Risk of Coronavirus Disease 2019 Messenger RNA Vaccination-Associated Myocarditis and Pericarditis - A Systematic Review of Population-Based Data.

Purpose: Early studies showed that the risks of mRNA vaccine-associated myocarditis and pericarditis are low but with substantial variation across studies. Study characteristics, ethnicity, vaccine types, dose intervals, and SARS-CoV-2 infection prevalence may influence the rates of myocarditis and pericarditis after mRNA vaccination in population-based studies. Methods: We comprehensively searched MEDLINE for relevant articles published before November 30, 2022. We also searched the websites of health authorities in several countries for unpublished surveillance data on myocarditis and pericarditis after mRNA vaccination. The outcome of interest was the incidence of myocarditis and pericarditis developed after mRNA vaccination for COVID-19. Results: A total of 17 studies form 10 countries were included for review. We noted that considerable heterogeneity in study characteristics, including surveillance method, case definition, and observation period, may partially be responsible for the widely varied reported rates. Studies from countries that adopted active surveillance reported higher rates than those using passive surveillance. Compared to BNT162b2 vaccine, mRNA-1273 may have a higher risk of myocarditis only in young men after the second dose. Our comparison of sex-, age-, vaccine type-, and dose-specific rates of myocarditis across countries did not support the hypothesis that individuals with recent SARS-CoV-2 infection and young Asian males were at higher risk. We also could not find sufficient evidence to conclude whether extending the between-dose interval could reduce myocarditis incidence following mRNA vaccination. Conclusion: Differences in the study characteristics must be fully considered when comparing the risks of mRNA vaccine-related myocarditis and pericarditis in different countries.

Risk of myocarditis and pericarditis following coronavirus disease 2019 messenger RNA Vaccination-A nationwide study.

BACKGROUND: An extended interval between the two primary doses may reduce the risk of myocarditis/pericarditis after COVID-19 mRNA vaccination. Taiwan has implemented a two-dose regimen with a 12-week interval for adolescents. Here we present nationwide data of myocarditis/pericarditis following COVID-19 vaccinations. METHODS: Data on adverse events of myocarditis/pericarditis were from the Taiwan Vaccine Adverse Events Reporting System between March 22, 2021, and February 9, 2022. The reporting rates according to sex, age, and vaccine type were calculated. We investigated the rates among young individuals under different two-dose intervals and among those who received two doses of different vaccines. RESULTS: Among 204 cases who met the case definition of myocarditis/pericarditis, 75 cases occurred after the first dose and 129 after the second. The rate of myocarditis/pericarditis after COVID-19 vaccination varied across sex and age groups and was highest after the second dose in males aged 12-17 years (126.79 cases per million vaccinees) for the BNT162b2 vaccine and in males aged 18-24 years (93.84 cases per million vaccinees) for the mRNA-1273 vaccine. The data did not suggest an association between longer between-dose interval and lower rate of myocarditis/pericarditis among males and females aged 18-24 or 25-29 years who received two doses of the BNT162b2 or mRNA-1273 vaccine. Rates of myocarditis/pericarditis in males and females aged 18-49 years after receiving ChAdOx1-S - mRNA-1273 vaccination was significantly higher than after ChAdOx1-S - ChAdOx1-S vaccination. CONCLUSIONS: Myocarditis and pericarditis are rare following mRNA vaccination, with higher risk occurring in young males after the second dose.

Urban wastewater treatment plants as a potential source of ketamine and methamphetamine emissions to air.

Urban wastewater treatment plants (WWTPs) can be an emission source of aerosol particles to the air and this process has the potential to spread emerging pollutants into the air, where the particles can be widely transported over long distances to areas where this pollution is unexpected. This study demonstrates aeration tanks in WWTPs as a potential source of ketamine, methamphetamine and other emerging contaminant emissions into the air. Ketamine and methamphetamine are frequently detected in high concentrations (maximum of 151.8-162.8 pg/m3) in gaseous and aerosol samples along with 24 other emerging contaminants. Through correlation analysis, the common occurrence of emerging contaminants in air is attributable to their high aqueous concentrations as well as their physicochemical properties. Two simple regression models are developed to provide a practical and convenient way to estimate the steady-state concentrations in air. The gas-phase emission model illustrates the relationship between the solubility, the pKa and the aqueous concentration of compounds in the aeration basin and their gaseous concentrations in air (statistical strength of 74.1%; p value < 0.05), while the partition model establishes the ratio of a compound in the gas and particulate phases in air (statistical strength of 82.6%; p value < 0.05). The results provide a basis for assessing the risk of the inhalation exposure to airborne emerging contaminants; however, in-depth research addressing the impact of aerosols containing persistent pharmaceuticals on human health is still needed.

