BACKGROUND: The effect of renin-angiotensin-aldosterone system (RAAS) inhibitors in coronavirus disease 19 (Covid-19) patients has not been fully investigated. We evaluated the association between RAAS inhibitor use and outcomes of Covid-19. METHODS: This study was a retrospective observational cohort study that used data based on insurance benefit claims sent to the Health Insurance Review and Assessment Service of Korea by May 15, 2020. These claims comprised all Covid-19 tested cases and the history of medical service use in these patients for the past five years. The primary outcome was all-cause mortality, and the rate of ventilator care was compared between the groups. RESULTS: From a total of 7,590 patients diagnosed with Covid-19, two distinct cohorts were generated based on RAAS inhibitors prescribed within 6 months before Covid-19 diagnosis. A total of 1,111 patients was prescribed RAAS inhibitors, and 794 patients were prescribed antihypertensive drugs, excluding RAAS inhibitors. In propensity-score matched analysis, 666 pairs of data set were generated, and all-cause mortality of the RAAS inhibitor group showed no significant difference compared with the non-RAAS inhibitor group (14.6% vs. 11.1%; hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.54-1.15; p = 0.22). The rate of ventilator care was not significantly different between the two groups (4.4% vs. 4.1%; HR, 1.04; 95%CI, 0.60-1.79; p = 0.89). CONCLUSIONS: RAAS inhibitor treatment did not appear to increase the mortality of Covid-19 patients compared with other antihypertensive drugs, suggesting that they may be safely continued in Covid-19 patients.

This paper raises systemic questions about capitalism and questions the role that self-interest played in the economy and society and also as a fundamental principle in the economics discipline. This article puts forward the possibility and importance of solidarity in building cohesion in our communities and helping the economic and social recovery globally. The authors advocate that economists should pay more attention to the economics of solidarity, a sub-discipline that can bring a paradigm shift in the way we conceptualise the individual behaviour in economics and could inform respectively the policy-makers on the significance of solidarity as a building stone for a future and better society. Copyright ? 2021 Inderscience Enterprises Ltd.

BACKGROUND: Although chronic cardio\metabolic disease is a common comorbidity among patients with COVID\19, its effects on the clinical characteristics and outcome are not well known. METHODS AND RESULTS: This study aimed to explore the association between underlying cardio\metabolic disease and mortality with COVID\19 among hospitalized patients. This multicenter, retrospective, and real\world study was conducted from January 22, 2020 to March 25, 2020 in China. Data between patients with and without 5 main cardio\metabolic diseases including hypertension, diabetes mellitus, coronary heart disease, cerebrovascular disease, and hyperlipidemia were compared. A total of 1303 hospitalized patients were included in the final analysis. Of them, 520 patients (39.9%) had cardio\metabolic disease. Compared with patients without cardio\metabolic disease, more patients with cardio\metabolic disease had COVID\related complications including acute respiratory distress syndrome (9.81% versus 3.32%; P<0.001), acute kidney injury (4.23% versus 1.40%; P=0.001), secondary infection (13.9% versus 9.8%; P=0.026), hypoproteinemia (12.1% versus 5.75%; P<0.001), and coagulopathy (19.4% versus 10.3%; P<0.001), had higher incidences of the severe type of COVID\19 (32.9% versus 16.7%; P<0.001), more were admitted to the intensive care unit (11.7% versus 7.92%; P=0.021), and required mechanical ventilation (9.8% versus 4.3%; P<0.001). When the number of the patients' cardio\metabolic diseases was 0, 1, and >2, the mortality was 4.2%, 11.1%, and 19.8%, respectively. The multivariable\adjusted hazard ratio of mortality among patients with cardio\metabolic disease was 1.80 (95% CI, 1.17C2.77). CONCLUSIONS: Cardio\metabolic disease was a common condition among hospitalized patients with COVID\19, and it was associated with higher risks of in\hospital mortality.

Background: Several countries are implementing COVID-19 booster vaccination campaigns. The objective of this study was to model the impact of different primary and booster vaccination strategies. Methods: We used a compartmental model fitted to hospital admission data in France to analyze the impact of primary and booster vaccination strategies on morbidity and mortality, assuming waning of immunity and various levels of virus transmissibility during winter. Results: Strategies prioritizing primary vaccinations were systematically more effective than strategies prioritizing boosters. Regarding booster strategies targeting different age groups, their effectiveness varied with immunity and virus transmissibility levels. If the waning of immunity affects all adults, people aged 30 to 49 years should be boosted in priority, even for low transmissibility levels. Conclusions: Increasing the primary vaccination coverage should remain a priority. If a plateau has been reached, boosting the immunity of younger adults could be the most effective strategy, especially if SARS-CoV-2 transmissibility is high.

