Neuropsychological Profile of Hospitalized Patients Due to COVID-19: Clinical and Inflammatory Correlates.

OBJECTIVES: In the present study, we investigated the pattern of cognitive difficulties in hospitalized patients due to COVID-19 and its relation with the clinical features of the disease. METHOD: Forty hospitalized patients with COVID-19 [mean age: 46.98 years (SD = 9.30); mean years of education: 13.65 (SD = 2.07) and 40 sex-, age- and education-matched healthy controls completed a set of neuropsychological measures administered by telephone. Participants' premorbid intellectual skills and patients' anxiety and depressive symptoms were also evaluated. The association of COVID-19-related biomarkers [oxygen saturation (SpO2), C-reactive protein (CRP), D-dimer and ferritin levels] with neuropsychological performances was examined with a series of hierarchical multiple linear regression analyses, after controlling for demographic and clinical characteristics, psychological distress and premorbid intellectual skills. RESULTS: Patients performed worse than healthy participants on measures of verbal memory, attention and working memory. SpO2 levels were associated with patients' performance on verbal and working memory, whereas CRP levels were associated with performance on verbal memory, abstract reasoning and verbal fluency, after controlling for demographic and clinical characteristics. Ferritin levels predicted performance on the verbal fluency test, whereas D-dimer levels did not predict any of the neuropsychological measures. CONCLUSIONS: Cognitive difficulties in verbal memory, attention and working memory were noted in patients with COVID-19. Markers of hyperinflammation predicted patients' performance above and beyond demographic characteristics, duration of symptoms, length of hospitalization and psychological distress.

Exposure to SARS-CoV-2 and Infantile Diseases.

Background and Aim Immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in newborns and children after prophylactic immunization is currently a relevant research topic. The present study analyzes the issue by examining the possibility that the anti-SARS-CoV-2 immune responses are not uniquely directed against the virus but can-via molecular mimicry and the consequent cross-reactivity-also hit human proteins involved in infantile diseases. Methods Human proteins that-if altered-associate with infantile disorders were searched for minimal immune pentapeptide determinants shared with SARS-CoV-2 spike glycoprotein (gp). Then, the shared pentapeptides were analyzed for immunologic potential and immunologic imprinting phenomena. Results Comparative sequence analysis shows that: (1) numerous pentapeptides (namely, 54) are common to SARS-CoV-2 spike gp and human proteins that, when altered, are linked to infantile diseases; (2) all the shared peptides have an immunologic potential since they are present in experimentally validated SARS-CoV-2 spike gp-derived epitopes; and (3) many of the shared peptides are also hosted in infectious pathogens to which children can have already been exposed, thus making immunologic imprint phenomena feasible. Conclusion Molecular mimicry and the consequent cross-reactivity can represent the mechanism that connects exposure to SARS-CoV-2 and various pediatric diseases, with a fundamental role of the immunologic memory and the history of the child's infections in determining and specifying the immune response and the pathologic autoimmune sequela.

Immunologic Profile of Severe COVID-19 Patients in Alborz Province, Iran

Background: The coronavirus disease 2019 (COVID-19) pandemic has prompted researchers to look for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenicity in depth. Immune system dysregulation was one of the major mechanisms in its pathogenesis. The evidence regarding the levels of interferons (IFNs) and pro-and anti-inflammatory cytokines in COVID-19 patients is not well-established. Objective(s): Therefore, this study evaluated the expression level of type-I, II, III IFNs, along with interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), and FOXP3 genes in patients with severe COVID-19 to provide additional insights regarding the regulation of these cytokines during COVID-19 infection. Method(s): Peripheral blood mononuclear cells were isolated from two groups, including severe COVID-19 patients and healthy con-trols. Ribonucleic acid was extracted to evaluate the expression level of IFN-a, IFN-b, IFN-g, IFN-la, IL-1, IL-6, IL-10, and FOXP3 genes using real-time polymerase chain reaction. The correlations between the expression levels of these genes were also assessed. Result(s): A total of 40 samples were divided into two groups, with each group consisting of 20 samples. When comparing the severe COVID-19 group to the controls, the expression levels of IFN-g, tumor necrosis factor-alpha (TNF-alpha), IL-6, and IL-10 genes were sig-nificantly higher in the severe COVID-19 group. The two groups had no significant differences in IFN-a, IFN-b, IFN-la, IL-1, and FOXP3 expression. The correlation analysis revealed a negative correlation between type I and type III IFNs (i.e., IFN-a and IFN-la) and pro-inflammatory cytokines (i.e., IL-1 and IL-10). Conclusion(s): This study suggests the possible upregulation of IFN-g, IL-6, IL-10, and TNF-alpha during SARS-CoV-2 pathogenicity. The pre-liminary findings of this study and those reported previously show that the levels of IFNs and pro-and anti-inflammatory cytokines are not uniformly expressed among all COVID-19 patients and might differ as the disease progresses to the severe stage.Copyright © 2023, Author(s).

The effect of Pickering emulsion adjuvants on the immune efficacy of the COVID-19 polypeptide vaccine

Pickering emulsions were prepared by phacoemulsification in an ice water bath with squalene as the oil phase and an aluminum adjuvant as the particle stabilizer. The effects of formulation and process conditions on the size and distribution of the Pickering emulsions were investigated. Pickering emulsions prepared under the optimal prescription and process conditions were mixed with a peptide antigen to obtain a peptide vaccine. The optimal prescription and process condition of the Pickering emulsion is as follows: squalene as the oil phase, ultra-pure water as the water phase with 5 mg/ml aluminum adjuvant, and an ultrasonication time of 4 min at 200 W power. BALB/c mice were immunized with the peptide vaccine, and the ability of the Pickering emulsion as an immunological adjuvant to improve the efficacy of the peptide vaccine was evaluated. Under optimal conditions, a Pickering emulsion with a small particle size (430.8 nm), uniform distribution (polydispersion index of 16.9%), and zeta potential of 31.5 mV, was obtained. Immunological results showed that the serum specific antibody level in the vaccinated group reached 1×104 after three immunizations. The proportion of CD4+T cells and CD4/CD8 cells was significantly higher (P < 0.05) in the vaccinated groups than the blank control group. Further, cytokine (TNF-α) secretion decreased in the aluminum adjuvant and Pickering emulsion groups but increased in the Freund's adjuvant group. All three vaccinated groups of mice exhibited low but detectable levels of IFN-γ secretion. © 2023

Takayasu arteritis associated with autoimmune/inflammatory syndrome induced by adjuvants: a case-based review.

Takayasu's arteritis (TA) is a chronic granulomatous vasculitis that predominantly affects the aorta and its major branches. Despite advancements in the understanding of the pathogenic pathways of vascular inflammation, the etiology and predisposing factors of TA remain to be fully understood. In susceptible individuals, exposure to adjuvants may trigger, unlock or unmask an autoimmune disorder, presenting as non-specific constitutional symptoms or a fully developed autoimmune syndrome such as vasculitis. Here, we hypothesize that TA could be triggered by siliconosis, a subtype of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). ASIA, also known as Shoenfeld syndrome, encompasses a wide range of autoimmune and immune-mediated diseases resulting from dysregulation of the immune response after exposure to agents with adjuvant activity. This case report describes the development of large artery vasculitis, TA, in an individual one year following the placement of silicone breast implants. The patient initially presented with non-specific symptoms, and multiple imaging methods were employed, including ultrasound diagnostics, CT angiography, and 18-fluorodeoxyglucose positron emission tomography/CT. These techniques revealed vasculitic alterations in the carotid arteries and thoracic aorta. Initial treatment with glucocorticosteroids proved ineffective, prompting the addition of steroid-sparing immunosuppressive agents. Due to the distinct clinical symptoms, disease progression, implant-associated fibrosis, and resistance to therapy, the potential involvement of implants in the development of large-vessel vasculitis was considered, and a potential association with ASIA was postulated. Although there is limited evidence to support a direct link between adjuvants and the pathogenesis of TA, similarities in cellular immunity between the two conditions exist. The diagnosis of this complex and potentially debilitating condition requires a comprehensive clinical examination, laboratory evaluation, and instrumental assessment. This will aid in identifying potential contributing factors and ensuring successful treatment.

