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BackgroundCOVID-19 has shaped the world over the last 3 years. Although the risk for severe COVID-19 progression in children is low it might be aggravated by chronic rheumatic disease or treatment with immunosuppressive drugs.ObjectivesWe analyzed clinical data of COVID-19 cases among paediatric patients with rheumatic diseases reported to BIKER between March 2020 and December 2022.MethodsThe main task of the German BIKER (Biologics in Pediatric Rheumatology) registry is safety monitoring of biologic therapies in JIA. After the onset of the COVID-19 pandemic, the survey was expanded with a standardized form to proactively interview all participating centers about occurrence, presentation and outcome of SARS-CoV-2 infections in children with rheumatic diseases.ResultsA total of 68 centres participated in the survey. Clinical data from 928 COVID infections in 885 patients with rheumatic diseases could be analyzed. JIA was the most common diagnosis with (717 infections), followed by genetic autoinflammation (103 infections), systemic autoimmune diseases (78 infections), idiopathic uveitis (n=25), vasculitis (n=5).In 374 reported COVID infections (40%), patients were receiving conventional DMARDs, in 331 (36%) biologics, mainly TNF inhibitors (TNFi, n=241 (26%)). In 567 reports (61%) patients used either a biologic or a DMARD, in 339 reports patients (37%) did not use any antirheumatic medication including steroid.Over the last 3 years, COVID-19 occurred in Germany in 5 distinguishable waves, calendar weeks (CW) 10-30 in 2020, CW 21/2020 – 8/2021(both predominantly wild-type variant), CW 9-27 in 2021 (Alpha variant in the majority of infections), CW 28-51 in 2021 (Delta variant), since CW 52/2021 (several Omikron variants;Robert-Koch Institute: VOC_VOI_Tabelle.xlsx;live.com))In our cohort, patients with SARS-CoV-2 infection were slightly older during the 1st and 2nd wave (mean age 12.7+/-3.5 and 12.8+/-4.3 years) compared to the 4th and 5th wave with 11.4+/-3.9 and 11.4+/-4.2 years;p=0.01.160 asymptomatic SARS-CoV-2 infections were reported, frequencies of symptoms associated with COVID-19 are shown in table 1.Five patients were hospitalized for 4-7 days. A 3½-year-old female patient succumbed during the first wave with encephalopathy and respiratory failure. The patient had been treated with MTX and steroids for systemic JIA. Genetic testing revealed a congenital immunodeficiency. No other patient needed ventilation or intensive care. One case of uncomplicated PIMS in an MTX treated JIA patient was reported.The duration of SARS-CoV-2 infection-associated symptoms was markably shorter during the 5th wave with 6.7+/-5.1 days, compared with reports from the other 4 waves (Table1).The duration of symptoms was higher in MTX treated patients (10.2+/-8.4 days) compared to patients without treatment (7.7+/-10.8;p=0.004) or patients treated with TNFi (8.2+/-4.8, p=0.002). Although patients treated with steroids also had a longer duration of symptoms (9.7+/-7.0), this was not significant.ConclusionExcept for one patient with congenital immunodeficiency who died, no case of severe COVID-19 was reported in our cohort. At the time of infection, over 60% of patients had been treated with conventional DMARDs and/or biologics. Although MTX treated patients had a slightly longer duration of symptoms, antirheumatic treatment did not appear to have a negative impact on severity or outcome of SARS-CoV-2 infection.Table 1.Characteristics and frequency of symptoms in SARS-CoV-2 infectionsN or mean (SD)1st wave N=202nd wave N=843rd wave N=384th wave N=1245th wave N=662female14532775432age at COVID-19, years12.7 (3.5)12.8 (4.3)11.8 (3.5)11.4 (3.9)11.4 (4.2)asymptomatic126132694duration of symptoms;days,11.9 (14.7)9.2 (7.0)14.1 (11.6)10.3 (7.6)6.7 (5.1)fever1218541306cough1015652245rhinitis5261344289headache4161227171sore throat61139132musculosceletal pain2751348loss of smell/taste71162113fatigue4882680dizziness122116gastrointestinal symptoms151864dyspnea1117pneumonia11bronchitis1REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Inter stsAriane Klein Speakers bureau: Novartis, Toni Hospach Speakers bureau: Speaking fee Novartis and SOBI., Frank Dressler Speakers bureau: Abbvie, Novartis, Pfizer, Advisory Boards Novartis and Mylan, Daniel Windschall Grant/research support from: research funds by Novartis, Roche, Pfizer, Abbvie, Markus Hufnagel: None declared, Wolfgang Emminger: None declared, Sonja Mrusek: None declared, Peggy Ruehmer: None declared, Alexander Kühn: None declared, Philipp Bismarck: None declared, Maria Haller: None declared, Gerd Horneff Speakers bureau: Pfizer, Roche, MSD, Sobi, GSK, Sanofi, AbbVie, Chugai, Bayer, Novartis, Grant/research support from: Pfizer, Roche, MSD, AbbVie, Chugai, Novartis.