BACKGROUND: As the Coronavirus disease 2019 (COVID-19) is spreading worldwide, countries are dealing with different phases of the pandemic. Lately, scientific evidence has been growing about the measures for reopening respiratory outpatient services during the COVID-19 pandemic. We aim to summarize the key differences and similarities among recommendations by different national and international organizations. METHODS: We searched on Google and Pubmed for recently published National and International Recommendations/Guidelines/Position Papers from professional organizations and societies, offering a guidance to physicians on how to safely perform pulmonary function testing during COVID-19 pandemic. We also searched for spirometry manufacturers' operational indications. RESULTS: Indications on spirometry were released by the Chinese Task force, the American Thoracic Society, the European Respiratory Society, the Thoracic Society of Australia and New Zealand, the Socit de Pneumologie de Langue Fran?aise, the Spanish Societies (Sociedad Espanola de Neumologia y Cirugia Toracica, Sociedad Espanola de Alergologia e Inmunologia Clinica, Asociacion de Especialistas en Enfermeria del trabajo, Asociacion de Enfermeria Comunitaria), the Sociedade Portuguesa de Pneumologia, the British Thoracic Society/Association for Respiratory Technology & Physiology, the Irish Thoracic Society, the Sociedad Uruguaya de Neumologia, the Italian Thoracic Society and the Italian Respiratory Society, Cleveland Clinic and Nebraska Medical Center. Detailed technical recommendations were found on manufacturers' websites. We found several similarities across available guidelines for safely resuming pulmonary function services, as well as differences in criteria for selecting eligible patients for which spirometry is deemed essential and advice which was not homogenous on room ventilation precautions. CONCLUSIONS: This study shows a synthesis of national/international guidelines allowing practicing physicians to adapt and shape the way to organize their outpatient services locally. There is generally good agreement on the importance of limiting pulmonary function testing to selected cases only. However, significant differences concerning the subsets of candidate patients, as well as on the management of adequate room ventilation, were observed.

Chronic pain is a major health concern, albeit underestimated in times of a pandemic. With about a third of pain patients without a diagnosis and delayed referral to pain therapy specialists, the current management of chronic pain requires significant re-evaluation. The COVID-19 pandemic has, on the one hand, made the gaps in health systems more evident and, on the other, acted as a catalyst for a profound transformation in pain care. Following an in-depth context analysis, the Science of Relief 2.0 Event brought together clinicians operating in pain therapy centers throughout Italy with the aim of identifying concrete solutions and sharing proposals to optimize the organization of chronic pain management and treatment through working groups and educational sessions. This document illustrates the salient points of the event and discusses its implications for clinical practice.

PURPOSE: To quantify the number of SARS-CoV-2 infections in students and teachers in 14 Secondary schools in eastern Saxony, Germany. Seroprevalence of SARS-CoV-2 antibodies in study population. Number of undetected cases. METHODS: Serial seroprevalence study. RESULTS: The role of educational settings in the SARS-CoV-2 Pandemic is still controversial. Seroprevalence increases from 0.8 to 5.9% from October to December when schools remained open and to 12.2% in March/April during a strict lockdown with closed schools. The ratio of undetected to detected cases decreased from 0.76 to 0.44 during the study period. CONCLUSION: During the second and third wave of the pandemic in Germany, students and teachers are not overrepresented in SARS-CoV-2 infections. The percentage of undetected cases is moderate and decreases over time. The risk of contracting SARS-CoV-2 within the household is higher than contracting it in educational settings making school closures rather ineffective in terms of pandemic control measures or individual risk reduction in children and adolescents. TRIAL REGISTRATION: DRKS00022455 (July 23rd, 2020). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s15010-022-01824-9.

