"Covid couldn't get us down": pandemic impact on effective access to transgender hormone therapy in Cordoba, Argentina / "La covid no ha podido con nosotrxs": impacto de la pandemia en el acceso efectivo de personas trans a tratamientos hormonales integrales en Córdoba, Argentina

Resumen El objetivo de este trabajo fue indagar el impacto de la pandemia de la covid-19 en el acceso de personas trans a tratamientos hormonales en los servicios de salud pública de la provincia de Córdoba, Argentina. En los meses de junio/julio de 2020, se realizaron 16 entrevistas telefónicas a personas trans en proceso de hormonización y usuarias de servicios públicos de salud, a profesionales sanitarios de dispositivos específicos de atención a personas trans, integrantes de organizaciones sociales y de gestión. Se aplicó un análisis temático que identificó tres temas y subtemas: 1) Estar a la deriva en relación al tratamiento hormonal: Reestructuración de servicios de salud; Sentimientos de incertidumbre; 2) Lo necesito, el cuerpo lo pide: suministro de hormonas: Significados en torno al tratamiento; Estrategias y resistencias; 3) Oportunidad de visibilizar fallas estructurales: las hormonas como la punta del iceberg: Déficit en las políticas públicas: en pandemia desde hace muchos años; Exclusiones del CIStema de salud. Se concluyó que la pandemia acarreó un grave retroceso para los derechos de las personas trans. Sin embargo, se identificaron estrategias claves de acceso, vinculadas principalmente a las organizaciones y activistas trans y travestis.

Abstract The purpose of this research was to study the impact of covid-19 pandemic on transgender people's access to healthcare and hormone gender-affirming treatments in public healthcare services of the province of Córdoba, Argentina. Between June/July-2020, sixteen telephone interviews were conducted with people in gender-affirming hormone treatments in public healthcare services, professionals, members of social organizations and management. A thematic analysis was carried out, identifiying three themes and sub-themes: 1) Being adrift in relation to hormonal treatment: Restructuring of healthcare services; Feelings of uncertainty. 2) I need it, the body asks for it: supply of hormones: Meanings around treatment; Strategies and resistance. 3) Opportunity to make visible structural failures: hormones as the tip of the iceberg: Deficit in public policies: in a pandemic for many years; Exclusions from the CISHealthcare System. We conclude that the pandemic implied a serious setback for transgender people's rights. However, strategies were identified, mainly linked to transgender organizations and activists, which were key to access.

Framework-Hotspot Enhanced Trans Cleavage of CRISPR-Cas12a for Clinical Samples Detection.

The trans-cleavage property of CRISPR-Cas12a system makes it an excellent tool for disease diagnosis. Nevertheless, most methods based on CRISPR-Cas system still require pre-amplification of the target to achieve the desired detection sensitivity. Here we generate Framework-Hotspot reporters (FHRs) with different local densities to investigate their effect on trans-cleavage activity of Cas12a. We find that the cleavage efficiency increases and the cleavage rate accelerates with increasing reporter density. We further construct a modular sensing platform with CRISPR-Cas12a-based target recognition and FHR-based signal transduction. Encouragingly, this modular platform enables sensitive (100 fM) and rapid (<15 min) detection of pathogen nucleic acids without pre-amplification, as well as detection of tumor protein markers in clinical samples. The design provides a facile strategy for enhanced trans cleavage of Cas12a, which accelerates and broadens its applications in biosensing.

Combining virtual screening with cis-/trans-cleavage enzymatic assays effectively reveals broad-spectrum inhibitors that target the main proteases of SARS-CoV-2 and MERS-CoV.

The main protease (Mpro) of SARS-CoV-2 is essential for viral replication, which suggests that the Mpro is a critical target in the development of small molecules to treat COVID-19. This study used an in-silico prediction approach to investigate the complex structure of SARS-CoV-2 Mpro in compounds from the United States National Cancer Institute (NCI) database, then validate potential inhibitory compounds against the SARS-CoV-2 Mpro in cis- and trans-cleavage proteolytic assays. Virtual screening of ∼280,000 compounds from the NCI database identified 10 compounds with highest site-moiety map scores. Compound NSC89640 (coded C1) showed marked inhibitory activity against the SARS-CoV-2 Mpro in cis-/trans-cleavage assays. C1 strongly inhibited SARS-CoV-2 Mpro enzymatic activity, with a half maximal inhibitory concentration (IC50) of 2.69 µM and a selectivity index (SI) of >74.35. The C1 structure served as a template to identify structural analogs based on AtomPair fingerprints to refine and verify structure-function associations. Mpro-mediated cis-/trans-cleavage assays conducted with the structural analogs revealed that compound NSC89641 (coded D2) exhibited the highest inhibitory potency against SARS-CoV-2 Mpro enzymatic activity, with an IC50 of 3.05 µM and a SI of >65.57. Compounds C1 and D2 also displayed inhibitory activity against MERS-CoV-2 with an IC50 of <3.5 µM. Thus, C1 shows potential as an effective Mpro inhibitor of SARS-CoV-2 and MERS-CoV. Our rigorous study framework efficiently identified lead compounds targeting the SARS-CoV-2 Mpro and MERS-CoV Mpro.

Antiviral Docking Analysis, Semisynthesis and Mechanistic Studies on the Origin of Stereo- and Chemoselectivity in Epoxidation Reaction of α'-trans-Himachalene

Epoxides are of great commercial relevance in several businesses due to their unique attributes. The epoxide C15H22O was synthesized via epoxidizing the α'-trans-himachalene 4 deploying meta-chloroperbenzoic acid (m-CPBA) in dichloromethane. The chemoselectivity of the reaction was investigated both experimentally and theoretically in the framework of the molecular electron density theory (MEDT). An experimental chemoselectivity with the best C3=C4 interaction was appropriately determined as predicted by the Parr functions, ELF analysis of the reactants and energetic study. In addition, the epoxidation reaction of α'-trans-himachalene 4 by m-CPBA possessed a lower activation energy in water and ethanol, which shows that this reaction can be performed in environmentally friendly solvents. The investigation of the mechanism indicates that this epoxidation reaction follows a one-step mechanism. Furthermore, a docking study has been carried out for α'-trans-himachalene 4, epoxide 5 and epoxide 6 docked in SARS-CoV2 main protease (6LU7) as compared to the Ribavirin, thus indicating that epoxide 6 could be the antiviral drug.

Pointed polysynchronous interactions in CLIL mathematics class during the COVID-19 pandemic: Translation, translanguaging, and trans-semiotizing

Pointed polysynchronous interactions (PPIs) were initiated by the participants of this study to promote more adequate interactions between learner-learner, learners-teachers, and learners-learning materials in Content and Language Integrated Learning (CLIL) science hybrid learning due to the COVID-19 pandemic. This photovoice study spotlighted Indonesian primary school teachers' initiatives in helping their pupils enhance their English proficiency while learning mathematics. We investigated their efforts for scaffolding when teaching mathematics to the first graders, with a particular focus on translation, translanguaging, and trans-semiotizing. As collaborative research, this photovoice study involved a mathematics' teacher and her co-teacher to provide photos of how translation, translanguaging, and trans-semiotizing were practiced within the PPIs. The teachers described their photos using the SHOWeD technique before we analyzed the data thematically, then returned them to the teachers for validation. Results showed successful practices of translation, translanguaging, and trans-semiotizing, while some challenges arouse because of time limitation for hybrid learning recommended by the Indonesian government. Translation enhanced the students' academic and social performances but required longer time of implementation. Meanwhile, trans-semiotizing was advocated to strengthen the teacher's translanguaging because of the students' English proficiency. Feasibility of alternating L2 and L1 in interaction and connecting them with semiotic resources to negotiate meaning are suggested to practice if hybrid learning should be conducted continuously during new normal.

