Convalescent plasma as adjunctive therapy for hospitalized patients with COVID-19:The Co-CLARITY Trial

Background and Objective@#Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients.@*Methods@#In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections.@*Results@#A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days.@*Conclusions@#Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference.

Convalescent Plasma Infusion in Italian Hospitalized Patients with Severe COVID 19 Pneumonia: Evaluation of Late Mortality Associated Factors

Background:This was a single center prospective study about factors related with mortality in hospitalized patients with severe COVID-19 pneumonia treated with convalescent plasma (CCP) infusion in Venice Prefecture. Methods:In this study were enrolled all the (376) consecutive hospitalized patients with severe COVID-19 pneumonia treated with CCP observed from 30/04/2020 to 31/10/2021. At hospital admission, in order to evaluate correlation with prognosis, study recorded demographic data, clinical data, presence of co morbidities, Rx findings, laboratory results. The endpoint was mortality at 30 days.Results:Using multivariate analysis, consideringdemographic data and co morbiditiesfour variables emerged as significant independent predictors of 30-day mortality: age>70 years, tobacco smoke, obesity (BMI>30), Diabetes. Considering Patients’ clinical characteristics at hospital admissiontwo variables emerged as significant independent predictors of 30-day mortality in this cohort of hospitalized patients with severe COVID-19 Pneumonia: PaO2/FiO2 ratio under 200 and lungs imaging with a score >3. Discussion:Late mortality was investigated in a series of consecutive, hospitalized, patients with severe COVID-19. We therefore believe that any influence linked to the level of expertiseof the clinical staff and available technology was minimal.Furthermore, we also tried to reduce, as much as possible, the variables related CCP infusion using plasma with a neutralizing antibody titer>80 and a standardized dose: a 200 mL unit per day for three consecutive days. Moreover, using both a univariate and multivariate analytical approach, numerous demographic variables were considered, relating to comorbidities, all clinical characteristics, to laboratory data; correlating them with mortality at 30 days.

Study of Effectiveness of Convalescent Plasma-therapy in Moderate to Severely ill COVID-19 Patients

Background : Convalescent Plasma-therapy, a classic adaptive immunotherapy used in the treatment of SARS, MERS and 2009 H1N1 pandemic with acceptable efficacy and safety in the past. Convalescent Plasma-therapy was taken into consideration in management of COVID-19 disease during the initial days of pandemic but was withdrawn later due to its doubtful beneficial role. This study aims to explore the beneficial role of Convalescent plasma and to determine whether Convalescent Plasma-therapy holds a second chance in treating SARS-CoV-2. Methods : This cross-sectional observational study includes 82 cases of moderate to severely ill COVID-19 patients who received Convalescent Plasma-therapy and 41 controls who didn抰. regular monitoring of Total Leukocyte Count (TLC), PaO2/FiO2 (PaO2 is partial pressure of Oxygen in arterial blood, fractional inspired oxygen (P/F ratio), Neutrophil to Lymphocyte Ratio (N/L ratio) inflammatory markers, respiratory rate, oxygen saturation, ABG and Radiological Imaging was done for comparative analysis. Results : In case group 39 patients (47.56%) were on oxygen mask, 17 patients (20.73%) on Non-invasive Ventilation (NIV), 9 Patients on Non-rebrether Mask (NRM) (10.97%), 16 patients (19.51%) on room air, 1(1.21%) on High Flow Nasal Cannula (HFNC) initially. After 7th day of Convalescent Plasma-therapy 49 patients (59.75%) were on room air which suggests significant improvement in mode of ventilation in case group as compared to Control Group. Mean respiratory rate in case group was 30.46 Cycles Per Minute (CPM) initially and 24.7 CPM on day 7th of Plasma-therapy which is statically significant. Conclusion : Plasma-therapy is effective if given in early stage of disease and Convalescent Plasma donors having adequate antibody titre.

