Sars-Cov-2 Vaccination Coverage in a Mexican Population with Rheumatic Disease

Objectives: Latest recommendation on SARS-CoV-2 vaccination in patients with systemic rheumatic diseases (SRD) by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) is 3 doses while the Centers for Diseases Control and Prevention (CDC) recommends 5 doses. Method(s): We performed a cross-sectional study from April to November 2022 about SARS-CoV-2 vaccination in an outpatient rheumatology clinic in northeast Mexico. Consecutive SRD patients with a history of COVID-19 vaccination were invited to participate. Patients without SRD were excluded. Eligible participants completed a survey that included demographic data (age, sex, rheumatic disease diagnosis) and SARS-CoV-2 vaccination history (number of doses, and type of vaccine). Result(s): We recruited 252 patients.Vaccine types administered were: BNT162b2 (Pfizer-BioNTech) 55 (23.11%);ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca) 130 (54.62%);Ad5-nCoV (CanSinoBIO) 31 (13.03%);Coronavac (Sinovac) 9 (3.78%);mRNA-1273 (Moderna)13 (5.46%). (See Table 1 and Table 2) Conclusion(s): Two thirds of our patients met SARS-CoV-2 vaccination recommendations by ACR and EULAR and 5.95% met CDC criteria. Population without any dose represents 6.74%. SARS-CoV-2 infection in vaccinated patients with SRD is associated with a better outcome compared with unvaccinated. Efforts to increase vaccination coverage need to be done.

Persistence of Symptoms One Year after Multisystem Inflammatory Syndrome in Children

Background: Long term evolution of Multisystem Inflammatory Syndrome in children (MIS-C) is poorly understood. In this report, we described the frequency of persistent symptoms and sequels after one-year monitoring in a cohort of MIS-C patients. Method(s): This is a prospective observational study in under-18-aged patients diagnosed with MIS-C between October 2020 and April 2021 in a tertiary hospital. Data from initial episode was obtained from the Spanish national database and the medical history. A standardized phone questionnaire was done one year after the acute episode. As patients pared by age and sex were included with i) history of acute COVID-19, from the same national database, and ii) with peritonitis diagnosis in the electronic medical record. Data was collected using REDCap and analysed with R. Ethics committee approval was obtained. Result(s): A total of 48 patients were included in the study, 16 in each group. Average age at hospitalization was 11,2 years old [IQR: 6,6-14,4] and 52% (23/48) were male. MIS-C patients presented high frequently 94% (15/16) cardiological complications during hospitalization, in contrast with 19% (3/16) of acute COVID-19 patients and 25% (4/16) of peritonitis group (p< 0.01). All of them resolved after a year except the ones associated to hypoxic ischemic encephalopathy in a patient with MIS-C that need ECMO assistance. Summary characteristics during acute episode are shown in Table 1. After one-year follow-up, 88% MIS-C patients suffered one or more symptoms, more frequently: headache (44%), fatigue (38%), insomnia (38%) and concentration problems (38%). A total of 56% of COVID-19 patients presented persisted symptoms, mainly fatigue and concentration problems (19%), and 31% in peritonitis group (19% loss of appetite and abdominal pain), (p< 0.001). MIS-C patients visited more frequently the medical professionals due to emotional change, behaviour or interpersonal relationships after the disease [4/16 (25%) in MIS-C vs. 0/16 (0%) in both control groups, p= 0.028]. Conclusion(s): Majority of MIS-C patients have persistent symptoms one year after acute episode, even with the resolution of cardiological complications. Frequency of long term symptoms in MIS-C patients is significantly higher than in COVID-19 hospitalized and than in a control group of surgical peritonitis patients. Summary characteristics during acute episode.

Neutrophil-lymphocyte ratio and systemic immune-inflammation index as risk factors for acute kidney injury in hospitalized patients with COVID-19

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 is high and is associated with a worse prognosis. The objective of this study is to determine the risk factors associated with AKI in hospitalized patients with COVID-19. Method(s): In this retrospective, single-center study, we analyzed data from electronic medical records of 494 hospitalized patients with COVID-19 pneumonia. We collected clinical and analytical data of baseline characteristics. Multivariable logistic regression was performed to identify factors associated with AKI. Result(s): During the study period, 129 (26.1%) out of 494 COVID-19 patients, developed AKI. The proportions with stages 1, 2, 3, 3D AKI were 46.5%, 30.2%, 10.9%, and 12.4%, respectively. In-hospital AKI mortality was 35.7%. The risk factors for AKI were previous chronic kidney disease (CKD) (OR = 2.8, 95% CI 1.4-5.2, p= 0.003);admission to intensive care unit (ICU) (OR = 4.8, 95% CI 1.5- 10.2, p= <0.001);neutrophil-lymphocyte ratio (NLR) >6.3 (OR = 2.28, 95% CI 1.5-3.4, p= 0.001);and systemic immune-inflammation index (SII) >1220 (OR= 1.2, 95% CI 1.01-2.1, p= 0.019). Among AKI survivors, 74 (91.36%) patients had renal recovery at discharge. Patients who recovered had median of NLR and SII on admission significantly lower than renal non-recovery and deceased patients, p < 0.001. Conclusion(s): NLR and SII are risk factors associated with AKI in addition to previous CKD, and admission to ICU. AKI is common among hospitalized patients with COVID-19, which is associated with higher mortality. The majority of AKI survivors at discharge recovered renal function. Further studies are needed to determine if lower levels of NLR and SII on admission are predictors of recovery of kidney function in patients with COVID-19.

