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The Effects of Demographic, Training, and Specialization Differences of Physicians in Coronavirus Disease 19 Treatment in Turkey
Abstract
Introduction:
The study aimed to determine how physicians' professional and institutional characteristics affect their treatment approaches for COVID-19 antiviral and supportive treatment, as well as their demographic characteristics and participation in COVID-19 trainings that may influence these orientations.
Methods:
After researching the literature and conducting interviews with the experts, a questionnaire was prepared. The convenience sampling method was used to distribute the questionnaire online to 408 physicians across the nation in January 2021. Exploratory factor analysis was used to verify the research scale, and the Cronbach's Alpha test was used to confirm its reliability. During the data analysis, descriptive and inferential statistical tests were used.
Results:
It was observed that the physicians were willing to give COVID-19 patients the antivirals but hesitant to provide and suggest supportive care. The training status for COVID-19 treatment was varied. Female physicians prescribed more antiviral drugs than male physicians, received more training, and scored higher across the scale than male physicians (p = 0.001). The treatment approaches of physicians varied according to their specializations (p = 0.002) all over the scale.
Discussion:
The publication of current Ministry of Health guidelines on a variety of themes related to COVID-19 treatment, as seen in Turkey, is both beneficial and important. However, because all physicians, regardless of specialty, are affected by current and will be in the future pandemics, it is necessary to design and maintain a continuous training program on pandemics and their management for all physicians.
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Background: The COVID-19 pandemic has caused a surge in research activity while restricting data collection methods, leading to a rise in survey-based studies. Anecdotal evidence suggests this increase in neurosurgical survey dissemination has led to a phenomenon of survey fatigue, characterized by decreased response rates and reducing the quality of data. This paper aims to analyze the effect of COVID-19 on neurosurgery surveys and their response rates, and suggest strategies for improving survey data collection.
Methods: A search was conducted on March 20, 2021, on Medline and EMBASE. This included the terms "neurosurgery", "cranial surgery", "spine surgery", and "survey" and identified surveys written in English, on a neurosurgical topic, distributed to neurosurgeons, trainees, and medical students. Results were screened by two authors according to these inclusion criteria, and included articles were used for data extraction, univariable, and bivariable analysis with Fisher's exact test, Wilcoxon rank-sum test, and Spearman's correlation.
Results: We included 255 articles in our analysis, 32.3% of which were published during the COVID-19 pandemic. Surveys had an average of 25.6 (95% CI=22.5-28.8) questions and were mostly multiple choice (78.8%). They were disseminated primarily by email (75.3%, 95% CI=70.0-80.6%) and there was a significant increase in dissemination via social media during the pandemic (OR=3.50, 95% CI=1.30-12.0). COVID-19 surveys were distributed to more geographical regions than pre-pandemic surveys (2.1 vs. 1.5, P=0.01) and had higher total responses (247.0 vs. 206.4, P=0.01), but lower response rates (34.5% vs. 51.0%, P<0.001) than pre-COVID-19 surveys.
Conclusion: The rise in neurosurgical survey distribution during the COVID-19 pandemic has led to survey fatigue, reduced response rates, and data collection quality. We advocate for population targeting to avoid over-researching, collaboration between research teams to minimize duplicate surveys, and communication with respondents to convey study importance, and we suggest further strategies to improve response rates in neurosurgery survey data collection.
COVID-19 emerged from China in December 2019 and during 2020 spread to every
continent including Antarctica. The coronavirus, SARS-CoV-2, has been identified as
the causative pathogen, and its spread has stretched the capacities of healthcare
systems and negatively affected the global economy. This review provides an update
on the virus, including the genome, the risks associated with the emergence of
variants, mode of transmission, immune response, COVID-19 in children and the
elderly, and advances made to contain, prevent and manage the disease. Although
our knowledge of the mechanics of virus transmission and the immune response has
been substantially demystified, concerns over reinfection, susceptibility of the elderly and
whether asymptomatic children promote transmission remain unanswered. There are
also uncertainties about the pathophysiology of COVID-19 and why there are variations
in clinical presentations and why some patients suffer from long lasting symptoms—“the
long haulers.” To date, there are no significantly effective curative drugs for COVID19, especially after failure of hydroxychloroquine trials to produce positive results. The
RNA polymerase inhibitor, remdesivir, facilitates recovery of severely infected cases but,
unlike the anti-inflammatory drug, dexamethasone, does not reduce mortality. However,
vaccine development witnessed substantial progress with several being approved in
countries around the globe
Since December 2019, a new form of severe acute respiratory syndrome (SARS) from a novel strain of coronavirus (SARS‐CoV‐2) has been spreading worldwide. The disease caused by SARS‐CoV‐2 was named Covid‐19 and declared as a pandemic by the WHO in March 2020. Clinical symptoms of Covid‐19 range from common cold to more severe disease defined as pneumonia, hypoxia, and severe respiratory distress. In the next stage, disease can become more critical with respiratory failure, sepsis, septic shock, and/or multi‐organ failure. Outcomes of Covid‐19 indicate large gaps between the male‐female and the young‐elder groups. Several theories have been proposed to explain variations, such as gender, age, comorbidity, and genetic factors. It is likely that mixture of genetic and non‐genetic factors interplays between virus and host genetics and determines the severity of disease outcome. In this review we aimed to summarize current literature in terms of potential host genetic and epigenetic factors that associated with increased severity of Covid‐19. Several studies indicated that the genetic variants of the SARS‐CoV‐2 entry mechanism related (Angiotensin converting enzymes, Transmembrane serine protease‐2, Furin) and host innate immune response related genes (Interferons, Interleukins, Toll like receptors); HLA, ABO, 3p21.31 and 9q34.2 loci are critical host determinants related to Covid‐19 severity. Epigenetic mechanisms also effects Covid‐19 outcomes by regulating interferon signalling, ACE2 expression and immunity related genes that particularly on the X chromosome. Enhanced understanding of host genetic and epigenetic factors and viral interactions of SARS‐CoV‐2 is critical for improved prognostic tools and innovative therapeutics.
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Thrombotic complications occur at high rates in hospitalized patients with COVID‐19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. We examined in‐hospital mortality with intermediate‐ compared to prophylactic‐dose anticoagulation, and separately with in‐hospital aspirin compared to no antiplatelet therapy, in a large, retrospective study of 2785 hospitalized adult COVID‐19 patients. In this analysis, we established two separate, nested cohorts of patients (1) who received intermediate‐ or prophylactic‐dose anticoagulation (“anticoagulation cohort”, N = 1624), or (2) who were not on home antiplatelet therapy and received either in‐hospital aspirin or no antiplatelet therapy (“aspirin cohort”, N = 1956). To minimize bias and adjust for confounding factors, we incorporated propensity score matching and multivariable regression utilizing various markers of illness severity and other patient‐specific covariates, yielding treatment groups with well‐balanced covariates in each cohort. The primary outcome was cumulative incidence of in‐hospital death. Among propensity score‐matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate‐ compared to prophylactic‐dose anticoagulation was associated with a significantly lower cumulative incidence of in‐hospital death (hazard ratio 0.518 [0.308‐0.872]). Among propensity‐score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in‐hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in‐hospital death (hazard ratio 0.522 [0.336‐0.812]). In this propensity score‐matched, observational study of COVID‐19, intermediate‐dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in‐hospital death.
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Introduction
Emerging evidence points to an association between severe clinical presentation of COVID-19 and increased risk of thromboembolism. One-third of patients hospitalized due to severe COVID-19 develops macrovascular thrombotic complications, including venous thromboembolism, myocardial injury/infarction and stroke. Concurrently, the autopsy series indicate multiorgan damage pattern consistent with microvascular injury.
Prophylaxis, diagnosis and treatment
COVID-19 associated coagulopathy has distinct features, including markedly elevated D-dimers concentration with nearly normal activated partial thromboplastin time, prothrombin time and platelet count. The diagnosis may be challenging due to overlapping features between pulmonary embolism and severe COVID-19 disease, such as dyspnoea, high concentration of D-dimers, right ventricle with dysfunction or enlargement, and acute respiratory distress syndrome. Both macro- and microvascular complications are associated with an increased risk of in-hospital mortality. Therefore, early recognition of coagulation abnormalities among hospitalized COVID-19 patients are critical measures to identify patients with poor prognosis, guide antithrombotic prophylaxis or treatment, and improve patients’ clinical outcomes.
