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Background: COVID 19 affects pregnant women more severe than the nonpregnant women of reproductive age. However, the rate of critical illness and fatality reported from the other studies varied in a wide range in both group. The study aims to investigate the clinical outcomes of pregnant and nonpregnant patients hospitalised with COVID 19 infection. Method: Clinical, radiologoic and laboratory data of pregnant and nonpregnant patients of reproductive age (18-45 years) infected with COVID 19 were analysed retrospectively. Results: Of 153 patients, 123 were nonpregnant and 30 were pregnant. 15 of the 30 pregnant patients delivered during the hopital stay and 6 of them received an urgent cesarean section. Of the six urgent delivery, five were due to respiratory insufficiency related to COVID 19 and one was unrelated to COVID 19. Four preterm birth, one perinatal death but no stillbirth or miscarriage was recorded. The most common symptom and comorbidity were cough and asthma in both group respectively. Semiquantative CT severity score was significantly higher in pregnants than in nonpregnants (9 points vs 2 points, p=0.022). Prognostic laboratory markers including lymphocytopenia, C-reactive protein and D-dimer were markedly worse in the pregnant group. Severe or critical patients were proportionally higher in the pregnants than in the nonpregnants (26% vs 15%, p=0.004). Hospital length of stay (HLOS) was median 4 vs 5 day; p=0.68, mortality rate was 1/123(0.8%) vs 0/30(0%), p=0.62; intensive care unit (ICU) admission rate was 3/123 (2.4%) vs 7/30 (23.3), p<0.001; need for invasive mechanical ventilation (IMV) was 2/123 (1.6%) vs 5/30 (17%), p=0.003 in nonpregnant and pregnant patients respectively. Conclusion: COVID 19 has a more severe course in pregnant women versus nonpregnant control group, but no difference was noted in terms of hospital length of stay and mortality.

Background: Recent evidences reported that co-infection with SARS-CoV-2 and Influenza virus is common. We explored hospital-based influenza surveillance (HBIS) data during the COVID-19 pandemic. Methods: We analyzed data from March to December 2020 among patients admitted with severe acute respiratory infections (SARI) defined as subjective or measured fever of ≥ 38 C° and cough with onset within the last ten days. Physicians recorded patients’ demographic, clinical, and laboratory information and obtained nasopharyngeal and oropharyngeal swabs to test for influenza virus and SARS-CoV-2 by rRT-PCR. Results: We enrolled 1,986 SARI case-patients with median age of 28 years (IQR: 1.2 ­ 53 years), and 67.6% were male. Among SARI case-patients, 285 (14.3%) were infected with SARS-CoV-2 and 175 (8.8%) infected with influenza virus. Only five (0.3%) SARI patients were co-infected with SARS-CoV-2 and influenza virus. Difficulty breathing (83% vs. 77%, p=0.024) and sore throat (26% vs. 17%, p<0.001) were more likely to be present in SARS-CoV-2-infected SARI patients. SARI case-patients with diabetes and hypertension were more likely (14% vs. 6%, p<0.001 and 27% vs. 12%, p<0.001 respectively) to be infected with SARS-CoV-2 virus than those without co-morbidities. Influenza virus remained undetectable during the first 14 weeks of the 20 weeks (May to September) of peak influenzacirculation period in Bangladesh. Conclusions: Our findings suggest that co-infection with SARS-CoV-2 and influenza virus was not very common together with nonappearance of the influenza virus during most of the peak influenza period in Bangladesh during COVID-19 pandemic. Future studies are warranted for further exploration.