The physiopathology of COVID acute respiratory failure

The current COVID-19 pandemic has posed an unusual challenge to health services in all countries. Although physiopathological knowledge about other coronaviruses, mainly SARS-CoV-1 and MERS, has been useful, SARS-CoV-2 has very particular aspects. Its lethality is lower than the previous ones, but its infectivity is much higher, which has resulted in a global expansion, not reached by previous viruses. The physiopathology of acute respiratory failure, in COVID-19, is especially complex and must be understood under a triple prism: specific viral action, the immunopathological response (which in turn has several phases) and the microvascular response. The fact that the elderly are particularly fragile to this virus is a particular challenge. Firstly, to understand what the differential physiopathological facts are. Secondly, to transfer this knowledge to the diagnostic and therapeutic field, in an attempt to reduce morbidity and mortality in this age group. At present, we need to continue to deepen our knowledge of the physiopathology of respiratory failure in the elderly in order to achieve the final objective in therapeutic terms. © Springer Nature Switzerland AG 2020.

COVID-19 susceptibility in endometriosis patients: A case control study.

PROBLEM: Starting from November 2019, the world has had to face a devastating pandemic caused by SARS-CoV-2. Various studies have identified potential risk factors facilitating the infection, however it has not been demonstrated whether endometriosis might represent one of them. The purpose of this study was to evaluate if patients with endometriosis had a higher risk of contracting COVID-19 infection and, in such case, whether they developed a more severe infection than the general population. Furthermore, this study evaluated the possible correlation with the stage of endometriosis, based on the r-ASRM score, and the potential worsening of the disease during the SARS-CoV-2 infection. METHOD OF STUDY: A case-control study was conducted from March 2020 to April 2021 at Macedonio Melloni Hospital, in Milan. A total of 401 women were recruited. The cases were 201 women with clinical or surgical diagnosis of endometriosis. The control group consisted of 200 women, without the disease. All women completed a self-administered questionnaire which evaluated their demographic and clinical characteristics, as well as a potential diagnosis of Covid-19. RESULTS: Comparison between the two groups showed that women with endometriosis had a higher frequency of COVID-19 than the control subjects (23% vs. 13.5%, P = .014), with a greater prevalence of fever (14.4% vs. 6%, P = .008) and myalgias or arthralgias (11.4% vs. 4.5%, P = .01). In multivariable logistic regression analyses, women with endometriosis had a higher risk of contracting SARS-CoV-2 infection (OR = 2.11, 95% IC: 1.20-3.80), regardless the stage of the disease. CONCLUSION: Endometriosis increases the susceptibility to COVID-19, and women who suffer from it should be considered as fragile patients, worthy of prior access to SARS-CoV-2 vaccination campaign.

COVID-19 vaccines and filler reactions: Should it be considered as a concern?

BACKGROUND: Any implant or external material used in the body tissues can potentially be followed by autoimmune or inflammatory reactions. With the global vaccination program against COVID-19, the reports of tissue filler reactions would be increasingly demonstrated. AIM: To summarize the data regarding COVID vaccination and filler reactions. METHOD: We reviewed the existing data in this regard through searching on PubMed, Google Scholar and Scopus. All of the relevant papers published until March 2022, which we could access to their fulltexts were included. RESULTS: Here, we summarized the data regarding COVID-19 vaccination and filler reactions and discussed its etiopathogenesis, management, and importance. CONCLUSION: Although the end of pandemic was announced, the necessity of continuing COVI-D19 vaccination in future mandates gathering data regarding safety of vaccines.

COI vs Ct: comparing automated antigen tests cut-off index (COI) to PCR cycle threshold (Ct)

Introduction: The objective of this study was to compare the numeric cut-off index (COI) of automated antigen tests with the cycle-threshold (Ct) value. Materials and methods: COI values of all samples processed with the Elecsys® SARS-CoV-2 Antigen (Roche, Switzerland) from January to February 2022 were retrieved and the positive were compared to RdRP Cts of Allplex Variants I (Seegene, Korea). COI between 0.6 and 1 were considered indeterminate and overproved by RT-PCR. Results: From 13,937 samples 7944(57%) were positive and 189(1.35%) indeterminate. There was a strong correlation between Cts and COI values at the positive samples, but that was not the case for indeterminates. Conclusions: COI values of the positive samples (COI >1) are comparable to Ct values and may therefore be used as proxy viral loads, however this is not the case for indeterminate samples. © 2022 Elsevier Inc.

