DNase analysed by a novel competitive assay in patients with complications after ChAdOx1 nCoV-19 vaccination and in normal unvaccinated blood donors

Increased levels of neutrophil extracellular traps (NETs) have been detected in individuals with vaccine complications after the ChAdOx1 nCov vaccine with a correlation between the severity of vaccine side effects and the level of NETosis. DNases may disrupt NETs by degrading their content of DNA, and a balance has been reported between NETs and DNases. Because of this and since the inflammatory marker NETs may be used as a confirmatory test in diagnosing VITT, it is of interest to monitor levels of DNase in patients with increased NETs levels. The current novel rapid DNase ELISA was tested in blood samples of patients with known increased levels of NETs with or without VITT after ChAdOx1 nCoV-19 vaccination. DNase levels in VITT patients were significantly increased compared with normal unvaccinated blood donors and compared with patients with post-vaccination symptoms but not VITT. However, since EDTA was found to inhibit DNase, serum and not EDTA-plasma samples should be applied for DNase testing. The novel DNase assay may serve as a supplementary test to the NETs test when analysing samples from patients with suspected increased NETs levels.Copyright © 2023 The Scandinavian Foundation for Immunology.

Housework and Parenting during the Lockdowns in France: How Have Socio-Economic and Gender Inequalities Changed?

The lockdowns imposed during the COVID-19 pandemic had an unprecedented impact on people's time use. This article analyses the changes in time spent on household tasks and parenting by men and women during the lockdowns of the spring and autumn of 2020 in France, by social category, education, working arrangements and family configurations, using data from the major longitudinal EpiCov survey. The time spent on housework was high in the spring of 2020 and caring for children was particularly time consuming. This additional domestic and parental burden affected both women and men, but women continued to perform the majority of the housework, in spite of the similar working conditions between the sexes during this period. During the first lockdown, women at the top of the social hierarchy, who generally perform fewer household chores, spent far more time than usual on these tasks, thereby temporarily reducing social differences. © 2022, Institut National de la Statistique et des Etudes Economiques. All rights reserved.

The relationship of functional outcome after mechanical thrombectomy and serum glucose is partially mediated by edema formation

IntroductionHigh blood glucose was shown to be associated with worse clinical outcome and increased edema formation in patient with acute stroke undergoing mechanical thrombectomy.1 A better understanding of the pathophysiological pathways and a quantification of their effects might support targeted therapeutic approaches.Aim of the StudyTo quantify the amount of outcome deterioration explained by edema formation due to high blood glucose.Methods124 patients with acute ischemic stroke who underwent mechanical thrombectomy were included. Mediation analysis was performed to quantify the amount of outcome deterioration (probability for mRS>2) explained by edema formation in patients with high blood glucose. In addition, the moderating effects of good and poor collaterals were investigated.ResultsProbability for poor outcome increased with increasing blood glucose levels (OR 1.23/10 mg/dl), edema formation (OR 1.13/% net water uptake) and poor collaterals (OR 1.64). Edema formation was also associated with higher blood glucose levels (regression coefficient 0.033). An increase of blood glucose levels from 100mg/dl to 200mg/dl resulted in a 47 percentage-points decrease of the probability of good outcome in patients with good collaterals and a 26 percentage points decrease in patients with poor collaterals. Edema formation explained 15% of the outcome deterioration caused by higher blood glucose levels.ConclusionEdema formation explains 15% of the total adverse effects of high blood glucose levels. Major pathways might include other direct effects of high blood glucose, such as altered vessel wall and thrombus characteristics and higher thrombogenicity of the cerebral blood flow.ReferencesThorén, M., et al. “Predictors for Cerebral Edema in Acute Ischemic Stroke Treated with Intravenous Thrombolysis.” Stroke 2017;48(9): 2464–2471.Do you have any conflict of interest to declare?: YesHelge Kniep is a consultant for Eppdata.Jens Fiehler received research support from: German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Route92, Stryker. He is consultant for: Acandis, Bayer, Cerenovus, Covidien, Medtronic, Microvention, Penumbra, Phenox, Stryker and stock holder of Tegus Medical.

How much of the improvement in functional outcome after successful recanalization is explained by follow-up infarct volume reduction?

IntroductionMechanical thrombectomy (MT) has been shown to improve functional outcome in patients with anterior circulation stroke. However, previous works suggest only limited explanatory effect of infarct volume reduction on outcome in patients undergoing MT vs. standard medical care1.Aim of the studyThe amount of improvement of functional outcome explained by follow-up infarct volume reduction after successful recanalization has not been investigated in detail. Results might allow quantification of pathophysiological effects and could improve the understanding of the value of follow-up infarct volume as imaging endpoint in clinical trials.MethodsAll patients from our institution enrolled in the German Stroke Registry from 05/2015 to 12/2019 with anterior circulation stroke, availability of the relevant clinical data and follow-up CT (12h-2 weeks) were analyzed. A mediation analysis was conducted to investigate the effect of successful recanalization (Tici≥2b) on good functional outcome (90d mRS≤2) with mediation through follow-up infarct volume.Results429 patients were included. Multivariate regression confirms significant association of successful recanalization with lower follow-up infarct volume and better functional outcome. Results of the mediation analysis suggest a 23 percentage points (pp) increase of probability of good function outcome (95%CI: 16pp-29pp) in patients with successful recanalization. 57% (95%CI: 38%-79%) of the treatment effect was explained by follow-up volume reduction.Conclusions57% of the improvement of functional outcome after successful recanalization is explained by follow-up infarct volume reduction. Results reflect established pathophysiological assumptions and confirm the value of infarct volume as imaging endpoint in clinical trials.ReferencesBoers AMM, Jansen IGH, Brown S, et al. Mediation of the relationship between endovascular therapy and functional outcome by follow-up infarct volume in patients with acute ischemic stroke. Jama Neurology 2019;76:194–202. DOI: 10.1001/Jamaneurol.2018.3661Do you have any conflict of interest to declare?: YesHelge Kniep, Fabian Flottmann and Friederike Austein are consultants for Eppdata.Milani Deb-Chatterji has received research grants from the Werner Otto Stiftung.Gabriel Broocks received grants from Balt USA, LLC.Götz Thomalla received fees as consultant from Acandis, Bayer, and Portola, and fees as lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer-Ingelheim, BristolMyersSquibb, Daiichii Sankyo, Portola, and Stryker.Jens Fiehler received research support from: German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Route92, Stryker. He is consultant for: Acandis, Bayer, Cerenovus, Covidien, Medtronic, Microvention, Penumbra, Phenox, Stryker and stock holder of Tegus Medical.

Thrombectomy for medium vessel occlusions: treatment effect of successful recanalization on long term functional outcome

IntroductionTreatment effects of successful recanalization after mechanical thrombectomy (MT) have been evaluated for acute ischemic strokes with large vessel occlusion. However, for medium-vessel occlusions (MeVO) treatment effects of successful recanalization have not been investigated in detail.Aim of the studyTo quantify treatment effects of different degrees of recanalization after MT in MeVO on long term function outcome.MethodsAll patients enrolled in the German Stroke Registry from 05/2015 to 12/2019 with MeVO of the middle cerebral artery and availability of the relevant data points were included. The treatment effect of different degrees of recanalization (TICI scores) was analyzed using established binarized outcome metrics (good outcome: 90d mRS≤2) and linearized outcome metrics defined as the mRS increase pre-stroke to 90d. Treatment effects were assessed using double robust inverse-probability-weighted regression-adjustment estimators for multivalued treatments.Results597 patients fulfilled the inclusion criteria. 97 (16%) patients had TICI<2b with good outcome in 19%. 194 (33%) patients had TICI 2b and 296 (50%) had TICI 3. For both cohorts, percentage of good outcome was 55%. Covariate-controlled treatment effect estimation suggests that TICI 2b recanalization increases probability of good long-term functional outcome from 27% to 58% (31 pp). Pre-stroke to 90d mRS increase was reduced by 1.0 mRS points. Full recanalization with TICI 3 did not further increase probability of good outcome and did not further reduce stroke-related mRS increase.ConclusionTICI 2b recanalization in MeVO increased probability of good outcome from 27% to 58%, TICI 3 recanalization did not further improve prognosis.Do you have any conflict of interest to declare?: YesConflict of Interest StatementHelge Kniep and Fabian Flottmann are consultants for Eppdata.Milani Deb-Chatterji has received research grants from the Werner Otto Stiftung.Götz Thomalla received fees as consultant from Acandis, Bayer, and Portola, and fees as lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer-Ingelheim, BristolMyersSquibb, Daiichii Sankyo, Portola, and Stryker.Jens Fiehler received research support from: German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Route92, Stryker. He is consultant for: Acandis, Bayer, Cerenovus, Covidien, Medtronic, Microvention, Penumbra, Phenox, Stryker and stock holder of Tegus Medical.

Is the Pope's Hope Being Dashed? Five Years of Research on Laudato Si

At the height of the deadlocks around global climate change discussions and negotiations, Pope Francis made entry with a morally captivating encyclical letter (Laudato Si) on the Care for Creation. Using a scoping review approach, we focused on a five-year-old body of research around the encyclical, identifying impacts as well as other issues arising from the scholarly engagements. Here, 150 English written publications from 2015 to 2020 were reviewed. The majority of these texts (80%) addressed the significance and vision of Laudato Si. The rest were distributed between those that presented criticisms of the letter (11%) and those that gauged the impact of the letter on environmental worldviews (9%). Second, the climate change (technological advancement)-poverty (climate justice) connection, which is the encyclical's major focus, remains contested and inconclusive as some critics have rather found and presented a positive relationship between these variables. Third, Laudato Si has recorded a mixed impact. To some people, it has not only led to increased credibility of the Pope but also the increased concern for climate change, whereas to others, it has led to a decreased credibility of the Pope as well as a lessened concern for climate change. Fourth, studies gauging Laudato Si's impact is geographically biased as they have largely focused on the US and Europe while neglecting other regions especially Africa. The implications of these findings for research and policy are discussed. © 2022 Copyright 2022 by Koninklijke Brill NV, Leiden, The Netherlands.

IMMUNOGENICITY AND SAFETY OF STANDARD AND THIRD DOSE SARS-COV-2 VACCINATION IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES;A PROSPECTIVE COHORT STUDY

Introduction: The immunogenicity and safety following standard two-dose SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseases (IMIDs) are not well characterised, and data on third dose vaccination in this patient group are currently lacking. Methods & Aims: This prospective, observational cohort study included adult patients on immunosuppressive therapy for Crohn's disease (CD), ulcerative colitis (UC), rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA), and healthy controls receiving standard two-dose SARS CoV-2 vaccination. Patients with a weak serologic response (<100 AU/ml) were allotted a third vaccine dose. Serum samples were collected prior to, and after vaccination for analyses of antibodies to the receptor-binding domain (RBD) of the SARSCoV- 2 spike protein. The aim of the study was to evaluate the immunogenicity and safety following standard and three dose SARS-CoV-2 vaccination in IMID patients on immunosuppressive therapies. Results: a total of 1641 patients (280 CD, 195 UC, 566 RA, 305 SpA, 295 PsA, median age 52 [IQR 40-63], 899 [55%] women), and 1114 healthy controls (median age 43 [IQR 32-55], 854 [77%] women), were included in the study. After standard SARS-CoV-2 two dose vaccination, 1504 (91%) patients compared to 1096 (98%) healthy controls were responders, p<0,001. Anti-RBD levels were lower in patients (median 619 AU/ml [IQR 192-4191]) than controls (median 3355 AU/ml [IQR 896–7849]), p<0,001. Response was shown in ≤90% of patients receiving methotrexate, tumor necrosis factor inhibitor (TNFi) monotherapy, ustekinumab, tozilizumab and vedolizumab, in 80–90% of patients receiving TNFi combination therapy and secukinumab and in £ 80% for JAK inhibitors (78%), and abatacept (53%) (fig.1). Lower age (OR 0.96 [95% CI 0.95–0.98]) and receiving the mRNA-1273 vaccine (OR 5.4 [95% CI 2.4–11.9]) were predictors of response. Of 153 patients with a weak response receiving a third vaccine dose, 129 (84%) became responders. After standard two dose vaccination, adverse events (AE) were reported in 50% of patients and in 78% of controls, with a comparable safety profile. Following the third dose, 44% of patients reported AEs, without new safety issues emerging. No serious AEs were reported. Conclusion: Response rate as well as anti-RBD levels were lower in IMID patients than healthy controls following standard vaccination. Third dose vaccination in serologically weak responders was safe and resulted in a response in most patients. Our data facilitate identification of patient groups at risk of an attenuated vaccine response eligible for post-vaccination serological monitoring. The data also support a third vaccine dose following standard SARS-CoV-2 vaccination to weak-responding IMID-patients. (Figure Presented) Fig.1 Anti-SARS-CoV-2 IgG antibodies following standard two dose SARS-CoV-2 vaccination according to medication group, compared to healthy controls. Violin plot showing the probability density of the data at different values, smoothed by a kernel density estimator. Each data point is a participant, and the solid orange line show the group median. The last row (CTRL vs) shows p-values for a comparison (Mann-Whitney U test) of anti-SARS-COV 2 antibodies between medication groups and healthy controls. ACE=Angiotensin converting enzyme, FL=full length, CTRL=Controls, TNF=Tumor necrosis factor inhibitor, TNF+= Tumor necrosis factor inhibitor combination therapy, MTX=methotrexate, VDZ=vedolizumab, JAK=Janus kinase inhibitor, TCZ=tocilizumab, UST=ustekinumab, ABA=abatacept, SCK=secukinumab.

Immunogenicity and safety of standard and third dose SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseases;a prospective cohort study

Background: The immunogenicity and safety following standard twodose SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseases (IMIDs) are not well characterised, and data on third dose vaccination in this patient group are currently lacking. Methods: This prospective, observational cohort study included adult patients on immunosuppressive therapy for Crohn's disease (CD), ulcerative colitis (UC), rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA), and healthy controls receiving standard two-dose SARS CoV-2 vaccination. Patients with a weak serologic response (<100 AU/ml) were allotted a third vaccine dose. Serum samples were collected prior to, and after vaccination for analyses of antibodies to the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein. The aim of the study was to evaluate the immunogenicity and safety following standard and three dose SARS-CoV-2 vaccination in IMID patients on immunosuppressive therapies. Results: A total of 1641 patients (280 CD, 195 UC, 566 RA, 305 SpA, 295 PsA, median age 52 [IQR 40-63], 899 [55%] women), and 1114 healthy controls (median age 43 [IQR 32-55], 854 [77%] women), were included in the study. After standard SARS-CoV-2 two dose vaccination, 1504 (91%) patients compared to 1096 (98%) healthy controls (p<0,001) were responders. Anti-RBD levels were lower in patients (median 619 AU/ml [IQR 192-4191]) than controls (median 3355 AU/ml [IQR 896-7849]), p<0,001. Response was shown in ≥90% of patients receiving methotrexate, tumor necrosis factor inhibitor (TNFi) monotherapy, ustekinumab, tozilizumab and vedolizumab, in 80-90% of patients receiving TNFi combination therapy and secukinumab and in ≤ 80% for JAK inhibitors (78%), and abatacept (53%) (Fig 1). Lower age (OR 0.96 [95% CI 0.95-0.98]) and receiving the mRNA-1273 vaccine (OR 5.4 [95% CI 2.4-11.9]) were predictors of response. Of 153 patients with a weak response receiving a third vaccine dose, 129 (84%) became responders. After standard two dose vaccination, adverse events (AE) were reported in 50% of patients and in 78% of controls, with a comparable safety profile. Following the third dose, 44% of patients reported AEs, without new safety issues emerging. No serious AEs were reported. Conclusion: Response rate as well as anti-RBD levels were lower in IMID patients than healthy controls following standard vaccination. Third dose vaccination in serologically weak responders was safe and resulted in a response in most patients. Our data facilitate identification of patient groups at risk of an attenuated vaccine response eligible for post-vaccination serological monitoring. The data also support a third vaccine dose following standard SARS-CoV-2 vaccination to weakresponding IMID-patients.

Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care.

BACKGROUND: Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors. METHODS: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March-April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively. RESULTS: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions>25% at admission (aHR: 2.2 [95% CI: 1.3-3.5]) and higher peak CRP levels and acute kidney failure (aHR: 2.0 [1.2-3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 [0.3-0.8]). CONCLUSION: No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.

Minimal change disease (MCD) after Moderna COVID-19 vaccination

Background: Post vaccination minimal change disease with nephrotic syndrome and acute kidney injury has been reported after influenza and Pfizer-BioNTech vaccine. Further research is needed to prove a correlation. Methods: Clinical case, renal biopsy, dialysis Results: We present a case of a 65 years old patient, who developed minimal change disease 8 days following first injection with Moderna COVID-19 vaccine. In his medical history the patient has collagenous colitis and was on treatment with budenofalk. He presented with full blown nephrotic syndrome and developed dialysis dependent acute kidney injury for two weeks. Renal biopsy showed minimal change disease with 90% loss of podocyte processes in electron microscopy. Two weeks of dialysis and immunosupressive therapy over three months after the event lead to recovery of renal function to baseline. The patient received the second COVID-19 vaccination without developing complications or relapse. Conclusions: We present one of the first patients with minimal change disease after Moderna COVID-19 vaccine. There was an association between the timing of the vaccination and clinical manifestation of ne-phrotic syndrome. A definite causal relation still needs to be elucidated. A possible pathomechanism would be, that mRNA vaccines initiate T-cell mediated injury. However further studies are needed to find the im-munological mechanism of action after COVID-19 vaccination. Out of many millions of mRNA vaccines administered so far, to our knowledge, 7 cases of de novo minimal change disease have been described as well as up to 17 other glomerular diseases de novo and relapsing after COVID-19 vaccination.

Performance of Pharmacy Students in a Communications Course Delivered Online During the COVID-19 Pandemic

Objective. To examine pharmacy student readiness, reception, and performance in a communications course during the COVID-19 pandemic and to compare that with the performance of students who completed the same course in person the previous year. Methods. First-year Doctor of Pharmacy students (2020 cohort) enrolled in a professional communications course completed pre- and post-course surveys regarding their readiness for and changes in perception of online learning. Student learning was assessed using midterm and final examination grades. These grades were then compared with those of students who had completed the same course in person (on campus) the previous year (2019 cohort). Results. Students' preference for face-to-face instruction decreased from the pre-course to the postcourse survey as indicated by responses made using a five-point Likert-scale (difference in means = -1.59;p < .05). Their comfort level with online learning increased (difference in means = +0.38, p < .05) by the end of the course. Students did not perceive any appreciable changes in rapport with the instructor by the end of the study. Course performance of students in the online cohort did not differ significantly from that of the 2019 cohort (p> .05). Conclusion. This study demonstrated that first year PharmD students were already somewhat prepared for online learning when they began a communication course, with further adjustment occurring as the quarter progressed. Remote online learning did not seem to impact pharmacy student learning in this communications course conducted during the COVID-19 crisis.

Transforming Education: Upskilling for a Cloudy Tomorrow

Cloud computing deployment and demand has increased year over year during the prior decade and has only accelerated during the COVID-19 pandemic. The rapid increase in cloud technology has also increased the need for higher education institutions to train students and re-skill or up-skill working professionals. This paper discusses the application of high impact training methodologies and their impact on student learning. © 2021 ACM.

How could the Covid-19 pandemic change our practices in the management of diabetes?

The Covid-19 pandemic has caused a major health crisis in France for about 1 year, forcing patients and healthcar professionals to change their approach to chronic disease Diabetes, which was quickly considered to be a medical situation at risk of a severe form of SARS-CoV-2 infection has therefore been the subject of very particular attention both in the daily glycemic monitoring and in the different car options (hospitalization, outpatient consultations), leading to a reorganization of care as profound as it is sudden. Ii this context, the reorganization of the diabetology unit and that of the outpatient diabetological consultation have benefited from the development of telemedicine solution currently available (teleconsultation, telemonitoring) in order to maintain good quality diabetes care. This unprecedented situation has opened up many prospects for improving the care of diabetic patients, even in the absence of any major public health crisis.

Potential risks of a widespread use of 3D printing for the manufacturing of face masks during the severe acute respiratory syndrome coronavirus 2 pandemic

Background: In 2020, the severe acute respiratory syndrome coronavirus 2 pandemic caused serious concerns about the availability of face masks. This paper studies the technical feasibility of user-specific face mask production by 3D printing and the effectiveness of these masks. Material & methods: Six different face mask designs were produced by 3D printing and tested by subjective experimenter evaluation and using a respirator fit testing kit. Results were compared with the requirements as given for standard protective face masks. Results: None of the printed masks came anywhere near the required standards for personal protective gear. Conclusion: In spite of their euphoric presentation in the press, none of the currently advertised 3D printed mask designs are suitable as reliable personal protective equipment.

Telemedicine for diabetes management during the COVID-19 pandemic: An observational prospective study

The COVID-19 pandemic has compelled the French government to impose confinement measures to stem the spread of the coronavirus. These measures may have had a potential impact on the glycemic control of diabetic patients. Within this context, telemedicine appears to be a viable option for follow-up appointments of diabetic patients. To assess this theory, we simultaneously led a prospective observational study during the novel coronavirus pandemic at Strasbourg's teaching hospital and at a private medical office to evaluate glycemic control in 491 diabetic patients either attending a telehealth appointment (n = 338) or whom in-person consultation had been postponed by 6 months (n = 153). Surveys were collected to assess both the patients’ and the physicians’ satisfaction. A decrease in average glycated hemoglobin (HbA1c) was observed among patients from the telehealth appointment group: ΔHbA1c = −0.33% (n = 175) as well as the other group: ΔHbA1c = −0.13% (n = 92) 3 months after the beginning of the study. Patients belonging to the telehealth appointment group at Strasbourg's teaching hospital (n = 97) experienced a decrease in their HbA1c average from 7.65 ± 1.19% to 7.18 ± 0.9%, while patients from the same group attending a private medical office (n = 78) also experienced a decrease from 7.28 ± 0.80% to 7.11 ± 0.79%. Ninety-two percent of patients were satisfied with the telehealth appointment, think it could be a virtual alternative to in-person consultation and would recommend it to other diabetic patients. Even though seven out of eight diabetologists had never offered telehealth appointments to their patients prior to the COVID-19 pandemic, all of them hope to provide such services to their patients once the health crisis is over. The tendency towards a decrease in HbA1c levels within our cohort should be qualified due to missing data caused by the disruption in data collection during the COVID-19 pandemic. Evaluation and assessment of the cohort's glycemic control 6 months after the beginning of the study could help confirm these results.