Влияние вируса COVID-19 на мозг: новые открытия
В начале пандемии COVID-19 врачи стали замечать нечто поразительное. Несмотря на то, что изначально вирус SARS-CoV-2 описывался как респираторный вирус, он казалось, сильно влиял на мозг, вызывая потерю вкуса и обоняния, проблемы с концентрацией внимания и в серьезных случаях — инсульт.
NYU Langone Health, исследовательская больница в Нью-Йорке, начала собирать эти анекдоты в надежде лучше понять, как вирус влияет на мозг и нервную систему. Спустя годы проект превратился из изучения только острых симптомов в отслеживание долгосрочных нейрологических проблем, с которыми сталкиваются некоторые люди с длительным течением COVID, говорит директор программы д-р Шэрон Мерополь.
Долгосрочные проблемы
Список нейрокогнитивных проблем, которые должна отслеживать команда Мерополь и другие исследователи, обширен: когнитивное ухудшение, изменения в размере и структуре мозга, депрессия и суицидальные мысли, дрожь, судороги, потеря памяти и обострение деменции были связаны с предыдущими инфекциями SARS-CoV-2. В некоторых случаях эти проблемы могут возникнуть даже у пациентов с относительно легким течением COVID-19.
В настоящее время, как отмечает Мерополь, священный грааль — это понять, что происходит в мозге пациентов с COVID-19 и как исправить ущерб.
Серые вещества
Если бы вы взглянули на мозг человека, зараженного determin вирусами, такими как бешенство, вы бы видели меткий вирус повсюду. Это четко видно, что мозг заражен, говорит д-р Авиндра Нат, клинический директор Национального института неврологических нарушений и инсультов (NINDS).
Вирус в мозгу
С момента работы Ната над сканированием мозга в начале пандемии другие исследователи обнаружили вирус в мозга у людей, умерших от COVID-19.
Источник: TIME
<strong>Потенциальное воздействие COVID-19 на мозг: что говорит исследование</strong>
Сравнение безопасности мРНК-вакцин у пожилых людей
Сравнительный риск нежелательных событий после вакцинации мРНК у пожилых взрослых
We observed few differences in baseline characteristics between groups. However, on average, individuals who received BNT162b2 were older (aged ≥90 years: 7.2% vs 5.2%; standardized difference, 0.09), were more likely to be Black (5.8% vs 4.8%; standardized difference, 0.05), and were more likely to be categorized as frail (6.8% vs 5.1%; standardized difference, 0.07).
Comparative Risk of Adverse Events Between mRNA-1273 and BNT162b2
The risk of all adverse events was low, with each occurring in less than 1.0% of eligible individuals (eTable 3 in Supplement 1). Deep vein thrombosis and pulmonary embolism were the most frequently identified events, occurring in 0.27% and 0.23% of individuals, respectively. Disseminated intravascular coagulation (0.002%), encephalomyelitis (0.0004%), Guillain-Barre syndrome (0.0003%), and transverse myelitis (0.0002%) were very rare and were thus not examined in the adjusted and/or stratified analyses due to instability of the model estimates.
Comparative Risk of Adverse Events by Frailty Category and Prior History of the Adverse Events of Interest
We compared the risk of potential adverse events between the mRNA-1273 and BNT162b2 vaccines in a cohort of more than 6 million older US adults. We observed that the risk of adverse events was very low in both vaccine groups, and the vaccines did not differ in risk for most outcomes in the overall analysis. However, mRNA-1273 was associated with a lower risk of some adverse events, including pulmonary embolism, compared with BNT162b2. Notably, individuals who received mRNA-1273 also had a 14.0% lower risk of diagnosed COVID-19. Because pulmonary embolism is a sequela of COVID-19,19 this and potentially other observed differences in adverse events may be the result of early vaccine effectiveness and differential mitigation of COVID-19. Some variation in the comparative risk of adverse events and diagnosed COVID-19 was observed across subgroups, with mRNA-1273 showing generally larger protective associations in individuals categorized as nonfrail.
Given the overlap in adverse events identified as potentially being associated with mRNA vaccines and those attributable to SARS-CoV-2, differences in safety outcomes between vaccines should be considered alongside early effectiveness.13,19 Differences in adverse events between vaccines may reflect the benefits of vaccination with a more effective product due to superior protection against COVID-19 and its sequelae. Results from our sensitivity analysis support the hypothesis that differences in the risk of pulmonary embolism between the vaccines are related to differential early effectiveness. Regardless of the underlying mechanism, however, the comparative reduction in morbidity associated with mRNA-1273 is notable and may have real benefits at the population level. Nonetheless, studies confirming the extent to which differences in adverse events can be attributed to early effectiveness are needed.
