Safety Recommendations and Medical Liability in Ocular Surgery during the COVID-19 Pandemic: An Unsolved Dilemma
coronavirus, recommendations, covid-19, SARS-CoV-2, ocular surgery, Eye surgery
Ocular surgery is one of the most performed medical procedures in the world. Its limitation or suspension, recursively extended over time, could be associated with a significant increase in the number of blind people worldwide. Indeed, cataract causes more than half of all cases of visual impairment in those countries with limited availability of means for performing eye operations (e.g., Africa or India). In this scenario, the pandemic of coronavirus disease 2019 (COVID-19) quickly resulted in the suspension or sharp reduction of various ophthalmic activities considered non-urgent, including lens replacement surgery or some intraocular injections. Despite the imperative need to continuously practice eye operations to avoid the abovementioned problems, there are currently little-shared and vague recommendations among the various countries on safety in operating rooms (for health care workers and patients) and poor legal protection for surgeons (potentially transmitting the COVID-19 infectious agent). Herein, we individuated and discussed some critical points in safety recommendations and medical liability. A paradigm shift for ocular surgery during the COVID-19 era is now mandatory. While telemedicine has been able to solve some problems in clinical ophthalmology, the lack of adequate health and legal protection for surgeons and patients may result in an excessive reduction in the volume of surgical interventions during a pandemic era and the immediately following period, thus determining inability to ensure health care to all patients.
Pietro Emanuele Napoli, Matteo Nioi, Ernesto d’Aloja, Maurizio Fossarello
Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study
Abstract Background It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele) of the angiotensin converting enzyme (ACE) gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS) in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D) polymorphism and the progression to ARDS or requirement of intensive care in SARS patients. Method One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis. Results There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care. Conclusion The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection.
Chiu Rossa WK, Chim Stephen SC, Wu Alan KL, Chung Grace TY, Hui David SC, Tang Nelson LS, Chan KC Allen, Lee Nelson, Choi KW, Sung YM, Chan Paul KS, Tong YK, Lai ST, Yu WC, Tsang Owen, Lo YM Dennis
The Post Pandemic City: Challenges and Opportunities for a Non-Motorized Urban Environment. An Overview of Italian Cases
Green Deal, cycling, Public spaces, Sustainable Urban Mobility, active mobility, post-pandemic city
COVID-19 has forced city governments to reconsider the relationship between mobility, urban space and health in order to ensure physical distancing while meeting the travel needs of inhabitants. Therefore, cities around the world are already involved in the transformation of mobility through new models of sustainable transport. The World Health Organization (WHO) guidelines on mobility during the COVID outbreak are mostly directed at creating more spaces for cyclists and pedestrians, especially in densely populated urban areas, thus avoiding the overloading of public transport and the use of private cars. Through the analysis of the programs set up by the 10 main Italian metropolitan cities, chosen as a case study, this research evaluates the response implemented by local governments in order to transform urban environments in one of the world’s most pandemic-affected countries in detail. Starting from the current mobility model, this paper focuses on local government policies concerning post-COVID sustainable mobility to understand policies, approaches and measures in depth, as well as the effectiveness of the ongoing actions in shaping future urban mobility. From the research, an almost homogeneous awareness among policy makers and planners emerges concerning the need to rethink urban spaces and mobility, to make up for lost time and to start a green revolution that is aimed at quickly decarbonizing urban transport and enhancing cycling and walking through the city.
Environmental effects of industries and plants, Renewable energy sources, Environmental sciences
Passata è la tempesta …”. A land use planning vision for the Italian Mezzogiorno in the post pandemic"
regional development, regional planning, Italian Mezzogiorno
The Covid-19 pandemic event can activate a comprehensive reflection on the change of development models, overcoming the current unsustainable ones. Present events in Italy are mainly affecting Northern Regions but also the Southern ones will suffer from economic consequences, related to the pandemic. This is particularly relevant for the marginal areas of the Italian Mezzogiorno. The article highlights issues that are deemed relevant for including inner areas of Italian Southern regions into the process of economic recovery after the pandemic, in order to avoid the deepening of the long lasting North South imbalance, in the light of the growing depopulation of this part of the Country. The focus is on the role of Health Services, Education, Built up Environment and Transports, systems considered as key elements for promoting a well-balanced use of existing territorial assets. The real challenge is to reverse this terrible threat into an opportunity, introducing effective changes into the way we waste our limited planetary resources, especially the territorial ones. In this direction, Southern regions can play a fundamental role for increasing the resilience of the entire nation.
