ABSTRACT
The aim of the current study was to assess the influence of the first wave of COVID-19 (March- June 2020) on individuals with depression and anxiety, evaluating the impact of different groups of factors in a complex (holistic) manner. Material(s) and Method(s): The study is cross-sectional, including outpatients with depressive and anxiety disorders in remission (n = 60), outpatients in relapse (n = 65), a group of healthy controls (n = 30), and a control group with relatives of the patients with depression and anxiety (n = 30) for the period July-October 2020. Socio-demographic factors, the presence of somatic comorbidity and risk factors related to it, and the need for medical care during the first COVID wave were analyzed. Result(s): Patients with deteriorated anxiety disorders have a significantly lower educational status (p < 0.001) in comparison to the other groups. Individuals with deteriorated major depressive disorder and controls-relatives have significantly more somatic comorbidity compared to healthy controls (p < 0.05). Individuals with anxiety disorders do not differ from healthy controls on this measure. Visits to medical specialists in those with worsening depression increased during the analyzed period but were comparable to the control groups. In persons with anxiety - worsened or in remission, there is a significant increase in this indicator compared to healthy controls (p < 0.05). Conclusion(s): In the conditions of the first COVIDwave, individuals with worsened depression, as well as relatives of anxious and depressed patients have significantly more somatic problems compared to healthy controls. However, individuals with anxiety but not depression seek significantly more healthcare consultations, despite the isolation. The holistic approach implies a complex assessment of somatic and mental comorbidity and the need for additional knowledge and resources in the service of persons with anxiety and depression, although there is relatively easy access to consultation care in our country.Copyright © 2023, Central Medical Library Medical University - Sofia. All rights reserved.
ABSTRACT
The objective: to assess risk factors for tuberculosis relapse during the COVID-19 pandemic. Results. During the retrospective study, medical documents of patients treated for tuberculosis in 2020-2022 were analyzed. 140 patients above 18 years old with confirmed tuberculosis were included: newly diagnosed tuberculosis – 50 patients, early relapses – 50 patients, and late relapses – 40 patients. At the first stage, significant factors for relapse development were identified (ANOVA): diabetes (F=19402,8;p=0,000000), substances abuse (F=547,6;p=0,000000), alcohol abuse (F=149,7;p=0,000000), MDR MTB (F=107,8;p=0,000000), HIV infection (F=72,4;p=0,000000), imprisonment (F=49,5;p=0,000000), chronic respiratory diseases (F=47,1;p=0,000000), smoking (F=29,0;p=0,000000), and social status (F=28,9;p= 0,000000). At the second stage (cluster analysis), factors implementing the risks of development of early or late relapses were identified. As well as before the COVID-19 pandemic, social, medical and biological risk factors play a significant role in the development of tuberculosis relapses;history of COVID-19 was not one of the risk factors;and stratification of the risk factors made it possible to identify factors that contribute to development of both early and late relapses and to determine preventive measures. © 2023 New Terra Publishing House. All rights reserved.
ABSTRACT
Background: People with chronic diseases of the immune system, such as multiple sclerosis (MS), are at risk for Covid-19 disease. However, more research is needed with long-term follow-up. The aim of the study was to follow up people with MS (PwMS) for up to three months after AstraZeneca vaccination for the recurrence of MS and Covid-19 infection. Method(s): This study was a case study (descriptive-analytical) of follow-up type. The study population was PwMS over 18 years of age in Kermanshah province who received both doses of the AstraZeneca vaccine. This study was conducted from August to November 2021. Sampling was done with existing methods based on the National MS Registry of Iran (NMSRI). Demographic information of patients was extracted from NMSRI. A researcher-made form was used to collect information by telephone three months after vaccination about clinical characteristics, Covid-19 infection, and recurrence of MS. Data were analyzed using SPSS-25 software. Result(s): Study participants were 40 MS patients with a mean (SD) age of 39.27 (8.8) years, including 32 (80.0%) women. A mean of 9.39 (4.6) years had passed since The patients were diagnosed with MS, and 29 (76.4%) had RR type MS. Four patients (10%) relapsed between the second dose and three months later, of whom two (50%) had sensory symptoms, one (25%) had optic nerve involvement, and one (25%) had motor symptoms and pyramidal pathway involvement. The symptoms of Covid-19 were mild in three patients (10%), while severe symptoms developed in one patient (10%) who received rituximab. Among the patients, no cases of thrombosis were observed. Infusion therapy, a leg fracture, and kidney stones were the only hospitalized cases. Conclusion(s): Covid-19 and MS relapse prevalence did not differ significantly in the three months before and after vaccination. There is a need for further studies with a longer follow-up period.Copyright © 2022 Razazian et al. Published by Tehran University of Medical Sciences.
