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1.
European Respiratory Journal ; 60(Supplement 66):2178, 2022.
Article in English | EMBASE | ID: covidwho-2293735

ABSTRACT

Purpose: Hypertensive disorders of pregnancy (HDP) are associated with longer term postpartum cardiovascular sequelae, including double the risk of ischaemic heart disease and cardiovascular mortality (1). Transthoracic echocardiograms (TTE) were performed in women with pregnancies complicated by gestational hypertension and pre-eclampsia, or uncomplicated pregnancy, at six months and two years postpartum. The aim was to longitudinally assess cardiac structure and function in women with HDP and compare this to women who had a normotensive pregnancy. The six-month results have been previously reported, we now present the two-year data. Method(s): A prospective cohort study was conducted in a pre-specified subgroup of 126 patients within a single, tertiary referral centre as part of the P4 (Post Partum, Physiology, Psychology, and Paediatric Follow Up) study (2). 74 (59%) women had a normotensive pregnancy, and 52 (41%) had a pregnancy complicated by HDP. Women with pre-existing hypertension were excluded from the study. The mean patient age at time of six-month postpartum TTE was 32 years (range 22-47 years). TTEs were performed by blinded experienced sonographers and reported by a single blinded imaging cardiologist. Result(s): Six months postpartum. 126 women underwent TTE at six months postpartum. Although all results fell within normal ranges, compared to women with a normotensive pregnancy, those with HDP had increased left ventricle (LV) wall thickness, higher relative wall thickness, and increased LV mass. E/A ratio was lower, and E/E' ratios higher in the group with pregnancy complicated by HDP, indicating a trend towards poorer diastolic function (2,3). Two years postpartum. 35 women completed a two year postpartum TTE (18 normotensive, 17 HDP). Measurements fell within normal ranges in both groups of women. At two years postpartum, women with HDP had larger BSA (1.9 vs 1.71 2 p=0.003), larger LV internal diastolic diameter (48.4 vs 45.5mm p=0.017) and increased inter-ventricular septum thickness (8.5 vs 7.7mm p=0.007) compared to those with normotensive pregnancy. LV mass was greater in women with HDP (98.1 vs 81.5g), as was LA volume indexed (25.4 vs 23.4 cm3/m3), however these differences did not reach significance (p=0.053 and 0.196 respectively). Compared to normotensive women, those with HDP had higher septal (8.7 vs 7.3 p=0.014) and lateral (6.6 vs 5.4 p=0.017) E/E' ratios, indicating a trend towards diastolic dysfunction. Conclusion(s): Despite measurements falling within normal ranges, our results indicate that women with HDP have changes in cardiac structure and function that persist out to two years postpartum. Limitations exist due to incomplete follow up, leading to small sample size;this was partially due to restrictions on service provision in the context of the COVID-19 pandemic. (Table Presented).

2.
Public Choice ; : 1-37, 2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-2268375

ABSTRACT

Public choice scholars have attended only modestly to issues in public health. We expect that to change rapidly given the Covid-19 pandemic. The time therefore is ripe for taking stock of public-choice relevant scholarship that addresses issues in public health. That is what we do. Our stock-taking highlights three themes: (1) Public health regulations often are driven by private interests, not public ones. (2) The allocation of public health resources often reflects private interests, not public ones. (3) Public health policies may have perverse effects, undermining instead of promoting health-consumer welfare.

