ABSTRACT
Since the start of the COVID-19 pandemic, the recognition and management of thrombotic complications has become a clinical challenge, either in severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) patients or in those receiving vector-based COVID-19 vaccination. In addition to blood clot formation, platelets can also respond to a variety of inflammatory cytokines and act in concert with circulating leukocytes to prevent pathogen infection. Herein, we review the basic biological roles of platelets in infection/inflammation, tools for assessment, and mechanisms of platelet activation to elucidate their immune regulatory roles. Copyright (C) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
ABSTRACT
Currently, vaccination against coronavirus disease (COVID-19) is being conducted worldwide, and studies on its side effects are required to evaluate its safety. We report a case of Guillain-Barré syndrome (GBS) after vaccination with ChAdOx1/nCoV-19. A healthy 32-year-old man presented with mild weakness in his bilateral upper extremities 19 days after the vaccination. At 24 days after the vaccination, nerve conduction study showed demyelinating neuropathy in the bilateral upper and lower extremities. Intravenous immunoglobulin (IVIg) was administered over 5 days, and at the 2-week follow-up after finishing IVIg treatment, the weakness in the upper extremities was fully resolved. Although GBS is an uncommon side effect after COVID-19 vaccination, clinicians should be aware of its possible occurrence. When a patient complains of weakness after COVID-19 vaccination, clinicians should consider the possibility of GBS development. © 2022, ASEAN Neurological Association. All rights reserved.
ABSTRACT
Background: Our study evaluates the efficacy of an outpatient personalized multidisciplinary intervention model guided by comprehensive geriatric assessment (CGA), for pre-frail and frail elderly. Methods: A single-arm self-controlled study was conducted at the outpatient departments (OPD) of a medical center in Taiwan. Subjects received personalized multidisciplinary intervention, including physical therapy, psychotherapy, a nutritional consultation, precise medicine, and social resource linkage, as determined by the results of their CGAs. After 3 months of interventions, change in the proportions of the frail status (frail, pre-frail and robust), functional scores, depressive status, cognition, nutritional status, percentage of inappropriate medication used and social resource usage were analyzed. A logistic regression model was applied to determine the predictive factors associated with an improvement in frail severity. Results: A significant improvement in frail status was found (proportion of frail: 44.5% versus 23.1%, p < 0.001). Physical function, depressive and nutritional status were also significantly improved. 18.5% of participants used inappropriate medications, with benzodiazepine hypnotics the most common (40.9%). 24.2% of subjects were successfully linked to social resources. The presence of the frail phenotypes exhaustion was significantly associated with an improvement in frail severity (odds ratio (OR) = 2.77, 95% confidence interval (CI) = 1.15–6.66, p = 0.023). There was a significant dose response relationship between the improvement of frail status and physical training times (proportion of improved frail status: 23.7%, 40.5% and 47.9% for 0, 1–3, and 4–6 times of physical training, p = 0.03). Conclusion: The reported CGA-based, personalized multidisciplinary intervention model was effective at improving frail severity among pre-frail and frail elderly in OPDs.