Community-Based Assessment of People with Chronic Diseases and Conditions Worsening the Severity of COVID-19 in Addis Ababa City Administration

AbstractBackground: the COVID-19 pandemic stayed in a sporadic form for a long time after introducing the coronavirus in the country, later appearing in clusters within communities. During such sporadic and clustered spread of the disease, the government of Ethiopia started identifying suspects through active surveillance for COVID-19. This study aimed to describe people who have chronic illnesses that could be underlying conditions for increased severity of COVID-19.Methods: A survey was conducted in May 2020 using active community-based case surveillance in 30 randomlyselected woredas in Addis Ababa City. Data were collected from each household member by assessing for general conditions and diseases expected to increase their risk of suffering higher severity from COVID-19. Data were stored in M.S. Excel and analyzed using SPSS-version 26 for windows. Descriptive analysis was conducted to know the proportion of persons with chronic diseases, and thus the population with a higher risk of suffering more severity from COVID-19 by place, person, and time. The results are presented using tables and graphs as appropriate.Results: The point prevalence of flu-like syndrome was 51.9 per 100,000 persons, and the prevalence was higher among older people. The study showed that 11,600 per 100,000 households have at least a member with chronic diseases that worsen the severity of COVID-19 morbidity. The survey also found 6,939 and 5,140 households per 100,000 households have diabetes mellitus and hypertension, respectively, and about 1950 per 100,000 households were with bronchial asthma. Nearly a quarter of the households have people with two or more chronic diseases that worsen their risk of facing a more severe course of COVID-19 than it would be for people without those underlying conditions.Discussion: High proportion of households have people with chronic diseases that worsen their risk of suffering a more severe course of COVID-19 than it would be for people without those underlying conditions. The Ministry of Health should devise and implement mechanisms to safeguard people with chronic diseases from contracting the diseases. [Ethiop. J. Health Dev. 2021; 35(2):133-140]Keywords: COVID-19, chronic diseases, severe course of COVID-19, Addis Abab

Traversing the Waste Spectrum: Unveiling Pakistan's MSW Landscape and Solutions

Municipal solid waste (MSW) management must be sustainable in order to meet the Sustainable Development Goals (SDGs) and address health, environmental, and disposal challenges caused by the vast amounts of trash generated. MSW management going wrong puts locals in danger. In Pakistan, the production of municipal solid trash is rising daily. Urban settlers and other organizations gather a lot of waste in various forms, usually defiling and making our surroundings uninviting.  Due to the indiscriminate dumping of various wastes, the soil quality in the metropolitan area has decreased as a result of solid and liquefied waste disposal. Significant environmental concerns regarding soil and water pollution arise from transferring contaminated garbage and mixed fluid outside of waste disposal borders. The impacts of municipal garbage disposal on soil and water quality at open waste dumping sites were the main focus of this review. Using a soil and water quality index, in many regions of the world especially in regions where waste management practices are insufficient, the contamination of soil and water owing to incorrect municipal solid waste disposal is a serious environmental hazard. Open dumping, unregulated landfilling, and illegal dumping are examples of improper waste disposal practices that can result in pollution that affects the quality of the soil and water. They must also seek to identify sustainable waste management solutions. The effect of these emitted gaseous emissions has, however, been thoroughly researched. To safeguard the environment and public health, quick action must be made to control trace element pollution

Baseline distributions and sources of polycyclic aromatic hydrocarbons (PAHs) in the surface sediments from the Prai and Malacca Rivers, Peninsular Malaysia

In this study, the surface sediments of the Malacca and Prai Rivers were analyzed to identify the distributions, and sources of Polycyclic Aromatic Hydrocarbons (PAHs). The total PAH concentrations varied from 716 to 1210 and 1102 to 7938 ng g−1 dw in the sediments of the Malacca and Prai Rivers, respectively. The PAH concentrations can be classified as moderate and high level of pollution in the sediments of the Malacca and Prai Rivers, respectively. The comparison of PAHs with the Sediment Quality Guidelines (SQGs) indicates that the PAHs in the sediments of the Malacca and Prai Rivers may have the potential to cause adverse toxicity effects on the sampled ecosystems. The diagnostic ratios of individual PAHs indicate both petrogenic- and pyrogenic-origin PAHs with dominance of pyrogenic source in both rivers. These findings demonstrate that the environmental regulations in Malaysia have effectively reduced the input of petrogenic petroleum hydrocarbons into rivers

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Laser-assisted synthesis of Z-scheme TiO2/rGO/g-C3N4 nanocomposites for highly enhanced photocatalytic hydrogen evolution

Constructing nanocomposite structures with favorable charge transfer routes is an effective way to obtain highly efficient photocatalysts. Herein, fabrication of indirect and noble metal-free Z-scheme photocatalytic architecture is demonstrated using pulsed laser ablation in liquids (PLAL) technique for the first time. The as-prepared ternary photocatalyst (denoted as TiO2/rGO/g-C3N4) comprises titanium dioxide (TiO2) nanotubes, reduced graphene oxide (rGO) nanosheets, and graphitic carbon nitride (g-C3N4) nanosheets. The photocatalytic activity of the as-synthesized composite is evaluated by monitoring water splitting. Various analytical techniques were employed to investigate the compositional, morphological, structural, and optical properties of the photocatalysts. The system of TiO2/rGO/g-C3N4 with the weight ratio of TiO2 to g-C3N4 of 2:4 and 1% rGO exhibited the highest hydrogen production rate of 32 +/- 1 mmol g(-1)h(-1), which is about 93, 3.8 and 2.6 times higher than those of pure g-C3N4, TiO2, and TiO2/rGO, respectively. This enhanced performance can be ascribed to the strong interfacial bonding (TiO2/rGO/g-C3N4), extended visible light absorption capacity due to higher photo-responsiveness of rGO and g-C3N4, the synergetic effect between TiO2 and g-C3N4 and direct contact between TiO2 and rGO which facilitated efficient separation and transfer of photogenerated charges. This study opens opportunities for the fabrications of different Z-scheme systems for various applications

Are sexual problems more common in men who have had a vasectomy? A population based study of Australian men

Introduction.: It is not known whether sexual problems are currently more prevalent among men who have had a vasectomy compared with those who have not had a vasectomy. Aim.: To investigate whether vasectomized men are more likely to report experiencing a range of sexual problems than nonvasectomized men and to assess their overall sexual and relationship satisfaction. Methods.: A population-based survey of 3,390 Australian men's sexual experiences was conducted using computer-assisted telephone interviewing. Main Outcome Measures.: Proportions of vasectomized and nonvasectomized men who: (i) reported a sexual problem for at least 1 month during the last 12 months; and (ii) rated their sexual and relationship satisfaction as either extremely satisfying or not extremely satisfying. Results.: Vasectomy was reported by 25.1% of men, almost 70% of whom were aged 40-59 years. Vasectomized men were more likely to be married, live in regional areas, and speak English at home. Having a vasectomy was not associated with any specific sexual problem, such as lacking interest in sex or taking too long to reach orgasm. Vasectomized men (10.8%) were slightly more likely than nonvasectomized men (8.2%) to report problems maintaining an erection, but this difference disappeared when age and other socio-demographic variations were taken into account. Although vasectomized men (33.7%) were just as likely as nonvasectomized men (33.0%) to be extremely satisfied sexually, they were significantly more likely to be extremely satisfied with their relationship overall (48.3% vs. 42.9%). Conclusion.: Our findings suggest that sexual problems are no more prevalent among vasectomized men than they are among nonvasectomized men