ABSTRACT
Introduction: Reports of reinfection in immunocompromised patients increased concern regarding multiple sclerosis (MS) patients since they are mostly on immunosuppressant agents. Objective(s): to compare the risk of reinfection between multiple sclerosis (MS) patients and a control group without MS. Aim(s): Measure the rate of possible reinfection among MS patients and control, protection against reinfection, odd of reinfection among those who previously tested positive;and effect of rituximab on the protection Method: In thisretrospective study, data of all SARS-CoV-2 tests (n=793,301) and almost all MS patients (n=10639) in Isfahan province were collected from January 01, 2020 to August 22, 2021. Of the 2196 MS patients and 793,301 persons from the general population who had been tested at least once, 3 control for each MS patient were identified, leaving 1560 MS patients and 4680 controls without MS. We compared the risk of reinfection after 90 days of a primary infection between those with and without a previous positive COVID-19 test. Result(s): 736 (48.2%) MS patients and 2013 (43.0%) control individuals had at least one positive test. A total of 17 (2.3%) and 22 (1.1%) possible reinfections in MS and control groups were observed. The adjusted risk ratio (RR) of infection among previously infected patients compared to uninfected persons in all MS patients was 0.318 (95%CI: 0.188, 0.538), MS patients on rituximab was 0.426 (95%CI: 0.169, 1.070), MS patients on DMTs rather than rituximab was 0.280 (95% CI: 146, 0.537), and control individuals was 0.179 (95%CI: 0.115, 0.279). The estimated protection against reinfection in all MS patients, MS patients on rituximab, MS patients on DMTs rather than rituximab, and controls were 68.2% (46.3%, 81.2%), 57.4% (-0.1%, 83.5%), 71.5% (45.5%, 85.2%), and 82.1% (72.1%, 88.5%), respectively. We found no statistically significant difference in estimated protection (p=0.123) and odd of reinfection (adjusted OR: 2.01 [0.98, 4.08]) between all MS patients and control group.Two patients were hospitalized at first infection but none required hospitalization at reinfection event. Conclusion(s): Prior SARS-CoV-2 infection is protective against reinfection in MS patients. Those on rituximab may be at a greater risk of reinfection. We found no evidence regrading increased risk of severe reinfection compared to the primary infection Further studies are required to assess the risk of the second reinfection among the MS population.
ABSTRACT
Background: Since December 2019, the world is struggling with an outbreak of coronavirus disease-2019 (COVID-19) infection mostly represented as an acute respiratory distress syndrome and has turned into the most critical health issue worldwide. Limited information is available about the association between dynamic changes in the naso/oropharyngeal viral shedding in infected patients and biomarkers, aiming to be assessed in the current study. Materials and Methods: This quasi-cohort study was conducted on 31 patients with moderate severity of COVID-19 manifestations, whose real-time polymerase chain reaction (RT-PCR) test was positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) RNA at baseline. RT-PCR was rechecked for patients every 3-4 days until achieving two negative ones. In parallel, biomarkers, including lymphocyte count, lactate dehydrogenase (LDH), and C-reactive protein (CRP), were assessed every other day, as well. Viral shedding also was assessed. Results: Spearman's correlation test revealed a significant direct correlation between the viral shedding from the symptom onset and the time, in which CRP (P = 0.0015, r = 0.54) and LDH (P = 0.001, r = 0.6207) return to normal levels after symptom onset, but not for lymphocyte count (P = 0.068, r = 0.34). Conclusion: Based on the current study's findings, the duration of SARS-CoV-2 RNA shedding was directly correlated with the required time for LDH and CRP return to normal levels. Therefore, these factors can be considered the determinants for patients' discharge, isolation, and return to social activities;however, further investigations are required to generalize the outcomes.
ABSTRACT
Introduction: The unrelenting storm of coronavirus disease (COVID-19) since late 2019 has turned into a crucial health matter of the globe. There is increasing evidence in terms of a hypercoagulable state by this infection. Objectives: The current study aims to clarify the association between thromboembolic events in COVID-19 and the patient, the infection and in-hospital related characteristics. Patients and Methods: The current case-control study has been conducted on 243 COVID-19 pneumonia patients including 83 cases with thrombotic events and 160 controls without thrombosis. The thrombotic events included deep venous thrombosis (DVT) (n = 9), pulmonary thromboembolism (PTE) (n = 48), acute myocardial infarction (AMI) (n = 17), cerebrovascular accidents (CVA) (n = 4) and arterial thrombosis (n = 5). On admission, hemodynamic parameters, on admission laboratory assessments, mobility during hospitalization, type of oxygenation, intensive care unit (ICU) admission requirement and duration of ICU and also hospital stay were recorded in the checklist. Results: According to logistic regression assessment, on admission O2 saturation (OR: 0.97, 95% CI: 0.94-0.99), hemoglobin level (OR: 0.87, 95% CI: 0.77-0.97) and albumin level (OR: 0.53, 95% CI: 0.3-0.86) were independently correlated with thrombosis due to COVID-19. Other factors, including demographic, infection severity, laboratory and in-hospital characteristics, were not significantly associated with thrombotic events. Conclusion: Based on this study's findings, hemoglobin and albumin levels were the independent factors associated with the thrombotic events in COVID-19 patients.