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Objectives: To evaluate the immunogenicity of ChAdOx1, Coronavac and BNT162B2 vaccines in SLE patients, including homologous and heterologous immunizations. Method(s): The 'Safety and efficacy on COVID-19 Vaccine in Rheumatic Disease-SAFER study' is a Brazilian multicentric longitudinal phase IV study to evaluate COVID-19 Vaccine in immune-mediated rheumatic diseases (IMRD) in real life, started on May 2021. SLE patients (according to the 2012 SLICC classification criteria), older than 18 years of age were recruited after 2 or 3 doses of vaccine against COVID-19 (ChAdOx1, BNT162b2 and CoronaVac) and were evaluated at baseline and on the 28th day after each dose. Homologous immunization was considered if they received three doses of the same vaccine and heterologous if a different one was applied. IgG antibody against SARS-CoV-2 spike receptor-binding domain were measured by chemiluminescence (SARS-CoV-2-IgG-II Quant assay, Abbott-Laboratories) at baseline and 28 days after the first, 2nd and 3rd doses (Seropositivity IgGSpike>= 7.1BAU/mL). Statistical analysis: ANOVA and pairwise comparisons tests Results: 316 SLE patients were included (255 heterologous and 61 homologous immunization), 89.2% were female and the mean age was 37.6 +/- 11.2 years. The two groups were homogeneous regarding demographical data, disease activity and immunosuppressive treatment. 49.7% used corticosteroids (alpha 5 mg/day in 52.3%), 83.5% antimalarials, 22.8% azathioprine and 20.3% mycophenolate mofetil. 207 patients received the first two doses with CoronaVac, 128 ChadOx-1 and 32 BNT162b2. Regarding the first two doses of the same vaccine, there was no difference in IgG titers over time between CoronaVac or ChadOx-1 (p = 0.313). IgG titers increased in all vaccine groups, with difference only after 2nd dose: 4.96 +/- 1.71BAU/mL CoronaVac vs. 6.00 +/- 1.99BAU/mL ChadOx-1 vs. 7.31 +/- 1.49BAU/mL BNT162b2 (p alpha 0.001). There was no difference in IgG titers over time between homologous or heterologous vaccine schedule (p = 0.872). IgG titers also increased in all groups, with difference only after 2nd dose: 5.49 +/- 1.96BAU/mL heterologous vs. 6.30 +/- 2.10BAU/mL homologous (p = 0.009). Conclusion(s): Induction of immunogenicity occurred in different vaccine regimens in SLE patients. Future research to explore different heterologous schemes in IMRD must be performed.
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On December 13, 2020, Yutian County People's hospital reported one imported malaria case in Hotan, Xinjiang. The patient had worked and lived in Yaounde, Cameroon, from January to September 2020. He was infected with malaria twice in March and May 2020. Antimalarial treatment was administrated by the team doctor for 2-3 days in each treatment. The treatment was stopped after the symptoms improved. The patient returned to China on September 16 and was hospitalized on December 13 due to a high fever of 39! and upper respiratory symptoms. Multiple detections of COVID-19 nucleic acid showed negative results. Peripheral blood from the patient was taken for Plasmodium rapid diagnostic test (RDT), which showed a positive result suggesting non Plasmodium falciparum infection. Ring stage P. ovale was found in the blood smear. Nested PCR showed positive for P. ovale. A diagnosis of imported ovale malaria was made. The patient was administrated with 4 dihydroartemisinin piperaquine tablets and 3 primaquine phosphate tablets daily. The malaria parasite test became negative after 8 days of treatment. The patient was followed up for 3 months after discharge and had no symptoms of chills or fever.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.
