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Eric Topol on Twitter
Eric Topol on Twitter
Two new studies highlight the importance of the gut microbiome for response of cancer immunotherapyProbiotic for renal cell carcinomahttps://t.co/63wYxPtkuZLargest metagenomic study, in advanced melanomahttps://t.co/8Atq2aWJtJ@NatureMedicine pic.twitter.com/1ly97vLjqZ— Eric Topol (@EricTopol) February 28, 2022
·twitter.com·
Eric Topol on Twitter
Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients
Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients
This analysis of 2-year retrospective cohort studies of individuals diagnosed with COVID-19 showed that the increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout. The differing trajectories suggest a different pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern.
This analysis of 2-year retrospective cohort studies of individuals diagnosed with COVID-19 showed that the increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout. The differing trajectories suggest a different pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern. The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects. Our findings are relevant to understanding individual-level and population-level risks of neurological and psychiatric disorders after SARS-CoV-2 infection and can help inform our responses to them.
We identified 1 487 712 patients with a recorded diagnosis of COVID-19 during the study period, of whom 1 284 437 (185 748 children, 856 588 adults, and 242 101 older adults; overall mean age 42·5 years [SD 21·9]; 741 806 [57·8%] were female and 542 192 [42·2%] were male) were adequately matched with an equal number of patients with another respiratory infection. The risk trajectories of outcomes after SARS-CoV-2 infection in the whole cohort differed substantially. While most outcomes had HRs significantly greater than 1 after 6 months (with the exception of encephalitis; Guillain-Barré syndrome; nerve, nerve root, and plexus disorder; and parkinsonism), their risk horizons and time to equal incidence varied greatly. Risks of the common psychiatric disorders returned to baseline after 1–2 months (mood disorders at 43 days, anxiety disorders at 58 days) and subsequently reached an equal overall incidence to the matched comparison group (mood disorders at 457 days, anxiety disorders at 417 days). By contrast, risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the 2-year follow-up period. Post-COVID-19 risk trajectories differed in children compared with adults: in the 6 months after SARS-CoV-2 infection, children were not at an increased risk of mood (HR 1·02 [95% CI 0·94–1·10) or anxiety (1·00 [0·94–1·06]) disorders, but did have an increased risk of cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures (HRs ranging from 1·20 [1·09–1·33] to 2·16 [1·46–3·19]). Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days). A sizeable proportion of older adults who received a neurological or psychiatric diagnosis, in either cohort, subsequently died, especially those diagnosed with dementia or epilepsy or seizures. Risk profiles were similar just before versus just after the emergence of the alpha variant (n=47 675 in each cohort). Just after (vs just before) the emergence of the delta variant (n=44 835 in each cohort), increased risks of ischaemic stroke, epilepsy or seizures, cognitive deficit, insomnia, and anxiety disorders were observed, compounded by an increased death rate. With omicron (n=39 845 in each cohort), there was a lower death rate than just before emergence of the variant, but the risks of neurological and psychiatric outcomes remained similar.
·thelancet.com·
Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients
SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland
SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland
Nature Medicine - Findings from the COVID-19 in Pregnancy in Scotland (COPS) study reveals low levels of vaccination uptake by pregnant women compared to women in the general population and that...
Fig. 5: Preterm birth and perinatal mortality after SARS-CoV-2 in pregnancy.a,b, Preterm birth (<37 weeks gestation) rate per 100 live births (a) and extended perinatal mortality rates (b) (stillbirths (death in utero ≥24 weeks gestation) and neonatal deaths within 28 d of birth per 1,000 total births) in different cohorts during the pandemic. Background rate is the rate for all babies born during the pandemic period (1 March 2020 to 31 October 2021); no confirmed SARS-CoV-2 is the rate for babies born during the pandemic period (1 March 2020 to 31 October 2021) to women with no confirmed SARS-CoV-2 infection during pregnancy; any SARS-CoV-2 is the rate for babies born to women who had confirmed SARS-CoV-2 during their pregnancy 1 December 2020 to 31 October 2021; SARS-CoV-2 within 28 d of birth is the rate for babies born to women who had confirmed SARS-CoV-2 during their pregnancy 1 December 2020 to 31 October 2021, restricted to babies born within 28 d of the date of onset of maternal infection; Any COVID-19 vaccination is the rate for babies born to women who had COVID-19 vaccination during their pregnancy 1 December 2020 to 31 October 2021; COVID-19 vaccination within 28 d of birth is the rate for babies born to women who had COVID-19 vaccination during their pregnancy 1 December 2020 to 31 October 2021, restricted to babies born within 28 d of the date of maternal vaccination.