3.
J Med Toxicol ; 19(2): 169-179, 2023 04.
Article in English | MEDLINE | ID: covidwho-2255198

ABSTRACT

INTRODUCTION: This study investigated the characteristics and compared the trends of pediatric suspected suicide and nonfatal suicide attempts reported to United States (US) poison control centers (PCCs) before and during the first year of the COVID-19 pandemic. METHODS: An interrupted time series analysis using an ARIMA model was conducted to evaluate the trends of suspected suicides and nonfatal suicide attempts among children 6-19 years old reported to the National Poison Data System during March 2020 through February 2021 (pandemic period) compared with March 2017 through February 2020 (pre-pandemic period). RESULTS: The annual number of cases of suspected suicides and nonfatal suicide attempts increased by 4.5% (6095/136,194) among children 6-19 years old during March 2020 through February 2021 compared with the average annual number during the previous three pre-pandemic years. There were 11,876 fewer cases than expected from March 2020 to February 2021, attributable to a decrease in cases during the initial three pandemic months. The average monthly and average daily number of suspected suicides and nonfatal suicide attempts among children 6-12 years old and 13-19 years old was higher during school months than non-school months and weekdays than weekends during both the pre-pandemic and pandemic periods. CONCLUSIONS: There was a greater than expected decrease in the number of suspected suicides and nonfatal suicide attempts among children 6-19 years old reported to US PCCs during the early pandemic months, followed by an increase in cases. Recognizing these patterns can help guide an appropriate public health response to similar future crises.


Subject(s)
COVID-19 , Suicide, Attempted , Humans , Child , United States/epidemiology , Adolescent , Young Adult , Adult , Pandemics , Poison Control Centers , COVID-19/epidemiology
4.
IDCases ; 31: e01692, 2023.
Article in English | MEDLINE | ID: covidwho-2230458

ABSTRACT

Thrombotic microangiopathy defines a group of pathologies characterized by microvascular dysfunction with the concurrence of microangiopathic hemolytic anemia, thrombocytopenia, and organ damage. It represents the most frequent microvascular manifestation of human immunodeficiency virus (HIV) infection. We report the case of a man in the seventh decade of life with a recent diagnosis of infection by HIV, who develops hemolytic uremic syndrome, requiring continuous renal replacement therapy and plasma replacement therapy, without response, ADAMTS13 with preserved activity, ruling out other etiologies (infectious, metabolic, and genetic) with successful response to eculizumab.

5.
Front Immunol ; 13: 1011829, 2022.
Article in English | MEDLINE | ID: covidwho-2154730

ABSTRACT

One of the mechanisms by which viruses can evade the host's immune system is to modify the host's DNA methylation pattern. This work aims to investigate the DNA methylation and gene expression profile of COVID-19 patients, divided into symptomatic and asymptomatic, and healthy controls, focusing on genes involved in the immune response. In this study, changes in the methylome of COVID-19 patients' upper airways cells, the first barrier against respiratory infections and the first cells presenting viral antigens, are shown for the first time. Our results showed alterations in the methylation pattern of genes encoding proteins implicated in the response against pathogens, in particular the HLA-C gene, also important for the T-cell mediated memory response. HLA-C expression significantly decreases in COVID-19 patients, especially in those with a more severe prognosis and without other possibly confounding co-morbidities. Moreover, our bionformatic analysis revealed that the identified methylation alteration overlaps with enhancers regulating HLA-C expression, suggesting an additional mechanism exploited by SARS-CoV-2 to inhibit this fundamental player in the host's immune response. HLA-C could therefore represent both a prognostic marker and an excellent therapeutic target, also suggesting a preventive intervention that conjugate a virus-specific antigenic stimulation with an adjuvant increasing the T-cell mediated memory response.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , HLA-C Antigens/genetics , Immune Evasion , RNA
6.
JCO Oncol Pract ; 18(10): e1603-e1610, 2022 10.
Article in English | MEDLINE | ID: covidwho-2140247

ABSTRACT

PURPOSE: Many cancer centers engage in multidisciplinary tumor board meetings to determine the optimal approach to complex cancer care. With the onset of the COVID-19 pandemic, many institutions changed the format of these meetings from in-person to virtual. The aim of this study was to determine if the change to a virtual meeting format had an impact on attendance and cases presented. METHODS: Tumor board records were analyzed to obtain attendance and case presentation information at a National Cancer Institute-designated Comprehensive Cancer Center. Twelve-month in-person tumor board data were compared with 12-month virtual tumor board data to assess for difference in attendance and case presentation patterns. RESULTS: Seven separate weekly tumor board meetings at the beginning of the study (breast, GI, gynecology, liver, lung, melanoma, and urology) were expanded to nine meetings on the virtual platform (+endocrine and pancreas). Overall attendance increased by 46% on the virtual platform compared with in-person meetings (4,030 virtual attendances v 2,753 in-person, P < .001). Increased attendance was present across all specialties on the virtual platform. In addition, the number of patient cases discussed increased from 2,127 in in-person meeting to 2,656 on the virtual platform (a 20% increase, P < .001). CONCLUSION: A significant increase was observed in overall tumor board attendance and in case presentations per meeting, requiring the expansion of additional weekly meetings. Furthermore, in a major cancer center with multiple community affiliates, virtual tumor boards may encourage increased participation from remote sites with the benefit of obtaining expert specialist advice as compared with geographically challenging in-person meetings.