Verification of detection method for multiple pathogens in plasma of convalescent patients with Coronavirus Disease 2019 / 中国生物制品学杂志

@#Objective To systematically verify the detection method for multiple pathogens in plasma of convalescent patients(CPs)with Coronavirus Disease 2019(COVID-19).Methods According to the actual situation of plasma samples and the requirements of kit,the molecular biological detection method for multiple pathogens in plasma of CPs with COVID-19 was systematically verified for specificity,reproducibility,intermediate precision and limit of detection(LOD),and confirmed for applicability by detecting 50 plasma samples of CPs with COVID-19.Results The results of interference test and cross test showed that the detection of positive samples and negative samples were not affected;The RSDs of melting temperature values(Tm)of the positive control four pathogens by the same or different test personnels at different time under the same test conditions were 0.07%,0.14%,0.07%,0.14% and 0.06%,0.23%,0.23%,0.20%,and those of internal control(IC)and amplification control(AC)1 and 2 were 0.07%,0.01%,0.07%,0.14% and 0.11%,0.10%,0.15%,0.22%,respectively.Meanwhile,the RSDs of reproducibility and intermediate precision were less than 15% and20% respectively,which met the requirements;The minimum LOD of 22 pathogens were determined;No pathogen was detected in 50 plasma samples of CPs with COVID-19.Conclusion The method for detecting pathogens in plasma of CPs with COVID-19 was specific,stable,reliable and reproducible,which was suitable for the detection of pathogens in plasma of CPs with COVID-19.

Clinical and imaging features of population receiving opportunistic screening for lung cancer and in convalescent stage of COVID-19 / 中华健康管理学杂志

Objective:To investigate the clinical and imaging features of population receiving opportunistic screening for lung cancer and in convalescent stage of COVID-19.Methods:Cross-sectional study and analysis was performed on the patients who underwent chest low-dose CT examination for cancer prevention in Cancer Hospital of Chinese Academy of Medical Sciences from December 28, 2022 to January 19, 2023. All the patients completed the COVID-19 questionnaire. A total of 334 questionnaires were sent out, all of which were recovered, and 321 valid questionnaires were collected, among them, 293 questionnaires were included in the analysis. Statistical analysis was conducted according to the questionnaire information, clinical symptoms and chest CT imaging results. The potential influencing factors of COVID-19 infection were explored, and the imaging characteristics of COVID-19 infection and early stage of lung cancer were compared.Results:A total of 293 patients underwent lung cancer screening during the convalescent stage of COVID-19 infection. A total of 231 (78.8%) cases had cough and 228 (77.8%) cases had fever. 214 (73.0%) cases still had clinical symptoms within 2 weeks after nucleic acid or antigen test showing negative, especially for cough in 171 (58.4%) cases, fatigue in 79 (25.3%) cases and sputum in 73 (24.9%) cases. There were 54 (18.4%) cases with positive chest CT changes. The main imaging findings showed that there were 46 cases with new patchy shadows, 25 cases with linear opacities, 10 cases with ground-glass opacities, 10 cases with nodular like shadows and 2 cases with consolidation, and most lesions were in the subpleural area of both lungs. Univariate analysis showed that positive CT findings were correlated with the time from positive detection of COVID-19 to screening ( P=0.026), age ( P<0.001) and underlying diseases ( P=0.006). Multivariate analysis showed that age≥65 years old ( OR=6.425, 95% CI: 2.688-15.358; P<0.001) and underlying diseases ( OR=2.292, 95% CI: 1.120-4.691; P=0.023) were risk factors for pulmonary imaging changes of COVID-19 infection. For lung cancer opportunistic screening, 36 (12.3%) cases showed ground-glass opacities in bilateral or unilateral lung lobes, among which 4 cases were suspected to be atypical adenomatous hyperplasia and 2 cases s were suspected to be early stage of lung cancer. Conclusions:Abnormal clinical symptoms and chest CT findings are still observed in the patients during the convalescent stage of COVID-19 infection. Age≥65 years, underlying diseases were the high-risk factors for the changes in chest CT imaging after COVID-19 infection. Attention should be paid to the differential diagnosis of chest CT findings between changes in the convalescent stage of COVID-19 and early stage of lung cancer.

Predictors of the Outcome Destination of Patients with a Proximal Femoral Fracture in a Convalescent Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

Purpose：This study aimed to clarify the conditions necessary for patients with a proximal femoral fracture in the convalescent ward to return home using a decision tree analysis. This study included 181 patients who were discharged from the convalescent ward between January 2018 and June 2022.Methods：Patients divided into two groups：home vs. facility according to the outcome. Basic characteristics, FIM at admission, and MMSE at admission were compared using the unpaired t-test, χ2 test, and Mann-Whitney U test, and a decision tree analysis was performed.Results：The decision tree analysis based on functional independence measures (FIM) on admission and toileting activities, etc. found that discharge was difficult (return home rate：9.7％-28.6％) when the problem-solving aspect of the FIM on admission was less than 4 points.Conclusion：When discharging patients with a proximal femoral fracture from the hospital, it is important to consider a combination of problem-solving in the admission FIM and toileting activities.

