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1.
Neumologia y Cirugia de Torax(Mexico) ; 81(2):80-85, 2022.
Article in Spanish | EMBASE | ID: covidwho-2164707

ABSTRACT

Introduction and objective: more than a year after the emergence of COVID-19, many drug therapies have been considered, all based on a critical evaluation of the emerging literature. The main objective of our study was to know the pre-hospitalary treatment of patients with COVID-19. Material(s) and Method(s): we reviewed 101 clinical records of hospitalized patients at the Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas National (INER) diagnosed with COVID-19 during the second wave of the pandemic. A database was created, and descriptive statistics were performed using the software GraphPad Prism version 8. Result(s): the mean age of the patients was 52.3 (+/- 11.9) years. Patients received 4-5 medications as pre-hospital treatment;the most commonly prescribed medications were corticosteroids and antibiotics. Conclusion(s): COVID-19 patients received a large number of unnecessary medications during pre-hospital medical care;several of them were prescribed despite the lack of scientific evidence on their use and the national and international recommendations for treating the disease. Copyright © 2022, Instituto Nacional de Enfermedades Respiratorias. All rights reserved.

2.
Journal of Mazandaran University of Medical Sciences ; 32(215):163-168, 2022.
Article in Persian | EMBASE | ID: covidwho-2156500

ABSTRACT

Background and purpose: Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6) receptor, is emerged as an alternative treatment for COVID-19 patients with a risk of cytokine storms. This study aimed at investigating the efficacy of TCZ in patients with COVID-19. Material(s) and Method(s): In a retrospective observational study, we examined the demographic and clinical characteristics of patients with COVID-19 and also the outcomes of TCZ therapy (Actemra and Temziva) in Qaemshahr Razi Hospital. Result(s): Out of 56 cases, 32 (57.1%) were women and the median age of the patients was 57.5 years. Among the patients, 19 (33.9%) were admitted to ICU where seven (12.7%) were intubated and eight (14.3%) patients deceased. Before TCZ therapy, mean oxygen saturation level was 90.1% which elevated to 93.8% after receiving TCZ (P=0.001). In this study, Temziva was associated with lower mortality rate compared with Actemra (P=0.004). Conclusion(s): TCZ therapy in patients with COVID-19 could improve oxygen saturation level and Temziva results in lower mortality rate. However, further studies with larger sample size are required to confirm these results. Copyright © 2022, Mazandaran University of Medical Sciences. All rights reserved.

3.
Tijdschrift voor Geneeskunde en Gezondheidszorg ; 78(11), 2022.
Article in Dutch | EMBASE | ID: covidwho-2156291

ABSTRACT

This retrospective cohort study analyses the impact of the COVID-19 pandemic on the prehospital pathology in 1 emergency response unit of Brussels. Three months of prehospital data with in total 1,030 interventions were analysed: 1 month in the first and second COVID-19 outbreak (April and November 2020 respectively) and 1 in the intermediate period (June 2020). The subtracted data contained altered respiratory signs as primary outcome parameter. Secondary outcome parameters were mean age, time from call to arrival of the intervention team, oxygen administration, medication administration, artificial ventilation and prehospital death. Statistical analyses are performed using SPSS, the cross table, the Chi-squared test and the Kruskal-Wallis test. Altered respiratory signs appeared in 31.9, 24.6 and 32.9% of the cases in April, June and November respectively (p-value: 0.039). Mean age was 59, 57 and 60 years (null hypothesis retained). Time from call to arrival of the intervention team was 11 minutes in all 3 periods (null hypothesis retained). Oxygen was administrated in 31.4, 27.4 and 32.6% of the cases (p-value: 0.315). Medication was given in 41.1, 39.7 and 41.2% (p-value: 0.908). Artificial ventilation was necessary in 2.8, 5.5 and 5.8% of the interventions (p-value: 0.115). Prehospital death was declared in 6.1, 4.9 and 6.9% of the cases. The COVID-19 pandemic had a significant impact on the prevalence of prehospital altered respiratory signs. Furthermore, no significant difference has been observed in the secondary outcome parameters. Copyright © 2022 The authors.

4.
European Psychiatry ; 65(Supplement 1):S719-S720, 2022.
Article in English | EMBASE | ID: covidwho-2154152

ABSTRACT

Introduction: Plenty of antidepressants have been reported to induce unpleasant tastes and/or odors as well as altered chemosensations when administered alone or in combination with other medications. Trazodone induced hypogeusia (decreased taste sensation) is a rare side effect. In this report, we would like to present a male patient with with hypogeusia after trazodona use and persisting for 3 months after the drug was discontinued will be discussed. Objective(s): A 52-year-old male, Trazodone 50 mg/day was started 4 months ago due to difficulty in falling asleep. On the 25th day of her daily treatment, her sense of taste began to decrease and gradually became more severe. So he stopped his treatment and he applied to the internal medicine and neurology polyclinics. Routine blood tests were within normal limits. To rule out the possibility of covid 19, 2 pcr tests were done and it was found negative. No recommendations other than chewing gum. The patient applied to the psychiatry polyclinic with the complaint of decreased taste sensation that in the 3rd month of his complaints. Method(s): CASE REPORT Results: CASE REPORT Conclusion(s): Chemosensory side effects due to drugs are frequently seen in the elderly and in polypharmacy. It is usually accompanied by a decrease in salivary secretion. It resolves shortly after the causative drug(s) are stopped. It is important that our patient is middle-aged, does not have additional medical diseases and does not use drugs, and his complaints continue for 3 months after the stopped of Trazodone.

