The Black Swan for Green Supply Chain Management in Pakistan

For the last few decades, the business practices have primarily been focusing on the green and sustainable practices that mainly focus on the preservation of the environment and correspond to corporate social responsibility. But the sudden outbreak of the COVID-19 pandemic has left unprecedented effects on the business world. Against this backdrop, the current study entails investigation of the antecedents and consequences of green supply chain management in the post-COVID-19 era. The term black swan stands true for the event. The term could be believed to be accurate as all aspects of the supply chain have been observed to be influenced by the swan (customers with panic/regulated buying, suppliers with hoarding, inventories witnessing bullwhip effects). The current study, therefore, offers a novel explanation by linking various actors of green supply chain management and how the interplay of those actors can influence the supply chain and overall firm performance post COVID-19.

Ecmo as a Bridge to Lung Transplantation for Covid-19 Respiratory Failure: Outcomes and Risk Factors for Early Mortality

Severe COVID-19 infection can cause advanced respiratory failure requiring ECMO. In some cases, lung transplantation (LT) is a last viable treatment option. This study aims to evaluate outcomes among COVID patients bridged to LT with ECMO and identify risk factors for early mortality post-LT. Using the UNOS database, we identified 442 patients who underwent LT for COVID-19 respiratory failure between August 2020 and September 2022. Outcomes of patients requiring preoperative ECMO (n=253) were compared to those who did not require ECMO pre-LT (n=189). Survival analyses were conducted using the Kaplan-Meier survival function and Cox proportional hazards models. Risk factors for post-LT mortality were analyzed using a multivariate logistic regression model. Out of 442 patients, 253 required preoperative ECMO support for a median of 73 days (IQR 40, 119). The most common ECMO platform was veno-venous (p=0.0008). Patients requiring ECMO were younger, more frequently in an ICU, had higher LAS scores, more likely to require bilateral LT, had higher rates of tracheostomy and pre-LT dialysis, and were more likely to have ARDS etiologies of respiratory failure (all p<0.0001). At 1 and 6 months post-LT, there was no difference in survival between ECMO and non-ECMO patients (95.5% vs 97.5% at 1 month, 92.7% vs 93.4% at 6 months) (Fig 1a). However, ECMO patients had higher rates of prolonged ventilation, post-operative ECMO, new dialysis, and increased length of stay (all p<0.0001) post-LT. Risk factors for mortality included BMI (p=0.007), pan-resistant bacterial infection (p=0.01), preoperative VA ECMO (p=0.0008), prior cardiac surgery (p=0.05), and single LT procedure (p<0.0001) (Fig 1b). Our findings suggest that ECMO can safely be used as a bridge to LT in well-selected patients with COVID-19 respiratory failure despite prolonged support. Here we identify possible risk factors associated with early mortality that may require further evaluation. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Development of myocarditis and pericarditis after COVID-19 vaccination in children and adolescents: A systematic review.

Myocarditis and pericarditis have been reported after COVID-19 vaccine administration in children and adolescents, raising the concern about their possible association with these vaccines. The objective was to explore the incidence, clinical presentation, and association of myocarditis and pericarditis with COVID-19 vaccines in children and adolescents. We conducted a systematic literature search on three databases, that is, Cochrane, MEDLINE/PubMed, and EMBASE from inception till March 2022. A total of three case reports, four case series, and six observational studies were included in the review. For case reports and case series, the mean age of the patients was 17.4 years, with 96.9% being male. Chest pain (n = 31, 93.9%), fever (n = 18, 54.5%), myalgias (n = 15, 45.4%) and headache (n = 9, 27.2%) were the most common presentations. Out of 33 patients, 32 (96.9%) of patients received Pfizer-BioNTech whereas only one (3.03%) received Moderna (mRNA 1273). Clinical investigations revealed ST elevation (n = 32, 97%), and elevated CRP (n = 9, 27.2%) and cardiac troponin (n = 29, 87.8%). The pooled incidence of myocarditis and pericarditis from observational studies was (0.00063%) and (0.000074%) %, respectively. Myocarditis and pericarditis in children and adolescents after the COVID-19 vaccines were more prevalent among males and more commonly observed after the second dose of Pfizer. Though the overall incidence was low, however, the clinicians should consider myocarditis and pericarditis as probable diagnosis when encountering young patients, with a history of vaccine administration, presenting with suggestive findings.

