Construction and use of a risk stratification instrument for vaccination of elderly against Covid-19 / Construção e utilização de instrumento de estratificação de risco para vacinação de idosos contra a Covid-19 / Construcción y uso de un instrumento de estratificación de riesgo para la vacunación del anciano contra el Covid- 19

Objetivo: Relatar a experiência da construção e utilização de um instrumento de estratificação de risco para vacinação de idosos contra a COVID-19. Métodos: Relato da experiência desenvolvida no município de Massapê ­ Ceará, durante o ano de 2021, a partir do início da campanha de vacinação de idosos contra a COVID-19. Descrição da Experiência: Por conta da escassez de imunobiológicos, na fase inicial da vacinação contra a COVID-19, a Secretaria da Saúde do município de Massapê, estado do Ceará, criou um instrumento para estratificação de riscos sanitários, epidemiológicos e sociais dos idosos, contendo seus dados sociodemográficos e as comorbidades. Após o estabelecimento das variáveis, foram estabelecidos escores para os estratos de risco, que foram classificados em baixo (um a três pontos), médio (quatro a seis pontos), alto (sete a nove pontos) e muito alto (dez pontos e mais). Considerações Finais: O estudo mostra que, apesar da pandemia de COVID-19, uma crise sanitária global sem precedentes como já dito, ações pontuais, mesmo que localizadas, podem ter efeito em cadeia e ser replicadas em outros cenários e momentos.

Objective: To report the experience of building and using a risk stratification instrument for vaccinating the elderly against COVID-19. Methods: Report of the experience developed in the municipality of Massapê - Ceará, during the year 2021, from the beginning of the vaccination campaign for the elderly against COVID-19. Experience Description: Due to the scarcity of immunobiologicals, in the initial phase of vaccination against COVID-19, the Department of Health of the municipality of Massapê, state of Ceará, created an instrument to stratify the health, epidemiological and social risks of the elderly, containing sociodemographic data and comorbidities of the elderly. After establishing the variables, scores were established for the risk strata, which were classified as low (one to three points), medium (four to six points), high (seven to nine points) and very high (ten points and more). Final Considerations: The study shows that, despite the COVID-19 pandemic, an unprecedented global health crisis as already mentioned, specific actions, even if localized, can have a chain effect and be replicated in other scenarios and times.

Objetivo: Relatar la experiencia de construcción y uso de un instrumento de estratificación de riesgo para la vacunación de ancianos contra la COVID-19. Métodos: Informe de la experiencia desarrollada en el municipio de Massapê - Ceará, durante el año 2021, desde el inicio de la campaña de vacunación de ancianos contra la COVID-19. Descripción de la Experiencia: Debido a la escasez de inmunobiológicos, en la fase inicial de la vacunación contra la COVID-19, la Secretaría de Salud del municipio de Massapê, estado de Ceará, creó un instrumento para estratificar los riesgos sanitarios, epidemiológicos y sociales de los ancianos, que contiene datos sociodemográficos y comorbilidades de los ancianos. Luego de establecer las variables, se establecieron puntajes para los estratos de riesgo, los cuales se clasificaron en bajo (uno a tres puntos), medio (cuatro a seis puntos), alto (siete a nueve puntos) y muy alto (diez puntos y más). Consideraciones finales: El estudio muestra que, a pesar de la pandemia de COVID-19, una crisis sanitaria mundial sin precedentes como ya se mencionó, las acciones específicas, aunque sean localizadas, pueden tener un efecto en cadena y replicarse en otros escenarios y tiempos.

Case Reports on Black Fungus of the Gastrointestinal Tract: A New Complication in COVID-19 Patients.

Gastrointestinal mucormycosis is a rare disease with a significant mortality rate, even when promptly diagnosed and treated. An unusual complication was observed in India during the second wave of coronavirus disease 2019 (COVID-19). Two incidences of gastric mucormycosis were found. A 53-year-old male patient with a history of COVID-19 one month earlier came into the intensive care unit. After admission, the patient developed hematemesis, which was initially treated with blood transfusions and digital subtraction angiography embolization. Esophagogastroduodenoscopy (EGD) revealed a large ulcer with a clot in the stomach. During an exploratory laparotomy, the proximal stomach was necrotic. Histopathological examination confirmed mucormycosis. The patient was started on antifungals, but despite rigorous therapy, the patient died on the tenth postoperative day. Another patient, an 82-year-old male with a history of COVID-19, arrived with hematemesis two weeks earlier and was treated conservatively. EGD revealed a large white-based ulcer with abundant slough along the larger curvature of the body. Mucormycosis was verified by biopsy. He was treated with amphotericin B and isavuconazole. He was discharged after two weeks in a stable condition. Despite quick detection and aggressive treatment, the prognosis is poor. In the second case, prompt diagnosis and treatment saved the patient's life.

Post-COVID-19 syndrome and diabetes mellitus: a propensity-matched analysis of the International HOPE-II COVID-19 Registry.

Background: Diabetes mellitus (DM) is one of the most frequent comorbidities in patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a higher rate of severe course of coronavirus disease (COVID-19). However, data about post-COVID-19 syndrome (PCS) in patients with DM are limited. Methods: This multicenter, propensity score-matched study compared long-term follow-up data about cardiovascular, neuropsychiatric, respiratory, gastrointestinal, and other symptoms in 8,719 patients with DM to those without DM. The 1:1 propensity score matching (PSM) according to age and sex resulted in 1,548 matched pairs. Results: Diabetics and nondiabetics had a mean age of 72.6 ± 12.7 years old. At follow-up, cardiovascular symptoms such as dyspnea and increased resting heart rate occurred less in patients with DM (13.2% vs. 16.4%; p = 0.01) than those without DM (2.8% vs. 5.6%; p = 0.05), respectively. The incidence of newly diagnosed arterial hypertension was slightly lower in DM patients as compared to non-DM patients (0.5% vs. 1.6%; p = 0.18). Abnormal spirometry was observed more in patients with DM than those without DM (18.8% vs. 13; p = 0.24). Paranoia was diagnosed more frequently in patients with DM than in non-DM patients at follow-up time (4% vs. 1.2%; p = 0.009). The incidence of newly diagnosed renal insufficiency was higher in patients suffering from DM as compared to patients without DM (4.8% vs. 2.6%; p = 0.09). The rate of readmission was comparable in patients with and without DM (19.7% vs. 18.3%; p = 0.61). The reinfection rate with COVID-19 was comparable in both groups (2.9% in diabetics vs. 2.3% in nondiabetics; p = 0.55). Long-term mortality was higher in DM patients than in non-DM patients (33.9% vs. 29.1%; p = 0.005). Conclusions: The mortality rate was higher in patients with DM type II as compared to those without DM. Readmission and reinfection rates with COVID-19 were comparable in both groups. The incidence of cardiovascular symptoms was higher in patients without DM.

Role of Serum Ferritin, D-Dimer, and C-Reactive Protein Parameters in COVID 19 Severity.

Following the epidemics caused by the transmission of the common virus between humans and animals (COVID-19), coronavirus 2 (SARS-CoV-2) is the third and most deadly strain of RNA virus that can cause respiratory, digestive, and nervous system problems, and there are many unknown complications. This study included 170 clinical samples of nasopharyngeal swaps (100 patients and 70 controls for both males and females). RT-PCR was performed, and blood samples were taken for biochemical analyses. They were obtained from Iraqi patients aged 25 to 92 years old. Between November 2021 and March 2022, COVID-19 patients were admitted to Dar al-salam Hospital, Alyarmok Teaching Hospital, and Alshefaa Hospital. AFIAS D-Dimer, AFIAS ferritin, and NycoCard CRP tests were performed on the patients and were classified depending on the severity of their infection (mild or moderate, severe and critical). The results showed a significant increase in ferritin in critically ill patients (545.58 ± 57.71). A significant increase of D-dimer was found with different severity with highly significant in the critical group (3.93 ± 0.79). With varying degrees of severity, a substantial rise in CRP was discovered with highly significant in the critical group (96.27 ± 14.55) between the severity group (p-value <0.001). Also, COVID-19 individuals in the age range (50 - 60) tended to be more severe than younger people, whereas the effect of gender is not significant in any patient group. The biochemical factors, including D-Dimer, ferritin, and CRP, are effective in the disease's occurrence of symptoms and severity.

Association of depressive symptoms with Geriatric Locomotive Function Scale score in community-dwelling older adults living in the state of emergency.

