ABSTRACT
Background/Purpose: Numerous case reports have referred to new onset or flare of SLE after SARS-CoV2 mRNA vaccines. Several observational studies showed that the short-term flare rate of SLE after SARS-CoV2 vaccination is low. However, no well-controlled clinical surveys are currently available, and the medium-term impact of SARS-CoV2 mRNA vaccines against the flare of SLE is still unknown. Therefore, we aimed to analyze the association between vaccination and medium-term subjective and objective disease activities of SLE and flares by using matched-pair methods. Method(s): One hundred-fifty SLE patients from the Kyoto Lupus Cohort were included. Patients who received two doses of SARS-CoV2 mRNA vaccines were 1:1 matched with unvaccinated patients based on the first vaccination date. The outcome measures were the SLEDAI, the Japanese version of the SLE symptom checklist questionnaire (SSC-J), and the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI flare index 30, 60, and 90 days after vaccination. Result(s): SLEDAI 30, 60 and 90 days after the second vaccination was not significantly different in SLE patients vaccinated and unvaccinated with SARS-CoV2 vaccines using a mixed-effects model (adjusted estimate [95% CI]: 30 days: -0.46 [-1.48-0.56], P = 0.39;60 days: 0.38 [-0.64-1.40], P = 0.47;90 days: 0.40 [-0.54-1.34], P = 0.41). The similar results were observed in SSC-J score (adjusted estimate [95% CI], 30 days: 0.05 [-1.46-1.56], P = 0.95;60 days: -0.63 [-2.08-0.82], P = 0.40;90 days: 0.27 [-1.04-1.58], P = 0.69) and flare index (adjusted odds ratio [95% CI], 30 days: 0.81 [0.36-1.85], P = 0.62;60 days: 1.13 [0.50-2.54], P = 0.77;90 days: 0.85 [0.32-2.26], P = 0.74). Restricting the patients with high disease activity at baseline (SLEDAI > 10), SLEDAI and SSC-J scores did not differ between the two groups (SLEDAI: adjusted estimate [95% CI], 30 days: -0.95 [-3.13-1.23], P = 0.40;60 days: 0.50 [-2.32-3.32], 0.73;90 days: 1.22 [-1.31-3.75], P = 0.35;SSC-J: adjusted estimate [95% CI], 30 days: 0.74 [-1.63-3.11], P = 0.55;60 days: -0.61 [-3.06-1.84], P = 0.63;90 days: -0.81 [-4.28-2.66], P = 0.65). Conclusion(s): SARS-CoV2 vaccination did not significantly influence the medium-term subjective and objective disease activities or flares of SLE until 90 days after the second vaccination. Even in patients with high disease activities, vaccination was not associated with increased disease activity.
ABSTRACT
Introduction: Information on COVID-19 infection prevention measures and vaccines for patients with neuromuscular diseases has been sufficiently disseminated, but the details of the actual course of infected patients are rarely directly involved by neurologists. We report four cases of COVID-19 with neuromuscular diseases and were able to observe their progress. Subjects: 1 case of multiple sclerosis (MS), 1 case of chronic inflammatory demyelinating polyradiculoneuropathy / dermatitis (CIDP / DM), 1 case of limb-girdle muscular dystrophy (LGMD) and one Duchenne muscular dystrophy carrier (DMD-C) were examined. Result: MS: A 32-year-old man who was taking fingolimod, but improved by waiting at home, and he did not relapse. CIDP / DM: 54-year-old female, PSL, taking tacrolimus, using remdesivir for pneumonia. After recovery, peripheral neuropathy worsened, and steroid pulse treatment was added. LGMD: 48-year-old female Although she had pneumonia, she did not need to be ventilated and improved with only oxygen administration and favipiravir without deterioration of% VC. DMD-C: 59-year-old female, improved only by oxygen administration. The DMD (second son, 29 years old) who were cared by her was hospitalized because no one could care him. Discussion: All cases were affected prior to vaccination. Regarding CIDP, there was a case report of deterioration after illness, and this case also deteriorated and required treatment. LGMD / DMD-C did not show any deterioration in respiratory function. It is a study of a small number of cases, and it is necessary to accumulate future cases.
ABSTRACT
Background: To examine influence of COVID-19 pandemic on cardiovascular risk factors in general population, incidence of newly diagnosed hypertension, diabetes mellitus, hypercholesterolemia and excess body weight during the COVID-19 pandemic period was compared with that of those before the pandemic period. Methods: Annual incidence of hypertension, diabetes mellitus, hypercholesterolemia and excess body weight was evaluated in subjects who had annual health checkup offered to adult citizens of Moriguchi city, Osaka, Japan in 2019 and 2020. Those with history of cardiovascular disease were excluded. The incidence was compared with that of those who received the checkup in 2018 and 2019 as the control value. The incidence of each risk factor was evaluated in separate models in which subjects with the risk factor of interest at baseline were excluded. Multivariate logistic regression analyses were performed adjusted for clinical valuables including age, sex, hypertension, diabetes, current smoking, drinking habit and excess body weight in each model. Results: Characteristics of the subjects at baseline and incidence of the risk factor next year in each model were presented in the table. The incidence of hypertension (odds ratio (OR)=1.45, 95% confidence interval (CI)=1.29 to 1.64, p<0.0001), hypercholesterolemia (OR=1.55, 95% CI=1.37 to 1.76, p<0.0001), and excess body weight (OR=1.50, 95% CI=1.23 to 1.82, p<0.0001) from 2019 to 2020 was significantly higher compared to that from 2018 to 2019 but that of diabetes was not increased (OR=0.94, 95% CI=0.71 to 1.24, p=0.6648). Conclusions: Increased incidence of hypertension, hypercholesterolemia, and excess body weight was observed during the COVID-19 pandemic period.
ABSTRACT
Background: To examine influence of COVID-19 pandemic on cardiovascular system in general population, ECG changes during the COVID-19 pandemic period were compared with those before the pandemic period. Methods: Incidence of newly appeared ECG abnormalities (T wave abnormalities and ST-segment depression including minor changes, and abnormal Q wave) was evaluated in subjects 40 to 74 years of age who had 12-lead ECG recording in annual health checkup offered to adult citizens of Moriguchi city, Osaka, Japan in 2019 and 2020. The incidence was compared with that of those who received ECG recording in 2018 and 2019 as the control value before the COVID-19 pandemic. Those with history of cardiovascular disease, any T wave abnormality, any ST-segment depression, abnormal Q wave, left bundle brunch block, or pace-maker rhythm at baseline ECG were excluded. Multivariate logistic regression analyses were performed adjusted for age, sex, hypertension, current smoking, diabetes, drinking habit and hypercholesterolemia. Results: There were 5,221 (mean age 63±10, men 40%) subjects who received ECG recording in 2018 and 2019 and 4,100 (mean age 63±10, men 41%) subjects who received ECG recording in 2019 and 2020. The incidence of newly appeared T wave abnormalities was 5.2 %, ST-segment depression was 2.8 % and abnormal Q wave was 1.1 % from 2018 to 2019, whereas the incidence of newly appeared T wave abnormalities was 5.8 %, ST-segment depression was 4.3 % and abnormal Q wave was 1.7 % from 2019 to 2020. The incidence of ST-segment depression (odds ratio (OR)=1.59, 95% confidence interval (CI)=1.27 to 1.98, p<0.0001) and that of abnormal Q wave (OR=1.56, 95% CI=1.09 to 2.22, p=0.0149) from 2019 to 2020 was significantly higher compared to that from 2018 to 2019. Conclusions: Increased incidence of ST-segment depression and abnormal Q wave was observed during the COVID-19 pandemic period.