Guillain-Barré syndrome after COVID-19 vaccination: A systematic review and analysis of case reports

INTRODUCTION

Cases of Guillain-Barré Syndrome (GBS) have been believed to be associated with the novel COVID-19 infection, and also with the following vaccines developed against the infection. Our work aims to investigate the incidence of GBS after COVID-19 vaccination, and describe its clinical characteristics and potential confounders.

METHODS

An electronic search was conducted through four databases: PubMed, Scopus, medRxiv, and Google Scholar for all case reports and case series describing after COVID-19 vaccine administration. All published articles from inception until November 1st, 2022 were included. Differences between groups were assessed using Pearson chi-square test. Modified Erasmus GBS Outcome Score (mEGOS) for the ability to walk after GBS was calculated for all cases with sufficient clinical data, and Kaplan-Meier survival analysis was performed to study the effect of vaccine type on the relationship between vaccination time and complication of GBS.

RESULTS

About 103 studies describing 175 cases of GBS following COVID-19 vaccination were included. The Acute Inflammatory Demyelinating Polyradiculoneuropathy subtype was the most reported subtype with 74 cases (42.29%). The affected age group averaged around 53.59 ±18.83 years, with AMSAN occurring in a rather older group (63.88 ±20.87 years, p=0.049). The AstraZeneca vaccine was associated with AIDP (n=38, 21.71%) more than other vaccines, p=0.02. The bilateral facial palsy subtype was mostly linked to adenoviral vector vaccinations, accounting for an average of 72% of the total BFP cases. Dysesthesias was the most reported sensory complication (60%, p=0.349). Most GBS patients survived (96%, p=0.036), however, most patients had low mEGOS scores (4 ±3.57, p<0.01). On average, patients developed GBS at 13.43 ±11.45 days from vaccination (p=0.73), and survival analysis for complication of GBS into mechanical ventilation or walking impairment yielded a severely increased probability of complication after 25 days (p<0.01). Intravenous immunoglobulins (p=0.03) along with rehabilitation (p=0.19) were the most commonly used treatment.

CONCLUSION

This work investigates the incidence of Guillain-Barré Syndrome after COVID-19 vaccination. Most cases occurred after receiving the AstraZeneca or Pfizer vaccines, and despite low mortality rates, ambulation was compromised in most patients. A higher risk of GBS complication is associated with an onset later than 12-13 days, particularly with Pfizer, AstraZeneca, and Moderna vaccines. No specific predisposing or prognostic factor was identified, and the relation between the COVID-19 vaccines and GBS remain unclear.

Systematic Review on the Efficacy, Effectiveness, Safety, and Immunogenicity of Monkeypox Vaccine

BACKGROUND

The variation in the reported vaccine safety and effectiveness could contribute to the high rates of vaccine hesitancy among the general population and healthcare workers in areas where monkeypox (mpox) is circulating. In this review, our objective was to evaluate the safety, immunogenicity, effectiveness, and efficacy of the mpox vaccines.

METHODS

An extensive search for articles across multiple databases was performed, including searching six databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Cochrane, ProQuest), two pre-print databases (European PMC Preprint and MedRxiv), and Google Scholar.

RESULTS

A total of 4290 citations were retrieved from the included databases. Following the removal of duplicates and the initial screening of records, a total of 36 studies were included into the analysis. Additionally, we identified five more studies through manual searches, resulting in a total of 41 eligible articles for qualitative synthesis. The study findings revealed that mpox vaccines demonstrate the ability to generate adequate antibodies; however, their effectiveness may decrease over time, exhibiting varying safety profiles. Most of the included studies consistently reported substantial levels of effectiveness and efficacy against mpox. Interestingly, the number of vaccine doses administered was found to influence the degree of immunogenicity, subsequently impacting the overall effectiveness and efficacy of the vaccines. Furthermore, we found that smallpox vaccines exhibited a form of cross-protection against mpox.

CONCLUSIONS

Vaccines can be used to prevent mpox and effectively control its spread.

