ABSTRACT
Introduction: In Argentina, multiple sclerosis patients (MSp) are vaccinated against SARS-CoV-2 using different formulations upon availability, including viral vector/inactivated virus/mRNA vaccines, at distinct times between doses. The real-world effectiveness of these unique vaccination schedules is scarce, so asthe efficacy to mount an appropriate immune response even more in MSp under treatment (DMTs) Aims: To analyze the presence of reactive CD4+ and CD8+ T cells for SARS-CoV-2, IgG and IgM anti-Spike and anti-RBD, in MSp after receiving a 3rd vaccine dose Methods: 27 MSp and 9 healthy controls (HC) were included in this study. SARS-CoV-2-reactive T cells were analysed with a T Cell Analysis Kit from Miltenyi as described by the manufacturer. In brief, peripheral blood mononuclear cells (PBMCs) were cultured with a pool of lyophilized peptides, consisting of 15-mer sequences with 11 amino acids overlap, covering the complete protein coding sequence (aa 5-1273) of the surface or Spike glycoprotein (S) of SAR-CoV-2 and controls. After stimulation, the cells were stained with the live/dead marker, washed, fixed, permeabilized and stained for lineage and activation markers as well as cytokines. Cells were analysed using a flow cytometer. Doublets, debris, and dead cells as well as CD14+ and CD20+ cells were excluded. Cells were pregated on CD3 as well as CD4 and CD8. For reactive CD4 T cells CD154 and TNF-alpha were assessed on CD4+ T cells while TNF-alpha and IFN-gamma in CD8+ T cells Results: IgG antibodies (Ab) against S and RBD were found in all analysed HC, while in 22 and 20 out of a total of 27 MSp. Levels of IgG against S were lower in MSp vs HC. IgM levels against RBD were found in all HC and MSp, but 8 MSp had low levels of those Ab.There were no differences between HC and MSp in the % of reactive CD4+ T cells to S (p= 0.151). However, we found a lower % of reactive CD8+ T cells in MSp than HC (p= 0.026). Actually, CD8+ T cells were not detected in 4 out of 5 MSp treated with Fingolimod (FTY) but were present in all patients treated with monoclonal Ab, IFN or DMF. Furthermore, MSp treated with FTY had lower values of reactive CD4+ T cells and IgG anti-RBD than patients receiving other DMTs Conclusion(s): Most MSp vaccinated against SARS-CoV-2 present some humoral and cellular response to SARS-CoV-2. This humoral and cellular response would be lower in MSp treated with FTY.
ABSTRACT
Objective: To compare professional burnout and depression in medical residents of our health institution before and after the pandemic. Background: Medical residencies are one of the most affected sectors within the health system by the COVID-19 pandemic, generating a negative impact on both clinical practice and professional exhaustion, as well as on the emotional aspect. Design/Methods: Observational analytical study conducted through anonymous self-administered questionnaires in two groups of medical residents, differed by 3 years (2018/2021). Demographic data and medical history were collected. In addition to Maslach Burnout Inventory (MBI, for professional exhaustion) and Beck Depression Inventory (BDI-II, for depression). Results: 68 residents participated (2018: 31;2021: 37), female (2018: 48%;2021: 62%), with an average age of 27.2 +-2.4 SD (2018);30.2 +-3.3 SD (2021). In 2021 there was a reduction in elderly residents' participation (2018/2021: PGY1 22.6%/18.9%, PGY2 22.6%/10.8%, PY3 35.5%/24.3%, PGY4 19.4%/45.9%). In 2018 no one reported insomnia neither chronic drug and/or alcohol abuse, in 2021 27% reported insomnia (p=0.02) and 8.1% abuse. Slept hours in the last 72 hours were 13.6 +- 4.1 SD in 2018 and 16.5 +-5.4 SD in 2021. Severe and extreme depression scored by BDI-II were a new finding this year (2018/2021: Normal 51.6%/16.2%, mild mood disturbance 25.8%/29.7%, mild depression 12.9%/21.6%, moderate depression 9.7%/10.8%, severe depression 0%/13.5% and extreme depression 0%/8.1%). In 2021 greater emotional exhaustion and lack of personal fulfillment were observed compared to 2018, but no depersonalization or burnout criteria were made when answered BDI-II (2018/2021: Normal 51.6%/16.2%, mild mood disturbance 25.8%/29.7%, mild depression 12.9%/21.6%, moderate depression 9.7%/10.8%, severe depression 0%/13.5% and extreme depression 0%/8.1%). Conclusions: In our medical residents an increased level of depression was observed in 2021 compared to 2018. The pandemic working overload probably exacerbated bad working conditions. It is important to improve the quality of life and work of doctors in training.
ABSTRACT
COVID-19 disease has spread around the world since December 2019. Neurological symptoms are part of its clinical spectrum. Objective: To know the neurological manifestations in patients infected by COVID-19 in Argentina. Methods: Multicenter study conducted in adults, from May 2020 to January 2021, with confirmed COVID-19 and neurological symptoms. Demographic variables, existence of systemic or neurological comorbidities, the form of onset of the infection, alteration in complementary studies and the degree of severity of neurological symptoms were recorded. Results: 817 patients from all over the country were included, 52% male, mean age 38 years, most of them without comorbidities or previous neurological pathology. The first symptom of the infection was neurological in 56.2% of the cases, predominantly headache (69%), then anosmia/ageusia (66%). Myalgias (52%), allodynia/hyperalgesia (18%), and asthenia (6%) were also reported. 3.2% showed diffuse CNS involvement such as encephalopathy or seizures. 1.7% had cerebrovascular complications. Sleep disorders were observed in 3.2%. 6 patients were reported with Guillain Barré (GBS), peripheral neuropathy (3.4%), tongue paresthesia (0.6%), hearing loss (0.4%), plexopathy (0.3%). The severity of neurological symptoms was correlated with age and the existence of comorbidities. Conclusions: Our results, similar to those of other countries, show two types of neurological symptoms associated with COVID-19: some potentially disabling or fatal such as GBS or encephalitis, and others less devastating, but more frequent such as headache or anosmia that demand increasingly long-term care.