ABSTRACT
Background: Thymic epithelial tumors (TETs) are rare malignancies associated with dysregulation of the immune system with humoral and cell mediated immunity abnormalities. Anti-syndrome coronavirus type 2 (SARSCoV- 2) vaccine is effective at preventing COVID-19 morbidity and mortality. No published data are available regarding the post-vaccine immunization in TET patients (pts). The aim of our study was to evaluate the immunization in TET pts, who received the third mRNA vaccine dose and who did not achieve seroconversion after the previous two doses. Method(s): Starting from November 2021 to March 2022, 23 consecutive TET patients (pts) found to be serologically negative after two doses of SARS-Cov-2 mRNA vaccine (BNT162b2 by Pfizer-BioNTech) were enrolled at the Rare Tumors Coordinating Center of Campania Region (CRCTR-Naples, Italy). SARS-CoV-2 spike-binding IgG antibody serological levels were centrally analyzed by chemiluminescent immunoassay (CLIA) at two different time-points: T0 (before the third dose) and T1 (one month after the third dose). Cut-off for Ab titers positivity was >25 AU/mL. Result(s): Among the 23 enrolled pts, 10 (43,5%) were female and 13 (56,5%) males;17 pts had thymoma and 6 thymic carcinoma. Autoimmune disorders were detected in 20 TET pts (87%), of whom 3 (15%) suffered from Myasthenia Gravis, 8 (40%) from Good's Syndrome, 7 (35%) from both diseases, and 2 (10%) from other autoimmune disorders. By the time of third vaccine dose 2 pts had died, 2 pts were lost to follow up, 5 pts had suffered from SARS-CoV-2 infection. Of the remaining 14 pts, 7 achieved seroconversion whereas 7 maintained negative serological antibody titers. Two of these 7 pts had SARSCoV- 2 infection after the third dose. Interestingly, among these 7 pts who did not develop positive antibody titers, 6 had active cancer disease and only one was diseasefree. Moreover, 6 out of these 7 pts suffered from Good's Syndrome. On the other hand, among the 7 pts who developed positive antibody titers, only 3 had active disease. Conclusion(s): Our preliminary results showed that TET pts who did not achieve seroconversion even after the third SARS-Cov-2 vaccine dose in most cases had active cancer disease. If confirmed on larger cohorts of patients, these data may have important clinical implications and may help to better identify fragile pts who could benefit the most from prophylactic therapy with monoclonal antibodies.
ABSTRACT
Background: Thymic epithelial tumors (TET) are rare malignancies associated with dysregulation of the immune system and humoral and cell mediated immunity abnormalities. Anti-syndrome coronavirus type 2 (SARS-CoV-2) vaccine is effective at preventing COVID-19 morbidity and mortality. No published data are available regarding the immunization in TET patients (pts). The aim of this study was to evaluate the immunization in TET pts who received two doses of mRNA vaccine, by longitudinal serological detection of SARS-COV-2 spike-binding IgG antibody. Methods: Starting from April 2021 to October 2021, consecutive TET pts referred to the Rare Tumors Coordinating Center of Campania Region (CRCTR - Naples, Italy) were enrolled. All study subjects received two doses of COVID-19 mRNA vaccine (BNT162b2 by Pfizer-BioNTech). SARS-CoV-2 spike-binding IgG antibody (Ab) serological levels were analyzed by centralized chemiluminescent immunoassay (CLIA) at different time-points, including before 1st vaccine dose (T0) and 1 month after 2nd dose (T2). Cut-off for Ab titers positivity was > 25 AU/mL. Results: Forty pts were enrolled;23 (57.5%) were female and 17 (42.5%) male. Eleven pts (27.5%) suffered from thymic carcinoma, 28 (70%) thymoma, and 1 (2.5%) thymic hyperplasia. At the time of study enrollment, 20 pts (50%) had no evidence of disease (NED) and were in followup;the remaining 20 pts had evidence of disease (ED) by imaging and were receiving systemic treatment (55% oral low-dose etoposide-based therapy, 40% somatostatin analogs + prednisone, 5% supportive care). Immune system disorders were diagnosed in 29 TET pts (72.5%): 19 pts (47.5%) had Good's Syndrome (GS) and 10 (25%) other immune disorders. At T0, all enrolled pts had negative Ab titers and no prior SARS-CoV-2 infection. At T2, Ab data were available for 37 pts (92.5%): 18 pts (48.7%) had positive Ab titers, whereas 19 (51.3%) did not achieve seroconversion. Among pts with ED, seroconversion was achieved only in 2 cases (11.8%). Lack of seroconversion at T2 was significantly associated with ED (Fisher's exact test p: 0.0001) and with the presence of GS (Fisher's exact test p: 0.0489). No significant association of seroconversion with other immune disorders and disease features was found. Conclusions: Our data showed that TET pts with ED had substantially higher probability of impaired seroconversion after SARS-COV-2 vaccine as compared with NED pts. We warrant further studies to evaluate the role of disease status, anti-tumor treatments and immune disorders in post-vaccine immunization of TET pts.
