Cellular and humoral response after MRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients.

According to preliminary data, seroconversion after mRNA SARS-CoV-2 vaccination might be unsatisfactory in Kidney Transplant Recipients (KTRs). However, it is unknown if seronegative patients develop at least a cellular response that could offer a certain grade of protection against SARS-CoV-2. To answer this question, we prospectively studied 148 recipients of either kidney (133) or kidney-pancreas (15) grafts with assessment of IgM/IgG spike (S) antibodies and ELISpot against the nucleocapside (N) and the S protein at baseline and 2 weeks after receiving the second dose of the mRNA-1273 (Moderna) vaccine. At baseline, 31 patients (20.9%) had either IgM/IgG or ELISpot positivity and were considered to be SARS-CoV-2-pre-immunized, while 117 (79.1%) patients had no signs of either cellular or humoral response and were considered SARS-CoV-2-naïve. After vaccination, naïve patients who developed either humoral or cellular response were finally 65.0%, of which 29.9% developed either IgG or IgM and 35.0% S-ELISpot positivity. Factors associated with vaccine unresponsiveness were diabetes and treatment with antithymocytes globulins during the last year. Side effects were consistent with that of the pivotal trial and no DSAs developed after vaccination. In conclusion, mRNA-1273 SARS-CoV-2 vaccine elicits either cellular or humoral response in almost two thirds of KTRs.

Integrated Management of Pain in Advanced Dementia.

AIM: Develop and evaluate the implementation of a protocol for comprehensive management of pain in advanced dementia. METHOD: Quasi-experimental study carried out between September 2015 and May 2016 in an acute geriatric unit. Following development of the protocol and nurse training, 22 participants were recruited through consecutive sampling to form the intervention group (IG). Pain assessment was performed using the Pain Assessment in Advanced Dementia Spanish version (PAINAD-Sp) instrument and by nurse report-rating using the Numeric Rating Scale (NRS) and control group, with pain assessment through nurse-report using an NRS. Interventions carried out following perception of pain were done according to the actions algorithm created for this purpose. Follow-up was carried out daily during the hospital stay. RESULTS: Some 98% of the actions were performed correctly following the protocol. All (100%) of patients had a scheduled prescription for analgesics. Significant differences between mean pain scores at admission and discharge were found through PAINAD-Sp using a Wilcoxon sign test of -2.9543 (p = .004). Analysis of pain perception scores revealed a statistically significant positive correlation between the number of nonpharmacological actions performed and the pain score values obtained in the IG (rho Spearman: 0.617, p < .001) and the control group (rho Spearman: 0.922, p < .001). A high correlation was also observed in the IG between assessments conducted using PAINAD-Sp and NRS (intraclass correlation coefficient: 0.921). CONCLUSIONS: The implementation of an agreed-upon, standardized protocol for comprehensive pain management in advanced dementia, including nurse training, leads to systematic application of all the protocol stages, and therefore better pain management.

Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review.

AIM: To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home. BACKGROUND: In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health. DESIGN: A quantitative systematic review. DATA SOURCES: Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018. REVIEW METHODS: The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA. RESULTS: A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions. CONCLUSION: Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy. IMPACT: Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results.

Humoral and Cellular Immune Responses After a 3-dose Course of mRNA-1273 COVID-19 Vaccine in Kidney Transplant Recipients: A Prospective Cohort Study.

In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 µg vaccine. Methods: Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose' and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively. Results: After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio' 3.14; 95% confidence interval' 1.10-8.96; P = 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (P < 0.001). Conclusions: A substantial proportion of kidney transplant recipients developed late seroconversion after 2 doses. Cellular immunity was associated with the development of a stronger humoral response.