Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy.

The Coronavirus-associated disease, that was first identified in 2019 in China (CoViD-19), is a pandemic caused by a bat-derived beta-coronavirus, named SARS-CoV2. It shares homology with SARS and MERS-CoV, responsible for past outbreaks in China and in Middle East. SARS-CoV2 spread from China where the first infections were described in December 2019 and is responsible for the respiratory symptoms that can lead to acute respiratory distress syndrome. A cytokine storm has been shown in patients who develop fatal complications, as observed in past coronavirus infections. The management includes ventilatory support and broad-spectrum antiviral drugs, empirically utilized, as a targeted therapy and vaccines have not been developed. Based upon our limited knowledge on the pathogenesis of CoViD-19, a potential role of some anti-rheumatic drugs may be hypothesized, acting as direct antivirals or targeting host immune response. Antimalarial drugs, commonly used in rheumatology, may alter the lysosomal proteases that mediates the viral entry into the cell and have demonstrated efficacy in improving the infection. Anti-IL-1 and anti-IL-6 may interfere with the cytokine storm in severe cases and use of tocilizumab has shown good outcomes in a small cohort. Baricitinib has both antiviral and anti-inflammatory properties. Checkpoints inhibitors such as anti-CD200 and anti-PD1 could have a role in the treatment of CoViD-19. Rheumatic disease patients taking immunosuppressive drugs should be recommended to maintain the chronic therapy, prevent infection by avoiding social contacts and pausing immunosuppressants in case of infection. National and international registries are being created to collect data on rheumatic patients with CoViD-19

Effectiveness of stretching of the flexor retinaculum with ultrasonic therapy in the management of carpal tunnel syndrome

Aims & Objective: The objective of study was to compare the effectiveness of manual stretching of the flexor retinaculum with or without ultrasonic therapy. Methods: The study was started by selecting the 50 patients from the out patients department of Al-nafees Hospital AlipurFarash and National institute of Rehabilitation Medicine Islamabad with history of carpal tunnel syndrome. The 25 patients in experimental group were treated with manual stretching of flexor retinaculum and ultrasound and 25 patients of control group were treated with manual stretching of flexor retinaculum. Every session was started by assessment of improvement of the symptoms in each patient. Data was collected through Numeric pain rating scale, point Paresthesia assessment scale and muscle strength by hydraulic hand dynamometer. Independent sample t-test was used to analyze the data with p ≤ 0.05. Results: The mean age of subjects was 1.78±0.64 and 41 subjects have CTS of Right hand remaining 9 subjects were left handed. After the completion of the treatment program it was observe that there was no difference in the effectiveness of manual Stretching of flexor retinaculum with ultra sound therapy and manual stretching of flexor retinaculum alone. The NPRS, paresthesia and muscle stretch showed p≥0.05 between experimental and control groups. Conclusion: This study proved that manual stretching of the flexor retinaculum along with ultra sonic therapy have same affects as manual stretching of the flexor retinaculum alone

Graves' ophthalmopathy: the clinical and psychosocial outcomes of different medical interventions - a systematic review.

Background Graves’ ophthalmopathy is a complex autoimmune disorder that can significantly affect quality of life (QoL), vision and physical appearance. Recently, a deeper understanding of the underlying pathogenesis has led to the development of novel treatment options. Aims The purpose of this review is to explore the current literature on conventional and novel treatment modalities and to evaluate which interventions provide the most favourable psychological and clinical outcomes in patients with moderate to severe, active Grave’s ophthalmopathy. For example, QoL is an important psychosocial outcome of disease management. However, available literature demonstrates that not all clinically effective treatment options improve patients’ QoL. Methods A systematic literature review was conducted to assess the clinical and psychosocial outcomes of different therapies for Graves’ ophthalmopathy. An extensive database search of Ovid Medline, Ovid Embase and Cochrane Central Register of Controlled Trials was conducted. Studies generated were reviewed and the relevant selected data were retrieved and analysed. Results Results showed intravenous steroids, rituximab (RTX), tocilizumab and teprotumumab were all significantly effective in improving Clinical Activity Scores. Orbital radiotherapy showed a slight improvement in proptosis and diplopia. All interventions were safe with few serious adverse events being reported across all studies. All treatment modalities demonstrated beneficial improvements in both components of the Graves’ Ophthalmopathy-QoL (QoL) questionnaire, apart from orbital radiotherapy which only demonstrated improvements in the visual functioning subscale. Teprotumumab was identified to be the most effective intervention for improving both clinical and psychosocial outcomes. However, further research needs to be conducted to evaluate its side effect profile and cost-effectiveness. Nonetheless, with time it has the potential to be a first-line treatment option in the management of active moderate to severe Graves’ ophthalmopathy

