ABSTRACT
Objetivos: O objetivo do estudo foi determinar a incidencia de possiveis reinfeccoes por SARS-CoV-2 em doadores de sangue de um hemocentro publico referencia da Organizacao Pan-Americana de Saude, localizado no estado de Sao Paulo. Material e Metodos: O presente trabalho utilizou os dados de um estudo de coorte prospectivo, com a coleta de amostras de sangue e saliva de 152 doadores de sangue, no periodo de julho de 2021 a janeiro de 2022. Desse total, 107 sao casos que tiveram sorologia previa positiva para SARS-CoV-2 e 45 sao controles negativos. Os participantes foram acompanhados em quatro visitas ao hemocentro, a cada dois meses, para a coleta de amostras e relatos de sintomas e vacinacao. Posteriormente, foram realizados testes sorologicos e RT-PCR em tempo real para deteccao de SARS-CoV-2 em todas as amostras. Resultados: Dos 152 participantes, 13 (8,6%) apresentaram resultados de RT-PCR positivos para SARS-CoV-2, sendo observado 7 casos de possiveis reinfeccoes e 6 casos recem-infectados. Avaliando apenas os participantes positivos, 8 (61,5%) sao do genero feminino e 5 (38,5%) do genero masculino. 100% dos participantes positivos alegaram estarem vacinados com ao menos duas doses da vacina para COVID-19, 2 (15,4%) declararam sintomas de COVID-19 durante a coleta de amostras, enquanto 11 (84,6%) negaram a presenca de sintomas. Com relacao a faixa etaria dos participantes infectados, 2 possuiam de 19-28 anos, 4 de 29-38 anos, 3 de 39-48 anos, 3 de 49-58 anos e 1 doador de 62 anos. Discussao: Foi evidenciado a possivel reinfeccao por SARS-CoV-2 em 7 participantes, como tambem 6 novas infeccoes nos casos controle. Tal achado, associado com o fato de que todos os participantes positivos estavam vacinados no periodo em que as amostras foram coletadas, sugere a tendencia de que mesmo com a vacinacao ainda e possivel infectar-se pelo virus, alem de que a infeccao previa nao confere imunidade duradoura, o que foi constatado tambem em outros estudos. Todavia, e interessante destacar que a maioria dos participantes infectados foram assintomaticos (84,6%), o que propoe que a vacinacao promove a diminuicao da gravidade dos casos. Os nossos achados tambem demonstraram que nas faixas etarias de 29 a 59 anos houveram mais participantes infectados, sendo justamente as faixas etarias expostas a situacoes de risco, possivelmente devido a necessidade de locomocao e trabalho. Ademais, o numero apresentado de casos positivos pode ser em razao da diminuicao das restricoes de distanciamento social. Conclusao: As nossas analises, apesar de apontarem para o surgimento de novos casos de SARS-CoV-2 na populacao estudada, confirmaram o importante papel da vacinacao, visto que foi observado a diminuicao de individuos sintomaticos e casos graves. Por fim, em nossos resultados preliminares foram constatadas provaveis reinfeccoes pelo virus, nas quais serao necessarios testes adicionais para confirmacao desse achado. Copyright © 2022
ABSTRACT
Background: The COVID-19 pandemic, with its uncertainties, fears of contagion, mass lockdowns and containment measures, has dramatically impacted on people's everyday lives leading to an increased risk of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD). Despite evidence in general population and healthcare workers1,2, scant data emerged on vulnerable populations, such as of patients with chronic illness, particularly rheumatic and musculoskeletal diseases (RMDs)3,4, who also underwent difficulties in the management and treatment of their disorders. Objectives: To assess PTSD and post-traumatic stress symptoms in a sample of patients with RMDs, during the COVID-19 pandemic in Italy. Methods: PERMAS is a monocentric prospective observational study led by the Rheumatology Unit, the Psychiatric Clinic and the Institute of Management of the School of Advanced Studies. Patients with a RMD diagnosis, were consecutively enrolled from May 2021 to January 2022. During the visit, sociodemographic characteristics and psychopathological data were collected through online survey, whereas clinical data were collected by physician. The survey included the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), aimed to assess symptomato-logical PTSD and post-traumatic stress symptoms related to the impact of the COVID-19 pandemic. Results: A total of 194 eligible patients, with a mean age of 50.3±12.17 years, was included: 142 (73.19%) were females;112 (57.74%) patients reported connective tissue diseases (CTD), 63 (32.47%) arthritis and 19 (9.8%) vasculitis. A total of 33 (17%) subjects reported a symptomatological PTSD by means of the TALS-SR. The prevalence of Partial PTSD (defned by at least 2 out of the 4 criteria for DSM-5 diagnosis of the disorder) was 56.7%, with signifcant higher rates among females (90, 81.8%) with respect to males (20, 18.2%) (p=.013). Accordingly, a IES-R mean total score of 21.90 ±15.98 was found in the total sample and a gender difference emerged, with higher mean scores among females rather than males (23.42 ±16.26 vs 21.90 ±15.98, p=.031). Conclusion: The present fndings point out high prevalence rates of symptoma-tological PTSD among patients suffering from RMDs, highlighting the potentially traumatic burden of the COVID-19 pandemic in this particular population, especially among females, suggesting the need of further investigations to address tailored prevention and intervention strategies.
