Atomic spectrometry update: review of advances in the analysis of clinical and biological materials, foods and beverages

This update covers publications from the second half of 2021 to the middle of 2022. Advances in the application of atomic spectrometry techniques to clinical and biological materials, foods and beverages are reviewed in the text, highlighting their key features. Technical details of sample collection and preparation, as well as progresses with analytical techniques are considered and three tables complement the text, summarising details of a larger spectrum of publications. During this period, the trend toward the application of multi-element techniques, such as EDXRFS, ICP-MS and LIBS continued, in particular for food authenticity studies. Triple quadrupole ICP-MS is becoming increasing popular, as it is less affected by interferences, as well as LIBS and XRF, that require minimal sample preparation. However, AAS is still considered a valid alternative for single or a limited number of elements: as in previous years, numerous pre-concentration techniques were presented, some of which explored "greener” reagents. The interest in NPs continued, both as a potential exposure risk and for their application as tags of biological materials, and led to a wider application of spICP-MS. Chromium speciation in food received more attention than usual during this period, providing evidence that the carcinogenic species CrVI was not present. A number of studies covered the application of atomic spectrometry techniques for the indirect determination of biological macromolecules, including an interesting application of LIBS for the rapid detection of the immune response to SARS-CoV-2. © 2023 The Royal Society of Chemistry.

Post COVID-19 recovery personalised care

The impact of the pandemic shifted the focus of global healthcare systems to treating and preventing COVID-19 infection. In October 2021 the World Health Organisation published a clinical case definition of Post COVID syndrome which included symptoms of post viral infection that had lasted for over 3 months which followed the work of patient led groups naming this condition Long Covid (Callard and Perego 2021). Globally more than 100 million people are living with prolonged symptoms of COVID-19 infection which is creating a huge demand on clinical services. Impact of Post COVID Syndrome: The symptoms of Post COVID syndrome are extensive, can fluctuate, be relapsing - remitting and can have a significant impact on an individuals activities of daily living including work. It was recognised by Greenhalgh et al (2020) that people with prolonged symptoms will require an interprofessional holistic assessment and a paced approach to recovery embracing self-management and peer support strategies. Personalised care approaches to Post COVID Care: The universal personalised care model embeds six evidencebased components of personalised care with well documented benefits in many conditions including asthma and COPD. These approaches must be embedded for people with Post COVID Syndrome and involve people with lived experience. Conclusion(s): Post COVID Syndrome can be a debilitating multisystem relapsing condition which needs a holistic, individualised, personalised approach to care.

Angiotensin 1-7 in severe COVID-19 patients: a phase 1 clinical trial (preprint)

Background: The coronavirus-related disease (COVID-19) is mainly characterized by a respiratory involvement, with few available therapeutics for critically cases. The renin-angiotensin system (RAS) has a relevant role in the pathogenesis of COVID-19, as the virus enter host's cells via the angiotensin-converting enzyme 2 (ACE2) and RAS disequilibrium promote inflammation and fibrosis. Exogenous angiotensin-(1-7) might modulate RAS in COVID-19 patients; however, no data on its safety are available in this setting. Methods: This investigator-initiated, open label, phase I clinical trial was conducted to test the safety of intravenous administration of Angiotensin-(1-7) in severe COVID-19 patients admitted in two intensive care units (ICU) in Belo Horizonte, Brazil. In addition to standard of care, intravenous administration of Angiotensin-(1-7) was started at 5 mcg/Kg*day and increased to 10 mcg/Kg*day after 24 hours and continued for a maximum of 7 days or until ICU discharge. The rate of serious adverse events (SAEs) served as the primary outcome of the study. Results: Between August and December 2020, 28 patients were included (mean age of 55.8 + or -12.0 years). All but one patient underwent dose escalation after 24 hours and 8 (28.5%) received the treatment until day 7. No significant differences in mean blood pressure and heart rate were observed before and after the initiation of the drug. During the period of intervention, 5/28 (17.8%) patients required vasopressors, 4 at low dose norepinephrine (i.e. <0.05 mcg/kg*min), while one patient required higher doses because of septic shock. One patient presented with sinus bradycardia, which was considered possibly related to the study drug and resolved after discontinuation. Six patients (21.4%) died before ICU discharge. Conclusions: Intravenous infusion of Angiotensin-(1-7) up to 10 mcg/Kg*day was safe in severe COVID-19 patients and could represent a potential therapeutic strategy in this setting.

Increased circulating levels of angiotensin-(1-7) in severely ill COVID-19 patients (preprint)

The mono-carboxypeptidase Angiotensin-Converting Enzyme 2 (ACE2) is an important player of the renin-angiotensin system (RAS). ACE2 is also the receptor for SARS-CoV-2, the new coronavirus that causes COVID-19. It has been hypothesized that following SARS-CoV-2/ACE2 internalization Ang II level would increase in parallel to a decrease of Ang-(1-7) in COVID-19 patients. In this preliminary report, we analyzed the plasma levels of angiotensin peptides in 19 severe COVID-19 patients and 19 non-COVID-19 volunteers. Unexpectedly, a significant increase in circulating Ang-(1-7) and lower Ang II plasma level were found in critically ill COVID-19 patients. Accordingly, an increased Ang-(1-7)/ Ang II ratio was observed in COVID-19 suggesting a RAS dysregulation toward an increased formation of Ang-(1-7) in these patients.

Reusable respirators as personal protective equipment during ENT surgery.

BACKGROUND: Robust personal protective equipment is essential in preventing the transmission of coronavirus disease 2019 to head and neck surgeons who are routinely involved in aerosol generating procedures. OBJECTIVE: This paper describes the collective experience, across 3 institutes, of using a reusable half-face respirator in 72 head and neck surgery cases. METHOD: Cost analysis was performed to demonstrate the financial implications of using a reusable respirator compared to single-use filtering facepiece code 3 masks. CONCLUSION: The reusable respirator is a cost-effective alternative to disposable filtering facepiece code 3 respirators. Supplying reusable respirators to individual staff members may increase the likelihood of them having appropriate personal protective equipment during their clinical duties.