The Bible of life is homeostasis. Plants respond to stresses by forming a coordinated defence process from a seemingly chaotic response. Plant molecular glycosylation is the most common and most extensive type of modification reaction in plants. Glycosylation is also an indispensable step for secondary metabolites to produce stable, soluble, storage, detoxification or inactive forms through conjugation with sugars. The present review adds to the description of glycosylation and corresponding glycosyltransferases (GTs) in plants during defence versus growth, which, in comparison to other plant defence regulations, are relatively uncharted. Growth inhibition under stress conditions is related to the redirection of plant resources (such as energy and metabolism) from primary metabolism and growth to activate defence mechanisms in resource-limited environments. A variety of small molecule compounds colored by GTs play an important role in buffering the effects of biotic and abiotic stresses on plants. Autotoxicity defense compounds are stored in the form of inactive glycosides in the defense reaction to release toxic aglycones and to produce cascade effects. All told, glycosylation of secondary metabolites is of first importance to balance growth and defence in an efficient and energy-saving way, but still far to go.

Rationale: Shared governance (SG) of employees is crucial in building trust within healthcare organizations. Improve decision-making and enhancing collaboration among the nursing staff and nurses’ leaders; pave the way for greater autonomy and management of healthcare delivery. Purpose: To examine the SG perceptions among Jordanian registered nurses in different clinical areas. Methods: A descriptive, cross-sectional design was used. A convenience sample of 261 nurses was recruited from three hospitals in Jordan between 2017 and 2018. tool Results: The total SG score ranged between 86 and 344 with a mean of 175.6. There was a slight difference in total SG scores among hospitals. However, when the subscales were compared across the three hospitals, some differences emerged specifically on nurses’ total perceived personnel and total perceived goal and conflict. The median age of the sample was 28 years, and about half of them (54%) were males. Conclusion: Our outcomes showed that there is a space to expand the degree of nurses control and impact in decision making, especially in those offices that scored lower on the IPNG Implications: The study results have implications in nursing administration, policy development, and decision making when choosing/adopting a model of organizational SG to cultivate excellence in the workplace.

Lumacaftor (LUM), approved by the FDA for the treatment of cystic fibrosis(CF), has shown great therapeutic potential in protein conformational diseases. As a chemical chaperone, LUM corrects the F508del CFTR mutation and increases the expression of chloride channels on the alveolar cell membrane. After Mehta et al’s research, the selectivity of LUM has been challenged. In human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), LUM has been also confirmed to be effective against heterozygous mutants (type II mutations) that cause cardiac hERG protein trafficking defects, which can clinically lead to long QT syndrome type 2 (LQT2). The effect of LUM in hERG protein reverses the clinical phenotype of LQT2. Recent studies have shown that LUM has an effect on more similar mutants in the hiPSC-CMs cells rather than heterologous TSA201 cells, among which may lead to more severe clinical phenotypes. Besides, comparing the negative effects of LUM in other hERG mutants and the different effects on mutations at the same site, what is the therapeutic potential and stereoselectivity of LUM for protein conformational diseases? And what this therapeutic effect should be attributed to requires further understanding.

Objective: To assess differences in cervical cerclage success rates, maternal and neonatal outcomes in patients with history-indicated, ultrasound-indicated and rescue cerclages, and identify factors associated with these differences. Design: A retrospective study of patients with cervical cerclages between January 2008 and October 2017 at National University Hospital, Singapore was performed. Method: Patients’ data was extracted from electronic health records and analysed. 163 cerclages were inserted; 14 patients were lost-to-follow-up and excluded. Results: The details of 149 cerclages were analysed (history-indicated, n=83, ultrasound-indicated, n=39, and rescue cerclages, n=27). Patients with rescue cerclages had the lowest cerclage success rate of 55.56%, defined as pregnancies continuing beyond 24 weeks. Patients with history-indicated and ultrasound-indicated cerclages had similarly high success rates of 91.57% and 92.31% respectively. Rescue cerclages, twin pregnancies, larger cervical dilation at presentation, pre-existing type 2 diabetes mellitus and Indian ethnicity were significantly associated with cerclage failure. Patients with rescue cerclages had the highest proportion of patients with one or more maternal complications, and highest rates of preterm premature rupture of membranes and preterm labour. Patients with rescue cerclages also had the lowest neonatal survival rate, lowest mean birth weight and highest proportion of neonatal complications i.e. respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis, and hypoxic-ischemic encephalopathy. Conclusion: Maternal and neonatal outcomes are significantly poorer in women with rescue cerclages, compared to patients with history-indicated and ultrasound-indicated cerclages. Appropriate assessment of risk factors for cervical incompetence and serial cervical length monitoring may reduce rescue cerclages, which may improve outcomes.

