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The nano-kirigami metasurfaces have controllable 3D geometric parameters and dynamic transformation functions and therefore provide a strong spectral regulation capability of thermal emission. Here, the authors propose and demonstrate a dynamic and multifunctional thermal emitter based on deformable nano-kirigami structures, which can be actuated by electronic bias or mechanical compression. Selective emittance and the variation of radiation intensity/wavelength are achieved by adjusting the geometric shape and the transformation of the structures. Particularly, a thermal management device based on a composite structure of nano-kirigami and polydimethylsiloxane (PDMS) thin film is developed, which can dynamically switch the state of cooling and heating by simply pressing the device. The proposed thermal emitter designs with strong regulation capability and multiple dynamic adjustment strategies are desirable for energy and sensing applications and inspire further development of infrared emitters.
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Photonic radio frequency (RF) switches are promising to replace conventional electronic RF switches in modern RF communication systems owing to their high switching speed and immunity to electromagnetic interference. However, existing photonic RF switches are generally based on frequency or polarization filtering. Thus, they require more light sources and filters to increase the number of switching channels, consequently limiting scalability. We propose a silicon-integrated photonic RF switch based on optical switching. RF signals are first modulated into the optical domain and switched through phase control of the phase shifters in the optical switch. Switching is not related to the frequency or polarization of the optical carriers, thus reducing the number of light sources required. Experimental results demonstrate 10-GHz switching of two RF signals with frequencies of 20â GHz and 30â GHz. The proposed photonic RF switch can be further expanded to form a large switch matrix, possibly contributing to the development of large-scale RF communication systems.
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Fiber optic oxygen sensors based on fluorescence quenching play an important role in oxygen sensors. They have several advantages over other methods of oxygen sensing-they do not consume oxygen, have a short response time and are of high sensitivity. They are often used in special environments, such as hazardous environments and in vivo. In this paper, a new fiber optic oxygen sensor is introduced, which uses the all-phase fast Fourier transform (apFFT) algorithm, instead of the previous lock-in amplifier, for the phase detection of excitation light and fluorescence. The excitation and fluorescence frequency was 4 KHz, which was conducted between the oxygen-sensitive membrane and the photoelectric conversion module by the optical fiber and specially-designed optical path. The phase difference of the corresponding oxygen concentration was obtained by processing the corresponding electric signals of the excitation light and the fluorescence. At 0%, 5%, 15%, 21% and 50% oxygen concentrations, the experimental results showed that the apFFT had good linearity, precision and resolution-0.999°, 0.05° and 0.0001°, respectively-and the fiber optic oxygen sensor with apFFT had high stability. When the oxygen concentrations were 0%, 5%, 15%, 21% and 50%, the detection errors of the fiber optic oxygen sensor were 0.0447%, 0.1271%, 0.3801%, 1.3426% and 12.6316%, respectively. Therefore, the sensor that we designed has greater accuracy when measuring low oxygen concentrations, compared with high oxygen concentrations.
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Tecnología de Fibra Óptica , Fibras Ópticas , Análisis de Fourier , Oxígeno , Espectrometría de FluorescenciaRESUMEN
OBJECTIVE: Coronavirus disease 2019 (COVID-19) can infect patients in any age group including those with no comorbid conditions. Understanding the demographic, clinical, and laboratory characteristics of these patients is important toward developing successful treatment strategies. Approach and Results: In a retrospective study design, consecutive patients without baseline comorbidities hospitalized with confirmed COVID-19 were included. Patients were subdivided into ≤55 and >55 years of age. Predictors of in-hospital mortality or mechanical ventilation were analyzed in this patient population, as well as subgroups. Stable parameters in overall and subgroup models were used to construct a cluster model for phenotyping of patients. Of 1207 COVID-19-positive patients, 157 met the study criteria (80≤55 and 77>55 years of age). Most reliable predictors of outcomes overall and in subgroups were age, initial and follow-up d-dimer, and LDH (lactate dehydrogenase) levels. Their predictive cutoff values were used to construct a cluster model that produced 3 main clusters. Cluster 1 was a low-risk cluster and was characterized by younger patients who had low thrombotic and inflammatory features. Cluster 2 was intermediate risk that also consisted of younger population that had moderate level of thrombosis, higher inflammatory cells, and inflammatory markers. Cluster 3 was a high-risk cluster that had the most aggressive thrombotic and inflammatory feature. CONCLUSIONS: In healthy patient population, COVID-19 remains significantly associated with morbidity and mortality. While age remains the most important predictor of in-hospital outcomes, thromboinflammatory interactions are also associated with worse clinical outcomes regardless of age in healthy patients.
