One of the limpet-like genera was undescribed and was here named Cryocapulus n. gen. We suggest that capulids evolved from a coiled suspension feeder lineage and that the shift to kleptoparasitism, which occurred in the family ancestor, may have represented a strategy to save energy through the exploitation of the water current produced by the host. Probably the major drivers of shell evolution in capulids are related to their ecology, most of them being kleptoparasites, include the shape and the kind of host substrate, and lead to the repeated acquisition of a limpet-like shape. The aim of this study was to evaluate the efficacy of anakinra in patients who were admitted to hospital for severe COVID-19 pneumonia requiring oxygen therapy. A prospective, open-label, interventional study in adults hospitalized with severe COVID-19 pneumonia was conducted. Patients in the interventional arm received subcutaneous anakinra (100 mg twice daily for 3 days, followed by 100 mg daily for 7 days) in addition to standard treatment. Main outcomes were the need for mechanical ventilation and in-hospital death. Secondary outcomes included successful weaning from supplemental oxygen and change in inflammatory biomarkers. Outcomes were compared with those of historical controls who had received standard treatment and supportive care. A total of 69 patients were included 45 treated with anakinra and 24 historical controls. A need for mechanical ventilation occurred in 14 (31%) of the anakinra-treated group and 18 (75%) of the historical cohort (p < 0.001). In-hospital death occurred in 13 (29%) of the anakinra-treated group and 11 (46%) of the historical cohort (p = 0.082). Successful weaning from supplemental oxygen to ambient air was attained in 25 (63%) of the anakinra-treated group compared with 6 (27%) of the historical cohort (p = 0.008). Patients who received anakinra showed a significant reduction in inflammatory biomarkers. In patients with severe COVID-19 pneumonia and high oxygen requirement, anakinra could represent an effective treatment option and may confer clinical benefit. ISRCTN74727214.ISRCTN74727214. With an eye toward possible public policy implications, our objective is to identify the socio-economic and demographic factors that drive the large variation in COVID-19 incidence rates observed within relatively compact geographic regions, and to quantify the relative impact of each of these factors. We use international comparisons as a starting point. New York City, consisting of some 175 zip codes, is an ideal arena to pursue the above study given the large variation in case incidence rates across zip codes. We conducted systematic regression studies employing data with zip code granularity. Our model specifications are based on a well-established epidemiologic model that explains the effects of household sizes on R0. Average household size emerges as the single most important driver behind the large variation in COVID-19 incidence rates. It independently explains 62% of the variation. The percentage of the population above the age of 65 and the percentage below the poverty line are also strongly positively associated with zip code incidence rates. As to ethnic/racial characteristics, the percentages of African Americans, Hispanics and Asians within the population are significantly associated, but the magnitude of the impact is smaller. (The proportion of Asians within a zip code has a negative association.) Contrary to common belief, population density, by itself, does not have a significantly positive impact (other than when a high population is driven by large household sizes). Our findings support implemented and proposed policies to quarantine patients and separate infected individuals from families or dormitories; they also support newly revised nursing home admission policies.Our findings support implemented and proposed policies to quarantine patients and separate infected individuals from families or dormitories; they also support newly revised nursing home admission policies. Methicillin-resistant Staphylococcus aureus (MRSA) is a significant health threat and public burden worldwide, particularly in developing countries, including Nepal, due to its low healthcare standards and irrational use of antibiotics. selleck kinase inhibitor It is evident that MRSA strains are frequently detected in Nepalese hospitals; however, they remain underreported. Therefore, to provide a comprehensive and clear understanding of MRSA infection at the national level, this systematic review and meta-analysis evaluated the prevalence and antimicrobial susceptibility patterns of MRSA in Nepal. PubMed, EMBASE, Cochrane CENTRAL, Google scholar, and Nepalese databases were searched for studies published between 1st January 2008 and 31st August 2020. A total of 26 original articles were selected for quantitative analysis. Data extraction was accomplished by three authors independently and meta-analysis was performed using MedCalc Version 19.5.1 and Comprehensive Meta-Analysis (CMA) software v.3.0. The pooled prevalence of MRSAimicrobial resistance as a whole.Early and fast detection of COVID-19 patients help limit the transmission and wide spread of the virus in the community and will have impact on mortality by reducing the incidence of infection among vulnerable people. Therefore, community-based screening is critical. We aimed to identify clinical signs and symptoms and epidemiological features that could help discriminate confirmed cases of COVID-19 from SARS-CoV-2 negative patients. We found that age (aOR1.02, 95%CI1.02-1.03, p less then 0.001), symptoms onset between 3 and 14 days (aOR1.35, 95%CI1.09)1.68, p = 0.006), fever or history of fever (aOR1.75, 95%CI1.42-2.14, p less then 0.001), cough (aOR1.68, 95%CI1.31-2.04), sore throat (aOR0.65, 95%CI0.49-0.85, p = 0.002), ageusia (aOR2.24, 95%CI1.42-3.54, p = 0.001), anosmia (aOR6.04, 95%CI4.19-8.69, p less then 0.001), chest pain (aOR0.63, 95%CI0.47-0.85, p = 0.003), myalgia and/or arthralgia (aOR1.64, 95%CI1.31-2.04, p less then 0.001), household cluster (aOR1.49, 95%CI1.17-1.91, p = 0.001) and evidence of confirmed cases in the neighbourhood (aOR1.