Erythema nodosum following the first dose of AstraZeneca COVID-19 vaccine

Introduction (contexte de la recherche): Erythema nodosum (EN) is a type IV delayed hypersensitivity reaction to a variety of antigens stimuli. In fact, EN is commonly caused by a range of conditions, including infections and vaccines. EN induced by COVID-19 vaccines is rarely reported. Objectif: Herein, we report an original clinical observation of EN occurring after the first dose of AstraZeneca COVID-19 vaccine (vaxzevria), a viral vector vaccine, without recurrence after the second dose. Methodes: This case was notified on August 2021 to Tunisian National Centre of Pharmacovigilance and was analyzed according to the French updated method for the causality assessment of adverse drug reactions. Resultats: A 46-year-old woman with no medical history, presented with diffuse erythematous painful and nodular lesions, located symmetrically over her legs. Eleven days before, she had received the first dose of vaxzevria which was followed by a sudden asthenia, and oedema over her lower limbs. The patient reported no recent infectious episodes. She had no known drug allergy. Skin examination showed multiple, tender, erythematous nodules, which ranged from 3 to 4 cm in diameter located over the tibial area. Some were regressive according to biligenesis shades. Laboratory tests including a complete blood count, renal and hepatic tests and antistreptolysin O titer were carried out and were negative except an elevated c-reactive protein of 45 mg/dL. The dermatological examination found lesions on both legs to be consistent with EN and started therapy with prednisone 40 mg daily for one week, subsequently gradually tapered and suspended, with complete regression of lower limb skin lesions within 10 days. No skin biopsy was performed due to the typical clinical presentation, color evolution and a complete response to steroid therapy. The patient subsequently received the second dose after two months without the reappearance of EN. Conclusion(s): In this case the role of vaccine was suspected in front of a temporal association between the first dose of vaccine and the onset of EN and the absence of another etiology. However, the good evolution of this skin manifestation will help reassure patients in the safety of vaccine administration.Copyright © 2023

Pulse of Asia 2021

The proceedings contain 67 papers. The topics discussed include: cardiovascular system and COVID-19;long term sequale on COVID-19;fighting vascular disease: thoughts about 2022 Taiwan hypertension guidelines;quantification of hemodynamic parameters using 4D flow MRI;nanomedicine for the treatment of atherosclerosis;direct thrombus imaging;clinical outcome in patients with deep vein thrombosis;cardiovascular benefits of SGLT-2 inhibitor;central blood pressure and pressure wave reflection in cardiovascular abnormalities: do not put them in shade;association between excess pressure and cognitive function among elderly population;visceral adipose tissue, coronary artery calcification and heart failure: a moderated mediation analysis;and the cardio-ankle vascular index was associated with CHADS2 score in patients with atrial fibrillation: a coupling registry study.

Domestic Violence- A Crying Call for Change

Domestic violence or intimate partner violence, can be defined as a pattern of behaviors which could be physical, sexual, emotional, economic or psychological actions or threats of actions in any relationship that is used to gain or maintain power and control over an intimate weaker partner that influence another person. Domestic abuse can happen to anyone regardless of age, race, gender, sexual orientation, religion or socioeconomic background and education levels. It can occur within a range of relationships and not just those who live with us in our homes. These incidents are seldom isolated and escalate in frequency and severity if not opposed initial stage itself and may harm physically as well as emotionally and at times even endangers lives. Statistics for this is grave be it our country be it abroad and it became more grim covid times when staying home was not always safe. There are various factors involved from genesis to the maintainence of this menace medicolegal aspects and many more. Multidisciplinary approach for awareness that one needs to seek help, that one is not alone and various measures for curbing this grave issue is required at all levels. Domestic violence is the outcome of cumulative irresponsible behaviour which a section of society demonstrates. It is also important to note that solely the abuser is not just responsible but also those who allow this to happen and act as mere mute spectators. In this era of rights-based mental health services, such 'hidden shades' of mental wellbeing form potent challenges, which face unique conditions of demographics, prevalence of mental disorders and awareness related to this grave issue of domestic violence. Human rights are universal and are vital for promoting mental health and dignity. With this premise, this symposium intends to unfold the various factors involved and highlight the intersections of Domestic volence and approaches required to bring about and discuss strategies to curb it in light of the lessons learnt from experiences across the globe.