COVID-19 vaccination in patients with cancer receiving immune checkpoint inhibitors: a systematic review and meta-analysis.

BACKGROUND: Immune checkpoint inhibitors (ICI) can cause off-target inflammatory and immune-related adverse events (irAE). Conceivably, COVID-19 vaccination could trigger an inflammatory and immune response that could induce or aggravate irAE. METHODS: The objective of this systematic review is to appraise the efficacy and safety of COVID-19 vaccination in patients with cancer treated with ICI. The literature search was performed in PubMed and Embase in English from December 2019 to February 2022. The review included clinical trials, observational cohort studies, case series, and case reports reporting on the clinical efficacy and safety of COVID-19 vaccines on patients with cancer treated with ICI. Outcomes of interest included seroconversion, SARS-CoV-2 infection rate, severe COVID-19, COVID-19 mortality rate. Incidence of ICI irAEs was also ascertained as well as vaccine adverse events. A meta-analysis was conducted to estimate the pooled effect sizes of the outcomes when possible, using random effects models. RESULTS: Overall, 19 studies were included for the analysis (n=10 865 with 2477 receiving ICI). We analyzed 15 cohort studies, 1 cross-sectional study, and 3 case reports. There were no statistically significant differences in seroconversion rates after the second dose of the vaccine when comparing patients with cancer receiving ICI with patients without cancer (risk ratio, RR 0.97, 95% CI 0.92 to 1.03) or with patients with cancer without active treatment (RR 1.00, 95% CI 0.96 to 1.04). There was a higher probability of seroconversion in patients with cancer treated with ICI compared with patients with cancer treated with chemotherapy (RR 1.09, 95% CI 1.00 to 1.18). In a single study in patients receiving ICI, no differences were observed in risk of irAE between those receiving inactivated vaccine and those unvaccinated (pneumonitis RR 0.88, 95% CI 0.33 to 2.3; rash RR 1.03, 95% CI 0.66 to 1.62; arthralgia RR 0.94, 95% CI 0.51 to 1.75). There were no studies for other types of vaccines comparing vaccinated vs not vaccinated in patients treated with ICI. The most common vaccine-related adverse events were local pain or fatigue. Overall, the quality of evidence was rated as very low. CONCLUSION: COVID-19 vaccination appears to be effective and safe in patients with cancer receiving ICI.

Does human-dog attachment increase the resilience and resistance to COVID-19? A biopsychosocial approach and future research

(Portuguese) Este artigo e uma proposta biopsicossocial sobre a melhora da resiliencia a doencas, incluindo a COVID-19, devido ao apego afetivo entre humanos e caes. A resiliencia diz respeito a capacidade fisica e emocional do ser humano de responder positivamente aos eventos adversos, como as doencas. Recentemente, alguns autores propuseram hipoteses independentes sobre o papel da oxitocina (OT) e da imunidade cruzada para aumentar a resiliencia e a resposta contra o COVID-19. Estende-se a hipotese a um campo biopsicossocial, incluindo os beneficios bem conhecidos do apego afetivo humano-cao a saude humana. E proposto que as relacoes de afeto reciproco e forte entre humanos e caes podem aumentar a resiliencia ao COVID-19, devido ao papel do OT na resposta imune, somando-se a imunidade cruzada. Outros beneficios, como protecao emocional, conforto mental e alivio do estresse sao funcoes auxiliares dos caes na saude humana e vice-versa. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) Este articulo es una propuesta biopsicosocial sobre la mejora de la resiliencia a enfermedades, incluida la COVID-19, debido al apego afectivo entre humanos y perros. La resiliencia se refiere a la capacidad humana fisica y emocional de responder positivamente a los eventos adversos, como las enfermedades. Recientemente, algunos autores han propuesto hipotesis independientes sobre el papel de la oxitocina (OT) y la inmunidad cruzada para aumentar la resiliencia y la respuesta frente a la COVID-19. Aqui se extiende esa hipotesis al campo biopsicosocial, incluyendo los bien conocidos beneficios del apego afectivo humano-perro sobre la salud humana. Se propone que las relaciones de afecto fuerte y reciproco entre humanos y perros pueden aumentar la resiliencia a la COVID-19, debido al papel de la OT en la respuesta inmune, sumando inmunidad cruzada. Otros beneficios como amortiguar el efecto de las emociones, la comodidad mental y el alivio del estres son funciones complementarias de los perros en la salud humana y viceversa. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Immune checkpoint inhibitor therapy and outcomes from SARS-CoV-2 infection in patients with cancer: a joint analysis of OnCovid and ESMO-CoCARE registries.