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As we know novel coronavirus is an emergent nuisance in this stipulated period. Corona virus is a group of enveloped viruses, with non-segmented, single stranded & positive sense RNA genomes. Human Corona virus is mainly subdivided into four categories such as 229E, NL63, OC43, HKU1. Epidemiologically it has a greater prevalence in the modern era. The features encountered in the clinical course of the disease are multifarious spanning from cough, sneezing, fever, breathlessness. It may take 2-14 days for a person to notice symptoms after infection. Azithromycin and 8 Hydroxychloroquine both plays an instrumental role for management of COVID-19. Azithromycin is a macrolide antibiotic and it binds with a 50s ribosome then inhibits bacterial protein synthesis. On the other hand 8-Hydroxychloroquine was approved by United State in the year of 1955 .Basically it is used as a antimalarial drugs . Briefly, in inflammatory conditions it binds with toll like receptor & blocks them. 8- hydroxychloroquine increases lysosomal pH in antigen presenting cells . In inflammatory conditions it blocks toll like receptors on plasmacytoid dendritic cells. In our review we focused on the role of Azithromycin, and 8-hydroxychloroquine in Covid-19 .Copyright © 2021 International Journal of Pharma and Bio Sciences. All rights reserved.
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The strategy of drug repurposing has been proved successful in response to the current corona-virus pandemic, with remdesivir becoming the first drug of choice, an antiviral drug approved for the treatment of COVID-19. In parallel to this, several drugs, such as antimalarial, corticosteroids, and antibi-otics, like azithromycin, are used to treat the severe condition of hospitalized COVID-19 patients, while clinical testing of additional therapeutic drugs, including vaccines, is going on. It is reasonably expected that this review article will deliver optimized and specific curative tools that will increase the attentive-ness of health systems to the probable outlook of epidemics in the future. This review focuses on the ap-plication of repurposed drugs by studying their structure, pharmacokinetic study, different mechanisms of action, and Covid-19 guidelines, which can potentially influence SARS-CoV-2. For most of the drugs, direct clinical evidence regarding their effectiveness in the treatment of COVID-19 is missing. Future clinical trial studies may conclude that one of these can be more potential to inhibit the progression of COVID-19.Copyright © 2022 Bentham Science Publishers.
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Background: The WHO has declared COVID-19 as a global pandemic. New cases are being added every day, as the case count in the United States is increasing to the maximum. No drugs or biol-ogics are yet found to be effective for the prevention or treatment of COVID-19. Objective(s): To discuss the possibilities of available treatments. Material(s) and Method(s): Brief out-look is undertaken over the past issues available over similar situations that occurred with respect to the current scenario and prospectives. Result(s): There can be various possibilities in the form of convalescent plasma therapy. The known drugs such as HIV drugs, anti-malarial medicines, and antiviral compounds can serve as a suggestive option. Conclusion(s): Until a validated medicine or vaccine is sorted out for Covid-19, we need to take natural immune-boosters, along with precautionary steps, social distancing, and other preventions as instructed for the benefit of everyone with an optimistic mind and attitude.Copyright © 2021 Bentham Science Publishers.
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Bachground: The coronavirus disease 2019 (COVID-19) pandemic, which started on February 26, 2020 in city of karachi, spread quickly throughout Pakistan. Material(s) and Method(s): The design of this study was a observational study design and this study was conducted at king Edward medical University Lahore. More than 6,200 persons were afflicted by the illness in the first seven weeks, and there were more than 111 documented fatalities. Many problems arise if we contrast the COVID-19 tragedies in Pakistan with those in nations like China, Iran, and the European Union. The geography of the nation, poverty, poor literacy rates, environmental circumstances, sanitary conditions, and dietary habits are only a few of the difficulties we face in containing this epidemic. Although there are terrible circumstances in each of these areas, Pakistan's COVID-19 epidemic was slower than that of other developing nations. Result(s): The impact of COVID-19 appears to be lessened by Pakistan's humid hot temperature, early reaction to COVID-19, population immune system, BCG vaccination, and the proportion of young individuals. In this essay, we explore the COVID-19 pandemic outbreak in China, Iran, and Pakistan and present its day-to-day changes. We outline the COVID-19 structure and how it compares to SARS-COV and SARS-COV2. The use of Remdesivir (an adenosine analogue used against RNA viruses), Chloroquine (a widely used anti-malarial drug), convalescent plasma, neutralising antibodies targeting the ACE-2 receptor, and an ACE-2-like molecule that might bind to the S protein of the coronavirus are also covered in terms of treatment options and their drawbacks. Also covered are the effects of COVID-19 on Pakistan's economy and government relief measures. Conclusion(s): In conclusion, it may be said that the support systems in place may not be sufficient to stop the spread of the virus. Even with the meagre assistance offered, it is weaker for rural places where the virus's effects may be severe than in the nation's cities. Further research is required as the epidemic develops to better understand governmental efforts to contain the virus and its effects across the nation.