, GMTs in the two age subgroups were 1,183,066 (95% CI, 379,698 to 3,686,201) and 3,638,522 (95% CI, 1,316,233 to 10,058,130), respectively. Researchers noted that after the second immunization, serum neutralizing activity was detected in all the participants by multiple methods.
    "Binding- and neutralizing-antibody responses appeared to be similar to those previously reported among vaccine recipients between the ages of 18 and 55 years and were above the median of a panel of controls who had donated convalescent serum," wrote Evan J. Anderson, MD, Emory University School of Medicine, Atlanta, Georgia, and colleagues. "These data also suggest that a second dose of vaccine is needed to achieve neutralizing antibodies in participants after the age of 56 years, and titers rapidly increased by 7 days after the booster vaccination," the authors noted.
    Meanwhile, the study also showed that the vaccine elicited a strong CD4 cytokine response involving type 1 helper (Th1) T cells among participants in the two age subgroups who received the 100-μg dose and among participants between the ages of 56 and 70 years administered the 25-μg dose. The authors noted that response involving Th2 T cells (IL-4 and IL-13) was found to be "minimal" regardless of age or dose, while CD8 T-cell responses to S-2P were observed only at low levels after the second vaccination among participants in the two age subgroups given the 100-μg dose.
    "Overall, these preliminary findings show that in a small group of participants, adverse events associated with the mRNA-1273 vaccine were mainly mild or moderate in older adults, a group that is particularly at risk for illness and death from COVID-19. The 100-μg dose induced higher binding- and neutralizing-antibody titers than the 25-μg dose, findings that support the continued evaluation of the 100-μg dose level and two-dose regimen in a large Phase III trial with a more diverse population to ascertain the safety and efficacy of the mRNA-1273 vaccine and to assess its level of protection against COVID-19," the authors concluded.
    Important limitations of this study, according to the authors, include the small numbers of participants and the limited ethnic diversity. "In addition, at the time of this interim report, the long-term durability of immunogenicity could not be assessed, although the magnitude of antibody, cellular, and memory responses will be followed for 12 months after the second vaccination," the authors said. They also suggested that "the presence of chronic diseases (eg, diabetes) and frailty may be better predictors of poor immunologic responses than age alone."




    Reference: https://www.nejm.org/doi/full/10.105...ed_coronavirus



    SOURCE: The New England Journal of Medicine
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  5. #24
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    Default Re: COVID 19 and Wegener's - and autoimmune disease

    October 15, 2020
    Increased risk of COVID-19 in patients with autoimmune diseases, glucocorticoid use plays a role: Study

    By Denise Baez

    NEW YORK -- October 15, 2020 -- Patients with autoimmune diseases appear to have an increased risk of coronavirus disease 2019 (COVID-19), primarily attributed to glucocorticoid use, although their clinical outcomes were not considerably worse when compared with individuals without autoimmune diseases, according to a meta-analysis published in the Annals of the Rheumatic Diseases.

    The study also found that monotherapy with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) was associated with a lower risk of severe COVID-19, suggesting its safety in the COVID-19 pandemic.

    Shintaro Akiyama, MD, University of Chicago Medicine, Chicago, Illinois, and colleagues scrutinised data from 62 observational studies including 319,025 patients with autoimmune diseases from 15 countries.

    Rheumatic diseases included rheumatoid arthritis, lupus, psoriatic arthritis, spondyloarthritis, ankylosing spondylitis, vasculitis, polymyalgia rheumatica, Sjögren’s syndrome, systemic sclerosis, and other autoimmune-mediated diseases, including Behcet’s syndrome, sarcoidosis, and inflammatory myopathies.

    Of the 319,025 patients, 878 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for an event rate of 0.011.

    Patients with lupus, Sjögren’s syndrome, and systemic sclerosis had a higher prevalence of COVID-19 (58 of 1,641; event rate of 0.034) when compared with the other disease groups, which is likely due to a higher proportion of glucocorticoid use (60.3%). Patients with irritable bowel disease had the lowest prevalence (309 of 251,568; event rate of 0.003).

    The researchers also analysed 7 case-controlled studies to compare the prevalence of COVID-19 in patients with and without autoimmune diseases. In this analysis, out of 30,771 patients with autoimmune diseases, 278 tested positive for COVID-19, compared with 144,283 out of 24,511,773 individuals without autoimmune diseases (odds ratio = 2.19; 95%  confidence interval [CI], 1.05-4.58; P = .038). These 7 studies only included individuals with psoriasis (OR = 3.43; 95% CI, 1.68-7.01; P = .001) and rheumatic diseases (OR = 1.60; 95% CI, 1.13-2.25; P = .008), both of which demonstrated an elevated risk of COVID-19 compared with controls.

