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1.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333683

ABSTRACT

Pregnant women appear to be at increased risk for severe outcomes associated with COVID-19, but the pathophysiology underlying this increased morbidity and its potential impact on the developing fetus is not well understood. In this study of pregnant women with and without COVID-19, we assessed viral and immune dynamics at the placenta during maternal SARS-CoV-2 infection. Amongst uninfected women, ACE2 was detected by immunohistochemistry in syncytiotrophoblast cells of the normal placenta during early pregnancy but was rarely seen in healthy placentas at full term. Term placentas from women infected with SARS-CoV-2, however, displayed a significant increase in ACE2 levels. Using immortalized cell lines and primary isolated placental cells, we determined the vulnerability of various placental cell types to direct infection by SARS-CoV-2 in vitro . Yet, despite the susceptibility of placental cells to SARS-CoV-2 infection, viral RNA was detected in the placentas of only a subset (~13%) of women in this cohort. Through single cell transcriptomic analyses, we found that the maternal-fetal interface of SARS-CoV-2-infected women exhibited markers associated with pregnancy complications, such as preeclampsia, and robust immune responses, including increased activation of placental NK and T cells and increased expression of interferon-related genes. Overall, this study suggests that SARS-CoV-2 is associated with immune activation at the maternal-fetal interface even in the absence of detectable local viral invasion. While this likely represents a protective mechanism shielding the placenta from infection, inflammatory changes in the placenta may also contribute to poor pregnancy outcomes and thus warrant further investigation.

2.
Blood ; 138(SUPPL 1):3525, 2021.
Article in English | EMBASE | ID: covidwho-1770434

ABSTRACT

Background - The WINDOW-1 regimen introduced first-line ibrutinib with rituximab (IR) followed by 4 cycles of R-HCVAD for younger mantle cell lymphoma (MCL) patients (pts) demonstrating 90% CR on IR alone and we aimed to improve the CR rate with the addition of venetoclax. We therefore investigated the efficacy and safety of IR and venetoclax (IRV) followed by risk-stratified observation or short course R-HCVAD/MTX-ARA-C as consolidation in previously untreated young patients with mantle cell lymphoma (MCL). Our aim was to use a triplet chemotherapy-free induction to reduce the toxicity, complications and minimize chemotherapy exposure in MCL pts. Methods - We enrolled 50 previously untreated pts in this single institution, single arm, phase II clinical trial - NCT03710772. Pts received IR induction (Part-1) for initial 4 cycles. Pts were restaged at cycle 4 and received IRV for up to eight cycles (Cycle 5 to Cycle 12) starting with ramp up venetoclax dosing in Cycle 5. All pts who achieved CR prior to cycle 12 continued to receive IRV for 4 cycles (maximum 12 cycles) and then moved to part 2. Pts were stratified into three disease risk groups: high, moderate and low risk categories from the baseline data for assignment to R-HCVAD/MTX-ARA-C as consolidation in part 2 (4 cycles, 2 cycles, or no chemotherapy for high, medium and low risk pts respectively). Briefly, low risk pts were those with Ki-67 ≤30%, largest tumor mass <3 cm, low MIPI score and no features of high risk disease (Ki-67 ≥50%, mutations in the TP53, NSD2 or in NOTCH genes, complex karyotype or del17p, MYC positive, or largest tumor diameter >5 cm or blastoid/pleomorphic histology or if they remain in PR after 12 cycles of part 1. Medium risk are pts which did not belong to low or high-risk category. Those who experienced progression on part 1 went to part 2 and get 4 cycles of part 2. Patient were taken off protocol but not off study, if they remained in PR after 4 cycles of chemotherapy, these patients were followed up for time to next treatment and progression free survival on subsequent therapies. After part 2 consolidation, all pts received 2 years of IRV maintenance. The primary objective was to assess CR rates after IRV induction. Adverse events were coded as per CTCAE version 4. Molecular studies are being performed. Results - Among the 50 pts, the median age was 57 years (range - 35-65). There were 20 pts in high-risk group, 20 pts in intermediate-risk group and 10 pts in low-risk group. High Ki-67 (≥30%) in 18/50 (36%) pts. Eighteen (36%) had high and intermediate risk simplified MIPI scores. Six (12%) pts had aggressive MCL (blastoid/pleomorphic). Among the 24 TP53 evaluable pts, eight pts (33%) had TP53 aberrations (mutated and/or TP53 deletion by FISH). Forty-eight pts received IRV. Best response to IRV was 96% and CR of 92%. After part 2, the best ORR remained unaltered, 96% (92% CR and 4% PR). The median number of cycles of triplet IRV to reach best response was 8 cycles (range 2-12). Fifteen pts (30%) did not receive part 2 chemotherapy, two pts (4%) received 1 cycle, 16 pts (32%) 2 cycles and 13 pts (26%) got 4 cycles of chemotherapy. With a median follow up of 24 months, the median PFS and OS were not reached (2 year 92% and 90% respectively). The median PFS and OS was not reached and not significantly different in pts with high and low Ki-67% or with/without TP53 aberrations or among pts with low, medium or high-risk categories. The median PFS and OS was inferior in blastoid/pleomorphic MCL pts compared to classic MCL pts (p=0.01 and 0.03 respectively). Thirteen pts (26%) came off study - 5 for adverse events, 3 for on study deaths, and 2 for patient choice, 2 patients lost to follow up and one for disease progression. Overall, 5 pts died (3 on trial and 2 pts died off study, one due to progressive disease and another due to COVID pneumonia). Grade 3-4 toxicities on part 1 were 10% myelosuppression and 10% each with fatigue, myalgia and rashes and 3% mucositis. One pt developed grade 3 atrial flutter on part 1. None had grade 3-4 bleeding/bruising. Conclusions - Chemotherapy-free induction with IRV induced durable and deep responses in young MCL pts in the frontline setting. WINDOW-2 approach suggests that pts with low risk MCL do not need chemotherapy but further follow up is warranted. This combined modality treatment approach significantly improves outcomes of young MCL pts across all risk groups. Detailed molecular analyses will be reported. (Figure Presented).

