Neuroautoimmune disorders, such as multiple sclerosis and Guillain-Barre syndrome, have been documented in relation to various vaccines in the past. This paper uses passive reporting information from the CDC/FDA's VAERS system to analyse whether neuroautoimmune presentations are reported at a relatively higher or lower rate, vis-a-vis other adverse effects, for COVID-19 vaccines than for other vaccines. Through computing the reporting odds ratios for a range of symptoms and comparator vaccines, a clear indication in favour of the safety of COVID-19 vaccines emerges, with reports of neuroautoimmune adverse events in relation to other adverse events being over 70% less likely for COVID-19 than for comparator vaccines (ROR: 0.292, p < 0.0001). In comparison with other vaccines given as part of routine care in adulthood, COVID-19 vaccines have the lowest reporting odds ratio of neuroautoimmune adverse effects (median ROR: 0.246).
The new barrier mode in Apache Spark allows for embedding distributed deep learning training as a Spark stage to simplify the distributed training workflow. In Spark, a task in a stage does not depend on any other tasks in the same stage, and hence it can be scheduled independently. However, several algorithms require more sophisticated inter-task communications, similar to the MPI paradigm. By combining distributed message passing (using asynchronous network IO), OpenJDK’s new auto-vectorization and Spark’s barrier execution mode, we can add non-map/reduce-based algorithms, such as Cannon’s distributed matrix multiplication to Spark. We document an efficient distributed matrix multiplication using Cannon’s algorithm, which significantly improves on the performance of the existing MLlib implementation. Used within a barrier task, the algorithm described herein results in an up to 24% performance increase on a 10,000 × 10,000 square matrix with a significantly lower memory footprint. Applications of efficient matrix multiplication include, among others, accelerating the training and implementation of deep convolutional neural network-based workloads, and thus such efficient algorithms can play a ground-breaking role in the faster and more efficient execution of even the most complicated machine learning tasks.
Autoimmune adverse effects following immunisation (AEFIs) are widely regarded as a chief concern driving vaccine hesitancy. This case-control study seeks to shed light on the true risk of autoimmune AEFIs associated with the COVID-19 vaccine through a case-control analysis of VAERS reports. Reports of autoimmune aetiology were matched with reports of non-autoimmune controls. Statistical analysis reveals that the safety profile of COVID-19 vaccines with regard to autoimmune AEFIs is highly favourable. In particular, neuroautoimmune AEFIs have statistically significant reporting odds ratios below unity (Guillain-Barre syndrome: 0.35, multiple sclerosis: 0.70, transverse myelitis: 0.79), indicating a reduced association of reports of these conditions with the COVID-19 vaccine versus other vaccines. Only three autoimmune aetiologies exceed a ROR of 2.0 and thus present a potential signal. Of these, myasthenia gravis (ROR = 3.90, p < 0.001, 95% CI: 2.63-5.80) may be the result of epidemiological confounding factors not sufficiently controlled by matching, as the population most likely to develop myasthenia gravis was strongly prioritised in the COVID-19 vaccine's initial rollout. Immune thrombocytopaenia (ROR = 26.83, p < 0.001, 95% CI: 16.93-42.54) is a clear safety signal, confirming a large number of case reports and studies that indicate a risk of immune thrombocytopaenic events following the COVID- 19 vaccine. The lone strong safety signal of immune thrombocytopaenia notwithstanding, this study attests to the safety of the COVID-19 vaccine where autoimmune conditions are concerned. Through quantifying the risk of autoimmune disorders associated with COVID-19 vaccination, this study contributes to a growing body of evidence supporting the safety of such vaccines.
Rationale: Polyserositis describes contemporaneous inflammation of multiple serous membranes accompanied by effusions in serous cavities. It has been associated with different aetiologies, including autoimmune diseases, endocrine diseases, neoplasia, drug-associated cases, and infectious diseases, such as tuberculosis. Patient concerns: We report the case of a 34-year-old woman who presented with abdominal swelling for 8 months, fatigability, and shortness of breath for 2 months. She denied a history of lower-limb swelling, orthopnea, paroxysmal nocturnal dyspnoea, or right upper quadrant pain. She had no history of cigarette smoking, prior treatment for tuberculosis, malignancy, or contact with someone known to have tuberculosis (TB). On examination, she had a weak pulse, muffled heart sounds, and ascites. Diagnosis: Polyserositis was suspected following visualization of fluid in the peritoneal, pleural, and pericardial cavities on imaging. Interventions: The patient underwent pericardiocentesis and ascitic taps. The patient also received spironolactone, prednisolone, and paracetamol. Despite repeated ascitic tapping and use of diuretics, fluid continued to accumulate until the initiation of empiric anti-TB drugs (rifampicin, isoniazid, pyrazinamide, and ethambutol), as noted from the elevated levels of adenosine deaminase (pleural fluid-46.30U/L) and living in an endemic area for tuberculosis (Kenya). Outcomes: Three weeks after the initiation of anti-TB drugs, the ascites and pericardial and pleural effusions resolved. Two months after discharge, the patient showed marked improvement, with no residual fluid noted in the serous cavities on imaging. Lessons learnt: We report a case of extrapulmonary TB presenting with polyserositis (pericardial, pleural, and ascitic fluid) with elevated adenosine deaminase levels when the traditional Ziehl Neelsen staining yielded negative results. Good clinical judgment and more novel diagnostic tools are necessary to avoid unnecessary delays in initiating definitive management.
Background: mRNA vaccines are a novel method of eliciting immunity, and play a significant role in the global fight against COVID-19. Anaphylactic reactions are a widespread concern driving vaccine hesitancy due to the serious and potentially fatal nature of anaphylaxis. A quantitative estimation of the risk of anaphylactic and anaphylactoid reactions deriving from mRNA vaccines is of a significant public health importance. Objective: To estimate the relative Reporting Odds Ratio of anaphylactic and anaphylactoid reactions following mRNA vaccination vis-a-vis other vaccinations. Design: Reporting case-control study. Setting: Persons reporting adverse events following vaccination to VAERS whose reports were received between 01 January 2000 and 02 July 2021, inclusive. Patients: Each case of anaphylaxis or anaphylactoid reaction was matched with 2.7 unique controls on average, by gender and age rounded to the nearest integer. Measurements: Overall and stratified Reporting Odds Ratios (ROR) were calculated. Stratified contingency tables were tested for homogeneity using the Breslow-Day procedure, and Cochran-Mantel-Haenszel statistics were calculated to test the hypothesis of a ROR of unity. Results: 2,665 cases of anaphylaxis or anaphylactoid reactions and 7,125 controls of non-anaphylactic/anaphylactoid reports were compared. The ROR of an anaphylactic or anaphylactoid reaction was 1.325 (95% CI: 1.212 - 1.448, p < 0.001). The matched set of cases and controls did not reveal inhomogeneity by gender or age band strata, suggesting that these factors have no impact on the likelihood to report an anaphylactic event as opposed to a non-anaphylactic event following mRNA vaccination. A slightly elevated ROR was observed with patients who reported a history of allergic reactions to NSAIDs and/or fluoroquinolone antibiotics. The precise meaning and relevance of this finding remains to be elucidated. Previous reactions to vaccines do not appear to correlate statistically significantly with a higher risk of reporting an anaphylactic adverse effect after mRNA vaccination. Limitations: As a reporting study using data from VAERS, our analysis is subject to under- and overreporting, the extent of each of which is not known with any degree of precision. Since the Emergency Use Authorizations for both mRNA vaccines mandate reporting of all serious adverse events, reporting bias is likely in favour of non- mRNA vaccines, where such reporting is not mandatory in adults. Consequently, this analysis may exaggerate the ROR of anaphylactic and anaphylactoid events associated with mRNA vaccines, which may in reality be significantly lower. Conclusions: mRNA vaccination is not associated with a statistically significant higher risk of reporting an anaphylactic adverse event to VAERS. Anaphylaxis is a serious but very rare complication of all immunisations. No significant increase in reporting odds was found in any age group or gender, nor in most cases of previously known allergic adverse events in relation to vaccines. This study contributes to the growing body of evidence proving the safety and tolerability of mRNA vaccines.
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