Safety and immunogenicity of a third dose of COVID-19 protein subunit vaccine (CovovaxTM) after homologous and heterologous two-dose regimens.

OBJECTIVES: To report the safety and immunogenicity profile of a protein subunit vaccine (CovovaxTM) given as a third (booster) dose to individuals primed with different primary vaccine regimens. METHODS: A third dose was administered to individuals with an interval range of 3-10 months after the second dose. The four groups were classified according to their primary vaccine regimens, including two-dose BBIBP-CorV, AZD1222, BNT162b2, and CoronaVac/AZD1222. Immunogenicity analysis was performed to determine binding antibodies, neutralizing activity, and the T-cell responses. RESULTS: Overall, 210 individuals were enrolled and boosted with the CovovaxTM vaccine. The reactogenicity was mild to moderate. Most participants elicited a high level of binding and neutralizing antibody against Wild-type and Omicron variants after the booster dose. In participants who were antinucleocapsid immunoglobulin G-negative from all groups, a booster dose could elicit neutralizing activity to Wild-type and Omicron variants by more than 95% and 70% inhibition at 28 days, respectively. The CovovaxTM vaccine could elicit a cell-mediated immune response. CONCLUSION: The protein subunit vaccine (CovovaxTM) can be proposed as a booster dose after two different priming dose regimens. It has strong immunogenicity and good safety profiles.

Covid-19 vaccines and neurological complications: a systematic review.

The COVID-19 mainly causes respiratory disorders with high infection and severe morbidity and mortality. Neurologists have concerns about potential neurological side effects, profits, and timing of COVID-19 vaccines. This study aimed to review systematically research for the COVID-19 vaccine and neurological complications. Data was searched in Scopus, ISI web of knowledge, Medline, PubMed, Wiley, Embase, International Clinical Trials Registry Platform and Clinical Trials, Cochrane Library, and Google Scholar. Two reviewer authors individually searched and assessed the titles and abstracts of all articles. The third reviewer resolved disagreement between them. Data were documented regarding study location, study design, type of complications, number of patients, various types of COVID-19 vaccine, and type of neurological complications. Six studies in COVID-19 vaccine and neurological complications include two studies about neurological manifestations after the mRNA vaccines, four records about side effects of vector-based vaccine were included in the study. The main neurological complication associated mRNA vaccines were body aches, paresthesia, and difficulty walking, erythema migrans lesion, fatigue, myalgia, and pain in the left lateral deltoid region. The major neurological complication related to vector-based vaccines were urinary retention difficulty, feeding and ambulating, arm soreness, mild fatigue, chills, left-sided facial droop, headaches, a generalized epileptic seizure, hemianopia, and mild aphasia, acute somnolence and right-hand hemiparesis, acute transverse myelitis, deep vein thrombosis in her left leg, a vigilance disorder and a twitching, a severe immobilizing opsoclonus myoclonus syndrome, and encephalitis. A large spectrum of severe neurological unfavorable has been reported. These complications could occur as a result of molecular stimulation and later neuronal damage. Generally, the advantages of COVID-19 vaccination are dominant on the risks of a neurological complication at both individual and population levels. Future investigations will be required to find any relationship between neurological complications and COVID-19 vaccines principally as new strains of the virus and new vaccines are technologically advanced against them.

Is There any Effect of COVID-19 on Follicular Environment in Women Underwent ART?

There is insufficient data on the impact of severe acute respiratory coronavirus-2 (SARS-CoV-2) on the reproductive tissues, its possible risk of cross-contamination, transmission and adverse effect on in vitro fertilization (IVF) outcome. Until today, there is no report associated with viral RNA in both follicular fluid and embryo culture medium from SARS-COV-2 positive women. In this case report, a 24-year-old woman with SARS-CoV-2 was presented. We investigated the SARS-COV-2 positivity in the follicular fluid and embryo culture medium of mildly symptomatic woman on oocyte pick up (OPU) day. We could not detect viral RNA in neither the follicular fluid nor the embryo culture medium. In addition, although the response of ovarian stimulation was normal, the number and maturity of the retrieved oocytes were low.

