COVID-19 vaccination and changes in blood pressure

Introduction: Some healthcare staff observed an increase in their blood pressures (BP) after the SARS-CoV-2 vaccination, thus Hospital Pulau Pinang (HPP) began collecting vital signs during the second dose of the vaccination. We aimed to compare the changes in BP after vaccination. Method(s): This was an observational study using secondary data collected as part of the SARSCoV- 2 vaccination in HPP. Changes in BP immediately after and 15-30 minutes post vaccination were compared with baseline using paired t-tests. Result(s): A total of 4906 staffs received 2 doses of the BNT162b2 mRNA COVID-19 vaccine. Most subjects did not report any adverse effects. Common adverse effects were redness, pain or swelling at the injection site, tiredness, fever, chills, headache and myalgia. Mean pre-vaccination systolic and diastolic BPs were 130.1 (SD 17.38) mmHg and 80.2 (SD 11.62) mmHg, respectively. BP was increased in more than half of the subjects immediately and 15-30 minutes post vaccination however, the mean increases were small. Among those with hypertension (n=244), only increases in diastolic blood pressure were significant. Overall, 58 (1.02%) were admitted into the observation room either due to hypertensive urgency or complaints of giddiness. Conclusion(s): Overall, the increases were relatively small and may not prevail over the benefits offered by vaccination. However, monitoring of BP may be warranted to prevent any unexpected serious events.

The arrhythmic events and short-term cardiovascular outcomes in patients hospitalized with COVID-19 infection in Taiwan

Objective: The aim of this study is to investigate the arrhythmic events and short-term cardiovascular (CV) outcomes in patients hospitalized with COVID-19 infection in a single Taiwan tertiary center. Method(s): A retrospective study was carried out on 186 confirmed COVID-19 infection patients admitted to our hospital between May, 2021 and September, 2021. We investigate their CV symptoms, vital signs, laboratory examinations, arrhythmic events, and major adverse cardiovascular events (MACE), including ischemic stroke or systemic embolism, myocardial infarction, CV death, and heart failure (HF) during hospitalization. Result(s): During the hospitalization, 29.6% of patients had an elevation of cardiac enzymes, 67.2% had an elevation of d-dimer level, and 7.5% had abnormal NT-pro BNP level. The most common recorded arrhythmia is sinus tachycardia (22%), followed by atrial arrhythmia (12.4%, including atrial fibrillation 7.0%), sinus bradycardia (3.2%), ventricular arrhythmia (1.6%), and paroxysmal supraventricular tachycardia (1.1%). A total of 68 patients (36.6%) had arrhythmic events during hospitalization. During the mean follow-up of 2.8 months, 17 patients (9.1%) developed MACE, including 6 ischemic strokes, one pulmonary embolism, one peripheral artery occlusive disease, 3 HF, and 7 CV death. The total mortality rate is 19.9%. The hospitalized patients with arrhythmic events were associated with a higher incidence of intubation (32% vs 15%, p = 0.0062), MACE (22% vs 2%, p < 0.001), and mortality (37% vs 10%, p < 0.001) than those without arrhythmic events. Conclusion(s): The patients hospitalized with COVID-19 infection were associated with higher CV manifestations and arrhythmic events in Taiwan. Those patients with arrhythmic events were associated with higher morbidity and mortality.

Pleiotropic Effects of Nitric Oxide on SARS-CoV-2 Infections

Infection by beta-coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coron-avirus-2) alters the homeostasis of the vascular endothelium, promoting an inflammatory state which causes damage and favors the prothrombotic state. The direct viral cytotoxicity induced by the SARS-CoV-2 leads to endothelial cell death;thus, altering the vessel functions. Moreover, SARS-CoV infection induces endothelial dysfunction (ED) and reduces the levels of nitric oxide (NO);thus, aggravating the vascular injuries, which promotes thrombotic events due to an altera-tion in the homeostasis. NO is a pleiotropic molecule that induces vasodilation, regulates the immune response, inhibits platelet aggregation, and decreases the cellular adhesion to vascular en-dothelium. Moreover, NO acts directly against invasive agents, exhibiting antibacterial, antiviral, and antifungal activity. High levels of NO result in an increase in the ED, causing an inflammatory amplification that aggravates the disease through undesirable positive feedback. The objective of this review was to present and discuss the involvement of NO on ED in SARS-CoV-2 infections. This review may also highlight new perspectives for therapeutic interventions through the supple-mentation of exogenous NO. The maintenance of homeostatic NO levels could represent a useful approach in the prevention of coronavirus-induced ED.Copyright © 2021 Bentham Science Publishers.

