Correction to: COVID-19 Vaccine Administration and Hesitation Among Psychiatric Emergency Services Patients

Community Mental Health Journal -     

COVID-19 Vaccine Administration and Hesitation Among Psychiatric Emergency Services Patients

Community Mental Health Journal - Psychiatric Emergency Services (PES) at Connecticut Department of Veterans Affairs (VACT) began offering the COVID-19 vaccine to eligible veterans in February...     

Bortezomib may stabilize pediatric renal transplant recipients with antibody-mediated rejection

Background

Current therapeutic strategies to effectively treat antibody-mediated rejection (AMR) are insufficient. Thus, we aimed to determine the benefit of a therapeutic protocol using bortezomib for refractory C4d + AMR in pediatric kidney transplant patients.

Methods

We examined seven patients with treatment-refractory C4d + AMR. Immunosuppression included antithymocyte globulin or anti-CD25 monoclonal antibody for induction therapy with maintenance corticosteroids, calcineurin inhibitor, and anti-metabolite. Estimated glomerular filtration rate (eGFR) calculated by the Schwartz equation, biopsy findings assessed by 2013 Banff criteria, and human leukocyte antigen (HLA) donor-specific antibodies (DSA) performed using the Luminex single antigen bead assay were monitored pre- and post- bortezomib therapy.

Results

Seven patients (86 % male, 86 % with ≥6/8 HLA mismatch, and 14 % with pre-formed DSA) age 5 to 19 (median 15) years developed refractory C4d + AMR between 1 and 145 (median 65) months post-transplantation. All patients tolerated bortezomib. One patient had allograft loss. Of the six patients with surviving grafts (86 %), mean pre-bortezomib eGFR was 42 ml/min/1.73 m² and the mean 1 year post-bortezomib eGFR was 53 ml/min/1.73 m². Five of seven (71 %) had improvement of histological findings of AMR, C4d staining, and/or acute cellular rejection. Reduction in HLA DSAs was more effective for class I than class II.

Conclusions

Bortezomib appears safe and may correlate with stabilization of eGFR in pediatric kidney transplant patients with refractory C4d + AMR.

     

Management Considerations for the COVID-19 Patient with Severe Disease: a Case Scenario and Literature Review

HSS Journal ® -     

A Comparison of Patient-Reported and Measured Range of Motion in a Cohort of Total Knee Arthroplasty Patients

Range of motion (ROM) is an important component of the assessment of total knee arthroplasty (TKA) outcome. We compared patient-reported versus clinically observed ROM in a prospective cohort. Clinically observed ROM was measured using a goniometer by a trained research assistant. Self-reported ROM was estimated using a set of lateral knee photographs depicting varying levels of flexion and extension. All measures were taken pre-operatively, three, and six months postoperatively. We found statistically significant associations between self-reported ROM and clinically observed ROM for flexion and extension (all P < 0.001). We dichotomized flexion at 90° and found that self-report had a specificity of 94% and sensitivity of 65%. We conclude that patient-reported ROM may be a useful outcome measure for TKA.