Predictors of a weak antibody response to COVID-19 mRNA vaccine in systemic lupus erythematosus.

OBJECTIVES: To characterize the antibody response to COVID-19 mRNA vaccination in patients with Systemic Lupus Erythematosus (SLE) and identify predictors of poor response. METHODS: SLE patients who are followed at the Beth Israel Deaconess Medical Center Lupus Cohort (BID-LC) were enrolled. SARS-CoV-2 IgG Spike antibody was measured in patients who received two doses of either the BNT162b2 (Pfizer-BioNTech) or the mRNA-1273 (Moderna) COVID-19 vaccine (n = 62). We defined non-responders as patients with an IgG Spike antibody titer less than two-fold (< 2) the index value of the test and responders as patients with antibody levels greater or equal to two-fold (≥ 2). A web-based survey was used to collect information regarding immunosuppressive medication use and SLE flares after vaccination. RESULTS: In our cohort of lupus patients, 76% were vaccine responders. The use of two or more immunosuppressive drugs was associated with being a non-responder (Odds Ratio 5.26; 95% CI 1.23-22.34, p = 0.02). Both Belimumab use and higher Prednisone dose were associated with vaccine non-response (p = 0.04 and p = 0.04). The non-responder group had higher mean levels of serum IL-18 than the responder group (p = 0.04) as well as lower C3 levels (p = 0.01). Lupus flares and breakthrough infections were uncommon post-vaccination. CONCLUSIONS: Immunosuppressive medications have a negative impact on vaccine humoral response in SLE individuals. We observed a trend towards vaccine no-response in BNT162b2 recipients and a relationship between IL-18 and impaired antibody response that merits further investigation.

Can Music Decrease Anxiety and Pain During Dental Implant Surgery? A Randomized Clinical Trial.

PURPOSE: Music has proven to be an effective tool in the management of anxiety during some surgical procedures. The aim of this study was to test the effect of baroque (BM) and classical era music (CM) as a nonpharmacological therapy on the control of anxiety and pain levels among patients undergoing dental implant placement surgery. METHODS: A randomized controlled clinical trial of patients attending a dental clinic was conducted. Patients with psychiatric disorders were excluded. Twenty six patients of Spanish nationality requiring single-tooth dental implant were included. Each patient was assigned to 1 of the 3 experimental groups, which acted as an independent variable: Group I (n = 8) listened to BM; Group II (n = 10) listened to CM; and Group III (n = 8) did not listen to music and was the control group (C). The dependent variables were divided into physiological variables and psychological variables. The physiological dependent variables analysed were systolic and diastolic blood pressure, heart rate, and oxygen saturation, recorded at 4 different times during surgery. The Kruskal-Wallis test compared each of these variables between the 3 experimental groups. The psychological dependent variable analyzed was the degree of anxiety, measured by the self-completed Modified Dental Anxiety Scale and Visual Analog Scale (measured before and after surgery). The Wilcoxon statistical test compared degree of anxiety before and after surgery. In all cases, the level of statistical significance was set at P < .05. RESULTS: The mean age of the sample was 46.5 ± 10.6 (range, 24-69 years), 50% male and 50% female. Statistically significant differences in degree of anxiety before and after surgery were found in the BM (P = .027, confidence interval [CI] = 0.146-6.104; BM before = 4.25 ± 3.91 and BM after = 1.13 ± 1.45) and CM groups (P = .044, CI = 0.161-3.039; CM before = 3.10 ± 2.88 and CM after = 1.50 ± 1.43) and were not found in group C (P = .180, CI = 1.104-3.604; C before = 2.63 ± 3.62 and C after = 1.38 ± 1.99). When comparing the perceived pain after the intervention among the 3 groups (C, BM, and CM), no significant differences were observed between them (P = .319; CI = -0.58-1.96; C = 0.75 ± 1.75, BM = 1.25 ± 1.75, and CM = 1.70 ± 1.70). CONCLUSION: Listening to BM and CM reduces anxiety in patients undergoing dental implant placement surgery. Musical flow should be applied in this practice.