The potential of tobacco in supporting farmers in East Lombok Regency during the Covid-19 Pandemic

Tobacco is a leading commodity that has high economic value. The derivative products from tobacco commodities have contributed greatly to state revenues through excise taxes, employment, and sources of farmers' income. This research aims to;1) explain the characteristics of tobacco farming;2) investigate the economic feasibility of tobacco farming;3) analyze the determinants of tobacco farmers' income. The research was conducted in Suralaga District, East Lombok Regency. The study was conducted from July 2021 to October 2021. The sampling technique used was purposive sampling. Primary data was collected from 40 tobacco farmers and analyzed by with R/C ratio and multiple linear regression. The results of this study indicate that tobacco farming is declared economically feasible, This result is evidenced by the R/C ratio value is 1.67 > 1. Furthermore, the results of the regression estimation show that determine the income of tobacco farmers are the tobacco production, land area, seed cost, fertilizer cost, pesticide cost, labor costs, and farming experience.

Impact of Virtual Interviewing on Geographic Placement for Cardiology Fellowship Recruitment.

Background Virtual interviewing for cardiology fellowship was instituted in the 2021 fellowship application cycle because of the COVID-19 pandemic and restricted travel. The impact on geographic patterns of fellow-training program matching is unknown. This study sought to determine if there was a difference in geographic placement of matched fellows for cardiology fellowship match after initiation of virtual interviews compared with in-person interviewing. Methods and Results All US-based accredited cardiovascular disease fellowship programs that participated in the 2019 to 2021 fellowship match cycles and had publicly available data with fellowship and residency training locations and training year were included. Each fellow was categorized based on whether their fellowship and residency programs were in the same institution, same state, same US census region, or different census region. Categories were mutually exclusive. Of 236 eligible programs, 118 (50%) programs were identified, composed of 1787 matched fellows. Compared with the previrtual cohort (n=1178 matched fellows), there was no difference in the geographic placement during the 2021 virtual cycle (n=609 matched fellows) (P=0.19), including the proportion matched at the same program (30.6% versus 31.5%), same state but different program (13% versus 13.8%), same region but different state (24.2% versus 19.7%), or different region (35% versus 33.1%). There was also no difference when stratified by program size or geographic region. Conclusions The use of virtual interviewing in the 2021 cardiology fellowship application cycle showed no significant difference in the geographic placement of matched fellows compared with in-person interviewing. Further study is needed to evaluate the impact of virtual interviewing and optimize its use in fellowship recruitment.

Mathematical model of COVID-19 transmission dynamics incorporating booster vaccine program and environmental contamination.

COVID-19 is one of the greatest human global health challenges that causes economic meltdown of many nations. In this study, we develop an SIR-type model which captures both human-to-human and environment-to-human-to-environment transmissions that allows the recruitment of corona viruses in the environment in the midst of booster vaccine program. Theoretically, we prove some basic properties of the full model as well as investigate the existence of SARS-CoV-2-free and endemic equilibria. The SARS-CoV-2-free equilibrium for the special case, where the constant inflow of corona virus into the environment by any other means, Ω is suspended ( Ω = 0 ) is globally asymptotically stable when the effective reproduction number R 0 c < 1 and unstable if otherwise. Whereas in the presence of free-living Corona viruses in the environment ( Ω > 0 ), the endemic equilibrium using the centre manifold theory is shown to be stable globally whenever R 0 c > 1 . The model is extended into optimal control system and analyzed analytically using Pontryagin's Maximum Principle. Results from the optimal control simulations show that strategy E for implementing the public health advocacy, booster vaccine program, treatment of isolated people and disinfecting or fumigating of surfaces and dead bodies before burial is the most effective control intervention for mitigating the spread of Corona virus. Importantly, based on the available data used, the study also revealed that if at least 70% of the constituents followed the aforementioned public health policies, then herd immunity could be achieved for COVID-19 pandemic in the community.

