Analysis of Experiences in Preventing COVID-19 in Hemodialysis Centers of the North of Poland before the Era of Vaccination

Background: The appearance of very contagious SARS-CoV-2 variants and waning vaccine immunity may indicate the need to return to using universal methods of preventing the spread of COVID-19. Methods: We performed a multicenter retrospective cohort survey study to describe the methods used in dialysis units to prevent and control the spread of SARS-CoV-2 and also the association between these methods and the incidence of COVID-19 among hemodialyzed (HD) patients before the era of vaccination. The study population included all maintenance HD patients (n = 1569) in 14 dialysis units in the Pomeranian Voivodeship. Results: The group of 352 patients (199 men, 153 female) were confirmed for COVID-19. The absolute cumulative incidence in the studied period was 22.4%. It varied widely by dialysis units, ranging from 9.4% to 36.9%. Universal preventive methods were applied by all units. Different additional methods were implemented in some stations with varying frequency (36–86%). In order to quantify the scale of the applied additional preventive methods, we calculated a summary prevention index (PI), i.e., one point for one additional method. Lower incidence was found in centers applying dialysis in isolation of patients hospitalized due to diseases requiring hospitalization (17.42% ± 6.89 vs. 26.54 ± 6.34; p = 0.028) and higher incidence in medium-size dialysis centers (ANOVA F: p = 0.017). Significant inverse correlation between PI and incidence was demonstrated as well (r = −0.759; p = 0.002). Conclusions: The higher the number of implemented preventive measures, the lower the risk of COVID-19 infection in HD patients. Among applied procedures the isolation of hospitalized patients is of significant importance. The measures proved to be effective in prevention before the vaccination era should be continued, as the threat of SARS-CoV-2 still exists.

Does serum Vitamin D affect lipid profile?

Introduction and Aim: Vitamin D, besides its classical physiological functions, exerts effects on brain, prostate, breast, colon, pancreas, and immune cells due to the ubiquitous presence of its receptors. Hypovitaminosis D predisposes individuals to various micro and macro vascular complications of metabolic syndrome and diabetes mellitus. Despite speculations regarding implications of its deficiency on the cardio metabolic health of general/ susceptible population, its role remains underexplored in the Indian population. Materials and Methods: This cross-sectional study carried out in Biochemistry Department of the institution, recruited 219 patients (after obtaining written consent) of both genders above18 years who underwent Vitamin D testing. Blood samples obtained were assayed for HbA1c, C Reactive protein, thiol and lipid. Kruskal Wallis test and Spearman correlation were employed for statistical analysis. Results: Significantly low HDL and high atherogenic index of plasma (AIP) were observed in males with vitamin D deficiency. Significant inverse correlation of vitamin D with CRP and total cholesterol (among vitamin D deficient males) was observed. A significant inverse correlation between serum HDL and AIP and a significant direct correlation between triglyceride and AIP were observed irrespective of their vitamin D status. Heat map showed marginally elevated lipid parameters among vitamin D insufficient males. Conclusion: Vitamin D may emerge as a surrogate marker in risk stratification of patients with diabetes and dyslipidaemia. More insights are required to assess the gender specific susceptibility to dyslipidaemia and atherosclerosis in relation to vitamin D levels.

Relationship between external weather conditions and number of hibernating bats in two caves in the western Italian Alps