Objective To study the mechanism underlying intrauterine adhesion fibrosis and the origin of fibroblasts in the repair of endometrial fibrosis. Design An experimental study involving an animal model of intrauterine adhesion and detection of fibrosis-related molecules. Setting Institute of Reproductive Health, Tongji Medical College. Population or Sample Forty-five adult (8-week-old) female Sprague–Dawley rats. Methods The levels of molecular factors related to the endothelial-to-mesenchymal transition (EndMT) were examined in a rat model of intrauterine adhesion using immunofluorescence, immunohistochemistry, qPCR and Western blot analyses. Main Outcome Measures Levels of the endothelial marker CD31 and the mesenchymal markers alpha-smooth muscle actin (α-SMA) and vimentin. Results Decreased CD31 levels and increased α-SMA and vimentin levels indicate that EndMT is involved in intrauterine adhesion fibrosis. Conclusions Endothelial cells promote the emergence of fibroblasts via the EndMT during the endometrial fibrosis of intrauterine adhesions. Funding This study was funded by National Natural Science Foundation of China (81971435). Keywords Intrauterine adhesion，EndMT, fibrosis

Biogeography is flawed by a poor understanding of microbial distribution, due to the lack of systematical research framework, especially appropriate study units. We studied the biogeographic patterns of Nematode-Trapping Fungi by collecting and analyzing 2,250 specimens from 228 sites in Yunnan Province, China. We found typical watershed patterns both at the level of species and gene of Nematode-Trapping Fungi. The results showed that microbial biogeography could be better understood by 1) using watersheds as research units, 2) removing the coverup of widespread species, and 3) applying good sampling efforts and strategies. We suggest that watersheds could help unify the understanding of biogeographic patterns of animal, plant, and microbe, and may also help account for the historical and contemporary factors driving species distribution.

Anthropogenic range contraction (ARC) dynamically alters species ranges, which can be problematic for correlational species distribution modelling (SDM). We used a virtual ecologist approach to simulate ARC and temporally-biased sampling, demonstrate its link to two principal forms of data misrepresentation, and investigate the outcomes to SDM performance. Occurrences sampled before ARC were mismatched against contemporary anthropogenic pressures (‘occurrence-habitat mismatching’), which impeded predictions of species responses to those pressures and produced models that underestimated the impact of human activity on species distribution. Occurrences sampled after ARC were truncated representations of historically realised niches (‘niche truncation’), which were carried over onto predictions of species-environment relationships, but were overcome by incorporating an appropriate anthropogenic predictor. Given the pervasive global human footprint and associated ARC, these data misrepresentations are likely inherent in most occurrence datasets and should be interrogated during model development. Accounting for these effects differs depending on the type of data misrepresentation.

Dextrocardia is a rare congenital cardiac anomaly where the base-apex axis of the heart is directed to the right side. It may be associated with situs solitus, situs inversus, or situs ambiguous. Here we report a case of a patient with dextrocardia and situs inversus totalis, who had severe aortic bioprosthetic valve degeneration needing a redo aortic valve replacement. Computed tomography scan played a crucial role for a proper preoperative anatomical evaluation and surgical planning. Regarding our operative strategy, the main surgeon stood on the left side of the patient to perform most surgical steps. This surgical management played an important role for the good result in this challenging scenario.

