Coronavirus disease 2019 (COVID-19) is caused by the novel SARS-CoV-2 virus and has been declared a pandemic on the 9th of March by the WHO. A hallmark of COVID-19 management is supportive care and there is still no convincing evidence for a treatment which will reduce mortality. Severe COVID-19-associated sepsis characterized by acute respiratory distress syndrome (ARDS), secondary bacterial pneumonias, thrombotic complications, myocarditis, and gastrointestinal involvement are more prevalent in those with comorbidities such as hypertension, diabetes, cardiac disease, cancer and age >70 years. 1,2 There is a paucity of data on COVID-19's impact on bone marrow transplant patients. Herein we reflect on the course of seven bone marrow transplant recipients in Birmingham Heartlands Hospital who have been found positive for SARS-CoV-2 RNA on real time polymerase chain reaction (RT-PCR) from nasopharyngeal swabs done in the context of symptoms (fever, cough, dyspnoea, and fatigue) or inpatient contact. The median age was 61 years (range 40-74). Out of these, five (71%) were female and two (29%) were male. The median time from stem cell infusion to the diagnosis of SARS-CoV-2 virus was 61 days (range 7-343). Patients were screened for SARS-CoV-2 via an RT-PCR-based technique.

B cell depleting agents are amongst the most commonly used drugs to treat haemato-oncological and autoimmune diseases. They rapidly induce a state of peripheral B cell aplasia with the potential to interfere with nascent vaccine responses, particularly to novel antigens. We have examined the relationship between B cell reconstitution and SARS-CoV-2 vaccine responses in two cohorts of patients previously exposed to B cell depleting agents: a cohort of patients treated for haematological B cell malignancy and another treated for rheumatological disease. B cell depletion severely impairs vaccine responsiveness in the first 6 months after administration: SARS-CoV-2 antibody seroprevalence was 42.2% and 33.3% in the haemato-oncological patients and rheumatology patients respectively and 22.7% in patients vaccinated while actively receiving anti-lymphoma chemotherapy. After the first 6 months, vaccine responsiveness significantly improved during early B cell reconstitution, however, the kinetics of reconstitution was significantly faster in haemato-oncology patients. The AstraZeneca ChAdOx1 nCoV-19 vaccine and the Pfizer BioNTech 162b vaccine induced equivalent vaccine responses, however shorter intervals between vaccine doses (<1m) improved the magnitude of the antibody response in haeamto-oncology patients. In a subgroup of haemato-oncology patients, with historic exposure to B cell depleting agents (>36m previously) vaccine non-responsiveness was independent of peripheral B cell reconstitution. The findings have important implications for primary vaccination and booster vaccination strategies in individuals clinically vulnerable to SARS-CoV-2.

Introduction. Acute urinary retention in a child is rare. Haematocolpos can cause a mechanical obstruction, resulting in acute urinary retention. Case Report. A 12-year-old girl presented to the surgical department with a one-day history of acute urinary retention and suprapubic tenderness. She had not started menses but had described period-like pains every month for the past six months. On examination, she had a palpable bladder with over 500 mls of residual urine and a bluish-grey bulge posterior to her urethral meatus. An US scan showed a large mass posterior to her bladder resembling a haematocolpos, and this was confirmed with an MRI scan. She was catheterised and eventually underwent a hymenectomy using a cruciate incision. She made a good recovery postoperatively. Conclusion. In the case of a peripubertal female presenting with acute urinary retention, haematocolpos should be considered as a diagnosis.

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