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1.
Tohoku Journal of Experimental Medicine ; 257(1):57-64, 2022.
Article in English | GIM | ID: covidwho-2045708

ABSTRACT

This study sought to evaluate the effects of two vaccine doses and the extent of SARS-CoV-2 infection among healthcare workers. We measured immunoglobulin G antibody titers against SARS-CoV-2 nucleocapsid and spike protein among healthcare workers at Gunma University Hospital. In March 2021, prior to BNT-162b2 vaccination, two of 771 participants were seropositive for nucleocapsid and spike protein, whereas 768 were seronegative. The remaining one participant was seropositive for nucleocapsid protein but seronegative for spike protein. A total of 769 participants were seropositive for spike protein after two vaccination doses. The two seropositive participants prior to vaccination showed the highest antibody titers after the second vaccination. They were probably infected with SARS-CoV-2 without clinical symptoms before March 2021. Four weeks after the second vaccination, a younger age was associated with higher antibody titers against SARS-CoV-2 spike protein. Thirty-two weeks after the second vaccination, blood samples were collected from 342 of 769 participants. Antibody titers at 32 weeks after the second vaccination significantly decreased compared with those at 4 weeks after the second vaccination among all age groups. The rate of decrease in antibody titers between 4 and 32 weeks after the second vaccination was greater in the female participants. No sex differences were observed in the antibody titers within each age group. BNT-162b2 vaccination thus induced seroconversion in an age-dependent manner. Serological screening could further establish the likelihood of subclinical SARS-CoV-2 infection.

2.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009513

ABSTRACT

Background: COVID-19 vaccination-related lymphadenopathy is a frequent imaging finding that may be indistinguishable from malignant nodes and can lead to diagnostic difficulties in patients with cancer or healthy individuals on cancer screening. However, no prospective trials regarding COVID-19 vaccination- related lymphadenopathy following a booster shot have been conducted. The purpose of this study was to determine the incidence and imaging characteristics of COVID-19 vaccination-related axillary lymphadenopathy and assess the recovery period following a booster shot. Methods: We prospectively enrolled healthy women working at St. Luke's International Hospital, who would receive the third shot of the Pfizer-BioNTech COVID-19 vaccine between December 6 and 28, 2021. Women with a history of cancer, atopic dermatitis, auto-immune disease, or axillary surgery were excluded. All participants underwent ultrasound (US) examinations for the bilateral axilla at baseline (prior to the third shot), early phase (1-3 days after the shot), and late phase (6 weeks after the shot) if lymphadenopathy was detected at the early phase. We evaluated the incidence and US characteristics of lymphadenopathy. As for US characteristics mimicking a malignant node, focal cortical thickening, absence of the echogenic hilus, and vascularity were examined. In this study, abnormal lymphadenopathy was defined as [1] an increase in the short-axis size by more than 2 mm compared with the baseline, [2] an increase in the number of nodes with short-axis diameter more than 5 mm, and [3] demonstrating US characteristics mimicking malignant nodes. Results: A total of 100 women were enrolled in this study. The median age was 41 years (range 23-63). Abnormal axillary lymphadenopathy on the vaccinated side was observed in 59% of participants in the early phase and 8% in the late phase. In the contralateral axilla, abnormal lymphadenopathy was observed in 1% of participants in the early phase and 2% in the late phase. The median short-axis size of ipsilateral abnormal lymphadenopathy was 7.6 mm in the early phase and 5.7 mm in the late phase. In the early phase, US characteristics mimicking malignant nodes were observed, including focal cortical thickening in 54% of participants, absence of the echogenic hilus in 16%, and hypervascularity in 33%. Conclusions: COVID-19 vaccination-related axillary lymphadenopathy indistinguishable from malignant nodes was observed in more than half of the participants compared with the baseline, which improved in most cases within 6 weeks after the latest booster shot. To avoid a diagnostic conundrum, patients with breast cancer should be vaccinated on the arm contralateral to the cancer side. It is recommended that non-urgent imaging screening for the axilla should be scheduled after 6 weeks following the latest vaccination.

