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The safety and immunogenicity of a protein-based tetravalent vaccine SCTV01E that contains spike protein ectodomain (S-ECD) of Alpha, Beta, Delta and Omicron BA.1 are assessed and compared with bivalent protein vaccine SCTV01C (Alpha and Beta variants) and monovalent mRNA vaccine (NCT05323461). The primary endpoints are the geometric mean titers (GMT) of live virus neutralizing antibodies (nAb) to Delta (B.1.617.2) and Omicron BA.1 at day 28 post-injection. The secondary endpoints include the safety, day 180 GMTs against Delta and Omicron BA.1, day 28 GMTs to BA.5, and seroresponse rates of neutralizing antibodies and T cell responses at day 28 post-injection. 450 participants, comprising of 449 males and 1 female, with a median age (range) of 27 (18–62) years, are assigned to receive one booster dose of BNT162b2, 20 µg SCTV01C or 30 µg SCTV01E and completed 4-week follow-up. All SCTV01E related adverse events (AEs) are mild or moderate and no Grade ≥3 AE, serious AE or new safety concerns are identified. Day 28 GMT of live virus neutralizing antibodies and seroresponse against Omicron BA.1 and BA.5 with SCTV01E are significantly higher than those with SCTV01C and BNT162b2. These data indicate an overall neutralization superiority with tetravalent booster immunization in men. Here the authors present interim results from a clinical trial of a protein-based tetravalent SARS-CoV-2 vaccine (SCTV01E). SCTV01E demonstrates a comparable safety profile to a bivalent protein vaccine, while exhibiting superior immunogenicity compared to both a bivalent protein vaccine and an mRNA vaccine.

Background These Delphi recommendations aimed to establish regional consensus for the effective management of Cytomegalovirus (CMV) reactivation/infection and CMV disease following allogeneic hematopoietic stem cell transplantation (alloHSCT). Method A modified Delphi approach, comprising three rounds of anonymous questionnaires with field experts, was used. The first round included open-ended questions to identify and prioritize key topics, while the subsequent rounds focused on refining responses and reaching a consensus. A predefined consensus threshold of 70% agreement among panelists was used. Results After two rounds, a consensus was reached on 21 key questions related to the diagnosis and management of CMV reactivation and CMV disease post-alloHSCT. The panel identified these areas as priorities for future research or guideline refinement. Conclusion This Delphi study successfully established an expert consensus on pre-emptive therapy and prophylactic treatment for managing CMV reactivation and treatment strategies for CMV disease. The study findings, based on inputs from experts related to clinical practices in the region, can serve as an additional tool for clinical decision-making. Moreover, the panelists highlighted the unmet need for harmonizing diagnostic practices and thresholds among hematology centers in the Gulf region. Clinical trial number Not applicable.

Introduction Stress and pain are high among patients undergoing hemodialysis. Benson's Relaxation technique affected a wide range of physical and psychological signs and symptoms among patients undergoing hemodialysis. Objective To evaluate the effectiveness of Benson's Relaxation Technique in reducing stress and pain among patients undergoing maintenance hemodialysis. Materials and Methods A systematic review of randomized controlled trials was conducted. A systematic literature search was carried out from 2000 to 2023. Searched databases included EBSCO-Host “Academic Search, Cochrane, CINAHL, Health Business, MEDLINE, Psychology and Behavioral Sciences, SPORTDiscus”, PubMed, Ovid, and Google Scholar. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were conducted. RCTs were critically appraised using the Cochrane's Risk of Bias Tool. Four RCTs met the inclusion criteria and included in this review since they were applicable to practice. Results Four randomized controlled trials were identified supporting the use of Benson's relaxation technique as a nursing treatment in managing stress and pain among patients undergoing maintenance hemodialysis, as it achieved a significant decrease in stress and pain scores. The overall quality of the randomized controlled trials was judged to be low to relatively moderate. Conclusions Most of the randomized controlled trials lacked details on intervention adherence. It is recommended to conduct additional longitudinal randomized controlled trials in different countries with bigger sample sizes, to provide more evidence for generalizing outcomes.

Objectives To compare the yield of early combined use of chest X-ray (CXR) and chest computed tomography (CT) in patients diagnosed with community-acquired pneumonia (CAP) presenting to the emergency department (ED) and assess the impact of chest CT on the initial diagnosis. Methods The medical records of 900 patients who presented to the ED and were diagnosed with CAP over a 1-year period were reviewed, and 130 patients who underwent CXR and chest CT within 48 hours were selected. CXR findings were classified as positive, negative, or inconclusive for CAP. Chest CT findings were defined as positive, negative, inconclusive, or positive with add-on to the CXR findings. CT was classified as having no benefit, large benefit, or moderate benefit based on the chest CT and CXR findings. Results Chest CT results were positive in 90.7% of patients, with 41.5% being newly diagnosed after negative or inconclusive CXR and 21.5% being diagnosed with add-on to the CXR findings. CT had large, moderate, and no benefit over CXR in diagnosing or excluding CAP in 45.3%, 21.5%, and 33.1% of patients, respectively. Conclusion Early chest CT may be used to compliment CXR in the early diagnosis of CAP among patients in the ED.