    The researchers also assessed 65 studies that included a total of 2,766 patients with autoimmune diseases who tested positive for COVID-19. Among this group, 1,102 patients were hospitalised for an event rate of 0.352, and 188 patients died, for a rate of 0.066.

    “Patients with rheumatic diseases had the highest mortality rate, which was consistent with the analysis of the hospitalisation rate,” the authors noted.

    Another meta-analysis of 6 case-controlled studies showed no differences in hospitalisations (OR = 1.05; 95% CI, 0.78-1.42; P = .73), death (OR = 0.55; 95% CI, 0.081-3.68; P = .53), admission to the intensive care unit ([ICU] OR = 1.22; 95% CI, 0.42-3.60: P = .72), or mechanical/non-invasive ventilation (OR = 1.03; 95% CI, 0.22-4.81; P = .97) when compared with the control population.

    “Subgroup analyses according to comorbidities showed that patients age ≥64 years, male gender, hypertension, diabetes, body mass index ≥30, and at least 1 comorbidity had higher rates of hospitalisation, ICU admission, ventilation, and death due to COVID-19 when compared with those without these comorbidities,” the authors wrote. “Subgroup analyses according to medical therapies showed that patients treated with glucocorticosteroids, conventional synthetic DMARDs, or a combination of biologic/targeted synthetic DMARDs and conventional synthetic DMARDs had a 2 to 3 times higher event rate of each clinical outcome when compared with those treated with biologic or targeted synthetic DMARD monotherapy. Importantly, patients with anti-tumour necrosis factor (TNF) monotherapy use tended to have a lower rate of hospitalisation and mortality when compared with those with non-TNF-targeted monotherapy.”

    “This study is the first comprehensive meta-analysis which determined the prevalence and clinical outcomes of COVID-19 in autoimmune diseases,” the authors concluded. “Our study suggests that glucocorticoid use increases the risk of SARS-CoV2 infection and might contribute to the higher prevalence of COVID-19 in [patients with] autoimmune disease.”
    Reference: https://ard.bmj.com/content/early/20...is-2020-218946
    SOURCE: Annals of the Rheumatic Diseases

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  6. #25
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    Default Re: COVID 19 and Wegener's - risk of infection

    OCTOBER 13, 2020
    Patients with mild, moderate COVID-19 unlikely to be infectious after day 10 of symptom onset
    By Denise Baez

    NEW YORK -- October 13, 2020 -- Patients with mild to moderate coronavirus disease 2019 (COVID-19) are highly unlikely to be infectious after day 10 of symptom onset, however, patients with severe disease may shed the virus for a longer period of time, according to a study published in the Journal of Infection.

    The findings come from a rapid review of 13 virus culture studies and 2 contact tracing studies conducted between January 1, 2020, and August 26, 2020. The studies were conducted in the United States, the United Kingdom, Taiwan, Germany, Switzerland, Australia, Canada, Spain, South Korea, Hong Kong, and the Netherlands.

    Across all 13 virus culture studies, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) culture was attempted from samples collected from at least 808 patients, with SARS-CoV-2 isolated in at least 206 of these patients. A total of at least 1,652 samples had SARS-CoV-2 culture attempted and at least 413 of these were positive.

    For 5 of the virus culture studies, the last day on which SARS-CoV-2 could be cultured occurred within the first 10 days since onset of symptoms. For the most part, the clinical severity of patients was mild to moderate in these 5 studies. For another 5 virus culture studies, SARS-CoV-2 was isolated beyond day 10 for approximately 3% of included patients. The remaining 3 virus culture studies included patients with severe or critical disease. In one of these studies, SARS-CoV-2 was isolated up to day 32, and in 2 studies that included immunocompromised patients, SARS-CoV-2 was isolated for up to 20 days.

    The 2 large contact tracing studies reported that when close contacts were first exposed greater than 5 days after symptom onset in the index case, there was no evidence of laboratory-confirmed onward transmission of SARS-CoV-2.

    “The evidence to date from virus culture studies would appear to suggest that patients with mild-to-moderate COVID-19 are highly unlikely to be infectious beyond 10 days from symptom onset,” wrote Kieran A. Walsh, MD, Health Information and Quality Authority, Cork, Ireland, and colleagues. “Evidence from large contact tracing studies appears to support this finding. However, evidence from a limited number of studies indicates that patients with severe or critical illness, and or those who are immunocompromised, may be infectious for a prolonged period, possibly for 20 days or more.”

    There were 6 studies that examined the relationship between viral load and culture of SARS-CoV-2, and all 6 studies found an inverse correlation. One study that included 234 samples (Basile et al) concluded that any clinical sample with a cycle threshold (Ct) value of ≥37 was not indicative of replicative (or potentially transmissible) virus. Another study that included 90 samples (Bullard et al) estimated that for every 1 unit increase in Ct value, the odds of culturing SARS-CoV-2 decreased by 32%.

