ABSTRACT
Purpose: The coronavirus disease 2019 (COVID-19) global pandemic has seen the development of effective vaccines in record time. We report a series of five liver transplant (LT) recipients who developed acute cellular rejection (ACR) after receiving COVID-19 vaccinations. Method(s): We performed a single-center, retrospective review of LT recipients who presented with biopsy-proven ACR after receiving a COVID-19 vaccination. Result(s): 603 LT recipients were fully vaccinated against COVID-19 at our center on 10/4/2021. Five (0.77%) patients developed elevated liver enzymes after COVID-19 vaccination without an identifiable cause and had a subsequent liver biopsy consistent with ACR: four (80%) patients were male and the median age was 54 years old. The indication for LT was cirrhosis secondary to non-alcoholic steatohepatitis in three (60%) and alcohol in two (40%) patients. The median time from LT to the first dose of COVID-19 vaccination was 19 months (range 7-26 months). Three (60%) patients had moderate (RAI= 5/9) ACR. All patients were treated with high-dose intravenous methylprednisolone for 3 days and had normalization of liver enzymes. No patients required rescue therapy with anti-thymocyte globulin or developed graft failure. All patients eventually completed their vaccination series. Conclusion(s): LT recipients may be at risk for developing ACR after the COVID-19 vaccination. Further study is required to better understand this relationship while closer monitoring following vaccination may be warranted in this patient population. (Figure Presented).
ABSTRACT
Introduction: Occupational noise exposure can lead to noise-induced hearing loss (NHL) with serious health and economic consequences for workers. The Center for Disease Control and Prevention and the National Institute for Occupational Safety and Health (NIOSH) have published a recommended exposure limit of 85-decibels (dB) for workplace exposure to prevent NHL. Despite these recommendations for workplace noise exposure, little is known about the noise levels generated during gastrointestinal (GI) endoscopy. We aimed to investigate the noise generated by suction during GI endoscopy. Methods: Sound levels were measured using the “NIOSH Sound Level Meter” smart phone application. The noise generated from an adult colonoscope (Olympus HQ190) at various levels of suction were measured using Neptune 3 (Stryker, Kalamazoo, MI) mobile surgical suction device (SSD) that allows a wide range of suction pressure levels versus “traditional” wall suction (WS). Measurements were obtained as average levels over a 30-second interval in a quiet, outpatient ambulatory endoscopy room. Noise measurements were obtained at various positions within the room (endoscopist, nurse/ technician) as well as next to the endoscope suction button. The measurements were obtained with the endoscopist applying no suction, partial suction and complete suction. Results: With the SSD, sound levels increased as suction pressure increased. The highest sound levels were generated when no endoscopic suction was applied. None of the measurements exceeded recommended exposure limits set by the NIOSH (Table 1). With pressure levels set at 200 mmHg (traditional wall suction maximums) sound levels at the endoscopist for SSD and WS were 54.3 dB and 47.1 dB, respectively, e.g. more than 7 times louder. Conclusion: Little is known about the occupational safety of noise levels in endoscopy nor the contribution suction contributes. In this study, noise levels did not exceed the recommended exposure limit set by the NIOSH. However, SSD generates significantly more noise than WS at the same pressure levels. While these levels may not constitute an occupational hazard, they make communication more difficult especially in the COVID era of enhanced PPE (e.g. face shield, N95). The techniques developed during the study offer a simple process that can be implemented in any GI endoscopy suite to assess the contributions of suction to workplace noise..