ABSTRACT
Background: Management of the health emergency caused by COVID-19 pandemic majorly disrupted the delivery of healthcare services to patients with chronic conditions like Systemic Autoimmune Diseases (SAD), both because resources were mainly channeled towards the care of infected patients, but also because patients tended to avoid seeking medical care for fear of becoming infected. PER-MAS is a 2-year project aimed at assessing the clinical, psychopathological, and socio-economic impact of COVID-19 in a cohort of patients with SAD. Objectives: To assess the impact of COVID-19 pandemic on drug withdrawal, disease fares and hospitalizations for disease exacerbation in a cohort of patients with SAD through an interim analysis of data from the PER-MAS project. Methods: A sample of 214 consecutive patients was recruited in a reference center for rare and complex autoimmune diseases from April 2021 to January 2022. Inclusion criteria were definite diagnosis of SAD (Connective Tissue Disease (CTD), Inflammatory Arthritis (IA) or Vasculitis), regular follow-up and at least 2 years of disease. Patients were asked to fill out an extensive self-administered questionnaire on disease activity and healthcare resource use during the pandemic (March 2020-moment of assessment). Pre-pandemic (March 2019-February 2020) and early pandemic (March 2020-February 2021) clinical data were recorded through retrospective chart review and patient interview. Results: At enrolment, 119 patients were affected by CTDs (55.6%), 71 by IA (33.18%), 24 by vasculitis (11.21%), with mean age 50.44± 12.97, and mean disease duration 11.17 ± 8.94. 30.37% took steroids, 39.7% hydroxy-chloroquine, 61.68% DMARDs, and 9.3% vasoactive drugs. Overall, disease course was similar in pre-pandemic and early pandemic phase: in the first period, rheumatologic condition was stable in 57.35% of patients, persistently active in 27.3% and 35.61% had ≥ 1 episode of disease exacerbation (mean 0.665±1.15, range 0-6);in the second period, 60.56% of patients was stable, 24.88% persistently active, and 39.44% had ≥1 exacerbation (mean 0.49 ±0.77, range 0-4). Mean number of visits (2.56±2.57 and 2.61±2.79), hos-pitalizations (0.168±0.698 and 0.14±0.473, p=0.6), number of patients with outpatient visits=0 (7.47 vs 7%), and number of patients with ≥ 1 hospital admission (10.28 vs 11.6%) were also similar, while the number of patients with hospital admissions for disease exacerbation was significantly higher in the second period (6.1 vs 11.21%, p=0.001). 170 patients completed the survey: from March 2020 to enrolment, 18.2% suspended ≥1 anti-rheumatic drug (6.25% of them for fear of contracting COVID-19 disease, 15.6% for difficulty in obtaining medications), 20% self-managed ≥ 1 disease exacerbation, and 40% had ≥ 1 telemedicine consult. From March to July 2020, 41.76% had their visit rescheduled (35.23% for hospital access restrictions, 5.3% for travel restrictions, 1.17% for fear). Conversely, only 14.7% of patients had their visit rescheduled (8.23% for hospital access restrictions, 4.7% for other reasons) from July 2020 to enrolment. Conclusion: In the early pandemic phase, overall disease course was similar to the pre-pandemic phase, but we observed an increase in the number of patients with ≥ 1 hospitalization for disease. Moreover, despite our efforts, patients reported a non-negligible rate of drug discontinuation for non-medical indication and difficulty to get access to rheumatologic consultation, highlighting the need of alternative organizational models in case of future pandemics.
ABSTRACT
In order to address the main challenges related to the rare diseases (RDs) the European Commission launched the European Reference Networks (ERNs), virtual networks involving healthcare providers (HCPs) across Europe. The mission of the ERNs is to tackle low prevalence and RDs that require highly specialised treatment and a concentration of knowledge and resources. In fact, ERNs offer the potential to give patients and healthcare professionals across the EU access to the best expertise and timely exchange of lifesaving knowledge, trying to make the knowledge travelling more than patients. For this reason, ERNs were established as concrete European infrastructures, and this is particularly crucial in the framework of rare and complex diseases in which no country alone has the whole knowledge and capacity to treat all types of patients. It has been five years since their kick-off launch in Vilnius in 2017. The 24 ERNs have been intensively working on different transversal areas, including patient management, education, clinical practice guidelines, patients' care pathways and many other fundamental topics. The present work is therefore aimed not only at reporting a summary of the main activities and milestones reached so far, but also at celebrating the first 5 years of the ERN on Rare and Complex Connective Tissue and Musculo-skeletal Diseases (ReCONNET), in which the members of the network built together one of the 24 infrastructures that are hopefully going to change the scenario of rare diseases across the EU.