Pathophysiologic mechanism for MYOcarditis in COVID-19 VAccinations ('MYOVAx' Study)

Objective: This is the first prospective cohort study in Singapore to investigate the COVID-19 vaccine-associated myocarditis to understand its pathophysiology. Introduction: Acute myocarditis and other cardiovascular symptoms have been observed to be associated with the two mRNA-based coronavirus disease 2019 (COVID-19) vaccines-namely Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273)-currently in-use in Singapore. The mechanisms through which myocarditis occurs are unknown, hence our study aims to understand the pathophysiology of myocarditis associated with COVID-19 vaccines. Method(s): Patients with onset of cardiac manifestations were recruited from multiple hospital outpatient clinics between November 2021 and September 2022. Clinical history and physical examination data was collected with blood sample collection, echocardiography, 12-lead electrocardiogram (ECG), coronary angiography and magnetic resonance imaging (MRI) at recruitment and 6-month follow-up. Analysis of biomarkers, genetic, serological and MRI data was conducted. Result(s): As of 6 September 2022, a total of 5 patients have been enrolled (4 males, 1 female). The most commonly reported symptoms across all patients were chest pain/discomfort (80%), followed by palpitations (40%). MRI evidence of myocarditis has been detected in 2 (50%) of the male patients, of which both reported two or more symptoms occurring 1-2 days post-vaccination. Both patients have each received at least two doses of either the Pfizer-BioNTech BNT162b2 vaccine or Moderna mRNA-1273 vaccine. Their MRI findings were consistent with myocarditis. On late gadolinium enhancement (LGE) imaging, epicardial enhancement at the basal inferolateral segment and mid-wall enhancement at the apical anterior, lateral and inferior walls were observed in one patient. Patchy, mid-wall LGE in the basal inferior/inferolateral wall was observed in the other patient. No MRI evidence of myocarditis was available for the sole female patient. Conclusion(s): While more data is needed to definitively prove the association of the two mRNA-based Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccines with post-vaccination myocarditis, we believe our findings may support further investigations to enable risk stratification for vaccine-associated myocarditis and identify potential preventative strategies accordingly.

COVID-19 Stress on Mental and Hair Health: A Marker for Diseases in the Post-Pandemic Era

The seriousness of the COVID-19 pandemic with accumulating stress factors, including lack of pharmacotherapy, quarantine, social distancing, delay of vaccination, and economic uncertainties, may foster fear and psychiatric disorders that can precipitate or aggravate hair/scalp disease. Hair loss can lead to decreased self-esteem, potentiating the negative effects on social life and generating a vicious cycle of stress during the pandemic. The relationship between environment and behavior can also trigger epigenetic changes in diseases, which may influence the health of the next generations. In this review, we describe the interaction between the physiological mechanisms of stress on hair follicles and hair disorders and openly discuss during pandemic/post-pandemic (not genetically determined but epigenetically triggered) hair loss as a point of concern as a health marker for further development of chronic diseases, such as diabetes, obesity, psychiatric disorders, and others.Copyright © 2022 Bentham Science Publishers.

IoT-Based Indoor and Outdoor Self-Quarantine System for COVID-19 Patients

Even after two years since the declaration of the new virus Coronavirus Disease 19 (COVID-19), the reported cases are still considerably high in many countries, including Malaysia. The health authorities cannot monitor the health condition and track the location of every home-monitored patient at once due to many confirmed cases in a day. In order to overcome the shortage of manpower, an Internet of Things (IoT)-based self-quarantine system with Radio Frequency Identification (RFID) and Global Positioning System (GPS) tracking is proposed in this paper to monitor the health conditions of the Covid-19 patients and track their real-time location via mobile application. Biomedical sensors are used to measure health conditions such as temperature, pulse oximetry, and heart-rate monitor. In addition, the RFID readers are used to detect patients that intend to leave the quarantine area, and the GPS modules are used to track their actual geometrical location so that the authorities can take further action. The real-time data is automatically pushed to the cloud server for the authorities to remotely view the patient's health condition and location on the Google map using smart devices. Finally, a hardware prototype and a mobile application have been successfully developed in this project The system is able to display the temperature, heartbeats, and blood oxygen saturation properly on a liquid crystal display (LCD) screen. All these measured values, together with the information from RFID detection and GPS location tracking, can be viewed on a smartphone.

