First reported case in an Irish flock of MCF- like systemic necrotizing vasculitis in sheep associated with ovine herpesvirus 2

BACKGROUND

Ovine gammaherpesvirus 2 (OvHV-2) is the causative agent of sheep associated malignant catarrhal fever (MCF). As sheep are the adapted host for OvHV-2, it is generally presumed that infection is not associated with disease in this species. However, a recent case review combined in-situ hybridisation, PCR and histopathology and correlated the viral distribution with systemic necrotizing vasculitis and concluded OvHV-2 was the likely agent responsible for sporadic, MCF-like vascular disease in sheep.

CASE PRESENTATION

Using similar methods this case study reports on the findings of the first reported cases in an Irish Flock of MCF- like systemic necrotizing vasculitis in sheep associated with OvHV-2. Sheep A, a 16-month-old Texel-cross hogget displayed signs of ill- thrift, Sheep B, a nine-month-old Belclare-cross lamb, was found dead having displayed no obvious symptoms. Both cases occurred on the same farm, however the animals were not related. Lymphohistiocytic vasculitis of various tissues was the predominant histopathological finding in both animals.

CONCLUSION

By combining histopathology, PCR and in-situ hybridisation results, MCF- like systemic necrotizing vasculitis associated with OvHV-2 has been diagnosed for the first time in an Irish flock.

The Influence of Social Determinants on Receiving Outpatient Treatment with Monoclonal Antibodies, Disease Risk, and Effectiveness for COVID-19

BACKGROUND

Limited research has studied the influence of social determinants of health (SDoH) on the receipt, disease risk, and subsequent effectiveness of neutralizing monoclonal antibodies (nMAbs) for outpatient treatment of COVID-19.

OBJECTIVE

To examine the influence of SDoH variables on receiving nMAb treatments and the risk of a poor COVID-19 outcome, as well as nMAb treatment effectiveness across SDoH subgroups.

DESIGN

Retrospective observational study utilizing electronic health record data from four health systems. SDoH variables analyzed included race, ethnicity, insurance, marital status, Area Deprivation Index, and population density.

PARTICIPANTS

COVID-19 patients who met at least one emergency use authorization criterion for nMAb treatment.

MAIN MEASURE

We used binary logistic regression to examine the influence of SDoH variables on receiving nMAb treatments and risk of a poor outcome from COVID-19 and marginal structural models to study treatment effectiveness.

RESULTS

The study population included 25,241 (15.1%) nMAb-treated and 141,942 (84.9%) non-treated patients. Black or African American patients were less likely to receive treatment than white non-Hispanic patients (adjusted odds ratio (OR) = 0.86; 95% CI = 0.82-0.91). Patients who were on Medicaid, divorced or widowed, living in rural areas, or living in areas with the highest Area Deprivation Index (most vulnerable) had lower odds of receiving nMAb treatment, but a higher risk of a poor outcome. For example, compared to patients on private insurance, Medicaid patients had 0.89 (95% CI = 0.84-0.93) times the odds of receiving nMAb treatment, but 1.18 (95% CI = 1.13-1.24) times the odds of a poor COVID-19 outcome. Age, comorbidities, and COVID-19 vaccination status had a stronger influence on risk of a poor outcome than SDoH variables. nMAb treatment benefited all SDoH subgroups with lower rates of 14-day hospitalization and 30-day mortality.

CONCLUSION

Disparities existed in receiving nMAbs within SDoH subgroups despite the benefit of treatment across subgroups.

Neutralizing Monoclonal Antibody Use and COVID-19 Infection Outcomes

Importance

Evidence on the effectiveness and safety of COVID-19 therapies across a diverse population with varied risk factors is needed to inform clinical practice.

Objective

To assess the safety of neutralizing monoclonal antibodies (nMAbs) for the treatment of COVID-19 and their association with adverse outcomes.

Design, Setting, and Participants

This retrospective cohort study included 167 183 patients from a consortium of 4 health care systems based in California, Minnesota, Texas, and Utah. The study included nonhospitalized patients 12 years and older with a positive COVID-19 laboratory test collected between November 9, 2020, and January 31, 2022, who met at least 1 emergency use authorization criterion for risk of a poor outcome.

Exposure

Four nMAb products (bamlanivimab, bamlanivimab-etesevimab, casirivimab-imdevimab, and sotrovimab) administered in the outpatient setting.

Main Outcomes and Measures

Clinical and SARS-CoV-2 genomic sequence data and propensity-adjusted marginal structural models were used to assess the association between treatment with nMAbs and 4 outcomes: all-cause emergency department (ED) visits, hospitalization, death, and a composite of hospitalization or death within 14 days and 30 days of the index date (defined as the date of the first positive COVID-19 test or the date of referral). Patient index dates were categorized into 4 variant epochs: pre-Delta (November 9, 2020, to June 30, 2021), Delta (July 1 to November 30, 2021), Delta and Omicron BA.1 (December 1 to 31, 2021), and Omicron BA.1 (January 1 to 31, 2022).

