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Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003480


Background: Global Health Partnerships (GHPs) represent collaborative efforts towards training, research, and capacity building. Virtual GHP initiatives (VGHPIs) evolved to ensure GHP continuity during the COVID-19 pandemic, however, the current VGHPI landscape is unknown. This study aimed to increase understanding of the existing GHPs' perspectives on VGHPIs to inform future approaches for re-organization and reprioritization of GH activities. Methods: From 15 October to 30 November 2020, authors conducted an online, international survey using snowball sampling to assess pandemic-related changes in activities and document perceived acceptability and barriers to VGHPIs. Analysis stratified responses by country income classification and GHP type. The authors described categorical and continuous data using descriptive statistics. Chisquare tests were used to analyze categorical variables, with alpha set at 0.05. Results: A total of 128 respondents described 219 GHPs, with 82/128 (64%) responding to >1 GHP. Most GHPs (152/219, 69%) were transnational, of >5 years duration (157/219, 72%) and with bidirectional site visits (127/219, 60%);with HIC partners sending significantly more learners to LMIC partner sites (P = 0.0098). Within GHPs, respondents reported the pandemic was a significant disruptor to communication (122/219, 56%), funding (71/219, 32%), activities (195/219, 89%), and access to professional support (73/219, 33%). While 84/219 (38%) of GHPs described VGHPIs prior to the pandemic, respondents indicated that VGHPIs would be important to the majority (206/219, 94%) of GHPs moving forward. Available resources for VGHPIs were significantly different between LMIC and HIC respondents, as were their preference for VGHPIs, technological capacity, and acceptability of VGHPIs (P < 0.0001). There was no significant difference between groups regarding VGHPIs' perceived barriers. Conclusion: The pandemic disrupted many essential GHP elements, compounding on differences in the resources and preferences for VGHPIs between LMIC and HIC. VGHPIs have the potential to bridge existing gaps and maximize gains, bi-directionality, and equity of GHPs during and after COVID-19.

Mult Scler J Exp Transl Clin ; 8(1): 20552173221078834, 2022.
Article in English | MEDLINE | ID: covidwho-1736272


BACKGROUND: Susac Syndrome (SuS) is an autoimmune endotheliopathy impacting the brain, retina and cochlea that can clinically mimic multiple sclerosis (MS). OBJECTIVE: To evaluate non-lesional white matter demyelination changes in SuS compared to MS and healthy controls (HC) using quantitative MRI. METHODS: 3T MRI including myelin water imaging and diffusion basis spectrum imaging were acquired for 7 SuS, 10 MS and 10 HC participants. Non-lesional white matter was analyzed in the corpus callosum (CC) and normal appearing white matter (NAWM). Groups were compared using ANCOVA with Tukey correction. RESULTS: SuS CC myelin water fraction (mean 0.092) was lower than MS(0.11, p = 0.01) and HC(0.11, p = 0.04). Another myelin marker, radial diffusivity, was increased in SuS CC(0.27µm2/ms) compared to HC(0.21µm2/ms, p = 0.008) and MS(0.23µm2/ms, p = 0.05). Fractional anisotropy was lower in SuS CC(0.82) than HC(0.86, p = 0.04). Fiber fraction (reflecting axons) did not differ from HC or MS. In NAWM, radial diffusivity and apparent diffusion coefficient were significantly increased in SuS compared to HC(p < 0.001 for both measures) and MS(p = 0.003, p < 0.001 respectively). CONCLUSIONS: Our results provided evidence of myelin damage in SuS, particularly in the CC, and more extensive microstructural injury in NAWM, supporting the hypothesis that there are widespread microstructural changes in SuS syndrome including diffuse demyelination.

Multiple Sclerosis Journal ; 26(3 SUPPL):555, 2020.
Article in English | EMBASE | ID: covidwho-1067121


Background: Neurological disability progression occurs across the spectrum of people living with multiple sclerosis (PwMS). Currently, no treatments exist that substantially modify the course of clinical progression in MS, one of the greatest unmet needs in clinical practice. Characterizing the determinants of clinical progression is essential for the development of novel therapeutic agents and treatment approaches that target progression in PwMS. Objectives: The overarching aim of CanProCo is to evaluate a wide spectrum of factors associated with the onset and rate of disease progression in MS, and to describe how these factors interact with one another to influence progression. Methods: CanProCo is a prospective, observational cohort study aiming to recruit 1000 individuals with radiologically-isolated syndrome (RIS), relapsing-remitting MS (RRMS), and primary-progressive MS (PPMS) within 10-15 years of disease onset, and 50 healthy controls (HCs) from five large academic MS centers in Canada. Participants undergo detailed clinical evaluations annually. A subset of participants enrolled within 5-10 years of disease onset (n=500) also have blood, cerebrospinal fluid, and MRIs collected facilitating study of biological measures (e.g. single-cell RNAsequencing[ scRNASeq]), MRI-based microstructural assessment, participant characteristics (self-reported, performance-based, clinician- assessed, health-system based), and environmental factors as determinants contributing to the differential progression in MS. Results: Recruitment commenced in April/May 2019 and n=536 patients have been recruited to date (RRMS=457, PPMS=35, RIS=25, HC=19). Baseline age, sex distribution, and Expanded Disability Status Scale (EDSS) scores (median, range) of each subgroup are: RRMS=38 years, 73% female, EDSS=1.5 (0-6.0);PPMS=52 years, 40% female, EDSS=4.0 (1.5-6.5);RIS=41 years, 68% female, EDSS=0 (0-3.0);HC=37 years, 63% female. Recruitment has surpassed the 50% target but has been paused due to the COVID-19 pandemic. scRNASeq on frozen blood samples has been validated. Conclusions: Halting the progression of MS is a fundamental clinical need to improve the lives of PwMS. Achieving this requires leveraging transdisciplinary approaches to better characterize mechanisms underlying clinical progression. CanProCo is the first prospective cohort study aiming to characterize these determinants to inform the development and implementation of efficacious and effective interventions.