Size distribution, biological characteristics and emerging contaminants of aerosols emitted from an urban wastewater treatment plant.

Air-liquid exchange process could spread pathogens and pharmaceutical emerging pollutants into the air as aerosol particles in an Urban wastewater treatment plants (UWTPs). These particles can later be transported to places where such pollution is unforeseen. In this study, measurements were conducted in the aeration area of a UWTP in northern Taiwan. According to this investigation, nanoparticles are major contributors to both the number and volume concentration of particles. Most fluorescent particles may be bacterial aggregates or fungal species. Moreover, nine common emerging contaminants were analyzed and found in both air and water samples. Among these contaminants, the most abundant chemicals in the air were erythromycin-H2O (191.45 pg/m3) and methamphetamine (39.02 pg/m3). These results imply that UWTPs could be an emission source of emerging contaminants and bioaerosols, and the potential risk of inhalation exposure should be carefully evaluated.

The design of a sunlight-focusing and solar tracking system: A potential application for the degradation of pharmaceuticals in water.

Photolysis is considered one of the most important mechanisms for the degradation of pharmaceuticals. Photodecomposition processes to remove pharmaceuticals in water treatment presently use artificial UV light incorporated in advanced oxidation processes. However, UV lighting devices consume a substantial amount of energy and have high operational costs. To develop low energy treatment systems and make good use of abundant sunlight, a natural energy resource as a green technology is needed. As such, a system that combines sunlight focusing, solar tracking and continuous reaction was designed and constructed in the present study, and its application potential as a pharmaceutical water treatment option was tested. Two representative photolabile pharmaceuticals, ciprofloxacin and sulfamethoxazole, were chosen as the target pollutants. The results indicate that the sunlight-focusing system consisting of a UV-enhancing-coated parabolic receiver can concentrate solar energy effectively and hence result in a more than 40% improvement in the direct photolysis efficiency of easily photoconvertible ciprofloxacin. The sunlight-focusing coupled with a solar tracker (SFST) system can improve the sunlight-focusing efficiency by more than 2-fold, thus leading to the maximization of the efficient use of solar energy. Sulfamethoxazole, which is difficult to photoconvert, was successfully degraded by more than 60% compared to direct photolysis through the designed SFST system in the presence of persulfate. The treatment system exhibited good and consistent performance during clear and cloudy days of summer. It is proven that the UV-enhanced coated SFST system with the addition of persulfate indeed has development potential for application in the degradation of pharmaceuticals in water.

Photolytic degradation of ciprofloxacin in solid and aqueous environments: kinetics, phototransformation pathways, and byproducts.

Many lipophilic pharmaceuticals may be sorbed in solid phases, leading to different photochemical behaviors. This study investigated the photochemistry of ciprofloxacin in a solid-phase system and compared it to that in a water-phase system. Kaolinite was used as the model solid matrix. The photolysis of ciprofloxacin in kaolinite fits pseudo-first-order kinetics for thicknesses less than 199 µm, and the rate constants k p decreased from 0.0154 to 0.0016 min-1 as the thickness of the layer increased. Unlike the aqueous phase, two-step degradation processes were observed for all kaolinite layer thicknesses (14-199 µm), and the pseudo-first-order constant at the surface of the kaolinite layer was smaller than that in the water phase. Comparatively , a similar photolysis rate constant of ciprofloxacin in a kaolinite suspension was also observed, and it was an order of magnitude smaller than that of the direct photodegradation (0.035 min-1) in water. The results indicate that ciprofloxacin is likely more stable when it is adsorbed on kaolinite and that the half-lives of ciprofloxacin in kaolinite and a kaolinite suspension are 2-25 times longer than that in deionized water (20 min) under simulated sunlight. Direct photolysis is proposed to be the main photodegradation mechanism for ciprofloxacin in kaolinite, and the cleavage of a piperazine ring is the main degradation pathway. However, the interaction between ciprofloxacin and kaolinite reduces the direct photolysis and leads to a higher light stability. In association with the reduction in photolysis, the yields of norfloxacin and defluorinated byproduct decreased significantly. Consequently, the interaction increases the persistence of ciprofloxacin and thus the ecological risk to the environment.