3.
Annals of the Rheumatic Diseases ; 81:720-722, 2022.
Article in English | EMBASE | ID: covidwho-2008862

ABSTRACT

Background: Evaluation of physical function is fundamental in the management of idiopathic infammatory myopathies (IIMs). Patient-Reported Outcome Measurement Information System (PROMIS) is a National Institute of Health initiative established in 2004 to develop patient-reported outcome measures (PROMs) with improved validity and efficacy. PROMIS Physical Function (PF) short forms have been validated for use in IIMs [1]. Objectives: To investigate the physical function status of IIM patients compared to those with non-IIM autoimmune diseases (AIDs) and healthy controls (HCs) utilizing PROMIS PF data obtained in the coronavirus disease-2019 (COVID-19) Vaccination in Autoimmune Diseases (COVAD) study, a large-scale, international self-reported e-survey assessing the safety of COVID-19 vaccines in AID patients [2]. Methods: The survey data regarding demographics, IIM and AID diagnosis, disease activity, and PROMIS PF short form-10a scores were extracted from the COVAD study database. The disease activity (active vs inactive) of each patient was assessed in 3 different ways: (1) physician's assessment (active if there was an increased immunosuppression), (2) patient's assessment (active vs inactive as per patient), and (3) current steroid use. These 3 defnitions of disease activity were applied independently to each patient. PROMIS PF-10a scores were compared between each disease category (IIMs vs non-IIM AIDs vs HCs), stratifed by disease activity based on the 3 defnitions stated above, employing negative binominal regression model. Multivariable regression analysis adjusted for age, gender, and ethnicity was performed clustering countries, and the predicted PROMIS PF-10a score was calculated based on the regression result. Factors affecting PROMIS PF-10a scores other than disease activity were identifed by another multivariable regression analysis in the patients with inactive disease (IIMs or non-IIM AIDs). Results: 1057 IIM patients, 3635 non-IIM AID patients, and 3981 HCs responded to the COVAD survey until August 2021. The median age of the respondents was 43 [IQR 30-56] years old, and 74.8% were female. Among IIM patients, dermatomyositis was the most prevalent diagnosis (34.8%), followed by inclusion body myositis (IBM) (23.6%), polymyositis (PM) (16.2%), anti-syn-thetase syndrome (11.8%), overlap myositis (7.9%), and immune-mediated necrotizing myopathy (IMNM) (4.6%). The predicted mean of PROMIS PF-10a scores was signifcantly lower in IIMs compared to non-IIM AIDs or HCs (36.3 [95% (CI) 35.5-37.1] vs 41.3 [95% CI 40.2-42.5] vs 46.2 [95% CI 45.8-46.6], P < 0.001), irrespective of disease activity or the defnitions of disease activity used (physician's assessment, patient's assessment, or steroid use) (Figure 1). The largest difference between active IIMs and non-IIM AIDs was observed when the disease activity was defned by patient's assessment (35.0 [95% CI 34.1-35.9] vs 40.1 [95% CI 38.7-41.5]). Considering the subgroups of IIMs, the scores were signifcantly lower in IBM in comparison with non-IBM IIMs (P < 0.001). The independent factors associated with low PROMIS PF-10a scores in the patients with inactive disease were older age, female gender, and the disease category being IBM, PM, or IMNM. Conclusion: Physical function is signifcantly impaired in IIMs compared to non-IIM AIDs or HCs, even in patients with inactive disease. The elderly, women, and IBM groups are the worst affected, suggesting that developing targeted strategies to minimize functional disability in certain groups may improve patient reported physical function and disease outcomes.

