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This study compares the serological antibody level post-COVID-19 vaccine among healthy subjects and psychiatric patients on antidepressant therapy. It also examines the difference in antidepressants' side effects experienced by psychiatric patients following the completion of two vaccine doses. A comparative posttest quasi-experimental study was conducted among healthy subjects and psychiatric patients on antidepressant medication in a teaching hospital in Malaysia. Elecsys Anti-SARS-CoV-2 assay was used to detect the antibody titre between weeks 4 and 12 post vaccination. The antidepressant side-effect checklist (ASEC) was used to monitor the occurrence of antidepressant-related side effects pre-and post-vaccination. 24 psychiatric patients and 26 healthy subjects were included. There was no significant difference in the antibody level between the patients (median = 1509 u/ml) and the healthy subjects (median = 995 u/ml). There was no significant worsening in the antidepressant-related side effects. The antibody level post-COVID-19 vaccine did not differ significantly between patients on antidepressant therapy and healthy subjects. Additionally, there was no change in the antidepressant side effects experienced by the patients following the completion of the vaccine.Copyright © 2022, Research Trends (P) LTD.. All rights reserved.
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Aims and objectives: The aim of this study was to compare the immediate adverse effects of the coronavirus disease 2019 (COVID-19) vaccine (COVAXIN) in a pregnant woman with that of a nonpregnant woman. Material(s) and Method(s): It is a prospective observational study done at Vanivilas Hospital, Bangalore Medical College & Research Institute (BMCRI) for 2 months. The sample size was 100 pregnant and 100 nonpregnant women. Telephonically, patients were followed-up, and details of the side/adverse effects were collected in a proforma after 2 and 14 days. Data collected from both groups were analyzed using the Chi-square test or Fisher's exact test. Result(s): The majority of women were in the age group of <=25 years (64.0% and 36.0%, respectively) with a mean age of 25.01 +/- 3.71 years among the pregnant and 28.52 +/- 6.00 years among nonpregnant women. About 25.0% of pregnant women and 38.0% of nonpregnant women reported side effects. About 15.0% and 22.0% had taken treatment for side effects among pregnant women and nonpregnant women, respectively. Among the pregnant women, the common side effects reported were injection site pain (17) followed by fever (5), fatigue (4), and myalgia (03). Whereas among the nonpregnant women, the common side effects reported were injection site pain (28) followed by fever (6), myalgia (3), headache (2), and fatigue (1). Conclusion(s): Side effects reported following the administration of Covaxin in pregnant and nonpregnant women are fever, fatigue, injection site pain, myalgia, and headache. The proportion of side effects was not significantly different in the pregnant and nonpregnant women following Covaxin administration. Clinical significance: Covaxin is an inactivated killed vaccine against COVID-19 by Bharat Biotech. The vaccine has been recommended for pregnant women by the Government of India during corona pandemic. Studies are lacking regarding the difference in adverse events in pregnant versus nonpregnant women, after vaccine administration.Copyright © The Author(s).