Staining effect of herbal immune boosters used during Covid-19 pandemic on teeth shade: In-vitro study

Objective: Assessment of staining effect of herbal immune boosters used during COVID-19 pandemic on teeth shade. Material and method: 70 extracted premolars (N=10) were assigned to different solutions which were formulated to mimic the impact of herbal immune boosters on teeth. A baseline reading was performed using in-vitro VITA Easy shade Advance 4.0 and one day later, seven days later, and fourteen days later. The data was entered into SPSS software version 26. Results: A statistically significant difference was noticed in orange, lemon, and curcuma. Conclusion: The consumption of some herbal products has an impact on teeth's shade. Moreover, some materials such as, orange, lemon, and curcuma had the ability to change the teeth shade faster and stronger effect on teeth shade.

COVID-19 vaccination program at a student-run free clinic: A descriptive study.

People historically excluded from receiving medical care in the United States, in addition to being at greater risk for SARS-CoV-2 infection, have had slower vaccine uptake due to structural barriers to availability. We present one student-run free clinic's SARS-CoV-2 vaccination program from January 15 to August 1, 2021, in Nashville, Tennessee. We tracked SARS-CoV-2 vaccine primary series completion among 273 free clinic patients with the help of medical student volunteers, who scheduled appointments and answered vaccine-related questions. We worked with our academic medical center partner to host a single-dose vaccination event at our clinic. We compared vaccine series completion in our clinic to adult vaccine completion in Davidson County, Tennessee on August 1, 2021. Of the 273 free clinic participants, 144 identified as Spanish-speaking (52.7%) and 172 (63%) had at least one qualifying comorbidity per the December 30, 2020, Tennessee COVID-19 Vaccination Plan. As such, 183 (67%) were characterized as vaccine eligible in Phase 1a2, 1b, or 1c. On August 1, 2021, 63.1% of free clinic patients had completed their primary SARS-CoV-2 vaccination series compared with 58.9% of adults in Davidson County, Tennessee (RD 4.2%, 95% CI: -1.5% to 9.9%). Spanish-speaking free clinic patients were most likely to have completed their vaccination series. We describe a framework for a patient-centered vaccination effort to reach individuals traditionally missed by large vaccination campaigns. We highlight structural hurdles experienced by vulnerable populations, including language barriers, lack of technology or reliable internet access, inflexible working schedules, lack of transportation, and vaccine misinformation.

Single, High Dose Vitamin D Supplementation in Vitamin D Deficient Severe COVID-19: Randomized, Double-Blind, Placebocontrol Study (Shade-S)

Aim and background: Efficacy of therapeutic vitamin D3 supplementation for ICU outcomes in severe COVID-19 is sparingly studied. Objective: Effect of single high-dose vitamin D3 supplementation on sequential organ failure assessment (SOFA) score in patients with moderate to severe COVID-19 disease. Materials and methods: A single centre, randomized, doubleblind, placebo-controlled study was carried out among 90 patients with moderate to severe COVID-19 ARDS defined by PaO2/FiO2 <200. Participants received 0.6 million IU vitamin D3 (oral nanoformulation) (intervention) or placebo (equal volume, oral). SOFA score on day-3, -7, -10, and -14 was measured. The primary outcome was a change in day-7 SOFA score from admission. Pre-specified secondary outcomes were day 10 and day-14 SOFA score, change in PaO2/FiO2 ratio, in-hospital all-cause mortality, and inflammatory cytokine levels. Results: A total of 358 patients were screened and 90 patients (45 in each group) were included. 25(OH)D3 levels were 12.0 (10.0-16.0) and 12.7 (12-18) ng/mL (p = 0.059) at study entry;60 (54.40 to 65.59) ng/mL and 3.8 [1.05 to 6.55] at day-3 in the intervention and placebo group, respectively. The SOFA score on day-7 was better in the treatment group [intergroup difference was -2 (95% CI, -3.99 to -0.01, p = 0.009) with effect-size of r = 0.35 (95% CI, 0.09-0.55). The all-cause mortality with intervention was 24.4% compared to 44.4% (p = 0.046) in the control group. A significant improvement in the day-7 PaO2/FiO2 ratio [200.50 (101.01-291.30) and 110.70 (66.20-166.50), p = 0.003;intergroup difference -98.6 (40.70 to 156.49)], a decrease in CRP [-48.63 (-80.78 to -16.48) and 5.4 (-17.62 to 28.42), p = 0.042)], ferritin [-412.3 (-736.29 to -88.31) and 41.5 (-293.68 to 376.68), p = 0.018] was observed in the intervention and placebo groups, respectively. Conclusion: Single high-dose oral cholecalciferol supplementation to increase vitamin D3 >50 ng/mL improves the SOFA score and reduces in-hospital mortality in vitamin-D deficient patients with severe COVID-19.