Weather conditions can influence the hibernation behaviour of temperate cave-dwelling bats that are tolerant to low temperatures, and their number can be correlated with weather variables. In this work a first assessment on the correlation between the number of individuals of three species of hibernating bats (Barbastella barbastellus, Myotis emarginatus and Rhinolophus hipposideros) and the environmental weather conditions before the survey was carried out is provided for two hibernacula of the Italian Western Alps. For the B. barbastellus, a significant inverse correlation was observed between the number of bats detected and the average daily temperature for thirty days preceding the count (p= 0.036) and ten days before counting (p= 0.036). A significant positive correlation was observed for M. emarginatus between the number of individuals and the average daily temperatures for thirty days preceding the count (p= 0.018). For R. hipposideros, a significant inverse correlation was observed with the average daily temperatures for the ten days before the count (p= 0.048) and the differences in the maximum and minimum temperature of the ten days preceding the count (p= 0.002). Results of this study show how the ambient temperatures before a count can influence the number of bats present in hibernacula. This confirms how the abundance of bats at underground hibernating sites can be used as an indicator of climate change, as temperature is an important factor controlling hibernation, although further studies are needed in order to better evaluate how the climatic variables interact with each other in regulating the number of bats in the hibernacula.

The Role of Hemoglobin and Hemolysis on Transcranial Doppler Velocities in Children with Sickle Cell Disease: Data from a Natural History Cohort

Background: Children with sickle cell disease (SCD) are at increased risk of cerebrovascular events that can impact neurocognitive development and quality of life (Colombatti 2016). Transcranial Doppler ultrasound (TCD) is a validated screening tool to identify pediatric SCD patients with the highest risk of stroke to start on a preventive chronic blood transfusion regimen (Estcourt 2020; Inusa 2019). High TCD velocities are an indication to start disease-modifying treatments or consider disease-curative options in children with SCD (Khemani 2019). However, real-world pediatric data on the correlation between hematological variables and TCD results are scarce (Salama 2020). We aimed to evaluate the distribution of TCD velocities in a pediatric natural history cohort and investigate their correlation with hematological variables and treatments. Methods: We performed a retrospective analysis on data from a prospective pediatric cohort followed from January 1,2009, to December 31, 2020 (censoring date). Standard care includes annual TCD from 2 years of age. We used transcranial Doppler imaging (TCDi) and classified results according to STOP criteria, considering terminal internal carotid artery (TICA) and middle cerebral artery (MCA) time-averaged maximum mean velocities (TAMMVs). Only complete exams with right and left measures available for both vessels were included. Hematological, clinical, and treatment variables were available from the natural history cohort database. Patients were divided according to genotype: HbSS/HbSβ 0 or HbSC/HbSβ +. Two-sample and Welch t-tests for unequal variances were used to compare mean hemoglobin (Hb) values and hemolysis markers in patients with and without abnormal/conditional TCDi results. Fisher and chi-square tests were used to compare categorical variables. Linear regression models were used to assess the effects of MCA and TICA TAMMVs as continuous variables on Hb. Odds ratios (ORs) for neurological events at different Hb levels were estimated using generalized estimated equations (GEE) with a binomial distribution, logistic function, and exchangeable correlation structure, allowing for correlation among repeated observations for the same patient. Multivariable GEE including characteristics and treatment variables were used to evaluate the association between neurological events and Hb. Results: Of the 182 SCD patients in the cohort, 169 had assessments of cerebral vasculopathy, and 155 had evaluable TCDi (583 exams). The median follow-up of the entire cohort was 79.8 months (range: 2.1-298.6 months) (interquartile range [IQR]: 36.9-126.3 months). The median age at the censoring date was 13.4 years (IQR: 9.1-17.5 years); 130 were HbSS/HbSβ 0, and 25 were HbSC/HbSβ +. Basic demographic characteristics of the cohort are in Table 1. The distribution of TCDi results was significantly different between genotypes (P<0.0001): in the HbSC/HbSβ + group (70 exams), 14 were normal (20.0%), and 56 were low (80.0%); in the HbSS/HbSβ 0 group (513 exams), 8 were abnormal (1.6%), 56 were conditional (10.9%), 311 were normal (60.6%), and 138 were low (26.9%). Only 37/138 (26.8%) low TCDi results were confirmed as stenosis at the nearest MRA. Patients with abnormal/conditional TCDi results had lower Hb (8.4 vs 8.9 g/dL, P≤0.0001) and higher reticulocyte counts (317,766 vs 262,750/mm 3, P≤0.0001), lactate dehydrogenase (843 vs 690 U/L, P=0.0012), and aspartate aminotransferase (61 vs 54 U/L, P=0.0007) compared with patients with normal/low results. We detected a linear correlation between TICA/MCA TAMMVs and Hb (Figure 1A and 1B). Univariate analysis showed significant inverse correlation between abnormal/conditional TCDi results and Hb considered as a continuous variable (OR: 0.484, P<0.001). In the multivariate analysis, the correlation between TCDi results and Hb remained significant; moreover, the risk of presenting abnormal/conditional TCDi results decreased with age (OR: 0.833, P<0.0064). Conclusions: This analysis from our natural history cohort shows a significant inverse correlation between Hb and MCA and TICA velocities, supporting the beneficial effect of higher Hb levels in reducing TAMMV. Disease-modifying therapies increasing Hb and reducing hemolysis could be helpful in reducing TAMMV in children with SCD. Funding: This study was supported by Global Blood Therapeutics. Figure 1 Figure 1. Disclosures Agodoa: Global Blood Therapeutics: Current Employment, Current equity holder in publicly-traded company. Beaubrun: Global Blood Therapeutics: Current Employment, Current equity holder in publicly-traded company. Biffi: BlueBirdBio: Consultancy, Other: Advisory Board. Colombatti: Global Blood Therapeutics: Research Funding; Addmedica: Consultancy; Forma Therapeutics: Consultancy; Novartis: Consultancy; NovoNordisk: Consultancy; BlueBirdBio: Consultancy; Global Blood Therapeutics: Consultancy; BlueBirdBio: Research Funding.

