Impacts of COVID-19 on proton therapy - Shaping the future of patient selection

Objectives: This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy centres. Method(s): This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines.1,2 A literature search was performed in Medline, Embase, Web Of Science and Scopus as well as grey literature. Keywords including "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 14 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Result(s): Six of 14 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of alternative therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment volume and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Discussion/Conclusion: Few publications detailed patient selection or workflow methods used during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in proton therapy, collecting this data could aid in future planning for proton therapy in Australia.

Impact of Covid-19 Pandemic on Pharmacologic Treatment of Patients Newly Diagnosed with Osteoporosis

Purpose of Study: The COVID-19 pandemic has presented considerable challenges in the care of patients with chronic diseases, including osteoporosis. In this study, we determined whether initiation of pharmacologic treatment was delayed for patients who were newly diagnosed with osteoporosis during the pandemic. Methods Used: Patients >= 50 years who were newly diagnosed with osteoporosis using dual-energy x-ray absorptiometry (DXA) screening at a single academic institution were included. Patients with osteoporosis diagnosed between March 1, 2018 to January 31, 2020 (pre-pandemic cohort) were compared to patients diagnosed between March 1, 2020 to January 31, 2022 (pandemic cohort). Basic demographics including age, gender, race, and ethnicity were evaluated. Primary outcomes included the proportion of patients who were initiated on pharmacologic therapy at 3-months and 6-months of diagnosis, as well as the mean time from osteoporosis diagnosis to initiation of pharmacologic treatment. Ordering providers (primary care vs specialty care providers) and types of pharmacologic agents were also compared. Summary of Results: In total, 1,189 were newly diagnosed with osteoporosis on DXA during the study period, with 576 patients in the pre-pandemic cohort and 613 in the pandemic cohort. There was no significant difference between cohorts with regard to age (69.3 vs 68.8 years, p=0.33), gender (87.0 vs 86.1% female, p=0.67), or ethnicity (88.2 vs 86.0% Non-Hispanic, p=0.25). However, there was a higher proportion of Whites in the pre-pandemic cohort (74.1 vs 68.4%, p=.028). Overall, only 40.5% of patients (n=481) newly diagnosed with osteoporosis were started on pharmacologic therapy within 6 months of diagnosis. Proportions of patients treated at 3-months (31.8 vs 35.4%, p=0.19) and at 6-months (37.8 vs 42.9, p=0.08) were comparable between cohorts (47.2 vs 50.2% p=0.30). Mean time from osteoporosis diagnosis to initiation of pharmacologic treatment was similar (46 vs 45 days, p=0.72). Ordering providers did not differ between cohorts (65.1 vs 57.4% primary care providers, p=0.08). Bisphosphonates were the most often prescribed in pre-pandemic (90%) and pandemic cohorts (82.1%). Conclusion(s): This is the first study to compare the impact of the COVID-19 pandemic on the pharmacologic treatment of patients who were newly diagnosed with osteoporosis. In our retrospective comparative study, we found only 40.5% of patients with newly diagnosed osteoporosis were treated pharmacologically within 6 months of diagnosis, and the COVID-19 pandemic did not significantly affect treatment rates. Bisphosphonates were the most often prescribed medication group. Further studies are needed to better understand patient-, provider-, and system-specific factors contributing to the low treatment rates of patients newly diagnosed with osteoporosis.

Impact of COVID-19 Pandemic on Osteoporosis Screening Using Dual-Energy X-ray Absorptiometry