Induced Pluripotent Stem Cell Derived Airway to Assess Cystic Fibrosis Intrinsic Epithelial Response to SARS-CoV-2

Rationale There is a lack of knowledge of how CFTR-deficient airway epithelium intrinsically responds to SARS-CoV-2. Though prior work has demonstrated altered CF airway expression of viral entry factors, it is unknown whether these alterations are protective and whether they reflect host genetic variation or secondary response of chronic inflammation. We address this gap by infecting induced pluripotent stem cell (iPSC)-derived airways from CF patients and syngeneic CFTR-corrected controls with SARS-CoV-2 and assessing differential susceptibility to infection and inflammatory and anti-viral response. MethodsCF (F508del homozygous) and syngeneic CFTR-corrected (CRISPR-Cas9) iPSC- were differentiated into airway epithelium cultured at airliquid interface (ALI) by a directed differentiation protocol that generates a pure population of major and rare airway cell-types. After 21 days in ALI culture, the iPSC-airway were infected with either mock or SARS-CoV-2 (isolate USA-WA1/2020) with MOI of 4, and harvested at 0, 1, 3 days post infection (dpi) for RT-PCR and immune-stainingResultsBoth CF and CFTR-corrected iPSC-airway express viral entry factors of ACE2 and TMPRSS2, and are permissive to SARS-CoV-2 infection. CF iPSC-airway exhibited significantly increase in SARS-CoV-2 nucleocapsid protein (N) transcript at 1 dpi, accompanied by increases in IFN2, RSAD2, and CXCL10 at 3 dpi, compared to its CFTR-corrected counter-part. There are no baseline significant differences in ACE2, TMPRSS2, TP63, NGFR, MUC5B, MUC5AC, SCGB1A1, FOXJ1, FOXI1 expression between CF and CFTR-corrected iPSC-airway before SARS-CoV-2 infection. ConclusionsOur preliminary studies indicate increased early SARS-CoV-2 infection in CFTR-deficient epithelium with accompanied subsequent rise in anti-viral and inflammatory response compared to its genetically controlled CFTR-corrected counterpart. Future studies are aimed at assessing differential CF epithelial kinetics of SARS-CoV-2 viral entry and replication, morphological changes, global transcriptomic response, and how treatment with CFTRmodulator would alter the epithelial response. Ultimately, we aim to establish a reductionist, physiologically relevant model system that is coupled with gene-editing technology to study intrinsic CF epithelial response to SARS-CoV-2, which would generate insights to aid practice guidelines for CF patients, and open future directions to evaluate gene-specific mechanisms of airway response to pathogens. (Figure Presented).

An empirical methodology for detecting and prioritizing needs during crisis events

In times of crisis, identifying essential needs is crucial to providing appropriate resources and services to affected entities. Social media platforms such as Twitter contain a vast amount of information about the general public’s needs. However, the sparsity of information and the amount of noisy content present a challenge for practitioners to effectively identify relevant information on these platforms. This study proposes two novel methods for two needs detection tasks: 1) extracting a list of needed resources, such as masks and ventilators, and 2) detecting sentences that specify who-needs-what resources (e.g., we need testing). We evaluate our methods on a set of tweets about the COVID-19 crisis. For extracting a list of needs, we compare our results against two official lists of resources, achieving 0.64 precision. For detecting who-needs-what sentences, we compared our results against a set of 1,000 annotated tweets and achieved a 0.68 F1-score. © 2020 Association for Computational Linguistics

Patient concerns during the COVID-19pandemic: Lessons from the lung cancer community

