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Arginase 1 Deficiency (ARG1-D) is a rare, progressive, metabolic disorder that is characterized by devastating manifestations driven by elevated plasma arginine levels. It typically presents in early childhood with spasticity (predominately affecting the lower limbs), mobility impairment, seizures, developmental delay, and intellectual disability. This systematic review aims to identify and describe the published evidence outlining the epidemiology, diagnosis methods, measures of disease progression, clinical management, and outcomes for ARG1-D patients.A comprehensive literature search across multiple databases such as MEDLINE, Embase, and a review of clinical studies in ClinicalTrials.gov (with results reported) was carried out per PRISMA guidelines on 20 April 2020 with no date restriction. Pre-defined eligibility criteria were used to identify studies with data specific to patients with ARG1-D. Two independent reviewers screened records and extracted data from included studies. Quality was assessed using the modified Newcastle-Ottawa Scale for non-comparative studies.Overall, 55 records reporting 40 completed studies and 3 ongoing studies were included. Ten studies reported the prevalence of ARG1-D in the general population, with a median of 1 in 1,000,000. Frequently reported diagnostic methods included genetic testing, plasma arginine levels, and red blood cell arginase activity. However, routine newborn screening is not universally available, and lack of disease awareness may prevent early diagnosis or lead to misdiagnosis, as the disease has overlapping symptomology with other diseases, such as cerebral palsy. Common manifestations reported at time of diagnosis and assessed for disease progression included spasticity (predominately affecting the lower limbs), mobility impairment, developmental delay, intellectual disability, and seizures. Severe dietary protein restriction, essential amino acid supplementation, and nitrogen scavenger administration were the most commonly reported treatments among patients with ARG1-D. Only a few studies reported meaningful clinical outcomes of these interventions on intellectual disability, motor function and adaptive behavior assessment, hospitalization, or death. The overall quality of included studies was assessed as good according to the Newcastle-Ottawa Scale.Although ARG1-D is a rare disease, published evidence demonstrates a high burden of disease for patients. The current standard of care is ineffective at preventing disease progression. There remains a clear need for new treatment options as well as improved access to diagnostics and disease awareness to detect and initiate treatment before the onset of clinical manifestations to potentially enable more normal development, improve symptomatology, or prevent disease progression.

Background: The adverse outcomes of COVID-19 on the healthcare system has prompted the enactment of social distancing and self-isolation or quarantine to minimize the spread of the contagious virus. The need for social distancing and isolation has made telehealth a game-changer in the war against COVID-19. Objectives: The objectives of this study were: (1) To evaluate the current trends of using telehealth during COVID-19 pandemic, (2) To discuss regulatory and policy changes related to telehealth at the service provider level, (3) To analyze recommendations by professional organizations, and (4) To evaluate challenges and recommendations for best practices. Methods: This is a narrative review. Most current information (focused on the measures that the healthcare system has adopted to integrate telehealth in the coronavirus response measures) was obtained from peer-reviewed journals and the website of payers, pharmacies, and professional organizations. Results: Response and management of COVID-19 has seen a surge in the use of telehealth and mobile applications. Health insurance providers have reformed their payer policies to integrate telehealth in COVID-19 response. Waiving premiums, co-pays, and cost-sharing are the most common changes across the industry. For example, Cleveland Clinic has reported a 1,665% increase in the number of telemedicine visits, recording 60,000 visits in March compared to 3,400 before coronavirus. The expansion of telehealth in the era of COVID-19 has presented practical challenges stymying progress. Conclsion: Telehealth is indisputable in promoting social distance, which is a proven public health promotion intervention for curbing the spread of coronavirus.

Objective: Collecting and synthesizing relevant data on COVID-19 from official sources of some different regulatory agencies around the world. Methods: The information and actions related to responding to the COVID-19 situation were collected from the websites of some regulatory agencies, including the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), Health Canada (HC), Swiss Agency for Therapeutic Products (Swissmedic), and the Australian Therapeutic Goods Administration (TGA). Results: All the regulatory agencies help in expediting the development of COVID-19 treatments and medical devices. These agencies also developed an international regulatory collaboration to develop cure models for the pandemic. While some of the agencies conduct the COVID-19 testing, like the US FDA, the others do not. The agencies also differ in their approaches towards resolving the pandemic. FDA and EMA are more aggressive in a way that they prioritize more testing and hospitalization coverage. However, as of the 22nd of June 2021, the FDA authorized the highest number (388) of diagnostic COVID-19 test kits followed by TGA (128), and EMA (88). Conclusions: Although the regulatory agencies differ in their approaches towards resolving pandemic COVID-19, all regulatory agencies help in expediting the development of COVID-19 treatments and medical devices.

