Showing papers in "QJM: An International Journal of Medicine in 2022"

Does vitamin D supplementation reduce COVID-19 severity?: a systematic review

Abstract: Summary Background The evidence regarding the efficacy of vitamin D supplementation in reducing severity of COVID-19 is still insufficient. This is partially due to the lack of primary robust trial-based data and heterogeneous study designs. Aim This evidence summary, aims to study the effect of vitamin D supplementation on morbidity and mortality in hospitalized COVID-19 patients. Design: Evidence summary of systematic reviews Methods For this study, systematic reviews and meta-analysis published from December 2019 to January 2022 presenting the impact of vitamin D supplementation on COVID-19 severity were screened and selected from PubMed and Google scholar. After initial screening, 10 eligible reviews were identified and quality of included reviews were assessed using AMSTAR and GRADE tools and overlapping among the primary studies used were also assessed. Results The number of primary studies included in the systematic reviews ranged from 3 to 13. Meta-analysis of seven systematic reviews showed strong evidence that vitamin D supplementation reduces the risk of mortality (Odds ratio: 0.48, 95% CI: 0.346–0.664; P < 0.001) in COVID patients. It was also observed that supplementation reduces the need for intensive care (Odds ratio: 0.35; 95%CI: 0.28–0.44; P < 0.001) and mechanical ventilation (Odds ratio: 0.54; 95% CI: 0.411–0.708; P < 0.001) requirement. The findings were robust and reliable as level of heterogeneity was considerably low. However the included studies were of varied quality. Qualitative analysis showed that supplements (oral and IV) are well tolerated, safe and effective in COVID patients. Conclusion The findings of this study show that vitamin D supplementation is effective in reducing the COVID-19 severity. Hence, vitamin D should be recommended as an adjuvant therapy for COVID-19. However, more robust and larger trials are required to substantiate it further.

OUP accepted manuscript

Abstract: To systematically evaluate the associations between glycemic control and short- to long-term outcomes in coronavirus disease 2019 (COVID-19) patients with type 2 diabetes (T2D).A multi-center prospective cohort study including 574 COVID-19 patients with T2D was conducted in Wuhan, China. All patients were followed-up 1 year after hospital discharge using a uniformed questionnaire including self-reported symptoms, and the chronic obstructive pulmonary disease assessment test items.Of the 574 patients, 443 (77.2%) had well-controlled blood glucose. Glycemic control was significantly associated with decreased risk of death [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.10-0.57], intensive care unit admission (OR 0.22, 95% CI 0.10-0.49), invasive mechanical ventilation (OR 0.25, 95% CI 0.08-0.72), disease progression (OR 0.25, 95% CI 0.11-0.55), and composite outcome (OR 0.26, 95% CI 0.14-0.49). The top five long-term sequelae include fatigue (31.5%), sweating (21.2%), chest tightness (15.1%), anxiety (12.2%), myalgia (10.6%) and short breath (6.4%). Glycemic control was associated with decreased risk of respiratory sequelae (OR 0.42, 95% CI 0.18-0.99; P = 0.048).Glycemic control was significantly associated with short-term outcomes in COVID-19 patients with T2D and showed a significant association with long-term respiratory sequelae. The management and control of blood glucose has a positive impact on prognosis of COVID-19.

Myocarditis post SARS-CoV-2 vaccination: a systematic review

Abstract: Abstract Background Variable clinical criteria taken by medical professionals across the world for myocarditis following COVID-19 vaccination along with wide variation in treatment necessitates understanding and reviewing the same. Objectives and Methods A systematic review was conducted to elucidate the clinical findings, laboratory parameters, treatment and outcomes of individuals with Myocarditis after COVID-19 vaccination after registering with PROSPERO. Electronic databases including MEDLINE, EMBASE, PubMed, LitCovid, Scopus, ScienceDirect, Cochrane Library, Google Scholar, Web of Science were searched. Results A total of 85 articles encompassing 2184 patients were analysed. It was a predominantly male (73.4%) and young population (Mean age 25.5 ± 14.2 years) with most having taken an mRNA-based vaccines (99.4%). The mean duration from vaccination to symptom onset was 4.01 ± 6.99 days. Chest pain (90.1%), dyspnoea (25.7%) and fever (11.9%) were the most common symptoms. Only 2.3% had comorbidities. CRP was elevated in 83.3% and cardiac troponin in 97.6% patients. An abnormal ECG was reported in 979/1313 (74.6%) patients with ST-segment elevation being most common (34.9%). Echocardiographic data was available for 1243 patients (56.9%) of whom 288 (23.2%) had reduced left ventricular ejection fraction. NSAIDS (76.5%), steroids (14.1%) followed by colchicine (7.3%) were used for treatment. Only 6 patients died among 1317 of whom data was available. Conclusion Myocarditis following COVID-19 vaccination is often mild, seen more commonly in young healthy males and is followed by rapid recovery with conservative treatment. The emergence of this adverse event calls for harmonizing case definitions and definite treatment guidelines which require wider research.

