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Blood pressure is controlled through a complex network of interacting peptide systems, principally involving the angiotensin, natriuretic peptide, endothelin and apelin families. The most complex and thoroughly investigated is the renin-angiotensin system (RAS) in which selective and potent inhibitors of the key biosynthetic proteolytic enzymes, renin and angiotensin-converting enzyme (ACE), have proved to be valuable drugs for the effective treatment of hypertension and heart failure, as well as other cardiovascular and renal disorders. Some of the other proteases in these pathways, e.g.neprilysin and ACE2, are also being explored as potential drug targets. © 2023 Elsevier Inc. All rights reserved.
ABSTRACT
Background: During the COVID-19 pandemic, a preventive and widely mandatory use of face masks was a dominant segment of the infection prevention and control of the epidemic. Covering about 60-70% of the facial surface, face masks dramatically affect social interactions-especially emotion recognition, expression and mentalization. Difficulties in communication in the doctor-patient relationship become of paramount importance to the effectiveness of the healing work. This becomes even more critical when the patient suffers from a disorder characterized by a mentalization deficit. In our study, we use the theory of social representations to examine the contents with which mask wearing has become part of our everyday knowledge. Objectives: We aimed to explore the social representations of mask wearing considering its impact on interpersonal communication, in groups where the effectiveness of mutual understanding is critical. Methods: In our study, carried out during the second and third waves of the coronavirus epidemic in Hungary, we gave a free association task to the target word .,mask-wearing"in a group of medical doctors, and hospitalized somatic and psychiatric patients and healthy controls (total of 81 subjects, mean age 43.1 [13.83] years), then used the obtained associations to form semantic categories and to map the structure of social representations within the groups using a rank-frequency method. Results: The positive experience of safety and the negative experience of physiological discomfort caused by the facemasks were consistently central to the social representations of mask-wearing in all study groups. Differences were found between groups in terms of more mature elaborative categories, as well as anxiety, aggression, helplessness, damaged dependency needs, and forced conformity. Conclusions: The analysis of the social representations revealed ambivalent meanings of the mask wearing. Although there were significant differences in the structure of mask-related social representations, the mask was recognized as an "inconvenient but necessary"health protection measure in most of the groups studied. Based on the results, each group may be at risk in a different way or deal differently with the pandemic based on their specific representations. © 2022 A Szerzo(k).
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Learning Objectives:Our objective for this initiative was to create a novel and interactive activity that would be feasible in the virtual setting and challenge the residents to collate and evaluate information to create an infographic resource, all while reviewing FOAM evaluation and the content area selected. : Emergency Medicine (EM) residents utilize free open access medical education (FOAM) sources, and many create them to distribute publicly. They often lack training on creation of educational resources despite serving in educator roles within their communities. During the COVID-19 pandemic, use of virtual resources increased with medical professionals seeking information from FOAM sources. The transition to virtual didactic conferences posed the challenge of creating active learning opportunities. Here we present a novel, interactive FOAM creation challenge for EM residents. Our objective was to create a unique challenge where residents would compete while creating, evaluating and disseminating FOAM resources. In May 2020, all 42 EM residents were placed in groups of 5-7 with diversity in training level and were tasked with creating a single-page infographic using free online sites to be used on-shift as a point-of-care reference. Groups met virtually during conference. We chose ECG interpretation and triage in the emergency department as the topic. At our institution, PGY-3 residents are allowed to “sign” triage 12-lead electrocardiograms (ECGs), a process including determining if it meets ST-elevation myocardial infarction (STEMI) criteria and identifying other pathologies needing immediate intervention. We further subdivided the topic into determination of STEMI, STEMI equivalents, STEMI mimics and other emergent findings. The residents and faculty jointly created and validated a novel grading rubric (Figure 1). Infographics from each team were then de-identified and assessed using the rubric and disseminated. This innovation can be utilized in any level and on any topic in medical education. It created an interactive activity challenging residents to work together virtually while applying knowledge to create usable on-shift resources. This intervention was met with positive feedback on its novelty, ability to make virtual learning interactive, and its relevance.
