scholarly journals Host Immune Response Driving SARS-CoV-2 Evolution

Viruses ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 1095 ◽  
Author(s):  
Rui Wang ◽  
Yuta Hozumi ◽  
Yong-Hui Zheng ◽  
Changchuan Yin ◽  
Guo-Wei Wei
Keyword(s):  
Immune Response ◽  
High Risk ◽  
Gene Editing ◽  
The Elderly ◽  
Host Immune Response ◽  
Social Inequities ◽  
Increased Risk ◽  
Type C ◽  
Systemic Health ◽  
Adar Gene

The transmission and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are of paramount importance in controlling and combating the coronavirus disease 2019 (COVID-19) pandemic. Currently, over 15,000 SARS-CoV-2 single mutations have been recorded, which have a great impact on the development of diagnostics, vaccines, antibody therapies, and drugs. However, little is known about SARS-CoV-2’s evolutionary characteristics and general trend. In this work, we present a comprehensive genotyping analysis of existing SARS-CoV-2 mutations. We reveal that host immune response via APOBEC and ADAR gene editing gives rise to near 65% of recorded mutations. Additionally, we show that children under age five and the elderly may be at high risk from COVID-19 because of their overreaction to the viral infection. Moreover, we uncover that populations of Oceania and Africa react significantly more intensively to SARS-CoV-2 infection than those of Europe and Asia, which may explain why African Americans were shown to be at increased risk of dying from COVID-19, in addition to their high risk of COVID-19 infection caused by systemic health and social inequities. Finally, our study indicates that for two viral genome sequences of the same origin, their evolution order may be determined from the ratio of mutation type, C > T over T > C.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing

2017 ◽  
Vol 9 (2) ◽  
pp. 145 ◽  
Author(s):  
Katharine Wallis ◽  
Rebecca Tuckey
Keyword(s):  
General Practice ◽  
High Risk ◽  
The Elderly ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Medicines Information ◽  
Care For The Elderly ◽  
Increased Risk ◽  
Information Brochure ◽  
Practice Methods

ABSTRACT INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs. The acceptability and utility of the SPACE intervention were assessed by semi- structured interviews involving study participants, including 11 patients with high-risk prescribing. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. RESULTS The pharmacist said the SPACE intervention facilitated communication with GPs, and provided a platform for their clinical advisory role at no extra cost to the PHO. GPs said the feedback session with the pharmacist was educational but added to time pressures. GPs selected 29 patients for the mail-out. Some GPs were concerned the mail-out might upset patients, but patients said they felt cared for. Some patients intended to take the letter to their next appointment and discuss their medicines with their GP; others said there were already many things to discuss and not enough time. Some patients were confused by the medicines information brochure. DISCUSSION The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further research is needed to test the effect of SPACE on high-risk prescribing.

scholarly journals How will new genetic technologies, such as gene editing, change reproductive decision-making? Views of high-risk couples

2020 ◽  
Vol 29 (1) ◽  
pp. 39-50
Author(s):  
Ivy van Dijke ◽  
Phillis Lakeman ◽  
Inge B. Mathijssen ◽  
Mariëtte Goddijn ◽  
Martina C. Cornel ◽  
...  
Keyword(s):  
Decision Making ◽  
Prenatal Diagnosis ◽  
High Risk ◽  
Gene Editing ◽  
Genetic Disorder ◽  
Clinical Genetics ◽  
Reproductive Decision ◽  
Reproductive Decision Making ◽  
Increased Risk ◽  
Genetic Technologies

AbstractCouples at increased risk of having offspring with a specific genetic disorder who want to avoid having an affected child have several reproductive options including prenatal diagnosis (PND) and preimplantation genetic testing (PGT). In the future, non-invasive prenatal diagnosis (NIPD), germline gene editing (GGE) and somatic gene editing (SGE) might become available. This study explores if, and how, availability of new genetic technologies, including NIPD, GGE, SGE, would change reproductive decision-making of high-risk couples. In 2018, semi-structured interviews were conducted with 25 genetically at-risk couples. Couples previously had received genetic counselling for PND and PGT, and in most cases opted for (one of) these techniques, at one Dutch Clinical Genetics Center between 2013 and 2017. Considerations participants mentioned regarding the hypothetical use of NIPD, GGE and SGE, seem similar to considerations regarding PND and PGT and are reflected in underlying concepts. These include safety and burden for mother and child, and moral considerations. Couples generally favoured NIPD over PND as this would be safe and enables earlier diagnosis. Increased opportunities of having a ‘healthy’ embryo and less embryo disposal were considerations in favour of GGE. Some regarded GGE as unsafe and feared slippery slope scenarios. Couples were least favourable towards SGE compared to choosing for a genetic reproductive technology, because of the perceived burden for the affected offspring. With the possibly growing number of technological options, understanding high risk couples’ perspectives can assist in navigating the reproductive decision-making process. Counsellors should be prepared to counsel on more and complex reproductive options.

scholarly journals Association of the systemic host immune response with acute hyperglycemia in mechanically ventilated septic patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248853
Author(s):  
Nauman Farooq ◽  
Byron Chuan ◽  
Hussain Mahmud ◽  
Samar R. El Khoudary ◽  
Seyed Mehdi Nouraie ◽  
...  
Keyword(s):  
Immune Response ◽  
Blood Glucose ◽  
Critically Ill ◽  
Bacterial Infections ◽  
Pearson Correlation ◽  
Glycemic Variability ◽  
Host Immune Response ◽  
Pentraxin 3 ◽  
Icu Admission ◽  
Increased Risk

Hyperglycemia during sepsis is associated with increased organ dysfunction and higher mortality. The role of the host immune response in development of hyperglycemia during sepsis remains unclear. We performed a retrospective analysis of critically ill adult septic patients requiring mechanical ventilation (n = 153) to study the relationship between hyperglycemia and ten markers of the host injury and immune response measured on the first day of ICU admission (baseline). We determined associations between each biomarker and: (1) glucose, insulin, and c-peptide levels at the time of biomarker collection by Pearson correlation; (2) average glucose and glycemic variability in the first two days of ICU admission by linear regression; and (3) occurrence of hyperglycemia (blood glucose>180mg/dL) by logistic regression. Results were adjusted for age, pre-existing diabetes mellitus, severity of illness, and total insulin and glucocorticoid dose. Baseline plasma levels of ST2 and procalcitonin were positively correlated with average blood glucose and glycemic variability in the first two days of ICU admission in unadjusted and adjusted analyses. Additionally, higher baseline ST2, IL-1ra, procalcitonin, and pentraxin-3 levels were associated with increased risk of hyperglycemia. Our results suggest associations between the host immune response and hyperglycemia in critically ill septic patients particularly implicating the interleukin-1 axis (IL-1ra), the interleukin-33 axis (ST2), and the host response to bacterial infections (procalcitonin, pentraxin-3).

CHARACTERISTICS OF IMMUNE RESPONSE IN ELDERLY AND AUTOIMMUNITY

2020 ◽  
pp. 246-255
Author(s):  
О. В. Москалец
Keyword(s):  
Immune Response ◽  
The Elderly ◽  
Low Grade ◽  
Aseptic Inflammation ◽  
Innate And Adaptive Immunity ◽  
Multiple Systems ◽  
Complex Process ◽  
Increased Risk ◽  
Autoimmune Processes ◽  
Autoantibody Detection

Cтарение - это очень сложный процесс, в результате которого происходит дисрегуляция всех систем организма. К наиболее значимым изменениям в функционировании иммунной системы, которые называются «физиологическое старение иммунной системы», относятся снижение иммунного ответа на инфекции, повышенный уровень провоспалительных медиаторов и снижение контроля над аутореактивными клонами. Вместе с физиологическим старением иммунной системы у пожилых обычно наблюдают вялотекущее асептическое воспаление («инфламмэйджинг»), с которым связывают более высокую частоту хронических неинфекционных возрастных заболеваний. В статье рассмотрены основные изменения врожденного и адаптивного иммунитета при старении и их влияние на индукцию аутоиммунных процессов, приведены данные о частоте выявления аутоантител у пожилых и особенностях клинической картины некоторых аутоиммунных заболеваний, дебютирующих в этом возрасте. Aging is a very complex process, resulting in dysregulation of multiple systems. The most prominent changes in immunological function, termed «immunosenescence», are diminished immune response against infection, increased levels of pro-inflammatory mediators and increased risk of autoimmunity. Immunoscenescence is accompanied by the low-grade aseptic inflammation observed commonly in elderly people - «inflammaging», which is associated with a higher incidence of chronic non-infectious age-associated diseases. The article discusses the main changes in innate and adaptive immunity in aging and their impact on the induction of autoimmune processes, provides data on the frequency of autoantibody detection in the elderly and the clinical features of some autoimmune diseases debuting at this age.

scholarly journals Comparison of COVID-19 outcomes among shielded and non-shielded populations

