New-Onset Thyroid Eye Disease After COVID-19 Infection in Patient with Graves' Disease Post-Radioactive Iodine Treatment

Introduction: Coronavirus disease 2019 (COVID-19) has been associated with dysregulation of the immune system and abnormal thyroid function. The aim of this novel case report is to inform physicians of the possibility that COVID-19 infection may precipitate thyroid eye disease (TED) in patients with Graves' Disease (GD) even after treatment with radioactive iodine (RAI). Case Description: In this report, we describe a patient with GD treated with RAI who developed TED after COVID-19 infection. The patient was initially diagnosed with GD in 2018. A thyroid uptake scan (I-123) was consistent with GD with moderately elevated uptake. She was initially managed with methimazole and atenolol and was eventually treated with RAI (16.32 millicurie I-131) in February 2021. She had post-ablative hypothyroidism managed with levothyroxine. The patient contracted COVID-19 in January 2022. In February 2022, the patient started experiencing eye irritation, dryness, protrusion of eyes, eyelid swelling, and visual disturbances. Thyroid stimulating hormone (TSH) receptor auto-antibodies (7.33 IU/L, normal < /=1.00 IU/L) and thyroid stimulating immunoglobulin (4.30 IU/L, normal < /=1.00 IU/L) were elevated. TSH was normal (2.180 mIU/L, normal 0.270 - 4.200 mIU/L) on levothyroxine 125 mcg daily. She was later diagnosed with TED. Discussion(s): GD is an autoimmune thyroid disorder related to the presence of TSH receptor-stimulating antibodies and is often associated with ocular symptoms. Activation of an autoimmune response during COVID-19 infection, may induce onset or relapse of GD. A study using the national health insurance service database in South Korea noted an increase in the incidence of subacute thyroiditis in 2020 in association with the COVID-19 pandemic. TED is usually seen in patients with GD. Radioactive iodine is widely used in the treatment of GD and has been associated with development or worsening of TED. There are published cases of TED occurring in patients with GD after receiving COVID-19 vaccine. It is thought that the inflammatory syndrome induced by the adjuvants could induce molecular mimicry, which could trigger TED. In most cases this adverse effect was transient, lasting a few months after treatment. There have been case reports of TED occurring after 3 to 21 days of COVID-19 vaccination in patients with controlled GD. Symptoms improved in 4-8 months. Development of TED in patients with GD who have been treated with RAI typically occurs soon after RAI therapy. For TED to occur in a GD patient 11 months after receiving RAI therapy is unusual. COVID-19 infection appears to have been the trigger for this patient's eye disease. This is highly unusual and has not been published to our knowledge.Copyright © 2023

Covid-19 Vaccine safety and adverse event analysis from Pakistan

Covid immunization commenced on 2nd Feb 2021 in Pakistan and as of 7th Sep 2021, over 84 million vaccine doses were administered in Pakistan, of which 72% procured by the government, 22% received through Covax and 6% were donated. The vaccines rolled out nationally included: Sinopharm, Sinovac and CanSinoBIO (China), AstraZeneca (UK), Moderna and Pfizer (USA), Sputnik (Russia), and PakVac (China/Pakistan). About half of the eligible population in Pakistan (63 m) had received at least one dose of Covid vaccine as of Sep 2021. Pakistan National Pharmacovigilance Centre (PNPC) in coordination with WHO, MHRA and Uppsala Monitoring Centre (UMC) established pharmacovigilance centers across Pakistan. The Covid vaccine AEFIs in Pakistan were mainly reported via NIMS (National Immunization Management System), COVIM (Covid-19 Vaccine Inventory Management System), 1166 freephone helpline and MedSafety. There have been 39,291 ADRs reported as of 30th Sept 2021, where most reported after the first dose (n = 27,108) and within 24-72 h of immunization (n = 27,591). Fever or shivering accounted for most AEFI (35%) followed by injection-site pain or redness (28%), headache (26%), nausea/vomiting (4%), and diarrhoea (3%). 24 serious AEFIs were also reported and investigated in detail by the National AEFI review committee. The rate of AEFIs reports ranged from 0.27 to 0.79 per 1000 for various Covid vaccines in Pakistan that was significantly lower than the rates in UK (~4 per 1000), primarily atrributed to underreporting of cases in Pakistan. Finally, Covid vaccines were well tolerated and no significant cause for concern was flagged up in Pakistan's Covid vaccine surveillance system concluding overall benefits outweighed risks.Copyright © 2022

