Acute Kidney Injury in Critical Care COVID-19 Patients on Invasive Mechanical Ventilation: The Potential Preventive Role of Dexamethasone.

Background: A high incidence of acute kidney injury (AKI) has been reported in coronavirus disease 2019 (COVID-19) patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone (DXM) as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study. Objective: The objective of this study was to evaluate the association between DXM and AKI in COVID-19. Methods: In this prospective observational cohort study, we evaluated the incidence of AKI in critically ill COVID-19 patients undergoing mechanical ventilation, and the association of DXM treatment with the incidence, severity, and outcomes of AKI. The association between DXM treatment and AKI was evaluated by multivariable logistic regression. The association of the combination of DXM treatment and AKI on mortality was evaluated by Cox-regression analysis. Results: We included 552 patients. AKI was diagnosed in 311 (56%), of which 196 (63%) corresponded to severe (stage 2 or 3) AKI, and 46 (14.8%) received kidney replacement therapy. Two hundred and sixty-seven (48%) patients were treated with DXM. This treatment was associated to lower incidence of AKI (Odds Radio 0.34, 95% Confidence intervals [CI] 0.22-0.52, p < 0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. DXM treatment significantly reduced mortality in patients with severe AKI (HR 0.63, 95%CI 0.41-0.96, p = 0.032). Conclusions: The incidence of AKI is high in COVID-19 patients under IMV. DXM treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI.

SMOKING PLAYING AS A RISK FACTOR TO OTHER DISEASES: A META-ANALYSIS

On July 21, 2021, a report from the World Health Organization indicated that there are presently 1.3 billion tobacco smokers globally. Data statistics show that the mortality rate of tobacco use is already at 3,021,098. Although smoking receives the lowest mortality rate among other communicable and non-communicable diseases in 2021, research suggests that smoking could hamper the quality of life of someone who already has an existing illness. This study investigated the adverse effects of smoking as a contributory factor to communicable diseases such as HIV/AIDS, Tuberculosis, and COVID-19, noncommunicable diseases like Malaria and Dengue, and risk factors such as alcohol and obesity. The locale of the study is Philippines. Meta-analysis is utilized in order to examine data statistics of the Philippines in comparison to its Southeast Asian neighbors. Meta-analysis was used by the author to extrapolate data from various quantitative and qualitative documents from 2000 up to the present. Specifically, open-access journal articles and data from legitimate databases like ISI Scopusindexed journals and/or websites were collated substantially. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis.

BACKGROUND: Patients undergoing surgery with perioperative COVID-19 are suggested to have worse outcomes, but whether this is COVID-related or due to selection bias remains unclear. We aimed to compare the postoperative outcomes of patients with and without perioperative COVID-19. METHODS: Patients with perioperative COVID-19 diagnosed within 7 days before or 30 days after surgery between February and July 2020 from 68 US hospitals in COVIDSurg, an international multicenter database, were 1:1 propensity score matched to patients without COVID-19 undergoing similar procedures in the 2012 American College of Surgeons National Surgical Quality Improvement Program database. The matching criteria included demographics (e.g., age, sex), comorbidities (e.g., diabetes, chronic obstructive pulmonary disease, chronic kidney disease), and operation characteristics (e.g., type, urgency, complexity). The primary outcome was 30-day hospital mortality. Secondary outcomes included hospital length of stay and 13 postoperative complications (e.g., pneumonia, renal failure, surgical site infection). RESULTS: A total of 97,936 patients were included, 1,054 with and 96,882 without COVID-19. Prematching, COVID-19 patients more often underwent emergency surgery (76.1% vs. 10.3%, p < 0.001). A total of 843 COVID-19 and 843 non-COVID-19 patients were successfully matched based on demographics, comorbidities, and operative characteristics. Postmatching, COVID-19 patients had a higher mortality (12.0% vs. 8.1%, p = 0.007), longer length of stay (6 [2-15] vs. 5 [1-12] days), and higher rates of acute renal failure (19.3% vs. 3.0%, p < 0.001), sepsis (13.5% vs. 9.0%, p = 0.003), and septic shock (11.8% vs. 6.0%, p < 0.001). They also had higher rates of thromboembolic complications such as deep vein thrombosis (4.4% vs. 1.5%, p < 0.001) and pulmonary embolism (2.5% vs. 0.4%, p < 0.001) but lower rates of bleeding (11.6% vs. 26.1%, p < 0.001). CONCLUSION: Patients undergoing surgery with perioperative COVID-19 have higher rates of 30-day mortality and postoperative complications, especially thromboembolic, compared with similar patients without COVID-19 undergoing similar surgeries. Such information is crucial for the complex surgical decision making and counseling of these patients. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.

