Prior cycles of anti-CD20 antibodies affect antibody responses after repeated SARS-CoV-2 mRNA vaccination.

BACKGROUNDWhile B cell depletion is associated with attenuated antibody responses to SARS-CoV-2 mRNA vaccination, responses vary among individuals. Thus, elucidating the factors that affect immune responses after repeated vaccination is an important clinical need.METHODSWe evaluated the quality and magnitude of the T cell, B cell, antibody, and cytokine responses to a third dose of BNT162b2 or mRNA-1273 mRNA vaccine in patients with B cell depletion.RESULTSIn contrast with control individuals (n = 10), most patients on anti-CD20 therapy (n = 48) did not demonstrate an increase in spike-specific B cells or antibodies after a third dose of vaccine. A third vaccine elicited significantly increased frequencies of spike-specific non-naive T cells. A small subset of B cell-depleted individuals effectively produced spike-specific antibodies, and logistic regression models identified time since last anti-CD20 treatment and lower cumulative exposure to anti-CD20 mAbs as predictors of those having a serologic response. B cell-depleted patients who mounted an antibody response to 3 vaccine doses had persistent humoral immunity 6 months later.CONCLUSIONThese results demonstrate that serial vaccination strategies can be effective for a subset of B cell-depleted patients.FUNDINGThe NIH (R25 NS079193, P01 AI073748, U24 AI11867, R01 AI22220, UM 1HG009390, P01 AI039671, P50 CA121974, R01 CA227473, U01CA260507, 75N93019C00065, K24 AG042489), NIH HIPC Consortium (U19 AI089992), the National Multiple Sclerosis Society (CA 1061-A-18, RG-1802-30153), the Nancy Taylor Foundation for Chronic Diseases, Erase MS, and the Claude D. Pepper Older Americans Independence Center at Yale (P30 AG21342).

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned.

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

Sistematização da assistência de enfermagem a paciente com síndrome hipertensiva específica da gestação / Nursing assistance systematization for the patient with pre–eclampsia / Sistematización de la asistencia de enfermería a paciente con síndrome hipertensivo específico de la gestación

A Síndrome Hipertensiva Específica da Gestação (SHEG) é uma doença de grande morbimortalidade na gestação, caracterizada por hipertensão arterial, proteinúria e/ou edema, possuindo elevada taxa de incidência e prevalência no Brasil. O objetivo foi elaborar um formulário de Sistematização da Assistência de Enfermagem (SAE) à pacientes com SHEG a partir da identificação de diagnósticos de enfermagem (DE) da NANDA. Pesquisa descritiva realizada em uma Maternidade-Escola na cidade de Fortaleza–Ceará, nos meses de abril a maio de 2009, com aplicação de histórico de enfermagem à gestantes com SHEG. Nos resultados identificou-se 11 DE. Os mais freqüen¬tes foram: risco de infecção, dor aguda, baixa auto-estima situacional, volume de líquidos excessivo, náusea, privação do sono, risco de função hepática prejudicada. Realizou-se prescrição de cuidados baseada na classificação da Nursing Intervention Classification (NIC). O estudo reflete a necessidade da implementação da SAE para a melhoria da assistência, tornando o cuidado diferenciado, individualizado e humanizado.

Pre-eclampsia and eclampsia are diseases with high morbidity and mortality in pregnancy characterized by hypertension, proteinuriaand/or swelling, having a high incidence and prevalence in Brazil. The aim of this research was to develop a form of Nursing Care System(NCS) to patients with Pre-eclampsia from the identification of nursing diagnoses (ND) of NANDA. This is a descriptive research conductedin a Maternity Teaching Hospital in the city of Fortaleza, Ceará, from April to May 2009, applying historical nursing on mothers withPre-eclampsia. The results identified 11 ND. The most common are: risk of infection, acute pain, situational low self-esteem, excessivevolume of fluid, nausea, sleep deprivation and risk of impaired liver function. We conducted care prescription based on classification ofNIC. The study reflects the need to implement the NCS for the improvement of care, making it carefully differentiated, individualized andhumanized.

El Síndrome Hipertensivo Específico de la Gestación (SHEG) es una enfermedad de alta morbilidad -mortalidad en el embarazo, caracterizadapor hipertensión arterial, proteinuria y / o edema, poseyendo alto porcentaje de incidencia y prevalencia en Brasil. El objetivofue elaborar un formulario de Sistematización de la Atención de Enfermería (SAE) aplicado a pacientes con SHEG, a partir de la identificaciónde diagnósticos de enfermería (DE) de NANDA. Investigación descriptiva realizada en una Maternidad Escuela en la ciudad deFortaleza-Ceará, en los meses de Abril a Mayo de 2009, con aplicación de histórico de enfermería a embarazadas portadoras de SHEG. Enlos resultados se identificaron 11 DE. Los más frecuentes fueron: riesgo de infección, dolor agudo, baja autoestima situacional, volumenexcesivo de líquidos, náusea, falta de sueño, riesgo de función hepática perjudicada. Se realizó prescripción de cuidados basada en laclasificación de la NIC. El estudio refleja la necesidad de implementación de la SAE para mejorar la atención, tornando el cuidado diferenciado,individualizado y humanizado.