TREE (Talk Read Engage Encourage) Program: Promoting Positive Parent Child Relationships in Low Income Families with Young Children by Pediatric Providers During Well Child Encounters

Background: Children living in poverty may endure Adverse Childhood Experiences (ACEs) that can affect their cognitive and social-emotional development. Safe and nurturing caregiverchild relationships mitigate many of the deleterious effects of ACEs. Child development research suggests that talking, reading, and playing with young children living in poverty improves their developmental outcomes. Developmental coaching, unlike traditional anticipatory guidance, is an interactive format engaging caregivers through self-reflection, encouraging parents to attempt novel interaction approaches, and strengthening parent self- confidence through positive feedback. This study examined the efficacy of the Grow Your Kids: TREE (Talk Read Engage Encourage) program, an interactive developmental coaching program promoting positive caregiver-child interactions during well-child encounters (ages 0-2) with lowincome families. The TREE program was developed by the Emotional Health Committee of the Maryland Chapter American Academy of Pediatrics. (https://www.mdaap.org/tree/) Methods: The study used a quasi-experimental design in two pediatric training programs in an eastern mid-sized city (residents: intervention n=24, control n=42). A convenience sample (n = 167 families) was recruited (79 intervention;88 control). Data collection included parent STIMQ2 pre/post (4-6 and 9-15 months of age) and pediatric resident report of training impact. The StimQ2 is a structured validated parent measure designed to assess caregiver-child interactions at home. Results: Recruited children were 3-10 months old (both sites), predominantly Black (76% intervention;77% control), and on Medicaid (81% intervention;78% control). Due to COVID-19, follow-up data was obtained from 45% of families (38 intervention;38 control). A significance level of p < .10 was used due to the small sample size. Analyses demonstrated differences in the STIMQ2 total (d = .43;95% CI, -.04 to .89;p = .07) and Parent Verbal Responsivity scales (d = .68;95% CI, .17 to 1.18;p = .009). There was also a significant change over time in the intervention group for reading quality subdimension (d= -.34, 95% CI, -.7 to .03, p=.07), whereas the control group's reading quality decreased. Intervention residents demonstrated significantly greater change in talking to, reading to, and being positive and encouraging with infants and toddlers as well as confidence in fostering interactions, conveying child development, and providing feedback (all p-values = .005 to .09). Conclusion: The TREE program is a feasible, brief, inexpensive, easily replicated and learned, universal developmental coaching intervention delivered by pediatric primary care providers during well child encounters that enhances caregiver-child interactions among low-income families. The study demonstrated increased overall parent-reported caregiver-child interactions, including verbal responsivity and reading behaviors and had a significant effect on pediatric residents' perceptions of their competency in promoting positive caregiver-child interactions. Antagonists' Skin Tones are Darker than Protagonist' Skin Tones in Animated Films. Average weighted grayscale values of protagonist and antagonist skin tones were plotted and arranged into a box and whisker plot. The median grayscale value of antagonists (106.7) was lower than that of protagonists (134.9), indicating that antagonists overall were darker than protagonists. This difference was significant (p<.001). Average grayscale values of protagonist and antagonist skin tones in 91 films were plotted against the year of production. Trend lines and confidence bands were superimposed on these data points. In recent years, the skin tones of both protagonists and antagonists have changed to include darker shades. However, differences between protagonist and antagonist skin tones have remained constant over time, with protagonists consistently having lighter skin tones compared to antagonists.

Impact of covid-19 pandemic on the consumption of herbal products and its effect on oral and dental health: A cross-sectional study in Saudi Arabia

Objective: The purpose of the study was to investigate, assess and explore the impact of herbal products and their effects on oral and dental health in Saudi Arabia. Materials and methods: It is a cross-sectional analytical study conducted in Saudi Arabia. Data were collected from laypeople in Saudi Arabia using a convenient sampling technique distributed electronically. A total of 20 questions were entered, including demographic variables, the usage of herbal products, and possible effects of oral and dental health. Data were analyzed using the SPSS statistical software version 23, and results with a p-value of equal or less than a level of 0.05 were considered significant. Results: 282 females and 103 males have filled the questionnaire in a total of 385. It was observed that about two-thirds of participants 69.9% and 66.8% used lemon and orange. Most of the participants used the herbal immune boosters less than one month 41.8% and 80.5% used these products one time per day. The majority of the participants 94.0% continued dental hygiene practices. Conclusion: COVID-19 pandemic made people try to enhance their immunity by consuming herbal immune boosters' products that may have some consequences on their oral health and dental well-being.

Shades of COVID-19 vaccine

SARS-CoV-2 infection is associated with a wide spectrum of skin manifestations and few may appear after immunization with vaccines expressing the SARS-CoV-2 spike protein. The COVID-19 pandemic has led to the rapid invention and approval of vaccines and, like any vaccination programme, reports of side-effects have begun to emerge. Though initial reports were about mild side-effects, reports of varied other moderate to severe side-effects have now started to emerge. Although these side-effects seem to be rare, the symptoms can be severe and data on them are scarce. We report a case of a 49-year-old woman with Fitzpatrick skin type VI developing coin-shaped well-defined, round to oval, erythematous to violaceous plaques with central dusky appearance along with vesicles and bullae on her right cheek, left cheek and left posterior thigh. This was seen a few days following each dose of AstraZeneca COVID vaccine but self-resolved in about 2 weeks with hyperpigmentation. There was no cutaneous disease elsewhere and no mucosal involvement. We considered a diagnosis of fixed drug eruption (FDE) based on history and clinical features. FDEs represent a cutaneous adverse drug reaction characterized clinically by the appearance of recurrent, quasiidentical, cutaneous eruptions in the same anatomical location on exposure and re-exposure to the offending drug.

COVID and Mental Health: The Challenge and aftermath Abstract

Department of psychiatry, Armed Forces Medical College (AFMC), Pune was involved since beginning in addressing the issues of mental health due to the COVID-19 pandemic and conducting research. The department collaborated with various agencies including government of India (GOI) in their outreach activities. Col Jyoti Prakash, Professor Psychiatry, AFMC, Pune had an honour of running a Defence Research Development Organisation (DRDO) made COVID hospital in Bihar. Office of Principal Scientific Advisor to GOI, had selected our department to collaborate with C-DAC (Centre for development of advanced computing) &NIMHANS towards creation of 'National Digital Wellness Program' delivered over smart phones-MANAS-Mental health And Normalcy Augmentation System for YoungISTAN-Young Indians: Smart, Talented &Natural. Project MANAS is in progress. The department conducted research on mental health impact on general population, Healthcare workers, COVID patients and their families. Last but not the least, we have managed mental health issues including grief arising during the pandemic. This symposium aims to highlight myriad mental health challenges of COVID 19 and aftermath. The symposium will cover COVID-19 mental health impact, administrative role, shades of grief and positive mental health by four speakers.

21st ESPD Annual Meeting

The proceedings contain 169 papers. The topics discussed include: GNAQ/11 mosaicism causes aberrant calcium signaling and drives systemic hypocalcemia;pediatric obesity and skin disease (PicoSkin-study): cutaneous findings and associated quality of life in 86 children and adolescents with obesity;what gives them the shivers? two new cases of infantile transient smooth muscle contraction of the skin;dermatologic manifestations of multisystem inflammatory syndrome in children during the COVID-19 pandemic;clinical characteristics and management of cutaneous lymphangioma circumscriptum;different shades of grey! infantile black hairy tongue- a case series and review of the literature;descriptive series of cases of pediatric linear morphea in a tertiary hospital in Barcelona;the prevalence of itch in German schoolchildren: a population-based study;neurocognitive functioning, physical health, and mental health of school-aged children treated with propranolol or atenolol for infantile hemangioma;and efficacy and safety of tralokinumab in adolescents with moderate-to-severe atopic dermatitis: results of the phase 3 ECZTRA 6 trial.

THE STATISTICS OF HUMAN SEXUALITY

INTRODUCTION AND OBJECTIVE: In 2015, English statistician and academic David Spiegelhalter wrote a book backed by the History of Medicine of the Wellcome Foundation entitled Sex by Numbers: What Statistics Can Tell Us About Sexual Behaviour. This represents an investigation into the statistics of human sexual activity to update the statistics of Kinsey and show the startling influence by the COVID-19 pandemic. METHODS: The investigation of the statistics of sexual activity is as enlightening as it is entertaining and there is a plethora of literature on modern sexual practices. This represents a concerted effort to track down these numbers and this data. The largest pornographic site, Pornhub®, also tracks its own statistics since its founding in 2007. RESULTS: An intriguing statistic is that the average number of sexual partners is about 9.9 (6.6 at Kinsey Center) for males and about 3.4 (4.3 at Kinsey) for females in their lifetimes. The exception to this is with homosexual persons, where the averages are much higher. Nature versus nurture is the classic tale of which is more important, genetics or environment, but most often there is a bit of both behind the scenes. Sexual activity is one of the most difficult topics of historical significance, because it is interleaved with so many socio-religious overtones. The average male loses his virginity at age 16.9, compared to age 17.4 for females. About 1 in 10 married adults sleep alone and not with their married spouse - shades of Dick Van Dyke and Mary Tyler Moore in The Dick Van Dyke Show. Only 29% of females achieve orgasm during sexual encounters, compared to 75% in their male counterparts. Currently, 66% of male college students report having “friends with benefits.” Also, currently 50% of sexually active men and women are infected with HPV at some point in their sexual lives. Sexual activity burns about 100-200 calories in males and about 69 calories in females but the heart rate at orgasm is about 140 and equal in both sexes. CONCLUSIONS: Spiegelhalter dedicated his statistical analysis “to everyone in history who has struggled with sex. And eventually called it a draw.” There is something like 900,000,000 acts of just heterosexual intercourse per year in Great Britain alone or roughly 100,000 per hour. This can all be extrapolated to the 7 billion humans around the world making close to 166,667 copulations per minute (or almost 4,000 per second).