Paolo La Greca, Francesco Martinico, Fausto Carmelo Nigrelli
TeMA: Journal of Land Use, Mobility and Environment
Transportation engineering, Urbanization. City and country
Reverse Logistics Network Design for Effective Management of Medical Waste in Epidemic Outbreaks: Insights from the Coronavirus Disease 2019 (COVID-19) Outbreak in Wuhan (China)
Medical Waste, Epidemic outbreak, Network design, reverse logistics, operations research, epidemic logistics
The outbreak of an epidemic disease may pose significant treats to human beings and may further lead to a global crisis. In order to control the spread of an epidemic, the effective management of rapidly increased medical waste through establishing a temporary reverse logistics system is of vital importance. However, no research has been conducted with the focus on the design of an epidemic reverse logistics network for dealing with medical waste during epidemic outbreaks, which, if improperly treated, may accelerate disease spread and pose a significant risk for both medical staffs and patients. Therefore, this paper proposes a novel multi-objective multi-period mixed integer program for reverse logistics network design in epidemic outbreaks, which aims at determining the best locations of temporary facilities and the transportation strategies for effective management of the exponentially increased medical waste within a very short period. The application of the model is illustrated with a case study based on the outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan, China. Even though the uncertainty of the future COVID-19 spread tendency is very high at the time of this research, several general policy recommendations can still be obtained based on computational experiments and quantitative analyses. Among other insights, the results suggest installing temporary incinerators may be an effective solution for managing the tremendous increase of medical waste during the COVID-19 outbreak in Wuhan, but the location selection of these temporary incinerators is of significant importance. Due to the limitation on available data and knowledge at present stage, more real-world information are needed to assess the effectiveness of the current solution.
Hao Yu, Xu Sun, Wei Deng Solvang, Xu Zhao
Early trends of socio-economic and health indicators influencing case fatality rate of COVID-19 pandemic
Coronavirus disease 2019, i.e. COVID-19, started as an outbreak in a district of China and has engulfed the world in a matter of 3 months. It is posing a serious health and economic challenge worldwide. However, case fatality rates (CFRs) have varied amongst various countries ranging from 0 to 8.91%. We have evaluated the effect of selected socio-economic and health indicators to explain this variation in CFR. Countries reporting a minimum of 50 cases as on 14th March 2020, were selected for this analysis. Data about the socio-economic indicators of each country was accessed from the World bank database and data about the health indicators were accessed from the World Health Organisation (WHO) database. Various socioeconomic indicators and health indicators were selected for this analysis. After selecting from univariate analysis, the indicators with the maximum correlation were used to build a model using multiple variable linear regression with a forward selection of variables and using adjusted R-squared score as the metric. We found univariate regression results were significant for GDP (Gross Domestic Product) per capita, POD 30/70 (Probability Of Dying Between Age 30 And Exact Age 70 From Any of Cardiovascular Disease, Cancer, Diabetes or Chronic Respiratory Disease), HCI (Human Capital Index), GNI(Gross National Income) per capita, life expectancy, medical doctors per 10000 population, as these parameters negatively corelated with CFR (rho = -0.48 to -0.38 , p
Ram Niwas, Naveen Dutt, Shahir Asfahan, Gopal Chawla, Aneesa Shahul, Neeraj Gupta
SARS-CoV-2 ile İlişkili Akut Böbrek Hasarı
covid-19, böbrek fonksiyonları, akut böbrek hasarı
2019 yılının sonunda Çin'de patlak veren yeni tip koronavirüs (COVID-19) çok kısa sürede küresel bir salgın halini aldı.COVID-19 infeksiyonu esas olarak solunum sistemini etkilemekle birlikte, şiddetli akciğer tutulumu olan olgularda ileriyaş, diyabet, hipertansiyon, kardiyovasküler hastalık, kronik böbrek hastalığı (KBH) gibi yüksek risk grubundakihastalarda böbrek tutulumu sık görülmektedir. Akut böbrek hasarı (ABH), COVID-19 infeksiyonunun majörkomplikasyonlarından biridir, KBH olanlarda daha sık görülmektedir ve artmış morbidite ve mortalite ile ilişkilidir. ABH gelişen olgularda kalıcı böbrek hasarı riski artmıştır. Özellikle COVID-19 infeksiyonu sırasında böbrek fonksiyonlarının dikkatle kontrol edilmesi ve süreç içinde yakın izlem gerektiği, halen etkin bir tedavisi olmayan bu pandemik infeksiyon için yaşamsal önemdedir. Bu derlemede COVID-19 seyri sırasında gelişebilecek böbrek tutulumu ve akut böbrek hasarı tartışılmıştır.
