Several recent studies have provided evidence that use of calcium channel blockers, especially amlodipine and nifedipine, can reduce mortality from Covid-19. Moreover, hypocalcemia (a reduced level of serum ionized calcium) has been shown to be strongly positively associated with Covid-19 severity. Both effectiveness of CCBs as antiviral therapy, and positive associations of hypocalcemia with mortality, have been demonstrated for many other viruses as well. We evaluate these findings in the contexts of virus-host evolutionary conflicts over calcium metabolism, and hypocalcemia as either pathology, viral manipulation, or host defence against pathogens. Considerable evidence supports the hypothesis that hypocalcemia represents a host defence. Indeed, hypocalcemia may exert antiviral effects in a similar manner as do CCBs, through interference with calcium metabolism in virus-infected cells. Prospective clinical studies that address the efficacy of CCBs and hypocalcemia should provide novel insights into the pathogenicity and treatment of Covid-19 and other viruses.

Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.

Severe acute respiratory syndrome coronaviruses have unusually large RNA genomes replicated by a multiprotein complex containing an RNA-dependent RNA polymerase (RdRp). Exonuclease activity enables the RdRp complex to remove wrongly incorporated bases via proofreading, a process not utilized by other RNA viruses. However, it is unclear why the RdRp complex needs proofreading and what the associated trade-offs are. Here we investigate the interplay among the accuracy, speed, and energetic cost of proofreading in the RdRp complex using a kinetic model and bioinformatics analysis. We find that proofreading nearly optimizes the rate of functional virus production. However, we find that further optimization would lead to a significant increase in the proofreading cost. Unexpected importance of the cost minimization is further supported by other global analyses. We speculate that cost optimization could help avoid cell defense responses. Thus, proofreading is essential for the production of functional viruses, but its rate is limited by energy costs.

BACKGROUND: The coronavirus emergency obliged Italy's government to stop production and trade activities to limit the =risk of contagion. Italy will restart activities in a few days and some security measures will have to be taken to limit the risks of spreading the virus as much as possible. OBJECTIVE: This work summarizes the rules that are to be adopted for the reduction of the risks of SARS-CoV-2 infection with particular regard to the air conditioning systems in working environments, the sources of risk, and possible risk reduction measures. RESULTS: Ducted air systems are of great importance, widespread, and often overlooked in risk assessment. Scientific evidence has shown that air conditioning systems can be both an infection risk reducer and, if misused, a multiplier of infection possibility. LIMITATIONS: A narrative review with paucity of literature.

Herein, we show differences in blood serum of asymptomatic and symptomatic pregnant women infected with COVID-19 and correlate them with laboratory indexes, ATR FTIR and multivariate machine learning methods. We collected the sera of COVID-19 diagnosed pregnant women, in the second trimester (n = 12), third-trimester (n = 7), and second-trimester with severe symptoms (n = 7) compared to the healthy pregnant (n = 11) women, which makes a total of 37 participants. To assign the accuracy of FTIR spectra regions where peak shifts occurred, the Random Forest algorithm, traditional C5.0 single decision tree algorithm and deep neural network approach were used. We verified the correspondence between the FTIR results and the laboratory indexes such as: the count of peripheral blood cells, biochemical parameters, and coagulation indicators of pregnant women. CH(2) scissoring, amide II, amide I vibrations could be used to differentiate the groups. The accuracy calculated by machine learning methods was higher than 90%. We also developed a method based on the dynamics of the absorbance spectra allowing to determine the differences between the spectra of healthy and COVID-19 patients. Laboratory indexes of biochemical parameters associated with COVID-19 validate changes in the total amount of proteins, albumin and lipase.

Rsum But: Etudier lintrt de la tlconsultation en priode de pandmie lie au Covid-19 Matriel et Mthodes: Etude prospective comportant une enqute de satisfaction ralise au sein dun service dORL dun Centre Hospitalo-Universitaire o la tlconsultation a t mise en place pour remplacer les consultations programmes Les patients taient rpartis en deux groupes selon leur niveau de satisfaction pour en identifier les facteurs prdictifs Une p-value <0,005 tait considre statistiquement significative Lobjectif principal tait dvaluer le taux de satisfaction des patients la suite dune tlconsultation en ORL pendant le confinement mondial Lobjectif secondaire tait didentifier des facteurs prdictifs de la satisfaction globale des patients Rsultats: 125 patients ont t vu en tlconsultation sur une priode de 7 jours dinclusion et 100 patients ont complt le questionnaire Le taux de satisfaction globale tait de 87% Aucun facteur prdictif cliniquement pertinent ntait associ de fa?on statistiquement significative avec la satisfaction Respectivement 76 et 61% des patients avaient jug satisfaisante la qualit du son et de la vido sans impact significatif sur leur satisfaction globale (respectivement OR = 3,40 ;p-value = 0,049 et OR = 3,79 ;p-value = 0,049) Labsence dexamen physique ntait pas significativement corrle une diminution de la satisfaction globale (OR = 0,30;p-value = 0,027) Conclusion: La tlconsultation ne permettait pas une prise en charge mdicale complte mais en situation de pandmie, elle a t bien accueillie par les patients Elle reprsentait un moyen simple de maintenir la continuit des soins mdicaux tout en rduisant le risque de contamination par contacte directe entre les patients et le personnel soignant Aims: To assess the benefit of telemedicine consultation during the Covid-19 pandemic Material and Methods: A prospective study of patient satisfaction with telemedicine consultation was carried out in the ENT department of a university hospital center where telemedicine consultations were set up to replace scheduled out-patient consultations Patients were divided into two groups according to overall satisfaction, in order to identify predictive factors The significance threshold was set at p<0 005 The main endpoint was patient satisfaction after an ENT telemedicine consultation during global lockdown The secondary endpoint comprised predictive factors for overall satisfaction Results: One hundred of the 125 patients with telemedicine consultation over a 7-day inclusion period completed the questionnaire Overall satisfaction was 87% There were no clinically relevant predictive factors significantly associated with satisfaction Sound and video quality was satisfactory for 76% and 61% of patients respectively, without significant impact on overall satisfaction (respectively: OR = 3 40, p-value = 0 049;and OR = 3 79, p-value = 0 049) Lack of physical examination did not significantly correlate with reduced overall satisfaction (OR = 0 30, p-value = 0 027) Conclusion: Telemedicine consultation did not allow complete medical care but, in a difficult time like the global pandemic, was well accepted by patients It is a simple way to maintain continuity of care while reducing contamination risk by avoiding direct contact between patients and healthcare professionals

Abstract Community respiratory viruses, such as respiratory syncytial virus (RSV), influenza viruses, parainfluenza viruses, adenoviruses, and picornaviruses, are an important cause of respiratory disease in the immunocompromised adult with cancer. Recent studies have demonstrated that a minimum of 31% of adult bone marrow transplant (BMT) recipients and 18% of adults with leukemia who are hospitalized with an acute respiratory illness have a community respiratory virus infection. The temporal occurrence of these infections in immunocompromised patients tends to mirror their occurrence in the community. The clinical illnesses range from self-limited upper respiratory illnesses to fatal pneumonias, depending on the type of virus and the type and degree of immunosuppression. The pneumonias may be viral, bacterial/fungal, or mixed. The highest frequency of progression to fatal viral pneumonia has been reported for RSV infections in recently transplanted BMT recipients and myelosuppressed patients with leukemia. Studies have suggested that early therapy for RSV pneumonia with a combination of aerosolized ribavirin and intravenous immunoglobulin may be of benefit. Defining effective prophylactic and therapeutic strategies will be a challenge, given the diversity of viruses, the wide spectrum of immunocompromised patients with varying vulnerability to serious community respiratory virus disease, and the frequent presence of other opportunistic infections and medical problems. A combination of antiviral drugs and immunotherapy may need to be considered for their potential additive effect as well as to prevent the emergence of resistant virus, as occurs during monotherapy for influenza with amantadine or rimantadine. The optimal therapies need to be defined in controlled trials; however, it appears that a favorable response will hinge on the initiation of therapy at an early stage of the respiratory illness.

Objective: To compare hypoxemia severity of patients with COVID-19 pneumonia that arrive at an emergency department as classified by three oxygenation indexes. Design: Retrospective analysis of pulse oximeter saturation and arterial blood gas analysis obtained at arrival. Setting: Tertiary referral hospital in Mexico City converted early in the pandemic to a COVID-19 center. Patients and measurements: A total of 2,960 patients with suspected COVID-19 pneumonia were admitted to the emergency department from April 2020 until March 2021. Pulse oximeter saturation and arterial blood gas analysis was obtained in all of them. Pulse oximeter saturation (SpO2) to inspired oxygen fraction ratio (FiO2), oxygen saturation in arterial blood (SatO2) to FiO2 ratio, and oxygen pressure in arterial blood to FiO2 ratio were calculated for every patient. Interventions: None. Main Results: A strong correlation was seen between PaO2/FiO2 & SpO2/FiO2 (rho = 0.6, p < 0.001), and SatO2/FiO2 & SpO2/FiO2 (rho = 0.65, p < 0.001), while a very strong correlation was seen between PaO2/FiO2 & SatO2/FiO2 (rho = 0.88, p < 0.001). When classifying severity by quantiles, considerable cross-over was observed when comparing oxygenation indexes, as only 785 (26.5%) patients were in the same quintile across the three indexes. Conclusions: Hypoxemia severity is heterogeneous according to the oxygenation index utilized. This limits their usefulness as sole markers of severity, as inter-observer variability, especially on FiO2 estimation, and different practices limit consistent follow up and treatment decisions.