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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COVID-19, a pandemic has led the whole globe through unprecedented times and unpre-dictability that has adversely affected the humanity as a whole. Although the severe acute respiratory syndrome was reported in the year 2002-2004 of zoonotic origin caused by SARS-CoV-1 strain. Now recently, in December 2019, SARS-CoV-2 virus has emerged and swiftly spread to the whole world, taking a heavy toll on life. Studies are being conducted worldwide to find antiviral drugs act-ing specifically on the virus and to develop the vaccine for the disease. The present review article summarizes the currently undergoing clinical trials of Indian Ayurvedic herbs and their role in promoting immunity. It also includes studies focused on repurposing the existing drugs and finding alternative treatment methods that can be opted for potential treatment/management of COVID-19. Last but not the least, this paper provides a background on the development of preventive vaccines and the various bioinformatic tools utilized in order to help accelerate the research on coronavirus. The manuscript gives a brief outline of all the possible strategies and therapeutics underway in India and at the global level to fight against the microscopic adversary and lead to an affordable and speedy remedy for COVID-19.Copyright © 2021 Bentham Science Publishers.
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COVID-19 is a disease caused by SARS-CoV-2 that can trigger respiratory tract infection. Due to its tendency to affect the upper respiratory tract (sinuses, nose and throat) or lower respiratory tract (windpipe and lungs), this disease is life-threatening and affects a large number of populations. This virus's unique and complex nature enhances the scope to look into the direction of herbal plants and their constituents for its prevention and treatment. The herbal remedies can have preventive as well as therapeutic actions. This review focuses on various aspects of using herbal medicines for COVID-19, as herbal constituents may also have adverse effects. Various studies revealed that some medicinal plants show life-threatening adverse effects, so selecting plants, and their related studies should be appropriate and strategic. This article includes various factors that should be considered before herbal drug use in COVID-19 patients. These are clinical trials, safety, molecular mechanism, and self-medication, which have been elaborated. This article also discusses the targets of covid-19 and different coronavirus strains. As before, treatment diagnosis of the disease is very important. Various patents have been filed and granted for its proper diagnosis so that its treatment can be easy.Copyright © 2022 Society of Pharmaceutical Sciences and Research. All rights reserved.
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A virus known as novel corona (SARS-CoV-2) which causes COVID-19 pandemic disease is an invisible enemy, appeared for the first time in the world's most populous country, China, and became a reason for causing death of many people all over the world. As a result of this, a remarkable investigation and clinical trials are ongoing to discover the treatment for this devastating pandemic disease. Effective vaccines and anti-viral treatments are immediately required in order to control and eradicate the disease. But still, neither vaccine nor any drug is approved for prevention and control of COVID-19 pandemic. Proper and well-designed strategies are needed to reduce social and economic consequences arisen due to this pandemic disease. There are some drugs that are used for other diseases which are showing valuable outcomes to elicit the virus causing COVID-19. However, there are no approved drugs full of clinical evidence. A systematic review literature search was carried out from different electronic databases to identify available articles on the effectiveness of drugs against COVID-19.Four therapies suggested recently via World Health Organization (abbreviated "WHO") that were later incorporated for under taking efficient clinical trial of the newly established project (European Discovery), comprise remdesivir, combination of anti-viral drugs (lopinavir and ritonavir), lopinavir plus ritonavir with beta interferon, and anti-malarial drugs like hydroxyl chloroquine and chloroquine. On May 25 2020, hy-droxychloroquine and chloroquine were suspended by WHO from Solidarity trial because of their safety and efficacy concerns. However, there were neither effective specific antivirals nor drug combinations approved which were supported by great-level of clinical evidence.Copyright © 2020 Bentham Science Publishers.
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Background: Novel coronavirus (2019-nCov) imposed deadly health calamity with unexpected disastrous situation alarming the globe for urgent treatment regimes. World Health Organization (WHO) termed the coronavirus disease as COVID-2019 on February 11, 2020 and announced its outbreak as pandemic on 11 March 2020. The first infection was noticed in Wuhan, Hubei province, China, in December 2019, and it is believed that the corona-virus is transmitted to humans through bats as a reservoir involving human to human transfer. However, the proper intermediary transmission channel is yet to be unestablished. Method(s): Elderly populations and patients with concomitant symptoms are more at risk as compared to middle-aged patients as it may progress to pneumonia followed by severe acute respiratory syndrome (SARS) and multi-organ failure. Morbidity rates estimated in patients are less, i.e., 2-3%, but the dearth of a specific treatment strategy to prevent coronavirus infection is a major concern. Result(s): Currently, anti-viral and anti-malarial drugs are in practice for the management of COVID-19 disease along with plasma therapy in the absence of a potent vaccine. Besides, home isolation and social distancing are the precautionary measures adopted by many countries to minimize the spread of infection. Various studies have been conducted, and numerous are still going on to establish specific treatment for COVID-19. Conclusion(s): In this review, we summarized information on the structural components of COVID19 virus with special emphasis on the virus genome, life cycle, the importance of protease enzyme, the role of spike proteins in viral replication, validated drug targets, ongoing effective treatments for COVID-19 management and the latest research on drug design to develop anti-CoV drugs.Copyright © 2021 Bentham Science Publishers.
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Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neu-ropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objective(s): This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Method(s): This prospective observational study included admitted children and adolescents (4-18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Result(s): Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 +/- 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and op-positional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusion(s): The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.Copyright © 2023, Author(s).
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The global outbreak of the new coronavirus infection COVID-19 is still ongoing, leading to coinfections such as malaria and COVID-19 and others. As evidenced, by the increase in various reports of coinfections. In recent years, Uzbekistan has achieved epidemiological stability for malaria and in 2018 received, an official World Health Organization certificate confirming the country's "malaria-free" status. At the present stage during the COVID-19 pandemic, imported, malaria from abroad, is relevant for our republic and, therefore, there is a constant danger of renewed, transmission, from imported cases. In this article presented the clinical case of coinfection, of COVID-19 and. malaria in a patient. From, the epidemiological data, the patient was a citizen of Cameroon. During treatment of coronavirus infection, the patient noted intermittent chills all over the body and sweating, clinical symptoms of tropical malaria began to appear. Microscopy of a thick drop and. a thin blood, smear confirmed, the presence of Pl. falciparum.. The patient was prescribed, antimalarial therapy with mefloquine, resulting in clinical recovery.Copyright © 2022 Authors. All rights reserved.
ABSTRACT
The global outbreak of the new coronavirus infection COVID-19 is still ongoing, leading to coinfections such as malaria and COVID-19 and others. As evidenced, by the increase in various reports of coinfections. In recent years, Uzbekistan has achieved epidemiological stability for malaria and in 2018 received, an official World Health Organization certificate confirming the country's "malaria-free" status. At the present stage during the COVID-19 pandemic, imported, malaria from abroad, is relevant for our republic and, therefore, there is a constant danger of renewed, transmission, from imported cases. In this article presented the clinical case of coinfection, of COVID-19 and. malaria in a patient. From, the epidemiological data, the patient was a citizen of Cameroon. During treatment of coronavirus infection, the patient noted intermittent chills all over the body and sweating, clinical symptoms of tropical malaria began to appear. Microscopy of a thick drop and. a thin blood, smear confirmed, the presence of Pl. falciparum.. The patient was prescribed, antimalarial therapy with mefloquine, resulting in clinical recovery.Copyright © 2022 Authors. All rights reserved.