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Betacoronavirus/patogenicidad , Reglas de Decisión Clínica , Infecciones por Coronavirus/virología , Admisión del Paciente , Neumonía Viral/virología , Tromboembolia/virología , Adulto , Factores de Edad , Anciano , Biomarcadores/sangre , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Estado de Salud , Mortalidad Hospitalaria , Interacciones Huésped-Patógeno , Humanos , Mediadores de Inflamación/sangre , L-Lactato Deshidrogenasa/sangre , Masculino , Persona de Mediana Edad , Pandemias , Fenotipo , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Valor Predictivo de las Pruebas , Pronóstico , Respiración Artificial , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , SARS-CoV-2 , Tromboembolia/diagnóstico , Tromboembolia/mortalidad , Tromboembolia/terapiaRESUMEN
BACKGROUND The use of monoclonal antibodies therapy (MAT) in early mild to moderate Coronavirus disease 2019 (COVID-19) has gained importance in recent times. However, there is limited information on the safety and efficacy of MAT in treating COVID-19 in patients with underlying rheumatologic diseases. Patients with rheumatologic diseases are usually on long-term corticosteroids and immunosuppressive therapy, which increases their risk for progressing to more severe forms of COVID-19. We report a case series of 4 patients with rheumatologic diseases who were treated with MAT for COVID-19. MATERIAL AND METHODS A retrospective observational study was conducted in our institution on patients with underlying rheumatological disorders who received MAT as per the EUA protocol of the FDA. RESULTS Two of the 4 patients were on immunosuppresive therapy at the time of receiving MAT. They recovered from COVID-19 without any adverse outcomes. No flare of underlying rheumatologic disease was noted. CONCLUSIONS MAT was observed to be a safe and effective therapy in 4 patients with rheumatological illnesses and COVID-19 treated at our hospital.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Artritis Reumatoide/epidemiología , Tratamiento Farmacológico de COVID-19 , COVID-19 , Inmunoterapia/métodos , SARS-CoV-2/inmunología , Anciano , COVID-19/epidemiología , Comorbilidad , Femenino , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
WHAT IS KNOWN AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) associated cytokine activation can lead to a rapid progression into respiratory failure, shock and multiorgan failure. Interleukin-6 (IL-6) is a pro-inflammatory cytokine that likely contributes to the pathogenesis of cytokine release syndrome. It is hypothesized that modulating IL-6 levels or its effects with tocilizumab, a recombinant humanized anti-IL-6 receptor monoclonal antibody, may alter the course of disease. METHODS: We examined the association between tocilizumab use and intubation or death at a community hospital in New York City. Data were obtained regarding consecutive patients hospitalized with COVID-19. The primary end point was a composite of intubation or death in a time-to-event analysis. We compared outcomes in patients who received tocilizumab with those in patients who did not, using a multivariable Cox model with inverse probability weighting according to the propensity score. RESULTS AND DISCUSSION: In this single-centre retrospective cohort study involving 1225 hospitalized patients with SARS-CoV-2 infection, the probability to respiratory failure, which was measured as intubation or death, was less frequent in patients who received tocilizumab. WHAT IS NEW AND CONCLUSION: Tocilizumab and other IL-6 receptor monoclonal antibodies may evolve as a viable option in treating patients with moderate and severe COVID-19.
