19 research outputs found
Viral Population Heterogeneity and Fluctuating Mutational Pattern during a Persistent SARSâCoVâ2 Infection in an Immunocompromised Patient
Literature offers plenty of cases of immunocompromised patients, who develop chronic and severe SARSâCoVâ2 infections. The aim of this study is to provide further insight into SARS-CoVâ2 evolutionary dynamic taking into exam a subject suffering from follicular lymphoma, who developed a persistent infection for over 7 months. Eight nasopharyngeal swabs were obtained, and were analyses by qRTâPCR for diagnostic purposes. All of them were considered eligible (Ct < 30) for NGS sequencing. Sequence analysis showed that all sequences matched the B.1.617.2 AY.122 lineage, but they differed by few mutations identifying three genetically similar subpopulations, which evolved during the course of infection, demonstrating that prolonged replication is paralleled with intraâhost virus evolution. These evidences support the hypothesis that SARSâCoVâ2 adaptive capacities are able to shape a heterogeneous viral population in the context of
immunocompromised patients. Spillâover of viral variants with enhanced transmissibility or immune escape capacities from these subjects is plausible
Recommended from our members
Inflation and Dark Energy from spectroscopy at z > 2
The expansion of the Universe is understood to have accelerated during two
epochs: in its very first moments during a period of Inflation and much more
recently, at z < 1, when Dark Energy is hypothesized to drive cosmic
acceleration. The undiscovered mechanisms behind these two epochs represent
some of the most important open problems in fundamental physics. The large
cosmological volume at 2 < z < 5, together with the ability to efficiently
target high- galaxies with known techniques, enables large gains in the
study of Inflation and Dark Energy. A future spectroscopic survey can test the
Gaussianity of the initial conditions up to a factor of ~50 better than our
current bounds, crossing the crucial theoretical threshold of
of order unity that separates single field and
multi-field models. Simultaneously, it can measure the fraction of Dark Energy
at the percent level up to , thus serving as an unprecedented test of
the standard model and opening up a tremendous discovery space
Health-Related Quality of Life in Children with Celiac Disease: A Study Based on the Critical Incident Technique
Celiac Disease (CD) is a chronic autoimmune disease triggered by dietary gluten. Gluten avoidance, which is the only available treatment for CD, could impact on quality of life of children with CD. We present the results of a qualitative study on the emotional impact of gluten free diet (GFD) on the everyday life of children affected with CD. We investigated 76 celiac patients aged 2â18 years (average age: 9.5 years). By using the Critical Incident Technique (CIT), we defined emotions related to difficulties and awkward situations experienced by the patients. Written answers to open-ended questions from either children (older than 8 years) and parents (children younger than 8 years) were analyzed qualitatively. We found 80 dilemmas experienced in three different arenas (food situations at school, meals at home, meals outside) and characterized lived experiences of children with CD in everyday life (specific emotions, difficulties in relationships and in management of daily life). Children with CD experience strong emotions related to the GFD, permeating several aspects of everyday life. These dilemmas may be missed by a conventional, questionnaire-based approach to the psycho-social consequences of CD treatment
Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study
Purpose: Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources.
Patients and Methods: All COVID-19 patients (26/02/2020\u201318/04/2020) in the Rimini Province of Italy were included in this population-based cohort study. The hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (Oxygen group), non-invasive ventilation (NIV-only group), invasive mechanical ventilation (IMV-only group), and IMV after an NIV trial (IMV-after-NIV group). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab.
Results: We identified a total of 1,424 symptomatic patients: 520 (36.5%) were hospitalized, while 904 (63.5%) were treated at home with no 60-day deaths. Based on the respiratory support, 408 (78.5%) were assigned to the Oxygen group, 46 (8.8%) to the NIV-only group, 25 (4.8%) to the IMV-after-NIV group, and 41 (7.9%) to the IMV-only group. There was no significant difference in the PaO2/FiO2 at IMV inception in the IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p=0.165). Compared with the Oxygen group, the adjusted 60-day mortality risk significantly increased in the IMV-after-NIV (HR 2.776; p=0.024) and IMV-only groups (HR 2.966; p=0.001).
Conclusion: This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV