ABSTRACT
BACKGROUND: The safety and efficacy of the AZD1222 (ChAdOx1 nCoV-19) vaccine in a large, diverse population at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States, Chile, and Peru has not been known. METHODS: In this ongoing, double-blind, randomized, placebo-controlled, phase 3 clinical trial, we investigated the safety, vaccine efficacy, and immunogenicity of two doses of AZD1222 as compared with placebo in preventing the onset of symptomatic and severe coronavirus disease 2019 (Covid-19) 15 days or more after the second dose in adults, including older adults, in the United States, Chile, and Peru. RESULTS: A total of 32,451 participants underwent randomization, in a 2:1 ratio, to receive AZD1222 (21,635 participants) or placebo (10,816 participants). AZD1222 was safe, with low incidences of serious and medically attended adverse events and adverse events of special interest; the incidences were similar to those observed in the placebo group. Solicited local and systemic reactions were generally mild or moderate in both groups. Overall estimated vaccine efficacy was 74.0% (95% confidence interval [CI], 65.3 to 80.5; P<0.001) and estimated vaccine efficacy was 83.5% (95% CI, 54.2 to 94.1) in participants 65 years of age or older. High vaccine efficacy was consistent across a range of demographic subgroups. In the fully vaccinated analysis subgroup, no severe or critical symptomatic Covid-19 cases were observed among the 17,662 participants in the AZD1222 group; 8 cases were noted among the 8550 participants in the placebo group (<0.1%). The estimated vaccine efficacy for preventing SARS-CoV-2 infection (nucleocapsid antibody seroconversion) was 64.3% (95% CI, 56.1 to 71.0; P<0.001). SARS-CoV-2 spike protein binding and neutralizing antibodies increased after the first dose and increased further when measured 28 days after the second dose. CONCLUSIONS: AZD1222 was safe and efficacious in preventing symptomatic and severe Covid-19 across diverse populations that included older adults. (Funded by AstraZeneca and others; ClinicalTrials.gov number, NCT04516746.).
Subject(s)
COVID-19/prevention & control , ChAdOx1 nCoV-19 , Vaccine Efficacy , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Neutralizing/blood , Antibodies, Viral/blood , COVID-19/epidemiology , ChAdOx1 nCoV-19/adverse effects , Chile/epidemiology , Double-Blind Method , Female , Humans , Immunogenicity, Vaccine , Male , Middle Aged , Peru/epidemiology , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , United States/epidemiology , Young AdultABSTRACT
The ALAT and SEPAR Treatment and Control of Smoking Groups have collaborated in the preparation of this document which attempts to answer, by way of PICO methodology, different questions on health interventions for helping COPD patients to stop smoking. The main recommendations are: (i)moderate-quality evidence and strong recommendation for performing spirometry in COPD patients and in smokers with a high risk of developing the disease, as a motivational tool (particularly for showing evidence of lung age), a diagnostic tool, and for active case-finding; (ii)high-quality evidence and strong recommendation for using intensive dedicated behavioral counselling and drug treatment for helping COPD patients to stop smoking; (iii)high-quality evidence and strong recommendation for initiating interventions for helping COPD patients to stop smoking during hospitalization with improvement when the intervention is prolonged after discharge, and (iv)high-quality evidence and strong recommendation for funding treatment of smoking in COPD patients, in view of the impact on health and health economics.
Subject(s)
Evidence-Based Medicine/methods , Pulmonary Disease, Chronic Obstructive/psychology , Smoking Cessation/psychology , Smoking/psychology , Spirometry/psychology , Biomarkers , Bupropion/economics , Bupropion/therapeutic use , Clinical Trials as Topic , Cost-Benefit Analysis , Counseling/economics , Counseling/methods , Humans , Motivation , Nicotine/economics , Nicotine/therapeutic use , Nicotinic Agonists/economics , Nicotinic Agonists/therapeutic use , Pulmonary Disease, Chronic Obstructive/physiopathology , Randomized Controlled Trials as Topic , Smoking/drug therapy , Smoking/economics , Smoking/therapy , Smoking Cessation/economics , Smoking Cessation/methods , Surveys and Questionnaires , Varenicline/economics , Varenicline/therapeutic useABSTRACT
Streptococcus pneumoniae is responsible for several clinical syndromes, such as community-acquired pneumonia, sinusitis, otitis media, and others. The most severe clinical entity caused by this bacteria is undoubtedly invasive pneumococcal disease. Certain factors are known to increase the risk of presenting invasive pneumococcal disease, the most important being smoking habit and underlying concomitant diseases. This article comprises a consensus document on antipneumococcal vaccination in smokers, drawn up by a Smoking Expert Group from the Spanish Society of Pulmonology and Thoracic Surgery and the Latin American Chest Association.