Short and long-term prognosis of glycemic control in COVID-19 patients with type 2 diabetes

Abstract: Abstract Background and aim To systematically evaluate the associations between glycemic control and short- to long-term outcomes in coronavirus disease 2019 (COVID-19) patients with type 2 diabetes (T2D). Design and methods A multi-center prospective cohort study including 574 COVID-19 patients with T2D were conducted in Wuhan, China. All patients were followed-up 1 year after hospital discharge using a uniformed questionnaire including self-reported symptoms, and the chronic obstructive pulmonary disease (COPD) assessment test (CAT) items. Results Of the 574 patients, 443 (77.2%) had well-controlled blood glucose. Glycemic control was significantly associated with decreased risk of death (OR: 0.24, 95% CI: 0.10-0.57), ICU admission (OR: 0.22, 95% CI: 0.10-0.49), invasive mechanical ventilation (OR: 0.25, 95% CI: 0.08-0.72), disease progression (OR: 0.25, 95% CI: 0.11-0.55), and composite outcome (OR: 0.26, 95% CI: 0.14-0.49). The top five long-term sequelae include fatigue (31.5%), sweating (21.2%), chest tightness (15.1%), anxiety (12.2%), myalgia (10.6%), and short breath (6.4%). Glycemic control was associated with decreased risk of respiratory sequelae (OR: 0.42, 95% CI: 0.18-0.99, P = 0.048). Conclusions Glycemic control was significantly associated with short-term outcomes in COVID-19 patients with T2D, and showed a significant association with long-term respiratory sequelae. The management and control of blood glucose has a positive impact on prognosis of COVID-19.

COVID-19 vaccine-induced encephalitis and status epilepticus

Abstract: Learning points for clinicians Convulsion/seizure may occur infrequently after mRNA-1273 vaccine (Moderna vaccine) administration, with an estimated risk of 285 events per million person-years. We report a rare case of coronavirus disease 2019 vaccine-induced encephalitis and status epilepticus. The patient recovered after pulse corticosteroid therapy administration. Clinicians should be aware of possible neurological complications post-vaccination.

New-onset IgA nephropathy following COVID-19 vaccination

Abstract: Abstract Coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused significant economic and health damage worldwide. Rapid vaccination is one of the key strategies to curb severe illness and death due to SARS-CoV-2 infection. Hundreds of millions of people worldwide have received various COVID-19 vaccines, including mRNA vaccines, inactivated vaccines and adenovirus-vectored vaccines, but the side effects and efficacy of most vaccines have not been extensively studied. Recently, there have been increasing reports of immunoglobulin A nephropathy (IgAN) after COVID-19 vaccination, however, whether their relationship is causal or coincidental remains to be verified. Here, we summarize the latest clinical evidence of IgAN diagnosed by renal biopsy associated with the COVID-19 vaccine published by 10 July 2022 with the largest sample size, and propose a hypothesis for the pathogenesis between them. At the same time, the new opportunity presented by COVID-19 vaccine allows us to explore the mechanism of IgAN recurrence for the first time. Indeed, we recognize that large-scale COVID-19 vaccination has enormous benefits in preventing COVID-19 morbidity and mortality. The purpose of this review is to help guide the clinical assessment and management of IgA nephropathy post-COVID-19 vaccination and to enrich the ‘multi-hit’ theory of IgA nephropathy.

