RESUMO
The use of antivirals, corticosteroids, and IL-6 inhibitors has been recommended by the WHO to treat COVID-19. CP has also been considered for severe and critical cases. Clinical trials on CP have shown contradictory results, but an increasing number of patients, including immunocompromised ones, have shown benefits from this treatment. We reported two clinical cases of patients with prolonged COVID-19 infection and B-cell depletion who showed rapid clinical and virological recovery after the administration of CP. The first patient in this study was a 73-year-old female with a history of follicular non-Hodgkin lymphoma previously treated with bendamustine followed by maintenance therapy with rituximab. The second patient was a 68-year-old male with chronic obstructive pulmonary disease, bipolar disorder, alcoholic liver disease, and a history of mantellar non-Hodgkin lymphoma treated with rituximab and radiotherapy. After the administration of CP, both patients showed a resolution of symptoms, improvement of their clinical conditions, and a negative result of the nasopharyngeal swab test. The administration of CP might be effective in resolving symptoms and improving clinical and virological outcomes in patients with B-cell depletion and prolonged SARS-CoV2 infections.
RESUMO
Early COVID-19 treatments can prevent progression to severe disease. However, real-life data are still limited, and studies are warranted to monitor the efficacy and tolerability of these drugs. We retrospectively enrolled outpatients receiving early treatment for COVID-19 in 11 infectious diseases units in the Tuscany region of Italy between 1 January and 31 March 2022, when Omicron sublineages BA.1 and BA.2 were circulating. Eligible COVID-19 patients were treated with sotrovimab (SOT), remdesivir (RMD), nirmatrelvir/ritonavir (NRM/r), or molnupiravir (MOL). We gathered demographic and clinical features, 28-day outcomes (hospitalization or death), and drugs tolerability. A total of 781 patients (median age 69.9, 66% boosted for SARS-CoV-2) met the inclusion criteria, of whom 314 were treated with SOT (40.2%), 205 with MOL (26.3%), 142 with RMD (18.2%), and 120 with NRM/r (15.4%). Overall, 28-day hospitalization and death occurred in 18/781 (2.3%) and 3/781 (0.3%), respectively. Multivariable Cox regression showed that patients receiving SOT had a reduced risk of meeting the composite outcome (28-day hospitalization and/or death) in comparison to the RMD cohort, while no significant differences were evidenced for the MOL and NRM/r groups in comparison to the RMD group. Other predictors of negative outcomes included cancer, chronic kidney disease, and a time between symptoms onset and treatment administration > 3 days. All treatments showed good safety and tolerability, with only eight patients (1%) whose treatment was interrupted due to intolerance. In the first Italian multicenter study presenting real-life data on COVID-19 early treatments, all regimens demonstrated good safety and efficacy. SOT showed a reduced risk of progression versus RMD. No significant differences of outcome were observed in preventing 28-day hospitalization and death among patients treated with RMD, MOL, and NRM/r.
Assuntos
COVID-19 , Pacientes Ambulatoriais , Humanos , Idoso , Estudos Retrospectivos , SARS-CoV-2 , Itália/epidemiologiaRESUMO
OBJECTIVE: To investigate the impact of 215 HIV-1 revertants on the risk of virological failure of the first thymidine analog-containing highly active antiretroviral therapy (HAART). DESIGN: The study included 491 HIV-1 subjects of the Italian Cohort Naive for Antiretrovirals, 405 of whom received a genotypic assay before therapy and had a virological follow-up. METHODS: Pre-treatment genotypic resistance was assessed by sequencing of the whole protease (PR) and reverse transcriptase (RT) region. RESULTS: Three (3.2%) and 13 (3.3%) individuals with recent (n = 95) and chronic (n = 396) HIV-1 infection carried an HIV-1 strain with 215 revertants (215D/C/E/A/V), respectively. In contrast, nucleoside associated mutations were higher in the former (15.8%) compared with the latter group (6.8%) (P = 0.005). A multivariable regression model, considering pre-HAART viral load levels, use of saquinavir-hard gel as the only PI, use of zidovudine, number of other RT and PR mutations, indicated that patients carrying 215 revertants had an increased risk of virological failure compared with those not carrying such mutants (adjusted relative hazard = 2.97 95% confidence interval, 1.11-7.94, P = 0.03). Among patients with 215 revertants, who experienced virological failure, four out of seven showed the emergence of the 215Y resistant mutation. The probability of 215Y occurrence was different between patients carrying 215 revertants compared with those who did not carried these mutants (P = 0.006). CONCLUSIONS: HIV-1 215 revertants with an increased ability for selecting 215Y mutation are associated with a higher risk of virological failure and may lead to the appearance of virus carrying 215Y/F mutation in vivo. These findings suggest that 215 revertant viruses may compromise the efficacy of the first thymidine analog-containing regimen.
