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Background/Aims The immune response to SARS-CoV-2 is known to be reduced in the immunocompromised. However, extent to which immunity is affected by immunosuppression in specific disease cohorts remains poorly characterised. Furthermore, implications of the ongoing vaccination booster programme require further study. Individuals with lupus nephritis (LN) require prolonged high-dose immunosuppression in order to maintain disease control, rendering them important to study in this context. We evaluated SARS-CoV-2 nucleocapsid and spike antibody response in this cohort during the Spring/Summer 2022 booster vaccine campaign. Nucleocapsid antibody indicates previous infection whilst spike antibody indicates previous infection and/or vaccination response. Titre of spike antibody to prevent infection is not known, but presence of antibodies is likely to protect against severe disease. Methods SARS-CoV-2 spike and nucleocapsid antibody were measured in adult patients with LN attending a tertiary centre rheumatology clinic. Data was collected retrospectively on disease, immunosuppression, vaccine status and history of natural exposure. Results 35 cases of LN were investigated, of which LN III, IV and V were predominant biopsy diagnoses. Regarding immunosuppressants, the Eurolupus Cyclophosphamide protocol had been used in the majority of patients to achieve initial control, with 3/35 patients still receiving pulsed courses at data collection. 18/35 were on Mycophenolate Mofetil;a further 13/35 had previously received this. 31/35 took at least 5mg Prednisolone daily;25/35 took Hydroxychloroquine;7/35 took Azathioprine;7/35 had previously been on Methotrexate, 3/35 took Tacrolimus;1/35 took Ciclosporin. Regarding B-cell depleting monoclonal antibody therapy, 13/35 had received Rituximab and 8/35 were receiving Belimumab. Antibody levels were measured between 4 weeks and 13 months after last dose of vaccination;mean duration was 6 months. 11/35 had confirmed COVID-19 infection;a further 8/35 reported a possible history. Of the 35, 32 (91%) had mounted detectable SARS-CoV-2 spike antibody above the bottom 10% of assay detection, indicating some immunity to vaccination or natural exposure. 20 (57%) had detectable nucleocapsid antibody, suggesting natural infection with antibody response. Only 2 (6%) had not mounted any antibody response. Of note, neither were fully vaccinated: one had 1 vaccination with blood test 8 months subsequent;one had 2 vaccinations with blood test 7 months subsequent. The latter was also notably on haemodialysis. All who received 3+ vaccinations had detectable spike antibody responses, as well as 75% of those who had received 2 vaccinations. Conclusion Our study is the first analysis, to our knowledge, of SARS-CoV-2 antibody response in a LN cohort. Whilst neutralising capacity and level of antibody providing protection remains under research, these findings provide at least some reassurance that individuals with LN on immunosuppression are capable of mounting an immune response against SARS-CoV-2. Further work is required to establish extent and duration of protection with serial vaccinations in this cohort.
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A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.
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Purpose: Prior studies demonstrated an increased immune response post-3rd COVID-19 vaccine dose when given 1-month post-2nd dose in solid organ transplant recipients (SOT). This study assessed whether a 3rd mRNA vaccine dose administered 6 months post-2nd dose enhanced humoral immune response in SOT. Method(s): A prospective cohort study was conducted of SOT, without prior COVID-19, who received 3 mRNA vaccine doses (BNT162b2 (Pfizer) or mRNA- 1273 (Moderna)). Primary outcome was a positive serologic response characterized by an anti-receptor-binding domain (RBD) antibody (Ab) level of >100 U/mL 4 weeks post-3rd dose (measured with the Roche Elecsys anti-SARS-CoV-2 immunoassay). Result(s): 175 SOT were enrolled: 48 (27%) heart, 72 (41%) lung, 51 (29%) kidney, 4 (2%) other SOT (Figure 1). A positive anti-RBD Ab level measured 4-weeks post-3rd vaccine dose was present in 105/175 (60%). In a multivariable model, age >60 years (adjusted odds ratio [aOR] 0.41;95% CI 0.19 to 0.87), heart (aOR 0.28;95% CI 0.10 to 0.76) or lung (aOR 0.20;95% CI 0.07 to 0.55) transplant, and mycophenolate use (aOR 0.24;95% CI 0.11 to 0.54) were independent risk factors for not developing a positive Ab post-3rd dose. Patients transplanted >10 years ago were more likely to have a positive Ab (aOR 4.95;95% CI 1.04 to 23.42). Those with a low positive Ab (>0.8 to <100 U/mL) post-2nd vaccine dose were more likely to have a positive Ab post-3rd dose than those with an undetectable Ab (<0.8 U/mL). But 26/105 (25%) participants with an undetectable Ab post-2nd dose developed an Ab of >100 U/ mL;9/26 (35%) developed an Ab >1000 U/mL (Figure 2). 4 (2%) SOT developed rejection within 30-days post-3rd dose. Conclusion(s): Despite the extended time interval of 6 months between the 2nd and 3rd doses, the proportion of non-responders (40%) in this study was similar to other studies when the 3rd dose was given 1-month post-2nd dose. These data suggest that a substantial proportion of SOT remain at risk for COVID-19 after 3 mRNA vaccine doses. Additional interventions need to be further studied, including monoclonal Ab as pre-exposure prophylaxis and 4th vaccine doses. (Figure Presented).
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This protective clothing design project responds to the urgent need for research into the redesign of personal protective equipment (PPE) isolation gowns, to be more fit for purpose and reusable to enhance the experiences of healthcare workers treating patients with COVID-19 and variants. Funded by the Arts and Humanities Research Council (AHRC) the research addresses the engineering question: "What new materials, design and manufacturing approaches should we start to consider in preparation for pandemics e.g. reusable PPE to replace single use?" The article focuses on the online questionnaire/ survey, its main findings and the 'participatory clothing design' methodology which prioritises the lived experiences and expressed needs of healthcare workers wearing disposable and reusable PPE in acute care scenarios. Research methods include literature and gown reviews, selected interviews and survey directed at nurses, to acquire first-hand qualitative data about the impact of current gown design and procurement policies on wearers. Selected results and commentary from the ongoing survey are presented and thematically analysed to inform the development of reusable gowns. Semi-structured interviews with clinical leads and caregivers, as well as responses from users, will be important to integrate expertise in fashion, textile and uniform design, clinical practice, and manufacturing. Further design will be based on a complex design brief that balances the needs of wearers and critical care providers while considering regulations, protection, comfort, sustainability, and cost. This research focuses on enhancing an overlooked area of critical care clothing and the people who wear it while reducing its detrimental impact on the planet.
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On May 19, 2020, after several days of heavy precipitation, two earth dams failed (Edenville and Sanford) and two other dams were damaged (Secord and Smallwood), north of the town of Midland, MI. The failures resulted in about $100M in damages and the evacuation of about 11,000 people during the COVID-19 pandemic. In response to this destructive event, the Geo-Institute Embankment, Dams, and Slopes Technical Committee organized a team with the main objective of capturing perishable data. The Edenville Dam site was of interest because the slope failure was captured on video and occurred prior to the dam being overtopped. Based on our observations, investigation and analyses, two failure mechanisms were considered likely for Edenville Dam: (1) static liquefaction (similar to 2019 failure of Brumadinho Dam in Brazil);and (2) slope instability, where the slide debris which was contractive in nature, expelled pore water in the form of water jets and flowed as it became liquefied along the toe of the dam. © 2021 American Society of Civil Engineers (ASCE). All rights reserved.