Clinical Outcome of Systemic Lupus Erythematosus during the Covid-19 Omicron Variantwave Compared to Previous Periods: Results from a Single Center Cohort of Puerto Rico

Objectives: Variant-related differences of SARS-CoV-2 have been reported such as higher transmissibility but less disease severity in omicron sublineages when compared to other variants. Although some studies have examined the outcomes of COVID-19 in systemic lupus erythematosus (SLE), most were conducted during the initial waves. Thus, we sought to compare the clinical outcomes of SLE patients with COVID-19 during the omicron and pre-delta/delta periods. Method(s): A cohort of adults with SLE from a single center in Puerto Rico was studied. SARS CoV-2 infection was confirmed by polymerase chain reaction or antigen tests. The pre-delta/delta variants period was defined as March 2020 to November 2021 and the omicron period as December 2021 to October 2022. Demographic parameters, cumulative SLE manifestations, disease activity, disease damage, lupus treatments, comorbidities, COVID-19 symptoms, SLE exacerbations, and hospitalizations were compared between the study periods using bivariate and multivariate analyses. Result(s): Of the entire SLE cohort (n = 347), 151 patients (43.5%) had COVID-19. In those with COVID-19, the mean (SD) age was 46.7 (12.5) years and 96.0% were women. Overall, clinical outcomes were favorable with low rates of hospitalizations (2.6%), lupus flares (3.3%), and mortality (0.7%). In 14.6% of cases, COVID-19 occurred during the pre-delta/delta period and in 85.4% during the omicron wave. Patients that had COVID-19 during the predelta/ delta period were younger and had a significantly higher proportion of oral ulcers, psychosis, anti-Smith antibodies, coronary artery disease, and chronic kidney disease compared to those during the omicron wave. Among COVID-19 symptoms, runny nose, cough, and sore throat were more common in the omicron period, whereas anosmia and anorexia were more frequent in the pre-delta/delta period. In the multivariable analyses adjusted by age, all variables retained significance except for psychosis, anti-Smith antibodies, and coronary artery disease. No significant differences were observed for other variables. Conclusion(s): In this group of Puerto Ricans with SLE, a higher proportion had COVID-19 during the omicron wave compared to previous periods. No differences were seen for severe outcomes such as hospitalizations, lupus flares, and mortality. Furthermore, COVID-19 did not appear to have a negative impact on the short-term clinical outcomes of these patients, regardless of the variant period examined.

Sociocultural factors associated with persistent prescription opioid use among Puerto Rican adults in Massachusetts

