Transfusion reactions associated with COVID-19 convalescent plasma therapy for SARS-CoV-2.

BACKGROUND: Convalescent plasma (CP) for treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown preliminary signs of effectiveness in moderate to severely ill patients in reducing mortality. While studies have demonstrated a low risk of serious adverse events, the comprehensive incidence and nature of the spectrum of transfusion reactions to CP is unknown. We retrospectively examined 427 adult inpatient CP transfusions to determine incidence and types of reactions, as well as clinical parameters and risk factors associated with transfusion reactions. STUDY DESIGN AND METHODS: Retrospective analysis was performed for 427 transfusions to 215 adult patients with coronavirus 2019 (COVID-19) within the Mount Sinai Health System, through the US Food and Drug Administration emergency investigational new drug and the Mayo Clinic Expanded Access Protocol to Convalescent Plasma approval pathways. Transfusions were blindly evaluated by two reviewers and adjudicated by a third reviewer in discordant cases. Patient demographics and clinical and laboratory parameters were compared and analyzed. RESULTS: Fifty-five reactions from 427 transfusions were identified (12.9% incidence), and 13 were attributed to transfusion (3.1% incidence). Reactions were classified as underlying COVID-19 (76%), febrile nonhemolytic (10.9%), transfusion-associated circulatory overload (9.1%), and allergic (1.8%) and hypotensive (1.8%) reactions. Statistical analysis identified increased transfusion reaction risk for ABO blood group B or Sequential Organ Failure Assessment scores of 12 to 13, and decreased risk within the age group of 80 to 89 years. CONCLUSION: Our findings support the use of CP as a safe, therapeutic option from a transfusion reaction perspective, in the setting of COVID-19. Further studies are needed to confirm the clinical significance of ABO group B, age, and predisposing disease severity in the incidence of transfusion reaction events.

Osteocyte-derived insulin-like growth factor I is essential for determining bone mechanosensitivity.

This study sought to determine whether deficient Igf1 expression in osteocytes would affect loading-induced osteogenic response. Tibias of osteocyte Igf1 conditional knockout (KO) mice (generated by cross-breeding Igf1 floxed mice with Dmp1-Cre transgenic mice) and wild-type (WT) littermates were subjected to four-point bending for 2 wk. Microcomputed tomography confirmed that the size of tibias of conditional mutants was smaller. Loading with an equivalent loading strain increased periosteal woven bone and endosteal lamellar bone formation in WT mice but not in conditional KO mice. Consistent with the lack of an osteogenic response, the loading failed to upregulate expression of early mechanoresponsive genes (Igf1, Cox-2, c-fos) or osteogenic genes (Cbfa-1, and osteocalcin) in conditional KO bones. The lack of osteogenic response was not due to reduced osteocyte density or insufficient loading strain. Deficient osteocyte Igf1 expression reduced the loading-induced upregulation of expression of canonical Wnt signaling genes (Wnt10b, Lrp5, Dkk1, sFrp2). The loading also reduced (by 40%) Sost expression in WT mice, but the loading not only did not reduce but upregulated (~1.5-fold) Sost expression in conditional KO mice. Conditional disruption of Igf1 in osteocytes also abolished the loading-induced increase in the bone ß-catenin protein level. These findings suggest an impaired response in the loading-induced upregulation of the Wnt signaling in conditional KO mice. In summary, conditional disruption of Igf1 in osteocytes abolished the loading-induced activation of the Wnt signaling and the corresponding osteogenic response. In conclusion, osteocyte-derived IGF-I plays a key determining role in bone mechanosensitivity.

High Blood Pressure Medication Adherence Among Urban, African Americans in the Midwest United States.

Hypertension is a chronic condition that disproportionately affects African Americans. Managing high blood pressure (HBP) requires adherence to daily medication. However, many patients with hypertension take their HBP medication inconsistently, putting them at heightened risk of heart disease. Researchers have shown that these health risks are greater for African Americans than for Caucasians. In this article, we examine barriers and facilitators of medication adherence among urban African Americans with hypertension. We interviewed 24 African Americans with hypertension (58.5% women, average age 59.5 years) and conducted a comprehensive thematic analysis. Twenty-two barriers and 32 facilitators to medication adherence emerged. Barriers included side effects and forgetting while facilitators included reminders, routines, and social support. Using this data, we developed a diagram of theme connectedness of factors that affect medication adherence. This diagram can guide multi-level HBP intervention research that targets African Americans to promote medication adherence, prevent heart disease, and reduce ethnic and racial health disparities.

Convalescent plasma treatment of severe COVID-19: a propensity score-matched control study.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments1. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. These antibodies, when transfused into patients infected with SARS-CoV-2, are thought to exert an antiviral effect, suppressing virus replication before patients have mounted their own humoral immune responses2,3. Virus-specific antibodies from recovered persons are often the first available therapy for an emerging infectious disease, a stopgap treatment while new antivirals and vaccines are being developed1,2. This retrospective, propensity score-matched case-control study assessed the effectiveness of convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 at The Mount Sinai Hospital in New York City. Oxygen requirements on day 14 after transfusion worsened in 17.9% of plasma recipients versus 28.2% of propensity score-matched controls who were hospitalized with COVID-19 (adjusted odds ratio (OR), 0.86; 95% confidence interval (CI), 0.75-0.98; chi-square test P value = 0.025). Survival also improved in plasma recipients (adjusted hazard ratio (HR), 0.34; 95% CI, 0.13-0.89; chi-square test P = 0.027). Convalescent plasma is potentially effective against COVID-19, but adequately powered, randomized controlled trials are needed.