COMMONLY USED MAGNESIUM SULFATE UNCOMMONLY CAUSING PULMONARY EDEMA

SESSION TITLE: Drug-Induced Critical Care SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Intravenous magnesium sulfate (MgSo4) is commonly used for inpatient magnesium repletion. However, it is infrequently shown to be associated with the development of pulmonary edema. We present a case of acute hypoxic respiratory failure due to pulmonary edema after starting magnesium infusion in a patient recovering from COVID-19. CASE PRESENTATION: 60 year old female with a history of metastatic breast cancer presented with hypoxic respiratory failure due to COVID-19. CT angiogram of her chest showed diffuse bilateral ground-glass opacities with no evidence of pulmonary embolism. She had prolonged weaning from high flow nasal cannula and was treated with antibiotics, remedesivir, and dexamethasone. Following treatment, her inflammatory markers significantly improved. On day thirty, she was on 25 L at 45% FiO2 on high flow nasal cannula. Her magnesium level was low at 1.5 mg/dl, and 2 grams of intravenous MgSo4 was given for replacement. A few minutes after starting the infusion, the patient complained of metallic taste, severe shortness of breath, and tachypnea with a drop in oxygen saturation to 67%, which improved with increasing oxygen. CXR showed worsening perihilar infiltrates compared to prior, suggesting acute pulmonary edema. An echocardiogram showed normal function without evidence of structural abnormalities. Thyroid function was normal. She did not receive any blood products or opioids prior to this event. She responded very well to diuresis, was weaned to 5L nasal cannula in three days, and was eventually discharged on 2L supplemental oxygen. DISCUSSION: Pulmonary edema is due to the movement of excess fluid into the alveoli. It can be due to cardiogenic and noncardiogenic causes. Noncardiogenic pulmonary edema is due to a rise in transcapillary filtration, causing an increase in capillary permeability due to several factors, most importantly direct endothelial damage due to inflammation. Mechanisms for MgSo4 induced pulmonary edema are unknown, but theories include direct capillary damage or transient cardiac depression. It is seen in studies to be an independent risk factor for the development of pulmonary edema in pregnancy. Higher risk is associated with faster MgSo4 infusion, less concentrated MgSo4, and infection[1]. She was on abemaciclib for breast cancer before her admission, known to cause pneumonitis but was thought unlikely to cause her acute decompensation. The lack of other etiologies explaining sudden respiratory failure, her rapid improvement on stopping magnesium, and her response to diuretics supported our diagnosis. CONCLUSIONS: Treatment of noncardiogenic pulmonary edema involves addressing the underlying cause of the event and is mainly supportive. Given how commonly Mgso4 is used for repletion in the inpatient setting, MgSo4 induced pulmonary edema should be in the differential for acute hypoxic respiratory failure and promptly addressed. Reference #1: Samol JM, Lambers DS. Magnesium sulfate tocolysis and pulmonary edema: the drug or the vehicle? Am J Obstet Gynecol. 2005 May;192(5):1430-2. doi: 10.1016/j.ajog.2005.02.093. PMID: 15902128. DISCLOSURES: No relevant relationships by Nasir Alhamdan No relevant relationships by Harshitha Mergey Devender No relevant relationships by Abira Usman No relevant relationships by Vishruth Vyata No relevant relationships by Harika Yadav

INVASIVE PULMONARY ASPERGILLOSIS ASSOCIATED WITH NONSPECIFIC INTERSTITIAL PNEUMONIA CAUSING RECURRENT RESPIRATORY FAILURE

