Clinical and economic benefits of continuous blood glucose monitoring devices

The main intervention to reduce the macro-and microvascular complications of diabetes mellitus (DM) remains to achieve better long-term glycemic control. We have discussed the clinical and economic advantages of using continuous glucose monitoring (CGM) devices for type 1 DM and type 2 DM (T1DM and T2DM) based on data from relevant studies in the literature. Our findings show that using these modalities is associated with remarkable outcomes, including reduced HbA1c levels and enhanced glycemic control among patients with T1DM and T2DM. This can enhance the quality of care and life for diabetic patients and intervene against the development of serious complications and hypoglycemia-related adverse events. The cost of routinely using these devices might seem relatively high. However, the estimated cost benefits are usually higher as they can significantly reduce hospitalization rates due to hypoglycemia and the frequency of diabetic therapy malpractices, which are frequently encountered. However, not many studies have reported these outcomes, indicating the need to conduct future relevant studies.

Evidence of early community transmission of Omicron (B1.1.529) in Delhi- A city with very high seropositivity and past exposure!

Background: Since identification, infections by the new SARS-CoV-2 variant Omicron are rapidly increasing worldwide. There is a huge gap of knowledge regarding virus behavior in the population from low and middle-income countries. Delhi being a unique population with a high seropositivity and vaccination rate against COVID-19 infection. We aimed to study the epidemiological and clinical presentations of a few early cases of community spread of Omicron infection in the state. Methods: This is a prospective study where respiratory specimen from all RT-PCR confirmed positive cases between November 25th-December 23rd 2021 collected from five districts of Delhi were subjected to whole-genome sequencing. Complete demographic and clinical details were recorded. We also analyzed the formation of local and familial clusters and eventual community transmission. Findings: Out of the 264 cases included during the study period, 68.9% (n=182)were identified as Delta and its sub-lineages while 31.06% (n=82) were Omicron with BA.1 as the predominant sub-lineage (73.1%). Most of the Omicron cases were asymptomatic (n=50,61%) and did not require any hospitalizations. A total of 72 (87.8%) cases were fully vaccinated. 39.1% (n=32) had a history of travel and/or contacts while 60.9 (n=50) showed a community transmission. A steep increase in the daily progression of Omicron cases with its preponderance in the community was observed from 1.8% to 54%. Interpretation: This study is among the first from India to provide evidence of community transmission of Omicron with significantly increased breakthrough infections, decreased hospitalization rates, and a lower rate of symptomatic infections among individuals with high seropositivity against SARS-CoV-2 infections.

Respiratory Syncytial Virus (RSV) Diseases

The respiratory syncytial virus (RSV) is an RNA virus that causes annual ARI outbreaks during winter with mild URTI in the general population, but with severe LRTI particularly among young children (bronchiolitis), patients with underlying diseases and people >65 years of age. RSV does not induce a long-lasting protective immunity and repeated infections throughout life are the norm. Basically, all children have been infected by 2 years of age and of those hospitalized, >50% are <3 months and 75% are <6 months of age. The overall CFR is 1/500. For adults ≥65 years, RSV hospitalization rates are 90–250/105. There is no specific therapy, general preventive measures include general hygiene and isolation/separation of patients. A monoclonal anti-F-protein antibody is available for passive immunization of selected high-risk children. It requires monthly injections, comes at a high cost and has limited efficacy (50% against RSV hospitalization). Active immunization failed in the past, probably as the post-fusion conformation of the F-protein was used. Long-acting monoclonal antibodies (for infants) as well as stabilized pre-fusion F-protein vaccines (for immunization of pregnant women, children, older adults) produced on various platforms are in late stages of clinical development.