Subject(s)
COVID-19 , Neoplasms , COVID-19/epidemiology , Humans , Neoplasms/complications , Neoplasms/therapy , Pandemics
7.
Clin Toxicol (Phila) ; : 1-10, 2022 Nov 28.
Article in English | MEDLINE | ID: covidwho-2123031

ABSTRACT

OBJECTIVE: To assess the association of the COVID-19 pandemic with pediatric poison exposures with a focus on unintentional exposures associated with exploratory behavior among children <6 years old. METHODS: An interrupted time series analysis was conducted to evaluate the association of the pandemic with poison exposures among youth <20 years old. Exposures reported to US poison centers (PCs) from 1 March 2017 through 28 February 2020 (pre-pandemic) compared with 1 March 2020 through 28 February 2021 (pandemic) were analyzed. RESULTS: From March 2017 through February 2021, there were 5,244,684 exposures reported to US PCs involving youth <20 years old. There was a 6.0% decrease in poison exposures among youth <20 years old reported to US PCs from pre-pandemic (annual average) to pandemic periods, and there were 93,336 (95% CI: 92,738-93,937) fewer exposures than expected among these individuals during March 2020 through February 2021. Unintentional poison exposures associated with exploratory behavior among children <6 years old accounted for 91.4% of exposures in this age group, and although there were 17,207 (95% CI: 16,951-17,466) fewer of these exposures than expected during the pandemic period, these exposures initially increased during the first two months of the pandemic before decreasing. CONCLUSIONS: The COVID-19 pandemic was associated with changes in poison exposure patterns among youth <20 years old, resulting in a decrease in the number of exposures reported to US PCs during the first pandemic year. Exposure patterns changed with progression from the initial months of the pandemic to later months and varied by age group and reason for exposure. Unintentional poison exposures associated with exploratory behavior among children <6 years demonstrated an increase during the initial first two months of the pandemic before decreasing. Understanding these patterns will help guide an appropriate response to similar future public health events.

9.
Frontiers in immunology ; 13, 2022.
Article in English | EuropePMC | ID: covidwho-2092689

ABSTRACT

One of the mechanisms by which viruses can evade the host’s immune system is to modify the host’s DNA methylation pattern. This work aims to investigate the DNA methylation and gene expression profile of COVID-19 patients, divided into symptomatic and asymptomatic, and healthy controls, focusing on genes involved in the immune response. In this study, changes in the methylome of COVID-19 patients’ upper airways cells, the first barrier against respiratory infections and the first cells presenting viral antigens, are shown for the first time. Our results showed alterations in the methylation pattern of genes encoding proteins implicated in the response against pathogens, in particular the HLA-C gene, also important for the T-cell mediated memory response. HLA-C expression significantly decreases in COVID-19 patients, especially in those with a more severe prognosis and without other possibly confounding co-morbidities. Moreover, our bionformatic analysis revealed that the identified methylation alteration overlaps with enhancers regulating HLA-C expression, suggesting an additional mechanism exploited by SARS-CoV-2 to inhibit this fundamental player in the host’s immune response. HLA-C could therefore represent both a prognostic marker and an excellent therapeutic target, also suggesting a preventive intervention that conjugate a virus-specific antigenic stimulation with an adjuvant increasing the T-cell mediated memory response.

