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Introduction: The COVID-19 pandemic strained many aspects of daily life, and the propensity of the virus to spread rapidly affected the world, bringing both stress and psychological health problems throughout the world. This study aims to investigate the level of psychological issues and problems among the population during the COVID-19 pandemic. Methodology: This was a repeated cross-sectional study (N = 650) made of Pre-Pandemic (n = 338) and During-Pandemic COVID-19 (n = 312) samples conducted in Dardania (Kosovo) municipalities of Prishtina, Prizren, Ferizaj, Gjilan, Gjakova, Peja, Podujeva, Suhareka, Mitrovica, and Vushtrri. The study used both the Demographic Questionnaire and the General Health Questionnaire 28. Results: There was a significant difference between the two samples in psychological health problems in general (p = .001), as well as depression (p = .001), social dysfunction (p = .001), somatization (p = .001), anxiety and insomnia (p = .001) in particular. Furthermore, Chi-square analysis showed a very large effect size for participants' reported accidents, natural disasters, losing a loved one, chronic illnesses, displacement, Domestic violence, imprisonment, and especially divorce. Conclusion: The COVID-19 pandemic increased psychological health problems, and there is a need for the mobilization of psychological health experts to support and decrease the level of risk in the population in future times. © 2023 Hysenaj et al.
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Background: As autoimmune phenomena following anti-nSARS-CoV2 vaccine was reported in the healthy population, there is increasing concern in patients with infammatory joint diseases regarding possible side effects and disease fare-ups. Objectives: We set out to evaluate the possible risk of disease exacerbation and the predisposing risk factors for the fare up. Methods: This is a single center prospective cohort study, enrolling patients attending Arthritis Clinic at San Bortolo Hospital, during a follow-up of 12 months. All patients, after obtaining informed consent, answered a 24-item questionnaire including information about nSARS-CoV2 infection, vaccination, disease activity, ongoing treatment, vaccine side effects, disease fare up and need to change therapy. Results: A total of 109 patients, 60 (55.1%) females and 49 (44.9%) males with a mean age of 60.1 years ±12.6 SD were enrolled. Forty-three (39.5%) were affected by rheumatoid arthritis, 43 (39.5%) from psoriatic arthritis and 23 from anchylosing spondylitis. There were 19 (17.43%) nSARS-CoV2 infection, of them 3 (15.8%) need hospitalization. Ninety-five (87.2%) receive at least one shot of nSARS-CoV2 vaccine, of these 78 (82.1%) got three shots of vaccine. Vaccine-related side effects were reported in 36 (37.9%), of these 15 (41.7%) have fever, 14 (38.8%) arthralgia and 29 (80.5%) fatigue. No patients required medical attention. Twenty (21.05%) of patients who receive at least one vaccine shot experienced a fare up. Nine (45%) need to change therapy. The risk of fare up was signifcantly associated with low disease activity/active disease in the last 12 months, p=0.009;OD 4.0;95% CI: 1.5-11.3. Conclusion: Overall, the nSARS-CoV2 vaccine is well tolerated in patients with infammatory arthritis. The risk of disease fare is associated with active disease within the past 12 months. According to our results, the patients affected by infammatory arthritis in sustained remission have no reason to hesitate to get the nSARS-CoV2 vaccination.
