A Comprehensive Review of COVID-19: Associated Endocrine Manifestations

Coronavirus disease 2019 (COVID-19) has played a significant part in systematic damage, affecting lives and leading to significant mortality. The endocrine system is one of the systems affected by this pandemic outbreak. The relationship between them has been identified in previous and ongoing research. The mechanism through which severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can achieve this is similar to that for organs that express angiotensin-converting enzyme 2 receptors, which is the primary binding site of the virus. Endocrine cells widely express angiotensin-converting enzyme 2 receptors and transmembrane serine protease 2, the primary mediators initiating the acute phase of the disease. This review aimed to identify and discuss the endocrine complications of COVID-19. This primary focus is on presenting thyroid disorders or newly diagnosed diabetes mellitus (DM). Thyroid dysfunction with subacute thyroiditis, Graves’ disease, and hypothyroidism caused by primary autoimmune thyroiditis has been reported. Pancreatic damage leads to type 1 DM because of the autoimmune nature of the disease and type 2 DM because of post inflammatory insulin resistance. Because follow-up data on COVID-19 on the endocrine glands are limited, long-term investigations are needed to assess specific effects

Counterspeeches up my sleeve! Intent Distribution Learning and Persistent Fusion for Intent-Conditioned Counterspeech Generation

Counterspeech has been demonstrated to be an efficacious approach for combating hate speech. While various conventional and controlled approaches have been studied in recent years to generate counterspeech, a counterspeech with a certain intent may not be sufficient in every scenario. Due to the complex and multifaceted nature of hate speech, utilizing multiple forms of counter-narratives with varying intents may be advantageous in different circumstances. In this paper, we explore intent-conditioned counterspeech generation. At first, we develop IntentCONAN, a diversified intent-specific counterspeech dataset with 6831 counterspeeches conditioned on five intents, i.e., informative, denouncing, question, positive, and humour. Subsequently, we propose QUARC, a two-stage framework for intent-conditioned counterspeech generation. QUARC leverages vector-quantized representations learned for each intent category along with PerFuMe, a novel fusion module to incorporate intent-specific information into the model. Our evaluation demonstrates that QUARC outperforms several baselines by an average of 10% across evaluation metrics. An extensive human evaluation supplements our hypothesis of better and more appropriate responses than comparative systems.Comment: ACL 202

Problem-based learning versus lecture-based learning in pharmacology in a junior doctor teaching program: a crossover study from northern India

Background: The undergraduate MBBS training in our country is still in the traditional mode. The main part of the curriculum consists of lecture, tutorial, practical and ward teaching classes with a limited number of problem based session. The objective of the study was undertaken to compare PBL with LBL in terms of students’ knowledge retention in the subject of Pharmacology in undergraduate medical training.Methods: The current survey was planned and executed by the Department of Pharmacology in collaboration with Medical Education Unit, MSDS Medical College, Fatehgarh in the batch currently posted in the Department of Pharmacology for practical classes. Fifty MBBS students posted were enrolled for the study and were divided in 2 groups. One of the topics was presented as LBL for the first group and as PBL for the second group. The other topic was presented as PBL for the first group and as LBL for the second group. Intervention and control groups were taken as those used PBL and LBL respectively. T test was used to compare mean scores obtained by students in the intervention and control groups.Results: Mean scores obtained by students in the intervention group (topics learnt with PBL) were higher (3.80 Vs 2.84) than mean scores obtained by students in the control group (topics learnt with LBL). Mean scores obtained by students in the intervention group were higher (3.72 Vs 2.96) than mean scores obtained by students in the control group.Conclusions: The current study indicates usefulness of Problem-based learning (PBL) over Lecture-based Learning (LBL) in terms of retention of knowledge. However further studies involving more number of students are warranted in order to generate stronger evidence on this tool for improving medical education in our setup.

Nationwide Analysis of The Outcomes and Mortality of Hospitalized COVID-19 Patients

Introduction: The Coronavirus disease 2019 (COVID-19) pandemic has affected people worldwide with the United States (US) with the largest number of reported cases currently. Previous studies in hospitalized COVID-19 patients have been limited by sample size. Methods: The National Inpatient Sample database which is the largest inpatient database in the US was queried in the year 2020 for the diagnosis of COVID-19 based on ICD-10-CM U07.1 and associated outcomes. Multivariate logistic regression analysis was used to identify predictors of mortality. STATA 16.0 was used for statistical analysis. Results: A weighted total of 1,678,995 hospitalizations for COVID-19 were identified. Median age of admitted patients with COVID-19 was 65 year (51-77) with 47.9% female and 49.2% White. Majority of the patients admitted were >65 years of age (49.3%). Hypertension and diabetes were the most common comorbidities (64.2% and 39.5%, respectively). Overall inpatient mortality was 13.2% and increasing to 55.9% in patients requiring mechanical ventilation. Trend of inpatient mortality was significantly decreasing over the year. Predictors of inpatient mortality included age, male sex, diabetes, chronic kidney disease, heart failure, arrythmia, obesity, and coagulopathy. Despite a lower proportion of patients admitted to hospital with COVID-19, Black, Hispanic, and Native Americans were at an increased adjusted odds of inpatient mortality. Disparity was also noted in income, with low median household income associated with higher risk of mortality. Conclusion: In the largest US cohort with >1.6 million hospitalized COVID-19 patients in 2020, overall inpatient mortality was 13.6% with significantly higher mortality in ventilated patients. Significant socioeconomic and racial disparities were present with minorities at higher odds of mortality

Finerenone: A New Era for Mineralocorticoid Receptor Antagonism and Cardiorenal Protection.

