The effect of renin-angiotensin blockers on COVID-19 related mortality: A tertiary center's experience

Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.Kontext: První zprávy o onemocnění koronavirem v roce 2019 (coronavirus disease 2019, COVID-19) ukazovaly na zvýšenou mortalitu jedinců s hypertenzí, což vyvolalo obavy ohledně užívání inhibitorů angiotenzin konvertujícího enzymu (ACEI) a blokátorů receptoru AT1 pro angiotenzin II (ARB). Cílem naší studie bylo posoudit možnost nepříznivého vlivu onemocnění covid-19 na závažnost hypertenze a účinnost antihypertenzní léčby. Metody: Do studie bylo zařazeno 183 pacientů s onemocněním covid-19 prokázaným PCR testem, kteří byli v období od 15. března do 15. dubna 2020 přijati do naší nemocnice a následně odesláni na kardiologickou kliniku. Údaje byly získány z nemocničních záznamů. Výsledky: Celkem 32 ze 183 pacientů s onemocněním covid-19 zemřelo v nemocnici. Incidence hypertenze se mezi pacienty, kteří přežili a zemřeli, statisticky významně nelišila (76 [50,3 %] vs. 19 [59,4 %]; p = 0,352). I když podíly pacientů užívajících inhibitory ACE byly v obou skupinách podobné, léčiva ze skupiny ARB užívalo statisticky významně více pacientů, kteří zemřeli, než těch, kteří přežili (11 [34,4 %] vs. 23 [15,2 %]; p = 0,011). Binární regresní analýza prokázala souvislost mezi užíváním ARB a mortalitou (OR: 0,032; 95% CI 1,045–2,623; p = 0,032). Závěr: Naše studie potvrdila původní obavy týkající se možných škodlivých účinků lékové skupiny ARB na mortalitu v souvislosti v onemocněním covid-19

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Design of Spatial Inverted Pendulum System

Pendulum-based systems which are highly non-linear and unstable have become one of the most widely studied subject of control theory. The close interest of researchers on inverted pendulum problem arises from its strong representation ability with real engineering applications. This study focuses on the design and production of an experimental setup in which a spatial inverted pendulum can be balanced by means of a planar mechanism in RRRRP configuration. A mechanism with two different motion inputs (rotational and linear) that no studies were performed on before was prototyped. This system is highly unstable and shows non-linear dynamic behavior. The mechanical parts that forms the system were manufactured by a 3D printer and a CNC milling machine. At the end of study, a four-degree of freedom spatial inverted pendulum experimental setup has been established on which the control works can be carried out, by installing the electronic and electro-mechanical equipment

Consumer bankruptcy:Decision, choice and access to credit afterwards

We examine the effects of the bankruptcy benefit and adverse events on the consumer bankruptcy decision. Employing zero-inflated ordered probit models and a unique longitudinal survey of approximately 66,000 individuals in Great Britain, we find that consumers are more likely to enter into bankruptcy proceedings when the bankruptcy benefit increases and when they become unemployed. We find that the effects of adverse events differ across bankruptcy types. Individuals who experience the onset of health problems are more likely to choose reorganization of debts (i.e., income gleaning), whereas individuals who get divorced or separated are more likely to prefer the discharge of debts (i.e., fresh start). We also examine access to credit after bankruptcy. We find that individuals are excluded from the credit markets post-bankruptcy and the impact differs across bankruptcy types. Credit exclusion for fresh starters is dramatic, swift but short-lived, while for income gleaners, it is gradual, slow but lasts longer

Consumer bankruptcy: decision, choice and access to credit afterwards

We examine the effects of the bankruptcy benefit and adverse events on the consumer bankruptcy decision. Employing zero-inflated ordered probit models and a unique longitudinal survey of approximately 66,000 individuals in Great Britain, we find that consumers are more likely to enter into bankruptcy proceedings when the bankruptcy benefit increases and when they become unemployed. We find that the effects of adverse events differ across bankruptcy types. Individuals who experience the onset of health problems are more likely to choose reorganisation of debts (i.e., income gleaning), whereas individuals who get divorced or separated are more likely to prefer the discharge of debts (i.e., fresh start). We also examine access to credit after bankruptcy. We find that individuals are excluded from the credit markets post-bankruptcy and the impact differs across bankruptcy types. Credit exclusion for fresh starters is dramatic, swift but short-lived, while for income gleaners, it is gradual, slow but lasts longer.</p

Consumer bankruptcy: decision, choice and access to credit afterwards

We examine the effects of the bankruptcy benefit and adverse events on the consumer bankruptcy decision. Employing zero-inflated ordered probit models and a unique longitudinal survey of approximately 66,000 individuals in Great Britain, we find that consumers are more likely to enter into bankruptcy proceedings when the bankruptcy benefit increases and when they become unemployed. We find that the effects of adverse events differ across bankruptcy types. Individuals who experience the onset of health problems are more likely to choose reorganisation of debts (i.e., income gleaning), whereas individuals who get divorced or separated are more likely to prefer the discharge of debts (i.e., fresh start). We also examine access to credit after bankruptcy. We find that individuals are excluded from the credit markets post-bankruptcy and the impact differs across bankruptcy types. Credit exclusion for fresh starters is dramatic, swift but short-lived, while for income gleaners, it is gradual, slow but lasts longer.</p

Serum Paraoxonase And Arylesterase Activities In Esophageal Cancer: A Controlled Study

Aim: Upper gastrointestinal tract carcinomas are major health problem around the world. Esophageal cancer (EC) is usually diagnosed at an advanced stage; therefore most therapeutic approaches are palliative. The aim of the study was to investigate the possible relationship between serum activities of paraoxonase (PON1) and arylesterase (ARE), and clinicopathological characteristics in EC. Method: Forty patients with EC and twenty seven healthy subjects were included in the study. The diagnosis of esophageal cancer was established by endoscopic examination of the esophagus and by biopsy confirmation. PON and ARE activities were determined by or with spectrophotometrically using paraoxon and phenyl acetate as substrates, respectively. Mann -Whitney-U test was used for statistical analysis. Result: The mean serum PON and ARE activities were significantly higher in the cancer group compared to healthy controls. Besides, mean values of serum PON and ARE activities decreased in stage 3 and stage 4 EC patients compared with stage 2 EC patients. This decrease was statistically significant. There were no statistically correlation between other clinicopathological characteristics and serum PON and ARE activities in this EC patient group. Conclusion: This is the first report on serum PON and ARE activities in patients with EC. Our results indicate that low serum PON and ARE activities may be an important indicator for advanced stage in EC. But these preliminary results need to be verified by further prospective studies for the early diagnosis of the tumor, for the detection of clinical relapse and for the monitoring of follow up treatment

The relationship between vasopressor dose and anastomotic leak in colon surgery: An experimental trial

Background: The effect of vasopressors on the healing of gastrointestinal anastomoses is still controversial. The purpose of our study was to research the relationship between dose of dopamine, which is used generally as a vasopressor in shock status, and anastomotic leak in colonic surgery