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Background: Some reports of small vessel vasculitis following nSARS-CoV2 vaccination are reported in the literature (1, 2). Objectives: We purpose to report the case of small-medium vessel vasculitis after BNT162b2 (BioNTech/Pfzer) vaccination. Methods: We present the case of a 48 years old man with an unremarkable history who underwent BNT162b2 vaccination. Results: Five days after the frst shot of BNT162b2 vaccine, the patient refer the onset of left inguinal adenopathy, and erythematous dermatitis of the trunk. Ultrasound of the groin found increase bilateral inguinal lymph nodes with reactive characters. Contextually, erythematous, itchy and painful nodular lesions appear in the lower and upper limbs as well as acrocyanosis and paresthesia in the right hand and foot. The tests performed showed thrombocytopenia and eosinophilia. While, CRP, search for fecal parasites, pANCA, cANCA, ANA, RAST test, serum tryptase were all absent. Haematological evaluation, bone marrow biopsy, karyotype and molecular biology (FIP1L1/PDGFRa), were performed, all results negative. The patient was admitted in Internal Medicine ward for worsening of skin lesions and of acrocyanosis with gangrenous lesions at the tips of the fourth fnger of the right hand. An angio-CT showed an occlusion of the right ulnar artery. At electromyography an axonal sensory neuropathy was found. The skin biopsy showed fbrinoid necrosis of venules of the superfcial vascular plexus associated with numerous eosinophils, lymphocytes and karyorrhetic debris (Figure 1). High-resolution CT scan described diffuse minimal accentuation of the interstitial texture with micronodular aspects and some ground glass appearance. The diagnosis of hypereosinophilic syndrome was made. Therapy with Methylprednisolone 500 mg/daily for 3 days then Prednisone 1 mg/kg daily in association with IL-5 inhibitor (mepolizumab) with good clinical response, in addition to anticoagulation with warfarin was started. Conclusion: To our knowledge this might be the frst case of (HES) following COVID vaccine. As our experience, due to the short commercialization of anti-nSARs-CoV2 vaccines, is limited further studies are needed to explore the possible effect on small-medium vessels.
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Background: Mixed cryoglobulinaemic vasculitis (MCV) is an immune-complex-mediated systemic vasculitis characterized by heterogeneous clinical manifestations mainly involving skin, kidney and peripheral nervous system. Despite reassuring safety data from EULAR Coronavirus Vaccine (COVAX) physician-reported registry, a signifcant proportion of patients with autoimmune diseases reported unwillingness to get vaccinated against SARS-CoV-2 infection in the preliminary results of the COVAD study, due to concerns about the lack of longterm safety data, and fear of associated side effects and disease fare. Objectives: Aims of this multicentre Italian study were to investigate the prevalence of vaccination against SARS-CoV-2 in Italian population of MCV patients, to explore the reason for the missed vaccination, and to investigate short and long-term side effects of the vaccine, including vasculitis fare. Methods: All MCV patients referring to 12 Italian centres were investigated about vaccination and possible both short-(within 48 hours) and long-term (within 30 days) adverse events (AE), classifed according to FDA Toxicity Grading Scale for preventive vaccine clinical trials, and possible disease fares. Patients with MCV related to lymphoproliferative disorders or connective tissue diseases were excluded from the study. The baseline variables were expressed as percentages or mean±standard deviation. The differences between continuous variables were analysed using the Mann-Whitney nonparametric test. The chi-squared test, or Fischer's exact when appropriate, were used for categorical variables (absolute numbers and percentages) regarding baseline characteristics. Results: A total of 416 patients, 69.2% females and 30.8% males, with a mean age of 70.4±11.7 years, were included in the study. Only 7.7% of patients were not vaccinated, mainly for fear of adverse events (50%) or for medical decision (18.8%). Corminaty was the vaccine most frequently used (80.5%). Interestingly, 6 patients (1.44%) were with a heterologous vaccination (usually AstraZeneca-Corminaty). Considering ongoing treatment, not vaccinated subjects were more frequently treated with chronic glucocorticoid therapy and/or Rituximab (p=0.049 and p=0.043 respectively). AE were recorded in 31.7% of cases, mainly mild and self-limiting (grade 1). More severe adverse events, such as fare of vasculitis, were observed in 5.3% of cases. AE were not associated with the kind of vaccine used and with the clinical manifestations of vasculitis. Patients with active MCV showed a lower frequency of short-term (within 48 hours) adverse events, but patients affected by peripheral neuropathies or skin vasculitis frequently showed a fare of their symptoms, recorded in 40% and 25% of cases, respectively. Finally, patients under glucocorticoid treatment were more prone to develop a vasculitis fare within a month after vaccination. Conclusion: Vaccination in MCV patients has been performed in a high percentage of patients showing a good safety. Other than patients' fear, treatments with rituximab and glucocorticoids are the main reasons for delaying vaccination, and it should be considered by the physician before starting therapy. Vasculitis fares were observed in about 5% of cases, in line with that observed in other autoimmune diseases. Specific attention should be reserved to people with purpura or peripheral neuropathy, for the increased risk of exacerbation of their symptoms.
