ABSTRACT
Dexamethasone (DEX) administration is recommended for moderate to severe COVID-19 patients who require supplemental oxygen on Japanese guidelines. For pregnant women, prednisolone (PSL), which has less placental transfer, should be considered. However, there are currently limited case reports. This report reviews a case of pregnant woman with COVID-19 treated with PSL, in which a healthy baby was delivered after successful treatment. A 31-year-old pregnant woman (G2P1) with a BMI of 38 and gestational diabetes was admitted to the hospital at the gestational age of 19 weeks and 4 days, with a decrease in oxygen saturation of 95% on 3 L/min oxygen flow. Remdesivir 100 mg/day, PSL 40 mg/day, and subcutaneous heparin Ca 10,000 units/day were administrated and continued until 21 weeks gestation. At the gestational age of 38 weeks and 2 days, she gave birth to a 2,988 g female baby with Apgar 8/9 by elective Caesarean section. Although short-term DEX administration would have less effect on the fetus given the gestational age of pregnancy, we decided to administrate PSL based on the guidelines after consultation with pharmacists and clinical departments. This case report has suggested that PSL has the same therapeutic effect on COVID-19 as DEX.
ABSTRACT
Background Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder that can be treated with a proton pump inhibitor (PPI). Pharmacogenetics (PGx) is the study of how variations in an individual’s genome influences drug response. Genetic variation in the metabolism gene CYP2C19 can produce differences in enzyme activity which is known to be a contributing factor for therapeutic failure with PPI treatment. Use of 2nd generation PPI (rabeprazole) can be beneficial in some as this PPI is less effected by CYP2C19 metabolism. PGx has been studied in PPI therapy for peptic ulcer disease but has not been demonstrated in patients with EoE. Aims To describe the CYP2C19 metabolism in patients with EoE on PPI and to estimate the clinical utility of PGx testing in directing subsequent changes in therapy with improvement in remission rates. Methods Interim analyses of a single centre, non-interventional, ongoing descriptive pilot study investigating CYP2C19 metabolism in patients with EoE, as part of a larger PGx pilot study and EoE- AHEAD Registry Study at SickKids. Patients with EoE that were newly diagnosed and started PPI or those not in remission on current non-PPI therapy or not in remission on dose PPI (2 mg/kg/day, max 30 mg lansoprazole BID) were included. Active disease was defined as a peak eosinophil count >15/hpf. Results 37 patients met the inclusion criteria with completed PGx test;mean age was 13 years, 29(78%) were male, and 13(35%) had concurrent atopic disease. PGx testing showed that 12(32%) and 4(11%) were rapid (RM) and ultrarapid metabolizers (URM) respectively (Fig.1), which is significantly higher than the population average. Of this subgroup, 9 started rabeprazole, 3 had a lansoprazole dose increase, and 4 had no changes. Overall, changes in therapy based on PGx testing were made in 29(78%) patients, 8 are awaiting follow-up (Fig 2). Currently, the patients with available repeat biopsy results after PGx test-guided therapy changes is limited due COVID-19 related delays in endoscopies. Conclusions The preliminary findings of our study using PGx to guide PPI dosing in pediatric patients with EoE demonstrate that PGx test results lead to a change in clinical management in most patients. In RM and URM, PGx results trigger an adjustment of PPI dose or type could lead to earlier disease remission in PPI-responsive patients, thereby optimizing PPI efficacy. PGx may support dose reduction in poor metabolizers aiming to avoid long-term adverse events. Further correlation with endoscopy and histology findings of patients after PGx-guided therapy changes will follow. Furthermore, it is important to examine if CYP2C19 variant information available before PPI therapy further streamlines an initial phase of the treatment. Funding Agencies Dr. Marcon: J Garfield Campbell Fund, Dr. Hulst: Start-up Funds from the Department of Pediatrics at SickKids
ABSTRACT
The rapid outbreak of COVID-19 pandemic has accelerated the adoption process of digital online tools for social communication across disciplines regardless of cultural backgrounds. Design to had to quickly migrate a considerable portion of its activities to the Internet, making it the preeminent platform in which a large portion of workshops take place nowadays. This swift change from a ‘face-to-face’ to ‘online’ reality is by no means without problems and hurdles, a significant one among these, is the scarcity of academic documentation that deals with the workshops from a communication point of view (beyond the technical aspects). This study aims to identify communication problems within ‘Online Design Workshops’ allowing the organizers to reroute efforts, from a technical and administrative point of view to the quality of the design output itself. The research method adopted was participatory research praxis based on the comparison of survey outputs taken during ‘face-to-face’ and ‘online’ workshops conducted between years 2012 ~ 2019, and 2020, respectively. Using the SMCR model as a framework of communication analysis it was discovered that the most critical aspects are those related to ‘understanding’ (between participants, of the online tools, and of the contents). Accordingly, a first attempt at optimal heuristic paths to the improvement of design stages within online workshops with focus on communication are proposed. Further design workshops can be approached using the process outlined in this paper, adding to the robustness of the heuristics. © PDE 2021.
ABSTRACT
Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves? disease and Hashimoto?s thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented the world?s first case of PPT developed following COVID-19. ABSTRACT Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves? disease and Hashimoto?s thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented