COPD care programme can reduce readmissions and in-patient bed days

SummaryBackgroundChronic obstructive pulmonary disease (COPD) is a common disease worldwide with significant morbidity and mortality.AimTo investigate the effect of a comprehensive COPD management programme in decreasing COPD readmissions 1 year before and 1 year after the programme.Method185 (166 males) patients admitted for acute exacerbation of COPD (AECOPD) were recruited between September 2010 and December 2012. COPD care team provided crisis support and maintenance therapy for the COPD patients for a total of 16 weeks. The protocol included COPD clinic run by respiratory physicians, COPD education and nurse clinics by respiratory nurses, out-patient pulmonary rehabilitation programme by physiotherapists, fast track doctor's clinic, telephone hotline for patients and nurse telephone calls to patients. Readmissions over a period of 1 year were assessed.ResultsThe mean (SD) age of the subjects and FEV1 % predicted normal were 76.9 ± 7.37 yrs and 44.4  ±  20.7% respectively. 40 (21.6%) patients required non-invasive positive pressure ventilation during the recruitment admission. Admissions for AECOPD decreased from 2.39 ± 2.05 one year before programme to 1.65 ± 2.1 one year after programme (mean difference 0.75 ± 2.11 episodes, p < 0.001). The length of hospital stay was reduced from 12.17 ± 9.14 days one year before programme to 9.09 ± 12.1 days one year after the programme (mean difference 3.09 ± 12.1 days, p < 0.001). The FEV1 percentage predicted and quality of life measured by St George's Respiratory Questionnaire showed no significant improvement at 16 weeks after recruitment into the programme as compared to at 6 weeks.ConclusionCOPD care programme is effective in decreasing readmissions and length of hospital day for COPD patients

Consensus Statements from the Diabetologists &amp; Endocrinologists Alliance for the Management of People with Hypertension and Type 2 Diabetes Mellitus

Hypertension and type 2 diabetes mellitus (T2DM) are important, intertwined public health issues. People with both conditions face significantly elevated risks of cardiovascular (CV) and renal complications. To optimize patient care, a multidisciplinary expert panel met to review recent evidence on optimal blood pressure (BP) targets, implications of albuminuria, and treatment regimens for hypertensive patients with T2DM, with the aim of providing recommendations for physicians in Hong Kong. The panel reviewed the relevant literature, obtained by searching PubMed for the publication period from January 2015 to June 2021, to address five discussion areas: (i) BP targets based on CV/renal benefits; (ii) management of isolated systolic or diastolic hypertension; (iii) roles of angiotensin II receptor blockers; (iv) implications of albuminuria for CV/renal events and treatment choices; and (v) roles and tools of screening for microalbuminuria. The panel held three virtual meetings using a modified Delphi method to address the discussion areas. After each meeting, consensus statements were derived and anonymously voted on by every panelist. A total of 17 consensus statements were formulated based on recent evidence and expert insights regarding cardioprotection and renoprotection for hypertensive patients with T2DM

Virus neutralization of SARS-CoV-2 Omicron variant BA.2 in those vaccinated with three doses of BNT162b2 or CoronaVac vaccines.

Abstract SARS-CoV-2 Omicron subvariant BA.2 is increasing in some areas of the world and it is important to assess how well current vaccines may protect against this infection. BioNTech Pfizer (BNT162b2) and CoronaVac are widely used COVID-19 vaccines globally. We determined the 50% plaque reduction neutralization test (PRNT50) and PRNT90 antibody titres to BA.2 virus in sera (twenty each collected 3-5 weeks after third dose) from cohorts vaccinated with three doses of BNT162b2, three doses of CoronaVac, two doses of CoronaVac followed by a third dose of BNT162b2 and those convalescent from SARS-CoV-2 (ancestral virus) (143-196 days after infection). We compared the PRNT titres to BA.2 with titres to BA.1 and ancestral virus. We demonstrate that PRNT50 and PRNT90 antibody titres to BA.2 are markedly reduced compared with those to ancestral virus and reduced as much as was observed for BA.1 virus. Those vaccinated with three doses of BNT162b2 or vaccinated with two doses of CoronaVac and a third dose of BNT162b2 develop PRNT antibody titres above the protective threshold from symptomatic infection. Those vaccinated with three doses of CoronaVac fail to achieve protective levels of PRNT50 antibody to BA.2 subvariant of Omicron 3-5 weeks after vaccination.</jats:p

Neutralizing antibody titres to SARS-CoV-2 Omicron variant and wild-type virus in those with past infection or vaccinated or boosted with mRNA BNT162b2 or inactivated CoronaVac vaccines

Abstract Omicron, a novel SARS-CoV-2 variant has emerged and is rapidly becoming the dominant SARS-CoV-2 virus circulating globally. It is important to define reductions in virus neutralizing activity in serum of convalescent or vaccinated individuals to understand potential loss of protection from infection or re-infection. Two doses of BNT162b2 or CoronaVac vaccines provided little 50% plaque reduction neutralization test (PRNT50) antibody immunity against the Omicron variant, even at one-month post vaccination. Booster doses with BNT162b2 in those with two doses of either BNT162b2 or CoronaVac provided acceptable neutralizing immunity against Omicron variant at 1-month post-booster dose. However, three doses of BNT162b2 elicited higher levels of PRNT50 antibody to Omicron variant suggesting longer duration of protection. Convalescent from SARS-CoV-2 infection did not have protective PRNT50 antibody levels to Omicron, but a single dose of BNT162b2 vaccine provided protective immunity. Field vaccine-efficacy studies against Omicron variant against different vaccines are urgently needed.</jats:p

