Background & objectives: Vaccination against COVID-19 induces spike protein-binding IgG antibodies, a robust correlate of protection against COVID-19. This study was undertaken to assess the humoral response after completion of both the doses of ChAdOx1 nCoV vaccine in healthcare workers (HCWs) at a tertiary care health centre in India. Methods: A cross-sectional COVID-19 vaccine-induced antibody study was conducted among HCWs. IgG antibodies against spike protein were measured at least 28 days after the first dose and the second dose of vaccination in both SARS CoV-2 naïve and recovered HCWs. Mean and median antibody titre following each dose of vaccine and its association with age, gender, co-morbidities and factors such as exercise, stress and sleep deprivation were also explored. Results: Among the 200 vaccine recipients, 91.5 per cent showed seroconversion after the first dose and 99.5 per cent after the second dose. The mean titre after the second dose was significantly higher when compared to the first dose (12.68±4.17 vs . 9.83±6.3, P =0.001). More than half (54%) had high antibody titre ≥12 S/Co (Signal/cut-off). Previous COVID-19 infection was the single most important factor influencing antibody production, where the mean titre just after a single dose [mean-17.81±5.94, median-20.5 (interquartile range [IQR]-3.7)] surpassed the titre after the second dose in SARS CoV-2 naïve individuals [mean-12.29±4.00, median-12.8 (IQR-3.7), P =0.001]. Furthermore, 28 per cent of vaccinees showed a reduction in titre after the second dose. The mean fall in titre was 2.25±1.40 and was more pronounced in males, the younger age group and those with previous COVID-19 infection. Interpretation & conclusions: ChAdOx1 nCov-19 vaccine after two doses elicited an excellent immune response. However, greater immunogenicity after the first dose was seen among those with previous COVID-19 infection, even surpassing the titre achieved by the second dose of vaccine in SARS CoV-2 naïve recipients. A fall in antibody titre after the second dose is a matter of concern and requires further studies.
Purpose Identifying persistent bacteremia early in patients with neutropenia may improve outcome. This study evaluated the role of follow-up blood cultures (FUBC) positivity in predicting outcomes among patients with neutropenia and carbapenem-resistant gram-negative bloodstream infections (CRGNBSI). Methods This retrospective cohort study conducted between December 2017 and April 2022 included patients more than 15 years old with neutropenia and CRGNBSI, who survived for ≥ 48 h, receiving appropriate antibiotic therapy and had FUBCs. Patients with polymicrobial bacteremia within 30 days were excluded. The primary outcome was 30 day mortality. Persistent bacteremia, septic shock, recovery from neutropenia, prolonged or profound neutropenia, requirement of intensive care and dialysis, and initiation of appropriate empirical therapy were also studied. Results In our study cohort of 155 patients, the 30 day mortality rate was 47.7%. Persistent bacteremia was common in our patient cohort (43.8%). Carbapenem resistant isolates identified in the study were K.pneumoniae (80%), E.coli (12.26%), P.aeruginosa (5.16%), A.baumanii (1.94%) and E.cloacae (0.65%). The median time for sending a FUBC was 2 days (IQR, 1–3 days). Patients with persistent bacteremia had higher mortality than those without (56.76% versus 32.1%; p < 0.001). Appropriate initial empirical therapy was given to 70.9%. Recovery from neutropenia occurred in 57.4% while 25.8% had prolonged or profound neutropenia. Sixty-nine percent (107/155) had septic shock and needed intensive care; 12.2% of patients required dialysis. Non-recovery from neutropenia (aHR, 4.28; 95% CI 2.53–7.23), presence of septic shock (aHR, 4.42; 95%CI 1.47–13.28), requirement of intensive care (aHR,3.12;95%CI 1.23–7.93), and persistent bacteremia (aHR,1.74; 95%CI 1.05–2.89) significantly predicted poor outcomes in multivariable analysis. Conclusion FUBC showing persistent bacteremia predicted poor outcomes among neutropenic patients with carbapenem-resistant gram-negative bloodstream infections (CRGNBSI) and should be routinely reported.
La hipoglucemia es una complicación importante de la terapia intensiva de la diabetes, una verdadera emergencia médica, que requiere un reconocimiento y tratamiento rápidos para prevenir el daño cerebral y de órganos. Por lo tanto, el conocimiento sobre la diabetes puede desempeñar un papel importante en el mantenimiento del control de la glucemia y prevenir las complicaciones hipoglucémicas. Objetivo: el objetivo del estudio es desarrollar y evaluar el impacto de los folletos de información al paciente para prevenir la hipoglucemia en pacientes ambulatorios con diabetes mellitus tipo 2 y estudiar el efecto del patrón de medicamentos recetados en los pacientes. Material y métodos: Este estudio abierto de intervención abierta se realizó en el Departamento de pacientes ambulatorios (OPD) de endocrinología en un hospital de atención terciaria durante un período de 9 meses en 55 pacientes. La información se proporcionó a los pacientes a través de un folleto de información al paciente y su conocimiento y estado glucémico se evaluaron mediante un cuestionario validado basado en el lenguaje vernáculo desarrollado internamente en una institución. El cuestionario con cuatro dimensiones diferentes de conocimiento del paciente, control glucémico, cumplimiento y estilo de vida se cuantificó en el estudio. Resultados: El estudio mostró una mejora, estadísticamente significativa (P <0,05), en el conocimiento y el control glucémico en pacientes masculinos y en el conocimiento, el cumplimiento y el control glucémico en pacientes femeninos. Los pacientes alfabetizados mostraron una mejora más significativa en el conocimiento, el cumplimiento, el estilo de vida y el control glucémico que los pacientes analfabetos. Conclusiones: Los resultados del estudio sugirieron que el farmacéutico brindó a los pacientes con hipoglucemia diabética tipo 2 información y conciencia para mejorar el conocimiento y el control glucémico.
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