ABSTRACT
Today, by talking about inclusive education, we are looking to the future to achieve the Sustainable Development Goals. The aim of this paper is to describe three experiences carried out in different contexts: Quebec (Canada), Montevideo (Uruguay) and the Region of Valencia (Spain) that respond to the principles of inclusive education. The experiences were selected according to a set of criteria and taking into account the attributes that good practice should have according to UNESCO: reproducible, sustainable, innovative and efficient. The first experience is in a context of great cultural and linguistic diversity where the family-school partnership has been fostered by participatory workshops. The second experience took place in a school which, following a diagnosis of the consequences of the COVID-19 pandemic, undertook an institutional project based on the use of technologies as a tool for inclusion. The third experience is held in a multi-grade classroom, in a rural setting, where students perform a children's opera with the help of teachers and family participation. To conclude, some key insights are presented in the form of lessons learned or challenges encountered.
ABSTRACT
Background: Virtual methods have been innovatively utilized by healthcare professionals to provide a variety of clinical services during the COVID-19 pandemic. In March 2020, the Odette Cancer Centre pharmacy modified the delivery of clinical pharmacy services (CPS) to minimize patient contact and decrease the risk of viral transmission. As part of the modified delivery model, CPS such as best possible medication histories (BPMH), baseline assessments, and medication therapy counsels were conducted via telephone. Objective: To describe the Odette Cancer Centre Pharmacy's modified CPS delivery model for ambulatory patients treated with intravenous anticancer therapy during the first wave of the COVID-19 pandemic. Methods: The modified CPS delivery model was implemented on 25 March 2020. A process map illustrating differences in workflow between the standard and modified CPS delivery models was created, and challenges to remote CPS delivery were identified. The number of BPMH/baseline assessments and medication therapy counsels completed virtually and in-person were tracked over a six-week follow up period and summarized as process metrics. Results: The high-level process map illustrates the stepwise differences in workflow for a single patient across a four-day period. During the six-week follow up period, 202 BPMH/baseline assessments and 199 medication therapy counsels were completed. Seventy-four percent (149/202) of BPMH/baseline assessments and 36% (74/199) of medication therapy counsels were provided remotely. Challenges to remote CPS delivery included patient acceptance and lack of technology to support system-level processes. Conclusion: By incorporating remote delivery approaches, clinical pharmacy service levels at the Odette Cancer Centre were maintained during the first wave of the pandemic without significant investment in resources. Further research to develop, refine, and individualize virtual clinical pharmacy care models will help to consolidate the role of these approaches in the post COVID-19 pandemic era.