Usefulness of Early-phase Online Home Visits for Improving Therapy for Inpatients in a Convalescent Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

Objective：Home visits conducted in the early rehabilitation phase through an online connection between the patient's home and the hospital are termed online home visits. They enable real-time sharing of home information and patient and family wishes between the family and the therapists participating from home with healthcare professionals at the hospital. This study aimed to evaluate the usefulness of online home visits.Methods：We enrolled 75 patients with musculoskeletal or cerebrovascular disease discharged from a convalescent rehabilitation ward and classified them as those who received online home visits (online group, n＝25) and in-person home visits (non-online group, n＝50) within 7 days of hospitalization. Functional independence measure (FIM) efficiency was compared between the groups. Rehabilitation treatment changes made by therapists after virtual home visits were surveyed.Results：In patients with musculoskeletal diseases, FIM efficiency was significantly higher, and the length of hospital stay was significantly shorter in the online group (n＝14, 1.0 ± 0.5 points/day) than in the non-online group (n＝26, 0.7 ± 0.5 points/day) (p＜0.05). Many therapists who participated in virtual home visits modified their rehabilitation therapy afterwards by recreating the home environment in the rehabilitation room and implementing rehabilitation therapy for home activities.Conclusion：Virtual home visits can facilitate rehabilitation therapy more appropriate to the home environment because they provide visual information about the home. The present findings indicate the contribution of online home visits to FIM efficiency improvement and home discharge preparation.

Usefulness of Early-phase Online Home Visits for Improving Therapy for Inpatients in a Convalescent Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

Objective：Home visits conducted in the early rehabilitation phase through an online connection between the patient's home and the hospital are termed online home visits. They enable real-time sharing of home information and patient and family wishes between the family and the therapists participating from home with healthcare professionals at the hospital. This study aimed to evaluate the usefulness of online home visits.Methods：We enrolled 75 patients with musculoskeletal or cerebrovascular disease discharged from a convalescent rehabilitation ward and classified them as those who received online home visits (online group, n＝25) and in-person home visits (non-online group, n＝50) within 7 days of hospitalization. Functional independence measure (FIM) efficiency was compared between the groups. Rehabilitation treatment changes made by therapists after virtual home visits were surveyed.Results：In patients with musculoskeletal diseases, FIM efficiency was significantly higher, and the length of hospital stay was significantly shorter in the online group (n＝14, 1.0 ± 0.5 points/day) than in the non-online group (n＝26, 0.7 ± 0.5 points/day) (p＜0.05). Many therapists who participated in virtual home visits modified their rehabilitation therapy afterwards by recreating the home environment in the rehabilitation room and implementing rehabilitation therapy for home activities.Conclusion：Virtual home visits can facilitate rehabilitation therapy more appropriate to the home environment because they provide visual information about the home. The present findings indicate the contribution of online home visits to FIM efficiency improvement and home discharge preparation.

Determination of the ELISA kits for screening convalescence plasma with high potency of SARS-CoV-2 IgG / 中国输血杂志