An Interesting Case of Inflammatory Myositis

Background: Idiopathic inflammatory myopathies (IIM) are a class of long-lasting autoimmune diseases that typically affect the proximal muscles. Dermatomyositis (DM), polymyositis (PM), necrotizing autoimmune myopathy (NAM), and sporadic inclusion body myositis are the most prevalent kinds. Patients usually have subacute to chronic proximal weakness, which presents as difficulty getting out of a chair, getting up the stairs, lifting objects, and brushing their hair. They are distinguished by their clinical presentation, which includes muscular and ex-tramuscular signs. Elevated serum creatine kinase (CK) levels and myositis-specific antibodies may help distinguish clinical phenotypes and confirm the diagnosis. Biopsy of the muscle, on the other hand, is still the gold standard for determining the cause of the problem. These disorders may be cured with proper diagnosis and treatment. The treatment's goals are to reduce inflammation, restore muscle performance, and alleviate pain. Method(s): 36-year-old man K/C/O dermatomyositis came complaints of redness swelling in the right eye for 3 months, dysphagia, easy fatiguability. Patient was neither hypertensive nor diabetic. Result(s): This case describes the severity of NXP2 autoantibody and a potential to be life threatening. Patient was started with immunoglobulins, monoclonal antibodies. After which patient improved from his present condition.Copyright © 2022 Novyi Russkii Universitet. All rights reserved.

Mental health trainees: Experience of online classes during COVID-19 pandemic

Objective: To determine experiences of mental health trainees with their online classes. Methodology: It was an online cross-sectional study carried out during month of June, 2020. The sample comprised of 231 mental health trainees of BS (n = 114) and MS (n = 117) programs of a private university of Lahore. A google doc. consisting of 15 statements was prepared to for online delivery of their classes. Result(s): 45% students responded on "to some extent to no difficulty" experience of smooth running of online lectures. On the item of overall satisfaction with delivery of online lectures, 50% students (out of 114) from BS program and 51% students (out of 117) from MS program rated on "not at all" Although satisfaction was high on the online availability of teacher for the counselling of students however, on understand lectures Only 14% students showed highest level of satisfaction. Conclusion(s): Online classes remained a big challenge for trainees and it was associated with lack of satisfaction in terms of their own learning, evaluation comprehension and health issues.Copyright © 2023, Pakistan Medical Association. All rights reserved.

Dermatomyositis: severe acute respiratory syndrome coronavirus 2, an initiator or a trigger?

Dermatomyositis is an immune-mediated inflammatory myopathy. In adults, the common triggering factors for its onset include viral infections, malignancy, and drugs. The clinical manifestation of these group of disorders may be cutaneous, neurological, pulmonary, or a combination of all. The cutaneous manifestations are helpful in the early clinical diagnosis. The detection of myositis-specific autoantibodies serves as specific biomarkers for the diagnosis and helps in predicting the prognosis. We are presenting two cases of dermatomyositis, temporally related to the severe acute respiratory syndrome coronavirus 2 infection and vaccination. Copyright © 2022 Journal of the Egyptian Women's Dermatologic Society.

Assessment of eye pain symptoms among pediatric students during the COVID-19 pandemic

Purpose : Computer Vision Syndrome (CVS) is a form of asthenopia that manifests with symptoms such as eye pain/discomfort, headache, and blurred vision, among others. Early identification of CVS is especially relevant during the COVID-19 pandemic, which has led to an increase in virtual schooling and digital screen time among children worldwide. This study seeks to evaluate differences in etiologies of eye pain, treatment recommendations, and the relationship between refractive errors and eye pain in the pediatric population before and during the COVID-19 pandemic. Methods : After IRB approval, we retrospectively reviewed the records of patients who visited our tertiary care institution between 2018 and 2021 with a chief complaint of eye pain, determined by the encounter's primary ICD-10 code. Patients who visited before 03/11/2020, when the WHO declared COVID-19 a pandemic, were classified as the pre-pandemic group (PPG), while patients who consulted after this date were classified as the during-pandemic group (DPG). Demographics, symptoms, refractive error, treatment, and schooling method were recorded as covariates and analyzed using a Chi-square and Fisher's exact test. Results : 38 patients were included in the study (21 PPG;17 DPG). The mean age was 10.1 ± 3.2 years, and the majority were African American (44.7%). Virtual school attendance for the PPG and DPG was 4.8% and 58.8%, respectively (P<0.05) (Table 1). There was a higher prevalence of reported blurry vision, headaches, eye redness, eye swelling, and rubbing among DPG patients (Table 1). Counseling on screen time minimization was more likely to be documented in the DPG (Table 2). A greater proportion of patients were prescribed new glasses in the DPG though there was no significant relationship between eye pain and refractive error or anisometropia in either group (P>0.05). Conclusions : The increased prevalence of CVS symptoms in the DPG suggests an association between virtual schooling and CVS in children. There is a role for ophthalmologists to improve rates of counseling for the prevention of eye pain-related symptomatology with digital device usage. Further studies will survey parents to assess their awareness of conservative treatments for eye pain such as artificial tears and decreased screen time.