3.
2021 ASEE Virtual Annual Conference, ASEE 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1695572

ABSTRACT

The current COVID-19 pandemic has forced many colleges and universities to remain on a completely online or remote educational learning environment for the 2020 Spring and Fall semesters, however there is a growing concern in STEM fields about how students will be able to achieve one of the major ABET learning outcomes without conducting physical, hands on laboratory exercises as many STEM disciplines are switching to virtual laboratory;an ability to develop and conduct appropriate experimentation, analyze and interpret data, and use engineering/scientific judgment to draw conclusions. In addition to the limited achievement of the ABET outcomes, roughly half of the population of a historically black university communicated their anxieties during the pandemic to the University President via Change.org. The students' main anxiety is portrayed in a statement culled from the petition as follows: “Most classes are very hands-on, and we are not able to do those from home because of the limited resources available at home”. This paper highlights the best practices for the implementation of home-based hands-on activities across multiple STEM fields. The paper further elaborates on the impact of remote and virtual labs on students' attitude, interest, and performance in STEM over the home-based hands-on experimentation. Home-based hands-on laboratory activities were performed in biology, electrical engineering, industrial engineering, transportation system, and civil engineering. The results of a Motivated Strategies for Learning Questionnaires (MLSQ) survey that was administered to about 100 STEM students revealed better gains in key constructs associated with student success, such as motivation, critical thinking, and metacognition. © American Society for Engineering Education, 2021

4.
Journal of Korean Academic Society of Nursing Education ; 27(4):359-368, 2021.
Article in Korean | Scopus | ID: covidwho-1627273