11.
Gastroenterology ; 162(7):S-591-S-592, 2022.
Article in English | EMBASE | ID: covidwho-1967332

ABSTRACT

Introduction: Ozanimod, a sphingosine 1-phosphate (S1P) receptor S1P1 and S1P5 modulator, is approved in the United States for moderately to severely active ulcerative colitis (UC) and in multiple countries for relapsing multiple sclerosis (MS). We describe COVID-19 outcomes in ozanimod-treated UC or MS patients in active phase 3 open-label extension studies. Methods: A database search identified COVID-19 infection reports in ozanimodtreated patients with UC in the True North open-label extension and MS in the DAYBREAK open-label extension. The analysis period was November 1, 2019 to either August 31, 2021 (UC) or May 10, 2021 (MS). The last COVID-19 event from all patients with ³1 event was analyzed. Results: Among 2792 ozanimod-treated patients with UC or MS, 258 developed COVID-19 (confirmed: 215);thus, the incidence in these clinical trial settings was 9.2% during the analysis periods. Most patients with confirmed cases (193/215 [89.8%]) had nonserious infections not requiring hospitalization or meeting other International Conference on Harmonisation criteria for a serious event. Of 611 ozanimod-treated patients with UC, 68 (11.1%) developed COVID-19 (confirmed: 55;Figure 1). A majority of UC patients with confirmed cases (45/55 [81.8%]) had nonserious COVID-19;most (54/55 [98.2%]) recovered (2 with sequalae) and 1 was recovering at data cutoff. One UC patient with confirmed COVID-19 discontinued ozanimod (1.8%), 23 temporarily interrupted it (41.8%), and 31 had no change to treatment (56.4%). No COVID-19-related deaths were reported in UC patients. Of 2181 ozanimod-treated pts with MS, 190 (8.7%) developed COVID-19 (confirmed: 160;Figure 2). Most MS patients with confirmed COVID-19 (148/160 [92.5%]) had nonserious cases;most (158/160 [98.8%]) recovered (5 with sequelae) (Figure 1). No MS patients with confirmed cases discontinued ozanimod, 61 temporarily interrupted it (38.1%), and 99 had no change to treatment (61.9%). Outcomes in 13 additional UC patients (Figure 1) and 30 additional MS patients (Figure 2) with suspected COVID-19 were similar to those with confirmed cases. There were 3 COVID-19-related deaths in the MS program. Conclusion: In the UC and MS open-label extension studies, most patients with confirmed COVID-19 had nonserious infections, recovered, and did not require ozanimod discontinuation. There were 3 deaths in MS patients (case-fatality rate 1.6% in MS, 1.2% overall). (Figure Presented)(Figure Presented)

12.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):160, 2022.
Article in English | EMBASE | ID: covidwho-1916253

ABSTRACT

Background: Over the summer of 2019/2020, NSW experienced the worst bushfires in recorded history shortly followed by the COVID-19 pandemic with mandated restrictions to movement from home and maternity care. A number of pregnancies spanned these events. Objective: To assess the impact of exposure to bushfires and pandemic restrictions on perinatal outcomes. Methods: The study included 60 054 pregnant women who gave birth November 2017-December 2020 in Sydney. Exposure cohorts were based on conception dates in relation to bushfire and pandemic restrictions: (1) bushfire exposure only;(2) bushfires in early pregnancy, born during lockdown;(3) conceived during bushfires, born during ongoing restrictions;(4) pandemic exposure only. Exposure cohorts were compared with pregnancies in the same periods in the two years prior. Generalised estimating equations assessed associations between the exposure cohorts with pregnancy and birth outcomes adjusting for covariates. Results: Pregnancies exposed to both bushfires and pandemic restrictions (2 and 3) had an increased risk of adverse perinatal outcomes compared to previous years and more than cohorts 1 and 4. For cohorts 2 and 3 unplanned caesarean sections were increased (aOR 1.16, 95% CI 1.04, 1.30);for cohort 2 low birthweight increased (aOR 1.21, 95% CI 1.03, 1.41);for cohort 3 gestational diabetes mellitus decreased (aOR 0.90, 95% CI 0.81, 1.00), while prelabour rupture of membranes and macrosomia increased (aOR 1.25, 95% CI 1.07, 1.4, aOR 1.17, 95% CI 1.03, 1.33 respectively). Conclusion: Exposure to both severe climate events and pandemic disruptions increases the risk of adverse perinatal outcomes. Given their increasing prevalence, additional research and vigilance is warranted.