Purpose of Study: Several survey studies have expressed concerns regarding a general decline in osteoporosis screening as a result of the COVID-19 pandemic. We compared our institution's experience on osteoporosis screening using dual-energy x-ray absorptiometry (DXA) before and during the COVID-19 pandemic. Methods Used: Patients >=50 years who received DXA screening at our academic institution were included. Patients with DXA completed between March 1, 2018 to January 31, 2020 (pre-pandemic cohort) were compared to patients with DXA completed between March 1, 2020 to January 31, 2022 (pandemic cohort). Basic demographics including age, gender, race, and ethnicity were evaluated. DXA utilization was calculated as the number of DXA studies completed monthly. The ordering providers (primary care vs specialty care providers) and mean time from initial order to DXA completion were compared between cohorts. Chi square tests were performed for categorical data, while independent t-tests were performed for continuous data, with significance set at 0.05. Summary of Results: In total, 10,680 DXA studies were completed at our institution over the study period. From March 1, 2018 to January 31, 2020, 5,375 DXA studies were completed (pre-pandemic cohort). From March 1, 2020 to January 31, 2022, 5,305 DXA studies were completed (pandemic cohort). Mean monthly DXA utilization did not differ between cohorts (233.7+/-28.5 vs 230.7+/-59.9 studies, p=0.83). There were also no statistically significant differences when comparing total DXA procedures per quarter per year between cohorts. Patients were older in the pandemic cohort at the time of DXA completion (69.3+/-8.2 vs 68.6+/-8.3 years, p<0.001). The distributions for gender (89.6% vs 89.2% female, p=0.5), ethnicity (90.3% vs 89.3% Non-Hispanic, p=0.09), and race (74.4% vs 73.3% White, p=0.21) did not differ between cohorts. The mean time from initial order to DXA completion was shorter for the pre-pandemic cohort (79.1+/-104.4 vs 88.8+/-107.6 days, p<0.001). The ordering providers (67.2% vs 62.7% primary care providers, p<0.001) also differed. Conclusion(s): This is the first study to quantitatively compare the rates of osteoporosis screening before and during the COVID-19 pandemic. In our retrospective study, we found that DXA utilization to screen for osteoporosis was not affected by the COVID-19 pandemic. However, DXA completion was more delayed, and the ordering providers were more likely to be non-primary care providers.

Disparities in public transit accessibility and usage by people with mobility disabilities: An evaluation using high-resolution transit data

Many people with mobility disabilities (PwMD) rely on public transit to access crucial resources and maintain social interactions. However, they face higher barriers to accessing and using public transit, leading to disparities between people with and without mobility disabilities. In this paper, we use high-resolution public transit real-time vehicle data, passenger count data, and paratransit usage data from 2018 to 2021 to estimate and compare transit accessibility and usage of people with and without mobility disabilities. We find large disparities in powered and manual wheelchair users' accessibility relative to people without disabilities. The city center has the highest accessibility and ridership, as well as the highest disparities in accessibility. Our scenario analysis illustrates the impacts of sidewalks on accessibility disparities among the different groups. We also find that PwMD using fixed-route service are more sensitive to weather conditions and tend to ride transit in the middle of the day rather than during peak hours. Further, the spatial pattern of bus stop usage by PwMD is different than people without disabilities, suggesting their destination choices can be driven by access concerns. During the COVID-19 pandemic, accessibility disparities increased in 2020, and PwMD disproportionately avoided public transit during 2020 but used it disproportionately more during 2021 compared to riders without disabilities. This paper is the first to examine PwMD's transit experience with large high-resolution datasets and holistic analysis incorporating both accessibility and usage. The results fill in these imperative scientific gaps and provide valuable insights for future transit planning. © 2023 Elsevier Ltd

Systemic risk and financial system network using financial risk meter: the case of Vietnam

In the financial market, systemic risk is defined as the possibility that an event at the company level could trigger severe instability or collapse of an entire industry or the whole economy. Thus, understanding systemic risk is crucial for the financial institutions, large corporations, investors and regulators. This article investigates systemic risk and spillover effect using the new Financial Risk Meter ((Formula presented.)) index, which is obtained from running quantile linear regression and Least Absolute Shrinkage and Selection Operator ((Formula presented.)) method. The (Formula presented.) index is obtained to identify the highly risky periods, the contributors to systemic risk and the potential activators of spillover effect. Moreover, interconnection between firms can be visualized as a network. We use a data set consisting of daily stock returns from 35 financial institutions and real estate firms in Vietnam, combined with 4 macroeconomic variables over the period from November 2011 to December 2020. The findings indicate that over the considered period, some detected highly risky periods are 2012, 2018 and 2020, probably due to the non-performing loan crisis in Vietnam, US-China trade war and global COVID-19 outbreak. Some active activators of risk spillover effect are also identified. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