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Anticuerpos Monoclonales Humanizados , Tratamiento Farmacológico de COVID-19 , COVID-19 , Síndrome de Liberación de Citoquinas , Interleucina-6 , Respiración Artificial , SARS-CoV-2 , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , COVID-19/diagnóstico , COVID-19/inmunología , COVID-19/mortalidad , Correlación de Datos , Síndrome de Liberación de Citoquinas/sangre , Síndrome de Liberación de Citoquinas/etiología , Femenino , Mortalidad Hospitalaria , Humanos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Interleucina-6/antagonistas & inhibidores , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/prevención & control , Ciudad de Nueva York/epidemiología , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , SARS-CoV-2/aislamiento & purificación , Resultado del TratamientoRESUMEN
Deformable liquid crystal polymers (LCPs) driven by more than one external stimulus have received extensive attention in fields ranging from multifunctional soft robots to bionic actuators. Combining responsive liquid crystal with nonmesogenic responsive groups within polymer offers a versatile way to obtain multiresponsive LCPs. However, the incorporation of nonmesogenic responsive groups causes interruption in the assembly of mesogens and brings a challenge to the alignment of LCPs. Herein, a new method is put forward to facilitate uniform mesogen alignment by exerting water vapor in the film preparation process. Using this method, vapor-assisted alignment, the homeotropic alignment of azobenzene mesogens is achieved in a copolymer containing nonmesogenic poly(ethylene glycol) (PEG). The obtained copolymer films present photodeformation brought by azobenzene isomerization and humidity-responsive deformation resulting from the asymmetric swelling of film surfaces. The dual-responsive smart "blinds" and bionic flower actuators are fabricated to demonstrate the integration of the two different stimuli. This work is anticipated to provide a feasible alignment method for multiresponsive LCPs, showing the potential applications in soft robots, sensors, and biomimetic devices.
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With the rapid development of micro/nanofabrication technologies, the concept of transformable kirigami has been applied for device fabrication in the microscopic world. However, most nano-kirigami structures and devices were typically fabricated or transformed at fixed positions and restricted to limited mechanical motion along a single axis due to their small sizes, which significantly limits their functionalities and applications. Here, we demonstrate the precise shaping and position control of nano-kirigami microrotors. Metallic microrotors with size of ~10 micrometers were deliberately released from the substrates and readily manipulated through the multimode actuation with controllable speed and direction using an advanced optoelectronic tweezers technique. The underlying mechanisms of versatile interactions between the microrotors and electric field are uncovered by theoretical modeling and systematic analysis. This work reports a novel methodology to fabricate and manipulate micro/nanorotors with well-designed and sophisticated kirigami morphologies, providing new solutions for future advanced optoelectronic micro/nanomachinery.
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BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective in diabetes and obesity, reducing hyperglycemia by increasing insulin release and delaying gastric emptying. However, they can cause gastroparesis, raising concerns about aspiration during procedures. Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration. AIM: To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures. METHODS: A retrospective chart review at BronxCare Health System, New York, from January 2019 to October 2023, assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures. Two groups were compared based on dietary status before the procedure. Data included demographics, symptoms of gastroparesis, opiate use, hemoglobin A1c, GLP-1 agonist indication, endoscopic details, and aspiration occurrence. IBM SPSS was used for analysis, calculating means, standard deviations, and applying Pearson's chi-square and t-tests for associations, with P < 0.05 as being significant. RESULTS: During the study, 306 patients were included, with 41.2% on a clear liquid/low residue diet and 58.8% on a regular diet before endoscopy. Most patients (63.1%) were male, with a mean age of 60 ± 12 years. The majority (85.6%) were on GLP-1 RAs for diabetes, and 10.1% reported digestive symptoms before endoscopy. Among those on a clear liquid diet, 1.5% had residual food at endoscopy compared to 10% on a regular diet, which was statistically significant (P = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications were reported during or after the procedures. CONCLUSION: The study reflects a significant rise in GLP-1 RA use for diabetes and obesity. A 24-hour liquid diet seems safe for endoscopic procedures without aspiration. Patients with upper gastrointestinal symptoms might have a higher residual food risk, though not statistically significant. Further research is needed to assess risks based on diabetes duration, gastroparesis, and GLP-1 RA dosing, aiming to minimize interruptions in therapy during procedures.