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Research-based learning (RBL) familiarizes students with the academic research process at an early stage and at the same time offers them the opportunity to actively shape their own learning process. Working on their own research problems allows students to go through the entire research cycle, which promotes not only subject and methodological competencies but also the students' self-competencies. The handling of subject-specific and didactic challenges of this form of teaching-learning has been discussed many times in the past. New challenges for research-based learning now arise from the shift of teaching and learning to virtual space associated with the COVID-19 pandemic. This paper focuses on the adaptation of a research-based teaching-learning format to the demands of e-learning in the course Interaction Science with Artificial Intelligence. We evaluated the adapted teaching-learning format with 18 students in a master's program in STEM. The students stated an increase in professional competence in the areas of programming, data preparation and data visualization. Our results suggest that peer group and direct interaction via synchronous communication channels are important structural frameworks for research-based learning in an online learning context. From our results, we can derive initial implications for online-based RBL in the field of computational education. © 2022 IEEE.
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The rapidly growing market of eSports has become a lucrative industry. Sim racing is one of the traditional sports that gain increasing popularity in eSports. With raising profits, lucrative sponsoring contracts, and competitive price money, incentives for fraud are also on the upraise. This is further facilitated by the COVID-19 pandemic, which led to the substitution of live eSport events by virtual formats. Particularly, in sim racing it becomes increasingly challenging to verify the contestants identity in virtual events. Here, we propose and evaluate a generic workflow to identify personal driving style by transforming raw racing data (including measurements extracted from the simulation software and connected simulator hardware) into a comparable representation (fingerprint). As data base we used an extensive collection of telemetry data recorded from the racing simulation Assetto Corsa on 3 immersive motion simulators. The set contains over 2,000 laps of seven player recorded in weekly sessions. The experiments demonstrate the feasibility to distinguish players using the proposed method on different tracks, car models, and motion simulators. Due to the extensive experiments, we could achieve a driver separation score of up to 89%. The raw data and the raw results are made publicly available on Github. © 2022 IEEE.
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Background: Although the risk for severe COVID-19 progression in children is low, this may be aggravated by the underlying disease and/or immunosuppres-sive drugs. Objectives: We analyzed clinical data of COVID-19 cases among paediatric patients with rheumatic diseases reported to the BIKER registry. Methods: The main task of the German BIKER (Biologics in Pediatric Rheumatology) registry is to monitor the safety of biologics therapies in JIA. After the onset of the COVID-19 pandemic, the survey was expanded with a standardized form to proactively interview all participating centers about the occurrence, presentation, and outcome of SARS-CoV-2-infections in children with rheumatic diseases. Interviews were conducted with 68 centers initially weekly and later biweekly. Results: A total of 68 centres participated in the survey. Clinical data from 194 COVID-19 cases reported to the BIKER registry from 41 German and 1 Austrian pediatric rheumatology institutions between February 2020 and December 2021 were analyzed. Juvenile idiopathic arthritis (JIA, n=144) was the most common diagnosis followed by genetic autoinflammation (n=18;i.e. FMF, TRAPS, CAPS, HIDS, DADA2), systemic autoimmune diseases (n=11;i.e. SLE, dermatomyositis, vasculitis) and 16 with other rheumatic diseases (i.e. CRMO, Uveitis). 5 patients with no rheumatic disease were excluded. 