Clinical risk factors for predicting anti-Sars-Cov-2 antibody immunoreactivity duration after mild COVID-19 infection / Fatores de risco clínicos para predizer a duração da imunoresatividade do anticorpo anti-Sars-Cov-2 após infecção leve por COVID-19

Introduction: coronavirus disease 2019 (COVID-19) is a complex multisystem disorder. It is not yet well known whether symptoms in the acute phase correlate with the duration of the immune response and the persistence of chronic symptoms.Objective: this study aimed to assess and monitor the clinical symptoms of COVID-19 and correlate them with the production of neutralizing antibodies.Methods: a cohort of 69 health workers at the University Hospital of the Federal University of Espírito Santo (HUCAM-UFES/EBSERH) diagnosed with SARS-CoV-2 infection confirmed via RT-PCR (Real-Time Reverse Transcription­Polymerase Chain Reaction) were evaluated from the onset of symptoms up to six months. SARS-CoV-2 IgG and IgM assays were used to detect the presence of IgG and IgM against the nucleocapsid protein of SARS-CoV-2 in serum samples. IgG and IgM antibody serology, pulmonary function via spirometry, and the clinical evolution of patients were performed at 15, 30, 45, 60, 90, and 180 days after the onset of COVID-19 symptoms.Results: sixty-nine health workers (age, 40 ± 10 years; 74% women) were evaluated for six months. All subjects showed mild to moderate COVID-19. The mean number of symptoms was 5.1 (± 2.3). The most common initial symptoms were muscle pain (77%), headache (75%), anosmia (70%), ageusia (64%), runny nose (59%), fever (52%), and coughing (52%). After 30 days, the patients had anosmia (18%), asthenia (18%), adynamia (14%), muscle pain (7%), and ageusia (7%). Regarding lung function, 9.25% presented with an obstructive pattern, and all recovered after six months. Of all analyzed participants, 18/69 (26%) did not have any reactive IgG or IgM values in any of the assessments. The IgG serology curve showed a peak, whereas IgM had the highest mean value on the 15th day. There was a progressive decrease and levels similar to those at baseline after 90 days, and 15/53 (28%) remained with reactive IgG after six months. Sore throat and shortness of breath were found to be independent risk factors, and patients with these symptoms were 5.9 times more likely to have reactive IgG on the 180th day. Patients with diarrhea were four times more likely to have reactive IgM.Conclusion: our findings showed that 26% of patients did not produce a humoral response post-mild COVID-19. Their antibody titers dropped significantly after 90 days, and only 28% maintained reactive IgG antibodies after six months. Sore throat and shortness of breath are predictors of a longer duration of the humoral immune response.

Introdução: a doença causada pelo coronavírus (COVID-19) é complexa e multissistêmica. Ainda não se sabe se os sintomas da fase aguda estão correlacionados com a duração da resposta imune e com a persistência dos sintomas crônicos.Objetivo: o presente estudo visa acessar e monitorar os sintomas clínicos do COVID-19, correlacionando-os com a produção de anticorpos neutralizantes.Método: uma coorte de 69 profissionais da saúde da Universidade Federal do Espírito Santo (HUCAM-UFES/EBSERH) diagnosticados com infecção por SARS-CoV-2 confirmada via RT-PCR (Real-Time Reverse Transcription-Polymerase Chain Reaction) foram avaliados do início dos sintomas até seis meses depois. Exames laboratoriais de IgG e IgM foram utilizados para detectar a presença de IgG e IgM contra a proteína do nucleocapsídeo do vírus SARS-CoV-2 nas amostras de plasma sanguíneo. Sorologia de anticorpos IgG e IgM, função pulmonar via espirometria e avaliação clínica dos pacientes foram realizadas nos dias 15, 30, 45, 60, 90 e 180 após o início dos sintomas da doença.Resultados: sessenta e nove profissionais da saúde (idade, 40 ± 10 anos; 74% mulheres) foram avaliados por seis meses. Todos apresentaram a forma leve a moderada do COVID-19. O número médio de sintomas foi 5.1 (± 2.3). O sintoma inicial mais comum foi dor muscular (77%), cefaleia (75%), anosmia (70%), ageusia (64%), coriza (59%), febre (52%), e tosse (52%). Após 30 dias, os pacientes mantiveram anosmia (18%), astenia (18%), adinamia (14%), dor muscular (7%), e ageusia (7%). Em relação à função pulmonar, 9.25% apresentaram padrão obstrutivo e todos recuperaram ao final dos seis meses. Dentre todos os participantes analisados, 18/69 (26%) não obtiveram nenhum valor de IgG e IgM considerados reagentes nos exames realizados. A curva sorológica de IgG mostrou um pico enquanto a de IgM apresentou seu maior valor médio no 15º dia. Houve um declínio progressivo e níveis similares aos basais aos 90. 15/53 (28%) permaneceram com IgG reagente após seis meses. Dor de garganta e dispneia foram considerados fatores de risco independentes, e os pacientes com esses sintomas tiveram 5,9 vezes mais chances de apresentar IgG reativa no 180º dia. Pacientes com diarreia tiveram quatro vezes mais chances de apresentar IgM reagente.Conclusão: nossos achados mostraram que 26% dos pacientes não produziram uma resposta humoral pós-COVID-19 leve. Seus títulos de anticorpos caíram significativamente após 90 dias e apenas 28% mantiveram anticorpos IgG reativos após seis meses. Dor de garganta e dispneia foram preditores de maior duração da resposta imune humoral

Prevalence of Sjögren's syndrome according to 2016 ACR-EULAR classification criteria in patients with systemic lupus erythematosus

Abstract Background Diagnosis of SS is a complex task, as no symptom or test is unique to this syndrome. The American-European Consensus Group (AECG 2002) and the American-European classification criteria of 2016 (ACR/EULAR 2016) emerged through a search for consensus. This study aims to assess the prevalence of Sjögren's Syndrome (SS) in patients with Systemic Lupus Erythematosus (SLE), according to AECG 2002 and ACR-EULAR 2016 classifications, as well as clinical and histopathological features in this overlap. To date, there is no study that has evaluated SS in SLE, using the two current criteria. Methods This cross-sectional study evaluated 237 SLE patients at the outpatient rheumatology clinic between 2016 and 2018. Patients were submitted to a dryness questionnaire, whole unstimulated salivary flow (WUSF), "Ocular Staining Score" (OSS), Schirmer's test I (ST-I), and labial salivary gland biopsy (LSGB). Results After verifying inclusion and exclusion criteria, a total of 117 patients were evaluated, with predominance of females (94%) and mixed ethnicity (49.6%). The prevalence of SS was 23% according to AECG 2002 and 35% to ACR- EULAR 2016. Kappa agreement between AECG 2002 and ACR-EULAR 2016 were 0.7 (p < 0.0001). After logistic regression, predictors for SS were: anti/Ro (OR = 17.86, p < 0.05), focal lymphocytic sialadenitis (OR = 3.69, p < 0.05), OSS ≥ 5 (OR = 7.50, p < 0.05), ST I positive (OR = 2.67, p < 0.05), and WUSF ≤ 0.1 mL/min (OR = 4.13, p < 0.05). Conclusion The prevalence of SS in SLE was 23% (AECG 2002) and 35% (ACR-EULAR 2016). The presence of glandular dysfunction, focal lymphocytic sialadenitis, and anti/Ro were predictors of SS in SLE. The greatest advantage of the new ACR-EULAR 2016 criteria is to enable an early diagnosis and identify the overlapping of these two diseases. ACR- EULAR 2016 criteria is not yet validated for secondary SS and this study is a pioneer in investigating prevalence based on the new criteria.

Pulmonary function and exercise capacity six months after hospital discharge of patients with severe COVID-19

ABSTRACT Introduction: The long-term consequences of COVID-19, especially pulmonary impairment, are frequent but not well understood. The knowledge about sequels or long COVID-19 are necessary, considering the high prevalence and need for specific public strategies. Method: The study was conducted to evaluate symptoms (standardized questionnaire), pulmonary function (spirometry), and exercise capacity (6-minute-walk-test) at 30 (D30), 90 (D90), and 180 (D180) days after hospital discharge of patients surviving to severe COVID-19. We excluded in this follow up patients with comorbidities before COVID infection. Results: 44 patients were included and 31 (26 men) completed the 6-month follow-up (age mean 53.6 ± 9.6 years). At D180, 28% presented still at least one symptom. The most common was dyspnea (17.2%), followed by cough (13.8%), and myalgia (10.3%). All spirometric parameters showed progressive improvement from D30 to D180. However, 16% maintained a restrictive pattern on spirometry test, 44% presented desaturation on the 6-minute walk-test, and 25% walked < 75% of the predicted value. Conclusion: 6-months after hospital discharge, reduced pulmonary function and reduced exercise capacity was founded frequently and more than a quarter remained symptomatic. The persistent symptoms and functional impairment suggest that sequels and development of Long COVID-19 are very common. The identification of these patients to provide the necessary health care is a challenging task, considering the large number of patients infected and surviving to COVID-19 disease.