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Gastroparesia , Agonistas Receptor de Péptidos Similares al Glucagón , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Endoscopía Gastrointestinal/efectos adversos , Endoscopía Gastrointestinal/métodos , Vaciamiento Gástrico/efectos de los fármacos , Gastroparesia/epidemiología , Gastroparesia/etiología , Gastroparesia/prevención & control , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Estudios RetrospectivosRESUMEN
Breast cancers metastasize most commonly to the bone, brain, liver, and lungs, but rarely to the gastrointestinal tract. Although metastatic breast carcinomas in the stomach can be confused with primary gastric cancers due to their nonspecific presentation and rare incidence, it is important to differentiate the two since the treatment is different. Clinical suspicion is imperative for a prompt endoscopic evaluation and a definitive diagnosis that will lead to appropriate treatment. Therefore, it is important for clinicians to be aware of the possibility of gastric metastasis of breast cancers, especially in those with a history of invasive lobular breast carcinoma and a new onset of gastrointestinal symptoms.
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The presence of foreign objects in the digestive system can lead to various complications within the gastrointestinal (GI) tract. In certain cases, ingesting foreign objects can pose a significant dilemma for surgical teams, primarily because they can lead to blockages or punctures in the upper or lower sections of the GI tract. On occasion, foreign objects located in the lower regions of the digestive tract, such as the colon and rectum, might have entered via the anal pathway, thereby carrying the potential risk of causing perforations in the rectum or sigmoid colon. The other complications encompass the creation of abscesses, blockages in the bowel, fistula, and bleeding. Although these issues associated with foreign objects can arise in a healthy bowel, they can pose challenges in diagnosis when occurring in a bowel that is already affected by inflammation, constrictions, or malignancy. We present a unique case report of a 72-year-old female who presented to the emergency department with left lower quadrant pain associated with nausea and vomiting. Following a detailed clinical evaluation and radiographic imaging, a chicken bone was identified as the culprit, causing an unusual impaction in the sigmoid colon. The patient's medical history revealed no prior GI complications, making this case particularly noteworthy. Timely identification and precise diagnosis of complications arising from foreign bodies are essential to efficiently handle and prevent unfavorable consequences.
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Aggregation-induced emission (AIE) and antenna effect (AE) are two significant behaviors that have attracted increasing attention. However, it is challenging to achieve the synergistic effect of AIE and AE in luminescent materials for more extensive applications. Here, four gelatinous Ln3+ coordination polymers (Ln-CPs) are synthesized by self-assembly of ciprofloxacin (CIP), adenosine monophosphate (AMP), and Ln3+ ions in aqueous medium. Encouragingly, a remarkable increase in the characteristic fluorescence of Ln3+ and a significant decrease in CIP are observed along with increasing concentration of Ln-CPs, which is attributed to the large aggregates formed by self-assembly that strictly constrain the intramolecular motions of antenna ligands, thereby achieving the aggregation-enhanced AE. More meaningfully, Eu-CP not only shows a rice-like morphology at high aggregation state, but also provides an opportunity for the selective detection of alkaline phosphatase (ALP). A new flower-like polymer is formed upon incubating Eu-CP with ALP, accompanied by the fluorescence quenching of Eu3+ and recovery of CIP, a ratiometric determination of ALP in the range of 0.1-6.0 U·L-1 is thus achieved. Additionally, ALP assay in human serum and bioimaging in living cells have been successfully performed. This research opens a new horizon for the fabrication of Ln3+-based luminescent materials with promising applications.
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Fosfatasa Alcalina , Elementos de la Serie de los Lantanoides , Humanos , Polímeros , Colorantes Fluorescentes , IonesRESUMEN
Background Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) share common modes of transmission; hence HBV and HCV infection are more prevalent among HIV patients. The co-infection with HIV/HBV, HIV/HCV, or HIV/HBV/HCV carries significant morbidity, with higher progression rates to end-stage liver disease or hepatocellular carcinoma (HCC). Methods We conducted a retrospective study among HIV adult patients co-infected with HBV or HCV and those with HCV, HIV, and HBV triple infection enrolled in the outpatient clinic of BronxCare Hospital between the years 2010 and 2021. Records were reviewed to obtain demographic data, including age and sex, hepatitis B surface antigen (HBsAg), anti-HCV antibodies, and CD4 T-lymphocyte count test results. Male and female patients ≥18 years with confirmed HIV by double enzyme-linked immunoassay (ELISA) and western blot, who underwent serology testing for both HBsAg and anti-HCV, were included in the study. Results In this study, 11355 HIV patients were included, comprising 7020 (61.8%) males and 4335 (38.2%) females. A total of 410 (3.6%) were hepatitis B positive, 1432 (12.6%) were hepatitis C positive, and 127 (1.1%) were both hepatitis B and C positive. Fifty-two (0.5%) patients were diagnosed with HCC. The majority of the patient with HCC (50%, n =26) were hepatitis C serology positive (p<0.001) while 9.6% (n=5) were positive for both hepatitis C and hepatitis B (p<0.001). Conclusion HIV/HBV/HCV triple-infected patients had a lower rate of HCC compared to HIV/HCV co-infected patients. HIV without hepatitis C or hepatitis B is an independent risk factor for HCC.
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Colorectal lymphomas are very rare and are usually found in male patients between the fifth and seventh decade of life. Our patient was a 30-year-old male who presented with the complaint of epigastric pain and abdominal mass for the past three months. Physical examination was remarkable for soft solid abdominal mass extending from the right side of the abdomen toward the left side. Computed tomography showed a large lobulated mass in the right lower quadrant involving multiple loops of bowel. The mass measured 15.1 x 12.5 cm in transverse dimension and 16.2 cm in craniocaudal dimension. Colonoscopy showed a villous and fungating mass occupying the whole cecum and extending into the ascending colon. Pathology from the colonoscopy mass revealed diffuse large B-cell lymphoma, which was CD20 (cluster of differentiation 20) positive. He was started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy regimen and is following at the oncology outpatient department. A combination of surgical resection and chemotherapy is used in treating patients with colorectal lymphoma.
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Object: Major depressive disorder (MDD) has been demonstrated to be associated with abnormalities in neural networks. However, few studies examined information flow in the salience network (SN). This study examined abnormalities in the causal connectivity between the SN and whole brain in drug-naive first-episode patients with MDD in the resting state. Methods: Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria, 23 drug-naive first-episode MDD patients and 20 matched healthy individuals were recruited and underwent a resting-state magnetic resonance scan. The acquired functional image data were preprocessed using resting-state functional magnetic resonance imaging (rs-fMRI) data analysis toolkit plus (RESTplus). Then, using the data processing & analysis for brain imaging (DPABI) software and a coefficient-based general component analysis method with the right anterior insula (rAI) as the region of interest (ROI), the causal connectivity of the SN with the whole brain and its correlation with cognitive and mental performance were examined in the resting state. Results: (1) The MDD group showed a significantly higher Hamilton Depression Rating Scale total score and significantly higher scores for anxiety, cognitive disturbance, and block factors compared with normal controls. (2) Compared with control: from whole brain to the rAI, the MDD group showed a lower causal connectivity in the left inferior frontal gyrus; from the rAI to the whole brain, the MDD group showed a lower causal connectivity in the right cingulate gyrus, the right precuneus, and extending to paracentral lobule but higher causal connectivity in the left inferior and middle frontal gyrus. (3) In the MDD group, from rAI to the whole brain, the causal connectivity values for the right cingulate gyrus/precuneus were negatively correlated with the score of Stroop Color-Word Test A, B, and C as well as interference times. Conclusion: Our results indicated disrupted causal connectivity among the default mode network (DMN), the central executive network (CEN), and SN in drug-naive first-episode MDD patients. Especially, our results suggest a unique role for rAI in the ordered or hierarchical information processing, presumed to include bottom-up and top-down reciprocal influences among the three networks in MDD.