104 (54%) patients were receiving conventional DMARDs, 81 (43%) received biologics, mainly TNF inhibitors (n=66 (35%)). Of the 189 rheumatic patients with SARS-CoV2 infection, 123 (63%) were female. The mean age was 12.4+/-4.4 years in females and 13.2+/-4.1 in males. The duration of SARS-Co2 infection associated symptoms was 13.8+/-15.3 days (max. 113 days), in 35 (43%) patients they lasted for > 12 days. 46 (24%) were asymptomatic. Patients with autoinflammation and systemic autoimmunopathies reported more symptoms such as fever, head and throat ache. 4 patients only complained about dyspnea. Only 3 patients were hospitalized and received Oxygen-supplementation. The only patients admitted to ICU, received ventilation but succumbed. This 3/-year-old patient, initially diagnosed with systemic JIA, developed fatal disease with intracranial edema and respiratory failure, as well as typical pulmonary texture changes. Prior to her SARS-CoV-2 infection, the patient was treated with MTX and low-dose steroids. Genetic testing revealed a so far unrecognized congenital immunodeficiency. In the total JIA cohort, treatment with corticosteroids, conventional DMARDs, biologics or combinations did not influence the number of reported symptoms or the favorable outcome of the cohort. However, the duration of symptoms was lower in the TNF-treated cohort (10.4+/-6.4 days vs. 15.7 +/-19.7 days). In the cohort with autoinflammation, fever was observed in 11 (61%). Those 6 who received IL-1-inhibitors did not show a different outcome than those 12 who did not. No case of PIMS/MISC in children with rheumatic diseases was reported. Conclusion: Except for one patient with congenital immunodefciency who died from her COVID-19 infection, no case of severe COVID-19 was reported in our cohort. At the time of infection, over 80% of patients in our cohort had been treated with conventional DMARDs and/or biologics. This did not appear to have a negative impact on the severity or outcome of SARS-CoV2 infection. Interestingly, no case of PIMS/MISC was observed.
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Background The mechanisms and outcomes in COVID-19- associated stroke are unique from those of non-COVID-19 stroke. Objectives The purpose of this study is to describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. Methods We conducted an international multicenter retrospective study of consecutively admitted COVID-19 patients with concomitant acute large vessel occlusion (LVO) across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a MT between January 2018 to December 2020.Results: The total cohort was 575 patients with acute LVO, 194 had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs. 71.2;p<0.001), and lacked vascular risk factors (49, 25.3% vs. 54, 14.2%;p =0.001). mTICI 3 revascularization was less common in the COVID-19 group (74, 39.2% vs. 252, 67.2%;p < 0.001). Poor functional outcome at discharge (defined as mRS 3-6) was more common in the COVID-19 group (150, 79.8% vs.132, 66.7%;p =0.004). COVID-19 was independently associated with a lower likelihood of achieving mTICI 3 (OR: 0.4, 95% CI: 0.2 -0.7;p<0.001), and unfavorable outcomes (OR: 2.5, 95% CI: 1.4 - 4.5;p=0.002). Conclusion COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. COVID-19 patients with LVO patients were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates. (Figure Presented).
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Introduction/Purpose Over the past few years, transradial access for neurointerventions has gained more popularity due to extrapolated interventional cardiology data, patient preference and early reports of feasibility using this approach. Our aim was to evaluate the incidence of periprocedural stroke in patients undergoing radial versus femoral access for diagnostic cerebral angiograms. Materials and Methods Retrospective review of our prospectively maintained neurointerventional database and identification of all patients who underwent a diagnostic cerebral angiogram between May 2019 and July 2021. These patients were further divided into radial versus femoral access. Patients in whom postprocedural stroke symptoms were identified were recorded. In those patients, symptoms and NIHSS were collected. Pertinent laboratory values and procedural data was reviewed, including COVID status, platelet count, INR, GFR, vessels catheterized, amount of contrast used, and fluoroscopy time. Patient imaging work-up for stroke symptoms was reviewed, if available. Results A total of 1238 diagnostic cases were performed between table 1 for a detailed overview. Conclusion In our experience, transradial access for diagnostic cerebral angiograms was associated with a low but not neglectable incidence of periprocedural strokes when compared to the traditional femoral approach. Patient vascular anatomy should be evaluated prior to selection of vascular access and patients should be made aware of the possibility of a slightly higher possibility of periprocedural stroke with transradial access. (Figure Presented).
