Recombinant human DNase-I improves acute respiratory distress syndrome via neutrophil extracellular trap degradation.

BACKGROUND: Respiratory failure is the primary cause of death in patients with COVID-19, whereas coagulopathy is associated with excessive inflammation and multiorgan failure. Neutrophil extracellular traps (NETs) may exacerbate inflammation and provide a scaffold for thrombus formation. OBJECTIVES: The goal of this study was to determine whether degradation of NETs by recombinant human DNase-I (rhDNase), a safe, Food and Drug Administration-approved drug, reduces excessive inflammation, reverses aberrant coagulation, and improves pulmonary perfusion after experimental acute respiratory distress syndrome (ARDS). METHODS: Intranasal poly(I:C), a synthetic double-stranded RNA, was administered to adult mice for 3 consecutive days to simulate a viral infection, and these subjects were randomized to treatment arms, which received either an intravenous placebo or rhDNase. The effects of rhDNase on immune activation, platelet aggregation, and coagulation were assessed in mice and donor human blood. RESULTS: NETs were observed in bronchoalveolar lavage fluid and within regions of hypoxic lung tissue after experimental ARDS. The administration of rhDNase mitigated peribronchiolar, perivascular, and interstitial inflammation induced by poly(I:C). In parallel, rhDNase degraded NETs, attenuated platelet-NET aggregates, reduced platelet activation, and normalized the clotting time to improve regional perfusion, as observed using gross morphology, histology, and microcomputed tomographic imaging in mice. Similarly, rhDNase reduced NETs and attenuated platelet activation in human blood. CONCLUSION: NETs exacerbate inflammation and promote aberrant coagulation by providing a scaffold for aggregated platelets after experimental ARDS. Intravenous administration of rhDNase degrades NETs and attenuates coagulopathy in ARDS, providing a promising translational approach to improve pulmonary structure and function after ARDS.

Covid-19 Opens up domestic market for Indian shrimp

COVID-19 pandemic presents both a challenge and an opportunity to the Indian shrimp sector. With revitalizing the institutional arrangements and redirecting the focus, the Indian shrimp industry can flourish just by adapting to the needs of the local demand, even when the export prospects are uncertain. This paper takes a historical perspective of Indian shrimp farming and exports and suggests a domestic alternative/supplementary market for Indian farmed shrimp, resulting from COVID-19.

‘Care is not a burden’: a 7-4-7 framework of action for operationalising the Triple R

Our research on government policy responses to address the increase in women’s unpaid care and domestic work during COVID-19, across 59 countries of Asia and the Pacific, shows that less than 30 per cent of measures are care-sensitive and of these only 12 per cent are gender-differentiated. From this analysis, this paper proposes a care-integral approach to ensure gender-transformative outcomes. This approach comprises a unique three-tier framework for policy action constituting: (1) seven foundational care normative principles, (2) typology of four care-sensitive policy categories, and (3) seven levers of change to guide implementation. Together this 7-4-7 framework presents comprehensive strategies for policymakers to operationalise the Triple R agenda of ‘Recognise’, ‘Reduce’, and ‘Redistribute’ unpaid work. Further, this paper makes a unique contribution by redirecting attention of the Triple R approach on quantity of care, to make a case for improving the overall quality of care. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Development And Validation of a Cognitive, Affective And Behaviour (CAB) Questionnaire On Dengue In Malaysia

Introduction: Dengue fever is one of the world's most severe mosquito-borne diseases, with high morbidity and mortality rate. Poor dengue prevention practices are one of the factors contributing to dengue outbreak. National Health and Morbidity Survey (NHMS) have collected lots of population data on the prevalence of various non-communicable and communicable diseases, including dengue. NHMS 2020 however, focus on communicable diseases i.e., Dengue, Malaria, HIV & Covid-19. Notwithstanding, data on Cognitive, Affective and Behaviour (CAB) domains are scarce. Thus, this study was aimed to develop and validate CAB questionnaire on dengue in Malaysia. Material and Methods: The questionnaire was developed by adapting and improvising similar previous questionnaires used during NHMS 2015, selected published questionnaires, expert panel and literature review. A sample of 200 respondents was used to evaluate the internal consistency of the final instrument. Results: 5 experts reviewed the content validity of the CAB questionnaire while 20 respondents tested its face validity. The Cronbach's alpha coefficients scores were within the acceptable range from 0.661 to 0.677. Various adjustments were made by deleting items with low Cronbach alpha values in attempt to attain the highest possible alpha values, but further deduction could not be made due to the retention of several important domain-measurement items. Conclusions: The validity and reliability of the CAB-IHBR-Dengue-A-01 questionnaire were of 'acceptable' ranges and can be used to assess CAB. The questionnaire is a valid and reliable tool for assessing the CAB's ability to influence dengue prevention among Malaysians. © 2022 UPM Press. All rights reserved.