SESSION TITLE: Unusual Pneumonias SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Invasive pulmonary aspergillosis (IPA) commonly occurs in the setting of immunosuppression. Underlying lung disease is a well-known risk factor for IPA;however, interstitial lung disease (ILD) has not been recognized as a risk factor for IPA[1]. CASE PRESENTATION: A 40-year-old male with a history of a failed kidney transplant now on hemodialysis (HD), Juvenile Rheumatoid Arthritis, Mixed Connective Tissue Disease, Aspergilloma led to right lower lobectomy a year ago, COVID-19 infection three months ago, chronic lung disease (CLD) thought to be due to Nonspecific interstitial pneumonia (NSIP) presented with dyspnea. He had several hospitalizations for respiratory failure needing intubation or NIPPV, broad-spectrum antibiotics, steroids, and HD with improved respiratory status, eventually discharged. Bronchoalveolar lavage fluid culture grew aspergillus terreus but was negative for Pneumocystis (PCP), bacteria, acid-fast bacilli, and Nocardia. The transbronchial biopsies showed mixed inflammatory type and fungal forms in one specimen. Additionally, the initially negative galactomannan converted into a serial rise in galactomannan (>3.75 Index) along with a rise in beta d-glucan (>500 pg/ml). Unfortunately, he had gaps in antifungals and was readmitted similarly. Micafungin was added for dual fungal coverage and was planned for surgical lung biopsy to characterize ILD further once his respiratory status allows. DISCUSSION: He has multiple risk factors for developing IPA, such as high-dose steroids for ILD and recent COVID infection. Initially, respiratory failure was thought to be due to exacerbation of ILD, and suspicion for IPA was low because of lack of neutropenia, negative fungal biomarkers, lack of classic findings on lung imaging, and in-hospital clinical improvement with steroids. However, the eventual course of recurrent respiratory failure while on high-dose steroids, along with gaps in antifungal therapy and continued growth of Aspergillus, made IPA the most likely diagnosis. For IPA, the mainstay of treatment is both adequate antifungal therapy and reduction in immunosuppression to the extent possible[2];however, it is unclear if his underlying ILD can tolerate steroid taper. He will need a lung transplant after adequately treating IPA. CONCLUSIONS: There are no current guidelines on simultaneously treating IPA and NSIP. It is challenging to balance reduction in immunosuppression as tolerated for ILD and concurrently maintain antifungal therapy. During this patient's hospitalization, there have been considerations of using a steroid-sparing agent for his suspected NSIP, however, in the setting of active infection, its benefit is debatable.[3] Reference #1: Matsuyama H, Miyoshi S, Sugino K, et al. Fatal Invasive Pulmonary Aspergillosis Associated with Nonspecific Interstitial Pneumonia: An Autopsy Case Report. Intern Med. 2018;57(24):3619-3624. doi:10.2169/internalmedicine.1144-18 Reference #2: Thomas F. Patterson, George R. Thompson, III, David W. Denning, Jay A. Fishman, Susan Hadley, Raoul Herbrecht, Dimitrios P. Kontoyiannis, Kieren A. Marr, Vicki A. Morrison, M. Hong Nguyen, Brahm H. Segal, William J. Steinbach, David A. Stevens, Thomas J. Walsh, John R. Wingard, Jo-Anne H. Young, John E. Bennett, Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 63, Issue 4, 15 August 2016, Pages e1–e60, https://doi.org/10.1093/cid/ciw326 Reference #3: Mezger, M., Wozniok, I., Blockhaus, C., Kurzai, O., Hebart, H., Einsele, H., & Loeffler, J. (2008). Impact of mycophenolic acid on the functionality of human polymorphonuclear neutrophils and dendritic cells during interaction with Aspergillus fumigatus. Antimicrobial agents and chemotherapy, 52(7), 2644–2646. https://doi.org/10.1128/AAC.01618-07 DISCLOSURES: No relevant relationships by Nasir Alhamdan No relevant relati nships by Parth Jamindar No relevant relationships by Harshitha Mergey Devender No relevant relationships by Abira Usman No relevant relationships by Vishruth Vyata

Chest Tubes in COVID-19 Patients on Extracorporeal Membrane Oxygenation: Time To Revisit Our Approach?