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BackgroundFibromyalgia (FM) is a chronic widespread pain syndrome of unknown origin that leads to hypersensitivity for physical, chemical and/or psychic triggers. Vaccination, as an inflammatory stimulus and as a psychologically stressful act, could represent a challenge for these patients.ObjectivesWe aimed to investigate the incidence of adverse reactions after vaccination for Sars-Cov2 in a series of FM patients versus healthy controls.MethodsWe recruited 65 consecutive FM patients classified according to the 2016 ACR diagnostic criteria¹ (M/F: 5/60;mean age 53.6 +/-12.5 years), without other associated rheumatologic conditions, and 65 age/sex-matched healthy controls.All patients filled a questionnaire in order to investigate eventual adverse events occurring up to 6 months after administration of a Sars-Cov2 vaccine. The questionnaire was divided into two parts: the first part included the patient's demographic information, the vaccine type performed and the anamnestic data. In the second part, the individuals described all new symptoms or signs occurred after the first, the second or the third dose of Sars-Cov2 vaccine.ResultsOverall, FM patients reported a higher frequency of adverse events after Sars-Cov2 vaccination in comparison with healthy controls. In particular, 44/65 FM patients vs. 11/65 controls complained of exacerbation of diffuse pain (p<0.001). Fatigue, diarrhea, sweating, tingles, headache, dizziness, transient respiratory discomfort, and paroxysmal vision blurring were also more frequent in FM patients than controls (47/65 vs. 30/65, p=0.004;6/65 vs. 0/65, p=0.028;18/65 vs. 8/65, p=0.047;20/65 vs. 0/65, p<0.001;22/65 vs. 9/65, p=0.013;21/65 vs. 5/65, p<0.001;10/65 vs 1/65, p=0.009;17/65 vs. 2/65, p< 0.001, respectively).No significant difference between FM and the control group as regards fever was reported (24/65 vs. 30/65;p=0.7).Interestingly, swelling at the injection vaccine site was more commonly reported in controls (9/65 vs. 20/65;p=0.034).Finally, one case of Bell's palsy was registered in the FM series while one case of myocarditis in the control group.ConclusionFM patients showed an increased frequency of adverse events to Sars-Cov2 vaccination compared to healthy controls. In particular, all the symptoms reported seemed to be associated with the functional hypersensitivity that characterizes FM.Reference[1]Wolfe F, et Al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016 Dec;46(3):319-329.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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The global outbreak of the new coronavirus infection COVID-19 is still ongoing, leading to coinfections such as malaria and COVID-19 and others. As evidenced, by the increase in various reports of coinfections. In recent years, Uzbekistan has achieved epidemiological stability for malaria and in 2018 received, an official World Health Organization certificate confirming the country's "malaria-free" status. At the present stage during the COVID-19 pandemic, imported, malaria from abroad, is relevant for our republic and, therefore, there is a constant danger of renewed, transmission, from imported cases. In this article presented the clinical case of coinfection, of COVID-19 and. malaria in a patient. From, the epidemiological data, the patient was a citizen of Cameroon. During treatment of coronavirus infection, the patient noted intermittent chills all over the body and sweating, clinical symptoms of tropical malaria began to appear. Microscopy of a thick drop and. a thin blood, smear confirmed, the presence of Pl. falciparum.. The patient was prescribed, antimalarial therapy with mefloquine, resulting in clinical recovery.Copyright © 2022 Authors. All rights reserved.
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Case report Background: Mutations in the PLCG2 gene can cause PLCG2-associated antibody deficiency and immune dysregulation (PLAID) or auto-inflammation with PLCG2-associated antibody deficiency and immune dysregulation (APLAID). PLAID is characterized by urticarial eruptions triggered by evaporative cooling along with cutaneous granulomas. APLAID may present with early-onset skin inflammation and non-infectious granulomas, uveitis, and colitis. Method(s): Case report and literature review. We performed in silico analysis for variants of uncertain significance (VUS). Result(s): A 29-day-old boy presented to emergency department for failure to thrive. He was found to be SARS-CoV2 positive, had an E. coli UTI in the setting of bilateral perinephric masses which subsequently resolved. He also had a perianal soft tissue abscess measuring 4cm in diameter. Mom reported a similar infection when she was age 2. She also reported intermittent diffuse urticaria triggered following perspiration evaporation.Abscess wall histology showed diffuse neutrophil and lymphocytic infiltration, with cultures growing polymicrobial enteric flora. His serum immunoglobulins G, A, M, and E were within reference range. Naive and memory CD4, CD8, CD19 lymphocyte subsets (including NK cells) were also within age-appropriate reference range. He had a normal neutrophil oxidative burst measured using dihydrorhodamine (DHR) flow cytometry following PMA stimulation, which ruled out a diagnosis of chronic granulomatous disease. On evaporative cooling, the patient had a 2mm wheal with surrounding erythema which resolved rapidly with warming. A targeted primary immunodeficiency panel showed a heterozygous VUS in PLCG2, c.688C > G (p.Leu230Val). The variant was absent from major databases and had a calculated CADD score of 17.77. He had symptomatic resolution after completing 3 weeks of ceftriaxone and metronidazole antimicrobials. Given the concern for PLCG2-associated very early-onset inflammatory bowel disease (VEO-IBD), a fecal calprotectin was obtained at 3 months and found to be elevated (157 mcg/g [ < = 49 mcg/g]). However, he had no symptomatic or macroscopic evidence for VEO-IBD. Conclusion(s): Presence of very early onset abscesses has not been previously described in patients with heterozygous PLCG2 deficiency. This case adds to the expanding variable phenotype of PLCG-2-associated immune dysregulation.