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bhautesh D. Jani ◽  
Frederick K. Ho ◽  
David J. Lowe ◽  
Jamie P. Traynor ◽  
Sean P. MacBride-Stewart ◽  
...  
Keyword(s):  
High Risk ◽  
A Priori ◽  
Case Fatality ◽  
The Elderly ◽  
Low Risk ◽  
Family Practitioner ◽  
Moderate Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Population Mortality

AbstractMany western countries used shielding (extended self-isolation) of people presumed to be at high-risk from COVID-19 to protect them and reduce healthcare demand. To investigate the effectiveness of this strategy, we linked family practitioner, prescribing, laboratory, hospital and death records and compared COVID-19 outcomes among shielded and non-shielded individuals in the West of Scotland. Of the 1.3 million population, 27,747 (2.03%) were advised to shield, and 353,085 (26.85%) were classified a priori as moderate risk. COVID-19 testing was more common in the shielded (7.01%) and moderate risk (2.03%) groups, than low risk (0.73%). Referent to low-risk, the shielded group had higher confirmed infections (RR 8.45, 95% 7.44–9.59), case-fatality (RR 5.62, 95% CI 4.47–7.07) and population mortality (RR 57.56, 95% 44.06–75.19). The moderate-risk had intermediate confirmed infections (RR 4.11, 95% CI 3.82–4.42) and population mortality (RR 25.41, 95% CI 20.36–31.71) but, due to their higher prevalence, made the largest contribution to deaths (PAF 75.30%). Age ≥ 70 years accounted for 49.55% of deaths. In conclusion, in spite of the shielding strategy, high risk individuals were at increased risk of death. Furthermore, to be effective as a population strategy, shielding criteria would have needed to be widely expanded to include other criteria, such as the elderly.

601 IMPROVING DELIRIUM ASSESSMENT IN A DISTRICT GENERAL HOSPITAL

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
C Finlow ◽  
L Azaden ◽  
C Abbott
Keyword(s):  
High Risk ◽  
Cognitive Assessment ◽  
Geriatric Medicine ◽  
District General Hospital ◽  
The Elderly ◽  
Ward Round ◽  
Risk Category ◽  
High Morbidity ◽  
Increased Risk ◽  
Service Redesign

Abstract Introduction Delirium affects a up to 20% of medical inpatients1. Patients in the high-risk category include those over 65, pre-existing cognitive impairment, current hip fracture and those with a serious illness 1,2. Often delirium goes undetected but is often related to high morbidity and motility rates with complications of insitionalisation, increased risk of dementia, high risk of falls and prolonged hospital stays1,2, recognition is the first step to reducing these risks. NICE guidance suggests that those patients showing indicators of delirium should have a formal cognitive assessment and a tailor-made plan should be documented within 24 hours 2. The detection of delirium can be sort using licensed tools including the 4AT score with the 4AT being the most sensitive, specific and practical1. Due to the ongoing risks of delirium, high risk patients on the Geriatric medicine firm and poor detection rate a quality improvement methodology was used to increase the rates of detection of delirium. The aim to have 90% of Geriatric medicine patients screened within 24 h admission and within 24 h of arrival to COTE ward/first consultant ward round within 4 months. Method 4 PDSA cycles were designed to trial changes including education of the Geriatric medicine team, lanyard cards, introduction of 4AT on the frailty proforma and a non-intervention cycle to see if these changes were sustained. Data was collected from the care of the elderly ward not including outliers of 27 patients. Any formal cognitive assessment that was documented either on admission or on arrival to the ward was included. Not included was those patients who were assessed for delirium or change in cognition after first consultant ward round or after 24 h of being on the ward. Results The uptake of 4AT improved by 50% after education and the lanyard cards. This was largely as a shift away from other assessments rather than more cognitive assessments done overall. During service redesign an Older Person’s Assessment Unit was formed with a Geriatrician based at the front door. This will improve the use of the 4AT for older patients admitted to hospital in the near future and is the subject of the next PDSA cycle. Conclusion Our journey to embed the 4AT is ongoing and we will continue to improve uptake using QI methodology.

scholarly journals Aging, Immunity, and COVID-19: How Age Influences the Host Immune Response to Coronavirus Infections?

