系统性红斑狼疮患者外周血中B淋巴细胞活化状况与疾病活动性的关系

目的探讨系统性红斑狼疮患者外周血中B淋巴细胞及其活化状况与疾病活动性的关系。方法应用流式细胞术检测活动期与稳定期系统性红斑狼疮患者外周血中CD19+、CD23+/CD19+及HLA-DR+/CD19+细胞的表达情况;同时应用免疫学方法检测血清中ds-DNA与ANA水平。结果活动期患者CD19+、CD23+/CD19+及HLA-DR+/CD19+细胞表达率均高于稳定期患者及正常对照组,差异均有显著性意义;稳定期患者CD23+/CD19+表达很低,而HLA-DR+/CD19+双阳性细胞表达率高于正常对照组,但差异无显著性意义;且CD23+/CD19+双阳性细胞表达率与病情积分、ds-DNA及ANA均成正相关(P<0.01),而HLA-DR+/CD19+双阳性细胞与三者无相关关系(P>0.05)。结论活动期与稳定期患者均存在B淋巴细胞的克隆性增生与异常活化,B细胞的异常活化是病情活动的直接原因,晚期B细胞的异常活化是系统性红斑狼疮患者难彻底治愈与病情反复的原因之一。     

中国健康人群和甲亢患者细胞色素氧化酶CYP2C19遗传多态性的比较

目的:考察中国健康人群和甲亢患者细胞色素氧化酶CYP2C19遗传多态性的相关性.方法:应用限制性片段长度多态性分析法(PCR-RFLP)对66例甲亢患者和74例健康志愿者进行了基因多态性分析.结果:甲亢患者和健康志愿者中基因型为野生型纯合子wt/wt的分别为34.85%(23/66)和41.89(31/74);基因型为杂合子wt/m1和wt/m2的分别为50.0%(33/66)和45.94%(34/74);基因型为突变型纯合子ml/ml和ml/m2的为15.15%(10/66)和12.16%(9/74).在本实验中未发现m2/m2基因型.甲亢患者和健康志愿受试者的wt/wt和ml/m1的频率没有显著差别.结论:中国甲亢患者和健康人群细胞色素氧化酶CYP2C19遗传多态性在统计学上没有差别.     

Severe pulmonary hemorrhage in a 3‐week‐old neonate with COVID‐19 infection: A case report

Our patient is a 3‐week‐old female neonate, presented with complaints of low‐grade fever and a congested nose for one day. Eventually, she developed progressive desaturation, hypotension, and poor perfusion due to severe pulmonary hemorrhage. Then, she developed cardiac arrest and was declared dead.     

Prevalence of antibodies against SARS‐CoV‐2 in the Norwegian population,August 2021

BackgroundOne year into the COVID‐19 pandemic, the cumulative number of confirmed COVID‐19 cases in Norway was still low. In January 2021, when the Norwegian COVID‐19 vaccination campaign started, the national seroprevalence estimate of SARS‐CoV‐2 antibodies was 3.2%. We have conducted a nationwide cross‐sectional study in August 2021 to investigate the overall prevalence of SARS‐CoV‐2 antibodies in Norway after 8 months of COVID‐19 mass vaccination and a third wave of SARS‐CoV‐2 infection.MethodsResidual sera were collected from laboratories across Norway in August 2021. In IgG antibodies against the spike protein, the spike receptor binding domain (RBD) and the nucleocapsid protein of SARS‐CoV‐2 were measured by a bead‐based flow cytometric assay.ResultsIn total, 1926 residual sera were collected from individuals aged 0–98 years; 55.1% were from women. The overall national estimated seroprevalence from vaccination and/or infection was 62.6% (credible interval [CrI] 60.1%–65.2%) based on having antibodies against both spike and RBD. Estimated seroprevalence increased with age. Among all samples, 11.7% had antibodies against nucleocapsid. For unvaccinated children <12 years, the seroprevalence estimate due to SARS‐CoV‐2 infection was 12.5% (95% CrI 9.3%–16.1%). Of seropositive samples from the unvaccinated children, 31.9% lacked anti‐nucleocapsid antibodies.ConclusionsThe high overall SARS‐CoV‐2 seroprevalence estimates are in line with Norwegian registry data. Vaccination, not infection, contributed the most to the high seroprevalence in August 2021. Lack of antibodies against nucleocapsid should not automatically be interpreted as absence of previous infection as this could lead to underestimation of COVID‐19 cases in seroprevalence studies.     