Purpose: To evaluate the impact of the COVID-19 pandemic and the national lockdown on the demographic and clinical profile of patients presenting with ocular trauma. Methods: In this retrospective, hospital-based, comparative analysis, patients presenting to the emergency department with ocular trauma in the following COVID-19 period (March 25, 2020 to July 31, 2020) were compared with patients in the pre-COVID-19 period (March 25, 2019 to July 31, 2019). Results: Overall, 242 patients (COVID-19 period: 71 and pre-COVID-19 period: 171) presented with ocular trauma. The mean age of the patients in COVID-19 and pre-COVID-19 periods were 26.7 17.3 and 34.1 20.3 years, respectively (P = 0.008). A majority of patients (68.6%) in both groups were from the rural background. Home-related injuries were common in the COVID-19 period (78.8%) as compared to pre-COVID-19 period (36.4%) (P < 0.0001). Iron particles (29.5%) were the common inflicting agents in the COVID-19 period while it was plant leaves (25.5%) in the pre-COVID-19 period. The most common ocular diagnosis was open globe injury (40.8%) in the COVID-19 period and microbial keratitis (47.9%) in the pre-COVID-19 period. Surgical intervention was required in 46.4% of patients in the COVID-19 period and 32.1% of patients in the pre-COVID-19 period (P = 0.034). Conclusion: During the COVID-19 period.there was a significant decline in the number of patients presenting with ocular trauma. In this period, a majority of patients sustained ocular trauma in home-settings. About half the patients required surgical intervention which was most commonly rendered in the form of primary wound repair.

BACKGROUND: Exposure to nicotine has been observed associated with tumor progression, metastasis, and therapy resistance of many cancers. Hepatocellular carcinoma (HCC) is one major cancer related to the liver and the most difficult to treat malignancies worldwide. The underlying mechanism of nicotine in the stimulation of HCC tumorigenesis is still not studied well. METHODS: Classically, nicotine binds to nicotinic acetylcholine receptors (nAChRs) and induces many downstream cancer-associated signaling pathways. Big data analysis is used to explore the importance of a7nAChR-Jak2 axis in the progression of hepatocellular carcinoma. Bioinformatic analysis was performed to determine gene associated with a7nAChR-Jak2 axis of HCC patients. Biological importance of a7nAChR-Jak2 axis was investigated in vitro (Hun7 and HepG2 cell lines), and athymic nude mouse models bearing HepG2-HCC cells xenografts were established in vivo. RESULT: We found that nicotine exposure stimulated the HCC tumorigenicity by inducing the expression of one of the key nAChRs subunit that is 7nAChR as well as the expression of Janus kinase (JAK)-2. In both the in vitro and in vivo studies, the reduced overexpression of 7nAChR and increased sensitization of HCC towards treatment is observed with dehydrocrenatidine (DHCT), a novel and potent JAK family kinase inhibitor. Interestingly, DHCT treatment results in the reduction of the epithelial-mesenchymal transition process which leads to a significant reduction of clonogenicity, migratory, and invasive ability of HCC cells. Moreover, DHCT treatment also inhibits the cancer stem cell phenotype by inhibiting the tumor-sphere formation and reducing the number of ALDH1+ cells population in nicotine-stimulated HCC cells. CONCLUSIONS: Taken together, the presented results indicate the positive effect of inhibition of nicotine induced overexpression of 7nAChR and JAK2, unique to HCC. Thus, these findings suggest the nicotine effect on HCC progression via 7nAChR-mediated JAK2 signaling pathways, and DHCT treatment enhances the therapeutic potential of HCC patients via overcoming/reversing the effect of nicotine in HCC patients.

