Impact of SARS-CoV-2 Mutations on Global Travel and the Increasing Number of Re-Infections: A Risk-Assessment Perspective

The outbreak of coronavirus disease 2019 (COVID-19) has stunned the world owing to the surreal, unprecedented, and completely unbelievable manner in which it has spread globally within a short span of time. This spread has led to the common combination of variety and has promoted the passage of species blockade and genetic combination of these types of viruses. Despite the short history of the COVID-19 outbreak, with its global spread and frequent mutations, it has impacted the whole world and has become a worrying threat to the society. Scientific reports have disclosed that members of the coronavirus family, such as SARS-CoV, Middle East respiratory syndrome coronavirus (MERS-CoV), HCoV-NL63, HCoV-229E, HCoV-OC43, and HKU1 have infected the humans earlier too and that mutations in these viruses have resulted in the more complex severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the present review, we have discussed how scientists keep track of the genetic tweaks to SARS-CoV-2 as it spreads globally. Currently, the only way to prevent more such outbreaks is maintaining social distancing, adhering to the World Health Organization guidelines and de-globalizing the world. Genetic variations/mutations reported to date in coronaviruses hint at their cryptic spread. Scientists are scouring the viral genome for mutations that might reveal how dangerous the pathogen is or how fast it spreads. Cases have been documented in almost all countries, and the mutations in the virus have created problems for the researchers in formulating effective vaccines. Furthermore, global travel has been severely affected after the new mutants have been detected. Therefore, more scientific investigations are necessary to understand how SARS-CoV-2 is likely to mutate in the future.

ASSESSMENT OF THE SITUATION OF USE OF BLOOD PRESSURED DRUGS IN THE TREATMENT OF HIGH BLOOD PRESSURE FOR OUTCOME PATIENTS AT NAM DINH PROVINCIAL HOSPITAL IN JANUARY 2021

Hypertension is a disease that seriously affects the health and life expectancy of the community, playing a major etiological role in target organ damage. The selection of antihypertensive drugs to ensure reasonable safety and effectiveness is always a matter of concern of the medical industry. Applying the cross-sectional method on 2,640 patients being examined and treated for hypertension at Nam Dinh general hospital, it was found that 54.67% female patients accounted for the majority. The age of disease in both sexes is over 50 years old with a relatively high frequency of comorbidities. Most of them were prescribed drug combinations in treatment 77,9%. The group of ACE inhibitors + calcium blockers is the most common combination. ACE inhibitors are also the most commonly prescribed drugs in monotherapy. 11,4% of cases had adverse drug interactions, the most dangerous combination is UCMC + Potassium chloride and UCMC + Spironolactone causing hypokalemia. The most common interaction between beta-blockers and calcium blockers increases the antihypertensive effect.

RESULTS OF TREATMENT PNEUMONIA FOR CHILDREN FROM 2 MONTHS TO 5 YEARS OLD AT YEN PHONG HEALTH CENTER, PROVINCE BAC NINH

Objectives: To evaluate results of treatment pneumonia for children aged 2 months to 5 years in pediatric deapartment at Yen Phong health center, Bac Ninh. Subjects: Patients with pneumonia aged 2 months to 5 years for treatment from September 2020 to June 2021. Methods: Descriptive study. Results: A total of 146 children were diagnosed with pneumonia, of which 82 were male (56.3%). The mean age was 20.6 ± 14.2 months. Prevalence of antibiotic use in the pre-hospital was 69.9%. The most common clinical manifestations were cough (100.0%), a subcrepitant rales (100.0%) and fever (29.5%). The most common X-ray was widespread patchy infiltrates (61.0%). 77.4% of children used combination antibiotics, in which the most common combination was Cephalosporin + Aminoglycoside (67.8%). Average duration of treatment was 6,7 ± 2,2 days. The cure rate was 100%. Conclusion: Pneumonia is more common in children less than 1 year old, with clinical manifestations of cough, shortness of breath and a subcrepitant rales. Combination antibiotics are effective in treating pneumonia in young children.