Assuntos
Terapia Antirretroviral de Alta Atividade , Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Adulto , Idoso , Doença Crônica , Estudos de Coortes , Feminino , Genótipo , Infecções por HIV/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutação/genética , Recidiva , Fatores de Risco , Timidina/análogos & derivados , Falha de TratamentoRESUMO
Na Itália, há alguns anos, uma nova profissão nasceu como resposta adaptativa ao envelhecimento da população: a das badanti. Esse termo popular designa as mulheres imigrantes trabalhadoras no domicílio de pessoas idosas. Esse fenômeno de sociedade diz respeito a quatro milhões de pessoas, contando os assistidos e as trabalhadoras. Essas pessoas se encontram à margem da sociedade e são desconsideradas. A desqualificação é implícita, inscrita na própria denominação. Badanti vem do verbo "badare", que significa "vigiar de perto", "guardar": a empatia inscrita no termo "care" ou "ajuda" não está presente. Esse welfare feito em casa, que se revelou um recurso diante da carência de serviços públicos, fez explodir as numerosas contradições que constituirão o objeto de nossa análise. A crônica dos jornais diários sobre incidentes fez vir à tona delitos, abandonos e litígios no momento de heranças, e também contradições nos grupos intermediários. O sindicato, por exemplo, é levado a gerir as guerras entre pobres: as badanti e os idosos aposentados. Todavia, a contradição mais saliente se encontra no cerne da atividade. A profissão apresenta várias facetas e, ao lado da identificação da badante com o assistido, encontramos a humilhação e o ressentimento que resultam das condições de exercício da atividade: a "domesticidade" e a "servidão".(AU)
En Italie, depuis quelques années, un nouveau métier est né en tant que réponse adaptative au vieillissement de la population: celui des "badanti". Ce terme populaire désigne les femmes immigrées travaillant au domicile des personnes âgées. Ce phénomène de société concerne quatre millions de personnes, en comptant les assistés et les travailleuses. Ces personnes se trouvent en marge de la société et sont déconsidérées. La disqualification est implicite, inscrite dans la dénomination même. "Badanti" vient du verbe "badare", qui signifie "surveiller de près", "garder": l'empathie inscrite dans le terme "care" ou "aide" n'est pas présente. Ce "welfare" fait maison, qui s'est révélé une ressource face à la carence de services publics, a fait exploser les nombreuses contradictions qui feront l'objet de notre analyse. La chronique des faits divers a fait émerger des délits, des abandons, des litiges lors des successions et aussi des contradictions dans les corps intermédiaires. Par exemple, le syndicat, est amené à gérer des guerres entre pauvres: les "badanti" et les vieux retraités. Toutefois, la contradiction la plus saillante se trouve au cur de l'activité. Le métier présente plusieurs facettes et à coté de l'identification de la "badante" avec l'assisté, nous trouvons l'humiliation et le ressentiment qui résultent des conditions d'exercice de l'activité: la "domesticité" et la "servitude".(AU)
During the last years a new trade appeared in Italy as an adaptive answer to the problems arising from the ageing process of population: that of "badanti". This popular term designates the immigrated women working at old persons homes. This social phenomenon concerns four million people, including workers and assisted. These persons are marginalized and discredited. Discredit is implicit in the denomination itself. "Badanti" comes from the verb "badare" that means "to strictly survey", "to control": the empathy inscribed in the words "care" or "help" is not present. This contribution will analyze this homemade welfare, that, even if it is allowing to face the lack of public services, is disclosing several contradictions. Newspapers are reporting crimes, abandons, arguments for successions, and even contradictions inside mediation organizations. Trade unions have to manage, for example, wars between poor people: "badanti" and old-age pensioners. Anyways, the most sensible contradiction is at the core of the activity. The trade presents several faces and, besides the identification of the "badante" with the assisted person, we find the humiliation and resentment, which result from the conditions of domestic labour and servitude.(AU)