4.
J Eur Acad Dermatol Venereol ; 36(7): e517-e520, 2022 07.
Article in English | MEDLINE | ID: covidwho-1901727
5.
Elementa-Science of the Anthropocene ; 10(1):20, 2022.
Article in English | English Web of Science | ID: covidwho-1883725

ABSTRACT

This study delves into the photochemical atmospheric changes reported globally during the pandemic by analyzing the change in emissions from mobile sources and the contribution of local meteorology to ozone (O-3) and particle formation in Bogota (Colombia), Santiago (Chile), and Sao Paulo (Brazil). The impact of mobility reductions (50%-80%) produced by the early coronavirus-imposed lockdown was assessed through high-resolution vehicular emission inventories, surface measurements, aerosol optical depth and size, and satellite observations of tropospheric nitrogen dioxide (NO2) columns. A generalized additive model (GAM) technique was also used to separate the local meteorology and urban patterns from other drivers relevant for O-3 and NO2 formation. Volatile organic compounds, nitrogen oxides (NOx), and fine particulate matter (PM2.5) decreased significantly due to motorized trip reductions. In situ nitrogen oxide median surface mixing ratios declined by 70%, 67%, and 67% in Bogota, Santiago, and Sao Paulo, respectively. NO2 column medians from satellite observations decreased by 40%, 35%, and 47%, respectively, which was consistent with the changes in mobility and surface mixing ratio reductions of 34%, 25%, and 34%. However, the ambient NO2 to NOx ratio increased, denoting a shift of the O-3 formation regime that led to a 51%, 36%, and 30% increase in the median O-3 surface mixing ratios in the 3 respective cities. O-3 showed high sensitivity to slight temperature changes during the pandemic lockdown period analyzed. However, the GAM results indicate that O-3 increases were mainly caused by emission changes. The lockdown led to an increase in the median of the maximum daily 8-h average O-3 of between 56% and 90% in these cities.

6.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779445

ABSTRACT

Background: COVID-19 vaccination-related lymphadenopathy is a frequent imaging finding which may be indistinguishable from malignant nodal involvement and lead to diagnostic difficulties in patients with cancer or healthy individuals on cancer screening. An expert panel of the leading cancer centers in United States recommended routine imaging examinations should be scheduled at least 6 weeks after the final vaccination to allow for any reactive lymphadenopathy to resolve. However, there were no prospective trials regarding COVID-19 vaccination-related lymphadenopathy and the evidence was so limited. The purpose of this study was to determine the incidence and imaging characteristics of COVID-19 vaccination-related axillary lymphadenopathy and assess the recovery period. Methods: We prospectively enrolled healthy women working at the St. Luke's International Hospital who received Pfizer COVID-19 vaccination within 8 weeks before enrollment between May 10th and 27th, 2021. Women with a history of any type of cancer or axillary surgery, active atopic dermatitis and auto-immune disease were excluded. Participants underwent ultrasound examinations for bilateral axilla at the enrollment. Lymphadenopathy was defined as demonstrating an enlarged node(s) with more than 5mm in short axis by ultrasound imaging in this trial. As for imaging characteristics, status of cortical thickening, echogenic hilus and vascularity of lymph nodes were evaluated. Other side effects by vaccination were assessed by a questionnaire. If lymphadenopathy was detected, we followed the participant by ultrasound examination every three weeks until the lymphadenopathy was resolved. We evaluated theincidence rate and imaging characteristics of lymphadenopathy detected by ultrasound examination, and the recovery period required for improvement of the lymphadenopathy. We also validated the association of the lymphadenopathy with the participant characteristics and other side effects. Results: A total of 135 women were enrolled in this study. Participants' median age was 37 years (range 23-63). Median time from the latest vaccination to the enrollment was 45 days (range 8-56). In the ultrasound examination at enrollment, axillary lymphadenopathy was observed in 67 participants (50%) on the injected (ipsilateral) side. In the contralateral axilla, 13 participants (10%) showed lymphadenopathy. In the ipsilateral axilla, the number of enlarged node(s) was 1 node in 25 cases (19%), 2 nodes in 24 cases (18%), 3 nodes in 13 cases (10%), 4 nodes in 4 cases (3%) and 5 nodes in 1 case (1%). Regarding the ipsilateral enlarged lymph node, focal cortical thickening was observed in 58 cases (43%) and the absence of the echogenic hilus was observed in 15 cases (11%). Hypervascularity was observed in 15 cases (11%). Incidence of the lymphadenopathy was not statistically correlated with participant's age or incidence of fever due to vaccination. At 6 weeks after the latest vaccination, the rate of ipsilateral axillary lymphadenopathy was 48%, 40% at 8 weeks, and 6% at 12 weeks. In participants with lymphadenopathy, median recovery period to resolve the lymphadenopathy was 75 days from the latest vaccination. Conclusion: A half of participants showed COVID-19 vaccination-related axillary lymphadenopathy and the imaging characteristics were often indistinguishable from malignant nodal involvement. Therefore, patients with breast cancer should be vaccinated on the contralateral arm to the cancer side to avoid diagnostic conundrum. The lymphadenopathy was commonly observed even in 8 weeks, and mostly resolved after 12 weeks from the vaccination. Therefore, non-urgent imaging examinations such as screening would be recommended to be scheduled at least 12 weeks following the latest vaccination.