Menjalani perkuliahan di tengah pandemi Covid-19 dapat menyebabkan pengaruh terhadap kesehatan mental mahasiswa baru yang masih berada dalam tahap adaptasi selepas menjalani pendidikan dari sekolah menengah menuju perguruan tinggi. Penguasaan teknologi menjadi tuntutan yang harus dipenuhi dalam menjalani pembelajaran online selain itu mahasiswa juga dituntut untuk dapat lebih aktif dan kreatif dalam menjalani perkuliahan secara online namun semua itu tidak lepas dari berbagai masalah dan kendala yang harus dihadapi dalam pelaksanaan pembelajaran serta berpengaruh terhadap kesehatan mental. Tulisan ini bertujuan untuk mengetahui adanya pengaruh yang signifikan antara perkuliahan online dan pengaruhnya terhadap kondisi mental mahasiswa baru serta untuk mengetahui apa saja permasalahan yang dihadapi dalam menjalani perkuliahan online ditengah pandemi.

A Translational Research Symposium was organized at the 2014 annual meeting of the European society for biomaterials. This brought together leading Tier one companies in clinical biomaterials and medical device markets, small and medium enterprises and entrepreneurial academics who shared their experiences on taking biomaterials technologies to commercial endpoints, in the clinics. The symposium focused on "Progressing Innovation in Biomaterials. From the Bench to the Bed of Patients". The aim of the present document is to illustrate the content of the symposium and to highlight the key lessons from selected lectures.

We consider a large random network, in which the performance of a node depends upon that of its neighbours and some external random influence factors. This results in random vector valued fixed-point (FP) equations in large dimensional spaces, and our aim is to study their almost-sure solutions. An underlying directed random graph defines the connections between various components of the FP equations. Existence of an edge between nodes $i,j$ implies the $i$-th FP equation depends on the $j$-th component. We consider a special case where any component of the FP equation depends upon an appropriate aggregate of that of the random `neighbour' components. We obtain finite-dimensional limit FP equations in a much smaller dimensional space, whose solutions aid to approximate the solution of FP equations for almost all realizations, as the number of nodes increases. We use Maximum theorem for non-compact sets to prove this convergence. We apply the results to study systemic risk in an example financial network with large number of heterogeneous entities. We utilized the simplified limit system to analyse trends of default probability (probability that an entity fails to clear its liabilities) and expected surplus (expected-revenue after clearing liabilities) with varying degrees of interconnections between two diverse groups. We illustrated the accuracy of the approximation using exhaustive Monte-Carlo simulations. Our approach can be utilized for a variety of financial networks (and others); the developed methodology provides approximate small-dimensional solutions to large-dimensional FP equations that represent the clearing vectors in case of financial networks.

BACKGROUND The outbreak of the pandemic Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus named Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), affecting a high number of patients in Italy, forced a great number of doctors, even dermatologists, to work in the first lines in the dedicated departments. We analyzed the features and the incidence of dermatological issues emerged during the hospitalization due to COVID-19 and absent before. METHODS All the SARS-CoV-2 positive patients hospitalized in Celio Military Hospital - COVID hub no-intensive care wards from March 16, 2020 until May 4, 2020 were evaluated by dermatologists several times during the hospital stay. RESULTS Ninety-six patients (15 civilians and 81 Italian servicepeople) were enrolled: 34 (35.4%) patients developed cutaneous manifestations; 15 (16.0%) suffered from skin dryness; 5 (5.2%) irritant contact dermatitis; 4 (4.2%) seborrheic dermatitis; 4 (4.2%) morbilliform rashes; 3 (3.1%) petechial rashes and 3 (3.1%) widespread hives. CONCLUSIONS A deeper knowledge of cutaneous manifestations in military and civilian hospitalized COVID-19 patients could suggest more effective treatments to win the battle against SARS-CoV-2.

A porcine epidemic diarrhoea outbreak first occurred in southern China at the end of 2010 and afterwards the disease spread throughout the country. Spike gene is divergent and important for understanding the genetic relations of porcine epidemic diarrhoea virus field strains, the epidemiological status of the virus and vaccine development. In this study, S1 regions of spike gene of 1,235 selected strains collected from 2012 to 2017 in China were clustered along with 25 references of spike sequences mainly from China. The phylogenetic analysis demonstrates that these sequences of S1 regions were genetically more diverse with time. In all strains, G1a, G1b, G2a and G2b clusters accounted for 1.9%, 9.6%, 32.2% and 56.3%, respectively, namely G2a and G2b were the two most prevalent clusters in China. Furthermore, we made a more detailed classification for G2 group based on phylogenetic tree, in which G2a was divided into two subgroups, and G2b was separated into four subgroups.

