Background Urinary tract infections (UTI) are common in renal transplant recipients. Trimethoprim/Sulfamethoxazole (TMP/SMZ) in moderate to high daily doses prevents Pneumocystis jiroveci (PCP) and reduces the risk of UTI in renal transplant patients. Low dose TMP/SMZ also reduces the risk of PCP, though its ability to reduce the risk of UTI is uncertain. Design Retrospective review of 158 patients who received a renal transplant without corticosteroids for maintenance immunosuppression. Results Forty percent of patients initially prescribed TMP/SMZ ultimately stopped this medication early due to an adverse reaction. Urinary infection occurred in 16%, without a significant difference in the risk of UTI between those treated with dapsone versus those treated with TMP/SMZ (HR[95%CI]: 1.7 [0.75, 3.9], p=0.2). In the subset of patients who were older than age 47 years, (mean age for this cohort, SD +/−6.2 years) those treated with dapsone originally or who switched from TMP/SMZ to dapsone had a greater risk of UTI compared to patients who remained on TMP/SMZ (HR[95%CI]: 4.3 [1.2, 15.5], p=0.024). Conclusions For renal transplant recipients over the age of 47 years, treated without long-term glucocorticoids, our retrospective data suggest low dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis.

Background Studies have demonstrated that mRNA-based SARS-CoV-2 vaccines are highly effective among dialysis patients. Because individual vaccines may be differentially available or acceptable to patients, it is important to understand comparative effectiveness relative to other vaccines, such those based on adenovirus technologies. Methods In this retrospective study, we compared the clinical effectiveness of adenovirus vector-based Ad26.COV2.S (Janssen/Johnson & Johnson) to mRNA-based BNT162b2 (Pfizer/BioNTech) in a contemporary cohort of dialysis patients. Patients who received a first BNT162b2 dose were matched 1:1 to Ad26.COV2.S recipients based on date of first vaccine receipt, US state of residence, site of dialysis care (in-center versus home), prior history of COVID-19, and propensity score. The primary outcome was the comparative rate of COVID-19 diagnoses starting in the seventh week postvaccination. In a subset of consented Ad26.COV2.S patients, blood samples were collected ≥28 days after vaccination and anti-SARS-Cov-2 immunoglobulin G antibodies were measured Results A total of 2572 matched pairs of patients qualified for analysis. Cumulative incidence rates of COVID-19 did not differ for BNT162b2 versus Ad26.COV2.S. No differences were observed in peri-COVID-19 hospitalizations and deaths among patients receiving BNT162b2 versus Ad26.COV2.S who were diagnosed with COVID-19 during follow-up. Results were similar when excluding patients with prior history of COVID-19, in subgroup analyses restricted to patients who completed the two-dose BNT162b2 regimen, and in patients receiving in-center hemodialysis. SARS-CoV-2 antibodies were detected in 59.4% of 244 patients who received Ad26.COV2.S. Conclusions In a large real-world cohort of dialysis patients, no difference was detected in clinical effectiveness of BNT162b2 and Ad26.COV2.S over the first 6 months postvaccination, despite an inconsistent antibody response to the latter.

patent ductus arteriosus, infective endocarditis, congenital heart disease, transthoracic echocardiographyA 25-year-old man with a history of "childhood murmur" was admitted to our institution Figure 1. Transthoracic echocardiogram, parasternal short axis view at cardiac base (Zoom on main pulmonary artery). A high-velocity jet (PDA) is seen directed from the inferior aspect of the MPA (I indicated with arrow) just above the pulmonary bifurcation. The jet flows superiorly to the mass (indicated with arrow) residing in the MPA.with a 1-week history of left-sided chest pain, dyspnea, fevers, and night sweats. On examination, his blood pressure was 110/75 mmHg, pulse 90/min, and temperature 38.7 • C. There was no jugular venous distention, and his lungs were clear to auscultation. There was a harsh, continuous murmur of III/VI in intensity at the

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