ABSTRACT
'BSH Global Speakers' was established in 2015 as a core project of the BSH Global Haematology Special Interest Group (SIG). As the project enters its eighth year, we present an update and reflection on the successes and challenges encountered. Initially known as the 'Plenary Speaker Scheme', the project was developed following a stakeholder meeting in 2015 at the inception of the SIG. Haematology colleagues from the UK and low-and middle-income countries (LMIC) came together to discuss how the BSH may be best placed to support haematologists practicing in LMICs. Sharing of expertise and building collaborative networks were identified as key priorities. The 'Plenary Speaker Project' was conceived;BSH haematologists would be supported in delivering plenaries at the meetings of colleagues in LMICs, with the aim that each visit could act as a catalyst for creating networks and developing collaborative projects in education, research, and capacity building. We established a yearly cycle of inviting applications from LMIC societies for a funded speaker at their scientific meetings, selecting the most impactful meetings, then recruiting appropriate UK-based speakers. We place emphasis on the likelihood of ongoing collaborative working or other impacts, for example engagement with local haematology trainees. To date, ten speakers have represented BSH at the meetings of LMIC societies, presenting on diverse topics, from molecularly guided interventions to prevent relapse in AML, to adapting lymphoma treatment strategies for low resource settings. Recently we have opened applications to nurse specialists and scientists, with our first scientific speaker presenting in Thailand May 2023. The COVID-19 pandemic created significant challenges for the project due to the disruption in international travel and the cancellation of many haematology meetings around the globe. We were, however, able to adapt the project to support virtual speakers at meetings in South Africa, Vietnam, and Ghana. Although virtual meetings do not naturally lend themselves to collaborative working, we were pleased that a longer term joint educational program in haemoglobinopathy care has been established with the Vietnamese Society of Haematology as a result of BSH support. The impact of BSH Global Speakers is significant. Even at smaller meetings, speakers will have the ear of the majority of practicing haematologists in a country. From the relationships built between societies and speakers we have seen the development of fellowship programmes, online education programmes, laboratory support, and numerous networks for informal advice in clinical care, research, and more.
ABSTRACT
Despite protection from severe COVID-19 courses through vaccinations, some people with multiple sclerosis (PwMS) are vaccination-hesitant due to fear of post-vaccination side effects/increased disease activity. The aim was to reveal the frequency and predictors of post-SARS-CoV-2-vaccination relapses in PwMS. This prospective, observational study was conducted as a longitudinal Germany-wide online survey (baseline survey and two follow-ups). Inclusion criteria were age ≥18 years, MS diagnosis, and ≥1 SARS-CoV-2 vaccination. Patient-reported data included socio-demographics, MS-related data, and post-vaccination phenomena. Annualized relapse rates (ARRs) of the study cohort and reference cohorts from the German MS Registry were compared pre- and post-vaccination. Post-vaccination relapses were reported by 9.3% PwMS (247/2661). The study cohort's post-vaccination ARR was 0.189 (95% CI: 0.167-0.213). The ARR of a matched unvaccinated reference group from 2020 was 0.147 (0.129-0.167). Another reference cohort of vaccinated PwMS showed no indication of increased post-vaccination relapse activity (0.116; 0.088-0.151) compared to pre-vaccination (0.109; 0.084-0.138). Predictors of post-vaccination relapses (study cohort) were missing immunotherapy (OR = 2.09; 1.55-2.79; p < 0.001) and shorter time from the last pre-vaccination relapse to the first vaccination (OR = 0.87; 0.83-0.91; p < 0.001). Data on disease activity of the study cohort in the temporal context are expected for the third follow-up.
ABSTRACT
OBJECTIVE: A succession of cases have reported flares of adult-onset Still's disease (AOSD) after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), raising concerns. We aimed to investigate the impact of inactivated SARS-CoV-2 vaccines on disease activity in patients with AOSD. METHODS: We prospectively enrolled clinically inactive AOSD patients visiting the outpatient clinics of our department. The patients received SARS-CoV-2 vaccines (BBIBPCorV, Sinopharm, Beijing, China) voluntarily. The occurrence of relapse in the participants was recorded during the follow-up period and a propensity score matching (PSM) method was used to compare the relapse rates between vaccinated and unvaccinated patients. Localized and systemic symptoms were assessed in the vaccinated patients. RESULTS: A total of 122 patients with inactive AOSD were included, of which 49.2% (n = 60) voluntarily received the inactivated SARS-CoV-2 vaccine. The relapse rate did not increase significantly in vaccinated patients in comparison with unvaccinated patients (after PSM: 6.8% versus 6.8%), and no relapse occurred within one month after vaccination. No obvious adverse reactions were reported in 75.0% of the participants, and none of the patients reported severe reactions. CONCLUSION: Increased disease activity or relapse following vaccination with inactivated SARS-CoV-2 were rare in patients with inactive AOSD. Local and systemic adverse reactions were found to be mild and self-limiting. These safety profiles of inactivated SARS-CoV-2 vaccines in patients with AOSD may assist in eliminating vaccine hesitancy and increase the vaccination rate against SARS-CoV-2.
ABSTRACT
OBJECTIVE: The aim of this study was to assess the frequency and correlates of relapse among patients with schizophrenia during the COVID-19 pandemic. METHODS: This retrospective study included 90 adults who met DSM-IV criteria for schizophrenia. The participants were evaluated using Positive and Negative Syndrome Scale (PANSS), Compliance Rating Scale (CRS) and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0) before and after the onset of COVID-19 pandemic. RESULTS: The mean score of CRS was decreased after the onset of COVID-19 pandemic compared to before COVID 19 ( p < 0.001). The mean total score of PANSS scale and the mean positive subscale (P) score had increased after the onset of COVID-19 pandemic compared to before COVID 19 ( p < 0.001). Following up the news about COVID-19 regularly and decreased level of family support after the pandemic onset were associated with lower CRS scores and higher PANSS scores. In addition, the presence of infection or death with COVID-19 among family members and lower CRS scores were associated with higher scores on PANSS positive subscale. CONCLUSIONS: The relapse rate had increased among patients with schizophrenia during COVID-19 pandemic. Non-compliance with medications and lack of family support were the main correlates of relapse in schizophrenia.Key PointsPatients with schizophrenia are at high risk for relapse during Covid-19 pandemic.Non-compliance with medications, lack of family support, COVID-19-related illness or death of family members and following the news of the pandemic are correlates of relapse in patients with schizophrenia.Psychoeducation, availability of medications and mental health services and family support may help to prevent relapse in patients with schizophrenia during pandemics.Prospective studies are needed to confirm the findings of this study.