The persistence and photostabilizing characteristics of benzotriazole and 5-methyl-1H-benzotriazole reduce the photochemical behavior of common photosensitizers and organic compounds in aqueous environments.

Benzotriazole (BT) and 5-methyl-1H-benzotriazole (5-MeBT) are broadly used in industrial applications, such as anti-icing fluids and dishwashing detergent, and act as the primary building blocks for UV absorbers and photostabilizers. This study examined the occurrence of these two compounds in the environment and their unique photochemical behavior affecting photosensitizers and other micro-organic pollutants in aqueous environments. BT and 5-MeBT were detected in all river water samples from the major rivers in Taipei City in the concentration ranges of 147 to 1560 ng/L and 22 to 235 ng/L, respectively, and both compounds persisted through a conventional wastewater treatment plant. The direct photolysis half-lives of BT and 5-MeBT were 56.9 and 14.0 h, respectively. The half-life of photolysis in river water for BT was 44.2 h, whereas the half-life of 5-MeBT was 24.7 h. The long half-lives in real-water matrices resulted in their prevalence in water bodies, and these compounds were also found to minimize the photosensitizing ability of nitrate and dissolved organic matter (DOM) and increase the persistence of other micro-organic pollutant. With BT present, the production of ·OH in nitrate photolysis was reduced, the degradation of DOM under sunlight was hindered, and the photodegradation of pharmaceutical residues in surface water, such as methotrexate, was completely impeded. This study suggests that in cases in which BT and 5-MeBT are highly concentrated, the effectiveness of natural attenuation process, i.e., photodegradation, in the aqueous environment is diminished, which increases the persistence of the pollutants as well as the risk of exposure.

Role of Dissolved Organic Matter in Sorption of Perfluorooctanoic Acid to Metal Oxides.

Perfluorooctanoic acid (PFOA) is an important perfluorinated chemical of significant environmental concern. It has been widely found at high concentrations in the environment. We have exposed sediment constituent minerals SiO2, Fe2O3, and Al2O3 to PFOA and humic acid (HA) and studied the adsorption of PFOA by introducing the adsorbates in different orders. The results suggest concurrent sorption of PFOA and HA to the mineral surface or enhanced PFOA sorption when both are introduced to the aqueous phase. However, when PFOA is introduced to the mineral surface that has already been exposed to and extensively coated with HA, little PFOA adsorption occurs, which implies that PFOA released to rivers rich in dissolved organic matter (DOM, i.e. HA) may be immune to sorptive retention by the sediment and be transported downstream unabated. DOM thus can play a significant role in the transport and fate of PFOA in the natural water system.

Occurrence of pharmaceuticals, hormones, and perfluorinated compounds in groundwater in Taiwan.

In this work, we investigated the emerging pollutants in Taiwanese groundwater for the first time and correlated their presence with possible contamination sources. Fifty target pharmaceuticals and perfluorinated chemicals in groundwater were mostly present at ng L(-1) concentrations, except for 17α-ethynylestradiol, sulfamethoxazole, and acetaminophen (maximums of 1822, 1820, and 1036 ng L(-1), respectively). Perfluorinated compounds were detected with the highest frequencies in groundwater at almost all of the sample sites, especially short-chained perfluorinated carboxylates, which were easily transferred to the groundwater. The results indicate that the compounds found to have high detection frequencies and concentrations in groundwater are similar to those found in other countries around the world. Most common pharmaceuticals that contain hydrophilic groups, such as sulfonamide antibiotics and caffeine, are easily transported through surface waters to groundwater. The results also indicated that the persistent natures of emerging contaminants with high detection frequencies in surface water and groundwater, such as perfluorooctanesulfonate (risk quotient >1), caffeine, and carbamazepine, should be further studied and evaluated.