ABSTRACT
Background: Clinical pharmacy services such as medication reconciliation, medication counselling, and toxicity follow up are integral elements of cancer patient care. Pharmacy professionals responded to the challenge of maintaining oncology clinical pharmacy services (CPS) while minimizing patient contact during COVID-19 pandemic restrictions. Objective: To survey pharmacy professionals from across Canada and describe how cancer centre pharmacies adapted to deliver oncology CPS at the onset of the COVID-19 pandemic. Methods: Pharmacy professionals at Canadian cancer facilities were invited to complete an online questionnaire. Recruitment occurred via the Canadian Association of Pharmacy in Oncology and Oncology Pharmacists of Toronto Regional Association networks. Survey items addressed practice site characteristics, changes to oncology CPS delivery models to accommodate COVID-19 pandemic restrictions, and barriers and facilitators to maintaining oncology CPS during the pandemic. Responses were summarized using descriptive statistics. Results: Twenty-one (45%) of the 47 respondents were from Ontario, with the remainder distributed across the provinces and one territory. Of the 43 participants who completed the survey, 63% (27/43) reported a decrease in face-to-face CPS interactions, and 63% (27/43) reported an increase in telephone CPS encounters during the first pandemic peak. Video communications were seldom used before or during the pandemic. Most respondents (34/43, 79%) were confident that CPS levels were maintained during the pandemic. Flexibility in the method and timing of service provision was a commonly reported facilitator to CPS delivery during the pandemic. Common factors which impeded successful CPS delivery included lack of resources (technology, equipment) and inadequate time to plan. Conclusion: Most pharmacists were satisfied with the level of oncology CPS maintained during the first wave of the COVID-19 pandemic. The majority of sites adapted by increasing telephone consultations and decreasing in-person encounters. Opportunities to improve remote CPS delivery include improved access to video technology and development of virtual patient-education aids.
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Objective: The coronavirus disease 2019 (COVID-19) pandemic is a global public health concern. Health Care Facilities in every country have to deal with a complete reorganization of labor and delivery unit, and resource management. Aim of this review is to summarizetheavailableliteraturedataabouttheimpactofCOVID-19on hysteroscopic surgery. Mechanism: A search on PubMed and Med-line databases was performed until March 2021. Findings in brief: Most of evidence agree on complete cancellation of elective endoscopic gynecologic surgery, and on its deferring until the pandemic has been contained. When hysteroscopy is performed, precautions should be observed to prevent COVID-19 infection. Conclusions: We summarized all best practice to perform safe and effective hysteroscopic surgery in COVID-19 times and in the slow restore of normal activities.
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Background: Pregnant women are usually more susceptible to infection due to typical physiological and mechanical changes, such as increased heart rate, stroke volume and pulmonary residual capacity. The aim of this study was to evaluate an innovative anesthesiologic opioid-free management protocol in symptomatic pregnant women, with COVID-19 and with oxygen therapy, undergoing cesarean delivery with spinal anesthesia. Methods: With the patient in the sitting position, spinal anesthesia was performed at the L1-L2 level. Vertebral level has been identified starting from the sacrum, we counted the laminae in the caudal-to-cephalad direction, which was then marked with a surgical pen. The technique was performed in asepsis, in the subarachnoid space after vision of clear Cephalo-Spinal Fluid (CSF) in the spinal needle 27 Gauge, without letting out the CSF, bupivacaine 0.5% 10 mg, dexmedetomidine 10 μg and dexamethasone 4 mg was injected. Results: During the study period, 40 pregnant women with one or more symptoms and supplemental oxygen (FiO2 35-40%) who underwent cesarean delivery were included in the study. All pregnant women had pain visual analog scale (VAS) <3, and no pregnant women required rescue dose. Adverse effects, such as nausea, vomiting, shivering, or pruritus were not recorded in any case. After a mean of 2.5 hours from the spinal anesthesia, all the included women had a complete motility of the lower limbs and were able to mobilize independently within 12 hours after delivery. Mean time to first latus was about 8 hours after delivery. Conclusions: Pregnant women in COVID-19 can safely receive intrathecal dexamethasone and dexmedetomidine during planned cesarean delivery. © 2021 The Author(s). Published by IMR Press.