IgG and IgA Antibodies Post SARS-CoV-2 Vaccine in the Breast Milk and Sera of Breastfeeding Women

The COVID-19 pandemic has carried massive global health and economic burden that is currently counteracted by a challenging anti-COVID-19 vaccination campaign. Indeed, mass vaccination against COVID-19 is expected to be the most efficacious intervention to mitigate the pandemic successfully. The primary objective of the present study is to test the presence of neutralizing anti-SARS-CoV-2 antibodies (IgA and IgG) in the breast milk and sera samples from vaccinated women at least 20 days after the complete vaccine cycle. A secondary aim is to compare the IgG antibodies level in maternal serum and breast milk. The third target is to evaluate the presence of the IgG antibodies in breast milk after several weeks from the vaccination. Finally, we collected information on the health status of infants in the days following maternal vaccination. Forty-two mothers were enrolled in the study. Thirty-six received the Pfizer/BioNTech vaccine, four the Astra Zeneca vaccine, one the Moderna vaccine and another woman Astra Zeneca in the first dose and Pfizer/BioNTech in the second dose. All 42 milk samples confirmed the presence of anti-SARS-CoV-2 IgG, and none showed IgA presence. Regarding the matched 42 sera samples, 41 samples detected IgG presence, with one sample testing negative and only one positive for seric IgA. None of the 42 infants had fever or changes in sleep or appetite in the seven days following the maternal vaccination. The level of IgG antibodies in milk was, on average, lower than that in maternal serum. According to our analysis, the absence of IgA could suggest a rapid decrease after vaccination even if frequent breastfeeding could favour its persistence. IgG were present in breast milk even 4 months after the second vaccine dose. Information on the immunological characteristics of breast milk could change mothers’ choices regarding breastfeeding.

Association Between Management of Continuous Subcutaneous Basal Insulin Administration and HbA1C

Background: While we expect that patients who adjust their insulin delivery algorithms between clinic visits to have better glucose control compared to those who do not, this effect has not been quantified. Method: This is a single-center retrospective cohort study including pediatric and adult patients with type 1 diabetes evaluating insulin pump self-management behaviors. Basal insulin dose information was obtained from the Glooko-Diasend database, and used to quantify the frequency and magnitude of basal insulin daily dose adjustments within the 90-day window preceding HbA1c measurement. We use a linear mixed-effects model to analyze associations between frequency/magnitude of daily basal insulin changes and HbA1c. Results: We present data on 114 adult (44 ± 17 years, 60% female) and 212 pediatric (12 ± 4 years, 50% female) patients. Individuals changed their basal insulin dose on 72%-94% (interquartile range [IQR]) of observed days relative to the previous day. These changes varied 0.6%-2.4% IQR from the previous day’s value. In pediatric patients, lower HbA1c was associated with more frequent daily profile adjustments, while controlling for rate of hypoglycemia (z = -3.2, P = .001). In adults, there was no relationship between HbA1c and magnitude or frequency of basal profile adjustments. Conclusions: Pediatric patients who frequently modify their basal insulin exhibit somewhat better clinical outcomes, although the magnitude by which their basal amount is changed does not contribute to this effect.

Effective Treatment of Neurological Symptoms with Normal Doses of Botulinum Neurotoxin in Wilson’s Disease: Six Cases and Literature Review

Background: Recent cell-based and animal experiments have demonstrated an effective reduction in botulinum neurotoxin A (BoNT/A) by copper. Aim: We aimed to analyze whether the successful symptomatic BoNT/A treatment of patients with Wilson’s disease (WD) corresponds with unusually high doses per session. Methods: Among the 156 WD patients regularly seen at the outpatient department of the university hospital in Düsseldorf (Germany), only 6 patients had been treated with BoNT/A during the past 5 years. The laboratory findings, indications for BoNT treatment, preparations, and doses per session were extracted retrospectively from the charts. These parameters were compared with those of 13 other patients described in the literature. Results: BoNT/A injection therapy is a rare (<4%) symptomatic treatment in WD, only necessary in exceptional cases, and is often applied only transiently. In those cases for which dose information was available, the dose per session and indication appear to be within usual limits. Conclusion: Despite the evidence that copper can interfere with the botulinum toxin in preclinical models, patients with WD do not require higher doses of the toxin than other patients with dystonia.

Do Claims about the Naturalness and Dose of Cosmetics Ingredients Affect the Public’s Perception of Their Safety?

Media articles have claimed that “synthetic mineral oil saturated hydrocarbons (MOSH)”, which are used in many cosmetics such as lip balms, are unsafe at any dose and should be replaced with natural alternatives. This paper examines whether these claims are correct and whether the perceived safety of these substances is influenced by the language used in the media. To achieve these goals, it first provides an extensive review of the toxicology literature, finding no support that MOSHs are unsafe at current usage levels. It then reviews the psychology literature to examine the effects of labelling a cosmetic ingredient as “natural” rather than “synthetic” and the effects of dose information. A 2 × 2 between-subjects experiments involving adult lip balm users shows that, as hypothesized, the perceived safety of lip balms increases when they are described as containing “naturally sourced mineral oil” rather than “synthetic mineral oil saturated hydrocarbon (MOSH)”, which are both correct descriptions. In addition, the perceived safety increases when the substance is described as being present in a low vs. a high dose, regardless of whether it was described as natural or synthetic. Overall, safety perceptions for common cosmetic substances can be significantly influenced by the language used in media reporting.