13.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):75, 2022.
Article in English | EMBASE | ID: covidwho-1916239

ABSTRACT

Background: Domestic and family violence (DFV) and mental health screening are core components of antenatal care. However, the COVID-19 pandemic both increased the prevalence of DFV and mental health issues and resulted in many antenatal visits becoming telehealth. DFV and mental health screening were consequently often delayed, potentially resulting in insufficient time to establish support systems before birth. This study assessed pandemic effects on DFV and mental health screening from the perspective of local maternity service providers. Methods: Maternity staff (midwives, doctors, allied health) at three Sydney metropolitan hospitals were surveyed regarding perceived impact of COVID-19 on the delivery, timeliness, and quality of overall pregnancy care, DFV and mental health screening and care, and their telehealth perceptions. Responses by hospital and maternity care provider subtype were compared. Results: Of 109 respondents, most felt the pandemic negatively impacted overall pregnancy care (60%), DFV screening/care (57%), and mental health screening/care (57%), significantly more believing COVID-19 'extremely' negatively impacted DFV screening (p = 0.02). Staff at the hospital with highest sociodemographic diversity were significantly more concerned about DFV screening/ care. Nominated telehealth advantages e.g. reduced travel (69%) and clinic overcrowding (62%) were fewer than disadvantages including no physical examinations (90%), difficulties picking up non-verbal cues (84%), and certain questions unsafe (62%). Fiftysix percent believed telehealth should be used for some antenatal care for select women (low-risk, multiparous). Conclusions: Telehealth may have an ongoing limited role in maternity care in Australia for low-risk women. Staff considered those high-risk for physical and/or psychosocial reasons unsuited to telehealth care.

14.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):109-110, 2022.
Article in English | EMBASE | ID: covidwho-1916230

ABSTRACT

Background: Shared decision-making (SDM) involves patients in making decisions about their care, informed by clinical evidence and patient values and preferences. Despite its importance to woman-centred care, effectively implemented SDM remains uncommon in maternity care. This project developed clinician SDM training to help reduce variation in planned birth (labour induction/elective Caesarean), and pilottested acceptability and feasibility. Methods: An online SDM clinician training intervention package was developed in 2020-2021 by a Sydney-based team including midwifery and medical maternity clinicians, consumers, and social scientists. The package included a preparatory online video and a two-hour practical workshop (converted to online due to COVID-19) where participants rotate roles (woman, clinician, observer/rater) in clinical scenarios devised to test SDM in planned birth. Participants completed online pre- and posttraining surveys. Results: Preliminary results (first workshop Oct 2021;second scheduled March 2022) suggest clinicians agree that SDM is easy to understand, facilitate and experiment with, compatible with current practices, enable women to make more informed decisions compared with the usual approach and produce more benefit than harm. There were mixed responses about whether SDM is better than or involves major changes to current practice, will help women make choices that align with their values, or enable partnership between women and clinicians. Conclusions: The SDM training program has potential to improve clinicians' capacity for engaging woman in decisions about their care around planned birth and its timing. Further workshops, qualitative interviews with participants and a posttraining consumer survey at each site is planned for 2022.

