Lichenoid cutaneous skin eruption and associated systemic inflammatory response following Pfizer-BioNTech mRNA COVID-19 vaccine administration.

The global effects of coronavirus disease 2019 (COVID-19) have driven unprecedented rapid development and mass deployment of vaccinations against the novel coronavirus. However, the short- and long-term adverse reactions following COVID-19 vaccinations are still under investigation as insufficient time has passed to fully explore these. The Pfizer-BioNTech COVID-19 mRNA vaccine has thus far shown a favourable safety profile in phase I-III studies. Although infrequent cases of generalized cutaneous reactions and systemic inflammatory response have been reported following other mRNA vaccines, these have not been reported following the Pfizer-BioNTech vaccine. We report a case of generalized lichenoid skin eruptions and systemic inflammatory response occurring together following the first dose of the Pfizer-BioNTech vaccine. Our case report adds to an accumulating body of literature connecting autoimmunity with the pathophysiology of the novel coronavirus disease.

Preventing adverse cardiac events (PACE) in chronic obstructive pulmonary disease (COPD): study protocol for a double-blind, placebo controlled, randomised controlled trial of bisoprolol in COPD.

INTRODUCTION: Heart disease in chronic obstructive pulmonary disease (COPD) is a common but neglected comorbidity. Patients with COPD are frequently excluded from clinical trials of treatments aimed at reducing cardiac morbidity and mortality, which has led to undertreatment of cardiovascular disease in patients with COPD. A particular concern in COPD is the underuse of beta (ß)-blockers. There is observational evidence that cardioselective ß-blockers are safe and may even reduce mortality risk in COPD, although some evidence is conflicting. There is an urgent need to answer the research question: Are cardioselective ß-blockers safe and of benefit in people with moderately severe COPD? The proposed study will investigate whether cardioselective ß-blocker treatment in patients with COPD reduces mortality and cardiac and respiratory morbidity. METHODS AND ANALYSES: This is a double-blind, randomised controlled trial to be conducted in approximately 26 sites in Australia, New Zealand, India, Sri Lanka and other countries as required. Participants with COPD will be randomised to either bisoprolol once daily (range 1.25-5 mg, dependent on tolerated dose) or matched placebo, in addition to receiving usual care for their COPD over the study duration of 24 months.The study will enrol 1164 participants with moderate to severe COPD, aged 40-85 years. Participants will be symptomatic from their COPD and have a postbronchodilator forced expiratory volume in 1 s (FEV1) ≥30% and ≤70% predicted and a history of at least one exacerbation requiring systemic corticosteroids, antibiotics or both in the prior 24 months. ETHICS AND DISSEMINATION: The study protocol has been approved by the Sydney Local Health District Human Research Ethics Committee at The Concord Repatriation General Hospital. TRIAL REGISTRATION NUMBERS: NCT03917914; CTRI/2020/08/027322.

Impact of COVID-19 pandemic restrictions on the cardio-respiratory health of New Zealanders.

BACKGROUND AND OBJECTIVE: The COVID-19 pandemic has caused disruption to health, social interaction, travel and economies worldwide. In New Zealand, the government closed the border to non-residents and required all arrivals to quarantine for 14 days. They also implemented a strict contact-restriction system to eliminate COVID-19 from the community. These measures also reduced the circulation of other respiratory viruses such as influenza and respiratory syncytial virus. We assessed the impact of these measures on hospital admissions for respiratory and cardiac diseases. METHODS: National data on hospital admissions for each week of 2020 were compared to admissions for the previous 5 years. Analyses were curtailed after week 33, when a COVID-19 outbreak in Auckland led to different levels of pandemic restrictions making national data difficult to interpret. RESULTS: The numbers of acute infectious respiratory admissions were similar to previous years before the introduction of COVID-19 restrictions, but then fell lower and remained low after the pandemic restrictions were eased. The usual winter peak in respiratory admissions was not seen in 2020. Other than small reductions during the period of the strictest contact restrictions, non-infectious respiratory and cardiac admissions were similar to previous years and the usual winter peak in heart failure admissions was observed. CONCLUSION: The observed patterns of hospital admissions in 2020 are compatible with the hypothesis that circulating respiratory viruses drive the normal seasonal trends in respiratory admissions. By contrast, these findings suggest that respiratory viruses do not drive the winter peak in heart failure.

Co-diagnoses of acute myeloid leukaemia and COVID-19: presentation and management implications.

We report a case of concurrent new diagnoses of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and acute myeloid leukaemia (AML). We review the existing literature on coronavirus disease 2019 (COVID-19) in the immunocompromised patient and the implications for managing our patient's haematological neoplasm. The implications of severe immunocompromise are unclear in the context of infection with SARS-CoV-2. Respiratory and viral systemic symptoms remained mild in this patient and this is consistent with the existing literature on COVID-19 in immunocompromised patients. To our knowledge, this is the first description of a case of SARS-CoV-2 infection with AML.