Letter from the Editors

Dear Colleagues! Our Authors and Friends! New Year 2022 rushes towards humanity. This universal arrangement of life on our planet presupposes changes. Their essence is in hopes for the best. We wish all of us not just hopes but confidence in the victory of good over evil, reasons over greed and cruelty. We hope that the Planet will overcome humankind's most severe viral attack – the SARS-CoV2 pandemic. We hope that the future brings us victories over epidemics, serious diseases, hunger, and lack of water. We hope that all types of violence, military conflicts, political, economic, religious confrontations will be stopped in a New Year. We are opening the third year of our journal, which was focused on different aspects of medicine. Last year we published eight papers from seven countries experts, each substantially contributed to medicine. We talked about COVID-19 pandemic, vital pediatric problems, and adult medicine. We will continue our mission to support and distribute the most valuable medical knowledge in the New Year. May the New Year celebrations bring only joy and harmony to your homes, souls, and the reasoning, which illuminate confidence in the future for our beautiful multinational green Planet - Earth! "Every end is a new beginning…." We wish you and your family a Happy Holidays! We hope that your New Year will be filled with peace, new ideas, and success! Editorial office

Study on Services of Chattogram Maa-O-Shishu Hospital

Background: Hospital services are the amenities provided by a hospital both for the patients and the workforces. Periodical assessment of hospital service quality discovers the demands and needs thus ensuring the development of the institution. The aim of the study to find out the problems regarding hospital services and its solution. Materials and methods: This observational study was conducted among the health personnel of Chattogram Maa-O-Shishu Hospital from 01 July to 30 August 2019 and 01 January to 29 February 2020. Purposive sampling technique was followed to collect data from 100 randomly selected samples. They were interviewed with pretested questionnaire and data were managed manually. Results: Different findings were drawn. These are: Lack of work dedication, responsibility, loyalty and internal co-operation among the staff (60%). Lack of manpower including doctors, nursing staff, cleaners and few recruitments are not so experienced as to fulfill the demands of their duty (56%). The number of beds is less compared to the number of patients who need them e.g. ICU, CCU, NICU, Paediatric ICU Adult medicine ward, etc. Hence patients are referred outside (46%). Patient visiting hours and number of visitors not properly maintained. Visitors make noise, take food on patient’s bed and sometime physically assault employees when they are asked to obey rules (40%). However, overall job satisfaction of the respondents was 78%. Conclusion: Ascertaining the issues regarding the improvement of hospital services is mandatory. Quick detection and early solution would gain confidence by employees and beneficiary which would ultimately boost up the reputation of the hospital. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 41-44

LB8. Lower SARS-CoV-2 IgG and Pseudovirus Neutralization Titers Post-mRNA Vaccination among People Living with HIV

Background Limited data are available on whether there are differences in the immune response to SARS-CoV-2 vaccination by HIV status or by mRNA vaccine type. Methods We saved residual outpatient laboratory samples of all previously mRNA-vaccinated individuals in the adult medicine clinics of a public hospital with a large outpatient HIV clinic during May 2021, and then excluded individuals with prior SARS-CoV-2 infection. We next 1:1 matched 100 PLWH to 100 outpatient HIV-negative adult medicine patients receiving care for chronic medical conditions on days since completion of second vaccination (minimum 10), sex, age +/-5 years, and the type of mRNA vaccine received. We defined a non-response as reciprocal pseudovirus neutralizing titer< 10 and anti-RBD IgG< 10 relative fluorescent units, and compared non-response by HIV status using mixed models. Results In each matched group there were 13 women; 25 received the mRNA-1273 vaccine and 75 received the BNT162b2 vaccine; the median age was 59. The median time from second vaccination was 35 days (IQR: 20–63). Among PLWH, the median CD4+ T-cell count was 511 (IQR: 351–796) and 5 individuals had HIV RNA > 200. We found 2.4-fold greater odds of pseudovirus neutralizing antibody non-response among PLWH compared to people without HIV (95% CI=1.1–5.4). Although few individuals in each group did not mount an IgG response (12 among PLWH vs. 5; p=0.08), continuous anti-RBD IgG concentrations were 43% lower among PLWH (95% CI=0.36–0.88). Among PLWH, when adjusting for age, sex, and days post-vaccination, each 100-cell increase in CD4+T-cell count was associated with 22% higher neutralizing antibody titers (GMR 1.22; 95% CI=1.09–1.37). Unsuppressed HIV RNA >200 was associated with 89% lower neutralizing antibody titers (GMR 0.11; 95% CI=0.01–0.84). Receipt of the BNT162b2 vs. mRNA-1273 vaccine was associated with 77% lower neutralizing titers (GMR 0.23; 95% CI=0.08–0.65) among PLWH. Post-mRNA Vaccination SARS-CoV-2 IgG Concentrations and Pseudovirus Neutralizing Titers by HIV Status and Vaccine Conclusion PLWH had lower than expected response to mRNA SARS-CoV-2 vaccines, with the highest non-response among those with low CD4+ counts, unsuppressed HIV RNA, and those who received the BNT162b2 vaccine. Immunization strategies to improve immune responses among PLWH should be studied, and may include booster vaccination or preference of the mRNA-1273 vaccine in this group. Disclosures Matthew A. Spinelli, MD, MAS, Nothing to disclose Monica Gandhi, MD, MPH, Nothing to disclose

PAH-CHD: transition to adulthood

Background A structured transition provides a framework of care that bridges the gap between paediatric and adult medicine. It is essential for achieving continuity of care and providing support and education around the challenging period of adolescence for young people with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). Presentation In this review of transition care in PAH-CHD, we evaluate the evidence supporting a structured programme of transition care and review the current principles and ‘best practice’ standards for transition in the UK. In the second part of the review, we highlight some important areas of education that are relevant to adolescents with PAH-CHD, including health education, exercise and participation in sports, pregnancy and contraception, employment, and driving. Conclusions As the number of young people embarking on transition continues to increase, the challenge is set to continue to improve the quality of care for our patients within the framework of available resources.

Paediatrics, ethics, and the law

Treating sick children creates a range of ethical and legal considerations that are different from adult medicine. Paediatrics adapts as children develop cognitively, physically, and in autonomy. The introduction of new vaccines, therapies, and technology has improved the outcome for many conditions, including preterm birth, CHD, and oncology. At the same time as improvements in medicine and technology has come increased societal expectation, the impact of social media, and the rise of obesity in childhood. There are complex and blurred lines to be negotiated in parental, individual clinician, and institutional responsibility, especially when things go wrong. Paediatrics involves complex cases of neglect and abuse of children that have occurred in all societies and cultures. In this chapter, some of these aspects are discussed, including an outline of ethical principles that allow us to frame decision-making, how the law in the United Kingdom has evolved, and some of the principles of the Children Act 1989 and the Human rights Act 1998.