fisiopatologia hematologica
razones de Alemania para suspender vacunacion menores de 50 años.
https://www.pei.de/EN/service/faq/coronavirus/faq-coronavirus-node.html?cms_tabcounter=3
Este es un blog medico que nunca podrá sustituir el buen juicio médico en la toma de decisiones.Intentamos compartir con los profesionales nuestras experiencias, conocimientos,lecturas,etc con la finalidad de mejorar la practica clinica.No es un blog para pacientes aunque no rechazamos sus comentarios
fisiopatologia hematologica
razones de Alemania para suspender vacunacion menores de 50 años.
https://www.pei.de/EN/service/faq/coronavirus/faq-coronavirus-node.html?cms_tabcounter=3
Guidance
This guideline covers the management of COVID-19 for children, young people and adults in all care settings. It brings together our existing recommendations on managing COVID-19 so that healthcare staff and those planning and delivering services can find and use them more easily. The guideline includes new recommendations on therapeutics, and we will update the guideline further as new evidence emerges.
The guideline updates and replaces our COVID-19 rapid guidelines on critical care in adults, managing symptoms (including at the end of life) in the community, managing suspected or confirmed pneumonia in adults in the community, acute myocardial injury, antibiotics for pneumonia in adults in hospital, acute kidney injury in hospital, and reducing the risk of venous thromboembolism in over 16s with COVID-19.
We have published this guideline in MAGICapp, a global evidence ecosystem already being used by key partners such as the Australian Taskforce for COVID-19 and the World Health Organization. The MAGICapp platform allows the efficient sharing of evidence between guideline developers from around the world. This means NICE can develop and update its COVID-19 guidance more quickly and efficiently as new evidence is assessed. We collaborated with the Australian National COVID-19 Clinical Evidence Taskforce during development of the guideline, and acknowledge their contribution to identifying and reviewing the evidence for therapeutics.
To access the guideline in MAGICapp, select the topic area you are interested in.
The guideline is part of a suite of products that NICE has developed to support healthcare staff during the pandemic. See our list of COVID guidelines.
Disclaimer
The MAGICapp publication platform is owned and operated by the MAGIC Evidence Ecosystem Foundation. While certain NICE content may be available on this platform, NICE is not responsible for the operation of this site, including the collection and use of user data, and you visit this site entirely at your own risk.
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Antibody evasion by the P.1 strain of SARS-CoV-2
P.1, B.1.351 and B.1.1.7 partially or fully escape most VH3-53 antibodies.Terminating the SARS-CoV-2 pandemic relies upon pan-global vaccination. Current vaccines elicit neutralizing antibody responses to the virus spike derived from early isolates. However, new strains have emerged with multiple mutations: P.1 from Brazil, B.1.351 from South Africa and B.1.1.7 from the UK (12, 10 and 9 changes in the spike respectively). All have mutations in the ACE2 binding site with P.1 and B.1.351 having a virtually identical triplet: E484K, K417N/T and N501Y, which we show confer similar increased affinity for ACE2. We show that, surprisingly, P.1 is significantly less resistant to naturally acquired or vaccine induced antibody responses than B.1.351 suggesting that changes outside the RBD impact neutralisation. Monoclonal antibody 222 neutralises all three variants despite interacting with two of the ACE2 binding site mutations, we explain this through structural analysis and use the 222 light chain to largely restore neutralization potency to a major class of public antibodies.
Remote management of covid-19 using home pulse oximetry and virtual ward support
- Trisha Greenhalgh, professor1,
- Matthew Knight, consultant respiratory physician2 3,
- Matt Inda-Kim, consultant acute physician4 5,
- Naomi J Fulop, professor6,
- Jonathan Leach, general practitioner7,
- Cecilia Vindrola-Padros, postdoctoral researcher6
- Correspondence to T Greenhalgh trish.greenhalgh@phc.ox.ac.uk
What you need to know
Pulse oximeters used at home can detect hypoxia associated with acute covid-19
Home oximetry requires clinical support, such as regular phone contact from a health professional in a virtual ward setting
More research is needed to understand the safety and effectiveness of home oximetry and to optimise service models and referral pathways
https://www.nature.com/articles/s41591-021-01296-8
Routine asymptomatic testing for SARS-CoV-2 before travel can be an effective strategy to reduce passenger risk of infection during travel, although abbreviated quarantine with post-travel testing is probably needed to reduce population-level transmission due to importation of infection when travelling from a high to low incidence setting. www.thelancet.com |
Impact of the COVID-19 Vaccine on Asymptomatic Infection Among Patients Undergoing Pre-Procedural COVID-19 Molecular Screening
Background
Several vaccines are now clinically available under emergency use authorization in the United States and have demonstrated efficacy against symptomatic COVID-19. The impact of vaccines on asymptomatic SARS-CoV-2 infection is largely unknown.
Methods
We conducted a retrospective cohort study of consecutive, asymptomatic adult patients (n = 39,156) within a large United States healthcare system who underwent 48,333 pre-procedural SARS-CoV-2 molecular screening tests between December 17, 2020 and February 8, 2021. The primary exposure of interest was vaccination with at least one dose of an mRNA COVID-19 vaccine. The primary outcome was relative risk of a positive SARS-CoV-2 molecular test among those asymptomatic persons who had received at least one dose of vaccine, as compared to persons who had not received vaccine during the same time period. Relative risk was adjusted for age, sex, race/ethnicity, patient residence relative to the hospital (local vs. non-local), healthcare system regions, and repeated screenings among patients using mixed effects log-binomial regression.
Results
Positive molecular tests in asymptomatic individuals were reported in 42 (1.4%) of 3,006 tests performed on vaccinated patients and 1,436 (3.2%) of 45,327 tests performed on unvaccinated patients (RR=0.44 95% CI: 0.33-0.60; p<.0001). Compared to unvaccinated patients, the risk of asymptomatic SARS-CoV-2 infection was lower among those >10 days after 1 st dose (RR=0.21; 95% CI: 0.12-0.37; p<.0001) and >0 days after 2 nd dose (RR=0.20; 95% CI: 0.09-0.44; p<.0001) in the adjusted analysis.
Conclusions
COVID-19 vaccination with an mRNA-based vaccine showed a significant association with a reduced risk of asymptomatic SARS-CoV-2 infection as measured during pre-procedural molecular screening. The results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.
Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant
Covid-19: Highest death rates seen in countries with most overweight populations
Perfect as the enemy of good: tracing transmissions with low-sensitivity tests to mitigate SARS-CoV-2 outbreaks
Perfect as the enemy of good: tracing transmissions with low-sensitivity tests to mitigate SARS-CoV-2 outbreaks
Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study
What Do Vaccine Efficacy Numbers Actually Mean?
Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain
,