15.
Journal of Educational Administration & History ; 54(3):245-262, 2022.
Article in English | Academic Search Complete | ID: covidwho-1908409

ABSTRACT

This paper is one of two which bring together leading educational researchers to consider some of the key challenges facing democracy and education during the twenty-first century, including rising social and economic inequality, political instability, and the existential threats of global pandemics and climate change. In this paper, key educational scholar–activists respond to the challenges and possibilities for democracy and education, with consideration of the importance of reimagining education as being for democracy. The questions asked in this paper have particular salience for educational leaders, who must be at the centre of any commitment to democratic education. [ FROM AUTHOR] Copyright of Journal of Educational Administration & History is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

16.
J Mater Res Technol ; 16: 1150-1164, 2022.
Article in English | MEDLINE | ID: covidwho-1814778

ABSTRACT

This investigation analyzes the main contributions that additive manufacturing (AM) technology provides to the world in fighting against the pandemic COVID-19 from a materials and applications perspective. With this aim, different sources, which include academic reports, initiatives, and industrial companies, have been systematically analyzed. The AM technology applications include protective masks, mechanical ventilator parts, social distancing signage, and parts for detection and disinfection equipment (Ju, 2020). There is a substantially increased number of contributions from AM technology to this global issue, which is expected to continuously increase until a sound solution is found. The materials and manufacturing technologies in addition to the current challenges and opportunities were analyzed as well. These contributions came from a lot of countries, which can be used as a future model to work in massive collaboration, technology networking, and adaptability, all lined up to provide potential solutions for some of the biggest challenges the human society might face in the future.

17.
International Journal of Advanced Computer Science and Applications ; 12(10), 2021.
Article in English | ProQuest Central | ID: covidwho-1811490

ABSTRACT

Recently, the need for online collaborative learning in educational systems have increased greatly because of COVID-19 pandemic. The pandemic has provided an opportunity for introducing online collaboration and learning among instructors and students in Nigeria. Currently, several schools, colleges, universities in Nigeria have discontinued face to face teaching and learning. Many schools resorted to ineffective alternatives such as the use of televisions and radio programmes to carry out distance education (DE). These alternatives have challenges such as lack of monitoring and evaluation of students’ learning. Collaborative Learning Management System (CLMS) is a research project that aims to assist instructors in achieving their pedagogical goals, organizing course content, collaborating, monitoring, and supporting students' online learning. It is an interactive, online based as well as android based system that has been designed, implemented, tested. The system demonstrates that it is robust, interactive, and achieves the predefined goals. As a Software Development Approach, it was created using the Rapid Application Development (RAD) Methodology. It also provides a secured and reliable platform for the schools, colleges, and universities to implement an online learning system.

18.
Cell reports methods ; 1(4), 2021.
Article in English | EuropePMC | ID: covidwho-1801491

ABSTRACT

Summary Multimodal advances in single-cell sequencing have enabled the simultaneous quantification of cell surface protein expression alongside unbiased transcriptional profiling. Here, we present LinQ-View, a toolkit designed for multimodal single-cell data visualization and analysis. LinQ-View integrates transcriptional and cell surface protein expression profiling data to reveal more accurate cell heterogeneity and proposes a quantitative metric for cluster purity assessment. Through comparison with existing multimodal methods on multiple public CITE-seq datasets, we demonstrate that LinQ-View efficiently generates accurate cell clusters, especially in CITE-seq data with routine numbers of surface protein features, by preventing variations in a single surface protein feature from affecting results. Finally, we utilized this method to integrate single-cell transcriptional and protein expression data from SARS-CoV-2-infected patients, revealing antigen-specific B cell subsets after infection. Our results suggest LinQ-View could be helpful for multimodal analysis and purity assessment of CITE-seq datasets that target specific cell populations (e.g., B cells). Graphical Highlights • LinQ-View integrates mRNA and protein expression data to reveal cell heterogeneity• LinQ-View prevents single dominant ADT features from affecting clustering• LinQ-View presents a quantitative purity metric for CITE-seq data• LinQ-View is specialized in handling CITE-seq data with fewer ADT features Motivation Multimodal single-cell sequencing enables multiple aspects for characterizing the dynamics of cell states and developmental processes. Properly integrating information from multiple modalities is a crucial step for interpreting cell heterogeneity. Here, we present LinQ-View, a computational workflow that provides an effective solution for integrating multiple modalities of CITE-seq data for downstream interpretation. LinQ-View balances information from multiple modalities to achieve accurate clustering results and is specialized in handling CITE-seq data with routine numbers of surface protein features. Li et al. present LinQ-View, a computational workflow that provides an effective solution for integrating multiple modalities of CITE-seq data and quantitative assessment of cluster purity. LinQ-View could be helpful for multimodal analysis and purity assessment of CITE-seq datasets that target specific cell populations.

