Effectiveness of the BNT162b2 mRNA COVID-19 Vaccine among Adolescents with Juvenile-onset Inflammatory Rheumatic Diseases.

OBJECTIVES: Effectiveness of the BNT162b2 mRNA COVID-19 vaccine for adolescents with juvenile-onset inflammatory rheumatic diseases (IRD) is unknown. Several studies suggested attenuated immunogenicity in patients with IRD. This study evaluated the effectiveness of the BNT162b2 mRNA COVID-19 vaccine in preventing COVID-19 infection in adolescents with juvenile-onset IRD compared with controls without immune rheumatic disease. METHODS: We used data from Clalit Health Services, the largest healthcare organization in Israel, to conduct an observational cohort study from February to December 2021, involving adolescents 12-18 years-old, diagnosed with IRD. Study outcomes included documented COVID-19 infection in relation to vaccination status and immunomodulatory therapy. We estimated vaccine effectiveness as one minus the risk ratio. Adolescents without immune rheumatic disease, 12-18 years-old, served as controls. RESULTS: A total of 1,639 adolescents with IRD (juvenile idiopathic arthritis, systemic lupus erythematosus, or familial Mediterranean fever) were included and compared with 524 471 adolescents in the same age range. There was no difference in COVID-19 infection rates after the second dose of vaccine for those with IRD and controls (2.1% vs 2.1% respectively, p= 0.99). The estimated vaccine effectiveness for adolescents with IRD was 76.3% after the first dose, 94.8% after the second and 99.2% after the third dose. CONCLUSION: We found that the BNT162b2 mRNA vaccine is effective against COVID-19 infection in adolescents with IRD, similar to controls without immune rheumatic disease. Immunomodulatory therapy did not affect its effectiveness. These results can encourage adolescents with IRD to get vaccinated against COVID-19.

The impact of COVID-19 pandemic on cardiac rehabilitation of patients following acute coronary syndrome.

BACKGROUND: Cardiac rehabilitation improves prognosis and symptoms in cardiac patients. In 2020, due to the COVID-19 pandemic, cardiac rehabilitation services were temporarily suspended between April and August. We aimed to investigate the effect of cardiac rehabilitation suspension during the COVID-19 pandemic on patients' exercise capacity and metabolic parameters. METHODS: Included were patients undergoing cardiac rehabilitation following hospital admission for ACS. Exercise capacity, weight and body fat percentage were compared between baseline, pre- and post-lockdown visits. RESULTS: A total of 281 patients participated in the cardiac rehabilitation program prior to its suspension. Of them, only 198 (70%) patients returned to the program on its renewal and were included in the analysis. Exercise capacity improved significantly in the pre-lockdown stress test compared to baseline. However, there was a significant decrease in exercise capacity in the post compared to pre-lockdown test (8.1±6.3 and 7.1±2.1 METs in pre- and post-lockdown measurements, respectively, p<0.001). Of the 99 (50%) of patients that demonstrated at least 10% improvement in exercise capacity in the pre-lockdown test, 48(48.5%) patients returned to their baseline values in the post-lockdown test. Post-lockdown assessment demonstrated a significant weight gain (80.3 and 81.1kg, in pre- and post-lockdown measurements, respectively, p<0.001) as well as an increase in visceral fat level and body fat percentage. CONCLUSIONS: Cardiac rehabilitation suspension for 4 months during COVID-19 pandemic caused a significant reduction in exercise capacity and increased weight and body fat percent. These findings highlight the importance of remote cardiac rehabilitation services that can continue uninterrupted in times of pandemic.

Coping strategies of families and their relationships with family quality of life during Covid-19 pandemic.

The COVID-19 pandemic has brought new challenges to almost every aspect of parents' and their children's lives, posing an acute threat to the families' quality of life (FQOL). This study had two aims: (1) to identify changes in family coping-strategy profiles among parents pre- and during the first COVID-19 lockdown and (2) to analyze interactions between the clusters of coping strategies pre-COVID with FQOL during the first lockdown. A sample of 253 parents (58.5% mothers) of children (3 to 18 yr old) completed the Family Pandemic Oriented Personal Evaluation Scales and the FQOL Scale about their family life pre- and during the COVID-19 lockdown. Four family coping-strategy clusters were found. Differences were found between those clusters pre- and during the first COVID-19 lockdown, with a high percentage of families using the positive appraisal strategy more often. Significant interactions were found between the family coping-strategy clusters pre-COVID-19 and the FQOL factors before and during the pandemic. Most families maintained their FQOL levels during the first lockdown. Close and frequent interactions between family members had relationships with positive emotions and significant effects on well-being. Results showed that positive cognitive appraisal was a protective factor against a significant decrease in FQOL during the first COVID-19 lockdown.