Differential Effects of Race/Ethnicity and Social Vulnerability on COVID-19 Positivity, Hospitalization, and Death in the San Francisco Bay Area

BACKGROUND: Higher COVID-19 incidence and morbidity have been amply documented for US Black and Hispanic populations but not as clearly for other racial and ethnic groups. Efforts to elucidate the mechanisms underlying racial health disparities can be confounded by the relationship between race/ethnicity and socioeconomic status. OBJECTIVE: Examine race/ethnicity and social vulnerability effects on COVID-19 outcomes in the San Francisco Bay Area, an ethnically and socioeconomically diverse region. DESIGN: Retrospective cohort study. SETTING: Geocoded patient records from the University of California, San Francisco Health system between January 1, 2020 to December 31, 2020. PATIENTS: Patients who underwent polymerase chain reaction testing for COVID-19. EXPOSURES: Race/ethnicity and Social Vulnerability Index (SVI). MAIN MEASURES: COVID-19 test frequency, positivity, hospitalization rates, and mortality. KEY RESULTS: Higher social vulnerability, but not race/ethnicity, was associated with less frequent testing yet a higher likelihood of testing positive. Asian hospitalization rates (11.5\%) were double that of White patients (5.4\%) and exceeded the rates for Black (9.3\%) and Hispanic (6.9\%) groups. A modest relationship between higher hospitalization rates and increasing social vulnerability was evident only for White individuals. The Hispanic group had the lowest mean age at death and thus highest years of expected life lost due to COVID-19. CONCLUSIONS: COVID-19 outcomes were not consistently explained by greater socioeconomic vulnerability. Asian individuals showed disproportionately high rates of hospitalization regardless of socioeconomic status. Study of the San Francisco Bay Area population not only provides valuable insights into the differential contributions of race/ethnicity and social determinants of health to COVID-19 outcomes but also emphasizes that all racial groups have experienced the toll of the pandemic, albeit in different ways and to varying degrees.

Associations of Atrial Fibrillation Patterns With Mortality and Cardiovascular Events: Implications of the MISOAC-AF Trial

Aim: This retrospective cohort study aimed to evaluate the prognostic implications of the distinct atrial fibrillation (AF) temporal patterns: first diagnosed, paroxysmal, and persistent or permanent AF. Methods: In this post hoc analysis of the MISOAC-AF trial (NCT02941978), a total of 1052 patients with AF (median age 76 years), discharged from the cardiology ward between 2015 and 2018, were analyzed. Kaplan-Meier and Cox-regression analyses were performed to compare the primary outcome of all-cause mortality, the secondary outcomes of stroke, major bleeding and the composite outcome of cardiovascular (CV) mortality or hospitalization among AF patterns. Results: Of patients, 121 (11.2%) had first diagnosed, 356 (33%) paroxysmal, and 575 (53.2%) persistent or permanent AF. During a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients died. Compared with paroxysmal AF, patients with persistent or permanent AF had higher mortality rates (adjusted hazard ratio (aHR), 1.37; 95% confidence interval [CI], 1.08-1.74, P = .009), but similar CV mortality or hospitalization rates (aHR, 1.09; 95% CI, 0.91-1.31, P = .35). Compared with first diagnosed AF, patients with persistent or permanent AF had similar mortality (aHR, 1.26; 95% CI, 0.87-1.82, P = .24), but higher CV mortality or hospitalization rates (aHR, 1.35; 95% CI, 1.01-1.8, P = .04). Stroke and major bleeding events did not differ across AF patterns (all P > .05). Conclusions: In conclusion, in recently hospitalized patients with comorbid AF, the presence of persistent or permanent AF was associated with a higher incidence of mortality and morbidity compared with paroxysmal and first diagnosed AF.

