ABSTRACT
The Health Sciences Foundation has assembled a multidisciplinary group around a series of questions about the impact of the COVID-19 pandemic on the mental health of the general population and specific groups within that population, particularly healthcare workers. In the general population, the most prevalent mental disorders have been anxiety, sleep disorders and affective disorders, primarily depression. There has been a considerable increase in suicidal behavior, especially in young women and men over 70 years of age. There has been an increase in alcohol abuse and nicotine, cannabis and cocaine use. In contrast, the use of synthetic stimulants during periods of confinement has decreased. With regard to non-substance addictions, gambling was very limited, pornography consumption increased significantly and there was an increase in compulsive shopping and the use of video games. Particularly vulnerable groups include adolescents and patients with autism spectrum disorders. Healthcare workers suffered an increase in depression, anxiety and post-traumatic stress, especially those who were exposed during the early stages of the pandemic. Female sex, being a nurse, proximity to patients with COVID-19, working in a rural environment and having previous psychiatric or organic illnesses were some of the most frequently repeated factors in various studies in this population group. The media have shown a good degree of knowledge about these problems and have dealt with them frequently and from the point of view of ethics, crisis situations, such as the one experienced, have triggered not only physical but also moral claudications.
Subject(s)
COVID-19 , Male , Adolescent , Humans , Female , Aged , Aged, 80 and over , Mental Health , Pandemics , SARS-CoV-2 , Population Groups , Health PersonnelABSTRACT
Introduction: Most reports related to humoral immune response to COVID 19 vaccines in people with Multiple Sclerosis (pwMS) were performed on mRNA-based vaccines. Objective(s): to analyze the longitudinal humoral immune responses to adenovirus-based vaccines (Sputnik V and AZD1222) in pwMS under different diseases modifying therapies (DMTs) Methods: IgG anti- SARS-COV-2 spike titers in a cohort of 101 pwMS and 28 healthy controls (HC) were measured 6 weeks after vaccination using the COVID-AR kit according to the manufacture instructions. Both patients and controls received two or three doses of Sputnik, AZD1222 or a mixed schedule (MS) of both vaccines. The neutralizing capacity was evaluated by measuring antibody neutralizing titers using SARS COV-2 pseudotyped particles. Result(s): 60.5% of pwMS were female, mean EDSS: 2.49 +/-1.5, age: 36.6 +/-10.7, disease duration 7.6 +/- 5.1 years. DMTs: 45 pwMS were under fingolimod, 23 under dimethyl fumarate, 14 under cladribine and 19 under antiCD20 monoclonal antibodies. Vaccines: 35.7% Sputnik V, 51.9% AZD1222 and 12.4 % MS. No antibody response to a 2nd dose was found in 41.3% of pwMS under fingolimod and 73.6% under antiCD20. We found a correlation between lower lymphocyte count and lower antibody titers in pwMS under fingolimod (r: 0.67, 95% CI: 0.46-0.81, p=<=0.0001). A correlation was also found between the antibody titer and the last dose of antiCD20 (r: 0.49, 95% CI: 0.03-0.7, p=0.03). In March 2022, 57 pwMS received their 3nddose, 6 patients under fingolimod and 7 under antiCD20 remained without any antibody response. We did not find differences in the neutralization capacity with different DMT and or vaccines. Multivariate regression analysis showed antiCD20 (beta= -,349, 95% CI: -3655.6-369.01, p=0.017) and fingolimod (beta=-,399, 95% CI: -3363.8-250.9, p=0.023) treatments as independent factor associated with low antibody response (r2 adjusted=0.157). Conclusion(s): This is the first report of longitudinal humoral immune response of patients under adenovirus-based vaccines, specially Sputnik V, that demonstrate that these vaccines have similar results to those obtained with mRNA-based vaccines.
ABSTRACT
Introduction: Multiple Sclerosis (MS) is a disabling chronic disease with clinical heterogeneity and uncertain prognosis. Evaluating the health-related quality of life (HRQoL) of patients is important for the multidisciplinary therapeutic approach including physical, psychic and social aspects that influence the wellbeing of people with consequences in the course of the disease. As of March 2020 due to the Coronavirus 2019 (COVID-19) pandemic and quarantine measures, habits and access to the health system have been substantially modified. Objective(s): Our aim was to evaluate depression level and HRQoL of MS patients and compare this results with pre-pandemic assessment (2019). Patients and Methods: A cross-sectional study was conducted between March and July 2021. Measuring instruments: Clinical, HRQoL: Multiple Sclerosis International Quality of Life questionnaire (MusiQol), Depression: Beck Depression Inventory II (BDI-II), and pandemic-related aspects using a ad-hoc questionnaire. The results of MusiQol and BDI-II were compared with those obtained from the 2019 evaluations. Parametric and nonparametric statistics were used, to define significance a value of p <0.05 was accepted. Result(s): We evaluated 62 patients. In the comparative analysis with 2019, a significant decrease in HRQoL was observed (z=- 2.21, p=0.03). The affected domains were activities of daily living, psychological well-being, and sexual and sentimental life. In contrast, no significant changes were observed in the assessment of depression using BDI-II (z=-0.39, p=0.69). Conclusion(s): HrQoL of MS patients is decreased compared to 2019. The pandemic itself, health and quarantine measures have negatively impacted on HRQoL, substantially impairing patients' performance in activities of daily living, psychological wellbeing, and sexual and sentimental life.
ABSTRACT
Introduction: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that is usually considered a monophasic disease. Postvaccination ADEM has been associated with several vaccines, however there is scarce information related to SARS-CoV-2 vaccines. We report the case of a 26-year-old female who suffered from ADEM four weeks after Gam-COVID-Vac administration. Method: Case report. Result: A 26-year-old female was admitted after 10 days of temporal spatial disorientation, inappropriate behavior and headache. She reported no upper respiratory infection or diarrhea and she has no significant medical history. Four weeks prior admission she received a first dose of Gam-COVID-Vac vaccine (human adenovirus viral vector). Neurological examination showed failure cognitive function in attention, deferred memory, orientation, visuospatial and language. Montreal Cognitive Assessment (MoCA) 12/30. Also right upper limb weakness and gait ataxia was noted. Her brain magnetic resonance imaging showed widespread abnormal signals on FLAIR images with ring enhancement pattern. Analysis of cerebrospinal fluid was normal and oligoclonal bands were positive. Anti-aquaporin-4 and anti-myelin oligodendrocyte glycoprotein were negative, also infectious diseases were ruled out. ADEM was suspected and she was treated with intravenous Methylprednisolone with partial recovery. MoCA at 30 days was 24/30. A brain biopsy confirmed a perivascular demyelination and reactive astrocytosis. Conclusion: Our patient met the ADEM diagnostic criteria set by the International Pediatric MS Study Group and alternative diagnoses were excluded. Although a plausible relationship was not demonstrated, the possibility of an association with vaccine is suspected.