Gen Z during the COVID-19 crisis: a comparative analysis of the differences between Gen Z and Gen X in resilience, values and attitudes.

In the current study we seek to examine the difference between Generation Z and Generation X in terms of coping with a global crisis (COVID-19), specifically regarding resilience in times of crisis, personal values ​​and attitudes during that time. Based on the theory of generations, we aimed to explore whether different generations have different levels of resilience, values and attitudes during the global crisis. Data were gathered in a cross-sectional study; 958 participants participated, divided into two age-groups: 508 participants of Generation Z (ages ranged between 18-24; 53.9% males [Age: M = 21.05, SD = 1.96]; 46.1% females [Age: M = 21.14, SD = 1.83]), and 205 participants of Generation X (ages ranged between 40-50; 54.2% males [Age: M = 45.16, SD = 3.15]; 45.8% females [Age: M = 45.23, SD = 3.01]). It was found that members of Generation Z (Gen Z) were less resilient. Also, Gen Z members had higher levels of openness to change, and self-enhancement as compared to Generation X (Gen X). In addition, Gen Z were found to be more positive in their attitudes toward flexible learning but no differences between the generations were found as for flexible work. Both generation members had the similar attitudes towards online consumption. Despite the magnitude and significance of the crisis, the main values of each generation remained unchanged in many respects, but attitudes of both generations are positive towards hybrid work and consumption.

Humoral Response to Pfizer BNT162b2 Vaccine Booster in Maintenance Hemodialysis Patients.

INTRODUCTION: Coronavirus disease is associated with increased morbidity and mortality in maintenance hemodialysis (MHD) patients. Recent breakthrough infection in vaccinated people has led some authorities to recommend a booster dose for patients fully vaccinated 5-8 months ago. We aimed to assess the humoral response of MHD patients following a booster dose with the BNT162b2 vaccine. METHODS: The study included 102 MHD patients vaccinated with 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine. A third dose (booster) was recommended to all MHD patients in our center and was given to those who opted to receive it, resulting in a booster group and a control group that did not receive the booster. Previous exposure was excluded by testing for the presence of the anti-nucleocapsid antibody (SARS-CoV-2) or positive PCR. We assessed the humoral response before and after the booster dose. RESULTS: Of 66 patients in the booster group, 65 patients (98.5%) developed a positive antibody response, from 472.7 ± 749.5 to 16,336.8 ± 15,397.3, as compared to a sustained decrease in the control group (695.7 ± 642.7 to 383.6 ± 298.6), p < 0.0001. No significant adverse effects were reported. Prior antibody titers were positively correlated to IgG levels following the booster dose. There was a significant association between malnutrition-inflammation markers and the humoral response. CONCLUSIONS: Almost all MHD patients developed a substantial humoral response following the booster dose, which was significantly higher than levels reported for MHD patients following administration of 2 doses alone. Further studies and observations are needed to determine the exact timing and dosing schedule.

Immature platelets in patients hospitalized with Covid-19.

Coronavirus disease 2019 (Covid-19) is associated with high incidence of venous and arterial thromboembolic events. Currently, there are no markers to guide antithrombotic therapy in Covid-19. Immature platelets represent a population of hyper-reactive platelets associated with arterial events. This prospective study compared consecutive Covid-19 patients (n = 47, median age = 56 years) to patients with acute myocardial infarction (AMI, n = 100, median age = 59 years) and a group of stable patients with cardiovascular risk factors (n = 64, median age = 68 years). Immature platelet fraction (IPF) and immature platelet count (IPC) were determined by the Sysmex XN-3000 auto-analyzer on admission and at subsequent time-points. IPF% on admission was higher in Covid-19 than the stable group and similar to the AMI group (4.8% [IQR 3.4-6.9], 3.5% [2.7-5.1], 4.55% [3.0-6.75], respectively, p = 0.0053). IPC on admission was also higher in Covid-19 than the stable group and similar to the AMI group (10.8 × 109/L [8.3-18.1], 7.35 × 109/L [5.3-10.5], 10.7 × 109/L [7.7-16.8], respectively, P < 0.0001). The maximal IPF% among the Covid-19 group was higher than the stable group and similar to the AMI group. The maximal IPC in Covid-19 was higher than the maximal IPC in both the stable and AMI groups (COVID-19: 14.4 × 109/L [9.4-20.9], AMI: 10.9 × 109/L [7.6-15.2], P = 0.0035, Stable: 7.55 × 109/L [5.55-10.5], P < 0.0001). Patients with Covid-19 have increased immature platelets indices compared to stable patients with cardiovascular risk factors, and as the disease progresses also compared to AMI patients. The enhanced platelet turnover and reactivity may have a role in the development of thrombotic events in Covid-19 patients.