ABSTRACT
Recent studies have shown a suboptimal humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients diagnosed with hematologic malignancies; however, data about cellular immunogenicity are scarce. The aim of this study was to evaluate both the humoral and cellular immunogenicity 1 month after the second dose of the mRNA-1273 vaccine. Antibody titers were measured by using the Elecsys and LIAISON anti-SARS-CoV-2 S assays, and T-cell response was assessed by using interferon-γ release immunoassay technology. Overall, 76.3% (184 of 241) of patients developed humoral immunity, and the cellular response rate was 79% (184 of 233). Hypogammaglobulinemia, lymphopenia, active hematologic treatment, and anti-CD20 therapy during the previous 6 months were associated with an inferior humoral response. Conversely, age >65 years, active disease, lymphopenia, and immunosuppressive treatment of graft-versus-host disease (GVHD) were associated with an impaired cellular response. A significant dissociation between the humoral and cellular responses was observed in patients treated with anti-CD20 therapy (the humoral response was 17.5%, whereas the cellular response was 71.1%). In these patients, B-cell aplasia was confirmed while T-cell counts were preserved. In contrast, humoral response was observed in 77.3% of patients undergoing immunosuppressive treatment of GVHD, whereas only 52.4% had a cellular response. The cellular and humoral responses to the SARS-CoV-2 mRNA-1273 vaccine in patients with hematologic malignancies are highly influenced by the presence of treatments such as anti-CD20 therapy and immunosuppressive agents. This observation has implications for the further management of these patients.
Subject(s)
COVID-19 , Hematologic Neoplasms , 2019-nCoV Vaccine mRNA-1273 , Aged , Antibodies, Neutralizing , Antibodies, Viral , BNT162 Vaccine , COVID-19 Vaccines , Hematologic Neoplasms/therapy , Humans , Immunogenicity, Vaccine , RNA, Messenger/genetics , SARS-CoV-2ABSTRACT
La osteomielitis del pie diabético puede presentar al clínico grandes desafíos diagnósticos y terapéuticos. La infección en pacientes con úlceras de pie diabético ocasiona una gran morbimortalidad. Las tasas de mortalidad, sobre todo cardiovascular, tras una úlcera y la amputación son muy elevadas, casi un 60% de las personas fallecen en el transcurso de 5 años tras una amputación y casi un 40% en el caso de las úlceras. El objetivo del artículo es describir el procedimiento con el que se aborda la osteomielitis en pacientes con úlceras de pie diabético a través de un equipo multiprofesional. METODOLOGÍA: A través de dos casos clínicos, se expone el planteamiento quirúrgico y médico para el abordaje de la osteomielitis. RESULTADOS: La resolución tanto de la osteomielitis como de la cicatrización de la úlcera se apoya tanto en la especialización de los profesionales a nivel clínico como en garantizar la continuidad asistencial en los niveles de atención existentes, evitando la variabilidad y garantizando la prestación de los recursos necesarios de manera eficiente. CONCLUSIONES: El abordaje quirúrgico o médico de la osteomielitis precisa de un equipo cualificado que pueda plantear ambas estrategias de atención, consiguiendo la resolución del caso
Osteomyelitis of the diabetic foot can present the clinician with great diagnostic and therapeutic challenges. Infection in patients with diabetic foot ulcers causes great morbidity and mortality. Mortality rates, especially cardiovascular, after an ulcer and amputation are very high, almost 60% of people die within 5 years after amputation and almost 40% in the case of ulcers. The objective of the article is to describe the procedure with which osteomyelitis is approached in patients with diabetic foot ulcers through a multiprofessional team. METHODOLOGY: Through two clinical cases, the surgical and medical approach for the osteomyelitis approach is exposed. RESULTS: The resolution of both osteomyelitis and ulcer healing relies both on the specialization of professionals at a clinical level, and on ensuring continuity of care at existing levels of care, avoiding variability and guaranteeing the provision of Necessary resources efficiently. CONCLUSIONS: The surgical or medical approach of osteomyelitis requires a qualified team that can propose both strategies of care, obtaining the resolution of the case