Six-month decline of serum anti-spike S1 subunit IgA in SARS-CoV-2 in seronegative healthcare workers after mRNA-based COVID-19 vaccination

Background: Since serum anti-SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) IgA antibodies correlate with secretory anti-SARS-CoV-2 IgA and contribute to virus neutralization, we planned an observational study to measure serum anti-SARS-CoV-2 IgAs kinetics throughout a 6-month period in coronavirus disease 2019 (COVID-19) vaccine recipients.Methods: The study sample consisted of 97 baseline SARS-CoV-2 seronegative healthcare workers (median age 42 years and IQR 31-52 years; 52 females), who underwent vaccination with Pfizer/BioNTech Comirnaty mRNA-based vaccine (two 30 µg doses, 21 days apart). Serum samples were collected at baseline, before the second vaccine dose (i.e., day 21), and then 51, 111 and 201 days after enrolment (i.e., 1, 3 and 6 months after the second vaccine dose). Serum anti-SARS-CoV-2 spike S1 subunit IgA were measured with Anti-SARS-CoV-2 ELISA IgA (Euroimmun, Lübeck, Germany).Results: Anti-SARS-CoV-2 spike S1 subunit IgA displayed a peak at 1 month after the second vaccine dose, but then progressively waned afterwards. The 6-month serum anti-spike S1 subunit IgA concentration was 71% lower than the peak concentration. The rate of subjects with positive IgA values was 0% at baseline, 80.4% at day 21, 97.9% at day 51, but then declined to 73.2% and 53.6% at 3 and 6 months after the second vaccine dose. Serum anti-spike S1 subunit IgAs measured at 111 and 201 days was significantly lower than at the 51-day peak (both p<0.001). Significant inverse correlation was found between anti-SARS-CoV-2 IgA antibodies decline at 6 months/ and recipients’ age (r=-0.24; p=0.019).Conclusion: These findings may provide possible explanation to decreased efficacy of COVID-19 vaccines in preventing SARS-CoV-2 infection 6 months after vaccination.