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Background: The health-care system has encountered exceptional circumstances, experiencing unique challenges, and manifesting as acute challenges in health-care services due to the spread of COVID-19. Aims and Objectives: The present study aimed to report the difficulties faced by the anesthetists while performing a cesarean section under the subarachnoid block (SAB) in COVID-19 patients at a dedicated COVID Level 3 hospital. Materials and Methods: Twenty healthy anesthetists (six consultants and 14 postgraduate) aged 20-40 years performed 60 elective or emergency cesarean sections of known COVID-19-positive gravida patients aged 20-35 years with no comorbidity and no spine abnormality under the SAB. Anesthetist;s responses to the challenges faced while performing procedures wearing the Level 3 personal protective equipment were recorded using a pre-structure self-administered questionnaire. To quantify the intensity of these problems, all the physical and psychological difficulties were graded as mild, moderate, and severe. Results: In the present study, 75% experienced moderate-to-severe sweating, and 60% experienced moderate-to-severe headaches. A total of 45% experienced moderate-to-severe breathlessness. Though there was little difficulty in communication among doctors and staff, almost 75% of anesthetists faced it. The fear of contracting the disease and spreading it to the family members was expressed by 75-80% of anesthetists. Conclusion: The present scenario has increased physical stress and other psychological problems among health workers. Therefore, hospital support with regular psychological counseling sessions is needed for healthcare workers to cope with the current situation.
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Chronic alcohol consumption, also called alcoholism, is a chronic disease characterized by compulsive alcohol consumption, loss of control over alcohol consumption and a negative emotional state in the absence/lack of consumption. Statistics show that the incidence of alcohol consumption in the adult population has been increasing during the isolation due to the pandemic. It is fre-quently associated with the consumption of other substances, in which case mortality is higher than in the case of single alcohol consumption. The patterns of alcohol consumption are varied, being related to a series of demographic, social, psychological and behavioral variables. The most worrying aspect of alcohol consumption is represented by the increase in the frequency of this type of addiction among teenagers and young people. It should also be mentioned that there is an increase in the incidence in females and there are new variables related to the context of consumption: increased boredom, alcohol consumption for the purpose of relaxation and alcohol consumption as an activity in the absence of an entourage. During the pandemic, there was also the myth that alcohol consumption would be the basis for reducing the risk of contamination with the SARS CoV 2 virus, an aspect disproved by specialist studies. The increased consumption of alcohol during the pandemic could be correlated with anxiety and depression determined by the fear of illness and depression due to the loss of the job, the lack of social relations or online education, being unanimously accepted that alcohol has an anxiolytic role. Regarding ethanolic withdrawal (EW) symptoms, studies show that approximately 50% of patients with chronic alcohol consumption will develop withdrawal symptoms when they reduce the quantity of alcohol or stop drinking alcohol.Copyright © 2022 Cristina Dimofte et al., published by Sciendo.