ABSTRACT
Mycobacterium tuberculosis complex (MTBC), the causative organisms of tuberculosis (TB), has afflicted man for millennia. TB was declared a global health emergency by the World Health Organization in 1993. Before the 2020 Covid pandemic, it was responsible for 10 million new cases annually and was the leading infectious disease killer worldwide. MTBC strain typing represents an important complementary tool to guide TB control measures. TB programmes can use genotyping results in combination with epidemiological information to determine if recent transmission has likely occurred, and hence identify outbreaks that require targeted public health action. MTBC genotyping also can differentiate between relapse or re-infection, detect false-positive cases, and identify and monitor the circulating TB strains in the population over time. Restriction Fragment Length Phenotyping (RFLP), introduced in the 1990s, was labour intensive, required large amounts of DNA and was not easily comparable between laboratories. These disadvantages are overcome by the PCR-based MIRU-VNTR and spoligotyping methods. More recently, whole genome sequencing (WGS) of MTBC has been shown to provide high resolution identification of recent transmission chains and their direction, as well as drug resistance prediction. Its increasing reliability and affordability has enabled this technology to transition from the research arena to clinical care and public health functions. Its application in high TB burden countries will hopefully revitalize global TB control efforts which have set back by the Covid pandemic.Copyright © 2023
ABSTRACT
Objectives: Patients with immune-mediated rheumatic diseases (IMRDs) develop more severe outcomes of Coronavirus disease 2019 (COVID-19). Recent studies have contributed to understand the safety and efficacy of COVID-19 vaccines in IMRDs, suggesting that different diseases and therapies may interfere on immunization efficacy. In this study we analyze the immunogenicity of COVID-19 vaccines in patients with Systemic Vasculitides (VASC), the rate of COVID-19 and the frequency of disease relapse following immunization. Method(s): We included patients with VASC (n = 73), a subgroup of the SAFER study (Safety and Efficacy on COVID-19 Vaccine in Rheumatic Disease), a longitudinal, multicenter, Brazilian cohort.We analyzed the geometric means of IgG antibody against receptor-biding domain of protein spike of SARS-CoV-2 (anti-RBD) after two shots of CoronaVac (Inactivated vaccine), ChadOx-1 (AstraZeneca) or BNT162b2 (Pfizer-BioNTech). IgG anti-RBD was measured by chemiluminescence test. We assessed new-onset COVID-19 episodes, adverse events (AE) and disease activity for each VASC. Result(s): The sample included Behcet's disease (BD) (n = 41), Takayasu arteritis (TAK) (n = 15), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) (n = 14), polyarteritis nodosa (n = 7) and other small vessel VASC(n = 6). The majority of patients were female (69%) without comorbidities (49%) and a median age of 37 years. The most common medication was conventional synthetic disease-modifying anti-rheumatic drugs, followed by biologic drugs. No patient received rituximab at baseline. Most patients received CoronaVac (n = 25) or ChadOx-1 (n = 36), while four received BNT162b2. Baseline IgG-RBD means were 1.34 BAU/mL. They increased to 3.89 and 5.29 BAU/mL after the 1st and 2nd vaccine dose, respectively. ChadOx-1 had higher antibody titers than CoronaVac (p = 0.002). There were no differences between different VASC. There were 3 cases of COVID-19 after immunization with CoronaVac. BD patients had a tendency for more cutaneous-articular activity following ChadOx-1. There were no severe relapses and no serious adverse events. Conclusion(s): Our results show the safety of different SARS-CoV-2 vaccines in VASC population. A progressive increase of IgG-RBD antibodies was observed after each dose. ChadOx-1 led to higher IgG-RBDgeometricmeans compared toCoronaVac. Finally, even though ChadOx-1 presented a tendency of triggering mild disease activity, there were no significant disease activity following vaccination in VASC patients. .
ABSTRACT
This study aims to explore the mechanism of psychological capital's influence on relapse tendency of drug addicts under the COVID-19, and construct a moderated mediation model. 977 individuals with drug addiction who come from a mandatory drug rehabilitation center in China completed the Chinese versions of Psychological capital Questionnaire, the Relapse Tendency Questionnaire,the Coping Style Questionnarie and the Life History Strategy Scale.The results showed that(1) there was a significant negative correlation between psychological capital and relapse tendency;(2)positive coping style mediated the relationship between psychological capital and relapse tendency;(3) life history strategy is an important moderator between psychological capital and positive coping style.These findings help us to better understand the impact of psychological capital and positive coping style on relapse tendency.
ABSTRACT
BACKGROUND: Paediatric patients with autoimmune rheumatic diseases (pARD) are often immunocompromised because of the disease and/or the therapy they receive. At the beginning of COVID-19 pandemic there was a great concern about the possibility of severe SARS-CoV-2 infection in these patients. The best method of protection is vaccination, so as soon as vaccine was licenced, we aimed to vaccinate them. Data on disease relapse rate after COVID-19 infection and vaccination are scarce, but they play important role in everyday clinical decisions. METHODS: The aim of this study was to determine the relapse rate of autoimmune rheumatic disease (ARD) after COVID-19 infection and vaccination. Data on demographic, diagnosis, disease activity, therapy, clinical presentation of the infection and serology were collected from pARD who had COVID-19 and from pARD who were vaccinated against COVID-19, from March 2020 to April 2022. All vaccinated patients received two doses of the BNT162b2 BioNTech vaccine, on average, 3.7 (S.D.=1.4) weeks apart. Activity of the ARD was followed prospectively. Relapse was defined as a worsening of the ARD in a time frame of 8 weeks after infection or vaccination. For statistical analysis, Fisher's exact test and Mann-Whitney U test were used. RESULTS: We collected data from 115 pARD, which we divided into two groups. We included 92 pARD after infection and 47 after vaccination, with 24 in both groups (they were infected before/after vaccination). In 92 pARD we registered 103 SARS-CoV-2 infections. Infection was asymptomatic in 14%, mild in 67% and moderate in 18%, 1% required hospitalization; 10% had a relapse of ARD after infection and 6% after vaccination. There was a trend towards higher disease relapse rate after infection compared to vaccination, but the difference was not statistically significant (p = 0.76). No statistically significant difference was detected in the relapse rate depending on the clinical presentation of the infection (p = 0.25) or the severity of the clinical presentation of COVID-19 between vaccinated and unvaccinated pARD (p = 0.31). CONCLUSIONS: There is a trend towards a higher relapse rate in pARD after infection compared to vaccination and connection between the severity of COVID-19 and vaccination status is plausible. Our results were, however, not statistically significant.
Subject(s)
Autoimmune Diseases , COVID-19 , Rheumatic Diseases , Humans , Child , COVID-19/epidemiology , COVID-19/prevention & control , BNT162 Vaccine , Pandemics , SARS-CoV-2 , Vaccination , Autoimmune Diseases/epidemiology , Chronic Disease , Rheumatic Diseases/epidemiologyABSTRACT
Introduction. Pediatric Inflammatory Multisystem Syndrome (MIS-C) is treated by the administration of intravenous polyvalent immunoglobulins and corticosteroids, as recommended by the French National Authority for Health (Haute Autorite de Sante) and the WHO (World Health Organization). However, no corticosteroids tapering schedule has been validated and patients returning home are not properly supervised by a pharmacist. Aims. Identify the occurrence of relapses according to the corticosteroid tapering schedules prescribed on return home. Analyze patients' reported compliance to these decreases. Identify possible links between poor compliance and relapse. Patients and method. This retrospective study analyzes the digital medical records on Orbis software of patients who have been hospitalized for a MIS-C between April 2020 and June 2021 in a French pediatric hospital. Results. 66 MIS-C patients were included. 54 were treated by intravenous corticotherapy 2 mg/kg/day, 2 with 1 mg/kg/day, 10 have not received any. Five different tapering schedules were prescribed, 3 patients relapsed. Recurrence of relapse is not significantly related to the tapering schedule followed (p = 0,759). 6/54 (11 %) patients wrongly followed their tapering schedules. Among them, 2 relapsed, versus 1/48 (2 %) among compliers (p = 0.029;OR = 0.04). Discussion - Conclusion. This study emphasizes the difficulty for a patient to comply with corticosteroids tapering schedule without supervision, as well as the subsequent rebound risks. Pharmaceutical counseling for patients returning home after hospitalization will be promoted to ensure better communication and patients' understanding and compliance.Copyright © 2023 John Libbey Eurotext. All rights reserved.