Serial Measurements of Circulating KL-6, SP-D, MMP-7, CA19-9, CA-125, CCL18, and Periostin in Patients with Idiopathic Pulmonary Fibrosis Receiving Antifibrotic Therapy: An Exploratory Study

Idiopathic pulmonary fibrosis (IPF) is a progressive and inevitably fatal disease with a heterogeneous clinical course. This study aimed to evaluate the usefulness of circulating biomarkers in routine IPF clinical practice. We conducted an exploratory study in a cohort of 28 IPF subjects qualified for anti-fibrotic therapy with up to 24 months serial measurements of seven IPF biomarkers, including those that are well-established, Krebs von den Lungen-6 (KL-6), surfactant protein D (SP-D), matrix metalloproteinase 7 (MMP-7), and more recently introduced ones, cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA-125), chemokine (C-C motif) ligand 18 (CCL18), and periostin. Among studied biomarkers, SP-D had the highest diagnostic accuracy to differentiate IPF subjects from controls, followed by MMP-7 and KL-6. At each study timepoint, KL-6 levels correlated inversely with forced vital capacity % predicted (FVC% pred.), and transfer factor of the lung for carbon monoxide % predicted (TL,CO% pred.), while SP-D levels correlated inversely with FVC% pred. and TL,CO% pred. at 24 months of anti-fibrotic therapy. Baseline KL-6 and CA19-9 concentrations were significantly elevated in patients with progressive disease in comparison to patients with stable disease. In addition, in the progressors subgroup CA19-9 concentrations significantly increased over the second year of study follow-up. In patients with progressive disease, we observed a significant inverse correlation between a change in SP-D levels and a change in FVC% pred. in the first year of treatment, whereas in the second year a significant inverse correlation between a change in KL-6 levels and a change in FVC% pred. was noted. Our study findings support the view that both well-established IPF biomarkers, including KL-6, SP-D, and MMP-7, and more recently introduced ones, like CA19-9, have the potential to support clinical practice in IPF.

The Dependence of Renal 68Ga[Ga]-DOTATOC Uptake on Kidney Function and Its Relevance for Peptide Receptor Radionuclide Therapy with 177Lu[Lu]-DOTATOC

Background: In addition to its SSTR-specific binding in tumors and healthy tissues, DOTATOC analogues accumulate in kidney parenchyma. Renal tracer uptake might be a surrogate of kidney function or dysfunction. This study aimed to evaluate if kidney function can be estimated from 68Ga[Ga]-DOTATOC uptake in PET/CT and its impact on the nephrotoxicity of 177Lu[Lu]-DOTATOC PRRT. Methods: Two cohorts of patients (A: 128 diagnostic patients; B: 32 PRRT patients) were evaluated retrospectively. SUV values of the kidneys, physiologically SSTR-expressing organs and in background compartments were assessed. Kidney function was calculated as eGFR by CKD-EPI creatinine equation. Pearson’s correlation coefficients and treatment-induced changes of uptake and kidney function were assessed and compared. Results: Kidney function and renal DOTATOC uptake showed a significant inverse correlation (R2 = 0.037; p = 0.029). Evaluated models of PET/CT measurements were not able to predict kidney function sufficiently. The uptake of other organs did not depend on eGFR. While the renal uptake increased after PRRT (p < 0.001), the kidney function did not change significantly (p = 0.382). Neither low pre-therapeutic eGFR nor high pre-therapeutic kidney uptake were risk factors of PRRT-induced deterioration in kidney function. Conclusion: The relevance of kidney function for renal 68Ga[Ga]-DOTATOC uptake is limited. The nephrotoxicity of 177Lu[Lu]-DOTATOC PRRT might be low and cannot be reliably predicted by pre-therapeutic measurements.

Age- and airway disease related gene expression patterns of key SARS-CoV-2 entry factors in human nasal epithelia

The global COVID-19 pandemic caused by SARS-CoV-2 predominantly affects the elderly. Differential expression of SARS-CoV-2 entry genes may underlie the variable susceptibility in different patient groups. Here, we examined the gene expression of key SARS-CoV-2 entry factors in mucosal biopsies to delineate the roles of age and existing chronic airway disease. A significant inverse correlation between ACE2 and age and a downregulation of NRP1 in patients with airway disease were noted. These results indicate that the interplay between various factors may influence susceptibility and the disease course.