MALIGNANT HYPERTENSION AFTER COVD-19 VACCINE INJECTION

Case;40 y/o male. Clinical course;The patient was transferred to our university hospital because of DOE and severe headache. He had been well and had no history of hypertension or obesity. He had experienced the COVID-19 vaccine injection two week before this visit. After the injection he had been experienced high fever and general fatigue as well as 7 kg of weight loss. On examnation, it was found that he had severe hypertension (190/110 mmHg) and hypertensive optic fundi. On chest X-ray, cardiomegaly and bilateral lung infiltrations was evident and biochemical data indicated renal dysfunction (serum creatinine 2.35 mg/dl), high levels of plasma renin activity (39.1 ng/ml/hour normal;0.6-3.9) and aldosterone concentration (176 pg/ml normal;4.0-82.1), and inflammatory changes (CRP = 23 mg/dl). We also found that increased levels of LDH and decreased levels of hemoglobin which indicated hemolytic anemia and thrombotic microangiopathy. After the control of high blood pressure by intravenous administration of Calcium channel blockades, We performed renal biopsy, which had a finding of diffuse findings of onion skin lesion and global glomerular sclerosis compatible with the diagnosis of malignant hypertension. Any secondary etiologies including renal artery disease or collagen disease had not been identified. Seven days after the admission, we started hemodialysis for this patient because of the renal failure was not resolved. We also had startred ACE inhibitors. We stopped the diuretics and minimized the ultrafiltration. Twenty-five days after the admission the patients was withdrawn from dialysis with the urine volume around 2000 ml/day and the serum creatinine concentration 5.29 mg/dl. He was discharged without any aid of dialysis and with small number of anti-hypertensives. Four months after the discharge, his serum creatinine concentration was 3.36 mg/dl and his blood pressure was 139/85 mmHg with the ACE inhibitor and calcium channel blockades. Conclusions;The case suggested that the malignant hypertension might be triggered by COVID-19 vaccine injection, which is of clinical importance.

From Pandemic Rumors to Reality: Arthritis Development and Exacerbations in Autoimmune Diseases After COVID-19 Vaccines

Introduction: There are similarities in the pathogenesis of COVID-19 and autoimmune diseases. In addition, due to the molecular similarities between the antigens of the virus and the antigenic structures in the human body, autoimmune diseases such as arthritis may occur or exacerbate after COVID-19 vaccines. In this publication, a retrospective evaluation of the patients who applied to the Rheumatology Outpatient Clinic with arthritis and other autoimmune complaints that developed or exacerbated after the COVID-19 vaccine was performed. Materials and Methods: Patients who applied to the Rheumatology outpatient clinics of our hospital were screened retrospectively, and patients who presented with newly developed or exacerbated autoimmune complaints after COVID-19 vaccination were determined. The files of these patients were reviewed retrospectively. Demographic characteristics of the patients, history of rheumatological disease, COVID-19 vaccinations, mean time to symptom development after vaccination, localization of arthritis, laboratory findings, imaging findings, treatment and treatment response were evaluated. Results: There are seven patients who applied to Rheumatology clinics with newly developed or exacerbated autoimmune complaints after COVID-19 vaccination in the last year. Three patients (no previous history of rheumatological disease) had newly emerged inflammatory arthritis, one stable gout, and one Sjögrens syndrome patient had exacerbated arthritis and two dermatomyositis cases (one newly diagnosed and the other exacerbation). Conclusion: The benefits of the vaccines are greater than the side effects that may develop, and vaccination should be continued in line with the recommendations. Although the temporal connection between the appearance of symptoms and the vaccination procedure in our study supports the relationship with the COVID-19 vaccine, it should never be forgotten that vaccines are the most effective way to prevent the disease.

Tixagevimab/ Cilgavimab Outcomes Among Patients with Immunodeficiency

Rationale: The FDA granted an emergency use authorization for tixagevimab/ cilgavimab in December 2021 for COVID-19 pre-exposure prophylaxis for individuals that are moderate to severely immunocompromised and has since recommended repeat dosing every 6 months. Given its novelty and resultant hesitation for use among some physicians and patients, our study aimed to observe safety and efficacy of tixagevimab/ cilgavimab, including against one of the newest variants, Omicron BA.5, among our patient population with immunodeficiencies 6 months post-administration via a telephone survey. We hypothesized that adverse outcomes would be minimal and COVID-19 incidence and severity would lessen following tixagevimab/cilgavimab administration. Methods: The Atrium Health Wake Forest Baptist Allergy, Asthma, and Immunology department recruited 15 patients with immunodeficiencies receiving immunoglobulin replacement and tixagevimab/ cilgavimab in March 2022 for a prospective cohort study. A telephone survey was conducted 6 months later regarding tixagevimab/ cilgavimab adverse effects and incidence/severity of COVID infection before and after administration. Results: Two patients experienced minor adverse effects (fatigue, bruising) following tixagevimab/ cilgavimab administration. No severe reactions were reported. Two patients required hospitalization for severe COVID-19 infection prior to tixagevimab/cilgavimab administration, whereas 0 patients required hospitalization for COVID-19 in the 6 months following administration. Four of 5 patients that had COVID-19 following administration had not yet received the bivalent Omicron booster vaccine and 2 had received no COVID-19 vaccines. Conclusions: Tixagevimab/ cilgavimab is associated with minor adverse effects and reduction of COVID-19 severity, albeit perhaps not associated with diminished incidence of newest COVID-19 strains, in a prospective, population-based cohort.

Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination

Acute exacerbations due to COVID-19 vaccination in patients with interstitial lung disease (ILD) have been reported, but their incidence is unknown. We investigated the incidence of exacerbations of ILD and respiratory symptoms due to the mRNA COVID-19 vaccines. A questionnaire survey was conducted on adverse reactions to the mRNA COVID-19 vaccination in 545 patients with ILD attending our hospital and retrospectively examined whether the eligible patients actually developed acute exacerbations of ILD induced by the vaccine. Of the 545 patients, 17 (3.1%) patients were aware of the exacerbation of respiratory symptoms, and four (0.7%) patients developed an acute ILD exacerbation after vaccination. Of the four patients who experienced exacerbations, two had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. Four patients were treated using steroid pulse therapy with a steroid taper, and two of the four also received intravenous cyclophosphamide pulse therapy. Tacrolimus was started in one patient with myositis-associated interstitial lung disease. Eventually, all patients exhibited improvement with immunosuppressive treatment and were discharged. COVID-19 vaccination for patients with ILD should be noted for developing acute exacerbations of ILD with low incidence, although manageable with early diagnosis and treatment. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Experience of Using Remdesivir in Patients with Novel Coronavirus Infection

Timely, effective, and safe antiviral therapy in COVID-19 patients reduces complications, disability and mortality rates. The greatest concern with remdesivir is the risk of drug-induced liver injury, including in patients whose liver function is compromised by COVID-19. The aim of the study was to investigate the efficacy and safety of remdesivir in patients with confirmed SARSCoV-2 infection who had been admitted to an infectious diseases hospital in the Volgograd region in March 2022. Materials and methods: the authors carried out an open, non-randomised, single-arm study using medical records of 234 patients who had been diagnosed with "U07.1 COVID-19, virus identified” and prescribed remdesivir upon admission. The effectiveness of therapy was evaluated using two criteria: the need for oxygen supplementation or ventilatory support, or mortality. The authors conducted the evaluation on days 7, 14, and 28 using the six-point ordinal severity scale by Y. Wang et al. The safety of therapy was assessed on the basis of complaints and changes in laboratory findings. Results: for the patients prescribed remdesivir at admission, the 7-day mortality rate was 3.0%, the 14-day mortality rate was 5.6%, and the 28-day mortality rate was 7.3%. With the exception of a patient with myocardial infarction, all the patients who had been hospitalised with mild COVID-19 and prescribed remdesivir did not require oxygen therapy and/or transfer to intensive care and were discharged following recovery. The patients with moderate to severe COVID-19 had the 14-day mortality rate of 6.4% and the 28-day mortality rate of 8.6%. 17 patients (7.2%) discontinued remdesivir prematurely for various reasons, including adverse drug reactions. Remdesivir therapy of 5-10 days was associated with an increase in ALT activity by 2.7 ± 0.8 times in 15.9% of patients with mild COVID-19, by 3.8 ± 1.8 times in 20.4% of patients with moderately severe COVID-19, and by 4.8 ± 2.7 times in 24% (12/50) of patients with severe COVID-19. In two patients (0.9%), the increase exceeded 10-fold the upper limit of normal. Conclusions: the obtained results support recommending remdesivir to patients with mild, moderate and severe COVID-19, including those with moderately elevated baseline activity of hepatic transaminases.

