Herpes zoster related hospitalisation after inactivated (CoronaVac) and mRNA (BNT162b2) SARS-CoV-2 vaccination: a self-controlled case series and nested case-control study

BACKGROUND: Stimulation of immunity by vaccination may elicit adverse events. There is currently inconclusive evidence on the relationship between herpes zoster related hospitalization and COVID-19 vaccination. This study aimed to evaluate the effect of inactivated virus (CoronaVac, Sinovac) and mRNA (BNT162b2, BioNTech/Fosun Pharma) COVID-19 vaccine on the risk of herpes zoster related hospitalization. METHODS: Self-controlled case series (SCCS) analysis was conducted using the data from the electronic health records in Hospital Authority and COVID-19 vaccination records in the Department of Health in Hong Kong. We conducted the SCCS analysis including patients with a first primary diagnosis of herpes zoster in the hospital inpatient setting between February 23 and July 31, 2021. A confirmatory analysis by nested case-control method was also conducted. Each herpes zoster case was randomly matched with ten controls according to sex, age, Charlson comorbidity index, and date of hospital admission. Conditional Poisson regression and logistic regression models were used to assess the potential excess rates of herpes zoster after vaccination. FINDINGS: From February 23 to July 31, 2021, a total of 16 and 27 patients were identified with a first primary hospital diagnosis of herpes zoster within 28 days after CoronaVac and BNT162b2 vaccinations. The incidence of herpes zoster was 7.9 (95% Confidence interval [CI]: 5.2–11.5) for CoronaVac and 7.1 (95% CI: 4.1–11.5) for BNT162b2 per 1,000,000 doses administered. In SCCS analysis, CoronaVac vaccination was associated with significantly higher risk of herpes zoster within 14 days after first dose (adjusted incidence rate ratio [aIRR]=2.67, 95% CI: 1.08–6.59) but not in other periods afterwards compared to the baseline period. Regarding BNT162b2 vaccination, a significantly increased risk of herpes zoster was observed after first dose up to 14 days after second dose (0-13 days after first dose: aIRR=5.23, 95% CI: 1.61–17.03; 14–27 days after first dose: aIRR=5.82, 95% CI: 1.62–20.91; 0-13 days after second dose: aIRR=5.14, 95% CI: 1.29–20.47). Using these relative rates, we estimated that there has been an excess of approximately 5 and 7 cases of hospitalization as a result of herpes zoster after every 1,000,000 doses of CoronaVac and BNT162b2 vaccination, respectively. The findings in the nested case control analysis showed similar results. INTERPRETATION: We identified an increased risk of herpes zoster related hospitalization after CoronaVac and BNT162b2 vaccinations. However, the absolute risks of such adverse event after CoronaVac and BNT162b2 vaccinations were very low. In locations where COVID-19 is prevalent, the protective effects on COVID-19 from vaccinations will greatly outweigh the potential side effects of vaccination. FUNDING: The project was funded by Research Grant from the Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (Ref. No.COVID19F01). FTTL (Francisco Tsz Tsun Lai) and ICKW (Ian Chi Kei Wong)’s posts were partly funded by D^{2}4H; hence this work was partly supported by AIR@InnoHK administered by Innovation and Technology Commission

Genome-wide copy number variation study in anorectal malformations

Anorectal malformations (ARMs, congenital obstruction of the anal opening) are among the most common birth defects requiring surgical treatment (2-5/10 000 live-births) and carry significant chronic morbidity. ARMs present either as isolated or as part of the phenotypic spectrum of some chromosomal abnormalities or monogenic syndromes. The etiology is unknown. To assess the genetic contribution to ARMs, we investigated single-nucleotide polymorphisms and copy number variations (CNVs) at genome-wide scale. A total of 363 Han Chinese sporadic ARM patients and 4006 Han Chinese controls were included. Overall, we detected a 1.3-fold significant excess of rare CNVs in patients. Stratification of patients by presence/absence of other congenital anomalies showed that while syndromic ARM patients carried significantly longer rare duplications than controls (P = 0.049), non-syndromic patients were enriched with both rare deletions and duplications when compared with controls (P = 0.00031). Twelve chromosomal aberrations and 114 rare CNVs were observed in patients but not in 868 controls nor 11 943 healthy individuals from the Database of Genomic Variants. Importantly, these aberrations were observed in isolated ARM patients. Gene-based analysis revealed 79 genes interfered by CNVs in patients only. In particular, we identified a de novo DKK4 duplication. DKK4 is a member of the WNT signaling pathway which is involved in the development of the anorectal region. In mice, Wnt disruption results in ARMs. Our data suggest a role for rare CNVs not only in syndromic but also in isolated ARM patients and provide a list of plausible candidate genes for the disorder.postprin

