Exploring the Efficacy of Nonlinear Filters in CMOS for 2-D Signal Processing for Image Quality Enhancement.

This study rigorously investigates the effectiveness of nonlinear filters in CMOS for 2-D signal processing to enhance image quality. We comprehensively compare traditional linear filters' performance, which operate on the principle of linearity, with nonlinear filters, such as the median-median (Med-Med) approach, designed to handle nonlinear data. To ensure the validity of our findings, we use widely accepted metrics like normalized squared error (NSE), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM) to quantify the differences. Our simulations and experiments, conducted under controlled conditions, demonstrate that nonlinear filters in CMOS outperform linear filters in removing impulse noise and enhancing images. We also address the challenges of implementing these algorithms at the hardware level, focusing on power consumption and chip area optimization. Additionally, we propose a new architecture for the Med-Med filter and validate its functionality through experiments using a 9-pixel image sensor array. Our findings highlight the potential of nonlinear filters in CMOS for real-time image quality enhancement and their applicability in various real-world imaging applications. This research contributes to visual technology by combining theoretical insights with practical implementations, paving the way for more efficient and adaptable imaging systems.

The role of duty, gender and intergenerational care in grandmothers' parenting of grandchildren: a phenomenological qualitative study.

OBJECTIVES: The aim of this study was to describe grandmothers' experiences of taking care of their grandchildren in terms of their care-giving tasks, motivations and emotions. METHODS: A qualitative phenomenological study was conducted. Purposive sampling was used, based on the relevance of the research question. Seventeen participants were included, women ≥ 65 years old, grandmothers who care for their grandchildren at least 10 h per week and who attended the Nursing units of the Primary Care Health Centers (Madrid Public Health Service). Seventeen in-depth interviews were conducted. The interviews were audio-recorded, transcribed verbatim and thematic analysis was carried out from the perspective of hermeneutic phenomenology. For the analysis, the Excel program was used to organize and share the coding process. Also, we followed COREQ guidelines. RESULTS: Four main themes were identified: (a) Care out of obligation, where participants feel an obligation to help their children by caring for grandchildren, regardless of their number, and prefer to do so voluntarily; (b) Care out of responsibility, where grandmothers see their role as a responsibility that includes saving costs by caring for grandchildren and facilitating their children's work life balance; (c) Care as a social duty, reflecting a moral commitment inherited from their mothers to help future generations; and (d) Construction of care from a gender perspective, where grandmothers, as women, primarily assume the care and upbringing of grandchildren. DISCUSSION: Our results contribute to increase knowledge about childcare provided by grandmothers to their grandchildren. Grandmothers become fundamental pillars of families by helping their children balance family and work. Behind this care there is a strong sense of obligation, duty and generational responsibility. Grandmothers' help presents differences in the distribution of tasks and care by sex. Identifying factors that motivate grandmothers to care for their grandchildren helps nurses to perform higher quality comprehensive care.

Under-graduate nursing students working during the first outbreak of the COVID-19 pandemic: A qualitative study of psychosocial effects and coping strategies.

BACKGROUND: The first wave of the COVID-19 pandemic caused a shortage of health care staff, forcing the hiring of senior nursing students. AIMS: To describe the psychosocial impact and coping strategies used by nursing students during the first outbreak of the COVID-19 pandemic and to understand the coping strategies they employed. METHOD: A qualitative exploratory study was conducted, based on Sandelowski's proposal. Purposive sampling was carried out to recruit 18 students hired during the pandemic. The students were interviewed between 18 March and 15 June 2020. Semi-structured interviews were conducted using a digital platform. An inductive thematic analysis was performed. FINDINGS: The students lived alone and isolated during their contract to protect their cohabitants from possible contagion. The impact of working during the pandemic leads to experiences of stress, insomnia, nightmares and anxiety. Nursing students coped with the emotional burden through mental disconnection and the support of co-workers and family members. CONCLUSION: Psychological support and tutoring should be provided by health centres. In addition, in these special circumstances, universities should adapt the training provided.

Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students.