ABSTRACT
Objectives: Electroconvulsive therapy (ECT) is important in the management of major, life-threating, and treatment-resistant psychiatric illness. The COVID-19 pandemic has significantly disrupted ECT services. The need for new infection control measures, staff/resource redeployment and shortages, and the perception that ECT is as an 'elective' procedure have caused changes to, and reductions in, ECT delivery. The aim of this study was to explore the impacts of COVID-19 on ECT services, staff, and patients globally. Method(s): Data were collected using an electronic, mixed-methods, cross-sectional survey. The survey was open March to November 2021. Clinical directors in ECT services, their delegates, and anaesthetists were asked to participate. Quantitative findings are reported. Result(s): One hundred and twelve participants worldwide completed the survey. The study identified significant impacts on services, staff, and patients. Based on quantitative results, most participants (57.8%, n=63) reported their services made at least one change to ECT delivery. More than three-quarters (81.0%, n=73) reported their service had identified at least one patient who could not access ECT. More than two-thirds (71.4%, n=67) reported their service identified at patients who experienced a relapse in their psychiatric illness due to lack of ECT access. Six participants (7.6%) reported their service had identified at least one patient who died, by suicide or other means, due to lack of ECT access. Participants' qualitative responses were detailed, averaging 43 words. Three qualitative themes were identified: (1) Service provision, about the importance of ECT services continuing during the pandemic, (2) Preparedness, through guidelines and environmental design, and (3) Personal protection, about strategies to increase staff safety. Conclusion(s): This is the first multi-site, international survey to explore the impacts of COVID-19 on ECT services, staff, and patients. Its findings can be used to inform evidence-based ECT practice. This supports the ongoing safe, effective operation of ECT services. Research Category and Technology and Methods Clinical Research: 2. Electroconvulsive Therapy (ECT) Keywords: Survey, Mixed Methods, COVID, Service changes;Copyright © 2023
ABSTRACT
Background: The emergence of the COVID-19 pandemic saw an increased use of cryopreserved (cryo) peripheral blood (PB) grafts for allogeneic hematopoietic stem cell transplantation (HSCT). Outcomes of patients receiving either fresh or cryo grafts have yielded heterogeneous results. Herein, we retrospectively compared the outcomes of patients receiving fresh and cryo grafts at a single center.(Table Presented)Methods: Between 2019 and 2021, we reviewed data from 380 patients;167 (44%) received a fresh, and 213 (56%) received a cryo graft. Patients underwent myeloablative or nonmyeloablative HSCT from either matched or mismatched, related or unrelated donors. Cell doses were determined by number of donor cells collected and recipient weight at infusion. Engraftment, disease risk (DR) and acute GVHD were classified based on established criteria. Donor chimerism was collected at approximately day 28 and day 80 after HSCT. Unadjusted and adjusted estimates of overall survival (OS), relapse, and non-relapse mortality (NRM) as a function of time were obtained. The adjusted odds (grades III-IV acute GVHD) and the adjusted cause-specific hazard of failure (all other outcomes) were compared between the 2 groups. with the use of logistic (Figure Presented) or Cox regression, respectively. These models were adjusted for various factors known to be associated with each outcome. Result(s): The characteristics of patients between the 2 groups are shown in Table 1. There was a higher proportion of patients with high/very high DR in the fresh graft group (Table 1). Median time to neutrophil engraftment was 17 and 18 days in fresh vs. cryo, respectively. The adjusted hazard ratio (HR) of neutrophil engraftment (fresh vs. cryo) was 1.07 (95% CI, 0.86-1.34, p=0.54). Median time to platelet engraftment was 13 and 15 days, respectively, and the adjusted HR of platelet engraftment was 1.32 (1.06-1.65, p=0.01). Day 28 chimerism data were available for 272 patients (113 fresh and 159 cryo). At day 28, donor CD3 chimerism was below 50% in 5 out of 113 (4.4%) and 17 out of 159 (10.7%) patients receiving fresh and cryo grafts, respectively (p= 0.06). At day 80, 3 out of 121 (2.5%) patients in the fresh group and 4 out of 165 (2.4%) in the cryo group had CD3 chimerism below 50%. The adjusted HRs (fresh vs. cryo) for death and NRM were 0.83 (0.54-1.28, p=0.40) and 0.71 (0.38-1.33, p=0.29), respectively (Figures 1 and 2). The adjusted HR for relapse was 0.65 (0.42-0.99, p=0.05) (Figure 3). The adjusted odds ratio (fresh vs. cryo) for grades III-IV GVHD was 1.65 (0.94-2.9, p=0.07). Conclusion(s): In this single-center retrospective study we observed numerically better outcomes with fresh grafts relative to cryo grafts for all examined endpoints with the exception of grades III-IV aGVHD, although none of the differences were definitive with the possible exception of relapse and platelet engraftment. Further studies are needed to confirm our observations.Copyright © 2023 American Society for Transplantation and Cellular Therapy
