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Information on Guillain-Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS-CoV-2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti-SARS-CoV-2 vaccines between December 24, 2020, and October 29, 2021, in Mexico.Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA-based (mRNA-1273 and BNT162b2), adenovirus-vectored (ChAdOx1 nCov-19, rAd26-rAd5, Ad5-nCoV, and Ad26.COV2-S), and inactivated whole-virion-vectored (CoronaVac) vaccines.We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33-60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97-1.45), with incidence higher among Ad26.COV2-S (3.86/1,000,000 doses, 95% CI 1.50-9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36-2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3-17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID-19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy-five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently.Guillain-Barré syndrome was an extremely infrequent AEFI against SARS-CoV-2. The protection provided by these vaccines outweighs the risk of developing GBS.

Introduction: COVID-19 pneumonia is a highly infectious disease caused by a respiratory syndrome secondary to coronavirus 2. It has been proposed that the tomographic findings of these patients with suspected COVID-19 infection be subclassified. Objective: To measure the correlation between the chest tomography severity index as well as the degree of pulmonary involvement by tomography and the prognosis of patients with COVID-19 infection. Material and methods: This is a retrospective analytical observational study in which a total of 233 patients were analyzed. Conclusion: We conclude that the severity index could be used to predict patients who will require mechanical ventilation. The percentage of lung volume affected and respected was useful to predict admission to the ICU, use of mechanical ventilation, days of hospital stay and the outcome.

SummaryBackgroundGuillain-Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS-CoV-2 has been linked to a few (ChAdOx1 nCov-19 and Ad26.COV2-S), but not all vaccines, including mRNA-based ones. Epidemiological information on GBS among recipients of other SARS-CoV-2-directed vaccines among Latinx/Hispanic recipients is scarce.MethodsWe report GBS incidence per million administered doses from a nationwide Mexican retrospective registry of adult (≥18 years) recipients of 81,842,426 doses of seven vaccines against SARS-CoV-2 immunized between December 24, 2020, and October 29, 2021. Cases were collected through a passive epidemiological surveillance system and defined as events occurring within 42 days from immunization. Vaccines were analyzed individually and by vector as either mRNA-based (mRNA-1273 and BNT162b2), adenovirus-vectored (ChAdOx1 nCov-19, rAd26-rAd5, Ad5-nCoV, and Ad26.COV2-S), or inactivated whole-virion-vectored (CoronaVac).FindingsWe identified 97 patients (52 [53.6%] males; median age 44 years (interquartile range 33–60), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97–1.45), higher among Ad26.COV2-S (3.86/1,000,000 doses, 95% CI 1.50–9.93) and BNT162b2 (1.92/1,00,000 doses, 95% CI 1.36–2.71) recipients. The overall interval from vaccination-to-GBS symptoms onset was 10 days (interquartile range 3–17). Preceding diarrhea (≤ 4 weeks) was reported in 21.6%, and four (4.1%) more had mild COVID-19. Only 18 patients were tested for Campylobacter jejuni infection; 16 (88.9%) were positive. Electrophysiological examinations were performed in 76 (78.4%) patients (axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar between platforms. On initial evaluation, 91.8% had a GBS disability score ≥ 3. Seventy-five (77.3%) patients received intravenous immunoglobulin, seven (7.2%) plasma exchanges, and 15 (15.5%) were treated conservatively. There were 10 (10.3%) deaths, and 79.1% of survivors were unable to walk independently at discharge.InterpretationIn our population, GBS was an infrequent AEFI, observed in less than 1.2/1,000,000 administered doses of vaccines against SARS-CoV-2. Observed incidences were higher among Ad26.COV2.S and BNT162b2 recipients individually and for mRNA-vectored vaccines as a group.