The renin-angiotensin-aldosterone system is a neurohormonal system responsible for maintaining homeostasis of fluid regulation, sodium balance, and blood pressure. The complexity of this pathway enables it to be a common target for blood pressure and volume-regulating medications. The mineralocorticoid receptor is one of these targets, and is found not only in the kidney, but also tissues making up the heart, blood vessels, and adipose. Mineralocorticoid receptor antagonists have been shown to slow progression of chronic kidney disease, treat refractory hypertension and primary aldosteronism, and improve morbidity and mortality in management of heart failure with reduced ejection fraction. The more well-studied medications were derived from steroid-based compounds, and thus come with a distinct side-effect profile. To avoid these adverse effects, developing a mineralocorticoid receptor antagonist (MRA) from a non-steroidal base compound has gained much interest. This review will focus on the novel non-steroidal MRA, Finerenone, to describe its unique mechanism of action while summarizing the available clinical trials supporting its use in patients with various etiologies of cardiorenal disease

POIROT: Aligning Attack Behavior with Kernel Audit Records for Cyber Threat Hunting

Cyber threat intelligence (CTI) is being used to search for indicators of attacks that might have compromised an enterprise network for a long time without being discovered. To have a more effective analysis, CTI open standards have incorporated descriptive relationships showing how the indicators or observables are related to each other. However, these relationships are either completely overlooked in information gathering or not used for threat hunting. In this paper, we propose a system, called POIROT, which uses these correlations to uncover the steps of a successful attack campaign. We use kernel audits as a reliable source that covers all causal relations and information flows among system entities and model threat hunting as an inexact graph pattern matching problem. Our technical approach is based on a novel similarity metric which assesses an alignment between a query graph constructed out of CTI correlations and a provenance graph constructed out of kernel audit log records. We evaluate POIROT on publicly released real-world incident reports as well as reports of an adversarial engagement designed by DARPA, including ten distinct attack campaigns against different OS platforms such as Linux, FreeBSD, and Windows. Our evaluation results show that POIROT is capable of searching inside graphs containing millions of nodes and pinpoint the attacks in a few minutes, and the results serve to illustrate that CTI correlations could be used as robust and reliable artifacts for threat hunting.Comment: The final version of this paper is going to appear in the ACM SIGSAC Conference on Computer and Communications Security (CCS'19), November 11-15, 2019, London, United Kingdo

In-Hospital Outcome In Patients With Acyanotic Congenital Heart Disease Undergoing Transcatheter Aortic Valve Replacement.

The purpose of the study was to determine the in-hospital outcome and resource utilization in patients with acyanotic congenital heart disease (ACHD) undergoing transcatheter aortic valve replacement (TAVR). Current guidelines from professional societies do not support TAVR in patients with ACHD, likely from a lack of supportive evidence. Temporal trends in patients with ACHD undergoing TAVR were determined using the 2016-2018 National Inpatient Sample database appropriate ICS-10-PCS code. Stata 16.0 was used for statistical analysis. 0.87% of patients undergoing TAVR had concomitant ACHD, with ASD being the most common (78%). After matching, there was no increased risk of mortality in ACHD patients undergoing TAVR compared to patients without ACHD (OR 1.43, P = 0.59). Additionally, no difference was found in the incidence of overall cardiac complications between patients with ACHD and patients without ACHD, except STEMI (OR 4.16, 95% CI, 1.08-16.00, P = 0.038), which is likely due to more comorbidity burden in the later cohort. Complications such as acute kidney injury, ischemic stroke, and bleeding were similar. Hospital resource utilization was higher in the ACHD group in the form of increased length of stay and higher mean total cost. The comparable in-hospital all-cause mortality and complication rate in ACHD patients undergoing TAVR compared to patients without ACHD is encouraging and will be helpful to design future randomized controlled trials

Phytochemical investigations, in-vitro antioxidant, antimicrobial potential, and in-silico computational docking analysis of Euphorbia milii Des Moul

Euphorbia milii Des Moul is a deciduous bush indigenous to Madagascar. The present study aims to investigate the presence of the phytochemical, in-vitro antioxidant and antimicrobial potency, and in-silico computational analysis of ethanolic and aqueous preparations of E. milii leaves and flowers. The ethanolic and aqueous extracts were tested for in-vitro antioxidant activity by DPPH, H2O2, TAC, and FRAP assay. In addition, antimicrobial potentials were assayed by agar well diffusion technique against Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Candida albicans for various clinical isolates. The qualitative phytochemical analysis results confirmed the existence of alkaloids, flavonoids, phenolics, and tannins. The quantitative analysis elicits the availability of a magnificent number of alkaloids, flavonoids, phenolics, flavonols, and tannins. Among all the extracts, aqueous extracts of leaves exhibited potent antioxidant activity in DPPH, FRAP, and H2O2 assay with the IC50 value of 30.70, 60.05, and 82.92µg/mL, respectively. In agar well diffusion assay, all extracts displayed zone of inhibition varies from 2-24mm at different concentrations ranging from 10-320 mg/mL, whereas no activity was observed against Candida albicans. Furthermore, docking-based computational analysis has revealed that beta-sitosterol and taraxerol are the plant's active constituents responsible for their antimicrobial and antioxidant activities. Research findings suggest that the E. milii plant has an excellent prospect for further study for its extended antioxidative and antimicrobial potential. It could be a natural source of various ailments and can be utilized to develop new drugs