ABSTRACT
Introduction: Vaccination is considered the most effective method of preventing diseases and their complications. Unfortunately, many people question their legitimacy and safety. At the beginning of 2021, a few months after the announcement of the SARS-CoV-2 pandemic by the World Health Organization (WHO), the first COVID-19 vaccines were granted a conditional marketing authorization. mRNA vaccines have attracted great interest due to the use of new technology and the content of polyethylene glycol (PEG 2000) in their composition, which may induce anaphylaxis. Due to vaccine tolerance concerns, some vaccination centres have refused to administer the vaccine to patients. Aim(s): Risk assessment of allergic reactions after administration of the COVID-19 vaccine. Material(s) and Method(s): 115 patients were admitted to the Department of Allergology and Clinical Immunology in Katowice, including 107 patients with a high risk of anaphylaxis after vaccination according to the referring physician and 8 patients with a history of hypersensitivity reactions after the first dose of COVID-19 vaccination. Patients were referred for diagnosis of hypersensitivity to components of the Pfizer/BioNTech COVID-19 vaccine and administration of the vaccine in a hospital setting. During hospitalization, all patients underwent skin prick and intradermal tests with the Pfizer/BioNTech COVID-19 vaccine components, with negative results. Patients were administered the Pfizer/BioNTech COVID-19 vaccine intramuscularly, followed by at least 60 minutes of observation in the Department. Result(s): No symptoms of early hypersensitivity were observed. One patient developed urticarial lesions on the skin of the neck approximately 4-5 hours after vaccination. Conclusion(s): The risk of anaphylaxis after COVID-19 vaccine administration is low, and only a small group of patients with an allergic history require a specialised diagnostics. Physicians authorised to administer the vaccine should be acquainted with the latest recommendations, assess the risk of anaphylaxis and avoid unnecessary delays in administering a vaccine that can protect against severe morbidity and death.Copyright © 2023, Termedia Publishing House Ltd.. All rights reserved.
ABSTRACT
Purpose: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is performed through various cannulation approaches but an optimal strategy remains uncertain. Methods: A retrospective, multi-center study was conducted. Adult patients (≥18 years old) placed on VV-ECMO for severe respiratory failure due to COVID-19 between March 1, 2020, to April 30, 2021, across the United States were included. Patients were divided into the following 3 groups based on initial cannulation: 1) femoral vein-femoral vein or femoral vein-internal jugular vein (Dual-Site, DS), 2) single, dual-lumen cannula in internal jugular vein with tip positioned in the pulmonary artery (PA) and 3) single, dual-lumen cannula in internal jugular vein with tip positioned in the inferior vena cava (IVC). The primary outcome was in-hospital mortality after VV-ECMO placement assessed by a time-toevent analysis. Results: Overall, 435 patients from 17 centers comprised the study cohort. DS cannulation was performed in 247 (age: 47±11, 30% female) cases, 99 (age 50±12, 26% female) received PA, and 89 patients got IVC (age 45±12, 33% female). At 90 days, in-hospital mortality across cannulation groups was 60% (DS), 41% (PA) and 61% (IVC), p=0.06 (Figure 1). After adjustment for clinical covariates, the likelihood of in-hospital mortality in comparison to DS, was lower with PA (aHR: 0.60, 95%CI 0.40-0.91, p=0.02) and similar with IVC (aHR: 0.99, 95%CI 0.68-1.43, p=0.95). Conclusion: Catheter directed flow into the PA with a single dual-lumen cannula is associated with reduced mortality during VV ECMO for COVID-19.
ABSTRACT
Background: Severe obesity (Body Mass Index (BMI) ≥40 kg/m2) is associated with a higher risk of developing severe symptoms and complications of coronavirus disease 19 (COVID-19), independent of other illnesses. Despite this, patients with severe obesity are less likely to receive Veno-Venous Extra Corporeal Membrane Oxygenation (VV-ECMO) support for severe Acute Respiratory Distress Syndrome (ARDS). Given this paradox, we examined the impact of severe obesity on outcomes of adult patients who underwent VV-ECMO implantation for ARDS at our center. Methods: We reviewed our ECMO database from May 2013 through May 2020. Adults, who had received VV-ECMO, either in-house or through our mobile ECMO program, were included. We grouped patients into those with BMI ≥40 kg/m2 or not and compared survival at 48 hours, survival to hospital discharge, and hospital length of stay. We conducted multiple logistic and linear regression analyses to analyze the association with categorical and continuous variables, respectively, controlling for patient age, gender, and use of mobile ECMO. Results: We identified 112 consecutive adult VV-ECMO patients;median age was 48 (34, 59) years, 61 (54.5%) were male, 56 (50%) were started on ECMO in-house, the median BMI was 31.7 (27.6, 38.8) Kg/ m2;and 23 (20.5%) had a BMI ≥40 kg/m2. Survival at 48 hours and hospital discharge were 69.6% and 61.6%, respectively;and, median hospital length of stay was 20 (9, 33) days. Logistic regression showed no evidence of an association between severe obesity and either 48-hour (OR 1.04, 95% CI 0.37-2.96) or hospital discharge survival (OR 1.06, 95% CI 0.38-2.93). There was, however, a significant correlation between increasing BMI and longer total hospital length of stay (R2 = 0.34;p = 0.0002) which remained significant in linear regression (p = 0.0002) (Figure). Conclusions: We found no association between severe obesity and survival at 48-hour and hospital discharge in patients supported on VV-ECMO. Severe obesity was associated with a longer hospital stay, however. Our experience suggests that severe obesity alone should not exclude candidacy for VV-ECMO support.
ABSTRACT
Biological therapy is the breakthrough in the management of spectrum of various diseases. It also concerns asthma therapy. The data regarding the role of biologics in the treatment strategy of severe asthma are presented. The overview on how mediators of type 2 inflammation drives the pathology of the disease is given. It justifies the biological treatment options approved. The development of treatment strategy targeting non-type 2 inflammation is also highlighted. The data regarding the risk and safety of biologics are discussed. Document includes the featured rules of the classification of patients with severe asthma to this reliable and efficient therapy. The outlook how to perceive the safety of biologics in the time of COVID-19 epidemic is also given.