COVID-19 infection in patients with intestinal failure: UK experience.

BACKGROUND: The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS: We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS: A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION: This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.

Effects of eosinophilic oesophagitis on quality of life in an adult UK population: a case control study.

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated esophageal disease, characterized by symptoms related to esophageal dysfunction and histologically by eosinophil predominant inflammation. Current evidence for an adverse impact on quality of life (QoL) is conflicting and there are no data from a UK population regarding QoL. We conducted a prospective cross-sectional observational study using the Short Form-36 Health Survey, Hospital Dysphagia/Odynophagia Questionnaire, and the EoE Adult Quality of Life Questionnaire to assess QoL and severity of dysphagia in EoE patients, compared to age and gender matched healthy control subjects. Data were also collected on comorbidity and medication use. Eighty-eight subjects were recruited (44 patients). Patients had higher rates of antihistamine and topical (swallowed) corticosteroid use. Physical QoL did not differ between patients and controls, although patients did report a statistically significant lower mental QoL, with small absolute magnitude of difference. Patients reported higher dysphagia scores and these were negatively correlated with both physical and mental QoL. Higher rates of dysphagia and medication use in patients may among other things account for lower mental QoL. However, a higher rate of dysphagia in patients is not associated with a reduced physical QoL. Our findings are of clinical value, particularly when a new diagnosis of EoE is made, as clinicians can reassure patients that their general physical health should not be greatly affected by the diagnosis. Moreover, it may also be useful for patients to be aware that EoE may have an impact on their mental health, but this effect is likely to be small. We therefore advocate education and reassurance in this respect for all patients at diagnosis.

Documentation of cerebrospinal fluid opening pressure and other important aspects of lumbar puncture in acute headache.

BACKGROUND: Measuring cerebrospinal fluid (CSF) opening pressure by lumbar puncture (LP) is an essential tool in the investigation of patients with acute headache. AIM: To assess documentation of opening CSF pressure in those with acute headache undergoing LP. General documentation of the procedure and CSF investigations was also assessed. METHODS: Retrospective review of medical records of patients admitted to a teaching hospital Acute Medical Admissions Unit over a three-month period with a presenting complaint of headache. RESULTS: A total of 106 patients presented with headache of whom 48 patients had at least one LP attempted. Only 41 patients (85%, 95% CI 72-94) had their LP documented. Of 47 patients that had a successful LP, 22 (47%) had a recorded opening pressure. Eighteen (32%) of all patients had their position recorded, with seven (15%) patients having had position and opening pressure documented. Twenty patients (43%) had the appropriate results documented. Twelve patients (31%) had paired serum glucose measured. CONCLUSIONS: Documentation of a LP for headache in the acute setting was generally poor. CSF opening pressure measurement was frequently omitted and no appropriate action taken if high. Paired serum glucose was rarely measured. Acute physicians may benefit from a proposed protocol and documentation sticker.

Trypanosoma brucei variable surface antigen is released by degenerating parasites but not by actively dividing parasites.

Surface antigen biosynthesis and fate in monomorphic and pleomorphic Trypanosoma brucei was examined to assess how slender and stumpy form T. brucei parasites present their variant specific glycoprotein (VSG) to the host immune system. Monomorphic and pleomorphic T. brucei did not release recently synthesized VSG in vitro. Slender form T. brucei, either from monomorphic or pleomorphic populations, did not release VSG in vivo. Detection of free VSG in plasma from irradiated mice infected with pleomorphic parasites correlated with the appearance of stumpy form parasites and possibly arose as a result of degeneration of those parasites. The in vivo released VSG was found to react well with some but not all antibodies directed against VSG determinants. Monoclonal and monospecific antibodies which react with VSG on living trypanosomes did not react with the released VSG whereas VSG-specific monoclonal antibodies which do not react with the surface of living T. brucei did react with the released VSG. It was unclear whether released VSG had lost a conformational determinant expressed on trypanosome-attached VSG or whether antibodies which react strongly with VSG on living trypanosomes are of such low avidity that they fail to bind released VSG. The results suggest that trypanosome-attached VSG is more important for stimulation of protective humoral responses than released VSG. The requirements for stimulation of protective anti-VSG responses are reported elsewhere (Sendashonga & Black 1982).

Induction and persistence of B-cell tolerance to the thymus-dependent component of the alpha(1 leads to 6) glucosyl determinant of dextran. Recovery induced by treatment with dextranase in vivo.

A direct comparison was made between thymus-dependent (TD) and thymus-independent (TI) responses in mice tolerized for (1 leads to 6) glycosyl determinants by the injection of dextran B512. Long-lasting B-cell tolerance by dextran was reversed when mice were treated with dextranase in vivo. Complete or partial reversion of tolerance with the enzyme was invariably obtained for the TI response but the TD component proved to be more resistant and dependent on the immunogen used to test the reversion. The uniformity of the spectrotype in BALB/c mice, even under conditions of partial tolerance, permitted the analysis by isoelectric focussing of serum from tolerant mice treated with dextranase and immunized with TD dextran-ovalbumin. Results showed that, with one single exception, mice thus treated produced spectrotypes no different from the pattern normally found in immune animals. The results presented suggest that at least some alpha(1 leads to 6) specific B cells, both TD and TI, persist in tolerized mice for at least 2 weeks after tolerance induction and they do not support the concept of clonal elimination for either TI or TD responses in adult mice.

Characteristics of the T-dependent alpha(1 leads to 6) glucosyl (dextran) antibody response induced in mice with isomaltohexaose coupled to chicken gamma-globulin.

Isomaltohexaose flavazole coupled to chicken gamma-globulin (IM6-CGG) induced T cell-dependent anti-alpha(1 leads to 6) dextran-specific IgM and IgG responses in CBA, BALB/c and A strain mice. The IgG responses were of restricted heterogeneity as judged by isoelectric focusing, and belonged mostly to the IgG1 subclass with a minor IgG3 component in the case of BALB/c and CBA mice. All four subclasses of IgG were produced in A strain mice. In contrast, native dextran B 512 induces exclusively T cell-independent IgM responses of the same specificity for all 3 strains. All BALB/c mice immunized with different doses of IM6-CGG either in Freund's adjuvant or with Al(OH)3 plus Bordetella pertussis showed the same spectrotypes by isoelectric focusing. Sera obtained at different times after immunization of BALB/c mice failed to show spectrotype variations. Late, but not early, bleedings from CBA mice showed a tendency towards more uniform isoelectric focusing patterns.