Robust Antibody Levels in Both Diabetic and Non-Diabetic Individuals After BNT162b2 mRNA COVID-19 Vaccination.

The emergence of effective vaccines for COVID-19 has been welcomed by the world with great optimism. Given their increased susceptibility to COVID-19, the question arises whether individuals with type-2 diabetes mellitus (T2DM) and other metabolic conditions can respond effectively to the mRNA-based vaccine. We aimed to evaluate the levels of anti-SARS-CoV-2 IgG and neutralizing antibodies in people with T2DM and/or other metabolic risk factors (hypertension and obesity) compared to those without. This study included 262 people (81 diabetic and 181 non-diabetic persons) that took two doses of BNT162b2 (Pfizer-BioNTech) mRNA vaccine. Both T2DM and non-diabetic individuals had a robust response to vaccination as demonstrated by their high antibody titers. However, both SARS-CoV-2 IgG and neutralizing antibodies titers were lower in people with T2DM. The mean ( ± 1 standard deviation) levels were 154 ± 49.1 vs. 138 ± 59.4 BAU/ml for IgG and 87.1 ± 11.6 vs. 79.7 ± 19.5% for neutralizing antibodies in individuals without diabetes compared to those with T2DM, respectively. In a multiple linear regression adjusted for individual characteristics, comorbidities, previous COVID-19 infection, and duration since second vaccine dose, diabetics had 13.86 BAU/ml (95% CI: 27.08 to 0.64 BAU/ml, p=0.041) less IgG antibodies and 4.42% (95% CI: 8.53 to 0.32%, p=0.036) fewer neutralizing antibodies than non-diabetics. Hypertension and obesity did not show significant changes in antibody titers. Taken together, both type-2 diabetic and non-diabetic individuals elicited strong immune responses to SARS-CoV-2 BNT162b2 mRNA vaccine; nonetheless, lower levels were seen in people with diabetes. Continuous monitoring of the antibody levels might be a good indicator to guide personalized needs for further booster shots to maintain adaptive immunity. Nonetheless, it is important that people get their COVID-19 vaccination especially people with diabetes.

Chronic cutaneous graft-versus-host disease in children: A report of 14 patients from a tertiary care pediatric dermatology clinic.

BACKGROUND/OBJECTIVES: Allogeneic hematopoietic stem cell transplantation (HSCT) is a treatment option for many life-threatening disorders in children. Chronic graft-versus-host disease (cGVHD) is a significant complication of HSCT, and its treatment is challenging. Skin is the most common organ affected in cGVHD, with protean manifestations posing a challenge in diagnosis and management. The objective was to have a better understanding of the spectrum of chronic cutaneous GVHD (cc-GVHD) in children. METHODS: Hospital records of 14 children with cc-GVHD, registered over 9 years, were reviewed. RESULTS: All the patients had received HSCT from related donors. Median duration between HSCT and onset of cc-GVHD was 7.5 months. Eighty-six percent of the patients had a prior history of aGVHD, and 14% had de novo onset of cc-GVHD. Of 14 patients, 71% had classic cc-GVHD. Overlap syndrome was observed in 29%. Tandem occurrence of multiple morphologies was noticed in 6 (43%) patients. Of classic cc-GVHD, lichen planus-like cc-GVHD was most common (57%) followed by scleroderma-like (29%) and poikiloderma (7%). Rare variants included eczema-like (14%) and psoriasis-like (7%) cc-GVHD. Mucosal involvement was seen in 78.6% of the patients, nail involvement in 50%, and hair abnormalities in 43%. After a median follow-up of 4.8 years, complete remission was observed in 50% and mortality in 14%. CONCLUSION: The study signifies the diverse nature of cc-GVHD and indicates the need for multicenter surveys including larger number of patients to have proper insight into and develop treatment guidelines for cc-GVHD in children.

Burkitt's lymphoma in a patient with adenosine deaminase deficiency-severe combined immunodeficiency treated with polyethylene glycol-adenosine deaminase.

We describe a patient with severe combined immunodeficiency because of aberrations in adenosine deaminase (ADA) who despite adequate replacement with polyethylene glycol-linked ADA (PEG-ADA) for 13 years developed Burkitt's lymphoma. Although treatment corrected the metabolic abnormalities caused by ADA deficiency, it failed to fully restore cellular immunity.

Immediate versus delayed access of implantable venous access devices: does the timing of access make a difference to the frequency of complications?

PURPOSE: In many institutions protocols have not been developed as to when implantable venous access devices are accessed in children with cancer. The differences in complication rates (infection, hematoma, mechanical failure, and extravasation) between immediate versus delayed access remain unknown. PATIENTS AND METHODS: This retrospective study looks at the incidence of complications in two groups of pediatric patients who had an implantable venous access device inserted between 1998 and 2001 at McMaster Children's Hospital. Group 1 (immediate access group) had 23 patients and group 2 (delayed access) had 74 patients. RESULTS: The incidence of infection was 22% in group 1 and 14% in group 2. The difference between these infection rates was not statistically significant. All infections occurred in patients with a diagnosis of acute lymphoblastic leukemia. Of the patients in this study with acute lymphoblastic leukemia, 33% in group 1 and 36% in group 2 developed infections. CONCLUSIONS: These results suggest that implantable venous access devices can be accessed at the time of device insertion to decrease painful needle punctures in children with cancer and to provide secure immediate central venous access.