Assuntos
Emigrantes e Imigrantes , Violência Doméstica , Violência contra a Mulher , ItáliaRESUMO
Na Itália, há alguns anos, uma nova profissão nasceu como resposta adaptativa ao envelhecimento da população: a das badanti. Esse termo popular designa as mulheres imigrantes trabalhadoras no domicílio de pessoas idosas. Esse fenômeno de sociedade diz respeito a quatro milhões de pessoas, contando os assistidos e as trabalhadoras. Essas pessoas se encontram à margem da sociedade e são desconsideradas. A desqualificação é implícita, inscrita na própria denominação. Badanti vem do verbo "badare", que significa "vigiar de perto", "guardar": a empatia inscrita no termo "care" ou "ajuda" não está presente. Esse welfare feito em casa, que se revelou um recurso diante da carência de serviços públicos, fez explodir as numerosas contradições que constituirão o objeto de nossa análise. A crônica dos jornais diários sobre incidentes fez vir à tona delitos, abandonos e litígios no momento de heranças, e também contradições nos grupos intermediários. O sindicato, por exemplo, é levado a gerir as guerras entre pobres: as badanti e os idosos aposentados. Todavia, a contradição mais saliente se encontra no cerne da atividade. A profissão apresenta várias facetas e, ao lado da identificação da badante com o assistido, encontramos a humilhação e o ressentimento que resultam das condições de exercício da atividade: a "domesticidade" e a "servidão"...
En Italie, depuis quelques années, un nouveau métier est né en tant que réponse adaptative au vieillissement de la population: celui des "badanti". Ce terme populaire désigne les femmes immigrées travaillant au domicile des personnes âgées. Ce phénomène de société concerne quatre millions de personnes, en comptant les assistés et les travailleuses. Ces personnes se trouvent en marge de la société et sont déconsidérées. La disqualification est implicite, inscrite dans la dénomination même. "Badanti" vient du verbe "badare", qui signifie "surveiller de près", "garder": l'empathie inscrite dans le terme "care" ou "aide" n'est pas présente. Ce "welfare" fait maison, qui s'est révélé une ressource face à la carence de services publics, a fait exploser les nombreuses contradictions qui feront l'objet de notre analyse. La chronique des faits divers a fait émerger des délits, des abandons, des litiges lors des successions et aussi des contradictions dans les corps intermédiaires. Par exemple, le syndicat, est amené à gérer des guerres entre pauvres: les "badanti" et les vieux retraités. Toutefois, la contradiction la plus saillante se trouve au cur de l'activité. Le métier présente plusieurs facettes et à coté de l'identification de la "badante" avec l'assisté, nous trouvons l'humiliation et le ressentiment qui résultent des conditions d'exercice de l'activité: la "domesticité" et la "servitude"...
During the last years a new trade appeared in Italy as an adaptive answer to the problems arising from the ageing process of population: that of "badanti". This popular term designates the immigrated women working at old persons homes. This social phenomenon concerns four million people, including workers and assisted. These persons are marginalized and discredited. Discredit is implicit in the denomination itself. "Badanti" comes from the verb "badare" that means "to strictly survey", "to control": the empathy inscribed in the words "care" or "help" is not present. This contribution will analyze this homemade welfare, that, even if it is allowing to face the lack of public services, is disclosing several contradictions. Newspapers are reporting crimes, abandons, arguments for successions, and even contradictions inside mediation organizations. Trade unions have to manage, for example, wars between poor people: "badanti" and old-age pensioners. Anyways, the most sensible contradiction is at the core of the activity. The trade presents several faces and, besides the identification of the "badante" with the assisted person, we find the humiliation and resentment, which result from the conditions of domestic labour and servitude...