Background: Understanding ecological-level factors associated with persistent prescription opioid use (PPOU) may inform research and efforts to reduce prescription opioid-related complications. Puerto Rican Adults (PRAs) have disparities in health outcomes and depression and may be at greater risk of PPOU. Determinants of allostatic loads, including acculturation, migration history, social support, perceived discrimination, have not been explored as correlates of PPOU among PRAs. Further, no study has explored whether depressive symptoms affect PRA's PPOU. Opioid overdose fatality rates among Hispanics have further increased amidst the ongoing COVID-19 pandemic, amplifying the need for exploration of socio-ecological level factors associated with PPOU. Aim: The primary aim of this study was to estimate the incidence and prevalence of prescription opioid use (POU) among PRAs and to evaluate whether sociocultural factors of acculturation and migration history (intrapersonal), social support and network size (interpersonal), and perceived discrimination (community level) predicted PPOU. Furthermore, this study examined the relationship between depression and PPOU and whether depression mediated the effects of perceived discrimination on PPOU. Method: The Socio-Ecological Model (SEM) was adapted to guide this longitudinal secondary analysis study of the Boston Puerto Rican Health Study (BPRHS) cohort. The BPRHS is an ongoing cohort study of PRAs in the Greater Boston area. Baseline (0-year), 2-year, and 5-year datasets were used to estimate incidence and prevalence of POU among the PRA's cohort. The measures were acculturation and migration history, social support and network size, perceived discrimination, depression symptoms, and PPOU. Association between incidence and prevalence of POU by demographic factors were examined. The relationship between SEM-level factors and depression were examined with binary logistic regression. Using Baron and Kenny's method (1986), multivariable binary logistic and linear regression models examined whether depression mediated the effects of perceived discrimination on PPOU. Results: Participants were 45-75 years old (N = 798) of Puerto Rican descent (72.9% women) with 6.5% persistent opioid users compared to non-users (93.5%). Increasing incidence and prevalence of POU were observed at each follow-up. Lower income households were more likely to have higher incidence and prevalence of POU. Multivariate logistic regression models revealed an association between perceived discrimination and PPOU (OR = 2.85, 95% CI 1.46-5.58). No significant association was observed between acculturation, migratory history, social support and PPOU. Depressive symptoms were associated with PPOU (OR = 1.03, 95% CI: 1.00-1.05, p <= 0.03) and partially mediated the effects of perceived discrimination on PPOU by 10.3%, after adjustment of covariates. Conclusion: Reports of associations between perceived discrimination, depression and PPOU broadens current knowledge on factors linked to PPOU in the PRAs subpopulation. This research has important implications for policy, nursing research and clinical practice. Nurses and healthcare professionals may design tailored interventions to reduce PPOU by targeting these risk factors. Addressing perceived discrimination and depressive symptoms may impact PRA's exposure to PPOU and reduce their risk of prescription opioid-related complications. Future research should explore other multi-level factors that may influence PPOU and other potential mechanisms that may explain the effects of perceived discrimination on PPOU. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Prevalence of Depression and Anxiety before and during the COVID-19 Pandemic in Puerto Ricans with Inflammatory Bowel Disease

Background: A higher rate of anxiety and depression is present in patients with inflammatory bowel disease (IBD). The COVID-19 pandemic has negatively impacted mental health in the general population. This study aims to compare the prevalence of depression and anxiety in patients with IBD during the pre-pandemic period and the pandemic period, and to explore trends in patients' specific IBD-related needs during the pandemic era. Method(s): Data was collected from subjects with IBD in two different timepoints: 2016 and 2021-2022. Self-administered questionnaires were given to adults with confirmed IBD attending an academic IBD Clinic. Data collected included demographic information, Patient Health Questionnaire-9 (PHQ-9) for major depressive disorder (MDD), General Anxiety Disorder-7 (GAD-7) questionnaire and subject's need for referrals to other services such as nutrition, pain management, mental health services. Scores of 10 or more in the GAD-7 or PHQ-9 indicate need for professional evaluation. Statistical analysis was performed using R Studio v.4.2.1. This study is approved by the UPR MSC-IRB. Result(s): Two hundred-fifty-two questionnaires were collected in 2016 and 196 during the 2021-22 pandemic period. The majority of subjects were male (54.6%) and had Crohn's disease (69.9%). Mean +/- SD age was 40.2 +/- 14.6. In the PHQ-9, 33.7% (n=91) during 2016, and 16.33% (n=32) during 2021-22 screened positive for MDD. For the GAD-7, 30.7% (n=83) during 2016, and 12.76% (n=25) during 2021- 22 screened positive for generalized anxiety disorder (GAD). Sex and age differences were not detected for MDD and GAD screening, with exception for age differences in MDD during 2021-2022. The most frequent needs for referrals during 2021-2022 were nutrition evaluation (n = 74), access to IBD education (n = 73), psychology services (n = 71) and participation in research for IBD studies (n = 66) Conclusion(s): The frequency of depression and anxiety in Puerto Ricans with IBD during the pandemic period was lower than pre-pandemic. Possible factors related to this include active use of telemedicine providing regular follow-up, integrated psychological support as part of the regular clinic services, and access to information regarding COVID-19 and IBD. (Figure Presented).