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Background: Motor vehicle crashes (MVCs) remain the leading cause of death for Kentucky children above age 1. The Nest has four separate non-profit programs that provide respite child care, legal/psychological support services to survivors of intimate partner violence, parenting classes, and crisis assistance to families (toiletries/cleaning-supplies/papergoods/diapers/formula/food/rental-assistance since COVID, serving more than 400 clients per month). Community need for car seats was previously demonstrated by the 57 used seats they distributed in a year. Methods: Standard national Child Passenger Safety (CPS) checkup forms were utilized, with an Excel data base of seats provided/notes of special circumstances/problems with seats/cars. Forms from October 1, 2020 to July 1, 2021 were reviewed for quality improvement at least monthly, with immediate adjustments as necessary. All education and seat installation occurred outdoors during fall months and on all but the coldest winter days. Staff and families were masked, items used were sanitized and meticulous hand washing was done between families due to COVID. New convertible seats from grants were supplemented with individually- purchased harnessed booster seats to serve older children and with current (never-in- crash, not -recalled) donated infant seats. CPS services were conducted in 4 languages (English, French, Spanish and Arabic) with fluent staff or consenting family members as translators, and were offered both by appointment/previous consultation/referral from Family Assistance and as walk-ins requesting help or were observed to have car-seat/booster-sized children. Results: A small program that distributed seats as commodities without instruction or assessment of child/car was revised into a formal CPS fitting station, addressing difficult cars, large families, grandparents raising grandchildren, and resettled international refugees. Approximately 90% of families had annual family incomes of < $20,000/year, many below $10,000. Almost every consult for one child revealed multiple children in need of car seat education or new seats. More than 150 seats were checked in nine months. Types of misuse (in >90%) seen include: no seat, child too loose in seat, seat too loose in car, use of infant seats facing forward for too-big toddlers, premature use of no-back boosters (NBB) for small young children when family has no money for harnessed seats or at the mis-direction of a medical professional. Families that live in high crime areas with car theft are bringing in car seats at night so need lighter weight ones, as do grandparents. Conclusion: Taking CPS to the parking lot of an established non-profit has permitted us to reach more families with great need in a place they trust. Types of misuse have provided a real-world window into the potential optimal timing/messages of CPS within pediatric anticipatory guidance, and families have shown how our anticipatory CPS guidance may need to be adapted to work in the environment that people actually live in.
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Background: COVID-19 is a major challenge worldwide. Although the risk for a severe disease course is low among children with COVID-19, symptoms may be exacerbated by underlying disease and/or immunosuppressive medication. We analysed clinical data from COVID-19 cases in among pediatric patients with juvenile idiopathic arthritis (JIA) in Germany reported to the BIKER registry. Objectives: This is an analysis of clinical data for 56 COVID-19 cases reported to the German BIKER registry from 29 German pediatric rheumatology centers and clinics from February 2020 to January 2021. Methods: The major task of the German BIKER (Biologics in Paediatric Rheumatology) Registry is surveillance of biologics used in pediatric rheumatology patients. Following the start of the COVID-19 pandemic in Germany, a survey was established to proactively interview all participating centers regarding the occurrence, presentation and outcome of SARS-CoV-2-infected children with rheumatic diseases. Initially, the interviews were conducted in weekly intervals, later bi-weekly. A standardized Adverse Event of Special Interest form was developed requesting biographic data, pre-treatment, current medication, data on clinical presentation, course, treatment and outcome of COVID-19 pediatric rheumatology patients. Results: In all, 56 patients with JIA and SARS-CoV-2 infection were reported (Table 1). Of these patients, 71% were 12 or more years old. At the time of infection, 41% of the patients received conventional DMARDs and 52% received biologics (Table 1). Forty-four patients (79%) received either a conventional DMARD or a biologic. Most patients had a polyarticular course of their JIA (57%). In 49 of the 56 cases (88%) COVID-19 was detected directly by PCR (n=46), by antigen test only (n=1) or an undisclosed method (n= 2). Six patients had detectable SARS-CoV2 antibodies and reported to have had typical symptoms. One patient tested negative but developed typical symptoms at approximately the same time a positive SARS-CoV-2 test was returned for a family member. Symptoms were reported in 43 of the 56 patients (77%): fever n=15, rhinitis n=14, cough n=12, headache n=10, loss of sense of taste and/or smell n=9, pharyngitis n=8, fatigue n=5, musculoskeletal pain n=5, GI symptoms n=2 (abdominal pain n=1, diarrhoea n=1), dizziness n=3, encephalitis/seizure/respiratory failure/death n=1. Thirteen patients (23%) were asymptomatic. A 3-year-old female patient initially diagnosed with systemic JIA developed intracranial oedema and respiratory failure. Her SARS-CoV2 PCR test was positive and pulmonary imaging displayed typical changes in lung texture. Before her SARS-CoV-2 infection, the patient was treated with methotrexate and low-dose steroids. Unfortunately, she died three days following hospital admission. Genetic testing revealed an inborn immunodeficiency. Except for this one patient, all other cases were treated as outpatients and no deaths were reported. Conclusion: Apart from one patient with an inborn immunodeficiency who died from her COVID-19 infection, no case of hospitalization or severe COVID-19 was reported in our cohort of JIA patients. At the time of COVID-19 diagnosis, nearly 80% of patients in our cohort had been treated with conventional DMARD and/ or biologics. This seemed not to have a negative effect on severity or outcome of SARS-CoV2 infection.
