Post Covid-19 with myocarditis: A case report

Introduction: Covid-19 infection, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a leading cause of morbidity and mortality worldwide. Myocarditis or pericarditis is a common clinical manifestation reported during the acute illness of Covid-19 infection. However, it is rarely reported during the recovery period or as part of post-Covid 19 conditions. We are reporting a case of a pregnant lady presented with post-covid 19 myocarditis with RVOT VT. Case presentation: A 44-year-old lady, Gravida 7 Para 6, presented to us at 32 weeks POA with the complaint of palpitation of 1 week, which was more frequent and persistent on the day of admission, associated with a presyncopal attack. Otherwise denied chest pain, fever or joint pain, or swelling. She had a history of Covid 19 infection 1 month prior to the onset of palpitation and had received 2 doses of SINOVAC vaccination. Upon presentation in the emergency department, she was tachycardic;however, her BP was normotensive and afebrile. Blood Investigations were unremarkable. ECG showed short run VT which self-reverted to sinus rhythm. Upon admission to CCU, she had multiple episodes of stable VT, which self-reverted to sinus rhythm. Echo showed EF 60% with no regional wall motion abnormality or valvular lesion. Cardiac MRI reported LV function of 46% with suspicion of fibrosis at the mid-septal wall. While in the ward, she had polyarthralgia, which improved with hydrocortisone. Blood investigation showed elevated inflammatory markers;otherwise, blood culture and ASOT were negative. Further investigations sent for connective tissue disease showed a positive result for ANA and ENA;however, it does not fulfill the SLICC criteria. Hence, we diagnosed her post covid 19 related myocarditis. She is currently generally asymptomatic with low-dose prednisolone and has been closely monitored for manifestation that may represent SLE. Discussion(s): The incidence of myocarditis in Covid-19 infection is 0.12%, which is 2-3 folder higher than non- covid 19 infection pneumonia;however, the prevalence in post covid infection is still unknown. It has been demonstrated that infectious causes are a significant initiating event in the pathophysiology of autoimmune disorders. A number of processes, including angiotensin-converting enzyme maladaptation, hypercoagulability, microvascular damage, and direct viral toxicity, may cause the etiology of post Covid-19 infection. Conclusion(s): Myocarditis in post Covid-19 condition is an uncommon but still possible condition that needs to be considered. It can be CTD mimickers;however, the symptoms must be closely monitored.Copyright © 2023

A systematic bibliometric review of the United Nation's SDGS: which are the most related to higher education institutions?

Purpose: This study aims to provide the current and future state of United Nations' Sustainable Development Goals (SDGs) in the higher education institutions (HEIs). Since the SDGs' proliferation, HEIs have played a crucial part in meeting the goals. Despite the central role of HEIs in accomplishing the SDGs, there has been little attention in providing a comprehensive overview of the SDGs in relation to HEIs. Design/methodology/approach: A total of 280 publications in the Web of Science database were analyzed through a bibliometric approach consisting of citation analysis, co-citation analysis and co-occurrence of keywords analysis. This review explores the current state of SDGs, its central themes of research streams and predicts future direction in the context of HEIs. Findings: The findings would assist stakeholders to strategize the SDGs on HEIs, including the government and policymakers, university top management, benefactors and academics. Three main research streams were observed sustainable curriculum;challenges and barriers of SDGs;and COVID-19 and health management. Research limitations/implications: Implications suggest that to achieve the stipulated goals in the SDGs, proper planning and strategy should be aligned proportionate to the national agenda. Originality/value: This paper presents a novel knowledge structure by mapping the most relevant SDGs in the context of HEIs based on bibliometric analysis. © 2022, Emerald Publishing Limited.