Recommendations for clinicians
Most of the guidelines and consensus documents published on behalf of professional societies focused on thrombosis and hemostasis advocate the use of anticoagulants in all patients hospitalized with COVID-19, as well as 2-6 weeks post hospital discharge in the absence of contraindications. However, since there is no guidance for deciding the intensity and duration of anticoagulation, the decision-making process should be made in individual-case basis.
Conclusions
Here, we review the mechanistic relationships between inflammation and thrombosis, discuss the macrovascular and microvascular complications and summarize the prophylaxis, diagnosis and treatment of thromboembolism in patients affected by COVID-19.
State governments and hospital facilities are often unprepared to handle a complex medical crisis, despite a moral and ethical obligation to be prepared for disaster. The 2019 novel coronavirus disease (COVID-19) has drawn attention to the lack of state guidance on how hospitals should provide care in a crisis. When the resources available are insufficient to treat the current patient load, crisis standards of care (CSC) are implemented to provide care to the population in an ethical manner, while maintaining an ability to handle the surge. This Editorial aims to raise awareness concerning a lack of preparedness that calls for immediate correction at the state and local level.
Analysis of state guidelines for implementation of CSC demonstrates a lack of preparedness, as only five states in the US have appropriately completed necessary plans, despite a clear understanding of the danger. States have a legal responsibility to regulate the medical care within their borders. Failure of hospital facilities to properly prepare for disasters is not a new issue; Hurricane Katrina (2005) demonstrated a lack of planning and coordination. Improving disaster health care readiness in the United States requires states to create new policy and legislative directives for the health care facilities within their respective jurisdictions. Hospitals should have clear directives to prepare for disasters as part of a “duty to care” and to ensure that the necessary planning and supplies are available to their employees.
This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.
Although prescribing is the most common intervention provided by physicians, limited research has examined the role of physician sex and gender on prescribing practices. In this article, we briefly summarize research relating to differences in prescribing behaviors based on physician sex and gender. To identify articles, PubMed was searched for studies from the last 20 years reporting on prescribing differences by physician sex or gender for the general population and specifically for older adults. We describe major themes emerging from the studies, illustrate findings from key studies, and note the major gaps in the literature, notably the lack of evidence on prescribing for older adults. Given the paucity of research in this area, we also explore evidence on the impact of physician sex and gender on other aspects of healthcare delivery, such as communication within the patient‐physician relationship, and consider how these findings may also apply to prescribing behaviors. In general, we note that female physicians have been observed to engage in more careful and conservative healthcare provision including prescribing. A careful and conservative approach to prescribing may reduce the incidence of adverse drug events in older adults and be linked to a more patient‐centered approach to care. To what extent these differences in prescribing are important for patient health outcomes is unknown, and further research is required to identify optimal prescribing practices that minimize harms.
Aim
To identify investigated interventions for COVID-19 prevention or treatment via trial registry entries on planned or ongoing randomised clinical trials. To assess these registry entries for recruitment status, planned trial size, blinding and reporting of mortality.
Methods
We identified trial registry entries systematically via the WHO International Clinical Trials Registry Platform and 33 trial registries up to June 23, 2020. We included relevant trial registry entries for randomized clinical trials investigating medical preventive, adjunct or supportive therapies and therapeutics for treatment of COVID-19. Studies with non-random and single-arm design were excluded. Trial registry entries were screened by two authors independently and data were systematically extracted.
Results
We included 1303 trial registry entries from 71 countries investigating 381 different single interventions. Blinding was planned in 47% of trials. Sample size was >200 participants in 40% of trials and a total of 611,364 participants were planned for inclusion. Mortality was listed as an outcome in 57% of trials. Recruitment was ongoing in 54% of trials and completed in 8%. Thirty-five percent were multicenter trials. The five most frequent investigational categories were immune modulating drugs (266 trials (20%)), unconventional medicine (167 trials (13%)), antimalarial drugs (118 trials (9%)), antiviral drugs (100 trials (8%)) and respiratory adjuncts (78 trials (6%)). The five most frequently tested uni-modal interventions were: chloroquine/hydroxychloroquine (113 trials with 199,841 participants); convalescent plasma (64 trials with 11,840 participants); stem cells (51 trials with 3,370 participants); tocilizumab (19 trials with 4,139 participants) and favipiravir (19 trials with 3,210 participants).
