Evaluation of the hematological and immunological markers after the first and second doses of BNT162b2 mRNA vaccine.

OBJECTIVE: Both humoral and cellular immunity can be significantly influenced by the immunological responses to vaccination, and both responses are essential. Vaccination is the most consistent, safe, and cost-efficient practice for controlling the COVID-19 pandemic. PATIENTS AND METHODS: Blood samples were collected from participants who received two vaccine doses of COVID-19 Pfizer/BioNTech (BNT162b2) before and on days 7 and 10 after the first and second immunization. We evaluated some hematological and immunological markers responses to the 1st and 2nd doses of the BNT162b2 mRNA (Pfizer/BioNtech) vaccine. RESULTS: In healthy subjects' neutrophil and WBC counts significantly increased compared to those after the first dose. The results of all first-group participant categories demonstrated no discernible variations in lymphocyte counts. There was no change in IgM or IgG in all second-group cohorts, except for a considerable rise in IgG levels in people with a history of coronavirus infection following the second dosage compared to baseline. After the second dose, CD4+ T-cell and CD8+ T-cell levels rose in all groups compared to before the immunization and after the first dosage. Data demonstrated a substantial rise in neutrophil-lymphocyte ratio (NLR) after the second dose of the vaccine. Individuals who had previously had COVID-19 disease experienced a considerable increase in C3 and C4 levels after the first and second dosages compared to baseline. Additionally, compared to their levels after the first dosage, C4 levels increased significantly following the second dosage. Interleukin (IL)-6, IL-15, macrophage colony-stimulating factor (M-CSF), granulocyte colony stimulating factor (G-CSF), interferon gamma-induced protein 10 (IP-10/CXCL10), and macrophage inflammatory protein-1 alpha (MIP-1α/CCL3) levels were increased after boost correlated with Spike antibody levels, supporting their utility as indicators of successful humoral immunity development in response to vaccination. CONCLUSIONS: We can conclude that the Pfizer/BioNTech vaccine produced a more potent T-cell response than humoral ones.

Molecular Detection of blaSHV-la Gene in Klebsiella pneumonia Isolated from Urinary Tract Infections, Najaf, Iraq.

Klebsiella pneumoniae is a gram-negative bacterium that causes serious illnesses, including pneumonia, liver abscess, meningitis, bloodstream infections, and urinary tract infections (UTIs). This study aimed to isolate and diagnose K. pneumoniae from clinical specimens of urine from patients with UTIs and perform molecular detection of the blaSHV-la gene in K. pneumonia in the Najaf Province, Iraq. The study included 100 clinical specimens from October 2021 to March 2022. As an initial diagnosis, K. pneumoniae isolates were diagnosed based on culture and biochemical features. Apart from the usage of polymerase chain reaction (PCR) technology to identify the blaSHV-la gene, the final diagnostic was achieved by the automated Vitek-2 compact system. The biochemical findings revealed that 40 out of every 100 isolates tested positive for K. pneumoniae. These results were validated by Vitek, which revealed that 40/100 of the samples tested positive for K. pneumoniae, and by PCR utilizing the blaSHV-la gene, which showed that 13/40 of the samples tested positive for K. pneumoniae isolated from the urine of patients with UTIs. In conclusion, the results indicated that the use of the Vitek-2 technique was required to confirm the accurate identification of the pathogen. Klebsiella pneumoniae clinical isolates showed multidrug resistance to antibiotics commonly used to treat UTIs. The blaSHV gene encoded for Extended-spectrum beta-lactam antibiotic was found almost in K. pneumoniae isolates.

Multiple sclerosis reactivation postfingolimod cessation: is it IRIS?

Although few recent studies have reported efficacy and safety data among patients with multiple sclerosis (MS) switching between immunotherapies, data on the mechanism of rebound activity postwithdrawal of fingolimod in patients with MS is scarce. A 36-year-old woman developed severe reactivation of her disease within 7 weeks of fingolimod's withdrawal despite the absence of breakthrough disease during the 8-week natalizumab washout period previously. The clinical presentation and radiological features were described indicating the diagnostic challenge given the potential risk of developing progressive multifocal leucoencephalopathy. The severe reactivation postwithdrawal of fingolimod could be due to the immune reconstitution inflammatory syndrome (IRIS) given the abrupt rise in lymphocyte count. Patients who discontinued fingolimod might be at risk of developing IRIS resulting in disease reactivation in the washout period.

Recurrent Wernicke's Encephalopathy in a 16-Year-Old Girl with Atypical Clinical and Radiological Features.

Background. Wernicke's Encephalopathy (WE) is a clinical diagnosis with serious neurological consequences. Its occurrence is underestimated in nonalcoholics and is uncommon in adolescents. We aim to draw the attention to a rare case, which had additional clinical and radiological features. Case. A 16-year-old girl presented with three-week history of vomiting secondary to intestinal obstruction. She developed diplopia soon after hospitalization. Neurological evaluation revealed restriction of bilateral lateral recti with horizontal nystagmus, and bilateral limb dysmetria. Brain MRI was normal. She had prompt improvement to thiamine. Four months later, she presented with headache, bilateral severe deafness, and tinnitus. Clinically, she had severe sensorineural hearing loss, bilateral lateral recti paresis, and gait ataxia. CT head showed bilateral caudate nucleus hypodensities. MRI brain revealed gadolinium enhancement of mamillary bodies and vermis. She had significant improvement after IV thiamine. Headache completely resolved while the ocular movements, hearing, and tinnitus improved partially in 72 hours. Conclusions. Recurrent WE in adolescence is uncommon. Headache, tinnitus, and deafness are rare clinical features. Although MRI study shows typical features of WE, the presence of bilateral caudate nuclei hypodensities on CT scan is uncommon. Prompt treatment with thiamine is warranted in suspected cases to prevent permanent neurological sequelae.

The effect of continuous subcutaneous glucose monitoring (CGMS) versus intermittent whole blood finger-stick glucose monitoring (SBGM) on hemoglobin A1c (HBA1c) levels in Type I diabetic patients: a systematic review.

BACKGROUND AND PURPOSE: Continuous glucose monitoring (CGMS) is a relatively new technology that measures interstitial glucose every 5 min for 72 h. The resulting profile provides a more comprehensive measure of glycemic excursions than intermittent self-blood finger-stick glucose monitoring (SBGM) and thus could potentially improve diabetes control. We performed a meta-analysis of randomized controlled trials comparing CGMS and SBGM in Type 1 diabetic patients. Our aim was to determine whether CGMS leads to better hemoglobin A1c (HBA1c) levels, a marker of long-term vascular risk. METHODS: Randomized controlled trials comparing CGMS and SBGM in Type 1 diabetic patients were identified using both manual and electronic searches of the literature in MEDLINE, EMBASE, PUBMED and Cochrane Central Registry of Controlled Trials from 1996 to March 2007. Relevant studies were independently selected by two reviewers, who also extracted data on study design, quality and effect on HBA1c levels. Data from all trials were pooled using a random effects model. RESULTS: Seven studies with a total of 335 patients fulfilled the inclusion criteria. Five studies were confined to the pediatric population (age<18 years). Study duration varied from 12 to 24 weeks. Compared with SBGM, CGMS was associated with a non-significant reduction in HBA1c (0.22%; 95% CI: -0.439% to 0.004%, p=0.055). CONCLUSIONS: There is insufficient evidence to support the notion that CGMS provides a superior benefit over SBGM in terms of HBA1c reduction. There was some indication of improved detection of asymptomatic nocturnal hypoglycemia in the CGMS group.