Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination

Acute exacerbations due to COVID-19 vaccination in patients with interstitial lung disease (ILD) have been reported, but their incidence is unknown. We investigated the incidence of exacerbations of ILD and respiratory symptoms due to the mRNA COVID-19 vaccines. A questionnaire survey was conducted on adverse reactions to the mRNA COVID-19 vaccination in 545 patients with ILD attending our hospital and retrospectively examined whether the eligible patients actually developed acute exacerbations of ILD induced by the vaccine. Of the 545 patients, 17 (3.1%) patients were aware of the exacerbation of respiratory symptoms, and four (0.7%) patients developed an acute ILD exacerbation after vaccination. Of the four patients who experienced exacerbations, two had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. Four patients were treated using steroid pulse therapy with a steroid taper, and two of the four also received intravenous cyclophosphamide pulse therapy. Tacrolimus was started in one patient with myositis-associated interstitial lung disease. Eventually, all patients exhibited improvement with immunosuppressive treatment and were discharged. COVID-19 vaccination for patients with ILD should be noted for developing acute exacerbations of ILD with low incidence, although manageable with early diagnosis and treatment. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination

Acute exacerbations due to COVID-19 vaccination in patients with interstitial lung disease (ILD) have been reported, but their incidence is unknown. We investigated the incidence of exacerbations of ILD and respiratory symptoms due to the mRNA COVID-19 vaccines. A questionnaire survey was conducted on adverse reactions to the mRNA COVID-19 vaccination in 545 patients with ILD attending our hospital and retrospectively examined whether the eligible patients actually developed acute exacerbations of ILD induced by the vaccine. Of the 545 patients, 17 (3.1%) patients were aware of the exacerbation of respiratory symptoms, and four (0.7%) patients developed an acute ILD exacerbation after vaccination. Of the four patients who experienced exacerbations, two had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. Four patients were treated using steroid pulse therapy with a steroid taper, and two of the four also received intravenous cyclophosphamide pulse therapy. Tacrolimus was started in one patient with myositis-associated interstitial lung disease. Eventually, all patients exhibited improvement with immunosuppressive treatment and were discharged. COVID-19 vaccination for patients with ILD should be noted for developing acute exacerbations of ILD with low incidence, although manageable with early diagnosis and treatment.

APPROACHES TO REMOTE LEARNING DURING COVID-19 IN THE SCHOOL OF INDUSTRIAL AND WELFARE ENGINEERING, TOKAI UNIVERSITY

Due to the spread of COVID-19, the daily lives of most people have changed drastically. The educational environment was certainly no exception. Most universities in Japan restricted access to their campuses and had to provide students with remote lectures. In our university, most lectures were provided remotely during the spring semester, 2020. Our school decided to give all lectures using Microsoft Teams and made videos on how to take the remote lectures using Microsoft Teams;thus we were able to start giving remote lectures smoothly. We report on the approaches which helped us to create a successful environment for providing remote lectures in our school. In this paper, we also report the effects of on-line flipped lectures, which we conducted on a trial basis. © 2022, ICIC International. All rights reserved.

GAS LEAKS FROM BIOPSY VALVES OF GASTROINTESTINAL ENDOSCOPY-ITS VISUALIZATION AND SEMI=QUANTIFICATION UTILIZING SCHLIEREN OPTICAL SYSTEM

<Background> With the global epidemic of COVID-19, there has been a growing concern about the risk of exposure to the virus among healthcare workers. Gastrointestinal (GI) endoscopy has been considered as one of the high infectious procedures because of the high risk of aerosol exposure. However, that caution is mainly directed at secretions and aerosols from the patient's mouth, and less attention is currently paid to air leaks from the endoscopic system itself. Although a few reports have been published on air leaks from GI endoscopic systems, no systematic and quantitative studies of air leaks have been conducted. Schlieren system is an optical device for visualizing minute changes in airflow that are invisible to the naked eye, by using differences in the refractive index of the medium, and has been mainly used in the field of engineering. We aimed to systematically evaluate air leaks from GI endoscopic systems using Schlieren system, and to determine the relationship between the amount of leakage and insufflation conditions including the types of biopsy valves. <Methods> The following experiments were performed on explanted swine stomachs while maintaining an intra-gastric pressure at each preset value. We attempted to visualize air leaks using System Schlieren (SS100, Kato Koken, Kanagawa, Japan). In all experiments, biopsy forceps were inserted and withdrawn 3 cm per 3 seconds. This action was repeated five times in each experiment. Experiment 1: Examined the feasibility of the Schlieren device in visualizing air leaks from biopsy valves. Experiment 2: The intragastric pressure was varied in the range of 4 to 15 mmHg and the air leaks were quantified and compared in each pressure. Experiment 2: Compared the air leaks between the types of biopsy valves, e.g. reusable, disposable, universal, deteriorated reusable valves after more than 10 times of uses. Image J (National Institute of Health, US) was used to measure the initial velocity and area of the leak on obtained images. The average values of initial velocity and leakage area over five sessions were calculated. For the leak area analysis, image analysis was performed for both forceps insertion and withdrawal. <Results> Experiment 1: Air leaks were seen at the moment of forceps insertion and withdrawal (Fig 1). Experiment 2: There was a linear relationship between intragastric pressure and initial velocity/diffusion range of the leak (Fig2A). Experiment 3: Disposable and deteriorated reusable biopsy valves had larger initial velocity/diffusion range of the leak (Fig2B). <Conclusions> We successfully visualized air leaks from GI endoscopic systems using the Schlieren system. We herein recommend the use of lower intragastric pressure at the times of insertion/withdrawal of forceps, and avoidance of using disposable/deteriorated biopsy valves, for less gas leakage and possibly less aerosol exposure.(Figure presented)Figure1. Visualization of air leak from biopsy valve(Figure presented)Figure 2. Results of analysis on air leakage from biopsy valve

