No abstract

evere infection with COVID-19 has been linked to immune dysregulation, including impaired or delayed production of type I and type III interferons 1-5 , marked lymphopenia [6][7][8][9][10] and a paradoxical increase in pro-inflammatory cytokines, such as TNF-α, IL-1β and IL-6 1,4,6,[11][12][13] . Alteration of T cell compartments include increases in effector and activated CD4 and CD8 T cells [14][15][16][17] , CD8 + T cells contribute to survival in patients with COVID-19 and hematologic cancer

Based on the known and emerging biology of autoimmune diseases and COVID‐19, it was hypothesised that whilst B‐cell depletion should not necessarily expose people to severe SARS‐CoV‐2‐related issues, it may inhibit or blunt the protective immunity following infection and vaccination. This is supported clinically, as the majority of SARS‐CoV‐2 infected, CD20‐depleted people with autoimmunity, have recovered. However, in CD‐20 treated people until naïve B‐cells repopulate, based on B‐cell repopulation‐kinetics and vaccination responses, from published rituximab, and unpublished ocrelizumab (NCT00676715, NCT02545868) trial data shown here suggests that it may be possible to undertake dose‐interruption to maintain inflammatory disease control, whilst allowing effective vaccination against SARS‐CoV‐29, if and when an effective vaccine is available.

The aim of this paper is to consider the diagnostic criteria for tuberculosis in ancient populations. It investigates the frequency of periosteal new bone formation on the visceral surfaces of ribs from 1718 individuals from the Terry Collection, Smithsonian Institution, Washington D.C. and attempts to determine the aetiological factors producing these lesions. Numbers of individuals with lesions according to cause of death were recorded and the patterning of lesions compared between people who had died from tuberculosis and those whose cause of death was unrelated to a pulmonary disease. Rib lesions were more common in individuals dying from tuberculosis (61.6% or 157 of 255) than in individuals dying from other causes (15.2% or 165 of 1086). It is suggested that tuberculosis at a peripheral lung focus may disseminate directly through the pleura to the visceral surfaces of the ribs, or that pulmonary tuberculosis may be the cause of empyema of the pleural cavity and that this, per se, may initiate inflammatory change on the visceral surfaces of ribs. The nonrecognition or description of these often very subtle proliferative lesions on ribs by radiological examination of tuberculous victims is significant in the discussion of bone changes in tuberculosis. The possibility that individuals with no recorded history of tuberculosis at death actually suffered from the disease was considered in light of the frequency of rib lesions and noncorrelation with a tuberculous cause of death. Differential diagnoses are discussed including the possibility that the lesions represent a general non-specific indicator of stress.

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Farming is among the three most hazardous occupations in modern society and perhaps also held a similar position during the medieval period. The goal of this study was to determine if there is a significant difference in frequencies and patterns of longbone fracture trauma observed between rural and urban activity bases that distinguish farming as a particularly dangerous occupation during the medieval period. The longbones of 170 individuals excavated from Raunds, a rural medieval British site (10th-12th centuries AD) were examined for fractures and compared to data collected from four contemporary British medieval sites, one rural and three urban. The fracture frequency for the Raunds individuals (19.4%) was significantly different from the urban sites (4.7-5.5%). Female fractures were characterized by injury to the forearm, while the males were predisposed to diverse fracture locations. Clinical research provided a source of documented farm-related trauma from North America and Europe where the crops and animals raised, the manual chores performed, and the equipment used in traditional or small-scale farms have changed little in form or function since the medieval period. Nonmechanized causes of injury contribute to approximately 40% of all modern farm-related injuries and are attributed to falls from lofts and ladders, animal assaults and bites, and falls from moving vehicles. These hazardous situations were also present in the medieval period and may explain some of the fracture trauma from the rural sites. A high fracture frequency for both medieval males and females is significantly associated with farming subsistence when compared to craft-orientated urban dwellers.

Traumatic lesions are commonly found in the archeological record and have potential to provide insight into the lives of past populations. This paper examines patterns of long bone fractures in the British medieval population of St. Helen-on-the-Walls from York (approximately 1100-1550) in an effort to determine patterns of healing and evidence for treatment. Long bones were macroscopically and radiologically examined. Clinical data were used to assess whether a fracture had successfully or unsuccessfully healed. The results indicate that fractures of the radius and ulna were most common. Males displayed more fractures than women. Most fractures were healed, well aligned, and without substantial deformity. Lack of evidence for deformity in bones likely to be severely affected by fracture implied that immobilization and possibly reduction was practiced on even the poorest residents of the medieval city.

The aim of this study was to examine the evidence, and consider the differential diagnosis, for tuberculosis (TB) in juvenile individuals from early 20th century documented skeletons. There are 66 male and female juvenile individuals in the Coimbra Identified Skeletal Collection (CISC) with an age at death ranging from 7-21 years. The individuals died between 1904 -1936 in different areas of Coimbra, Portugal. Eighteen of these individuals died from TB affecting different parts of the body. Thirteen (72.2%) showed skeletal lesions that may be related to this infection. Of the 48 individuals with a non-tuberculous cause of death, only 2 (4.2%) had skeletal changes that could be attributed to TB. The distribution of skeletal manifestations caused by the types of TB under study, based on macroscopic and radiological findings, is described and discussed. In addition, the medical records from 6 tuberculous individuals who died in Coimbra University Hospital (CUH) were analysed, and the information, including their diet and access to treatment, is presented. This work, based on data arising before antibiotics became available for treatment, can contribute to the future diagnosis of TB in non-documented skeletal material, and will facilitate a more reliable diagnosis of TB in juvenile individuals. Am