Objectives The antiphospholipid syndrome (APS) is an autoimmune disease associated with thrombotic and non-thrombotic neurologic manifestations. APS is classified as primary (PAPS) or secondary (SAPS) when it co-exists with another autoimmune disease. We aim to describe the spectrum of acute cerebrovascular disease among patients with APS, their differences between stroke subtypes, and long-term functional outcomes. Methods Retrospective cohort study including adult (≥18 years) patients with APS followed in the stroke clinic of a tertiary-care reference center for autoimmune diseases in Mexico from 2009 to 2019. Results We studied 120 cases; 99 (82.5%) women; median age 43 years (interquartile range 35–52); 63.3% with SAPS. Demographics, comorbidities, and antiphospholipid antibodies (aPL) positivity were similar between APS type and stroke subtypes. Amongst index events, we observed 84 (70%) acute ischemic strokes (AIS), 19 (15.8%) cerebral venous thromboses (CVT), 11 (9.2%) intracerebral hemorrhages (ICH), and six (5%) subarachnoid hemorrhages (SAH). Sixty-seven (55.8%) were known patients with APS; the median time from APS diagnosis to index stroke was 46 months (interquartile range 12–96); 64.7% of intracranial hemorrhages (ICH or SAH) occurred ≥4 years after APS was diagnosed (23.5% anticoagulation-related); 63.2% of CVT cases developed before APS was diagnosed or simultaneously. Recurrences occurred in 26 (22.8%) patients, AIS, in 18 (69.2%); intracranial hemorrhage, in eight (30.8%). Long-term functional outcomes were good (modified Rankin Scale ≤2) in 63.2% of cases, during follow-up, the all-cause mortality rate was 19.2%. Conclusion We found no differences between stroke subtypes and APS types. aPL profiles were not associated with any of the acute cerebrovascular diseases described in this cohort. CVT may be an initial thrombotic manifestation of APS with low mortality and good long-term functional outcome.

mRNA-based COVID-19 vaccines are effective; however, persistent vaccine hesitancy is partly due to a misperception of their potential adverse events. Non-specific sensory symptoms (NSSS) following immunization are thought to be mediated by stress-related responses. In this case-control study, we evaluated NSSS from a cohort of 7,812,845 BNT162b2 first-dose recipients, of whom 10,929 reported an adverse event following immunization (AEFI). We found an overall frequency of 3.4% (377 cases) or 4.8 cases per 100,000 doses administered. Anatomically, the arms (61%) and face/neck region (36.2%) were the most commonly affected sites. The control group had significantly higher rates of reactogenicity-associated symptoms, suggesting that NSSS are reactogenicity-independent; in multivariable analysis, healthcare workers reported sensory symptoms less frequently (aOR 0.54; 95% CI 0.40-0.72;p

Background Coronavirus disease 2019 (COVID-19) is a systemic disease that can rapidly progress into acute respiratory failure and death. Timely identification of these patients is crucial for a proper administration of health-care resources. Objective To develop a predictive score that estimates the risk of invasive mechanical ventilation (IMV) among patients with COVID-19. Study design Retrospective cohort study of 401 COVID-19 patients diagnosed from March 12, to August 10, 2020. The score development cohort comprised 211 patients (52.62% of total sample) whereas the validation cohort included 190 patients (47.38% of total sample). We divided participants according to the need of invasive mechanical ventilation (IMV) and looked for potential predictive variables. Results We developed two predictive scores, one based on Interleukin-6 (IL-6) and the other one on the Neutrophil/Lymphocyte ratio (NLR), using the following variables: respiratory rate, SpO2/FiO2 ratio and lactic dehydrogenase (LDH). The area under the curve (AUC) in the development cohort was 0.877 (0.823–0.931) using the NLR based score and 0.891 (0.843–0.939) using the IL-6 based score. When compared with other similar scores developed for the prediction of adverse outcomes in COVID-19, the COVID-IRS scores proved to be superior in the prediction of IMV. Conclusion The COVID-IRS scores accurately predict the need for mechanical ventilation in COVID-19 patients using readily available variables taken upon admission. More studies testing the applicability of COVID-IRS in other centers and populations, as well as its performance as a triage tool for COVID-19 patients are needed.