Opportunities for Correction of Immunosuppression in Patients with Covid-19

Here, we review thematic publications in available literature sources of the databases PubMed, Scopus, Web of Science, eLibrary, 49 of which were dated of the years 1997-2022. Analysis of such reports is aimed at assessing features of cytokine storm-induced hyperinflammatory reaction with signs of immunosuppression accompanied by pronounced lymphopenia and lowered count of CD4(+)T helpers during severe COVID-19. The prognostic factor for unfavorable prognosis was based on the marker of systemic inflammatory reaction correlating with the disease severity - the soluble IL-2 receptor as well as the neutrophil-to-lymphocyte ratio and the lymphocyte subset imbalance. An immunosuppressive therapy of severe forms of COVID-19, aimed at weakening the inflammatory response, exacerbates immune dysfunction by suppressing the T cell function, mainly due to Th1 lymphocytes involved in recognizing and eliminating intracellular pathogens particularly viruses. Upon that, cell-mediated immunity becomes compromised that relies on cytotoxic T-lymphocytes, natural killer cells and macrophages. Timely and targeted immunocorrection is required to prevent or reduce the immunosuppression that accompanies a severe disease course and leads to serious and prolonged complications, as well as to association of secondary infections. In fight against the cytokine storm, it is important not to miss a time point of developing immunosuppressive condition that transitions into immunoparalysis as follows from recent publications covering the tactics of treating immune-mediated complications of coronavirus infection. The review discusses opportunities for immunosuppressive therapy along with glucocorticosteroids and monoclonal antibodies blocking IL-6 or cognate receptors. Studies using mesenchymal stem cells (MSCs) to reduce systemic inflammatory response at COVID-19 are outlined in the review. The use of antigen-specific Treg and their combinations with antagonists of tumor necrosis factor-alpha (TNF alpha), interferon-gamma (IFN gamma) as well as low-dose IL-2 in patients with SARS-CoV-2 infection were analyzed. The prognostic perspectives for CAR-T cells and CAR-NK cells technology have been considered as novel therapeutic approaches aimed at "training" effector cells to recognize the surface SARS-CoV-2 virus spike-like (S) protein. The feasibility of a therapeutic approach is also emphasized by comparatively analyzed of efficacy of using IL-7 or IL-15 during lymphopenia in patients with COVID-19. Here, side effects complicating immunocorrection come to the fore. Critical evaluation of corrected immunosuppressive conditions in patients with COVID-19 in the post-COVID-19 period by using low-dose IL-2 therapy revealed its ability to repair cellular immune response. As a result, a low-dose IL-2 therapy is recommended as a cytokine replacement therapy in such patients with COVID-19 during hyper-to-hypo-inflammatory phase transition in immune response.

Embodying transnational queer Black and Brown utopia in alternative QTPOC nightlife spaces

This focus explores queer Black and Brown feminist and utopian politics as imagined in modern-day alternative nightlife spaces. This is done through case studies of the QTPOC (Queer and Trans People of Colour) nightlife spaces of Queertopia by the Other Village People in Johannesburg, Misery Party and Pxssy Palace in London, and Papi Juice and BK Boihood in New York. These cities are particularly lifted up as spaces of Black and Brown resistance to white dominance and racial capital, even within LGBTQIA+ spaces that implicitly or explicitly do not cater to Black and Brown queers. Through these examinations, it is argued that queer feminists of colour are embodying queer utopia through parties that centre healing, mental health, ancestral faith practices, queer Black and Brown music and dance traditions, and spaces for activists and cultural workers to gather beyond mainstream bars and nightlife. By linking these practices to transnational resistance to racial capitalism and cisheterophobia, and by particularly catering to queer people of colour involved in social movement, resistance, and cultural organising work, these parties exist as experiments in Black and Brown transnational feminist practice. This article examines the bonds that organisers and attendees of these parties build with each other across borders, both in physical nightlife spaces as well as in digital spaces conducted during COVID-19 lockdowns that explicitly brought queer people of colour together to dance and dream transnationally. It ultimately argues that these nightlife spaces are practices of imagining the possibility of utopias where queer people of colour thrive beyond borders.