2021 ◽  
Vol 11 ◽  
Author(s):  
Varnica Bajaj ◽  
Nirupa Gadi ◽  
Allison P. Spihlman ◽  
Samantha C. Wu ◽  
Christopher H. Choi ◽  
...  
Keyword(s):  
Immune Response ◽  
Immune System ◽  
Infectious Diseases ◽  
Respiratory Infections ◽  
Management Strategies ◽  
The Elderly ◽  
Host Immune Response ◽  
Peripheral Tissues ◽  
Age Related ◽  
Age Related Changes

The novel coronavirus severe acute respiratory syndrome coronavirus 2 causing the Coronavirus disease (COVID-19) pandemic has ravaged the world with over 72 million total cases and over 1.6 million deaths worldwide as of early December 2020. An overwhelming preponderance of cases and deaths is observed within the elderly population, and especially in those with pre-existing conditions and comorbidities. Aging causes numerous biological changes in the immune system, which are linked to age-related illnesses and susceptibility to infectious diseases. Age-related changes influence the host immune response and therefore not only weaken the ability to fight respiratory infections but also to mount effective responses to vaccines. Immunosenescence and inflamm-aging are considered key features of the aging immune system wherein accumulation of senescent immune cells contribute to its decline and simultaneously increased inflammatory phenotypes cause immune dysfunction. Age-related quantitative and qualitative changes in the immune system affect cells and soluble mediators of both the innate and adaptive immune responses within lymphoid and non-lymphoid peripheral tissues. These changes determine not only the susceptibility to infections, but also disease progression and clinical outcomes thereafter. Furthermore, the response to therapeutics and the immune response to vaccines are influenced by age-related changes within the immune system. Therefore, better understanding of the pathophysiology of aging and the immune response will not only help understand age-related diseases but also guide targeted management strategies for deadly infectious diseases like COVID-19.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): a pilot study in general practice

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101594
Author(s):  
Katharine A Wallis ◽  
C Raina Elley ◽  
Simon Moyes ◽  
Ngaire Kerse
Keyword(s):  
General Practice ◽  
Pilot Study ◽  
High Risk ◽  
Controlled Trial ◽  
Randomised Trial ◽  
The Elderly ◽  
Multiple Chronic Conditions ◽  
Outreach Visit ◽  
Care For The Elderly ◽  
Increased Risk

BackgroundHigh-risk prescribing places patients at increased risk of adverse drug events (ADEs). High-risk prescribing and ADE hospitalisations are increasingly common as people are living longer and taking more medicines for multiple chronic conditions. The Safer Prescribing and Care for the Elderly (SPACE) intervention is designed to foster patient engagement in medicines management and prompt medicines review.AimTo pilot the SPACE intervention in preparation for a larger cluster randomised controlled trial (RCT).Design & settingA pilot study in two general practices. Study participants were all patients at increased risk of an adverse drug reaction (ADE) from non-steroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet medicines. The primary outcome was the proportion of participants receiving high-risk prescribing at 6 months and 12 months compared with baseline.MethodThe SPACE intervention comprised automated practice audit to identify and generate for each GP a list of patients with high-risk prescribing for these medicines; an outreach visit by clinical advisory pharmacist to deliver education and to go through with each GP their list of at-risk patients and indicate in a tick-box the intended action for each patient; and a mail-out from GPs to selected patients containing a medicines information brochure and a letter encouraging patients to discuss their medicines when they next see their GP.ResultsSPACE can be delivered within existing primary care infrastructure. The rate of high-risk prescribing was reduced at 6 months following the delivery of the intervention, but these improvements were not evident at 12 months.ConclusionSPACE prompts medicines review and shows promising signs of supporting safer prescribing in general practice in the short term. A randomised trial of SPACE started in 2018.

Suicide in Nógrád County, Hungary, 1970-1994

Crisis ◽  
1999 ◽  
Vol 20 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Tamás Zonda
Keyword(s):  
High Risk ◽  
Psychiatric Disorders ◽  
Suicide Rate ◽  
Risk Groups ◽  
The Elderly ◽  
Female Ratio ◽  
Suicide Notes ◽  
Suicidal Intention ◽  
Male Female Ratio

The author examined completed suicides occurring over a period of 25 years in a county of Hungary with a traditionally low (relatively speaking) suicide rate of 25.8. The rates are clearly higher in villages than in the towns. The male/female ratio was close to 4:1, among elderly though only 1.5:1. The high risk groups are the elderly, divorced, and widowed. Violent methods are chosen in 66.4% of the cases. The rates are particularly high in the period April-July. Prior communication of suicidal intention was revealed in 16.3% of all cases. Previous attempts had been undertaken by 17%, which in turn means that 83% of suicides were first attempts. In our material 10% the victims left suicide notes. Psychiatric disorders were present in 60.1% of the cases, and severe, multiple somatic illnesses (including malignomas) were present in 8.8%. The majority of the data resemble those found in the literature.

Sign in / Sign up

Export Citation Format

Share Document