5.
European Psychiatry ; 65(Supplement 1):S542, 2022.
Article in English | EMBASE | ID: covidwho-2154109

ABSTRACT

Introduction: Vaccines are effective interventions that can reduce the high burden of COVID19 globally. However, public vaccine hesitancy is a pressing problem for public health authorities. Objective(s): This study aimed to assess the prevalence of vaccination within mentally ill population and to point out the factors of acceptance and reticence. Method(s): We conducted a cross-sectional, descriptive and analytical study. It was carried out on a clinical population who consult in the psychiatry department in Sfax's university hospital Hedi Chaker. Patients included in our study were aged between 21 and 69 years and were not in a decompensation phase of their psychiatric illness Results: Forty five patients were included. The mean age was 45+/-13 years old. Our population was made up of 3 women (6.7%) and 42 men (93.3%).A rate of 42.2% of the patients was of urban origin, 15.6% lived with a partner, 77.8% were unemployed and 46.7% were schizophrenic. In our study population, five patients had COVID 19 (11.1%), fourteen patients (31.1%) were vaccinated and eight patients (17.8%) asked their psychiatrist to vaccine. The main reasons of vaccination were their belief that vaccination decreases the chance of contracting COVID 19 and its complications (0.00) , that COVID is lethal (0.002), and the fact that they trust it (0.001). Thirtyone patients (68.9%) refused vaccination, mainly due to reading or hearing negative information about vaccination (0.025). Vaccination wasn't correlated neither to the fact that it could be a conspiracy nor to the diagnostic. Conclusion(s): Our study reveals that one third of mentally ill patients are vaccinated. The reasons of acceptance of vaccination are multiple in opposite of the hesitancy factors.

6.
European Psychiatry ; 65(Supplement 1):S540-S541, 2022.
Article in English | EMBASE | ID: covidwho-2154105

ABSTRACT

Introduction: The covid pandemic has become a unique phenomenon in world history with great impact on mental health. Objective(s): A great growth of anxious depressive pathology in relation to the Covid situation has appeared with the need to increase the psychiatric approach in the general population Methods: A 58-year-old woman with no personal medical story of interest is referred to the high-resolution Covid program due to severe depressive symptoms: intense apathy, abulia, anhedonia, weight loss, insomnia and important social distancing after the beginning of the confinement due to the Covid Pandemic. 4 psychotherapy sessions are performed, with a maximum duration of 45 minutes. It is necessary to add antidepressant medication with sertraline up to 100mg to improve psychotherapeutic work. Result(s): A complete recovery of symptoms is achieved even their severity with normalization of daily life. Conclusion(s): Small psychotherapeutic interventions have been shown, even with critically ill patients, to be very effective in helping patients regain their baseline status.

7.
European Psychiatry ; 65(Supplement 1):S501, 2022.
Article in English | EMBASE | ID: covidwho-2153999

ABSTRACT

Introduction: Clinical practice has shown that SARS-CoV-2 viral infection increases the likelihood of developing mental disorders. Clinical practice has shown that SARS-CoV-2 viral infection increases the likelihood of developing mental disorders. Objective(s): To analyze clinical indicators of patients with COVID- 19 with mental disorders and to identify predictors of adverse outcomes associated with mental state on its basis. Method(s): The study included 97 patients, 41 men and 56 women (62.3+/-15.3 years of age). During the observation period, 26 people died and 71 people recovered. Data collection was carried out using a questionnaire (109 variables). Binary logistic regression and Cox proportional hazards regression were used. Result(s): In the study group, death occurred on average after 11.5 days. In this group, the mental state of patients was more severe with a predominance of cases of delirium.With age, the probability of a fatal outcome increased by 1.03 with each year of life.The severity of mental disorder had a greater impact onthe risk of deathcompared to age (p=0.003). Improvement of the mental state of patients during psychotropic therapywas associated with a reduction in the risk of an unfavorable outcome of coronavirus infection by 11.11 times. The greatest contribution to the unfavorable outcome was made by the severity of infection: the risk of death increased by 33.17 times. Conclusion(s): Asevere or extremely severemental state increased the risk of death by 4.55 times. The most significant factor in predicting mortality was associated with the severity of the underlying disease.