Subject(s)
Pneumococcal Infections/prevention & control , Pneumococcal Vaccines , Smoking , Vaccination , Bacterial Adhesion , Comorbidity , Cost-Benefit Analysis , Disease Susceptibility , Humans , Immunization Schedule , Immunocompromised Host , Pneumococcal Infections/epidemiology , Pneumococcal Vaccines/administration & dosage , Pneumococcal Vaccines/economics , Respiratory System/drug effects , Respiratory System/immunology , Respiratory System/microbiology , Respiratory System/pathology , Risk Factors , Smoke/adverse effects , Smoking/adverse effects , Smoking/epidemiology , Spain/epidemiology , Nicotiana , Tobacco Smoke Pollution/adverse effects , Vaccination/economicsABSTRACT
La actinomicosis es una infección bacteriana lentamente progresiva, cuya frecuencia en nuestro país se desconoce habiéndose publicado un número muy limitado de casos, tanto en la literatura nacional como internacional, es producida por bacterias grampositivas anaerobias o microaerófilas que colonizan la orofaringe y el tracto gastrointestinal. Su principal agente productor en humanos es actinomyces israelí. Se describe un caso clínico de un paciente de acho años de edad con cuadro clínico de tumoración en pared torácica y efusión seropurulenta, que requirió cirugía torácica diagnostica y terapeútica cuyo estudio anatomopatológico concluyó neumonía poractinomices.
Subject(s)
Humans , Male , Child , Actinomycosis , Actinomycosis/surgery , Actinomycosis/therapy , Pneumonia , Thoracic WallABSTRACT
Se realizó estudio descriptivo prospectivo para evaluar la utilidad de la broncofibroscopia en el diagnóstico de las enfermedades neumológicas prevalentes en nuestro medio. Se realizaron 141 broncofibroscopias. Resultados bacteriológicos: de 84 pacientes (con sospecha de TBC) resultaron 20 pacientes (23.8 por ciento) con baciloscopias positivas; de 48 muestras para cultivo de gérmenes comunes se identificaron: pseudomonas 20 muestras (46.5 por ciento), estreptococos 08 muestras (18.6 por ciento), estafilococos 04 muestras (9.3 por ciento), Neisseria 03 muestras (7 por ciento), y 08 muestras (18.4 por ciento) de otros gérmenes y en examen para hongos, de 71 muestras se obtuvo 04 (5.6 por ciento) cultivos positivos (3:candida albicans, 1:aspergillus fumigatus). Resultados citológicos: En 36 pacientes se realizó papanicolao (PAP) en 5 (13.9 por ciento) se evidenciaron células sospechosas de neoplasia. Resultados histológicos: En 86 pacientes se realizaron biopsias; los resultados fueron bronquitis crónica 43 (46.7 por ciento), Inflamación crónica 15 (16 por ciento), bronquitis aguda 07 (7.6 por ciento), metaplasia epidermoide 07 (7.6 por ciento, granuloma tuberculosos 02 (2.2 por ciento) y otros más. Conclusiones: Se demostró la importancia del uso de la broncofibroscopia flexible en el diagnóstico de enfermedades infecciosas en nuestro medio, siendo el mayor aporte en la detección precoz de la TBC posibilitando su tratamiento con los mas importantes beneficios epidemiológicos, sin dejar de mostrar su aporte importante en el diagnóstico de neoplasias pulmonares.
Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Female , Bronchoscopy , Lung Diseases/diagnosis , Lung Diseases/therapy , Epidemiology, Descriptive , Prospective StudiesABSTRACT
Que de los 32 pacientes con cirrosis hepática en el presente estudio encontramos que las manifestaciones respiratorias en los mismo son muy frecuentes. Ya sean estas desde el punto de vista clínico como disnea, tos y platipnea, asi como funcional: Desaturación de oxígeno y espirometría anormal. Estas manifestaciones reafirman la sospecha del Sindrome hepatopulmonar en aproximandamente el 20 por ciento de los pacientes. Este comportamiento se asocia con una alta frecuencia de pacientes en estado Child B, demostrando su implicancia como factor pronóstico.