The Presence of Non-pharmaceutical Interventions Correlates with Decreased Rates of Asthma Exacerbations and RSV infections in Arkansas

Rationale: To reduce transmission of SARS-CoV-2, non-pharmaceutical interventions (NPIs), including school closures, hand hygiene, mask mandates, and social distancing, were enforced in Arkansas from 3/2020-2/2021. We hypothesized that the presence of NPIs would correlate with a decrease in asthma exacerbations and viral infections. Methods: Demographic information was collected on subjects with asthma exacerbations or viral infections from 3/2018-5/2022, including age, race, ethnicity, and sex. To evaluate the effects of NPIs, three periods were considered: pre- (03/2018-02/2020), during (03/2020-02/2021), and post- (03/2021-05/2022) NPIs. ANOVA analysis and generalized linear models were performed to determine statistical significance. The stringency of NPIs was evaluated using publicly available data (Oxford Covid-19 Government Response Tracker), which allows for direct comparison of Arkansas NPI status to exacerbation data during the same time periods. Results: 5055 asthma exacerbations (3322 unique subjects) occurred between 3/2018-5/2022. Asthma exacerbations decreased from 3/2020-3/2021 and returned to pre-pandemic numbers by summer 2021 (p<0.0001). Similar downward trends occurred for respiratory syncytial virus (RSV) with out-of-season return in summer 2021 (p<0.0001). Rhinovirus was present throughout NPIs. The mean age of exacerbations decreased by 0.9 years when comparing the during NPIs and after NPIs periods (p = 0.0002). An increase in the proportion of exacerbations was noted for non-black and other/unknown ethnicity subjects during and after NPIs. Conclusions: Fewer asthma exacerbations occurred during the most significant NPI employment period (03/2020-02/2021), and an increase in exacerbations was seen as mitigation strategies were relaxed, which correlated with timing of increasing RSV infections.

Faculty perspectives on a collaborative, multi-institutional online hydrology graduate student training program

The CUAHSI Virtual University is an interinstitutional graduate training framework that was developed to increase access to specialized hydrology courses for graduate students from participating US institutions. The program was designed to capitalize on the benefits of collaborative teaching, allowing students to differentiate their learning and access subject matter experts at multiple institutions, while enrolled in a single course at their home institution, through a framework of reciprocity. Although the CUAHSI Virtual University was developed prior to the COVID-19 pandemic, the resilience of its online education model to such disruptions to classroom teaching increases the urgency of understanding how effective such an approach is at achieving its goals and what challenges multi-institutional graduate training faces for sustainability and expansion within the water sciences or in other disciplines. To gain faculty perspectives on the program, we surveyed (1) water science graduate program faculty who had served as instructors in the program, (2) water science graduate program faculty who were aware of the program, but had not participated, and (3) departmental chairs of participating instructors. Our data show widespread agreement across respondent types that the program is positive for students, diversifying their educational opportunities and increasing access to subject matter experts. Concerns and factors limiting faculty involvement revolved around faculty workload and administrative barriers, including low enrollment at individual institutions. If these barriers can be surmounted, the CUAHSI Virtual University has the potential for wider participation within hydrology and adoption in other STEM disciplines.

Antiviral potential of diminazene aceturate against SARS-CoV-2 proteases using computational and in vitro approaches.

Diminazene aceturate (DIZE), an antiparasitic, is an ACE2 activator, and studies show that activators of this enzyme may be beneficial for COVID-19, disease caused by SARS-CoV-2. Thus, the objective was to evaluate the in silico and in vitro affinity of diminazene aceturate against molecular targets of SARS-CoV-2. 3D structures from DIZE and the proteases from SARS-CoV-2, obtained through the Protein Data Bank and Drug Database (Drubank), and processed in computer programs like AutodockTools, LigPlot, Pymol for molecular docking and visualization and GROMACS was used to perform molecular dynamics. The results demonstrate that DIZE could interact with all tested targets, and the best binding energies were obtained from the interaction of Protein S (closed conformation -7.87 kcal/mol) and Mpro (-6.23 kcal/mol), indicating that it can act both by preventing entry and viral replication. The results of molecular dynamics demonstrate that DIZE was able to promote a change in stability at the cleavage sites between S1 and S2, which could prevent binding to ACE2 and fusion with the membrane. In addition, in vitro tests confirm the in silico results showing that DIZE could inhibit the binding between the spike receptor-binding domain protein and ACE2, which could promote a reduction in the virus infection. However, tests in other experimental models with in vivo approaches are needed.

COVID-19 Impacts Highlight the Need for Holistic Evaluation of Research in the Hydrologic Sciences

As we reckon with the effect of COVID-19 on the research enterprise in hydrologic science, it is important to acknowledge that disruptions will be persistent and that institutional-level adjustments, while helpful, are not sufficient to mitigate all impacts on hydrologic scientists. Here, we describe the breadth of research contributions in the hydrologic sciences, consider how the pandemic has impacted this portfolio of contributions, document one impact that is already being realized in publication of research, and suggest guidance to the hydrologic science community, institutions, review panels, and funding organizations in considering these impacts at various stages of hiring and promotion in our community. Acknowledging the diversity of contributions to research is particularly valuable because it provides a more objective, transparent, and holistic basis for evaluating individuals within the context of norms of the hydrologic science community. With clearly established values, it is easier to identify impacts of life events, such as those related to the COVID-19 pandemic, as they are manifested in individuals under a diversity of circumstances.

Disproportionalities in COVID-19 Clinical Drug Trials in the United States: A Systematic Literature Review

Background. To combat higher rates of COVID-19 infection, hospitalization, and death among minorities, it is crucial to identify safe, efficacious, and generalizable treatments. Therefore, the purpose of this systematic literature review was to assess the demographic characteristics of COVID-19 clinical trial participants. Methods. A literature search was performed according to the PRISMA checklist using PubMed from December 1, 2019 to November 24, 2020 with the following search terms: 2019-nCoV, COVID-19, SARS-CoV-2, clinical trial, randomized controlled trial, observational study, and veterinary. To capture additional results, keyword searches were performed using various versions and plural endings with the title/ field tag. Randomized controlled trials evaluating a pharmacologic treatment for COVID-19 patients from one or more U.S site written in the English language were eligible for inclusion. Descriptive statistics were calculated to characterize age, gender, race, and ethnicity of patients enrolled in the included COVID-19 clinical trials, as well as for comparison with national COVID-19 data. Results. A total of 4472 records were identified, of which 16 were included. Most were placebo-controlled (69%) and included hospitalized patients with COVID-19 (69%). Demographic data were reported for each study arm in 81% of studies. Median number of participants was higher in studies of nonhospitalized patients (n=452 [range 20-1062] vs n=243 [range 152-2795]). Nine (56%) studies reported mean or median ages of 50 years or older amongst all study arms. Males comprised more than half of the study cohort in 50% of studies. Race and ethnicity were reported separately in five (31%) studies, reported in combination in four (25%), while six (38%) reported only race or ethnicity. White or Caucasian patients made up most participants across all arms in 75% of studies. Based on national COVID-19 data, hospitalizations were similar between White persons and African American persons, but higher than other race or ethnic groups, and evenly distributed among males and females. Conclusion. Lack of heterogeneously reporting demographic characteristics of COVID-19 clinical trial participants limits the ability to assess the generalizability of pharmacologic treatments for COVID-19.

Feasibility of Telemedicine Home Assessments for Identification of Asthma Triggers in a Rural State