Conclusion
An extraordinary number of randomized clinical trials investigating COVID-19 management have been initiated with a multitude of medical preventive, adjunctive and treatment modalities. Blinding will be used in only 47% of trials, which may have influence on future reported treatment effects. Fifty-seven percent of all trials will assess mortality as an outcome facilitating future meta-analyses.
Governments worldwide have implemented countless policies in response to the COVID-19 pandemic. We present an initial public release of a large hand-coded dataset of over 13,000 such policy announcements across more than 195 countries. The dataset is updated daily, with a 5-day lag for validity checking. We document policies across numerous dimensions, including the type of policy, national versus subnational enforcement, the specific human group and geographical region targeted by the policy, and the time frame within which each policy is implemented. We further analyse the dataset using a Bayesian measurement model, which shows the quick acceleration of the adoption of costly policies across countries beginning in mid-March 2020 through 24 May 2020. We believe that these data will be instrumental for helping policymakers and researchers assess, among other objectives, how effective different policies are in addressing the spread and health outcomes of COVID-19. The COVID-19 Government Response Event Dataset (CoronaNet v.1.0) compiles real time, publicly available (https://coronanet-project.org) data on policy announcements made in response to the COVID-19 pandemic across the world.
Introduction: Ever since World Health Organization declared COVID-19 as a public health emergency of international concern, Ghana is one of the most affected countries in Africa. However, the knowledge, practice, and preparedness of healthcare providers on the novel COVID-19 in the country has not been studied. This study assessed health workers’ knowledge, practice, and preparedness on the current pandemic in three Ghanaian hospitals.
Methods: This multi-centre cross-sectional survey recruited 261 healthcare workers in Offinso North district between April and May, 2020, through self-administered questionnaire. SPSS version 22.0 was used for the analysis and statistical significance set at p < 0.05.
Results: We identified that 65.1% of the healthcare providers had adequate knowledge, 27.6% of them had received appropriate in-service training, 57.5% had adequately prepared themselves and willing to care for affected patients and 63.0% were duly aware of their facility’s preparedness for the situation. Again, only 57.5% of the health workers adhered strictly to the practice of precautionary measures, and 62.5% had varying forms of misconceptions about the aetiology of the novel COVID-19. Majority (77.1%) of the respondents received regular information on the COVID-19 from the Ministry of Health, Ghana.
Conclusion: The overall knowledge, practice and willingness of healthcare workers to handle COVID-19 were encouraging; however, this study still elucidates the knowledge gap of the professionals on the pandemic. We advocate for progressive training of staff on COVID-19, to advance the appreciation of the risks and precautionary measures and clear the misconceptions. This, we believe, would boost the confidence and increase their willingness to deliver efficiently.
Nobody can be fully prepared to a pandemic. Of course there are signs of it, the scientists can predict, alarming speeches can be made. But there are always alarmist people around, maybe that is why sometimes even the most serious warnings may be not considered by the authorities on time. The first patients may be lost without a proper diagnosis. When everybody realizes that there may be a big problem in the horizon, sometimes it is too late. That is why it is very important to monitor contagious diseases and follow the warnings and releases of national and international disease control centers and other related organizations. China celebrated Lunar New Year with more than 40thousand families on the 18 of January 2020. Nobody seem to be expecting this emerging new viral pneumonia outbreak appeared in Wuhan, in the last days of 2019, will break the chains and turn out to be a pandemic! But maybe this time it was not too late. There were four important pandemics within the last century: Spanish Flu, Hong Kong Flu, Asian Flu and Swine Flu. Each left different story behind. Millions of people had infected, hundreds, thousands of people died. This time, the Modern World had different tools to limit the SARS CoV2 outbreak. The national and international institutions of our globe were all communicating and taking precautions in a very fast manner than ever. However, this time, unexpectedly, the SARS-CoV-2 contagion was also faster. Beside the international organizations like WHO, UNESCO and UNICEF, the roles of local authorities, health ministries, disease control centers, health protection agencies, research centers and universities are all very important in different operational levels to control and survive from the pandemic. This paper will review the immediate response of different national and international institutions and authorities to COVID-19 pandemic.