Background: The COVID-19 pandemic generated intense concern across the lung cancer (LC) community due toreports that LC patients are at higher risk for severe illness and/or death from COVID-19. Patient advocacy groups(PAGs) may need to revise their programs in order to address these concerns. To understand the specific needs ofthe LC community, LC PAGs conducted a survey to ask USA LC patients and caregivers to rank their concernsacross a number of COVID-19-related topics. Methods: A rapid needs assessment survey was created with input from LC patients and PAGs to cover threedomains: General Information About COVID-19, What If I Get COVID-19, and COVID-19 Impact on Lung CancerCare. The first two domains had 8 items while the third had 9 items. LC patients and caregivers in the USA wereasked to rate their level of concern about each item on a 5-point Likert scale (where 1 = Not at all concerned to 5 =Extremely concerned). Data were collected for 5 days through an online platform during the first week of June.Weighted responses and percentages were calculated for each item using SPSS. Results: Eighty-three participants responded to the survey;most were dealing with non-small cell LC, and 70%were stage IV. 1. General Information About COVID-19: Two top areas of concern were “How to know when it's safeto return to normal activity” (80.5% very or extremely concerned), and “How to protect myself from COVID-19” (71%very or extremely concerned). On the other hand, participants were least concerned about “Origins of SARS-CoV-2-(only 25% very or extremely concerned) and “Stress/Anxiety affecting wellbeing” (only 25% very or extremelyconcerned). 2. What If I Get COVID-19: More than 80% of respondents were very or extremely concerned about-Vaccines/Treatments for COVID-19” and “Learning about risk factors that make LC patients vulnerable to COVID-19.” Interestingly, “Preparation of legal documents in anticipation of COVID-19” was not a top concern forparticipants (only 23% were very or extremely concerned). 3. COVID-19 Impact on Lung Cancer Care: Participants were very or extremely concerned that “The pandemic would delay or terminate LC research” (77%) and “Berefused treatment due to limit resources” (66%). 4. Lastly, we evaluated patient concerns by age. Respondents werestratified into two groups: 60 and younger or 61 and older. Those 60 and younger were more concerned about their-cancer center being a COVID-19 hotspot” and the “delay or termination in LC research” whereas those 61 andolder were more concerned that they “would not be able to contact their health care provider.” Conclusions: By collaborating with patients to identify and rank specific concerns of the LC community, patientadvocacy groups can be better positioned to prioritize those programs and services that will help patients andcaregivers navigate the ongoing challenges of the COVID-19 pandemic.

Collaborating to share evidence-basedCOVID-19 information across lung cancer patientadvocacy groups

Background: The COVID-19 pandemic has presented an urgent and serious threat to multiple at-risk populations, including those with lung cancer (LC). This rapidly evolving crisis has seen a growing onslaught of information andguidance from multiple sources, much of which is confusing and conflicting. Thus, LC patient advocacy groups(PAGs) in the USA collaborated to share carefully vetted COVID-19 information for LC patients and caregiversonline. Our goals were to gather evidence-based information that addressed concerns of LC patients andcaregivers, translate it in a manner understandable for the general public, and share it with one voice across all LCnonprofits. This retrospective study examined whether the online LC community found this collaboration valuableand whether the weekly updates addressed useful topics in a trustworthy manner. Methods: The first “Joint Statement on Coronavirus COVID-19 from Lung Cancer Advocacy Groups” was publishedon March 3, 2020. Updates were published most Mondays thereafter. We also produced an IASLC podcast. Anonline survey (conducted over a 5-day period in early June) asked USA LC patients and caregivers (1) if they wereaware of the updates, (2) whether they found the updates useful, (3) which topic areas they found most helpful, and(4) what value they saw in the collaboration across LC advocacy groups. We also collected web statistics for eachPAGs posts of this content. Results: Cumulatively, online posts of the weekly updates received over 34,000 views between March 3 and theend of May and reached over 71,000 on Facebook. The podcast received twice the number of listens compared tothe average of pre-COVID-19 podcasts on the IASLC and Soundcloud sites. Of the 83 LC patients and caregiverswho responded to the online survey, three quarters were dealing with stage III or IV non-small cell LC, and half wereolder than 60. About 2/3 were aware of the weekly updates, and of those, over 80% found the statements helpful.The five most helpful topics were (1) effect of the pandemic on LC diagnosis, treatment, and clinical trials;(2) effectof the pandemic on LC research;(3) COVID-19 treatments and vaccines;(4) who is likely to have a severe case ofCOVID-19;and (5) what we know about developing immunity to COVID-19. Based on coding responses from anopen-ended question, the majority of respondents found the collaboration valuable and trustworthy (for example,Increased trust and credibility knowing all orgs are behind it). The updates were found so valuable that they arealso translated into Spanish by a pan-cancer Latin American PAG for their communities. Conclusions: Lung cancer patients and caregivers, particularly those considered to be at higher risk for severesymptoms or death from COVID-19, found evidence-based, patient-focused collaborative updates about COVID-19from major lung cancer PAGs informative, helpful, and trustworthy.