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Background: It is important to understand HCWs' (healthcare workers) psychological responses to the Coronavirus disease 2019 (COVID-19) pandemic as theare exposed to the virus on a daily basis. This study helps identify some of the challenges they face. Aim: The overall aim of the study was to investigate psychological responses to COVID-19, including vaccinations and stressors, amongst healthcarHCWs in South Africa during the pandemic. Setting: HCWs who worked in private and state hospitals and private practice in Tshwane, South Africa. Methods: A quantitative approach using a cross-sectional survey design was used. Several standardised and validated questionnaires were used in the surveincluding the Coronavirus-19 Fear Scale, the COVID-19-related stigma scale and the COVID-19 stress scale. A purposive sample (N=103) waanalysed using descriptive statistics and chi-square. Results: There were 103 completed questionnaires. Many (76% and 54%) either knew someone close who contracted COVID or died from COVID-19respectively. Most (58%) were in favour of being vaccinated. A significant proportion (42%;p= 0.009) of the HCWs felt uncomfortable whethinking about COVID. Physical reactions such as sweating, or a pounding heart were reported by 17% of the HCWs. A majority of the HCWdisagreed with any form of stigmatization of COVID-19. Most of the HCWs expressed a need for mental health support during the COVID-1pandemic. About three-quarters of the respondents expressed a need to talk to someone about their worries about COVID-19. Conclusion: Most of the respondents either knew someone who either contracted COVID-19 or died because of it. Many experienced anxiety symptoms whethinking about COVID-19. Many HCWs reported anxiety and stress symptoms such as insomnia, palpitations, sweating and difficultconcentrating. An overwhelming majority of the HCWs stated that people should not be discriminated against or stigmatized in any way because oCOVID-19. The majority of the HCWs expressed a need for psychological support during the COVID-19 pandemic. About 20% of the HCWwere against being vaccinated. This is worrisome as they are at high risk. The HCWs clearly expressed a need for more attention and supportowards their mental health during the COVID-19 pandemic. © 2023 Nel et al.
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In recent decades, the global economy has become increasingly structured around supply chains that connect firms within and across national borders, a reliance that has been the subject of controversy in light of disruptions from the COVID-19 pandemic. In response to these disruptions, firms have adapted in various ways to maintain their level of production. In this essay, we describe two approaches companies pursued during the pandemic: the "sweating" strategy in which firms shifted costs onto the worker, and the "securing" strategy in which firms chose instead to invest resources into supporting their workforce. In doing so, we argue that the companies' respective approaches in the context of the COVID-19 pandemic reflected their long-standing management models. Furthermore, we suggest that the insights gained from examining these approaches may provide a novel perspective on how to reimagine the current political economy.
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Weiqi, defensive qi (qi defensivum, weiqi) is deployed throughout the external surfaces (extima, biao) and flows through the channels. This defensive qi (qi defensivum, weiqi) protects the body from external heteropathies (xie). It also regulates body temperature, sweating, circadian rhythm and sensory perceptions. In the system of six main channels in the Treatise on Cold Damage (Shanghan lun) a disorder of the major yang (yang maior, taiyang) is regarded as an illness of the defensive qi (qi defensivum, weiqi). In the four-levels model of Warm Diseases (morbi temperati, wenbing) a disturbance of this defensive layer (qi defensivum, weiqi) is related to the early stage of fever caused by warm pathogens (calor heteropathies, rexie) as, for example, in the case of influenza, pneumonia, Covid-19, etc. This article cites passages from the Treatise on Cold Damage (Shanghan lun) and from the doctrine of Warm Diseases (morbi temperati, wenbing) for the treatment with Chinese phytotherapy;it also describes the corresponding acupuncture points and moxibustion treatments and how the theory of defensive qi (qi defensivum, weiqi) is to be applied in the treatment of long Covid, sleep disorders, depression and anxiety, sweating and bi-syndrome.Copyright © 2023, The Author(s) under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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The global outbreak of the new coronavirus infection COVID-19 is still ongoing, leading to coinfections such as malaria and COVID-19 and others. As evidenced, by the increase in various reports of coinfections. In recent years, Uzbekistan has achieved epidemiological stability for malaria and in 2018 received, an official World Health Organization certificate confirming the country's "malaria-free" status. At the present stage during the COVID-19 pandemic, imported, malaria from abroad, is relevant for our republic and, therefore, there is a constant danger of renewed, transmission, from imported cases. In this article presented the clinical case of coinfection, of COVID-19 and. malaria in a patient. From, the epidemiological data, the patient was a citizen of Cameroon. During treatment of coronavirus infection, the patient noted intermittent chills all over the body and sweating, clinical symptoms of tropical malaria began to appear. Microscopy of a thick drop and. a thin blood, smear confirmed, the presence of Pl. falciparum.. The patient was prescribed, antimalarial therapy with mefloquine, resulting in clinical recovery.Copyright © 2022 Authors. All rights reserved.
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The global outbreak of the new coronavirus infection COVID-19 is still ongoing, leading to coinfections such as malaria and COVID-19 and others. As evidenced, by the increase in various reports of coinfections. In recent years, Uzbekistan has achieved epidemiological stability for malaria and in 2018 received, an official World Health Organization certificate confirming the country's "malaria-free" status. At the present stage during the COVID-19 pandemic, imported, malaria from abroad, is relevant for our republic and, therefore, there is a constant danger of renewed, transmission, from imported cases. In this article presented the clinical case of coinfection, of COVID-19 and. malaria in a patient. From, the epidemiological data, the patient was a citizen of Cameroon. During treatment of coronavirus infection, the patient noted intermittent chills all over the body and sweating, clinical symptoms of tropical malaria began to appear. Microscopy of a thick drop and. a thin blood, smear confirmed, the presence of Pl. falciparum.. The patient was prescribed, antimalarial therapy with mefloquine, resulting in clinical recovery.Copyright © 2022 Authors. All rights reserved.
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Introduction: Coronavirus disease 2019 (COVID-19) was described for the first time in December 2019. Symptoms include cough, fever, myalgia, headache, dyspnea, sore throat, diarrhoea, nausea, vomiting, and loss of smell or taste. Viral-induced myocarditis and pericarditis have been described in developed countries, and SARS-CoV-2 is cardiotropic. Pericarditis can mimic myocardial infarction (MI) in its presentation and ECG findings. Case report: A 46-year-old smoker with no previous medical condition presented with left-sided chest pain, sweating, trouble breathing, palpitations, and left-hand numbness. He denied having reduced effort tolerance, orthopnea, or paroxysmal nocturnal dyspnea. Three weeks earlier, he was infected with Covid-19 category 2A infection. On examination, he is haemodynamically stable, and his respiratory and cardiovascular exams were unremarkable. His ECG showed anterior ST elevation, and the bedside echocardiography showed no hypokinesia or pericardial effusion. High-sensitive cardiac troponin T reached 5000. The emergency team contacted the on-call cardiologist for primary PCI. After analysing the serial ECG and bedside echocardiography, he decided against primary PCI due to acute pericarditis. He was started on intravenous diclofenac acid and colchicine. His pain subsided after 3 days with NSAIDs and colchicine. He was reviewed back in the clinic and had a normal ECG and ECHO. Discussion(s): Pericardial disease caused by COVID-19 has been more common since the pandemic outbreak. Mycobacterium tuberculosis, Borrelia burgdorferi, Parvovirus B19, and Epstein-Barr virus are the most common infecting agents. Most cases of acute pericarditis in developing nations are due to tuberculosis infection. Nearly half of all patients who had previously recovered from COVID-19 infection have now presented with new cardiac MRI findings indicating pericardial involvement. Fibrosis and/or oedema may be linked to persisting active pericarditis following infection resolution, which may lead to short and long-term clinical consequences. Conclusion(s): The ST elevation in post-covid patients does not always signify myocardial infarction. Despite complaints and ECG findings, this could not be an acute myocardial infarction, for which clinicians should have a high index of suspicion.Copyright © 2023
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Background: The COVID-19 pandemic has necessitated the use of personal protective equipment (PPE) among the frontline health care workers (HCWs). Even though PPE helps in preventing infection, it poses significant physical and psychological impacts at varying levels. Correspondingly, multiple independent studies have brought out the PPE-associated problems. However, there exists a lacuna on comprehensive information of global prevalence related to the same. Aim: To estimate the prevalence and risk factors of PPE among HCWs during COVID-19 across the globe. Design: Systematic review and meta-analysis. Method: The review was undertaken as per the protocol registered in PROSPERO CRD42021272216 following Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA) guidelines. Two independent reviewers have undertaken the search strategy, study selection, and methodological quality assessment. Discrepancies were addressed by the third reviewer. Heterogeneity was addressed through I2 statistics and forest plots generated by open meta-software. Results: A total of 16 articles conducted across 6 different countries among 10,182 HCWs were included in the review. The pooled prevalence of skin lesions, headache, sweating, breathing difficulty, vision difficulty, thirst/dry mouth, fatigue, and communication difficulty, anxiety, fear were 57 (47-66%), 51 (37-64%), 75 (56-90%), 44 (23-68%), 61 (21-94%), 54 (30-77%), 67 (58-76%), 74 (47-94%), 28 (24-33%), 14 (10-17%), respectively. Moreover, the various risk factors included are the use of PPE for >6 h and young females. In addition, the medical management of new-onset problems created an additional burden on the frontline health care personnel (HCP). Conclusion: The frontline HCWs encountered physical and psychological problems at varying levels as a result of wearing PPE which needs to be addressed to prevent the inadequate use of PPE leading to infections.
