Are diabetes and its medications risk factors for the development of COVID-19? Data from a population-based study in Sicily.

Background and aims: Diabetes mellitus (DM) has been associated with higher incidence of severe cases of COVID-19 in hospitalized patients, but it is unknown whether DM is a risk factor for the overall COVID-19 incidence. The aim of present study was to investigate whether there is an association of DM with COVID-19 prevalence and case fatality, and between different DM medications and risk for COVID-19 infection and death. Methods and results: retrospective observational study on all SARS-CoV-2 positive (SARS-CoV-2+) cases and deaths in Sicily up to 2020, May 14th. No difference in COVID-19 prevalence was found between people with and without DM (RR 0.92 [0.79-1.09]). Case fatality was significantly higher in SARS-CoV-2+ with DM (RR 4.5 [3.55-5.71]). No diabetes medication was associated with differences in risk for SARS-Cov2 infection. Conclusions: in Sicily, DM was not a risk factor for COVID-19 infection, whereas it was associated with a higher case fatality

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Hydrologically Induced Deformation in Long Valley Caldera and Adjacent Sierra Nevada

Vertical and horizontal components of GNSS displacements in the Long Valley Caldera and adjacent Sierra Nevada range show a clear correlation with hydrological trends at both multiyear and seasonal time scales. We observe a clear vertical and horizontal seasonal deformation pattern primarily attributable to the solid earth response to hydrological surface loading at large-to-regional (Sierra Nevada range) scales. Several GNSS sites, located at the eastern edge of the Sierra Nevada along the southwestern rim of Long Valley Caldera, also show significant horizontal deformation that cannot be explained by elastic deformation from surface loading. Due to the location of these sites and the strong correlation between their horizontal displacements and spring discharge, we hypothesize that this deformation reflects poroelastic processes related to snowmelt runoff water infiltrating into the Sierra Nevada slopes around Long Valley Caldera. Interestingly, this is also an area where water infiltrates to feed the local hydrothermal system, and where snowmelt-induced earthquake swarms have been recently detected

Effects of glucagon-like peptide-1 receptor agonists on mortality and cardiovascular events. A comprehensive meta-analysis of randomized controlled trials

Introduction The publication of the results of LEADER and SUSTAIN-6 trials suggested a possible beneficial effect of the class of GLP-1 receptor agonists on cardiovascular morbidity and mortality. The aim of the present meta-analysis is to collect and synthetize all available evidence on the effect of GLP-1 receptor agonists on cardiovascular events and mortality. Methods A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration > 11 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. The principal outcome of this analysis was the effect of GLP-1 receptor agonists on all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure. Results Out of 113 trials fulfilling inclusion criteria (mean duration 41.7 ± 38.2 weeks), 32, 25, 48, 43 and 32 reported at least one event for all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure, respectively. In GLP-1 receptor agonist-treated patients, all-cause mortality, cardiovascular mortality, and myocardial infarction were significantly lower than in comparators (MH-OR [95% CI] 0.88 [0.79–0.97], p = 0.015, 0.84 [0.74–0.96], p = 0.009, and 0.90 [0.80–1.00], p = 0.050, respectively), whereas no beneficial effect was observed for stroke and heart failure (MH-OR [95% CI] 0.90 [0.81–1.00]. p = 0.059. 0.89 [0.76–1.04]. p = 0.15. and 0.92 [0.81–1.06]. p = 0.25. respectively). Conclusions Overall, the agents of this class appear to reduce all-cause mortality, cardiovascular mortality, and the incidence of myocardial infarction at mid-term follow up

Characterization of Groundwater Recharge and Flow in California's San Joaquin Valley From InSAR-Observed Surface Deformation.

Surface deformation in California's Central Valley (CV) has long been linked to changes in groundwater storage. Recent advances in remote sensing have enabled the mapping of CV deformation and associated changes in groundwater resources at increasingly higher spatiotemporal resolution. Here, we use interferometric synthetic aperture radar (InSAR) from the Sentinel-1 missions, augmented by continuous Global Positioning System (cGPS) positioning, to characterize the surface deformation of the San Joaquin Valley (SJV, southern two-thirds of the CV) for consecutive dry (2016) and wet (2017) water years. We separate trends and seasonal oscillations in deformation time series and interpret them in the context of surface and groundwater hydrology. We find that subsidence rates in 2016 (mean -42.0 mm/yr; peak -345 mm/yr) are twice that in 2017 (mean -20.4 mm/yr; peak -177 mm/yr), consistent with increased groundwater pumping in 2016 to offset the loss of surface-water deliveries. Locations of greatest subsidence migrated outwards from the valley axis in the wetter 2017 water year, possibly reflecting a surplus of surface-water supplies in the lowest portions of the SJV. Patterns in the amplitude of seasonal deformation and the timing of peak seasonal uplift reveal entry points and potential pathways for groundwater recharge into the SJV and subsequent groundwater flow within the aquifer. This study provides novel insight into the SJV aquifer system that can be used to constrain groundwater flow and subsidence models, which has relevance to groundwater management in the context of California's 2014 Sustainable Groundwater Management Act (SGMA)