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Background: Cutaneous adverse drug reactions (CADRs), also known as toxidermia, are skin manifestations resulting from systemic drug administration and it constituted 10%-30% among all reported adverse drug reactions (ADRs). These reactions range from mild morbilliform drug rash to much more severe reactions. Material(s) and Method(s): A retrospective observational study was conducted at dermatology outpatient department of rural based tertiary care center for a duration of 03 years from August 2019 to July 2022, a total of 211 patients who had been clinically diagnosed or were suspected to have drug reactions were studied. Result(s): In this observation there was male preponderance (59.72%) and majority of patients were in their 3rd and 4th decade (40.28%) with maculopapular drug rash (33.17%) being most common clinical profile of CADRs, followed by urticaria (23.70%). Less frequently seen CADRs were acneiform eruptions (21), hair Loss (9), photodermatitis (9), generalised pruritus (7), erythroderma (2), pityriasis rosea (2), Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) (4), lichenoid drug eruptions (3), Vasculitis (1) and pustular drug eruption (1). The most common group of drugs causing CADRs were antibiotics (40.28%), followed by NSAIDs (28.43%). Conclusion(s): Cutaneous Adverse Drug Reactions (CADRs) are price we pay for the benefits of modern drug therapy;knowledge of these reactions is important for treating physician as prompt recognition and treatment can prove lifesaving.Copyright © 2022 Academic Medicine and Pharmacy
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An outburst of a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a grave threat to global health and the economy. As of May 13, 2020, a total of 42,81,838 cases have been confirmed, with over 2,92,376 deaths worldwide. In India, 75,048 cases have been reported to date with 2,440 deaths. Management of this new coronavirus (COVID19) has mainly focused on infection prevention, case detection, monitoring, and supportive care. As there is no vaccine or specific antiviral treatment for human SARS-CoV-2, therefore identifying the drug treatment options as soon as possible is critical for the response to the COVID19 outbreak. Pro-inflammatory cascade and cytokine storm play a key role in the pathogenesis of new coronavirus. A large number of therapeutic interventions such as antiviral, antimalarial, convalescent plasma therapy, BCG vaccine, mTOR inhibi-tors, Tissue Plasminogen Activator, Human monoclonal antibodies, Anti-parasitic agents, Immunoen-hancers, Nutritional interventions, JAK-STAT signaling inhibitors, ACE2 receptor modulators, and An-giotensin II receptor blockers have been either tried or suggested for effective treatment of patients with SARS-CoV-2 disease. Hence, we recommend that all the above potential interventions must be imple-mented in terms of their safety and efficacy through proper clinical experiments to control the emerging SARS-CoV-2 disease.Copyright © 2021 Bentham Science Publishers.
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Ethics in research and how it is translated into practice is fundamental to rule out any potential misconduct either with the scientific method or the way results are presented to the world, thus impacting patients outcomes. The last two years of the Covid-19 pandemic were prolific in exposing the scientific community and healthcare professionals to the many flaws regarding the different studies either with promising simple treatments or sophisticated medications. Supposedly high-profile papers with the antimalarial medication hydroxychloroquine either favoring its use or indicating the risk of death were retracted from very prestigious journals such as the Lancet and the New England Journal of Medicine. Ethics in research became fundamental in reaction to abuses practiced against people as the Nazi studies on concentration camp prisoners or the syphilis study with American prisoners or the US governments radiation experiment. Copyright © 2023 The Author(s)
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Guduchi (Tinospora cordifolia) is an essential drug of the Ayurvedic medicine system used in different Ayurvedic formulations to treat a variety of ailments. Guduchi is a member of the Menispermaceae family and is widely produced in tropical and sub-tropical countries such as India, Sri Lanka, China, Myanmar, Philippines, South Africa, Thailand, Bangladesh, and several south-east Asian continents such as Indonesia, Malaysia. All parts of Guduchi have nutritional value and medicinal importance, including the roots, stem, bark, and leaves. A different class of phytochemicals like alkaloids, glycosides, aliphatic compounds, diterpenoids, sesquiterpenoids, phenolic compounds, steroid and polysaccharides, etc., are found in Guduchi. Tinosporaside, tinosporine, magnosporine, berberine, choline, Jatrorrhizine, palmatine, beberine, giloin, giloinsterol, and other beneficial biomarkers are present in this herb. Guduchi is used to treat cold, fever, headache, jaundice, digestive disorder, among other things, and it shows several proven pharmacological activities such as anti-oxidant, anti-inflammatory, antidiabetic, immunomodulatory activity, anti-toxic, hepatoprotective, anticancer, cardioprotective activity, radioprotective, antimicrobial, anti-stress, anti-HIV and many more. This review article majorly highlights the phytochemical present in Guduchi, analytical works and pharmacological activities of Guduchi. Copyright © 2022 are reserved by International Journal of Pharmaceutical Sciences and Research.