BACKGROUND: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. OBJECTIVES: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. RESEARCH DESIGN: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat room platform. A thematic, inductive analysis was performed of the information gathered. PARTICIPANTS AND RESEARCH CONTEXT: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. ETHICAL CONSIDERATIONS: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. RESULTS: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. CONCLUSIONS: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine.

Evolution of N-balance with qualitative expert evaluation approach.

Pollution of rivers by nitrate is a major issue. Many land use units are considered as net nitrate producers when the input dominates the uptake (e.g. agricultural areas), or in the opposite, net consumers (e.g. wetlands), but the role of their spatial organization and temporal dynamics together across the watershed is unclear. Here, we used a Nitrate-related Ecological Functions (NEF) concept, together with an expert-based analysis in a Geographical Information System, to investigate the role of two opposite landscape types in the nitrate regulation across the Garonne river watershed (France). At any point in a watershed, there is nitrate production (NP) and nitrate removal (NR). The nitrate net balance (NNB) between NP and NR functions can be neutral (NB, Neutral Balance) when nitrate fluxes balance over space and time. The first landscape type, called Actual, was obtained using a set of 7 actual environmental variables, as land cover types, soil organic matter content and wetlands presence. The second landscape type, called Natural, described a non-anthropized landscape, using the same layer types as the Actual landscape. Potentials in NP and NR for each class in each map layer were rated by a set of experts according to their scientific knowledge. NP, NR and by difference, NNB maps were obtained, overlaid and compared to provide an evaluation of the potential for each landscape. In both landscapes, NNB were largely balanced (Actual = 48% and Natural = 67%). In the Actual landscape, NNB were secondly dominated by an imbalance toward NP (43%) and in the Natural landscape secondly imbalanced toward NR (32%). We constructed 'maps of disagreement' between both landscapes to provide a spatially explicit assessment of NNB evolution caused by changing land cover. We found that 67% of the agricultural areas and 60% of the artificial areas of the watershed had been subjected to a loss of nitrate ecological functions from Natural to Actual landscapes. Some management practices able to modify these factors may improve ecological functions and diminish the NEF disagreement of the watershed.

Applications of a SWAT model to evaluate the contribution of the Tafna catchment (north-west Africa) to the nitrate load entering the Mediterranean Sea.

An elevated nitrogen concentration in water is one of the main problems affecting water quality in Mediterranean rivers. The objectives of this study were (1) to evaluate the contribution of the Tafna catchment to the nitrate load entering the Mediterranean Sea, (2) to quantify the impact of agriculture on the nitrate concentration in water bodies, (3) to evaluate nitrate loads entering groundwater, and (4) to quantify the role of reservoirs in nitrate retention. A SWAT model was applied during the period 2003 to 2011. The discharge calibration was based on a previous study by Zettam et al. (2017). NSE efficiencies ranged from 0.421 to 0.75, R2 ranged from 0.25 to 0.84, and PBIAS ranged from 3.68 to 39.42. The simulations of monthly nitrate loads were satisfactory in the upstream sampling stations, with NSE between 0.48 and 0.65 and R2 between 0.63 and 0.68. The PBIAS was satisfactory in all the sampling stations (- 36.30 to 10.42). In the downstream sampling stations, the calibration of the monthly nitrate loads was unsatisfactory (NSE ranged from - 0.26 to 0.21 and R2 ranged from 0.02 to 0.25). Fertilisation was the main N input in the catchment, while the main N output was plant uptake. The Tafna River carried an annual average of 37 to 85.5 t N year-1 into the Mediterranean Sea. The simulation also showed that reservoirs in the Tafna basin contain a large quantity of nitrates, i.e. 62% on average of the total amount of nitrates transported annually by the Tafna River.

Perspectives of Victims of Gender Violence.

The purpose of the current study was to explore the experiences of women who have been affected by violence and received mental health care. A qualitative phenomenological design was used with in-depth interviews and personal letters in a sample of 29 women from a public mental health center of Madrid, Spain, who were affected by physical, mental, and/or sexual abuse. The analysis revealed three themes: (1) Living With Fear; (2) Feeling Guilty; and (3) Experiencing the Imposition of So-Called "Womanly Duties" (i.e., being a maid, babysitter, and/or sexual slave). The current study highlights the importance of developing educational programs for the prevention of abuse. [Journal of Psychosocial Nursing and Mental Health Services, 58(6), 30-39.].