Characterization of an aging Puerto Rican cohort with cancer: Analyzing sociodemographic factors and concomitant comorbidities. [R]

Background: Incidence of cancer is constantly increasing in the United States, and Puerto Rico is no exception. The island is currently experiencing low birth rates, signifying that its population is primarily composed of aging citizens that experience a growing need for access to healthcare and medical literature, especially in those with cancer. In this study, we aimed to characterize an aging Puerto Rican cohort with a diagnosis of cancer. Method(s): A questionnaire with sociodemographic and medical inquiries was administered to participants receiving an mRNA vaccine at a COVID-19 vaccination clinic between December 2020 and June 2021. Participants of age 60+ with a diagnosis of cancer, along with their comorbidities, were identified. Multivariate analyses were executed. This study is IRB approved. Result(s): A total of 100 aging participants with a diagnosis of cancer were included: 55 were female and 45 were male, with a mean age of 72.70+/-8.07 (age range: 61-95). When assessing race, participants identified as follows: 68% White, 23% Black or African American, 8% other race, and 1% American Indian or Alaska Native. Concerning ethnicity, 97% identified as Hispanic or Latino, while 3% did not regard themselves as such. When evaluating the cancer diagnoses provided, 27% of female participants had breast cancer and 7% had some form of gynecologic malignancy. Whereas, in males, 42% indicated a diagnosis of prostate cancer. Regarding concomitant comorbidities, 45% of participants had hypertension, 30% had diabetes mellitus, 18% had hypothyroidism, 15% had asthma, and 3% had chronic obstructive pulmonary disease. There was no statistically significant difference when comparing sex and prevalence of concomitant diabetes mellitus or hypertension (p=0.2125). There was also no statistically significant difference when assessing racial identity and presence of concomitant diabetes mellitus or hypertension (p=0.7373). Out of 91 participants who answered the health insurance inquiry, 82% possessed private insurance, 13% had public insurance, and 4% did not have insurance. There was no statistically significant difference when assessing private, public, or no health insurance status and the presence of concomitant diabetes mellitus or hypertension (p=0.9086). Conclusion(s): Data evidenced a diverse aging Puerto Rican cohort with cancer, showing a predominance in prostate cancer in men and breast cancer in women. Analysis suggested that the presence of concomitant diabetes mellitus or hypertension in an aging population with cancer was not linked to sex or racial identity. Additionally, the type or lack of health insurance did not influence the prevalence of concomitant diabetes mellitus or hypertension. Characterizing the aging Hispanic population in Puerto Rico and the United States is important, as these studies could be beneficial in the future approach, understanding and treatment of this population with historically limited medical data available.

Sociocultural factors associated with persistent prescription opioid use among Puerto Rican adults in Massachusetts

Background: Understanding ecological-level factors associated with persistent prescription opioid use (PPOU) may inform research and efforts to reduce prescription opioid-related complications. Puerto Rican Adults (PRAs) have disparities in health outcomes and depression and may be at greater risk of PPOU. Determinants of allostatic loads, including acculturation, migration history, social support, perceived discrimination, have not been explored as correlates of PPOU among PRAs. Further, no study has explored whether depressive symptoms affect PRA's PPOU. Opioid overdose fatality rates among Hispanics have further increased amidst the ongoing COVID-19 pandemic, amplifying the need for exploration of socio-ecological level factors associated with PPOU. Aim: The primary aim of this study was to estimate the incidence and prevalence of prescription opioid use (POU) among PRAs and to evaluate whether sociocultural factors of acculturation and migration history (intrapersonal), social support and network size (interpersonal), and perceived discrimination (community level) predicted PPOU. Furthermore, this study examined the relationship between depression and PPOU and whether depression mediated the effects of perceived discrimination on PPOU. Method: The Socio-Ecological Model (SEM) was adapted to guide this longitudinal secondary analysis study of the Boston Puerto Rican Health Study (BPRHS) cohort. The BPRHS is an ongoing cohort study of PRAs in the Greater Boston area. Baseline (0-year), 2-year, and 5-year datasets were used to estimate incidence and prevalence of POU among the PRA's cohort. The measures were acculturation and migration history, social support and network size, perceived discrimination, depression symptoms, and PPOU. Association between incidence and prevalence of POU by demographic factors were examined. The relationship between SEM-level factors and depression were examined with binary logistic regression. Using Baron and Kenny's method (1986), multivariable binary logistic and linear regression models examined whether depression mediated the effects of perceived discrimination on PPOU. Results: Participants were 45-75 years old (N = 798) of Puerto Rican descent (72.9% women) with 6.5% persistent opioid users compared to non-users (93.5%). Increasing incidence and prevalence of POU were observed at each follow-up. Lower income households were more likely to have higher incidence and prevalence of POU. Multivariate logistic regression models revealed an association between perceived discrimination and PPOU (OR = 2.85, 95% CI 1.46-5.58). No significant association was observed between acculturation, migratory history, social support and PPOU. Depressive symptoms were associated with PPOU (OR = 1.03, 95% CI: 1.00-1.05, p <= 0.03) and partially mediated the effects of perceived discrimination on PPOU by 10.3%, after adjustment of covariates. Conclusion: Reports of associations between perceived discrimination, depression and PPOU broadens current knowledge on factors linked to PPOU in the PRAs subpopulation. This research has important implications for policy, nursing research and clinical practice. Nurses and healthcare professionals may design tailored interventions to reduce PPOU by targeting these risk factors. Addressing perceived discrimination and depressive symptoms may impact PRA's exposure to PPOU and reduce their risk of prescription opioid-related complications. Future research should explore other multi-level factors that may influence PPOU and other potential mechanisms that may explain the effects of perceived discrimination on PPOU. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Acute Disseminated Encephalomyelitis in a Puerto Rican patient with positive SARS-Cov-2: Casualty or Causality?

