Health-Related Quality of Life and Depressive Symptomatology in High School Students during the Lockdown Period Due to SARS-CoV-2.

The objectives of this study were to evaluate and compare the prevalence of health-related quality of life and depressive symptomatology in high school students during the lockdown period due to the SARS-CoV-2 pandemic. A cross-sectional survey was conducted with students attending the High School Education System of the University of Guadalajara, Jalisco, México. Through a Google Forms survey, students answered their perceptions of health-related quality of life and depressive symptomatology. The outcome variable was the presence of depressive symptoms, assessed using the Children's Depression Inventory (CDI). Cronbach's alpha coefficient was 0.8 in both surveys. A total of 1446 students participated (women, 64.9%; mean age of 16.1 ± 0.9 years). Among the students, 22% manifested clinical depressive symptoms (24.4 ± 5.0), and males showed lower scores on health-related quality of life and depressive symptoms (44.9 ± 11.9, p = 0.005) (12 ± 7.7, p = <0.001) compared to their female peers (45.2 ± 10.6, p = 0.005) (13.7 ± 7.5, p = <0.001), respectively. During the lockdown due to the SARS-CoV-2 pandemic, a high prevalence of depressive symptomatology was identified in our students with in addition to a low perception of health-related quality of life in dimensions, mood and emotions, and peers and social support.

Role of targeted therapies in rheumatic patients on COVID-19 outcomes: results from the COVIDSER study.

OBJECTIVES: To analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases. METHODS: The COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed. RESULTS: A total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients' hospitalisation. CONCLUSIONS: The use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.

SARS-CoV-2-specific T-cell responses after COVID-19 recovery in patients with rheumatic diseases on immunosuppressive therapy.

BACKGROUND: In patients with immune-mediated rheumatic diseases (RMD), the development of T-cell responses against SARS-CoV-2 may be impaired by either the immune disturbances associated with the disease, or by the effects of immunosuppressive therapies. We aimed at determining the magnitude of SARS-CoV-2-specific interferon (IFN)-γ-producing T-cell response after COVID-19 recovery in a cohort of patients with RMD on different immunosuppressive therapies. PATIENTS AND METHODS: 53 adult patients with inflammatory or autoimmune RMD and 61 sex and age-matched non-RMD patients with confirmed COVID-19 were included. Peripheral blood mononuclear cells were obtained and T-cell-IFN-γ antigen-specific responses against the S1 domain of the spike glycoprotein, the nucleoprotein (N) and the membrane (M) protein from SARS-CoV-2 were assessed by FluoroSpot assay. RESULTS: Patients with RMD and COVID-19 showed positive T-cells-IFN-γ responses to SARS-COV-2 antigens, in a similar proportion and magnitude as non-RMD patients at a median of 298 [151-316] and 165 [162-167] days after COVID-19 respectively. Among RMD patients 83%, 87% and 90%, and among non-RMD patients, 95%, 87% and 93% responded to S1, N and M protein respectively. Similar responses were observed in the different diagnostic and therapeutic groups, including conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), TNF-α inhibitors, IL-17 inhibitors, rituximab, JAK inhibitors or other immunosuppressants. CONCLUSION: T-cell responses to the main SARS-CoV-2 antigens are present after COVID-19 recovery in most patients with RMD and are not impaired by immunosuppressive therapies.

SARS-CoV-2-reactive interferon-γ-producing CD8+ T cells in patients hospitalized with coronavirus disease 2019.