Female Family Caregivers' Experiences During Nursing Home Admission: A Phenomenological Qualitative Study.

The experience of nursing home (NH) admission has a significant impact on older adults and their relatives. The aim of the current study is to describe the life experiences of female family caregivers (N = 20) after long-stay NH admission of their relative. A qualitative phenomenological approach was followed with purposeful sampling. Data were collected over 18 months using unstructured interviews, letters, and diaries and were analyzed using systematic text condensation analysis. Three themes emerged: The Value of Experience: Deciding on Admission and Defending One's Criteria; Living on Two Sides of the Same Coin; and Maintaining Contact. Results provide insight into female caregivers' experiences of NH admission, which may improve relationships established between female family caregivers and NH staff and help inform the decision-making process. [Journal of Gerontological Nursing, 45(6), 33-43.].

Is the experience of meaningful activities understood in nursing homes? A qualitative study.

Lack of occupation can lead to boredom, apathy, social exclusion and solitude. Occupation should incorporate meaningful activities. The aim of this study is to describe how Spanish Nursing Home residents experienced and made sense of meaningful activities. A qualitative phenomenological approach was followed. Data were collected over an 18-month period between 2012 and 2014. Purposeful sampling was conducted with Spanish residents in nursing homes in Madrid. Data were collected using unstructured and semi-structured interviews. The data were analyzed using the Giorgi proposal. Thirty-eight residents (20 female and 18 male) participated. Three main themes describing the significance of meaningful activity in nursing homes emerged from the data: Feeling the passage of time, Seeking an occupation, and Living with restrictions. Nursing homes should strive to develop diverse and meaningful activity programs for residents in order to occupy their time and provide them with a greater sense of purpose.

Daily nitrate losses: implication on long-term river quality in an intensive agricultural catchment of southwestern france.

High nitrate concentrations in streams have become a widespread problem throughout Europe in recent decades, damaging surface water and groundwater quality. The European Nitrate Directive fixed a potability threshold of 50 mg L for European rivers. The performance of the Soil and Water Assessment Tool model was assessed in the 1110-km Save catchment in southwestern France for predicting water discharge and nitrate loads and concentrations at the catchment outlet, considering observed data set uncertainty. Simulated values were compared with intensive and extensive measurement data sets. Daily discharge fitted observations (Nash-Sutcliffe efficiency coefficient = 0.61, = 0.7, and PBIAS = -22%). Nitrate simulation (1998-2010) was within the observed range (PBIAS = 10-21%, considering observed data set uncertainty). Annual nitrate load at the catchment outlet was correlated to the annual water yield at the outlet ( = 0.63). Simulated annual catchment nitrate exportation ranged from 21 to 49 kg ha depending on annual hydrological conditions (average, 36 kg ha). Exportation rates ranged from 3 to 8% of nitrogen inputs. During floods, 34% of the nitrate load was exported, which represented 18% of the 1998-2010 period. Average daily nitrate concentration at the outlet was 29 mg L (1998-2010), ranging from 0 to 270 mg L. Nitrate concentration exceeded the European 50 mg L potability threshold during 244 d between 1998 and 2010. A 20% reduction of nitrogen input reduced crop yield by between 5 and 9% and reduced by 62% the days when the 50 mg L threshold was exceeded.

Simulating land management options to reduce nitrate pollution in an agricultural watershed dominated by an alluvial aquifer.

