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Background: Literature describing triggers of GFAP astrocytopathy (GFAP-A) is limited. We report a case of GFAP-A in a patient with recent messenger ribonucleic acid (mRNA) severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination and discuss the possible pathogenesis. Case description: A 45-year-old gentleman presented with features of meningoencephalitis 31 days after the first dose and 4 days after the second dose of mRNA SARS-CoV-2 vaccination. He sequentially developed brainstem/cerebellar, autonomic and cord dysfunction. Cerebrospinal fluid was positive for GFAP autoantibody. Clinical improvement occurred after intravenous methylprednisolone and immunoglobulins. Conclusion(s): Although we are uncertain of a causal link of GFAP-A to mRNA vaccine, indirect activation of an underlying dysregulated immune milieu is plausible.Copyright © 2021 The Author(s)
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Background. Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported amongst hospitalised patients with COVID-19 in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. As such, we sought to examine the evolving trends in electrocardiographic and cardiovascular manifestations in patients hospitalised for COVID-19 infection. Methods. We examined the first 1781 consecutive hospitalised patients with polymerase chain reaction (PCR) confirmed COVID-19 in a tertiary academic centre. We divided the population based on those who had an abnormal electrocardiogram (ECG) and those who had a normal ECG, comparing the baseline characteristics and outcomes between the 2 groups. Cardiovascular complications such as acute myocardial infarction, stroke, pulmonary embolism, myocarditis and mortality were also examined over time. Results. Of the 261 (14.7%) patients presenting with abnormal ECG, they were more likely to be symptomatic with complaints of breathlessness, palpitations and chest pain. Sinus tachycardia was the most common arrhythmia. Troponin I levels (41.6+/-264.3 vs 97.0+/-482.9, p=0.047) and C-reactive protein levels (20.1+/-50.7 vs 13.9+/-24.1 mumol/L, p=0.003) were significantly higher amongst those with abnormal ECGs at presentation, with a higher prevalence of myocarditis (1.9% vs 0.5%, p=0.021), pulmonary embolism (1.9% vs 0.3%, p=0.009) and acute myocardial infarction (1.1% vs 0.1%, p=0.025). Over time, there was a trend towards a higher proportion of hospitalised patients with cardiovascular complications. Baseline characteristics of hospitalised patients with COVID-19, with or without abnormal ECG at presentation Changes in percentage of hospitalised patients with COVID-19, experiencing cardiovascular events (acute myocardial infarction, stroke, myocarditis, pulmonary embolism and death) over time Conclusion. A baseline ECG at presentation is a simple test that provides valuable information on potential cardiovascular complications in the context of COVID-19. Although the prevalence of abnormal ECGs is relatively low, it appears to be increasing over time amongst hospitalised patients with COVID-19.
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Introduction: Several studies have reported attenuated humoral responses following SARS-CoV-2 mRNA vaccination in Multiple Sclerosis (MS) patients on anti-CD20 therapies and fingolimod. However, neutralising antibodies (NAbs) against the receptorbinding domain of the SARS-CoV-2 spike protein were quantified in only a few reports and there is limited data in neuromyelitis optica spectrum disorder (NMOSD) patients. Objectives and Aims: To measure serum NAbs levels prior to, and, at several time points after the first (V1) and second (V2) SARS-CoV-2 mRNA vaccination in patients with neuroimmunological conditions on various immunotherapies, and, to identify the factors associated with poor humoral responses. Method(s): This was a prospective observational study performed at the National Neuroscience Institute, Singapore. Patients with MS (n=77), NMOSD (n=33), myelin oligodendrocyte glycoprotein- antibody associated disease (n=6), autoimmune encephalitis (n=3), other CNS inflammatory diseases (n=5), myasthenia gravis (n=9) and healthy controls (HCs, n=42) were recruited. No subjects had COVID-19 infection prior to V1, V2 and the sampling time points. NAbs were measured using the Genscript cPassTM surrogate virus neutralisation test. Result(s): No patients or HCs had detectable NAbs prior to V1. Two to 4 weeks after V1, patients on anti-CD20 therapies had lower NAbs levels (p=0.010) compared to HCs and untreated patients. Two to 6 weeks post V2, patients on disease-modifying anti-rheumatic drugs (DMARDs) (p=0.010), fingolimod (p<0.0001) and anti-CD20 therapies (p<0.0001) showed decreased NAbs levels compared to HCs and untreated patients. This was also observed 8 to 16 weeks post V2 - DMARDs (p=0.046), fingolimod (p<0.0001) and anti-CD20 therapies (p<0.0001). NAbs levels decreased in both HCs and patients with increasing time interval following V2. There was no correlation between NAbs levels and the time interval from last anti-CD20 treatment to V1 (p=0.508). A multivariable logistic regression model adjusted for age, expanded disability status scale, gender, mRNA vaccine type, ethnicity and body mass index, revealed that fingolimod (p=0.026) and anti-CD20 therapies (p=0.003) were independent predictors of undetectable NAbs following V2. Conclusion(s): Fingolimod and anti-CD20 therapies are associated with attenuated NAbs levels post-vaccination. Future studies are needed to determine whether this translates to an increased risk of COVID-19 infection.
