Immune-Mediated Organ-Specific Reactions to COVID-19 Vaccines: A Retrospective Descriptive Study.

Severe acute respiratory syndrome coronavirus 2 caused the global COVID-19 pandemic and public health crisis, and it led to the rapid development of COVID-19 vaccines, which can cause rare and typically mild hypersensitivity reactions (HRs). Delayed HRs to COVID-19 vaccines have been reported, and the excipients polyethylene glycol (PEG)2000 and polysorbate 80 (P80) are the suspected culprits. Skin patch tests do not help in diagnosing delayed reactions. We aimed to perform lymphocyte transformation tests (LTT) with PEG2000 and P80 in 23 patients with suspected delayed HRs. Neurological reactions (n = 10) and myopericarditis reactions (n = 6) were the most frequent complications. Seventy-eight percent (18/23) of the study patients were admitted to a hospital ward, and the median time to discharge was 5.5 (IQR, 3-8) days. Some 73.9% of the patients returned to baseline condition after 25 (IQR, 3-80) days. LTT was positive in 8/23 patients (5/10 neurological reactions, 2/4 hepatitis reactions and 1/2 rheumatologic reactions). All myopericarditis cases had a negative LTT. These preliminary results indicate that LTT with PEGs and polysorbates is a useful tool for identifying excipients as causal agents in HRs to COVID-19 vaccines and can play an important role in risk stratification in patients with HRs.

LTT and HLA testing as diagnostic tools in Spanish vancomycin-induced DRESS cases: A case-control study.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe T-cell-mediated off-target adverse reaction. DRESS cases caused by vancomycin have often been reported. The HLA-A*32:01 allele has been associated with genetic susceptibility to vancomycin-induced DRESS in US citizens of European descent. We have analyzed the association of the HLA-A*32:01 allele in 14 Spanish DRESS cases in which vancomycin was suspected as the culprit drug, and the lymphocyte transformation test (LTT) as an in vitro assay to evaluate vancomycin sensitization. The results were compared to vancomycin-tolerant control donors. LTT was performed in 12 DRESS cases with PBMCs from resolution samples available and in a group of 12 tolerant donors. ROC curves determined that LTT is a suitable tool to identify patients sensitized to vancomycin (AUC = 0.9646; p < 0.0001). When a stimulation index >3 was regarded as a positive result, contingency tables determined 91% sensitivity, 91.67% specificity, 91% positive predictive value, and 91.67% negative predictive value (p = 0.0001, Fisher's exact test). The HLA A*32:01 allele was determined by an allele-specific PCR assay in 14 cases and 25 tolerant controls. Among the DRESS cases, five carriers were identified (35.7%), while it was detected in only one (4%) of the tolerant donors, [odds ratio (OR) = 13.33; 95% CI: 1.364-130.3; p = 0.016]. The strength of the association increased when only cases with positive LTT to vancomycin were considered (OR = 24.0; 95% CI: 2.28-252.6; p = 4.0 × 10-3). Our results confirm the association of the risk allele HLA-A*32:01 with vancomycin-induced DRESS in Spanish cases, and support LTT as a reliable tool to determine vancomycin sensitization.

Déficit de vitamina D y osteomalacia en ancianos no institucionalizados con fractura de cadera / Vitamin D deficiency and osteomalacia in non-institutionalised elderly individuals with hip fracture

Objetivo: determinar la prevalencia del déficit de vitamina D en un grupo de ancianos con fractura de cadera en comparación con controles de similar edad, y analizar si presentan mayor riesgo de fractura. Secundariamente se estudia su potencial relación con la sospecha de osteomalacia «clínica y bioquímicamente probable». Material y métodos: estudio prospectivo y descriptivo de 68 ancianos no institucionalizados con independencia funcional previa, que ingresan por fractura de cadera. Se les realizan historia clínica, toma de muestra sanguínea de calcio, fósforo, 25-OH vitamina D, fosfatasa alcalina, parathormona y magnesio, y se comparan con un grupo control de ancianos sin fractura de cadera. A los pacientes que, clínica y bioquímicamente, presentaban datos compatibles con probable osteomalacia se les realizaba una prueba terapéutica con vitamina D durante 6 meses, con posterior control analítico similar al descrito. Estudio comparativo con un nivel de significación de p < 0,05. Resultados: el 60% de los ancianos con fractura de cadera presentaba déficit de vitamina D al ingreso frente a un 9,5% en el grupo control (p = 0,004). Cinco pacientes presentaron probable osteomalacia; tras las pruebas terapéuticas 4 pacientes mejoraron su clínica y 3 normalizaron las concentraciones de fosfatasa alcalina. Conclusiones: el déficit de vitamina D es muy prevalente en la población anciana; en este estudio se asoció a fractura de cadera. La osteomalacia es una enfermedad curable que, pese a su baja prevalencia, debe sospecharse en estos casos

