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The aim of this study was to examine the levels of cerebral blood flow in relation to motor and cognitive functions in 300 chronic unilateral stroke patients (age, 64 +/- 12 years; mean +/- SD). Cerebral blood flow was measured by the 133Xe inhalation method, adjusted for age, sex, and PCO2 level. Motor function was scored according to Brunnstrom hemiplegic staging and cognitive function according to the Hasegawa dementia rating scale tested in Japanese. Asymmetries of blood flow between affected and nonaffected hemispheres increased with lesion size and were highest in 11 embolic strokes (20 +/- 9%) and higher in 80 nonembolic cortical infarctions (11 +/- 11%) and 76 hemorrhages (9 +/- 7%) than in the group of 133 subcortical infarctions (2 +/- 6%) or 16 control subjects (1 +/- 2%). Severity of hemiparesis correlated with decreased cerebral blood flow in the affected hemisphere (P < .01) and increased hemispheric asymmetries of blood flow (P < 001). Cognitive impairments, after adjusting for age, correlated with decreased cerebral blood flow in the nonaffected hemisphere (P < .0001), left hemispheric lesions (P < .0005), and embolic stroke (P < .005) but not with asymmetries of blood flow. Among 67 patients having bilateral reductions of cerebral blood flow, 25 patients with left hemispheric lesions showed more severe cognitive impairments than among 42 patients with right hemispheric lesions (P < .05). We confirmed that severity of hemiparesis correlated with the degree of asymmetries of cerebral blood flow, reflecting the extent and location of the lesions. Bilateral reductions of cerebral blood flow in patients with left hemispheric lesions may in part contribute to cognitive impairments, indicating reductions of global neuronal activities in the contralateral hemisphere or diffuse cerebrovascular changes. Further studies of cerebral metabolism and follow-up of cerebral circulation are required to reveal the pathophysiology and clinical consequences.

Objectives To identify potential predictors of COVID-19 vaccine hesitancy (C19-VH) in adults with immune-mediated inflammatory diseases (IMID). Methods A total of 1,000 IMID patients were enrolled in this web-based cross-sectional study. A standardised and self-administered survey was designed by members of the Brazilian Society of Rheumatology Steering Committee for Infectious and Endemic diseases and distributed to IMID patients spread across Brazil. Results Of the 908 (90.8%) respondents eligible for analysis, 744 (81.9%) were willing to get vaccinated against COVID-19. In our multivariable logistic regression model, concurrent malignancy, fibromyalgia, hydroxychloroquine use, and recent corticosteroid pulse therapy were independently associated with higher odds of C19-VH. The short duration of COVID-19 vaccine clinical trials was the main reason for C19-VH. Conclusion We identified novel characteristics potentially associated with C19-VH among adults with IMID. Greater awareness on the safety and efficacy of COVID-19 vaccines is needed for both IMID patients and attending physicians.

Human herpesvirus-6 (HHV-6) may cause serious diseases in immunocompromised individuals. SARS-CoV-2/HHV-6 coinfection has been emphasized in previous works, mostly case reports, small series, or epidemiological studies, but few are known about its real clinical outcomes. Here we present a real-world pilot study aiming to understand the frequency and the clinical impact of HHV-6 coinfection in moderate to critically ill patients hospitalized due to COVID-19. SARS-CoV-2 and HHV-6 were evaluated in nasopharyngeal samples at the hospital admission of suspected COVID-19 patients. From 173 consecutive cases, 60 were SARS-CoV-2 positive and 13/60 (21.7%) were HHV-6 positive after identified as the HHV-6B species by a Sanger sequencing. The SARS-CoV-2+/HHV-6+ group was younger but not significant for cardiovascular diseases, diabetes, obesity, and cancer, but significant among therapeutic immunosuppressed patients (as systemic lupus erythematosus and kidney transplant patients). In the medical records, only sparse data on cutaneous or neurological manifestations were found. Biochemical and hematological data showed only a trend towards hyperferritinemic status and lymphopenia. In conclusion, despite the impressive high frequency of HHV-6 coinfection in SARS-CoV-2 positive cases, it did not impact general mortality. We suggest larger future prospective studies to better elucidate the influence of HHV-6 reactivation in cases of COVID-19, designed to specific assessment of clinical outcomes and viral reactivation mechanisms.

Objective To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.