Background In the current coronavirus disease-2019 (COVID-19) pandemic, the pattern of hospital admissions for acute ST-elevation myocardial infarction (STEMI) is changing, and increased mortality and morbidity is being noted in these patients Cardiac manifestations of COVID-19 are complex and include STEMI, myocarditis, myocardial injury, and cardiomyopathy The objective of our study was to compare the data of patients with STEMI presenting in COVID-19 versus the non-COVID-19 era Methods We analyzed the clinical and angiographic characteristics of STEMI patients undergoing primary percutaneous coronary intervention (PCI) at our center The primary outcome variables were admission rate for STEMI, mean total ischemic time (TIT), coronary artery disease burden, mean ejection fraction, and in-hospital mortality for three defined groups Group A consisted of patients who underwent primary PCI from March through April 2020 Group B included patients who underwent primary PCI from January to February 2020 Group C consisted of patients who underwent primary PCI from March to April 2019 We then compared the data among the three groups and calculated any significant p-value (p&lt; 001) Results In Group A, 1139 patients were admitted for primary PCI The mean admission rate was 18 6 +/- 4 36 admissions per day There were 1535 patients in Group B and an admission rate of 26 01 +/- 4 90 (p&lt; 001 compared to Group A) In Group C, there were 1537 patients and an admission rate of 24 8 +/- 4 55 (p&lt; 001, compared to Group A) The mean TIT was 429 25 +/- 272 16 minutes for Group A, 359 78 +/- 148 04 minutes for Group B, and 346 75 +/- 207 31 minutes for Group C (p&lt; 001) A higher mortality rate was noted in Group A (COVID-19 era) versus Group C (non-COVID-19 era;p&lt; 001) Conclusions A lower admission rate, higher TIT, and higher mortality rates were noted in patients with acute STEMI during the COVID-19 pandemic compared to the pre-COVID era During the COVID-19 pandemic, physicians should bear in mind that patients with STEMI have increased mortality and morbidity Where possible, efforts should be made for timely management of these critical patients to decrease mortality

Background: With the rapid urbanization, citizenization of migrants is becoming the development tendency in China. It is significant to analyze the determining factors of the settlement intention of migrants. Methods: The data we used were taken from the China Migrants Dynamic Survey (CMDS) in 2017. Multilevel mixed-effects logistic regression was used to analyze the relationship between air pollution, economic advantages, and settlement intention between different migrants and the moderating effect of social welfare. Results: At the individual level, being female, married, urban and other ethnic, having higher education, older, and health associated with likelihood of settlement intention of migrants. Higher health education, social integration, and, have a health record were positively associated with the likelihood of settlement intention. Higher educated, urban areas, and Han migrants were willing to reduce their pursuit of health for economic development. Conclusion: Health education and more social organizational participation can reduce the negative effect of air pollution and increase the positive effect of economic advantages on settlement intention of migrants. But, in less economically advantaged areas, it has no obvious effect. In the choice of health and wealth, the settlement intention of migrants shows difference, and unfairness and social welfare, in particular health education, can narrow this difference.

The systemic nature of SARS-CoV-2 infection is highly recognized, but poorly characterized. A non-invasive and unbiased method is needed to clarify whole body spatiotemporal dynamics of SARS-CoV-2 infection after transmission. We recently developed a probe based on the anti-SARS-CoV-2 spike antibody CR3022 to study SARS-CoV-2 pathogenesis in vivo. Herein, we describe its use in immunoPET to investigate SARS-CoV-2 infection of three rhesus macaques. Using PET/CT imaging of macaques at different times post-SARS-CoV-2 inoculation, we track the 64Cu-labelled CR3022-F(aba?)2 probe targeting the spike protein of SARS-CoV-2 to study the dynamics of infection within the respiratory tract and uncover novel sites of infection. Using this method, we uncovered differences in lung pathology between infection with the WA1 isolate and the delta variant, which were readily corroborated through computed tomography scans. The 64Cu-CR3022-probe also demonstrated dynamic changes occurring between 1- and 2-weeks post-infection. Remarkably, a robust signal was seen in the male genital tract (MGT) of all three animals studied. Infection of the MGT was validated by immunofluorescence imaging of infected cells in the testicular and penile tissue and severe pathology was observed in the testes of one animal at 2-weeks post-infection. The results presented here underscore the utility of using immunoPET to study the dynamics of SARS-CoV-2 infection to understand its pathogenicity and discover new anatomical sites of viral replication. We provide direct evidence for SARS-CoV-2 infection of the MGT in rhesus macaques revealing the possible pathologic outcomes of viral replication at these sites.

Infection with the mouse hepatitis coronavirus (MHV) provides an excellent model for the study of viral diseases of the central nervous system and the gastrointestinal tract. With the ultimate aim of studying mucosal immunity to MHV we have cloned the genes encoding the structural proteins of MHV strain A59 (MHV-A59) into the E3 region of a human adenovirus type 5 vector. Infection of HeLa cells with the resulting recombinant adenoviruses AdMHVS, AdMHVN and AdMHVM revealed the correct expression of the spike (S), nucleocapsid (N) and membrane (M) proteins, respectively. Intraperitoneal inoculation of BALB/c mice with the recombinant viruses elicited serum antibodies which specifically recognized the respective MHV proteins in an immunoprecipitation assay. Only antibodies to the S protein neutralized MHV-A59 in vitro but titres were low. When analysed by ELISA or by immunofluorescence only the antibody response to the N protein was significant; weak responses or no detectable response at all were found for S and M, respectively. Upon intracerebral challenge with a lethal dose of MHV-A59 we found that a significant fraction of animals vaccinated with adenovirus vectors expressing either the S protein or N protein were protected. This protective effect was significantly stronger when the animals were given a booster immunization with the same vector prior to challenge. No protection was induced by AdMHVM. Interestingly, enhanced protection resulted when AdMHVS and AdMHVN were applied in combination as compared to survival after single immunizations. The results indicate that both the N and S proteins generate a protective immune response and suggest that this response is enhanced by combined expression of the two proteins.

Considering the influence of environmental capacity and forgetting on rumor spreading, we improve the traditional SIR (susceptibleCinfectedCremoved) rumor propagation model and give two dynamic models of rumor propagation in heterogeneous environment and homogeneous environment, respectively. The main purpose of this paper is to make a dynamic analysis of rumor propagation models. In the spatial heterogeneous environment, we have analyzed the uniform persistence of the rumor propagation model and the asymptotic behavior of the positive equilibrium point when the diffusion rate of rumorCsusceptible tends to zero. In the spatial homogeneous environment, we discuss the stability of rumor propagation model. Further, optimal control and the necessary optimality conditions are obtained by using the maximum principle. Finally, we study the Hopf bifurcation phenomenon through inducing time delay in the reactionCdiffusion model. In addition, the existence of Hopf bifurcation is verified and the influence of diffusion coefficients is studied by numerical simulations.

The health of our planet and humanity is threatened by biodiversity loss, disease and climate crises that are unprecedented in human history, driven by our insatiable consumption and unsustainable production patterns, particularly food systems. The One Health approach is a pathway to synergistically addressing outcomes in term of health and sustainability, but gender issues at the One Health and biodiversity nexus are largely ignored. By examining the roles and responsibilities of Indigenous and Local People, and especially women, in conserving natural resources, and the social costs of living at the Human-Animal-Environment interface under current conservation strategies, we show that women bear a disproportionate health, poverty and climate burden, despite having pivotal roles in conserving biodiversity. To mitigate risks of emerging infectious diseases, food insecurity and climate change impacts, a gender perspective has previously been proposed, but implementation lags behind. Endemic zoonotic diseases, human-wildlife conflict and environmental pollution lack gender-sensitive frameworks. We demonstrate that women can be powerful agents for change at all levels of society, from communities to businesses, and policy-making institutions, but gender inequalities still persist. We develop a framework for mainstreaming a gender-responsive and rights-based One Health approach, in order to heal ourselves and nature. Using a leverage-points perspective, we suggest a change of paradigm, from the pursuit of GDP and over-consumption, to a focus on human well-being and their reconnection with healthy environments, using a One Health understanding of nature and health. We recommend learning from Indigenous People to re-position ourselves within nature and to better conserve biodiversity. We also propose integration of gender equity in leadership, the respect of human rights, womens rights (access to health care, healthy food, land tenure, natural resources, education, and economic opportunities), and the rights of nature, through the implementation of gender-responsive and rights-based One Health Action Plans, at policy-making level, in the private sector and the civil society. As the COVID-19 pandemic continues to unveil deep socio-economic inequities in the wealthiest economies and the vital role of nature in supporting our health, we argue to seize this opportunity to build back better and improve resilience and sustainability by using a gender-responsive and rights-based One Health approach.