Impact of IFN‐β1a in treatment of a COVID‐19 patient with beta thalassemia and diabetes mellitus: A case report

Patients with chronic diseases are severely affected by acute coronavirus syndrome. In this regard, patients with beta thalassemia intermedia and diabetes mellitus (DM) are also at high risk for coronavirus‐induced respiratory failure. The present study aimed to report a case with COVID‐19 with a history of chronic diseases, beta thalassemia intermedia, and DM. A 25‐year‐old man visited with complaints of severe shortness of breath, fever, cough without sputum, and tachypnea and admitted to the Intensive Care Unit. The patient had a history of DM, beta thalassemia intermedia, and pervious history of the splenectomy. In peripheral complete blood count (CBC diff), the number of white blood cell count was 41,100 of which 38.6% were lymphocytes. We measured the normal platelet count, hemoglobin level (9.4), and red blood cell count (3.56). ESR was 97, CRP = pos+++ and PCR was positive. The high‐resolution lung CT indicated ground glass opacities in peripheral areas. The patient underwent 13 days of oxygen therapy with reservoir bag‐mask, non‐invasive ventilation, nasal oxygen, and pharmacological treatment with IFN‐β1a and meropenem, and finally discharged with an improvement of the clinical condition. Timely initiation of treatment is very important and significant for patients with beta thalassemia intermedia with COVID‐19, especially despite the underlying disease of DM. According to the present report, the use of IFN‐β1a was effective as a treatment option for COVID‐19.     

Effectiveness of two and three mRNA COVID‐19 vaccine doses against Omicron‐ and Delta‐Related outpatient illness among adults,October 2021–February 2022

BackgroundWe estimated SARS‐CoV‐2 Delta‐ and Omicron‐specific effectiveness of two and three mRNA COVID‐19 vaccine doses in adults against symptomatic illness in US outpatient settings.MethodsBetween October 1, 2021, and February 12, 2022, research staff consented and enrolled eligible participants who had fever, cough, or loss of taste or smell and sought outpatient medical care or clinical SARS‐CoV‐2 testing within 10 days of illness onset. Using the test‐negative design, we compared the odds of receiving two or three mRNA COVID‐19 vaccine doses among SARS‐CoV‐2 cases versus controls using logistic regression. Regression models were adjusted for study site, age, onset week, and prior SARS‐CoV‐2 infection. Vaccine effectiveness (VE) was calculated as (1 − adjusted odds ratio) × 100%.ResultsAmong 3847 participants included for analysis, 574 (32%) of 1775 tested positive for SARS‐CoV‐2 during the Delta predominant period and 1006 (56%) of 1794 participants tested positive during the Omicron predominant period. When Delta predominated, VE against symptomatic illness in outpatient settings was 63% (95% CI: 51% to 72%) among mRNA two‐dose recipients and 96% (95% CI: 93% to 98%) for three‐dose recipients. When Omicron predominated, VE was 21% (95% CI: −6% to 41%) among two‐dose recipients and 62% (95% CI: 48% to 72%) among three‐dose recipients.ConclusionsIn this adult population, three mRNA COVID‐19 vaccine doses provided substantial protection against symptomatic illness in outpatient settings when the Omicron variant became the predominant cause of COVID‐19 in the United States. These findings support the recommendation for a third mRNA COVID‐19 vaccine dose.     

Efficacy and safety of nafamostat mesilate anticoagulation in blood purification treatment of critically ill patients: a systematic review and meta-analysis

