Limited evidence on long-term COVID-19 vaccine safety in patients with idiopathic inflammatory myopathies (IIMs) continues to contribute to vaccine hesitancy. We studied delayed-onset vaccine adverse events (AEs) in patients with IIMs, other systemic autoimmune and inflammatory disorders (SAIDs), and healthy controls (HCs), using data from the second COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. A validated self-reporting e-survey was circulated by the COVAD study group (157 collaborators, 106 countries) from Feb-June 2022. We collected data on demographics, comorbidities, IIM/SAID details, COVID-19 history, and vaccination details. Delayed-onset (> 7 day) AEs were analyzed using regression models. A total of 15165 respondents undertook the survey, of whom 8759 responses from vaccinated individuals [median age 46 (35-58) years, 74.4% females, 45.4% Caucasians] were analyzed. Of these, 1390 (15.9%) had IIMs, 50.6% other SAIDs, and 33.5% HCs. Among IIMs, 16.3% and 10.2% patients reported minor and major AEs, respectively, and 0.72% (n = 10) required hospitalization. Notably patients with IIMs experienced fewer minor AEs than other SAIDs, though rashes were expectedly more than HCs [OR 4.0; 95% CI 2.2-7.0, p < 0.001]. IIM patients with active disease, overlap myositis, autoimmune comorbidities, and ChadOx1 nCOV-19 (Oxford/AstraZeneca) recipients reported AEs more often, while those with inclusion body myositis, and BNT162b2 (Pfizer) recipients reported fewer AEs. Vaccination is reassuringly safe in individuals with IIMs, with AEs, hospitalizations comparable to SAIDs, and largely limited to those with autoimmune multimorbidity and active disease. These observations may inform guidelines to identify high-risk patients warranting close monitoring in the post-vaccination period.

BACKGROUND: What baseline predictors would be involved in mortality in people with primary Sjögren syndrome (SjS) remains uncertain. This study aimed to investigate the baseline characteristics collected at the time of diagnosis of SjS associated with mortality and to identify mortality risk factors for all-cause death and deaths related to systemic SjS activity measured by the ESSDAI score.

METHODS: In this international, real-world, retrospective, cohort study, we retrospectively collected data from 27 countries on mortality and causes of death from the Big Data Sjögren Registry. Inclusion criteria consisted of fulfilling 2002/2016 SjS classification criteria, and exclusion criteria included chronic HCV/HIV infections and associated systemic autoimmune diseases. A statistical approach based on a directed acyclic graph was used, with all-cause and Sjögren-related mortality as primary endpoints. The key determinants that defined the disease phenotype at diagnosis (glandular, systemic, and immunological) were analysed as independent variables.

FINDINGS: Between January 1st, 2014 and December 31, 2023, data from 11,372 patients with primary SjS (93.5% women, 78.4% classified as White, mean age at diagnosis of 51.1 years) included in the Registry were analysed. 876 (7.7%) deaths were recorded after a mean follow-up of 8.6 years (SD 7.12). Univariate analysis of prognostic factors for all-cause death identified eight Sjögren-related variables (ocular and oral tests, salivary biopsy, ESSDAI, ANA, anti-Ro, anti-La, and cryoglobulins). The multivariate CPH model adjusted for these variables and the epidemiological features showed that DAS-ESSDAI (high vs no high: HR = 1.68; 95% CI, 1.27-2.22) and cryoglobulins (positive vs negative: HR = 1.72; 95% CI, 1.22-2.42) were independent predictors of all-cause death. Of the 640 deaths with available information detailing the specific cause of death, 14% were due to systemic SjS. Univariate analysis of prognostic factors for Sjögren-cause death identified five Sjögren-related variables (oral tests, clinESSDAI, DAS-ESSDAI, ANA, and cryoglobulins). The multivariate competing risks CPH model adjusted for these variables and the epidemiological features showed that oral tests (abnormal vs normal results: HR = 1.38; 95% CI, 1.01-1.87), DAS-ESSDAI (high vs no high: HR = 1.55; 95% CI, 1.22-1.96) and cryoglobulins (positive vs negative: HR = 1.52; 95% CI, 1.16-2) were independent predictors of SjS-related death.

INTERPRETATION: The key mortality risk factors at the time of SjS diagnosis were positive cryoglobulins and a high systemic activity scored using the ESSDAI, conferring a 2-times increased risk of all-cause and SjS-related death. ESSDAI measurement and cryoglobulin testing should be considered mandatory when an individual is diagnosed with SjS.

FUNDING: Novartis.

With the intensification of human activities, nitrate pollutants in groundwater are receiving increasing attention worldwide. Especially in the arid Nile Delta of Egypt, groundwater is one of the most valuable water resources in the region. Identifying the source of nitrate in groundwater with strong human disturbances is important to effective water resource management. This paper examined the stable isotopes (δ15N/δ18O-NO3 and δ2H/δ18O-H2O) and the hydrogeochemical parameters of the shallow groundwaters in the arid southeast of the Nile Delta to assess the potential sources and transformation processes of nitrate under severe urban and agricultural activities. The results revealed that the groundwaters were recharged by the Nile River. Meanwhile, the infiltration of irrigation water occurred in the west, while the mixing with the deep groundwater occurred in the east regions of the study area. The TDS, SO42−, NO3−, and Mn2+ concentrations of groundwaters (n = 55) exceeded the WHO permissible limit with 34.6%, 23.6%, 23.6%, and 65.5%, respectively. The NO3− concentrations in the shallow groundwaters ranged from 0.42 mg/L to 652 mg/L, and the higher levels were observed in the middle region of the study area where the unconfined condition prevailed. It extended to the deep groundwater and eastward of the study area in the groundwater flow direction. The δ15N-NO3 and δ18O-NO3 values suggested that the groundwater NO3− in the west and east regions of semi-confined condition were largely from the nitrification of soil organic nitrogen (SON) and chemical fertilizer (CF). In contrast, wastewater input (e.g., domestic sewage and unlined drains) and prevalent denitrification were identified in the middle region. The denitrification might be tightly coupled with the biogeochemical cycling of manganese. This study provides the first report on the groundwater NO3− dynamics in the Nile Delta, which generated valuable clues for effective water resource management in the arid region.

BACKGROUND: Surgeons can preoperatively assess bone quality using dual-energy X-ray absorptiometry or computed tomography; however, this is not feasible for all patients. Recently, a MRI-based scoring system was used to evaluate the lumbar spine's vertebral bone quality.

OBJECTIVE: To create a similar MRI-based scoring system for the cervical spine (C-VBQ), correlate C-VBQ scores with computed tomography-Hounsfield units (HU), and evaluate the utility of this scoring system to independently predict cage subsidence after single-level anterior cervical diskectomy and fusion (ACDF).

METHODS: Demographic, procedure-related, and radiographic data were collected for patients. Pearson correlation test was used to determine the correlation between C-VBQ and HU. Cage subsidence was defined as ≥3 mm loss of fusion segmental height. A multivariate logistic regression model was built to determine the correlation between potential risk factors for subsidence.

RESULTS: Of 59 patients who underwent single-level ACDF, subsidence was found in 17 (28.8%). Mean C-VBQ scores were 2.22 ± 0.36 for no subsidence levels and 2.83 ± 0.38 ( P < .001) for subsidence levels. On multivariate analysis, a higher C-VBQ score was significantly associated with subsidence (odds ratio = 1.85, 95% CI = 1.39-2.46, P < .001) and was the only significant independent predictor of subsidence after ACDF. There was a significant negative correlation between HU and C-VBQ (r 2 = -0.49, P < .001).

CONCLUSION: We found that a higher C-VBQ score was significantly associated with cage subsidence after ACDF. Furthermore, there was a significant negative correlation between C-VBQ and HU. The C-VBQ score may be a valuable tool for assessing preoperative bone quality and independently predicting cage subsidence after ACDF.