Results

Among 167 183 patients, the mean (SD) age was 47.0 (18.5) years; 95 669 patients (57.2%) were female at birth, 139 379 (83.4%) were White, and 138 900 (83.1%) were non-Hispanic. A total of 25 241 patients received treatment with nMAbs. Treatment with nMAbs was associated with lower odds of ED visits within 14 days (odds ratio [OR], 0.76; 95% CI, 0.68-0.85), hospitalization within 14 days (OR, 0.52; 95% CI, 0.45-0.59), and death within 30 days (OR, 0.14; 95% CI, 0.10-0.20). The association between nMAbs and reduced risk of hospitalization was stronger in unvaccinated patients (14-day hospitalization: OR, 0.51; 95% CI, 0.44-0.59), and the associations with hospitalization and death were stronger in immunocompromised patients (hospitalization within 14 days: OR, 0.31 [95% CI, 0.24-0.41]; death within 30 days: OR, 0.13 [95% CI, 0.06-0.27]). The strength of associations of nMAbs increased incrementally among patients with a greater probability of poor outcomes; for example, the ORs for hospitalization within 14 days were 0.58 (95% CI, 0.48-0.72) among those in the third (moderate) risk stratum and 0.41 (95% CI, 0.32-0.53) among those in the fifth (highest) risk stratum. The association of nMAb treatment with reduced risk of hospitalizations within 14 days was strongest during the Delta variant epoch (OR, 0.37; 95% CI, 0.31-0.43) but not during the Omicron BA.1 epoch (OR, 1.29; 95% CI, 0.68-2.47). These findings were corroborated in the subset of patients with viral genomic data. Treatment with nMAbs was associated with a significant mortality benefit in all variant epochs (pre-Delta: OR, 0.16 [95% CI, 0.08-0.33]; Delta: OR, 0.14 [95% CI, 0.09-0.22]; Delta and Omicron BA.1: OR, 0.10 [95% CI, 0.03-0.35]; and Omicron BA.1: OR, 0.13 [95% CI, 0.02-0.93]). Potential adverse drug events were identified in 38 treated patients (0.2%).

Conclusions and Relevance

In this study, nMAb treatment for COVID-19 was safe and associated with reductions in ED visits, hospitalization, and death, although it was not associated with reduced risk of hospitalization during the Omicron BA.1 epoch. These findings suggest that targeted risk stratification strategies may help optimize future nMAb treatment decisions.

Bone status in professional cyclists

Professional cycling combines extensive endurance training with non weight-bearing exercise, two factors often associated with lower bone mineral density (BMD). Therefore BMD was measured with dual-energy x-ray absorptiometry in 30 professional road cyclists (mean (SD) age: 29.1 (3.4) years; height: 178.5 (6.7) cm; weight: 71.3 (6.1) kg; %fat mass: 9.7 (3.2)%; VO (2)max: 70.5 (5.5) ml.kg (-1).min (-1)) and in 30 young healthy males used as reference (28.6 (4.5) years; 176.5 (6.3) cm; 73.4 (7.3) kg; 20.7 (5.8)%). Adjusting for differences in age, height, fat mass, lean body mass, and calcium intake by ANCOVA, professional cyclists had similar head BMD (p=0.383) but lower total body (1.135 (0.071) vs. 1.248 (0.104) g.cm (-2); p<0.001), arms (0.903 (0.075) vs. 0.950 (0.085), p=0.028), legs (1.290 (0.112) vs. 1.479 (0.138); p<0.001), spine (0.948 (0.100) vs. 1.117 (0.147) g.cm (-2); p<0.001), pelvis (1.054 (0.084) vs. 1.244 (0.142), p<0.001), lumbar spine (1.046 (0.103) vs. 1.244 (0.167), P<0.001), and femoral neck BMD (0.900 (0.115) vs. 1.093 (0.137), p<0.001) compared to reference subjects. Professional cycling appears to negatively affect BMD in young healthy and highly active males, the femoral neck being the most affected site (-18%) in spite of the elevated muscle contractions inherent to the activity.

Low bone mineral density and calcium intake in elite cyclists

AIM

High physical activity is associated with larger bone mineral content (BMC) and density (BMD) in young males though competitive road cyclists have been reported to have similar or lower BMD than controls.

METHODS

BMC and BMD were assessed in 73 highly trained (42 professional and 31 elite amateur) road cyclists (CYCLIST; age: 25.8+/-4.3 years; height: 179.7+/-6.3 cm; weight: 71.6+/-6.3 kg; %Fat mass: 9.5+/-3 %; VO(2max): 68.5+/-5.7 mlxkg(-1)xmin(-1)) and in 30 healthy males used as reference (REF: 28.3+/-4.5 years; 176.6+/-6.2 cm; 74.5+/-8.4 kg; 21.3+/-6.1%).

RESULTS

Daily calcium intake estimated from a food-questionnaire was higher in CYCLIST than in REF (942+/-374 vs 753+/-315 mgxd(-1); P=0.008). Compared to REF, CYCLIST had lower L1-L4 BMD (1.004+/-0.125 vs 1.240+/-0.163 gxcm(-2); P<0.0001) and femoral neck BMD (0.986+/-0.132 vs 1.098+/-0.137; P<0.003). In CYCLIST, daily calcium intake is correlated with total BMC and BMD (r=0.27-0.26, P=0.02) and femoral BMD (r=0.35; P=0.002). Divided by tertiles (high, medium and low Ca), CYCLIST with high Ca (1320+/-382 mgxd(-1)) had lower lumbar BMD values (-6.68%; P=0.02) and tended to have lower femoral neck BMD (-4.77%; P=0.09) and radius UD BMD (-5.9%; P=0.07) than REF.

CONCLUSIONS

There was no difference between medium Ca and high Ca for any BMC or BMD parameters. Differences between low Ca and high Ca could be detected only for Total BMC (-8.4%; P=0.01), Pelvis BMD (-7.4%; P=0.01) and femoral neck BMD (-9.9%; P=0.006).