Rationale, Aims and Objectives: Antiresorptive treatment in androgen deprivation therapy (ADT) has proved effective in clinical trials, however its real-world efficacy has not been reported. Furthermore, different schemes of ADT are available and its effect on bone health is still under study. The objectives of this research is are to evaluate the basal and evolution of bone health of patients with prostate cancer receiving different schemes of luteinizing hormone-releasing hormone (LH-RH) agonists. Furthermore, to assess the effect of antiresorptive treatment in a real-world setting. Material and Methods: A 24-month longitudinal observational study with a standardized clinical practice was conducted. Demographics, osteoporosis risk factors, LH-RH treatment regimen, osteoporosis treatment were collected. Laboratory tests and BMD were compiled. Antiresorptive treatment compliance was reviewed in a post-hoc study. Results: 83 patients (mean age 71 ± 8 years) completed basal evaluation. 57 patients completed 24-month follow-up. At the basal evaluation, 80% of patients had inadequate vitamin D levels. Vitamin D >30 ng/mL was correlated with higher T-scores. Continuous LH-RH agonists scheme was associated with a decrease in BMD, especially at the total hip. Adding antiresorptive treatment was correlated to statistically significant better BMD evolution in patients under continuous LH-RH agonist scheme. Patients with intermittent LH-RH treatment and without antiresorptive treatment showed a better evolution at femoral neck BMD. More than one-third of patients under LH-RH intermittent scheme had problems with compliance of denosumab. Conclusion: Bone health assessment in patients with LH-RH agonist treatment is essential. Inadequate vitamin D levels were commonly presented in our patients, suggesting that bone health evaluation in these patients is still underperformed. Intermittent LH-RH scheme and antiresorptive treatment correlated to a better evolution of BMD. Denosumab patients’ non-compliance can become a problem in patients under intermittent LH-RH scheme, which could lead to a decrease of its efficacy.

Background: Sepsis is still developing exorbitantly high mortality. T cell activation plays a crucial role in sepsis’s initial innate immune reactions. The imbalance between Th17 and Treg participates in sepsis progression. CD28 signaling pathway was essential for the expression of inflammatory cytokines related to Th17, and play a crucial role in the maintenance of Treg. Methods: 60 sepsis patients’ baseline conditions were recorded, and the expressions of inflammatory factors in the peripheral blood and levels of procalcitonin (PCT) were detected. PBMCs were separated, subtypes of T cells and related biomarkers were measured by FACS. Furthermore, the relationship between the above indicators and patients’ condition scoring (APACHEⅡand SOFA) and ICU hospitalization time were analyzed. To investigate effects of CD28 on the balance of Th17 between Treg, anti-CD28 antibody was intraperitoneal administrated to cecal ligation and puncture (CLP) mice. Results: Compared with septic patients who stay in ICU more than 14 days, the Th17/Treg ratio of patients fewer than 14 days was significantly lower. Moreover, the expression of CD28 was significantly higher in sepsis patients than that of healthy donors. After administration of CD28 monoclonal antibody, 7-day mortality and clinical score were significantly improved in septic mice, with splenocyte Th17/Treg ratio decreased. CD28 antibody alleviates the expression of pro-inflammatory factors and spleen injury related to apoptosis. Conclusions: Th17/Treg ratio revealed septic patient severity and as a predictor of ICU stay. CD28 monoclonal antibody could improve 7-day mortality of septic mice by decreasing T cell apoptosis and amending the ratio of Th17/Treg.

Background. Adult mid-clavicle fractures are common but there is no consensus on the optimal treatment. Objective. The present network meta-analysis investigated the safety and efficacy of plate internal fixation, intramedullary fixation, and conservative treatment for adult mid-clavicle fracture. Methods. PubMed, OVID, EMbase, Cochrane Library, VIP, WanFang, and CNKI databases were searched up to March 2020 by two independent researchers for randomized controlled trials (RCTs) including patients treated by plate fixation, intramedullary fixation, or conservative treatment for mid-clavicle fractures. Primary outcomes were Constant score, Disabilities of the Arm, Shoulder and Hand (DASH) score, nonunion rate, and healing time.  Data were analyzed using GeMTC 14.3 and Stata 14 software. Results. A total of 27 RCTs were included. The network meta-analysis revealed no significant differences in Constant score among groups at 3-months and 12-months post-treatment (P > 0.05); however, at 24-months, intramedullary and plate fixation treatments were superior to conservative treatment according to probability ranking. There were significant differences in DASH score at 3-, 12-, and 24-months post-treatment (P< 0.05), and again probability ranking indicated that intramedullary and plate fixation treatments were superior to conservative treatment at 3 and 12 months, while conservative treatment was superior at 24 months. Nonunion rate also differed among treatments, with intramedullary and plate fixation superior to conservative treatment by probability ranking. Finally, healing time was significantly shorter following intramedullary and plate fixation compared to conservative treatment. Conclusion. Plate internal fixation and intramedullary fixation achieve superior functional outcome, lower nonunion rate, and shorter healing time for treatment of adult mid-clavicle fractures compared to conservative treatment.