Pattern of admission and outcome of patients admitted to dedicated trauma intensive care unit (ticu), emergency department, teaching hospital, north-eastern malaysia

Background: The role of dedicated Trauma ICU (TICU) in Emergency Department is vital in the chain of trauma care to ensure rehabilitation and sustainable critical care for a better survival outcome. This study is conducted to find out demographic patterns and predictors that can affect the outcomes of trauma patients.Methods: A retrospective review of all patients admitted to TICU, Hospital Universiti Sains Malaysia (HUSM) was carried out from January 1st, 2016 till December 31st, 2018. Data were collected from TICU admission and discharge registers and were analyse using SPSS version 23.0. Results: A total of 108 trauma patients were included in this study. All cases were exclusively blunt trauma (99.1%) and mainly attributed by road traffic injuries (92.6%). In terms of trauma clinical scoring, 25%(p= 0.001) presented with GCS score < 4, 46.9% (p=0.001) with RTS score <5.5 and 15.6% (p=0.012) with APACHE II score > 28had demonstrated prolonged ICU stay (> 7 days). Meanwhile 62.5% (p= 0.000) with GCS < 4, 75% (p= 0.000) with RTS < 5.5 and 75% (p= 0.000) with APACHE II > 28 were died in TICU. Besides that, those who had prolonged ICU stay (> 7 days) were 8.5 times higher odds to get sepsis (adj OR= 8.532;95% CI: 2.710, 26.863;p= 0.000) and 7 times higher odds to get acute kidney injury (AKI) (adj OR= 7.131;95% CI: 1.464, 34.733;p= 0.015). Meanwhile, patient who received blood transfusion led to 5 folds higher odds ofassociation with rhabdomyolysis (adj OR= 4.968;95% CI: 1.821, 13.549;p= 0.002).Conclusion: In the midst of pandemic COVID-19 it is important for ED physician to early identify and prioritise high risk trauma patient based on predictors and allows for targeted monitoring and intervention that may improve their outcome and also optimise resources accordingly.

Tourists' intention to visit green hotels: building on the theory of planned behaviour and the value-belief-norm theory

Purpose: This study integrates the theory of planned behaviour (TPB) and value-belief-norm (VBN) theory to investigate tourists' intention and behaviour to visit green hotels in Malaysia. Design/methodology/approach: A total of 160 valid questionnaire responses were collected via an online survey. The partial least square–structural equation modelling (PLS-SEM) technique was utilised to assess the study framework and the hypothesised relationship. Findings: The study's results confirmed that tourists' intention to stay at a green hotel is directly influenced by their subjective norms and perceived behavioural control. Besides, the study confirms the insignificant relationship between green trust, personal norms and tourists' stay intention. On the other hand, perceived morals, responsibility, willingness to pay more and perceived consumer effectiveness were significant in explaining the customer's subjective norms, personal norms and perceived behaviour control. Research limitations/implications: The hotel industry may benefit from this empirical outcome to devise effective marketing strategies for retaining their customers, particularly in rejuvenating the impact of the COVID-19 pandemic on the industry. Practical implications: This study provides valuable practical implications for green hotel operators to develop effective strategies to attract tourists to green hotel visits. Originality/value: This study is the first to integrate the extended TPB and VBN theory to understand tourist intention to visit a green hotel. Notably, the extended TPB and VBN theory was practical and helpful in predicting tourist intention to visit a green hotel. © 2022, Muhammad Ashraf Fauzi, Mohd Hafiz Hanafiah and Velan Kunjuraman.

Mobile Network Coverage Prediction based on Supervised Machine Learning Algorithms

The need for wider coverage and high-performance quality of mobile networks is critical due to the maturity of Internet penetration in today’s society. One of the primary drivers of this demand is the dramatic shift toward digitalization due to the Covid-19 pandemic impact. Meanwhile, the emergence of the 5G wireless standard and the increasingly complex actual operating environment of mobile networks make the traditional prediction model less reliable. With the recent advancements and promising capabilities of machine learning (ML), it is seen as an alternative to the traditional approaches for ground to ground (G2G) mobile communication coverage prediction. In this study, various ML models have been tested and evaluated to develop an ML-based received signal strength prediction model for mobile networks. However, the challenge is to identify a practical ML model that can fulfill the criteria of computing speed, while still meet the prediction accuracy. A total of six categories of ML models, namely Linear Regression (LR), Artificial Neural Network (ANN), Support Vector Machine (SVM), Regression Trees (RT), Ensembles of Trees (ET), and Gaussian Process Regression (GPR) that consists of more than 20 types of established algorithms/kernels have been tested and evaluated in this paper to identify the best contender among them, in terms of speed and accuracy. Findings from the evaluation showed that the GPR model is the most accurate model for Reference Signal Received Power (RSRP) prediction in terms of RMSE and R2, followed by ET, RT, SVM, ANN and LR. Nevertheless, prediction speed and model training times are also important factors in determining the most practical model for RSRP prediction for several real-world mobile network planning applications. Finally, the ET model with Random Forest (RF) algorithm has been selected and highly recommended as the most practically employed ML model for developing rigorous RSRP predictions model in multi-frequency bands and multi-environment. The developed prediction model is capable to be utilized for the purposes of network analysis and optimization. Author