Post-COVID-19 HSV encephalitis: a review

Abstract: Summary Background Herpes simplex virus encephalitis (HSVE) is one of the most common infectious causes of sporadic encephalitis. Coronavirus disease (COVID-19) has been associated with immune dysregulation of the host that might increase the risk of infections like HSVE following SARS-CoV-2 infection. There is paucity of literature on post COVID-19 HSVE. This study was conducted with the aim of analyzing the clinical presentation, brain imaging, and outcome of patients presenting with HSVE within 6 weeks of COVID-19 and providing a comprehensive review on the possible mechanisms of post-COVID-19 HSVE. Methods This observational study included patients who had laboratory-confirmed HSVE (type 1 or type 2) and a history of COVID-19 within the previous 6 weeks. Patients were followed up for 3 months. Results Eight patients were included and all of them had type 1 HSVE. The mean latency of onset of neurological symptoms from being diagnosed with COVID-19 is 23.87 days and a majority of the patients have received injectable steroids with a mean duration of 6.5 days. Behavioral abnormality was the commonest neurological presentation and typical brain imaging involved T2 FLAIR hyperintensities of the medial temporal lobes. All patients received intravenous acyclovir 10 mg/kg every eight hourly for atleast 14 days. One patient with concomitant rhinocerebral mucormycosis succumbed while the majority had a complete recovery. Conclusion Possible immune dysregulation in COVID-19 may increase the susceptibility of HSVE in patients with a history of recent SARS-CoV-2 infection. The clinical manifestations and laboratory findings of HSVE in such patients are similar to typical HSVE.

OUP accepted manuscript

Abstract: Isotonitazene is a novel opioid that was first reported in Europe in 2019. There have been no reports of the detection of isotonitazene in patients presenting to the emergency department with acute drug toxicity.There was an increase in presentations to our emergency department with acute opioid toxicity in August 2021. We aim to describe this outbreak and provide detail on two cases in which isotonitazene was quantified in serum samples.Serum samples were available for comprehensive toxicological analysis for two presentations. Written consent was obtained and the samples were analysed through a Thermo XRS ultrahigh-performance liquid chromatography system, interfaced to a Thermo Q Exactive high-resolution accurate mass spectrometer, operating in heated positive ion electrospray mode. Acquired data were processed using Toxfinder software (Thermo) against a regularly updated in-house database.There was an increase in acute opioid presentations to our emergency department from a median of 10 per month to 36 in August 2021. Twenty were treated with naloxone, and 23 were admitted to the hospital for observation and treatment. Serum sample analysis from two patients with acute opioid toxicity responsive to naloxone detected the presence of isotonitazene (0.18 and 0.81 ng/ml).We report a cluster of acute opioid toxicity presentations to our Emergency Department with detection of isotonitazene in two cases. Analytical screening is important in determining the presence of novel psychoactive substances (NPS) and to help inform the public health of the implications of NPS use, particularly during clusters of acute recreational drug toxicity presentations.

Giant cell arteritis presenting with chronic cough and headache after BNT162b2 mRNA COVID-19 vaccination

Abstract: A 74-year-old Japanese man presented with cough and headache following the Coronavirus disease 2019 (COVID-19) vaccination. Two months before, the day after the third dose of BNT162b2 mRNA COVID-19 vaccination, he presented with a left temporal headache. One month ago, he developed a right temporal headache and cough. His medical history revealed hypertension, for which he was prescribed amlodipine (2.5mg/ day). Physical examination was unremarkable. Auscultation and chest radiograph were normal. His C-reactive protein (6.32mg/dl) levels and erythrocyte sedimentation rate (79mm/ h) were elevated. Neck and chest contrast-enhanced computed tomography (CT) showed no abnormalities of the lung, thoracic aorta, its branches or pulmonary arteries. Positron emission tomography/CT (PET/CT) showed hyperaccumulation in the thoracic aorta, subclavian, axillary, brachial and temporal arteries (Figure 1a and b). Giant cell arteritis (GCA) was diag-nosed. Symptoms improved with oral administration of pred-nisolone (30mg/day). GCA is the most common form of vasculitis in older adults, affecting people > 50years of age. 1 Common symptoms of GCA include headache, scalp tenderness, jaw claudi-cation, ocular ischemic manifestations and inflammatory arthralgia. 1 Cough is a rare initial manifestation of GCA and is often overlooked. 2 The mechanism of cough formation is unclear; however, inflammation of the artery adjacent to the cough reflex pathway is thought to cause cough. 3 GCA patho-physiology is not fully understood but environmental factors and infections are likely to play a role. 4 Additionally, it has been reported that GCA can occur after influenza vaccination and COVID-19 vaccination, which could act as an inflammatory trigger. 5 With advances in

OUP accepted manuscript

Abstract: Abstract The COVID-19 pandemic has caused significant morbidity and mortality worldwide. As with many other infectious diseases in history, the vaccination programme has been successful in helping offer a much welcomed control measure over the pandemic and can reduce the severity of illness in those subsequently infected. Minor side effects are common whereas serious adverse effects are fortunately rare. We describe a case of eosinophilic pneumonia following COVID-19 vaccination. The patient presented with symptoms which were almost identical to that of acute COVID-19 infection.