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Introduction: Underlying biological, genetic, or epigenetic characteristics may predispose to health differences and outcomes with COVID-19 associated stroke. Social determinants of health, access and geographical differences pertaining both to population density and other location-based factors may also be important. Methods: We report 69 cases of acute stroke in patients positive for SARS-CoV-2, in a dichotomized analysis of ischemic stroke outcomes between patients of African American background versus all other backgrounds. All patients presented to 14 major hospitals in the United States and Canada, from March 14-April 14, 2020. All patients had nasopharyngeal swab samples that were positive for SARS-CoV-2 on qualitative RT-PCR assays. Results: We found no significant difference in age (64.4 versus 62.9 years) or the proportion of females (51.9% versus 38.1%) (table 1). Diabetes mellitus was present significantly less in African American cases versus others (37% vs. 66.7%). The African American cohort had a similar mean NIHSS score of 16.3 compared with 14.9 in other races (p=0.63). The door-to-CT time was also similar (23 versus 19 minutes). The proportion of patients presenting with a large vessel occlusion was not significantly different (40.7% versus 47%). We noted 14.8% of African American cases received intravenous tPA compared to 31% in other races but was not significantly different. The proportion of thrombectomy cases mirrored this (14.8% versus 31%). Regarding stroke functional outcomes, there was no difference between African Americans and other races with respect to discharge mRS or proportion of favorable outcome (mRS 0-2). Symptomatic intracranial hemorrhage (sICH) was significantly higher for African Americans (11.1% versus 3%, p<0.001).Mortality was significantly higher in African Americans compared to other races (51.9% vs. 28.6%,p=0.03). Discussion: The reasons for increased mortality in African Americans with COVID-19-associatedstroke are unknown. The finding in this study that mortality rate of COVID-19 positive stroke patientsis greater than that previously reported in either COVID-19 respiratory infection alone or acuteischemic stroke alone, suggests an interaction that also warrants further study.