Clinical and economic research fosters corporate integrity. A company's products, services and solutions are designed to improve the health and well-being of customers. A company must develop superior standards in order to make strong claims as well as create a brand built upon having true influence on customers' lives. There are two, over-arching reasons to develop a centralized, Clinical and Economic Research Service. First, as a part of all quality initiatives, the company must demonstrate that it does not only devote efforts towards quality in engineering or manufacturing. The company must emphasize that quality signifies the effects its products have on people's lives. The second reason is to reduce the risks associated with making claims that the company's products, services and solutions cannot stand behind. The company wants to make strong claims for its products, but if they do not meet established standards then the firm has created an ambiguous situation. The company must mitigate risks by incorporating standards into its end-to-end efforts, and it must back these standards with a corporate-level presence. Although the company may compete against many types of businesses in the health and wellness sector, by mitigating risks the firm will maintain exceptional branding as well as innovate with quality.

The productivity of rice is affected by infection of Rhizoctonia solani, which prompts to search for resistance sources from the available germplasm. An effort has been made to understand the heritability and QTLs of the traits related to sheath blight (SB) resistance in rice. A core panel of 192 genotypes was formed from 330 rice accessions based on the disease reaction against SB for association mapping studies. The study confirmed that population had significant amount of genetic variation for SB related traits across seasons. The correlation analysis showed positive association between PDI’s and AUPDC and negative association between PDI and plant height, flag leaf length, and grain yield. 133 microsatellite markers classified the genotypes into three major clusters, while model-based approach grouped the genotypes into two subpopulations. By employing both GLM and MLM (Q+K) models, 30 SSRs were associated with targeted traits across seasons. Eight QTLs namely qPh.2-1, qShB.4-1, qShB.4-2, qPh.8-1, qShB.8-2, qShB.10-1, qShB.10-2, and qPh.12-1 were novel QTLs related to sheath blight resistance and plant height traits. Further, elite alleles associated with markers imparting resistance against sheath blight was identified in IC283139, IC 277248, Sivappu Chithirai Kar and Bowalia, which would be useful in developing rice varieties with durable disease resistance.

Hybrid nanofluids (HNFs) comprise combinations of different nanoparticles suspended in base fluids. Applications of such nanofluids are growing in the areas of energy and biomedical engineering including smart (functional) coatings. Motivated by these developments, the present article examines theoretically the magnetohydrodynamic (MHD) coating boundary layer flow of HNFs from a stretching surface under a transverse magnetic field in porous media with chemically reactive nanoparticles. Darcy’s law is deployed. Both first and second order momentum slip is included as is solutal slip. The transformed boundary value problem is solved analytically. Closed form solutions for velocity are derived in terms of exponential functions and for the concentration field in terms of incomplete Gamma functions by the application of the Laplace transformation technique.The influence of selected parameters e.g. suction/injection, magnetic field and slip parameterson velocity and concentration distributions are visualized graphically. Concentration magnitudes are elevated with stronger magnetic field whereas they are suppressed with greater wall solutal slip. Magnetic field suppresses velocity and increases hydrodynamic boundary layer thickness. The flow is accelerated with reduction in inverse Darcy number and stronger suction leads to a decrease in skin friction. The analysis provides a good foundation for further investigations using numerical methods.