8.
Journal of the American Society of Nephrology ; 33:76, 2022.
Article in English | EMBASE | ID: covidwho-2124754

ABSTRACT

Background: Cytokines are involved in the pathogenesis of AKI. The aim of this study was to investigate the urine cytokine profile in patients with severe Pneumonia by SARS-COV-2 and AKI. Method(s): This prospective, longitudinal cohort study was conducted at the National Institute of Respiratory Diseases. We included individuals with Severe pneumonia caused by SARS-CoV-2, >18 years of age;without chronic kidney disease (CKD). AKI was defined as creatinine elevation >0.3 mg/dL in 48 hours or level or TIMP2xIGFBP7 >0.3 ng/ ml. Urine samples were collected in critical areas and frozen at -80, urinary concentrations of TIMP-2 and IGFBP7, NGAL and a panel of 27 cytokines were analized. Statistical Analysis: We first explored wheter cytokine patterns between AKI and NO-AKI groups using the Mann-Whitney test, because of a high level of correlation between our panel of urine cytokines and kidney damage biomarkers we performed Principal Component Analysis (PCA). Statistical significance was set at p<0.05. Result(s): We included 51 patients, 30 were male (58.8%);the median age was 53 years (IQR, 40-61);14 had hypertension (27.5%);16 had diabetes (31.4%);and 21 were obese 41.2%. Significant characteristics as well as serum biochemical laboratories, urine kidney stress biomarkers and cytokines are shown in Table 1. We used Principal Component Analysis to built dimensions associated to AKI outcome. After adjustment by Age and Sex, Dimension 2 composed by IL-5, IP 10 (CXCL10), IGFBP7, MIG (CXCL9) was associated with AKI [aHR 95% CI 19.84 (1.00-399) p= 0.050] as well as Dimension 3 composed by N-GAL, RANTES, IL 8, INF-gamma [aHR 95% CI 21.52 (1.91-242) p=0.013]. Conclusion(s): In our study, some cytokines and biomarkers of kidney damage, such as IGFBP7 and N-Gal, were involved in the development of AKI. (Table Presented).

9.
Front Public Health ; 10: 958189, 2022.
Article in English | MEDLINE | ID: covidwho-2142322

ABSTRACT

Background: Group-based physical activity is an important positive factor assisting the middle-aged to older population to be regularly physically active, especially inside a society with a large population and highly sociable environment. However, when group-based physical activity is restricted during a public health crisis such as the infectious disease pandemic, the influence of social distancing on physical activity among this vulnerable group needs to be recognized. Objectives: This study aimed to investigate the influence of social distancing on physical activity among the middle-aged to older Chinese population at the national level. Methods: Data from a nationally representative social follow-up survey (China Family Panel Studies, CFPS) for 2018 and 2020 were used. Physical activity level in year 2018 was set as the baseline to be compared with that for each individual in 2020, when China implemented social distancing during the COVID-19. Chinese population with an age greater than 45 years were included, and three levels of physical activity were established. Logistic models were developed to identify sociodemographic characteristic that may be associated with a higher probability of worse PA behaviors during the social distancing. Results: Over 46% respondents could be described as being Physically Inactivity during 2018 and this proportion increased to 67.2% in 2020. Respondents who live in the Northeast or rural regions, having a spouse, being employed, having a low level of education, and being of low-income level showed a higher decrease in physical activity compared to other groups. However, individuals living with chronic diseases emerge as being more likely to maintain positive habits with respect to physical activity in this context. Conclusion: Social distancing during the COVID-19 pandemic has significantly influenced the extent of physical activity among middle-aged to older Chinese residents. This is especially true in respect to middle-aged and elderly people who are at increased risk of chronic diseases. Given this, there is a clear need to consider effective modalities for physical activity in the context of social distancing based on home quarantine and city lockdown. Furthermore, specific health-related strategies need to be considered in relation to different regions and populations.


Subject(s)
COVID-19 , Physical Distancing , Humans , Middle Aged , Aged , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , China/epidemiology , Exercise , Surveys and Questionnaires , Chronic Disease
10.
International Journal of Stroke ; 17(3 Supplement):243, 2022.
Article in English | EMBASE | ID: covidwho-2139014

