Association between disease-modifying therapies and adverse clinical outcomes in multiple sclerosis patients with COVID-19 infection.

BACKGROUND: This study aimed to consider the main risk factors related to adverse clinical outcomes in MS patients with COVID-19. METHODS: Using the electronic health records systems, this is a cross-sectional study of two years of hospital admissions in terms of COVID-19 in Iran from March 2019 to August 2021. The severities of COVID-19 outcomes were admitted to ICU, hospitalization days, and in-hospital mortality. RESULTS: A total of 1634 hospitalized MS patients with a definite diagnosis of COVID-19 based on PCR were recorded in the electronic health systems. MS patients had a 7% increased risk for longer hospitalization, a 3% increased risk for the need to the ICU, and no increased risk of mortality compared with the general population. MS patients who were taking immunosuppressive (IS)-disease modifying therapies (DMT) had longer hospitalization (adjusted OR=2.06, 95%CI: 1.48, 2.86) and higher mortality risk (adjusted OR=2.05, 95%CI: 1.52, 6.29) compared to patients were under the immunomodulatory (IM)-DMT. There was not any significant association between the types of DMT and ICU (12.2% vs. 12.7%). Besides, MS patients who were vaccinated against COVID-19 before admission had shorter hospitalization (adjusted OR=0.40, 95% CI: 0.18, 0.92). CONCLUSIONS: The current data suggest that MS healthcare providers should consider specific risks of severe COVID-19 infection before starting IS-DMT.

Air pollution during pregnancy and placental adaptation in the levels of global DNA methylation.

BACKGROUND: Health in early life is crucial for health later in life. Exposure to air pollution during embryonic and early-life development can result in placental epigenetic modification and foetus reprogramming, which can influence disease susceptibility in later life. Objectives: The aim of this paper was to investigate the placental adaptation in the level of global DNA methylation and differential gene expression in the methylation cycle in new-borns exposed to high fine particulate matter in the foetal stage. STUDY DESIGN: This is a nested case-control study. We enrolled pregnant healthy women attending prenatal care clinics in Tehran, Iran, who were residents of selected polluted and unpolluted regions, before the 14th week of pregnancy. We calculated the regional background levels of particle mass- particles with aerodynamics diameter smaller than 2.5 µm (PM2.5) and 10 µm (PM10)-of two regions of interest. At the time of delivery, placental tissue was taken for gene expression and DNA methylation analyses. We also recorded birth outcomes (the new-born's sex, birth date, birth weight and length, head and chest circumference, gestational age, Apgar score, and level of neonatal care required). RESULTS: As regards PM2.5 and PM10 concentrations in different time windows of pregnancy, there were significantly independent positive correlations between PM10 and PM2.5 in the first trimester of all subjects and placental global DNA methylation levels (p-value = 0.01, p-value = 0.03, respectively). The gene expression analysis showed there was significant correlation between S-adenosylmethionine expression and PM2.5 (p = 0.003) and PM10 levels in the first trimester (p = 0.03). CONCLUSION: Our data showed prenatal exposures to air pollutants in the first trimester could influence placental adaptation by DNA methylation.