Unilateral total ophthalmoplegia with proptosis and loss of vision in a patient of herpes zoster ophthalmicus: A rare case report

Herpes zoster Ophthalmicus accounts for a minority of all patients with zoster infections. It leads to varied clinical presentations, but total unilateral ophthalmoplegia has rarely been reported in the literature. We hereby present a 50-year-old male patient presenting with the above combination for aiding the clinical diagnosis by dermatologists and ophthalmologists. Early initiation of treatment leads to a near total recovery of ophthalmoplegia in the majority of treated patients.

Allergic reactions of COVID-19 vaccine in a teaching hospital

Introduction: Because of the epidemic, countries have begun to administer the COVID-19 vaccine. The adverse reactions (ADRs) following the vaccine can be divided into three categories. Categories are allergic reactions including anaphylaxis, vasovagal reaction including vasovagal syncope and vaccine side effects including local and systemic. Allergic reactions occurring within 5-30 minutes are considered as autoimmune problems, and the problems caused are usually unpredictable and may be serious. Objectives: For further analysis of the types of allergic reactions, medical professionals could remind the patient, prepare the responder as soon as possible, and as a reference for diagnosis and related treatment. Methods: This study is a cross-sectional study that analyzes the notification data of adverse drug reaction cases in a regional hospital from March 30 to July 31, 2021, including the AstraZeneca® (AZ) brand and the Moderna® brand. And analyze whether the discomfort immediately after vaccination is Allergic reactions, vasovagal reaction or vaccine side effects. Results: The total number of COVID-19 vaccines administered under the AZ® brand was 27,131, and Moderna® had a total of 9,203 people. A total of 80 adverse events were received. The AZ ® brand had 75 and the Moderna® brand had 5 ADRs. Among the ADRs of AZ®, there are 17 allergic reactions (22.67%), 1 vasovagal reaction reaction, and 57 vaccine side effects. Among the ADRs of Moderna®, there are 3 allergic reactions (60.00%), 0 vasovagal reaction reactions, and 2 vaccine side effects. Out of a total of 20 Allergic reactions, 20 cases require additional processing to deal with side effects. These side effects include problems related to the injection site (redness at the injection site∗2, itching at the injection site∗5, rash at the injection site∗3, soreness at the injection site, pain at the injection site, swollen left upper arm∗2, red upper left arm, lower arm Itchy rash on the other side of the armpit∗2), skin-related problems (red rash on the chest with oxygen, hives∗2, itchy rash on the face and neck∗2, skin rash∗4), other problems (wheezing, vomiting∗3, red and swollen eyes, chest tightness, dizziness). Among them, one case was reported as a 'serious adverse event', who died eight hours after vaccination. Conclusion: In the ADR of AZ®, 22.67% of allergic reactions is allergic reactions, which is 0.63 of the number of people who were administered. Although the proportion is not high, the adverse reactions caused by autoimmunity are likely to become very serious. Medical professionals should pay more attention to these information before administering the vaccine.

Mucormycoses in Covid-19 Patients

Objective: The goal of the study was to report clinical characteristics, contributing variables and outcome of patients with coronavirus disease 2019 (COVID-19)-Associated mucormycosis (CAM). Study Design: Observational/descriptive study Place and Duration: Multan Medical and Dental College and Bakhtawar Amin Medical and Dental College. Duration Jan 2021 to July 2021. Methods: Total 90 patients of both genders had symptoms of mucormycosis during pandemic corona virus disease were presented in this study. Patients were aged between 22-80 years. Patients detailed demographics age, sex, body mass index and duration of disease were calculated after taking informed written consent. Patients were admitted in COVID-19 emergency ward and underwent for RT-PCR and MRI. Comorbidities, symptoms and cause of mucormycosis were assessed. At the end of study mortality rate, hospital stay and ICU admission were calculated. The SPSS 20.0 version was used to examine the entire set of data. Results: Majority of the patients 65 (72.2%) were males and the rest were females 25 (27.8%). Mean age of the patients were 51.42±12.64 years with mean BMI 28.44±8.72 kg/m2. 55 (61.1%) cases had COVID-19 and 35 (38.9%) were recovered from corona virus in this study. Mean duration of mucormycosis was 18.08±7.11 days. Most common symptoms of disease were eye pain/swollen of eyes, nasal stiffness, headache and blurring of vision. Rhino-orbital mucormycosis found in 63 (70%) cases. Majority of the cases were from urban areas 60 (66.7%) and 38 (42.2%) were literate. Diabetes mellitus was the most common comorbidity found in 70 (77.8%). Frequent consumption of the steroids during pandemic disease was the most common cause found in 59 (65.6%) cases. Mortality rate was 32 (35.6%) at the end of study. Conclusion: In this study we found that the complication of COVID-19 in high-risk patients can be mucormycosis. Poor diabetes mellitus is a significant CAM predisposing factor and frequent usage of excess steroids were the most common cause. Systematic surveillance for diabetes mellitus control and to educate the doctors are indicated for early detection of CAM.