ABSTRACT

Background and Aims: The benefits of stroke management is timesensitive. However, healthcare service disruptions and fears related to the COVID-19 pandemic have resulted in reduced stroke admissions. We aim to compare variables associated with early versus late time-toadmissions following acute stroke and transient ischemic attack (TIA) during the pandemic. Method(s): We conducted a prospective cross-sectional study in a 5-month period. Data was collected via questionnaire and guided interview. Descriptive and bivariate chi-square analyses was conducted comparing variables between early and late admission (cut-off 4.5 hours). Result(s): 137 patients were included. Most were male (59.1%) with a mean age of 61.12 (SD +/-13.52). Diagnoses were ischemic stroke (83.2%), hemorrhagic stroke (9.5%), and TIA (7.3%). Median time-to-admission was 7 hours (IQR 2.00-23.00). 60.6% of patients experienced delayed time-to-admission exceeding 4.5 hours. Factors associated with early arrival include a diagnosis of hemorrhagic stroke (p<0.001), symptoms of altered mentation (p<0.001) and visual dysfunction (p=0.001), routine anti-hypertensive usage (p=0.015), higher education level (p=0.004), perceptions of seriousness (p<0.001) and urgency (p<0.001), and recognition of stroke (p<0.001). Being alone during onset of symptoms was significantly associated with delayed arrival (p<0.001). Conclusion(s): A majority of stroke patients were admitted after the golden period, due to failure in recognizing symptoms of stroke and low perceptions of seriousness and urgency. Other factors such as perceived severity of symptoms (i.e., altered mental status, visual dysfunction), a higher education, and routine use of hypertensives, contributes to early arrival. This study can be used to inform future public health intitiatives and campaigns.

11.
Multiple Sclerosis Journal ; 28(3 Supplement):606-607, 2022.
Article in English | EMBASE | ID: covidwho-2138900

ABSTRACT

Background: Although a full course of vaccine against Sars- Cov-2 is effective in most patients with MS (PwMS), the duration of the protection and the efficacy of a booster dose remain poorly explored, especially across different disease modifying treatments (DMTs). Aim(s): To characterize humoral and T-cell immune response along time and following third dose of COVID-19 vaccination in PwMS. Method(s): From an established cohort evaluated at baseline (T0), PwMS were recruited after 24 weeks (T1) from the first cycle of mRNA vaccine and 4 weeks after third dose (T2). At each timepoint we evaluated the serological response by measuring the anti- Region-Binding-Domain (RBD). Cell-mediated response was analyzed by computing interferon (IFN)-gamma in response to spike peptides. Result(s): The baseline cohort consisted of 134 PwMS [mean age 46.6+/-10.8 years;F:92;mean disease duration 15.1+/-9.4 years;26.9% ocrelizumab (OCR) 30.6% fingolimod (FTY), 16.4% cladribine (CLA), 26.1%IFN-s-1a (IFNB)]. Of them, 109 were reassessed at T1, 78 at T2 and 64 completed all evaluations. In the whole cohort there was a significant reduction (p<0.0001) in anti- RBD rate from T0 [76% positive, median 52.8 BAU/ml Interquartile Range (IQR) 1150.9] to T1 (57.8% positive, median 13.2 BAU/ml IQR 95.98] and a significant 20- and 5-fold increase in median titer at T2 (75% positive, median 272.3 BAU/ml IQR 4212.3) from T1 and T0 respectively (p<0.0001). Median IFN-gamma level at T2 was significantly higher than those evaluated at T1 (p<0.0001) and T0 (p=0.009). These latter results were consistent across all DMTs. At T1 the highest detectable anti-RBD response was found in CLA (100%, median 87.7 BAU/ml IQR 22) and IFNB (93.5%;median 126.3 BAU/ml IQR 149.2) cohort, while PwMS treated with FTY and OCR showed 60% (median 8.25 BAU/ml IQR 34.3) and 21% (median 0.8 BAU/ml IQR 6) rate of anti-RBD response respectively. At T2 100% PwMS showed positive anti-RBD response except those treated with OCR (23.8% positive, median 0.6 BAU/ml IQR 4.1). IFN-gamma-S-specific T-cell response was reduced in FTY cohort at both T1 and T2 (3.3 % positive, median 0.8 pg/ml IQR 3.1 and 0.6 pg/ml IQR 2.4 respectively). Conclusion(s): A third dose of COVID-19 vaccine reinforces both humoral and cell-mediated immune response in PwMS on DMTs. Despite vaccination, PwMS treated with OCR and FTY show lower humoral and T-cell specific immune response respectively, suggesting the need of specific treatment to halt COVID-19 in case of infection.

12.
Multiple Sclerosis Journal ; 28(3 Supplement):684, 2022.
Article in English | EMBASE | ID: covidwho-2138896

ABSTRACT

Introduction: Multiple sclerosis drugs (DMTs) were expected to increase the incidence and risk of severe infection for SARSCoV- 2 and to decrease the response to the vaccine, but has it been the case? Objectives: 1) To evaluate the relationship between the use of DMTs and the incidence and severity of SARS-CoV-2 infection. 2) To evaluate the relationship between the use of DMTs and the incidence and severity of SARS-CoV-2 infection after vaccination. Aim(s): To demonstrate that treatment with DMTs does not increase the incidence and risk of severe illness or the response to vaccination due to SARS-CoV-2 infection. Method(s): Retrospective cohort study of 472 adults with MS in a MS Unit between March, 2020 and March, 2022. All DMTs were prescribed prior to COVID-19 testing. Variables: Demographics data, DMTs, SARS-CoV-2 test results, severity of the infection (hospitalized and death), infection after vaccination. Result(s): Among 472 patients with MS, 120 patients (25.4%) had SARS-CoV-2 infection (Incidence in the general population of Catalonia: 22.7%);83 (26%) were women;mean age: 49 years (44.5 yrs for infected;50.6 yrs for not infected);there was no significant difference in the incidence of infection between 66 (29.3%) of the 213 treated and 52 (21.8 %) of the 259 untreated patients (p=0,059). There was also no significant difference in hospitalization between the 4 treated (5.9 %) and 3 untreated (2.5 %) patients. None of them died. There wasn't a significant difference between post-vaccination incidence of infection between the 26 treated (41.3%) and 16 untreated (36.4%) patients either. Conclusion(s): The use of DMTs was not associated with an increase in incidence or severity of SARS-CoV-2 infection, and a favorable vaccine-induced SARS-CoV-2 response was observed. Further research is needed to determine the possible protective role of MS drugs on risk and severity of SARS-CoV-2 and the mechanisms that underlie these findings.

13.
Multiple Sclerosis Journal ; 28(3 Supplement):133-134, 2022.
Article in English | EMBASE | ID: covidwho-2138894

ABSTRACT

Neuromyelitis optica spectrum disorders (NMOSD) is an immunemediated inflammatory disorder of the central nervous system. SARS-CoV-2 infections not only affect the lungs but generally all organs including the central nervous system. The underlying pathophysiology for SARS-CoV-2 associated CNS disease is suspected to be immunogenic. Therefore, the question is whether COVID-19 can trigger relapses in NMOSD patients. On the other hand, there have been reports that COVID-19 vaccination may trigger a relapse. The aim of our study was to assess the risk of NMOSD relpase after SARS-CoV-2 infection or after vaccination. Department of Neurology Medical University of Warsaw is a reference center for treatment of NMOSD patients in Poland. Nowadays we are taking care on seventy-five patients meeting NMOSD diagnostic criteria. As of March 31, 2022, we registered 47 SARS-CoV-2 infections. Twenty-two SARS-CoV-2 infections were reported in patients prior to COVID-19 vaccination (19 females, 3 males). Mean age of patients was 49+/-10 years, mean EDSS 4.5+/-1.5. Twenty (90.9%) patients were on immunosuppressive therapy (rituximab -11, steroids-4, inebilizumab -2, azathioprine -1, satralizumab -1, mycophenolate mofetil -1). Twenty-five SARS-CoV-2 infections occurred after the full course of vaccination (23 females, 2 males). Mean age of patients was 50+/-12 years, mean EDSS 3.6+/-1.7. Twenty-three (92%) patients were on immunosuppressive therapy (rituximab - 12, inebilizumab - 1, azathioprine - 3, satralizumab - 3, mycophenolate mofetil - 4). Three patients had a relapse after COVID-19 (within three months). Two of these people were still unvaccinated at the time. These patients were not receiving full immunosuppressive treatment at the time (one patient developed COVID-19 right after the first dose of rituximab, the other patient received the last dose of rituximab 18 months earlier). The third patient was treated with rituximab and was fully vaccinated. NMOSD relapse occurred in 6% of patients confirmed with COVID-19. Thee risk of relapse was even lower (2%) among patients properly treated with immunosuppressants. Of our seventy-five patients, only two were not vaccinated against SARS-CoV-2. All patients receivedmRNA SARS-CoV-2 vaccines. No vaccine-related NMOSD attack has been reported. Conclusion(s): Patients with NMOSD treated with immunosuppressants have a low risk of a relapse due to COVID-19 infection. In our study mRNA COVID-19 vaccines do not increase the risk of a relapse.

