Pain in individuals with idiopathic inflammatory myopathies, other systemic autoimmune rheumatic diseases, and without rheumatic diseases: A report from the COVAD study.

OBJECTIVES: To compare pain intensity among individuals with idiopathic inflammatory myopathies (IIMs), other systemic autoimmune rheumatic diseases (AIRDs), and without rheumatic disease (wAIDs). METHODS: Data were collected from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study, an international cross-sectional online survey, from December 2020 to August 2021. Pain experienced in the preceding week was assessed using numeral rating scale (NRS). We performed a negative binomial regression analysis to assess pain in IIMs subtypes and whether demographics, disease activity, general health status, and physical function had an impact on pain scores. RESULTS: Of 6988 participants included, 15.1% had IIMs, 27.9% had other AIRDs, and 57.0% were wAIDs. The median pain NRS in patients with IIMs, other AIRDs, and wAIDs were 2.0 (interquartile range [IQR] = 1.0-5.0), 3.0 (IQR = 1.0-6.0), and 1.0 (IQR = 0-2.0), respectively (P < 0.001). Regression analysis adjusted for gender, age, and ethnicity revealed that overlap myositis and antisynthetase syndrome had the highest pain (NRS = 4.0, 95% CI = 3.5-4.5, and NRS = 3.6, 95% CI = 3.1-4.1, respectively). An additional association between pain and poor functional status was observed in all groups. Female gender was associated with higher pain scores in almost all scenarios. Increasing age was associated with higher pain NRS scores in some scenarios of disease activity, and Asian and Hispanic ethnicities had reduced pain scores in some functional status scenarios. CONCLUSION: Patients with IIMs reported higher pain levels than wAIDs, but less than patients with other AIRDs. Pain is a disabling manifestation of IIMs and is associated with a poor functional status.

COVID-19 severity and vaccine breakthrough infections in idiopathic inflammatory myopathies, other systemic autoimmune and inflammatory diseases, and healthy controls: a multicenter cross-sectional study from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) survey.

OBJECTIVES: We aimed to compare the spectrum and severity of COVID-19 and vaccine breakthrough infections (BIs) among patients with IIMs, other systemic autoimmune and inflammatory diseases (SAIDs), and healthy controls (HCs). METHODS: This is a cross-sectional study with data from the COVAD study, a self-reported online global survey that collected demographics, COVID-19 history, and vaccination details from April to September 2021. Adult patients with at least one COVID-19 vaccine dose were included. BIs were defined as infections occurring > 2 weeks after any dose of vaccine. Characteristics associated with BI were analyzed with a multivariate regression analysis. RESULTS: Among 10,900 respondents [42 (30-55) years, 74%-females, 45%-Caucasians] HCs were (47%), SAIDs (42%) and IIMs (11%). Patients with IIMs reported fewer COVID-19 cases before vaccination (6.2%-IIM vs 10.5%-SAIDs vs 14.6%-HC; OR = 0.6, 95% CI 0.4-0.8, and OR = 0.3, 95% CI 0.2-0.5, respectively). BIs were uncommon (1.4%-IIM; 1.9%-SAIDs; 3.2%-HC) and occurred in 17 IIM patients, 13 of whom were on immunosuppressants, and 3(18%) required hospitalization. All-cause hospitalization was higher in patients with IIM compared to HCs [23 (30%) vs 59 (8%), OR = 2.5, 95% CI 1.2-5.1 before vaccination, and 3 (18%) vs 9 (5%), OR = 2.6, 95% CI 1.3-5.3 in BI]. In a multivariate regression analysis, age 30-60 years was associated with a lower odds of BI (OR = 0.7, 95% CI 0.5-1.0), while the use of immunosuppressants had a higher odds of BI (OR = 1.6, 95% CI 1.1-2.7). CONCLUSIONS: Patients with IIMs reported fewer COVID-19 cases than HCs and other SAIDs, but had higher odds of all-cause hospitalization from COVID-19 than HCs. BIs were associated with the use of immunosuppressants and were uncommon in IIMs.

Deaths announced in Brazil - A dark sweetness: COVID-19 among children and adolescents.

While the Ministry of Health of Brazil postpones the inclusion of children aged 5-12 years in the National Immunization Plan against COVID-19, current evidence highlights that the number of hospitalizations and deaths caused by COVID-19 in the pediatric population, of in general, including the group of children aged 5-11 years, it is not within acceptable levels. Unfortunately, child mortality and fatality rates in Brazil are among the highest in the world. In 2020, there were 1203 deaths from Severe Acute Respiratory Syndrome (SRAG). In 2021, there were 2293. Also 65 deaths were reported from Pediatric Multisystem Inflammatory Syndrome (P-SIM); an aggressive manifestation of the virus in children.

Inflammatory myopathies overlapping with systemic sclerosis: a systematic review.

We performed a systematic review of the clinical manifestations and complementary exams of patients with myopathies and systemic sclerosis overlap syndrome (MyoSScOS). Systematic review from January 1976 to November 2021 according PRISMA protocol on three electronic databases: PubMed, Web of Science, and Scopus. Studies were analyzed based on the following eligibility criteria: at least one combination of the terms described in the search strategy appears in the title; written in English, Portuguese, or Spanish; and addresses MyoSScOS. Brief communications, reviews, studies that addressed myopathies in children, congress proceedings, monographs, and dissertations were excluded. Thirty-five articles were selected. MyoSScOS seems to be more common in women. It also commonly affects the esophagus and joints with symmetrical and bilateral muscle involvement, Raynaud's phenomenon, and impairment of forced vital capacity. Concerning SSc, the most common subtype was the diffuse form. Cardiovascular and pulmonary complications are an important cause of death. Anti-centromere, anti-PM/Scl, anti-Scl70, anti-RNA polymerase III, anti-Ku, and anti-RNP were more correlated with this entity, and muscle biopsies may present a more aggressive pattern. Electroneuromyography patterns are quite similar to those found in inflammatory myopathies. The absence of studies with robust methodologies and the large number of case reports and series make more robust statistical analyses such as meta-analyses unfeasible. The characterization of MyoSScOS is important for the formulation of therapeutic measures and specific treatments aiming at better quality of life and prognosis. Greater and better theoretical contributions are necessary to better characterize it.

Reflections on early childhood education in the COVID-19 pandemic.

The COVID-19 pandemic is a complex and multifaceted event, and it is even argued that it should be seen as a syndemic and not a pandemic . Its impacts will still be felt over the years and, perhaps, are irreparable in some aspects. It is essential to mobilize Governments, civil society and non-governmental organizations to outline measures to combat school dropout and social inclusion.

An alert from the present to the future: The impact of environmental disasters on health of children and adolescents.

Storms unleashed devastating tornadoes southern United States. National Weather Service maps revealed one supercell, which may have been a single tornado or a cluster. One of the most devastated sites is the southwestern Kentucky city of Mayfield. In Warren County, where about 12 people were killed, including several children, the process of identifying victims has been slowed because the people who could make those identifications are themselves recovering from injuries sustained in the storm. There's a lot of people injured and in hospitals. The death toll from the devastating tornado outbreak that ripped across six states last weekend held steady at 88 on Tuesday, including at least 13 children. Two-month-old baby was confirmed dead.

Challenges to food safety for children and adolescents in Brazil.

Malnutrition increases the chance of cognitive delay, recurrent infections, micro and macronutrient deficiencies, stigmatization. According to the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria), more than half (58%) of Brazilian families with children and adolescents reported changes in eating habits in the same period. For 31%, there was an increase in consumption of processed foods such as chocolate, filled cookies, instant noodles, and canned foods. Therefore, despite food security being a human right contemplated in article 25 of the Universal Declaration of Human Rights and reiterated by article 6 of the Brazilian Federal Constitution in 2010, the country still has a long way to go. With the advent of the COVID-19 pandemic, there was a deepening of poverty, misery, and hunger in the country, which directly reflected on the income of families and placed children/adolescents in a situation of extreme vulnerability.

Pandemic of hunger: The severe nutritional deficiency that kills Yanomami ethnic children.

