ABSTRACT
Aim/Introduction: During the COVID 19 pandemic, mass vaccination campaign has played an important role, with a special importance in oncological and immunosuppressed patients, who form a large part of our [18F]FDG-PET/CT studies. Unexpected findings in the form of reactive lymphadenopathy were commonly detected in [18F]FDG-PET/CT studies. It is essential to recognize them and adapt their interpretation to the current epidemiological context. Material(s) and Method(s): Retrospective study of consecutive [18F] FDG-PET/CT studies performed at our center in 219 patients with oncological pathology from June 15 to September 20, 2021. A structured interview was conducted on all the patients who came to undergo [18F]FDG-PET/CT, in which they were asked about the type, date and arm of administration of the vaccine. The frequency of appearance of reactive lymphadenopathy, its relationship with the type of vaccine, sex, age and the importance of a detailed clinical interview prior to the isotope injection and/ or study interpretation were analyzed. Patients that presented ipsilateral axillary lymphadenopathies following vaccination and presented increased metabolic activity regardless of node size were considered positive, size and SUVmax were assessed. Result(s): From De 219 patients reviewed, 32% presented positive [18F]FDG-PET/CT axillary lymph nodes ipsilateral to the arm where the vaccine was inoculated. There was a relationship (p=0.01) between the mean size of the lymph nodes (11+/-9mm) and its mean metabolic activity (3.7+/-2.6 SUVmax). The appearance of lymphadenopathy was more frequent in women (40.5% vs 21% p<0.001), in younger patients (mean age 53+/-14 years vs 68.5+/-13 years p<0.001), in patients who had received the Moderna vaccine (58.5% p<0.001) and in which the time elapsed between vaccination and the performance of [18F]FDG-PET/CT was shorter. Conclusion(s): The appearance of post SARS-CoV2-vaccination reactive lymphadenopathies has been a frequent finding in [18F]FDG-PET/CT despite the main oncological indication of the study. Knowing the circumstances of these findings in oncological patients is important when interpreting them, so the use of a structured directed clinical interview has been very useful to help the physician understand and differentiate these findings.
ABSTRACT
Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance. Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown. Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs. Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise. Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.