Brain stimulation for late-life depression: a review

The burden of depression in older adults is enormous. Apart from being highly prevalent, late-life depression is associated with significant morbidity and mortality. While pharmacotherapy and psychological interventions remain as the mainstay of treatment, evidence supporting treatment using brain stimulating technologies is emerging. In the current article, the efficacy of four brain stimulating technologies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation as treatment for older adults with depressive disorders is reviewed

Empagliflozin-induced severe osmotic nephrosis and acute renal injury in advanced chronic kidney disease

10.47102/annals-acadmedsg.2020526Annals of the Academy of Medicine, Singapore503255-25

Helping smokers to quit via the Smoke-free Teen Contest 2011: a randomized controlled trial

BACKGROUND: The home is the primary source of SHS exposure. The scientific evidence shows that there is no risk-free level of exposure to SHS that stop smoking is the sole way to completely eliminate the risk of SHS exposure. Although research studies indicated that smoking bans in restaurants, bars, and workplaces can significantly reduce the level of SHS exposure, governments lack the authority to restrict smoking in homes. Therefore, parental cessation is a more effective means to reduce the SHS exposure. AIM: The aims are (1) to promote smoking cessation in the community and (2) assess the effect of different smoking cessation approaches through the Smoke-free Teen Contest. The specific objectives of the study are to test the effectiveness of different smoking cessation approaches on quit rate and change in smoking behaviours among smokers who are referred by Hong Kong Council on Smoking and Health (COSH). METHODS: The referred smokers were nominated by primary 1 to secondary 3 students who joined the Smoke-free Teen Contest organized by COSH. Two domains of outcome will be assessed: (1) the primary outcome is the self-reported 7-day point prevalence (pp) quit rate at 6 months and (2)the secondary outcomes included (i) biochemical validated quit rate at 6 months and (ii) rate of smoking reduction by at least of half and (iii) number of quit attempts at 6 months. Procedure Smokers, who are referred by the Hong Kong Council on Smoking and Health (COSH), were nominated by primary 1 to secondary 3 students joined Smoke-free Teen Contest organized by COSH. Those smokers will be randomized into two groups (Intervention group and Control group) using the clustered randomization method by school. After the clustered randomization, the oral consent of eligible subjects were obtained to the study through telephone interview. Intervention group will receive 1,2,3, 8-week and 6-month telephone follow-up after baseline, while control group will only receive 6-month telephone follow-up after baseline. Those participants who reported to have stopped smoking will be invited for biochemical validation of smoking status at 6-month follow-up. Hypothesis We hypothesize that the intensive telephone counselling plus NRT treatment will lead to significant increases in rates of smoking cessation in the intervention groups than the control group

Sick Chinese school-age children’s behaviours in response to second hand smoke exposure: a qualitative study

Poster Presentation: Theme 4 - Public Health & Chinese Medicine: no. 4.31The 16th Research Postgraduate Symposium, the University of Hong Kong (RPS 2011), Hong Kong, 7-8 December 2011

Genomi-wide association study on anorectal malformations in the Chinese population

Poster Presentation: abstract 2942/TAnorectal malformations (ARM) represent a complex group of congenital diseases characterized by the obstruction of anal opening. Occurring in 1 out of every 4,000 to 5,000 individuals, ARMs are one of the most common pediatric surgical problems. The spectrum of ARMs ranges from anal stenosis to anal atresia/imperforated anus with/without fistula to persistent cloaca. The etiology of ARMs remains unknown, although there is strong evidence for a genetic component. This is indicated by the very early developmental disruption, its recurrence in families and the high concordance of its existence with some abnormalities. Though several candidate genes e.g. endothelin-β receptor (EDNRB) and sonic hedgehog (Shh) were proposed for their potential roles in the development of ARMs, the causes of ARMs still remain unknown. To explore the genetic contribution to the pathogenesis of ARM, we performed systematic analyses of genetic markers, in 176 Chinese patients and 2986 ethnically matched individuals as controls. The genome-wide association study (GWAS) was performed using the Illumina Human 610-Quad BeadChips with 488, 394 SNPs successfully genotyped. An association peak encompassing two gene members of the solute carrier (SLC) family was observed, with p-value= (odds ratio 1.94, 95% CI: 1.54-2.45 for allele C) for the most associated SNP (rs11045422). To confirm the observed association, those statistically significant SNPs will be genotyped in an independent set of cases and controls. Bioinformatics and experimental analysis will be used to study the biological relevance of SLC genes in ARMs.link_to_OA_fulltextThe 60th Annual Meeting of the American Society of Human Genetics (ASHG 2010), Washington D.C., 2-6 November 2010