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This paper analyses how migrant community practices of transnational lived citizenship were altered by both, COVID-19 and the policy response from the Kenyan government. It is based on interviews with members of the Eritrean and Ethiopian diaspora residing in Nairobi. The paper demonstrates how policies introduced because of the pandemic caused migrant communities to lose local and remittance income. More than the loss of material resources, however, they were impacted by the elimination of social spaces that enable diaspora lives. These two dynamics have intensified a trend that may have been present before the pandemic, a local turn of transnational lived citizenship. By focusing on lived experiences and how they have been re-assessed during the pandemic, the paper argues that transnational lived citizenship is always in flux and can easily become reconfigured as more localized practices. The concept of transnational lived citizenship is demonstrated to be a useful lens for analysing shifting migrant livelihoods and belonging. © 2022 The Authors. Global Networks published by Global Networks Partnership and John Wiley & Sons Ltd.
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Background: Long-term survival of kidney allografts is limited by either inadequately controlled rejection and/or by side effects of long-term immunosuppression (drug toxicity, infections and neoplasia). Induction of donor-specific tolerance would resolve most, if not all of these limitations. Here, we report on 6 patients included in the first European trial of combined kidney and hematopoietic stem cell transplantation (HSCT;swisstolerance. CH). Methods or Case description: Six patients (3 female / 3 male) underwent combined kidney and hematopoietic stem cell transplantation from their HLA-identical living siblings between 2016 and 2022. Conditioning therapy for HSCT and immunosuppression was performed according to the Stanford protocol including total lymphoid irradiation, anti-thymocyte globulin followed by corticosteroids (3 days), mycophenolate (1 months) and cyclosporine for 6-15 months. After 9-15 months all immunosuppression was withdrawn. Results or Learning points: Five out of six patients were completely withdrawn from all immunosuppression (follow-up between 6 years and 4 months). No rejection or graft-versus-host disease episodes and no relevant infections occurred. Initial donor chimerism was seen in all patients. However, in 5/6 patients the chimerism level was declining, whereas one patient remained a stable mixed chimera. Specificity of tolerance was tested by molecular microscope analysis (absence of rejection signature) and by successful SARS CoV2 vaccination in some of the patients. One patient experienced a relapse of her primary glomerulonephritis in the allograft. She developed proteinuria, but renal function remained normal so far. Conclusion(s): Combined HSCT and kidney transplantation from the same living donor provides tolerance to a kidney allograft. This tolerance is donor-specific, as shown by protective immune responses against a SARS-CoV2-specific vaccine and absence of "molecular rejection".
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Background: Since January 2021, the two in Switzerland approved severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines tozinameran (Pfizer/Biontech) and elasomeran (Moderna) have been used to vaccinate the Swiss population. These vaccines were found to be safe in licensing trials with excellent efficacy of 95% and 94% in terms of preventing COVID-19 illness 14 days after the second vaccination. However, randomized evidence on the comparative effectiveness of both vaccines in immunocompromised patients is currently lacking. Methods: We conducted a parallel, two-arm (allocation 1:1) open-label, non-inferiority randomized clinical trial (RCT) nested into the Swiss HIV Cohort Study (SHCS) and the Swiss Transplant Cohort Study (STCS). Patients living with HIV and solid organ transplant recipients (i.e. lung and kidney) from these cohorts were randomized to receive either tozinameran or elasomeran. The primary endpoint was an antibody response to SARS-CoV-2 spike (S1) protein receptor binding domain using Elecsys® Anti-SARS-CoV-2 S assay from Roche (binary, cut-off ≥0.8 Units/ml) 12 weeks after first vaccination (8 weeks after second vaccination). Secondary outcomes were immune response measured with the Antibody CORonavirus Assay (ABCORA), clinical and safety outcomes. Results: A total of 430 patients were randomized and 412 were included in the intention-to-treat analysis (341 HIV patients and 71 solid organ transplant recipients). Antibody response was for elasomeran 92.1% (95% CI 88.4-95.8%;186/202) and for tozinameran 94.3% (95% CI 91.2-97.4%;198/210;difference:-2.2%;95% CI-7.1-2.7%), fulfilling non-inferiority of elasomeran. Overall, neutralization activity to SARS-CoV-2 Wuhan HU-1 strain was estimated to 96.5% (95% CI 94.5-98.4%) in HIV patients and 21.1% (95% CI 11.6-30.6%) in solid organ transplant recipients. 5 SARS-CoV-2 infections occurred (3 elasomeran;2 tozinameran) and 18 serious adverse event occurred (9 elasomeran;9 tozinameran). Conclusion: In immunocompromised patients the antibody response of elasomeran was comparable to tozinameran. People living with HIV had in general a sufficient immune response while a high proportion of transplant recipients had no immune response. Nearly 80% of patients with solid organ transplant have not developed neutralizing activity and need booster vaccination.
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This article focuses on the everyday humanitarianism of migrant communities in three cities in the Horn of Africa: Nairobi, Addis Ababa, and Khartoum. It is framed around the concept of lived citizenship, defined as a means to secure wellbeing through everyday acts and practices. Based on an analysis of comparative interview data among Eritrean and Ethiopian migrant communities in each city, the article argues that the Covid-19 pandemic has impacted lived citizenship practices to different degrees, linked to previous forms of precarity, and the means and networks of coping with those. Disruptions of transnational support networks resulted in a turn towards local networks and everyday practices of solidarity. These forms of everyday humanitarianism range from spontaneous to more organised forms, united by a perceived lack of involvement by international humanitarian actors and the local state. The article raises important questions in relation to transnational humanitarian action in a global crisis.
ABSTRACT
Antiparkinsonian activity of amantadine was first described in 1969 and was confirmed by several trials in later years. The improvement of parkinsonian symptoms is mild. However, in patients with motor fluctuations a clear reduction of dyskinesia and akinetic crisis could be observed. A possible neuroprotective impact is still under discussion, but lacking evidence. Moreover, amantadine is efficient in the treatment of disorders of vigilance, chronic fatigue (e. g. multiple sclerosis), tardive dykinesia and neurolepticas induced extrapyramidal motor symptoms. The clinical efficacy is caused by manifold mechanism of action. Initially, enhancement of dopaminergic transmission has been observed after amantadine and considered main mechanism of action. Currently, several direct targets are likely such as: (1) aromatic aminoacid decarboxylase, (2) Sigma-1 receptors, (3) nicotinergic receptors, (4) phosphodiesterase, (5) GDNF (glial-cell-derived neurotrophic factor). Dose dependently, there are also other probable targets like NMDA antagonism, serotoninergic-5-HT3 antagonism and potassium channel blockade. Preclinical data suggest an association of both neuroprotective potential and antidyskinetic properties with the antiglutamatergic activity of amantadine. Since the COVID- 19 pandemic, the antiviral efficacy of amantadine generated increasing interest. Several in vitro studies detected inhibition of SARS-CoV-2 virus. These results could support clinical renaissance of this drug in the coming years. © 2021 Wissenschaftliche Verlagsgesellschaft mbH. All rights reserved.
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Background: Induction of immunological tolerance has been the holy grail of transplantation immunology for decades. The only successful approach in the clinical situation has been a combined kidney and hemato-poietic stem cell transplantation from the same living donor. Here, we report the first three patients included in this first European trial to induce tolerance by mixed lymphohematopoietic chimerism. Methods: The protocol followed previous studies at Stanford University: kidney transplantation was performed on day 0 including induction with anti-thymocyte globulin followed by conditioning with 10x1.2 Gy total lymphoid irradiation and the transfusion of CD34+ stem cells together with a body weight-adjusted dose of donor T cells. Immunosuppression consisted of cyclosporin and steroids for 10 days, cyclosporin and mycofenolate mofetil for 1 month, and then cyclosporin monotherapy with tapering over 9-20 months. Results: Two female and one male patients were transplanted with a kidney and peripherally mobilized hematopoietic stem cells from their HLA-identical sibling donor. No rejection or graft-versus-host disease occurred in these patients, which are currently off immunosuppression since 31, 18 and 6 months. Chimerism was stable in the first, but slowly declining in the other two patients. A molecular microscope analysis in patient 2 revealed the genetic profile of a normal kidney. No relevant infections were observed, and the quality of life in all three patients is excellent. During the SARS-CoV2 pandemic, all three patients were vaccinated with the mRNA vaccine, and they showed excellent humoral and cellular SARS-CoV2-specific immunity. Conclusions: Combined kidney and hematopoietic stem cell transplantation is a feasible and successful approach to induce specific immuno-logical tolerance in the setting of HLA-matched living kidney donation while maintaining immune responsiveness to a viral vaccine.
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Objective: Hemorrhage and thrombotic events are common issues during extracorporeal membrane oxygenation (ECMO). Furthermore, severe COVID-19 infection is frequently associated with coagulopathy, leading to lung embolism and influencing ECMO oxygenator functionality. Therefore, providing ECMO therapy in those patients might be challenging. We aimed to identify differences in coagulation parameters between patients with COVID-19 and non- COVID-19 viral pneumonia on venovenous (VV) ECMO. Methods: A retrospective single-center study on patients supported with VV ECMO for acute respiratory failure associated with COVID-19 or non-COVID-19 viral pneumonia was performed. Coagulation parameters at different time points were analyzed. Results: Between January 2018 and December 2020, 68 patients, including 31 with COVID-19 pneumonia and 37 with non-COVID-19 viral pneumonia, were eligible for the analysis. Activated partial thromboplastin time (aPTT) on day one and international normalized ratio (INR) on day one and five were significantly lower in the COVID-19 group. At all respective time points, COVID-19 patients showed higher levels of platelets and fibrinogen. In contrast, non-COVID-19 patients had greater d-dimer levels on day five. Additionally, significant differences in factor VIII and XIII activity levels were observed (Figure 1). ECMO weaning rate did not differ significantly between the groups. Conclusions: Coagulation parameters before and during the first days of ECMO for acute respiratory failure differed significantly between patients with COVID-19 and non-COVID-19 viral pneumonia. Monitoring coagulation parameters in order to prevent hemostatic complications will play a crucial role in COVID-19 patients and especially anticoagulation management will be of particular importance and should therefore be further investigated in future studies.