Background: COVID-19 outbreak impacted all healthcare specializations including the oncology field. Objective: To discuss in detail the varied effects of COVID-19 on the oncology field. Methods: For this narrative review, the researchers relied only on accredited and peer-reviewed resources. As such, the references of this paper were mostly taken from Google Scholar and online repositories, such as PubMed, which hosts the National Center for Biotechnology Information (NCBI), Science Direct, JSTOR, and The Lancet. Results: COVID-19 and the necessity of physical distancing have significantly changed the practice in the oncology field. The use of telehealth is widely adopted, physicians are recommended to consider other forms of treatment, and decisions on immediate cancer treatment depend on the level of risk of progression with cancer care delay. Cancer treatment delay is causing the highest mortality rate for patients who are suffering from cancer of the bladder, lungs, ovary, stomach, and esophagus. COVID-19 has shifted the focus of healthcare professionals away from other life-threatening diseases, like cancer. In the United Kingdom, it has been projected that there is at least a 20% increase in the expected cancer-related mortality rate. This is due to abrupt changes in diagnosing and treating cancer patients, physical distancing protocols, economic downfall, as well as the public's behavior in opting for medical assistance. Conclusion: With the spread of COVID-19, the situation has become more difficult for cancer patients. The mortality rate for cancer patients has worsened during COVID-19. Health professionals working in the oncology field are also devastated by COVID-19.

Background: Since COVID-19 spreads from one person to others, it is necessary to stay away from others or reduce contact. This habit or practice is called social distancing. It encourages people to stay at their homes and to avoid crowded and/or public places. Objective: To evaluate and discuss changes and shifts in the pharmaceutical marketing strategies due to COVID-19. Methods: This is a narrative review articles and we use triangulation method to collect the related information from multiple electronic database. The results and findings of the selected articles were summarized and synthesized. Results: As the number of COVID-19 infected people grows and the uncertainty of finding a cure continues, the people are becoming more apprehensive. Pharmaceutical companies made changes to their marketing strategies. From being too invested with in-person marketing, most companies are now exploring options that do not require as much physical interaction. Pharmaceutical companies have been reliant on telemarketing, digital marketing, and miscellaneous offers. This change is primarily driven by fear of being infected by the virus and self-preservation. Conclusions: Based on the studies collected and reviewed in this paper, the changes appear to be successful especially with regard to digital marketing. This review provides an insight to marketing managers in the pharmaceutical industryto continue adjusting and modifying theirmarketing strategies due to COVID-19.Because this study focused on a specific sector (i.e., pharmaceutical)the results cannot be generalized and extended to other sectors.Future studies are needed to investigate the trends of changes and shifts of the pharmaceutical marketing strategies due to COVID-19.

This paper aims to review different kinds of conversational agents used in health care for chronic conditions, types of communication technology, evaluation measures of conversational agents, and AI methods used

Many countries resorted to the lockdown model that includes shutting down all non-essential activities to avoid the spread of COVID-19. Comparatively, Sweden applied the herd immunity model. The aim of this study is to analyze the Swedish model compared to the lockdown model based in other countries to understand the impact of these models on public health, health economics and overall economy of the respective countries. Based on the findings, the paper aims to shed light on which model proves to be more effective to cope with the pandemic and provide recommendations for other countries to follow accordingly. Our methodology was a narrative review that synthesizes current literature obtained from searches on various databases, authoritative texts, and hand searches. While it is too early to determine the long term effects of both models, it seems that Sweden’s herd immunity model is more effective considering aspects of overall public health, health economic factors, and the overall economy. The major cons of the Swedish model was a failure in controlling infection spread in elderly nursing homes, as half the death toll comprises individuals belonging to this community. While Sweden was able to soften the effect of COVID-19 impact on its economy without a lockdown, the manufacturing industry was impacted due to lack of availability of required parts to be supplied by other countries. Thus from our review , we found that Herd-immunity model is more effective, but it depends on other factors of the country such as population density, as it is not plausible for countries such as Spain, the US or Germany, which need to expose high numbers of people to COVID-19 to attain herd immunity.