    “The findings from our rapid review are largely in agreement with 4 previous reviews conducted in this general area,” the authors wrote. “All of these reviews concluded that infectiousness generally declines 7 to 10 days after symptom onset, and point to uncommon outlier cases where this duration is exceeded. Another common finding across 3 of these reviews was the prolonged duration of SARS-CoV-2 RNA detection, sometimes for 2-3 months after onset of symptoms, along with cases of repeat SARS-CoV-2 RNA detection after a patient has clinically recovered. Hence, patients are unlikely to be infectious for the entire duration of viral RNA detection as the presence of viral RNA may not represent transmissible or replication-competent virus. Our rapid review is the first to attempt to quantify the proportion of patients with COVID-19 that are potentially infectious beyond day 10 post symptom onset, and draws on more recent evidence, including both virus culture and contacting tracing studies.”

    Reference: https://www.journalofinfection.com/a...651-4/fulltext
    SOURCE: Journal of Infection
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    Default Re: COVID 19 treatment recommendations

    October 7, 2020
    Updated guidance on the management of COVID-19 from an American Thoracic Society/European Respiratory Society coordinated task force

    An International Task Force convened by the American Thoracic Society (ATS) and European Respiratory Society (ERS) has updated its guidance on the pharmacological management of acute coronavirus disease 2019 (COVID-19), including remdesivir, hydroxychloroquine (HCQ) and dexamethasone.

    “The changes to these consensus suggestions reflect the publication of several randomised trials since the prior guidance was issued, the Task Force noted.

    The updated guidance was published in European Respiratory Review. The Task Force, composed of respiratory physicians, critical care physicians and infectious disease physicians, made seven consensus suggestions. Agreement was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process.

    For hospitalised patients with COVID-19 pneumonia who require supplemental oxygen but are not mechanically ventilated or receiving extracorporeal membrane oxygenation (ECMO), the Task Force suggests remdesivir.
    For hospitalised patients with COVID-19 pneumonia who are mechanically ventilated or receiving ECMO, the Task Force suggests remdesivir.
    For hospitalised patients with COVID-19 pneumonia who require supplemental oxygen but are not mechanically ventilated or receiving ECMO, the Task Force suggests not using HCQ except within a clinical trial.
    For hospitalised patients with COVID-19 pneumonia who are mechanically ventilated or receiving ECMO, the Task Force suggests not using HCQ except within a clinical trial.
    For hospitalised patients with COVID-19 pneumonia who require supplemental oxygen but are not mechanically ventilated or receiving ECMO, the Task Force suggests dexamethasone.
    For hospitalised patients with COVID-19 pneumonia who are mechanically ventilated or receiving ECMO, the Task Force suggests dexamethasone.
    For adults who were hospitalised with COVID-19 pneumonia and had confirmed venous thromboembolism, the Task Force suggests therapeutic-dose anticoagulant therapy for 3 months to reduce the risk of recurrent venous thromboembolism.

    “It is noteworthy that there was more agreement for remdesivir in less severely ill patients (ie conventional supplemental oxygen) than more severely ill patients (i.e. invasive mechanical ventilation or ECMO) and, conversely, there was more agreement for dexamethasone in more severely ill patients than less severely ill patients, reflecting the trends in beneficial outcomes across subgroups in the clinical trials and some Task Force members’ willingness to incorporate the subgroup analyses into their clinical decisions,” the Task Force noted.

    The Task Force also urged caution in dexamethasone, particularly when administering to patients who require only a small amount of supplemental oxygen as these patients may not benefit as much as those who are more severely ill, are aged >70 years and mechanically ventilated, or are diabetic. “Alternative glucocorticoids are a reasonable choice (40 mg of solumedrol daily is equivalent) if dexamethasone is not available. Use of early dexamethasone in patients with COVID-19 pneumonia to avoid progression to ARDS and mechanical ventilation needs to be demonstrated, and delayed resolution of viral shedding needs further study,” the Task Force added.

    Further, the Task Force made no suggestion for or against routine referral for pulmonary rehabilitation, pulmonary function testing, or mental health testing within 30–60 days after discharge.

    “The clinical suggestions should never be considered mandates as no suggestion can incorporate all potential clinical circumstances. They are not intended to supplant physician judgment as it pertains to individual patients. The suggestions are interim guidance that should be re-evaluated as new evidence accumulates,” the Task Force cautioned.
    Reference: https://err.ersjournals.com/content/29/157/200287
    SOURCE: European Respiratory Review
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