Anxiety Depression and Quality of Life among Working Married and Unmarried Women: A Comparative Study

Background: Anxiety and depression are the most common problems that we face in our daily life and both affect our quality of life. So, the present study was done to assess and compare anxiety, depression and quality of life among working married and unmarried women. Methods and Materials: Purposive sampling technique was used for recruiting 100 working women (an equal number of married and unmarried), with their informed consent. The tools used for the present study were Hamilton Anxiety Rating Scale, Beck Depression Inventory-II and WHO Quality of Life-Bref for anxiety, depression and quality of life assessment respectively. Results: Result shows significant differences in the levels of anxiety, depression and quality of life of working married and unmarried women. Conclusion: The present study also concludes that married working women do experience a higher level of anxiety and depression as well as a lower quality of life in comparison to unmarried working women. Keywords:  Anxiety, depression, quality of life, working wome

Electrolysers for the hydrogen revolution: challenges, dependencies, and solutions

Due to Europe's gas crisis and the Russian invasion of Ukraine, ramping up the hydro­gen market has become more urgent than ever for European and German policymakers. However, ambitious targets for green hydrogen present an enormous challenge for the European Union (EU) and its young hydrogen economy. Apart from the demand for electricity, there is above all a lack of production capacities for electrolysers. The envisioned production scaling of electrolysers is almost impossible to achieve, and it also conflicts with import efforts and cements new dependencies on suppliers of key raw materials and critical components. Although a decoupling from Russia’s raw ma­terial supply is generally possible, there is no way for the EU to achieve its goals with­out China. Aside from loosened regulations and the active management of raw material supply, Europe should also reconsider its biased preference for green hydrogen. (author's abstract

The Gulf States, China, and Central Asia's green energy sector: interactions patterns, geopolitical dynamics, and implications for the EU and Germany

Central Asian economies, particularly Kazakhstan and Uzbekistan, are pursuing increasingly ambitious goals for renewable energy. Apart from China - an established player in the market - it has increasingly been Gulf countries that have been implementing respective projects, particularly Saudi Arabia and, to a lesser extent, the United Arab Emirates (UAE). Both China and Gulf countries seem to have found a cooperative approach that is based on sharing the Central Asian market along the value chain. This approach could be a blueprint for future Gulf-China relations, which have become relevant for global politics. Simultaneously, the dynamics also exemplify the growing number of energy and geopolitical dynamics over which Europe has little influence. For the European Union (EU) and Germany, the developments serve as a reminder: While intra-Asian dynamics are gaining importance, Germany and the EU risk being marginalised in matters concerning energy, climate, and geopolitics - and not just in Central Asia. In response, a more consistent Central Asia strategy is required, alongside a constructive and non-ideological approach towards relations with the Arab Gulf States. (author's abstract

The geopolitics of the energy transition in Greater Asia: background, dynamics, and trend mapping from within the region

Greater Asia is emerging as a major factor in the global energy transition. This shift is associated with growing independence from external actors such as the European Union and the United States, with unfolding developments increasingly concentrated within the region itself. Key trends include the monopolisation of critical raw materials, the formation of new alliances that intersect with new value chain interdependencies, and the adoption of innovative technologies like small modular nuclear reactors. At the same time, geopolitical tensions and crises have the potential to reshape the region and its energy transition. To remain relevant and effective in Asia, Germany and the EU need to ensure that their engagement is constructive and attuned. (author's abstract

