Association between vaccination status and reported incidence of post-acute COVID-19 symptoms in Israel: a cross-sectional study of patients infected between March 2020 and November 2021

Background: Long COVID is a post-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection syndrome characterised by not recovering for several weeks or months following the acute episode. The effectiveness of COVID-19 vaccines against long-term symptoms of COVID19 is not well understood. We determined whether vaccination was associated with reporting long-term symptoms post-SARS-CoV-2 infection by comparing, among individuals previously infected with SARS-CoV-2, those who were vaccinated to those who were not, in terms of self-reported long-term symptoms. Methods: We invited individuals who were PCR tested for SARS-CoV-2 infection at participating hospitals between March 2020-June 2021 to fill an online questionnaire that included baseline demographics, details of their acute episode and information about symptoms they were currently experiencing. Using binomial regression, we compared vaccinated individuals with those unvaccinated in terms of self-reported symptoms post-acute infection. Results: Of 951 previously infected individuals who filled the survey 637(67%) were vaccinated. The most commonly reported symptoms were; fatigue (22%), headache (20%), weakness (13%), and persistent muscle pain (10%). After adjusting for follow-up time and baseline symptoms, fully vaccinated (2 or more doses) individuals were less likely than unvaccinated individuals to report any of these symptoms by 64%, 54%, 57%, and 68% respectively, (Risk ratios 0.36, 0.46, 0.43, 0.32, p<0.04 in the listed sequence). Conclusions: Vaccination with at least two doses of COVID-19 vaccine was associated with a substantial decrease in reporting the most common post-acute COVID19 symptoms. Our results suggest that, in addition to reducing the risk of acute illness, COVID-19 vaccination may have a protective effect against long COVID.

Kānuka honey for the treatment of herpes simplex labialis within an novel community pharmacy-based network

<p>BACKGROUND Herpes simplex virus infection is common with an estimated global prevalence of over 90%. Of those harbouring the dormant virus, around one third suffer from recurrent episodic reactivation on the vermillion border of the lip, leading to herpes simplex la- bialis (HSL), or a ‘cold sore’. The painful lesions associated with HSL are treated with a range of therapeutic approaches globally, from pharmaceuticals to complementary and alternative medicines (CAM), many of which have a limited or absent evidence base for efficacy and safety. Honey is one such CAM product with growing evidence for efficacy in wound healing, often applied topically for various dermatological ailments and of interest in the management of HSL. Obtaining robust evidence of the efficacy and safety of novel therapies for HSL is a complex and costly undertaking, traditionally requiring large randomised controlled trials (RCT), and as such has been limited to pharmaceutical funded drug development programmes. Given the paucity of high-quality evidence for many CAM therapies there is a clear need for a novel research methodology to overcome the existing barriers and ensure the timely recruitment of participants with an acute episode of HSL and the collection of valid, standardised outcome data at a modest cost. RESEARCH AIMS The primary aim was to investigate the effectiveness, safety and tolerability of a kānuka honey/glycerin cream compared to 5% aciclovir cream in the treatment of HSL. The secondary aim was to establish whether it was feasible to conduct an adequately powered, interventional RCT which includes electronic capture and transmission of data within a New Zealand wide network of community pharmacies, the Pharmacy Research Network (PRN). METHODS A phase III, open label, RCT of adults aged 16 and over presenting to a community pharmacy with an acute episode of HSL was conducted between September 2015 and December 2017. Participants were recruited within 72 hours of the onset of symptoms, and randomly allocated to either the kānuka honey/glycerin formulation or 5% aciclovir cream, to be applied five times daily until skin returned to normal or study day 14, whichever occurred first. All outcome data were collected remotely using a customised digital system. The primary outcome was time taken for skin to return to nor- mal at the site of the HSL lesion, analysed by Kaplan-Meier estimates with 95% Confidence Internal (CI). The PRN was established for the purpose of undertaking this trial. FINDINGS 952 participants with HSL presenting to one of the 76 pharmacies within the PRN were randomised. For the primary outcome variable of time for skin to return to normal, there was no significant difference between kānuka honey/glycerin and 5% aciclovir cream, 9 (95% CI 8 to 9) vs 8 (95% CI 8 to 9) days respectively, Hazard Ratio (HR) (95% CI) 1.06 (0.92 to 1.22) P=0.56. There was no difference between treatments for all secondary outcomes, including healing time to ulceration, healing time from ulceration to resolution, time to resolution of pain, maximal pain, acceptability and adverse events. The PRN was shown to be a robust clinical research infrastructure, able to fully recruit a large-scale randomised trial at fractional cost of traditional models with acceptable recruitment, attrition and deviation rates. CONCLUSION In one of the largest RCTs of a therapy in HSL, there was no evidence of superior effectiveness for either kānuka honey/glycerin or 5% aciclovir cream. This unique, real- world PRN using electronic capture and transmission of data provides a model for future research of CAM in the community setting.</p>

Kānuka honey for the treatment of herpes simplex labialis within an novel community pharmacy-based network