Government pandemic response strategies for AEC enterprises: lessons from COVID-19

Purpose: Policymakers are developing government-level pandemic response strategies (GPRS) to assist architecture, engineering and construction (AEC) enterprises. However, the effectiveness of the GPRS has not been assessed. Therefore, this study aims to investigate the interrelationships between GPRS and AEC enterprises. To achieve that aim, the study objectives are to compare GPRS effectiveness between small-medium and large AEC enterprises, develop groupings to categorize interrelated GPRS and evaluate the effectiveness of the GPRS and interrelated constructs. Design/methodology/approach: A systematic literature review and semi-structured interviews with 40 AEC industry professionals were carried out, generating 22 GPRS. Then, questionnaire survey data was collected among AEC professionals. In total, 114 valid survey answers were received and analyzed using the Kruskal–Wallis H test, normalized mean analysis, factor analysis and fuzzy synthetic evaluation. Findings: Small-medium enterprises have four distinct critical GPRS: “form a special task force to provide support in maneuvering COVID-19,” “provide infrastructure investment budgets to local governments,” “develop employee assistance programs that fit all types of working groups” and “diversify existing supply chain.” Large enterprises have two distinct critical GPRS: “provide help in digitalizing existing construction projects” and “mandate COVID-19 as force majeure.” Eighteen GPRS can be categorized into the following five constructs: “market stability and financial aid,” “enterprise capability management,” “supply chain improvement,” “law and policy resources” and “information and workforce management.” The former two constructs are more effective than other GPRS constructs. Originality/value: This is the first paper that evaluates the effectiveness of GPRS for AEC enterprises, providing new evidence to policymakers for well-informed decision-making in developing pandemic response strategies. © 2022, Emerald Publishing Limited.

Callus inducement of Toona sinensis: Potential agents against SARS-Corona virus replication

Bioprospecting of anti-SARS-corona virus phytochemical agents is an important issue today as an alternative to chemical drugs whose effectiveness has not been fully successful with no light effect. Quercetin, a component of Toona sinensis young leaves extract, was reported to have anti-viral activity against SARS-corona virus replication in vitro. Currently, the low efficiency of secondary metabolite production is an obstacle. Production of secondary metabolites from callus induction in vitro is considered more efficient and in a short time for commercial applications. The composition of hormones in callus media affects the secondary metabolites formed. The study was conducted to determine the effect of synthetic hormones auxin (BAP) and cytokinin (NAA) on callus percentage, fresh and dry callus cell weight and the average time of callus formation. The call percentage (100%) was obtained in different combinations of BAP and NAA in MS medium. The highest fresh weight of callus (165.50 gL−1) and dry cell weight (28.47 gL−1) were observed in MS medium (1.5 mgL−1 BAP and 1 mgL−1 NAA) within 7 days initial formation time of callus. The results showed that all the indices measured were positively correlated with callus induction in T. sinensis.

Activity screening and structure modification of artocarpin against ACE2 and main protease through in Silico method

Objective: SARS-CoV-2 is a type of coronavirus that causes COVID-19 disease. Currently, the right and effective drug for the treatment of COVID-19 has not been found. Artocarpin in the breadfruit plant (Artocarpus altilis), which was tested, has been shown to have antiviral activity. However, artocarpin has a hydroxyl group that can undergo oxidation within a certain time, thereby reducing the stability of the compound and non-specific antiviral activity. Methods: In this study, the structural modification of artocarpin was carried out to obtain compounds with anticoronavirus activity with good physicochemical properties. This research was conducted in silico, including molecular docking simulation, bioavailability prediction, and preADMET. Results: The top 20 modified compounds were selected from each target's top 3 compounds, which had better bond energies compared to the positive control. These 3 compounds have the potential to inhibit ACE2 and Mpro receptors and 1 compound are better at i nhibiting both. Conclusion: From the results of the research conducted, we conclude that the 3 best compounds can be potential candidates that can be dev eloped as COVID-19 therapy. © 2021 The Authors. Published by Innovare Academic Sciences Pvt Ltd.