COVID-19 lockdown impacts on biochemical and microbiological parameters in southern Indian coast

The world’s majority of human populations are located along the coastal areas. In global scenario the coastal pollution rates are twice than that of inland sites due to the generations of wastewater releasing into the marine waters either by directly or indirectly. Water plays a significant role in transmitting diseases and indicator microorganisms that could be helpful for the screening of environmental pollutants. In coastal zones, microbial pollution cause serious ecological and public health concern, especially those occurring within or near dense populations. In India, around 72% of rural coastal populations do not use any method of water disinfection and have no sanitary facilities. Unexpectedly, the month of December 2019 has been foot printed with most unpredicted dangerous novel virus COVID-19, which caused severe morbidity and mortality throughout the world. This report highlights, regard the lockdown measures due to COVID-19 make considerable beneficial effects into the coastal ecosystems, especially in point of less pollution at the Gulf of Mannar coastal regions of Tuticorin coast and increased number in fishes indicates less human activity during the lock down period. Reduced concentration of heavy metals and mesoplastics among these costal sites are highly notable and other parameters such as drainage effluents, solid waste disposals were additionally reduced. The shutdown of NO2 emissions from the industries has its indirect reflect in southern Indian coast, with the massive decline in NO2 in coastal nitrogen, it affects the tropical conditions of coastal waters across the coastal regions through the evidence of chlorophyll-a’ decline, which is the indicator for phytoplankton biomass. © 2021 Elsevier Inc.

Assessment of Psychological Stress Associated with COVID-19 Lockdown in the Urban Adult Population of India

COVID-19, the unprecedented deadly pandemic has turned the world topsy-turvy. It has affected all the people like poor and rich, young and old, educated and uneducated, male and female with detrimental consequences. People who are in quarantine and/or lockdown are likely to develop a wide range of symptoms like psychological stress, irritability, anxiety, depression etc. Hence, this study was undertaken to assess the psychological effects of COVID-19 lockdown among adult population residing in Chennai, India. This study is a cross sectional descriptive study carried out in Chennai, India. A structured questionnaire was developed containing 25 questions related to the emotional disturbance, depression, self-concept, physical problems, cognitive changes and role performance and 7 questions related to the demographics. An online survey was conducted using a structured questionnaire using a non-probability snowball sampling technique. A total of 579 responses were received. The findings of the present study revealed that, among 579 respondents, more than half of the respondents 320(56.3%) were under severe psychological stress, 192(33.2%) respondents that is one third of the people had moderate psychological stress and remaining were having mild psychological stress. The study also revealed that there was a statistically significant association of psychological problems associated with demographic variables. Our Study revealed that people living in Chennai had severe psychological problem due to theCOVID-19 lockdown. This highlights the importance and immediate need for the development special intervention programmes for the people with psychological problems due to the COVID-19 lockdown.

Covid-19 Opens up domestic market for Indian shrimp.

COVID-19 pandemic presents both a challenge and an opportunity to the Indian shrimp sector. With revitalizing the institutional arrangements and redirecting the focus, the Indian shrimp industry can flourish just by adapting to the needs of the local demand, even when the export prospects are uncertain. This paper takes a historical perspective of Indian shrimp farming and exports and suggests a domestic alternative/supplementary market for Indian farmed shrimp, resulting from COVID-19.