A New Chapter for Medical Image Generation: The Stable Diffusion Method

Data collecting and sharing have been widely accepted and adopted to improve the performance of deep learning models in almost every field. Nevertheless, in the medical field, sharing the data of patients can raise several critical issues, such as privacy and security or even legal issues. Synthetic medical images have been proposed to overcome such challenges;these synthetic images are generated by learning the distribution of realistic medical images but completely different from them so that they can be shared and used across different medical institutions. Currently, the diffusion model (DM) has gained lots of attention due to its potential to generate realistic and high-resolution images, particularly outperforming generative adversarial networks (GANs) in many applications. The DM defines state of the art for various computer vision tasks such as image inpainting, class-conditional image synthesis, and others. However, the diffusion model is time and power consumption due to its large size. Therefore, this paper proposes a lightweight DM to synthesize the medical image;we use computer tomography (CT) scans for SARS-CoV-2 (Covid-19) as the training dataset. Then we do extensive simulations to show the performance of the proposed diffusion model in medical image generation, and then we explain the key component of the model. © 2023 IEEE.

Usefulness of day-one chest X-ray score for predicting mortality and ICU admission in COVID-19 patients

We aimed to investigate the performance of a chest X-ray (CXR) scoring scale of lung injury in prediction of death and ICU admission among patients with COVID-19 admitted at Vinmec Central Park hospital (HCM City, VN) during the peak epidemic in 2021. X-ray images and clinical data were collected from patients with SARS-CoV-2 PCR positive from July to September 2021. Three radiologists independently assessed the CXR score at admission which is the sum of severity and extent of lung injuries on four lung quadrants (maximum score = 24). Among 219 patients included, 28 died including 25 from 34 patients admitted to the ICU. There was a high consensus for CXR scoring among radiologists (kappa = 0.90;CI95%: 0.89-0.92). CXR score was the strongest predictor of mortality (tdAUC 0.85;CI95%: 0.69-1) within the first 3 weeks after admission. Multivariate model with adjustment for age confirmed a significant effect of increased CXR score on mortality risk (HR = 1.33, CI95%: 1.10 to 1.62). At a threshold of 16 points, the CXR score allows predicting in-hospital mortality and ICU admission with good sensitivity (0.82 (CI95%: 0.78 to 0.87) and 0.86 (CI95%: 0.81 to 0.90)) and specificity (0.89 (CI95%: 0.88 to 0.90) and 0.87 (CI95%: 0.86 to 0.89), respectively). The day-one CXR score is a reliable predictor of the risk of death and ICU admission and could be used to identify high-risk patients in needy countries like Vietnam.

Effectiveness and safety of switching to teriflunomide in older patients with relapsing multiple sclerosis: A real-world retrospective multicenter analysis.

BACKGROUND: The prevalence of multiple sclerosis (MS) in older people is increasing due to population aging and availability of effective disease-modifying therapies (DMTs). Treating older people with MS is complicated by age-related and MS-related comorbidities, immunologic effects of prior DMTs, and immunosenescence. Teriflunomide is a once-daily oral immunomodulator that has demonstrated efficacy and acceptable safety in clinical trials of adults with relapsing forms of MS (RMS). However, there are limited clinical trial and real-world data regarding teriflunomide use in people with MS aged >55 years. We analyzed real-world data to assess the effectiveness and safety of teriflunomide in older people with RMS who had switched to this agent from other DMTs. METHODS: People with RMS (relapsing remitting and active secondary progressive MS) aged ≥55 years who had switched from other DMTs to teriflunomide (7 mg or 14 mg) for ≥1 year were identified retrospectively by chart review at four sites in the United States. Data were extracted from medical records from 1 year pre-index to 2 years post-index (index defined as the teriflunomide start date). Assessments of effectiveness included annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score, and magnetic resonance imaging (MRI) outcomes. Assessments of safety included lymphocyte counts, infections, and malignancies. We examined the effectiveness outcomes and lymphocyte counts within sub-groups defined by age (55-64, ≥65 years), sex, MS type, and prior route of DMT administration (oral, injectable, infusible). RESULTS: In total, 182 patients with RMS aged ≥55 years who switched from other DMTs to teriflunomide were identified (mean [SD] age: 62.5 [5.4] years). Mean ARR decreased from the start of teriflunomide treatment (mean [SD]: 0.43 [0.61]) to year 1 post-index (0.13 [0.65]) and year 2 post-index (0.05 [0.28]). Mean EDSS score remained unchanged from index (mean [SD]: 4.5 [1.8]) to 1 year post-treatment (4.5 [1.8]) and increased slightly at 2 years post-treatment (4.7 [1.7]). MRI scans from index and years 1 and 2 post-index compared with scans from the previous year indicated that most patients had stable or improved MRI outcomes at index (87.7%) and remained stable or improved at years 1 (96.0%) and 2 (93.6%). Lymphopenia decreased at years 1 (21.4%) and 2 post-index (14.8%, compared to index (23.5%). By 1 year post-index, fewer patients had grade 3 or 4 lymphopenia, and at 2 years post-index, there were no patients with grade 3 or 4 lymphopenia. Infection incidence was low (n = 40, 22.0%) and none were related to teriflunomide. The decreases in lymphopenia were driven by decreases among people who switched from a prior oral DMT; there were no notable differences in lymphopenia across the other sub-groups examined. ARR, EDSS score, and MRI outcomes across all sub-groups were similar to the results of the overall population. CONCLUSION: Our multicenter, longitudinal, retrospective study demonstrated that patients with RMS aged 55 or older switching to teriflunomide from other DMTs had significantly improved ARR, stable disability, and stable or improved MRI over up to 2 years' follow up. Safety results were acceptable with fewer patients exhibiting lymphopenia at years 1 and 2 post-index.

The COVID-19 pandemic and financial stability in Vietnam: evidence from the interbank market

Purpose: This study investigates the impact of the COVID-19 pandemic on financial stability in Vietnam, a developing country characterized by a bank-based financial system. Design/methodology/approach: Using a sample of daily data from January 23, 2020 to June 30, 2022, the VECM and NARDL models are employed to study Vietnam's financial stability in face of the COVID-19 disaster. Following the literature on COVID-19, the authors measure the impact of the pandemic by the number of daily infected cases and the national lockdown. Given the reliance of the Vietnamese government on the banking system to regulate the economy, the authors evaluate financial stability from the interbank market and stock market perspectives. Findings: The authors find that the pandemic imposes a destructive effect on financial stability during the early time of the pandemic;however, the analysis with an extended period indicates that this effect gradually fades in the long term. In addition, from the NARDL results, the authors reveal an asymmetric relationship between the financial market and the COVID-19 pandemic in both short term and long term. Research limitations/implications: An implication drawn from this study is that unprecedented health disasters should be resolved by unprecedented stringent countermeasures when conventional methods are ineffective. Although rigorous remedies may increase short-term liabilities, their implementation quickly ceases disease diffusion and helps an economy enter the recovery stage in a timelier manner. Originality/value: The study is the first to examine the impact of the COVID-19 pandemic on financial stability, via the interbank market lens, in a developing country that relies on the bank-based financial system. © 2023, Emerald Publishing Limited.

Insight into cervical cancer prevention awareness, experiences, and attitudes among Southern Vietnamese women

Background At least 80% of new cervical cancer cases and deaths occur in low- and middleincome countries. Vietnam is a middle-income country where cervical cancer is the second most common and the deadliest gynecologic cancer. Cervical cancer incidence in Southern Vietnam has been shown to be 1.5-4 times higher than that in Northern Vietnam. However, less than 10% of Southern Vietnamese women have received the Human papillomavirus (HPV) vaccine and only 50% have ever been screened for cervical cancer. No study has examined the perceptions toward cervical cancer prevention and screening in Southern Vietnamese women. Hence, this study aimed to explore cervical cancer awareness, barriers to screening, and acceptability of HPV self-sampling for cervical cancer screening among rural and urban women in Southern Vietnam. Methods In October-November 2021, three focus groups were conducted in the rural district of Can Gio (n=21 participants) and three were conducted in the urban District Four (n=23 participants) in Ho Chi Minh City, Southern Vietnam. All participants were cervical cancer-free women aged 30-65 years. Awareness of, attitudes toward, and experience with cervical cancer prevention and screening were explored using audio-recorded, semi-structured discussions in Vietnamese. During the focus groups, participants also watched four short videos with Vietnamese subtitles and voiceover about cervical cancer screening methods and discussed their views on each. The recordings were transcribed, translated into English, and coded and analyzed using Dedoose 9.0.46. Results Four main themes emerged. First, women showed low awareness, but high acceptance of cervical cancer screening and HPV vaccination. Second, screening barriers were related to logistics (e.g., cost, time, travel distance), psychology (e.g., fear of pain, embarrassment, fear of the test revealing they had cancer), and healthcare providers (e.g., doctors' impolite manners, male doctors). Third, women were concerned about self-sampling incorrectly and pain, but believed HPV self-sampling to be a feasible screening tool in some circumstances (e.g., during the COVID-19 pandemic, those living in remote areas). Fourth, women related cervical cancer prevention to COVID-19 prevention;they believed strategies that have been successful for COVID-19 control in Vietnam could be applied to cervical cancer. No differences in themes emerged by rural/urban areas. Conclusions Southern Vietnamese women showed low awareness but high acceptance of cervical cancer screening despite barriers. Strategies for successful COVID-19 control in Vietnam, including campaigns to increase public awareness, advocacy from the government and doctors, and efforts to increase access to screening and vaccination, should be applied to cervical cancer control. Health education programs to address HPV self-sampling concerns and promote it as a cervical cancer screening tool are warranted given its potential to improve screening uptake in this low-resource setting.

Expert opinion on COVID-19 vaccines and cladribine tablets in MS: A plain language summary.

WHAT IS THIS SUMMARY ABOUT?: People with multiple sclerosis (shortened to MS) who are taking cladribine tablets may have concerns about whether they can be vaccinated against COVID-19. This summary details the findings from a previously published article, in which an international committee of 10 MS experts developed recommendations to answer some important questions about COVID-19 vaccines in people with MS (including relapsingremitting or active secondary progressive disease) taking cladribine tablets. WHAT WERE THE RESULTS?: The committee identified 13 recommendations, which were all agreed upon by at least three-quarters (75%) of the 38 voting MS experts. Generally, they recommended that people with MS taking cladribine tablets should be vaccinated for COVID-19 as soon as possible, because the vaccine is thought to be both safe and effective, and vaccine responses were not likely to be affected by cladribine tablets. WHAT DO THE RESULTS MEAN?: Overall, people with MS taking cladribine tablets should receive the COVID-19 vaccine to protect themselves, unless advised differently by their healthcare provider.

Automated Classification of Lung Injury from X-ray Images using Deep Learning Network

This paper presents a new approach for supporting the diagnosis of lung injury from chest X-ray images. Specifically, this paper proposes using the DarkCovidNet model for classifying the damage as Covid-19 or other causes. Since the approach also takes into account the dataset feature to train classification models, data augmentation using an interpolation algorithm was also researched and used to enrich the dataset. The experimented results done on different databases show that the proposed method help to improves the the accuracy of lung injury classification models. © 2022 Asia-Pacific of Signal and Information Processing Association (APSIPA).

Corporate Governance and Financial Stability: The Case of Commercial Banks in Vietnam

Bank stability is a goal that bank managers aim for in addition to the goal of maximizing shareholder value. To achieve this goal, commercial banks have applied various solutions, including corporate governance because corporate governance plays an important role in the business activities of an enterprise in general as well as in that of a commercial bank in particular. The purpose of this paper is to investigate the impact of corporate governance on the stabilities of Vietnamese commercial banks in the period from 2009 to 2020. Using hand-collected data from 25 commercial banks in Vietnam, by system GMM estimation and the Bayesian Mixed-Effects approach, the paper identifies the characteristics of corporate governance affecting bank stability. Board size, women board members, and board members' education have a positive impact, and dependent board and foreign board members have a negative impact on bank stability. Our findings show important evidence for an emerging country, such as Vietnam. From the empirical results, the authors suggest several recommendations to maintain and enhance bank stability in the future time.

COVID-Net Network and Application on Support Diagnosis COVID-19 over X-ray Images

Early diagnosis through X-ray images is the diagnosis with low cost, often used in hospitals to assist doctors in making health treatment plans. This paper presents a new approach for supporting the diagnosis of Covid-19 based on chest X-ray images. Specifically, this paper proposes using the Covid-net model for classifying the damage as Covid-19 or other causes. Data augmentation using seam carving was also researched and evaluated with different energy functions. The experimented results done on different databases are promising. © 2022 IEEE.

Cash Flow and External Financing in the Covid Pandemic Context and Financial Constraints

The article examines the impact of cash flow on the need to increase funding in the Covid pandemic context and the financial constraints of listed companies in Vietnam. We build hypotheses based on the self-ranking match theory framework and research overview. We use data from 5894 observations for 2010-2020 and the general regression model GLS to test the expected hypotheses. The research results show that cash flow significantly influences the external financing needs of the business. In particular, the cash flow impact and increased need for external financing are more evident in financial constraints and the context of the covid pandemic. The study also shows that the group of companies with financial constraints moved to increase funding when cash flow was in short supply during the Covid pandemic. Besides, the high financial leverage ratio in the previous year can be one of the barriers for businesses that want to access a variety of external financing. The study contributes to the analysis and assessment of the problematic situation of listed companies. In the future, this study can be extended when approaching businesses in the financial sector and evaluating other macro factors that can affect the capital sources of enterprises.

Is Climate Change Crisis a New Global Security Threat? Evidence from the Quality of Government Dataset

Over the past decade, climate change has become one of the most important issues to citizens in countries around the world. As the Covid-19 pandemic has demonstrated, no country is immune from actor-less threats like novel disease outbreaks and climate change. When combined with other security threats like transnational terrorism and ubiquitous cyberattacks, it becomes one of the key global security threats. However, while there have been many theoretical arguments that the overall impacts of climate change on international security are inevitable, and predictable posing escalating risks to stability and security, with potentially far-reaching consequences, the empirical evidence of this link is limited. This study takes an important step in filling this gap by measuring the effect of climate change on the global security quantitatively based on the quality of government (QoG) dataset. Contributing to the growing body of work on climate change and global security, this study suggests that (1) climate change crisis can be considered an existential global security threat;and (2) developing countries are the most impacted by climate change and the least able to afford its consequences. © 2022, Council for Social and Economic Studies. All rights reserved.

Medical-Waste Chain: A Medical Waste Collection, Classification and Treatment Management by Blockchain Technology

To prevent the spread of the COVID-19 pandemic, 2019 has seen unprecedented demand for medical equipment and supplies. However, the problem of waste treatment has not yet been given due attention, i.e., the traditional waste treatment process is done independently, and it is not easy to share the necessary information. Especially during the COVID-19 pandemic, the interaction between parties is minimized to limit infections. To evaluate the current system at medical centers, we also refer to the traditional waste treatment processes of four hospitals in Can Tho and Ho Chi Minh cities (Vietnam). Almost all hospitals are handled independently, lacking any interaction between the stakeholders. In this article, we propose a decentralized blockchain-based system for automating waste treatment processes for medical equipment and supplies after usage among the relevant parties, named Medical-Waste Chain. It consists of four components: medical equipment and supplies, waste centers, recycling plants, and sorting factories. Medical-Waste Chain integrates blockchain-based Hyperledger Fabric technology with decentralized storage of medical equipment and supply information, and securely shares related data with stakeholders. We present the system design, along with the interactions among the stakeholders, to ensure the minimization of medical waste generation. We evaluate the performance of the proposed solution using system-wide timing and latency analysis based on the Hyperledger Caliper engine. Our system is developed based on the hybrid-blockchain system, so it is fully scalable for both on-chain and off-chain-based extensions. Moreover, the participants do not need to pay any fees to use and upgrade the system. To encourage future use of Medical-Waste Chain, we also share a proof-of-concept on our Github repository.

PRESERVED SARS-COV-2 VACCINE CELL-MEDIATED IMMUNOGENICITY IN INFLAMMATORY BOWEL DISEASE PATIENTS ON IMMUNEMODULATING THERAPIES

BACKGROUND: Immune-modulating medications for inflammatory bowel diseases (IBD) have been associated with suboptimal vaccine responses. There is conflicting data with SARS-CoV-2 vaccination. METHODS: We measured SARS-CoV-2 vaccine immunogenicity at 2 weeks post 2nd mRNA vaccine in IBD patients as compared to normal healthy donors (NHD). We measured humoral immune responses to SARS-CoV-2: anti-spike Immunoglobulin G (IgG) and anti-receptor binding domain (RBD) IgG were measured by ELISA, and neutralizing antibody titers were measured using recombinant, reporter SARS-CoV-2. Antigen specific memory B cells were measured using recombinant SARS-CoV-2 proteins. Activation induced marker T cell (AIM) assays were performed using SARS-CoV-2 spike megapools. Immunophenotyping was performed by flow cytometry. RESULTS: We enrolled 29 patients with IBD (19 with Crohn's disease, 10 with ulcerative colitis) on infliximab (IFX) monotherapy (N=9), IFX combination therapy with a thiopurine (N=9), vedolizumab monotherapy (N= 11) as compared to matched NHD (N=12). At 2 weeks post vaccination, all subjects made detectable anti-spike IgG and anti-RBD IgG. There were no differences in anti-spike IgG titers among the different groups. IBD patients on IFX monotherapy, but not IBD patients on IFX combination therapy or vedolizumab monotherapy, had lower anti-RBD and neutralization titers as compared to NHD (p-value: 0.041 and 0.023, respectively) (Fig. 1). There were no significant differences in the percentage of spike-specific or RBD-specific memory B cells in IBD patients as compared to NHD (Fig. 1). There were no differences in the percentage of spike-specific CD4+ or CD8+ T cells in all IBD patients as compared to NHDs (Fig. 2). CONCLUSIONS: We demonstrate overall comparable and perserved cell-mediated immunity to SARS-CoV-2 vaccination in a small cohort of IBD patients treated with a range of different immune-modulating medications as compared to healthy controls. Larger numbers of patients are needed to validate these findings.

GLOBAL IMPACT OF THE COVID19 PANDEMIC ON SUBARACHNOID HEMORRHAGE ADMISSIONS, ANEURYSM TREATMENT AND IN-HOSPITAL MORTALITY: 1 YEAR FOLLOW-UP

Background: Prior studies indicated a decrease in the incidences of subarachnoid hemorrhage (SAH) during the early stages of the COVID- 19 pandemic. We evaluated differences in the incidence, severity of SAH presentation, and ruptured aneurysm treatment modality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centers. We recorded volumes for: COVID-19 hospitalizations, SAH hospitalizations, Hunt-Hess Grade, coiling, clipping, and aneurysmal SAH (aSAH) in-hospital mortality. Diagnoses were identified by ICD-10 codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16,247 aSAH admissions, 344,491 COVID-19 admissions, 8,300 coiling and 4,240 aneurysmal clipping procedures. Declines were observed in aSAH admissions (-6.4% [95%CI -7,-5.8];p=0.0001) during the first year of the pandemic compared to the prior year, most pronounced in high-volume SAH and highvolume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentation of aSAH (mild: -5%[-5.9,-4.3], p=0.06;moderate: -8.3%[-10.2,-6.7], p=0.06) but no difference in higher SAH severity. The clipping rate remained unchanged (30.7% vs. 31.2%, p=0.58), whereas coiling increased (53.97%vs.56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%,p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the coiling rate, but no change in clipping rate, nor change in aSAH in-hospital mortality.