ABSTRACT

Purpose: The purpose of this study was to investigate the mediating effect of self-leadership on the relationship between media literacy and learning agility in nursing students based on their experiences in online classes during the Coronavirus Disease-19 pandemic. Methods: A descriptive survey was conducted among 165 nursing students from four universities in Busan. Data were collected from June 2 to 13, 2021, and was analyzed using a t-test, one-way ANOVA, Pearson's correlation coefficients, and stepwise multiple regression with SPSS/WIN 26.0. Results: Significant relationships were found between learning agility and media literacy (r=.62, p<.001), between learning agility and self-leadership (r=.58, p<.001), and between media literacy and self-leadership (r=.53, p<.001). Additionally, self-leadership had a partial mediating effect on the relationship between media literacy and learning agility (Z=4.30, p<.001);its explanatory power was 46.0%. Conclusion: These results indicate that interventions to increase the level of media literacy, along with self-leadership, are necessary to improve the level of learning agility of nursing students who will be essential human resources in a rapidly changing healthcare field. Copyright © 2021 Korean Academic Society of Nursing Education.

5.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407271
6.
Journal of Clinical Urology ; 14(1 SUPPL):26, 2021.
Article in English | EMBASE | ID: covidwho-1325315

ABSTRACT

Introduction: COVID-19 has had potential impact on presentation and outcome of patients to cancer services. The objective of this study was to analyse pandemic effects on patients with penile SCC by comparison with previous years within a stable 10 million population referral base. Patients and Methods: All patients referred to the penile supranetwork MDT (snMDT), 1st January 2020 to 31st December 2020 identified (COVID-19 Group A). Prospectively collated data from previous 3 years (2017- 19) referrals analysed to create a service year mean dataset (Non-COVID-19 Group B). Variables compared: (i) overall demographics, (ii) pathological stage (TNM 8), (iii) time from presentation to first treatment. Chi-squared test to evaluate the pathological stage (TNM 8) and Mann- Whitney U Test to assess time from presentation to first treatment. Results: Group A, 123 new referrals. Group B mean referrals 129 (118 - 147). Primary stage Group A, 45.4% pT1, 30.2% pT2, 24.4% pT3/pT4 vs Group B, 48.6% pT1, 38.2% pT2, 13.2% pT3/pT4 (p=0.01). Nodal stage pN0 Group A 62% vs 70% Group B, (NS p = 0.08). Median time (days) presentation to first treatment Group A, 22 (IQ 15 - 36) vs Group B, 26 (13 - 36.5). Conclusion: No. of referrals were statistically similar in COVID-19 and Non-COVID-19 years and managed within similar time frame. However, there was a statistically higher pT disease stage in the COVID-19 group but no significant difference in pN stage (although trend towards higher nodal stage). Data is not yet mature to determine an effect on cancer specific survival.