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Exercise-basedcardiac rehabilitation (EBCR) is a well-established multidisciplinary form of treatment for the majority of cardiovascular diseases. It has been shown to reduce cardiovascular mortality and morbidity as well as improve risk factor control, quality of life, mental wellbeing and physical fitness. Despite these proven benefits, EBCR has historically faced multiple challenges such as poor uptake, high dropout rates and low referral rates. The ongoing COVID-19 pandemic has thrust technology into focus and facilitated the use of telehealth in EBCR. This presentation provides an opportunity to learn about the provision of EBCR within government restructured hospitals in Singapore, as well as the transition from a traditional face-to-face service to the utilisation of remote methods in changing perspectives of patients and healthcare providers alike.
Subject(s)
COVID-19 , Encephalitis , Hashimoto Disease , Humans , Receptors, GABA-B , COVID-19/complications , Encephalitis/diagnosis , Encephalitis/etiology , AutoantibodiesABSTRACT
Objectives: Cardiac rehabilitation (CR) exercise classes in Singapore were either cancelled or suspended due to the ongoing COVID-19 pandemic. In response, a hybrid CR programme utilising telehealth was created to reduce reliance on in-person sessions. Our study aimed to assess early patients' impressions of this novel CR delivery method. Methods: Each hybrid CR programme comprises: (a) one CR orientation session via the Zoom video conferencing platform where patients interact with CR nurses and physiotherapists, (b) two 6-minute walk test fitness assessments (at baseline and upon completion), (c) five in-person supervised exercise classes and (d) two teleconsultation sessions (scheduled after exercise sessions 2 and 4) where CR physiotherapists review symptoms and discuss exercise prescriptions with patients over the phone. Upon programme completion, patients filled 2 anonymous online questionnaires - one assessing the videoconferencing component and another assessing the teleconsultation component and overall programme. Results: Seven patients underwent the hybrid CR programme. The majority were male (n=6, 86%), aged between 51 to 65 years (n=4, 57%) and had previously used a wide range of mobile applications (n=6, 86%). 100% of patients either agreed or strongly agreed that both videoconferencing and teleconsultation were: (a) easy to use, (b) as valuable as in-person sessions, (c) saved time and (d) had lower infection risk compared to in-person sessions (Figure). The overall ratings for videoconferencing, teleconsultation and the hybrid programme were 9.3, 9.6 and 9.6 (out of 10) respectively. All patients would definitely recommend the programme to others. Conclusion: Responses by participants of a novel hybrid CR programme utilising telehealth are highly encouraging. From a patient perspective, incorporation of telehealth to enable remote CR is feasible, acceptable and should be considered as an alternative CR delivery method.
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The COVID-19 pandemic has resulted in enforced and prolonged social and physical distancing. For cardiac patients, this has led to suspension of group exercise classes, whereas many healthcare providers were re-deployed to the frontlines of the COVID-19 battle. Strict travel restrictions within and between countries have also led to many families being separated from one another in different parts of the world, leading to significant stress, anxiety and even depression. Find out how both patients and healthcare workers have been impacted by the pandemic, how technology has played a part in delivering cardiac rehabilitation remotely, as well as available resources for stress relief.
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Although the end of the COVID-19 pandemic is still not in sight, it is stablising as life gradually returns to a new form of normal. This is especially important for physical activity, whether in competitive athletes, healthy individuals engaging in recreational sport or those with pre-existing heart conditions looking to improve their fitness. Avoiding sedentary behaviour, along with regular physical activity, are essential in reducing cardiovascular risk. However, with more evidence reporting multiple adverse short and long term cardiovascular sequelae in COVID-19 patients, how can we keep ourselves safe while continuing to enjoy physical activity? This lecture will cover contemporary guidelines and recommendations for physical activity and sports amidst the COVID-19 pandemic, especially in those who have contracted the disease, as well as those with pre-existing heart conditions.