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Purpose: To evaluate specialist eye care in the Kimberley region after introduction of the Lions Outback Vision Kimberley Hub. The regionally based service commenced in 2020 and was established in new premises with retinal surgical services since March 2021. Kimberley region serves a population of 34,364 people including 14,299 Aboriginal people (41.6%). Methods: Ophthalmology activity in the Kimberley was compared between 2019-2021 sampling the first six-months of the year with a retrospective audit of an electronic medical records database. Population-based needs were determined with a service delivery planning calculator at Indigenous Eye Health Unit, University of Melbourne. Results: In the first six-months of 2021, there were 731 ophthalmology attendances in the Kimberley region. This compares to 310 in Jan-Jun 2020 and 662 in Jan-Jun 2019. Highest rate of telehealth consultations was during first 6 months of 2020 (19.2%) compared to 2019 (4.0%) and 2021 (6.5%). Of 102 cataracts surgeries, 50 were for Aboriginal patients in first half of 2021 compared to 26 in 2020 and 32 in 2019. Reduction in the failure to attendance rates in 2021 (21.3%) compared to 2019 (29.1%). Conclusion: A regionally-based service has resulted in an uplift in specialist eye care in the Kimberley region. COVID-19 impacted the initial services in 2020 but in 2021 there has been an increase in cataract surgeries to 74% of population-based needs for 2021 (Jan-Jun). Introduction of retinal services has resulted in eleven pars-plana vitrectomies for diabetic eye disease. This audit serves as a baseline for further monitoring of service delivery in the region.
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Background As part of an ongoing sexual network study, we assessed the impact of COVID-19 on sexual behavior of men who have sex with men (MSM). Methods The Columbus, Ohio arm of the multi-site Network Epidemiology of Syphilis Transmission (NEST) study is following 241 MSM over two years. Participants attend quarterly visits with behavioral surveys and HIV/STI testing. In April 2020, we implemented an additional survey to measure the impact of COVID-19 on sexual behavior. Our analysis compared participants' reported sexual behavior during two periods: April-July 2020 (T1) and August-December 2020 (T2). Results Of the 200 participants who completed at least one COVID-19 survey in either time period, 10 (5%) self-reported a previous COVID-19 diagnosis. We compared behaviors reported by 174 respondents who submitted surveys in both time periods. During T1, about half (46%) said they felt more anxious about sex since COVID-19;anxiety was similar during T2 (43%). Many reported engaging in online sexual activities, though we saw no meaningful differences by time period for starting or increasing chatting on hookup apps (T1=30%, T2=30%), sexting (T1=30%, T2=25%), or video chat sex (T1=16%, T2=14%). Watching pornography was reported more often in T1 than T2 (53% vs. 42%). Nearly a third of respondents (30%) in T1 reported that they were not having sex;this decreased to 17% in T2. Compared to prepandemic behavior, in T1 a majority of participants (74%) said they were less likely to have sex with a new partner, compared to 61% during T2. Conclusion During COVID-19, nearly half of MSM reported feeling more anxious about sex, and many turned to online activities in lieu of in-person sex. However, when comparing the early months of the pandemic to later months of 2020, more participants are resuming in-person sex, and willingness to have sex with new partners also rose.