19.
Journal of the Scholarship of Teaching and Learning ; 21(4), 2021.
Article in English | ProQuest Central | ID: covidwho-1786372

ABSTRACT

In a time when truth has become malleable and people are being told that the only obligation of citizenship is to consume, language has become thinner, more individualistic, detached from history, and more self-oriented, all the while undermining viable democratic social spheres as spaces where politics brings people together as collective agents willing to push at the frontiers of the political and moral imagination. Too many people across the globe have forgotten their civic lessons, and in doing so cede the ground of history to the purveyors of lies, militarism, and white supremacy. As educators and intellectuals, it is crucial to remember that there is no genuine democracy without the presence of citizens willing to hold power accountable, engage in forms of moral witnessing, break the continuity of common sense, and challenge the normalization of antidemocratic institutions, policies, ideas, and social relations. 

20.
Journal of Crohn's and Colitis ; 16:i452, 2022.
Article in English | EMBASE | ID: covidwho-1722338

ABSTRACT

Background: Ozanimod, a sphingosine 1-phosphate (S1P) receptor S1P1 and S1P5 modulator, is approved in the United States for moderately to severely active ulcerative colitis (UC) and in multiple countries for relapsing multiple sclerosis (MS). We describe COVID-19 outcomes in ozanimod-treated UC or MS patients (pts) in active phase 3 openlabel extension (OLE) studies. Methods: A database search identified COVID-19 infection reports in ozanimod-treated pts with UC in the True North OLE and MS in the DAYBREAK OLE. The analysis period was November 1, 2019 to either August 31, 2021 (UC) or May 10, 2021 (MS). The last COVID-19 event from all pts with ≥1 event was analyzed. Results: Among 2792 ozanimod-treated pts with UC or MS, 258 developed COVID-19 (confirmed: 215);thus, the incidence in these clinical trial settings was 9.2% during the analysis periods. Most pts with confirmed cases (193/215 [89.8%]) had nonserious infections not requiring hospitalization or meeting other International Conference on Harmonisation criteria for a serious event. Of 611 ozanimod-treated pts with UC, 68 (11.1%) developed COVID-19 (confirmed: 55;Fig 1). A majority of UC pts with confirmed cases (45/55 [81.8%]) had nonserious COVID-19;most (54/55 [98.2%]) recovered (2 with sequalae) and 1 was recovering at data cutoff. One UC pt with confirmed COVID-19 discontinued ozanimod (1.8%), 23 temporarily interrupted it (41.8%), and 31 had no change to treatment (56.4%). No COVID-19-related deaths were reported in UC pts. Of 2181 ozanimod-treated pts with MS, 190 (8.7%) developed COVID-19 (confirmed: 160;Fig 2). Most MS pts with confirmed COVID-19 (148/160 [92.5%]) had nonserious cases;most (158/160 [98.8%]) recovered (5 with sequelae) (Fig 1). No MS pts with confirmed cases discontinued ozanimod, 61 temporarily interrupted it (38.1%), and 99 had no change to treatment (61.9%). Outcomes in 13 additional UC pts (Fig 1) and 30 additional MS pts (Fig 2) with suspected COVID-19 were similar to those with confirmed cases. There were 3 COVID-19-related deaths in the MS program. One pt died from a presumed pulmonary embolism;this pt had received high-dose corticosteroids for MS relapse immediately before COVID-19 symptom onset. Another pt died from suspected COVID-19-related respiratory failure. One tetraplegic, cachectic pt died from a lung abscess following COVID-19 infection. Conclusion: In the UC and MS OLE studies, most pts with confirmed COVID-19 had nonserious infections, recovered, and did not require ozanimod discontinuation. There were 3 deaths in MS patients (casefatality rate 1.6% in MS, 1.2% overall).

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