【Objective】 To determine the ELISA kit for screening convalescence plasma with high potency of SARS-CoV-2 IgG by comparing and analyzing the plasma detection results of convalescent plasma collected in different periods via ELISA kits from two manufacturers and the results of mixed plasma with different potency via pseudovirus neutralization experiments. 【Methods】 Two ELISA kits from different manufacturers(named A, B) were used to detect the plasma of 269 convalescent patients collected from Feb.2020~Jan.2022. The correlation and concordance rate of the two results were analyzed to determine the kit preliminarily. According to the titers of diluted series of standard of the preliminary selected kit, 5 mixed plasma samples (G4-G128) with different potency were prepared. The correlation of ELISA IgG results of product A/B, as well as the pseudovirus neutralization test of the original strain, Omicron mutant BA.1 and BA.2 strains were analyzed. Combined with the outside-well dilution mode of the strongly positive samples, the kit for high potency of SARS-CoV-2 IgG screening was determined. 【Results】 When the internal control reference B2 was used as the standard, the detection sensitivity of product A and B was 1∶32 vs 1∶8; the detection sensitivity of product A was 4 times that of product B. The correlation Pearson r between the results given by two kits was 0.944 1(P<0.000 1). Product B with low sensitivity was primarily selected as an alternative kit. The ELISA IgG results of samples from mixed plasma showed that the order of correlation r between product A and B was 0.988. The correlation r between product A and neutralization antibody potency of the three viruses was original strain (0.978)>BA.2(0.970)>BA.1(0.799); the order of correlation r between ELISA IgG results of product B and neutralization antibody potency of the three viruses was original strain(0.994)>BA.2(0.968)>BA.1(0.804). If twice-diluted B2 was taken as the excellent standard, 55.4% of product B met the criterion, while 47.2% of product A met.For positive plasma with high IgG potency, the product B kit required a lower dilution of the sample, which was more convenient to operate. 【Conclusion】 Both of the ELISA IgG kit from product A and B can be used to screen IgG antibodies of SARS-CoV-2, while product B is more suitable for screening positive plasma with high IgG potency.

Efficacy of autologous ozoneized blood transfusion in improving motor function in convalescent stroke patients / 中国输血杂志

【Objective】 To investigate the efficacy of autologous ozoneized blood transfusion(AOBT) in improving consciousness and motor function in convalescent stroke patients. 【Methods】 A total of 44 patients who were diagnosed as convalescent cerebral apoplexy and received treatment in Rehabilitation Department of our hospital from August 2016 to September 2021 were randomly divided into the experimental group and control group by blind method. The experimental group (n=22) received general rehabilitation training (such as exercises, occupational therapy, acupuncture and transcranial magnetic stimulation) plus AOBT (200 mL venous phlebotomy at the median elbow), once every 2 to 3 days and 12 occasions as a course of treatment; the control group solely recieved general rehabilitation training. The consciousness (GCS score) and ability of daily living (Barthel index score) score of the two groups before and after treatment were statistically compared, and Ueda motor function grade, Brunnstrom stage and muscle tone grade were observed and evaluated. 【Results】 After the treatment, the experimental group and the control were compared as follows: 1) the GCS score and Barthel score was 14.82±0.39 vs 12.41±2.52, 61.14±12.24 vs 52.05±11.72(P<0.05); 2) The recovery rate of motor function was 95.45% (21/22) vs 63.64% (14/22) (P<0.05); 3) The total recovery rate of muscle tone was 90.91% (20/22) vs 63.64% (14/22) (P<0.05). 【Conclusion】 AOBT, with somewhat high safety and effectiveness, can improve the state of consciousness, motor function and muscle tone in convalescent patients with stroke.

Analysis of related factors of plasma antibody titer in convalescent patients with COVID-19 / 中国输血杂志

【Objective】 To study the relationship between the plasma IgG, IgM, neutralizing antibody titer and sex, age, collection interval in convalescent patients with COVID-19, so as to guide the plasma collection of convalescent patients with COVID-19. 【Methods】 COVID-19 convalescent plasma was collected to determine the antibody titer, and the difference and correlation of data in each group were analyzed by SPSS statistical analysis software. 【Results】 The median titers (AU/mL)of IgG, IgM and neutralizing antibodies in males and females were 484.24 vs 516.04, 2.13 vs 1.73, and 1 124.74 vs 1 143.99, respectively, and there was no significant difference(P>0.05) . Age had weak positive correlation with IgG and neutralizing antibody, and the Spearman correlation coefficient was 0.188 (P<0.05). The median titers (AU/mL) of IgG, IgM and neutralizing antibody at first donation of 30 repeated donors were 522.3, 2.64 and 1 174.6, respectively, but at second donation were 332.08, 0.63 and 708.96, showing significant difference (P<0.05). 【Conclusion】 There was no significant difference in the plasma IgG, IgM and neutralizing antibody titers in convalescent COVID-19 patients of different ages and genders, and the titers met the requirements of clinical treatment guidelines. Although the plasma antibody level of repeated donors has decreased, it still has clinical value.