7.
American Journal of Transplantation ; 21(SUPPL 4):785-786, 2021.
Article in English | EMBASE | ID: covidwho-1494538

ABSTRACT

Purpose: One month before the COVID-19 pandemic was declared, liver transplant (LT) allocation in the US was updated (February 4th, 2020), by introducing the acuity circle (AC)-based model. This study evaluated the early effects of the AC-based allocation on waitlist outcomes. Methods: Adult candidates listed between January 1st, 2019, and June 30th, 2020, were evaluated. Two periods were defined according to the listing date (pre- and post-AC), and 90-day waitlist outcomes were compared. Data was censored if none of the events had occurred before the end of the period. The median transplant MELD score of each state was calculated, and states were defined as low-(<25th%ile), mid- (25th-75th%ile), and high-(>75th%ile) MELD regions. In addition, transplanted patients were categorized into 3 groups according to their final MELD score (6-14, 15-28, 29+). Organ sharing and donor characteristics were compared between eras. Results: 12,546 and 3,932 candidates in pre and post-AC eras were eligible. The post-AC era was associated with significantly lower 90-day waitlist mortality (HR=0.75, 95%CI=0.62-0.90;p=0.002) and higher transplant probability (HR=1.19, 95%CI=1.10-1.29;p<0.001). When outcomes were assessed in each MELD region group, improvement in outcomes was significant in mid-MELD regions, but not in other MELD regions. Among 5,971 and 772 transplanted in the pre and post- AC eras, national sharing significantly increased in all groups (overall: 7.4% to 32.5%, P<0.001). In contrast, a significant increase and decrease in the proportion of donation-after-circulatory-death (DCD)-LT was observed in the low- and mid- MELD regions, respectively. Another subgroup analysis showed that national sharing significantly increased in those with a score of 15-28 (7.6% to 22.1%, P<0.001) and 29+ (5.0% to 39.6%, P<0.001), but not in those with score of 6-14 (15.7% to 22.7%, P=0.11). Patients with a MELD score 15-28 received DCD-LT more frequently in post-AC era, but not in those with a score of 29+. (Table). Conclusions: Despite the COVID-19 pandemic, AC-based allocation improved waitlist outcomes in mid-MELD regions. While other regions had comparable out comes, aggressive utilization of DCD might offset possible negative effects of the AC-based model and/or pandemic in low-MELD regions. Organ acceptance practice may be significantly changed in certain regions/patient populations such as DCD acceptance for patients with mid MELD score in lower MELD regions. It is crucial to carefully monitor possible effects of those changes on post-transplant outcomes. (Table Presented).

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