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SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has caused an influx of hospitalized patients with acute disease, as well as an influx of outpatient visits for long-term symptoms. There is still much to learn about symptom patterns in different patient groups based on age, race, sex, and illness severity. Patients with post-acute COVID-19 syndrome (PACS), colloquially called long-haulers, are another group who may have unique symptom profiles. We conducted this study to characterize patients’ experiences with COVID-19 symptoms in both the acute and long-term phase. METHODS: Participants were recruited using existing research panel through Qualtrics, a national consumer insights platform. Eligible participants included those who reported a positive COVID-19 test sometime in 2021 and sought some type of medical care. In an online survey, participants were asked about the three most bothersome physical symptoms they experienced out of body aches or joint pain, “brain fog”, chest pain, cough, fatigue or feeling tired/weak, fever/chills/sweating, GI issues such as vomiting/diarrhea, headache, loss of taste or smell, shortness of breath, and insomnia. This list of physical symptoms was sourced by qualitative, in-depth interviews with 55 hospitalized and recovered COVID-19 patients. In addition, participants reported basic demographics, hospitalizations, and whether they considered themselves long-haulers. RESULTS: Of these patients, 29.8% considered themselves long-haulers. There were 2570 survey respondents who participated, of which 61% were female, 48% were male, and 1% were nonbinary. The patients were all age 18 years or older with 14% Hispanic/Latino/a/x/or Spanish origin, and 25% were non-white. Of those who sought medical treatment through a hospital, 59% reported that they sought treatment for COVID-19 in the emergency room, 32% were hospitalized, and 9% were hospitalized in the Intensive Care Unit (ICU). The most bothersome symptoms reported overall were cough, fatigue/feeling weak, and body aches. We compared bothersome symptoms by hospitalization location and long-haul status descriptively. For 18% of participants hospitalized in the ICU, the most bothersome symptom was shortness of breath compared to 11% of those hospitalized on the general floor, and 11% of those seen in the emergency room. Among participants who reported that they consider themselves long-haulers, the most common symptom reported most bothersome was cough. CONCLUSIONS: Data indicate that symptom patterns may differ by illness severity, age, and race. Patients who consider themselves long-haulers also have a different symptom pattern from those who do not report long-term symptoms. CLINICAL IMPLICATIONS: Our findings contribute to the understanding of patient experience with COVID-19 symptoms both in the acute and long-term phase. DISCLOSURES: No relevant relationships by Samuel Brown No relevant relationships by Jorie Butler no disclosure on file for Hirshberg Elliotte;No relevant relationships by Danielle Groat No relevant relationships by Kathryn Hendrickson No relevant relationships by Stephanie Stokes
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Introduction: Polyethylene glycol (PEG) is one of the ingredients in the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine) and has been known to cause hypersensitivity [1-3]. Polysorbate is an ingredient in the Johnson vaccine (adenovirus vaccine) which may crossreact with PEG. Objective: We report a case of cross-reactivity between Pfizer/ BioNTech and Johnsson vaccines. Methods: This observation was notified in the pharmacovigilance center of Sfax, Tunisia (faculty of medicine of Sfax). The study of drug imputability was carried out according to the WHO method. Results: We report the case of a 32-year-old Tunisian woman with a history of atopy and intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) but no history of SARS-CoV-2 infection. On August 15, 2021 (at 08:30), she developed sweating, vomiting and dizziness immediately after receiving the initial dose of Johnson COVID-19 vaccine. Her blood pressure became lower (less than 90/60 mmHg). She had to stay at the vaccination centre for one hour, and the clinical signs improved spontaneously after one hour. In the evening of the same day, the patient