Severe refractory warm autoimmune haemolytic anaemia after the SARS-CoV-2 Pfizer-BioNTech vaccine (BNT162b2 mRNA) managed with emergency splenectomy and complement inhibition with eculizumab.

A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and autoimmune haemolytic anaemia (AIHA, aged 6 years) presented with jaundice, dark urine, fatigue and chest discomfort that began 48 hours after the first dose of SARS-CoV-2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed a warm AIHA picture. Over 4 weeks the patient developed life-threatening anaemia culminating in haemoglobin of 35 g/L (after transfusion), lactate dehydrogenase of 1293 units/L and bilirubin of 228 µmol/L, refractory to standard treatment with corticosteroids and rituximab. An emergency splenectomy was performed that slowed haemolysis but did not completely ameliorate it. Eculizumab, a terminal complement pathway inhibitor, was initiated to arrest intravascular haemolysis and showed a favourable response. AIHA is rare but described after the SARS-CoV-2 Pfizer-BioNTech vaccine. This case highlights the rare complication of AIHA, the use of emergency splenectomy for disease control, and the use of eculizumab.

Impact of SARS-CoV-2 pandemic on pancreatic cancer services and treatment pathways: United Kingdom experience.

INTRODUCTION: The SARS-CoV-2 pandemic presented healthcare providers with an extreme challenge to provide cancer services. The impact upon the diagnostic and treatment capacity to treat pancreatic cancer is unclear. This study aimed to identify national variation in treatment pathways during the pandemic. METHODS: A survey was distributed to all United Kingdom pancreatic specialist centres, to assess diagnostic, therapeutic and interventional services availability, and alterations in treatment pathways. A repeating methodology enabled assessment over time as the pandemic evolved. RESULTS: Responses were received from all 29 centres. Over the first six weeks of the pandemic, less than a quarter of centres had normal availability of diagnostic pathways and a fifth of centres had no capacity whatsoever to undertake surgery. As the pandemic progressed services have gradually improved though most centres remain constrained to some degree. One third of centres changed their standard resectable pathway from surgery-first to neoadjuvant chemotherapy. Elderly patients, and those with COPD were less likely to be offered treatment during the pandemic. CONCLUSION: The COVID-19 pandemic has affected the capacity of the NHS to provide diagnostic and staging investigations for pancreatic cancer. The impact of revised treatment pathways has yet to be realised.

Digital Phenotypes for Understanding Individuals' Compliance With COVID-19 Policies and Personalized Nudges: Longitudinal Observational Study.

BACKGROUND: Governments promote behavioral policies such as social distancing and phased reopening to control the spread of COVID-19. Digital phenotyping helps promote the compliance with these policies through the personalized behavioral knowledge it produces. OBJECTIVE: This study investigated the value of smartphone-derived digital phenotypes in (1) analyzing individuals' compliance with COVID-19 policies through behavioral responses and (2) suggesting ways to personalize communication through those policies. METHODS: We conducted longitudinal experiments that started before the outbreak of COVID-19 and continued during the pandemic. A total of 16 participants were recruited before the pandemic, and a smartphone sensing app was installed for each of them. We then assessed individual compliance with COVID-19 policies and their impact on habitual behaviors. RESULTS: Our results show a significant change in people's mobility (P<.001) as a result of COVID-19 regulations, from an average of 10 visited places every week to approximately 2 places a week. We also discussed our results within the context of nudges used by the National Health Service in the United Kingdom to promote COVID-19 regulations. CONCLUSIONS: Our findings show that digital phenotyping has substantial value in understanding people's behavior during a pandemic. Behavioral features extracted from digital phenotypes can facilitate the personalization of and compliance with behavioral policies. A rule-based messaging system can be implemented to deliver nudges on the basis of digital phenotyping.