<p>BACKGROUND Herpes simplex virus infection is common with an estimated global prevalence of over 90%. Of those harbouring the dormant virus, around one third suffer from recurrent episodic reactivation on the vermillion border of the lip, leading to herpes simplex la- bialis (HSL), or a ‘cold sore’. The painful lesions associated with HSL are treated with a range of therapeutic approaches globally, from pharmaceuticals to complementary and alternative medicines (CAM), many of which have a limited or absent evidence base for efficacy and safety. Honey is one such CAM product with growing evidence for efficacy in wound healing, often applied topically for various dermatological ailments and of interest in the management of HSL. Obtaining robust evidence of the efficacy and safety of novel therapies for HSL is a complex and costly undertaking, traditionally requiring large randomised controlled trials (RCT), and as such has been limited to pharmaceutical funded drug development programmes. Given the paucity of high-quality evidence for many CAM therapies there is a clear need for a novel research methodology to overcome the existing barriers and ensure the timely recruitment of participants with an acute episode of HSL and the collection of valid, standardised outcome data at a modest cost. RESEARCH AIMS The primary aim was to investigate the effectiveness, safety and tolerability of a kānuka honey/glycerin cream compared to 5% aciclovir cream in the treatment of HSL. The secondary aim was to establish whether it was feasible to conduct an adequately powered, interventional RCT which includes electronic capture and transmission of data within a New Zealand wide network of community pharmacies, the Pharmacy Research Network (PRN). METHODS A phase III, open label, RCT of adults aged 16 and over presenting to a community pharmacy with an acute episode of HSL was conducted between September 2015 and December 2017. Participants were recruited within 72 hours of the onset of symptoms, and randomly allocated to either the kānuka honey/glycerin formulation or 5% aciclovir cream, to be applied five times daily until skin returned to normal or study day 14, whichever occurred first. All outcome data were collected remotely using a customised digital system. The primary outcome was time taken for skin to return to nor- mal at the site of the HSL lesion, analysed by Kaplan-Meier estimates with 95% Confidence Internal (CI). The PRN was established for the purpose of undertaking this trial. FINDINGS 952 participants with HSL presenting to one of the 76 pharmacies within the PRN were randomised. For the primary outcome variable of time for skin to return to normal, there was no significant difference between kānuka honey/glycerin and 5% aciclovir cream, 9 (95% CI 8 to 9) vs 8 (95% CI 8 to 9) days respectively, Hazard Ratio (HR) (95% CI) 1.06 (0.92 to 1.22) P=0.56. There was no difference between treatments for all secondary outcomes, including healing time to ulceration, healing time from ulceration to resolution, time to resolution of pain, maximal pain, acceptability and adverse events. The PRN was shown to be a robust clinical research infrastructure, able to fully recruit a large-scale randomised trial at fractional cost of traditional models with acceptable recruitment, attrition and deviation rates. CONCLUSION In one of the largest RCTs of a therapy in HSL, there was no evidence of superior effectiveness for either kānuka honey/glycerin or 5% aciclovir cream. This unique, real- world PRN using electronic capture and transmission of data provides a model for future research of CAM in the community setting.</p>

Laryngotracheal stenosis: A more common problem in the COVID era

Laryngotracheal stenosis (LTS) is a rare cause of dyspnoea. It is associated with emergency or prolonged intubation and with tracheostomy. It is expected to increase in incidence following the coronavirus 2019 (COVID-19) pandemic, due to the increased numbers of prolonged intensive care admissions. Presentation may be weeks or even years after the acute episode. A variety of symptoms may be present, and include dyspnoea, cough, dysphagia, stridor or voice change. LTS can be confused with commoner respiratory diseases such as asthma. Awareness of the condition is important to facilitate a timely referral to Otolaryngology for diagnosis and management.

An Overview of Postpartum Psychosis

The Postpartum period is characterized by overwhelming emotional, biological, physical, and social changes. It needs significant personal and interpersonal adaptation, especially in primigravida. Pregnant women and their families are colored by the joyful arrival of a new baby in the postpartum period. But also, the mother in the postpartum period can be vulnerable to a range of postpartum psychosis. Postpartum psychosis is one of serious mental disorder that can result in adverse consequences such as suicide. Suicide is rare during the acute episode, but the rate is high later in the mother’s life and first-degree relatives. Psychosis postpartum is frequently under‑diagnosed, it needs early screening and diagnosis to determine the appropriate treatment as a mandatory part of postpartum care.

Cortical function and sensorimotor plasticity predict future low back pain after an acute episode: the UPWaRD prospective cohort study

Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes (UPWaRD) study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N=120) participated in a prospective cohort study with six-month follow-up. Candidate predictors were selected from the neurobiological (e.g. sensorimotor cortical excitability assessed by sensory and motor evoked potentials, Brain Derived Neurotrophic Factor genotype), psychological (e.g. depression and anxiety), symptom-related (e.g. LBP history) and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with presence of low back pain at six months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress and pain catastrophizing were the strongest predictors (R2=0.47) of pain intensity at six months. Older age and higher pain catastrophizing were the strongest predictors (R2=0.30) of disability at six months. When LBP outcome was dichotomised, sensory cortex and corticomotor excitability, BDNF genotype, depression and anxiety, LBP history and baseline pain intensity, accurately discriminated those who did and did not report LBP at six months (c-statistic 0.91). This study identifies novel risk factors for future LBP after an acute episode that can predict an individuals pain intensity and level of disability at six-month follow-up, and accurately discriminate between those who will and will not report LBP at six months.