Outpatient treatment with concomitant vaccine-boosted convalescent plasma for patients with immunosuppression and COVID-19

Although severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. In addition, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 ("vax-plasma"). Thus, we report the clinical outcome of 386 immunocompromised outpatients who were diagnosed with COVID-19 and who received contemporary COVID-19-specific therapeutics (standard-of-care group) and a subgroup who also received concomitant treatment with very high titer COVID-19 convalescent plasma (vax-plasma group) with a specific focus on hospitalization rates. The overall hospitalization rate was 2.2% (5 of 225 patients) in the vax-plasma group and 6.2% (10 of 161 patients) in the standard-of-care group, which corresponded to a relative risk reduction of 65% (P = 0.046). Evidence of efficacy in nonvaccinated patients cannot be inferred from these data because 94% (361 of 386 patients) of patients were vaccinated. In vaccinated patients with immunosuppression and COVID-19, the addition of vax-plasma or very high titer COVID-19 convalescent plasma to COVID-19-specific therapies reduced the risk of disease progression leading to hospitalization.IMPORTANCEAs SARS-CoV-2 evolves, new variants of concern (VOCs) have emerged that evade available anti-spike monoclonal antibodies, particularly among immunosuppressed patients. However, high-titer COVID-19 convalescent plasma continues to be effective against VOCs because of its broad-spectrum immunomodulatory properties. Thus, we report clinical outcomes of 386 immunocompromised outpatients who were treated with COVID-19-specific therapeutics and a subgroup also treated with vaccine-boosted convalescent plasma. We found that the administration of vaccine-boosted convalescent plasma was associated with a significantly decreased incidence of hospitalization among immunocompromised COVID-19 outpatients. Our data add to the contemporary data providing evidence to support the clinical utility of high-titer convalescent plasma as antibody replacement therapy in immunocompromised patients.

Corticosteroid Therapy in Acute and Subacute Arachnoiditis - A Case Series

Arachnoiditis is difficult to treat. Patients are often left frustrated after many failed trials of conservative therapies without symptom resolution. Surgery may provide symptom relief for a short period of time, but their pain often returned. Herein, we present three cases of acute arachnoiditis following three different pain procedures: epidural blood patch, IDDS implant, and epidural steroid injection. The patients were diagnosed and treated with corticosteroids within 10 days of the procedure. Two patients were treated with the same oral steroid regiment, while the third patient was treated with both oral and IV steroid. All three patients had good outcomes at the completion of their steroid therapy. This case series may provide insight into treating acute and subacute arachnoiditis from pain interventions.

A Comprehensive Review of the Genetic and Epigenetic Contributions to the Development of Fibromyalgia

This narrative review summarizes the current knowledge of the genetic and epigenetic contributions to the development of fibromyalgia (FM). Although there is no single gene that results in the development of FM, this study reveals that certain polymorphisms in genes involved in the catecholaminergic pathway, the serotonergic pathway, pain processing, oxidative stress, and inflammation may influence susceptibility to FM and the severity of its symptoms. Furthermore, epigenetic changes at the DNA level may lead to the development of FM. Likewise, microRNAs may impact the expression of certain proteins that lead to the worsening of FM-associated symptoms.

Greater central airway luminal area in people with COVID-19: a case-control series

Respiratory epithelium in the conducting airways of the human body is one of the primary targets of SARS-CoV-2 infection, however, there is a paucity of studies describing the association between COVID-19 and physical characteristics of the conducting airways. To better understand the pathophysiology of COVID-19 on the size of larger conducting airways, we determined the luminal area of the central airways in patients with a history of COVID-19 compared to a height-matched cohort of controls using a case-control study design. Using three-dimensional reconstruction from low-dose high-resolution computed tomography, we retrospectively assessed airway luminal cross-sectional area in 114 patients with COVID-19 (66 females, 48 males) and 114 healthy, sex- and height-matched controls (66 females, 48 males). People with a history of smoking, cardiopulmonary disease, or a body mass index greater than 40 kg·m-2 were excluded. Luminal areas of seven conducting airways were analyzed, including trachea, left and right main bronchus, intermediate bronchus, left and right upper lobe, and left lower lobe. For the central conducting airways, luminal area was ~ 15% greater patients with COVID-19 compared to matched controls (p < 0.05). Among patients with COVID-19, there were generally no differences in the luminal areas of the conducting airways between hospitalized patients compared to patients who did not require COVID-19-related hospitalization. Our findings suggest that males and females with COVID-19 have pathologically larger conducting airway luminal areas than healthy, sex- and height-matched controls.

Ga3+ Incorporation into Al13 Keggin Polyoxometalates and the Formation of δ-(GaAl12)7+ and (Ga2.5Al28.5)19+ Polycations

Keggin-type polyaluminum species (ε-Al₁₃, δ-Al₁₃, Al₂₆, Al₃₀, Al₃₂) can form upon partial hydrolysis of Al³⁺-bearing solutions and are important species for water purification and contaminant transport. While the structural features for the major Al³⁺ polyaluminum species have been delineated, much less is known regarding heteroatom substitution and resultant structures other than the previously identified ε-GaAl₁₂⁷⁺ and ε-GeAl₁₂⁸⁺ cations. Single-atom substitution within polyaluminum species can change the surface reactivity within water treatment scenarios; thus, it is important to understand heteroatom incorporation within this system. The present work describes the synthesis and characterization of two novel Ga³⁺-substituted Keggin-type polyaluminum species. Na[GaO₄Al₁₂(OH)₂₄(H₂O)₁₂](2,6-NDS)₄(H₂O)_20.5 (δ-GaAl₁₂) and [Ga₂O₈Al_28.5Ga_0.5(OH)₅₈(H₂O)₂₇(SO₄)₂](SO₄)₄Cl₇(H₂O)_8.5 (Ga_2.5Al_28.5) were crystallized from a thermally aged, partially hydrolyzed Ga³⁺/Al³⁺ solution. Structural refinement from single-crystal X-ray diffraction indicated fully occupied Ga³⁺ within tetrahedral site(s) of both isolated species. Partial substitution was observed for octahedral sites for the larger Ga_2.5Al_28.5 cluster. The chemical compositions of both clusters were confirmed by inductively coupled plasma mass spectrometry (ICP-MS). Density functional theory (DFT) calculations corroborated the structural refinement, with the energetics of Ga³⁺ substitution suggesting preferential substitution within tetrahedral sites for both species. Additional theoretical work suggests that the rotated trimer in δ-GaAl₁₂ is highly reactive, which can serve as the driving force in the formation of the Ga_2.5Al_28.5 cluster.