·nature.com·
SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland
Siglec-9 Restrains Antibody-Dependent Natural Killer Cell Cytotoxicity against SARS-CoV-2 | mBio
Siglec-9 Restrains Antibody-Dependent Natural Killer Cell Cytotoxicity against SARS-CoV-2 | mBio
One mechanism that cancer cells use to evade natural killer cell immune surveillance is by expressing high levels of sialoglycans, which bind to Siglec-9, a glyco-immune checkpoint molecule on NK cells. This binding inhibits NK cell cytotoxicity.
vaccination
·journals.asm.org·
Siglec-9 Restrains Antibody-Dependent Natural Killer Cell Cytotoxicity against SARS-CoV-2 | mBio
Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study
Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study
A total of 536 individuals (mean age 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post COVID-19); 331 (62%) with organ impairment or incidental findings had follow-up, with reduced symptom burden from baseline (median number of symptoms 10 and 3, at 6 and 12 months, respectively). Extreme breathlessness (38% and 30%), cognitive dysfunction (48% and 38%) and poor health-related quality of life (EQ-5D-5L  0.7; 57% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single-organ impairment. Single- and multi-organ impairment were present in 69% and 23% at baseline, persisting in 59% and 27% at follow-up, respectively.
·journals.sagepub.com·
Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study
Antigenic mapping of emerging SARS-CoV-2 omicron variants BM.1.1.1, BQ.1.1, and XBB.1
Antigenic mapping of emerging SARS-CoV-2 omicron variants BM.1.1.1, BQ.1.1, and XBB.1
Novel SARS-CoV-2 omicron variants, including BM.1.1.1, BQ.1.1, and XBB.1, continue to emerge at an unprecedented rate, evading pre-existing immunity from vaccination and previous infection. Quantifying the antigenic diversity of variants might assist in selecting future vaccine strains. To determine the antigenic relationships between emerging SARS-CoV-2 omicron variants, we and others1–4 used antigenic cartography, whereby multidimensional scaling is used to generate antigenic maps in which the positions of antigens and antiserum samples directly correspond to neutralising titres.
·thelancet.com·
Antigenic mapping of emerging SARS-CoV-2 omicron variants BM.1.1.1, BQ.1.1, and XBB.1
Circulating Spike Protein Detected in Post–COVID-19 mRNA Vaccine Myocarditis
Circulating Spike Protein Detected in Post–COVID-19 mRNA Vaccine Myocarditis
Cases of adolescents and young adults developing myocarditis after vaccination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–targeted mRNA vaccines have been reported globally, but the underlying immunoprofiles of these individuals have not been described in detail. METHODS: From January 2021 through February 2022, we prospectively collected blood from 16 patients who were hospitalized at Massachusetts General for Children or Boston Children’s Hospital for myocarditis, presenting with chest pain with elevated cardiac troponin T after SARS-CoV-2 vaccination. We performed extensive antibody profiling, including tests for SARS-CoV-2–specific humoral responses and assessment for autoantibodies or antibodies against the human-relevant virome, SARS-CoV-2–specific T-cell analysis, and cytokine and SARS-CoV-2 antigen profiling. Results were compared with those from 45 healthy, asymptomatic, age-matched vaccinated control subjects. RESULTS: Extensive antibody profiling and T-cell responses in the individuals who developed postvaccine myocarditis were essentially indistinguishable from those of vaccinated control subjects, despite a modest increase in cytokine production. A notable finding was that markedly elevated levels of full-length spike protein (33.9±22.4 pg/mL), unbound by antibodies, were detected in the plasma of individuals with postvaccine myocarditis, whereas no free spike was detected in asymptomatic vaccinated control subjects (unpaired t test; P0.0001). CONCLUSIONS: Immunoprofiling of vaccinated adolescents and young adults revealed that the mRNA vaccine–induced immune responses did not differ between individuals who developed myocarditis and individuals who did not. However, free spike antigen was detected in the blood of adolescents and young adults who developed post-mRNA vaccine myocarditis, advancing insight into its potential underlying cause.
·ahajournals.org·
Circulating Spike Protein Detected in Post–COVID-19 mRNA Vaccine Myocarditis
Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection
Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection
Nature Cardiovascular Research - Through analysis of the electronic medical records of 284,592 vaccinated patients, using a sequence–symmetry analysis, Kwan et al. show that the risk of...
·nature.com·
Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection
Class switch toward noninflammatory, spike-specific IgG4 antibodies after repeated SARS-CoV-2 mRNA vaccination
Class switch toward noninflammatory, spike-specific IgG4 antibodies after repeated SARS-CoV-2 mRNA vaccination
RNA vaccines are efficient preventive measures to combat the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. High levels of neutralizing SARS-CoV-2 antibodies are an important component of vaccine-induced immunity. Shortly after the initial two mRNA vaccine doses, the immunoglobulin G (IgG) response mainly consists of the proinflammatory subclasses IgG1 and IgG3. Here, we report that several months after the second vaccination, SARS-CoV-2–specific antibodies were increasingly composed of noninflammatory IgG4, which were further boosted by a third mRNA vaccination and/or SARS-CoV-2 variant breakthrough infections. IgG4 antibodies among all spike-specific IgG antibodies rose, on average, from 0.04% shortly after the second vaccination to 19.27% late after the third vaccination. This induction of IgG4 antibodies was not observed after homologous or heterologous SARS-CoV-2 vaccination with adenoviral vectors. Single-cell sequencing and flow cytometry revealed substantial frequencies of IgG4-switched B cells within the spike-binding memory B cell population [median of 14.4%; interquartile range (IQR) of 6.7 to 18.1%] compared with the overall memory B cell repertoire (median of 1.3%; IQR of 0.9 to 2.2%) after three immunizations. This class switch was associated with a reduced capacity of the spike-specific antibodies to mediate antibody-dependent cellular phagocytosis and complement deposition. Because Fc-mediated effector functions are critical for antiviral immunity, these findings may have consequences for the choice and timing of vaccination regimens using mRNA vaccines, including future booster immunizations against SARS-CoV-2.
