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Background: To mitigate the COVID-19 pandemic, many countries have recommended the use of booster vaccinations. The relationship between the degree of adverse vaccine reactions and elevated antibody titers is of interest;however, no studies have investigated the temporal changes in antibody titers based on repeated measurements after a third dose of the BNT162b2 vaccine. Methods: This prospective longitudinal cohort study was conducted with 62 healthcare workers who received a third dose of the BNT162b2 at Okayama University Hospital, Japan. Venous blood draw and fingertip whole blood test sample collection were conducted at the early (3–13 days) and 1-month time points;only FWT sample collection was conducted at the 2-month time point. Information on adverse reactions within 1 week after vaccination was also obtained. The association between fever of 37.5 °C or higher and antibody titers after the third dose of BNT162b2 was examined using a mixed-effects model and Poisson regression with robust variance. Results: A trend toward higher antibody titers in the early period after vaccination was observed in the febrile individuals, but the differences were not significant at 1 and 2 months post-vaccination (the partial regression coefficient for fever was 8094.3 [-1910.2, 18,098.8] at 1 month after vaccination, and 1764.1 [-4133.9, 7662.1] at 2 months after vaccination in the adjusted models). Conclusion: The findings suggest that the presence of fever after the third vaccine does not predict a sustained elevation in serum antibody titers. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
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COVID-19 has been prevalent worldwide since 2019. Increasing COVID-19 vaccination coverage is an important measure to combat the disease. An online survey was conducted with university students and personnel who were vaccinated against COVID-19 at a mass vaccination event to examine the factors promoting vaccination among young adults. The online survey was conducted with persons vaccinated at Okayama University from June 5 to September 27, 2021. Although the number of those who had fever >37.5..C increased after the second vaccination compared to the first, the vaccinated persons got more satisfied after the second shot.
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INTRODUCTION: Osimertinib is a molecular targeted antineoplastic tyrosine kinase inhibitor that is primarily used in the treatment of non-small cell lung cancer (NSCLC). It has been associated with the development of interstitial lung disease/pneumonitis that requires discontinuation of the drug and occurs usually within the first 2-3 months of therapy. Approximately 3% of patients treated with osimertinib will experience lung toxicity. Acute fibrinous and organizing pneumonia (AFOP) is a rare form of interstitial pneumonitis that has been associated with drug toxicity but to our knowledge has not yet been described in association with osimertinib. Here we present one such case. DESCRIPTION: A 77 year old woman with a history of EGFR+ stage IIB adenocarcinoma presented with two weeks of shortness of breath, fevers, and dry cough. She had been started on osimertinib two months prior to presentation. On admission she was noted to be hypoxic with new oxygen requirement of 4L nasal cannula. CT chest showed bilateral ground glass opacities. She was started on empiric vancomycin and zosyn without improvement in symptoms. She underwent bronchoscopy on hospital day 3 with lung biopsy pathology showing AFOP. Infectious workup including bronchoalveolar lavage, blood, and sputum cultures, as well as respiratory viral panel and COVID-19 test was negative. Transthoracic echocardiogram showed normal cardiac function with an ejection fraction of 64%. Given these findings she was started on methylprednisolone 1 mg/kg for TKI-induced pneumonitis on day 5. Her oxygen requirements increased during hospitalization and on day 7 she acutely desaturated and was intubated. Repeat chest CT was negative for pulmonary embolism but showed interval worsening of infiltrates and consolidation at lung bases. Her methylprednisolone was increased to 2 mg/kg on day 10. Her pulmonary function improved and she was extubated to nasal cannula on day 12. DISCUSSION: Molecular targeted antineoplastic agents have been associated with lung toxicity, which can be severe and even fatal. To our knowledge this is the first known case of osimertinib-induced AFOP, which improved with discontinuation of the drug and initiation of high-dose methylprednisolone.
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INTRODUCTION: Acute kidney injury (AKI) is strongly associated with poor prognosis of Coronavirus disease 2019 (COVID-19) patients. The great pandemic made it challenging to allocate renal replacement therapy (RRT) such as hemodialysis or continuous hemodiafiltration to anuria patients in terms of infection control and medical resources. Herein, using an actual case, we argue that peritoneal dialysis (PD) could become a more practical and safer RRT, particularly during this pandemic crisis. METHODS: Our case was a 62-year-old male with a PCR test positive for severe acute respiratory syndrome coronavirus (SARS-CoV-2). He had a medical history of lung cancer and some commodities of hypertension, hyperuricemia, and hyperlipidemia. The next day after the admission, his oxygenation and hemodynamics rapidly deteriorated. We started mechanical ventilation, and administered vasopressors, favipiravir, and ciclesonide. Additionally, serum creatinine also became gradually elevated (creatinine: day1 0.77 mg/dL → day5 7 mg/dL). We diagnosed with COVID-19-associated AKI, because urine tests and sonography did not indicate any other cause. It progressed to anuria and made it difficult to control the serum potassium and the hemodynamics due to acidemia. On day 6, using a portable X-ray machine, we inserted the peritoneal dialysis (PD) catheter to the recto-vesical pouch at the bedside and infused the peritoneal dialysate. Although the anuria persisted for a while, the increased amount of peritoneal dialysate easily normalized the acidemia and serum potassium level. After the normalization, the vasopressors could be tapered off, and the inflammation status was also improved. On day 14, the patient was discharged from our ICU with the PD catheter. SARS-CoV-2 was detectable in sputum, but not in the peritoneum and PD waste. The whole procedure of PD catheter insertion and dialysate exchange did not influence the respiratory status and hemodynamics at any time. RESULTS: Taken together, PD could be a useful option for the AKI management, particularly in the COVID-19 pandemics.