Rationale: Identification and control of environmental triggers is one of the cornerstones of asthma management. Access to homes, underscored during the COVID-19 pandemic, frequently limits mitigation efforts. We sought to determine the feasibility of telemedicine for identification of home asthma triggers. Methods: Patients age 5-18 years with persistent asthma, recent exacerbation, home Internet access, and stable residency were eligible. Families were randomized to standard of care (SOC) or telemedicine (TELE);virtual assessments were performed at 2, 4, and 6 months. Data included demographics and standardized assessment of the home environment. Results: Eighteen participants were enrolled (9 TELE, 9 SOC). There were no significant differences in baseline demographics between groups. Sensitization to pollens and dust mites was most common in both groups. Housing conditions were similar. In both groups, 89% lived in detached homes with forced air (standard filter) being the most common heating source (33%). Visible signs of pests/mold were seen in <12%. 89% use scented air fresheners/candles/potpourri. The SOC group had more pets (67% versus 33%) and smoking in the home (22% versus 11%). There was less evidence of mold in the TELE group (0 versus 22%). All SOC participants use bleach/ammonia cleaning products (78% in TELE). Thirteen participants (72%) completed at least one virtual home visit. No significant barriers were identified to telemedicine encounters. All participants reported “completely” or “very” satisfied with telemedicine visits. Conclusions: Virtual home assessments for identification of asthma triggers is a feasible alternative to in-person home visits, and it is well accepted by patients.

Observational cohort study of patients referred by their GP to a covid respiratory clinic

P141 Figure 1Lung function results[Figure omitted. See PDF]ConclusionOverall, we concluded that most patients had normal chest radiographs and lung function tests. Long Covid causes a heavy symptom burden significantly affecting the individual’s quality of life with chronic breathlessness and fatigue being the most common symptoms. Females, of white British origin with a mean age of fifty-one were most frequently referred to our clinic.The results prompted us to build a suitable management plan for these patients and we questioned why predominantly white British women were referred, as data has indicated Covid 19 disproportionately affected ethnic minority groups. (Razai et al, 2021)ReferencesNHS England 2021, National Guidance for post COVID syndrome assessment clinics, viewed 21/6/20201, available at < https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/11/C1248-national-guidance-post-covid-syndrome-assessment-clinics-v2.pdf>Razai MS, Kankam HKN, Majeed A, Esmail A, Williams DR. Mitigating ethnic disparities in covid 19 and beyond. The Bmj 2021;372:m4921.

AMPLIFIED VULNERABILITIES AND RECONFIGURED RELATIONS: COVID-19, TORTURE PREVENTION AND HUMAN RIGHTS IN THE GLOBAL SOUTH

The COVID-19 pandemic has reconfigured personal, organisational and political landscapes in quite radical ways. This paper reflects on the differentiated impact of the COVID-19 pandemic and responses to it. We unpack some of the effects of the crisis on populations already subject to harassment, persecution and deprivation due to their marginal position in society or their resistance to state power. We illuminate how the current crisis is much more than a health crisis;the ways it exacerbates already existing deprivations;and how it might reveal hitherto unrecognised opportunities through which to make the world a more, rather than less, just and equitable place. Focus is on the way the crisis calls forth amplified forms of repression and consonantly amplified forms of vulnerability as well as reconfigured spaces for the operation of civil society organisations. We forward one key proposition, namely that while securitised responses to the crisis reveal an inherent conservatism, civil society responses reveal an agility and a capacity to innovate. While the inherent conservatism of securitised responses gives cause for serious concern, there is some hope to be found in the potential for innovation of civil society organisations. The revelation of humankind's shared vulnerability that is a feature of the crisis may serve as a springboard for the propagation of progressive change if we keep in mind the fundamentally human, and thus relational, nature of human rights and anti-torture work.

Same, but different? A state-level chronology of the 2014-2016 Brazilian economic recession and comparisons with the GFC and (early data on) COVID-19

This paper identifies and discusses the regional heterogeneity of the Brazilian great economic recession of 2014-16. Specifically, we outline a state-level chronology of the recession by applying the Bry-Boschan algorithm, using the states' monthly index of economic activity as reference variables. The results indicate that the recession lasted 32 months, and the economic activity fell (peak to trough) 11.8% for the average Brazilian state. However, we find a significant heterogeneity regarding timing, duration, and magnitude of the recession -- on average, more industrialized states (with greater participation of the agricultural sector) entered before (after) and stayed more (less) in a state of recession. We also find the dispersion, severity, and diffusion of the 2014-16 recession across states was far more significant than in the 2008-09 economic recession. Finally, preliminary data suggests that the significant and widespread drop in regional economic activity following the COVID-19 shock is 12.7% and 77.1% larger than those observed in the 2014-16 and the 2008-09 recessions, respectively. Our results have critical implications for policymakers.