Aerosol demasking enhances climate warming over South Asia.

Anthropogenic aerosols mask the climate warming caused by greenhouse gases (GHGs). In the absence of observational constraints, large uncertainties plague the estimates of this masking effect. Here we used the abrupt reduction in anthropogenic emissions observed during the COVID-19 societal slow-down to characterize the aerosol masking effect over South Asia. During this period, the aerosol loading decreased substantially and our observations reveal that the magnitude of this aerosol demasking corresponds to nearly three-fourths of the CO2-induced radiative forcing over South Asia. Concurrent measurements over the northern Indian Ocean unveiled a ~7% increase in the earth's surface-reaching solar radiation (surface brightening). Aerosol-induced atmospheric solar heating decreased by ~0.4 K d-1. Our results reveal that under clear sky conditions, anthropogenic emissions over South Asia lead to nearly 1.4 W m-2 heating at the top of the atmosphere during the period March-May. A complete phase-out of today's fossil fuel combustion to zero-emission renewables would result in rapid aerosol demasking, while the GHGs linger on.

Evaluating spontaneous stone passage rates during the COVID-19 pandemic

INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic our institution limited elective surgery including management of kidney stones. Additionally, patients themselves were reluctant to pursue elective surgery. This presented us a unique opportunity to reassess the natural history of symptomatic nephrolithiasis given potentially prolonged periods of conservative management. METHODS: A retrospective review was performed of patients presenting to the emergency room (ER) with flank pain secondary to nephrolithiasis from March to April of 2020 (COVID peak period of elective surgery limitations), and a comparative cohort from March and April 2019. Assessed outcomes included definitive stone treatment at initial presentation to the ER, rate of spontaneous stone passage, and time to elective surgery from initial ER presentation. Chi-square or Mann-Whitney U tests were utilized for dependent binary variables and continuous variables, respectively. A Kaplan Meier analysis was used to demonstrate differences in time to elective surgery between the two eras. RESULTS: Baseline characteristics did not differ between groups (Table). Patients discharged from the ER were more often offered medical expulsive therapy (71.6% vs 55.0%, p=0.026) during the COVID era. The rate of surgical stone management or stent placement at initial presentation did not differ, however, discharged patients waited longer from initial ER presentation to elective surgery (55.3 vs 33.1 days, p=0.02). Spontaneous stone passage rates were similar between groups despite the delay, and similar stone location and stone size between eras. CONCLUSIONS: During the height of the COVID pandemic, ER patients with symptomatic stones had similar characteristics at presentation but were more often offered MET. Spontaneous stone passage during the pandemic was no different than in 2019, despite a significant difference in time to elective surgery from initial presentation to the ER with flank pain .

Key clinical research questions asked during epidemic respiratory outbreaks: A systematic review of the literature published on severe acute respiratory syndrome and middle east respiratory syndrome

Background. As evidenced by the COVID-19 pandemic, rapid collection of data on clinical characterization, treatment, and diagnostics to inform rapid public health response is paramount in an outbreak of a novel infectious agent. In 2018, The World Health Organization R&D Blueprint identified a list of priority diseases for accelerated research based on their potential to cause a public health emergency. Among these diseases were Severe acute respiratory syndrome-coronavirus (SARS-CoV) and Middle East respiratory syndrome-coronavirus (MERS-CoV). To facilitate a rapid research response during an outbreak, standardized research protocols must be prepared before the outbreak occurs. The aim of this systematic review is to identify the most common clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV to inform future clinical research protocol development for coronaviruses. Methods. Medline, Embase, and Global Health bibliographic databases were searched to identify clinical studies published on SARS-CoV and MERS-CoV in the outbreak setting. Studies were grouped thematically according to the clinical research question addressed. Results. From the research questions and objectives, eleven themes in the literature were identified: Clinical characterisation, prognosis, diagnosis, clinical management, viral pathogenesis, epidemiological characterisation, infection prevention and control, transmission, susceptibility, psychosocial, and aetiology. Case series made up the highest proportion of study designs, while clinical trials made up the lowest. 83% of the SARS-CoV studies were published after the end of the outbreak. Conclusion: The thematic analysis was used to identify the key clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV and study designs were recommended to answer these questions. By defining the key clinical research questions, this study provides a first step in creating standardized clinical research protocols and defining core data variables to be collected during future outbreaks of respiratory coronaviruses.

Anesthesia for Cardiac Surgery during COVID-19 Pandemic

The new coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure to multisystem organ dysfunction and death. Healthcare workers, particularly anesthesiologists, are at increased risk since their airway management expertise is required in situations where suspected or confirmed cases of COVID-19 require surgical procedures and in critical care settings. Such patients undergoing surgery have a higher perioperative morbidity and mortality. Additionally, aerosol-generating procedures place the operating room staff at high risk of contracting the COVID-19 infection. Here, we present a review of COVID-19 management, particularly in the perioperative setting. In addition, this article highlights specific concerns with the use of transesophageal echocardiography and the precautions to be taken during cardiopulmonary resuscitation. This review article is based on this institutional protocol supported by literature from recent publications and guidelines from major health organizations on COVID-19.