Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study.

BACKGROUND AND OBJECTIVES: Information on stroke among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines remains scarce. We report stroke incidence as an adverse event following immunization (AEFI) among recipients of 79,399,446 doses of 6 different SARS-CoV-2 vaccines (BNT162b2, ChAdOx1 nCov-19, Gam-COVID-Vac, CoronaVac, Ad5-nCoV, and Ad26.COV2-S) between December 24, 2020, and August 31, 2021, in Mexico. METHODS: This retrospective descriptive study analyzed stroke incidence per million doses among hospitalized adult patients (≥18 years) during an 8-month interval. According to the World Health Organization, AEFIs were defined as clinical events occurring within 30 days after immunization and categorized as either nonserious or serious, depending on severity, treatment, and hospital admission requirements. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral venous thrombosis (CVT) cases were collected through a passive epidemiologic surveillance system in which local health providers report potential AEFI to the Mexican General Board of Epidemiology. Data were captured with standardized case report formats by an ad hoc committee appointed by the Mexican Ministry of Health to evaluate potential neurologic AEFI against SARS-COV-2. RESULTS: We included 56 patients (31 female patients [55.5%]) for an overall incidence of 0.71 cases per 1,000,000 administered doses (95% CI 0.54-0.92). Median age was 65 years (interquartile range [IQR] 55-76 years); median time from vaccination to stroke (of any subtype) was 2 days (IQR 1-5 days). In 27 (48.2%) patients, the event was diagnosed within the first 24 hours after immunization. The most frequent subtype was AIS in 43 patients (75%; 0.54 per 1,000,000 doses, 95% CI 0.40-0.73), followed by ICH in 9 (16.1%; 0.11 per 1,000,000 doses, 95% CI 0.06-0.22) and SAH and CVT, each with 2 cases (3.6%; 0.03 per 1,000,000 doses, 95% CI 0.01-0.09). Overall, the most common risk factors were hypertension in 33 (58.9%) patients and diabetes in 22 (39.3%). Median hospital length of stay was 6 days (IQR 4-13 days). At discharge, functional outcome was good (modified Rankin Scale score 0-2) in 41.1% of patients; in-hospital mortality rate was 21.4%. DISCUSSION: Stroke is an exceedingly rare AEFI against SARS-CoV-2. Preexisting stroke risk factors were identified in most patients. Further research is needed to evaluate causal associations between SARS-COV-2 vaccines and stroke.

Quality of life and level of burden in primary caregivers of patients with epilepsy: Effect of neuropsychiatric comorbidity.

BACKGROUND: Few studies are focused on the quality of life (QOL) of primary caregivers and the effects of the clinical variables of epilepsy and patient psychiatric comorbidity on primary caregivers. PURPOSE: Our main objective was to describe QOL and level of burden (LB) in caregivers of people with epilepsy (PWE) at a tertiary-care hospital in Mexico City. A secondary purpose was to determine if LB and QOL were different between caregivers of patients with neuropsychiatric comorbidity and caregivers of patients without neuropsychiatric comorbidity. METHODS: One hundred and fifty-one caregivers of PWE were assessed with the short version of the World Health Organization Quality of Life (WHOQOL) scale (WHOQOL-BREF) and the Zarit Burden Interview. Patients' clinical and demographic data, along with their psychiatric histories, were collected. RESULTS: One hundred and twelve patients had psychiatric comorbidity. The mean LB score of the caregivers was 26.25±16.28. The mean scores for the WHOQOL-BREF domains were as follows: physical health, 47.8±10.7; psychological health, 55.4±11.5; social relationships, 47.23±18.6; and environment, 48.7±11.6. The caregivers of patients with psychiatric comorbidity had lower scores in the domains of psychological health (p=0.034) and social relationships (p=0.029) compared with caregivers of PWE without comorbidity. On adjusted multivariate analysis, aggressiveness (p=0.008), age at onset of epilepsy (p=0.02), and years with epilepsy (p=0.01) were associated with higher caregiver LB scores; higher caregiver years of education were associated with better psychological health (p=0.002) and more years with epilepsy (p=0.03) with lower QOL scores. CONCLUSION: Aggressive behavior was the psychiatric comorbidity most clearly associated with lower QOL and higher LB. Longer duration of epilepsy was related to higher burden and lower QOL. More years of education of the caregiver were associated with better QOL. We found no significant correlation between seizure control and QOL or LB.