Currently, there is not any specific effective anti-viral treatment for COVID-19. Although most of the COVID-19 patients have mild or moderate courses, up to 5-10% can have severe, potentially life-threatening course and there is an urgent need for effective drugs. Optimized supportive care remains the mainstay of therapy. There have been more than 300 clinical trials going on, various antiviral and immunomodulating agents are in various stages of evaluation for COVID-19 in those trials and some of them will be published in the next couple of months. Despite the urgent need to find an effective antiviral treatment for COVID-19 through randomized controlled studies, certain agents are being used all over the world based on either in-vitro or extrapolated evidence or observational studies. The most frequently used agents both in Turkey and all over the world including chloroquine, hydroxychloroquine, lopinavir/ritonavir, favipiravir and remdesivir will be reviewed here .Nitazoxanide and ivermectin were also included in this review as they have recently been reported to have an activity against SARS-CoV-2 in-vitro and are licensed for the treatment of some other human infections.
Just when I thought I was out, they pull me back in: the older physician in the COVID-19 pandemic - Carmelle Peisah, Peter Hockey, Susan Mary Benbow, Betsy Williams
To achieve compliance with the revised World Health Organization International Health Regulations (IHR 2005), countries must be able to rapidly prevent, detect, and respond to public health threats. Most nations, however, remain unprepared to manage and control complex health emergencies, whether due to natural disasters, emerging infectious disease outbreaks, or the inadvertent or intentional release of highly pathogenic organisms. The US Centers for Disease Control and Prevention (CDC) works with countries and partners to build and strengthen global health security preparedness so they can quickly respond to public health crises. This report highlights selected CDC global health protection platform accomplishments that help mitigate global health threats and build core, cross-cutting capacity to identify and contain disease outbreaks at their source. CDC contributions support country efforts to achieve IHR 2005 compliance, contribute to the international framework for countering infectious disease crises, and enhance health security for Americans and populations around the world.
Objectives
Celiac disease (CD) is commonly found in women. Given the sex differences in diagnosed patients, we hypothesized sex differences in physicians obtaining biopsies for CD may exist.
Materials and methods
We retrospectively reviewed duodenal biopsies for suspected CD excluding pre-existing CD patients. Appropriate biopsy practice was defined as ≥5 specimens per ACG guidelines.
Results
We included 125 patients (females, 92). There were 85 properly (68%) biopsied. Presence of a female endoscopist was associated with better adherence to biopsy guidelines (OR, 2.99, 95% CI, 1.19–7.54; p = .02) which remained significant after multivariable adjustment (adjusted OR, 2.7; p = .047).
Conclusions
Physician sex-based differences in biopsy patterns may exist.
In the eleven months elapsed since the identification of the SARS-CoV-2 virus and its genome, an exceptional effort by the scientific community has led to the development of over 300 vaccine projects. Over 40 are now undergoing clinical evaluation, ten of these are in Phase III clinical trials, three of them have ended Phase III with positive results. A few of these new vaccines are being approved for emergency use. Existing data suggest that new vaccine candidates may be instrumental in protecting individuals and reducing the spread of pandemic. The conceptual and technological platforms exploited are diverse, and it is likely that different vaccines will show to be better suited to distinct groups of the human population. Moreover, it remains to be elucidated whether and to what extent the capacity of vaccines under evaluation and of unrelated vaccines such as BCG can increase immunological fitness by training innate immunity to SARS-CoV-2 and pathogen-agnostic protection. Due to the short development time and the novelty of the technologies adopted, these vaccines will be deployed with several unresolved issues that only the passage of time will permit to clarify. Technical problems connected with the production of billions of doses and ethical ones connected with the availably of these vaccines also in the poorest countries, are imminent challenges facing us. It is our tenet that in the long run more than one vaccine will be needed to ensure equitable global access, protection of diverse subjects and immunity against viral variants.
Pandemics and related problems have been an important publich health issue throughout history and will continue to be so in the future. Soon after its outbreak in Wuhan, China, in December 2019, COVID-19 was declared as a global pandemic which caught many countries unprepared with exceptions. Turkey was one of them. Having worked on plans and preparations for a possible pandemic since 2004 the Turkish Ministry of Health performed well in curbing the initial spread of the virus after its entrance into the country and has played an important role in Turkey’s successful fight against COVID-19 since then. Turkey’s successful management of the crisis has been marked by its idiosyncratic approach to the crisis and the robustness of its healthcare sytstem which have helped taking COVID-19 pandemic under control and preventing its devastating consequences.