The World Health Organization (WHO) declared the pandemic status of coronavirus disease of 2019 (COVID-19). The necessity for social distancing has prompted states to make policy changes. These policy changes are in line with the policies and recommendations set by the WHO, the Centers for Disease and Control Prevention (CDC), the United States Department of Health and Human Services (HHS), the Centers for Medicare and Medical Services (CMS), the Kaiser Permanente, the National Institutes of Health (NIH), the United States Food and Drug Administration (FDA), and the American Medical Association (AMA). The aim of this study is to discuss and analyze the effectiveness of many organizations in responding to the COVID-19 crisis. Three processes were involved in conducting the narrative review: (1) a search was conducted through the websites of eight organizations (CDC, HHS, CMS, Kaiser Permanente, NIH, WHO, FDA, and AMA), (2) Selection of relevant information related to the responses taken by the eight organizations between January 21, 2020 and April 24, 2020 were included, (3) the information selected from the websites of the eight organizations were recorded, summarized, and integrated in this paper.COVID-19 is a health problem that needs to be approached in a collaborative manner. All eight organizations that have taken action against the further spread of the virus. The different policy changes and/or recommendations from the eight organizations have one common ground and that is the necessity for social distancing. To prevent overcrowding in hospitals and in other healthcare facilities, the organizations have decided to expand telehealth coverage. In Conclusions Health-related and policy-issuing organizations provided policies that are aligned with one another in order to contain the spread of COVID-19.

Arginase 1 Deficiency (ARG1-D) is an inherited metabolic disease that leads to significant morbidity.Despite the recognized burden of disease, information on health care resource utilization (HCRU) among patients with ARG1-D is lacking. We, therefore, sought to evaluate HCRU in ARG1-D relative to non-ARG1-D cohort.Patients with ≥2 ICD-10-CM diagnosis codes for ARG1-D were identified (first diagnosis code = index date) using professional fee claims linked with prescription claims. Patients with ARG1-D were matched 1:1 to a comparator cohort of patients with other medical conditions. Matching variables included age, sex, index year, payer type (Medicare, Medicaid, third party) and geographic region.A total of 77 patients met the inclusion criteria for the ARG1-D cohort, with a median age of 15 years, 52%18 years, and 52% male. Several concurrent diagnoses were recorded at a higher frequency in the ARG1-D cohort versus the matched comparator (spasticity 7 times higher; developmental delay ∼2 times higher; intellectual disability 5 times higher; and seizures 8 times higher). Emergency room visits occurred twice as often, laboratory tests were performed 1.5 times more often, hospitalization was required 3 times more often, and mean length of stay was longer for patients with ARG1-D than the comparator cohort (2.4 days vs. 0.3 days).A relatively short study period while the burden of ARG1-D increases over a lifetime due to disease progression.Patients with ARG1-D had significantly greater HCRU compared with those without the disease; they presented with a more extensive comorbidity profile, accessed the health care system more frequently, required more intense monitoring and management, and had more frequent and longer hospitalizations relative to the comparator group. These findings demonstrate a high health burden in ARG1-D that is not mitigated by standard-of-care measures and emphasize the need for improved treatment options.

The coronavirus disease 2019 (COVID-19) pandemic has had a devastating impact on the health and welfare of the global population. A key measure to combat COVID-19 has been the effective screening of infected patients. A vital screening process is the chest radiograph. Initial studies have shown irregularities in the chest radiographs of COVID-19 patients. The use of the chest X-ray (CXR), a leading diagnostic technique, has been encouraged and driven by several ongoing projects to combat this disease because of its historical effectiveness in providing clinical insights on lung diseases. This study introduces a dilated bi-branched convoluted neural network (CNN) architecture, VGG-COVIDNet, to detect COVID-19 cases from CXR images. The front end of the VGG-COVIDNet consists of the first 10 layers of VGG-16, where the convolutional layers in these layers are reduced to two to minimize latency during the training phase. The last two branches of the proposed architecture consist of dilated convolutional layers to reduce the model's computational complexity while retaining the feature maps' spatial information. The simulation results show that the proposed architecture is superior to all the state-of-the-art architecture in accuracy and sensitivity. The proposed architecture's accuracy and sensitivity are 96.5% and 96%, respectively, for each infection type. © This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: To explore the best pricing benchmark for workers’ compensation drugs reimbursement at retail pharmacies. Materials & methods: We used California workers’ compensation system (CAWCS) total cost of pharmacy dispensed medications (2017–2019) as a proxy to estimate drug prices using alternative pricing mechanism fee schedules. Results: CAWCS paid 65.6% of the average wholesale price (AWP), 104.1% of Medi-Cal, 122.1% of the wholesale acquisition cost (WAC), 140.1% of the national average drug acquisition cost (NADAC), and 253.5% of the federal upper limit. In addition, we found the AWP-based formulas: CAWCS = AWP - 34.4%, Medi-Cal = AWP - 36.9%, WAC = AWP - 46.3%, NADAC = AWP - 53.2%, and federal upper limit = AWP - 74.1%. We found that AWP: 50% for generics and AWP - 18.2% for brands are the lowest paying formulas. The estimated median cost savings were $8.7 million (by adapting 97% of the WAC) and $9.5 million (by adapting the NADAC) across all states. Conclusion: NADAC was the best pricing benchmark for reimbursement of pharmacy dispensed drugs.