CASE REPORT: A RARE CASE OF ALVEOLAR HEMORRHAGE AFTER COVID-19 VACCINATION IN A PATIENT WITH RENAL-LIMITED ANTINEUTROPHIL CYTOPLASMIC ANTIBODYASSOCIATED VASCULITIS

The coronavirus disease 2019 (COVID-19) vaccination campaign has progressed worldwide. Rare but severe adverse events of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases of new-onset antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after COVID-19 mRNA vaccination have been reported. In contrast, relapse of AAV in remission has not been recognized enough as an adverse outcome of COVID-19 vaccination. We report, to the best of our knowledge, a first case of renal-limited AAV in remission using every 6-month rituximab administration that relapsed with pulmonary hemorrhage, but not glomerulonephritis, following the first dose of the COVID-19 vaccine. Notably, the patient received the COVID-19 vaccine more than 6 months after the last dose of rituximab according to the recommendations. Ironically, his CD19 positive B cell counts were found to be increased after admission, indicating that our case might have been prone to relapse after COVID-19 vaccination. Although our case cannot establish causality between AAV relapse and COVID-19 mRNA vaccination, a clinical vigilance for relapse of AAV especially in patients undergoing rituximab maintenance therapy following COVID-19 vaccination should be maintained. Furthermore, the elapsed time between rituximab administration and COVID-19 mRNA vaccination should be carefully adjusted based on AAV disease-activity (Nishioka et al. Front Med 2022. in press).

Adverse Drug Reactions during COVID-19 Treatment

Adverse drug reactions are unintented and harmful reactions to drugs. Coronavirus disease 2019 (Covid-19) has been widely spread. Although many drugs are used in the treatment of COVID-19, there is still no specific treatment with proven reliability and effectiveness and there are many studies to find effective treatment. Attention should be taken regarding the properties, interactions and undesired drug reactions of drugs used in the treatment of COVID-19. The aim of this review is to draw attention to adverse drug reactions of the drugs that are being used in COVID-19 treatment.

POST-GAM-COVID-VAC COMBINED VECTOR VACCINE CELLULAR AND HUMORAL IMMUNE RESPONSE

Currently, as the SARS-CoV-2 pandemic evolves, there has been increasingly more attention paid to building natural and vaccine-induced immunity against SARS-CoV-2 and related disease known as COVID-19. Widespread preventive vaccination plays an important role in effectively protecting people from viral infections and can reduce national economic costs. Purpose - to study peripheral blood cell subset composition and magnitude of humoral response in vaccinated Gam-COVID-Vac subjects. The prospective study included 352 patients, of which 194 (119 women and 75 men) underwent an immunogram study and assessed level of anti-SARS-CoV-2 antibodies. In patients, the study of the lymphocyte subset composition and estimation of anti-SARS-CoV-2 antibodies was carried out at two time points - prior to vaccination and 90 days after inoculated component 1 of the Gam-COVID-Vac vaccine. In general, vaccination was well tolerated by patients, with no serious adverse events after immunization. The reaction to the vaccine (fever, malaise, headache, local reactions) was short-term (1-2 days) and more often noted after inoculated vaccine component 2. Comparatively analyzed immunogram parameters in females before and after vaccination revealed increased relative level of T-lymphocytes (CD3+), T-helper cell subset (CD3+CD4+), increased absolute and relative level of activated CD3+CD25+ T-lymphocytes, but decreased absolute and relative level of natural killer (CD3-CD56+CD16+) and natural killer T-cell (CD3+CD56+CD16+) cell subsets as well as decreased CD147 receptor expression on T-lymphocytes. Similar patterns were also found while examining the immunogram in males exepting increased level of lymphocytes and lowered CD147 expression on both T- and B-lymphocytes. No changes in the parameters of the immune T-cell arm was found. The high efficacy of the vaccine was confirmed by development of SARS-CoV-2-specific class G antiviral antibodies in 97.5% and 92.3% of vaccinated females and males, respectively. The data obtained evidence that: 1) vaccination induces a specific humoral immune response determined three months post-vaccination, and 2) it caused no serious disturbances in the immune system functioning, which could be reflected in the peripheral blood lymphocyte subset composition. Thus, the data presented allow to conclude that Gam-COVID-Vac is effective vaccine against SARS-CoV-2 infection.