There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) T-cell immune responses in patients with coronavirus disease 2019 (COVID-19). Both CD4+ and CD8+ T cells may be instrumental in resolution of and protection from SARS-CoV-2 infection. Here, we tested 25 hospitalized patients either with microbiologically documented COVID-19 (n = 19) or highly suspected of having the disease (n = 6) for presence of SARS-CoV-2-reactive CD69+ expressing interferon-γ (IFN-γ) producing CD8+ T cells using flow-cytometry for intracellular cytokine staining assay. Two sets of overlapping peptides encompassing the SARS-CoV-2 Spike glycoprotein N-terminal 1 to 643 amino acid sequence and the entire sequence of SARS-CoV-2 M protein were used simultaneously as antigenic stimulus. Ten patients (40%) had detectable responses, displaying frequencies ranging from 0.15 to 2.7% (median of 0.57 cells/µL; range, 0.43-9.98 cells/µL). The detection rate of SARS-CoV-2-reactive IFN-γ CD8+ T cells in patients admitted to intensive care was comparable (P = .28) to the rate in patients hospitalized in other medical wards. No correlation was found between SARS-CoV-2-reactive IFN-γ CD8+ T-cell counts and SARS-CoV-2 S-specific antibody levels. Likewise, no correlation was observed between either SARS-CoV-2-reactive IFN-γ CD8+ T cells or S-specific immunoglobulin G-antibody titers and blood cell count or levels of inflammatory biomarkers. In summary, in this descriptive, preliminary study we showed that SARS-CoV-2-reactive IFN-γ CD8+ T cells can be detected in a non-negligible percentage of patients with moderate to severe forms of COVID-19. Further studies are warranted to determine whether quantitation of these T-cell subsets may provide prognostic information on the clinical course of COVID-19.

Stroke and COVID-19: A review of observational studies published during the pandemic

RESUMEN INTRODUCCIÓN: En marzo 2020 la Organización Mundial de la Salud decretó la pandemia por covid-19. Se han informado casos de ACV relacionados con esta infección viral. OBJETIVOS: Conocer la experiencia de diferentes partes del mundo respecto al ACV y covid-19 con el fin de mejorar el reconocimiento y saber qué hacer cuando se empiecen a presentar estos pacientes en nuestro medio. MÉTODOS: Se hizo una revisión de los estudios observacionales disponibles utilizando PubMed, Scopus, así como otras fuentes de literatura gris para las publicaciones sobre ACV y covid-19. Se identificaron datos demográficos, tiempo de aparición del ACV desde el diagnóstico de covid-19. Principales hallazgos radiológicos, laboratorios y pronóstico. RESULTADOS: Se obtuvieron ocho estudios, con 43 sujetos que tuvieron ACV isquémico e infección por SARS-CoV-2. La edad promedio fue de 67,4 años, siendo en su mayoría hombres (58,1%).Un hallazgo importante fue el número de casos de ACV con oclusión de vaso grande en 22 de 31 casos reportados (71%). La mediana de NIHSS fue de 14,5 puntos. Se presentó una mortalidad del 27,5% de los sujetos con ACV El estadio más frecuente por covid-19 fue el de condición severa 58,3%. La aparición del ACV luego de la infección por SARS-CoV-2 fue de 10,6 días en promedio. En los laboratorios se identificó una elevación del fibrinógeno (92%), dímero-D (76%) y LDH (82%) respectivamente. El tratamiento recibido de forma más frecuente para el ACV fue la antiagregación, en 51%, mientras que las terapias de reperfusión se hicieron en el 30% de los casos. La mayoría de los pacientes (93%) presentaron síntomas de covid-19, solo 3 pacientes (7%) no presentaron síntomas típicos de esta enfermedad, sin embargo tuvieron alteración del estado de conciencia asociado al ACV CONCLUSIÓN: Los estados de inflamación e hipercoagulabilidad que se presentan durante la infección por SARS-CoV-2 probablemente están en relación con el desarrollo de ACV, lo cual en este caso podrá explicar el gran número de oclusiones de vaso grande. Los marcadores de inflamación generalmente están presentes. Establecer códigos protegidos de ACV es una medida a efectuar en nuestro medio. SUMMARY INTRODUCTION: In March 2020, COVID-19 was declared a pandemic by the World Health Organization and cases of stroke related to the virus soon were reported. OBJECTIVES: To become aware of the experiences different parts of the world have encountered with stroke and COVID 19 in order to enhance our knowledge, improve recognition and response to patients in our clinical setting. METHODS: A review of the available observational studies was done using PubMed, Scopus and other sources of gray literature for the publications on stroke and COVID-19. Demographic data, time of stroke onset since the diagnosis of COVID-19, main radiological findings, lab tests and prognosis were identified. RESULTS: Eight studies were selected with 43 subjects who had ischemic stroke and SARS-CoV-2 infection. The average age was 67.4 years, being mostly men (58%). An important finding was the number of stroke cases with large vessel occlusion, with 22 of 31 cases reported (71%). The NIHSS median was 14.5 points, and 27.5% of subjects with stroke and COVID-19 died. The most frequent disease severity for COVID-19 was "severe", accounting for 58% of the cases. The onset of stroke after SARS-CoV-2 infection was 10.6 days on average. In the laboratories an elevation of fibrinogen (92%), D-Dimer (76%) and LDH (82%) were respectively identified. The most frequent treatment received for stroke were antiplatelet medications (51%), while reperfusion therapy was done in 30% of cases. Most patients presented to the hospital with typical symptoms of COVID-19 (93%), (7%) 3 patients did not have respiratory symptoms, however they presented with a decreased level of consciousness associated with stroke findings. CONCLUSION: Inflammation and hypercoagulability, both present during the infection by SARS-CoV-2, are probably related to the development of a stroke, which in this case could explain the large number of large vessel occlusions. Protected stroke code is a protocol that should be implemented in our region.

Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study.

OBJECTIVES: The impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here, we compare the outcomes of a cohort of patients with rheumatic diseases with a matched control cohort to identify potential risk factors for severe illness. METHODS: In this comparative cohort study, we identified hospital PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or connective tissue diseases (CTDs). Non-rheumatic controls were randomly sampled 1:1 and matched by age, sex and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, intensive care unit admission or serious complications. We assessed the association between the outcome and the potential prognostic variables, adjusted by COVID-19 treatment, using logistic regression. RESULTS: The cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 (IQR 53-78) years and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and CTD (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID-19 was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID-19 were increased age (OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21 to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30). CONCLUSION: In hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.

Stroke and COVID-19: A review of observational studies published during the pandemic ACV y covid-19: una revisión de los estudios observacionales publicados en época de pandemia / Stroke and COVID-19: A review of observational studies published during

SUMMARY INTRODUCTION: In March 2020, COVID-19 was declared a pandemic by the World Health Organization and cases of stroke related to the virus soon were reported. OBJECTIVES: To become aware of the experiences different parts of the world have encountered with stroke and COVID 19 in order to enhance our knowledge, improve recognition and response to patients in our clinical setting. METHODS: A review of the available observational studies was done using PubMed, Scopus and other sources of gray literature for the publications on stroke and COVID-19. Demographic data, time of stroke onset since the diagnosis of COVID-19, main radiological findings, lab tests and prognosis were identified. RESULTS: Eight studies were selected with 43 subjects who had ischemic stroke and SARS-CoV-2 infection. The average age was 67.4 years, being mostly men (58%). An important finding was the number of stroke cases with large vessel occlusion, with 22 of 31 cases reported (71%). The NIHSS median was 14.5 points, and 27.5% of subjects with stroke and COVID-19 died. The most frequent disease severity for COVID-19 was "severe", accounting for 58% of the cases. The onset of stroke after SARS-CoV-2 infection was 10.6 days on average. In the laboratories an elevation of fibrinogen (92%), D-Dimer (76%) and LDH (82%) were respectively identified. The most frequent treatment received for stroke were antiplatelet medications (51%), while reperfusion therapy was done in 30% of cases. Most patients presented to the hospital with typical symptoms of COVID-19 (93%), (7%) 3 patients did not have respiratory symptoms, however they presented with a decreased level of consciousness associated with stroke findings. CONCLUSION: Inflammation and hypercoagulability, both present during the infection by SARS-CoV-2, are probably related to the development of a stroke, which in this case could explain the large number of large vessel occlusions. Protected stroke code is a protocol that should be implemented in our region.