8.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277323

ABSTRACT

Rationale: Observational studies describe high sedative and analgesic medication (SA) requirements in patients with COVID-19 ARDS. High levels of SA have been shown to increase ICU length-of-stay, incidence of delirium, and mortality;all of which increase health system utilization. The aim of this study is to evaluate SA parameters in patients with COVID-19 ARDS undergoing tracheostomy. Methods: We enrolled 55 COVID-19 positive adult patients undergoing tracheostomy between 4/16/20 and 8/26/20. Cumulative dosage and sedation parameters, Richmond Agitation-Sedation Scale (RASS) scores, Glasgow Coma Scale (GCS) were collected in the 48-hour periods pre-and post-tracheostomy via chart review. Data analysis was performed with Microsoft Excel Analysis ToolPak. Results: Baseline characteristics include a mean age of 60.2, mean BMI of 30.2 kg/m2, 28 (51%) were male, and 39 (70.9%) of the tracheostomies were placed percutaneously. Fentanyl was used in 38 (69.1%), dexmedetomidine in 28 (50.9%), midazolam in 13 (23.6%), hydromorphone in 13 (23.6%), and propofol in 12 (21.8%) patients. •Total fentanyl dose (6940.3 mcg to 5382.2 mcg p=0.02) and total propofol dose (67066 mcg/kg to 24098 mcg/kg, p=0.02) were significantly lower post-tracheostomy compared to pre-tracheostomy (Figure 1). •There was a trend toward lower dexmedetomidine (27.7 mcg/kg to 27.4 mcg/kg, p=0.91), midazolam (183.4 mg to 133.8 mg, p=0.27), and hydromorphone (216.0 mg to 206.2 mg, p=0.72) total doses in the post-tracheostomy period. •Mean ordered RASS goals were similar in both groups (-1.1 to-0.9, p=0.12). Mean RASS deviations from goal were also similar in both groups (-0.3 vs-0.2, p=0.64). •Mean GCS values (8.4 to 9.1, p=0.007) were significantly higher in the post-tracheostomy group. Conclusions: In this retrospective cohort of COVID-19 ARDS patients undergoing tracheostomy, SA requirements were decreased in the post-tracheostomy period. Both fentanyl (22.4% reduction) and propofol (64.1% reduction) total doses were significantly lower post-tracheostomy. All other recorded SA trended toward reduction in the post-tracheostomy period but without statistical significance (Figure 1). Assessment of sedation scores showed that reduction in SA use were not associated with changes in ordered RASS goals or worse adherence to RASS goals, as these were similar in both groups. These findings suggest that the same RASS goal, and an increased GCS, may be equally obtained with less sedation in the post-tracheostomy period. We recognize the limitations of a retrospective, single-enter, cohort study. Early tracheostomy should be considered in appropriate patients to reduce SA administration and reduce health care utilization, particularly with ICU beds at a premium.

9.
Asia-Pacific Psychiatry ; 13(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1214770

ABSTRACT

Purpose: Coronavirus disease 2019 (COVID-19) pandemic sweeps across the world. Government policy to control the outbreak is to quarantine. The purpose of this study was to assess the psychological impacts of quarantine during COVID-19 outbreak. Materials and method: Self-report questionnaire was conducted from March 17, 2020, to April 20, 2020 including the outburst period in Daegu, Republic of Korea. Two-thousand and eighty subjects were participated. The online link was sent to the subjects who were now quarantined (NQ) or past-quarantined (PQ). The self-report questionnaire included patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), primary care post-traumatic stress disorder screen for diagnostic and statistical manual-5 (PTSD-PC), state- trait anger expression inventory (STAX-I), and P4 suicidality screener scale(P4). Results: Among 2080 subjects 52.5% (95% CI, 50.3%-54.7%) for PHQ-9, 44.5% (95% CI, 42.4%-46.7%) for GAD-7, 39.4% (95% CI, 37.3%-41.6%) for PTSD-PC, 31.6% (95% CI, 29.6%-33.6%) for STAX-I, and 10.9% (95% CI, 9.6%-12.3%) for P4 exceeded cutoff value. NQ group (n = 608, 29%) show more anger than PQ (n = 1472, 71%) (aORs, 1.417 [95% CI, 1.119-1.796]). Especially subjects who were quarantined for more than 28 days in NQ (n = 238, 39%) had high risk for symptoms of PHQ-9 (aORs, 1.428 [95% CI, 1.081-1.886]), GAD-7 (aORs, 1.326 [95% CI, 1.008-1.744]), PTSD-PC (aORs, 1.427 [95% CI, 1.083-1.879]), and STAX-I (aORs, 1.354 [95% CI, 1.017-1.802] than PQ . Conclusion: Our result suggest that quarantine have negative psychological effects such as depression, anxiety, post-traumatic stress disorder, anger. In particular NQ experiences more anger than PQ and the longer the period, the more depression, anxiety, PTSD, and anger. The result of this study will contribute to identify high risk individuals for mental health during quarantine.

10.
Asia-Pacific Psychiatry ; 13:1, 2021.
Article in English | Web of Science | ID: covidwho-1197917
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