Efficacy of Antibody Cocktail Drug in COVID-19 Positive Patients: A Retrospective Single-centered Study

Introduction: Neutralising monoclonal antibodies (mABs) have been proposed and developed for the treatment of Coronavirus Disease-2019 (COVID-19) patients with mild to moderate diseases and to prevent further progression. The combination of Casirivimab and Imdevimab blocks the entry of virus into cells by attaching to receptor binding domain of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) spike glycoprotein. The mABs are utilised as a pre-emptive strategy in certain high-risk groups such as those suffering from chronic liver, kidney and respiratory disease, malignancies and other immunocompromised states where efficacy of vaccines may be suboptimal. Aim: To evaluate the clinical outcomes in COVID-19 patients who were treated with Antibody Cocktail drug (casirivimab and imdevimab). Materials and Methods: A retrospective observational study was conducted in patients confirmed positive for SARS-CoV-2 from June 2021 to January 2022 and subsequently, the collected data was analysed from May 2022 to June 2022. The study was conducted in a tertiary care referral hospital in eastern India. All eligible patient subsequently received casirivimab and imdevimab at COVID-19 facility. Monitoring of patients was done upto 12 hour postinfusion. Demographic parameters, routine investigations and clinical outcomes were assessed. Data entry was done using Microsoft Excel. Data was entered, coded and analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0. All analysis was done at a preset alpha error of 5% and results expressed at confidence levels of 95%. Results: Total 104 eligible cases were taken in present study. Nearly, 93% of those patients who had not been vaccinated were at higher risk for having severely elevated levels of C-Reactive Protein (CRP) as compared to 48% of those with COVID-19 vaccination. Nearly, 9 out of 10 patients with moderate-severe CRP levels were at nine times more risk for longer duration of hospitalisation as compared to normal levels of CRP. All patients having moderate-severe CRP levels required mechanical ventilation in comparison to mild CRP levels. Patients with comorbidities were more likely to get severe COVID-19 infections (p-value ≤0.05). Unvaccinated subjects were more likely to have severe infections than vaccinated subjects. (p-value ≤0.05). Prolonged hospitalisation (>7 days) was statistically significant in severe COVID-19. Unvaccinated subjects had a statistically significant rise in CRP over vaccinated subjects. The majority of the patients receiving antibody cocktail did not require prolonged hospitalisation while a minor fraction required invasive ventilation. Antibody cocktail was safe, well tolerated and had good efficacy and low mortality rate as compared to other modalities of treatment in this study. Conclusion: The duration of hospitalisation and outcomes were superior in patients having mild to moderate COVID-19 who received antibody cocktail without any serious side-effects.

136. Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Purpose: Telemedicine for adolescent and young adult (AYA) care, including long-acting reversible contraception (LARC) care, was quickly implemented in response to the COVID-19 pandemic. Therefore, outcomes of telemedicine LARC care is understudied. We compare outcomes of AYAs receiving LARC follow-up care via telemedicine and in-person over 1 year. Methods: This cohort study includes patients who had LARC, intrauterine device (IUD) or implant, inserted between 4/1/20-3/31/21 and attended an initial LARC follow-up visit at 4 US Adolescent Medicine clinics. Initial LARC follow-up visit was defined as the first visit within 12 weeks of insertion. Eligible patients were 13-26 years old, had LARC inserted without sedation, and had LARC in place for at least 12 weeks. We compared outcomes over 1 year between patients attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported side effects, medical menstrual management, acne management, IUD malposition or expulsion, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of medical menstrual management. Site-specific institutional review board approvals were obtained. Results: Our study included 194 AYAs, ages 13.9-25.7 years (mean 18.7 years, SD = 2.3) who attended an initial follow-up visit. Most AYAs (n = 168, 86.6%) attended only one visit in the 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site of LARC insertion (p =.43), age (p =.17), race/ethnicity (p =.25), prior pregnancy (p =.95), complex medical diagnoses (p =.32), menstrual diagnoses (p =.11), and reason for LARC (p =.82). In-person attendees were more likely to have the IUD than telemedicine attendees (p =.003). Bivariate analyses showed similar frequency of patient-reported symptoms over 1 year between groups. Outcomes of menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), IUD expulsion (p =.13), IUD malposition (p =.51), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing done (p =.001) than telemedicine attendees. However, no positive STI tests were captured in either group. Conclusions: Roughly two-fifths of patients presenting to an initial LARC follow-up visit did so via telemedicine. Type of LARC may influence modality of follow-up visit. Except for STI testing, outcomes over 1 year were similar regardless of the first visit modality. Reassuringly, no positive STI tests were detected in either group over 1 year of follow-up. More research is needed to determine if the decrease in STI testing for patients seeking care via telemedicine is clinically significant. Telemedicine may play an important role in AYA LARC follow-up care, and more research is needed in this area. Sources of Support: N/a.