presented a febrile maculopapular eruption in the abdomen, trunk, and face. The rash resolved spontaneously over a week. The patient was referred to the pharma-covigilance center of Sfax (Tunisia). The messenger RNA vaccine was advocated for the second vaccine. On December 2021, she was received the second dose of the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine). Six hours later, she experienced a pruritic maculopapular rash on the abdomen, trunk, neck, and face. These clinical signs improved spontaneously after two days. the diagnosis of cross-allergy between these two vaccines was retained for this patient Conclusion: To our knowledge, this is the first cross-allergy between mRNA and adenovirus COVID-19 vaccines notified in Tunisian population. Healthcare professionals should be aware that hypersen-sitivity can occur with COVID-19 vaccines containing macrogols/ PEGs and those containing polysorbates. Its recognition may be challenging and often require skin testing. Per CDC guidance, con-sultation with an allergist-pharmacologist should be considered to help determine if the patient can safely receive vaccination [4].
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Objectives: to study the clinical and laboratory features of septal panniculitis in the form of erythema nodosum (EN) in a cohort of patients with COVID-19 referred to a rheumatological center. Methods: In 2020-2021 we examined 21 patients (18 women and 3 men, average age 43.2±11.4 years) with EN and polyarthralgia/arthritis. Depending on the time of EN and articular syndrome associated with COVID-19 development, patients were divided into three groups: 1) up to 4 weeks-acute COVID (symptoms potentially associated with infection);2) from 4 to 12 weeks-ongoing symptomatic COVID and 3) more than 12 weeks-post-COVID syndrome (persistent symptoms not associated with an alternative diagnosis). All patients underwent a comprehensive clinical, laboratory and instrumental examination, including ultrasound of the joints and chest computed tomography (CT), as well as pathomorphological examination of skin and subcutaneous adipose tissue from the node area (in 9 cases). Results: Based on the history data, COVID-19 in the study cohort had mild (in 3 patients), moderate (12) and severe (6) severity. Two patients (21 and 23 years old) with a mild severity of the disease on the 2nd-3rd day of the development of the respiratory symptom for the frst time noted red painful (45 mm on a visual analogue scale) nodes on the legs and polyarthralgia. In 9 patients (52.3%), similar skin changes were detected 24.5 ± 7. 6 days after stopping active COVID-19, i.e. during the period of ongoing symptomatic COVID. In 8 patients (38%), including 6 with moderate severity of the disease, nodules appeared after 85.6 ± 12.3 days, which corresponded to post-COVID syndrome. At the time of examination, 100 and 71.4% of patients complained of skin rashes and joint pain, respectively. Shortness of breath, weakness, cough, sweating and myalgia disturbed 67% of patients. An increase in body temperature to subfebrile was observed in 43% of cases, mainly with ongoing symptomatic COVID. In the overwhelming majority of cases (86%), UE was located on the anterior and lateral surfaces of the legs, less often on the posterior and medial surfaces. It is noteworthy that the lesion of more than 50% of the surface of the lower and upper extremities was associated with the number of nodes (p <0.02), CRP level (p <0.03) and post-COVID syndrome (p <0.2). Sixteen patients (76.1%) had signs of arthralgia, mainly ankle (81%) and knee (56%) joints. In a laboratory study, the median ESR was 39 [14;62] mm/h, the level of CRP was 17 [2;79] mg/l. The results of the polymerase chain reaction for SARS-CoV-2 were negative in 90.4 % of patients. In 90.4 % of cases, IgG antibodies were detected and in 52.3%-IgM to the SARS-CoV-2 virus. At CT of the chest, ≤25% of lung lesions were detected in 51% of patients, from 25 to 50%-in 33% and from 50% to 75%-in 9.5 % of cases. Pathomorphological examination of the nodes showed signs of septal panniculitis. Conclusion: When EN associated with SARS-CoV-2 appears it is important to timely suspect a post-infectious manifestation, based on the clinical picture of the disease and to determine the scope of further examination and adequate treatment.