BACKGROUND: As management and prevention strategies against COVID-19 evolve, it is still uncertain whether prior exposure to immune checkpoint inhibitors (ICIs) affects COVID-19 severity in patients with cancer. METHODS: In a joint analysis of ICI recipients from OnCovid (NCT04393974) and European Society for Medical Oncology (ESMO) CoCARE registries, we assessed severity and mortality from SARS-CoV-2 in vaccinated and unvaccinated patients with cancer and explored whether prior immune-related adverse events (irAEs) influenced outcome from COVID-19. FINDINGS: The study population consisted of 240 patients diagnosed with COVID-19 between January 2020 and February 2022 exposed to ICI within 3 months prior to COVID-19 diagnosis, with a 30-day case fatality rate (CFR30) of 23.6% (95% CI 17.8 to 30.7%). Overall, 42 (17.5%) were fully vaccinated prior to COVID-19 and experienced decreased CFR30 (4.8% vs 28.1%, p=0.0009), hospitalization rate (27.5% vs 63.2%, p<0.0001), requirement of oxygen therapy (15.8% vs 41.5%, p=0.0030), COVID-19 complication rate (11.9% vs 34.6%, p=0.0040), with a reduced need for COVID-19-specific therapy (26.3% vs 57.9%, p=0.0004) compared with unvaccinated patients. Inverse probability of treatment weighting (IPTW)-fitted multivariable analysis, following a clustered-robust correction for the data source (OnCovid vs ESMO CoCARE), confirmed that vaccinated patients experienced a decreased risk of death at 30 days (adjusted OR, aOR 0.08, 95% CI 0.01 to 0.69).Overall, 38 patients (15.8%) experienced at least one irAE of any grade at any time prior to COVID-19, at a median time of 3.2 months (range 0.13-48.7) from COVID-19 diagnosis. IrAEs occurred independently of baseline characteristics except for primary tumor (p=0.0373) and were associated with a significantly decreased CFR30 (10.8% vs 26.0%, p=0.0462) additionally confirmed by the IPTW-fitted multivariable analysis (aOR 0.47, 95% CI 0.33 to 0.67). Patients who experienced irAEs also presented a higher median absolute lymphocyte count at COVID-19 (1.4 vs 0.8 109 cells/L, p=0.0098). CONCLUSION: Anti-SARS-CoV-2 vaccination reduces morbidity and mortality from COVID-19 in ICI recipients. History of irAEs might identify patients with pre-existing protection from COVID-19, warranting further investigation of adaptive immune determinants of protection from SARS-CoV-2.

COVID-19 Molecular Pathophysiology: Acetylation of Repurposing Drugs.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces immune-mediated type 1 interferon (IFN-1) production, the pathophysiology of which involves sterile alpha motif and histidine-aspartate domain-containing protein 1 (SAMHD1) tetramerization and the cytosolic DNA sensor cyclic-GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) signaling pathway. As a result, type I interferonopathies are exacerbated. Aspirin inhibits cGAS-mediated signaling through cGAS acetylation. Acetylation contributes to cGAS activity control and activates IFN-1 production and nuclear factor-κB (NF-κB) signaling via STING. Aspirin and dapsone inhibit the activation of both IFN-1 and NF-κB by targeting cGAS. We define these as anticatalytic mechanisms. It is necessary to alleviate the pathologic course and take the lag time of the odds of achieving viral clearance by day 7 to coordinate innate or adaptive immune cell reactions.

Exercise modulates the immune system in cardiorespiratory disease patients: Implications for clinical practice during the COVID-19 pandemic.