What Do We Long For? Refllections on Feminist Movements for Social Justice

In this collective essay, we contemplate tipping points including the COVID-19 pandemic, climate crisis, and gendered and racialized forms of state violence through our reflections on shifting meanings of and movements for social justice, shaped by our own lived experiences. Inspired by the writings of feminist scholars and activists including Grace Lee Boggs, adrienne maree brown, Dean Spade, bell hooks, and others, we grapple with the meanings of social justice in contemporary contexts.

Impact of Divalent Metal Ions on Regulation of Trans-Cleavage Activity of CRISPR-Cas13a: A Combined Experimental and Computational Study.

CRISPR-LbuCas13a has emerged as a revolutionary tool for in vitro diagnosis. Similar to other Cas effectors, LbuCas13a requires Mg2+ to maintain its nuclease activity. However, the effect of other divalent metal ions on its trans-cleavage activity remains less explored. Herein, we addressed this issue by combining experimental and molecular dynamics simulation analysis. In vitro studies showed that both Mn2+ and Ca2+ could replace Mg2+ as cofactors of LbuCas13a. In contrast, Ni2+ , Zn2+ , Cu2+ , or Fe2+ inhibits the cis- and trans-cleavage activity, while Pb2+ does not affect it. Importantly, molecular dynamics simulations confirmed that calcium, magnesium, and manganese hydrated ions have a strong affinity to nucleotide bases, thus stabilizing the conformation of crRNA repeat region and enhancing the trans-cleavage activity. Finally, we showed that combination of Mg2+ and Mn2+ can further enhance the trans-cleavage activity to allow amplified RNA detection, revealing its potential advantage for in vitro diagnosis.

Polytrauma patient with lateral thoracic spondyloptosis: case report and literature review

Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.

Unpacking the Black Box of China's State Capitalism

Much ink has been splashed on the ideological, conceptual, and practical challenges that China's state capitalism has posed to global trade rules. There is a growing perception that the current international trade rules are neither conceptually coherent nor practically effective in tackling China's state capitalism. This perception has not only led to the emergence of new trade rules in regional trade agreements, but also culminated in the US-China trade war, only further aggravated by the Covid-19 pandemic. This Article contributes to the debate of what trade rules may be needed to counteract China's state capitalism by unpacking the black box of China's state capitalism. Based on an analysis of the nature of China's state capitalism, this Article provides a preliminary evaluation of current trade rules taken to counteract China's state capitalism, in particular the new rules in the Comprehensive and Progressive Agreement for Trans-Pacific Partnership, and explain why they are unlikely to be successful.

Health and access to gender-affirming care during COVID-19: Experiences of transmasculine individuals and men assigned female sex at birth

Since the onset of the COVID-19 pandemic, global research has suggested that the pandemic has negatively affected lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) populations, including by limiting health care access. There is little research on the impact of COVID-19 among transmasculine persons and men assigned female sex at birth (AFAB) in the United States, who face unique health care challenges outside of the pandemic context. Between May and June of 2020, 20 transmasculine individuals and AFAB men who have sex with men participated in semi-structured interviews about their experiences during the early months of the COVID-19 pandemic. Participants were asked how the pandemic affected their access to health care, overall health, and well-being. Interviews were analyzed using an inductive, thematic approach. Participants reported reduced access to in-person health care, which in some cases meant overdue hormone-related bloodwork and unmet health care needs. Most participants reported that they were able to maintain their testosterone regimen, although some were concerned about future access, citing anxiety about potential shortages. Three participants reported canceled or deferred gender-affirming procedures, which they were uncertain would be rescheduled soon. Participants generally reported that the expansion of telehealth improved access to care, particularly for gender-affirming psychotherapy that was otherwise inaccessible or inconvenient prior to the pandemic. Other salient themes include the pandemic's impact on health behaviors and daily routines. Although the COVID-19 pandemic created new challenges for maintaining health, it also expanded access to gender-affirming health care, largely through the expansion of telehealth. Our findings provide new insights for supporting the health of transmasculine individuals and AFAB men. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

