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COVID-19 spread by the SARS-CoV-2 virus is one of the most pronounced ongoing communicable deathly disease outbreaks in Malaysia. The immunization programme is currently administering Pfizer–BioNTech, Oxford–AstraZeneca and Sinovac (CoronaVac) candidate vaccines in several phases targeting different categories of recipients per phase and is expected to be completed by February 2022. Issues pertaining to COVID-19 vaccine literacy, acceptance and hesitancy still need more investigation to generate baseline information as an initial step for interventions and building trust in vaccination efforts. This will accelerate the achievement of the immunization programme's target of immunizing at least 80% of Malaysian by 2022. © TheEditor(s) (ifapplicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021, 2022.
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Objectives: There are concerns for COVID-19 vaccination in causing thyroid dysfunction and triggering thyroid autoimmunity. Also, data on the impact of pre-existing thyroid autoimmunity on COVID-19 vaccination efficacy are limited. We evaluated the impact of COVID-19 vaccination on thyroid function and antibodies, and the influence of pre-existing thyroid autoimmunity on neutralizing antibody (NAb) responses. Methods: Adults without history of COVID-19 or thyroid disorders who received COVID-19 vaccination between 14 June 2021 and 8 August 2021 at three vaccination centers were recruited. All participants received two doses of vaccines. Thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies were measured at baseline and 8 weeks after the first dose of vaccination. Post-vaccination NAb against SARS-CoV-2 receptor-binding domain was measured. Results: In total, 215 individuals were included (129 BNT162b2 [60%] and 86 CoronaVac [40%] recipients): mean age 49.6 years, 37.2% men, and 12.1% positive for anti-TPO/anti-Tg at baseline. After vaccination, TSH levels did not change (p=0.225), but fT4 slightly increased (from 12. 0±1.1 to 12.2±1.2 pmol/L, p<0. 001) and fT3 slightly decreased (from 4.1±0.4 to 4. 0±0.4 pmol/L, p<0. 001). Only 3 patients (1.4%) had abnormal thyroid function after vaccination: two occurred among BNT162b2 recipients - both were subclinical thyrotoxicosis (TSH 0.32mIU/L, fT4 11.51pmol/L and fT3 4.40pmol/L;TSH 0.34mIU/L, fT4 12.67pmol/L and fT3 4.22pmol/L;both were anti-TPO and anti-Tg negative before and after vaccination);one occurred among CoronaVac recipients - isolated mild low fT3 (TSH 0.90mIU/L, fT4 9.94pmol/L and fT3 2.33pmol/L;anti-TPO/Tg negative before and after vaccination). All three recipients were asymptomatic. Both anti-TPO and anti-Tg titers increased modestly after vaccination (anti-TPO: from 7.50 [IQR: 5.90-11.2] to 9.80 IU/mL [IQR: 7.80-13.1], p<0. 001;anti-Tg: from 12.4 [IQR: 11.1-14.9] to 15.7 IU/mL [IQR: 14.2-18.2], p<0. 001), without significant changes in anti-TPO/Tg positivity. Changes in thyroid function and anti-thyroid antibodies were generally consistent between BNT162b2 and CoronaVac recipients, although anti-TPO titer rise was greater after BNT162b2 (p<0. 001). NAb responses were similar between individuals with and without pre-existing thyroid autoimmunity (p=0.855). Conclusion: COVID-19 vaccination was associated with a modest increase in anti-thyroid antibody titers. Anti-TPO increase was greater among BNT162b2 recipients. However, there was no clinically significant thyroid dysfunction 8 weeks post-vaccination. NAb responses were not influenced by pre-existing thyroid autoimmunity. Our results provided important reassurance to people to proceed to COVID-19 vaccination.Presentation: No date and time listed
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PURPOSE: Thyroid dysfunction in COVID-19 carries clinical and prognostic implications. In this study, we developed a prediction score (ThyroCOVID) for abnormal thyroid function (TFT) on admission amongst COVID-19 patients. METHODS: Consecutive COVID-19 patients admitted to Queen Mary Hospital were prospectively recruited during July 2020-May 2021. Thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were measured on admission. Multivariable logistic regression analysis was performed to identify independent determinants of abnormal TFTs. ThyroCOVID was developed based on a clinical model with the lowest Akaike information criteria. RESULTS: Five hundred and forty six COVID-19 patients were recruited (median age 50 years, 45.4% men, 72.9% mild disease on admission). 84 patients (15.4%) had abnormal TFTs on admission. Patients with abnormal TFTs were more likely to be older, have more comorbidities, symptomatic, have worse COVID-19 severity, higher SARS-CoV-2 viral loads and more adverse profile of acute-phase reactants, haematological and biochemical parameters. ThyroCOVID consisted of five parameters: symptoms (malaise), comorbidities (ischaemic heart disease/congestive heart failure) and laboratory parameters (lymphocyte count, C-reactive protein, and SARS-CoV-2 cycle threshold values). It was able to identify abnormal TFT on admission with an AUROC of 0.73 (95% CI 0.67-0.79). The optimal cut-off of 0.15 had a sensitivity of 75.0%, specificity of 65.2%, negative predictive value of 93.5% and positive predictive value of 28.1% in identifying abnormal TFTs on admission amongst COVID-19 patients. CONCLUSION: ThyroCOVID, a prediction score to identify COVID-19 patients at risk of having abnormal TFT on admission, was developed based on a cohort of predominantly non-severe COVID-19 patients.