BACKGROUND: Patients with cardiorespiratory problems often suffer from systemic inflammation. Stress due to the disease and continuous inflammation can undermine the success of the rehabilitation program. OBJECTIVE: This review has been undertaken primarily to understand the effectiveness of exercise training on the immune system in individuals undergoing cardiorespiratory rehabilitation and its implications for further management during the COVID-19 pandemic. METHODS: Assessors analyzed related studies identified in the MEDLINE, PROQUEST, PUBMED, Cochrane Library, CINAHL, EMBASE, Google Scholar, Physiotherapy Evidence, and Science Direct databases. The studies were divided into groups focused on the effect of exercise on blood leukocytes, the anti-inflammatory effect, and the role of nutrition and exercise in resolving inflammation. RESULTS: Twenty-eight studies were included in this review. The number of studies included in each section was as follows: the effects of exercise training on leukocytes in cardiorespiratory conditions (n = 8), anti-inflammatory effect (n = 6), and the role of nutrition and exercise in resolving inflammation (n = 14). The bias risk assessment showed poor internal validity; most included studies were assigned no and unclear descriptors. CONCLUSIONS: Substantive evidence is presented that emphasizes the role of moderate-intensity exercise in boosting the immune system in patients with cardiorespiratory diseases. Exercise has anti-inflammatory effects that are vital for overall well-being and resolving longstanding inflammation. Individuals with an active lifestyle had a better pathogen immune response than more sedentary individuals. Our findings highlight the current need to investigate the long-term effects of cardiorespiratory rehabilitation programs.

From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19?

Complex immune response to infection has been highlighted, more than ever, during the COVID-19 pandemic. This review explores the immunomodulatory treatment of moderate-to-severe forms of this viral sepsis in the context of specific immunopathogenesis. Our objective is to analyze in detail the existing strategies for the use of immunomodulators in COVID-19. Immunomodulating therapy is very challenging; there are still underpowered or, in other ways, insufficient studies with inconclusive or conflicting results regarding a rationale for adding a second immunomodulatory drug to dexamethasone. Bearing in mind that a "cytokine storm" is not present in the majority of COVID-19 patients, it is to be expected that the path to the adequate choice of a second immunomodulatory drug is paved with uncertainty. Anakinra, a recombinant human IL-1 receptor antagonist, is a good choice in this setting. Yet, the latest update of the COVID-19 Treatment Guidelines Panel (31 May 2022) claims that there is insufficient evidence to recommend either for or against the use of anakinra for the treatment of COVID-19. EMA's human medicines committee recommended extending the indication of anakinra to include treatment of COVID-19 in adult patients only recently (17 December 2021). It is obvious that this is still a work in progress, with few ongoing clinical trials. With over 6 million deaths from COVID-19, this is the right time to speed up this process. Our conclusion is that, during the course of COVID-19, the immune response is changing from the early phase to the late phase in individual patients, so immunomodulating therapy should be guided by individual responses at different time points.

Benefits of Inactivated Vaccine and Viral Vector Vaccine Immunization on Covid-19 Infection in Kidney Transplant Recipients

Purpose: Most developing countries do not have access to high-efficiency mRNA vaccine. In Thailand, the first and most available vaccines were inactivated, and later on, viral vector vaccine. Here, we reported the efficacy of inactivated and viral vector vaccine in preventing severe disease and death in kidney transplant recipients. Method(s): This is a retrospective study comprised 45 kidney transplant recipients with Covid-19 infection. Patients were classified into 2 groups based on vaccination status before COVID-19 infection. Patients in group 1 were vaccinated with either inactivated or viral vector vaccine and patients in group 2 were unvaccinated. Group 1 was also subdivided into fully and partially vaccinated. All patients received the same standard of care. Outcomes of interest were rate of death, pneumonia and requirement of oxygen therapy. Result(s): There were 23 patients (51%) in group 1 [7 fully vaccinated (5 inactivated, 2 viral vector), 16 partially vaccinated (all viral vector)] and 22 patients (49%) in group 2. All of baseline characteristics including recipient factors, donor factors, immunologic factors and immunosuppressive regimens were similar between groups except only mean recipient age was older in group 1 (55 +/- 11 years in group 1 VS 48 +/- 15 years in group 2, p = 0.035). Of 45 patients in this study, 11 patients died (24%). Significantly more death occurred in group 2. Three patients (all partially vaccinated) and 8 patients died in group 1 and group 2 respectively (13% VS 36%, p = 0.03). No patient receiving full vaccination died. Pneumonia developed equally in both groups (70% VS 71%, p = 0.89). There was a trend toward less oxygen requirement in group 1 (50% VS 74% p = 0.10) as well as less ventilator requirement (9% VS 19% p = 0.48). Conclusion(s): Inactivated and viral vector COVID-19 vaccines have good efficacy in mortality reduction in kidney transplant recipients. Even partial vaccination can exert some protection against death. However, to achieve better prevention, full vaccination should be encouraged to all kidney transplant recipients.