The Effect of Work Motivation, Work Stress and Work Satisfaction on The Performance of Employees Working from Home (Wfh) During the Covid-19 Pandemic at Xyz University Jakarta

This study aims to investigate the partial and simultaneous effect of work motivation, work stress, work satisfaction on the performance of employees working from home (WFH) during the Covid-19 Pandemic at XYZ University Jakarta. The research method used is descriptive and verification methods with a quantitative approach. This research comprises independent variables, specifically, work motivation, work stress, work satisfaction, and the dependent variable is the performance of work from home employees. Questionnaires as a data collection technique used are distributed to work from home employees at XYZ University Jakarta with 100 respondents. Data analysis techniques used are descriptive analysis and multiple linear regression analysis. The results at a significance level of 5% indicate that: (1) work motivation, work stress, and work satisfaction have a simultaneous and significant positive effect on the performance of work from home employees at XYZ University Jakarta with the F test value showing F_calculate (73.997)>F_Table (2.70). (2) work motivation has a partial and significant effect on the performance of WFH employees at XYZ University Jakarta with the T-test value showing t_calculate (2,933) >t_Table (1,98). (3) work stress has no significant effect on the performance of WFH employees at XYZ University Jakarta with the T- test value showing t_calculate (1.544) <t_Table (1,98) (4) work satisfaction partially and significantly affects the performance of WFH employees at XYZ University Jakarta with the T-test value of t_. Calculate (3,771) >(1,98). © 2021. RIGEO. All Rights Reserved.

Cost Analysis of Distribution of the Covid-19 Vaccineusing K-Means Method and Center of Gravityin Java Island - Indonesia

The Covid-19 pandemic has caused panic everywhere, hundreds of thousands of people have been infected and thousands of others have died. After vaccines from several countries were found, WHO recommended mass vaccination to prevent Covid-19. The vaccine distribution process has been intensified, including in Indonesia. The vaccine distribution center on the island of Java is located in Bandung City, which is proposed to create a new Distribution Center so that the distribution process of vaccines at the 6 Health Offices in Java Island can be carried out quickly, in a structured manner, and that the distribution costs incurred are a minimum. The research objective was to analyze transportation costs by designing a distribution network of several distribution schemes to minimize the distribution costs for the covid-19 vaccine in Java using the K-means Method and the Center of Gravity Method. The results of the research to determine the clusterization obtained 2 clusters. Cluster 1 consists of the provinces of Central Java, D.I Yogyakarta, and East Java, cluster 2 consists of the provinces of DKI Jakarta, Banten, and West Java. From the 2 clusters, we determined the location of the new Distribution Center and obtained 2 Distribution Centers. DC cluster 1 is located at (-7.318609331, 111.3109342) Gembol area, Karanganyar District, Ngawi Regency, East Java, and DC cluster 2 is located at (-6.394390567, 106.8367357) JL Area. Sentosa Raya 9-16, Mekar Jaya, Sukmajaya District, Depok City, West Java. The total transportation cost for distributing the Covid-19 vaccine in scheme 1 is Rp. 67.748.880, the proposal for scheme 2 is Rp. 92.391.067, and the proposed scheme 3 is Rp. 80.089.714.

Critical analysis of pandemic impact on AEC organizations: the COVID-19 case

Purpose: This study aims to investigate the interrelationships between COVID-19 pandemic impact and architectural, engineering and construction (AEC) organizations. To achieve that aim, the objectives are to: identify the critical pandemic impact (CPI) of COVID-19 on AEC organizations;compare the CPI between the different organization characteristics;and analyze the interrelationships between the CPI. Design/methodology/approach: A systematic literature review of 519 articles and in-depth interviews with 40 AEC practitioners were carried out, yielding 12 COVID-19 impacts. Then, data on the 12 impact’s criticality were collected through a survey among AEC practitioners. In total, 127 valid responses were received and analyzed using mean ranking analysis, analysis of variance and Spearman’s correlation. The findings were also compared with pandemic impacts from prior works. Findings: Five CPI exist among the 12 impacts, namely, “reduced construction productivity,” “reduced foreign investment in the construction industry,” “reduced demand on construction-related works,” “disruption in the supply chain” and “reduced number of public projects.” “Reduced foreign investment in the construction industry” and “reduced demand on construction-related works” significantly impact small-medium enterprises than large enterprises. Also, “disruption in the supply chain” and “reduced construction productivity” are recurring impacts in all countries compared. Finally, moderate relationships exist between “reduced foreign investment in the construction industry” and “reduced demand on construction-related works” and “disruption in the supply chain” and “reduced construction productivity.” Originality/value: The findings can be used to prioritize available resources in developing short-term responses for COVID-19. Also, action plans can be developed to mitigate the CPI from recurring. © 2021, Emerald Publishing Limited.