A potential role for cannabichromene in modulating TRP channels during acute respiratory distress syndrome.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a life-threatening clinical syndrome whose potential to become one of the most grievous challenges of the healthcare system evidenced by the COVID-19 pandemic. Considering the lack of target-specific treatment for ARDS, it is absolutely exigent to have an effective therapeutic modality to reduce hospitalization and mortality rate as well as to improve quality of life and outcomes for ARDS patients. ARDS is a systemic inflammatory disease starting with the pulmonary system and involves all other organs in a morbid bidirectional fashion. Mounting evidence including our findings supporting the notion that cannabinoids have potential to be targeted as regulatory therapeutic modalities in the treatment of inflammatory diseases. Therefore, it is plausible to test their capabilities as alternative therapies in the treatment of ARDS. In this study, we investigated the potential protective effects of cannabichromene (CBC) in an experimental model of ARDS. METHODS: We used, for the first time, an inhalant CBC treatment as a potential therapeutic target in a murine model of ARDS-like symptoms. ARDS was induced by intranasal administration of Poly(I:C), a synthetic mismatched double-stranded RNA, into the C57BL/6 mice (6-10 male mice/group, including sham, placebo, and CBC treated), three once-daily doses followed by a daily dose of inhalant CBC or placebo for the period of 8 days starting the first dose 2 h after the second Poly(I:C) treatment. We employed histologic, immunohistochemistry, and flow cytometry methods to assess the findings. Statistical analysis was performed by using one way analysis of variance (ANOVA) followed by Newman-Keuls post hoc test to determine the differences among the means of all experimental groups and to establish significance (p < 0.05) among all groups. RESULTS: Our data showed that CBC was able to reverse the hypoxia (increasing blood O2 saturation by 8%), ameliorate the symptoms of ARDS (reducing the pro-inflammatory cytokines by 50% in lung and blood), and protect the lung tissues from further destruction. Further analysis showed that CBC may wield its protective effects through transient receptor potential (TRP) cation channels, TRPA1 and TRPV1, increasing their expression by 5-folds in lung tissues compared to sham and untreated mice, re-establishing the homeostasis and immune balance. CONCLUSION: Our findings suggest that inhalant CBC may be an effective alternative therapeutic target in the treatment of ARDS. In addition, Increased expression of TRPs cation channels after CBC treatment proposes a novel role for TRPs (TRPA1 and TRPV2) as new potential mechanism to interpret the beneficial effects of CBC as well as other cannabinoids in the treatment of ARDS as well as other inflammatory diseases. Importantly, delivering CBC through an inhaler device is a translational model supporting the feasibility of trial with human subjects, authorizing further research.

Recurrent acute otitis media: a survey of current management in England.

OBJECTIVE: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. METHODS: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. RESULTS: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. CONCLUSION: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.

Impact of the COVID-19 pandemic on virtual care in home dialysis

Background: While almost every provider and the majority of patients in the United States (US) possess the technology needed to conduct a telemedicine visit, prior to the current pandemic utilization in home dialysis was relatively low. The current study examined trends in telehealth utilization before and during the COVID-19 pandemic in US home dialysis patients treated by a large dialysis organization in the US. Methods: Telehealth was delivered using a proprietary multiparty, video, secure messaging (HIPAA compliant), scheduling, and educational resource telehealth platform DaVita Care Connect™ (DCC™) application. IT systems data were utilized to develop ongoing reports depicting patient, facility, and physician adoption rates across 1750 home dialysis programs. Data were segmented by geographic areas (9) and by time of COVID-19 dissemination within locales. Results: A meaningful increase in telehealth utilization was observed since the start of the pandemic (prior to March 2020). Among 28,500 home dialysis patients treated, the DCC™ application was installed on 18,300 patient cell phones (65.3%). Overall, 16,000 peritoneal dialysis (PD) patients and 2,200 home hemodialysis (HHD) patients participated in a telehealth visit. Fifteen thousand visits were performed in April 2020. There were 18,000 messages sent between the care team and patient and 6000 educational resources viewed by patients at home since the COVID-19 pandemic (mid-March). The numbers of social worker and dietician visits and interdisciplinary team rounds also increased over time. There was significant variation DCC™ app download and utilization across geographic regions. Conclusions: The COVID-19 pandemic has dramatically increased the use of telehealth management for home dialysis patients in the US. Examining the impact of virtual visits on patient outcomes going forward will be critical in designing post-COVID care. Balancing the integration of telehealth visits and face-to-face visits to optimize care will necessitate advancing a new care model for patients with end-stage kidney disease.

Assessment of a laboratory-based SARS-COV-2 antibody test among hemodialysis patients: A quality improvement initiative

Background: The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Assessment of newly developed anti-SARS-CoV-2 antibody tests in hemodialysis patients is needed. Methods: As part of a quality improvement (QI) initiative, nasopharyngeal swabs and predialysis blood samples were collected on the same day from adults receiving routine dialysis care at clinics managed by a large dialysis organization in the Miami, Florida, region (April 23-30, 2020). Polymerase chain reaction (PCR) tests for SARS-CoV-2 (Fulgent Genetics, Temple City, California) and chemiluminescence immunoassays (Diazyme Laboratories, Inc, Poway, California) were performed according to manufacturer protocols. For antibody tests (IgM and IgG), a reading of >;1 arbitrary unit/ mL was scored as positive. Results: Of 715 participants in the QI initiative, 38 had symptoms consistent with COVID-19 prior to or during the initiative. Among these, COVID-19 was confirmed in 14 and ruled out in 20, with 4 being inconclusive. Among the 34 patients with known COVID-19 status, the sensitivity and specificity of the antibody test were 57.1% and 85.0%, respectively, when both IgM and IgG were considered. The remaining 677 patients had no record of symptoms consistent with COVID-19 or any known exposure. Of these, 38 (5.6%) tested positive for anti-SARS-CoV-2 antibodies;none of the antibody-positive patients with available PCR results (N=33) tested positive for SARS-CoV-2. Conclusions: The operational characteristics of the laboratory-based antibody test make it sufficient to rule in, but not rule out, SARS-CoV-2 infection in the appropriate clinical circumstance. A substantial proportion of dialysis patients may have had asymptomatic SARS-CoV-2 infection.