POETRY IN PANDEMIC TIMES: MOURNING COLLECTIVE VULNERABILITY IN SUE GOYETTE'S SOLSTICE 2020. AN ARCHIVE

Focusing on Canadian poet Sue Goyette's collection Solstice 2020. An Archive (2021), this article examines how dealing with the effects of a global pandemic through the medium of poetry can act as a powerful catalyst in raising awareness about collective vulnerability and mourning. During the locked-down days of 2020, Goyette felt it was her responsibility as a poet to find words to convey the sense of shared vulnerability people experienced in the face of a momentous event that confined them to their homes for days on end. Drawing on vulnerability theory, ecophilosopher David Abram's thinking on the more-than-human world, Stacy Alaimo's concept of trans-corporeality, as well as on recent theorizations on the COVID-19 pandemic, this article argues that Goyette's Solstice 2020 is a most interesting sociological document that represents collective vulnerability, testifies to the conundrums posed by the still ongoing pandemic, and makes visible the deep affinities between humankind and the more-than-human world © 2022,Revista de Estudios Norteamericanos. All Rights Reserved.

Creating Time for LGBT+ Disabled Youth: Co-production Outside Chrononormativity

This article explores how ‘chrononormative' constructions of time shape research and offers an approach to co-production and research involvement that draws on insights from trans, queer, and disability studies. The article presents early reflections on an NIHR School for Social Care–funded research study, approved prior to but developed under the context of the Covid-19 pandemic, investigating personal support, sexuality, and gender in young disabled adults' lives. This project has been supported by a Participatory Advisory Group (PAG) of LGBT+ young disabled adults and we reflect on how engagement with the PAG has shaped our understanding of debates around time and involvement in co-production discourse. Our engagement with trans, queer, and disability theory allows us to think about the constraints on time that such involvement has pushed against as we have sought to account for the diverse needs of the body-minds of the PAG in pandemic times. We suggest that this may speak to opening up the diversity and accessibility of co-production across other research contexts and intend this piece to encourage these conversations. The article thus offers a critical exploration of themes of time, embodiment, and identity in the way in which co-production is enacted in funded research. © The Author(s) 2023.

Induction of systemic, mucosal, and cellular immunity against SARS-CoV-2 in mice vaccinated by trans-airway with a S1 protein combined with a pulmonary surfactant-derived adjuvant SF-10.

Background: There is a need for vaccines that can induce effective systemic, respiratory mucosal, and cellular immunity to control the COVID-19 pandemic. We reported previously that a synthetic mucosal adjuvant SF-10 derived from human pulmonary surfactant works as an efficient antigen delivery vehicle to antigen presenting cells in the respiratory and gastrointestinal tracts and promotes induction of influenza virus antigen-specific serum IgG, mucosal IgA, and cellular immunity. Methods: The aim of the present study was to determine the effectiveness of a new administration route of trans-airway (TA) vaccine comprising recombinant SARS-CoV-2 spike protein 1 (S1) combined with SF-10 (S1-SF-10 vaccine) on systemic, local, and cellular immunity in mice, compared with intramuscular injection (IM) of S1 with a potent adjuvant AddaS03™ (S1-AddaS03™ vaccine). Results: S1-SF-10-TA vaccine induced S1-specific IgG and IgA in serum and lung mucosae. These IgG and IgA induced by S1-SF-10-TA showed significant protective immunity in a receptor binding inhibition test of S1 and angiotensin converting enzyme 2, a receptor of SARS-CoV-2, which were more potent and faster achievement than S1-AddaS03™-IM. Enzyme-linked immunospot assay showed high numbers of S1-specific IgA and IgG secreting cells (ASCs) and S1-responsive IFN-γ, IL-4, IL-17A cytokine secreting cells (CSCs) in the spleen and lungs. S1-AddaS03™-IM induced IgG ASCs and IL-4 CSCs in spleen higher than S1-SF-10-TA, but the numbers of ASCs and CSCs in lungs were low and hardly detected. Conclusions: Based on the need for effective systemic, respiratory, and cellular immunity, the S1-SF-10-TA vaccine seems promising mucosal vaccine against respiratory infection of SARS-CoV-2.

