SARS-CoV-2 mRNA Vaccination and Graves' Disease: A Report of 12 Cases and Review of the Literature.

CONTEXT AND OBJECTIVE: Thyroid autoimmunity has been reported to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the SARS-CoV-2 vaccination recently. We report a series of patients who presented with new onset or relapse of Graves' disease-related hyperthyroidism shortly after receiving the SARS-CoV-2 messenger RNA (mRNA) vaccine at a single tertiary institution in Singapore. METHODS AND RESULTS: We describe 12 patients who developed hyperthyroidism within a relatively short interval (median onset, 17 [range, 5-63] days) after receiving the SARS-CoV-2 mRNA vaccine. The majority were females (11/12) with median age of 35.5 (range, 22-74) years. Six patients had new-onset hyperthyroidism, whereas the other 6 had relapse of previously well-controlled Graves' disease. TSH receptor antibody concentrations ranged from 2.4 to 32 IU/L. The majority of the patients were able to go for the second dose of the vaccine without any further exacerbations. Literature review revealed 21 other similar cases reported from across the world. CONCLUSION: Our case series provides insight into the characteristics of individuals in whom Graves' disease was triggered by the SARS-CoV-2 vaccination. Clinicians need to be vigilant of precipitation or exacerbation of autoimmune thyroid disorders in predisposed individuals after exposure to the SARS-CoV-2 vaccination. Further epidemiological and mechanistic studies are required to elucidate the possible associations between the SARS-CoV-2 vaccines and the development of thyroid autoimmunity.

Evaluating a bedside tool for neuroanatomical localization with extended-matching questions.

Neuroanatomical localization (NL) is a key skill in neurology, but learners often have difficulty with it. This study aims to evaluate a concise NL tool (NLT) developed to help teach and learn NL. To evaluate the NLT, an extended-matching questions (EMQ) test to assess NL was designed and validated. The EMQ was validated with fourth-year medical students and internal medicine and neurology residents. The NLT's usability was evaluated with third- and fourth-year students, and the effectiveness was evaluated with an experimental study of second-year students, using the EMQ as the outcome measure. Students were taught how to use both the NLT and textbook algorithms (control) to perform NL, then randomized into either group, and only allowed to use their assigned tool to complete the EMQ. Primary outcome was the difference in mean EMQ scores expressed as a percentage of total score. For EMQ validation, students (n = 56) scored lower than residents (n = 50) (76.7% ± 1.7 vs. 83.0% ± 1.6; mean ± standard error of mean, P < 0.009). The EMQ demonstrated good reliability (Cronbach's α 0.85) and generalizability (G-coefficient 0.85). Third- (n = 77) and fourth-year (n = 42) students found the NLT user-friendly and helpful in their learning of NL. In the experimental study, scores were significantly higher for NLT group (n = 94) than for controls (n = 101) (42.5 vs. 37.0%, P = 0.014); the effect size (Cohen's d) was 0.36. The EMQ is validated to reliably assess NL and is generalizable, feasible, practical, and of low cost. The concise and user-friendly NLT for NL was effective in aiding medical student performance of NL. Anat Sci Educ 11: 262-269. © 2017 American Association of Anatomists.

Preliminary Investigations Showing Venous Thromboembolism Recurrence in Patients with Residual Venous Obstruction in Singaporean Population.

This study aims to determine the association of residual venous obstruction (RVO) with recurrent venous thromboembolism (VTE). A retrospective cohort study was conducted determining if RVO on ultrasonography is associated with recurrent VTE in a Singaporean population. The subjects were identified from the Vascular Diagnostic Laboratory patients' record of Tan Tock Seng Hospital (TTSH), Singapore between 2008 and 2013. All the patients included had RVO after 3 months of anticoagulation. Data such as age, gender, race, thrombus location, etiology, history of malignancy, thrombophilia screen, treatment duration, and follow-up were recorded for analysis. Statistical analysis was performed using Stata/SE 13.1 (StataCorp LLC). The study was approved by the National Healthcare Group Domain Specific Review Board (DSRB), Singapore. Out of the 34 patients who had RVO, 6 (17.6%) developed VTE recurrence. Patients were treated with anticoagulation for a mean time of 24.5 months. The mean follow-up time for VTE recurrence was 25.4 months. Out of the six patients who had VTE recurrence, one had common iliac vein involvement, four had superficial femoral vein and common femoral vein involvement, zero had popliteal vein involvement, and one had calf veins involvement. There was a significant association between thrombophilia ( p = 0.0195) and malignancy ( p = 0.020) at inclusion with the risk of recurrent VTE. The presence of RVO after 3 months of anticoagulation is likely to increase the risk of VTE recurrence. Larger studies with RVO are needed to evaluate if there is an increased risk of VTE recurrence in the Asian population.