COVID MED - An Early Pandemic Trial of Losartan for Hospitalized COVID-19 Patients

Background ACEi/ARB medications have been hypothesized to have potential benefit in COVID-19. Despite concern for increased ACE-2 expression in some animal models, preclinical and observational-retrospective and uncontrolled trials suggested possible benefit. Two RCTs of the ARB losartan from University of Minnesota showed no benefit yet safety signals for losartan in outpatient and hospitalized COVID-19 patients. COVID MED, started early in the pandemic, also assessed losartan in a RCT in hospitalized patients with COVID-19. Methods COVID MED was quadruple-blinded, placebo-controlled, multicenter randomized clinical trial (RCT). Hospitalized COVID-19 patients were randomized to receive standard care and hydroxychloroquine, lopinavir/ritonavir, losartan, or placebo. Hydroxychloroquine and lopinavir/ritonavir arms were discontinued after RCTs showed no benefit. We report data from the losartan arm compared to combined (lopinavir-ritonavir and placebo) and prespecified placebo-only controls. The primary endpoint was the NCOSS slope of change. Slow enrollment prompted early stopping. Results Of 432 screened patients, 14 were enrolled (3.5%), 9 received losartan and 5 combined control (lopinavir/ritonavir [N=2], placebo [N=3]); 1 hydroxychloroquine arm patient was excluded. Most baseline parameters were balanced. Treatment with losartan was not associated with a difference in NCOSS slope of change in comparison with combined control (p=0.4) or placebo-only control (p=0.05) (trend favoring placebo). 60-day mortality and overall AE and SAE rates were numerically but not significantly higher with losartan. Conclusions In this small blinded RCT in hospitalized COVID-19 patients, losartan did not improve outcome vs. control comparisons and was associated with adverse safety signals.

Impact of COVID-19 on Rural Tourism in Nepal

This paper has focused upon the rural tourism in Nepal and the impacts of COVID-19 on its development. In Nepal tourism mostly occurs in rural environments and involves rural experiences. Wonderful rural cultures and traditional farming are attracting tourists in the rural areas. The villages of Nepal have their own unique natural and cultural dimensions. The fresh environment, natural and cultural artifacts, and the lifestyle of the local people are the main things to experience in the villages. Greatest potential benefit of rural tourism is its ability to generate money, which can translate into numerous positive economic opportunities for locals and their communities. But the COVID-19 pandemic has had a significant adverse impact on most businesses including rural tourism. Before COVID-19, rural tourism had become one of the most important activities to generate income in some rural areas of Nepal. But now all activities of rural tourism are in coma. Thus, in the post COVID-19 scenario, the very survival of the rural tourism industry will become the biggest challenge because there was no specific preparedness strategy in case of any crisis of this scale. Some measures are suggested to address the challenges and help prepare the strategy.

Video-consultation in the Emergency Department: An Assessment of the Potential Benefit for a UK District General Hospital (Preprint)

BACKGROUND DGH Emergency department referrals to a tertiary centre depend on information available from a ‘generalist’ clinician in discussion with a specialist team. If there is uncertainty, the lowest risk strategy is often to transfer the patient. Video consultation allowing the specialist team to see and talk to the patient whilst still in the Emergency department could improve decision making about patient transfer. OBJECTIVE This study assessed the potential benefit of real time video consultation between remote specialist and Emergency department patient across all specialities. METHODS Detailed patient data was collected prospectively for 6 months on all patients presenting to a DGH Emergency department who required input from a specialist team in the nearest tertiary centre. These patients were discussed retrospectively with the specialist teams to determine whether video conferencing could have benefited the patient’s management. The logistics for use of videoconferencing were explored. RESULTS 18,799 patients were seen in the Emergency department during the study period. 413 referrals were made to the tertiary centre specialist teams. Review of patients transferred indicated 193 might have benefited from video consultation. If the specialist team could be accessed via video conferencing only whilst a senior member was available in hospital (0800-2200hr) then a maximum of only 5 patients per week across all specialities would use the equipment. If 24hr specialist access was available this would increase to 7 patients per week. CONCLUSIONS Video consultation between emergency department patient and specialist has limited potential to improve patient management.

Efficiency Evaluation of the Dual System Power Inverter for On-Grid Photovoltaic System

The implementation of a dual electric system that is capable of operating with either constant current and variable voltage, or constant voltage and variable current appliances, is one of the possible options to solve low-intensity stochastic energy utilization problems from renewable energy sources. This research paper analyzes the potential benefit of a novel three-phase dual system power inverter over the conventional inverter used in a solar power plant. The concept of such a power inverter is explained, and the digital twin model is created in a MATLAB Simulink environment. The efficiency characteristic of the simulated inverter is compared to the efficiency characteristic of a real conventional inverter. A standalone data logging system and an additional data acquisition system were used to collect and process data from the real inverter. Comparison of the digital twin inverter and the real conventional inverter shows the potential benefit of this novel inverter technology. It is shown that the novel inverter can operate in a wider range of DC input power. The potential economic benefit is also presented and discussed in the paper.

A principled approach to bioethical regulation of genetic counseling: mapping the bioethical problems of genetic counseling and models for their solution

Genetic counseling is a field of high-tech medicine, and its development gives rise to many ethical and legal problems associated primarily with the specifics of genetic data. The purpose of this article is to map the problems of bioethical regulation in genetic counseling, as well as approaches to their solution. To structure the problem field, a principlist approach was chosen. Main results: It is shown that bioethical problems of genetic counseling arise not only in connection with adherence to separate bioethical principles, but also in connection with the conflict between the principles of autonomy and beneficence. It is proposed to distinguish two dimensions of this conflict: 1. Individual, associated primarily with the exercise by a person of the right not to know about his/her hereditary risks; 2. Family, associated with the contradiction between the observance of medical secrecy (as part of autonomy) and the potential benefit from informing the patient's relatives about their possible hereditary risks. Conclusions: The models for resolving bioethical collisions highlight new aspects of meaning of autonomy. In the context of genetic counseling, it is possible to understand autonomy not as non-interference, but as an opportunity to control the disposal of genetic data. At the same time, in the context of regulating this disposal, the autonomy of the patient's family members can also be taken into account.

INVESTIGATING LIGHT AND CRIME USING AMBIENT LIGHT LEVEL

A recent study investigated the influence of lighting on crime by considering the effect of change in ambient light level on crimes recorded in three US cities for the ten-year period 2010 to 2019. The results suggested a significant increase in robbery after dark, but did not suggest significant change in for any other type of crime. The current study was conducted to validate this by considering crimes recorded in three different US cities. This analysis confirmed the statistically significant increase in robbery after dark. These data do not suggest that change in ambient light level has a practically relevant effect on overall crime counts: in other words, the potential benefit of lighting for crime reduction is limited.

Tackling Workplace Bullying for Minority Ethnic Doctors

Workplace bullying, undermining and microaggressions are a reality for many, and although the prevalence may vary, there is no environment that is free of such hostile interactions. The healthcare workforce is focussed on empathy, kindness and caring, yet the daily experiences of many are in stark contrast to this. Although awareness of these issues exist, incidents of bullying are still grossly under-reported. Bullying and undermining behaviours stem from a gradient of power and lack of appreciation of the societal advantages of diversity. In keeping with this, the experience of particular sub-populations are disproportionately worse, such as for women, minority ethnic groups, those with disability, LGBTQ+ and those from deprived backgrounds. There have been campaigns and initiatives to change workplace behaviours, with mixed successes. A less explored role is that of organisations whose declared mission is to stand up for equality, represent the voice of the minorities and the under-represented, akin to self-help groups and advocacy. This article explores workplace bullying from the perspective of the minority ethnic doctors and proposes the potential benefit of their representative organisations in helping to balance the inherent workplace disadvantages.

Hypoxic preconditioning in renal ischaemia–reperfusion injury: a review in pre-clinical models

Ischaemia–reperfusion injury (IRI) is a major cause of acute kidney injury (AKI) and chronic kidney disease, which consists of cellular damage and renal dysfunction. AKI is a major complication that is of particular concern after cardiac surgery and to a lesser degree following organ transplantation in the immediate post-transplantation period, leading to delayed graft function. Because effective therapies are still unavailable, several recent studies have explored the potential benefit of hypoxic preconditioning (HPC) on IRI. HPC refers to the acquisition of increased organ tolerance to subsequent ischaemic or severe hypoxic injury, and experimental evidences suggest a potential benefit of HPC. There are three experimental forms of HPC, and, for better clarity, we named them as follows: physical HPC, HPC via treated-cell administration and stabilised hypoxia-inducible factor (HIF)-1α HPC, or mimicked HPC. The purpose of this review is to present the latest developments in the literature on HPC in the context of renal IRI in pre-clinical models. The data we compiled suggest that preconditional activation of hypoxia pathways protects against renal IRI, suggesting that HPC could be used in the treatment of renal IRI in transplantation.