Assessing the Impact of SARS-CoV-2 Lineages and Mutations on Patient Survival.

OBJECTIVES: More than two years into the COVID-19 pandemic, SARS-CoV-2 still remains a global public health problem. Successive waves of infection have produced new SARS-CoV-2 variants with new mutations for which the impact on COVID-19 severity and patient survival is uncertain. METHODS: A total of 764 SARS-CoV-2 genomes, sequenced from COVID-19 patients, hospitalized from 19th February 2020 to 30 April 2021, along with their clinical data, were used for survival analysis. RESULTS: A significant association of B.1.1.7, the alpha lineage, with patient mortality (log hazard ratio (LHR) = 0.51, C.I. = [0.14,0.88]) was found upon adjustment by all the covariates known to affect COVID-19 prognosis. Moreover, survival analysis of mutations in the SARS-CoV-2 genome revealed 27 of them were significantly associated with higher mortality of patients. Most of these mutations were located in the genes coding for the S, ORF8, and N proteins. CONCLUSIONS: This study illustrates how a combination of genomic and clinical data can provide solid evidence for the impact of viral lineage on patient survival.

Characteristics of subjects who died of chronic obstructive pulmonary disease in Andalusia in 2010 and 2011.

BACKGROUND: The place of death is an important consideration in the end-of-life care of patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: This study aimed to describe the place of death for patients with COPD in Andalusia (Spain) and the determinants of death at home compared to death outside of home. DESIGN: This observational study analyzed place of death from death certificates for the years 2010 and 2011 in Andalusia, Spain (over 8 million inhabitants, 17.8% of the Spanish population). MEASUREMENTS: Death certificates obtained from the Institute of Statistics and Cartography of Andalusia were used to describe where patients with COPD died. All deaths with ICD-10 codes J40 to J44 or J47 (International Classification of Diseases, Tenth Revision) were included for the years 2010 and 2011. Upon review of the death certificates, the following data were recorded: age, sex, marital status, rural areas, and place of death. RESULTS: Out of a total of 119,589 decedents, the research team retrieved the place of death for 4983 subjects. The chance of dying at home was higher for COPD patients aged ≥ 89 years and for females. Married and widowed persons had a greater likelihood of dying at home than singles. Moreover, the likelihood of death at home was higher for individuals residing in rural areas. CONCLUSIONS: Age, sex, marital status, and rural areas of residence determine where COPD patients will end their life in Andalusia. Knowledge about place of death and its determinants will facilitate the planning of health care palliative services.

Niveles de anticuerpos bactericidas frente a meningococo C tras la vacunación de niños de 2 a 6 años de edad en Andalucía / Levels of bactericidal antibodies against meningococcus C following the vaccination of children between 2 and 6 years of age in Andalusia

FUNDAMENTO: En 1997 el 18,5 por ciento de los casos de enfermedad meningocócica por serogrupo C en Andalucía fueron niños de 2 a 4 años de edad; edades donde respuesta inmune inicial y duración de la vacuna antimeningocócica de polisacárido capsular A+C, es menor que en edades superiores. Se diseñó una investigación para medir la respuesta inmune producida por esta vacuna, en niños de 2 a 6 años de edad, y compararla con la inmunidad natural presente en niños no vacunados. MÉTODOS: I.- Doble estudio de seguimiento: a) grupos de niños previamente vacunados y grupos control, b) grupo de niños que iba a ser vacunado, para análisis pre y postvacunal (1, 6 y 12 meses) y grupo control. II.- La actividad bactericida se midió según protocolo estandarizado del CDC frente a cepa de N. meningítidis C-11. Los sueros con título de actividad bactericida (TAB) ³ 1:8 se consideraron protectores. RESULTADOS: Al mes y a los 2 meses de vacunarse la proporción de TAB³ 1:8 era significativamente superior a la del grupo control (65,5 por ciento y 73,9 por ciento frente a 2,2 por ciento y 12 por ciento. En el prevacunal y en el postvacunal a los 6, 7, 12 y 13 meses no se observó diferencia significativa entre vacunados y controles. CONCLUSIONES: Las diferencias entre vacunados y no vacunados 1 y 2 meses después de la vacunación indican seroconversión en los vacunados. Para el grupo de edad de 2 a 6 años la actividad bactericida adquirida declina rápidamente, ya que a los 6 meses dejan de observarse diferencias con el grupo control (AU)