ABSTRACT
Background: The use of cryopreservation for stem cell grafts for both autologous stem cell and allogeneic cord blood transplant has been utilized for years. For other allogeneic stem cell transplant sources, the use of fresh collected grafts has been preferred due to concerns that cryopreservation may result in impaired graft function. With the onset of the COVID-19 pandemic a shift was made at our institution to exclusive use of cryopreservation Methods: In this retrospective single-center analysis a total of 133 patients undergoing allogeneic stem cell transplant at the University of Minnesota between 1/2018-6/2021 for a variety of malignancies were included, with 62 patients receiving fresh stem cell product and 71 patients receiving frozen stem cell product. Univariate statistical analysis was performed. Result(s): There was no significant difference between the two groups with regards to product type, sex, age, diagnosis (acute leukemia vs other), disease risk index, conditioning regimen, Karnofsky score, co-morbidity index, or cell dose (Table 1). Donor type was notably different between the two groups (p<0.01): matched sibling grafts were more commonly used for fresh products than frozen (85% vs. 35%), while matched unrelated donors were used more frequently for frozen than for fresh products (54% vs. 6%). Use of frozen product was associated with delayed neutrophil and platelet engraftment compared to fresh (median days to engraftment 15 vs 12 for neutrophils, 23 vs 17 for platelets, p<0.01 for both). Two-year relapse rates were significantly lower for frozen products (4%) than fresh (24%) (Table 2). This may be partially attributable to differences in follow up between the groups, as fresh products had a total of 910 days of follow up vs 432 for frozen products (P<0.0001). The difference in follow up remained statistically significant if the data was censored at 730 days (P<0.0001). Of note, the use of frozen products was associated with a lower rate of chronic graft-versus-host disease at one year post-transplant (p<0.01). There was no significant difference in the rates of acute GVHD between the groups. There were significant differences in GVHD prophylaxis regimens between the fresh and frozen groups (p<0.01). (Figure Presented)Two-year overall survival did not differ between groups (p=0.96). Conclusion(s): Use of cryopreserved stem cell products is associated with similar efficacy and outcomes as those seen with the use of fresh stem cell products. Although the data presented here suggest novel finding of decreased risk of relapse and chronic GVHD with the use of frozen stem cell products, additional follow up may abrogate these differences. Regardless, the logistical benefits of cryopreservation make this an attractive option for continued use in allogeneic transplants and our data presented here suggests that cryopreserved products remain an appropriate option for allogeneic stem cell transplant.Copyright © 2023 American Society for Transplantation and Cellular Therapy
ABSTRACT
Allogeneic hematopoietic stem cell transplantation (allo- HSCT) has traditionally involves administering fresh peripheral blood or bone marrow stem cells. At onset of the COVID-19 pandemic in March 2020, the National Marrow Donor Program (NDMP) mandated cryopreservation of all unrelated peripheral blood stem cell (PBSC) products to prevent interruptions in transplant plans by donor COVID-19 infection after recipient's start of conditioning chemotherapy. Since the lifting of this mandate, many centers have continued to cryopreserve grafts prior to initiation of conditioning, but the longer-term clinical outcomes of this practice including chronic graft versus host disease (cGVHD) rates of patients receiving cryopreserved stem cells have not been previously well described. Prior work has raised concern for a deleterious effect of cryopreservation on overall survival and non-relapse mortality (PMID: 33865804). However, heterogeneity in the patient population and reason for cryopreservation