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Management of refractory skin lesions in patients with lupus erythematosus involves combinations of local measures and systemic agents requiring adjustment to activity and development of the disease. The treatment options are fairly similar for the different cutaneous manifestations;however, no drugs have been licensed specifically for the treatment of skin lesions in this disease. Therefore, the aim of the European guideline was to achieve a broad consensus on treatment strategies for patients with cutaneous lupus erythematosus (CLE) by a European subcommittee, guided by the European Dermatology Forum (EDF) and supported by the European Academy of Dermatology and Venereology (EADV). Standard treatment of CLE includes preventive measures such as smoking cessation and photoprotection. Ultraviolet (UV) A and B light is one of the most important risk factors for CLE, clearly documented by photoprovocation studies in large patient cohorts. In the past years, several trials have been performed to investigate the preventive effect of sunscreens in patients with UV-induced CLE. A randomised controlled trial demonstrated that the application of a broadspectrum sunscreen with a high protection factor prevents UVinduced skin lesions under standardised conditions. First-line treatment options in CLE include topical corticosteroids or calcineurin inhibitors. Currently available topical calcineurin inhibitors (0.03% and 0.1% tacrolimus ointment, 1% pimecrolimus cream) have been licensed for the use in patients with atopic dermatitis. The major advantage of these agents is their better safety profile when compared to topical corticosteroids. A multicentre, randomised, double-blind, vehicle-controlled trial showed significant improvement for oedema and erythema of CLE lesions using 0.1% tacrolimus ointment compared to the vehicle. In patients with disfiguring and widespread disease, systemic agents need to be applied. The first-line systemic treatment is antimalarials, such as hydroxychloroquine, chloroquine or quinacrine, which are particularly recommended in patients with a high risk of scarring and/or the development of systemic disease. In addition, systemic corticosteroids are recommended as first-line treatment in highly active and/or severe CLE. Second- and third-line systemic treatments include methotrexate, retinoids, dapsone and mycophenolate mofetil or mycophenolate acid, respectively. Thalidomide should only be used in selected therapy-refractory CLE patients, preferably in addition to antimalarials. Several new therapeutic options, such as B-cell- or interferon alpha-targeted agents, need to be further evaluated in clinical trials to assess their efficacy and safety in the treatment of patients with CLE. In 2011, the monoclonal antibody belimumab, a B lymphocyte stimulator-specific inhibitor, was introduced for SLE as an adjunct therapy for patients with autoantibody-positive disease who despite standard therapy show high disease activity, intolerance of other treatments, or an unacceptably high need for corticosteroids. Currently, a validated skin score is used to confirm the efficacy of belimumab on mucocutaneous manifestations. In summary, there is a high unmet need for new therapeutic strategies, such as B-cell- or interferon-targeted agents, focusing on cutaneous manifestations in lupus erythematosus. Therefore, innovative designs of randomised controlled trials are warranted to develop new therapeutic options for patients with refractory skin manifestations in this disease. Case 1: 40-year-old man with SLE and painful erythemato-violaceous lesions Marzia Caproni A 40-year-old man was diagnosed with systemic lupus erythematosus (SLE) in 2013 based on photosensitivity, Raynaud's phenomenon, positive direct Coombs test, ANA, antidsDNA, Sm, Ro, La, RNP antibodies and low complement, followed by malar rash and discoid lesions on the ears. He started hydroxychloroquine (HCQ) 400 mg/day, nicotinamide 500 mg/day, topical corticosteroids and calcineurin inhibitors with benefit, followed by reactivation of malar rash, w rsening of immunological parameters, proteinuria and lupus nephritis two years later. Prednisone 25 mg/day and mycophenolate mofetil (MMF) 640 mg/day were added with good clinical and laboratory control. In March 2018 he was hospitalised because of suspected macrophage activation syndrome triggered by cytomegalovirus and MMF was withdrawn. As lupus reactivated, in May 2018 he restarted MMF 320 mg/day with prednisone 25 mg/day and HCQ 200 mg/ day. In August 2018, rituximab was administered because of the development of sensory neuropathy with no improvement, thus he underwent intravenous immune globulin treatment with control. In 2020, he developed painful erythemato-violaceous lesions associated with small bullae and ulcers on the distal phalanges of the fingers and toes and of the tip of the nose. Skin lesions were consistent with chilblain lupus. Topical corticosteroid was added. Systemic treatments were replaced by belimumab. Discussion Points • Specific and non-specific skin manifestations during SLE course • Cutaneous lupus erythematosus (CLE) guidelines • Chilblain lupus: differential diagnosis at the time of Covid-19 Case 2: 35-year-old female with SLE and erythemato-desquamative plaques Marzia Caproni A 35-year-old female was diagnosed with SLE in 2013 on the basis of discoid lesions of the face and head, photosensitivity, ANA positivity, lymphadenopathy, hypocomplementemia, leukopenia, low-grade fever and diffuse arthralgias. Comorbidities included Hashimoto's thyroiditis and fybromyalgia under L-tyroxine, baclofen and escitalopram treatment. She started HCQ 400 mg/day and prednisone 25 mg/day, tapering to 5 mg/day with initial control. After 2 years of treatment arthralgias worsened as well as skin lesions and laboratory findings. On examination, atrophic painful plaque of the scalp and erythemato-desquamative plaques on the face were revealed. Topical and IV corticosteroids were added without improvement. Patient also underwent methotrexate, cyclosporine, mycophenolate, rituximab and azathioprine treatment without improvement. We introduced mepacrine 100 mg/day with skin lesion improvement. Due to the difficulty in finding the drug, the patient stopped the treatment with reactivation of the skin manifestations and systemic involvement. We started belimumab 660 mg IV with HCQ 400 mg/day, prednisone 5 mg/day, azathioprine 50 mg/day and duloxetine 60 mg/day with control. Discussion Points • Discoid lupus erythematosus: clinical and histopathological findings • CLE guidelines: topical treatments of discoid lupus erythematosus • CLE guidelines: mepacrine in recalcitrant cutaneous lupus erythematosus • Belimumab and skin lesions in SLE.
