ABSTRACT
Background & Aims: Liver injury with autoimmune features after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is increasingly reported. We investigated a large international cohort of individuals with acute hepatitis arising after SARS-CoV-2 vaccination, focusing on histological and serological features. Methods: Individuals without known pre-existing liver diseases and transaminase levels ≥5x the upper limit of normal within 3 months after any anti-SARS-CoV-2 vaccine, and available liver biopsy were included. Fifty-nine patients were recruited;35 females;median age 54 years. They were exposed to various combinations of mRNA, vectorial, inactivated and protein-based vaccines. Results: Liver histology showed predominantly lobular hepatitis in 45 (76%), predominantly portal hepatitis in 10 (17%), and other patterns in four (7%) cases;seven had fibrosis Ishak stage ≥3, associated with more severe interface hepatitis. Autoimmune serology, centrally tested in 31 cases, showed anti-antinuclear antibody in 23 (74%), anti-smooth muscle antibody in 19 (61%), anti-gastric parietal cells in eight (26%), anti-liver kidney microsomal antibody in four (13%), and anti-mitochondrial antibody in four (13%) cases. Ninety-one percent were treated with steroids ± azathioprine. Serum transaminase levels improved in all cases and were normal in 24/58 (41%) after 3 months, and in 30/46 (65%) after 6 months. One patient required liver transplantation. Of 15 patients re-exposed to SARS-CoV-2 vaccines, three relapsed. Conclusion: Acute liver injury arising after SARS-CoV-2 vaccination is frequently associated with lobular hepatitis and positive autoantibodies. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. A close follow-up is warranted to assess the long-term outcomes of this condition. Impact and implications: Cases of liver injury after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) have been published. We investigated a large international cohort of individuals with acute hepatitis after SARS-CoV-2 vaccination, focusing on liver biopsy findings and autoantibodies: liver biopsy frequently shows inflammation of the lobule, which is typical of recent injury, and autoantibodies are frequently positive. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. Close follow-up is warranted to assess the long-term outcome of this condition. © 2022 The Author(s)
ABSTRACT
Background: The COVID 19 Pandemic has been an unprecedented global health crisis. We undertook a retrospective observational study to evaluate its impact on the management of hepatocellular cancer (HCC) in a large tertiary referral service in the UK offering all treatment modalities: liver transplantation and resection through to locoregional, systemic therapy and specialist palliative care. HCC in adults is often diagnosed in advanced stages as symptoms are only apparent later in the disease, and recent reviews have highlighted more patients presenting later with decompensation and a backlog of deferred care1. This study reviews outcomes pre and post the first wave of the Pandemic, including disease presentation, time to treatment and loss to follow up. Methods: Retrospective study of consecutive new referrals to a tertiary treatment centre. These included patients discussed between Dec 2019-Feb 2020 ('pre-COVID';total referrals n=98 with 66 newly diagnosed HCC), and July-Sept 2020 ('post 1st wave COVID';total referrals n=81 with 51 newly diagnosed HCC). NHS Providers had been asked to maintain access to essential cancer treatment throughout the Pandemic with easing of lockdown on 11 May 2020. Patients were longitudinally followed up and analysed using electronic medical records. Descriptive results were expressed as median with IQR for continuous data and as frequency (%) for categorical data. Baseline characteristics of patients were compared between the two cohorts using the Mann-Whitney U test for continuous data, and χ2 test for qualitative data. Results: As shown in Table 1, post 1st wave there has been a reduction in total number of referrals. Median age, sex and aetiology were similar between groups. Differences were noted in patient characteristics of the 'post 1st wave' cohort with a greater proportion presenting with Child Pugh C (19% vs 4%, p=0.037) and BCLC stage D (25.5% vs 12% p=0.019). Among the group of patients presenting during the Pandemic none had a diagnosis of COVID 19 infection. While there were no significant differences in loss to follow up or the decision to treatment time interval (excluding transplant) between 2019 & 2020 (p=0.672), 3 patients in 2020 had treatment cancellations due to capacity. Conclusion: After the 1st wave there has been a reduction in external referrals and an increase in number of patients presenting with advanced chronic liver disease and untreatable HCC. Whilst these are likely to represent the effects of major service reconfiguration during the Pandemic at both a 1° and 2° care level our study suggests we need to better understand medium to longterm impact. We note local efforts to preserve cancer care avoided treatment delays post 1st wave but further analysis is underway to assess impact of the second wave on quality of care received and mortality.
ABSTRACT
The Covid-19 pandemic has been causing mental health problems, one of which is anxiety. The cognitive model theory state bias in implicit memory plays a significant role in causing a person to experience intense anxiety and severity. This study aimed to examine the effect of stimulus presentation (threatening & non-threatening) on implicit memory bias in the anxious and non-anxious participants. This study used a factorial experimental research design and used the Psycopy version 3 program to create computer-based experimental manipulations. A total of 46 participants (22 anxious and 24 non-anxious) of college students joined this research. A computer-based Word Stem Completion Test (WSCT) used for measuring implicit memory bias and STAI for participants selection. A two-way ANOVA (2x2) with JASP software to test the hypothesis. The results showed that there was an effect of the presentation of the stimulus on implicit memory bias. The presentation of a threatening stimulus caused implicit memory bias in both groups (anxious and non-anxious).The implication study results will be discussed in more detail in the discussion. © IEOM Society International.