Background: Venous leg ulcers (VLUs) present a significant economic burden on the US healthcare system and payers (US$14.9 billion). Aim: To evaluate the quality of life (QoL) of patients with VLUs; to analyze the limitations of standard of care (SOC) for VLUs; and to explain how using bilayered living cellular construct (BLCC) with SOC for treatment of VLUs can help heal more VLUs faster (than using SOC alone) as well as help improve QoL and help reduce the burden on the US healthcare system and payers. Materials & methods: This is a review study. The search was conducted in February 2020 by way of electronic databases to find relevant articles that provided information related to QoL of patients with VLUs, limitations of SOC for VLUs and economic analyses of using BLCC for treatment of VLUs. Results: VLUs impact patients’ physical, functional and psychological status and reduce QoL. A total 75% of VLU patients who used SOC alone failed to achieve healing in a timely fashion, which led to increased healthcare costs and healthcare resource utilization. Although the upfront cost is high, the greater effectiveness of BLCC offsets the added cost of the product during the time period of the studies. Therefore, BLCC helps to improve the QoL of VLU patients. As an example, for every 100 VLU patients in a healthcare plan, the use of BLCC can create cost savings of US$1,349,829.51. Conclusion: Payers’ coverage of BLCC results in reduction of the overall medical cost for treating VLU patients.

Arginase 1 deficiency (ARG1-D) is a rare, progressive and debilitating urea cycle disorder characterized by clinical manifestations including spasticity, seizures, developmental delay, and intellectual disability. The aim of this systematic review was to identify and summarize the natural history of ARG1-D and the unmet needs of patients.A comprehensive search of published case reports was undertaken to identify patients with ARG1-D regardless of interventions, comparisons, or outcomes. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other evidence-based medicine literature databases were searched on 20 April 2020. Quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. (PROSPERO registration: CRD42020212142.).One hundred and fifty seven ARG1-D patients were included from 111 publications (good overall quality based on JBI's Checklist); 84 (53.5%) were males. Motor deficits (including spasticity), intellectual disability, and seizures were reported in50% of the cases. Mean age (SD) at diagnosis was 6.4 years and the laboratory findings most commonly reported to support diagnosis included elevated plasma arginine (81.5%), mutation inThis review illustrates a significant burden of disease and highlights a considerable unmet need for clinically effective treatment options for patients with ARG1-D.

Background: Saudi Arabia aims to affirm the basic human rights for all its citizens. The medical students need to be aware about globally recognized rights in their study and career. Only few studies have measured the knowledge of medical students about public health rights (PBR) in Saudi Arabia. The present study aims to assess the current knowledge of medical students in Jeddah, Saudi Arabia concerning health empowerment issues and health rights. Methods: Descriptive cross-sectional study was conducted at Jeddah, Saudi Arabia among the medical students of Ibn Sina National College (ISNC), Batterjee Medical College (BMC), King Abdul-Aziz University (KAU) and King Saud bin Abdul-Aziz University (KSAUHS) Jeddah branch, between July and August 2020. Questionnaire was used to collect demographic data, along with knowledge of the rights of female patients, laws and rights of patients with disabilities, special needs and senility, reproductive health rights, and health rights of cancer patients. The data were analyzed using statistical package of social science (SPSS) version 25. Results: Of the 393 participants, 58.3% were females and 41.7% were males. Regarding consent, 72.3% and 65.1% of the participants responded that a male guardian was not required to give consent for hospital admission and discharge, respectively, and only 46.1% knew that a female patient could provide consent for a caesarean section. Only 51.7% of the students were aware about Saudi Arabian health rights including the disabled individuals; while, 44.0% did not know. About half (53.2%) knew that that special needs patients have health rights, and 25.2% believed that abortion is never allowed in Islam. Concerning the woman’s right to attain contraception, 51.1% stated that the consent was not required; while, 25.7% responded that consent from a male guardian/partner is first required. Approximately half (49.6%) were aware that cancer patients have the right to free medical treatment, and 52.9% knew that cancer patients have the right to free surgical treatment. Conclusions: The knowledge of medical students regarding health rights of certain patient populations was not satisfactory in Saudi Arabia, which highlights the importance of health rights education in medical school. Trial registration: 95/IRB/2020