Subject(s)
COVID-19 , Triiodothyronine , C-Reactive Protein , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , SARS-CoV-2 , Thyroid Function Tests , Thyroid Gland , Thyrotropin , ThyroxineABSTRACT
Purpose/Background: Hospitals and ambulatory surgery care centers had to adapt as the COVID-19 pandemic progressed. Elective surgeries were initially restricted. Protocols to test for COVID-19 fluctuated as elective surgeries resumed, patients were vaccinated, and variants increased infection rates. Hypothesis/Aim: Our study aims to look at the number of breakthrough cases of COVID-19 on vaccinated ambulatory patients and the impact this had on a single colorectal division at a large urban academic institution. Methods/Interventions: This is a retrospective comparative cohort study that studied 123 surgeries from July 2021-October 2021. Prior to August 16, 2021, elective and ambulatory surgeries at our institution did not require a negative COVID test for vaccinated patients. After that date, vaccinated patients still had to get tested 3-5 days before surgery in order to proceed. Our study evaluates a cohort of patients prior to that date and compares it to patients after that date to see if there were breakthrough infections in vaccinated patients, but also to see if this significantly affected the number of cancellations in our surgical division. Analysis was performed in Microsoft Excel and R. Results/Outcome(s): Amongst the two groups, there were equal distributions amongst sex, age, and type of operation scheduled. The majority were ambulatory anorectal cases. Of 123 surgeries, 89 (72%) were completed. The rest were canceled (16%), rescheduled (11%), or no-show (1%). Of the rescheduled surgeries, two were repeat patients, and one was a close contact of a COVID+ person. In the period before the August 16th cutoff, all of the patients canceled for reasons other than COVID-19, and four of them had negative COVID tests recorded. All of the patients (n=2, 6%) who tested positive with breakthrough infections after COVID vaccination occurred after the August 16th cutoff. They both had recorded vaccinations 3-6 months prior. Limitations: This is a small study based on a single division at an academic institution during a limited time period. Conclusions/Discussion: New York City's positive COVID test rate reached a nadir on July 14, 2021, at 1.51%. As people were vaccinated and establishments re-opened, the positivity rate increased, reaching a peak of 4.02% on August 14, 2021. In response to this, our institution required COVID testing to assess for breakthrough cases in vaccinated patients. Two of our vaccinated patients tested positive and had their elective surgeries canceled, a rate of 6%, double the average positivity rate in New York City during the same time period. While the impact of two cancellations may seem small, this study addresses the fact that the new testing policies did catch significant breakthrough infections. Furthermore, this study supports hospital policies that may seem damaging to the hospital's revenue in favor of public safety. Future studies will examine the patient factors related to breakthrough infections in a vaccinated surgery population.
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OBJECTIVE: We aimed to evaluate the impact of glycaemic status on clinical outcomes and anti-SARS-CoV-2 antibody (Ab) response among patients with predominantly non-severe COVID-19, highly relevant to the current COVID-19 vaccination programme. METHODS: We included consecutive adults admitted to Queen Mary Hospital for COVID-19 from July 2020 to May 2021. Glycaemic status was defined by HbA1c on admission: normoglycaemia (<5.7%), prediabetes (5.7-6.4%) and diabetes (≥6.5% or known diabetes). Clinical deterioration was defined by radiological progression, new oxygen requirement, intensive care unit admission, or death. COVID-19 survivors had Ab measurements at 1-month, 2-month, 3- month and 6-month post-discharge, with a live SARS-CoV-2-based microneutralization assay which correlated well with anti-SARS-CoV-2 receptor binding domain IgG (≥1:20 defined as positive). RESULTS: Among 605 patients (age 50.2 - 17.1 years;45.1% men;96.9% non-severe COVID-19), 325 had normoglycaemia, 185 had prediabetes and 95 had diabetes. 74 had clinical deterioration (12.2%): 16 required intensive care and 4 died. Clinical deterioration was more likely with worse glycaemic status (P < 0.001) and higher HbA1c (OR 1.403, P < 0.001). Older age (P < 0.001), higher viral loads (P < 0.001), higher C-reactive protein (CRP) (P < 0.001) and symptomatic presentation (P = 0.008), but not glycaemic status/HbA1c, independently predicted clinical deterioration. 314 patients had Ab measured upon follow-up (1-month: 295;2-month: 227;3-month: 207;6-month: 122). Ab titres were comparable across glycaemic status throughout follow-up period. CRP (P = 0.003), but not glycaemic status/HbA1c, was the only positive independent determinant of Ab levels. Rate of decline of Ab titre was comparable across glycaemic status, and did not correlate with HbA1c. Furthermore, most patients remained Ab-positive throughout follow-up (1-month: 94.9%, 2-month: 93.8%, 3-month: 87.4%, 6-month 80.3%), similar across glycaemic status. CONCLUSION: Worse glycaemic status was associated with a higher chance of clinical deterioration in COVID-19, contributed by older age, more severe inflammation and higher viral loads. Importantly, glycaemic status did not adversely influence the Ab response.
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This research is aimed at identifying the financial ratio that influences the company value that is incorporated with tourism sectors during the COVID-19 pandemic. An independent variable used in this research was Return on Total Asset (ROA), Current Ratio (CR), Debt to Total Asset (DAR), Total Asset Turnover (TATO), and Price Earning Ratio (PER), with the value of the company (PBV) as a dependent variable. The selected samples were about six companies, and the method of the study used verificative-descriptive. The technique of data analysis used in this research was data panel regression combined with Eviews 9 appricatio. The result indicated that Price Earning Ratio had influenced the value of the company.