Symptomatic COVID-19 course and outcomes after three mRNA vaccine doses in multiple sclerosis patients treated with high-efficacy DMTs.

BACKGROUND: Little is known about COVID-19 course and outcomes after a third booster dose of mRNA vaccine against SARS-CoV-2 (mRNA-Vax) in patients with multiple sclerosis (pwMS) treated with ocrelizumab (OCR) and fingolimod (FNG), which showed a weakened immune response to mRNA-vax. OBJECTIVES: The aim of this study was to evaluate COVID-19 course and outcomes in pwMS on OCR and FNG after receiving the third dose of mRNA-Vax and to compare it with pwMS on natalizumab (NTZ). METHODS: Inclusion criteria: >18 years of age, being treated with OCR/FNG/NTZ since the first mRNA-Vax dose; COVID-19 after a third booster dose of mRNA-Vax; no steroids use. RESULTS: Overall, 290 pwMS (79 NTZ, 126 OCR, and 85 FNG) from 17 Italian MS centers were included. Age, Expanded Disability Status Scale (EDSS) score, MS phenotype, disease, and treatment duration were significantly different across groups. PwMS who had COVID-19 on OCR and FNG compared with those on NTZ were slightly more symptomatic with higher hospitalization rates (11.1% vs 7.1% vs 1.3%, respectively). Regression models showed that the majority of the differences observed were not related to the disease-modifying treatments (DMTs) used. No fatal cases were observed. CONCLUSION: Our results support the effectiveness of the third booster dose of mRNA-Vax against severe forms of COVID-19 in pwMS treated with OCR and FNG.

Novel coronavirus infection and pregnancy: features of the course of gestation and the possibility of predicting the progression of COVID-19 severity in pregnant women

The authors analyzed the literature data on the possibility of timely diagnosis and prognosis of COVID-19 progression and development of life-threatening complications during gestation. Pregnant women are at high risk for a severe course of the disease, which is inherent in the prerequisites of gestational adaptation mechanisms. This review presents various aspects of COVID-19 and pregnancy, ranging from the etiopathogenesis and clinical features of the course of the disease in pregnant women to highly informative laboratory methods for predicting the severity of COVID-19. The studies presented demonstrate the scientific and practical interest in developing and implementing pathogenetically valid markers to stratify pregnant women at risk for COVID-19 progression and adverse gestational, perinatal, and somatic outcomes. The current knowledge and practice are insufficient for their large-scale application to effectively address the challenges of timely diagnosis of COVID-19 severity and the prognosis of life-threatening complications, prolonged course of disease, or postconceptional syndrome, which is essential to maintain quality of life, fully develop the biological system of mother and newborn, and preserve reproductive potential. © 2023, Media Sphera Publishing Group. All rights reserved.

Exposure to psychotropic medications and COVID-19 course after hospital admission: Results from a prospective cohort study.

OBJECTIVE: There is evidence of a bidirectional association between COVID-19 disease and psychiatric disorders. We aimed to assess whether exposure to psychotropic medications prior to hospitalization was associated with mortality or discharge within 30 days after hospital admission. METHODS: In this prospective study, we included all individuals with a laboratory-confirmed COVID-19 infection who were admitted to the Bologna University Hospital between 1st March 2020 and 31st January 2021. We collected data about pre-existing psychiatric disorders and the use of psychotropic medications at the admission. As univariate analyses, we estimated cumulative incidence functions for 30-day mortality and discharge stratifying by exposure to each of the psychotropic medication classes. Finally, we fitted Cox regression models to estimate cause-specific Hazard Ratios (HR) of 30-day mortality and discharge. Results were adjusted for sociodemographic (age, sex), clinically relevant variables (comorbidity, c-reactive protein levels, severity of disease at presentation, history of smoking, study period), and psychiatric variables (psychiatric disorder diagnosis, number of psychotropic medications). RESULTS: Out of a total of 1238 hospitalized patients, 316 were prescribed psychotropic medications at the time of admission. Among these, 45 (3.6%) were taking a first-generation antipsychotics (FGA) and 66 (5.3%) a second generation antipsychotic (SGA). Exposure to SGA was associated with increased rates of 30-day mortality (HR = 2.01, 95%CI = 1.02-3.97) and exposure to FGA was associated with decreased rates of 30-day discharge (HR = 0.55, 95%CI = 0.33-0.90). CONCLUSION: Patients with COVID-19 infection exposed to FGA and SGA may have worse COVID-19 infection outcomes.

Novel coronavirus infection and pregnancy: features of the course of gestation and the possibility of predicting the progression of COVID-19 severity in pregnant women

The authors analyzed the literature data on the possibility of timely diagnosis and prognosis of COVID-19 progression and development of life-threatening complications during gestation. Pregnant women are at high risk for a severe course of the disease, which is inherent in the prerequisites of gestational adaptation mechanisms. This review presents various aspects of COVID-19 and pregnancy, ranging from the etiopathogenesis and clinical features of the course of the disease in pregnant women to highly informative laboratory methods for predicting the severity of COVID-19. The studies presented demonstrate the scientific and practical interest in developing and implementing pathogenetically valid markers to stratify pregnant women at risk for COVID-19 progression and adverse gestational, perinatal, and somatic outcomes. The current knowledge and practice are insufficient for their large-scale application to effectively address the challenges of timely diagnosis of COVID-19 severity and the prognosis of life-threatening complications, prolonged course of disease, or postconceptional syndrome, which is essential to maintain quality of life, fully develop the biological system of mother and newborn, and preserve reproductive potential. © 2023, Media Sphera Publishing Group. All rights reserved.