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American Journal of Hospice & Palliative Medicine ; : 10499091231152610, 2023.
Article in English | MEDLINE | ID: covidwho-2195041

ABSTRACT

Background: Palliative care programs have played a significant role during the COVID-19 pandemic. However, the financial impact of the pandemic and operational challenges for palliative care programs have raised concerns for their future viability. Objectives: To explore palliative care program leaders' perceptions of the future viability of their programs in the context of the pandemic and inform future educational and program development.

2.
Journal of Interferon & Cytokine Research ; 29:29, 2022.
Article in English | MEDLINE | ID: covidwho-2134720

ABSTRACT

Maladjusted immune responses to the coronavirus disease 2019 (COVID-19), for example, cytokine release syndrome, may result in immunopathology and acute respiratory distress syndrome. Sphingosine-1-phosphate (S1P), a bioactive lipid mediator, and its S1P receptor (S1PR) are crucial in maintaining endothelial cell chemotaxis and barrier integrity. Apart from the S1P1 receptor-mediated mechanisms of sequestration of cytotoxic lymphocytes, including Th-17 and S1P1/2/3-mediated endothelial barrier functions, S1PR modulators may also attenuate cytokine release via activation of serine/threonine protein phosphatase 2A and enhance the pulmonary endothelial barrier via the c-Abl tyrosine kinase pathway. Chronic treatment with fingolimod (S1PR1,3,4,5 modulator) and siponimod (S1PR1,5 modulator) has demonstrated efficacy in reducing inflammatory disease activity and slowing down disease progression in multiple sclerosis. The decision to selectively suppress the immunity of a critically ill patient with COVID-19 remains a difficult choice. It has been suggested that treatment with fingolimod or siponimod may be appropriate to attenuate severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-induced hyperinflammation in patients with COVID-19 since these patients are already monitored in an intensive care setting. Here, we review the use of S1PR modulators, fingolimod and siponimod, in regulating the inflammatory response to SARS-CoV-2 with the aim of understanding their potential rationale use in patients with COVID-19.

3.
Consultant ; 60(11):3-13, 2020.
Article in English | EMBASE | ID: covidwho-1370004

ABSTRACT

Multiple chronic medical conditions are common to patients served by the community mental health (CMH) system. Medical diseases are present in at least 50% of all patients with psychiatric conditions, and severe mental disorders are associated with significant physical comorbidity and mortality. Early data show that individuals with preexisting multiple chronic conditions have a higher mortality risk when they are symptomatic with COVID-19. Although mitigation guidelines and recommendations are constantly being reviewed and updated, we found no specific recommendations targeting the vulnerable population who use CMH systems or the publicly funded and managed behavioral health entities which serve them. We reviewed the Centers for Disease Control and Prevention guidelines regarding infection control in health care facilities that provide ambulatory care, including behavioral health clinics, as well as reviewed recent population outcomes data. We posit that the population served by the CMH systems is a higher-risk cohort than the general population and offer recommendations for effective infection prevention strategies specific to this population.

4.
Revue Medicale Suisse ; 16(692):930-932, 2020.
Article in French | EMBASE | ID: covidwho-668253
5.
European Journal of Neurology ; 27:1306, 2020.
Article in English | EMBASE | ID: covidwho-710401

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is a viral infection caused by a newly emergent coronavirus, SARS-CoV-2, primarily affecting the respiratory tract. Maladjusted immune responses, e.g. cytokine release syndrome, may result in immunopathology and acute respiratory distress syndrome (ARDS). Sphingosine-1-phosphate (S1P), a bioactive lipid mediator, is crucial in maintaining endothelial cell chemotaxis and barrier integrity (Table 1). An industry- independent clinical study is currently underway in China investigating the efficacy of oral fingolimod 0.5 mg (a non selective S1P receptor modulator) taken once-daily, for three consecutive days in patients with COVID-19. Methods: Here we review the potential mechanisms by which fingolimod may regulate the inflammatory response to SARS-CoV-2 and assess the potential benefit-risk of short-term treatment with fingolimod in patients with COVID- 19 experiencing ARDS. Results: The key hypotheses through which beneficial effects manifest are (1) attenuation of cytokine release via activation of serine/threonine protein phosphatase 2A (PP2A);(2) inhibition of Th17-mediated pathway;and (3) enhancement of the pulmonary endothelial barrier via c-Abl tyrosine kinase pathway (Table 2). The short-term intervention with fingolimod might rapidly attenuate maladjusted immune responses while sparing memory immune responses and thus has relatively low risk of infections. Any potential effects on heart rate and cardiac rhythm could be managed under the intensive care treatment setting. Furthermore, simulations from a PKPD model of lymphocyte count data with short-term fingolimod treatment will be presented. Conclusions: S1P receptor modulators, such as fingolimod, may represent a potential treatment option to ameliorate immune responses against SARS-CoV-2 and merit further investigation following careful benefit-risk evaluation in this setting. (Table Presented) .

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