Chronic malnutrition is the painful reality that Yanomami children face in Brazil's largest Indigenous Land and is pointed out by specialists as one of the results of the federal government's "anti-indigenous policy". The lack, or scarcity, of medical care, together with the lack of environmental inspection, pushes the Yanomami into a desperate scenario. It is estimated that 20,000 illegal miners operate in the territory. Mining activity contaminates rivers with mercury and has caused deformities and illnesses in women and children. They live on the largest indigenous reserve in Brazil. There are nine million hectares within the Amazon Forest. Malaria has persistently advanced in Yanomami land: there are more than 16,000 cases this year alone. Several children are dying.

"Between the cross and the sword": Brazilian children face an influenza epidemic while still dealing with the COVID-19 pandemic.

The Influenza activity remained at inter-seasonal levels; however, influenza A(H3N2) detections continue to increase in Brazil, Chile, Paraguay, and Uruguay. Most of the activity and rising trend of A(H3N2) detections are recorded in Brazil. A bulletin issued by the Oswaldo Cruz Foundation (Fiocruz) reported significant presence of the influenza A virus, both in children and in the adult population, among cases of SARS-Cov-2.This situation is worrying, as vaccination campaigns were hampered by the COVID-19 pandemic.

Children are in need of humanitarian aid in Afghanistan.

Almost 60% of Afghans forced to flee their homes in 2021 because of the Taliban advance are children. They are starving. It is estimated that approximately one million will suffer from severe, life-threatening malnutrition by the end of 2021. Many have been separated from their families by the chaos that has ensued in Afghanistan after Taliban took power, and hundreds of them were driven out of the country unaccompanied. How must these children have been when they suddenly found themselves without their relatives during the chaotic crisis, or when they boarded an evacuation flight? It is vital to identify them quickly. Too many children witnessed scenes that no child should see. Children and teenagers are dealing with anxiety and fear and desperately need help and mental health care. This is the sad reality facing Afghan children, regardless of ongoing political developments and changes in government.

Children are in need of humanitarian aid in Afghanistan.

Almost 60% of Afghans forced to flee their homes in 2021 because of the Taliban advance are children. They are starving. It is estimated that approximately one million will suffer from severe, life-threatening malnutrition by the end of 2021. Many have been separated from their families by the chaos that has ensued in Afghanistan after Taliban took power, and hundreds of them were driven out of the country unaccompanied. How must these children have been when they suddenly found themselves without their relatives during the chaotic crisis, or when they boarded an evacuation flight? It is vital to identify them quickly. Too many children witnessed scenes that no child should see. Children and teenagers are dealing with anxiety and fear and desperately need help and mental health care. This is the sad reality facing Afghan children, regardless of ongoing political developments and changes in government.

Electroconvulsive Therapy in the Treatment of Catatonia Due To Systemic Lupus Erythematosus.

The use of electroconvulsive therapy in case of catatonia due to systemic lupus erythematosus refractory in treatment with immunosuppressant is rare. Therefore, we report a case of catatonia due to systemic lupus erythematosus treated with electroconvulsive therapy as an adjuvant to cyclophosphamide treatment. A 34-year-old female patient diagnosed with systemic lupus erythematosus attended the rheumatology outpatient clinic with a history of catatonia for 8 weeks and laboratory tests revealed high titers of anti-ds DNA positive anti-RNP and polyclonal gammopathy. cyclophosphamide pulse therapy was scheduled in association with electroconvulsive therapy, in 12 sessions, twice a week. The patient evolved with significant clinical improvement after 6 sessions of electroconvulsive therapy and 2 pulses of cyclophosphamide, with negative anti-ds DNA and normalization of gamma globulin levels. Thus, electroconvulsive therapy should be considered as adjuvant therapy in severe cases of neuropsychiatric systemic lupus erythematosus, including catatonia, especially in those with relapses and poor response to immunosuppressant and psychotropic drugs.

Analysis of the prison population's mental health in Sars-Cov-2 pandemic: Qualitative analysis.

