Effects of IFIH1 rs1990760 variants on systemic inflammation and outcome in critically ill COVID-19 patients in an observational translational study

Background:

Variants in IFIH1, a gene coding the cytoplasmatic RNA sensor MDA5, regulate the response to viral infections. We hypothesized that IFIH1 rs199076 variants would modulate host response and outcome after severe COVID-19.

Methods:

Patients admitted to an intensive care unit (ICU) with confirmed COVID-19 were prospectively studied and rs1990760 variants determined. Peripheral blood gene expression, cell populations, and immune mediators were measured. Peripheral blood mononuclear cells from healthy volunteers were exposed to an MDA5 agonist and dexamethasone ex-vivo, and changes in gene expression assessed. ICU discharge and hospital death were modeled using rs1990760 variants and dexamethasone as factors in this cohort and in-silico clinical trials.

Results:

About 227 patients were studied. Patients with the IFIH1 rs1990760 TT variant showed a lower expression of inflammation-related pathways, an anti-inflammatory cell profile, and lower concentrations of pro-inflammatory mediators. Cells with TT variant exposed to an MDA5 agonist showed an increase in IL6 expression after dexamethasone treatment. All patients with the TT variant not treated with steroids survived their ICU stay (hazard ratio [HR]: 2.49, 95% confidence interval [CI]: 1.29–4.79). Patients with a TT variant treated with dexamethasone showed an increased hospital mortality (HR: 2.19, 95% CI: 1.01–4.87) and serum IL-6. In-silico clinical trials supported these findings.

Conclusions:

COVID-19 patients with the IFIH1 rs1990760 TT variant show an attenuated inflammatory response and better outcomes. Dexamethasone may reverse this anti-inflammatory phenotype.

Funding:

Centro de Investigación Biomédica en Red (CB17/06/00021), Instituto de Salud Carlos III (PI19/00184 and PI20/01360), and Fundació La Marató de TV3 (413/C/2021).

The health-development link: travel as a public health issue

The process of globalization has rendered societies interdependent on one another and has fostered the movement of people, goods and ideas at unprecedented speed and volume. Global travel has grown from 25 million in 1950 to 500 million in 1993, and estimations by 2010 reach 1 billion. The increased intensity and quantity of travel has resulted in greater vulnerability to the domino-type spread of old, new and re-emerging infectious diseases. Travelers and local populations are also vulnerable to death and disability due to accidents, violence and injuries, chronic diseases such as those due to substance abuse (tobacco, alcohol and others), and to undesirable behaviors such as those related to sex-tourism. This article argues that tourism, understood as any type of travel, is one of the most important sectors of the economy in many countries and, therefore, can contribute to community and national development. It also asserts that travel, as a factor in the spread of disease, lies in the realm of public health inquiry. It calls for greater collaboration between the tourism-travel industry and community, national and global leaders to promote and enforce "responsible tourism."

Cultural paradoxes relating to sexuality and breastfeeding

Despite the widely acknowledged evidence supporting the benefits of breastfeeding, the prevalence and duration of breastfeeding in the United States and other Western countries remain low. To investigate this phenomenon, we conducted an analysis of the socio-cultural factors that influence women's infant-feeding decisions and examined how breastfeeding is treated in the mass media and by U.S. legislation. We found that cultural notions of the female breast as a primarily sexual object place the act of breastfeeding in a controversial light and can be one of the most influential factors in a woman's decision not to breastfeed. This notion is often supported by the media and legislation. Further research needs to focus on the relationship between sexuality and breastfeeding to help our understanding of breastfeeding behavior. This research should assist policymakers and health workers in their efforts to protect and promote breastfeeding and to increase its social acceptability.

A community-based approach to the promotion of breastfeeding in Mexico

A comprehensive education strategy is presented that links training, community education, research, and mass-media efforts to enhance breastfeeding practices. Breastfeeding promotion models, an administrative system, and lessons learned during the project are described. The keys to effective breastfeeding promotion are shown to be accurate information; appropriate education, training, and follow-up; and a supportive administrative system.