Prevalence and sunlight photolysis of controlled and chemotherapeutic drugs in aqueous environments.

This study addresses the occurrences and natural fates of chemotherapeutics and controlled drugs when found together in hospital effluents and surface waters. The results revealed the presence of 11 out of 16 drugs in hospital effluents, and the maximum detected concentrations were at the µg L(-1) level in the hospital effluents and the ng L(-1) level in surface waters. The highest concentrations corresponded to meperidine, morphine, 5-fluorouracil and cyclophosphamide. The sunlight photolysis of the target compounds was investigated, and the results indicated that morphine and codeine can be significantly attenuated, with half-lives of 0.27 and 2.5 h, respectively, in natural waters. Photolysis can lower the detected environmental concentrations, also lowering the estimated environmental risks of the target drugs to human health. Nevertheless, 5-fluorouracil and codeine were found to have a high risk quotient (RQ), demonstrating the high risks of directly releasing hospital wastewater into the environment.

Effects of water washing on removing organic residues in bottom ashes of municipal solid waste incinerators.

Due to their potential toxicity and odourous nature, the residual organics in municipal solid waste incinerators are recently gaining attention as an important issue of resources recovery apart from their complex mixture of organic counterpart. Studies of the organic fractions in municipal solid waste incinerator residues have been limited. In this study, extended solid-phase extraction of the water-washed bottom ash and liquid-phase extraction of the washing water were carried out with regard to bottom ash samples from three mass-burning incinerators in Taipei County (Taiwan) during four consecutive seasons of year 2008-2009. Supercritical fluid extraction and Soxtec extraction techniques along with GC-MS were successfully used to characterize the residual organics in weathered and washed bottom ashes. Supercritical fluid extraction provided the quantification of aliphatics and aromatic compounds such as hexanoic acid and benzaldehyde, respectively. Soxtec extraction was useful for qualitative analysis of aromatic and aliphatic groups in the ashes and many of which were odourous and toxic compounds. By mixing one unit weight (g) bottom ash with two unit volume (mL) water for 15 min, total organic carbon in the bottom ash was greatly reduced (e.g., from 4.1 to 1.8 wt.%). Among the removed were foul odour-causing compounds such as pyridine and quinoline derivatives, while some aromatic compounds such as 4-hydroxybenzaldehyde and low-molecular-weight aliphatics such as hexanoic acid remained. The results here suggest that washing with water can be an effective pre-treatment step for removing odour-causing and environmental concerned organics.

Characteristics of residual organics in municipal solid waste incinerator bottom ash.

Although heavy metals in bottom ash have been a primary issue in resource recovery of municipal solid waste incinerator residues in past decades, less studied are potentially toxic and odorous organic fractions that exist as they have not been completely oxidized during the mass burn process. Using supercritical fluid extraction (SFE) and soxtec extraction (SE) techniques, this study investigated the characteristics of un-oxidized organic residues contained in bottom ash from three municipal solid waste incinerators in Taiwan during 2008-2009. All together 99 organics were identified in bottom ash samples using gas chromatography-mass spectrometry (GC-MS). Among the identified organics, aromatic compounds were most frequently detected. No polycyclic aromatic hydrocarbons were extracted by SFE or SE. Several phthalates (e.g., phthalic acid isobutyl tridec-2-yn-1-yl ester, dibutyl phthalate and 2-butoxyethyl butyl benzene-1,2-dicarboxylate), organic phosphates (e.g., octicizer and phosphoric acid isodecyl diphenyl ester), and aromatics and amines including pyridine, quinoline derivatives, chloro- and cyano-organics were successfully extracted. Aromatic amines (e.g., 1-nitro-9,10-dioxo-9,10-dihydro-anthracene-2-carboxylic acid diethylamide and 3-bromo-N-(4-bromo-2-chlorophenyl)-propanamide) and aromatic compounds (other than amines) (e.g., 7-chloro-4-methoxy-3-methylquinoline and 2,3-dihydro-N-hydroxy-4-methoxy-3,3-dimethyl indole-2-one) are probably the major odorous compounds in bottom ash. This work identifies organic pollutants in incinerated bottom ash that have received far less attention than their heavy metals counterpart.