Adult-onset Still's disease after ChAdOx1 nCoV-19 vaccine: a possible association

ABSTRACT With emergent Sars-Cov-2, a highly transmissive virus that caused millions of deaths worldwide, the development of vaccines became urgent to combat COVID-19. Although rare, important adverse effects had been described in a hypothetical scenario of immune system overstimulation or overreaction. Still's disease is a rare inflammatory syndrome of unknown etiology. It manifests as a cytokine storm, mainly IL-18 and IL-1β, and presents itself with fever spikes, joint pain, maculopapular evanescent salmon-pink skin rash, and sore throat, among other symptoms. Here, we report a case of a 44-year-old healthy male who developed adult-onset Still's disease (AOSD) with atypical symptoms after both doses of ChAdOx1 nCoV-19 vaccine with 3 months of dose interval. The medical team suspected Still's disease and started prednisone 1 mg/kg (40mg). The next day the patient showed a marked improvement in articular and chest pains and had no other fever episodes. Therefore, he was discharged to continue the treatment in outpatient care. On the six-month follow-up, the patient was free of complaints, and the progressive corticoid withdrawal plan was already finished.

Anti-SARS-CoV-2 antibody immunoreactivity profiles during COVID-19 recurrence

ABSTRACT Background: This study aimed to evaluate IgG and IgM levels in COVID-19 recurrence. Methods: The serum antibody levels and clinical data from 73 healthcare workers with SARS-CoV-2 divided into seroconverted (n=51) and non-seroconverted (n=22) groups were assessed. The presence of specific anti-nucleocapsid (anti-N) IgM and IgG for SARS-CoV-2 was evaluated. IgG antibodies to the SARS-CoV-2 spike receptor-binding domain were used to confirm non-seroconversion in all negative anti-N. Results: Four recurrent cases displayed mild symptoms and were non-seroconverted until the recurrence of symptoms. Conclusions: Undetectable anti-nucleocapsid IgM and IgG levels may be correlated with symptomatic COVID-19 recurrence.

Pulmonary function evaluation after hospital discharge of patients with severe COVID-19

OBJECTIVES: Coronavirus disease 2019 (COVID-19) may be associated with prolonged symptoms and post-recovery health impairment. This study aimed to evaluate the persistence of symptoms, lung function, and pulmonary diffusion for carbon monoxide (DLCO) in patients between 15 and 30 days after hospital discharge after admission for severe COVID-19. METHODS: The evaluation consisted of 1) comparative analysis between the initial symptoms and symptoms still present at the post-discharge evaluation 2) analysis of the chest images obtained during hospitalization, and 3) conducting spirometry, plethysmography, and DLCO assessment. RESULTS: Forty-one patients who were hospitalized for 16±8 days with severe COVID-19 were included. Patients were predominantly men (73%) and had a mean age of 51±14 years. The most frequent comorbidities were arterial hypertension (51%) and diabetes mellitus (37%). Pulmonary evaluation was performed a mean of 36 days after the onset of symptoms, with the most frequent persistent symptoms being dyspnea (83%) and coughing (54%). Approximately 93% of patients still had at least one symptom, and 20% had more than five symptoms. Chest imaging revealed a typical pattern of COVID-19 on X-ray (93%) and computer tomography (95%). Lung function test results showed a restrictive pattern with a reduction in forced vital capacity (FVC) in 54% of individuals, with an average FVC of 78±14%. A reduction in DLCO was observed in 79% of patients. CONCLUSIONS: We observed a high prevalence of symptoms, in addition to a significant change in lung function and DLCO, in the post-discharge assessment of patients requiring hospitalization after admission for COVID-19.

Giant lactating adenoma

Lactating adenoma is a rare benign breast lesion that most often presents as a small (up to 3 cm), solid, well-circumscribed, solitary, painless, mobile, lobulated mass. The highest incidence occurs in primiparous women (20 to 40 years old) during the third trimester of pregnancy. However, in the rare case presented herein, in addition to its giant size (more than 10 centimeters on palpation), this lactating adenoma is distinctive due to the presence of multiple nodules, poorly defined ultrasonographic margins, worrisome radiologic features, growth since early pregnancy, presence of infarction and association with chronic mastitis. From the clinical-radiologic perspective, the differential diagnoses included abscess associated with puerperal mastitis, phyllodes tumor, and galactocele. Biopsy was performed, and pathologic examination revealed the classic characteristics of lactating adenoma with multiple infarcted areas, leading to an unexpected confirmed case of giant lactating adenoma.