Major histocompatibility complex antigens are critical to an animal's immune response. In most animals, the extreme polymorphism of MHC molecules complicates studies of the role of this complex in the immune response. In mice, however, MHC haplotype-homozygous inbred strains have been developed which are invaluable in the study of the immune system and the search for immune response genes. The human MHC bears many similarities to its murine equivalent with regard to antigen structure and polymorphism; furthermore, a number of combinations of specific MHC alleles between HLA-B and HLA-DR/DQ (extended haplotypes) are found in people more commonly than predicted by individual allele frequencies. Over 30 percent of Caucasian haplotypes are extended haplotypes, and over 55 percent of individuals have at least one extended haplotype. Examples of the same extended haplotype, even in unrelated individuals, should either all have or lack any gene within the MHC region. The value of considering extended haplotypes in searching for associations between the MHC and diseases, or immune response, is shown in three examples: congenital adrenal hyperplasia, hepatitis B immunization, and transfusion-associated graft-versus-host disease.

PURPOSE OF REVIEW: Youth sports participation has shifted from a school-based, seasonal activity to club-based, year-round activity over the past 10C15 years. Single sport specialization has become increasingly common with a concurrent increase in injury and burnout. Paralleling trends seen in other aspects of health care, disparities in regard to participation in youth sports, and subsequent injury treatment exist as well. Recognition of these disparities amongst coaches, parents, and athletes involved in youth sports are essential to promote the short- and long-term health of pediatric and adolescent athletes. RECENT FINDINGS: Multiple barriers exist for youth in regard to sports participation. Youth who come from families without extensive financial means are increasingly finding it difficult to play organized sports, with this trend holding when broken down by insurance status (public versus private). This problem is further exacerbated by the lack of community-based programming in locations where organized (albeit expensive) options do not exist. The lack of athletic trainers increases the divide, as well as the care that injured athletes receive (particularly in public schools within communities of color) is not equivalent to schools with extensive financial resources. Thus, ability to quickly return to play after injury and/or access the health care system is limited. This is further exemplified by inferior outcomes in regard to care for anterior cruciate ligament, meniscus, shoulder instability, and concussions in this population. SUMMARY: Youth sports participation is laden with multiple disparities. This is unfortunately reflective of historical barriers to opportunities/advancements in multiple other areas of society. These disparities place certain groups of children at an uphill battle not only for participation when healthy, but also returning to participation when injured. Larger structural changes in youth sports are necessary to promote life-long, healthy physical activities for individuals most at risk.

This paper assesses the Granger causality between government spending and gross domestic product (GDP) in the United States at multiple horizons. This paper also analyses the role the real exchange rate plays in the causality measure during the zero lower bound (ZLB) period. Many researchers using theoretical models built in a closed economy suggest that the elasticity between government spending and GDP is very large, when the nominal interest rate is binding. Other researchers, also using theoretical models generally built in an open economy, suggest that the elasticity in the ZLB period is not large. The same conflicting results are reported in the empirical literature mostly using vector auto regressives (VARs), with different restrictions. In this paper, we use a different approach to measure the link between the two variables. The new approach has the advantage of not relying on any restrictions, as is the case with VARs when dealing with causalities. Moreover, our approach is not related to the way the model is built, as is the case with dynamic stochastic general equilibrium (DSGE) types of models. In this paper, we use a Granger causality measure to compare the causality for normal periods with the causality for the ZLB period. We emphasize the role played by the real exchange rate. Our empirical results provide evidence that the causality measures between government spending and GDP are larger and persistent in the ZLB period, but only if the exchange rate is not taken into account. When the exchange rate is taken into account, our measure of causality becomes very small and non-persistent.

Background: . Coronavirus disease 2019 (Covid-19) has emerged as a pandemic by end-January 2020. Of the infected patients, 10%-15% may develop severe or critical illness. So far, no definite treatment is available for Covid-19. Cytokine release syndrome may underlie the pathogenesis of severe and critical disease. Anti-interleukin (IL)-6 therapies are being tried to improve clinical outcomes. Methods: . We did a systematic review to identify the available literature on anti-IL-6 therapies in the treatment of Covid-19 and used the GRADE method to assess the quality of evidence. Results: . Four case series and 10 case reports were identified. On critical assessment, we found that these studies reported some beneficial effect of anti-IL-6 therapy, but all the studies had a high risk of bias. The pooled estimate showed that 42% of patients improved but with a very wide confidence interval (CI) (95% CI 1%-91%) and substantial heterogeneity (I2 = 95%). The overall quality of evidence was graded as 'very low'. Conclusions: . Although promising, anti-IL-6 therapy for Covid-19 needs to be tested in randomized controlled trials to provide robust evidence.