SARS-CoV-2 total antibody detection results in blood donors from Shenzhen during different periods of COVID-19 epidemic prevention and control / 中国输血杂志

【Objective】 To analyze the SARS-CoV-2 detection results among blood donors in different periods of COVID-19 pandemic control in Shenzhen and assess the antibody levels and infection status of blood donors in different periods, so as to provide reference for subsequent blood testing strategies. 【Methods】 A total of 4 768 plasma samples of blood donors were subjected to pooled testing by nucleic acid testing(NAT) with 8 samples per pool. Additionally, these samples were subjected to a 1000-fold dilution, and the detection of SARS-CoV-2 total antibody was performed by enzyme-linked immunosorbent assay (ELISA). The 4 768 plasma samples were collected from blood donors at different time points in Shenzhen, with inquiries made to determine whether donors during the COVID-19 pandemic were in the convalescence. The antibody positive rates in blood screening samples during different periods of the pandemic and samples from individuals in the convalescence of COVID-19 infection were analyzed. Furthermore, the antibody levels were examined for differences based on gender, age, and blood type. 【Results】 All 4 768 plasma samples from blood donors were negative by NAT, while 2 342 samples were detected positive by the SARS-CoV-2 total antibody detection, with a positive rate of 49.1%. These samples from four periods (September 30 to October 3, 2022; November 3 to 6, 2022; December 27 to 31, 2022; January 6 to 18, 2023) were subjected to a 1 000-fold dilution for COVID-19 antibody detection, and the positive rates were 21.3%, 15.8%, 65.9%, and 93.9%, respectively. 【Conclusion】 The prevalence of COVID-19 antibodies among blood donors in Shenzhen during different periods of the pandemic varied significantly. There was no difference in antibody prevalence among different genders and blood types, while younger individuals exhibited a higher prevalence of antibodies. The risk of COVID-19 transmission through blood transfusion was found to be extremely low.

Passive antibody therapy in emerging infectious diseases / 医学前沿

The epidemic of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 and its variants of concern (VOCs) has been ongoing for over 3 years. Antibody therapies encompassing convalescent plasma, hyperimmunoglobulin, and neutralizing monoclonal antibodies (mAbs) applied in passive immunotherapy have yielded positive outcomes and played a crucial role in the early COVID-19 treatment. In this review, the development path, action mechanism, clinical research results, challenges, and safety profile associated with the use of COVID-19 convalescent plasma, hyperimmunoglobulin, and mAbs were summarized. In addition, the prospects of applying antibody therapy against VOCs was assessed, offering insights into the coping strategies for facing new infectious disease outbreaks.

Neutralization against SARS-CoV-2 Delta/Omicron variants and B cell response after inactivated vaccination among COVID-19 convalescents / 医学前沿

Emerging SARS-CoV-2 variants have made COVID-19 convalescents susceptible to re-infection and have raised concern about the efficacy of inactivated vaccination in neutralization against emerging variants and antigen-specific B cell response. To this end, a study on a long-term cohort of 208 participants who have recovered from COVID-19 was conducted, and the participants were followed up at 3.3 (Visit 1), 9.2 (Visit 2), and 18.5 (Visit 3) months after SARS-CoV-2 infection. They were classified into three groups (no-vaccination (n = 54), one-dose (n = 62), and two-dose (n = 92) groups) on the basis of the administration of inactivated vaccination. The neutralizing antibody (NAb) titers against the wild-type virus continued to decrease in the no-vaccination group, but they rose significantly in the one-dose and two-dose groups, with the highest NAb titers being observed in the two-dose group at Visit 3. The NAb titers against the Delta variant for the no-vaccination, one-dose, and two-dose groups decreased by 3.3, 1.9, and 2.3 folds relative to the wild-type virus, respectively, and those against the Omicron variant decreased by 7.0, 4.0, and 3.8 folds, respectively. Similarly, the responses of SARS-CoV-2 RBD-specific B cells and memory B cells were boosted by the second vaccine dose. Results showed that the convalescents benefited from the administration of the inactivated vaccine (one or two doses), which enhanced neutralization against highly mutated SARS-CoV-2 variants and memory B cell responses. Two doses of inactivated vaccine among COVID-19 convalescents are therefore recommended for the prevention of the COVID-19 pandemic, and vaccination guidelines and policies need to be updated.