Psychological and quality of life effects of vaccination against COVID-19 in patients with systemic autoimmune diseases.

To verify the psychological and quality of life benefits of vaccination against COVID-19 in patients with systemic autoimmune diseases. In this study, levels of psychological stress, psychopathological symptoms, quality of life, and satisfaction with life were compared in patients with systemic autoimmune diseases vaccinated against COVID-19 (n = 132) versus unvaccinated patients (n = 254). To this end, we used the Perceived Stress Scale (PSS), Symptom Checklist-90-Revised (SCL-90-R), EUROQoL-5Q health questionnaire, and Satisfaction with Life Scale (SWLS), respectively. Statistically significant differences were found with better scores in the vaccinated group in the following quality of life dimensions: mobility (p ≤ 0.010), domestic activities (p ≤ 0.004), pain/discomfort (p ≤ 0.001), and anxiety/depression (p≤ 0.005). The scores were also significantly higher in the vaccinated group for the total values of quality of life (p ≤ 0.001), health status self-assessment on the EUROQoL-5Q (p ≤ 0.043), and satisfaction with life (p ≤ 0.015). In addition, the unvaccinated group presented higher scores with clinically pathological levels in depression and psychoticism for somatizations (p ≤ 0.006), depression (p ≤ 0.015), anxiety (p ≤ 0.003), and phobic anxiety (p ≤ 0.001). Finally, participants vaccinated with the complete regimen showed better levels of psychological well-being than those who were not vaccinated or those that had not completed the vaccination regimen. Our results reflect and confirm the positive effects reported elsewhere of the COVID-19 vaccine in autoimmune patients with systemic diseases, both in terms of quality and satisfaction with life as well as psychopathological symptoms and perceived stress. These benefits increased as the patients completed their vaccination schedule.

Digital Technology in Psychiatry: Survey Study of Clinicians.

BACKGROUND: Digital technology has the potential to transform psychiatry, but its adoption has been limited. The proliferation of telepsychiatry during the COVID-19 pandemic has increased the urgency of optimizing technology for clinical practice. Understanding clinician attitudes and preferences is crucial to effective implementation and patient benefit. OBJECTIVE: Our objective was to elicit clinician perspectives on emerging digital technology. METHODS: Clinicians in a large psychiatry department (inpatient and outpatient) were invited to complete a web-based survey about their attitudes toward digital technology in practice, focusing on implementation, clinical benefits, and expectations about patients' attitudes. The survey consisted of 23 questions that could be answered on either a 3-point or 5-point Likert scale. We report the frequencies and percentages of responses. RESULTS: In total, 139 clinicians completed the survey-they represent a variety of years of experience, credentials, and diagnostic subspecialties (response rate 69.5%). Overall, 83.4% (n=116) of them stated that digital data could improve their practice, and 23.0% (n=32) of responders reported that they had viewed patients' profiles on social media. Among anticipated benefits, clinicians rated symptom self-tracking (n=101, 72.7%) as well as clinical intervention support (n=90, 64.7%) as most promising. Among anticipated challenges, clinicians mostly expressed concerns over greater time demand (n=123, 88.5%) and whether digital data would be actionable (n=107, 77%). Furthermore, 95.0% (n=132) of clinicians expected their patients to share digital data. CONCLUSIONS: Overall, clinicians reported a positive attitude toward the use of digital data to not only improve patient outcomes but also highlight significant barriers that implementation would need to overcome. Although clinicians' self-reported attitudes about digital technology may not necessarily translate into behavior, our results suggest that technologies that reduce clinician burden and are easily interpretable have the greatest likelihood of uptake.

Clinical course of Covid-19 in a cohort of patients with Behçet disease.