Objective: NA Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory disease of the central nervous system thought to be caused by environmental factors to genetic susceptible individuals, where there is autoimmunity towards myelin components. Given the wide variety of symptoms, etiology and mimickers, ADEM is a diagnosis of exclusion, making difficult a prompt diagnosis. The pathogenesis associated between COVID-19 and ADEM is unknown, however, it could be secondary to immune-mediated mechanisms or molecular mimicry, creating a neuro-inflammatory response. Design/Methods: A previously healthy 22-year-old Puerto Rican male presented to the ED with altered mental status, incoherent speech, imbalance, and dizziness of 2 months progression. Neurological examination was remarkable for slow mentation, positive right Hoffman, left leg weakness and bilateral sustained clonus. Brain MRI showed innumerable foci of increased T2/FLAIR signal intensity throughout supra and infratentorial gray and white matter, none showing contrast enhancement. CSF with evidence of high protein levels, WBC of 7 (100% mononuclear) and normal glucose levels. Extensive workup for evaluation of infectious, demyelinating, inflammatory and vascular etiologies came back negative. Patient with recent history of gastrointestinal symptoms, reason why COVID-19 IgG/IgM Rapid Test was performed with positive IgG results 2 months prior to our evaluation. Patient was treated with intravenous steroids and intravenous immunoglobulin, with marked clinical improvement. Results: NA Conclusions: Here we present a case of atypical coronavirus disease 2019 (COVID-19) manifestation of a Puerto Rican male patient that 2 weeks after detecting SARS-COV-2 on his blood neurological symptoms started to develop. This is the first case of a young Puerto Rican patient without any other comorbidities where an association of COVID-19 infection and ADEM was found. Since ADEM if a diagnosis exclusion, it is vital to being able to distinguish this syndrome when it comes to a patient with history of COVID-19 infection and vaccine for prompt management.

Humoral immune response to mRNA COVID-19 vaccine in Puerto Ricans with IBD does not differ between class of biologics