SARS-CoV-2 Omicron variant BA.2 neutralisation in sera of people with Comirnaty or CoronaVac vaccination, infection or breakthrough infection, Hong Kong, 2020 to 2022

Background Omicron subvariant BA.2 circulation is rapidly increasing globally. Aim We evaluated the neutralising antibody response from vaccination or prior SARS-CoV-2 infection against symptomatic infection by BA.2 or other variants. Methods Using 50% plaque reduction neutralisation tests (PRNT50), we assessed neutralising antibody titres to BA.2, wild type (WT) SARS-CoV-2 and other variants in Comirnaty or CoronaVac vaccinees, with or without prior WT-SARS-CoV-2 infection. Titres were also measured for non-vaccinees convalescing from a WT-SARS-CoV-2 infection. Neutralising antibodies in BA.2 and BA.1 breakthrough infections and in BA.2 infections affecting non-vaccinees were additionally studied. Results In vaccinees or prior WT-SARS-CoV-2-infected people, BA.2 and BA.1 PRNT50 titres were comparable but significantly (p &lt; 10 − 5) lower than WT. In each group of 20 vaccinees with (i) three-doses of Comirnaty, (ii) two CoronaVac followed by one Comirnaty dose, or (iii) one dose of either vaccine after a WT-SARS-CoV-2 infection, ≥ 19 individuals developed detectable (PRNT50 titre ≥ 10) antibodies to BA.2, while only 15 of 20 vaccinated with three doses of CoronaVac did. Comirnaty vaccination elicited higher titres to BA.2 than CoronaVac. In people convalescing from a WT-SARS-CoV-2 infection, a single vaccine dose induced higher BA.2 titres than three Comirnaty (p = 0.02) or CoronaVac (p = 0.00001) doses in infection-naïve individuals. BA.2 infections in previously uninfected and unvaccinated individuals elicited low (PRNT50 titre ≤ 80) responses with little cross-neutralisation of other variants. However, vaccinees with BA.1 or BA.2 breakthrough infections had broad cross-neutralising antibodies to WT viruses, and BA.1, BA.2, Beta and Delta variants. Conclusions Existing vaccines can be of help against the BA.2 subvariant. </jats:sec

Comparison of the immunogenicity of BNT162b2 and CoronaVac COVID-19 Vaccines in Hong Kong

AbstractBackgroundFew head-to-head evaluations of immune responses to difference vaccines have been reported.MethodsSurrogate virus neutralization test (sVNT) antibody levels of adults receiving either 2 doses of BNT162b2 (n=366) or CoronaVac (n=360) vaccines in Hong Kong were determined. An age-matched subgroup (BNT162b2 (n=49) vs CoronaVac (n=49)) were tested for plaque reduction neutralizing (PRNT) and spike binding antibody and T cell reactivity in peripheral blood mononuclear cells (PBMC).FindingsOne month after the second dose of vaccine, BNT162b2 elicited significantly higher PRNT50, PRNT90, sVNT, spike receptor binding, spike N terminal domain binding, spike S2 domain binding, spike FcR binding and antibody avidity levels than CoronaVac. The geometric mean PRNT50 titres in those vaccinated with BNT162b2 and CoronaVac vaccines were 251.6 and 69.45 while PRNT90 titres were 98.91 and 16.57, respectively. All of those vaccinated with BNT162b2 and 45 (91.8%) of 49 vaccinated with CoronaVac achieved the 50% protection threshold for PRNT90. Allowing for an expected seven-fold waning of antibody titres over six months for those receiving CoronaVac, only 16.3% would meet the 50% protection threshold versus 79.6% of BNT162b2 vaccinees. Age was negatively correlated with PRNT90 antibody titres. Both vaccines induced SARS-CoV-2 specific CD4+ and CD8+ T cell responses at 1-month post-vaccination but CoronaVac elicited significantly higher structural protein-specific CD4+ and CD8+ T cell responses.ConclusionVaccination with BNT162b2 induces stronger humoral responses than CoronaVac. CoronaVac induce higher CD4+ and CD8+ T cell responses to the structural protein than BNT162b2.Summary At a GlanceThrough the head-to-head comparison, vaccination with BNT162b2 induces significantly higher levels of SARS-CoV-2 specific binding and neutralizing antibody responses when compared to CoronaVac. CoronaVac induce higher CD4+ and CD8+ T cell responses to the structural protein than BNT162b2.</jats:sec

Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank

Rationale &amp; Objective: Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes. Study Design: Multicenter prospective cohort study. Settings &amp; Participants: 19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank. Exposures: DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR. Outcomes: All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction ≥40%). Analytical Approach: Multivariable Cox proportional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates. Results: Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.44]), hospitalization for HF (HR, 3.08 [95% CI, 1.82-5.21]), and CKD progression (HR, 2.37 [95% CI, 1.63-3.43]), but the risk of CVD was not significantly greater (HR, 1.14 [95% CI, 0.88-1.48]). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR &lt;30 mL/min/1.73 m2 yielded similar findings. Limitations: Potential misclassification because of drug use. Conclusions: Nonalbuminuric DKD was associated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR. © 2022 The Author