Persistence of neutralizing antibodies and clinical protection up to 12 months after SARS-CoV-2 infection in elderly

Background

COVID-19 has severely affected the elderly who are expected to display decreased immune responses due to immunosenescence.

Methods

This study retrospectively assesses neutralizing antibodies (NAb) productions up to 12 months(M) after infection in Long-term care patients. We used Roche diagnostics immunoassay to quantify anti-Spike(S) antibodies and a competitive immunoassay from Yhlo as a surrogate test for NAb.

Results

We included 91 patients, mean age 86 years. There was no significant variation of anti-S titers over time. There was a significant decrease of NAb titers between M3 and M6 but no further significant change up to M12. Overall, 75/91 (82%) and 52/91 (57%) patients had at least once anti-S titers >75 U/mL and NAb titers >50 AU/mL, respectively, corresponding to a significant neutralizing activity in vitro. All 68 patients studied at M12 had detectable anti-S antibodies and 60 (88%) had detectable NAb; 60/68 (88%) and 29/68 (42.6%) still had anti-S titers >75 U/mL and NAb titers >50 AU/mL. Higher NAb titers were correlated with severe infection, higher levels of CRP and lower lymphocyte counts. No patient developed reinfection.

Conclusion

Elderly people can display robust and persistent humoral response after SARS-CoV-2 infection, with NAb lasts up to 12 months.

Diabète de primodécouverte chez les patients atteints de covid-19 dans l’unité d’isolement de l’hôpital de Mahdia

Introduction

La relation entre diabète et infection Covid 19 avait suscité un intérêt particulier. L’infection ainsi que son traitement par corticoïdes pourrait décompenser, révéler ou induire un diabète sucré.

Résultats

Il s’agit d’une étude rétrospective portant sur 200 patients hospitalisés pour pneumopathie due au SARS-cov2 entre décembre 2020 et avril 2021. Presque la moitié avait un diabète connu (45 %). L’âge moyen était plus avancé chez cette population (66 ans pour les sujets ayant un diabète vs 63,9 ans). La moyenne des glycémies à l’admission des personnes non connues avoir un diabète était à 13. 94 mmol/l et celle de l’HBA1C à 8. 58 %. 86 % d’entre eux avaient des comorbidités (HTA dans 50 % des cas). Le tableau clinique chez ces patients était marqué par la dyspnée (91 %), la fièvre (72,3 %), la toux sèche (36,4 %) et l’asthénie (27,3 %). Une hospitalisation initiale en réanimation avait intéressé 13. 6 % de ces patients. L’atteinte scanographique était sévère (> 50 % du parenchyme) dans 75 % des cas. Leur PaO2 moyenne initiale était de 70,59 mmhg avec un besoin en oxygène de 5,12 l/min. La corticothérapie était prescrite chez 86,4 % de ces patients. L’évolution était favorable dans 90 % des cas. À la sortie, 50 % des patients qui n’avaient pas de diabète dans leurs antécédents étaient traités par insuline.

Conclusion

Malgré la sévérité de l’atteinte pulmonaire, les comorbidités et la prévalence de diabète associé à l’infection Covid 19 chez nos patients, le pronostic était globalement favorable. Il sera important de rechercher la proportion et le type de diabètes démasqués ou induits par l’infection.

[Prognostic factors in idiopathic pulmonary fibrosis in a tunisian cohort]

We present data on prognostic factors in a Tunisian cohort of people with Idiopathic pulmonary fibrosis.

INTRODUCTION

Idiopathic pulmonary fibrosis (IPF) has a poor prognosis, with a median survival in patients with the condition of only 3 to 5 years. Previous studies have identified a number of prognostic factors in this chronic pulmonary disease.

METHODS

We conducted a retrospective study, including patients with idiopathic pulmonary fibrosis (IPF) who were diagnosed at the Pneumology Department of the University Hospital Fattouma-Bourguiba, Monastir, between 1991 and 2014. The aim of this study was to compare clinical, radiological, pulmonary functional predictors of survival in IPF in a Tunisian cohort with those of previous studies.

RESULTS

This study included 126 patients. Their mean age was 66 years, with a male predominance (68.3%). Respiratory function tests revealed a restrictive ventilatory deficit in 72.6% of cases. The median survival of our study population was 22.5 months [6.7-49.5]. In univariate analysis, factors associated with a poor prognosis were: lower baseline values of TLC, FCV and DLco, level of dyspnea assessed by mMRC scale, hypoxemia at diagnosis, the degree of desaturation during exercise, a higher annual decline of FVC and DLco, acute respiratory distress and also the GAP score. In multivariate analysis, independent prognostic factors were: baseline DLco, level of dyspnea, desaturation at exertion and the annual decline of the DLco.

CONCLUSION

Lower baseline DLco, the level of dyspnea, desaturation on exercise, and annual decline in DLco are all associated with a poor prognosis in IPF.

Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study

BACKGROUND

Diabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk grade.

METHODS

Cross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included.

RESULTS

Among 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10 g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher-risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR = 2.529, CI95 [1.131-5.655], p = 0.024), hyperkeratosis (OR = 2.658, CI95 [1.222-5.783], p = 0.014) and school level (OR = 0.489, CI95 [0.253-9.44], p = 0.033).

CONCLUSIONS

Risk factors for foot ulceration were rather common in outpatients with diabetes. The screening of patients at risk for foot ulceration should start early, integrated with sustainable patient education.