Objectives: The purpose of this study was to compare the outcomes of chest tubes (CT) inserted via three approaches in COVID-19 patients undergoing extracorporeal membrane oxygenation (ECMO): open thoracostomies (OT), percutaneously at bedside (PERC), and percutaneously by interventional radiology (PERC IR). Methods: We conducted an institutional review board - approved retrospective study of all COVID-19 patients who required CT placement while undergoing ECMO in our institution from February 2020 till February 2022. Insertions prior to ECMO cannulation or after decannulation, and those related to post-operative lung transplantation during ECMO were excluded from our analysis. Depending on the insertion approach, eligible CT insertion events were divided in three groups: OT, PERC and PERC IR. Data regarding patients' demographics and CT characteristics, clinical indications and associated complications for each group were collected and analyzed. Bleeding related to CT insertion was diagnosed based on requirement of blood transfusion, cessation of anticoagulation and/or ongoing bloody CT output. Results: Study criteria were met by 43 patients, with 35 (83.7%) of male sex. Mean age was 45 years. Mean BMI was 31.6 kg/m2. Forty patients (93.0%) had COVID-related acute respiratory distress syndrome as primary diagnosis. All patients but one had been receiving therapeutic anticoagulation which was held prior to CT insertion. Eighty-seven CT insertion events were recorded, of which 34 (39.1%) comprised the OT group, 20 (23.0%) the PERC group, and 33 (37.9%) the PERC IR group. Table 1 demonstrates a descriptive comparison of CT and insertion data among the three groups. Table 2 depicts the major outcomes among the three groups. Conclusions: For COVID-19 patients on ECMO, insertion of CTs percutaneously by IR is associated with significantly fewer bleeding episodes, transfusions, thoracic consults and explorations in the operating room compared to bedside OT or percutaneous CTs. One third of the percutaneously placed CTs by IR required tube upsizing in the IR suite, a rate still lower compared to the overall CT manipulations or repeat interventions required for CTs inserted via OT or percutaneously at bedside. (Table Presented).

A Successful Elimination of Indonesian SARS-CoV-2 Variants and Airborne Transmission Prevention by Cold Plasma in Fighting COVID-19 Pandemic: A Preliminary Study

Global infection and mortality rates have soared to millions due to SARS-CoV-2 human-to-human transmission via droplets which then declared as pandemic. This study examined the created cold plasma equipment (CPE) effectiveness in reducing COVID-19 transmission in a confined space. CPE sucked air using a fan in a test chamber then pushed it into a cold plasma reactor. The results indicated that it was able to terminate all SARS-CoV-2 variants along with bacteria and fungi indoors by keeping it turned on for 30 min' minimum. CPE was proven as safe and effective to hinder virus transmission with the acceptable ozone emission as the side effect. © 2022 University of Kerbala.

The Best Solution for Pandemic Prevention of Covid-19: Important Notes in Light of the Quranic Perspectives

This article analytically discusses how the Quran commands Muslims to be prudent in the face of a pandemic crisis. The Quran is the holy book of Islam and is considered by Muslims to be the word of God and is a valid source of guidance alongside science advisories from government authorities. Using a qualitative method, this study investigates the Quranic assertion that in the face of a pandemic crisis, Muslims are required to do charitable deeds and keep striving with the hope that the solution to problems people face can be actively found, rather than just fatalistically surrendering to fate and Allah's power alone. In this regard, the Quran commands Muslims to be prudent and to take precautions against the spread of disease, practice charity, endure, not be fooled by false gossip and to place trust in the religious and health authorities during times of crisis. © 2022 International Islamic University Malaysia. All rights reserved.