Can We Measure a COVID-19-Related Slowdown in Atmospheric CO2 Growth? Sensitivity of Total Carbon Column Observations
covid-19, lockdown, TCCON, fossil fuel emission reduction, atmospheric CO2 growth, total carbon column observations
The COVID-19 pandemic is causing projected annual CO2 emission reductions up to −8% for 2020. This approximately matches the reductions required year on year to fulfill the Paris agreement. We pursue the question whether related atmospheric concentration changes may be detected by the Total Carbon Column Observing Network (TCCON), and brought into agreement with bottom-up emission-reduction estimates. We present a mathematical framework to derive annual growth rates from observed column-averaged carbon dioxide (XCO2) including uncertainties. The min–max range of TCCON growth rates for 2012–2019 was [2.00, 3.27] ppm/yr with a largest one-year increase of 1.07 ppm/yr for 2015/16 caused by El Niño. Uncertainties are 0.38 [0.28, 0.44] ppm/yr limited by synoptic variability, including a 0.05 ppm/yr contribution from single-measurement precision. TCCON growth rates are linked to a UK Met Office forecast of a COVID-19-related reduction of −0.32 ppm yr−2 in 2020 for Mauna Loa. The separation of TCCON-measured growth rates vs. the reference forecast (without COVID-19) is discussed in terms of detection delay. A 0.6 [0.4, 0.7]-yr delay is caused by the impact of synoptic variability on XCO2, including a ≈1-month contribution from single-measurement precision. A hindrance for the detection of the COVID-19-related growth rate reduction in 2020 is the ±0.57 ppm/yr uncertainty for the forecasted reference case (without COVID-19). Only assuming the ongoing growth rate reductions increasing year-on-year by −0.32 ppm yr−2 would allow a discrimination of TCCON measurements vs. the unperturbed forecast and its uncertainty—with a 2.4 [2.2, 2.5]-yr delay. Using no forecast but the max–min range of the TCCON-observed growth rates for discrimination only leads to a factor ≈2 longer delay. Therefore, the forecast uncertainties for annual growth rates must be reduced. This requires improved terrestrial ecosystem models and ocean observations to better quantify the land and ocean sinks dominating interannual variability.
Potential Antiviral Options against SARS-CoV-2 Infection
antivirals, broad-spectrum antivirals, antiviral drug combinations
As of June 2020, the number of people infected with severe acute respiratory coronavirus 2 (SARS-CoV-2) continues to skyrocket, with more than 6.7 million cases worldwide. Both the World Health Organization (WHO) and United Nations (UN) has highlighted the need for better control of SARS-CoV-2 infections. However, developing novel virus-specific vaccines, monoclonal antibodies and antiviral drugs against SARS-CoV-2 can be time-consuming and costly. Convalescent sera and safe-in-man broad-spectrum antivirals (BSAAs) are readily available treatment options. Here, we developed a neutralization assay using SARS-CoV-2 strain and Vero-E6 cells. We identified the most potent sera from recovered patients for the treatment of SARS-CoV-2-infected patients. We also screened 136 safe-in-man broad-spectrum antivirals against the SARS-CoV-2 infection in Vero-E6 cells and identified nelfinavir, salinomycin, amodiaquine, obatoclax, emetine and homoharringtonine. We found that a combination of orally available virus-directed nelfinavir and host-directed amodiaquine exhibited the highest synergy. Finally, we developed a website to disseminate the knowledge on available and emerging treatments of COVID-19.
Aleksandr Ianevski, Magnar Bjoras, Denis E. Kainov, Eva Zusinaite, Tanel Tenson, Valentyn Oksenych, Hilde Lysvand, Rouan Yao, Mona Høysæter Fenstad, Svetlana Biza, Tuuli Reisberg, Kirsti Løseth, Veslemøy Malm Landsem, Janne Fossum Malmring, Sten Even Erlandsen, Per Arne Aas, Lars Hagen, Caroline H. Pettersen, Jan Egil Afset, Svein Arne Nordbø
Environments, Behaviors, and Inequalities: Reflecting on the Impacts of the Influenza and Coronavirus Pandemics in the United States
coronavirus pandemic, social determinants of health, influenza pandemic, Health and social inequalities
In the past century, dramatic shifts in demographics, globalization and urbanization have facilitated the rapid spread and transmission of infectious diseases across continents and countries. In a matter of weeks, the 2019 coronavirus pandemic devastated communities worldwide and reinforced the human perception of frailty and mortality. Even though the end of this pandemic story has yet to unfold, there is one parallel that is undeniable when a comparison is drawn between the 2019 coronavirus and the 1918 influenza pandemics. The public health response to disease outbreaks has remained nearly unchanged in the last 101 years. Furthermore, the role of environments and human behaviors on the effect and response to the coronavirus pandemic has brought to light many of the historic and contemporaneous inequalities and injustices that plague the United States. Through a reflection of these pandemic experiences, the American burden of disparity and disproportionality on morbidity, mortality and overall social determinants of health has been examined. Finally, a reimagination of a post-coronavirus existence has also been presented along with a discussion of possible solutions and considerations for moving forward to a new and better normal.