14.
Multiple Sclerosis Journal ; 28(3 Supplement):214-215, 2022.
Article in English | EMBASE | ID: covidwho-2138881

ABSTRACT

Background: Utilization of teleneurology for MS care rapidly expanded during the COVID-19 pandemic to maintain healthcare access. Disparities in telehealth use have been described in other health conditions, but not in a MS population. Objectives/Aims: To evaluate longitudinal utilization of teleneurology across age, race, geographic factors, and insurance categories to identify potential disparities in utilization at a single academic MS center (Cleveland Clinic). Method(s): MS patients attending a specialty clinic in Cleveland, a medium-sized city, who completed >=2 visits at least 24 months apart from 1/2019 to 6/2021 were studied. Patients with fully inperson care were compared to patients with <50% or >50% teleneurology care. Categories of age, race, geographic factors, and insurance were compared using Kruskal-Wallis tests and pairwise Wilcoxon rank sum tests with Bonferroni correction for multiple comparisons. Result(s): 892 patients met the inclusion criteria and completed 3710 visits during the study timeframe: mean age 49.1+/-11.7 years, 73.7% female, 85.6% white, median disease duration 11.2 years [0.15;60.3], and relapsing-remitting 62.3%. 37% patients were fully in-person, 37.2% patients had <50% teleneurology care, and 25.8% patients had >50% teleneurology care. There were no significant differences for race (white, black, other), insurance type (Medicare, Medicaid, private, non/other), area deprivation index (ADI), and residence location (rural vs metropolitan) in the use of teleneurology. Use of teleneurology care varied based by age, with older patients utilizing more in-person care. In person care was 23.4% for ages 18-39, 38.5% for ages 40-60, and 47.8% for those greater than 60 (p<0.001). Patients residing in greater Cleveland had significantly more in-person care (55.3%) compared to residents residing in Ohio outside of the greater Cleveland area (34.7%) and outside of Ohio (10.1%) (p=0.031). Conclusion(s): There were no significant differences in teleneurology utilization across race, insurance, ADI or rural vs metropolitan residence, suggesting it is a broadly accessible tool to overcome disparities in access to MS care. Utilization of teleneurology care for older and local patients was lower, which may be due to decrease demand in these groups. Future studies should assess the optimal integration of teleneurology and in-person visits in MS management.

15.
Multiple Sclerosis Journal ; 28(3 Supplement):173, 2022.
Article in English | EMBASE | ID: covidwho-2138874

ABSTRACT

Background: Whether vaccines play a role triggering or reactivating inflammation in Multiple Sclerosis (MS) has been long debated. There are few reports suggesting that Sars-Cov2 vaccines, as well as COVID-19 infection, may exacerbate relapses in MS. Studies on large cohorts are needed to establish the safety of Sars-Cov2 vaccines in the MS population. Aim(s): To assess the risk of clinical and radiological reactivation following Sars-Cov2 vaccines in patients with MS. Method(s): Patients with MS with known date of SarsCov2 vaccination were identified among those followed up at the Multiple Sclerosis Center of the Tor Vergata University Hospital. Data on clinical relapses and radiological activity (Gadolinium enhancing and new T2 lesions) in the 12 months before and after vaccination were extracted from clinical charts. Result(s): We enrolled 751 patients (64,7% female, mean age 45.9 +/- 11.63 years, 89.9% relapsing-remitting, 5.5% secondary progressive and 4.7% primary progressive, disease duration 11.2 +/- 8.11 years, median EDSS 2.0 [1.0 - 4.0], 12.1% untreated, 41.1% treated with first line immunomodulators and 46.7% with second line high efficacy treatments). Among them, 96.7% received mRNABNT162b2 (Pfizer), 2% mRNA-1273 (Moderna) and 1.3% other COVID-19 vaccines. In the whole cohort we did not find a significant increase of the rate of patients with relapse in the 12 months after vaccines (2.3%) compared to the 12 months before (2,9%, McNemar test, p=0.5), as well as of the rate of patients with radiological activity (both 11.5%, McNemar test, p=0.13). Similar findings were obtained separately analysing untreated patients, patients treated with first line and treated with second line drugs at the time of vaccination. Conclusion(s): Our preliminary results in a large monocentric cohort of MS patients suggest that vaccination with Sars-Cov2 vaccines does not induce disease reactivation. Further analyses are needed to confirm these findings.

16.
Multiple Sclerosis Journal ; 28(3 Supplement):586, 2022.
Article in English | EMBASE | ID: covidwho-2138869

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) ranges from paucisymptomatic course to severe pneumonia and lifethreatening conditions. Although the efficacy and safety of that vaccines in counteract COVID-19 have been established yet, patients with Multiple Sclerosis (MS) are still concerned about vaccination believing that vaccines may worsen their underlying disease. Objective(s): To assess the effect of the new COVID-19 vaccines in a cohort of patients with MS, Dementia, Parkinson disease and atypical parkinsonismson neurofilament light chain (NfL) and other cerebrospinal fluid (CSF) parameters. Aim(s): to determine possibile variation of CSF parameters indicating blood brain barrier disruption and to calculate NfL levels comparing different time points since vaccination against SARS-CoV-2. Method(s):We enrolled patients admitted to the Neurologic Unit of University Hospital Paolo Giaccone who underwent lumbar puncture (LP) between February 2021 and December 2021. CSF parameters and NfL were compared between unvaccinated and vaccinated patients at three different intervals from vaccination (<4 weeks, 4-8 weeks, 8 weeks). Also, these parameters were evaluated between patients with MS and patients with Dementias, Parkinson disease and atypical parkinsonisms. Result(s): A total of 116 patients underwent LP (median age 59 years, [37-51];50% females);n=14 (<4 weeks), n=10 (4-8 weeks), n=25 (>8 weeks) and n=25 (unvaccinated) respectively were included in the final analysis. No significative differences emerged between vaccinated and unvaccinated patients for TPc (p=0.2), CSF glucose (p=0.5), CSF/SGluratio (p=0.3), number of cells per mm3(p=0.7) and CSF-NfL (p=0.6). When comparing vaccinated and unvaccinated patients according to underlying neurological diagnosis, no further differences emerged evaluating CSF parameters between groups (overall p>0.5). CSF-TPc and NfL positively correlated with participants' age (p=0.03) while number of cells per mm3was inversely correlated (p<0.0001). Conclusion(s): NfL and CSF parameters did not differ between vaccinated and unvaccinated patients. COVID-19 vaccines are not associated with neuroinflammation and neuro-axonal degeneration in people with MS and other neurological diseases.