Background/objectives: The outcome of refractory/relapsed systemic Anaplastic Large Cell Lymphoma (R/R-sALCL), especially for anaplastic lymphoma kinase-1 (ALK-1)-negative disease, remains dismal even after autologous hematopoietic stem cell transplantation (AHSCT). The intensification of both salvage and conditioning regimens, without increasing the toxicity, could improve the outcome of AHSCT in R/R-sALCL. Methods: Based on the successful experience of the incorporation of antiD20 monoclonal antibodies in the treatment of B-Cell Lymphomas, we designed a salvage and conditioning regimen incorporating the antiCD30-conjugated antibody (Brentuximab Vedotin, BV) to standard chemotherapy regimens, and we describe herein the clinical course of a patient with AKL-ve, R/R-sALCL, who received salvage regimen BV + DHAP, followed by AHSCT with preparative regimen consisted of BV plus standard BEAM. Results: The novel regimen was well tolerated, and no severe adverse effects were noticed. The engraftment was prompt and successful. The patient remained in complete metabolic remission for almost 12 months post-transplant. Conclusions: The proposed treatment approach, which combines antiCD30-conjugated antibody with standard salvage and conditioning regimens, demonstrated a completely acceptable toxicity with promising efficacy.

Tumor necrosis factor (TNF) inhibition has become a widely used biological therapy in patients with underlying autoimmune diseases and its association with increased risk for tuberculosis and other granulomatous diseases has been extensively studied recently.1 Non-tuberculous mycobacterial infections are also associated with the immune dysfunction caused by the use of immunomosdulatory drugs, mainly anti TNF-alpha (a), ranging from localized skin infection to disseminated disease.2,3 Psoriasis and psoriatic arthritis patients treated with anti-TNF are at higher risk of developing skin non-tuberculous mycobacterial infection due to the disease itself and the combined side effect of the medications used.4 The following case describes a skin infection with Mycobacterium marinum (M. marinum) associated with the use of golimumab, a fully human monoclonal antibody against TNF-a, in a patient with psoriatic arthritis. A 53-year-old female patient with psoriatic arthritis followed at the rheumatology-dermatology clinic presented for evaluation of a non-resolving indurated plaque over the base of the right fifth digit despite the use of local steroid and systemic treatment for her arthritis. Mycobacterium marinum is an atypical mycobacteria or mycobacteria other than Mycobacterium tuberculosis that is typically associated with fishes and water.5 Few cases of M. marinum infection were reported in patients treated with anti-TNF-a ranging from localized skin infection to disseminated disease.2,3 The literature mentions only six cases of psoriasis associated with M. marinum infection and anti-TNF-a was administered in all cases.4,6-9 This is another rare case of M. marinum sporotrichoid-like skin infection in a patient on anti-TNF-a treatment.

Amyloid deposition in the thyroid gland is a common presentation, yet amyloid goiter remains relatively rare. Proper differentiation of this condition from other goiter types and malignancies is essential. Although amyloid extensively invades the thyroid gland, patients are usually euthyroid, and many different presentations may occur. We report a case of a 42-year-old male patient who was diagnosed with secondary amyloidosis due to Behcet's disease. He presented with clinical manifestations of hyperthyroidism and systemic amyloidosis complicated by chronic kidney disease, which is the first case of such an entity to be reported in Palestine.

Despite its long-term history, haematopoietic stem cell transplantation (HSCT) still faces challenges in several countries under development and especially in the private health sector. In this retrospective analysis, we present our experience and the results of 48 adult patients who underwent HSCT (autologous 37, allogeneic 9) at a private-sector hospital in Abu Dhabi, United Arab Emirates (UAE). The main indications were multiple myeloma and acute myeloid leukaemia in the autologous and allogeneic setting, respectively. All patients successfully engrafted, and after a median follow-up of 6 (range: 1-11) months, 42 patients are alive (36 autografted and 6 allografted). The 1-year overall survival rates were 97% and 62% for autografted and allografted patients, respectively, while 4 patients died within 100 days post-transplant from treatment-related causes (1 patient from the autografted group and 3 patients from the allografted group). Our data confirm that HSCT is a feasible, safe, and effective treatment approach, offering high success rates to UAE patients with haematological malignant diseases.

Hematopoietic stem cell transplantation (HSCT) is increasingly indicated for various malignant and non-malignant diseases. In the United Arab Emirates (UAE), patients that could benefit from the procedure commonly need to seek medical care abroad in view of the lack of a comprehensive HSCT facility that could offer the full spectrum of interventions and monitoring protocols. This comes with considerable challenges related to coverage and logistics of travel. It also limits the continuity of clinical care, and presents inconvenience to patients who come from a different cultural background. In this article, we share our experiences and lessons learned during the establishment of the first comprehensive adult and pediatric HSCT unit in the UAE that is designed to cater for local citizens and residents, as well as neighboring countries facing similar availability challenges.