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Introduction. Vaccination against SARS-CoV2 is beneficial for patients with autoimmune disease. Therefore, we recommended basic immunization as soon as it has become available for our patients. We preferred mRNAbased vaccination based on the international recommendations. However, several patients received other types of vaccines at their own or their general practitioner's discretion. Based on the antibody levels against the SARSCoV2 spike protein measured at the Institute of Laboratory Medicine of our university, we were able to draw initial conclusions about the effectiveness of vaccination regarding our primary Sjogren's syndrome patients. Patients and methods. Antibodies to SARS-CoV2 spike protein were analyzed in the sera of 77 patients with primary Sjogren's syndrome after being vaccinated with two doses between 1st January and 30th April, 2021, at least 30 days after the second vaccination. Antibody responses were classified as high (above 250 U/ml), moderate (between 50 and 250 U/ml) and low (below 50 U/ml). Relying on the SPSS statistical program, we were seeking correlations between the serum levels and the EULAR Sjogren's syndrome disease activity index (ESSDAI) and the potential influence of the different immunosuppressive treatment modalities, respectively. For the statistical analysis, chi2 tests were performed. Result(s): Pfizer vaccine was given to 58 patients, and the rest of our cohort received Moderna (2 patients), Sinopharm (10 patients), Astra Zeneca (6 patients) and Sputnik vaccine (1 patient). High antibody levels were found in 54 subjects (70.1%), moderate levels in 11 subjects (14.3%), and low levels in 12 subjects (15.6%). After having received the Pfizer vaccine, 86.2% had high, and only 5.2% had low antibody levels. One patient vaccinated with Moderna had high, while the other had low antibody level. The majority (55%) of those vaccinated with Astra Zeneca achieved high titers, and 17% were classified as low responders. After immunization with Sinopharm vaccine, 20% of the patients were classified into moderate response category, while the rest (80%) presented low antibody levels. We also measured low value in the serum of the patient that received the Sputnik vaccine. Serum levels of specific antibodies in patients not receiving any specific therapy (14 subjects) did not differ significantly from those treated with antimalarials (18 subjects), methotrexate (19 subjects), azathioprine (6 subjects), or low-dose steroids (20 subjects). Based on our results, the type of immunosuppressive treatment had less effect on the protection developed than the type of vaccination. There was no significant correlation between Sjogren's syndrome disease activity and the degree of specific antibody response to the vaccine. Conclusions. Our initial results suggest that the use of COVID vaccines is safe and effective for Sjogren's syndrome patients, regardless of the treatment used or of the ESSDAI.
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Background: Patients with systemic lupus erythematosus (SLE) may have an increased risk of mortality from COVID-19 due to underlying immuno-suppression, comorbidities, and abnormalities in the innate immune system. Studies have shown that autoimmune diseases and some immunosuppres-sive agents are risk factors for hospitalization, ventilation, and mortality from COVID-19. Objectives: To compare the outcomes of patients with or without SLE who were diagnosed with COVID-19 and to identify the factors associated with 30-day hos-pitalization, mechanical ventilation, and mortality. We hypothesized that patients with SLE had a higher risk of adverse outcomes. Methods: This retrospective cohort study used the deidentifed Optum COVID-19 electronic health record dataset to identify adult patients with COVID-19 diagnosis from 1/1/2020-12/31/2020. The SLE cohort was defned as patients who had two or more international classifcation of diseases (ICD) 9 or 10 diagnosis codes of 710.0 or M32.xx but not M32.0 within one year before COVID-19 diagnosis and were on either antimalarial or immunosuppressive therapy. The general cohort excluded patients with SLE. We matched SLE cases with controls at a ratio of 1:10 by age, sex, race and ethnicity, and month of COVID-19 diagnosis via a propensity score matching with exact matching for the latter three variables. Outcomes included 30-day mortality, hospitaliza-tion, and mechanical ventilation after COVID-19 diagnosis. We performed multivariable logistic regression models to estimate the odds of 30-day mortality, hospitalization, and mechanical ventilation after adjusting for age, sex, race and ethnicity, COVID-19 diagnosis quarter, insurance, region, severe obesity, smoking status, and comorbidities. Results: We included 687 SLE cases matched with 6,870 controls. After matching, the 30-day mortality for SLE and control was 3.6% and 1.8% (p <0.001), the 30-day mechanical ventilation was 6.0% and 2.5% (p <0.001), and 30-day hospitalization was 31.0% and 17.7% (p <0.001). After multivariable adjustment (Table 1) for age, sex, race, COVID-19 diagnosis quarter, insurance, region, severe obesity, and smoking status, patients with SLE had higher odds of death (Odds Ratio (OR)=2.09;95% CI 1.31-3.32), mechanical ventilation (OR=2.43;95% CI 1.67-3.54) and hospitalization (OR=2.06;95% CI 1.71-2.49). After additionally adjusting for comorbidities, the OR decreased to 1.39 (95%CI 0.79-2.44), 1.81 (95%CI 1.16-2.82), and 1.32 (95%CI 1.05-1.65) for mortality, mechanical ventilation, and hospitalization respectively. Older age, male sex, Hispanic ethnicity or Black race, severe obesity, and smoking had increased risk of adverse outcomes. Conclusion: Patients with SLE have an increased risks of mortality, mechanical ventilation, and hospitalization within 30 days of COVID-19 diagnosis. The risks decreased after adjustment for comorbidities but remained statistically signifcant for mechanical ventilation and hospitalization.
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Background: Systemic lupus erythematosus (SLE) prognosis is determined by a wide range of factors, such as the severity of the disease manifestations, the psychosocial aspects of patients, the proper management of comorbidities, adoption of a healthy lifestyle and adherence to treatment. Studies on chronic diseases highlight the value of patient education to foster treatment adherence and improve prognosis. Objectives: To promote health education to SLE patients and their families providing accessible and comprehensive Scientific information, in order to improve adherence to treatment and the patient's prognosis. Methods: The Waiting Room Project is linked to the Extension Health Care Program for SLE patients and their families of Universidade Federal de Minas Gerais, Brazil, since 2011. A total of 700 patients under SLE treatment at the Rheumatology Unit of the University Hospital are involved. Medical students and rheumatology fellows, altogether, developed high-quality informative texts, with clear content and layman language appropriate for the patient, under the supervision of the rheumatology professors. The texts are illustrated by the team of the Communication Department of the Medical School and medical students, and are printed in a leafet format. The material is handed out to the patients, while they wait for their medical appointment, by the students and the care team. The content of the leafets is discussed, making sure that all the concerns and doubts are properly addressed Results: The Waiting Room Project has produced 17 leafets, addressing different aspects of SLE, comorbidities, and treatment. The texts approach the traditional cardiovascular risk factors (Smoking, Arterial Hypertension, Diabetes, Obesity, Physical Activity), and some medical conditions related to general health and SLE treatment (Sun Protection, Healthy Food, Oral Care, Vaccination, Pregnancy, Osteoporosis). In 2020 and 2021, two leafets about Covid-19 were produced in order to clarify important aspects of this disease, its impact on lupus patients and to solve questions about SLE medications: one regarding the association between Lupus and Covid-19 and another about the treatment of lupus and Covid-19. Other four leafets were produced concerning SLE treatment, including Adherence to Treatment, the use of Antimalarials, Corticos-teroids, and Immunosuppressants. Information about the drugs, general importance on lupus treatment, recommendations and possible adverse events were described. Futhermore, additional content is currently in production with themes such as Intravenous Corticosteroid and Cyclophosphamide, Human Papilloma-virus Infection, Malignant Neoplasm, and specifc cancers frequently affecting women, such as Colorectal Cancer, Cervical Cancer, and Breast Cancer. The leafets are also available online on the Medical School website in Portuguese and in English (medicina.ufmg.br/alo/material-didatico/), on the Minas Gerais Rheumatology Society website (reumatologia.org.br/orientacoes-ao-paciente/), and on the Instagram page @lupusufmg Conclusion: The leafets have been an important source of information and health education for SLE patients and their families, improving student/physician-patient communication. Despite the adversities caused by the coronavirus pandemic, the Waiting Room Project has kept its purpose to make each patient with SLE an agent of their healthcare. Improving the patients' access to evidence-based information must be a goal of healthcare professionals that treat patients with SLE.