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Background: Adults with rheumatic diseases are a COVID-19 vulnerable population with potential increased risk for severe infection. COVID-19 vaccines are a key strategy to ending the pandemic. Unfortunately, fears about vaccines, some of which are propagated by misinformation, are common and may prevent or inappropriately delay vaccination. Refusal or uncertainty to get a vaccine despite its availability is known as vaccine hesitancy. Objectives: This study aims at defining causes of COVID-19 vaccine hesitancy among rheumatology patients. Methods: Between November and December 2020, a cross-sectional survey was completed by rheumatology patients presenting to a large Canadian tertiary-care center for influenza immunization. COVID-19 risk factors, previous COVID-19 infection, the likelihood of getting a future COVID-19 vaccine (scale 0-10), and contextual, individual, and vaccine-specific potential determinants of vaccine hesitancy were assessed. Patients were classified into 5 groups based on how likely they were to get a future COVID-19 vaccine (0= not likely at all;2.5= unlikely;5= intermediate;7.5= likely;10= highly likely). A machine learning approach (XgBoost) was used to fit univariate models for a multi-class correlation. Results: 157 rheumatology patients completed the survey. Most were females (n=112, 71%) with a mean age of 54.6 (standard deviation 17.9). The majority (73%) had tertiary-education, and 46% were employed at the time of the survey. The most common rheumatology diagnoses were rheumatoid arthritis (n=90, 58%), systemic lupus erythematosus/vasculitis (n=41, 26%) and spondyloarthropathies (n=39, 25%). Most patients were on immunosuppressors (n=93, 59%). Only half (n=85, 54%) were highly likely to accept a future COVID vaccine, 17% (n=26) likely, 19% (n=30) intermediate, 6% (n=10) unlikely, and 4% (n=6) not likely at all. One hundred thirty-five patients (86%) previously received the flu vaccine, whereas 6% (n=10) previously rejected it. Only three patients were previously diagnosed with COVID-19 (2%) one of whom was hospitalized. Eighty-seven patients (56%) considered that the COVID-19 vaccine should be mandatory, and 101 (65%) that they should receive it. Most respondents were somewhat concerned about receiving a future COVID-19 vaccine (n=116, 76%) despite that 65% believed that vaccines benefits outweighed their risks. Almost all, (n=145, 96%) believed that governmental decisions about vaccines are in the best interest of the population, while less than half (n=70, 45%) were confident that pharmaceutical companies would provide safe and effective vaccines. One hundred participants (65%) denied feeling social pressure to get the vaccine, and 55% (n=81) were willing to pay for the vaccine. Feeling social pressure about getting a COVID-19 vaccine, having severe concerns about receiving a future COVID-19 vaccine, distrust in pharmaceutical companies, lower education, and doubts of whether vaccines benefits outweigh their risks, were negatively associated with COVID vaccine acceptance. Conclusion: Forty six percent of rheumatology patients being immunized against influenza showed at least some hesitancy towards COVID-19 vaccination. Multiple contextual, individual, and vaccine-related factors may contribute. Targeted educational strategies, including producing and communicating data on vaccine safety, may help promote vaccine uptake in this potentially vulnerable population.
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Governments restricted mobility and effectively shuttered much of the global economy in response to the COVID-19 pandemic. Six San Francisco Bay Area counties were the first region in the United States to issue a "shelter-in-place" order asking non-essential workers to stay home. Here we use CO2 observations from 35 Berkeley Environment, Air-quality and CO2 Network (BEACO(2)N) nodes and an atmospheric transport model to quantify changes in urban CO2 emissions due to the order. We infer hourly emissions at 900-m spatial resolution for 6 weeks before and 6 weeks during the order. We observe a 30% decrease in anthropogenic CO2 emissions during the order and show that this decrease is primarily due to changes in traffic (-48%) with pronounced changes to daily and weekly cycles;non-traffic emissions show small changes (-8%). These findings provide a glimpse into a future with reduced CO2 emissions through electrification of vehicles.
ABSTRACT
Neprilysin (NEP) is an integral membrane-bound metallopeptidase with a wide spectrum of substrates and physiological functions. It plays an important role in proteolytic processes in the kidney, cardiovascular regulation, immune response, cell proliferation, foetal development etc. It is an important neuropeptidase and amyloid-degrading enzyme which makes NEP a therapeutic target in Alzheimer's disease (AD). Moreover, it plays a preventive role in development of cancer, obesity and type-2 diabetes. Recently a role of NEP in COVID-19 pathogenesis has also been suggested. Despite intensive research into NEP structure and functions in different organisms, changes in its expression and regulation during brain development and ageing, especially in age-related pathologies, is still not fully understood. This prevents development of pharmacological treatments from various diseases in which NEP is implicated although recently a dual-acting drug sacubitril-valsartan (LCZ696) combining a NEP inhibitor and angiotensin receptor blocker has been approved for treatment of heart failure. Also, various natural compounds capable of upregulating NEP expression, including green tea (EGCG), have been proposed as a preventive medicine in prostate cancer and AD. This review summarizes the existing literature and our own research on the expression and activity of NEP in normal brain development, ageing and under pathological conditions.