Humoral immune responses against SARS-CoV-2 variants including omicron in solid organ transplant recipients after three doses of a COVID-19 mRNA vaccine

BackgroundSolid organ transplant recipients (SOTR), who typically receive post-transplant immunosuppression, show increased COVID-19-related mortality. It is unclear whether an additional dose of COVID-19 vaccines in SOTR can overcome the reduced immune responsiveness against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants. MethodsWe performed a prospective cohort study of 53 SOTR receiving SARS-CoV-2 vaccination into a prospective cohort study performing detailed immunoprofiling of humoral immune responses against SARS-CoV-2 and its variants. ResultsPrior to the additional vaccine dose, 60.3% of SOTR showed no measurable neutralization and only 18.9% demonstrated neutralizing activity of >90% following two vaccine doses. More intensive immunosuppression, antimetabolites in particular, negatively impacted antiviral immunity. While absolute IgG levels were lower in SOTR than controls, antibody titers against microbial recall antigens were in fact higher. In contrast, SOTR showed reduced vaccine-induced IgG/IgA antibody titers against SARS-CoV-2 and its delta variants. Vaccinated SOTR showed a markedly fewer linear B cell epitopes, indicating reduced B cell diversity. Importantly, a third vaccine dose led to an increase in anti-SARS-CoV-2 antibody titers and neutralizing activity across alpha, beta and delta variants. However, we observed a significant decrease in anti-spike antibody titers with the omicron variant. ConclusionsOnly a small subgroup of SOTR generated functionally relevant antibodies after completing the initial vaccine series based on dysfunctional priming of immune responses against novel antigens. An additional dose of the vaccine results in dramatically improved antibody responses against all SARS-CoV-2 variants except omicron.

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series

Purpose@#To evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block. @*Methods@#This retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinal detachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRD with/without VH. @*Results@#Twenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2 mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy (n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuity in groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for each group was logarithm of the minimum angle of resolution 0.59 ± 0.79, 0.48 ± 0.26, and 1.25 ± 0.64, respectively (p = 0.006). The development of RRD was associated with a larger AL (p = 0.015); while the development of significant VH associated with the superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p = 0.015). @*Conclusions@#Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.

Problem Based Learning (PBL) - An Effective Approach to Improve Learning Outcomes in Medical Teaching.

INTRODUCTION: As the "Science of Medicine" is getting advanced day-by-day, need for better pedagogies & learning techniques are imperative. Problem Based Learning (PBL) is an effective way of delivering medical education in a coherent, integrated & focused manner. It has several advantages over conventional and age-old teaching methods of routine. It is based on principles of adult learning theory, including student's motivation, encouragement to set goals, think critically about decision making in day-to-day operations. Above all these, it stimulates challenge acceptance and learning curiosity among students and creates pragmatic educational program. AIM AND OBJECTIVES: To measure the effectiveness of the "Problem Based Learning" as compared to conventional theory/didactic lectures based learning. MATERIAL AND METHODS: The study was conducted on 72 medical students from Dayanand Medical College & Hospital, Ludhiana. Two modules of problem based sessions designed and delivered. Pre & Post-test score's scientific statistical analysis was done. Student feed-back received based on questionnaire in the five-point Likert scale format. RESULTS: Significant improvement in overall performance observed. Feedback revealed majority agreement that "Problem-based learning" helped them create interest (88.8 %), better understanding (86%) & promotes self-directed subject learning (91.6 %). Substantial improvement in the post-test scores clearly reveals acceptance of PBL over conventional learning. CONCLUSION: PBL ensures better practical learning, ability to create interest, subject understanding. It is a modern-day educational strategy, an effective tool to objectively improve the knowledge acquisition in Medical Teaching.