Early signals of significantly increased vaccine breakthrough, decreased hospitalization rates, and less severe disease in patients with COVID-19 caused by the Omicron variant of SARS-CoV-2 in Houston, Texas

Genetic variants of SARS-CoV-2 continue to dramatically alter the landscape of the COVID-19 pandemic. The recently described variant of concern designated Omicron (B.1.1.529) has rapidly spread worldwide and is now responsible for the majority of COVID-19 cases in many countries. Because Omicron was recognized very recently, many knowledge gaps exist about its epidemiology and clinical severity and disease course. A comprehensive genome sequencing study of SARS-CoV-2 in the Houston Methodist healthcare system identified 862 symptomatic patients with infections caused by Omicron from late November 2021 through December 18, 2021. Omicron very rapidly increased in only three weeks to cause 90% of all new COVID-19 cases. Compared to patients infected with either Alpha or Delta variants in our healthcare system, Omicron patients were significantly younger, had significantly increased vaccine breakthrough rates, and were significantly less likely to be hospitalized. Omicron patients required less intense respiratory support and had a shorter length of hospital stay, consistent with decreased disease severity. Although the number of Omicron patients we studied is relatively small, in the aggregate the data document the unusually rapid spread and increased occurrence of COVID-19 caused by the Omicron variant in metropolitan Houston, and provide information about disease character.

Covid vaccine dilemma curbing the herd immunity in India- Jab or no jab?

After the devastating second wave of COVID-19, with the rapid increase in the number of new cases in many states of India marking the beginning of a probable third wave of COVID-19, our best bet is taking a jab to protect against COVID-19. Currently, licensed vaccines are found to be reasonably safe and effective. The second wave of COVID-19 was devastating, but it's a silver lining to note that most of the individuals who had taken the jab recovered with mild infections, and the hospitalization rates among jabbed individuals were meager. Various rumours related to the efficacy, safety, content, and side effects of the vaccine in India had caused a plunge in the vaccine acceptance rate leading to hesitancy and carelessness among the Indian population. This is a critical time for facts, not fear or rumors. This review provides an insight into the myths, pros and cons, and efficacy of the available vaccines.

Correlation Between Duration of Hemodialysis and Depression in Chronic Kidney Disease

Depression is commonly found in stage 5 CKD patients. However, depression in HD patients is usually neglected, underdiagnosed, and remains untreated. Duration of HD is reported to be significantly correlated with depression. Previously, there were several similar studies with varying results. This study is needed to detect depression and give early intervention to reduce hospitalization rates and patient mortality. This study aims to find the correlation between the duration of hemodialysis and depression in CKD patients. A cross-sectional was carried out on 52 patients with CKD undergoing HD in Dr. Soetomo General Academic Hospital using consecutive sampling. Beck Depression Inventory-II (BDI-II) questionnaire was used to measure the depression score. Data were analyzed with the Pearson correlation test. This study showed a significant negative correlation between the duration of hemodialysis and depression (p =0.005, p > 0,05; r= -0.094). Duration of hemodialysis was significantly correlated with depression. The longer duration of hemodialysis, the lower score of depression. Periodic evaluation of HD patients for depression is needed for early intervention to reduce morbidity.

SIR model for assessing the impact of the advent of Omicron and mitigating measures on infection pressure and hospitalization needs

Background: On 26 November 2021, the world health organization (WHO) designated the coronavirus SARS-CoV-2 B.1.1.529 a variant of concern, named Omicron (WHO, 2021a). As of December 16, Omicron has been detected in 89 countries (WHO, 2021b). The thread posed by Omicron is highly uncertain. Methods and findings: For the analysis of the impact of Omicron on infection pressure and hospitalization needs we developed an open-source stochastic SIR (Susceptible-Infectious-Removed) fast-model for simulating the transmission in the transition stage from the prevailing variant (most often Delta) to Omicron. The model is capable to predict trajectories of infection pressure and hospitalization needs, considering (a) uncertainties for the (Omicron) parametrization, (b) pre-existing vaccination and/or partial immunity status of the population, and demographic specific aspects regarding reference hospitalization needs, (c) effects of mitigating measures including social distancing and accelerated vaccination (booster) campaigns. Conclusions: The SIR model approach yields results in fair agreement with Omicron transmission characteristics observed in South Africa and prognosis results in Europe. The equations underlying the SIR formulation allows to effectively explore the effect of Omicron parametrization on anticipated infection growth rates and hospitalization rates relative to the prevailing variant. The models are online available as open source on GitHub.