Cost analysis of distribution of the Covid-19 vaccine using K-means method and center of gravity in Java Island - Indonesia

The Covid-19 pandemic has caused panic everywhere, hundreds of thousands of people have been infected and thousands of others have died. After vaccines from several countries were found, WHO recommended mass vaccination to prevent Covid-19. The vaccine distribution process has been intensified, including in Indonesia. The vaccine distribution center on the island of Java is located in Bandung City, which is proposed to create a new Distribution Center so that the distribution process of vaccines at the 6 Health Offices in Java Island can be carried out quickly, in a structured manner, and that the distribution costs incurred are a minimum. The research objective was to analyze transportation costs by designing a distribution network of several distribution schemes to minimize the distribution costs for the covid-19 vaccine in Java using the K-means Method and the Center of Gravity Method. The results of the research to determine the clusterization obtained 2 clusters. Cluster 1 consists of the provinces of Central Java, D.I Yogyakarta, and East Java, cluster 2 consists of the provinces of DKI Jakarta, Banten, and West Java. From the 2 clusters, we determined the location of the new Distribution Center and obtained 2 Distribution Centers. DC cluster 1 is located at (-7.318609331, 111.3109342) Gembol area, Karanganyar District, Ngawi Regency, East Java, and DC cluster 2 is located at (-6.394390567, 106.8367357) JL Area. Sentosa Raya 9-16, Mekar Jaya, Sukmajaya District, Depok City, West Java. The total transportation cost for distributing the Covid-19 vaccine in scheme 1 is Rp. 67.748.880, the proposal for scheme 2 is Rp. 92.391.067, and the proposed scheme 3 is Rp. 80.089.714.

The work posture analysis of packaging workers at PT. X using the reba method

PT. X reduced the drug packaging operators due to the Covid-19 pandemic. As a result, the workload they got was heavier than usual, the work posture which not following to the standards, and caused excessive fatigue for these operators. The results of systematic scientific research of Global Burden of Disease (GBD) states that one of the mains causes of lost life due to a disability (Years Lived with Disability) in Indonesia had caused by MSDs (Musculoskeletal Disorders). The purpose of this research was to analyze the work posture of PT. X's drug packaging operators so that they can anticipate muscle injury problems if the operator continues to apply for an ineffective work posture. The REBA (Rapid Entire Body Assessment) method being used to find out postural disturbances that occurred. The research was conducted by interviewing, recording, and taking photos at the drug packaging operator Line 1 at PT. X must be analyzed so that a suitable fixing or solution can be applied. And the results obtained through REBA analysis get a final value of 4, which means they got the medium level of risk activities category in Line 1 PT. X requires further research and recommending a right manual handling way to improve the operator's work posture.

COVID-19 pandemic in Southeast Asia: intervention and mitigation efforts

Purpose Coronavirus disease 2019 (COVID-19) has sent shockwaves throughout the world in less than two months. Countries in South East Asia are not spared in this plight. As the disease can be transmitted from human to human, extensive control and mitigation efforts have been taken by almost every country where the disease has been reported. Southeast Asian countries or the Association of Southeast Asian Nations (ASEAN), being one of the closest regions with China, have taken various measures to slow down and contain the spread of the pandemic virus. Design/methodology/approach Multiple strategies have been taken by the government to reduce the number of infections in the region. This includes phases of lockdowns in affected areas and federal order to close businesses to reduce the rate of infection among the people. As ASEAN comprises diverse cultures, socioeconomic backgrounds and geographical differences, steps taken are definitely based on what are deemed important and applicable to each country. Findings This paper reviews what has been taken by each of the ASEAN members and further recommendations that can be taken to ensure the issue of human security in the region can be preserved. Originality/value The originality of this paper is to show mitigation and prevention strategies undertaken by ASEAN nation in combating COVID-19.

