Anti-CD20 and COVID-19 in multiple sclerosis and related disorders: A case series of 60 patients from Madrid, Spain Dear Editor, We have read with great interest the case report of a patient with Multiple Sclerosis (MS) treated with ocrelizumab that developed COVID-19 without serious complications (Novi et al., 2020). The authors suggest a potential protective effect for severe complications of COVID-19 of anti-CD20 drugs. Besides, Prof. Giovannoni's editorial reviews the evidence supporting the hypothesis that immunosuppression of patients with MS on certain disease-modifying therapies may protect of severe COVID-19 infection (Giovannoni, 2020). These data contradict the first assumption that patients with MS on immunosuppressive therapies could be at risk of severe complications of COVID-19.We aimed to analyze the frequency and severity of COVID-19 in our series of patients treated with anti-CD20 in a tertiary hospital in Madrid, Spain, one of the regions worst affected by the pandemic. All patients were contacted by phone from 28 th to 29 th April 2020 (Matías-Guiu et al., 2020a), when total confirmed cases in the Region of Madrid accounted for 60,765. At the moment of the beginning of the pandemic, 60 patients were treated with anti-CD20 (54 with rituximab and 6 with ocrelizumab). The mean age was 47.21 ± 9.86 years-old in the whole group, 47.09 ± 9.56 in patients with rituximab, and 48.33 ± 12.16 in patients with ocrelizumab. 32 patients were classified as having relapsing-remitting MS (53.3%), 14 (23.3%) as secondary-progressive, 9 (15.0%) as primary-progressive forms and 5 as optic neuromyelitis (8.3%). COVID-19 infection was reported in 9 (15%) in the whole sample, 7 (12,9%) in patients receiving rituximab, and 2 (33,3%) in patients with ocrelizumab. Main clinical characteristics of COVID-19 are depicted in Table 1. Interestingly, all patients with COVID-19 did not show serious complications, despite that a patient required admission to a hospital.We also analyzed the time of administration and the frequency of infection by SARS-CoV2, with no apparent relationship. In this regard, 2 (15.38%) of the 13 patients that received treatment in June-August 2019 were infected; 1 (10%) of 10 patients treated in September-October 2019; 2 (13,3%) of the 15 patients that were treated in November-December 2019; and 4 (20%) of 20 patients that received the treatment in January-February 2020. Two patients had received the first dose with the onset of the pandemic, and no one was infected.

Background Series of patients with SARS‐CoV‐2 infection report headache in 6%‐15% of cases, although some data suggest that the actual frequency is higher, and that headache is not associated with fever. No study published to date has analyzed the characteristics of headache in these patients. Objective To analyze the characteristics of COVID‐19 related headaches. Methods We conducted a survey of Spaniard healthcare professionals who have been infected by SARS‐CoV‐2 and presented headache during the course of the disease. The survey addressed respondents’ medical history and headache characteristics, and we analyzed the association between both. Results We analyzed the responses of a sample of 112 healthcare professionals. History of migraine was reported by 20/112 (17.9%) of respondents, history of tension‐type headache by 8/112 (7.1%), and history of cluster headache was reported by a single respondent; 82/112(73.2%) of respondents had no history of headache. Headache presented independently of fever, around the third day after symptom onset. The previous history of migraine was associated with a higher frequency of pulsating headache (20% in patients with previous migraine vs 4.3% in those with no history of migraine, P = .013). Conclusion Headache is often holocranial, hemicranial, or occipital, pressing, and worsens with physical activity or head movements. Because the characteristics of the headache and the associated symptoms are heterogeneous in our survey, we suggest that several patterns with specific pathophysiological mechanisms may underlie the headache associated with COVID‐19.

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Recibido el 27 de marzo de 2020; aceptado el 31 de marzo de 2020 Accesible en línea el 6 de abril de 2020 PALABRAS CLAVECoronavirus; SARS-CoV; MERS-CoV; Esclerosis múltiple; SARS-CoV-2; Virus murino de la hepatitis; Síntomas neurológicos; Sistema nervioso central Resumen Introducción: Diversas evidencias sugieren que el SARS-CoV-2 puede penetrar en el sistema nervioso central (SNC). Los autores revisan los datos de la literatura sobre los hallazgos de coronavirus en el SNC asociado a enfermedades neurológicas.Desarrollo: En las distintas epidemias con SARS-CoV y MERS-CoV la presencia de cuadros neurológicos es baja, pero se describen cuadros aislados de pacientes. También existen casos asociados a OC43-CoV y 229E-CoV. La existencia de lesiones neurológicas, especialmente desmielinizantes en el modelo MHV-CoV pueden explicar mecanismos de penetración de los CoV en el SNC y especialmente aquellos relacionados con la respuesta inmune, que puede justificar la existencia de CoV en pacientes con esclerosis múltiple. Los autores revisan aspectos diferenciales de SARS-CoV-2 y se plantean si debido al alto número de infectados, el virus puede afectar de forma mayor al SNC.Conclusión: Aunque la presencia de síntomas neurológicos en las epidemias de CoV es baja, la mayor frecuencia de infectados por SARS-CoV-2 podría justificar el paso del virus y la posibilidad de clínica neurológica precoz o tardía con mayor incidencia. El seguimiento de los pacientes de la epidemia debe atender con cuidado a la evaluación del SNC.

The coronavirus disease 2019 (COVID-19) pandemic has affected everyone around the world, not least through pressure on health care systems and delivery of care. The initial wave and consequent lockdowns led to the cancellation of routine investigations and elective interventions, and many health care providers had to move to alternative models of care delivery.First reported in China, COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 infection is associated with a respiratory illness of varying severity, from asymptomatic to respiratory distress syndrome to multiorgan failure with a hypercoagulable and/or hyperinflammatory syndrome associated with high mortality. Tens of millions of cases of COVID-19 have been confirmed globally, with millions

Introduction: Since the beginning of the Covid-19 epidemic produced by SARS2-Cov virus, olfactory alterations have been observed at a greater frequency than in other coronavirus epidemics. While olfactory alterations may be observed in patients with rhinovirus, influenza virus, or parainfluenza virus infection, they are typically explained by nasal obstruction with mucus or direct epithelial damage; in the case of SARS-CoV-2, olfactory alterations may present without nasal congestion with mucus. We performed a study of patients presenting olfactory/gustatory alterations in the context of SARS-CoV-2 infection in order to contribute to the understanding of this phenomenon. Material and Methods: We performed a descriptive, cross-sectional, observational study of the clinical characteristics of olfactory/gustatory alterations using a self-administered, anonymous online questionnaire. Results: A total of 909 patients with SARS-CoV-2 infection and olfactory/gustatory alterations responded to the questionnaire in the 4-day data collection period; 824 cases (90.65%) reported simultaneous olfactory and gustatory involvement. Patients' responses to the questionnaire revealed ageusia (581, 64.1% of respondents), hypogeusia (256, 28.2%), dysgeusia (22, 2.4%), anosmia (752 82.8%), hyposmia (142, 15.6%), and dysosmia (8, 0.9%). Fifty-four percent (489) did not report concomitant nasal congestion or mucus. Conclusion: Olfactory alterations are frequent in patients with SARS-CoV-2 infection and is only associated with nasal congestion in half of the cases.

Six azobenzene derivatives bearing polyaromatic fragments have been prepared and their reversible photoisomerization has been assessed. Corannulene-functionalized molecules have demonstrated excellent switchable hosting abilities towards fullerenes in which an interesting range of affinities has been found. The success of this design relies upon the reversible formation and destruction of tweezer-like structures.