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Hypogammaglobulinemia commonly presents with chronic diarrhea. Unfortunately, these patients require intravenous immunoglobulin (IVIG) transfusions of 400–800 mg/kg every 3–4 weeks as a standard treatment for hypogammaglobulinemia. Repeated transfusion of IVIG is costly, and many patients may not be able to afford it. We report the case of a young male with chronic small intestinal diarrhea who was later diagnosed with hypogammaglobulinemia. We treated the patient with fresh-frozen plasma (FFP) and the patient responded favorably. FFP transfusion may be an affordable alternative to IVIG in the treatment of hypogammaglobulinemia.

Abstract Background and aims Endoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) is a therapeutic option for patients with gastric outlet obstruction (GOO), which provides long‐term luminal patency without the risk of tumor ingrowth and/or overgrowth and avoids surgical morbidity. The goal of this study was to assess technical success, clinical success, and adverse events associated with a nasojejunal tube‐assisted EUS‐ GJ technique. Methods This was a retrospective study conducted at a single tertiary care center. The nasojejunal tube (14F) was used to perform the EUS‐GJ (device‐assisted method). During the study period, consecutive GOO patients who underwent EUS‐GJ between August 2018 and December 2021 were included. Technical success was defined as adequate positioning and deployment of the stent. The patient's ability to tolerate a normal oral diet without vomiting was defined as clinical success. Results Thirty patients underwent EUS‐GJ during this study period. Twenty‐six patients had malignant GOO, while four had a benign obstruction. EUS‐GJ was successfully performed in 29 patients, and technical success was 96.67% (29/30). Nasojejunal tube‐assisted EUS‐GJ technique was used in all patients. Clinical success was achieved in all patients who had technical success (29/29, 100%). The adverse events rate was 6.6%. During the procedure, the median procedure time was 25 min (interquartile range 15–42.5), and the average hospitalization was 4.4 days. Normal meals were tolerated by all patients. After 210 days of median follow‐up (range 5–880 days), no recurrence of symptoms was observed. Conclusion The nasojejunal tube‐assisted EUS‐GJ is a safe and effective technique to treat GOO symptoms.

Introduction: Data are limited on antibody response to the ChAdOx1 nCoV-19 vaccine (AZD1222; Covishield®) in cirrhosis. We studied the antibody response following two doses of the ChAdOx1 vaccine, given 4–12 weeks apart, in cirrhosis. Methods: Prospectively enrolled, 131 participants (71% males; age 50 (43–58); alcohol-related etiology 14, hepatitis B 33, hepatitis C 46, cryptogenic 21, autoimmune 9, others 8; Child–Turcott–Pugh class A/B/C 52/63/16). According to dose intervals, the participants were grouped as ≤6 weeks (group I), 7–12 weeks (group II), and 13–36 weeks (group III). Blood specimens collected at ≥4 weeks after the second dose were tested for anti-spike antibody titre (ASAb; positive ≥ 0.80 U/mL) and neutralizing antibody (NAb; positive ≥20% neutralization) using Elecsys Anti-SARS-CoV-2 S (Roche) and SARS-CoV-2 NAb ELISA Kit (Invitrogen), respectively. Data are expressed as number (proportion) and median (interquartile range) and compared using non-parametric tests. Results: Overall, 99.2% and 84% patients developed ASAb (titre 5440 (1719–9980 U/mL)) and NAb (92 (49.1–97.6%)), respectively. When comparing between the study groups, the ASAb titres were significantly higher in group II than in group I (2613 (310–7518) versus 6365 (2968–9463), p = 0.027) but were comparable between group II and III (6365 (2968–9463) versus 5267 (1739–11,653), p = 0.999). Similarly, NAb was higher in group II than in group I (95.5 (57.6–98.0) versus 45.9 (15.4–92.0); p < 0.001), but not between the groups II and III (95.5 (57.6–98.0) versus 92.4 (73.8–97.5); p = 0.386). Conclusion: Covishield® induces high titres of ASAb and NAb in cirrhosis. A higher titre is achieved if two doses are given at an interval of more than six weeks.

A lead-free series of 1−x(K0.4Na0.6Nb0.96Sb0.04O3)-x(Bi0.5 K0.5TiO3) (0.00 ≤ x ≤ 0.07) composites were prepared by the conventional solid-state reaction route. Rietveld's refined XRD pattern revealed phase transitions from orthorhombic (Amm2) to rhombohedral (R3m) and rhombohedral to tetragonal (P4mm) with x = 0.03 and 0.05 content of (Bi0.5K0.5TiO3). SEM images reveal that the microstructure consists of small, randomly oriented, well-inter-linked, and non-uniform-shaped grains. Dielectric study indicates that Curie temperature (TC) decreases from 340 to 160 °C as the BKT content increases from x = 0.00 to 0.07 and the first transition temperature shifts below room temperature. The complex modulus plots exhibited two semicircles, confirming the ceramics' presence of bulk grain and grain boundary. The impedance and modulus plots confirm the presence of a non-Debye type of relaxation in the ceramics. The ac conductivity increases with a rise in the temperature, confirming negative temperature coefficient resistance (NTCR) behavior. Therefore, conductivity may increase due to the charge carrier hopping rate or the oxygen vacancies (V″O). [ABSTRACT FROM AUTHOR]

Introduction: Data are limited on antibody response to the ChAdOx1 nCoV-19 vaccine (AZD1222; Covishield®) in cirrhosis. We studied the antibody response following two doses of the ChAdOx1 vaccine, given 4–12 weeks apart, in cirrhosis. Methods: Prospectively enrolled, 131 participants (71% males; age 50 (43–58); alcohol-related etiology 14, hepatitis B 33, hepatitis C 46, cryptogenic 21, autoimmune 9, others 8; Child–Turcott–Pugh class A/B/C 52/63/16). According to dose intervals, the participants were grouped as ≤6 weeks (group I), 7–12 weeks (group II), and 13–36 weeks (group III). Blood specimens collected at ≥4 weeks after the second dose were tested for anti-spike antibody titre (ASAb; positive ≥ 0.80 U/mL) and neutralizing antibody (NAb; positive ≥20% neutralization) using Elecsys Anti-SARS-CoV-2 S (Roche) and SARS-CoV-2 NAb ELISA Kit (Invitrogen), respectively. Data are expressed as number (proportion) and median (interquartile range) and compared using non-parametric tests. Results: Overall, 99.2% and 84% patients developed ASAb (titre 5440 (1719–9980 U/mL)) and NAb (92 (49.1–97.6%)), respectively. When comparing between the study groups, the ASAb titres were significantly higher in group II than in group I (2613 (310–7518) versus 6365 (2968–9463), p = 0.027) but were comparable between group II and III (6365 (2968–9463) versus 5267 (1739–11,653), p = 0.999). Similarly, NAb was higher in group II than in group I (95.5 (57.6–98.0) versus 45.9 (15.4–92.0); p < 0.001), but not between the groups II and III (95.5 (57.6–98.0) versus 92.4 (73.8–97.5); p = 0.386). Conclusion: Covishield® induces high titres of ASAb and NAb in cirrhosis. A higher titre is achieved if two doses are given at an interval of more than six weeks. [ABSTRACT FROM AUTHOR]