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Aims and objectives: To establish that non-invasive ventilation (NIV) can be substituted by high flow nasal cannula (HFNC) for respiratory support during oral feeding of a patient with COVID-19 patients. Materials and methods: This prospective case series was conducted after taking informed and written consent from the patients. Ten patients with severe COVID-19 disease requiring NIV with inspiratory pressure of <10 cm H2O, positive end-expiratory pressure of <6 cm H2O and FiO2 <0.6 were included in this study. Patients with altered consciousness, circulatory failure, or worsening acidosis were not included in the study. Patients underwent HFNC trial for 10 minutes and were screened for risk of dysphagia and aspiration using a 3-ounce water swallowing test. The patients were given a trial of HFNC for 10 minutes with a flow of 60 L/minute and FiO2 of 0.1 more than their requirement on NIV. The patients were observed for hypoxemia (SpO2 <88%) or signs of respiratory distress, e.g., increase in respiratory rate (>35/minute), laboured breathing pattern, use of accessory muscle of respiration, heart rate (>20% change), blood pressure (>20% change), perspiration, and anxiety. Then, HFNC was used for supporting respiration during oral feeding for up to 20 minutes. Feeding was started with a hypocaloric target on starting day and was increased progressively as per European Society for Clinical Nutrition and Metabolism guidelines to the target estimated caloric requirement. Results: The HFNC support for oral feeding was successful with adequate diet intake in eight patients without desaturation/respiratory distress during oral feeding. Other than COVID-19, co-morbidities in these eight patients included diabetes mellitus, obesity, chronic obstructive pulmonary disease, coronary artery disease, and dilated cardiomyopathy. Six patients, previously on enteral nutrition using the nasogastric tube, were successfully switched to oral feeding with help of HFNC. Four patients were directly started on the oral diet with help of HFNC support. HFNC could not support respiration adequately in two of these four patients. The initial trial was successful for one of the patients and HFNC support for oral feeding was used for 3 days, but a progressive increase in ventilatory requirements resulted in failure of HFNC trial subsequent days and the patient was switched to nasogastric feeding. In another patient, the initial trial of HFNC failed due to rapid desaturation within a few minutes of the trial. The eight patients in whom HFNC was used successfully for feeding were switched to HFNC completely and discharged from the hospital after weaning off from oxygen support. The patients who failed the HFNC support for feeding required higher ventilatory requirements and needed endotracheal intubation. Conclusion: Based on our case series, using daily screening trial of oral feeds with HFNC support in selected patients of severe COVID-19 pneumonia on NIV seems thought-provoking and should be explored for its potential in improving patient's nutrition with a positive impact on the outcome.
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Intracranial cystic lesions are common findings in cerebral imaging and might represent a broad spectrum of conditions. These entities can be divided into nonneoplastic lesions, comprising Rathke cleft cyst, arachnoid cyst, and colloid cyst, as well as neoplastic lesions, including benign and malignant components of neoplasms such as pilocytic astrocytoma, hemangioblastoma, and ganglioglioma. Surgical resection and histological evaluation are currently the most effective methods to classify cysts of the central nervous system. The authors report two uncommon cases presenting as cystic lesions of the encephalic parenchyma-a enterogenous cyst and a glioblastoma-and discuss typical histological findings and differential diagnosis.