Vaccinating with a COVID-19 Vaccine: Experience of the Tertiary Allergology Center

Background: Allergic reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but detailed descriptions and further actions are not well characterized. Objective: To describe the symptoms of possible allergic reactions after the mRNA COVID-19 vaccine and outcomes of further vaccination. Methods: We descriptively analyzed data of adult (≥18 years of age) patients, who were sent for vaccination to our outpatient center for the Diagnostics and Treatment of Allergic and Immune diseases. All patients were vaccinated with the Pfizer–BioNTech Comirnaty® vaccine.Results: From January 2021 to July 2021 twenty-two patients were vaccinated in our center. Six patients experienced a reaction after the first Comirnaty® dose in different vaccination centers. The majority of them complained of various types of rashes after the first dose, one case was consistent with anaphylaxis. The latter patient was tested with the skin prick using Pfizer–BioNTech Comirnaty® vaccine and the test was negative. Other sixteen patients were vaccinated in our center from the first dose because of past allergic reactions to other medication or due to concomitant mast cell disorder. All patients were vaccinated without any immediate adverse reactions.Conclusions: None of our patients experienced repeated cutaneous reactions after the second dose. Patients with previous anaphylaxis or mastocytosis also were safely vaccinated.

Outcomes of a Single-Segment Intrastromal Corneal Ring in Early Keratoconus Versus Early Pellucid Marginal Degeneration

Purpose: To determine the effect of a single-segment intrastromal corneal ring segment (ICRS;Intacs-SK) on early keratoconus (KCN) or pellucid marginal degeneration (PMD).Methods: It is a prospective interventional study. One-hundred-twenty-four eyes (99 patients) with KCN and 36 eyes (26 patients) with PMD at early stage (the maximum keratometric reading less than 55 diopters) were included to ICRS implantation using femtosecond laser at a tertiary university-based hospital and a private outpatient center. The uncorrected distance and spectacle-corrected visual acuity (UDVA and SCDVA), manifest spherical and cylindrical refractions, and keratometry indices were measured preoperatively and postoperatively, 1 week, 2 and 6 months.Results: One week after surgery, significant improvements were observed in UDVA, SCDVA, cylinder and keratometry readings of both KCN and PMD groups (all P<0.05) with no significant changes afterwards. No significant change occurred in the sphere refraction of PMD group (P=0.10) in contrast to KCN group (P<0.001). Corneal irregularity of KCN group in central 3 and 5 mm zones increased at 1 week (both P<0.001) and then continued to decrease up to 6 months. However, the corneal irregularity of PMD group had significant reduction only at 1 week in 5-mm zone (P=0.02) and 2 months in 3-mm zone (P=0.01) postoperatively. The final efficacy indexes were 1.44±0.71 and 0.87±0.40 in KCN and PMD groups, respectively. Conclusion: Visual acuity and keratometry values reached stability at 1 week, after one-segment Intacs-SK implantation in KCN and PMD groups. The short-term efficacy of the procedure was more in early KCN compared to early PMD.

POS1254 INCIDENCE AND OUTCOME OF COVID-19 IN ROUTINE RHEUMATOLOGY CARE: DATA FROM A SINGLE OUTPATIENT CENTER IN GERMANY

Background:Coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and its associated disease COVID-19 (Corona Virus Disease 2019) has become a worldwide pandemic since its first cases in December 2019 in Wuhan Province in China. Until now little is known about the incidence and the course of the disease in a routine setting of rheumatology outpatient care.Objectives:Aim of the study was to identify cases with COVID-19, to analyse course and outcome of the disease and the potential role of antirheumatic medication.Methods:On the occasion of a routine follow-up examination all consecutive patients of our rheumatology outpatient center were questioned about the history of established COVID-19, about typical symptoms or about contacts with patients in the period from March to the end of December 2020. Diagnostic work-up (results of PCR or antibody testing, imaging) was documented. Antibody ELISA-tests (IgG, IgA, IgM, Euroimmun) were performed in patients reporting typical signs and symptoms. Course and outcome of COVID-19 were divided in 5 groups (mild, moderate, severe, most severe, and lethal).Results:About 2.000 patients were screened. Positive findings for SARS-CoV-2 confirmed by PCR or serological testing were detected in n=33/2000 (1.65%) patients (n=14/33 (43%) rheumatoid arthritis (RA), n=8/33 (24%) psoriatic arthritis (PsA), n=7/33 (21%) spondyloarthritis (SpA), n=4/33 (12%) other diseases).No patient died and no patient required intensive care or invasive mechanical ventilation. N=2/33 patients (6%) suffered a severe course with hospitalization, one of these required intermittent oxygen administration. Both patients had no ongoing therapy with disease modifying antirheumatic drugs (DMARDs). One patient suffered from SpA, one patient from RA. Both patients had relevant comorbidities with chronic lung disease and breast cancer.Symptoms were absent or mild in n=21/33 (64%) patients, moderate in n=10/33 (30%). N=22/31 (71%) of patients with absent, mild or moderate symptoms were treated at least with one DMARD.Conclusion:For an at-risk population, the incidence of COVID-19 was unexpectedly low. Overall, patients had a mild course despite immunosuppressive therapy. This finding is consistent with published data from a single university center (1) and other university outpatient clinics (2). Possibly DMARD-therapy may protect against the occurrence of cytokine storm and vasculitic complications, which lead to severe courses and lethal outcomes in some of the patients. The data support the recommendation not to discontinue DMARDs for fear of COVID-19.References:[1]Simon D et al. Patients with immune-mediated inflammatory diseases receiving cytokine inhibitors have low prevalence of SARS-CoV-2 seroconversion. Nat Commun. 2020 Jul 24;11(1):3774. doi: 10.1038/s41467-020-17703-6. PMID: 32709909; PMCID: PMC7382482.[2]Gianfrancesco M et al. COVID-19 Global Rheumatology Alliance. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020 Jul;79(7):859-866. doi: 10.1136/annrheumdis-2020-217871. Epub 2020 May 29. PMID: 32471903; PMCID: PMC7299648.Disclosure of Interests:None declared

Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine

Background Integrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain conditions. The COVID-19 pandemic prompted rapid implementation of telehealth services. Objective We present outcomes of a complete and rapid transition to telehealth visits at an outpatient integrative medicine center in the Southeastern United States. Method Patients and administrative staff took surveys comparing telehealth to in-person visits within four weeks of our clinic's transition to telehealth and three months later. Beginning four weeks after the clinic’s telehealth conversion in March 2020, patients who had a telehealth visit at the center completed a survey about their telehealth experience and another survey three months later. Results Patient quality judgements significantly favored telehealth at baseline, B = .77 [0.29 – 1.25], SE = .25, t(712) = 3.15, p = .002, and increased at three months, B = .27 [–0.03 – 0.57], SE = .15, t(712) = 1.76, p = .079. Telehealth technology usability and distance from the center predicted patient ratings of telehealth favorability. Providers favored in-person visits more than patients, B = –1.00 [–1.56 – –0.44], SE = .29, t(799) = –3.48, p < .001, though did not favor either in-person or telehealth more than the other. Patient discrete choice between telehealth and in-person visits was split at baseline (in-person: n = 86 [54%]; telehealth: n = 73 [46%]), but favored telehealth at three months (in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete choice favored telehealth at follow-up across providers and patients, OR = 2.69 [.1.18 – 6.14], z = 2.36, p = .018. Major qualitative themes highlight telehealth as acceptable and convenient, with some challenges including technological issues. Some felt a loss of interpersonal connection during telehealth visits, while others felt the opposite. Conclusion We report converging mixed-method data on the successful and sustained implementation of telehealth with associated policy and clinical implications during and beyond the COVID-19 pandemic.

Barriers to and Facilitators of Physical Activity among Korean Female Adults with Knee Osteoarthritis and Comorbidity: A Qualitative Study

When knee osteoarthritis is combined with comorbidity, it is associated with limited physical activity. This study aimed to identify barriers to and facilitators of physical activity among Korean female adults with knee osteoarthritis and comorbidity, such as hypertension, diabetes, and dyslipidemia. A qualitative content analysis study was conducted. Ten female knee osteoarthritis participants with comorbidity were recruited at an orthopedic outpatient center in South Korea. Data were collected using in-depth interviews and were analyzed using a conventional content analysis method. Ten participants with a mean age of 70.7 years participated in this study. Four categories of barriers and three of facilitators were identified. Barriers to physical activity were physical hardships, lack of motivation, environmental restrictions, and lack of knowledge. Categories of facilitators were pain management, self-control in physical activity, and understanding the importance of physical activity. Participants did not express any social or environmental facilitators of physical exercise. Healthcare professionals should include social support and environmental facilities to achieve medical and institutional compliance. Understanding female adults with knee osteoarthritis and comorbidity would support provision of appropriately tailored interventions that account for the characteristics of the comorbidity.

Cross Validation of the Prodromal Questionnaire 16-Item Version in an Adolescent Help-Seeking Population

The Prodromal Questionnaire 16-item version (PQ-16) is used as a screener in the early detection of psychosis. We wished to cross-validate it in a help-seeking population of adolescents aged 12–17 who had been referred for assessment and treatment to an outpatient Center for Child and Adolescence Psychiatry (CCAP). To examine the psychometric properties of the PQ-16 for adolescents, we used reliability analysis and receiver-operating-characteristic (ROC) curves. The internal consistency of the 16-item version was good, with Chronbach’s α = 0.84. A cutoff of 7 or more items marked as true, showed acceptable sensitivity (.77) and specificity (.55). Half (51.3%) of the above cutoff sample were classified by the Comprehensive Assessment of At-Risk Mental States (CAARMS) assessment as having Ultra-High Risk (UHR) status or as having reached the psychosis threshold. Differentiation between boys and girls showed that the use of distress scores improved sensitivity and specificity values for girls but worsened them for boys. When a cutoff score of 7 or more items marked as true is used, the PQ-16 is a feasible instrument with acceptable screening properties for UHR and psychosis in boys and girls aged 12–17 attending a CCAP.

Experiences of violence at school from the stuttering patients’ perspective

ABSTRACT Purpose: to characterize school-aged patients with persistent stuttering regarding their self-reported experiences of violence at school. Methods: the sample comprised 10 patients with persistent stuttering, 10 to 17 years old, regardless of their sex and stuttering characteristics, who received care at a fluency outpatient center in the heart of São Paulo State, Brazil. The collection instrument was an 11-question, multiple-choice, self-administered questionnaire. The data were descriptively analyzed based on the frequency of the answers. Results: almost half of the stuttering patients reported suffering bullying, in which they were given nicknames, defamed, blamed for everything that happened, physically attacked, and mocked. The classroom was the most mentioned environment where bullying took place. The following reactions to violence were mentioned: “talking to friends, teachers/principals, and relatives”, “sadness”, and “desire to change schools”. Conclusion: despite the small sample size, it was possible to note alarming data and the importance of educative/preventive actions in the school environment, approaching both bullying and stuttering.