MACHINE LEARNING AND RADIOMICS IDENTIFY NOVEL BIOMARKERS OF BONE LOSS

Purpose: Altered bone turnover is a factor in many diseases including osteoarthritis (OA), osteoporosis, inflammation, and viral infection. The absence of obvious symptoms and insufficiently sensitive biomarkers in the early stages of bone loss limits early diagnosis and treatment. Therefore, it is urgent to identify novel, more sensitive, and easy-to-detect biomarkers which can be used in the diagnosis and prognosis of bone health. Our previous data using standard micro-computed tomography (μCT) measurements showed that SARS-CoV-2 infection in mice significantly decreased trabecular bone volume at the lumbar spine, suggesting that decreased bone mass, increased fracture risk, and OA may be underappreciated long-haul comorbidities for COVID patients. In this study, we applied integrated state-of-the-art radiomics and machine learning models to identify more sensitive image-based biomarkers of SARS-CoV-2-induced bone loss from μCT images. These radiomic biomarkers can potentially provide a non-invasive way of quantifying and monitoring systemic bone loss and evaluating treatment efficacy in both research and clinical practices. Methods: All animal use was performed with approval of the Institutional Animal Care and Use Committee. To quantify SARS-CoV-2-induced bone loss, 6-week-old transgenic mice (16 male, 16 female) expressing humanized ACE2 receptors were inoculated with a 2020 strain of SARS-CoV-2 or phosphate-buffered saline (Control) [Fig. A]. Viral infection was confirmed by detection of infectious SARS-CoV-2 in throat swabs and histological identification of SARS-CoV-2 labeled cells. At 6-14 days post-infection, lumbar vertebral bodies (L5) were scanned with μCT (μCT 35, SCANCO Medical AG;6 μm nominal voxel size). The open-source research platform 3D Slicer v2020 with a built-in Python console v3.8 was used for medical image computing and fully automated segmentation of cortical and trabecular bone. Standard μCT assessment of bone microstructure was performed. Radiomic feature extraction and data processing were performed using python based PyRadiomics v3.0.1. A total of 120 radiographic features were extracted from the segmented images [Fig. B]. Principle component analysis (PCA) for feature selection, a support vector machine learning (SVML) predictive model for classification, holdback method for model validation, and all statistical analyses (significance at p<0.05) were performed using JMP Pro v15 (SAS). Results: Using standard μCT methods, SARS-CoV-2 infection significantly reduced the bone volume fraction (BV/TV) by 10 and 10.5% (p= 0.04) and trabecular thickness (Tb.Th) by 8 and 9% (p= 0.02) in male and female mice, respectively, compared to PBS control mice [Fig. C]. Radiomics detected a 20-fold greater magnitude in change over standard methods. SARS-CoV-2 infection significantly changed radiographic parameters with the largest change being a 300% increase in the second-order parameter: cluster shade [Fig. D]. The 45 radiomic features comprising the first 3 principal components were selected for inclusion in the SVML model. The SVML Model (radial basis function kernel;cost = 4.8;gamma = 0.46) produced an area under the receiver operating characteristic curve (AUC) of 1.0 which reflects a perfectly accurate test [Fig. E]. Conclusions: SARS-CoV-2 infection of humanized ACE2 expressing mice caused significant bone changes, suggesting that decreased bone mass, increased fracture risk, OA, and other musculoskeletal complications could be long-term comorbidities for people infected with COVID-19. We developed an open-source, fully automated segmentation and radiomics system to assess systemic bone loss using μCT images. When coupled with machine learning, this system was able to identify novel radiographic biomarkers of bone loss that better discriminate differences in bone microstructure between SARS-CoV-2 infected and control mice than standard bone morphometric indices. The high accuracy of the SVML model in classifying SARS-CoV-2 infected mice opens the possibility of translating these biom rkers to the clinical setting for early detection of skeletal changes associated with long-haul COVID. The methods presented here were demonstrated using SARS-CoV-2 as a model system and can also be adapted to other diseases associated with altered bone turnover. Development of machine-learning methods for radiomic applications is a crucial step toward clinically relevant radiomic biomarkers of bone health and provides a non-invasive way of quantifying and monitoring systemic bone loss and evaluating treatment efficacy. [Formula presented]

A human-centred assessment framework to prioritise heat mitigation efforts for active travel at city scale.

Hot weather not only impacts upon human physical comfort and health, but also impacts the way that people access and experience active travel options such as walking and cycling. By evaluating the street thermal environment of a city alongside an assessment of those communities that are the most vulnerable to the effects of heat, we can prioritise areas in which heat mitigation interventions are most needed. In this paper, we propose a new approach for policy makers to determine where to delegate limited resources for heat mitigation with most effective outcomes for the communities. We use eye-level street panorama images and community profiles to provide a bottom-up, human-centred perspective of the city scale assessment, highlighting the situation of urban tree shade provision throughout the streets in comparison with environmental and social-economic status. The approach leverages multiple sources of spatial data including satellite thermal images, Google street view (GSV) images, land use and demographic census data. A deep learning model was developed to automate the classification of streetscape types and percentages at the street- and eye-view level. The methodology is metrics based and scalable which provides a data driven assessment of heat-related vulnerability. The findings of this study first contribute to sustainable development by developing a method to identify geographical areas or neighbourhoods that require heat mitigation; and enforce policies improving tree shade on routes, as a heat adaptation strategy, which will lead to increasing active travel and produce significant health benefits for residents. The approach can be also used to guide post COVID-19 city planning and design.