EFFECT OF TELEREHABILITATION IN FACILITATING UPPER EXTREMITY HOME PROGRAMS AND ASSOCIATED FUNCTIONAL REGAIN AMONG CHRONIC STROKE SURVIVORS: A PILOT STUDY

Background: Stroke is a leading cause of disability in adults, requiring regular patient-therapist contacts to achieve greater functional regain of the affected extremities. Factors such as the recent Covid-19 pandemic have limited access to Rehabilitation services across several communities globally. A proliferation of telerehabilitation to ameliorate these healthcare challenges has been palpable in the recent years across the globe. Purpose: To assess the effect of telerehabilitation in facilitating upper extremity home program and associated functional regain among chronic stroke survivors. Methods: Two groups pretest-posttest study design was employed. Participants were instructed to perform upper extremity home programs three times a week for four weeks. A task-oriented, individually tailored, and intensive home-based telerehabilitation program was administered to the participants using audio calls. Upper extremity functional status was assessed using Fugl-Meyer Motor Assessment, and Wolf Motor Function Test. The Barthel Index was used to assess the extent of activities of daily living. Results: A total number of 14 people were recruited (experimental n=7 age, 58 ± 5.83;control n=7, age 50.71 ± 8.62). Participants showed significant improvement for Fugl-Meyer Motor Assessment changed from 17.57 to 25.86 (p=0.02), whereas Wolf Motor Function Test changed from 28.14 to 43.71 (p=0.03). Conclusions: Amidst situations restricting regular hospital visit among stroke survivors;telerehabilitation could serve as an adjunct therapeutic option for upper extremity rehabilitation. Future studies should employ a randomized controlled trial design with a larger sample size to confirm the utility of telerehabilitation.

Management of Symptomatic Inguinal Hernia under Local Anesthesia in Covid Pandemic Our Experience

Background: Health care burden has increased since the pandemic of Covid-19 has emerged. The healthcare resources are limited currently and majority surgeries have been postponed because of the current pandemic. Therefore, the main concern of carrying out any surgery at current point is mainly in those patients that are landing in emergency. Symptomatic inguinal hernia being a common presentation in emergency can be dealt by applying local anesthesia. Objective: To evaluate the outcome (in terms of efficacy and safety) of local anesthesia for managing symptomatic inguinal hernia in a tertiary care hospital during current Covid-19 pandemic. Methodology: It was a descriptive study.60 males were enrolled with inguinal hernia of age 30-60 years. IV line was secured and local anesthesia was administered under aseptic measures. Lichtenstein repair, a mesh technique was applied in all patients for treating the inguinal hernia. Patients were evaluated postoperatively after 2 hours and 6 hours for any complications. Results: Mean age of the patients was 38.2±10.542, Mean time to eat was 3.85 ±3.138. Mean time to ambulate was 4.37 ±2.51. Mean pain score was 5.78± 2.131 postoperatively and after 6 hours it was 2.24 ±0.84. Indirect hernia was present in 74% patients whereas direct hernia was present in 26%. 6.67% patients had nausea/vomiting, 3.3% developed hematoma and 1.67% had wound infection. Conclusion: Local anesthesia is effective in all patients who have to undergo inguinal hernia surgery, in terms of efficacy and safety.

KNOWLEDGE, RISK PERCEPTION AND PREVENTIVE PRACTICES OF COVID-19 AMONG STAFF OF PRIMARY AND SECONDARY SCHOOLS IN KADUNA STATE, NIGERIA

INTRODUCTION: Kaduna State is among the three States with the highest number of confirmed COVID-19 cases. The objective of this study was to assess the knowledge, risk perception and practices of staff towards prevention and control of COVID-19 infection in schools to provide policy makers, education and health managers required information to manage the epidemic as the schools prepare to re-open. METHODS: This was a school-based survey conducted using purposive sampling of 55 schools located in nine LGAs with the highest number of reported COVID-19 cases as at October 2020. Five schools with the highest students'/pupils' enrollment in each of the LGA were selected and all staff were interviewed. Information on knowledge, risk perception and practices of prevention was collected. Descriptive statistics were generated using Stata v14 software. RESULTS: A total of 1065 staff in 55 schools completed the interview. Major sources of information are television (73%), radio (61%), and social media (57%);and 76% indicated that a virus is the causative agent of COVID-19. Overall, 70%, 19%, 7%, 9.3% and 0% respectively had adequate knowledge of cause, preventive measures, respiratory hygiene, modes of transmission and symptoms of COVID-19;however only 14% ever attended a workshop on COVID-19. Eighty-two percent and 89% respectively believed in the efficacy of face masks and handwashing as means of prevention;39% thought that they are likely to contract COVID-19. Ninety-nine percent and 90% have ever used face mask and hand sanitizer to prevent COVID-19;96% and 85% respectively have use these methods in previous 24hours. Between 42% and 73% of schools needed additional commodities/requirements/supplies to comply fully with COVID-19 prevention protocols. CONCLUSION: While knowledge of COVID-19 is suboptimal, perception is positive and practice is high. Thus, teachers need to be well informed and encouraged to sustain current levels of preventive measures. Government needs to provide schools with adequate preventive commodities to ensure compliance.

