Inpatient COVID-19 vaccination rollout: Improving access to vaccination.

BACKGROUND: We were aware of high numbers of inpatients unvaccinated against COVID-19 at Guy's and St Thomas' NHS Foundation Trust (GSTT). Due to this, an inpatient vaccination protocol was set up in July 2021, with initially limited uptake. METHODS: From October 2021, a multidisciplinary team worked to improve the protocol for inpatient vaccination, with the development of a system that gave ownership to clinical teams. RESULTS: In 4 months (July 2021 to November 2021), 20 inpatients had been vaccinated at GSTT. Following our intervention, rates of uptake increased, and 34 patients were vaccinated in less than 2 months (November 2021 to January 2022). Forty-five patients who had been referred were discharged without vaccination; attempts were made to invite them to receive a vaccine. CONCLUSION: An improved pathway and referral process increased the number of inpatient vaccinations delivered. Further work is required in order to ensure that more patients who have been referred are vaccinated.

Pattern of relapses in Iranian patients with ulcerative colitis. A prospective study.

BACKGROUND: The pattern of relapses in patients with ulcerative colitis (UC) has a significant role in taking decisions about the therapy and the follow up of patients. This study is designed to find out the pattern, time and severity of relapses in Iranian patients with UC. METHOD: From 1991 to 2003, a period of 13 years, the pattern of relapses in 163 patients with UC who had been admitted to a private referral gastroenterology clinic in Iran were evaluated. RESULTS: 163 patients (58.3% female, 41.7% male) were included, aged from 17 to 74 years with mean age of 38.9 ± 12.3 years. Mean follow up time was 52.7 ± 41.4 months (ranges 12 and 155 months). Mean relapse chance was 0.028 ± 0.036 for each patient in every month (ranges 0-0.21). The mean time from the initial attack to the first relapse was 23.8 ± 22.5 months, which was not the same in patients with different primary disease severity (p = 0.03). CONCLUSION: The time and severity of the relapses relate to the severity of UC. Iranian patients have a milder course of the disease.

Gastrointestinal complications in two patients with common variable immunodeficiency.

Common variable immunodeficiency (CVID) is a primary immunodeficiency disease characterized by hypogammaglobulinemia and recurrent bacterial infections especially in respiratory and gastrointestinal systems. We present here 2 cases of CVID with gastrointestinal complications.Case 1 is a 25-year-old man with a history of chronic diarrhoea from childhood. Ultrasonography revealed ascites, with liver size smaller than normal. Liver biopsy showed non-specific hepatitis. Lymphoid proliferation and Histiocytosis were reported in his ascites cytology. Moreover friability in colonoscopy due to moderate active chronic colitis was detected. Case 2 is a 26-year-old man with chronic diarrhoea since 8 years. Abdominal sonography revealed increased liver echogenicity, increased liver size, and some enlarged lymph nodes beside pancreas. Colonoscopy revealed friability and decreased vascularity while biopsy showed moderate active chronic colitis. Lymph node biopsy showed unusual immunologic reaction. Moreover, small bowel transition test showed nodularity. CVID should be considered in any patient with gastrointestinal manifestations especially chronic diarrhoea in association with recurrent bacterial infections in other organs. Diagnostic delay results in more morbidity and complications in untreated patients..

Alterations in antioxidant power and levels of epidermal growth factor and nitric oxide in saliva of patients with inflammatory bowel diseases.

Despite extensive investigation, the pathophysiology of human inflammatory bowel disease (IBD) remains incompletely understood. We examined the existence of oxidative and nitrosative stress and also alterations in epidermal growth factor (EGF) secretion in saliva of IBD patients. Saliva samples were obtained from 30 nonsmoking IBD patients including 16 Crohn's disease (CD) patients and 16 ulcerative colitis (UC) patients and 16 age- and sex-matched controls. Samples were analyzed for thiobarbituric reactive substances (TBARS) as a marker of lipid peroxidation, ferric reducing ability (antioxidant power), and EGF and nitric oxide (NO) levels. Saliva TBARS levels increased significantly (P < 0.01) in CD patients but not in UC patients. Analysis of antioxidant power revealed that saliva of CD patients has lower antioxidant power (P < 0.01) than saliva of the healthy control population. The concentration of EGF was found to be increased (P < 0.01) in saliva of CD patients in comparison to that of healthy subjects. NO levels increased in saliva of both CD and UC patients in comparison to that of healthy subjects. It is concluded that excessive NO production is present in saliva of both CD and UC patients but only saliva of CD patients is oxidatively stressed. EGF secretion is normal in UC patients, although CD patients show a significant increase in salivary EGF levels.