The geopolitics of hydrogen: technologies, actors and scenarios until 2040

The transition to a hydrogen-based economy is gaining momentum in both Germany and the European Union (EU). Used as an energy carrier, hydrogen holds the promise of freeing hard-to-decarbonise sectors like heavy industry, aviation, and maritime trade from their emissions. At the same time, policymakers hope that hydrogen will promote Europe's energy independence, push sustainable development, and strengthen value-based trade. This study presents three plausible yet disruptive scenarios for the geo­politics of hydrogen up to the year 2040 (developed with a team of experts in a multi-stage foresight process). "Hydrogen Realignment" considers the possibility of an eastward shift of industry, power, and technological lead­er­ship; "Hydrogen (In)Dependence" depicts a future, in which Europe pur­sues hydrogen self-sufficiency but becomes dependent on raw material supply; and "Hydrogen Imperialism" delves into the dystopian scenario of a hydrogen transition dominated by hegemons and despots. The transition to hydrogen is likely to shift and complicate Europe's exter­nal dependence rather than eliminate it; the role of supply chains will become more important. Moreover, the potential of hydrogen trade for global sustainable development is limited and requires targeted efforts. Resource distribution, production potential, current geopolitical power dynamics, and their interplay will influence hydrogen policy and deci­sion-making along the entire value chain, with actors often giving priority to socioeconomic, geopolitical, and technopolitical considerations. Germany and the EU must pursue a proactive hydrogen strategy, acknowl­edge the preferences of external actors, and form pragmatic partnerships to keep sight of climate goals, retain industry, and avoid losing global influence. In addition to promoting targeted technologies, decision-makers must manage dependencies across sectors and do so in an anticipatory way. Pursuing diversification is indispensable, and instituting targeted diplomacy and development assistance would be helpful. The new hydrogen sector also needs governing institutions - for example a "Hydrogen Alli­ance" - to mitigate geopolitical risks and allocate investments correctly. (author's abstract

Ethical preferences for influencing superiors: A 41-society study

With a 41-society sample of 9990 managers and professionals, we used hierarchical linear modeling to investigate the impact of both macro-level and micro-level predictors on subordinate influence ethics. While we found that both macro-level and micro-level predictors contributed to the model definition, we also found global agreement for a subordinate influence ethics hierarchy. Thus our findings provide evidence that developing a global model of subordinate ethics is possible, and should be based upon multiple criteria and multilevel variables

Intermicrobial interaction: Aspergillus fumigatus siderophores protect against competition by Pseudomonas aeruginosa

International audiencePseudomonas aeruginosa and Aspergillus fumigatus are pathogens frequently co-inhabiting immunocompromised patient airways, particularly in people with cystic fibrosis. Both microbes depend on the availability of iron, and compete for iron in their microenvironment. We showed previously that the P. aeruginosa siderophore pyoverdine is the main instrument in battling A. fumigatus biofilms, by iron chelation and denial of iron to the fungus. Here we show that A. fumigatus siderophores defend against anti-fungal P. aeruginosa effects. P. aeruginosa supernatants produced in the presence of wildtype A. fumigatus planktonic supernatants (Afsup) showed less activity against A. fumigatus biofilms than P. aeruginosa supernatants without Afsup, despite higher production of pyoverdine by P. aeruginosa. Supernatants of A. fumigatus cultures lacking the sidA gene (AfΔsidA), unable to produce hydroxamate siderophores, were less capable of protecting A. fumigatus biofilms from P. aeruginosa supernatants and pyoverdine. AfΔsidA biofilm was more sensitive towards inhibitory effects of pyoverdine, the iron chelator deferiprone (DFP), or amphothericin B than wildtype A. fumigatus biofilm. Supplementation of sidA-deficient A. fumigatus biofilm with A. fumigatus siderophores restored resistance to pyoverdine. The A. fumigatus siderophore production inhibitor celastrol sensitized wildtype A. fumigatus biofilms towards the anti-fungal activity of DFP. In conclusion, A. fumigatus hydroxamate siderophores play a pivotal role in A. fumigatus competition for iron against P. aeruginosa