ABSTRACT
Background: Over 600 million of COVID-19 cases have been reported. A remarkable fragment of these cases are reinfections, which are mostly explained by the genomic variability of the SARS-CoV-2 variants. However, little is known about other factors fostering these reinfections. Method(s): We recorded clinical and demographic data from subjects (N=3303, March 2020 - March 2022) with at least 2 PCR+ events separated by >=90 days, analyzed by the Microbiology Department, Northern Metropolitan Clinical Laboratory from Germans Trias i Pujol Hospital (Spain). Data collected included: age, sex, comorbidities, adjusted morbidity group (GMA), hospitalization, symptomatology, NAAT (PCR, TMA) tests, antigen tests, serology, and vaccination. Temporal data was encoded using Python, and demographic characterization was performed under R. Result(s): We identified 2344 cases of confirmed reinfections, where the 2 PCR+ events were separated by >=90 days and a negative test was obtained between episodes. 72.2% of reinfected subjects were females with a median age of 45 IQR [28-63] years. Age density analysis showed three peaks at 24, 45, and 85 years, probably mostly composed of young people, who usually are less cautious, healthcare workers, and people living in nursing homes, respectively, being all of them groups prone to be tested. Regarding health status, 86.2% of participants had at least one chronic condition, with 40.5% of patients having chronic conditions in >=4 systems based on GMA assessment. Interestingly, 75.2% of reinfected subjects < 26 years had at least one chronic condition. 121 (4.2%) participants were hospitalized during a COVID-19 episode, highlighting 8.3% (N=10) of them hospitalized during the reinfection (half of them vaccinated before hospitalization), and 5% (N=6) of them during both infections. The severity of the second infection may be caused by a diminished acquired immunity after the first infection. Time between reinfections density analysis provided three peaks at ~200, ~400, and ~600 days, corresponding with time between waves. A decrease of reinfections was observed between 40 and 100 days after vaccination, which would be the period of highest protection against reinfection. Conclusion(s): SARS-CoV-2 reinfections are more prevalent among women. Importantly, people with an undermined health status, independently of age, are more sensitive to reinfections, but in most of the cases no hospitalization was required. Finally, vaccination seems to have a short protective effect on reinfection.
ABSTRACT
Background: SARS-COV2, the virus responsible for COVID-19, has posed unique challenges in the management of individuals with demyelinating diseases. Objective: To describe the demographic, clinical, and outcome characteristics of patients diagnosed with multiple sclerosis and spectrum of neuromyelitis optica disease who had a SARS-CoV-2 infection during the pandemic. Methods: A retrospective descriptive study was carried out of a cohort of patients diagnosed with multiple sclerosis (MS) and neuromyelitis optic spectrum disease (NMOSD) who got infected with SARS-CoV-2. Results: 26 patients were included. Median age was 33.5 years (IQR 29-44), 81% of them were female, with a median duration of disease of 5 years (IQR 3-14). The diagnosis of COVID-19 infection was established by reverse transcriptase polymerase chain reaction (RT-PCR) in 14 patients. The remaining patients were diagnosed based on clinical symptoms and an epidemiological nexus. 77% have diagnosis of RRMS, 11% of PPMS, and seropositive and seronegative NMOSD, 8 and 4% respectively. 65% had minimal or no disability (EDSS 0 to 2), and 23% had a higher functional compromise (EDSS 6 to 9). 35% received Natalizumab, 19% Fingolimod, 15% Ocrelizumab, 8% Alemtuzumab, and 8% Rituximab;15% were not receiving DMT, and 27% had received the last dose of their respective DMT in the previous 30 days[IA1]. 12% of patients had comorbidity with hypothyroidism, 12% migraine, 8% dysautonomia and 4% diabetes mellitus, hypertension, dyslipidemia, or smoking. The most frequently reported COVID-19 symptoms were asthenia and fatigue in 65% and 15% of the patients were asymptomatic. 85% of patients were treated in an outpatient setting, 8% hospitalized and 8% required admission to the ICU. Regarding the outcome, 8% mortality was evidenced[MIZR2] (1 patient with PPMS and 1 with NMOSD )[IA3] , 100% of them had greater functional compromise, with an EDSS previous to COVID infection between 6 and 9 points. No relationship has been found between the treatment received and mortality but a higher frequency of admission into ICU was found in patients with a history of DM2, hypertension and use of AntiCD20 therapies. Conclusion: Clinical outcomes of COVID infection in patients with MS and NMOSD did not differ from what is reported in similar studies in Latin-American population.
ABSTRACT
Background and Aims: We evaluated whether stroke severity, functional outcome and mortality are different in patients with ischemic stroke with or without COVID-19 infection. Methods: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had had an acute ischemic stroke within 48 hours and a previous modified Rankin scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, NIHSS score, rate of reperfusion therapies, logistics and metrics. Primary end-point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariate analyses. Results: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men), and 91 (13%) had COVID-19 infection. Median baseline NIHSS score was higher in COVID-19 patients compared to patients without COVID-19 [8 (3-18) vs 6 (2-14), p=0.049)]. Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariate logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among COVID-19 patients and 16.1% in the non-COVID-19 group. In the multivariate logistic regression analysis, COVID-19 infection was a risk factor for mortality (HR 3.14 (95% CI, 2.10-4.71;p<0.001). Conclusions: Patients with ischemic stroke and COVID-19 infection have more severe strokes and higher mortality than stroke patients without COVID-19 infection. However, functional outcome is comparable in both groups.
ABSTRACT
Background and purpose: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. Methods: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID- 19 from 31 hospitals in 4 countries (3/1/20-6/16/20). Results: Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60-79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p=0.01). In that model, older age (aOR2.05 per decade, 95%CI 1.35-3.11, p<0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p=0.01) were also independently predictive of mortality. Conclusions: Our findings suggest that cryptogenic stroke among COVID-19 patients may berelated to more severe disease and carries a significant risk of early mortality.
ABSTRACT
Wars and natural disasters cause profound disturbances in human lives and social services. Historically, large pandemics have hit communities triggering rapid transformation of societies. The global COVID-19 outbreak has definitively challenged the world in an unprecedented way. Despite disruption of industry, trade, education, and social services due to prolonged home confinements, online activities have experienced an extraordinary revival. Lockdowns and social distancing have strongly penalized education programs based on classrooms face-to-face learning. Most schools and universities were abruptly forced to stop in-person classes and defer exams, experiencing great disturbance. Upon the first weeks of silence, expectation, and chaos, creative and innovative solutions were unfolded. They partially mitigated and fixed many of the most important challenges risen by COVID-19 shutdowns and home confinement. Engagement with e-teaching rapidly adapted to diverse student needs. On the other site, home confinement awakened a huge interest for e-learning. Online education has been pushed to be first in line. Once consolidated, it will stay for the long run, replacing traditional face-to-face education and expanding it to a much wider student population, ready to enjoy its flexibility and convenience. However, other teaching and learning benefits derived from direct personal interactions could experience downsides and result in the lost of very valuable skills, including those linked to body language, emotional intelligence, and deep feelings. Planning actions to confront these new threats are urgently needed. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
ABSTRACT
The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has shaken hospitals worldwide. Some authors suggest that neurologic involvement could further complicate the disease. This descriptive study is a cross-sectional review of 103 patients diagnosed with COVID-19 who underwent neuroimaging (of a total of 2249 patients with COVID-19 in our center). Analyzed variables were neurologic symptoms and acute imaging findings. The most frequent symptoms that motivated neuroimaging examinations were mild nonfocal neurologic symptoms, code stroke (refers to patients presenting with signs and symptoms of stroke whose hyperacute assessment and care is prioritized), focal neurologic symptoms, postsedation encephalopathy, and seizures. No cases of encephalitis or direct central nervous system involvement were detected. Thirteen patients presented with acute ischemic events, and 7, with hemorrhagic events; however, most reported multiple vascular risk factors. Despite the large cohort of patients with COVID-19, we found a large number of symptomatic patients with negative neuroimaging findings, and no conclusions can be drawn concerning concrete associations between neuroimaging and COVID-19.