Neutralization against SARS-CoV-2 Delta/Omicron variants and B cell response after inactivated vaccination among COVID-19 convalescents / 医学前沿

Emerging SARS-CoV-2 variants have made COVID-19 convalescents susceptible to re-infection and have raised concern about the efficacy of inactivated vaccination in neutralization against emerging variants and antigen-specific B cell response. To this end, a study on a long-term cohort of 208 participants who have recovered from COVID-19 was conducted, and the participants were followed up at 3.3 (Visit 1), 9.2 (Visit 2), and 18.5 (Visit 3) months after SARS-CoV-2 infection. They were classified into three groups (no-vaccination (n = 54), one-dose (n = 62), and two-dose (n = 92) groups) on the basis of the administration of inactivated vaccination. The neutralizing antibody (NAb) titers against the wild-type virus continued to decrease in the no-vaccination group, but they rose significantly in the one-dose and two-dose groups, with the highest NAb titers being observed in the two-dose group at Visit 3. The NAb titers against the Delta variant for the no-vaccination, one-dose, and two-dose groups decreased by 3.3, 1.9, and 2.3 folds relative to the wild-type virus, respectively, and those against the Omicron variant decreased by 7.0, 4.0, and 3.8 folds, respectively. Similarly, the responses of SARS-CoV-2 RBD-specific B cells and memory B cells were boosted by the second vaccine dose. Results showed that the convalescents benefited from the administration of the inactivated vaccine (one or two doses), which enhanced neutralization against highly mutated SARS-CoV-2 variants and memory B cell responses. Two doses of inactivated vaccine among COVID-19 convalescents are therefore recommended for the prevention of the COVID-19 pandemic, and vaccination guidelines and policies need to be updated.

Narrativas del donante de plasma convaleciente en EsSalud: motivaciones, miedos, expectativas y experiencias

Objetivos: Explorar, desde las narrativas de la población de donantes de plasma convaleciente en un ensayo clínico, las experiencias en el proceso de donación de sangre. Métodos: Se realizó un estudio cualitativo con diseño fenomenológico. La investigación se llevó a cabo en un hospital de la seguridad social del Perú aplicándose entrevistas semiestructuradas a profundidad. Resultados: Se entrevistó a once donantes de plasma convaleciente. Se identificó que las principales motivaciones de los donantes fueron tanto el poder contribuir a la investigación nacional como, apoyar a pacientes afectados por la COVID-19. Los principales miedos se centran en el posible riesgo de contagio dentro del hospital. Por otro lado, los donantes resaltaron la atención y acompañamiento del personal de salud en el proceso. Las principales expectativas y sugerencias apuntan hacia una mayor difusión de las campañas de donación de sangre en general, con especial énfasis en el tema de seguridad, la mejora en el tiempo del procedimiento de donación (en el caso de la donación de plasma convaleciente, desde el enrolamiento hasta la extracción de plasma convaleciente) y, la implementación de espacios amigables para incentivar las futuras campañas de donación de sangre en general. Conclusiones: Las experiencias de los donantes de plasma convaleciente fueron positivas. Sin embargo, aún hay mejoras que realizar a nivel de procesos e infraestructuras para asegurar campañas exitosas de donación de sangre futuras.

Objectives: To know and explore from convalescent plasma donators' voices the experience in the blood donation process at a social security hospital. Methods: Qualitative study with a phenomenological design. The investigation was carried out in 01 hospitals of the social security of Peru. Semi-structured interviews were carried out. Results: Eleven donors of convalescent plasma were interviewed. The main motivations for donating were being able to contribute to national research and supporting patients affected by COVID-19. Fears focus on the possible risk of contagion within the hospital. Donors emphasised the attention and support of health personnel alongside the donation procedure. The main expectations and suggestions point towards greater dissemination of donation campaigns with special emphasis on safety. Likewise, an improvement in the time of the donation procedure (from enrolment to the extraction of convalescent plasma), and the implementation of friendly spaces to encourage future blood donation campaigns were highlighted. Conclusions: The experience of the convalescent plasma donors was positive. However, improvements must be made in terms of processes and infrastructure to ensure future successful blood donation campaigns.