BackgroundNafamostat mesilate (NM), a broad-spectrum and potent serine protease inhibitor, can be used as an anticoagulant during extracorporeal circulation, as well as a promising drug effective against coronavirus disease 2019 (COVID-19). We conducted a systematic meta-analysis to evaluate the safety and efficacy of NM administration in critically ill patients who underwent blood purification therapy (BPT).MethodsThe Cochrane Library, Web of Science and PubMed were comprehensively searched from inception to August 20, 2021, for potential studies.ResultsFour randomized controlled trials (RCTs) and seven observational studies with 2723 patients met the inclusion criteria. The meta-analysis demonstrated that conventional therapy (CT) significantly increased hospital mortality compared with NM administration (RR = 1.25, p = 0.0007). In subgroup analyses, the in-hospital mortality of the NM group was significantly lower than that of the anticoagulant-free (NA) group (RR = 1.31, p = 0.002). The CT interventions markedly elevated the risk ratio of bleeding complications by 45% (RR = 1.45, p = 0.010) compared with NM interventions. In another subgroup analysis, NM used exhibited a significantly lower risk of bleeding complications than those of the low-molecular-weight heparin (LMWH) used (RR = 4.58, p = 0.020). The filter lifespan was decreased significantly (MD = −10.59, p < 0.0001) in the NA groups compared with the NM groups. Due to the poor quality of the included RCTs, these results should be interpreted with caution.ConclusionGiven the better survival outcomes, lower risk of bleeding, NM anticoagulation seems to be a safe and efficient approach for BPT patients and could yield a favorable filter lifespan. More multi-center RCTs with large samples are required for further validation of this study.     

Retinal venous occlusion following COVID-19 vaccination: Report of a case after third dose and review of the literature

A 28-year-old, healthy male presented with blurring of vision in the right eye following third dose of the AstraZeneca/COVISHIELD vaccine. Further examination revealed ischemic central retinal vein occlusion, and subsequent laboratory investigations were inconclusive for his eye disease. He responded to pulse corticosteroid and tapering doses of oral corticosteroids without requiring any intra-vitreal injection. Twelve articles were identified with the help of a PubMed literature search, and a short review of these patients was performed. Retinal vein occlusion can occur because of inflammation-induced thrombosis after coronavirus disease 2019 vaccination and may respond to anti-inflammatory therapy.     

Reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic

Purpose:To analyze the reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic.Methods:This was a prospective, cross-sectional, multicenter questionnaire study which included patients with mature cataract, nuclear sclerotic cataract grade IV, and cataracts with best corrected visual acuity (BCVA) <5/60, during the COVID-19 pandemic from December 2020 to April 2021. Reasons for delay in presentation to the hospital were analyzed.Results:One thousand four hundred seventy two patients were recruited with advanced cataracts. Absence of ophthalmic care nearby (44.2%), lack of awareness regarding elective surgeries (42.6%), lack of public transportation (37%), fear of contracting COVID-19 (23.4%), and waiting for outreach camps (20.4%) were found to be the reasons behind the delay in cataract surgery. 53.7% of the patients had worsening of defective vision and 55.3% of them had difficulty in carrying out activities of family living. 30.8% of the patients faced difficulty in commuting and 8.4% of the patients suffered a fall during this pandemic due to worsening of the visual acuity.Conclusion:The lockdown imposed during the pandemic has created a significant backlog of patients who are progressing to advanced cataracts due to lack of ophthalmic care nearby, lack of awareness regarding elective surgeries, lack of public transportation, and no outreach camps. Proactive measures to deal with this backlog are of utmost need to prevent blindness due to cataract.     

Feasibility study for measuring patients’ visual acuity at home by their caregivers

Purpose:To assess the feasibility of measuring patients’ visual acuity (VA) in their homes by their caregivers.Methods:Patients consulting in a tertiary eye care institute were prospectively enrolled with informed consent. All underwent standard COMPlog distance VA testing. Patients and caregivers were oriented to test distance VA using the Peek Acuity app. The app was installed on the caregiver’s or patient’s smartphone. The patient’s VA was measured by the caregiver in the clinic (baseline value) under supervision. After 1 week, the caregivers recorded the patient’s VA with the Peek Acuity app at their home and reported the value in a telephone consultation. A questionnaire to assess the ease of using the app was administered at both the baseline visit and 1 week later.Results:A total of 100 patients (age group: 13 to 76 years) and 100 caregivers (age group: 17 to 65 years) participated. VA measurements with the Peek Acuity app were comparable with COMPlog (P > 0.1) both during the baseline and after 1-week measurement, regardless of the underlying ocular condition or educational level of the caregivers/patients. Most caregivers (95%) felt the app was easy to use.Conclusion:Though the Peek Acuity app was originally developed for health care workers to be used in field visits, we found that with proper orientation, the layperson can also use it. Such orientation can enable caregivers to effectively measure VA at home. Such a tool would enhance teleophthalmology consultations and can minimize the need for short follow-up visits.