Impact of dexamethasone on SARS-CoV-2 concentration kinetics and antibody response in hospitalized COVID-19 patients: results from a prospective observational study.

OBJECTIVES: Dexamethasone has become the standard of care for severe coronavirus disease 2019 (COVID-19), but its virological impact is poorly understood. The objectives of this work were to characterize the kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) concentration in the upper respiratory tract (URT) and the antibody response in patients with (D+) and without (D-) dexamethasone treatment. METHODS: Data and biosamples from hospitalized patients with severe COVID-19, enrolled between 4th March and 11th December 2020 in a prospective observational study, were analysed. SARS-CoV-2 virus concentration in serial URT samples was measured using RT-PCR. SARS-CoV-2-specific immunoglobulins A and G (IgA and IgG) were measured in serum samples using S1-ELISA. RESULTS: We compared 101 immunocompetent patients who received dexamethasone (according to the inclusion criteria and dosage determined in the RECOVERY trial) to 93 immunocompetent patients with comparable disease severity from the first months of the pandemic, who had not been treated with dexamethasone or other glucocorticoids. We found no inter-group differences in virus concentration kinetics, duration of presence of viral loads >106 viral copies/mL (D+ median 17 days (IQR 13-24), D- 19 days (IQR 13-29)), or time from symptom onset until seroconversion (IgA: D+ median 11.5 days (IQR 11-12), D- 14 days (IQR 11.5-15.75); IgG: D+ 13 days (IQR 12-14.5), D- 12 days (IQR 11-15)). CONCLUSION: Dexamethasone does not appear to lead to a change in virus clearance or a delay in antibody response in immunocompetent patients hospitalized with severe COVID-19

Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study.

Funder: Humboldt-Universität zu Berlin (1034)PURPOSE: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. METHODS: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. RESULTS: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. CONCLUSIONS: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

Demokraten erobern Weißes Haus, aber Mehrheitsverhältnisse im Senat begrenzen wirtschaftspolitischen Spielraum

Der demokratische Herausforderer in der US-Präsidentschaftswahl, Joe Biden, hat das Weiße Haus erobert. Allerdings haben es die Demokraten nicht geschafft, eine klare Mehrheit im Senat zu erringen. Auch im Repräsentantenhaus verloren sie Sitze. Dies schränkt den Gestaltungsspielraum Bidens ein. Trotzdem erleichtert der Sieg Bidens die konjunkturelle Erholung nach der Corona-Krise, da nun zumindest nicht mehr die Drohung eines Vetos Konjunkturpakete behindern wird. Wegen der Mehrheitsverhältnisse im Senat droht der fiskalische Stimulus aber geringer auszufallen, als das bei einem demokratischen Durchmarsch der Fall gewesen wäre. Handelspolitisch wird der neu gewählte US-Präsident die von seinem Vorgänger geerbten Druckmittel nicht vorschnell zurücknehmen. Da Biden aber im Gegensatz zu Trump an einer Kooperation mit den Verbündeten interessiert ist, wird er den Handelsstreit mit der EU nicht verschärfen. Auch für die deutsche Exportwirtschaft ist das eine gute Nachricht, weil die Gefahr einer Eskalation im transatlantischen Handelskonflikt deutlich abnimmt. Insgesamt stehen die Chancen gut, dass unter dem neuen US-Präsidenten die USA mittelfristig zum Multilateralismus zurückkehren. Der Wechsel im Weißen Haus wird den internationalen Klimaschutz nicht zuletzt wegen des angekündigten Wiedereintritts der USA in das Pariser Klimaabkommen deutlich voranbringen. Allerdings wird die neue Regierung den ambitionierten Biden-Klimaplan ohne klare Mehrheit im Senat nur in Teilen umsetzen können.?Deutsche Wirtschaft profitiert von leicht besseren US-Konjunkturaussichten und Entspannung beim Handelskonflik

Consequences of antisense RNA inhibition of starch branching enzyme activity on properties of potato starch

Antisense constructs containing cDNAs for potato starch branching enzyme (SBE) were introduced into potato (Solanum tuberosum L.). A population of transgenic plants were generated in which tuber SEE activity was reduced by between 5 and 98% of control values. No significant differences in amylose content or amylopectin branch length profiles of transgenic tuber starches were observed as a function of tuber SEE activity. Starches obtained from low SEE activity plants showed elevated phosphorous P-31 n.m.r. analysis showed that this was due to proportionate increases in both content. 3- and 6-linked starch phosphates. A consistent alteration in starch gelatinisation properties war; only observed when the level of SEE activity was reduced to below similar to 5% of that of control values. Starches from these low SEE activity plants showed increases of up to 5 degrees C in d.s.c. peak temperature and viscosity onset temperature. Studies on melting of crystallites obtained from linear (1 --> 4)-alpha-D-glucan oligomers suggest that all average difference of double helix length of about one glucose residue might be sufficient to account for the observed differences in gelatinisation properties. We speculate that the modification of gelatinisation properties at low SEE activities is due to a subtle alteration in amylopectin branch patterns resulting in small changes in double helix lengths within granules. (C) 1998 Elsevier Science Ltd. All rights reserved