Background
Disentangling the effects of SARS-CoV-2 variants and vaccination on the occurrence of post-acute sequelae of SARS-CoV-2 (PASC) is crucial to estimate and reduce the burden of PASC.
Methods
We performed a cross-sectional analysis (May/June 2022) within a prospective multicenter healthcare worker (HCW) cohort in North-Eastern Switzerland. HCW were stratified by viral variant and vaccination status at time of their first positive SARS-CoV-2 nasopharyngeal swab. HCW without positive swab and with negative serology served as controls. The sum of eighteen self-reported PASC symptoms was modeled with univariable and multivariable negative-binomial regression to analyse the association of mean symptom number with viral variant and vaccination status.
Results
Among 2’912 participants (median age 44 years, 81.3% female), PASC symptoms were significantly more frequent after wild-type infection (estimated mean symptom number 1.12, p<0.001; median time since infection 18.3 months), after Alpha/Delta infection (0.67 symptoms, p<0.001; 6.5 months), and after Omicron BA.1 infections (0.52 symptoms, p=0.005; 3.1 months) compared to uninfected controls (0.39 symptoms). After Omicron BA.1 infection, the estimated mean symptom number was 0.36 for unvaccinated individuals, compared to 0.71 with 1-2 vaccinations (p=0.028) and 0.49 with ≥3 prior vaccinations (p=0.30). Adjusting for confounders, only wild-type (adjusted rate ratio [aRR] 2.81, 95% confidence interval [CI] 2.08-3.83) and Alpha/Delta infection (aRR 1.93, 95% CI 1.10-3.46) were significantly associated with the outcome.
Conclusions
Previous infection with pre-Omicron variants was the strongest risk factor for PASC symptoms among our HCW. Vaccination prior to Omicron BA.1 infection was not associated with a clear protective effect against PASC symptoms in this population.
We repor there on a 16-year-old patient who presented with pain and swelling in the hypothenar eminence as well as loss of sensibility in the fingers of the region innervated by the ulnar nerve; this happened 2-3 weeks after an injury by a glass splinter in his proximal palm. A pseudoaneurysm could be verified by duplex sonography. The patient wished to avoid any graft for arterial bridging for religious reasons. On the basis of an the Allen test preoperatively and the intraoperative findings, an adequate blood supply of the finger by the radial artery was expected. Thus, in respect to the patients wish, the aneurysm was resected without bridging. The patient recovered perfectly. 4 years later, an MR-angiography showed the deep and superficial transverse palmar arc to be supplied by a voluminous radial artery. The ulnar finger arteries originated from the deep arc, the radial finger arteries from the superficial arc. In this paper, the criteria pro and contra grafting the ulnar atery at Guyons's canal will be discussed.
We report a severe hand injury with a fracture of the third metacarpal bone, destruction of the metacarpophalangeal joint of the fourth finger, amputation of the little finger of the right hand and several tendon injuries, in an active musician. The fourth metacarpal bone was offset close to the base, the hand narrowed, and the ring finger transferred to the base of the little finger. The outcome was very favourable.
1. The humoral immunosystem is impaired in those cases of catabolic metabolism in which quantitative and qualitative insufficient alimentation is expected after operation. 2. We showed that after cardiac surgery with extracorporal circulation as well as after other operations a reasonably balanced parenteral nutrition composed of carbohydrates and amino acids could considerably inhibit the changes in the humoral immunity, which is a valuable contribution to the prevention of infection. 3. In our experiments on transformation of lymphocytes after mitogenic stimulation, the depressive effects of operation on the cellular immunity were found to be etiologically more complex than was previously assumed in publications.
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