This study aimed to analyze the possible impacts on the prison population's mental health in the context of the new COVID-19 pandemic. Qualitative study was carried out following a lexical and content analysis using the software IRaMuTeQ, version 0.7 alpha 2, in the speech of the short communication and headlines from newspapers. Three groups emerged from the analysis: "spatial conditions for infection" (39.2% of the text segments); "disease outbreaks in prisons" (30,4%) and "public responsibility" (30,4%). Precarious conditions of prisons, high rate of infections and psychiatric illnesses, and lack of government assistance are issues that should be given special attention in order to formulate health promotion and prevention policies focusing on mental health in prison population.

The mental health of those whose rights have been taken away: An essay on the mental health of indigenous peoples in the face of the 2019 Coronavirus (2019-nCoV) outbreak.

Background: : In Latin America there are about 45 million indigenous people in 826 communities that represent 8.3% of the population. An estimated 798,365 Aboriginal and Torres Strait Islander were in Australia, 5,2 million indigenous people living in America and 2,13 million in Canada. Racial/ethnic disparities in mental health service use have increased especially in the context of the new coronavirus pandemic. Thus, we aimed to describe the mental health situation of the indigenous population in the context of the COVID-19 pandemic. Method: : The studies were identified in well-known international journals found in three electronic databases: PubMed, Scopus, and MEDLINE. The data were cross-checked with information from the main international newspapers. Results: : According to the literature, due to the COVID-19 pandemic there is a lack of specialized mental health services and professionals, a restricted access to quality information and a lack of access to inputs, causing negative feelings and it can exacerbate pre-existing mental problems (eg: depression, suicidal ideation, smoking and binge drink). The cultural differences are a risk factor to worsen the mental health of this already vulnerable population. Conclusion: : providing psychological first aid is an essential care component for indigenous populations that have been victims COVID-19 pandemic.

A crisis within the crisis: The mental health situation of refugees in the world during the 2019 coronavirus (2019-nCoV) outbreak.

BACKGROUND: 68.5 million people around the world have been forced to leave their houses. Refugees have mainly to face their adaption in a host country, which involves bureaucracy, different culture, poverty, and racism. The already fragile situation of refugees becomes worrying and challenged in the face of the new coronavirus (COVID-19) epidemic. Therefore, we aimed to describe the factors that can worsen the mental health of refugees. METHOD: The studies were identified in well-known international journals found in three electronic databases: PubMed, Scopus, and Embase. The data were cross-checked with information from the main international newspapers. RESULTS: According to the literature, the difficulties faced by refugees with the COVID-19 pandemic are potentiated by the pandemic state. There are several risk factors common to coronavirus and psychiatric illnesses as overcrowding, disruption of sewage disposal, poor standards of hygiene, poor nutrition, negligible sanitation, lack of access to shelter, health care, public services, and safety. These associated with fear and uncertainty create a closed ground for psychological sickness and COVID-19 infection. CONCLUSIONS: There should be not only a social mobilization to contain the virus, but also a collective effort on behalf of the most vulnerable populations.

When health professionals look death in the eye: the mental health of professionals who deal daily with the 2019 coronavirus outbreak.

BACKGROUND: The fact that COVID-19 is transmissible from human to human and associated with high morbidity and potentially fatality can intensify the perception of personal danger. In addition, the foreseeable shortage of supplies and an increasing flow of suspected and real cases of COVID-19 contribute to the pressures and concerns of health professionals. METHOD: The studies were identified in well-known international journals found in two electronic databases: Scopus and Embase. The data were cross-checked with information from the main international newspapers. RESULTS: Work-related stress is a potential cause of concern for health professionals. It has been associated with anxiety including multiple clinical activities, depression in the face of the coexistence of countless deaths, long work shifts with the most diverse unknowns and demands in the treatment with patients with COVID-19. Therefore, it is an important indicator of psychic exhaustion. CONCLUSIONS: As coronavirus cases increase and deaths surge in Italy, new figures show an "enormous" level of contagion among the country's medical personnel. At least 2,629 health workers have been infected with coronavirus since the outbreak onset in February, representing 8.3% of total cases. The percentage of infected health workers has almost doubled the number registered in China throughout the epidemic. Intensive care unit physicians are on their stress limit, especially when dealing with older patients and with death prospects. Doctors, not a relative, are inevitably the last people a dying COVID-19 patient will see.