suggest that further study is needed to assess these outcomes. Here we report our single-institution experience of clinical outcomes using cryopreserved versus fresh URD PBSCs for allo-HSCT. We examined long-term outcomes in 387 patients who received unrelated donor (URD) PBSCs (136 cryopreserved, 251 fresh) between January 1, 2019 and July 31, 2021. The cohorts had similar baseline characteristics including donor/recipient age/sex, disease, conditioning regimen/intensity, and GVHD prophylaxis regimens. Two-year OS, PFS, relapse, NRM, and acute GVHD rates were not different between recipients of fresh versus cryopreserved PBSCs. Strikingly, 2-year incidence of cGVHD (28% vs 52%, p=0.00001) and moderate/severe cGVHD (9% vs 24%, p=0.00016) was substantially lower in recipients of cryopreserved PBSCs compared to fresh, respectively (Figure 1). This difference was only noted in patients receiving a GVHD prophylaxis regimen without post-transplantation cyclophosphamide (PTCY) (no PTCY 2-year cGVHD incidence cryopreserved vs fresh: 29% vs 57%, p=0.000016), moderate/severe cGVHD 16% vs 34%, p=0.0006) (Figure 2). For patients receiving a PTCY-containing GVHD prophylaxis regimen, there was no difference in cGVHD incidence (cGVHD cryopreserved vs fresh: 24% vs 27%, p=0.56, moderate/severe cGVHD 7% vs 9.3%, p=0.3, Figure 3). (Figure Presented) (Figure Presented) (Figure Presented) While survival and relapse rates are not different, cryopreservation is associated with a marked reduction in cGVHD rates in the setting of non-PTCy based GVHD prophylaxis. Larger multicenter or registry analyses are needed to confirm these observations and may prompt a re-assessment of the role of cryopreservation of stem cell products in clinical practice. If confirmed, it will be critical to understand the immunologic consequences of cryopreservation and how they might influence the clinical impact on chronic GVHDCopyright © 2023 American Society for Transplantation and Cellular Therapy
ABSTRACT
Case presentation: Supportive periodontal care (SPC) is defined as step IV by the 2020 and 2022 EFP Guidelines for the treatment of periodontitis stages I-IV. SPC aims to maintain periodontal stability after active periodontal treatment is finished and the endpoints of periodontal therapy are achieved. SPC presumes preventive and therapeutic procedures performed at individualised, patient-based intervals. This case report describes a patient, 43 y/o female, with diagnoses of generalised periodontitis stage IV, grade C and periodontal health on reduced periodontium who was enrolled in longterm SPC provided at 3 - 4-monthly intervals. During the COVID-19 pandemic, the patient did not report for regular SPC due to personal fears of the contagion. After 20 months of absence, the patient was admitted for SPC. The comprehensive periodontal exam showed excellent oral hygiene (FMPS=7%), the presence of five 4 and 5 mm pockets and relapse of periodontal inflammation (FMBS=42%). The affected areas were mostly in the lower jaw. As periodontitis is a chronic disease, patients need to be continuously monitored. SPC reduces the probability of disease progression and tooth loss, as timely re-treatment can be provided in cases of disease recurrence. Various factors can contribute to disease relapse. In terms of the described patient, despite good oral hygiene, factors such as psychological stress and unhealthy living habits experienced during the COVID-19 pandemic might have negatively impacted the innate host response and led to disease relapse.
ABSTRACT
Objective: This study aims to determine the demo-graphic and clinical characteristics of patients admitted to the emergency department of a training and research hos-pital within 72 hours of the diagnosis of COVID-19. Materials and Methods: The study was designed as descriptive and single-centered. The data of patients who presented to the emergency room with the diagnosis of COVID-19 were obtained retrospectively from the Hospi-tal Information Management System. Results: 56.497 patients diagnosed with COVID-19 presented to our emergency room, and 0.4% returned to the emergency room with similar complaints within 72 hours. Among those who returned, 51.4% were female, and the mean age was 41.67. This study found that 30.8% of readmitted people had at least one comorbidity. It was found that 30.8% of the readmission had at least one comorbidity;nausea and cough were the most common reasons for admission in patients with comorbidities. Conclusion: There is a need to design further studies to establish the criteria for the safe return of COVID-19 pa-tients to home, to reduce the re-admission rates, and in-crease the quality of care.