Cannabidiol (CBD) modulation of apelin in acute respiratory distress syndrome.

Considering lack of target-specific antiviral treatment and vaccination for COVID-19, it is absolutely exigent to have an effective therapeutic modality to reduce hospitalization and mortality rate as well as to improve COVID-19-infected patient outcomes. In a follow-up study to our recent findings indicating the potential of Cannabidiol (CBD) in the treatment of acute respiratory distress syndrome (ARDS), here we show for the first time that CBD may ameliorate the symptoms of ARDS through up-regulation of apelin, a peptide with significant role in the central and peripheral regulation of immunity, CNS, metabolic and cardiovascular system. By administering intranasal Poly (I:C), a synthetic viral dsRNA, while we were able to mimic the symptoms of ARDS in a murine model, interestingly, there was a significant decrease in the expression of apelin in both blood and lung tissues. CBD treatment was able to reverse the symptoms of ARDS towards a normal level. Importantly, CBD treatment increased the apelin expression significantly, suggesting a potential crosstalk between apelinergic system and CBD may be the therapeutic target in the treatment of inflammatory diseases such as COVID-19 and many other pathologic conditions.

Neurological consequences of COVID-19: what have we learned and where do we go from here?

The coronavirus disease-19 (COVID-19) pandemic is an unprecedented worldwide health crisis. COVID-19 is caused by SARS-CoV-2, a highly infectious pathogen that is genetically similar to SARS-CoV. Similar to other recent coronavirus outbreaks, including SARS and MERS, SARS-CoV-2 infected patients typically present with fever, dry cough, fatigue, and lower respiratory system dysfunction, including high rates of pneumonia and acute respiratory distress syndrome (ARDS); however, a rapidly accumulating set of clinical studies revealed atypical symptoms of COVID-19 that involve neurological signs, including headaches, anosmia, nausea, dysgeusia, damage to respiratory centers, and cerebral infarction. These unexpected findings may provide important clues regarding the pathological sequela of SARS-CoV-2 infection. Moreover, no efficacious therapies or vaccines are currently available, complicating the clinical management of COVID-19 patients and emphasizing the public health need for controlled, hypothesis-driven experimental studies to provide a framework for therapeutic development. In this mini-review, we summarize the current body of literature regarding the central nervous system (CNS) effects of SARS-CoV-2 and discuss several potential targets for therapeutic development to reduce neurological consequences in COVID-19 patients.

The negative impact of wearing personal protective equipment on communication during coronavirus disease 2019.

BACKGROUND: Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally. METHOD: Bamford-Kowal-Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice. RESULTS: There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB). CONCLUSION: Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.

Cannabidiol Modulates Cytokine Storm in Acute Respiratory Distress Syndrome Induced by Simulated Viral Infection Using Synthetic RNA.

Introduction: In the absence of effective antivirals and vaccination, the pandemic of COVID-19 remains the most significant challenge to our health care system in decades. There is an urgent need for definitive therapeutic intervention. Clinical reports indicate that the cytokine storm associated with acute respiratory distress syndrome (ARDS) is the leading cause of mortality in severe cases of some respiratory viral infections, including COVID-19. In recent years, cannabinoids have been investigated extensively due to their potential effects on the human body. Among all cannabinoids, cannabidiol (CBD) has demonstrated potent anti-inflammatory effects in a variety of pathological conditions. Therefore, it is logical to explore whether CBD can reduce the cytokine storm and treat ARDS. Materials and Methods: In this study, we show that intranasal application of Poly(I:C), a synthetic analogue of viral double-stranded RNA, simulated symptoms of severe viral infections inducing signs of ARDS and cytokine storm. Discussion: The administration of CBD downregulated the level of proinflammatory cytokines and ameliorated the clinical symptoms of Poly I:C-induced ARDS. Conclusion: Our results suggest a potential protective role for CBD during ARDS that may extend CBD as part of the treatment of COVID-19 by reducing the cytokine storm, protecting pulmonary tissues, and re-establishing inflammatory homeostasis.