Background: The COVID-19 vaccine trials did not include subjects with IBD or immunosuppression, limiting the effectiveness data of the vaccine in this population. The impact of biologics with different mechanisms of action on antibody concentrations and neutralizing capacity produced by the vaccine may alter prevention strategies. We aim to describe a comparison of the humoral response to COVID-19 vaccine in patients with IBD on biologics between different therapies and a control group. Methods: Patients ≥21 years of age with Crohn's disease (CD) and ulcerative colitis (UC) on biologic therapy were recruited. Blood samples were collected at 14 ± 2 days (Cohort 1) and 60 ±7 days (Cohort 2) after receiving a 2nd dose of mRNA COVID-19 vaccine [BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna). Anti-spike protein receptor binding domain IgG levels and neutralizing capability using SARS-CoV-2 surrogate virus neutralization test (sVNT%) were measured. A result >30% is positive for effective viral inhibition. Results were stratified by mechanism of action of the drug and compared with a healthy control group. Comparisons were evaluated by Kruskal-Walls test and Dunns Pairwise/Bonferroni. The study is approved by the MSC IRB. Results: 32 subjects exposed to biological therapy divided into 2 cohorts (14-days, n=19/60-days, n=13) and 18 samples of healthy controls (14-days, n=12/60-days, n=6) are reported. Of the IBD subjects, 81% (26/32) had CD, 56% were males (18/32) and mean age was 39. All subjects were receiving biological monotherapy, one subject was also on azathioprine. All groups developed detectable antibody levels and >60% neutralizing antibody detection after 14 and 60 days of the second vaccine dose. IgG levels at 14 days (p<0.001) and sVNT% at 14- and 60-days post second vaccine dose (p=0.007, 0.024) were significantly different between subjects vs. controls. When stratified by mechanism of action, there was a significant difference between each biologic vs. control (p<0.001), but no difference between biologic classes. Initial analysis for the sVNT% at 14 days showed statistical significance (p=0.046). Post-hoc analysis showed no statistical significance in the individual comparisons. No significant differences were found between each therapy vs. control for IgG levels nor sVNT% at 60-days (p=0.257, 0.113). Conclusion: Our study shows that IBD patients on biological therapy who receive a COVID-19 vaccine develop a lower but effective humoral response up to 60 days after the second dose when compared to healthy individuals. No difference was found between class of biologics. A larger sample is needed.

Euglycemic diabetic ketoacidosis in a patient with COVID-19 case report

Purpose of The Study Awareness of Covid-19 virus infection can precipitate decompensation of chronic diseases such as type 2 diabetes Mellitus. Euglycemic diabetic ketoacidosis (eu- DKA) has been seen in patients using sodium-glucose co-transporter 2 inhibitor (SGLT2i) and with COVID-19 infection. Methodology Authors identified the case while providing clinical care of a 61-year-old man with medical history of Diabetes Mellitus Type II using SGLT2i and hypertension presented to the Emergency Room with chief complaint of fever, chills, dry cough, watery diarrhea and general malaise 5 days prior arrival to the hospital. Summary of Results A 61-year-old man Puerto Rican male with medical history of Diabetes Mellitus Type II using sodium-glucose co-transporter 2 inhibitor (SGLT2i), and hypertension, already vaccinated against COVID-19, who presented to the Emergency Room with chief complaint of fever, chills, dry cough, watery diarrhea and general malaise 5 days prior arrival to the hospital after returning from a recent family trip to Florida. Home medications include Empagliflozin. Patient referred he had a recent travel to Florida (United States) and was in contact with a family member infected with COVID-19 infection. Physical examination was remarkable for dry oral mucosa and laboratories showed a metabolic acidosis with a high anion gap of 20 mEq/L with a marked increase in plasma b-hydroxybutyrate of 57.8 mg/dL and a central glucose <300 g/dL. Patient tested positive for COVID- 19 infection. Chest X-ray showed bilateral scattered peripheral hazy groundglass opacities. Considering mentioned findings patient placed on airborne isolation precautions and was admitted to Medical Intensive Care Unit where he was started on DKA protocol with continuous intravenous regular, D5W and aggressive hydration. Medical therapy also included Remdesivir and Dexamethasone. Patient improved after 2 days with resolved eu-DKA. Patient transferred to Internal Medicine Ward. Conclusion Eu-DKA has been seen in patients using SGLT2i and with COVID-19 infection;several cases described in literature are suggestive of a specific association between these factors. Our case also highlights the importance of early recognition and management of euglycemic DKA in patients using SGLT2i infected with COVID-19, both increase the risk of dehydration. Physicians must be aware and identify this patients earlier in outpatient setting and be more aggressive in hydration, maintaining euvolemic status to avoid admission to Intensive Care Unit.