Does The Lockdown Due To Covid-19 Pandemic Affect The Lifestyle And Disease Activity Of Patients With Inflammatory Bowel Disease?

Background: In December Of 2019, Coronavirus Disease 2019 (Covid-19) Emerged In Wuhan. The Government Of Japan Declared A “State Of Emergency” On April 16, 2020. Although This Approach Was Partially Successful For Temporarily Stopping The Spread, Concerns Were Raised Regarding The Negative Impact Of These Measures, Not Only In Terms Of Economics, But Also In Terms Of Mental And Physical Health, Such As Anxiety And Depression. Inflammatory Bowel Diseases (Ibd) Are Intestinal Disorders Affected By Environmental Factors, Such As Sleep, Stress, Diet, And Smoking. Therefore, This Study Aimed To Assess The Effects Of The Covid-19 Pandemic And State Of Emergency On The Lifestyle And Disease Activity Of Patients With Ibd. Methods: We Conducted A Questionnaire Survey In Ibd Patients With Regular Follow-Up At Osaka City University Hospital In Japan, From June 16 To August 21, 2020. The Questionnaire Included Questions Regarding The Patient’S Epidemiological History Of Covid-19, Demographic Data, Gastrointestinal Symptoms, Lifestyle Changes And Stress Related To The State Of Emergency, And Current Medication Use. Gastrointestinal Symptoms Were Assessed Before And During The State Of Emergency Using The 6-Point Mayo Score9 And Patient-Reported Outcome 2 (Pro2) Score10 For Ulcerative Colitis (Uc) And Crohn’S Disease (Cd), Respectively. Results: Overall, 451 Patients Completed The Survey. Patients With Exacerbated Uc Tended Have Younger Age, Less Sleep, And More Stress Against Covid-19 Than Did Patients With Non-Exacerbated Uc. Figure 1 Summarizes The Lifestyle Changes And Stress Related To The State Of Emergency. Patients With Exacerbated Uc Tended Have Younger Age, Less Sleep, And More Stress Against Covid-19 Than Did Patients With Non-Exacerbated Uc. Multivariate Logistic Regression Analysis Identified Younger Age (Odds Ratio [Or] 1.020, 95% Confidence Interval [Ci] 1.010-1.040;P = 0.011), Fewer Sleep Hours (Or 1.320, 95% Ci 1.020-1.720;P = 0.035), And Increased Stress Due To The Covid-19 Pandemic (Or 5.530, 95% Ci 1.650-18.500;P < 0.01) As Independent Risk Factors Associated With Uc Exacerbation During The State Of Emergency. Patients With Exacerbated Cd Had Younger Age At Cd Onset And Had Higher Pro2 Scores Before The State Of Emergency Than Did Patients With Non-Exacerbated Cd. On Multivariate Analysis, Only Younger Age (Or 1.030, 95% Ci 1.010-1.05;P < 0.01) Was Independently Associated With Exacerbation During The State Of Emergency. Conclusions: We Have Showed Data On The Association Between Ibd Activity And Lifestyle Changes / Psychological Stress Due To The State Of Emergency During The Covid-19 Pandemic. This Study Suggests That Improving Sleep Quality And Preventing Psychological Stress Might Be Key In Ibd Management During The Pandemic, Especially In Young Patients. (Figure Presented) (Figure Presented) (Figure Presented) (Figure Presented)