geoffrey modest medical blogs

  A recent VA study assessed mRNA vaccine effectiveness in veterans with cirrhosis (see  covid mRNA vaccine in cirrhosis jamaintmed2021  in dropbox, or doi:10.1001/jamainternmed.2021.4325 ).    Details:  -- mRNA vaccines were administered to 20,037 veterans (51% Moderna, 49% Pfizer), from Dec 18,2020 to March 17, 2021      -- 99.7% of those receiving a first dose who had a follow-up of least 42 days received a second dose  -- median age 69, 97% male, 45% age 60-70yo/43% 70-85yo, 61% white/23% Black/8% Latinx, 42% alcohol-associated cirrhosis, 77% overweight or obese, 52% diabetes, 39% current smoker/32% former  -- propensity matching for the control group (also 20,037 veterans as controls) to achieve similarity regarding age, sex, race or ethnicity, duration of follow-up, comorbidities, alcohol-associated liver disease, and severity of liver disease estimated by the Child-Turcotte-Pugh score  -- primary outcome: Covid-19 i...

  A French study documented an improved immunologic response after a third dose of the Pfizer vaccine in immunocompromised patients (see  covid immunocomp getting 3rd dose nejm2021  in dropbox or DOI: 10.1056/NEJMc2108861 )    Details:  -- 101 consecutive solid organ transplant recipients were given a third dose of the Pfizer vaccine  -- mean age 58, 62% men, in a retrospective study  -- transplant recipients: 78 kidney, 12 liver, 8 lung or heart, and 3 pancreas   -- time from transplant to initiating vaccination was 98 months  -- first two doses were given one month apart, third dose was 61 days after the second dose  -- medications: glucocorticoids 87%, calcineurin inhibitors 79%, mycophenolic acid 63%, mammalian target of rapamycin inhibitors 30%, belatacept 12%  -- antibody levels were assessed against the SARS-CoV-2 spike protein    Results:  -- prevalence of anti-SARS-CoV-2 antibodies:   ...