ABSTRACT
Background: There is still controversy about the efficacy of COVID-19 vaccination and its extent in lowering immunogenicity of Rheumatoid Arthritis (RA) patients. The guideline in whether immunosuppressive agents need to be discontinued before the vaccination is continuously updated because it is considered to lower immunogenicity. Furthermore, there is great discussion on the effectiveness of the COVID-19 booster vaccine and interest in antibody generation in different types of vaccine, as in South Korea there are many patients who were prescribed the mRNA booster vaccine after two doses of ChAdOx1-S nCoV-19 vaccine. Objectives: Thus, we investigated the differences of antibody production between patients who received only two doses of ChAdOx1-S nCoV-19 and those who received the mRNA booster vaccine. Also, antibody production under different types of immunosuppressive agents was analyzed. Methods: From October 14, 2021 to January 21, 2022 at a tertiary referral center, two patient groups diagnosed with RA were studied prospectively;one group that completed 1st and 2nd doses of ChAdOx1-S nCoV-19 vaccine, second group that completed mRNA booster vaccine as well as two doses of ChAdOx1-S nCoV-19 vaccine. SARS-CoV-2 antibody testing on the semiquantitative anti-SARS-CoV-2 S enzyme immunoassay was done, and differences in antibody titers were analyzed in patients who received different immunosup-pressive agents such as csDMARD, TNF inhibitor, JAK inhibitor, Tocilizumab, Abatacept and Corticosteroid. Statistical analysis with a multivariate logistic regression model was performed. Results: In a total of 261 patients, 153 patients had completed two doses of ChAdOx1-S nCoV-19, 108 patients had completed third mRNA booster vaccine. Anti-SARS-CoV-2 RBD antibody positive rate (titer>0.8U/mL) was 97%(149/153) and 99%(107/108) respectively, and only 5 patients showed negative result. In the aspect of high antibody titer(>250U/mL), which is the upper limit of the RBD antibody immunoassay, the result showed rate of 31% (47/153) in the non-booster group and 94%(102/108) in the booster group respectively. Among the different immunosuppressive agents and other clinical aspects, multivariate analysis revealed that corticosteroid use (OR 0.91;95% CI: 0.86-0.98), older age(OR 4.33;95% CI: 1.34-13.91), and male gender(OR 0.35;95% CI 0.16-0.75) were signifcantly associated with low rate of high antibody titer. Furthermore, out of 14 patients who underwent antibody test twice before and after the mRNA booster vaccine, other than four patients who already showed high titer of >250U/mL before the mRNA booster vaccine, 10 patients showed an increase in titer after the booster vaccine and 7 patients were acquired high titer of >250U/mL. Conclusion: Anti-SARS-CoV-2 RBD antibody positive rate was 97% or more regardless of the mRNA booster vaccination. However, patients who received the mRNA booster vaccine after two doses of ChAdOx1-S nCoV-19 vaccine showed high antibody titer (>250U/mL) three times more than those who did not receive the booster shot. Our fndings also showed that corticosteroid use, old age, and male gender is signifcantly associated with low rate of acquiring high antibody titer.
ABSTRACT
Background: In Korea, it has been reported that the incidence of some respiratory diseases and Kawasaki diseases has decreased compared to the previous year along with active non-pharmaceutical interventions in the early stages of the COVID-19 pandemic. Autoimmune infammatory rheumatic disease (AIIRD) is mainly affected musculoskeletal organs and connective tissues due to impaired immune regulation. Although gout and osteoarthritis are rheumatic diseases, they are not a disease of the immune system, and are not included in the AIIRD. Objectives: In this study, we investigated the change and difference in the incidence rate of various rheumatic diseases during the COVID-19 pandemic after 2020. Methods: The number of patients for each disease from January 2016 to December 2020 was obtained from the Korea Health Insurance Review and Assessment Service database. We compared the incidence of 9 rheumatic diseases [systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS), Sjogren syndrome (SJS), Behcet's disease (BD), infammatory myositis (IIM), scleroderma, polymyalgia rheumatica (PMR), and gout] and hypertension before and after the COVID-19 outbreak. The incidence rates of patients before and after the COVID-19 outbreak were compared using the Poisson test. Results: From 2016 to 2019, the prevalence of rheumatic diseases showed gradually increased. In 2020, the incidence of SLE, AS, SJS, BD, and IIM were signif-cantly decreased compared to the previous 4 years. In contrast, the incidences of gout and hypertension during the COVID-19 pandemic period were signifcantly increased from the predicted values. Conclusion: In conclusion, we found that the incidence of many AIIRDs, including SLE, AS, SJS, BD, and IIM decreased despite the increased incidence of hypertension and gout during the COVID-19 pandemic.
