COVID-19 lateral flow IgG seropositivity and serum neutralising antibody responses after primary and booster vaccinations in Chile: a cross-sectional study.

BACKGROUND: By June 30, 2022, 92·6% of the Chilean population older than 18 years had received a full primary SARS-CoV-2 vaccine series, mostly with CoronaVac (Sinovac Biotech), and 78·4% had received a booster dose, mostly heterologous with BNT162b2 (Pfizer-BioNTech) and ChAdOx1 (AstraZeneca). We previously reported national seroprevalence data from lateral flow testing of IgG SARS-CoV-2 antibodies up to 16 weeks after primary vaccination. Our aim here was to study IgG seropositivity dynamics up to 30 weeks after primary vaccination and, in CoronaVac recipients, up to 26 weeks after booster vaccination, and to establish the correlation between lateral flow tests and neutralising antibody titres. METHODS: In this cross-sectional study, testing stations for SARS-CoV-2 IgG detection were selected and installed from March 12, 2021, in hotspots in 24 large Chilean cities, and were maintained until March 31, 2022. Individuals voluntarily approaching the testing stations were invited to perform a rapid lateral flow test via a finger prick and complete a questionnaire. Between Aug 12, 2021, and April 1, 2022, volunteers seeking medical care in the Mutual de Seguridad de la Cámara Chilena de la Construcción provided blood samples for lateral flow testing and neutralising antibody studies; inclusion criteria were age at least 18 years, history of complete primary vaccination series with CoronaVac, BNT162b2, or ChAdOx1, or no vaccine, and no previous COVID-19 diagnosis. We tested the difference in IgG positivity across time, and between primary and booster doses, in all eligible participants with complete records, controlling for age, gender, and comorbidities. We also assessed the predictive power of neutralising antibody titres and sociodemographic characteristics on the probability of IgG positive results using multivariable logistic regression. FINDINGS: Of 107 220 individuals recruited at the testing stations, 101 070 were included in our analysis (59 862 [59·2%] women and 41 208 [40·8%] men). 65 902 (65·2%) received primary vaccination series with CoronaVac, 18 548 (18·4%) with BNT162b2, and 606 (0·6%) with ChAdOx1, and 16 014 (15·8%) received no vaccine. Among the 61 767 individuals with a complete primary vaccination series with CoronaVac, 608 (1·0%) received a CoronaVac booster, 10 095 (16·3%) received a BNT162b2 booster, and 5435 (8·8%) received a ChAdOx1 booster. After ChAdOx1 primary vaccination, seropositivity peaked at week 5 after the second dose, occurring in 13 (92·9%, 95% CI 79·4-100·0) of 14 individuals. In participants who received a complete CoronaVac primary series, the decline in seropositivity stabilised at week 18 after the second dose (86 [44·7%, 95% CI 41·8-47·7] of 1087 individuals), whereas after receiving BNT162b2, seropositivity declined slightly by week 25 after the second dose (161 [94·2%, 90·6-97·7] of 171). A lower proportion of individuals who received the CoronaVac primary series and a homologous booster were seropositive (279 [85·6%, 95% CI 81·8-89·4] of 326) by weeks 2-18 than those who received a BNT162b2 booster (7031 [98·6%, 98·4-98·9] of 7128) or a ChAdOx1 booster (2893 [98·0%, 97·5-98·5] of 2953). The correlation between IgG positivity and log of the infectious dose in 50% of neutralising antibodies was moderate, with a sensitivity of 81·4% (95% CI 76·3-86·6) and specificity of 92·5% (73·3-100·0). INTERPRETATION: Dynamic monitoring of IgG positivity to SARS-CoV-2 can characterise antibody waning over time in the absence or presence of booster doses, providing relevant data for the design of vaccination strategies. The correlation between lateral flow test IgG titres and neutralising antibody concentrations suggests that they could be a quick and effective surveillance tool to measure protection against SARS-CoV-2. FUNDING: Instituto Sistemas Complejos de Ingeniería, Subsecretaría de Redes Asistenciales, Ministry of Health, Chile, and Mutual de Seguridad de la Cámara Chilena de la Construcción.

[Use of bisoprolol in heart failure. The BISOCOR observational study]. / Empleo de bisoprolol en la insuficiencia cardíaca. Resultados del estudio BISOCOR.