Embryo-endosperm interaction strongly affects the developmental process of seeds and hence the formation of crop yield and quality. However, signals that orchestrate developmental processes of the two compartments are largely unknown. This study aims to provide an integrative landscape of rice seed development by organizing the information about embryo-endosperm interaction. Using a mutant with notched-belly grains, we devised a novel comparison method that can quantitatively evaluate the effect of embryo on the developmental process of endosperm, by comparing the upper and bottom endosperms of the mutant. Global comparison of mRNAs datasets in embryo and endosperm samples collected from 5 DAF (day after fertilization) through maturity uncovered a dragging effect of embryo on the developmental transition of the endosperm, extending the middle stage and delaying the late stage. Biochemical analysis revealed that signaling pathways of T6P-SnRK1, and GA or IAA may be involved in mediating this developmental transition. Integrating the information about embryo-endosperm bidirectional dialogue enables a new rice seed developmental staging system to be proposed. The results obtained should be valuable for elucidating the biological processes and signatures of grain formation, hence providing a valuable resource for modifying the molecular and physiological processes responsible for cereal grain yield and quality.

Reconstruction of historical relationships between geographic regions within a species’ range, determined through phylogeographic study, can indicate dispersal patterns and help predict future responses to shifts in climate. Ascaphus truei (coastal tailed frog) is an indicator species of the health of forests and perennial streams in the Coastal and Cascade Mountains of the Pacific Northwest of North America. We used two genetic techniques — microsatellite and genotype-by-sequencing (GBS) — to compare the within region genetic diversity of populations near the northern extent of the species’ range (British Columbia, Canada) to two geographic regions in British Columbia and two in Washington, USA, moving towards the core of the range. Allelic richness and heterozygosity declined substantially as latitude increased. The northernmost region had the lowest mean observed heterozygosities for both techniques (microsatellite, M = 0.19, SE = 0.073; GBS, M = 0.028, SE = 0.0011) and the southernmost region had the highest (microsatellite, M = 0.86, SE = 0.072; GBS, M = 0.18, SE = 0.0027). For both genetic techniques, geographic regions (N=5) separated into 4 genetic clusters with the two most northern regions clustering together. Our discovery of reduced diversity may have important conservation and management implications for population connectivity and the response of A. truei to climate change.

Tropical cyclone (TC) Idai landing twice in March 2019 had made great losses to Malawi and surrounding countries. Before the TC Idai landed, Malawi had already experienced heavy rainfall since January. In order to observe this disaster situation, 17 images of Sentinel-1 Synthetic Aperture Radar (SAR) from 13 January 2019 to 19 April 2019 are used here to estimate the flooding extent based on change detection. Results show that the flooding area varied from 315 to 622 km2, arable land suffered most, and for the percentage of flooding area the urban area suffered most. This demonstrates obviously that the TC Idai may cause great agricultural losses and make many people homeless. For flood detection, SAR has shown much more powerful that optical sensors for its ability of all-weather and all-day.

Sir, We have recently become aware of new small (2.2mm to 5.5mm) ear wax removal endoscopes (similar to otoendoscopes) aimed at the home market (See Figure 1). These are powered by USB attachments and can be viewed on mobile phones or home PCs. They are targeted at the home market for examination of ears, nose, and mouths and even some sellers advocate using their use on pets too. They often come with attachments to allow ear cleaning of wax and removal of foreign bodies etc. These are available on various online seller websites and can cost as little as £11. These have been available for purchase for a few years, but we were not aware of them until we started having some patients attend our emergency ENT clinic recently having damaged their ear canals with them during use. In one case, a child presented with extensive abrasions/laceration of the ear canal after her mother attempted to clean wax from the child’s ears. Similarly, looking at the customer reviews on these online seller websites, other buyers have reported harm using these devices i.e. bleeding from the ear, pushing ear wax further in the ear canal and resulting in hearing loss 1,2. Having purchased one of these items for home research, we found the otoendoscope unwieldy and it was difficult to gain a good image. Also with mono-ocular vision, there is no depth perception, consequently this may increase the risk of self-injury for new/untrained users. Whilst such devices may well be helpful in the current COVID crisis and could be used for telemedicine to help with distant patient examination during lockdowns 3,4, we would like to highlight the potential dangers of the use of these items by the public.