ABSTRACT
Due to COVID-19, people have to adapt to the new lifestyle until scientists develop a permanent solution for this pandemic. Monitoring the respiration rate is very important for a COVID-infected person because the Coronavirus infects the pulmonary system of the person. Two problems that arise while monitoring the breath rate are: sensors are contact based and expensive for mass deployment. A conventional wearable breath rate monitoring system burdens the COVID-affected patient and exposes the caregivers to possible transmission. A contactless low-cost breath monitoring system is required, which monitors and records the breath rate continuously. This paper proposes a breath rate monitoring system called COVID-Beat, a wireless, low-cost, and contactless Wi-Fi-based continuous breath monitoring system. This sensor is developed using off-the-shelf commonly available embedded Internet of Thing device ESP32, and the performance is validated by conducting extensive experimentation. The breath rate is estimated by extracting the channel state information of the subcarriers. The system estimates the breath rate with a maximum accuracy of 99% and a minimum accuracy of 91%, achieved by advanced subcarrier selection and fusion method. The experimental results show superior performance over the existing breath rate monitoring technologies.
ABSTRACT
Introduction: The advent of mRNA vaccines has been a major component of the vaccination effort against COVID-19. Immunization with mRNA vaccines has been associated with a systemic inflammatory response.1 We present two cases of patients with ulcerative colitis (UC) in long-term remission who experienced flare following vaccination. Case description/methods: Patient 1: A 50-year-old female with history of UC in remission of 4 years on mesalamine who received both doses of the mRNA-1273 mRNA vaccine, 28 days apart, presented with diarrhea and bloody stools that developed 1 week after dose 1. Patient had worsening diarrhea 1 week following vaccination that progressed to hematochezia. Abdominopelvic CT demonstrated contiguous colitis. She was treated with mesalamine and methylprednisolone. Her symptoms improved in 2 days, and she was discharged on a steroid taper. Patient 2: A 52-year-old female with history of UC in remission of 5 years on mesalamine who received both doses of the BNT162b2 mRNA vaccine, 21 days apart, presented with abdominal pain, diarrhea, and bloody stool that developed 1 day after dose 2. Abdominopelvic CT demonstrated diffuse colitis, and she underwent colonoscopy, which was aborted due to extensive colitis. Sigmoid colon biopsy confirmed crypt abscess formation architectural distortion and ulceration. She was treated with mesalamine and methylprednisolone. Her acute disease was complicated by bowel perforation, and she underwent total colectomy. Discussion: The presence of an environmental trigger is frequently linked to onset of disease flare in patients with UC.2 These two patients were in symptomatic remission on 5-ASA maintenance agents for several years prior to vaccination. The lack of clear alternate environmental changes in these patients suggests provocation of flare by the inflammatory response following vaccination. Existing literature evaluating SARS-CoV-2 mRNA vaccine adverse-events in patients with UC suggests that gastrointestinal side-effects are uncommon.3 In addition, biologic agent use may decrease rate of vaccine-related adverse events.3 Recommendations from an international expert consensus favors vaccination of patients with UC.4 In addition, recent literature demonstrates strong immunologic response following vaccination of patients with UC despite concurrent use of biologic agents.5 Consideration should be given to pre-treatment of patients with UC in remission to decrease risk of flare.