Assessments of potential adverse events by frailty level and their prior history of occurrence reinforced the primary analysis and provide evidence of mRNA vaccine safety in real-world and more clinically vulnerable populations. These analyses also preliminarily favor attributing the observed differences in adverse events to early effectiveness rather than safety. The mRNA-1273 vaccine was associated with generally larger reductions in adverse events and diagnosed COVID-19 among individuals categorized as nonfrail. Because frailty is known to attenuate vaccine response,15 the greater immunogenicity associated with mRNA-1273 may have been diminished in individuals categorized as frail, thereby reducing its degree of differential protection against COVID-19 and its sequelae.12,30
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Accepted for Publication: June 21, 2023.
Author Contributions: Drs Harris and Hayes had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Harris, Hayes, Zullo, Mor, Deng, Djibo, Gravenstein.
Acquisition, analysis, or interpretation of data: Harris, Hayes, Zullo, Mor, Chachlani, McCarthy, Djibo, McMahill-Walraven, Gravenstein.
Drafting of the manuscript: Harris, Zullo, Deng.
Critical review of the manuscript for important intellectual content: Harris, Hayes, Zullo, Mor, Chachlani, McCarthy, Djibo, McMahill-Walraven, Gravenstein.
Statistical analysis: Harris, Hayes, Zullo, Chachlani, McCarthy, Gravenstein.
Obtained funding: Zullo.
Supervision: Harris, Hayes, Zullo, Mor, McMahill-Walraven, Gravenstein.
Funding/Support: This work was supported by the NIA of the National Institutes of Health under award number U54AG063546 (Dr Mor), which funds the NIA IMPACT Collaboratory. Supplemental funding was provided under grant numbers 3U54AG063546-S07 and 3U54AG063546-S08 (Dr Mor).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Data Sharing Statement: See Supplement 2.
Andrews NJ , Stowe J , Ramsay ME , Miller E . Risk of venous thrombotic events and thrombocytopenia in sequential time periods after ChAdOx1 and BNT162b2 COVID-19 vaccines: a national cohort study in England. Lancet Reg Health Eur. 2022;13:100260. doi:10.1016/j.lanepe.2021.100260 PubMedGoogle ScholarCrossref
Andrew MK , Shinde V , Ye L , et al; Serious Outcomes Surveillance Network of the Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) and the Toronto Invasive Bacterial Diseases Network (TIBDN). The importance of frailty in the assessment of influenza vaccine effectiveness against influenza-related hospitalization in elderly people. J Infect Dis. 2017;216(4):405-414. doi:10.1093/infdis/jix282 PubMedGoogle ScholarCrossref
Helms J , Tacquard C , Severac F , et al; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46(6):1089-1098. doi:10.1007/s00134-020-06062-x PubMedGoogle ScholarCrossref
Mues KE , Liede A , Liu J , et al. Use of the Medicare database in epidemiologic and health services research: a valuable source of real-world evidence on the older and disabled populations in the US. Clin Epidemiol. 2017;9:267-277. doi:10.2147/CLEP.S105613 PubMedGoogle ScholarCrossref
Kim DH , Schneeweiss S , Glynn RJ , Lipsitz LA , Rockwood K , Avorn J . Measuring frailty in Medicare data: development and validation of a claims-based frailty index. J Gerontol A Biol Sci Med Sci. 2018;73(7):980-987. doi:10.1093/gerona/glx229 PubMedGoogle ScholarCrossref
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Ведущий научный сотрудник лаборатории патогенеза инфекционных заболеваний МГМСУ, кандидат медицинских наук Максим Гультяев считает, что COVID-19, скорее всего, станет сезонным заболеванием, при этом он не ожидает в 2021 году новой волны коронавируса, сообщает радио Sputnik.
По словам Гультяева, в период изменчивой погоды болезнь будет проявлять себя более агрессивно и будет более заразной.
«Но этот коронавирус далеко не первый в нашей жизни, с течением времени мы друг к другу приспособимся и будем легче переносить заболевание», — отметил ученый.
В следующем году он ожидает рост числа случаев, однако, по его словам, «не будет таких чудовищных цифр». К тому времени «сознательное население» сделает прививки от коронавируса и будет защищено. К тому же многие уже переболели и имеют антитела.
Гультяев считает, что спасением от инфекции является вакцинация. «У нас будет не одна, не две, а десятки вакцин, это будут не только наши, но и зарубежные, будет из чего выбирать на любой вкус, возраст, степень поражения организма, наличие хронических заболеваний», — отметил ученый МГМСУ.
В России с начала осени число выявляемых случаев коронавирусной инфекции бьет рекорды. Накануне был установлен новый суточный рекорд по числу заболевших COVID-19. За последние 24 часа в стране выявили 21 798 случаев. При этом предыдущий максимум, зафиксированный 6 ноября, был превзойден более чем на 1,2 тыс. заболевших. С начала эпидемии в России COVID-19 выявили почти у 1,8 млн человек.
Из-за ухудшения эпидемиологической ситуации многие страны Европы, в частности Германия, Австрия, Франция, Великобритания, ужесточают ограничения и возвращаются к самоизоляции.
Updated COVID Vaccines and the JN.1 Variant
Vaccines & Immunity
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Department of Cardiology, North Zealand Hospital, Hillerod, Denmark
Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Kathrine Kold Sørensen
Pia A. Eiken
Department of Endocrinology, Bispebjerg Hospital, Copenhagen, Denmark
Thea K. Fischer
Department of Clinical Research, North Zealand Hospital, Hillerod, Denmark
Peter Lommer Kristensen
Department of Endocrinology and Nephrology, North Zealand Hospital, Hillerod, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Maria Elisabeth Lendorf
Department of Oncology and Palliative Medicine, North Zealand Hospital, Hillerod, Denmark
Rúna L.M. Nolsoe
Diabetes Care 2023;46(8):1477–1482
To compare the incidence of type 1 diabetes (T1D) before and during the coronavirus disease 2019 (COVID-19) pandemic and determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with T1D development.
RESEARCH DESIGN AND METHODS
There was an increase in T1D incidence during April–June 2021 compared with April–June 2015–2019, but this could not be attributed to SARS-CoV-2 infection.
Graphical Abstract
Introduction
In the fall of 2020, the U.S. Centers for Disease Control and Prevention reported an increased risk of diabetes within 30 days of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients aged <18 years based on data from health insurance claims (1). However, the type of diabetes was not specified, and the incidence was evaluated using health insurance claims. Additionally, there were reports of increased rates of type 1 diabetes (T1D) diagnoses and diabetic ketoacidosis admissions among European pediatric populations during the coronavirus disease 2019 (COVID-19) pandemic (2–4). A study based on registries from 13 countries investigated time trends of diabetic ketoacidosis and found an increase in prevalence of diabetic ketoacidosis during the COVID-19 pandemic (5). Given the known association between other viral infections, especially other coronaviruses, and β-cell islet damage, it is possible that the observed increase in incidence and prevalence was causal (6). A large cohort study in Scotland used the nationwide Scottish Care Information–Diabetes registry to investigate a possible association between T1D and SARS-CoV-2 infection. This study found a positive association between T1D and SARS-CoV-2 infection within 30 days but no association after 30 days. However, the association was suspected to be due to a possible detection bias, as there were increased numbers of both positive and negative SARS-CoV-2 tests around the time of T1D presentation (7). Given the importance of replicating these findings in countries with widely available and validated nationwide health registers and the potential public health implications of a possible association between T1D and SARS-CoV-2 infection, we aimed to replicate the study. First, we investigated whether the incidence of T1D in individuals aged <30 years has increased during the COVID-19 pandemic in Denmark compared with previous years. Second, we investigated whether a positive SARS-CoV-2 test result was associated with an increased risk of developing T1D by creating a cohort of people testing positive for SARS-CoV-2 matched by age, sex, and vaccination status to three people not yet infected with SARS-CoV-2.
Research Design and Methods
The Danish government implemented a strict lockdown policy starting on 13 March 2020, which included the closure of schools, kindergartens, restaurants, and shopping malls, as well as a restriction on social gatherings to a maximum of 10 people (8). These measures were partially lifted in mid-April with the reopening of certain businesses and were further relaxed in mid-May and early June, allowing for larger social gatherings and the reopening of additional businesses (8). However, some of these measures were reintroduced in the autumn of 2020 and relaxed during the summer of 2021. By November 2021, the mask mandate was reinforced, but by February 2022, most restrictions were lifted, and COVID-19 was no longer regarded as a critical threat (8). Nationwide vaccination programs were initiated on 27 December 2020 and suspended in April 2022 (8).
Study Population
All permanent residents in Denmark aged <30 years or individuals born after 1 January 2015 were included in the period 1 January 2015 to 31 December 2021. People with any prior diagnosis of diabetes, prior use of immunomodulating therapies, cancer, or diagnosis of autoimmune disease (celiac disease, psoriasis, Morbus Crohn disease, colitis ulcerosa, hypothyroidism, hyperthyroidism, or multiple sclerosis) were not included. To ensure the use of information on past exposure and covariates, people who immigrated to Denmark after 1 January 2010 were not included.
Exposure
A positive SARS-CoV-2 PCR test result was used to define all cases in the cohort. Only first-time positive PCR tests were included.
Comorbidities
Concomitant medical therapy was defined as the presence of at least one redeemed prescription 6 months prior to the inclusion date. Comorbidities were defined as the presence of an ICD-8 or ICD-10 diagnosis in hospital discharge records, including ambulatory contacts up to 10 years prior to inclusion date. The complete list on ICD-8, ICD-10, and Anatomical Therapeutic Chemical codes used to describe comorbidities are listed in Supplementary Table 1.
Outcome
Register-based research is granted permission by Danish law to be performed without the requirement of ethical approval or informed consent. This project was approved by the Knowledge Centre on Data Protection Compliance–The Capitol Region of Denmark (approval no. P-2010-191).
Data and Resource Availability
The data sets generated during and/or analyzed in the current study are not available because of the data protection policies issued by Statistics Denmark.
Results
Flow chart of the study population.
Baseline characteristics among individuals diagnosed with T1D from 2015 to 2021
2015–2017 (n = 1,491)2018–2019 (n = 964)2020–2021 (n = 1,124)P
0–15 903 (60.6) 562 (58.3) 648 (57.7)
15–30 588 (39.4) 402 (41.7) 476 (42.3)
Male 868 (58.2) 565 (58.6) 656 (58.4)
Female 623 (41.8) 399 (41.4) 468 (41.6)
Mode of diagnosis 0.005
T1D diagnosis 1,220 (81.8) 817 (84.8) 971 (86.4)
Ketoacidosis admission 271 (18.2) 147 (15.2) 153 (13.6)
No 1,491 (100.0) 964 (100.0) 1,005 (89.4)
Yes 0 (0.0) 0 (0.0) 119 (10.6)
SARS-CoV-2 test status <1e−04
No positive test result 1,491 (100.0) 964 (100.0) 1,088 (96.8)
Positive test result 0 (0.0) 0 (0.0) 36 (3.2)
Crude incidence rates (IRs) per 100,000 person-years (PY), and adjusted IRRs of T1D in each quarter of 2020 and 2021, with 2015–2019 as the reference. The IRRs were adjusted for age and sex.
The Association of SARS-CoV-2 and T1D Development
Conclusions
The strengths of this study are the nationwide completeness of data and the number of patients included. We used well-validated measures to assess exposure and outcome (14–17), but although we relied on diagnosis codes of T1D, hospital admission for ketoacidosis, and prescriptions of insulin, we lacked information on important biochemical markers of insulin production, which could have strengthened the definition of T1D. The testing capacity in Denmark was reduced in the beginning of the pandemic, and new-onset T1D cases occurring after SARS-CoV-2 infection might have been missed, making the study susceptible of exposure misclassification and ultimately biasing the results toward a null finding. More importantly, we lacked information on the presence of other viral infections, as there is a known association between certain viral infections and the development of T1D. We have presented an association, not causation, and residual confounding cannot be ruled out since we lacked important information on behavioral risk factors, such as adherence to containment measures, family history of diabetes, and other environmental triggers.
In conclusion, we observed an increase in T1D incidence during April–June 2021 compared with April–June 2015–2019. However, this observation could not be explained by a SARS-CoV-2 infection alone, as no statistically significant association was found between a positive SARS-CoV-2 test result and development of T1D.
Article Information
Funding. This project was funded by Nordsjaellands Hospital, The Capitol Region of Denmark.
Duality of Interest. U.P.-B. has served on advisory boards for Sanofi, Novo Nordisk, and Vertex and has received lecture fees from Abbott, Sanofi, and Novo Nordisk. No other potential conflicts of interest relevant to this article were reported.
Author Contributions. B.Z. analyzed the data and drafted the manuscript. B.Z., C.T.-P., and R.L.M.N. researched data, contributed to the discussion, and reviewed and edited the manuscript. B.Z. and R.L.M.N. designed the study. K.K.S., P.A.E., T.K.F., P.L.K., M.E.L., and U.P.-B. contributed to the discussion and reviewed and edited the manuscript. All authors approved the final version of the manuscript. B.Z. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: the double-wave occurrence
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Эта статья об инфекционном заболевании; о пандемии, вызванной заболеванием, см. Пандемия COVID-19.
Запрос «ковид» перенаправляется сюда; см. также другие значения.
Передача и жизненный цикл вируса SARS-CoV-2, вызывающего инфекцию COVID-19
Медицинская специальность , , , и неотложная медицинская помощь
Причины заболевания и его развитие
См. также: § Серологические тесты
Острый респираторныйдистресс-синдром 9 (8—14)
Механическая вентиляциялёгких 10,5 (7—14)
Переводв отделение реанимации 10,5
Гипервоспалительный синдром, связанный с COVID-19
Применение медицинских масок среди населения
Рекомендации для заболевших
См. также: § Экспериментальные терапии и направления исследований
Мультисистемный воспалительный синдром, связанный с COVID-19
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