Higher and Sustained Cell-Mediated Immune Responses After 3 Doses of mRNA COVID-19 Vaccine in Patients With Inflammatory Bowel Disease on Anti-Tumor Necrosis Factor Therapy.

INTRODUCTION: Studies suggest that the generation of durable T-cell immunity following coronavirus disease 2019 (COVID-19) vaccination protects against severe disease. The aim of this study was to measure cell-mediated immune response (CMIR) 1-2 months and 6 months after a third dose of a COVID-19 mRNA vaccine. METHODS: This prospective study (HumoRal and CellULar initial and Sustained immunogenicity in patients with inflammatory bowel disease [IBD]) evaluated CMIR at 28-65 days (t 1 ) after dose 2, 28-65 days (t 2 ) (n = 183) and 6 months (±45 days) (t 3 ) (n = 167) after a third dose of an mRNA COVID-19 vaccine. A small cohort had blood sample available 28-65 days (t 4 ) (n = 55) after a fourth dose. Primary outcomes were CMIR at (t 2 ) and (t 3 ). Secondary outcomes included the effect of immunosuppressing IBD medications on CMIR and response at (t 4 ). RESULTS: All patients had measurable CMIR at all time points. CMIR increased at t 2 compared with that at t 1 (median 1,467 responding cells per million (interquartile range [IQR] 410-5,971) vs 313 (94-960) P < 0.001). There was no significant waning in t 2 vs t 3 or significant boosting at t 4 . Those on anti-tumor necrosis factor monotherapy had a higher CMIR compared with those not on this therapy at t 2 (4,132 [IQR 1,136-8,795] vs 869 [IQR 343-3,221] P < 0.001) and t 3 (2,843 [IQR 596-6,459] vs 654 [IQR 143-2,067] P < 0.001). In univariable analysis, anti-tumor necrosis factor monotherapy was associated with a higher CMIR at t 2 ( P < 0.001) and t 3 ( P < 0.001) and confirmed in a multivariable model ( P < 0.001). DISCUSSION: A third dose of a COVID-19 vaccine boosts CMIR, and the response is sustained in patients with IBD.

Persistence of Antibodies Six Months after Three COVID-19 mRNA Vaccine Doses in Patients with Inflammatory Bowel Disease.

We evaluated antibody concentrations 6 months after a third coronavirus disease 2019 messenger RNA vaccine dose in patients with inflammatory bowel diseases. Almost all patients had an antibody response, and those with a previous SARS-CoV-2 infection had higher antibody concentrations.

Uptake Rates of Three COVID-19 Vaccine Doses and Risk Factors for Incomplete Vaccination Among Patients With Inflammatory Bowel Disease Residing in Wisconsin: A Single-Center Cohort.

INTRODUCTION: Patients with inflammatory bowel disease on systemic corticosteroids may be at higher risk of adverse outcomes of COVID-19 infection, and vaccination is an essential preventive measure. Uptake of the original 2-dose COVID-19 messenger RNA (mRNA) primary vaccine series was previously high among patients with inflammatory bowel disease, while uptake of subsequent doses based on interval recommendations made by the Advisory Committee on Immunization Practice remains unknown. Herein, we evaluated uptake of 3 COVID-19 mRNA vaccine doses among patients with inflammatory bowel disease. METHODS: A total of 1012 patients were identified; 728 (71.9%) patients received 3 COVID-19 vaccine doses. Multivariable logistic regression revealed that younger age (odds ratio [OR] 1.02; 95% CI, 1.01 - 1.03; P = 0.001), rural status (OR 3.44; 95% CI, 2.17 - 5.56; P < 0.001), underrepresented minority status (OR 3.85; 95% CI, 1.89 - 7.69; P < 0.001), and absence of influenza vaccination (OR 8.17; 95% CI, 5.41 - 12.33; P < 0.001) were significantly associated with incomplete COVID-19 vaccination. RESULTS: Of 1362 patients, 83.3% completed a COVID-19 vaccination series. Younger patients had increased odds of not completing a COVID-19 vaccination series (mean [SD] 46.7 [14.7] vs 54.3 [15.8]; OR 1.03; 95% CI, 1.02-1.04; P < 0.001). Those who identified as non-White (1.88; 95% CI, 1.16-3.04; P = 0.010) or current smoker (1.85, 95% CI, 1.85-2.79; P = 0.004) had increased odds of not completing a COVID-19 vaccination series. Those who resided in rural ZIP codes (1.81; 95% CI, 1.35-2.43; P < 0.001), had not received a 2019-2020 influenza vaccine (5.13; 95% CI, 3.79-6.96; P < 0.001), or had lower comorbidity scores (2.95; 95% CI, 1.98-4.41; P < 0.001) had higher odds of not completing a COVID-19 vaccination series. CONCLUSIONS: Receipt of 3 COVID-19 mRNA vaccine doses is high overall among patients with inflammatory bowel disease. Younger age, underrepresented race/ethnicity, rural status, and lack of influenza vaccination are associated with incomplete COVID-19 vaccination.