·science.org·
Class switch toward noninflammatory, spike-specific IgG4 antibodies after repeated SARS-CoV-2 mRNA vaccination
A World First: Effect of Covid Reinfection on People Living With Long Covid
A World First: Effect of Covid Reinfection on People Living With Long Covid
Long Covid Support and Long Covid Kids publish the first data on the effect of COVID reinfections on adults and children living with Long Covid. Long Covid Kids recommends reading this article in combination with our child-specific infection analysis blog which runs from the beginning of the pandemic to 1st April 2022 when final protections in England were removed. Prof Daniel M Altmann, Professor of Immunology, Department of Immunology and Inflammation, Imperial College, Faculty of Medicine and
·longcovidkids.org·
A World First: Effect of Covid Reinfection on People Living With Long Covid
Bivalent Covid-19 Vaccines — A Cautionary Tale
Bivalent Covid-19 Vaccines — A Cautionary Tale
What lessons can be learned from our experience with bivalent vaccines? Fortunately, SARS-CoV-2 variants haven’t evolved to resist the protection against severe disease offered by vaccination or previous infection. If that happens, we will need to create a variant-specific vaccine. Although boosting with a bivalent vaccine is likely to have a similar effect as boosting with a monovalent vaccine, booster dosing is probably best reserved for the people most likely to need protection against severe disease — specifically, older adults, people with multiple coexisting conditions that put them at high risk for serious illness, and those who are immunocompromised. In the meantime, I believe we should stop trying to prevent all symptomatic infections in healthy, young people by boosting them with vaccines containing mRNA from strains that might disappear a few months later.
·nejm.org·
Bivalent Covid-19 Vaccines — A Cautionary Tale
Suicide in the context of covid 19
Suicide in the context of covid 19
The COVID-19 pandemic has had damaging health, social and economic impacts across the world. In some countries the health impacts have been dominated by the large number of deaths as a direct result of COVID-19.1 In countries like Australia, where the numbers of COVID-19 cases and deaths have been fewer, the health impacts are likely to relate more to the consequences of social distancing and stay-at-home orders.2 There has been considerable concern about the mental health of populations during this time and in particular, concerns that suicides might increase as a consequence of the pandemic.3-5 To date, most international and Australian based research has found no overall increase in suicides in the initial months of the pandemic.6-8 However, experts have noted that we need to remain vigilant, and that increases in suicide may still occur.2,9 Recent findings from Japan suggest this caution is warranted; after an initial reduction in suicide in that country, there was a subsequent increase. 10,11 In addition to continuing to monitor overall trends in suicide as the pandemic continues, it is important to consider whether patterns may vary for different subgroups in the population.9 Monitoring suicide numbers for different demographic subgroups (e.g., males and females in different age groups) is important, but even this only tells part of the story. It is also important to track whether certain the social determinants of suicide are increasingly being implicated in suicides during the pandemic. Doing so will give us deeper insights into where to focus prevention efforts. The effects of economic damage from the pandemic such as financial problems and unemployment are a major concern given research following the global economic crisis of 2008 showed an increase in suicide in two thirds of the countries studied.12 Other risk factors for suicide that may be heightened by the pandemic include relationship breakdown and homelessness. Recent research from Queensland using the interim Queensland Suicide Register (iQSR), found no absolute or relative increases in four motives for suspected suicides, namely recent unemployment, financial problems, relationship breakdown, or domestic violence in the initial months of the pandemic. 7 The current study complements the Queensland study 7 by including data from the Victorian Suicide Register (VSR) and the Tasmanian Suicide Register (TSR). Pooling data from these three registers meant that we could include approximately half of all the suicides that occurred in Australia over the study period and allowed us to build on other research by stratifying the analyses by age group and sex of the deceased. The aims of this study were two-fold: (1) to determine whether there has been a change in the number of suicides occurring overall and in age and sex subgroups since the COVID-19 pandemic began and (2) to determine whether particular risk factors for suicide (namely relationship breakdown, financial stressors, 8 unemployment, and homelessness) have become more prominent as likely underlying contributing factors for suicide during the pandemic
·aihw.gov.au·
Suicide in the context of covid 19