ABSTRACT
Multiple myeloma (MM) patients are at risk of fatal outcome after SARS-CoV-2 infection. Preliminary data suggest that MM patients have an impaired response to vaccination. This prospective study analyzed the humoral and cellular immune responses to two doses of BNT162b2 in 72 MM patients, including 48 receiving anti-CD38 immunotherapy. Results evidenced that MM patients display lower levels of SARS-CoV-2 specific IgG and IgA antibodies and decreased neutralization of alpha and delta variants when compared to healthy controls. They also showed decreased numbers of circulating IFN{gamma}-producing Spike SARS-CoV-2 specific T lymphocytes. This defective immune response was particularly marked in patients receiving anti-CD38 immunotherapy. Furthermore, a retrospective investigation of MM patients among COVID-19-related death in the Paris area suggested a limited efficacy of BNT162b2 in patients treated with anti-CD38. Overall, these results show a decreased immunogenicity of BNT162b2 in MM patients and stress the need for novel strategies to improve SARS-CoV-2 prophylaxis in immunocompromised individuals.
ABSTRACT
BACKGROUND: Abdominoplasty is a commonly performed aesthetic surgical procedure worldwide, and one of the most frequently performed cosmetic surgical procedures in the United States. Classic abdominoplasty was merged with liposuction in the past decade to create a new technique-lipoabdominoplasty-that was proven to be safe and effective and that improves body contour. The authors have been using lipoabdominoplasty since 2003 with excellent outcomes; however, some details have been added to improve significant shortcomings, including the lack of treatment of the pubic area and flanks, the presence of a high-position scar and, sometimes, a bulging inferior abdomen. METHODS: The authors retrospectively studied 348 patients who underwent lipoabdominoplasty with these related surgical improvements between January of 2010 and February of 2015. Improvements to the original surgical technique included deep liposuction in the lower abdomen, pubic liposuction, and liposuction of the flanks or dorsum with power-assisted liposuction, Scarpa fascia removal in the inferior abdomen, lipoplasty and mons lipolifting, and pubic fixation. RESULTS: Following these key points, superior flap slides to the pubic region by elongation of the vessels and nerves, preserving those structures, avoiding creation of a dead space, and reducing the number of the most common complications. Scarpa fascia removal in the infraumbilical region avoided bulging without increasing the seroma rate. Pubic lifting and its fixation promote rejuvenation of the entire region and avoid elevation of the remnant scar. CONCLUSION: These surgical modifications are safe and avoid common complications related to lipoabdominoplasty, with improved outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Subject(s)
Abdominal Wall/surgery , Abdominoplasty/methods , Adipose Tissue/transplantation , Lipectomy/methods , Surgical Flaps , Suture Techniques , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome , Young AdultABSTRACT
Introdução: A queimadura representa um importante fator traumático em idosos que, somado às condições estruturais e funcionais associadas a patologias crônicas, leva esse grupo de indivíduos a terem maior morbimortalidade decorrente desse agravo. Métodos: O presente estudo avalia os dados epidemiológicos envolvidos no trauma por queimadura na população de idosos internados no Centro de Tratamento de Queimados Dr. Oscar Plaisant do Hospital Federal do Andaraí, Rio de Janeiro-RJ, entre 2009 e o primeiro semestre de 2014. Resultados: Dos 57 idosos internados, 29 eram homens, 61,7 anos, com trauma em forma de acidente decorrente de chama, dentro do domicílio, tendo taxa de óbito de 32%. Conclusão: Queimaduras em idosos necessitam de atenção especial devido às condições diferenciadas desses pacientes, expondo-os ao maior risco, bem como maior índice de complicações e óbito.
Introduction: Burns represent a major trauma factor in elderly patients that, added to physiological changes and chronic pathologies, lead this group to a highermorbidity and mortality. Methods: This study evaluate epidemiologic data in old patients burned and hospitalized in Burn Treatment Unit Dr. Oscar Plaisant from Andaraí Federal Hospital, Rio de Janeiro-RJ, between 2009 and first half of 2014. Results: From 57 elderly patients hospitalized, 29 were men, 61.7 years, with trauma from accidents by flame, inside home, with 32% death rate. Conclusion: Burns in the elderly require special attention due to unique conditions of these patients, exposing them to higher risk as well as higher rates of complications and death.