Humoral Immunogenicity of 3 COVID-19 Messenger RNA Vaccine Doses in Patients With Inflammatory Bowel Disease.

Herein, we evaluated the humoral immunogenicity of a third coronavirus disease 2019 messenger RNA vaccine dose in patients with inflammatory bowel diseases. All patients displayed a humoral immune response, and median antibody concentrations were higher after the third dose than after completion of the 2-dose series.

Dasatinib-Induced Nephrotic Syndrome: A Case Report.

Second-generation tyrosine kinase inhibitors (TKI), such as nilotinib and dasatinib, are used in the first-line treatment of chronic myeloid leukemia (CML), usually after the failure or resistance to imatinib. Despite a good safety profile, medications in this category have an increased incidence of specific adverse events such as pulmonary hypertension, pleural effusion, and cardiovascular/peripheral arterial events. However, renal complications are rarely reported and observed. We herein report a case of a 46-year-old patient with CML who developed nephrotic syndrome upon switching from imatinib to dasatinib therapy, with the resolution of symptoms upon treatment discontinuation and switching to nilotinib. Limited cases were reported in the literature. It is thought that the inhibition of the vascular endothelial growth factor (VEGF) pathway is the main mechanism leading to proteinuria. Dasatinib-induced nephrotic syndrome should be looked for as it can be resolved by either reducing the dose or stopping it altogether and switching to another TKI.

Perceptions of preclinical medical students towards extracurricular activities.

OBJECTIVES: To determine the percentage of students involved in extracurricular activities (EAs), explore relationships between participation in EAs and students' characteristics, and investigate students' perceptions (i.e., motives and barriers) towards participation in EAs. METHODS: An online, anonymous, random, cross-sectional, self-rating survey was administered during spring 2015-2016 to second-year and third-year students (n=340). Chi-square test was used to explore relationships between participation in EAs and students' characteristics. Mann-Whitney U-test was used to compare the mean 5-point Likert scale responses according to students' characteristics. Statistical significance was determined as p<0.05. RESULTS: Two hundred thirty-seven students participated in the survey (n=237/340, response rate: 69.7%). Only 143 students (60.3%, n=140/237) participated in EAs, and this percentage significantly differed by gender (χ2(1, N=237)=4.3205, p<0.037), nationality (χ2(1, N=237)=18.7069, p<0.000) and cumulative grade point average (cGPA, χ2(1, N=237)=17.8296, p<0.000). The top three motives towards participation in EAs were: "improve resume" (83.5%, n=198), "improve networking skills" (82.7%, n=196) and "improve teamwork skills" (76.8%, n=182). The top three barriers towards participation in EAs were: "lack of time" (61.2%, n=145), "lack of equal opportunities in EAs" (57.8%, n=137) and "lack of curricular emphasis of EAs" (52.7%, n=125). There was a statistically significant difference of means between male (mean=2.8) and female (mean=3.2) students regarding the following barrier: "affect academic performance negatively" (U=5389.5, p<0.002). CONCLUSIONS: The participation rate in EAs was satisfactory, and positively related to students' characteristics of male gender, non-Saudi nationality and high cGPA. Medical schools should facilitate all potential motives and resolve all associated barriers towards participation in EAs.