Effect of COVID-19 on building construction projects: Impact and response mechanisms

The construction industry plays significant roles in the country's economic development and growth. There would be a domino impact on the economy if any construction projects are being delayed. As the pandemic of COVID-19 had arisen into our global that had affected the construction industry, including building projects. Identifying the underlying problems caused by COVID-19 can provide the best solution to reduce the pandemic's impact. Consequently, emphasizing the impact of COVID-19 and the strategies to address those problems in the building construction industry becomes vital. Thus, this research objective is to identify problems caused by COVID-19 in the building construction industry and mechanisms to reduce COVID-19's negative impact. The data collection involved individual interviews with 20 contractor companies that are engaged in building construction projects. Then, the data is analyzed using the thematic analysis approach. The findings show that COVID-19 is causing operational and financial issues, while financial aids and complete information is needed to overcome those impacts. These findings will help policymakers improve existing strategic plans and create new policies to cope with the circumstances caused by COVID-19 among building construction organizations. © Published under licence by IOP Publishing Ltd.

Mechanisms for addressing the impact of COVID-19 on infrastructure projects

The COVID-19 pandemic has affected the overall economy and the construction industry badly. The Movement Control Order (MCO) caused the suspension of the construction sector, including infrastructure projects. Contractors are suffering losses and facing many problems caused by the pandemic, even with the on-going government financial aids. By identifying the right approaches to improve existing government policies and strategies, contractors could better manage the problems. Thus, this research aims to explore mechanisms for reducing COVID-19's negative impact on the infrastructure construction industry. To achieve that objective, this study involves collecting and analyzing interview data with industry practitioners. The significant findings from the analysis are: (1) COVID-19 affects the infrastructure construction industry by causing financial and productivity problems;and (2) mechanisms to address those problems include legal, financial, productivity, and environmental support. This paper's finding is valuable for the government in determining the right actions in assisting contractors in this critical period. © Published under licence by IOP Publishing Ltd.

Analysis of elementary school students' mathematical resilience during learning during the COVID 19 Pandemic

This research is motivated by a change in learning methods that were initially face-to-face to online learning that resulted from the COVOD-19 outbreak. The purpose of this study was to analyze the mathematical resilience of elementary school students during learning during the COVOD-19 pandemic. The method used in this research is descriptive method with 36 elementary school students as subjects in one of the primary schools in Majalengka district, West Java, Indonesia. The results of this study, mathematics resilience of elementary school students is in the medium category. The findings related to mathematics resilience of elementary school students namely resilience is not only influenced by the complexity of the material and changes in learning methods. However other factors such as the packaging of learning by the teacher, the media used by the teacher, and the communication used by the teacher also affect the mathematics resilience of elementary school students. © 2020 Institute of Physics Publishing. All rights reserved.

Natural Flavonoids as Potential Angiotensin-Converting Enzyme 2 Inhibitors for Anti-SARS-CoV-2.

Over the years, coronaviruses (CoV) have posed a severe public health threat, causing an increase in mortality and morbidity rates throughout the world. The recent outbreak of a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the current Coronavirus Disease 2019 (COVID-19) pandemic that affected more than 215 countries with over 23 million cases and 800,000 deaths as of today. The situation is critical, especially with the absence of specific medicines or vaccines; hence, efforts toward the development of anti-COVID-19 medicines are being intensively undertaken. One of the potential therapeutic targets of anti-COVID-19 drugs is the angiotensin-converting enzyme 2 (ACE2). ACE2 was identified as a key functional receptor for CoV associated with COVID-19. ACE2, which is located on the surface of the host cells, binds effectively to the spike protein of CoV, thus enabling the virus to infect the epithelial cells of the host. Previous studies showed that certain flavonoids exhibit angiotensin-converting enzyme inhibition activity, which plays a crucial role in the regulation of arterial blood pressure. Thus, it is being postulated that these flavonoids might also interact with ACE2. This postulation might be of interest because these compounds also show antiviral activity in vitro. This article summarizes the natural flavonoids with potential efficacy against COVID-19 through ACE2 receptor inhibition.