COVID-19 Vaccination: Public Health Lessons from a Large Indoor Gathering

COVID-19 transmission rates among vaccinated persons attending large gatherings have not been reported widely. This research was intended to track the potential incidence of COVID-19 among physicians and their families who attended a large in-person gathering in Atlanta in August 2021. After the successful conclusion of a large-scale indoor gathering, we encouraged all attendees to self-report the incidence of COVID-19 illness. In addition, an online questionnaire was disseminated to collect basic information about age, gender, place of residence, vaccination status including the number of doses, type, and date of each dose as well as behavioral and convention factors that would have contributed to the infection rates. Information about current COVID-19 infection status, symptoms, and severity were also collected. We also contacted the attendees through telephone to gather pending information about their COVID-19 status, after attending the meeting. Most attendees were physicians, employees in the healthcare industry or family members of healthcare professionals. Among the 520 participants of the meeting, no COVID-19 illness was reported up to six weeks after attending the convention. As a sub-group analysis, we obtained demographic data from 143 attendees, through an online survey. Among the survey respondents, 43% were over the age of 60 years, 10% over the age of 70 years, 29% and 14% each between 31-45 years and 12-30 years. 53% were women. Almost 99% had received both doses of COVID-19 mRNA vaccine in January and February of 2021. Public health measures including the use of indoor masks, social distancing, and personal hygiene were followed by 76%. None of the convention attendees who responded had any symptoms or tested positive for COVID-19 infection six weeks after leaving the convention. None reported being diagnosed with COVID-19 for at least 30 days before attending the convention. This report confirms the efficacy of COVID-19 mRNA vaccines against protection from COVID-19 illness among participants of large scale indoor gatherings. Our findings support the notion that large-scale events can be successfully conducted among fully vaccinated persons who follow public health guidelines

Alterations of Bone Mineral Density, Microarchitecture and Strength in Patients with Ankylosing spondylitis: a Cross-sectional Study using High-resolution Peripheral Quantitative Computerized Tomography

Patients with ankylosing spondylitis (AS) have high fracture risk. BMD, bone microarchitecture and strength determine bone strength. However, the effect of AS on bone microarchitecture and strength is not studied yet. This study aimed to analyze how AS affects bone microarchitecture and strength. Volumetric BMD (vBMD) and microarchitecture were measured using HRpQCT, and bone strength was estimated using finite element analysis. Multivariable linear regression was used to analyze the effect of AS on HRpQCT and FEA parameters. There were 44 AS patients and 85 non-AS subjects. In multivariable linear regression models, AS patients had lower volumetric BMD, cortical thickness, BV/TV and higher cortical porosity and trabecular separation when compared to non-AS controls. FEA parameters such as bone stiffness and stress were also abnormal in AS patients. To conclude, it was found that volumetric BMD, trabecular and cortical microarchitecture as well as FEA parameters were worse in AS patients than non-AS subjects. These abnormalities might partly explain the high fracture risk in patients with AS.M.H.Sc

Juvenile granulosa cell tumor presenting as isosexual precocious puberty: A case report and review of literature

The differential diagnosis for precocious puberty in a young female includes peripheral causes. This case report documents a rare cause of isosexual precocious puberty, a juvenile granulosa cell tumor of the ovary-and a brief literature review. A 7-year-old girl presented with rapid onset of pubertal development and elevated estradiol levels. Abdominal ultrasound revealed a mass in the right adnexa. Other causes of precocious puberty were excluded. Elective surgery was planned, but the patient presented to the emergency room with torsion of ovary. She underwent an exploratory laparotomy for tumor resection and right salpingo oophorectomy. Pathology reported a juvenile granulosa cell tumor of the ovary. Postoperatively, she experienced a cessation of vaginal bleeding and estradiol levels normalized. Early stage disease has good prognosis. Adjuvant chemotherapy is not indicated in this setting

Alterations of bone mineral density, bone microarchitecture and strength in patients with ankylosing spondylitis: a cross-sectional study using high-resolution peripheral quantitative computerized tomography and finite element analysis

Abstract Introduction Ankylosing spondylitis (AS) is an inflammatory disease associated with new bone formation and an increased risk of osteoporosis and fractures. The negative effects of AS on bone microarchitecture and strength are unclear. Thus, we conducted an observational study to analyze the effect of AS on bone microarchitecture and strength. Methods Patients with AS (n = 53) and non-AS subjects (n = 85) were recruited for the study. All subjects underwent clinical evaluation, DXA and high-resolution peripheral quantitative CT scans (HRpQCT). Results The AS patients were aged 44 ± 12 (mean ± standard deviation) years and had a median disease duration of 17 (interquartile range: 7–27) years. They were found to have lower cortical, trabecular and total vBMD at the distal radius and tibia than non-AS subjects on multivariable regression analysis. Cortical parameters such as cortical thickness and porosity, and bone strength parameters such bone stiffness and stress as estimated by finite element analysis (FEA) in AS patients were significantly worse than that of-non-AS subjects. Among patients with AS, male sex, mSASSS greater than zero and HLA-B27 negative status were associated with worse bone microarchitecture. Conclusions Patients with AS have worse bone mineral density, microarchitecture and strength when compared to non-AS subjects. More research is needed to understand the mechanisms underlying bone pathology in AS and to assess the effect of treatments such as TNF inhibitors on bone quality and fracture risk