Once in a blue moon: A rare case of Duchenne muscular dystrophy complicated by COVID-19

Patients suffering from Duchenne Muscular Dystrophy (DMD) are at higher risk of suffering significant morbidity resulting from COVID-19, considering their pre-existing respiratory insufficiency and immunocompromised state. We present such a case who was admitted to our intensive care unit. A 21-year-old patient, who was a diagnosed case of DMD since the age of 8 and on treatment with steroids, angiotensin-converting enzyme inhibitors, and intermittent home-oxygen support, presented with fever and breathlessness and was diagnosed to have COVID-19 pneumonia. Oxygen support was provided by non-invasive ventilation (NIV), along with therapeutic and supportive treatment, namely, azithromycin, remdesivir, dexamethasone, and heparin. Dyselectrolytemia was corrected and convalescent plasma was transfused. The patient was weaned off NIV and discharged on significant improvement in his general condition. Although the treatment of COVID-19 using convalescent plasma has now fallen out of favor, we found some clinical improvement in our patient. DMD complicated by COVID-19 can seem like a daunting challenge, but providing fundamental, yet, simple treatment measures goes a long way in the patient care

Development and implementation of a COVID-19 convalescent plasma program in a middle-income economy

Abstract Introduction Convalescent Plasma therapy is one of the therapeutic strategies that has been used for patients with the Covid-19 disease. Implementing a program with national extension to supply hospitals with this blood component is a great challenge mainly in a middle-income economy. Objectives Our objective was to develop and implement a Covid-19 Convalescent Plasma Program which met established quality standards and was adapted to a reality of limited resources. Methods A multicentric convalescent plasma collection program was developed and implemented, based on four main sequential procedures: selective donor recruitment, pre-donation antibody screening (Anti-SARS-CoV-2- Chemiluminescence IgG Abbott), convalescent plasma collection by apheresis or whole-blood processing and distribution to the hospitals according to local demand. Results From the 572 candidates submitted to the pre-donation antibody screening, only 270 (47%) were considered eligible for plasma donation according to the established criteria. Higher levels of total antibody were associated with the donor age being above 45 years old (p= 0.002), hospital admission (p= 0.018), and a shorter interval between the diagnosis of the SARS-CoV-2 infection and plasma donation (p < 0.001). There was no association between the ABO and Rh blood groups and their antibody levels. Of the 468 donations made, 61% were from the collection of whole-blood and 39%, from apheresis. The Covid-19 Convalescent Plasma units obtained were distributed to 21 different cities throughout the country by air or ground transportation. Conclusion The implementation of a Covid-19 Convalescent Plasma program in a continental country with relatively scarce resources is feasible with alternative strategies to promote lower cost procedures, while complying with local regulations and meeting quality standards.

Isolated Unilateral Third Cranial Nerve Palsy : A Rare Presentation of Dengue Fever

We herein report a case of unilateral 3rd cranial nerve palsy in a 15 years old boy. It can be due to numerous aetiologies like infectious, inflammatory, malignant, metabolic or vascular. In our case the nerve palsy was preceded by history of high grade fever of 5 days. Involvement of 3rd cranial nerve started 9 days after fever onset, insidiously, presenting as Ptosis and Diplopia. No history of altered sensorium, limb weakness, diurnal variation. Routine investigation was normal. Integrated Counselling and Testing Centre (ICTC) was negative. Cerebrospinal Fluid (CSF) study revealed viral picture but was negative for neurotropic viral panel. MRI brain was essentially normal except for presence of small Lipoma over prepontine cistern. Antinuclear Antibody (ANA) and Antineutrophil Cytoplasmic Antibodies (ANCA) were negative. Serology for Dengue was sent considering the history of high grade fever associated with blanchable rash. Dengue IgM report came out to be reactive. CSF Dengue IgM also came out to be reactive. Patient was put on short course of oral steroid therapy and cranial nerve palsy improved gradually. Neurological complications of dengue is uncommon. Few cases of Cranial Nerve Involvement associated with Dengue have been reported in the literature, most of them are associated with encephalitis. But in our case Cranial Nerve involvement was not associated with Encephalitis, it was probably due to immune reactions secondary to Dengue, making this case atypical.

Retrospective analysis on efficacy of convalescent plasma in acute respiratory distress syndrome due to COVID-19

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. OBJECTIVES: To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN AND SETTING: Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. METHODS: The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. RESULTS: During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nineteen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CONCLUSION: CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.