BACKGROUND: Under the state of emergency, it has been reported that the amount of physical activity among community-dwelling older adults has decreased significantly due to refraining from going out, and there are strong concerns about the Geriatric Locomotive Function Scale and deterioration of mental health. Therefore, this study aimed to investigate whether the depressive state before the coronavirus disease 2019 (COVID-19) pandemic affected the 25-Geriatric Locomotive (GLFS) score during the COVID-19 pandemic among community-dwelling older adults. METHODS: The participants were 194 community-dwelling older adults (45 men, 149 women) with an average age of 75.5 ± 5.5 years who responded to a self-administered survey conducted three times (preliminary, second, and third) from before the 2018 COVID-19 pandemic to March 2021. Individuals with a score of ≥ 10 on the Geriatric Depression Scale 15 (GDS 15) were excluded. The survey items included the 25-question Geriatric Locomotive Function Scale (GLFS25), GDS 15, and other basic attributes. Those with scores of 5 to 9 on the GDS 15 and those with scores of 0 to 4 were assigned to the depressive symptoms (DS) group and the non-DS group, respectively. Statistical analysis was performed using two-way analysis of variance. The Mann-Whitney U test was used for comparisons between the groups. RESULTS: In total, 187 patients were included in the analysis, excluding 7 patients. GLFS 25 showed a significant increase in scores at the second and third time points compared with baseline, and a main effect was confirmed in both groups, with no interaction effect. The second time, the score was 10.0 ± 8.5 and 13.7 ± 10.5 in the non-DS and DS groups, respectively. The third time, the non-DS and DS groups scored 10.8 ± 10.5 and 14.9 ± 10.1 points, respectively, indicating a significant difference. CONCLUSIONS: Our results revealed that the increase in the GLFS 25 score in community-dwelling older adults during the COVID-19 pandemic was related to their DS during normal times before the pandemic. Evaluating such individuals and providing social support may effectively reduce the deterioration of the GLFS 25 score.

Recurrent bilateral adrenal infarction with myelodysplastic/myeloproliferative neoplasm-unclassifiable (MDS/MPN-U): a case report.

BACKGROUND: Bilateral adrenal infarction is rare and only a small number of cases have been reported so far. Adrenal infarction is usually caused by thrombophilia or a hypercoagulable state, such as antiphospholipid antibody syndrome, pregnancy, and coronavirus disease 2019. However, adrenal infarction with myelodysplastic/myeloproliferative neoplasm (MDS/MPN) has not been reported. CASE PRESENTATION: An 81-year-old man with a sudden severe bilateral backache presented to our hospital. Contrast-enhanced computed tomography (CT) led to the diagnosis of bilateral adrenal infarction. Previously reported causes of adrenal infarction were all excluded and a diagnosis of MDS/MPN-unclassifiable (MDS/MPN-U) was reached, which was considered to be attributed to adrenal infarction. He developed a relapse of bilateral adrenal infarction, and aspirin administration was initiated. Partial primary adrenal insufficiency was suspected as the serum adrenocorticotropic hormone level was persistently high after the second bilateral adrenal infarction. CONCLUSION: This is the first case of bilateral adrenal infarction with MDS/MPN-U encountered. MDS/MPN has the clinical characteristics of MPN. It is reasonable to assume that MDS/MPN-U may have influenced bilateral adrenal infarction development, considering the absence of thrombosis history and a current comorbid hypercoagulable disease. This is also the first case of recurrent bilateral adrenal infarction. It is important to carefully investigate the underlying cause of adrenal infarction once adrenal infarction is diagnosed, as well as to assess adrenocortical function.

SARS-CoV-2 IgG Spike antibody levels and avidity in natural infection or following vaccination with mRNA-1273 or BNT162b2 vaccines.

Certain aspects of the immunogenicity and effectiveness of the messenger ribonucleic acid (mRNA) vaccines (mRNA-1273 and BNT162b2) developed in response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are still uncharacterized. Serum or plasma samples from healthy donor recipients of either vaccine (BNT162b2 n = 53, mRNA-1273 n = 49; age 23-67), and individuals naturally infected with SARS-CoV-2 (n = 106; age 18-82) were collected 0-2 months post-infection or 1- and 4 months after second dose of vaccination. Anti-Spike antibody levels and avidity were measured via an enzyme-linked immunosorbent assay (ELISA). Overall, vaccination induced higher circulating anti-Spike protein immunoglobulin G (IgG) antibody levels and avidity compared to infection at similar time intervals. Both vaccines produced similar anti-Spike IgG concentrations at 1 month, while mRNA-1273 demonstrated significantly higher circulating antibody concentrations after 4 months. mRNA-1273 induced significantly higher avidity at month 1 compared to BNT162b2 across all age groups. However, the 23-34 age group was the only group to maintain statistical significance by 4 months. Male BNT162b2 recipients were approaching statistically significant lower anti-Spike IgG avidity compared to females by month 4. These findings demonstrate enhanced anti-Spike IgG levels and avidity following vaccination compared to natural infection. In addition, the mRNA-1273 vaccine induced higher antibody levels by 4 months compared to BNT162b2.

Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives.

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

Clinical characteristics and risk factors associated with COVID-19 mortality in a non-Intensive Care Unit.

Introduction: The Coronavirus disease 2019 caused by a new Coronavirus (SARS-CoV-2) throughout the pandemic period has been characterised by a wide spectrum of clinical manifestations, courses, and outcomes. In particular, most patients with severe or critical symptoms re-quired hospitalization. The demographic and clinical characteristics of patients upon admission to the hospital, as well as pre-existing medical conditions, seem to have affected the clinical out-come. Predictive factors of inauspicious outcome in non-Intensive Care Unit hospitalized patients were investigated. Methods: A retrospective, single-centre, observational study of 239 patients with confirmed COVID-19 disease admitted during the first waves of the pandemic to the Infectious Disease Operative Unit of a hospital in Southern Italy was conducted. Demographic characteristics, under-lying diseases, and clinical, laboratory, and radiological findings were collected from the patient's medical records. Information about in-hospital medications, days of admission, and out-come were also considered. Inferential statistical analysis was performed to evaluate the association between patients' characteristics upon hospital admission and during in-hospital length of stay and death. Results: Mean age was 67.8 ± 15.8 years; 137/239 (57.3%) patients were males, and 176 (73.6%) had at least one comorbidity. More than half of patients (55.3%) suffered from hypertension. The length of stay in hospital was 16.5 ± 9.9 days and mortality rate of 12.55%. In multivariable logistic regression analysis, predictors of mortality of COVID-19 patients included age (OR, 1.09; CI, 1.04-1.15), Chronic Kidney Disease (OR, 4.04; CI, 1.38-11.85), and need of High Flow Oxygen therapy (OR, 18.23; CI, 5.06-65.64). Conclusions: Patients who died in the hospital had shorted length of stay than that of the surviving patients. Older age, pre-existent chronic renal disease and need of supplemental oxygen represented independent predictors of mortality in patients hospitalized in non-Intensive Care Unit with COVID-19. The determination of these factors allows retrospectively a greater understanding of the disease also in comparison with the successive epidemic waves.

Hospital admissions and deaths due to acute cardiovascular events during the COVID-19 pandemic in residents of long-term care facilities.

Hospital admissions due to acute cardiovascular events dropped during the COVID-19 pandemic in the general population; however, evidence for residents of long-term care facilities (LTCF) is sparse. We investigated rates of hospital admissions and deaths due to myocardial infarction (MI) and stroke in LTCF residents during the pandemic. Our nationwide cohort study used claims data. The sample comprised 1,140,139 AOK-ensured LTCF residents over 60 years of age (68.6% women; age 85.3 ± 8.5 years) from the largest statutory health insurance in Germany (AOK), which is not representative for all LTCF residents. We included MI and stroke admission and compared numbers of in-hospital deaths from January 2020 to end of April 2021 (i.e., during the first three waves of the pandemic) with the number of incidences in 2015-2019. To estimate incidence risk ratios (IRR), adjusted Poisson regression analyses were applied. During the observation period (2015-2021), there were 19,196 MI and 73,953 stroke admissions. MI admissions declined in the pandemic phase by 22.5% (IRR = 0.68 [CI 0.65-0.72]) compared to previous years. This decline was slightly more pronounced for NSTEMI than for STEMI. MI fatality risks remained comparable across years (IRR = 0.97 [CI95% 0.92-1.02]). Stroke admissions dropped by 15.1% (IRR = 0.75 [CI95% 0.72-0.78]) in the pandemic. There was an elevated case fatality risk for haemorrhagic stroke (IRR = 1.09 [CI95% 1.03-1.15]) but not for other stroke subtypes compared to previous years. This study provides first evidence of declines in MI and stroke admissions and in-hospital deaths among LTCF residents during the pandemic. The figures are alarming given the acute nature of the conditions and the vulnerability of the residents.