Small fiber neuropathy following SARSCOV- 19 vaccination. A case series

Background and aims: Small fiber neuropathy (SFN) is a polymorphous disease affecting thin nervous fibers conducting temperature and pain sensations and involved in autonomic transmission. Etiology is diverse and remains elusive in 70% of cases. Methods: We describe a case series of 6 patients who developed symptoms of SFN following SARS-COV-19 vaccination. Neurologic examination was normal whilst paraclinical results were consistent with SFN. Confirmation by skin biopsy was obtained in 4 cases. Results: Six patients, 5 female and 1 male, ages 31, 34, 39, 42, 44 and 62 years, consulted our department with intense pain and numbness involving the arms and legs 2 to 15 days following SARS-COV-19 vaccination. Neurologic examination was normal. A preliminary diagnostic protocol comprising autoimmune, metabolic, infectious and inflammatory panel, cerebral and spinal cord magnetic resonance imaging and electromyography was normal. Functional neurophysiologic testing showed reduced activation of fibers involved in sweat gland control indicating SFN. Skin biopsy of distal calf and thigh in 4 patients, three female and one male, showed rarefaction of thin intraepidermic nerve fibers in a non length dependent manner, allowing for a diagnosis of SFN. Conclusion: Whereas autoimmune, infectious, metabolic, toxic and genetic causes are well described in SFN, evidence of possible association with vaccination is confounding. Given their small caliber and richness of surface antigens, small nervous fibers are vulnerable to a wide spectrum of disease. Immunologic factors intervening on a predisposing substrate could be a hypothesis for the mechanism involved in development of SFN following SARS-COV-19 and possibly other vaccination.