17.
Multiple Sclerosis Journal ; 28(3 Supplement):170-171, 2022.
Article in English | EMBASE | ID: covidwho-2138848

ABSTRACT

Introduction: Several studies in literature suggest that viral infections may trigger multiple sclerosis (MS) relapses. Among these, respiratory tract infections seem to be the most frequent. To date, there are very few data about the association between COVID-19 infection and the risk of relapses in MS. Objective(s): To evaluate the risk of clinical/MRI disease activity after COVID-19 infection in patients with MS. Method(s): We prospectively collected all incident cases of COVID-19 in a population of approximately 1500 MS patients followed by the MS Center of the AOU Citta della Salute e della Scienza di Torino University Hospital, from March 2020 onwards. Clinical features and outcome of the COVID-19 infection, and MS clinical/MRI outcomes in the 6 months following COVID-19 infection were recorded. Propensity score matching was used to compare MS clinical/MRI outcomes over 6 months between patients with or without COVID-19 infection, matched for age, sex, disease duration and MS disease-modifying treatment. Result(s): 143 patients with COVID-19 infection were identified: 103 F, 40 M, with median age of 46 (range 18-82 years). 132/143 had a relapsing-remitting form of MS, while 11 had a progressive form (primary/secondary). 127/143 subjects were under DMT at the time of the infection. 68/143 patients had already received at least one vaccine dose at the time they contracted the infection. Outcome of COVID-19 was usually favorable with mild disease not requiring hospitalization;severe disease was observed in 14 patients, two of whom died. Symptoms suggestive of long COVID (defined as persistence of symptoms after 4 weeks from the resolution of the infection) were observed in 43 patients (30%). In multivariate forward logistic regression, the only variable predictive of long COVID was anti-CD20 therapy (OR 2.42, p = 0.027). No significant differences were found in MS clinical/MRI outcomes (NEDA-3 at 3 and 6 months) after COVID-19 infection, compared to matched MS patients without COVID-19 infection (NEDA-3 at 3 months 78.3% vs 84.8%, p = n.s.;NEDA-3 at 6 months 66.2% vs 76.1%, p = n.s.). Conclusion(s): COVID-19 infection does not appear to influence the risk of MS clinical/MRI disease activity in the months following the infection. Persistence of symptoms suggestive of long Covid is quite common in MS patients.

18.
Multiple Sclerosis Journal ; 28(3 Supplement):104-105, 2022.
Article in English | EMBASE | ID: covidwho-2138838

ABSTRACT

Introduction: In patients with Multiple Sclerosis (pwMS) treated with anti-CD20 treatment or fingolimod it was observed a reduced humoral response after the second dose of mRNA-based SARS-CoV-2 vaccines.It is important to evaluate the effect of the third dose in these groups of patients. Aim(s): To describe the demographical and clinical characteristics of pwMS which received the third dose of Covid-19 vaccine and compare within patients the antibody levels measured just before the third dose with the same assessment executed one month after the third dose. Method(s): The CovaXiMS study is a prospective study for the evaluation of immunogenicity of anti-SARS-CoV2 vaccines in pwMS. Adult pwMS who have performed a third dose of SARSCoVv- 2 vaccination were included in the study. The main endpoint is the change in the antibody levels from six months after the second dose vs one month following the third dose, by considering actual DMTs. Result(s): Out of 1881 enrolled pwMS, 318 (16.9%) received the third dose (83.6% mRNA BNT162b2 and 16.4%mRNA-1273) with a complete assessment of antibody levels before and after the injection. Of them, 236 (74.2%) were females, with a mean age of 48.1 (SD:12.43). Median EDSS was 2.0 [IQR: 1.0-3.5], 8 (2.5%) pwMS recorded at least one relapse in the three months before enrollment, 271 (85.2%) were RRMS, 27 (8.5%) SPMS, and 20 (6.3%) PPMS. Fifty-six (17.6%) pwMS were on fingolimond, 52 (16.4%) on anti-CD20, and 210 (66.0%) on other drugs. Median antibody level (BAU/ml) measured just before the third dose was: 0.0 for pwMS treated with anti-CD20, 35.7 for pwMS on fingolimod and 680.9 for pwMS with other therapies. One month after the third dose the median change in the antidoby levels (BAU/ml) was: +0.6 for pwMS on anti-CD20, +694.6 for pwMS on fingolimod and +13879.4 BAU/ml for pwMS on other DMTs (p<0.001). Considering 659 BAU/mL as the best cut-off indicating a protective antibody level, as suggested by previous literature, 98% of pwMS on other DMTs showed a value above this value, 55% of pwMS on fingolimod, and 23% of pwMS on anti-CD20 (p<0.001). Conclusion(s): After the third dose, a significant increase in antidoby levels was detected in patients with MS. Patients in fingolimod and anti-CD20 had an increase significantly lower than patients in other drugs, but 55% of patients on fingolimod reached an antibody level considered as protective.