ITGB1 (Integrin β1, CD29) is a member of the integrin family and roles as a major adhesion receptor. Gastric cancer (GC) is an important cause of mortality worldwide, especially in China. As a potential cancer enhancer, the roles ITGB1 plays in GC progression keep unclear. In the current study, our assay on the databases about tumor associated gene expression and interaction found that the high expression of ITGB1 was closely correlated with the poor prognosis of GC patients. To explore the roles ITGB1 plays in GC progression, an ITGB1 deleted cell line (ITGB1-/-SGC7901) was generated using CRISPR/Cas9 method. The tumor malignancy associated cell behaviors and microstructures were detected, imaged, and analyzed using MTT, wound healing, transwell, scanning electron microscope (SEM), laser scanning confocal microscope (LSCM) and others. The results indicated that ITGB1 deletion decreased the GC cell proliferation and motility, and inhibited motility relevant microstructures, such as pseudopodia and filopodia markedly in ITGB1deleted SGC7901 cells. The analysis of STRING database suggested that ITGB1 contributes to the malignancy of GC mediated by Src-mediated FAK/PI3K/Akt signaling pathways. Taken together, the results above showed that ITGB1 may be a potential targeting marker for GC diagnosis and therapy, and it enhances GC progression via Src-mediated FAK/PI3K/Akt signal pathway that needs further validation in future.

In Poland the poultry industry is dynamically developing and, as a result, constant threat from the rapidly changing IB virus explains the need to constantly monitor the epidemiological situation in a given region. Therefore, the aim of this publication is to present the current epidemiological IB field situation in Poland based on research done recently. Knowledge of the current field status can help to find the best solution and quick response in the case of a new variant of IB virus with altered pathogenicity. The following publication shows changes in the epidemiological situation in the frequency of infections with various IB virus serotypes, mainly 793B, Var2, and QX. Understanding the epidemiology of IBV and the structure of the occurrence of individual viral serotypes allows the use of optimal vaccination programmes and improvement of production efficiency.

ARNI-drug, which consists of two components: the blocker of angiotensin receptors -valsartan and the neprilysin inhibitor-sacubitril. As a rule, the drugs available in cardiological practice, both two-component and fixed 3 or more component, consist of a combination of drugs that are successfully used as monotherapy. Examples include calcium antagonists, β-blockers, hydrochlorothiazide, indapamide, valsartan, perindopril, etc. All these drugs have been used successfully for many years as monotherapy, and nowadays, both as monotherapy and in combinations.But sacubitril is only drug in cardiovascular practice which is not recommended as monotherapy,only as combination – sacubitril/valsartan. LCZ 696 were represented by drug makers as very difficult to create, even at 696 attempt, < monolith molecule>. Cause of ? The reason is not entirely clear and, as I understand it, is explained by the necessity of compulsory fusion into a for the simultaneous release of both components of both valsartan and sacubitrile so that valsartan mitigates the negative effect of sacubitril caused NEP-dependent degradation of angiotensin II.Weak explanation,isn’t it? But No sacubitril monotherapy studies were conducted. However, a sacubitril 200 mg monotherapy arm of 165 patients was included in the HTN study CLCZ696A2201. A Multi-center, Randomized, Double-blind, Placebo and Active Controlled, Parallel Group, Dose Range Study to Evaluate the Efficacy and Safety of LCZ696 Comparatively to Valsartan, and to Evaluate AHU377 to Placebo After 8 Week Treatment in Patients With Essential Hypertension. In monotherapy arm, participants received AHU377 200 mg and matching placebo to LCZ696 and Valsartan.