Objective: The implications of Covid-19 in patients with Behçet's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. Methods: A retrospective study was conducted among 244 patients with BD (86.1% females; mean age 43.95 ± 11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. Results: The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5 mg/day of colchicine compared to those taking 1.5 mg/day (p = 0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p = 0.032). With regards to oral glucocorticoids, no significant differences were found. Conclusions: The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea; oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.

Objetivo: Se desconocen las implicaciones de la Covid-19 en pacientes con enfermedad de Behçet (EB). Los pacientes con EB generalmente tienen tratamiento de larga duración con agentes terapéuticos que se han probado en pacientes con Covid-19. Nuestro objetivo fue evaluar la prevalencia de la Covid-19 en una cohorte de pacientes con EB e investigar si los pacientes con un tratamiento de larga duración con colchicina, inhibidores del factor de necrosis tumoral (TNFi) o glucocorticoides tienen una prevalencia reducida o aumentada en los resultados clínicos de la Covid-19. Métodos: Se realizó un estudio retrospectivo en 244 pacientes con EB (86,1% mujeres; edad media, 43,95 ± 11,11 años). Cada participante completó un cuestionario en línea sobre datos demográficos, afecciones médicas, tratamiento con colchicina, TNFi o glucocorticoides orales, infección por Covid-19, síntomas clínicos y recuperación. Resultados: La prevalencia de la infección por Covid-19 fue del 14,75%. En cuanto a la dosis de colchicina, la presencia de ageusia fue menor en los pacientes que tomaban 0,5 mg/día de colchicina en comparación con los que tomaban 1,5 mg/día (p = 0,021). La prevalencia de disnea fue significativamente mayor en los pacientes que tomaban TNFi en comparación con aquellos sin terapia (p = 0,032). Con respecto a los glucocorticoides orales, no se encontraron diferencias significativas. Conclusiones: La prevalencia de Covid-19 en pacientes con EB parece ser superior a la de la población general en España. La terapia continua con TNFi podría aumentar la prevalencia de peores resultados clínicos como la disnea; los glucocorticoides orales y la colchicina aparentemente no proporcionan protección contra los resultados clínicos relacionados con la Covid-19 en pacientes con EB.

A case of de novo seronegative inflammatory oligoarthritis associated with COVID-19 infection

Infection with SARS-CoV-2 (COVID-19) virus is characterized by an acute respiratory viral illness, often accompanied by extrapulmonary manifestations. Musculoskeletal symptoms such as myalgias and arthralgias are observed in 60 – 70% of cases. Inflammatory arthritis associated with SARS-CoV-2 infection has been reported in the literature, however, nearly all such cases described a post-viral or reactive phenomenon occurring a few weeks following the infection. We report a unique case of de novo arthritis at the onset of a confirmed COVID-19 infection in a 55-year-old woman. Magnetic resonance imaging demonstrated synovial enhancement consistent with synovitis. Her disease was deemed refractory after failing several immunosuppressive agents. Lastly, we compare our patient's clinical presentation with two other similar cases to understand the natural history of this emerging syndrome.

Clinical course of Covid-19 in a cohort of patients with Behçet disease Evolución clínica de la Covid-19 en una cohorte de pacientes con enfermedad de Behçet

Objective The implications of Covid-19 in patients with Behçet's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. Methods A retrospective study was conducted among 244 patients with BD (86.1% females;mean age 43.95 ± 11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. Results The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5 mg/day of colchicine compared to those taking 1.5 mg/day (p = 0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p = 0.032). With regards to oral glucocorticoids, no significant differences were found. Conclusions The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea;oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.

The Relationship Between Health Literacy and Quality of Life, Attitudes and Perceptions of Covid-19 and Vaccination Among Patients with Systemic Autoimmune Diseases.