With the spread of the new Coronavirus, there was an increase in the generation of contaminated waste. Thus, healthcare waste management (HCWM) became even a greater challenge in hospitals due to Coronavirus easily spread. In this context, it was necessary to create tools that could aid healthcare facilities in evaluating their HCWM. Therefore, the objective of this article was to elaborate a support tool that helps in identifying the shortcomings of hospitals' HCWM. For this purpose, the Health Service Waste Management Index was developed based on the selection of indicators in the area. The index was applied to six hospitals in the state of Minas Gerais, Brazil. Its application meet the purpose of this research, since the results in the form of an index objectively summarize the reality of the HCWM in healthcare facilities. From the six hospitals investigated, four were classified as highly efficient. However, even though most of them were well evaluated, they still have difficulties with properly training their employees, which can be even a worse problem during a pandemic, when every precaution is extremely important to reduce the spread of the disease. Therefore, beyond this article contribution related to sustainability by demanding the hospitals to check which points of HCWM should be improved, it also adds academically by developing a tool with indicators that evaluate operational, human, economic and environmental factors in an innovative way.

There are significant misconceptions and many obstacles in the way of illuminating the epidemiological and clinical aspects of COVID-19 as a new emerging epidemic In addition, usefulness of some evidence published in the context of the recent epidemic for decision making in clinic as well as public health is questionable However, misinterpreting or ignoring strong evidence in clinical practice and public health probably results in less effective and somehow more harmful decisions for individuals as well as subgroups in general populations of countries in the initial stages of this epidemic Accordingly, our narrative review appraised epidemiological and clinical aspects of the disease including genetic diversity of coronavirus genus, mode of transmission, incubation period, infectivity, pathogenicity, virulence, immunogenicity, diagnosis, surveillance, clinical case management and also successful measures for preventing its spread in some communities

Missense and truncating variants in protocadherin 19 (PCDH19) cause PCDH19-related epilepsy. In this study, we aimed to investigate variations in distributional characteristics and the clinical implications of variant type in PCDH19-related epilepsy. We comprehensively collected PCDH19 missense and truncating variants from the literature and by sequencing six exons and intron-exon boundaries of PCDH19 in our cohort. We investigated the distribution of each type of variant using the cumulative distribution function and tested for associations between variant types and phenotypes. The distribution of missense variants in patients was clearly different from that of healthy individuals and was uniform throughout the extracellular cadherin (EC) domain, which consisted of six highly conserved domains. Truncating variants showed two types of distributions: (1) located from EC domain 1 to EC domain 4, and (2) located from EC domain 5 to the cytoplasmic domain. Furthermore, we also found that later onset seizures and milder intellectual disability occurred in patients with truncating variants located from EC domain 5 to the cytoplasmic domain compared with those of patients with other variants. Our findings provide the first evidence of two types of truncating variants in the PCDH19 gene with regard to distribution and the resulting clinical phenotype.

The author aims to depict the current COVID-19 pandemic and personal protective equipment (PPE) crisis in the UK. The current situation is put into context exploring the history of global outbreaks of infectious disease and what has been learnt. These lessons are then applied and weighed against the recent response to coronavirus. An in depth interview with a UK biomedical SME based in Shanghai, China is reported in order to inform future procurement of PPE. It is hoped that an appreciation of the dynamic nature of the market will allow adaptations to be made in order to secure reliable supply chains moving forwards.

To evaluate the use of an aerosol box during video laryngoscopy intubation, we conducted a two-phase simulation-based study to assess if there were significant differences in time needed to safely intubate a patient with an aerosol box in place, as well as assess changes in laryngoscopists hand motions as determined by changes in accelerometry. 20 anesthesiology providers from our institution participated in the first phase assessing the time to intubation. Use of the aerosol box led to statistically significant increases in intubation times (Wilcoxon-Signed Rank test p < 0.001, z-score = 3.921), with the calculated Pearsons correlation coefficient (r = 0.877) indicating a large effect size. An 8.5 - 11.5 second difference in median intubation times was maintained between corresponding attempts with versus without the aerosol box. 15 participants completed an optional post-assessment survey, with 10 of 15 respondents firmly stating they would not use the box in clinical practice. The hand accelerometry assessment included five anesthesiology providers from our institution. This revealed a statistically significant increase in trials with aerosol boxes for the left hands general accelerometry with a medium effect size (p = 0.031; z = -1.873; r = -0.484), as well as for the right hands general accelerometry with a large effect size (p < 0.001; z = -3.351; r = -0.865). Although the aerosol box is an interesting concept, its use is associated with increased time to intubation and a change in ergonomics, which may increase risk during airway management and represents a concern for patient safety.