The enduring role of sense of coherence in facing the pandemic.

Research has been focussing on protective and resistance-related factors that may help people face the long-lasting psychological challenges of the COVID-19 pandemic. Sense of coherence allows to remain healthy and to recover after stressful or traumatic life experiences. We aimed at investigating whether, and the extent to which, social support, in terms of both family and friends support, mediated the well-established link between sense of coherence and mental health as well as that between sense of coherence and COVID-19-related Post-Traumatic Stress Disorder (PTSD) symptoms. In May 2021, 3048 Italian respondents (51.5% women) aged between 18 and 91 (Mage = 48.33, SD = 14.04) filled in a self-report questionnaire. The mediation analyses we carried out on their responses showed a difference between focussing on mental health or on a psychological disorder. Indeed, despite the respectively positive and negative relation between sense of coherence and mental health and PTSD symptoms, this confirming the protective role of sense of coherence more than 1 year after the beginning of the pandemic, social support only mediated, partially, the former link. We also discuss practical implications and further expansion of the study.

The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study.

BACKGROUND: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. OBJECTIVE: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. METHODS: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. RESULTS: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. CONCLUSIONS: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.

Risk factors for complicated course and recurrence of Clostridioides Difficile infections during COVID-19 pandemic.

INTRODUCTION: The primary symptom of Clostridioides difficile infection (CDI) is diarrhea of varying severity. Both malnutrition and clinical nutrition increase the risk for contracting Clostridioides difficile (C. difficile) infection and the likelihood of relapses. Moreover, the risk for recurrence is higher if there is infection with a hypervirulent strain (NAP1/BI/027). Hypoalbuminemia predisposes to a severe course of the disease and morbidity. MATERIAL AND METHODS: Analysis was carried out of the data regarding patients hospitalized at the Regional Hospital for Infectious Diseases in Warsaw from 01 January 2020 to 31 December 2021 who were diagnosed with C. difficile infection. A severe course of infection was diagnosed when a blood test showed a leukocyte count greater than or equal to 15,000/µl and/or a creatinine concentration >1.5 mg/dl (>132.6 mmol/l). RESULTS: Clostridioides difficile infection was the reason for 185 hospitalizations (involving 108 women and 77 men), of 167 patients aged from 22 to 93 years old. There were 68 (37%) cases of recurrent infection. Seventy-five (41%) infections met the study's criteria for severe CDI, and 12 (7%) patients died. Out of the total number of hospitalizations, 41 (22%) were due SARS-CoV-2 co-infection. PCR tests detecting binary toxin revealed 34 (18%) positive results. Infection with a hypervirulent strain was an independent risk factor for the recurrence of diarrhea which had C. difficile etiology. Overall, during an episode of diarrhea, one antibacterial drug was used in 139 cases (75%), two in 27 (15%), three in 14 (8%) situations, and four - twice (1%). Among these, drugs not recommended for the treatment of CDI were used in 21 (11%) cases. The number of antibacterial drugs administered during an episode of diarrhea was an independent risk factor for the death of the infected person. Clinical nutrition was applied during 19 hospitalizations (10%), out of which 12 (63%) cases showed a severe course of C. difficile infection, while four patients (21%) died. Using clinical nutrition methods was an independent risk factor for a severe course of the disease and patient death. CONCLUSIONS: Clinical nutrition and the number of antibiotics used during an episode of diarrhea are independent risk factors for the death of a patient with CDI. Infection with a hypervirulent strain increases the risk for relapse.

Efficacy of Remdesivir and Neutralizing Monoclonal Antibodies in Monotherapy or Combination Therapy in Reducing the Risk of Disease Progression in Elderly or Immunocompromised Hosts Hospitalized for COVID-19: A Single Center Retrospective Study.

INTRODUCTION: Remdesivir (REM) and monoclonal antibodies (mAbs) could alleviate severe COVID-19 in at-risk outpatients. However, data on their use in hospitalized patients, particularly in elderly or immunocompromised hosts, are lacking. METHODS: All consecutive patients hospitalized with COVID-19 at our unit from 1 July 2021 to 15 March 2022 were retrospectively enrolled. The primary outcome was the progression to severe COVID-19 (P/F < 200). Descriptive statistics, a Cox univariate-multivariate model, and an inverse probability treatment-weighted (IPTW) analysis were performed. RESULTS: Overall, 331 subjects were included; their median (q1-q3) age was 71 (51-80) years, and they were males in 52% of the cases. Of them, 78 (23%) developed severe COVID-19. All-cause in-hospital mortality was 14%; it was higher in those with disease progression (36% vs. 7%, p < 0.001). REM and mAbs resulted in a 7% (95%CI = 3-11%) and 14% (95%CI = 3-25%) reduction in the risk of severe COVID-19, respectively, after adjusting the analysis with the IPTW. In addition, by evaluating only immunocompromised hosts, the combination of REM and mAbs was associated with a significantly lower incidence of severe COVID-19 (aHR = 0.06, 95%CI = 0.02-0.77) when compared with monotherapy. CONCLUSIONS: REM and mAbs may reduce the risk of COVID-19 progression in hospitalized patients. Importantly, in immunocompromised hosts, the combination of mAbs and REM may be beneficial.

Post nirmatrelvir/ritonavir erythema multiforme in a patient with coronavirus disease infection.

Erythema multiforme (EM), an immune-mediated skin condition, can occur after infection or following the use of medications. In this study, we describe a patient who developed EM after nirmatrelvir/ritonavir administration. An 81-year-old woman presented with fever and dyspnea. Laboratory investigations showed positive coronavirus disease (COVID-19) based on polymerase chain reaction assay, and she received a 5-day regimen of nirmatrelvir/ritonavir. We observed development of EM after this treatment and initiated prednisone (1 mg/kg) therapy, which led to rapid improvement. Our study is the first to report EM in a patient with COVID-19, who received nirmatrelvir/ritonavir and showed a favorable response.

Risk of myocarditis and pericarditis after a COVID-19 mRNA vaccine booster and after COVID-19 in those with and without prior SARS-CoV-2 infection: A self-controlled case series analysis in England.

BACKGROUND: An increased risk of myocarditis or pericarditis after priming with mRNA Coronavirus Disease 2019 (COVID-19) vaccines has been shown but information on the risk post-booster is limited. With the now high prevalence of prior Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, we assessed the effect of prior infection on the vaccine risk and the risk from COVID-19 reinfection. METHODS AND FINDINGS: We conducted a self-controlled case series analysis of hospital admissions for myocarditis or pericarditis in England between 22 February 2021 and 6 February 2022 in the 50 million individuals eligible to receive the adenovirus-vectored vaccine (ChAdOx1-S) for priming or an mRNA vaccine (BNT162b2 or mRNA-1273) for priming or boosting. Myocarditis and pericarditis admissions were extracted from the Secondary Uses Service (SUS) database in England and vaccination histories from the National Immunisation Management System (NIMS); prior infections were obtained from the UK Health Security Agency's Second-Generation Surveillance Systems. The relative incidence (RI) of admission within 0 to 6 and 7 to 14 days of vaccination compared with periods outside these risk windows stratified by age, dose, and prior SARS-CoV-2 infection for individuals aged 12 to 101 years was estimated. The RI within 27 days of an infection was assessed in the same model. There were 2,284 admissions for myocarditis and 1,651 for pericarditis in the study period. Elevated RIs were only observed in 16- to 39-year-olds 0 to 6 days postvaccination, mainly in males for myocarditis. Both mRNA vaccines showed elevated RIs after first, second, and third doses with the highest RIs after a second dose 5.34 (95% confidence interval (CI) [3.81, 7.48]; p < 0.001) for BNT162b2 and 56.48 (95% CI [33.95, 93.97]; p < 0.001) for mRNA-1273 compared with 4.38 (95% CI [2.59, 7.38]; p < 0.001) and 7.88 (95% CI [4.02, 15.44]; p < 0.001), respectively, after a third dose. For ChAdOx1-S, an elevated RI was only observed after a first dose, RI 5.23 (95% CI [2.48, 11.01]; p < 0.001). An elevated risk of admission for pericarditis was only observed 0 to 6 days after a second dose of mRNA-1273 vaccine in 16 to 39 year olds, RI 4.84 (95% CI [1.62, 14.01]; p = 0.004). RIs were lower in those with a prior SARS-CoV-2 infection than in those without, 2.47 (95% CI [1.32,4.63]; p = 0.005) versus 4.45 (95% [3.12, 6.34]; p = 0.001) after a second BNT162b2 dose, and 19.07 (95% CI [8.62, 42.19]; p < 0.001) versus 37.2 (95% CI [22.18, 62.38]; p < 0.001) for mRNA-1273 (myocarditis and pericarditis outcomes combined). RIs 1 to 27 days postinfection were elevated in all ages and were marginally lower for breakthrough infections, 2.33 (95% CI [1.96, 2.76]; p < 0.001) compared with 3.32 (95% CI [2.54, 4.33]; p < 0.001) in vaccine-naïve individuals respectively. CONCLUSIONS: We observed an increased risk of myocarditis within the first week after priming and booster doses of mRNA vaccines, predominantly in males under 40 years with the highest risks after a second dose. The risk difference between the second and the third doses was particularly marked for the mRNA-1273 vaccine that contains half the amount of mRNA when used for boosting than priming. The lower risk in those with prior SARS-CoV-2 infection, and lack of an enhanced effect post-booster, does not suggest a spike-directed immune mechanism. Research to understand the mechanism of vaccine-associated myocarditis and to document the risk with bivalent mRNA vaccines is warranted.