Isotonitazene, a novel psychoactive substance opioid, detected in two cases following a local surge in opioid overdoses.

Abstract: BACKGROUND Isotonitazene is a novel opioid that was first reported in Europe in 2019. There have been no reports of the detection of isotonitazene in patients presenting to the emergency department with acute drug toxicity. AIM There was an increase in presentations to our emergency department with acute opioid toxicity in August 2021. We aim to describe this outbreak and provide detail on two cases in which isotonitazene was quantified in serum samples. METHODS Serum samples were available for comprehensive toxicological analysis for two presentations. Written consent was obtained and the samples were analysed through a Thermo XRS ultrahigh-performance liquid chromatography system, interfaced to a Thermo Q Exactive high-resolution accurate mass spectrometer, operating in heated positive ion electrospray mode. Acquired data were processed using Toxfinder software (Thermo) against a regularly updated in-house database. RESULTS There was an increase in acute opioid presentations to our emergency department from a median of 10 per month to 36 in August 2021. Twenty were treated with naloxone and 23 admitted to hospital for observation and treatment. Serum sample analysis from two patients with acute opioid toxicity responsive to naloxone detected presence of isotonitazene (0.18 and 0.81 ng/mL). CONCLUSION We report a cluster of acute opioid toxicity presentations to our Emergency Department with detection of isotonitazene in two cases. Analytical screening is important in determining the presence of novel psychoactive substances (NPS) and to help inform the public health of the implications of NPS use, particularly during clusters of acute recreational drug toxicity presentations.

Predictors of in-hospital mortality in HIV-infected patients with COVID-19.

Abstract: BACKGROUND Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with HIV (PWH) with COVID-19 is under debate. METHODS Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list. RESULTS A total of 117,694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs 66.5 years-old; p < 0.001) and more frequently male (74.8% vs 56.6%; p < 0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia, cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs 4.4%; p < 0.001). In-hospital mortality was lower in PWH (9.4% vs 16%; p = 0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (RR: 7.6) were the major determinants of death in PWH hospitalized with COVID-19. CONCLUSION HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.

Minimal change glomerulonephritis following the second dose of the Moderna COVID-19 vaccine

Abstract: mRNA-based coronavirus disease 2019 vaccines may cause de novo or relapsing glomerulonephritis, including minimal change disease. Clinicians should be aware of the various potential renal complications after vaccination.

The global burden of sudden infant death syndrome from 1990 to 2019: A systematic analysis from the Global Burden of Disease Study 2019.

Abstract: BACKGROUND Sudden infant death syndrome (SIDS) still remains one of the leading causes of infant death worldwide, especially in high-income countries. To date, however, there is no detailed information on the global health burden of SIDS. AIMS To characterize the global disease burden of SIDS and its trends from 1990 to 2019 and to compare the burden of SIDS according to the socio-demographic index (SDI). DESIGN Systematic analysis based on the Global Burden of Disease (GBD) 2019 data. METHODS Epidemiological data of 204 countries from 1990 to 2019 were collected via various methods including civil registration and vital statistics in the original GBD study. Estimates for mortality and disease burden of SIDS were modelled. Crude mortality and mortality rates per 100,000 population were analyzed. Disability-adjusted life years (DALYs) and DALY rates were also assessed. RESULTS In 2019, mortality rate of SIDS accounted for 20.98 [95% Uncertainty Interval (UI), 9.15 to 46.16] globally, which was a 51% decrease from 1990. SIDS was most prevalent in Western sub-Saharan Africa, High-income North America and Oceania in 2019. The burden of SIDS was higher in males than females consistently from 1990 to 2019. Higher SDI and income level was associated with lower burden of SIDS; further, countries with higher SDI and income had greater decreases in SIDS burden from 1990 to 2019. CONCLUSIONS The burden of SIDS has decreased drastically from 1990 to 2019. However, the improvements have occurred disproportionately between regions and SDI levels. Focused preventive efforts in under-resourced populations are needed.