Objective: To explore the clinical efficacy of paliperidone palmitate long-acting injection combined with electroacupuncture in the treatment of methamphetamine addicts. Methods: This study focused on methamphetamine addicts who were admitted to our hospital from January 2020 to December 2020 as the main research object, with a total of 89 cases. The patients were divided into a control group of 45 cases and a study group of 44 cases according to the treatment method. The control group was treated with electroacupuncture, and the study group was treated with paliperidone palmitate long-acting injection on the basis of electroacupuncture in the control group. After 6 months of continuous treatment, the treatment effect of methamphetamine withdrawal symptom score before and after treatment was used; Hamilton Anxiety Scale score and Hamilton Depression Scale were used to compare the anxiety and depression situation of the two groups; the brain wave and wave situation of the two groups were compared. Result: The results showed that there was no significant difference in the scores of Ma withdrawal symptoms, Hamilton Anxiety and Hamilton Depression between the two groups before treatment (p < 0.05); after 3 and 6 months of treatment, the scores of Ma withdrawal symptoms, Hamilton Anxiety and Hamilton Depression in the study group were significantly lower than those in the control group and the difference was statistically significant (p < 0.05); 6 months after the completion of the treatment, the wave amplitude and Fourier transformed brain wave (FFT()) in the study group were significantly higher than those in the control group, and the difference was statistically significant (p < 0.05). Conclusion: Paliperidone palmitate long-acting injection combined with electroacupuncture is better than electroacupuncture alone in the treatment of methamphetamine addicts, and can significantly improve anxiety, depression and brain waves, thereby preventing addicts from relapse.

CONTEXT: The safety and efficacy of several repurposed drugs, including hydroxychloroquine and chloroquine, with or without azithromycin, were presumed to be miraculous in treating patients with COVID-19. However, as it later transpired, these therapeutic agents seem to be associated with critical adverse cardiac events. OBJECTIVES: Given the skepticism around the advantages and disadvantages of the aforementioned treatment strategies, the present study aimed to investigate the clinical efficacy and cardiac toxicity of hydroxychloroquine or chloroquine with or without azithromycin in the setting of COVID-19 infection. METHOD: This was an umbrella review conducted on patients with COVID-19 who received hydroxychloroquine or chloroquine with or without azithromycin from January 2020 to November 2020. We systematically searched PubMed, Scopus, Cochrane, ProQuest, Web of Science, and Embase databases. RESULTS: Three studies (systematic review and meta-analysis) were analyzed to evaluate the arrhythmogenic potential of hydroxychloroquine or chloroquine with or without azithromycin in patients with COVID-19 and identify the clinical efficacy of such a combination. CONCLUSIONS: We found no benefit for patients with COVID-19 who received hydroxychloroquine or chloroquine alone or in combination with azithromycin. Moreover, it is noteworthy that these medications, particularly when considering co-administration, could result in both statistically and clinically elevated risks of notorious arrhythmias, such as TdP.

Surface waters are very important for society, as they are a source of potable water, as well a water supply for agricultural, industrial and recreational purposes. This paper presents changes in the quality of the water in the Utrata River, along its entire length, as a function of the catchment areas land use. Water-quality measurements were carried out once a month for a total period of one year (April 2019CMarch 2020) at 24 measurement points. The concentrations of the following compounds were measured: total phosphorus, ammonia nitrogen and nitrate nitrogen, dissolved oxygen, and chemical oxygen demand. The results were compared with the limit values specified in the Regulation of the Minister of Maritime Economy and Inland Navigation. In order to determine the impact of land use on water quality in the Utrata River, principal component analyses (PCA) were conducted. The research demonstrated a considerably negative impact of agricultural land use and the presence of urban areas on the water quality of the Utrata River, with elevated concentrations of total phosphorus, ammonia nitrogen, nitrate nitrogen and COD, and decreasing concentrations of dissolved oxygen. The presented results point to the need for effective strategies to mitigate the adverse impact of agriculture and urbanisation on the environment and surface waters.