The Role of Transferrin and Laminin Biomarkers in the Diagnosis of Diabetic Nephropathy in Type II Diabetic Patients

Background/Aim: Diabetic nephropathy is one of the most important microvascular complications associated with type II diabetic patients. It occurs in 20-40% patients with diabetes mellitus, and microalbuminuria is still considered as the first sign of diabetic nephropathy. Low sensitivity and specificity of microalbuminuria leads to more sensitive biomarkers that may be used to detect diabetic nephropathy at an earlier stage with higher accuracy. This study was carried out to detect the validity of using serum Transferrin and Laminin as a diagnostic biomarkers for diabetic nephropathy in type ΙΙ diabetic patients. Methods: Egyptian patients (n=96) included 72 type 2 diabetic patients who were classified into three groups: group 1 - normoalbuminuric patients (uACR up to 30 mg/g), group 2 - microalbuminuric patients (uACR from 30 – 300 mg/g), group 3 - macroalbuminuric patients (uACR from >300 mg/g) and 24 healthy control were surveyed in a cross-sectional study over a period of 6 months at biochemistry department, KASR ALAINY Hospital of Cairo University. Patients were subjected to measurement of Albumin creatinine ratio, eGFR, Serum creatinine, glycosylated hemoglobin (HbA1c) and lipid profile. The serum concentrations of transferrin and lamnin were measured using a highly sensitive one-step sandwich enzyme immunoassay kit. Results: Serum laminin was significantly higher in macroalbuminuric patients than in the microalbuminuric and in microalbuminuric patients than in the normoalbuminuric and healthy control subject. By comparing these goups according to serum laminin concentration we found statistically significant positive correlation (p value <0.001, r= 0.670), serum transferrin was significantly lower in macroalbuminuric patients than in the microalbuminuric and in microalbuminuric patients than in the normoalbuminuric and healthy control subject. By comparing these goups according to serum transferrin concentration we found statistically significant inverse correlation (p value <0.001, r= -0.579). There was no correlation between level of serum transferrin /laminin and glycoregulation, and statistically significant positive correlation was found between serum laminin and duration of diabetes and statistically significant inverse correlation was found between serum transferrin and duration of diabetes. Conclusions: The results from this study provide the evidence that serum laminin and transferrin could be used as a diagnostic markers of diabetic nephropathy.

Communication Patterns and Related Factors among Iranian Couples: A Cross-sectional Study

Background: Given the effect of various factors on the use of communication patterns by couples, this study aimed to determine the most common communication pattern among couples and related factors in Sari, northern Iran. Methods: This cross-sectional study was performed on 520 people (260 couples) in Sari. Data were collected using a demographic–fertility factors questionnaire, Enrich couple scale, communication patterns questionnaire, general health questionnaire (GHQ-28), and NEO personality inventory. Data analysis was performed in SPSS version 25 using descriptive and inferential statistics (multiple regression model). Results: While the mean (standard deviation) age of women included in the study was 34.08 (7.71) years, the mean age of men was 39.13 (9.18) years. The most common communication patterns in both women and men was the mutual constructive communication, whereas the lowest frequent communication pattern was the demand/withdraw communication in both men and women. Marital satisfaction had a significant positive correlation with mutual constructive communication pattern in women and men (P = 0.001). In addition, a significant inverse correlation was observed between the number of marriage to date, women’s age, and spouses' demand/withdraw communication pattern with mutual constructive communication pattern in women. Also, a significant inverse correlation was observed between flexibility (P = 0.047), number of marriages (P = 0.013), and the wives' age (P = 0.005) with mutual constructive communication pattern in men. Conclusion: According to the results of the study, it is necessary to recognize the factors related to couples’ communication patterns in order to improve the communication patterns so that marital conflicts could be avoided while a more effective communication is established. Keywords: communication patterns, couples, personality characteristics, marital satisfaction, public health