The study area (Alegria watershed, Basque Country, Northern Spain) considered here is influenced by an important alluvial aquifer that plays a significant role in nitrate pollution from agricultural land use and management practices. Nitrates are transported primarily from the soil to the river through the alluvial aquifer. The agricultural activity covers 75% of the watershed and is located in a nitrate-vulnerable zone. The main objective of the study was to find land management options for water pollution abatement by using model systems. In a first step, the SWAT model was applied to simulate discharge and nitrate load in stream flow at the outlet of the catchment for the period between October 2009 and June 2011. The LOADEST program was used to estimate the daily nitrate load from measured nitrate concentration. We achieved satisfactory simulation results for discharge and nitrate loads at monthly and daily time steps. The results revealed clear variations in the seasons: higher nitrate loads were achieved for winter (20,000 kg mo NO-N), and lower nitrate loads were simulated for the summer (<1000 kg mo NO-N) period. In a second step, the calibrated model was used to evaluate the long-term effects of best management practices (BMPs) for a 50-yr period by maintaining actual agricultural practices, reducing fertilizer application by 20%, splitting applications (same total N but applied over the growing period), and reducing 20% of the applied fertilizer amount and splitting the fertilizer doses. The BMPs were evaluated on the basis of local experience and farmer interaction. Results showed that reducing fertilizer amounts by 20% could lead to a reduction of 50% of the number of days exceeding the nitrate concentration limit value (50 mg L) set by the European Water Framework Directive.

A qualitative study of the relationships between residents and nursing homes nurses.

AIMS AND OBJECTIVES: To explore the relationships between residents and nurses in Spanish nursing homes. BACKGROUND: The nurses are one of the elements conditioning the life of the nursing home resident, influencing sense of security and mediating the relationships among residents. DESIGN: A qualitative phenomenological approach was applied. METHODS: An initial purposeful sampling of Spanish residents from nursing homes in the southern area of Madrid was conducted. The study included nursing home residents, aged 60 and over, with no cognitive impairment and who were able to communicate verbally in Spanish. Data were collected using unstructured and semi-structured interviews, researcher field notes, and personal diaries and letters from the residents. Data collection was concluded once theoretical saturation was reached, and data were analysed using the Giorgi proposal. RESULTS: Two main themes emerged: (1) 'meeting the nursing home nurses,' residents interact with nurses and establish relationships with them. The relationship is perceived as positive yet distant, and at times it is difficult to establish a closer relationship; and (2) 'managing relationships with the nursing home nurses,' residents learn to manage their relationships with the nurses, acquiring new behaviours to get closer to them, avoiding confrontations and helping each other. CONCLUSIONS: Residents manage their relationships with nurses using multiple behavioural strategies. They perceive these adjustments as necessary to facilitate daily life or avoid problems and/or confrontations. Deepening the relationships between residents and nurses could improve the management of nursing homes. RELEVANCE TO CLINICAL PRACTICE: Dialogue and active listening with residents must be incorporated into the daily nursing care. It should be given the same attention to all residents, with special attention to residents with cognitive and functional difficulties.

Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care.

Chronic Obstructive Pulmonary Disease (COPD) constitutes a major public health problem, and it is anticipated that its prevalence will continue to increase in the future. Its progressive nature requires a continuous and well-coordinated care approach. The follow-up for COPD should primarily focus on disease screening and control, which includes monitoring of pulmonary function, prevention of exacerbations, identification of aggravating factors and comorbidities, as well as ensuring treatment adequacy and adherence. However, existing clinical practice guidelines and consensus documents offer limited recommendations for the follow-up. In this context, we undertake a review of COPD treatment and the continuity of care recommendations endorsed by several scientific societies. Moreover, we underscore the importance of the involvement of nursing and community pharmacy in this process, as well as the utilization of quality indicators in the provision of care for the disease.

The role of ponds in pesticide dissipation at the catchment scale: The case of the Save agricultural catchment (Southwestern France).

Pesticides are a major source of pollution for ecosystems. In agricultural catchments, ponds serve as buffer areas for pesticide transfers and biogeochemical hotspots for pesticide dissipation. Some studies have highlighted the specific impact of ponds on the dynamics of pesticides, but knowledge of their cumulative effect at the watershed scale is scarce. Hence, using a modelling approach, we assessed the cumulative role of ponds in pesticide transfer in an agricultural basin (Southwest of France, 1110 km2). The Soil and Water Assessment Tool (SWAT) model was used to model the Save basin, including 197 ponds selected with a Multi-Criteria Decision Aiding Model based on their pesticide interception capacities. The daily discharge, the suspended sediment loads and two herbicide loads (i.e. S-metolachlor and aclonifen) in dissolved and particulate phases were accurately simulated from January 2002 to July 2014 at a daily time step. The presence of ponds resulted in a yearly mean reduction at the watershed outlet of respectively 61 % and 42 % of aclonifen and S-metolachlor fluxes compared to the simulations in the absence of ponds. Sediment-related processes were the most efficient for pesticide dissipation, leading to a mean dissipation efficiency by ponds of 51.0 % for aclonifen and 34.4 % for S-metolachlor. This study provides a first quantification of the cumulative role of ponds in pesticide transfer at the catchment scale in an intensive agricultural catchment.

Is the influence of nurse care practices and nursing home organization understood? A qualitative study.

AIM: To describe residents' experience of nursing home organization and nursing care practices in a region of Spain. BACKGROUND: Nursing home organization, nursing practices and rules within the institution may all influence residents' daily living and their perception on the quality of care provided. DESIGN: A qualitative approach was conducted, using purposeful and theoretical sampling. Data were collected from nursing home residents, following unstructured and semi-structured interviews, researcher field notes and residents' personal diaries and letters. Giorgi analysis was conducted. RESULTS: Two main themes emerged. (1) 'Following nursing home rules'. Norms may be seen as boundaries, especially for those residents who were independent before admission. (2) 'Prioritizing nursing care in residents'. Prioritizing the nursing care may limit the autonomy of residents because it does not meet their preferences and needs. CONCLUSION: Understanding the meaning of nursing home organization and nursing care practices with nursing home residents might provide deeper insight into their expectations. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing staff should have greater involvement in the nursing home organization, as well as in prioritizing the care provision based on resident's needs and preferences.

Identification of critical effect factors for prediction of spatial and intra-annual variability of shallow groundwater nitrate in agricultural areas.

Shallow groundwater nitrate nitrogen (NO3--N) concentrations in agricultural areas usually show high spatial and intra-annual variability. It is hard to predict such concentrations due to the complexity of influencing factors (e.g., different forms of N in soil, vadose zone characteristics, and groundwater physiochemical conditions). Here, a large number of groundwater and soil samples were collected monthly over two years at 14 sites to analyze the soil and groundwater physiochemical properties and the stable isotopes of δ15N and δ18O of groundwater NO3--N in agricultural areas. Based on field observations, a random forest (RF) model was used to predict the groundwater NO3--N concentrations and reveal the importance of effect factors. The results show that there are large spatiotemporal variations in NO3--N, δ15N-NO3-, and δ18O-NO3- in groundwater. NO3--N is the major dominant specie of inorganic N in groundwater, and the groundwater NO3--N concentration in 24 % of the samples failed to meet the drinking water standard of the WHO (10 mg L-1). The RF model satisfactorily predicted groundwater NO3--N concentrations with R2 of 0.90-0.94, RMSE of 4.54-5.07, and MAE of 2.17-3.38. Groundwater nitrite and ammonium are the most important factors related to NO3--N consumption and production, respectively, in groundwater. Denitrification and nitrification were further identified by the relationships among δ15N-NO3-, δ18O-NO3-, and NO3--N, and by the ranges of δ15N-NO3-, δ18O-NO3-, temperature, pH, DO, and ORP in groundwater. Soil-soluble organic nitrogen (S-SON) and the depth of groundwater table were identified as vital factors related to N sourcing and leaching. Overall, as a first approach to adopting a RF model for high spatiotemporal-resolution prediction of groundwater NO3--N variations, the findings of this study enable a better understanding of groundwater N pollution in agricultural areas. Optimizing management of irrigation and N inputs is anticipated to reduce S-SON accumulation and mitigate the threat to groundwater quality in agricultural areas.

Assessing fluvial organic carbon flux and its response to short climate variability and damming on a large-scale tropical Asian river basin.

Fluvial organic carbon (OC) transfer is an essential resource for downstream ecosystems. Multiple factors affect its transfer process, e.g., climate or anthropogenic activities. Quantifying OC fluxes with fine spatiotemporal resolution is challenging in anthropised catchments. This study aims to quantify daily OC dynamics and to assess the impacts of short climate variability and damming on OC spatiotemporal transfer processes in a large tropical Asian river basin (the Red River) for an extended period (2003-2013) by combining empirical equations with modelling outputs. Firstly, empirical equations for calculating dissolved (DOC) and particulate OC (POC) concentrations were calibrated based on in-situ sampling data. Then, simulated daily discharge (Q) and suspended sediment concentrations were used to quantify daily OC fluxes. Results show that the parameters of the DOC and POC equations well represent the subbasins characteristics, underlining the effects of soil OC content, mean annual Q and Chlorophyll a. DOC and POC exports reached 222 and 406 kt yr-1 at the basin outlet, accounting for 0.38 % of the total OC (TOC) exported by Asian rivers to the ocean. However, the specific yields of DOC (1.62 t km-2 yr-1) and POC (2.96 t km-2 yr-1) of the Red River basin were ~ 1.5 times those of other Asian basins. By comparing a reference scenario (without dams) to current conditions, we estimated 12 % and 88 % decreases in DOC and POC fluxes between 2008-2013 and 2003-2007, mainly due to damming. This study shows that climate variability may not impact OC dynamics in rivers as it explained <2 % of the variations. However, dam management, especially recent ones operating since 2008, deeply influences OC variations as the POC/TOC ratio decreased from 86 % to 47 %. Damming significantly decreased POC exports due to sediment retention, altering the equilibrium of OC cycling downstream, which may impact the food chain.

A Network Meta-Analysis on the Surgical Management of Thoracolumbar Burst Fractures: Anterior, Posterior, and Combined.

Background: Thoracolumbar burst fractures (BFs) are traumatic lesions instigated by compression forces. Canal compression and compromise may lead to neurological deficits. Optimal surgical management is yet to be fully defined since various approaches such as anterior, posterior, or combined exist. This study aims to determine the operative performance of these three treatment modalities. Methods: In accordance with the PRISMA guidelines, a systematic review was performed, identifying studies comparing anterior, posterior, and/or combined surgical approaches in patients with thoracolumbar BFs. To analyze available evidence, a Bayesian network meta-analysis framework was utilized. Results: In this study, 16 studies were included. The shortest operative times and lowest operative blood losses were found for a posterior approach. The length of stay (LoS) was shorter with the posterior approach compared with the other two modalities. Return to work, postoperative kyphotic angle (PKA), and complications all favored the posterior approach. The visual analog scale score was similar between groups. Conclusions: This study suggests that the posterior approach has significant advantages in terms of operative time, blood loss, LoS, PKA, return to work, and complication rates when compared to the other approaches. Treatment should remain an individualized process, and before choosing an approach, factors such as patient characteristics, surgeon experience, and hospital settings should be considered.

Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients.

Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703-0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217-0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623-0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822-0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829-0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity.

A review: inflammatory process in Alzheimer's disease, role of cytokines.

Alzheimer's disease (AD) is the most common neurodegenerative disorder to date. Neuropathological hallmarks are ß-amyloid (Aß) plaques and neurofibrillary tangles, but the inflammatory process has a fundamental role in the pathogenesis of AD. Inflammatory components related to AD neuroinflammation include brain cells such as microglia and astrocytes, the complement system, as well as cytokines and chemokines. Cytokines play a key role in inflammatory and anti-inflammatory processes in AD. An important factor in the onset of inflammatory process is the overexpression of interleukin (IL)-1, which produces many reactions in a vicious circle that cause dysfunction and neuronal death. Other important cytokines in neuroinflammation are IL-6 and tumor necrosis factor (TNF)-α. By contrast, other cytokines such as IL-1 receptor antagonist (IL-1ra), IL-4, IL-10, and transforming growth factor (TGF)-ß can suppress both proinflammatory cytokine production and their action, subsequently protecting the brain. It has been observed in epidemiological studies that treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) decreases the risk for developing AD. Unfortunately, clinical trials of NSAIDs in AD patients have not been very fruitful. Proinflammatory responses may be countered through polyphenols. Supplementation of these natural compounds may provide a new therapeutic line of approach to this brain disorder.