Novel mutations of the OPA1 gene in Chinese dominant optic atrophy.

PURPOSE: To investigate OPA1 gene mutations in Chinese patients with autosomal dominant optic atrophy and sporadic optic atrophy. DESIGN: Molecular genetic studies and observational case series. PARTICIPANTS: Twenty-four patients from 10 unrelated Chinese pedigrees of autosomal-dominant optic atrophy, 35 isolated cases with bilateral optic atrophy of unknown cause, and 50 unrelated normal controls. METHODS: Genomic DNA was extracted from peripheral blood leukocytes. All 28 coding exons of the OPA1 gene and flanking intron splice sites were sequenced. Putative mutations were reexamined for segregation in the respective families by direct sequencing. Further characterization of selected splicing site mutations was performed by reverse transcription-polymerase chain reaction (PCR) of each patient's leukocyte mRNA. MAIN OUTCOME MEASURES: Direct sequencing of the OPA1 gene. RESULTS: Four OPA1 gene mutations were detected, including 2 splicing site mutations (c.1065+2T>C on intron 10 and c.1212+2insT on intron 12), 1 deletion (c.1776_1778delACT on exon 19), and 1 missense mutation (c.2846 T>C on exon 28). The c.1212+2insT, c.1776_1778delACT, and c.2846T>C mutations were newly identified OPA1 mutations. Reverse transcription (RT)-PCR and direct sequencing revealed that the splicing site mutations on c.1065+2T>C and c.1212+2insT caused skipping of exons 10 and 12, respectively. The c.1776_1778delACT mutation led to a deletion of the Leu amino acid on residue 593. OPA1 mutations were found in 4 of 10 familial cases (40 %) and in 1 of 35 sporadic cases of optic atrophy. CONCLUSIONS: OPA1 gene mutations are causative in Chinese autosomal-dominant optic atrophy and sporadic optic atrophy. Screening for OPA1 gene mutations in patients with childhood onset optic atrophy who have no affected relatives is useful in making the diagnosis.

Systemic lupus erythematosus-associated optic neuritis: clinical experience and literature review.

PURPOSE: This study aimed to evaluate the visual outcome of optic neuritis in patients with systemic lupus erythematosus (SLE). METHODS: A retrospective, case-observational study was conducted by reviewing eight patients with SLE-associated optic neuritis from January 1986 to October 2004. The demographic data, clinical manifestations, laboratory data, medical management and disease courses of these eight patients were retrospectively analysed. Main outcome measurements included final visual acuity (VA) and relapse of optic neuritis. Statistical analyses were made using the chi-square test and a linear regression model. The English-language literature on SLE-associated optic neuritis was reviewed. RESULTS: Initial visual loss was severe in SLE-associated optic neuritis. Seven patients (87%) had VA < 20/200 at onset. All patients received steroid pulse therapy followed by oral steroid tapering. Final visual outcome was highly variable, ranging from the complete recovery of VA in four patients, to partial recovery in one and poor recovery in three. Better visual recovery occurred in patients who received earlier treatment (within 10 days). However, longer duration of steroid administration was found to have no significant benefit on visual outcome. CONCLUSIONS: Systemic lupus erythematosus-associated optic neuritis is not common. However, it is important that ophthalmologists differentiate SLE-associated optic neuritis from idiopathic optic neuritis because of the severe visual impairment and steroid dependence associated with the former. Early diagnosis and prompt treatment are important for restoring visual function in these patients.

Systemically disseminated extranodal marginal zone B-cell lymphoma of lacrimal gland in a patient with systemic lupus erythematosus.

