Torquetenovirus viral load is associated with anti-spike antibody response in SARS-CoV-2 mRNA BNT162b2 vaccinated kidney transplant patients

Introduction: Kidney transplant patients (KT) are at high risk for severe COVID-19 and presented attenuated antibody responses to vaccination when compared to immunocompetent individuals. Torquetenovirus (TTV) has recently gained attention as a potential surrogate marker of the net state of immunosuppression. We evaluated the association between pre-vaccination TTV viral load and anti-spike total antibody response to SARS-CoV-2 vaccination in KT. Material and Methods: The 114 adult KT recipients enrolled in this prospective single-center cohort study received two doses of SARS-CoV-2 mRNA BNT162b2 vaccine. Serum samples were collected immediately before vaccination at the days when patients received both the first (T0) and the second dose (T1) and 16–45 days after the second dose (T2). Primary endpoint was the development of anti-spike total antibodies after vaccination. Demographic, clinical, and laboratorial parameters were compared between patients with and without detectable SARS-CoV-2 antibodies at T2. Results: Ninety-nine patients (86.8%) were naïve for SARS-CoV-2 before vaccination. Fifty-six (56.6%) patients developed anti-spike total antibodies at T2. The use of mTOR inhibitors was associated with a favorable response (p =.005); conversely, mycophenolic acid (MPA) was associated with a negative response (p =.006). In a multivariable model, the presence of TTV at T0 ≥ 3.36 log10 cp/ml was associated with unfavorable vaccine response (OR: 5.40; 95% CI: 1.47–19.80; p =.011), after adjusting for age and eGFR at T0. Conclusions: Higher TTV viral loads before vaccination are associated with reduced anti-spike total antibody response in SARS-CoV-2 mRNA BNT162b2 vaccinated KT patients. The association between TTV viral load and vaccine response may be an added-value in the optimization of vaccination regimens in KT.publishersversionpublishe

Esófago de Barrett: da molécula ao cancro

Trabalho final de mestrado integrado em Medicina (Biologia Aplicada/Medicina Interna), apresentado à Faculdade de Medicina da Universidade de Coimbra.O Esófago de Barrett (EB) consiste numa metaplasia, na qual o epitélio escamoso estratificado do esófago é substituído por epitélio colunar simples. Este constitui o principal fator de risco para o desenvolvimento de adenocarcinoma do esófago (ACE), uma neoplasia que tem vindo a crescer em incidência, em particular, nos países ocidentais. Este aumento tem originado uma onda de preocupação, por não se conseguir predizer quais os doentes com EB que progredirão para ACE. A vigilância dos doentes com EB tem um custo-benefício desfavorável e baixa sensibilidade, e embora sejam realizadas endoscopias e biopsias de controlo a todos, a capacidade de se predizer a evolução para ACE continua a ser deficitária e apenas uma pequena parte destes doentes evoluirá para neoplasia. Desta forma, muitos têm sido os investigadores que desenvolvem trabalho no sentido de validar biomarcadores que possam prever quais os doentes com maior risco de ACE, por forma a que estes sejam acompanhados com maior proximidade. A sua aplicação na prática clínica terá interesse se os mesmos permitirem a determinação de grupos de risco, se forem de fácil utilização, baixo custo e não invasivos. Este trabalho de revisão tem por objetivo apresentar uma versão atualizada e crítica acerca dos fatores de risco, mecanismos fisiopatológicos e marcadores moleculares subjacentes à transição EB-ACE.Barrett’s esophagus (EB) is defined as a metaplasia, where esophageal squamous stratified epithelium is replaced by a simple columnar epithelium. It is the main risk factor for the development of esophageal adenocarcinoma (ACE), which incidence has been rising, specially, in the western countries. This rise has led to a great concern because it cannot be predicted which EB patients will progress to ACE. The surveillance of EB patients has low cost-effectiveness and sensibility, since endoscopies and biopsies are performed on all of them, but only a small group will develop ACE. Hence, many investigators have studied biomarkers that would be able to predict whose patients are at higher risk of ACE, so only those would be followed closely. Their clinical use would be of great interest, not only because it could determine risk groups, but also because they are easy to use, low cost and non-invasive. Therefore, this review will present a critical and updated version about risk factors, physiopathological mechanisms and molecular markers involved in EB-ACE conversion

Osmotic Demyelination Syndrome in a Patient with Hypokalemia but No Hyponatremia

Osmotic demyelination syndrome (ODS) is characterized by loss of myelin in various parts of the central nervous system. It is mainly caused by a rapid correction of hyponatremia, although other factors that may cause rapid rise in serum osmolality can also be associated with its development. Its prognosis is poor and the recovery rate is unknown. The authors report a rare case of a patient with multiple risk factors for ODS, without hyponatremia, who developed ODS and surprisingly recovered. This case report highlights the importance of recognizing risk factors for the development of ODS, even if the main one is not present

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

© 2020 British Journal of AnaesthesiaBackground: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP

Management practices for postdural puncture headache in obstetrics : a prospective, international, cohort study

Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score <= 3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP