Immune response against SARS-CoV-2 vaccines in treatment-naive multiple sclerosis patients

Introduciton: Multiple Sclerosis (MS) is an autoimmune disease with B-cell dysregulation playing an essential role in pathogenesis. As B-cells are also responsible for antibody production, their disfunction could also affect the humoral immune response against SARS-CoV-2 vaccines. Aim(s): To compare the immune response after messenger RNA (mRNA) BNT162b2 (Pfizer/BioNTech) and inactivated Coronavac vaccines in newly diagnosed treatment-naive MS (tnMS) patients and healthy controls (HC). Method(s): A single-center cross-sectional study evaluating antibody response against SARS-CoV-2 vaccines (inactivated vs mRNA) in HC and newly diagnosed and treatment-naive MS patients. Serum samples were collected at least two weeks after the second dose of the vaccine. The cutoff level of seropositivity is >= 50 antibody unit (AU)/ml. Result(s): 46 participants had two doses of inactivated Coronavac (35 HC and 11 tnMS), and 103 (57 HC and 46 tnMS) had two doses of mRNA. There was no significant difference in antibody response between HC and tnMS in the inactivated vaccine group. In the mRNA group, the antibody titers were significantly higher in HC (p=0.009), though no difference in the seropositivity rates was observed. Conclusion(s): Although MS is an autoimmune inflammatory disease, it does not affect immunity against the SARS-CoV-2 vaccine in treatment-naive patients.

COVID-19 antibody response after two doses of SARSCoV- 2 vaccines in multiple sclerosis patients' an update to the previous study

Introduction: Disease-modifying therapy (DMT) may decrease the immune response to COVID-19 vaccines, and the antibody response against SARS- CoV-2 is still not fully explored in people with multiple sclerosis(pwMS). Aim(s): To evaluate the immune response after messenger RNA (mRNA) BNT162b2 (Pfizer/BioNTech) and inactivated Coronavac vaccines in pwMS treated with a DMT compared to healthy controls(HC). Method(s): Patients who came to our MS unit for treatment or routine control were included in the study. Serum samples were collected at least two weeks after the second dose of the vaccine. The cutoff level or seropositivity is >= 50 antibody units (AU)/ml. The antibody titers were compared between HC and each treatment group. Result(s): 815 pwMS treated with DMT, 90 untreated MS patients and 92 healthy controls were enrolled in this single-center crosssectional study. In total, 500 (50.2%) participants received two doses of inactivated Coronavac, and 497(49.8%) received two doses of BNT162b2. In HC group, only one patient who had mRNA vaccine was seronegative. All patients on cladribine (n =14, 100%)and azathioprine (n=5) treatment have seropositive results in both vaccine types. Among treatment groups, fingolimod and ocrelizumab were associated with lower antibody titers (p<0.005). Only in fingolimod group, seropositivity rate was higher for mRNA vaccine compared to inactivated vaccine. The SARS CoV-2 antibody titer was significantly associated with mRNA vaccine [beta= 0.739 (0.067) 95%CI= 0.607;-0.870 p<0.001], EDSS [beta= -0.061 (0.024) 95%CI= -0.108;-0.013 p<0.012], time between second vaccine dose and sample collection dates [beta=-0.002 (0.001) 95%CI= -0.003;-0.001 p<0.001] and relapsing MS type [beta= -0.395 (0.136) 95%CI= -0.662;-0.127 p<0.004] Conclusion(s): Fingolimod and ocrelizumab therapy are associated with decreased immunity after SARS CoV2 vaccines. mRNA type of vaccine is the preferable choice in pwMS.

Antibody response after a booster dose of SARS-CoV2 vaccines in multiple sclerosis

Introduction/Objectives: Immunity after two doses of inactivated and messenger RNA(mRNA) SARS-CoV 2 vaccines in Multiple Sclerosis (MS) is influenced by the Disease-Modifying Therapy (DMT) and vaccine type used. Being lower in fingolimod, ocrelizumab, and inactivated vaccine groups. A booster dose could change this discrepancy. Aim(s): To compare the immunogenicity of a booster dose of mRNA BNT162b2 (Pfizer/BioNTech) versus inactivated vaccine, performed after completing two doses of inactivated Coronavac in people with MS (pwMS). Method(s): pwMS and Healthy Controls (HC) who received a booster dose of SARS-CoV 2 mRNA or inactivated vaccine after completing two doses of inactivated Coronovac were enrolled in this single-center cross-sectional study. Serum samples were collected at least two weeks after the third dose of the vaccine. The antibody titers were compared between HC, MS, and each treatment group. Result(s): Each of 339 pwMS and 52 HC received three doses of SARS-CoV-2 vaccines. 283 (72,3%) participants received a booster dose of mRNA, and 108 (27,7%) participants received a booster dose of inactivated Coronavac. In all comparisons, patients treated with ocrelizumab had the lowest antibody titer (p<0.005). In the fingolimod group, booster mRNA caused a higher antibody titer than the inactivated vaccine. In total, pwMS had a lower antibody titer than HC regardless of the vaccine type. In regression analyses having a booster mRNA [beta= -0.671 (0.133) 95%CI= -0.933 - -0.409, p<0.001] and lower disease duration [beta-0.019 (0.010)95%CI= -0.038 - 0.000, p=0.44] were two markers which significantly associated with higher antibody titer in pwMS. Conclusion(s): The study shows that a third dose vaccine is an effective strategy to boost antibody response in the MS population, and the mRNA SARS CoV-2 vaccine's booster is preferable to inactivated ones.

Compressing urban living in the dwelling: pandemic living praxis

Purpose This paper aims to understand how the residents have utilized domestic spaces and furniture during three months' lockdown time for the Covid-19 virus spread measures and to explore how domestic living practices were adjusted which had been the daily urban activities previously. Design/methodology/approach The research method is a qualitative interpretivist philosophical approach with a quantitative data collection. Short questionnaires were conducted via e-mails with attached links via SurveyMonkey. The sample was the group of people who had been in active urban life before the pandemic and had been actively working at the office spaces. Findings Separate learning/working spaces were urged at home, at least for the set intervals in the daytime. Production in the kitchen also acted as an interactive production and entertainment. Balconies and terraces were re-discovered and acted as "urban-substitute open spaces". The living room became the new venue for domestic interaction especially during working-learning breaks, for watching movies, personal care or reading sessions. Computers, tablets and smartphones became the urban activity base due to online meeting applications for social reasons, online shopping, working and learning. The separation of domains at home became essential. Research limitations/implications The study only focuses domestic uses of white-collar workers;during the lock-down period, Covid-19 pandemic. Sampling constraints are the employees who were active urban life before the pandemic and working at the office space. Sharing the house at least with one other roommate, sibling or spouse with or without children. Individuals who had not been working outside the home before the pandemic, people aged over 65, retired, permanent home workers, housewives, freelancers and other such demographic structures are excluded from the study. Social implications Due to the COVID-19 pandemic, the first wave lockdown began between early March-June 2020, and millions of people were confined to the dwellings. "Staying home" stood for working-learning-shopping-interacting online, more production in the kitchen, using the living room as a domestic multi-functional venue, spending time on the terraces and balconies as domestic open spaces. The active living in the urban context dramatically shifted to "at-home living". Originality/value The study only focuses on the three months' interval in which strict rules for staying home were enforced in Istanbul, Turkey. Schemas, charts and tables are generated concerning the input. The study challenges the making meaning via praxis of "to dwell" and urban living. Nevertheless, the main questions of housing such as production, social aspects, shared spaces, interaction are re-configured and the substitute urban space is created at home.

Medical education in epidemic and disaster situations

There is no standard practice for the sustainability of medical education in epidemics such as Covid-19 and disasters affecting society. Synchronous or asynchronous trainings have been carried out in some of universities and colleges that have distance education technical infrastructure, during the Covid-19 pandemic. If every student has access to information technologies and the skills of the instructors who will prepare and deliver the training increase their ability to use information technologies, there is no problem in the implementation and maintenance of theoretical lessons. During the Covid-19 pandemic, we had to go to distance education, which we had not yet implemented at Bezmialem Vakif University Faculty of Medicine. During this period, we applied asynchronous and synchronous education models (mixed model) for theoretical lessons. However, the fact that practical and internship applications were carried out by distance education - although videos about skills and practices were shot and uploaded to the system - it was not possible to replace the formal education. Distance education is inevitable for the continuity of education in epidemic and disaster situations. However, after the epidemic and disaster situations have passed, practical and internship practices should be carried out as much as possible in addition to distance education in medical education. In normal times, distance education can only be used to support formal education in medical education. As a result of all these evaluations and experiences we gained in the Covid 19 pandemic, we think that synchronous/synchronous distance education applications will improve over time and contribute to medical education.