Optic Nerve Sheath Diameter, Intensive Care Unit admission & COVID-19-Related-In-hospital Mortality

Abstract: Abstract Background Hypoxia and hypercapnia due to acute pulmonary failure in patients with coronavirus disease 2019 (COVID-19) can increase the intracranial pressure (ICP). ICP correlated with the optic nerve sheath diameter (ONSD) on ultrasonography and is associated with a poor prognosis. Aim We investigated the capability of ONSD measured during admission to the intensive care unit (ICU) in patients with critical COVID-19 in predicting in-hospital mortality. Methods A total of 91 patients enrolled in the study were divided into two groups: survivor (n = 48) and nonsurvivor (n = 43) groups. ONSD was measured by ultrasonography within the first 3 h of ICU admission. Results The median ONSD was higher in the nonsurvivor group than in the survivor group (5.95 mm vs. 4.15 mm, p < 0.001). The multivariate Cox proportional hazard regression analysis between ONSD and in-hospital mortality (contains 26 covariates) was significant (adjusted hazard ratio, 4.12; 95% confidence interval, 1.46–11.55; p = 0.007). The ONSD cutoff for predicting mortality during ICU admission was 5 mm (area under the curve, 0.985; sensitivity, 98%; and specificity, 90%). The median survival of patients with ONSD >5 mm (43%; n = 39) was lower than those with ONSD ≤ 5 mm (57%; n = 52) (11.5 days vs 13.2 days; log-rank test p = 0.001). Conclusions ONSD ultrasonography during ICU admission may be an important, cheap, and easy-to-apply method that can be used to predict mortality in the early period in patients with critical COVID-19.

Potential Mechanisms for Lung Fibrosis Associated with COVID-19 Infection.

Abstract: Pulmonary fibrosis is a sequalae of SARS-CoV-2 infection that currently lacks effective preventative or therapeutic measures. Post-viral lung fibrosis due to SARS-CoV-2 has been shown to be progressive on selected patients using imaging studies. Persistent infiltration of macrophages and monocytes, a main feature of SARS-CoV-2 pulmonary fibrosis, and long-lived circulating inflammatory monocytes might be driving factors promoting the profibrotic milieu in the lung. The upstream signal (s) that regulates the presence of these immune cells (despite complete viral clearance) remains to be explored. Current data indicate that much of the stimulating signals are localized in the lungs. However, an ongoing low-grade systemic inflammation in long COVID-19 symptoms suggests that certain non-pulmonary regulators such as epigenetic changes in hematopoietic stem cells might be critical to the chronic inflammatory response. Since nearly one-third of the world population have been infected, a timely understanding of the underlying pathogenesis leading to tissue remodeling is required. Herein, we review the potential pathogenic mechanisms driving lung fibrosis following SARS-CoV-2 infection based upon available studies and our preliminary findings.

OUP accepted manuscript

Abstract: Summary Background Previous studies have reported differing clinical outcomes among hospitalized heart failure (HF) patients admitted under cardiology and general medicine (GM) without consideration of patients’ frailty. Aims To explore outcomes in patients admitted under the two specialities after taking into account their frailty and other characteristics. Methods This retrospective study included all HF patients ≥18 years admitted between 1 January 2013 and 31 December 2019 at two Australian tertiary hospitals. Frailty was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥ 5 were classified as frail. Propensity score matching (PSM) was used to match 11 variables between the two specialities. The primary outcomes included the days-alive-and-out-of-hospital (DAOH90) at 90 days of discharge, 30-day mortality and readmissions. Results Of 4913 HF patients, mean age 76.2 (14.1) years, 51% males, 2653 (54%) were admitted under cardiology compared to 2260 (46%) under GM. Patients admitted under GM were more likely to be older females, with a higher Charlson index and poor renal function than those admitted under cardiology. Overall, 23.8% patients were frail and frail patients were more likely to be admitted under GM than cardiology (33.6% vs. 15.3%, P &lt; 0.001). PSM created 1532 well-matched patients in each group. After PSM, the DAOH90 was not significantly different among patients admitted in GM when compared to cardiology (coefficient −5.36, 95% confidence interval −11.73 to 1.01, P = 0.099). Other clinical outcomes were also similar between the two specialities. Conclusions Clinical characteristics of HF patients differ between GM and cardiology; however, clinical outcomes were not significantly different after taking into account frailty and other variables.

Do Medical Algorithms always Benefit the Patient? - A Patient Perspective.

Abstract: As a retired physician, I have been wrestling with longer-term cardiorespiratory complications of COVID-19.1 The central chest pain with neck radiation that I experienced after COVID-19 infection in 2020 was similar, but of less intensity to the angina that I had experienced prior to myocardial infarction and subsequent coronary artery stenting some years previously.2 In the wake of contracting COVID-19 again in 2021, I underwent extensive investigation including further coronary angiography. This revealed clear stents and a lessening of distal coronary artery plaques, since I had been started on evolucumab, a proprotein convertase subtilisin/kexin type 9 inhibitor for my dyslipidemia.3 However, in the absence of new coronary artery disease, further imaging (cardiac magnetic resonance imaging) highlighted small vessel disease of the heart, which with continued vasodilators eventually resolved symptomatically over a period of 6 months or so. Seven days after a recent COVID-19 vaccine booster (Moderna), my chest pain returned quite suddenly, but basically in the same pattern as before. My consultant cardiologist (whom I texted) advised phoning for an ambulance, as I was breathless. Of course, I knew that this was likely to be related to the previous small vessel cardiac involvement, or related to my COVID-19 booster in some way, rather than large vessel coronary artery disease, but ST elevation on the paramedics’ electrocardiogram (ECG) monitor drove the algorithm for my transfer to the local heart attack center.

Factors associated with depression in residents in the post-epidemic era

Abstract: Summary Objective To explore the factors associated with depression in residents in the post-epidemic era of COVID-19. Methods A multi-stage stratified random sampling method was used to conduct a questionnaire survey among community residents through self-designed questionnaires and self-rating depression scale (SDS). Multivariate logistic regression analysis was performed on the influencing factors of depressive symptoms. Results A total of 1993 residues completed the survey of depression status. The incidence of depressive symptoms was 27.04%. The multivariate logistic regression analysis showed that female (odds ratio (OR): 6.239, 95% confidence interval (CI): 2.743–10.698), body mass index (BMI) > 24 (OR: 2.684, 95% CI: 1.059–3.759) and drinking (OR: 1.730, 95% CI: 1.480–3.153) were the risk factors for developing depressive symptoms. Married (OR: 0.417, 95% CI: 0.240–0.652), monthly income (3001–5000 yuan, OR: 0.624, 95% CI: 0.280–0.756; >5000 yuan, OR: 0.348, 95% CI: 0.117–0.625), ordinary residents (OR: 0.722, 95% CI: 0.248–0.924) and urban residents (OR: 0.655, 95% CI: 0.394–0.829) were the protective factors of depressive symptoms. Conclusions Under the post-epidemic era of COVID-19, depressive symptoms are still common among community residents in China. Gender, BMI, drinking, marriage, monthly income and nature of personnel and residential area are associated with the incidence of depressive symptoms.

Eosinophilic pneumonia and COVID-19 vaccination

Abstract: The COVID-19 pandemic has caused significant morbidity and mortality worldwide. As with many other infectious diseases in history, the vaccination programme has been successful in helping offer a much welcomed control measure over the pandemic and can reduce the severity of illness in those subsequently infected. Minor side effects are common whereas serious adverse effects are fortunately rare. We describe a case of eosinophilic pneumonia following COVID-19 vaccination. The patient presented with symptoms which were almost identical to that of acute COVID-19 infection.

Low incidence of neurological recurrent side-effects following COVID-19 reimmunization.

Abstract: BACKGROUND Individuals who suffered a neurological adverse event after COVID-19 vaccine could hesitate and defer reimmunization. AIM We examine the risk of recurrence following reimmunization among patients who developed a neurological event after first dose of COVID-19 mRNA vaccine. DESIGN Observational study. METHODS Individuals who developed an adjudicated neurological adverse event (based on Brighton Collaboration criteria) within 6 weeks of first dose of COVID-19 vaccine requiring hospitalization were enrolled into a multi-center national registry in Singapore. Neurological recurrence, defined by development of another neurological event within 6 weeks of second vaccine dose, was reviewed. Clinical characteristics were compared between patients who chose to proceed or withhold further vaccination, and between those who received timely (3-6 weeks) or delayed (>6 weeks) reimmunization. RESULTS From 235 patients (median age, 67 years; 63% men) who developed an adjudicated neurological event after their first dose of mRNA vaccine between 30 December 2020 and 20 April 2021, 181 (77%) chose to undergo reimmunization. Those who decided against reimmunization were older (median age, 74 vs 66 years) and had greater physical disability following their primary neurological event (46% vs 20%, p < 0.001). Patients who suffered greater physical disability were 3 times more likely to delay their reimmunization (odds ratio 3.36, 95% CI: 1.76-6.40). Neurological recurrence was observed in only 4 individuals (3 with seizures and 1 with myasthenia gravis exacerbation). CONCLUSION A prior neurological event should not necessarily preclude reimmunization and the decision to proceed with reimmunization should consider the overwhelming benefits conferred by vaccination towards ending this pandemic.