Effect of Saline Water Irrigation on Growth and Physiological Responses of Three Rose Rootstocks.

Salt-tolerant landscape plants are needed for arid and semiarid regions where the supply of quality water is limited and soil salinization often occurs. This study evaluated growth, chloride (Cl) and sodium (Na) uptake, relative chlorophyll content, and chlorophyll fluorescence of three rose rootstocks [Rosa ×fortuniana Lindl., R. multiflora Thunb., and R. odorata (Andr.) Sweet] irrigated with saline solutions at 1.6 (control), 3.0, 6.0, or 9.0 dS·m (-1) electrical conductivity in a greenhouse. After 15 weeks, most plants in 9.0 dS·m (-1) treatment died regardless of rootstock. Significant growth reduction was observed in all rootstocks at 6.0 dS·m (-1) compared with the control and 3.0 dS·m (-1), but the reduction in R. ×fortuniana was smaller than in the other two rootstocks. The visual scores of R. multiflora at 3.0 and 6.0 dS·m(-1) were slightly lower than those of the other rootstocks. Rosa odorata had the highest shoot Na concentration followed by R. multiflora; however, R. multiflora had the highest root Na concentration followed by R. odorata. All rootstocks had higher Cl accumulation in all plant parts at elevated salinities, and no substantial differences in Cl concentrations in all plant parts existed among the rootstocks, except for leaf Cl concentration in R. multiflora, which was higher than those in the other two rootstocks. The elevated salinities of irrigation water reduced the relative chlorophyll concentration, measured as leaf SPAD readings, and maximal photochemical efficiency of photosystem II (PSII) and minimal fluorescence (F(0))/maximum fluorescence (F(v)/F(m)), but the largest reduction in F(v)/F(m) was only 2.4%. Based on growth and visual quality, R. ×fortuniana was relatively more salt-tolerant than the other two rootstocks and R. odorata was slightly more salt-tolerant than R. multiflora.

Defectos bucodentales en personas con síndrome de Down: una prioridad en salud bucal / Oral-dental defects in people with Down's syndrome: a priority in oral health

RESUMEN El síndrome de Down con frecuencia se acompaña de defectos bucodentales que comprometen la función masticatoria y fonatoria del paciente. Las acciones de prevención y promoción de salud bucal, el diagnóstico precoz y seguimiento de estas enfermedades, contribuyen al logro del verdadero enfoque interdisciplinario que demandan estos pacientes, para lograr una plena inclusión social. Se realizó una búsqueda bibliográfica sobre el tema, con el objetivo de estructurar los referentes teóricos relacionados con los principales defectos bucodentales -congénitos y adquiridos- que afectan a la población con síndrome de Down, para lograr la prevención de estos defectos y el incremento de la calidad de vida de los pacientes. Los defectos bucodentales congénitos más frecuentes encontrados en la trisomía 21, fueron la microdoncia, la macroglosia y la erupción dental tardía. La enfermedad periodontal fue el defecto adquirido de mayor presentación, al que se asocian diversos factores de riesgo, muchos modificables. Las intervenciones tempranas en salud bucal pueden incrementar la calidad de vida de los niños y adultos que padecen este trastorno, ayudándolos a lograr un pleno desarrollo como seres humanos (AU).

ABSTRACT Down's syndrome is frequently accompanied by oral-dental defects compromising the masticatory and phonatory function of the patients. Oral health promotion and prevention actions, precocious diagnosis and follow-up of these diseases contribute to achieving the true interdisciplinary approach these patients demand to reach their full social inclusion. A bibliographic search on the theme was carried out, with the objective of structuring the theoretical referents related to the main oral-dental defects -congenital and acquired-, affecting the population with Down's syndrome to reach these defects prevention and increasing these patients' life quality. The congenital oral-dental defects more commonly found in trisomy 21 were microdontia, macroglossia, and delayed tooth eruption. Periodontal disease was more frequently found acquired defect, to which several risk factors are associated, many of them modifiable. Early interventions in oral health may improve the life quality of these children and adults, helping them to achieve a full development as human beings (AU).

Growth and Landscape Performance of Ten Herbaceous Species in Response to Saline Water Irrigation.

Ten herbaceous perennials and groundcovers were grown in raised beds from June to September in a dry, hot desert environment and micro-spray drip irrigated with synthesized saline solutions at electrical conductivity of 0.8 (tap water), 3.2, or 5.4 dS/m. Plant height and two perpendicular widths were recorded monthly to calculate the growth index. Landscape performance was assessed monthly by visual scores. Salinity did not affect the visual scores in Achillea millefolium L., Gaillardia aristata Pursh, Lantana x hybrida 'New Gold', Lonicera japonica Thunb. 'Halliana', and Rosmarinus officinalis L. 'Huntington Carpet' throughout the experiment. Glandularia canadensis (L.) Nutt. 'Homestead Purple' performed better than Glandularia x hybrida (Grönland & Rümpler) G. L. Nesom & Pruski. Lantana montevidensis (Spreng.) Brig. had lower visual scores at 5.4 dS/m compared to the control and 3.2 dS/m. Most plants of Rudbeckia hirta L. did not survive when irrigated at 3.2 dS/m or 5.4 dS/m. Shoot biomass of A. millefolium, G. aristata, L. x hybrida, L. japonica, R. officinalis, and V. macdougalii was not influenced by the salinity of irrigation water. Therefore, A. millefolium, G. aristata, L. x hybrida, L. japonica, and R. officinalis can be irrigated with non-potable water at salinity up to 5.4 dS/m with little reduction in growth and aesthetic appearance.