Preterm birth rates and race disparities pre and post COVID vaccination

Objective: The impact of 2021 vaccination and social restriction reversal on preterm birth (PTB) is unclear. We sought to compare the rates of PTB during the COVID pre- and post- vaccination periods with pre-pandemic rate. Study Design: Retrospective cohort comparing all deliveries over 20 weeks at a single tertiary center during ‘early’ COVID (ECOVID 3/2020-6/2020) vs. ‘late’ COVID (LCOVID 3/2021–6/2021), and LCOVID vs. pre-COVID (3-6/2014-2019). PTB < 37weeks, < 34weeks and < 28weeks were compared and stratified by race/ethnicity. Results: There were 20334 deliveries including 2647 ECOVID, 2114 LCOVID and 15574 pre-COVID. We noted 87 (0.03%) and 37 (0.02%) COVID infections in pregnancy during ECOVID and LCOVID, respectively. PTB rate during LCOVID (12.1%) was lower compared to ECOVID (14.5%), p=0.02. Rate of PTB < 34 was also lower during LCOVID (4.4% vs 5.7%, p=0.04). PTB < 28 did not differ (Table1). When controlling for prior PTB, LCOVID was associated with a decreased risk of PTB, adjusted odds ratio (aOR) 0.83[95% confidence interval (CI) 0.70, 0.99]. Among the small number of American Indian patients, PTB increased during LCOVID vs. ECOVID. There were no other significant differences based on race/ethnicity. Overall, PTB rates did not differ in LCOVID vs. pre-COVID. When stratified by race and ethnicity, White individuals had reduced PTB < 37 during LCOVID compared to pre-COVID, aOR 0.70 [95% CI 0.63, 0.99]. PTB rate was unchanged comparing LCOVID vs. pre-COVID in all other racial groups. Among small numbers of Hispanic Puerto Rican patients, PTB rate increased LCOVID vs. pre-COVID (Table 2). Conclusion: During 2021, PTB rates decreased from rates observed in 2020 at the height of COVID restrictions. Among White birthing individuals, PTB decreased in 2021 compared to pre-COVID rates. This decrease was not observed in Black and Hispanic birthing individuals. These data highlight the continued racially disparate impact of the COVID pandemic on PTB rates. [Formula presented] [Formula presented]

Annual SO2 exposure, asthma, atopy, and lung function in Puerto Rican children.

BACKGROUND: Long-term effects of sulfur dioxide (SO2 ) exposure on children, a vulnerable population, are largely unknown. Further, how long-term SO2 affects Puerto Rican children living in the island of Puerto Rico, a group with high asthma prevalence, is unclear. We evaluated the effects of annual average 1-hour daily maximum SO2 average on asthma, atopy, total immunoglobulin E (IgE), and lung function in Puerto Rican children. METHODS: A cohort of 678 children (351 with asthma, 327 without asthma) was recruited in Puerto Rico from 2009 to 2010. Annual average 1-hour daily maximum SO2 exposure was interpolated utilizing publicly available monitoring data. Multivariable logistic and linear regression was used for the analysis of asthma, atopy (defined as an IgE ≥0.35 IU/mL to at least one of five common aero-allergens), total IgE, and lung function measures (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], and FEV1/FVC ratio). RESULTS: Annual SO2 exposure (per 1 ppb) was significantly associated with asthma (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.05-1.91) and atopy (OR = 1.35; 95% CI = 1.02-1.78). Such exposure was also significantly associated with lower FEV1/FVC in all children (ß = -1.42; 95% CI = -2.78 to -0.08) and in children with asthma (ß = -2.39; 95% CI= -4.31 to -0.46). Annual SO2 exposure was not significantly associated with total IgE, FEV1, or FVC. CONCLUSIONS: Among Puerto Rican children in Puerto Rico, long-term SO2 exposure is linked to asthma and atopy. In these children, long-term SO2 exposure is also associated with reduced FEV1/FVC, particularly in those with asthma.