This study aimed to evaluate health literacy in patients (n=395) with systemic autoimmune diseases (SAD) and analyze their relationships with health-related quality of life (HRQoL), attitudes and beliefs about Covid-19 and vaccination, and perceptions of changes in medical care during the pandemic. This study was cross-sectional and the majority (81%) of particpants resided in Spain. An anonymous online survey was distributed to an online SAD association. Health literacy was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the SF-36 tool was used to assess HRQoL. More than half of patients (57.7%) have inadequate health literacy and the mean health literacy level was 9.63(5.66). Patients with inadequate health literacy levels presented the lowest HRQoL scores in all SF-36 domains (p < .001). Health literacy scores were positively correlated with all SF-36 domains (p < .001). The reservations to get vaccinated against Covid-19 were linked to health literacy level (p = 0.024). There are high levels of inadequate health literacy among patients with SAD and it is associated with worse HRQoL and risk attitudes about Covid-19 vaccination and medical care during the pandemic.

Clinical course of Covid-19 in a cohort of patients with Behçet disease.

OBJECTIVE: The implications of Covid-19 in patients with Behçet's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. METHODS: A retrospective study was conducted among 244 patients with BD (86.1% females; mean age 43.95±11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. RESULTS: The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5mg/day of colchicine compared to those taking 1.5mg/day (p=0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p=0.032). With regards to oral glucocorticoids, no significant differences were found. CONCLUSIONS: The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea; oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.

COVID-19 vaccine literacy in patients with systemic autoimmune diseases.

COVID-19 related infodemic is a threat to the successful COVID-19 vaccination campaigns. This might be especially apparent for patients with autoimmune diseases since there is no data available about the balance between benefits and risks of the newly developed COVID-19 vaccines in this population. We aim (i) to evaluate vaccine literacy skills in a population of patients with systemic autoimmune diseases, (ii) to examine the potential associations between vaccine literacy skills and sociodemographic characteristics and (iii) to analyze the relationships between attitudes, perceptions and beliefs about current vaccinations and vaccine literacy skills and sociodemographic characteristics. A cross-sectional study was conducted among 319 patients with systemic autoimmune diseases (92% females; 49.5% of patients in the 31-50 years age category). The vaccine literacy levels were determined using the Health Literacy about Vaccination in adulthood in Italian (HLVa-IT). Sociodemographic characteristics including gender, age, country and area of residence, civil status, socioeconomic status, educational attainment and occupational status were evaluated. The mean vaccine literacy functional and interactive-critical scores were 2.59 ± 0.74 and 3.07 ± 0.60, respectively. The vaccine literacy interactive-critical score was higher in females than in males (p = 0.048). Interactive-critical scores were associated with the area of residence, civil status and socioeconomic status, with the highest score in urban area of ≥ 100.000 inhabitants (p = 0.045), in widow patients (p = 0.023) and in patients with high socioeconomic status (p = 0.018). Significant differences were observed between the different education levels, for both the functional and the interactive-critical scores (p = 0.002 and p < 0.001, respectively), the highest score was observed in patients who completed a university degree. The level of vaccine literacy for functional and interactive-critical scales were medium. Area of residence, civil status and socioeconomic status represented determinants of vaccine literacy interactive-critical scale. Educational attainment also contributes to vaccine literacy functional scale. Insight into these factors is required to ensure an optimal vaccine literacy level in patients with autoimmune diseases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02713-y.

Characteristics and outcomes from COVID-19 among Peruvian physicians: a nationwide register-based study.

The healthcare workforce has played an integral role in fighting COVID-19 and continues to do so despite the continuous adverse outcomes. To address this issue, official public data concerning COVID-19 cases and deaths of Peruvian physicians was used to quantify the risk of death and infection by SARS-CoV-2. 20.9% Peruvian physicians were infected and 0.7% died, with the male general practitioners being the most affected group within the workforce. Notably, the Loreto region was disproportionately affected and had the highest cumulative incidence, mortality and case fatality rate. Ultimately, this identified risk group needs to be supported with sufficient resources/tools such as personal protective equipment, training, access to health care, vaccination, etc.