Using chitosan nanoparticles and N-acetyl thiazolidine 4-carboxylic acid for olive trees efficiency raising, improving fruits properties and oil quality

Recently exposure of olive trees to many stresses particularly oil varieties led to decline in the olive yield. The target of the study is to improve vegetative growth and increase olive fruits quality as well as the fruit oil % and oil quality by applying chitosan nanoparticles (CHNPs) and N-acetyl thiazolidine 4-carboxylic acid (N-ATCA) under the conditions of Egypt. The experiment was carried out in the seasons of 2021 and 2022 on Arbosana olive trees 8 years old and 4×6 m apart the trees sprayed three times on 15th Sept., 1st Oct. and 15th Oct. with (CHNPs at 500, 1000 and 1500 ppm), (N-ATCA at 50, 100 and 150 ppm) and a combination between them and evaluate the vegetative growth of trees, fruit physiochemical characteristics, and oil properties during both study seasons. The application of CHNPs and N-ATCA and a combination of them led to increasing leaf area, total chlorophyll and proline content also increment fruit weight, flesh weight, oil color and oil % moreover improving the quality of produced oil. The improvement in growth, fruit quality, oil % and oil quality, were associated with increasing concentrations of CHNPs, N-ATCA and a combination of them especially (CHNPs at 1500 ppm + N-ATCA at 100 ppm and CHNPs at 1500 ppm + N-ATCA at 150 ppm). Spraying (CHNPs at 1500 ppm + N-ATCA at 150 ppm) is recommended to improve the tree growth, fruit quality, oil % and quality of Arbosana olive.

How can imported monkeypox break the borders? A rapid systematic review

BACKGROUND

Monkeypox was designated as an emerging illness in 2018 by the World Health Organization Research and Development Blueprint, necessitating expedited research, development, and public health action. In this review, we aim to shed the light on the imported cases of monkeypox in attempt to prevent the further spread of the disease. Methodology An electronic search in the relevant database (Web of Science, PubMed Medline, PubMed Central, Google scholar, and Embase) was conducted to identify eligible articles. In addition to searching the grey literature, manual searching was carried out using the reference chain approach.

RESULTS

A total of 1886 articles were retrieved using the search strategy with 21 studies included in the systematic review. A total of 113 cases of imported monkeypox were confirmed worldwide. Nineteen patients mentioned a travel history from Nigeria, thirty-eight infected cases had travel destinations from Europe, fifty-four cases traveled from European countries such as; Spain, France, and the Netherlands, one case from Portugal, and another one from the United Kingdom (UK). All reported clades of the virus were West African clade. Nine studies showed the source of infection was sexual contact, especially with male partners. Six studies mentioned the cause of infection was contact with an individual with monkeypox symptoms. Two studies considered cases due to acquired nosocomial infection. Ingestion of barbecued bushmeat was the source of infection in three studies and rodent carcasses were the source of infection in the other two studies.

CONCLUSION

The development of functioning surveillance systems and point-of-entry screening is essential for worldwide health security. This necessitates ongoing training of front-line health professionals to ensure that imported monkeypox is properly diagnosed and managed. In addition, implementing effective health communication about monkeypox prevention and control is mandatory to help individuals to make informed decisions to protect their own and their communities' health.

GATA3 rs3824662 gene polymorphism as possible risk factor for systemic lupus erythematosus

Background

There is no report about the association between GATA3 rs3824662 polymorphism and systemic lupus erythematosus (SLE).

Objective

To investigate the possible role of GATA3 rs3824662 polymorphism as a susceptibility risk factor for either adult SLE (aSLE) or pediatric SLE (pSLE) and to evaluate its role in the development of lupus nephritis (LN) in pSLE.

Methods

Typing of GATA3 rs3824662 polymorphism was done using real-time polymerase chain reaction for three groups; 104 pSLE patients, 140 aSLE patients and 436 age- and sex-matched healthy controls.

