Vaccination in rheumatic disease patients: results of a pilot quality improvement program.

OBJECTIVES: Patients with rheumatic diseases (RD) are at increased risk of infections. Vaccination is recognized as a successful public health measure and is recommended for RD patients. The aim of this study was to describe the strategies implemented in an academic rheumatology outpatient clinic as part of a fellow-in-training-led vaccination quality improvement (QI) program and to explore the vaccination uptake before and one year after the implementation. MATERIAL AND METHODS: The program's objective is the promotion of vaccination among patients and rheumatology fellows (by educational interventions, development of vaccination charts and orders, and modifications to electronic medical records to register vaccination dates and generate reminders). As part of the continuous evaluation of the QI program, a descriptive cross-sectional study was performed to evaluate vaccine uptake pre- and post-interventions and vaccination barriers one year after implementation. Consecutive patients with RD answered a self-administered questionnaire. Results are shown as descriptive statistics. RESULTS: Before the program started 73 patients were surveyed and 102 patients one year after. The vaccination uptake rates for influenza pre- and post-interventions were 43% and 55%; for pneumococcal vaccination they were 26% and 30%; for herpes zoster they were 0% and 4%; for human papillomavirus they were 4% and 10%; for hepatitis B (HBV) they were 19% and 25% respectively. Eighty percent of patients reported some barriers to receiving any of the previous vaccines. The three main reasons for not receiving a vaccine were the lack of recommendation, the lack of availability, and the belief that vaccines do not work. CONCLUSIONS: The implementation of a pilot vaccination QI program led by rheumatology fellows-in-training showed promising preliminary benefits in the vaccination uptake among RD patients and helps to evaluate the barriers to surpass.

Cognitive dysfunction in Sjögren's syndrome using the Montreal Cognitive Assessment Questionnaire and the Automated Neuropsychological Assessment Metrics: A cross-sectional study.

AIM: To describe the prevalence of cognitive impairment and the most affected cognitive domains, employing the Montreal Cognitive Assessment (MoCA) and the Automated Neuropsychological Assessment Metrics (ANAM) of a Latin American primary Sjögren's syndrome (pSS) cohort, and compare these patients to secondary Sjögren's syndrome (sSS) subjects and controls. METHODS: This was a comparative cross-sectional study of patients with a diagnosis of pSS who fulfilled the American-European Consensus Group 2002 criteria and/or American College of Rheumatology/European League Against Rheumatism 2016 criteria; clinical information was evaluated prior to cognitive evaluation, which consisted of a single session in which the MoCA and ANAM were applied. RESULTS: A total of 122 subjects were included in the analysis (51 pSS, 20 sSS and 51 controls); mean age of pSS was 56 years (SD 10.4), of which 47 (92.15%) were women. Moderate-severe cognitive impairment by MoCA was 17% in pSS, 5% in sSS, and 15% in controls, and by ANAM were 29% in pSS and 10% in sSS (P > .05). Visuospatial/executive subdomain in the MoCA was different between the pSS and the control group (P = .005). We encountered a statistically significant difference between pSS patients and control scores from the program in 6 of the 7 domains tested by the ANAM. CONCLUSION: No difference was found in the prevalence of cognitive impairment between pSS subjects and controls by MoCA. Several subdomain scores differed between groups in both scales. Evaluation of cognitive disorders in patients with SS, even in early stages of the disease, seems advisable but the best strategy is yet to be elucidated.

Neuropsychiatric symptoms in a patient with Dyke-Davidoff-Masson syndrome and systemic lupus erythematosus: a case report.

BACKGROUND: Dyke-Davidoff-Masson syndrome is an uncommon constellation of radiological and clinical findings. Few reports describe co-occurring psychiatric manifestations. Systemic lupus erythematosus is a systemic disease with vascular, neurologic, and psychiatric involvement. To the best of our knowledge, no case reports have been made associating these entities. CASE PRESENTATION: We present the case of a 21-year-old Mexican mestizo woman with a history of systemic lupus erythematosus diagnosed at 4 years of age, who developed focal impaired awareness seizures when she was 8-years old, which became treatment-resistant at age 15. Two years prior to our evaluation, she developed deep vein thrombosis; clinical and laboratory criteria were met to diagnose secondary antiphospholipid syndrome. After being treated with anticonvulsants, glucocorticoids, and immunosuppressants with only a partial response, she developed a severe major depressive episode 1 year prior to our assessment, including two suicide attempts. She was referred to the out-patient clinic of our department for evaluation; intellectual disability, depressive symptoms, and behavioral symptoms were documented. Imaging studies revealed structural abnormalities in the left cerebral hemisphere: cortical atrophy, enlargement of sulci and cisternal spaces, and hyperpneumatization of the frontal sinus. Treatment with an antidepressant was initiated and maintained for 1 year, added to anticonvulsants and immunosuppressants. Depressive and behavioral symptoms diminished and no suicidal ideation has been noted at follow-up. CONCLUSIONS: Dyke-Davidoff-Masson syndrome was diagnosed, accompanied by clinical symptoms previously reported as epilepsy and intellectual disability. This case report illustrates the complexity of syndrome presentation in an adult female, constituting a diagnostic and therapeutic challenge. This constellation of symptoms and structural brain abnormalities should be kept in mind in patients with neuropsychiatric manifestations and systemic diseases with central nervous system involvement, especially when diagnosed at a young age.