COVID-19 TANISI ALAN ÇOCUKLARIN B LENFOSÍT HÜCRELERÍNÍN VE ALT GRUPLARININ AKIŞ SÍTOMETRÍK DEĞERLENDÍRÍLMESÍ

Objective: During viral infections, antibody production of B cells are critical for protective immunity. It is known that the COVID-19 disease has a milder course in children. It is crucial to evaluate the causes of this situation from a pediatrician’s perspective to determine the treatment goals of the disease. We aimed to examine the flow cytometric changes in B cells and subtypes observed in children diagnosed with the COVID-19 infection. Materials and Methods: This is a prospective cohort study including 22 children aged 0-18 who had been diagnosed with COVID-19. CD19+B cells, CD27-IgD+ naive B, CD21low immature B, CD21lowCD- 38low active B, CD27-IgD- double-negative B, CD27- non-memory B, CD27+ memory B, CD27+IgD- switched memory B, and CD27+IgD+ non-switched memory B cells were studied using flow cytometry. Results: B cells counts decreased as a percentage in the 2-5 years age group and the 10-16 age group as an absolute number. Naive and non-memory B cell frequencies increased in the 5-10 years old and over 16 years old groups. Double negative B cells were normal in all age groups. Non-memory B cells increased in the 5-10 and over 16 years old groups, whereas memory B cells decreased. In all groups, switched memory B cells decreased. Non-switched memory B cell counts were within reference ranges in all groups except for the over 16 years group. Conclusion: Although the decrease in B cell count is associated with the severity of the disease, naive B cell subgroups did not decrease in the pediatric patients included in the study. All groups showed increased switched memory B cell counts, in accordance with the literature. Unlike adults, naive B cells, non-switched memory B cells, and double-negative B cells were normal in children. (English) [ FROM AUTHOR] Amaç: Viral enfeksiyonlar sırasında B hücrelerinin antikor üretimi, koruyucu bağışıklık için kritiktir. Çocuklarda COVID-19 hastalığının daha hafif seyrettiği bilinmektedir. Bu durumun nedenlerini çocuk doktoru gözüyle değerlendirmek, hastalığın tedavi hedeflerini belirlemek açısından çok önemlidir. COVID-19 enfeksiyonu tanısı alan çocuklarda gözlenen B hücre ve alt tiplerinde akım sitometrik değişiklikleri incelemeyi amaçladık. Gereç ve Yöntem: Çalışmamız 0-18 yaş arası COVID-19 teşhisi konulan 22 çocuğu içeren prospektif kohort bir araştırmadır. CD19+B hücreleri, CD27-IgD+ saf B, CD21düşük olgunlaşmamış B, CD21düşükCD38düşük aktif B, CD27-IgD- çift negatif B, CD27- bellek B, CD27+ bellek B, CD27+IgD- dönüşmüş (switched) bellek B, CD27+IgD+ dönüşmemiş (non-switched) bellek B hücreleri akış sitometrisi ile incelenmiştir. Bulgular: B hücre sayısı 2-5 yaş grubunda yüzde olarak, 10-16 yaş grubunda ise mutlak sayı olarak azaldı. 5-10 yaş ve 16 yaş üstü gruplarda naif ve hafıza dışı B hücrelerinin oranları arttı. Çift negatif B hücreleri tüm yaş gruplarında normaldi. Bellek dışı B hücreleri 5-10 yaş arasında ve 16 yaş üzerinde artarken, aynı gruplarda bellek B hücreleri azaldı. Dönüşmüş bellek B hücreleri tüm yaş gruplarında azaldı. Dönüşmemiş bellek B hücreleri, 16 yaşın üzerinde azaldı ve diğer tüm yaş gruplarında normal görünüyordu. Sonuç: B hücre sayısındaki azalma hastalığın şiddeti ile ilişkili olmasına rağmen, çalışmaya dâhil edilen çocuk hastalarımızda naif B hücre alt gruplarında azalma olmadı. Literatüre uygun olarak tüm gruplarda dönüşmüş bellek B hücreleri arttı. Çocuklarda yetişkinlerden farklı olarak naif B hücreleri, dönüşmemiş bellek B hücreleri ve çift negatif B hücreleri normaldi. (Turkish) [ FROM AUTHOR] Copyright of Istanbul Tip Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Prophylactic vaccinations management in patients undergoing allergen immunotherapy – a review

Allergen immunotherapy (AIT) is the only casual method of allergy treatment. It is based on regular administration of a gradually increasing dose of an allergen to induce immunological tolerance to a particular sensitising factor. Due to proven efficacy, including preventive effect as well as favourable safety profile, it should be widely applicable, particularly among older children and adolescents. While the number of patients suffering from non-communicable diseases, including allergies, is rising, there is a false im-pression that the impact of infectious diseases can be disregarded. Thanks to prophylactic vaccines, many infectious diseases that used to be a threat to people’s lives have been forgotten. In order to tackle familiar and emerging infectious diseases (such as COVID-19), there is a need to keep in mind vaccinations in all age groups. As allergen immunotherapy and prophylactic vaccines affect the immunologic system, performing both interventions in one patient may raise concerns about safety and effectiveness. However, a large-scale study on this topic has not been performed to date. This article summarises immunological responses occurring after contact with pathogens and allergens as well as describes reactions triggered by prophylactic vaccines and AIT. What is more, possible interference of receiving both a prophylactic vaccine and AIT is discussed. © by Wydawnictwo Continuo.

Prenatal stress and child development-Pathways, mechanisms and interventions

We are writing this Introduction at a time of unprecedented population-wide stress and uncertainty associated with the COVID-19 pandemic. Beyond the actual infection itself, this world crisis affects us all, and not surprisingly, the most vulnerable remain disproportionately affected by the many of the unintended social, economic and health consequences that follow the loss of employment, social isolation and stress inherent to an uncertain future. What could be a more poignant reminder of the enduring impact of a prenatal stress affects mothers' well-being and the developmental health of her children? (PsycInfo Database Record (c) 2022 APA, all rights reserved)