Results

Non-significant differences were found between SLE patients and healthy controls for the allele and genotype frequencies of GATA3 rs3824662 ( p > 0.05). In pSLE; the AC genotype was associated with LN ( p = 0.04); the A allele and AC genotype were associated with persistent proteinuria ( p = 0.036 and 0.01, respectively) and both the A allele and AA genotype were associated with higher chronicity index ( p = 0.031 and 0.04, respectively). In aSLE; the C allele was associated with cellular cast ( p = 0.03) and thrombocytopenia ( p = 0.01). Logistic regression analysis revealed significant association between the AC+AA genotypes and the prediction of LN and renal active disease in pSLE ( p = 0.04 and 0.01, respectively).

Conclusion

GATA3 rs3824662 is not associated with susceptibility to SLE either in adult or in pediatric patients; however, in pSLE patients, the heterozygous AC genotype could be considered a risk factor for LN. At the same time, the AC and AA genotypes could be considered as predictors for LN and active renal disease. However, the small sample size is a limiting factor of the present study when interpreting the positive association.

Angiotensin-converting enzyme insertion/deletion gene polymorphism in Egyptian children with systemic lupus erythematosus: a possible relation to proliferative nephritis

Introduction Angiotensin-converting enzyme (ACE) is crucial in the pathogenesis of systemic lupus erythematosus through angiotensin II which regulates vascular tone and endothelial functions. Objectives To study the frequency of ACE insertion/deletion (I/D) gene polymorphism in Egyptian children with systemic lupus erythematosus and its possible relation to the renal pathology in cases with lupus nephritis. Subjects and methods The frequency of ACE gene insertion/deletion polymorphism genotypes was determined in 78 Egyptian children with systemic lupus erythematosus and compared to a matched group of 140 healthy controls using polymerase chain reaction. Results The DD genotype of the ACE gene was higher in systemic lupus erythematosus patients when compared to controls ( P<0.0001; odds ratio (OR) 2.4; 95% confidence interval (CI) 1.7-3.3) and the D allele was more frequent than the I allele in systemic lupus erythematosus patients in comparison to controls ( P < 0.0001; OR = 2.2; 95% CI = (1.6-3.1). In the lupus nephritis group, the DD genotype was significantly higher in those with proliferative lupus nephritis when compared to those with non-proliferative lupus nephritis ( P = 0.02; OR = 1.45; 95% CI = 1.4-1.6). Also, patients with proliferative lupus nephritis showed a higher frequency of the D allele ( P < 0.001; OR = 1.98; 95% CI = 1.3-2.9). Conclusion The D allele and DD genotype of the ACE gene appear to be a risk factor for the susceptibility of systemic lupus erythematosus and occurrence of proliferative nephritis in Egyptian children.

C1q rs292001 polymorphism and C1q antibodies in juvenile lupus and their relation to lupus nephritis

C1q deficiency is related strongly to systemic lupus erythematosus (SLE), but very few and inconsistent studies explored the single nucleotide polymorphisms of the C1q gene in relation to juvenile SLE (jSLE) and lupus nephritis (LN). The objective of this study was to analyse whether C1q rs 292001 polymorphism is associated with SLE and disease phenotype, especially nephritis, and to investigate the relation between this polymorphism and clinical data, treatment outcome, serum level of C1q protein and antibodies. Typing of C1q rs292001 polymorphism using restriction fragment length polymorphism and measuring serum levels of C1q protein and antibodies by enzyme-linked immunosorbent assay (ELISA) were performed for 130 children with SLE and 208 healthy controls. The A allele of C1q rs292001 was associated with jSLE and LN (P = 0·005 and 0·013, respectively) and the AA genotype was associated with jSLE (P = 0·036). Low serum levels of C1q protein were found in jSLE and LN (P < 0·001 and 0·009, respectively), and these levels were increased after treatment in patients with LN (P = 0·009) and active renal disease (P = 0·027). Higher titres of C1q antibodies were found in patients with LN (P = 0·015) and correlated negatively with C1q protein level (P < 0·001) and patient age (P = 0·04). The A allele and AA genotype of C1q rs292001 can be considered a susceptibility risk factor and the GG genotype could be considered protective for jSLE and LN in the studied cohort of Egyptian children. Decreased serum levels of C1q protein and increased titres of C1q antibodies may be involved in the pathogenesis of jSLE, especially LN.