Evolution of anti-sars-cov-2 igg antibody and igg avidity post pfizer and moderna mrna vaccinations

Introduction: Messenger RNA (mRNA) based vaccines (Pfizer/BioNTech and Moderna) have shown to be highly effective at providing immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aims: To study the duration of immunity, evolution of IgG antibody levels and IgG avidity (an index of antibody-antigen binding strength), and differences in immune responses between (mRNA) based vaccines. Methods: We performed a prospective study of 72 subjects without a history of SARS-CoV-2 who received both doses of either the Pfizer (n=55) or Moderna (n=17) mRNA vaccine. Anti-spike protein receptor binding domain (RBD) IgG antibody levels and IgG avidity indices were measured longitudinally using a qualitative finger stick MidaSpot™ rapid test at the point-of-care and a quantitative dry blood spot-based pGOLD™ laboratory test over ∼ 4 months post-vaccination. Results: On average, anti-RBD IgG antibody levels peaked at ∼2 weeks after second vaccination dose and declined thereafter, while antibody avidity increased suggesting antibody maturation (Figure). Moderna vaccine recipients exhibited higher side effect severity, higher peak anti-RBD IgG antibody levels and higher avidity up to the 90 days point, when compared to Pfizer vaccine recipients. Nevertheless, the differences in antibody and avidity levels diminished at ∼ 120 days post-vaccination, in line with the similar efficacy of the two vaccines. A qualitative MidaSpot finger stick rapid test detected 100% anti-SARS-CoV-2 RBD positivity for fully vaccinated subjects in both Pfizer and Moderna cohorts and turning negative greater than 90 days post-vaccination for 9% of subjects in the Pfizer cohort whose quantitative anti-IgG fell below the 25-percentile levels. Conclusions: Longitudinal quantitative measurements of anti-RBD antibody and avidity levels provide insight to immune responses and could aid the assessment of immunity and vaccine effectiveness.

Perimyocarditis following first dose of the mRNA-1273 SARS-CoV-2 (Moderna) vaccine in a healthy young male: a case report.

BACKGROUND: Half of U.S. adults have received at least one dose of the COVID-19 vaccines produced by either Pfizer, Moderna, or Johnson and Johnson, which represents a major milestone in the ongoing pandemic. Given the emergency use authorizations for these vaccines, their side effects and safety were assessed over a compressed time period. Hence, ongoing monitoring for vaccine-related adverse events is imperative for a full understanding and delineation of their safety profile. CASE PRESENTATION: An 22-year-old Caucasian male presented to our hospital center complaining of pleuritic chest pain. Six months prior he had a mild case of COVID-19, but was otherwise healthy. He had received his first dose of the Moderna vaccine three days prior to developing symptoms. Laboratory analysis revealed a markedly elevated troponin and multiple imaging modalities during his hospitalization found evidence of wall motion abnormalities consistent with a diagnosis of perimyocarditis. He was started on aspirin and colchicine with marked improvement of his symptoms prior to discharge. CONCLUSIONS: We present a case of perimyocarditis that was temporally related to COVID-19 mRNA vaccination in an young male with prior COVID-19 infection but otherwise healthy. Our case report highlights an albeit rare but important adverse event for clinicians to be aware of. It also suggests a possible mechanism for the development of myocardial injury in our patient.