19.
Multiple Sclerosis Journal ; 28(3 Supplement):737, 2022.
Article in English | EMBASE | ID: covidwho-2138796

ABSTRACT

Introduction: People with multiple sclerosis (MS) are vulnerable to severe outcomes from COVID-19 infection and were prioritised for COVID-19 vaccination in Australia from March 2021. Despite this, vaccine hesitancy may hinder optimal vaccination uptake. Aim(s): This study explored COVID-19 vaccine uptake, beliefs, and hesitancy in people with MS. Method(s): People with MS receiving MS healthcare management at two Australian health services were invited to participate in an online survey, between September and October 2021. The survey collected sociodemographic and disease-specific characteristics, as well as vaccine status, vaccine hesitancy and beliefs towards COVID-19 vaccination using validated scales: the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six. Regression analyses were used. Result(s): Of the 281 people with MS (mean age 47.7 [SD 12.8] years;75.8% females) who participated, 82.9% had received >=1 COVID-19 vaccine dose. There were 17.1% who were unvaccinated, of which 51.2% reported they were likely to accept vaccination in future. Younger participants were less likely to be vaccinated (B[SE] 0.05[0.01]), as were those within 1-5 years disease duration (B[SE] -1.17[0.39]), all p<0.05. Compared to vaccinated participants, unvaccinated participants reported higher vaccine hesitancy (B[SE] 9.66 [0.72]), greater negative attitudes around vaccine complacency and confidence (B[SE] 13.36[1.40]), greater complacency toward COVID-19 in the context of MS (B[SE] 1.80[0.50]), and higher MS interaction concerns (B[SE] 3.38[0.52]), all p<0.001. Participants who reported no impact of MS on their daily life had lower concerns about the impact of COVID-19 vaccination on MS treatments or disease progression, compared with those reporting MS impacted their daily life all of the time (B[SE] -2.00[0.66], p=0.002). Conclusion(s): General and disease-specific COVID-19 vaccine concerns may influence uptake for people with MS. Understanding the reasons for hesitancy and how they correlate with MS disease and treatment interaction concerns may inform tailored education messages at individual and population levels that addresses these concerns, particularly for ongoing booster doses.

20.
Multiple Sclerosis Journal ; 28(3 Supplement):724-725, 2022.
Article in English | EMBASE | ID: covidwho-2138793

ABSTRACT

Introduction: The experience of suffering multiple sclerosis (MS) can generate patient personal benefit gain and self-improvement. The global pandemic might play a role in the development of post-trauma growth, as patients can perceive the 2019 coronavirus (Covid-19) as a higher threat than the average due to MS condition. Objectives/Aims: To study possible changes in post-traumatic growth in people with MS and Covid-19 influence. Method(s): The sample comprised 260 participants (179 women and 81 men), receiving health care at Virgen Macarena University Hospital. Mean age was 45.05 years (SD= 10.61), from 19 to 78 years old. The MS type were Relapsing-Remitting (n=228) and Progressive (n=32), the Expanded Disability Status Scale (EDSS) mean score was 3.21 (SD=1.93), and mean MS duration was 144.77 months since diagnosis (SD=89.33). Post-traumatic growth inventory (PGI-21) was applied to evaluate patient perception of personal benefit on two different occasions: (T1) 2018- 2019 and, 18 months later, (T2) 2020-2021. At T2, Covid-19 influence was appraised asking patients if they felt affected or not about the Covid situation. Paired t-test examine changes in Post- Traumatic Growth between T1 and T2. Unpaired t-test tested differences in patients affected (n=123) and not affected (n=137) by Covid-19 at T2. Result(s): From T1 to T2 every subscale: relating to others, new possibilities, personal strength, spiritual change, appreciation of life, and PGI-21 total score significantly increased (p<0.0001 for all). Patients affected by Covid-19 reported significant higher scores of PGI-21 subscales and total scores than patients stated not to be affected by Covid-19. Conclusion(s): Patients showed an increase in post-traumatic growth over an 18 months follow-up period, this suggest that elaborating a post-trauma growth is a process that might require time. Additionally, patients who felt affected by Covid-19 presented higher scores in post-traumatic growth. Feeling in an adverse situation, as a global pandemic, might promote the personal benefit gain process in MS.

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