Prescription of Radix Salvia miltiorrhiza in Taiwan: A Population-Based Study Using the National Health Insurance Research Database

Objective: While radix Salvia miltiorrhiza (Danshen; RSM) is commonly used in Chinese herbal medicine, its current usage has not yet been analyzed in a large-scale survey. This study aimed to investigate the conditions for which RSM is prescribed and the utilization of RSM in Taiwan.Methods: 1 million beneficiaries enrolled in the Taiwan National Health Insurance Research Database were sampled to identify patients who were prescribed RSM. Next, the diagnoses of these patients based on the International Classification of Diseases 9th Revision Clinical Modification code were analyzed. Logistic regression analysis was employed to estimate the odds ratio (OR) for RSM utilization.Results: Patients with disorders of menstruation and abnormal bleeding from the female genital tract due to other causes were the diagnostic group most commonly treated with RSM (9.48%), followed by those with general (9.46%) and cardiovascular symptoms (4.18%). Subjects treated with RSM were mostly aged 35–49 years (30.1%). The most common combination of diseases for which RSM was prescribed (0.17%) included menopausal disorders and general symptoms. Women were more likely to receive RSM than men (OR = 1.75, 95% confidence interval = 1.73–1.78). RSM was frequently combined with Yan-Hu-Suo and Jia-Wei-Xiao-Yao-San for clinical use.Conclusion: To date, this is the first study to identify the most common conditions for which RSM is used in modern Taiwan. The results indicate RSM as a key medicinal herb for the treatment of gynecological diseases, including menstrual disorders, female genital pain, menopausal disorders, etc. The most common combination for which RSM is prescribed is menopausal disorders and general symptoms. Further research is needed to elucidate the optimal dosage, efficacy, and safety of RSM.

Prevalence and Genetic Diversity of Group A Rotavirus Genotypes in Moscow (2019–2020)

Group A rotavirus (RVA) infection is the leading cause of hospitalization of children under 5 years old, presenting with symptoms of acute gastroenteritis. The aim of our study was to explore the genetic diversity of RVA among patients admitted to Moscow Infectious Disease Clinical Hospital No. 1 with symptoms of acute gastroenteritis. A total of 653 samples were collected from May 2019 through March 2020. Out of them, 135 (20.67%) fecal samples were found to be positive for rotavirus antigen by ELISA. RT-PCR detected rotavirus RNA in 80 samples. Seven G-genotypes (G1, G2, G3, G4, G8, G9, and G12) and three P-genotypes (P[8], P[4], and P[6]) formed 9 different combinations. The most common combination was G9P[8]. However, for the first time in Moscow, the combination G3P[8] took second place. Moreover, all detected viruses of this combination belonged to Equine-like G3P[8] viruses that had never been detected in Russia before. The genotype G8P[8] and G9P[4] rotaviruses were also detected in Moscow for the first time. Among the studied rotaviruses, there were equal proportions of Wa and DS-1-like strains; previous studies showed that Wa-like strains accounted for the largest proportion of rotaviruses in Russia.

Anti-seizure Medication Prescription in Adult Outpatients With Epilepsy in China, 2013–2018

This study aimed to assess the national trends in anti-seizure medication (ASM) prescription in Chinese adult outpatients with epilepsy over a 6-year period from 2013 to 2018. Prescriptions for adult outpatients with epilepsy from hospitals in six major cities were extracted from the database of the Hospital Prescription Analysis Cooperative Project. Trends in the annual prescriptions and expenditure of ASM were analyzed. Prescription patterns (monotherapy or combination therapy) were also assessed. A total of 225,767 prescriptions from 60 hospitals were eligible and extracted for analysis. The number of ASM prescriptions increased from 28,360 in 2013 to 44,110 in 2018, and the corresponding cost increased from 9,452,990 Chinese Yuan (CNY) in 2013 to 14,627,865 CNY in 2018. The share of newer ASM use increased continuously, accounting for 56.75% of prescriptions and 85.03% of expenditure in 2018. The most frequently prescribed ASMs were sodium valproate and levetiracetam. The proportion of sodium valproate use decreased, while the proportion of levetiracetam use increased dramatically in terms of both ASM prescriptions and expenditure. Monotherapy was more frequent than combination therapy. The three most common combination therapies were sodium valproate/lamotrigine, levetiracetam/oxcarbazepine, and sodium valproate/levetiracetam. In summary, ASM use increased rapidly in terms of the number of ASM prescriptions and cost during the 6-year period, which raises concern regarding the rational use and pharma-economic profiles of ASMs. In place of valproate, levetiracetam became the most frequently used ASM. The development of ASM prescription is in line with therapy guidelines and reflects the current state of research in China.

Involvement in Multiple Race Events Among International Para and Non-disabled Swimmers

International elite Para swimmers form a large portion of the overall multi-medalist winning population. For the highest performing Para swimmers, world class performances were achieved across different strokes. The aim of this study was to quantify the level of involvement across different events and to examine this in relation to the level of performance. The performances in swimming speed of the top 100 females and males for both Para- and non-disabled swimmers were collected in 11 race events between 2009 and 2019 (4,400 performances for 307 Para females and 365 Para males, 605 non-disabled females, and 715 non-disabled males). We tallied the number of events in which each swimmer was involved. Swimmers were grouped according to the total number of race events in which they participated. Then the association between involvement and level of performance was investigated. Para swimmers with impairment from classes seven to 14 were involved in a range of race events across different strokes. The most common combination for both Para and non-disabled athletes was over similarly distanced races of the same stroke (50 and 100 m freestyle). The more race events in which Para swimmers involved, the higher the level of performance that was achieved. This trend can partially be explained by the less concentrated competition pool for Para swimmers compared to able-bodied swimmers. Para swimmers with minimal and no physical impairment perform in multiple race events more often than able-bodied swimmers. Fewer Para swimmers at the international level and a less concentrated competition pool could explain these differences.

Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function

Objectives To establish the prevalence of multimorbidity in people with chronic kidney disease (CKD) stages 1–5 and transiently impaired renal function and identify factors associated with multimorbidity. Design and setting Prospective cohort study in UK primary care. Participants 861 participants aged 60 and older with decreased renal function of whom, 584 (65.8%) had CKD and 277 (32.2%) did not have CKD. Interventions Participants underwent medical history and clinical assessment, and blood and urine sampling. Primary and secondary outcome measures Multimorbidity was defined as presence of ≥2 chronic conditions including CKD. Prevalence of each condition, co-existing conditions and multimorbidity were described and logistic regression was used to identify predictors of multimorbidity. Results The mean (±SD) age of participants was 74±7 years, 54% were women and 98% were white. After CKD, the next most prevalent condition was hypertension (n = 511, 59.3%), followed by obesity (n = 265, 30.8%) ischemic heart disease (n = 145, 16.8%) and diabetes (n = 133, 15.4%). Having two co-existing conditions was most common (27%), the most common combination of which was hypertension and obesity (29%). One or three conditions was the next most prevalent combination (20% and 21% respectively). The prevalence of multimorbidity was 73.9% (95%CI 70.9–76.8) in all participants and 86.6% (95%CI 83.9–89.3) in those with any-stage CKD. Logistic regression found a significant association between increasing age (OR 1.07, 95%CI 1.04–0.10), increasing BMI (OR 1.15, 95%CI 1.10–1.20) and decreasing eGFR (OR 0.99, 95%CI 0.98–1.00) with multimorbidity. Conclusions This analysis is the first to provide an accurate estimate of the prevalence of multimorbidity in a screened older primary care population living with or at risk of CKD across all stages. Hypertension and obesity were the most common combination of conditions other than CKD that people were living with, suggesting that there may be multiple reasons for closely monitoring health status in individuals with CKD.

Mixed steatohepatitis: more questions than answers (Part 1)

The term steatohepatitis is used for a heterogeneous group of diseases of various etiologies, characterized by a similar morphological picture. Earlier the diagnosis of non-alcoholic fatty liver disease implied the exclusion of other causes of steatohepatitis, in recent years it has been suggested that a combination of various etiological variants of steatohepatitis is possible. The review considers the terminological, epidemiological and pathogenetic aspects of the most common combination: metabolic and alcoholic genesis, the issues of the mutual influence of etiopathogenetic factors and the identification of the predominant process. Issues of existing and prospective pathogenetic and symptomatic therapy are discussed in detail. Treatment of steatohepatitis is based on the elimination of known causal factors and lifestyle modification; therapy includes medications, that have been proven to be effective in certain types of steatohepatitis and symptomatic therapy as well.

Prevalence of the Metabolic Syndrome in Patients With Type B Aortic Dissection

Background/Objective: The aim of this study is to detect the prevalence of metabolic syndrome (MS) and its components in type B aortic dissection patients. This study assessed the association of MS and its component with type B aortic dissection in Chinese patients.Methods: This cross-sectional prospective observation study consisted of 445 patients who were first diagnosed with type B aortic dissection. Demographic information, clinical symptoms and laboratory parameters were collected using a standard form.Results: Among the 445 TBAD patients 38.4% had MS. Hypertension was present in 78.2% of all TBAD patients. Hypertension, high fasting glucose and obesity were the most common combination of metabolic abnormalities (93%, 79.5% and 63.2%) in the TBAD patients, and a same phenomenon was seen in acute TBAD patients. But among chronic TBAD patients the most frequent individual components were hypertension, hyper- triglyceride and high fasting glucose (92.6%, 75%, and 70.6%). Presence of two or more components of the metabolic syndrome was common: 22.7% had one component, 31.9% had two components, 24.9% had three components, 10.8% had four components and 3.1% had five components. In TBAD, hypertension, obesity, triglycerides and FBG (fasting blood-glucose) were main risk factors for MS.ConclusionThis is the first study provided information on the prevalence and components of MS in the initial TBAD patients. Hypertension, high fasting glucose and obesity were the most common combination of metabolic abnormalities in TBAD patients.