A UK wide study of current prostate planning practice

Objectives: The objective of this work was to undertake a non-judgemental study of prostate planning practice across the UK by inviting all departments to undertake the same case. Methods: An invitation to take part in the study was sent to the Heads of all UK radiotherapy departments and posted on the UK Medical Physics mailbase. Individuals interested in participating were able to access a single anonymised CT dataset for download with the prostate gland, seminal vesicles, bladder, rectum, bowel, femoral heads, and penile bulb outlined. A brief patient history was also supplied. Participants were asked to create planning target volumes (PTVs) according to their local clinical protocol and plan to give 60 Gy in 20 fractions to the PTV receiving the highest dose. No guidance was given for acceptable organ at risk doses. Dicom plan and dose information was loaded back into ProKnow for analysis by contributors. Results: There were 102 plan submissions made to the study representing 48 different UK radiotherapy departments. Seventeen distinct methodologies for creating the prescription PTV from the prostate and seminal vesicles were identified with the ethos of the CHHIP trial protocol for margin growing followed in nearly two-thirds of cases. Positive correlations were found when assessing the doses received by the bladder and rectum against the volume of the PTV to which 60 Gy was prescribed. Conclusions: A national planning study whereby staff from a multitude of radiotherapy departments create plans based solely on a single dataset is feasible. The cohort of data was made available to all participants following the study to enable self-assessment and benchmarking against that of their peers. Advances in knowledge: This is the first UK wide treatment planning study to investigate local clinical prostate planning practice. This has given UK departments the opportunity to evaluate their planning practices against those of their peers.

4501 Statistical Modeling for Predicting Correct Drug Dose in the Presence of Conflicting Dose Information Extracted from Electronic Health Records

OBJECTIVES/GOALS: Diverse medication-based studies require longitudinal drug dose information. EHRs can provide such data, but multiple mentions of a drug in the same clinical note can yield conflicting dose. We aimed to develop statistical methods which address this challenge by predicting the valid dose in the event that conflicting doses are extracted. METHODS/STUDY POPULATION: We extracted dose information for two test drugs, tacrolimus and lamotrigine, from Vanderbilt EHRs using a natural language processing system, medExtractR, which was developed by our team. A random forest classifier was used to estimate the probability of correctness for each extracted dose on the basis of subject longitudinal dosing patterns and extracted EHR note context. Using this feasibility measure and other features such as a summary of subject dosing history, we developed several statistical models to predict the dose on the basis of the extracted doses. The models developed based on supervised methods included a separate random forest regression, a transition model, and a boosting model. We also considered unsupervised methods and developed a Bayesian hierarchical model. RESULTS/ANTICIPATED RESULTS: We compared model-predicted doses to physician-validated doses to evaluate model performance. A random forest regression model outperformed all proposed models. As this model is a supervised model, its utility would depend on availability of validated dose. Our preliminary result from a Bayesian hierarchical model showed that it can be a promising alternative although performing less optimally. The Bayesian hierarchical model would be especially useful when validated dose data are not available, as it was developed in unsupervised modeling framework and hence does not require validated dose that can be difficult and time consuming to obtain. We evaluated the feasibility of each method for automatic implementation in our drug dosing extraction and processing system we have been developing. DISCUSSION/SIGNIFICANCE OF IMPACT: We will incorporate the developed methods as a part of our complete medication extraction system, which will allow to automatically prepare large longitudinal medication dose datasets for researchers. Availability of such data will enable diverse medication-based studies with drastically reduced barriers to data collection.

A new Monte Carlo tool for organ dose estimation in computed tomography

The constant increase of computed tomography (CT) exams and their major contribution to the collective dose led to international concerns regarding patient dose in CT imaging. Efforts were made to manage radiation dose in CT, mostly with the use of the CT dose index (CTDI). However CTDI does not give access to organ dose information, while Monte Carlo (MC) simulation can provide it if detailed information of the patient anatomy and the source are available. In this work, the X-ray source and the geometry of the GE VCT Lightspeed 64 were modelled, based both on the manufacturer technical note and some experimental data. Simulated dose values were compared with measurements performed in homogeneous conditions with a pencil chamber and then in CIRS ATOM anthropomorphic phantom using both optically stimulated luminescence dosimeters (OSLD) for point doses and XR-QA Gafchromic® films for relative dose maps. Organ doses were ultimately estimated in the ICRP 110 numerical female phantom and compared to data reported in the literature. Comparison of measured and simulated values show that our tool can be used for a patient specific and organ dose oriented radiation protection tool in CT medical imaging.

Application of mobile X-ray barriers during angiography procedure: how much is it effective? A case study

Introduction: This study intended to assess the effectiveness of application the mobile X-ray barriers (lead-wall) in reducing the radiation dose to interventionists during the brain angiography procedures. Moreover, the radiation dose of patients also evaluated to assess whether the application of lead-wall affects the patient’s dose or not? Material and method: Two interventionists took part in this study. Thermoluminescent dosimeters (TLD-100) were used to monitor the doses to interventionists. 1st-interventionist routinely used lead-wall and 2nd-interventionist didn’t use it. Demographic information of patients and radiation dose information was also recorded. Results: The results of measurements showed that the radiation dose of the 1st-interventionist was 83.57% lower than the 2nd-interventionist (p = 0.04). The amount of dose/min and DAP/min of the 1st-interventionist’s patients were 33.50% and 17.54% less than the 2nd-interventionist’s patients (p = 0.006) and (p = 0.0004). Discussion and conclusion: The results showed that application of lead wall can effectively reduce the occupational dose and it doesn’t lead to increase the patient’s dose.