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Background: Since the start of coronavirus disease 2019 (COVID-19) pandemic, several studies have linked obesity with severity of illness as well as mortality in patients with COVID-19. Outcomes of patients with overweight or obesity, who develop critical illness, have been studied extensively over the past decade where the studies have shown conflicting results. In this study, we aimed to assess the association between the body mass index (BMI) classes and outcomes among hospitalized patients with COVID-19. Methods: This was a retrospective chart review of all adults admitted to our hospital with COVID-19 illness between 1 March 2020 and 30 June 2020. Patients were divided into four groups based on their BMI range as follows: patients with underweight (BMI < 18.5 kg/m2), patients with normal weight (BMI 18.5-24.9 kg/m2), patients with overweight (BMI 25-29.9 kg/m2), and patients with obesity (BMI ≥ 30 kg/m2). Results: 1274 patients were admitted during the study period. There were 24 (1.9%) patients with underweight, 268 (21%) patients with normal weight, 445 (34.9%) patients with overweight, and 537 (42.2%) patients with obesity. Patients with obesity were younger (p < 0.001) and there were more females among patients with underweight and patients with obesity (54% and 48% respectively, p < 0.001). There were no differences in subgroup with regards to presence of hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, and dyslipidemia. In a multivariate logistic regression model, patients with overweight and patients with obesity had higher odds of requiring mechanical ventilation. BMI class was not associated with difference in survival time in a multivariate analysis. Conclusions: In our large single-center study of hospitalized patients with COVID-19, patients with overweight and obesity had higher need for mechanical ventilation but had similar mortality when compared to patients with normal weight and underweight.
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BACKGROUND: Monoclonal antibody therapy (MAT) is recommended in mild to moderate Coronavirus disease 2019 (COVID-19) patients who are at risk of progressing to severe disease. Due to limited data on its outcomes and the logistic challenges in administering the drug, MAT has not been widely used in the United States (US) despite of emergency use authorization (EUA) approval by the Food and Drug Administration (FDA). AIM: We aim to study the outcomes of MAT in patients predominantly from ethnic minority groups and the challenges we experienced in implementing the infusion therapy protocol in an inner-city safety-net-hospital in the South Bronx. METHODS AND RESULTS: We conducted a retrospective observational study of 49 patients who were offered MAT as per EUA protocol of FDA. Patient who met the criteria for MAT and received therapy were included in treatment group (nâ¯=â¯38) and the remaining (nâ¯=â¯11) who declined treatment were included in the control group. A majority of patients (76%) in the study group reported symptomatic improvement, the day after infusion. There was statistically significant reduction in COVID-19 related hospitalizations (7.8 vs 54.5%, Pâ¯=â¯< 0.001) mortality (0 vs 18.1%, P valueâ¯=â¯0.008) in the treatment group. CONCLUSION: MAT reduced both hospitalization and mortality in this predominantly Hispanic patient population with mild to moderate COVID-19 with high risk factors for disease progression.