[Evolution and treatment of storm cytoquine syndrome associated to SARS-CoV-2 infection among octogenarians]. / Tratamiento y evolución del síndrome de tormenta de citoquinas asociados a infección por SARS-CoV-2 en pacientes octogenarios.

INTRODUCTION: Cytokine storm syndrome (CTS) is a serious complication of patients with SARS-CoV-2 infection. Treatment and evolution in octogenarians are not well defined. Our objective is to describe its clinical characteristics, the treatments and its clinical evolution. PATIENTS AND METHOD: Retrospective observational study of consecutive patients admitted in the period between March 23 and April 12, 2020 with confirmed SARS-CoV-2 infection, with pneumonia by radiological study or chest tomography, whith STC criteria and who received treatment. We classified patients as those who received only glucocorticoid (GC) pulses, or GC and tocilizumab pulses. We determined serum levels of ferritin, CRP and D-dimers. The final variable was survival. RESULTS: 21 patients, (80-88 years). The mean ferritin was 1056 microg/L (317-3,553), CRP 115.8mg/dL (22-306) and D-dimers 2.9m/L (0.45-17.5). All patients received GC pulses and in 2 cases simultaneously tocilizumab. The mean follow-up time was 13.7 days (8-21). The overall mortality was 38.1% (8/21 patients). The 2 patients who received tocilizumab died. The deceased had significantly higher levels of ferritin (1,254 vs. 925microg/L; P=.045) and CRP (197.6 vs. 76mg / dL; P=.007). At the end of the follow-up, a decrease in the biochemical parameters was observed with ferritin of 727microg/L, CRP of 27mg/dl and D-dimers of 1.18mg/L. In 13/21 patients (61.9%), the CTS was controlled without the need to add other treatments. CONCLUSIONS: STC mortality from SARS-CoV-2 is high despite treatment. A greater inflammatory response was associated with a higher mortality. Although it seems that the early use of GC pulses could control it, and the use of other treatments such as tocilizumab shouldo be, with the study design and its limitations, this conclusion cannot be stablished.

Immune thrombocytopenia and COVID-19: Case report and review of literature.

Immune thrombocytopenia, also known as immune thrombocytopenic purpura (ITP), has been reported as an important complication related to COVID-19.We present a 49-year-old male patient with systemic lupus erythematosus with lupus nephritis, antiphospholipid syndrome and history of ITP who developed an ITP flare in the context of COVID-19. He had no bleeding manifestations and had a good response to prednisone treatment.We review the characteristics of the cases reported to date in the literature, with an analysis of 57 patients. Mean age was 56 years (±19.6 SD), and 50.9% were male. This was the first episode of ITP in most of the patients (86.05%), with SARS-CoV-2 acting as the initial trigger. We found that ITP flares may appear in both mild and severe COVID-19 cases. They also appeared at any time during the course of the disease, 48.2% of patients developed it during hospitalization, while it was diagnosed at admission in the rest of the cases. Platelet counts were significantly lower than other ITP series, with a median nadir platelet count of 8 × 109/L (IQR 2-17.75 × 109/L). These patients show a higher bleeding rate (61.4%) compared with other ITP series. They also show a better response to treatment, with good response to the first line therapies in 76.9% of them. The most common first-line treatment was intravenous immunoglobulin (IVIG), used alone or combined with corticosteroids in 40.4% and 32.7% of cases respectively, while 25% of patients received only corticosteroids.Our review suggests that COVID-19-related ITP can be seen even in previously healthy patients. Clinicians must be aware that ITP may appear both in mild and severe COVID-19, at any time during its course. Given that this kind of ITP seems to be associated with a higher bleeding risk, its diagnosis in a clinical scenario such as COVID-19, where anticoagulant therapy is frequently used, may be critical. Treatment with IVIG and/or corticoids is often effective.