A 33-year-old woman with systemic lupus erythematosus had bilateral eyelid swelling. On examination, bilateral lacrimal gland mass were palpable. The morphologic and the immunohistochemical features were supportive of the diagnosis of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue-type (MALT lymphoma). Further systemic evaluation revealed she had clinical stage IV disease with bone marrow involvement. She underwent local radiotherapy and several cycles of chemotherapy. However, the patient died of sepsis with the disease after 48 months. Systemically disseminated MALT lymphoma presenting initially in the lacrimal gland of a patient with systemic lupus erythematosus is rare, and the prognosis is poor.

Early relapse in multiple sclerosis-associated optic neuritis following the use of interferon beta-1a in Chinese patients.

PURPOSE: The incidence of multiple sclerosis (MS) is relatively rare in Chinese. The beneficial effect of interferon beta-1a in modifying the disease course of MS has been rarely analyzed in Chinese patients. The aim of this study was to investigate the clinical response to interferon beta1-a in Chinese patients with MS-associated optic neuritis (ON). METHODS: A retrospective case control study was conducted in 20 MS patients with optic nerve involvement. The interferon (IF) group comprised ten patients receiving interferon beta-1a. The noninterferon (NIF) group comprised another ten MS patients with optic nerve involvement who did not receive interferon treatment. The clinical characteristics, laboratory data, management, and disease course were retrospectively analyzed. The main outcomes of the study were the annualized relapse rate (ARR) for MS, and final visual outcome data. RESULTS: The ARR did not differ between the pretreatment period and the posttreatment period within the IF group. There was also no significant decrease of ARR in the IF group when compared with the NIF group. However, we observed an early recurrence of ON in 50% of the IF cases following the use of interferon beta-1a. The final visual outcome did not differ between the IF group and the NIF group. CONCLUSIONS: The use of interferon beta-1a should be carefully monitored because early relapse of ON may complicate the treatment course in this patient group.

Low conversion rate to multiple sclerosis in idiopathic optic neuritis patients in Taiwan.

PURPOSE: To investigate the clinical characteristics of patients with idiopathic optic neuritis (ON) in Taiwan and to assess the conversion rate to multiple sclerosis (MS) in these patients. METHODS: We studied the medical records of a total of 109 patients with a clinical diagnosis of idiopathic ON treated in the Taipei Veterans General Hospital during the period from January 1986 to May 2003. Clinical characteristics, management, and disease courses were retrospectively reviewed. Our main focus was on the development of multiple sclerosis after an ON attack. Univariate and multivariate analyses were used to evaluate the risk indicators for MS conversion. RESULTS: The patients (58 women, 51 men) had a mean age of 41.2 years at onset. ON was retrobulbar in 46.8% of the patients. Management with or without pulse therapy did not affect the final visual outcome. Female sex, retrobulbar type ON, recurrent cases, elevated cerebrospinal fluid (CSF) IgG index, and central nervous system (CNS) imaging abnormalities were identified as risk indicators for the development of MS (P < 0.05). The 2-year cumulative probability of developing MS was 5.92%, and the 5-year cumulative probability was 14.28%. The conversion rate to MS did not differ among treatment groups. CONCLUSIONS: Idiopathic ON patients in Taiwan have an older age at onset and a higher percentage of optic disc edema than reported in previous literature. The characteristic features of ON patients associated with a high risk of developing MS are female sex, retrobulbar type ON, CNS imaging abnormalities, elevated CSF IgG index, and recurrence. Idiopathic ON patients in Taiwan display a significantly lower conversion rate to MS.

Phthiriasis palpebrarum: an unusual blepharoconjunctivitis.

Phthiriasis palpebrarum is an unusual cause of blepharoconjunctivitis and may easily be overlooked because of the failure of physicians to recognize Phthirus pubis. We report a case of a 30-year-old woman with persistent itching in the left eyelid which was unsuccessfully treated under the diagnosis of allergic blepharoconjunctivitis. Careful ophthalmic examination revealed seven bugs with multiple red pinpoint excretions and numerous small translucent oval eggs (nits) coating the eyelashes. The patient was successfully treated with mechanical removal of all the lice and nits from the eyelashes. The specimen proved histopathologically to be the Phthirus pubis infestation. The Phthirus pubis infestation is usually associated with poor hygiene in overcrowded or undeveloped country. However, it may become a notable problem because of frequent traveling and commercial activities across the different countries.