HEALTHY BUILDINGS: A COMBINATION OF NATURE AND TECHNOLOGY CAN SECURE A SUSTAINABLE FUTURE

Can buildings be designed to provide people who work in close proximity to each other with physical and emotional comfort or safety, while minimizing the risk of increased viral infection? COVID-19 had a major impact on our country with increased infection rates/deaths, mask mandates, and building occupancy limitations. With the vaccine, mandates were relaxed, including building occupancy levels. Despite this progress, many people are still anxious to work in close proximity to each other in public buildings. This paper seeks to address how healthy building ideals can set the precedent for future public buildings. Healthy buildings are key to bringing back full access to positive communal interaction. Healthy buildings provide for human comfort via advanced building systems, sustainable design thinking, and the utilization low emissive natural materials. Technical innovation and mechanical stability, focusing on indoor air quality and low emissive materials, guarantee occupant safety, while safeguarding a sustainable future. The researcher’s proposition was explored through a graduate design thesis project. The building type utilized was a laboratory research center for contagious diseases. Pfizer, Moderna, and the Center for Virology and Vaccine Research were studied as precedents for their current practices related to viral infectious research. Drawing from nature, the geometry and molecular makeup of the atom was used to derive the building form. The design process focused on a combination of natural flora and sustainable technology to eliminate social and psychological fears, while facilitating the required security levels. The results are presented as both an architectural design proposition and related technical and statistical data for a net-zero design. The paper’s contention is that research design proposals of this nature help promote healthy building ideals, while ensuring a healthy sustainable future. © 2022 WIT Press.

Incidence and type of arrhythmias recorded by one-month continuous ECG monitoring in stroke patients

BACKGROUND The incidence of atrial fibrillation (AF) following stroke has been studied with implantable loop recorders. However, these devices do not record short lasting AF episodes (<30-120 seconds [s]). In addition, the incidence and type of other clinically relevant arrhythmias is poorly understood in this clinical setting. PURPOSE To evaluate the incidence, type and clinical relevance of arrhythmias detected by one-month continuous ECG monitoring in patients after cryptogenic stroke. MATERIAL AND METHODS Consecutive patients (p) with stroke and no previous AF or other cardioembolic or atheroembolic causes were prospectively enrolled in the study. An external wearable 2-lead ECG monitoring system (NUUBO) was used for 30 days (d) in all of them after the acute phase of the stroke. In the absence of documented AF, a parafibrillatory status was defined as >3000 atrial ectopic beats/d or >2 “micro AF” episodes (fibrillatory burst <30 s)/d or ≥1 episode of “micro AF” >14 s. RESULTS 130 p. were included in the study (age 73 ± 12, 57% males, 19% previous stroke, 7% ischemic cardiopathy, CHA2DSVA2Sc pre-stroke 3.1 ± 1.7). 3 were withdrawn from the study due to inadequate use (recording time <14 d) and 1 due to stroke during SARS-CoV2 infection. Total recording time was 28 ± 3 d, total analyzable ECG time was 23 ± 5 d. ECG monitoring was repeated in 12 (9.5%) p due to poor ECG quality in 6 p or high suspicion of AF despite an initial negative result in 6 p. AF >30 s was detected in a total of 27 (21.4%) p, average AF duration was 52 hours (range 30 s-22 d). AF >30s was detected in 2 (17%) p with repeated monitoring. All these patients were placed on anticoagulation. Sustained paroxysmal supraventricular tachycardia (SVT) was documented in 4 (4.4%) p without AF. All episodes of AF and SVT were asymptomatic. Mobitz I second degree AV block in 4 (3.2%) p. 3 (2.4%) p had a pacemaker implanted: 2 for severe sinus dysfunction and 1 for AV block. High-density ventricular ectopy (>3000/d) was present in 7 (6%) p and ≥1 episode of non-sustained ventricular tachycardia was detected in 26 (21%) p. A parafibrillatory status was identified in 27 (21%) p with no AF >30 s. At 1-year follow up 4/22 (18%) of patients with parafibrillatory status and 3/59 (5%) without parafibrillatory status suffered a new stroke (p = 0.08). CONCLUSIONS: AF and other potentially relevant arrhythmias are frequent after stroke and easily detectable with one-month non-invasive continuous ECG monitoring. Patients with a parafibrillatory status could benefit from longer monitoring time to detect AF.

Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. / Impacto de la pandemia de COVID-19 en la organización asistencial del ictus. Plan Ictus Madrid.

INTRODUCTION: The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. METHODS: We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). RESULTS: The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. CONCLUSIONS: The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.

Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations. / Atención al ictus agudo durante la pandemia por COVID-19. Recomendaciones Plan Ictus Madrid.

INTRODUCTION: The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals. METHODS: We conducted a non-systematic literature search using the keywords "stroke" and "COVID-19" or "coronavirus" or "SARS-CoV-2." Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee. RESULTS: These recommendations address 5 main objectives: 1) coordination of action protocols to ensure access to hospital care for stroke patients; 2) recognition of potentially COVID-19-positive stroke patients; 3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; 4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and 5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home). CONCLUSIONS: The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals.