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Background. Patients receiving CAR-T therapy may have impaired humoral responses to SARS-CoV-2 vaccinations due to their high net state of immunosuppression associated with the underlying disease, prior lines of therapy and CAR-T treatment associated hypogammaglobinemia. Comprehensive data on vaccine immunogenicity in this patient population are currently lacking. Methods. A single-center retrospective study of adults receiving CD19 CAR-T therapy for non-Hodgkin's lymphoma was conducted between 3/27/2018 - 8/31/ 2021. Patients received at least two doses of COVID-19 vaccinations with BNT162b2 (Pfizer, BioNTech), mRNA-1273 (Moderna), or 1 dose of Ad26.COV2.S (Janssen) and had SARS-CoV-2 anti-spike (S) levels measured at least one month after the last vaccine dose. We excluded patients who received COVID-19 monoclonal antibody therapy or immunoglobulin within 3 months of the index anti-S titer. Patients were followed from the time of the first COVID-19 vaccines through their index anti-S antibody result. Patients were censored on the first day of any additional antineoplastic therapy after disease relapse. Our primary endpoint was the percentage of patients who develop a positive anti-S response (assessed by anti-S assay cutoff of >0.8 U/mL, Roche assay). Results. Twenty-five patients met eligibility. Median age was 65 years (range 41 - 78), and majority of patients were male (72%). The number of patients with a positive antibody response was 12 (48%). Median number of vaccines received was 3. 18 patients (72%) received Pfizer vaccines, 4 patients (16%) received Moderna, 2 patients (8%) received Moderna and Pfizer, and 1 patient (4%) received Janssen and Pfizer. Median anti-S titers among patients with a positive response was 111 U/mL (range 2.44 - 12500). Two patients (8%) had COVID-19, both with negative anti-S responses. Conclusion. Our analysis shows that only 48% of patients who received CAR-T therapy developed a positive antibody response after at least two COVID-19 vaccine doses, with a low median titer among responders. This patient population is at higher risk for developing severe COVID-19 disease and likely remains vulnerable even after vaccination. Alternative approaches are needed to prevent COVID-19 and mitigate disease severity in patients undergoing CAR-T.
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Background: SARS-CoV-2 may present with symptoms, coughing, fever, weakness, and breathlessness. Other common symptoms are discoloring skin, rashes or toes color changes, swelling, present with pain, and some individuals without pain. Some researchers think that these rashes are due to respiratory tract infection, which invades the peripheral skin. It has no relation with the Raynaud phenomena because of the periphery's coldness, stress, or ischemia and low blood supply to a region affected. Aim: No all the Patients with Covid-19 toes are favorable for the Covid-19 testing, and some develop covid-19 toes after the symptoms of covid-19 have subsided;therefore, it grows in the different stages of covid-19 infection and not necessarily reflected inactive phases of the covid-19 disease. On the other hand, many patients with Covid-19 toes do not have severe symptoms but mild congestion and fever at a younger age, leading to kolviras et al. to propose a mechanism for antiviral response mediated by more immature immune cells. Method: The Covid-19 toe primarily presents moderate to severe levels in half of the cases, which show damage to vessels and leaking of blood, which directly links to inflammation. However, even when inflammation was mild, there was evidence of damage to the vasculature and leaking. We do not know much about the cause of Covid-19 toe. Still, some researchers suggested coagulation pathways and various interferons might be responsible. Others say viral particles may lead to immune cells proliferating and cause the bursting of covid-19 toes. The findings of SARS-CoV-2 on endothelial cells of a skin lesion by immunohistochemistry show the pathophysiology of COVID-19. Results: Patient-reported on 20 July 2020 developed mild symptoms of Covid-19 with mild fever, dry cough, smell loss nearly wholly, and headache for four days;RTPCR for SARS-CoV-2%25 were positive. The patient had a history of diabetes for 10 years, without hypertension, or any chronic disease. Pt received Vavipiravir 3.6 gm in 14 days, Ivermectin 12 mg once a day for five days, along with VitD3 60,000 IU, Doxycycline for seven days. After three days of starting antiviral drugs favipiravir, the symptoms were relieved, and fever subsided after five days. Patients developed reddish discoloration of great right toes after one month of symptoms with involvement of almost two-thirds of the toe with no pain or any pus formation (fig 1). It took eleven months to grow a new nail and replace most dark red discoloration, still, a broken nail at the upper margin. [Formula presented] Discussion: It's not a common manifestation of covid-19 infection. It may last from weeks to months, and some may not require treatment except for some with topical steroids. In this patient involvement of a single toe started after one month of infection and partial recovery of new growth of nail took 11 months which shows even in mild covid19 infection peripheral vascular complication may manifest after the infection subsided and may continue even after one year of post covid19. Therefore we need to keep watch and screen all the post covid19 patients.
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Digital technologies have been widely utilized to assist with disease detection and management throughout the Covid-19 pandemic. The prevalence of smartphone usage amongst populations has assisted the provision of mobile applications that citizens can use to manage their health. Covid-19 symptom checker smartphone apps enable users to enter their health characteristics and receive validated advice related to self-isolation, testing and whether to seek clinical care. Moreover, the collection of symptom data can assist healthcare providers with disease surveillance and resource allocation. However, the adoption of symptom checker apps can be influenced by several factors including the functionality of the app, and data privacy and protection policies. In this study, we reviewed nine symptom checker apps that were available on the Android and iOS platforms. We analyzed characteristics related to the functionality and accessibility of the apps, and factors that related to privacy, transparency and trust. We found that most of the apps were multifunctional and several (n = 4) combined contact tracing and symptom checking functionalities. Moreover, there was variation in the quantity of personal data collected and symptom checking questions. For all the apps reviewed information related to privacy and data protection was available, however, there was variability in the content and readability of this material. Information regarding the technical profile of the apps was also inconsistent. For several of the apps, access to the symptom checking functionality was restricted by location. This review suggests that symptom checker apps provide an effective tool for public health management during the Covid-19 pandemic. © 2021, Springer Nature Switzerland AG.
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Personal protective equipment (PPE) can potentiate heat stress, which may have a negative impact on the wearer's performance, safety and well-being. In view of this, a survey was distributed to healthcare workers (HCWs) required to wear PPE during the coronavirus disease 2019 pandemic in the UK to evaluate perceived levels of heat stress and its consequences. Respondents reported experiencing several heat-related illness symptoms, and heat stress impaired both cognitive and physical performance. The majority of respondents stated that wearing PPE made their job more difficult. These, and additional, responses suggest that modification to current working practices is required urgently to improve the resilience of HCWs to wearing PPE during pandemics.