Navigating the Complexities of Dementia Care: The Lived Experiences of Black American Family Caregivers.

Black American individuals have a higher rate of Alzheimer's disease and related dementias (ADRD) diagnoses compared to other racial/ethnic groups, and their family caregiver population is expected to increase rapidly over the next 2 decades. The current study aimed to explore Black American women's experiences caring for family members with ADRD. An interpretative phenomenology approach was used to gain a deeper understanding of the caregiving experiences of Black American women. Participants in the study were all Black American married women aged 63 to 81 years (mean = 71.3 years, SD = 6.6 years). Key themes that emerged from the study included: (a) Family Care Obligation, (b) Caregiving Journey, (c) Prioritizing Health Concerns, (d) Coping Behaviors, and (e) Support Needs and Challenges. Family caregivers require ongoing support, education, and guidance. Implications for nursing practice include focusing on family assessments, increased education and awareness, and collaboration with interdisciplinary teams to provide the best resources. [Journal of Gerontological Nursing, 49(6), 19-26.].

Changes in SARS-CoV-2 seroprevalence and population immunity in Finland, 2020-2022.

Studying the prevalence of SARS-CoV-2 specific antibodies (seroprevalence) allows for assessing the impact of epidemic containment measures and vaccinations and estimating the number of infections regardless of viral testing. We assessed antibody-mediated immunity to SARS-CoV-2 induced by infections and vaccinations from April 2020 to December 2022 in Finland by measuring serum IgG to SARS-CoV-2 nucleoprotein (N-IgG) and spike glycoprotein from randomly selected 18-85-year-old subjects (n = 9794). N-IgG seroprevalence remained at <7% until the last quartile (Q) of 2021. After the emergence of the Omicron variant, N-IgG seroprevalence increased rapidly and was 31% in Q1/2022 and 54% in Q4/2022. Seroprevalence was highest in the youngest age groups from Q2/2022 onwards. We did not observe regional differences in seroprevalence in 2022. We estimated that 51% of the Finnish 18-85-year-old population had antibody-mediated hybrid immunity induced by a combination of vaccinations and infections by the end of 2022. In conclusion, major shifts in the COVID-19 pandemic and resulting population immunity could be observed by serological testing.

Understanding Differential Stress and Mental Health Reactions to COVID-19-Related Events.

The effects of the pandemic on mental health can be studied through different variables, such as the number of COVID-19 stressors, the stressor types, and the stress responses. Understanding the sources of mental strain is crucial for developing effective interventions. The present study analyzed the relationship between these COVID-19-related variables and positive and negative mental health. A cross-sectional study was conducted with 666 individuals from the Portuguese general population, mostly females (65.5%) between 16-93 years old. They completed self-report measures regarding the number of COVID-19 stressors, the stressor types, the stress responses (IES-R), and positive (MHC-SF) and negative mental health (BSI-18). The results demonstrated that a higher number of COVID-19-experienced stressors and more stress responses were related to worse mental health. Regarding stressor types, experiences not related to the COVID-19 infection (e.g., tension at home) presented the largest effects on mental health. The strongest predictor was the stress responses for negative (ß = 0.50) and positive mental health (ß = -0.17). The predictors explained more about negative mental health than positive. These findings support the idea that individual appraisals play a crucial role in mental health.