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IntroductionThere has been limited evidence on the influence of racial background in stroke outcomes in COVID-19. Underlying biological, genetic, or epigenetic characteristics may predispose to health differences and outcomes. Social determinants of health, access and geographical differences pertaining both to population density and other location-based factors may also be important.MethodsWe report 69 cases of acute stroke in patients positive for SARS-CoV-2, including 27 of African American background and 42 of other racial backgrounds, including Caucasian, Hispanic, and Asian. All patients presented to 14 major hospitals in the United States and Canada, from March 14-April 14, 2020. All patients had nasopharyngeal swab samples that were positive for SARS-CoV-2 on qualitative RT-PCR assays. We present a dichotomized analysis of ischemic stroke outcomes between patients of African American background as reported on hospital intake questionnaire versus all other backgrounds.ResultsComparison between Caucasian, Hispanic and Asian backgrounds did not show disparities in stroke outcomes. We found no significant difference in age (64.4 versus 62.9 years) or the proportion of females (51.9% versus 38.1%) (table 1). Diabetes mellitus was present significantly less in African American cases versus others (37% vs. 66.7%). No significant difference between groups was found regarding other comorbidities including smoking, atrial fibrillation, prior anticoagulation, coronary artery disease, congestive heart failure, hypertension, hyperlipidemia, cerebrovascular accident, peripheral vascular disease, or chronic kidney disease. With respect to presenting SARS-CoV-2 symptoms, we found no difference in exposure history, asymptomatic cases, fever, cough, dyspnea, nausea or vomiting, chills, malaise, or lethargy. The African American cohort had a similar mean NIHSS score of 16.3 compared with 14.9 in other races (p=0.63). The door-to-CT time was also similar (23 versus 19 minutes). The proportion of patients presenting with a large vessel occlusion was not significantly different (40.7% versus 47%). We noted 14.8% of African American cases received intravenous tPA compared to 31% in other races, but this was not significantly different in this sample. The proportion of thrombectomy cases mirrored this (14.8% versus 31%). Laboratory findings were not significantly different between African Americans and all others. Regarding stroke functional outcomes, there was no difference between African Americans and other races in terms of discharge mRS (p=0.27). For mRS 0–2, there was no significant difference noted (14.8% versus 16.7%). Symptomatic intracranial hemorrhage (sICH) was significantly higher for African Americans (11.1% versus 3%, p0.001). Mortality was significantly higher in African Americans compared to other races (51.9% vs. 28.6%, p=0.03).DiscussionOur preliminary data suggest that there may be a mortality difference amongst stroke patients of African American background afflicted with COVID-19. The reasons for increased mortality in African Americans with COVID-19-associated stroke are unknown. Racial disparities in case counts and outcomes during the COVID-19 pandemic have been highlighted, particularly regarding African American communities. In addition, the finding in this study that mortality rate of COVID-19 positive stroke patients is greater than that previously reported in either COVID-19 respiratory infection alone or acute ischemic stroke alone, suggests an interaction that also warrants further study.DisclosuresA. Dmytriw: None. K. Phan: None. C. Schirmer: None. F. Settecase: None. M. Heran: None. A. Efendizade: None. A. Kuhn: None. A. Puri: None. B. Menon: None. M. Dibas: None. S. Sivakumar: None. A. Mowla: None. L. Leung: None. A. Malek: None. B. Voetsch: None. S. Segal: None. A. Wakhloo: None. H. Wu: None. A. Xavier: None. A. Tiwari: None.