Objective: to determine the prevalence of vitamin D deficiency in elderly individuals with hip fracture compared with a control group of similar age, and to analyze its association with the risk of fracture. A secondary aim was to determine the relationship between vitamin D deficiency and suspected osteomalacia based on clinical and biochemical evidence. Material and methods: we performed a prospective descriptive study of 68 non-institutionalized elderly individuals with prior functional independence who were admitted to hospital with hip fracture. A clinical history was taken and blood samples for calcium, phosphorus, 25-OH vitamin D, alkaline phosphates, parathormone and magnesemia determinations were obtained. Patients with clinical and biochemical evidence compatible with osteomalacia underwent a therapeutic intervention consisting of vitamin D supplementation for 6 months and laboratory determinations similar to those described above were performed. A comparative study with a significance level of p < 0.05. Results: sixty percent of the elderly patients with hip fracture had vitamin D deficiency on admission to hospital versus 9.5% of the control group (p = 0.004%). Five patients had probable osteomalacia. After the therapeutic intervention, symptoms improved in four patients and alkaline phosphate levels were normalized in three. Conclusions: vitamin D deficiency is highly prevalent in the elderly population and is associated with a higher risk of hip fracture. Osteomalacia is a curable disease which, despite its low prevalence, should be considered in these patients

Valoración de la efectividad de la derivación lumboperitoneal en ancianos con hidrocefalia en las áreas cognitivas de atención, memoria y función ejecutiva prefrontal / Evaluation of the effectiveness of lumboperitoneal shunt placement in improving attention, memory and prefrontal executive function in elderly patients with hydrocephalus

Objetivo: determinar la efectividad de la derivación ventricular quirúrgica (lumboperitoneal) en las funciones cognitivas de predominio «subcortical» (atención, memoria y la función ejecutiva prefrontal) en ancianos diagnosticados de hidrocefalia normotensiva. Material y métodos: estudio descriptivo y prospectivo de 10 pacientes, con una media de edad de 74 años, diagnosticados de hidrocefalia normotensiva, con criterios estrictos de selección. Han sido evaluados según protocolo de estudio piloto de cribado, en el que se ha valorado la efectividad de la derivación lumboperitoneal en las funciones cognitivas. La evaluación se ha realizado previa a la intervención, a los 15 días y 3 meses de la derivación. Las pruebas estadísticas se han considerado significativas cuando alcanzan un valor p < 0,05 (intervalo de confianza del 95%). Resultados: en la evaluación de la mayoría de los parámetros cognitivos hay una mejoría, no estadísticamente significativa, a los 15 días y a los 3 meses de la derivación. En el test de los 25 pasos hay una mejoría estadísticamente significativa a los 15 días de la derivación, que se mantiene a los 3 meses (p < 0,008). Conclusiones: es de gran utilidad y eficacia la realización de un protocolo previo de valoración cognitiva, incidiendo en la afectación cognitiva subcortical que permita clasificar, derivar y seguir a los pacientes diagnosticados de hidrocefalia normotensiva para someterse a derivación lumboperitoneal, para que la respuesta clínica sea la mayor posible. El protocolo parece una herramienta más, a considerar, para esta exploración cognitiva

Objective: to determine the effectiveness of ventricular shunting (lumboperitoneal) on «subcortical» cognitive function (attention, memory and prefrontal executive function) in elderly patients with a diagnosis of normal pressure hydrocephalus. Material and methods: we performed a prospective, descriptive study of 10 patients diagnosed with normal pressure hydrocephalus, following strict selection criteria. The mean age was 74 years. The patients were evaluated using the protocol of a pilot screening study to evaluate the effectiveness of lumboperitoneal shunting on cognitive function. Evaluations were performed prior to the intervention, and 15 days and 3 months after shunting. Statistical tests were considered significant when p < 0.05 (95% confidence interval). Results: most of the cognitive parameters showed a nonsignificant improvement 15 days and 3 months after shunting. A 7.67-meter (25 steps) walk test showed a statistically significant improvement 15 days after shunting, which was maintained at 3 months (p < 0.008). Conclusions: cognitive evaluation, especially of subcortical cognitive involvement, prior to lumboperitoneal shunting is highly useful and effective in the classification, selection, and follow-up of patients with normal pressure hydrocephalus, thus contributing to the achievement of an optimal clinical response. The protocol applied is a tool that can be used in cognitive assessment