In patients with severe or critical Coronavirus disease 2019 (COVID-19) manifestations, a thromboinflammatory syndrome, with diffuse microvascular thrombosis, is increasingly evident as the final step of pro-inflammatory cytokines storm. Actually, no proven effective therapies for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exist. Preliminary observations on anticoagulant therapy appear to be associated with better outcomes in moderate and severe COVID-19 patients with signs of coagulopathy and in those requiring mechanical ventilation. The pathophysiology underlying the prothrombotic state elicited by SARS-CoV-2 outlines possible protective mechanisms of antithrombotic therapy (in primis anticoagulants) for this viral illness. The in- dications for antiplatelet/anticoagulant use (prevention, prophylaxis, therapy) are guided by the clinical context and the COVID-19 severity. We provide a practical approach on antithrombotic therapy management for COVID-19 patients from a multidisciplinary point of view.
People worry that many COVID-19 decisions are not evidence based, but applying typical evidence-based management (EBM) in a pandemic seems difficult. A pandemic is characterized by uncertainty, high potential loss, time pressure, and competing values, all posing challenges to EBM. Drawing on events in government responses to COVID-19, this essay focuses on three issues: What should be considered as evidence in pandemic-like situations? How can we make evidence more accessible to decision makers in such situations? And, does evidence have a role in ethical judgments in a pandemic? The essay argues that EBM must be extended to address pandemic-like situations. The evidentiary standard should take into consideration “appropriateness,” “reasonableness,” and “intuition,” paying attention to the stages of a pandemic and the type of errors we want to avoid. In addition, the essay calls for building policy capacity in terms of coproducing and applying evidence in and outside government, as well as strengthening public managers’ capacity in evidence-based ethical analysis.
Background and aims:
Untreated individuals with familial hypercholesterolaemia (FH) are at increased risk of developing premature cardiovascular disease (CVD). Early diagnosis and treatment can result in a normal life expectancy. A recent survey commissioned by the European Atherosclerosis Society (EAS) reported a lack of awareness of FH in the general population. We conducted a survey to assess knowledge among healthcare professionals involved in the assessment and management of cardiovascular risk and disease in the United Kingdom.
Methods:
A survey designed to assess knowledge of diagnostic criteria, risk assessment, the role of cascade screening, and management options for patients with FH was distributed to 1000 healthcare professionals (response rate 44.3%). The same survey was redistributed following attendance at an educational session on FH.
Results:
151 respondents (40.5%) reported having patients under their care who would meet the diagnostic criteria for FH, but just 61.4% recognized that cardiovascular risk estimation tools cannot be applied in FH, and only 22.3% understood the relative risk of premature CVD compared to the general population. Similarly, just 65.9% were aware of recommendations regarding cascade screening.
Conclusions:
The prevalence and associated risk of FH continue to be underestimated, and knowledge of diagnostic criteria and treatment options is suboptimal. These results support the recent Consensus Statement of the EAS and production of quality standards by the National Institute for Health and Care Excellence. Further work is required to formulate interventions to improve FH awareness and knowledge, and to determine the effect these interventions have on patient outcomes.
Bioactive compounds from marine flora and fauna have extensive past and present use in the treatment of many diseases and serve as compounds of interest both in their natural form and as templates for synthetic modification. Several molecules isolated from various marine organisms (microorganisms, algae, fungi, invertebrates, and vertebrates) are currently under study at an advanced stage of clinical trials, some of them have already been marketed as drugs. This article gives an overview of current trends in screening and the activity analysis of metabolites from marine resources. Although the marine resources have been somewhat limited to date, selected bioactive from marine flora and fauna have already published. This report summarizes the screening for bioactive compounds of marine animals and marine microorganisms. Finally, new approaches for the screening of metabolites from marine resources are discussed. The goal of this article is to expose the new models and mechanisms of action of marine substances to bring new solutions for tackling some of the major public health problems.
Managing emerging infectious diseases with information systems: reconceptualizing outbreak management through the lens of loose coupling
- Chen
Assessing the impact of the COVID-19 pandemic in Spain: large-scale, online, self-reported population survey
- Oliver