Evaluation of Pregnant Women's Approaches to the COVID-19 Vaccine- Survey Study

Introduction: Pregnant women are at high risk for COVID-19 infection. The World Health Organization recommends COVID-19 vaccination in all weeks of pregnancy. However, there is insufficient data on vaccination rates and the opinions of pregnant women regarding vaccination. Therefore, this study was planned to investigate the hesitation, perspectives, and approaches of pregnant women regarding the COVID-19 vaccination. Materials and Methods: Between January 2022 and June 2022, pregnant women who applied to the Gynecology and Obstetrics outpatient clinics of Ankara Training and Research Hospital were voluntarily given a series of questionnaires, and their responses were recorded. Results: Vaccination rate was 63% (945) among 1500 pregnant women who participated in the study. When pregnant women who refused the vaccine were questioned, the most common responses given were fear of side effects (45%) and adverse effects on the baby (44%). Of the pregnant women who had received the vaccine, 85.8% had received the vaccine before pregnancy. When the COVID-19 vaccination status of the pregnant women was assessed, there was no statistically significant difference between age groups, gestational weeks, or educational status (p> 0.05). It was observed that pregnant women with lower educational status were more afraid of the injection (p< 0.05). Conclusion: It is crucial that pregnant women and their relatives are informed about vaccination practices during pregnancy. The main reasons why pregnant women avoid vaccination are the side effects of the vaccine and particularly, its potential harm to the fetus. Adequate and accurate vaccine information will influence the opinions of patients, particularly pregnant women.

Assessing the adverse effects of COVID-19 vaccine in different scenarios in Saudi Arabia: A cross-sectional study.

OBJECTIVES: To assess the different side effects of COVID-19 vaccines at different scenarios in Saudi Arabia. METHODS: This cross-sectional study sought to investigate the side effects of COVID-19 vaccines through an online survey of 2,718 participants in Saudi Arabia. RESULTS: People can manage their expectations about vaccine side effects and deal with symptoms better by knowing beforehand that they are likely to experience mild side effects for a short period, symptoms that are manifested regardless of age, and infection before or after vaccination. There are certain uncommon side effects that affect more people who got infected, and not before vaccination; there are side effects that disproportionately impact women, and also the side effects that wane after the second dose. CONCLUSION: These findings can assist in evaluating the concerns regarding vaccine acceptance. The public should be made aware that they are likely to experience at least one side effect, with temporary post-injection inflammation, musculoskeletal pain, fever, and headache as the most commonly reported side effects across the board. However, the common symptoms are mild to moderate, and the side effects last for a short period for most people.

Influenza vaccine and subsequent development of zoster.

BACKGROUND: Herpes zoster (HZ), which is caused by reactivation of the latent varicella zoster virus, was not listed as a side effect of any vaccines until the introduction of coronavirus disease 2019 (COVID-19) vaccine. This study used a nationwide population database to examine whether the HZ risk is increased after receiving the influenza vaccination. METHODS: This population-based retrospective self-controlled case series evaluated the association between influenza vaccine exposure and HZ risk. Data were collected from Taiwan's National Health Insurance Research Database between 2015 and 2017. Patients with HZ diagnosed within 6 months before and after receiving the influenza vaccination were included. After receiving the influenza vaccine, the first 15 and 30 days were defined as risk intervals, while the other periods were defined as control intervals. Poisson regression was used to compare the incidence rate ratio (IRR) for HZ during the risk interval vs. the control interval. RESULTS: In total, 13,728 patients were diagnosed with HZ before and after receiving the influenza vaccine. The IRR for days 1-15 was significantly higher (IRR = 1.11; 95% confidence interval [CI], 1.02-1.20), but insignificant for days 1-30 (IRR = 1.04; 95% CI, 0.98-1.10). In a subgroup analysis, the IRRs were significantly higher in participants, including 50-64 years old (1.16; 95% CI, 1.02-1.33), males (1.14; 95% CI, 1.01-1.28), and healthier individuals (i.e., no history of cancer or autoimmune diseases). CONCLUSIONS: There was a slight increase in risk of HZ in people receiving influenza vaccine in the first 1-15 days after vaccination.

Corticosteroids Induced Avascular Necrosis of Hip, a "Long Covid-19" Complication: Case Report

Since it first surfaced, the new Coronavirus has multiplied and mutated into different forms, leading to a significant impact on people's lives. COVID-19's long-term impact is not completely known: It can only be hypothesized based on the prior outbreak of severe acute respiratory syndrome (SARS). Avascular necrosis (AVN) is one of these consequences, which if left untreated can lead to catastrophic events and bone collapse. It's important to remember that individuals who have recovered from COVID-19 infection are still at risk of developing AVN. The pathological findings in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are very similar to those seen in severe acute respiratory syndrome coronavirus (SARS-CoV) infection. We present cases of 27- and 69-years old men with no comorbidities admitted with complaints of bilateral hip pain post Covid treatment with corticosteroids and antivirals. The diagnosis was established based on history, physical examination, and magnetic resonance imaging (MRI). The use of corticosteroids in the treatment of SARS-CoV-2 infection has saved many lives, and it is still advised for moderate to severe cases on a short-term basis. The long-term use of corticosteroids is associated with numerous side effects. One of the most prevalent side effects of steroids is avascular necrosis of the femoral head, which is aggravated by the disease process. Early detection of avascular necrosis is very crucial in its management due to its high progression rate. Low therapeutic doses of corticosteroids with minimal effective duration remain the key to halting its occurrence.

Covid-19 vaccination status and adverse events following sars-cov- 2 vaccine in autoimmune inflammatory rheumatic disease (AIRD) patients: A single center experience

Background: Autoimmune inflammatory rheumatic diseases (AIRD) were associated with an increased risk for COVID-19 infection, worse clinical outcomes, and COVID-19- related deaths. Vaccines carry the potential benefit of reducing disease transmission and disease severity. Issues on vaccine safety, trigger of an autoimmune reaction or disease flares has been a long issue. Thus this study describes the COVID-19 vaccination status and adverse events following SARS-COV 2 vaccine in a tertiary hospital in Manila, Philippines. Method(s): This retrospective cross-sectional study included patients diagnosed with AIRD and seen in the clinics over 12 months (March 2021-March 2022).We collected data from patients' clinic records and analyzed the clinicodemographic profile, vaccination status, adverse events and development of new onset autoimmune reaction and disease flares post vaccination and those who developed COVID-19 infection even after vaccination. Result(s): There were 204 respondents included in this study: 174 (85%) were female and 30 (14%) were male;63.2 % with SLE, 10.8% rheumatoid arthritis, 8.3% psoriatic arthritis, 6.4% ankylosing spondylitis and other systemic autoimmune disease. Others included were scleroderma and inflammatory arthritis and myopathies. The median age is 38.4 years. 100% of the respondents were fully vaccinated;87 (42.6%) received inactivated vaccine, 63 (30.8%) viral vector vaccine and 54 (26.4%) mRNA vaccine. 133 (65.2%) reported no adverse events while 71 (34.8%) experienced constitutional symptoms, musculoskeletal, cutaneous, respiratory, gastrointestinal and cardiovascular symptoms after vaccination. There were 9 (4.4%) of the respondents who developed new onset autoimmune reaction and disease flares 7-28 days post vaccination;1 patient had new onset amyopathic dermatomyositis;3 SLE patients developed severe hematologic, cutaneous and renal flare;2 rheumatoid arthritis, 1 spondyloarthritis, and 1 inflammatory arthritis patients in long remission had disease flares and 1 patient with henoch schonlein purpura developed flare. Twenty two (10.8%)of the respondents developed COVID-19 infection after 30-120 days post vaccination;19 (86.4%) had mild symptoms, 2 (9.1%) moderate infection and 1 (4.5%) had severe infection and all of the patients recovered. Conclusion(s): This study showed that patients with AIRD experienced varied organ system adverse events following vaccination ranging from mild side effects, disease flares and new onset autoimmune reactions. The development of an autoimmune reaction following SARS-COV 2 vaccination is of scientific and public importance and still needs to be investigated. Even after a complete vaccination, some patients still had COVID-19 infection, however preventing them from worse complications, hospitalization and mortality.

All in the Marrow - a Case of Primary Bone Marrow Oedema

Introduction/Background: Primary bone marrow oedema syndrome is an elusive and less well-defined entity. Whether Rheumatologists should consider it as a stand alone diagnosis, is debatable. It possibly would be best described as an MRI feature which could be a finding in a number of diseases which would include the initial phases of Osteonecrosis of the bone, Rheumatoid Arthritis, Spondyloarthritis, Enthesitis related, Post traumatic, OA, Infections and Cancers. The treatment options become constricted due to the paucity of evidence. Rheumatologists need to consider this as an area of unmet need with development of consensus classification criteria and treatment approaches. Description/Method: 27-year-old male, Height 174 cms Weight 90 Kgs BMI 29 Kg/m2, became symptomatic in Jan 2022 with complains of pain in the both hip joints & groin regions, pain became excruciating and he became bed-bound, with early morning stiffness lasting approximately 45 mins. Had received steroids for COVID infection in August 2020. Investigations Hb 13.5gm/dl TLC 7000/mm3 Platelet 400 x 103/mm3 Sr Bil 0.8mg/dl AST 16 IU/L. ALT 24 IU/L Sr Creatininine 1.1mg/dl Blood Sugar Levels, Fasting 89 mg/dl Post Prandial 102 mg/dl ESR 10mm in 1st hour by Wintrobes method CRP Quantitative 29.38mg/L HLA B27 by PCR Negative, RF Negative, ACCP Negative Serum, IgG, Beta2 Glycoprotein 1.44 SGU Serum, IgM, Beta2 Glycoprotein 3.44 SGU Serum, IgG, Cardiolipin antibody 8.4 GPL Serum, IgG, Cardiolipin antibody 17.45 GPL Lupus anticoagulant by DRVVT Negative Sr Cholesterol 211mg/dl HDL 29 mg/dl LDL 156mg/dl TGs 130 mg/dl MRI Hips & SI joints Transient bone marrow oedema/osteopenia of bilateral hip. PET CT Increased metabolic activity in both hip joints Bone Scan (99mTcMDP) Increased vascularity in perfusion phase, increased accumulation in soft tissue in blood pool phase and increased uptake in bilateral Hip joints in skeletal phase scan, suggestive of CRPS Type-I. Management Was initially managed with Tab Etoricoxib 90mg BD, also started on Tab Sulphaslazine and Tab Methotrexate. However, when he had no symptomatic relief he was administered Inj Infliximab on 12 May 2022 and a second dose on 9 June 2022. He had excellent pain relief after the 1st dose, however after 10 days of the administration, he again began experiencing pain especially after walking. He also had pain in the knees on this occasion. He was also administered Inj Zoledronic 4mg on 23 May 2022. He is at present not requiring any NSAIDs over the last 1 month. Discussion/Results: The patient having presented with excruciating and debilitating pain was worked up and evaluation revealed features of bone marrow oedema on MRI which was corroborated with bone scan and PET CT imaging. The acute phase reactant CRP was also significantly elevated. The patient also gave history of early morning stiffness lasting approximately 45 mins. Hence an underlying Inflammatory process such as Spondyloarthritis(Peripheral) with enthesitis was considered. The confounding factors were the pain which worsened on mobilization, HLA B27 negative status, Rheumatoid Factor and ACCP negative status and past history of having received IV Corticosteroids for COVID infection in August 2020. In view of the debilitating pain and aworking diagnosis of Spondyloarthritis, hewas started onNSAIDs alongwith rest, initially, followed by conventional synthetic disease modifying agents in Rheumatic disease followed by biologic synthetic diseasemodifying agent - Inj Infliximab. The thought process was to avoid prolonged NSAID use to prevent the associated side effects. However, since Avascular Necrosis of the Femoral head is a very likely possibility, the patient is planned to be kept under close follow up. Key learning points/Conclusion: Collaborative efforts between the Departments of Nuclear Medicine, Radiology, Orthopaedics and Rheumatology are crucial in the early detection and approach to cases of Bone Marrow oedema. Avascular necrosis of head of Femur is a far more common entity and must be kept in ind even when a diagnosis of Bone Marrow oedema syndrome is being entertained. Diagnosis of Bone Marrow oedema syndrome must be entertained only as a diagnosis of exclusion. Continued follow up and regular imaging must be pursued rigorously in patients diagnosed with Bone Marrow oedema syndromes. There is a requirement to document acute phase reactants such as CRP and ESR in patients diagnosed with Avascular necrosis of bone as this data could help us differentiate AVN from Primary Bone marrow oedema in the early stages.