Olfactory dysfunction: A plausible source of COVID-19-induced neuropsychiatric symptoms.

Olfactory dysfunction and neuropsychiatric symptoms are commonly reported by patients of coronavirus disease 2019 (COVID-19), a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Evidence from recent research suggests linkages between altered or loss of smell and neuropsychiatric symptoms after infection with the coronavirus. Systemic inflammation and ischemic injury are believed to be the major cause of COVID-19-related CNS manifestation. Yet, some evidence suggest a neurotropic property of SARS-CoV-2. This mini-review article summarizes the neural correlates of olfaction and discusses the potential of trans-neuronal transmission of SARS-CoV-2 or its particles within the olfactory connections in the brain. The impact of the dysfunction in the olfactory network on the neuropsychiatric symptoms associated with COVID-19 will also be discussed.

[Prehospital ultrasound and cardiological emergencies]. / Échographie préhospitalière et urgences cardiologiques.

Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.

Delays in gender affirming healthcare due to COVID-19 are mitigated by expansion of telemedicine.

BACKGROUND: Gender-affirming healthcare is vital for transgender and gender diverse (TGD) patients, and during the pandemic, accessing healthcare became challenging. Hypothesizing that many had procedures postponed, we sought to characterize the impact of the pandemic on TGD patients. METHODS: A mixed-methods approach was employed, combining surveys and interviews; Duke patients were identified by ICD-10 codes, while non-Duke (national) patients were recruited through online social media. RESULTS: All specialties increased telemedicine usage during the pandemic. Duke surgical patients reported a nearly three-fold increase in telemedicine access. COVID-19 symptoms were reported by 24% of Duke and 20% of national patients; barriers to urgent care included the fear of discrimination (27%). CONCLUSION: Delays were experienced in all domains of care, mitigated in part by telemedicine. Nearly one-third of patients cite discrimination as a barrier to care. Though pandemic-related expansion of telemedicine may be a marker of success, significant barriers still complicate delivery of healthcare.

Association between trans fatty acids and COVID-19: A multivariate Mendelian randomization study.

Traditional observational studies have suggested a potential association between trans fatty acids (TFAs), which are considered to be health-damaging fatty acids, and coronavirus disease 2019 (COVID-19). However, whether there is a causal relationship between them is currently unclear. We aimed to investigate the causal link between genetically determined TFAs and COVID-19. We performed univariate and multivariate Mendelian randomization (MR) studies using summary statistics from the European Pedigree TFAs (n = 8013), COVID-19 susceptibility (n = 159 840), COVID-19 hospitalization (n = 44 986), and COVID-19 severity (n = 18 152) genome-wide association studies (GWAS). The inverse variance weighted (IVW) method was used as the primary MR analysis, and several other methods were used as supplements. In univariate MR analysis, higher levels of circulating trans, cis-18:2 TFAs were positively associated with a higher COVID-19 hospitalization rate (p < 0.0033; odds ratio [OR] = 1.637; 95% confidence interval [CI]: 1.116-2.401) and COVID-19 severity (p < 0.0033; OR = 2.575; 95% CI: 1.412-4.698). Furthermore, in multivariate MR analysis, trans, cis-18:2 had an independent and significant causal association with a higher COVID-19 hospitalization rate (p = 0.00044; OR = 1.862; 95% CI = 1.316-2.636) and COVID-19 severity (p = 0.0016; OR = 2.268; 95% CI = 1.361-3.779) after the five TFAs were adjusted for each other. Together, our findings provide evidence that trans, cis-18:2 TFAs have an independent and robust causal effect on COVID-19 hospitalization and severity.