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Introduction: In Antiphospholipid Syndrome (APS) myocardial tissue can be involved through immune-mediated or thrombotic mechanisms, giving chest pain and increase of myocardial cytolysis markers. This may occur without any signs of myocardial injury at the moment of echocardiography, coronarography and cardiac magnetic resonance (CMR). The aim is to increase the awareness about this life-threating condition.Case summary. We present the case of 26-year-old woman few days after childbirth, affected by APS in anticoagulant therapy with previous deep vein thrombosis and without any other cardiovascular risk factors. She was symptomatic for intermittent chest-epigastric pain, fever and skin livedo reticularis. Lab Tests: TnI 750 ng/L, C-reactive protein 9.6 mg/dL, D-dimer 1693 μg/L;anemia;Antithyroid Antibodies and ANA 1:160 (SSB/LA). Blood cultures and COVID test were negative.Results. Echocardiography showed normal left/right ventricular function, but minimal pericardial effusion was present. Pulmonary Angio-CT revealed small thromboembolic event, ground-glass lungs compatible with hemorrhagic alveolitis.After a few days, the patient presented increased epigastric pain, headache, vomiting up to presenting a comatose state. Thrombotic or hemorrhagic events with cerebral CT and MR were excluded. Total-body CT was negative, except for peri-splenic and recto-uterine pouches.For the increase of TnI up to 4741 ng/L, the patient underwent coronary angiography which demonstrated non-obstructive coronary arteries. The assembled Neuro-Cardio-Rheumatology team suspected a rapidly developing Catastrophic APS which was developing quickly with multi-organ and life-threatening involvement.The patient underwent 4 cycles of plasmapheresis, intravenous human IgG and corticosteroids, with rapid clinical improvement. CMR subsequently demonstrated a small transmural late enhancement area on lateral left ventricle wall.The patient was discharged from the hospital on Day 6 post- therapies.Conclusions. APS may involve more organs, including myocardial tissue with different mechanisms of damage and high mortality rate. The presented case poses a multidisciplinary challenge, because thrombotic multiorgan microangiopathy may be not always diagnosed. Imaging methods such as CMR could be optimized with adenosine stress-CMR. Clinical attention is required among women with APS, to reach early diagnosis of myocardial thrombotic microangiopathy and to establish the best effective treatment.
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Introduction: Sweet syndrome (SS) is a rare skin disease, characterized by rapid onset of plaques or nodules with extensive infiltration of neutrophils into epidermidis and dermis. Three main types of SS are known: classical or idiopathic, malignancy-associated, drug-induced. Case report: A 69 yo woman was admitted because of recent pirexya, painful and asymmetric erythematous plaques on legs and buttock, painful wrist and elbow tenderness for 6 days. History: hypertension and dyslipidemia. Eighteen days before she received Vaxzevria first dose. Physical examination revealed normal findings except of skin lesions. Biohumoral exams showed increased CRP, normal GB count;negative SARS-CoV-2 test, as well as HBV, HCV, CMV, EBV, Quantiferon, ANA, ANCA, LAC. C3 and C4 were normal. Blood and skin coltures were negative. Chest X-ray, ECG, ecocardiography, EGDS, colonscopy, PET TC were all normal. A broad spectrum antibiotic and anti-inflammatory therapy was initially set (vasculitis vs staphylococcus infection). Skin biopsy was performed: it showed a dense interstitial neutrophilic infiltrate of the dermis, according with SS. Corticosteroid therapy caused a prompt improvement of skin lesions. Conclusions: A classical SS induced by SARS-CoV-2 vaccine was diagnosed at the discharge. A vaccine-associated SS is well known: some post CoViD and post mRNA SARS-CoV-2 vaccine SS are described in literature. This is probably the first case of a SS induced by SARS-CoV-2 adenovirus vaccine. An alert was sent to AIFA.
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Introduction: In this study, we investigated the sources of information that have had the highest impact on Kosovans’ compliance with preventive measures against COVID-19. Methods: We recruited 744 participants, aged 18-35, to participate in this cross-sectional survey between 27th April and 5th May 2020, utilising an online questionnaire. Results: Our findings show that public health experts had the greatest influence in persuading citizens to obey the recommendations, with 63.2% (470) compliance, followed by family members, with 18% (134), and health workers, with 10.2% (76). Conclusion: Our study has shown that public health experts have had the greatest impact on Kosovo citizens, persuading them to follow recommendations designed to prevent the spread of COVID-19.