呼吸器・呼吸器内科

Omicron is a new variant of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and globally it created a challenging and hostile situation. it is highly contagious and has spread to more than 150 countries. Omicron variant has critical mutations in the spike protein than other Variants of Concern (VoC) -Alpha, Beta, Gamma and Delta and Variants of Interest (VoI) – Mu, Lambda. According to the latest WHO report, the United Kingdom has reported the highest number of SARS-CoV-2 Omicron variant cases. Unlike the previous SARS-CoV-2 variants including Delta, the present variant, Omicron does not lead to severe respiratory infection. The variant’s spike protein has a higher affinity for the human Angiotensin-Converting Enzyme 2 (ACE2) receptor. The present context explores the details about the epidemiology, risk assessment and the genetic comparison of Omicron with other SARS-CoV-2 variants along with the impact of vaccines on Omicron infection.

A small amount of the drug is delivered to the lung because to poor absorption or gastrointestinal degradation in the vast majority of ongoing antiviral/hostile to SARS-CoV-2 specialists that are taken orally. In order to treat pneumonic diseases like the Coronavirus, breathed-in treatment by pneumonic medicine conveyance could be considered an expected strategy. It is possible to directly deliver pharmaceuticals to the lung using pneumonic conveyance, which ensures higher medication fixation in the lung and avoids unpleasant side effects because lesser dosages are needed.

Objective: Pulmonary Arterial Hypertension (PAH) is a progressive disease characterized by increased pulmonary arterial pressure and pulmonary vascular resistance that can lead to right heart failure. Connective Tissue Disease-Associated PAH (CTD-PAH) often has a worse outcome than idiopathic or Hereditary PAH (I/HPAH), suggesting the presence of non-PAH factors that may affect the prognosis of CTD-PAH patients. This study aimed to identify prognostic factors for CTD-PAH.

Methods: Medical records from the April 1999 through November 2014 period were reviewed to determine the time from treatment initiation to occurrence of a clinically worsening event (hospitalization for PAH exacerbation, progression to WHO Functional Class III or worse, decrease in 6-min walking distance by ≥ 15% from baseline, initiation of parenteral prostanoid therapy, or death), and the time elapsed until death. Data at baseline and final assessment were used to identify prognostic factors associated with these events.

Results: In 36 CTD-PAH patients analyzed, the proportions with no clinically worsening events at 1, 2 and 3 years after treatment initiation were 62, 52 and 45%, with survival rates of 88, 77 and 77%, respectively. In multivariate analysis for survival rate, no variable was identifiable as a prognostic factor. However, baseline hemoglobin, QR pattern in electrocardiogram lead V1, 60-min erythrocyte sedimentation rate and mean pulmonary artery pressure at the final assessment were identified as factors significantly associated with clinical worsening.

Conclusion: Not only hemodynamic status, but also non-PAH factors such as anemia, nutritional status and inflammatory activity of the underlying CTD were suggested to influence the prognosis of CTD-PAH patients. Development of a more multifactorial treatment strategy is necessary.

The pursuit of a safe and effective HIV vaccine holds lifesaving potential for people globally; unfortunately, a number of ongoing HIV vaccine safety and efficacy trials are being shortened paused or postponed amidst the Coronavirus Disease-19 (COVID-19) crisis. The COVID-19 outbreak that started in Wuhan, megacity of China late December, 2019, has spread to 188 countries and territories, with more than 9 million total confirmed cases and 470,061 total deaths globally as at 22 June, 2020 and still counting. Currently, no approved vaccines exist to prevent infection with the novel Coronavirus; however, the impact of the pandemic has been enormous with devastating effects on the global health and economy, with many countries introducing stringent response measures to de-escalate the spread of the virus. Recruiting and retaining volunteers for HIV vaccine trials this period has become very challenging due to a lot of factors including fear of potential exposure to the new coronavirus, ethical issues and safety concerns. The protection and safety of participants and clinic staff remain a priority for HIV vaccine investigators worldwide. They are at the moment making conscious efforts to implement measures necessary to prevent potential exposure and transmission of COVID-19 among study participants and clinic staff in various study sites. To this end, the pursuit of a safe and effective HIV vaccine must continue to follow global best practices, devoid of any form of political, religious or racial bias. The pursuit for vaccine to curb the HIV pandemic is on and should not be at the expense of ethical principles such as informed consent and medical privacy. Despite the draw backs experienced so far, it is very important that virologists and vaccine developers do not relent in their quest for safe and effective HIV vaccines. Instead, they should redouble their efforts and build on past lessons. The scientific integrity of each clinical trial must not be compromised for political or economic gains, rather the World Health Organization with other important stakeholders must continue to monitor and ameliorate the impact of COVID-19 on the conduct of the early and large-scale HIV vaccine clinical trials globally.