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Anticuerpos Monoclonales/uso terapéutico , COVID-19 , COVID-19/terapia , Hispánicos o Latinos , Mortalidad Hospitalaria , Hospitalización , Humanos , Grupos Minoritarios , Ciudad de Nueva York , Estudios Retrospectivos , Proveedores de Redes de SeguridadRESUMEN
Vaccines will play a key role in ending the COVID-19 pandemic. Vaccination against infections remains an important part of the management of patients with multiple sclerosis. However, there are limited data about the safety and efficacy of the currently available COVID-19 mRNA vaccines in patients with multiple sclerosis receiving concurrent immunosuppressive therapies. Patients on B cell depleting therapy such as ocrelizumab have an attenuated vaccine response. We report the first case of COVID-19 vaccine failure in a patient with relapsing-remitting multiple sclerosis on B cell depleting therapy, ocrelizumab. We offer suggestions to improve vaccine efficacy in these patients.
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BACKGROUND It is unknown if the efficacy of the coronavirus disease-19 (COVID-19) vaccine is affected by the co-administration of other vaccines. The Centers for Disease Control and Prevention (CDC) has shifted their recommendations recently, allowing for the co-administration of the currently available COVID-19 vaccines with other vaccines. This is based on the experience with non-COVID-19 vaccines, where the immunogenicity and adverse event profiles were generally similar when vaccines are administered simultaneously or alone. CASE REPORT We present a case of a 29-year-old Asian woman who received the first dose of BNT162b2 mRNA vaccine and the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine at around the same time. BNT162b2 mRNA vaccine and Tdap vaccine were administered into the deltoid region of the left arm and right arm, respectively. We then monitored for immunogenicity. We observed a delay in the development of SARS-CoV-2 Spike (S1) protein antibodies at around 8 weeks after the second dose. CONCLUSIONS Unless warranted, it is important to adhere to current CDC recommendations with regards to the co-administration of vaccines. Although the administration of Tdap with COVID-19 vaccine in our case caused delay in immunogenicity, it did not negate the ability of the BNT162B2 mRNA vaccine to elicit an adequate immune response. The reason for delay in immune response with co-administration of COVID-19 vaccines with other vaccines is unknown and further studies are needed.
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COVID-19 , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Adulto , Anticuerpos Antibacterianos , Vacuna BNT162 , Vacunas contra la COVID-19 , Femenino , Humanos , ARN Mensajero , SARS-CoV-2 , ToxoidesRESUMEN
INTRODUCTION: The true impact of prediabetes and type-2 diabetes in patients with COVID-19 remains unknown, with studies thus far providing conflicting evidence. METHODS: This is a single-center retrospective observational study involving 843 hospitalized patients with SARS-CoV-2 infection. Primary outcomes, mortality, and mechanical ventilation use were compared among the three groups: control, prediabetes, and type-2 diabetes. Binomial regression analysis was used to determine predictors of mortality and mechanical ventilation requirement. RESULTS: Age was a significant predictor of mortality. On stratifying our patients based on their age, older patients aged 55 years and above had no difference in mortality or mechanical ventilation requirement among the three groups of control, prediabetes, and type-2 diabetes. However, among the younger population aged less than 55 years, patients with type-2 diabetes had significantly higher mortality as compared with patients in control and prediabetes groups (27% vs 12.5% vs 9%, p 0.025). Additionally, newly diagnosed type-2 diabetes patients demonstrated lower mortality rate in comparison to previously known type-2 diabetes patients (18% vs 40%, p 0.005). Outcomes in the prediabetes group were similar to that in the control group. Admission hyperglycemia was associated with higher mortality regardless of diabetes status. CONCLUSION: In older patients aged 55 years and above, status of type-2 diabetes does not influence their mortality. However, in younger patients aged less than 55 years, the presence of type-2 diabetes is an important driver of mortality. Newly diagnosed type-2 diabetes, in comparison with previously diagnosed type-2 diabetes, may have better survival. Presence of prediabetes did not affect outcomes in patients with COVID-19 infection.