INTRODUCTION AND OBJECTIVES: The benefits of beta blockers in heart failure are highly dependent on dosage. This study aimed to analyze the degree of concordance between targeted (CIBIS II) and achieved doses of bisoprolol in a group of patients with stable heart failure on conventional treatment. We also evaluated functional parameters, adverse effects and the reasons for withdrawal or drop-out. PATIENTS AND METHOD: The study group consisted of 334 patients with stable systolic heart failure who were receiving conventional treatment. Treatment with bisoprolol was initiated according to current guidelines (starting dose 1.25 mg/day, with weekly increments to 5 mg/day, and then increments every four weeks to a targeted dosis of 10 mg/day). The main endpoint was the comparison between targeted dose and dose reached at each follow-up. Secondary endpoints were quality of life assessment (Minnesota Living with Heart Failure Questionnaire), functional status (New York Heart Association), ejection fraction change, and side effects during the 9-month follow-up period. RESULTS: Thirty-four (10%) patients did not finish the study: 1 because of sudden death, 2 because of surgery, and 31 because of side effects. 63% of the patients attained the maximum targeted dose; the mean dose at the end of follow-up was 8.5 mg. Functional status, quality of life and ejection fraction improved significantly between the beginning and the end of the study. Only 4 patients had severe adverse effects. CONCLUSIONS: This is the first study in Spain to show that bisoprolol can be used effectively at the maximum recommended doses, for the outpatient treatment of heart failure.

Empleo de bisoprolol en la insuficiencia cardíaca. Resultados del estudio BISOCOR / Use of Bisoprolol in heart failure. The BISOCOR observational study

Introducción y objetivos. La eficacia clínica y pronóstica de los bloqueadores beta en la insuficiencia cardíaca depende de la dosis. Este estudio prospectivo de observación pretendió comparar las dosis de bisoprolol alcanzadas en pacientes con insuficiencia cardíaca con las recomendadas (CIBIS II). También se evaluaron los parámetros funcionales, los efectos adversos y las causas de abandono del tratamiento. Pacientes y método. Se incluyeron 334 pacientes con insuficiencia cardíaca sistólica estable con tratamiento habitual. Iniciaron tratamiento ambulatorio con bisoprolol con la dosificación progresiva recomendada (inicio con 1,25 mg/día, aumentos semanales en la misma cuantía hasta los 5 mg/día y, después, incrementos de 2,5 mg/día cada 4 semanas hasta 10 mg/día). El seguimiento máximo fue de 9 meses. La variable principal fue la comparación del promedio de la dosis tomada en cada visita con la esperada. La calidad de vida se analizó con el cuestionario Minnesotta. Resultados. Hubo 34 retiradas (10 por ciento): un paciente por fallecimiento súbito, dos por cirugía y 31 por efectos adversos. Del grupo total de pacientes, el 64 por ciento alcanzaron la dosis máxima al final del estudio; la dosis media final fue de 8,5 mg/día. El grado funcional, las puntuaciones de calidad de vida y la fracción de eyección mejoraron significativamente entre el inicio y el final del estudio. Sólo hubo cuatro reacciones adversas graves. Conclusiones. El estudio confirma la factibilidad de introducir el bisoprolol en el tratamiento ambulatorio de la insuficiencia cardíaca crónica en las dosis máximas recomendadas (AU)

Estudio y mejoramiento del alumbrado publico en la ciudad de La Paz

En nuestra ciudad, se hace necesario el estudio planificado para el alumbrado de sus vias, a partir delmicro centro hacia las zonas perifericas. El estado que se encuentra el alumbrado en nuestra ciudad y el poco o nada de mantenimiento que se le dedica, hace preveer, de que no se ha efectuado el estudio y proyecto correspondiente para la iluminacion de una determinada via, precautelando asi, por la seguridad del peaton y de los conductores de vehiculos. De esta manera, el proyecto se divide en tres partes: la primera parte, da la introduccion de los efectos fisicos de la luz y su control. La segunda parte, desarrolla el estudio correspondiente, al estado actual en el que se encuentra el sistema de alumbrado en nuestra ciudad. La tercera parte, propone el mejoramiento de sus vias, normalizacion de las fuentes de luz, estudio de costos y el mantenimiento que se le debe otorgar al alumbrado, todo lo espuesto, basandose en las recomendaciones de los organismos internacionales de la A.S.A., I.E.S., C.I.E.